Imaging of chondrocalcinosis: calcium pyrophosphate dihydrate (CPPD) crystal deposition disease -- imaging of common sites of involvement

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is characterised by the accumulation of pyrophosphate dihydrate crystals in articular and periarticular tissues and it can be classified as sporadic, hereditary or secondary. The diagnosis frequently rests on radiographic findings. Computed tomography scanning can detect well mineralised deposits in joints and also ultrasound may be useful in detecting CPPD crystal deposits. About MRI recent studies have demonstrated the utility of high field in depiction of CPPD crystal deposits. The aim of this review is to focus on the clinical-classificative and radiological aspects of CPPD, particularly the contribution of the different imaging techniques.

Relationship between body composition, body mass index and bone mineral density in a large population of normal, osteopenic and osteoporotic women

PURPOSE

The knowledge of factors modulating the behaviour of bone mass is crucial for preventing and treating osteoporotic disease; among these factors, body weight (BW) has been shown to be of primary importance in postmenopausal women. Nevertheless, the relative effects of body composition indices are still being debated. Our aim was to analyze the relationship between body mass index (BMI), fat and lean mass and bone mineral density (BMD) in a large population of women. Moreover, this study represents a first important report on reference standard values for body composition in Italian women.

MATERIALS AND METHODS

Between 2005 and 2008, weight and height of 6,249 Italian women (aged 30-80 years) were measured and BMI was calculated; furthermore BMD, bone mineral content, fat and lean mass were measured by dual-energy X-ray absorptiometry. Individuals were divided into five groups by decades (group 1, 30.0-39.9; group 2, 40.0-49.9; group 3, 50.0-59.9; group 4, 60.0-69.9; group 5, 70.0-79.9). Differences among decades for all variables were calculated using a one-way analysis of variance (ANOVA) and Bonferroni test by the SPSS programme.

RESULTS

Mean BW was 66.8±12.1 kg, mean height 159.1±6.3 cm and mean BMI 26.4±4.7 kg/m(2). According to BW and BMI, there was an increase of obesity with age, especially in women older than 50 years (p<0.001). Lean mass increased until 50 years of age but significantly decreased after this age (p<0.001). The percentage of osteopenia and osteoporosis in the examined population was 43.0% and 16.7%, respectively.

CONCLUSIONS

Our data show that obesity significantly decreased the risk for osteoporosis but did not decrease the risk for osteopenia. It is strongly recommended that a strong policy regarding prevention of osteopenia and osteoporosis be commenced. An overall examination of our results suggests that both fat and lean body mass can influence bone mass and that their relative effect on bone could be modulated by their absolute amount and ratio to total BW.

Recurrent vertebral hydatid disease: spectrum of MR imaging features

INTRODUCTION

This study aimed to describe a spectrum of magnetic resonance (MR) imaging findings in a case series of four patients with recurrent vertebral hydatid disease (HD).

METHODS

Four patients with recurrent spinal HD, who were studied with MR imaging at 1.5T or 0.5T MR units, were encountered during a ten-year period. All patients had a history of repeated spinal surgery for hydatid resection.

RESULTS

HD involving the lumbar spine was found in two patients, the thoracolumbar spine in one patient and the lumbosacral in one patient. Skip lesions were seen in one patient. All patients had extensive involvement of the extradural space, soft tissues of the back and posterior vertebral elements. HD involving the vertebral body, intervertebral disk and iliopsoas muscles were noted in three, two and three patients, respectively. Bone and extradural hydatids were typically small, and appeared hypointense on T1-weighted images, with a mildly enhancing rim on post-contrast T1-weighted images. Sacral hydatid was an expansile multicystic process. Muscle hydatids were large, surrounded by a gadolinium-enhancing rim and assumed a variety of patterns - either multilocular or a nonspecific inhomogenous cystic or dumbbell configuration.

CONCLUSION

MR imaging is a valuable diagnostic tool for follow-up of patients with vertebral HD. Recurrent HD is characterised by extensive involvement of soft tissues of the back and extradural space. Extension into the intervertebral disk and iliopsoas muscles and skip lesions in the extradural space are not uncommon.

Percutaneous ablative treatment of metastatic bone tumours: visual analogue scale scores in a short-term series

INTRODUCTION

The aim of this study was to examine the role of palliative percutaneous secondary lesions bone treatment by comparing the visual analogue scale (VAS) scores of cryoablation plus vertebroplasty versus radiofrequency (RF) plus vertebroplasty so as to determine their feasibility, reliability and efficacy in a short-term series.

METHODS

Combined RF thermal ablation plus osteoplasty or cryoablation plus osteoplasty was performed in osteolytic secondary bone localisations in 30 consecutive patients who were suffering from pain refractory to conservative therapies. We evaluated pain with the VAS during the preoperative period and at four hours, 24 hours, one week, one month, three months and six months post procedure.

RESULTS

There were no statistically significant differences in the VAS score between patients treated with cryoablation plus osteoplasty and those treated with RF ablation plus osteoplasty at one week (p-value is 0.34), one month (p-value is 1), three months (p-value is 0.68) and six months (p-value is 0.65) post procedure. Patients treated with cryoablation plus vertebroplasty have less pain at four hours (p-value less than 0.001) and 24 hours (p-value less than 0.001) than patients treated with RF ablation plus vertebroplasty.

CONCLUSION

Both RF ablation and cryoablation are optimal techniques in the treatment of painful bone metastatic cancer. Cryoablation achieves less treatment-related pain during the early period of follow-up and better volume control by real-time depiction of ablation margins.

Real-time monitoring of membrane bioreactors with 2D-fluorescence data and statistically based models

The application of membrane bioreactors (MBR) for wastewater treatment is growing worldwide due to their compactness and high effluent quality. However, membrane fouling, mostly associated to biological products, can reduce MBR performance. Therefore, it is important to monitor MBRs as close to real-time as possible to accelerate control actions for maximal biological and membrane performance. 2D-fluorescence spectroscopy is a promising on-line tool to simultaneously monitor wastewater treatment efficiency and the formation of potential biological fouling agents. In this study, 2D-fluorescence data obtained from the wastewater and the permeate of a MBR was successfully modelled using projection to latent structures (PLS) to monitor variations in the influent and effluent total chemical oxygen demand (COD). Analysis of the results also indicated that humic acids and proteins highly contributed to the measured COD in both streams. Nevertheless, this approach was not valid for other performance parameters of the MBR system (such as influent and effluent ammonia and phosphorus), which is usually characterised through a high number of analytical and operating parameters. Principal component analysis (PCA) was thus used to find possible correlations between these parameters, in an attempt to reduce the analytical effort required for full MBR characterisation and to reduce the time frame necessary to obtain monitoring results. The 3 first principal components, capturing 57% of the variance, indicated and confirmed expected relationships between the assessed parameters. However, this approach alone could not provide robust enough correlations to enable the elimination of parameters for process description (PCA loadings ≤ 0.5). Nevertheless, it is possible that the information captured by 2D-fluorescence spectroscopy could replace some of the analytical and operating parameters, since this technique was able to successfully describe influent and effluent total COD. It is thus proposed that combined modelling of 2D-fluorescence data and selected performance/operating parameters should be further explored for efficient MBR monitoring aiming at rapid process control.

Alternate anoxic/aerobic operation for nitrogen removal in a membrane bioreactor for municipal wastewater treatment

A large pilot-scale membrane bioreactor (MBR) with a conventional denitrification/nitrification scheme for municipal wastewater treatment has been run for one year under two different aeration strategies in the oxidation/nitrification compartment. During the first five months air supply was provided according to the dissolved-oxygen set-point and the system run as a conventional predenitrification MBR; then, an intermittent aeration strategy based on effluent ammonia nitrogen was adopted in the aerobic compartment in order to assess the impact on process performances in terms of N and P removal, energy consumption and sludge reduction. The experimental inferences show a significant improvement of the effluent quality as COD and total nitrogen, both due to a better utilization of the denitrification potential which is a function of the available electron donor (biodegradable COD) and electron acceptor (nitric nitrogen); particularly, nitrogen removal increased from 67% to 75%. At the same time, a more effective biological phosphorus removal was observed as a consequence of better selection of denitrifying phosphorus accumulating organisms (dPAO). The longer duration of anoxic phases also reflected in a lower excess sludge production (12% decrease) compared with the standard pre-denitrification operation and in a decrease of energy consumption for oxygen supply (about 50%).

[Incidence and socioeconomic burden of hip fractures in Italy: extension study 2003-2005]

OBJECTIVES

We aimed to analyze incidence and costs of hip fractures in Italy.

METHODS

We analyzed the Italian Ministry of Health national hospitalization and DRGs databases concerning fractures occurred in people > or =65 between 2003 and 2005. We have estimated incidence and direct costs sustained by the National Health Service for hospitalization and treatment of hip fractures on the basis of the value of the Diagnosis Related Groups (DRGs) referring to hip fractures. The expenses of rehabilitation and indirect costs were based on regional estimations.

RESULTS

Between 2003 and 2005 we registered almost 90,000 hospital admissions per year (corresponding to 75,000 patients) because of hip fractures in people aged > or =65. Women accounted for the majority of hospital admissions due to hip fractures (78.0%; n=214,519). Among women, 84.3% of fractures (n=180,861) occurred in patients > or =75, which is known to be the age group with the highest prevalence of osteoporosis. Hospitalizations of both men and women showed an increasing trend across all the examined period. Hospital costs increased up to 467 million euros in 2005, while rehabilitation costs rose up to 531 million in the same year.

CONCLUSIONS

Hip fractures in the Italian population are increasing and represent a major public health challenge.

[Methodology and results of an experience of medical surveillance of people previously exposed to asbestos in Tuscany]

Although medical surveillance of workers previously exposed to asbestos has been made mandatory by several laws since 1991 (recently confirmed by the law 81/08), neither the subject encharged of it nor the medical protocols have been yet established. In the absence of a specific regulation different medical protocols have been proposed by several centers often with no respect of ethical or radioprotectionist principles, such as some screening programs exclusively based on radiologic exams. With the aim of setting up a secondary preventive health program according both to a correct ethical and economic cost-effective balance, we followed up a cohort of 647 workers. The medical protocol included a physical exam, functional respiratory tests, thoracic Xray and low dose CT scans along with some experimental biologic markers such as mesothelin and osteopontin. All the mentioned tests were periodically administered to asbestos workers according to the individual level of risk. This risk-modulated preventive medical protocol allowed us to diagnose respiratory diseases in up to 39% of the investigated population, 2/3 of which were classified as asbestos-related occupational diseases. In conclusion our data suggest that the integration of different kind of exams, with limited use of radiology, is effective in the medical follow-up of asbestos-exposed workers. Regional health politics should begin to take into account this reported evidence.

Activated sludge model (ASM) based modelling of membrane bioreactor (MBR) processes: a critical review with special regard to MBR specificities

Membrane bioreactors (MBRs) have been increasingly employed for municipal and industrial wastewater treatment in the last decade. The efforts for modelling of such wastewater treatment systems have always targeted either the biological processes (treatment quality target) as well as the various aspects of engineering (cost effective design and operation). The development of Activated Sludge Models (ASM) was an important evolution in the modelling of Conventional Activated Sludge (CAS) processes and their use is now very well established. However, although they were initially developed to describe CAS processes, they have simply been transferred and applied to MBR processes. Recent studies on MBR biological processes have reported several crucial specificities: medium to very high sludge retention times, high mixed liquor concentration, accumulation of soluble microbial products (SMP) rejected by the membrane filtration step, and high aeration rates for scouring purposes. These aspects raise the question as to what extent the ASM framework is applicable to MBR processes. Several studies highlighting some of the aforementioned issues are scattered through the literature. Hence, through a concise and structured overview of the past developments and current state-of-the-art in biological modelling of MBR, this review explores ASM-based modelling applied to MBR processes. The work aims to synthesize previous studies and differentiates between unmodified and modified applications of ASM to MBR. Particular emphasis is placed on influent fractionation, biokinetics, and soluble microbial products (SMPs)/exo-polymeric substances (EPS) modelling, and suggestions are put forward as to good modelling practice with regard to MBR modelling both for end-users and academia. A last section highlights shortcomings and future needs for improved biological modelling of MBR processes.

Effect of inhaled glucocorticoids and beta(2) agonists on vertebral fracture risk in COPD patients: the EOLO study

Although inhaled glucocorticoids (GCs) and beta(2) agonists are being more frequently prescribed in the management of chronic obstructive pulmonary disease (COPD), their role in the impairment of bone status and in fracture risk remains controversial. This study aimed to evaluate whether the dose of inhaled GCs and beta(2) agonists may independently influence bone status and vertebral fracture risk in COPD patients aged 50 years or over. COPD severity, presence of vertebral fractures on lateral chest X-ray, and bone status by quantitative ultrasound (QUS) at the calcaneus were evaluated. The risk of vertebral fractures was significantly increased in patients taking the highest daily dose (>1,500 microg) of inhaled GCs (OR = 1.4, CI 1.04-1.89). The highest dose of inhaled GCs was significantly associated with low values of stiffness index (OR = 1.74, CI 1.03-2.94). Inhaled beta(2) agonists were not associated either with increased risk of vertebral fracture or with reduced values of stiffness. Moreover, the risk of fractures was markedly increased in patients with very severe or severe COPD (OR = 2.05, CI 1.28-3.28, and OR = 1.40, CI 1.06-1.82, respectively). In conclusion, in COPD patients high doses of inhaled GCs, but not beta(2) agonists, are associated with an increased risk of vertebral fractures and a reduction of QUS at the calcaneus.

Hip fractures in Italy: 2000-2005 extension study

SUMMARY

A total of 507,671 people > or =65 experienced hip fractures between 2000 and 2005. In 2005, 94,471 people > or =65 were hospitalized due to hip fractures, corresponding to a 28.5% increase over 6 years. Most fractures occurred in patients > or =75 (82.9%; n = 420,890; +16% across 6 years), particularly in women (78.2%; n = 396,967).

INTRODUCTION

We aimed to analyze incidence and costs of hip fractures in Italy over the last 6 years.

METHODS

We analyzed the national hospitalization and DRG databases concerning fractures occurred in people > or =65 between 2000 and 2005.

RESULTS

A total of 507,671 people > or =65 experienced hip fractures across 6 years, resulting in about 120,000 deaths. In year 2005 94,471 people aged > or =65 were hospitalized due to hip fractures, corresponding to a 28.5% increase over 6 years. The majority of hip fractures occurred in patients > or =75 (82.9%; n = 420,890; +16% across 6 years) and particularly in women (78.2%; n = 396,967). Among women, 84.2% of fractures (n = 334,223; +28.0% over 6 years) were experienced by patients > or =75, which is known to be the age group with the highest prevalence of osteoporosis, accounting for 68.6% of the overall observed increase in the total number of fractures. Hip fractures in men > or =75 increased by 33.1% (up to 16,540). Hospitalization costs increased across the six examined years (+36.1%) reaching 467 million euros in 2005, while rehabilitation costs rose up to 531 million in the same year.

CONCLUSIONS

Hip fractures of the elderly are increasing and represent a major health problem in industrialized countries such as Italy.

Subclinical hypercortisolism: correlation between biochemical diagnostic criteria and clinical aspects

OBJECTIVE

Subclinical hypercortisolism (SH) has been associated with increased prevalence of hypertension, type 2 diabetes mellitus, dyslipidaemia, central obesity, osteoporosis and vertebral fractures. We aimed to investigate the accuracy of different SH diagnostic criteria in predicting the presence of complications.

DESIGN

This was a retrospective study.

PATIENTS

We evaluated data from 231 patients (120 women and 111 men) affected with adrenal incidentalomas (AI).

MEASUREMENTS

We studied the accuracy of different SH diagnostic criteria (cortisol after 1 mg overnight dexamethasone suppression test - 1mg-DST - at different cut-off such as 49.7, 82.8, 137.9 nmol/l, elevated urinary free cortisol, reduced adrenal corticotroph hormone (ACTH) levels alone or various combination of these parameters) in predicting the concomitant presence of the following three complications: hypertension, type 2 diabetes and vertebral fractures.

RESULTS

The criterion characterized by the presence of two of 1mg-DST >82.8 nmol/l, elevated UFC and reduced ACTH struck the best balance between sensitivity and specificity, reaching a good accuracy in predicting the cluster of complications (61.9%; 77.1% and 75.8%, respectively). The presence of this cluster was associated with this criterion (OR 4.75, 95%CI 1.8-12.7, P = 0.002) regardless of gonadal status, body mass index (BMI) and age.

CONCLUSIONS

The SH criterion characterized by the presence of two of 1mg-DST >82.8 nmol/l, elevated UFC and reduced ACTH seems the best in predicting the presence of chronic manifestations of subtle cortisol excess.

Underreported vertebral fractures in an Italian population: comparison of plain radiographs vs quantitative measurements

PURPOSE

Vertebral fractures (VFs) are the hallmark of osteoporosis and are responsible for almost 70,000 hospital admissions yearly, implying social costs and impaired quality of life for patients. In recent years, several techniques, both qualitative and quantitative, have been proposed for VF diagnosis, but a gold standard is not yet available and the visual semiquantitative (VSQ) assessment proposed by Genant remains the most validated. However, given the lack of a standardised method, in clinical practice, the diagnosis of VF is often missed, and patients are not correctly assessed. The aim of our study was to estimate the percentage of VFs not detected in clinical practice in italian population using the VSQ method and a new morphometric technique.

MATERIALS AND METHODS

In 283 postmenopausal women referred to our clinic for osteoporosis screening, we performed a clinical examination, plain spinal radiographs (for VSQ assessment) and digital computerised morphometry (DCM) to assess VFs. Bone density was measured using dual-energy X-ray absorptiometry (DXA).

RESULTS

Forty-seven percent of patients had a T score <-2.5 standard deviations (SD), and 35.2% were osteopenic, but no significant correlations between T score and grade or number of fractures were found. DCM identified VFs in 38.5% of patients versus 32.5% using the VSQ method. Overall, 280 VFs were detected by DCM and 236 by VSQ, whereas only 105 were recognised by the reports.

CONCLUSIONS

VFs went undetected in 55.5% according to the VSQ method on standard spinal radiographs. Therefore, the morphometric technique may be helpful when performed with the semiquantitative approach to improve recognition of VFs. However, other studies are needed to further validate the utility of this new morphometric technique in clinical practice.

Imaging of giant cell tumour of the tendon sheath

Giant cell tumours of the tendon sheath (GCTTS) and pigmented villonodular synovitis (PVNS) are part of a spectrum of benign proliferative lesions of synovial origin that may affect the joints, bursae and tendon sheaths. This review article describes the clinicopathological features and imaging findings in patients with GCTTS. GCTTS usually presents as a soft tissue mass with pressure erosion of the underlying bone. Magnetic resonance (MR) imaging of GCTTS typically shows low to intermediate signal on T1- and T2-weighted spin-echo sequences due to the presence of haemosiderin, which exerts a paramagnetic effect. On gradient-echo sequences, the paramagnetic effect of haemosiderin is further exaggerated, resulting in areas of very low signal due to the blooming artefact. Ultrasonography shows a soft mass related to the tendon sheath that is hypervascular on colour or power Doppler imaging.

Echocardiography and dual-energy x-ray absorptiometry in the elderly patients with metabolic syndrome: a comparison of two different tecniques to evaluate visceral fat distribution

OBJECTIVES

Metabolic syndrome (MetS) is an important risk factor for vascular diseases. Two simple and low cost measurements, the epicardial fat (EFT) obtained by echocardiography and abdominal fat (AFT) thickness evaluated by Dual-Energy X-Ray Absorptiometry (DEXA), have been validated as a markers of fat storage in young adults and elderly patients affected by MetS. At present no studies are available yet to compare the two techniques and to test their relationship with MetS. Moreover, no data exit concerning the association between hepatic steatosis, a well known indicator of intra hepatic fat storage and perivisceral fat storage. Aims of our study were: 1) to compare EFT and AFT in a group of patients with and without MetS; 2) to study whether and how these two different approaches predict MetS or risk of malnutrition in the obese elderly; 3) to evaluate the relationship between MetS occurrence, EFT, AFT and hepatic steatosis (HS).

SETTING AND PARTICIPANTS

We studied 55 elderly outpatients ( 29 males and 26 females) referred to MetS service of the IRCCS "Casa Sollievo della Sofferenza" during the year 2007.

MEASUREMENTS

Subjects underwent a complete clinical and anthropometric evaluation, laboratory tests for glycaemia and lipid profile for MetS definition. Liver ultrasound was executed to verify the occurrence of HS, a well known indicator of intraparenchymal fat storage. HS was defined as hyperechoic liver pattern in patients without liver disease or hepatic enzymes abnormalities. MetS was defined according to National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Echocardiography for EFT evaluation and DEXA for AFT and fat free mass of the abdomen (FFM) measurement were also performed. Mini Nutritional Assessment (MNA) was used to test the risk of malnutrition in the elderly.

RESULTS

Patients were divided in two groups according to the absence (24 patients Group 1) or the presence (31 patients Group 2) of the MetS. HS was present in 26 (57.7%) patients. MetS patients had significantly higher AFT and EFT, and lower FFM than patients without MetS. MNA scores were not different. EFT and AFT showed a good correlation ( R 0.8 p < 0.001) but only EFT was associated with the MetS. HS was also correlated to EFT and AFT. MNA showed a risk of malnutrition in 73% of MetS patients and 23% in patients without MetS but both EFT and AFT were not correlated with MNA scores.

CONCLUSIONS

In the elderly patient with MetS, AFT and EFT are greater than in non MetS patients. Both AFT and EFT are strongly correlated to HS but only EFT was associated with MetS. In obese patients, the risk of malnutrition, as evaluated by MNA, is not associated with an increased fat tissue measured by echocardiography or DEXA.

Gallstones and biliary sludge in Greek patients with complete high spinal cord injury: an ultrasonographical evaluation

INTRODUCTION

We used ultrasonography to detect the presence of biliary sludge or gallstones in Greek patients with complete high spinal cord injury (SCI) above the seventh thoracic segment (T7), within the first six months from injury onset, in order to evaluate the effects of neurological instability and dysfunction of the sympathetic nervous system (SNS) on the gallbladder function in the early post-SCI phase.

METHODS

We evaluated 78 asymptomatic patients (57 males, 21 females; mean age 34.8 (range 19-56) years) with complete high SCI located above the T7 segment, and 78 healthy subjects (59 males, 19 females; mean age 35.2 (range 21-59) years) matched for age, gender and race, for a total period of 39 months. All the participants underwent ultrasonographical examination of the gallbladder and common bile duct within the first six months from the injury, in order to investigate the development of biliary sludge and gallstones.

RESULTS

The incidence of biliary sludge was significantly higher in patients with SCI compared with the control group. The incidence of biliary sludge and gallstones was also significantly higher in patients with SCI patients in comparison with the healthy subjects. In male SCI patients, the incidence of biliary sludge was significantly increased in comparison with healthy subjects. No significant difference was revealed between the two groups in detection of gallstones.

CONCLUSION

Our study indicates that the detection of gallbladder sludge and gallstones are significantly higher in Greek patients with complete high SCI above the T7 segment, as compared with healthy control subjects within the first six months of the injury onset. The complete disruption of the SNS and the neurological instability in the early post-SCI phase is probably responsible for the biliary sludge and gallstone formation. Our results suggest that ultrasonography should be performed in these patients at the first 3-6 months from the injury for the early diagnosis of the lithogenic bile.

Vertebral fractures in patients with chronic obstructive pulmonary disease: the EOLO Study

SUMMARY

This study aimed to evaluate the prevalence of vertebral fractures to investigate the determinants of vertebral fracture risk in patients with COPD. The risk of vertebral fractures is strictly related to the severity of the disease. The use of glucocorticoids and the presence of low values of quantitative ultrasound (QUS) may represent additional risk factors.

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) appears to be associated with osteoporosis. Our study aimed to evaluate the prevalence of vertebral fractures and to investigate the main determinants of vertebral fracture risk in patients with COPD.

METHODS

In 3,030 ambulatory COPD patients (1,778 men and 1,262 women) aged 50 years or over, we evaluated: COPD severity, presence of vertebral fractures on lateral chest X-ray and bone status by using a quantitative ultrasound device.

RESULTS

In men there was a strong association between COPD severity and fractures (p < 0.001), conversely in women the association between COPD severity and fractures was at limit (p = 0.049). In men, but not in women, glucocorticoid treatment was significantly associated with vertebral fractures. The patients with high or moderate risk of osteoporosis presented an increased risk of vertebral fracture (OR 2.71; 95% CI 2.04-3.60 and OR 1.54; 95% CI 1.26-1.88, respectively). Logistic regression analysis showed that COPD severity and glucocorticoid treatment, both inhaled and oral, were associated with increased risk of vertebral fractures.

CONCLUSION

In COPD patients the risk of vertebral fractures is strictly related to the severity of the disease. The use of glucocorticoids and reduced QUS at calcaneous may represent additional risk factors.

Imaging of sternocostoclavicular joint in spondyloarthropaties and other rheumatic conditions

OBJECTIVE

To retrospectively evaluate the role of the various imaging techniques in the study of the sternocostoclavicular joint, in patients with spondyloarthropathies and other rheumatic conditions and to assess potential pitfalls in the radiological diagnosis.

SUBJECTS AND METHODS

Thirty patients, 11 male and 19 female, mean age 45 years, with involvement of the sternocostoclavicular joint as part of rheumatologic disorders (psoriatic arthritis, ankylosing spondylitis, Tietze syndrome, SAPHO syndrome, and condensing osteitis of the clavicle) were studied. Conventional radiography, CT, MRI and bone scintigraphy were performed. The following imaging findings were evaluated: soft tissue swelling, bone sclerosis, cortical bone erosions, joint space narrowing, subchondral sclerosis, periosteal new bone formation, synovial reaction and intrarticular effusion. All the images were independently reviewed by two musculoskeletal radiologists.

RESULTS

Conventional radiography demonstrated only sclerosis of the clavicula in 8 pts (26%) and the sternum in 3 pts (10%), cortical bone erosions in 7 pts (23%), joint space narrowing in 6 pts (23%) and periosteal bone formation in 2 pts (10%). At the CT examination sclerosis of the clavicula and the sternum was observed in 13 pts (44%), cortical bone erosions in 22 pts (76%), joint space narrowing in 10 pts (34%), ligament ossification in 12 pts (41%), subchondral sclerosis in 9 pts (34%) and periosteal bone formation in 10 pts (34%). The MRI was the most sensitive technique in the evaluation of the soft tissue swelling in 9 pts (56%), intrarticular effusion in 13 pts (81%) and synovial reaction in 13 pts (81%). Finally, bone scintigraphy showed an increased uptake at the sterno-costoclavicular joint in all patients who underwent the examination.

CONCLUSION

The radiological evaluation of the anterior chest wall in patients with different rheumatic disorders represents a problem of difficult diagnostic evaluation both for the anatomic region complexity and for the variability of the radiographic findings. The integrated use of X-ray, CT, MRI and nuclear medicine is suggested to avoid misdiagnosis.

[Psychiatric support of healthcare workers undergoing periodic health assessment]

INTRODUCTION

An integrated mental health surveillance program was developed by the department of occupational medicine at S. Chiara University Hospital in Pisa, Italy, in order to better assist and treat hospital staff suffering from psychiatric disorders in a preventive medical setting.

MATERIAL AND METHODS

During the occupational medical surveillance of 4000 employees of S. Chiara Hospital in Pisa (Italy), 30 health care workers with psychiatric disorders were included in our program, which provided psycho-educational support and pharmacological treatment. Measures of effectiveness were: Clinical Global Impression (CGI scale) and a comparison between the average number of lost workdays due to mental illness before and after treatment.

RESULTS

At the end of the observation period there was a decrease in the CGI severity score with a improved CGI score ranging from 1 to 2 and a reduction in absenteeism, from an annual average of 36.70 to 25.10 lost workdays.

CONCLUSION

Our outcome measures data seem to indicate that a preventive medicine setting can offer effective psychiatric support that is better accepted and tolerated by health care workers and that this approach may reduce absenteeism.

Membrane bioreactors for winery wastewater treatment: case-studies at full scale

The membrane bioreactor technology (MBR) is nowadays a suitable alternative for winery wastewater treatment, thanks to low footprint, complete suspended solids removal, high efficiency in COD abatement and quick start-up. In this paper, data from two full-scale MBRs equipped with flat-sheet membranes (plant A and plant B) are presented and discussed. COD characterisation by respirometry pointed out the high biodegradability degree of both wastewater, with a strong prevalence of the readily biodegradable fraction. An extended version of Activated Sludge Model No. 3 was used to fit the experimental OUR profiles and to assess the maximum growth rate of heterotrophic biomass on sludge samples collected at both sites; the stoichiometric yield coefficients were also calculated. Sludge filterability and dewaterability were investigated with batch tests; laboratory results confirmed the field observations. Finally, some considerations are listed, aimed at defining possible key-issues for optimal process design and operation.

Radiation therapy in urinary cancer: state of the art and perspective

Invasive urinary tumours are relatively rare, and their treatment may cause important changes in urinary, sexual and social functions. A systematic review of external radiation therapy studies in urinary cancers was performed. This synthesis of the literature is based on data from meta-analyses, randomised and prospective trials and retrospective studies. There are few controlled clinical trials using adjuvant or radical radiotherapy with or without chemotherapy in cancer of the kidney, ureter and urethra. There are several reports on multimodality treatment in invasive bladder cancer: intravesical surgery and neoadjuvant chemotherapy to radiotherapy or concomitant radiochemotherapy with organ preservation. The conclusions reached for renal cancer are controversial, and data on cancers of the urethra and ureter are few and inconclusive. Sufficient data now exist in the literature to demonstrate that conservative management with organ preservation is a valuable alternative to radical cystectomy, the traditional gold standard, in invasive bladder cancer.

An aeration energy model for an immersed membrane bioreactor

A simple model for evaluating energy demand arising from aeration of an MBR is presented based on a combination of empirical data for the membrane aeration and biokinetic modelling for the biological aeration. The model assumes that aeration of the membrane provides a proportion of the dissolved oxygen demanded for the biotreatment. The model also assumes, based on literature information sources, a linear relationship between membrane permeability and membrane aeration up to a threshold value, beyond which permeability is unchanged with membrane aeration. The model was benchmarked against two full-scale plant to obtain the most appropriate and conservative value of the slope of the flux:aeration curve and the blower efficiency. Benchmarking in this way produced a match to within 20% of all key process plant operational parameters. The model demonstrated that significant reductions in aeration energy could be obtained through operation at lower flux and reducing the membrane aeration requirement accordingly, so-called "proportional aeration" at lower flows. Similarly, increasing oxygen transfer from membrane aeration would also be expected to decrease energy demand. A sensitivity analysis of some of the key parameters revealed that, of the key operating parameters, loading, SOTE and MLSS concentration remain the most critical in determining energy demand. It is suggested that a key parameter representing membrane aeration in MBRs is the mean in-module air upflow velocity U, since this gives a reasonable representation of the shear applied through membrane aeration. U was found to vary between 0.04 and 0.1m/s across a number of modern large pilot and full-scale plant. An analysis reveals that significant reductions in energy demand are attained through operating at lower MLSS levels and membrane fluxes. Evidence provided from recent controlled pilot trials implies that halving the flux can reduce the aeration is suggested whereby the number of membrane tanks on line and/or the membrane aeration intensity is adjusted according to the flow, and thus flux, so as to reduce the overall aeration energy demand.

The crowned dens syndrome as a cause of neck pain: clinical and computed tomography study in patients with calcium pyrophosphate dihydrate deposition disease

OBJECTIVE

To investigate the association between articular chondrocalcinosis and calcification of the atlantoaxial region on a cervical computed tomography (CT) scan and to explore the relation between such calcifications and neck pain.

MATERIALS AND METHODS

CT slices of the cervico-occipital junction were performed routinely in 49 consecutive patients (male/female ratio 28/21; mean age 70.4 yrs), diagnosed with calcium pyrophosphate dihydrate crystal deposition disease (CPPD). Of these, 35 met criteria for definite CPPD and 14 met the criteria for probable. The cervical CT scans were analyzed for the presence of periodontoid calcifications by 2 independent musculoskeletal radiologists. Both assessors were blinded to the disease status of the patients. Furthermore, conventional radiographs of the upper cervical spine were performed. An ad hoc designed protocol was used to register information at diagnosis, including age, sex, location of pain and stiffness, fever, presence of synovitis and its location.

RESULTS

CT scan of the cervico-occipital junction showed periodontoid calcified deposits in 25 out of 49 patients (51%) with CPPD. In 10 of the 25 cases (40%) with periodontoid calcified deposits, CT scanning showed osseous abnormalities of the odontoid process, such as subchondral cysts or erosions. Conventional radiographs showed calcification behind the odontoid process in 17 patients (34.7%). Nine of CPPD cases (18.4%) presented with neck symptoms. In three patients, articular chondrocalcinosis was revealed only by an acute attack of neck pain with segmentary stiffness, fever, and an increased erythrocyte sedimentation rate; in one of them initial clinical examination found cervical stiffness with Kernig's and/or Brudzinski's sign. For the other two patients, impairment of general condition, occipito-temporal and mandible pain and weakness with inflammatory pain of the shoulder girdle was suggestive of giant cell arteritis (GCA) and/or polymyalgia rheumatica (PMR). In the six additional patients, questioning elicited a history of previous subacute or chronic neck pain, from one week to one year before their admission to our ambulatory or hospital.

CONCLUSIONS

These results suggest that CPPD deposition disease frequently involves the cervical spine. Although such calcification often remains asymptomatic, it may be associated with attacks of acute neck pain with segmentary stiffness, fever, and an increased erythrocyte sedimentation rate, sometimes mimicking PMR and/or GCA or neurological symptoms.

Clinics in diagnostic imaging (124). Multiple enchondromatosis in Ollier disease

A three-year-old girl presented with slow-growing swellings at the left foot and upper right humerus. Radiographs show multiple enchondromas in both feet, proximal humeri and scapulae, as well as at multiple sites in the hands, distal forearm bones and pelvis, in keeping with multiple enchondromatosis in Ollier disease. The clinical presentation and imaging features of enchondromas and the different types of enchondromatosis are discussed.

Endovascular treatment of middle cerebral artery aneurysms. Overall perioperative results. Apropos of 113 cases

SUMMARY

The endovascular approach is described in 113 middle cerebral artery (MCA) aneurysms. The treatment failed in six cases with no adverse clinical consequences. Out of the 107 treated cases, it was possible to obtain a complete occlusion in 50 aneurysms (47%), whereas a residual aneurysm neck was observed in 54 cases (50%). Follow-up angiograms were performed in 60 cases, showing a 22% rate of further thrombosis of the aneurysm. Recanalization of the aneurysm was observed in 8% of cases, which required retreatment. The technique-related permanent morbidity rate was 9% while the mortality rate was 2%. A review of the surgical and endovascular literature is presented. The endovascular approach is particularly indicated when normal MCA branches do not arise from the aneurysm base. It must be meticulously planned in all other cases. Endovascular coil treatment of MCA aneurysms is feasible, with acceptable morbi-mortality rates.

Preliminary Report on the Thrombogenic Properties of Tantalum-GDC Coils An Experimental Study

In order to overcome the possibility of re-canalization and compaction with Platinum GDC coils Tantalum coils were placed in three aneurysms in swine. Comparative coiling was done on the other side in each animal with platinum GDC.

More stable thrombus was observed on the aneurysms coiled with Tantalum GDC.

Impact of chemical cleaning and air-sparging on the critical and sustainable flux in a flat sheet membrane bioreactor for municipal wastewater treatment

The paper discusses the experimental optimisation of both chemical and mechanical cleaning procedures for a flat-sheet submerged membrane bioreactor fed with municipal wastewater. Fouling was evaluated by means of the critical flux concept, which was experimentally measured by short-term flux-stepping tests. By keeping constant most important parameters of the biological process (MLSS, sludge age), two different chemical cleaning protocols (2,000 mg L(-1) NaOCl and 200 mg L(-1) NaOCl) were applied with different frequency and, after approximately 9 months of operation, the criticality threshold was determined under different values of SAD(m) (specific aeration demand per unit of membrane surface area). The weaker and more frequent chemical cleaning regime (200 mg L(-1), monthly) proved much more effective than the stronger and less frequent strategy (2,000 mg L(-1), once every three months). The improvement of performances was quantified by two TMP-based parameters, the fouling rate and the DeltaTMP (difference between TMP values during the increasing and decreasing phase of hysteresis). The best performing configuration was then checked over a longer period by running four long-term trials showing an exponential trend of the sub-critical fouling rate with the imposed flux.

History of endovascular endosaccular occlusion of brain aneurysms: 1965-1990

SUMMARY

A concise historical review of the endovascular, endosaccular treatment of intracranial aneurysms is reported. The transition from detachable balloons to detachable coils is described. The development of microcatheters for intracranial endovascular navigation is also reported.

Endovascular occlusion of the posterior cerebral artery in the treatment of p2 ruptured aneurysms

SUMMARY

Four cases of posterior cerebral artery (PCA) aneurysms are described. The aneurysms were located at the P2 segment of PCA. All cases presented with a subarachnoid hemorrhage (SAH). Endovascular treatment was performed, with occlusion of the aneurysm and parent vessel, using platinum coils. Two patients developed a homonymus lateral hemianopia after treatment.

[Evaluation of a series of serum mesothelin in patients with pleural malignant mesothelioma]

Pleural Malignant Mesothelioma (MM) is a highly aggressive neoplasm with a poor survival rate, hard diagnosis and treatment. The incidence of MM in Western Europe countries is expected to increase drammatically in the next 10-15 years. In spite of this drammatic scenario, at this time the only instruments for screening and early diagnosis are based on radiological tests with evident ethical and economical problems. For this reason, some authors are evaluating biological indicators with the significance of screening and early diagnosis markers. One of the most promising marker is serum mesothelin (SMRP). SMRP levels appeares to be significantly related to MM and its clinical (diagnostic/prognostic) usefulnes has been suggested. The purpose of this research is to show SMRP trend in relation both to the course of the disease and the response to therapies in some Epithelioid MM patients. The analysis of SMRP levels in these patients suggests that it may be a useful marker for monitoring the response to treatment. In fact, it was observed that SMRP increases in patients who did not respond to therapy, it tends to remain stable when therapies results into a clinical stabilization, while it decreases after surgical procedure and in case of clinical improvement.

[Medical surveillance of previously asbestos-exposed workers: report of a case of lung cancer with high level of serum mesothelin]

Recently, the number of previously asbestos-exposed workers performing, at our department, medical exams aimed at an early diagnosis of asbestos-related tumors, has been progressively increasing. The diagnostical protocol we propose to these subjects include both radiological exams and some serum markers such as mesothelin and osteopontin. In this case-report we illustrate the history of a worker who, after having diagnosed a pulmonary asbestosis, developed a Lung Cancer. The significance of this case is based on the importance of the high mesothelin dosage which prompted further radiological exams resulting into the final diagnosis. In spite of the early diagnosis and treatment the patient finally died. Nevertheless, serum markers like mesothelin and osteopontin (especially the first) may result very helpful in monitoring and screening the population of workers previously exposed to asbestos.

[Management of latex allergy in the Pisa University Hospital: analysis of data deriving from the Registry filing both allergic patients and employees]

Recently, Tuscany regional government has promulgated (Regional law n. 464/07) guidelines for setting up suitable sanitary rooms for patients allergic to latex. These guidelines enforced the managers of the Tuscany Local Health Units to promote educational activities and a correct methodology for the safe management of both health workers and patients who need latex-free diagnostical and/or therapeutical procedures. An other Regional law (n.345/05) had previously enforced all the Tuscany Local Health Units managers to implement and update a Registry of every latex-allergic patients ever hospitalized in their own local facilities. Since 2002 a multi-disciplinary task force of health operators, lead by the Preventive Medicine Section, has been elaborating and implementing a plan for the safety of latex-allergic patients of the Pisa University Hospital, along with a Registry where each of these patients were recorded. Moreover, since 2005 under the responsabilities of the staff of the Preventive Medicine Section, another Registry has been implemented and updated. In this Registry all the Hospital employees who have been diagnosed a latex allergy, through the medical exams performed within the occupational medical surveillance activity, have been filed. In this study we report the results of this preventive activity both aimed at patients and heatlh operators safety.

[Serum mesothelin dosages in follow-up of previously exposed workers]

High dosages of Serum Mesothelin have been demonstrated to be significantly associated to Pleural Malignant Mesothelioma. We recently demonstrated that Serum Mesothelin may be clinically helpful both for diagnostic and prognostic purposes, with the best cut-off corresponding to 1 nM. We also discovered that high levels of Serum Mesothelin are significantly associated to Lung Cancer. The usefulness of this marker in secondary prevention has been suggested, though never demonstrated. We therefore started a long-term prospective cohort study including previously asbestos-exposed workers. These subjects periodically underwent both radiological tests and serum mesothelin dosages. As a mid-term goal of this longitudinal study we decided to check the variability of mesothelin dosages, comparing baseline and follow-up values, as well as the possible correlation with age, duration of exposure, smoking, any abnormality of respiratory functional tests (RFT) and/or radiological tests. At baseline, Mesothelin mean value was 0.66 +/- 0.4 (range 0.08-2.2 nM). Both age (p = 0.04) and abnormal thoracic TC (p = 0.04) were significantly correlated with increased serum mesothelin levels and increasing age. No association was found between baseline mesothelin levels and duration of asbestos exposure (p = 0.5), smoking habits (p = 0.2), abnormal RFT, DLCO (carbon monoxide diffusing capacity) or thoracic X-ray. No significant variation was observed between mesothelin values at baseline and at follow-up (p = 0.2).

Endovascular Thermal Coagulation Using the Double-Helix GDC

An experimental study was undertaken to explore the possibility of treating this subset of aneurysms with thermal coagulation.

Endovascular endosaccular thermal coagulation of experimental aneurysms was successfully performed using a radiofrequency electrical current applied to a novel device, the double-helix GDC. Theoretically this technique could be utilized in selected patients to occlude large and giant intracranial aneurysms.

Quantitative ultrasound technique at the phalanges in discriminating between uremic and osteoporotic patients

This study was conducted to test the ability of quantitative ultrasound technique (QUS) at the phalanges to discriminate between uremic and osteoporotic patients. Three groups of subjects (38 dialytic women, 16 osteoporotic women with vertebral fractures, 19 non-dialytic and non-fractured women) were recruited at the Department of Radiology at "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy. The groups were matched for age and body mass index (BMI). On all subjects the following measurements were performed: spinal BMD by QCT and by DXA, Femoral BMD by DXA, phalangeal QUS. For QUS measurements, the DBM Sonic (IGEA, Carpi, Italy) was applied to the metaphysis of the proximal phalanges of the last four fingers of the hand. Osteoporotic women with vertebral fractures showed significantly lower values of spinal BMD by QCT and DXA and Ward's Triangle BMD with respect to hemodialytic patients (p<0.005). All QUS values, except for BTT and SoS, showed lower values in osteoporotic women with respect to hemodialytic patients (p<0.05). Control group showed higher values of AD-SoS, BTT and SoS than hemodialytic patients (p<0.005) while the two groups did not differ for BMD values measured with both QCT and DXA. UBPI and FWA data showed a similar behaviour to DXA and QCT results, whereas BTT and SoS showed a completely different behaviour. AD-SoS was the only parameter that could effectively discriminate among the three groups (ANOVA, p<0.0001). We conclude that phalangeal QUS can discriminate between hemodialysed patients and controls with similar bone mineral density, and can also discriminate between hemodialysed and osteoporotic subjects with vertebral fractures. Different characteristics of ultrasound signal can be ascribed to each bone tissue condition, enabling a clear differentiation of bone tissue changes occurring in menopause, osteoporosis and renal osteodystrophy.

Accurate positioning of detachable coils using alternate electric current. A technical note

SUMMARY

A new method of positioning detachable coils is presented. It does not rely on markers, but on the decrease of electric resistance that occurs when the platinum-stainless steel junction emerges from the microcatheter tip.

Influence of anthropometric parameters and bone size on bone mineral density using volumetric quantitative computed tomography and dual X-ray absorptiometry at the hip

PURPOSE

To evaluate the influence of anthropometric parameters (age, height, and weight) and bone size on bone mineral density (BMD) using volumetric quantitative computed tomography (QCT) and dual X-ray absorptiometry (DXA) in a group of elderly women.

MATERIAL AND METHODS

BMD values were obtained with DXA and QCT at the spine and hip in a cohort of 84 elderly women (mean age 73 +/- 6 years). QCT measures included trabecular, integral, and cortical BMD assessed at the hip and spine as well as cross-sectional areas of the mid-vertebrae and proximal femora. Spinal integral and femoral neck BMD measures were well matched to the regions of bone quantified on anteroposterior (AP) spine DXA and the femoral neck region of hip DXA.

RESULTS

When QCT parameters were linearly regressed against body height and weight, only the relationships with weight were found to be statistically significant. Except for cortical BMD at the femoral neck, all BMD and geometric parameters measured from both DXA and QCT showed statistically significant associations with body weight (r2 = 0.4, 0.0001 < P < 0.02). The strongest associations with weight were found for DXA Neck (DXA_NECK) and DXA lumbar spine (DXA_LSP) (r2 = 0.4, P < 0.0001).

CONCLUSION

The relationship of DXA BMD is stronger than QCT BMD with body weight and it encompasses the response of both bone size and density to increasing body mass.

Endovascular embolization with radiopaque silk threads: a feasibility study in Swine

SUMMARY

Surgical suture endovascular embolization of brain arteriovenous malformations (AVMs) is an accepted method of preoperative treatment.A major drawback of AVM embolization with surgical sutures is that the sutures are not visible under fluoroscopy. An experimental study using swine is presented where surgical sutures were rendered radiopaque using platinum markers.

Medical surveillance of workers previously exposed to asbestos

According to current Italian law health surveillance of workers exposed to asbestos in the past must be maintained even after cessation of asbestos exposure (D.Lgs. 277/91). The law, however, makes no reference to timescales or time limits for clinical monitoring, nor to who is responsible. The main aims of health surveillance of individuals formerly exposed to asbestos can be summarized as follows: early diagnosis of the principal diseases associated with asbestos; counselling for workers; work-related disease certification; epidemiological studies. Medical check-ups entail a complete personal and work history, Chest X-Ray, respiratory function tests, TLCO. In all cases the worker must undergo a LDCT. We propose two new possible biological markers for the health surveillance of past-exposed patients: serum mesothelin and osteopontin.

Electrical models in the analysis of hemodynamic characteristics of arteriovenous malformations. Part 1: baseline measurements

SUMMARY

This paper describes the creation of two electric arteriovenous malformation (AVM) models where electric resistors simulate AVM vessels. The flow of electrons simulates the flow of blood. Using the models, it was possible to analyze the pressure and flow patterns in the nidus of a small, low-flow AVM and in the nidus of a large, high-flow AVM. "Normal" hemodynamic "physiologic" conditions of the two AVMs were studied, including the autoregulation of normal brain surrounding the AVMs. It is the first time that the hemodynamics within the different parts of the nidus (arterious, arteriolar, venular, venous) can be determined. The models will be utilized to assess AVM hemodynamic changes when different parameters (systemic blood pressure, embolization of arterial feeders, embolization of nidus, embolization of draining veins, surgical by-pass of the AVM) are changed. This will be the subject of part 2 of this paper.

[Experience of a centre for the study of occupational adjustment disorders referred to psychological harassment-related diseases at the workplace]

BACKGROUND

The rising awareness of psychological harassment at the workplace means that it is ever more important to collect clinical data and test tools to assess psychiatric disease connected with this phenomenon.

OBJECTIVES

The aim of the study was to assess the experience gained by the centre for work maladjustment of the University Hospital of Pisa on a sample of patients, using the methods proposed by the centre at the Clinica del Lavoro "Luigi Devoto".

MATERIALS AND METHODS

The patients were submitted to a diagnostic protocol consisting of work history, medical examination, psychological assessment, psychiatric examination, subjective questionnaires, mood scale and Neutest. The analysis was made in two phases in which 109 subjects were examined to check occupational stress effects in the period March 2002 - July 2004, after which 50 subjects were selected (45.9%) with the adaptation disorder and a history of adverse working conditions.

RESULTS

The data gathered showed a slight predominance of workers from the public administration sector. The most representative range of duration of the psychological violence varied from 6 months to 2 years (46%). From close examination of the causes of the maladjustment disorders, structural changes in organization appeared to be the most frequent (13 cases). Among patients with positive diagnosis of disorder caused by psychological violence at the workplace, three situations were prominent: attitude to being a social outcast, behaviour to ignore proposals, and professional declassing.

CONCLUSIONS

The multidisciplinary approach was culturally very stimulating and fundamental in reaching a final diagnosis of occupational disease: diagnosis of bullying at work and related disease was possible only thanks to the fact that three specialists agreed on the aetiological role of psychological harassment at the workplace. Our experience confirms that psychological harassment can cause health impairment and the most common diagnosis is maladjustment disorder.

Quantitative ultrasound of the hand phalanges in a cohort of monozygotic twins: influence of genetic and environmental factors

OBJECTIVE

Our objective was to evaluate the similarities and differences in bone mass and structure between pairs of monozygotic twins as measured by means of the quantitative ultrasound (QUS) technique.

DESIGN

A cohort of monozygotic twins was measured by QUS of the hand phalanges using the DBM sonic bone profiler (IGEA, Carpi, Italy). The parameters studied were amplitude-dependent speed of sound (AD-SoS), ultrasound bone profile index (UBPI), signal dynamics (SDy) and bone transmission time (BTT). Linear correlation coefficients, multivariate linear analysis and the ANOVA test were used to assess intrapair associations between variables and to determine which factors influence the intrapair differences in QUS variables.

PATIENTS

One hundred and six pairs of monozygotic twins were enrolled in the study, 68 females and 38 males in the age range 5 to 71 years.

RESULTS

Significant intrapair correlations were obtained in the whole population and separately for males and females, regarding height ( r =0.98-0.99, p <0.0001), weight ( r =0.95-0.96, p <0.0001), AD-SoS ( r =0.90-0.92, p <0.0001), BTT ( r =0.94-0.95, p <0.0001) and other QUS parameters ( r >0.74, p <0.0001). Multivariate analysis revealed that intrapair differences between AD-SoS, SDy, UBPI and BTT are significantly influenced by age in the whole population and in the female population. Furthermore, the ANOVA test showed, for the female group, a significant increase in the intrapair differences in SDy and UBPI above 40 years.

CONCLUSIONS

A relative contribution of genetic factors to skeletal status could be observed by phalangeal QUS measurement in monozygotic twins. A significant increase in the intrapair difference in QUS parameters with increasing age and onset of menopause also suggests the importance of environmental factors in the female twin population.