Bone mineral density in postmenopausal breast cancer survivors

PURPOSE

The overall purpose of this longitudinal 18-month study was to test the feasibility and effectiveness of a multicomponent intervention for prevention and treatment of osteoporosis. The purpose of this article is to describe the baseline bone mineral density (BMD) findings for 30 postmenopausal women and to compare these BMD findings to time since menopause, body mass index, and tamoxifen use.

DATA SOURCES

Baseline data of BMD findings for 30 postmenopausal women, who have had a variety of treatments including surgery, adjuvant chemotherapy and or tamoxifen, and are enrolled in the 18-month longitudinal study. A demographic questionnaire and a three day dietary record were used to collect baseline data.

CONCLUSIONS

Eighty percent of the women with breast cancer history had abnormal BMDs at baseline (t-scores below -1.00 SD). Thinner women showed a greater risk for accelerated trabecular bone loss at the spine and hip.

IMPLICATIONS FOR PRACTICE

These findings suggest the need for early BMD assessments and for aggressive health promotion intervention strategies that include a multifaceted protocol of drug therapy for bone remodeling, 1500 mg of daily calcium, 400 IU vitamin D and a strength weight training program that is implemented immediately following chemotherapy treatment and menopause in this high risk population of women.

Views of Earth's magnetosphere with the image satellite

The IMAGE spacecraft uses photon and neutral atom imaging and radio sounding techniques to provide global images of Earth's inner magnetosphere and upper atmosphere. Auroral imaging at ultraviolet wavelengths shows that the proton aurora is displaced equatorward with respect to the electron aurora and that discrete auroral forms at higher latitudes are caused almost completely by electrons. Energetic neutral atom imaging of ions injected into the inner magnetosphere during magnetospheric disturbances shows a strong energy-dependent drift that leads to the formation of the ring current by ions in the several tens of kiloelectron volts energy range. Ultraviolet imaging of the plasmasphere has revealed two unexpected features-a premidnight trough region and a dayside shoulder region-and has confirmed the 30-year-old theory of the formation of a plasma tail extending from the duskside plasmasphere toward the magnetopause.

The superolateral approach for aspiration of total hip arthroplasties

Hip aspiration for exclusion of infection is a common procedure prior to revision arthroplasty. Some patients with total hip arthroplasties develop superomedial migration of the prosthesis, while others can have extensive heterotopic bone formation. The traditional approaches may be contraindicated due to overlying bowel or bone anterior/lateral to the prosthesis. These patients are candidates for the superolateral approach. With the patient supine marks are made on the skin at (i) the greater trochanter and (ii) a superior site that aligns with the neck of the prosthesis and soft-tissue window. The needle enters the lateral skin parallel to the table top. Usually only one pass is necessary.

Imaging of skeletal and soft tissue injuries in and around the knee

This article addresses the place of MR imaging in the diagnosis of knee injuries. MR imaging of subtle fractures and bone contusions is described with emphasis placed on those types of fractures frequently associated with specific patterns of soft tissue injury. Soft tissue injuries are divided into ligamentous, meniscal, and muscular; each is discussed separately. The MR imaging appearance of these lesions is explained.

Risk factors for progression to new sites of radiographically defined osteoarthritis in women

OBJECTIVE

To describe the association between hormonally related risk factors and the progression to new sites of radiographically defined full body (generalized) osteoarthritis (OA) in a cohort of older women.

METHODS

A retrospective cohort design was used to study former radium dial painters over the age of 40 years who had minimal radium exposure. At study entry and at varying followup times, clinical examinations were conducted and full body radiographs were taken. Two followup groups were defined: women with a followup radiograph 1-9 years after baseline (n = 75) and 10-19 years after baseline (n = 53). Fifty-five joints (10 joint groups) were independently graded at baseline and followup for OA by the method of Kellgren and Lawrence, and provided the basis for summary full body OA progression scores. Progression was defined as an increase in the number of sites with OA and in separate analyses as an increase in the number of joint groups with OA.

RESULTS

Increasing length of followup and lower baseline OA score were associated with greater OA progression, while age at baseline examination showed no clear relation to progression. Beyond these variables, increasing height and having ever smoked were inversely associated with OA progression, while body mass index (BMI) showed a weak positive association. In multivariable modeling for followup 1-9 years, only lower baseline OA score predicted greater OA progression to new sites (partial r2 = 0.13, p = 0.0009). In followup 10-19 years, baseline OA score (partial r2 = 0.12, p = 0.0011), height (partial r2 = 0.057, p = 0.033), and smoking status (partial r2 = 0.09, p = 0.035) were independent predictors of OA progression to new sites, while greater BMI was a positive, weak, and nonsignificant predictor (partial r2 = 0.031, p = 0.29). History of prior cholecystectomy, hysterectomy, dilation and curetage, number of pregnancies, and change in BMI were not significantly related to progression of OA to new sites. Similar results were found for predictors of OA progression to new joint groups.

CONCLUSION

Lower baseline level of OA is associated with greater OA progression to new sites or joint groups independent of age, suggesting a "burnout" phenomenon. In addition, shorter height and having never smoked appear to be independent risk factors that predict the progression of radiographic OA to new sites or joint groups.

Patellar fatigue fractures

Three cases of patellar fatigue fracture are reviewed. Two fractures presented with acute displacement and were initially thought to represent pathological fractures. Histological appearances in one case, and the clinical course in another, subsequently indicated that these were fatigue fractures. A third patient developed a chronic undisplaced fracture and followed the typical clinical course of fatigue fractures at other sites. The importance of recognizing patellar fatigue fractures and of differentiating spontaneously displaced fatigue fractures from pathological fractures is emphasized.

Decreased survival with increasing prevalence of full-body, radiographically defined osteoarthritis in women

The relation between full-body, radiographically defined osteoarthritis and survival was examined in a cohort of 296 women aged 42-76 years (mean age, 57.1 years). These women were a random sample of women with very low body burdens of radium who were part of a larger cohort of women first employed in the US radium dial-painting industry between 1915 and 1945. At entry into the study between 1957 and 1982, these women had a clinical examination, and full-body radiographs were taken. Fifty-five joints (18 joint groups) of the hands, feet, cervical spine, lumbar spine, pelvis, and knees in each woman were graded for osteoarthritis by the method of J. H. Kellgren and J. S. Lawrence (Ann Rheum Dis 1957; 16:494-502). Through 1985, 18.6% (n = 55) of the women died. Cox regression showed a decreased survival for women with an increasing number of joint groups affected with osteoarthritis after adjusting for age at examination (hazard ratio = 1.45 for each increase in 3.1 joint groups (1 standard deviation) affected with osteoarthritis, 95% confidence interval 1.12-1.87). Further adjustment for a history of diabetes, smoking, alcohol use, and body mass index only slightly altered the risk. Similar results were obtained for the number of joints with osteoarthritis and the number of structures (e.g., left hand and right hand) with osteoarthritis. These results suggest that an increasing prevalence of full-body radiographic osteoarthritis is associated with decreased survival independent of age and several comorbid conditions related to osteoarthritis.

Detection of herpes simplex viral DNA in the iridocorneal endothelial syndrome

OBJECTIVE

To test the hypothesis that the iridocorneal endothelial (ICE) syndrome has a viral origin by comparing the incidence of viral DNA in corneal specimens from patients with the ICE syndrome and from controls.

DESIGN

Thirty-one corneas obtained from 25 patients with the ICE syndrome and six with chronic herpetic keratitis (n = 31) were compared with 30 control specimens obtained from 15 healthy donors and from 15 patients with other, nonviral chronic corneal diseases.

METHODS

Primer pairs and polymerase chain reaction methods were used to identify and amplify either a segment of the DNA polymerase gene in the case of the herpes simplex and zoster viruses or a region of the nuclear antigen gene for the Epstein-Barr virus. The oligonucleotide amplified by polymerase chain reaction was fully characterized with the use of restriction enzyme, hybridization, and sequence analyses to determine that it contained the expected base pair sequence.

RESULTS

Sixteen of 25 ICE syndrome specimens and four of six herpetic keratitis specimens were positive for herpes simplex virus (HSV) DNA. All nine ICE syndrome specimens tested were negative for the presence of DNA from the herpes zoster or the Epstein-Barr viruses. Controls were uniformly negative for HSV DNA whether they were obtained from ostensibly normal corneas (n = 15) or from corneas with intestinal keratitis, aphakic bullous keratopathy, or keratoconus (n = 15). Tissue samples cut from positive ICE syndrome specimens yielded negative results when retested after the endothelial layer was removed. These findings indicate that localization of HSV DNA is within the endothelium, the tissue primarily involved in the pathogenesis of the ICE syndrome.

CONCLUSIONS

Polymerase chain reaction evidence shows that HSV DNA is present in a substantial percentage of ICE syndrome corneal specimens and that HSV-DNA is absent in normal corneas and in corneas from patients with three other chronic corneal diseases. These results provide direct evidence to support our hypothesis that the ICE syndrome has a viral origin. We discussed clinical implications, including possible therapeutic interventions.

Unusual radiological features in Paget's disease of bone

The radiological diagnosis of Paget's disease of bone is usually straightforward because most cases conform to well-established classic descriptions. Diagnosis becomes more difficult, however, when radiological appearances are not typical or other disease processes mask or alter the behavior of Paget's disease. Examples are presented to illustrate four categories of unusual radiological presentation of Paget's disease: (1) unusual disease progression, (2) massive post-immobilization lysis, (3) metastatic spread to pagetic bone, and (4) vertebral end-plate destruction that mimics infection.

Comparison of a videodisc system with a conventional film file for medical student teaching

PURPOSE

The authors assessed the effectiveness of a videodisc film file compared with a conventional film file for teaching radiology to medical students.

METHODS

Fourth-year medical students (N = 134) studied 116 cases selected from the American College of Radiology Learning File. Half the students studied 58 skeletal cases using conventional films and half studied the same cases on a videodisc system. Student groups were then switched and those who studied skeletal cases on films studied 58 chest cases on videodisc and vice versa. Students received the same skeletal and chest tests and completed a questionnaire.

RESULTS

For both skeletal and chest radiology, students studying films scored minimally higher than students using the videodisc. Students rated films superior to the videodisc for amount learned, convenience of use, and ability to detect lesions.

CONCLUSIONS

Conventional film and videodisc methods resulted in similar levels of learning; however, students perceived conventional films to be a superior learning experience.

Gadolinium-enhanced MRI of soft tissue masses

The efficacy of gadopentetate dimeglumine (Gd-DTPA) enhanced magnetic resonance (MR) imaging in the diagnosis and differentiation of soft-tissue, neoplastic and non-neoplastic lesion has not been well established. Thirty patients with soft tissue masses (18 neoplastic and 12 non-neoplastic) were studied, using MR imaging with and without administration of Gd-DTPA. Gd-DTPA proved helpful in characterisation of several entities, including differentiation of solid mass from proteinaceous cyst, demonstration of tumour nodules within haemorrhagic or necrotic masses, and delineation of tumour adjacent to oedema. The use of Gd-DTPA may provide additional information for tissue specificity and, in complicated cases, Gd-DTPA may also provide essential information that cannot be obtained using other methods. We recommend the use of contrast enhanced MR as an adjunct to conventional MR imaging in the initial assessment of musculoskeletal soft tissue masses. However, T2-weighted images show better tissue contrast of the lesions, and are equal to contrast enhanced images in delineation of tumour margins. Non-contrast enhanced images are, therefore, probably adequate for the delineation of lesions for surgical planning when a diagnosis has already been made.

The use of intravenous gadopentetate dimeglumine in magnetic resonance imaging of synovial lesions

Spin echo T1- and T2-weighted images and intravenously administered gadopentetate dimeglumine-enhanced T1-weighted images were obtained in 4 normal volunteers and 11 patients (11 joints) with painful, intermittent, or persistent joint swelling of unknown etiology. These studies were retrospectively reviewed to assess the benefits of contrast-enhanced magnetic resonance imaging (MRI) in evaluating the synovium. Normal synovium and joint fluid showed no visually apparent enhancement on images obtained immediately after intravenous injection of gadopentetate dimeglumine. Abnormal synovium enhanced significantly, allowing the precise identification of equivocal or unsuspected synovial disease processes. These results suggest that, in selected cases, enhanced MRI can be a useful adjunct in the evaluation of suspected synovial disease processes.