Measurement of intrinsic bone quality in vivo by reflection ultrasound: correction of impaired quality with slow-release sodium fluoride and calcium citrate

The intrinsic (material) quality of cancellous and cortical bone was evaluated in vivo from the measurement of reflection ultrasound velocities in the ulna. In cancellous bone, the reflection ultrasound velocity was inversely correlated with age in normal women (r = -0.48, p = 0.001), with a significantly lower mean value in 32 normal postmenopausal women than in 14 premenopausal women (3124 versus 3341 m/s, p < 0.0001). In 32 untreated osteoporotic women the cancellous bone velocity was lower than in normal postmenopausal subjects (2906 versus 3124 m/s, p = 0.0001). Following treatment with slow-release sodium fluoride plus calcium citrate (mean 2.4 years in 33 osteoporotic patients with no fracture during treatment), the cancellous bone velocity was significantly higher than in untreated osteoporotic women (3082 versus 2906 m/s, p = 0.0002) and was not significantly different from that in normal postmenopausal women. The cortical bone velocity displayed similar trends, but the changes did not attain statistical significance. The measurements were repeated approximately 9 months later in 9 untreated and in 20 treated patients; in 5 additional patients, the measurements were made both before and after 9 months of treatment with slow-release sodium fluoride and calcium citrate. The cancellous bone velocity increased significantly (p = 0.046) in these patients, from 3008 m/s before treatment to 3112 m/s after the first 9 months of treatment. The velocity rose significantly from 3037 to 3167 m/s (p = 0.017) in patients treated for a short time (12-30 months at first measurement), but it did not change in untreated patients or those treated for more than 30 months. Thus, the material quality of cancellous bone decreases with normal aging and is reduced further with the osteoporotic process. This impaired quality may be corrected by treatment with slow-release sodium fluoride plus calcium citrate.

Hearing loss and temporal bone structure in achondroplasia

Characteristic temporal bone changes have recently been defined by high resolution CT in nine patients with achondroplasia (Cobb et al., Am J Neuroradiol 9:1195, 1988). These included narrowing of the skull base and "towering" petrous ridges resulting in abnormal orientation of the inner and middle ear structures. In order to determine whether these morphologic changes are the cause of the hearing deficit in achondroplasia, audiometric studies and ENT evaluation were performed in eight of the nine patients. All had a history of frequent otitis media and four had experienced tympanic membrane tube insertion. Three patients had significant sensorineural hearing loss, two had conductive hearing loss and one patient had combined hearing loss. None of the temporal bone morphologic changes were found to be correlated with the degree of either sensorineural or conductive hearing loss. Fusion of the ossicular chain was not present in any of our cases. Appropriate treatment of frequent acute otitis media and early awareness of middle ear effusions and conductive hearing loss in children with achondroplasia may be of great importance in preventing permanent hearing loss.

Management of screen-detected breast cancer: audit of the first 100 cases in the Southampton and Salisbury breast screening programme

With the natural history and optimal treatment of a high proportion of screen-detected breast cancers yet to be determined, treatment poses the management team with a number of therapeutic dilemmas. This study surveys the management policy and treatment of a consecutive series of 100 screen-detected cancers treated in a single breast unit. The problems encountered are discussed. There were 87 women with stage Tis or T1 tumours, including 26 women with in situ cancers, four with invasive cancers less than 5 mm in size, and seven with tubular cancers. Sixty-six women were managed with breast-conserving surgery and 36 women underwent localisation biopsy as the sole surgical treatment of the breast. With selection bias for high-grade and lateral tumours, only 2/13 cancers up to 10 mm in size were lymph node positive on axillary clearance. All lymph node positive women received adjuvant therapy. No adjuvant therapy was given in 43 cases, including those with in situ cancer. Thirty-six had extensive intraductal component (EIC). Patient and surgeon choice tends to be a major factor both in type of surgery and adjuvant therapy for screen-detected breast cancer. The optimal treatment for tumours detected by breast cancer screening is debatable and randomised trials on their management need to be expedited.

Impact of an Extensive in Situ Component on the Presence of Residual Disease in Screen Detected Breast Cancer

This study investigates the histopathological characteristics of a consecutive series of 100 screen detected breast cancers in relation to residual disease. Tumour type, size, grade, resection margins and extent of primary or associated in situ disease were all assessed by one pathologist. Thirty-seven women underwent further surgery (wider excision or mastectomy) and the resected specimen was examined for residual in situ or invasive cancer.

In total, 36 cancers had an extensive in situ component, of which 69% were predominantly intra-duct carcinoma of comedo type. Of the 37 women who underwent further resection, 21 (57%) women had residual cancer. Of those with initial disease at the resection margin, 16/25 (64%) had residual disease. Five of 12 (42%) with disease close to (within 2–3 mm) but not at the margin had residual disease. Of those with an extensive in situ component, 18/25 (72%) had residual disease, whereas only 2/12 (17%) women with none or some in situ disease had residual cancer.

In screen detected breast cancer, residual cancer was present in 72% of women with an extensive in situ component at initial surgery. These women comprise a group in whom conservation surgery may be inappropriate if completeness of excision is considered a prerequisite for breast conserving surgery.

Association of hypovolemia after subarachnoid hemorrhage with computed tomographic scan evidence of raised intracranial pressure

Hypovolemic patients are more likely to suffer delayed cerebral ischemia and infarction after a subarachnoid hemorrhage (SAH). Prompt recognition and correction of hypovolemia may improve the outcome. We have identified computed tomographic (CT) scan findings that increase the probability of a patient presenting with hypovolemia soon after an SAH. The plasma volume (PV) of 25 patients admitted within 96 hours of an SAH was measured using radioiodinated serum albumin. The normal PVs were measured in an outpatient setting 6 months later or predicted from their total body water. Nine patients (36%) were found to be hypovolemic, defined as a fall in PV exceeding 10% of the normal PV (mean fall, 18 +/- 2%). Sixteen patients were normovolemic or hypervolemic (mean PV, +9 +/- 2%). The basal cisterns were compressed or obliterated on the CT scans of all hypovolemic patients compared with 12.5% of normovolemic patients (chi-square, 14.52; P less than 0.01). The probabilities of a patient being hypovolemic if the CT scan indicated raised intracranial pressure were high: hydrocephalus, P = 0.80; compression of the basal cisterns, P = 0.82; and compression of the basal cisterns associated with intracerebral hematoma or midline shift, P = 1.00. Patients with an SAH and radiological evidence of raised intracranial pressure should be considered at particular risk for systemic hypovolemia.

Suicidal behavior in "normal" adolescents: risk and protective factors

Risk and protective factors were examined in suicidal and nonsuicidal public high school students. With life stress and depression as independent risk factors, family cohesion was found to offset the effect of stress, and friendships to have a more indirect effect. Differential effects of ten sources of stress were analyzed from a developmental perspective, and the probability of suicidal behavior associated with clusters of factors was estimated for the general population.

Changes in the guanine nucleotide-binding proteins, Gi and Go, during differentiation of 3T3-L1 cells

Differentiation of 3T3-L1 cells from fibroblasts to adipocytes is accompanied by increased adenylate cyclase response to lipolytic agents. We used pertussis toxin and specific antibodies to measure the inhibitory guanine nucleotide-binding protein, Gi, and the novel G-protein, Go, in membranes from 3T3-L1 cells. Pertussis toxin-dependent labeling of a 39-40 kDa protein showed an initial 30% rise, followed by an 80% fall during differentiation. Immunoblots showed that 3T3-L1 cells contain Go, as well as Gi, and that changes in the former parallel the changes in pertussis toxin labeling. Changes in Gi and GO may contribute to altered adenylate cyclase response during 3T3-L1 cell differentiation.

Changes in serum ferritin and other 'acute phase' proteins following major surgery

We have measured ferritin concentrations in healthy women, and ferritin, C-reactive protein, iron and total iron-binding capacity in patients undergoing hysterectomy or major gastrointestinal surgery. Pre-operative serum ferritin concentrations in patients awaiting hysterectomy were significantly lower than those for patients awaiting gastrointestinal surgery and also lower than those for healthy women of similar age. Healthy women aged between 51 and 60 years had significantly higher ferritin levels than women aged 35-50 years. All patients studied showed large increases in serum ferritin and C-reactive protein concentrations after surgery and approximately similar decreases in iron and in total iron-binding capacity.

Comparison of stem-cell recovery in autoimmune and normal strains

The capacity of NZB stem cells to proliferate in vivo was evaluated in two systems which required repopulation of peripheral organs. In both types of depletion systems, stem-cell repopulation after cyclophosphamide treatment or adoptive transfer repopulation in lethally irradiated hosts, it was found that NZB stem cells were hyperproliferating. The increase in proliferating cells was most pronounced in the spleens of NZB mice treated with high-dose cyclophosphamide and in lethally irradiated F1 mice reconstituted with NZB T-cell-depleted bone marrow. Thus, upon a stimulus to repopulate, NZB marrow stem cells will hyperproliferate in peripheral organs resulting in an increase in cell number. The abnormality in the marrow cells can be observed in young NZB mice when their marrow cells are in an environment which requires recovery and division.

Stress analysis of the human tooth using a three-dimensional finite element model

A three-dimensional finite element model has been developed for the purpose of analyzing the stress distribution in a human mandibular right first molar. The model takes into account the non-symmetric geometry and loading, and the material inhomogeneities of the tooth. Comparisons with existing two-dimensional analyses are given.

Pulmonary function in firefighters: a six-year follow-up in the Boston Fire Department

Tests of ventilatory capacity, objective cough, and standardized respiratory questionnaires were used in a prospective study to measure the effect of firefighting on pulmonary function in a cohort of 951 white Boston firefighters between 1970-1976. During the six years of follow-up, the mean annual decrements in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were 36 and 29 ml per year, respectively. At the end of the study in 1976, the mean FEV1 for this group was 98.3% of the level predicted for healthy nonsmoking adults, while the FVC was 97.8%. Current cigarette smoking was associated with an increased prevalence of bronchitis, a loose cough, reduced levels of FEV1 and FVC, and increased longitudinal changes in FEV1 and FVC. The longitudinal changes and current levels of FEV1 and FVC were not correlated with any index of firefighting exposure in active firefighters. Increased use of protective respiratory apparatus and previously described selection effects within the Boston Fire Department appear to be protecting this group of firefighters from long-term effects of smoke exposure as measured by these techniques.

Ultrasound appearance of myositis ossificans

Ultrasonic evaluation of a soft tissue mass of the thigh was performed and suggested the diagnosis of myositis ossificans. Correlation with routine radiographic studies is made, as well as with the follow-up radiographic examination.

Ultrasound diagnosis of masses elevating the inferior vena cava

The inferior vena cava is frequently involved in diseases of the abdomen and retroperitoneum. Critical evaluation of this vessel's course can greatly help in determining the origin of an adjacent mass. Ultrasound was used to divide the inferior vena cava into three parts. A vector type principle was applied to masses anteriorly displacing the vena cava, and the location of the mass was compared to the particular portion of the cava most affected. With this approach, it was often possible to determine what structures a mass may have originated from.