Ultrasound and X-ray-based bone densitometry in patients with anorexia nervosa

In 20 patients (mean age 23+/-5 years) with anorexia nervosa (AN), bone mass was evaluated by broadband ultrasound attenuation (BUA) of the calcaneus, peripheral quantitative computed tomography (pQCT) of the distal radius, and dual X-ray absorptiometry (DXA) of the lumbar spine and the hip. Compared with 20 age- and sex- matched healthy controls, patients with AN showed marked osteopenia at all measuring sites. Values of BUA (33.0+/-9 dB/MHz vs. 51.0+/-5.7 dB/MHz; P<0.0001) and of BMD of all regions of the hip (e.g., femoral neck: 0.71+/-0.13 g/cm(2) versus 0.89+/-0.07 g/cm(2); P<0.001), lumbar spine (0.82+/-0.15 g/cm(2) versus 1.24+/-0.06 g/cm(2); P<0.003) and total BMD of the peripheral radius (303.2+/-75 g/cm(3) versus 369.4+/-53.2 g/cm(3), P<0.001) were significantly reduced. Calculating a Z-score we found the most prominent differences between AN and controls by BUA of the calcaneus (-3.2+/-1.6), followed by DXA at the lumbar spine (-2.9+/-2.2) and the hip (femoral neck -2.1+/-1.7) and by pQCT at the distal radius (total BMD -1.2+/-2.0). There were highly significant correlations between BUA of the calcaneus and BMD of the femoral neck (r = 0.78, P<0.0001) and lumbar spine (r = 0.75, P<0.0001) as well as between BMD values of the femoral neck and lumbar spine (r = 0.95; P<0.0001). In addition, there were significant correlations (P<0.001) between body mass index (BMI) and the three different measuring sites and between the duration of the disease and BUA (r = 0.5, P<0.05). Our data suggest that BUA of the calcaneus is a valuable tool in the management of osteoporosis. Being a fast, radiation-free investigation method of good acceptance, it may be well suited for an assessment of the skeletal status in patients with AN.

Regional aspects and statistical characterisation of the load with semivolatile organic compounds at remote Austrian forest sites

Spruce needles and humus layer of 25 remote forest sites spread all over Austria were investigated for their concentrations of PCDD/F, PCB, HCH, HCB, PCP, DDX and PAH. Influences of the sites' location on the detected concentrations have been identified: The north of Austria was characterised by a comparably higher overall pollutant load. In addition, altitudinal aspects were addressed. Between several compounds significant positive correlations have been identified, which were more pronounced for compounds with a stronger causal relationship. Pattern analyses allowed to identify--even for the remote sites--differences between the relative PCDD/F, HCH, DDX and PAH patterns of the sites. Partly, these different patterns were related to significantly higher or lower corresponding absolute concentrations of the sites.

Crystal polymer interaction with new injectable bone substitute; SEM and Hr TEM study

A composite constituted of calcium phosphate (CaP) granules and a hydrophilic polymer as a carrier (hydroxy-propyl-methyl cellulose, HPMC) was developed to be an injectable bone substitute (IBS, CNRS patent). IBS is a composite and not an ionic cement. The composite obtained is ready to use and sterile. Chemical interactions between organic and inorganic components appeared during the association of the two. The interactions of the CaP and the polymer have been studied using scanning electron microscopy (SEM), electron microprobe (EDX), and high-resolution transmission electron microscopy (HrTEM) SEM revealed a degradation of the granules into smaller particles while EDX was unable to show significant changes in the Ca/P ratio during aging of the composite. With Hr TEM, however, we observed hydrolysis (process of dissolution and precipitation) from the surface to about 13 nm into the HA crystals and occasional dissolution with precipitation of beta-TCP crystals. In HA, the first zone of interaction consisted of a single layer of small globular crystals of 2 to 3 nm in diameter. Numerous lattice patterns in all three axes could be observed. Under the globular crystals zone, the inter-reticular distances of the single crystals appeared enlarged by 1.2% (from 0.817 to 0.827 nm). The enlargement seems to correspond to diffusion of HPO(4) into the crystal lattice. In beta-TCP crystals, dissolution was observed to be several nanometers deep, but globular surface precipitation rarely was observed. With time or after steam sterilization, no changes were observed. These data demonstrate the strong interactions of the hydrophylic polymer with calcium phosphate, but only in the first several nanometers of thickness.

Detection of soluble alpha1 integrin in human serum

An enzyme-linked immunosorbent assay (ELISA) for the detection and quantitation of soluble alpha1beta1 integrins (salpha1) in human serum samples was developed. Solid phase-bound anti-alpha1 integrin monoclonal antibody (mAb) TS2/7 was used to capture salpha1, and mAb 1B3.1 was used to detect the immobilized integrin. An extract of human placenta (PE) containing 340 ng/mL of VLA-1 molecules served as a positive control, and serum samples from normal donors and patients were assayed. Optimal binding of anti-alpha1 integrin mAb 1B3.1, expressed as specific optical density (OD), was obtained when a 5 microng/mL solution of anti-alpha1 integrin "capture" mAb TS2/7 was immobilized to the wells and the PE was added. Solutions of albumin or collagen, in contrast, did not result in binding, confirming the specificity of the assay for sal. Furthermore, the specific OD of the wells correlated directly with the concentration of PE. A concentration of salpha1 above that of a 1:100 dilution of PE--that is, >3.4 ng/mL of integrin, in which the intra-assay correlation of variance was <5.7%, was found in 5 of 8, 3 of 8, and 6 of 9 serum samples from normal individuals, patients with connective tissue diseases (CTD), and patients with liver diseases (LD), respectively. These results suggest, for the first time, that salpha1 are present in healthy and diseased human serum.

Nimesulide-induced hepatitis and acute liver failure

BACKGROUND

Nimesulide is a relatively new non-steroidal anti-inflammatory drug that is gaining popularity in many countries because it is a selective cyclooxygenase 2 inhibitor. Occasionally, treatment is associated with mild elevation of liver enzymes, which return to normal upon discontinuation of the drug. Several cases of nimesulide-induced symptomatic hepatitis were also recently reported, but these patients all recovered.

OBJECTIVES

To report the characteristics of liver injury induced by nimesulide.

PATIENTS AND METHODS

We report retrospectively six patients, five of them females with a median age of 59 years, whose aminotransferase levels rose after they took nimesulide for joint pains. In all patients nimesulide was discontinued, laboratory tests for viral and autoimmune causes of hepatitis were performed, and sufficient follow-up was available.

RESULTS

One patient remained asymptomatic. Four patients presented with symptoms, including fatigue, nausea and vomiting, which had developed several weeks after they began taking nimesulide (median 10 weeks, range 2-13). Hepatocellular injury was observed with median peak serum alanine aminotransferase 15 times the upper limit of normal (range 4-35), reversing to normal 2-4 months after discontinuation of the drug. The remaining patient developed symptoms, but continued taking the drug for another 2 weeks. She subsequently developed acute hepatic failure with encephalopathy and hepatorenal syndrome and died 6 weeks after hospitalization. In none of the cases did serological tests for hepatitis A, B and C, Epstein-Barr virus and cytomegalovirus, as well as autoimmune hepatitis reveal findings.

CONCLUSIONS

Nimesulide may cause liver damage. The clinical presentation may vary from abnormal liver enzyme levels with no symptoms, to fatal hepatic failure. Therefore, monitoring liver enzymes after initiating therapy with nimesulide seems prudent.

Kinetic study of bone ingrowth and ceramic resorption associated with the implantation of different injectable calcium-phosphate bone substitutes

This study investigated the in vivo performance of two composite injectable bone substitutes (IBS), each with different calcium-phosphate particles granulometries [40-80 (IBS 40-80) and 200-500 microm (IBS 200-500)]. These biomaterials were obtained by associating a biphasic calcium-phosphate (BCP) ceramic mineral phase with a 3% aqueous solution of a cellulosic polymer (hydroxy-propyl-methyl-cellulose). Both materials were injected for periods of 2, 3, 8, or 12 weeks into bone defects at the distal end of rabbit femurs. Quantitative results on new bone formation, BCP resorption, and staining for tartrate-resistant acid phosphatase (TRAP) activity were studied for statistical purposes. Measurements with scanning electron microscopy and image analysis showed that the final rates of newly formed bone were similar for both tested IBS after 12 weeks of implantation. Bone colonization occurred more extensively during early implantation times for IBS 40-80 than for IBS 200-500. For the latter, BCP degradation occurred regularly throughout the implantation period, whereas it was very intensive during the first 2 weeks for IBS 40-80. Positive TRAP-stained degradation cells were significantly more numerous for IBS 40-80 than for IBS 200-500 regardless of implantation time. With the granulometry of either mineral phase, both tested IBS supported extensive bone colonization, which was greater than that previously reported for an equivalent block of macroporous BCP. The resorption-bone substitution process seemed to occur earlier and faster for IBS 40-80 than for IBS 200-500. Both tested IBS expressed similar biological efficiency, with conserved in vivo bioactivity and bone-filling ability.

Biphasic calcium phosphate/hydrosoluble polymer composites: a new concept for bone and dental substitution biomaterials

Calcium phosphate materials have been increasingly employed in orthopedic and dental applications in recent years and are now being developed for use in noninvasive surgery or as carriers for drug delivery systems. We developed an injectable bone substitute (IBS) constituted of biphasic calcium phosphate and a hydrosoluble polymer as a carrier. In vivo biocompatibility and biofunctionality of IBS were tested in rabbits using implants in osseous and nonosseous areas. The results obtained demonstrated that the concept of IBS, a filler without initial mechanical properties but able to be rapidly resorbed and replaced by newly formed bone, can be applied to new surgical applications in orthopedic surgery, maxillofacial surgery, and dentistry for pulp capping and root filling.

Short-term effects of mineral particle sizes on cellular degradation activity after implantation of injectable calcium phosphate biomaterials and the consequences for bone substitution

This in vivo study investigated the influence of two calcium phosphate particle sizes (40-80 microm and 200-500 microm) on the cellular degradation activity associated with the bone substitution process of two injectable bone substitutes (IBS). The tested biomaterials were obtained by associating a biphasic calcium phosphate (BCP) ceramic mineral phase and a 3% aqueous solution of a cellulosic polymer (hydroxypropylmethylcellulose). Both were injected into osseous defects at the distal end of rabbit femurs for 2- and 3-week periods. Quantitative results for tartrate-resistant acid phosphatase (TRAP) cellular activity, new bone formation, and ceramic resorption were studied for statistical purposes. Positive TRAP-stained degradation cells were significantly more numerous for IBS 40-80 than IBS 200-500, regardless of implantation time. BCP degradation was quite marked during the first 2 weeks for IBS 40-80, and bone colonization occurred more extensively for IBS 40-80 than for IBS 200-500. The resorption-bone substitution process occurred earlier and faster for IBS 40-80 than IBS 200-500. Both tested IBS displayed similar biological efficiency, with conserved in vivo bioactivity and bone-filling ability. Differences in calcium phosphate particle sizes influenced cellular degradation activity and ceramic resorption but were compatible with efficient bone substitution.

Injectable bone substitute using a hydrophilic polymer

We studied a new injectable biomaterial for bone and dental surgery consisting of a hydrophilic polymer as matrix and bioactive calcium phosphate (CaP) ceramics as fillers. This material is composed of complex fluids whose flow is determined by the laws of rheology. We investigated the macromolecular effects on this composite in a tube. The stability of the polymer and the mixture is essential to the production of a ready-to-use injectable biomaterial. These flow properties are necessary to obtain CaP bioactivity in a dental canal or bone defect during percutaneous surgery. Macromolecules provide spaces between CaP ceramic granules and facilitate the role of the biological agents of bone substitution.

Immune activation and virologic response to immunization in recent HIV type 1 seroconverters

Antigenic stimulation from invasive bacterial infections, and the vaccines designed to prevent them, may promote T cell activation and enhancement of HIV-1 replication. Changes in viral load have been correlated with antigen-specific responses. We prospectively determined the impact of immunization with 23-valent pneumococcal vaccine (PVAX) and Haemophilus influenzae type b (Hib)-modified diphtheria toxoid CRM197 (DT) vaccine on HIV-1 replication in recent HIV-1 seroconverters (n = 14; median, 5.5 months from infection; median CD4+ T cells, 535 microl), and correlated results with vaccine-related immune activation. Specific antibody responses, markers of CD4+ T cell activation (transferrin and interleukin 2 receptors), and viral burden were measured at weeks -2 (pre), 0, 1, 2, 6, and 12 after immunization. By week 2, levels of IgG had increased significantly over baseline in both HIV-1-infected patients and HIV-1-seronegative control subjects (n = 9) for each antigen (geometric mean fold rise: PVAX, 10.1 versus 5.3; Hib, 16.0 versus 11.7; and DT, 26.2 versus 24.5, respectively). Despite these vigorous responses to both polysaccharide and protein antigens, HIV-1-infected patients showed limited evidence of CD4+ T cell activation at 1 week, no consistent rise in HIV-1 burden at any point, and no decline in CD4+ T cell number over time. We conclude that recent HIV-1 seroconverters show vigorous humoral responses to vaccine antigens and limited early evidence of T cell activation, but no substantial or sustained increase in viral replication or decline in CD4+ T cell number. Thus, respiratory bacterial vaccines appear immunogenic and safe early in HIV-1 infection.

Experiences with sexual aggression within the general population in the Czech Republic

In a representative survey of the sexual behavior of the inhabitants of the Czech Republic (862 men and 825 women older than 15), questions were included concerning experience with sexually aggressive behavior: 11.6% of women reported this kind of experience (3.4% of them more than once). The average age at the time of rape was 21.2 years. Most of these experiences occurred within marriage or a stable partnership. In only a tenth of them the perpetrator was a stranger. Only 3.4% of the offenses were reported to police. Of Czech men, 4.8% replied positively to the question whether they had ever forced a woman to have sexual contact. The most common form of these enforced contacts was vaginal coitus.

A new injectable calcium phosphate biomaterial for immediate bone filling of extraction sockets: a preliminary study in dogs

BACKGROUND

Many different bone substitutes, such as autografts, allografts or synthetic biomaterials have been proposed to restore alveolar bone loss and support efficient placement of dental implants. This experimental study evaluated the osteoconductive properties of an injectable bone substitute (IBS) composed of a polymeric carrier and a calcium phosphate mineral phase, used to fill mandibular and maxillary canine extraction sockets.

METHODS

The polymer was a cellulose derivative (methyl-hydroxy-propyl-cellulose, MHPC), and the mineral phase consisted of granules of biphasic calcium phosphate (BCP) ceramics 200 to 500 microm in diameter. Mandibular and maxillary premolars extracted from 3 dogs (a total of 60 extraction sites) were immediately treated with the IBS or left unfilled as control sites. Animals were sacrificed 3 months after implantation and all extraction sockets were prepared for histological evaluation.

RESULTS

Qualitative histological studies showed that the IBS was able to support the extensive apposition of well-mineralized newly formed lamellar bone over the entire socket surface and appeared to prevent alveolar ridge bone loss in treated extraction sites. Quantitative evaluation showed that the amount of newly formed bone was significantly higher in mandibular than maxillary extraction sockets for both treated and control sites.

CONCLUSIONS

An injectable bone substitute composed of a polymeric carrier and calcium phosphate was effective in enhancing the bone fill of extraction sockets. This approach may prove promising for periodontal lesions. The material expressed osteoconductive capacities, and the biological properties of the mineral phase were conserved.

Polysplenia syndrome detected in adulthood: report of eight cases and review of the literature

BACKGROUND

To present the computed tomographic (CT) features of the abdominal anomalies consistent with polysplenia syndrome in adults. Awareness of these abnormalities may avoid misdiagnosing characteristic findings as separate pathological processes.

METHODS

Imaging studies, mainly abdominal CT scans, of eight patients were reviewed. Attention was directed to the location of the multiple spleens, stomach, and liver and to the possible presence of a short pancreas, malrotation of the intestine, and venous anomalies. We also reviewed the CT findings of 15 adult patients described in the literature.

RESULTS

Three men and five women underwent CT for various unrelated conditions. The most common findings were multiple spleens along the greater curvature of the stomach, which were located in the right upper quadrant in six patients. The inferior vena cava was seen on the left side in seven subjects, with azygos/hemiazygos continuation in six. A preduodenal portal vein was present in seven subjects. The liver was in the midline in four patients and on the left side in two. A short pancreas was seen in four patients, intestinal nonrotation in five, and dextrocardia in two. The prevalence of these anomalies was similar to that of the reviewed cases.

CONCLUSIONS

CT proved to be an excellent imaging modality in the diagnosis of the abdominal anomalies. Some of these (a short pancreas, multiple spleens, and azygos continuation) can simulate pathological processes. Hence the importance of recognizing these CT findings as part of a syndrome.

Reversible cerebral ischemia in patients with pheochromocytoma

Cerebral ischemia and symptoms of stroke can occur as a rare manifestation in patients with pheochromocytoma. We describe a 45-year-old woman who was admitted because of a right-sided hemiparesis due to an ischemic lesion in the left hypothalamus. The clinical diagnosis of a pheochromocytoma was proven by highly elevated urinary catecholamines and confirmed histologically after operation. The successful removal of the tumor led to the almost complete recovery of the neurological deficiencies. It is of vital importance to know this atypical presentation of pheochromocytoma. The diagnosis of pheochromocytoma should be suspected in patients with focal cerebral symptoms, particularly in the presence of intermittent hypertension or other paroxysmal symptoms suggestive of pheochromocytoma.

Grasping an object: one movement, several components

The visuomotor transformations for producing a grasping movement imply simultaneous control of different visual mechanisms. The object size, orientation and 3D characteristics have to be encoded for the selection of the appropriate opposition space, within which the opposition forces will be applied on the object surface. These mechanisms also have to combine with those of the transport of the hand to the object location. Finally, biomechanical constraints impose categorical visuomotor decisions for positioning the opposition space according to object changes in size, orientation and spatial location. This paper examines possible interactions between the specialized structures for visuomotor transformation and the internal model that adapts prehension to its goals.

Bilateral high-frequency stimulation of the internal globus pallidus in advanced Parkinson's disease

We report here the results of an open prospective study in 9 patients suffering from severe Parkinson's disease with on/off fluctuations and restricted off-period mobility, who underwent bilateral implantation of stimulating electrodes in the internal pallidum. At 3-month follow-up, the total Unified Parkinson's Disease Rating Scale (UPDRS) motor score in the medication-off state was reduced from 54.1+/-14.8 to 23.9+/-11.7 (44.2%) when stimulation was turned on. Comparison of UPDRS subscores revealed significant improvements for tremor, rigidity, bradykinesia, gait and posture, and dyskinesias. The results of the clinical scoring could be confirmed by significant changes in the quantitative assessment of hand function and walking. Bilateral pallidal stimulation reduced the amount and severity of on/off fluctuations. Additional follow-up at 6 months (n=6), 9 months (n=6), and 12 months (n=4) did not show a decline in effectiveness of stimulation. There was no permanent morbidity associated with the procedure. A subtle reduction of verbal fluency, which was not evident to the patients, was the only cognitive side effect of the procedure in neuropsychological testing. Chronic bilateral high-frequency stimulation of the internal pallidum seems to be a neurologically safe and highly effective treatment for "off" symptoms, dyskinesias, and motor fluctuations in advanced stages of Parkinson's disease.

[Factors affecting the attitude of the Czech population towards induced abortion]

Based on an anonymous questionnaire survey of a representative population group above 15 years of age in the Czech Republic (862 men and 857 women) the authors investigated also sociodemographic factors affecting attitudes of the Czech population to induced abortions. The findings suggest that attitudes of men and women to induced abortions do not differ essentially in any of the investigated criteria. The size of domicile does not affect the attitudes substantially. The most restrictive views are expressed by respondents of the oldest age group (above 60 years) and respondents of the youngest age group (15-17 years). The liberal attitude to induced abortions increases with the educational level. Religious belief has a marked effect on restrictive attitudes to abortions, nevertheless among catholic subjects only 7% male and female respondents expressed refused induced abortions unequivocally.

The perception of discrimination in the HIV policy among Czech gay men

The study aimed to evaluate the perception of discrimination in the Czech national HIV policy among gay men. The anonymous questionnaires were published in the gay journal and 191 respondents filled them and returned back. Their assessment of discrimination in the HIV policy and other life activities were ranked in 5-points scale. Assumed discrimination in the HIV policy was found to be one of the lowest one. Forty-one percent of men who answered did not find any discrimination in the HIV policy at all, eleven percent of them perceived it at the highest level. The personal perception of HIV discrimination was related to the fear of discrimination in the health facilities and to the general evaluation of political change for gay life. HIV policy is generally viewed as tolerant and without discriminative approach toward vulnerable minorities. The number of negative evaluations can play important role in the obstacles of preventive programs.

[Use of condoms among the population of the Czech Republic: results of a national study]

Based on an anonymous survey, using questionnaires, in a representative group of the population of the Czech Republic above 15 years of age (862 men and 857 women) the authors investigated the use of condoms at the onset of sex life and with a steady and casual sexual partner. From the results ensues that the use of condoms in our population is lower than in advanced western European countries and the USA. During the first intercourse it was used only by 19% men and 14% women, in particular those of younger age groups. In a steady partnership two thirds of the respondents have experience with a condom, however, only one fifth uses it regularly. The position is similar during intercourse also with casual sexual partners, though the respondents use it more frequently. However not even then one third of men and almost half the women do not use protection by condoms. The most important influence on the reported use of condoms is exerted by the factors of sex (men, probably to appear socially in the most favourable light report its more frequent use) and age (condoms are used more frequently by younger men and women). In the Czech population the effect of religion and education is not important in this respect.

Application of FT-IR microspectroscopy to the study of an injectable composite for bone and dental surgery

Hydroxypropylmethylcellulose (HPMC) of high-viscosity grade is used as a ligand for a bioactive calcium phosphate ceramic (the filler) in a ready-to-use injectable sterilized biomaterial for bone and dental surgery. Application of physico-chemical methods such as XPS, NMR, or Raman spectroscopy encounters difficulties when used to study such a multiphased material. This paper reports on the application of FT-IR microspectroscopy (FT-IRM) for the investigation of inorganic and organic phases of the rough composite and separated phases obtained by mechanical or chemical extraction methods. A comparison of FT-IRM with the conventional KBr pellet method was made and indicates that the macro and micro FT-IR methods are complementary: the former revealed new chemical groups not visualized with the KBr method whereas the latter detected the major compound of the blend. FT-IR microspectroscopy was revealed to be a powerful method of analysis that is complementary to other existing spectroscopic methods. Moreover, it is expected to be a useful tool in the study of biomaterials in biological samples.

Time dependence of left ventricular recovery after delayed recanalization of an occluded infarct-related coronary artery: findings of a pilot study

OBJECTIVES

We sought to test the hypothesis that late recanalization of infarct-related coronary arteries (IRAs) improves long-term left ventricular (LV) function.

BACKGROUND

Reperfusion within 24 h of an acute myocardial infarction (MI) has been shown to improve myocardial healing and to reduce infarct expansion. Uncontrolled data suggest that there may be a time window of several weeks for such an effect.

METHODS

Sixteen asymptomatic patients 10 +/- 4 days after a first Q wave anterior wall MI with persistent left anterior descending coronary artery occlusion and infarct-zone akinesia were randomized to immediate (2 weeks) or delayed (3 months) angioplasty. Repeat catheterization and cardiac magnetic resonance imaging (MRI) were performed after 3 and 12 months.

RESULTS

Angiography 3 months after MI revealed that LV ejection fraction (LVEF) had increased ([mean +/- SD] 54.4 +/- 4.3% vs. 63.9 +/- 7.4%, p < 0.01) as a result of improved regional function (p < 0.01) and LV end-systolic volume had decreased (p < 0.002), whereas LV end-diastolic volume remained unchanged. With delayed angioplasty, LVEF, infarct zone wall motion and LV volumes did not improve. Cardiac MRI at baseline and at 3 and 12 months confirmed these findings and extended them up to 1 year, indicating that delayed angioplasty could no longer improve LV function because of marked LV dilation (p < 0.01). Immediate angioplasty had a high success rate, but restenosis (50%) was accompanied by new severe angina as a clinical indicator of salvaged myocardium, which did not occur after delayed angioplasty.

CONCLUSIONS

This pilot study in selected patients supports the hypothesis that myocardial viability persists ("hibernation") for 2 to 3 weeks but not for 3 months after MI, during which time it may be worthwhile to restore blood flow to a large myocardial territory, even in asymptomatic patients, to improve long-term LV function.

Getting a Grasp on Coordination

Motor coordination is realized by the nervous system at different levels. Concepts about the coordination within a limb define the controlled parameter in cartesian or joint space, whereas concepts about the coordination between limbs stress the temporal control of schemas. Motor deficits of neurological patients point to the role of the different motor areas in motor coordination.