Value of Osteoporosis Self-assessment Tools for Asians (OSTA) with or without Brown's clinical risk factors in detection of postmenopausal osteoporosis

OBJECTIVE

To evaluate the value of Osteoporosis Self-assessment Tools for Asians (OSTA) score, Brown's clinical risk assessment and their combination as screening tools for postmenopausal osteoporosis.

METHODS

Two hundred postmenopausal women were enrolled between August 2010 and January 2011. The weight and age of all participants were collected for the OSTA score. Clinical risk factors were collected for Brown's criteria. Bone mineral density was measured using dual-energy X-ray absorptiometry.

RESULTS

The mean age (± standard deviation (range)) of the studied population was 60.1 ± 7.8 (41-81) years. Twenty-one percent of the participants had either osteoporosis of the lumbar spine, or femoral neck or both, of which 8% had osteoporosis at the lumbar spine and 17% had osteoporosis at the femoral neck. The sensitivity and specificity for OSTA score cut-off values of ≤ -1 were 78.6% and 58.2% and for Brown's clinical risk factors were 57.1% and 71.5%, respectively. When the OSTA score of ≤ -1 and Brown's clinical risk factors were combined to screen participants with positive values for one or both test(s), the sensitivity increased from 78.6% to 81.0%, while the specificity decreased from 58.2% to 50.6%. The positive predictive values of the OSTA score, Brown's clinical criteria and the combined tools ranged between 30.4 and 70.6%.

CONCLUSIONS

An OSTA score of ≤ -1 seems to have higher sensitivity compared to Brown's clinical risk factor assessment. The combination of both tools provides a slight improvement in sensitivity but with a decline in specificity.

Bone density and 25-hydroxyvitamin D level in extrahepatic biliary atresia

Biliary atresia (BA) represents a common cholestatic affliction of the gastrointestinal tract affecting infants and children. The objective of the present study was to evaluate 42 patients (20 with and 22 without jaundice) diagnosed with extrahepatic BA for bone mineral content and serum 25-hydroxyvitamin D (HVD) levels. Physical examination and anthropometric nutritional assessment were performed. The investigation included liver function tests and serum calcium (Ca), phosphate (P), magnesium (Mg), and 25-HVD levels. Dual-energy X-ray absorptiometry was used to measure the bone mineral density (BMD) of the lumbar spine (L(1)-L(4)). Our results showed that 16 jaundiced patients (80%) and only 3 nonjaundiced patients (13.6%) showed osteoporosis (P< 0.05). All patients had normal serum Ca and P levels. Only 1 nonjaundiced patient had a low serum Mg level. Serum 25-HVD levels (mean +/- SD) were 20.71 +/- 8.24, 16.12 +/- 4.3, and 9.18 +/- 5.84 ng/ml, respectively, in subjects with normal bone density (n=7), osteopenia (n=3), and osteoporosis (n=11). Bone disease represents a well-known complication among long-term survivors of BA. To date, the pathogenesis has remained unexplained. Since, as demonstrated in the present study, jaundiced patients develop osteoporosis more frequently than nonjaundiced patients, hyperbilirubinemia may have an influence. Bone-mineral deficiency can be detected earlier by means of BMD measurement (non-invasive method) than by measuring serum Ca, P, and Mg levels in these patients.

Oral ceftibuten switch therapy for acute pyelonephritis in children

The available oral third generation of cephalosporin, "ceftibuten" was used to substitute the intravenous drug after defervescence in acute pyelonephritis in children. This randomized controlled study compared the efficacy of an oral ceftibuten switch therapy with a ceftriaxone in both short-term and long-term outcomes. 36 99mTc-dimercaptosuccinic acid (DMSA) scan proved pyelonephritis patients were randomized into the study group, "ceftibuten" (N=18) and the control group, "ceftriaxone" (N=18). Ceftriaxone (75 mg/kg/day) was the initial antibiotic in both groups. After defervescence for 24-48 hours, oral ceftibuten (9 mg/kg/day) was substituted in the study group and continued for 10 days. The subject characteristics and laboratory data were not different between the two groups. The urine culture at D14 was sterilized in both groups. The incidence of renal scarring was 66.6 per cent and 61.1 per cent in the study group and the control group respectively. The rate of recurrent infection showed no statistical significance. The duration of hospitalization was shorter in the study group than in the control. In conclusion, oral ceftibuten switch therapy can be recommended as a safe and effective treatment for acute pyelonephritis in children. The use of oral therapy may result in a significant reduction of health care expenditure.

Diffusion and fate of intramuscularly injected human rabies immune globulin

The importance of rabies immune globulin (RIG) in postexposure rabies treatment is well known and it has been emphasized that the local injection into the animal bite sites is crucial. This preliminary study used a radioisotope tracer that allows following the fate of human rabies immune globulin (HRIG) injected intramuscularly. There was significant retention and local diffusion of the immune globulin at the injection site and significant radiotracer could still be detected at the site 24 h later.

Report of the Radionuclides in Nephrourology Committee for evaluation of transplanted kidney (review of techniques)

Comprehensive evaluation of renal transplants has been important in differential diagnosis of medical and surgical complications in the early post-transplantation period and in the long-term follow-up. If performed well, it yields excellent functional and good anatomic information about the graft that can be effectively used in the patient. That includes selection of patients for biopsy and for various drug regimens. This is true especially in patients with anuric acute tubular necrosis (ATN) and in patients with developing chronic rejection. Improving indices of renal function (effective renal plasma flow, uptake of tubular tracers) can indicate resolution of tubular injury (ATN) while there is still no improvement in plasma creatinine. In patients with chronic rejection, plasma creatinine increases only after approximately 30% of renal function is lost due to graft fibrosis. Early recognition of this condition could permit treatment and delay of retransplantation. The protocol recommended at the Copenhagen meeting includes a flow study, scintigram of the kidneys, prevoid and postvoid bladder image, injection site image (quality control), time/activity curves of the graft and bladder, and quantitative data of perfusion, function, and tracer transit. The flow study obtained during the initial transit of the bolus through the graft could be performed either with 99mTc mercaptoacetyltriglycine, or 99mTc diethylenetriaminepentaacetate (DTPA). Quantitative analysis of perfusion facilitates interpretation of the study during the early post-transplantation period. ATN, common in cadaver transplants, typically shows adequate perfusion. The function phase should include images and time/activity curves. Images alone are insufficient. Quantitative data such as clearance or other indices of function and indices of tracer transit are essential for correct interpretation of the results. Normal images and normal graft function reliably exclude clinically important complications. A single scintigram demonstrating prolonged tracer transit with decreased function cannot separate acute rejection and ATN. On serial studies, decline in function and poor perfusion are indicative of acute rejection. A normally appearing scintigram without cortical retention, but with low function, is consistent with chronic rejection. Pharmacological intervention to exclude obstruction (diuretic renogram) or hemodynamically significant renal artery stenosis (angiotensin converting enzyme challenge) should be used whenever indicated.

Value of radioimmunoscintigraphy with technetium-99m labelled anti-CEA monoclonal antibody (BW431/26) in the detection of colorectal cancer

This study was undertaken as part of a Coordinated Research Programme initiated by the International Atomic Energy Agency to evaluate the usefulness of radioimmunoscintigraphy (RIS) in the management of patients with colorectal cancer. Technetium-99m labelled BW431/26, a monoclonal antibody against carcinoembryonic antigen (CEA), was used. The study included 73 patients (31 females and 42 males). Sixty-eight patients were suspected of having recurrent colorectal adenocarcinoma while another five were suspected to have primary colorectal cancer. Images were acquired at 10 min and 4 and 24 h following the injection of radioantibody. The efficacy of RIS in tumour detection was evaluated by the findings at surgery, histological investigation and/or other diagnostic modalities and clinical follow-up. Four of five patients with suspected primary colorectal cancer gave true-positive results (three at primary sites, one at the site of a metastatic lesion) while one was false-positive. The overall accuracy of RIS in the diagnosis of recurrent colorectal cancer was 87%. Its sensitivity in the detection of locoregional or abdominal recurrence and liver metastases was 97% and 89% respectively. RIS was more accurate than computed tomography (CT) scan in the detection of pelvic recurrence and liver metastases while CT scan was far superior to RIS in detecting lung metastases. RIS proved most useful in patents who had rising CEA levels on clinical follow-up but in whom other work-up, including CT scan, was negative. The advantages of RIS include the ability to detect tumour recurrence prior to other investigations and to identify tumour recurrence in areas such as the pelvis, where CT and magnetic resonance imaging have their greatest weaknesses in diagnosing recurrent disease. The imaging accuracy is significantly increased when combined CT and antibody imaging is performed.

Deconvolution analysis of renal blood flow: evaluation of postrenal transplant complications

Medical complications after renal transplantation cause problems in treatment decision making. To differentiate acute tubular necrosis from acute rejection when it occurs in the early posttransplant period is difficult. Renal scintigraphy offers a noninvasive means for renal blood flow (RBF) and renal function assessment.

METHODS

This retrospective study of RBF and renal function evaluation after kidney transplantation is an attempt to calculate the "renal vascular transit time" from the 99mTc-diethylenetriaminepentaaacetic acid renal vascular flow with a deconvolution technique. The results of 102 studies on 38 graft recipients were evaluated. Of these, 19 were diagnosed as acute rejection, 12 as acute tubular necrosis, 4 as chronic rejection, 1 as vesicoureteric reflux, 1 as recurrent immunoglobulin A nephropathy, 1 as iliac vein thrombosis, 1 as cyclosporine nephrotoxicity and 63 as normal. All diagnoses were established by clinical and/or pathologic criteria.

RESULTS

With renal vascular transit times more than 12.8 secm the sensitivity and specificity for the detection of acute rejection was 95% and 94%, respectively. The sensitivity and specificity for the differential diagnosis of acute rejection against acute tubular necrosis was 95% and 92%, respectively.

CONCLUSION

The use of renal vascular transit time in addition to 131I-labeled hippuran renogram provides a promising diagnostic parameter to differentiate between acute rejection and acute tubular necrosis.

Validation of renal output efficiency as an objective quantitative parameter in the evaluation of upper urinary tract obstruction

This is a preliminary study of the parameter, renal output efficiency (ROE), for the quantitation of furosemide (frusemide) response in diuresis renography. This is calculated by a technique independent of variations in uptake rate by the kidneys. Eleven healthy volunteers and 34 patients suspected of upper urinary obstruction were subjected to gamma camera studies using 99mTc-MAG3 and a standard protocol. Furosemide was given at 18 min after the study was started. The ROE was calculated in each kidney and the results were correlated with final diagnosis. The range of ROE in healthy individuals varied between 82% and 98% (mean = 91.6%); while obstructed kidneys showed significantly reduced values (p < 0.001) ranging between 30% and 76% (mean = 56%). In the diagnosis of urinary obstruction, the ROE has a sensitivity of 91%, specificity of 94% and accuracy of 94%. ROE complements conventional diuresis renography and provides better diagnostic yield in patients with impaired renal function.

Clinical evaluation of 99mTc diaminocyclohexane, a renal tubular agent with cationic transport: results in healthy human volunteers

As alternatives to anionically transported hippuran, structure distribution experiments on a series of 99mTc-labelled primary substituted ethylene diamine compounds led to selection of 99mTc diaminocyclohexane (DACH) for clinical evaluation, 99mTc DACH, a cation with the structure trans-[O2(DACH)2 99mTc]+ is prepared by mixing 50 mumol DACH, 1 mumol stannous tartrate and 500 MBq of 99mTc. Seven normal volunteers underwent renal imaging and clearance studies using 150 MBq of 99mTc DACH and 1 MBq of 125I hippuran simultaneously. The images with 99mTc DACH revealed good uptake and excretion. The mean +/- 2 SD values of parenchymal and whole-kidney transit time indices and mean parenchymal transit time were 46 +/- 33, 75 +/- 64 and 141 +/- 51 s, respectively, similar to mercaptoacetyl triglycine. The mean clearance of 99mTc DACH was found to be 163 ml/min (SD = 32). Following cationic blockade with 900 mg oral thiamine, significant reduction (p < 0.001) in DACH clearance was noted, but hippuran clearance remained unaltered. The results support the hypothesis that 99mTc DACH is transported cationically.