Search

Joseph F Griffith,1 Jeffrey L Goldberg2 1Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, 2Shiley Eye Center, University of California San Diego, La Jolla, CA, USA Background: Patients with various retinal diseases and patients who have undergone retinal procedures and surgeries have an increased risk of developing ocular hypertension and glaucoma. Little is known about the epidemiology of comorbid retinal diseases in glaucoma patients. This study evaluated the prevalence of retinal comorbidities in a population of patients with five types of glaucoma.Methods: A longitudinal, retrospective study was conducted using International Classification of Disease (ICD-9) billing records from 2003 to 2010 at an academic medical center. Patients were classified as having primary open-angle glaucoma (POAG), low tension open-angle glaucoma (NTG), pigmentary open-angle glaucoma, chronic-angle closure glaucoma (CACG), or pseudoexfoliation glaucoma (PXG) if they had at least three clinic visits with the same ICD-9 code. Patients were classified as having a retinal comorbidity if they had two visits with the same code. Variables were analyzed with the independent t-test, χ2 test, analysis of variance, or Fisher’s exact test.Results: A total of 5,154 patients had glaucoma, and 14.8% of these had a retinal comorbidity. The prevalence of comorbid retinal disease was higher in patients with POAG (15.7%) than in those with NTG (10.7%), PXG (10.1%), or pigmentary open-angle glaucoma (3.7%; P

The article presents a study which investigates the risk factors and incidence of non-vertebral and vertebral fracture in female Chinese patients with systemic lupus erythematosus (SLE). Topics discussed include the measurement of bone mineral density (BMD), the prevalence of osteoporosis, and the use of dual-energy X-ray absorptiometry.

The article discusses the study on the impact of systemic lupus erythematosus (SLE) disease on the deterioration of cortical microstructure, bone strength, and bone mineral density. It details how the study was conducted, which involved 60 SLE patients and 60 healthy controls. The results reportedly revealed that SLE contributes to the deterioration of bone strength, cortical microstructure and bone density.

Objective: To determine the relative performance of T1rho and T2 relaxation times in disc degeneration assessment.Methods: Lumbar sagittal MRI was performed at 3 T in 52 subjects. With a spin-lock frequency of 500 Hz, T1rho was measured using a rotary echo spin-lock pulse embedded in a three-dimensional (3D) balanced fast field echo sequence. A multi-echo TSE sequence was used for T2 mapping. Regions of interest (ROIs) were drawn over the T1rho and T2 maps, including nucleus pulposus (NP) and annulus fibrosus (AF). Eight- and five-level disc degeneration semi-quantitative grading was performed.Results: For NP, T1rho and T2 decreased quadratically with disc degeneration grades and had no significant trend difference (P = 0.40). For AF, T1rho decreased linearly as the disc degenerated and had a slope of -3.02 and -4.56 for eight- and five-level gradings respectively; while the slopes for T2 values were -1.43 and -1.84 respectively, being significantly flatter than those of T1rho (P < 0.001). There was no significant difference in T1rho and T2 values for both NP and AF among discs of grade 5/8 to 8/8 degeneration.Conclusion: T1rho is better suited for evaluating AF in degenerated disc than T2. In NP, T1rho and T2 decrease in a similar pattern following disc degeneration. [ABSTRACT FROM AUTHOR]

Objective: To determine whether MR perfusion indices or marrow fat content at baseline can predict areal bone mineral density (BMDa) loss.Methods: Repeat dual x-ray absorptiometry (DXA) of the hip was performed in female subjects at 2 years (n = 52) and 4 years (n = 45) following baseline MR perfusion imaging and spectroscopy of the hip.Results: Percentage reduction in femoral neck BMDa at 4 years post-baseline was greater in subjects with below median acetabulum enhancement slope (E(slope)) (-5.6 ± 1.2 Vs -1.1 ± 1.2 (mean ± standard error) p = 0.014) or muscle maximum enhancement (E(max)) (-5.7 ± 1.2 Vs -0.23 ± 1.2, p = 0.009) after adjusting for baseline co-variables. Baseline MR parameters correlated with reduction in BMDa at 4 years (acetabulum E(slope) r = 0.517, p = 0.0003; muscle E(max) r = 0.306, p = 0.043) as well as traditionally applied clinical risk factors. Acetabulum E(slope), femoral neck E(max) and marrow fat content at baseline had sensitivities of 89%, 81% and 72% respectively at distinguishing between fast (>1%/annum) (n = 18) and slow (<1%/annum) (n = 27) BMD losers.Conclusion: Elderly female subjects with reduced perfusion indices at baseline had increased femoral neck bone loss at 4 years. Selected perfusion indices and marrow fat content have a moderate to high sensitivity in discriminating between fast and slow bone losers. [ABSTRACT FROM AUTHOR]

Intravascular papillary endothelial hyperplasia is a rare benign vascular proliferative process as a result of papillary proliferation of the endothelial cells within the vascular lumen. We report two cases of intravascular papillary endothelial hyperplasia affecting the extremities. The characteristic sonological and MR imaging features are discussed, with updated review of literature. Imaging features are helpful in achieving a definitive diagnosis of the intravascular papillary endothelial hyperplasia. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the frequency of metastatic neck nodes detected using sonography in patients with stomach cancer at presentation according to primary subsite and to assess the effect of metastatic neck node detection on tumour staging. Imaging and histological records of 233 patients diagnosed with stomach cancer were reviewed. All patients underwent neck ultrasound at presentation with ultrasound-guided fine needle aspiration for cytology (FNAC) of sonographically abnormal neck nodes. Abnormal nodes were classified positive or negative for metastases based on the FNAC result. Clinical records were also reviewed for evidence of subsequent neck nodal metastases. Sonographically abnormal neck nodes were present in 14/233 (6.0%) patients; 7 were reactive and 7 were metastatic based on FNAC findings and clinical follow-up. Overall, 7/233 (3.0%) patients with stomach cancer had nodal metastases, although tumour stage was altered in only 2/233 (0.9%) patients; 57% of metastatic nodes were impalpable. Nodal metastases from gastric cardia tumours (6%) were more common than from the body (2%) or antrum (3%). Neck node metastases are uncommon in stomach cancer at presentation, are usually associated with extensive intra-abdominal metastatic spread, and adversely influence tumour staging in only a small minority of patients. [ABSTRACT FROM AUTHOR]

Purpose: To determine the reproducibility of proton ((1)H) magnetic resonance (MR) spectroscopy and dynamic contrast-enhanced MR imaging in a clinical setting for the assessment of marrow fat fraction and marrow perfusion in longitudinal studies.Materials and Methods: In all, 36 subjects (17 females, 19 males, mean age 72.9 +/- 2.9 years) who underwent MR spectroscopy and/or dynamic contrast-enhanced perfusion imaging of the proximal femur were asked to return after 1 week for a repeat MR examination.Results: Reproducibility of (1)H MR spectroscopy in all bone areas tested was high, ranging from 0.78-0.85, with the highest reproducibility being in the femoral head and lowest in the femoral neck. Reproducibility of paired perfusion measurements ranged from 0.59 (enhancement slope femoral head) to 0.98 (enhancement maximum acetabulum). Overall reproducibility of (1)H MR spectroscopy and dynamic contrast-enhanced imaging tended to be best in areas with the highest inherent fat fraction or perfusion.Conclusion: Reproducibility of (1)H MR spectroscopy or perfusion imaging is sufficiently high to warrant these techniques being applied to the longitudinal study of bone diseases. [ABSTRACT FROM AUTHOR]

Peripheral quantitative CT (pQCT) is the main method of bone mineral density (BMD) measurement in small animals. However, pQCT is usually only available in specialized centers, while clinical multidetector computed tomography (MDCT) is much more widely available. This study investigated the feasibility of using clinical 64-slice MDCT for measuring the BMD of rat lumbar vertebrae. The lumbar vertebrae of 18 7-month-old female Sprague-Dawley rats were studied. Two MDCT protocols (General Electric LightSpeed), comprising single 2.5-mm and continuous 0.625-mm acquisitions, and a single pQCT protocol (Scanco Densiscan 2000), comprising 1-mm acquisitions, were performed. The following comparisons were carried out: 2.5-mm MDCT densitometry versus 0.625-mm MDCT densitometry; 0.625-mm MDCT densitometry compared to pQCT densitometry; same day repeatability of 0.625-mm MDCT densitometry; longitudinal repeatability of 0.625-mm MDCT densitometry on day 0 and day 28 and longitudinal 0.625-mm MDCT densitometry in ovariectomized rats on day 0 and day 28. Comparisons were made using intra-class correlation coefficient (ICC). Examination time per animal was 5 min for MDCT and 30 min for pQCT. Acquisitions of 2.5-mm MDCT had a larger coefficient of variation (CoV) than 0.625-mm acquisitions. MDCT densitometry had good agreement with pQCT densitometry (ICC = 0.85). Same-day MDCT densitometry with 0.625-mm acquisitions had a small CoV (1.61%). MDCT densitometry of non-ovariectomized animals at 28 days showed no BMD change, while MDCT densitometry of ovariectomized animals showed a 13.7 +/- 6.7% BMD reduction at 28 days. Clinical MDCT can reliably and accurately measure rat lumbar vertebral BMD and is much faster than pQCT. [ABSTRACT FROM AUTHOR]

The purpose of this study is to investigate the role of femoral marrow MR imaging as predictor of outcome for hemopoietic stem cell transplantation (HSCT) in beta-thalassemia major. MR imaging of the proximal femur, including T1- and T2-weighted spin echo and short-tau inversion recovery and in-phase and out-of-phase fast field echo images, was prospectively performed in 27 thalassemia major patients being prepared for HSCT. The area of red marrow and its percentage of the proximal femur were measured, and the presence of marrow hemosiderosis was assessed. Age-adjusted multivariate logistic regression was used to determine the relationship between red marrow area percentage and marrow hemosiderosis and HSCT outcome. Red area percentage were less in patients with successful (90.25 +/- 4.14%) compared to unsuccessful transplants (94.54% +/- 2.93%; p = 0.01). Red marrow area percentage correlated positively with duration of symptoms(r = 0.428, p = 0.026) and serum ferritin (r = 0.511, p = 0.006). In multivariate-adjusted logistic regression analyses, red marrow area percentage was significantly inversely associated with successful HSCT (OR = 1.383, 95% CI: 1.059-1.805, p = 0.005). Marrow hemosidersosis and duration of sympotms and serum ferritin were not associated with HSCT outcome(p = 0.174, 0.974, 0.762, respectively). Red marrow area percentage of proximal femur on MR imaging is a useful predictor of HSCT outcome. [ABSTRACT FROM AUTHOR]

Deliberate self-injection of metallic mercury into subcutaneous tissue is uncommon. A 41-year-old lady with a history of schizophrenia was admitted to our hospital after deliberate injection of metallic mercury into her right wrist and antecubital fossa. Physical examination was unremarkable except for the injection marks over right antecubital fossa and wrist. The presence of subcutaneous mercury deposits in her right elbow and wrist was confirmed by X-rays and ultrasound scan. Three days later, erythema, swelling, induration and tenderness were seen over the injection sites. At the operation on day 9, mercury streaks were seen within the brachialis muscle belly, surrounded by friable necrotic tissues along the tract. A similar picture was noted in her right wrist. The necrotic tissues and mercury streaks were removed. The patient had been unco-operative and she only received incomplete treatment with dimercaprol and 2,3-dimercaptosuccinic acid. Her total blood mercury level (normal < 50 nmol/L) decreased from 101–151 nmol/L in the first two weeks to 42 nmol/L 3 months later. Her 24-hour urinary mercury excretion (normal < 10 nmol) changed from 55.7–209.5 nmol in the first 7 weeks to 125.4 nmol 3 months later. This case illustrates that soft tissue metallic mercury can produce local necrosis and may allow continuous absorption with persistent elevations in blood and urinary mercury levels. Therefore, early surgical removal of subcutaneous mercury deposits is required to prevent local complications and minimize the risk of systemic absorption and toxicity. [ABSTRACT FROM AUTHOR]

Study Design: Cross-sectional study. Objective: The purpose of this study was to examine disc morphology and spinal mobility in subjects with varying degrees of osteoporosis. Summary Of Background Data: There was limited information on the effect of osteoporosis on lumbar morphology and spinal mobility. It was also unclear how osteoporosis affects the nonosseous tissues such as the intervertebral disc. Methods: Ninety elderly subjects with varying bone mineral densities (22 normal, 28 osteopenia, 40 osteoporosis) were recruited from an osteoporosis clinic. Lateral radiographs and magnetic resonance images of their lumbar spines were obtained. An electromagnetic tracking device was employed to measure the ranges of motion of the whole lumbar spine. Results: Although the thoracic spine had been shown to have decreased anterior vertebral body height in subjects with osteoporosis, this study revealed that the anterior height was increased in the lumbar region. Osteoporosis was associated with expansion of the middle of the disc with corresponding collapse of vertebral bodies, but osteoporosis was found not to be related to either disc preservation or degeneration. No significant change in spinal mobility was observed in patients with osteoporosis. Conclusion: Osteoporosis does not only affect the bone but also the nonosseous tissues. It was found to be associated with expansion of the intervertebral disc, which was likely to be secondary to changes in the vertebral endplate. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: A reliability study was conducted. OBJECTIVE.: To modify a grading system for lumbar disc degeneration and to test the reliability of this modified grading system. SUMMARY OF BACKGROUND DATA: The 5-level Pfirrmann grading system for disc degeneration did not prove discriminatory when used to assess disc degeneration in the elderly spine. Such discriminatory power is necessary to test the association between other variables and severity of disc degeneration. METHODS: An 8-level modified grading system for lumbar disc degeneration was developed including a description of the changes expected for each grade and a 24-image reference panel. The reliability of the modified grading system was tested on 260 lumbar intervertebral discs in 52 subjects (26 men, 26 female) with a mean age of 73 years (range, 67-83 years). All examinations were analyzed independently by 3 readers. Intraobserver and interobserver reliabilities were assessed by calculating weighted kappa statistics. RESULTS: On average, for all 3 readers, 0.39% of the 260 discs were classified as Grade 2, 22% were classified as Grade 3, 21.5% were classified as Grade 4, 25.3% were classified as Grade 5, 19.1% were classified as Grade 6, 7.1% were classified as Grade 7, and 4.8% were classified as Grade 8. Intraobserver agreement was excellent (weighted kappa range, 0.79-0.91) with substantial interobserver agreement (weighted kappa range, 0.65-0.67). Complete intraobserver agreement was obtained, on average, in 85% of all discs with 84% of disagreement being as a result of a 1 grade difference. Complete interobserver agreement was obtained, on average, in 66% of all discs with 91% of disagreement being as a result of a 1 grade difference. CONCLUSION: The modified Pfirrmann grading system is useful at discriminating severity of disc degeneration in elderly subjects. The system can be applied with good intra- and interobserver agreement. [ABSTRACT FROM AUTHOR]