The importance of morphometric radiographic vertebral assessment for the detection of patients who need pharmacological treatment of osteoporosis among postmenopausal diabetic Korean women.

UNLABELLED: Many diabetic patients with vertebral fractures remain undiagnosed and untreated. We found that more than two-thirds of osteoporotic diabetic women could not be identified for pharmacological treatment according to the NOF guidelines if without radiographic vertebral assessment. This study shows the importance of radiographic vertebral assessment for identifying patients who need treatment for osteoporosis in diabetic women. INTRODUCTION: Diagnosis of vertebral fracture (VF) is important for identifying patients who need pharmacologic therapy for osteoporosis. However, many patients with vertebral fractures remain undiagnosed and untreated. This study evaluated the number of patients with VFs who would be unrecognized as candidates for osteoporosis treatments according to the National Osteoporosis Foundation (NOF) Clinician's Guidelines to the Treatment of Osteoporosis, among postmenopausal diabetic Korean women without spinal imaging. METHODS: A total of 873 postmenopausal diabetic women were enrolled. Lateral plain radiographs of the thoracolumbar spine and total hip BMD were obtained. The Fracture Risk Assessment Tool (FRAX®) probability was computed using the algorithm available online at http://www.shef.ac.uk/FRAX (South Korea version). The subjects with and without VFs were classified into candidates for osteoporosis treatment [Tx+by NOF] and not candidates for osteoporosis treatment [Tx−by NOF] according to the NOF pharmacologic treatment guidelines, regardless of the presence of VFs. RESULTS: Forty-six percent of postmenopausal diabetic womenhad morphometric VFs. Among the subjects with morphometric VFs, only 2% of the patients had previously diagnosed VFs by medical doctors. In addition, 73.6% of the patients with VFs were not included in the [Tx+by NOF] group, given the assumption of no radiographic diagnosis of VFs. CONCLUSIONS: With regard to increased risk of VFs in postmenopausal Korean women with type 2 diabetes mellitus, radiographic vertebral assessment would be useful for the clinical identification of osteoporosis and fractures.

Dual x-ray absorptiometry forearm software: accuracy and intermachine relationship.

An ash study was performed to analyze the accuracy of forearm measurements at the one-third site of three dual x-ray absorptiometry (DXA) systems using 20 cadavers. A Hologic QDR-2000, a Hologic QDR-1000/W, and a Lunar DPX-L system were used. The correlations between ash weight and DXA BMC were excellent for the three instruments (r > 0.97, p < 0.001), with accuracy errors < 5.2%. To perform a forearm cross-calibration of bone mineral content (BMC) and density (BMD) between the scanners, 10 healthy volunteers were additionally scanned at the distal one-third radius. The correlations among the DXA machines were excellent (r > 0.95); the absolute BMC and BMD values were significantly different between the two Hologics and the Lunar machine. The slope and intercept of both the BMC and BMD between the two Hologic systems were close to unity. In conclusion, the DXA forearm software packages provide accurate methods for assessing bone mineral content and density. The conversion of data among different manufacturers should be performed by careful cross-calibration measurements.

Detection of extrapulmonary tuberculosis with gallium-67 scan and computed tomography.

We evaluated 23 patients with extrapulmonary tuberculosis (TB) with 67Ga imaging to assess its usefulness in the diagnosis of this condition. We performed computed tomography (CT) in 17 patients to assess CT features of extrapulmonary TB in comparison with findings from 67Ga scans. Nineteen of 23 patients (83%) had positive findings on 67Ga scans. One of five patients with tuberculous mediastinal lymphadenopathy, two patients with cervical lymphadenitis and a patient with renal TB had negative 67Ga scans. It was observed that the detection of previously unrecognized primary foci of TB, without concomitant pulmonary TB, was possible using 67Ga imaging in five patients (22%). The 67Ga scan was relatively sensitive for the localization of extrapulmonary TB. It is suggested that the 67Ga scan could serve as a screening method, when followed by CT and ultrasonography, for the initial detection of occult tuberculous lesions, especially in patients with prolonged fever.

Imaging and quantitation of dopamine transporters with iodine-123-IPT in normal and Parkinson's disease subjects.

UNLABELLED: Iodine-123-N-(3-iodopropene-2-yl)-2beta-carbomethoxy-3beta-( 4-chlorophenyl) tropane (123I-IPT) is a new dopamine transporter ligand that selectively binds the dopamine reuptake sites. Transporter concentrations have been known to decrease in Parkinson's disease patients. The purpose of this study was to evaluate the usefulness of IPT as an imaging agent for measuring changes in transporter concentrations in Parkinson's disease. METHODS: IPT labeled with 6.78 +/- 0.67 mCi 123I was injected intravenously as a bolus into eight normal controls (mean age 41 +/- 12 yr) and 17 Parkinson's disease patients (mean age 55 +/- 9 yr). Dynamic SPECT scans of the brain were then performed for 5 min each over 120 min on a triple-headed gamma camera equipped with medium-energy collimators. Regions of interest were drawn on the middle set of the image at the level of the basal ganglia (BG) for each subject. Time-activity curves were generated for the left BG, right BG and occipital cortex (OCC). The empirical ratios between BG-OCC and OCC, which represent specific-to-nonspecific binding ratios, were computed at various time points. The statistical parameter k3/k4 was estimated by two methods: a variation of the graphic method that derives the ratio of ligand distribution volumes (R[V]) and the area ratio method (R[A]), in which the ratio is calculated from the areas under the specific and nonspecific binding activity curves. RESULTS: The mean (BG-OCC)/OCC ratio for normal controls (3.07 +/- 0.73) was significantly higher than that for Parkinson's disease patients at 115 min (1.10 +/- 0.56) (p = 2.76 x 10[-5]). The mean R(V) and R(A) for normal controls were 2.06 +/- 0.27 and 1.50 +/- 0.15, respectively. The mean R(V) and R(A) for Parkinson's disease patients were 0.78 +/- 0.31 and 0.65 +/- 0.24, respectively. Both R(V) and R(A) for normal controls were significantly higher than those for Parkinson's disease patients (p values for R(V) and R(A) were 1.91 x 10(-8) and 3.46 x 10(-10), respectively). The R(V) has linear relationships with both R(A) and (BG-OCC)/OCC ratio at 115 min. The R(V) has a higher correlation (r = 0.99) with R(A) than it does with (BG-OCC)/OCC (r = 0.93). CONCLUSION: The R(V), R(A) and (BG-OCC)/OCC for Parkinson's disease patients were clearly separated from those of normal controls, and they may be useful outcome measures for clinical diagnosis. The simplest (BG-OCC)/OCC ratio, requiring a single late time point, could be useful in clinical situations, whereas R(V) or R(A) is preferred when the dynamic data are available. The findings suggest that 123I-IPT is a useful tracer for diagnosing Parkinson's disease and studying dopamine reuptake sites.

Noninvasive bone mineral density measurement in the evaluation of osteoporosis.

Bone densitometry has developed considerably during the past several decades. Because the techniques have become more precise than before, osteoporotic patients can now be followed over time, allowing for assessment of disease or response to treatment. Several densitometry techniques have been shown to allow for the assessment of fracture risk. Factors other than density, however, additionally influence fracture risk. The next step will be the evaluation of microstructure and bone quality.

Solitary fibrous tumor in the buccal space: MR findings with pathologic correlation.

We report MR findings in a case of a solitary fibrous tumor involving the buccal space in a middle-aged man. On MR images, most of the mass was isointense and hyperintense to the muscle on T1- and T2-weighted images, respectively, and showed homogeneously strong enhancement on contrast-enhanced T1-weighted images. The medial peripheral portion, which was isointense on T2-weighted images and showed less enhancement on contrast-enhanced T1-weighted images, corresponded to the hypocellular and collagenous sclerotic area on pathologic correlation.

Socioeconomic and health effects on mortality declines in developing countries.

It has been argued that mortality declines in developing countries have not been associated with social and economic factors because of the diffusion from the developed countries to the developing countries of health and medical techniques. This paper examines the relationship between socioeconomic development and health and mortality declines in developing countries which are in two different stages of the demographic transition. A path model linking socioeconomic and health variables and mortality is developed and tested for early and late transition nations. The empirical findings indicated that the network of socioeconomic variables and their effects on mortality were much more significant in late transition countries than in early transition countries. While the impact of health services on crude death rates is large in the early transition nations, its impact declines considerably as countries reach a more transitionally 'mature' stage.

Stimulating technetium-99m cerebral perfusion studies with a three-dimensional Hoffmann brain phantom: collimator and filter selection in SPECT neuroimaging.

The choice of collimator and the selection of a filter can affect the quality of clinical SPECT images of the brain. The compromises that 4 different collimators make between spatial resolution and sensitivity were studied by imaging a three-dimensional Hoffmann brain phantom. The planar data were acquired with each collimator on a three-headed SPECT system and were reconstructed with both a standard Butterworth filter and a Wiener pre-filter. The reconstructed images were then evaluated by specialists in nuclear medicine and were also quantitatively analyzed with specific regions of interest (ROI) in the brain. All observers preferred the Wiener filter reconstructed images regardless of the collimator used to acquire the planar images. With this filter, the ultrahigh-resolution fan-beam collimator was the most subjectively preferable and quantitatively produced the highest contrast ratios. The findings support suggestions that higher resolution collimators are preferable to higher sensitivity collimators, and indicate that fan-beam collimators are preferable to parallel-hole collimators for clinical SPECT studies of cerebral perfusion. The results also suggest that Wiener filter enhances the quality of SPECT brain images regardless of which collimator is used to acquire the data.

Use of Tc-99m HMPAO leukocyte scans to evaluate bone infection: incremental value of additional SPECT images.

PURPOSE: In this study, the diagnostic value of Tc-99m hexamethylpropylene amine oxime (HMPAO) leukocyte scans and the role of additional SPECT in the diagnosis of bone infection were evaluated. MATERIALS AND METHODS: The Tc-99m HMPAO leukocyte scans of 37 patients with clinically suspected bone infection were reviewed. The patients were divided into two groups according to the presence of orthopedic implants. Early (4 to 6 hours) and delayed (18 to 20 hours) planar images and early SPECT images were obtained. The final diagnosis of infection was made based on the pathologic, bacteriologic, and surgical data and clinical follow-up. RESULTS: Group 1 (25 patients with orthopedic implants) included 15 true-positive, 1 false-negative, 7 true-negative, and 2 false-positive results. Group 2 (12 patients without orthopedic implants) included 7 true-positive, 1 false-negative, and 4 true-negative results. The overall sensitivity of the Tc-99m HMPAO leukocyte scan with SPECT to detect bone infection was 92%, with a specificity rate of 85%. (Group 1: sensitivity, 94%; specificity, 78%. Group 2: 88% and 100% sensitivity and specificity, respectively.) CONCLUSION: The Tc-99m HMPAO leukocyte scan is useful in the diagnosis of bone infection, regardless of the presence of orthopedic implants. The additional SPECT images may be helpful to localize the site of infection more accurately.

Diagnosis of orbital cavernous hemangioma with Tc-99m RBC SPECT.

The authors report two cases of orbital cavernous hemangioma diagnosed by Tc-99m RBC SPECT. Tc-99m RBC SPECT showed a typical scintigraphic pattern commonly seen in hepatic hemangioma in which there is intense focally increased uptake on delayed SPECT images. Tc-99m RBC SPECT in orbital cavernous hemangioma may be as useful a diagnostic modality as in hepatic hemangioma.

Jejunal leiomyosarcoma detected by Tc-99m sulfur colloid gastrointestinal bleeding scan.

Jejunal leiomyosarcoma was initially detected in a patient by a gastrointestinal bleeding scan with Tc-99m sulfur colloid (SC). The scan showed increased blood flow and delayed persistent accumulation of radiotracer in the tumor. The Tc-99m SC gastrointestinal bleeding scan provided useful information to help determine the differential diagnosis of gastrointestinal tumor with bleeding.

An orally active cathepsin K inhibitor, furan-2-carboxylic acid, 1-{1-[4-fluoro-2-(2-oxo-pyrrolidin-1-yl)-phenyl]-3-oxo-piperidin-4-ylcarbamoyl}-cyclohexyl)-amide (OST-4077), inhibits osteoclast activity in vitro and bone loss in ovariectomized rats.

Human cathepsin K, a cysteine proteinase of the papain family, has been recognized as a potential drug target for the treatment of osteoporosis. The predominant expression of cathepsin K in osteoclasts has rendered the enzyme into a major target for the development of novel antiresorptive drugs. Now, we report the pharmacological properties of OST-4077 [furan-2-carboxylic acid (1-{1-[4-fluoro-2-(2-oxo-pyrrolidin-1-yl)-phenyl]-3-oxo-piperidin-4-ylcarbamoyl}-cyclohexyl)-amide] as a novel selective cathepsin K inhibitor. Human and rat cathepsin K were inhibited in vitro by OST-4077 with the IC50 values of 11 and 427 nM, respectively. OST-4077 suppressed bone resorption induced by rabbit osteoclasts (IC50, 37 nM) but did not affect bone mineralization or cellular alkaline phosphatase activity in MC3T3-E1 cells. Parathyroid hormone-induced bone resorption was inhibited in a dose-dependent manner in thyroparathyroidectomized rats gavaged with a single dose of OST-4077 (ED50, 69 mg/kg). When given orally twice daily for 4 weeks to 3-month-old ovariectomized (OVX) rats, OST-4077 dose-dependently prevented bone loss, as monitored by bone densitometry, ash content, and urinary excretion of deoxypyridinoline. No change in serum osteocalcin in the OVX rats by OST-4077 suggested that bone formation might not be affected by the agent. In summary, OST-4077 selectively inhibited bone resorbing activities of osteoclasts and prevented bone loss induced by estrogen deficiency but did not affect bone formation. OST-4077, an orally active selective human cathepsin K inhibitor, may have the therapeutic potential for the treatment of diseases characterized by excessive bone loss including osteoporosis.

Modernization and fertility in Puerto Rico: a re-examination.

PIP: This study examines the relationship between modernization and fertility in Puerto Rico using data from the 1970 census on 75 municipios, and compares the findings with results of similar studies in 1950 and 1960. The technique of path analysis was used to test the inverse relationship between urbanization/industrialization and the dependent variable, fertility, through 3 intervening variables, income, education, and proportion of women in the labor force. All 5 independent variables were found to be inversely correlated with the dependent variable, statistically significant at the .001 level for all variables except industrialization. Path analysis indicates that 27% of the variation in fertility ratios are explained by industrialization, education, income, and women working. A comparison of individual correlations and path analysis results for the 3 census years of 1950, 1960, and 1970 indicates that since 1950 the inverse relationship of urbanization, industrialization, education, income, and women working with fertility has persisted. Urbanization has had no direct effect on the community's fertility level since 1960, its effects being distributed indirectly through other variables such as education, income, and women working. Industrialization, which did not have a direct influence on fertility in 1950, began showing increasing direct influence thereafter in addition to its indirect influence through income, education, and women working. Education has always been important. The negative effect of income decreased from 1950-60 and in 1970 its direct negative effect on fertility was no longer operating. The effect of women working has also declined over the 3 decades. An interesting finding is that the proposed model with urbanization, industrialization, education, income, and women working as indicators is significantly less able to explain variations in fertility in 1970 than in 1950.^ieng

Assessment of anterior shoulder instability by CT arthrography.

Computed tomography (CT) immediately after double-contrast shoulder arthrography was taken in twenty-two young male patients with anterior shoulder instability including recurrent dislocation and subluxation. This recently developed technique called CT arthrography can provide significant information about patients with glenohumeral instability which is difficult to obtain by conventional arthrography. Information about glenoid labrum pathology is useful for proper management of the shoulder with instability. Lesions identified in this study include anterior labral defects (attenuation, tear, displacement), anterior capsular distension and/or detachment, Hill-Sachs lesion, anterior glenoid rim compression fracture, and fracture of scapula. This article describes the method used in CT arthrography of the glenohumeral joint, reviews the normal cross-sectional anatomy, and emphasizes the importance of the application of CT arthrography in the shoulder disorder with instability. CT arthrography of the glenohumeral joint is easy to perform, is accurate, and has lower radiation dose than arthrotomography.

CT features of histiocytic medullary reticulosis.

Five cases of histiocytic medullary reticulosis (HMR) are presented and the computed tomographic (CT) findings described. All patients were young adults in their early twenties with fever, malaise and weight loss as their chief complaints. Survival was less than 5 months in all cases. The CT findings were hepatosplenomegaly (5), abdominal lymphadenopathy (5) and bilateral renal enlargement (2). Patchy low attenuation areas in the liver (2), wedge shaped splenic infarcts (2) and focal low attenuation areas in the kidneys (1) were also noted. Ascites (3) and pleural effusion (3) were associated findings.

Accuracy and diagnostic sensitivity of radiographic absorptiometry of the second metacarpal.

The accuracy of a radiographic absorptiometry (RA) technique called digital image processing (DIP), discriminative ability of RA for osteoporotic fracture, and the relationship between RA and dual X-ray absorptiometry (DXA) of the spine and forearm were evaluated. We measured 16 cadaver hands, 32 healthy non-black premenopausal women, 39 healthy non-black postmenopausal women, and 35 non-black osteoporotic postmenopausal females. The overall correlation between the ash weights of the entire metacarpal and the DIP values was excellent (r = 0.954, P < 0.001, SEE = 0.14, CV = 6.4%). Short-term precision error of DIP was 3.5%. Age-related bone loss determined by DIP is comparable to that of spinal and forearm DXA: annual BMD decreases were 0.46% for DIP, 0.45% for forearm, and 0.32% for the spine. DIP of the 2nd metacarpal shows a gradient of risk for spinal fracture only slightly below that of forearm DXA, but substantially below that of spinal DXA. Age-adjusted odds ratios were 1.81 for RA, 2.45 for spinal DXA, and 1.94 for forearm DXA.

Significance of QCT bone mineral density and its standard deviation as parameters to evaluate osteoporosis.

OBJECTIVE: A study using quantitative CT (QCT) of the spine was carried out to determine whether the standard deviation (SD) of the bone mineral density (BMD) within a given region of interest (ROI) could be used as a parameter to evaluate osteoporosis. MATERIALS AND METHODS: A low dose single energy protocol was used. The elliptical ROIs inside the trabecular bone of the vertebral bodies T12-L3 were analyzed for four patient groups: Group 1, 52 healthy premenopausal women (age 41 +/- 2 years); group 2, 119 healthy early postmenopausal women (53 +/- 4 years); group 3, 45 postmenopausal relatively healthy women (age 65 +/- 5 years); group 4, 26 osteoporotic women (age 67 +/- 5 years). Average group mean BMD values and their coefficients of variation (CV = SD/BMD) were calculated. The t values, percent decrements, z-scores, and analysis of variance (ANOVA) served to compare capabilities of the BMD and the CV to discriminate groups pairwise using all possible group combinations. RESULTS: The use of z-scores and percent decrements gave ambivalent and mostly insignificant results. The CV performed better than BMD in separating group pairs (1,3), (1,4), (2,3), and (2,4), but BMD was superior for group pairs (1,2) and (3,4). Using SD as an independent variable in addition to age and BMD in the ANOVA did not significantly change r2 or the standard error of the estimate. The t test showed highly significant better discriminatory capabilities for BMD compared to CV> CONCLUSION: The results of our study did not indicate a significant potential of the BMD SD as measured in trabecular single energy low dose spinal QCT to improve the discriminatory capabilities of BMD for a separation of osteoporotic from nonosteoporotic subjects.

Impact of childhood cancer on Korean families.

A health care system that includes institutions such as the home, clinic, or hospital as well as interpersonal relationships between providers and receivers of health care is a part of any culture. Clinical issues are a part of all cultures, and cross-cultural comparisons are useful in understanding health care. With immigration and travel, a better understanding of the situation of families who have a child with cancer in various countries, different health care systems, and different cultures is needed. Understanding the situation for families with a child who has cancer in South Korea will lead one to a better understanding of a Korean family who has immigrated to the west and has a child develop cancer or is in need of treatment.

Histiocytic medullary reticulosis: radiologic diagnosis of splenic infarction--a case report.

A case of histiocytic medullary reticulosis with splenic infaraction from a 23-year-old male is presented. Radiologic findings on selective spleen scintigraphy and abdominal CT are described. Selective spleen scintigraphy showed huge, multilobulated spleen with numerous photon-deficient areas in it and peripherally. Abdominal CT showed large peripheral band-like low density and infiltrative lesion in spleen with accompanying intraabdominal lymphadenopathy. Histoligical features were consistent with HMR in spleen and liver specimens.