RESUMO
INTRODUCTION: To evaluate by junior urologists the morphology of urinary stone using visual endoscopic recognition after expert teaching. Material From December 2017 to May 2018, surface and section stone pictures extracted from digital ureteroscopy had been submitted to description and recognition. Participants could take benefit from an expert coaching. Each stone was evaluated by a different coherence questionnaire (score 1-5). RESULTS: Nine stones had been analyzed by 15 junior urologists. Mean score was initially 1.94/4 and then from 2.07 to 4.07/5 during the study. A perfect stone recognition and a matching etiological lithiasis research had been observed in 40.7% and 55.6% of cases respectively. CONCLUSION: This first teaching experience of the urinary stone morphological endoscopic typing confirms the possibility to train urologists to gain this specific initial skill. Thereby, they could play a more important role in the etiological and diagnostic lithiasis research.
Assuntos
Ureteroscopia , Cálculos Urinários/patologia , Humanos , Estudos Prospectivos , Ureteroscopia/educaçãoRESUMO
BACKGROUND: Vitamin D is essential for bone mineralization, and its deficiency may be the cause of skeletal fractures and osteomalacia. Geographical or ethnic factors may modulate the cutaneous synthesis of vitamin D. We hypothesized that major changes in keratinization may similarly alter the cutaneous synthesis of vitamin D. OBJECTIVES: To explore calciotrophic hormones, parameters of bone remodelling and bone mineral density (BMD) in nine patients with non-bullous congenital ichthyosis. PATIENTS AND METHODS: Six patients were European, three were North African. Four had received acitretin over a long period of time. A complete biological investigation, including serum and urinary calcium and phosphorus, calciotrophic hormones [intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25-(OH)D) and 1,25-dihydroxyvitamin D (1,25-(OH)2D)], bone formation and resorption markers, was performed on all patients during the winter season and repeated among four patients after summer. BMD was measured in all patients. RESULTS: All patients had a marked 25-(OH)D deficiency, clearly below the deficiency threshold of 25 nmol/L. Patients from North Africa had a greater deficiency than European patients, perhaps because of the difference in skin pigmentation. iPTH remained normal in European patients but was elevated among the North Africans. After sun exposure, an improvement in vitamin status was visible in only one patient. Bone formation and resorption markers remained normal. Femoral neck osteodensitometry indicated values near the osteopaenic threshold in two young North African females. No deleterious effect of retinoids on vitamin D metabolism was observed. CONCLUSION: Patients, and in particular pigmented patients, with congenital ichthyosis present a severe deficiency in vitamin D. Care provided to protect the skeletal future of these patients involves measuring BMD and prescribing supplementation.
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Ictiose/etiologia , Vitamina D/análogos & derivados , Adolescente , Adulto , Densidade Óssea , Remodelação Óssea , Feminino , Humanos , Ictiose/metabolismo , Masculino , Hormônio Paratireóideo/metabolismo , Pigmentação da Pele , Vitamina D/metabolismoRESUMO
To study the usefulness of bone mineral density (BMD) in the follow-up of myeloma (MM) patients, BMD was evaluated in 44 MM patients in sustained remission for at least 2 years (35.4 +/- 10.5 months) after high-dose or conventional chemotherapy in a retrospective study. Patients never received bisphosphonates before or during the follow-up. Patients underwent lumbar spine (LS) BMD and a whole body (WB) BMD testing before therapy and at least once in the remission period. At baseline, mean LS BMD was 0.863 +/- 0.026 g/cm2, mean lumbar Z-score was -1.45 SD. LS BMD significantly increased from baseline by 5 +/- 1.8%, 9.3 +/- 1.7%, and 14 +/- 1.9% at 1, 2, and 3 years, respectively. The percentage of patients with a T-score below 2.5 SD decreased from 39% at baseline to 18.5% at 3 years. Compared with baseline, WB BMD decreased by -2.8 +/- 0.5%, -2.6 +/- 0.7%, and -1.7 +/- 0.6% at 1, 2, and 3 years, respectively. Mean percentage change of the fat compartment increased from baseline by +28.4 +/- 7.1% at the trunk, and +17.1 +/- 5% in peripheral areas at 3 years. In conclusion, in MM patients in remission after chemotherapy, LS BMD progressively increased after a mean follow-up of 3 years. These patients never received bisphosphonates, so this increase was related to the anti-myeloma treatment. The major effect on BMD was observed at the LS, which is primarily composed of trabecular bone containing the bone marrow. Interestingly, a drastic increase of the fat content was also observed. These results underlined that BMD and fat-lean evaluation could be of interest in the follow-up of MM patients.
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Tecido Adiposo/patologia , Densidade Óssea , Mieloma Múltiplo/metabolismo , Mieloma Múltiplo/patologia , Adulto , Idoso , Osso e Ossos/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/tratamento farmacológico , Indução de Remissão , Estudos Retrospectivos , Fatores de TempoRESUMO
An automatic method of correcting radio-frequency (RF) inhomogeneity in magnetic resonance images is presented. The method considers that image intensity variation due to radio-frequency inhomogeneity contains not only low frequency components, but also high frequency components. The variation is regarded as a multiplication of low frequency (capacity variation of coil) and the frequency of object (true image). The efficiency of the proposed method is illustrated with the aid of both phantom and physical images. The impact of the inhomogeneity correction on brain tissue segmentation is studied in detail. The results show significant improvement of the tissue segmentation after inhomogeneity correction.
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Encéfalo/anatomia & histologia , Imageamento por Ressonância Magnética/métodos , Ondas de Rádio , Humanos , Imagens de Fantasmas , Intensificação de Imagem RadiográficaRESUMO
Quantitative computed tomography (QCT) was compared to dual X-ray absorptiometry (DXA) measured in the lumbar spine of 508 European women defined as normal without fracture (NoF), or osteoporotic (OP), with either vertebral fracture (VF), or peripheral fracture (PF). The correlations between QCT and DXA BMD measurements were significantly different in normal and in osteoporotic patients, indicating that the two exams do not measure the same bone aspects. According to ROC curves results, QCT Z-scores separate OP from NoF with better sensitivity than all other measurements. A threshold to differentiate OP from NoF was chosen at Z-score = -1 for DXA-BMD and -1.5 for QCT-BMD. VF patients showed a highly significant decrease in BMD by DXA or QCT. PF patients revealed measurements lower than those of normal subjects but greater than those of VF, calling into question the idea of a diffuse osteoporosis causing nonvertebral fractures that is measurable by spinal DXA or QCT. DXA is weakly dependent upon age, and T-score or Z-score are equivalent for evaluating osteoporosis. QCT depends greatly upon age, and Z-score appears to be more efficient.
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Absorciometria de Fóton , Vértebras Lombares/diagnóstico por imagem , Osteoporose Pós-Menopausa/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea , Feminino , França , Humanos , Vértebras Lombares/lesões , Programas de Rastreamento , Pessoa de Meia-Idade , Curva ROCRESUMO
We assessed the role of spinal magnetic resonance imaging (MRI) and bone densitometry as prognostic factors in patients with asymptomatic stage I multiple myeloma (MM) and negative skeletal survey. 55 consecutive patients underwent spinal MRI and 41 of them underwent bone densitometry by dual-energy X-ray absorptiometry (DEXA). Spinal MRI studies showed evidence of bone marrow involvement in 17/55 patients (31%). A diffuse pattern was present in three patients and a focal pattern in 14 patients, nine of them with only one nodular lesion. During a median follow-up of 25 months, 10 patients had disease progression, 8/17 patients with abnormal MRI and 2/38 patients with normal MRI. Median time to disease progression was not reached in both groups but was significantly different for patients with normal and those with abnormal patterns on MRI (P < 0.0001). Lumbar BMD was only slightly decreased compared with normal people (median lumbar Z score -0.43) and was not of prognostic value. Using a multivariate analysis the only two independent significant prognostic parameters were abnormal MRI (P<0.001, HR 30.4, 95% CI 4.3-213) and bone marrow plasmacytosis >20% (P=0.004, HR 16.4, 95% Cl 2.6-104). Thus, spinal MRI but not bone densitometry, appeared to be justified in patients with stage I asymptomatic MM and negative skeletal survey.
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Imageamento por Ressonância Magnética/métodos , Mieloma Múltiplo/diagnóstico , Absorciometria de Fóton , Adulto , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea , Neoplasias da Medula Óssea/diagnóstico , Progressão da Doença , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Prognóstico , Doenças da Coluna Vertebral/diagnósticoRESUMO
BACKGROUND: Demineralization is a common hallmark of multiple myeloma (MM) that can be evaluated by dual-energy X-ray absorptiometry (DEXA). The evolution of lumbar and whole body bone density were investigated by DEXA in patients with MM treated by conventional or intensive therapy supported by autologous blood stem cell transplantation. METHODS: Sixty six patients younger than 66 years with MM were randomly assigned to either conventional (30 patients, Group A) or intensive therapy supported by autologous blood stem cell transplantation (36 patients, Group B). For all patients, lumbar bone mineral density (BMD) was measured by DEXA at diagnosis and 13.2 +/- 4.2 months after the initiation of treatment. Whole body examinations were performed in 45 patients; in addition to whole body BMD, independent BMD values were recorded for various skeletal sites. RESULTS: At diagnosis, mean lumbar Z score (lumbar mean BMD value) was low (-1.24 +/- 1.45) without any significant difference between the 2 groups. Under treatment, lumbar BMD increased 0.7% in Group A and 4.6% in Group B (P = 0.02). This difference was mainly related to nonresponders in group A who featured a lumbar BMD change of -3.9%, whereas patients in remission in both groups displayed a 4.1% increase (P < 0.001). There was a correlation between the variation of lumbar BMD and the decrease of the serum or urinary monoclonal component (r = 0.34, P = 0.006). After intensive therapy, increase of lumbar BMD was higher in men than in women (7.2% vs. 1%, P = 0.005) perhaps because of variations in hormonal status in women. Unexpectedly, whole body BMD decreased in responders (-3%) because of a decrease in appendicular BMD outweighing the increase in axial BMD. This suggests a redistribution from cortical to cancellous bone in patients with MM responsive to chemotherapy. CONCLUSION: Bone densitometry is a marker of treatment response that may be particularly useful in nonsecretory and light chain MM. Moreover, it provides new information on bone remodeling in patients treated for MM, which may have therapeutic consequences.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Osso e Ossos/diagnóstico por imagem , Mieloma Múltiplo/diagnóstico por imagem , Absorciometria de Fóton , Adulto , Densidade Óssea , Osso e Ossos/metabolismo , Feminino , Transplante de Células-Tronco Hematopoéticas , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/metabolismo , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/metabolismo , Análise de Regressão , Indução de RemissãoRESUMO
Local mediators of bone resorption may be involved in bone loss in recently postmenopausal women and in osteoporosis. In the present study, we investigated the production of cytokines and the formation of osteoclast-like cells in marrow cultures from 16 late postmenopausal nonosteoporotic women (mean age: 66 +/- 8 years; time after menopause: 15 +/- 8 years) undergoing hip replacement for arthrosis. Marrow adherent mononuclear cells (MMNC) isolated from femoral diaphysis marrow were cultured for 10 days in the absence or in the presence of 1,25(OH)2D3. In vivo bone resorption was concomitantly assessed by histomorphometry on femoral neck bone sections. The number of TRAP+ multinucleated cells obtained after 10 days in MMNC cultured in the presence of 1,25(OH)2D3 correlated with the number of osteoclasts measured on the bone femoral neck biopsies (r = 0.65, p < 0.01), suggesting that the formation of multinucleated cells in vitro could reflect the osteoclast differentiation in vivo. Furthermore, the number of osteoclasts was related to the eroded volume and the trabecular separation of the femoral neck bone biopsies. Finally, the release of interleukin-1 (IL-1), IL-6, and TNF-alpha by cultures of peripheral blood mononuclear cells (PBMC) and MMNC was measured by radioimmunoassay. The cytokine levels of basal and 1,25(OH)2D3-treated MMNC decreased from days 2 to 5 and then reached a plateau to day 10. The number of TRAP+ multinucleated cells obtained after 10 days in MMNC cultures correlated with the basal IL-6 release in the same cultures determined at day 2 (r = 0.55, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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Densidade Óssea/fisiologia , Reabsorção Óssea/fisiopatologia , Citocinas/biossíntese , Colo do Fêmur/patologia , Leucócitos Mononucleares/metabolismo , Pós-Menopausa , Absorciometria de Fóton , Idoso , Análise de Variância , Artrite/cirurgia , Células da Medula Óssea , Calcitriol/farmacologia , Células Cultivadas , Feminino , Colo do Fêmur/citologia , Prótese de Quadril , Humanos , Interleucina-1/biossíntese , Interleucina-6/biossíntese , Leucócitos Mononucleares/citologia , Leucócitos Mononucleares/efeitos dos fármacos , Pessoa de Meia-Idade , Osteoclastos/citologia , Osteoclastos/fisiologia , Pós-Menopausa/fisiologia , Radioimunoensaio , Fator de Necrose Tumoral alfa/biossínteseRESUMO
85 adults of both sexes, suffering from variety of bone disorders were studied by means of humeral radiodensitometry and histomorphometric analysis of iliac bone biopsies. Trabecular bone volume (TBV) was not related to cortical thickness. Bone mineral density was related to iliac TBV only in female subjects. The value of these measures is limited in osteoporosis because of measurement errors and skeletal inhomogeneity. In osteoporosis, variable histomorphometric features were observed. However, radiodensitometry proved a good measure of the state of mineralization in osteomalacia.
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Osso e Ossos/anatomia & histologia , Osteomalacia/patologia , Osteoporose/patologia , Absorciometria de Fóton , Adulto , Idoso , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/patologia , Feminino , Humanos , Úmero/diagnóstico por imagem , Ílio/anatomia & histologia , Ílio/patologia , Masculino , Metacarpo/anatomia & histologia , Metacarpo/patologia , Pessoa de Meia-Idade , Osteomalacia/diagnóstico por imagem , Osteoporose/diagnóstico por imagemRESUMO
Measurement of the bone trabicular volume (BTV) of 60 iliac crests obtained at necropsy, was done by morphometry on decalcified bone preparation. Changes in the site and the techniques of biopsy introduce variations which may reach 50% for sites which are one or two centimeters apart. The iliac bone is not especially imprecise and should be replaced by the transfixing horizontal biopsy. For a given zone, one observes a good correlation between the BTV and the ash weight per cubic centimeter of psongious bone, a point which justifies the interest in morphometry for the evaluation of the body bone mass.