Similar dietary regulation of IGF-1- and IGF-binding proteins by animal and plant protein in subjects with type 2 diabetes.

Increased animal but not plant protein intake has been associated with increased mortality in epidemiological studies in humans and with reduced lifespan in animal species. Protein intake increases the activity of the IGF-1 system which may provide a link to reduced lifespan. We, therefore, compared the effects of animal versus plant protein intake on circulating levels of IGF-1 and the IGF-binding proteins (IGFBP)-1 and IGFBP-2 over a 6-week period. Thirty seven participants with type 2 diabetes consumed isocaloric diets composed of either 30% energy (EN) animal or plant protein, 30% EN fat and 40% EN carbohydrates for 6 weeks. The participants were clinically phenotyped before and at the end of the study. Both diets induced similar and significant increases of IGF-1 which was unaffected by the different amino acid compositions of plant and animal protein. Despite improvements of insulin sensitivity and major reductions of liver fat, IGFBP2 decreased with both diets while IGFBP-1 was not altered. We conclude that animal and plant protein similarly increase IGF-1 bioavailability while improving metabolic parameters and may be regarded as equivalent in this regard.

Isocaloric Diets High in Animal or Plant Protein Reduce Liver Fat and Inflammation in Individuals With Type 2 Diabetes.

BACKGROUND & AIMS: Nonalcoholic fatty liver disease (NAFLD) is associated with increased risk of hepatic, cardiovascular, and metabolic diseases. High-protein diets, rich in methionine and branched chain amino acids (BCAAs), apparently reduce liver fat, but can induce insulin resistance. We investigated the effects of diets high in animal protein (AP) vs plant protein (PP), which differ in levels of methionine and BCAAs, in patients with type 2 diabetes and NAFLD. We examined levels of liver fat, lipogenic indices, markers of inflammation, serum levels of fibroblast growth factor 21 (FGF21), and activation of signaling pathways in adipose tissue. METHODS: We performed a prospective study of individuals with type 2 diabetes and NAFLD at a tertiary medical center in Germany from June 2013 through March 2015. We analyzed data from 37 subjects placed on a diet high in AP (rich in meat and dairy foods; n = 18) or PP (mainly legume protein; n = 19) without calorie restriction for 6 weeks. The diets were isocaloric with the same macronutrient composition (30% protein, 40% carbohydrates, and 30% fat). Participants were examined at the start of the study and after the 6-week diet period for body mass index, body composition, hip circumference, resting energy expenditure, and respiratory quotient. Body fat and intrahepatic fat were detected by magnetic resonance imaging and spectroscopy, respectively. Levels of glucose, insulin, liver enzymes, and inflammation markers, as well as individual free fatty acids and free amino acids, were measured in collected blood samples. Hyperinsulinemic euglycemic clamps were performed to determine whole-body insulin sensitivity. Subcutaneous adipose tissue samples were collected and analyzed for gene expression patterns and phosphorylation of signaling proteins. RESULTS: Postprandial levels of BCAAs and methionine were significantly higher in subjects on the AP vs the PP diet. The AP and PP diets each reduced liver fat by 36%-48% within 6 weeks (for AP diet P = .0002; for PP diet P = .001). These reductions were unrelated to change in body weight, but correlated with down-regulation of lipolysis and lipogenic indices. Serum level of FGF21 decreased by 50% in each group (for AP diet P < .0002; for PP diet P < .0002); decrease in FGF21 correlated with loss of hepatic fat. In gene expression analyses of adipose tissue, expression of the FGF21 receptor cofactor ß-klotho was associated with reduced expression of genes encoding lipolytic and lipogenic proteins. In patients on each diet, levels of hepatic enzymes and markers of inflammation decreased, insulin sensitivity increased, and serum level of keratin 18 decreased. CONCLUSIONS: In a prospective study of patients with type 2 diabetes, we found diets high in protein (either animal or plant) significantly reduced liver fat independently of body weight, and reduced markers of insulin resistance and hepatic necroinflammation. The diets appear to mediate these changes via lipolytic and lipogenic pathways in adipose tissue. Negative effects of BCAA or methionine were not detectable. FGF21 level appears to be a marker of metabolic improvement. ClinicalTrials.gov ID NCT02402985.

Liver fat scores do not reflect interventional changes in liver fat content induced by high-protein diets.

Non-alcoholic fatty liver disease (NAFLD) is common in Metabolic Syndrome and type 2 diabetes (T2DM), driven by energy imbalance, saturated fats and simple carbohydrates. NAFLD requires screening and monitoring for late complications. Liver fat indices may predict NAFLD avoiding expensive or invasive gold-standard methods, but they are poorly validated for use in interventional settings. Recent data indicate a particular insensitivity to weight-independent liver fat reduction. We evaluated 31 T2DM patients, completing a randomized intervention study on isocaloric high-protein diets. We assessed anthropometric measures, intrahepatic lipid (IHL) content and serum liver enzymes, allowing AUROC calculations as well as cross-sectional and longitudinal Spearman correlations between the fatty liver index, the NAFLD-liver fat score, the Hepatosteatosis Index, and IHL. At baseline, all indices predicted NAFLD with moderate accuracy (AUROC 0.731-0.770), supported by correlation analyses. Diet-induced IHL changes weakly correlated with changes of waist circumference, but no other index component or the indices themselves. Liver fat indices may help to easily detect NAFLD, allowing cost-effective allocation of further diagnostics to patients at high risk. IHL reduction by weight-independent diets is not reflected by a proportional change in liver fat scores. Further research on the development of treatment-sensitive indices is required.Trial registration: The trial was registered at clinicaltrials.gov: NCT02402985.

Bioceramic vertebral augmentation with a calcium sulphate/hydroxyapatite composite (Cerament SpineSupport): in vertebral compression fractures due to osteoporosis.

A prospective, non-randomized multicenter study was initiated to study efficacy and safety of a partly resorbable composite of calcium sulphate and hydroxyapatite (Cerament SpineSupport), a novel, injectable bioceramic, in osteoporotic patients with vertebral compression fractures during 18-month follow-up. Fifteen patients with low-energy trauma and 1-2 vertebral compression fractures verified by magnetic resonance imaging were recruited to undergo percutaneous bioceramic vertebral augmentation under fluoroscopy. The patients were treated with a highly flowable bioceramic containing calcium sulphate, hydroxyapatite and the non-ionic radiocontrast agent iohexol, with final setting time within 1 h. After the procedure, the patients were allowed to mobilize after 2 h. Pain (VAS), occurrence of remote and adjacent fractures, and Quality of Life (QoL; SF-36 and EQ-5D) was recorded during 18 months. The injected volume of the composite material ranged from 2.8 to 9 mL (mean 4.2 mL). Pre-operative VAS score was mean 70.3 (CI95% +/-8.7) with an immediate post-operative pain relief, which was maintained at the 4-week visit (mean 26.4 with CI95% +/-16.1) and 8-week visit (mean 18.0 with CI95% +/-13.5 pain relief). Eighty percent of the patients demonstrated a clinical improvement. The pain relief was maintained over 18 months and no adjacent fractures were observed. There was a statistically significant improvement of physical components in the QoL assessment. No extra-vertebral leakage or neurological deficits were reported in this series. This first prospective multicenter study on a partly resorbable bioceramic material indicate that fracture healing can be achieved with sustained pain relief over a follow-up period of 18 months in an osteoporotic patient population with vertebral compression fractures.

Dietary Rapeseed Oil Supplementation Reduces Hepatic Steatosis in Obese Men-A Randomized Controlled Trial.

SCOPE: Effective treatment for obesity associated non-alcoholic fatty liver disease (NAFLD) is limited. Dietary supplementation of n-3 polyunsaturated fatty acids, specifically alpha linolenic acid (ALA), can resolve intrahepatic lipid content (IHL). This study investigates the effect of daily supplementation of either refined rapeseed (RA), containing high amounts of ALA, or refined olive (OL) oil on IHL and glucose metabolism in NAFLD patients. METHODS AND RESULTS: 27 obese men consumed an isocaloric diet including either 50 g of RA or OL daily for 8 weeks. Hepatic proton magnetic resonance spectroscopy, hyperinsulinemic-euglycemic clamp studies and blood tests are performed before and at the end of the study. At 8 weeks a significant reduction in IHL is observed for RA (13.1 ± 1.6 before versus 11.1 ± 1.6% after intervention) versus OL (13.3 ± 2.5 before versus 15.7 ± 2.7% after intervention). For RA, a 21% reduction (P < 0.02) in serum free fatty acids (FFA) and a 1.68-fold increase (P = 0.03) of serum interleukin-6 (IL-6) is observed after 8 weeks. CONCLUSION: RA has a beneficial effect on hepatic lipid metabolism as shown by reduced IHL and serum FFA. RA induced IL-6 production seems to be liver protective confirming previous results.

Percutaneous cementoplasty in the palliative, multimodal treatment of primary bone tumors of the distal aspect of the radius in four dogs.

OBJECTIVE: To (1) evaluate the analgesic effect of percutaneous cementoplasty (PC) in dogs with primary bone tumor (PBT) of the distal aspect of the radius and (2) evaluate the impact on the course of disease by adding PC to a palliative, multimodal treatment protocol in these dogs. STUDY DESIGN: Prospective pilot study. ANIMALS: Dogs (n=4) with PBT of the distal aspect of the radius. METHODS: Tumor lesions were filled percutaneously with polymethylmethacrylate under fluoroscopic guidance. Pamidronate was administered once in a week before PC. Radiotherapy and chemotherapy were initiated 2 and 6 weeks after PC, respectively. Force plate analysis was performed immediately before 2, and 6 weeks after PC. Survival time was defined from PC to euthanasia. RESULTS: Two dogs had a significant increase in peak vertical force 2 weeks after PC (P=.043) and remained free of lameness for 18 and 20 weeks, respectively. One dog had an acute relapse after an initially lame-free period of 10 days. The remaining dog failed to improve (P=.686). Three dogs developed at least 2 complications including transient worsening of the lameness after PC, cement leakage, wound infection and suspected thromboembolism in combination with cough and anemia. Median survival was 4.8 months (range, 1-5.7 months). CONCLUSIONS: PC in combination with pamidronate significantly improved lameness in 2 dogs; however, PC is not risk-free. Deep wound infection, intraarticular cement leakage, and venous thrombosis were the main complications. CLINICAL RELEVANCE: PC might be a useful addition to established palliative, multimodal treatment protocols in dogs with PBT; however, because of the complications encountered PC warrants further study before routine use can be considered.

Prediction of Circulating Adipokine Levels Based on Body Fat Compartments and Adipose Tissue Gene Expression.

BACKGROUND: Adipokines are hormones secreted from adipose tissue (AT), and a number of them have been established as risk factors for chronic diseases. However, it is not clear whether and to what extent adiposity, gene expression, and other factors determine their circulating levels. OBJECTIVES: To assess to what extent adiposity, as measured by the amount of subcutaneous AT (SAT) and visceral AT (VAT) using magnetic resonance imaging, and gene expression levels in SAT determine plasma concentrations of the adipokines adiponectin, leptin, soluble leptin receptor, resistin, interleukin 6, and fatty acid-binding protein 4 (FABP4). METHODS: We performed a cross-sectional analysis of 156 participants from the EPIC Potsdam cohort study and analyzed multiple regression models and partial correlation coefficients. RESULTS: For leptin and FABP4 concentrations, 81 and 45% variance were explained by SAT mass, VAT mass, and gene expression in SAT in multivariable regression models. For the remaining adipokines, AT mass and gene expression explained <16% variance of plasma concentrations. Gene expression in SAT was a less important predictor compared to AT mass. SAT mass was a better predictor than VAT mass for leptin (partial correlation r = 0.81, 95% confidence interval 0.75-0.86, vs. r = 0.58, 95% confidence interval 0.46-0.67), while differences between AT compartments were small for the other adipokines. CONCLUSIONS: While plasma levels of leptin and FABP4 can be explained in a large and medium part by the amount of AT and SAT gene expression, surprisingly, these predictors explained only little variance for all other investigated adipokines.

Bone mineral density during maintenance treatment with supraphysiological doses of levothyroxine in affective disorders: a longitudinal study.

BACKGROUND: This prospective study was designed to determine whether patients with prophylaxis-resistant affective disorders, receiving adjunctive maintenance therapy with supraphysiological doses of levothyroxine (L-T4), show evidence of accelerated bone loss compared to the reference population database. METHODS: In 21 patients, bone mineral density (BMD) of the spine (lumbar vertebrae L1-L4) and femur (femoral neck, trochanter, and Ward's triangle) was measured by dual energy X-ray absorptiometry (DXA). BMD measurement was performed first after patients had been on thyroid-stimulating hormone (TSH)-suppressive therapy with L-T4 (mean dose=411 mcg/d) for an average of 16.4 months and again after 33.6 months of L-T4 (mean dose=416 mcg/d) therapy. RESULTS: There was no statistically significant difference between the actual percentage decline in bone mineral density and the expected percentage decline in any of the measured bone regions. In a stepwise linear regression analysis, age was identified as a predictor of percentage change in BMD. After controlling for age, the only other variable that showed a consistent trend was the dose of L-T4, with higher doses being positively correlated with the percentage decline of BMD. LIMITATIONS: Relatively small sample size, no bone density assessment prior to treatment with L-T4, no patient control group with mood disorders who did not receive L-T4 treatment, and bone density follow-up intervals were variable. CONCLUSIONS: This study did not demonstrate evidence that long-term treatment of affectively ill patients with supraphysiological doses of L-T4 significantly accelerates loss of bone mineral density compared to the age-matched reference population. However, the decline of BMD in one individual patient underscores that caution is indicated and that regular assessment of BMD during longer-term supraphysiological thyroid hormone treatment is needed.

Forgotten nephrologists: Leonhard Thurneysser and Hermann Senator.

Leonhard Thurneysser and Hermann Senator are examples of "Forgotten Nephrologists". Leonhard Thurneysser was born in Basel, Switzerland in the 16th Century and worked for many years in Berlin. He was a goldsmith, miner, printer, astrologist and uroscopist. He traveled all over Europe. His importance stems from the physicochemical methods he introduced into uroscopy. He prosposed that urine distillates and their residues should be burnt in order to define their composition from the colour of the flame. He developed a overcomplicated system of fractionated distillations and drew more and more speculative conclusions. Hermann Senator lived in the 19th Century. Born and trained in Berlin, he became a critical and experienced nephrologist. His observations of "physiological" and "pathological" protein excretion in humans became important. Critical oberservations in the hospital, experimental testing of derived hypotheses and careful analyses of derived concepts characterize his work. He stimulated many young physicians to cooperate. Together with Munck he formulated the "Senator-Munck-Doctrine", according to which current concepts of urine formation as postulated by Bowman, Ludwig, Heidenhain et al could be and were unified in a "Filtration-Secretion-Reabsorption-Concept".

Validation of anthropometric indices of adiposity against whole-body magnetic resonance imaging--a study within the German European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts.

BACKGROUND: In epidemiological studies, measures of body fat generally are obtained through anthropometric indices such as the body mass index (BMI), waist (WC), and hip circumferences (HC). Such indices, however, can only provide estimates of a person's true body fat content, overall or by adipose compartment, and may have limited accuracy, especially for the visceral adipose compartment (VAT). OBJECTIVE: To determine the extent to which different body adipose tissue compartments are adequately predicted by anthropometry, and to identify anthropometric measures alone, or in combination to predict overall adiposity and specific adipose tissue compartments, independently of age and body size (height). METHODS: In a sub-study of 1,192 participants of the German EPIC (European Prospective Investigation into Cancer and Nutrition) cohorts, whole-body MRI was performed to determine adipose and muscle tissue compartments. Additional anthropometric measurements of BMI, WC and HC were taken. RESULTS: After adjusting for age and height, BMI, WC and HC were better predictors of total body volume (TBV), total adipose tissue (TAT) and subcutaneous adipose tissue (SAT) than for VAT, coronary adipose tissue (CAT) and skeletal muscle tissue (SMT). In both sexes, BMI was the best predictor for TBV (men: r = 0.72 [0.68-0.76], women: r = 0.80 [0.77-0.83]) and SMT (men: r = 0.52 [0.45-0.57], women: r = 0.48 [0.41-0.54]). WC was the best predictor variable for TAT (r = 0.48 [0.41-0.54]), VAT (r = 0.44 [0.37-0.50]) and CAT (r = 0.34 [0.26-0.41]) (men), and for VAT (r = 0.42 [0.35-0.49]) and CAT (r = 0.29 [0.22-0.37]) (women). BMI was the best predictor for TAT (r = 0.49 [0.43-0.55]) (women). HC was the best predictor for SAT (men (r = 0.39 [0.32-0.45]) and women (r = 0.52 [0.46-0.58])). CONCLUSIONS: Especially the volumes of internal body fat compartments are poorly predicted by anthropometry. A possible implication may be that associations of chronic disease risks with the sizes of internal body fat as measured by BMI, WC and HC may be strongly underestimated.

Modulation of amino acid metabolic signatures by supplemented isoenergetic diets differing in protein and cereal fiber content.

CONTEXT: Amino-acid (AA) metabolic signatures differ in insulin-resistant (IR) obese vs normal-weight subjects, improve after weight loss, and seem to predict the risk of type 2 diabetes. It is unknown whether weight-maintaining dietary measures aimed at influencing IR alter AA signatures of high-risk subjects. SETTING AND DESIGN: In the randomized controlled Protein, Fiber and Metabolic Syndrome (ProFiMet) trial we investigated effects of four isoenergetic, moderately fat-reduced diets varying in protein and cereal-fiber contents on complete AA metabolic signatures in 76 group-matched overweight or obese high-risk subjects. We analyzed the relation of whole-body and hepatic IR with AA signatures, body fat composition and liver fat, after 0, 6, and 18 weeks of dietary intervention. Discrimination between diets was further enhanced by providing tailored dietary supplements for twice-daily consumption over 18 weeks in all groups. RESULTS: Baseline AA, including branched-chain signatures significantly related to IR, liver fat, and visceral fat mass. Isoenergetic variation of protein and cereal-fiber dietary contents, but not fat restriction, significantly influenced IR, whereas the relation of AA with IR changed with all diets. The tryptophan ratio was significantly suppressed in obese vs overweight participants, but increased after 6 weeks of high cereal-fiber intake to a nonobese phenotype. Modeling analyses revealed diet-induced alterations of complex AA profiles to relate to 70% and 62% of changes in whole-body and hepatic IR. CONCLUSIONS: We demonstrate that relatively short-term isoenergetic changes in the diet significantly alter the relation of AA signatures with IR, with possible implications on the determination and treatment of diabetes risk.

Cement directed kyphoplasty reduces cement leakage as compared with vertebroplasty: results of a controlled, randomized trial.

STUDY DESIGN: A novel randomized, controlled, unblinded clinical trial comparing 2 procedural interventions for painful osteoporotic vertebral compression fractures. OBJECTIVE: The primary study objective was to evaluate cement leakage for a cement directed kyphoplasty system (CDKS) with anteriorly biased cement flow and vertebroplasty. The secondary study objective was to compare adjacent level fracture rates and vertebral body height for these 2 intervention methods. SUMMARY OF BACKGROUND DATA: Cement leakage remains a significant clinical problem associated with vertebroplasty and kyphoplasty procedures. Uncontrolled cement flow in the posterior direction can result in leakage into the vertebral veins or spinal canal, leading to potentially serious clinical complications. METHODS: Seventy-seven patients with painful osteoporotic vertebral compression fractures were enrolled. Patients were randomized 2:1 for treatment with CDKS (49 patients, 65 levels) or vertebroplasty (28 patients, 39 levels). Cement leakage was evaluated from radiographs and computed tomographic scans. Three- and 12-month follow-ups included additional radiographs and computed tomographic scans to assess changes in vertebral body height and the incidence of new fractures. RESULTS: Treatment with CDKS significantly reduced the number of levels with leaks and the total number of leaks per level, as compared with vertebroplasty (P = 0.0132 and P = 0.0012, respectively). Significantly, fewer lateral cortical and spinal canal leaks (posterior leaks) occurred in the CDKS group (P = 0.0050, P = 0.02260, respectively). Three adjacent level fractures occurred in the vertebroplasty group, as compared with 2 in the CDKS group. Vertebral body height maintenance was equivalent. CONCLUSION: Cement directed kyphoplasty effectively reduces posterior cement leakage, reducing the risk of leakage related complications. LEVEL OF EVIDENCE: 2.

Quantifying the improvement of surrogate indices of hepatic insulin resistance using complex measurement techniques.

We evaluated the ability of simple and complex surrogate-indices to identify individuals from an overweight/obese cohort with hepatic insulin-resistance (HEP-IR). Five indices, one previously defined and four newly generated through step-wise linear regression, were created against a single-cohort sample of 77 extensively characterised participants with the metabolic syndrome (age 55.6 ± 1.0 years, BMI 31.5 ± 0.4 kg/m(2); 30 males). HEP-IR was defined by measuring endogenous-glucose-production (EGP) with [6-6(2)H(2)] glucose during fasting and euglycemic-hyperinsulinemic clamps and expressed as EGP*fasting plasma insulin. Complex measures were incorporated into the model, including various non-standard biomarkers and the measurement of body-fat distribution and liver-fat, to further improve the predictive capability of the index. Validation was performed against a data set of the same subjects after an isoenergetic dietary intervention (4 arms, diets varying in protein and fiber content versus control). All five indices produced comparable prediction of HEP-IR, explaining 39-56% of the variance, depending on regression variable combination. The validation of the regression equations showed little variation between the different proposed indices (r(2) = 27-32%) on a matched dataset. New complex indices encompassing advanced measurement techniques offered an improved correlation (r = 0.75, P<0.001). However, when validated against the alternative dataset all indices performed comparably with the standard homeostasis model assessment for insulin resistance (HOMA-IR) (r = 0.54, P<0.001). Thus, simple estimates of HEP-IR performed comparable to more complex indices and could be an efficient and cost effective approach in large epidemiological investigations.

Effects of supplemented isoenergetic diets differing in cereal fiber and protein content on insulin sensitivity in overweight humans.

BACKGROUND: Despite their beneficial effects on weight loss and blood lipids, high-protein (HP) diets have been shown to increase insulin resistance and diabetes risk, whereas high-cereal-fiber (HCF) diets have shown the opposite effects on these outcomes. OBJECTIVE: We compared the effects of isoenergetic HP and HCF diets and a diet with moderate increases in both cereal fibers and dietary protein (Mix diet) on insulin sensitivity, as measured by using euglycemic-hyperinsulinemic clamps with infusion of [6,6-(2)H(2)]glucose. DESIGN: We randomly assigned 111 overweight adults with features of the metabolic syndrome to 1 of 4 two-phased, 18-wk isoenergetic diets by group-matching. Per 3-d food protocols, the percentages of energy derived from protein and carbohydrates and the intake of cereal fiber per day, respectively, were as follows-after 6 wk: 17%, 52%, and 14 g (control); 17%, 52%, and 43 g (HCF); 28%, 43%, and 13 g (HP); 23%, 44%, and 26 g (Mix); after 18 wk: 17%, 51%, and 15 g (control); 17%, 51%, and 41 g (HCF); 26%, 45%, and 14 g (HP); and 22%, 46%, and 26 g (Mix). Eighty-four participants completed the study successfully and were included in the final analyses. Adherence was supported by the provision of tailored dietary supplements twice daily in all groups. RESULTS: Insulin sensitivity expressed as an M value was 25% higher after 6 wk of the HCF diet than after 6 wk of the HP diet (subgroup analysis: 4.61 ± 0.38 compared with 3.71 ± 0.36 mg · kg(-1) · min(-1), P = 0.008; treatment × time interaction: P = 0.005). Effects were attenuated after 18 wk (treatment × time interaction: P = 0.054), which was likely explained by lower adherence to the HP diet. HP intake was associated with a tendency to increased protein expression in adipose tissue of the translation initiation factor serine-kinase-6-1, which is known to mediate amino acid-induced insulin resistance. Biomarkers of protein intake indicated interference of cereal fibers with dietary protein absorption. CONCLUSION: Greater changes in insulin sensitivity after intake of an isoenergetic HCF than after intake of an HP diet might help to explain the diverse effects of these diets on diabetes risk. This trial is registered at clinicaltrials.gov as NCT00579657.

Can chronic irritations of the trigeminal nerve cause musculoskeletal disorders?

In this article, five cases of odontogenous dysfunctions and musculoskeletal complaints are presented. A common finding in all patients of this study was that the presence of joint complaints was related to deficits in the corresponding muscular function. These deficits were determined by manual muscle tests as described by Kendall et al. [Muscles - Testing and Function, ed 4. Baltimore, Williams and Wilkins, 1993] and were eliminated immediately by a neural therapeutic test injection into the disturbed dental region. The therapy provided solely aimed to eliminate the odontogenous dysfunction. No other therapeutic measures were carried out with regard to the patients' respective muscle, tendon, or joint complaints.

Detection of cement leakage after vertebroplasty with a non-flat-panel angio unit compared to multidetector computed tomography--an ex vivo study.

The purpose of this study was to investigate the detection of cement leakages after vertebroplasty using angiographic computed tomography (ACT) in a non-flat-panel angio unit compared to multidetector computed tomography (MDCT). Vertebroplasty was performed in 19 of 33 cadaver vertebrae (23 thoracic and 10 lumbar segments). In the angio suite, ACT (190 degrees ; 1.5 degrees per image) was performed to obtain volumetric data. Another volumetric data set of the specimen was obtained by MDCT using a standard algorithm. Nine multiplanar reconstructions in standardized axial, coronal, and sagittal planes of every vertebra were generated from both data sets. Images were evaluated on the basis of a nominal scale with 18 criteria, comprising osseous properties (e.g., integrity of the end plate) and cement distribution (e.g., presence of intraspinal cement). MDCT images were regarded as gold standard and analyzed by two readers in a consensus mode. Rotational acquisitions were analyzed by six blinded readers. Results were correlated with the gold standard using Cohen's j-coefficient analysis. Furthermore, interobserver variability was calculated. Correlation with the gold standard ranged from no correlation (osseous margins of the neuroforamen, j = 0.008) to intermediate (trace of vertebroplasty canula; j = 0.615) for criteria referring to osseous morphology. However, there was an excellent correlation for those criteria referring to cement distribution, with kappa values ranging from 0.948 (paravertebral cement distribution) to 0.972 (intraspinal cement distribution). With a minimum of j = 0.768 ("good correlation") and a maximum of j = 0.91 ("excellent"), interobserver variability was low. In conclusion, ACT in an angio suite without a flat-panel detector depicts a cement leakage after vertebroplasty as well as MDCT. However, the method does not provide sufficient depiction of osseous morphology.

Incidence of symptomatic vertebral fractures in patients after percutaneous vertebroplasty.

The aim of this study was to evaluate the incidence of secondary symptomatic vertebral compression fractures (VCFs) in patients previously treated by percutaneous vertebroplasty (VTP). Three hundred sixteen patients with 486 treated VCFs were included in the study according to the inclusion criteria. Patients were kept in regular follow-up using a standardized questionairre before, 1 day, 7 days, 6 months, and 1 year after, and, further on, on a yearly basis after VTP. The incidence of secondary symptomatic VCF was calculated, and anatomical distribution with respect to previous fractures characterized. Mean follow-up was 8 months (6-56 months) after VTP. Fifty-two of 316 (16.4 %) patients (45 female, 7 male) returned for treatment of 69 secondary VCFs adjacent to (35/69; 51%) or distant from (34/69; 49%) previously treated levels. Adjacent secondary VCF occurred significantly more often compared to distant secondary VCF. Of the total 69 secondary VCFs, 35 of 69 occurred below and 27 of 69 above pretreated VCFs. Of the 65 sandwich levels generated, in 7 of 65 (11%) secondary VCFs were observed. Secondary VCF below pretreated VCF occurred significantly earlier in time compared to VCF above and compared to sandwich body fractures. No major complication occurred during initial or follow-up intervention. We conclude that secondary VCFs do occur in individuals after VTP but the rate found in our study remains below the level expected from epidemiologic studies. Adjacent fractures occur more often and follow the cluster distribution of VCF as expected from the natural history of the underlying osteoporosis. No increased rate of secondary VCF after VTP was observed in this retrospective analysis. In accordance with the pertinent literature, short-term and also midterm clinical results are encouraging and provide further support for the usefulness and the low complication rate of this procedure as an adjunct to the spectrum of pain management in patients with severe midline back pain due to osteoporotic spine fractures.

Interventional management of renal bleeding after partial nephrectomy.

OBJECTIVE: Partial nephrectomy (PN) has emerged as a serious alternative to nephrectomy in oncologic therapy of renal tumours. While complications are rare in general, renal hemorrhage may occur und necessitate angiographic embolization. In this retrospective study, we evaluate the clinical, imaging and procedural findings of seven interventions in five patients with renal hemorrhage after PN. In four out of five patients (80%) the bleeding could be treated successfully by embolotherapy. CONCLUSION: Angiographic embolization in patients with renal hemorrhage after PN is feasible and has a high success rate. The procedure might facilitate avoidance of nephrectomy.

Complications in percutaneous vertebroplasty associated with puncture or cement leakage.

Due to the minimally invasive character and excellent clinical outcome of percutaneous vertebroplasty (PVP), the procedure is being performed in greatly increasing numbers. While PVP has a low complication rate in general, severe complications can occur. We focus on the imaging appearance of complications of PVP associated with puncture or cement leakage--from harmless to life-threatening.

The discovery of renal contrast media in Berlin.

After X-rays were detected and cystoscopes had become available, progress in nephrology depended on the development of contrast media which would permit imaging of the kidneys and the urinary system. We describe how A. Binz and C. Räth, two chemists at the Agricultural Academy in Berlin, synthesized iodinated derivatives which were potent chemotherapeutics. Moses Swick tested the substances in the clinics of L. Lichtwitz (Hamburg) and A. von Lichtenberg (Berlin) and discovered a rapid renal excretion. He also observed that an iodinated N-acetylated derivative, later named Uro-Selectan, amplified X-ray contrast after intravenous application. With this substance and other derivatives which were produced by Schering-Kahlbaum AG, the door was open for excretion urography.