Lumbar Mass Research Articles

Tumores de vaina de nervio periférico intracraneales e intrarraquídeos. Informe de 20 casos de autopsia

Tumors arising from the sheath of peripheral nerves, both intracranial and intraspinal, are uncommon and are sometimes of difficult clinical diagnosis, especially when they occur in unusual sites. Schwannomas, neurofibromas and perineuromas are depicted in this descending order of frequency. Most are sporadic and some can be part of hereditary syndromes. Histological malignancy of this neoplasm is rare.The clinical and pathological findings of 20 autopsy cases of intracranial and intraspinal peripheral nerve tumors are analyzed. The average age at presentation was 35 years and the male/female ratio was 1:1.19 were schwannomas, 13 of the 8th cranial nerve (two associated with neurofibromatosis type 2), two originated in the trigeminal and one in the 12th nerves. Three were intraspinal, one of this underwent malignant changes and was part of neurofibromatosis type 1 (NF-1), another was an intraspinal lumbar mass with schwannomatosis and the third was a case of multiple intraspinal neurofibromas as a part of NF-1. 14 cases were surgically treated and the causes of death were ischemic lesions due to the large size of the tumors. The correct clinical diagnosis was made in 14 patients. In 11 instances there was corroboration by biopsy. Three were misdiagnosed and three were autopsy findings.In this series more cases were sporadic. No sex predominance was encountered. The importance of early detection on intracranial and intraspinal peripheral tumors is paramount, since the large size of these histologically benign neoplasms makes them biologically malignant.

Lumbar teratoma presenting intradural and extramedullary extension in a neonate

Background context The association of teratomas and spinal malformations such as spina bifida, partial sacral agenesis, hemivertebrae, and diastematomyelia has been described in the literature. Reported cases, however, are mainly presacral or sacrococcygeal with an extremely rare presentation of intradural extension. Purpose A case of lumbar teratoma with an intradural extension and extramedullary component and the clinical outcome following surgical treatment are reported. Study design/setting To our knowledge, among the reported teratoma cases with an intradural extension and extramedullary component, our case has a distinguishing feature regarding the involvement of the lumbar spine. It is also the first case, showing no neurological deficit during the postoperative period. Methods A full-term, female infant presented with a 30×30×10 mm lumbar mass covered with normal skin. The mass contained an irregular, bone-like, hard and mobile material accompanying cystic components. Magnetic resonance imaging revealed a total closure defect of the first and second lumbar laminae and a subcutaneous mass with intradural extension. The lesion was found to penetrate the dural sac through an extended exposure from T12 to L3. There was no firm attachment of the intradural, extramedullary component of the lesion. Total removal of the tumor was achieved. Results The patient was discharged on day 7 without any neurological deficit or sign of hydrocephalus. The pathological examination showed a benign teratoma containing mature cartilage, muscle, adipose tissue, and glandular tissue. Follow-up at 2 years showed no recurrence or neurological deficit and a normal sphincter tone. Urodynamic evaluation was within normal limits. Conclusion Accompanying a spinal dysraphic state, the mature teratoma in our case may support the idea of a tumor actually arising from a dysraphism and growing outward to produce the mass.

Inter-arm asymmetry in bone mineral content and bone area in postmenopausal recreational tennis players

Objective: To determine whether long-term recreational tennis participation is associated with increased bone and muscle mass in the dominant compared to the non-dominant arm, in postmenopausal tennis players. Methods: Dual-energy X-ray whole body scans were performed in 10 postmenopausal tennis players (mean±S.D.; 59.7±4.8 years) and 12 postmenopausal non-active women (62.8±7.2 years) matched for age and height. Tennis players started in this sport at 31.4±8.8 years, and had been playing for 26.8±6.8 years, at least 3 h per week. In addition, shoulder isokinetic muscular strength was also evaluated. Results: Tennis participation resulted in a lower whole mass and fat mass in both arms ( P<0.05). Dominant arm muscle mass and shoulder joint isokinetic strength were essentially similar in both groups, however, the tennis players showed 8% greater bone mineral content and 7% greater osseous area in the dominant than in the non-dominant arm ( P<0.05). No inter-arm differences were found in bone mineral density. A relationship was observed between the length of tennis participation and the degree of inter-arm asymmetry in bone mineral content ( r=0.81, P<0.01) and bone area ( r=0.78, P<0.01). However, the BMD of the arms was essentially similar in both groups. No differences were observed in femoral and lumbar bone mass and density between groups. Conclusions: Long-term tennis participation is associated with increased bone mass, but not BMD, in the dominant arm of postmenopausal tennis players. The magnitude of the inter-arm asymmetry of postmenopausal tennis players is proportional to the length of tennis participation.

Isolated Renal Mucormycosis in Children

Mucormycosis (invasive zygomycosis) usually affects patients with debilitating conditions such as cancer and diabetes mellitus. While renal involvement is not uncommon in disseminated mucormycosis, isolated renal mucormycosis is extremely rare, especially that which does not exhibit any predisposing factors, and few cases have been reported in the literature. We report on 3 children with isolated renal mucormycosis. CASE REPORTS Case 1. A 3-month-old preterm (36 weeks) female presented with a right lumbar mass 2 months in duration without fever or hematuria. The mother appeared healthy, and AIDS and fungal evaluations were negative during gestation. On physical examination a well demarcated hard mass about 6 cm in diameter was palpated in the right lumbar region, which was shown on B-ultrasound (B-US) to be a solid mass of the upper kidney. Right nephroblastoma was diagnosed preoperatively. During exploratory surgery a 6.0 6.0 5.0 cm mass was located in the upper part of the right kidney. The upper part of the mass adhered closely to the hepatic flexure of the colon. Many swollen lymph nodes were found in the mesentery of the ascending colon. Complete resection was difficult, so the majority of the mass was excised and swollen lymph nodes in the mesentery were biopsied. Case 2. A 12-year-old otherwise healthy student presented with a 1-month history of fever followed by 1 week of severe right lumbar pain and hematuria. No history of diabetes mellitus or AIDS was noted. Initial treatment with cephalosporin was ineffective and B-US detected a renal abscess. On admission to the hospital the patient had a body temperature of 40C, and there was marked tenderness and percussion pain in the right lumbar region and slight tenderness in the bladder region. Abdominal computerized tomography showed diffuse enlargement and multiple low density areas of the right kidney with several small perirenal abscesses. Renal perfusion scans demonstrated a nonfunctioning right kidney. Renal abscess was diagnosed and surgically managed. During surgery the right kidney became markedly swollen and soft, and many foci could be seen. There was about 100 ml yellow-white pus in the abscess, which was aspirated for fungal culture, and renal parenchyma was biopsied. Case 3. A 14-year-old boy was hospitalized with fever, hematuria and flank pain 1 month in duration, deteriorating with dysuria, polyuria and pyuria for 2 weeks. No predisposing diseases or recent drug abuse could be elicited. Gross hematuria was observed, routine urinalysis revealed numerous hyphae of Mucor corymbifer and red blood cells were (4). Body temperature was 39.5C. Marked tenderness and percussion pain were noted in the right lumbar region and bladder region. B-US detected a low echo right kidney. Excretory urography and renal perfusion showed a nonfunctioning right kidney. Therefore, renal mucormycosis with infarction was diagnosed. The patient was administered systemic amphotericin B and subsequently underwent right nephrectomy. Pathological results. Frozen sections in cases 1 and 2 demonstrated the mass was mainly inflammatory and necrotic tissue, and many fungi were scattered in the tissue. Hematoxylin and eosin sections confirmed the diagnosis of mucormycosis in all 3 cases, although fungal cultures were negative in case 2. The diagnostic criteria were established only when frozen and hematoxylin and eosin sections were consistent with acute purulent inflammation, and the broad nonseptate fungal hyphae with right angled branches, typical of M. corymbifer, were detected in the tissue (fig. 1). The hyphae were readily observed by silver staining and periodic acidSchiff reaction (fig. 2). The swollen lymph nodes in case 1 were confirmed to be reactive proliferation of inflammation without M. corymbifer. Antifungal treatment (intravenous amphotericin B lipid complex at a daily dose of 2 mg/kg and a total dosage of 300 to 2,160 mg during 3 to 4 weeks, followed by 30 to 50 mg/kg 5-fluorocytocine orally per day for 3 months) followed or was continued after nephrectomy. The 3 children recovered uneventfully, and hepatic and renal function remained normal during followup. DISCUSSION Mucormycosis occurs predominantly in immunocompromised patients, in whom it carries a serious prognosis. Mucormycosis can usually be divided into 5 different subtypes— cerebral, pulmonary, gastrointestinal, cutaneous and systemic, none of which is uncommon. Renal involvement is

Avancées diagnostiques et thérapeutiques dans le cancer du rein

Over the last two decades, several improvements have been made in the diagnosis and treatment of renal carcinoma. In the past, renal cancer was usually discovered after hematuria, pain, or palpation of a lumbar mass, and required total nephrectomy. Today, about 40% of renal tumors are discovered incidentally by ultrasonography or computed tomography. Therefore, the majority of renal carcinomas are discovered at an early stage. Partial nephrectomy has been developed for polar and small tumors. This surgery can now be performed using a laparoscopic approach, thereby decreasing morbidity and shortening the hospital stay.

Body composition of patients on a very low-protein diet: a two-year survey with DEXA

Background: It has been reported that patients on a very-low-protein diet (VLPD) maintain a satisfactory nutritional status because of a conserved adaptive metabolic response. However, only few studies have examined the course of nutritional status and body composition in the long term (2 years). Methods: Thirteen stable patients (8 men; age, 55 ± 12 years; glomerular filtration rate (GFR), 15 ± 5 mL/min) receiving a VLPD (0.3 g/kg/day protein) supplemented with amino acids and ketoanalogues (SVLPD) were studied for 2 years. A joint visit with a physician and a dietitian and routine blood and urine analyses were performed every month. Dual-energy x-ray absorptiometry (DEXA), which was used to assess modification of body composition, and GFR (urinary 51Cr-EDTA) and urinary urea and creatinine excretion, which were used to assess nutritional status and compliance to the diet, were assessed every 3 months. Results: GFR, albumin, and prealbumin levels remained stable. Urea urinary excretion decreased at 3 months and then slightly increased at 2 years, but the calculated protein intake remained low at 0.38 ± 0.1 g/kg/day. Energy intake remained close to 30 kcal/kg/day. No significant change was observed for total fat mass or percent fat mass. After an initial decrease, lean body mass stabilized at 6 months and then increased significantly from 6 to 24 months ( P = .02, paired t-test); the mean increase during this period was of 2 kg, that is, 4.6%. Urinary creatinine excretion showed the same profile. Total bone mass, lumbar or hip site bone mass, and Z-score significantly decreased from T0 to 1 and 2 years ( P < .05). Conclusion: This study confirms that a supplemented VLPD is nutritionally safe for a long period, but attention must be paid to bone mass.

Cancer du rein : à propos de 47 cas

The authors report a series of 47 cases observed over a 15-years period in the department of carcinological at the national oncological institute of Rabat. Patients consisted of 16 mean and 21 women (57%), with a mean age of 49 years old (range 29 to 70 years). The clinical features were polymorph, firstly loin pain (81%), hematuria is the next (25%). A lumbar mass (10%). The diagnosis was established by ultra-sonography and CT - scan in all the patients. The mean tumour diameter was 10cm (5–17cm), it were located in down pole in 53%. The surgical procedure consisted of radical nephrectomy and regional or hailer lymph node dissection in 46 patients. The post operative course was marked by one death due to pulmonary metastases. The mean follow-up was (2 to 15 years). Asynchronies metastases occurred in 6 patients after a mean interval (9 to 36 months). The overall 5 year survival was 100% PT1, 78% PT2, 34% PT3.

Lasofoxifene (CP-336,156), a novel selective estrogen receptor modulator, in preclinical studies

Estrogen replacement therapy is reported to reduce the incidence of vertebral fractures in postmenopausal women, however, its compliance is limited because of side effects and safety concerns. Estrogen's side effects on breast and uterine tissues leading to the potential increased risk of uterine and breast cancer limit widespread estrogen usage. Thus, there is a significant medical need for a therapy that protects against postmenopausal bone loss but is free of estrogen's negative effects on reproductive tissues. Selective estrogen receptor modulators (SERMs) have been investigated as an alternative to hormone replacement therapy. One such compound, raloxifene, has been approved for the prevention and treatment of osteoporosis. Lasofoxifene (LAS), a new, nonsteroidal, and potent SERM, is an estrogen antagonist or agonist depending on the target tissue. LAS selectively binds with high affinity to human estrogen receptors. In ovariectomized (OVX) rat studies, LAS prevented the decrease in femoral bone mineral density, tibial and lumbar vertebral trabecular bone mass at an ED100 of about 60 μg/kg/day. LAS inhibited the activation of trabecular and endocortical bone resorption and bone turnover in tibial metaphyses and diaphyses, and lumbar vertebral body in OVX rats. In addition, LAS decreased total serum cholesterol, inhibited body weight gain and increased soleus muscle weight in OVX rats. Similarly, LAS prevented bone loss induced by orchidectomy or aging in male rats by decreasing bone resorption and bone turnover while it had no effect in the prostate. Further, LAS decreased total serum cholesterol in intact aged male rats or in orchidectomized male rats. Synergestic skeletal effects were found with LAS in combination with bone anabolic agents such as prostaglandin E2 (PGE2), parathyroid hormone (PTH) or a growth hormone secretagoue (GHS) in OVX rats. In combination with estrogen, LAS inhibited the uterine stimulating effects of estrogen but did not block the bone protective effects of estrogen. In immature and aged female rats, LAS did not affect the uterine weight and uterine histology. In OVX adult female rats, LAS slightly but significantly increased uterine weight. These results demonstrated that LAS produced effects on the skeleton indistinguishable from estrogen in female and male rats. However, unlike estrogen, LAS had little effect on uterine weight and cellular proliferation of uterus in female rats. In preclinical anti-tumor studies, LAS inhibited human breast cancer growth in mice bearing MCF7 tumors, prevented NMU-induced mammary carcinomas and possessed chemotherapeutic effects in NMU-induced carcinomas in rats. Therefore, we conclude that LAS possesses the antiestrogenic effects in breast tissue and estrogenic effects in bone and serum cholesterol, but lacks estrogen's side effects on uterine tissue. These data support the therapeutic potential of LAS for the prevention and treatment of postmenopausal bone loss and mammary carcinomas in humans.

Stress fractures in rheumatological practice: clinical significance and localizations.

The objective of this study was to analyze the clinical characteristics, associated disorders, and the most common sites of stress fractures in rheumatological patients. Over a 3-year period, 35 patients with 44 stress fractures were prospectively recruited from an outpatient rheumatological department (32 postmenopausal women and three men aged 47 to 86 years, mean 70+/-10.6 years). Clinical diagnosis was established by compatible clinical and radiological data. In addition, previous skeletal fractures were recorded in all patients. Bone mass assessment was performed in 23 patients and spinal X-ray in 21. The diagnosis of osteoporosis was defined by the presence of atraumatic vertebral fractures and/or densitometric criteria (lumbar or femoral bone mass <-2.5 T score). The most frequent stress fractures were: pelvic ring (13 sacrum and eight pubic) and metatarsal (11 fractures), followed by tibia (seven fractures), calcaneus (three fractures), femur (one), and tarsal (one). Nine patients (26%) presented simultaneous stress fractures. Twenty-four patients (69%) suffered previous osteoporotic fractures, vertebral and Colles' fractures being the most frequent. Most of the evaluated patients (25 out of 30) had osteoporosis (83%). Six patients had associated disorders (glucocorticoids use in three patients, neurologic disorders in two, and rheumatoid arthritis in one). Except for the patient with a femur fracture which required internal fixation, no other clinical complications were observed after conservative treatment. In conclusion, fractures of the pelvic ring, especially sacrum, and metatarsal are the most frequent stress fractures in rheumatological practice. The association with osteoporosis and the history of prior low-trauma fractures are common in these patients.

Myelomeningocele in a child with intrauterine exposure to efavirenz

The authors report a case of a full-term male neonate born to a 34-year-old woman with heterosexually acquired asymptomatic HIV infection, with a CD4 cell count of 390/mm3 (26%) and an HIV-RNA level of 7600, receiving zidovudine, stavudine and efavirenz therapy before pregnancy. She was counselled regarding the potential risks of this therapy and the necessity for adequate birth control. After a period of amenorrhoea she performed a pregnancy test, which was positive. For this reason antiretroviral therapy was switched to an alternative regimen with lamivudine, stavudine and nelfinavir at 24 weeks of pregnancy. Obstetric controls were performed regularly and no side-effects were reported. Before and during the whole pregnancy the patient was submitted to daily folic acid supplementation. Ultrasound surveillance performed at the second trimester of gestation showed regular fetal growth and the presence of a lumbar mass and a triventricular hydrocephalus. The baby was born at the 38th week of gestational age, weight 3450 g, length 49 cm and head circumference 34.5 cm, presenting with a lumbo-sacral mass compatible with a myelomeningocele of 13 cm diameter with full intact skin (Fig. 1). A cerebral ultrasound showed a triventricular hydrocephalus. Magnetic resonance imaging confirmed a large sacral myelomeningocele lesion (10 cm diameter). Laboratory evaluation showed hepatic, renal and metabolic assessment in the normal range. The serological test for HIV (enzyme-linked immunosorbent assay and Western blot) was positive. HIV-1 DNA polymerase chain reaction at birth on plasma and cerebrospinal fluid was negative. The newborn was submitted to surgical repair of the myelomeningocele lesion and ventriculo–peritoneal shunting. Prophylactic therapy with zidovudine 2 mg/kg a day trial was started.Fig. 1.: Myelomeningocele in efavirenz-exposed newborn.The aetiology of myelomeningocele and other neural-tube defects still remain to be completely understood, although genetics, race, socioeconomics and environmental factors are recognized [1]. The role of folic acid deficiency as the major cause of spina bifida has been recognized, but at least 30% of cases are not prevented by periconceptional multivitamins containing folic acid supplementation. Therefore other specific environmental causes have been involved; to date maternal diabetes and fetal exposure to some anti-epileptic drugs such as valproic acid have been identified [2]. Efavirenz is a potent non-nucleoside reverse transcriptase inhibitor that shows a durable suppression of HIV replication. In animal studies [3], efavirenz crosses the placenta and produces fetal blood concentrations similar to maternal blood concentrations. Teratogenic effects have been observed in three out of 20 fetuses from efavirenz-treated cynomolgus monkeys from the 20th to the 150th days of gestation in a developmental toxicity study. Drug-induced neural tube defects such as anencephaly and unilateral anophthalmia were observed in one fetus, microophthalmia was observed in another fetus, and cleft palate was observed in a third fetus. These effects were not noted on rats and rabbits probably because of different pharmacokinetics. The use of this drug is not allowed in pregnant women for two reasons: first, the teratogenic effects were observed in monkeys exposed at the same recommended dose as in humans; second, the drug follows the same metabolic pathway in humans and monkeys (the 8-OH conjugated glucuronide is the major metabolite in plasma and urine) [4]. To date, this case is the first report of neural tube defect in a human fetus accidentally exposed to efavirenz during the first month of pregnancy. This hypothesis is supported by strong evidence: (i) the extension of fetal exposure to efavirenz occurred within the first 28 days of gestation, exactly corresponding to the embryological period of neural tube closure [5]; (ii) the teratological effect observed in our neonate involved neural tube development, as did the anencephalia observed in fetuses from efavirenz-treated monkeys. In conclusion, this case suggests special considerations: the demonstration of a possible teratogenic effect in humans strengthens the recommendation that pregnancy should be avoided in women receiving efavirenz. Moreover, efavirenz-treated women should be carefully advised to shift to an alternative antiretroviral treatment before pregnancy. If our report is confirmed by further observations, we believe that the advisability of efavirenz proscription in women of reproductive age should be prudently considered. Carlo Fundarò Orazio Genovese Claudia Rendeli Enrica Tamburrini Elio Salvaggio

Grynfeltt's hernia

The aim of this study is to report a case and review the relevant literature. The patient was a 64-year-old male with a right lumbar mass of 5 × 6 cm, which protruded when abdominal pressure was increased. Surgery revealed a defect of 3 × 2 cm in the transversalis fascia in the superior lumbar triangle; prosthetic material was used in the preperitoneal space. Lumbar hernias are rare defects of the abdominal wall (2% of wall hernias); fewer than 300 cases have been reported in the literature. All lumbar hernias can be corrected with surgical treatment. A tension-free mesh repair is almost always necessary, and gives satisfactory results.

Cyclical etidronate versus sodium fluoride in established postmenopausal osteoporosis: a randomized 3 year trial

To compare the effects of sodium fluoride and etidronate in severe postmenopausal osteoporosis, we conducted a 3 year, prospective, trial in 118 postmenopausal osteoporotic women with at least one vertebral fracture, who were randomly assigned to receive sodium fluoride (25 mg twice daily, as enteric-coated tablets) plus calcium (1000 mg/day) or intermittent etidronate (400 mg/day for 14 days) followed by calcium (1000 mg/day for 76 days). Lateral spine X-ray films and dual-energy X-ray absorptiometry (DXA) measurements of the lumbar spine and proximal femur were performed at enrollment and yearly. Nonvertebral fractures were recorded every 6 months. Thirty-one women in the fluoride group and 47 in the etidronate group completed the trial. At 36 months, the mean change from baseline of the lumbar bone density in the fluoride group was 8.5 ± 2.04% ( p = 0.001) and in the etidronate group was of 3.6 ± 0.84% ( p < 0.001). The changes in the fluoride group were significantly higher than in the etidronate group ( p = 0.01). Both groups showed nonsignificant changes in femoral neck bone density. There was no significant difference between groups in the cumulative proportion of women with new vertebral fractures, with an incidence in the fluoride group of 16% vs. 17% in the etidronate group. However, the number of new vertebral fractures was significantly lower in the fluoride group (6 fractures) than in the etidronate group (19 fractures) ( p = 0.05). The number of patients with nonvertebral fractures was similar in both groups. A high incidence of side effects, mainly gastrointestinal symptoms and lower extremity pain syndrome, was observed in the fluoride group. Etidronate was well tolerated. We conclude that, in women with severe osteoporosis, although sodium fluoride is more favorable than cyclical etidronate for increasing lumbar bone mass, no differences were observed in the incidence of fractures.

Possible Intraspinal Metastasis of a Canine Spinal Cord Nephroblastoma

A 2-year-old Basset Hound was admitted to the University of Florida Veterinary Medical Teaching Hospital with progressive spastic paraparesis. At necropsy, intradural extramedullary tumors produced areas of spinal cord swelling and softening in spinal cord segments T11-T12 and L4-L6. Histologic examination of the masses revealed sheets of polygonal blastemal cells, epithelial cells forming tubules and rosettes, and embryonal glomeruloid-like structures in the thoracic mass. Cells in the lumbar mass were less differentiated, forming rare tubules and no glomeruloid-like structures. The occurrence of two tumors in the spinal cord along with the less differentiated appearance of the lumbar tumor raises the possibility that the lumbar mass arose as a result of intraspinal metastasis. To our knowledge, this is the first report of multifocal or metastatic canine spinal nephroblastoma. In addition, the vimentin and cytokeratin immunohistochemical staining characteristics of these spinal cord nephroblastomas are described.

Effect of exercise on tibial and lumbar vertebral bone mass in mature osteopenic rats: Bone histomorphometry study

The effect of moderate running exercise on tibial and lumbar vertebral bone mass was examined in mature osteopenic rats by bone histomorphometry. Ten 37-week-old female Wistar rats, with bone loss resulting from being fed a relatively low-calcium diet for 14 weeks after ovariectomy at the age of 23 weeks, were randomly divided into two groups of five animals each; control and exercise groups. The exercise consisted of treadmill running at 12m/min for 1h per day on 5 days per week for 12 weeks. During the exercise period, all animals were fed a standard calcium diet. After 12 weeks of exercise, bone histomorphometry was evaluated for cancellous bone (secondary spongiosa) of the proximal tibia and the fourth lumbar vertebra and for cortical bone of the tibial shaft. The findings suggested that in the mature osteopenic rat, there was a beneficial effect of moderate running exercise with adequate calcium intake on bone mass only in a weight-bearing long bone, the tibia. The mechanism for increased bone mass appeared to be both decreased bone resorption and increased bone formation in cancellous bone and increased bone formation in cortical bone.

Dairy Supplementation Prevents Seasonal None Loss in Elderly Women

Seasonal decrements in femoral and lumbar bone mass among postmenopausal women have recently been reported by several groups. However, previous studies have been relatively short-term or observational. We now report interim one year results from a two year randomized double blinded(single blinded for dietary), placebo controlled calcium intervention study in elderly women. Sixty active but older postmenopausal women (mean age 72 years: range 61-88 years) with mean daily calcium intake of 571± 50mg/day were randomized to one of three intervention arms: 1) Placebo-Calcium (PC) twice daily (n=20); 2) CaC03 (CC) n=21: two 500mg tablets with meals; 3) Dietary Calcium (DC) milk, 3–3.5 glasses/day to a total .daily intake of 1200mg/day; (n=19). Bone mineral density of the spine (L2-L4) and greater trochanter of the hip (GT) were measured by DXA at six month intervals (longitudinal c.v. = 1.0% spine, 2.0%-GT). The six month intervals were October-March (winter,), April-September (summer,). DC women were telephoned frequently while all women were seen for non-calcium dietary discussions at three and nine months. Grocery slips were monitored for the DC group and compliance was assessed by urinary calcium clearance, dietary records (4 day food records) and food frequency questionnaire. Vitamin D content of the milk was also measured. Sixty women began the study and 53 women completed 12 months. Only one subject dropped out in the DC group. Initial BMD (L2–L4 and GT) did not differ among groups, nor did age, height, weight or initial Ca intake. Among DC women, no significant change in weight was noted. Calcium intake and % change in BMD(± SEM) are noted below:In conclusion: 1) Among elderly women in northern New England who consume low calcium diets, seasonal bone loss from both cortical and trabecular sites is significant; 2) annual declines in BMD within this cohort occur only during late fall and winter; 3) DC or CC are equally effective in preventing winter time bone loss from the L-spine, but only DC prevented bone loss from occurring in the GT, 4) consumption of milk products (to 1200mg/day) was well tolerated and resulted no significant weight change, 5) there are differential effects on conical bone mass between CC and DC which may reflect differences in calcium bioavailability or mechanisms of action distinct from calcium alone Funded by the National Dairy Promotion and Research Board and administered in cooperation with the National Dairy Council.

Multicentric Skeletal Sarcomas Associated with Probable Retrovirus Particles in Two African Hedgehogs (Atelerix albiventris)

Multicentric Skeletal Sarcomas Associated with Probable Retrovirus Particles in Two African Hedgehogs (<i>Atelerix albiventris</i>)

A one-year prospective comparison of calcium supplementation, low dose continuous, and moderate dose cyclical oestrogen and progestagen replacement therapy in the protection of bone mass

SummaryAfter 6 months of calcium supplementation, 86 recently postmenopausal women chose either to remain on calcium or to add hormone replacement therapy. Women who chose hormones were allocated at random to either a low dose continuous (conjugated oestrogens, 0-3 mg/ day and medroxyprogesterone, 2-5 mg/day) or a moderate dose cyclical (conjugated oestrogens, 0-625 mg/ day, and medroxyprogesterone, 5 mg/day) regimen. Lumbar spine bone mineral density and mass, mid radius bone mineral content, and whole body bone turnover were measured.Menopause symptoms were controlled by both hormone regimens, and both produced decreases in whole body bone turnover and increases in lumbar spine density and mass over 1 year. On calcium only, lumbar spine bone mass continued to fall. Hormone replacement also prevented an age related decrease in the serum concentration of high density lipoproteins. More than 70 per cent of the subjects on moderate dose cyclical hormones experienced bleeding problems. With low dose continuo...

Are patients with fractures of the femoral neck more osteoporotic?

Combined cancellous/cortical density and mass in the femur and lumbar spine were assessed 2 or 3 days after femoral neck fractures and compared to identical measurements in control subjects. Cancellous density was also assessed in the spine. Correction for age differences between patients and controls were made by means of regression analyses and by selecting groups without age differences. After compensation for the age differences, the patients were found to have significantly lower femoral bone mass and lumbar density than the controls. The femoral density and lumbar mass density were not significantly different in the two groups after age correction. The findings for the cancellous spinal density was equivocal. The study indicates that in the femur the total bone mineral content is lower in patients with femur neck fractures and that it is at least one of the etiological factors of these fractures. However, in the femur it is not the bone density that is the decisive factor, but the amount of calcified bone, or the bone mass.

Case report: Magnetic resonance imaging with Gadolinium-DTPA enhancement in the differentiation of benign from neoplastic cord cavitation

A patient with an extensive spinal cord glioma is presented. The lumbar mass and cervical cavity associated with the tumour were demonstrated by myelography and computed tomography. Magnetic resonance imaging provided greater detail than these conventional imaging modalities without exposure to ionising radiation and was of considerable additional value in the planning of surgery.

Exercise patterns and trabecular bone density in college women

To assess the effects of physical activity patterns on trabecular bone density in college women, we studied three groups of nonsmoking eumenorrheic women with different (but chronic) exercise regimens. There were nine sedentary (SED) women exercising less than 1 h/week, nine women who performed aerobic (AER) exercise greater than 2.5 h/week, and nine women who supplemented aerobics with muscle-building activities (MB) for more than 1 h/week. Resting energy expenditure, calorie, protein, and calcium intake, total body weight, and body mass index were not statistically different among the three groups. AER and SED women had similar lumbar bone mineral density (BMD). MB women had significantly greater spinal bone density (p less than 0.007 versus SED, AER). IGF-1 (insulin-like growth factor) concentrations were greatest in MB (p less than 0.01), and hours muscle building per week correlated with IGF-1 (r = 0.86, p less than 0.03). For all 27 women (mean age 24.5 years), body mass index was the single best predictor of lumbar BMD (r = 0.42, p less than 0.03); hours in muscle-building exercise per week conferred an additive effect on lumbar BMD. This cross-sectional study of young women suggests chronic muscle-building exercises may augment lumbar bone mass. The additive effect of anaerobic exercise on bone density may be mediated by both local weight-bearing changes and possible systemic factors.