Biomedical subjects

Charles F Hildebolt

Publications and source records attributed to Charles F Hildebolt.

18 recordsLinked to original sources

PubMed2006

The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders.

BACKGROUND: Very little comparative information is available regarding the demographic and morphological characteristics of asymptomatic and symptomatic rotator cuff tears. This information is important to provide insight into the natural history of rotator cuff disease and to identify which factors may be important in the development of pain. The purpose of the present study was to compare the morphological characteristics and prevalences of asymptomatic and symptomatic rotator cuff disease in patients who presented with unilateral shoulder pain. METHODS: Five hundred and eighty-eight consecutive patients in whom a standardized ultrasonographic study had been performed by an experienced radiologist for the assessment of unilateral shoulder pain were evaluated with regard to the presence and size of rotator cuff tears in each shoulder. The demographic factors that were analyzed included age, gender, side, and cuff thickness. All of these factors were evaluated with regard to their correlation with the presence of pain. RESULTS: Of the 588 consecutive patients who met the inclusion criteria, 212 had an intact rotator cuff bilaterally, 199 had a unilateral rotator cuff tear (either partial or full thickness), and 177 had a bilateral tear (either partial or full thickness). The presence of rotator cuff disease was highly correlated with age. The average age was 48.7 years for patients with no rotator cuff tear, 58.7 years for those with a unilateral tear, and 67.8 years for those with a bilateral tear. Logistic regression analysis indicated a 50% likelihood of a bilateral tear after the age of sixty-six years (p < 0.01). In patients with a bilateral rotator cuff tear in whom one tear was symptomatic and the other tear was asymptomatic, the symptomatic tear was significantly larger (p < 0.01). The average size of a symptomatic tear was 30% greater than that of an asymptomatic tear. Overall, patients who presented with a full-thickness symptomatic tear had a 35.5% prevalence of a full-thickness tear on the contralateral side. CONCLUSIONS: There is a high correlation between the onset of rotator cuff tears (either partial or full thickness) and increasing age. Bilateral rotator cuff disease, either symptomatic or asymptomatic, is common in patients who present with unilateral symptomatic disease. As the size of a tear appears to be an important factor in the development of symptoms, we recommend surveillance at yearly intervals for patients with known rotator cuff tears that are treated nonoperatively.

Female↗

PubMed2006

Hybrid peripheral 3D contrast-enhanced MR angiography of calf and foot vasculature.

OBJECTIVE: The objective of our study was to describe hybrid peripheral (HyPer) 3D contrast-enhanced MR angiography (CE-MRA) using sagittal acquisition with parallel imaging of the calf and foot station. The benefit of a dedicated sagittal 3D CE-MRA acquisition of the calf and foot was evaluated by assessing the degree of venous contamination and its diagnostic quality compared with standard bolus chase 3D CE-MRA alone. MATERIALS AND METHODS: Fifty-three patients (99 legs) were scanned with a 1.5-T MR system equipped with a dedicated bilateral lower extremity phased-array coil. First, high-resolution 3D CE-MRA images of the calves and feet were obtained using two separate sagittal slabs with parallel imaging, with a resulting voxel size of 1.4 x 1.0 x 1.0 mm3. Second, standard bolus chase 3D CE-MRA was performed from the abdomen and pelvis station to the calf-foot station. Images were interpreted by two radiologists. The calf-foot arterial trees were divided into 12 segments. Each segment was characterized as diagnostic or nondiagnostic. The degree of venous contamination was assessed as interfering with the diagnosis or not. Paired Student's t test and Wilcoxon's signed rank test were used to test for statistically significant differences between the techniques. RESULTS: For the left leg (n = 48), the mean number (+/- SD) of diagnosed arterial segments for HyPer 3D CE-MRA was 9.2 +/- 2.3 and for bolus chase 3D CE-MRA, 7.1 +/- 4.2 (p < or = 0.0004). For the right leg (n = 51), the corresponding values were 9.4 +/- 2.2 and 7.6 +/- 3.5 (p < or = 0.0005), respectively. For bolus chase 3D CE-MRA, venous contamination interfered with the diagnosis in 24 of 99 legs, whereas with HyPer 3D CE-MRA, there was no interference. Selective analysis of the dorsalis pedis arteries showed that the number of diagnostic vessels was 62 (62.6%) of 99 for HyPer 3D CE-MRA and 13 (13.1%) of 99 for bolus chase 3D CE-MRA. CONCLUSION: HyPer 3D CE-MRA is an alternative method for time-resolved high-resolution peripheral CE-MRA in evaluating the trifurcation and feet vessels with no venous contamination.

Adolescent↗

PubMed2005

CT depiction of pulmonary emboli: display window settings.

PURPOSE: To compare computed tomographic (CT) window settings selected by radiologists with those determined by using two alternative approaches for depiction of pulmonary emboli (PE). MATERIALS AND METHODS: Institutional review board approval was obtained; informed consent was not required. This study was compliant with the Health Insurance Portability and Accountability Act. Twenty-five clinical chest CT studies were obtained with a standardized PE protocol and retrospectively evaluated by five chest and two body CT radiologists. Of these studies, 13 were positive for PE, and 12 were negative. At the main pulmonary artery (PA), mean attenuations (MPA) and standard deviations (SDPA) were measured. Initially, images were displayed with a standard mediastinal window setting (window width, W = 400 HU; window center, C = 30 HU), and each observer adjusted the setting to a personally preferred setting (eg, "personal") for PE detection. Images displayed at this setting were compared in a side-by-side fashion with the "modified" (W = MPA + 2 . SDPA, C = W/2) and "double-half" (W = 2 . MPA, C = MPA/2) window setting. Each observer rated images from 1 (ie, most preferred) to 3 (ie, least preferred). For quantitative analysis, window width and center value of each setting were divided by corresponding MPA to compute a width ratio and a center ratio. Window settings and ratings were compared with repeated-measures analysis of variance, paired t tests, and Wilcoxon signed-rank tests. RESULTS: Ratings for all three types of window settings were significantly different (P < .001). Observers preferred their personal settings the most and the modified settings the least. Mean ratios for the seven observers were 1.68 +/- 0.20 for window width and 0.47 +/- 0.08 for window center. Window width ratios for all settings were significantly different from each other (P < .001). Window center ratios were significantly higher for the modified setting than for the double-half setting (P = .013). Values for mean PA attenuation were correlated with window width ratios for six (86%) observers (mean r2 value = 0.29 +/- 0.19, P < or = .03) and with window center ratios for four (57%) observers (mean r2 value = 0.16 +/- 0.14, P < or = .02), thus indicating a trend of setting window width and window center higher when contrast enhancement is lower and vice versa. CONCLUSION: On average, observers selected CT window settings for PE detection at a window width of slightly less than twice the mean PA attenuation and at a window center of about half the mean PA attenuation. Observers tended to use larger window widths and centers as the degree of PA enhancement was lower.

Adult↗

PubMed2005

Evaluation of 1H-magnetic resonance spectroscopy of breast cancer pre- and postgadolinium administration.

OBJECTIVES: We sought to evaluate spectroscopic measurements in breast cancer and compare variability in choline peak parameters related to contrast administration versus that inherent to repeated measurements. MATERIALS AND METHODS: Single-voxel, proton spectroscopy measurements were obtained before and after the administration of gadolinium on 15 patients with > or = 1-cm breast cancers. The protocol was repeated on a separate day in 7 patients. RESULTS: Postcontrast spectra demonstrated a significant increase in choline peak linewidth (day 1: 15% +/- 21%, P = 0.03; day 2: 19% +/- 12%, P = 0.001) and decrease in choline peak area (day 1: 11% +/- 9% (P < 0.001); day 2: 18% +/- 21% (P = 0.03). A variance-components analysis indicated that day-to-day variation in linewidth accounted for 0.0% of the total variation in width measurements and was not significant (P = 0.85). Day-to-day variation in area was also not significant (0.0%, P = 0.95). CONCLUSIONS: Contrast administration caused significant increases in choline peak linewidth and decreases in choline peak area in spectroscopic measurements of breast cancer.

Breast Neoplasms↗

PubMed2005

Volumetric measurement of synthetic lung nodules with multi-detector row CT: effect of various image reconstruction parameters and segmentation thresholds on measurement accuracy.

PURPOSE: To evaluate the effect of various multi-detector row computed tomographic (CT) reconstruction parameters and nodule segmentation thresholds on the accuracy of volumetric measurement of synthetic lung nodules. MATERIALS AND METHODS: Synthetic lung nodules of four different diameters (3.2, 4.8, 6.4, and 12.7 mm) were scanned with multi-detector row CT. Images were reconstructed at various section thicknesses (0.75, 1.0, 2.0, 3.0, and 5.0 mm), fields of view (30, 20, and 10 cm), and reconstruction intervals (0.5, 1.0, and 2.0 mm). The nodules were segmented from the simulated background lung region by using four segmentation thresholds (-300, -400, -500, and -600 HU), and their volumes were estimated and compared with a reference standard (measurements according to fluid displacement) by computing the absolute percentage error (APE). APE was regressed against nodule size, and multivariate analysis of variance (MANOVA) was performed with APE as the dependent variable and with four within-subject factors (field of view, reconstruction interval, threshold, and section thickness). RESULTS: The MANOVA demonstrated statistically significant effects for threshold (P = .02), section thickness (P < .01), and interaction of threshold and section thickness (P = .04). The regression of mean APE values on nodule size indicates that APE progressively increases with decreasing synthetic nodule size (R2 = 0.99, P < .01). CONCLUSION: For accurate measurement of lung nodule volume, it is critical to select a section thickness and/or segmentation threshold appropriate for the size of a nodule.

Acrylic Resins↗

PubMed2005

Effect of vitamin D and calcium on periodontitis.

The anthropological record indicates that we are exposed to considerably less ultraviolet radiation (required for the synthesis of vitamin D) and consume considerably less calcium than did our early ancestors. Most U.S. citizens have calcium intakes and serum levels of vitamin D far below recommended values. This is despite there having been extensive evidence that optimal calcium and vitamin D intakes not only benefit our postcranial bone health but also have many other health benefits. Numerous articles indicate that vitamin D and calcium deficiencies result in bone loss and increased inflammation, which are well recognized symptoms of periodontal disease. For more than 40 years, investigators have suggested that calcium intake may be associated with alveolar bone resorption, and more recently there have been a number of studies in which investigators have suggested that calcium and vitamin D may benefit periodontal health, and it has been suggested that calcium deficiency may be a risk factor for periodontal disease. There has not, however, been a vitamin-D-calcium-periodontitis clinical trial in which randomization and masking were carefully controlled, the periodontal disease status of patients known, periodontal disease measures were the primary outcomes, and levels of intake optimized to produce maximal effects. Such research might demonstrate that calcium and vitamin D are important adjuncts to standard treatments for preventing and treating periodontal disease.

Alveolar Process↗

PubMed2004

The accuracy of high-resolution ultrasound for evaluating focal lesions of the hand and wrist.

PURPOSE: Although several articles have described the sonographic features of solid and cystic lesions of the hand and wrist, few have investigated its accuracy for diagnosing such lesions. The purposes of this retrospective study were to determine the accuracy of sonography for diagnosing focal lesions of the hand and wrist against the standard of histologic examination of the resected specimen and to compare the accuracy of sonography against the recorded initial clinical impression. METHODS: A medical record search for all sonographic studies of the hand and wrist at our institution was performed. Eighty-four patients had correlative surgery and made up the study group. All sonogram reports were reviewed for the absence or presence of focal lesions and specific diagnoses and all medical records were reviewed for the initial clinical impression. Both were compared with histologic findings and tested for agreement with the kappa statistic and for significant differences with the McNemar test RESULTS: Seventy-six of the 84 patients had focal lesions of the hand and wrist and 8 had normal sonograms. Overall, ultrasound correctly diagnosed 83% of the lesions and the initial clinical impression was correct in 54%. Of the 76 lesions ultrasound correctly diagnosed 87% of cystic lesions, 73% of solid lesions, 75% of tenosynovitis cases and the single-vessel thrombosis. The initial clinical impression was correct in 67% of cystic lesions and 75% of tenosynovitis cases. The solid or cystic nature of the 15 solid lesions and the single-vessel thrombosis could not be determined by history or physical examination alone. Of the 35 cases in which the recorded clinical impression was incorrect or not recorded ultrasound provided the correct diagnoses in 71% of these cases. Agreement with the kappa statistical analysis was only fair and the recorded initial clinical impression was less accurate than ultrasound. CONCLUSIONS: Ultrasound was statistically more accurate than the initial clinical impression for distinguishing solid from cystic lesions of the hand and wrist. Ultrasound was very accurate for specifically diagnosing ganglions and slightly less for solid lesions and tenosynovitis.

Adolescent↗

PubMed2004

Estrogen and/or calcium plus vitamin D increase mandibular bone mass.

BACKGROUND: We have previously reported that estrogen/hormone replacement therapy (E/HRT) has beneficial effects on oral bone density over 3 years and that calcium and vitamin D supplementation has a lesser effect. Here we report on mandibular bone mass for 49 women (of the original cohort of 135) who continued in an additional 2-year, open-label extension. METHODS: Postmenopausal women were randomly assigned to receive calcium and vitamin D plus E/HRT, or calcium and vitamin D only. Regression analysis of mandibular bone mass over time was performed for each woman. RESULTS: Twenty-two of 26 women who took calcium and vitamin D plus E/HRT for 5 years had small mandibular bone mass increases (0.35 +/- 0.38%, P<0.001). Seventeen of 19 women who took only calcium and vitamin D for 3 years had increases in mandibular bone mass (0.74 +/- 0.89%, P<0.002). The largest gains in mandibular bone mass occurred during the first 3 years of the study. CONCLUSIONS: The data of this study indicate that E/HRT and/or calcium and vitamin D may result in increases of mandibular bone mass in postmenopausal women. Because of the long-term risks associated with E/HRT, caution should be exercised in prescribing E/HRT for prevention of chronic menopausal conditions.

Alveolar Bone Loss↗

PubMed2004

MDCT evaluation of thoracic aortic anomalies in pediatric patients and young adults: comparison of axial, multiplanar, and 3D images.

OBJECTIVE: The objective of our study was to compare accuracies of axial, multiplanar, and 3D volume-rendered images in the diagnosis of thoracic aortic anomalies in pediatric patients and young adults. MATERIALS AND METHODS: Fourteen patients, 17 days to 20 years old, with thoracic aortic anomalies underwent MDCT using axial, multiplanar, and 3D volume-rendering imaging. All images were reviewed by three radiologists for position of the aortic arch, coarctation, vascular compression of the airway, collateral vessel formation, and aortopulmonary shunts (patent ductus arteriosus). Final diagnosis was determined by echocardiography, conventional angiography, bronchoscopy, or surgery. Diagnostic accuracy, sensitivity, and interobserver agreement were evaluated. RESULTS: Average accuracies (average of the three observers for a correct diagnosis) were greater than or equal to 96% for diagnoses of aortic position and airway narrowing on all image types. For the diagnosis of coarctation, average sensitivities (average of the three observers for a true diagnosis) were 73% for axial, 100% for multiplanar, and 100% for 3D volume-rendered images. For the diagnosis of patent ductus arteriosus, average sensitivities were 78% for axial, 94% for multiplanar, and 89% for 3D volume-rendered images. No patients in this study had collateral vessel formation. For the diagnosis of absence of collateral vessel formation, average sensitivities were 100% for axial, 100% for multiplanar, and 100% for 3D volume-rendered images. There were no significant statistical differences in diagnostic performances, agreement with truth, or confidence scores among observers or imaging formats (p > 0.05). CONCLUSION: Axial, multiplanar, and 3D volume-rendered images serve equally well as methods for assessing the side of the aorta to diagnose anomalies. For evaluation of coarctation and patent ductus arteriosus, multiplanar and 3D volume-rendered images perform slightly better than axial images.

Adolescent↗

PubMed2004

Sonography and MRI of the shoulder: comparison of patient satisfaction.

OBJECTIVE: MRI and sonography are both used to evaluate patients with painful shoulders. This study was conducted to compare patients' perceptions and satisfaction with both tests. SUBJECTS AND METHODS: One hundred eighteen patients with shoulder pain and a clinically suspected rotator cuff tear underwent both MRI and sonography and filled out satisfaction surveys after both tests. Patients were asked the following questions: Did the test cause pain? If it did, they were asked to grade the pain on a scale of 1-10 (1, minimal pain; 10, severe pain). Did the test take too long? Would they be willing to undergo the test again? How would they grade their overall satisfaction with the test (1, poor; 2, fair; 3, good; 4, very good; and 5, excellent)? Which test did they prefer if both were equally accurate? RESULTS: Sonography caused pain above the baseline in 39 patients, with an average pain score (mean +/- SD) of 5.4 +/- 2.3, and MRI caused pain above the baseline in 40 patients, with an average pain score of 6.1 +/- 2.7 (p = 0.36). Two patients thought the sonography examination took too long, and 28 patients though the MRI examination was too long (p < 0.001). The average satisfaction level for sonography was 4.3 +/- 0.7 and for MRI, 3.6 +/- 1.2 (p < 0.001). The satisfaction score was higher for sonography in 54 patients, higher for MRI in 13 patients, and the same for both in 50 patients (p < 0.001). All patients were willing to repeat the sonography, but 10 patients were unwilling to repeat the MRI (p = 0.002). Ninety-three patients preferred sonography, eight patients preferred MRI, and 17 patients had no preference (p < 0.001). CONCLUSION: Most patients with shoulder pain prefer sonography to MRI.

Female↗

PubMed2004

Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases.

BACKGROUND: Although many investigators have evaluated the accuracy of ultrasonography and magnetic resonance imaging for the detection of full and partial-thickness rotator cuff tears, few have directly compared the two tests. The purpose of our study was to compare the accuracy of the two tests for detection and measurement of the size of rotator cuff tears, with arthroscopic findings used as the standard. METHODS: One hundred and twenty-four consecutive patients with shoulder pain were prospectively studied with ultrasonography and magnetic resonance imaging. Seventy-one had subsequent arthroscopy, and they formed the study group. The arthroscopic diagnosis was a full-thickness tear in forty-six patients, a partial-thickness tear in nineteen, and no tear in six. The presence or absence of a full or partial-thickness tear and the tear size as demonstrated by each imaging test and at the time of arthroscopy were recorded. The findings of the imaging tests and arthroscopy were then compared for each parameter. RESULTS: Ultrasonography correctly identified forty-five of the forty-six full-thickness tears and magnetic resonance imaging, all forty-six. Ultrasonography correctly identified thirteen of the nineteen partial-thickness rotator cuff tears and magnetic resonance imaging, twelve of the nineteen. The overall accuracy for both imaging tests was 87%. Ultrasonography correctly predicted the degree of retraction of 73% of the full-thickness tears and the length of 85% of the partial-thickness tears, and magnetic resonance imaging correctly predicted the retraction and length of 63% and 75%, respectively. Ultrasonography correctly predicted the width of 87% of the full-thickness tears and 54% of the partial-thickness tears, and magnetic resonance imaging correctly predicted the width of 80% and 75%, respectively. No significant differences between ultrasonography and magnetic resonance imaging were demonstrated (p > 0.05). CONCLUSIONS: Ultrasonography and magnetic resonance imaging had comparable accuracy for identifying and measuring the size of full-thickness and partial-thickness rotator cuff tears. When an investigator has comparable experience with both imaging tests, the decision regarding which test to perform for rotator cuff assessment does not need to be based on accuracy concerns. The choice can be based on other factors, such as the importance of ancillary clinical information (regarding lesions of the glenoid labrum, joint capsule, or surrounding muscle or bone), the presence of an implanted device, patient tolerance, and cost.

Adult↗

PubMed2004

A short pain survey for postoperative assessment of spine patients in a nonacademic setting.

Surveys for assessing outcomes of spine surgery are typically cumbersome and require statistical analyses, which make their use impractical in nonacademic settings. The objective of this study was to develop a short pain survey (SPS) to assess patient satisfaction following spinal surgery and to compare the results with those of the Brief Pain Inventory-Short Form (BPI-SF), which is widely used in academic settings. Patients (n = 101) completed the BPI-SF prior to spinal fusion. Six months after surgery, patients completed the BPI-SF and SPS. Marginal homogeneity tests and paired t tests of the BPI-SF indicated highly significant (p < .001) postoperative improvements. One-sample binomial tests and Blyth-Still-Casella 95% confidence intervals also indicated highly significant (p < .001) postoperative improvements with SPS. There was a highly significant congruence (p < .002) between the responses for the two surveys. It was concluded that the SPS can be easily used in nonacademic settings to assess patient satisfaction and clinical success following spine surgery.

Health Status Indicators↗

PubMed2003

Visibility of trabecular structures in oral radiographs.

OBJECTIVES: To determine whether alveolar trabecular bone is visible and quantifiable in projection radiographs. Radiographic changes in oral trabecular bone have been studied as possible indications of bone loss, but in some previous studies, observed structures have been attributed entirely to the endosteal surface. METHODS: Computed radiography (CR) images of human mandibles in molar and pre-molar regions were compared with simulations calculated from high-resolution computed-tomography (CT) and micro-CT volumes. By digitally editing the CT volumes, the simulations were separated into trabecular and cortical components. High-pass-filtered CR images revealed structural details of cortical and trabecular bone. RESULTS: Trabecular bone constitutes as much as 38% of the total alveolar bone, and accounts for most of the observed alveolar fine structure. Several morphological types of fine structure can be distinguished. The noise in filtered images appears to be a meaningful measure of trabecular bone. CONCLUSION: Trabecular bone is highly visible in intraoral radiographs.

Alveolar Process↗

PubMed2003

Digital image analysis of cadaver mandibular trabecular bone patterns.

BACKGROUND: The purpose of this study was to investigate the source of radiographic trabecular patterns by removing trabecular bone in four sequential steps from six cadaver mandible sections, radiographing the sections after each removal, and using four digital-image analysis methods to quantify any resulting changes to the radiographs. METHODS: Mandible sections were cut sagittally into halves. Trabecular bone was removed from each section in four stages. Following each stage, standardized radiographs were taken, using direct digital equipment. Trabecular bone in the resulting digital images was measured with four methods. Mean gray level values (method 1) and cumulative percent histograms (method 2) were calculated from the raw data. Morphological image processing was used to skeletonize the trabecular structure, which was quantified by counting the number of trabecular ends and segments in the skeletonized images (method 3) and performing fractal analyses of the skeletonized images (method 4). Repeated measures analysis of variance (ANOVA) was used to test for changes in measurements attributable to bone removal. RESULTS: Repeated measures ANOVA indicated that the use of gray levels, cumulative percent histograms, and morphologic operators resulted in highly significant changes in measurements following bone removal (P < 0.01). Ends and segments demonstrated similar performance, with changes highly significant over time (P < 0.01). Fractal analysis also resulted in highly significant changes over time (P < 0.01). CONCLUSIONS: The analyses performed in this study demonstrated consistent image differences following the four steps of bone removal. These differences appeared whether light, cancellous bone or heavier endosteal bone was removed. These findings indicate that trabecular and endosteal bone combine to form the structure that most dentists identify as trabeculae on intraoral radiographs.

Analysis of Variance↗

PubMed2003

Sonography of the medial collateral ligament of the elbow: a study of cadavers and healthy adult male volunteers.

OBJECTIVE: We assessed the ability of high-resolution sonography to reveal the size and echogenicity of the anterior bundle of the normal medial collateral ligament of the elbow in cadavers and uninjured male volunteers. MATERIALS AND METHODS: The anterior bundle of the medial collateral ligament in five cadaveric elbows was imaged and injected with contrast material by experienced musculoskeletal radiologists using a 12-MHz linear array transducer. Immediate ligament dissection was performed. The bilateral ligaments in 30 healthy 21- to 34-year-old male volunteers were imaged with gravitational stress. Of these, five randomly selected subjects also received approximately 5 lb (11.3 kg) of applied stress. RESULTS: Contrast material was injected directly into all five cadaveric ligaments. The anterior bundle of the medial collateral ligament in all 30 asymptomatic male volunteers was hyperechoic in comparison with surrounding muscle and had a fibrillar pattern and fanlike shape. Its mean dimensions were 2.6 +/- 0.31 x 2.2 +/- 0.47 x 4.0 +/- 0.88 mm on the right and 2.6 +/- 0.36 x 2.1 +/- 0.42 x 4.0 +/- 0.86 mm on the left, in longitudinal short, transverse short, and transverse long axes, respectively. Differences in ligament measurements in sidedness, stress application, and hand dominance did not approach statistical (Bonferroni corrected, p > 0.01) or clinical (all differences, <0.2 mm) significance. CONCLUSION: Radiologists can accurately use sonography to identify and measure the size of the anterior bundle of the normal medial collateral ligament of the elbow. These baseline parameters for the normal ligament may prove useful when evaluating the injured ligament.

Adult↗

PubMed2002

Alveolar and postcranial bone density in postmenopausal women receiving hormone/estrogen replacement therapy: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: We conducted a 3-year, double-blind, randomized, placebo-controlled study to determine whether the positive effects of hormone/estrogen replacement therapy (H/ERT) on postcranial bone density are accompanied by similar positive effects on oral bone mass. METHODS: A total of 135 postmenopausal women (aged 41-70 years) with no evidence of moderate or severe periodontal disease were randomized to receive daily oral conjugated estrogen (Premarin; 0.625 mg) alone or in combination with medroxyprogesterone acetate (Prempro; 0.625 and 2.5 mg, respectively) or placebo. All subjects received calcium carbonate (1000 mg/d) and cholecalciferol (400 [corrected] IU/d) supplements. The primary efficacy end points were the changes in alveolar crest height and alveolar bone density. Alveolar crest height was measured on bite-wing radiographs, and changes in alveolar bone mass were assessed by means of digital-subtraction radiography. Postcranial bone density was measured in the lumbar spine and left proximal femur by means of dual-energy x-ray absorptiometry. RESULTS: Hormone/estrogen replacement therapy significantly increased alveolar bone mass compared with placebo (+1.84% vs +0.95% [P =.04]), and tended to improve alveolar crest height (+4.83% vs +3.46% [P =.34]). Bone mineral density of the proximal femur significantly increased in the H/ERT compared with the placebo group (total proximal femur, +3.59% vs +0.22% [P =.001]; neck, +2.05% vs -0.34% [P =.02]; trochanter, +3.49% vs +0.08% [P<.001]), but not the lumbar spine (+1.01% vs +0.17% [P =.39]). Changes in alveolar bone mass correlated with bone density changes in the total femur (r = 0.28 [P =.02]) and femoral trochanter (r = 0.25 [P =.04]) in the H/ERT but not in the placebo group. CONCLUSIONS: Postcranial and oral bone mass were increased in postmenopausal women receiving H/ERT. Improvement in oral bone health constitutes an additional benefit of H/ERT.

Absorptiometry, Photon↗

PubMed2002

The pattern of alveolar crest height change in healthy postmenopausal women after 3 years of hormone/estrogen replacement therapy.

BACKGROUND: The loss of ovarian function at menopause is associated with loss of postcranial and oral bone. Hormone/estrogen replacement therapy (HRT/ERT) has a positive effect on both postcranial and oral bone. The objective of the study was to determine if the positive effect of HRT/ERT on alveolar crest height (ACH) is generalized or site specific. METHODS: The sample consisted of 49 women who completed a 3-year, HRT/ERT prospective study. Cemento-enamel junction distances (ACH) were measured on digitized images of bitewing radiographs. Lumbar spine and proximal femur bone mineral densities (BMDs) were determined with dual-energy x-ray absorptiometric scans. Measurements were made at baseline and at the end of year 3. For the 3-year study period, mean change in ACH was determined for each patient. In addition, the sites with the greatest, second and third greatest ACH changes were determined for each patient. Correlations between changes in ACH (as determined by the various methods) and postcranial BMD were determined. RESULTS: Mean ACH changes had an average correlation (r) of -0.24 with femoral and lumbar spine BMDs. Although the largest site-specific change in ACH resulted in a mean correlation of -0.21, the correlations for the second and third largest changes in ACH dropped to -0.15 and -0.12. Overall, the correlations for site-specific changes were substantively smaller than those for generalized change. CONCLUSIONS: The data of this study indicate that ACH change attributable to HRT/ERT is generalized rather than site specific. Studies of the effect of HRT/ERT on ACH should employ multiple measurements to minimize measurement errors associated with site-specific measurements.

Absorptiometry, Photon↗

PubMed2002

Relationships between clinical attachment level and spine and hip bone mineral density: data from healthy postmenopausal women.

BACKGROUND: There are physiological reasons to expect an association between bone mineral density of the spine and hip and attachment loss. To this point, however, most studies have found no correlation. METHODS: The 135 patients in this report were part of a randomized controlled trial of estrogen replacement. All patients were in good oral health at entry and received annual oral prophylaxis as part of the study. Standard probing measurements were made with a pressure sensitive probe at 6 sites on each tooth. Bone mineral density was measured with dual-energy x-ray absorbtiometry at the lumbar spine (anterior-posterior and lateral) and proximal femur (neck, trochanter, intertrochanter, Ward's triangle, and total area). These procedures were performed at baseline and at annual intervals for 3 years. RESULTS: Correlations between cross-sectional measurements of clinical attachment level and bone mineral density were very weak, and did not approach statistical significance (-0.06 < or =r < or =0.10, 0.15 < or =P < or =0.75). A few somewhat stronger correlations were found between longitudinal changes in bone mineral density and attachment (-0.20 < or = r < or =-0.02, 0.02 < or = P < or =0.81). Although the correlations in the longitudinal changes were weak, they were consistently in the direction of greater bone mineral density being associated with less attachment loss. CONCLUSIONS: There is no clear association between clinical attachment level and bone mineral density of the lumbar spine and proximal femur, whether examined on a cross-sectional or longitudinal basis. Patterns in the data suggest there may be a weak association in the longitudinal changes.

Absorptiometry, Photon↗