M Bicocchi | PubMed Health

PubMed1997

Three-year longitudinal study with quantitative ultrasound at the hand phalanx in a female population.

A longitudinal study was conducted to assess the value of quantitative ultrasound (QUS) measurement in predicting the risk of fracture and to evaluate how QUS parameters change with ageing and the climacteric. A group of 211 female subjects underwent assessment by QUS at the distal metaphysis of the first phalanx of the last four fingers of the hand on two occasions 3 years apart. The subjects were selected from outpatients attending the orthopaedic clinic, provided they were not affected by metabolic disease or under treatment with drugs known to interfere with bone metabolism. In vivo the coefficient of variation and the standardized coefficient of variation of the QUS device were respectively 0.5% and 3.5%. The correlation between the values of the amplitude-dependent speed of sound (AD-SoS) in the two measurements was r = 0.92. In 77.3% of the subjects during the observation period we recorded a reduction in AD-SoS. During the study 22 fractures were observed in peripheral sites, 8 of which were associated with 'low-energy trauma'. By multiple logistic regression analysis we found that the relative risk of fracture for a 1 SD reduction in AD-SoS was 1.5 (95% CI 1.1-1.7) (p < 0.03). The percentage of low-energy fractures significantly increased among those subjects with an AD-SoS value lower than 1850 m/s (T-score < -3.5) at the first examination (p <0.0001). QUS investigation proved to be especially sensitive to hormonal changes associated with the climacteric: we observed a mean decrease of 56 m/s in the AD-SoS for women who entered the menopause between the first and the second QUS test (average time since menopause 2 years), as against 10 m/s in subjects remaining premenopausal. In a group of 146 subjects with 'normal' Ad-SoS at the first examination, we observed a significant reduction in AD-SoS only after 40 years of age. This study demonstrates that measurement of the AD-SoS at the phalanx is reproducible, can be employed to assess the risk of fracture, and is able to detect age-related alterations in bone tissue.

Adult↗

PubMed1996

[Bronchial involvement in sarcoidosis. Study with high resolution computerized tomography].

We investigated the HRCT findings of bronchial abnormalities in thoracic sarcoidosis, the post-treatment reversibility of such patterns and their specificity for sarcoidosis. Sixty-one sarcoidosis patients were submitted to chest radiography and HRCT at onset. The diagnosis had transbronchial biopsy confirmation in all patients. HRCT was repeated in 21 patients after a cycle of steroid therapy. Sarcoidosis patients were randomized with 29 patients with diffuse infiltrative lung diseases of different nature. The HRCT findings of bronchial abnormalities follow: extrinsic bronchial compression or displacement by lymphadenopathies (regular/irregular), bronchial wall thickening (regular/irregular), bronchial lumen abnormalities, traction bronchiectasis and bronchiolectasis. Bronchial abnormalities were found in the first HRCT study in 44/61 sarcoidosis patients (72.1%), in 18 patients with extrinsic bronchial compression or displacement by lymphadenopathies (40.9%), in 2 with bronchiectasis or bronchiolectasis (4.5%) and in 24 with one or more other abnormalities (54.5%). Bronchial signs were found in 16/21 patients examined with HRCT after steroid therapy (76.1%). Bronchial abnormalities remained unchanged in 11 patients (68.7%), they improved or disappeared in 5 patients (31%) and appeared ex novo in 2 patients. HRCT patterns of bronchial abnormalities were found in 17/29 patients with other diseases (58.6%), with high rates of bronchial wall thickening and bronchiectasis or bronchiolectasis. The most common HRCT bronchial finding in sarcoidosis was extrinsic bronchial compression of displacement by lymphadenopathies. This was the only sign which could actually differentiate sarcoidosis from other patients (p < 0.01). Other signs (bronchial lumen abnormalities and bronchial wall thickening) were frequently found in both sarcoidosis and non-sarcoidosis patients and did not permit to distinguish the former from the latter. In our experience, HRCT findings of bronchial abnormalities were frequently observed in sarcoidosis patients, but they are not specific enough to diagnose sarcoidosis and their usefulness is limited in predicting posttreatment reversibility (activity evaluation) of this condition.

Adult↗