[Bone lesions in patients with multiple myeloma].
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Biomedical subjects
Publications and source records attributed to M Tsubuku.
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The detection of skeletal involvement in multiple myeloma (MM) is often difficult. Plain radiographs have a very low yield in depicting skeletal lesions when they are confined to the bone marrow. The major advantage of bone scintigraphy is the ability to evaluate the entire skeletal system and to detect the bone lesions with a single examination. However it is well known that the false negative bone scan may occur frequently in MM. The advantage of magnetic resonance imaging (MRI) is the availability to detect myeloma foci within the spine, particularly early epidural involvement and spinal cord compression due to fracture. MRI is becoming increasingly routine in the work-up of patients with MM. Further investigations are required for the improved assessment of therapeutic response, correct diagnosis of diffuse bone marrow infiltration and distinction between pathologic and osteoporotic compression fractures.
A 70-yr-old man who was diagnosed as early gastric cancer showed leukocytopenia after total gastrectomy. Osteosclerotic findings on radiography were not remarkable. 99mTc-HMDP bone scintigraphy showed diffusely increased uptake in the axial skeleton, but visualization of the kidney and urinary bladder was apparent. However, whole body 201Tl-chloride scintigraphy showed diffuse abnormal visualization of axial skeleton. Physical and ultrasonographic examination indicated no abnormality in prostate. Afterward, further investigation, including bone marrow biopsy and immunohistochemical study, confirmed the diagnosis of bone metastasis from prostatic cancer. Microscopically, metastatic tumor cells were located in the intertrabecular space. Furthermore, no osteoclastic bone resorption or new trabecular bone formation was seen in this biopsy specimen. These findings suggest that whole body 201Tl-chloride scintigraphy can be a useful non-invasive diagnostic tool to investigate patients with suspicious malignancy in the bone marrow.
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This paper investigates the possible role of mechanical stress in the development of the osteoarthrotic lesions frequently observed in the patellofemoral compartment of the knee joint. First the location of these destructive lesions was determined by studying the location and pattern of contact in the patellofemoral joint. The study was carried out on 39 cadaveric knees for the range of flexion 0 degrees -120 degrees. It was shown that the lesions were localised to the areas corresponding to the range of flexion 40 degrees -80 degrees. These areas have been shown to be subjected to a low stress for most of the time and to a much higher stress for only part of the time. This mode of stressing this area of the cartilage is a consequence of the style of life of the average Western man in which the most predominant activity is level walking, during which the load and in turn the stress are much lower than they are during other ambulatory activities such as ramp and stair ascent and descent. The same area of the cartilage seems to be subject to a similar mode of stress during sedentary occupations. It is suggested that this mode of stressing the cartilage conditions it chemically, and hence mechanically, to transmit low stresses, so that when the much less frequent but higher stresses are applied it cannot transmit them without sustaining some damage.
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Magnetic resonance (MR) imaging of pituitary adenoma is usually carried out in dynamic studies with bolus contrast material injections, with the result that few strong images are obtained. Dynamic studies using a slowly injected contrast material were carried out in 14 cases of pituitary adenomas. The examinations were performed with a 1.5 Tesla superconducting MR imaging system using the spin-echo technique. Gd-DTPA (0.1 mmol/kg) was slowly injected (within 90 sec) by hand, providing seven to nine dynamic images during 350 sec from the start of injection. The average time to reach the maximum signal intensity was 170.6 sec in adenoma and 156.2 sec in normal gland tissue. The maximum contrast signal intensity ratio of adenoma to normal gland was 0.527 in the fifth image. The contrast of adenoma to normal gland tissue was calculated by the following formula: ASII (adenoma signal intensity index) = (adenoma signal intensity-tissue signal intensity)/tissue signal intensity. The most remarkable contrast between adenoma and normal tissue was obtained from the fourth to eighth images. In other words, we could obtain the strongest contrast at 144.8 sec to 299.6 sec from the start of contrast injection. Our results with slow injection suggest that stronger images can be obtained a longer period after contrast injection.