Biomedical subjects
Publications and source records attributed to R J Coles.
We report the case of a 76 year old woman who presented with a clinical picture initially typical of a vascular dementia. The diagnosis was revised to Creutzfeldt-Jacob Disease in the terminal stages. While Creutzfeldt-Jacob Disease is rare, one must consider it in the differential diagnosis as it can mimic other dementias particularly in the chronic form which we describe here.
Osteoporotic vertebral fractures result in loss of height and so regular measurement of stature may be a useful method for detecting the onset of the disease and monitoring its progress. The aim of this study was to evaluate the reliability of height measurement in a clinical setting by estimating its precision and the effects of diurnal variation and supine bone densitometry. Duplicate measurements of standing height were made in 50 normal volunteers (25 female) in the morning and 7h later; similar measurements were made in 25 female patients before and after densitometry (spine, one hip and whole body). Portable Harpenden stadiometers were used. The pooled standard deviation (coefficient of variation) ranged from 0.9 mm (0.05%) to 1.7 mm (0.11%). Significant height decrease (> 6 mm) occurred in volunteers during the course of a day while patients showed a significant increase (> 5 mm) after lying supine for an average period of 49 min. Height can be estimated precisely if measurements are made consistently, i.e. using the same equipment and technique, at the same time of day and before bone densitometry. The provision of stadiometers in primary care surgeries and hospital clinics would provide a simple, inexpensive and non-invasive method of assessing the progress of spinal osteoporosis.
Explore the source record for details and available documents.
A 14-y follow-up of 581 children who took part in a randomized controlled trial of the effect of a milk supplement on growth of children was conducted to investigate the supplement's effect on adult bone mineral content (BMC) and density (BMD). BMC and BMD of the nondominant forearm were measured by single-photon absorptiometry in 371 subjects (64%) aged 20-23 y, at a proximal site (shaft of radius and ulna) and at a distal site near the wrist. BMCs and BMDs tended to be higher in the intervention group (NS). Cross-sectionally, BMD was positively associated with body weight (P less than 0.01) in both sexes; inversely associated with alcohol consumption (P less than 0.05), and positively with manual occupation (NS) in men; positively associated with current intakes of calcium (P less than 0.05), vitamin D (P less than 0.01), and sports activity during adolescence (P less than 0.01), and inversely with parity (NS) in women. In multiple linear-regression analysis body weight and sports activity during adolescence were stronger determinants of female BMD than was diet.
Bone mineral density of the radius was measured by single-photon absorptiometry in 50 patients with inflammatory bowel disease. Thirty-three had Crohn's disease and 17 ulcerative colitis; 25 were women. The mean age was 45 years (range, 18-70 years). Measurements were repeated in 39 of them after a mean follow-up period of 7.9 years (range, 7.1-8.2 years). In female patients the mean (95% confidence interval) annual change in radial bone mineral density was -0.74% (-1.34% to -0.14%) (P = 0.022), the greatest bone loss occurring in postmenopausal women (mean, -1.16% (-2.01% to -0.30%)). In male patients the mean annual rate of bone loss was -0.07% (-0.41% to 0.28%) (P = NS). Patients with abnormally low values at the first measurement remained osteopenic at the second measurement, whilst some others with normal values initially showed increased rates of bone loss and had a subnormal bone mineral density after the follow-up period. These results show increased rates of cortical bone loss in some patients with inflammatory bowel disease and emphasize the need to monitor bone mass in these patients so that prophylactic measures can be instituted.