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Biomedical subjects

S Sonne-Holm

Publications and source records attributed to S Sonne-Holm.

At least 19 recordsLinked to original sources

Digital x-ray radiogrammetry identifies women at risk of osteoporotic fracture: results from a prospective study.

Using digital X-ray radiogrammetry (DXR) on hand radiographs from a large population-based study, 1,370 postmenopausal women were evaluated in a prospective fashion; fracture occurrence was compared with DXR measurements of historic radiographs. Further, the aim of the study was to evaluate factors affecting DXR bone mineral density (BMD) in this cohort. The study is based on data from a subgroup of women participating in the third Copenhagen City Heart Study and additional data from a questionnaire obtained in 1999. The mean follow-up time was 6.1 years. During the observation period, 245 women suffered a fracture. Odds ratios (ORs) per 1 standard deviation decline in DXR-BMD were statistically significant for fracture in the groups of wrist fractures, proximal humerus fractures, vertebral fractures, and other fractures as well as in the total fracture group. In the hip fracture group, the P value almost reached significance (0.052). The highest ORs (2.4) were found in the group with proximal humerus fractures and in the vertebral fracture group (2.0). In the wrist fracture and hip fracture groups, ORs were 1.7 and 1.4, respectively. The group with other fractures had an OR of 1.7, and the OR in the entire fracture group was 1.6. Age, fracture, and smoking were negatively correlated with DXR-BMD, whereas BMI, age at menopause, hormone replacement therapy, and physical fitness and muscle strength were positively correlated with DXR-BMD. In conclusion, BMD estimated by DXR of the metacarpals predicts later osteoporotic fracture and seems to provide meaningful information on bone mass in epidemiological studies, where DXA measurements are not available.

Absorptiometry, Photon↗

Osteoarthritis of the first carpometacarpal joint: a study of radiology and clinical epidemiology. Results from the Copenhagen Osteoarthritis Study.

BACKGROUND: The radiological and epidemiological data from the Copenhagen Osteoarthritis Study (COS) were analysed in order to assess the prevalence of osteoarthritis (OA) of the first carpometacarpal joint (CMCJ). Another aim of the study was to analyse relationships between radiologic CMCJ OA and self-reported pain. The third aim was to analyse if additional information could be obtained applying a new method of correlating individual radiological features to self-reported pain, compared to Kellgren and Lawrence's (K-L's) radiologic OA classification. METHODS: Between 1992 and 1994 standardised radiographs of both hands were recorded in 3,355 participants of the COS cohort. Subjects with known rheumatoid arthritis, other inflammatory arthritis or earlier fractures of the hand were excluded. OA of the CMCJ was assessed according to K-L's radiologic classification by two senior radiologists at our institution. The radiologists further evaluated individual radiologic features of CMCJ OA as recommended by K-L according to the text attached to each picture in their radiologic atlas of OA. To estimate inter- and intraobserver reproducibility a subset of 100 radiographs was reread. RESULTS: Our analyses demonstrated that the K-L method was not able to classify all X-rays. In 608 (18.1%) cases, combinations of joint space width (JSW) measurements, the graduation of osteofytes, sclerosis and cysts fell outside the classification. The radiological evaluation of individual features of OA demonstrated an acceptable reproducibility, intrapersonal (kappa=0.79) as well as interpersonal (kappa=0.65). The prevalence of each radiological feature increased after the fifth decade, progressively more so among women (P<0.001), with the highest prevalence (36.0%) of grades 3 and 4 JSW reduction among women>80 years. A significant correlation was found between signs of radiologic degeneration and self-reported pain (P<0.001); however, different combinations of OA features had different relations to symptoms. Logistic regression analyses revealed sclerosis to have an independent influence on pain in the thumb compared with the presence of osteofytes, cysts and diminished JSW. Body mass index (BMI) was positively related to radiological changes. In logistic regression analyses BMI did not demonstrate an independent positive relation to OA. CONCLUSION: Radiological degenerative changes in the CMCJ by age especially among women are quite common. However, it is demonstrated that global radiologic classifications of OA of the CMCJ have serious limitations in epidemiological studies. Not all cases fit into classification based on the K-L-atlas. Among the radiological features, subchondral sclerosis is significantly related to self-reported pain. Specific radiologic data should be incorporated in epidemiological studies on hand OA.

Age Distribution↗

Joint space width in dysplasia of the hip: a case-control study of 81 adults followed for ten years.

In a longitudinal case-control study, we followed 81 subjects with dysplasia of the hip and 136 control subjects without dysplasia for ten years assessing radiological evidence of degeneration of the hip at admission and follow-up. There were no cases of subluxation in the group with dysplasia. Neither subjects with dysplasia nor controls had radiological signs of ongoing degenerative disease at admission. The primary radiological discriminator of degeneration of the hip was a change in the minimum joint space width over time. There were no significant differences between these with dysplasia and controls in regard to age, body mass index or occupational exposure to daily repeated lifting at admission. We found no significant differences in the reduction of the joint space width at follow-up between subjects with dysplasia and the control subjects nor in self-reported pain in the hip. The association of subluxation and/or associated acetabular labral tears with dysplasia of the hip may be a conditional factor for the development of premature osteoarthritis in mildly to moderately dysplastic hips.

Adult↗

Hip dysplasia: a significant risk factor for the development of hip osteoarthritis. A cross-sectional survey.

OBJECTIVES: The aim of this cross-sectional survey of 2232 women and 1336 men (age range 20-91 yr) was to investigate individual risk factors for hip joint osteoarthritis (OA). METHODS: Standardized, weight-bearing pelvic radiographs were evaluated. Radiological hip joint OA was defined as minimum joint space width (JSW) </=2.0 mm. Hip dysplasia was evaluated according to common radiographic indices. Radiographic findings were correlated to general health and lifestyle information obtained at baseline examinations and questionnaires. The study focused on age; self-reported hip pain, occupational exposure to repeated daily lifting, body mass index, smoking and hip dysplasia. RESULTS: Hip dysplasia (HD) prevalence ranged from 5.4-12.8% depending on the radiographic index applied. Hip OA prevalence was 1.0-2.5% in subjects <60 yr of age and 4.4-5.3% in subjects >/=60 yr of age. Of factors entered into logistic regression analyses, only age (P<0.001 for right hips and P<0.001 for left hips) and hip dysplasia (P<0.001 for right hips and P = 0.004 for left hips) were significantly associated with hip OA prevalence in women. In men, only hip dysplasia was associated with hip OA prevalence, P<0.001 in right hips and P = 0.001 in left hips. CONCLUSIONS: Of the individual risk factors investigated in this study, only age and hip dysplasia were associated with the development of hip osteoarthritis.

Adult↗

Factors influencing hip joint space in asymptomatic subjects. A survey of 4151 subjects of the Copenhagen City Heart Study: the Osteoarthritis Substudy.

OBJECTIVE: The aims of the study were to investigate the distribution of hip joint space width (JSW) in asymptomatic subjects without radiologic evidence of degeneration, and investigate the influence of age, sex, physical parameters, occupational activity, and smoking on JSW. MATERIALS AND METHODS: The distribution of minimum JSW was determined in hip joints in standardized, weight-bearing pelvic radiographs of the Copenhagen City Heart Study: The Osteoarthritis Substudy cohort of 4151 subjects. Asymptomatic subjects without radiologic osteoarthritis were included (1018M/1554F). Occupational exposure to repeated daily lifting, smoking, and physical parameters were registered for each individual. RESULTS: Overall, female minimum JSW was significantly smaller compared with male JSW (P < 0.0001). Female minimum JSW decreased significantly with age (P < 0.0001), while male minimum JSW remained relatively unaltered throughout life (P(right) = 0319, P(left) = 0.18). Minimum JSW correlated positively with height, weight, and BMI, as did femoral head radius. Multiple logistic regression analysis revealed significant influence of sex and age on minimum JSW in females only. Positive or adverse effects of cigarette smoking on hip JSW were not documented. Type and duration of occupational exposure to repeated daily lifting did not affect hip JSW significantly. CONCLUSION: Minimum JSW decreased progressively with age in women, while it was unaltered in men. A history of smoking or different occupational exposure to repeated daily lifting did not influence minimum hip JSW significantly. Differences in body mass index, height or weight did not significantly influence minimum hip joint JSW.

Adult↗

Studies on YKL-40 in knee joints of patients with rheumatoid arthritis and osteoarthritis. Involvement of YKL-40 in the joint pathology.

OBJECTIVE: The presence of YKL-40 (human cartilage glycoprotein 39) in synovium, cartilage and synovial fluid (SF) from knee joints of patients with rheumatoid arthritis and osteoarthritis (OA) were related to histopathological changes in synovium and cartilage and to serum YKL-40 and other biochemical markers. METHODS: The localization of YKL-40 in synovium and cartilage was determined by immunohistochemistry. Synovial inflammation was estimated histologically and by magnetic resonance imaging (MRI). Biochemical markers of inflammation, neutrophil activation and cartilage metabolism were analysed. YKL-40 concentrations in serum and SF were determined by RIA and ELISA. RESULTS: In the synovium YKL-40 positive cells were found in lining and stromal cells (macrophages) and the number of YKL-40 positive cells was related to the degree of synovitis. In arthritic cartilage, YKL-40 was located to chondrocytes. YKL-40 levels in SF were higher in RA patients with moderate/severe or none/slight synovitis of the knee joint compared to OA patients with moderate/severe or none/slight synovitis. SF YKL-40 correlated with the synovial membrane and the joint effusion volumes determined by magnetic resonance imaging (MRI) and with other biochemical markers of intercellular matrix metabolism. SF YKL-40 was higher than serum YKL-40, and a relationship existed between the YKL-40 levels in SF and serum. Intraarticular glucocorticoid injection was followed by clinical remission and a decrease in serum YKL-40, which increased again at clinical relapse. CONCLUSIONS: YKL-40 in SF is derived from cells in the inflamed synovium, chondrocytes and SF neutrophils. Joint derived YKL-40 influences serum YKL-40. YKL-40 may be involved in the pathophysiology of the arthritic processes and reflect local disease activity.

Adipokines↗

[Bone lengthening. History of the development and field of applications].

Leg lengthening has been performed since early in this century. The first successful lengthening was reported in 1905. Leg lengthening evolved from forced lengthening of the bone during anaesthesia, through use of cortical bone grafts, plate and screws to callus distraction (callotasis). Development of external fixators and evolution of biological concepts of bone regeneration has been important. In 1951 Ilizarov developed his apparatus. Ilizarov pioneered the biology of bone and soft-tissue regeneration. He performs a percutaneous subperiosteal corticotomy and waits five to seven days prior to distraction with a rate of 0.25 mm of length four times each day. The method has increased the opportunities in reconstructive bone surgery. The technique is difficult with many problems and obstacles which can be overcome.

Bone Lengthening↗

Patient compliance and effect of orthopaedic shoes.

Orthopaedic shoes are individually handmade after a prescription from an orthopaedic surgeon, hence relatively expensive. Bad compliance is mentioned in the literature but not investigated. In order to evaluate patient compliance and the effect of orthopaedic shoes, 85 patients who were prescribed orthopaedic shoes at the authors' department during a 3 year period received a questionnaire concerning relief of symptoms and daily use of the shoes. The answers from 74 patients were correlated to the prescription procedure and the degree of medical follow-up. Only 60 of 74 patients used their shoes. Some 51 patients had some benefit while 23 had no effect or even worse symptoms. Some patients even used their shoes despite no symptomatic relief. However, patients who felt they were well informed about the purpose and function of their shoes had more benefit than the rest. Only 12 patients of the 74 were checked by the orthopaedic surgeon after delivery of the shoes. In conclusion the authors believe there is a great need for information to be given to the patients about the functions and limitations of orthopaedic shoes and that every patient should be offered a control check-up by the surgeon. Further investigations of the effect of orthopaedic shoes should be carried out to optimise the use of these expensive devices.

Aged↗

Quantification of synovistis by MRI: correlation between dynamic and static gadolinium-enhanced magnetic resonance imaging and microscopic and macroscopic signs of synovial inflammation.

Dynamic and static gadolinium-diethylenetriaminepentaacetic acid(Gd-DTPA)-enhanced magnetic resonance imaging (MRI) were evaluated as measures of joint inflammation in arthritis, by a comparison with macroscopic and microscopic signs of synovitis. Furthermore, the importance of the size of the evaluated synovial areas was investigated, as was the optimal time for enhancement measurements. Seventeen rheumatoid arthritis knees and 25 osteoarthritis knees, scheduled for arthroscopy or arthrotomy, were included. Macroscopic and microscopic synovial inflammation as well as nine histologic tissue characteristics were graded at four preselected biopsy sites. Preoperative T1-weighted dynamic fast low angle shot and static spin-echo Gd-enhanced MRI were performed. The dynamic enhancement rate and the static enhancement were measured in the entire synovial membrane of a preselected slice as well as at the four biopsy sites, and compared to synovial pathology. The rate of early enhancement of the total synovial membrane of the preselected slice, determined by dynamic MRI, was highly correlated with microscopic evidence of active inflammation (Spearman p = 0.73; p < 10(-7). Dynamic MRI could distinguish knees with and without synovial inflammation with a high predictive value (0.81-0.90). Moderate and severe inflammation could not be differentiated. The early enhancement rate was correlated with histologic features of active inflammation, particularly vessel proliferation and mononuclear leucocyte infiltration. Dynamic evaluation of small synovial sections at the biopsy sites and static spin-echo MRI resulted in considerably weaker correlations to histologic inflammation than dynamic evaluation of the total synovium. The optimal time for enhancement measurements was one-half to one minute after Gd injection, as the highest correlation coefficients to histologic inflammation were observed in this interval. Dynamic MRI can be used to determine synovial inflammation. Evaluation of large synovial areas one-half to one minute after Gd injection best reflects joint inflammation.

Adult↗

Effect of intraarticular osmic acid on synovial membrane volume and inflammation, determined by magnetic resonance imaging.

The changes in MR-determined synovial membrane volume, early synovial enhancement, and cartilage and bone erosions after osmic acid knee synovectomy were studied. Gadolinium-DTPA enhanced magnetic resonance imaging (MRI) of 18 knees with persistent arthritis was performed before and 1 month after treatment. The synovial membrane volume was significantly reduced (median -52%) in all 9 patients brought into clinical remission (p < 0.01), while no significant change was found in patients with clinical relapse. The early synovial enhancement was not significantly changed. MRI revealed progressive erosive changes in 2 patients. The time of relapse was correlated to a MR-erosion score, but not to early synovial enhancement or volumes of synovium or effusion (Spearman tests). MRI-determined synovial membrane volumes and early synovial enhancement may be objective quantitative markers of inflammation. MR-scores of cartilage and bone erosions are sensitive to progressive changes occurring within a month.

Adult↗

Compromise of the spinal canal in Proteus syndrome.

We report on 2 children with spinal stenosis and neurologic sequelae. They illustrate the 2 ways in which spinal compromise may develop in Proteus syndrome--vertebral anomalies or tumor infiltration. In one patient, spinal stenosis resulted from an angular kyphoscoliosis. In the other, cord compression resulted from infiltration of a paraspinal, intrathoracic angiolipoma.

Angiolipoma↗

[Purulent coxitis with hip luxation and acute peritonitis].

A boy aged five months was admitted to a hospital elsewhere on account of failure to thrive for three weeks and intermittent pyrexia. X-ray revealed dislocation of the right hip. After attempted reduction, the infant developed peritonitis. Laparotomy revealed pus which originated from purulent coxitis draining through a defect at the base of the acetabulum. Arthrocentesis should be performed in children with acute coxitis and high fever. If pus or cloudy joint fluid is obtained, the hip joint should be opened and drained at the same session. Neglected purulent coxitis results in destruction of the joint and prolonged incapacity which was the result in the case reported here.

Acute Disease↗

Talectomy for equinovarus deformity in arthrogryposis. A 13 (2-20) year review of 17 feet.

Ten children (17 feet) with arthrogryposis multiplex congenita and severe, rigid equinovarus deformity underwent talectomy to bring the foot plantigrade. One child had a bilateral talectomy after only one manipulation, whereas the others were operated on an average of three times before talectomy. After a mean follow-up of 13 years, 14 out of 17 feet were satisfactory. We recommend that children with arthrogryposis and severe rigid equinovarus deformity be treated with talectomy before the expected age of walking.

Adolescent↗

[The Swanson silicone implant for wrists in rheumatoid arthritis].

The Swanson silastic implant was employed in 16 wrists in 13 patients who were followed up for a median of 59 months. At follow up examination, pain had decreased in ten wrists while three remained unchanged. Ten patients were satisfied with the total result. Only few complications occurred. Prosthetic fracture occurred in two wrists (14%). The authors consider that the Swanson silastic wrists implant can produce favourable results in patients with rheumatoid arthritis with moderate to severe radiological destruction.

Adult↗

Epidemiology of meniscal lesions in the knee. 1,215 open operations in Copenhagen 1982-84.

In a suburban area of Copenhagen with approximately 620,000 inhabitants, all the openly operated on meniscal lesions of the knee joint between 1982 and 1984 inclusive were reviewed. The mean annual incidence of meniscal lesions per 10,000 inhabitants was 9.0 in males and 4.2 in females. The highest incidences were seen in the 3rd, 4th, and 5th decades of life. A higher frequency of trauma related to onset of symptoms was found among males (77 percent) than among females (64 percent). The bucket-handle lesion was the most frequent type of meniscal lesion in males (35 percent), whereas peripheral detachment was the most frequent in females (41 percent). A variable frequency of trauma inducing the lesions in males and females did not explain differences in type of meniscal lesion. Nineteen percent of our 1,215 patients had a partial meniscectomy, whereas 0.7 percent had meniscal repair.

Adolescent↗

Long-term changes of body weight in adult obese and non-obese men.

In this study the long-term changes of body weight during adulthood in men obese as young adults are compared to those occurring in a random sample from the underlying population. Among 362,200 Danish draftees from 1943 to 1977, 1940 were obese (body mass index greater than or equal to 31 kg/m2). A random sample, comprising 0.5 per cent (1801), was drawn from the remaining population. In 1981-83, 4-40 years later, those living in the same region were invited to a health examination, which was attended by 964 (58 per cent) obese and 1134 (75 per cent) control subjects. In the obese group median change of body weight was 1.3 kg, and in the control group 8.3 kg. Weight change was positively correlated to duration of observation in both groups. Those with lowest body mass index at first examination tended to increase most, and those with highest body mass index tended to lose weight. However, the 5th to 95th percentiles of changes in body weight extended in the obese group from -24 to 29 kg, and in the control group from -2 to 25 kg. The range in weight change increased strikingly with increasing first body mass index exceeding 27 kg/m2. The study indicates that the greater the body mass index among young adult men, the less is the median change in body weight, but the greater is the variation of the body weight changes. These results suggest that the size of the fat mass is subject to intra-individual environmental influences that change over time.

Adult↗