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Biomedical subjects

S Stuckey

Publications and source records attributed to S Stuckey.

At least 19 recordsLinked to original sources
PubMed2006

The solitary enhancing cerebral lesion: can FLAIR aid the differentiation between glioma and metastasis?

BACKGROUND AND PURPOSE: The purpose of this study is to investigate the diagnostic utility of fluid-attenuated inversion recovery (FLAIR) in differentiating between glioma and metastasis by assessing for nonenhancing adjacent cortical signal intensity abnormality in patients who present with a solitary enhancing cerebral lesion. METHODS: After approval from the institutional ethics committee was obtained, the MR imaging studies of 70 patients with a solitary enhancing lesion, without previous surgery or treatment, were reviewed. The axial FLAIR studies were initially reviewed for cortical involvement. If cortex involvement was detected, comparison with the axial T1, with and without gadolinium enhancement, was made to determine whether the cortex involvement was in an area without enhancement. If this was the case, the study was considered positive for glioma. Statistical analysis consisted of binary logistic regression and a 2 x 2 contingency table. RESULTS: Involvement of the adjacent cortex with FLAIR signal intensity abnormality but without enhancement was seen in 19 of 70 patients; 16 were gliomas and 3 were solitary metastasis. The sensitivity and specificity of this finding were 44% and 91%, respectively. The positive predictive value for glioma was 84%. CONCLUSION: FLAIR, when interpreted in concert with pre- and postgadolinium T1-weighted images, may be useful in differentiating glioma from metastasis when a solitary enhancing cerebral lesion is present. The presence of nonenhancing adjacent cortical involvement in a solitary enhancing lesion is a frequent and relatively specific sign.

Adult↗
PubMed2005

Macroscopic vascular invasion in synovial sarcoma evident on MRI.

We present a case of recurrent synovial sarcoma in the soft tissues of the calf, where MR imaging not only confirmed the diagnosis of tumour recurrence, but also demonstrated direct venous invasion and tumour thrombus within the popliteal vein and its tributaries. Venous invasion has particular relevance to synovial sarcoma prognostication and should be actively sought on MR imaging. To our knowledge this is the first reported case in the English literature of histologically proven macroscopic popliteal vein invasion from a synovial sarcoma demonstrated on MR imaging.

Amputation, Surgical↗
PubMed2005

The management of scaphoid fractures.

Appropriate management of scaphoid fractures is important because of the risk of long-term complications such as delayed or non-union, pain and disability. Up to 25% of scaphoid fractures are not visible on the initial radiographs. Consequently, all clinically suspected scaphoid fractures are treated as fractures with cast immobilisation until cause of the symptoms is clarified. The diagnosis often utilises a number of second line investigations that are generally performed 10-14 days after the injury. Bone scintigraphy is currently the most commonly used of these as it rarely misses a fracture. However, it does not visualise anatomical structure and therefore alternative diagnoses are difficult. Magnetic resonance imaging (MRI) is at least as sensitive and more specific than bone scanning and has the advantages of being able to identify other lesions and not expose the patient to any radiation. Furthermore, the scan may be performed as early as 2.8 days following an injury rather than 10 days later in the case of a bone scan. Although the cost of MRI is higher than other imaging modalities, it may be cost-effective in the overall management of patients with occult scaphoid fractures since it may prevent unnecessary cast immobilisation in active people. The most appropriate method of cast immobilisation is presently unclear but evidence exists for improved clinical outcomes in those that have both the thumb and elbow immobilised for the first six weeks.

Diagnostic Imaging↗
PubMed2004

Relationship between the area of cartilage shown on the magnetic resonance imaging middle-slice image of the medial and lateral tibial cartilages with cartilage volume and grade of osteoarthritis over time.

OBJECTIVE: Knee cartilage volume measurement requires significant time and training. Simplifying the measurement may improve feasibility. We investigated whether the area of cartilage shown on the middle slice of the medial and lateral tibial cartilages on sagittal MRI correlates with radiological features of osteoarthritis (OA), cartilage volume, and longitudinal change in cartilage volume. METHODS: One hundred and seventy-three subjects (normal and osteoarthritic), who had serial magnetic resonance imaging (cartilage volume measured) and baseline weight-bearing antero-posterior radiographs of the same knee were examined. RESULTS: In the lateral compartment, with increasing grade of OA there was a significant reduction in cartilage area. In the medial compartment, this was true for medial joint-space narrowing (after adjusting for gender). There was a moderate to strong association between cartilage area and volume, especially in those with early or no OA. However, when change over time was examined, the strength of these relationships was weak. CONCLUSION: Our data suggests that cartilage area may provide a simple surrogate measure of cartilage volume, in cross-sectional studies, after adjustment for gender: especially in subjects with early disease. However, before it can be widely used, further investigation will be required.

Aged↗
PubMed2004

Tibial cartilage volume change in healthy postmenopausal women: a longitudinal study.

OBJECTIVE: To determine whether the amount of joint cartilage in healthy postmenopausal women is stable or changes over time, and whether oestrogen replacement therapy (ERT) influences this. DESIGN: A cohort study in healthy postmenopausal women without knee pain, initially selected on the basis of having either used ERT long term (more than five years) or never having used ERT. METHODS: 81 women (42 taking ERT and 39 non-users) had baseline knee radiographs and magnetic resonance imaging (MRI) on the dominant knee; 57 of these (70%) were followed with repeat MRI approximately 2.5 years later. Knee cartilage volume was measured at baseline and at follow up. Risk factors assessed at baseline, including ERT use, were tested for their association with change in knee cartilage volume over time. RESULTS: 29 subjects who were initially taking ERT and 28 non-users at baseline completed the study. Total tibial articular cartilage decreased, on average, by (mean (SD)) 2.4 (3.2)% per year (95% confidence interval for mean, 1.5% to 3.2%). Average annual reduction in medial and lateral tibial cartilage was 2.4 (3.6)% (1.4% to 3.3%) and 2.3 (4.2)% (1.2% to 3.4%), respectively. No association between ERT and the rate of reduction in cartilage volume was shown. CONCLUSIONS: Mean tibial cartilage volume loss in healthy postmenopausal women is between 1.5% and 3.2% a year. Whether this rate of change is similar throughout adult life or in men will require further investigation.

Cartilage, Articular↗
PubMed2004

How does tibial cartilage volume relate to symptoms in subjects with knee osteoarthritis?

BACKGROUND: No consistent relationship between the severity of symptoms of knee osteoarthritis (OA) and radiographic change has been demonstrated. OBJECTIVES: To determine the relationship between symptoms of knee OA and tibial cartilage volume, whether pain predicts loss of cartilage in knee OA, and whether change in cartilage volume over time relates to change in symptoms over the same period. METHOD: 132 subjects with symptomatic, early (mild to moderate) knee OA were studied. At baseline and 2 years later, participants had MRI scans of their knee and completed questionnaires quantifying symptoms of knee OA (knee-specific WOMAC: pain, stiffness, function) and general physical and mental health (SF-36). Tibial cartilage volume was determined from the MRI images. RESULTS: Complete data were available for 117 (89%) subjects. A weak association was found between tibial cartilage volume and symptoms at baseline. The severity of the symptoms of knee OA at baseline did not predict subsequent tibial cartilage loss. However, weak associations were seen between worsening of symptoms of OA and increased cartilage loss: pain (r(s) = 0.28, p = 0.002), stiffness (r(s) = 0.17, p = 0.07), and deterioration in function (r(s) = 0.21, p = 0.02). CONCLUSION: Tibial cartilage volume is weakly associated with symptoms in knee OA. There is a weak association between loss of tibial cartilage and worsening of symptoms. This suggests that although cartilage is not a major determinant of symptoms in knee OA, it does relate to symptoms.

Adult↗
PubMed2002

The effect of mechanical loading on the size and shape of bone in pre-, peri-, and postpubertal girls: a study in tennis players.

Exercise during growth results in biologically important increases in bone mineral content (BMC). The aim of this study was to determine whether the effects of loading were site specific and depended on the maturational stage of the region. BMC and humeral dimensions were determined using DXA and magnetic resonance imaging (MRI) of the loaded and nonloaded arms in 47 competitive female tennis players aged 8-17 years. Periosteal (external) cross-sectional area (CSA), cortical area, medullary area, and the polar second moments of area (I(P), mm4) were calculated at the mid and distal sites in the loaded and nonloaded arms. BMC and I(P) of the humerus were 11-14% greater in the loaded arm than in the nonloaded arm in prepubertal players and did not increase further in peri- or postpubertal players despite longer duration of loading (both, p < 0.01). The higher BMC was the result of a 7-11% greater cortical area in the prepubertal players due to greater periosteal than medullary expansion at the midhumerus and a greater periosteal expansion alone at the distal humerus. Loading late in puberty resulted in medullary contraction. Growth and the effects of loading are region and surface specific, with periosteal apposition before puberty accounting for the increase in the bone's resistance to torsion and endocortical contraction contributing late in puberty conferring little increase in resistance to torsion. Increasing the bone's resistance to torsion is achieved by modifying bone shape and mass, not necessarily bone density.

Adolescent↗
PubMed2000

Comparison and reproducibility of fast and conventional spoiled gradient-echo magnetic resonance sequences in the determination of knee cartilage volume.

Quantitation of articular cartilage by magnetic resonance imaging and three-dimensional reconstruction has been validated and is likely to be a useful outcome measure in clinical trials of arthritis. The cost of magnetic resonance imaging is largely dependent on scanning time. The aim of this study was to compare a fast spoiled gradient-echo sequence magnetic resonance imaging scanning protocol, which takes 5 minutes and 44 seconds, with the standard, previously validated spoiled gradient-echo sequence protocol, which takes 11 minutes and 56 seconds, in the measurement of knee cartilage volume. Cartilage volumes calculated from the standard and fast magnetic resonance imaging sequences were similar. The median absolute percentage overestimation or underestimation of the cartilage volume with the fast sequence for 10 normal subjects was 2.5, 4.1, and 3.2% for patellar, femoral, and tibial cartilage, respectively. For eight subjects with osteoarthritis, the percentages were 4.3 and 3.9% for femoral and tibial cartilage, respectively. The fast spoiled gradient-echo sequence protocol had very high intra-rater and inter-rater reproducibility in normal subjects and in those with osteoarthritis. Because the cost of magnetic resonance imaging scanning is largely determined by scan time, the faster scanning protocol means that the cost of estimates of knee cartilage volume can be significantly reduced, thus increasing the feasibility of this methodology.

Adult↗
PubMed2000

Short stature and delayed puberty in gymnasts: influence of selection bias on leg length and the duration of training on trunk length.

BACKGROUND: Delays in bone age, the onset of puberty, and skeletal growth in gymnasts could be, in part, the reason for an interest in gymnastics, rather than being the result of vigorous exercise. We hypothesized that short stature and delayed bone age are present at the start of gymnastics, and training delays growth, producing short stature, even after retirement. METHODS: Sitting height and leg length were measured in 83 active female gymnasts, 42 retired gymnasts, and 154 healthy control subjects. Results were expressed as age-specific SD scores (mean +/- SEM). RESULTS: In the cross-sectional data, active gymnasts had delayed bone age (1.3 +/- 0.1 years), reduced height -1.32 +/- 0.08 SD, sitting height -1.24 +/- 0.09 SD, and leg length, -1.25 +/- 0.08 SD (all P <.001). However, in those training for less than 2 years, the deficit was confined to leg length (-0.8 +/- 0.2 SD). During 2 years of follow-up of 21 gymnasts, only the deficit in sitting height worsened (by 0.4 +/- 0.1 SD). In 13 gymnasts followed up in the immediate 12 months after retirement, sitting height accelerated, resulting in a lessening of the deficit in sitting height by 0.46 +/- 0.14 SD (P <.01). Adult gymnasts who had been retired for 8 years had no deficit in sitting height, leg length, or menstrual dysfunction. CONCLUSIONS: Short stature in active gymnasts is partly due to selection of individuals with reduced leg length. Reduced sitting height is likely to be acquired but is reversible with cessation of gymnastics. A history of gymnastic training does not appear to result in reduced stature or menstrual dysfunction in adulthood.

Adolescent↗
PubMed2000

Heterogeneity in the growth of the axial and appendicular skeleton in boys: implications for the pathogenesis of bone fragility in men.

Men with spine fractures have reduced vertebral body (VB) volume and volumetric bone mineral density (vBMD). Men with hip fractures have reduced femoral neck (FN) volume and vBMD, site-specific deficits that may have their origins in growth. To describe the tempo of growth in regional bone size, bone mineral content (BMC), and vBMD, we measured bone length, periosteal and endocortical diameters, BMC, and vBMD using dual-energy X-ray absorptiometry in 184 boys aged between 7 and 17 years. Before puberty, growth was more rapid in the legs than in the trunk. During puberty, leg growth slowed while trunk length accelerated. Bone size was more advanced than BMC in all regions, being approximately 70% and approximately 35% of their predicted peaks at 7 years of age, respectively. At 16 years of age, bone size had reached its adult peak while BMC was still 10% below its predicted peak. The legs accounted for 48%, whereas the spine accounted for 10%, of the 1878 g BMC accrued between 7 and 17 years. Peripubertal growth contributed (i) 55 % of the increase in leg length but 78% of the mineral accrued and (ii) 69% of the increase in spine length but 87% of the mineral accrued. Increased metacarpal and midfemoral cortical thickness was caused by respective periosteal expansion with minimal change in the endocortical diameter. Total femur and VB vBMD increased by 30-40% while size and BMC increased by 200-300%. Thus, growth builds a bigger but only slightly denser skeleton. We speculate that effect of disease or a risk factor during growth depends on the regions maturational stage at the time of exposure. The earlier growth of a regions size than mass, and the differing growth patterns from region to region, predispose to site-specific deficits in bone size, vBMD, or both. Regions further from their peak may be more severely affected by illness than those nearer completion of growth. Bone fragility in old age is likely to have its foundations partly established during growth.

Absorptiometry, Photon↗
PubMed1999

Gender differences in knee cartilage volume as measured by magnetic resonance imaging.

OBJECTIVE: The aim of this study was to analyze sex differences in knee cartilage volume. METHODS: Articulate cartilage volumes were determined by processing images acquired in the sagittal plane using T1-weighted fat saturation magnetic resonance on an independent work station. The knees of 28 subjects (17 male, 11 female) who underwent MRI for clinical indications (pain <3 months) but who had a normal X-ray and structurally normal MRI were examined. RESULTS: Males had significantly larger cartilage volumes than females, with difference in cartilage volume remaining statistically significant after adjusting for age, height, weight and bone volume. The differences for males relative to females were: femoral cartilage volume [4.1 ml 95% CI (2.0, 6.1)]; and patella cartilage volume [1.4 ml (0.2, 2.7)]. Although not statistically significant, the tibial cartilage volume also showed these sex differences. Exploratory analysis indicated an increasing gender difference with increasing age for patellar cartilage volume. CONCLUSION: Men have significantly larger knee cartilage volume than women, independent of body and bone size. The mechanisms for this will need to be determined.

Adult↗
PubMed1996

A rural nursing experience.

This paper describes student observations and responses to an introduction of nursing in a rural area. As many rural areas of the United States continue to face a shortage of nurses, working in a rural area is an option for employment upon graduation. Independence is a major factor in choosing a rural setting for a nurse anesthesia practice.

Curriculum↗
PubMed1993

A comparison of laparoscopically assisted vaginal hysterectomy vs traditional total abdominal and vaginal hysterectomies.

The objective of this work was to compare laparoscopically assisted vaginal hysterectomy to traditional total abdominal and vaginal hysterectomies in seven critical areas: anesthesia time, surgery time, hospital stay, operative blood loss, total analgesic use, time required to return to work, and total cost of each of these procedures. The first 25 unscreened, consecutive laparoscopically assisted vaginal hysterectomies performed by the senior author were compared with 25 randomly selected traditional total abdominal and 25 randomly selected vaginal hysterectomies performed by the senior author's professional corporation. Laparoscopically assisted vaginal hysterectomy compared favorably to abdominal and vaginal hysterectomy in three areas and was superior to both total abdominal hysterectomy and vaginal hysterectomy in the remaining four areas. Although the use of the endoscopic stapling device and laser made the laparoscopically assisted vaginal hysterectomy a more expensive procedure than traditional vaginal hysterectomy, the expense was not significant and was justified by the decreased surgery time. The results of this comparative study suggest that laparoscopically assisted vaginal hysterectomy is superior or comparable to total abdominal hysterectomy and vaginal hysterectomy, especially for patients who may not have been candidates for vaginal hysterectomy. This procedure has allowed the gynecologic endoscopic surgeon to convert abdominal to vaginal procedures. Laparoscopically assisted vaginal hysterectomy provides an overall cost savings to the patient, has a low complication rate, adapts well to the outpatient setting, causes less patient discomfort, and allows the patient to return rapidly to home and workplace.

Adult↗
PubMed1990

Modification of methyliminodiacetato-trans-R,R-1,2-diamminocyclohexane platinum(II) pharmacology using a platinum-specific monoclonal antibody.

Platinum complexes are extremely active chemotherapeutic agents. A murine monoclonal antibody designated 1C1 was developed that binds to the third-generation platinum complex methyliminodiacetato-trans-R,R-1,2-diamminocyclohexane platinum(II) (MIDP). Competitive enzyme-linked immunosorbent assay (ELISA) shows that antibody 1C1 binds preferentially to the 1,2-diamminocyclohexane (DACH) side-chain of the platinum complex, although non-DACH-containing platinum complexes can compete for binding at high concentrations. When tested against MCF-7 breast carcinoma cells, the 1C1-MIDP complex caused 50% growth inhibition at 0.63 micrograms Pt/ml, whereas MIDP alone caused 50% growth inhibition at a concentration of 0.16 micrograms Pt/ml. Pharmacokinetic studies in rats using [3H]-MIDP showed that the drug was cleared triphasically from plasma, with elimination-phase half-lives (t1/2) of 1.2, 10.2, and 243 min for alpha, beta, and gamma phases, respectively. The MIDP-1C1 complex was cleared with longer half-lives of 5, 26, and 291 min, respectively. The overall clearance rate from plasma of the MIDP-1C1 complex was 10-fold lower than that of MIDP alone (0.37 vs 3.01 ml/kg x min). Tissue concentrations of [3H]-MIDP 3 h after administration showed that 1C1 antibody prevented MIDP distribution to most organs and dramatically reduced [3H] concentration in the intestine, liver, kidney, heart, and skeletal muscles. Studies are under way to determine the relative therapeutic activity of the 1C1 antibody-MIDP complex and assess whether the 1C1 antibody may be useful for antibody-directed delivery of platinum complexes to tumors.

Animals↗