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[The early radiological findings of idiopathic necrosis of the femoral head in adults (author's transl)].

Idiopathic necrosis of the femoral head in adults occurs in about 2 to 3% of all cases of degenerative hip disease. Advanced necrosis with collapse of the head offers a difficult therapeutic problem in younger patients. Early radiological diagnosis is therefore important. The typical, early radiological findings were studied in a hundred patients with idiopathic necrosis of the femoral head. They consist of an area of sclerosis at the junction of the head and neck, with a periosteal response on the inferior margin of the neck. The relationship of these changes with mechanical stress and defective blood supply is discussed. Signs of more advanced necrosis are band-like sclerosis at the point of demarkation and sub-chondral decalcification of the femoral head. Recognition of the early radiological features improves the chances of successful treatment, particularly in the lower age group.

Adult

[Shoulder arthrography in rheumatoid arthritis].

Shoulder arthrography in a patient with rheumatoid arthritis is performed to differentiate between a rheumatoid flare and limitation of motion secondary to tear in the rotator cuff. Accurate diagnosis is important because of the therapeutic implications. The arthrographic findings characteristic of rheumatoid involvement of the shoulder joint are nodular filling defects of the joint, the subacromial and subdeltoideal bursa in case of rotator cuff tear, irregular capsular attachment, contracted joint space and visualized lymphatic drainage. A dilatation of the biceps tendon sheath has not been shown.

Arthritis, Rheumatoid

Skeletal demineralization and growth retardation in inflammatory bowel disease.

Skeletal growth and mineralization in 54 adolescent and adult patients with inflammatory bowel disease have been analyzed comprehensively. Quantitative and qualitative radiologic techniques consisted of conventional roentgenography, photon absorptiometry, and radiographic morphometry. The data are correlated with the type, duration, and severity of disease, and with several modes of therapy. The results indicate the osteopenia and retardation of growth are common in patients with inflammatory bowel disease, particularly in adolescents, in whom the effects of corticosteroids on the skeleton are most deleterious.

Adolescent

Bone mineral analysis using single-energy computed tomography.

We present a new method for evaluating in vivo changes in bone mineralization in the peripheral skeleton, using computed tomography (CT). A set of bone mineralization indices are generated from numerous CT images of the patient's distal radius. The cross-sectional anatomy displayed by the CT scan allows for separate evaluation of the cortical and trabecular bone. Correction for possible drift of the CT number scale (Hounsfield scale) is achieved by scanning standard solutions of dipotassium hydrogen phosphate simultaneously with the forearm. Preliminary data indicate that this is a precise method for evaluating in vivo changes in bone mineralization.

Adolescent

A randomized double blind placebo controlled trial of the effects on bone metabolism of the combination of nafarelin acetate and norethisterone.

OBJECTIVE: We observed the effects on bone metabolism of the addition of different doses of oral norethisterone during treatment with the GnRH agonist nafarelin (Synarel, Syntex). PATIENTS: Ninety-four women with a subjective complaint of heavy menstrual blood loss or objective evidence of endometriosis received intra-nasal nafarelin 400 micrograms daily for 6 months and also received, in a randomized, double blind manner, either 0.7 mg (n = 24), 1.4 mg (n = 23) or 2.45 mg (n = 23) of oral norethisterone or placebo (n = 24) daily. Follow-up was continued for a further 6 months after treatment. RESULTS: Thirty-one patients (33%) left the study prematurely and three patients were non-compliant with the study drug. By 6 months significant increases in urinary calcium/creatinine ratio were seen, compared to baseline, in the nafareline and placebo (P = 0.001, n = 14), 0.7 mg (P = 0.04, n = 13) and 1.4 mg norethisterone groups (P = 0.009, n = 17) but not in the nafarelin or 2.45 mg norethisterone groups (P = 0.72, n = 16). Densitometry of the spine, however, showed decreases at 6 months in all groups: 6.14% (P = 0.0004, n = 11), 5.46% n = 0.0006, n = 13), 3.93% (P = 0.008, n = 14) and 4.04% (P = 0.004, n = 16) for the groups receiving nafarelin and placebo, nafarelin and norethisterone 0.7, 1.4 and 2.45 mg respectively. Six months after stopping nafarelin, with or without norethisterone, bone mass was not different from baseline. CONCLUSION: The concomitant daily use of up to 2.45 mg of norethisterone does not eliminate the bone demineralization seen during GnRH agonist therapy with nafarelin in premenopausal women.

Administration, Oral

Osteolytic sterol in human breast cancer.

Eleven of twelve human breast cancers contained a lipid which increased urinary (45)Ca and (40)Ca excretion of (45)Ca-labeled, parathyroidectomized rats receiving a low Ca diet. The lipid has mobility on thin-layer chromatography and gas-liquid chromatography close to, but not identical with, that of 7-dehydrocholesterol. Authentic 7-dehydrocholesterol has osteolytic activity similar to that of the extracted sterol. Fluorescence and Lieberman-Burchard reactions of the extracted sterol are similar to those of 7-dehydrocholesterol. The lipid was found by thin-layer chromatography in the extracts which had osteolytic activity. Neither the lipid nor osteolytic activity was found in extracts of tissue from two normal human breasts.

Animals

Dental enamel: detection of surface changes by ultrasound.

Evidence indicates that the tooth surface differs in structure from the enamel immediately beneath it, and particularly that the enamel rod type structure is minimal in the true natural surface. Furthermore, the rod ends appear to disappear with age after the eruption of the tooth. The thickness of the surface layer may be as much as 25 micrometers. Studies of caries incidence show a peak in the attack curve 2 to 4 years after eruption and a decline thereafter for all teeth. This information indicates that the mechanical structure of the tooth surface should be carefully studied. A highly useful means appears to be ultrasound since the specific acoustic impedance of highly mineralized tissue like enamel is strongly dependent on fraction volume mineralization and since non-destructive test techniques can be based on ultrasonics. An experimental demonstration of ultrasonic detection in vitro of tooth surface demineralization is given.

Collagen