Proximal tibial osteophyte volumes are correlated spatially and with knee alignment: a quantitative analysis suggesting the influence of biochemical and mechanical factors in the development of osteophytes.

OBJECTIVE: To characterize the differences and correlations in osteophyte volumes between and within proximal tibial compartments, and to assess the correlations between osteophyte volumes and the femorotibial angle. DESIGN: CT scans of 73 knees with predominantly medial femorotibial osteoarthritis (21 K/L2, 28 K/L3, 24 K/L4) were retrospectively analyzed using a new, reproducible method measuring total and subregional osteophyte volumes in the medial and lateral compartments. Non-parametric statistics was used for comparison and correlation analyses. RESULTS: Total osteophyte volumes were larger in the medial than in the lateral compartment for all severity groups (p < 0.05). Additionally, statistically significant differences were observed among subregions of the lateral compartment in K/L3 and K/L4 knees. Statistically significant positive correlations were found between the medial and lateral total osteophyte volumes in K/L3 and K/L4 knees (ρ ≥ 0.44, p = 0.03), and among most subregional osteophyte volumes within each compartment in K/L3 knees. Markedly fewer statistically significant correlations were present in K/L2 and K/L4 knees. In K/L3 knees, the femorotibial angle was statistically significantly positively correlated with the total osteophyte volume in the medial compartment (ρ = 0.50, p = 0.01), with osteophyte volumes in most medial subregions, and with the osteophyte volume in the lateral posterior subregion (ρ = 0.40, p = 0.05). CONCLUSIONS: Quantitative assessment of osteophytes may bring insight on factors influencing their development. Positive correlations of osteophyte volumes found between and within compartments suggest the influence of biochemical mediators acting on the entire joint, while positive correlations between the femorotibial angle and osteophyte volumes suggest a role of mechanical factors. These hypotheses are to be further confirmed.

Relationships between cartilage thickness and subchondral bone mineral density in non-osteoarthritic and severely osteoarthritic knees: In vivo concomitant 3D analysis using CT arthrography.

OBJECTIVE: To test whether subchondral bone mineral density (sBMD) and cartilage thickness (CTh) of femoral condyles are correlated in knees without and with severe medial femorotibial osteoarthritis (OA), using a subregional analysis with computerized tomography (CT) arthrography. METHODS: CT arthrograms of 50 non-OA (18 males, 58.7 (interquartile range (IQR) = 6.6 years)) and 50 severe medial OA (24 males, 60.5 (IQR = 10.7) years) knees, were retrospectively analyzed. Bone and cartilage were segmented using custom-designed software, leading to 3D models on which each point of the subchondral surface is given a CTh and sBMD value. The average sBMD and CTh were then calculated for the entire weight-bearing regions as well as specific subregions of interest. Linear bivariate and multivariable analyses were performed to test for relationships between sBMD and CTh (regional and subregional measures, or medial-to-lateral ratios), with confounders of age, gender, femoral bone size and femorotibial angle. RESULTS: In non-OA knees, the sBMD and CTh medial-to-lateral ratios were positively correlated for the total region and the external and internal subregions (r ≥ 0.341, P ≤ 0.015). In OA knees, sBMD and CTh medial-to-lateral ratios were negatively correlated for the total region and the external and central subregions (r ≤ -0.538, P < 0.001). Additional positive/negative relationships in the non-OA/OA knees were observed between sBMD and CTh measures in the medial compartment. CONCLUSIONS: The positive correlation between sBMD and CTh in non-OA knees, and the negative one in OA knees, bring support to the theory of a subchondral bone/cartilage functional unit, which could help to better understand the pathophysiology of OA.

Quantitative regional and sub-regional analysis of femoral and tibial subchondral bone mineral density (sBMD) using computed tomography (CT): comparison of non-osteoarthritic (OA) and severe OA knees.

OBJECTIVE: This study aimed to compare subchondral bone mineral density (sBMD) between non-radiographic osteoarthritic (OA) and medial femorotibial OA knees, using computed tomography (CT). DESIGN: CT exams from 16 non-radiographic OA (KL grade < 2) and 16 severe medial OA (KL grade ≥ 3) knees (average age of 61.7 ± 3 and 62.2 ± 5 years old respectively, 50% male in each group), were retrospectively analyzed. CT exams were segmented and 3D maps of sBMD based on the CT number in the most superficial 3 mm of femoral and tibial subchondral bone were computed. Average sBMD and medial-to-lateral sBMD ratios were calculated for total load-bearing regions and for sub-regions of interest in the femur and tibia. RESULTS: The analysis of total load-bearing regions did not reveal any significant difference between groups, except for the lateral tibia, where OA knees had lower sBMD. Sub-regional analysis unveiled differences with some sub-regions of the femur and tibia presenting significantly lower (in the lateral compartment) or higher (in the medial compartment) sBMD in OA knees compared to non-OA knees. The M/L sBMD ratios were significantly higher for OA knees compared to non-OA knees for all regions and sub-regions, except for the internal sub-regions. CONCLUSIONS: sBMD locally differs between non-OA and OA knees, in agreement with prior knowledge on biomechanics. CT proved to be a valuable tool for 3D analysis of femoral and tibial sBMD, which can be used in future studies to describe the chronology of sBMD alterations and improve our understanding of the role of subchondral bone in knee OA.

[Addiction]. / Addictions.

What's new in addiction medicine in 2012? The news are presented according three axes: first, in the field of neuroscience, the process of extinction of addiction memories. Then in the clinical field, a reflexion is reported on how to treat addiction in psychiatric hospitals. At last, in the area of teaching, an e-learning development with a virtual patient shows a great interest in addiction psychiatry.

[Shared decision-making with hypertensive patients. Results of an implementation in Germany]. / "Shared Decision-Making" mit Bluthochdruckpatienten. Ergebnisse einer Implementierung in Deutschland.

BACKGROUND AND OBJECTIVE: Lack of compliance is a common problem in the treatment of hypertension. Ineffective physician-patient-communication and a lack of patients involvement can play a crucial role. We tested the hypothesis that shared decision-making (SDM) results in higher involvement of patients in their blood pressure lowering therapy and evaluated the effects of SDM on the control of blood pressure. PATIENTS AND METHODS: Two groups of 84 hypertensives were compared: an intervention group (26 women and 13 men, age 61 +/- 10 years) treated by 15 specially SDM-trained primary care physicians, and a control group of 45 hypertensives. All 84 patients were enrolled in a patient education programme. Changes of blood pressure were assessed after one year by self-measurements. Questionnaires about their attitude to patient autonomy, the SDM process, quality of life, physician-patient-relationship and life-style changes were analysed as well. RESULTS: After one year the blood pressure had decreased in both the intervention group (-9.26 +/- 10.2/-5.3 +/- 9.5 mmHg, p < 0.001) and in the control group (-6.0 +/- 11.8/-3.0 +/- 8.3 mmHg, p < 0.05), without a significant difference between the two groups. Among a subgroup of patients with a marked preference for SDM there was a close correlation between an increase of SDM and a decrease in systolic blood pressure (p = 0.016). Also, the numbers of antihypertensive drugs increased more in the intervention group (p = 0.022) than in control patients. Furthermore, increase in knowledge about hypertension and its treatment was greater in the intervention group (P=0.006). CONCLUSION: Implementation of SDM had a significant effect on systolic blood pressure control only in the subgroup of patients with marked preference for SDM. Thus, the identification of patients with a preference for SDM may improve blood pressure control and their adherence to the prescribed drug therapy.

[Retinopathy in the course of a homozygous haemoglobinopathy (author's transl)]. / Retinopathie im Verlauf einer homozygoten Hämoglobin-C-Krankheit.

Fundus examination of a young African female affected with acute benign unilateral iridocyclitis showed lesions similar to those of sickle cell disease. She had a homozygous C/C hemoglobinosis, which was previously unknown. Certain hematological lesions confirmed the pathogenesis of these pathological entities in absence of sickle cell formation.