Differences in the mineral density of lower limb bone tissue in a healthy population sample.

This article presents the results of research to evaluate the impact of the functional asymmetry of the lower limbs on the precision of the densitometric measurements used in the diagnosis of metabolic bone diseases and in monitoring treatment outcomes. The study subject were 46 healthy adults, in whom the mineral density of the bone tissue (BMD) was measured in the proximal epiphysis of the femoral bone in both the left and right lower limb. In 43 of the analyzed cases (94%), higher BMD was found in the dominant extremity (avg. 2,8%, range 0,6-11,8%). Although lateralization of the lower limbs was confirmed in every case in this population sample, no statistically significant differences in BMD were found between the dominant and subdominant limb. However, due to the large differences in BMD found in individual cases, control DEXA measurements should always be taken from the same side when monitoring the outcome of metabolic bone disease treatment in individual patients.

The most common errors in the densitometric diagnosis of osteoporosis.

A review of world literature on the subject indicates that, given the present state of our knowledge, and the technological possibilities and availability of the apparatus, the most useful method for the evaluation of bone metabolism, especially the diagnosis of osteoporosis, is dual energy X-ray absorptiometry (DEXA). However, this method is not free of errors that can exert a negative impact on the final results of examination. On the basis of heir own experience, the authors have presented here the most common errors encountered in the densitometric technique. A DPV-L densitometric apparatus (Lunar Corporation) was used in this research. Errors in densitometric testing are divided into three groups: those dependent on the object investigated, those dependent on densitometric data analysis, and others. In the first group we took into account factors which can lead to either overestimating (+) or underestimating (-) the final test results: degenerative changes (+), scoliosis (+), the presence of foreign bodies, such as metal (-), status post fracture (+), the presence of pathological structures (+ or -), osteoporotic fractures (+), and incorrect arrangement of the investigated object (+ or -). Errors in data analysis included erroneous data entry regarding the patient's age, height, body mass (affecting the value of the Z-score), and sex (distorting the T-score and the Z-score), and incorrect settings regarding the measurement field. Other errors to densitometric technique included failure to calibrate or improper calibration of the measurement apparatus and errors in computer programming. Individual errors were responsible for falsifying results from 1 to 37%. If several of these errors are accumulated, the accuracy of examination may change more than 100%. Densitometric examinations of the lumbar spine are the most subject to error. The repeatability of the results generated by the DEXA apparatus (as stated in the equipment specifications) ranges for particular skeletal regions from 0,9% to 2,5% of the coefficient of variance, while the precision ranges from 3% to 5%. This means that even if we follow the strictest guidelines for test procedures, the margin of error is still several percent. We also cannot exclude the impact of errors of the three types listed above on the final results. We are convinced that the DEXA method is an excellent instrument for the diagnosis of osteoporosis (in static bone evaluation). However, its value diminishes in monitoring dynamic changes in bone tissue, even at 1-2 year intervals.

A novel cis-peptide bond motif inducing beta-turn type VI. The synthesis of enkephalin analogues modified with 4-aminopyroglutamic acid.

A new pathway leading to a mixture of four isomers of 4-aminopyroglutamic acid is described. Michael type addition of Z-deltaAla-OMe to enolates prepared from acylaminomalonates, followed by hydrolysis and decarboxylation give protected 4-aminopyroglutamic acid with the cis:trans ratio approximately 3:2. This mixture was incorporated into Leu-enkephalin (position 2-3). After separation of peptides it appeared that all analogues were essentially inactive in guinea pig ileum and mouse vas deferens bioassays.

[Ender nails in the stabilization of trochanteric fractures of the femur in the elderly]. / Gwozdzie endera w stabilizacji zlaman przezkretarzowych kosci udowej u osób w podeszlym wieku.

Results of treatment for trochanteric fracture of the femur in 50 patients aged 25-91 (mean 71 years) are presented. In all cases reviewed the fracture has been stabilized with 3 or 4 Ender nails. In majority of cases bony union has been achieved. Short operating time, small incision remote from fracture site, early weight bearing constitute unquestionable advantages of the method. Most frequent complications as shortening of the extremity involved, excessive external rotation, pain related to migration of the nails, varus deformity at the fracture site were usually found in patients with marked osteoporotic changes.

[Densitometry for assessment of periacetabular bony changes after Parhofer-Mönch total hip replacement]. / Densytometryczna ocena kostnych zmian okolopanewkowych po endoprotezoplastyce stawu biodrowego typu Parhofera-Möncha.

Densitometry for assessment of mineral changes after Parhofer-Mönch total hip replacement 10 mm around the acetabular component has been done in 53 patients (31 females and 22 males, mean age 52.1 years) with unilateral hip arthritis. Lunar DPX apparatus has been used, "manual analysis" of "Orthopedic" software and modification of DeLee and Charnley zones for DEXA technique was employed. After 6 months follow-up BMC and BMD decreased in all zones analyzed, especially in zone 2. These values increased in next 6 and 12 months but did not compensate for the primary loss.

[Early results of densitometry around the cementless stem of the Parhofer-Mönch hip endoprosthesis]. / Wczesne wyniki badania densytometrycznego tkanki kostnej wokól trzpieni endoprotez bezcementowych stawu biodrowego typu Parhofera-Möncha.

Fifty-three patients with unilateral hip arthritis (31 females, 22 males) aged from 29 to 66 years (mean 52.1 years) after total hip replacement with cementless Parhofer-Mönch endoprosthesis underwent densitometry. The content (BMC) and mineral density (BMD) of calcium within proximal end of the femur was evaluated at 8-12 days postoperatively and at 6, 12 and 18 months follow-up. Early results show various mineral changes in Gruen zones around the stem. The greatest BMC and BMD decrease was found at 6 months follow-up in zones 1 and 7 as well as 2 and 6. The BMC and BMD tendency to decrease gradually ceased and slightly positive values were found in zone 3, 4 and 5 at the final evaluation.

[Use of densitometry examinations for evaluation of proximal femur fracture risk in people over 50 years of age]. / Zastosowanie badania densytometrycznego w ocenie ryzyka zlaman blizszej nasady kosci udowej u osób powyzej 60 roku zycia.

The paper presents the use of dual energy X-ray absorptiometry for selecting patients with high risk of proximal femur fracture. A group of 63 patients with fracture has been compared with a group of 306 patients who fell down but did not sustain a fracture, all individuals aged over 60. Most significant bone density decrease (p < 0.001) presented as Z indices related to young population was found in all three examined areas of the proximal femur. The difference between the groups ranged between 1.62 to 2.19 SD depending on the area and the sex. Threshold values for ZYA have been established. For the femoral neck it was -1.3 SD, for Ward's triangle -1.5 SD and for trochanteric area -0.4 SD.

[Results of treating forearm bone shaft fractures with a 3.5 mm self compressive plate]. / Wyniki leczenia zlaman trzonów kosci przedramienia plytka samodociskowa 3.5 mm.

Results of 29 forearm bones shaft fracture treatment with 3.5mm self compressive plate in 26 patients aged 18-64 (mean 33) are presented. Open reduction with 3.5mm self compressive plate fixation has been performed in all cases. Anderson et al criteria were used to assess functional and radiological outcome. Excellent and good functional results were achieved in 25 cases, one was rated fair, no poor results were observed.

[Treatment of compound C2 tibial shaft fracture with Polfix fixator in the pillar version]. / Leczenie zlaman zlozonych trzonu kosci piszczelowej typu C2 sposobem Polfix w wersji filarowej.

Pillar version of POLFIX fixator for treatment of compound C2 tibial shaft fractures presented. The method was employed in 9 cases and in 8 of them (89%) the fracture healed within 32 weeks on an average. In 1 case of IIIB open fracture infection developed and no union has been achieved. The fixator can be designed preoperatively; there is no need to dismantle the template when drilling, tapping or inserting screws what makes an osteosynthesis easy. The method may be used also in metaphyseal fractures. Pillar version of POLFIX fixator proved useful in treatment of compound tibial fractures.

[Use of densitometric examination in evaluation of cementless hip endoprosthesis]. / Zastosowanie badania densytometrycznego w ocenie endoprotezoplastyki bezcementowej stawu biodrowego.

Five patients underwent densitometry in order to establish bone mineral content (BMC) and bone mineral density (BMD) around Parhofer-Mönch total hip components. The measurements were taken with LUNAR DPX unit twice: 11 days and 6 month postoperatively. "Orthopedic" software was employed to analyze them. Bone around the stem was evaluated with "auto analysis" option and relation to Gruen zones; "manual analysis" was used in modified DeLee and Charnley zones around the acetabulum. After six months BMC and BMD decrease in all Gruen zones was noted. In DeLee and Charnley zones BMC and BMD decreased in field 1 but slightly increased in field 2 and 3. The authors consider densitometry as important tool for monitoring and documentation of postoperative bone reaction to the implanted endoprosthesis.

[Reproducibility of densitometric examinations of the tibial shaft]. / Powtarzalnosc badania densytometrycznego trzonu kosci piszczelowej.

The aim of this paper is to evaluate the reproducibility of tibial shaft densitometry in own method under development. It will be expressed as percentage value of coefficient of variability (%CV). Bone mineral content (BMC) and bone mineral density (BMD) were measured with a dual energy X-ray densitometer Lunar DPX; the data were analyzed with a "Orthopedic" software. Three tibial bone scans were done in 10 males. High reproducibility was found, ranging from 0.98% to 1.45% and from 1.45% to 2.08% for BMC and BMD respectively. Reproducibility increases as the analyzed surface increases. Reproducibility so high allows for further investigations; it might be interesting to monitor BMC and BMD of the tibia in course of fracture treatment by Polfix or Zespol method.

[Treatment outcome for forearm shaft fracture using AO plate stabilization]. / Wyniki leczenia zlaman trzonów kosci przedramienia sposobem stabilizacji plytkowej AO.

Results of treatment for 104 forearm shaft fractures in 70 patients have been presented. In all cases included in this study an open reduction of the fracture was followed by AO plate stabilization. Functional and radiological assessment was carried out according to the criteria of Anderson et al. Excellent and good functional results were achieved in 48 cases, fair in 10 and poor in 12 cases. The ulna united in 75%, the radius in 78% (delayed union included). Cross- union occurred in three patients, one case of destabilization at fracture site was observed, no infection has been noted. AO plate osteosynthesis proved to be still valuable mode of treatment for forearm shaft fracture.

[Treatment outcome of juvenile slipped capital femoral epiphysis with Imhauser osteotomy]. / Wyniki leczenia mlodzienczego zluszczenia glowy kosci udowej osteotomia Imhäusera.

Results of Imhauser osteotomy for treatment of slipped capital femoral epiphysis grade II and III performed in 32 patients (33 hips) are presented. The average correction of the slip angle was 39.7 +/- 14.9 degrees. Excellent results were found in 16 hips (48.5%), good in 10 (30.3%), fair in 5 hips (15.1%) and poor results in 2 hips (6.1%). No head-neck fixation after osteotomy did not lead to further slippage and decreased the risk of other complications. In 6 hips (18.2%) chondrolysis occurred. In one case prolonged immobilization of the hip was to blame, perforation of the femoral head in another, no cause has been identified in remaining cases. Avascular necrosis of the head was not observed.

[Z-plasty in treatment of snapping hip]. / Plastyka "Z" w leczeniu operacyjnym biodra trzaskajacego.

The study deals with clinical assessment of results of surgical treatment of 13 snapping hips. Bringnall and Stainsby procedure has been employed; the surgical technique has been described. The mean age at the operation was 19 years, mean follow-up was 21 months. In 11 cases (84.6%) the symptoms abated completely. The results justify conclusion, that Z-plasty with transposition of created flaps should be recommended as a mode of surgical treatment for snapping hip.

[Case of peripheral multiple nodular pulmonary carcinoid of the lung]. / Przypadek mnogiej obwodowej postaci karcinoidu pluca.

A case of forty-year-old woman with bilateral small and medium-sized patchy and streaky opacities in the lungs X-ray examination, initially treated as bronchogenous pneumonia, is presented. Because no response after antibiotic, a biopsy of the lung during thoracotomy has been made which provided a proper diagnosis: Argentaffinoma malignum. A patient was given twelve courses of MACC chemotherapy. Control chest X-ray showed an absence of the densities described before.

Accumulation of major organic osmolytes in rat renal inner medulla in dehydration.

Osmotically active organic solutes, osmolytes, exist at high concentrations in the renal inner medulla; however, their modulation during antidiuresis remains largely undefined. Renal osmolyte levels were measured by nuclear magnetic resonance spectroscopy and biochemical assays in perchloric acid extracts from normal and dehydrated (3 days) rats. Dehydration increased urine osmolality from 1,503 to 3,748 mosmol/kg and inner medullary urea content from 2,036 to 4,405 nmol/mg protein. In addition, inner medullary trimethylamines [glycerophosphorylcholine (GPC) and betaine] and polyhydric alcohols (inositol and sorbitol) significantly increased by 95 and 78%, respectively. Ninhydrin-positive substances (amino acids), although abundant, were unchanged. Renal cortex also contained GPC, betaine, and inositol but only inositol increased with dehydration. Analysis of correlations among inner medullary osmolytes showed that only GPC was consistently elevated by dehydration and was not directly correlated with the other osmolytes. In contrast, betaine and inositol contents were linearly related to each other and both tended to rise only when sorbitol content was unchanged. In conclusion, the major osmolytes in the rat renal inner medulla can increase during antidiuresis but they are regulated in a complex manner.

Silver ion (Ag+)-induced increases in cell membrane K+ and Na+ permeability in the renal proximal tubule: reversal by thiol reagents.

The initial mechanisms of injury to the proximal tubule following exposure to nephrotoxic heavy metals are not well established. We studied the immediate effects of silver (Ag+) on K+ transport and respiration with extracellular K+ and O2 electrodes in suspensions of renal cortical tubules. Addition of silver nitrate (AgNO3) to tubules suspended in bicarbonate Ringer's solution caused a rapid, dose-dependent net K+ efflux (Km = 10(-4) M, Vmax = 379 nmol K+/min/mg protein) which was not inhibited by furosemide, barium chloride, quinine, tetraethylammonium, or tolbutamide. An increase in the ouabain-sensitive oxygen consumption rate (QO2) (13.9 +/- 1.1 to 25.7 +/- 4.4 nmol O2/min/mg, P less than 0.001), was observed 19 sec after the K+ efflux induced by AgNO3 (10(-4) M), suggesting a delayed increase in Na+ entry into the cell. Ouabain-insensitive QO2, nystatin-stimulated QO2, and CCCP-uncoupled QO2 were not significantly affected, indicating preserved function of the Na+,K+-ATPase and mitochondria. External addition of the thiol reagents dithiothreitol (1 mM) and reduced glutathione (1 mM) prevented and/or immediately reversed the effects on K+ transport and QO2. We conclude that Ag+ causes early changes in the permeability of the cell membrane to K+ and then to Na+ at concentrations that do not limit Na+,K+-ATPase activity or mitochondrial function. These alterations are likely the result of a reversible interaction of Ag+ with sulfhydryl groups of cell membrane proteins and may represent initial cytotoxic effects common to other sulfhydryl-reactive heavy metals on the proximal tubule.