Can you diagnose for vertebral fracture correctly by plain X-ray?

INTRODUCTION: A wrong diagnosis of latent vertebral fracture is often made when it is based on plain X-ray imaging. Magnetic resonance imaging (MRI) has a high degree of accuracy for the definite diagnosis. This study was designed to identify ways to support improvements in the diagnostic accuracy of plain X-ray (X-P). METHODS: We studied X-P and MRI images of 120 women and men (age range: 50-96 years). Five orthopedists and two radiologists interpreted front and lateral thoracolumbar X-Ps and MRI images. The correct diagnosis rate for the presence and location of incident vertebral fractures and the correct diagnosis rate according to morphological classifications were analyzed. RESULTS: A correct diagnosis of incident fractures was made in 51.5% of cases overall. Diagnoses of non-incident fracture based on X-P in those cases with incident fracture based on MRI (false positive) occurred in 24.8% of the patients, while diagnoses of incident fracture based on X-P in those cases without incident fracture based on MRI (false negative) occurred in 6.5% of the patients. The application of morphological classifications (the primary osteoporosis diagnostic criteria and Yoshida's classification) resulted in the correct diagnosis rate being significantly higher in the group without prevalent fracture even when there were morphological changes (wedge, indented, protruding type) in the anterior bone cortex. Odds ratios were investigated for factors that would affect the correct diagnosis rate, including age, body weight, lumbar vertebrae bone mineral density, and examiner ability. In an overall investigation, age (OR=0.660), body weight (OR=2.082), and examiner ability (p=0.0205) affected the correct diagnosis rate. CONCLUSION: The correct diagnosis rate for incident vertebral fractures with X-Ps was low (24.8%) and in cases with prevalent fractures, the rate was even lower (16.8%), but the number of prevalent fractures and BMD did not exert an effect. One key improving the correct diagnosis rate may be to pay attention to morphological changes in the anterior bone cortex.

Dilatation of stent-grafts by luminal pressures: experimental evaluation of polytetrafluoroethylene (PTFE) and woven polyester grafts.

PURPOSE: To evaluate the effect on dilatation of three types of covering materials used for endovascular stent-grafts. METHODS: Stent-grafts with three types of covering material [0.1-mm polytetrafluoroethylene (PTFE), 0.2-mm PTFE, and 0.15-mm woven polyester] were placed in a fluid circuit. For the pulsatile pressure test, the luminal pressure of 190/130 mmHg was loaded up to 300,000 pulses. For the static pressure test, the luminal pressure was increased from 50 to 300 mmHg at 50-mmHg increments. The percent of dilatation of each stent-graft was compared. RESULTS: The 0.1-mm PTFE stent-graft was significantly more dilated than the 0.2-mm PTFE and the 0.15-mm woven polyester stent-graft (p < 0.005) in both examinations. There was no significant difference between the 0.2-mm PTFE and the 0.15-mm woven polyester stent-grafts. The dilatation of the 0.1-mm PTFE stent-graft was irreversible. CONCLUSION: The 0.15-mm woven polyester and the 0.2-mm PTFE stent-grafts may be preferable to the 0.1-mm PTFE stent-graft with regard to dilatation and deformity.

[An intensification therapy of adults acute leukemia].

Between January 1980 and March 1983, a study was conducted on the effects of intensification therapy in 20 adult acute leukemia patients who had achieved complete remission with induction therapy. Intensification therapy consisted of cyclic administration of six combination therapies given at gradually longer intervals, using daunorubicin, cytosine arabinoside, 6-mercaptopurine and prednisolone (DCMP), cyclocytidine (DCyMP), vincristine (DCVP), behenoyl-ara-c (BHAC-DMP), aclacinomycin (BHAC-AMP) and (ACM-MP). Six combinations were given sequentially at one-month intervals, at 2-, 3-, 4-, 5- and eventually 6-month intervals, until 5-year survival. The median remission duration was 38 months for AML, and 17 months for ALL. The median survival was 66 months for AML, and 37 months for ALL. The five year survival rate was 50%. Nine of the 20 patients are still alive. Methotrexate and prednisolone were administered intrathecally for prophylaxis of CNS leukemia on Day 4 for each intensification therapy. There was no CNS leukemia. This intensification protocol was shown to be effective in improving the prognosis of adults acute leukemia.

[Clinical evaluation of sulpiride against nausea and vomiting during cancer chemotherapy compared with domperidone--envelope method].

Sulpiride, which has been utilized as an antipeptic ulcer and antidepressant in Japan, is one of the dopamine antagonists, and is considered to have anti vomiting activity. We designed a comparative controlled study of Sulpiride and Domperidone, against nausea and vomiting during cancer chemotherapy. A total of 69 cases were entered into this study, 34 cases being treated with Sulpiride at a dose of 100 mg i.v. or i.m. (S group), and 35 cases being treated with Domperidone at a dose of 10 mg i.v. (D group), before and after chemotherapy. Three cases from the S group and 4 cases from the D group were excluded from this study because of differences in the administration schedule. There was no difference in patient characteristics between the two groups, such as age, sex, original disease and antitumor agents. According to our criteria 27 of 31 cases in the S group showed effectiveness of the agent against nausea and vomiting (87%), while in the D group, 24 cases showed effectiveness (77%). There was no statistical difference between them, and no side effects were found in either group.

[Clinical evaluation of cefotiam in internal medicine].

Cefotiam (CTM) was administered to 52 patients with infectious disease associated with respiratory system, hematological malignancy, urinary system and other system. Good clinical responses were obtained in 38 out of 52 cases (73.1%). Neither objective and subjective side effects nor extreme abnormalities of laboratory tests were observed in these patients. It can be, therefore, concluded that CTM is 1 of the most useful drugs for infectious diseases in respiratory system, hematological malignancy, urinary system and other system.

Clinical and pathologic studies of gastrointestinal hemorrhage in acute leukemia.

One hundred and sixty cases of acute leukemia observed at our Department between 1953 and 1977 were reviewed as to the presence and nature of the accompanying gastrointestinal hemorrhage. A massive gastrointestinal hemorrhage requiring blood transfusions occurred in 29 cases (18%). The most common lesion was hemorrhagic necrosis of the small intestines. There were three forms of hemorrhage: Type I: thrombocytopenia, hemorrhagic diathesis, diffuse hemorrhage of mucosa and submucosa, but no erosion nor ulceration. Type II: no specific pathologic findings. Diffuse hemorrhage, superficial erosions, bacterial and fungal invasions were observed. Type III: single and/or multiple ulcerations, necrosis and perforation of the small intestines and colon. Thrombocytosis was almost always present at the prebleeding phase in these cases. Intravascular microthrombi at the basis of ulceration were seen. Usually, more than one process were seen in each case. An appropriate approach to the severe gastrointestinal hemorrhage with a combination of anti-leukemic chemotherapy, anti-coagulant therapy, platelet transfusion, etc. would further add to the number of long-term survivors in acute leukemia.