The influence of knee bolster on lumbar spinal stenosis parameters on MR images.

OBJECTIVE: To estimate the effect of the knee bolster use during an MRI on lumbar spinal stenosis parameters and low back pain-related disability. METHODS: A repeated-measurement study of 27 males and 19 females with mean age 55.78 ± 14.36, referred for an MRI of the lumbar spine due to low back pain, performed with and without standard knee bolster. A radiologist evaluated the lumbar lordosis Cobb's angle, the cross-sectional area of the right and left intervertebral foramina and spinal canal at L1-L2, L2-L3, L3-L4 spinal levels. Spinal symptoms were evaluated by the Oswestry Disability Questionnaire. RESULTS: The Cobb angle of lumbar lordosis was found significantly greater on an MRI performed without knee bolster than with bolster (47.30 ± 9.90 vs. 42.57 ± 10.62, p < 0.001). The cross-sectional area of the intervertebral foramina and spinal canal at all evaluated levels was smaller when performed without knee bolster than with bolster. However, differences were significant only at the L1-L2 level and in the spinal canal at all evaluated levels. The Cobb angle, measured with and without knee bolster, showed significant positive correlations with back pain while standing and walking. The spinal canal area without knee bolster showed greater correlations with the Oswestry score parameters than with knee bolster. CONCLUSIONS: MR images at evaluated spinal levels taken without knee bolster showed greater correlations of the spinal canal cross-sectional area with the Oswestry score than ones with knee bolster. Thus, one may prefer MR images acquired without a bolster below the knee compared to an MRI with a knee bolster.

Indices of Paraspinal Muscles Degeneration: Reliability and Association With Facet Joint Osteoarthritis: Feasibility Study.

STUDY DESIGN: A reliability and cross-sectional observational study. OBJECTIVE: To introduce a scoring system for visible fat infiltration in paraspinal muscles; to evaluate intertester and intratester reliability of this system and its relationship with indices of muscle density; to evaluate the association between indices of paraspinal muscle degeneration and facet joint osteoarthritis. SUMMARY OF BACKGROUND DATA: Current evidence suggests that the paraspinal muscles degeneration is associated with low back pain, facet joint osteoarthritis, spondylolisthesis, and degenerative disc disease. However, the evaluation of paraspinal muscles on computed tomography is not radiological routine, probably because of absence of simple and reliable indices of paraspinal degeneration. METHODS: One hundred fifty consecutive computed tomography scans of the lower back (N=75) or abdomen (N=75) were evaluated. Mean radiographic density (in Hounsfield units) and SD of the density of multifidus and erector spinae were evaluated at the L4-L5 spinal level. A new index of muscle degeneration, radiographic density ratio=muscle density/SD of density, was calculated. To evaluate the visible fat infiltration in paraspinal muscles, we proposed a 3-graded scoring system. The prevalence of facet joint osteoarthritis was also evaluated. Intraclass correlation and κ statistics were used to evaluate inter-rater and intra-rater reliability. Logistic regression examined the association between paraspinal muscle indices and facet joint osteoarthritis. RESULTS: Intra-rater reliability for fat infiltration score (κ) ranged between 0.87 and 0.92; inter-rater reliability between 0.70 and 0.81. Intra-rater reliability (intraclass correlation) for mean density of paraspinal muscles ranged between 0.96 and 0.99, inter-rater reliability between 0.95 and 0.99; SD intra-rater reliability ranged between 0.82 and 0.91, inter-rater reliability between 0.80 and 0.89. Significant associations (P<0.01) were found between facet joint osteoarthritis, fat infiltration score, and radiographic density ratio. CONCLUSIONS: Two suggested indices of paraspinal muscle degeneration showed excellent reliability and were significantly associated with facet joint osteoarthritis. Additional studies are needed to evaluate the associations with other spinal degeneration features and low back pain.

Lumbar facet joint orientation and osteoarthritis: a cross-sectional study.

BACKGROUND AND OBJECTIVE: The association between facet orientation, tropism (asymmetry of the facet angles) and facet joint osteoarthritis (OA) has been previously reported, however, it is necessary to confirm the association in other samples. Our aim was to evaluate the association between facet orientation, tropism, and facet joint OA in an Israeli sample. METHODS: One hundred and fifty low back and abdominal CTs of 82 males (mean age 61.74 ± 12.99) and 68~females (mean age 59.51 ± 11.74,) were evaluated in a cross-sectional study. Facet joint OA was evaluated at the L4-L5 spinal level using a 4-graded scale. The association between facet joint OA, facet orientation and tropism was examined using multiple logistic regressions adjusted for age and sex. RESULTS: Facet orientation showed a statistically significant association with facet joint OA on the right side (p=0.009) and in a model where both sides were combined (p=0.003). Facet joints with OA were more sagittally oriented. Tropism was not associated with facet joint OA on either side (p=0.251 for right and 0.609 for the left side), or in a combination of both sides (p=0.482). CONCLUSIONS: We confirm a significant association between sagittal orientation and OA of the lumbar facet joints at level L4-L5. Facet tropism was not associated with facet joint OA. Additional longitudinal studies are needed to understand the causal relationship between facet joint orientation and OA.

Potential link between C3a, C3b and endothelial progenitor cells in resistant hypertension.

INTRODUCTION: Endothelial progenitor cells (EPC) and complement C3 are involved in the pathophysiology of arterial hypertension. C3a is the negative regulator of progenitor cells egress during their mobilization from bone marrow. Previously, higher plasma concentration of C3 was observed in resistant arterial hypertension (RAH) than in controlled arterial hypertension (CAH). Thus, we hypothesized that RAH would be associated with complement C3 activation and reduced number of circulating EPCs. OBJECTIVE: To compare C3a, C3b and their correlation with circulating EPC in subjects with RAH and CAH. METHODS: Blood pressure was measured by electronic sphygmomanometer. EPCs were identified as CD34+/CD133+/KDR+ cells by flow cytometry. C3a and C3b were determined using enzyme-linked immunosorbent assay (Quidel, CA). RESULTS: : RAH group (n = 20) and CAH group (n = 20) and 17 healthy individuals (control group) were recruited. In the RAH group, C3a (858.1 +/- 70.6 microg/dL) was higher than in the CAH group (816.1 +/- 123.3 microg/dL; P < 0.001), and in the control group (751.3 +/- 98.8; P < 0.001), C3b (564.1 +/- 54.7 microg/dL) was higher than in the CAH group (490.2 +/- 58.5 microg/dL; P < 0.001). In control group (456.3 +/- 98.8; P < 0.001), statistically significant negative correlation was observed between C3a and blood levels of EPC (r = -0.523, P = 0.018); statistically significant positive correlation was observed between systolic blood pressure and blood levels of C3a (r = 0.52, P = 0.02) and between systolic blood pressure and blood levels of C3b (r = 0.57, P = 0.009). CONCLUSION: RAH is characterized by higher levels of C3 component fragments and a negative correlation between circulating C3a and EPCs.

Circulating endothelial progenitor cells, Th1/Th2/Th17-related cytokines, and endothelial dysfunction in resistant hypertension.

INTRODUCTION: A possible link between chronic vascular inflammation and arterial hypertension is now an object of intensive studies. OBJECTIVE: To compare Th1/Th2/Th17 cells-related cytokines, circulating endothelial progenitor cells (EPC), and endothelial function in subjects with resistant arterial hypertension (RAH) and controlled arterial hypertension (CAH). METHODS: Blood pressure was measured by electronic sphygmomanometer. EPC were identified as CD34+/CD133+/kinase insert domain receptor (KDR)+ cells by flow cytometry. Th1/Th2/Th17 cells-related cytokines were identified using the Human Th1/Th2/Th17 Cytokines MultiAnalyte ELISArray Kit. Endothelium-dependent (FMD) vasodilatation of brachial artery was measured by Doppler ultrasound scanning. RESULTS: RAH group (n = 20) and CAH group (n = 20) and 17 healthy individuals (control group) were recruited. In the RAH group, lower blood levels of EPC number (42.4 +/- 16.7 cells/mL) and EPC% (0.19 +/- 0.08%) were observed than in the CAH group (93.1 +/- 88.7 cells/mL; P = 0.017; 0.27 +/- 0.17; P = 0.036) and control group (68.5 +/- 63.6 cells/mL; P < 0.001; 0.28 +/- 0.17%; P = 0.003), respectively. Plasma transforming growth factor-beta1 levels were significantly higher in the RAH group (1767 +/- 364 pg/mL) than in the CAH group (1292 +/- 349; P < 0.001) and in control group (1203 +/- 419 pg/mL; P < 0.001). In the RAH group, statistically significant negative correlation was observed between systolic blood pressure and EPC% (r = -0.72, P < 0.01). FMD in the RAH group was significantly lower (5.5 +/- 0.8%) than in the CAH group (9.2 +/- 1.4; P < 0.001) and in healthy controls (10.1 +/- 1.1%; P < 0.001). CONCLUSION: RAH is characterized by reduced circulating EPC, substantial endothelial dysfunction, and increased plasma transforming growth factor-beta1 levels.

Diameter-by-age reference curves for the uterine cervix by computerized tomography.

OBJECTIVE: To create diameter-by-age reference curves for the uterine cervix using computerized tomographic studies. METHODS: Measurements of the anterior-posterior (AP) and lateral diameters of nonpathological cervices were made at the level of the vaginal fornices in 499 computerized tomographic studies. Patients were grouped by 10-year age intervals. For each age group, median AP and lateral cervical diameters were calculated, as were 10th and 90th percentile values. Values for the 3 curves were smoothed across age categories using second-order polynomial regression procedures. RESULTS: The median AP diameter was 26 mm (range, 15-45 mm), and the median lateral diameter was 32 mm (range, 20-70 mm). For both measurements, the range of values between the 10th and 90th percentiles decreased with increasing age, creating funnel-shaped plots. CONCLUSIONS: Radiological measurements of cervical diameters and comparison to standard curves may contribute information in the evaluation of uterine cervical pathology or may heighten awareness of pathologies not previously identified.

Effect of short-term dutasteride therapy on prostate vascularity in patients with benign prostatic hyperplasia: a pilot study.

OBJECTIVES: In this study we assessed the possible influence of dutasteride (types 1 and 2 isoenzymes of 5-alpha-reductase inhibitors) on prostate tissue vascularity. We also attempted to evaluate whether preoperative treatment with dutasteride could help to avoid excessive bleeding in patients undergoing transurethral resection of prostate (TUR-P). METHODS: This pilot study has 3 phases. All patients enrolled in the study had a prostate-specific antigen < 4 ng/mL and normal digital rectal examination. In the first phase we included 10 patients with benign prostatic hyperplasia treated with alpha-blockers. The end point of this phase was to choose the preset that could exclude noise signals and be reproducible. In the second phase, we included 32 patients in whom color Doppler sonography (CDS) was performed before and 6 weeks after treatment with 0.5 mg dutasteride per day. We counted every discrete color Doppler signal (CD-spot). To compare the CDS data, we used the Student t test, and P < .05 was considered significant. Afterward, 46 patients joined the third phase. Patients were assigned to the control and study groups according to sequentially numbered sealed envelopes. Patients in the study group received 0.5 mg dutasteride 6 weeks before TUR-P. RESULTS: In the first phase: color Doppler preset with pulse repetition frequency of 0.3 kHz was chosen as the most sensible. In the second phase, a significant decline in CD-spots count was detected in 23 (72%) patients (P < .05) and was more distinctive in the periurethral zone. In the third phase, only 43 of the patients continued with TUR-P (in 3 patients, voiding symptoms improved). Operating time and volume of irrigation fluid were significantly different (50.55 minutes/42.65 minutes, P = .014; 8.03/13.10 L, P = .047). CONCLUSIONS: Six weeks of dutasteride treatment may reduce prostate tissue vascularity in the periurethral area proximal to the verumontanum. The third phase of our study confirmed that preoperative treatment with dutasteride could improve operative performance and avoid TUR syndrome.

A radiological study on the anatomical proximity of the ureters and the cervix.

In order to evaluate risk factors for anatomical proximity between the cervix and the ureters the distance between the ureters and the cervix was measured in 499 computerized tomography (CT) studies at the most dorsal reflection of the ureters. The relationship between the ureter-cervical distance and the presence of pelvic pathology was assessed by correlation tests and regression analysis. Of the 499 CT studies, 252 demonstrated radiographic pathologies. Among abnormal scans, 126 (50%) involved cervical pathology. At least one ureter was within 0.5 cm of the cervix in 3.6% of patients with normal CT scans and in 10.3% of patients with cervical pathology. Overall, the right ureter was significantly closer to the cervix than the left (2.0 +/- -0.8 cm vs. 2.2 +/- 1.0 cm, p < 0.05). In cases were the pathology was limited to the cervix, the right ureter was more distant than the left (2.0 +/- 0.6 cm vs. 1.7 +/- 0.6 cm, p < 0.05). The distance between the ureters and the cervix was inversely correlated with the lateral diameter of the cervix (r = 0.18, p < 0.001) and its anterior-posterior diameter (r = 0.11, p < 0.001). Age did not correlate with the distance of the ureters from the cervix (r = 0.002, p = N.S). In conclusion, approximately 10% of patients with cervical pathology can be expected to have a ureter proximate less than 5 mm from the cervix. For patients with cervical pathology undergoing a planned hysterectomy, preoperative measurement of cervical-ureteric distance may be warranted. In these circumstances intra-operative measures to protect the ureter and ascertain its integrity may be invaluable.

Non-contrast computerized tomography (NCCT) and dynamic renal scintigraphy (DRS) in the patients with refractory renal colic.

OBJECTIVES: To assess the importance of combined use of non-contrast computerized tomography (NCCT) and dynamic renal scintigraphy (DRS) in evaluation of patients with refractory flank pain in the emergency department. METHODS: The study involved 64 consecutive patients with refractory renal colic. All patients were evaluated with plain abdominal films kidneys, ureters and bladder (KUB), NCCT and DRS. We assessed the accuracy of different diagnostic procedures and their combinations; in addition, we determined their importance for different steps of evaluation. RESULTS: Urololithiasis was diagnosed in 76.6% (n=49) of the patients. Twenty-nine percent of calculi were > 4 mm. Surgical intervention were performed in 20 patients (40.8%). A combination of NCCT plus DRS yielded the greatest sensitivity (96%) in establishing final diagnosis, however clinical, laboratory and KUB data in combination with DRS, yielded greater specificity (93%) and PPV (97%). Sex (male), WBC (mean 10.2 x 10(3) +/- 3.1) and KUB (calculus > 4 mm) were chosen in the three-step multi-variant analysis, while only male sex was found to be the strongest predictor (p<0.056) of necessity to perform NCCT. In making decision for definitive treatment NCCT and DRS provided the most important information about stone size and obstruction (kappa=0.734, p<0.001 and kappa=0.625, p<0.001), while DRS was selected as the most important diagnostic procedure in the emergency department (kappa=0.527, p<0.001). CONCLUSIONS: In the emergency department, DRS combined with the results of clinical investigation may indicate candidates for hospitalization with emergency intervention. Immediate NCCT must be strongly considered in men with WBC> or =10 x 10(3) and calculi > 4 mm on the KUB.

Oral contraceptives and liver hemangioma: a case-control study.

OBJECTIVE: To study whether there is an epidemiological association between liver hemangiomas and oral contraception use, as may be suggested by clinical observations of liver hemangioma growth during pregnancy and under estrogen administration. METHODS: A case-control study of 40 women with liver hemangiomas, as diagnosed by imaging studies [ultrasonography (US) or computed tomography (CT) and nuclear scan], and 109 age-matched control with normal studies. The women were interviewed with respect to their menstrual, reproductive and oral contraception use history. RESULTS: The liver hemangioma and control groups did not differ significantly with regard to their menstrual or reproductive history. Ever oral contraception use was reported by 30% of the cases and 27% of controls. The odds ratio (OR) was 1.1 [95% confidence interval (CI) 0.52-2.60] for ever use, 1.64 (95% CI 0.37-7.13) for initiation before the age of 20, and 0.62 (95% CI 0.16-2.42) for use duration of less than 1 year. On the multivariate analysis only the women's age emerged as a predictor for liver hemangiomas (OR 3.1; 95% CI 1.16-8.96). CONCLUSIONS: In this study liver hemangiomas were not associated with menstrual, reproductive and oral contraception use history.