LAM KID

[Vertebral deformity]

TÓTH EDIT

JULY 03, 2012

LAM KID - 2012;2(02)

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LAM KID

[The cellarer’s meditation]

DÁNIEL Zsolt

LAM KID

[Bone status in praediabetic state - Relationship of bone density and energy homeostasis before the manifestation of type 2 diabetes mellitus]

BUDAY BARBARA, VITAI Márta, PACH Péter, LITERÁTI Nagy Botond, PÉTERFAI Éva, BEZZEGH Katalin, PAUER József, KORÁNYI LÁSZLÓ

[INTRODUCTION - All forms of diabetes are associated with increased fracture risk. In type 2 diabetes, bone mineral density is increased. In order to determine whether increased bone density is a consequence of diabetes-related metabolic changes or rather a primary alteration independent of these changes, we examined women and men with the following characteristics: normal glucose tolerance; genetically determined risk of T2DM but healthy on the basis of detailed metabolic tests; or incipient glucose intolerance, praediabetic state. PATIENTS AND METHODS - We included 72 men with normal glucose tolerance; seven men with normal glucose tolerance and first-degree relative(s) with diabetes; 64 body fat mass adjusted and BMI-adjusted men with glucose intolerance; 36 healthy women with normal glucose tolerance; 12 women with normal glucose tolerance and first-degree relative(s) with T2DM and 88 women with glucose intolerance. Muscle glucose uptake was measured by hyperinsulinaemic-normoglycaemic clamp, and bone density was measured by DEXA. RESULTS - In healthy men, the connection between leptin and BMDL1-4 is positive and the relationship between testosterone and BMDL1-4 is negative, but both correlations disappear in the early praediabetic stage. In the whole female study population, negative correlations were found between total BMD and adiponectin (r=-0.318, p<0.0001), and osteocalcin (r=-0.412, p<0.0000), which stayed significant after adjustments for body fat percent and age in case of impaired glucose tolerance. CONCLUSION - In women with healthy glucose metabolism who have first-degree relative(s) with diabetes, increased bone density is not related to changes in glucose metabolism. Our study emphasizes the substantial gender differences in the relationship between density of the femur and vertebrae and metabolism. Our data question the mediatory role of adiponectin shown in animal studies in the insulin-sensitizing, glucose metabolism improving effect of osteocalcin in men.]

LAM KID

[Practical questions regarding the use of teriparatide]

TAKÁCS István

[Teriparatide has become one of the most important drug in the treatment of osteoporosis in Hungary. Although this is not a new drug, a number of questions arise regarding its use in everyday practice. When should we use it as first-line treatment? When should we change the used therapy to teriparatide? What kind of effect can we expect after the start of teriparatide therapy? What are the potential side effects? Financing rules limit, but do not fully control our therapeutic decisions, as these are mostly based on scientific data. In this review, we summarise new and older scientific data regarding teriparatide from practical aspects.]

LAM KID

[Strontium ranelate effect in postmenopausal women with different clinical levels of osteoarthritis]

BALLA Bernadett

LAM KID

[To drink or not to drink - how much and what?]

KISS László

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Ca&Bone

[Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures]

KULCSÁR Zsolt, SZIKORA István, BERENTEI Zsolt, MARTOS János, NYÁRY István

[Percutaneous vertebroplasty is a minimally invasive procedure that is increasingly applied for the treatment of osteoporotic compression fractures. The authors discuss its indications, patient selection criteria, the issue of diagnostic imaging, the technique of the procedure, its potential complications, review the literature on post-procedure pain relief, and briefly present their own experience in the treatment of osteoporotic fractures. Vertebroplasty is indicated for patients with severe, persistent, often incapacitating focal back pain not responding to standard medical therapy, which is related to the collapse of one or more vertebral bodies. Patients selected carefully by the clinical symptoms and the imaging studies usually respond promptly to the treatment, experience significant pain relief, improvement of the quality of life, and an increase in mobility.Vertebroplasty is a safe procedure with relatively low complication rates.The potential neurological complications, however, necessitate an instantly available neurosurgical background.]

LAM KID

[The efficacy of ibandronate and the importance of adherence - Results of the BOUNCE study]

DONÁTH Judit, POÓR Gyula

[Bisphosphonates play a substantial role inthe treatment of postmenopausal osteo-porosis. Ibandronate is the first bisphos-phonate that can be used both orally andintravenously. A number of studies haveproved that ibandronate reduces boneturnover, increases bone mineral densityand reduces the risk of vertebral fractures.It is a well-known fact that the patients’adherence to oral medications is very poorthroughout the world. So far, very fewinternational studies have been performedon the patients’ compliance in medicinetaking. The BOUNCE study, carried out inseveral countries including Hungary tostudy the adherence of patients in the oralintake of ibandronate, aims to fill this gap.]

Clinical Neuroscience

[A rare complication of a rare disease; stroke due to relapsing polychondritis]

KILIÇ ÇOBAN, EDA XANMEMMEDOV, ELMIR ÇOLAK, MELEK SOYSAL

[Relapsing polychondritis (RP) is an episodic and progressive inflammatory disease of cartilaginous structures. Its diagnosis is based primarily on clinical features such as laboratory parameters, biopsy. Neurological complications occur in 3% of the cases and are classified as an important cause of death. The cranial nerve disorders are most common but hemiplegia, ataxia, myelitis, polyneuritis, seizures, confusion, hallucination and headache can also happen. The aetiology of central nervous system involvement is still unknown. Moreover stroke has rarely reported in these patients. The diagnosis of stroke is challenging because of its rarity among these patients. Perhaps vasculitis is the common underlying mechanism. Also meningitis and encephalitis can occur during the course of RP. A 44 year-old woman was admitted with uncontemplated left hemiparesis, redness, swelling, and tenderness of the metacarpophalangeal and interphalangeal joints of the right hand and the cartilaginous portion. White blood cell count, C-reactive protein and the erythrocyte sedimentation rate were elevated. Vasculitis biomarkers were normal in our patient. Carotid and vertebral artery doppler ultrasonography, cranial and cervical MR Angiography were normal. Echocardiography showed a mild mitral valve prolapse and regurgitation. Our patient had the history of auricular polychondritis but she had not been diagnosed. Hemiparesis was her first neurological manifestation that led her to doctors for diagnosis. Our patient fulfilled the criteria of RP so no biopsy was needed. She was treated with oral prednisolone (80 mg/day) and aspirin (300 mg/day) and now she is on 10 mg prednisolone and 150 mg azathioprine. Two months later her physical and neurological symptoms returned to normal.]

Hungarian Radiology

[Pictures to the past Methodological possibilities in the palaeoradiology]

ALIDA Lilla Kristóf, BARTA H. Miklós, PETRIK Anikó, PAP Ildikó, PÁLFI György, FORNET Béla, FORRAI Gábor

[INTRODUCTION - The radiology as a method is useful not only in the field of the traditional medicine, but in the historic anthropology examining the ancient human remains, and in the palaeopathology examining the pathological changes of the ancient human remains. The aim of our study was the correction of the palaeopathological methods and the radiological diagnosis of the ancient pathological remains. MATERIAL AND METHODS - Approximately 25 specimens originating from the Avar-, the Hungarian Conquest Period and from the Arpadian Age with pathological changes were examined. Besides these 11 naturally mummified individuals were examined by radiological methods, too. The X-ray examinations were done at the Department of Radiology of the National Medical Centre, in Budapest. RESULTS - Vertebral changes, pulmonary tuberculosis and traumatic lesions were found on the mummified individuals. The most frequent changes of the bone alterations were traumas: fractures of the ulna, clavicule, ribs, and trephanation of the skull. Several degenerative changes of the vertebral columns and of the articulation surfaces were detected (osteophyta, spondylosis, arthrosis). The rheumatoid arthritis, Paget-disease, facies leprosa, and the traces of vertebral tuberculosis should be mentioned among the rare pathological disorders. CONCLUSIONS - Since there are no sufficient palaeoradiological methodological references, it was necessary to develop new methods for X-ray examinations.]

Hungarian Radiology

[Radiological assessment of the combined high tibial osteotomy in the frontal plane]

PAPP Miklós, KÁROLYI Zoltán, FAZEKAS Péter, SZABÓ László, PAPP Levente, RÓDE László

[INTRODUCTION - High tibial osteotomy (HTO) is a generally accepted treatment for medial unicompartmental osteoarthritis of the knee with varus alignment. The main principle of HTO is to achieve a transfer of loading from diseased, arthritic areas of the joint to areas with relatively intact, healthly cartilage. This stress reduction can be achieved with correction of the loading axis. A stress reduction occurs in the medial compartment of the knee when the loading axis is transferred from the medial compartment to just lateral to the center of the joint. PATIENTS AND METHODS - We performed radiological assessment of 52 knees preoperatively and after combined high tibial osteotomy (CO) in the 10th postoperative week, in the 12th postoperative month and in the 5th postoperative year on a standing weight-bearing anteroposterior radiograph. CO involved performing a proximal osteotomy parallel to the tibial plateau, followed by a distal osteotomy extending from the lateral part of the tibia to the line of the proximal osteotomy at the center of the tibial condyle. After closure of the lateral part of the osteotomy and consequent opening of the medial part, the removed lateral bone wedge was transferred to the gap on the medial side. Pre- and postoperatively we measured the lateral angle between the anatomic axis of the femur and the distal articular surface of the femur (FCFS), the lateral angle between the anatomic axis of the tibia and the proximal articular surface of the tibia (TP-TS) and the lateral angle between the distal articular surface of the femur and the proximal articular surface of the tibia (the articular component of the varus deformity FC-TP). We determined the FTA as a sum of FC-FS, TP-TS and FC-TP. RESULTS - The FC-TP, the TP-TS and the FTA decreased significantly after CO according to data measured in the 10th postoperative week. We achieved the planned correction (FTA 171-169°) in 77% of cases. Undercorrection (FTA ≥172°) was detected in 7, overcorrection (FTA ≤168°) was noted in 5 cases. We detected significant loss of correction between the 10th postoperative week and the 12th postoperative month (the FTA increased significantly, the loss of correction was 1° in 26 cases, 2° in 7 cases). The valgus alignment did not increase in any case. The articular component did not change in 36 cases. We did not note significant loss of correction and the valus alignment did not increase in any case between the 12th postoperative month and 5th postoperative year. We noted the recurrence of varus deformity in 1 case. We detected loss of correction due to increasing articular component in further 4 cases. The FC-FS did not change during the first 5 postoperative years. CONCLUSION - If we achieved the planned correction (FTA 171-169°) according to data measured in the 10th postoperative week on a standing weight-bearing anterposterior radiographs, we did not detect recurrence of varus deformity in any case during the first 5 postoperative years. If the articular component (FC-TP) did not change between the 12th postoperativ month and the 5th postoperative year (in 61.5% of cases), in our opinion we achieved the optimal correction.]