Isaac Leichter

Combined Effect of Foot Arch Structure and an Orthotic Device on Stress Fractures

In a prospective study, quantitative measures of the structure of the longitudinal arch of the foot were established and related to the incidence of stress fractures in the bones of the lower limbs of military recruits. In addition, the role of a semirigid orthotic device (Langer military stress orthotic) in preventing stress fractures was evaluated as a function of the structure of the longitudinal arch. Femoral and tibial stress fractures were found to be more prevalent in the presence of feet with high arches, whereas the incidence of metatarsal fractures was higher in feet with low arches. The use of an orthotic device reduced the incidence of femoral stress fractures only in the presence of feet with high arches and the incidence of metatarsal fractures only among feet with low arches. The findings suggest that the normal foot with a low arch acts as a better shock absorber than the normal foot with a high arch, and that an orthotic device may improve the shock absorbing capacity of the arch.

Increased trabecular bone density due to bone-loading exercises in postmenopausal osteoporotic women

SummaryA program of diverse and dynamic loading exercises of the distal forearm, a common site of osteoporotic fractures, was applied three times a week for 5 months to 14 postmenopausal osteoporotic women. Two parameters were used to assess the effect of the exercises on bone mass. The mass density of bone (g/cm3) was measured by the Compton scattering technique. The bone mineral content (g/cm2) was measured by single photon absorptiometry. Both measurements were taken at the same location in the distal radius 1 year prior to the exercise period, at its beginning, and at its end, in both the exercised group and a matched control group of 25 osteoporotic women. During the exercise period the mean bone density decreased by 1.9% in the control group whereas it increased by 3.8% in the exercise group. The bone mineral content results did not demonstrate any significant trend over the whole period of the study. It is concluded that the trabecular bone tissue in the distal radius of postmenopausal osteoporotic women responds favorably to dynamic and diverse bone stressing exercises even in the seventh decade of life.

Effect of swimming on bone growth and development in young rats.

The effect of chronic swimming on bone modelling was studied. Forty female Sabra rats (5 weeks old) were randomly assigned to the following experimental groups: 30 rats were trained to swim (water bath 35 +/- 1 degree C, one h daily, five times a week) for 20 weeks--20 of them loaded with lead weights (1% body weight) while the rest (10 animals) swam load free. Ten sedentary rats matched for age and weight served as controls. At the end of the twenty-week swimming period, all rats were sacrificed, both humeri bones were dissected and prepared for the following examinations: morphometric, bone density (BD), bone mineral content (BMC), compression tests and cross-sectional geometrical parameters, histomorphometry and biochemical analysis of minerals (Ca, Pi, Mg, Zn). All measured parameters were found to be significantly higher (P less than 0.05) in the swimming rats irrespective of load, as compared with the controls. Bone weight was higher by 19%, bone volume by 11%, bone length by 2.8%, cortical area by 16%, BD by 7% and BMC by 15%. The compression breaking force at the distal shaft of the humerus was higher by 24% in the trained group, while the ultimate compressive stress was not significantly different. Maximal and minimal moment of inertia at the distal diaphysis were 33.4 and 40% higher, respectively, for the swimming groups than the controls. Ca, Pi, Mg and Zn levels per total humeral bone were significantly higher in the exercising rats. The histomorphometry and cross-sectional data emphasize longitudinal and transversal growth. These data indicate that swimming exercise exerts a positive effect on bone growth and development in young rats.

THE EFFECT OF SWIMMING ACTIVITY ON BONE ARCHITECTURE IN GROWING RATS

The effect of non-habitual physical activity on bone architecture in the rat humeral shaft was examined. Two groups of rats were trained to swim for 1 h a day, for 20 weeks, at two training levels. The control group consisted of sedentary rats. Parameters of cross-sectional bone morphology (cross-section areas, principal area moments of inertia and their ratio) were used to evaluate the response of bone architecture to mechanical loading. The strength of bone was assessed by measuring the ultimate compressive force and stress. The cortical cross-section area and principal moments of inertia were found to be significantly higher in the swimming groups than in the controls. Examination of the ratio between the major and minor moments of inertia revealed a pronounced change in the shape of the bone cross-section which became more rounded following swimming training. The ultimate compressive force was significantly higher in the swimming rats while the changes in ultimate stress were not significant. Our results indicate a gain of bone strength due to increased periosteal apposition and modified bone tissue distribution. The marked changes in bone morphology are attributed to the different nature of the forces and moments exerted on the humerus during swimming compared to those prevailing during normal locomotion.

Bone density, mineral content, and cortical index in patients with thalassemia major and the correlation to their bone fractures, blood transfusions, and treatment with desferrioxamine

SummaryIn an attempt to explain the increased frequency of pathological fractures found in thalassemia major patients, we examined noninvasively several properties of bones in 17 patients. We found a significant decrease in the bone mineral content (BMC) and the bone density (BD) of both trabecular (34% and 4% diminution, respectively) and cortical bone (24% and 3% diminution, respectively), as compared with normal controls. We also found that metacarpal cortical indices (CI) were significantly lower in thalassemic patients as compared with normal controls (36% diminution). As expected, upper limb fractures were more frequent in those patients with greater bone diminution. Furthermore, the degree of bone diminution was greater in patients receiving fewer blood transfusions and shorter courses of desferrioxamine. Bone densitometry should probably be included in the comprehensive evaluation of thalassemia patients in order to help guide overall treatment.

Ability of different techniques of measuring bone mass to determine vertebral bone loss in aging female rats

SummaryChanges in vertebral trabecular bone were quantified in female Wistar rats. This study utilized single photon absorptiometry for the measurement of bone mineral content (BMC), quantitative computed tomography (QCT) for the measurement of bone mineral density (BMD), and image analysis histomorphometry for the measurement of trabecular bone volume (TBV). The above measurements were accompanied by biochemical assays of protein and calcium concentrations in the tissues. Also, the activity of bone alkaline and acid phosphatases was measured. Lumbar vertebrae (L4, L5) in old rats 27 months old, compared with those of young rats 7 months old, showed significant decreases in BMC, BMD, TBV, protein and calcium, and enzyme activity. A high degree of correlation was recorded between the above changes. The various changes were accompanied by a marked reduction in the overall wet weight of the vertebrae. Hence, new noninvasive methods to quantitate bone mass can be appliedin vivo to small laboratory animals such as the rat. These methods are much more accurate than standard radiographs in quantitating bone loss and are, therefore, recommended for experimental longitudinal studies related to aging of the skeleton.

Improved mammographic interpretation of masses using computer-aided diagnosis

Abstract. The aim of this study was to evaluate the effectiveness of computerized image enhancement, to investigate criteria for discriminating benign from malignant mammographic findings by computer-aided diagnosis (CAD), and to test the role of quantitative analysis in improving the accuracy of interpretation of mass lesions. Forty sequential mammographically detected mass lesions referred for biopsy were digitized at high resolution for computerized evaluation. A prototype CAD system which included image enhancement algorithms was used for a better visualization of the lesions. Quantitative features which characterize the spiculation were automatically extracted by the CAD system for a user-defined region of interest (ROI). Reference ranges for malignant and benign cases were acquired from data generated by 214 known retrospective cases. The extracted parameters together with the reference ranges were presented to the radiologist for the analysis of 40 prospective cases. A pattern recognition scheme based on discriminant analysis was trained on the 214 retrospective cases, and applied to the prospective cases. Accuracy of interpretation with and without the CAD system, as well as the performance of the pattern recognition scheme, were analyzed using receiver operating characteristics (ROC) curves. A significant difference (p < 0.005) was found between features extracted by the CAD system for benign and malignant cases. Specificity of the CAD-assisted diagnosis improved significantly (p < 0.02) from 14 % for the conventional assessment to 50 %, and the positive predictive value increased from 0.47 to 0.62 (p < 0.04). The area under the ROC curve (Az) increased significantly (p < 0.001) from 0.66 for the conventional assessment to 0.81 for the CAD-assisted analysis. The Az for the results of the pattern recognition scheme was higher (0.95). The results indicate that there is an improved accuracy of diagnosis with the use of the mammographic CAD system above that of the unassisted radiologist. Our findings suggest that objective quantitative features extracted from digitized mammographic findings may help in differentiating between benign and malignant masses, and can assist the radiologist in the interpretation of mass lesions.

Can the size of microcalcifications predict malignancy of clusters at mammography

RATIONALE AND OBJECTIVES The purpose of this study was to determine whether the size of mammographically detected microcalcifications is predictive of malignancy. MATERIALS AND METHODS Two hundred sixty mammograms showing clustered microcalcifications with proven diagnoses (160 malignant, 100 benign) were respectively reviewed by experienced mammographers. Lesions that were obviously benign in appearance were excluded from the study. A computer-aided diagnosis system digitized the lesions at 600 dpi, and the microcalcifications on the digital image were interactively defined by mammographers. Subsequently, three quantitative features that reflected the size of the microcalcifications-length, area, and brightness-were automatically extracted by the system. For each feature, the standard average of values obtained for individual calcifications within the cluster and the average with emphasis on extreme values (E) obtained in a single cluster were analyzed and matched with pathologic results. RESULTS In the malignant group of cases, the mean values of the standard average length and area were significantly higher (P < .0001) than the mean values in the benign group. Distribution analysis demonstrated that an average length of more than 0.41 mm was associated with malignant lesions 77% of the time, while an average length of less than 0.41 mm was associated with benign lesions 71% of the time. The mean of the average length (E) and area (E) of microcalcifications within the cluster demonstrated an even higher discriminative power when compared with the standard average length and area. The average brightness, on the other hand, showed only a low discriminative power. CONCLUSION Digital computerized analysis of mammographically detected calcifications demonstrated that the average length and area of the calcifications in benign clusters were significantly smaller than those in malignant clusters.

Optimizing parameters for computer-aided diagnosis of microcalcifications at mammography.

RATIONALE AND OBJECTIVES The purpose of this study was to optimize selection of the mammographic features most useful in discriminating benign from malignant clustered microcalcifications. MATERIALS AND METHODS The computer-aided diagnosis (CAD) system automatically extracted from digitized mammograms 13 quantitative features characterizing microcalcification clusters. Archival cases (n = 134; patient age range, 31-77 years; mean age, 56.8 years) with known histopathologic results (79 malignant, 55 benign) were selected. Three radiologists at three facilities independently analyzed the microcalcifications by using the CAD system. Stepwise discriminant analysis selected the features best discriminating benign from malignant microcalcifications. A classification scheme was constructed on the basis of these optimized features, and its performance was evaluated by using receiver operating characteristic (ROC) analysis. RESULTS Six of the 13 variables extracted by the CAD system were selected by stepwise determinant analysis for generating the classification scheme, which yielded an ROC curve with an area (Az) of 0.98, specificity of 83.64%, positive predictive value of 89.53%, and accuracy of 91.79% for 98% sensitivity. When patient age was an additional variable, the schemes performance improved, but this was not statistically significant (Az = 0.98). The ROC curve of the classifier (without age as an additional variable) yielded a high Az of 0.96 for patients younger than 50 years and an even higher (P < .02) Az of 0.99 for those 50 years or older. CONCLUSION Stepwise discriminant analysis optimized performance of a classification scheme for microcalcifications by selecting six optimized features. Scheme performance was significantly (P < .02) higher for women 50 years or older, but the addition of patient age as a variable did not produce a statistically significant increase in performance.

The relative significance of trabecular and cortical bone density as a diagnostic index for osteoporosis

The density of the distal radius in the non-dominant forearm was measured non-invasively by Compton spectrometry in 234 post-menopausal women. The density of the trabecular tissue was determined almost independently from that of cortical tissue by horizontal and vertical scanning of the bone. It was found that the lower the density of the trabecular bone, the greater the difference between the density of the cortical and trabecular bone. As osteoporosis progresses, trabecular bone density in the distal radius seems to decrease faster than that of compact bone. Hence the severity of the disease is best determined by measuring the density of trabecular bone.