Trippi D

Biochemical and ultrasound tests for early diagnosis of active neuro-osteoarthropathy (NOA) of the diabetic foot.

OBJECTIVES To test the effectiveness of a combined approach to an early diagnosis of neuro-osteoarthropathy (NOA) of the diabetic foot, we studied a group of outpatients with active NOA, presenting for the first time to our Diabetic Foot Clinic in 1998, by means of an integrated approach designed to assess bone turnover. PATIENTS AND METHODS Fifteen consecutive diabetic patients (five Type 1 and ten Type 2 diabetic individuals, age 61.9+/-12.2 years, diabetes duration 18.7+/-8.9 years, HbA(1c) 8.4+/-1.5%) with active NOA (Group 1) were compared to nine diabetic patients with chronic stable NOA (Group 2), 14 neuropathic diabetic patients without NOA (Group 3), 13 non-neuropathic diabetic patients (Group 4) and 15 healthy controls (Group 5). Determination of serum carboxy-terminal collagen telopeptide (ICTP), bone alkaline phosphatase isoenzyme (B-ALP), osteocalcin (BGP) concentrations, as well as urinary excretion of deoxypyridinoline (DPD) were obtained in all individuals for assessment of bone reabsorption and new bone formation. Moreover in all individuals quantitative ultrasound (QUS) of the calcaneal bone was performed and mass density of lumbar spine and femur bone was determined by dual-energy X-ray absorptiometry (DEXA). RESULTS QUS was significantly lower in the active NOA patients as compared with other groups (P<0.01), while ICTP was higher in both NOA groups (P<0.01). Urinary DPD was higher in the neuropathic non-NOA group (P<0.01) than the other groups, and osteocalcin was higher in healthy controls compared to diabetic patients without NOA. QUS and ICTP were inversely correlated (r=0.44, P=0.000). QUS in the active NOA group was significantly (P<0.01) lower in the affected compared to the unaffected foot. CONCLUSION Our results indicate a possible role for an integrated approach to the diagnosis and monitoring of NOA involving the diabetic foot. DPD may identify patients at-risk for NOA, ICTP could be tested as a marker for NOA in asymptomatic cases. Finally, QUS of the calcaneal bone may be useful in discriminating active versus quiescent phases.

Location of functioning metastases from differentiated thyroid carcinoma by simultaneous double isotope acquisition of I-131 whole body scan and bone scan

In a young patient with differentiated thyroid carcinoma (DTC), previously submitted to total thyroidectomy and I-131 therapy for ablation of thyroid remnant, a follow-up I-131 diagnostic whole body scan (WBS) demonstrated four small abnormal I-131 uptake areas. Two of these were projected over the thoracic region and corresponded to lung nodules, as later demonstrated by lung computerized tomography (CT)-scan. The remaining two areas were found in the lumbar-pelvic region, but their precise location could not be determined. Standard bone Rx examination and bone scan were negative. After I-131 therapy, we simultaneously acquired a I-131 WBS and a Tc-99m oxidronate bone scan by setting a dual window on the gamma camera. Comparing the I-131 and bone images we were able to identify the 4th lumbar vertebra and right ilium as the bone segments to be studied by a radiological approach. Eventually, the thin slice CT-scan demonstrated the presence of two small osteolytic lesions in these areas. In conclusion, the simultaneous acquisition of images both from I-131 and a bone-seeking agent may be useful to locate functioning bone metastases from DTC.

Reflex sympathetic dystrophy syndrome with microtrabecular fracture in a patient with osteogenesis imperfecta

SummaryA case of reflex sympathetic dystrophy syndrome (RSDS) in a patient with osteogenesis imperfecta (OI) is reported. We discuss the association of OI, manifested by microfractures of the trabecular bone due to marked bone fragility, and the appearance of RSDS. Magnetic resonance imaging (MRI) was helpful in assessing the presence and extent of the trabecular fractures.

A computer-assisted method for the study of the trabecular bone of the distal radius on conventional radiographs

The procedure described is based on the acquisition and processing of x-rays of the distal radius obtained under standard conditions. An x-ray was obtained of the forearm together with an aluminum step wedge to automatically normalize the photometric values of the bone with respect to the photometric values of the reference aluminum wedge. Densitometric values for thickness (T) and a coarseness parameter (C) that depends on the trabecular bone pattern are measured on interactively selected rows and regions of interest (ROIs) of the digital image. Twenty-five women were examined and two different measurements were performed. The first measurement considers C in three sites of the radial epiphisis. The trabecular bone coarseness appears to increase from the distal to the very-very distal site and the value of C in the very distal site, which is located 1 cm distally to the distal one tenth of the radius, seems to be related to the pathological variations more than the value of C in the other sites. The second measurement is the C/T ratio of eight ROIs of 15 patients: five healthy and 10 osteoporotic women. This ratio is significantly different for the two groups in all the eight ROIs and the variations are particularly significant at 6 to 12 mm from the subchondral line.

Ossification of the posterior longitudinal ligament in one of a pair of identical twins concordant for ankylosing spondylitis

SummaryA pair of identical twins suffering from ankylosing spondylitis is reported. One brother developed an earlier-onset disease and showed ossification of the posterior longitudinal ligament and the flavum ligament in his cervical spine.