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In a prospective uncontrolled study 12 patients suffering from a rupture of the Achilles tendon treated operatively with surgical repair and post-operative immobilization in a short plaster cast for 6 weeks had bilateral measurements of bone mineral content (BMC) of the proximal tibia and bone mineral density (BMD) of the femoral neck and greater trochanter. The measurements were performed by dual energy X-ray absorptiometry (DEXA) and scans were performed post-operatively within 7 days after the operation and with follow up after 6 weeks, 3, 6, and 12 months. In the operated legs, BMC of the proximal tibia showed a progressive decrease reaching a total bone loss of 6.4% (95%-CL: -10.6%; -2.3%) 1 year after the injury. Bone mineral density at the hip of the operated legs also decreased significantly and 1 year after the injury BMD was 2.5% (95%-CL: -5.5%; 0.5%) and 6.8% (95%-CL: -9.8%; -3.7%) below the initial value in, respectively, the femoral neck and greater trochanter. Patients with a previous Achilles tendon rupture must be considered to be some years ahead in their natural osteoporotic process of the bones of the affected legs, and an increased risk of osteoporotic fractures must be considered not to be only theoretical.

The influence of regional size on the precision error in the evaluation of bone mineral changes along femoral components in uncemented THA's was studied methodologically using Dual Energy X-ray Absorptiometry (DEXA) and with a review of the literature. A significant negative relation between region size and precision error was found in experimental studies and the precision error was shown to vary with type of DEXA scanner when reviewing the literature. When using Gruen's zones we found that the precision was best at the tip and poorest in the proximal regions. Guidelines based upon calculations of the approximate percentage changes necessary in a single individual to be statistically significant in a longitudinal study with 95% probability were made for three different types of DEXA scanners.

SummaryThe aim of this study was to evaluate the feasibility of using measurements of bone mineral content (BMC) and bone mineral density (BMD) by dual photon absorptiometry (DPA; Gadolinium-153), as an objective measure of limb functional status in the dog. The in vitro accuracy error expressed as the standard error of the estimate (SEE) for BMC and BMD measurements was 3.2% and 1.1% respectively, and the precision in vivo for measurements of BMC and BMD in the distal diaphysis of the tibia and fibula was 2.1% and 1.9% respectively. A significant difference in bone mineral between right and left leg was not found in normal dogs, and in these dogs the average percentage intra-individual difference, between bone mineral in the legs with the highest bone density and the legs with the lowest density, was 2.2% and 3.7% for BMC and BMD respectively. However the BMC and BMD in eight clinical cases of unilateral lameness were significantly decreased in the affected legs, when compared to the healthy contralateral legs, by 20.4% (P = 0.01) and 18.3% (P = 0.01)respectively. Measurements of BMC and BMD by DP A in weight-bearing extremities in the dog showed that bone mineral is highly sensitive to decreased loading of the extremity. This method might well be used not only as an objective measure of limb activity, but also for measurement of prospective changes in bone mineral, following treatment of musculoskeletal diseases and injuries.The feasibility of using bone mineral measurements by dual photon absorptiometry, as an objective measure of limb functional status in the dog, was evaluated. Precision and accuracy were calculated from in vitro and in vivo studies. In eight cases of unilateral lameness bone mineral was significantly decreased (20%) in the affected legs when compared to the healthy contralateral legs.

The in vitro effect of methylprednisolone on prostaglandin E2 (PGE2), leukotriene B4 (LTB4) and thromboxane B2 (TXB2) synthesis by adherent monocytes was examined using samples of peripheral blood from 15 patients with multiple sclerosis and 18 normal controls. Eicosanoid production by monocytes was reduced in patients compared with controls and there was a dose-dependent inhibitory effect of methylprednisolone on eicosanoid production in both groups. In vitro production of PGE2 and TXB2 but not LTB4 was reduced in patients with multiple sclerosis following intravenous treatment with methylprednisolone compared with pretreatment samples. In a separate cohort of 20 patients with multiple sclerosis and 15 controls, the in vitro inhibition of PGE2 release by methylprednisolone was not associated with reduced pokeweed-mitogen-stimulated immunoglobulin G synthesis by peripheral blood mononuclear cells. These results suggest that methylprednisolone inhibits monocyte-macrophage function, but this effect is not specific to patients with multiple sclerosis.

A natural gas-fueled turbine power plant is being built on the south bank of the Yangtze River, near Nanjing City, China. The project site is located on existing farmland that includes fishing ponds. Subsurface investigations indicated that significant deep soft clay deposits exist in the plant area. To address this situation, prestressed high strength concrete (PHC) piles are being used to support important structures, such as the turbine pedestal. Because of the contingent schedule, the pile lateral capacity was initially developed using the software program LPILE. The pile group for the turbine pedestal was then designed following appropriate procedures in Chinese design codes. Later, however, the pile load test results indicated that the lateral capacity had been greatly overestimated. This paper discusses the reason for this overestimation and presents a methodology to increase lateral capacity. The differences in lateral capacity design between Chinese codes and U.S. practice are also compared and discussed.

This paper shows the load comparisons between the numerical simulation and the full-scale load measurement data. First part of this paper includes the comparisons of statistic load in terms of maximum, mean, and minimum values for the selected normal operation cases. The blade root bending moments and tower top bending moments are compared. Second part of this paper introduces the dynamic response comparisons during an extreme wind gust condition where the wind speed changed approximately 10m/s during three seconds. The rotor speed and blade root flapwise and edgewise bending moment are compared. The nonlinear aeroelastic simulation code HAWC2 is used for the simulations. A very fine agreement between the simulated and the full-scale measured loads is seen for the both comparisons.

It is unclear whether patients with knee osteoarthritis (OA) and hip OA differ regarding soft tissue composition and bone mineral density (BMD). A total of 42 women waiting for a replacement of the hip (n = 20) or the knee (n = 22) due to OA were examined. Fat mass (FM), percent body fat (%fat), lean mass (LM) and BMD were measured by dual energy X-ray absorptiometry (DEXA). Knee extensor and flexor strength was measured by an isokinetic dynamometer. No significant differences in age, height, disease duration, Lequesne score or pain scores were found between the groups. Comparing the radiographic changes of the knees with those of the hips, changes were most severe in the joints which were to be replaced. Body weight, body mass index, total and regional FM, and %fat were more than 15% higher in patients waiting for a knee replacement (p0.001). Also lean mass tended to be higher in the knee patients. Differences in BMD did not remain statistically significant after correction for body weight. Muscle strength was similar in the two groups but was reduced by 20% in the legs in which the joint was to be replaced compared to the contralateral legs. However, the mean difference in lean mass between the two legs was only 3% (p0.05). The scores for pain felt during strength testing were significantly higher for the involved legs than for the contralateral legs. In conclusion, fat mass values were considerably higher in patients scheduled for a knee replacement. Impaired strength performance in OA may be more strongly associated with pain than with reduced muscle mass.

We report a case of a spontaneous humeral shaft fracture sustained during pitching by a 22-year-old previously healthy female European team handball player. The fracture was treated by closed reposition followed by immobilization in a hanging cast. The fracture healed uneventfully, and normal function and range of motion were reached within 6 months. Between 1 and 2 years after the fracture, bone mineral measurements showed a decreased bone mass (1.43-2.56 SD below mean values of normal women) at all measuring sites; proximal tibia bilaterally (bone mineral content (right) = 2.68 g/cm, bone mineral content (left) = 2.79 g/cm), lumbar spine (bone mineral density (L2-4) = 0.814 g/cm2), and right hip (bone mineral density (neck) = 0.697 g/cm2, bone mineral density (Ward's) = 0.626 g/cm2). A thorough endocrinological examination indicated that a state of bone loss existed, but no specific endocrine disease was found. The unusual fracture presented must be considered the result of the torsional forces transmitted to a severely osteoporotic bone.

We have studied the effects of 131I therapy on thyrotrophin binding inhibiting immunoglobulins (TBII) in fifty-five patients with Graves' disease and five patients with toxic multinodular goitre (MNG). A group of forty patients with Graves' disease and four patients with toxic MNG were treated with drugs and acted as controls. In 78% of patients treated with 131I there was a marked increase in the serum TBII activity during the 3 months following therapy, whereas drug-treated patient showed a decrease (77%) or no change in TBII activity over the same period. TBII activity was not detectable in patients with toxic MNG before or after drug or 131I therapy. Consideration of the mechanisms involved in the changes in serum TBII activity after 131I treatment or during drug treatment provide insight into the basic defects responsible for the development of hyperthyroid Graves' disease and suggest that both the thyroid and immune system are involved.

Rats were treated continuously for 12 months with therapeutically equivalent doses of either haloperidol (1.4-1.6 mg/kg/day), sulpiride (102-109 mg/kg/day), or clozapine (24-27 mg/kg/day). After treatment for 3 and 12 months with haloperidol or clozapine but not sulpiride, striatal acetylcholine levels were increased. Striatal choline acetyltransferase activity was not altered by any drug treatment. Vmax for striatal acetylcholinesterase activity during the course of 12 months' treatment with haloperidol or clozapine, but not with sulpiride, tended to increase; Km was not altered by any drug treatment. Bmax for specific striatal [3H]quinuclidinyl benzilate binding was not altered by haloperidol or sulpiride treatment but was transiently elevated after 6 months of clozapine treatment, thereafter returning to control levels. Kd was not altered by any drug treatment. These findings indicate that alterations in striatal acetylcholine content caused by chronic treatment with some but not all neuroleptics are due to changes in cholinergic neuronal activity rather than neurotransmitter synthesis or destruction. The effects of haloperidol but not those of clozapine may be related to the emergence of functional striatal dopamine receptor supersensitivity. Since haloperidol (which is associated with a high prevalence of tardive dyskinesias) but not clozapine (which is not) had similar effects on striatal cholinergic function, the latter may not be related to the emergence of tardive dyskinesias during chronic therapy.

Within a year of stopping a 6-month course of carbimazole treatment 41 of 65 patients (63%) with hyperthyroid Graves' disease had a recurrence of their hyperthyroidism. By combined analysis of the HLA-DRw3 status and the level of thyrotrophin-receptor antibody at the time of drug withdrawal relapse or remission could be predicted in 62 of the 65 patients.

Serum 25-hydroxyvitamin D and immunoreactive parathyroid hormone concentrations were measured in normal elderly subjects living at home and in sick elderly patients in hospital. Normal old people tended to have high 25-hydroxyvitamin D and low parathyroid hormone concentrations; in the sick elderly this pattern was reversed. The raised serum parathyroid hormone concentrations in the sick elderly were not due to poor renal function and may have been a response to vitamin D deficiency. A high serum parathyroid hormone concentration in an elderly patient must be interpreted in the light of the patient9s general health and nutritional state. Caution is needed in diagnosing primary hyperparathyroidism in this age group.

Microsomal antibodies and antibodies directed toward the receptor for thyroid-stimulating hormone (TSH) decreased in parallel while patients with Graves' disease were taking carbimazole, whereas no significant changes were observed during treatment with placebo or propranolol. The changes in autoantibody levels during carbimazole treatment were independent of changes in serum thyroxine and could have been due to a direct effect of the drug on autoantibody synthesis. Evidence for this suggestion was provided when low doses of methimazole (the active metabolite of carbimazole) were found to inhibit thyroid-autoantibody production in cultured lymphocytes. Since thyroid lymphocytes are probably a major site of thyroid-antibody synthesis in Graves' disease and methimazole is concentrated in the thyroid during treatment, a local action of the drug on antibody production seems likely. This possibility could be important in the use of carbimazole to control hyperthyroidism.