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Management of a well menopausal 13 woman: the role of menopause clinics
Published in Barry G. Wren, Progress in the Management of the Menopause, 2020
How can osteoporosis be best diagnosed before fracture occurs, rather than after the event? Can osteoporosis be prevented? Can fracture be prevented? Should bone density be measured in all women? Can osteoporosis be predicted on clinical factors only? Ribot and co- workers4concluded that ‘Direct bone densitometry remains indispensable to assess osteoporosis since risk factors alone are not sufficient for accurate delineation of either low or normal bone density’. If bone densitometry is an essential screening tool in all clinics, what is the cost/benefit ratio? This appears not to have been evaluated so far5. This and similar questions may be best answered in a well women’s screening clinic.
Musculoskeletal system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The World Health Organization (WHO) [91] has established axial DXA scanning as the most appropriate technique for the assessment of osteoporosis. DXA uses, as its name suggests, two X-ray energies that are absorbed differentially by bone and soft tissue. This technique measures bone mineral density (BMD) from the following areas: lumbar vertebrae (Fig. 3.58a), femoral neck, the forearm and total body scanning, which provides information on body composition. This technique is considered the ‘gold standard’ in measuring BMD. Indications for a DXA are shown in Fig. 3.58b. The technique has superseded dual photon absorpitometry (DPA). Equipment manufacturers use different methods to obtain the peak energies. An X-ray tube pulsed on two alternative kVp settings (100 kVp and 140 kVp) can be used, or a rare earth ‘K’ edge filter can shape the broad spectrum from the X-ray tube into two narrow energy bands. A cerium filter, for example, produces two peaks at 38 keV and 70 keV (Figs 3.58c,d). The detector system coupled to the X-ray tube allows the transmitted photons of each energy to be counted separately. Bone densitometry actually measures the bone mineral content (BMC) at a skeletal site and the area size of the bone.
Revision high-grade spondylolisthesis surgery
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
The surgeon must carefully consider the patient's anatomy prior to revision surgery. Doing so requires obtaining the appropriate preoperative radiographic studies. These generally include upright AP and lateral long-cassette radiographs that clearly demonstrate the sacropelvic anatomy, lumbar flexion/extension radiographs, a lumbosacral CT scan, and a lumbar MRI scan. A myelogram with a postmyelo CT scan may be necessary in some cases. Bone densitometry may be indicated in some patients.
Mastocytosis and related entities: a practical roadmap
Published in Acta Clinica Belgica, 2023
Michiel Beyens, Jessy Elst, Marie-Line van der Poorten, Athina Van Gasse, Alessandro Toscano, Anke Verlinden, Katrien Vermeulen, Marie-Berthe Maes, J. N. G. Hanneke Oude Elberink, Didier Ebo, Vito Sabato
If a child presents with typical cutaneous lesions of mastocytosis one should obtain a thorough history and perform a complete physical examination. Laboratory tests include a complete blood count, serum electrolytes, transaminases and measurement of bST. Furthermore, an abdominal ultrasound should be performed. A bone densitometry is only recommended in selected cases (e.g. a child with unexplained bone pain). If a child with suspicious skin lesions presents with – (a) clinically significant abnormalities in cytology or biochemistry, (b) a bST >100 ng/mL or a rapidly rising bST or (c) obvious organomegaly – a BM biopsy should be obtained. The prevalence of SM in children with MIS is unclear, mostly because children undergo a bone marrow only when signs and symptoms suggest the presence of an advanced/progressive neoplasm. Detection of KIT (D816V) in peripheral blood and the morphology (e.g. monomorphic lesions) of skin lesions might be suggestive of systemic disease and might represent an indication for BM examination [17]. On the other hand, if no abnormalities are found, we suggest a watchful waiting approach in these patients, because of the invasive nature of a BM examination.
Long-term use of ospemifene in clinical practice for vulvo-vaginal atrophy: end results at 12 months of follow-up
Published in Gynecological Endocrinology, 2022
Carmen Pingarrón Santofímia, Pilar Lafuente González, María del Carmen Guitiérrez Vélez, Virginia Calvente Aguilar, Silvia Poyo Torcal, Pablo Terol Sánchez, Santiago Palacios
Diagnostic tests done at baseline and 12 months later are shown in Table 1. Cytology compatible with atrophy significantly decreased from 100% at baseline to 5.3% at month 12 (p < .0001). No statistical differences were observed in endometrial thickness, spine T-score, and mammography. Although the change in hip T-score was statistically significant (from −1.20 to −1.30 after 12 months with ospemifene, p = .0487), it is considered normal in clinical practice. To properly assess changes in bone densitometry, one or two years are usually required. In addition, it is expected an improvement in spine T-score, but not in hip T-score with SERMs [19]. Moreover, although no statistical differences were observed in bone resorption markers at 12 months, the difference at 6 months was statistically significant (0.43 versus 0.37 pg/ml, p = .0018) [14].
Facial nerve stimulation in a post-meningitic cochlear implant user: using computational modelling as a tool to probe mechanisms and progression of complications on a case-by-case basis
Published in Cochlear Implants International, 2021
Werner Badenhorst, Tania Hanekom, Liezl Gross, Johan J. Hanekom
Changes in temporal bone density. To investigate how changes in bone density and hence resistivity contribute to the user's FNS symptoms and CI performance, bone densitometry was used to measure the user's temporal bone density (in Hounsfield units, HU) as an indirect, non-invasive gauge of bone resistivity. The bone densitometry method used and specific regions measured were based on four studies (Grayeli et al., 2004; Kawase et al., 2006; Kutlar et al., 2014; Marshall et al., 2005; Saha and Williams, 1989). These studies all determined bone density in otosclerotic users together with a control group of normal, healthy ears. The measurements were subsequently used in the present study as a benchmark against which to compare the density for the case of meningitis. The five regions measured are the 1) posterior semi-circular canal (PSCC), 2) fissula ante fenestrum (FAF), 3) cochlear apex, 4) precochlear region and 5) anterior margin of IAC.