18-F scintigraphy in diagnosis and management of avascular necrosis bone disorders.
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Biomedical subjects
Publications and source records attributed to R S Riggins.
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The genetics of an inherited form of scoliosis in chickens was studied to estimate the number of genes involved, whether they are autosomal or sex-linked, their degree of dominance and penetrance, and the heritability of this trait in this population. Expression of scoliosis and in the progeny was analyzed by radiographs of birds 12 weeks of age or older. Crosses between an inbred line selected for scoliosis expression (incidence of scoliosis - 89 percent) and a highly inbred line displaying normal spinal development provided data for genetic analyses. The incidence of expression of scoliotic parent line implicates three major autosomal, recessive genes. The significantly higher incidence of severe scoliosis found in the homogametic male sex is ascribed to a sex-influenced, on the scoliosis trait rather than to sex-linkage. Variation of expression observed in the scoliotic line is attributed to incomplete penetrance of the major genes, additive effects of minor modifying genes, and primarily to environmental effects. Because of the similarities in the expression of this disease in chickens and humans, the inheritance pattern determined for chickens may provide useful insights into that operating for so-called adolescent idiopathic scoliosis in humans.
Of 2,712 Board certified orthopedic surgeons selected from the directory of the American Academy of Orthopaedic Surgery, 1,683 (62.1%) responded to a mailed questionnaire concerning their preferred treatment for osteoarthritis of the hip in a specified active 53-year-old man. A Müller total hip arthroplasty was the most frequently performed operation in 1973; only 23 per cent of the respondents considered osteotomy the preferred treatment.
The strength of osteopenic bone from calcium deprived rats, quail and roosters was significantly reduced after fluoride supplementation. Using a device which measures torque, femurs from rats fed low calcium diets with 100 parts per million fluoride added to the water supply fractured at lower torque values than those values observed for rats fed a low calcium diet without fluoride. Fluoride administration and calcium restriction in adult roosters and young Japanese quail also resulted in a reduction in bone strength. This detrimental effect on bone strength must be considered in any therapeutic attempt to use fluoride ion to stimulate bone formation in osteopenic bone disorders.
A 17-year-old girl was immobilized in traction for 3 months and in a spica cast for 6 weeks for fractures of the femur and pelvis. Seven weeks after injury and after her acute renal failure had resolved, serum calcium rose and remained elevated for the duration of her immobilization. Conservative treatment by hydration, diuresis, and later tilttable therapy failed to relieve her hypercalcemia. Only after mobilization did the serum calcium levels return to normal and the symptoms abate. Administration of recently developed medical methods of management of hypercalcemia may have prevented this complication.
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Scintigraphy, using 99mTc diphosphonate, has the potential for diagnosing osteonecrosis before irreversible changes are visible in routine roentgenograms. If obtained within weeks of an avascular insult, a cold area will appear on scintiscan. However, months later, the revascularization and reparative processes of the dead bone produce a hot area on scintiscan.
The systematic examination of synovial fluid confirms the noninflammatory nature of degenerative joint disease, is diagnostic of gout, pseudogout, and septic arthritis, and will usually allow the identification of rheumatoid arthritis, systemic lupus erythematosus and Reiter's syndrome.
99MTc diphosphonate scintigraphy and tetracycline labeling were performed on 22 hips in 20 patients in whom the femoral heads were subsequently removed. Twelve of the hips had acute neck fractures, and 10 hips had roentgenographic evidence of avascular necrosis. This technique is of greater value for recent fractures, for once revascularization begins to occur, increased radioactivity is usually found by scintiscan. There was good correlation between roentgenogram, scintiscan and tetracycline fluorescence. 99mTe diphosphonate scintigraphy, which can be performed outside the operating theater with little discomfort to the patient, proved to be a reliable, noninvasive method of assessing the blood flow to the femoral head. 99mTc diphosphonate scintigraphy is not a quantitative technique; it detects the presence or absence of femoral head blood flow, not the adequacy of that blood supply.