Bone Mineral Density Evaluation

Svjetska zdravstvena organizacija kao jedinu metodu za dijagnosticiranje osteoporoze priznaje dvoenergijstu apsorpciometriju, DEXA. Pretraga je jednostavna, ozračenje bolesnika malo, mjerenje točno. Kvaliteta uređaja i računalna programska podrška omogućuje jednostavnu analizu koštane mase i praćenje promjene mineralne gustoće tijekom terapije. Kvalitetni ultrazvuk je jednostavna i jeftina metoda napose za screening, no odnos između mineralne gustoće kalkaneusa i rizik frakture kuka ili kralješnice zahtijeva daljnje istraživanje. Određivanje koštanih markera dobro je za praćenje metabolizma kosti, a li ne i za određivanje mineralne gustoće tako da se sada koriste samo za praćenje rezultata terapije.The only rationale for diagnosing low bone mineral density (BMD), recommended by WHO, is dual Energy absorptiometry known as DEXA, it is easy to handle, painless for patient and accorate. It sensivity enables to measure bone mineral density and follow the changes in BMD therapy. Quantitative ultrasonography is ideal for screening patients with suspected low BMD but relation between calcanear BMD and risk to hip or vertebral fragility fracture needs to be further investigated. Measuring biochemical bone markers is good method for detecting bone turnover but no bone mass and is especialy worth in evaluating therapy

Korelacija koštane mineralne gustoće mjerene kvalitativnim ultrazvukom i dvoenergetskom rendgenskom apsorpciometrijom

Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with consequential increase in bone fragility and susceptibility to fracture. Bone mineral density (BMD) is an important determinant factor of fracture risk. Fifty-eight healthy postmenopausal women aged 53-91 years were included in the study. The subjects were divided into three age groups. Heel bone (calcaneus) BMD detected by qualitative ultrasound (QUS) was correlated with lumbar spine and proximal femur BMD detected by dual energy x-ray absorptiometry (DEXA). Also, subject age and anthropometric parameters (body weight and height) were correlated with BMD values in the calcaneus, spine and proximal femur. A chart was made of T-score conversion for lumbar spine according to T-score of heel bone detected by QUS. Calcaneal BMD showed best correlation in group 2 (58-67 yrs) with total femoral BMD (R=0.72) and intertrochanteric area (R=0.719), both statistically significant (p1=0.0007, p1<0.001; p2=0.0008, p2<0.001). There was no significant correlation between any of the calculated BMD values (calcaneus, lumbar spine and proximal femur) and age, body weight or body height. According to our conversion chart, when T-score calculated on ultrasound densitometry is equal or below -1 it yields a final T-score of lumbar spine between -1 and -2.5, which according to WHO criteria is diagnosed as osteopenia. This makes ultrasound densitometry an excellent screening method to identify patients at a risk of fracture.Osteoporoza je sistemska skeletna bolest obilježena malom koštanom masom i mikroarhitektonskim pogoršanjem koštanoga tkiva, s posljedičnim porastom krhkosti kostiju i sklonosti za prijelome. Koštana mineralna gustoća (BMD) je važan čimbenik koji određuje rizik od prijeloma. Ispitivanje je provedeno u 58 zdravih žena u postmenopauzi, u dobi od 53 do 91 godine. Ispitanice su bile podijeljene u tri dobne skupine. BMD petne kosti (kalkaneus) izmjerena kvalitativnim ultrazvukom (QUS) korelirana je s BMD lumbalne kralješnice i proksimalnog femura izmjerenom dvoenergijskom rendgenskom apsorpciometrijom (DEXA). Također su dob i antropometrijski parametri (tjelesna težina i visina) korelirani s vrijednostima BMD za kalkaneus, kralješnicu i proksimalni femur. Izrađena je vlastita tablica za konverziju T-vrijednosti za lumbalnu kralješnicu prema T-vrijednosti za petnu kost izmjerenima pomoću QUS. Najbolja korelacija za BMD kalkaneusa nađena je u 2. skupini (58-67 godina) s ukupnim BMD femura (R=0,72) i intertrohanterskog područja (R=0,719), obje statistički značajne (p1=0,0007, p1<0,001; p2=0,0008, p2<0,001). Nije bilo značajne korelacije između bilo koje izračunate vrijednosti BMD (kalkaneus, lumbalna kralješnica i proksimalni femur) i dobi, tjelesne težine i tjelesne visine. Prema vlastitoj tablici konverzije, kada je T-vrijednost izračunat ultrazvučnom denzitometrijom jednak ili ispod -1, to daje konačnu T-vrijednost za lumbalnu kralješnicu između -1 i -2,5, što se prema kriterijima SZO dijagnosticira kao osteopenija. To čini ultrazvučnu denzitometriju izvrsnom metodom probira za prepoznavanje bolesnika s rizikom od prijeloma

Influence of the Incoming Solar Radiation on the Bone Mineral Density in the Female Adult Population in Croatia

The relationship between the bone mineral density (BMD) in Croatian female adults and the average incoming solar radiation at the ground was investigated. The study included 387 volunteers of average age of 60 years from three different towns: Pula (n= 128, age from 35 to 76), Krapina (n=141, age from 43 to 77), and Zagreb (n=118, age from 32 to 79). Apart from the different lifestyle, each of above towns is characterized by different incoming solar radiation, where values of 503.3 kJ cm–2, 471.2 kJ cm–2 and 436.3 kJ cm–2 correspond to average annual radiation at the ground for Pula, Krapina and Zagreb, respectively. Heel BMD was measured by clinical bone sonometer (Sahara). On the average the BMD was highest for Pula (0.469 g cm–2) and the lowest for Zagreb (0.433 g cm–2). Similarly, the percentage of normal bones was the highest for Pula (46.1%) and the lowest for Zagreb (32.2%). Osteopenic bones were the most frequent for Zagreb (61.0%), while corresponding figures for Pula and Krapina were 46.9% and 43.6%, respectively. Osteoporosis varied from 6.8% in Zagreb to 11.4% in Krapina. A test of independence by contingency table confirmed at the significance level =0.05 that probability of normal bone occurrence increases with the increase of incoming solar radiation. Results of the multiple regression analysis suggest the dependence of BMD on woman’s age and weight, and incoming solar radiation at the place of habitation

Ultrasonographic Measurement of the Thyroid Volume

According to the published data, endemic goiter was until recently, still present in some regions in Croatia. In this study the thyroid volume in grown-up, student population was measured. It was also analyzed which of the several traditional physiological attributes (body weight, body height, and body surface area (BSA)) were best correlated with the thyroid volume. Fifty one randomly selected female students from University of Zagreb Medical School were studied. Mean age of our subjects was 22 (range 20–38). All of them were healthy and with normal thyroid hormonal status. The mean thyroid volume was 10.68+/-2.83 mL (range 5.71–17.09 mL). The results show that thyroid volume was best correlated with body height (r=0.37; p=0.001), followed with body surface area (r=0.28; p=0.017). The thyroid volume was found normal in all our subjects

Possibilities and difficulties in cytological diagnosis of neurinoma

Neurinom ili švanom rijetki je benigni tumor koji potječe od Schwannovih stanica ovojnice živca. To je spororastući, solitarni i inkapsulirani tumor. Može nastati u bilo kojoj dobi, ali najčešće se javlja između 30. i 60. godine života. Na glavi i vratu neurinomi se javljaju u mlađih osoba, u dobi od 20. do 30. godine. Citološka je dijagnoza važna zbog odabira pravilnog liječenja, otkrivanja recidiva ili pojave novog neurinoma na drugome živcu. Citološke punkcije mogu se raditi „naslijepo” ili češće pod kontrolom ultrazvuka. Tijekom sedam godina, od 1. siječnja 2007. do 31. prosinca 2013., punktirano je 14 322 pacijenta na Odjelu za kliničku citologiju i citometriju KB-a Dubrava, a samo u 10 (0,07 %) pacijenata postavljena je citološka dijagnoza neurinoma. Najviše punktiranih neurinoma bilo je u području glave i vrata, u sedam pacijenata od njih 10. Retrospektivno smo analizirali preparate i nalaze i odredili točnost citologije uspoređujući citološku dijagnozu s patohistološkim nalazom. U šest je pacijenata patohistološki potvrđena citološka dijagnoza neurinoma. U četiri pacijenta čija je patohistološka dijagnoza bila neurinom, citološka je dijagnoza glasila mezenhimalni tumor u tri pacijenta, a u četvrtog tumor vretenastih stanica, što su sve bile dijagnoze benignih lezija.Neurinoma (schwannoma) is a rare benign tumor that originates from Schwann cells of the nerve sheath. Neurinoma is a slow-growing, solitary and encapsulated tumor. These neoplasms may occur at any age but are more common between the ages of 30 and 60. Neurinoma of the head and neck occurs in younger people, at the ages of 20 and 30. Cytological diagnosis is important for the accurate treatment, detection of recurrence of the disease and diagnosing a new neurinoma on another nerve. Fine needle aspiration cytology (FNAC) can be done with or without ultrasound guidance. During 7 years - from 1 January 2007 until 31 December 2013, 14 322 FNAC have been done at the Department of Cytology and Cytometry, Dubrava University Hospital and only 10 (0.07%) patients had cytological diagnosis of neurinoma. The most FNAC of neurinoma was done in the head and neck, in 7 patients out of 10. We have analysed retrospectively cytology slides and reports and we determined the accuracy of cytology by comparing cytological diagnoses with pathohistological findings. Cytological diagnosis of neurinoma was accurate in 6 patients according to pathohistological diagnosis. In 4 patients with pathohistological diagnosis of neurinoma cytological diagnoses were mesenchymal tumor in 3 patients and spindle cell tumor in one patient, all of them were benign lesions

Cytology and DNA Analysis of Ameloblastoma - A Case Report

Ameloblastoma is a benign odontogenic tumour that may have aggressive biological behavior with local recurrence and metastasis after the surgical resection. We report a case of cytology of recurrent ameloblastoma. The first tumour was diagnosed in the left mandible in 57-yers-old woman thirteen years ago. The patient was operated on, the tumour was enucleated, pathohistological diagnosis of ameloblastoma was put and DNA analysis by flow cytometry of the tumour was performed. DNA analysis showed that the tumour was diploid but proliferative. Two years after the operation, a new tumour appeared on the scar. Fine needle aspiration cytology with ultrasound guidance of the tumour was performed; cytological diagnosis of recurrent ameloblastoma was put and confirmed by pathohistology. Until now the patient is well without any new recurrent ameloblastoma