People Ex. Rel. Scott v. Briceland: Powers of the Attorney General Revisited, 11 J. Marshall J. Prac. & Proc. 441 (1978)

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Testosterone and the Male Skeleton: A Dual Mode of Action

Testosterone is an important hormone for both bone gain and maintenance in men. Hypogonadal men have accelerated bone turnover and increased fracture risk. In these men, administration of testosterone inhibits bone resorption and maintains bone mass. Testosterone, however, is converted into estradiol via aromatization in many tissues including male bone. The importance of estrogen receptor alpha activation as well of aromatization of androgens into estrogens was highlighted by a number of cases of men suffering from an inactivating mutation in the estrogen receptor alpha or in the aromatase enzyme. All these men typically had low bone mass, high bone turnover and open epiphyses. In line with these findings, cohort studies have confirmed that estradiol contributes to the maintenance of bone mass after reaching peak bone mass, with an association between estradiol and fractures in elderly men. Recent studies in knock-out mice have increased our understanding of the role of androgens and estrogens in different bone compartments. Estrogen receptor activation, but not androgen receptor activation, is involved in the regulation of male longitudinal appendicular skeletal growth in mice. Both the androgen and the estrogen receptor can independently mediate the cancellous bone-sparing effects of sex steroids in male mice. Selective KO studies of the androgen receptor in osteoblasts in male mice suggest that the osteoblast in the target cell for androgen receptor mediated maintenance of trabecular bone volume and coordination of bone matrix synthesis and mineralization. Taken together, both human and animal studies suggest that testosterone has a dual mode of action on different bone surfaces with involvement of both the androgen and estrogen receptor

Flexorenthesopathie bij een Italiaanse cane corso : diagnostische bevindingen en resultaat na behandeling

The pathological condition of the enthesis at the medial humerus epicondyle is referred to as flexor enthesopathy. Lesions include thickening, inflammation, fibrillation, partial rupture and calcification of the enthesis. In this case report, the evolution of primary flexor enthesopathy in a 1,5-year-old Italian cane corso is described. Several medical imaging techniques, i.e. radiography, ultrasound and computed tomography were used to diagnose primary flexor enthesopathy, in this case bilaterally. An intra-articulair injection with methylprednisolone-acetate is regarded the standard treatment. The long term follow-up was evaluated based on the clinical improvement, the size of the calcification and the increase in osteoarthritis

Medial coronoid disease in an eleven-year-old Labrador retriever

In this case report, the occurrence of medial coronoid disease (MCD) is described in an eleven-year-old Labrador retriever. A left frontleg lameness had started six months before presentation. Radiographs showed minimal pathology and computed tomography (CT) demonstrated a discrete fissure of the medial coronoid process. Arthroscopy confirmed the presence of a coronoid lesion, visible as chondromalacia. Treatment was performed by arthroscopic removal of the diseased cartilage and subchondral bone. Despite the successful procedure, the dog needed continuous physiotherapy to maintain an acceptable gait. MCD is a developmental disorder mainly affecting young large breed dogs. However, the described dog was already eleven years old. Nevertheless, the duration of lameness was rather short and the imaging and arthroscopic findings could not demonstrate a chronic problem. In the literature, little information is available about the etiology, prevalence and treatment outcome of medial coronoid pathology in old dogs

Calcium and Vitamin D Supplementation in Men

Calcium and vitamin D supplements reverse secondary hyperparathyroidism and are widely prescribed to prevent osteoporotic fractures, with proven antifracture efficacy when targeted to individuals with documented insufficiencies. Men who should particularly be considered for calcium and vitamin D supplements include elderly or institutionalized individuals, patients with documented osteoporosis on antiresorptive or anabolic medication, and individuals receiving glucocorticoids. Benefits are most apparent when a daily dose of 1000–1200 mg calcium is complemented with 800 IU vitamin D. Compliance is the key to optimizing clinical efficacy. While (conventionally dosed) vitamin D has not been associated with safety concerns, recent meta-analytic data have provided evidence to suggest that calcium supplements (without coadministered vitamin D) may potentially be associated with cardiovascular risks

Primary flexor enthesopathy of the canine elbow : imaging and arthroscopic findings in 8 dogs with discrete radiographic changes

Objective: To describe the radiographic, ultrasonographic, computed tomography (CT), magnetic resonance imaging (MRI), and arthroscopic findings in eight dogs with elbow lameness caused by primary flexor enthesopathy. Study design: Clinical study. Animals: Eight client-owned dogs. Methods: In all dogs, lameness was localized to the elbow by clinical examination. Radiographic examination, ultrasound, CT and MRI were performed prior to arthroscopy. In seven dogs, surgical treatment and subsequent histopathology were performed. Results: Primary enthesopathy of the medial epicondyle was diagnosed in eight dogs (13 joints) by combining the minimal radiographic changes with specific ultrasonographic, CT, MRI and arthroscopic findings at the medial epicondyle. In all joints, any other pathology could be excluded. Histopathology of the affected tissue revealed degeneration and metaplasia in the flexor muscles. Conclusions: Primary flexor enthesopathy at the medial epicondyle is an unrecognized condition and is a possible cause of elbow lameness in the dog. Diagnosis is based on specific imaging and arthroscopic findings. Clinical relevance: The most important cause of elbow lameness in dogs is medial coronoid disease. Often this condition presents with minimal radiographic and arthroscopic changes. In these cases, primary enthesopathy of the medial epicondyle should be considered as a differential diagnosis, in order to make the correct treatment decision