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KoHrpecu, cMMno3iyMM, WKonu / Congresses, Symposiums, Schools
ZHULKEVYCH I., YAVORSKA YU., UGLYAR T. Ternopil State Medical University named after I.Ya. Gorbachevsky, Ternopil, Ukraine
Virtual Computer-Based Biopsy as a Non-Invasive Method for Diagnostics and Monitoring of Bone Tissue Status
Introduction. The evaluation of bone tissue (BT) status including its histomorphometric parameters requires invasive sampling which is traumatic, and therefore there is a need for non-invasive methods providing information on trabecular and cortical bone status.
Aim of study. To create a non-invasive technique for histo-morphometric evaluation of thoracic and lumbar BT status of trabecular and cortical bone at the mesoscopic level for clinical use in oncology and osteology practice.
Materials and methods. The current method is based on estimating the dynamics of densitometric, lineal and spatial characteristics on axial sections obtained by multislice computed tomography (CT) which is routinely used in oncology practice. The standardization and stabilization of the obtained trabecular bone image was achieved by using Mexican Hat wavelet filtering. Densitometry in trabecular and lumbar vertebrae was performed using medical imaging analysis software — Clear Canvas Worskstation and ImageJ with
ZYMA A., KINCHAYA-POLISHCHUK T., DEMYAN Y., ZOTYA A. Institute of Orthopedics and Traumatology, National Academy of Medical Sciences, Kiev, Ukraine
Efficacy of Pamidronate Therapy Treatment in Patients with Osteogenesis Imperfecta
Introduction. Nowadays, orthopedic scientific achievement in the treatment of osteogenesis imperfecta (OI) is not limited to surgery, but also have in their arsenal modern medical therapy, which involves the use of drugs pamidronic acid (DPA) to correct structural and functional state of bone tissue (SFSBT). However, the treatment of these patients with drugs of pamidronic acid, will remain as unsolved issue regarding schemes, doses, combination with other antiosteoporo-tic drugs, the number of cycles of administration depending on the type of OI and extent of damage of SFSBT.
The aim of the study. To improve the results of orthopedic treatment in patients with OI by applying antiosteoporotic therapy that includes DPA.
Materials and methods. Orthopaedic treatment was conducted in 21 patients with OI, among them 13 — males and 8 — female. The mean age of patients was 9.4 ± 0.6. Distribution by type ofOI (Sillence D., 1982), I — 10, III — 11. Antiosteoporot-ic therapy using the DPA, as an independent method was used in 10 patients and in the other 11 patients it was used along with the surgery. All patients received basic therapy of calcium supplements and active forms of vitamin D. DPA used in cycles, at a dose of 0.5—1.0 mg/kg for one cycle controlled by serum Ca level. Pharmacological preparation included 3—4 cycles separated by three month intervals. In type I of OI (level b-Cross-Laps of 0.500 to 1.5 ng/ml, Z-score from -2.5 to -3.5) DPA was used in a dose of 0.5 mg/kg weight per cycle; in severe, with
BoneJ application which is a freeware program developed at the National Institute of Health (USA).
Results. We evaluated the following parameters by means of axial CT scans and specialized software: bone surface (BS), bone volume fraction (BV/TV), structure model index (SMI), fractal dimension (box- and map-counting algorithms), trabecular thickness and separation (Tb.Th., Tb.Sp.), topological characteristics (Connectivity, Euler characteristic) and textural parameters of trabecular bone.
According to our algorithm based on the recommendations of Standardized nomenclature of histomorphometric parameters from the American Society of Bone and Mineral Research, we assessed BT status, the degree of trabecular and cortical vertebral bone changes in patients with Hodg-kin (HL) and non-Hodgkin lymphoma (NHL) at the presentation of the disease and after the chemo and radiation therapy and during the follow-up examinations.
Conclusion. We have developed a non-invasive technique for early detection and effective monitoring of vertebral BT status, which includes densitometric and histomorphomet-ric assessment after chemo and radiation therapy in HL and NHL patients and allows creating valid approaches to timely differential implementation of structural and functional thoracic and lumbar vertebral BT modifiers in supportive therapy at all stages of specialized medical care.
type III OI (b-CrossLaps from 1.5 to 3.5 ng/ml, Z-score of -3.5 and below) — in a dose of 1 mg/kg body weight per cycle. The effectiveness of treatment was assessed by the level of b-Cross-Laps after 6 months and Z-score criterion of lumbar spine after a year of treatment.
Results. Clinically evaluated the results of 21 patients, paraclinically: Z-score — in 18 patients, b-CrossLaps in 21 patients. There was reduction of pain intensity in all patients after treatment. 18 patients (86 %) — no repeated pathological fractures; only 3 patients (14 %) during treatment had repeated pathological fractures — two fractured femur and one — tibia. Before treatment, 13 patients went independently, 8 lost this feature. Among the subgroup of operated 11 patients moved alone 4 (36 %), the other 7 (64 %) did not move. After a year of treatment alone 8 patients (72 %) moved alone; after 1.5 years — 9 (82 %) patients. In one patient among subgroup with nonoperative treatment who did not move after a year of the DPA therapy restored the function of walking. Observation period — 2-3 years after treatment.
In the overall group of patients there was noted increased Z-score by 1.13 (27 %), p = 0.022 and b-CrossLaps decreased by 0.46 (37 %), p = 0.021; in a subgroup of patients undergoing surgery — increased Z-score by 1.23, p = 0.05 and b-CrossLaps decreased by 0.26 ng/ml, p = 0.134; in the subgroup with nonoperative treatment — increased Z-score to 1.01, p = 0.2 and b-CrossLaps decreased by 0.67, p = 0.05, indicating significant effectiveness of the proposed treatment.
Conclusion. The technique of complex treatment of orthopedic manifestations of OI, which includes drug therapy using the DPA as an independent method or in combination with surgical methods are appropriate and effective as evidenced by the positive dynamics of clinical and paraclinical parameters, regain patients gait function and support. ■
102
Brnb. CyM06u. Xpe6eT, ISSN 2224-1507
№ 2 (18), 2015
