Reliability and accuracy of MRI scanogram in the evaluation of limb length discrepancy

The purpose of this study was to compare MRI scanogram with traditional radiographic methods for measurement of limb length. The authors hypothesized that MRI scanogram would be as reliable and accurate as radiographic scanogram in measurement of limb length without exposing patients to ionizing radiation. Twelve cadaveric femurs were measured using AP conventional radiographic scanogram, CT scanogram, MRI scanogram, and electronic caliper. Three orthopaedists performed two separate measurements using each technique. Intraobserver and interobserver variability was assessed for each of the three radiographic techniques. Accuracy was assessed by comparison of radiographic measurements to electronic caliper measurements of femur length. The reliability of all three radiographic limb length measurement techniques was excellent (ICC > 0.99). The accuracy of plain radiographic scanogram was slightly superior to CT scanogram and MRI scanogram. The mean absolute differences for radiographic, CT, and MRI scanograms compared with the gold standard, direct caliper measurement, were 0.52 mm, 0.68 mm, and 2.90 mm, respectively. All three scanogram techniques showed excellent reliability and accuracy. Radiographic scanogram remains the gold standard for leg length measurement. MRI scanogram is slightly less accurate compared with radiographic scanogram, but it does not use ionizing radiation. MRI scanogram merits clinical study and comparison with the traditional radiographic scanogram method for measurement of limb length.     

Preteen attitudes about smoking and parental factors associated with favorable attitudes

PURPOSE: To describe youth smoking-related attitudes and evaluate the effects of parental factors on child adoption of positive attitudes about smoking. DESIGN: This study used baseline and 20-month data from a family-based smoking-prevention study (82.9% completed both surveys). SETTING: Telephone recruitment from two health maintenance organizations. SUBJECTS: Children aged 10 to 12 years and one parent of each child (n=418 families) were randomly assigned to a frequent assessment cohort (12.5% of participants). Intervention. Families received a mailed smoking-prevention packet (parent handbook, videotape about youth smoking, comic book, pen, and stickers), outreach telephone counselor calls to the parent, a newsletter, and medical record prompts for providers to deliver smoking-prevention messages to parents and children. MEASURES: Demographics, tobacco status, attitudes about smoking (Teenage Attitudes and Practices Survey), family discussions about tobacco, family cohesiveness (family support and togetherness), parent involvement, parent monitoring, and parenting confidence. Results. One-third of the children endorsed beliefs that they could smoke without becoming addicted, and 8% to 10% endorsed beliefs on the benefits of smoking. Children's positive attitudes about smoking were associated with lower family cohesiveness (p = .01). Parental use of tobacco was the only significant predictor of children's positive attitudes about tobacco at 20 months (p = .03). CONCLUSIONS: Children as young as 10 years underestimate addictive properties of smoking, which may place them at risk for future smoking. Parental use of tobacco and family cohesiveness are important factors in the formulation of preteen attitudes about smoking.     

What is the Role of Magnetic Resonance Imaging in the Evaluation of Total Hip Arthroplasty?

MRI has been shown to be an extremely effective instrument in the management of painful hip arthroplasty. Its superior soft tissue contrast and direct multiplanar acquisition compared to computerized tomography (CT) and radiographs allows for reproducible visualization of periacetabular osteolysis, demonstrating compression of neurovascular bundles by extracapsular synovial deposits. In addition, MRI can often elucidate etiology of neuropathy in the perioperative period and is further helpful in evaluating the soft tissue envelope, including the attachment of the hip abductors, short external rotators and iliopsoas tendon. A further advantage of MRI over CT is its lack of ionizing radiation. Most importantly, MRI can disclose intracapsular synovial deposits that precede osteoclastic resorption of bone.     

A Shearing Osteochondral Fracture of the Humeral Head Following an Anterior Shoulder Dislocation in a Child

A dislocation of the shoulder joint is rare in children with an open physis. The fractures associated with an anterior dislocation generally reported in the literature have been Hill-Sachs lesions, avulsions of the greater tuberosity and glenoid fractures. We present a case of a previously unreported shearing osteochondral fracture, which is distinct from a classic Hill-Sachs lesion of the humeral head, in 12-year-old boy. The patient suffered a traumatic anterior shoulder dislocation with a spontaneous reduction along with this associated fracture. The fracture subsequently healed with no further evidence of persistent instability.     

A comparison of the LeJour and Wise pattern methods of breast reduction

Supporters of the vertical mammoplasty state the resultant breast shape and scar are superior to the Wise pattern breast reduction. This study contains a comparison of the LeJour vertical reduction with the Wise pattern reduction by analysis of pre- and postoperative photographs, as well as a retrospective review comparing operative times, blood loss, complications, and a postoperative patient questionnaire. Of the 112 women who had moderate to large reductions (>500 g/breast) between 1999 and 2002, 65 subjects had adequate standard perioperative photographs. Esthetic appearance, symmetry, nipple quality, and scarring were assessed using a Likert scale (10 = superior, 1 = poor) by 30 evaluators. Based on the photographic analysis, there is no difference in the esthetic outcome between the vertical reduction mammaplasty and the inferior pedicle Wise pattern mammaplasty. Additionally, this study indicates that vertical patients with moderate to large reductions have a significantly higher rate of complications when their body mass index is greater than 30 kg/m.     

Effects of shearing stress on aortic histamine synthesis

The potential of elevated shearing stresses imposed on the endothelial surface of rabbit thoracic aorta to increase aortic histamine synthesis through activation of aortic histidine decarboxylase (HD) has been examined. Using a Tyrodes-glycerine solution (37°C, pH 7.4, 3.5 centipoise) as the perfusion solution, aortas were subjected to shearing stresses of 8 (control), 27, and 800 dynes/cm², respectively. Additional nontreated and incubated controls were also used. The aortic HD activity, expressed as histamine forming capacity (HFC), for the three treatment groups were (in dpm/mg protein) 302 ± 10, 1537 ± 26, and 969 ± 16, respectively. Histological examination of similarly treated segments revealed no endothelium present in the 800 dynes/cm² stressed group. These data indicate that aortic histamine synthesis increased approximately 5-fold in response to a 3 $\text{1}\text{2}\text{-}\text{fold}$ increase in shear exposure and that over 50% of the increase in histamine synthesis occurred in the endothelial monolayer. These data have been discussed both in relation to the role of the endothelium in regulation of, and the effects of histamine on, vascular wall permeability.     

Hypertension in a population sample of female Punjabi Indians in Southall.

A population-based survey of female Punjabi Indians aged 11 and over now living in Southall, a district in west London, showed a steady and significant increase in blood pressure with increasing age. The crude population prevalence of hypertension, defined according to the criteria of the World Health Organisation, was 16%; for women over the age of 40 it was 62%. About two-thirds of those in the hypertensive range did not know of their high blood pressure. Among those who did know, up to 75% were receiving medical treatment for the condition.     

Developmental language disorders--a follow-up in later adult life. Cognitive, language and psychosocial outcomes

BACKGROUND: Little is known on the adult outcome and longitudinal trajectory of childhood developmental language disorders (DLD) and on the prognostic predictors. METHOD: Seventeen men with a severe receptive DLD in childhood, reassessed in middle childhood and early adult life, were studied again in their mid-thirties with tests of intelligence (IQ), language, literacy, theory of mind and memory together with assessments of psychosocial outcome. They were compared with the non language disordered siblings of the DLD cohort to control for shared family background, adults matched to the DLD cohort on age and performance IQ (IQM group) and a cohort from the National Child Development Study (NCDS) matched to the DLD cohort on childhood IQ and social class. RESULTS: The DLD men had normal intelligence with higher performance IQ than verbal IQ, a severe and persisting language disorder, severe literacy impairments and significant deficits in theory of mind and phonological processing. Within the DLD cohort higher childhood intelligence and language were associated with superior cognitive and language ability at final adult outcome. In their mid-thirties, the DLD cohort had significantly worse social adaptation (with prolonged unemployment and a paucity of close friendships and love relationships) compared with both their siblings and NCDS controls. Self-reports showed a higher rate of schizotypal features but not affective disorder. Four DLD adults had serious mental health problems (two had developed schizophrenia). CONCLUSION: A receptive developmental language disorder involves significant deficits in theory of mind, verbal short-term memory and phonological processing, together with substantial social adaptation difficulties and increased risk of psychiatric disorder in adult life. The theoretical and clinical implications of the findings are discussed.