Magnetic resonance imaging as the primary imaging modality in children presenting with acute non-traumatic hip pain

The role of magnetic resonance imaging (MRI) in children presenting with acute non-traumatic hip pain was evaluated prospectively. Hip MRI was performed in addition to standard investigations (arthrosonography ± hip radiographs) in 50 children presenting to the accident and emergency department of a paediatric hospital. MRI was performed on an open 0.23T system and comprised gradient echo T1 weighted coronal, fast spin echo T2 weighted coronal and inversion recovery spin echo (IRSE) axial sequences. Diagnostic quality MRI examinations were obtained in 94% of children. The IRSE sequence was the most reliable at determining underlying disorder (p<0.002). Interobserver agreement on the MRI examinations was very good with unweighted κ value of 0.89, 95% confidence intervals 0.79, 0.99. Sensitivity of MRI was 0.79 (0.68, 0.90, specificity 1.00 (0.89, 1.00), accuracy 0.81 (0.70, 0.92), PPV 1.00 (0.89, 1), NPV 0.36 (0.25, 0.47). Sensitivity of standard imaging was 0.70 (0.54–0.86), specificity 0.57 (0.41, 0.73), accuracy 0.72 (0.56, 0.88), PPV 0.91 (0.75, 1.00), NPV 0.24 (0.08, 0.40). MRI correctly identified all seven children with serious underlying disorder whereas conventional imaging correctly diagnosed only two. Pelvic musculoskeletal infection was associated with the combination of marked alteration in signal in tissues adjacent to a symptomatic hip and an erythrocyte sedimentation rate of >20 mm 1st h (p<0.0001). In conclusion, MRI is a practical, well accepted and accurate non-invasive imaging technique in children presenting with acute non-traumatic hip pain. Combined with inflammatory markers MRI can be used to determine those children who require aggressive management. Where it is available, MRI is the imaging modality of choice in this condition.     

Preparedness for hospital practice among graduates of a problem-based,graduate-entry medical program

OBJECTIVE: To compare preparedness for hospital practice between graduates from a problem-based, graduate-entry medical program and those from other programs (undergraduate problem-based and traditional). DESIGN: Survey of graduates (by mailed questionnaire) and organisers of clinical training (by semistructured interview); results were compared with published results of surveys of graduates from other programs. SETTING AND PARTICIPANTS: All graduates of the first intake of the University of Sydney graduate-entry medical program were surveyed at the end of their first intern year (2001), along with the director of clinical training or intern manager at each of the New South Wales hospitals that employed the graduates. MAIN OUTCOME MEASURES: Graduates' self-reported level of preparedness in the eight domains of the Preparation for Hospital Practice Questionnaire; and organisers' opinions of their strengths and weaknesses. RESULTS: 76 of 108 graduates from the graduate-entry program (70%) and organisers of clinical training at all 17 hospitals participated. Graduates from the program felt more prepared than did those from other programs in five of the eight domains assessed (interpersonal skills, confidence, collaboration, holistic care, and self-directed learning) and no less prepared in any domain. Organisers rated the graduates highly, especially in clinical competence, confidence, communication and professional skills. Opinions of interns' knowledge of basic sciences conflicted, with strengths and weaknesses mentioned with equal frequency. CONCLUSION: Graduates from the graduate-entry, problem-based program are at least as well prepared for their intern year as graduates from traditional and undergraduate problem-based programs.     

Group problems in problem-based learning

Successful small-group learning in problem-based learning (PBL) educational programmes relies on functional group processes. However, there has been limited research on PBL group problems, and no studies have been conducted on problems as perceived by both students and tutors in the same educational context. The authors investigated PBL group problems in a graduate-entry medical programme, and report the most common group problems, and those that hinder students' learning the most. The possible causes of individual quietness and dominant behaviour, and potential influences that group problems may have on the tutorial process are summarized in an exploratory model of PBL group dysfunction that could be used to guide further research. Specifically, there is a need for further evidence on which to base guidelines for tutors and students to effectively manage group problems.     

Childhood disintegrative disorder: should it be considered a distinct diagnosis?

First termed Dementia Infantilis by Theodore Heller in 1908, Childhood Disintegrative Disorder (CDD) has had a history longer than that of Autistic Disorder. Presently, CDD is classified as a Pervasive Developmental Disorder in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. The characteristics most often cited as distinguishing CDD from Autistic Disorder, another one of the Pervasive Developmental Disorders, is the age of onset and evidence of normal development prior to the presence of symptomatology. Otherwise, the behavioral symptoms of CDD and Autistic Disorder are strikingly similar. The purpose of this article is to provide a historical background on CDD, examine the evolution of diagnostic criteria, review the existing literature pertaining to the disorder, and, finally, to draw conclusions regarding the validity of CDD as a distinct diagnosis with reference to current and alternative classification approaches.     

Long-term retention of fast blue in sympathetic neurones after axotomy and regeneration—Demonstration of incorrect reconnections

Using the fluorescent dyes Fast Blue and Diamidino Yellow to trace neuronal connections, the regeneration of the superior cervical ganglionic neurones after axotomy has been examined. Fast Blue has the property of remaining within the neuronal perikaryon for many months after its retrograde axonal transport, even after transection of the axon. Thus, Fast Blue can be used to label neurones as to their original target and Diamidino Yellow subsequently used to demonstrate the specificity of reconnection. The results suggest that apparent return of appropriate function occurs in the presence of a large component of inappropriate reconnections.     

Increased lysine transport capacity in erythrocytes from patients with chronic renal failure

1. The initial rate of L-lysine influx into erythrocytes from 13 patients with chronic renal failure has been measured using 14C-labelled lysine. Ten patients were on maintenance haemodialysis and three had never been dialysed. The results are compared with data obtained from 12 normal individuals. 2. The rate of lysine influx into washed cells from buffered saline containing 0.02-0.5 mmol of L-lysine/l has been calculated. The results can be fitted with a model in which influx has a single saturable component obeying Michaelis-Menten kinetics, and a linear non-saturable component. 3. In uraemic erythrocytes the saturable component had a mean Vmax. of 0.762 mmol h-1 litre-1 of cells (n = 13, SEM 0.072) and a mean Km of 68.2 mumol/l (SEM 5.7). These values in normal erythrocytes were 0.566 mmol h-1 litre-1 of cells (n = 12, SEM 0.033) and 70.5 mumol/l (SEM 4.1), respectively. The mean apparent diffusion constant (KD) for the linear component of influx was 0.224 h-1 (SEM 0.039) in uraemic cells and 0.178 h-1 (SEM 0.028) in normals. 4. The 35% increase in mean Vmax seen in uraemic erythrocytes was statistically significant (P = 0.02). A similar increase in Vmax. in uraemic cells compared with controls was seen in erythrocytes which were studied in zero-trans conditions after depletion of intracellular amino acids. The mean values of Km and KD were not significantly different in uraemia. The origins of this increased membrane transport capacity for lysine in uraemia are discussed.     

Detubularisation in cystoplasty: clinical review

Cystoplasty using a detubularised bowel segment is preferable to using a tubularised length of intestine. This has been shown experimentally to result in a reduction in the contractility of the neobladder, although contractions are not completely abolished. Incontinence, especially nocturnal, may still be a problem. Assessment of renal function has shown a marked incidence of upper tract dysfunction despite detubularisation. All patients remain at risk of upper tract obstruction following cystoplasty. Because bowel contraction waves are brought on by distension, it may be possible either to postpone or to prevent the onset of contractions by avoiding an excessive build-up of bladder volume. Clean intermittent self-catheterisation is an efficient means of emptying the bladder, although sphincter rebalancing may also be required.     

Choline acetyltransferase-immunoreactive neurons in fetal monkey cerebral cortex

Two monoclonal antibodies to choline acetyltransferase (ChAT) were used to stain the cerebral cortex of fetal monkeys at 110-150 days post-conception. In addition to a small number of immunostained fibers, cells resembling typical non-pyramidal neurons were immunostained in developing layers V and VI and in the subjacent white matter of each area examined (sensory-motor and visual areas). ChAT-immunoreactive neurons have not been described in the cerebral cortex of adult primates, but the present observations indicate such neurons exist in the developing primate cortex.