Body size,biological maturation,and sport participation related to cortical bone in adolescent girls

The purposes of this study were twofold: (1) to describe the growth of metacarpal bone dimensions in a large sample (n = 819) of Flemish girls, 12–18 years, and (2) to investigate the relationship among cortical bone dimensions, biological maturation, and participation in sports activities. Besides body mass and stature, Tanner-Whitehouse skeletal age (SA) was estimated and menarcheal status was assessed. Second metacarpal bone dimensions were measured on radiographs. Sports participation was determined by a standardized questionnaire. Results show that whereas medullary diameter decreased, all other second metacarpal dimensions increased significantly with age. When the girls were divided into five subgroups by SA, significant differences were found for metacarpal bone dimensions among the groups. Analysis of covariance revealed that skeletal maturity significantly differentiated for medullary diameter, cortical thickness, cortical area, and percent cortical area, even when chronological age, body mass, and stature were partialled out. However, no differences were found between contrasting SA groups for metacarpal length and periosteal diameter when chronological age, body mass, and stature were held constant. The metacarpals of postmenarcheal girls are ～4% longer and ～7% wider, and had ～14% more bone area than age-matched, premenarcheal peers. No differences were found in periosteal diameter between pre- and postmenarcheal 14–15-year-old girls. Finally, sports participation was not associated with cortical bone in this group of healthy females (?0.16 ≤ r ≤ 0.17). © 1994 Wiley-Liss, Inc.     

Basic treatment considerations: chemotherapy

Lung cancer represents a major global health problem, with more than a million deaths reported each year. Because there are no effective screening tools to date, diagnosis of the disease at an advanced stage is a common feature. Over the past 20 years, elegant strides have been made in the treatment of patients with advanced NSCLC. Several novel chemotherapy agents that are efficacious and possess favorable toxicity profiles have been developed recently. In addition to evaluating novel combinations, alternative schedules to improve toxicity profiles are subjects of clinical trials. Much work needs to be done, however, to improve the outcome for patients with lung cancer. Chemotherapy extends life and improves quality of life for patients with stage IIIB/IV NSCLC. Combined modality therapy with radiation and chemotherapy improves the outcome for patients with locally advanced NSCLC and is associated with a curative potential. Molecularly targeted therapies are under rigorous evaluation, although the initial results have been disappointing. In the upcoming years, we will learn effective means to incorporate molecularly targeted therapies to existing treatment paradigms in lung cancer.     

Extremity injuries remain a high surgical workload in a conflict zone: experiences of a British Field Hospital in Iraq, 2003

BACKGROUND: During this conflict 34 Field Hospital, the sole Coalition field hospital located in Iraq, received and treated casualties with a wide range of injuries. Located very close to the front line during the period of combat hostilities, it was potentially going to deal with relatively fewer battle-injured extremities. METHOD: A retrospective review of battle casualties admitted to the hospital was carried out based on casualty records and operating theatre logbooks. Data was collected for the period between the 26th March and the 8th May, focusing on casualties who had surgery for battle-injured extremities during the conflict. RESULTS: Sixty eight (55%) of the 124 casualties who underwent surgery did so for battle injuries to extremities. 139 (58%) of all operating theatre episodes and 189 (53%) of all surgical procedures undertaken were for battle-injured extremities. Fourteen major limb amputations were carried out from a total of 87 battle-injured limbs that had surgery, giving an amputation rate of sixteen percent (14/87). CONCLUSION: The experience at 34 Field Hospital confirms that extremity injuries do confer a high surgical workload in war. Surgical resources should, therefore, be aimed at this and surgical teams deployed to such environments should be well versed in the surgical management of casualties with limb trauma.     

Immunoglobulin G, A, and M responses in serum and circulating immune complexes elicited by the 16-kilodalton antigen of Mycobacterium tuberculosis

The 16-kDa cytosolic antigen of M. tuberculosis was purified to homogeneity by molecular sieving chromatography, and the diagnostic potential of the antigen was evaluated in various categories of patients by enzyme-linked immunosorbent assay (ELISA). The immunoglobulin G (IgG), IgA, and IgM antibody levels to 16-kDa antigen were estimated in the two polar groups, namely, smear- and culture-positive pulmonary tuberculosis (S(+)C(+)) patients and healthy subjects (HS). Sensitivities of 62, 52 and 11% with specificities of 100, 97, and 95% were obtained for the three isotypes, respectively. The total number of positives by a combination of the three isotypes was analyzed in the polar groups, and the sensitivity improved to 83% with a specificity of 93%. Even when a combination of IgG and IgA alone was considered, the sensitivity was 82% with a specificity of 97%. Polyethylene glycol precipitation of the circulating immune complex (CIC) in sera was carried out. The CIC-bound antibodies to 16-kDa antigen were assessed by ELISA in the S(+)C(+), S(-)C(+), and S(-)C(-) categories of patients. Measuring the IgG-IgA-IgM combination positivities of the CIC-bound antibodies gave sensitivities of 97.5, 100, and 45.3%, respectively. The specificity of the assay with these combinations was maintained at 95.4%.     

Mammography registry: considerations and options

Radiologists are being urged to provide high-quality low-cost screening mammography to all women over 40 years of age. A mammography registry coupled with existing cancer registries would permit the quality and effectiveness of screening efforts to be evaluated. Standards of care would be determined that would permit quality assessment at individual centers and that could enhance medicolegal defense. The organizing group should consist of physician users, experts in mammography, statisticians, and administrators. Data regarding the number and type of studies, findings, interpretations, and recommendations could be collected and reported easily and cheaply with a standardized form. The registry could be financed by federal, state, or private funds; the latter are most preferable, but a combination of the three is most feasible. Screening mammography presents a serious public health challenge that is best addressed by the organization and support of a registry by radiologists.     

Neck neoplasms: MR imaging. Part II. Posttreatment evaluation

Thirty-three patients who had undergone prior surgery and/or radiation therapy for malignant neoplasms of the neck were studied with magnetic resonance (MR) imaging. Twenty-seven of these patients were also evaluated with computed tomography (CT). Ten patients were healthy posttreatment volunteers, and 23 had documented tumor recurrence. MR images better demonstrated normal muscular landmarks, especially in patients with obliterated fat planes. Areas of posttreatment fibrosis or scarring were low in signal intensity with all MR pulse sequences. However, in three patients, high signal intensity from postradiation edema of the supraglottic area mimicked neoplasm. In patients with recurrent tumor, MR imaging was superior to CT in defining the relationship of tumor and muscle and in demonstrating vascular anatomy when no intravenous contrast material was given during the CT examination. In two patients tumor and fibrosis were separated on MR images because of signal intensity differences. CT scans, however, showed adjacent bone and cartilage anatomy better. Our data indicate that an MR examination may be helpful in patients in whom CT is indeterminate either because of anatomical distortion or suboptimal demonstration of vascular anatomy.     

Postauricular cerebellar encephalocoele secondary to chronic suppurative otitis media and mastoid surgery

Cerebellar herniation into the mastoid through the posterior aspect of the temporal bone as a result of chronic suppurative otitis media and mastoid surgery is a rare event. A case is reported in which such a hernia presented subcutaneously behind the pinna; its repair is discussed.