Sexual precocity: sex incidence and aetiology

The aetiology of 197 girls and 16 boys presenting with sexual precocity was reviewed. Ninety one girls and four boys had central precocious puberty (M:F 23:1); a cause was identified in all the boys but in only six girls. All boys with precocious puberty need detailed investigation; in girls investigation should be based on clinical findings, particularly the consonance of puberty.     

Thymic cysts in mediastinal Hodgkin disease

Three cases of proved thymic cysts associated with mediastinal Hodgkin disease are presented. Two illustrate regression of lymphoma with chemotherapy but persistence of thymic cysts. The third case demonstrates a thymic cyst in untreated Hodgkin disease. These cases suggest that such cysts are probably neither coincidental with nor a consequence of therapy but are probably related to initial thymic involvement by Hodgkin disease.     

Hormone Replacement and Strength Training Positively Influence Balance During Gait in Post-Menopausal Females: A Pilot Study

This study examined the effects of hormone replacement combined with strength training on improving dynamic balance control in post-menopausal women. Thirty one participating post-menopausal women were divided into three groups (hormone replacement (HR), non-hormone replacement (NR) and control (CR) group). HR and NR groups were tested for muscle strength and balance control during gait, prior to training and following a six week lower body strength training program. Quadriceps muscle strength was evaluated as isokinetic peak torque (60°·sec^-1) using a CYBEX NORM and balance control was evaluated by center of mass - base of support relationships and ground reaction forces during gait perturbations. Only the HR group showed significantly (p < 0.05) improved balance control during the initial phase of unexpected gait termination and single stance periods while walking across uneven terrain following training. The strength gains in the HR group tended to be greater than in the NR group over the six week training program, although neither group showed statistically significant increases. The CR group showed no significant differences between testing times. HR in post-menopausal females may enhance dynamic balance control when combined with a strength training program, even if no statistically significant gains in strength are achieved.

Key Points

• This study provides evidence that even a short modest strength training program can enhance dynamic balance control in older adult females taking hormone replacement.
• If potential benefits of hormone replacement therapy extend to enhancing muscle strength then this would be important in designing optimal interventions for both strength and balance for this cohort.
• Future work should explore the influence of hormone replacement therapy on other dynamic balance or functional tasks.

Key words: Estrogen replacement, gait, balance, strength     

Initial patterns of clinical care and recovery from whiplash injuries: a population-based cohort study

BACKGROUND: Little is known about the most effective pattern of clinical care for acute whiplash. We designed a cohort study to determine whether patterns of early clinical care (involving visits to general practitioners, chiropractors, or specialists) were associated with different rates of recovery. METHODS: We studied 2486 Saskatchewan adults with whiplash injuries. We defined 8 initial patterns of care that integrated type of provider and number of visits. We used multivariable Cox models to estimate the association between patterns of care and time to recovery while controlling for injury severity and other confounders. RESULTS: There was an independent association between the type and intensity of initial clinical care and time to recovery. We found that patients in the low-utilization general practitioner group had the fastest recovery, even after controlling for injury severity and other confounders. Compared with this group, the high-utilization general practitioner group experienced a 1-year rate of recovery that was 27% slower (adjusted hazard rate ratio [HRR], 0.73; 95% confidence interval [CI], 0.61-0.87); for the high-utilization chiropractic group it was 39% slower (HRR, 0.61; 95% CI, 0.46-0.81); for the high-utilization general practitioner plus chiropractic combined group it was 28% slower (HRR, 0.72; 95% CI, 0.57-0.91); and for those who consulted general practitioners and specialists, it was 31% slower (HRR, 0.69; 95% CI, 0.55-0.87). CONCLUSIONS: The type and intensity of clinical care initiated within the first month after the injury is associated with the rate of recovery from whiplash injuries. Our study does not support the hypothesis that early aggressive care promotes faster recovery.     

Histocompatibility studies in psoriasis vulgaris: family studies

A significant correlation between certain histocompatibility antigens, psoriasis and psoriatic arthritis is well established. Familial studies of psoriatic patients have shown a familial aggregation of psoriasis and psoriatic arthritis. In the present investigation, we studied 2 families in which psoriasis and/or psoriatic arthritis were seen in several members of different generations. HLA typing and mixed lymphocyte culture studies were performed. The results provide further documentation of the complexity of the genetic influences in psoriatic arthritis and psoriasis.     

Surfing for back pain patients: the nature and quality of back pain information on the Internet

STUDY DESIGN: A prospective, systematic review of web sites related to back pain. OBJECTIVE: To assess the nature and quality of back pain-related information on the World Wide Web during a 2-year period. SUMMARY OF BACKGROUND DATA: The Internet has become a rich source of medical information. Limited knowledge is available, however, about the quality of online resources. Although previous systematic reviews on medical-related web sites found problems in varying degrees with the credibility of information, no such review was conducted to assess the back pain-related sites. METHODS: A search of web sites was conducted in November 1996 using five search engines (AltaVista, Infoseek, Lycos, Yahoo, and Magellan) and two key terms ("back pain" and "back problems"). A sample of sites was evaluated by two independent reviewers. Each site was described by the type and nature of the sponsor, target audience, and content. Overall quality was assessed in terms of evidence-based information available. RESULTS: Seventy-four web sites were reviewed in 1996, and nine of them (12.2%) were identified as high-quality sites. Advertising was the focus of 80.8% of the sites. Eleven sites (14.9%) were found to be discontinued 1 year later, and 20 (27.0%) were not accessible by the reviewers at the 2-year follow-up evaluation. Of the remaining 54 sites, 44.4% were produced by for-profit companies, and most sites targeted people with back pain (63.0%). Only seven out of the nine high-quality sites held their ratings at the 2-year follow-up evaluation. CONCLUSION: Most back pain-related web sites can be classified as advertising. The quality varied considerably, resulting in difficulties for patients to find useful information in this field. The increasing number of people seeking medical information on the Web creates a need for more high quality sites. Further, systematic review of web sites should be encouraged to monitor the accuracy of Internet publication.     

Minimal clinically important difference. Low back pain: outcome measures

A proposed standard "core set" of outcome measures for low back pain includes 5 domains: back-specific function, generic health status, pain, work disability, and patient satisfaction. This paper focuses on the 2 recommended back-specific measures of function: the Roland-Morris Disability Questionnaire (RDQ) and the Oswestry Disability Index (ODI). We specifically address their ability to measure change. A systematic review of the literature identified a total of 78 and 71 (RDQ and ODI, respectively) articles as potentially relevant. Detailed tables are provided for each citation, with the type of back pain population studied, the type of change measured, the estimate of change, and the interval over which the change was studied. These tables should be used as a reference for sample size calculation. The responsiveness of the RDQ found in the literature ranges from 2 to 8 points on its 0 to 24 scale depending on what change is being measured. As a rough guide, Roland recommends that a change in 2-3 points on the RDQ should be considered the minimum clinically important change. Choosing any value larger than 5 in designing a clinical trial would risk underpowering the trial, since fewer patients are needed if a trial is designed on the basis of a large change score.     

What do we know about the reliability and validity of physical examination tests used to examine the upper extremity?

The literature regarding the reliability and validity of commonly used clinical tests for disorders of the upper extremity was reviewed. Formal literature search, standard texts, and experts in the field of upper extremity were consulted to locate relevant articles. Range of motion and strength testing of the upper limb have been shown to be reliable, while various tests used for the diagnosis of conditions in the upper limb, such as carpal tunnel syndrome and rotator cuff tendinopathy, have been shown to have varying degrees of validity. Overall, however, we determined that there is little evidence regarding the reliability and validity of physical examination for the upper extremity and specifically less information available regarding the reliability of diagnostic physical examination tests and the validity of impairment measures used for the upper limb. Further studies in this area are warranted in view of the impact of these findings on the treatment of patients.