Prevalence,incidence and progression of lumbar spondylosis by gender and age strata

Abstract

Objectives. To identify the prevalence, incidence and progression of radiographic lumbar spondylosis (LS).

Methods. From the Adult Health Study conducted by the Radiation Effects Research Foundation, 1,204 participants aged 44–85 years who had lumbar spine radiographs in 1990–1992 were reexamined in 1998–2000 (mean 7.9-year interval). The radiographic severity of LS was determined by Kellgren/Lawrence (KL) grading.

Results. In the overall population, the prevalence of radiographic KL ≥ 2 and ≥ 3 LS was 52.9% and 23.6%, respectively. KL ≥ 2 LS was more prevalent in men, whereas KL ≥ 3 LS was more prevalent in women. During the 8-year follow-up, the incidence of KL ≥ 2 LS in men and women was 65.5% and 46.6%, that of KL ≥ 3 LS was 27.3% and 29.5%, that of progressive LS was 31.3% and 34.0%, and multilevel LS was 44.9% and 33.4%, respectively. Body–mass index was a risk factor for both KL ≥ 2 and KL ≥ 3 LS, after adjusting for age and sex.

Conclusions. The present longitudinal study revealed the prevalence, incidence and progression of radiographic LS. Prevalence and incidence of KL ≥ 2 LS was higher in men than women, while, those of KL ≥ 3 were similar between men and women.     

Zur Röntgendiagnostik frühkindlicher Ohrerkrankungen

Ohne ZusammenfassungMit 6 Textabbildungen.     

Outcome and prognostic factors during the course of primary small-vessel vasculitides

OBJECTIVE: To identify the prognostic factors of relapse and/or death during the course of primary small-vessel vasculitides (PSVV), and to differentiate their prognostic relevance by the type of vasculitis. METHODS: Seventy-five patients were retrospectively followed up after diagnosis: 36 with Wegener's granulomatosis (WG), 23 with Churg-Strauss syndrome (CSS), and 16 with microscopic polyangiitis. Cox regression analysis was used to identify the significant predictors of relapse and death. RESULTS: Gastrointestinal (GI) involvement was associated with an increased risk of relapse, mainly in the patients with CSS, whereas renal disease and perinuclear antineutrophil cytoplasmic antibody positivity were correlated with a lower risk of relapse. Presence of nasal Staphylococcus aureus tended to increase the risk of relapse in CSS [hazard ratio (HR) 4.45, p = 0.087], but to decrease it in WG (HR 0.12, p = 0.066). Older age, renal and hepatic involvement, erythrocyte sedimentation rate >or= 100 mm/h, and serum creatinine level >or= 1.5 mg/dl were all related to higher risk of death in univariate analysis; however, only cerebral (HR 8.52, p = 0.021) and hepatic involvement (HR 4.40, p = 0.028) and serum creatinine level >or= 1.5 mg/dl (HR 5.72, p = 0.044) were independently correlated with an unfavorable prognosis for survival. The risk of death associated with each of these indicators did not depend on the form of PSVV. CONCLUSION: GI involvement increases the risk of relapse in CSS, whereas the prognostic significance of nasal S. aureus in terms of relapse seems to be opposite in patients with CSS and those with WG. Patients with cerebral, hepatic, and renal involvement have the poorest prognosis for survival. Our data do not show that the prognostic relevance of these factors depends on the form of PSVV.     

A disease-specific activity index for Wegener's granulomatosis: modification of the Birmingham Vasculitis Activity Score. International Network for the Study of the Systemic Vasculitides (INSSYS)

OBJECTIVE: To refine and validate the Birmingham Vasculitis Activity Score (BVAS) as a disease-specific activity index for Wegener's granulomatosis (WG). METHODS: Sixteen members of the International Network for the Study of the Systemic Vasculitides (INSSYS) revised the BVAS, with 3 goals: to reduce the redundancy of some component items, to enhance its ability to capture important disease manifestations specific to WG, and to streamline the instrument for use in clinical research. We defined the items and weighted them empirically as either minor (e.g., nasal crusting = 1 point) or major (e.g., alveolar hemorrhage = 3 points). We then validated the new, disease-specific BVAS/WG in 2 simulation exercises and a clinical case series that involved 117 patients with WG. RESULTS: We removed 38 items from the original BVAS, revised 9 items, and added 7 new items. Correlations between the scores on the BVAS/WG and the physician's global assessment (PGA) of disease activity were high, even when patients in remission were excluded. In the clinical case series, Spearman's rank correlation coefficient between the BVAS/WG and the PGA was r = 0.81 (95% confidence interval 0.73-0.87). The interobserver reliability using intraclass (within-case) correlation coefficients in the 2 simulation exercises was r = 0.93 for the BVAS/WG and r = 0.88 for the PGA in the first and r = 0.91 for the BVAS/WG and r = 0.88 for the PGA in the second. There was no significant observer effect in the scoring of the BVAS/WG or the PGA. The discriminant validity of the BVAS/WG was good: r = 0.73 (95% confidence interval 0.43-0.83). CONCLUSION: The BVAS/WG is a valid, disease-specific activity index for WG. Tested in simulation exercises and in actual patients, the BVAS/WG correlates well with the PGA, is sensitive to change, and has good inter- and intraobserver reliability. The INSSYS will use the BVAS/WG to assess the primary outcome in a phase II/III trial of etanercept in WG.     

Über die hohe Duodenalfistel

Zusammenfassung Wenn wir nun unsere diesbezüglichen Experimente mit unseren anderweitigen Versuchen, mit den Tierexperimenten anderer und den Daten der menschlichen Pathologie in Einklang bringen, so läßt sich folgendes feststellen: hohe Duodenalfisteln rufen eine Änderung in der Muskelfunktion des Magens hervor. Diese besteht darin, daß eine Muskelexcitation am Magen entsteht, als deren Folge dann der Magen sich rasch entleert. Diese Veränderung am Magen ist analog mit jener, die durch ein Duodenalgeschwür hervorgerufen wird und die wir auf experimentellem Wege durch Reizung des Duodenums hervorrufen konnten. Die Erklärung der analogen Veränderungen ergibt sich, dem Bayliss-Starlingschen Darmgesetz entsprechend, aus dem Mechanismus des duodenalen Muskelsyndroms.Jene tierexperimentellen Resultate, die sich bei hohen Duodenalfisteln ergaben, zeigen nicht die Physiologie der Magenmuskulatur, sondern einen pathologischen Zustand, der dem in der menschlichen Pathologie bekannten Duodenalgeschwür entspricht.