Radiologic Indices Research Articles

Effects of Zoledronic Acid and Vitamin E on Surgical- Induced Osteonecrosis of the Femoral Head in Rabbit.

Femoral head osteonecrosis is a progressive disease with disabling outcomes in hip joint if not treated. This study was designed to compare the effects of zoledronic acid plus vitamin E versus zoledronic acid alone in surgical induced femoral head osteonecrosis in rabbits. 26 Japanese white adult normal male rabbits at 28-32 weeks old were undertaken surgical femoral dislocation to devastate the femoral neck vessels; the femoral neck vessels were ligated and the hip was relocated. Next, the first 10 rabbits received zoledronic acid injections at 1st and the 4th weeks; the second group (10 rabbits) received zoledronic acid injections at 1st and the 4th week along with daily oral vitamin E for 12 weeks; and the third group was considered as non-treated control group. Radiographic and postmortem pathological assessments including the Ficat classification, epiphyseal quotient (EQ), new bone formation, and residual necrotic bone (RNB) were performed and compared after week 12. A significant difference was found between the combination therapy group and the control group in Ficat classification at 12th weeks (P=0.048), but, the difference between monotherapy and combination therapy groups at 12th weeks was nonsignificant (P=0.37). Also, both treated groups had significant difference with the control group for RNB (P=0.015). There were no significant differences between the three groups for Ficat classification at the 6th week (P=0.65); EQ at 6th (P=0.59) and 12th week (P=0.64); and NBF (P=0.55). Although zoledronic acid therapy along with vitamin E could improve some radiologic and pathological indices related to femoral head osteonecrosis, vitamin E showed a relative impact. I.

SURGICAL TREATMENT OF CHILDREN WITH CONSEQUENCES OF INFANTILE SEPTIC ARTHRITIS

Introduction. The consequences of infantile septic arthritis are quite diverse and can manifest themselves as a damage to the growth zone, deformation and destruction of the articular components, and violation of the articular relationships. To treat this pathology, technically complex and traumatic surgical interventions are used. The purpose of this work is to analyze the medium-term results of the use of these methods in the treatment of children with septic coxitis consequences.Material and methods. The outcomes of treatment for 37 children with consequences of septic coxitis using Ilizarov apparatus were analyzed. Average age of patients at the time of the surgery was 8.2±0.5 years (from 6 to 10 years). Follow up period was from 3 to 10 years (average 4.7 years). Functional outcomes were assessed by C.L. Colton, radiologic indices — by E. Severin score and J. Kruczynski.Results. Patients were distributed into three groups according to anatomical features. Functional outcomes of patients in the 1st group: good (12–15 points) — 3 joints, satisfactory (9–11 points) — 5 joints, unsatisfactory (8 points) — 1 joint. X-ray findings of patients in the 1st group according to J. Kruczynski criteria: good — 5 joints, satisfactory — 4 joints; by E. Severin criteria: Ia — 1, Ib –1, IIa — 2, IIb — 3, III — 2. Functional outcomes of patients in the 2nd group: good (12–14 points) — 10 joints, satisfactory (9–11 points) — 8 joints. Distribution in the second group by J. Kruczynski criteria: good — 9, satisfactory — 9; by E. Severin criteria: IIa — 14, IIb — 4. Distribution of functional outcomes in the 3rd group in accordance with C.L. Colton criteria: good (12–15 points) — 3 joints, satisfactory (9–11 points) — 7 joints. Distribution in the third group according to J. Kruczynski criteria: good — 4, satisfactory — 6; by E. Severin criteria: IIa — 5, IIb — 4, III — 1.Conclusion. The use of the presented transosseous external fixation technique in children with the consequences of septic coxitis provides sufficient stability of the joint without causing its decompensation and stiffness. The use of the Ilizarov fixator extends the age limits for reconstructive treatment of abnormal distal hip dislocation.

Prognostic value of computed tomography pulmonary angiography indices in patients with cancer-related pulmonary embolism: Data from a multicenter cohort study

Prognostic value of computed tomography pulmonary angiography indices in patients with cancer-related pulmonary embolism: Data from a multicenter cohort study

How well do Radiologic Assessments of Truncal and Shoulder Balance Correlate With Cosmetic Assessment Indices in Lenke 1C Adolescent Idiopathic Scoliosis?

A correlation study. The primary objective was to determine the correlation between radiologic and cosmetic indices of trunk and shoulder balance before and after scoliosis surgery in Lenke 1C adolescent idiopathic scoliosis and to determine whether postoperative trunk shift is affiliated with worsening of the patients' cosmesis. Achieving a symmetrical appearance with truncal and shoulder balance is of prime importance to adolescent idiopathic scoliosis patients and their surgeons. However, surgeons prefer radiographic indices rather than measures of patients' clinical appearance. If radiographic indices are to be considered accurate depictions of the patient's cosmesis, radiologic and cosmetic indices must necessarily exhibit high association. Radiographic and cosmetic indices of trunk and shoulder balance, along with posterior trunk symmetry index, were measured preoperatively and 3 months postoperatively in 33 Lenke 1C scoliosis patients. Pearson correlation analysis was performed. Paired t test was used to determine significant changes in radiographic and cosmetic indices after surgery. Independent-sample t test was used for all intergroup analyses in trunk shift and no-trunk-shift groups. Correlation coefficients between radiologic and cosmetic indices ranged between -0.63 and 0.70 with thoracic apical vertebra-central sacral vertical line (AV-CSVL) distance and first rib angle showing consistent correlations with cosmetic trunk and cosmetic shoulder balance indices. Trunk shift, a postoperative iatrogenic phenomenon, was seen in 19 (58%) patients. These patients had higher preoperative thoracic AV-CSVL translation, thoracic apical vertebra-first thoracic vertebra (AV-T1) translation, thoracic deformity correction rate, AV-T1 correction rates, and shorter fusions compared with the no-trunk-shift group. Posterior trunk symmetry index worsened in trunk shift group and improved significantly (-7.94 vs. 16.53) in no-trunk-shift group. Significant association (P=0.004) was seen between radiographic and cosmetic trunk shift. Radiographic indices can only minisculely (r≤0.7) reflect cosmetic deformity in Lenke 1C scoliosis, which emphasizes not only the vulnerability of overreliance on radiographic indices but also the vital importance of clinical cosmetic evaluations. In particular, cosmetic shoulder height and angle are not represented by radiographic indices. However, radiograph trunk shift was significantly associated with cosmetic trunk shift in cosmetic pictures.

Predictive Value of Unenhanced Computerized Tomography for Detecting Hepatosteatosis in Living Liver Donors

Predictive Value of Unenhanced Computerized Tomography for Detecting Hepatosteatosis in Living Liver Donors

One stage soft tissue release, open reduction, femoral shortening, osteotomy and peri acetabular augmentation for spastic dislocated hip-early results

Objectives: The goals of hip surgery in cerebral palsy are to maintain adequate reduction of the femoral head, prevent pain, improve sitting balance and maintain motion and the ambulatory status of the patient. It is now well accepted that soft tissue release, open reduction and femoral shortening were necessary for a stable hip along with some type of pelvic osteotomy. We evaluated the clinical and radiological results of one-stage correction of hip dislocation for cerebral palsy patients. Materials and Methods: We reviewed clinical outcomes and radiologic indices of 32 dislocated hips in 24 children with cerebral palsy (13 males, 11 females; mean age, 8.6 years). All 32 hips had dislocation. Preoperative Gross Motor Function Classification System (GMFCS) scores of the patients were as follows; level V (13 patients), level IV (9), and level III (2). The combined surgery included release of contracted muscles, (adductors, rectus femoris, iliopsoas) open reduction of the femoral head, femoral shortening varusderotation osteotomy and the modified Dega osteotomy along with shelf procedure. Hip range of motion, GMFCS level, acetabular index, center- edge angle, migration percentage, neck shaft angle, Sharp's angle was measured before and after surgery. The mean follow-up period was 38.1 months. Results: Hip abduction (median, 40°), sitting comfort and GMFCS level were improved after surgery, and pain was decreased. There were no femoral head avascular necrosis, no infection or nonunion. There was no redislocation. All radiologic indices showed improvement after surgery. Conclusions: So, we believe that a combined approach of muscle releases, open reduction, femoral shortening varus-derotation osteotomy, Dega osteotomy and penicapsularacetabular augmentation was a highly effective method for the treatment of spastic dislocated hips in our patients.

The Role of the Radiological Parameters in the Diagnosis of the Ankle Joint Fractures

Abstract The ankle stability and its biomechanics can be compromised after ligamentous and malleolus lesions. The complete early diagnosis, and also the early and late postsurgery results, must be formulated and explained using the tibio-astragalus radiologic indices. The paper evaluates the importance of these presurgery and postsurgery indices, analyzing also the late results under causal report. Our subordinating to the exigency of radiologic indices to obtain a reparation as anatomic as possible, shows that the surgical treatment must be applied to osteo-ligamentous lesions properly, so that to get the remake of tibio-astragalus biomechanics.

Clinical, Radiologic, and Genetic Features in Blepharophimosis, Ptosis, and Epicanthus Inversus Syndrome in the Indian Population

To study the clinical, radiologic, and genetic features in Indian Blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES) patients. A total of 33 clinically well characterized BPES cases who presented between 2009 to 2011 were recruited. Clinical evaluation consisted of ophthalmic and orthoptic examination. For orbital indices, computed tomography (CT) scan of orbits was performed. Genetic studies included cytogenetic analysis and molecular analysis of FOXL2 gene. Significant clinical findings included a high incidence of refractive error in 94%, amblyopia in 60%, and strabismus in 40% of BPES cases. Orbital radiologic indices on CT scan in BPES were found to be comparable to the control group. On karyotyping, 8 out of 33 (24%) cases harbored chromosomal abnormalities. These abnormalities included 46,XY;del(3qter), 46,XY;del(3q26.3), 46,XX;del(3q24-25), and 46,XY;del(3q26qter). On molecular analysis, a novel mutation consisting of heterozygous substitution at c1635 that replaced cytosine by thymidine was detected. To the best of our knowledge, this is the first study on clinical features in BPES patients of Indian origin. A high incidence of refractive error, strabismus, and amblyopia was found in BPES cases. Orbital imaging confirmed that clinical features are limited to soft tissue abnormalities, with no underlying bony changes. Cytogenetic studies showed that most chromosomal abnormalities in the Indian population are in the region of the long arm of chromosome 3. Results of molecular analysis indicate that there may be loci other than the FOXL2 gene, which are affected in BPES cases. Our study expands the existing mutation spectrum of FOXL2 gene.

Risk Factors for Redisplacement of Pediatric Distal Forearm and Distal Radius Fractures

Fractures of the distal forearm and distal radius represent the most common types of fracture in the pediatric population, with the majority treated by closed reduction and cast. Redisplacement has been known to occur in up to 39% of cases. There have been numerous risk factors and radiologic indices put forward as methods of predicting redisplacement, but this topic remains a matter of debate. This retrospective study aims to further assess the significance of the many factors in redisplacement after treatment with closed reduction. This retrospective study included 155 children with distal radius and forearm fractures. Age, sex, location of fracture, angulation, displacement, an associated ulna fracture, obliquity of fracture, and accuracy of reduction were measured for assessment as potential risk factors. In addition, the cast index, padding index, Canterbury index, second metacarpal-radius index, gap index, and 3-point index were measured on postreduction radiographs. Redisplacement occurred in 33 of the 155 cases (21.3%). Initial displacement and accuracy of the reduction were identified as significant risk factors for redisplacement. Initial displacement of >50% (of the radius width) was significantly associated with redisplacement (odds ratio of 5.4). Failure to achieve anatomic reduction was significantly higher in the redisplacement group (odds ratio 3.9). The only radiologic index that differed significantly between groups was the cast index, with more patients without redisplacement meeting the cut-off value (60% vs. 32%, P=0.010). Initial displacement of >50% and inability to achieve anatomic reduction are major risk factors for redisplacement. Given its effectiveness and ease of clinical application, the cast index remains the most useful measure of cast molding. Level II--Retrospective prognostic study.

Early results of one-stage correction for hip instability in cerebral palsy.

BackgroundWe evaluated the clinical and radiological results of one-stage correction for cerebral palsy patients.MethodsWe reviewed clinical outcomes and radiologic indices of 32 dysplastic hips in 23 children with cerebral palsy (13 males, 10 females; mean age, 8.6 years). Ten hips had dislocation, while 22 had subluxation. Preoperative Gross Motor Function Classification System (GMFCS) scores of the patients were as follows; level V (13 patients), level IV (9), and level III (1). Acetabular deficiency was anterior in 5 hips, superolateral in 7, posterior in 11 and mixed in 9, according to 3 dimensional computed tomography. The combined surgery included open reduction of the femoral head, release of contracted muscles, femoral shortening varus derotation osteotomy and the modified Dega osteotomy. Hip range of motion, GMFCS level, acetabular index, center-edge angle and migration percentage were measured before and after surgery. The mean follow-up period was 28.1 months.ResultsHip abduction (median, 40°), sitting comfort and GMFCS level were improved after surgery, and pain was decreased. There were two cases of femoral head avascular necrosis, but no infection, nonunion, resubluxation or redislocation. All radiologic indices showed improvement after surgery.ConclusionsA single event multilevel surgery including soft tissue, pelvic and femoral side correction is effective in treating spastic dislocation of the hip in cerebral palsy.

The Position of Proximal Reference Point of Tibia Plateau for Correct Tibial Osteotomy in Total Knee Replacement: Prospective Randomized and 6 Years Follow-up Study

PurposeWhen there is a varus deformity in proximal tibia, the extension of a tibial shaft axis tends to pass through the lateral intercondylar eminence. A prospective randomized study was conducted to find out whether the lateral eminence of tibia could serve as a reference point for proximal tibial osteotomy during total knee arthroplasty and results from 6-years follow up period were reported.Materials and MethodsForty-six patients (50 knees) who received total knee replacement arthroplasty from April to December 2004, were randomly divided into two groups. For a proximal tibial osteotomy, the proximal tibial reference point was located at the center of intercondylar eminence for group I and at the lateral eminence for group II and subsequently, the results were evaluated. Radiologic indices were the angles between the axis of the prosthesis and the mechanical/shaft axes of tibia and angle of the prosthesis in sagittal plane. Clinical indices were pain and function score of American knee society, functional score of Hospital for Special Surgery and range of knee joint motion.ResultsThe angles between the axis of the prostheses and the mechanical/shaft axes of tibia were varus 1.64°/2.12° in group I and valgus 0.57°/0.38° in group II (p=0.589/p=0.558). There were 6 cases of outliers (27.2%) in group 1 and 3 cases (15.0%) in group 2. There was a significant difference in the pain score between group I (82.9) and II (91.4) (p=0.032), respectively.ConclusionsBy moving the reference point of proximal tibial osteotomy laterally, lower incidence of outlier and residual varus deformity could be achieved.

How Well Does Radiological Measurements Correlate With Cosmetic Indices in Adolescent Idiopathic Scoliosis With Lenke 5, 6 Curve Types?

An association study between radiologic measurements and cosmetic appearance in adolescent idiopathic scoliosis (AIS) patients with Lenke 5 and 6 curve types. The present study aimed at investigating the correlation between radiologic measurements and clinical cosmetic assessment indices in AIS with Lenke 5 and 6 curve types. Cosmetic truncal and pelvic distortions are of important concern to patients with AIS. In the clinical assessment of AIS, over reliance on radiologic evaluations without corresponding objective assessment of the external physical appearance is commonly practiced. Patients having the same radiologic findings could be quite different in their physical appearance and the reverse could also happen. These observations imply that discrepancies could well exist in the cosmetic versus radiologic evaluation in AIS. A total of 52 AIS patients with dominant lumbar/thoracolumbar curve including 36 Lenke type 5 and 16 Lenke type 6 were recruited. Cobb angles, coronal balance, thoracic containment, apical vertebral translation (AVT), pelvic oblique, apical vertebral rotation were measured in the standard long-standing posteroanterior radiographs. Waistline Height Index, Waistline Depth Index, Waistline Area Index, Waist Area Index, and hump index (α) were measured clinically and the 5 parameters combined into a composite cosmetic Index (CCI). Pearson rank correlation coefficient was used to assess measurement reliability for the cosmetic indices; correlation analysis and multiple linear regression analysis were made between the radiologic measurements and CCI. The correlation coefficients between radiologic measurements and CCI ranged from -0.29 to 0.57, among which AVT was found to have the highest correlation coefficient, but not the Cobb angle. AVT, Cobb angle, coronal balance, thoracic containment were found to be significantly correlated with CCI (P < 0.05) with all correlation coefficients below 0.6. From linear regression analysis, CCI could be predicted by the equation (CCI = 98.0-1.18 x AVT-0.29 x Cobb angle) with adjusted R2 of 0.33 (implying that 33% of CCI variation could be accounted for by Cobb angle and AVT). The present study showed that a number of radiologic indices could only partially reflect the objective cosmetic appearances in Lenke type 5 and 6 curves in AIS. Spine surgeons should put more emphasis in the clinical cosmetic evaluations and not relying solely on the radiologic assessment in AIS.

Psoriatic Arthritis Spondylitis Radiology Index: A Modified Index for Radiologic Assessment of Axial Involvement in Psoriatic Arthritis

To develop and validate a modified index for assessing the radiologic axial involvement in psoriatic arthritis (PsA) in a group of patients with established disease. Patients were included on clinical and/or radiologic criteria. The modified index combined features of existing radiologic indices for ankylosing spondylitis (AS) with the addition of scores for the facet joints of the cervical and lumbar regions. Scores for the BathAS Radiology Index (BASRI), the modified Stoke AS Scoring System (mSASSS), and the new index were obtained from current radiographs. The construct validity of the new index was assessed by examining the correlation with patient reported outcomes, such as the Revised Leeds Disability Questionnaire (RLDQ) and BathAS Functional Index (BASFI), and anthropometric measures. Radiographs were available for 73 patients (54 men, 19 women, mean age 49.4 +/- 11.0 yrs, mean disease duration 14.0 +/- 7.9 yrs). Due to difficulty in visualizing and interpreting the lumbar facet joints, only the cervical facet joints were included in the new score, called the PsA Spondylitis Radiology Index (PASRI). Overall, the PASRI resulted in less missing data than the mSASSS, but had less complete data than the BASRI. The PASRI also had fewer zero scores than the mSASSS and the score range for the PASRI exceeded that of the mSASSS and the BASRI. Correlation with anthropometric and patient reported outcomes was good for both the PASRI and BASRI, with both these measures outscoring the mSASSS. The PASRI encompasses a greater range of the spinal radiologic features of PsA, provides a greater score range and fewer zero scores, and correlates well with anthropometric and patient reported measures.

Surgical Strategy for Thyroid Bed Recurrence in Patients with Well-Differentiated Thyroid Carcinoma

Well-differentiated thyroid carcinoma (WTC) has a low but definite rate of recurrence. The majority of these occur locoregionally and present a significant diagnostic and management challenge. It is the aim of this article to convey the complexities associated with revision surgery involving the thyroid bed and to present sound surgical strategies to deal with this problem in a manner that minimizes morbidity, adheres to oncologic principles, and achieves appropriate cure rates. Between 1992 and 2002, 14 patients with revision surgery involving the thyroid bed were identified and managed according to an algorithm taking into account clinical, biochemical, and radiologic indices. All underwent revision surgery, and we applied our technique of wide field exposure by horizontally sectioning all of the ipsi- or bilateral strap muscles. We use blunt dissection to identify the recurrent laryngeal nerves and parathyroid glands. There were six males and eight females, with a median age of 38 years (range 23-62 years). The median time between procedures was 25 months (range 6-120 months). The diagnosis was established by clinical examination, thyroglobulin determination, and/or imaging. All were treated with surgery and postoperative iodine 131 (I131). The median follow-up was 6 months (range 2-48 months). Complications included two cases of temporary recurrent laryngeal nerve palsy, two patients with permanent and two patients with temporary hypocalcemia, two cases of temporary chyle leaks, and one recurrence. One patient underwent a negative exploration. The management of infield recurrence of WTC presents both a diagnostic and a therapeutic challenge owing to the disparity in presentation, the complexity of the anatomy, and indistinct tissue planes. The optimal treatment of these patients is surgical resection and postoperative I131. This can be accomplished safely and with little morbidity. The key to this type of surgery is a sound and systematic approach.

Rotational Acetabular Osteotomy for the Dysplastic Hip: A Follow-up for 5 to 18 years

Purpose: To evaluate the midterm result of patients who underwent rotational acetabular osteotomy for the treatment of acetabular dysplasia. Materials and Methods: The clinical and radiographic outcomes of 36 patients, who underwent rotational acetabular osteotomy between January 1987 and September 1998, were evaluated after a minimum followup of five years. The mean follow-up period was 8.6 years. The clinical evaluation included recording the level of pain, the ambulation status and range of motion according to the d'Aubigne and Postel system. Radiographic analysis included the C-E angle of Wiberg, the acetabular roof obliquity, and arthritis grade of Tonnis. Results: The average Postel score increased from 12.5 points preoperatively to 15.7 points at the final follow up. All the radiologic indices improved after surgery. In five hips (13.1%), there was a progression of arthritis prior to surgery. Conclusion: Rotational acetabular osteotomy is a valuable procedure for preventing the progression of early osteoarthritis in patients with a dysplastic hip. However the results were unsatisfactory for hips with more advanced osteoarthritis.

Octreotide improves biochemical, radiologic, and symptomatic indices of gastroenteropancreatic neoplasia in patients with multiple endocrine neoplasia type 1 (MEN‐1)

BACKGROUND Multiple endocrine neoplasia type 1 (MEN-1) is an autosomal dominant tumor syndrome associated with parathyroid, gastroenteropancreatic (GEP), and pituitary neoplasia. Gastrinoma and GEP malignancy are common life-threatening endocrine complications of MEN-1. An effective management strategy for these disorders remains to be determined. The authors attempted to determine the role of the somatostatin analogue, octreotide, in ameliorating features of hypergastrinemic GEP neoplasia associated with MEN-1. METHODS Five MEN-1 patients with hypergastrinemia and either symptoms of GEP neoplasia or hepatic metastases received a trial of octreotide, 100 μg subcutaneously, three times daily for 3 months. RESULTS Treatment with octreotide was associated with a rapid symptomatic and biochemical response. In all patients serum gastrin fell to < 25% of the pretreatment value. The serum glycoprotein-αsubunit (a marker of enterochromaffin-like [ECL] cell hyperplasia, gastric carcinoidosis, and disseminated enteropancreatic malignancy) was elevated at baseline in three patients. In each case the serum glycoprotein-αsubunit normalized after treatment with octreotide. Hepatic metastases were present in two patients at baseline. The size of the metastases diminished by up to 15% during the period of octreotide treatment. Four patients reported symptoms prior to treatment: lethargy, easy fatigability, and generalized musculoskeletal discomfort. A marked symptomatic improvement occurred in each case. No patient experienced side effects related to octreotide therapy and all elected to remain on treatment after completion of the trial. CONCLUSIONS Octreotide is a safe and effective adjunct to surgical strategies for the management of GEP neoplasia in hypergastrinemic MEN-1 patients. Cancer 1999;86:2154–9. © 1999 American Cancer Society.

Octreotide improves biochemical, radiologic, and symptomatic indices of gastroenteropancreatic neoplasia in patients with multiple endocrine neoplasia type 1 (MEN-1)

Multiple endocrine neoplasia type 1 (MEN-1) is an autosomal dominant tumor syndrome associated with parathyroid, gastroenteropancreatic (GEP), and pituitary neoplasia. Gastrinoma and GEP malignancy are common life-threatening endocrine complications of MEN-1. An effective management strategy for these disorders remains to be determined. The authors attempted to determine the role of the somatostatin analogue, octreotide, in ameliorating features of hypergastrinemic GEP neoplasia associated with MEN-1. Five MEN-1 patients with hypergastrinemia and either symptoms of GEP neoplasia or hepatic metastases received a trial of octreotide, 100 microg subcutaneously, three times daily for 3 months. Treatment with octreotide was associated with a rapid symptomatic and biochemical response. In all patients serum gastrin fell to < 25% of the pretreatment value. The serum glycoprotein-alphasubunit (a marker of enterochromaffin-like [ECL] cell hyperplasia, gastric carcinoidosis, and disseminated enteropancreatic malignancy) was elevated at baseline in three patients. In each case the serum glycoprotein-alphasubunit normalized after treatment with octreotide. Hepatic metastases were present in two patients at baseline. The size of the metastases diminished by up to 15% during the period of octreotide treatment. Four patients reported symptoms prior to treatment: lethargy, easy fatigability, and generalized musculoskeletal discomfort. A marked symptomatic improvement occurred in each case. No patient experienced side effects related to octreotide therapy and all elected to remain on treatment after completion of the trial. Octreotide is a safe and effective adjunct to surgical strategies for the management of GEP neoplasia in hypergastrinemic MEN-1 patients.

DEFINING OSTEOARTHRITIS OF THE HIP FOR EPIDEMIOLOGIC STUDIES

The authors compared seven radiologic indices of hip osteoarthritis to establish which provided the best definition of the disease for epidemiologic purposes. Hip joints were assessed from intravenous urograms taken in a British hospital between 1982 and 1987 in 1,315 men aged 60-75 years. The indices examined were an overall qualitative grading of osteoarthritis, four measures of joint space, the maximum thickness of subchondral sclerosis, and the size of the largest osteophyte. Minimal joint space (i.e., the shortest distance between the femoral head margin and the acetabulum) was the index most strongly associated with other radiologic features of osteoarthritis. Among a subset of 759 men who answered a questionnaire about symptoms, the overall qualitative grading, minimal joint space, and thickness of subchondral sclerosis were the radiologic indices most predictive of hip pain. Within- and between-observer repeatability were tested in a subset of 50 subjects. Measures of joint space were more reproducible than other indices. These data suggest that, at least in men, minimal joint space is the best radiologic criterion of hip osteoarthritis for use in epidemiologic studies.

Preoperative and Postoperative Abnormalities in Chest X-ray Indices and in Lung Function in Pectus Deformities

Preoperative and Postoperative Abnormalities in Chest X-ray Indices and in Lung Function in Pectus Deformities

Parathyroid and bone response of the diabetic patient to uremia

Parathyroid and bone response of the diabetic patient to uremia