Symptomatic Young Adults Research Articles

The posterior crescent sign on MRI and MR arthrography: is it a marker of hip dysplasia and instability?

To evaluate the prevalence of the 'posterior crescent sign' in symptomatic patients referred for MRI/MR arthrogram of the hip and identify any correlation with imaging features of joint pathology. Retrospective imaging assessment of a cohort of 1462 hips, from 1380 included MR examinations (82 bilateral) retrieved from a search of all examinations in patients 16-50years old from June 2018 to June 2021, with median age 45.8years (range 17.8-50.0) and 936 hips (64%) in women. Radiographic and MR findings related to hip dysplasia, femoroacetabular impingement and osteoarthritis were assessed. Fifty-one hips (3.5%) were positive for the posterior crescent sign, median age of 45.8years (range 17.8-50.0) and 29 (58%) in women. Radiographic findings included the following: mean lateral centre edge angle (LCEA) 22.2° (± 7.8°) with LCEA < 20° in 15 (31%) and LCEA 20-25° in 17 (35%) and mean acetabular index (AI) of 13.1° (± 5.8°) with AI > 13° in 22 (45%). MR findings included the following: mean anterior acetabular sector angle (AASA) 54.3° (± 9.8°), mean posterior acetabular sector angle (PASA) 92.7° (± 7.0°), labral tear at 3-4 o'clock in 20 (39%), high-grade acetabular chondral loss in 42 (83%) and ligamentum teres abnormality in 20 (39%). The posterior crescent sign occurs in 3.5% of symptomatic young and middle-aged adults on MR. It is associated with overt and borderline hip dysplasia and other findings of hip instability. It is also associated with osteoarthritis in some cases and should be interpreted with caution in these patients.

Radiographic incidence of femoral acetabular impingement in young adults

After Ganz’s first work in 2003 on femoral acetabular impingement (FAI), the interest in this pathology has steadily increased. Several treatments have been proposed and many parameters have been evaluated to reach a diagnosis as accurate as possible. In fact, the resulting cartilage lesions are often associated with early development of osteoarthritis in symptomatic patients. Although there is a considerable percentage of elderly patients who meet radiographic criteria for FAI but are asymptomatic, this disease is commonly underestimated in young adults with coxalgia. The purpose of our study was to investigate these signs in radiographic images in patients under the age of 60 years who have undergone hip replacement surgery to see if FAI criteria were present. We found such signs in most of the patients examined. The most frequent type was mixed impingement. Diagnosis of FAI in symptomatic young adults, in the light of radiographic data, is likely to be underestimated. Early diagnosis and treatment therefore play a non-secondary role.

Abstract 13095: Persistent Impairment in Peripheral but Not Cerebral Vascular Function in Young Healthy Adults With Long-Term Symptoms From COVID-19

Vascular dysfunction and inflammation are precursors to cardiovascular disease (CVD). Notably, young adults who were symptomatic from COVID-19 during the acute phase of illness (within 4 weeks from diagnosis) have shown to exhibit peripheral vascular dysfunction. Importantly, many young adults report persistent symptoms from COVID-19 for several months, including cognitive difficulties. However, it remains unknown whether vascular dysfunction persists beyond the acute phase of COVID-19 in symptomatic young adults. We tested the hypothesis that peripheral and cerebral vascular function would be blunted in symptomatic (SYM) young adults who are beyond 4 weeks from a COVID-19 diagnosis, compared to asymptomatic adults (ASYM). Since COVID-19 causes inflammation that may negatively impact vascular function, we also hypothesized that serum hsCRP would be elevated in SYM compared to ASYM. We studied 15 otherwise healthy adults (age = 23 ± 1 years; mean ± SE) with a positive lab diagnosis of COVID-19. Eight were SYM (14 ± 1 weeks from diagnosis) while seven were ASYM (13 ± 2 weeks from diagnosis) at time of testing. Brachial artery flow-mediated dilation (FMD; duplex Doppler ultrasound) was performed, and macro- and microvascular function were quantified as FMD% and peak blood velocity after cuff release, respectively. Cerebral vasomotor reactivity (CVMR) was quantified as percent increase in middle cerebral artery blood velocity (transcranial Doppler ultrasound) to rebreathing induced hypercapnia. Serum hsCRP level was measured. FMD was lower in SYM (3.81 ± 0.60%) compared to ASYM (7.10 ± 0.94%, P = 0.010). Likewise, peak blood velocity after cuff release was lower in SYM (47 ± 3 cm/s vs. ASYM: 65 ± 8 cm/s, P = 0.037). However, CVMR was not different between the two groups (P = 0.91). Serum hsCRP was higher in SYM (3.4 ± 1.0 mg/L vs. ASYM: 0.7 ± 0.1 mg/L, P = 0.036). These preliminary results indicate that peripheral macro- and microvascular function remain blunted beyond the acute phase in young adults with persistent symptoms from COVID-19, whereas cerebral vascular function appears unaffected. The extent to which this sustained vascular impairment and elevated hsCRP contributes to increased CVD risk in these otherwise healthy young adults remains to be determined.

Surgical Treatment of Carotid Webs in Symptomatic Young Adults

Carotid webs are possibly responsible for ischemic stroke in young adults. We aim to report a case series study about surgical treatment of this uncommon condition. We performed a retrospective analysis on clinical, imaging, pathological, operative data, and outcomes about consecutive patients affected with carotid ischemic stroke due to carotid webs in a single institution. During a three-year period, a total of 123 patients were treated for carotid stroke, in five cases (4%) (median age 48.4 years, range 44-53, 2 men and 3 women, median NIHSS score 8.4, range 4-17) due to a carotid web. Patients were all Caucasian excepting for one. No severe comorbidities were detected. Preoperatively thrombectomy of middle cerebral artery was needed in three cases. Surgical treatment consisted in web resection and carotid end-to-end anastomosis (3 cases) or web excision and patch angioplasty (2 cases). In-hospital NIHSS score improved postoperatively of more than 2 points (median 3.6, range 2-7) in all cases. No major complications were detected. One patient experienced a local hematoma treated conservatively. At a mean follow-up of 18months (range 1-35months), no recurrent stroke nor myocardial infarction nor death were remarked. In young patients presenting with ischemic stroke without neither conventional stroke risk factors nor other possible sources of embolism, a carotid web should be suspected. Surgery guarantees excellent results in prevention of recurrences.

Prevalence of Adenomyosis Among Symptomatic Young Adults in Association with Patient-Reported Outcomes: A Pilot Study

Study Objective To estimate the prevalence of adenomyosis among young adult patients with dysmenorrhea and/or heavy menstrual bleeding based on transvaginal ultrasounds (TVUS) and to assess various patient-reported outcome measures. Design Prospective cohort study. This abstract is an interim analysis of a larger ongoing study. Setting Outpatient minimally invasive gynecologic l surgery (MIGS) clinic. Patients or Participants Patients ages of 18 to 27 presenting with dysmenorrhea and/or heavy menstrual bleeding (n=15). Interventions TVUS to evaluate menstrual complaints and study questionnaires including self-reported health and demographic information, as well as validated patient-reported outcome measures (PROMs) from the Menstrual Bleeding Questionnaire (MBQ), Endometriosis Health Profile-30, and the EQ-5D-3L to evaluate menstrual symptoms, health status, and impact on quality of life. Measurements and Main Results Data from 15 patients have been analyzed thus far. TVUS reports were assessed for markers associated with adenomyosis and based on the presence of these markers, were given a TVUS diagnosis of adenomyosis. The prevalence of TVUS-diagnosed adenomyosis among the sample was 33.3%. The most common ultrasound markers were a heterogenous myometrium (60.0%) and asymmetrical thickening (26.7%). Patients with TVUS-diagnoses of adenomyosis had higher EHP-30 pain scores (59.1±28.3 vs. 42.1±20.2; p=0.249), EHP-30 emotional well-being scores (43.8±30.9 vs. 26.7±17.4; p=0.205), and higher EHP-30 composite scores, which includes impact on quality of life (53.1±29.8 vs. 36.9±20.2; p=0.258) than patients without TVUS-diagnoses of adenomyosis. Patients with TVUS-diagnoses of adenomyosis had similar MBQ scores as patients without the TVUS diagnoses (18±9.8 vs. 23.1±10.7; p=0.938). Conclusion Findings of this pilot study support a higher prevalence of adenomyosis among young adults than has been reported in previous literature. Patients with TVUS-diagnosed adenomyosis trended towards worse dysmenorrhea, physical and mental health statuses and overall quality of life. Current research gaps in adenomyosis among this age group necessitate further research, especially as we learn more about true prevalence rates.

Faecal calprotectin effectively excludes inflammatory bowel disease in 789 symptomatic young adults with/without alarm symptoms: a prospective UK primary care cohort study.

Primary care faecal calprotectin testing distinguishes inflammatory bowel disease (IBD) from functional gut disorder in young patients presenting with abdominal symptoms; however, previous evaluations have excluded patients with alarm symptoms. We sought to evaluate the diagnostic accuracy of calprotectin to distinguish IBD from functional gut disorder in young adults in whom general practitioners (GPs) suspected IBD; including patients reporting gastrointestinal alarm symptoms. We hypothesised that calprotectin would reduce secondary care referrals and healthcare costs. We undertook a prospective cohort study of 789 young adults (18-46years old) presenting with gastrointestinal symptoms to 49 local general practices that had undergone calprotectin testing (1053 tests: between Jan 2014 and May 2016) because of suspected IBD. We considered calprotectin levels of ≥100μg/g positive. Primary and secondary care records over 12months from the point of calprotectin testing were used as the reference standard. Overall, 39% (308/789) patients reported gastrointestinal alarm symptoms and 6% (50/789) tested patients were diagnosed with IBD. The positive and negative predictive values of calprotectin testing for distinguishing IBD from functional gut disorder in patients with gastrointestinal alarm symptoms were 50% (95% CI 36%-64%) and 98% (96%-100%): and in patients without gastrointestinal alarm symptoms were 27% (16%-41%) and 99% (98%-100%), respectively. We estimate savings of 279 referrals and £160 per patient. Calprotectin testing of young adults with suspected IBD in primary care accurately distinguishes IBD from functional gut disorder, even in patients with gastrointestinal alarm symptoms and reduces secondary care referrals and diagnostic healthcare costs.

Cone-beam tomography assessment of the condylar position in asymptomatic and symptomatic young individuals

Statement of ProblemStudies of the condyle-mandibular fossa relationship are common, although the role of this relationship in the development of a temporomandibular disorder remains controversial. PurposeThe purpose of this study was to quantitatively evaluate the condyle-mandibular fossa relationship in young individuals with intact dentitions and compare it to that between individuals with and without symptoms of temporomandibular disorder. Material and MethodsVolunteers were classified as asymptomatic (n=20) or symptomatic (n=20) according to research diagnostic criteria for temporomandibular disorders. Each participant underwent 2 cone beam-computed tomography scans of the middle and lower third of the face: 1 scan of the maximum intercuspation position and 1 of the centric relationship position. The distance between the condyle and mandibular fossa was measured on frontal and lateral images of the temporomandibular joint. The condylar position was compared across groups (asymptomatic, symptomatic) by using the Mann-Whitney U test (α=.05). Within each group, the condylar position was compared across maximum intercuspation and centric relationship positions by using the Mann-Whitney U test (α=.05). ResultsNo statistically significant differences were found in condylar positions between centric relationships and maximum intercuspation in either asymptomatic or symptomatic young adults, and no significant differences were found between asymptomatic and symptomatic young adults. ConclusionsThe condyle-mandibular fossa relationships of these young adults were similar in the centric relationships and maximum intercuspation positions when evaluated by computed tomography. The presence or absence of temporomandibular disorder was not correlated with the condyle position in the temporomandibular joint.

Findings of diagnostic colonoscopy in young adults versus findings of screening colonoscopy in patients aged 50 to 54 years: a comparative study stratified by symptom category

The threshold for diagnostic colonoscopy in symptomatic patients aged<50 years remains controversial. Previous studies on the prevalence of neoplasia or other serious pathology in young patients mostly have been uncontrolled, providing only limited data on the risk associated with specific symptoms. To compare colonoscopy findings in patients aged<50 years who have various symptoms (diagnostic cohort) against those of concurrent patients aged 50 to 54 years who are asymptomatic (screening cohort). Retrospective controlled cohort study. Teaching hospital. Symptomatic patients aged between 18 and 49 years and asymptomatic patients aged between 50 and 54 years. Colonoscopy. Prevalence of advanced neoplasia. During the study period, 1638 patients underwent colonoscopy in the screening cohort (mean [±standard deviation{SD}] age 51.7 ± 1.4 years) and 1266 underwent colonoscopy in the diagnostic cohort (40.4 ± 8.0 years). Despite the age difference, the prevalence of advanced neoplasia in patients with rectal bleeding was comparable with that in the screening controls: 28 of 472 (5.9%) versus 113 of 1638 patients (6.9%) (P= .459). Furthermore, 10patients (2.1%) with rectal bleeding were newly diagnosed with inflammatory bowel disease. In contrast, other symptoms that commonly lead to colonoscopy, such as abdominal pain, changes in bowel habits, and weight loss, were associated with much lower risks for neoplasia. As a result, the overall prevalences of neoplasia and advanced neoplasia were significantly higher in the screening cohort than in the diagnostic cohort: 467 of 1638 patients (28.5%) versus 179 of 1266 patients (14.1%), and 113 patients (6.9%) versus 48 patients (3.8%), respectively (both P< .001). No data on duration of symptoms; discrepant sex ratios between cohorts. The threshold for diagnostic colonoscopy in symptomatic young adults should be individualized foreach symptom category. Rectal bleeding warrants colonoscopy to detect advanced neoplasia or inflammatory bowel disease in most young patients, especially those aged 40 to 49 years, whereas non-bleeding symptoms, including some traditionally regarded as "alarm" symptoms, were associated with a much lower risk for neoplasia compared with the risk in screening patients aged 50 to 54 years.

Screening young adults for nonhereditary colorectal cancer.

The public health burden of colorectal cancer is a significant challenge,withmorethan50 000deathsannually in theUnited States.Widespreadadoptionof theUSPreventativeTaskForce Guidelines for mandatory screening for colon cancer, along with improvement in access to advanced fiber optic technology and training of physicians, among other factors, are some of the reasons why the overall incidence of colorectal cancer has been decreasing in the United States and in other developed nations. Randomized trials andepidemiological studieshavedemonstrated significant decreases in the incidence and mortality from colorectal cancer with the use of colonoscopy (and flexible sigmoidoscopy), with the reduction of risk persistent even at 15 years after a negative colonoscopy finding.1,2 In the setting of these congratulatory reports of a successful public health screening program, this report from Bailey et al3 is rather unsettling. The authors examined the incidenceof colorectal cancer in9Surveillance,Epidemiology, and EndResults registries from 1975 to 2010 and describe a rather alarming trend of an increase in the incidences of colon and rectal cancers inyoungadults, especially in the20to-34-yearoldagegroup.This incidencewaspervasive regardlessof stage of disease, although not as dramatic in patients aged 35 to 49 years. Their data suggest an overall decrease in the ageadjusted incidenceof colorectal cancer,which couldbe attributed predominantly to the decrease in the incidence of all stages of cancer in the older population, although limitations in the use of all the registries could contribute to lack of generalizability.3 Temporal trends in incidence are rather difficult for clinicians to interpret given the changing technology and understanding/detection of disease. While it is possible that this increase in the incidence of cancer in young adults could be owing to increased detection from frequent use of colonoscopies in symptomatic young adults or to sophisticated pathological techniques/imaging, the simultaneous temporal decrease in the incidence of cancer in those older than 50 years is intriguing. One might argue that perhaps the risk reduction (or decrease in incidence) in this age group would have been higher had these temporal trends not been a factor. Nevertheless, assuming that this increasing incidence of colorectal cancer in young adults is a real phenomenon, it begs the question of why this is occurring and what one should do about it. The authors suggested the Western diet and lifestyle might be some of the contributing factors for this trend. Tumors occurring in younger patients are frequently different in their expression of microsatellite instability, BRAF, KRAS, or in the CpG island methylator phenotype and are more frequently mucinous and aggressive.2 Further epidemiological investigation into causality is critical to reduction in the nonhereditary cancer incidence in younger adults. While it is attractive to suggest that all adults should obtain a colonoscopy, especially given the possible durability of cancer risk reduction, it is important to note that the absolute incidence of colorectal cancer in the young adults (aged 20-34 years) is 1% of the total colorectal cancer burden and similarly fairly lowinthe35to49-year-oldagegroup(6.8%).Hence, Related article page 17 Research Original Investigation US Age-Related Incidence of Colon and Rectal Cancers

Adjacent disc and facet joint degeneration in young adults with low-grade spondylolytic spondylolisthesis: A magnetic resonance imaging study.

Premature adjacent-level degeneration has been attributed to vertebral fusion, but spondylolisthesis has not been reported as a pathological factor responsible for the degeneration of adjacent disc and facet joint. We hypothesized that the degeneration of disc and facet joints in the adjacent levels is correlated with spondylolisthesis. Magnetic resonance images of 35 symptomatic young adults (16-29 years old) with low-grade L5-S1 spondylolytic spondylolisthesis (Meyerding Grade 1 or 2) and 50 symptomatic young referents (20-29 years old) with L5-S1 disc herniation without spondylolisthesis were recruited to compare the differences between disc and facet-joint degenerations at the olisthetic and adjacent levels using the Mantel extension test. There were statistically significant degenerative changes of the discs and facet joints at the olisthetic and adjacent levels of patients with spondylolytic spondylolisthesis compared with the reference group. There is a trend that the disc and facet joints degenerate the most at the olisthetic level and become less affected at adjacent levels away from the lesion of pars defect. Low-grade spondylolytic spondylolisthesis was associated with significant degenerations of the disc and facet joints at olisthetic and adjacent levels in young adults.

The Increasing Incidence of Young-Onset Colorectal Cancer: A Call to Action

In the United States, colorectal cancer (CRC) is the third most common and second most lethal cancer. More than one-tenth of CRC cases (11% of colon cancers and 18% of rectal cancers) have a young onset (ie, occurring in individuals younger than 50 years). The CRC incidence and mortality rates are decreasing among all age groups older than 50 years, yet increasing in younger individuals for whom screening use is limited and key symptoms may go unrecognized. Familial syndromes account for approximately 20% of young-onset CRCs, and the remainder are typically microsatellite stable cancers, which are more commonly diploid than similar tumors in older individuals. Young-onset CRCs are more likely to occur in the distal colon or rectum, be poorly differentiated, have mucinous and signet ring features, and present at advanced stages. Yet, stage-specific survival in patients with young-onset CRC is comparable to that of patients with later-onset cancer. Primary care physicians have an important opportunity to identify high-risk young individuals for screening and to promptly evaluate CRC symptoms. Risk modification, targeted screening, and prophylactic surgery may benefit individuals with a predisposing hereditary syndrome or condition (eg, inflammatory bowel disease) or a family history of CRC or advanced adenomatous polyps. When apparently average-risk young adults present with CRC-like symptoms (eg, unexplained persistent rectal bleeding, anemia, and abdominal pain), endoscopic work-ups can expedite diagnosis. Early screening in high-risk individuals and thorough diagnostic work-ups in symptomatic young adults may improve young-onset CRC trends.

Utility of Observation Units for Young Emergency Department Chest Pain Patients

BackgroundDetermining which patients presenting to the Emergency Department (ED) require further work-up for acute coronary syndrome (ACS) can be difficult. The utility of routine observation for cardiac testing in low-risk young adult patients has been questioned. Study ObjectivesWe investigated the rate of positive findings yielded by routine cardiac observation unit work-up in patients aged 40 years or younger. MethodsThis was a retrospective observational cohort study of patients aged 18–40 years who were evaluated for ACS in an ED-based observation unit. Data were collected by trained abstractors from electronic medical records. ResultsA total of 362 patients met inclusion criteria. Of those, 239 received stress testing, yielding five positive and nine indeterminate results. One other patient had acute troponin elevation while under observation. The positive stress test patients and troponin-elevated patient underwent cardiac angiography. Only one positive stress test patient showed significant coronary stenosis and received coronary interventions. In follow-up data, one patient had an adverse cardiac outcome within 1 year of index visit, but no coronary interventions. Thus, only 3 patients had adverse cardiac events, with only one patient warranting intervention discovered by observation unit stress testing and a second via serial cardiac markers. ConclusionRoutine observation of symptomatic young adults for ACS had low yield. Observation identified one patient with acute cardiac marker elevation and further stress testing identified only one patient with intervenable ACS, despite a high false-positive rate. This suggests that observation and stress testing should not be routinely performed in this demographic absent other high-risk features.

Reports of magnetic resonance images of the hip in patients with femoroacetabular impingement: is useful information provided to the orthopedic surgeon?

The aim of this study was twofold: (1) To evaluate the quality of radiology reports of MR imaging/arthrography (MRI/MRA) of the hip performed on symptomatic young adults with suspected femoroacetabular impingement (FAI); and (2) to assess if MRI/MRA reports provide relevant information for surgical decision-making. We evaluated 110 MRI/MRA reports provided by 73 radiologists from 42 institutions. The images were requested preoperatively in young adults who underwent hip-preserving surgery for treatment of FAI. The quality of reports was graded using Lee's method by two independent observers. The description of seven characteristics of the hip joint was scrutinized in order to assess if the reports contained relevant information for surgical decision-making. The quality of reports was Grade IIA in two cases (1.8 %), IIB in six (5.5 %), III in 60 (54.5 %), and IV in 42 (38.2 %). Relevant hip characteristics for the study of FAI were reported as follows: acetabular labrum (88.1 %), cartilage characteristics (69 %), morphology of the femoral head-neck junction (34.5 %), acetabular version (6.3 %), acetabular coverage (20.9 %), soft tissues description (82.7 %), and presence of bone marrow edema (80.9 %). The vast majority (91.8 %) of the reports described five or less relevant FAI characteristics. Most of the radiology reports of MRI/MRA of the hip performed on symptomatic young adults with FAI were of the highest quality. However, some characteristics believed to be important for surgical decision-making in this particular group of patients were frequently not described. The inclusion of these hip joint characteristics in the radiology reports may improve the usefulness of the information provided to the orthopedic surgeon.

A Review on Advanced Atrioventricular Block in Young or Middle‐Aged Adults

Complete atrioventricular block is a relatively uncommon arrhythmia that is nonetheless increasingly seen in elderly people of developed countries, due to the increase in life expectancy. Congenital and degenerative etiologies are the most commonly seen among young and old patients, respectively. However, scientific literature is surprisingly scarce regarding the etiology of complete atrioventricular block in the asymptomatic otherwise healthy young and middle-aged adult population. Coronary artery disease, autoimmune disorders such as systemic lupus erythematosus or rheumatoid arthritis, history of acute or chronic infectious or hypersensitivity myocarditis, infiltrative processes, hypothyroidism, congenital cardiopathies such as left ventricular noncompaction or Ebstein anomaly, lamin A/C mutations, and pathologic hypervagotony and idiopathic degenerative scleroatrophy of the atrioventricular junctional specialized tissue (Lenegre-Lev disease) are among the most frequent etiologies of complete atrioventricular block in young or middle-aged adults. To our knowledge, no comprehensive review on the specificities of the investigation warranted in this age group has ever been developed, nor have the implications of particular diagnoses on treatment modalities been appropriately addressed. We aim at reviewing the most frequent differential diagnoses of advanced atrioventricular block in otherwise healthy asymptomatic or mildly symptomatic young or middle-aged adults and their impact on therapeutic options. Additionally, we suggest a diagnostic algorithm that may be helpful in this group of patients.

Arthroscopic Treatment of Labral Tears After a Previous Pemberton Osteotomy

We present 3 patients followed at our institution for developmental hip dysplasia for an average of 20 years. Each patient underwent a Pemberton pelvic osteotomy for developmental hip dysplasia and remained symptom-free during childhood. All 3, however, returned as young adults at an average 12 years from surgery with delayed onset of ipsilateral hip pain associated with a damaged labrum. The purpose of this report is to describe the late presentation of 3 symptomatic young adults with a history of childhood pelvic osteotomy. All the 3 patients were subsequently diagnosed with and successfully treated for symptomatic acetabular labral damage. All patients were informed that data concerning their case would be submitted for publication.

Symptomatic Respiratory Syncytial Virus Infection in Previously Healthy Young Adults Living in a Crowded Military Environment

Respiratory syncytial virus (RSV) infection is a potentially important cause of acute respiratory illness in many populations, including military recruits receiving basic training. Understanding the full impact of RSV infection is challenging because of difficulties in diagnosis and the limitations of past epidemiologic studies. In this study, we set out to determine the prevalence and clinical characteristics of RSV infection and infection caused by other common viral agents in a population of previously healthy young adults, namely, military recruits receiving basic training. In addition to standard viral culture techniques, we employed serologic testing and a recently described, novel, highly sensitive real-time PCR and a molecular beacon probe assay for the detection of RSV infection. Among 256 military trainees with respiratory symptoms, RSV infection was identified in 11% by means of serologic testing and real-time PCR. Viral culture identified adenovirus in 48% of symptomatic recruits, influenza viruses in 11%, parainfluenza virus 3 in 3%, and enterovirus in <1%. The majority of recruits with RSV infection experienced a nonproductive cough, sore throat, and nasal congestion, and almost half reported symptoms of wheeze or shortness of breath. Almost all (94%) of the recruits lost > or =1 day(s) from training because of illness. This study demonstrates the challenges of diagnosis and clinical significance of RSV infection in symptomatic young adults. RSV may account for 11% of clinically important respiratory illnesses in this population, which is as much as 25% of previously undiagnosed illness. These results have implications for treatment and prevention of RSV in young adults.

Serologic Testing for Celiac Disease in Young Adults?A Cost?Effect Analysis

In recent years, there has been a marked increase in the diagnostic workups for celiac disease among military personnel, thereby significantly increasing overall laboratory testing expenditures and burden. We evaluated the serologic testing procedure in symptomatic young adults, using a "cost-effect" approach. We evaluated the serologic screening policy for celiac disease among serologically tested military personnel. The study population was divided into subgroups according to the clinical presentation prior to screening: isolated (low-risk) and combined complaints (high-risk). Sensitivity, specificity, and predictive values of serologic markers for celiac disease were evaluated. Cost analyses were based on diagnostic expenditures. Cost-effect ratio is expressed as cost per newly diagnosed patients, and cost minimization as cost per screened individuals. Five hundred thirty-eight military personnel were serologically tested for celiac disease. Eight new cases of celiac were diagnosed, all of whom belonged to the high-risk subgroup and tested positive for at least two positive serologic tests (tTG + EMA or tTG + AGA IgG + EMA). EMA Ab measured the highest sensitivity, specificity, and predictive values. Average screening expenditure was U.S. $287 per patient. The lowest cost-effect and cost minimization ratios were achieved by implementing a two-step single-marker screening protocol for high-risk subjects and one-step follow-up for low-risk subjects. Among patient population of young adults, selective diagnostic workup could result in cost-minimization without risking quality of diagnosis. From a cost-effect perspective, implemented screening procedures need to be dependent on subgroup: low-risk, clinical follow-up; and high-risk, serological testing for EMA and, only if positive, possibly a small-bowel biopsy.

Split cord malformation in adults.

Although split cord malformations have been well documented in children, there is no consensus about their surgical indications and clinical course in adults because of their rarity. Medical records of nine young adult patients with split cord malformations were reviewed retrospectively. The most common complaint was radicular low back pain persisting more than 1 year, and the most common finding was hypertrichosis. Adult split cord malformation patients in our series had neither scoliosis nor foot deformities. Radiologically, all had low-situated conus medullaris. Eight of them underwent surgery. The radicular low back pain decreased in all the surgically treated patients at short-term follow-up but had not disappeared. Although pain originating from split cord malformations seems to be the most common surgical indication in adult patients and shows good short-term results, in our opinion long-term pain improvement is necessary for confirmation. According to our results, it seems that symptomatic young adults with split cord malformations are good candidates for complaint and deficit stabilization surgery.

MRI changes of cervical spine in asymptomatic and symptomatic young adults

Several work-related, psychosocial and individual factors have been verified as being related to neck and shoulder pain, but the role of pathology visualized by magnetic resonance imaging (MRI) remains unclear. In this study, the relationship between neck and shoulder pain and cervical high-field MRI findings was investigated in a sample of persons in a longitudinal survey. The study aimed to determine whether subjects with persistent or recurrent neck and shoulder pain were more likely to have abnormal MRI findings of cervical spine than those without neck and shoulder pain. A random sample of 826 high-school students was investigated initially when the students were 17-19 years, and again when they had reached 24-26 years of age. Eighty-seven percent participated in the first survey in 1989, of whom 76% took part in the second survey, in 1996. The validated Nordic Musculoskeletal Questionnaire was used to collect data about neck and shoulder symptoms. Two groups were chosen for the MRI study: the first group ( n=15) consisted of the participants who had reported no neck and shoulder symptoms in either of the inquiries, while the second group ( n=16) comprised those who were suffering from neck and shoulder symptoms once a week or more often at the time of both surveys. The degrees of disc degeneration, anular tear, disc herniation and protrusion were assessed by two radiologists. The differences between the two study groups were evaluated. The study found that abnormal MRI findings were common in both study groups. Disc herniation was the only MRI finding that was significantly associated with neck pain. These findings indicate that pathophysiological changes of cervical spine verified on MRI seem to explain only part of the occurrence of neck and shoulder pain in young adults.

Sequential Radionuclide Imaging of the Patellofemoral Joint in Symptomatic Young Adults S. F. Dye, MD, P. K. Peartree, MD—San Francisco, California

Sequential Radionuclide Imaging of the Patellofemoral Joint in Symptomatic Young Adults S. F. Dye, MD, P. K. Peartree, MD—San Francisco, California