Classification and regression tree analysis for predicting morphological hand types based on radiography data / Análisis de árbol de clasificación y regresión para predecir tipos morfológicos de la mano basados en datos radiográficos

SUMMARY: Analysis and systematization of the longitudinal dimensions of the phalanges of the index and ring fingers for the classification of morphological types of the hand using classification and regression trees (CART). X-rays of the hands of 50 men and 50 women (mean age 47.16 (10.1) years, range 23-65 years) were studied. Each hand, depending on the ratio of the length of the index and ring fingers, was classified into three types: radial (R, 2d>4d), indefinite (N, 2d=4d), ulnar (U, 2d>4d). Morphometry of radiographs included measurements of the lengths of the proximal (PP), middle (MP), and distal (DP) phalanges. The sex differences of the analyzed indicators are statistically significant. There were no significant bilateral differences between the phalanges of the II and IV fingers in length, regardless of sex (p>0.05). A set of rules for classifying the morphological types of the hand depending on the lengths of the phalanges of the index and ring fingers was created by constructing a binary decision tree. The CART method demonstrates the usefulness of this statistical procedure for developing a scientifically based prediction of the morphological type of the hand. The results of this study can be the basis of an algorithm for determining the morphological type of the hand depending on the length of the phalanges of the fingers.

RESUMEN: En este estudio se realizó un análisis y sistematización de las dimensiones longitudinales de las falanges de los dedos índice y anular para la clasificación de tipos morfológicos de la mano, mediante árboles de clasificación y regresión (CART). Se estudiaron radiografías de las manos de 50 hombres y 50 mujeres (edad media 47,16 (10,1) años, rango 23-65 años). Cada mano, según la proporción de la longitud de los dedos índice y anular, se clasificó en tres tipos: radial (R, 2d> 4d), indefinida (N, 2d = 4d), ulnar (U, 2d> 4d). La morfometría de las radiografías incluyó mediciones de las longitudes de las falanges proximal (FP), media (FM) y distal (FD). Las diferencias de sexo de los indicadores analizados fueron estadísticamente significativas. No hubo diferencias bilaterales significativas entre las falanges de los dedos II y IV en longitud, independientemente del sexo (p> 0,05). Se creó un conjunto de reglas para clasificar los tipos morfológicos de la mano en función de las longitudes de las falanges de los dedos índice y anular mediante la construcción de un árbol de decisión binario. El método CART demuestra la utilidad de este procedimiento estadístico para desarrollar una predicción con base científica del tipo morfológico de la mano. Los resultados de este estudio pueden ser la base de un algoritmo para determinar el tipo morfológico de la mano en función de la longitud de las falanges de los dedos.

Recommendations for improving photo quality in close range photogrammetry, exemplified in hand bones of chimpanzees and gorillas / Recomendaciones para mejorar la calidad de las fotos en fotogrametría de corto alcance, ejemplificado en huesos de las manos de chimpancés y gorillas

SUMMARY: Photogrammetry is becoming increasingly popular in morphological research and teaching due to its portability, ability to reliably render 3D models, and quality-to-price relationship relative to some popular surface scanners. Compared to surface scanners, however, the learning process in photogrammetry can be very time consuming. Here we describe common mistakes of photo capture in close-range photogrammetry that greatly affect 3D output and tips to improve them. Problems were identified after the 3D model construction of 780 hand bones of chimpanzees and gorillas from museum collections. Their hands are composed of 27 bones which vary in length and complexity. We show how lighting, object position and orientation, camera angle, and background affect the 3D output. By taking these factors into account, time and error rates for beginners can be greatly reduced and 3D model quality can be considerably improved.

RESUMEN: La fotogrametría está siendo cada vez más popular en la investigación y enseñanza morfológica. Esto debido a su portabilidad, confiabilidad de los modelos 3D y buena relación calidadprecio. Comparada con los escáneres de superficie, sin embargo, el proceso de aprendizaje de la fotogrametría puede llevar mucho tiempo. Aquí se describen errores comunes en la toma de fotos para fotogrametería que afectan de manera importante la creación de los modelos 3D, así como consejos para superarlos. Los problemas descritos fueron identificados luego de la construcción de 780 modelos 3D de huesos de la mano de chimpancés y gorillas depositados en distintas colecciones de museos. Las manos de estas especies están compuestas por 27 huesos que varían en tamaño y complejidad. En este artículo mostramos como la luz, la posición y orientación del objeto, el ángulo de la cámara y el fondo de la imagen afectan el resultado en 3D. Considerando estos factores, personas que están aprendiendo esta técnica pueden reducir de manera importante el tiempo y la probabilidad de error, y mejorar considerablemente la calidad de los modelos 3D.

Acrometástasis óseas, serie de casos y revisión de la literatura / Bone acrometástasis, case series and literature review

Resumen: Las acrometástasis se definen como metástasis óseas localizadas distales al codo y la rodilla. Su prevalencia es muy baja, aproximadamente el 0,1% de todas las metástasis óseas y se presentan en pacientes con enfermedad avanzada y son indicador de mal pronóstico. Hasta en el 10% de los casos se presentan como el primer signo de neoplasia oculta. Su forma de presentación clínica y radiológica es inespecífica, lo que genera retraso en su diagnóstico y tratamiento. La resonancia magnética es la imagen de elección para el diagnóstico. El tratamiento en la mayoría de los casos es paliativo. Presentamos cuatro pacientes con acrometástasis y una revisión de la literatura.

Abtract: Acrometastasis are defined as localized bone metastases distal to the elbow and knee. Its prevalence is very low, approximately 0.1% of all bone metastases and they present in patients with advanced disease and are considered indicators of poor prognosis. In up to 10% of cases are the first sign of undiagnosed neoplasia. Its clinical and radiological presentation is non-specific which generates delays in its diagnosis and treatment. Magnetic resonance is the image of choice for diagnosis. The treatment in most cases is palliative. We present four patients with acrometastasis and a review of the literature.

Acromicric Dysplasia Caused by a Novel Heterozygous Mutation of FBN1 and Effects of Growth Hormone Treatment

No abstract available.

A radiological investigation on the hand development in human fetuses throughout the fetal period and an evaluation performed in terms of its clinical importance hand development / Investigación radiológica sobre el desarrollo de la mano en fetos humanos a lo largo del período fetal y una evaluación realizada en términos de su importancia clínica en el desarrollo de la mano

It was aimed in this study that the morphometric development of the hand in human fetuses throughout the fetal period be radiologically investigated and the clinical importance of this period be evaluated. A total of 50 fetuses with no external pathology or anomaly, and the ages of which varied between 20-40 gestational weeks were incorporated into the study. The fetuses were separated into groups according to gestational weeks, trimesters and months. After the general external measurements of the fetuses were performed, mammography and hand radiographies of the fetuses were shot in the way that their hands would be in a pronational position. Afterwards, the morphometric measurements of the hands were performed with the help of a digital caliper through the hand radiographies that were shot. The averages and standard deviations of the measured parameters were determined according to gestational weeks, trimesters and months. There was a significant correlation between the measured parameters and the gestational age (p<0.001). Additionally, it was observed that there was some difference among the groups in the comparison of the measured parameters involving trimesters and months (p<0.05). We are of the opinion that in evaluating the clinical studies regarding the morphometric development of the hand throughout the fetal period and in determining the pathologies and variations related to the fetal hand development, the data obtained in our study will be of use to the clinicians engaged in gynecology, and forensic medicine as well as those involved in this field.

Se investigó radiológicamente el desarrollo morfométrico de la mano en fetos humanos a lo largo del período fetal y se evaluó la importancia clínica de este período. La muestra consistió en 50 fetos de 20 a 40 semanas de gestación, sin patología externa o anomalía. Los fetos se dividieron en grupos según las semanas, trimestres y meses de gestación. Después de las mediciones externas generales de los fetos se realizaron mamografías y radiografías de mano de los fetos en posición de pronación. Posteriormente, las mediciones morfométricas de las manos se realizaron en las radiografías con la ayuda de un calibre digital. Hubo una correlación significativa entre los parámetros medidos y la edad gestacional (p <0,001). Adicionalmente, se observó que hubo una diferencia entre los grupos en la comparación de los parámetros medidos según los trimestres y meses (p <0,05). Consideramos que al evaluar los estudios clínicos sobre el desarrollo morfométrico de la mano a lo largo del período fetal y la determinación de patologías y variaciones relacionadas con el desarrollo de ésta, serán de utilidad para los clínicos intervinientes en las áreas de ginecología y medicina forense.

Rol de la ecografía en la evaluación de la cortical ósea / Role of ultrasound in the evaluation of the bone cortex

La ecografía es el método de elección para la evaluación inicial de las partes blandas y el sistema muscular, siendo una técnica accesible, portátil y de bajo costo. Sin embargo, ha sido excluida de la exploración y evaluación de las patologías óseas debido a la idea de que es incapaz de penetrar la superficie del hueso. De hecho, muchos radiólogos admiten que esta es una de las pocas localizaciones donde la ecografía no resulta efectiva. Si bien algunos de estos conceptos son ciertos, este método puede aportar valiosa información diagnóstica sobre el estado del hueso, principalmente sobre la cortical ósea, en variadas circunstancias. La ecografía de la cortical ósea es posible por el artefacto de reflexión hiperecogénico lineal y regular que esta genera. En manos experimentadas, el reconocimiento y exploración de la superficie ósea permiten obtener datos muy útiles. Los tumores óseos generan reacciones periósticas fácilmente observables y caracterizables por ultrasonido, con la ventaja adicional de que el Doppler color identifica la vascularización del tumor. Las fracturas se observan como disrupciones de la cortical y la patología degenerativa se puede sospechar ante irregularidades corticales. Asimismo, es posible reconocer patologías como avulsiones, callos óseos de procesos previos e incluso fracturas por estrés. En este ensayo iconográfico mostramos diferentes casos de ecografías de partes blandas que evidenciaron hallazgos patológicos en la cortical ósea, permitiendo arribar a un diagnóstico o guiando en la elección de un estudio adicional.

Ultrasound is the best choice to evaluate soft tissues and the muscular system because of its accessibility, low cost and portability. Historically, the assumption has been that because ultrasound waves cannot penetrate bone, it is not useful in the evaluation of the skeletal system and its diseases. Radiologists admit that one of the very few tissue types which ultrasound cannot evaluate is bone. There is, of course, much truth in this, but recent studies suggest that ultrasound can provide valuable diagnostic information regarding the state of bone in some circumstances. The high reflectivity of sound at the bone-soft tissue interface is what allows the bone surface to be visualised. Valuable diagnostic information can be obtained by exploring bone surface in detail. The fact that bone tumours manifest themselves as periosteal reactions makes them easily recognisable by ultrasound, with the additional advantage if using Doppler colour. Bone fractures could be seen as interruptions of the bone continuity, and degenerative diseases should be suspected when an irregular surface is observed. Likewise, other pathologies such as avulsion fractures, bone callus stemming from previous processes, and even stress fractures can be identified. In this pictorial essay different cases are presented of musculoskeletal ultrasound in which bone surface was evaluated and abnormalities discovered, making a diagnosis or suggesting an additional test.

Assessment of Bone Age in Prepubertal Healthy Korean Children: Comparison among the Korean Standard Bone Age Chart, Greulich-Pyle Method, and Tanner-Whitehouse Method

OBJECTIVE: To compare the reliability of the Greulich-Pyle (GP) method, Tanner-Whitehouse 3 (TW3) method and Korean standard bone age chart (KS) in the evaluation of bone age of prepubertal healthy Korean children. MATERIALS AND METHODS: Left hand-wrist radiographs of 212 prepubertal healthy Korean children aged 7 to 12 years, obtained for the evaluation of the traumatic injury in emergency department, were analyzed by two observers. Bone age was estimated using the GP method, TW3 method and KS, and was calculated in months. The correlation between bone age measured by each method and chronological age of each child was analyzed using Pearson correlation coefficient, scatterplot. The three methods were compared using one-way analysis of variance. RESULTS: Significant correlations were found between chronological age and bone age estimated by all three methods in whole group and in each gender (R2 ranged from 0.87 to 0.9, p 0.01). CONCLUSION: The KS, GP, and TW3 methods show good reliability in the evaluation of bone age of prepubertal healthy Korean children without significant difference between them. Any are useful for evaluation of bone age in prepubertal healthy Korean children.

Evaluation of Femoral Neck Bone Mineral Density and Radiographic Hand and Knee Osteoarthritis in a Korean Elderly Population

BACKGROUND: Reports on the relationship between osteoporosis and osteoarthritis (OA) have tended to disagree, especially in non-weight bearing joints such as the hand joints. We aimed to investigate the relationship between bone mineral density (BMD) and hand and knee OA in a general Korean elderly population. METHODS: We evaluated femur neck BMD and the hand and knee radiographs of 143 men and 123 women over 65 years of age who participated in a population-based cohort study. The Kellgren-Lawrence criteria for grading OA were implemented, and grade 2 or higher were categorized as radiographic OA. BMD was compared according to the existence of radiographic OA in the hand and knee using analysis of covariance, and correlation analyses were performed to explore the relationship between BMD and radiographic OA grade. RESULTS: After controlling for age and body mass index, there was no significant difference in BMD between participants with and without hand OA (p = 0.717 in male and p = 0.862 in female), between those with and without knee OA (p = 0.974 in male and p = 0.563 in female), and between those with only hand OA and those with only knee OA (p = 0.920 in male and p = 0.961 in female). Furthermore, there was no significant correlation between BMD and the radiographic OA grade of the hands (p = 0.182 in male and p = 0.897 in female) and knees (p = 0.245 in male and p = 0.098 in female). CONCLUSIONS: In our cohort of the general Korean elderly population, no association was found between osteoporosis and OA, regardless of the weight bearing status of the joints.

Hand function in systemic sclerosis: a clinical and ultrasonographic study

To evaluate hand impairment and functional disability in scleroderma patients using clinical and ultrasonographic [US] measures. Fifteen scleroderma patients and 10 age and sex-matched healthy controls were studied. Patients underwent clinical examination including modified Rodnan skin score. Hand function assessment included pinch and grip strength measurement, finger range of motion [ROM] assessment, Hand Mobility in Scleroderma [HAMIS] test and Hand Functional Index [HFI]. Hand disability was assessed by Health Assessment Questionnaire [HAQ], Scleroderma HAQ Visual Analogue Scale [SHAQ VAS] and Cochin scale. US hand examination included measuring hand skin thickness, screening of the finger flexor and extensor tendons, measuring cartilage thickness of the 2nd MCP joint, anteroposterior thickness of the flexor retinaculum, and surface area of the median nerve. Nine patients had healed digital ulcers while only one patient had active ulcers. Seven patients had arthralgia in the hand joints. The patients had a significant decrease in grip strength and finger ROM. By US, patients showed significant increase in hand skin thickness and flexor retinaculum thickness and a significant decrease in median nerve surface area. Hand disability measures showed variable significant correlations with pinch and grip strength and hand mobility measures which were significantly correlated with US skin thickness of the 2nd inter-metacarpal web space. Hand disability in scleroderma was mainly related to impaired hand mobility and also diminished strength. The use of US in adjunct to clinical examination refines the evaluation of hand impairment in scleroderma

Nontuberculous Mycobacterial Tenosynovitis in the Hand: Two Case Reports with the MR Imaging Findings

Nontuberculous mycobacterial infections can cause destructive tenosynovitis of the hand. We report on and discuss the clinical course and distinctive radiologic findings of two patients with hand tenosynovitis secondary to M. marinum and intracellulare infection, which are different from those of the nontuberculous mycobacterial infections reported in the previous literature.

Hand osteoarthritis: clinical and imaging study

To examine the validity of US in assessing hand osteoarthritis [OA] and to study the relationship between ultrasonographic findings and OA symptoms. This study was carried out on thirty patients with primary hand OA, and fifteen healthy subjects serving as a control group. Patients were classified according to ultrasonographic findings of joint involvement into two subgroups: 15 patients with interphalangeal [IP] OA and 15 patients with IP and first carpometacarpal [CMC] joint OA. All hand joints were examined for tenderness, soft tissue swelling, hard tissue enlargement [nodes], and deformity. Functional assessment by AUSCAN questionnaire, grip and pinch strength measurement and pain assessment by Visual Analogue Scale [VAS] were carried out. Plain X-rays of both hands were taken and classified according to the Kellgren-Lawrence [K-L] grading scale. High resolution US of the hand joints was performed which focused on examining cartilage thinning, joint space narrowing [JSN], and osteophytes [OST]. There was a positive correlation between the K-L grading and US findings regarding JSN and OST. There was a positive correlation of AUSCAN score with cartilage thinning, OST and JSN. There was a negative correlation of grip strength with cartilage thinning and OST. There was a negative correlation between pinch strength and US findings [cartilage thinning, OST and JSN]. There was a positive correlation between pain and US findings. Heberden's nodes were associated with underlying distal IP cartilage thinning, OST and JSN. On comparing the two subgroups of patients; patients with both IP and first CMC joint involvement experienced significantly higher levels of pain and disability and had weaker pinch strength. Ultrasonographic findings correlated with clinical findings as nodes, functional parameters as grip and pinch strength, and pain. The increased detection of OA structural pathology by US may make this a useful tool for hand OA assessment

Puberty growth spurt age in local population - a study

The biologic aspects of facial growth are fundamentally important in dentofacial orthopedics. The beginning, intensity, onset, and duration of the pubertal peak of facial growth have great variations among patients. The aim of the present study was to find the puberty growth spurt age in local population for diagnostic and optimum treatment planning issues. Hand- wrist radiographs of 200 patients were evaluated according to Bjork's method of assessment to determine the puberty growth spurt age. The spearman rank correlation between chronologic age and skeletal maturation intervals was 0.731 [P<.001] for both the genders combined. The mean chronological age of females in accelerating, peak and decelerating growth spurt was less than male subjects

Comparative evaluation between cervical vertebrae and hand-wrist maturation for assessment of skeletal maturity orthodontic patients

The aim of the study was to find a correlation between the evaluation of skeletal maturation performed by the study of cervical vertebrae maturation indicators and the evaluation obtained by the hand and wrist maturation indicators. A radiographic hand-wrist bone analysis and cephalometric cervical vertebral analysis of 100 patients [36 males and 64 females] ranging from 9 to15 years were examined. The hand-wrist bone analysis was evaluated by the Bjork index, whereas the cervical vertebral analysis was assessed by the cervical vertebral maturation stages method of Bacetti. To define vertebral stages, morphological evaluation of three cervical vertebrae [2nd to 4th] was done. Bjork's nine stages were reduced to five growth intervals [A-E] to relate to five stages [I-V] of cervical vertebral maturation method. The spearman correlation coefficient was 0.944 [P<.01] between cervical vertebral maturation and hand-wrist maturation for sexes combined and 0.936 [P<.01] for males and 0.912 [P<.01] for females respectively. The result shows that cervical vertebrae can be used with the same confidence as hand-wrist radiographs to evaluate skeletal maturity, thus avoiding the need for an additional radiograph

Hand disability related variables in an Egyptian female RA patients sample

The aim of the present work is to study hand affection in Rheumatoid Arthritis [RA] in an Egyptian female sample to establish a map of lesions underlying the rheumatoid hand dysfunction using clinical, laboratory and imaging techniques. This study comprised 100 adult female RA patients. They were clinically assessed for pain using visual analogue scale [VAS], joint tenderness using Ritchie Articular Index, assessment of grip strength, assessment of functional ability using Health Assessment Questionnaire [HAQ], and assessment of hand function using Sequential Occupational Dexterity Assessment score [SODA] patients were subjected to the following laboratory investigations: full blood picture, ESR, C-reactive protein concentration and rheumatoid factor. Radiological investigations included plain X-ray examination and Magnetic resonance imaging. SODA score for hand dexterity had highly significant correlations with disease duration, morning stiffness, ESR, Ritchie index, VAS, HAQ, Duke index disease activity, and hand grip [p<0.001 for all]. It was significantly higher in patients with muscle wasting, deformity and tenosynovitis of the hand, moreover, it showed highly significant correlations with X-ray score and MRI scores. SODA score for hand dexterity had highly significant correlations with clinical findings. SODA score is valuable for evaluation of hand disability and disclosure of the underlying clinical, laboratory and imaging variables in RA female patients

Femoral Neuropathy in a Patient with Rheumatoid Arthritis

Femoral mononeuropathy (FMN) as an extraarticular finding of rheumatoid arthritis (RA) is a phenomenon which has not been reported previously. We report a 53-year-old female patient with RA, presenting FMN findings during the course of the disease. On examination, right quadriceps and iliopsoas muscles showed grade 3 weakness on the Medical Research Council (MRC) scale. Sensory examination revealed sensory loss in the right medial leg and thigh. Patellar tendon reflex was absent in the right side. A diagnosis of a partial right femoral neuropathy was confirmed using nerve conduction study and electromyography. The probable mechanism of FMN was thought to be vasculitis.

Independent associations of anti-cyclic citrullinated peptide antibodies and rheumatoid factor with radiographic severity of rheumatoid arthritis

Recent studies have established a strong association between anti-cyclic citrullinated peptide antibody [anti-CCP] positive rheumatoid arthritis [RA] and carriage of shared epitope [SE] alleles. Although anti-CCP have also been associated with more severe RA, the issue of whether this is independent of rheumatoid factor [RF] has not been addressed. To indentify associations between RF, anti-CCP, SE status and radiological damage, we studied a large cross-sectional cohort with longstanding RA. Individuals [n=100] enrolled in the study all fulfilled the American College of Rheumatology criteria for RA had a minimum disease duration of 4 years, and at least one definite radiographic erosion was present in hands or feet. Radiographs were scored blind at study entry by a single musculoskeletal radiologist using a modified Larsen's score, Anti-CCP and RF levels were determined using enzyme-linked immunosorbent assay, and DRBI typing was performed using polymerase chain reaction based methodology. Both anti-CCP and RF status, evidence of independent associated with radiographic severity [P<0.0001]. In subgroups stratified for both anti-CCP and RF status, evidence of independent associations of both antibodies with radiographic outcome was found [P<0.0001]. An association of SE alleles playing at most a secondary role. Our study support the view that previously described associations between SE and radiological severity, especially in RF-negative patients, may be indirect and due to an association with anti-CCP

[Bone age: when how why]

The determination of the bone age is an evaluation method of a child's growth and maturation without including his theoric age, height or weight. Nevertheless, several practicians try to obtain the most precise maturation data, which are unreachable with actual methods, neglecting the evaluation given by the hand and wrist X ray. Several informations of bone maturation, morphology, and also mineralization, are given by X ray images allowing the diagnosis of a delay or an advance child's height. We will resume in this article, the bone age indications, and several methods and data given by the most important one, which's the left hand and wrist X ray

Association between chronological and skeletal ages among a sample of Saudi male children

Assessment of skeletal maturity is a necessary clinical need in orthodontics and other health professions. The aim of this study was to detect the association between chronological age and skeletal age in a selected Saudi male sample and to compare their skeletal maturity rate with other populations. Hand-wrist radiographs were obtained for 115 subjects and the skeletal age for each subject was determined using a standard hand-wrist radiographic atlas. Also, the skeletal maturity stage for each subject was established using Bjork assessment method. Statistical tests were performed to detect signifcant differences between chronological and skeletal ages at different skeletal maturity stages. The rate of skeletal maturity of the participating Saudi sample was also compared to analogous values that were previously established for other populations. The fndings of the present study indicated that the participating Saudi children had a tendency towards late maturation with the mean skeletal age of the participating subjects being signifcantly lower [P<0.05] than the chronological age at various skeletal maturity stages. When considering the rate of skeletal maturity, the participating Saudi children demonstrated a comparable maturity rate to that of other children from different populations. The results of the present study could enhance the diagnosis and treatment planning in orthodontics, pedodontics, and other health disciplines

Profile of systemic sclerosis in a tertiary care center in North India.

AIM: To study the clinical and immunological profile in patients of systemic sclerosis from North India and compare it with other ethnic groups. METHODS: Patients presenting to us between the years 2001 and 2004 and fulfilling the American Rheumatism Association (ARA) criteria for systemic sclerosis were included. There were 84 females and 16 males with the mean age of 32.5 +/-11.62 years and a mean duration of 6.49 +/- 4.34 years. All patients were admitted to the dermatology ward for detailed history and examination including Rodnan score. Investigations including hemogram, hepatic and renal functions, serum electrolytes, urine for albumin, sugar, microscopy and 24h urinary protein estimation, antinuclear antibody, chest X-ray, barium swallow, pulmonary function test, electrocardiogram and skin biopsy were done. RESULTS: The most common presenting symptoms were skin binding-down (98.5%), Raynaud's phenomenon 92.9%, pigmentary changes 91%, contracture of fingers 64.6%, fingertip ulcer 58.6%, restriction of mouth opening 55.5%, dyspnea 51.1%, joint complaints 36.7% and dysphagia in 35.2%. The mean Rodnan score was 25.81 +/- 10.04 and the mean mouth opening was 24.6 +/- 19.01 mm. The laboratory abnormalities included raised ESR in 87.8%, ANA positive in 89.1%, proteinuria in 6.0%, abnormal chest X-ray in 65.3%, abnormal barium swallow in 70.2% and reduced pulmonary function test in 85.8%. CONCLUSION: The clinical and immunological profile of systemic sclerosis in North India is similar to that of other ethnic groups except that pigmentary changes are commoner and renal involvement is relatively uncommon.