Feasibility of Dual Energy X-Ray Absorptiometry Based Images for Measurement of Height, Sitting Height, and Leg Length in Children.

BACKGROUND: Interpretation of pediatric bone mineral density by dual energy absorptiometry (DXA) requires adjustment for height (Ht). This is often not easily obtainable in nonambulant subjects. AIMS: To investigate the feasibility of using DXA images to evaluate measurements of Ht, sitting height (SH), and leg length (LL). METHODOLOGY: A total of 2 observers performed measurements of Ht, SH, and LL on 3 separate occasion using DXA digital images in 125 children. Intraclass correlation and relative technical error of measurement (rTEM) were performed to assess reliability of repeated measurements. In 25 children, Ht and SH were measured in clinic on the same day and Bland-Altman analysis was performed to compare DXA measured Ht, SH, LL with clinic measurements for these 25 children. RESULTS: Intraclass correlation for DXA based Ht, SH, and LL measurements ranged from 0.996 to 0.998 (p < 0.0001). rTEM of Ht, SH, and LL for observer 1 was 0.0016%, 0.002%, and 0.0034%, respectively. rTEM of Ht, SH, and LL between observer 1 and 2 was 0.0047%, 0.0049%, and 0.0087%, respectively. Mean difference between clinic and DXA measurements from Bland-Altman plots were +0.57 cm (95% confidence interval [CI] -0.54 to +1.68) for Ht, +1.33cm (-1.60 to +4.24) for SH, and -0.76cm (-3.88 to +2.37) for LL. CONCLUSIONS: Our study demonstrated for the first time that Ht, SH, and LL in children can be measured very precisely using DXA images. Ht can be measured accurately. We believe this may be a convenient method to obtain Ht measurements to allow size adjustment of DXA bone mineral density in immobile children with chronic conditions.

An investigation into risk factors for bilateral canine cruciate ligament rupture.

OBJECTIVES: To investigate the incidence of bilateral cranial cruciate ligament (CrCL) rupture and determine any associated risk factors. METHODS: The patient information system and surgical database at the Queen Mother Hospital for Animals, Royal Veterinary College, were searched from March 1998 to March 2007. Patient files were reviewed and data recorded. The risk factors considered included: gender, neuter status, breed, body mass, age and concurrent orthopaedic disease. RESULTS: In total, 511 dogs were identified as having cruciate rupture and included for analysis. Bilateral rupture of the CrCl was present in 38.7% (198/511) of the dogs. The mean (± SD) time that passed until the contralateral CrCL ruptured was 57.9 weeks (± 54.1; range 3 to 260 weeks). Dogs with bilateral cruciate rupture were younger (mean ± SD; 4.3 ± 2.7 years) than dogs with unilateral cruciate rupture (mean ± SD; 5.3 ± 2.8 years). In dogs with CrCL rupture, male dogs were more likely to have bilateral rupture than female dogs, overweight dogs were more likely to have bilateral rupture, Golden Retrievers were less likely to have bilateral rupture, and Rottweilers had the highest odds of bilateral rupture. CLINICAL SIGNIFICANCE: In dogs with CrCL rupture, this study suggests possible relationships towards the incidence of a bilateral rupture also occurring as more likely in male dogs, young dogs with a mean age of four years (4.3 ± 2.7 years), Rottweiler dogs, and with an average elapsed time between ruptures of 57.9 weeks.

Assessment of sun protection for children's summer 2005 clothing collection.

Overexposure to solar ultraviolet radiation (UVR) in childhood is considered to be a critical factor for developing skin cancer in later life. Clothing may offer a simple and effective means of protection against overexposure to the sun, but its use has often been underrated in public opinion. The Health Protection Agency, in close collaboration with a number of UK retailers, conducted a study to evaluate the UVR protection characteristics of the summer 2005 collection of children's clothing for outdoor activity. The current paper presents a summary of the assessment and the effects of stretching and wetting on the Ultraviolet Protection Factor (UPF) rating of children's clothing. The results demonstrate the need for better public guidance in sun protection of children and more comprehensive evaluation procedures for sun protection provided by clothing.

Radiation and chemical degradation of UVR protection characteristics of fabrics.

Clothing can provide substantial protection against solar ultraviolet radiation (UVR) and quantifying the amount of protection can have useful applications to recreational, occupational and medical situations. However, exposure of fabrics to sunlight and sea water can alter their physical and chemical properties, resulting in a change of UVR attenuation characteristics. The objective of the current study was to evaluate the effects of environmental degradation of fabrics on their UVR protection characteristics. The methodologies applied in this study can be used also for the assessment of protective clothing against occupational exposure.

Equal access to training for black and minority ethnic nurses.

Black and minority ethnic young people are increasingly attracted to nursing. However, statistics published by the Nursing and Midwifery Admissions Service in 2005 suggest that black and ethnic minorities have less than half the chance of getting into a nursing school that white applicants have. This article examines the evidence of race inequality in access to nurse and midwifery training, a pattern that can be traced back nearly 20 years. It asks why this information seems to have generated less concern and less action than in medical schools when evidence of similar levels of unequal access to medical training came to light in the mid-1990s. The article also considers why nursing schools are able to deny access to their admissions statistics when the deans of the medical schools decided, in 1998, to put their admissions data into the public domain to improve their selection procedures.

A new methodology for the assessment of hand protection from ultraviolet exposure.

A number of industrial applications and public services involve occupational exposure to ultraviolet radiation (UVR) from a variety of lamps and lasers. The aim of this study was to develop a methodology for the assessment of the UV protection level for disposable gloves. Glove UV protection factor is defined as a time-scale increase in exposure permitted for the hand protected by a glove with respect to an unprotected hand. Our study showed that for all tested gloves a change in UVR attenuation with stretching is characteristic for the type of glove material and can be included as a scaling factor in the definition of UVR protection. Glove material has a bigger effect on UVR protection level than variations in the glove thickness or its colour. Examples of assessment of the 'worst case scenario' are compared with the protection level against a number of sources, together with the guidance on a simplified evaluation protocol. An application-specific assessment, illustrated for 'SmartWater' forensic examinations and biological trans-illuminators, demonstrates that some gloves provide inadequate protection against occupational UV exposure.

AUStralian study of titration to effect profile of safety (AUS-STEPS): high-dose gabapentin (neurontin) in partial seizures.

PURPOSE: To evaluate the safety, tolerability, efficacy, and impact on quality of life of gabapentin (Neurontin; GBP) as adjunctive therapy in patients with refractory partial seizures. METHODS: AUS-STEPS was an open-label, multicenter, prospective study in patients experiencing partial seizures who were inadequately controlled with one to three concurrent antiepileptic drugs (AEDs). GBP treatment was titrated to a maximum of 4,800 mg/day, over a treatment period of 24 weeks, to achieve an efficacious and tolerable dosage. Efficacy was assessed by seizure-frequency data. Quality of life was evaluated by using the QOLIE-10 questionnaire, and safety was assessed by adverse-event reports and clinical laboratory findings. RESULTS: A total of 176 patients received treatment with GBP, with 174 evaluable for intention-to-treat (ITT) efficacy analysis. A reduction of >50% in overall seizure frequency was observed in 93 patients (53%). There was a small (4.6%) overall improvement in QOLIE-10 score. The most frequent adverse events were dizziness (31%), fatigue (29%), somnolence (27%), headache (21%), and ataxia (20%), with no major increase seen in adverse events necessitating discontinuation as the dose of GBP was titrated upward. CONCLUSIONS: This study indicates that patients with partial epilepsy may be effectively treated with GBP at dosages of < or =4,800 mg/day, without altering the safety profile of the drug.

Clinical and biochemical features, molecular diagnosis and long-term management of a case of cerebrotendinous xanthomatosis.

Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive sterol storage disease characterised clinically by juvenile bilateral cataracts, progressive neurological dysfunction, and formation of tendon xanthomata. We describe the clinical and biochemical features, molecular diagnosis and long-term management of the first reported Australasian case of CTX. Molecular analysis confirmed the diagnosis of CTX and demonstrated that the patient was homozygous for a G-->A transition in the splice donor site of intron 4 of the sterol 27-hydroxylase gene. Serum cholestanol concentrations were decreased with the HMG-CoA reductase inhibitor simvastatin alone and greater reductions were achieved after the addition of the bile acid chenodeoxycholic acid; suggesting a synergistic effect of this combination. Despite serum cholestanol concentrations remaining within the low-normal range, there has been no significant improvement in mental and physical abilities or in EEG abnormalities with 5 years of treatment. Metabolism of radiolabeled 7-ketocholesterol to aqueous soluble products was absent in CTX-derived macrophages. Consistent with this finding, plasma 7 alpha-hydroxycholesterol, 7 beta-hydroxycholesterol, and 7-ketocholesterol concentrations were increased in the CTX subject compared with controls.

UV protection by clothing: an intercomparison of measurements and methods.

In an attempt to reduce the incidence of skin cancer, cancer foundations have run educational campaigns which encourage the general population to limit their solar UVR exposures. An important part of these campaigns, in particular in Australia, but also more recently in Europe and the U.S., has been the adoption of protective measures such as sunscreens, hats, sunglasses and clothing. The protective properties of fabrics and clothing against ultraviolet radiation (UVR) have been known for some time, but recently there has been considerable interest in quantifying the degree of protection. This has been generated, in part, by the requirements for occupational protection for outdoor workers as well as the provision of UVR protection for the recreational market. The quantification of UVR protection has been laboratory based using in vitro test methods. Development of a standard test method has become an important part of the testing process, and this paper presents results from an intercomparison involving five independent testing laboratories. Agreement is good, in particular for samples with protection factors below 50. Technical difficulties and sources of errors associated with the measurements are discussed.

Cerebral cavernous angioma: a potentially benign condition? Successful treatment in 16 cases.

Cerebral cavernous angioma (cavernoma) has previously been treated by resection for all presentations when surgically resectable. In this retrospective series of 16 cases, it is demonstrated that, for those patients presenting with epilepsy alone, surgery is often unnecessary. Diagnosis can be made radiologically and excellent seizure control can be obtained with medications. In the authors' experience, those cavernomas symptomatic as epilepsy rarely cause major haemorrhage and the need for surgery as prophylaxis against bleeding in this group is unproven.

Intravenous immunoglobulin therapy in the inflammatory neuropathies.

The inflammatory demyelinating polyneuropathies are presumed to be autoimmune diseases and as such have been treated in the past with corticosteroids, plasmapheresis and immunosuppressants. Immunoglobulin infusions represent a fourth treatment with the potential to modify the activity of the immune system in disease states. Limited past experience suggests that both acute inflammatory polyneuropathy and chronic inflammatory demyelinating polyneuropathy may respond to immunoglobulin infusions with minimal morbidity. We here outline our successful experience of this treatment in 5 of 6 patients with inflammatory demyelinating polyneuropathies and review the literature describing its use.

Familial motor neurone disease associated with non-specific organic dementia. A clinico-pathological study of a family.

Two sisters developed motor neurone disease (MND), which was associated with progressive intellectual impairment in one; they survived for 18 and 24 months, respectively. At necropsy, the features of MND were confirmed, and the demented patient had severe non-specific cerebral atrophy. No evidence of Alzheimer's disease was found. Organic dementia of non-specific type can be associated with up to 15% of the familial cases of MND and with about 2% of the sporadic cases of MND in the Western world.

Amoebic hepatic abscess--potential causes of delay in diagnosis.

Delay in diagnosis can be serious in amoebic hepatic abscess, which is readily treatable. Two cases are presented to illustrate potential causes of delay. The first case had never been to an endemic area, apparently contracting the infection from his wife. The second case had negative serological tests.

Smoking, transient ischaemic attacks and stroke: A temporal association.

Two patients are described, both of whom demonstrate a temporal association between the clinical manifestations of cerebral ischaemia and smoking. A number of mechanisms through which smoking may influence cerebral blood flow and platelet function are discussed, and their relevance to the present cases is considered.

A blind controlled trial of dextran 40 in the treatment of ischaemic stroke.

A blind controlled trial of dextran 40 in ischaemic stroke is reported. In the treated group mortality in the acute stage in patients with severe strokes was significantly reduced but survivors were severely disabled and six months later no significant benefit could be detected. In less severe strokes no effect of treatment was found. It is concluded that the action of dextran 40 in reducing acute mortality probably lay in preventing or reversing cerebral swelling but no evidence of the expected action in reducing the area of infarction following improved blood flow was found. The importance of extending assessment beyond the two weeks customary in therapeutic trials in stroke is emphasized.

Internuclear ophthalmoplegia in progressive supranuclear palsy.

Internuclear ophthalmoplegia has not previously been described in progressive supranuclear palsy. The present report draws attention to the occurrence of varying degrees of anterior internuclear ophthalmoplegia in 4 out of 13 cases of this condition studied over a 4-yr period. This finding suggests that the medial longitudinal fasciculus may be involved in the degenerative process in some cases of progressive supranuclear palsy.

Predicting the outcome of stroke: acute stage after cerebral infarction.

On admission to hospital during the acute phase of a stroke presumed due to ischaemic infarction in one cerebral hemisphere 93 patients were examined to determine the factors associated with a poor prognosis for immediate survival. The patients particularly at risk were those who were overtly unconscious and those with any combination of impaired consciousness, dense hemiplegia, and failure of conjugate ocular gaze towards the side of the limb weakness. Necropsy evidence suggested that these signs usually indicate infarction of the whole of one middle cerebral artery territory which is often secondary to internal carotid artery occlusion and commonly produces fatal cerebral oedema.