Intra- and interobserver variability of novel magnetic resonance imaging parameters for hip screening and treatment outcomes at age 5 years.

BACKGROUND: The outcome measure of neonatal hip screening is usually the radiographic acetabular index. OBJECTIVE: To assess the feasibility of magnetic resonance imaging (MRI) without sedation and compare the utility of outcome parameters measured from MRI images. MATERIALS AND METHODS: The invitation for MRI scanning at 5 years of age was incorporated into follow-up for babies who had more than one ultrasound examination during treatment or surveillance. RESULTS: Diagnostic images were obtained in 132 of 134 children. The mean osseous acetabular index (standard deviation [SD]) was 16.6 (3.3) degrees for the right hip and 17.8 (3.2) for the left; the values for the cartilaginous acetabular index were 3.1 (3) and 3.4 (3.2). The mean downslope of a tangent to the lateral bony acetabular roof was 10.4 (4.5) and 9.0 (4.3) with respect to Hilgenreiner's line and that of a line drawn through the apex to the margin of the acetabulum was 3.7 (4.6) and 3.9 (4.7). Intra- and interobserver variation was greater for measures specific to the lateral acetabular roof than for ossific and cartilaginous indices. There was significant negative correlation between the downslope of the tangent to the lateral roof index and the age at onset of treatment on both sides, but no significant correlation for ossific or cartilaginous acetabular indices or apex-marginal index. CONCLUSION: MRI without sedation at 5 years of age is feasible as an outcome measure for hip screening programmes. Parameters specific to the lateral acetabulum may better reflect acetabular sufficiency, despite having greater observer variation than cartilaginous and ossific acetabular indices.

Primary intracranial melanoma in a child with a giant congenital melanocytic naevus and normal MRI.

We present a case of a 10-year-old girl with a giant congenital melanocytic naevus, and malignant cerebral melanoma.

Infantile chylothorax associated with staphylococcal paravertebral discitis.

We report an unusual case of chylothorax in an infant associated with a staphylococcal paravertebral abscess secondary to discitis affecting the thoracic spine. We discuss the initial presentation with sepsis and chylothorax and the delayed diagnosis of discitis. We also discuss the imaging features and treatment in this case.

Prospective evaluation of unsuspected pulmonary embolism on contrast enhanced multidetector CT (MDCT) scanning.

AIM: To quantify the incidence of unsuspected pulmonary emboli (PE) in an unselected inpatient population undergoing contrast enhanced multidetector CT (MDCT) scanning of the thorax and to assess aetiological factors in their development. METHODS: All inpatients undergoing MDCT scanning of the thorax over a 10 month period were prospectively identified. Patients with previous or suspected current PE were excluded. CT scans were reviewed and the degree of contrast enhancement and presence of PE recorded. Where PE was found, the level of the most proximal thrombus was identified. Patient age, length of admission, slice scan thickness and clinical indication were noted. RESULTS: 547 inpatients who had undergone MDCT scanning were identified. Following exclusions 487 remained, 28 of whom (5.7%) had PE. Unsuspected PE was more common with increasing age, occurring in 9.2% (20/218) of all patients over 70 years and 16.7% (11/66) of those over 80 years (p<0.001). Eighteen of the 28 positive scans (64.3%) were at the segmental or subsegmental level. No other aetiological factor was identified which significantly increased the incidence of unsuspected PE. No significant difference was noted between 4-slice and 16-slice MDCT. Nine of the cases of incidental PE (32.1%) were not identified by the original reporting radiologists. CONCLUSION: PE is an unsuspected finding on contrast enhanced MDCT scanning of the thorax in 5.7% of all inpatients. The incidence is higher in older patients. Most are peripheral and >30% are missed on initial review. PE should be routinely sought in all contrast enhanced MDCT scans of the chest, irrespective of the indication for the CT scan.

Insulin nanoparticles: a novel formulation approach for poorly water soluble Zn-insulin.

PURPOSE: To determine the feasibility of using wet milling technology to formulate poorly water soluble zinc-insulin as a stable, biologically active, nanoparticulate dispersion. METHODS: The feasibility of formulating zinc-insulin as a nanoparticulate dispersion using wet milling technology was studied. An insulin nanoparticulate formulation was reproducibly obtained after milling zinc-insulin in the presence of F68, sodium deoxycholate and water at neutral pH. The physical and chemical properties of these peptide particles were studied using electron microscopy, laser light scattering, HPLC and SDS-PAGE. To verify efficacy, hyperglycemic rats were dosed subcutaneously and intraduodenally with nanoparticles or solubilized insulin. Glucose and insulin levels were monitored on blood samples collected throughout the study. RESULTS: Zn-insulin (mean size = 16.162 microm) was processed using milling technology to form an aqueous-based nanoparticle dispersion with a mean particle size of less than 0.150 microm. The formulation was homogeneous and exhibited a unimodal particle size distribution profile using laser light diffraction techniques. Insulin, processed as a peptide-particle dispersion, was shown to be comparable to unprocessed powder using HPLC and SDS-PAGE. In addition, HPLC analyses performed on samples, heat-treated at 70 degrees C for 100 minutes, demonstrate that under conditions which effect the solubilized peptide, formulated as a peptide-particle dispersion, insulin was chemically stable. Also, when stored refrigerated, the insulin dispersion was chemically and physically stable. Finally, peptide particles of insulin, dosed subcutaneously and intraduodenally, were effective at lowering blood glucose levels of hyperglycemic rats. CONCLUSION: Water insoluble Zn-insulin can be formulated as a stable, biologically active nanometer-sized peptide particle dispersion using wet media milling technology.