The effects of minor hip flexion, abduction or adduction and x-ray beam angle on the radiographic joint space width of the hip.

OBJECTIVE: Joint pain may cause patients to hold their limbs in mild flexion, abduction or adduction to minimize pain, regardless of the extent of articular pathology, and these positional changes may have substantial effects on the interpretation of radiographic joint space. We aimed to study the impacts of minor degrees of flexion, abduction or adduction of the hip, as well as the angle of the x-ray beam on the radiographic joint space width (JSW) of the hip joint. METHODS: In the first part of the study, 65 patients (44 males, 21 females, mean+/-SD age 49+/-17) without clinical evidence of hip osteoarthritis (OA) who underwent intravenous pyelography (IVP) were studied. The hips were differentially positioned during the sequential radiographs required for the IVP procedure. Baseline radiographs were taken at 15 degrees internal rotation of the hips [the standard position for anteroposterior (AP) pelvis radiography]; additional positions included the hips at 15 degrees and/or 30 degrees flexion, and 15 degrees adduction and/or 30 degrees abduction. Radiographic JSWs were measured at three sites using a dial caliper: superomedial, superolateral, and the point of narrowest JSW. In the second part, 15 patients without clinical evidence of hip OA who underwent supine abdominal radiography for non-rheumatological indications were evaluated by standard (AP) pelvis x-ray in the same setting and JSW measurements were made as described above. RESULTS: When the average of the three measurements of the JSW was taken for each hip, baseline JSW was 4.38+/-0.55 mm (mean+/-SD). Positioning of the hip significantly (P<0.01) affected the radiographic JSW, with apparent widening during adduction and 30 degrees flexion, (JSW 4.56+/-0.51 mm and 4.53+/-0.58 mm, mean+/-SD), respectively, but narrowing during abduction (4.17+/-0.59 mm, mean+/-SD). Fifteen degree flexion of the hip did not result in statistically significant change in JSW measurements. Upon comparison of the AP pelvis view with the supine abdominal view, neither the average JSW nor the point of narrowest JSW differed significantly, although the superolateral JSW was significantly greater on the AP pelvis view (P=0.02). CONCLUSIONS: Subtle positional changes in the hip, such as may occur during pain or in OA, may artifactually alter the measured radiographic JSW. Thus, longitudinal studies which employ hip JSW to assess disease progression may yield biased results due to changes in pain rather than structure unless care is taken to ensure constant positioning of the hip.

Combination therapy with pegylated interferon plus ribavirin in the treatment of hepatitis C virus-related thrombocytopenia.

BACKGROUND: Isolated thrombocytopenia is a common manifestation of hepatitis C virus (HCV) infection. There is no established treatment modality for this condition. The efficacy of standard interferon (IFN) monotherapy has been reported in some studies. The major disadvantage of this treatment is the high rate of recurrence due to viral breakthrough during the first 12 weeks of treatment. Pegylated IFNs are now the standard regimen for chronic hepatic disease due to HCV infection. However, due to a lack of evidence, pegylated IFNs are not widely used for HCV-related isolated thrombocytopenia. OBJECTIVE: The aim of this report was to present the case of a male patientwith severe symptomatic thrombocytopenia due to HCV infection. METHODS: Thrombocytopenia was treated with pegylated IFN plus ribavirin. RESULTS: Although standard IFN monotherapy failed to achieve virologic and hematologic improvement, therapy with pegylated IFN alfa-2a plus ribavirin was associated with both virologic and hematologic improvement without any significant adverse effects. CONCLUSIONS: Pegylated IFN plus ribavirin was effective in this patient for thetreatment of HCV-related thrombocytopenia. However, further research is needed to define the response rate in different patient populations.

Radiographic hip osteoarthritis and acetabular dysplasia in Turkish men and women.

The prevalence of hip osteoarthritis (OA) varies with different regions, and the reasons for this remain unclear. Mild acetabular dysplasia has been considered a risk factor for hip OA, but recent studies have not confirmed this. In Turkey, the prevalence of significant radiographic hip OA, i.e. Kellgren-Lawrence (K-L) grades 3 and 4, is lower than in Western populations. We aimed to investigate the potential effects of radiographic measures of acetabular dysplasia on this discrepancy. Ninety-two Turkish patients (65 males, 27 females) aged 55 and over were studied. Plain supine abdominal radiographs and intravenous pyelographs were evaluated. Centre-edge (CE) angle and acetabular depth (AD) of each hip were measured, and K-L grading was done. The mean CE angles +/- SD of right and left hips were 34+/-7 degrees and 35+/-7 degrees (range 14-52 and 18-50), respectively. The mean AD+/-SD of right and left hips was 13.7+/-3.4 and 13.6+/-3.4 (range 6-23 and 8-25), respectively. Mean CE angle or acetabular depth of the hips with K-L grade 2 did not differ from those with grades 0 and 1. There was no patient with grade 3 or 4. The prevalence of acetabular dysplasia based on a CE angle of <25 degrees was 9.8% in both right and left hips. When it was defined as having an AD of <9 mm, the prevalence was 4.3% and 1.1% in the right and left hips, respectively. Overall, 10.4% of the hips (13% of the men and 3.7% of the women) had acetabular dysplasia based on at least one of these measurements. Mild acetabular dysplasia appears to be relatively common among Turks aged 55 and over. However, it does not seem to play a major role in the development of radiographic hip OA.

Solitary Plasmacytoma of Tibia in a 29-Year-Old Woman.

Solitary plasmacytoma of the bone is a plasma cell tumor characterized by a single bone lesion with no evidence of myeloma elsewhere, including fewer than 5% plasma cells in the bone marrow. Although median age is about 14 years younger than that of patients with multiple myeloma, both diseases are extremely uncommon under 30 years of age. Solitary plasmacytoma of bone seem to have a prediction to occur in the axial skeleton, particularly in a vertebra and long bones are rarely affected. Herein, we report a case of solitary plasmacytoma of bone involving the tibia in a 29-year-old woman.