Review of source images is necessary for the evaluation of gadolinium-enhanced MR angiography for renal artery stenosis.

The purpose of this study was to assess interobserver variability and accuracy in the evaluation of renal artery stenosis (RAS) with gadolinium-enhanced MR angiography (MRA) and digital subtraction angiography (DSA) in patients with hypertension. The authors found that source images are more accurate than maximum intensity projection (MIP) for depicting renal artery stenosis. Two independent radiologists reviewed MRA and DSA from 38 patients with hypertension. Studies were post-processed to display images in MIP and source images. DSA was the standard for comparison in each patient. For each main renal artery, percentage stenosis was estimated for any stenosis detected by the two radiologists. To calculate sensitivity, specificity and accuracy, MRA studies and stenoses were categorized as normal, mild (1-39%), moderate (40-69%) or severe (> or =70%), or occluded. DSA stenosis estimates of 70% or greater were considered hemodynamically significant. Analysis of variance demonstrated that MIP estimates of stenosis were greater than source image estimates for both readers. Differences in estimates for MIP versus DSA reached significance in one reader. The interobserver variance for MIP, source images and DSA was excellent (0.80< kappa< or = 0.90). The specificity of source images was high (97%) but less for MIP (87%); average accuracy was 92% for MIP and 98% for source images. In this study, source images are significantly more accurate than MIP images in one reader with a similar trend was observed in the second reader. The interobserver variability was excellent. When renal artery stenosis is a consideration, high accuracy can only be obtained when source images are examined.

Hip fracture and osteoporosis in a XIIth Dynasty female skeleton from Lisht, upper Egypt.

Osteoporosis and complications arising from loss of bone mass have been present in human populations for thousands of years. However, reports of this disease in antiquity remain uncommon. The purpose of this report is to describe an important case of osteoporosis in ancient Egypt because of its intrinsic interest and to provide perspectives on factors contributing to this condition today. The case providing the focus for this report is from Lisht, Upper Egypt and is dated to the XIIth Dynasty (1990-1786 B.C.). Methods used to characterize the pathology include gross anatomical study, radiology, and radiographic measurements. Observations, measurements, and indices all indicate osteoporosis complicated by fracture of the femoral neck and compression fractures of some vertebrae. The Lisht case adds to a small corpus of reports on osteoporosis and complicating factors of this disease in antiquity. Long-term survival of an extracapsular fracture of the femoral neck in this case is remarkable and may reflect supportive social conditions.

New approaches to the study of disease in archeological New World populations.

One of the objectives of paleopathology is to clarify the role of disease in the evolution of human groups. The recovery of DNA and immunoglobulins from archeological human skeletal tissue offers a method for enhancing and expanding our knowledge about the presence and significance of disease in past human populations. DNA also might reveal the presence of genetic disease. Immunoglobulins recovered from archeological bone indicate some of the diseases to which an individual was exposed during life. This information also provides supporting evidence for anatomical observations of skeletal disease. This is illustrated by the identification of treponemal antibody in an archeological skeleton that has gross lesions suggestive of treponematosis. Similar biochemical methods could be applied to other research problems to clarify the presence of various syndromes of the inflammatory erosive arthropathies, such as rheumatoid arthritis, in New World archeological populations. Some of these syndromes are associated with DNA sequences and specific proteins that are recoverable from archeological skeletal tissue.

Histologic examination of age of the First African Baptist Church adults.

This study applies a recently formulated method of histologic estimation of age at death to samples of anterior femoral cortex taken from adult skeletons from the First African Baptist Church cemetery and compares the results with macroscopic age estimates made by J.L. Angel and J.O. Kelley. Of the 65 samples taken, 44 were sufficiently well preserved to produce readable thin sections, although most were so fragile that they had to be embedded before sectioning. In most cases the histologic ages agreed with the macroscopic age estimations within the standard error of the estimate of the histologic method. Most cases of disagreement could be attributed to poor preservation. Despite differences between individual gross and microscopic age estimates, the two methods proved to be significantly correlated and produced the same overall demographic picture of a population whose female members were likely to die at earlier ages than the males.