Corticosteroid-induced osteoporosis in patients with uveitis.

AIMS: To estimate the prevalence of low bone density and osteoporosis in a population of patients with uveitis taking systemic steroid treatment; to clarify the risks of steroid-induced fracture and to suggest a protocol for the prevention and management of bone loss in patients with ophthalmic inflammatory disease. METHODS: Bone densitometry was performed on 129 adult patients with prednisolone-treated uveitis from four centres. Information on uveitis diagnosis, associated risk factors, steroid dosage and treatment duration, prophylaxis and management, was collected. Juveniles, patients with scleritis and those who had used deflazacort, were excluded. RESULTS: Steroid treatment time varied from 13 weeks to 31 years, and the total dosage from 1.29 g to 166.5 g. Twenty-six percent of patients also used one or more immunosuppressives. Forty-eight percent had additional risk factors for bone loss. Bone density was abnormally low in 44.2%, and 15.5% had osteoporosis. Osteoporosis was substantially more common in males (20.6%, all under 60 yrs) than in females (9.8%). Seven symptomatic fractures occurred in patients on treatment. Bone loss correlated with total steroid dose, mean dose, duration of treatment and the presence of pre-existing risk factors. CONCLUSIONS: The prevalence of steroid-induced osteoporosis and fracture is low for patients with uveitis but young males are at risk. Patients at high risk should be identified, and prophylaxis and treatment should be used as required. The guideline of the National Osteoporosis Society is recommended as a management protocol.

The trunk muscles of elite oarsmen.

OBJECTIVES: To investigate the trunk strength of elite rowers and the impact of low back pain on these measures in order to determine if asymmetries or weakness were present. METHODS: Twenty two elite rowers were recruited: 13 reported previous low back pain, five current low back pain, and the remainder had no history of low back pain. All subjects were scanned during simulated rowing in an interventional open magnetic resonance imaging scanner. In each simulated rowing position, axial scans were obtained at the level of the L4-5 and L5-S1 disc interspace to determine the cross sectional area of the posterior trunk muscles. RESULTS: Considerable differences were observed between the three groups of rowers. In contrast with expectations and previous literature, the trunk muscles of rowers with low back pain had significantly larger cross sectional areas (p<0.001). No left/right asymmetries were observed and no differences between oarside and non-oarside in terms of muscle cross sectional area. CONCLUSION: These findings suggest that low back pain in rowers does not arise as a result of muscle weakness.

Assessment of spinal kinematics using open interventional magnetic resonance imaging.

Assessment of spinal intersegmental motion has been a focus for research and has depended on radiographic techniques. Radiographic techniques are limited because of ionizing radiation exposure, magnification errors, and image quality. Interventional magnetic resonance scanners, however, allow dynamic imaging in the scanner in different positions. Twelve healthy subjects were scanned using a General Electric Signa SP10 open interventional magnetic resonance scanner. Subjects were scanned while they were in the supine position and during sitting in flexed and extended positions. Measurements of lumbar curvature and intersegmental motion were made from the sagittal images obtained. The results showed that it was possible to obtain repeatable measures of intersegmental rotation and translation from open magnetic resonance images of the spine in flexed and extended positions. These measures of motion are in agreement with previous data and suggest that the greatest motion occurs at the L4-L5 level. The use of interventional magnetic resonance imaging for assessing lumbar intersegmental mobility seems promising.

Prevalence of visual impairment in children: a review of available data.

Data on the prevalence, magnitude and causes of blindness and severe visual impairment in children are needed for planning and evaluating preventive and curative services for children, and for planning special education and low vision services. Prevalence data can be obtained from a variety of different sources, each of which has limitations. The available data suggest that there may be a ten-fold difference in prevalence between the wealthiest countries of the world and the poorest, ranging from as low as 0.1/1000 children aged 0-15 years in the wealthiest countries to 1.1/1000 children in the poorest. In this paper, the available data are reviewed and the epidemiological methods and findings are discussed.

Orbital cellulitis demands early recognition, urgent admission and aggressive management.

Orbital cellulitis is an emergency. Confusion still exists between the diagnosis of this serious condition and that of preseptal cellulitis. Delay in treatment may cause blindness and progression to life-threatening sequelae such as brain abscess, meningitis or cavernous sinus thrombosis. We report a case in which, despite late referral, emergency surgical intervention was sight saving.

Retinal and optic disc neovascularization in leukaemia.

We report a case of chronic myeloid leukaemia initially presenting with a vitreous haemorrhage associated with bilateral retinal and optic disc neovascularization. The literature is briefly reviewed and the probable reasons for the observed microcirculatory disturbances are discussed.