The Long Term Results of Femoral Varus Osteotomy in Patients with Legg-Calve-Perthes Disease

PURPOSE: The purpose of this study was to evaluate the long term results of performing femoral varus osteotomy (FVO) for the treatment of Legg-Calve-Perthes disease (LCPD). MATERIALS AND METHODS: We selected 35 LCPD patients who received FVO and they were followed up to the time their skeletons' matured. The inclusion criteria were patients in a fragmentation stage, the patients were in Catterall group III or IV, and the patients underwent a teleoroentgenographic examination at the time of full skeletal maturity. RESULTS: The radiological outcome at the time of skeletal maturity was assessed using Stulberg's classification. The final results were 4 hips in class I, 17 hips in class II, 13 hips in class III, one hip in class IV and none in class V. The satisfactory results (good+fair hips) were 34 hips (97%). Significant shortening (>10 mm) was observed in 12 hips (34%). In 35 patients, 5 (14%) had same leg length (less than 2 mm difference), 27 (77%) had shortening of 2 mm or more, and 3 had lengthening of 2 mm or more in the operated limb. Of these 12 patients with significant shortening, only 3 patients (9%) showed shortening of 21 mm or more. CONCLUSION: FVO is a reliable method for managing LCPD in patients who are in Catterall group III or IV and who are in the fragmentation stage of disease.

The effect of cider vinegar on some nutritional and physiological parameters in mice.

The present work was designed to investigate health effects of cider vinegar using mice as experimental model. Groups of female ICR (CD-1) mice were treated with daily oral doses of 0.17, 0.51 and 1.02 ml of the vinegar/kg body weight for 4 weeks. Cider vinegar induced a significant reduction in weight gain in animals treated with 0.51 ml/kg while others showed no significant differences in weight gain. The mean dry matter intake increased in animals treated with the smallest dose and significantly decreased in others. Hemoglobin (Hb), total erythrocyte counts (TEC) and total leukocyte counts (TLC) were raised in all treated groups. The activity of liver aspartate amino transferase (AST) decreased in the group treated with the smallest dose while no significant variations were recorded in the other groups. No significant differences were recorded neither in the activity of hepatic alanin amino transferase (ALT) nor in hepatic acid phosphatase (ACP). Liver alkaline phosphatase (ALP) noticeably elevated only in animals treated with 0.51 ml of vinegar/kg body weight per day. Treated groups also showed statistically significant increases in both mean liver and spleen weight. Kidney weight did not show significant differences. High doses of cider vinegar induced histopathological alterations in liver, stomach and duodenum. Vacuolated hepatocytes, erosion of gastric mucosa, dilatation in gastric glands and duodenum villus blunting are the common observed lesions noticed in organs of high dose-treated animals.

Automated detection of the left ventricular region in magnetic resonance images by Fuzzy c-Means model.

A new method for automated detection of the Left Ventricular (LV) region in Magnetic Resonance Imaging is presented. This method is based on the Fuzzy c-Means (FCM) clustering algorithm. The FCM is applied to each static frame of the cardiac cycle to detect the LV region. Delineation of this region is essential in the quantitative analysis of the cardiac function. The effectiveness of the method is demonstrated by application to sequences of cardiac images.

Tuberculin survey among Afghan refugee children. Tuberculosis control programme among Afghan refugees in North West Frontier Province (NWFP) Pakistan.

Since 1982 over 2 million Afghan refugees have settled in the North West Frontier Province (NWFP) of Pakistan. Socio-economical factors, sudden urbanisation and psychological stress may influence the pattern of tuberculosis morbidity and infection among refugees as compared with the original population. In order to study the prevalence of tuberculous infection among Afghan children a tuberculin survey was carried out in April and May 1985 on a cluster sample of male children attending the first two grades of primary schools in refugee camps in the NWFP. The sample size was 4108 male children with an average age of 8 years. 1358 of them, average age of 7.8 years, had not been vaccinated with BCG. An infection prevalence of 13.8% was found when using a transverse diameter of 10 mm induration or more for the tuberculin test as the criterion for infection. The findings were compared with the results of a national sample survey carried out in Afghanistan in 1978: a downward trend of the annual risk of infection (ARI) of 7.8% per year was found in children of the same age group. Thus, Afghan children living in refugee camps in NWFP showed a lower ARI than was observed in their homeland 7 years earlier.

Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease.

In a randomized, double-blind five-year trial, we tested the efficacy of simultaneously elevating serum levels of high-density lipoprotein (HDL) cholesterol and lowering levels of non-HDL cholesterol with gemfibrozil in reducing the risk of coronary heart disease in 4081 asymptomatic middle-aged men (40 to 55 years of age) with primary dyslipidemia (non-HDL cholesterol greater than or equal to 200 mg per deciliter [5.2 mmol per liter] in two consecutive pretreatment measurements). One group (2051 men) received 600 mg of gemfibrozil twice daily, and the other (2030 men) received placebo. Gemfibrozil caused a marked increase in HDL cholesterol and persistent reductions in serum levels of total, low-density lipoprotein (LDL), and non-HDL cholesterol and triglycerides. There were minimal changes in serum lipid levels in the placebo group. The cumulative rate of cardiac end points at five years was 27.3 per 1,000 in the gemfibrozil group and 41.4 per 1,000 in the placebo group--a reduction of 34.0 percent in the incidence of coronary heart disease (95 percent confidence interval, 8.2 to 52.6; P less than 0.02; two-tailed test). The decline in incidence in the gemfibrozil group became evident in the second year and continued throughout the study. There was no difference between the groups in the total death rate, nor did the treatment influence the cancer rates. The results are in accord with two previous trials with different pharmacologic agents and indicate that modification of lipoprotein levels with gemfibrozil reduces the incidence of coronary heart disease in men with dyslipidemia.

The Helsinki Heart Study: basic design and randomization procedure.

The Helsinki Heart Study is a coronary primary prevention trial in a group of middle aged men with lipid abnormalities. Its aim is to investigate the effects on the incidence of coronary heart disease of simultaneously lowering serum total and low density lipoprotein (LDL)-cholesterol and elevating high density lipoprotein (HDL)-cholesterol with gemfibrozil, over a period of 5 years. Participants were selected from a population of 23 531 men between 40 and 55 years of age. The mean serum total cholesterol among 18 966 screened subjects was 6.3 mmol l-1 (245 mg dl-1) and the mean HDL-cholesterol 1.3 mmol l-1 (50.3 mg dl-1). All subjects meeting the lipid acceptance criterion of non-HDL-cholesterol (i.e. total cholesterol minus HDL-cholesterol) greater than 5.2 mmol l-1 (200 mg dl-1) on two separate occasions two to three months apart, who were free from coronary heart disease or other major illness, were invited to participate. The total cholesterol level for the final 4081 study participants was 7.5 mmol l-1 (290 mg dl-1) and HDL-cholesterol was 1.23 mmol l-1 (47.6 mg dl-1). Mean systolic and diastolic blood pressures were 141.7 and 91.3 mmHg. About 15% of participants were hypertensive and 36% were smokers. A total of 2051 men were randomly allocated to receive gemfibrozil 600 mg twice daily and 2030 matching placebo capsules. A cholesterol-lowering diet was also prescribed for all participants. The randomized treatment groups were well balanced. Equal distribution of major risk factors was achieved in relevant sub-groups. This report describes the procedures involved in setting up the study, summarizes the baseline data obtained and reviews the success of the randomization procedure. Finally, it compares the design of this study with that of some other major preventive trials.

Recent PCB accidents in Finland.

Twenty-eight polychlorinated biphenyl (PCB) accidents were recorded during a 1-year period in Finland. They comprised leaks, fires or explosions of capacitors. Some of the explosions and fires gave rise to high concentrations of PCBs in air and of PCBs and tetrachlorodibenzofurans (TCDFs), including 2,3,7,8-TCDF, on surfaces. One large explosion is described in detail, and biomedical data and findings of this case are compared with those of smaller accidents in Finland.

Reversible nerve lesions after accidental polychlorinated biphenyl exposure.

Several capacitors containing polychlorinated biphenyls (PCB) exploded in a cardboard plant. During the accident, and in the clearing work, several workers were in probable contact with PCB and/or its degradation products. Nausea, intense perspiration, and headache were acute symptoms, which cleared quickly. The 15 men with the greatest exposure were studied neurophysiologically twice, namely, two and six months after the explosion. Motor conduction velocities (MCV) of the right median, ulnar, and peroneal nerves; sensory conduction velocity (SCV) of the right sural nerve; and distal SCVs of the right median and ulnar nerves were measured with skin electrodes. Thirty male workers with a similar age distribution served as referents. Two months after the explosion all SCVs and distal SCVs were slower in the exposed men, and still six months after the explosion the distal SCV of the ulnar nerve and the SCV of the sural nerve were slightly slower among the exposed. However, clear improvement occurred in the distal SCVs during the follow-up. As in many toxic distal axonopathies, the distal SCVs were reversibly impaired after an accidental exposure to PCB fumes. PCB seem to exhibit neurotoxic properties in humans.

Biological monitoring of workers exposed to polychlorinated biphenyl compounds in capacitor accidents.

For biological monitoring of workers exposed to polychlorinated biphenyl (PCB) compounds, a gas-chromatographic method for analysis of PCBs in serum was developed. The quantitation is performed with 15 pure isomers, and extraction and concentration factors are corrected with the aid of asymmetric PCB compounds added to each specimen. By this method, humans with no known occupational exposure to PCB compounds showed PCB levels in serum that were always less than 3 micrograms/l. Workers exposed in capacitor accidents have shown maximal concentrations close to 50 micrograms/l.

Anti-smoking legislation in Finland.

The act which outlined measures for restricting tobacco smoking in Finland took effect on 1 March 1977. This act is presented and its background described. The main regulations provided by the law are: 1) Health authorities administer all tobacco regulation, except taxation; 2) 5% of tobacco taxes are alloted annually to health education research and evaluation; 3) advertising and promotion of tobacco are prohibited; 4) limits on tar, nicotine and carbon monoxide are set by the government; these must be met for a permit to be granted; 5) tobacco products are quality controlled; 6) cigarette packets must bear health warnings; 7) no tobacco products may be sold to persons under sixteen years; 8) they may be sold only from supervised dispensing machines; 9) smoking is prohibited in all public areas, including transport; 10) the Board of Health administers nation-wide education measures. With regard to the latter regulation, some past and projected programmes are described. Initial results of the campaign were limited; further support from taxation and a pricing policy is necessary.

Risk of infection among seafarers: a prospective seroepidemiological survey of the crew of a passenger cruiser.

Serial blood specimens for various serological examinations were taken from the crew of a passenger ship which sailed on winter cruises. The study covered 3 successive seasons totalling about 150 years of observation. The figures on the rates of infection were compared with data available from the general population. The study revealed no clear evidence of an increased infection risk among the crew.

Cost-benefit studies of vaccinations in Finland.

The benefits of vaccination are, in general, recognized. For some diseases these benefits are obvious. When starting or evaluating new vaccination programmes, a more critical approach is needed. Before starting vaccination against measles and rubella in Finland a cost-benefit study was performed. According to those studies the net benefits of each vaccination would be ca. 100 million Finnish marks in 25-30 years. Those benefits not measurable in money value of human life, decrease of suffering, etc., were not included. For the purpose of formulating the national influenza vaccination policy a similar study was performed on influenza. The method used before seemed to be less suitable, however, with certain assumptions the vaccinations against influenza proved to be profitable.

Costs and benefits of measles vaccination in Finland.

Measles vaccination is fairly beneficial. During the third year after launching of the vaccination programme, cumulative benefits accuring from vaccination outweigh the cumulative costs of vaccination. This conclusion is based on a study of the vaccination programme in Finland. According to the vaccination programme, all 1-year-old infants in Finland are vaccinated. The duration of the period under survey has been set at 25 years, the measuring unit is the Finnish mark and the price level is that of the year 1975. When comparing costs and benefits, these are converted to present day monetary values. Vaccination costs per vaccinated infant amount to 32 marks, and in total during the period 1975--1999 they will amount to about 34 million marks according to an interest rate of 9% and to about 41 million marks according to an interest rate of 6% in current monetary value. Benefits gained by vaccination, compared with costs, are manifold. The benefits of one vaccination have been estimated at 230 marks. In total, benefits during the period 1975--99 constitute ca 117 million marks at an interest rate of 9%, and ca 159 million marks at an interest rate of 6% in current monetary value, without any deduction for vaccination costs. The net gain of vaccination--with a deduction of vaccination costs--is ca 84 million marks at an interest rate of 9%, and ca 118 million marks at an interest rate of 6% in current monetary value.

Syphilis, homosexuality and legislation.

The proportion of cases with fresh syphilis in males contracted by homosexual contacts in Helsinki before and after the change of the criminal law in 1971 was studied. Since 1971, homosexuality is by law no longer a crime in Finland. In 1964, only 2% of males with fresh syphilis admitted a homosexual contact. The same figure was 8% in 1970, and increased to about 50% in 1974 and 1975. It was concluded that a change of legislation concerning homosexuality, probably by several different routes, changed the proportion of cases of detected homosexually transmitted early syphilis. This was thought to be of special importance for case finding and controlling of the spread of syphilis.