Facial thermography is a sensitive and specific method for assessing food challenge outcome.

BACKGROUND: Oral challenge is widely used for diagnosing food allergy but variable interpretation of subjective symptoms may cause error. Facial thermography was evaluated as a novel, objective and sensitive indicator of challenge outcome. METHODS: A total of 24 children with a history of egg allergy underwent oral challenge, which were scored positive when objective symptoms occurred or negative after all doses were consumed without reaction. Facial temperatures were recorded at baseline and 10-min intervals. The difference between mean and baseline temperature (DeltaT), maximum DeltaT during challenge (DeltaT(max)) and area under curve of DeltaT against time (DeltaTAUC) were calculated for predefined nasal, oral and forehead areas, and related to objective challenge outcome. RESULTS: There were 13 positive and 11 negative challenges. Median nasal DeltaTAUC and DeltaT(max) were greater in positive compared with negative challenges (231- and 5-fold, respectively; P < 0.05). In positive challenges, nasal temperatures showed an early transient rise at 20 min, preceding objective symptoms at median 67 min. There was a sustained temperature increase from 60 min, which was reduced by antihistamines. A cut-off for nasal DeltaT(max) of 0.8 degrees C occurring within 20 min of the start of the challenge predicted outcome with 91% sensitivity (positive predictive value [PPV] 100%) and 100% specificity (negative predictive value [NPV] 93%). Subjective symptoms occurred in four of 13 positive and three of 11 negative challenges. CONCLUSIONS: Facial thermography consistently detects a significant early rise in nasal temperature during positive compared with negative food challenges, which is evident before objective symptoms occur. Thermography may therefore provide a sensitive method to determine outcome of food challenges and investigate the pathophysiology of food allergic reactions.

Talar callosity--a little-recognized common entity.

An ankle callosity overlying the talus is defined and described in three patients and the lesion is considered common but often unrecognized. The aetiology is discussed.

Acetabular protrusion and the Monk Duopleet prosthesis in subcapital femoral neck fractures.

A total of 166 patients with acute, displaced subcapital fractures of the femoral neck were treated over a 5-year period with the Monk Duopleet bi-articular prosthesis. The average age at operation was 77.8 years. 81 patients were available for review at an average of 37.1 months after surgery. Radiographic evidence of acetabular protrusion was found in 3 patients (3.7 per cent). This incidence of protrusion is considerably lower than that normally reported for one-piece prostheses such as the Austin Moore or Thompson. The causes of acetabular protrusion are discussed.

Monthly screening in the first six months of life for congenital hip dislocation.

The experience is reported of a five-year study of monthly assessment for congenital dislocation of the hip in suspected cases. The importance of persisting instability and of the "tightening adductor phenomenon" is stressed. The results indicate that monthly follow-up for six months greatly diminishes the incidence of late-diagnosed CDH.

Anterior cruciate ligament repair for rotatory instability: the Lindemann dynamic muscle-transfer procedure.

The Lindemann operation, originally performed in 1950 as a reconstructive procedure for the anterior cruciate ligament, was performed in the knees of eight patients suffering from rotatory instability. Although the instability persisted, as shown by roentgenographic and clinical examination, treatment with the tendon transfer appears to have provided dynamic stabilization. Seven of the eight patients so treated were subjectively improved, and they returned to sports or activities which they had not been able to perform prior to surgery.