The Effect of Older Siblings on Language Development as a Function of Age Difference and Sex

The number of older siblings a child has is negatively correlated with the child’s verbal skills, perhaps because of competition for parents’ attention. In the current study, we examined the role of siblings’ sex and age gap as moderating factors, reasoning that they affect older siblings’ tendency to compensate for reduced parental attention. We hypothesized that children with an older sister have better language abilities than children with an older brother, especially when there is a large age gap between the two siblings. We reanalyzed data from the EDEN cohort ( N = 1,154) and found that children with an older sister had better language skills than those with an older brother. Contrary to predictions, results showed that the age gap between siblings was not associated with language skills and did not interact with sex. Results suggest that the negative effect of older siblings on language development may be entirely due to the role of older brothers. Our findings invite further research on the mechanisms involved in this effect.

Anesthesiology's Future with Specialists in Population Health

In population health medicine, often it is not primary care, but rather the specialists' care teams that are responsible for the most overall spending for health care. Engaging specialists in population health medicine is a prerequisite to be successful in improving the quality of care by reducing complications, unnecessary utilization, avoidable Emergency Department visits/readmissions, and total cost of care. Creating patient-centric, physician-lead, interdisciplinary care teams to redesign the delivery of care across the continuum of the episode of care (eg, shadow bundle) is a successful approach to commercial or Centers for Medicare and Medicaid Services value-based payments.

A Systematic Investigation on Barriers and Critical Success Factors for Clinical Information Systems in Integrated Care Settings

OBJECTIVES

Clinical Information Systems (CIS) have ever since the introduction of information technology in healthcare played an important role to support healthcare professionals and the process of treatment. With the rise of the concept of integrated care organizational borders, the sole focus on data aggregation or healthcare professionals as users disappear more and more. The manuscript discusses the concept of CISs and investigates critical success factors for CISs in the context of integrated care and in the course of time.

METHODS

In order to identify critical success factors and barriers for CISs a systematic literature review was conducted based on the results from PubMed and Cochrane, using MaxQDA. Search results were thereby limited to reviews or meta-analysis.

RESULTS

We have found 1919 references of which 40 met the inclusion criteria. The analysis of the manuscripts resulted in a comprehensive list of success factors and barriers related to CISs in integrated care settings. Most barriers were user-related whereas for the success factors an even distribution of organizational, technical and user-related factors was observed. The vast majority of publications was focused on healthcare professionals.

CONCLUSION

It is important to incorporate experiences made/ collected over time, as the problems encountered seem to remain almost unvaried. In order to support further systematic investigations on the topic it is necessary to rethink existing concepts and definitions to realign them with the ideas of integrated care.

Observing health professionals' workflow patterns for diabetes care - First steps towards an ontology for EHR services

Increasing the flexibility from a user-perspective and enabling a workflow based interaction, facilitates an easy user-friendly utilization of EHRs for healthcare professionals' daily work. To offer such versatile EHR-functionality, our approach is based on the execution of clinical workflows by means of a composition of semantic web-services. The backbone of such architecture is an ontology which enables to represent clinical workflows and facilitates the selection of suitable services. In this paper we present the methods and results after running observations of diabetes routine consultations which were conducted in order to identify those workflows and the relation among the included tasks. Mentioned workflows were first modeled by BPMN and then generalized. As a following step in our study, interviews will be conducted with clinical personnel to validate modeled workflows.

Structuring clinical workflows for diabetes care: an overview of the OntoHealth approach

BACKGROUND

Electronic health records (EHRs) play an important role in the treatment of chronic diseases such as diabetes mellitus. Although the interoperability and selected functionality of EHRs are already addressed by a number of standards and best practices, such as IHE or HL7, the majority of these systems are still monolithic from a user-functionality perspective. The purpose of the OntoHealth project is to foster a functionally flexible, standards-based use of EHRs to support clinical routine task execution by means of workflow patterns and to shift the present EHR usage to a more comprehensive integration concerning complete clinical workflows.

OBJECTIVES

The goal of this paper is, first, to introduce the basic architecture of the proposed OntoHealth project and, second, to present selected functional needs and a functional categorization regarding workflow-based interactions with EHRs in the domain of diabetes.

METHODS

A systematic literature review regarding attributes of workflows in the domain of diabetes was conducted. Eligible references were gathered and analyzed using a qualitative content analysis. Subsequently, a functional workflow categorization was derived from diabetes-specific raw data together with existing general workflow patterns.

RESULTS

This paper presents the design of the architecture as well as a categorization model which makes it possible to describe the components or building blocks within clinical workflows. The results of our study lead us to identify basic building blocks, named as actions, decisions, and data elements, which allow the composition of clinical workflows within five identified contexts.

CONCLUSIONS

The categorization model allows for a description of the components or building blocks of clinical workflows from a functional view.

The perioperative surgical home: what anesthesiologists need to do

Healthcare delivery systems will change in dramatic ways in the years ahead. Anesthesiologists have to adapt and support the innovators. The Perioperative Surgical Home (PSH) is a patient-centered and physician-led multidisciplinary and team-based system of coordinated care. The goal of the PSH is to create a better patient experience and make surgical care safe, efficient, and aligned in order to promote a better medical outcome at a lower cost.

Pre-pregnancy body mass index and weight gain during pregnancy: relations with gestational diabetes and hypertension, and birth outcomes

To study the relationship between pre-pregnancy body mass index (BMI) and weight gain during pregnancy with pregnancy and birth outcomes, with a focus on gestational diabetes and hypertension and their role in the association with fetal growth. We studied 1,884 mothers and offspring from the Eden mother-child cohort. Weight before pregnancy (W1) and weight after delivery (W2) were collected and we calculated BMI and net gestational weight gain (netGWG = (W2 - W1)/(weeks of gestation)). Gestational diabetes, hypertension gestational age and birth weight were collected. We used multivariate linear or logistic models to study the association between BMI, netGWG and pregnancy and birth outcomes, adjusting for center, maternal age and height, parity and average number of cigarettes smoked per day during pregnancy. High BMI was more strongly related to the risk of giving birth to a large-for-gestational-age (LGA) baby than high netGWG (odds ratio OR [95% CI] of 3.23 [1.86-5.60] and 1.61 [0.91-2.85], respectively). However, after excluding mothers with gestational diabetes or hypertension the ORs for LGA, respectively weakened (OR 2.57 [1.29-5.13]) for obese women and strengthened for high netGWG (OR 2.08 [1.14-3.80]). Low in comparison to normal netGWG had an OR of 2.18 [1.20-3.99] for pre-term birth, which became stronger after accounting for blood pressure and glucose disorders (OR 2.70 [1.37-5.34]). Higher net gestational weight gain was significantly associated with an increased risk of LGA only after accounting for blood pressure and glucose disorders. High gestational weight gain should not be neglected in regard to risk of LGA in women without apparent risk factors.

Influence of fetal and parental factors on intrauterine growth measurements: results of the EDEN mother-child cohort

OBJECTIVE

In small-for-gestational-age neonates, parental and fetal characteristics can be used to distinguish between constitutionally small size and growth restriction, which is associated with a higher risk of morbidity and mortality. The aim of this study was to quantify relationships of parental and fetal characteristics with fetal ultrasound measurements.

METHODS

The EDEN mother-child cohort included 2002 pregnant women with singleton pregnancies attending one of two university hospitals. Data from two routine ultrasound examinations for fetal biometry were recorded, at 20-25 and 30-35 weeks of gestation. Biparietal diameter (BPD), head circumference (HC), femur length (FL), abdominal circumference (AC) and estimated fetal weight (EFW) were studied as a function of prepregnancy maternal body mass index (BMI), maternal height, paternal height, fetal sex and gestational age.

RESULTS

Data were obtained at the first scan from 1833 women and at the second scan from 1752 women. Parental anthropometric characteristics were significantly associated with ultrasound measurements at both scans. Maternal BMI was more strongly associated with AC and EFW, whereas both maternal and paternal height were more strongly associated with FL. An association was also found between fetal sex and all ultrasound measurements other than FL.

CONCLUSION

Maternal and paternal anthropometric characteristics are significantly associated with ultrasound measurements in mid to late pregnancy. These relationships provide support for the use of these characteristics in ultrasound fetal size reference charts.

Relevance of an academic GMP Pan-European vector infra-structure (PEVI)

In the past 5 years, European investigators have played a major role in the development of clinical gene therapy. The provision of substantial funds by some individual member states to construct GMP facilities makes it an opportune time to network available gene therapy GMP facilities at an EU level. The integrated coordination of GMP production facilities and human skills for advanced gene and genetically-modified (GM) cell therapy, can dramatically enhance academic-led "First-in-man" gene therapy trials. Once proof of efficacy is gathered, technology can be transferred to the private sector which will take over further development taking advantage of knowledge and know-how. Complex technical challenges require existing production facilities to adapt to emerging technologies in a coordinated manner. These include a mandatory requirement for the highest quality of production translating gene-transfer technologies with pharmaceutical-grade GMP processes to the clinic. A consensus has emerged on the directions and priorities to adopt, applying to advanced technologies with improved efficacy and safety profiles, in particular AAV, lentivirus-based and oncolytic vectors. Translating cutting-edge research into "First-in-man" trials require that pre-normative research is conducted which aims to develop standard assays, processes and candidate reference materials. This research will help harmonise practices and quality in the production of GMP vector lots and GM-cells. In gathering critical expertise in Europe and establish conditions for interoperability, the PEVI infrastructure will contribute to the demands of the advanced therapy medicinal products* regulation and to both health and quality of life of EU-citizens.

Laparoscopic antecolic Roux-en-Y gastric bypass with closure of internal defects leads to fewer internal hernias than the retrocolic approach

BACKGROUND

Laparoscopic Roux-en-Y gastric bypass surgery reportedly has a higher rate of postoperative internal hernias than open bypass surgery. Even with closure of mesenteric defects, hernias occur in up to 9% of cases. To minimize this complication, an antecolic antegastric approach to anastomosis of the Roux limb and gastric pouch has been used. Whereas the retrocolic retrogastric technique creates three mesenteric defects, the antecolic approach produces only two: Petersen's defect and the jejunojejunostomy. The rate of internal hernias was compared among patients undergoing laparoscopic Roux-en-Y gastric bypass surgery using the retrocolic and antecolic approaches.

METHODS

The experience of a single surgeon from August 2001 to September 2005 was reviewed. Only Roux-en-Y gastric bypass procedures were included. Patients were followed for a minimum of 18 months postoperatively. The retrocolic approach was used for 274 patients and the antecolic approach for 205 patients. All defects were closed at the time of surgery. With the antecolic approach, Petersen's defect was closed from the root of the mesentery of the Roux limb and the transverse colon mesentery up to the transverse colon.

RESULTS

Of the 274 patients, 7 (2.6%) experienced a symptomatic internal hernia with the retrocolic retrogastric technique. No internal hernias were reported among the 205 patients treated with the antecolic antegastric method. Chi-square analysis showed that an antecolic approach was associated with a decreased rate of internal hernias (p < 0.025). Of 479 patients, 35 (7%) underwent diagnostic laparoscopy without any internal hernia found. Of these patients, 15 were found to have cholelithiasis and subjected to laparoscopic cholecystectomy.

CONCLUSIONS

The antecolic antegastric approach to laparoscopic Roux-en-Y gastric bypass is associated with fewer postoperative hernias than the retrocolic retrogastric approach. The frequency of hernias using either technique is low if meticulous attention is paid to closure of all mesenteric defects.

Compact x-ray microtomography system for element mapping and absorption imaging

We have designed and built a compact x-ray microtomography system to perform element mapping and absorption imaging by exploiting scanning fluorescence tomography and full-field transmission microtomography, respectively. It is based on a low power microfocus tube and is potentially appropriate for x-ray diagnostics in space. Full-field transmission tomography yields the three-dimensional inner structure of an object. Fluorescence microtomography provides the element distribution on a virtual section through the sample. Both techniques can be combined for appropriate samples. Microradiography as well as fluorescence mapping are also possible. For fluorescence microtomography a small and intensive microbeam is required. It is generated using a polycapillary optic. Operating the microfocus tube with a molybdenum target at 12 W, a microbeam with a full width at half maximum lateral extension of 16 microm and a flux of about 10(8) photonss is generated. As an example of application, this beam is used to determine the element distribution inside dried plant samples. For full-field scanning tomography, the x-ray optic is removed and the sample is imaged in magnifying projection onto a two-dimensional position sensitive detector. Depending on the sample size, a spatial resolution down to about 10 microm is possible in this mode. The method is demonstrated by three-dimensional imaging of a rat humerus.

An electronic educational resource for ready reference in the OR

Nurses and surgical technologists working on weekends or after hours may not always be familiar with a specific setup for an emergent surgical procedure. At St. Vincent Healthcare, Billings, Mont., an electronic tool was developed to address this concern. The Powerpoint-based Electronic Education Resource (PEER) system provides staff members with a quick, educational overview of surgical setup, patient positioning, and procedural steps.

Advancements in the diagnosis of acute appendicitis in children and adolescents

The aim of our study was to further improve the preoperative diagnosis of acute appendicitis in children and adolescents. All diagnostic parameters from the patients' medical history (duration and quality of abdominal pain, stool behaviour), the laboratory (leukocytes, C-reactive protein), the clinic (defense, tenderness on percussion, nausea, vomiting, dry tongue) and repeated ultrasound investigations (visualisation of the appendix, indirect signs of an inflammatory process in the appendix region) were documented prospectively and were re-assessed with regard to their diagnostic value. As an additional parameter, procalcitonin was determined. 1156 patients (593 male/563 female) with a mean age of 9.51 years (+/- 1.2 yrs) (max. 15 yrs/min. 2.3 yrs), referred to the department with acute abdominal pain, were examined. 233 (141 male/92 female; 20.1 %) of these patients with a mean age of 10.47 years (+/- 1.1 yr) had appendicitis. Based on the patients' medical history, laboratory findings, the initial clinical investigation and the initial ultrasound investigation, 173 patients (74.3 % of the later operated 233 children with appendicitis) were diagnosed with certainty. The diagnosis of 60 patients (25.7 %) of this group remained uncertain. These patients received a saline enema (Clysmol, Pharmacia & Upjohn Company) and were subjected to a second clinical and sonographic investigation after approximately four hours of parenteral fluid substitution (Ringer's lactate, Mayrhofer Pharmazeutika Company, 4 ml/kg/h). The other 923 patients (79.83 %) were discharged and were followed up as outpatients in the following days. Based on this stepwise procedure, the percentage of correctly diagnosed appendicitis could be increased to 97.4 %. The measurement of procalcitonin proved to be of no value in the diagnosis of acute appendicitis. It may be concluded that in children with abdominal pain, high diagnostic accuracy can only be achieved by a carefully combined evaluation of all individual diagnostic parameters and repeated investigations.

[Prevention of congenital toxoplasmosis in France. Risk assessment. Results and perspectives of prenatal screening and newborn follow up]

In France, a national program for the prevention of congenital toxoplasmosis has been set up 25 years ago. This program is here presented and discussed in details. It is based on a decision tree well defined, with pre and/or per gravidic serological screening with several different tests, completed, if necessary, by ultrasounds examinations of the fetus, biomolecular tests (PCR) on amniotic fluid, and by clinical, biological, and radiological surveillance of neo-nates. The purpose of this prevention program is to: 1/identify nonimmune young women and limit their contamination risk during pregnancy by appropriate counseling on hygiene and diet; 2/screen and treat per gravidic toxoplasmosis as early as possible so as to prevent or limit transmission to the fetus and its consequences. 3/in utero diagnose and treat infestation of the fetus; 4/diagnose and treat asymptomatic congenital toxoplasmosis in neonates, to prevent risks of reactivation and late complications, especially ocular. Such a prevention program has a cost validated by the prevalence of acquired toxoplasmosis in adults in France (over 50% of the population) and by the yearly incidence of congenital toxoplasmosis (at least 0.1% of births according to the best hypothesis). These 6 to 700 congenital toxoplasmosis cases per year may be compared to the 6 to 7,000 per gravidic seroconversions which could lead to fetal contamination if no preventive measures are taken. Nevertheless, as it is often the case in the field of prevention, it is very difficult to statistically assess the efficacy of this program even though several arguments show that it allows to eliminate the most serious toxoplasmosis, sources of serious handicaps at birth, and to limit the frequency of late complications (especially retino-choroiditis) of asymptomatic infections in neonates. The position of European countries varies as to prevention of congenital toxoplasmosis. Some countries (Austria, Belgium) have national prevention programs similar to the French one, whereas others have set up only limited programs or set up no systematic prevention. These differences may be accounted for by the different frequencies of toxoplasmic risk. It seems mandatory to forget all dogmatism and not to stick to a strictly statistical approach for a disease with not only medical but also social and human consequences.

The incisor-lip relationship in Herbst/multibracket appliance treatment of Class II, Division 2 malocclusions

The purpose of this investigation was to examine the effect of Herbst/multibracket appliance treatment on the upper incisor-lower lip relationship in the management of Class II, division 2 malocclusions. The study evaluated 19 successfully treated subjects using lateral head films analyzed at 3 occasions: before (T1) and after (T2) Herbst/multibracket appliance treatment and 1-year posttreatment (T3). The average treatment (T1-T2) changes showed (1) the lower lip overlap on the upper incisors was reduced from 6.0 mm to 4.2 mm (P < .001), (2) the upper incisors were proclined 15.3 degrees (P < .001) and the lower incisors were proclined 9.6 degrees (P < .001), (3) the overbite was reduced from 7.3 mm to 1.7 mm (P < .001), and (4) the sagittal jaw base relationship (Wits) improved from +3.5 to +0.5 mm (P < .001). The average posttreatment (T2-T3) changes showed (1) the upper incisor-lower lip relationship remained stable, (2) the upper (0.6 degrees; P < .001) and lower (2.3 degrees; P < .001) incisors retroclined, (3) the overbite increased (1.2 mm; P < .001), and (4) the sagittal jaw base relationship remained unchanged. In conclusion, it was found that the upper incisor-lower lip relationship was improved by Herbst/multibracket appliance treatment and remained stable during a 1-year posttreatment period in spite of minor relapses of incisor tooth positions and relationships.

Iliotibial band friction syndrome: MR imaging findings in 16 patients and MR arthrographic study of six cadaveric knees

PURPOSE

To define magnetic resonance (MR) imaging findings in patients with the iliotibial band friction syndrome (ITBFS) and to correlate these findings with anatomic features defined at magnetic resonance (MR) arthrography in cadavers.

MATERIALS AND METHODS

The anatomic relationship of the iliotibial tract (ITT) to the lateral recesses of the knee joint and the lateral femoral epicondyle was investigated with MR arthrography at full extension and at 30 degrees and 60 degrees of knee flexion in six cadaveric knees. Seventeen MR imaging studies in 16 patients with ITBFS were evaluated.

RESULTS

In the cadaveric study, no interference of the lateral synovial recess with the lateral femoral epicondyle at full extension and at 30 degrees and 60 degrees of knee flexion was observed. In all specimens, correlation of MR images with macroscopic and microscopic sections revealed no primary bursa between the lateral femoral epicondyle and the ITT. In clinical studies, MR imaging findings of poorly defined signal intensity abnormalities or circumscribed fluid collections were located in a compartmentlike space confined laterally by the ITT and medially by the meniscocapsular junction, the lateral collateral ligament, and the lateral femoral epicondyle.

CONCLUSION

MR imaging accurately depicts the compartmentlike distribution of signal intensity abnormalities in patients with ITBFS.

Pericruciate meniscal cysts arising from tears of the posterior horn of the medial meniscus: MR imaging features that simulate posterior cruciate ganglion cysts

OBJECTIVE

The purpose of this study is to describe MR imaging features of an unusual type of meniscal cyst arising from tears of the posterior horn of the medial meniscus in 10 patients.

MATERIALS AND METHODS

Retrospective review of MR examinations of the knee was performed of 10 patients (nine men, one woman; mean age, 39 years) in whom evidence of a meniscal tear and a cyst-like structure around the posterior cruciate ligament (PCL) was seen.

RESULTS

An oval mass with low signal intensity on T1-weighted MR images and increased signal intensity on T2-weighted MR images posterior to the PCL, simulating a PCL ganglion cyst, was seen in all 10 patients. A tear of the posterior horn of the medial meniscus was also seen in all patients. The sites of communication between the cyst and meniscal tear were observed in sagittal MR images in eight patients. Septation within the cyst and associated joint effusion were seen in eight and four patients, respectively. Arthroscopy in eight patients and transmeniscal needle drainage in the other two patients confirmed both the meniscal tear and the pericruciate meniscal cyst.

CONCLUSION

Pericruciate meniscal cysts cause fluid collections posterior to the PCL, simulating a PCL ganglion cyst. Careful analysis of the posterior horn of the medial meniscus should be performed when a cyst-like structure is seen adjacent to the PCL.

Sequence specific hybridization properties of methylphosphonate oligodeoxynucleotides

Methylphosphonate oligodeoxynucleotides (MPO's) with isomerically pure Rp-configurated methylphosphonates (MP's) were synthesized by block coupling of ApT and TpA dinucleoside methylphosphonates (DMP's, p indicating MP-linkage). Oligonucleotide duplexes (20 mers) with these Rp-MP's showed almost the same melting temperatures (Tm) as those with phosphorodiester bonds. Further a dependence of the duplex stability from the nucleosides (bases) adjacent to the MP moiety was observed. For the first time thermodynamic parameters for the duplex to coil transition of isomerically pure MP's were determined from the concentration dependence of the Tm. CD-spectra of the duplexes show structural changes which can be associated with the transition to a compact helix with higher helix winding angle.

Chronic eosinophilic pneumonia with pleural effusion

The case history of a 77-year-old lady with chronic eosinophilic pneumonia is presented. The diagnosis was difficult due to the simultaneous presence of a pleural effusion and congestive heart failure. Radiological findings and treatment are discussed.

Efficacy of magnetic resonance imaging in the evaluation of posterior cervical spine fractures

STUDY DESIGN

A retrospective study using two independent, blinded musculoskeletal radiologists to evaluate the sensitivity, specificity, and predictive value of cervical spine magnetic resonance imaging in detecting posterior element fractures of the cervical spine.

OBJECTIVE

To evaluate the sensitivity, specificity, and predictive value of magnetic resonance imaging, using computed tomographic scanning as the gold standard, in the diagnosis of posterior element cervical spine fractures.

SUMMARY OF BACKGROUND DATA

Few investigators have evaluated the accuracy of magnetic resonance imaging in the determination of cervical spine fractures.

METHODS

From January 1994 through June 1996, 75 cervical spine fractures in 32 patients were confirmed by computed tomography. Two musculoskeletal radiologists who were blinded to the clinical history and presence or absence of cervical injury among the study population, independently evaluated each cervical magnetic resonance image recording the presence or absence of soft tissue or bony injury.

RESULTS

The overall sensitivity and specificity rates for the diagnosis of a posterior element fracture by magnetic resonance imaging was 11.5% and 97.0%, respectively. The positive predictive value for this group was 83%, and the negative predictive value was 46%. In reference to anterior fractures, the sensitivity was 36.7% and the specificity 98%. Positive and negative predictive values were 91.2% and 64%, respectively.

CONCLUSIONS

Magnetic resonance imaging was not effective in recognizing bony injury to the cervical spine and in particular was not as sensitive or as specific as computed tomography in identifying cervical spinal fractures. Computed tomography remains the study of choice for the detection and precise classification of bony injuries to the cervical region, especially when plain radiographs are difficult to evaluate. Magnetic resonance imaging, although not as effective as computed tomography in defining specific bony disorders, remains the gold standard in the evaluation of spinal cord injury, occult vascular injury, and intervertebral disc disruption (hyperextension injury), including herniation and other soft tissue disorders (hematoma, ligament tear).

Post-traumatic and stress-induced osteolysis of the distal clavicle: MR imaging findings in 17 patients

OBJECTIVE

To describe the MR imaging findings in patients with osteolysis of the distal clavicle and to compare the MR imaging appearance of clavicular osteolysis following acute injury with that related to chronic stress.

DESIGN AND PATIENTS

MR imaging examinations were reviewed in 17 patients (14 men, 3 women; ages 16-55 years) with the diagnosis of post-traumatic or stress-induced osteolysis of the clavicle. A history of a single direct injury was present in seven patients and a history of weight-lifting, participation in sports, or repetitive microtrauma was present in 10 patients.

RESULTS

MR imaging showed edema in the distal clavicle in 17 patients and, of these, eight also had edema in the acromion. The edema was most evident in STIR and fat-suppressed T2-weighted pulse sequences. Other findings about the acromioclavicular (AC) joint were prominence of the joint capsule in 14, joint fluid in eight, cortical irregularity in 12, and bone fragmentation in six patients. No differences in the MR imaging features of post-traumatic and stress-induced osteolysis of the distal clavicle were observed.

CONCLUSION

Post-traumatic and stress-induced osteolysis of the distal clavicle have similar appearances on MR imaging, the most common and conspicuous MR imaging feature being increased T2 signal intensity in the distal clavicle.

Meniscal cysts causing bone erosion: retrospective analysis of seven cases

Meniscal cysts of the knee are common and well evaluated by magnetic resonance (MR) imaging, a method that also reveals the frequently associated meniscal tear. Diagnosis of meniscal cysts with routine radiography is difficult, although bone erosions are reported as a very rare manifestation of such cysts. Our retrospective study describes seven patients in whom meniscal cysts were associated with adjacent erosion of bone.

Condensing osteitis of the clavicle: MRI

PURPOSE

Condensing osteitis of the clavicle is a rare benign disorder, seen exclusively in women and characterized by expansion and sclerosis of the medial end of the clavicle. The aim of this study was to evaluate the MR findings of this disorder.

METHOD

MR images, obtained in four patients with evidence of condensing osteitis of the clavicle based on plain radiographs and clinical symptoms, included pre- and postcontrast T1 SE sequences, T2 SE images, GE images.

RESULTS

MR images revealed consistent hypointense areas on T1-weighted SE images, corresponding to regions of clavicular sclerosis (n = 4). T2-weighted SE images showed signal characteristics ranging from low intermediate signal intensity in regions of sclerosis (n = 4). T2-weighted GE images revealed moderate to high signal intensity presumably related to bone marrow edema (n = 2). Contrast-enhanced T1-weighted SE images were characterized by mild to extensive intraosseous and periosseous enhancement of signal intensity (n = 2).

CONCLUSION

MRI in cases of condensing osteitis of the clavicle reveals variable findings perhaps indicative of different stages of activity in this disease.

[Prenatal diagnosis of a pancreatic cyst due to Ivemark II syndrome]

We present a case of pancreatic cyst associated with other malformations which was diagnosed at antenatal ultrasound. Renal, hepatic, and pancreatic dysplasia as described by Ivemark in 1959 was confirmed by the pathology examination. This uncommon and lethal syndrome demonstrates autosomic recessive transmission. Ultrasound evidence of renal, hepatic and pancreatic dysplasia, associated with femoral abnormalities is suggestive of Meckel's syndrome. Other differential diagnoses are more easily distinguished (chondrodysplasia, chromosomal or metabolic abnormalities).

Evidence of the subperiosteal origin of osteoid osteomas in tubular bones: analysis by CT and MR imaging

OBJECTIVE

A large series of patients with pathologically proven osteoid osteoma of tubular bones was reviewed to determine the frequency of a subperiosteal site of origin.

MATERIALS AND METHODS

Thirty-eight cases that were included met two criteria: the tumor was located in a tubular bone, and the lesion had been evaluated by CT scanning or MR imaging, or both. The location of the osteoid osteoma was categorized as intracortical, sub-periosteal, endosteal, or medullary.

RESULTS

Among the 38 cases, 19 were imaged with CT scanning, 14 with MR imaging, and five with both techniques. The most common affected sites were the femur (n = 13), tibia (n = 15), and humerus (n = 4). Among these 38 cases, 18 were intracortical, two were intramedullary, and 18 were subperiosteal.

CONCLUSION

Osteoid osteomas occurring in a subperiosteal or surface location are not rare. Indeed, many osteoid osteomas arising in a tubular bone possibly originate in a subperiosteal site and later appear as an intracortical lesion. This site of origin appears to relate principally to continual remodeling of bone with subperiosteal deposition and endosteal erosion.

Silicone synovitis: MR imaging in five patients

Silicone synovitis is a known complication of silicone implants used in orthopedic surgery for joint reconstruction. It has been studied with routine radiography; however, no report on magnetic resonance imaging abnormalities of this condition exist in the literature. This article reports on five patients with silicone synovitis studied by magnetic resonance imaging. All patients showed hypointense implants that were deformed, fragmented or subluxed, and intra- and periarticular silicone particles were evident on T1- and T2-weighted images.

MR imaging of dislocation of the posterior tibial tendon

OBJECTIVE

The purpose of this article is to describe the MR imaging appearance of seven cases of posterior tibial tendon dislocation and subluxation.

CONCLUSION

Posterior tibial tendon dislocation is a rare but important entity usually related to a previous traumatic event. The clinical diagnosis is often missed because of its rarity. MR imaging provides important clues to the diagnosis and preoperative evaluation of this condition.

Arthropathies and inflammatory conditions of the elbow

MR imaging of arthropathies and inflammatory conditions affecting the elbow are presented. Noninfectious conditions discussed include osteoarthritis, disorders characterized by synovial proliferation, pigmented villo- nodular synovitis, synovial osteochondromatosis, crystal deposition disorders, and neuropathic osteoarthropathy. Infectious conditions discussed include septic olecranon bursitis, septic arthritis, osteomyelitis, and pyomyositis. Clinical aspects of these entities are discussed, including utility of MR imaging for diagnosis and clinical management.

Acromegaly with normal basal growth hormone levels

BACKGROUND

The most common cause of acromegaly is excess of growth hormone (GH) secretion.

METHODS

We report a 42-year-old male patient, who had become acromegalic over the past 5 years. There were no visual changes or change in sexual function, no gynaecomastia or galactorrhoea. Both CT and MRI scans showed a large mass measuring 2.5 x 2.5 x 3.5 cm, originating from the sella turcica and extending into and totally filling up the sphenoid sinus with diffusely invasive features.

RESULTS

Basal serum GH level was within normal range, but insulin-like growth factor 1 (IGF-1) was elevated with slightly increased prolactin (PRL) and impaired GH secretory regulation as well. A pituitary adenoma was partially removed through transsphenoidal microsurgery. Pathology confirmed a mammo-somatotrophic adenoma but immunocytochemistry study of the tumour showed only positivity for PRL but not GH.

CONCLUSIONS

When acromegaly occurs without GH level elevation, one should pay attention that: 1) IGF-1 might be the cause of the clinical feature of acromegaly; 2) The tumour might undergo morphological transformation; and 3) Hyperinsulinemia or GH receptor antibody formation could also be the cause of the acromegalic appearance.

MR imaging of lipoma arborescens of the knee joint

OBJECTIVE

The purpose of this study was to define MR imaging of patients with lipoma arborescens of the knee.

CONCLUSION

MR images showed villous lipomatous proliferation (100%) with signal intensity similar to that of fat on T1- and T2-weighted images, masslike subsynovial fat deposition (38%), joint effusion (100%), erosive bone changes at articular margins (38%), associated synovial cysts (25%), and degenerative changes (13%). MR imaging is a valuable technique for examining patients with lipoma arborescens of the knee and can support the diagnosis of this rare condition.