BACKGROUND:In children with unexplained fractures who are below the age of two years, it may be difficult to distinguish those with low bone mineral density (BMD) due to conditions such as osteogenesis imperfecta (OI) from those who have been abused. Currently, no imaging modality can readily or reliably assess BMD or evaluate bone strength in this age group. AIM:To investigate whether bone health index (BHI) and bone health index standard deviation scores (SDS) are sufficiently sensitive to distinguish between children under two years old with and without OI. METHODS:In this retrospective pilot study, we measured BHI and BHI SDS from 122 radiographs (33 OI, 89 suspected abuse) using BoneXpert software. Standard statistical methods (t-test, Pearson's correlation) were applied in addition to clinical diagnostics, sensitivity, specificity, and receiver operating characteristic (ROC) curves. An arbitrary level of p < 0.05 was assumed. RESULTS:BHI was significantly greater in the group without OI compared to the group with OI, 3.75 and 3.41, respectively (p = 0.003). The percentage of children in the OI/non-OI groups with BHI ≤ 2.49, 2.5-2.99, 3-3.49, and ≥4 was 0 %/0 %, 27 %/7 %, 58 %/28 %, 18 %/29 %, and 12 %/36 %, respectively. While BHI SDS was significantly greater in the group without OI compared to the group with OI, -0.039 and -0.451, respectively (p = 0.01), BHI SDS was within the normal range (±2) for both groups. CONCLUSION:Although BHI SDS is lower in OI children, it remained within the normal range. Infants without OI had better volumetric bone mineral density, associated with stronger bones. This suggests BHI might be used to differentiate between young children with low BMD and those with healthy bones. Clinicians may find the cut-points established in this study useful for assessing the sensitivity and specificity of BHI in detecting OI and identifying individuals without OI. Further research is needed to assess BHI's clinical utility in this age group.

Diffuse damage to the periventricular white matter has recently been suggested to be a cause of the cognitive deficits seen following preterm birth. It is unclear whether this form of injury can be visualised on MR imaging, but one group has described diffuse excessive high signal intensity (DEHSI) as a possible form of diffuse white matter injury. This finding is dependant on window imaging and the subjective assessment of the reviewer, but little data have been published on the degree of subjectivity on its appearance among raters.

We have reviewed, retrospectively, all children with a lower limb deformity who underwent an acute correction and lengthening with a monolateral fixator between 1987 and 1996. The patients were all under the age of 19 years and had a minimum follow-up of eight months after removal of the fixator. A total of 41 children had 57 corrections and lengthening. Their mean age was 11.3 years (3.2 to 18.7) and there were 23 girls and 18 boys. The mean maximum correction in any one plane was 23 degrees (7 to 45). In 41 bony segments (either femur or tibia) a uniplanar correction was made while various combinations were carried out in 16. The site of the osteotomy was predominantly diaphyseal, at a mean of 47% (17% to 73%) of the total bone length and the mean length gained was 6.4 cm (1.0 to 17.0). Univariate analysis identified a moderately strong relationship between the bone healing index (BHI), length gained, maximum correction and grade-II to grade-III complications. For logistic regression analysis the patients were binary coded into two groups; those with a good outcome (BHI < or = 45 days/cm) and those with a poor outcome (BHI > 45 days/cm). Various factors which may influence the outcome were then analysed by calculating odds ratios with 95% confidence intervals. This analysis suggested a dose response between increasing angular correction and poor BHI which only reached statistical significance for corrections of larger magnitude. Longer lengthenings were associated with a better BHI while age and the actual bone lengthened had little effect. Those patients with a maximum angulatory correction of less than 30 degrees in any one plane had an acceptable consolidation time with few major complications. The technique is suitable for femoral deformity and shortening, but should be used with care in the tibia since the risk of a compartment syndrome or neurapraxia is much greater.

Journal of the Royal Statistical Society: Series D (The Statistician)Volume 52, Issue 3 p. 417-418 Cross-over Trials in Clinical Research Alan S. Rigby, Alan S. Rigby University of SheffieldSearch for more papers by this author Alan S. Rigby, Alan S. Rigby University of SheffieldSearch for more papers by this author First published: 21 August 2003 https://doi.org/10.1111/1467-9884.00369_22Citations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume52, Issue3October 2003Pages 417-418 RelatedInformation

Journal of the Royal Statistical Society: Series D (The Statistician)Volume 52, Issue 4 p. 690-691 Statistics in Clinical Practice Alan S. Rigby, University of SheffieldSearch for more papers by this author Alan S. Rigby, University of SheffieldSearch for more papers by this author First published: 19 November 2003 https://doi.org/10.1046/j.1467-9884.2003.t01-1-00383_3.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Volume52, Issue4December 2003Pages 690-691 RelatedInformation

BACKGROUND:Injuries are a major cause of mortality and morbidity in young people. Despite this, the long-term consequences for young survivors of severe injury are relatively unexplored.METHODS:Population based cohort study involving 5 year post injury structured interview of all cases of major trauma (Injury Severity Score > 15) identified retrospectively for 12 month period (1988 to 1989) within former Yorkshire Health Authority area of the United Kingdom.RESULTS:125 individuals aged 11-24 years at time of injury were identified. Of these, 109 (87%) were interviewed. Only 20% (95% CI 14-29%) of those interviewed reported no disability. Mean Office of Population Census and Surveys (OPCS) disability score of the remainder was 7.5 (median 5.8, range 0.5 to 19.4). The most commonly encountered areas of disability were behaviour (54%, 95% CI 45-63%), intellectual functioning (39%, 95% CI 31-49%) and locomotion (29%, 95% CI 22-39%). Many respondents reported that their daily lives were adversely affected by their health problems for example, causing problems with work, 54% (95% CI 45-63%), or looking after the home, 28% (95% CI 21-38%). Higher OPCS scores were usually but not always associated with greater impact on daily activities. The burden of caring responsibilities fell largely on informal carers. 51% (95% CI 42-61%) of those interviewed would have liked additional help to cope with their injury and disability.CONCLUSION:The study has revealed significant disability amongst a cohort of young people 5 years post severe injury. Whilst many of these young people were coping well with the consequences of their injuries, others reported continuing problems with the activities of daily life. The factors underpinning the young people's differing experiences and social outcome should be explored.

Aim: Normal growth patterns are seen throughout the first decade in children with cystic fibrosis (CF). Growth in the second decade is, however, less satisfactory and may reflect pubertal delay. This study was performed to assess the extent of pubertal delay, to examine factors that influence the timing and magnitude of the pubertal growth spurt, and to establish whether the final height for most CF patients differed significantly from the normal population. Methods: Thirty subjects (16 male) attending a single centre were studied. Peak height velocity (PHV), final height and ages when achieved were compared with population norms. Outcome data were correlated with disease severity using Shwachman and Chrispin-Norman scores and forced expiratory volume in 1 s.Results: PHV was significantly later in both genders in this CF population compared with Tanner and Whitehouse standards: boys 14.6 y (95% confidence interval (95% CI) 12.4-16.8, p < 0.01) and girls 12.6 y (95% CI 10.5-14.7, p < 0.01). Mean PHV was also lower in both genders (boys 7.7 cm y -1 and girls 6.4 cm y -1 , both p < 0.001). However, final heights did not differ significantly from Freeman standards (height standard deviation scores: males-1.2, females-0.1); 52% of final heights equalled or exceeded the mid-parental centile.Conclusion: CF patients showed suboptimal PHVs with a later pubertal growth spurt influenced by disease severity, but eventually achieved a normal final height.

Conference Abstract| July 01 2002 Determinants of Bone Health in Children and Young Adults with Cystic Fibrosis YY Chan; YY Chan Search for other works by this author on: This Site PubMed Google Scholar CJ Taylor; CJ Taylor Search for other works by this author on: This Site PubMed Google Scholar N Beckles Willson; N Beckles Willson Search for other works by this author on: This Site PubMed Google Scholar AS Rigby; AS Rigby Search for other works by this author on: This Site PubMed Google Scholar NJ Bishop NJ Bishop Search for other works by this author on: This Site PubMed Google Scholar Clin Sci (Lond) (2002) 103 (s47): 53P. https://doi.org/10.1042/cs103053P Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Citation YY Chan, CJ Taylor, N Beckles Willson, AS Rigby, NJ Bishop; Determinants of Bone Health in Children and Young Adults with Cystic Fibrosis. Clin Sci (Lond) 1 July 2002; 103 (s47): 53P. doi: https://doi.org/10.1042/cs103053P Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsClinical Science Search Advanced Search This content is only available as a PDF. © 2002 The Biochemical Society and the Medical Research Society2002 Article PDF first page preview Close Modal You do not currently have access to this content.

There has been no study of the reliability between observers of the widely used Poser criteria' for the diagnosis of multiple sclerosis. We aimed to determine if the Poser diagnostic criteria could be consistently applied in practice, and whether the course of multiple sclerosis could be defined reliably. The case records of 85 consecutive outpatients with multiple sclerosis attending a general neurology outpatient clinic at St James's University Hospital were retrospectively analysed by two independent observers (HLF: observer 1; MHJ: observer 2). The patients had an average age of 46 (range 23-74) years; 62 (73%) of the patients were women. The patients were classified according to the Poser criteria' as clinically definite multiple sclerosis, laboratory supported definite multiple sclerosis, clinically probable multiple sclerosis, laboratory supported probable multiple sclerosis, suspected multiple sclerosis, and unable to classify. The course was defined as early relapsing-remitting, benign, secondary progressive, primary progressive, and unable to classify.2 Overall, there was substantial agreement between the two observers in classifying multiple sclerosis according to the Poser criteria (ic= 0-65, 95% confidence interval (95% CI) = 0 52-0-78).3 There was poor agreement in the historical information used