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Objective Assessment of human joint cartilage is a crucial tool to detect and diagnose pathological conditions. This exploratory study developed a workflow for 3D modeling of cartilage and bone based on multimodal imaging. New evaluation metrics were created and, a unique set of data was gathered from healthy controls and patients with clinically evaluated degeneration or trauma. Design We present a novel methodology to evaluate knee bone and cartilage based on features extracted from magnetic resonance imaging (MRI) and computed tomography (CT) data. We developed patient specific 3D models of the tibial, femoral, and patellar bones and cartilages. Forty-seven subjects with a history of degenerative disease, traumatic events, or no symptoms or trauma (control group) were recruited in this study. Ninety-six different measurements were extracted from each knee, 78 2D and 18 3D measurements. We compare the sensitivity of different metrics to classify the cartilage condition and evaluate degeneration. Results Selected features extracted show significant difference between the 3 groups. We created a cumulative index of bone properties that demonstrated the importance of bone condition to assess cartilage quality, obtaining the greatest sensitivity on femur within medial and femoropatellar compartments. We were able to classify degeneration with a maximum recall value of 95.9 where feature importance analysis showed a significant contribution of the 3D parameters. Conclusion The present work demonstrates the potential for improving sensitivity in cartilage assessment. Indeed, current trends in cartilage research point toward improving treatments and therefore our contribution is a first step toward sensitive and personalized evaluation of cartilage condition.

OBJECTIVES: To describe the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in a large population-based study of elderly Icelanders, with particular reference to weight related factors and the metabolic syndrome. METHODS: The study population comprised 5321 participants aged 68–96 (2276 males mean age 76(5) and 3045 females mean age 77(6)) from the AGES-Reykjavik Study. DISH diagnosis was based on CT scans, and interpreted strictly by the Resnick criteria and additional suggestions for CT interpretation by Oudkerk et al. Radiology readings were done by a radiology resident with sample readings by two experienced radiologists. RESULTS: A diagnosis of DISH was made in 13.7% of males and 2.8% of females. There was no association with age, but a strong association was seen with the metabolic syndrome (OR 2.12 (1.69–2.64), p=3,9×10(−11)). Among the components of the metabolic syndrome the association with DISH was significant for the insulin resistance criterion, (OR 1.66 (1.32–2.01), p

Í samfélagsumræðunni er oft fjallað um vandamál innan mannvirkjageirans - eins og framúrkeyrslu í kostnaði og tafir, og ekki síður vandamál sem tengjast gæðum. Stundum er til þess vísað að þessi vandamál séu afleiðing af hinu ófyrirsjáanlega eðli greinarinnar. Hins vegar liggur fyrir að einn áhrifamesti þátturinn sem hefur áhrif á útkomu slíkra verkefna er val á verktökum, sem fer fram á fyrri stigum verkefnanna. Megintilgangur þessarar rannsóknar var að fara yfir aðferðir við val á verktökum, sem íslenskar skipulagsheildir notast við. Þessar aðferðir voru bornar saman við alþjóðlegar aðferðir - sem endurspegla faglegt þekkingarstig samtímans. Niðurstöðurnar benda til þess að íslenskar skipulagsheildir notist við margþætt viðmið að einhverju leyti, en verð er þó langmikilvægasta viðmiðið og í því getur falist áhætta.

Chitosan is a biocompatible polymer that has been widely studied for tissue engineering purposes. The aim of this research was to assess bone regenerative properties of an injectable chitosan and calcium phosphate-based composite and identify optimal degree of deacetylation (%DDA) of the chitosan polymer. Drill holes were generated on the left side of a mandible in Sprague-Dawley rats, and the hole was either left empty or filled with the implant. The animals were sacrificed at several time points after surgery (7–22 days) and bone was investigated using micro-CT and histology. No significant new bone formation was observed in the implants themselves at any time points. However, substantial new bone formation was observed in the rat mandible further away from the drill hole. Morphological changes indicating bone formation were found in specimens explanted on Day 7 in animals that received implant. Similar bone formation pattern was seen in control animals with an empty drill hole at later time points but not to the same extent. A second experiment was performed to examine if the %DDA of the chitosan polymer influenced the bone remodeling response. The results suggest that chitosan polymers with %DDA between 50 and 70% enhance the natural bone remodeling mechanism.

Bone remodelling after total hip arthroplasty has been largely observed and investigated. Most studies rely on projective images and only few obtain 3D information with limited spatial resolution. This study proposes a method to provide quantitative, 3D high-resolution data about femur bone density variations, by means of CT volume processing. This would offer a tool for further research and clinical studies. Five patients subjected to primary, cementless total hip arthroplasty were considered. Calibrated CT volumes were acquired before, just after surgery and 1 yr later. Bone remodelling hinders accurate alignment of femur volumes acquired after a year; instead, prosthesis stem remains unchanged. Thus, after metal artefact reduction, prosthesis was segmented, and stem-based accurate alignment was obtained. A test to exclude prosthesis migration was performed by considering specific femur anatomical landmarks. Bone density error due to artefact reduction and realignment was estimated. Quantitative differences in bone mineral density were computed for each voxel, providing a resolution of about 1 mm. Preliminary results showed that the femur underwent consistent remodelling after a year. Widespread bone density losses appeared in those areas where strain-adaptive remodelling is normally expected, particularly about the calcar. Conversely, distal areas with clear stem-bone contact showed considerable density gains.

Total Hip Arthroplasty has been one of the most successful surgical procedure in terms of patient outcomes and satisfaction. However, due to increase in life expectancy and the related incidence of age-dependent bone diseases, a growing number of cases of intra-operative fractures lead to revision surgery with high rates of morbidity and mortality. Surgeons choose the type of the implant, either cemented or cementless prosthesis, on the basis of the age, the quality of the bone and the general medical conditions of the patients. Generally, no quantitative measures are available to assess the intra-operative fracture risk. Consequently, the decision-making process is mainly based on surgical operators&rsquo, expertise and qualitative information obtained from imaging. Motivated by this scenario, we here propose a mechanical-supported strategy to assist surgeons in their decisions, by giving intelligible maps of the risk fracture which take into account the interplay between the actual mechanical strength distribution inside the bone tissue and its response to the forces exerted by the implant. In the presented study, we produce charts and patient-specific synthetic &ldquo, traffic-light&rdquo, indicators of fracture risk, by making use of ad hoc analytical solutions to predict the stress levels in the bone by means of Computed Tomography-based mechanical and geometrical parameters of the patient. We felt that if implemented in a friendly software or proposed as an app, the strategy could constitute a practical tool to help the medical decision-making process, in particular with respect to the choice of adopting cemented or cementless implant.

Total Hip Arthroplasty (THA) is the gold standard for hip replacement surgery. It can be performed with two different kinds of prostheses: cemented and uncemented. The surgeons have always decided on the type of prosthesis based on the age, sex of the patient and bone stock on x rays. In this paper 42 subjects underwent THA and performed both gait analysis and bone mineral density (BMD) evaluation through CT scans; spatial and temporal gait parameters were used to predict BMD of the distal and proximal parts of the femur before and one year after surgery using machine learning regression analysis. A simple linear regression (LR) and k-nearest neighbor (KNN) were implemented coding with Python Scikit-Learn libraries and some evaluation metrics were computed: the coefficient of determination (R2), mean absolute error, mean squared error and root mean squared error. Both the algorithms had a R2 greater than 75% in predicting both proximal and distal; particularly, LR obtained the highest score of 88.4% in predicting the BMD before the THA and of 81.3% after the THA. All the R2 of KNN ranged from 75% and 77%. All the calculated errors were always below 0.001. In conclusion, this research shows the feasibility of gait parameters for assessing the follow-up after 52 weeks of patients undergoing THA by predicting the BMD. Moreover, the results give insights about the relationship between the patterns of gait and BMD.

Background The aim of the study was to compare the bone mineral density changes between unmatched patients undergoing total hip arthroplasty receiving uncemented and cemented type of implants. Previous studies have used DEXA or a two dimensional analysis to estimate the bone quality following total joint replacement, whereas this study presents the changes in three dimensions. Methods Fifty subjects both male and females receiving both cemented and uncemented type of implant were recruited. Two CT scans were taken of each subject, the first at 24 h post surgery and the second one 1 year after surgery. The scans were calibrated using a phantom converting the Hounsfield units to bone mineral density values in g/cm3. The two scans were registered together using anatomical landmarks and resliced to compare the two femurs in the identical frame of reference. The bone density gain and loss was calculated by comparing density values between the two sets of scans. Findings The results showed that most of the bone loss was located around the Lesser Trochanter and some bone density gain at the distal tip of the implant. The three dimensional density changes occur differently between individuals and the study showed no correlation of bone loss with age. Interpretation The bone loss occurred mostly at the proximal femur, which is in agreement with previously presented studies. By carrying out three dimensional analysis on the bone gain and loss on the femur, it is possible to identify the patients that are showing high degree of bone loss.

There are two surgical approaches to performing total hip arthroplasty (THA): a cemented or uncemented type of prosthesis. The choice is usually based on the experience of the orthopaedic surgeon and on parameters such as the age and gender of the patient. Using machine learning (ML) techniques on quantitative biomechanical and bone quality data extracted from computed tomography, electromyography and gait analysis, the aim of this paper was, firstly, to help clinicians use patient-specific biomarkers from diagnostic exams in the prosthetic decision-making process. The second aim was to evaluate patient long-term outcomes by predicting the bone mineral density (BMD) of the proximal and distal parts of the femur using advanced image processing analysis techniques and ML. The ML analyses were performed on diagnostic patient data extracted from a national database of 51 THA patients using the Knime analytics platform. The classification analysis achieved 93% accuracy in choosing the type of prosthesis, the regression analysis on the BMD data showed a coefficient of determination of about 0.6. The start and stop of the electromyographic signals were identified as the best predictors. This study shows a patient-specific approach could be helpful in the decision-making process and provide clinicians with information regarding the follow up of patients.

Purpose - We wanted to examine the potential of the Scandinavian Sarcoma Group (SSG) Central Register, and evaluate referral and treatment practice for soft-tissue sarcomas in the extremities and trunk wall (STS) in the Nordic countries. Background - Based on incidence rates from the literature, 8,150 (7,000-9,300) cases of STS of the extremity and trunk wall should have been diagnosed in Norway, Finland, Iceland, and Sweden from 1987 through 2011. The SSG Register has 6,027 cases registered from this period, with 5,837 having complete registration of key variables. 10 centers have been reporting to the Register. The 5 centers that consistently report treat approximately 90% of the cases in their respective regions. The remaining centers have reported all the patients who were treated during certain time periods, but not for the entire 25-year period. Results - 59% of patients were referred to a sarcoma center untouched, i.e. before any attempt at open biopsy. There was an improvement from 52% during the first 5 years to 70% during the last 5 years. 50% had wide or better margins at surgery. Wide margins are now achieved less often than 20 years ago, in parallel with an increase in the use of radiotherapy. For the centers that consistently report, 97% of surviving patients are followed for more than 4 years. Metastasis-free survival (MFS) increased from 67% to 73% during the 25-year period. Interpretation - The Register is considered to be representative of extremity and trunk wall sarcoma disease in the population of Scandinavia, treated at the reporting centers. There were no clinically significant differences in treatment results at these centers. Funding Agencies|National Advisory Unit on sarcomas in Norway; Swedish Cancer Society

INTRODUCTION: Traumatic spinal cord injury (TSCI) is serious and often has long-term consequences. Since no cure has been found the emphasis has been on preventive measures. The incidence of TSCI varies between countries and the epidemiology has been changing. The aim of this study was to gather epidemiological data on patients with TSCI in Iceland and search for risk factors. MATERIAL AND METHODS: Hospital records of everyone diagnosed with TSCI in 1975-2014 admitted to Landspitali University Hospital were reviewed and information gathered on incidence, age, gender and causes of injury. The American Spinal Injury Association Impairment Scale (AIS) was used to assess the extent of TSCI. RESULTS: A total of 233 patients were diagnosed with TSCI during the study period or 26 per million annually on average. Males were 73% and the mean age was 39 years. Traffic accidents were the most common cause of TSCI. The majority were car rollovers in rural areas. Around 50% did not use a seatbelt. The second most common cause of TSCI were falls. The most common sport/leisure accidents were those related to horseback-riding and winter sports. A third of patients had a complete SCI. At discharge 9% had gained full recovery. CONCLUSIONS: Safe roads and good traffic culture are essential factors in the prevention of serious traffic accidents. Strict safety regulations in the work place and an investigation of causes of falls amongst the elderly could decrease SCIs due to falls. Further preventive measures and protective equipment could possibly be of use in sport- or leisure-related activities. Key words: Traumatic spinal cord injury, incidence, age, gender, causes, extent. Correspondence: Pall E. Ingvarsson, [email protected]/* */ Language: is

This article outlines the methods and applications of threshold-based techniques to assess in vivo muscle and bone tissue distribution in normal and pathological conditions using computed tomography imaging. The approaches described here use medical imaging processing techniques and computational methods to study bone mechanical proprieties, analyze and quantify muscle morphology, visualize changes with 3-D models, develop subject-specific numerical profiles, and assess muscle and bone changes during clinical treatments.

Total Hip Arthroplasty requires pre-surgical evaluation between un-cemented and cemented prostheses. A Patient with intra-operative periprosthetic fracture and another with a successful outcome were recruited, and their finite element models were constructed by processing CT data, assuming elastic-plastic behavior of the bone as function of the local density. To resemble the insertion of the prosthesis into the femur, a fictitious thermal dilatation is applied to the broach volume. Strain-based fracture risk factor is estimated, depicting results in terms of the total mechanical strain expressed using a simple "traffic lights" color code to provide immediate, concise, and intelligible pre-operative information to surgeons.

STUDY DESIGN: A retrospective epidemiological study. SETTING: Landspítali University Hospital, Iceland. OBJECTIVES: Assessment of epidemiological data and risk factors for traumatic spinal fractures (SFs) and associated spinal cord injury (SCI). METHODS: A retrospective review of hospital admissions due to traumatic SFs during a 5-year period, with analysis of epidemiological parameters and occurrence of concomitant SCI. Patients with asymptomatic SFs and non-traumatic SCI were excluded. RESULTS: A total of 487 patients were diagnosed with a SF or 310 PMI (per million inhabitants), 42 of them (9%, 27 PMI) with an associated SCI. The mean age was 56 years, males were 57%. Falls were the leading cause of both SFs (49%) and SCIs (43%). Low falls (

Total hip arthroplasty is a ubiquitously successful orthopedic surgical procedure, whose prevalence is rising worldwide. While many investigations focus on characterizing periprosthetic pathophysiology, the objective of our research is to develop and describe multi-metric assemblies as a first step toward creating a patient-specific mobility index that rehabilitators and orthopedic surgeons can utilize for prescribing their respective procedures. In total, 48 total hip arthroplasty patients (both cemented and uncemented) undergoing unilateral, primary surgery went through computed tomographic scans and gait analysis measurements both before and 1 year following their surgery. Altogether, the reported quantitative metrics include 11 spatial and temporal gait parameters, muscle density, and electromyography signals from the rectus femoris, vastus lateralis, and vastus medialis, and bone mineral density values from bioimage analysis around the implant stem. We found that measured parameters from a subgroup were sensitive to changes observed during patient recovery, implicating the predictive sensitivity of these patient conditions. Most post-operative gait parameters changed significantly, while electromyography data indicated few significant differences. Moreover, results from bioimage analyses indicate a general reduction of periprosthetic bone mineral density after 1 year, in association with increasing density of the quadriceps muscles. Furthermore, this work identifies which quantitative metrics undergo the greatest variation after total hip arthroplasty and demonstrates the clinical feasibility of a multimodal approach to mobility assessment that may ultimately support decision-making for post-surgical rehabilitation protocols.

Recent evidences indicating that cellular kinase signaling cascades are triggered by oligomers of N-acetylglucosamine (ChOS) and that condrocytes of human osteoarthritic cartilage secrete the inflammation associated chitolectin YKL-40, prompted us to study the binding affinity of partially acetylated ChOS to YKL-40 and their effect on primary chondrocytes in culture. Extensive chitinase digestion and filtration of partially deacetylated chitin yielded a mixture of ChOS (Oligomin™) and further ultrafiltration produced T-ChOS™, with substantially smaller fraction of the smallest sugars. YKL-40 binding affinity was determined for the different sized homologues, revealing micromolar affinities of the larger homologues to YKL-40. The response of osteoarthritic chondrocytes to Oligomin™ and T-ChOS™ was determined, revealing 2- to 3-fold increases in cell number. About 500 μg/ml was needed for Oligomin™ and around five times lower concentration for T-ChOS™, higher concentrations abolished this effect for both products. Addition of chitotriose inhibited cellular responses mediated by larger oligosaccharides. These results, and the fact that the partially acetylated T-ChOS™ homologues should resist hydrolysis, point towards a new therapeutic concept for treating inflammatory joint diseases.

Total hip arthroplasty (THA) can be achieved by using a cemented or noncemented prosthesis. Besides patient's age, weight, and other clinical signs, the evaluation of the quality of the bones is a crucial parameter on which orthopedic surgeons base the choice between cemented and noncemented THA. Although bone density generally decreases with age and a cemented THA is preferred for older subjects, the bone quality of a particular patient should be quantitatively evaluated. This study proposes a new method to quantitatively measure bone density and fracture risk by using 3D models extracted by a preoperative computed tomography (CT) scan of the patient. Also, the anatomical structure and compactness of the quadriceps muscle is computed to provide a more complete view. A spatial reconstruction of the tissues is obtained by means of CT image processing, then a detailed 3D model of bone mineral density of the femur is provided by including quantitative CT density information (CT must be precalibrated). A finite element analysis will provide a map of the strains around the proximal femur socket when solicited by typical stresses caused by an implant. The risk for structural failure due to press-fitting and compressive stress during noncemented THA surgery was estimated by calculating a bone fracture risk index (ratio between actual compressive stress and estimated failure stress of the bone). A clinical trial was carried out including 36 volunteer patients (ages 22-77) who underwent unilateral THA surgery for the first time: 18 received a cemented implant and 18 received a noncemented implant. CT scans were acquired before surgery, immediately after, and after 12 months. Bone and quadriceps density results were higher in the healthy leg in about 80% of the cases. Bone and quadriceps density generally decrease with age but mineral density may vary significantly between patients. Preliminary results indicate the highest fracture risk at the calcar and the lowest at the intertrocanteric line, with some difference between patients. An analysis of the results suggest that this methodology can be a valid noninvasive decision support tool for THA planning; however, further analyses are needed to tune the technique and to allow clinical applications. Combination with gait analysis data is planned.

Total Hip Arthroplasty (THA) is one of the most utilized and successful orthopedic surgical procedures, and with increasing life expectancies in many populations worldwide, THA rates are projected to continue to rise accordingly. Despite the procedure’s rising prevalence, many periprosthetic fracture and unloading events are still reported. While many investigations have recently focused on potential assessment modalities and metrics to observe and characterize periprosthetic pathophysiology in THA patients, there is no extant, reliable method for the quantitative assessment of patients prior to THA. In most cases, respective opinions of the physicians involved dictate this decision, and procedures are therefore founded upon both the surgeon’s own experiences and qualitative generalizations based on suggested indicators of bone quality (gender, age, and qualitative assessment of CT images). There is therefore a great need for a quantitative, multimodal gold standard to securely choose the appropriate implant on a patient-specific basis. The objective of the re- search presented herein was to describe a novel assembly of such data from a 72-patient cohort as a first step towards eventually creating a patient-specific, presurgical application that orthopedic surgeons can utilize for determining the optimal THA prosthesis procedure. Here, we report the use of 3D soft tissue segmentation of the Rectus femoris, Vastus lateralis, and the Vastus medialis muscles, the use of 3D FEA to compute Fracture Risk Indices (FRI), the pre-operative measurement and user-friendly assembly of 11 gait parameters, and the measurement and analyses of EMG activation data – all of which are presented herein as a comprehensive patient report for a representative 60 year-old female patient.

Clinical theory suggests that altered alignment of the shoulder girdle has the potential to create or sustain symptomatic mechanical dysfunction in the cervical and thoracic spine. The alignment of the shoulder girdle is described by two clavicle rotations, i.e, elevation and retraction, and by three scapular rotations, i.e., upward rotation, internal rotation, and anterior tilt. Elevation and retraction have until now been assessed only in patients with neck pain. The aim of the study was to determine whether there is a pattern of altered alignment of the shoulder girdle and the cervical and thoracic spine in patients with neck pain. A three-dimensional device measured clavicle and scapular orientation, and cervical and thoracic alignment in patients with insidious onset neck pain (IONP) and whiplash-associated disorder (WAD). An asymptomatic control group was selected for baseline measurements. The symptomatic groups revealed a significantly reduced clavicle retraction and scapular upward rotation as well as decreased cranial angle. A difference was found between the symptomatic groups on the left side, whereas the WAD group revealed an increased scapular anterior tilt and the IONP group a decreased clavicle elevation. These changes may be an important mechanism for maintenance and recurrence or exacerbation of symptoms in patients with neck pain.

The variability in patient outcome and propensity for surgical complications in total hip replacement (THR) necessitates the development of a comprehensive, quantitative methodology for prescribing the optimal type of prosthetic stem: cemented or cementless. The objective of the research presented herein was to describe a novel approach to this problem as a first step towards creating a patient-specific, presurgical application for determining the optimal prosthesis procedure. Finite element analysis (FEA) and bone mineral density (BMD) calculations were performed with ten voluntary primary THR patients to estimate the status of their operative femurs before surgery. A compilation model of the press-fitting procedure was generated to define a fracture risk index (FRI) from incurred forces on the periprosthetic femoral head. Comparing these values to patient age, sex, and gender elicited a high degree of variability between patients grouped by implant procedure, reinforcing the notion that age and gender alone are poor indicators for prescribing prosthesis type. Additionally, correlating FRI and BMD measurements indicated that at least two of the ten patients may have received nonideal implants. This investigation highlights the utility of our model as a foundation for presurgical software applications to assist orthopedic surgeons with selecting THR prostheses.

Because of current cost restrictions, we studied the effect of a shorter hospital stay on function, pain and quality of life (QOL) after total hip replacement (THR).50 patients from two hospitals were randomized into a study group (SG) of 27 patients receiving preoperative and postoperative education programs, as well as home visits from an outpatient team, and a control group (CG) of 23 patients receiving "conventional" rehabilitation often augmented by a stay at a rehabilitation center.Mean hospital stay was shorter for the SG than for the CG (6.4 days and 10 days, respectively; p0.001). During the 6-month study period, there were 9 non-fatal complications in the SG and 12 in the CG (p = 0.3). The difference in Oxford Hip Score between the groups was not statistically significant before the operation, but was better for the SG at 2 months (p = 0.03) and this difference remained more or less constant throughout the study. The overall score from the Nottingham Health Profile indicated a better QOL in the SG.Our preoperative education program, followed by postoperative home-based rehabilitation, appears to be safer and more effective in improving function and QOL after THR than conventional treatment.

Introduction. A questionnaire-based, cross-sectional study with an 18-month follow-up telephone interview was designed to determine whether symptom characteristics differ in women presentin...

Introduction. A questionnaire-based, cross-sectional study with an 18-month follow-up telephone interview was designed to determine whether symptom characteristics differ in women presenting with chronic (> 6 months) neck pain related to whiplash associated disorder (WAD), grades I-II (n = 41) and chronic insidious onset neck pain (IONP) (n = 39).Methods. The women were recruited from informed doctors and physical therapists. The duration of symptoms was > 6 months and < 48 months in both groups. The main outcome is given as frequency distribution of duration and nature of neck pain and related disorders.Results. Neck pain, shoulder pain, self-reported activity-related complaints and specific complaints, like numbness in the arms, memory loss and poor concentration, were significantly more prevalent and severe in the WAD-group as compared to the IONP-group (p = 0.01,0.001 and 0.01, respectively). The telephone interview 18 months later showed that 97.3% of the respondents in the WAD-group and 47.2...

Background - Judicious use of antibiotics is an important factor in decreasing the current increase in bacterial resistance. Discussion with patients and their guardians on whether to use antibiotics or not can be expected to increase in the future. Objective - To explore the views and feelings of parents of children with acute otitis media towards the disease and its treatment. Design - A qualitative study with semi-structured interviews. Subjects - Twenty-one parents of pre-school children with newly diagnosed acute otitis media who had attended a primary care centre in Reykjavik. Results - The parents did not consider the disease a threat. They generally thought the disease was caused by environmental factors or by a disturbance in body mechanism. The majority thought that treatment with antibiotics could harm their children. Conclusion - The parents of young children hold views on acute otitis media and antibiotics which are markedly different from the medical model.

Study Design and Method Case report.Summary of Background Data. Persistent neck pain and bizarre cranial symptoms are common sequelae of whiplash-type injuries. Since soft tissue injuries of the neck are rarely fatal, only few pathoanatomical studies of such injuries have been conducted. We report on a man who had been extensively investigated after a whiplash injury sustained in a traffic accident. He died at the age of 42 of a heart attack 12 years after the injury. The cervical spine was examined in great detail by cryosectioning and the brachial plexa were examined microscopically.Results There were marked isolated degenerative changes in the C5-C6 segment such as disc degeneration, uncovertebral osteophytosis, and zygapophyseal joint osteoarthrosis with subluxation, including degeneration of the meniscoid folds. Contralateral to the C5-C6 changes, and consistent with symptoms and clinical signs, there were marked fibrotic perineural adherences in the brachial plexus.Conclusions The findings m...

The objectives of this study were 1 to assess in a population-wide study the genetic component of hip OA in Iceland leading to total joint replacement (THR) 2 to describe a large kinship with inherited hip OA and its associated susceptibility locus

was >50/100mm in 64.2% of patients, on a visual analogic scale at the time of diagnosis. Median pain durationwas 1 year (Interquartile range: 7months 3.5 years). Obesity was present in 52% of patients, hypertension in 37.2% and diabetes in 8.8%. Knee x-ray showed that 35.5% of patients were beyond grade III according to Kellgen and Lawrence classification. Bilateral bi-compartmental knee osteoarthritis was found in 38.5% of patients, followed by bilateral tri-compartmental knee osteoarthritis in 14.2%. Pain intensity did not correlate with radiological findings whereas there was a positive correlation between pain and Lequesne disability index. Conclusion: Knee osteoarthritis is common in patients in Cameroon. Most patients present at later stages of the disease with a high disability index in a setting where access to health care is limited.

De auteurs hebben bij 50 patienten de klinische en rontgenologische gegevens en latere gevolgen van vormen van whiplashtrauma na nekdistorsies onderzocht (bij 17 mannen en 33 vrouwen met een gemiddelde leeftijd van 33 jaar).

Fifty-one consecutive patients with metastatic lesions of the cervical spine were treated surgically. The most common primary tumor types were breast cancer and myeloma. In 14 (27%) patients, the cervical lesion was the first manifestation of the malignancy. All patients suffered from severe pain but only six had long tract symptoms. Five tetraparetic patients were confined to bed. Vertebral body collapse occurred in 73% of cases. The surgical technique was individualized according to the patient's general condition, the site of metastasis on the vertebra, and the level and number of levels bearing in mind that the treatment is palliative in nature. The goal of treatment was a better quality of life. In the upper cervical spine the technique described by Sjostrom et al. was used, if technically possible. If the odontoid process had been totally destroyed, an occipitocervical stabilization was chosen. In the lower cervical spine, an anterior approach was used to resect the tumor growth. Anterior support was provided with bone cement if the patient was not expected to survive long; otherwise bone grafting was used. In cases with two or more levels of involvement, a combined anteroposterior stabilization was usually performed. Good pain relief was achieved postoperatively. The operation was generally well-tolerated by the patients, mild dysphagia being the most common complaint. One patient died 2 days postoperatively of heart failure, giving a post-operative mortality of 2%. Rhizopathy symptoms were relieved totally in 15 patients and partially in 6. Five of six tetraparetic patients could walk postoperatively. Mechanical failures occurred three times, due to local progress of the metastatic lesion, which led to reoperation on two occasions. The average postoperative survival was 12 months. Patients with metastases from breast cancer or myeloma had the longest survival. Our study suggests that stabilization is important in the cervical spine when metastatic lesions jeopardize stability. Stabilization is effective in relieving pain and preventing paraplegia.

To assess the effect of workplace-oriented dietary intervention on serum lipids.A cohort study. Screening for blood lipids and subsequent dietary intervention performed at a ferro-alloy factory where all the workers have at least one meal per working day served by the factory kitchen.Employees at Grundartangi ferro-alloy factory, Iceland.From 1 June 1989 to 1 June 1991, 155 workers participated in the screening and prevention programme.Changing the food served by the kitchen to 200 workers by lowering the total number of calories and increasing the content of fibre and unsaturated fats in the diet.The mean serum cholesterol was lowered from 6.64 to 6.09 mmol/l or by -8.28% for the whole group (p0.001) after two years of intervention. In the subgroups studied, serum high density lipoprotein (HDL) increased (p0.001), whereas serum low density lipoprotein (LDL) decreased. Cholesterol/HDL and LDL/HDL ratios were reduced. General dietary habits seemed to change in a favourable way. No significant change occurred in body mass index or smoking habits, and there was little effect on exercise habits.Workplace dietary intervention seems to be effective in reducing cardiovascular risk factors. Information provided to the kitchen staff is of importance, as well as information given to the employees, in order to obtain beneficial results from dietary change.