Thirty-one cases of stage 1 or 2 osteonecrosis (ON) of the hip in 27 patients were studied with T1-weighted coronal magnetic resonance (MR) imaging. Three quantitative parameters were measured on the contiguous MR sections, corresponding to the 2-cm-wide median portion of the femoral head: the angle filled by ON (alpha), the percentage of weight-bearing femoral cortex involved with ON (WB), and the percentage of femoral head surface involved with ON. The clinical and radiologic courses were assessed after at least 2 years of follow-up (mean, 46 months). Core decompression was performed in 12 cases of ON. Values were strikingly lower in the group with good clinical or radiologic outcome versus poor outcome, with very little overlapping. WB was the more reliable parameter. Outcome of hips treated with versus without core decompression appeared closely related with these MR parameters and not with the treatment procedure. Thus, a quantitative approach to determination of extent and location of the lesion on the initial MR image appears accurate for use in the prediction of long-term outcome of ON. Effectiveness of core decompression should be reevaluated on this basis.
Seronegative spondylarthropathies are disorders with the same predisposing antigen, namely HLA B27, a class I molecule of the HLA system. The mechanisms of the different diseases are unknown, and there is no proof of immune system participation. We have investigated patients with spondylarthropathies in order to search for an immunological component in the pathophysiology of these disorders, by measuring the serum level of two inflammatory cytokines--IL1 beta and TNF alpha--by a radioimmunological assay and the serum level of two soluble T cell activation markers--soluble IL2 receptor and soluble CD8--by an enzyme-linked immunosorbent assay. The choice of soluble CD8 can be explained by the strong link between HLA B27 and spondylarthropathies. Our series compared 24 patients to 24 healthy matched controls. A similar IL1 beta serum level was observed in both groups, while in the patients there was a nonsignificant increase in the TNF alpha level, a significant decrease in the soluble IL2 receptor level and a significant increase in the soluble CD8 serum level. The normal or moderately increased serum IL1 beta and TNF alpha levels in the disease group do not exclude a local role for these cytokines in the synovium or other inflammatory areas. However, we found a higher soluble CD8 serum level in the patient group. Most of these patients were in clinical exacerbation of their disease. As the serum level of soluble CD8 is well correlated with T CD8 lymphocyte activation, our data suggest that this lymphocyte subset is stimulated and consequently probably involved in seronegative spondylarthropathies.
In everyday practice, triple therapy is safe but has moderate efficacy, especially for patients over 65 years of age, with advanced fibrosis, non-responders to peginterferon + ribavirin.
A newborn with a prenatal diagnosis of right hydroureteronephrosis and enlarged penis is presented. At birth, the baby had an imperforate anus (IA) with a megalourethra; radiologic and ultrasonographic studies showed a left polycystic kidney and right hydroureteronephrosis, right vesicoureteral reflux, and an incomplete urethral duplication with dilatation of the posterior urethra. The IA was corrected on the 1st day of life and a vesicostomy was performed at 1 month. At 1 year of age the valve obstructing the ventral posterior urethra was resected and the vesicostomy was closed. At 14 months the baby underwent a urethroplasty with a vertical preputial tubularized island flap and excision of the penile urethral duplication. Exact knowledge of the malformation was essential in planning the appropriate surgical treatment.
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