Aim:We investigated whether anthropometric measurements or metabolic risk factors correlated more with vascular changes associated with obesity. Methods: One hundred never smoking subjects (71 women, 29 men) without vascular events, with blood pressure (BP) o140/ 90 mm Hg, LDL cholesterol o4 mmol/l, glucose o6.2 mmol/l participated. Anthropometric measurements (body mass index (BMI), waist/hip ratio (WHR), waist circumference (WC) and Waist/height ratio WHTR) and metabolic risk factors (glucose, insulin, lipid and uric acid levels plus BP) were assessed. Subjects underwent vascular measurements (Carotid intima-media thickness (IMT) using duplex ultrasonography, vascular stiffness assessment (Augmentation Index) by applanation tonometry and brachial artery reactivity tests). Results: Risk factors were in the 'normal distribution'. BMI, WHR, WC, WHTR correlated significantly with triglyceride, HDL, LDL, insulin, glucose, uric acid and systolic BP levels (Po0.001). IMT correlated with WHTR, BMI, WC, Glucose (Po0.001), Homoeostasis Model Assessment (HOMA) and cholesterol levels (Po0.05). Only Age, WHTR or BMI were significant correlates of IMT in a multivariate analysis (Po0.01) including WHTR or BMI, with age, sex, systolic BP, HDLc and HOMA. Augmentation Index correlated with age (Po0.0001), WHTR and WC (Po0.0005) but with age only in a multivariate analysis. Brachial reactivity did not correlate with any anthropometric or metabolic parameters. Anthropometric cutoff points, (BMI X25, WC X102 cm men, X88 cm women, WHR X0.9 men, X0.8 women and WHTR X0.5 men and women) significantly differentiated normal from abnormal metabolic and vascular measurements. The WHTR ratio X0.5 was as reliable as the BMI cutoff X25 in determining metabolic and vascular abnormalities. BMI and WHTR were strongly associated with 89% agreement (Po0.0001). Conclusion: These results demonstrated that in 'healthy individuals', anthropometric parameters and metabolic risk factors correlated with each other, but anthropometric parameters were the only significant correlates of carotid IMT. A waist/height ratio X0.5 predicts both early vascular and metabolic changes. These data support a risk factor independent vasculotrophic effect of obesity.

The proximal tibiofibular joint is often neglected in the evaluation of lateral knee pain. The images presented in this article highlight the diverse disorders of this area. Because this joint is usually in the field of view in radiography, CT, and MRI of the knee, evaluation of it should be a part of all knee imaging assessments.

Novel approaches to percutaneous gastrostomy have evolved because of catheter clogging and displacement, which is commonly seen with currently available gastrostomy catheters. Low-profile button gastrostomy catheters, designed to be inserted into mature tracts, have recently been inserted into fresh gastrostomy tracts. Catheter clogging rarely occurs with these low-profile devices. Catheter displacement remains a problem but new buttons can be inserted at the patient's bedside without the need for a return visit to the radiology department. A 90 to 100% success rate has been shown for placement of gastrostomy buttons. Pull-type endoscopic gastrostomy catheters can be placed radiologically using a standard puncture of the stomach and cannulation of the gastroesophageal junction. A guide wire is manipulated up the esophagus and out the mouth. The pull-type gastrostomy catheter is then attached and pulled down through the esophagus and out through the anterior abdominal wall. These catheters have very good retention devices and rarely become dislodged. Catheter clogging is also rarely seen, provided larger devices are used. Radiological placement of percutaneous endoscopic gastrostomy tubes has been termed the ''hybrid method'' and has been shown to be cheaper than endoscopic and other fluoroscopic methods of gastrostomy.

There are significant problems to consider when we reflect on ''Standards for Gynecologic Surgery.'' Surely most professional standards are already in place, or are they? Are standards already available, locally, nationally, or internationally? Where those standards are not already available will it be possible set new standards for the multiplicity of operative interventions, performed by an array of trainees, specialists, and colleagues many of whom are outside of our remit and spread over the continents? If we do set standards how do we audit outcomes to gynecologic surgery and insure that the standards are being complied with? How do we tutor our trainees effectively and also insure that established specialists retain their skill base, are up-to-date, and compliant with continuing medical education? It is important to realize that the success or failure of a modern surgical investigation or procedure will now be judged not on the pure surgical outcome alone, but will also need to reflect patient focus through excellence in the areas of communication, patient information, informed consent and confidentiality. The accessibility to services, appropriate environment, and processes being offered by trained and competent staff members-who are supervised when required-should all be included in audits of outcomes set against agreed auditable standards.