The sacroiliac auricular surface has a variable morphology and size. The impact of such variation... more The sacroiliac auricular surface has a variable morphology and size. The impact of such variations on subchondral mineralization distribution has not been investigated. Sixty‐nine datasets were subjected to CT‐osteoabsorptiometry for the qualitative visualization of chronic loading conditions of the subchondral bone plate using color‐mapped densitograms based on Hounsfield Units in CT. Auricular surface morphologies were classified into three types based on posterior angle size: Type 1: >160°, Type 2: 130–160° and Type 3: <130°. Auricular surface size was categorized based on the mean value (15.4 cm2) separating the group into ‘small’ and ‘large’ joint surfaces. Subchondral bone density patterns were qualitatively classified into four color patterns: two marginal patterns (M1 and M2) and two non‐marginal patterns (N1 and N2) and each iliac and sacral surface was subsequently categorized. ‘Marginal’ meant that 60–70% of the surface was less mineralized compared with the highly dense regions and vice versa for the ‘non‐marginal’ patterns. M1 had anterior border mineralization and M2 had mineralization scattered around the borders. N1 had mineralization spread over the whole superior region, N2 had mineralization spread over the superior and anterior regions. Auricular surface area averaged 15.4 ± 3.6 cm2, with a tendency for males to have larger joint surfaces. Type 2 was the most common (75%) and type 3 the least common morphology (9%). M1 was the most common pattern (62% of surfaces) by sex (males 60%, females 64%) with the anterior border as the densest region in all three morphologies. Sacra have a majority of surfaces with patterns from the marginal group (98%). Ilia have mineralization concentrated at the anterior border (patterns M1 and N2 combined: 83%). Load distribution differences related to auricular surface morphology seems to have little effect on long‐term stress‐related bone adaptation visualized with CT‐osteoabsorptiometry. Higher iliac side mineralization was observed in larger joint surfaces and age‐related morphomechanical size alterations were seen in males.
Sacroiliac joint dysfunction (SIJD) is an underappreciated source of back pain. Mineralization pa... more Sacroiliac joint dysfunction (SIJD) is an underappreciated source of back pain. Mineralization patterns of the sacroiliac (SIJ) subchondral bone plate (SCB) may reflect long-term adaptations to the loading of the joint. Mineralization densitograms of 27 SIJD patients and 39 controls, were obtained using CT osteoabsorptiometry. Hounsfield unit (HU) values of the SCB mineralization of superior, anterior and inferior regions on the iliac and sacral auricular surfaces were derived and statistically compared between SIJD-affected and control cohorts. Healthy controls showed higher HU values in the iliac; 868 ± 211 (superior), 825 ± 121 (anterior), 509 ± 114 (inferior), than in the sacral side; 541 ± 136 (superior), 618 ± 159 (anterior), 447 ± 91 (inferior), of all regions (p < 0.01). This was similar in SIJD; ilium 908 ± 170 (superior), 799 ± 166 (anterior), 560 ± 135 (inferior), sacrum 518 ± 150 (superior), 667 ± 151 (anterior), 524 ± 94 (inferior). In SIJD, no significant HU differe...
We have undertaken a phase 1 — phase 2 study of the effectiveness of photoirradiation therapy or ... more We have undertaken a phase 1 — phase 2 study of the effectiveness of photoirradiation therapy or photodynamic therapy (PDT) in the treatment of advanced esophageal cancer.
Aim: To emphasise osteitis as a feature of the spondyloarthritides. Method: We describe four case... more Aim: To emphasise osteitis as a feature of the spondyloarthritides. Method: We describe four cases spanning a spectrum of the spondyloarthritides in which osteitis was a feature. Results: One patient had psoriatic arthritis with palmar-plantar pustular psoriasis and extensive osteitis involving the tibia and fibula. This case provides a link with two cases with SAPHO syndrome (synovitis, acne, pustulosis hyperostosis, osteitis) who had palmar-plantar pustulosis and osteitis. Many now argue that this syndrome is a form of spondyloarthritis. The fourth case, which was of particular interest to us, had enteric reactive arthritis and scintigraphic changes strongly suggesting the presence of osteitis of individual bones in the wrist. Conclusion: We propose that these four cases demonstrate that osteitis may be another feature common to the spondyloarthritides and SAPHO. Awareness of this may facilitate better documentation of this feature of the disease.
This book outlines the various procedures necessary for the successful practice of diagnostic rad... more This book outlines the various procedures necessary for the successful practice of diagnostic radiology. Topics covered are: general principles, imaging of the urinary and gastrointestinal tracts, vascular radiology, arthrography, and miscellaneous diagnostic radiologic procedures.
Aims: To study the experience of general practitioners in Otago and Southland with the existing b... more Aims: To study the experience of general practitioners in Otago and Southland with the existing breast cancer screening programme and the reviews on future programmes. Methods: A questionnaire was sent to all 210 general practitioners in Otago and Southland in June 1996. Results: The response rate was 71%. All the 141 respondents except one encouraged eligible women to take part in the programme; this was done mainly during individual doctor-patient consultations, by pamphlets and posters, and in the work of the practice nurse. Ten percent of practitioners had a practice-based recall system for breast cancer screening. Seventy-five percent of general practitioners currently provide a list of eligible women to the programme, and of these, 52% check the list to exclude ineligible women. Only 24% of practitioners supplying a patient list to the programme reported that a patient had ever requested that their name be excluded from the list. Twenty-five percent of general practitioners providing lists had a notice in the waiting room stating that. Of those who did not provide lists, concerns about logistics, ethical issues and cost were raised, although 40% of these general practitioners intended to provide lists in the future. In a future programme, 57% of general practitioners felt they should be paid for supplying lists defined by age only and 82% felt they should be paid for supplying a list of women eligible by both age and medical history. Most general practitioners felt that general practitioner lists were the preferred source for invitations to the breast screening programme and that general practitioners had an important part in any future programme. Screening at the ages 50-64 (as currently proposed) is supported by 95% of general practitioners; in addition, 64% supported screening at ages 65-69. Only a minority of general practitioners supported screening at ages 40-49 or ages 70-74. Most general practitioners would offer screening to women under age 50 with either a strong or a weak family history, or even with a past history of a fibroadenoma. Conclusions: These results show that almost all general practitioners support breast cancer screening programmes and feel that they have an important role in future programmes. The majority support extension of the programme to ages 65-69, but not to ages 40-49. The majority support screening women with individual risk factors at ages under 50, although their responses show that better information on the importance of different risk factors is required.
Background: The sacroiliac joint (SIJ) forms a complex joint and has shown to be underappreciated... more Background: The sacroiliac joint (SIJ) forms a complex joint and has shown to be underappreciated in its involvement with lower back pain. Research efforts have intensified on SIJ anatomy and biomechanics because of its predisposing position to pain and dysfunction in individuals suffering from lower back discomfort. Previous work has focused on SIJ anatomy including bone and joint structure, innervation, as well as biomechanics and the treatment of SIJ pain. However, to date, no review exists describing the range of 'normal' anatomic features of the SIJ. Objectives: To describe the normal appearance of the SIJ and adjacent tissues, as opposed to 'abnormal' conditions involving SIJ morphology. It will also identify key areas that require further study because of lacking information or disagreement. Study design: A systematic literature review. Setting: The research took place at the University of Otago, New Zealand. All published research on 'normal SIJ anatomy' available from MEDLINE, OVID, Scopus, Web of Science, PubMed, and Science Direct were included, available until December 2018, in English, French, and German. Subject areas included bony landmarks, joint type, bone morphology, ligamentous attachments, muscular and fascial relationships, blood supply, fatty infiltration, and morphologic variation. Methods: Articles met the selection criteria if they contained specific information on SIJ anatomy, including bone morphology and architecture, ligaments, muscle attachments, innervation, vasculature, and the presence of fat. Biomechanics and kinematics related keywords were used as the literature often couples these with the anatomy. Keywords of individual articles were named as 'structures of interest.' Results: A total of 88 primary and 101 secondary articles were identified in the time frame from 1851 to 2018. Primary articles provided quantitative data and detailed anatomic descriptions. Secondary articles did not focus specifically on the anatomy of the SIJ. Although research appeared to be in general agreement on bony landmarks, joint type, myofascial attachments, vasculature, and innervation of the SIJ, there was only part consensus on ligament attachments and cartilage structure. Information regarding bone density of the articulating surfaces of the SIJ is lacking. Despite its potential clinical significance, fatty infiltration within the joint lacks research to date. Limitations: Only the given databases were used for the initial search. Keyword combinations used for this review may not have been inclusive of all articles relevant to the SIJ. Work in languages other than the ones listed or work that is not available via the internet may be missing. Conclusions: This study provides an overview of normal SIJ structures, including all neuromusculoskeletal elements related to the joint. There is a lack of knowledge on the SIJ ligaments warranting further investigation. Furthermore, there are discrepancies in relation to the nomenclature, layers, attachment sites, and on the topographical relationships between ligamentous tissues and nerves. Subsequent studies on the quantification of fat and bone density in the SIJ have been suggested. These could be useful radiologic parameters to assess the condition of the joint clinically. This review may provide insight into the clinical signs and abnormal biomechanical features of the joint for the purposes of treating SIJ pain. Key words: Bone density, bony landmarks, fat infiltration, innervation, ligaments morphology, muscles, sacroiliac joint, vasculature.
Percutaneous biopsy procedures using current imaging methods are becoming increasingly popular. T... more Percutaneous biopsy procedures using current imaging methods are becoming increasingly popular. The result of a percutaneous biopsy may lead to a total rejection of surgery, and dictate appropriate palliative therapy in a patient with incurable malignant disease; in others, it will allow more precise preoperative planning. The techniques of percutaneous computed tomographic biopsy procedures is discussed, along with its advantages and disadvantages in comparison with other imaging methods.
The technique of computed tomographic guided drainage of abdominal abscesses is simple, and is be... more The technique of computed tomographic guided drainage of abdominal abscesses is simple, and is becoming increasingly available. Obvious advantages include the avoidance of general anaesthesia and major surgery. Three illustrative cases of the drainage of abscesses in different locations are presented together with a description of the technique.
The sacroiliac auricular surface has a variable morphology and size. The impact of such variation... more The sacroiliac auricular surface has a variable morphology and size. The impact of such variations on subchondral mineralization distribution has not been investigated. Sixty‐nine datasets were subjected to CT‐osteoabsorptiometry for the qualitative visualization of chronic loading conditions of the subchondral bone plate using color‐mapped densitograms based on Hounsfield Units in CT. Auricular surface morphologies were classified into three types based on posterior angle size: Type 1: &gt;160°, Type 2: 130–160° and Type 3: &lt;130°. Auricular surface size was categorized based on the mean value (15.4 cm2) separating the group into ‘small’ and ‘large’ joint surfaces. Subchondral bone density patterns were qualitatively classified into four color patterns: two marginal patterns (M1 and M2) and two non‐marginal patterns (N1 and N2) and each iliac and sacral surface was subsequently categorized. ‘Marginal’ meant that 60–70% of the surface was less mineralized compared with the highly dense regions and vice versa for the ‘non‐marginal’ patterns. M1 had anterior border mineralization and M2 had mineralization scattered around the borders. N1 had mineralization spread over the whole superior region, N2 had mineralization spread over the superior and anterior regions. Auricular surface area averaged 15.4 ± 3.6 cm2, with a tendency for males to have larger joint surfaces. Type 2 was the most common (75%) and type 3 the least common morphology (9%). M1 was the most common pattern (62% of surfaces) by sex (males 60%, females 64%) with the anterior border as the densest region in all three morphologies. Sacra have a majority of surfaces with patterns from the marginal group (98%). Ilia have mineralization concentrated at the anterior border (patterns M1 and N2 combined: 83%). Load distribution differences related to auricular surface morphology seems to have little effect on long‐term stress‐related bone adaptation visualized with CT‐osteoabsorptiometry. Higher iliac side mineralization was observed in larger joint surfaces and age‐related morphomechanical size alterations were seen in males.
Sacroiliac joint dysfunction (SIJD) is an underappreciated source of back pain. Mineralization pa... more Sacroiliac joint dysfunction (SIJD) is an underappreciated source of back pain. Mineralization patterns of the sacroiliac (SIJ) subchondral bone plate (SCB) may reflect long-term adaptations to the loading of the joint. Mineralization densitograms of 27 SIJD patients and 39 controls, were obtained using CT osteoabsorptiometry. Hounsfield unit (HU) values of the SCB mineralization of superior, anterior and inferior regions on the iliac and sacral auricular surfaces were derived and statistically compared between SIJD-affected and control cohorts. Healthy controls showed higher HU values in the iliac; 868 ± 211 (superior), 825 ± 121 (anterior), 509 ± 114 (inferior), than in the sacral side; 541 ± 136 (superior), 618 ± 159 (anterior), 447 ± 91 (inferior), of all regions (p < 0.01). This was similar in SIJD; ilium 908 ± 170 (superior), 799 ± 166 (anterior), 560 ± 135 (inferior), sacrum 518 ± 150 (superior), 667 ± 151 (anterior), 524 ± 94 (inferior). In SIJD, no significant HU differe...
We have undertaken a phase 1 — phase 2 study of the effectiveness of photoirradiation therapy or ... more We have undertaken a phase 1 — phase 2 study of the effectiveness of photoirradiation therapy or photodynamic therapy (PDT) in the treatment of advanced esophageal cancer.
Aim: To emphasise osteitis as a feature of the spondyloarthritides. Method: We describe four case... more Aim: To emphasise osteitis as a feature of the spondyloarthritides. Method: We describe four cases spanning a spectrum of the spondyloarthritides in which osteitis was a feature. Results: One patient had psoriatic arthritis with palmar-plantar pustular psoriasis and extensive osteitis involving the tibia and fibula. This case provides a link with two cases with SAPHO syndrome (synovitis, acne, pustulosis hyperostosis, osteitis) who had palmar-plantar pustulosis and osteitis. Many now argue that this syndrome is a form of spondyloarthritis. The fourth case, which was of particular interest to us, had enteric reactive arthritis and scintigraphic changes strongly suggesting the presence of osteitis of individual bones in the wrist. Conclusion: We propose that these four cases demonstrate that osteitis may be another feature common to the spondyloarthritides and SAPHO. Awareness of this may facilitate better documentation of this feature of the disease.
This book outlines the various procedures necessary for the successful practice of diagnostic rad... more This book outlines the various procedures necessary for the successful practice of diagnostic radiology. Topics covered are: general principles, imaging of the urinary and gastrointestinal tracts, vascular radiology, arthrography, and miscellaneous diagnostic radiologic procedures.
Aims: To study the experience of general practitioners in Otago and Southland with the existing b... more Aims: To study the experience of general practitioners in Otago and Southland with the existing breast cancer screening programme and the reviews on future programmes. Methods: A questionnaire was sent to all 210 general practitioners in Otago and Southland in June 1996. Results: The response rate was 71%. All the 141 respondents except one encouraged eligible women to take part in the programme; this was done mainly during individual doctor-patient consultations, by pamphlets and posters, and in the work of the practice nurse. Ten percent of practitioners had a practice-based recall system for breast cancer screening. Seventy-five percent of general practitioners currently provide a list of eligible women to the programme, and of these, 52% check the list to exclude ineligible women. Only 24% of practitioners supplying a patient list to the programme reported that a patient had ever requested that their name be excluded from the list. Twenty-five percent of general practitioners providing lists had a notice in the waiting room stating that. Of those who did not provide lists, concerns about logistics, ethical issues and cost were raised, although 40% of these general practitioners intended to provide lists in the future. In a future programme, 57% of general practitioners felt they should be paid for supplying lists defined by age only and 82% felt they should be paid for supplying a list of women eligible by both age and medical history. Most general practitioners felt that general practitioner lists were the preferred source for invitations to the breast screening programme and that general practitioners had an important part in any future programme. Screening at the ages 50-64 (as currently proposed) is supported by 95% of general practitioners; in addition, 64% supported screening at ages 65-69. Only a minority of general practitioners supported screening at ages 40-49 or ages 70-74. Most general practitioners would offer screening to women under age 50 with either a strong or a weak family history, or even with a past history of a fibroadenoma. Conclusions: These results show that almost all general practitioners support breast cancer screening programmes and feel that they have an important role in future programmes. The majority support extension of the programme to ages 65-69, but not to ages 40-49. The majority support screening women with individual risk factors at ages under 50, although their responses show that better information on the importance of different risk factors is required.
Background: The sacroiliac joint (SIJ) forms a complex joint and has shown to be underappreciated... more Background: The sacroiliac joint (SIJ) forms a complex joint and has shown to be underappreciated in its involvement with lower back pain. Research efforts have intensified on SIJ anatomy and biomechanics because of its predisposing position to pain and dysfunction in individuals suffering from lower back discomfort. Previous work has focused on SIJ anatomy including bone and joint structure, innervation, as well as biomechanics and the treatment of SIJ pain. However, to date, no review exists describing the range of 'normal' anatomic features of the SIJ. Objectives: To describe the normal appearance of the SIJ and adjacent tissues, as opposed to 'abnormal' conditions involving SIJ morphology. It will also identify key areas that require further study because of lacking information or disagreement. Study design: A systematic literature review. Setting: The research took place at the University of Otago, New Zealand. All published research on 'normal SIJ anatomy' available from MEDLINE, OVID, Scopus, Web of Science, PubMed, and Science Direct were included, available until December 2018, in English, French, and German. Subject areas included bony landmarks, joint type, bone morphology, ligamentous attachments, muscular and fascial relationships, blood supply, fatty infiltration, and morphologic variation. Methods: Articles met the selection criteria if they contained specific information on SIJ anatomy, including bone morphology and architecture, ligaments, muscle attachments, innervation, vasculature, and the presence of fat. Biomechanics and kinematics related keywords were used as the literature often couples these with the anatomy. Keywords of individual articles were named as 'structures of interest.' Results: A total of 88 primary and 101 secondary articles were identified in the time frame from 1851 to 2018. Primary articles provided quantitative data and detailed anatomic descriptions. Secondary articles did not focus specifically on the anatomy of the SIJ. Although research appeared to be in general agreement on bony landmarks, joint type, myofascial attachments, vasculature, and innervation of the SIJ, there was only part consensus on ligament attachments and cartilage structure. Information regarding bone density of the articulating surfaces of the SIJ is lacking. Despite its potential clinical significance, fatty infiltration within the joint lacks research to date. Limitations: Only the given databases were used for the initial search. Keyword combinations used for this review may not have been inclusive of all articles relevant to the SIJ. Work in languages other than the ones listed or work that is not available via the internet may be missing. Conclusions: This study provides an overview of normal SIJ structures, including all neuromusculoskeletal elements related to the joint. There is a lack of knowledge on the SIJ ligaments warranting further investigation. Furthermore, there are discrepancies in relation to the nomenclature, layers, attachment sites, and on the topographical relationships between ligamentous tissues and nerves. Subsequent studies on the quantification of fat and bone density in the SIJ have been suggested. These could be useful radiologic parameters to assess the condition of the joint clinically. This review may provide insight into the clinical signs and abnormal biomechanical features of the joint for the purposes of treating SIJ pain. Key words: Bone density, bony landmarks, fat infiltration, innervation, ligaments morphology, muscles, sacroiliac joint, vasculature.
Percutaneous biopsy procedures using current imaging methods are becoming increasingly popular. T... more Percutaneous biopsy procedures using current imaging methods are becoming increasingly popular. The result of a percutaneous biopsy may lead to a total rejection of surgery, and dictate appropriate palliative therapy in a patient with incurable malignant disease; in others, it will allow more precise preoperative planning. The techniques of percutaneous computed tomographic biopsy procedures is discussed, along with its advantages and disadvantages in comparison with other imaging methods.
The technique of computed tomographic guided drainage of abdominal abscesses is simple, and is be... more The technique of computed tomographic guided drainage of abdominal abscesses is simple, and is becoming increasingly available. Obvious advantages include the avoidance of general anaesthesia and major surgery. Three illustrative cases of the drainage of abscesses in different locations are presented together with a description of the technique.
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