Using B-mode ultrasound to evaluate Risser grading for the determination of skeletal maturity in adolescents.

INTRODUCTION: Rapid adolescent growth is associated with an increased risk of disease and disease progression. This study assesses the reliability and validity of non-ionising B-mode ultrasound for the assessment of skeletal maturity (Risser Grade) and offers procedural guidelines for its use. METHODS: Twenty-three female adolescents with primary-right-thoracic scoliosis (age: 13.8 (1.6) years) and twenty age-matched female control participants without scoliosis (age: 13.1 (1.8) years) were recruited. Skeletal maturity was determined from (i) a series of nine B-mode ultrasound images collected at sites equally spaced between the anterior and posterior superior iliac spines of the pelvis and (ii) clinical spine radiographs obtained as part of standard scoliosis care. Inter-rater reliability was assessed between a novice researcher and an experienced medical doctor. Concurrent-validity was assessed by comparing the location and degree of apophysis growth and fusion obtained via ultrasound with that obtained using radiograph Risser grading for scoliosis participants only. RESULTS: The inter-rater reliability of ultrasound Risser grading was strong [ICC(2,1): 0.99, p < 0.001]. High concurrent-validity was determined, with no difference in Risser grading identified between the radiograph and ultrasound grading methods (Wilcoxon signed-rank: Z = -1.93, p = 0.053). CONCLUSION: Ultrasound provides a reliable non-ionising alternative to the gold standard of Risser grading from radiographs to determine and monitor skeletal maturity. This study provides a detailed methodology for using ultrasound to assess skeletal maturity. IMPLICATIONS FOR PRACTICE: Rapid adolescent growth is associated with an increased risk of disease and disease progression. Therefore, accurately determining and monitoring skeletal maturity in these adolescents is crucial. This study assesses the reliability and validity of non-ionising B-mode ultrasound for the assessment of skeletal maturity and offers procedural guidelines for its use.

Oxymetazoline nasal spray three times daily for four weeks in normal subjects is not associated with rebound congestion or tachyphylaxis.

Topical decongestants are available over the counter and provide rapid relief of nasal obstruction for conditions of short duration, for example the common cold. Manufacturers' recommendations are that topical decongestants should not be used regularly for more than 1 week in view of the risk of rebound mucosal hyperaemia with persistent nasal obstruction and refractoriness to further effects of decongestants. For this reason we performed a randomised double-blind placebo-controlled trial in 30 normal adult subjects with 0.05% oxymetazoline nasal spray 2 sprays (0.1 ml/spray) to each nostril 3 times daily over an extended period of 4 weeks. Degree of nasal blockage was assessed before and after 4 weeks treatment and for 2 weeks following discontinuation of treatment. Outcome measures included diary symptom scores and measurements of nasal peak inspiratory flow, airway resistance (using posterior active rhinomanometry) and volume (using acoustic rhinometry). Nasal patency was assessed at baseline and 15 minutes after oxymetazoline challenge at each clinic visit. Results demonstrated no significant increases in subjective nasal blockage throughout the 6 weeks study period in either oxymetazoline- or placebo-treated subjects. No significant differences were observed between groups for baseline measurements of nasal peak inspiratory flow, airway resistance or volume at each clinic visit. A highly significant decongestant effect of oxymetazoline was observed at each clinic visit with changes in all 3 measurements for both treatment groups, again with no significant differences between groups. In summary, in normal subjects, we identified no significant nasal blockage or impaired decongestant response to oxymetazoline following 4 weeks treatment with oxymetazoline compared to matched placebo nasal spray.

Tasmanian survey of pill symptoms.

OBJECTIVE: To investigate young women who were currently using oral contraceptives with respect to their satisfaction, side effects, understanding of long term benefits and anxieties. METHOD: The survey was completed by 227 attendees at Family Planning Tasmania who completed a survey questionnaire during their visit. RESULTS: Seventy-eight per cent of respondents were 'very happy' or 'happy' with oral contraceptives. Overall the group reported shorter, lighter and less painful periods when compared prior to pill use, with slight increase in breast swelling and tenderness as well as fluid retention. Overall there was weight gain more often than weight loss during pill use. There was very poor understanding of the long term benefits of pill use. DISCUSSION: Although oral contraceptives are the most effective form of contraceptive, many women discontinue their use because of side effects. If women are warned about these possible effects, they may be more prepared to tolerate them. However, there is very little objective data available on the incidence of various effects on Australian women. This study shows that the single most important side effect reported was weight gain, and that we recommend that women be counselled about diet when commencing the pill. There also needs to be education about the numerous beneficial long term effects of oral contraceptive use.

Inadvertent pregnancies in oral contraceptive users.

Two hundred and nine inadvertent pregnancies in oral contraceptive users were studied to determine the associated factors. The percentage of Pill types also were compared with the market usage over the same period. We found that the classically-suggested cofactors, such as missed pills, late pills, drug ingestion, and gastrointestinal upsets were reported commonly. The triphasic Pills also were represented more frequently than would have been expected from their share of the market.

PIP: Although oral contraceptives (OCs) are the most effective form of reversible fertility control, inadvertent pregnancies do occur in OC users. The most common causes of these pregnancies seem to be missed pills, drug interactions, and malabsorption resulting from vomiting or diarrhea. To assess the relative importance of these causes, a pilot study was conducted at family planning centers in Australia. In response to a questionnaire, 12 centers reported 209 cases of OC-associated inadvertent pregnancy occurring between December 1985 and July 1986. Triphasic OCs were used by 52% of these women, while only 42% of Australian women overall use this type of formulation. 35% of women with inadvertent pregnancies reported they had missed taking pills; another 25% had taken a pill late (at least 36 hours after the previous tablet). 34% of these women had used drugs believed to interact with OCs in their last 2 cycles before conception. In the majority of these cases (67%), these were antibiotic agents--most often amoxicillin. 27% reported vomiting or diarrhea in association with OC failure. Finally, 22% of the women had suffered some form of illness (various respiratory, urinary, and gastrointestinal infections) since the last menstrual cycle. 16% of the women experienced breakthrough bleeding in the cycle in which conception occurred. No predisposing factors could be identified in 14% of the women with unintended pregnancies. The most significant finding of this study is the higher rate of inadvertent pregnancies among users of triphasic as opposed to monophasic OCs. Also confirmed were the well-recognized risks of missed pills, late pills, drug interactions, and diarrhea and vomiting. OC users should be advised to take additional contraceptive precautions until at least 7 consecutive tablets have been taken after an episode that may impair the efficacy of the pill.