Diagnostic Accuracy of Symptoms, Endoscopy, and Imaging Signs of Chronic Rhinosinusitis Without Nasal Polyps Compared to Allergic Rhinitis.

Objectives The diagnosis of chronic rhinosinusitis without nasal polyps (CRSsNP) and distinguishing it from allergic rhinitis is difficult. Yet, early detection of CRSsNP is important to prevent progressive and severe chronic rhinosinusitis. Our aim was to compare diagnostic accuracy of symptoms, endoscopy, and imaging signs of CRSsNP and allergic rhinitis -only phenotypes. Setting Prospective controlled follow-up study. Participants Forty-two nonsmoking patients visiting tertiary care due to CRSsNP and 19 nonsmoking volunteer controls with allergic rhinitis filled a symptoms questionnaire and underwent nasal endoscopy off-seasonally. All CRSsNP patients underwent computed tomography scans of paranasal sinuses. All the allergic rhinitis control subjects and 14 of the CRSsNP patients underwent sinus magnetic resonance imaging. Results Radiologic Lund-Mackay score, duration of symptoms, visual analogue scale scores of symptoms, and Sinonasal Outcome Test 22 were significantly higher in the CRSsNP group compared to allergic rhinitis control group. These factors also correlated in part with each other. Endoscopic score did not correlate with other factors, nor did it differ between CRSsNP and allergic rhinitis groups. The highest area under curve value was demonstrated for visual analogue scale score of facial pain/pressure (0.93) and score ≥4/10 showed 60% sensitivity and 95% specificity for detecting CRSsNP group ( P < .001). Radiologic sign of obstructed osteomeatal complex showed 100% specificity and 38% sensitivity for detecting CRSsNP group ( P < .001). Conclusions CRSsNP phenotype could be primarily distinguished from allergic rhinitis by higher facial pain/pressure score and secondarily by radiologic sings of obstructed ostiomeatal complex and higher Lund-Mackay score. Endoscopic score has limited value in distinguishing CRSsNP from allergic rhinitis.

Load-specific differences in the structure of femoral neck and tibia between world-class moguls skiers and slalom skiers.

Bone structure of weight-bearing proximal femur and tibia was examined among the Finnish world-class moguls skiers and slalom skiers. We hypothesized that these bones, during typical sport-specific performance, had been subjected not only to extreme loading but also to distinct loading in terms of rate and primary direction. Bone [dual-energy X-ray absorptiometry (DXA), peripheral quantitative computed tomography (pQCT), magnetic resonance imaging] and muscle performance data of the lower extremities were obtained from the five Finnish male moguls skiers and six slalom skiers competing at the World Cup level. Data (DXA, pQCT) from 12 age- and weight-matched normally active men were used for comparison. The ANCOVA with body height as a covariate was used for statistical analysis. The weight-bearing bones of the athletes were 10-60% stronger than those of the normally active men. Compared with the moguls skiers, the slalom skiers showed an average 43% thicker anterior cortex at the narrowest region of the femoral neck. This study suggests that the bone structure at skiers' heavily loaded lower extremities was very robust. A specific finding was the thick anterior cortex of the femoral neck among the slalom skiers. Apparently, the predominant loading type had modulated the site-specific skeletal response to physical exertion.

Magnetic resonance imaging of the femoral neck cortex.

PURPOSE: To determine the in vivo precision and accuracy of magnetic resonance imaging (MRI) in evaluating the thin (approximately mm) femoral neck cortex. MATERIAL AND METHODS: Hip regions of 30 volunteers were scanned with standard 1.5 T MRI twice with repositioning, and the images of the narrow-neck cross-sections were obtained. Two radiologists independently delineated periosteal and endosteal cortical boundaries, and several structural variables were determined. For precision, 95% limits of agreement and coefficients of variation were calculated. Accuracy was determined with phantoms. RESULTS: In vivo precision of the directly delineated measurements varied from 0.9% (periosteal circumference) to 1.6% (total area), while the precision of the calculated variables remained poorer, from 7.3% (cortical to total area ratio) to 15.1% (torsional rigidity). The root-mean-square error of the cortical thickness measurement was 0.15 mm. CONCLUSION: Thin cortical bone at the narrowest location of the femoral neck can be delineated precisely and accurately with a standard clinical 1.5 T MRI device. MRI provides a feasible tool for the assessment of mechanically important cortical bone at the femoral neck and may be of clinical utility in assessing hip fragility.

Immunocytochemical localization of glucocorticoid receptor in rat skin.

The aim of the present study was to map immunohistochemically the distribution of the glucocorticoid receptor (GR) in rat skin. Nuclear GR-like immunoreactivity (LI) was found in both epidermis and dermis. In the epidermis, the basal cell layer showed an intense immunoreaction; the lower part of the spinous layer was also labelled. In the dermis, the fibroblasts as well as the sweat glands, sebocytes and adipocytes were GR-immunoreactive (IR). In the root sheath of the hair follicle the staining was most intensive in the outer layer. The endothelial cells comprising the smooth muscle cells of the blood vessels, as well as the arrector pili muscle, showed GR-LI. In the peripheral nerves, the immunoreaction was localized to the nuclei of the Schwann cells and in the perineurial fibroblasts. Mast cells did not show nuclear GR-LI. Based on our immunocytochemical findings that several cell types of the skin are GR-IR, the variable physiological and pharmacological effects of glucocorticoids are easier to understand.