The vertebral body growth plate in scoliosis: a primary disturbance of growth?

Study Design and Aims: This was an observational pilot study of the vertebral body growth plates in scoliosis involving high-resolution coronal plane magnetic resonance (MR) imaging and histological examination. One aim of this study was to determine whether vertebral body growth plates in scoliosis demonstrated abnormalities on MR imaging. A second aim was to determine if a relationship existed between MR and histological abnormalities in these vertebral body growth plates. Methods: MR imaging sequences of 18 patients demonstrated the vertebralbody growth plates well enough to detect gross abnormalities/ deficient areas/zones. Histological examination of ten vertebral body growth plates removed during routine scoliosis surgery was performed. Observational histological comparison with MR images was possible in four cases. Results: Four of the 18 MR images demonstrated spines with normal curvature and normal vertebral body growth plates. In 13 scoliotic spines, convex and concave side growth plate deficiencies were observed most frequently at or near the apex of the curve. One MR image demonstrated a 55° kyphosis and no convex or concave side deficiencies. The degree of vertebral body wedging was independent of the presence of vertebral body growth plate deficiency. Histological abnormalities of the vertebral body growth plates were demonstrated in four with MR imaging abnormalities. Conclusion: This study demonstrated MR image abnormalities of scoliotic vertebral body growth plates compared to controls. A qualitative relationship was demonstrated between MR imaging and histological abnormalities. The finding that vertebral body growth plate deficiencies occurred both on the convex and concave sides of the spine, closest to the apical vertebra of the scoliosis curve, implied that they are less likely to be the result of adaptive changes to the physical forces involved in the scoliotic deformity. One explanation is that they represent a primary disturbance of growth

Twenty years on, the Methadone Treatment Protocol in Ireland: Reflections on General Practice

Background: Opioid dependence, characterised by socio economic disadvantage and significant morbidity and mortality, remains a major public health problem in Ireland. Through the methadone treatment protocol (MTP), Irish general practice has been a leader in the introduction and expansion of Irish harm reduction services, including opioid substitution treatment (OST), needle and syringe programs (NSP) and naloxone provision. These services have been effective in engaging opiate users in treatment, reducing human deficiency virus (HIV) and hepatitis C virus (HCV) transmission and reducing drug related morbidities. Challenges remain in relation to choice of substitution treatments, timely access to OST services, adequate coverage of NSP, naloxone provision and increasing drug related deaths.Methods: A narrative review was conducted and designed to present a broad perspective on the Irish MTP, and to describe its history and development in terms of clinical care, stakeholder views and changing trends.Results: Three themes emerged from the analysis; The History of the Methadone Treatment Protocol, Service User and Provider Views, and Challenges and Developments. Despite initial concern about methadone maintenance treatment (MMT) in Ireland, increased participation by Irish GPs in the treatment of opioid dependence is observed over the last two decades. There are now over 10,000 people on methadone treatment in Ireland, with 40% treated in general practice. The MTP provides structure, remuneration and guidance to GPs and is underpinned by; training, ongoing education and a system of quality assurance provided by the Irish College of General Practice (ICGP). Challenges include the negative views of patients around how methadone services are delivered, the stigma associated with methadone treatment, the lack of choice around substitution medication, waiting lists for treatment in certain areas and rates of fatal overdose.Conclusion: Twenty years of the MTP has been the mainstay of harm reduction services in Ireland. It has provided a network of specially trained GPs who provide methadone to over 10,000 patients across Ireland within a structured framework of training, quality assurance and remuneration. With the ongoing commitment of Irish specialists in the field of addiction medicine, further improvements to support and treat patients can be made

Physical activity in older age: perspectives for healthy ageing and frailty.

Regular physical activity helps to improve physical and mental functions as well as reverse some effects of chronic disease to keep older people mobile and independent. Despite the highly publicised benefits of physical activity, the overwhelming majority of older people in the United Kingdom do not meet the minimum physical activity levels needed to maintain health. The sedentary lifestyles that predominate in older age results in premature onset of ill health, disease and frailty. Local authorities have a responsibility to promote physical activity amongst older people, but knowing how to stimulate regular activity at the population-level is challenging. The physiological rationale for physical activity, risks of adverse events, societal and psychological factors are discussed with a view to inform public health initiatives for the relatively healthy older person as well as those with physical frailty. The evidence shows that regular physical activity is safe for healthy and for frail older people and the risks of developing major cardiovascular and metabolic diseases, obesity, falls, cognitive impairments, osteoporosis and muscular weakness are decreased by regularly completing activities ranging from low intensity walking through to more vigorous sports and resistance exercises. Yet, participation in physical activities remains low amongst older adults, particularly those living in less affluent areas. Older people may be encouraged to increase their activities if influenced by clinicians, family or friends, keeping costs low and enjoyment high, facilitating group-based activities and raising self-efficacy for exercise

The vertebral body growth plate in scoliosis: a primary disturbance of growth?-6

<p><b>Copyright information:</b></p><p>Taken from "The vertebral body growth plate in scoliosis: a primary disturbance of growth?"</p><p>http://www.scoliosisjournal.com/content/3/1/3</p><p>Scoliosis 2008;3():3-3.</p><p>Published online 26 Jan 2008</p><p>PMCID:PMC2253511.</p><p></p

The vertebral body growth plate in scoliosis: a primary disturbance of growth?-5

<p><b>Copyright information:</b></p><p>Taken from "The vertebral body growth plate in scoliosis: a primary disturbance of growth?"</p><p>http://www.scoliosisjournal.com/content/3/1/3</p><p>Scoliosis 2008;3():3-3.</p><p>Published online 26 Jan 2008</p><p>PMCID:PMC2253511.</p><p></p

The vertebral body growth plate in scoliosis: a primary disturbance of growth?-2

<p><b>Copyright information:</b></p><p>Taken from "The vertebral body growth plate in scoliosis: a primary disturbance of growth?"</p><p>http://www.scoliosisjournal.com/content/3/1/3</p><p>Scoliosis 2008;3():3-3.</p><p>Published online 26 Jan 2008</p><p>PMCID:PMC2253511.</p><p></p

The vertebral body growth plate in scoliosis: a primary disturbance of growth?-0

<p><b>Copyright information:</b></p><p>Taken from "The vertebral body growth plate in scoliosis: a primary disturbance of growth?"</p><p>http://www.scoliosisjournal.com/content/3/1/3</p><p>Scoliosis 2008;3():3-3.</p><p>Published online 26 Jan 2008</p><p>PMCID:PMC2253511.</p><p></p

The vertebral body growth plate in scoliosis: a primary disturbance of growth?-1

<p><b>Copyright information:</b></p><p>Taken from "The vertebral body growth plate in scoliosis: a primary disturbance of growth?"</p><p>http://www.scoliosisjournal.com/content/3/1/3</p><p>Scoliosis 2008;3():3-3.</p><p>Published online 26 Jan 2008</p><p>PMCID:PMC2253511.</p><p></p