The Experts below are selected from a list of 1815 Experts worldwide ranked by ideXlab platform

Daniel C Perry - One of the best experts on this subject based on the ideXlab platform.

  • the outcomes of Perthes Disease
    Journal of Bone and Joint Surgery-british Volume, 2020
    Co-Authors: Donato Giuseppe Leo, Daniel C Perry, Helen Jones, Rebecca Murphy, Justin Wei Leong, Tina Gambling, Andrew F Long, Jennifer C Laine
    Abstract:

    Aims To identify a suite of the key physical, emotional, and social outcomes to be employed in clinical practice and research concerning Perthes' Disease in children. Methods The study follows the guidelines of the COMET-Initiative (Core Outcome Measures in Effectiveness Trials). A systematic review of the literature was performed to identify a list of outcomes reported in previous studies, which was supplemented by a qualitative study exploring the experiences of families affected by Perthes’ Disease. Collectively, these outcomes formed the basis of a Delphi survey (two rounds), where 18 patients with Perthes’ Disease, 46 parents, and 36 orthopaedic surgeons rated each outcome for importance. The International Perthes Study Group (IPSG) (Dallas, Texas, USA (October 2018)) discussed outcomes that failed to reach any consensus (either ‘in’ or ‘out’) before a final consensus meeting with representatives of surgeons, patients, and parents. Results In total, 23 different outcome domains were identified from the systematic review, and a further ten from qualitative interviews. After round one of the Delphi survey, participants suggested five further outcome domains. A total of 38 outcomes were scored in round two of the Delphi. Among these, 16 outcomes were scored over the prespecified 70% threshold for importance (divided into six main categories: adverse events; life impact; resource use; pathophysiological manifestations; death; and technical considerations). Following the final consensus meeting, 14 outcomes were included in the final Core Outcome Set (COS). Conclusion Core Outcome Sets (COSs) are important to improve standardization of outcomes in clinical research and to aid communication between patients, clinicians, and funding bodies. The results of this study should be a catalyst to develop high-quality clinical research in order to determine the optimal treatments for children with Perthes’ Disease.

  • Perthes Disease classification using shape and appearance modelling
    Computational Methods and Clinical Applications in Musculoskeletal Imaging: 6th Workshop & Challenge in conjunction with MICCAI 2018, 2018
    Co-Authors: Adrian K Davison, Timothy F Cootes, Daniel C Perry, Weisang Luo, Claudia Lindner
    Abstract:

    We propose to use statistical shape and appearance modelling to classify the proximal femur in hip radiographs of children into Legg-Calve-Perthes Disease and healthy. Legg-Calve-Perthes Disease affects the femoral head with avascular necrosis, which causes large shape deformities during the growth-stage of the child. Further, the dead or dying bone of the femoral head is prominent visually in radiographic images, leading to a distinction between healthy bone and bone where necrosis is present. Currently, there is little to no research into analysing the shape and appearance of hips affected by Perthes Disease from radiographic images. Our research demonstrates how the radiographic shape, texture and overall appearance of a proximal femur affected by Perthes Disease differs and how this can be used for identifying cases with the Disease. Moreover, we present a radiograph-based fully automatic Perthes classification system that achieves state-of-the-art results with an area under the receiver operator characteristic (ROC) curve of 98%.

  • the outcomes of Perthes Disease of the hip a study protocol for the development of a core outcome set
    Trials, 2018
    Co-Authors: Donato Giuseppe Leo, Helen Jones, Rebecca Murphy, Tina Gambling, Andrew F Long, Wei Yee Leong, Daniel C Perry
    Abstract:

    Perthes’ Disease is an idiopathic osteonecrosis of a developmental hip that is most frequent in Northern Europe. Currently, the absence of a common set of standardised outcomes makes comparisons between studies of different interventions challenging. This study aims to summarise the outcomes used in clinical research of interventions for Perthes’ Disease and define a set of core outcomes (COS) to ensure that the variables of primary importance are measured and reported in future research studies investigating Perthes’ Disease. A systematic review of the current literature will be used to identify a list of outcomes reported in previous studies. Additional important outcomes will be sought by interviewing a group of children with Perthes’ Disease, adults who were treated with the Disease in infancy and parents of children with the Disease. This list will then be evaluated by experts in Perthes’ Disease using a Delphi survey divided into two rounds to ascertain the importance of each outcome. The final outcomes list obtained from the Delphi survey will be then discussed during a consensus meeting of representative key stakeholders in order to define the COS to be reported in future clinical trials related to Perthes’ Disease. The absence of high-quality research and clear guidelines concerning the management of Perthes’ Disease is, at least in part, due to the difficulties in the comparing the results from previous studies. The development of a COS seeks to standardise outcomes collected in future research studies to enable comparisons between studies to be made and to facilitate meta-analyses of results. Core Outcome Measures in Effectiveness Trials Initiative (COMET), 1003 . Registered on 20 July 2017. Prospero International Prospective Register of Systematic Reviews, CRD 42017069742 . Registered on 10 July 2017.

  • the aetiology of Perthes Disease a twin study
    Orthopaedic Proceedings, 2018
    Co-Authors: David Metcalfe, S Van Dijck, N Parsons, Kaare Christensen, Daniel C Perry
    Abstract:

    This study sought to determine the genetic contribution of Perthes' Disease, using the world's largest twin-registry.We extracted all twin pairs from the Danish Twin Registry (DTR) in which at least one individual had Perthes' Disease. The DTR captures every twin pair born alive in Denmark. Those with Perthes' Disease were identified using health record linkage to the Danish Morbidity Record. Probandwise concordance was calculated to describe the likelihood that any given individual had LCPD if their co-twin was also diagnosed.There were 81 twin pairs; 10 monozygotic (MZ), 51 dizygotic (DZ), and 20 unclassified (UZ). There was no association between birth weight and being the affected co-twin. Four pairs (two dizygotic and two unclassified) were concordant for LCPD, which is greater than would be expected assuming no familial aggregation. There were no concordant MZ twin pairs. The overall probandwise concordance was 0.09 (95% CI 0.01–0.18): 0.00 for the MZ, 0.08 (95% CI 0.00–0.18) for the DZ, and 0.18 (9...

  • abnormalities of vascular structure and function in children with Perthes Disease
    Orthopaedic Proceedings, 2018
    Co-Authors: Daniel C Perry, Daniel J Green, C E Bruce, Daniel Pope, P H Dangerfield, Mary Jane Platt, Andrew J Hall, Helen Jones
    Abstract:

    ObjectiveThere is mounting evidence to suggest a vascular insult is responsible for Perthes' Disease, and it is suggested that this may have long-term implications for the vascular health of affected individuals. This study sought to use ultrasound measures to investigate vascular structure and function in children affected by Perthes' Disease.Material and MethodsThis case control study encompassed 149 cases and 146 controls, frequency matched for age and sex. Endothelial function was measured using the technique of flow-mediated dilatation of the brachial artery, and alterations in arterial flow were recorded in response to an ischaemic stimulus.ResultsThere was a significant structural alteration in the vasculature amongst individuals with Perthes' Disease (resting brachial artery diameter (cases 2.97mm vs. controls 3.11mm; p=0.01)), which remained even after adjusting for height. Additionally, there was a notable reduction in blood velocity (cases 33.84cm/sec vs controls 37.83cm/sec; p=0.01) and blood ...

Harry K W Kim - One of the best experts on this subject based on the ideXlab platform.

  • assessment of femoral head revascularization in legg calve Perthes Disease using serial perfusion mri
    Journal of Bone and Joint Surgery American Volume, 2016
    Co-Authors: Harry K W Kim, Jamie Burgess, Alec Thoveson, Paul Gudmundsson, Molly Dempsey
    Abstract:

    Background: Legg-Calve-Perthes Disease is a juvenile form of osteonecrosis of the femoral head. The purpose of this study was to use serial perfusion magnetic resonance imaging (MRI) to determine the pattern and rate of revascularization of the femoral heads of patients with the active stage of Legg-Calve-Perthes Disease. Methods: We performed a prospective study of 29 patients (30 hips) with a mean age (and standard deviation) of 8.4 ± 1.9 years who were diagnosed with Waldenstrom Stage-1 or 2 Legg-Calve-Perthes Disease. All patients had ≥2 perfusion MRIs, and 21 patients (22 hips) had ≥3. Perfusion percentages of the femoral epiphyses were measured by 2 independent observers. Statistical analyses included calculation of the intraclass correlation coefficient, the paired t test, the Mann-Whitney U test, and the Kruskal-Wallis test. Results: Initial perfusion MRIs showed the percent perfusion in the affected femoral heads to range from 5% to 70%. The average percent perfusion (and standard deviation) was 35% ± 16% on the first MRI, which increased to 77% ± 14% on the follow-up MRI acquired at an average of 10.5 ± 2.9 months later (p < 0.01). Serial assessment showed a general pattern of revascularization starting from the periphery of the posterior, lateral, and medial aspects of the femoral epiphysis and converging toward the anterocentral region. The average rate of revascularization was 4.9% ± 2.3% per month with a wide range among the patients (0.6% to 10.4% per month). Conclusions: Revascularization of the necrotic femoral head increased over time in a horseshoe pattern, starting from the posterior, lateral, and medial aspects of the femoral epiphysis. The rate of revascularization was highly variable among patients. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • interobserver and intraobserver reliability of the modified waldenstrom classification system for staging of legg calve Perthes Disease
    Journal of Bone and Joint Surgery American Volume, 2015
    Co-Authors: Joshua E Hyman, Benjamin Joseph, Kishore Mulpuri, Harry K W Kim, Evan Trupia, Margaret L Wright, Hiroko Matsumoto, Virginia F Casey, Pablo Castaneda, Paul D Choi
    Abstract:

    Background: The absence of a reliable classification system for Legg-Calve-Perthes Disease has contributed to difficulty in establishing consistent management strategies and in interpreting outcome studies. The purpose of this study was to assess interobserver and intraobserver reliability of the modified Waldenstrom classification system among a large and diverse group of pediatric orthopaedic surgeons. Methods: Twenty surgeons independently completed the first two rounds of staging: two assessments of forty deidentified radiographs of patients with Legg-Calve-Perthes Disease in various stages. Ten of the twenty surgeons completed another two rounds of staging after the addition of a second pair of radiographs in sequence. Kappa values were calculated within and between each of the rounds. Results: Interobserver kappa values for the classification for surveys 1, 2, 3, and 4 were 0.81, 0.82, 0.76, and 0.80, respectively (with 0.61 to 0.80 considered substantial agreement and 0.81 to 1.0, nearly perfect agreement). Intraobserver agreement for the classification was an average of 0.88 (range, 0.77 to 0.96) between surveys 1 and 2 and an average of 0.87 (range, 0.81 to 0.94) between surveys 3 and 4. Conclusions: The modified Waldenstrom classification system for staging of Legg-Calve-Perthes Disease demonstrated substantial to almost perfect agreement between and within observers across multiple rounds of study. In doing so, the results of this study provide a foundation for future validation studies, in which the classification stage will be associated with clinical outcomes.

  • perfusion mri in early stage of legg calve Perthes Disease to predict lateral pillar involvement a preliminary study
    Journal of Bone and Joint Surgery American Volume, 2014
    Co-Authors: Harry K W Kim, Jamie Burgess, Molly Dempsey, Kathryn Wiesman, Vedant Kulkarni, Elena Chen, Case Brabham, Haseeb Ikram, Ashok V Kulkarni, Anthony J Herring
    Abstract:

    Background: Current radiographic classifications for Legg-Calve-Perthes Disease cannot be applied at the early stages of the Disease. The purpose of this study was to quantify the perfusion of the femoral epiphysis in the early stages of Legg-Calve-Perthes Disease with use of perfusion magnetic resonance imaging (MRI) and to determine if the extent of epiphyseal perfusion can predict the lateral pillar involvement at the mid-fragmentation stage. Methods: Twenty-nine patients had gadolinium-enhanced perfusion MRI at the initial stage or early fragmentation stage of Legg-Calve-Perthes Disease and were followed prospectively. The percent perfusion of the whole epiphysis and its lateral third was measured by four independent observers using image analysis software. The radiographs obtained at the mid-fragmentation stage were used for the lateral pillar classification. Intraclass correlation coefficient (ICC) and logistic regression analyses were performed. Results: The mean age (and standard deviation) at diagnosis was 7.7 ± 1.7 years (range, 5.3 to 11.3 years). The mean interval between the MRI and the time of maximum fragmentation was 8.2 ± 5.5 months. The interobserver ICC for the percent perfusion of the lateral third of the epiphysis was 0.90 (95% confidence interval [CI]: 0.83 to 0.95). The mean percent perfusion of the lateral third of the epiphysis was 92% ± 2%, 68% ± 18%, and 46% ± 12% for the hips in which the lateral pillar was later classified as A, B, and C, respectively (p = 0.001). When the perfusion level was ≥90% in the lateral third of the epiphysis, the odds ratio of the lateral pillar being later classified as group A, as opposed to B or C, was 72.0 (CI: 3.5 to 1476). With a perfusion level of ≤55% in the lateral third of the epiphysis, the odds ratio of the lateral pillar being later classified as group C, as opposed to A or B, was 33.3 (CI: 2.8 to 392). Similar results were obtained for the whole epiphysis. Conclusions: Perfusion MRI measurements of the total epiphysis and its lateral third obtained at the early stages of Legg-Calve-Perthes Disease were predictive of lateral pillar involvement at the mid-fragmentation stage of the Disease. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

  • a comparison of non contrast and contrast enhanced mri in the initial stage of legg calve Perthes Disease
    Pediatric Radiology, 2013
    Co-Authors: Harry K W Kim, Molly Dempsey, Sue C Kaste, David Wilkes
    Abstract:

    Background A prognostic indicator of outcome for Legg-Calve-Perthes Disease (LCP) is needed to guide treatment decisions during the initial stage of the Disease (stage 1), before deformity occurs. Radiographic prognosticators are applicable only after fragmentation (stage II).

  • pathophysiology and new strategies for the treatment of legg calve Perthes Disease
    Journal of Bone and Joint Surgery American Volume, 2012
    Co-Authors: Harry K W Kim
    Abstract:

    Legg-Calve-Perthes Disease is a juvenile form of idiopathic osteonecrosis of the femoral head that can lead to permanent femoral head deformity and premature osteoarthritis. According to two recent multicenter, prospective cohort studies, current nonoperative and operative treatments have modest success rates of producing a good outcome with a spherical femoral head in older children with Legg-Calve-Perthes Disease. Experimental studies have revealed that the immature femoral head is mechanically weakened following ischemic necrosis. Increased bone resorption and delayed new bone formation, in combination with continued mechanical loading of the hip, contribute to the pathogenesis of the femoral head deformity. Biological treatment strategies to improve the healing process by decreasing bone resorption and stimulating bone formation appear promising in nonhuman preclinical studies.

C E Bruce - One of the best experts on this subject based on the ideXlab platform.

  • abnormalities of vascular structure and function in children with Perthes Disease
    Orthopaedic Proceedings, 2018
    Co-Authors: Daniel C Perry, Daniel J Green, C E Bruce, Daniel Pope, P H Dangerfield, Mary Jane Platt, Andrew J Hall, Helen Jones
    Abstract:

    ObjectiveThere is mounting evidence to suggest a vascular insult is responsible for Perthes' Disease, and it is suggested that this may have long-term implications for the vascular health of affected individuals. This study sought to use ultrasound measures to investigate vascular structure and function in children affected by Perthes' Disease.Material and MethodsThis case control study encompassed 149 cases and 146 controls, frequency matched for age and sex. Endothelial function was measured using the technique of flow-mediated dilatation of the brachial artery, and alterations in arterial flow were recorded in response to an ischaemic stimulus.ResultsThere was a significant structural alteration in the vasculature amongst individuals with Perthes' Disease (resting brachial artery diameter (cases 2.97mm vs. controls 3.11mm; p=0.01)), which remained even after adjusting for height. Additionally, there was a notable reduction in blood velocity (cases 33.84cm/sec vs controls 37.83cm/sec; p=0.01) and blood ...

  • a case control study to determine the association between Perthes Disease and the recalled use of tobacco during pregnancy and biological markers of current tobacco smoke exposure
    Journal of Bone and Joint Surgery-british Volume, 2017
    Co-Authors: Daniel C Perry, C E Bruce, Daniel Pope, C Thomson, Mary Jane Platt
    Abstract:

    Aims It is well established that there is a strong association between Perthes’ Disease and worsening socioeconomic deprivation. It has been suggested that the primary determinant driving this association is exposure to tobacco smoke. This study aimed to examine this hypothesis. Patients and Methods A hospital case-control study (n = 149/146) examined the association between tobacco smoke exposure and Perthes’ Disease, adjusting for area-level socioeconomic deprivation. Tobacco smoke exposure was assessed by parental questionnaire of smoking habits during pregnancy, and by quantitative assay of current exposure using the urinary cotinine-creatinine ratio, which is a widely used and validated measure of tobacco smoke exposure. Results The odds of Perthes’ Disease significantly increased with reported in utero exposure after adjustment for socioeconomic deprivation (maternal smoking odds ratio (OR) 2.06, 95% confidence interval (CI) 1.17 to 3.63; paternal smoking OR 2.09, 95% CI 1.26 to 3.46). The cotinine-creatinine ratio was significantly greater in cases, OR 1.63 (95% CI 1.09 to 2.43), suggesting a greater ‘dose’ of current tobacco exposure. Conclusion An association exists between tobacco smoke exposure and Perthes’ Disease but we remain unable to disentangle the association with socioeconomic deprivation. Cite this article: Bone Joint J 2017;99-B:1102–8.

  • the lognormal age of onset distribution in Perthes Disease an analysis from a large well defined cohort
    Journal of Bone and Joint Surgery-british Volume, 2016
    Co-Authors: Daniel C Perry, P J Skellorn, C E Bruce
    Abstract:

    Aims To explore the of age of onset distribution for Perthes’ Disease of the hip, with particular reference to gender, laterality and conformity to the lognormal distribution. Patients and Methods A total of 1082 patients were identified from the Liverpool Perthes’ Disease Register between 1976 and 2010, of which 992 had the date of diagnosis recorded. In total, 682 patients came from the geographical area exclusively served by Alder Hey Hospital, of which 673 had a date of diagnosis. Age of onset curves were analysed, with respect to the predefined subgroups. Results The age of onset demonstrated a positive skew with a median of 5.8 years (interquartile range 4.6 to 7.5). Disease onset was a mean five months earlier in girls (p = 0.01) and one year earlier in those who went on to develop bilateral Disease (p < 0.001). There was no difference in the age of onset between geographical districts with differing incidence rates. The entire dataset (n = 992) conformed to a lognormal distribution graphically and with the chi-squared test of normality (p = 0.10), but not using the Shapiro-Wilk test (p = 0.01). The distribution for the predefined geographical subgroup (n = 673) conformed well to a lognormal distribution (chi-squared p = 0.16, Shapiro-Wilk p = 0.08). Given the observed lognormal distribution it was assumed that Perthes’ Disease followed on incubation period consistent with a point-source Disease exposure. The incubation period was further examined using Hirayama’s method, which suggested that the Disease exposure may act in the prenatal period. Conclusion The age of onset in Perthes’ Disease conforms to a lognormal distribution, which allows comparisons with infectious Disease epidemiology. Earlier onset in girls and those who develop bilateral Disease may offer clues to understanding the aetiological determinants of the Disease. The analysis suggests that an antenatal aetiological determinant may be responsible for Disease. Take home message: Perthes’ Disease age of onset conforms to a lognormal model, which is most typical of infectious Diseases. The shape of the distribution suggests that an aetiological trigger in the pre-natal period may be an important determinant of Disease. Cite this article: Bone Joint J 2016;98-B:710–14.

  • comorbidities in Perthes Disease a case control study using the general practice research database
    Journal of Bone and Joint Surgery-british Volume, 2012
    Co-Authors: Daniel C Perry, C E Bruce, Daniel Pope, P H Dangerfield, Mary Jane Platt, Andrew J Hall
    Abstract:

    Perthes’ Disease is an osteonecrosis of the juvenile hip, the aetiology of which is unknown. A number of comorbid associations have been suggested that may offer insights into aetiology, yet the strength and validity of these are unclear. This study explored such associations through a case control study using the United Kingdom General Practice Research database. Associations investigated were those previously suggested within the literature. A total of 619 cases of Perthes’ Disease were included, as were 2544 controls. The risk of Perthes’ Disease was significantly increased with the presence of congenital anomalies of the genitourinary and inguinal region, such as hypospadias (odds ratio (OR) 4.04 (95% confidence interval (CI) 1.41 to 11.58)), undescended testis (OR 1.83 (95% CI 1.12 to 3.00)) and inguinal herniae (OR 1.79 (95% CI 1.02 to 3.16)). Attention deficit hyperactivity disorder was not associated with Perthes’ Disease (OR 1.01 (95% CI 0.48 to 2.12)), although a generalised behavioural disorder was (OR 1.55 (95% CI 1.10 to 2.17)). Asthma significantly increased the risk of Perthes’ Disease (OR 1.44 (95% CI 1.17 to 1.76)), which remained after adjusting for oral/parenteral steroid use. Perthes’ Disease has a significant association with congenital genitourinary and inguinal anomalies, suggesting that intra-uterine factors may be critical to causation. Other comorbid associations may offer insight to support or refute theories of pathogenesis.

  • Perthes Disease of the hip socioeconomic inequalities and the urban environment
    Archives of Disease in Childhood, 2012
    Co-Authors: Daniel C Perry, C E Bruce, Daniel Pope, P H Dangerfield, Mary Jane Platt, Andrew J Hall
    Abstract:

    INTRODUCTION: Perthes' Disease is a puzzling childhood hip disorder for which the aetiology is unknown. It is known to be associated with socioeconomic deprivation. Urban environments have also been implicated as a risk factor, however socioeconomic deprivation often occurs within urban environments and it is unclear if this association is the result of confounding. The objective of the current work was to gain a greater understanding of the influence of the urban/rural environment in Perthes' Disease. METHODS: This was a descriptive observational study using the Scottish Morbidity Record, based in Scotland, UK using data from 2000-2010. A total of 443 patients with a discharge diagnosis of Perthes' Disease were included. Socioeconomic deprivation was determined using the Scottish Index of Multiple Deprivation, and exposure to the 'urban environment' was recorded based on the Scottish Urban-Rural Classification. RESULTS: There was a strong association with socioeconomic deprivation, with rates among the most deprived quintile more than twice those of the most affluent (RR 2.1 (95% CI 1.5 to 2.9)). Urban areas had a greater rate of Perthes' Disease discharges (RR 1.8 (95% CI 1.1 to 3.2)), though this was a reflection of greater deprivation in urban areas. Stratification for socioeconomic deprivation revealed similar discharge rates in urban and rural environments, suggesting that the aetiological determinants were not independently associated with urban environments. CONCLUSIONS: The occurrence of Perthes' Disease within urban environments is high, yet this appears to be a reflection of higher socioeconomic deprivation exposure. Disease rates appear equivalent in similarly deprived urban and non-urban areas, suggesting that the determinant is not a consequence of the urban environment.

Andrew J Hall - One of the best experts on this subject based on the ideXlab platform.

  • abnormalities of vascular structure and function in children with Perthes Disease
    Orthopaedic Proceedings, 2018
    Co-Authors: Daniel C Perry, Daniel J Green, C E Bruce, Daniel Pope, P H Dangerfield, Mary Jane Platt, Andrew J Hall, Helen Jones
    Abstract:

    ObjectiveThere is mounting evidence to suggest a vascular insult is responsible for Perthes' Disease, and it is suggested that this may have long-term implications for the vascular health of affected individuals. This study sought to use ultrasound measures to investigate vascular structure and function in children affected by Perthes' Disease.Material and MethodsThis case control study encompassed 149 cases and 146 controls, frequency matched for age and sex. Endothelial function was measured using the technique of flow-mediated dilatation of the brachial artery, and alterations in arterial flow were recorded in response to an ischaemic stimulus.ResultsThere was a significant structural alteration in the vasculature amongst individuals with Perthes' Disease (resting brachial artery diameter (cases 2.97mm vs. controls 3.11mm; p=0.01)), which remained even after adjusting for height. Additionally, there was a notable reduction in blood velocity (cases 33.84cm/sec vs controls 37.83cm/sec; p=0.01) and blood ...

  • comorbidities in Perthes Disease a case control study using the general practice research database
    Journal of Bone and Joint Surgery-british Volume, 2012
    Co-Authors: Daniel C Perry, C E Bruce, Daniel Pope, P H Dangerfield, Mary Jane Platt, Andrew J Hall
    Abstract:

    Perthes’ Disease is an osteonecrosis of the juvenile hip, the aetiology of which is unknown. A number of comorbid associations have been suggested that may offer insights into aetiology, yet the strength and validity of these are unclear. This study explored such associations through a case control study using the United Kingdom General Practice Research database. Associations investigated were those previously suggested within the literature. A total of 619 cases of Perthes’ Disease were included, as were 2544 controls. The risk of Perthes’ Disease was significantly increased with the presence of congenital anomalies of the genitourinary and inguinal region, such as hypospadias (odds ratio (OR) 4.04 (95% confidence interval (CI) 1.41 to 11.58)), undescended testis (OR 1.83 (95% CI 1.12 to 3.00)) and inguinal herniae (OR 1.79 (95% CI 1.02 to 3.16)). Attention deficit hyperactivity disorder was not associated with Perthes’ Disease (OR 1.01 (95% CI 0.48 to 2.12)), although a generalised behavioural disorder was (OR 1.55 (95% CI 1.10 to 2.17)). Asthma significantly increased the risk of Perthes’ Disease (OR 1.44 (95% CI 1.17 to 1.76)), which remained after adjusting for oral/parenteral steroid use. Perthes’ Disease has a significant association with congenital genitourinary and inguinal anomalies, suggesting that intra-uterine factors may be critical to causation. Other comorbid associations may offer insight to support or refute theories of pathogenesis.

  • Perthes Disease of the hip socioeconomic inequalities and the urban environment
    Archives of Disease in Childhood, 2012
    Co-Authors: Daniel C Perry, C E Bruce, Daniel Pope, P H Dangerfield, Mary Jane Platt, Andrew J Hall
    Abstract:

    INTRODUCTION: Perthes' Disease is a puzzling childhood hip disorder for which the aetiology is unknown. It is known to be associated with socioeconomic deprivation. Urban environments have also been implicated as a risk factor, however socioeconomic deprivation often occurs within urban environments and it is unclear if this association is the result of confounding. The objective of the current work was to gain a greater understanding of the influence of the urban/rural environment in Perthes' Disease. METHODS: This was a descriptive observational study using the Scottish Morbidity Record, based in Scotland, UK using data from 2000-2010. A total of 443 patients with a discharge diagnosis of Perthes' Disease were included. Socioeconomic deprivation was determined using the Scottish Index of Multiple Deprivation, and exposure to the 'urban environment' was recorded based on the Scottish Urban-Rural Classification. RESULTS: There was a strong association with socioeconomic deprivation, with rates among the most deprived quintile more than twice those of the most affluent (RR 2.1 (95% CI 1.5 to 2.9)). Urban areas had a greater rate of Perthes' Disease discharges (RR 1.8 (95% CI 1.1 to 3.2)), though this was a reflection of greater deprivation in urban areas. Stratification for socioeconomic deprivation revealed similar discharge rates in urban and rural environments, suggesting that the aetiological determinants were not independently associated with urban environments. CONCLUSIONS: The occurrence of Perthes' Disease within urban environments is high, yet this appears to be a reflection of higher socioeconomic deprivation exposure. Disease rates appear equivalent in similarly deprived urban and non-urban areas, suggesting that the determinant is not a consequence of the urban environment.

  • abnormalities of vascular structure and function in children with Perthes Disease
    Pediatrics, 2012
    Co-Authors: Daniel C Perry, Daniel J Green, C E Bruce, Daniel Pope, P H Dangerfield, Mary Jane Platt, Andrew J Hall, Helen Jones
    Abstract:

    BACKGROUND AND OBJECTIVES: Perthes Disease is a childhood precipitant to osteoarthritis of the hip, for which the etiology and mechanism are unknown. There is mounting evidence to suggest a vascular insult is responsible for Disease, and it is suggested that this may have long-term implications for the vascular health of affected individuals. This study sought to use ultrasound measures to investigate vascular structure and function in children affected by Perthes Disease. METHODS: This case control study encompassed 149 cases and 146 controls, frequency matched for age and gender. Endothelial function was measured by using the technique of flow-mediated dilation of the brachial artery, and alterations in arterial flow were recorded in response to an ischemic stimulus. RESULTS: There was a significant structural alteration in the vasculature among individuals with Perthes Disease (resting brachial artery diameter (cases 2.97 mm versus controls 3.11 mm; P = .01), which remained even after adjusting for height. In addition, there was a notable reduction in blood velocity (cases 33.84 cm/s versus controls 37.83 cm/s; P = .01) and blood flow (cases 149.82 mL/min versus controls 184.67 mL/min; P = .001), which was independent of baseline arterial size. There was no evidence to suggest that flow-mediated dilation of the brachial artery was impaired among affected individuals (P = .71). CONCLUSIONS: Children with Perthes Disease exhibit small artery caliber and reduced function, which is independent of body composition. These data imply that that Perthes Disease may reflect a wider vascular phenomenon that could have long-term implications for the vascular health of affected individuals.

  • legg calve Perthes Disease in the uk geographic and temporal trends in incidence reflecting differences in degree of deprivation in childhood
    Arthritis & Rheumatism, 2012
    Co-Authors: Daniel C Perry, C E Bruce, Daniel Pope, P H Dangerfield, Mary Jane Platt, Andrew J Hall
    Abstract:

    Objective Little is known about Legg-Calve-Perthes Disease, a common childhood precursor to osteoarthritis of the hip. This study was undertaken to analyze the incidence of Legg-Calve-Perthes Disease in the UK, with respect to geographic and temporal trends over a 19-year period. Methods The General Practice Research database was analyzed to identify incident cases between 1990 and 2008 in children ages 0–14 years. Incidence rates were calculated by year and by region (National Health Service Strategic Health Authority regions in England, and Scotland, Wales, and Northern Ireland), and the association with regional markers of deprivation examined. Results Over the 19-year period there was a dramatic decline in Legg-Calve-Perthes Disease incidence, with annual rates among children 0–14 years old declining from 12.2 per 100,000 to 5.7 per 100,000 (P < 0.001). There was also marked geographic variation, with incidence rates in Scotland more than twice those in London (10.39 [95% confidence interval 8.05–13.2] versus 4.6 [95% confidence interval 3.4–6.1] per 100,000 0–14-year-olds). A more rapid decline in incidence was apparent in the Northern regions compared to Southern regions. The quintile with the highest degree of deprivation had the highest Disease incidence (rate ratio 1.49 [95% confidence interval 1.10–2.04]) and, with the exception of London, regional incidence showed a strong linear relationship with regional deprivation score (P < 0.01). Conclusion The incidence of Legg-Calve-Perthes Disease in the UK has a strong North-South divide, with a greater Disease incidence within the Northern regions of the UK. There was a marked decline in incidence over the study period, which was more marked in Northern areas. The declining incidence, along with the geographic variation, suggests that a major etiologic determinant in Legg-Calve-Perthes Disease is environmental and closely linked to childhood deprivation.

Mary Jane Platt - One of the best experts on this subject based on the ideXlab platform.

  • abnormalities of vascular structure and function in children with Perthes Disease
    Orthopaedic Proceedings, 2018
    Co-Authors: Daniel C Perry, Daniel J Green, C E Bruce, Daniel Pope, P H Dangerfield, Mary Jane Platt, Andrew J Hall, Helen Jones
    Abstract:

    ObjectiveThere is mounting evidence to suggest a vascular insult is responsible for Perthes' Disease, and it is suggested that this may have long-term implications for the vascular health of affected individuals. This study sought to use ultrasound measures to investigate vascular structure and function in children affected by Perthes' Disease.Material and MethodsThis case control study encompassed 149 cases and 146 controls, frequency matched for age and sex. Endothelial function was measured using the technique of flow-mediated dilatation of the brachial artery, and alterations in arterial flow were recorded in response to an ischaemic stimulus.ResultsThere was a significant structural alteration in the vasculature amongst individuals with Perthes' Disease (resting brachial artery diameter (cases 2.97mm vs. controls 3.11mm; p=0.01)), which remained even after adjusting for height. Additionally, there was a notable reduction in blood velocity (cases 33.84cm/sec vs controls 37.83cm/sec; p=0.01) and blood ...

  • a case control study to determine the association between Perthes Disease and the recalled use of tobacco during pregnancy and biological markers of current tobacco smoke exposure
    Journal of Bone and Joint Surgery-british Volume, 2017
    Co-Authors: Daniel C Perry, C E Bruce, Daniel Pope, C Thomson, Mary Jane Platt
    Abstract:

    Aims It is well established that there is a strong association between Perthes’ Disease and worsening socioeconomic deprivation. It has been suggested that the primary determinant driving this association is exposure to tobacco smoke. This study aimed to examine this hypothesis. Patients and Methods A hospital case-control study (n = 149/146) examined the association between tobacco smoke exposure and Perthes’ Disease, adjusting for area-level socioeconomic deprivation. Tobacco smoke exposure was assessed by parental questionnaire of smoking habits during pregnancy, and by quantitative assay of current exposure using the urinary cotinine-creatinine ratio, which is a widely used and validated measure of tobacco smoke exposure. Results The odds of Perthes’ Disease significantly increased with reported in utero exposure after adjustment for socioeconomic deprivation (maternal smoking odds ratio (OR) 2.06, 95% confidence interval (CI) 1.17 to 3.63; paternal smoking OR 2.09, 95% CI 1.26 to 3.46). The cotinine-creatinine ratio was significantly greater in cases, OR 1.63 (95% CI 1.09 to 2.43), suggesting a greater ‘dose’ of current tobacco exposure. Conclusion An association exists between tobacco smoke exposure and Perthes’ Disease but we remain unable to disentangle the association with socioeconomic deprivation. Cite this article: Bone Joint J 2017;99-B:1102–8.

  • comorbidities in Perthes Disease a case control study using the general practice research database
    Journal of Bone and Joint Surgery-british Volume, 2012
    Co-Authors: Daniel C Perry, C E Bruce, Daniel Pope, P H Dangerfield, Mary Jane Platt, Andrew J Hall
    Abstract:

    Perthes’ Disease is an osteonecrosis of the juvenile hip, the aetiology of which is unknown. A number of comorbid associations have been suggested that may offer insights into aetiology, yet the strength and validity of these are unclear. This study explored such associations through a case control study using the United Kingdom General Practice Research database. Associations investigated were those previously suggested within the literature. A total of 619 cases of Perthes’ Disease were included, as were 2544 controls. The risk of Perthes’ Disease was significantly increased with the presence of congenital anomalies of the genitourinary and inguinal region, such as hypospadias (odds ratio (OR) 4.04 (95% confidence interval (CI) 1.41 to 11.58)), undescended testis (OR 1.83 (95% CI 1.12 to 3.00)) and inguinal herniae (OR 1.79 (95% CI 1.02 to 3.16)). Attention deficit hyperactivity disorder was not associated with Perthes’ Disease (OR 1.01 (95% CI 0.48 to 2.12)), although a generalised behavioural disorder was (OR 1.55 (95% CI 1.10 to 2.17)). Asthma significantly increased the risk of Perthes’ Disease (OR 1.44 (95% CI 1.17 to 1.76)), which remained after adjusting for oral/parenteral steroid use. Perthes’ Disease has a significant association with congenital genitourinary and inguinal anomalies, suggesting that intra-uterine factors may be critical to causation. Other comorbid associations may offer insight to support or refute theories of pathogenesis.

  • Perthes Disease of the hip socioeconomic inequalities and the urban environment
    Archives of Disease in Childhood, 2012
    Co-Authors: Daniel C Perry, C E Bruce, Daniel Pope, P H Dangerfield, Mary Jane Platt, Andrew J Hall
    Abstract:

    INTRODUCTION: Perthes' Disease is a puzzling childhood hip disorder for which the aetiology is unknown. It is known to be associated with socioeconomic deprivation. Urban environments have also been implicated as a risk factor, however socioeconomic deprivation often occurs within urban environments and it is unclear if this association is the result of confounding. The objective of the current work was to gain a greater understanding of the influence of the urban/rural environment in Perthes' Disease. METHODS: This was a descriptive observational study using the Scottish Morbidity Record, based in Scotland, UK using data from 2000-2010. A total of 443 patients with a discharge diagnosis of Perthes' Disease were included. Socioeconomic deprivation was determined using the Scottish Index of Multiple Deprivation, and exposure to the 'urban environment' was recorded based on the Scottish Urban-Rural Classification. RESULTS: There was a strong association with socioeconomic deprivation, with rates among the most deprived quintile more than twice those of the most affluent (RR 2.1 (95% CI 1.5 to 2.9)). Urban areas had a greater rate of Perthes' Disease discharges (RR 1.8 (95% CI 1.1 to 3.2)), though this was a reflection of greater deprivation in urban areas. Stratification for socioeconomic deprivation revealed similar discharge rates in urban and rural environments, suggesting that the aetiological determinants were not independently associated with urban environments. CONCLUSIONS: The occurrence of Perthes' Disease within urban environments is high, yet this appears to be a reflection of higher socioeconomic deprivation exposure. Disease rates appear equivalent in similarly deprived urban and non-urban areas, suggesting that the determinant is not a consequence of the urban environment.

  • abnormalities of vascular structure and function in children with Perthes Disease
    Pediatrics, 2012
    Co-Authors: Daniel C Perry, Daniel J Green, C E Bruce, Daniel Pope, P H Dangerfield, Mary Jane Platt, Andrew J Hall, Helen Jones
    Abstract:

    BACKGROUND AND OBJECTIVES: Perthes Disease is a childhood precipitant to osteoarthritis of the hip, for which the etiology and mechanism are unknown. There is mounting evidence to suggest a vascular insult is responsible for Disease, and it is suggested that this may have long-term implications for the vascular health of affected individuals. This study sought to use ultrasound measures to investigate vascular structure and function in children affected by Perthes Disease. METHODS: This case control study encompassed 149 cases and 146 controls, frequency matched for age and gender. Endothelial function was measured by using the technique of flow-mediated dilation of the brachial artery, and alterations in arterial flow were recorded in response to an ischemic stimulus. RESULTS: There was a significant structural alteration in the vasculature among individuals with Perthes Disease (resting brachial artery diameter (cases 2.97 mm versus controls 3.11 mm; P = .01), which remained even after adjusting for height. In addition, there was a notable reduction in blood velocity (cases 33.84 cm/s versus controls 37.83 cm/s; P = .01) and blood flow (cases 149.82 mL/min versus controls 184.67 mL/min; P = .001), which was independent of baseline arterial size. There was no evidence to suggest that flow-mediated dilation of the brachial artery was impaired among affected individuals (P = .71). CONCLUSIONS: Children with Perthes Disease exhibit small artery caliber and reduced function, which is independent of body composition. These data imply that that Perthes Disease may reflect a wider vascular phenomenon that could have long-term implications for the vascular health of affected individuals.