The British journal of radiology
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The radiographic appearances are reported of chronic stress to the wrist joints of eight adolescent males, seven gymnasts and one roller skater. These consist of bilateral, asymmetrical widening and irregularity of the distal radial growth plates with an ill-defined cystic appearance, sclerosis and flaring of the metaphyses in all eight cases. ⋯ Rapid healing of the stress fracture will occur with cessation of the sporting activity but continued strenuous use of the wrists will result in further widening and irregularity of the growth plate. The differential diagnosis of the radiographic appearances and previous literature are discussed.
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In a series of studies, we have shown that phenytoin, 300 mg daily for one week, produces consistent hepatic microsomal enzyme induction, resulting in a decrease of 25% in misonidazole half-life, without causing any toxicity per se. A longer period of administration gives only a slightly greater induction. Phenobarbitone in a daily dose of 90 mg causes a reduction of 18% and 23% in misonidazole half-life after 1 and 2 weeks' pre-treatment respectively, but is less suitable clinically because of its sedative effect. ⋯ In single doses of above 3.0-4.0 g of misonidazole, severe nausea and vomiting are prominent, so that this side effect is a determining factor in the treatment fractionation. Audiometric studies show no correlation between the incidence of peripheral neuropathy and abnormal audiograms, and have no value in the early prediction of neurotoxicity. It seems that despite causing increased metabolism, enzyme induction does not protect against neurotoxicity and thus will not permit the use of higher doses of misonidazole for increased radiosensitisation.
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The hypoxic cell radiosensitiser desmethylmisonidazole (DMM, Ro-05-9963) was administered orally to C3Hf female mice at three different dose levels (1.4, 1.6 and 1.8 mg g-1 day-1). Behavioural and morphological end-points were used to evaluate the neurotoxicity of this compound at these doses. The behavioural changes present at all three dose levels appeared when the total dose approached approximately 19 mg g-1. ⋯ DMM appears to affect both the central and peripheral nervous systems at the same time at these dose levels. This is in some degree different from previous experience with misonidazole where peripheral damage distinctly precedes central effects. The development of the disorder appeared to be more rapid and severe when compared with earlier experience with misonidazole.