Biomedical subjects
Publications and source records attributed to M Silberstein.
Two unusual complications of immunosuppression, Castleman's disease and Kaposi's sarcoma, occurring in a renal transplant recipient, are reported. Kaposi's sarcoma is a potentially curable condition in immunosuppressed patients if recognized and treated appropriately. In this patient, the pulmonary Kaposi's sarcoma was not diagnosed and this lead to the patient's death.
In a retrospective analysis of 27 consecutive patients with acute cervical spine injury who underwent Magnetic Resonance (MR) Imaging, 14 had prevertebral soft tissue swelling on initial lateral radiographs, of whom 13 had anterior longitudinal ligament disruption on MR. Of the eight patients who had isolated prevertebral swelling in the absence of vertebral body fracture or significant subluxation, seven had anterior longitudinal ligament disruption shown on MR imaging. Of the patients with MR documented ligament injury, three had dynamic flexion-extension radiographs within 2 weeks of injury and all demonstrated cervical instability. As cervical prevertebral swelling following trauma was indicative of ligament injury in nearly half the patients, this finding should prompt clinical and radiographic follow-up to exclude spinal instability.
In a retrospective review of 94 consecutive patients with past spinal cord injury referred for magnetic resonance imaging (MRI) for the evaluation of new neurological symptoms, 59% were found to have cystic spinal cord lesions. Twelve of these patients underwent surgical cyst drainage, half having presented with increased myelopathy, and half with ascent of the neurological level. All of the operated cysts were greater than 2 cm in diameter (mean 15.8 cm), and 4 had areas of signal void indicating turbulent flow. All 12 patients had clinical improvement following surgery. The future prospective use of MRI in patients with longstanding spinal cord injury may prove valuable in the identification of patients with syrinx formation, at risk of developing neurological deterioration, who may benefit from early cyst drainage. At present, however, the decision to operate on these patients should be based primarily on clinical criteria.
The effect of spinal cord compression identified with magnetic resonance imaging (MRI), on neurological prognosis, was retrospectively evaluated in 36 patients with acute spinal cord injury. Of the 21 patients without cord compression, 16 had potentially reversible injury (normal spinal cord or cord oedema), all having functional recovery. Of the 15 patients with cord compression, 3 had operative decompression. In the 12 patients who did not undergo surgery, the degree of recovery was directly related to the magnitude of spinal cord compression, only one of the patients with moderate or marked cord compression having useful motor function at follow up. In contrast, the 3 patients with surgical decompression had at least 2 grades of improvement, all having functional recovery. These findings raise the possibility that MRI may be used to identify a patient group who will benefit from surgical decompression. A numerical index is proposed to prospectively identify patients for surgical decompression, and further studies are underway to evaluate this.
Magnetic Resonance Imaging (MRI) at 0.3T and Computed Tomography (CT) were compared in the retrospective evaluation of 34 patients with acute spinal cord injury. MRI was highly accurate in the imaging of vertebral body fracture, and spondylitic changes, and is the method of choice for imaging ligament injury, traumatic disc protrusion and spinal cord compression. It was also useful for the identification of subtle subluxations in the sagittal plane. CT remains the method of choice for imaging neural arch fractures. MRI at 0.3T is a valid technique for assessing patients with acute spinal trauma.
MRI at 0.3T and CT with myelographic contrast (CTM) were compared in the retrospective evaluation of 35 patients investigated for the development of new neurological symptoms following longstanding spinal cord injury. Compared with MRI, CTM was relatively accurate for the demonstration of spinal cord compression, but failed to identify 23% of patients with spinal cord atrophy, and 43% of patients with post-traumatic syrinx formation. However, 5 patients had unsatisfactory MR imaging, either due to motion or metallic artifact, and in 3 of these, CTM demonstrated a syrinx. Although MRI is the method of choice in the investigation of this problem, CTM may still be required for patients with an unsatisfactory MR examination. Magnetic Resonance (MR) imaging is now an established technique for imaging the spine, with accurate depiction of the spinal cord, as well as the adjacent soft tissues (1, 2). However, the cost of this technique, and its as yet limited availability in Australasia, has resulted in the necessity to demonstrate its superiority over other imaging modalities for any specific clinical problem (3). One of the major areas of impact of MR has been in the investigation of the problem of acute neurological deterioration in patients with past spinal trauma (4, 5, 6). Some of these patients will have treatable causes of deterioration, either a post-traumatic syrinx, or spinal cord compression (6), and MR can be used to image these conditions (7), which, until recently, were investigated with computed tomography with myelographic contrast medium (CTM), (8, 9).(ABSTRACT TRUNCATED AT 250 WORDS)
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The radiological findings in five patients with pelvic soft tissue neoplasms directly involving the sacroiliac joint, are described. All patients had Computed Tomography (CT) examinations, two of the patients also having Magnetic Resonance Imaging (MRI). The role of imaging in this uncommon entity is discussed as well as the importance of making this diagnosis, thereby excluding unilateral sacroiliitis. The therapeutic implications of this diagnosis relate to local neural involvement, especially the sciatic nerve, and the fact that involvement of the sacroiliac joint by tumors significantly compromises chances of a successful surgical outcome. The role of MR in this condition is not yet certain, but it may prove to be the method of choice in view of its excellent depiction of skeletal neoplasms.
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A case of massive mesenchymal hamartoma of the liver is described in a 13-month-old infant. A complex multicystic mass was demonstrated by ultrasound and computed tomography (CT). The appearances suggested the preoperative diagnosis.
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Reformation of the curve of the Simmons sidewinder catheter may be difficult in some patients, and the originally described technique using the left subclavian artery may be unsuccessful. We review the techniques available for curve reformation, identifying the limitations and problems associated with each technique. We believe that reformation in the descending aorta without a guidewire is the method of choice in most patients. Knowledge of a number of different techniques is advisable.
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INTRODUCTION: Awareness of the risk of spinal-cord damage in moving an unconscious person with a suspected neck injury into the "lateral recovery position," coupled with the even greater risk of inadequate airway management if the person is not moved, has resulted in a suggested modification to the lateral recovery position for use in this circumstance. HYPOTHESIS: It is proposed that the modification to the lateral recovery position reduces movement of the neck. In this modification, one of the patient's arms is raised above the head (in full abduction) to support the head and neck. The position is called the "HAINES modified recovery position." HAINES is an acronym for High Arm IN Endangered Spine. METHODS: Neck movements in two healthy volunteers were measured by the use of video-image analysis and radiographic studies when the volunteers were rolled from the supine position to both the lateral recovery position and the HAINES modified recovery position. RESULTS: For both subjects, the total degree of lateral flexion of the cervical spine in the HAINES modified recovery position was less than half of that measured during use of the lateral recovery position (while an open airway was maintained in each). CONCLUSION: An unconscious person with a suspected neck injury should be positioned in the HAINES modified recovery position. There is less neck movement (and less degree of lateral angulation) than when the lateral recovery position is used, and, therefore, HAINES use carries less risk of spinal-cord damage.
PURPOSE: To 1) correlate spinal MR features and modes of clinical presentation associated with symptomatic neurologic deterioration following longstanding spinal trauma; 2) correlate degree of neurologic deficit with spinal MR appearance in these patients; and 3) determine the relationship between new symptoms and ongoing cord compression. METHODS: Retrospective examination of MR images, and correlation with clinical data, in 94 consecutive patients. RESULTS: Sixty-seven patients presented with either an increase in degree of myelopathy or ascending neurologic level. Spinal cord atrophy (43%), syrinx (41%), and cord compression (24%) were found most frequently. Whereas in patients with complete motor and sensory deficit cord atrophy was the most frequent finding (52%), 75% of patients with useful motor function had normal spinal cords. There was a significant association (P less than .05) between cord compression and the MR findings of cord atrophy and myelomalacia, whereas a normal cord was over twice as frequent in patients without spinal cord compression. MR imaging led to an active change in management in 15% of patients, with improvement following surgery in all operated cases. CONCLUSION: Although syrinx is a frequent, and treatable cause of delayed neurologic deterioration, MR will frequently show other abnormalities such as ongoing cord compression. MR imaging should be performed urgently in all patients with new symptoms to enable early treatment to prevent irreversible loss of function.
PURPOSE: 1) To determine whether MR appearances of the spinal cord in acute trauma correlate with clinical prognosis, and 2) to identify other MR and CT prognostic factors in acute spinal trauma. METHODS: Retrospective evaluation of MR, CT, and clinical examinations in 32 acute spinal trauma patients examined between 1987 and 1990. RESULTS: All 21 patients with abnormal spinal cords on MR had complete motor paralysis at presentation, compared to only three of 11 patients with normal cords. Whereas cord transection and hemorrhagic contusion had poor prognoses, 73% of patients with cord edema and 100% of patients with normal cord had useful motor function at outcome. At follow-up MR, areas of cord contusion developed into cysts, while edema resolved, leaving residual areas of myelomalacia. Associated spinal fractures, ligament injury, and cord compression were associated (P < .05) with a worse prognosis. Spondylotic changes were a significant risk factor for spinal cord injury, mediated by cord compression. CONCLUSIONS: MR and CT are valuable techniques for quantifying injury and predicting prognosis in acute spinal trauma.