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PubMed1988

[Phlebography of the mediastinum in lung cancer].

The state of the major mediastinal veins was studied in 113 patients with central cancer of the right lung upper lobe with metastases to the regional lymph nodes. Routine angiography was performed in 92 patients, digital subtraction angiography--in 21 patients. Vascularization was shown to be more common in and adenocarcinoma. The authors identified 2 groups of angiographic signs: marked and doubtful ones. They have been of opinion that only the presence of marked signs can be a contraindication for surgical intervention. The informative value of routine angiography was compared with that of digital subtraction angiography.

Adenocarcinoma↗

PubMed2004

Feasibility of MR-guided angioplasty of femoral artery stenoses using real-time imaging and intraarterial contrast-enhanced MR angiography.

PURPOSE: To show the feasibility of magnetic resonance (MR) for guided interventional therapy of femoral and popliteal artery stenoses with commercially available materials supported by MR real-time imaging and intraarterial MR angiography. MATERIALS AND METHODS: Three patients (1 female, 2male), suffering from symptomatic arterial occlusive disease with stenoses of the femoral (n = 2) or popliteal (n = 1) arteries were included. Intraarterial digital subtraction angiography was performed in each patient pre- and post-interventionally as standard of reference to quantify stenoses. The degree of the stenoses reached from 71 - 88 %. The MR images were acquired on a 1.5 T MR scanner (Magnetom Sonata; Siemens, Erlangen, Germany). For MR-angiography, a Flash 3D sequence was utilized following injection of 5 mL diluted gadodiamide (Omniscan; Amersham Buchler, Braunschweig, Germany) via the arterial access. Two maximum intensity projections (MIP) were used as road maps and localizer for the interactive positioning of a continuously running 2D-FLASH sequence with a temporal solution of 2 images per second. During the intervention, an MR compatible monitor provided the image display inside the scanner room. Safety guidelines were followed during imaging in the presence of a conductive guidewire. The lesion was crossed by a commercially available balloon catheter (Wanda, Boston Scientific; Ratingen, Germany), which was mounted on a 0.035" guidewire (Terumo; Leuven, Belgium). The visibility was provided by radiopaque markers embedded in the balloon and was improved by injection of 1 mL gadodiamide into the balloon. After dilation, the result was checked by intraarterial MR angiography and catheter angiography. RESULTS: The stenoses could be correctly localized by intraarterial MR angiography. There was complete correlation between intraarterial MR angiography and digital subtraction angiography. The combination of guidewire and balloon was visible and the balloon was placed correctly to cover the entire stenoses. Balloon dilation reduced the degree of stenosis about 45 % on average. A prolonged dilation was necessary in one patient due to a relevant residual stenosis, which was recognized by intraarterial MR angiography. CONCLUSION: MR-guided balloon dilatation of femoral and popliteal artery stenoses supported by real time imaging and intraarterial MR angiography is feasible with commercially available materials in the above mentioned way.

Aged↗

PubMed2001

Carbon dioxide digital subtraction angiography: the practical approach.

CO(2) has developed into a viable alternative to iodinated contrast for digital vascular imaging. Because CO(2) is a gas, it has a unique set of properties that affords certain advantages over iodinated contrast in a variety of settings. However, if CO(2) is used inappropriately, these same properties are associated with a unique set of rare but potentially harmful events. Therefore, it is essential that these unique characteristics be understood in order to employ a few simple precautionary measures. Fortunately, there is a delivery system currently available that is readily assembled and easy to use that ensures the appropriate administration of CO(2). This system, combined with experience, can reduce the greater labor intensity sometimes associated with CO(2) digital subtraction angiography. When it is used appropriately, CO(2) digital subtraction angiography alone or in combination with iodinated contrast offers diagnostic and interventional rewards that are not available with traditional intravascular contrast examinations.

Angiography, Digital Subtraction↗

PubMed2004

Obstructive apneic events induce alpha-receptor mediated digital vasoconstriction.

STUDY OBJECTIVE: To characterize the role of alpha-receptors in autonomic control of digital skin blood flow change in response to obstructive apnea-hypopnea events. DESIGN: Experimental intervention study. SETTING: Sleep laboratory in a university hospital. PATIENTS: Eight male patients with severe obstructive sleep apnea (OSA). INTERVENTIONS: Patients received four cumulative dosage steps of phentolamine (0.066, 0.2, 2 and 5 [n=3] microg/min/100 ml forearm tissue) via brachial artery infusion during nonrapid eye movement sleep (stage 1 and 2). MEASUREMENTS AND RESULTS: The pulse amplitude determined with peripheral arterial tonometry (PAT) was periodically attenuated during the immediate post apnea-hypopnea period coinciding with arousal. PAT ratio (smallest pulse amplitude post apnea divided by largest pulse amplitude during apnea), was determined as a measure of digital vasoconstriction. We found that, compared with baseline, PAT ratio dose-dependently increased during phentolamine (0.2, 2 and 5 microg) infusion by 11.2+/-1.7%, 24.4+/-2.1% and 30.9+/-4.1%, respectively (P<0.001). Systemic blood pressure and heart rate were largely unaffected by the pharmacological intervention. CONCLUSION: OSA related alteration of the pulse amplitude includes a constriction of digital skin vasculature that to a large extent is mediated via sympathoadrenergic alpha-receptors.

Adrenergic alpha-Antagonists↗

PubMed2006

Using digital videos displayed on personal digital assistants (PDAs) to enhance patient education in clinical settings.

OBJECTIVES: To evaluate the effects of using an audiovisual animation (i.e., digital video) displayed on a personal digital assistant (PDA) for patient education in a clinical setting. METHODS: Quasi-experimental study of a prospective technology intervention conducted in an outpatient infectious diseases clinic at an academic medical center. Subjects responded to questions immediately before, immediately after, and 4-6 weeks after watching a digital video on a PDA. Outcome measures include participant knowledge of disease, knowledge of medications, and knowledge of adherence behaviors; attitudes toward the video and PDA; self-reported adherence; and practicality of the intervention. RESULTS: Fifty-one English-speaking adults who were initiating or taking medications for the treatment of HIV/AIDS participated in the study. At visit one, statistically significant improvements in knowledge of disease (p<0.005; paired t-test), knowledge of medications (p<0.005; paired t-test), and knowledge of adherence behaviors (p<0.05; ANOVA) were measured after participants watched the PDA-based video. At visit two (4-6 weeks later), statistically significant improvements in self-reported adherence to the medication regimens (p<0.005; paired t-test) were reported. Participants liked the PDA-based video and indicated that it was an appropriate medium for learning, regardless of their baseline literacy skills. The video education process was estimated to take 25 min of participant time and was viewed in both private and semi-private locations. CONCLUSIONS: Technology-assisted education using a digital video delivered via PDA is a convenient and potentially powerful way to deliver health messages. The intervention was implemented efficiently with participants of a variety of ages and educational levels, and in a range of locations within clinical environments. Additional study of this methodology is warranted.

Adult↗

PubMed1997

[Angiography during interventional procedures with carbon dioxide (CO2) (carbo-angiography) in patients with increased contrast media risk].

Within the last 18 months we examined 130 patients with known complications or contraindications using iodinated contrast media for angiography by using carbon dioxide as contrast agent in digital subtraction angiography technique. These were diagnostic pelvis-leg angiographies (n = 106) with simultaneous consecutive interventional radiologic therapy in 68 cases. In 19 dialysis access fistulas 11 angioplasties were performed in the same session. In 5 cases of renal allografts no interventional radiologic therapy was necessary. For CO2 application an electronic controlled special injector was used. Carbon dioxide has a number of advantages: no adverse reactions, nonallergenic and can be used several times without increasing risks and is cost-saving. CO2 angiography is a sensitive method, for detection vessel wall processes below the diaphragm. It can replace conventional angiography.

Angiography, Digital Subtraction↗

PubMed2003

[The stenosed Brescia-Cimino fistula: operation or intervention?].

INTRODUCTION: Stenosis of the vein close to the arteriovenous anastomosis is the most frequent cause for late failure of Brescia-Cimino fistulae (BCF). Although since decades proximal re-anastomosis has been regarded as the surgical standard treatment, success rates can hardly be deducted from the literature. Considering the increasing activities of interventional radiologists surgical position finding seems necessary. METHODS: Over three years 30 anastomotic BCF stenoses were treated in 28 patients. In 15 patients the stenosis had caused fistula thrombosis. In all cases the fistula vein was re-anastomosed to the proximal radial artery. All patients could be followed up (average 12 months). Each fistula functioning after 24 hours was classified as procedural success. For calculation of patency rates (life table analysis), however, usability of the needling segment of the access was assessed. RESULTS: Procedural success rate was 100%. One fistula thrombosed on the second postoperative day after a successful dialysis session due to an overlooked proximal stenosis of its feeding radial artery. In five fistulae stenoses developed after 4 to 13 months. In only one fistula this was a true re-stenosis of the newly created anastomosis (0.03 per patient-year). Two of the stenoses occurred in the needling segment of the access vein and within its central venous outflow, respectively. Overall re-intervention rate was 0.3 per patient-year, and primary (secondary) patency was 80% (95%) at one year and 67% (87%) at two years. CONCLUSION: In BCF proximal re-anastomosis is a simple and effective therapeutic option for anastomotic venous stenosis. Re-intervention rates are low and procedural success rates as well as primary and secondary patency rates at least equal those of interventional radiology.

Angiography, Digital Subtraction↗

PubMed1977

Quantitative coronary arteriography: estimation of dimensions, hemodynamic resistance, and atheroma mass of coronary artery lesions using the arteriogram and digital computation.

More accurate characterization of coronary artery lesions is needed for evaluation of short and long-term interventions in coronary disease. A method of segmental artery analysis has been developed to maximize the information obtained from coronary arteriograms. Coronary lesions are traced from two projected, perpendicular, 35 mm cineangiographic views and transmetted, in digital form, to a PDP 11/45 computer. Magnification and distortion of the image are compensated for in order to determine the actual vessel profiles, using the catheter and its location as a scaling device. The two views are matched; a spatial representation of the vessel centerline is constructed mathematically; and orthogonal vessel diameters are computed at increments along this centerline. Assuming an elliptical lumen, the absolute and percentage reduction in diameter and cross-sectional area in the stenosis are computed. More complex functions (integrated atheroma mass, Poiseuille resistance, and orifice resistance) are then calculated. The accuracy and variability of the different steps involved in lesion analysis have been determined. Dimensional accuracies of +/- 150 microns (SD) are feasible. Examples are given of patients with Prinzmetal's angina and with progressive coronary disease.

Adult↗

PubMed1997

Densitometric quantitative analysis of intracoronary ultrasound images: anatomopathological correlation.

To establish if the videodensitometric analysis (VDA) of the intracoronary ultrasound images (IVUS) can predict the qualitative and quantitative composition of the atherosclerotic coronary plaques, thirty-one patients who had undergone anatomopathological study of directional coronary atherectomy (DCA) samples and pre- and post-intervention IVUS image were analyzed. The video IVUS images were digitized in a 512 x 512 matrix and analyzed for densitometric differences with an Automatic Image Analysis System (AIAS) (Vidas 2000, Zeiss Kontron). The components of the plaque were arbitrarily divided into three densitometric categories using a 256 gray scale: high density (HD) 121-255, medium (MD) 81-120 and low (LD) 30-80. The relative percentage of each component was automatically recorded. The DCA samples were microscopically examined and put into the AIAS. The components were divided into: collagenous tissue (CT); lipid-necrotic debris (LND); proliferative tissue (PT). The area of each component was expressed as a percentage of the total. Linear correlation analysis was applied. Comparison between the IVUS and the histological composition of the plaque showed that: HD corresponded to CT; MD to PT; LD to LND. The correlation between the percentage distribution of the densitometric categories and the anatomopathological components showed a correlation coefficient r = 0.91 between HD and CT; r = 0.87 between MD and PT; r = 0.88 between LD and LND. The VDA of the IVUS can distinguish three basic components of the atherosclerotic plaque: fibrous, lipid-necrotic and proliferative tissue, allowing absolute and relative quantitative analysis. This capability may be of interest for device selection and histopathological correlation.

Adult↗

PubMed2006

Synchronized, interactive teleconferencing with digital cardiac images.

St James's Hospital is a tertiary referral center for percutaneous intervention and cardiothoracic surgery for a number of referring hospitals. This article reports on the development and implementation of a synchronized, interactive teleconferencing system for cardiac images that links St. James's Hospital with a remote site (Sligo General Hospital) and overcomes the problems of transmission of large image files. Teleconferencing was achieved by setting up lossless auto transmission of patient files overnight and conferencing the next morning with linked control signals and databases. As a suitable product was not available, a commercially new software was developed. The system links the imaging databases, monitors and synchronizes progress through imaging sequences, and links a range of image processing and control functions. All parties to the conference are ensured that they are looking at the same images as they are played or at specific aspects of an image that the other party is highlighting. The system allows patient management decisions to be made at a weekly joint teleconference with cardiothoracic surgeons and interventional cardiologists from both sites. Rapid decision making was facilitated with 70% of decisions obtained within 24 h, and 88% within 1 week of their procedure. In urgent cases, data can be transmitted within 20 min of the diagnostic procedure. The system allows increased access to angiography for patients living in rural areas, and provides a more focused referral for revascularization. Participation of the referring cardiologist has improved the quality of decision making.

Academic Medical Centers↗

PubMed1998

Spontaneous arterial thrombosis in association with pancreatic carcinoma: diagnosis and interventional management.

A 58-year-old woman presented with bilateral upper limb ischaemia. Digital subtraction angiography demonstrated upper limb arterial thrombosis, extensive on the left. This was initially treated with catheter-directed thrombolysis which cleared the thrombus on the right, although the left upper limb required supplementary surgical embolectomy. Subsequently, biopsy-proven pancreatic adenocarcinoma was detected. The upper limb arterial thrombosis appeared to be spontaneous in association with the malignancy because there was no obvious embolic source.

Adenocarcinoma↗

PubMed1991

Quantitative assessment of the age of fibrotic lesions using polarized light microscopy and digital image analysis.

Reliable histologic methods for gauging the maturity of fibrotic lesions are limited, making interventions in the healing process difficult to assess. As collagen ages there is enhanced birefringence due to increased molecular and fibrillar organization. The purpose of this study was to develop a microscopal technique to quantify this process and to determine its ability to distinguish scars of varying ages. Fibrosis in the rat gracilis muscle was studied 5 to 63 days after superficial injury. Sections were stained with picrosirius red and illuminated with monochromatic, polarized light. The microscope fields were digitized using a computer-video system yielding an image in which noncollagenous material was dark (gray level 0) and collagen was depicted by grey levels 1 to 255. In the fibrosis model used, the collagen area fraction plateaued at 80% by day 21. The median collagen grey level increased progressively as the scar aged. It is concluded that this histologic, nondestructive technique can reliably quantify age-related optical properties of fibrotic collagen and that this could be used to determine the maturity of fibrotic lesions.

Aging↗

PubMed2006

Telemedicine in dermatology: a randomised controlled trial.

OBJECTIVES: To compare the clinical equivalence, patient and clinician opinion of store-and-forward (SF) teledermatology with conventional face-to-face consultation in setting a management plan for new, adult outpatient referrals. To assess the equivalence of digital photography and dermoscopy with conventional face-to-face consultation in the management of suspected cases of malignant melanoma or squamous cell carcinoma. DESIGN: For the SF teledermatology aspect of the study, a prospective randomised controlled trial was carried out. SETTING: Eight general practices and a hospital dermatology department in Sheffield, England. PARTICIPANTS: For the SF teledermatology part of the study, adults (aged 16 years and over) requiring a new (not seen by a hospital dermatologist within the past year) consultant opinion. For the digital photography element of the study, adults (aged 16 years and over) requiring a consultant opinion due to suspicion of malignant melanoma or squamous cell carcinoma. INTERVENTIONS: Patients in the telemedicine intervention group were referred to the consultant, and managed as far as possible using one or more digital still images and a structured, electronic referral and reply. The control group was managed by conventional hospital outpatient consultation. Patients referred to the 2-week wait clinic were invited to have a series of digital photographs, with and without dermoscopy, immediately before their face-to-face consultation. A second consultant viewed these and outlined a diagnosis and management plan which was compared with the actual management. Both were compared with the definitive diagnosis (either the final clinical or histological diagnosis, where undertaken). MAIN OUTCOME MEASURE: The concordance between the consultant who had managed the case and an independent consultant who gave a second face-to-face opinion. RESULTS: A total of 208 patients were recruited. There was also a greater loss of control cases (26%) than intervention cases (17%). A statistically significant difference in ages between the two groups completing the study (mean age of intervention group 43.6 years, control group 49.7 years, p = 0.039) indicates that this may have introduced a bias between the two groups. A further possible source of bias is the delay (mean difference of 54 days, p = 0.0001) between the SF opinion and the second opinion in the SF group, whereas control patients usually received their second opinion on the same day as their outpatient appointment. In 55% (51/92) of telemedicine cases and 78% (57/73) of control cases, the diagnosis concurred, with the second opinion. In 55% (51/92) of telemedicine cases and 84% (61/73) of control cases, the management plan concurred with the second opinion. Of the 92 telemedicine cases, 53 were judged also to require a face-to-face consultation, mainly to establish a diagnosis and treatment plan. With the digital photography for suspected skin cancer aspect of the study, it was found that an unexpectedly high proportion (33%, 85/256) of referrals proved to have a malignancy or a severely dysplastic lesion, with almost 22% having a malignant melanoma or squamous cell carcinoma, possibly reflecting the rise in incidence of skin cancers reported elsewhere. When both standard and dermoscopic images were employed, diagnostic concordance was modest (68%). The approach was highly sensitive (98%, 95% CI: 92 to 99%), at the expense of specificity (43%, 95% CI: 36 to 51%). Overall, 30% of cases would not have needed to be seen face-to-face, though two squamous cell carcinomas would have been missed (a number-needed-to-harm of 153). If the highest level of clinician confidence had been applied, no cancers would have been missed, but only 20% of patients would have avoided an outpatient appointment. CONCLUSIONS: In view of the difficulties in recruitment and the potential biases introduced by selective loss of patients and the delay in obtaining a valid second opinion in the study group, no valid conclusions can be drawn regarding the clinical performance of this model of SF telemedicine. With regard to digital photography in suspected skin cancer, it is unlikely that this approach can dramatically reduce the need for conventional clinical consultations, whilst still maintaining clinical safety. Additional research on the assessment of diagnostic and management agreement between clinicians would be valuable in this and other fields of research.

Adolescent↗

PubMed2006

Evaluation of clinical pharmacy services in a hematology/oncology outpatient setting.

BACKGROUND: The Veterans Affairs North Texas Health Care System in Dallas, TX, provides a unique opportunity for clinical pharmacists to work as providers. Even though clinical pharmacists are actively involved in patient care, many of their efforts remain undocumented, resulting in an underestimation of the importance of their services and missed opportunities for improvements and new directions. OBJECTIVE: To document and evaluate the services of a hematology/oncology clinical pharmacy in the outpatient setting. METHODS: Pendragon Forms 3.2 software was used to design the documentation template. The template was designed to collect diagnoses, supportive care issues, drug-specific interventions, and prescriptions written. This template was uploaded to the personal digital assistant (PDA) for documentation. Patient-specific information was documented in a password-protected PDA. Data collected from November 1, 2002, to October 31, 2003, were retrospectively analyzed. RESULTS: Clinical pharmacists were involved in 423 patient visits for chemotherapy follow-up or disease management. Cancer diagnoses included colorectal (n = 99), multiple myeloma (59), non-small cell lung (56), chronic lymphocytic leukemia (44), myelodysplastic syndromes (22), and chronic myelogenous leukemia (19). During the 423 patient visits, 342 supportive care issues were addressed including anemia (34%), pain management (22%), constipation/diarrhea (15%), and nausea/vomiting (8%). Major drug-specific interventions included drug addition (41%), discontinuation (23%), and adjustment (21%). Four hundred forty-five prescriptions were filled, of which 181 were new and 150 were refilled. CONCLUSIONS: This is the first study, as of July 25, 2006, to document considerable contribution of an outpatient clinical pharmacist in direct cancer patient care. Although the disease management and supportive care issues addressed here may differ based on institution and patient population, the results of our study show that clinical pharmacists have ever-growing roles in the management of these patients.

Ambulatory Care↗

PubMed1990

Comparison of digital and cine coronary arteriography.

Digital coronary arteriography has advanced from a curiosity to a powerful clinical tool. This development has been motivated by the new imaging demands of interventional cardiology, by the need for quantifying atherosclerotic disease, and by advances in computer and video technology. Digital imaging has now essentially replaced cinefilm for clinical decision making in some catheterization laboratories, although uncertainty remains regarding the diagnostic comparability of the two modalities. Therefore, we compared simultaneously acquired digital and cine arteriograms from 18 patients with multivessel coronary artery disease. Digital utilized pulse-progressive technique, a 512 x 512 pixel x 8 bit image matrix, and no post processing. Four angiographers interpreted the arteriograms, identifying 131 stenotic lesions for measurement with manual calipers. Measurements of percent diameter stenosis by digital and cine correlated closely (r = 0.88), but digital estimated stenoses to be significantly more severe than cine (p less than 0.0001). This difference was most significant in small (less than 2 mm diameter) arteries, in branch arteries, and with mild stenoses. The differences between digital and cine were not statistically significant for stenoses greater than 50% diameter narrowing. Interobserver variability was similar for digital and cine imaging. Thus, unprocessed digital and film-based coronary arteriography yield similar assessments of atherosclerotic stenoses, but the techniques may not be diagnostically interchangeable. This paper discusses the technical advances which have occurred in digital coronary arteriography, the comparability of digital and cine imaging, and the factors which may be responsible for observed differences between the two modalities.

Cineangiography↗

PubMed1996

Renal angiomyolipoma: diagnosis with B-ultrasonography, CT scanning, DSA and its interventional treatment.

From 1989, 15 cases of renal angiomyolipoma (AML) have been diagnosed by ultrasonography. CT scanning and digital subtraction angiography (DSA) at our hospital. In 8 patients with uneven hyperechoes on B-mode ultrasonography (B-US) (8/15) and 7 with low density of fat on CT scanning (7/12) accurate diagnosis was established preoperatively. DSA revealed the "berry-like" pseudoaneurysms in the arterial phase (14 cases), the defined lucent area in the nephrogram phase (10 cases) and the "onion-peel appearances" during venous phases (8 cases), correct diagnosis was achieved in all patients. 8 cases were surgically treated and 7 treated by subselective embolization of renal artery. Effects in all cases were good. The diagnostic value of B-US, CT scanning, DSA and interventional treatment of AML was discussed. It was believed that the diagnosis with DSA was a technique with high specificity, and embolization therapy was simple and effective for AML.

Adult↗

PubMed2002

[Stereotactic vacuum biopsy in prone and sitting position].

PURPOSE: The purpose of our study was to determine the accuracy of vacuum-assisted biopsy (VB) and to evaluate the side effects of this method depending on the positioning of the patient during the intervention. METHODS: Interventions were performed with the 11-G biopsy needle either in prone position (Mammotest S, Fischer Imaging, USA) on a dedicated table for breast intervention (n = 308) or in upright position with a dedicated digital stereotactic mammography system (Mammomat 3000, Optima, Siemens, Germany). VB was indicated because of indeterminate or suspicious microcalcifications (84.1%) or because of dense lesions (15.9%). All benign results found with VB have been followed up after 6 and 12 months by mammography. All malignant or histological findings discordant to imaging features have been verified by open surgery. RESULTS: Histology after VB offered 215 (64.4%) benign lesions. In neither case a carcinoma developed during follow-up. In 90 (27%) cases malignancy was found with VB. After reexcision the diagnosis of VB was confirmed in 85.6%. In 8.9% of the cases in which VB showed DCIS, histology after open surgery revealed also invasive tumor components. Technical problems occurred in 4 cases. Major side effects developed neither in prone position nor in upright, sitting position of the patient. CONCLUSION: VB is a reliable method with less side effects for the histological evaluation of breast lesions. The accuracy and complications are not depending on the type of stereotactic device or on the patients position. The accuracy of the histological diagnosis achieved with VB can be compared to that of open surgery. The relative high costs of this method may cause a problem. But compared to the costs resulting by open diagnostic surgery this disadvantage is only a relative one.

Adult↗

PubMed2005

Myelopathy: a report of two cases.

OBJECTIVE: To present diagnostic imaging findings of two cases of cervical myelopathy, with different etiologies, presenting to a chiropractic office. CLINICAL FEATURES: The patient with acute transverse myelitis had neck and upper back pain and nonspecific headaches for 40 years. The patient with posttraumatic syringomyelia experienced intermittent left arm pain starting in the anterolateral shoulder and radiating down the arm into the third, fourth, and fifth digits. Neither of these patients presented with typical myelopathic symptoms. INTERVENTION AND OUTCOME: Chiropractic spinal manipulative therapy using high-velocity low-amplitude thrusts and concomitant medical management were used for the patient with posttraumatic syringomyelia. The patient with acute transverse myelitis was not treated. CONCLUSION: Practitioners should be aware of the etiology, pathophysiology, clinical features, laboratory, diagnostic imaging findings, and treatment options pertaining to patients with cervical myelopathy.

Adult↗