Diffusion-weighted MR imaging (DWI) in the evaluation of epidural spinal lesions

Introduction Epidural spinal cord compression is one of the most critical emergency conditions requiring medical attention and requires prompt and adequate treatment. The aim of our study was to assess the role of diffusion-weighted magnetic resonance (MR) imaging (DWI) in the diagnosis and differentiation of epidural spinal lesions. Methods Three patients with epidural lymphoma, two with sarcoma and three with epidural metastatic disease were imaged on a 1.5T MRI unit. DWI was performed using navigated, interleaved, multi-shot echo planar imaging (IEPI). Three region of interest (ROI)-measurements were obtained on corresponding apparent diffusion coefficient (ADC) maps, and the mean ADC value was used for further analysis. The cellularity of tumors was determined as the N/C ratio (nucleus/cytoplasma ratio) from histological samples. The ADC values and N/C ratios of lesions were compared using a Kruskal-Wallis test. Results The mean ADC of the lymphomas was 0.66 × 10⁻³ mm²/s, that of the sarcomas was 0.85 × 10⁻³ mm²/s and the ADC of the metastatic lesions was 1.05 × 10⁻³ mm²/s; however, the differences were not statistically significant. Mean N/C ratios in the lymphoma, sarcomas and metastases were 4:1, 2:1, and 2.6:1, respectively, with a statistically significant difference between the groups (p < 0.025). Conclusion Although not statistically significant due to the small patient sample, our results clearly show a tendency toward decreased diffusivity in neoplastic lesions with higher cellularity. The data from our study suggest that DWI is a feasible and potentially useful technique for the evaluation of epidural lesions that cause spinal cord compression on a per-patient basis.     

Suicide attempts in Slovenian juveniles, 1978-1994

In the present study the characteristics of all 374 juveniles admitted between 1978 and 1994 to the General Hospital in Maribor, Slovenia, after suicide attempts were investigated. Comparisons were made between elementary school children, aged 9-14 years (n =84), and high school students, aged 15-18 years (n=290), with regard to social situation and motivation for and means of attempting suicide. The majority, 89.6%, of the suicide attempters were girls. Six children had tried to commit suicide by means of alcohol, whereas all the others (98.4%) had used other drugs. A high proportion had dysfunctional family backgrounds. A disturbed parent-child relationship was the primary reason for the suicide attempt in 38.5%, whereas the act was ascribed to disappointments in love in 21.4% and to despair over poor school performance in 18.2%. A combination of reasons was given in 21.9%. The quality of relationships to others played a central role in both age groups. The main difference between the groups was that the predominant problem among the elementary school children was family relationships, whereas the high school students were more vulnerable to problems in relationships with the opposite sex.     

Prevalence, characteristics, and impacts of work-related musculoskeletal disorders: a survey among physical therapists in the State of Kuwait

Background  

Physical therapists working in the State of Kuwait are at risk of work-related musculoskeletal disorders (WMSDs). However, prevalence rates and risk factors are not well documented. The objective of this study was to determine the prevalence, characteristics, and impacts of WMSDs among physical therapists in the State of Kuwait.