A Comparison Between M.R.I. and C.T. in the Investigation of Neurological Deterioration in Longstanding Spinal Trauma

MRI at 0.3 T and CT with myelo-graphic 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). In the largest reported study comparing MR and CTM, Betz et al (6) reported the results of 43 children who were investigated up to 48 months from original injury, of whom 24 had CTM. They concluded that although MR was indicated for the evaluation of subacute and chronic spinal cord injured patients, CT-myelography remained essential before considering surgery for spinal cord decompression (6). We retrospectively evaluated the results of MR and CT-myelography in 35 patients who developed new symptoms following past spinal cord injury to determine whether there was still any place for CTM in the evaluation of this problem.     

Using Intracardiac Catheter Recordings from the His and Proximal Coronary Sinus to Distinguish Isthmus Conduction Block During Catheter Ablation of Type I Atrial Flutter

Isthmus conduction block, demonstrated with the use of multipolar catheter recordings, is considered the preferred endpoint for ablation of type I atrial flutter. This study investigated the feasibility of using recordings from the His and coronary sinus (CS) to document isthmus conduction block. Isthmus conduction block was produced with linear radiofrequency (RF) ablation in 27 patients with type I atrial flutter. In 13 patients (group I), RF was delivered until bidirectional isthmus conduction block was demonstrated with multipolar Halo catheter recordings. In 14 patients (group II), RF was delivered during pacing from the lateral isthmus at 600 ms until a reversal in activation of the proximal CS and His occurred. At this point, data from the Halo recordings were reviewed to see if reversal correlated with conduction block; if not, further ablation was performed until block was demonstrated. The initial reversal in His and CS activation during RF energy delivery correlated with isthmus block in only 4 (28.6%) of 14 patients in group II. Additional RF delivery produced isthmus block in the other ten patients resulting in a further increase in the St-CS interval of 35 ± 20 ms. A His-CS interval of at least -40 ms signified isthmus block with a sensitivity and specificity of 48% and 100%, respectively. Reversal in His-CS activation during pacing from the lateral margin of the isthmus is not specific for the creation of isthmus block. While activation of the proximal CS bipole > 40 ms after activation of the His appears specific for isthmus block, the low sensitivity of this finding limits its clinical use.     

Peripheral Arteries May Be Reliable Indicators of Coronary Vascular Disease

Atherosclerosis is a stronger predictor for ischemic cardiovascular events than traditional risk factors such as race, age, sex, history, and metabolic profile. Previous research had primarily used ultrasound; however, we performed a study using histopathology to more accurately grade atherosclerosis development using the American Heart Association's grading scale. We cross‐sectioned 13 different arteries from 48 cadavers and placed them into three separate groups based on anatomic location: central arteries, peripheral arteries, and carotid arteries. The central artery group included arteries that are non‐palpable and commonly lead to ischemic diseases when occluded. The peripheral artery group included arteries that are accessible to palpation. The carotid artery group included branches of the carotid artery. We investigated whether a centrally located atherosclerotic vessel was associated with atherosclerosis of a specific peripheral artery. We hypothesized a correlation between carotid, peripheral and central arteries that may point to specific arteries that are more effective to analyze clinically when assessing cardiovascular risk. We observed a correlation between pathology in the left coronary artery and bifurcation of the carotid artery (r = 0.37 P ≤ 0.016), two arteries known to be implicated in ischemic stroke and ischemic heart disease. Importantly, our study demonstrates that the radial artery, a peripheral vessel, exhibited a positive correlation between both the pathologic left coronary (r = 0.33 P ≤ 0.041) and bifurcation of the carotid arteries (r = 0.34 P ≤ 0.025). Therefore, we propose investigating the radial artery as a clinically accessible location to monitor with ultrasound when assessing a patient's risk for ischemic cardiovascular disease. Anat Rec, 300:1230–1239, 2017. © 2017 Wiley Periodicals, Inc.     

Hyoid Bone Development: An Assessment Of Optimal CT Scanner Parameters and Three‐Dimensional Volume Rendering Techniques

The hyoid bone anchors and supports the vocal tract. Its complex shape is best studied in three dimensions, but it is difficult to capture on computed tomography (CT) images and three‐dimensional volume renderings. The goal of this study was to determine the optimal CT scanning and rendering parameters to accurately measure the growth and developmental anatomy of the hyoid and to determine whether it is feasible and necessary to use these parameters in the measurement of hyoids from in vivo CT scans. Direct linear and volumetric measurements of skeletonized hyoid bone specimens were compared with corresponding CT images to determine the most accurate scanning parameters and three‐dimensional rendering techniques. A pilot study was undertaken using in vivo scans from a retrospective CT database to determine feasibility of quantifying hyoid growth. Scanning parameters and rendering technique affected accuracy of measurements. Most linear CT measurements were within 10% of direct measurements; however, volume was overestimated when CT scans were acquired with a slice thickness greater than 1.25 mm. Slice‐by‐slice thresholding of hyoid images decreased volume overestimation. The pilot study revealed that the linear measurements tested correlate with age. A fine‐tuned rendering approach applied to small slice thickness CT scans produces the most accurate measurements of hyoid bones. However, linear measurements can be accurately assessed from in vivo CT scans at a larger slice thickness. Such findings imply that investigation into the growth and development of the hyoid bone, and the vocal tract as a whole, can now be performed using these techniques. Anat Rec, 298:1408–1415, 2015. © 2015 Wiley Periodicals, Inc.     

Creating consensus about nursing outcomes. II. Nursing outcomes as agreed by patients,nurses and other health professionals

• ? The questions ‘what is it that you want from nursing?’ and ‘how would you know when you have got what you want from nursing?’ were put to patients, nurses and other health professionals.
• ? The patients identified essential qualities of nurses.
• ? Problems within the nursing group are identified. The view of each group on the other's work is discussed.
• ? Areas of consensus related to respect, communication, competence, co-operation and context.
• ? Indicators or measures of the consensus areas are reported.

     

Update on electrophysiology in schizophrenia

Event-related potentials (ERPs) provide a non-invasive, functional method to evaluate neural activation and cognitive processes in schizophrenia, with a temporal resolution in the millisecond range, literally at the speed of thought. Auditory ERP components tested in schizophrenia, in order of latency of occurrence, include the P50 sensory gating response, the mismatch negativity, P300, and the N400 component. Abnormalities in these components demonstrate pervasive disruption of auditory processing as early as 50 milliseconds after stimulus onset. All of these abnormalities appear to tasks which require sensory memory or working memory operations. The anatomic substrates for these ERP components probably include the posterior superior temporal gyrus and medial temporal lobe structures. P300 topographic asymmetries have been associated with left posterior superior temporal gyrus abnormalities. Future work will focus on relating ERP abnormalities to specific neural circuit disturbances in this disorder.     

A Cross-Sectional Prevalence Study of Ethnically Targeted and General Audience Outdoor Obesity-Related Advertising

Context: Commercial marketing is a critical but understudied element of the sociocultural environment influencing Americans'' food and beverage preferences and purchases. This marketing also likely influences the utilization of goods and services related to physical activity and sedentary behavior. A growing literature documents the targeting of racial/ethnic and income groups in commercial advertisements in magazines, on billboards, and on television that may contribute to sociodemographic disparities in obesity and chronic disease risk and protective behaviors. This article examines whether African Americans, Latinos, and people living in low-income neighborhoods are disproportionately exposed to advertisements for high-calorie, low nutrient–dense foods and beverages and for sedentary entertainment and transportation and are relatively underexposed to advertising for nutritious foods and beverages and goods and services promoting physical activities.Methods: Outdoor advertising density and content were compared in zip code areas selected to offer contrasts by area income and ethnicity in four cities: Los Angeles, Austin, New York City, and Philadelphia.Findings: Large variations were observed in the amount, type, and value of advertising in the selected zip code areas. Living in an upper-income neighborhood, regardless of its residents'' predominant ethnicity, is generally protective against exposure to most types of obesity-promoting outdoor advertising (food, fast food, sugary beverages, sedentary entertainment, and transportation). The density of advertising varied by zip code area race/ethnicity, with African American zip code areas having the highest advertising densities, Latino zip code areas having slightly lower densities, and white zip code areas having the lowest densities.Conclusions: The potential health and economic implications of differential exposure to obesity-related advertising are substantial. Although substantive legal questions remain about the government''s ability to regulate advertising, the success of limiting tobacco advertising offers lessons for reducing the marketing contribution to the obesigenicity of urban environments.     

The elderly mentally handicapped in the community and a psychiatric service

The contacts of a Mental Handicap and a General Psychiatric Service with elderly mentally handicapped patients were surveyed over a six year period for a district with a population of approximately 200,000. Only 10 individuals were referred, seven to the mental illness service. Behaviour disturbance or psychiatric symptomatology was usually present, but self-care was relatively good. Another eight elderly patients were discharged from the mental handicap hospital to residential homes for the elderly; this was usually successful. The reasons for the low referral rate are discussed.