Efficacy of CT-guided biopsies of the spine in patients with spondylitis--an analysis of 164 procedures

Objective

To evaluate efficacy of CT-guided spinal biopsy (CTSB) in patients with spondylitis considering patient characteristics, technical issues, antibiotic therapy, histopathological, and microbiological findings.

Materials and methods

All CTSB procedures performed between 1995 and 2009 in patients with proven spondylitis were re-evaluated. Patient sex and age, antibiotic treatment, biopsy approach, number of specimens, length of needle path, laboratory results (CRP, WBC), and histopathological/microbiological findings were documented and compared to the final diagnosis of spondylitis. Statistical analysis was performed using Chi-square test and Student's t-test. The p-value was set to 5%.

Results

164 CTSB procedures were performed in 159 patients (mean age 65 years, 60% men) in which spondylitis was histopathologically verified in 95%. Neither patient sex nor age, positioning, localization of the spinal lesion, bioptic approach, number of specimens, or depth of the needle showed significant impact on the rate of positive histopathological findings. A causative germ was identified in 40/127 biopsies (32%) with Staphylococcus aureus being identified in 50%. Tuberculous spondylitis was diagnosed in ten cases (6%). CRP significantly correlated with bacterial growth (13.3 ± 12.2 mg/dl versus 8.8 ± 7.6 mg/dl; p = .015) whereas administration of antibiotics did not show any significant impact on bacterial growth (29% versus 36% in patients without antibiotics; p = 0.428). Patients with histopathological signs of active spondylitis showed a significantly higher CRP (16.5 ± 15.8 mg/dl versus 8.9 ± 8.0 mg/dl, p < .001). Complication rate was 0.6% (one focal bleeding).

Conclusion

CTSB of the spine in suspected spondylitis is an effective and safe procedure for establishing final histopathological diagnosis. However, microbiological yield is low regardless of technical issues and antibiotic therapy. Other than CRP values, laboratory investigations added little useful information to diagnose infection in our study group. CRP values significantly correlated with bacterial growth and with histopathological signs of active spondylitis.     

Transcranial US of preterm neonates: High risk gestational age and birth weight for perinatal asphyxia

Objective

The study aims to determine the high risk gestational week (GW) and/or birth weight (BW) of the preterm neonate, below which perinatal hypoxic cerebral injuries are expected to occur.

Material and methods

Eighty preterm neonates, born at or before 37 GW, were included. Twenty-three of them were <32 GW and 57 >32 GW. Also, 28 of them were <1500 g and 52 >1500 g. Imaging was done by transcranial ultrasound with 4–9 MHz curvilinear probe. CT scan was additionally performed for only 18 candidates. The study protocol was approved by the ethics committee in Al-Mana General Hospital (AGH).

Results

Intraventricular hemorrhage (IVH) was diagnosed in six preterm neonates <32 GW and two >32 GW. Three <32 GW and one >32 GW presented with hypoxic ischemic encephalopathy (HIE) with no hemorrhage. Two preterm neonates <32 GW had both IVH & HIE. All positive cases were below 1500 g BW.

Conclusion

Preterm neonates <32 GW and/or <1500 g are highly susceptible for HIE and/or IVH. Thus, special medical care, including post-labor hospitalization in well equipped special baby care units (SCBU) and routine transcranial ultrasound (TCUS) screening is recommended for those preterm neonates.     

看图对话工具对提高新发糖尿病患者治疗依从性的研究

【摘要】目的 研究看图对话工具对初发糖尿病患者治疗依从性的影响。方法 随机选取80例初发糖尿病患者,分为实验组、对照组各40例（其中两组分别失访3例、8例）,两组患者在基线人口学资料、接受教育程度、治疗等方面差异无统计学意义（p>0.05)。实验组由教育护士利用“糖尿病看图对话”工具进行互动式教育,对照组采用常规糖尿病教育。每月回访一次。结果 通过随访6个月显示,实验组患者在糖尿病知识的掌握、治疗依从性的评分、糖化血红蛋白水平改善均优于对照组,差异有统计学意义（p<0.05)。结论 应用看图对话工具能够提高患者对糖尿病综合知识掌握的主动性和对治疗的依从性,帮助其形成正确的生活方式,从而更好的控制血糖波动,防止并发症的发生。     

Analysis and Comparison of the Tongue Picture of 34 Patients with Severe Acute Respiratory Syndrome

Objective: To explore the changes of tongue pictures in the developing process of disease in patients with severe acute respiratory syndrome (SARS), and to compare the tongue pictures of SARS patients with those of suspected SARS patients. Methods: Materials of tongue picture were dynamically collected from 34 SARS patients and 35 suspected SARS patients, and the difference and similarity between them were analyzed. Meanwhile, the changes in clinic symptoms and tongue picture after integrative medicinal treatment were observed. Results: Characteristics of tongue picture in SARS patients were changed along with the progress of the disease, showing that there existed a tendency of the pathogen invading from exterior to interior, from surface to the deep. Also the tongue pictures were varied due to the coexistence of dampness pathogen; the time of the early stage was generally 1 - 1.5 days, shorter than that of other stages. While in the patients with suspected SARS, the tongue picture was mostly red with     

螺旋藻干粉对电离辐射所致小鼠血像改变的影响

目的：探讨螺旋藻（SP）干粉对电离辐射所致小鼠血像改变的影响。方法：按体重将小鼠随机分为9个组，即空白对照组和4、7Gy的单纯照射组及每一照射剂量再分别给予400、800、1200mg/kg3个SP剂量给药组。给药（灌胃）后第8天照射。照射前1d、照射后4h、照射后第7天各处死一批小鼠，进行白细胞（WBC）、血小板（Plt)计数和血红蛋白（Hb）含量测定。结果：照射后WBC、Plt呈下降趋势，给药组WBC均高于单纯照射组，Hb影响不大。结论：SP对辐射所致血像改变有保护作用。     

A time–motion study of digital radiography at implementation

With increasing budgetary restraints on the health system, it is apparent that the main contribution that radiology departments can make to significant cost reduction in hospitals is to decrease the length of time between requesting an X-ray examination and receiving the report (and images). Digital radiography (DR) was introduced into the Radiology Department at the Royal Adelaide Hospital as a pilot project to research the cost–benefits and efficiency of the system, and to determine future directions for planning a digital department. The business plan developed prior to implementation of this pilot project predicted a saving of one bed-day per inpatient when a fully digital department with a picture archiving and communication system (PACS) is installed. This initial study comparing DR and conventional radiography (convR) provides baseline data and shows encouraging results for more rapid transmission of reports to clinicians.     

Extraspinal ependymoma in the sacrococcygeal region

Summary We describe on a primary, subcutaneous sacrococcygeal ependymoma presenting in a young female patient. Detailed immunohistochemical and electron microscopic examinations were performed. Out of the 40 similar cases reported in literature this is the first in which the determination of DNA content was also used to predict biological behaviour. The tumour proved to be aneuploid with low proliferative capacity in spite of absent histological signs of malignancy. It is suggested that DNA determination may be helpful in establishing prognosis and that it may contribute to a better understanding of the biological behaviour of this tumour.