Search

Study design:Single-centre, prospective (comparative cohort) clinical study, with ethical approval and patient consent.Objective:Confirmation of vertebral fracture union can pose significant challenges for clinicians in the management of spinal cord injury and in the decisions around patient mobilization. Bony union is usually assessed with computed tomography (CT). This study hypothesizes that magnetic resonance imaging (MRI) can identify vertebral bone union.Setting:A major spinal injuries unit in the United Kingdom.Method:Patients underwent CT and MRI at 12 weeks post-injury, if conservatively managed, or 12 weeks post-fixation. With CT as the gold standard, the MRI scans were reviewed blind to the CT result and indicators for fracture healing were compared.Results:A total of 35 patients with 55 fractures were imaged. Comparison of CT and MRI showed sensitivity of 88%, specificity of 100% and positive predictive value of 100% for fracture union imaged with MRI using CT as the gold standard.Conclusion:MRI correlates well with CT in identifying vertebral fracture union and non-union. We suggest that where imaging is indicated in the assessment of vertebral body fracture healing MRI can be used routinely with CT reserved for problematic or inconclusive cases. [ABSTRACT FROM AUTHOR]

Using TaqMan qPCR assays, DNA of P. ramorum, P. kernoviae and P. austrocedri was detected in 500 g soil samples collected from twelve infected forest and woodland sites in northern Britain. Phytophthora DNA was also amplified in soil adhering to boots after walking transects along footpaths or animal trails. At two sites, Phytophthora DNA was detected in soil over a 4-year period following removal of infected hosts. This new method enabling assessment of larger quantities of soil demonstrates the contamination risk of these pathogens in soil at infected sites and improves our understanding of the mechanisms of persistence and spread. [ABSTRACT FROM AUTHOR]

Background:Pulmonary embolism (PE) is a significant cause of morbidity and mortality in patients with spinal cord injury (SCI). Prophylactic anticoagulation is associated with a reduction in mortality rates, but there is limited evidence regarding the incidence rate of PE following cessation of anticoagulation after the first 3 months of injury.Study design:Single-centre retrospective study.Objective:To estimate the incidence rate of PE after 90 days of SCI.Setting:The National Spinal Injuries Centre at Stoke Mandeville Hospital, Aylesbury, UK.Methods:The study includes 640 new-onset SCI patients. All computer tomography pulmonary angiograms (CTPAs) or ventilation-perfusion lung scans between 2008 and 2013 were identified. Medical notes and scans were reviewed and clinical outcomes and radiological findings were recorded.Results:A total of 91 patients with a new-onset SCI had a CTPA or a perfusion lung scan. PE was detected in a total of 8 patients. The incidence of PE was 1.25%; 95% confidence interval (0.39-2.11) over a 6-year period. The duration of injury at the time of PE was 7 months.Conclusion:The incidence rate of PE post 3 months of SCI remains significant, though much lower than immediately post injury. [ABSTRACT FROM AUTHOR]

Study design:Case report.Objective:To describe the clinical benefit of a spinal cordectomy with the aim of limiting neurological deterioration related to the development of a subacute posttraumatic ascending myelopathy (SPAM) supporting previously described mechanism for SPAM formation.Setting:National Spinal Injuries Centre, Stoke Mandeville Hospital, UK.Method and results:A 38-year old patient presented 6 months after spinal cord injury substantial neurological deterioration expanding from the initial T4-injury level through C4. Magnetic resonance imaging revealed intra-medullary haemorrhage at the site of injury and subsequent-ascending cord oedema. A cordectomy was performed leading to neurological stabilisation and complete resolution of SPAM.Conclusion:Cordectomy can be an effective intervention in case of rapid progressive neurological deterioration. [ABSTRACT FROM AUTHOR]

Introduction: Imaging in stroke, allows its classification into ischaemic stroke (IS) or intracranial haemorrhagic stroke (ICH), ensuring time-sensitive treatment to be administered. Imaging can also allow detection of cerebral microbleeds (CMBs), which may further determine pharmacological intervention in acute stroke. True gradient echo (T2∗GRE) or susceptibility weighted imaging (SWI) have high sensitivity for the detection of CMBs. These two sequences are included in the national guidelines; however, the implementation of these guidelines can vary depending on local interpretation and scanner capabilities., Aim: To explore the use and application of blood sensitive MRI sequences in a specialist UK stroke unit for the detection of CMBs, to improve local practice., Methods: A retrospective data analysis of the native database, spanning a 6-month period, was used. The data of 281 acute stroke patients with an MRI were reviewed and analysed. The MRI sequences applied, and the final diagnosis were noted for each case., Results: Of the 281 acute stroke patients with MRI, 259 (92.1%) had an IS, 16 (5.68%) an ICH and 6 (2.14%) had both. Overall, 13 (4.63%) had a CMB diagnosis. All of these 13 patients had a true T2∗GRE sequence. CMBs were not detected in the absence of a T2∗GRE sequence., Conclusion: T2∗GRE imaging is essential for detecting CMBs. When omitted, CMB incidence can be considerably lower than that suggested in the literature. Missing CMB diagnoses in stroke patients may result in suboptimal treatment pathways, compromising the patients' standard of care., Implications for Practice: When SWI is not available, it is imperative to always include a true T2∗GRE sequence to detect microbleeds in suspected acute stroke cases., Competing Interests: Conflict of interest statement None., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)