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1. To introduce tools that can be used for image-guided percutaneous spine and rib biopsy procedures 2. To learn when and how to use these instruments 3. To learn techniques that can be applied with these tools to improve their diagnostic utility 4. To learn the basic technical aspects of CT guidance in order to perform these procedures

A biopsy procedure does not necessarily start and end with the performance of the procedure. The objective of a biopsy is to obtain pathologic tissue in a sufficient amount so as to enable a pathologist and/or a microbiologist to make the diagnosis. The assumption that all that is necessary is to provide them with a specimen and that they will make the diagnosis can be equated with the request for an imaging study and the typical poor/vague history that presents itself at the radiologist’s reading station. Neither of these scenarios results in excellent medical care.

1. To learn the pertinent radiologic anatomy, including bony, neural, and vascular anatomy, as it relates to image-guided lumbar spine biopsy 2. To review the most common indications and contraindications for image-guided lumbar spine biopsy 3. To review different approaches and techniques when planning image-guided coaxial lumbar spine biopsy

BackgroundTreatment of spinal metastatic lesions by radiofrequency ablation (RFA) before cementation can potentially help in local tumor control and pain relief. This is often limited by access and tumor location. This study reports multicenter clinical and imaging outcomes following targeted RFA (t-RFA) and cement augmentation in neoplastic lesions of the spine.Material and methodsA retrospective multicenter study of 49 patients with 72 painful vertebral lesions, evaluated for clinical and imaging outcomes following RFA and cement augmentation of spinal metastatic lesions, was undertaken. Visual Analogue Pain score (VAS) and Oswestry Disability Index (ODI) were obtained before and 2–4 weeks after treatment. Pre- and post-procedure imaging examinations including MRI and positron emission tomography (PET) were also evaluated.ResultsMean ablation time was 3.7±2.5 min (range 0.92–15). Mean VAS scores decreased from 7.9±2.5 pre-procedure to 3.5±2.6 post-procedure (pConclusionst-RFA followed by vertebral augmentation in malignant vertebral lesions resulted in significant pain reduction and functional status improvement, with no major complications. t-RFA permitted access to vertebral lesions and real-time accurate monitoring of the ablation zone temperature. Post-procedure MRI and PET examinations correlated with a favorable tumor response and helped to monitor tumor growth and the timing of adjuvant therapy.

Physical and optical characterization of thin films doped with Au Nanoparticles onto a silica substrate is presented. Films were prepared through sol-gel process, by using Au nanoparticles immersed in lipoic acid as dopant by means of hydrolysis and acid catalyzed reaction of tetraethyl-orthosilicate. The surface was characterized by SEM and AFM microscopies. Z-scan technique was used to measure nonlinear optical properties as nonlinear absorption and refraction indexes, using two different wavelengths. At 633 nm it was possible to observe nonlinear absorption only but at 514 nm both nonlinear properties were observed.

Characterization of thin films doped with organic metal materials onto a silica substrate is presented. Films were prepared through sol-gel process, by using macrocycles with Cu as dopant by means of hydrolysis and acid catalyzed reaction of tetraethylorthosilicate. Z-scan technique was used to measure nonlinear optical properties, nonlinear absorption and refraction indexes.

There is currently great concern about the processes that directly or indirectly contribute to the potential for global warming, such as stratospheric ozone depletion or acidification. In this context, and provided that treated water is a basic public utility in urban centers around the world as well as in some rural areas, its impact on the environment is of great interest. Therefore, this study applied the environmental methodology of Life Cycle Assessment (LCA) to evaluate the environmental loads of four potable water treatment plants (PWTPs) located in northeastern Colombia following the international guidelines delineated in ISO 14040. The different stages of the drinking water process were thoroughly assessed, from the catchment point through pumping to the distribution network. The functional unit was defined as 1 m3 of drinking water produced at the plant. The data were analyzed through the database Ecoinvent v.3.01, and modeled and processed in the software LCA-Data Manager. The results showed that in plants PLA-CA and PLA-PO, the flocculation process has the highest environmental load, which is mostly attributable to the coagulant agent, with a range between 47-73% of the total impact. In plants PLA-TON and PLA-BOS, electricity consumption was identified as the greatest impact source, with percentages ranging from 67 to 85%. Treatment processes and techniques, bioclimatic conditions and culturally driven consumption behavior varied from region to region. Furthermore, changes in treatment processes and techniques are likely to affect the environment during all stages of a plant's operational cycle. Resumo Atualmente, existe uma grande preocupação com os processos que direta ou indiretamente contribuem para as alterações climáticas, destruição da camada de ozônio ou acidificação, entre outros impactos ambientais. Neste contexto, e desde que a água tratada constitui um serviço público básico em centros urbanos de todo o mundo e em algumas áreas rurais, o impacto de suas emissões no meio ambiente tem sido considerado de grande interesse. Assim, na pesquisa atual foi aplicada a metodologia ambiental de avaliação do ciclo da vida (LCA) para avaliar os impactos ambientais de quatro estações de tratamento de água potável (PWTPs), localizadas no nordeste da Colômbia seguindo diretrizes internacionais da ISO 14040. As diferentes etapas do processo de purificação a partir do ponto de captação por meio de bombeamento para a rede de distribuição foram completamente avaliadas. A unidade funcional foi definida como 1 m3 de água potável produzida na fábrica. Os dados foram analisados com base no banco de dados Ecoinvent v.3.01 e processados no software LCA-Data Manager. Os resultados possibilitaram determinar que em plantas PLA-CA e PLA -POR, o processo de floculação tem a maior carga ambiental, o que é principalmente atribuível ao agente coagulante, com uma percentagem entre 47 e 73% do impacto total. Em plantas PLA-TON e PLA-BOS, o consumo de energia eléctrica foi identificado como sendo a maior fonte de impacto, com percentagens que variam de 67 a 85%. Os processos e técnicas de tratamento, condições bioclimáticas e comportamento de consumo culturalmente impulsionado variam de região para região. Além disso, mudanças nos processos e técnicas de tratamento podem afetar o meio ambiente durante todos os estágios do ciclo de operação de uma planta.

There is currently great concern about the processes that directly or indirectly contribute to the potential for global warming, such as stratospheric ozone depletion or acidification. In this context, and provided that treated water is a basic public utility in urban centers around the world as well as in some rural areas, its impact on the environment is of great interest. Therefore, this study applied the environmental methodology of Life Cycle Assessment (LCA) to evaluate the environmental loads of four potable water treatment plants (PWTPs) located in northeastern Colombia following the international guidelines delineated in ISO 14040. The different stages of the drinking water process were thoroughly assessed, from the catchment point through pumping to the distribution network. The functional unit was defined as 1 m3 of drinking water produced at the plant. The data were analyzed through the database Ecoinvent v.3.01, and modeled and processed in the software LCA-Data Manager. The results showed that in plants PLA-CA and PLA-PO, the flocculation process has the highest environmental load, which is mostly attributable to the coagulant agent, with a range between 47-73% of the total impact. In plants PLA-TON and PLA-BOS, electricity consumption was identified as the greatest impact source, with percentages ranging from 67 to 85%. Treatment processes and techniques, bioclimatic conditions and culturally driven consumption behavior varied from region to region. Furthermore, changes in treatment processes and techniques are likely to affect the environment during all stages of a plant's operational cycle.

Vertebral augmentation techniques use image guidance for the percutaneous placement of spinal implants that stabilize a painful osteoporotic or pathologic vertebral compression fracture. The initial implant, acrylic bone cement, was injected through a bone needle into the vertebral body, a procedure referred to as vertebroplasty. A modification of this procedure, kyphoplasty, entails the temporary use of an inflatable balloon tamp before cement injection. Other techniques and the equipment required to perform these vertebral augmentation procedures have evolved significantly during the past two decades. It is now possible to perform vertebral body reconstruction in patients with painful fractures of compromised vertebrae with excellent outcomes in terms of sustainable pain relief and marked reduction in patient morbidity.

Synovial cysts have long been known to create radicular pain in the spine, with the clinical effect mimicking a disk herniation. These cysts have traditionally been treated with open surgical therapy. Now a minimally invasive, image-guided approach to treatment is available to relieve this problem, using a simple percutaneous needle stick and injection. This article describes the technical aspects and precautions needed for this intervention.

The diagnosis of diskogenic low back pain (LBP) can be elusive. Physical examination of the lumbar disk is limited and imaging offers few objective clues. While invasive, lumbar diskography is a method available to examine or "provoke" the disk directly and determine if LBP is coming from a disk and which disk(s) is responsible for the pain. Once identified, features of the abnormal disk can be evaluated, including the disk's response to intradiskal local anesthetic and disk architecture as observed on diskography imaging and postdiskogram computed tomography. Response to anesthetic can be correlated with imaging features potentially impacting treatment but can also stand alone as an independent objective marker of diskogenic LBP. Here we review the indications for lumbar diskography and the basic lumbar diskogram procedure. We also review the alternative more advanced technique for studying the anesthetic and mechanical features of the disk, functional anesthetic diskography.

Emergency radiologic evaluation of the pediatric cervical spine can be challenging because of the confusing appearance of synchondroses, normal anatomic variants, and injuries that are unique to children. Cervical spine injuries in children are usually seen in the upper cervical region owing to the unique biomechanics and anatomy of the pediatric cervical spine. Knowledge of the normal embryologic development and anatomy of the cervical spine is important to avoid mistaking synchondroses for fractures in the setting of trauma. Familiarity with anatomic variants is also important for correct image interpretation. These variants include pseudosubluxation, absence of cervical lordosis, wedging of the C3 vertebra, widening of the predental space, prevertebral soft-tissue widening, intervertebral widening, and "pseudo-Jefferson fracture." In addition, familiarity with mechanisms of injury and appropriate imaging modalities will aid in the correct interpretation of radiologic images of the pediatric cervical spine.

Chronic low back pain is a common but challenging problem for the spine specialist. Although not completely understood, the concept of a discogenic pain mechanism as a source of low back pain has been described. Discogenic low back pain may be refractory to conservative measures. This pain is typically characterized by low back pain, which is usually exacerbated by axial loading such as prolonged standing or sitting. Concurrent leg pain or lateralizing pain may likewise be present but is typically less severe than the low back pain and does not possess the typical radicular pattern of pain distribution. A discogenic etiology is suggested by a combination of this clinical presentation and a positive discogram. The pain mechanism is believed to be caused by pathologic tears of the disc annulus with subsequent irritation of nerve fibers that innervate the annulus fibrosus. 1,2 Substance P, vasoactive intestinal peptide, and calcitonin have also been identified as nociceptive neurotransmitters within these annular nerve fibers. 3 The sinuvertebral nerve and the dorsal ramus mediate the mechanical or chemical stimulation of these nociceptive fibers. Granulation tissue and neural tissue have been demonstrated within these annular tears on histopathologic specimens and thus may also play a role in discogenic pain. 4 The traditional management of discogenic low back pain has relied on conservative measures including rest, physical therapy, and oral or locally administered medications. For those patients who fail to respond to a 6-month course of these conservative measures, surgical intervention with discectomy and fusion is often considered. Surgery is expensive and is associated with a long recovery period. Spine surgery is not without complications and requires anesthesia. Disc surgery is not always successful, and repeat operations are not uncommon. Ultimately, the spinal fusion itself may not succeed in alleviating the patient’s symptoms, and nonunion may be observed. 5 An alternative treatment to spinal fusion for the management of discogenic back pain is intradiscal electrothermal therapy (IDET). 6,7 This minimally invasive procedure involves the application of thermal energy to damaged disc tissue by a percutaneously placed catheter that contains a thermal resistive coil. Thermal energy shrinks and reorients collagen fibrils and cauterizes neural and granulation tissue within the torn annulus. This promotes healing of the annulus fibrosus. Coagulation of the irritated and damage nerve fibers promotes annular denervation and contributes to pain reduction. IDET is a relatively new procedure; it received Food & Drug Administration (FDA) clearance in 1998. Preliminary results with this procedure seem to indicate reasonable safety and efficacy in properly selected patients.

Postoperative paraspinal fluid collections can present a management dilemma to both radiologists and surgeons. Although many of these collections present as incidental findings and are unrelated to the presenting signs and symptoms that led to the imaging study, certain collections in the context of the appropriate clinical scenario may require additional evaluation and even emergent intervention. This article reviews those collections that are most frequently encountered and suggests management strategies that may assist in the evaluation and management of the patient.

Primary or metastatic spine tumors can present with pain and/or neurologic compromise depending on their location within the spinal axis. Metastases and multiple myeloma comprise most of these lesions. Management of spinal tumors includes surgical decompression with stabilization (neo), adjuvant chemotherapy and radiation therapy, curettage, bone grafting, bone marrow replacement, and palliative treatment with vertebral augmentation. Pre- and postoperative imaging plays a critical role in the diagnosis and management of patients with spinal tumors. This article reviews postoperative imaging of the spine, including imaging protocols, immediate and long-term routine imaging findings, and emergent findings in symptomatic patients.

Se realizó una investigación descriptiva-prospectiva con el objetivo de validar nuestros criterios de riesgos en la identificación de la infección bacteriana severa (IBS) en niños febriles, para lo cual se establecieron las categorías de riesgos y se aplicaron en 215 niños febriles que habían ingresado por esta causa en un período de 12 meses. Se obtuvo que el 54,9 % de los niños se clasificaron como bajo riesgo y el 71,6 % sin IBS. No obstante, la frecuencia de dicha afección resultó elevada, 28,4 %, con predominio de las infecciones urinarias. Se triplicó el riesgo de padecer IBS en los niños con aspecto tóxico, temperatura mayor o igual a 39°C, test clínico de Bonadio mayor que 8, cituria mayor o igual a 10 000 células/mm³, con diferencias significativas entre las categorías de riesgo y la IBS, y fue mayor la frecuencia en los niños tóxicos y de riesgos, 92,8 y 54,3 %, respectivamente. Uno de cada 4 niños febriles presentó IBS. Se introdujo la categoría "Riesgo" y se recomienda un flujograma de evaluación.A descriptive-prospective research study was carried out to validate our risk criteria in the identification of severe bacterial infection in febrile young children. For this purpose, risk categories were set and applied in 215 febrile children who had been admitted in a period of 12 months. 54.9 % of febrile children were at low risk for serious bacterial infections whereas 71.6 % presented no risk at all. Nevertheless, the frequency of this affection was high, accounting for 28.4 % with predominance of urinary infections. The risk of getting SBI trippled in children who shared toxic look, temperature greater than or equal to 39 °C, Bonadium clinical test higher than 8, cyturia values over or equal to 10 000 cell/mm³, significant differences between risk and SBI categories and the highest frequency of such affection found in toxic children and in children at low risk (92.8 vs 54.3 %). One in every four febrile children had SBI. The Risk category was introduced and an evaluating flow chart is recommended.

Allergy is an important consideration in the evaluation of patients with rhinosinusitis. Several studies have addressed staging systems for rhinosinusitis based on the extent of disease present on computed tomography (CT) scanning. The severity and extent of sinus disease present on CT imaging helps guide decisions regarding medical and surgical treatment options. This study evaluates the severity of sinus disease in allergic and nonallergic patients. A total of 42 patients at our institution underwent both modified RAST and coronal sinus CT scan in the evaluation of their rhinosinusitis symptoms. A single, blinded staff neuroradiologist staged all 42 CT scans using the Lund-Mackay staging system. None of the patients had undergone sinus surgery. Age, sex, co-morbidities, asthma, smoking, RAST score, total IgE, and CT staging score were analyzed. Allergic patients were found to have a higher CT scan score (mean score = 12) when compared to nonallergic patients (mean score = 6), indicating more extensive sinus disease (p = 0.03). We conclude that allergy is a significant factor in the development of rhinosinusitis, and allergic patients are more likely to demonstrate advanced disease on CT scan when compared to nonallergic patients.

Posttraumatic cervical injuries represent a spectrum of injuries ranging from simple traction to frank nerve root avulsion with meningocele formation. The authors describe 3 patients with cervical nerve injuries, depicted by magnetic resonance imaging, highlighting unusual imaging manifestations.

Se realizó un trabajo descriptivo-retrospectivo sobre la influencia del bajo peso al nacer en el estado de salud al año de edad en el municipio Jaruco, desde el 1ro de enero de 1994 hasta 31 de diciembre de 1995. Se estudiaron 2 grupos de niños: grupo 1: formado por 55 niños con peso menor de 2 500 g en el período estudiado y grupo 2: escogidos del resto de nacidos con peso superior a los 2 500 g, numéricamente similar. Se concluye que los niños con bajo peso al nacer no muestran diferencias en el desarrollo físico al año de edad, pero sí aumento en los índices de morbilidad ambulatoria y hospitalaria por infecciones respiratorias agudas, enfermedades diarreicas agudas, sepsis urinaria y anemia, así como un peso importante en la mortalidad infantil. Se recomiendan actividades de promoción y prevención para disminuir el bajo peso al nacer.A descriptive and retrospective study was conducted on the influence of low birth weight on the health status at 1 year of age in Jaruco municipality from January 1, 1994 to December 31, 1995. Two groups of infants were studied: group 1 consisted of 55 infants with a body weight lower than 2 500 g during the period studied, and group 2 which consisted of infants selected from the rest of newborn infants with a body weight greater than 2 500 g. The groups were similar regarding the number of subjects. It is concluded that infants with low birth weight show no differences with respect to physical development, but they show an increase in the indexes of ambulatory and hospital morbidity due to acute respiratory infections, acute diarrhea, urinary sepsis and anemia, as well as a great infant mortality. Promotion and prevention interventions are recommended to reduce low birth weight.

Diferentes investigadores han realizado estudios sobre el manejo del niño febril y plantean que es un dilema al que se enfrenta a diario el médico que atiende niños. Motivados por este tema se efectuó un estudio descriptivo retrospectivo de los niños febriles, sin causa aparente en su valoración inicial, que asistieron al servicio de urgencias en un período de 9 meses, con el objetivo de identificar el diagnóstico definitivo al egreso y se precisó el tipo de infección bacteriana severa y relacionó la presencia de éstos con parámetros clínicos y de laboratorios. El mayor número de niños febriles valorados e ingresados mostraron edades desde 91 días hasta 36 meses. El menor porcenaje de ellos ingresaron y desarrollaron alguna infección bacteriana severa principalmente neumonía, y fue mayor el porcentaje de niños con esta patología a menos edad con predominio del aspecto tóxico y de la temperatura 39 EC. Resultó el manejo ambulatorio del niño febril mayor de 90 días y bajo riesgo de infección bacteriana severa un ahorro en vidas y dinero, por lo que se recomienda generalizar el flujograma propuesto para la evaluación y manejo del niño febril de 3 a 36 meses de edad.Different researches have performed studies on the management of the febrile infant and they point out that this is a dilemma faced by every physician who takes care of children. Motivated by this subject, a descriptive and retrospective study of febrile infants was conducted. The study was carried out to evaluate febrile infants without evident cause at the baseline evaluation who attended the emergency service during a period of 9 months with the objective of identifying the definite diagnosis at admission. The type of bacterial infection was accurately assessed and the presence of this was related to clinical and laboratory parameters. The greatest number of febrile infants evaluated and admitted to hospital were 91 days-36 months old. The lowest percentage of them were admitted to hospital and they developed some serious bacterial infection, mainly pneumonia. The percentage of infants presenting with pneumonia was greater in infants under the age above mentioned with predominance of the toxic aspect and of a temperature 39 EC. The outpatient management of the febrile infant over 90 days of life and low risk of serious bacterial infection resulted in lifes and money saved; that's why we recommend to systematized the flujogram proposed for the evaluation and management of the 3-36 months old febrile infant.

BACKGROUND The association of intracranial aneurysm and pregnancy is uncommon. Hemodynamic stress plays an important role in the growth of aneurysms. METHODS The authors report the case of an enlarging cavernous carotid aneurysm in a pregnant 15-year-old young woman. RESULTS The aneurysm was initially diagnosed prior to the patient's pregnancy by both cross-sectional imaging and cerebral angiography. Further imaging evaluation was required during pregnancy, which demonstrated significant enlargement of the aneurysm. Following delivery, the lesion decreased in size. CONCLUSIONS We review potential factors associated with pregnancy that may increase hemodynamic stress and influence aneurysm growth. Additionally, the management of pregnancy-related intracranial aneurysms is discussed.

Management of patients with cerebrospinal fluid rhinorrhea (CSF) remains controversial. Most studies recommend either an endoscopic or an external extracranial approach, depending on the surgeon's preference. Eighteen patients with CSF rhinorrhea have been managed at our institution since 1990. The causes of the CSF rhinorrhea consisted of functional endoscopic sinus surgery (7), lateral rhinotomy with excision of a benign nasal tumor (3), spontaneous rhinorrhea (7), and secondary repair after intranasal ethmoidectomy (1). In 11 patients the CSF leak was recognized at the time of surgery; in 10 of these patients it was repaired during the primary surgery, whereas one patient underwent secondary repair after failure of conservative management of his CSF fistula. Seven patients underwent exploration for spontaneous CSF rhinorrhea. Four patients had computer tomography scans that showed the leak, and two patients had cisternography to localize the leak. One patient underwent magnetic resonance cisternography. Both of these leaks were identified with cisternography and were then confirmed intraoperatively. Repair methods included a pedicled septal mucosal flap (4), a free mucosal graft from the septum (7), and a middle turbinate (5). Two patients had obliteration of the sinus with muscle/fascia and fibrin glue. Eight patients were repaired endoscopically. The remainder underwent repair through external approaches. Seventeen patients (at a minimum 1 year follow-up) remain free from leakage. One patient required a second repair 8 months after surgery. Iatrogenic trauma remains the most common cause of CSF rhinorrhea. Management at the initial setting is the least morbid approach and is successful in 95% of cases. Whether an endoscopic or external approach is used depends on surgical expertise and experience.

Purpose To determine if lumbar synovial cyst rupture in symptomatic patients results in improved clinical outcome when using direct tandem and/or coaxial percutaneous CT guided techniques. Materials and methods 20 patients with unilateral lower extremity radiculopathy and/or low back pain underwent CT guided percutaneous treatment for their symptomatic lumbar synovial cysts. Cysts were identified with the use of a low osmolar non-ionic contrast agent via facet joint injection or through direct injection. Cyst rupture, using a direct tandem and/or coaxial technique, was attempted in all patients using an 18 gauge guide needle and a 22 gauge insert needle. Following attempted cyst aspiration, cyst rupture was performed using 1–3 mL of a mixture of methylprednisolone (2 mL, 80 mg) and bupivacaine (3 mL, 0.5%). All patients were followed-up in clinic for a minimum of 6 months after their procedures and up to a maximum of 24 months. Results 11 patients were male and nine were female, with an average age of 65.6 years. 17 patients presented with severe unilateral lower extremity radiculopathy and three patients were experiencing low back pain. One of the patients had two synovial cysts, and therefore a total of 21 lumbar synovial cysts were treated in this group of patients. Direct cyst puncture was achieved using a tandem technique in nine patients, a coaxial interlaminar approach in seven patients, a coaxial transforaminal approach in two patients, and a coaxial trans-facet approach in three patients. Cyst rupture was documented in all cases, as evidenced by CT confirmation of cyst decompression and contrast agent extravasation into the epidural space. The mean surveillance period in these patients was 18 months. Six patients experienced their usual radicular pain within 2 months of their treatment. Four of these patients were re-treated for recurrent smaller cysts. These patients have not had a recurrence at 24 months of follow up. Two of these six patients elected to undergo open surgical decompression without symptomatic improvement. No treatment related complications were observed in this group of patients. Conclusions Direct tandem and/or coaxial percutaneous CT guided techniques for rupture and treatment of symptomatic lumbar synovial cysts reduces recurrence rates and therefore helps avoid more invasive open surgical procedures in this group of patients.

It has been suggested that the size of the corpus callosum may have diagnostic significance in cerebral palsy, although this relationship is incompletely defined. Ninety-one patients with cerebral palsy had been studied by magnetic resonance imaging in the 5-year period from 1990 to 1994. Fifty-seven of these 91 patients had a technically appropriate midsagittal magnetic resonance image for quantitative morphometric analysis. The ratio of the area of the corpus callosum to the area of the supratentorial brain was compared to published age- and gender-specific norms. Imaging findings were correlated with clinical history and cause of cerebral palsy. The corpus callosum was of normal size in 43 patients and more than 2 standard deviations below the mean in 14 patients. The causes for cerebral palsy included hypoxic ischemic encephalopathy (32), cerebral dysgenesis (8), and porencephalic strokes (6); the etiology could not be established in 11 patients. The size of the corpus callosum was highly correlated with the cause of cerebral palsy, such that all patients with cerebral dysgenesis had hypoplasia of the corpus callosum (one-sided z test, p < 0.0001). Conversely, the callosum was of normal size in 32 of 38 patients with hypoxic ischemic encephalopathy and porencephalic strokes. The presence of a hypoplastic corpus callosum is highly associated with cerebral dysgenesis as a cause for cerebral palsy.

Fifty patients with intractable benign pain were treated with intrathecal morphine (IT-MS) infusion therapy. Median follow-up was 39 months (range 5–70). Breakthrough pain was reported in 45 (90%) pat

To assess the outcomes and safety after CT-guided percutaneous sacroplasty in patients with painful sacral insufficiency fractures or pathologic sacral lesions.A retrospective multicenter analysis of consecutive patients undergoing CT-guided sacroplasty for painful sacral insufficiency fractures or sacral lesions was undertaken. The inclusion criteria consisted of severe sacral pain not responding to conservative medical management with imaging evidence of unilateral or bilateral sacral insufficiency fractures or lesions. Outcome measures included hospitalization status (inpatient or outpatient), pre-treatment and post-treatment visual analog scale (VAS) scores, analgesic use and complications. Patients were followed at approximately 1 month and for at least 1 year after their sacroplasty procedure.Two hundred and forty-three patients were included in the study, 204 with painful sacral insufficiency fractures and 39 with symptomatic sacral lesions. The average pre-treatment VAS score of 9.2±1.1 was significantly improved after sacroplasty to 1.9±1.7 in patients with sacral insufficiency fractures (p0.001). The average pre-treatment VAS score of 9.0±0.9 in patients with sacral lesions was significantly improved after sacroplasty to 2.6±2.4 (p0.001). There were no major complications or procedure-related deaths. One patient who was treated for a sacral insufficiency fracture experienced radicular pain due to local extravasation of cement that subsequently required surgical decompression for symptomatic relief.CT-guided percutaneous sacroplasty is a safe and effective procedure in the treatment of painful sacral insufficiency fractures or lesions. It is associated with prompt and durable pain relief and should be considered as an effective treatment option in this patient population.

To investigate the risk factors for, and the incidence of, structural abnormalities on brain imaging in allogeneic haematopoietic stem cell transplant (HSCT) patients, and correlate these findings with survival.We retrospectively reviewed all brain computed tomography (CT) and/or magnetic resonance imaging (MRI) studies obtained during the first post-HSCT year from 2004 thru 2007 in allogeneic HSCT recipients.A total of 128 patients had brain imaging in the first post-HSCT year. Forty one of these 128 patients (32 %) had structural abnormalities on brain imaging: cerebrovascular complications (n = 10), central nervous system (CNS) infection (n = 9), subdural fluid collection (n = 6), CNS recurrence of haematological malignancy (n = 11), and drug toxicity abnormalities (n = 5). The only significant risk factor for structural imaging abnormality was younger patient age (P = 0.01). MRI was significantly more likely than CT to provide specific imaging diagnosis of cerebral lesions (P = 0.001). HSCT patients with cerebrovascular complications have poor survival (P 0.05). However, overall survival was not significantly worse for the 41 patients with the structural imaging abnormalities as compared to the 87 patients who had brain imaging but no structural abnormalities.There was no survival difference in patients whose brain imaging was normal or abnormal. However, there was poor outcome in patients with cerebrovascular complications after HSCT.• Brain imaging frequently demonstrates neurological complications following haematopoietic stem cell transplantation. • Younger HSCT patients are more likely to exhibit abnormal brain imaging findings. • HSCT recipients with cerebrovascular complications have the worst survival. • However brain imaging results are weak indicators of overall survival after HSCT.

Purpose To assess the short term efficacy of Cyberknife stereotactic radiosurgical treatment of trigeminal neuralgia (TN). Methods 17 consecutive patients with medically or surgically refractory unilateral TN were treated with Cyberknife radiosurgery. Using superimposed CT cisternogram and MR images, the target segment of the trigeminal nerve was consistently defined as a 6 mm length of nerve approximately 2–3 mm distal to the dorsal root entry zone of the brainstem. A radiosurgical rhizotomy was performed with the Cyberknife utilizing a single collimator to deliver an average maximum dose of 73.06 Gy (range 72.91–73.73) to the target. Results Follow-up data were available for 16 of the 17 patients post-treatment (range 1–27 months, average 11.8 months). Overall, 14 of 16 (88%) patients responded favorably with either partial or complete relief of symptomatology. 11 of these patients were successfully free of all pain at some point in their post-treatment course, with seven patients pain free to the last follow-up visit (average 5.0 months, range 1–13 months). Symptoms recurred in four patients, taking place at 3, 7.75, 9 and 18 months after Cyberknife therapy. Only two patients reported side effects. One patient developed a bothersome feathery dysesthesia while the second patient reported a non-bothersome mild jaw hypoesthesia. There were no substantial complications related to stereotactic radiosurgery. Conclusion Cyberknife radiosurgery is a viable treatment alternative in patients with TN with competitive efficacy demonstrated in our group of patients while minimizing adverse effects.

The recognition of sacral insufficiency fractures continues to be poor, and diagnosis is often delayed resulting in significant morbidity. Percutaneous sacroplasty is an image guided procedure that is safe and potentially effective for treating the pain and disability related to these fractures. Several cohort studies reviewed here report successful outcomes using this procedure, with patients experiencing nearly full pain relief immediately and longitudinally. As with the well proven results from percutaneous vertebral augmentation within the thoracic and lumbar spine, sacroplasty reduces the cost associated with bed rest and physical therapy and allows patients to return to activities of daily living sooner than with conservative therapy.

Pain from sacral insufficiency fractures or metastatic tumor to the sacrum, refractory to radiation and/or chemotherapy, can be extremely debilitating to affected patients. Conservative medical therapy with rest, limited ambulation, and pain medication has been the mainstay of treatment. Open surgical fixation is reserved for severe fracture that does not heal with rest. A minimally invasive treatment, sacroplasty, is gaining popularity and uses image-guided, percutaneous injection of surgical cement into the fracture. This article reviews the incidence, causes, diagnosis, presentation, and treatment options for sacral fractures, and describes detailed technical steps of the sacroplasty procedure.

Life Cycle Assessment (LCA) tool has been applied to evaluate environmental impacts through the whole building life cycle. LCA has been carried out in accordance to the international standard of ISO 14040 and ISO 14044. As a reference, an application of LCA has been made to a Catalan house located in Barcelona, Spain with a projected 50 years life span. In this work, construction, use (operationand maintenance) and end-of-life phases have been considered. The operational energy consumed during thedwelling period was modeled using a mix of electrical power for electrical appliances, illumination, heating and cooling; and using thermal energy from natural gas for domestic hot water and cooking. Result shows that the highest environmental impacts during the dwelling’s life cycle took place during the use hase. The total impact of global warming potential was 4.52+01 kgCO2-Equiv. m-2 a-1 of which use phase accountedfor 92% (operation 90% and maintenance 2%), construction represented 7% and end-of-life contributed less than 1%. Regarding the operation phase, cooling had the highest environmental burden with 33%, heating represented 9%, followed by illumination 26% and electrical appliances 19%. The other two household activities accountedfor less than 12% (domestic hot water 9% and cooking 4%) of total phase. During the construction phase, the production of building materials represented about 97%, transport to the job site 2% and waste management 1% of total phase. The total primary energy demand was 5.26E+01 MJ m-2 a-1 (gross calorific value) of which non renewableprimary energy demand represents 78% and renewable energy demand 22%. In summary, data for a Catalan home has been provided to evaluate environmental impacts using LCA tool. Data have been modelled into the Gabi software system. Finally, LCA is a suitable tool to evaluate environmental impacts throughout all phases of the building life cycle.