Life cycle assessment of the production and use of polypropylene tree shelters.

A detailed Life Cycle Assessment (LCA) has been conducted for the manufacture, use and disposal of polypropylene tree shelters, which are used to protect young seedlings in the first few years of growth. The LCA was conducted using Simapro software, the Ecoinvent database and ReCiPe assessment methodology. Detailed information on materials, manufacturing, packaging and distribution of shelters was obtained from Tubex Ltd. in South Wales, UK. Various scenarios based on different forest establishment methods, with or without tree shelters were derived and analysed using data from published literature and independent sources. The scenarios included commercial forestry in northern temperate conditions, amenity forest establishment in temperate conditions, and forest establishment in semi-arid conditions. For commercial forestry, a reduction in required seedling production and planting as well as additional time-averaged wood production led to significant benefits with tree shelters, both compared to unprotected and fenced cases. For the amenity forest scenarios, tree shelter use had a net environmental impact, while for semi-arid forestry, the benefits of reduction in water use outweighed shelter production impacts. The current practice of in-situ degradation was compared to collection and disposal and it was found that in-situ degradation was slightly preferable in terms of overall environmental impact. Use of biopolymer-based shelters would improve the environmental performance slightly.

VZV infection in pregnancy: a retrospective review over 5 years in Sheffield and discussion on the potential utilisation of varicella vaccine in prevention.

OBJECTIVES: To study retrospectively the epidemiology, demography and clinical issues related to varicella in pregnancy in a UK city over a 5-year period and help inform the debate on the potential of varicella immunisation in prevention. METHODS: The hospital records of pregnant women with varicella receiving care at the Regional Department of Infection and Tropical Medicine in Sheffield between 1997 and 2002 were reviewed. Data on pregnant women with varicella not presenting acutely to medical care were obtained. The use of Varicella Zoster Immune Globulin (VZIG) in prevention of varicella during the same 5-year period was determined. The records from the maternity department of Sheffield Hospitals for women undergoing VZV antibody testing between January and December 2004 were reviewed. Data on annual number of deliveries were recorded and the neonatology database used as a source of information regarding effects of chickenpox on the baby. RESULTS: The incidence of varicella infection in pregnancy was at least 6 per 10,000 deliveries. Nineteen pregnant women with varicella were admitted to hospital. Three had pneumonia. Infection occurred in the first pregnancy in a quarter of cases. The minimum cost for all cases admitted to hospital during this period (basic costs per day) was 20,520 pounds sterling. The cost of VZIG use for chickenpox during the same period adjusted for the population size was 10,881 pounds sterling. This was not a comprehensive health economic study and did not attempt to assess additional GP, midwifery, obstetric or social costs nor costs associated with those who did not attend hospital. Two hundred and thirty-three women underwent VZV antibody test during 2004 usually after contact with chickenpox. Sixty percent of women in contact with chickenpox did not present to their GP or hospital immediately. CONCLUSION: Varicella in pregnancy may be associated with significant morbidity and health care cost and prevention by immunisation is desirable. Though targeted vaccination is attractive, screening in pregnancy followed by a post-partum varicella immunisation programme would fail to protect 25% and would be associated with logistical challenges not occurring with rubella immunisation. Varicella is now a preventable disease by immunisation. Exposure in pregnancy with or without infection has financial costs related to antibody testing and prophylaxis. Infection in pregnancy may be associated with additional costs and potential morbidity to mother and baby. Potential immunisation strategies are considered.

Patient education in physiotherapy of low back pain: acute outcomes of group instruction.

BACKGROUND: Adults with recalcitrant mechanical low back pain of more than six weeks duration can encounter unacceptable waiting periods for specialised care. AIM: To evaluate the effectiveness of rapid treatment by means of group sessions. METHODS: We instituted a rapidly accessed patient education programme in physiotherapy for low back pain. Pain and disability were assessed before and after the programme. The programme included four sessions of group instruction for self-actuated physiotherapy There were six to 10 patients per group. RESULTS: In eight months, 160 patients were admitted to the programme. The average waiting time was 16 business days for the first appointment. Seventy-three per cent of the patients who attended some portion of the programme completed all sessions. At least 30% of the incompletions were ascribable to rapid improvement. Of patients completing the programme, 80% reported significant resolution of the pain and improvement in function. Twenty per cent reported no significant response, but no patients worsened during participation. Of the 20% with no subjective improvement, 50% were pursuing medico-legal claims. In comparison, 9% of those reporting a successful response were pursuing litigation. CONCLUSIONS: Group instruction in physiotherapy for low back pain is safe, generally successful, and highly acceptable to patients.

Reversible posterior leukoencephalopathy following organ transplantation. Description of two cases.

Although neurologic changes after organ transplantation are often secondary to opportunistic infections or vascular insults, new pathological entities are emerging. We have recently encountered two patients who, a few days after liver and heart transplant, respectively, developed neurological signs and symptoms. Head computerized tomography (CT) scan showed nonenhancing areas of low attenuation, and magnetic resonance imaging (MRI) demonstrated multiple areas of increased signal intensity in the subcortical white matter on T2-weighted images. Stereotactic biopsy of the intracranial lesions was performed in one case. Light microscopic examination demonstrated only mildly edematous white matter. No infectious organisms were observed on light or electron microscopy. In one patient, follow-up MRI 3 months later showed almost complete resolution of the signal abnormalities. Both patients' clinical condition progressively improved. The neuroradiological abnormalities described are consistent with the 'reversible posterior leukoencephalopathy' syndrome associated with cyclosporine toxicity. The pathophysiology of these lesions is unclear; however, it has been suggested that cyclosporine causes an acute ischemic insult secondary to vascular spasm with resultant axonal swelling. This hypothesis is supported by the hypoattenuation seen on CT, the prolonged T2 relaxation seen on MRI, and the absence of contrast enhancement. Concomitant factors (such as hypocholesterolemia or associated therapy with high dose steroids) are important in the development of these lesions as in both of our patients cyclosporine levels were in the normal range. Fortunately, these lesions and the associated manifestations are most often reversible and regress with adjustments of cyclosporine dosage and/or correction of concomitant facilitating factors.

Solitary fibrous tumor of the spinal cord.

We report a case of primary solitary fibrous tumor occurring in the intramedullary thoracic spinal cord in a 47-year-old man. The tumor predominately consisted of spindle cells separated by abundant collagen; a few areas of hemangiopericytomatous morphology were also present. The diagnosis was confirmed by immunohistochemistry and electron microscopy. The tumor was reactive to vimentin and CD34 but was negative for glial fibrillary acid protein (GFAP), S-100, smooth muscle actin, epithelial membrane antigen, HMB-45, myelin basic protein, and keratin; ultrastructural examination showed fairly undifferentiated cells within a collagenous matrix, few tight junctions, and sparse extravascular basement membrane. The occurrence of this tumor within the spinal cord parenchyma and in other extraserosal sites emphasizes the current belief that solitary fibrous tumors arise from mesenchymal tissues and are not restricted to the pleura and other serosal surfaces. Furthermore, solitary fibrous tumor is an entity that must be considered in the differential diagnosis of spindle cell central nervous system neoplasms.

Giant glioependymal cyst resembling holoprosencephaly on prenatal ultrasound: case report and review of the literature.

We report the earliest in utero presentation of a 'giant' glioependymal cyst detected on routine prenatal ultrasound at 22 weeks estimated gestational age. The clinicopathologic features of these rare lesions are reviewed as well as previous reports of glioependymal cysts detected in utero. The effects of large intracranial cysts on neurodevelopment are discussed as well as the differential diagnosis of infantile intracranial cysts and therapeutic alternatives.

Tumoral calcium pyrophosphate dihydrate deposition disease mimicking a cervical spine neoplasm: case report.

A case of tumoral calcium pyrophosphate dihydrate crystal deposition disease involving the upper cervical spine is reported. It presented clinically, radiographically, and by preliminary intraoperative pathological evaluation as a possible malignant soft tissue tumor. An aggressive resection of the lesion was performed. This case differs from previous reports of calcium pyrophosphate dihydrate crystal deposition disease of the cervical spine by the size, location, and radiographic appearance of the lesion. We suggest that radical surgical procedures should not be performed without consideration of this diagnosis in lesions with similar presentations. A brief review of spinal and tumoral calcium pyrophosphate dihydrate crystal deposition is presented.

Utility of postmortem magnetic resonance imaging in clinical neuropathology.

Over 200 brains were examined by postmortem magnetic resonance imaging to determine the utility of this imaging procedure as an adjunct to the standard postmortem examination of the brain and spinal cord. One unembalmed cadaver was also studied using a conventional 1.5-tesla (T) field-strength unit, and three formalin-fixed sections of the hippocampus were imaged using a high field-strength (7.0-T) prototype imaging system. The postmortem magnetic resonance images proved to be an invaluable aid that complemented the standard pathologic examination of the brain and spinal cord. The compelling advantages of this postmortem radiographic procedure included the three-dimensional aspects of the images; the ability to detect mineral (ie, iron) deposits; small focal lesions such as hemorrhages or infarcts; and the ability to evaluate the extent of cerebral edema. For the same reasons, as well as its archival potential for documenting the topographic distribution of pathologic processes, this technique has great promise for forensic cases. High field-strength (7.0-T) imaging brought the resolution of magnetic resonance to the microscopic level and reaffirmed the potential value of magnetic resonance imaging for diagnostic and investigative studies in which both the histologic and fine radiologic features of lesions are of interest.

Hemangiopericytoma of the sciatic nerve. Case report.

The authors report the case of a hemangiopericytoma arising in a sciatic nerve. It was found to be invasive within the epineurium but sparing surrounding tissues. Adequate resection required sacrifice of the nerve. Hemangiopericytomas can be added to the short list of mesodermal peripheral-nerve tumors.