Symptomatic lumbar spinal arachnoiditis: fact or fallacy?

It is generally accepted that chronic adhesive lumbar arachnoiditis is a cause of symptoms, notably back pain and/or pain (of almost any type, not necessarily 'anatomical') in the lower limbs, although there is no clearly defined clinical pattern which is clearly associated with this syndrome. There is no doubt that arachnoiditis occurs as a pathological and radiological entity due to a number of causes. In the view of the present authors, the nexus between the pathology and radiology on the one hand, and the patients' symptoms on the other hand, has not been demonstrated with any degree of scientific rigor.

Ataxia telangiectasia with long survival.

A few patients with ataxia telangiectasia survive into the 3rd decade. In the central nervous system, dilated meningeal veins have been noted in a few cases but as a rule the vasculature in both brain and spinal cord appears normal. We present the case of the longest reported surviving patient with ataxia telangiectasia who died at the age of 34 years and showed numerous vascular malformations with gliosis and haemosiderin in the cerebral white matter and spinal cord. These are similar to the features described in three previously reported long surviving cases of ataxia telangiectasia. In addition, however, numerous corpora amylacea were present, a finding not previously described. Also presented is the magnetic resonance imaging (MRI) scan which was of diagnostic-value; there have been very few MRI scans recorded in ataxia telangiectasia. It showed lesions consistent with vascular malformations in cerebral white matter with surrounding abnormal tissue consistent with gliosis. Gross cerebellar atrophy was also demonstrated. It is significant that MRI scans 6 months apart at the age of 32 years showed progression of the lesions.

The cervical spine in fatal motor vehicle accidents.

Of 100 fatal accident cases involving motor vehicles, 60 showed damage to the cervical spine, involving bony or disc damage in 31 and focal haemorrhages in another 29. In 8 cases, pre-autopsy radiology failed to detect lesions which were found by radiology and pathological examination of the post-autopsy specimen. Most of the lesions missed were at the C6-7 region. In some cases, the initial pathological examination 'missed' laterally placed fractures and small chip fractures. Narrow cervical canals in the elderly indicated advanced spondylosis.

Outpatient transurethral balloon urethroplasty.

Transurethral balloon dilatation was performed on 6 patients, who were assessed pre- and post-procedure on symptomatic and urodynamic criteria. Follow-up was on average 11.7 months. Only 1 patient had a successful result, despite early initial improvement in five. In view of our results and reports from other centres we cannot recommend transurethral balloon dilatation of the prostate as treatment in patients with bladder outlet obstruction due to benign prostatic hypertrophy, except in exceptional circumstances.

CT of the spine: are plain spine radiographs necessary?

This study was designed to determine whether plain radiographs added any information of clinical significance to the information provided by CT (computed tomography) and its standard digital radiographs in 100 patients presenting for CT of the lumbar spine and 46 patients presenting for cervical spine CT. In only three (3%) of the lumbar studies and two (4.3%) of the cervical studies did the plain radiographs add diagnostic information. The added diagnostic information did not affect patient management in all cases with indications other than trauma. Good quality oblique cervical spine digital radiographs were obtained in 10 cases simply by moving the tube and detectors to the 45 degrees and 135 degrees azimuths. The evidence from this study suggests that when a CT examination of lumbar or cervical spines is planned on a high resolution CT scanner for indications other than trauma, a conventional plain radiographic examination can be omitted in the first instance.

The relation of radionuclide uptake by bone to the rate of calcium mineralization. I: Experimental studies using 45Ca, 32P and 99Tcm-MDP.

The study of the uptake of radionuclides by bone has been undertaken in a mouse tail graft model using 45Ca, 32P and a routine bone scanning agent 99Tcm-MDP, together with serial calcium determinations. The model provided an experimental system in which the calcium mineral content and the rate of mineralization both changed progressively throughout its development. A significant linear correlation was found between 45Ca and 32P uptake and the rate of calcium mineralization, which held for all stages of the graft's growth. Both radiotracers therefore accurately reflected the calcium mineral deposition. In the case of 99Tcm-MDP, the correlation with mineralization rate only applied for the most active growth period of the graft when the rate was increasing. For all radiotracers, the peak in bone uptake corresponded to the maximum in mineralization rate.

The relation of radionuclide uptake by bone to the rate of calcium mineralization. II: Patient studies using 99Tcm-MDP.

The relation of radionuclide uptake by bone and rate of calcification has been studied in normal vertebrae and in vertebral metastases from cancer of the prostate. Specifically, the determination of 99Tcm-MDP uptake by radionuclide scanning and the estimation of calcium concentration of trabecular bone by dual-energy computed tomography have provided the means of obtaining a relation between these parameters which was similar to that found in an animal model, in which the dependence of radionuclide uptake on the rate of mineralization was established. This relationship has enabled the experimental findings to be extrapolated to those in patient studies and has shown that in sclerotic bone lesions, the increase in 99Tcm-MDP uptake accompanying the progression of the metastases was proportional to the rate of calcification.

Comparison of mammary serum antigen assay with mammography in patients with breast cancer.

Mammary serum antigen levels and two-view xeromammography were evaluated in a study of 97 patients who presented at a specialist breast clinic in a major teaching hospital, in order to determine their single and combined value in the detection of breast cancer. Raised mammary serum antigen levels (greater than 300 inhibition units) were found in 76% of patients with stage-1 (including carcinoma-in-situ) and stage-II breast cancer compared with 54% of patients whose mammograms were suggestive of cancer (probability of carcinoma, greater than 50%). Four patients with carcinoma-in-situ had elevated mammary serum antigen levels, but their mammograms did not suggest the presence of cancer (probability of carcinoma, less than 50%). The over-all sensitivity, specificity and predictive value of a positive test-result in detecting breast cancer were 76%, 82% and 72%, respectively, for the mammary serum antigen test, and 54%, 88% and 74%, respectively, for mammography. When the mammary serum antigen test and mammography were used together, a combined evaluation enhanced the sensitivity in the detection of breast cancer (89%) but with a concomitant reduction in specificity (72%). The mammary serum antigen test was superior to mammography in the detection of breast cancer in this study and may prove to be a useful adjunct to conventional methods of clinical assessment and to mammography for the detection of breast cancer.