Natural history of the cervical high-intensity intramedullary lesion in achondroplasia.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The cervical high-intensity intramedullary (CHII) lesion is a recognised finding in achondroplasia, manifesting as a focal area of increased T2W signal intensity in the upper cervical cord in the absence of cervical cord compression. The aim of this study is to determine the natural history of this abnormality. SETTING: Tertiary referral spinal and orthopaedic hospital, UK. METHODS: A retrospective review was undertaken of all patients with achondroplasia who had undergone at least one MRI study which included the cervical spine. Patient age at presentation was recorded and presence of the CHII lesion was determined on the sagittal T2W FSE sequence. For patients who had follow-up studies, presence of the CHII lesion was assessed for any change in morphology (resolution, partial resolution or enlargement). The development of new CHII lesions and presence of associated cord atrophy was also recorded. RESULTS: The study group consisted of 40 patients (20 males, 20 females: mean age at first MRI of 32.6 years (range 7-66 years). The CHII lesion was identified in 19 (47.5%) cases and was associated with focal cord atrophy in 17 (85%) cases. There was no change or resolution of these lesions nor any associated cord compression. No new CHII lesions developed but progressive cord atrophy was evident. CONCLUSION: The CHII lesion is seen in 47.5% of cases of achondroplasia. It appears to be a stable abnormality which does not progress or change its morphology. However, it does appear to be associated with progressive cord atrophy.

Transvaginal ultrasound-guided aspiration of an anterior sacral meningocele masquerading as a hydrosalpinx, resulting in abscess formation.

Anterior sacral meningoceles (ASMs) have a recognized association with a number of connective tissue disorders, including Marfan's syndrome, neurofibromatosis Type 1 and Ehlers-Danlos syndrome. We present the case of a patient with Marfan's syndrome and ASMs who was referred to gynaecology owing to dysmenorrhoea and left-sided pelvic pain radiating to the left leg. A transvaginal ultrasound scan (TVUS) detected a left pelvic cystic tubular structure, attributed to a hydrosalpinx, which, in retrospect, likely corresponded to the ASM. The patient went on to have TVUS-guided drainage of this cystic structure, resulting in an ASM abscess. It is difficult to distinguish ASM from the vastly more common hydrosalpinx using TVUS alone, and in patients with an atypical appearing posteriorly positioned cystic pelvic lesion or in the presence of underlying conditions known to be associated with ASMs, MRI should be considered before any interventional procedure to drain the suspected hydrosalpinx transvaginally. The patient was successfully treated using a minimally invasive CT-guided posterior trans-sacral drainage technique.

A recombinant DNA vaccine encoding Eimeria acervulina cSZ-2 induces immunity against experimental E. tenella infection.

The study describes vaccination experiments with highly immunogenic sporozoite Eimeria acervulina cSZ-2 to determine its efficacy against E. tenella challenge. Chickens were randomly divided into six groups. The chickens in the vaccinated groups were vaccinated with pVAX1-cSZ2, pVAX1-IL-2 and pVAX1-cSZ2-IL-2 twice 'at days 14 and 21' with dose rate of 100microg intramuscularly. At 28 days of age, all chickens except the non-vaccinated non-challenged control group were inoculated orally with 5x10(4) sporulated oocysts of E. tenella. Seven days later, all chickens were weighed and slaughtered for caecum examination. Our findings make it obvious that cSZ-2 DNA immunisation can induce host immune responses by decreasing intestinal lesions, body weight loss and oocyst ratio, imparting partial protection. It is concluded that co-administration of interleukin 2 can further enhance its immunity, leading towards further research.

A rare case of adult primary jejunal volvulus.

Jejunal volvulus is a rare and life threatening presentation of intestinal ischaemia. Clinical features, laboratory investigations and plain abdominal films are non-specific and so computed tomography (CT) scanning is useful in reaching a timely diagnosis. Rapid recourse to surgical intervention is typical and life saving. We report a rare case of primary jejunal volvulus which, after diagnosis on emergency CT scanning, was successfully treated by laparotomy and resection of infarcted bowel.

Venepuncture technique training vs practice: a survey of foundation year 1 doctors.

This survey investigated potential disparity between foundation year 1 doctors' formal undergraduate venepuncture training and their actual clinical practice. Is there still a high prevalence of needle and syringe use?