✓Modic Type 2 (MT2) neuroimaging changes are considered stable or invariant over time and relatively quiescent, whereas Modic Type 1 (MT1) changes are considered unstable and more symptomatic. The authors report two cases in which MT2 changes were symptomatic and evidently unstable, and in which chronic low-back pain severity remained unaltered despite a MT2–MT1 reverse transformation. Two women (41 and 48 years old) both presented with chronic low-back pain. Magnetic resonance (MR) images demonstrated degenerating discs at L5–S1 associated with well-established MT2 changes in adjacent vertebrae. Repeated MR imaging in these two patients after 11 months and 7 years, respectively, revealed reverse transformation of the MT2 changes into more florid MT1 changes, despite unaltered chronic low-back pain severity. Following anterior discectomy and disc arthroplasty, immediate abolition of chronic low-back pain was achieved in both patients and sustained at 3-year follow up. Modic Type 2 changes are therefore neither as stable nor as quiescent as originally believed. Each type can change, with equal symptom-generating capacity. More representative imaging–pathological correlates are required to determine the precise nature of MT changes.
We have previously reported that intravenously administered contrast media produce a rise in plasma vasopressin (antidiuretic hormone) concentrations. We have now shown that this occurs both when contrast medium is injected into a peripheral vein and when it is centrally injected into the right atrium. The peak vasopressin concentration recorded varies with the osmolality of the contrast medium. The vasopressin response was greater when contrast agent was centrally injected.
Relatively simple modifications to MRI parameter settings can be made on conventional high field-strength (1.5T) closed-bore scanners, which minimize metal artefact and enhance imaging of adjacent segments with ferromagnetic TDA devices. Such modifications effectively match appearances to those obtained with outmoded low field-strength (0.3T) open-bore scanners.
We are grateful for the comments on our case report. With regard to that from Drs Hinwood and Manhire, we read with interest of their experience of the technique.
Dilatation of the renal tract in pregnancy is a common event (Peake et al, 1983). Whilst frequently asymptomatic, the distension can be associated with considerable pain, the acute presentation of which may be attributed to other surgical or obstetric emergencies such as appendicitis or placental separation (Anteby et al, 1975). Renal tract obstruction may also occur in pregnancy, and failure to recognize it may lead to rupture of the urinary tract and loss of the kidney (Meyers et al, 1985).
We present a case in which such a renal tract obstruction was relieved percutaneously. Whilst percutaneous nephrostomy is a commonly practised technique, its use in pregnancy has not been reported previously.
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