One hundred and fifty three patients who had sustained a spinal cord injury more than 20 years previously were assessed neurologically and by MRI scanning of their spinal cords. The spinal cord pathologies shown were, in order of prevalence, extended atrophy, malacia, syrinx, cyst, disruption and tethering. There was no relationship between the prevalence of any type of pathology and the degree of spinal canal compromise or angulation of the spine adjacent to the level of injury. Neurological changes after initial neurological stabilisation were seen only in patients with extended atrophy, malacia or a syrinx, not in those with only a cyst or cord disruption. Tethering is always associated with other lesion(s). Longer syrinxes were more likely to have associated neurological changes than shorter ones. The most common neurological change was pain.
Heterotopic ossification (HO) is a potentially disabling complication of spinal injuries and other chronic disorders. It is of unknown aetiology and currently there is no easy or convenient diagnostic method that will allow very early confirmation of the inflammatory changes that precede osteoid and, later, true bone formation. Clinical experience, however, indicates that early treatment with radiotherapy, antiinflammatory agents or diphosphonates is needed to control the progression.This study was undertaken to assess the role of ultrasound (US) in the very early diagnosis of HO in patients with spinal injuries.US was found to be very sensitive in detecting focal soft tissue abnormalities around joints and in the muscles of these patients. If combined with a Doppler study to exclude deep venous thrombosis (DVT), and infection or tumour could be excluded clinically, US was extremely accurate in predicting the presence or absence of early HO changes within hours of the clinical manifestation. In 2 patients it successfully predicted HO in the opposite leg before clinical signs were evident.This study also provided supportive evidence of the theory of microtrauma in the aetiology of HO.As ultrasound is portable, safe, cheap, reproducible and accurate, it is the method of choice in the early diagnosis of HO. It allows early treatment to prevent the formation of osteoid and subsequent bone formation.
Splenic cyst is extremely rare in pregnancy. All the six cases that had been described in literatures were treated surgically. However, we report the first case of a huge splenic cyst during pregnancy managed by conservative approach in the form of analgesia, antibiotics and percutaneous aspiration.Keywords Pregnancy . Spleen . Cyst . Haemorrhage Case reportA 34-year-old woman presented in her second pregnancy at 24 weeks gestation with a 4-week history of increasing left upper abdominal and left shoulder pain. There was no history of abdominal trauma or foreign travel.She was admitted to the hospital to investigate the pain, particularly to exclude a pulmonary embolism and computed tomography pulmonary angiography (CTPA) was performed. This excluded a pulmonary embolism, but revealed a large splenic cyst. Palpation of the abdomen showed an enlarged spleen. The diagnosis was then confirmed by abdominal ultrasound scan, which revealed a huge round 20 cm splenic cyst with a smooth thin wall, filled by 2 l of homogenous fluid with no signs of malignancy (Fig. 1). The serology for hydatid IgG was negative. Platelets, liver and kidney function tests were normal. However, the haemoglobin level (Hb) on admission was 8.3 g/dl, a reduction of 1.3 g/dl compared to the previous week. This raised the possibility of a haemorrhage into the cyst. However, the ultrasound didn't suggest this.In liaison with the surgical and radiology teams, it was decided to postpone aspiration of the cyst until a time of fetal maturation, to avoid unwarranted effect on the fetus should laparotomy be needed. Pain was controlled by morphine and pethidine. Iron tablets were given for anaemia and a daily full blood count revealed no further drop in the Hb level. Two units of cross-matched blood were made available for any emergency.At 26 weeks the patient experienced shivering and a fever of 39°C. Haemoglobin dropped to 7.8 g/dl with raised C-reactive protein of 99 mg/l. Two units of blood were transfused and intravenous co-amoxiclav was started to treat the septicaemia which was presumed to be from the infected haemorrhagic cyst. Betamethasone was also given in case of preterm delivery. Abdominal ultrasound showed no increase in the size of the cyst and satisfactory fetal growth. The patient's general condition improved with the treatment.At 27 weeks a percutaneous aspiration under ultrasound guidance was performed. This was earlier than planned to avoid further episodes of infection. Three and a half litres of greyish brown fluid were aspirated and coagulase negative staphylococci sensitive to co-amoxiclav were cultured. The patient showed a good improvement and was discharged 2 days later on oral co-amoxiclav.Ultrasound scans at 32 and 35 weeks revealed reaccumulation of the cyst to measure 15 cm. No further aspiration was performed, as the patient was asymptomatic. At 40 weeks the patient went into spontaneous labour and had a normal vaginal delivery. Ultrasound scan 6 weeks following the delivery showed persistence of the cyst. This G...
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