Routine sagittal whole-spine magnetic resonance imaging in finding incidental spine lesions.

PURPOSE: To examine the efficacy and feasibility of T2-weighted whole-spine sagittal magnetic resonance imaging (MRI) screening for all patients who undergo MRI of the lumbar spine for any indication. METHODS: A review of 1145 consecutive T2-weighted whole-spine sagittal MRI screening sequences performed for lumbar spine imaging was undertaken for the purposes of documenting the incidence and clinical significance of thoracic and cervical spine incidental findings, as well as to establish correlation between these pathologies and those found in the lumbar spine. RESULTS: Out of the 1145 patients included in the study, 103 (9%) patients had incidental findings thought to be significant. These findings included cervical spinal stenosis (n = 85), thoracic disc herniation (n = 9), syrinx (n = 5), intradural tumor (n = 2), and signal changes within the spinal cord (n = 2). In follow-up exams, 35 patients had clinically significant findings which included cervical myelopathy (n = 25), thoracic myelopathy (n = 3), syrinx (n = 5) and intradural tumor (n = 2). Among the 172 patients presenting with lumbar spinal stenosis, 42 (24.4%) had such incidental findings, and of those 41 (23.8%) had cervical stenosis with spinal cord compression (p < 0.0001). CONCLUSION: T2-weighted whole-spine sagittal screening is useful in demonstrating clinically relevant incidental findings in any patients undergoing MRI of the lumbar spine. There is a statistically significant correlation between lumbar spinal stenosis and cervical spinal stenosis with spinal cord compression.

Association between blood glucose levels and development of candidemia in hospitalized patients.

OBJECTIVE: To examine the relationship between blood glucose levels in hospitalized patients and the risk of occurrence of candidemia. METHODS: We undertook a retrospective review of medical records and hospital computerized database information to compare blood glucose levels in 48 patients with nosocomial candidemia and 144 contemporaneous matched control subjects without candidemia at a tertiary teaching hospital. RESULTS: The proportions of days (for patients with candidemia versus control subjects without candidemia) with blood glucose levels >or=100 mg/dL (293 of 325 [90%] versus 849 of 1,007 [84%]; P = .009), >or=140 mg/dL (184 of 325 [57%] versus 507 of 1,007 [50%]; P = .049), and >or=200 mg/dL (80 of 325 [25%] versus 163 of 1,007 [16%]; P = .001) were significantly higher during the 7 days preceding the diagnosis of candidemia than during a 7-day period of hospitalization of control subjects. Blood glucose levels exceeding 200 mg/dL for 4 or more days of the week preceding the diagnosis of candidemia were significantly associated with its development (P = .04; odds ratio, 2.44; and 95% confidence interval, 1.01 to 5.94). CONCLUSION: Inpatient hyperglycemia is an important--and potentially modifiable-risk factor for development of nosocomial candidemia. These findings have implications for innovative infection control strategies that focus on glycemic control.