Normal anterior-posterior diameters of the spinal cord and spinal canal in healthy term newborns on sonography.

BACKGROUND: There are no published normal values for spinal cord and canal diameters in newborns. Spinal cord and spinal canal diameters are assessed subjectively by radiologists without any objective values for the upper limit of normal. OBJECTIVE: To determine normal values for anteroposterior (AP) diameters of the spinal cord and spinal canal on sonography in healthy term newborns. MATERIALS AND METHODS: We performed ultrasound of the entire spine on 37 healthy newborns (23 male, 14 female). The AP diameters of the spinal canal and spinal cord were measured at representative levels of the cervical (C4, C5, C6), thoracic (T5, T6, T7, T8) and lumbar spine (lumbar enlargement and above and below the lumbar enlargement level). Statistical analysis was performed to determine the mean and standard deviation of the spinal canal and spinal cord AP diameter at each aforementioned vertebral level, and their correlations with birth weight, length and head circumference. RESULTS: The mean AP spinal cord diameter was 4.1±0.5 mm at the cervical level, 3.3±0.3 mm at the thoracic level and 4.4±0.6 mm at the lumbar level. The mean AP spinal canal diameter was 7.7±0.7 mm at the cervical level, 6.2±0.8 mm at the thoracic level, and 8.4±0.7 mm at the lumbar level. CONCLUSION: In this prospective study, we have determined normal values for AP diameters of the spinal cord and spinal canal on sonography in healthy newborns at representative cervical, thoracic and lumbar levels. This data may assist in evaluating the neonatal spine in clinical situations such as suspected spinal cord injury.

Single-incision technique for tunneled central venous access.

PURPOSE: To describe the authors' experience in using a single-incision technique for placing implantable chest ports and tunneled dialysis catheters. MATERIALS AND METHODS: Implantable chest ports and tunneled dialysis catheters were placed in 130 consecutive unselected patients aged 18 to 81 years over a 6-month period. A micropuncture needle bent into a C shape was used to access the internal jugular vein (IJV) from an infraclavicular access under real-time ultrasonographic (US) guidance. A microwire and sheath were then passed into the superior vena cava; this was followed by placement of the tunneled catheter either through a peel-away sheath (implantable chest port) or de novo over the wire (tunneled dialysis catheter). Technical success of procedure performance, total US and procedure times, and adverse procedural outcomes were documented for each case. Follow-up for infections and catheter outcomes was performed, with an average follow-up of 2 months. RESULTS: One hundred thirty of the 131 placements were successful. Fifty-eight implantable chest ports and 72 tunneled dialysis catheters were placed. Four implantable chest ports and 16 tunneled dialysis catheters were placed via the left IJV; the remainder were placed via the right IJV. There were no procedure-related complications. The average US and total procedure times were the same as those for a conventional technique. The lack of a second incision in the lower neck improved the cosmetic result. CONCLUSIONS: The single-incision technique for tunneled central venous access is feasible and safe. Total US and procedure times are within the range of those with a conventional technique. Cosmetically, this technique is superior to the conventional technique.

De novo placement of a tunneled dialysis catheter over a wire with the single-incision technique.

The authors describe a technique for the de novo placement of a tunneled dialysis catheter (TDC) over a wire. With use of a micropuncture needle bent into a C shape, the internal jugular vein was accessed under real-time ultrasonographic guidance from the expected catheter exit location in the deltopectoral fossa. The TDC was placed over the wire alone, without the use of a peel-away sheath. Twelve TDCs were successfully placed with this technique without any complications at an average follow-up of 2 months.

Progressive Bronchiectasis as a Manifestation of Chronic Graft Versus Host Disease Following Bone Marrow Transplantation.

We describe a case of progressive bronchiectasis resulting in cystic bronchiectasis with regions of mucoid impaction as a manifestation of chronic graft versus host disease as a late complication of allogeneic bone marrow transplantation.