Skin to cervical epidural space distances as read from magnetic resonance imaging films: consideration of the "hump pad.".

STUDY OBJECTIVE: To measure the distances from the skin to the epidural space (DSES) of the lower cervical and upper thoracic intervertebral spaces. DESIGN: Retrospective review of films of the cervical spine as obtained by magnetic resonance imaging (MRI). SETTING: Health care facility that provides diagnosis and treatment of patients with chronic pain. MEASUREMENTS AND MAIN RESULTS: MRI sagittal films of 100 patients, who had diagnostic studies for chronic headaches and cervicobrachial radiculopathy, were reviewed. Measurements were made of DSES, the dural sac, and the spinal cord by centimeter ruler. Estimates were also made of the width of the epidural space by measuring the distance from the ligamentum flavum to the dural sac. The longest DSES were noted at C6-7 and C7-T1 levels, with a mean of 5.7 cm, but they decreased to a mean of 5.4 cm at the T1-2, and to 4. 7 cm at the T2-3 intervertebral spaces. One of the major factors in this variability was the presence of an accumulation of fatty tissue along the lower cervical and upper thoracic area, which the authors named the "hump pad." This accumulation appears to be thicker in obese patients, with a slight correlation coefficient with the patient's weight. The distances from ligamentum flavum to dural sac, representing the depth of the epidural space, averaged 0.3 cm, 0.4 cm, 0.5 cm, and 0.4 cm, respectively. CONCLUSIONS: In the cervical spine, DSES varies from space to space. In obese individuals, the fat pad may increase DSES at the lower cervical intervertebral spaces. The longest mean distances from the ligamentum flavum to the dural sac and to the spinal cord were found at the T1-2 and T2-3 levels, precisely where DSES is shorter. All things being equal, the upper thoracic intervertebral spaces appeared to provide a greater margin of safety for insertion of epidural catheters to treat cervicobrachial radiculopathies.

Effect of PEMF on fresh fracture-healing in rat tibia.

The present experiment was designed to find out whether PEMF can act as a healing agent on induced fracture of rat tibia. Eighty rats were taken for this experiment. Under general anaesthesia mid-shaft of tibia and fibula of all rats were osteotomied, Intramedullary nailing was done for proper alignment of the fractured fragments. The animals were then divided into two groups: group-1 and Group-II. Each group contained forty animals. Out of these forty animals twenty were treated as experimental and twenty as control. From the third day of osteotomy, PEMF was applied to experimental rats around the osteotomy sites for a period of nine hours a day. PEMF was not applied to the control rats. The animals of group-1 and group-II were sacrificed after applied one week and three weeks of PEMF, respectively. Radiological and microscopical examination of the callus were performed. Gross and microscopic measurements of the callus were statistically analysed. The growth of callus was taken as a criterion of fracture healing. The results of the present experiment revealed significant enhancement of fracture healing in group-I. The results of the radiological evaluation of group-II experimental animals were also consistent with the morphological analysis. It was concluded that healing of fractured rat tibia was enhanced by the application of PEMF and this effect of PEMF was more pronounced at the end of third week.

Screening for retinopathy of prematurity in a regional neonatal intensive care unit.

Retinopathy of prematurity (ROP) is attracting renewed interest from ophthalmologists and neonatologists because of the improved survival of very low birthweight premature infants, some of whom develop blinding disease. Ophthalmologists may find increasing pressure from paediatric colleagues to provide a screening service for babies at risk. The results of the last twenty-two months of a continuing programme at this hospital demonstrate the benefits of active screening, but indicate some of the potential problems for ophthalmologists who are likely to become involved in this work now and in the future.

Outcome of preterm infants who suffered neonatal apnoeic attacks.

Thirty infants of less than 31 weeks post-menstrual age were monitored for apnoea using routine medical equipment and intermittent 24-h pneumocardiograms. These infants were examined again between 16 and 36 months of age. Full physical and ophthalmological examinations were carried out as well as audiometry and assessment using the Griffiths mental developmental scales. Twenty-five of these infants had suffered apnoeic attacks and two of these infants had an abnormal developmental quotient. Neither sensorineural deafness of retinopathy of prematurity were detected in the children who suffered apnoeic episodes. The poor prognosis which has been associated with neonatal apnoea may not apply to those infants without other serious neonatal problem.

Ophthalmic screening of patients receiving ketoprofen or flurbiprofen medication for inflammatory and degenerative joint diseases.

Twenty-seven patients with inflammatory and degenerative arthritis, who had been treated with either ketoprofen and flurbiprofen, for a period of up to twenty-four months, were examined for evidence of ocular toxicity. A practical method for examining the ocular structures and assessing visual function is described. A number of ophthalmic abnormalities were noted but these were related to previous or present eye disease or degeneration. It was considered that no ocular toxic sideeffects could be attributed to either drug during the period of treatment.

Ocular damage in the battered-baby syndrome.

Twelve out of 19 battered babies seen with ocular damage have permanent impairment of vision affecting one or both eyes. Ocular disease, especially retinal haemorrhage, is common in the battered-baby syndrome, and infants with this condition should always have a complete ophthalmic examination.