Can clinical presentation predict radiologically confirmed cauda equina syndrome: retrospective case review of 530 cases at a tertiary emergency department.

PURPOSE: Cauda equina syndrome (CES) may have significant individual consequences if diagnostic delays occur. Our aim was to evaluate the presenting subjective and objective features of patients with suspected CES in comparison to those with radiologically confirmed cauda equina compression (CEC).. METHODS: This was a retrospective analysis of all cases presenting with suspected CES to a tertiary emergency care unit over a two-year period. CEC was defined as radiological confirmation of CEC by Consultant Musculoskeletal (MSK) Radiologist report (MSK-CEC) and by measured canal occupancy due to an acute disc extrusion (> 75%)[measured by a Senior Spinal Surgeon (SP-CEC)]. Routine data collection was compared between categories. Chi square, multivariate regression analyses and ROC analysis of multiple predictors was performed. RESULTS: 530 patients were included in this analysis, 60 (11.3%) had MSK-CEC, and 470 had NO- CEC. Only 43/60 (71.7%) had emergent surgery. Those with MSK-CEC and SP-CEC were statistically more likely to present with bilateral leg pain [(MSK-CEC OR 2.6, 95%CI 1.2, 5.8; p = 0.02)(SP-CEC OR 4.7, 95%CI 1.7, 12.8; p = 0.003)]; and absent bilateral ankle reflexes [(MSK-CEC OR 4.3; 95% CI 2.0, 9.6; p < 0.001)(SP CEC OR 2.5; 95%CI 1.0, 6.19; p = 0.05)] on multivariate analysis. The ROC curve analysis acceptable diagnostic utility of having SP-CEC when both are present [Area under the curve 0.72 (95%CI 0.61, 0.83); p < 0.0001]. CONCLUSION: This study suggests that in those presenting with CES symptoms, the presence of both bilateral leg pain and absent ankle reflexes pose an acceptable diagnostic tool to predict a large acute disc herniation on MRI scan..

Nomenclatural changes in Mymaridae (Hymenoptera: Chalcidoidea).

Three New World species are transferred from Polynema Haliday to other genera of Mymaridae and redescribed based on examination of their type specimens: Polynema albicoxa Ashmead to Acmopolynema Ogloblin as Acmopolynema albicoxa (Ashmead), comb. n., Polynema porteri (Brèthes) to Agalmopolynema Ogloblin as Agalmopolynema porteri (Brèthes), comb. n., and Polynema giraulti Perkins, for which a lectotype is designated, to Stephanodes Enock as Stephanodes giraulti (Perkins), comb. n. Agalmopolynema shajovskoii Fidalgo, syn. n. is synonymized under Agalmopolynema porteri; Polynema (Dorypolynema) gaucho Triapitsyn & Aquino, syn. n. and P. grenadensis Ashmead, syn. n., are synonymized under Polynema (Dorypolynema) magniceps Ashmead, for which taxonomic notes are given. Caenomymar Yoshimoto, syn. n. is synonymized under Omyomymar Schauff, and its only species Caenomymar howdeni Yoshimoto is transferred to Omyomymar as Omyomymar howdeni (Yoshimoto), comb. n. Gonatocerus chula Triapitsyn & Bernal is transferred to Cosmocomoidea Howard as Cosmocomoidea chula (Triapitsyn & Bernal), comb. n. Erythmelus mirus Girault is transferred to Cleruchoides Lin & Huber as Cleruchoides mirus (Girault), comb. n. and compared with Cleruchoides noackae Lin & Huber, a species introduced from Australia into South America as a biological control agent of Thaumastocoris peregrinus Carpintero & Dellapé (Hemiptera: Thaumastocoridae), an introduced pest of Eucalyptus. Four spelling corrections are made to species names in Cosmocomoidea and Lymaenon Walker.

Two new species of Anagyrus (Hymenoptera: Encyrtidae) from Argentina, parasitoids of Hypogeococcus spp. (Hemiptera: Pseudococcidae), with taxonomic notes on some congeneric taxa.

Two new species of Anagyrus Howard (Hymenoptera: Encyrtidae) are described from Argentina, A. cachamai Triapitsyn, Logarzo & Aguirre sp. n. (Catamarca, Córdoba, Salta and Tucumán Provinces) and A. quilmes Triapitsyn, Logarzo & Aguirre sp. n. (Catamarca, Salta and Tucumán). Both new species are parasitoids of Hypogeococcus spp. (Hemiptera: Pseudococcidae). Anagyrus cachamai is a parasitoid of H. pungens Granara de Willink on Alternanthera paronychioides, A. pungens and Gomphrena sp. (Amaranthaceae), and also of a Hypogeococcus sp. on Cleistocactus baumannii and Hypogeococcus sp. on C. smaragdiflorus (Cactaceae). Anagyrus quilmes is a parasitoid of H. pungens on A. paronychioides, A. pungens and Gomphrena sp. Other biological traits of the new species are also reported. These parasitoids may be of importance as potential candidate biological control agents against a Hypogeococcus sp., commonly called the Harrisia cactus mealybug and identified as H. pungens, but possibly not belonging to that species. This mealybug threatens the native cacti in some Caribbean islands and Florida, USA, and is devastating the native columnar cacti in Puerto Rico. Illustrations and taxonomic notes on the type specimens of some other, little known described species of Anagyrus from Argentina and Chile are provided, and a key to females of the 14 species of Anagyrus known from Argentina is given. Anagyrus nigriceps (De Santis) syn. n. is synonymized under A. bellator (De Santis). Lectotypes are designated for Paranusia bifasciata Brèthes, Philoponectroma pectinatum Brèthes, and Protanagyrus aciculatus Blanchard.