Three-dimensional laser imaging system for measuring wound geometry

BACKGROUND AND OBJECTIVE

A low cost laser imager was designed and fabricated for measurement of wound geometry.

METHODS

The accuracy of the imager was validated using reference depressions of known dimensions. Perimeter, area, and volume were compared to planimetric and packing techniques on simulated wound models.

RESULTS

Wound tracing and alginate measurement methods required approximately 20 times longer for the reference standards, and 11 times longer for the simulated wounds than with the laser scanning method (LSM). LSM consistently overestimated the reference perimeter by 0.73+/-0.20 cm and the area by 0.98+/-0.62 cm2. Volume estimates were not statistically different. The tracing method underestimated the perimeter by 0.34+/-0.27 cm and the area by 1.07+/-1.09 cm2. Volume measurements by the alginate method were not statistically different. The perimeters of the simulated wounds averaged 1.29+/-0.27 cm greater using the LSM than obtained by the tracing method, and areas greater by 2.02+/-1.30 cm2. Volume scans averaged 1.04+/-0.61 cm3 greater than by the alginate method.

Structural basis for the heterodimeric interaction between the acute leukaemia-associated transcription factors AML1 and CBFbeta

Mutations in the genes encoding the interacting proteins AML1 and CBFbeta are the most common genetic abnormalities in acute leukaemia, and congenital mutations in the related AML3 gene are associated with disorders of osteogenesis. Furthermore, the interaction of AML1 with CBFbeta is essential for haematopoiesis. We report the 2.6 A resolution crystal structure of the complex between the AML1 Runt domain and CBFbeta, which represents a paradigm for the mode of interaction of this highly conserved family of transcription factors. The structure demonstrates that point mutations associated with cleidocranial dysplasia map to the conserved heterodimer interface, suggesting a role for CBFbeta in osteogenesis, and reveals a potential protein interaction platform composed of conserved negatively charged residues on the surface of CBFbeta.

A note on robust variance estimation for cluster-correlated data

There is a simple robust variance estimator for cluster-correlated data. While this estimator is well known, it is poorly documented, and its wide range of applicability is often not understood. The estimator is widely used in sample survey research, but the results in the sample survey literature are not easily applied because of complications due to unequal probability sampling. This brief note presents a general proof that the estimator is unbiased for cluster-correlated data regardless of the setting. The result is not new, but a simple and general reference is not readily available. The use of the method will benefit from a general explanation of its wide applicability.

Ewing's family of tumors involving structures related to the central nervous system: a review

This review consolidates information gleaned from several case reports and larger series on Ewing's sarcoma family of tumors (EFT) involving structures related to and found in the central nervous system (CNS). These tumors involve the skull, the spinal column, adjacent soft tissues, the meninges, and the brain. We have separated the cases by skull region and spinal column level, and we discuss the attendant differences in prognosis following treatment by neurosurgery, radiation, and chemotherapy. Light and electron microscopic features can be used to differentiate EFT from other small round blue cell tumors that involve the CNS (central primitive neuroectodermal tumor, lymphoma, etc.). Recent molecular and genetic findings in EFT provide new diagnostic methods. We conclude that EFT involving the CNS and adjacent structures is not so rare as previously stated and that the prognosis is more favorable, as a rule, than for the more common examples arising in the long bones and pelvis.

Subject-by-formulation interaction in bioequivalence: conceptual and statistical issues. FDA Population/Individual Bioequivalence Working Group. Food and Drug Administration

PURPOSE

The FDA has proposed replacing the current average bioequivalence criterion with population and individual bioequivalence criteria that consider variances in addition to the difference of averages. One of these variances in the individual bioequivalence criterion measures subject-by-formulation interaction, the extent to which the test-reference difference varies from person to person. This paper discusses conceptual and statistical issues raised in various publications and presentations with respect to the presence and estimation of such an interaction.

METHODS

We focus on the importance of subject-by-formulation interaction, an understanding of what is a large interaction, and the assessment of the magnitude of this interaction in bioequivalence studies. Simulation studies, examples from the literature, and data from FDA files are used to demonstrate the magnitude of the interaction and its distribution under various conditions.

RESULTS

The concept of a large interaction is tied to the concept of a large mean difference. We suggest that an interaction greater than 0.15 is a conservative criterion for a large interaction. Magnitudes of estimated interaction are affected by variability, sample size, and the selection of data sets that pass average bioequivalence.

CONCLUSIONS

Examples of substantial interactions are beginning to appear. More data is needed before reaching definitive conclusions regarding the frequency and importance of observed interactions.

Biomaterials used in the posterior segment of the eye

The treatment of posterior segment eye disease and related conditions has improved greatly in recent years with the advent of new therapies, materials and devices. Vitreoretinal conditions, however, remain significant causes of blindness in the developed world. Biomaterials play a major role in the treatment of many of these disorders and the success rate of vitreoretinal surgery, especially in the repair of retinal detachment and related conditions, would increase with the introduction of new and improved materials. This review, which focuses on disorders that feature retinal detachment, briefly describes the anatomy of the eye and the nature and treatment of posterior segment eye disorders. The roles, required properties and suitability of the materials used in vitreoretinal surgery as scleral buckles, tamponade agents or drug delivery devices, are reviewed. Experimental approaches are discussed, along with the methods used for their evaluation, and future directions for biomaterial research in the posterior segment of the eye are considered.

Tools for community-oriented primary care: use of key informant trees in eleven practices

Physicians increasingly need information about their communities to use in care of the individual patient. Busy practitioners need feasible methods for collecting this information before they can begin to gather and use it, however. Our objective was to study key informant trees as a practical approach for practice-based gathering of qualitative data from a community. Following a standard protocol, key informant trees were set up in 11 different practices to study the costs, advantages, and problems with their use for this purpose. Time studies showed that each tree took 7 to 11 hours of physician time and 7 hours of clerical time to organize and conduct. The technique appeared to be best suited for two qualitative informational needs: idea generation and explanatory data gathering. Trees appeared most productive where there was stability of physician staff in the practice, where the practice had been present in the community for some years, and where community residents were relatively stable. Response and selection biases are important considerations in use of this technique.

Bioequivalence of methylphenidate immediate-release tablets using a replicated study design to characterize intrasubject variability

PURPOSE

To determine the relative bioavailability of two marketed, immediate-release methylphenidate tablets. The study used a replicated study design to characterize intrasubject variability, and determine bioequivalence using both average and individual bioequivalence criteria.

METHODS

A replicated crossover design was employed using 20 subjects. Each subject received a single 20 mg dose of the reference tablet on two occasions and two doses of the test tablet on two occasions. Blood samples were obtained for 10 hr after dosing, and plasma was assayed for methylphenidate by GC/MS.

RESULTS

The test product was more rapidly dissolved in vitro and more rapidly absorbed in vivo than the reference product. The mean Cmax and AUC(0-infinity) differed by 11% and 9%, respectively. Using an average bioequivalence criterion, the 90% confidence limits for the Ln-transformed Cmax and AUC(0-infinity), comparing the two replicates of the test to the reference product, fell within the acceptable range of 80-125%. Using an individual bioequivalence criterion the test product failed to demonstrate equivalence in Cmax to the reference product.

CONCLUSIONS

The test and reference tablets were bioequivalent using an average bioequivalence criterion. The intrasubject variability of the generic product was greater and the subject-by-formulation interaction variance was borderline high. For these reasons, the test tablets were not individually bioequivalent to the reference tablets.

Clinical pharmacology studies in patients with renal impairment: past experience and regulatory perspectives

The objective of this report is to provide a regulatory perspective on the quality of pharmacokinetic studies in renal impairment (RI) studies submitted in support of new drug applications (NDAs) or supplements to NDAs (sNDAs) submitted to the Food and Drug Administration (FDA). Fifty-one NDA and 20 sNDA submissions reviewed between 1996 and 1997 by the Office of Clinical Pharmacology and Biopharmaceutics were evaluated for the following: (1) whether an RI study was conducted; (2) contribution of the renal clearance to the overall clearance in subjects without renal impairment; (3) degree of plasma protein binding (%PB) in subjects without renal impairment; (4) dose proportionality of single and multiple doses; (5) study design, including dosing regimen; (6) definition of renal impairment; (7) stratification of renal functions; (8) number of subjects/group; (9) data analysis and interpretation; and (10) impact on labeling. Results of the analysis indicated that 67% of the NDAs and 30% of supplemental NDAs contained RI-studies (34/51 for NDAs and 6/20 for sNDAs). No obvious differences in the pharmacokinetic characteristics (e.g., percentage excreted unchanged in urine and %PB) were observed between drugs for which RI studies were conducted versus those not conducted. Most studies conducted were designed as single dose (70%). Seventy-five percent of the studies used doses within the therapeutic dosage range of the drug. The measured 24-hour creatinine clearance was most often used to assess the renal function. Stratification of renal function ranged from one to five groups, with 6 to 8 subjects enrolled per group. In most studies conducted (38/40), data were analyzed by point estimate using ANOVA. Results of RI studies were adequately reflected in the labeling. The survey reveals that RI study design can be improved for regulatory review purposes. In part based on this analysis, the FDA has prepared a guidance that provides recommendations on the design, analysis, and impact on dosing and labeling for RI studies to include recommendations on when RI studies do not need to be performed. The guidance proposes an equivalence approach with confidence intervals, as opposed to a point estimate approach, to assess the impact of RI on systemic exposure measures.

Interventions for treating hallux valgus (abductovalgus) and bunions

BACKGROUND

Hallux valgus is classified as an abnormal deviation of the great toe (hallux) towards the midline of the foot.

OBJECTIVES

To identify and evaluate the evidence from randomised trials of interventions used to correct hallux valgus.

SEARCH STRATEGY

Medline (1966-October 1998), Embase (1980-1998), Cinahl (1982-1998), Amed (1993-1998), the Cochrane Controlled Trials Register, the Cochrane Musculoskeletal Injuries Trials Register and bibliographies of identified trials were searched. Hand searching of podiatry journals was undertaken. Date of the most recent search: October 1998.

SELECTION CRITERIA

Randomised or quasi-randomised trials of both conservative and surgical treatments of hallux valgus. Excluded were studies comparing areas of surgery not specific to the control of the deformity such as use of anaesthetics or tourniquet placement.

DATA COLLECTION AND ANALYSIS

Methodological quality of trials which met the inclusion criteria was independently assessed by two reviewers. Data extraction was undertaken by one reviewer and confirmed by another. The trials were grouped according to the interventions being compared, but the dissimilarity in the comparisons prevented pooling of results.

MAIN RESULTS

The methodological quality of the 12 included trials was poor and trial sizes were small. Two trials involving 150 patients evaluated conservative treatments. There was no difference in outcomes between treatment and no treatment. Two trials involving 133 patients compared Keller's arthroplasty with other surgical techniques. In general, there was no advantage in using Keller's over the other techniques, particularly in terms of range of motion and intermetatarsal angle. Three trials involving 205 patients compared chevron (and chevron-type) osteotomy with other techniques. The chevron osteotomy offered no advantages in these trials. For some outcomes, other techniques gave better results. Three trials involving 157 patients compared outcomes between original operations and surgeon's adaptations. There was no advantage found for any of the adaptations. Two trials involving 95 patients evaluated methods of post-operative rehabilitation. The use of continuous passive motion appeared to give an improved range of motion and earlier recovery following surgery; early weightbearing was not found to be detrimental to final outcome.

REVIEWER'S CONCLUSIONS

There is insufficient evidence from randomised trials to determine which methods of either conservative, operative or post-operative treatment are the most appropriate for the hallux valgus. It is notable that the numbers of patients remaining dissatisfied at follow-up were consistently high (25 to 33%), even when the hallux valgus angle and pain had improved. Assessment of future research should focus on evaluating basic intervention types in eligible patients with similar degrees of deformity. Future research should include patient-focused outcomes, standardised assessment criteria and longer surveillance periods.

Bioequivalence of immediate-release theophylline capsules

A three-way crossover study in 18 healthy male volunteers was conducted to evaluate the bioequivalence of three different 200 mg anhydrous theophylline immediate-release (IR) capsules. The products had not been rated as therapeutically equivalent by the US Food and Drug Administration (FDA) owing to a lack of bioequivalence data. Serum samples were obtained from 0 to 34 h after dosing. Mean time of maximum serum concentration (T(max)) ranged from 1.3 to 1.4 h. Mean values for the maximum serum concentration (C(max)) and the area under the serum concentration-time curves (AUC) differed by <5% for the three products. The confidence limits for Ln-transformed C(max) and AUC ranged from >/=89 to </=113%. It was concluded that the three products were bioequivalent. In addition, the rapid in vitro dissolution of these formulations, as well as the reported high solubility and high permeability of theophylline, was predictive of the lack of any bioavailability differences among the three products.

Mammalian phosphoinositide-specific phospholipase C

Mammalian phosphoinositide-specific phospholipases C (PI-PLCs) are involved in most receptor-mediated signal transduction pathways. The mammalian isozymes employ a modular arrangement of domains to achieve a regulated production of two key second messengers. The roles of the PH, EF hand, C2, SH2 and SH3 modules in regulation of these enzymes and in interactions with membranes and other proteins is becoming apparent from recent structural and functional studies.

Structural insights into phosphoinositide 3-kinase catalysis and signalling

Phosphoinositide 3-kinases (PI3Ks) are ubiquitous lipid kinases that function both as signal transducers downstream of cell-surface receptors and in constitutive intracellular membrane and protein trafficking pathways. All PI3Ks are dual-specificity enzymes with a lipid kinase activity which phosphorylates phosphoinositides at the 3-hydroxyl, and a protein kinase activity. The products of PI3K-catalysed reactions, phosphatidylinositol 3,4,5-trisphosphate (PtdIns(3,4,5)P3), PtdIns(3,4)P2 and PtdIns(3)P, are second messengers in a variety of signal transduction pathways, including those essential to cell proliferation, adhesion, survival, cytoskeletal rearrangement and vesicle trafficking. Here we report the 2.2 A X-ray crystallographic structure of the catalytic subunit of PI3Kgamma, the class I enzyme that is activated by heterotrimeric G-protein betagamma subunits and Ras. PI3Kgamma has a modular organization centred around a helical-domain spine, with C2 and catalytic domains positioned to interact with phospholipid membranes, and a Ras-binding domain placed against the catalytic domain where it could drive allosteric activation of the enzyme.

Assessment of the quality and quantity of drug-drug interaction studies in recent NDA submissions: study design and data analysis issues

This report investigates the quality and quantity of drug-drug interaction studies in recent new drug applications (NDAs). Eighty-nine studies contained in 14 NDAs submitted between December 1995 and November 1996 to the U.S. Food and Drug Administration (FDA) were reviewed. The results indicated that the median number of clinical drug-drug interaction studies per NDA was 6, almost double that of a 1994-1995 survey. In vitro metabolism data were present in 70% of the submissions. More than 50% of the submissions contained interaction studies using a battery of drugs (cimetidine, digoxin, or warfarin) without optimal use of the in vitro metabolism or in vivo mass balance data. Various study designs using a median number of 12 subjects were employed in the evaluation of drug-drug interactions. Some of the important study design factors such as dose size, dosing regimen, dosing duration, and timing of coadministration were considered, although not consistently, by the sponsors in their study design. Seventy-five percent of the studies used normal, healthy male subjects, and 25% used patients for whom the new molecular entities were intended. In 33% of the studies, female subjects were also recruited. Although the majority (80%) of the submissions still used p-values to determine the significance of drug interactions, 30% used a more relevant equivalence approach with 90% confidence intervals for key pharmacokinetic and/or pharmacodynamic parameter ratios to assess the extent of drug interactions. Overall, 82% of the studies concluded no interaction. Although population pharmacokinetic analysis can be a useful tool in studying drug-drug interactions, only 21% of the submissions used this approach. In summary, this assessment reveals that the quantity and quality of drug-drug interaction studies in NDAs have improved over the years. These improvements, as well as others that can be implemented, should result in more informative labeling and better patient care. FDA guidance for industry dealing with the design, analysis, and labeling language of in vivo metabolic drug-drug interactions has been developed to assist sponsors and FDA reviewers with these issues.

Development of in vivo bioequivalence methodology for dermatologic corticosteroids based on pharmacodynamic modeling

BACKGROUND

Dermatologic corticosteroid products produce skin blanching that is related to clinical potency and dose. (For application of the vasoconstrictor assay to bioavailability and bioequivalence assessment, dose is defined in terms of duration of treatment exposure [dose duration], so the terms dose and dose duration have been used interchangeably). The vasoconstrictor assay is the method of choice to assess dermatologic corticosteroid products bioequivalence if dose-response is validated. This article examines dose-response validation to meet objectives of US Food and Drug Administration (FDA) bioequivalence guidance for dermatologic corticosteroid products.

METHODS

An exploratory dose-response study was conducted to determine applicability of the empirical maximum effect (Emax) model to the individual subject and population dose-response relationships of six dermatologic corticosteroid product creams that varied from the most to the least potent classes. Products were applied to the skin of 10 healthy subjects in each of two dosing periods for dose durations of 0.5, 1, 2, and 6 hours. Skin blanching was measured by reflectance colorimeter through 24 hours after application. Area under the effect curve (AUEC) was determined for each dose duration. An Emax model was fitted to the AUEC versus dose duration data. A similar analysis was conducted for a bioequivalence study on two formulations of a dermatologic corticosteroid product in 40 healthy subjects.

RESULTS

In the exploratory study, the number of individual subject data sets for which the Emax model provided an acceptable fit generally increased with the potency of the dermatologic corticosteroid product. On the basis of population modeling, dose-response data of all products, except the lowest potency cream, were adequately described by the Emax model. Values for population ED50 (the dose duration required to achieve 50% of the fitted AUECmax value) decreased with increase in dermatologic corticosteroid product potency.

CONCLUSIONS

Acceptable model fits to all individual subject dose-response data were not achieved for any dermatologic corticosteroid product. However, population dose-responses were adequately described by the Emax model. On the basis of these data, the optimal dose duration used for comparison of multisource dermatologic corticosteroid products is recommended to be equal to the ED50 based on population modeling of pilot dose-response study data.

Practical skills and valued community outcomes: the next step in community-based education

OBJECTIVES

Community-based medical education (CBE) has clear value. However, there are aspects of CBE where improvement is possible. First, communities do not generally receive valued outcomes in exchange for participation in the CBE process. Secondly, students are usually not trained to influence health in the community using methods that are realistic in busy clinical practice.

DESIGN

A CBE rotation was designed to address these problems. Rotation activities were structured to facilitate development of a health programme desired by the community while giving students practical skills for later use. Working with community residents and health staff, sequential groups of students carried out, in turn, problem analysis, resource identification, planning and implementation activities aimed at establishing a community tuberculosis (TB) control programme.

SETTING

The University of Natal in Durban, South Africa.

SUBJECTS

Final-year medical students.

RESULTS

At the end of the academic year, the TB control programme was approximately 60% in place, and 90% of TB patients cared for by the students were completing treatment. Overall, students rated the experience good for learning about health care in community settings and about methods for community health programme development. Student ratings were significantly higher for those groups whose activities brought them into greater contact with community residents. The 'real-time' nature of planning the sequential student groups' work created logistical problems and, as an isolated activity, the rotation had little impact on student attitudes toward community-based careers.

CONCLUSIONS

Expanding the goals for CBE is both feasible and important. Further work should focus on refining designs for this next step in CBE.

Removal of a thrombus from the sigmoid and transverse sinuses with a rheolytic thrombectomy catheter

A rheolytic thrombectomy catheter was used to remove thrombus without thrombolytics from the sigmoid and transverse sinuses of a 34-year-old woman. Using small, high-flow fluid jets and Venturi-effect suction, this catheter allowed mechanical removal of thrombus. This technique may obviate the need for thrombolytic agents and the risks associated with their use.

Evaluation of the test system used for in vitro release of drugs for topical dermatological drug products

The purpose of this research was to evaluate different parameters that can influence in vitro drug release from topical dermatological drug products such as creams, gels, and ointments. In vitro release from topical dermatological drug products was carried out by using a static diffusion cell, a synthetic membrane, and an appropriate receptor medium. The receptor medium was mixed by means of a magnetic bar rotated at 400 rpm. Experiments were designed to evaluate the influence of (i) receptor media, (ii) different lots of synthetic membranes, and (iii) agitation on drug release. Release experiments were also carried out to study inter- and intralot variability. The in vitro release test was used to evaluate the marketed glucocorticoid products. Among the parameters studied, the receptor medium was found to be the most important and critical variable that influenced drug release. The release rate ranged between 0.61 and 2.68 micrograms/cm2/min0.5 for betamethasone dipropionate, depending on the percentage of ethanol in the receptor medium. The drug release was not influenced by agitation or by different lots of synthetic membranes. Very small inter- and intralot variability was observed. These experiments establish the ruggedness of the in vitro diffusion cell test system used for the drug release measurements.

The structure of a tunicate C-type lectin from Polyandrocarpa misakiensis complexed with D -galactose

C-type lectins are calcium-dependent carbohydrate-recognising proteins. Isothermal titration calorimetry of the C-type Polyandrocarpa lectin (TC14) from the tunicate Polyandrocarpa misakiensis revealed the presence of a single calcium atom per monomer with a dissociation constant of 2.6 microM, and confirmed the specificity of TC14 for D -galactose and related monosaccharides. We have determined the 2.2 A X-ray crystal structure of Polyandrocarpa lectin complexed with D -galactose. Analytical ultracentrifugation revealed that TC14 behaves as a dimer in solution. This is reflected by the presence of two molecules in the asymmetric unit with the dimeric interface formed by antiparallel pairing of the two N-terminal beta-strands and hydrophobic interactions. TC14 adopts a typical C-type lectin fold with differences in structure from other C-type lectins mainly in the diverse loop regions and in the second alpha-helix, which is involved in the formation of the dimeric interface. The D -galactose is bound through coordination of the 3 and 4-hydroxyl oxygen atoms with a bound calcium atom. Additional hydrogen bonds are formed directly between serine, aspartate and glutamate side-chains of the protein and the sugar 3 and 4-hydroxyl groups. Comparison of the galactose binding by TC14 with the mannose binding by rat mannose-binding protein reveals how monosaccharide specificity is achieved in this lectin. A tryptophan side-chain close to the binding site and the distribution of hydrogen-bond acceptors and donors around the 3 and 4-hydroxyl groups of the sugar are essential determinants of specificity. These elements are, however, arranged in a very different way than in an engineered galactose-specific mutant of MBPA. Possible biological functions can more easily be understood from the fact that TC14 is a dimer under physiological conditions.

Practical tools for qualitative community-oriented primary care community assessment

BACKGROUND AND OBJECTIVES

The evolution of managed care is creating a need for feasible methods for clinical practices to perform community assessments. Since some types of clinically useful data are best obtained through a qualitative community assessment, practical methods of carrying out this type of assessment are needed. Such practical methods are also important for community-oriented primary care, an attractive model for the marriage of population perspectives and clinical primary care.

METHODS

Using methods suitable for busy clinical practices, qualitative data useful for clinical purposes were collected either by mail surveys, telephone surveys, or during focus group discussions in a low-income community. Characteristics of data obtained through each method, together with the costs, advantages, and disadvantages of each approach, were examined.

RESULTS

All three methods revealed similar themes in their responses, though the range and emotional content of the responses varied by approach. Clinically useful data were obtained, although the potential for sampling and response biases must be considered. Costs, primarily related to professional time, varied by as much as 50% among the methods examined; telephone surveys were the least expensive per enrolled subject.

CONCLUSIONS

The methods tested are potentially feasible in busy practices. However, practices should clarify their objectives and resources prior to using these methods.

Acute spontaneous spinal epidural hematomas

BACKGROUND AND PURPOSE

Although previous reports have characterized MR imaging features of spinal epidural hematomas (EDH), few cases have been reported during the acute or hyperacute phase within the first 48 hours. Our goal in this investigation was to correlate the MR imaging features of acute (< or =48 hours) spontaneous EDH with clinical management and outcome.

METHODS

Eight patients with acute spontaneous EDH (five men and three women; age range, 31-81 years) underwent MR imaging at 1.5 T (T1-weighted, n = 8; T1-weighted after the administration of 0.1 mmol/kg contrast material, n = 6; T2-weighted, n = 8; and T2-weighted, n = 4). The interval from symptom onset to hospital admission ranged from immediate to 5 days. Two neuroradiologists reviewed the MR images for signal characteristics, contrast enhancement, and cord compression. Treatment and clinical outcome were correlated with the imaging findings.

RESULTS

The EDH were located in the cervical (n = 3), cervicothoracic (n = 2), thoracolumbar (n = 2), and lumbar (n = 1) regions. On T1-weighted images, the signal intensity of the EDH was isointense to spinal cord in five cases, hyperintense in two cases, and hypointense in one case and did not correlate with time to imaging. Isointensity on T1-weighted images persisted for 5 days in one case. On T2-weighted images, all EDHs were hyperintense with focal, heterogeneous hypointensity. Cord compression was severe in six patients, moderate in one patient, and minimal in one patient. Four cases were treated conservatively with complete resolution or improvement of symptoms within 1 to 3 weeks.

CONCLUSION

MR imaging findings were useful in establishing the diagnosis of EDH but did not influence management or predict outcome in this series. Heterogeneous hyperintensity to cord with focal hypointensity on T2-weighted images should suggest the diagnosis of acute spinal EDH. Severity of neurologic impairment had the greatest impact on management and outcome. Nonoperative treatment may be successful in cases with minimal neurologic deficits, despite cord compression revealed by MR imaging.

MR imaging of intraventricular silicone: case report

A 42-year-old man with human immunodeficiency viral infection developed cytomegaloviral retinitis that was complicated by retinal detachment and was treated with an intravitreous injection of silicone. Fifteen months later, magnetic resonance imaging revealed intraocular and intraventricular silicone. Signal intensity characteristics and chemical shifts of silicone in the two locations were identical.