All of you must
be quite aware that the incidence of cervical spondylosis is highest
in the third and fourth decades of life (as compared to lumbar spondylosis
which occurs in older people). The diagnosis in such patients should
be made by neck pain, which radiates along the root to the arm, depending
on which root is pressed.
However, here I am discussing neck pains, which are approximately
of less than ten days duration and are often due to bad posture of
neck during sleep or a bad pillow. Such pains often respond to hot
or cold compresses to the neck application of some liniment or ointment
at night to the neck, or change of pillow. Sometimes, one can advise
a cervical collar. There is no sense in continuing to prescribe painkillers
in all the above cases.
DIAGNOSIS
OF STROKE ON NEUROIMAGING
‘Scan all immediately’ strategy improves outcomes
and reduces costs.
In an NHS health technology assessment study, on average each
hospital admission for stroke cost about 11,000 ($19 800; €
16,000). A few patients per day per hospital quickly accumulate
high costs. A computed tomography scan costs between £
44 and £ 130. The imaging strategy for computed tomography
producing the highest number of quality adjusted life years
at the lowest cost was ‘scan all immediately’. Even
a marginal shift from dependent to independent survival after
stroke through correct early diagnosis with computed tomography
and appropriate treatment (aspirin for most patients with ischaemic
stroke and its avoidance in intracerebral haemorrhage) is the
most cost effective strategy, despite the marginal benefits
of treatment.
JM Wardlaw, AJ Farrall, BMJ, 2004; 328 : 655-56. |
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital,
Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital,
Mumbai 400 008.
