Absent cervical spine pedicle and associated congenital spinal abnormalities - a diagnostic trap in a setting of acute trauma: case report

BACKGROUND: Congenital spinal abnormalities can easily be misdiagnosed on plain radiographs. Additional imaging is warranted in doubtful cases, especially in a setting of acute trauma. Case Presentation This patient presented at the emergency unit of our university hospital after a motor vehicle accident and was sent to our radiology department for imaging of the cervical spine. Initial clinical examination and plain radiographs of the cervical spine were performed but not conclusive. Additional CT of the neck helped establish the right diagnosis. CONCLUSION: CT as a three-dimensional imaging modality with the possibility of multiplanar reconstructions allows for the exact diagnosis and exclusion of acute traumatic lesions of the cervical spine, especially in cases of doubtful plain radiographs and when congenital spinal abnormalities like absent cervical spine pedicle with associated spina bifida may insinuate severe trauma

Simulated lifetime costs of three types of employer-based, periodic, breast cancer screening programs for working-age women.

PURPOSE: To estimate the lifetime cost of three types of employer-sponsored breast cancer screening programs and to identify factors influencing cost. DESIGN: A computerized decision analysis model was constructed to compare lifetime costs of providing breast cancer screening in each of three screening programs: on-site within an employer, mobile unit visiting the employer, and off-site. SUBJECTS: Three hypothetical cohorts of 10,000 female employees 38 years of age at time of first screening. INTERVENTION: A cohort was enrolled in each screening program and received screening from age 38 through age 64. Employees continued to receive benefits related to breast cancer until age 100 or death. MEASURES: Costs in the model included those for screening, workup for a suspicious mammogram, treatment for breast cancer, short-term losses in employee productivity, and disability due to breast cancer. APPROACH: The model was used to estimate the mean lifetime cost per employee, to the employer, of the On-Site program. This cost was compared to the cost of the other programs. RESULTS: Mean lifetime cost per employee was 5,485 for the On-Site screening program. This cost was significantly (P < .0001) lower than in the Off-Site program (by 311) or the Mobile program (by $212). The baseline results for the On-Site program were quite sensitive to the cost of screening, the sensitivity and specificity of screening, age at initiation of screening, and the underlying incidence of breast cancer in the population. CONCLUSION: Employers and other entities should consider these factors such as location and content in selecting the most efficient and effective breast cancer screening program