bluuebunny/crossref_metadata_2025 huggingface dataset:
Ovarian failure following abdominal irradiation in childhood: the radiosensitivity of the human oocyte
Authors: Wallace W. H. B. , Shalet S. M. , Hendry J. H. , Morris-Jones P. H. , Gattamaneni H. R.
Published: July 2009

Ovarian function has been studied sequentially since 1975 in 19 patients treated in childhood for an intra-abdominal tumour with surgery and whole abdominal radiotherapy (total dose 30 Gy). Eleven patients received chemotherapeutic agents that are not known to cause gonadal dysfunction. All but one patient have developed ovarian failure with persistently elevated gonadotrophin levels (FSH and LH >32 IU/litre) and low serum oestradiol values (<40 pmol/litre) before the age of 16 years. The majority (n = 12) did not progress beyond breast stage I without sex steroid replacement therapy. As the number of oocytes within the ovary declines exponentially by atresia from approximately 2 000 000 at birth to approximately 2000 at the menopause, we have been able to estimate that the LD50 for the human oocyte does not exceed 4 Gy.
Ultrasound-guided chemical parathyroidectomy in patients with primary hyperparathyroidism: a prospective study
Authors: Karstrup Steen , Transbøl Ib , Holm Hans Henrik , Glenthøj Anders , Hegedüs Laszlo
Published: July 2009

Twenty of 31 consecutive ultrasound examined patients with primary hyperparathyroidism were selected for treatment with ultrasound-guided percutaneous injection of ethanol (96%) into biopsy-verified solitary parathyroid tumours following a strict protocol with regard to dose, number of treatments and a minimum of 6 months follow-up. Of 18 patients completing the above protocol, a biochemical improvement was observed in 12, of whom eight became normocalcaemic during the follow-up period of 6 months after the last treatment. An obvious clinical improvement was seen in eight of the patients. In four patients, a unilateral vocal cord paralysis was observed, but was permanent in only one patient. Progressive fibrosis of the parathyroid tumours following injections impeded the intraglandular dissemination of ethanol. Another problem noted was the inability of ultrasound to detect multiglandular involvement. We find ultrasound-guided chemical parathyroidectomy an attractive alternative to surgery in patients who are not well suited for surgical intervention. However, the technique has not been fully developed, and in the present study, possible improvements are indicated.
Gadolinium-enhanced magnetic resonance imaging of spinal tumours
Authors: Rothwell C. I. , Jaspan T. , Worthington B. S. , Holland I. M.
Published: July 2009

The use of gadolinium diethylenetriamine-penta-acetic acid (Gd-DTPA) (Magnevist) enhanced magnetic resonance imaging (0.15 T) in the assessment of spinal tumours is described. Thirty-five patients were entered into the study and a total of 39 examinations were performed. The information obtained from unenhanced T  1 and T  2-weighted spin–echo sequences was compared with the Gd-DTPA-enhanced T  1 images. Thirty patients had intradural lesions and five had extradural lesions. A variable pattern of enhancement of intramedullary tumours was found, which in part reflected differences in the cystic component of the lesions. Extramedullary intra- and extradural lesions generally showed marked enhancement. The greatest contribution to management decisions was in the evaluation of intramedullary tumours where the use of contrast enhancement facilitated the precise localization of active tumour, differentiation of cystic and solid components of tumour, separation of tumour from peritumoral oedema and, in cases of suspected recurrence, aided distinction between tumour and both post-operative scarring and radiation damage.
A localized hypersensitivity reaction to co-trimoxazole in a pre-irradiated field simulating a recall phenomenon
Authors: Atahan I. Lale , Akyol Fadíl H. , Gürkaynak Murat , Alanyali Hilmi F. , Özyar Enis
Published: July 2009

Recall of latent radiation reactions following subsequent administration of cytotoxic agents is a well recognized phenomenon mainly reported with actinomycin-D and adriamycin (D'Angio et al, 1959; Donaldson et al, 1974; Burdon et al, 1978). To our knowledge, similar reactions with non-cytotoxic antibiotics have not been reported. We present a case of a delayed localized hypersensitivity reaction to cotrimoxazole similar in nature to a recall phenomenon, 3 years following radiotherapy.
Randomized trial of laser-assisted passage through occluded femoro-popliteal arteries
Authors: Jeans W. D. , Murphy P. , Hughes A. O. , Horrocks M. , Baird R. N.
Published: July 2009

A randomized trial was carried out in patients with occlusions of the femoro-popliteal artery to compare the passage of metal-tipped optical fibres with guide wires and catheters through the occlusions, prior to balloon angioplasty. The study was in a provincial English teaching hospital providing a vascular service for the area. Fifty patients were entered; 25 into the “laser” group and 25 into the “control” group. End points were (a) the success in passage through the occlusion and (b) the outcome 1 month after passage. Comparison of the groups showed no appreciable difference between the two methods with regard to age, sex, symptoms, incidence of diabetes, or previous myocardial infarctions. Successful passage through the occlusion followed by dilatation was achieved in 18 (72%) patients in the laser group and 20 (80%) in the control group. After 1 month, 13 (52%) arteries in the laser group were patent compared to 13 (57%) in the control group. Confidence limits for the difference in success of passage are − 15% to + 31%, and −24% to + 33% for patency after 1 month. Since these limits include zero, it is unlikely that a longer trial would alter the difference between the two methods. The results suggest that the laser system currently in use is no better than conventional methods.
Prognostic factors of nasopharyngeal carcinoma: a review of 759 patients
Authors: Sham Jonathan S. T. , Choy D.
Published: July 2009

The records of 759 Stage I to IV nasopharyngeal carcinoma patients seen between January 1976 and December 1983 were reviewed. There were 72 (9.5%), 162 (21.3%), 317 (41.8%) and 208 (27.4%) patients with Stage I, II, III and IV disease, respectively. Ho's stage classification was found to give a reliable prognosis. The actuarial survival at 5 and 10 years for Stage I, II, III and IV disease was 80.8%, 71.5%, 40.7%, 17.7% and 33.4%, 48.4%, 30.0%, 9.5%, respectively. The significant factors affecting survival were found using Cox multivariate analysis, N and T stages, the size and degree of fixation of neck nodes, sex, age, the presence of cranial nerve palsy and ear symptoms at presentation. Bilateral neck node involvement, histology subtypes of tumour, headache and nasal symptoms at presentation, the difference in radiation dose to the primary tumour and the neck, the initial haemoglobin and white blood count were not significant factors in the present study. The N stage was found to be prognostically significant even among patient groups stratified for the size and degree of fixation of the neck nodes involved. Women bad a better survival rate than men, and the survival of patients less than 40 years old was better than those who were older at 5 years, although by 10 years the survival for the two groups was comparable.
Corrigendum
Authors: Bentzen S M. , Thames H. D.
Published: July 2009

In the letter from T. Conere et al (An interesting radiation protection finding around a linear accelerator, BJR, 62, 1033) the sentence in the third paragraph, “For nominal beam result of the Thomas' trial does not conflict with the LQ model predictions.
Book reviews
Authors: Rees Michael R.
Published: July 2009

Although digital vascular imaging has been with us for several years, the cardiac applications of this technique have been limited by the need for high frame rates required for cine cardiac imaging. In the past only tape based systems such as the Siemens angiotron have been able to give subtracted images at 25 or 50 frames a second. These systems suffer from the disadvantage of limited post processing and analytical facilities. As newer systems become available there will be an increased interest in cardiac applications of digital imaging.

This book is a collection of papers by different authors with the aim as outlined in the introduction of “bringing together the work of many of the investigators throughout the world who initiated and continue to advance the field of cardiac digital angiography”. There are 19 chapters, and 24 contributing authors from 14 centres predominantly in the USA but with contributions from Switzerland, West Germany and Australia.
Book reviews
Authors: Lavender J. P.
Published: July 2009

In the current spate of medical publications, one approaches an “atlas” with a cynical feeling of paying heavily for a minor increase in real knowledge. This atlas, however, does represent a useful volume. Its success lies in the choice of subject matter involving selected, often lesser used, diagnostic tests, which are well described and illustrated. Each chapter briefly outlines the literature, the technique and clinical indications. The majority of these introductions are fairly substantial and well referenced reviews. This is followed by a series of illustrative cases. Subjects range from oesophageal transit studies to paediatric radionuclide lymphology. They are all, in the view of the editors, procedures that are dealt with inadequately in larger texts, but do not merit a book or a monograph of their own.
Galactocele of the breast: radiologic and ultrasonographic findings
Authors: Salvador Rafael , Salvador Manuel , Jimenez Jose A. , Martinez Manuel , Casas Lourdes
Published: July 2009

A galactocele is a benign lesion of the breast, denned as an encysted collection of milk products. It is usually found in young women during lactation, although it has also been described in girls and men (Vabderschueren- Lodeweycky et al, 1979). The quantity of milk is almost always limited, although an excess may sometimes lead to signs of pressure.

A case of a galactocele is reported, together with its radiological and ultrasound findings.
Cineradiography of a cracking joint
Authors: Watson Peter , Mollan Raymond A. B.
Published: July 2009

Human synovial joints are superb bearings which operate on a mixture of boundary and fluid-film lubrication mechanisms. The fluid in the joint, though present in very small amounts, is subjected to a wide range of pressures, from highly positive during loading to negative during rest and parts of the walking cycle. Just as the pressure in the synovial fluid is raised when the joint faces move towards each other, the pressure is lowered as they move apart.

Cavitation is a well documented engineering phenomenon (Knapp et al, 1970) which describes the growth and collapse of gas or vapour bubbles in a liquid. Gaseous cavitation occurs where bubbles grow by gaseous diffusion, for example in carbonated drinks, and is usually harmless. Vapourous cavitation occurs where the local pressure in a liquid drops to its vapour pressure. Bubbles of vapour are then formed, often explosively. This form of cavitation can be extremely noisy and harmful because the vapour bubbles are unstable and collapse violently when a higher ambient pressure is encountered. Fluid machinery such as propellers, pumps and valves are highly susceptible to erosion from this mechanism.

The cracking sound produced by synovial joints has been the subject of scientific curiosity for many years. Roston and Wheeler-Haines (1947) were the first to make a study of the distracting loads needed to produce the sound from the metacarpophalangeal (MCP) joint. Mennel (1947) mentioned that the MCP joint frequently cracked during rigorous examination or therapeutic manipulation.
Book reviews
Authors: Britten A. J.
Published: July 2009

This publication collects together 45 conference papers, which attempt, in the words of the preface, to be “an update of the present status of radiographic chest imaging”. One-third of the papers address what may be considered as conventional technical topics in chest radiology, including a review of radiographic techniques and film–screen technology. The overwhelming emphasis and value of this work is, however, as an update on the emerging research and development work in improving image quality either by optimally modulating exposure of all regions of the chest or by capturing the image on a device with greater latitude than film, or by a combination of both approaches. This is plainly not, nor does it pretend to be, a book about chest imaging in its entirety, and although CT and MRI are briefly discussed there is no mention of nuclear medicine or positron emission tomography (PET).
Book reviews
Authors: Hall Christine M.
Published: July 2009

As expected of an atlas, the illustrations in this second edition of a Radiologic Atlas of Pulmonary Abnormalities in Children are excellent. The authors, all radiologists, present a valuable collection of radiographs unsurpassed by other texts.

Whilst the radiograph still provides the single most important examination of the chest, many other imaging modalities have been illustrated where appropriate. These include xerography, computed tomography, angiography, ultrasound, contrast studies including bronchography and some histology.
Nasopharyngeal carcinoma: pattern of skeletal metastases
Authors: Sham Jonathan S. T. , Cheung Y. K. , Chan F. L. , Choy D.
Published: July 2009

The records of 153 nasopharyngeal carcinoma patients with skeletal metastases were reviewed. The skeletal system was the most common site of distant metastases. The patients who developed skeletal metastases were significantly younger than those without skeletal metastases, although there was no difference between sexes. The pattern of skeletal involvement conforms to the general pattern, the spine and pelvis being the common sites. The first region of involvement was lumbar spine (28.4%), then dorsal spine (27.7%), sacrum and pelvis (16.3%), femur (9.9%), rib and sternum (7.8%), humerus (5.0%), cervical spine (3.5%) and skull vault (1.4%). Radiologically, the lesions were lytic in 66.0%, mixed lytic and sclerotic in 12.8% and sclerotic in 21.2%. The time to development of symptomatic skeletal metastases of mixed or sclerotic nature was significantly longer than lytic lesions, and patients with mixed or sclerotic metastases also had better survival.
Radiotherapy of Morbus Gorham—Stout: the biological value of low irradiation dose
Authors: Handl-Zeller L. , Hohenberg G.
Published: July 2009

Morbus Gorham–Stout is a very rare disease. A patient with this disease was treated at the University Clinic of Radiobiology in Vienna. The clinical and radiological findings place special emphasis on the radiotherapeutic treatment, and the biological basis of the recommended dose is discussed.
Ultrasound evaluation of ectopic pregnancy including correlation with human chorionic gonadotrophin levels
Authors: Chambers S. E. , Muir B. B. , Haddad N. G.
Published: July 2009

A total of 267 patients referred for ultrasound examination because of clinical suspicion of ectopic pregnancy were studied prospectively. The outcome was correlated with the ultrasound findings and human chorionic gonadotrophin levels using a quantitative serum assay. The value of the following in the diagnosis of ectopic pregnancy are assessed: ultrasound criteria for early diagnosis of intrauterine pregnancy before visualization of a viable fetus, the discriminatory zone of hCG and extrauterine abnormalities.
The range of bone density in normal British women
Authors: Hall M. L. , Heavens J. , Cullum I. D. , Ell P. J.
Published: July 2009

A study to determine the range of bone density in British females was carried out on a group of 165 normal women. The results showed an increase in mineral content with peak values occurring in the fourth decade (mean 1.06 g/cm2; 95% confidence limits 0.783–1.343) and subsequent decline with increasing age. There was no significant effect from any risk factor but strict exclusion criteria were applied. The results from each age group were compared with those from the USA and showed a difference in the timing of peak bone density (third decade for the USA). Age-matched, clinically well-defined normal controls should be used for comparison with groups of patients in future studies.
The use of small fraction numbers in high dose-rate gynaecological afterloading: some radiobiological considerations
Authors: Dale R. G.
Published: July 2009

Using commonly assumed α/β ratios for tumours and late-reacting tissues, the linear-quadratic (LQ) model has been used to compare low dose-rate (LDR) gynaecological treatment with high dose-rate (HDR) techniques given in small fraction numbers. Even in the absence of relatively favourable tissue recovery constants (μ values) it is shown that, provided a modest extra amount of geometrical sparing of critical tissues is available (by means of spacing or shielding), HDR treatment in a small number of fractions may be used in place of an LDR regime without loss of therapeutic ratio. This general result, although not universally true, does indicate that HDR treatment delivered in a small number of fractions may be more feasible than is sometimes thought. These findings do not contradict currently accepted radiobiological philosophy, which cautions against the use of small numbers of high-dose fractions. Primarily they serve to emphasize the importance of the recommendations of the ICRU (1985), which stress the need to consider the complete time–dose pattern of radiation delivery to all the critical tissues in an intracavitary treatment.
Congenital biliary dilatation: a spectrum of disease detailed by ultrasound
Authors: Young William , Blane Caroline , White Susan J. , Polley Theodore Z.
Published: July 2009

Recently we have examined six children with the diagnosis of choledochal cyst who demonstrate a greater spectrum of biliary involvement than expected. Classically choledochal cysts have been divided into types and subtypes based on the configuration of common bile duct dilatation; however, this simplified information is misleading since surgical management is dependent on the exact extent of intrahepatic and extrahepatic biliary abnormalities. The pre-operative ultrasound examination must be meticulous to provide enough pertinent anatomic details. Much of the intrahepatic anatomy is not visualized at surgery nor on the operative cholangiograms where reflux of contrast into the intrahepatic ducts may not be consistently achieved.
The effect of Captopril on benign and malignant reactions in irradiated rat skin
Authors: Ward W. F. , Molteni A. , Ts'ao C. , Hinz J. M.
Published: July 2009

The effect of the angiotensin converting enzyme inhibitor Captopril on the severity of radiation-induced epilation and moist desquamation and the incidence of skin tumours was determined for up to 52 weeks in male rats. The irradiation consisted of a range of single doses (0, 10, 20, 30 Gy) of 60Co gamma rays to a 3.5 cm2 right hemithorax port. Half of each radiation dose group consumed control powdered chow, and half consumed chow containing Captopril (50 mg/kg/day) continuously after irradiation. There were time- and radiation-dose-dependent increases in all three skin reactions. Rats exposed to 10 Gy exhibited a mild and transient epilation, but no moist desquamation or neoplasia in the radiation port. In animals exposed to 30 Gy, however, epilation began at 2 weeks after irradiation, reached a peak at approximately 7 weeks, then persisted essentially unchanged through 52 weeks. Captopril had no significant effect on the epilation reaction. Two waves of moist desquamation were observed after 30 Gy. The first appeared at 3 weeks after irradiation, reached a peak from 6−10 weeks, then subsided partially but significantly from 12−26 weeks. The second wave of moist desquamation began at 26−28 weeks, often was ulcerative, and occasionally was accompanied by the appearance of tumours in the irradiated volume. Captopril significantly (p <0.05) reduced the severity of both phases of the moist desquamation reaction after 30 Gy, and reduced the percentage of animals exhibiting the most severe desquamation score (involving 50% of the radiation port). Of particular interest was the observation that Captopril also reduced the incidence of tumours. Of the 14 tumours detected, all were malignant (fibrosarcomas, squamous cell carcinomas), and only three (p <0.05) occurred in rats receiving Captopril. Multiple tumours (three cases), tumours induced by 20 Gy (three cases), and tumours appearing before 6 months (one case) were observed only in rats consuming control diet, never in Captopriltreated animals. Animals which developed tumours in the second 6 months post-irradiation exhibited significantly more severe moist desquamation during the first 6 months than did the tumour-free members of their treatment group. Thus Captopril, known to ameliorate acute lung damage in irradiated rats, also reduces chronic benign and malignant skin reactions in the radiation treatment field.
Raynaud's disease in childhood with radiological features
Authors: Shono T. , Okadome K. , Naritomi G. , Suita S.
Published: July 2009

There have been many descriptions of Raynaud's phenomenon in adults (Allen & Brown, 1932; Gifford & Hines, 1957), but Raynaud's phenomenon has been only rarely reported in childhood, and Raynaud's disease itself is even more rare (Guntheroth et al, 1967; Burns et al, 1985). We describe here a 5-year-old boy with Raynaud's disease who had a 4-month history of pain, coldness and pallor of fingers in both hands on exposure to coldness. His right trans-femoral axillary arteriogram showed distal vascular abnormalities which were considerable owing to the peripheral arterial spasm. He had neither clinical haematological and serological evidence of collagen disease nor any other systemic disease, and has been successfully treated with oral prostaglandin El analogue (limaprost).

A 5-year-old boy noticed the first signs of Raynaud's phenomenon after developing paleness, coldness and pain in the fingers of both hands about 4 months before admission to our hospital. The symptoms occurred on exposure to coldness and were relieved by warming. An epidermal ulceration was also found on the tip of his right middle finger (Fig. 1).
Book reviews
Authors: Maher E. J.
Published: July 2009

This is a book published by the Chairman of the Head and Neck Committee of the Radiation Therapy Oncology Group (RTOG) covering the management of cancer of the head and neck, with specific emphasis on the use of radiotherapy. In the preface the editor expresses the hope that the book provides a comprehensive review, suitable both for practising radiation oncologists and the resident in training.
Book reviews
Authors: Walker Anne
Published: July 2009

This report is one of a series of three addressing the problems of determining dose-equivalents resulting from exposure to sources external to the body. The first part (Report 39) introduced new quantities to be employed in radiological protection monitoring of both the environment and the individual, namely ambient dose-equivalent (H*(d)), directional dose-equivalent (H′(d)) and individual dose-equivalent penetrating (H(d)) and superficial (H(d)).
Book reviews
Authors: Duck F. A.
Published: July 2009

Over 8 years ago, Dr Meire wrote a valuable review of the first edition of this book (BJR, 54, 275), and much of what he said then remains entirely relevant for this third edition. As a basic ultrasound physics text, including many exercises to test the reader's understanding, it is a valuable introduction for novices, or for the more experienced user who may have difficulty understanding the technical basics.
Radiological features of extraskeletal Ewing sarcoma
Authors: O'Keeffe Francis , Lorigan James G. , Wallace Sidney
Published: July 2009

The radiological features of extraskeletal Ewing sarcoma were reviewed in 22 patients whose average age was 22 years. Tumours were located in the extremities (11 patients), abdomen or pelvis (six patients) and the chest (five patients). The tumours ranged in size from 2 cm to 20 cm, were mainly well circumscribed and showed no evidence of calcification prior to treatment. Most tumours (13 out of 14) were of low attenuation or contained areas of lower attenuation than muscle on computed tomographic examination, and in six out of seven patients studied by ultrasound the tumours were hypoechoic or partly anechoic. No distinctive post-contrast medium enhancement pattern on CT examination (11 patients) or angiographic features (three patients) were evident. Tumour haemorrhage was a frequent microscopic finding and changes consistent with this were present in one patient on magnetic resonance imaging examination. Distant metastases or local recurrence developed in 13 patients with lung being the most frequent metastatic site (eight patients). Although its radiological features are non-specific, extraskeletal Ewing sarcoma should be included in the differential diagnosis of noncalcified soft-tissue tumours especially in a young age group and where located in an extremity or paravertebral region of the chest.
Further studies on selective radioprotection by organic zinc salts and synergism of zinc aspartate with WR 2721
Authors: Floersheim G. L. , Bieri A.
Published: July 2009

The organic zinc salts zinc aspartate, zinc histidine, zinc orotate and zinc acetate reduced the fall of the haematocrit, thrombocytes, erythrocytes and leucocytes in irradiated mice. In general, zinc aspartate was more effective than the other organic zinc salts. Protection of the haematocrit and thrombocytes by small doses of the aminothiol radioprotector WR2721 was markedly improved by the concomitant administration of small doses of zinc aspartate. Zinc aspartate was the only one of the four tested organic zinc salts that did not inhibit in any instance the regression induced by radiotherapy of human tumours grown as xenografts in immunosuppressed mice. This also applied to the combination of zinc aspartate with WR2721. In an experiment performed to determine the toxicity of the combined regimen, a dose of zinc aspartate which afforded synergistic haematological protection did not enhance the toxicity of WR2721. The synergism of zinc aspartate with WR2721 and the differential radioprotection of the combined protocol may make it possible in clinical cancer radiotherapy to obtain selective radioprotection at a lower toxicity giving an improved therapeutic ratio compared with WR2721 alone.
Pelvic haematoma following orchidectomy: a pitfall in the staging of non-seminomatous germ cell tumour
Authors: Russell S. A. , Johnson R. J. , Russell J. M.
Published: July 2009

Treatment of non-seminomatous germ cell tumour (NSGCT) is critically dependent on the stage of disease at presentation. Staging is by clinical examination, estimation of tumour markers (serum human chorionic gonadotrophin, HCG, and alpha-fetoprotein, AFP) and imaging; the latter comprising chest radiography and thoraco-abdominal computed tomographic (CT) scan.

Three cases are presented whose staging CT scan showed abnormality confined to the external and common iliac region ipsilateral to orchidectomy, subsequently diagnosed as resulting from a post-operative haematoma. The importance in considering this differential diagnosis and its effect on treatment are stressed.
Book reviews
Authors: Jones Colin H.
Published: July 2009

This short book is the result of an international workshop, organized jointly by the Institute of Radiation Hygiene and the World Health Organization, held in the Federal Republic of Germany in December 1984. It defines quality assurance in radiotherapy as “all those procedures that ensure consistency of the medical prescription and the safe fulfilment of that prescription as regards dose to the target volume, together with minimal dose to normal tissue, minimal exposure of personnel, and adequate patient monitoring aimed at determining the end result of treatment.”
Radiological anatomy of the kidney revisited
Authors: Palma L. Dalla , Bazzocchi M. , Cressa C. , Tommasini G.
Published: July 2009

In recent years some structures or features such as the “inter-renuncular septum”, the “echogenic triangle” and the “echogenic line” have been described to support the concept of a kidney resulting from the fusion of two masses or renunculi. To clarify this concept and to understand the meaning of the above echographic features better, the authors have examined prospectively by sonography the kidneys of 50 children, 200 adults with a single collecting system, 25 adults with a duplicated collecting system and 32 cadavers. Furthermore, to help explain the sonographic features, we have examined 32 cadaver kidneys with sonography and 10 cadaver kidneys with magnetic resonance imaging (MRI). The sonographic, MRI and anatomical correlations have shown that the “echogenic triangle” and the “echogenic line” are not renuncular residuals, but simply an extension of the hilar fat visible when the renal sinus is rather deep. The intermediate cortical mass is not a septum dividing the kidney into an upper and lower renunculus, but a column of parenchymal tissue crossing the renal sinus, which, from an anatomical point of view, is an accessory renal lobe. The presence of two renunculi, suggested in a previous study with cortical nephrotomography, has not been confirmed.
Book reviews
Authors: Harland S. J.
Published: July 2009

Intravesical instillation of BCG, first described in 1976, has now attained widespread usage in the treatment of superficial transitional cell carcinoma of bladder. Its impact has been greatest in high grade disease, notably carcinoma in situ where until recently a prophylactic cystoprostatectomy was routinely carried out because of the high risk of progression to incurable disease. The 381 pages of this book attest to the enthusiasm for intravesical BCG but also to the fact that this is the book of a meeting — held in fact in September 1988. British urologists have only recently taken up this type of treatment and will find this volume most useful, bringing together most of those who have published on the subject.
Stereotactic multiple arc radiotherapy
Authors: Thomson E. S. , Gill S. S. , Doughty D.
Published: July 2009

A radiotherapy technique is presented for delivering a concentrated pattern of absorbed dose to intracranial lesions. Treatment takes place on a conventional, isocentrically mounted linear accelerator, rotated in several planes around a single target site. A new, relocatable sterotactic frame is used which enables fractionated radiotherapy to be administered if required. Calculations of the absorbed dose distribution in three orthogonal planes are performed using specially prepared software on a computer used for standard treatment planning. In this way, the need for excessive computing power is avoided.
Quantitative γ-ray computed tomography of the radius in normal subjects and osteoporotic patients
Authors: Smith D. A. S. , Hosie C. J. , Deacon A. D. , Hamblen D. L.
Published: July 2009

A new design of γ-ray computed tomography (CT) scanner was used to measure bone density in 516 normal adults and in 116 female patients with osteoporotic fractures. Trabecular bone density (TBD) was measured for a core of the ultradistal radius; cortical bone mass per unit length (MLS) and mass per unit volume (MVS) were computed for the radius shaft. TBD, MLS and MVS peaked at the age of about 40 in females and fell by 32%, 15% and 24%, respectively, by the age of 65. In males, TBD decreased from the third decade and MLS and MVS peaked in the fourth decade. The corresponding falls by 65 years were 20%,6% and 7%. In patients with Colles' fracture TBD and MLS were reduced by 13% and 10%, respectively, relative to age matched normal female subjects. For patients with vertebral crush fracture the reductions relative to age matched normal females were 36%, 17% and 16% for TBD, MLS and MVS. In fracture patients the deficit in TBD was significantly greater than that for cortical bone but TBD was no better at discriminating normal and osteoporotic individuals because of its larger normal range. We conclude that γray CT may best be used for monitoring changes in bone rather than as a diagnostic screening tool.
Sedation in children scanned with high-field magnetic resonance; the experience at The Hospital for Sick Children, Great Ormond Street
Authors: Shepherd J. K. , Hall-Craggs M. A. , Finn J. P. , Bingham R. M.
Published: July 2009

Patient movement is the most common cause of image degradation when performing magnetic resonance scans in children. This is a particular problem scanning at high field, as noise levels of up to 90 dB may be reached. Movement can be reduced by adequate sedation. We present the results of two sedation protocols when scanning with a 1.5T Magnetom scanner. Optimal scan quality can be achieved in up to 85% of scans using Pethco combined with triclofos in children aged 1 month–2 years, and trimeprazine combined with papaveretum in children over 2 years. When heavy sedation is used, patient selection must be cautious, and there is a minimum acceptable level of monitoring including close physical observation, electrocardiographic and apnoea monitoring.
Progressive systemic sclerosis (diffuse scleroderma) and radiotherapy
Authors: Cooper Stephen G. , Denham James W.
Published: July 2009

The rheumatological manifestations of cancer are many and varied. Progressive systemic sclerosis has been reported both as an initial manifestation of malignancy (Caldwell & McCallum, 1986) and, of course, as coexisting with malignant disease. Surprisingly, only one case report is to be found in the literature reporting on the interaction between radiotherapy and scleroderma (Ransom & Cameron, 1987), the consequences of which may carry significant morbidity.

Our patient was 49 years old in May 1987 when referred for the management of a mass in the right neck. This right cervical node measured 6 × 5 cm, was fungating through the skin, with biopsy confirming metastatic squamous cell carcinoma. No primary site was identified either on direct ear, nose and throat examination or with computed tomography.
Unusual presentation of non-Hodgkin's lymphoma of the small bowel
Authors: Nicholson D. A.
Published: July 2009

Small bowel non-Hodgkins lymphoma (NHL) usually present with abdominal pain (72%), vomiting and diarrhoea (28%); however, gastrointestinal (GI) bleeding is an uncommon mode of presentation (4%) (Makepeace et al, 1987). A case is presented where a patient with coexisting small bowel NHL and an abdominal aortic aneurysm presented with clinical symptoms suggestive of an aortoenteric fistula.

The mode of presentation for NHL is unusual, with computed tomography (CT) playing a significant role in the diagnosis and management.

A 75-year-old man presented with a 1-month history of intermittent episodes of non-colicky upper abdominal pain, mild weight loss, malaise, and black stools. Past medical history was unremarkable.

On examination he was anaemic with a pulsatile abdominal mass. Investigation revealed a haemoglobin of 4.9 g/dl, with normal urea, electrolytes, liver function tests and white count. Severe melaena with positive occult bloods was confirmed.

An abdominal ultrasound scan showed the presence of an 8 cm abdominal aortic aneurysm, with no evidence of leakage. Initially the patient was transfused with 6 units of blood. An urgent fibre-optic gastroscopy revealed no gastric or proximal duodenal abnormality. A presumptive diagnosis of aortoenteric fistula was made, on the clinical triad of upper GI bleeding, abdominal pain and abdominal aortic aneurysm (Ferguson & Arden, 1966).
Book reviews
Authors: Pilling D. W.
Published: July 2009

This volume (number 24 in the Clinics In Diagnostic Ultrasound series) brings together a distinguished group of specialists in paediatric ultrasound from America and Canada. In 10 chapters, all the important facets of neonatal and paediatric ultrasound are covered with particular emphasis on cranial sonography, but this is adequately balanced by sections on the abdomen, hip and paediatric Doppler application.
Book reviews
Authors: Gleeson J. A.
Published: July 2009

This well produced, multi-authored book is essentially a question-and-answer aid to diagnosis. The stated aim is to enable clinicians, particularly surgeons, to choose the most appropriate imaging modality to help solve a specific diagnostic problem.
Gallbladder wall thickening (congestive cholecystopathy) in chronic liver disease: a sign of portal hypertension
Authors: Saverymuttu S. H. , Grammatopoulos A. , Meanock C. I. , Maxwell J. D. , Joseph A. E. A.
Published: July 2009

A thickened gallbladder wall is often seen with ultrasound in alcoholic cirrhosis. Hypoalbuminaemia is thought to be the cause since there is a strong association between bowel wall thickening and low serum albumin. To determine the role of portal hypertension in producing gallbladder wall thickening we studied 40 consecutive stable patients—37 with cirrhosis and three with portal hypertension due to primary biliary cirrhosis. Ultrasound assessment of the gallbladder wall was made after an overnight fast using a Technicare autosector. Wall thickness 4 mm or greater was considered abnormal. Twenty-seven patients had a thickened gallbladder wall and all had evidence of portal hypertension. Hypoalbuminaemia was not an important factor since it was only present in six cases with thickened walls. In two cases reduction in portal pressure with oral propranolol was associated with a decrease in gallbladder wall thickness. These results suggest that portal hypertension, not hypoalbuminaemia, is the dominant factor causing gallbladder wall thickening in cirrhosis. Ultrasound demonstration of gallbladder wall thickening in chronic liver disease should suggest the presence of portal hypertension.
The prognostic significance of radiologically detected knee joint effusions in the absence of associated fracture
Authors: Maskell T. W. , Finlay D. B. L.
Published: July 2009

The significance of radiologically detected knee joint effusion as a marker of soft tissue injury following trauma is uncertain. In this study 100 patients presenting to the casualty department following acute injury, with effusions but no fracture, were assessed. Of those available for follow-up, 20% required further investigation and 11% proceeded to surgery for significant soft tissue injury. It is concluded that radiologically detected knee joint effusions are a useful marker for underlying soft tissue injury.
Book reviews
Authors: Baddeley H.
Published: July 2009

The choice of the most suitable radiological investigation, or sequence of investigations, to solve a particular clinical problem is often complex, particularly as more imaging modalities become available and as there is increasing emphasis on the efficient and effective use of radiology in clinical practice.
Determinations of organ doses and effective dose equivalents from computed tomographic examination
Authors: Nishizawa Kanae , Maruyama Takashi , Takayama Makoto , Okada Minoru , Hachiya Jun-ichi , Furuya Yoshiro
Published: July 2009

The organ or tissue doses were determined with a phantom measurement for 12 types of CT scanners widely used in Japan. Two types of thermoluminescent dosimeters were used for the dose determinations in a Rando woman phantom. The effective dose equivalents recommended by the International Commission on Radiological Protection were calculated using the measured organ or tissue doses. It was found that the CT scanners currently available give quite different organ or tissue doses. When selecting the optimum technical factors for scanning, therefore, it is important to take into consideration the balance of the image quality and the radiation exposure to patients.
Carcinoma of the breast: measurement and the management of treatment. I. The value of the data
Authors: Cheung C. W. D. , Johnson A. E.
Published: July 2009

This is the first of a series of papers in which we shall explore some insights into the biological changes which accompany the treatment of human tumours which may be obtained through estimation of volume changes in relation to treatment. We have adopted a working hypothesis that regression slopes reflect the composition of individual tumours and, indirectly, their intrinsic growth rate rather than the effectiveness of treatment. The breast has proved to be a suitable site for measurement and our interpretation of the results has led to the development of a new style of management for carcinoma of the breast: measurement based sequential therapy (MBST). In this paper the method of measurement and detailed statistical evaluation of the quality of the data from 262 patients (263 tumours) is presented. Exponential regression lines have been fitted to describe volume changes in relation to treatment by radiation, chemotherapy and hormones. A simple classification of steepness of slopes is introduced.
Selective uptake of toxic nucleoside (125IUdR) by resistant cancer
Authors: Bagshawe Kenneth D. , Sharma K. , Southall Peter J. , Boden Joan A. , Boxer Geoffrey M. , Patridge Terence A. , Antoniw Pari , Pedley Rosamond B.
Published: July 2009

We report uptake of a thymidine analogue 125-Iodine-5-iodo-2′-deoxyuridine (125IUdR) by nude mice bearing human xenografts of choriocarcinoma or colonic cancer. When 125IUdR was given alone, uptake by intestinal tissues was 5–10 times greater than by the tumours as measured by tissue γ counting. This ratio was reversed when hydroxyurea or cytosine arabinoside were used as inhibitors of ribonucleotide reductase and were given in combination with 5-fluorouracil or methotrexate to inhibit thymidine synthesis shortly before injecting 125IUdR. Counting the radioactivity in tissues removed 24 hours after 125IUdR gave tumour to highest normal tissue ratios of up to 15:1, but the corresponding nuclear grain counts, which is probably a more reliable indicator of selective uptake into DNA, were in excess of 100: 1. The addition of unlabelled IUdR to the regimen only reduced the uptake of l25IUdR when given in relatively large amounts. For this approach to be exploited it is concluded that the tumour must be resistant at the cell level to the inhibitor of DNA synthesis either de novo or as a result of prior exposure to it. This inhibitor can then be used to block uptake of the potentially toxic nucleoside analogue by normal renewal tissues while it is taken up by the resistant cancer cells. By inhibiting synthesis of the corresponding normal nucleosides with inhibitors to which the cancer cells are not resistant, incorporation of the toxic analogues into tumour DNA was enhanced. Although 125IUdR is a convenient agent for exploring this approach and is highly cytotoxic when incorporated in DNA, the clinical potential of reverse role chemotherapy probably lies with the development of toxic non-radioactive nucleoside analogues.
Tissue dose estimates following the selective uptake of 125IUdR and other radiolabelled thymidine precursors in resistant tumours
Authors: Humm J. L. , Bagshawe K. D. , Sharma S. K. , Boxer G.
Published: July 2009

For the purposes of evaluation of the therapeutic potential of the radiohalogenated thymidine analogue 125IUdR, estimation of the radiation dose to the tumour cells and normal tissues is important. To determine the dose to any tissue from the radionuclide 125I is not simple, since the major emissions are very short-range Auger electrons. The cytotoxicity of 125I is strongly dependent on the position of the decay relative to the DNA, the principal target for cell sterilization. Estimates of the cytotoxicity of 125I based on the traditional MIRD recommended formulation (ICRU Report 32, 1979) may produce gross underestimates if it is incorporated into the DNA via the thymidine precursor 125IUdR. In this work, tissue count and autoradiography (ARG) data from studies by Bagshawe et al were used to estimate tissue doses following the administration of 125IUdR to LS174/T (a colorectal carcinoma) and CC3 (a choriocarcinoma) tumour-bearing animals, after a hydroxyurea block of the normal tissue turnover. The tumour cell toxicity is estimated from ARG data on the degree of 125I incorporation into the cell nucleus. Major drawbacks with 125I for this type of therapy are the long 60-day half-life, leading to radiological and waste disposal problems and the extreme short range of the radiotoxic effects. Possible alternative radiohalogens, 123I, 77Br, 131I and 211At, are suggested in place of 125I in the thymidine analog iododeoxyuridine. Dose calculations are performed and cytotoxicities estimated on the assumption that their biological retention characteristics are the same as for 125IUdR.
Cranio-facial melorheostosis: case report and review of the literature
Authors: Williams J. W. , Monaghan D. , Barrington N. A.
Published: July 2009

Melorheostosis is a rare condition principally affecting the bones of the appendicular skeleton, producing characteristic radiographic features of flowing “candle wax” subperiosteal bone and streaky endosteal bone formation in the diaphysis and epiphysis, which may affect only one side of long bones within a limb. Radiographic appearances form the basis of the diagnosis, as clinical and histological findings are non-specific.

Our patient, an elderly woman, was admitted from the Casualty Department following a fall. Radiographs of her pelvis and left elbow were obtained (Figs 1 and 2) showing the typical longitudinal distribution of flowing subperiosteal and endosteal new bone. The left wrist and right elbow were similarly affected, but to a lesser extent. Skull radiographs showed (Fig. 3) bony obliteration of the left maxillary antrum without expansion of its outline, thought to be due to melorheostosis and similar in appearance to a previously described case. Thickening of the vault may be partially due to hyperostosis frontalis interna, but is asymmetrical, and melorheostosis was suspected in addition.

Examination revealed no skin changes, vascular abnormalities or joint deformity and the patient had experienced no pain in the affected areas.

Over 200 cases have now been reported. The classic pattern of subperiosteal bone deposition may be monostotic, polyostotic, monomelic or affect multiple limbs and the trunk (Morris et al, 1963). Extra-osseous bone deposition can occur.
Lymphangiohaemangioma of the mediastinum
Authors: Toye Rosemary , Armstrong Peter , Dacie Janet E.
Published: July 2009

Lymphangiohaemangiomas are rare congenital malformations, which on histological examination show both vascular and lymphatic elements. Clinically they tend to behave as lymphangiomas. Conservative management is usually recommended, with intervention only if vital structures are affected or if required for cosmetic reasons (Bruce Williams, 1981). Mediastinal lymphangiohaemangiomas are exceedingly rare and may require treatment because of their position.

A case of benign lymphangiohaemangioma of the mediastinum is presented. Unlike the only previously reported case of computed tomography (CT) in this condition (Angtuaco et al, 1983), our case showed neither near-water density nor contrast enhancement following intravenous contrast medium administration.

A girl of 2 years and 8 months was admitted to Queen Elizabeth Hospital, Hackney, with a discharging cervical tuberculous fistula. She was incidentally found to have a superior mediastinal mass. After treatment of her tuberculosis, at the age of 2 years and 10 months, an exploratory thoracotomy was performed at Great Ormond Street Hospital. The operative findings were of an irresectible tumour densely adherent to the pericardium and to the great vessels in both thoracic cavities. Histological specimens showed a complex vascular malformation predominantly of lymphangiomatous tissue but containing abnormal blood vessels, appearances consistent with a diagnosis of benign lymphangiohaemangioma. A subtotal resection was performed at the age of 3 years 4 months. The left phrenic nerve was noted to pass through part of the tumour and had to be resected.

At 4 years and 7 months the patient presented with a persistent cough.