bluuebunny/crossref_metadata_2025 huggingface dataset:
Neoadjuvant intra-arterial chemotherapy in inflammatory carcinoma of the breast
Authors: Bilbao J. I. , Rebollo J. , Longo J. M. , Mansilla F. , Muñoz-Galindo L. , Vieitez J. M.
Published: July 2009

From 1982 to 1989, 18 eligible patients (median age 50.5 years, range 30–72 years) with inflammatory breast carcinoma have been treated with neoadjuvant intra-arterial (IA) chemotherapy. The treatment regimen includes IA cisplatin, adriamycin, mytomycin C and thiotepa on Day 1 and intravenous 5-fluorouracil on Days 1 and 2. An objective clinical response rate of 100% (eight complete and 10 partial) has been observed. The median disease-free and overall survivals are 27 months (range 5–85 + months) and 33 months (range 8–85 + months), respectively. With a median follow-up of 21.5 months, six (33.3%) patients remain alive and free of disease and 12 patients have died because of distant metastases. No local recurrences have been observed. Intra-arterial chemotherapy is an attractive technique for the treatment of locally advanced breast carcinoma with mild toxicity and high local control rate.
The potential of ytterbium 169 in brachytherapy: a brief physical and radiobiological assessment
Authors: Loft S. M. , Coles I. P. , Dale R. G.
Published: July 2009

Ytterbium 169 (half-life 32 days; mean gamma emission 93 keV, after excluding photons of energy < 10keV) is a radionuclide with interesting potential for brachytherapy applications. Although not yet commercially available, its possible application as a clinical radionuclide is currently being considered by Amersham International. This article presents an assessment of some properties of the nuclide that may be clinically relevant. Use is made of some new ideas that allow quantification of the likely dose homogeneity that can be obtained in a brachytherapy distribution, and in this context ytterbium 169 is shown to be superior to some currently available brachytherapy nuclides. The assessment also uses recent extensions to the linear-quadratic model to consider the likely radiobiological implications associated with the use of the nuclide. From this it is suggested that the main potential for ytterbium 169 would be as a source that may be re-used for a number of short-term applications, rather than as a permanently implantable nuclide.
Percutaneous sclerotherapy for simple renal cysts in children
Authors: Reiner I. , Donnell S. , Jones M. , Carty H. L. M. , Richwood A. M. K.
Published: July 2009

Simple renal cysts are rare in children although numbers detected have increased of late owing to ultrasonography. Where the lesion is asymptomatic and the diagnosis is not in doubt, an expectant approach is appropriate, but other circumstances may call for active intervention. We describe their treatment by sclerotherapy.

Between the years 1986 and 1990, 2880 renal ultrasound scans were performed on children referred to the Department of Urology. Sixteen renal cysts were identified in 16 patients, an incidence of 0.55%. In two cases symptoms were considered to be related to the cysts and in two further cases ultrasonography could not exclude other lesions.

This female child presented at 4 years of age with episodic left hypochondrial pain. Intravenous urography (IVU) suggested a space-occupying lesion within the left upper renal pole, which ultrasonography confirmed as a simple, 4 cm × 4 cm cyst (Fig. 1a).
Book reviews
Authors: Golding Stephen
Published: July 2009

Truly a curious book. Has interventional computed tomography (CT) really expanded sufficiently to justify a complete and sizeable book? First glances at the list of contents raised high expectations; it includes not only the procedures usually practised under CT control but a wide range of techniques that will, I suspect, be new to some readers; in cancer care, pain relief and treatment of occlusive vascular disease. The authors are clearly prepared to place a needle absolutely anywhere in the body (but not the brain) under CT control and their ingenuity and wide experience are amply borne out by numerous case illustrations, which form the bulk of the book.
Book reviews
Authors: Dick Robert
Published: July 2009

The pale blue cover of this slim-volume seems like an old friend, and its aquaintance does not disappoint. The 156 pages of text provide a lively update on interventional radiology of the biliary tract. There are contributions from seven countries, beginning with a vivid account of the final illness of the exiled Shah of Persia in 1979. Burhenne suggests that the radiologically controlled removal of a retained common duct stone in the Shah and its subsequent worldwide press coverage marked the start of biliary tract interventional radiology, and who would disagree?
99Tcm HMPAO SPECT in progressive multifocal leucoencephalopathy
Authors: Bowler J. V. , Davies P. T. G. , Perkin G. D.
Published: July 2009

Progressive multifocal leucoencephalopathy (PML), a rare condition caused by the JC papovavirus, is characterized by multiple areas of demyelination within the central nervous system. It almost always occurs in the context of immunosuppression and as a result of AIDS the number of cases has increased (Levy et al, 1988; Lang et al, 1989). Both computed tomography (CT) scanning and magnetic resonance imaging (MRI) have been found to be of limited value in establishing the diagnosis of PML. An alternative technique that might support a clinical diagnosis of PML would therefore be valuable, particularly if it would avoid the need to proceed to biopsy. We report a case of biopsy proven PML investigated by single photon emission computerized tomography (SPECT) using 99Tcm hexamethylpropyleneamineoxime (99Tcm HMPAO).
The use of theophylline, an adenosine antagonist in the prevention of contrast media induced nephrotoxicity
Authors: Gandhi M. R. , Brown P. , Romanowski C. A. J. , Morcos S. K. , Campbell S. , El Nahas A. M. , Gray T. A.
Published: July 2009

Impaired renal perfusion has been implicated in the pathogenesis of contrast media (CM) induced nephrotoxicity (El-Sayed et al, 1991). Animal and, more recently, clinical studies have suggested that endogenous adenosine may mediate the renal haemodynamic response to intravascular CM (Arend et al, 1987; Katholi et al, 1991).
Book reviews
Authors: Williams E. D.
Published: July 2009

Radiopharmacy is a new field of work which has appeared in hospitals within the last 20 years. When 99Tcm first came into use in the mid 1960s, the “brews” made up in beakers on the laboratory bench were usually referred to as radioisotopically labelled compounds or something similar. However, the 1970s saw increasing concern with the conditions under which the preparation of these compounds took place and the subsequent introduction of much more elaborate facilities for preparation of what were then becoming known as radiopharmaceuticals.
Book reviews
Authors: Shaw D. G.
Published: July 2009

This is the first in a series of books on radiological and pathological correlations from the Armed Forces Institute of Pathology in the United States. Many radiologists appreciate the Atlases of Tumor Pathology well established since the 1940s.
Pancreatic metastasis from renal cell carcinoma
Authors: Rypens F. , Gansbeke D. Van , Lambilliotte J. P. , Regemorter G. Van , Verhest A. , Struyven J.
Published: July 2009

Pancreatic metastasis from renal cell carcinoma is exceptional, but may appear many years after initial diagnosis and radical nephrectomy of an apparently limited tumour. We report one case of an asymptomatic isolated pancreatic metastasis discovered fortuitously, 21 years after right radical nephrectomy for a low-grade renal cancer.

In 1969, a 47-year-old man underwent right nephrectomy for renal cell carcinoma of “low-grade malignancy”. At this time, no metastases were evident and he remained well on follow-up.
Results from the HAD psychometric questionnaire in 54 breast cancer patients treated with breast conservation
Authors: Bull A. R.
Published: July 2009

The letter from A. Bulman makes an interesting point that the HAD scale results were similar amongst cancer patients as among our non-cancer patients. The HAD scale is designed to detect overall psychological state rather than anxieties focussed on a particular problem which would explain a lack of sendsitivity in these circumstances.
Routine radiographer screening for fetal abnormalities by ultrasound in an unselected low risk population
Authors: Shirley Isabel M. , Bottomley Fiona , Robinson Victor P.
Published: July 2009

A screening programme for fetal abnormalities began at The Hillingdon Hospital in July 1986. Second trimester ultrasound scans are performed by radiographers. A combined prospective and retrospective study of the ultrasound findings and outcome in all pregnancies delivered in 1989–1990 was undertaken. 6412 babies were born during this period, of whom 6183 (96%) were examined by ultrasound in the second trimester; 29 pregnancies were terminated for fetal abnormality. Of the 89 fetuses who were abnormal at birth or at induced termination of the pregnancy (1.4%), 84 were scanned in the second trimester. In 51 cases the abnormality was detected before 22 weeks gestation (sensitivity, 60.7%). 56 of these 84 abnormal fetuses scanned had potentially lethal or major handicapping abnormalities of which 41 were detected by ultrasound before 22 weeks gestation (sensitivity, 73%). There was one false positive diagnosis of abnormality which did not affect outcome. 6352 babies were normal at delivery or on discharge from hospital (specificity, 99.98%).
A role for ultrasound in limb lengthening
Authors: Derbyshire N. D. J. , Simpson A. H. R. W.
Published: July 2009

The distraction gap at eight sites in six patients undergoing limb lengthening was monitored by both standard radiographs and ultrasound. Using the measurements obtained we were able to assess the rate and quality of callus formation at the distraction site, something that radiographs alone do not enable one to do. We suggest that ultrasound has a valuable role to play in gauging the optimum rate of lengthening for a particular patient and commend it as a technique to complement radiographs in the follow-up of the increasing numbers of patients undergoing distraction osteogenesis.
The value of ultrasound in the assessment of bone
Authors: Steiner G. M. , Sprigg A.
Published: July 2009

The impenetrability of bone to ultrasound can be turned to advantage and the effects of bony lesions on the adjacent soft tissues can be analysed. Fractures, bone destruction, inflammation, distraction of bone and new bone formation can be diagnosed.
The radiology and terminology of cryptogenic organizing pneumonia
Authors: Haddock J. A. A. , Hansell D. M.
Published: July 2009

The clinical features, radiographic and computed tomographic findings of nine patients with histological proof of cryptogenic organizing pneumonia were analysed. Patients present with cough, dyspnoea and malaise and commonly have bilateral multifocal consolidation on chest radiography, which may show resolution or relapse with or without steroid treatment. A good response to steroids is the rule, usually with complete radiological resolution or minimal residual scarring. The relative merits of the terms cryptogenic organizing pneumonia and bronchiolitis obliterans organizing pneumonia, both currently used to describe this entity, are discussed.
Virtual source distances and field geometry independent output factors for 5–14 MeV electron beams from a Siemens Mevatron M7145
Authors: Plane J. H. , Trevor M. M.
Published: July 2009

It is well established that an inverse square factor based on virtual source distance (VSD) corrects for an air space between the electron applicator and the skin surface (ICRU, 1972; Almond, 1976). Values of VSD have been measured for electron fields of a Siemens Mevatron M7145. Double scattering foils and collimators above the applicator reduce scatter from the applicator walls. As a result some virtual sources are near to the electron window. However, there is some variation with energy and field size.
Small cell carcinoma of the prostate
Authors: Sule-Suso J. , Brunt A. M.
Published: July 2009

Primary small cell carcinoma of the prostate gland is a rare disease entity with a poor prognosis. Even more unusual than primary disease is a metastasis from a lung primary (Johnson et al, 1974; Hodge & Carson, 1985). We confine ourselves in this paper to primary disease, which has to be differentiated clinically from a pulmonary metastasis.

Primary small cell carcinoma of the prostate has been described as occurring after a diagnosis of adenocarcinoma of the prostate (Schron et al, 1984), as a combination of the two histologies at the time of initial diagnosis (Tetu et al, 1987) or on its own (Sarma & Weilbaecher, 1989).Though it has been suggested that small cell carcinoma of the prostate reflects a terminal aggressive phase of adenocarcinomatous disease (Schron et al, 1984), the occurrence of “pure” small cell carcinoma presents an argument against this in at least a proportion of cases (Tetu et al, 1987; Sarma & Weilbaecher, 1989).

The origin of small cell carcinoma of the prostate is not clear. It has been suggested that this malignancy derives from the argyrophil and argentaffin cells found in the normal prostatic epithelium (Wenk et al, 1977).

However, Schron et al (1984) noted that the small cell carcinoma in their three patients developed in association with, and during the course of progression of, “normal” prostatic adenocarcinoma.
Macrodystrophia lipomatosa: radiographic observations
Authors: Gupta S. K. , Sharma O. P. , Sharma S. V. , Sood B. , Gupta Sanjay
Published: July 2009

23 cases of macrodystrophia lipomatosa (MDL) are reported showing a wide spectrum of radiographic findings. Typical findings were hypertrophy of all the mesodermal tissues of the affected digits with dramatic overgrowth of fat. Phalanges were enlarged both in length and transverse diameter, but the trabecular pattern was maintained. In one patient, the phalanges and metatarsals were elongated but thinned. In another case, all the phalanges and metatarsals of the great toe were small. The little toe was also involved in two cases. Articular surfaces were slanting. There was a high incidence of palmar and plantar involvement. In a few cases the forearm and leg were also involved. Other uncommon features observed were early maturation of epiphyseal centres of ossification of phalanges and metatarsals, syndactyly, polydactyly, brachydactyly and symphalangism. Angiography was uncharacteristic.
Fatty infiltration of the liver: analysis of prevalence, radiological and clinical features and influence on patient management
Authors: El-Hassan Abdulla Y. , Ibrahim Ezzeldin M. , Al-Mulhim Fatma A. , Nabhan Arwa A. , Chammas Milad Y.
Published: July 2009

Over a 6-year period, in 1425 adult computed tomographic studies, radiological evidence of fatty infiltration of the liver (FIL) was found in 138 patients (9.7%). Patients with FIL had a mean age ±SD of 45.9±15.7 years and 57% were males; the majority were Saudis (73%). Most patients (95%) had one or more underlying aetiological causes. Haematological and nonhaematological malignancies with or without liver involvement were the most frequently encountered aetiological factors (66% of patients). FIL contibuted to hepatomegaly or was associated with abnormality in one or more of the liver function tests in 30% and 39% of patients, respectively. Assessment of the various radiological patterns showed diffuse fatty changes in 68% of patients and solitary or multiple focal changes in 9% and 22%, respectively. 13 patients (9%) showed sparing of the caudate lobe within a diffuse fatty process. Patients with diffuse FIL had significantly higher values for alkaline phosphatase (p = 0.0016) and serum asparate aminotransferase (p = 0.0251) than those who had the focal pattern. FIL in 20 patients (14%) imposed a difficulty in making an appropriate diagnosis, led to inaccurate impressions, or forced unnecessary invasive or non-invasive investigations. We conclude from our large series of patients that FIL is not uncommon in hospital practice and among those at risk should always be considered as an appropriate diagnosis.
External carotid angioplasty in the treatment of developing stroke
Authors: Troughton A. H. , Morgan R. A. , Paxton R. M. , Wells I. P.
Published: July 2009

Percutaneous transluminal angioplasty (PTA) is gradually becoming accepted as a method of treatment for internal and common carotid stenoses, although the exact indications, risks and outcomes have not yet been determined (Brown et al, 1990). Angioplasty of atherosclerotic stenoses of the external carotid artery has been performed less often. We present a case where a patient developed increasing hemiparesis since much of the left cerebral circulation was supplied from a stenosed external carotid artery and collaterals. The left internal carotid artery was occluded and the right internal carotid stenosed. The patient's symptoms improved markedly following PTA of the left external carotid artery.

A 76-year-old woman presented with a 2 month history of slurred speech and increasing weakness of the right arm and leg. She was a lifelong smoker. On examination she was dysarthric, normotensive and in sinus rhythm. The heart sounds were normal but there were bilateral high pitched carotid bruits. On the right side there was mild weakness of the arm and leg, an increased ankle jerk and an extensor plantar reflex. Cranial nerve assessment was normal.

Carotid angiography demonstrated complete occlusion of the left internal carotid and a severe stenosis at the orgin of the left external carotid artery (Fig. 1).
Radiation-induced hearing impairment—a pilot study in patients treated for malignant parotid tumours
Authors: Kirkbride P. , Liu F.-F. , Wax M. K.
Published: July 2009

There are few reports in the literature concerning the long-term effects of radiation on hearing. A recent paper reviewed eight studies which estimated the incidence of post-irradiation hearing loss at 0–54% (Talmi et al, 1989). The nature of the impairment is unclear, since both sensorineural and conductive deafness are reported. Most surveys have studied patients with cancer of the nasopharynx or paediatric tumours, the management of which require bilateral radiotherapy techniques, thus any deterioration in hearing that may occur after radiotherapy (XRT) owing to the lack of controls cannot be definitely ascribed to the effects of ionizing radiation.

Radical radiation of parotid tumours involves unilateral techniques which encompass the entire ear. The 10 year survival from parotid tumours is high—71% at the Princess Margaret Hospital (PMH) (Theriault & Fitzpatrick, 1986)—and, therefore, such patients are ideal candidates to be evaluated for the long-term effects of XRT on the ear. We recently reviewed 269 patients with malignant parotid tumours treated at PMH between 1970 and 1986 and noted that 10 patients out of 202 who received XRT reported unilateral hearing loss during follow-up. This number may be an underestimate of the true incidence because auditory function is not routinely discussed at routine follow-up visits.

Therefore, in an attempt to elucidate the magnitude of this problem, we contacted all patients in the above survey treated between 1978 and 1983, who therefore had at least 7 years of follow-up, and we requested their attendance for a formal audiometric evaluation.
The role of hysterosalpingography in modern gynaecological practice
Authors: Rajah R. , McHugo J. M. , Obhrai M.
Published: July 2009

A retrospective review of hysterosalpingography (HSG) in a major gynaecological centre was carried out. 324 patients attended (95%) for HSG out of 341 patients referred for this investigation. 189 examinations (58.3%) were abnormal. The requests and radiological findings were reviewed and the results compared with laparoscopy. HSG remains an integral part of gynaecological investigation and its value has not diminished in modern practice.
Efficacy of low-dose iodine-131 ablation of post-operative thyroid remnants: a study of 69 cases
Authors: Leung S. F. , Law Martin W. M. , Ho Stephen K. W.
Published: July 2009

Low-dose iodine-131 of mean activity 1117 MBq was used to ablate post-operative thyroid remnants in 69 patients with differentiated thyroid cancer. Successful ablation was defined as uptake of less than 1% at 48 h and absence of visible image on the post-ablation scan. Ablation by one dose was successful in 95% of patients after total or subtotal thyroidectomy, and 56% of patients after partial or hemithyroidectomy. All patients with uptake of 10% or less on the pre-ablation scan had successful ablation. The results are compared with other reports using low-dose radioiodine ablation and the significance of the findings discussed.
Visualization of the axillary vein during 99Tcm methoxy-isobutyl-isonitrile (MIBI) myocardial imaging
Authors: Bearcroft P. W. P. , Wraight E. P.
Published: July 2009

99Tcm methoxy-isobutyl-isonitrile (MIBI) is a cationic complex which is replacing thallium in the investigation of cardiac ischaemia in many centres (Wackers et al, 1989) and is also finding non-cardiac applications (Piwnica-Worms & Holman, 1990). We wish to report on the visualization of the axillary vein after injection in two patients undergoing myocardial scintigraphy at rest using this agent. Incidental venous visualization has been reported after intravenous injection of thallium- 201. This was shown not to be a trivial finding since arm vein uptake compromised myocardial counting statistics significantly and was associated with a lower myocardial washout of thallium (Gal & Port, 1986). In that study, venous uptake appeared to be associated with the site of injection.
Radiation protection associated with well woman screening
Authors: Roebuck E. J.
Published: July 2009

It was of interest to see the issues on this topic which Moores and Henshaw considered worthy to be raised in your pages (Moores & Henshaw, 1992).

The principle issue in their eyes seems to be the classification for radiation protection purposes of women presenting for breast screening. An examination of the design and structure of the NHS Breast Screening Programme will confirm that in no way can this be confused with a research project. Breast screening is offered to (a section of) the public, just like any other service in the NHS. In common with all the other medical services, this offer can be accepted or rejected. All patients are, in this sense, “volunteers” and simply to accept an offer of an established service does not make one the subject of a research project.
Standards of radiation protection in mammographic screening
Authors: Shrimpton P. C. , Wall B. F.
Published: July 2009

We wish to clarify some of the radiological protection issues raised by Moores and Henshaw (1992) in connection with the UK breast cancer screening programme using X-ray mammography.

The International Commission on Radiological Protection (ICRP) has defined the category of “medical exposure” as principally the exposure of persons as part of their diagnosis or treatment with such exposure usually intended to provide a direct benefit to the exposed individual (ICRP, 1991). If the practice is justified and the protection optimized, the dose to the patient will be as low as is compatible with the medical purpose. ICRP suggests that the application of limits might be to the patient's detriment and therefore does not recommend dose limits for medical exposures.
Calcium antagonists protect mice against lethal doses of ionizing radiation
Authors: Floersheim G. L.
Published: July 2009

Currently available radioprotectors are poorly tolerated in man and the general use of aminothiol radioprotectors is compromised by their side-effects. In a search for less toxic radioprotective agents, diltiazem, a calcium antagonist with a

benzothiazepine structure, was found to protect mice against a lethal (LD100) γ radiation dose allowing survival of up to 93%. Dihydropyridine calcium antagonists such as nifedipine, nimodipine, isradipine and nitrendipine also provided radioprotection. Calcium antagonists might attenuate radiation-induced injury by inhibiting cellular calcium overload, subsequent to cell: membrane damage caused by radiation-generated free radicals. In view of their good tolerance, calcium antagonists may be applied safely in situations of radiation exposure, including radiotherapy and internal radionuclide contamination. These calcium antagonists may also be viewed in other contexts where free radicals are implicated in pathological processes.
Transitional cell carcinoma of the bladder associated with Crohn's disease: case report and review of the literature
Authors: Fujimura Y. , Kihara T. , Uchida J. , Hoshika K. , Sato I. , Eimoto T. , Furukawa Y. , Sone A. , Ohashi K.
Published: July 2009

Transitional cell carcinoma of the bladder rarely occurs within the first two decades of life. We report a case of transitional cell cancer of the bladder complicating Crohn's disease and review the relevant literature.

The patient was a 15-year-old boy admitted to hospital in May 1990 with a fever and diarrhoea of four years' duration. There was no relevant past or family history. On admission, his temperature was 38.2°C and there was tenderness on palpation of the right lower quadrant. Laboratory findings on admission were as follows: white blood cell count was normal, C-reactive protein was 4.2 mg/dl (normal < 0.3 mg/dl), the erythrocyte sedimentation rate was 30 mm/h, albumin was 2.2 g/dl (normal, 3.5–4.5 g/dl), cholesterol was 92 mg/dl (normal, 130–220 mg/dl) and other blood tests were within normal limits. There were 20–25 red blood cells per high-power field in his urine. A chest radiograph was normal.
Book reviews
Authors: Moskovic E.
Published: July 2009

This book presents a comprehensive and honest review of the various imaging modalities currently available for interrogating the pelvis, with an emphasis on the burgeoning role of Magnetic Resonance Imaging (MRI). Although ultrasound is clearly the method of choice for the investigation of benign disease, Computed Tomography (CT) scanning has for years now been the workhorse of any X-ray department with an oncology commitment; and MRI has yet to supersede CT in some fundamental areas of diagnosis, particularly staging of abdominopelvic malignancy.
Book reviews
Authors: Irving H. C.
Published: July 2009

This multi-author work is based upon more than 20 years' experience of solid-organ transplantation at the University of Minnesota, and is a worthy testament to the considerable teamwork between physicians, surgeons, radiologists and pathologists of all the different subspecialities that form the essence of this exciting and rapidly advancing area of medical practice.
Book reviews
Authors: Glaholm J.
Published: July 2009

This book is based upon the proceedings of the 20th International Symposium of The Princess Takamatsu Cancer Research Fund, Tokyo, 1989.
Vasoconstriction by angiographic contrast media in isolated canine arteries
Authors: Gomi Naoya
Published: July 2009

To study the mechanism of the pain produced by contrast media (CM) in peripheral arteriography, we examined the direct effects of low concentrations (1.85–100 mg I/ml) of CM (diatrizoate, iopamidol, ioxaglate, and iotrolan) on helically cut strips of canine blood vessels taken from six different regions. We found that: (a) low concentrations of CM induced vasoconstriction. (b) This occurred immediately after the application of CM and produced sustained constriction, (c) The constriction produced in arteries was dose-dependent, (d) The production and intensity of constriction in the arterial strips differed as follows: cranial mesenteric artery > renal artery > femoral artery > common carotid artery > thoracic aorta > coronary artery. The effects of the CM were, in order of magnitude: diatrizoate > iopamidol > ioxaglate > iotrolan. Differences between CM corresponded with the differences in osmolality of the CM solutions, (e) Low concentrations of meglumine and mannitol also produced vasoconstriction. (f) Constriction caused by all drug samples used was reversible, but the process of relaxation to the original tension was much slower in CM-treated arterial strips than in the other strips. From these results, we confirmed that the incidence and degree of vasoconstriction produced by all drug samples used in this experiment depended on solution osmolality, rather than on chemotoxicity or ionicity. We discuss the physiological mechanism of these results and stress the importance of CM hyperosmolality in vasoconstriction and vascular pain production.
One-view versus two-view mammography in baseline screening for breast cancer: a review
Authors: van Dijck J. A. A. M. , Verbeek A. L. M. , Hendriks J. H. C. L. , Holland R.
Published: July 2009

Two-view mammography is generally preferred as an initial screening examination because the number of missed carcinomas and false positive results in one-view mammography is considered too large. The present review was performed to assess the difference in screening quality between one- and two-view mammography. Nineteen previous studies were reviewed and differences in sensitivity as well as specificity between two-view and one-view mammography were calculated. The results ranged from –5.7% to 19.4% (median 3.9%), and 2.7% to 36.1% (median 14.8%), respectively, and indicate a higher screening quality of two-view mammography. However, in the studies considered there is a large variation in study population, screening tests used and assessment of disease outcome, which makes the numerical results less conclusive. None of the studies provided adequate information for deciding whether two-view mammography in baseline screening for breast cancer is preferable to one-view mammography. If a screening programme using one-view mammography has already achieved high sensitivity and specificity, the value of an additional craniocaudal view is only marginal.
Prediction of birthweight by fetal ultrasound biometry
Authors: Nzeh D. A. , Rimmer S. , Moore W. M. O. , Hunt L.
Published: July 2009

A total of 104 women with singleton pregnancies who were delivered between 37 and 42 weeks gestation had ultrasound scans during the fortnight before delivery. The biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) were measured in all cases. Estimation of fetal weight (EFW) was done by four different methods: using AC alone, AC/BPD, AC/FL and AC/BPD/FL. Results were compared with values of actual birthweights at delivery. There was no significant difference between the mean birthweights of the 47 boy and 57 girl fetuses studied. The EFW(Shepard) method showed the least bias overall: mean percentage error 1.7%, standard deviation (SD) 10.6%. The other three methods significantly underestimated birthweights on average: EFW(Deter), mean error 2.2%, SD 9.3%, p < 0.02; EFW (Campbell), mean error 5.4%, SD 9.5%, p < 0.001; EFW(Hadlock), mean error 5.6%, SD 9.3%, p < 0.001. The percentage error in each group was significantly negatively correlated (p < 0.001) with the scan–delivery interval. Two new equations were generated which gave more accurate predictions for the cases under study using AC, BPD and FL as a combination and also in addition to scan–delivery interval (SDI) in days.
Clearance of iopamidol, a non-ionic contrast medium, by CAPD in patients with end-stage renal failure
Authors: Donnelly P. K. , Burwell N. , McBurney A. , Ward J. W. , Walls J. , Watkin E. M.
Published: July 2009

In normal healthy subjects radiographic contrast media are cleared by the kidneys with a half-life of approximately 2 h and a total body clearance of 8 1/h. The mechanism of contrast clearance has not been previously investigated in chronic renal failure patients undergoing continuous ambulatory peritoneal dialysis (CAPD). A study was undertaken to investigate the pharmacokinetics of a non-ionic water soluble radiographic contrast medium (iopamidol) in 10 patients stabilized on CAPD. All patients (eight male, two female) aged 22–68 years (median 53 years) had injection of 30 ml of iopamidol 300 via a forearm vein to investigate subclavian vein patency following previous cannulation for haemodialysis. Venous blood samples, CAPD dialysate and urine were collected for seven days post injection. The mean plasma half-life was 37.9 h (SD 10.6) (range 24.1–57.2 h) for the CAPD patients and was greatly prolonged in comparison to healthy subjects. The total body clearance of iopamidol was also greatly reduced (0.377 1/h). CAPD removed an average of 53.6% of the administered dose (range 36.3–80.8%) whilst an average of 26.9% was excreted in the urine (range 1.3–56.3%). The combined renal and dialysate clearance was up to 93% of the administered dose over the period of the study. There is therefore some evidence for a small extra renal clearance of iopamidol in end-stage renal failure patients. This study has shown for the first time that patients with end-stage renal failure undergoing CAPD have significantly delayed elimination of contrast medium. This should be taken into consideration when extensive or prolonged investigations using contrast medium are proposed.
Late follow-up of lung function after whole lung irradiation for Wilms' tumour
Authors: Attard-Montalto S. P. , Kingston J. E. , Eden O. B. , Plowman P. N.
Published: July 2009

Radiotherapy is known to have acute and long term deleterious effects on lung tissue. However, pulmonary irradiation is an established treatment in advanced childhood tumours with pulmonary metastases not responsive to chemotherapy. In this study eight patients with Wilms' tumours and lung metastases treated with whole lung irradiation (1200–1837 cGy) and chemotherapy were reassessed clinically, radiologically and with lung function tests 6–26 years after radiotherapy. One patient was breathless after mild exertion, four after strenuous exercise and three were asymptomatic. Clinically all had small chests and four of five females had underdeveloped breasts. A chest radiograph showed clear lung fields in all cases. Lung volumes, especially total lung capacity (TLC) and vital capacity (VC), were decreased when compared with predicted values for age and height. However, gas transfer per unit lung volume (KCO) was normal. This study suggests that pulmonary irradiation in childhood results primarily in underdevelopment of the thorax and that diffuse interstitial lung fibrosis is not a significant feature at this dose level.
Sialography using a paediatric intravenous cannula
Authors: Walker G. D.
Published: July 2009

Sialography is the best way of assessing disease of the duct system of the parotid and submandibular glands. However, it can often be difficult to cannulate the orifices of Stenson's and Wharton's ducts with the available range of plastic and metal instruments.

A 24 G Jelco Teflon intravenous cannula (Critikon Ltd) offers practical benefits whilst costing less than 5% of one commercially produced alternative in use in the department.
Yolk sac tumour of the testis in childhood
Authors: Thava V. , Cooper N. , Egginton J. A.
Published: July 2009

Despite being a rare neoplasm, yolk sac tumour is the commonest of all childhood testicular malignancies. Early detection and treatment result in an excellent prognosis. Ultrasound can play a valuable role in differentiating benign and malignant forms of testicular pathology at any age. Detailed description of ultrasonic appearances of specific tumours with pathological correlation is, however, as yet incomplete.

A 13-month-old child was admitted with a scrotal swelling that was thought by the mother to have been present since birth but had increased considerably in size over the previous 4 weeks. Clinical examination revealed a large, tense, non-tender swelling which did not transilluminate. A complicated hydrocele was suspected.
Book reviews
Authors: Preece A. W.
Published: July 2009

This is an important area with much good and competitive literature and this book is aimed at students and practitioners in ionising radiation subjects covering medical and industrial applications. The contents list and index are comprehensive and thus useful. As a translation it retains traces of its Gallic origins and many of the references and official documents quoted tend to be French and not necessarily easily accessible.
Abnormalities in rCBF and computed tomography in patients with Alzheimer's disease and in controls
Authors: Wyper D , Teasdale E , Patterson J , Montaldi D , Brown D , Hunter R , Graham D , McCulloch J
Published: July 2009

The pattern of abnormal distribution of the single photon emission computed tomography (SPECT) cerebral blood flow tracer 99m-technetium-hexamethylpropyleneamine oxime (99Tcm-HMPAO) was investigated in 14 patients with clinically diagnosed Alzheimer's disease (AD) who subsequently had post-mortem confirmation of the disease and also in 14 elderly control subjects. These abnormalities were compared with computed tomography (CT) scans to investigate the degree to which the focal SPECT deficits were due to atrophy. The results show that SPECT imaging with 99Tcm-HMPAO and CT scanning both have a higher incidence of abnormality in AD patients than in controls and that the difference between patients and controls is greater with SPECT than with CT. Frontal SPECT and CT abnormalities in moderate/severe Alzheimer's disease occur as frequently as temporal/occipital abnormalities but the latter are rare in control subjects. Around 50% of the SPECT deficits occur in CT normal brain regions, showing that atrophy is not the sole cause of SPECT deficits.
Imaging of dialysis access: a review of 67 failing fistulas investigated by intravenous digital subtraction angiography
Authors: England R E M , Jackson A
Published: July 2009

We have reviewed 67 failing haemodialysis fistulas imaged by intravenous digital subtraction angiography (IVDSA). Peripheral venous injection of non-ionic contrast was used in all examinations. No complications relating to peripheral injection, contrast dose or fluid load were experienced. Image quality was poor, owing to inadequate vascular opacification, in 1/67. Image quality was excellent (53/67), or good (13/67) in the remaining 66. 56/66 of these examinations were diagnostic. Diagnoses included abnormalities of feeding arteries, anastomoses, draining veins, and central veins. Multiple abnormalities were demonstrated in 10/56 examinations. Conventional arm venography was performed in addition to IVDSA in five cases where venous images were inadequate owing to anastomotic obstruction (3/5) or poor opacification (2/5). 5/66 examinations were non-diagnostic owing to failure to image the central veins where no cause for fistula failure had been demonstrated. A further 5/66 examinations were non-diagnostic owing to failure to obtain oblique projections of the shunt where vascular details was obscured by overlapping vessels. The authors recommended routine imaging of the dialysis shunt in two planes and central venous imaging in all cases. This would have resulted in reduction of the failure rate from 16% to 1.5% in this series. IVDSA using a peripheral injection technique is simple, free from complications, and provides good quality images of both arterial and venous components of the fistula. Images of vessels not directly involved in fistula formation are routinely obtained and aid the planning of fistula revision.
Book reviews
Authors: Moskovic E
Published: July 2009

This is a large book, over 1100 pages, and containing thousands of high quality illustrations. It is comprehensive, covering the entire spectrum of head and neck pathology, including anatomy and embryology, and trauma, as well as excellent chapters on malignant disease, the skull base, orbit and the inner ear.
Book reviews
Authors: Morris G M
Published: July 2009

The failure of current radiotherapy treatment modalities to control adequately high grade neoplasms of the central nervous system, has reignited interest in neutron capture therapy (NCT).
Book reviews
Authors: Virjee J
Published: July 2009

Interpretation of head and neck films is a task which some radiologists, particularly those with a non-surgical background, regard with some trepidation and consciousness of a somewhat hazy notion of the relevant anatomy.
Metaphyseal abnormalities in fibrodysplasia ossificans progressiva
Authors: O'Reilly Marian , Renton Peter
Published: July 2009

Fibrodysplasia ossificans progressiva (FOP) is a rare, congenital disorder characterized by diffuse ossification of extraskeletal connective tissue. The classical features and progression of the disease are described and three cases are presented which fall into the general pattern of FOP clinically and radiologically. A constant feature seen was a slight metaphyseal flaring with spiking at the edges of the metaphyses, compatible with minor alteration in bone morphology during growth. These changes cannot be seen after epiphyseal fusion. The major abnormalities persist into adult life.
Compensation for field non-uniformity on a mammographic X-ray unit
Authors: Cowen A R , Brettle D S , Workman A
Published: July 2009

A well observed phenomenon in diagnostic radiology is that of the anode heel effect. The heel effect is caused by target absorption of X rays emitted from an electron impact site at angles more nearly parallel to the anode face (Curry et al, 1984). This has the consequence of producing a non-uniform exposure profile in the image plane (Figure 1). Other non-uniformities may be caused by imperfections in any pre-filtration foils (IPSM, 1989).

Although non-uniformity is tolerated and to a large extent is of no clinical concern, there are applications where a uniform field exposure is required. One such area is where quantitative measurements need to be made at different spatial positions. Additionally it may prove advantageous to use a flat field exposure in mammographic examination of women with very large breasts where areas towards the breast periphery may get a significantly lower exposure than at the chest wall, reducing image contrast in that region.

As part of a Department of Health evaluation into the use of computed radiography (CR) in mammography (see, for example, Takeno et al, 1987) the authors have been investigating the mammographic imaging performance of CR using quantitative measurement techniques. One such technique is noise power spectrum analysis. Because this technique requires uniform exposure distribution over a large field area (12 cm × 12 cm) it was necessary to develop a technique to compensate for X-ray beam non-uniformity on a clinical mammography unit (Philips Diagnost UC).
Use of ultrasound in osteomyelitis
Authors: Nath A K , Sethu A U
Published: July 2009

We were pleased to read the points raised by Dr Derek Roebuck and we fully appreciate his conclusion in the last paragraph. However, we wish to make the following comments:

1. In the conclusion of our paper we have also suggested use of ultrasound in screening of all patients who are clinically suspected of having osteomyelitis.
Clinical experience with electron pseudoarc therapy
Authors: McKenzie M R , Freeman C R , Pla M , Guerra J , Souhami L , Pla C , Podgorsak E B
Published: July 2009

Between November 1986 and June 1990, 24 patients were treated with electron pseudoarc therapy at McGill University. There were 21 females and three males aged 27 to 81 years (median 62 years). 17 patients, nine of whom had received previous conventional locoregional irradiation, were treated palliatively for locally extensive breast carcinoma. Eight of these 17 patients achieved a complete, and six a partial, response to treatment; nine subsequently developed evidence of progressive disease within the treatment field after intervals of one to 27 months (median 5 months) following therapy. Eight patients developed moist desquamation of the treated chest wall, which was extensive in four; one of these patients developed chronic ulceration of the skin. The latter and one additional patient developed radiation pneumonitis. Seven patients were treated with radical intent, two following mastectomy for breast carcinoma, and one each for chest wall lymphoma, chest wall sarcoma, scalp angiosarcoma, scalp lymphoma and posterior cervical soft tissue sarcoma. Local control was achieved in six of these seven patients with minimal toxicity. Electron pseudoarc therapy is a treatment option for selected breast carcinoma patients for palliation of extensive chest wall disease, although morbidity may be considerable. The technique may, however, play a more useful role in other situations where the superficial portion of large curved surfaces is to be treated with curative intent.
Fatal pulmonary Kaposi's sarcoma and Castleman's disease in a renal transplant recipient
Authors: Mandel C , Silberstein M , Hennessy O
Published: July 2009

Two unusual complications of immunosuppression, Castleman's disease and Kaposi's sarcoma, occurring in a renal transplant recipient, are reported. Kaposi's sarcoma is a potentially curable condition in immunosuppressed patients if recognized and treated appropriately. In this patient, the pulmonary Kaposi's sarcoma was not diagnosed and this lead to the patient's death.
Haemothorax in hereditary multiple exostosis
Authors: Castells L , Comas P , González A , Vargas V , Guardia J , Gifré L
Published: July 2009

Hereditary multiple exostosis (HME) or diaphysial aclasis is an autosomal dominant condition characterized by multiple exostoses which appear in different parts of the skeleton (Solomon, 1963). Lesions occur in infants and children and usually cease to enlarge at puberty. Complications are uncommon, and haemothorax has occasionally been described (Balatskii et al, 1973; Proper et al, 1980; Tejeira et al, 1989). We report a patient presenting with spontaneous haemothorax as a complication of costal exostoses.

A 19-year-old boy known to have multiple exostoses was admitted with sudden pleuritic right-sided pain. There was no history of recent trauma. On examination he was apyrexial and blood pressure was normal. He had pain in the right side of his chest and shortness of breath and there was dullness to percussion and reducedbreath sounds at the right base.
Spinal bone density measured with a 5 s scan
Authors: Buxton F M A , Blake G M , Parker J C , Lewis M K , Fogelman I
Published: July 2009

Absorptiometry provides a convenient, non-invasive method of measuring bone mass in the skeleton with high precision and low radiation dose to the patient (Tothill, 1989). Dual photon absorptiometry (DPA) based on the radionuclide source 153Gd was developed for measuring bone mineral density (BMD) at the clinically important sites of the spine and the hip (Wilson & Madsen, 1977). Recently, dual X-ray absorptiometry (DXA) has superseded DPA (Cullum et al, 1989). Compared with DPA, DXA has advantages of improved precision (coefficient of variation of 1% for spinal DXA compared with 2–3% for DPA) and shorter scanning times (6–8 min for DXA compared with 20–30 min for DPA) (Sorenson et al, 1989). Use of an X-ray tube instead of a radionuclide eliminates the problems associated with radioactive decay of the source (Lindsay et al, 1987).

In the most recent development in DXA technology at least two manufacturers have introduced scanners based on a fan beam configuration coupled to a multidetector scanning head (Pommet et al, 1991; Steiger et al, 1991). Compared with the conventional configuration of a pencil X-ray beam linked to a single detector, scanning times are considerably shortened. In the instrument used for the study described in this report, the Hologic QDR-2000, fan beam scans of the lumbar spine (L1–L4) can be performed in either 1 min (sampling 5 lines cm−1 or 2 min (sampling 10 lines cm−1) depending on the precision required.