bluuebunny/crossref_metadata_2025 huggingface dataset:
A penile clamp for retrograde urethrography using external compression by a balloon catheter
Authors: Houghton‐Allen B
Published: March 2008

A penile clamp for retrograde urethrography is described. The seal around the fine‐bore catheter that injects the contrast is produced by external compression of the penis by the air‐filled balloon of a large Foley catheter that acts against counter‐pressure from an encircling bandage.
A review of computerized tomography in blunt abdominal trauma at Christchurch Hospital
Authors: Bohmer RD , Cowan I
Published: March 2008

A review was undertaken of computerized tomography (CT) of the abdomen, performed between March 1993 and December 1994 for blunt abdominal trauma at Christchurch Hospital. CT findings were correlated with the clinical outcome. The outcome was either recovery from an abdominal point of view with or without laparotomy, or postmortem. A total of 116 CTs were reviewed, of which 76 were abnormal.

CT was highly sensitive and specific for a variety of abdominal traumatic lesions. There were 1 false positive and 4 false negatives (only 2 of these significant). There was 1 non‐therapeutic laparotomy based on CT findings. There was only 1 case of delayed treatment based on CT results. Three patients had unexplained findings of pneumoperitoneum. Care should be taken when interpreting the presence of free intraperitoneal air on CT scan. The possibility of missed bowel perforation should be considered, especially in the presence of free intra‐abdominal fluid and no solid organ injury to account for it. CT scans are useful in the conservative management of solid organ injuries.
Diagnostic difficulties in extraosseous Ewing's sarcoma: A proposal for diagnostic criteria
Authors: Christie DRH , Bilous AM , Carr PJA
Published: March 2008

Five cases diagnosed as extraosseous Ewing's sarcoma (EES) during a 15‐year period, and the relevant literature, were reviewed. The diagnosis in these cases was difficult to confirm, mainly because the distinction between the osseous form of Ewing's sarcoma (OES) and either periosteal reactions or direct tumour invasion into adjacent bone by EES was often unclear. The literature suggests that other authors have also encountered difficulties. The authors believe that many cases reported as EES are likely to have been OES. This distinction has some importance, as the two conditions are usually treated in differing ways. The following criteria are proposed for the diagnosis of primary EES: (i) no evidence of bony involvement on magnetic resonance imaging; (ii) no evidence of increased uptake in bone or periosteum adjacent to the tumour on static isotope bone scan images; (iii) a small round cell tumour with no differentiating features on light microscopy, immunochemistry or electron microscopy; and (iv) demonstration of cytoplasmic glycogen.
Audit in radiation therapy: Long‐term survival and cost of treatment
Authors: Stevens Graham , Firth Ian
Published: March 2008

In order to determine the cost of radiation treatment and the survival rate of a cohort of patients treated in a 6‐month period in 1988, estimates of the capital and recurrent costs of this service were made for the calendar year 1988, expressed as $A(1988). Data collected prospectively included workload statistics, including number of attendances, field treated and complexity of treatment. Patient and tumour‐related data included tumour site, intent of treatment and survival. The survival rate of patients during this period was determined in June 1995. The cost per field in 1988 was estimated at $A44.32. The 1988 costs of courses of definitive, adjuvant and palliative radiation therapy were estimated at $A2545, $A2482 and $A929, respectively. The major contributor to the cost was salaries and consumables within the Radiation Oncology Department (81.6%), with capital costs accounting for 13.5%, overheads accounting for 4.5% of the costs and planned admissions accounting for 0.2%. The median survival time of 580 patients with malignant disease treated during this period in 1988 was 12.4 months. The overall 5‐year survival rate was 27%. For 105 patients treated definitively with radiation therapy, the median and 5‐year survival rate figures were 26.0 months and 40%. For 149 patients treated with adjuvant radiation therapy, the 5‐year survival rate was 62% (median survival rate not reached). For 279 patients treated palliatively, median and 5‐year survival rate figures were 5.2 months and 3%. The cost per month of survival for all patients with malignancy was $A67, the figures for definitive, adjuvant and palliative treatments being $A74, $A48 and $A105, respectively. A sensitivity analysis indicated that these figures were robust. The cost of radiation treatment per field was comparable to reports for other centres and emphasizes the utility of radiation therapy as a cost‐effective cancer treatment modality. With increasing pressure on treatment facilities in the public sector, further cost/benefit analysis is required to optimize the use of restricted resources.
Malignant melanoma presenting as bilateral breast masses
Authors: Jayalakshmi S , Chancier S , Prasad RR , Saxena AK , Sharma MC , Rath GK
Published: March 2008

Malignant melanoma presenting initially with disseminated disease is common. However, bilateral breast masses as the initial symptom of malignant melanoma are rare. One such case is detailed here, together with a review of literature.
Aggressive hydatid disease of the foot and ankle
Authors: Akyar GŞ , Berksun A , Oǧuz T
Published: March 2008

An extremely rare case of aggressive hydatid disease of bone is described in a 29‐year‐old male. Although the disease was limited to the talus at initial presentation, it spread through the entire foot and ankle after surgical treatment. The unusual aggressive nature of the recurrence was attributed to the spread of infestation during the first surgery. Amputation of the foot and ankle was performed due to the invasive nature of the bone and soft tissue involvement.
Acute vascular embolus resulting from metastatic endocardial involvement with synovial sarcoma: Report of a case and review of the literature
Authors: Khoo Vincent , Ngan Samuel , Guiney Michael , Lim‐Joon Daryl
Published: March 2008

A rare case of metastatic soft tissue sarcoma (STS) involving the endocardium of the left ventricle of the heart is described. A 57‐year‐old man with a previously resected synovial sarcoma of the anterior abdominal wall presented 5 years later with an acute ischaemic arm resulting from tumour embolus. The treatment and outcome of the patient are outlined. Metastatic STS cardiac involvement and management of this complication are reviewed.
Lymphomatoid granulomatosis: Case report and review of the literature
Authors: Ng Perry , Dwyer Ross , Hughes Andrew , Despas Paul
Published: March 2008

Lymphomatoid granulomatosis (LG) is an uncommon disease now regarded by most authors as an unusual form of lymphoma with the ability to affect any bodily system. The disease and its complications may result in a spectrum of radiological appearances. A case illustrating how cerebral lesions may mimic demyelinating plaque, neoplasm or infection and how pulmonary lesions may lead to pneumopericardium is presented. The difficulty in establishing a definitive diagnosis, due to the non‐specificity of symptoms, pathological investigations and radiological appearances of the disease, is emphasized. Clinicians must therefore consider LG in their differential diagnoses, as delayed treatment may affect prognosis.
Progressive massive fibrosis in the absence of lung modulation
Authors: McCloskey Malachy , Cook Nicola , Cameron David , Summers Quentin
Published: March 2008

Progressive massive fibrosis is a well‐recognized complication of long‐term industrial dust exposure. Typically, it occurs in a setting of background parenchymal nodulation. We wish to report a case occurring in the absence of lung nodules.
Comparison ofthallium‐201 and gallium‐67 scintigraphy in soft tissue and bone marrow multiple myeloma: A case report
Authors: Roach Paul J , Arthur Christopher K
Published: March 2008

A 68‐year‐old female was referred for assessment of multiple myeloma. A large myelomatous infiltrate involving the left triceps muscle showed avid uptake on both thallium‐201 and gallium‐67 scintigraphy. Following radiotherapy, imaging with both radiopharmaceuticals showed resolution of disease; however, tumour recurrence in the bone marrow was seen only on thallium‐201 imaging. This observation suggests that while soft‐tissue myeloma shows similar appearances on thallium‐201 and gallium‐67 scintigraphy, both at baseline and following therapy, gallium‐67 may not demonstrate bone marrow infiltration which is visualized on thallium‐201 imaging. Therefore, thallium‐201 appears to be superior to gallium‐67 in evaluation of patients with multiple myeloma when soft tissues and bone marrow are involved.
Surgical thrombectomy and stent placement for iliac compression syndrome
Authors: La Hei Erik R , Appleberg Michael , Roche James
Published: March 2008

There have been several methods, both surgical and radiological, to attempt to treat ilio‐femoral thrombosis secondary to the iliac compression syndrome. A case is reported here which was managed by a combination of surgical thrombectomy and radiological stenting of the left common iliac vein.
Compression in mammography and the perception of discomfort
Authors: Poulos Ann , Rickard Mary
Published: March 2008

Breast compression in mammography is an uncomfortable experience for most women. The discomfort experienced has the potential to deter women from attending regular breast screening by mammography. The aim of the present study was to assess factors related to the degree of discomfort experienced by women attending for first‐time mammography at the Central and Eastern Sydney BreastScreen Service. Prior to the mammogram, expectations of discomfort, menstrual status, existing breast pain, and other breast problems were recorded on a questionnaire. At the time of the mammogram, breast size and weight were estimated. During the mammogram one of the craniocaudal views of the breast was taken at a slightly lower level of compression and after the procedure the participants were asked if they perceived any difference in discomfort between the normally compressed view and the less compressed view. Radiologists were asked to comment on any differences in image quality between the same two cranio‐caudal films. A total of 200 women, including non‐English‐speaking women, participated in the present study. A total of 29% of women reported moderate, considerable or severe discomfort, a much higher level than reported in previous studies. The source of expectations (P=0.001) had a significant relationship to the expectation of discomfort. Prior expectations (P=0.01) and breast weight (P=0.001) were the only factors found to have a significant relationship to the experience of discomfort. The analysis of differences in level of compression and discomfort indicates that the relationship between mammography discomfort and level of compression is complex and not simply the result of the amount of compression applied. However, analysis of the relationship of varying compression and image quality suggests that a slight lowering in the level of compression is unlikely to significantly compromise perceived image quality. Directions for further research are suggested.
Four‐week arc radiotherapy for B2‐Cprostate cancer: The need for prospective evaluation of short fractionation schemes
Authors: Graham PH , Morris WJ , Pickles P
Published: March 2008

A retrospective review of 173 men with clinical stage B2‐C prostate cancer treated by small‐volume arc radiotherapy to 5200 cGy in 16 fractions over 4 weeks was undertaken. At 5 years, clinical local failure rates were 14% for stage B2 and 18% for stage C. Five‐year survival rates were 81 and 61 %, respectively. No discernible differences were detected between a policy of encompassing the planning target volume by the 90% or 95% isodose. The limitations of this retrospective evidence and that of the literature are discussed. In the context of resource limitations affecting radiation oncology, prospective assessment of this technique is required to determine the true outcome.
WART revisited: The treatment of epithelial ovarian cancer by whole abdominal radiotherapy
Authors: Hruby G , Bull CA , Langlands AO , Gebski V
Published: March 2008

The present study investigated outcomes for 78 women with epithelial ovarian carcinoma treated by whole abdominal radiotherapy (WART) after cyto‐reductive surgery at Westmead Hospital between 1980 and 1993. These patients had 5‐year relapse‐free and overall survival rates of 52 and 55%, respectively. The median follow‐up was 7.5 years. Fifty‐eight of the 78 women fulfilled the criteria as defined by the Princess Margaret Hospital's ‘intermediate risk’ category. These patients had both a relapse‐free and overall survival rate of 62% at 5 years (P= 0.001 as compared with the remaining 20 women). Mild gastrointestinal upset was common during radiotherapy. Five women did not complete treatment. Late toxicity (grade 3 or more, using the Radiotherapy Oncology Group (RTOG) system) occurred in eight women, and five women required surgery for intestinal complications (6.4%). There were no deaths due to late side effects. In conclusion the results are consistent with those of other series in the treatment of epithelial ovarian cancer by adjuvant WART. When compared to a similar‐stage disease treated with cisplatin‐based chemotherapy, there is no evidence to support the exclusive use of chemotherapy.
Transcatheter embolization of a congenital intrahepatic arterioportal venous malformation: A case report
Authors: Sing TMYS , Le SDV , Wong KP , Young N
Published: March 2008

Congenital intrahepatic arterioportal venous malformations (APVM) are uncommon lesions. A congenital intrahepatic APVM found incidentally in a 51‐year‐old man during pre‐operative aortography for an abdominal aortic aneurysm is reported here. This was successfully treated by transcatheter embolization of the involved hepatic artery prior to surgical repair of the aortic aneurysm.
Intracerebral haematoma formation in Herpes simplex encephalitis: A case report
Authors: Malik A , Goyal M , Mishra NK , Gaikwad SB , Padma V
Published: March 2008

Acute viral encephalitides have a high mortality and morbidity in all age groups. Early institution of appropriate medical treatment can alter the prognosis dramatically. Imaging studies may be normal or may show a wide variety of subtle findings in the initial stages. Knowledge of the extremely varied clinical as well as radiological expression of the disease is essential to enable timely diagnosis. A case is presented here of histopathologically proven Herpes simplex encephalitis (HSE), wherein a large intracerebral haematoma was seen on imaging studies. Observation of the accompanying subtle findings and knowledge of the variability of expression of this disease helped in reaching the correct diagnosis.
Bamboo skewer perforation of the bowel: Computed tomography appearances
Authors: Peh WCG , Helpert C , Chan CW
Published: March 2008

A 25‐year‐old Chinese woman presented with a painful left‐lower‐quadrant abdominal mass. Computed tomography (CT) demonstrated a dense forked foreign body within an extraluminal mass. A 2.5 cm bamboo skewer surrounded by inflamed omentum was found at laparotomy. Different CT densities of bamboo skewers were obtained when exposed to air, water and 2% Gastrografin in an in vitro experiment. Awareness of the possible variations in appearances of wooden foreign bodies in and around the bowel may aid their CT diagnoses.
Plain radiography and computed tomography of invasive thymomas: Clinico‐radiologic‐pathologic correlation
Authors: Yang WT , Lei KIK , Metrewell C
Published: March 2008

Fifteen computed tomography (CT) scans in nine patients with invasive thymoma are presented. The CT findings were an anterior mediastinal mass (89%), pleural deposits (78%), local infiltration of the mediastinum (100%), invasion of the cardiovascular structures (22%), lung invasion (11%) and diaphragmatic or subdiaphragmatic deposits (33%). Radiologic‐pathologic correlation available in six patients showed a sensitivity of 89.5%, specificity of 87.5% and accuracy of 88.6% for CT. We conclude that CT is superior to plain radiography in the diagnosis of invasive thymoma. It provides an accurate pre‐operative assessment by better demonstration of the full extent of abnormalities, and is useful in surgical planning, monitoring of therapeutic response and detecting recurrence.
Intraluminal brachytherapy in the treatment of bile duct carcinomas
Authors: Leung JT , Kuan R
Published: March 2008

Patients with carcinoma of the biliary tract have a poor prognosis because the disease is often unresectable at diagnosis. Intraluminal brachytherapy has been reported as an effective treatment for localized cholangiocarcinoma of the biliary tract. The purpose of our study was to analyse the survival of patients treated with brachytherapy and make some recommendations regarding its use. Fifteen patients underwent brachytherapy via a trans‐hepatic approach at the Royal Prince Alfred Hospital from 1983 to 1993. Eleven patients had low‐dose rate brachytherapy and four patients had high‐dose rate treatment. There were nine males and six females. The median age was 64 years. Other treatment included bypass procedures in two patients, endoscopic stents in 14 patients and external beam irradiation in one patient. The median survival was 12.5 months and 47% of the patients survived 1 year. The only complication reported was cholangitis which was seen in one patient. There did not seem to be any difference in survival or complications between low‐ and high‐dose rate brachytherapy. We conclude that the addition of intraluminal brachytherapy after biliary drainage prolongs survival and is a safe and effective treatment, but patients still have a high rate of local failure, and further studies will be needed to address this problem.
Acetabular labrum tear in a 15‐year‐old male: Diagnosis with correlative imaging
Authors: Kelley B , Anderson R , Miles K
Published: March 2008

A 15‐year‐old male with unresolved hip pain after minor trauma is presented. The diagnosis of an acetabular labral tear was made using correlative scintigraphic and magnetic resonance (MR) imaging, obviating the more invasive investigations of arthrography or arthroscopy of the hip. The clinical and radiological features of this lesion are reviewed. Undiagnosed, acetabular labral tears may result in considerable morbidity. Appropriate operative or conservative management of the condition usually provides symptomatic relief.
Leiomyosarcoma of the oesophagus: A case report and literature review of leiomyosarcoma
Authors: Visioli A , Daniel FJ
Published: March 2008

Leiomyosarcomas are uncommon tumours. Oesophageal leiomyosarcomas are even rarer. A case is presented of this rare tumour which on review of the literature seems to be the first patient surviving 22 years from the original treatment. We include a literature review of the clinical behaviour and management of leiomyosarcoma.
Budd‐Chiari syndrome: Intractable ascites managed by a trans‐hepatic portacaval shunt
Authors: Nicoll A , Fitt G , Angus P , Sewell R , Hennessy O
Published: March 2008

Transjugular intrahepatic portosytemic shunts (TIPS) have recently been used to manage the portal hypertensive complications of the Budd‐Chiari syndrome. We report this application of TIPS (to our knowledge the first such application in Australia) in a young man with an excellent result and no major complications. This treatment offers an alternative to portacaval shunt surgery and has the advantage of bypassing a stenosed or compressed inferior vena cava. Additionally, the procedure does not complicate liver transplantation surgery if this is indicated at a later date.
A case of bladder agenesis
Authors: Paşaoglu E , Tokoglu F , Boyacigil S , Karakaş M , Ardiç S , Yüksel E
Published: March 2008

Agenesis of the bladder is a rare anomaly, and it is usually associated with the absence of the urethra. In the case report herein, a normal urethra was found with ureters emptying into the posterior urethra. The right kidney was non‐functioning and small.
Extrarenal angiomyolipomas of the perinephric space in tuberose sclerosis
Authors: Hanna RM , Dahniya MH , Al‐Marzouk N , Grexa E
Published: March 2008

A case of bilateral angiomyolipomas of the perinephric space in a young Arab woman with tuberose sclerosis is reported. Multiple small angiomyolipomata were present in both kidneys and there was pulmonary involvement. The literature on this very rare occurrence is briefly reviewed.
Endoluminal brachytherapy for recurrent laryngeal carcinoma
Authors: Latham MM , Smart GP , Hedland‐Thomas B , Harper CS
Published: March 2008

Early‐stage squamous cell carcinoma of the larynx is usually treated with local field radiotherapy. Surgery is used for salvage following recurrence. Further recurrences present a more difficult therapeutic problem which requires individualized management. The aims of local control, survival, maintenance of function and minimizing side effects all need to be balanced according to the site and extent of disease. The present case study looks at the management of a 54‐year‐old man with multiple recurrences from a squamous cell carcinoma of the larynx. It describes a technique of endoluminal brachytherapy using an iridium‐192 wire spiralled around the outer part of a tracheostomy tube that achieves good local control while enabling self‐insertion and self‐cleaning during the procedure. The dose given was 2500 cGy at 5 mm over 25.2 h and was achieved with minimal early or delayed side effects. The patient had no further symptoms relating to the stomal recurrence until his death from metastatic disease 6 months later.
Aggressive skin cancers in a cardiac transplant recipient
Authors: Veness MJ
Published: March 2008

Skin cancers following cardiac transplantation are a serious problem that may lead to significant morbidity and mortality. While the majority of skin cancers represent minimally invasive lesions that are treated adequately by local means, a small subset exhibits a potentially life‐threatening natural history. The aggressiveness of these skin cancers, despite standard treatment, is indicative of the aggressive nature displayed by a subset of secondary malignancies following cardiac transplantation. The need for lifelong maintenance immunosuppression after transplantation is a major factor in the development of these secondary malignancies. Presented here is the case study of a cardiac transplant recipient who developed multiple aggressive squamous and non‐squamous cell scalp skin cancers.
Computed tomography features of lung parenchymal changes in pulmonary tuberculosis
Authors: Aribandi M , Gulati M , Behera D , Das KM , Chandra NE , Suri S
Published: March 2008

Twenty‐five patients with active pulmonary tuberculosis were prospectively studied with CT. Three major parenchymal patterns were noted. The nodular opacities pattern was seen in all cases. Confluent consolidation was seen in 37% of patients and consolidation with associated loss of volume (CWALV) was seen in 69% of patients. High‐resolution CT (HRCT) features of bronchogenic spread included (i) a centrilobular nodule or a branching linear structure (92.3%); (ii) bronchial wall thickening (61.5%); (iii) a‘tree in bud’appearance (92.3%); and (iv) poorly marginated 5‐8 mm nodules (61.5%). Most of the patterns showed satellite lesions in the form of small nodules or peripheral areas of increased attenuation. Cavitation was most common in CWALV lesions. Bronchiectasis was a common accompaniment (81.3%), and its occurrence paralleled the distribution of parenchymal lesions. Associated pleural thickening was noted in half the cases. To conclude, distinctive parenchymal changes were noted with CT in cases of pulmonary tuberculosis, which may suggest the diagnosis in the appropriate clinical setting.
An unusual consequence of stereotactic colloid cyst aspiration: Case report
Authors: Desai SR , Sidhu PS , Dawson JM
Published: March 2008

The removal of a colloid cyst of the third ventricle by stereotactic cyst aspiration is frequently performed as an alternative to a transcortical‐transventricular or transcallosal operative route. A consequence of a CT‐guided stereotactic aspiration, where residual colloid cyst material has been dislodged into the lateral ventricle and likened to an intraventricular mouse, is described.
1996 Australian radiology workforce report
Authors: O'Donnell Chris , Jones D Neil , Stuckey John
Published: March 2008

A questionnaire was sent to all radiologists in Australia using a mailing list supplied by individual State Workforce subcommittee members. A reply rate of 72% was obtained. There are currently 1061 radiologists (1010.5 full‐time equivalents) or 55.5 radiologists per million population, placing Australia in the mid‐range compared with other OECD countries. This has increased slightly from 54.1 in 1994. There is a small but definite State variation. Utilizing current trainee numbers and traditional attrition rates, there is no projected change in these figures (55.3 in 2001), but the continued introduction of‘migrant’radiologists is postulated to cause an increase (56.6 with 25 migrants and 58.4 with 50 migrants in 2001). Analysis of work‐practice indicates a performance rate of 14 100 procedures per year per practising radiologist. There is again a State variation. It is estimated that the total number of medical imaging procedures per 1000 population per year (rendered by radiologists) is 815. These latter two figures place Australia in the mid‐range compared with the United States and Great Britain. General radiography, mammography, ultrasound, and CT are the most common procedures (in that order), and are performed by the largest proportion of radiologists.
Computed tomography of abdominal neurogenic tumours
Authors: Pui Margaret H , Yang Zhi Yun , Li Zi Ping
Published: March 2008

Abdominal and pelvic neurogenic tumours are uncommon neoplasms in adults apart from those tumours found in patients with neurofibromatosis. Malignant degeneration occurs in 2.4‐29% of neurofibromatosis. Biopsy of neurofibromas can be complicated by sensorimotor nerve deficit. Distinction of malignancy by imaging may circumvent biopsies of asymptomatic benign neurogenic tumours. Benign neurogenic neoplasm is suspected on CT scan if the tumour is in the region of known nerve ganglia or pathway, and is well demarcated, solid, homogeneous, hypodense relative to muscle, and enhances with contrast material. Malignant neurogenic tumours are often large, irregular, infiltrative, and necrotic with heterogeneous contrast enhancement. Computed tomography is valuable in distinguishing malignant from benign neurogenic neoplasms, predicting resectability, detecting distant metastases, and evaluating response to treatment.
Longitudinal tibial stress fractures
Authors: Daunt Nicholas , Gribbin Denis , Slater Greg S
Published: March 2008

The tibia is a fairly common site for stress fractures of both the fatigue and insufficiency types. The majority are transverse or, less frequently, oblique. The present report outlines four cases of vertical stress fractures, an orientation that is very uncommon and leads to bone scan findings which can be misleading.
The role of the barium enema in the diagnosis of colorectal neoplasia
Authors: Mendelson Richard M
Published: March 2008

The recent interest in guidelines for colorectal cancer diagnosis, management and in screening has important implications for radiologists. The present article reviews the role of the barium enema in colorectal neoplasia diagnosis in symptomatic patients, and in the context of screening programmes.
Radiologically placed hepatic artery catheter allows selection of patients with high‐volume liver metastases for regional chemotherapy
Authors: Zhao Jing , Clingan Philip R , Glenn Derek , Morris David L
Published: March 2008

Regional chemotherapy has achieved high response rates in hepatic metastases from colorectal cancer and has been shown to improve survival significantly. The present paper reports the use of pre‐operative regional therapy to establish marker response as a means of selection of patients for surgery. Fourteen patients underwent radiologically placed hepatic artery catheter (HAC) for chemotherapy. In the 11 patients with carcino‐embryonic antigen (CEA) fall the patient proceeded to open surgical placement of HAC. The predictive effect of CEA fall following radiological HAC was good. Non‐responding patients are clearly spared the discomfort and inconvenience and costs of an unnecessary operation.
Delayed presentation of primary testicular seminoma
Authors: Capp Anne L , Kearsley John H
Published: March 2008

A case is reported here of delayed presentation of primary testicular seminoma, 9 years after initial presentation with retroperitoneal disease. The diagnostic difficulty associated with primary extragonadal germ cell tumour is emphasized.
Clinical radiohypersensitivity screening using radiation‐induced chromosomal aberrations
Authors: Kearsley JH , Fang ZM , Clarke RA
Published: March 2008

Severe acute toxicity to radiotherapy (radiohypersensitivity) can limit the effective use of radiotherapy and it is not usually possible to identify such individuals before treatment commences. Five patients with acute radiohypersensitivity (RH) were detected over a 3‐year period. All five RH subjects demonstrated a significantly higher degree of radiation‐induced chromosomal aberrations (ICA) in fresh blood lymphocytes when compared to normal controls. Results indicate the feasibility of using the ICA assay in conjunction with other tests to screen for radio‐sensitivity.
Extensive intracranial calcification secondary to hypoxia, presenting with dyspraxic gait
Authors: Nagaratnam N , Plew JD
Published: March 2008

The imaging appearances of a case of extensive intracranial calcification presenting with dyspraxic gait are described. Computed tomography showed bilateral calcification in the anterior, posterior and central watershed areas and in the basal ganglia. It is believed that the changes are secondary to previous hypoxaemia and hypotension, and that subsequent development of the symptoms is due to calcification in the dystrophic tissue.
Arterial haemorrhage following instillation of silver nitrate in chyluria: Treatment by coil embolization
Authors: Srivastava Deep Narayan , Yadav Surinder , Hemal Ashok Kumar , Berry Manorama
Published: March 2008

Chyluria is a urological manifestation of lymphatic system disease. Sclerotherapy of the renal pelvis (RPIS) using 1% silver nitrate, along with diethyl carbamazine, is the treatment most frequently used. Massive haematuria due to intrarenal aneurysm following RPIS has not been reported. A case is described here of arterial haemorrhage following instillation of silver nitrate which was treated by coil embolization. The haematuria was immediately stopped and the renal function returned to normal gradually.
Iatrogenic gallstones: A ceftriaxone complication
Authors: Kearney DK , O'Donnell D
Published: March 2008

The authors report a case of biliary colic secondary to gallstones formed during a course of therapy with Ceftriaxone. Three weeks after cessation of therapy the gallstones dissolved.
Axillary lymph node calcification due to metastatic papillary carcinoma
Authors: Chen Suet Wan , Bennett Genevieve , Price Jeremy
Published: March 2008

A case is presented in which calcification in an axillary lymph node seen on a screening mammogram was the presenting feature of metastatic papillary carcinoma, presumed to be of thyroid origin. The differential diagnosis of axillary lymph node calcification seen on mammography is reviewed.
Malignant ascites visualized on a radionuclide bone scan
Authors: Wong DC
Published: March 2008

A case report of malignant ascites visualized on a Tc‐99 m methylene diphosphate (MDP) radionuclide bone scan is presented.
Neuroradiologic findings in brown snake envenomation: Computed tomography demonstration
Authors: Midyett F Allan
Published: March 2008

A case of fatal brown snake (Pseudonaja textilis) envenomation is presented. The CT examinations show rapid development and progression of atypical bilateral intracerebral haematomas (ICH) which produce a fatal outcome despite correction of the underlying coagulopathy. The striking CT appearance suggests coagulopathy and is predictive of increased mortality.
Splenic metastasis in germ cell tumour
Authors: Geetha N , Hussain BM , Ajitkumar TV , Ittiyavirah AK , Nair M Krishnan
Published: March 2008

Metastasis to the spleen from carcinomas is a rare event. A case is described here of a 28‐year‐old man with germ cell tumour of the testis in whom splenic metastasis was demonstrated radiologically. The lesion resolved with chemotherapy and the patient has been in complete remission for 1 year.
Hyperprolactinaemia: Don't forget hypothyroidism!
Authors: Tan TH , Carty H , Ong KL
Published: March 2008

Female patients with mild clinical symptoms and signs of hypothyroidism may be overwhelmed by the accompanying manifestations of hyperprolactinaemia. Radiological imaging may show enlargement of the pituitary gland. In these cases a primary diagnosis of hypothyroidism may not be considered. Long‐term bromocriptine mesylate treatment or surgery can be avoided if the diagnosis is considered and the thyroid function test performed.
Congenital tuberculosis
Authors: Popli MB , Mehta N , Nijhavan VS , Popli V
Published: March 2008

Congenital tuberculosis is a rare disease. The non‐specific nature of presenting signs and symptoms (because of the lack of host response) and the fatal outcome in the absence of early therapy all underscore the importance of early diagnosis and treatment in infants. Recognition requires awareness that tuberculosis at this age has manifestations not found in older children. Here a case of congenital tuberculosis is presented, where changes were confined only to the thorax. Tuberculosis in the mother could be diagnosed only retrospectively.
Torsion of the wandering spleen
Authors: Hon TYW , Chan CC , Loke T , Chan CS
Published: March 2008

A case of torsion of the wandering spleen with splenic infarction is reported. The medical imaging studies performed with typical findings are described. Case reports have been reviewed. Although rare, torsion of the spleen remains an important differential diagnosis in patients presenting with acute abdominal pain. Early intervention is necessary to reduce the risk of splenic infarction and other complications, and an increased awareness of the condition together with the use of appropriate medical imaging can lead to the correct diagnosis more readily.
Radiology of the parapharyngeal space
Authors: Chong VFH , Fan YF
Published: March 2008

The parapharyngeal space (PPS) is a central space in the deep neck. Intrinsic lesions within this space are limited. Other spaces in the neck are closely related to the PPS and the direction of displacement of this space often suggests the origin of a lesion. The morphology of a lesion, together with the site of origin, helps in narrowing the diagnostic possibilities. The behaviour of the PPS often helps to determine whether a lesion is an intrinsic abnormality or whether it arises from a neighbouring space. Such information is crucial in the planning of surgical approach and the placement of drains.
Failed magnetic resonance imaging examinations due to claustrophobia
Authors: Sarji SA , Abdullah BJJ , Kumar G , Tan AH , Narayanan P
Published: March 2008

A recognized cause of incomplete or cancelled MRI examinations is anxiety and claustrophobic symptoms in patients undergoing MR scanning. This appears to be a problem in many MRI centres in Western Europe and North America, where it is said to be costly in terms of loss of valuable scan time, and has led to researchers suggesting several anxiety‐reducing approaches for MRI. To determine the incidence of failed MRI examination among our patients and if there are any associations with a patient's sex, age and education level, we studied claustrophobia that led to premature termination of the MRI examination in the University Malaya Medical Centre (UMMC) in 3324 patients over 28 months. The incidence of failed MRI examinations due to claustrophobia in the UMMC was found to be only 0.54%. There are associations between claustrophobia in MRI with the patients’sex, age and level of education. The majority of those affected were male patients and young patients in the 25‐45‐year age group. The patients’education level appears to be the strongest association with failed MRI examinations due to claustrophobia, where the majority of the affected were highly educated individuals. Claustrophobia in MRI is more of a problem among the educated individuals or patients from a higher socio‐economic group, which may explain the higher incidence in Western European and North American patients.
Stenting in malignant and benign vena caval obstruction
Authors: Laing Andrew DP , Thomson Kenneth R , Vrazas John I
Published: March 2008

Expandable metallic stents have been used with considerable success for the palliation of malignant vena caval obstruction. The role of stenting in vena caval obstruction of benign aetiology is less well defined. A review of 11 patients stented for vena caval obstruction and a review of recent series in the literature is presented. Of the 11 patients, seven patients had involvement of the superior vena cava (SVC), and four patients had inferior vena caval (IVC) obstruction. Seven cases had malignant vena caval obstruction, with a benign aetiology (SVC n = 3; IVC n= 1) in the other four cases. All seven patients treated with SVC stents experienced complete resolution or significant improvement in symptoms with no recurrence over the duration of available follow‐up, over an average of 4.3 months (range: 1 week‐12 months). Only one of four IVC lesions stented resulted in a good clinical response. All four patients with vena caval obstruction of benign aetiology had a good outcome. One patient experienced a small pulmonary embolus following SVC stent insertion without further sequelae. No other serious complications were encountered. Stenting can provide prompt relief of vena caval obstruction with low morbidity, and high patency rates in both benign and malignant vena caval lesions.
Radiology in forensic identification: The Mt Erebus disaster
Authors: Alexander CJ , Foote GA
Published: March 2008

Although radiology has exceptional discriminatory power in the identification of individuals, it is not often used for this purpose. This under‐utilization stems in part from insufficient appreciation of its potential, and in part from a lack of agreed operational protocols. Descriptions of criteria used for radiological identification are scattered in individual reports and have not been collated. The circumstances in which identification is required are various and pose different problems for which guidelines have not been established. The areas in which radiology has a high capacity for identification of age, sex or identity are reviewed and their strengths and limitations are discussed. A survey of the literature identified three different circumstances in which cadaver identification is needed, and a protocol is suggested to meet the differing requirements of these three situations. The use of these protocols and techniques in the identification of bodies recovered from the Mt Erebus disaster is described. Postmortem radiographs established the identity of 11 bodies not identified by other techniques. There is a need for greater awareness in police and forensic circles of the identifying power of radiology.
An evaluation of bone mineral density in Australian women of Asian descent
Authors: Larcos G , Baillon LG
Published: March 2008

Asian women have been reported to have lower bone mineral density (BMD) than Caucasians, but this could be due to body habitus rather than ethnicity. The purpose of the present study was to determine whether Australian women of Asian descent have intrinsically dissimilar BMD compared to Australian women of Caucasian origin. We compared Australian Asian (n= 36) and Caucasian (n= 304) women who were referred for bone densitometry and in whom disorders or medications known to interfere with bone metabolism were excluded. Covariables including age, postmenopausal status, years since menopause (YSM), alcohol and smoking consumption, family history, current exercise levels, height, weight, body mass index (BMI) and Asian origin were analysed by multivariate linear regression to determine the independent predictors of BMD in the spine, hip and distal radius. The BMD in the spine (R2= 0.31), hip (R2= 0.27) and distal radius (R2= 0.31) were associated with YSM (all sites), postmenopausal status, weight and smoking (spine and hip), BMI (spine and wrist), family history (hip) and height (wrist). The BMD at these sites were similar for Asian and Caucasian women after adjusting for these variables. Thus, Asian‐Australians have similar BMD to Caucasian‐Australians after adjusting for potential confounding variables. Bone mineral density is independently related to a number of clinical and lifestyle‐related factors, but not ethnicity.
The influence of dose per fraction on the pathogenesis of radiation nephropathy
Authors: Yildiz Ferah , Atahan I Lale , Tuncel Murvet , Konan Ali
Published: March 2008

Both kidneys of male Wistar rats were irradiated with either a 10‐Gy single dose or 26 Gy at a rate of 2 Gy per fraction per day. Serum blood urea nitrogen (BUN), creatinine and blood haematocrit levels were assessed prior to radiotherapy and at intervals of 8 weeks thereafter. A subset of animals from each dose group were killed at 4, 8,16 and 24 weeks and both kidneys of each animal were examined by electron microscopy. In both dose groups a significant increase in BUN and creatinine levels, together with a decrease in haematocrit level, was observed at 16 weeks, and this was followed by an apparent improvement at 24 weeks. There was no statistical difference in these responses between the two groups. The morphological changes in both dose groups were essentially similar, but differed in severity. At 4 weeks after irradiation glomerular and proximal tubular injury were observed in both groups. A marked increase of glomerular and tubular injury in the 10‐Gy dose group, without any apparent progression in the 26‐Gy dose group, was detected at 8 weeks. By 16 weeks a noticeable improvement in both tubular and glomerular lesions (especially in the 10‐Gy dose group) was observed. No apparent difference from the 16th week of evaluation was found at 24 weeks. These findings indicate that there is some recovery in kidney after irradiation, but the extent of the recovery process is somewhat limited.
Glomus vagale presenting as a supraclavicular mass: Magnetic resonance imaging findings
Authors: Puvaneswary M , Gani J , Kalnins IK
Published: March 2008

Glomus vagale are rare vascular tumours of the paraganglion cells of the vagus nerve, and they usually occur in the carotid space. Tumours can be familial, multicentric, malignant but rarely hormonally active. A rare case is reported of glomus vagale presenting as a supraclavicular mass.
Inflammatory pseudotumour of the post‐bulbar duodenum
Authors: Low Vincent HS , Heyneman Laura E , Hough David M
Published: March 2008

The cases of five patients with upper gastrointestinal barium examination findings suggestive of a post‐bulbar duodenal tumour are presented. Further investigations failed to confirm evidence of a neoplasm, but instead identified post‐bulbar duodenal ulceration or scarring. Possible causes for these findings, technical considerations for avoiding this pitfall, and the importance of appropriate further investigations are discussed.
Tuberous sclerosis: Ultrasound, CT and MRI features of two cases with multiple organ involvement
Authors: Arslan Arzu , Cliftçi Ercüment , Çetin Ajda , Selçuk Hakan , Demirci AN
Published: March 2008

The cases of two patients with tuberous sclerosis with multiple sites of involvement are presented. Both patients had characteristic cerebral lesions of tuberous sclerosis associated with bilateral renal angiomyolipomas and hepatic hamartomas. Additionally there were diffuse pulmonary cystic changes in one patient and cardiac rhabdomyoma in the other.
Thoracic chordoma mimicking a neurogenic tumour
Authors: Holden A , Khangure M , Robins P
Published: March 2008

A case of chordoma arising in the thoracic spine of a 20‐year‐old man is presented. Plain film and magnetic resonance imaging findings are included. The case is unusual in that the neoplasm presented as dumb‐bell‐shaped extradural mass, traversing and expanding a thoracic neural foramen and thereby mimicking a neurogenic tumour.
Gadolinium‐enhanced dynamic MRI of the fractured carpal scaphoid: Preliminary results
Authors: Munk Peter L , Lee Mark J , Janzen Dennis L , Vellet A Dale , Connell Douglas G , Poon Peter Y , Logan P Mark , Favero Kenneth J , Struk Daniel
Published: March 2008

The aim of the present report was to evaluate the vascularity of fracture fragments of the fractured carpal scaphoid in the acute (< 4 weeks) and chronic (> 3 months) phases using a gadolinium‐enhanced dynamic MRI sequence. Eight patients with acute scaphoid fractures, six patients with chronic scaphoid fractures, and three control patients without fractures were evaluated using a T1‐weighted fast spoiled gradient recalled acquisition (fSPGR) sequence with gadolinium‐DTPA enhancement (0.1 mmol/kg bodyweight). Signal intensity over time plots were obtained using region of interest measurements from both fracture fragments. Enhancement factors (EF) were then calculated from the plots. No enhancement of the scaphoid was seen in control subjects (EF: distal scaphoid pole 1.04 ±0.01, proximal pole 1.07 ± 0.08). In acute fracture patients, enhancement of the distal pole was greater than that of the proximal in all cases but one in which the two poles enhanced in a similar fashion (EF: distal 1.99 ± 0.77, proximal 1.43 ± 0.99). In chronic fracture patients the enhancement pattern was reversed, as the proximal pole enhanced to a greater degree than the distal with the exception of one case where both poles enhanced equally (EF: distal 1.74 ± 0.52, proximal 2.64 ± 0.50). Using a two‐tailed non‐parametric Mann‐Whitney U‐test, the difference in enhancement of the proximal poles between the acute and chronic groups was found to be highly significant (P < 0.003). Dynamic contrast‐enhanced (fSPGR) MRI demonstrates significant differences in the enhancement patterns of the scaphoid when chronic and acute fractures are compared.
Thyroid dysfunction after mantle irradiation of Hodgkin's disease patients
Authors: Khoo VS , Liew KH , Crennan EC , D'Costa IM , Quong G
Published: March 2008

Thyroid dysfunction can develop in patients with Hodgkin's disease who are treated with mantle irradiation. During the period 1970‐89, the records of 320 patients who received mantle irradiation and who had thyroid function tests (TFT) were retrospectively reviewed. The median age was 30 years (range, 7‐69 years). The median mantle and thyroid dose was 36 Gy (range, 30‐40 Gy) and 39.8 Gy (range, 32‐65 Gy), respectively. Overall thyroid dysfunction was present in 39% of the patients. Clinical hypothyroidism was seen in 10% and biochemical hypothyroidism was noted in 25%. Hyperthyroidism was found in 4% of patients. Thyroid nodules had developed in six patients (2%), of which those in four patients were malignant. Age, sex, histological subtype, stage of disease, dose, lymphangiogram and treatment with chemotherapy were not significant factors in the development of thyroid dysfunction. The narrow dose range prevented adequate analysis of dose effect. The results indicate that the incidence of thyroid abnormalities is high enough to warrant regular TFT assessment with pre‐irradiation levels and follow‐up testing for life because the development of abnormalities can occur many years later. Thyroid examination should form part of the routine follow‐up examination and any abnormality should be promptly investigated.