bluuebunny/crossref_metadata_2025 huggingface dataset:
Lipoma arborescens of the knee
Authors: Armstrong S. J. , Watt I.
Published: July 2009

Lipoma arborescens is a rare intra-articular lesion, consisting of collections of fat beneath the synovial lining producing clusters of swollen villous projections. It macroscopically resembles pigmented villonodular synovitis, but is macroscopically and histologically different from a synovial lipoma. Histologically, lipoma arborescens is indistinguishable from other collections of subsynovial fat, the only differences being its large size and frond-like macroscopic appearance. The alternative name of “villous lipomatous proliferation of the synovial membrane” has been suggested (Hallel et al, 1988).
Evaluation of response following irradiation of juvenile angiofibromas
Authors: Robinson Anne C. R. , Khoury G. G. , Ash D. V. , Daly B. D.
Published: July 2009

Ten cases of angiofibroma treated by irradiation are reported. Relief of symptoms occurred by the end of treatment in eight patients. Objective regression was much slower, six having visible disease for greater than 6 months and four for at least 1 year. Only one was symptomatic. Radiological resolution lagged behind clinical improvement and was complete in only one of three asymptomatic patients evaluated by computed tomography (CT) at between 2 and 3 years after treatment. The significance of these residual masses seen on CT is unclear.
Phalangeal osteoid osteoma
Authors: Meng Quanfei , Watt lain
Published: July 2009

Although the typical features of osteoid osteomas are well known, those arising in phalanges are frequently misdiagnosed. This is partly because of their rarity (9% of osteoid osteomas in the Bristol Bone Tumour Registry occur in phalanges), and also because of atypical radiological features. The most common appearance is of an eccentric lesion with soft-tissue swelling and a relative absence of sclerosis, suggesting osteomyelitis.
The prevalence and characterization of simple hepatic cysts by ultrasound examination
Authors: Gaines P. A. , Sampson M. A.
Published: July 2009

To help assess the significance of liver cysts we have prospectively documented their prevalence and characteristics within a general population being referred for ultrasound. Simple hepatic cysts occur in 2.5% of the population, becoming increasingly common with age. They show a preference for women, the right lobe of the liver and are occasionally multiple. The differential diagnosis is discussed.
Structure–function analysis of angiotensin-converting enzyme inhibitors as modifiers of radiation-induced pulmonary endothelial dysfunction in rats
Authors: Ward W. F. , Molteni A. , Kim Y. T. , Ts'ao C.
Published: July 2009

We have previously demonstrated that thiol-containing collagen antagonists (penicillamine) and angiotensin-converting enzyme (ACE) inhibitors (Captopril and CL242817) ameliorate endothelial dysfunction in irradiated rat lung. The purpose of the present study was to determine whether the non-thiol ACE inhibitor CGS13945 also modifies radiation-induced pulmonary endothelial dysfunction in rats sacrificed 2 months after a single dose (0–30 Gy) of 60Co γ rays to the right hemithorax. The CGS13945 was administered in the feed continuously after irradiation at a regimen of 30 mg (kg body weight)-1 day-1. Four markers of lung endothelial function were monitored: ACE activity, plasminogen activator (PLA) activity, and prostacyclin (PGI2) and thromboxane (TXA2) production. Right lung ACE and PLA activities decreased with increasing radiation dose, and CGS 13945 significantly ameliorated both responses. Dose-reduction factors (DRF) for the inhibitor were 1.80 for ACE activity and 1.41 for PLA activity (p<0.05). In contrast, lung PGI2 and TXA2 production increased with increasing radiation dose, and CGS 13945 did not influence either response significantly. Thus the ACE inhibitor CGS 13945 modifies radiation-induced pulmonary endothelial dysfunction in rats, indicating that the presence of a thiol group is not essential for therapeutic efficacy in this class of compounds. On the other hand, CGS 13945 exhibits a differential sparing of radiation-induced pulmonary endothelial dysfunction, as does penicillamine. A structure-function analysis of the present and previous data indicates that all of the ACE inhibitors tested (Captopril, CL242817 and CGS 13945) spare the radiation-induced suppression in lung ACE and PLA activity; all of the thiol compounds tested (penicillamine, Captopril and CL242817) spare the radiation-induced elevation in lung PGI2 and TXA2 production; and the thiol ACE inhibitors (Captopril and CL242817) spare all four endothelial responses. These data confirm a novel and potentially important application for ACE inhibitors as modifiers of radiation-induced lung injury, and suggest that there are at least two components to their mechanism of therapeutic action in this model.
Balloon embolization of a congenital arterio-venous fistula between the internal mammary artery and a portal vein radicle
Authors: Cobby Mark J. D. , Culling William , Jordan Stephen C. , Hartnell George G.
Published: July 2009

Congenital arterio-venous fistulae between a systemic artery and portal vein are extremely rare. There are only two case reports in the English language (Glass et al, 1960; Stanford et al, 1970) of a fistula between an internal mammary artery and the portal venous system. We report a case presenting at an early age, which was successfully treated by balloon embolization.

A full-term, female infant was noted to have a loud, continuous murmur over the left lower sternum when 2 days old. The pregnancy had been uneventful and feeding and growth progressed normally over the next 5 months. There were no episodes of cyanosis or other abnormality. The chest radiograph was normal. A provisional diagnosis of a coronary artery fistula was made.

Echocardiography showed no intracardiac abnormality and no evidence of a coronary artery fistula. At the age of 7 months, the child underwent cardiac catheterization, which showed normal pressures, saturations and anatomy. A dilated and hypertrophied vessel arising from the left subclavian artery in the expected position of the internal mammary artery was observed. This crossed the midline at the level of the diaphragm and became narrowed and kinked, communicating with a large anterior vessel that passed into the liver to supply the portal venous system (Fig. 1). A subsequent aortogram and selective arteriogram demonstrated normal origins and anatomy of the coeliac and superior mesenteric arteries with a patent portal vein.
Magnetic resonance imaging of ruptured aneurysm of the ascending aorta
Authors: Spielmann R. P. , Küng E. E. , Witte G. , Heller M.
Published: July 2009

Magnetic resonance imaging (MRI) has been recognized as an excellent method to assess pathology of the thoracic aorta (Amparo et al, 1985; Geisinger et al, 1985; Glazer et al, 1985; Dinsmore et al, 1986). However, it is generally not feasible in the investigation of acute complications of aortic disease, because the strength of the magnetic field and the restricted access to the patient during the investigation preclude adequate monitoring and therapy in most instances. In this paper, the case of a ruptured aortic aneurysm is presented, which was imaged a few hours after the onset of symptoms. Although the patient was haemodynamically stable at the time of the examination, she died 2h after the procedure, before surgery could be performed. A postmortem examination was obtained, and the findings were compared with the magnetic resonance images.

An 80-year-old woman was admitted to our hospital within 1 h of the onset of severe chest pain. Blood pressure values were in the lower normal range, although there was a long history of arterial hypertension. Myocardial infarction was excluded by electrocardiogram (ECG) and enzyme examination. The physical examination revealed a diastolic heart murmur suggestive of incompetence of the aortic valve. A plain radiograph of the thorax showed abnormal widening of the mediastinum. On subsequent two-dimensional echocardiography, aneurysm of the ascending aorta and some pericardial fluid were recognized.
Secretion of radioactivity in breast milk following administration of 123I hippuran
Authors: Mountford P. J. , Coakley A. J.
Published: July 2009

Administration of a radiopharmaceutical to a lactating mother will result in the secretion of radioactivity in her milk, and her breast-fed infant will receive a radiation dose from ingested activity. For many radiopharmaceuticals, there is little data available on which to base appropriate radiation protection advice (Mountford & Coakley, 1988). The recent referral of a hypertensive lactating mother for an 123I-OIH dynamic renal scan (DRS) provided an opportunity to obtain some relevant measurements.
The quality of high-energy X-ray beams
Authors: LaRiviere Philip D.
Published: July 2009

Supplement 17 of the British Journal of Radiology is a survey of central-axis depth doses for radiotherapy machines, patterned largely on BJR Supplement 11 published some 11 years earlier. Inspection of the high-energy X-ray depth doses for a 10 × 10 cm field at an SSD of 100 cm disclosed large differences between the two sets of data, especially for qualities above 8 MV. For example, a depth dose of 80% at 10 cm is rated at about 19 MV according to BJR Supplement 11, and 23 MV according to BJR Supplement 17. It was found that the Supplement 17 depth-dose data above 8 MV were erratic, but that the Supplement 11 data could be represented by an analytical expression, providing a unique means of assigning MV quality. It was also found that the dose– weighted average energy of the filtered beam plotted smoothly against depth dose. For dosimetric purposes, it is suggested that this parameter be used as a true measure of beam quality, removing the discrepancies introduced by the use of nominal MV for this purpose.
Atypical radiological features of β-glucuronidase deficiency (mucopolysaccharidosis VII) occurring in an elderly patient from an inbred kindred
Authors: Chapman S. , Gray R. G. F. , Constable T. J. , Bundey S.
Published: July 2009

Sly et al (1973) described the first patient with mucopolysaccharidosis VII and concluded that the condition was autosomal recessive in view of the profound deficiency of β-glucuronidase in the affected patient and intermediate levels in his parents. The classical clinical picture consists of mental retardation, failure to thrive, hepatosplenomegaly, macrocephaly, dysostosis multiplex and inconstant corneal clouding. However, this can vary as shown by the further 20 patients (Bernsen et al, 1987) described since 1973. For example, two patients have died in the neonatal period with hydrops, while three adult patients have been asymptomatic. In addition, one sister, clinically affected like her two siblings, had a level of β-glucuronidase that was in the heterozygote range (Bernsen et al, 1987) so that even the enzyme levels do not correlate with the clinical picture.

This patient, now 37 years old, was born in Pakistan, and came to this country in 1984. Deformed feet were noticed at birth and he did not walk until the age of 7 years. His height was normal as a child, but as he aged, short stature became apparent and the joints of his hands became swollen. He has had two herniorrhaphies; he is not deaf nor has he had attacks of rhinitis.

On examination, he is severely mentally retarded, is very short (height 144 cm) and has a large head (90th centile) and coarse facial features (Fig. la).
Foregut cyst of the mediastinum: fluid re-accumulation after transbronchial needle aspiration
Authors: van Beers Bernard , Trigaux Jean-Paul , Weynants Patrick , Collard Jean-Marie , Melange Michel
Published: July 2009

Cysts arising from embryonic remnants of the primitive foregut include bronchogenic cyst, oesophageal duplication and neurenteric cyst (Kirwan et al, 1973). The place of computed tomography (CT) and needle biopsy in the diagnosis and the management of foregut cysts of the mediastinum has been demonstrated (Schwartz et al, 1985, 1986; Kuhlman et al, 1988).

We report a case of a foregut cyst diagnosed and treated by these methods, but without long-term symptomatic relief inasmuch as symptoms recurred 3 years later with re-accumulation of fluid.

In 1986, a 27-year-old man complained of vague right thoracic pain. A right mediastinal mass was discovered on chest radiographs (Fig. la, b). A CT scan showed a tubular cystic mass (internal density + 30 HU). This had regular and smooth borders and was located on the right side of the entire thoracic oesophagus (Fig. lc, d). There was no subdiaphragmatic extension and a CT scan of the upper abdomen did not show any abnormality. In particular, no pancreatic lesion was detected. A rigid bronchoscopy was performed and a Storz transbronchial needle was used to puncture the cyst transcarinally. This aspiration biopsy needle has an outer diameter of 1·4 mm. Seventy millilitres of clear, yellow fluid were aspirated and the procedure was well tolerated.

Cultures of the fluid were negative and cytological examination showed no malignant cells. The presumptive diagnosis, based on CT and needle aspiration, was oesophageal duplication cyst.
X-ray dual-photon absorptiometry: a new method for the measurement of bone density
Authors: Cullum I. D. , Ell P. J. , Ryder J. P.
Published: July 2009

A recently introduced method (dual-photon X-ray absorptiometry, DEXA) capable of measuring skeletal density in man (at present in the spine and hips, but ultimately for the whole body) has been evaluated in terms of its ability to perform longterm assessment of bone density changes. The method, which uses X rays rather than γ rays as its photon source, represents a significant improvement over present systems both in image quality and precision (reproducibility) of results, which is better than 1% in vivo. Scannning time is approximately halved compared with present techniques and the radiation dose is reduced by 25%. First data on long-term drift of results and effects of changes in patient composition (i.e. thickness and fat content) are given and show the new method to be superior to present radionuclide systems. It is likely that this new method will become the standard for bone density measurements.
Use of a radon mould technique for skin cancer: results from the Peter MacCallum Cancer Institute (1975–1984)
Authors: Ashby Michael A. , Pacella Juan A. , de Groot Raymond , Ainslie Jill
Published: July 2009

During the period from 1975 to 1984, 642 patients had non-melanoma skin cancers (NMSC) treated by a radon mould technique following the principles of the Manchester system. The results of 77 out of 642 (12%) with histologically verified lesions are presented. The sites of the lesions were as follows: head and neck 25 (32%), upper limbs 38 (49%), lower limbs 13 (17%) and trunk one case only. The histological diagnosis was squamous cell carcinoma 48 (62%), basal cell carcinoma in 22 (29%) and other in seven (9%). There were nine out of 77 (12%) failures, four with persistent disease, which did not clear after initial treatment (and for whom the radon mould was an inappropriate choice of technique), and five (6%) recurrences after clearance of the initial lesion. There was a sharp rise in failures after 1979 when there was a change of radon supplier, but no calibration error was substantiated. It is clearly beneficial for institutions to cross-check the manufacturer's brachytherapy source data. There have been no further recurrences or any symptomatic late morbidity. This is a safe, effective and practical radiotherapeutic technique for superficial lesions (not exceeding a depth of 4 mm) in areas of poor radiation tolerance, and may obviate the need for a prolonged fractionated course of external-beam radiation in selected patients. Alternatives to radon are discussed.
The use of real-time orbital ultrasound in Graves' ophthalmopathy: a comparison with computed tomography
Authors: Given-Wilson Rosalind , Pope Richard M. , Michell Michael J. , Cannon Richard , McGregor Alan M.
Published: July 2009

Evaluation of the severity of orbital involvement and likelihood of the development of optic neuropathy in Graves' disease can be clinically difficult. We describe the use of real-time orbital ultrasound scanning to measure the medial rectus muscle width in 20 patients with Graves' ophthalmopathy and 21 normal individuals. The normal reference interval (to 2 SDs) was 1.75 to 4.07 mm. Significantly (p< 0.001; Mann Whitney U-test) larger values were observed in the patients compared with controls, and there was good correlation between medial rectus width and a clinical index of disease severity in individual eyes (p< 0.001; Spearman rank correlation coefficient). Comparison of the medial rectus measurements obtained using orbital computed tomography and ultrasound showed positive correlation at the p< 0.001 significance level. Computed tomographic medial rectus measurements also correlated with horizontal and vertical muscle indices for that orbit. We suggest that real-time ultrasound of medial rectus width, using widely available equipment, provides an accurate, simple and non-invasive means of evaluating the orbits of patients with Graves' disease. Repeated measurements may be of value in identifying patients at high risk of visual failure, and in following prospectively the orbital response to therapy in patients with Graves' ophthalmopathy.
Dysphagia after fast neutron therapy to the head and neck
Authors: Alexander Mark S. M. , Edelman Gill M. , Man Kate , Randall Christopher J.
Published: July 2009

Nine patients presenting with dysphagia following successful treatment for head and neck cancer with neutron radiotherapy are reviewed. Combined clinical and videofluoroscopic investigation is used to analyse their deficits and provide indications for management. All patients show impairment of both the oral and pharyngeal phases of the swallow, with the exception of one subject who shows signs of focal neurological damage. It is suggested that fibrosis is the underlying cause of dysphagia in the remainder.
Clinical significance of cranial nerve deficit in the therapy of nasopharyngeal carcinoma
Authors: Chen Ming-Shen , Lin Fang-Jen , Tang Simon G. , Leung Wai-Man , Leung Wan
Published: July 2009

The results of radiation treatment of nasopharyngeal carcinoma (NPC) have recently been improved, but the prognosis remains relatively poor in cases with cranial nerve (CN) involvement. A total of 109 cases with histologically-proven NPC and cranial nerve involvement treated during 1979–1985 were reviewed and analysed. Definitive radiotherapy (RT) was given to patients with a high upper margin of the RT field at 2.5 cm above the base of the skull to a total dose of 70.2 Gy/39 fractions/8 weeks, with two applications of intranasopharyngeal brachytherapy. There were 37 cases (34%) in Group I (upward invasion only) and 72 cases (66%) in Group II (bidirectional invasion). Abducens, trigeminal, occulomotor and facial were the commonly involved nerves. Headache was the major symptom at diagnosis and was present in 82.6% of the patients, significantly higher than in general NPC cases (p< 0.005). Fifty per cent (31/62) achieved complete response to definitive RT, but it did not correlate well with survival rate. The residual neurological deficit of each CN ranged from 31 to 57%. The actuarial 5-year survival rates of Groups I and II were similar in spite of neck lymph node metastasis in Group II (33% (I) compared with 24% (II); p> 0.05). Cases with single CN deficit did not show better results than those with multiple CN involvements. Five-year survivors were seen only in those who received a complete course of definitive RT.
Book reviews
Authors: Jones A. J.
Published: July 2009

This book is the seventh in the series and is intended to illustrate a wide range of conditions in which abdominal ultrasonography is useful in diagnosis. It is written in the form of a series of exercises with ultrasound illustrations on the lefthand page and explanatory text and schematic drawingson the right. A total of 114 separate exercises are present and proceed logically through the biliary tree and liver, pancreas, adrenal glands, kidneys, spleen and miscellaneous structures.
Book reviews
Authors: Freeman A.
Published: July 2009

This is an intriguing book dedicated to diagnostic imaging of the liver, biliary tract and pancreas. As stated in the preface “the development and the widespread clinical application of various diagnostic imaging modalities, such as diagnostic ultrasonography, X-ray computed tomography, single photon emission computed tomography and magnetic resonance imaging have been beyond all expectation”. Reading the book, however, your reviewer began to wonder if the authors had lost sight of the patient amidst their adulation of all these (relatively) new imaging methods.
A real headache!
Authors: Jackson J. E. , O'Donnell C. J.
Published: July 2009

This 31-year-old female patient had recently undergone a uterine myomectomy. Histology of the resected surgical specimen had demonstrated borderline sarcomatous change in a fibroid and, in view of a complaint of headaches, the patient was referred for further radiological investigation to exclude cerebral metastatic desease. There had been no previous history of trauma. Neurological examination was unremarkable. A plain frontal skull radiograph (Fig. 1) and a computed tomogram at the level of the lateral ventricles, following intravenous contrast medium (Fig. 2), are shown. What abnormalities are present and what are the likely causes for these appearances?

The plain frontal skull radiograph (Fig. 1) demonstrates elevation of the right lesser wing of sphenoid. The computed tomogram (Fig. 2) shows a water-density extracerebral mass over the right cerebral convexity and a higher-density extracerebral collection over the left fronto-parietal convexity, which shows enhancement of its wall.
Alterations in body and skin temperatures caused by magnetic resonance imaging: is the recommended exposure for radiofrequency radiation too conservative?
Authors: Shellock Frank G. , Schaefer Daniel J. , Crues John V.
Published: July 2009

Increases in tissue temperature caused by exposure to radiofrequency (RF) radiation are a primary safety concern of magnetic resonance imaging (MRI). Therefore, body and skin temperatures were measured in six subjects before (20 min), during (30min) and after (20 min) MRI procedures performed at specific absorption rates (SARs) six to 10 times higher than the limit recommended by the UK National Radiological Protection Board. Body temperature was unchanged throughout the experiment. Abdominal skin temperature increased significantly (p<0.05) during MRI, decreased significantly post-MRI, but was still significantly (p<0.05) higher than baseline. The highest abdominal skin temperature recorded was 36°C. Upper arm, forearm and chest skin temperatures increased significantly (p<0.05) during MRI and remained elevated post-MRI. The highest skin temperatures recorded on the upper arm, forearm and chest were 38.1, 36.0 and 34.5°C, respectively. Thigh and calf skin temperatures were not significantly changed during MRI. These alterations in tissue temperatures were physiologically trivial and easily tolerated by the subjects, suggesting that the recommended exposure to RF radiation during MRI of the body for patients with normal thermoregulatory function may be too conservative.
Residual radiation-induced injury in dermal tissue: implications for retreatment
Authors: Simmonds R. H. , Hopewell J. W. , Robbins M. E. C.
Published: July 2009

The evidence for residual radiation-induced injury has been investigated in the dermal vascular/connective tissue of pig skin at intervals of 17–52 weeks after irradiation. The primary irradiation was a single dose of 18 Gy, which represents the upper limit of “tolerance” to X irradiation of pig dermal tissue. Re-irradiation was with graded single doses of X rays in order to establish dose–effect relationships for the incidence of late ischaemic dermal necrosis of the skin; dose–effect curves obtained for previously irradiated skin were compared with those obtained using previously unirradiated skin in the same group of animals. At intervals of 17, 35 and 52 weeks after the primary treatment the resulting ED50 values for dermal necrosis were not significantly different from those obtained for previously unirradiated skin. This suggests little or no effective residual injury at these time intervals after a primary full “tolerance” dose. This conclusion was supported by the findings for the latency time for the development of dermal necrosis, which were similar in re-irradiated and previously unirradiated skin. Epithelial desquamation was not induced by the doses used in these studies, either after the primary treatment or after re-irradiation; however, the early erythema reactions seen in re-irradiated skin were markedly reduced, particularly when this was carried out after 35 and 52 weeks, when compared with skin that had not previously been irradiated. This suggests that the early erythema reaction may be a particularly poor predictor of late effects after the re-irradiation of the skin. Although the present results suggest that dermal and subcutaneous tissues may safely be retreated with a full tolerance dose at relatively early times after an initial radical treatment, caution is recommended in extrapolating these results to other late-responding normal tissues. In other tissues some persistent injury may be present even at very long time intervals after the primary treatment.
Retroperitoneal mass and spinal cord compression due to extramedullary haemopoiesis in polycythaemia rubra vera
Authors: Jackson A. , Burton I. E.
Published: July 2009

The development of discrete masses of extramedullary haemopoietic tissue is well recognized in a number of diseases (Ward & Block, 1971); however, it has been described only rarely in the proliferative phase of polycythaemia rubra vera (Rice et al, 1980; Robitaille et al, 1985). Most cases of extramedullary haemopoiesis present with posterior mediastinal or extradural masses (Ward & Block, 1971) and spinal cord compression is also well documented with over 30 cases in the world literature (Cromwell & Kerber, 1978; Ligumski et al, 1978; Mann et al, 1987). The diagnosis of extradural extramedullary haemopoiesis is important since it responds well to radiotherapy (Sorsdahl et al, 1964; Cromwell & Kerber, 1978) and can otherwise lead to serious neurological sequelae or death.
Agenesis of the salivary glands: a report of two cases
Authors: Whyte A. M. , Hayward M. W. J.
Published: July 2009

Congenital absence of the major salivary glands is uncommon with only a few reported cases in the world literature. Agenesis may be partial or total; the more severely affected patients suffer from a dry mouth, an increased rate of dental decay and difficulty in wearing dentures. Following exclusion of the more common causes of a dry mouth by the clinician, the diagnosis of salivary gland agenesis can be confirmed by computed tomography (CT) and a 99Tcm-pertechnetate scintiscan.
Total abdominal and pelvic ultrasound: incidental findings and a comparison between outpatient and general practice referrals in 1000 cases
Authors: Mills P. , Joseph A. E. A. , Adam E. J.
Published: July 2009

Ultrasound examination is a rapid and non-invasive method of examing the abdomen. Opinions differ as to whether the entire abdomen and pelvis should be examined in all cases or whether examination can be confined to the region of suspected pathology. The aim of this study was to evaluate the diagnostic yield of total abdominal and pelvic ultrasound examination in patients referred for primary diagnostic ultrasound and with particular reference to specific symptoms. The results of 1000 examinations were analysed. In 25% of patients, a significant abnormality was found and almost one-third of these were incidental findings. The incidence of abnormalities was not significantly different between patients referred via their general practitioners and those referred via the hospital outpatients department. We recommend total abdominal and pelvic examination in all cases regardless of the presenting symptoms.
Can ultrasound replace the intravenous urogram in preliminary investigation of renal tract disease? A prospective study
Authors: Lewis-Jones H. G. , Lamb G. H. R. , Hughes P. L.
Published: July 2009

The intravenous urogram has long been the mainstay of urinary tract imaging in adult practice. It has been shown recently that in many clinical situations the routine use of intravenous urography is no longer justified and in some situations avoidance of adverse contrast reactions, reduced examination time and significant cost reduction. In order to assess the clinical and financial aspects of a change in practice in our department, a prospective study was undertaken over a total of 10 weeks when 328 patients who were referred for intravenous urography were also examined independently by ultrasound combined with the plain abdominal radiograph. The results were compared and in 81.4% of cases the two techniques yielded identical information. Ultrasound plus a plain abdominal radiograph provided more diagnostic information in a further 12.5% of cases, whilst intravenous urography was more informative in only 6.1%. The findings of the study are discussed by considering the main clinical groups and comparing the relative yields of ultrasound and urography. A scheme of routine urinary tract investigations using ultrasound and the plain abdominal radiograph is proposed. We estimate a 58% reduction in number of urographic examinations while retaining diagnostic accuracy. The financial and planning implications for our department are discussed.
Double-contrast computed tomographic arthrography of the shoulder joint
Authors: Cook J. V. , Tayar R.
Published: July 2009

Dislocation of the shoulder joint can cause post-traumatic injury to certain anatomical structures, which may lead to recurrent dislocation. The operative visualization of some of these abnormalities may be difficult and their identification preoperatively allows selection of the appropriate surgical approach and avoids the necessity for lengthy surgery. Fifty-one patients with a history of recurrent dislocation, single dislocation or suspected recurrent subluxation as a cause of pain were examined over a 3-year period by double-contrast computed tomographic (CT) arthrography. Thirty-five patients had a demonstrable abnormality and 13 were considered suitable for surgical intervention on radiological criteria. A further 12 patients were advised to have surgery on a combination of clinical and radiological grounds. Eleven of these have so far had surgery, eight of which required an arthrotomy and the CT findings have been confirmed in all these cases. The results of CT arthrography in the patients examined are reported and the technique, normal anatomy and pathological findings are described. The technique is suggested as the imaging method of choice in recurrent dislocation.
Demonstration of osteochondritis dissecans of the talus by coronal computed tomographic arthrography
Authors: Davies A. M. , Cassar-Pullicino V. N.
Published: July 2009

Ten cases of osteochondritis dissecans of the talus are reviewed. Coronal computed tomographic arthrography identified the precise location in each case and consistently revealed the extent of the lesion to be greater than that apparent on the plain radiographs. The talar cartilage over the lesion was shown to be thinned in four cases, deficient in two, and fissuring of the cartilage was demonstrated in four. Subarticular cysts were identified in all but two cases and contrast medium was shown to enter the cysts in two cases indicating a communication with the ankle joint. The aetiology and relevance of these findings to treatment are discussed.
Sublethal damage repair and radiosensitivity of human squamous cell carcinoma cells grown with different culture techniques
Authors: Schwachöfer J. H. M. , Crooijmans R. P. M. A. , van Gasteren J. , Hoogenhout J. , Jerusalem C. R. , Kal H. B.
Published: July 2009

In this study, cells of a human squamous cell carcinoma line, HN-1, were grown in monolayers and as multicellular tumour spheroids (MTS). Repair of radiation-induced damage was studied by irradiation with single and split doses of X rays (4–8 Gy). It was shown that the amount of sublethal damage that was repaired in this dose range was equal in cells growing in monolayers and as MTS. The radiosensitivity of spheroids, as expressed by spheroid “cure” dose, increased with increasing MTS diameter. It is postulated that, in MTS with no signs of hypoxia, radioresistance diminishes when MTS increase in diameter.
Asymmetrical pulmonary changes in premature infants with surgical closure of a persistent ductus arteriosus
Authors: Steinberg J. D. J. , Oetomo S. Bambang , Martijn A.
Published: July 2009

The chest radiographs of 57 premature infants admitted consecutively with hyaline membrane disease and receiving respirator therapy were reviewed, comparing right and left pulmonary abnormalities. Fifteen infants (Group I) did not develop a persistent ductus arteriosus (PDA). Forty-two infants developed a PDA, which was successfully treated with indomethacin in 17 infants (Group II), while in 25 infants (Group III) the ductus was closed surgically. Analysis of the three groups showed that infants who had undergone surgical closure of their PDA developed significantly more asymmetrical broncho-pulmonary damage. Statistically significant fewer radiological findings of broncho-pulmonary damage were found on the left side in comparison with the right side in the group treated surgically.
Calcification of the intrathoracic trachea demonstrated by computed tomography
Authors: Lloyd D. C. , Taylor P. M.
Published: July 2009

The presence of intrathoracic tracheal calcification was assessed on computed tomographic (CT) scans of 90 consecutive male and female patients. The presence of calcification was demonstrated to be common and to increase with age. No female preponderance was shown.
The radiology of Coffin–Lowry syndrome
Authors: Padley S. , Hodgson S. V. , Sherwood T.
Published: July 2009

The Coffin–Lowry syndrome is a rare disorder inherited as an X-linked condition, affecting men much more severely than women. The characteristics are mental retardation, skeletal abnormalities with short stature, hypermobile joints, loose skin, tapering fingers and dysmorphic facial features.

The proband was referred for genetic assessment at the age of 15 years because of developmental delay with dysmorphic features. He was the first child of unrelated parents, and had a younger sister. His mother was said to be mildly educationally subnormal, but she came from a family of highly educated people, and there was no other family history of retardation (Fig. 1). His sister (aged 16 years) was of normal intelligence and had no dysmorphic features.

The proband was induced at 36 weeks gestation because of placenta praevia in an otherwise normal pregnancy, and was healthy at birth (birth weight 5 lb 2 oz). His milestones were delayed, sitting at 18 months and only walking at 3 years of age, and making no meaningful sounds until the age of 2 years. He went into residential care for the moderately to severely retarded from 5 years of age, at which time he only had two or three words of speech.

In his early teens he developed epilepsy in the form of “drop attacks”, which caused him to fall backwards to the ground; he would rise immediately afterwards.
The development and use of digital subtraction angiography
Authors: Jeans W. D.
Published: July 2009

The technique of radiographic subtraction was first described in 1935 (Ziedses des Plantes, 1935), although the first English language paper on the subject did not appear until 27 years later (Hanafee & Stout, 1962). This commented that the technique provided an economical photographic method of reducing the confusion of overlapping bony structures in angiographic studies. The advantages of radiographic subtraction can be summarized as (a) providing image enhancement and (b) improving and bringing out detail in areas hidden by overlying bone or poor contrast. These features may therefore save the situation when the density of contrast medium is insufficient to show a lesion (Leeds, 1974). Previously, intravenous injections of contrast medium had been used to show the aorta and other arteries (Steinberg et al, 1959).

Digitization of images was introduced experimentally (Meyers et al, 1963), with the aim of automating the reading of radiographs. Manipulation of digitized information became widely used when computerized tomographic (CT) scanners were introduced, and an early use of computerized subtraction was for the assessment of regional cerebral blood flow (Zilkha et al, 1976) in which pre-injection scans were subtracted from postinjection scans to allow analysis of areas of the scan sections. A series of papers then appeared from workers at the University of Wisconsin describing “computerized fluorography” in which images from an image intensifier were collected, amplified logarithmically and digitized, before being integrated, processed and redisplayed on a monitor (Kruger et al, 1979).
Anatomical variations of the carotid bifurcation: implications for digital subtraction angiography and ultrasonography
Authors: Trigaux J. P. , Delchambre F. , Van Beers B.
Published: July 2009

Intravenous digital subtraction angiography was used to determine prospectively the positional variations of the common carotid bifurcation in 100 consecutive patients with clinically suspected arteriosclerotic disease. The most common position (97/200, 48.5%) of the external carotid artery was anteromedial to the internal carotid artery. Position of the external carotid artery anterolateral to the internal carotid artery was noted in 26/200 (13%) bifurcations, but this anatomical variant was more common on the right (21/100) than on the left (5/100) (p<0.0l). Practical implications may be drawn from this study. For digital subtraction angiography, the left anterior oblique view has to be considered the projection of choice and the right common carotid bifurcation is less likely to be adequately displayed than the left one; for duplex ultrasonography, optimal visualization is obtained from a posterolateral orientation of the transducer.
The use of combined transoesophageal echocardiography and fluroscopy in the biopsy of a right atrial mass
Authors: Scott P. J. , Ettles D. F. , Rees M. R. , Williams G. J.
Published: July 2009

Transoesophageal echocardiography has increasing application to the diagnosis of a wide range of cardiac disorders (Roelandt & Sutherland, 1988). Recently, simultaneous ultrasound imaging of the heart by the oesophageal route has been used during certain interventional cardiac procedures (Cryan et al, 1988; Neumann et al, 1988).

We report a case in which transoesophageal echocardiography was used in combination with fluroscopy to facilitate the biopsy of a right atrial mass.

A 14-year-old Asian boy presented with a short history of malaise, cough and haemoptysis associated with intermittent pleuritic chest pain. Physical examination revealed signs of bilateral pleural effusions and right-sided heart failure, with jugular venous pressure elevated 6 cm above the suprasternal notch and mild peripheral oedema. His pulse rate was 90 beats/ min and his blood pressure was 140/80 mmHg with no paradox. The pleural effusions were confirmed radiologically, but the chest radiograph and electrocardiogram (ECG) yielded no further diagnostic information. Pulmonary infarcts were suspected and, in the search for a source of emboli, praecordial cardiac ultrasound revealed distortion of the tricuspid valve annulus. This was further delineated by transoesophageal echocardiography which clearly showed a mass in the posterolateralwall of the right atrium causing displacement of the tricuspid valve (Fig. 1).

The patient's family were unwilling to allow cardiac surgery to be performed and so a biopsy of the mass was chosen as the next diagnostic approach. A Cordis bioptome was introduced via the right femoral vein and tip positioned at the junction of the inferior vena cava and the right atrium using radiological screening.
A real headache!
Authors: Burrows E. H.
Published: July 2009

Drs Jackson and O'Donnell (1989) provided a useful review of intracranial arachnoid cysts when reporting their case which was associated with a contralateral chronic subdural haematoma. Radiologists should be able to recognize such cysts with confidence because they will find that their clinical colleagues are often unfamiliar with this rare lesion.
The ultrasound cystodynamogram—a new radiological technique
Authors: Boothroyd A. E. , Dixon P. J. , Christmas T. J. , Chappie C. R. , Rickards D.
Published: July 2009

Voiding dysfunction may be assessed using the intravenous urodynamogram (IVUD) or combined with pressure studies in the videocystometrogram (VCMG). However, VCMG requires bladder catheterization and voiding in public which often leads to inhibition of sphincter relaxation. For this reason the urinary flow rate measurement performed in private is more representative of the true voiding pattern. The ultrasound cystodynamogram (USCD) evaluates the bladder capacity, mean and maximum flow rates, flow pattern and post-micturition residual. The diagnostic capability of USCD was studied in 116 consecutive cases 46 of whom had also had VCMG. Comparison of the data obtained using both techniques revealed no significant difference. USCD has proved to be accurate, safe and reproducible and is of particular value in patient follow-up.
Malignant struma ovarii: presentation and management
Authors: O'Connell M. E. A. , Fisher C. , Harmer C. L.
Published: July 2009

Struma ovarii are rare tumours and just over 400 cases are reported in the world literature (Gould et al, 1983). The incidence of malignancy is reported as 5–10% of all cases of struma ovarii (Marcus & Marcus, 1961) but has been reported as less (Gould et al, 1983). The metastasis rate is estimated to be 5–6% (Emge, 1940) and only 21 cases with metastases have so far been reported (Dalley, 1970; Pardo-Mindan & Vazquez, 1983; Willemse et al, 1987; Rosenblum et al, 1989). Owing to their rarity, there is no universal agreement as to management. Surgical excision continues to remain the initial definitive primary treatment. However, metastatic and recurrent malignant struma ovarii have been treated with radioactive 131I (Woodruff et al, 1966; Kempers et al, 1970; Willemse et al, 1987). Intra-peritoneal radiocolloids (Woodruff et al, 1966; Rosenblum et al, 1989) and external beam radiotherapy (Gonzalez-Angulo et al, 1963; Woodruff et al, 1966; Pardo-Mindan & Vazquez, 1983) have also found a useful role in palliation.

This paper describes the presentation and management of two patients with malignant struma ovarii referred to the Royal Marsden Hospital between 1945 and 1989, during which time nearly 3000 other ovarian tumours were recorded.

A 35-year-old married woman with no previous or family history of thyroid disease presented in 1951 with severe recurrent abdominal pain. Laparotomy was performed and both ovaries were found to be cystic.
Tuberculosis of the patella
Authors: Shah Priti , Ramakantan Ravi
Published: July 2009

Tuberculosis causing an osteolytic lesion in the patella is very rare, having been reported on only four previous occasions. We present such a case and discuss the radiological features which help in differentiating tuberculosis from other similar lesions.

A 25-year-old man in good health presented with a 3 month history of pain, swelling and restriction of movement of the right knee. There were no systemic symptoms or other joint involvement. Examination of the knee revealed an effusion with minimal terminal restriction of flexion. Radiographs of the knee joint demonstrated swelling (Fig. 1) and an osteolytic lesion in the patella (Fig. 2). Radionuclide bone scans showed an area of increased uptake in the right patella; no other lesions were seen on the scan. A chest radiograph revealed no abnormality.
Discovertebral destruction in ankylosing spondylitis: the role of computed tomography and magnetic resonance imaging
Authors: Kenny J. B. , Hughes P. L. , Whitehouse G. H.
Published: July 2009

The computed tomography and magnetic resonance imaging appearances are described in five cases of ankylosing spondylitis with discovertebral destruction. Computed tomography revealed erosions of the vertebral bodies not visible on plain radiographs. The different appearances of the involved disc spaces on magnetic resonance imaging are described and their significance in relation to the pathology of this condition is discussed.
Urinary tract infection in paediatrics: the role of diagnostic imaging
Authors: Gordon I.
Published: July 2009

Infection of the urinary tract (UTI) has several clinical subgroups, each requiring different degrees of investigation. The most severe, acute pyelonephritis, is characterized by ill health, anorexia, pyrexia (>38.5°C), an erythrocyte sedimentation rate greater than 20 mra/h or C-reactive protein greater than 10mg/l, pyuria, bacteruria and possible septicaemia. The child may well require hospitalization and parenteral antibiotics. The term cystitis is used to refer to children with lower urinary tract symptoms but without systemic illness who have more than 100000 bacteria per ml in the urine. They should be distinguished from children who are asymptomatic but nevertheless have positive urine cultures, i.e. asymptomatic bacteruria. This last group usually consists of girls over 5 years old and do not require much investigation. Clinically these three groups overlap to some extent, but nevertheless the presentation should be a guide to the choice of the appropriate imaging.

Urinary tract infection is common: the imaging that children undergo is important in terms of resource utilization as well as discomfort and radiation exposure. A conscious effort must be made not to over-investigate the child or to overburden the radiology department, yet treatable disorders or potential long-term complications must be detected (Saxena et al, 1975; Asscher, 1980).

A prospective study by Dickson (1979) found 3.1/ 1000 girls and 1.7/1000 boys presented annually with a first symptomatic UTI. The incidence of end-stage renal failure due to pyelonephritis in Europe in individuals under 40 years of age is 4–5 per million per year (Broyer et al, 1984).
Initial experience with percutaneous transluminal angioplasty in the management of Takayasu's arteritis
Authors: Sharma Sanjiv , Rajani Mira , Kaul Upendra , Talwar K. K. , Dev Vishwa , Shrivastava Savitri
Published: July 2009

We have performed percutaneous transluminal angioplasty (PTA) for 15 arterial stenoses in 11 patients with Takayasu's arteritis. The lesions included tight, proximally located renal artery stenosis (12 stenoses; nine patients), localized abdominal aortic stenosis (two patients) and occluded left common iliac artery (one patient). Clinically successful dilatation was achieved in seven patients (10 stenoses) with renal artery stenosis, in both the patients with abdominal aortic stenosis and in the only patient with an occluded left common iliac artery. No complications related to the procedure were encountered. The followup period (n = 7) ranged between 1 and 16 months, mean follow-up period after renal angioplasty was 5 months and after abdominal aortic angioplasty was 12.5 months. Initial success has been maintained in both the patients with abdominal aortic stenoses and in four out of five patients with renal artery stenosis. Percutaneous transluminal angioplasty offers an attractive alternative for the management of stenosing lesions in Takayasu's arteritis with good short term results.