bluuebunny/crossref_metadata_2025 huggingface dataset:
Salivary gland scintigraphy—a suitable substitute for sialography?
Authors: Pilbrow W. J. , Brownless S. M. , Cawood J. I. , Dynes A. , Hughes J. D. , Stockdale H. R.
Published: July 2009

By comparing 27 patients who had both scintigraphy and sialography in the assessment of salivary gland disease, scintigraphy has been shown to correlate well with abnormal sialograms. It is suggested that scintigraphy could become the initial screening procedure in the assessment of salivary gland disease. A normal scintiscan is unlikely to miss significant pathology (as demonstrated by sialography), but sialography must always be performed if there is a suspicion of duct obstruction on scintigraphy. Patients suspected of focal salivary gland pathology such as tumour have not been investigated. The series documents the findings in patients who presented with facial pain, swelling or xerostomia suggesting sialadenitis, duct occlusion or Sjögren's syndrome.
A real headache!
Authors: Jackson James
Published: July 2009

Dr Burrows makes a good point regarding the differential diagnosis of an extradural collection with a linear enhancing rim. As he rightly points out, mistaken radiological diagnoses may be made if the clinical history is not taken into account.
Book reviews
Authors: Roberts G. M.
Published: July 2009

This book looks good, feels good and is good. It presents an up-to-date review of the role of modern imaging techniques in the management of critically ill patients. Clearly laid out and liberally illustrated with good quality images (apart from the inevitable poor quality portable chest radiographs in Chapter 5), the book packs an enormous amount of useful information into its 184 pages. Some may think the slim volume expensive at £93, but it fills an important gap in the literature.
Book reviews
Authors: McCarthy P.
Published: July 2009

This 76-page book is the latest in a series of pocket MRI atlases from the Raven Press. It is presented by two widely respected authors in the field. It covers the normal anatomy of the neck, para-nasal sinuses, pharynx and skull base including a section on the temporal bone.
The role of the STIR sequence in magnetic resonance imaging examination of bone tumours
Authors: Golfieri Rita , Baddeley Hiram , Pringle Jean S. , Souhami Robert
Published: July 2009

Sixty patients with primary bone tumours were evaluated with magnetic resonance imaging (MRI) at 0.5 T with both conventional spin–echo (SE) and short inversion time inversion recovery (STIR) sequences. The results have been reviewed in order to evaluate the accuracy of STIR and conventional SE sequences in the detection of tumours, the definition of intramedullary extent and soft-tissue involvement. The intraosseous neoplastic extent has been compared with macroslides of surgical specimens in 24 cases. The role of the STIR sequence in detection of recurrences in the post-surgical follow-up was also evaluated. The STIR sequence, designed to suppress signal from fat, also enhances the signal from tissue with long T  1 and T  2 relaxation times, such as neoplastic and inflammatory tissue. The STIR sequence with T  1 of 120–130 ms in all cases suppressed the high signal from fatty bone marrow, giving a clear depiction of tumour extent, in both its intramedullary and soft-tissue components, and is superior to conventional SE images. The high sensitivity (100% of our cases) of this technique is counterbalanced by its lack of specificity: on STIR sequences both tumour and peritumorous oedema give an increase of signal intensity, limiting assessment of tumour extent. Peritumoral oedema, only present in our series in malignant neoplasms, may however be differentiated on the basis of the configuration of the abnormal areas, and by comparing STIR images with short repetition time/echo time sequence results.
Congenital indifference to pain mistaken for non-accidental injury
Authors: Spencer J. A. , Grieve D. K.
Published: July 2009

Congenital indifference to pain is a rare autosomal recessive inherited condition with cutaneous and skeletal lesions that mimic non-accidental injury(NAI). We present this case to illustrate the difficulty in differentiatingthe two conditions in early childhood and to demonstrate discriminatory features in the older child.

The affected boy, born in the UK to Pakistani parents, first came to medical attention aged 6 months. (He had escaped the obstetric profession having been delivered by his father in the family car in the hospital car park!) When admitted to investigate recurrent chest infections, he was noted to have burns on his left hand. His parents explained that he had touched anelectric heater while crawling. He was underweight, but his parents claimedthat he was a poor feeder. Over a 6 month period there were several furtheradmissions with chest infections, mainly affecting the right upper lobe. Nounderlying cause was found. The pneumonias resolved and were retrospectively attributed to episodes of aspiration. A further unexplained feature was recurrent oral and labial ulceration including one deep lesion on the tongue.

At 18 months of age he was taken to the Accident Department by his parents who had noticed a boggy mass over his occiput. An occipital fracture was present (Fig. 1). No explana-tion was offered by his parents. Further suspicion of nonaccidental injury (NAI) was raised by burns on the fingers of the right hand, deep cuts to both index fingers and a number of bruises about the trunk and limbs (Fig. 2). One revealing note by the admitting physician was his father's comment that the child was always running into things but never cried. This admission was following by a case conference under the Child Abuse Procedures at which close supervision by his GP and community services were urged.
Alterations in body and skin temperatures caused by MRI
Authors: Shellock Frank G. , Schaefer Daniel J. , Crues John V.
Published: July 2009

Thank you for allowing us to respond to the letter from J. A. Dennis and R. D. Saunders concerning our recent article (Shellock et al, 1989).

We would like to indicate that the United States Food and rug Administration (FDA) has relaxed the guidelines for exposure to radiofrequency (RF) electromagnetic fields during clinical magnetic resonance imaging (MRI) based, in part, on our recent publications as well as those from other investigators.
Book reviews
Authors: Ring E. F. J.
Published: July 2009

This densely packed volume is based on the Second International Workshop on Methodological Problems of Photon Absorptiometry held in Belgium in 1987. It is valuable collection of comparative and investigative studies on bone mineral measurement over the most active growth phase of its development.
The role of dacryocystography in the management of patients with epiphora
Authors: Nixon J. , Birchall I. W. J. , Virjee J.
Published: July 2009

A retrospective study has been carried out on 114 patients who have undergone dacryocystography (DCG) for epiphora, to assess the role of DCG in their management. It was found that 16/66 (24%) patients who were offered surgery after DCG refused it or were assessed as unfit for surgery, demonstrating the need for careful counselling and assessment of patients prior to investigation. The presence of lacrimal system obstruction on DCG was an important factor in determining whether a patient underwent lacrimal surgery. However, the actual level of the obstruction influenced neither the likelihood of a patient undergoing lacrimal surgery nor the form of lacrimal surgery undertaken. This suggests that, unless the surgical approach will be modified in the light of the anatomical information furnished by DCG, DCG is not necessary. Lacrimal scintigraphy would provide sufficient information for the practical management of epiphora. Syringing of the lacrimal system correlates poorly with DCG in detecting obstruction.
Book reviews
Authors: Morgan Helen
Published: July 2009

This booklet written by two distinguished American physicists was originally published by the US Bureau of Radiological Health and now appears in revised form. It lives up to its title and is easy to read with key words printed in bold type. There are plenty of diagrams to accompany the explanations, and some black and white photographs of particular examples.
Comparison of 99Tcm dimercaptosuccinic acid scans and intravenous urography in children
Authors: Whitear Patrick , Shaw Penny , Gordon Isky
Published: July 2009

A retrospective comparison of 99Tcm dimercaptosuccinic acid (DMSA) scans and intravenous urograms (IVUs) was performed on a large, unselected paediatric population to assess critically the relative merits of these two techniques. A total of 205 children were studied, providing 388 kidneys for comparison. The studies agreed in 81%, both being normal in 39%, and both abnormal in 42%. In 28 kidneys (7%), the IVU was abnormal when the 99Tcm DMSA was normal. There was a collecting system abnormality in 27 kidneys, but 10 kidneys also showed a parenchymal abnormality. In all these the parenchymal abnormality was global thinning on the IVU, and the contralateral kidney was small. In 40 kidneys (10%) the 99Tcm DMSA was abnormal when the IVU was normal: the abnormalities demonstrated were predominantly focal defects. After excluding IVUs of poor diagnostic quality, only 14 kidneys (3.6%) showed this disparity. The important clinical subgroups are infection, with or without reflux (27 kidneys), hypertension (4) and neonates with poor renal function (2). The one false positive 99Tcm DMSA was a result of an anatomical variant. Global thinning in a “normal” kidney on a 99Tcm DMSA scan may be overlooked when the contralateral kidney is poorly functioning and small.
A comparison of two methods of in vivo dosimetry for a high energy neutron beam
Authors: Blake S. W. , Bonnett D. E. , Finch J.
Published: July 2009

Two methods of in vivo dosimetry have been compared in a high energy neutron beam. These were activation dosimetry and thermoluminescence dosimetry (TLD). Their suitability was determined by comparison with estimates of total dose, obtained using a tissue equivalent ionization chamber. Measurements were made on the central axis and a profile of a 10 × 10 cm square field and also behind a shielding block in order to simulate conditions of clinical use. The TLD system was found to provide the best estimate of total dose.
A dedicated microcomputer for a superficial radiotherapy unit
Authors: Cassell K. J. , Gamble J. M. , Gerard-Martin S.
Published: July 2009

A computer system has been developed for the purpose of calculating patient treatment times and output calibration measurements and monitoring set-up conditions on a Philips RT100 superficial radiotherapy unit. With minor modifications it could be used with other superficial therapy units.

The system has been developed around a Gemini Galaxy microcomputer wh

ich has a Z80 processor and 64K of RAM. The software is written in BCPL, a highlevel structured language which runs under the CP/M operating system but is also available on the latest 32 bit IBM-compatible microcomputers running under the MS-DOS operating system. All programs are menudriven with facilities for returning to the start of the previous section by means of the “ESC” key. All data validated at the time of entry according to the data type and expected length or magnitude.

A pROM-based system is used on the RT100 machine for calibration checks, treatment time calculations and set-up checks. This system has a safety feature in that contains two sets of identical data stored in two separate pROMs which are checked against each other before entry to the program is allowed. An additional safety feature is that the pROM data cannot be modified on this system by the system operator.

The full system which includes the editor and hard-copy sections, runs on a microcomputer with Winchester or floppy disk and can be used in place of the pROM-based system if required.
Retroperitoneal haematoma following orchidectomy: implications for staging computed tomography
Authors: Page J. E. , Prendergast C. M. , King D. M.
Published: July 2009

Retroperitoneal haematoma, a rare complication of transinguinal orchidectomy, may be clinically silent. The discovery of a mass on staging-computed tomography (CT) is often the first and only sign of its presence. This may be misinterpreted as representing involved lymph nodes. Recognition of this benign complication is vital if the patient is to be correctly staged.

Correct management of testicular tumours depends on precise determination of the extent of dissemination, and to that end, most patients who are found to have a malignant testicular mass are staged by CT. These tumours have a predilection for metastasis to lungs and lymph nodes, hence most patients receive a CT examination of the thorax as well as the abdomen and pelvis. Abnormal masses discovered in the pelvic or para-aortic lymph node chain are usually the result of lymph node enlargement.

We present three cases where a retroperitoneal haematoma, consequent upon orchidectomy, mimicked lymph node enlargement. The literature contains only single previous report (Kullmann & Lien, 1987).

A 33-year-old man with a past medical history of bilateral orchidopexy at the age of 12 years, presented with a 4 month history of painful swelling of the left testis. Clinical examination indicated the presence of a testicular neoplasm and orchidectomy was performed through the previous incision. Histological examination of the resected specimen confirmed seminoma. Several days after surgery he was noted to be clinically anaemic and his haemoglobin had fallen from 14.2 g/dl pre-operatively to 7.2 g/dl. Accordingly he was transfused and further haemoglobin estimations showed no further diminution.
Book reviews
Authors: Taylor P. M.
Published: July 2009

When computed tomography (CT) imaging first became widely available a decade ago radiologists were stimulated to relearn their anatomy and many of us now see the body as a series of cross-sections. Several authors, realizing a demand, produced books correlating CT images with pathological sections, line drawings or both. Consequently many departments will have such a book for teaching, learning or reference. This new book is therefore the latest in a long line of cross-sectional anatomy books and is aimed, according to the author, at medical students. To be successful it must be as good if not better than the others and preferably contain some innovative material. How then does it compare?

The book contains a series of CT sections with correlative cross-sectional post-mortem photographs from the vertex to the symphysis pubis. Each pair is labelled and there is a short accompanying description.
Book reviews
Authors: Martin Derrick F.
Published: July 2009

As an atlas of gastrointestinal disease from mouth to anus, this book is a “tour de force”. It contains over 600 colour clinical photographs, photographs of macroscopic and microscopic pathological specimens and radiographs ranging from the everyday occurrence to hens' teeth. The chapters are divided by anatomical section from the mouth to the anus taking in the pancreas en route and including hernias and stomas. Each anatomical section is divided into two chapters, one covering normal appearances which is prefaced by a brief description normal anatomy, and the second on the pathological appearances of the region. Each photograph is accompanied by a few lines of relevant text. The whole provides an extraordinarily comprehensive expedition through the gastrointestinal tract.
Book reviews
Authors: Dendy P. P.
Published: July 2009

Assessment of any release of radioactivity to the environment is important for the protection of public health, especially if the released radioactivity can enter the food chain. This technical report has therefore been published as a guide to the measurement of radionuclides in food and environmental samples, both for training courses and to help in the establishment of central and local environmental laboratories.

The book is divided into two parts. In the first part general issues are covered: pathways and samples of interest; radionuclides of interest; requirements for laboratories, equipment and personnel; collection and preparation of samples: analytical methods and analytical quality control.
Book reviews
Authors: Notley H. M.
Published: July 2009

Ref 85–5 (F)

This tape/slide presentation is another in the series prepared by St Bartholomew's Hospital dealing with radiation safety in the medical environment. It is the first of two programmes for domestic staff (the second one being concerned with radiation safety in laboratories).

The programme covers all areas where radiation may be used in hospitals, from the diagnostic X-ray department through the radiotherapy department to the use of radioactive sealed sources on wards. No real mention is made of problems in operating theatres, although they are referred to in the text. is primarily intended for use in a radiotherapy centre.
The effect of ultrasound on the cytoxicity of adriamycin
Authors: Loverock Pam , ter Haar Gail , Ormerod M. G. , Imrie P. R.
Published: July 2009

The effect of continuous wave ultrasound exposures on the cytoxicity of adriamycin has been studied. It has been found that 2.6 MHz, 2.3 Wcm−2 (spatial average) ultrasound can enhance the cell killing potential of adriamycin both in suspensions of single V79 Chinese hamster fibroblast cells and in spheroids formed from these cells. The ratio of the slopes of the survival curves for single cell suspensions is 1.5. For spheroids, the growth delay is increased by 1.3 days by simultaneous ultrasound exposure. Flow cytometric studies of the intracellular concentration of adriamycin following ultrasound exposure reveals that this is increased when compared with that measured when the cells are only exposed to adriamycin. Evidence is presented to suggest that this is a non-thermal effect of ultrasound.
Pathological fracture of the femoral shaft in a case of Servelle–Martorell syndrome (phleboeclatic osteohypoplastic angiodysplasia with associated arterio-venous malformation)
Authors: Gibbon W. W. , Pooley J.
Published: July 2009

A case is presented of a pathological femoral shaft fracture in a 47-year-old woman with a rare form of skeletal angiodysplasia (Servelle–Martorell syndrome). A simple classification of bony changes in congenital skeletal angiodysplasia is included with a literature review.

A 47-year-old woman presented to the Accident and Emergency Department having tripped and fallen in the street whilst shopping. The patient had walked with a limp since childhood because of a “short” left leg. A mole had been removed from her left thigh at the age of 9 years. Examination of the left lower limb demonstrated a clinical fracture of the left femoral shaft, 1.5 cm shortening of the left tibia and extensive varicosities with palpable fluid thrill.
Quality assurance of ultrasound test objects
Authors: Brannigan P. D. , Bell T. K.
Published: July 2009

A recent survey on ultrasound tissue equivalent test objects carried out by the Institute of Physical Sciences in Medicine clearly shows these objects to have limited useful lifetimes with deterioration setting in within 1 year of purchase.
Book reviews
Authors: Whitehouse G. H.
Published: July 2009

Using 83 illustrative cases, this small book demonstrates the salient mammographic features of a wide range of breast abnormalities. Produced in Strasburg, a pre-eminent centre of breast imaging, the book is intended for radiologists and clinicians.
Percutaneous femoral artery puncture: practice and anatomy
Authors: Grier D. , Hartnell G.
Published: July 2009

In a survey of the superficial landmarks used to select the site of puncture of the femoral artery for angiography, the inguinal skin crease was most popular, preferred by 39.2% of angiographers. The maximal femoral pulse irrespective of the position of the skin crease was the next most popular landmark (24.7%). Bony landmarks were least popular (13.0%). The majority (73.7%) of those using the skin crease punctured at the same level or distal to it. The relationship of these superficial landmarks to the common femoral artery (CFA) and its bifurcation were investigated. The inguinal skin crease was distal to the bifurcation of the CFA in 71.9% of limbs (mean, 0.61 cm). The maximal femoral pulse was over the CFA in 92.7% of limbs, and the CFA was projected over the medial aspect of the femoral head in 77.9% of limbs. The use of the inguinal skin crease is a popular though unreliable guide for puncture of the CFA. Use of the maximal femoral pulse will enable more constant puncture of the CFA.
Transforming growth factor beta: a promotor of late connective tissue injury following radiotherapy?
Authors: Canney Peter A. , Dean Stephen
Published: July 2009

Transforming growth factor beta (TGF-β) is a peptide which has a fundamental role in controlling proliferation of many cell types. Its main effect upon connective tissues in vivo is to stimulate growth. It can result in endothelial cell proliferation but tends to inhibit epithelial cell growth. Damage to the connective tissues and the vasculature are the principal findings in late radiotherapy damage. Following the initial cellular depletion after radiotherapy, an abnormal proliferation of these tissues occurs, which does not respond to normal feedback mechanisms. Immunocytochemical staining for TGF-β has been performed upon six patients who had received pre-operative radiotherapy and three patients who had surgery alone for large bowel tumours. Transforming growth factor beta was found in relation to the pathological changes of late radiation damage in the non-tumourbearing tissues of four out of six previously irradiated patients, but in none of the non-irradiated patients. This paper proposes that TGF-β activity may modulate late post-radiation changes.
An instance of clinical radiation morbidity and cellular radiosensitivity, not associated with ataxia-telangiectasia
Authors: Plowman P. N. , Bridges B. A. , Arlett C. F. , Hinney A. , Kingston J. E.
Published: July 2009

A 14-year-old boy received standard induction chemotherapy for acute lymphoblastic leukaemia followed by standard dose cranial radiation prophylaxis (18 Gy). Severe chemosensitivity and acute radiation reactions occurred and he died at 8 months from late radiation damage. In vitro radiobiological studies of the boy's fibroblasts in culture demonstrated an enhanced radiosensitivity indistinguishable from ataxia-telangiectasia (A-T) cells. However, unlike A-T cells, DNA synthesis following irradiation was inhibited in a normal manner. This patient represents yet another example of extreme radiosensitivity, and the possibility of clinical prediction in the future is discussed.
Book reviews
Authors: Bomford C. K.
Published: July 2009

This report is necessarily very brief, for its aim is to cover the radiation protection requirements of medical radiation generators of all descriptions — except heavy particles — including design, performance and use. The result is that diagnostic equipment is covered in 45 pages while less than half that space is allocated to therapy equipment. The remainder of the text deals with general aspects of radiation protection and the promotion of the NCRP. The preface confesses to “considerable duplication of recommendations in the report” particularly in the diagnostic section to avoid “the need to keep referring back to the basic recommendations…” The reader is constantly referred to other supporting texts including 21 other NCRP reports.
Book reviews
Authors: Lomas David J.
Published: July 2009

In 217 pages, this book partially achieves its aims of correlating cadaveric human sectional anatomy with MR and CT images.
Ultrasound appearances of extramedullary haematopoiesis in the liver and spleen
Authors: Bradley M. J. , Metreweli C.
Published: July 2009

Extramedullary haematopoiesis is an uncommon finding in the adult patient. Many sites have been described, the liver and spleen being more common. The ultrasound appearances have not been well documented. Two cases of extramedullary haematopoiesis in the liver and spleen are presented.

A 58-year-old man presented with a history of a cough, haemoptysis, dyspnoea and weight loss. On examination he had finger clubbing, no significant chest signs and hepatomegaly. A bronchial neoplasm was suspected clinically and the initial chest radiograph demonstrated a right lung mass adjacent to the hilum. Full blood count was normal and the erythrocyte sedimentation rate was raised at 52 mm/h. Bronchoscopy revealed extrinsic compression of the right upper lobe bronchus but biopsy was unsuccessful. Ultrasound examination of the abdomen demonstrated multiple echogenic lesions in an enlarged liver (Fig. 1). Some of these lesions contained central echo-poor areas. The spleen was of normal size, and contained one echogenic mass similar to those in the liver. No other abnormality was shown in the remainder of the abdomen and pelvis.

The most likely diagnosis for these lesions was metastatic carcinoma. Ultrasound-guided Trucut biopsy was performed. The lesion chosen was peripheral and without any central echopoor area.

Histology revealed immature and mature cells of the myeloid and erythroid series with occasional megakaryocytes. Dilated sinusoids and portal tracts contained pleomorphic infiltrate. These are the features of hepatic extramedullary haematopoiesis. An isotope bone scintigram using 99Tcm MDP revealed multiple hot spots in the femora, ribs, skull and spine, interpreted as being metastases.
Book reviews
Authors: Carr Denis H.
Published: July 2009

This book is an atlas of dynamic, contrast-enhanced CT scans of the mediastinum. It covers three areas, namely, technique, normal anatomy and abnormal anatomy. The quality of the CT images is acceptable rather than outstanding, although the anatomy and pathological features are clear on all scans. The book is well written and clearly laid out.
Book reviews
Authors: Pilling D. W. , Whitehouse G. H.
Published: July 2009

This book is divided into three parts. The first concentrates on the technique of hysterosalpingography and normal radiological appearances while the other sections are concerned with hysterosalpingographic findings in tubal and uterine abnormalities. The author's preference lies with the increasingly popular balloon catheter method for hysterosalpingography. Complications of the technique, as well as anatomical variants, are also described in the first section. A particular strength of the subsequent sections is a relating of clinical and pathological aspects to radiological findings. Further virtues are the large and clear illustrations, with the use of accompanying line drawings where appropriate, and a concise text with up-to-date references. The chapter on fallopian tube surgery is particularly good.
The relationship of “high risk” mammographic patterns to histological risk factors for development of cancer in the human breast
Authors: Arthur Justine E. , Ellis I. O. , Flowers C. , Roebuck E. , Elston C. W. , Blarney R. W.
Published: July 2009

In the UK Trial for the Early Detection of Breast Cancer in Nottingham, 119 women were identified as having fibrocystic change with epithelial hyperplasia or in situ carcinoma. Their mammograms were classified according to Wolfe's criteria and the corresponding histology for each patient was classified for degrees of epithelial hyperplasia, atypia and in situ neoplasia using Page's criteria. A control population of patients presenting for breast screening was used to represent the general population. No correlation was found between the four mammographic Wolfe patterns, Nl, P1, P2 and DY and histological evidence of epithelial hyperplasia, atypia or in situ carcinoma. A further study was carried out to determine histological features of Wolfe pattern, using radiological examination of resected breast tissue. The variation in Wolfe pattern was related to the distribution of fibrous and adipose tissue in the breast interlobular stroma and appeared to have no relationship to epithelial parenchymal content. This information does not support the hypothesis that radiographic densities of P2 and DY patterns correspond to high risk epithelial proliferation.
A survey of the radiation exposures received by the staff at two cardiac catheterization laboratories
Authors: McParland Brian J. , Nosil Josip , Burry Brian
Published: July 2009

Staff working in cardiac catheterization laboratories receive radiation exposures from primary radiation (if any part of their body is placed within the X-ray beam) or from secondary radiation due to scatter from the patient and image intensifier and to leakage from the X-ray tube. As a result, the radiation exposure distribution over a staff member's body is expected to be non-uniform. In order to evaluate the radiation somatic risk to be assigned to an individual, and to assess the efficacy of the personal shielding used, radiation exposures must be measured at specific anatomical locations.

In the study described here, radiation exposures received by catheterization laboratory personnel were measured at various body locations in two separate laboratories over 3–5 day periods. This study was initiated as a consequence of conventional radiation monitoring by the federal regulatory agency (Bureau of Radiation and Monitoring Devices, Health and Welfare Canada), which had indicated that occasional high exposures were received by some individuals.
Computed tomography in volvulus of the midgut
Authors: Paul A. B. , Dean D. M.
Published: July 2009

Herniation of the midgut into the umbilical cord and its rotation and return are normally complete by the tenth week of intra-uterine life. Abnormalities of this process lead to the various types of malrotation of the gut. These may lead to a variety of problems in extra-uterine life (Dott, 1923). We recently encountered a patient with such a condition which was diagnosed only at laparotomy. In retrospect the computed tomographic (CT) findings could have allowed a pre-operative diagnosis.
Multifocal central nervous system lesions and retropharyngeal lymphadenopathy on magnetic resonance imaging: an association that suggested progressive multifocal leukoencephalopathy in a patient with acute aphasia
Authors: Llewelyn J. G. , Valentine A. R. , Bradley C. , King K. , Gross M. L. P.
Published: July 2009

Progressive multifocal leukoencephalopathy (PML) is an uncommon condition associated almost exclusively with impaired host immunity. More recently it has been recognized as a complication of the acquired immunodeficiency syndrome (AIDS), occurring in as many as 3.8% of these patients (Krupp et al, 1985). It may, rarely, be the initial manifestation of primary HIV infection, and in documented cases presents as focal limb weakness, altered mental state, ataxia, visual loss, headache and speech or language disturbance (Berger et al, 1987). We report a case of PML which presented as an acute aphasia, and in whom the diagnosis of an immunodeficient state was suggested by the magnetic resonance imaging (MRI) finding of enlarged retropharyngeal lymph nodes.
A case of colonic defection
Authors: Butterworth Rosalind , Adams H.
Published: July 2009

A 76-year-old woman presented with a 6-month history of left iliac fossa pain, associated with alternating constipation and diarrhoea.

For 30 years she had suffered from severe, generalized osteoarthritis. A left knee arthroplasty had been performed 8 years previously but this subsequently failed. Arthrodesis was therefore undertaken with internal fixation using an intramedullary nail. The nail later fractured and the patient underwent further surgery to the left knee with bone grafting.
Book reviews
Authors: Pilling D. W.
Published: July 2009

Rapid advances in probe technology has lead to exploitation of a number of ultrasound endoprobes. This book explores in depth the use of endovaginal probes beginning with basic ultrasound, physics and instrumentation and a chapter on the method of examination, very necessary even for those experienced in abdominal ultrasound, as this technique is very different in image orientation.
Book reviews
Authors: Todd C. E. C.
Published: July 2009

Diagnostic and Interventional Radiology: A Clinical Manual is a pocket-sized book of 316 pages edited by three American radiologists with contributions from seven others. The stated aim of the authors is to provide a guide to the repertoire of the X-ray department, and how to get the best use from it, for medical students and newly qualified doctors.
Magnetic resonance imaging of primary skeletal muscle diseases: patterns of distribution and severity of involvement
Authors: Lamminen Antti E.
Published: July 2009

Magnetic resonance imaging of the lower extremities was performed with a low field system in 51 patients representing three different categories of biopsy-proven primary skeletal muscle disease: muscular dystrophies, congenital myopathies and polymyositis. The intermuscular distribution of abnormal signal intensity and the grade of involvement of individual muscles were assessed. Large differences in the degree of pathological signal intensity between individual muscles were found in all categories. In the muscular dystrophy and polymyositis patients, the overall involvement was significantly more severe than in patients with congenital myopathy. Definite patterns of selective involvement were seen. Statistical evidence of selective muscle sparing was found; the gracilis muscle was significantly less affected than the other muscles in all three disease groups. Other muscles with significant sparing include the rectus femoris and sartorius muscles of the thigh and the tibialis posterior muscle of the leg. Common anatomical and functional characteristics of muscles may be related to the distribution of muscular disease.
Book reviews
Authors: Evans S. E.
Published: July 2009

This book is one of a series which share a common format of case presentations, illustrated by appropriate imaging, with questions and answers included in the text.

It covers a wide variety of cardio-thoracic conditions, with emphasis on the more common, but including some rare congenital cardiac abnormalities.
Book reviews
Authors: Reidy J. F.
Published: July 2009

As the editor of this “state of the art” review points out, in the last 20 years there has been little change in invasive cardiology (angiography) but there have been considerable developments in non-invasive techniques so that now with the exception of coronary artery anatomy virtually every cardiac diagnosis can be made non-invasively.

This small volume aims to give an introduction and general account of these non-invasive cardiac imaging techniques to “anyone newly entering the field, either as a clinician or research worker”.
Book reviews
Authors: Wilson A. G.
Published: July 2009

This is the second edition of The Mediastinum, the first having appeared over 10 years ago in 1977, and, for those familiar with the book, it closely resembles the first edition with identical chapter headings and format. The contention of the author — that accurate radiological diagnosis is based on a thorough understanding of correlated radiographic anatomy and pathology — also remains the same and the book is a brilliant expose of this philosophy.

There are 10 chapters in all mostly concerned with separate regions of the mediastinum.
Book reviews
Authors: McNally N. J.
Published: July 2009

In her review of the first edition of this book, Dr Spittle commented on the absence of sections on cytotoxic chemotherapy and on statistics, but said it should be a standard text for Part 1 of the FRCR examination. In what is now a single author book, Professor Nias has expanded the text on chemotherapy but, correctly in my view, not included a chapter on statistics. The other comments by Dr Spittle are, in general, as valid for this edition as for the first.
Magnetic resonance angiography of abdominal vessels: early experience using the three-dimensional phase-contrast technique
Authors: Vock P. , Terrier F. , Wegmüller H. , Mahler F. , Gertsch Ph. , Souza S. P. , Dumoulin C. L.
Published: July 2009

Based on three-dimensional acquisition of three sequences sensitive to one flow-direction, abdominal magnetic resonance phase-contrast angiography (MRA) was performed in 13 volunteers and 20 patients. The subjects received no antiperistaltic medication and were allowed to breath normally during the three acquisition periods of 11 minutes. The frequency of demonstration of the normal aorta, superior mesenteric and right and left renal arteries was 100%/100%/91%/100%, and of the inferior vena cava, splenic, superior mesenteric and portal veins was 92%/67%/92%/100%, respectively, whereas other abdominal vessels were seen less constantly. In renal artery stenosis or occlusion, MRA detected eight out of nine pathological arteries, missed only a minimal stenosis and was never false positive. In all 10 cases of portal hypertension, MRA demonstrated the venous collaterals detected by conventional angiography and in six cases showed more collaterals, particularly paravertebral vessels. A Budd–Chiari syndrome was investigated as well. If the accuracy of MRA can be proved in larger studies, it may become an important diagnostic tool in evaluating abdominal vascular pathology, such as renal artery stenosis or portal hypertension.
The effect of sodium iothalamate on the vascular resistance of the isolated perfused rat kidney
Authors: Haylor J. L. , El Sayed A. A. , EI Nahas A. M. , Morcos S. K.
Published: July 2009

The direct effects of sodium iothalamate on renal vascular resistance (RVR) were examined using the isolated perfused rat kidney experimental model. A concentration-dependent biphasic change in RVR was produced with the hyperosmolar solution of sodium iothalamate [(Conray 420), 420 mgl/ml, 2500 mOsmol/kg/H2O]. The response characterized by an initial fall followed by a prolonged increase in RVR on discontinuation of the iothalamate infusion. No significant change in RVR was observed when iothalamate was infused as an iso-osmotic solution (60 mgl/ml, 280 mOsmol/kg/H2O) at a rate of 0.525 ml/min. to produce a concentration of 4.2 mgl/ml in the renal perfusate. We conclude that sodium iothalamate can exert direct biphasic effects on RVR which are mediated by its hyperosmolality rather than its chemical content.
Book reviews
Authors: Henk J. M.
Published: July 2009

This is a compact volume of just over 200 pages, edited by two ENT surgeons, with contributions from six other surgeons, an anatomist, a pathologist and a radiotherapist. It deals with cancer of the oral cavity and oropharynx, concentrating mainly on squamous carcinoma with only a brief mention of other types of tumour.
Neuroblastoma of the tail of the pancreas in childhood
Authors: Hoeffel J. C. , Galloy M. A. , Schmitt C. , Schmitt M.
Published: July 2009

We report a rare case of this condition in a child 4 years old, with the computed tomography and ultrasound findings.

A 4-year-old boy presented with a firm, non-tender left upper quadrant abdominal mass. There was mild fever and moderatee anaemia. Plain radiographs of the abdomen revealed an opacity in the left upper quadrant with calcification.
Measurement of time-averaged flow in the middle cerebral artery by magnetic resonance imaging
Authors: Tarnawski Maria , Padayachee Soundrie , Graves Martin J. , Taylor M. Graeme , Ayton Victoria T. , Smith Michael A.
Published: July 2009

Magnetic resonance imaging (MRI) sequences have been developed specifically for the quantitative evaluation of blood flow in vessels. The most promising sequences are those utilizing gradient field echoes to produce two interleaved images with a velocity-induced phase difference between images (Firmin et al, 1987; Ridgeway & Smith, 1987). Velocity values within a pixel can be extracted by subtraction of the images, producing a phase map where the phase is directly proportional to velocity. It is generally accepted that there is a lower limit to the size of vessel in which flow can be measured owing to the resolution restriction imposed by the image pixel size. This constraint is due to the partial volume effect, in which a pixel covering a vessel edge may contain both stationary tissue and flowing blood, and as a consequence produces limitations in the accurate measurement of vessel cross-sectional area.

Conventional methods of flow calculation generally combine a measure of the vessel cross-sectional area with the mean velocity. In small vessels, where the pixel size is a significant proportion of the vessel diameter, significant errors can occur in both the measurement of the mean velocity and, more importantly, in the cross-sectional area. In the latter a 10% error results in a 20% error in the flow.

The problems posed by the measurement of time-averaged flow using MR in small vessels can be solved using a simple theoretical evaluation of the partial volume effect.
Central venous catheter placement for intravenous digital subtraction angiography: an assessment of technical problems and success rate
Authors: Sharma S.
Published: July 2009

I read the article by Barber (1989) with great interest. I compliment the author for highlighting the frequently encountered but rarely reported problems related to central venous catheterization. Venous spasm in the arm is, indeed, a problem in catheterizing the cephalic vein, especially if J-guide wire is used. Some time ago, I switched over to using RadiofocusTM guide wire M (Terumo Corp., Tokyo) for catheterization of the right atrium by upper extremity venous route. In the last 100 consecutive unselected patients who underwent intravenous digital subtraction angiography (IV-DSA) by this route, I have used this guide wire and have seen no instance of dissection and only two instances of venous spasm, both related to the cephalic venous puncture.
Acute spinal cord injury: magnetic resonance imaging correlated with myelopathy
Authors: Yamashita Yasuyuki , Takahashi Mutsumasa , Matsuno Yasuharu , Kojima Ryutaro , Sakamoto Yuji , Oguni Tasturo , Sakae Terumi , Kim E. Edmund
Published: July 2009

Thirty-one patients (29 males and two females, 13–87 years of age (mean, 46.7 years)) with acute spinal cord injury were studied by MR (magnetic resonance) imaging and the results were correlated with neurological findings. Magnetic resonance images were obtained with a 0.5 T superconductive MR scanner (Phillips Gyroscan S5). Initial imaging was performed within 24 hours after trauma in 13 patients, 1–7 days in 13 patients and 7–14 days in five patients. Twenty-six patients underwent follow-up examinations with MR imaging. Cord abnormalities including cord compression (23 patients), cord swelling (seven patients), and abnormal signal intensities on either T  1 or T  2 weighted images (26 patients) were observed on initial examination. Multivariate analysis showed that cord compression and abnormal intensities on T  1-weighted images were important prognostic indicators. Hyperintensity on T  2-weighted images was non-specific but correlated well with clinical recovery. Magnetic resonance imaging is useful in predicting the prognosis and for planning treatment following spinal cord injuries.
In vivo phosphorus-31 magnetic resonance spectroscopy of normal and pathological breast tissues
Authors: Redmond O. M. , Stack J. P. , O'Connor N. G. , Codd M. B. , Ennis J. T.
Published: July 2009

In vivo phosphorus-31 magnetic resonance spectroscopy, at 1.5 T, in addition to magnetic resonance imaging and mammography, was performed on the breast tissue of 59 subjects, using a 40 mm or 80 mm surface coil for spectral localization. The patients were divided into three groups: Group 1, 46 control subjects; Group 2, nine patients with breast carcinoma; Group 3, four patients with benign breast disease. The relationship of age, menopausal status, breast size and pattern, use of contraceptive pill and history of breast disease to spectral characteristics of breast tissue was examined for the control group. In multivariate analysis, only menopausal status and age were found to be significantly related to tissue biochemistry. Pre-menopausal women had reduced phosphocreatine (PCr) (%) (p = 0.02), and increased phosphomonoesters (PMEs) and β-nucleotide triphosphate (β-NTP) (%) (p = 0.05), while the fat-to-water ratio was higher in older women (p = 0.02). No significant differences were identified between the control subjects and the patients with benign breast disease. When spectra from patients with breast carcinoma were compared with an age-matched volunteer group, α- and γ-NTP (%) were found to be higher in the cancer tissue (p < 0.01 and p = 0.01, respectively), while PCr (%) was reduced (p < 0.01). The ratio β-NTP:PCr was higher in the carcinoma group of patients (p < 0.05). In vivo phosphorus-31 magnetic resonance spectroscopy is a non-invasive examination which may prove useful in the early differentiation of malignant breast disease from normal and benign conditions.
Ultrasound of the pelvis and renal tract combined with a plain film of abdomen in young women with urinary tract infection: can it replace intravenous urography? A prospective study
Authors: McNicholas M. M. J. , Griffin J. F. , Cantwell D. F.
Published: July 2009

Urinary tract infection (UTI) is common in women and intravenous urography (IVU) is a frequently requested radiological investigation for recurrent UTI. The aim of this study was to assess whether pelvic and renal ultrasound combined with a plain film of the abdomen (KUB) could replace IVU as the initial radiological investigation in young women with recurrent UTI. Ninety-four young women with recurrent UTI who were referred for IVU were studied. Ultrasound of the pelvis and renal tract was performed, and information obtained from ultrasound and KUB was compared with that obtained from the IVU examination. Patient management was altered as a result of radiological investigation in eight cases. A case of staghorn calculus and a case of pelviureteric junction obstruction were diagnosed by both IVU and ultrasound with KUB. An intrarenal abscess was diagnosed by ultrasound in a patient with a normal IVU. In addition ultrasound demonstrated significant findings in the pelvis, including ovarian and uterine abnormalities and an ectopic and an intrauterine pregnancy. In all cases the patient had symptoms referable to the urinary tract and a history of documented UTI. The KUB did not yield any unsuspected finding not diagnosed by ultrasound, but did serve to delineate more clearly the extent of calculus disease in two patients. We suggest that ultrasound of the pelvis and renal tract combined with a KUB should be the radiological investigation of choice in young women with UTI.
Concomitant pelvic irradiation, 5-fluorouracil and mitomycin C in the treatment of advanced cervical carcinoma
Authors: Khoury G. G. , Bulman A. S. , Joslin C. A. F. , Rothwell R. I.
Published: July 2009

This was a Phase II study of 24 late (FIGO) Stage IIb and 39 Stage III patients. External beam radiotherapy was given daily, five days a week, using 15 × 15 cm parallel opposed pelvic fields. The first 20 patients had 45.00 Gy mid-plane dose in 20 fractions, Days 1–28, the last 43 patients had 50.40 Gy in 28 fractions, Days 1–43. This was followed by an intracavitary boost of 17.00 Gy to Point A in two fractions over seven days. The first seven patients had concomitant 5-fluorouracil (5FU) 1 g/m2day (maximum 1.5 g/day) Days 2·5, 30–33 and 57–60, with mitomycin C 10 mg/m2 (maximum 15 mg) Days 2 and 57. Two patients had WHO Grade 4 cytopenia, and only two were able to have full dose intensity. The 5FU dose was reduced to 0.8 g/m2/day, for Days 2–5 and 30–33; mitomycin C was given on Day 2 only. Treatment morbidity with the reduced chemotherapy intensity was comparable with that of radiotherapy alone. Median follow-up was 16 months (range 6–44). Median survival was 35 months. The results were compared with historical controls treated using the same radiation method alone. Two-year survival for late Stage IIb patients was 67% with the combination and 72% with radiotherapy alone; for Stage III, 67% and 49% respectively. Two-year pelvic control for late Stage IIb was 87% (combination) and 84% (radiotherapy alone) and for Stage III, 61% and 55% respectively. In contrast to reports from other centres, these results do not show an overall significant improvement on radiotherapy alone. A Phase III study may not be practicable.