bluuebunny/crossref_metadata_2025 huggingface dataset:
Splenectomy of the fetal lamb early in development as a model for congenital asplenia
Authors: King Karen J. , Mccullagh Peter
Published: March 2003

Background: The liability to overwhelming infection of children lacking a spleen either as a result of its congenital absence or because of splenectomy, has been frequently documented. Although there have been numerous studies of the consequences of experimental splenectomy in postnatal animals, this is the first study of the effects of this operation in early fetal life.

Methods: A technique is described for microsurgical removal of the spleen from fetal lambs approximately one‐third of the way through gestation, when the fetus is approximately the size of a mouse. Lambs that had been splenectomized in utero were submitted to haematological examination in postnatal life and were challenged with pneumococcal polysaccharide to test their immunological competence.

Results: Lambs in which splenectomy had been performed close to the gestational age of initiation of the splenic contribution to differentiation of immune and haemopoietic systems, exhibited insignificant deviations from normality in postnatal life.

Conclusion: Provided the spleen is removed from the fetal lamb sufficiently early in gestation, it is possible for other lymphoid tissues to compensate for most of the deficiencies that would be anticipated in animals lacking a spleen. In this experiment, splenectomy was performed at approximately the developmental stage equivalent to that at which the spontaneous interruption of development that leads to human congenital asplenia occurs. The absence of major postnatal abnormalities observed in these lambs reinforces the significance of the associated abnormalities in the development of the clinical deficits observed in children with spontaneous asplenia.
Implementing guidelines about colorectal cancer: A national survey of target groups
Authors: Gattellari Melina , Ward Jeanette , Solomon Michael
Published: March 2003

Background: An Australia‐wide postal survey was undertaken to determine surgeons’ attitudes towards guidelines and their preferred strategies for dissemination and implementation of guidelines for the management of colorectal cancer, developed by the Australian Cancer Network (ACN) and the Clinical Oncological Society of Australia (COSA). This survey was conducted as a baseline before the release of the definitive guidelines.

Methods: All members of the Royal Australasian College of Surgeons (RACS) with a self‐nominated special interest in colorectal surgery and members of the Colorectal Surgical Society of Australia (CSSA) were surveyed.

Results: A total of 195 of the 219 surgeons eligible for the study returned questionnaires (89% response rate). Most (86%) were aware that these guidelines were being developed. More than one‐half had read at least one draft version. Almost half (44.6%; 95%CI: 37.6–51.9%) agreed that guidelines represented ‘cookbook medicine’ and one‐third (33.3%; 95%CI: 26.9–40.5%) agreed that guidelines might increase the number of malpractice suits. Local adaptation of guidelines and ‘academic detailing’ were most favourably ranked to assure implementation. Further, 54.9% (95%CI: 47.6–61.9%) of respondents believed that a successful legal defence of a surgeon whose practice had been within the guidelines would encourage uptake. Surgeons operating outside teaching hospitals were more likely to endorse this view than others.

Conclusions: These results demonstrate that an important target group for colorectal cancer guidelines, namely surgeons, appears receptive to clinical practice guidelines. These results could also permit interventions that target attitudinal barriers to implementing guidelines and subgroups of surgeons who have particular concerns. Expensive strategies for implementation ought to be subject to rigorous evaluation for their impact in modifying clinical practice.
Cronic radiation proctitis
Authors: Tagkalidis Peter P. , Tjandra Joe J.
Published: March 2003

Background: Increasing use of radiation therapy in pelvic malignancy has led to an increase in the incidence of chronic radiation proctitis. The commonest presenting complaint is rectal bleeding.

Methods: A comprehensive MEDLINE search was undertaken for all articles relating to radiation proctitis.

Results: The natural history of the disease is poorly documented but improvement is likely in milder forms, with persistence of symptoms in more severe forms. The pathological manifestations of the disease are summarized with particular comparison to acute radiation proctitis. The common clinical presentations and the principles of assessing patients with radiation‐induced proctitis will be reviewed. The present article also reviews current treatment options, with particular reference to newer endoscopic therapies and surgical principles of management.

Conclusions: The initial therapy for problematic rectal bleeding related to radiation‐induced proctitis shoud be endoscopic therapy with argon plasma coagulation or topical formalin therapy. Surgery is reserved as a last resort for resistant rectal bleeding and for complicated radiation‐induced strictures and fistulas.
Diagnostic accuracy of vacuum‐assisted biopsy device for image‐detected breast lesions
Authors: Hung Wai‐Ka , Lam Hon‐Shing , Lau Yvonne , Chan Chi‐Mui , Yip Andrew Wai‐Chun
Published: March 2003

Background: Non‐palpable breast lesions present diagnostic difficulties. Ultrasound‐guided fine‐needle aspiration cytology (FNAC) is a common method used to obtain a diagnosis, but FNAC is frequently inconclusive or insufficiently accurate. Recently a vacuum‐assisted biopsy device (Mammotome®, Ethicon, Endo‐surgery, USA) has been introduced. The diagnostic accuracy of this biopsy device was assessed for lesions that were visible on ultrasound.

Methods: Fifty ultrasound‐guided mammotome biopsies were performed. All were small breast lesions primarily detected by ultrasound. All received FNAC as initial assessment. Mammotome biopsy was performed whenever the breast lesion was considered indeterminate or if it was considered benign and there were associated risk factors such as a family history of breast cancer.

Results: Of 50 mammotome biopsies 45 had benign histology. Three of 45 lesions were excised at the patients’ request and were confirmed to be benign. The remaining 42 patients received an ultrasound follow up at 6 months. The lesion size remained static in 39 patients. In three patients the lesion size increased and they were excised and histology was benign. For the four malignancies diagnosed with mammotome biopsy, three patients received definitive treatment and one patient defaulted. There was one failed mammotome biopsy in the present series.

Conclusions: Mammotome biopsy is an acceptable diagnostic method for small breast lesions seen on ultrasound. It reduces the need for open biopsy without compromising diagnostic accuracy.
The Australian Health Care Agreement 1998–2003: Implications and strategic directions for occupational therapists
Authors: Brandis Susan
Published: March 2003

Funding for public health services in Australia is provided to the States and Territories from the Commonwealth. Contractual obligations for how these monies are allocated are detailed in the Australian Health Care Agreement 1998–2003, which has replaced the Medicare Agreement 1993–1998. Key issues identified in the new Agreement, which will impact on occupational therapy services, include arrangements for mental health services, palliative care initiatives, casemix, health system reform, and private health insurance. Particular implications stem from the proposed reforms to the health system. These include the quality agenda, outcome‐based funding and evidence‐based practice. Other themes identified include future opportunities for occupational therapists working in health services and the imperative to form collaborative partnerships with consumers and other health care providers. The Australian Health Care Agreement is analysed and suggestions given for strategic directions for occupational therapists to consider.
Patients’ perceptions of home health occupational therapy
Authors: Boutin‐Lester Paige , Gibson Robert W.
Published: March 2003

Home health occupational therapy plays an important and growing role in patients’ recovery. Home health treatment is unique in that the therapist is a visitor in the patient’s home environment. A phenomenological approach was used to examine perceptions of five individuals who were interviewed twice to collect their impressions of home health occupational therapy. Participants’ goals for therapy as solicited by home health occupational therapists and participants perceived goals were not always pursued collaboratively. Therapeutic and compensatory occupations were incorporated less often than purposeful exercise. Participants valued those occupations engaged in, despite limited physical recovery. Participants’ perceptions of occupational therapists were generally positive. Participants were unprepared for discharge, which was perceived as significant and they as helpless to prevent it despite desire for continued services. Few occupations reported in their treatment coincided with participants’ difficulty distinguishing between occupational and physical therapies. Continued research focused on patients’ perceptions of home health occupational therapy would be useful in further examining this phenomenon and would enlighten home health occupational therapy practice.
Twin ectopic pregnancy 10 years after permanent sterilization
Authors: Ansari Selim M. , Nessa Lutfun , Saha Samiran K.
Published: March 2003

An ectopic twin pregnancy was reported in a 37‐year‐old woman with a history of tubectomy for permanent sterilization 10 years earlier. Ectopic pregnancy is common, but twin ectopic pregnancy is a rarer case.
Mesenteric Castleman’s disease: Ultrasound, computed tomography and angiographic appearance
Authors: Malara Fa , Price D , Fabiny R
Published: March 2003

The localized form of Castleman’s disease is rare, and a mesenteric location is particularly unusual. A case of an asymptomatic young woman having the hyaline vascular type is presented and the ultrasound, CT and angiographic features of the condition are demonstrated.
Functional entrapment of the popliteal artery
Authors: Sperryn Cw , Immelman Ej
Published: March 2003

A case of functional entrapment missed at the initial angiogram is presented. The imaging of popliteal artery entrapment syndrome and functional entrapment is discussed. The importance of appropriate imaging is emphasized. The classification of popliteal artery entrapment syndrome is discussed and it is proposed that functional entrapment is added to the existing classification in the interest of consistent reporting.
The value of narrow CT window settings in the recognition of subtle acute aortic intramural haematoma
Authors: Holden Andrew
Published: March 2003

Four patients with acute aortic intramural haematoma are presented. In all patients the typical crescentic hyperdense rim within the aortic wall was not obvious on unenhanced CT when reviewed on standard mediastinal windows, but the hyperdense crescentic rim was well seen on narrow window settings. The findings suggest that all patients with a typical clinical presentation of acute thoracic aortic dissection who do not have a classical dissection on contrast‐enhanced CT or a hyperdense intramural haematoma on standard mediastinal settings, should have the non‐contrast scans reviewed on narrow window settings.
Decision‐making models in the analysis of portal films: A clinical pilot study
Authors: See Andrew , Kron Tomas , Johansen Jørgen , Hamilton Chris , Bydder Sean A , Hawkins Janelle , Roff Marianne , Denham James W
Published: March 2003

Portal films continue to play an important role in the verification of radiotherapy treatment. There is still some discussion, however, as to what action should be taken after a port film has shown a radiation field deviation from the prescribed volume. It was the aim of the present pilot study to investigate the performance of three decision‐making models (‘Amsterdam’, ‘Quebec’ and ‘Newcastle’) and an expert panel basing their decision on intuition rather than formal rules after portal film acquisition in a clinical setting. Portal films were acquired on every day during the first week of treatment for five head and neck and five prostate cancer patients (diagnostic phase). If required, the field position was modified according to our normal practice following the recommendation of the expert panel. In order to analyse the results of the models, however, additional port films were taken in the following 3 treatment weeks with the patient moved as required by the different models (intervention phase). The portal films were taken over 4 consecutive days, positioning the patient according to each of the different models on one day each. None of the models diagnosed a field misplacement in the head and neck patients, while the ‘Amsterdam’ and ‘Quebec’ models predicted a move in one prostate patient. The ‘Newcastle’ model, which is based on Hotelling’s T 2 statistic, proved to be more sensitive and diagnosed a systematic displacement for three prostate patients. The intervention phase confirmed the diagnosis of the model, even if the three portal films taken with the patient position adjusted as required by the model proved to be insufficient to demonstrate an improvement. The ‘Newcastle’ model does not rely on assumptions about the random movement of patients and requires five portal films before a decision can be reached. This approach lends itself well to incorporation into electronic portal imaging ‘packages’, where repeated image acquisitions present no logistical difficulty.
Projected requirements for radiation oncologists and trainees in Australia and New Zealand to 2007
Authors: Morgan Graeme , Wigg David , Childs John
Published: March 2003

Workloads in radiation oncology facilities in Australia and New Zealand have been increasing steadily for many years and it is anticipated that this trend will continue. In the present paper the projected number of radiation oncologists required to meet this demand to the year 2007 are estimated, along with the number of trainees required. The estimates are based on data from regular surveys by the Royal Australian and New Zealand College of Radiologists (RANZCR) for the years 1988–97 (inclusive). From these surveys profiles of numbers, age and gender of specialists and trainees are documented together with increases from the training programme and losses from retirement. It is concluded that if the current trainee numbers are increased by 12 in Australia and two in New Zealand, there will be approximately 10 radiation oncologists per million of population by the year 2007. This number is considered appropriate considering the anticipated increase in demands and complexity of treatment. Because projections too far forward are unreliable, careful monitoring of progress is essential to obtain the appropriate balance between requirement and supply. Comparisons are made with other estimates of needs including the 1998 Australian Medical Workforce Advisory Committee (AMWAC) Report and the New Zealand Clinical Agency Workforce Project Report in 1997.
Candida jejunitis: A rare cause of intestinal pneumatosis in the immunocompromised patient
Authors: Tie Mark Lh , Stephens David H
Published: March 2003

A case of fatal necrotizing jejunitis caused by Candida albicans is described in a patient with acute myeloid leukaemia undergoing chemotherapy. The diagnosis was made at autopsy. Computed tomography findings were of small bowel dilatation with pneumatosis.
Atrial myxoma demonstrated by cine gradient refocused echo magnetic resonance imaging
Authors: Puvaneswary M , Edwards Jrm , Bastian Bc , Bellamy Gr , Khatri Sk
Published: March 2003

A case of atrial myxoma presenting with syncope evaluated by echocardiography and MRI is described. Cine gradient‐echo MRI demonstrated atrial myxoma as a very low signal intensity mass indicating the presence of haemosiderin.
Segmental infarction of the omentum secondary to torsion: Ultrasound and computed tomography diagnosis
Authors: Stella Dl , Schelleman Tg
Published: March 2003

Segmental infarction of the omentum is a rare clinical entity that is seldom considered in the differential diagnosis for acute abdominal pain, especially as the clinical findings are so non‐specific. Consequently, the diagnosis is usually made intraoperatively. The two cases presented here demonstrate the characteristic appearance of omental infarction on ultrasound and CT, which enables preoperative diagnosis. Preoperative radiological diagnosis may prevent unnecessary surgery.
Rhombencephalosynapsis
Authors: Scroop R , Sage M , Voyvodic F
Published: March 2003

A case report of rhombencephalosynapsis in a 34‐year‐old female is presented and the clinical features and possible pathogenesis of this disorder are reviewed.
Percutaneous transhepatic changing of an endoscopically placed stent
Authors: Cameron Dc , Styles Cl
Published: March 2003

Biliary stents are commonly positioned for the relief of obstructive jaundice secondary to malignancy. It is occasionally necessary to percutaneously replace a biliary stent placed by the endoscopist. This is usually because there has been progression of the tumour, which has prevented further endoscopic access. The technique described has real merit since it can further extend palliation.
Contrast media and the brain. The basis of computed tomography and magnetic resonance imaging enhancement: A review
Authors: Sage Michael R , Wilson Alan J , Scroop Rebecca
Published: March 2003

The blood, cerebrospinal fluid (CSF), and extracellular fluid of the parenchyma form the fluid compartments of the brain with three interfaces between, namely the blood–brain interface (BBB), the CSF–brain interface, and the blood–CSF interface. When either water‐soluble iodinated contrast media (CM) or water‐soluble paramagnetic CM are injected intravenously, they are rapidly brought into contact with both the BBB and the blood–CSF interface. It is the behaviour of the water‐soluble CM at these two interfaces that determines the normal and abnormal enhancement patterns demonstrated by either CT or MRI. Unlike lipophilic solutes, current iodinated and MRI contrast media all have high affinities for plasma water, low affinities for plasma proteins and, in particular, extremely low partition coefficients. Therefore they do not penetrate the normal BBB. On the other hand, radiopharmaceuticals used in positron emission tomography (PET) and single photon emission computed tomography (SPECT) to demonstrate regional cerebral blood flow are highly lipophilic and readily cross the intact BBB completely during the first pass through the cerebral vasculature. It is the inability of the current iodinated and MRI contrast media to cross the normal intact BBB that is the basis of their use in CT and MRI studies of the brain.
Value of a contrast agent in equivocal carotid ultrasound studies: Pictorial essay
Authors: Holden Andrew , Hope John Ker Ayton , Osborne Mark , Moriarty Maurice , Lee Kevin
Published: March 2003

The aim of the present study was to assess the use of an echo‐enhancing agent (Levovist; Schering AG) in equivocal carotid bifurcation ultrasound studies and compare the information obtained with digital subtraction angiography (DSA). Contrast‐enhanced carotid ultrasound studies were performed on 30 carotid bifurcations in 28 patients. The standard carotid ultrasound examinations were considered equivocal for two reasons: apparent acute internal carotid artery occlusions (n = 10), and possibly patent but critically stenosed internal carotid arteries with the residual flow lumen being incompletely visualized (n = 20). All patients underwent subsequent carotid digital subtraction angiography. All patients with apparent acute carotid occlusions (n = 10) were correctly characterized on contrast‐enhanced ultrasound when compared with DSA. The majority were complete occlusions (n = 8) although in two cases there were critical carotid stenoses requiring surgical endarterectomy. In the ‘incompletely visualized lumen’ group (n = 20), the majority (n = 16) were correctly characterized on contrast enhanced ultrasound: 13 cases of critically stenotic but patent internal carotid arteries, two cases without a haemodynamically significant stenosis and one case of a carotid occlusion with patent vasa vasorum. One of the critical carotid stenoses was prospectively reported as occluded on the ‘gold standard’ angiography. In three cases the flow lumen was still incompletely visualized due to calcified plaque despite an echo‐enhancing agent; angiography revealed no significant stenosis in all cases. There was one false negative for internal carotid occlusion. This occurred early in the series and could be considered to be a technical error. Importantly, there were no false positives for carotid occlusion. Contrast‐enhanced carotid ultrasound significantly improves diagnostic confidence in equivocal carotid ultrasound studies. In appropriate clinical settings this may reduce the need for subsequent carotid angiography.
Subsequent investigation and management of patients with intermediate‐category and ‐probability ventilation–perfusion scintigraphy
Authors: Walsh Geraldine , Jones D Neil
Published: March 2003

The authors wished to determine the proportion of patients with intermediate‐category and intermediate‐probability ventilation–perfusion scintigraphy (IVQS) who proceed to further imaging for investigation of thromboembolism, to identify the defining clinical parameters and to determine the proportion of patients who have a definite imaging diagnosis of thromboembolism prior to discharge from hospital on anticoagulation therapy. One hundred and twelve VQS studies performed at the Flinders Medical Centre over a 9‐month period were reported as having intermediate category and probability for pulmonary embolism. Medical case notes were available for review in 99 of these patients and from these the pretest clinical probability, subsequent patient progress and treatment were recorded. Eight cases were excluded because they were already receiving anticoagulation therapy. In the remaining 91 patients the pretest clinical probability was considered to be low in 25; intermediate in 30; and high in 36 cases. In total, 51.6% (n = 47) of these patients (8% (n = 2) with low, 66% (n = 20) with intermediate, and 69.4% (n = 25) with high pretest probability) proceeded to CT pulmonary angiography (CTPA) and/or lower limb duplex Doppler ultrasound (DUS) evaluation. Of the patients with IVQS results, 30.7% (n = 28) were evaluated with CTPA. No patient with a low, all patients with a high and 46% of patients with an intermediate pretest probability initially received anticoagulation therapy. This was discontinued in three patients with high and in 12 patients with intermediate clinical probability prior to discharge from hospital. Overall, 40% of patients discharged on anticoagulation therapy (including 39% of those with a high pretest probability) had a positive imaging diagnosis of thromboembolism The results suggest that, although the majority of patients with intermediate‐to‐high pretest probability and IVQS proceed to further imaging investigation, CTPA is relatively underused in this group. Most patients with a high pretest clinical probability receive anticoagulation therapy irrespective of imaging findings, and less than half of all patients discharged from hospital on anticoagulation therapy have a positive imaging diagnosis of thromboembolism.
Perineural spread leading to orbital invasion from skin cancer
Authors: Veness Michael J , Biankin Sandra
Published: March 2003

Orbital and intracranial invasion from skin cancer is an uncommon but serious consequence of skin cancer located around the orbit, particularly the forehead. Perineural spread is an aggressive manifestation of skin cancer similar to lymph node metastases. Such spread can provide access to the orbit and squamous cell carcinoma is the most common histology reported. Treatment should be directed at preventing such orbital spread. Adjuvant radiotherapy is strongly recommended. Disease may present in an advanced state within the orbit or beyond the orbital apex and involve the cavernous sinus. Palliative radiotherapy should be considered in such advanced cases. Presented are the cases of four patients treated for advanced orbital and intracranial spread from periorbital skin cancer.
Cortical blindness after subclavian arteriography
Authors: Boyes Lyn A , Tew Khimseng
Published: March 2003

Transient cortical blindness is a rare complication of angiographic contrast use. A 64‐year‐old man experienced transient cortical blindness after subclavian arteriography for an occluded axillofemoral graft. The literature on transient cortical blindness is reviewed.
Magnetic resonance findings in knee dislocation: Pictorial essay
Authors: Coates Mark , Stewart Neal , Morganti Vicki , Twaddle Bruce
Published: March 2003

Magnetic resonance images depicting the range of soft‐tissue and bony injuries associated with knee dislocation are presented. Those injuries that are less well described or more difficult to diagnose are emphasized.
Value of pharyngography in patients without suprasternal symptoms
Authors: Low Vincent Hs , Sitarik Kathleen M
Published: March 2003

The purpose of the present paper was to determine if pharyngeal or cervical oesophageal lesions may present with distal symptoms. All patients presenting for barium swallow underwent examination of the pharynx and oesophagus. The pharyngeal examination included spot films of the pharynx as well as views of the pharyngo‐oesophageal segment filmed at three frames per second. During the 18‐month period of the present study interrogations were carried out to identify patients without symptoms in the cervical or suprasternal region. One hundred and twelve patients were identified; 58 were male and 54 were female. The age range was 18–84 years. Examinations revealed abnormalities within the pharynx in 42 patients (38%); of this group of 42, 34 also had an oesophageal abnormality. The majority of the pharyngeal findings were minor. There were, however, three patients who each had a pharyngeal abnormality (pharyngeal carcinoma, obstructive cricopharyngeal narrowing, pharyngo‐oesophageal junction stricture) as well as an oesophageal lesion (hiatal hernia, achalasia, reflux oesophagitis), either of which may have been the source of the symptoms. The remaining eight patients (7%) of this group of 42 with detected pharyngeal abnormality had normal oesophageal examinations. Most of these were again minor changes and were unlikely to be significant. There was, however, one patient in whom the only abnormality was an infiltrative cancer of the posterior wall of the pharyngo‐oesophageal junction. In conclusion, the identification of patients in the present study with pharyngeal lesions and without distal abnormal findings indicates that a proximal lesion may present with downstream symptoms. Furthermore, there were also patients in whom the examination found abnormalities in multiple segments of the pharynx and oesophagus. We suggest that examination of the pharynx is warranted as part of the barium swallow in patients without cervical or suprasternal symptoms.
Magnetic resonance imaging of lipoma and liposarcoma: Potential of short tau inversion recovery as a technique of fat suppression
Authors: Pang Alan Kwok Kuen , Hughes Tudor
Published: March 2003

The present limited retrospective study was performed to assess MR imaging of lipomatous tumours of the musculoskeletal system and to evaluate the potential of the T2 short tau inversion‐recovery (STIR) technique for differentiating lipomas from liposarcomas. Magnetic resonance imaging of 12 patients with lipomatous tumours of the musculoskeletal system (eight benign lipomas, three well‐differentiated liposarcomas and one myxoid liposarcoma) were reviewed. Benign lipomas were usually superficial and showed homogeneity on T1‐ and T2‐weighted spin echo sequences. Full suppression at T2 STIR was readily demonstrated. In contrast, the liposarcomas in the present series were all deep‐seated. Two well‐differentiated liposaromas showed homogeneity at long and short relaxation time (TR) but failed to show complete suppression at T2 STIR. One case of well‐differentiated liposarcoma (dedifferentiated liposarcoma) and one of myxoid liposarcoma showed mild and moderate heterogeneity at T1 and T2, respectively, and posed no difficulty in being diagnosed correctly. In conclusion, short and long TR in combination with T2 STIR show promise in differentiating benign from malignant lipomatous tumours of the musculoskeletal system, when taken in combination with the position of the tumour.
How do waiting times affect radiation dose fractionation schedules?
Authors: Franklin Conrade Iv , Poulsen Michael
Published: March 2003

The purpose of the present paper was to evaluate the changing patterns of dose prescription at the Queensland Radium Institute from 1995 to 1998 inclusive. Data were analysed from the treatment files collected on each patient and these were compared with data on delay time. There has been an increased use of shorter fractionation schedules in the period studied. Paradoxically, radical treatments have become longer. The average number of fractions for all patients was 17.4 and for palliative treatments it was 7.4. The monthly delay varied from 0 to 22 working days and the average was 7 working days. When fraction number was compared to treatment delay, there was a negative linear correlation (R = –0.25). The correlation was stronger (R = –0.467) when palliative treatments were compared, indicating that clinicians were more prepared to alter palliative treatments in the presence of a treatment delay than curative ones.
Magnetic resonance imaging of the wrist in early rheumatoid arthritis: A pictorial essay
Authors: Stewart Neal R , McQueen Fiona M , Crabbe Jeffrey P
Published: March 2003

This pictorial essay describes the changes seen in the wrist in early rheumatoid arthritis (RA) on MRI. Magnetic resonance imaging can demonstrate bone erosions, bone marrow signal changes, synovitis and tenosynovitis in early rheumatoid arthritis. Magnetic resonance imaging of the wrist can identify erosions in RA earlier than plain radiographs and can detect more erosions. Common sites include the capitate, lunate and scaphoid. Bone marrow signal changes occur frequently and are most common in the capitate, lunate and triquetrum. Synovial thickening and enhancement are clearly demonstrated with MRI and are most commonly seen in the radiocarpal joint (RCJ). Tenosynovitis can be seen in the wrist in more than half of patients presenting with RA. This most commonly involves the extensor carpi ulnaris tendon and is seen as sheath fluid, thickening and enhancement.
Central nervous system aspergillus infection complicating renal transplantation
Authors: Coates Mark , Wilson John
Published: March 2003

A case of catastrophic intracerebral haemorrhage secondary to aspergillus infection in an immunocompromised renal transplant patient is presented. The pathological features and related images are described and the radiology of CNS aspergillus infection is reviewed.
Unusual extrathyroidal iodine accumulation in a post‐ablative I‐131 scan
Authors: McEwan Louise M , Fong William
Published: March 2003

A case of iodine‐131 accumulation in the gall bladder following an ablative dose for thyroid carcinoma is presented.
Computed tomography colonography (virtual colonoscopy): Review
Authors: Mendelson Richard M , Forbes Geoffrey M
Published: March 2003

Computed tomography examination of the colon performed after bowel cleansing and distension of the lumen with gas goes by several different names—CT colonography (CTC) and CT colography perhaps being the most common. Strictly, the term ‘virtual colonoscopy’ (VC), should be reserved for the process of examining 3‐D, simulated endoluminal images with a capability to navigate through the bowel using appropriate software. Computed tomography colonography appears to be the name that has gained favour among radiologists, although it is suspected that ‘virtual colonoscopy’ will persist as a generic term due to its attractive ‘high‐tech’ connotations for non‐radiological medical and lay persons. Whatever the name, the technique has been made possible through the advent of fast helical CT scanners which allow acquisition of a volume of data, and of proprietary software which enables multiplanar reformatting and 3‐D endoluminal reconstructions.

It is evident that if CTC/VC can be shown to be acceptable to patients, safe, affordable and accurate, it has enormous potential as a diagnostic and screening tool for colorectal neoplasia.
Computed tomography fluoroscopy‐guided chemical lumbar sympathectomy: Simple, safe and effective
Authors: Tay Victoria KM , Fitridge Robert , Tie Mark LH
Published: March 2003

Demographic, clinical and laboratory data were retrospectively collected from records of 146 cases of CT fluoroscopy‐guided chemical lumbar sympathectomy for the palliation of inoperable peripheral vascular disease (PVD) between January 1997 and August 1999. Of these, 16% had claudication, 39% had rest pain and 44% had ischaemic ulcers or gangrene. Seventy‐three percent of elective cases were outpatients. At 3 months, 27 cases were lost to follow up, leaving 119 cases. Within 3 months, improvement, defined as doubling of the walking distance, cessation of rest pain or healing of ulcers, occurred in 30.3% of cases. No change was observed in 45.4% of cases and 24.3% of cases deteriorated. Patients with ulcers or gangrene had significantly poorer results than those without any ischaemic lesions, as only 19% versus 39% of patients improved (P <
0.05). The presence of hypertension, diabetes mellitus, hyperlipidaemia and smoking
had no value in predicting clinical outcome (P > 0.05). There were no major complications noted. CT fluoroscopy‐guided chemical lumbar sympathectomy is safe and effective, with a complication rate of less than 1%, and efficacy of at least 30% measured within 3 months. It is a simple and minimally invasive procedure, easily performed on an outpatient basis. CT fluoroscopy‐guided chemical lumbar sympathectomy should be considered for all patients in the early stages of inoperable PVD.
Acute tuberculous abscess of the thyroid gland
Authors: Parmar Hemant , Hashmi Mohammed , Rajput Ashish , Patankar Tufail , Castillo Mauricio
Published: March 2003

Isolated tuberculous thyroid abscess is an extremely rare form of infection of the thyroid gland. We present a case of a female patient who presented with an acute abscess of thyroid gland associated with pain and fever and without cervical lymphadenopathy. We describe the pathology of the disease and the imaging findings with their differential diagnosis.
Mammographic features of tuberculous axillary lymphadenitis
Authors: Muttarak M , Pojchamarnwiputh S , Chaiwun B
Published: March 2003

The clinical and mammographic findings of 10 patients with pathologically proven tuberculous axillary lymphadenitis were reviewed. The cases were identified from 10 173 mammograms performed over 6 years at Maharaj Nakorn Chiang Mai University Hospital. The 10 patients were aged 31–65 years. All cases were initially diagnosed to have breast carcinoma with axillary nodal metastases. Eight patients presented with axillary swelling, while two presented with breast enlargement. None of these cases had a palpable breast mass. Associated supraclavicular, cervical or groin nodes were found in seven cases, and two patients had evidence of pulmonary tuberculosis. All lesions were unilateral, affecting the right side in eight cases and left side in two cases. On mammogram, the axillary nodes were enlarged and homogeneously dense. The nodes were sized 2.5–5 cm. Nodal margins were variable. Some nodes were matted. Macrocalcifications were noted in three cases. Ipsilateral breast oedema without mass or microcalcifications was present in two cases. Patients with tuberculous axillary lymphadenitis have large homogeneously dense nodes with either well‐ or ill‐defined margins. It is impossible to differentiate tuberculous from malignant nodes. The presence of macrocalcifications might suggest tuberculous axillary lynphadenitis. Biopsy of enlarged axillary nodes is necessary to determine its aetiology.
Multiple sclerosis in a radiosensitive family with low levels of the ATM protein
Authors: Clarke Raymond A , Fang Zhi M , Lee Cheok S , Sarris Maria , Murrell Dédée , Kearsley John H
Published: March 2003

Multiple sclerosis (MS) is a chronic neurological disease of the central nervous system (CNS) characterized by demyelination associated with progressive disability. The mechanisms underlying the pathogenesis of MS remain a mystery. The highly pleiotropic syndrome known as ataxia telangiectasia (A‐T) overlaps with MS in that it also presents with demyelination in the CNS. Whether demyelination in MS or in A‐T is initiated through neuronal degeneration or immune dysfunction is not yet known. However, unlike MS, the underlying cause of A‐T is known to result from mutations in the A–T gene (ATM) that often result in the complete loss of ATM protein and loss/gain of function. ATM is implicated in neurological degeneration, particularly in the cerebellum, cellular apoptosis, immunodeficiency, double stranded deoxyribonucleic acid (DNA) rejoining, VDJ antibody recombination, tumour suppression, particularly T‐lymphoid malignancies, signal transduction, cell‐cycle control and cellular radiohypersensitivity. In this study, we describe a case of MS in a family with cellular radiosensitivity and abnormally low postinduction levels of the ATM protein. Defective DNA repair/rejoining may impact on autoimmunity.
Percutaneous retrieval of a proximally migrated common bile duct endoprosthesis from the right anterior duct
Authors: Gupta Ashu , Frazer Christopher , Brennan Frank
Published: March 2003

Common bile duct (CBD) endoprostheses that are inserted at endoscopy are in routine clinical use to decompress the obstructed biliary tract. This case describes the proximal migration of a CBD endoprosthesis into the right anterior duct. An attempt at endoscopic retrieval failed. The endoprosthesis was retrieved by a percutaneous transhepatic approach using an Amplatz goose‐neck snare. To the best of our knowledge, use of the Amplatz goose‐neck snare has not been reported for this application.
Thrombin injection for repair of pseudoaneurysms: A case for caution
Authors: Teh LG , Sieunarine K
Published: March 2003

Treatment of pseudoaneurysms by the injection of thrombin have been reported in the literature with a success rate approaching 100%. Complications have been reported with its use. We report a case where thrombin was used to thrombose a superficial temporal artery pseudoaneurysm leading to the development of seizure and ischaemia of the scalp. We advise that thrombin should be not be used to thrombose pseudoaneurysms of arteries supplying critical areas.
Primary parenchymal cerebral cystic haemangiopericytoma: A 5‐year follow up of disease progression
Authors: Kuzeyli Kayhan , Çakir Ertuğrul , Karaarslan Gokalp , Usul Haydar , Reis Abdülkadir , Baykal Süleyman , Dinç Hasan , Sari Ahmet
Published: March 2003

Haemangiopericytoma (HPC) is a rare tumour of the cental nervous system. Previously, HPCs were thought to originate from meninges and ventricular walls. Currently, they are accepted as distinctive mesenchymal neoplasms unrelated to meningiomas. Imaging appearances, clinical progression and haemorrhage into a cystic tumour is documented in  an 18‐year‐old man where the final diagnosis, with histopathological verification, proved to be a cystic HPC. This interesting and illustrative case is discussed with the relevant literature.
MRI of partial anomalous pulmonary venous return (scimitar syndrome)
Authors: Puvaneswary M , Leitch J , Chard RB
Published: March 2003

We report a case of anomalous pulmonary venous drainage into the inferior vena cava (scimitar syndrome). Cine MRI and 3‐D contrast‐enhanced MR angiography provides an non‐invasive diagnostic technique in the evaluation of anomalous pulmonary venous return.
KIDNEY DENERVATION COMBINED WITH ELIMINATION OF ADRENAL–RENAL PORTAL CIRCULATION PREVENTS THE DEVELOPMENT OF HYPERTENSION IN SPONTANEOUSLY HYPERTENSIVE RATS
Authors: Abramczyk Piotr , Zwoliñska Agnieszka , Oficjalski Piotr , Przybylski Jacek
Published: March 2003

1. Kidney denervation in spontaneously hypertensive rats (SHR) during the prehypertensive stage delays and attenuates the development of hypertension. The same results have been obtained after elimination of the adrenal–renal portal circulation (ARPC). The aim of the present study was to investigate the influence of concomitant kidney denervation and elimination of ARPC on hypertension in SHR.

2. Experiments were performed on 6‐week‐old male SHR and Wistar‐Kyoto (WKY) rats. In the first group of animals (group I), the ARPC was eliminated by removing the left adrenal gland and the right kidney. In the second group of rats (group II), the right kidney and the right adrenal gland were removed and the left kidney was denervated. In the third group of rats (group III), the right adrenal gland and the left kidney were removed and the right kidney was denervated. In the fourth group of rats (group IV), the right adrenal gland and the right kidney were removed. Group IV served as the control group. Denervations were repeated every 3 weeks. Systolic blood pressure was measured indirectly.

3. Elimination of ARPC (group I) and kidney denervation (group II) delayed and attenuated hypertension to the same degree (163±5 and 157±4 mmHg, respectively). Application of the these two methods concomitantly (group III) prevented the development of hypertension (130±6 mmHg).

4. We conclude that both intact efferent sympathetic renal nerves and adrenal hormones reaching the kidney through the ARPC may be mandatory factors for the development of arterial hypertension in SHR.
ATP‐SENSITIVE POTASSIUM CHANNEL ACTIVATION MIMICS THE PROTECTIVE EFFECT OF ISCHAEMIC PRECONDITIONING IN THE RAT ISOLATED WORKING HEART AFTER PROLONGED HYPOTHERMIC STORAGE
Authors: Hicks Mark , Du Zu Y , Jansz Paul , Rainer Steven , Spratt Phillip , Macdonald Peter S
Published: March 2003

1. Ischaemic preconditioning (IP) can significantly reduce the extent of infarct size, contractile dysfunction and necrosis in hearts from a number of animal species. Activation of ATP‐ sensitive potassium channels has been implicated in this process. The aims of the present study were to determine the extent to which IP preserves haemodynamic function in the rat isolated working heart model after prolonged hypothermic storage and to examine the involvement of activation of potassium channels in this process.

2. Hearts from Wistar rats were perfused on a Langendorff apparatus. After stabilization in working mode, baseline measurements of heart rate, aortic flow, coronary flow and cardiac output were performed. Hearts were randomized to one of six treatment groups: (i) untreated control; (ii) IP; (iii) 3 min perfusion with 200 μmol/L pinacidil; (iv) pinacidil vehicle; (v) 3 min perfusion with 10 μmol/L glibenclamide before IP; and (vi) 3 min perfusion with glibenclamide then pinacidil. Hearts were stored in an extracellular‐based preservation solution for 6 or 12 h at 2–3°C, remounted on the perfusion apparatus, stabilized as before and then haemodynamic measurements were repeated, after which time heart water contents were determined.

3. Recovery of haemodynamic function was markedly enhanced in the IP and pinacidil‐treated groups compared with untreated and vehicle controls. These beneficial effects were completely blocked by glibenclamide. These results suggest that strategies for activating potassium channels in donor hearts may protect organs during hypothermic storage prior to transplantation.
AN ACTION OF ERYTHROMYCIN IN THE INTESTINE THAT IS NOT MEDIATED VIA MOTILIN RECEPTORS
Authors: Furness JB , Clark MJ , Wright T , Bertrand PP , Bornstein JC , Verlinden M
Published: March 2003

1. Erythromycin lactobionate caused a concentration‐ dependent inhibition of nerve‐mediated contractions of the longitudinal muscle of the guinea‐pig ileum, with a threshold for effect of 10–30 μmol/L. The non‐antibiotic derivative of erythromycin ABT‐229 had a similar effect, but was approximately 10‐fold less potent. At a greater concentration (1 mmol/L), erythromycin also depressed the direct contractile effect of 10 μmol/L carbachol on the muscle.

2. Human/porcine motilin (up to 100 μmol/L) did not reduce the nerve‐mediated contractions, although it did contract the muscle (threshold 30 μmol/L). Antagonists of motilin receptors (phe3leu13motilin, up to 1 μmol/L, and GM‐109, up to 3 μmol/L) did not reduce responses to erythromycin.

3. Erythromycin contracted the longitudinal muscle of the rabbit duodenum, with a threshold concentration of 0.1 μmol/L and ABT‐229 contracted this tissue at a threshold concentration of 0.01 μmol/L. Effects of both agonists were antagonized by the motilin receptor antagonists phe3leu13motilin (0.3 μmol/L) and GM‐109 (1 μmol/L).

4. It is concluded that the site(s) at which erythromycin acts in the guinea‐pig ileum is not a motilin receptor and that ABT‐229 is selective for the motilin receptor in comparison with non‐motilin erythromycin sites and is unlikely to act at the latter site in therapeutic doses.
BRADYKININ‐INDUCED VASCULAR RESPONSES IN DOG ISOLATED LINGUAL ARTERY
Authors: Tsukada Miyoko , Chiba Shigetoshi
Published: March 2003

1. Kinin‐induced vascular responses were studied and kinin receptor subtypes were characterized in canine isolated and preconstricted lingual arteries.

2. A low dose of bradykinin (BK; < 3 × 10–14 mol) induced only vasodilation, while a higher dose of BK (> 3 × 10–13 mol) frequently induced a biphasic response: a transient constriction followed by dilation.

3. The BK‐induced vasodilation was mostly endothelium dependent but was also partly endothelium independent because although the dilation response was greatly reduced after removal of the endothelium, it was not completely abolished.

4. The dilation response to BK was significantly inhibited by the B2 kinin receptor antagonist HOE 140 and was partly reduced by indomethacin (10 μmol/L) (P < 0.05).

5. Bradykinin‐induced vasoconstriction was enhanced in endothelium‐denuded preparations. The constriction was significantly inhibited by HOE 140 (10–10 mol/L). The BK‐induced responses were not affected by the B1 kinin receptor antagonist des‐Arg9‐[Leu8]‐BK (3 × 10–11 mol/L).

6. The B1 kinin receptor agonist des‐Arg9‐BK (> 10–12 mol/L) produced vasodilation in 60% of endothelium‐intact preparations. In 20% of the endothelium‐intact preparations des‐Arg9‐BK produced a biphasic response: weak vasoconstriction followed by weak vasodilation. The des‐Arg9‐BK‐induced dilation and constriction were significantly inhibited by des‐Arg9‐[Leu8]‐BK (3 × 10–11 mol/L), but were not affected by HOE 140 (10–10 mol/L).

7. In conclusion, it appears that both B1 and B2 kinin receptors are present in the dog lingual artery. Both receptor subtypes mediate either vasodilation or vasoconstriction and BK‐induced vasodilation is mostly endothelium dependent, although it may also be partially prostaglandin dependent.