bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of response to chemotherapy of human cystic echinococcosis
Authors: Todorov T. , Vutova K. , Mechkov G. , Petkov D. , Nedelkov G. , Tonchev Z.
Published: July 2009

Fifty-five patients with echinococcosis were treated with mebendazole (30) and albendazole (25). To determine changes in cyst morphology and to evaluate the varying degree of response, progress during follow-up was shown by radiography, computerized tomography and ultrasonography. Persistence of cysts without any change in the morphology and cyst enlargement were taken as criteria for unsuccessful treatment. Development of echogenic foci and increase in density of cyst fluid were considered as a therapeutic effect. Changes in cyst wall such as thickening and deposition of calcium and detachment of the cyst membrane may also indicate response. An essential criterion, for a positive drug effect, was cyst size reduction as well as shape deformation. However, the most convincing and reliable criterion was the complete disappearance of hydatid cysts. Comparative assessment of the therapeutic effect of the two drugs favoured albendazole.
Smoking and mucosal reactions to radiotherapy
Authors: Rugg Terence , Saunders Michele I. , Dische Stanley
Published: July 2009

The pattern of cigarette smoking of 41 patients receiving continuous, hyperfractionated, accelerated radiotherapy for locally advanced head and neck cancer was examined to determine any relationship with the duration of mucositis. The uniformity of the treatment given made it possible to perform an analysis of the factors influencing the duration of the mucositis. There was no correlation with age, sex or weight loss prior to treatment. A highly significant correlation was shown with smoking during and/or after treatment (p = 0.014) and with the volume of mucosa irradiated (p = 0.025). Both appeared to act independently. It is important to encourage patients to cease smoking totally, prior to radiotherapy, to minimize the duration of mucositis associated with radiotherapy.
Hepatic imaging with computed tomography of chronic tyrosinaemia type 1
Authors: Macvicar D. , Dicks-Mireaux C. , Leonard J. V. , Wight D. G. D.
Published: July 2009

Tyrosinaemia type 1 (fumaryl acetoacetase deficiency, hepato-renal tyrosinaemia) is a rare inborn error of metabolism which, in its chronic form, leads to cirrhosis in early childhood and subsequent development of hepatocellular carcinoma in a high proportion of cases. Imaging with computed tomography has an important role in assessing the progress of the liver disease and may be helpful in timing liver transplantation. The radiological features of seven cases are described and the implications discussed.
Tissue standard ratios for irregularly shaped radiotherapy fields
Authors: Hounsell A. R. , Wilkinson J. M.
Published: July 2009

A method of calculating dose for a 6 MV X-ray beam using tissue standard ratios (TSR) is described. TSRs may be divided into a primary component and a scatter component, and the latter can then be further divided into contributions from elemental scattering volumes of 1 cm × 1 cm cross-sectional area at 1 m from the source. The magnitude of the various components have been determined by analysing measurements of square and rectangular fields, involving the fitting of the scatter data to an exponential function of radial distance from the scatter element. The coefficient and exponent of this function were found to be functions of depth, and this variation is described. A method of utilizing reconstructed scatter data that is compatible with the motion of a multileaf collimator system is presented. Results obtained by re-combining the data for various non-standard geometries are compared with further experimental work.
Epidermoid cyst of the spleen: a case report and review of the literature
Authors: Younger Kirsten A. , Hall Christine M.
Published: July 2009

True cysts of the spleen are rare, those caused by the parasite Taenia ecchinococcus accounting for over two thirds of the world's cases. In non-endemic areas, benign non-parasitic cysts prevail, and only 10% of these are epidermoid. Pseudocysts, resulting from trauma, haemorrhage or infarct are four times as common as true cysts, the latter being defined as those with an epithelial lining.

Epidermoid cysts of the spleen usually present in the second to fourth decades, 60% are in females, 80% are unilocular and solitary and only 10% calcify (Robbins et al, 1978).

There are few reports of epidermoid cysts of the spleen in British radiological literature (Zimmerman et al, 1972; Bhimji et al, 1977; Daneman & Martin, 1982).

A 10-year-old Caucasian boy was transferred to The Hospital for Sick Children, Great Ormond Street with a 2-day history of abdominal pain, distension, retching and constipation.

The history dated back 4 months, when he presented to his general practitioner following a heavy and spontaneous epistaxis. After this he developed myalgia and polyarthralgia for which a diagnosis of reactive arthralgia was made. This slowly resolved with non-steroidal anti-inflammatory medication.
Magnetic resonance imaging, computed tomography and endosonography in the local staging of carcinoma of the cervix
Authors: Cobby Mark , Browning James , Jones Angela , Whipp Elizabeth , Goddard Paul
Published: July 2009

Thirty-seven patients with carcinoma of the cervix were prospectively staged by examination under anaesthesia (EUA), transvaginal and transrectal ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). Pathological correlation was available for 20 patients. In the pathologically staged patients, EUA agreed with the staging in 17, understaging three patients. Endosonography agreed with the staging in 19, CT in 16 and MRI in 18 patients. For the remaining 17 patients, endosonography agreed with the EUA findings in 13, CT in 12 and MRI in 12. This study has shown that endosonography and MRI are more accurate than CT in the local staging of carcinoma of the cervix. Computed tomography was least accurate in staging early tumours and differentiating between Stage Ib and IIb disease. Lymph node involvement was detected with equal frequency by both CT and MRI. Magnetic resonance imaging was useful in identifying vaginal and bladder wall involvement and in one patient showed features due to an unsuspected early pregnancy.
Radiologically visible gallbladder calcification due to schistosomiasis
Authors: Fataar S. , Bassiony H. , Satyanath S. , Rudwan M. A. , Al Ansari A. G.
Published: July 2009

In four out of six gallbladders with schistosomal infestation, calcified granulomas were dense enough to be seen on abdominal radiographs. In one patient, faint calcification seen on a specimen of the excised gallbladder was not visible on the abdominal radiograph. Calcification on abdominal radiographs, especially serpiginous, seen in the region of the neck of gallbladder, appears to be the clue to the diagnosis of gallbladder schistosomiasis in people from endemic areas.
Ultrasonography in patients with suspected acute appendicitis: a prospective study
Authors: Skaane P. , Amland P. F. , Nordshus T. , Solheim K.
Published: July 2009

The diagnostic accuracy of high-resolution real-time ultrasonography was prospectively studied in 240 patients admitted to the hospital with suspected acute appendicitis. The criteria for ultrasound diagnosis of appendicitis included asausage-shaped, aperistaltic, hypoechoic structure when imaged along its longitudinal axis, with a target-like appearance on transverse section. The ultrasonographic findings were correlated with surgical-pathological outcome in 82 cases with proven appendicitis, with laparotomy findings in another 21 patients and with clinical follow-up in the remainder. The overall sensitivity, specificity and accuracy of ultrasonography in the diagnosis of acute appendicitis were 78%, 92% and 87%, respectively. The positive predictive value was 84% and the negative predictive value was 88%. Ultrasonography may significantly improve the diagnostic accuracy in patients with suspected acute appendicitis and should be performed in all patients in whom the clinical diagnosis is equivocal. The ultrasonographic findings must be interpreted in light of the clinical findings.
Radiological diagnosis and management of a solitary tuberculous hepatic abscess
Authors: Reed D. H. , Nash A. F. , Valabhji P.
Published: July 2009

Tuberculous hepatic abscesses are rare and usually associated with foci of infection in the lung or gastrointestinal tract (Leader, 1952). Primary hepatic abscesses, with no evidence of infection elsewhere, are even less common. To date only 13 cases have been described in the English language literature (Dhekne etal, 1987, Goh et al, 1987, Spiegel & Tuazon, 1984, Stevens & Little, 1987). The diagnosis is often elusive and made at laparotomy or post mortem. This case illustrates that the diagnosis may be made radiologically and then successfully managed by percutaneous drainage.

A 32-year-old man was admitted with a 4-week history of lethargy, anorexia, weight loss and night sweats. Fourteen years previously a chest radiograph had been taken because of contact with a relative who had pulmonary tuberculosis. The radiograph was normal and he was not followed up.
Computed tomographic assessment of old calcaneal fractures
Authors: Bradley S. A. , Davies A. M.
Published: July 2009

Prolonged pain and disability are common complications of calcaneal fractures. A prospective study was conducted on the value of computed tomography (CT) in 63 patients with 73 calcaneal fractures sustained more than 6 months before. The fractures were classified from the initial plain radiographs, and the patients' current clinical condition assessed in terms of a “disability score”. The mean disability scores (MDS) associated with the different types of fracture were correlated with the CT findings. The highest MDS was found in the intra-articular fracture group which comprised 71% of the series. In this group the MDS was increased in the presence of post-traumatic osteoarthrosis of the subtalar joint (61% of cases), involvement of the calcaneocuboid joint (39% of cases) and subluxation/dislocation of the peroneal tendons (47% of cases). Structural abnormalities of the peroneal tendons were associated with a higher MDS including chronic tenosynovitis (eight cases), chronic partial tendon rupture (eight cases), complete peroneus brevis tendon rupture (two cases) and scarring indicating stenosing tenosynovitis (14 cases). A similar spectrum of appearances affecting the medial tendons of the hindfoot was identified in eight cases. Direct CT measurements of the degree of comminution did not correlate well with the patients' MDS. In the patient with persistent symptoms, CT is of value in the later assessment of long-term complications by revealing abnormalities of the subtalar joints and adjacent tendons.
Direct analysis of quantitative data from radiobiological studies on pig lung
Authors: Rezvani M.
Published: July 2009

An alternative approach for the analysis of quantitative data, obtained from functional measurements, has been developed. The method does not require conversion of the quantitative measurements into quantal data thus denning a threshold level of effect. This method describes a parameter, equivalent to an iso-effective dose, which can be used for the comparison of different fractionation schedules by the assessment of lung function in radiobiological studies. The method only requires the use of a standard linear regression analysis and is therefore very simple to use.
Severe dwarfism with cataracts. A new osteo-chondrodysplasia
Authors: Chapman S. , Bundey S. , Fletcher R. F.
Published: July 2009

We report the findings of a new osteo-chondrodysplasia which does not fulfil the diagnostic criteria of any previously reported dysplasia. Severe short stature, resulting from spine and rhizomelic limb shortening, and cataracts are associated with radiological abnormalities of the spine, epiphyses and metaphyses. M.S. was born in 1973 in a village in Bangladesh. No measurements were made at birth but his mother says he was a little smaller than her three later born children. As a child he was always smaller than the other children but his short staturebecame more obvious with age and by the time he was 10 years old it was clear that he was severely short. When he went to the village school at the age of 5, poor vision was noted and subsequently he went to an ophthalmic service in Sylhet where bilateral cataracts were operated on with some visual improvement. No retinal abnormality was commented upon. He came with his mother and younger brothers to the UK in 1989 to join his father, who had been here intermittently since 1960. M.S. was then referred to R.F.F. because of his short stature.

He was a broad, muscular, post-pubertal 16-year-old boy of normal intelligence and hearing but with partial sight. The eyes showed clear ocular cornea, deep anterior chambers, and there were fairly dense posterior capsular remnants on both sides. His fundi showed no abnormality of retinae or optic nerves; an electroretinogram was normal.
Paraganglioma of the duodenum: a case report with radiological findings and literature review
Authors: Imai Shigeki , Kajihara Yasumasa , Komaki Kuwako , Nishishita Soichi , Fukuya Takashi
Published: July 2009

Paraganglioma of the gastrointestinal tract is an uncommon, usually benign neoplasm. It usually occurs in the second section of the duodenum. A review of the literature reveals 73 reported cases. We studied a case of paraganglioma by hypotonic duodenography (HDG), computed tomography (CT), angiography and histological examination.

The rare occurrence of this neoplasm and the first comparative study using HDG, CT and angiography justify this case report.

A 65-year-old Japanese woman had been in excellent health until she presented to her physician with tarry stool. The bleeding site was not determined. Seven months later, she visited another physician because of general fatigue, and was found to be anaemic and bleeding from the gastrointestinal tract.

She was referred to the Kawasaki Medical School Hospital for further evaluation. On admission, she was moderately anaemic but not jaundiced. The abdomen was flat and soft without rebound tenderness. A slightly rough-surfaced, gooseegg sized mass was palpable in the right upper quadrant of the abdomen which moved with respiration but was not tender. Routine laboratory examination showed no abnormalities except anaemia.

A hypotonic duodenogram showed a relatively smoothedged filling defect with a deep and irregular niche on the lateral wall of the second portion of the duodenum (Fig. 1).

Contrast-enhanced CT revealed an inhomogeneous mass of soft-tissue density along the lateral aspect of the duodenum. This study was carried out with Gastrografin so that the mass could be easily demonstrated (Fig. 2).
Ultrasound in the investigation of the right iliac fossa mass
Authors: Millard F. C. , Collins M. C. , Peck R. J.
Published: July 2009

Patients presenting with a right iliac fossa (RIF) mass are a diagnostic problem. The objective of this study was to assess the role of ultrasound (US) in their investigation. A prospective series of 50 patients presenting with a clinically suspected RIF mass was examined by US and the findings correlated with the final diagnosis. There was a positive finding in 34 patients (68%). Ultrasound correctly identified the organ of origin in 33 (97%) and was able to guide the patients' further management. In 12 cases no abnormality was found in the RIF, of which 11 had no positive findings at follow-up and one was shown to have an unrelated abnormality at laparotomy. In four cases the findings were due to normal variants. Ultrasound is the imaging modality of first choice in patients presenting with a RIF mass.
Sonographic detection of foreign bodies of the extremities
Authors: Banerjee B. , Das R. K.
Published: July 2009

A propspective study to assess the accuracy of ultrasound in the detection and localization of foreign bodies of the extremities was undertaken. Forty-five patients with clinical suspicion of foreign bodies were included in the study. Among 20 patients with radio-opaque foreign bodies, ultrasonic detection of foreign bodies was achieved in 19 patients. In 25 patients, with no radiographic evidence of foreign body, ultrasonic detection of foreign bodies was made in seven patients and among these foreign bodies were confirmed and removed at surgery in five patients. Accurate pre-operative ultrasonic localization of foreign bodies was carried out in three patients.
Fractionated high dose rate versus low dose rate regimens for intracavitary brachytherapy of the cervix. I. General considerations based on radiobiology
Authors: Brenner D. J. , Hall E. J.
Published: July 2009

Intracavitary brachytherapy at low dose rate (LDR), often with the addition of external-beam radiotherapy, has long been considered the treatment of choice for carcinoma of the cervix, maximizing acute damage in the treatment volume, whilst minimizing late effects. In recent years, primarily for reasons of convenience and cost, there has been a move towards treatments involving a few fractions at high dose rate (HDR). Using data from cells of human origin cultured in vitro, we make estimates of the doses that, delivered in 2–12 HDR fractions, produce tumour control and early effects equivalent to intracavitary treatments at LDR. We also show that, for situations where the normal-tissue dose responsible for late effects is significantly smaller than the tumour dose, HDR schemes may be devised which, while yielding early killing comparable with that of LDR, should not result in worse late effects. We suggest that this scenario probably applies to treatment of carcinoma of the cervix.
Radiation induced extraskeletal osteosarcoma
Authors: Logue J. P. , Cairnduff F.
Published: July 2009

Radiation induced neoplasms are a well recognized complication of radiation therapy. Among these neoplasms osteosarcoma is not uncommon, classically affecting the skeleton. We report a case of extraskeletal osteosarcoma occurring in the nasal cavity following kilovoltage radiotherapy.

A 62-year-old woman presented with a 1 × 1 cm Basal cell carcinoma on the skin of her left upper nose. She was treated with a single exposure of radiotherapy to a skin dose of 20 Gy using 100 Kv (3 mm Al) at a focus–skin distance of 15 cm to a circular area of a diameter of 2 cm. She was reviewed 6 weeks later at which time the lesion had completely resolved.
Unsuspected sphincter damage following childbirth revealed by anal endosonography
Authors: Burnett Sarah J. D. , Spence-Jones Clive , Speakman Christopher T. M. , Kamm Michael A. , Hudson Christopher N. , Bartram Clive I.
Published: July 2009

Anal endosonography was performed in 62 consecutive patients with incontinence of flatus or faeces following obstetric trauma, and in 18 parous controls. Of the incontinent group, 90% had defects in the external sphincter, 65% in the internal sphincter and 44% disruption of the perineal body, compared with none of the controls. This triad of lesions is pathognomonic of obstetric trauma. Anal endosonography revealed a higher prevalence of sphincter damage than expected from anorectal physiology tests, and therefore has a role in screening patients following complicated or difficult deliveries.
Application of the linear-quadratic model with incomplete repair to radionuclide directed therapy
Authors: Millar William T.
Published: July 2009

The linear-quadratic (LQ) model for fractionated external beam therapy has been modified by previous authors to include the effects due to an exponentially decaying dose rate. However, the LQ model has now been extended to include a general time varying dose rate profile, and the equations can be readily evaluated if an exponential radiation damage repair process is assumed. These equations are applicable to radionuclide directed therapy, including brachytherapy. Kinetic uptake data obtained during radionuclide directed therapy may therefore be used to determine the radiobiological dosimetry of the target and non-target tissues. Also, preliminary tracer studies may be used to pre-plan the radionuclide directed therapy, provided that tracer and therapeutic amounts of the radionuclide carrier are identically processed by the tissues. It is also shown that continuous radionuclide therapy will induce less damage in late-responding tissues than 2 Gy/fraction external beam therapy if the ratio of the maximum dose rate and the sublethal damage repair half-life in the tissue is less than 1.0 Gy. Similar inequalities may be derived for β-particle radionuclide directed therapy. For example, it can be shown that radionuclide directed therapy will induce less damage to slowly repopulating tissue than 2 Gy/fraction external beam therapy for the same total dose if the maximum percentage initial uptake in tissue is less than 0.046%/g or 0.23%/g for an injected activity of 50mCi of 90Y or 131I, respectively.
The most advantageous timing of external ureteric compression during intravenous urography
Authors: Hughes T. H. , Hine A. L.
Published: July 2009

The objective of this study was to ascertain the most advantageous time during an intravenous urogram to apply external ureteric compression to gain the greatest calyceal distension. This was a prospective randomized trial of 60 patients, divided into three equal groups with compression applied immediately after injection, at 5 minutes and after the 5 minute film had been viewed. Patients with the usual criteria for avoiding compression were excluded. A statistically significant improvement in calyceal distension occurred when compression was applied at 5 minutes compared with that applied after the 5 minute film had been viewed. No improvement was seen when the compression was applied immediately after injection. We recommend that external ureteric compression should be applied immediately after the 5 minute film.
Use of percutaneous nephrostomy in malignant ureteric obstruction
Authors: Chapman M. E. , Reid J. H.
Published: July 2009

Seventeen patients with malignant disease underwent percutaneous nephrostomy to relieve renal failure secondary to ureteric obstruction. Renal function improved in 88%. The median survival time was 18 weeks and 58% left the primary hospital to return home or to a terminal care hospice. Minor complications occurred in 58%. The use of bilateral nephrostomy tubes conferred no greater benefit than a unilateral tube. Intervention in malignant ureteric obstruction may confer some benefit and should not necessarily be viewed with pessimism.
Book reviews
Authors: Reidy J. F.
Published: July 2009

Despite considerable developments in non-invasive imaging, invasive procedures still play a central role in investigation of cardiac disease and in particular in coronary artery disease. This text book concentrates on cardiac catherization and cardiac angiography and as the preface states is “addressed to cardiologists undertaking catheterization procedures in the hope that a description of the various procedures will be of use in helping them to develop the necessary skills”. It is largely written by Dr Graham Miller who was for many years in charge of the cardiac catheterization laboratory at the Brompton Hospital. As would be expected it is a very practical book. Though it concentrates on adult cardiac catheterization it also covers congenital heart disease.
Pitfalls of bone scintigraphy in suspected hip fractures
Authors: Lewis S. L. , Rees J. I. S. , Thomas G. V. , Williams L. A.
Published: July 2009

In a review of 2617 patients who were admitted with a suspected fractured neck of femur over a period of five years, 213 had normal or equivocal plainradiographs, and were subsequently investigated by bone scintigraphy. Normal scans were obtained in 127 (60%) cases. Of the remaining 86 cases,82 (38%) were reported to show fractures of the proximal femur, three showed pubic ramus fractures, and one acetabular fracture was demonstrated. Review and follow-up has revealed eight false positive and two false negative scans. The various factors accounting for these errors are considered, and the clinical implications discussed. Careful analysis of accompanying plain radiographs is stressed when interpreting scintigrams.
Non-ionic contrast media: a comparison of iodine delivery rates during manual injection angiography
Authors: Hughes P. M. , Bisset R.
Published: July 2009

Iodine delivery rates (IDR) of five commonly used non-ionic contrast media were determined at room temperature (24°C) and body temperature (37°C). Contrast media of strength 300 mgl/ml were also evaluated at 50%dilution (150 mgl/ml) with N-saline. Iodine delivery differed significantly(p < 0.005) between samples at room temperature: Omnipaque 350 (1163 mg/s) < Niopam 370 (1311 mg/s) < Omnipaque 300 (1422 mg/s) < Niopam 300 (1635 mg/s) and Ultravist 300 (1636 mg/s). Niopam 300 and Ultravist 300 delivered 41% more iodine per second than Omnipaque 350 at room temperature. Similar differences were identified at body temperature, while delivery of individual media was on average 23.5% greater than at room temperature. No significant difference between iodine delivery rates of diluted media at room temperature or body temperature was identified. The results demonstrate that iodine delivery and hence vascular opacification are better achieved during handinjection arteriography by using relatively low viscosity media such as Niopam 300 or Ultravist 300. In digital subtraction arteriography all 300 strength contrast media diluted to 150 strength are equally effective.
Haemodynamic effects of water-soluble contrast media on the isolated perfused rat kidney
Authors: El Sayed A. A. , Haylor J. L. , Nahas A. M. El , Salzano S. , Morcos S. K.
Published: July 2009

The precise mechanism underlying the nephrotoxicity of radiocontrast media remains ill defined. In this study we have examined the direct effect of a wide range of low- and high-osmolar water-soluble contrast media (WSCM) on the vascular resistance of the isolated perfused rat kidney (IPRK). Water-soluble contrast media led to a significant fall in the renal perfusate flow and an increase in the renal vascular resistance (RVR). The magnitude of these haemodynamic changes was independent of the osmolality of the tested agents. This study shows a direct effect of WSCM on the vascular resistance of the isolated perfused rat kidney.
Intersite comparison of the Hologic QDR-1000 dual energy X-ray bone densitometer
Authors: Blake G. M. , Tong C. M. , Fogelman I.
Published: July 2009

We have compared results from 13 Hologic QDR-1000 bone densitometers: (i) by performing spine and hip scans on two normal volunteers; (ii) by acquiring sets of 10 sequential scans on a Hologic anthropomorphic spine phantom. For each QDR-1000 site visited a set of spine phantom scans was also acquired on a QDR-1000 at Guy's Hospital to serve as a control study. All scans were analysed using the Hologic scan comparison software. Radiographers at each site were asked to perform their own independent analysis of the scans of the two volunteers. The precision of the bone mineral density (BMD), bone mineral content (BMC) and projected area (Area) results for a set of 10 phantom scans was 0.11%, 0.14% and 0.12% respectively. The coefficient of variation (CV) between sites for the sets of phantom scans was 0.58% for BMD, 0.71% for BMC and 0.35% for Area. In comparison, CVs for the phantom scans acquired on a single QDR-1000 were 0.23%, 0.23% and 0.09% respectively. The CV for the BMD results on the two volunteers obtained using the scan comparison software averaged 1.4% for the spine and 2.1% for the femoral neck. The CV for the results obtained by site radiographers averaged 2.2% for the spine and 3.7% for the femoral neck. Significant differences in the technique used for hip analysis were found. Conclusions: (i) differences in calibration between systems were generally less than 1%; (ii) variations in results resulting from differences in analytical technique were more significant than those resulting from differences in calibration.
Assessment of the psychological impact of a breast screening programme
Authors: Bull A. R. , Campbell M. J.
Published: July 2009

In order to assess the psychological effect of mammographic screening, questionnaires (which included psychometric tests) were sent to 750 women at invitation and, 6 weeks after screening, to 420 women normal after the first mammograph, to 240 women normal after special assessment, and to 68 women normal after open biopsy. Increasing degree of the investigation was associated both with increasing frequency of breast self examination (10% were practising breast self-examination at least once a week before screening compared with 24% for women after special assessment and 35% of women who had had an open biopsy (p < 0.001)), and with greater confidence that any malignancy in the breast would have been found. Psychometric scores showed no increase of general levels of anxiety or depression in the screened groups. For anxiety, percentages abnormal were 5, 4, 2 and 6 for the four groups, respectively, and for depression the percentages abnormal were 5, 4, 4 and 6, respectively; 10% of screened women were more anxious about having breast cancer as a result of the screening. At least 10% of women proceeding to open biopsy of benign lesions require professional counselling and support. Psychological ill effects were not detected by the psychometric test among women who did not proceed to this final investigation. Behavioural changes did suggest a raised awareness or fear of potential cancer among the screened population.
Ovarian ablation failures by radiation: a comparison of two dose schedules
Authors: Leung S. F. , Tsao S. Y. , Teo Peter M. L. , Choi Peter H. K. , Shiu Wesely C. T.
Published: July 2009

Sixty Chinese breast cancer patients underwent ovarian irradiation with one of two dose schedules: 12 Gy/4 fractions/4–6 days or 14 Gy/4 fractions/4–6 days. The ovarian ablation failure rates were 14% and 0% respectively in patients above 40 years of age. The overall ablation failure rate in younger patients was unacceptably high at 35%. The significance of the findings is discussed.
Fibrous dysplasia of the skull: disease activity in relation to age
Authors: Davies M. L. , Macpherson P.
Published: July 2009

Eighteen of 19 patients with histologically confirmed fibrous dysplasia of the skull seen at the Institute of Neurological Sciences, Glasgow, in the past 20 years have been reviewed and recent radiographs obtained. Sex, age at presentation and at follow-up were recorded, in addition to the site, type and extent of cranial involvement. The findings have been related to disease activity and progression. In comparison with other reports we found the proportion of patients with activity in adulthood to be relatively high (37%). Overall, there was an equal sex distribution, but of seven patients presenting as adults, six were female as were six of seven patients with evidence of disease activity in adulthood.
Dose to red bone marrow from natural radon and thoron exposure
Authors: Richardson R. B. , Eatough J. P. , Henshaw D. L.
Published: July 2009

The age-dependent radiation dose to the haematopoietic tissue of bone marrow has been calculated for exposure to radon, thoron and their daughter products. The component of dose due to pure radon is dependent on the fat content of the marrow, since the solubility of radon in fat is about 16 times that in tissue. The mean dose equivalent μSv to the total active marrow is estimated for a range of fat cell diameters from 25 to 200 μm, taking account of the percentage cellularity and distribution of active marrow as a function of age. Similarly, the dose due to the inhalation of short-lived radon daughters was estimated, based on measurements in blood and marrow, modified to allow for the greater deposition of daughter products expected in children. An estimate of the age-dependent dose from long-lived radon daughters was made from uranium miner and natural exposure data. Dose estimates were made for the average UK indoor exposure to radon gas of 20 Bq/m3 and an equilibrium equivalent thoron concentration of 0.3 Bq/m3. The annual radon and thoron derived dose to the active marrow of the newborn was calculated as 30 and 40 μSv, respectively. For a 10-year-old child, the radon and thoron derived annual dose are 70 and 40 μSv, and for a 40-year-old adult 90 and 30 μSv, respectively. The above values exhibit wide range limits due principally to uncertainties in the accumulation of 210Pb in bone, and 210Po in marrow. These data indicate that at the average UK exposure, the alpha-particle dose to active marrow is dominated by that derived from inhaled radon and thoron compared with dietary intake. In infants the dose is dominated by thoron daughters. At the UK radon Action Limit of 200 Bq/m3, the radon and associated thoron derived dose is similar to that from all low LET sources. This work shows that the dose to red bone marrow from radon and thoron is significant, and that the possibility of leukaemia induced by these radiation sources warrants further investigation.
Magnetic resonance imaging in the staging of renal cell carcinoma
Authors: Kabala J. E. , Gillatt D. A. , Persad R. A. , Penry J. B. , Gingell J. C. , Chadwick D.
Published: July 2009

A prospective study has been carried out to examine the role of magnetic resonance imaging (MRI) in the investigation of renal cell carcinoma in 24 patients. In all cases the inferior vena cava (IVC) was well demonstrated with MRI. In 14 out of 15 patients where surgical correlation was available, the MRI and operative staging were in agreement. Magnetic resonance imaging and computed tomographic (CT) staging were in agreement in 16 out of the 17 patients where both were performed. In one case, CT suggested hepatic invasion but this was found not to be present on MRI and at operation. Magnetic resonance imaging also provided substantial additional information in three patients, including two cases where MRI demonstrated a patent IVC that appeared occluded on CT (one of which also had vertebral metastases seen on MRI but missed on CT) and one case where CT failed to demonstrate minimal involvement of the IVC. Magnetic resonance imaging is an accurate means of staging renal cell carcinoma with clear advantages over CT. In no case in this series was inferior vena cavography found to be necessary.
A soldier with recurrent back pain
Authors: Barker P. G. , Raby N. D.
Published: July 2009

A 39-year-old man presented with acute lower back pain referred down the back of the right leg to the knee. There were no abnormal neurological findings and clinical examination was unremarkable. He had a longstanding history of recurrent back pain, which had required hospitalization in the past. Lumbar spine radiographs 3 months previously appeared normal. In view of these symptoms and past history, a radiculogram (Fig. 1) and subsequently a computed tomographic (CT) myelogram of the lumbar spine were performed (Fig. 2).
Body composition by intercomparison of underwater weighing, skinfold measurements and dual-photon absorptiometry
Authors: Verlooy H. , Dequeker J. , Geusens P. , Nijs J. , Goris M.
Published: July 2009

Since Stern (1901) and Behnke (1961) introduced their techniques for densitometry by submersion, many other methods have been described to estimate body composition in men, ranging from simple to very complex (Siri, 1956, 1961; Garrow, 1982). None of them meets all the desirable criteria: cost, ease of operation and accuracy.

Dual-photon absorptiometry (DPA) is based on measurements of radiation transmission of two separate photon energies through a medium consisting of two different materials, bone and soft tissue. The dichromatic beam from a gadolinium- 153 source, with photon energy peaks at 44 and 100 keV, can be used for this purpose. Dual-photon absorptiometry allows measurements on hitherto inaccessible body areas (Peppier & Mazess, 1981).

The present study was designed to validate DPA as an alternative technique for the assessment of the lean body mass and the percentage fat.
Comparison of colour Doppler ultrasound with venography in the diagnosis of axillary and subclavian vein thrombosis
Authors: Baxter G. M. , Kincaid W. , Jeffrey R. F. , Millar G. M. , Porteous C. , Morley P.
Published: July 2009

The primary imaging technique in suspected venous occlusive disease has for many years been contrast venography. Recent studies have shown ultrasound with the addition of colour Doppler imaging to be a suitable alternative method in the diagnosis of lower limb venous thrombosis. We have applied these techniques to the upper limb venous system, and have performed a prospective study of 19 patients (30 limbs) comparing colour Doppler ultrasound with venography in the diagnosis of axillary and subclavian vein thrombosis, for which colour Doppler ultrasound has a sensitivity and specificity of 100%. If vein stenosis is included, the sensitivity falls to 89%. We propose that colour Doppler ultrasound is a suitable first-line alternative to venography in the diagnosis of axillary and subclavian vein thrombosis. In addition to showing the major venous drainage of the upper limb, ultrasound routinely assesses patency of the internal jugular vein, which is, on occasion, of clinical relevance when determining possible future sites of venous access. If, however, colour Doppler ultrasound is normal then bilateral upper limb venography is indicated to exclude a more central venous problem or localized stenotic lesion.
Tumour size as a prognostic factor in carcinoma of the cervix: assessment by transrectal ultrasound
Authors: Magee B. J. , Logue J. P. , Swindell R. , McHugh D.
Published: July 2009

Transrectal ultrasound (TRUS) was used to measure tumour size in patients with carcinoma of the cervix and to assess its prognostic significance. Clinical staging was conducted and at the time of examination under anaesthesia, TRUS was used to assess maximum transverse diameter of the tumour. Eighty-one patients were studied. FIGO stages were 1B 34 patients, IIA seven patients, IIB 31 patients, IIIA two patients and IIIB seven patients. Mean tumour diameters by stage were IB 37 mm, IIA 37 mm, IIB 49 mm, IIIA 42 mm and IIIB 50 mm. There was a significant correlation between size and stage (p = 0.001). With a median follow-up of 18 months, 16 relapses have occurred. The actuarial relapse rates at median follow-up by stage were IB 10%, IIA 17%, IIB 22%, IIIA 0% and IIIB 35%. The actuarial relapse rates by size grouping at median follow-up were less than 30 mm 0%, greater than 30 and less than 40 mm 11%, greater than 40 and less than 50 mm 22%, and greater than 50 mm 38%. There was a significant difference between the mean recorded size of the tumours in the relapsed group and the relapse-free group (p = 0.02). Despite the small number of patients and short follow-up, tumour size as measured by TRUS appears to predict relapse.
Spinal cord compression in Paget's disease due to extradural pagetic ossification
Authors: Nicholson D. A. , Roberts T. , Sanville P. R.
Published: July 2009

Neurological complications resulting from single vertebral involvement have been described but the condition is usually asymptomatic (Dinneen & Buckley, 1987). The mechanisms for neurological involvement include compression of the spinal cord by bony expansion from the pagetic process, vertebral collapse with haemorrhage, or neoplastic degeneration (Resnick, 1988). Other non-compressive vascular causes have also been described (Herzberg & Bayliss, 1980; Douglas et al, 1981).

We describe a case of severe spinal cord compression secondary to Paget's disease, as a result of extradural pagetic ossification of the ligamentum flavum and epidural fat, with the actual bony spinal canal being of normal size.
Ultrasound diagnosis of horseshoe kidney
Authors: Banerjee B. , Brett I.
Published: July 2009

Ultrasound diagnosis of horseshoe kidneys depends on the demonstration of an isthmus or band of renal tissue across the midline of abdomen connecting the lower poles of the kidneys. In a number of cases this band of renal tissue may evade ultrasonic detection. In a series of 11 patients with horseshoe kidneys, sonographic detection of renal isthmus was achieved in seven patients, but in all 11 cases there was demonstrable alteration of renal outlines. Instead of normal reniform shape, the kidneys appeared “inverted pyriform” or “inverted triangular”. Detection of such an altered renal outline should raise suspicion of horseshoe kidney.
Spiking of the tubercles of the intercondylar eminence of the tibial plateau in osteoarthritis
Authors: Reiff D. B. , Heron C. W. , Stoker D. J.
Published: July 2009

“Spiking”, “sharpening” or “peaking” ofthe tubercles of the intercondylar eminence of the tibial plateau has been described as an early sign of osteoarthritis of the knee joint, but there are no reports confirming this association. The radiographs of 55 patients with established osteoarthritis of the knee joint and 36 controls were reviewed. Measurements were made of the angulation of the tips of the medial andlateral tubercles, and the ratio of the tubercle height to the width of the tibial plateau was calculated. There was a significant difference in both these parameters between the two groups, confirming that lengthening and sharpening of the angles of the tubercles are features of osteoarthritis of the knee joint.
Endothelial cell population dynamics in rat brain after local irradiation
Authors: Ljubimova N. V. , Levitman M. Kh. , Plotnikova E. D. , Eidus L. Kh.
Published: July 2009

The dynamics of the endothelial cell population was investigated in the ratbrain after local irradiation with different doses of X rays. A fluorescent–histochemical technique was used for the visualization of the cells. A decrease in endothelial cell number was observed within 1 day of irradiation with doses of 5–200 Gy. At this time the endothelial cell number had decreased by up to 15% compared with the pre-treatment values. This early dose-independent loss in cell number was maintained for up to 1 month after irradiation. This was then followed by a slow dose-independent decrease in cell density up to 6 months after exposure. Subsequently the depletion of the endothelial cell population exposed to 40 and 60 Gy continued. After a dose of 25 Gy an abortive recovery of cell numbers occurred followed by an abrupt depletion of the endothelial cell population. The possible mechanisms of such changes are discussed.
Measurement of regional left ventricular function using labelled magnetic resonance imaging
Authors: Buchalter M. B. , Sims C. , Dixon A. K. , Weissberg P. L. , Stone D. L. , Shah N. J. , Hall L. D. , Wilkinson I. D. , Lomas D. J. , Freer C. E. L.
Published: July 2009

A technique for assessing regional left ventricular function using magnetic resonance imaging is described. Spatial modulation of magnetization (SPAMM) is effected immediately before images are obtained at various intervals during the cardiac cycle using a modified field echo even rephasing technique (FEER). By performing such modulation in two planes, a grid pattern of labelling can be produced across the image. On the resulting labelled short axis images of the left ventricle, the systolic increase in thickness (thickening) and decrease in length (shortening) of different regions of myocardium can then be measured. The findings in five normal volunteers are presented. Radial shortening was twice as great in the endocardium (mean 20.4%, standard deviation (SD) 5.7) than in the epicardium (mean 10.2%, SD 5.5) and appears to offer more promise as a marker of regional function than simple thickening (mean 9.8%, SD 13.6).
The radiologist cries “HELLP”!
Authors: Thomas E. A. , Copplestone J. A. , Dubbins P. A. , Friend J. R.
Published: July 2009

We report a case of the haemolysis, elevated liver enzymes, low platelets (HELLP) syndrome in a primigravida, in whom ultrasound examination demonstrated large, “geographical” areas of increased echogenicity within the right lobe of the liver. Haematological investigations showed classical features of the HELLP syndrome. Both the ultrasound signs and the serological tests reverted to normal soon after the delivery of the baby. There are no other reports of hepatic parenchymal abnormality detected sonographically. Although these features are non-specific, recognition of similar ultrasound appearances should alert radiologists to the need for urgent haematological investigations. Delayed treatment may lead to the death of the mother or baby.
Comparative performance in vitro and in vivo of Lunar DPX and Hologic QDR-1000 dual energy X-ray absorptiometers
Authors: Laskey M. A. , Flaxman M. E. , Barber R. W. , Trafford S. , Hayball M. P. , Lyttle K. D. , Crisp A. J. , Compston J. E.
Published: July 2009

The measured absolute bone mineral density values of spine and femur and their precision were compared on two dual energy X-ray absorptiometers, the Lunar DPX and the Hologic QDR-1000. There were systematic differences between the two systems, the Lunar DPX always giving a higher bone density value. The ratio of the mean Lunar DPX/Hologic QDR-1000 bone density measurements obtained in vivo was 1.13 g/cm2 for spine (L2–L4) and 1.20–1.43 g/cm2 for femur measurements. For both systems, short- and long-term precision (coefficient of variation) was below 0.5% for spine in vitro measurements and below 1.5% for neck of femur in vitro measurements. Precision of in vivo measurements was less good, especially for femur measurements. The coefficient of variation of spine measurements was dependent on bone density and deteriorated with decreased bone mineral density and increased body thickness.
Three-dimensional (3D) ultrasound imaging of the gallbladder and dilated biliary tree: reconstruction from real-time B-scans
Authors: Fine D. , Perring S. , Herbetko J. , Hacking C. N. , Fleming J. S. , Dewbury K. C.
Published: July 2009

Ultrasound is perhaps the most operator-dependent imaging technique. Clinicians rarely master the interpretation of ultrasound images and even experienced ultrasonographers may experience difficulty interpreting “hard copy” images produced by other operators. Reconstructed three-dimensional (3D) computer images of computed tomography (CT) scans have been shown to aid interpretation of CT data by clinicians, particularly before reconstructive and orthopaedic surgery (Lafferty et al, 1986; Linney et al, 1989). We propose that similar reconstruction of ultrasound images may aid clinicians' understanding of the anatomy of the enlarged biliary tree and gallbladder.

Ultrasound studies of the biliary tree were performed using a Toshiba 100 real-time ultrasound system with a 3.5 MHz curved array transducer. The probe was located on the skin surface, then smoothly rotated by hand at the probe face so as to obtain a continuous, sequential sweep across the volume of the liver. The sequence of B-scans obtained was recorded on videotape. The angle of rotation of the probe was estimated by eye. Regular sample frames of the videotaped data were selected for digitization by frame by frame examination of the videotaped data. Images were digitized using an Oggitronics 8-bit recursive video processor. The images were transferred to a DEC VAX 11–730 minicomputer and SIGMEX A7000 display processor, running the Southampton General Hospital PICS general image processing software (Fleming et al, 1987). Images were compressed to 256 × 256 pixel square matrix format. In each study, 20–30 sample images were taken.