bluuebunny/crossref_metadata_2025_split huggingface dataset:
A man with three knees? False “hot spot” with dual isotope imaging
Authors: Miles K. A. , Barber R. W. 
Published: July 2009

Radionuclide imaging is subject to a wide range of potential artefacts. We have recently come across an unusual example which we have not seen previously described (Wells & Bernier, 1988; Ryo et al, 1985). A 66-year-old man presented with a pyrexia, 3 months after undergoing bilateral upper tibial osteotomies. The patient was referred for a 99Tcm methylene diphosphonate (MDP) bone scan followed by 111 In labelled white blood cell (WBC) scanning to determine whether one of the osteotomy sites was infected. Three hours before imaging, 400 MBq of 99Tcm&gt; MDP was administered. Blood was taken for white cell labelling 90 min prior to MDP imaging. The MDP images showed intense uptake at the osteotomy sites, but were otherwise normal (Fig. la).
Immediately after the MDP bone scan images had been obtained, 15.4 MBq of 111 In WBC were injected. Three hours later, the knees were imaged with the same gamma camera (IGE400A) fitted with a high energy collimator. Energy windows were reset to include the two 111 In peaks at 170 and 245 keV. An area of activity was seen at the site of each osteotomy with an additional area located between the knees (Fig. lb). This additional area of activity proved not to be contamination as it could be eliminated by moving one or other knee out of the field of view.
Computerized calculation of radiation dose to patients from radiography
Authors: Chappie C.-L. , Faulkner K. 
Published: July 2009

Further details concerning the computer programs are available from the authors.
There are a number of occasions on which it may be necessary to make a retrospective calculation of the radiation dose to a patient. For instance, a fetal dose may need to be determined. Irradiation during pregnancy is avoided whenever possible, but sometimes the patient's condition may be considered to necessitate a radiological examination, or a pregnancy may be unsuspected at the time of the examination. When this occurs the radiation dose, and the associated risk of harm, to the fetus from the X-ray examination should be estimated. Dose estimates may also be requested for a patient who has received an unusually large number of radiographs over a period of time, to assess the cumulative dose to that patient.
Current procedures for making retrospective dose calculations, which are usually performed manually, can be quite lengthy, and require thorough error checking. A computerized method for estimating fetal doses using tissue-air-ratio data has been described (Clarkson & Brennen, 1987), but this requires considerable data preparation and knowledge of the exact area of irradiation.
This article describes a method of automatically estimating patient doses with a microcomputer, using exposure information typed in by the operator and normalized organ dose data (Jones & Wall, 1985) already stored in the computer memory. The software has been derived from that written for an on-line automated quality assurance and dosimetry system which has been described previously (Faulkner et al, 1990).
Ultrasonic appearances of the early changes in fibrodysplasia ossificans progressiva
Authors: McAteer E. J. , Hallam L. A. , Hendry G. M. A. 
Published: July 2009

Progressive heterotopic ossification and congenital skeletal anomalies characterize the very rare and relentless condition of fibrodysplasia ossificans progressiva (FOP) or myositis ossificans progressiva (MOP)(McKusick, 1972). These patients frequently present with subcutaneous masses which are often painful (Lindhout & Golding, 1985) and therefore ultrasound may be used in the initial investigation. We report a case of FOP presenting with recurrent soft-tissue swellings and demonstrate the ultrasonic appearances not previously documented in this condition.
A 5-year-old boy first presented with a history of pain in his right knee following a minor injury. Radiographs showed an apparent simple exostosis arising from the medial side of the proximal tibial metaphysis (Fig. 1); no further investigations were performed at this time. He presented again several months later with a swelling in the subcutaneous tissues of the left anterior thigh and with pain on walking. No soft-tissue abnormality was identified on the radiographs. Ultrasonic examination using a Diasonics 5 MHz rotating transducer demonstrated an increase in the thickness of the soft tissues and a well defined hypoechoic lesion with an echogenic central region in the deep compartment of the anterior thigh (Fig. 2). When radiographs were repeated 3 months later ossification had taken place in this area (Fig. 3.).
Further similar swellings developed in the para-vertebral tissues of the lumbar region and around the right scapula. Ultrasound now demonstrated separation of the normal muscular fasicular planes by echogenic material together with increase in the muscle size (Fig. 4).
Cystic lymphangioma of the pelvis in childhood
Authors: Hoeffel J. C. , Marchal A. L. , Pierre E. , Derelle J. 
Published: July 2009

We report a case of a multicystic retroperitoneal lymphangioma appearing in an infant as an inguinal mass.
A 1-year-old boy presented with a right inguinal mass which had the appearance of a lymph node. After biopsy, the pathologist reported “non-specific adenitis”. Six weeks later the boy was admitted because of a recurrent swelling. The inguinal mass was large and irreducible. On urography, the bladder was displaced to the left and there was a right hydronephrosis.
A barium enema demonstrated upward displacement of the ascending colon.
Ultrasound examination showed a large inguinal mass of 8 cm, with solid and liquid areas (Fig. 1). The right ureter was dilated and displaced by the tumour.
On computed tomography (CT), a large tumour was demonstrated (Fig. 2) extending from the aortic bifurcation down to the right inguinal area. It contained fluid levels and areas of mixed density from 25 to 100 Hounsfield Units. Posteriorly, the tumour extended to the right ileo-psoas and anteriorly to the abdominal wall. There was no enhancement after an intravenous injection of contrast medium but the vessels were clearly visible (Fig. 3) within the mass. A diagnosis of cystic lymphangioma was made because of the association of fluid levels with solid areas.
A case of post-operative paresis
Authors: Olliff J. F. C. , Gwyther S. J. , Hart G. 
Published: July 2009

An 82-year-old man was admitted for biopsy of an anal mass lesion. Histology revealed a moderately well differentiated squamous cell carcinoma originating at the anal margin. Post-operative pyrexia resolved with intravenous antibiotics. Five days after this he developed neck stiffness, urinary retention and left-sided weakness with a sensory level at C4. Radiographs of the cervical spine were obtained and a cervical myelogram performed (Figs 1 and 2).
What features are seen on the two examinations and what are the likely causes?
The cervical spine radiograph (Fig. 1) shows degenerative changes with reduced height of the disc joint and osteophyte formation at C5/6 and C6/7. The height of the disc joint is also reduced at C3/4 with grade 1 backward slip of C3 on C4. The marginal hypertrophic changes are relatively slight. Subtle prevertebral softtissue swelling can be recognized anteriorly at this level. The myelogram shows almost complete obstruction to flow of contrast medium at the level of the C4/5 disc joint. The theca is displaced posteriorly at this level and the appearances would be in keeping with an extradural obstruction: only a small amount of contrast medium being visible superiorly at C2.
Magnetic resonance imaging (MRI) of the neck was undertaken. The sagittal T 1, weighted (time to repeat (TR) 500 ms, time to echo (TE) 17 ms) image demonstrates abnormal low signal in the vertebral bodies of C3 and C4 with thickening of the pre-vertebral, retropharyngeal soft tissues anteriorly (Fig. 3a).
Mathematical models of repopulation and reoxygenation in radiotherapy
Authors: Scott O. C. A. 
Published: July 2009

Mathematical models of the effect of ionizing radiation on tumours have not, so far, received general acceptance, and Wheldon (1989) warns of the dangers of over-generalization. Nevertheless, the construction of models may have a certain value, in that we are forced to define our assumptions with clarity.
It is interesting to compare two models which have been described in the columns of the BJR: “Misonidazole in fractionated radiotherapy: are many small fractions best?” (Denekamp et al, 1980) and “The linear-quadratic formula and progress in fractionated radiotherapy” (Fowler, 1989). The former gives a detailed description of the possible effect of reoxygenation on tumour response, but excludes repopulation. The latter is much concerned with repopulation, but excludes reoxygenation. Evidence that hypoxic cells may be important in the clinical response of tumours has been published recently (Gatenby et al, 1988; Whittle et al, 1990), and it would appear to be logical to combine the two models.
Denekamp et al give a full description of their model, and any computer-literate reader could reconstruct the programs from which they worked. The addition of repopulation is a simple matter, but the marriage of the two programs forces us to face an interesting question: which class of cells repopulates, the oxic or the hypoxic? The work of Tannock (1968), also quoted by Suit et al (1977), suggests that cells deprived of both oxygen and nutrients in a tumour cord are less likely to divide.
Urinary tract dilatation in constipated children
Authors: Herbetko J. , Hyde I. 
Published: July 2009

Abstract
Abnormalities of the upper urinary tract were sought retrospectively in 180 children with constipation who had been investigated surgically over a 5-year period. Of those in whom an intravenous urogram had been performed, the incidence of dilatation of the upper renal tract was high, but only 12% of the patients with non-organic constipation had been so investigated.
A clinical application of iodine quantitation using digital fluorography
Authors: Thompson W. D. , Kotre C. J. , Owen J. P. , Laker M. F. 
Published: July 2009

Abstract
A preliminary clinical study of 20 patients is described in which a method of iodine quantitation in vitro using digital fluoroscopy was applied to the intravenous urogram. It was possible to quantitate iodine levels, in terms of mass thickness, in both the renal parenchyma and collecting system in 38 of 40 kidneys studied (20 patients). In the two kidneys on which measurements could not be made, the cause of failure was subtraction artefact due to movement of bowel gas, compounded in one case by poor renal opacification. The variations of iodine mass thickness against time were plotted and their forms were similar to dynamic computed tomography and magnetic resonance imaging studies of transplanted kidneys. Potential clinical applications of this method, in particular the functional assessment of the dilated upper urinary tract, are suggested based on its ability to offer quantitative information in addition to anatomical images.
A model for hematopoietic death in man from irradiation of bone marrow during radioimmunotherapy
Authors: Scott Bobby R. , Dillehay Larry E. 
Published: July 2009

Abstract
There are numerous institutions worldwide performing clinical trials of radioimmunotherapy (RIT) for cancer. For RIT, an exponentially decaying radionuclide is attached by using a chelating agent to a specific monoclonal or polyclonal tumour antibody (e.g. antiferritin IgG). The major limitation to RIT is toxicity to normal tissue in organs other than the one containing the tumour (e.g. bone marrow). The focus of this manuscript is on modelling the risk (or probability) of hematopoietic death in man for exponentially decaying patterns of high-energy β irradiation (e.g. 90Y) of bone marrow by radioimmunoglobulin injected into the blood. The analytical solutions presented are only applicable to protocols for which significant uptake of radioactivity by the bone marrow does not occur, and only for high energy β emitters. However, the generic equation used to obtain the analytical solutions is applicable to any continuous pattern of high energy β irradiation. A model called the “normalized dose model” was used to generate calculated values for the LD50 as a function of the effective half-time for the radioimmunoglobulin in the blood. A less complicated empirical model was used to describe the calculated values. This model is presumed to be valid for effective halftimes in blood of up to about 20 days. For longer effective half-times, the LD50 can be estimated using the normalized-dose model presented. In this manuscript, we also provide a modified Weibull model that allows estimation of the risk of hematopoietic death for single or multiple injections (in one cycle) of radioimmunoglobulin, for patients with normal susceptibility to irradiation and for patients with heightened susceptibility. With the modified Weibull model, the risk of hematopoietic death depends on the level of medical treatment provided to mitigate radiation injuries.
Lack of late skin necrosis in man after high-dose irradiation using small field sizes: experiences of grid therapy
Authors: Shirato H. , Gupta N. K. , Jordan T. J. , Hendry J. H. 
Published: July 2009

Abstract
Out of a total of 437 patients with superior vena caval syndrome or advanced malignancy, given single-dose grid radiotherapy, four survived to 7 years. The dose to the skin under each of the 77 holes in the grid was approximately 58 Gy. The lack of skin necrosis in the total of 308 skin circles of 1 cm diameter among these survivors, compared with known necrosis rates in larger irradiated areas, implies that there is a marked field-size effect for late necrosis in small areas of irradiated skin.
Calibration of radiotherapy beams using a PC-based dosimetry recording system
Authors: Kenny M. B. , Millar R. M. 
Published: July 2009

Routine calibration of radiotherapy treatment units involves the following steps:
1. radiation measurement under standardized conditions;
2. recording of the resultant data;
3. applying correction factors to the data which take into account the response of the calibrating instrument, the effects of the measurement geometry and the beam type, etc.;
4. scrutinizing the results for significant changes in output from previous calibrations and, if necessary, making appropriate adjustments to the machine's dosimetry system;
5. recording all calculations and sundry other relevant information including date, time, operator, temperature, and barometric pressure etc.;
6. issuing a calibration certificate which either states the machine output or attests that the dosimetry system is set within acceptable tolerances.
Ultrasound cystography: a valuable technique
Authors: Coulden R. A. , Hanbury D. C. , Farman P. 
Published: July 2009

Ultrasound is a reliable method for demonstrating dilated upper renal tracts and obstruction (Scheible & Talner, 1979). However, not all dilated pelvicalyceal systems and ureters are obstructed (Flower, 1977). Similar appearances can be seen in vesico-ureteric reflux (VUR), megaureter and pregnancy (Cietak & Newton, 1985). Where there is doubt concerning the cause of dilatation, other techniques are required.
Ultrasound cystography, performed as a part of micturating cystography, has been shown to be useful in demonstrating VUR in children (Kessler & Altman, 1982). In this case report, we demonstrate its wider application in the distinction between obstruction and VUR in a complex urological problem.
Deterioration following delay in performing femoral angioplasty
Authors: Spencer J. A. , Fletcher E. W. L. 
Published: July 2009

Abstract
It is not uncommon for a delay to occur between assessment arteriography and angioplasty attempt. We reviewed retrospectively the arteriograms of 61 patients where such a delay occurred to assess progression of superficial femoral artery (SFA) disease in this interval. A mean delay of 14.6 days (range 2–60 days) occurred between arteriogram and angioplasty attempt. Arteriographic deterioration was found in six of 61 patients (9.8%) and in three this precluded angioplasty. Of the six patients four had initial arteriography via the same side as the SFA disease whilst two had arteriography via the contralateral femoral approach. We discuss the aetiology of this phenomenon and suggestions are made to reduce its incidence.
Occupational exposure and the Central Index of Dose Information
Authors: Kendall G. M. , Hughes J. S. 
Published: July 2009

Occupational exposure to ionizing radiation in the UK is presently controlled by the Ionizing Radiation Regulations, 1985 (Parliament, 1985) which were based on the recommendations of ICRP Publication 26 (ICRP, 1977). These recommendations and, in particular, the dose limits were formulated in the light of contemporary information about the risks of ionizing radiation (UNSCEAR, 1977). Recently, new epidemiological analyses of the survivors of the atomic bombs at Hiroshima and Nagasaki have been published (UNSCEAR, 1988; National Academy of Sciences, 1990). These studies suggest that the risk estimates for low doses and low dose rates may be higher by a factor of about 3 than previous analyses had indicated (Stather et al, 1988). In the light of preliminary announcements of the re-analyses of the atomic bomb survivors (e.g. Preston & Pierce, 1987) and of the ICRP Como Statement (ICRP, 1987), the NRPB recommended that occupational exposure to ionizing radiation should be controlled so as not to exceed an average dose equivalent of 15 mSv per year (NRPB, 1987). This has prompted renewed interest in the levels and distribution of occupational exposure to ionizing radiation.
This paper is based on a talk to the meeting organized by the British Institute of Radiology in December 1989 to discuss the implications of the new risk estimates. It presents statistics on occupational exposures in the UK in recent years and discusses the role of the Central Index of Dose Information (CIDI).
The scintigraphic detection of ossific mediastinal and pulmonary metastases in osteosarcoma
Authors: Brady Adrian P. , Ennis Joseph T. 
Published: July 2009

Osteosarcoma primarily occurs in the metaphyses of long bones, and metastatic spread is generally hematogenous (Price & Jefree, 1973). While localized lymph node dissemination is frequent, spread to distant nodes is unusual. Detection of occult metastases can influence patient prognosis. This case demonstrates the sensitivity of scintigraphy in detecting ossific metastases not recognized on conventional radiography and not detected by computerized tomography (CT).
A 24-year-old man presented with pain and swelling in the region of the left knee. Plain radiographs demonstrated intense osteoblastic changes in the distal left femur; a radiological diagnosis of osteosarcoma was made (Fig. 1), which was confirmed histologically. Thoracic CT demonstrated no evidence of metastatic spread. Scintigraphy with 99Tcm-MDP demonstrated focal intense uptake in the region of the tumour, but no evidence of satellite lesions.
Misinterpretation of the upper parathyroid adenoma on thallium-201/technetium-99m subtraction scintigraphy
Authors: Chan T. Y. K. , Serpell J. W. , Chan O. , Gaunt J. I. , Young A. E. , Nunan T. O. 
Published: July 2009

Abstract
Pre-operative thallium–technetium subtraction scintigraphy of 50 patients with primary hyperparathyroidism, which was subsequently proven on histology to be due to an adenoma, was compared with operative findings. Six scans were negative and seven uninterpretable. Of the remaining 37 patients, 34 had correct scan prediction of the anatomical locations of the adenomas. On examination of the origins of the adenomas, all six scintigraphic predictions of upper adenomas corresponded to tumours arising from the upper gland found at operation. Of the 25 lower predictions, there was one false positive and 16 were correct, i.e. of lower gland origin, but eight were found to originate from the upper gland. This misinterpretation is thought to be due to the prolapse of an adenoma arising from the upper gland towards the lower pole of the thyroid, thereby mimicking a lower lesion on the scan.
Splenic calcification following treatment of Hodgkin's disease
Authors: Moody A. R. , King D. M. 
Published: July 2009

Calcification within the spleen has many different manifestations and aetiologies. We report a single case of a patient with Stage IV Hodgkin disease who developed splenic calcification following chemotherapy. A search of the literature has failed to reveal a previous report of this phenomenon.
A 43-year-old man presented with a 6-month history of increasing painless swelling in the left side of his neck. Latterly this had been accompanied by the development of further smaller cervical nodules. He was otherwise asymptomatic.
On examination, mobile rubbery lymph nodes were confirmed in the left cervical and supra-clavicular regions, the largest being up to 1 cm in diameter. Smaller nodes were also found in the left axilla and both inguinal regions. One of the nodes in the left posterior cervical triangle was removed and histological examination revealed mixed cellularity Hodgkin disease.
A plain radiograph of the chest demonstrated no abnormality and computed tomography (CT) of the thorax and abdomen was performed to delineate the extent of the disease. There was no evidence of mediastinal or other lymph node enlargement; the liver and spleen were normal in size and shape and contained no focal abnormality (Fig. 1). A bipedal lymphogram was performed which demonstrated an unusual and suspicious appearance in the proximal inguinal regions. Lymph node biopsy revealed no evidence of disease. The patient was therefore staged as IA mixed cellularity Hodgkin disease.
Carcinoma of the breast: measurement and the management of treatment. II. The regression of tumours
Authors: Cheung C. W. D. , Johnson A. E. 
Published: July 2009

Abstract
Regression slopes fitted in 238 new cases of primary breast cancer submitted to a variety of managements are analysed. Contrary to the original hypothesis that slopes would primarily reflect the composition of the tumours, the steepness of resorption slopes is found also to be treatment dependent. Investigation of other factors influencing slopes is confined to radiotherapy where the expectation that the prescribed dose will be delivered is high. A large cumulative radiation effect before the start of shrinkage is associated with steeper slopes. A small correlation between slope and both menopausal status and starting diameter has been found, with premenopausal patients and small tumours producing the steepest slopes. The full range of slopes has been seen in postmenopausal patients. The data has been fitted to a linear model to evaluate the relative importance of these associations. Illustrative cases support the hypothesis that resorption slopes are a product of tumour architecture and histology but we conclude that the maximum possible steepness of slope is not always achieved in the clinic, even when radiation is used. A combination of histological and regression data is therefore required to characterize a tumour for predictive purposes.
Gallium scintigraphy in the diagnosis and management of multi-focal Castleman's disease
Authors: Stansby G. , Hilson A. , Hamilton G. 
Published: July 2009

Castleman's disease is a rare condition which can mimic the presentation of more common disorders. We describe the first reported case of the use of gallium scintigraphy in the multifocal form of this disease and suggest that gallium scintigraphy may have an important role to play in both its diagnosis and management.
The patient was a 37-year-old roofer who had previously always been fit and well. He was transferred to our hospital with a 10-day history of dry cough, myalgia and rigours. Except for symmetrical lower limb weakness, examination was normal and the erythrocyte sedimentation rate (ESR) was raised at 58 mm/h. The initial diagnosis was one of a post-viral myositis and he was discharged home on a reducing dose of steroids.