bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accuracy of ultrasound and oral cholecystography in assessing the number and size of gallstones: implications for non-surgical therapy
Authors: Brakel Koen , Laméris Johan S. , Nijs Huub G. T. , Ginai Abida Z. , Terpstra Onno T. 
Published: July 2009

Abstract
Prior to non-surgical therapy of gallstones it is important to assess their number and size. In order to evaluate the accuracy of ultrasound (US) and oral cholecystography (OCG) in counting and measuring gallstones, a prospective blind study was conducted to compare the results of US (n = 99) and OCG (n = 36), either alone or in combination (n = 34), with the number and size of gallstones retrieved after cholecystectomy. The number of gallstones was accurately estimated by US and OCG in 74% and 69% of the cases, respectively. In assessing the presence of up to three, five or 10 gallstones both US and OCG proved reliable. In measuring the size of gallstones, there was 19% accuracy with US compared with only 3% with OCG. With an accepted measurement error of 3 mm these values increased to 80% for US and 44% for OCG. US proved more reliable than OCG in discriminating gallstones smaller or larger than 10 mm and smaller or larger than 20 mm, but with US, detection of gallstones larger than 30 mm was problematic. Both US and OCG underestimated gallstone size. The combination of both techniques did not significantly improve the assessment of either number or size of gallstones compared with the results obtained with US or OCG alone. It is concluded that (1) both US and OCG have some limitations in assessing the number and size of gallstones, (2) the combination of both examinations does not improve acccuracy, and (3) patient selection for non-surgical treatment of gallstones can be started by US alone.
An investigation into the effect of protective devices on the dose to radiosensitive organs in the head and neck
Authors: Marshall N. W. , Faulkner K. , Clarke P. 
Published: July 2009

Abstract
A series of experiments were performed to determine the dose reduction afforded to radiosensitive organs in the head and neck by various protective devices. These included spectacles with plastic, standard glass, photochromic and lead-glass lenses, a thyroid collar and a lead-acrylic face mask. The measurements were performed using an anthropomorphic phantom loaded with lithium fluoride thermoluminescent dosemeters, in conditions realistic of clinical practice. Irradiations were performed using scattered radiation produced by a pelvic phantom, for X-ray beams generated at 80 kVp and 110 KVp. It was found that the reduction in dose to the lens of the eye ranged between 0% and 97%, whilst the dose to the thyroid and oesophagus was reduced by between 76% and 97%, and was dependent on the protective device and tube potential employed. A reduction in brain dose of up to 81% was also measured, for the lead-acrylic face mask. Also presented is the ratio of organ dose to dose to the bridge of the nose for thyroid, oesophagus, brain and sinuses, as measured for the case of no head or neck protection.
Evaluation and skeletal metastases
Authors: Merrick M. V. , Beales J. S. M. , Garvie N. , Leonard R. C. O. 
Published: July 2009

Bone scintigraphy remains one of the commonest isotope imaging investigations employed for the detection of occult skeletal metastases when staging a number of common cancers. The objectives of staging are firstly, to identify patients in whom the disease may be locally curable and secondly, to identify those who may have dissemination, in whom radical local treatment is inappropriate. Increasingly, formal restaging is also repeated at first recurrence. The information considered necessary for clinical management is changing continuously, with developments both in treatment and imaging techniques. The costs must be balanced against those of inappropriate administration or withholding of treatment; in the case of bone scintigraphy, a relatively low-cost procedure, it is not difficult to identify net benefits which offset the costs. The objectives of the panel and its associated floor discussion were to review current practice and to determine, clarify and possibly extend areas in which there is agreement.
Cancer of the lung is the commonest single malignancy in the UK, comprising approximately 25% of all cancers. It is responsible for approximately 40000 deaths per annum in the UK (Capewell et al, 1987). The case mortality is one of the highest of all tumours, being second only to carcinoma of the pancreas. Untreated, the mean survival from diagnosis is less than 3 months (Capewell et al, 1990). There is a 30% 5 year survival for patients with “locally curable” disease, mostly squamous carcinoma, but these patients constitute only a small percentage of the overall population with lung cancer.
An afterloading technique utilizing The Royal London Hospital caesium-137 brain needle in an oral obturator
Authors: Tierney A. M. , Mantell B. S. 
Published: July 2009

The intended use of the brain needle (Fig. 1) is the irradiation of brain tumours using a stereotactic technique (Mantell et al, 1986). We have adapted the needle to suit another purpose.
A patient with a mixed tumour of the right paranasal sinuses was treated by initial chemotherapy followed by maxillectomy, leaving a large cavity extending to the roof of the sphenoid sinus, where histology of the resected specimen showed residual squamous cell carcinoma. Post-operative external irradiation using 8 MV X rays was given to the entire operated volume as a dose of 5000 cGy in 24 fractions over 36 days. It was intended to boost the dose to the region of the sphenoid sinus to minimize the risk of recurrence at this site, while keeping the dose to the brain stem within tolerance.
Can serum prostate-specific antigen replace bone scintigraphy in the follow-up of metastatic prostatic cancer?
Authors: Sissons G. R. J. , Clements R. , Peeling W. B. , Penney M. D. 
Published: July 2009

Abstract
Bone scintigraphy is the most sensitive imaging technique for the initial detection of bone metastases and is widely used in the staging of prostatic cancer. This study was performed to assess whether the development of further bone metastases can be detected by serial measurements of the serum glycoprotein prostate-specific antigen (PSA) as an alternative to follow-up scintigraphy. The bone scintigrams and PSA levels of 101 patients with metastatic prostate cancer entered into two therapeutic trials have been reviewed. Serial results of both investigations were available in 59 cases. In three cases new bone deposits were observed without a corresponding rise in PSA. In two other cases the scintigrams were considered to be suspicious of progression with no change in PSA levels; however, further follow-up indicated that these changes were not due to metastases. In 13 cases PSA levels were rising in advance of new deposits on the scintigrams. In the remaining 41 cases the PSA levels and scintigraphic findings paralleled each other. We conclude that serial estimation of PSA levels is a simpler marker for disease progression than bone scintigraphy in metastatic prostatic cancer, but that neither technique in isolation gives complete accuracy.
Radial diffusion coefficient mapping
Authors: Madden Anthoula , Leach Martin O. 
Published: July 2009

Abstract
The two-dimensional mapping of the effective diffusion coefficient of water in tissues may provide a useful method of tissue characterization to complement T 1 and T 2 relaxation time studies for diagnostic purposes. Current diffusion techniques rely on the application of large gradient strengths and long echo times to achieve the required sensitivity. This, in turn, limits the applicability of the technique to tissues having long T 2s with rapid water diffusion. In addition, the inherent directionality of these methods results in only the partial encoding of diffusion information. A modified diffusion sequence is presented, radial diffusion mapping (RAD), which provides enhanced sensitivity diffusion maps by employing gradient sensitization in three orthogonal directions. Results in both phantoms and volunteers are presented, together with an investigation of the effects of T 2 on the measurement accuracy. Using RAD, a two- to five-fold improvement in sensitivity was achieved, thus significantly enhancing the dynamic range of the method and allowing more accurate in vivo diffusion measurements to be carried out.
Functional changes in the pig kidney following irradiation with fractionated doses of fast neutrons (42 MeVd→Be)
Authors: Robbins M. E. C. , Barnes D. W. H. , Hopewell J. W. , Knowles J. F. , Rezvani M. , Sansom J. M. 
Published: July 2009

Abstract
The right kidney of female Large White pigs, approximately 14 weeks old, was irradiated with fractionated doses of fast neutrons (42MeVd→Be). The total doses used were 6.6–9.2 Gy. Changes in kidney function, assessed as the functional index (FI, where FI = irradiated kidney function/unirradiated kidney function) or as individual kidney glomerular filtration rate (GFR) and effective renal plasma flow (ERPF), were serially determined up to 104 weeks after irradiation using 99Tcm-DTPA and 13lI-hippuran renography. The animals were then euthanized, the kidneys removed and weighed. A dose-dependent reduction in FI was seen within 13 weeks of irradiation. Measuring individual kidney function revealed a hyperaemic response in both irradiated and unirradiated kidneys 4 weeks after irradiation. This was followed by a dose-dependent reduction in irradiated kidney GFR and particularly ERPF. The ED50 value for the impairment in ERPF, assessed as the percentage of irradiated kidneys exhibiting a ≥ 50% reduction in ERPF, was significantly lower than that for GFR, i.e. 7.20 ± 0.10 Gy compared with 8.44 ± 0.07 Gy (p &lt; 0.001). A dose-related reduction in irradiated kidney weight was also observed. These fast neutron-induced changes in renal function and weight are qualitatively similar to those observed following photon irradiation of the pig kidney.
Localization of impalpable breast lesions using the Hawkins needle
Authors: Walker T. M. , Ross H. B. 
Published: July 2009

Pre-operative localization of impalpable breast lesions detected by mammography has become a routine procedure, especially in those units involved with breast screening. Various techniques are available to facilitate localization, either with the injection of dyes, or using one of a variety of flexible wires or rigid needles.
A new needle, the Hawkins needle*, has recently become available (Urratia et al, 1988), and we wish to describe its use in 99 patients.
The Hawkins needle (Fig. 1) is a co-axial system which consists of a rigid 20-gauge outer sheath with a blunt tip and a small window 1.5 cm from the tip; an inner core has a sharp tip and a spring-hook. When the inner core is advanced the needle point protrudes from the outer sheath; if the core is withdrawn the point is hidden in the sheath and the spring-hook protrudes from the window in the outer sheath. Clear markings at 1 cm intervals are etched on the needle shaft. The proximal end of the inner core has an 18-gauge hub welded to it. There is also a two-part removable plastic hub which fits over the proximal end of the needle. It is available in 10 cm or 12.5 cm lengths.
Second malignant neoplasm following treatment of Hodgkin's disease: a case report
Authors: Rao V. S. N. , Dinshaw K. A. , Shrivastava S. K. , Muckaden M. A. , Susnerwala S. , Advani S. H. , Vyas J. J. , Kavarana N. M. 
Published: July 2009

Improvement in the treatment of Hodgkin's Disease (HD) over the past decade has led to increased survival rates, particularly in the early stages. Recognition of long-term complications of the treatment have also increased. Prolonged survival following aggressive treatment of HD is accompanied by an increased risk of the oncogenic effects of radiotherapy and chemotherapy (Halperin etal, 1984). Second malignant neoplasms (SMN) may also develop after the primary has been successfully treated and cured (Kim et al, 1978; Valagussa et al, 1986; Boivin & O'Brien, 1988). We report a case of HD, successfully treated by combined modality treatment developing a chondrosarcoma arising in the chest wall 9 years later.
A 5-year-old female child presented to the Tata Memorial Hospital, in February 1980 with bilateral cervical and left axillary lymphadenopathy of 15 months duration. There was no history suggestive of “B” symptoms. The liver and spleen were not palpable. The chest radiography, bone marrow aspiration and biopsy and lymphogram were all normal. A biopsy of a cervical lymphnode revealed Hodgkin's disease of lymphocyte-predominance type. Thus she was staged clinically as Hodgkin's disease IIA as per the Ann-Arbor classification (Carbone, 1971). The child was treated by radical irradiation with 60Co gamma rays to a total dose of 4000 cGy in 20 fractions over 36 days to the mantle field with a further boost of 1000 cGy in 1 week to the left supraclavicular fossa between March and April 1980.
Segmental reversal of intrahepatic portal flow due to a liver metastasis
Authors: Kishimoto Riwa , Choji Kiyoshi , Massoud Tarik F. , Matsuoka Shin-ichi , Chen Minhua , Fujita Nobuyuki , Irie Goro 
Published: July 2009

A 60-year-old woman who had a Dukes C colonic adenocarcinoma resected four years previously presented with malaise, hepatomegaly and elevated serum tumour markers. Her radiological investigations included liver ultrasonography, computed tomography (CT) (Fig. 1), and magnetic resonance imaging. These revealed a 6 cm solitary metastasis mainly in the right lobe (segments S8 and S4) not extending to the porta hepatis. The tumour compressed the inferior vena cava (IVC) and the right hepatic vein. No portal vein thrombosis was demonstrated. Angiography was performed prior to surgical removal of the tumour. The portal phase of a selective superior mesenteric arteriogram unexpectedly revealed abrupt “cut-oft” the main right portal branch at the porta hepatis, and no portal branches were demonstrated within the right lobe of the liver (Fig. 2). A selective common hepatic arteriogram demonstrated the tumour blush in the upper part of the right lobe of the liver as well as a faint blush-like impression of the main branch of the right portal vein in the late phase.
In view of these portal venographic appearances, a duplex ultrasonographic examination was performed for further assessment (Fig. 3a). Due to the patient's abdominal discomfort, she was most at ease whilst lying supine with her knees flexed. In this position, normal flow in all the hepatic veins as well as the intrahepatic portal branches was observed (Fig. 3b). However, when the patient extended her knees fully the haemodynamics altered.
Intrarenal varices mimicking hydronephrosis
Authors: Kincaid W. , Edwards R. 
Published: July 2009

A case of intrarenal varices mimicking hydronephrosis on ultrasound examination is described. This is an important differential diagnosis if intervention is being considered.
A 20-year-old male with portal hypertension secondary to idiopathic portal vein thrombosis presented with left loin pain. 3 years previously he had a successful end-to-side distal sple-norenal shunt. Ultrasound examination was reported as showing a mild left hydronephrosis and multiple splenic varices. Doppler examination was not performed. On intravenous urography the left kidney excreted promptly. There was widespread deformity of the calyces but no dilatation. His pain settled and he was discharged.
The Swiss cheese brain
Authors: Jackson A. , Dobson M. J. , Cooper P. N. 
Published: July 2009

A 37-year-old Indian man presented with a 6-month history of focal and grand mal convulsions. He had emigrated from India 2 years previously and was working as a chef in a local restaurant. There was no significant past medical history. Initial investigations included a computed tomogram (CT) of his brain (Fig. 1), which demonstrated a number of small enhancing parenchymal lesions with surrounding low-attenuation changes which were attributed to oedema. A magnetic resonance (MR) scan was performed and is illustrated (Figs 2–4).
What are the radiological findings' What is the diagnosis and what other information would you seek to confirm this'
The MR images demonstrate multiple, well-defined lesions throughout the brain, which show a predilection for grey matter.
The role of 99Tcm-HMPAO white cell imaging in suspected orthopaedic infection
Authors: Copping C. , Dalgliesh S. M. , Dudley N. J. , Griffiths P. A. , Harrington M. , POtter R. , Smith B. D. 
Published: July 2009

We thank you for the opportunity to respond to the interesting letter from Dr Wilson concerning our recent article (Copping et al, 1992).
The group of patients included in the study were those with suspected latent infection. They presented with pain, no elevation of temperature and subsequent negative blood tests. In our opinion, aspiration is not the primary investigation of choice for such patients.
Coil embolization using a saline flush technique
Authors: Tarazov P. G. , Gapchenko E. M. , Dmitrieva I. A. , Ryzhkov V. K. 
Published: July 2009

We read with great interest the article by Makita et al (1991). We would like to report our experience with the saline flush technique for coil embolization.
We have been using a similar technique since 1982. The saline flush manoeuvre was carried out in about 200 patients (approximately 400 coils). The splenic, hepatic, renal and hypogastric arteries were successfully embolized.
Lethal micromelic facial bones sclerosis dysplasia
Authors: Müller D. , Kozlowski K. , Sillence D. 
Published: July 2009

This stillborn female, the third born of unrelated parents, was delivered by spontaneous vaginal delivery at 31 weeks gestation after a pregnancy complicated by polyhydramnios. The birth weight was 2750 g and the length 42 cm. Severe hydrops foetalis was present (Fig. 1).
The mother had been treated for insulin dependent diabetes mellitus for the past 10 years. The first child, delivered at 31 weeks of gestation, died aged 7 days with a diagnosis of diabetic fetopathy. There was neither clinical, radiographic nor anatomo-pathological evidence of bone dysplasia. The second child was normal. The father had no history of bone dysplasia.
Non-endoscopic per oral biliary stent insertion
Authors: Singanayagam J. , Chow H. K. , West D. J. 
Published: July 2009

We describe a new technique of biliary stent insertion which is particularly suitable for patients with previous gastric surgery where endoscopic or combined endoscopic and percutaneous biliary stent insertion would be technically difficult.
A 64-year-old lady with previous history of palliative polya gastrectomy for antral carcinoma presented with obstructive jaundice due to recurrent tumour. Under local anaesthesia and light sedation a percutaneous transhepatic approach was made into the dilated right intrahepatic biliary tree using a van Sonnenberg two part needle. A percutaneous transhepatic cholangiogram confirmed a dilated biliary tree, occlusion of the common bile duct and multiple stones in the gallbladder (Fig. 1). A hydrophilic guide wire (150 cm long, 0.035″ diameter, Radifocus angled type from Terumo Corporation, Tokyo) was manipulated through the occluded segment of the common bile duct into the proximal duodenal loop. A 110 cm long 5 F cobra catheter was inserted over the guide wire and was used to steer the guide wire through the gastro jejunal anastomosis into the stomach and thereafter through the gastro oesophageal junction into the oesophagus and mouth (Fig. 2).
Fit and … well
Authors: Thomas R. D. , Gould A. J. 
Published: July 2009

Previously fit and well, a 65-year-old gentleman awoke at 3 am with searing interscapular pain. The general practitioner administered morphine and referred him urgently to hospital. On arrival he was found to be pale and sweaty with a mild tachycardia and he refused to move his arms. Physical examination was otherwise unremarkable and, of note, his blood pressure was normal. He was considered likely to have suffered a myocardial infarction though an electrocardiogram (ECG) showed only the tachycardia. A chest radiograph was considered normal by the admitting clinicians.
The “arrest team” was called 2 h after admission and found the patient cyanosed and having a grand mal epileptic attack. He recovered spontaneously.
Acronyms in bone densitometry
Authors: Genant H. K. , Gluer C. C. , Faulkner K. G. , Majumdar S. , Harris S. T. , Engelke K. , Kuijk C. van 
Published: July 2009

In response to our publication (Gluer et al, 1990a), Wilson and colleagues (1990) proposed the adoption of a uniform terminology and corresponding abbreviation for Dual X-ray Absorptiometry (DXA).
We supported this suggestion (Gluer et al, 1990b). Since then, the number of papers on DXA has increased considerably. Still, different abbreviations (DEXA, DER, DRA, QDR and DPX) for this technique for bone densitometry are used, several of which are proprietary in origin. DXA is the upgraded version of DPA (Dual Photon Absorptiometry). The nuclear source has been replaced by an X-ray source and this improved technology has gained wide-spread acceptance and distribution.
Book reviews
Authors: Jackson P. C. 
Published: July 2009

This book is excellent: it is the “Kaye & Laby” and “Geigy Scientific Tables” for those who work or are connected with the medical sciences.
The book consists of nine chapters covering the thermal, optical (including ultraviolet and infrared), acoustic (i.e., ultrasonic), mechanical and electrical properties of tissue; together with the effects of ionizing radiation and nuclear magnetism within tissues. An additional chapter and appendices provide information on tissue composition and perfusion rates.
Subtraction gadolinium enhanced magnetic resonance for head and neck imaging
Authors: Lloyd G A S , Barker P G , Phelps P D 
Published: July 2009

Abstract
The subtraction method of Des Plantes has been applied to gadolinium enhanced magnetic resonance imaging (GdMR). Using short acquisition times, T 1 weighted spin echo pulse sequences are made immediately before and after the intravenous administration of gadolinium DTPA. To avoid moving the patient from the scanning tunnel the venipuncture is made into the dorsum of the foot. The needle is placed in the vein prior to putting the patient into the scanner and is irrigated with saline while the control series is obtained. 42 patients with naso-sinus or skull base tumours have been successfully investigated by this technique and satisfactory subtraction studies are now obtained on all patients other than the claustrophobic. Subtraction GdMR provides the best demonstration of the effects of gadolinium DTPA on the magnetic resonance signal for both normal and abnormal tissues. The signal recorded on the subtraction image is dependent on tissue blood supply and provides a more accurate record of tumour extent than that shown by unsubtracted GdMR scans.
Use of peritoneal insufflation to displace the small bowel during pelvic and abdominal radiotherapy in carcinoma of the cervix
Authors: Hindley A , Cole H 
Published: July 2009

Abstract
Peritoneal insufflation is a technique which reliably displaces small bowel from pelvic and abdominal radiotherapy fields with the aim of reducing bowel reactions which limit the dose of radiation applied to these sites. Use of this technique in five patients undergoing radiotherapy for advanced carcinoma of the cervix, and the degree of bowel displacement resulting, dosimetry, acute reactions and tolerability of the technique are presented, with discussion of the possibility of future escalation in radiotherapy dose.