Values and beliefs of vegetarians and omnivores

Following the claim by some anthropologists and sociologists that 1 symbolic meaning of meat is a preference for hierarchical domination (C. J. Adams, 1990; N. Fiddes, 1989; D. D. Heisley, 1990; J. Twigg, 1983), the authors compared the values and beliefs of vegetarians and omnivores in 2 studies conducted in New Zealand. They compared the full range of vegetarians and omnivores on right-wing authoritarianism, social dominance orientation, human values, and consumption values. The participants tending toward omnivorism differed from those leaning toward veganism and vegetarianism in 2 principal ways: The omnivores (a) were more likely to endorse hierarchical domination and (b) placed less importance on emotional states. Accordingly, the acceptance or rejection of meat co-varied with the acceptance or rejection of the values associated with meat; that finding suggests that individuals consume meat and embrace its symbolism in ways consistent with their self-definitions.

The value of MRI in the diagnosis and management of neurocysticercosis

The clinical manifestation of neurocysticercosis is quite protean and variable making it the 'great imitator' of almost any neurological disorder. In the last decade, developments in diagnostic imaging and effective anticysticercus drug therapy have changed the outlook of the disease. Two cases investigated with CT scan and MRI are reported here. One case was treated effectively with antihelminthic therapy. In both cases MRI was found to be much more sensitive than CT scan in picking up the multiple cystic lesions. In addition, 'protoscoleces' and 'differential ring enhancements' not apparent in CT scan were well shown in MRI hence enabling the demonstration of different activity stages. In the treated patient, repeat MRI showed degeneration of the cyst. These illustrate that MRI is superior to CT scan in both the diagnosis and management of the illness.

Hepatic inflammatory mass secondary to toothpick perforation of the stomach: triphasic CT appearances

Unintentional ingestion of foreign bodies is common in daily life. The unintentional ingestion of sharp foreign bodies such as toothpicks, fish bones and chicken bones carries a significant risk of perforation of the gastrointestinal tract. Herein, we report a case of hepatic inflammatory mass complicated by the perforation of an ingested toothpick that had a distinctive enhancement pattern on dynamic computed tomograms (CT). Understanding the phenomenon of enhancement in triphasic CT study is the basis in differentiating liver neoplasms.

Locally recurrent nasopharyngeal carcinoma

PURPOSE

To assess the outcome of and determine prognostic factors for locally recurrent nasopharyngeal carcinoma (NPC) in patients treated with a second course of radiotherapy (RT).

MATERIALS AND METHODS

From 1982 to 1995, 186 NPC patients, who had initially been treated in the Department of Radiation Oncology, Chang Gung Memorial Hospital-Linkou, developed local recurrence in the nasopharynx and were re-treated with RT (>/=20 Gy). The time from the initial RT to re-treatment ranged from 8 to 136 months (median: 23 months). All patients were treated with external RT and conformal radiotherapy was used in 35 patients after 1993. Fifteen received radiosurgery as a boost treatment. The RT dose at the nasopharyngeal tumor area ranged from 20 to 67.2 Gy (median 50 Gy). Eighty-two patients received one to eight courses of cisplatin-based chemotherapy in addition to RT.

RESULTS

The 1-, 3- and 5-year survival was 54.9, 22. 1 and 12.4%, respectively. Patients whose tumor relapsed later than 2 years after the first treatment had a better survival than those with earlier relapse (3-year survival: 30.1 vs. 10.8%; P=0.015), but the difference became insignificant in patients who received >/=50 Gy. Patients without evidence of intracranial invasion or cranial nerve palsy had better survival than those with such lesions (3-year survival: 30.9 vs. 3.7%; P=0.006). A re-treatment dose >/=50 Gy yielded better survival (3-year survival: 22.8 vs. 18.5%; P=0.003). Addition use of radiosurgery may improve survival. The use of chemotherapy did not improve survival. Conformal radiotherapy resulted in significantly fewer severe complications than conventional RT.

CONCLUSIONS

A repeat course of RT for locally recurrent NPC successfully prolongs survival in a significant number of patients. Intracranial invasion and/or cranial nerve palsy and re-treatment dose affect the prognosis, with a dose of >/=50 Gy significantly improving survival. Radiosurgery boost may also improve survival. Our preliminary data indicates that conformal radiotherapy may decrease the severity of radiation-induced complications. However; longer follow-up and larger sample size is necessary to document the findings.

Embolization of a pulmonary arteriovenous fistula by electrolytic detachable coils: case report

Transarterial embolization with detachable coils is a technique commonly used for the treatment of intracranial aneurysms. We report on a patient with a pulmonary arteriovenous fistula (PAVF) treated successfully with this technique. The patient presented with a history of intermittent hemoptysis, nasal bleeding, numbness of the upper extremities, and seizures. Computed tomographic angiography and magnetic resonance angiography demonstrated a single-hole arteriovenous fistular lesion in the left lower lung. Pre-embolization superselective pulmonary angiography revealed multiple fistulae communicating to the venous sac of the lesion. Eleven detachable coils were deployed into the venous sac, with resultant total occlusion of the pulmonary arteriovenous fistula. We conclude that venous sac embolization in treating this kind of patients is effective. The combined use of a microcatheter system and electrolytic detachable coils may be an excellent technique for achieving this kind of embolization. Superselective angiographic evaluation is essential before embolization, because many occult feeders can be present in cases of high-flow PAVF.

MRI in recurrent nasopharyngeal carcinoma

In this study, we retrospectively reviewed the MRI features of recurrent nasopharyngeal carcinoma (NPC) in 72 patients who underwent MRI before and after gadolinium injection. Recurrent NPC exhibited a high degree of regional spread and a variety of signal intensities and contours. MRI showed a nasopharyngeal mass in 50 patients (69.4 %); other sites of involvement included the parapharyngeal space (44.4 %), nasal cavity (12.5 %), paranasal sinuses (27.8 %), oropharynx (4.2 %), orbit (8.3 %), infratemporal fossa (18.1 %), skull base (59.8 %), intracranial area (51.4 %) and regional lymph nodes (15.3 %). On T2-weighted images, the nasopharyngeal mass gave high signal in 9 of 50 cases (18 %), intermediate in 27 (54 %), mixed in 8 (16 %) and low signal in 6 (12 %). Contrast enhancement was strong in 12 cases (24 %), moderate in 29 (58 %) and heterogeneous in 9 (18 %). The lesion was convex in 31 cases (62 %) and concave or straight in 19 (38 %). Recognition of the distribution and the appearance of recurrent NPC on MRI is essential for timely diagnosis and appropriate treatment.

Angiolipoma of the breast with microcalcification. Mammographic, sonographic, and histologic appearances

Angiolipoma of the breast is a rare benign fatty tumor that can be mammographically confused with breast carcinoma. We herein report such a case presenting as a partial obscured mass with microcalcification on mammogram. Sonogram revealed an encapsulated hyperechoic nodule with homogeneous internal echo. Microscopic evaluation revealed abundant adipose tissues with evidence of proliferating vessels and intravascular hyaline thrombi. To our knowledge, angiolipomas of the breast containing microcalcification secondary to intravascular thrombi had not been previously reported.

Nasopharyngeal carcinoma: review of how imaging affects staging

Imaging plays an important role in the staging of carcinoma of the nasopharynx. Accurate staging is necessary as the treatment is directly dependent on stage. Clinical examination provides information on mucosal involvement but is unable to determine the deep extension or presence of skull base invasion or intracranial spread. The 1997 International Union Against Cancer (UICC) and American Joint Committee on Cancer (AJCC) staging manuals were a collaborative project that provided a unified classification for nasopharyngeal carcinoma (NPC). The majority of staging can be identified only on imaging and not by clinical examination. The intent of this article is to provide information on the specific imaging findings that will directly affect the stage and treatment of NPC.

Magnetic resonance imaging of nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) is a malignant tumor that shows distinct distributions into geographical and into well-defined high-risk ethnic groups. Radiation therapy is the mainstay of treatment, and imaging plays a central role in tumor mapping and post-treatment follow-up. Magnetic resonance imaging is better than computed tomography in demonstrating tumor extent, tumor recurrence, and postradiation complications. However, differentiating postradiation changes from tumor recurrence may be difficult using magnetic resonance imaging. Mucosal recurrence is best detected with endoscopy.

Development of a device for immobilization of head and correlation of functional-anatomical brain images

BACKGROUND

The excellent resolution of brain imaging modalities has important contributions in the diagnosis of brain diseases. However, involuntary movement by the patient may cause poor image quality. In this study, we developed a device to help keep a patient's head immobilized during brain image acquisition, for comparison between each follow-up study, and for functional-anatomical image correlation.

METHODS

This device includes an acrylic material head supporter and a thermoplastic material facemask. The head supporter and the facemask can be firmly attached as a whole to support the head in a fixed position. Two capillary tubes filled with technetium-99m solution were placed perpendicularly on one side of the facemask as fiducial for imaging correlation between different studies. Ten patients, who each had two technetium-99m hexamethyl propyleneamine oxime (99mTc-HMPAO) brain single photon emission computer tomography (SPECT), were tested with this device for imaging.

RESULTS

Three-dimensional cine motion and sectional imaging were displayed and confirmed head immobilization in all of these studies. In addition, the 99mTc fiducial were useful in the comparison of head positions among the different studies. In five subjects, the device also proved to be useful in functional-anatomical correlation among SPECT, magnetic resonance imaging (MRI), and computed tomography (CT) images.

CONCLUSION

In conclusion, this device has been developed and found to be useful in (1) keeping patient's head immobilization, (2) keeping consistent head position for follow-up studies, and (3) SPECT, MRI and CT functional-anatomical imaging correlation.

Lymphangiectasia within angiomyolipoma in a tuberous sclerosis patient

This is a presentation of a case of tuberous sclerosis with multifocal hamartomas in the retroperitoneum, both kidneys, and the liver. Lymphangiectasia and numerous ectatic lymphatic channels penetrating through the retroperitoneal angiomyolipoma were demonstrated by lymphography and computed tomography. The findings in our study may document the presence of degenerative change in the lymphatic system--not just in elastic vessels--an association which has not yet been reported in the radiological literature.

MRI of thoracic vascular lesions with emphasis on two-dimensional time-of-flight MR angiography

MRI is a valuable method for evaluating thoracic vascular lesions by virtue of its non-invasiveness and multiplanar capability. In addition, ionizing radiation and iodinated contrast medium are not required. Electrocardiographically gated T1 weighted spin echo MRI remains the principal technique for demonstrating the anatomy and morphology of thoracic vascular diseases. Cine MRI allows dynamic evaluation of vascular flow, whereas MR angiography is particularly useful in the two-dimensional (2D) or three-dimensional (3D) display of vascular anatomy. This pictorial review illustrates the use of 2D time-of-flight MR angiography in the assessment of various thoracic vascular conditions including aortic arch and great vessel anomalies, heterotaxic syndromes, aortic dissection, aortic or arch vessel aneurysms, pulmonary embolism, pulmonary sequestration, axillofemoral bypass and tumour/vessel relationships.

Adult ovarian granulosa cell tumors: spectrum of sonographic and CT findings with pathologic correlation

OBJECTIVE

The objective of this study was to evaluate the spectrum of sonographic and CT findings in adult ovarian granulosa cell tumors with pathologic correlation.

MATERIALS AND METHODS

Transabdominal sonograms and CT scans in 13 patients with pathologically proven adult ovarian granulosa cell tumors were retrospectively reviewed. Morphologic characteristics of the lesions shown on sonography and CT were correlated with the histopathologic findings.

RESULTS

On the basis of sonographic and CT findings, 13 cases of adult ovarian granulosa cell tumor were categorized into five morphologic patterns: multilocular cystic (n = 6), thick-walled unilocular cystic (n = 2), thin-walled unilocular cystic (n = 1), homogeneously solid (n = 2), and heterogeneously solid (n = 2) masses. Histopathologically, the multilocular cystic masses were characterized by a predominately macrofollicular pattern of granulosa cells and multiple cystic spaces with watery fluid or hemorrhage. Unilocular central cystic masses seen on CT correlated pathologically with confluence and expansion of the cystic spaces. Homogeneously solid masses seen on sonography and CT were correlated with evenly distributed trabecular or diffuse patterns in the tumor cells. Intratumoral bleeding, infarcts, fibrous degeneration, and irregularly arranged tumor cells yielded heterogeneously solid tumors.

CONCLUSION

Adult ovarian granulosa cell tumors have a varied histologic appearance and a varied arrangement of tumor cells, both of which can create a spectrum of imaging manifestations. Appreciation of these manifestations is helpful in the diagnosis of this tumor.

MRI features of Balo's concentric sclerosis

We report MRI findings in a 56-year-old woman with Balo's concentric sclerosis (BCS) who initially presented with a progressive hemiparesis. MRI showed two lesions with a concentric pattern in the left frontoparietal region and a laminated, arcuate pattern in the right frontal region. These patterns were best seen in post-contrast images and were consistent with BCS. In addition, there were several small cerebral multiple sclerosis-like plaques. The clinical symptoms improved and the MR findings regressed after corticosteroid therapy. The patient had completely recovered 12 months later, except for mild right hand numbness. MRI showed further regression of the lesions, but the concentric pattern was still present. This case demonstrated that BCS can run a benign prolonged course and may persist for a long time. Concentric or laminated contrast enhancement in the acute phase may suggest that bands of demyelination in BCS occur synchronously rather than successively.

Airway stenting for tracheal stenosis

Patients with upper airway obstruction from malignant disease are difficult to manage. A 62 year old patient presented with stridor and was found to have an upper tracheal tumour. Bronchoscopy, dilatation and stenting were performed successfully. The techniques and indications for the use of dynamic airway stent are discussed.

Hepatic abscess due to gastric perforation by ingested fish bone demonstrated by computed tomography

Perforation of the gastrointestinal tract by ingested foreign bodies is rare. Preoperative diagnosis of complications due to foreign bodies in the gastrointestinal tract can rarely be achieved because the conventional radiographic appearance is nonspecific. This report describes a 69-year-old woman who presented with vague clinical manifestations, intermittent abdominal pain, and low-grade fever. Hepatic abscess, secondary to a foreign body penetrating the gastric wall, was diagnosed preoperatively using computed tomography findings. On exploration, the foreign body turned out to be a fish bone. The abscess was confirmed and drained during surgery and a partial gastrectomy was performed. This case illustrates the value of CT in the evaluation of this condition.

Routine donor leg angiography before vascularized free fibula transplantation is not necessary: a prospective study in 120 clinical cases

To evaluate the value of routine preoperative angiographies of donor sites, 120 patients with free fibula osteoseptocutaneous flap transplantations were included in this prospective study, which consisted of preoperative evaluation of dorsalis pedis and tibial posterior artery pulsation and angiographies of the donor legs (120 patients) and contralateral legs (111 patients). Both pedal pulses were palpable in 114 patients, and only one pulse was palpable in six patients. The respective nonpalpable foot pulses were detectable with pencil Doppler in five patients, but they were not detectable in one patient. Intraoperatively, the latter patient had a relatively hypertrophied peroneal artery as compared with both the tibial posterior and tibial anterior arteries. The angiographic result was arteria peronea magna. The other five patients showed intraoperatively and angiographically normal-sized major arteries of the lower leg. In three patients with normal pedal pulses, hypoplasias of either the tibial anterior or tibial posterior arteries were found intraoperatively. These findings corresponded with the angiographical results. In all patients (n = 119), except one with peroneal artery hemangioma, free osteoseptocutaneous fibula flap was harvested from the originally planned leg without subsequent sequelae to the respective donor leg. In 231 leg angiographies, only 7 cases (3 percent) with abnormalsized major lower leg arteries were described. The diagnoses in these cases were hypoplasia of either the tibial posterior or tibial anterior artery (4 cases), arteria peronea magna (2 cases, one of which was a false positive), absence of peroneal artery combined with hypoplastic tibial posterior artery (1 case), and hemangioma of the peroneal artery (1 case). From this prospective study, it was determined that routine preoperative angiography of the donor leg before fibula transplantation is not justified. It does not add relevant new information about donor leg vascularity, provided that the clinical evaluation of the pedal pulses is well conducted. The only two conditions that may require a preoperative donor leg angiography are abnormal pedal pulses or significant previous lower leg trauma.

Congenital Ewing's sarcoma of the humerus

We report an extremely rare case of Ewing's sarcoma (ES) of the humerus in a Chinese neonate. Plain radiography and magnetic resonance imaging showed extensive neoplastic involvement of the humeral diaphysis and adjacent soft tissues, confirmed on histology and immunohistochemistry as being due to ES. This is the first report of congenital ES in a long bone. Since ultrasound at 20 weeks gestation showed a normal fetal skeleton, the ES may have begun to develop in the late middle or third trimester.

CT features of calcifications in abdominal malignant fibrous histiocytoma

The purpose of this study was to describe the computed tomographic (CT) features of intralesional calcifications in abdominal malignant fibrous histiocytomas (MFH). Forty-three pathologically proven abdominal MFH with preoperative CT were retrospectively reviewed, of which seven tumors with intralesional calcifications were studied with pathohistologic correlation. All seven calcified abdominal MFH belonged to the storiform-pleomorphic subtype with peripherally located calcifications that appeared as either lumpy (three cases) or ringlike (four cases), which were due to the presence of variable amounts of osseous (six cases) and chondroid metaplasia (two cases). About 16% of abdominal MFH, especially the storiform-pleomorphic subtype, exhibited metaplastic calcifications which were characteristically located at the periphery of the tumor and appeared as either lumpy or ringlike on CT.

Congenital bilateral cystic neuroblastoma with liver metastases and massive intracystic haemorrhage

A case of bilateral cystic neuroblastoma with liver metastases in a newborn is reported. CT showed a 10 cm right suprarenal multicystic mass and numerous hepatic cystic masses with intracystic fluid-fluid levels. Multiple smaller cystic lesions were also present in the left adrenal gland. To our knowledge, the CT findings of neonatal bilateral cystic neuroblastoma with liver metastasis and massive acute intracystic haemorrhage has not been previously documented.

Comparison of cerebral occipital gray and parietal white matter metabolite differences using PRESS and STEAM at different echo times

BACKGROUND

Reports regarding the differences in metabolite ratios with different echo times (TEs) at various brain regions are rare. The purpose of this study is to investigate in Chinese the cerebral metabolite ratios in gray matter (GM) and white matter (WM) using both STEAM and PRESS techniques at TEs of 30 ms and 136 ms, respectively.

MATERIALS AND METHODS

Using GE Signa 1.5 T Scanner with STEAM and PRESS sequences, automated single voxel localized proton magnetic resonance spectroscopy (1H-MRS) were applied to identify the metabolite ratio differences in cerebral parietal white and occipital gray matter of healthy volunteers.

RESULTS

Metabolite ratios between GM and WM were significantly different in N-acetyl aspartate/creatine (Cr), choline/Cr and myo-inositol/Cr. There were also significant differences in metabolite ratios when different echo times were applied.

CONCLUSION

Reliable metabolite ratios at different brain regions can be obtained using automated data acquisition and spectral processing in single voxel localized 1H-MRS. This technique may remove user-dependent bias and provide more efficient and consistent ways to analyze the spectral data. However, one must be careful in interpreting spectroscopic data based on different regions and acquisition parameters.