And The Awards Go To

Recently, Ian at 'The Daily Dose of Reality' and Geof at 'Enter The Man Cave' (thank you both!) bestowed upon me a couple of awards.... Apparently, the rules of receiving the awards mention that you pass on the awards to other bloggers.... I only have enough time to post six, maybe I'll post more later.... So here we go.... And the awards go to:


1. Jerry at 'My Thoughts Brought To The Light': My first blog follower, my cousin-in-law, and the person who convinced me to move my blog from MySpace to Blogger....

2. Powdered Toast Man at 'Just The Cheese': Another one of my first followers, he's got a great blog! He posts great trivia and movie reviews....

3. Ally at 'Tales Of A Fourth Grade Nothing': A great blog about her growing up in the 70's, 80's and 90's and her favorite things! She actually wrote and received a letter from Mario Lopez during his days on Kids Incorporated! I'm so jealous! Oh, and she loves Judy Blume! Go Superfudge!

4. Eternally Distracted at 'Eternally Distracted': Read about her experiences living in a foreign country and life being 'lost in translation'.

5. Kitty at 'Kitty Tells It As It Is': She doesn't blog often, but when she does, it's great! You'll want her to post more when you read her posts about her new date! It's definitely quality over quantity!

6. Melissa at 'Sugar Filled Emotions': She's constantly trying new things with her blog, and writes about her amazing experiences with depression and anxiety, and how they affect her and her family....

Can You Guess This TV Theme? #30 - Answer

Over seven seasons and 168 episodes, the protagonist of 'The Mary Tyler Moore Show', Mary Richards, played by Mary Tyler Moore, showed the world that it was okay to be over 30, female and single. Mary moves to Minneapolis, Minnesota for a fresh start after ending her relationship with her fiance, and applying for a job at WJM-TV....

Cantankerous news director Lou Grant, played by Ed Asner, gives her the job of producer of the 'Six O'Clock News', and Mary's cute quirkiness shines on from there.... Throughout the show's run, Mary develops wonderful relationships with her neighbors and co-workers, played by notables Cloris Leachman, Betty White, Georgia Engel, Ted Knight, Valerie Harper and Gavin MacLeod.

Did you know that 'The Mary Tyler Moore Show', has won a total of 29 Emmy Awards! Three of them being 'Outstanding Lead or Supporting Actress or Actor In A Comedy' awards won by Mary Tyler Moore, Ed Asner and Valerie Harper won three Emmy's each for lead and supporting actor and actress roles! The record of 29 Emmy Awards, held by 'The Mary Tyler Moore Show' for 25 years, was broken by 'Frasier' in 2002. 'Frasier' went on to win a total of 37 Emmy Awards!

I'm not sure I agree with 'Entertainment Weekly', but they list Mary Tyler Moore's throwing her hat up in the air in the show's introduction as #2 on their list of '100 Greatest Moments on Television'..... The #1 selection on their list was the assassination and funeral of John F. Kennedy. Mary tossing her hat in the air beat out:

• #9 - The Beatles first appearance on 'The Ed Sullivan Show',
• #17 - Edward R. Murrow interviews Sen. Joseph McCarthy,
• #36 - The Challenger explosion,
• #51 - The Dick Van Dyke Show - The first ottoman pratfall
• #71 - Bill Clinton playing saxophone on the 'Arsenio Hall Show', and
• #91 - The premiere of 'A Charlie Brown Christmas'

The list was made in 1999, however, I still think it might need some alterations.....

Perfect Strangers In Seattle?

Everybody remembers 'Perfect Strangers', right? The lovable Balki Bartokomous and his Cousin Larry Appleton living together in Chicago.... Well, Ian Hugh Fraser and Christopher Bange recreated the show's intro using Seattle, Washington as the backdrop.... We need more of these! I want to see the 'Full House' intro in Baltimore, Maryland! Or the 'Laverne and Shirley' intro in Albuquerque, New Mexico! Ooooooh, or the 'Moonlighting' intro in New York City! Ok, now all of you get an expression of shock on your face and say 'NEW YORK CITY!?!?!' Sorry.... I had to do it....

By the way, did you know that Louie Anderson was cast for the role of Larry Appleton in the original pilot episode? It's true! Look!

Can You Guess This TV Theme? #30

Everybody's favorite game is back! Last week I couldn't post 'Can You Guess This TV Theme' because of a glitch in the system.... But we're back on board. Come join us! Are you up to the challenge? Can you guess this TV theme?

Man Vs. Toddler

The guys over at BaratsandBereta.com have created one of the funniest videos ever! I laugh out loud every time I see it! They pit Man versus Toddler in five grueling competitions.... Who will emerge the victor? Will Man win? Will Toddler win? The suspense is killing me! Go watch the video!

Sinonasal undifferentiated carcinoma (SNUC)

Findings

Heterogeneously enhancing mass centered at the junction of the left nasal cavity and ethmoid sinus has eroded through the cribriform plate and extends into the anterior cranial fossa. Sharp interface between the mass and the brain parenchyma, with mass-effect and vasogenic edema in the left frontal lobe. Left orbit medial wall has been eroded, and the extraconal mass has mass-effect on the left medial rectus with the fat plane between the mass and the muscle intact. Mass extends posteriorly to the margin of the left sphenoid sinus Bilateral frontal sinuses are fluid filled with the mass minimally extending into the inferior portion of the right frontal sinus. Ethmoid sinuses are completely occupied by the mass. Right maxillary and sphenoid sinuses are clear. Left maxillary sinus is almost completely fluid filled, and the left osteomeatal unit is completely obstructed by the mass.

Differential diagnosis:
- Esthesioneuroblastoma
- Squamous cell carcinoma
- Sinonasal undifferentiated carcinoma (SNUC)
- Sinonasal melanoma
- Meningioma
- Metastasis
- Lymphoma


Diagnosis: Sinonasal undifferentiated carcinoma (SNUC)


Key points

Aggressive
Rapidly growing
No histologic differentiating features
Presentation: usually older patients


Imaging appearance

Difficult to distinguish from ENB, SCCA, sinonasal adenocarcinoma

Differential diagnosis:
- Esthesioneuroblastoma (ENB)
- Squamous cell carcinoma (SCCA) of the nose
- Meningioma (specifically extracranial nasal meningioma)
- Sinonasal melanoma
- Lymphoma (specifically Non-Hodgkin lymphoma of the nose)


Esthesioneuroblastoma (ENB)

Neuroendocrine malignancy of neural crest origin
Arises from olfactory epithelial of superior nasal cavity
Presentation: adolescent or middle-aged patient with nasal obstruction with epistaxis
May bleed profusely on biopsy

Imaging appearance:
- Dumbbell mass
- Upper portion in intracranial fossa
- Lower portion in upper nasal cavity
- Waist at cribriform plate (blood-brain barrier)
- Calcifications within mass
- Cyst formation at tumor-brain interface
- Destruction of cribriform plate
- Homogenously enhance (CT or MR)
- When large, may have non-enhancing areas of necrosis

Treatment: Resection with radiotherapy
20% have nodal metastasis at presentation
Tendency to recur late


Squamous cell carcinoma (SCCA) of the nose

Malignant epithelial tumor growing from sinus surface epithelium
More common on maxillary antrum than nasal vault—only 30% primarily in nose
Presentation: Older male with sinusitis refractory to medical therapy

Exposures that increase risk:
- Nickel
- Thorotrast
- Possibly formaldehyde and asbestos

Imaging appearance:
- Typically aggressive antral mass
- Invasion and destruction of sinus walls
- Irregular margins
- Indistinguishable from esthesioneuroblastoma if begins high in nasal vault
- Enhancement: heterogenous, less than ENB, adenocarcinoma, melanoma

Treatment: Resection and XRT
With recurrence, 90% < 1 year survival


Meningioma (specifically extracranial nasal meningioma)

Presentation: Middle-aged, typically asymptomatic

Imaging appearance:
- Dural-based avidly enhancing mass
- Hyperostosis in adjacent skull base
- Peritumoral vasogenic edema
- Not associated with cyst formation at tumor-brain interface

Treatment is typically serial imaging, then resection, rarely XRT


Sinonasal melanoma

Neural crest cell malignancy arising from melanocytes in sinonasal mucosa
Presentation: Older patients

Imaging appearance:
- High T1 signal nasal cavity mass
- Can initially resemble nasal polyp on CT

Metastasis: lung, kidney, and breast


Lymphoma (specifically Non-Hodgkin lymphoma of the nose)

Malignant lymphoproliferative disorder arising from variety of immune cell types
B-cell type is most frequent in the paranasal sinuses and is less aggressive

Presentation:
- Nasal obstruction with sinusitis symptoms
- Constitutional symptoms—fever, fatigue, and weight loss
- Unilateral facial swelling

Imaging appearance:
- Dense on non-enhanced CT
- Less enhancement than ENB
- Rarely breaches skull base

Treatment:
- Primarily local XRT
- Chemotherapy if higher stage

Smart Guy Predicts The Super Bowl

In 1997, 'Smart Guy' premiered on the 'WB' channel.... You may now know the channel as the 'CW' (commonly pronounced as 'QUA'). Anyway, the show was about a ten year old genius trying to survive in high school.... Well, who knew that the producers of 'Smart Guy' were able to predict the future?

In an episode of 'Smart Guy', the kids sneak into the television station to try to get their father's commercial for his roofing business to play during the prime time television hours. Little did they know that the commercial was going to play at halftime during the Super Bowl.... Ok, ok.... I'll get to the point.... Right before the commercial airs, the announcer reveals the halftime score of the Super Bowl:

New Orleans - 54
Indianapolis - 3

I wouldn't run to Vegas just yet.... The sports books have the Indianapolis Colts as six point favorites over the New Orleans Saints in Super Bowl XLIV.... I don't see the Saints being up by 51 points at halftime....

Injured petrous internal carotid with proximal occlusion and clot from stab wound

Findings

Figure 1: Transaxial CT scan of the brain. Knife entering the superolateral aspect of the left nasal cavity.
Figure 2, Figure 3, and Figure 4: Transaxial CT scan of the brain. Knife traversing the midline.
Figure 5: Transaxial CT scan of the brain. Knife traverses the carotid canal with tip at the level of the internal auditory canal.
Figure 6: Transaxial CT scan of the brain. Postoperative pneumocephalus and posttraumatic infarction in the distribution of the right middle cerebral artery. Knife has been removed.
Figure 7: Angiogram of the right internal carotid artery in an oblique projection. Knife tip in close proximity to the right internal carotid artery with little flow seen intracranially. Spasm noted at the catheter tip in the internal carotid artery.
Figure 8: Angiogram of the right internal carotid artery in an AP projection. The knife traverses the midline with the knife tip in the right carotid canal.


Diagnosis: Injured petrous internal carotid with proximal occlusion and clot from stab wound


Gunshot wounds to the head have become the leading or second leading cause of head injury in many cities in the United States; penetrating head injuries can also be the result of stab wounds, and motor vehicle or occupational accidents. Knives are the most frequent weapon used in stab wounds to the cranium although bizarre craniocerebral-perforating injuries have been reported that were caused by nails, metal poles, ice picks, keys, pencils, crochet needles, chopsticks, and power drills. A mortality rate of 17% has been reported for cranial stab wounds, mostly related to vascular injury and massive intracerebral hematomas. The orbital surfaces and squamous portions of the temporal bones are the most frequently affected since these bones are thin and easily traversed. The morbidity from stab wounds to the squamous portion of the temporal bone is more severe due to the short distance to the deep brain stem and vascular structures.

CT scans are vital in the work up of patients with penetrating head injuries since they do show the extent of intracranial injury and fracture and rule out the presence of radiopaque foreign bodies. CT angiography is limited in the presence of metallic foreign bodies because of artifact; in these cases, conventional angiography is important in ruling out vascular injury and preoperative planning. Potential signs of vascular injury include transection, pseudoaneurysm and arterial-venous fistula. Occlusion is a sign, albeit a nonspecific sign, of an underlying vascular injury. In the case of a vascular injury, injection of the contralateral artery should be done to demonstrate crossfilling via collateral circulation in the circle of Willis prior to intervention. Cerebral vasospasm is another noteworthy finding since it can portend a poor outcome.

Patients with penetrating head injuries are often taken to surgery to remove hematomas which may be causing mass effect, to remove dead brain tissue to prevent further swelling and necrosis, and to control active bleeding. Metallic foreign bodies are often removed to prevent infection, the potential for fibroglial scarring with the ensuing development of epilepsy and intracranial migration. Knives should only be removed in the OR under direct visualization. Clot was noted in the proximal ICA below the presumed level of injury; coils were placed proximal to the clot to prevent migration of the clot. In the case of an obvious direct transection, coils may also be used to prevent exsanguinations when the knife is removed. Occlusion balloons can also be used.

Another Rescue On The Hudson

Everybody remember the crash of US Airways Flight 1549? Where Chesley 'Sully' Sullenberger heroically landed the huge A320 Airbus on the Hudson River, saving the lives of all 155 people on board....

Since the plane crash, reporters and camera crews were kept away from the scene by the police and the FBI.... However, New Yorker David Hugh Martin, who has an apartment right above the Hudson River, positioned his camera to record the rescue of the plane.... Three days of rescue footage were clipped together to make an amazing time lapse video of crews trying to bring the plane out of the river. It's amazing to watch the plane struggle to stay afloat as huge chunks of ice barrage the rescue efforts....

Commercial Fit For The Super Bowl

Did anybody else see this commercial? I would have expected to see this commercial between quarters in the Super Bowl, not during the AFC Championship Game between the New York Jets and the Indianapolis Colts.... WalMart better bring during the Super Bowl....

One can really appreciate how WalMart was not only able to plug their status as the nation's low price leader, but also able to take a jab at people's inherent fear of clowns.... Well done WalMart. Well done....

Sialolithiasis with sialadenitis

Findings

The right parotid duct is markedly dilated. There is an obstructing calculus in the distal duct. There is inflammation in the right buccal space, the right masseter space, and in the right parotid gland. There is also a large non-obstructive stone in the right submandibular gland which was unchanged from a previous study.


Diagnosis: Sialolithiasis/sialadenitis


Discussion

Calculus disease is the most common benign condition to affect the salivary glands. The most common glands affected are the submandibular glands because secretions are more mucinous, viscous, and alkaline. Additionally, the duct drains uphill, making stasis more likely. Parotid glands are affected less frequently, and sublingual and minor salivary gland calculi are very uncommon. Patients generally have painful glands, worsened with chewing foods that precipitate salivation. Treatment is by administration of solutions that increase salivation to promote passing of the calculus. Transoral resection can be performed for calculi close to the ampulla. Resection of the gland may be used for proximal, glandular and/or recurrent sialoliths.


Radiologic overview

Imaging can be performed with plain radiographs, CT, and MRI. Most calculi are radio dense, but approximately 20% may not be visible on plain radiographs.

CT is more sensitive for detection of calcification than plain radiographs, and is also useful for detecting inflammatory masses and abscess formation.
In the case of non-radiopaque calculi, conventional sialography can be performed by cannulating the salivary duct and injecting contrast. The presence of a calculus is inferred by the presence of an intraluminal filling defect.
A new technique is MR sialography which is similar to MR cholangiopancreatography. The technique utilizes either a single shot fast spin echo T2-weighted sequence to image the duct alone, or a high resolution 3D fast spin echo T2 sequence to image the gland and duct.
Sialography is useful to demonstrate ductal strictures after passage of the stone, and in the evaluation of chronic sialadenitis from autoimmune causes.

Are You As LOST As I Am?

Only 11 more days until the premier of the sixth season of LOST! Being that it seems like I watched the last new episode of LOST way back in the early 1990's, I was having trouble remembering a few of the details.... Until I met Mike and his extended Italian family! They have taken the time to provide a recap of the show's first five seasons in under five minutes for LandlineTV! Watch it and get caught up before the new season starts on February 2, 2010!

As a short warning, there is a commercial for Netflix at the end of the video, and I know how everybody hates commercials....

Neurocysticercosis (Calcified stage)

Findings

CT with contrast images showed a 7 mm calcified enhancing lesion within the posterior aspect of the left frontal lobe with a small amount of surrounding oedema. MRI images confirm the presence of a calcified ring enhancing lesion within the left posterior frontal lobe.

Differential diagnosis:
- Neurocysticercosis
- Tuberculoma


Diagnosis: Neurocysticercosis


Discussion

Cysticercosis is caused by larvae of the pork tape worm Taenia solium. Infestation occurs via the fecal-oral route. It is the most common parasitic infection involving the central nervous system in developing countries with 90% of patients present with seizures. Parenchymal cysticercosis is the most common type with lesions most commonly being peripherally distributed near the grey-white matter junction. The parasite goes through different stage of involution, each of which has different imaging features on CT and MRI.

These include the following:
- Vesical stage: CT shows hypodense non enhancing lesions. On MRI cysts follow CSF signal; T2 hyper intense scolex may be seen. No edema. Usually no enhancement.
- Colloidal stage: CT shows hypodense/isodense lesion with peripheral enhancement and perilesional edema. On MRI Cysts are hyperintense to CSF; surrounding edema, cyst wall enhances.
- Granular stage: CT shows nodular enhancing lesions. On MRI the cyst wall thickens and retracts, there is a decrease in edema, and there is nodular or ring enhancement.
- Calcified stage: When the parasite dies, nodular parenchymal calcifications are seen. These findings are best seen on CT.

Holy Kramer Entrances, Batman!

Do you remember the video of all of the curse words in 'The Sopranos', that Victor Solomon put together after watching edited versions of 'The Sopranos' while confined to a hospital bed?

I was amazed by the amount of time he must have spent, and how much work he must have put into the project....

Well, here are two more videos by dedicated fans of their favorite television shows....

In the first video, YouTube user Apennyw put together every one of Robin's 'Holy Exclamation Quotes' from the first season of television's original 'Batman' show....

YouTube user tylercreviston put together a video of every single Kramer entrance from 'Seinfeld' in chronological order!

I can't even imagine how long it would have taken me to put one of these videos together....

Klippel-Feil anomaly

Findings

There are multiple segmentation anomalies of the cervical spine, with fusion of C1-3.; left C6 hemivertebra.


Diagnosis: Klippel-Feil anomaly


Key points

Klippel-Feil anomaly refers to segmentation defects (congenital fusion) of the cervical spine.
Fusion of C2-3 and C5-6 most common
Frequently associated with Chiari malformation and syringohydromyelia.

Three categories:
- Group 1 = short, webbed neck, low hairline, complete lack of cervical segmentation
- Group 2 = isolated cervical segmentation defects
- Group 3 = segmentation defects affecting separate thoracic and/or lumbar level in addition of cervical involvement

Restricted motion at level of non-segmentation leads to accelerated disc degeneration.
50% of patients have at least partial dorsal splitting of the spinal cord. Defects in decussation of the corticospinal tracts can lead to "mirror movements" on physical exam.
Other CNS associations: occipital encephalocele, Dandy-Walker malformation, Duane syndrome, nasofrontal dermoid
Associated visceral anomalies: Sprengel deformity (20-30%, congenital elevation of the scapula, often with tethering omovertebral bone), cervical ribs, supranumary digits, tracheal and proximal bronchial stenosis, sickle sacrum, cleft palate, various renal anomalies.

Happiness Machine

In the spirit of Volkswagen's The Fun Theory, Coca-Cola has taken steps to add a little happiness at a college campus.....

Coca-Cola installed what seemed to be a run of the mill vending machine at a cafeteria on a college campus.... But when the a college student goes to get a bottle of soda, the soda machine gives and gives and gives.... Watch and see what comes out of the 'Happiness Machine'! I wish I had a 'Happiness Machine' at my college....

The Late Shift

Don't get me wrong, I'm on Team Conan, but YouTube user FiveAlex2009 has posted 26 Jay Leno appearances on 'The Late Show with David Letterman'....

All before their friendship crumbled because Jay Leno and his manager used shady tactics to beat out David Letterman for the 'Tonight Show' host position after Johnny Carson had retired.... And when I say beat out, I mean, having an agent who bullies NBC executives and hiding in closets during executive meetings to gain an upper hand in negotiations.... Have you seen the movie 'The Late Shift'? It's about the battle for the 'Tonight Show' host gig.... Now we need 'The Late Shift 2' to cover NBC's latest debacle between Jay and Conan O'Brien....

Keep in mind, most of the videos include David Letterman asking Jay Leno a question, then Jay proceeding to talk for four to five minutes. But it was interesting to see their dynamic (and Jay 'Elvis' Leno) before the feud.... Click on the photo of Jay and Dave to see the videos....

Chuckles And The Chin - Team Conan or Team Leno?

Are you on Team Conan or Team Leno?

Either way, both team wins.... Conan gets $32.5 million to stay at home and Jay Leno gets 'The Tonight Show' back.... I still think they should make up and create the buddy cop show 'Chuckles and The Chin'. They don't need to star in it, just use a large CGI chin with a mouth and a CGI ginger hairdo with a mouth.... They could fight crime and wisecrack all day long.... Come on, if we can make 'Avatar', we can definitely make 'Chuckles and The Chin'!

The real losers are Conan's staff. All of the staff that had moved from New York to California with their families to work on 'The Tonight Show'.... They're getting a severance package, but now they're all unemployed in a horrible job market....

Oh, and NBC loses too.... Now they don't have Conan O'Brien and they're out $40 million.... That's one expensive mistake....

January Of Death

The old tale that 'bad things come in 3's' should be changed to 'bad things come in 4's'....

First Art Clokey, creator of Gumby, passes away on Friday, January 10, 2010 at the age of 88....


Then Donald Goerke, inventor of SpaghettiO's and Campbell's Chunky Soup line of products, passes away on Sunday, January 12, 2010 at the age of 83.... Did you know that during testing for the perfect spaghetti shape, they tested baseball, cowboy, spaceman and star shapes before they settled on the O's?


Then, Jan C. Gabriel, the man who coined the phrase 'Sunday! Sunday!!!! SUNDAY!!!!!', which is used in all those monster truck rally commercials, passed away at the age of 69....

It's a great coincidence that he died on a 'Sunday! Sunday!!!! SUNDAY!!!!!'

And now, Glen Bell, the man who invented Taco Bell, passed away on Sunday, January 17, 2010 at the age of 86....

After all these years, I never knew that Taco Bell was named after Mr. Bell.... I just thought 'Taco Bell' was a catchy name they came up with in a marketing meeting.... Did you know that he sold the Taco Bell chain to PepsiCo for in 1978 for $125 million in stock? Keep in mind that the price of the stock was around $26.00 a share in 1978.... Over the past 30 years, it's split three times after the price had risen to around $70.00 to $90.00 a share.... And now the price is around $60.00 a share.... How much money would he have if he had held on to that stock?

All. All money.

I Have A Dream

It amazes me to think that it was only 47 years ago that Martin Luther King Jr. delivered his 'I Have A Dream' speech. It's amazing that only 47 years ago, human beings had to fight for simple rights only because of the color of their skin.... If you've never heard or read Martin Luther King Jr.'s speech, take a bit and give it a gander.... It's amazingly powerful.... Oh, and look at that.... I have it right here for you.... Enjoy reading!

Five score years ago, a great American, in whose symbolic shadow we stand signed the Emancipation Proclamation. This momentous decree came as a great beacon light of hope to millions of Negro slaves who had been seared in the flames of withering injustice. It came as a joyous daybreak to end the long night of captivity. But one hundred years later, we must face the tragic fact that the Negro is still not free.

One hundred years later, the life of the Negro is still sadly crippled by the manacles of segregation and the chains of discrimination. One hundred years later, the Negro lives on a lonely island of poverty in the midst of a vast ocean of material prosperity. One hundred years later, the Negro is still languishing in the corners of American society and finds himself an exile in his own land.

So we have come here today to dramatize an appalling condition. In a sense we have come to our nation's capital to cash a check. When the architects of our republic wrote the magnificent words of the Constitution and the Declaration of Independence, they were signing a promissory note to which every American was to fall heir.

This note was a promise that all men would be guaranteed the inalienable rights of life, liberty, and the pursuit of happiness. It is obvious today that America has defaulted on this promissory note insofar as her citizens of color are concerned. Instead of honoring this sacred obligation, America has given the Negro people a bad check which has come back marked "insufficient funds." But we refuse to believe that the bank of justice is bankrupt. We refuse to believe that there are insufficient funds in the great vaults of opportunity of this nation.

So we have come to cash this check -- a check that will give us upon demand the riches of freedom and the security of justice. We have also come to this hallowed spot to remind America of the fierce urgency of now. This is no time to engage in the luxury of cooling off or to take the tranquilizing drug of gradualism. Now is the time to rise from the dark and desolate valley of segregation to the sunlit path of racial justice. Now is the time to open the doors of opportunity to all of God's children. Now is the time to lift our nation from the quicksands of racial injustice to the solid rock of brotherhood.

It would be fatal for the nation to overlook the urgency of the moment and to underestimate the determination of the Negro. This sweltering summer of the Negro's legitimate discontent will not pass until there is an invigorating autumn of freedom and equality. Nineteen sixty-three is not an end, but a beginning. Those who hope that the Negro needed to blow off steam and will now be content will have a rude awakening if the nation returns to business as usual. There will be neither rest nor tranquility in America until the Negro is granted his citizenship rights.

The whirlwinds of revolt will continue to shake the foundations of our nation until the bright day of justice emerges. But there is something that I must say to my people who stand on the warm threshold which leads into the palace of justice. In the process of gaining our rightful place we must not be guilty of wrongful deeds. Let us not seek to satisfy our thirst for freedom by drinking from the cup of bitterness and hatred.

We must forever conduct our struggle on the high plane of dignity and discipline. we must not allow our creative protest to degenerate into physical violence. Again and again we must rise to the majestic heights of meeting physical force with soul force.

The marvelous new militancy which has engulfed the Negro community must not lead us to distrust of all white people, for many of our white brothers, as evidenced by their presence here today, have come to realize that their destiny is tied up with our destiny and their freedom is inextricably bound to our freedom.

We cannot walk alone. And as we walk, we must make the pledge that we shall march ahead. We cannot turn back. There are those who are asking the devotees of civil rights, "When will you be satisfied?" we can never be satisfied as long as our bodies, heavy with the fatigue of travel, cannot gain lodging in the motels of the highways and the hotels of the cities. We cannot be satisfied as long as the Negro's basic mobility is from a smaller ghetto to a larger one. We can never be satisfied as long as a Negro in Mississippi cannot vote and a Negro in New York believes he has nothing for which to vote. No, no, we are not satisfied, and we will not be satisfied until justice rolls down like waters and righteousness like a mighty stream.

I am not unmindful that some of you have come here out of great trials and tribulations. Some of you have come fresh from narrow cells. Some of you have come from areas where your quest for freedom left you battered by the storms of persecution and staggered by the winds of police brutality. You have been the veterans of creative suffering. Continue to work with the faith that unearned suffering is redemptive.

Go back to Mississippi, go back to Alabama, go back to Georgia, go back to Louisiana, go back to the slums and ghettos of our northern cities, knowing that somehow this situation can and will be changed. Let us not wallow in the valley of despair. I say to you today, my friends, that in spite of the difficulties and frustrations of the moment, I still have a dream. It is a dream deeply rooted in the American dream.

I have a dream that one day this nation will rise up and live out the true meaning of its creed: "We hold these truths to be self-evident: that all men are created equal." I have a dream that one day on the red hills of Georgia the sons of former slaves and the sons of former slave owners will be able to sit down together at a table of brotherhood. I have a dream that one day even the state of Mississippi, a desert state, sweltering with the heat of injustice and oppression, will be transformed into an oasis of freedom and justice. I have a dream that my four children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character. I have a dream today.

I have a dream that one day the state of Alabama, whose governor's lips are presently dripping with the words of interposition and nullification, will be transformed into a situation where little black boys and black girls will be able to join hands with little white boys and white girls and walk together as sisters and brothers. I have a dream today. I have a dream that one day every valley shall be exalted, every hill and mountain shall be made low, the rough places will be made plain, and the crooked places will be made straight, and the glory of the Lord shall be revealed, and all flesh shall see it together. This is our hope. This is the faith with which I return to the South. With this faith we will be able to hew out of the mountain of despair a stone of hope. With this faith we will be able to transform the jangling discords of our nation into a beautiful symphony of brotherhood. With this faith we will be able to work together, to pray together, to struggle together, to go to jail together, to stand up for freedom together, knowing that we will be free one day.

This will be the day when all of God's children will be able to sing with a new meaning, "My country, 'tis of thee, sweet land of liberty, of thee I sing. Land where my fathers died, land of the pilgrim's pride, from every mountainside, let freedom ring." And if America is to be a great nation, this must become true. So let freedom ring from the prodigious hilltops of New Hampshire. Let freedom ring from the mighty mountains of New York. Let freedom ring from the heightening Alleghenies of Pennsylvania! Let freedom ring from the snow capped Rockies of Colorado! Let freedom ring from the curvaceous peaks of California! But not only that; let freedom ring from Stone Mountain of Georgia! Let freedom ring from Lookout Mountain of Tennessee! Let freedom ring from every hill and every molehill of Mississippi. From every mountainside, let freedom ring.

When we let freedom ring, when we let it ring from every village and every hamlet, from every state and every city, we will be able to speed up that day when all of God's children, black men and white men, Jews and Gentiles, Protestants and Catholics, will be able to join hands and sing in the words of the old Negro spiritual, "Free at last! free at last! thank God Almighty, we are free at last!

Can You Guess This TV Theme? #29 - Answer

Wow! I did not feel the love for 'Home Improvement' in the comments of the previous post!



Tim Allen plays Tim 'The Tool Man' Taylor, a bumbling husband and father of three.... Here's the twist, you see, 'The Tool Man' has his own television show called 'Tool Time', but he's extremely clumsy and was always trying to add more power to more tools, and he hurts himself while building something in almost every episode....

Thank goodness he had his sidekick Al Borland, played by Richard Karn (the Family Feud guy), and his wise neighbor, Wilson Wilson, who was only seen from the nose up throughout the run of the show, to keep him on the straight and narrow....

No matter what kind of ridiculous situations Tim Taylor was able to bring on himself, his wife, played by Patricia Richardson, and his kids, played by Zachery Ty Bryan, Jonathan Taylor Thomas and the other kid who became a goth in the later seasons of the show, always stood by his side....

Apparently, very few people hated the show during its eight season run.... At it's worst, 'Home Improvement' was 10th in the Nielsen Ratings, and allegedly Tim Allen was offered $50 million and Patricia Richardson was offered $25 million to stay for a 9th season. A wee bit more then I would have offered, but America loves a grunting, power tool obsessed man.... Although the show did jump start Pamela Anderson's blockbuster television career!

Can You Guess This TV Theme? #29

Good morning everybody! One quick note, before I get to today's theme, I'd like to mention that Powdered Toast Man kindly asked me to provide a guest post about my love/hate relationship with the Oakland Raiders over at 'Just The Cheese'! Give it a peek when you have a chance....

It's finally Friday! You know what that means? Can You Guess This TV Theme?

Lhermitte-Duclos disease

Findings

There is a small amount of increased signal on FLAIR and T2-weighted images with mild post contrast enhancement in the right cerebellar hemisphere. No mass effect is seen. Contrast images show an incidentally noted venous developmental anomaly on the right draining into the sylvian vein.

Differential diagnosis for the cerebellar lesion:
- Low-grade glioma
- Medulloblastoma
- Pilocytic astrocytoma
- Ganglioglioma
- Lhermitte-Duclos disease
- Cerebellar stroke


Diagnosis: Lhermitte-Duclos disease (dysplastic gangliocytoma of the cerebellum)


Key points

Lhermitte-Duclos disease (LDD) is a very rare benign cerebellar mass
Often associated with Cowden Syndrome–macrocephaly; benign breast, skin, and thyroid lesions; oral papillomas; GI tract hamartomas/polyps; cataracts; genitourinary neoplasia
Lesions grow very slowly or not at all
May cause obstructive hydrocephalus–presentation is usually vague neurologic symptoms related to hydrocephalus
Most commonly present at age 30-40, but can present from birth to age 60
Treatment–surgery for symptomatic patients
Rare recurrence, although complete resection is almost never possible
If confirmed LDD, no followup is needed unless patient is symptomatic

Radiologic appearance
- Well-defined cerebellar mass with striated or "gyriform" appearance
- CT–hypo dense cerebellar mass with hyper dense striations, rare enhancement
- MR
Striated mass with increased T2 and FLAIR signal +/- contrast enhancement
Bright on diffusion weighted images without signal decrease on ADC
MR Spectroscopy–decreased NAA, increased lactate, increased or normal choline
May use MRS to confirm LDD over glioma

Animal Instincts

Do you remember all the news stories after the huge earthquake and tsunami in Thailand in 2004, about how very few animals died because they may have a 'sixth sense' or 'animal instinct' that may have been able to sense the ground shaking before humans could, giving them the opportunity to run to higher ground before they were in any danger?

Security cameras in newspaper offices in Arcata, California were rolling before and during the magnitude 6.5 earthquake that struck just off the coast of Eureka, California on Saturday, January 9, 2010.....

You can clearly see the dog jumping up and bolting to find its owner before the earthquake occurs..... All reports indicate that the dog and it's owner did get out of the building safely....

Arachnoid cyst with complicating intracystic and subdural hemorrhage

Findings

Figure 1 and Figure 2: Initial non-contrast (Figure 1) and contrast enhanced (Figure 2) axial head CT images. At the level of lateral ventricles an isoattenuating left sided subdural hematoma with mass effect and midline shift is demonstrated. Contrast enhanced imaging shows no abnormal enhancement within the subdural hematoma.
Figure 3 and Figure 4: More inferiorly, a hemorrhagic round extra-axial mass in anterior aspect of the left middle cranial fossa is seen. Bone window image (Figure 4) demonstrates focal thinning with endosteal scalloping of the overlying bone.

Figure 5: Diffusion weighted image through the lesion in the left middle cranial fossa shows no evidence of abnormally restricted diffusion of water. This confirms the lesion is not an epidermoid cyst as they characteristically show intense signal abnormality on DWI.
Figure 6, Figure 7, Figure 8, and Figure 9: The lesion demonstrated isointense signal on T2-weighted imaging (Figure 6). T1-weighted MR imaging (Figure 7) better demonstrates the lesion's complex nature. The lesion represents an arachnoid cyst which shows evidence of hemorrhage as demonstrated by the presence of T1 shortening. The surrounding subdural hematoma shows well demarcated prominent T1 shortening indicative of hemorrhage. Contrast enhanced axial T1-weighted MR imaging (Figure 8) shows no enhancement within the arachnoid cyst but does show enhancement of the dural membrane (arrow). The coronal contrast enhanced T1-weighted MR image (Figure 9) shows the arachnoid cyst, arachnoid membrane, and subdural hematoma.


Diagnosis: Arachnoid cyst with complicating intracystic and subdural hemorrhage


The widespread use of neuroimaging has increased incidental detection of arachnoid cysts. Arachnoid cysts constitute approximately 1% of all intracranial space-occupying lesions. Common locations include the middle cranial fossa, cerebral convexity, perisellar, retrocerebellar, cerebellopontine angle, and quadrigeminal plate cisterns. While some arachnoid cysts arise from post-inflammatory changes after trauma, intracranial hemorrhage, or infection, most are thought to be congenital. It is theorized that these cysts form due to an aberration in arachnoid development resulting in splitting or duplication of the membrane, a defect in condensation of the mesenchyme, or abnormalities of CSF flow. The exact means of arachnoid cyst genesis remains unclear.

On both CT and MRI scans arachnoid cysts are non-enhancing well-circumscribed extra-axial lesions with the same attenuation (on CT) or signal (on all MRI pulse sequences) as that of CSF. Bony erosion and remodeling, features suggestive of longstanding processes, are often associated with arachnoid cysts. These findings are seen in nearly half of cases, and are felt to be secondary to chronic fluid accumulation with transmitted CSF pulsations. Adjacent deformity or even hypoplasia of the subjacent brain may be present depending on the size and location of the cyst.

Rare complications of arachnoid cysts such as intracystic hemorrhage, subdural hematoma, or subdural hygroma may occur either after head injury or spontaneously. Rupture of the outer arachnoid cyst wall and surrounding fragile veins allows blood to accumulate within the cyst and/or subdural compartment. Intracystic hemorrhage can also be due to interruption of the highly vascular arachnoid cyst membrane or of the bridging veins traversing the cyst cavity. Fluid production by flat arachnoid cells lining the cyst walls may explain spontaneous cyst enlargement and hemorrhage if sufficient intracystic pressure is attained to breech the wall and disrupt the vasculature.

All Right Mr. President! I'll Get My Own Fries!

I know I've posted this before, but we're one week away from the anniversary of Barack Obama being inaugurated as the President of the United States, and these clips are awesome....

Who knew the President was such a potty mouth? Before I heard these, I would never have read any of Barack Obama's books, but now I want to read every single one! Here are some clips of Barack Obama reading from his book "Dreams From My Father". Apparently he's quoting a close friend from his youth. These are going to be my ringtones for a long time!

P.S. If you do not like foul language, do not listen to these clips.

Way Too Complicated

Sure You Can Have My Number

Sorry Ass Mother-@#$#@

Buy Your Own Damn Fries

Ignorant Mother-@#$#@#

Terminator 2 Remix: Skynet Symphonic

I posted the 'Hook' and 'Up' remixes from from Fagottron and POGO here at 'I Think It's Interesting' here before.... (Hint: Click the names of the previous remixes to see those posts....)

Typically, he uses video clips and sounds from movies, and adds some synthesizers, drums and bass to make his remix videos. This time, with his 'Terminator 2: Judgement Day' remix, he only uses sounds from the movie.... 'Terminator 2' is from director James Cameron (director of Titanic and Avatar) by the way.... Each section is composed entirely of sounds from a major scene in the film. For example, the Terminator pounding on the fire escape door is used as a kick drum. Bones breaking play the role of a snare. Electrical disturbance acts as a crash cymbal.

For the men, there's lots of action. For the women, a shirtless ripped Arnold Schwarzenegger. For everybody, awesome music and an awesome video....



By the way.... If you click on the banner below, it will take you directly to his YouTube channel where you can see the rest of his videos. Do yourself a favor and check them out.... They're awesome!

Diffuse axonal injury (DAI)

The patient was in a motor vehicle accident.


Findings

Non-contrast head CT demonstrates few punctuate hyper attenuating foci, including one near the gray-white junction in the right frontal lobe. MRI brain demonstrates multiple punctuate foci of T2/FLAIR prolongation, with corresponding restricted diffusion, within the subcortical frontal, temporal, and parietal lobes bilaterally. Most occur near the gray-white junction. The corpus callosum, deep gray matter structures, and brainstem are spared.

Differential diagnosis:
- Diffuse axonal injury.
- Multifocal nonhemorrhagic lesions:
Aging/microvascular ischemic disease
Demyelinating disease (MS, ADEM, etc.)
Marchiafava-Bignami syndrome
- Multifocal hemorrhagic lesions:
Cerebral amyloid angiopathy
Chronic hypertension
Cavernous malformation
Hemorrhagic tumors


Diagnosis: Diffuse axonal injury


Key points

Clinical Presentation
- Usually occurs in setting of high-speed MVC
- Transient loss of consciousness and retrograde amnesia common in minor traumatic brain injury
- LOC at moment of impact seen in moderate/severe TBI

Pathophysiology:
- Does not require direct impact to skull
- Occurs due to shear forces from differential acceleration/deceleration and rotational forces
- Cortex moves at different speed relative to underlying deep brain structures, creating axonal stretching.
- Non-traumatically disrupted axons are also damaged by traumatic depolarization, ion fluxes, and ultimately toxic edema.

50-80% of initial CT studies appear normal.
Hyper dense petechial hemorrhage, especially near gray-white junctions, seen in approximately20% of cases.
MRI is most-sensitive routine study for detection, especially when GRE sequences are utilized.

Typical MRI Findings:
- T1WI: Usually normal. May see hyper intense hemorrhage between 3-14 days.
- T2WI: Hyper intense foci seen at expected locations (gray-white junctions, corpus callosum, brainstem, uncommonly deep gray matter, internal/external capsules, corona radiata). Hemorrhagic lesions appear hypo intense on T2WI.
- FLAIR: Both hyper intense and hypo intense lesions at expected locations.
- DWI: Hyper intense foci of restricted diffusion.
- T2 GRE: Most sensitive sequence. Hypo intense foci due to susceptibility from blood products.

Increasing severity of traumatic force correlates with deeper brain involvement.

Staging based on Adams and Gennarelli system:
- Stage 1: Involves gray-white junctions of frontal and temporal lobes (mild)
- Stage 2: Involves corpus callosum and lobar white matter (moderate)
- Stage 3: Involves midbrain and pons (severe)