Sunday, June 26, 2011

Cochlear implants and the Radiologist


9 yr old girl  shows presence of cochlear implant in situ, shows  pneumocochlea, pneumocephalus, and subtle  fluid density in to the middle  ear location, possibly perilymph fistula,  through the  iatrogenic, intended cochleostomy. The electrodes appear close to cochlea particularly apical region and are normal. There is no evidence of infection on this. Treatment of such moderate air without parenchymal presence is usually conservative. Case and discussion by Dr MGK Murthy






Indication
Nonfunctional  (ganglion cells ineffective)cochlea on  both sides leading to bilateral sensorineural  deafness with intact auditory nerve function. Usually in children, but of late the adult varieties are receiving the implant

Contraindications
·         Obliterative labyrinthine ossification, severe cochlear or fenestrative otosclerosis, congenital cochlear  malformations(mondini deformity, ossified cohlea etc), severe bilateral temporal bone fractures, Infected middle ear
·         Usually HRCT temporal bone would evaluate all , but some prefer MRI to evaluate 8th nerve, speech and language functional MRI as well


Normal hearing
Sound from the environment—via the external and middle ear(including tympanic membrane and ossicles)--- Cochlea spiral ganglion cells----auditory nerve---brainstem.

Implant  has two parts

External-microphone  to pick the environment sound
-Speech processor-digitizes the signal
-Transmitter-converts to FM type  of Radiosignals

Internal –kept aligned well by the magnets , and placed underskin behind ear
  -Receiver/stimulator(disk shape)-converts FM signals to electric signals
- through a wire connected to Electrodes(usually 24)
-stimulate the spiral ganglion cells (apical better because sound will be more natural)------auditory nerve---brain. Sound produced is different from ordinary and robotic, needs adjustment, because 24 electrodes cannot match 15000 haircells normally present

Surgery
Making communication between mastoid/ middle ear and mastoid / cochlea . Intra -operative Radiographs help in correct positioning of the electrodes


Complications
Extra cochlear placement of the electrodes including in the semicircular canals, breakage facial palsy, infection, pneumocephalus, fluid drainage, meningitis, cochlear damage during insertion of electrodes, osteogenesis, vestibular symptoms etc

MR Safety
Previously thought to be Unsafe (because of the magnets with in the gadgets), recent models are classified as conditional (can be performed with specific recommendations of the manufacturer  including the magnetic strength)

HRCT (if needed with contrast) is adequate for post operative evaluation including electrodes malpositioning

Jose Rizal: First Filipino Saint?

For the past few years, I have been studying some of the Rizalista sects in Mount Makiling, Mount Banahaw , and Mount Arayat . These Rizalista sects worship Jose Rizal as God. They call Rizal in a variety of names: the Tagalog Christ, the Jove Rex Al, the Son of God, Amang Doktor, Amang Rizal, and so on.


One time, while on discussion about Rizal’s various mystical powers, one ageing Rizalista seriously told me that Rizal could also be considered the Filipino Buddha because he was the first Filipino to attain enlightenment. You could imagine my amusement thinking about Rizal sitting in Buddha-like position trying to achieve Nirvana!


It amused me because some years back, I was asked by a young smart-aleck student if Rizal could be considered for sainthood since he died a martyr’s death. I remember answering that Rizal will never be canonized by the Catholic Church since during his life, Rizal attacked the Catholic Church. But then again in more enlightened retrospect, I knew I made a mistake, because Rizal never attacked the Catholic Church itself, but rather the bad practices in it.


Nevertheless, the thought of Jose Rizal becoming a saint was a rather cool idea. I wanted to find out if there were some people in the past who may have lobbied for Rizal’s sainthood. My research led me to some dusty shelves in the Filipiniana section of the National Library where I asked a bespectacled librarian if there was ever a book or a monograph about a move to beatify Jose Rizal.


The bewildered librarian looked at me as if I had just come from outer space, and perhaps considered me as one of those rabid Rizalistas who invade the library every now and then to research on the divinity of God Rizal. Then she told me that there was no such a thing. As consolation for my weird research, she handed me Rudy Astronomo’s Kristong Kayumanggi (Tagalog Christ), which of course, I already read many times before, the book being freely given in many Rizalista churches.



I went home and totally forgot about St. Jose Rizal. Then one evening, while browsing some old newspapers in my collection, I came across an old Renacimiento newspaper from 1903. It contained news of Jose Rizal canonization in the Philippine Independent Catholic Church or more widely known as the Aglipayan Church . Indeed, unknown to most of us, Jose Rizal was canonized as a saint on September 24, 1903 by the Aglipayan Church .


This canonization of Rizal was not, of course, recognized by the Roman Catholic Church, since the Aglipayan Church was a breakaway Catholic group. Nevertheless, this was the very first known act of any organized religion in the Philippines to venerate Rizal as a saint, making him as the first Filipino saint! Consequently, after Rizal’s canonization, hymns and prayers were composed in his honor, and his birth and death anniversaries became important feast days. Rizal’s pictures and statuettes were placed in the altars of Aglipayan churches.


It is important to note, however, that at present, the Aglipayan Church has already ceased to recognize Rizal as saint. According to present Aglipayan Bishop Rev. Fr. Efraim Fajutagana, Rizal’s sainthood was revoked in the 1950s, since it was only done during the nationalistic phase of their church—that is, during the early years of their separation from the Catholic Church. So at present, the church no longer celebrates the feast days of Saint Jose Rizal, although they still recognize Rizal as the foremost Philippine hero.


The question now is: in the light of Rizal’s unjust execution (like Joan de Arc who became St. Joan of Arc), if it’s now possible for the Roman Catholic Church to beatify Rizal and elevate him to the official roster of Catholic saints. Since the Catholic Church claimed that Rizal retracted his “errors in faith” shortly before his death, then it can be argued that it is already high time for the Catholic Church to retract its own condemnation of Rizal as enemy of the church. This would be complicated, as anti-retractionists would argue that Rizal did not retract because he had nothing to retract.


Nevertheless, immaterial to whether Rizal retracted or not, the issue is clear: Rizal was unjustly executed partly because of the role played by the Catholic Church. So the first thing the Catholic Church should consider is to issue a long-due apology for its role in the martyrdom of Rizal. As a Catholic and Rizalist, I feel that this is a just demand because our greatest hero was wrongly executed. For the record, Spain already issued an official apology for executing Rizal. Now, a Rizal monument similar to the one we have in the Luneta stands in the heart of Madrid.


Rizal’s retraction would no longer be the issue here but the Church’s retraction. But I guess it would be very unlikely since the Church as an institution has not admitted errors, just as in the Middle Ages--during the Inquisition—it committed serious errors in executing so many innocent people.


Hence, I believe that Jose Rizal joining the ranks of the Catholic saints would be a remote possibility at present. Nonetheless, for the Rizalistas, it does not matter: God Rizal always sounded better than St. Jose Rizal.



*This article originally published here at the Philippine Online Chronicles.

Saturday, June 25, 2011

Umblical Artery Reference Calculator

Just came across this link on Perinatology.com  which has an excellent tool for calculation of reference range for umblical artery doppler parameters based on article -Am J Obstet Gynecol.2005;192:937-44

UMBLICAL ARTERY REFERENCE RANGE CALCULATOR

Friday, June 24, 2011

Glenoid Subchondral Cystic Lesion -Approach.




A 23 year old young male after a fall from motor bike complains of chronic pain of 2 months duration. MRI shows a well defined, regular, complex heterogenously altered lobulated completely intraosseous lesion in the subchondral location of the glenoid with no expansion / bleed / labral / cartilage / joint involvement. The differential diagnosis is possibly intraosseous ganglion, post traumatic cyst ( no bleed or fluid / fluid level or heterogenity would make this less likely ), osteoid osteoma ( absence of nidus make this unlikely). Caries sicca ( uncommon location, septal indentification predomiant fluid make this less likely). Case by Dr MGK Murthy and Mr Abdul Hamid.




Teaching points
Intraosseous ganglion cyst are uncommon entities in general with femur and medial malleolus accounting for majority of them, followed by knee and ankle regions. Bone scan / X-ray would suggest presence of activity and no significant calcification.
            

Wednesday, June 22, 2011

Radiology MCQs-Maharashtra Mch Exam


Q- Pseudo billroth sign is present in
Crohns
ca stomach
 ulcer

Answer
The earliest radiographic sign in Crohn's disease is aphthous ulcers. The most common radiologic findings in gastroduodenal Crohn's disease are mucosal nodularity, or “cobblestoning,” thickened folds, and ulcerations. A pseudo-Billroth I appearance of involved antrum and proximal duodenum has been described. A rare but classic radiographic finding is the funnel-shaped deformity of diseased antrum and duodenal bulb, known as the “ram's horn” sign

Q-scimitar sign is present in
 1 ca rectum 
2 chordoma 
3 sacrococcgeal teratoma
 4 anterior meningocele

Answer-
Anterior sacral meningocele is an unusual lesion that usually presents as a presacral mass. Radiography of the pelvis demonstrates a sacral deformity or “scimitar sign” that is pathognomonic for anterior sacral meningocele.




Fibrous Dysplasia of Maxilla

 Fibrous dysplasia of the facial skeleton commonly involves the maxilla.  It commonly involves one maxilla.  CT scan shows a lesion that is confined to the bone with no soft tissue component. It is helpful in distinguishing fibrous dysplasia from a malignancy. Features of malignancy include osteolysis, destruction of sclerotic margins, and cortical destruction with soft tissue extension.  The bony lesion shows a homogenous matrix with obliteration of maxillary sinus cavity.


Tuesday, June 21, 2011

Buford Complex-Normal Variant


 An absent anterior superior labrum and an associated cordl like middIe glenohumeral ligament represent the normal variation that is known as the Buford complex rather than an avulsed labrum. This normal variation may be mistaken for a detached labrum.





Monday, June 20, 2011

Calcaneal Fracture-Plain Film

56 yr old with history of fall from ladder. Case discussion series by Dr MGK Murthy.


1.What is it?
It is calcaneal fracture–comminuted, intra articular variety of tuberosity fragment fracture with Bohlers angle reduced




2.How many type are there?
Mainly two- Intra (important) and extra articular

3. Subtypes?
Primary fracture line is through the posterior  facet (uncommonly it can be anterior or middle)

Three-
a) sustentacular fragment(constant)
b) Tuberosity fragment------- leads to incongruity of post facet ---widening and shortening of heel------further damage-----tuberosity fragment creation(superolateral fragment of posterior facet)
c) if axial load bearing continues –Thalamic fragment(depressed posterior part of the posterior facet)


4. Complications ?
Calcaneal cuboidal joint displacement Tendoachilles/peroneal tendons distraction
Heel short and wide
lateral wall comminution/talus dorsiflexion

5.Associated injuries? (Mechanism -fall from height)
Other foot/spinal
Soft tissue compartmental syndromes
Fracture blisters

6.Radiography?
True lateral and oblique play more role along with other side comparison in case of doubt. Bohlers angle (normally 20 -40 deg)(intersection line drawn from the most cephalic portion of tuberosity to highest point of posterior facet)is critical.

7.Best way to calculate?
MDCT

8. Management
Initially all -with rest and elevation till swelling subsides
Then if bohlers angle mildly or moderately reduced – conservative, if severely reduced (< or equal to 0)- surgery

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Sunday, June 19, 2011

The Story of the Rizal Monument


Of all the historical landmarks in the Philippines, the Rizal monument in Luneta easily stands out as the most recognizable and most photographed. It is thus an irony that very few Filipinos know the story behind the building of this important national memorial, and how, more than a century ago, some of the world’s leading sculptors participated in an international contest to design and build it.

Built by virtue of the United States Philippine Commission Act No. 243, dated September 28, 1901, the Rizal monument was approved by no less than United States President Theodore Roosevelt. The act stipulated the allocation of land in the Luneta to build the memorial, near where Rizal fell when he was executed by the Spaniards on December 30, 1896. It also specified that the monument bear the statue of Rizal, as well as serve as the final resting place of his remains. To fund the project, a Rizal committee was set up to raise funds from public solicitations. The committee—whose members included Paciano Rizal (Rizal’s brother), and Tagalog novelist Pascual Poblete–was also tasked to hold a design contest for the future monument.

In 1905, when the committee gathered enough funds, it announced the art competition. Local and foreign sculptors were invited to participate, with the year 1907 as the deadline of submission. It was a reasonable period of time to conceptualize and design a scale model for the future Rizal national monument. The grand prize winner would be awarded a cash prize of P5,000, as well as the P100,000-contract to build the monument. It was a huge sum during that time and thus many sculptors, including some of the best in Europe, participated.

Forty artists submitted their bozetos (scale models) in 1907. From these forty, ten bozetos made it to the finals. Some of the bozetos were titled “Noli Me Tangere” (Rizal’s first novel), “Motto Stella” (Guiding Star), “1906”, “Al Martir de Bagumbayan”, “Eripitur Persona Manet Res”, “F.F”, “Victoria”, and “Maria Clara.” The bozetos were exhibited in the Marble Hall of the Ayuntamiento in Intramuros. The judges, all non-artists, were headed by then American Governor of the Philippines Frank Smith.

Bozeto finalists

Bozeto finalists

Extant photographs of the exhibit revealed the superior qualities of the finalists. Most were meticulously made in the Art Nouveau style that was very popular at that time. After thorough deliberation, the jury reached a decision. They awarded the P5,000-grand prize to bozeto No. 21 entitled “Al Martir de Bagumbayan” designed by the famous Italian sculptor Carlo Nicoli of Carrara, Italy. The jury gave the second prize to bozeto No. 9 entitled “Motto Stella” by the Swiss sculptor Richard Kissling. Kissling received a P2,000 cash prize.

Al Martir de Bagumbayan

Al Martir de Bagumbayan by Carlo Nicoli. Grand Prize Winner

Motto Stella by Richard Kissling

Motto Stella by Richard Kissling, Second-place Winner

As the first prize winner, Carlo Nicoli was supposed to have been awarded the contract to build the monument in the Luneta. However, for some reason the contract went instead to second-prize winner Richard Kissling, for his bozeto.

Some speculated that Nicoli’s intricate design would cost so much more than the P100,000 budget to build the monument. Indeed, Nicoli’s bozeto required installations of intricate parts that were lacking in the Philippines and needed to be imported from Italy. Nicoli also specified that in order to construct the bozeto faithfully, Carara marble (the famed marble that was favored by Italian sculptors like Michaelangelo and Bernini), must be used. Of course, the contract stipulated that all materials would be from local sources.

There was also a theory that Nicoli backed out of the contract because he failed to put up the P20,000-peso bond as guarantee to finish the monument. Or that Nicoli was not able to come to the signing of the contract. Whatever the case, Richard Kissling was eventually awarded the contract, and his “Motto Stella” bozeto was the one upon which construction was started in 1908.

In comparison with Nicoli’s grand prize-winning bozeto, Kissling’s model was more streamlined, and almost lacks the grandeur that befits the greatest hero of the land. Indeed, when news of the change of model spread, some of the local press criticized Kissling’s model. A newspaper caricature poked fun at its design. Some unscrupulous people even put forward the ridiculous suggestion that the famous Filipino painter Felix Resurreccion Hidalgo should inspect and modify the design. In fairness to Hidalgo, he might not even have known of the suggestion and even if he did, would most likely have rejected the idea. Indeed the suggestion was quickly rejected by the jury. Meanwhile the work on the monument was already in progress. The figure of Rizal was cast in bronze while the obelisk and the base were sculpted from unpolished granite.

In retrospect, looking at the extant photographs of the two bozetos now, the change in the design was, in my opinion, highly propitious. Nicoli’s design was, of course, aesthetically speaking, more beautiful to look at. No one will ever doubt that it was designed by a master, as indeed Nicoli was. But it also looked very European with all its elaborate designs. It would have been perfect in a city such as Rome or Vienna. But in Manila’s Luneta—with its then grassy fields– it would have looked totally out of place.

The strength of Kissling’s design—which was perhaps well appreciated by the jury who adjudged it second prize—was its stark simplicity. Rizal’s posture in the bozeto was subtle but heroic. The hero, attired in his usual overcoat and holding a book in his hand, was depicted as if looking towards the breaking of dawn after the long troubled night. The figures beside him are very strong symbols of a struggling nation’s hope for a better future through progress and education—a mother rearing her beloved child, and the evocative figures of two young Filipino boys ardently reading. Of all the entries, it was the only one that approached the embodiment of the very ideals of Rizal: family, education, and enlightenment.

Every time I visit the Rizal monument, I always feel proud and fortunate to be a Filipino, having been born a free man because of Rizal’s martyrdom. Our forefathers—our beloved Rizal among them– were not so fortunate to see the light of dawn emerge from the darkness.

On the sixteenth death anniversary of Dr. Jose Rizal on December 30, 1912, as the monument was nearing completion, the remains of the national hero was transferred through a solemn procession from the Ayuntamiento to the Rizal monument. A year later, on December 30, 1913, the monument was unveiled to the public.

Rizal monument

The Rizal Monument today


This article originally appeared in the websites Thepoc.net and MyRizal@150 website that you can visit here.

Mobile Version of Sumer's Radiology Blog

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Thursday, June 16, 2011

Recurrent Dislocation Shoulder- MRI

This patient has a history of previous dislocations, 17 year old  boy with evidence of altered contour and possible periosteal sleeve avulsion involving the anteroinferior labrum with asssociated localized fluid collection in relation to anterior labrum possible labral tear and associated paralabral cyst. Likely ALPSA lesion: anterior labroligamentous periosteal sleeve avulsion. In the Bankart lesion, the anterior cartilage labrum is detached and torn from the periosteum. In the ALPSA, the labral fragment remains attached to the periosteum of the scapular margin and can be tethered in this abnormal position, increasing the likelihood further medial displacement and of re-dislocation.




Striatocapsular haemorrhage-MRI

13 yr old with movement disorders with history of hypoxia. MR shows bilateral, symmetrical linear altered  signal intensity with no restricted diffusion or blooming on susceptibility images. Possibly represents striatal haemorrhage sequelae in the external capsular area between lateral putamen and insular cortex. By Dr MGK Murthy, Mr Hamid and Dr Mukarab.



Teaching points

Striatocapsular haemorrhage is classfied by chung etal
type1-Anterior                                  in the region of artery of heubner
type2-Middle-                                   in the  region of medial lenticulostriatal  artery
type3-Posteromedial-                       in the region of Postero medial branches of  lateral lenticulostriatal artery
type4-Posterolateral-                        in the region of postero lateralbranches of lateral lentiuclostriate artery
type5-lateral-                                   Most lateral branches of lateral lenticulostriatal artery
type6-Massive 

Stress Fracture Sacrum -Case Discussion


50 yr old post menopausal lady with back pain. Case submitted by Dr MGK Murthy.

(A)What is the finding?
An ill defined, irregular ,marrow oedema with no joint abnormality with subtle vertical dark line on T2



(B)What is the diagnosis ?
The finding is nonspecific to etiology. The possibilities include
-Bone marrow syndrome -this  is supported by  focal osteoporosis on Xray, however is unusual site for occurrence
 -Insufficiency fracture-possible because of the gender and age ,as well as subtle darkline on T2 and the orientation is vertical .
However there is no horizontal component across the middle of sacrum at S2 or S3 , and the second vertical component of Honda sign
- sacroilitis of non specific cause-  is unlikely as the joint is not abnormal
-sacroilitis of infective variety possibly TB-unlikely as there is no destruction, joint involvement, and no soft  tissue collection

(C) what should be next step?
Radionuclide scan will show Honda sign of  increased activity. CT would show fracture line

(D) what should be done if the patient is not keen get other tests done?
As the treatment is usually conservative ,  Review after treatment for at least 6 weeks is helpful

(E) Is it necessary to do Review MRI?
No , A review Xray  would be adequate , as it is likely to show sclerosis along the fracture line

Acquired cystic kidney disease


End stage renal disease on dialysis for 10 years with ultrasonography showing multiple renal cysts. The MR urogram shows multiple cysts of varying sizes involving both kidneys with normal pelvicalyceal system with no splaying and normal kidney sizes. All the cysts fall into Bosnaik type-I or type-II and hence are possibly to be ignored. Acquired cystic kidney disease ( ACKD) is frequent finding in patients long term dialysis. Case by Dr MGK Murthy and Mr Hamid

Teaching points :-
1)      Criteria for ACKD
-        Presence of atleast 1 to 5 kidneys cyst
-        Pathologically an extension to the cyst more than 25% of the renal parenchyma.

 2)      Usually ESRD kidneys are small in size. However normal to enlarged kidneys in ESRD are known to occur in specific causes.

Wednesday, June 15, 2011

MR Arthrography Shoulder

Teaching points 
Usually done under fluoroscopy /ultrasonography/CT guidance to avoid labral cartilage injury. By Dr MGK Murthy and Dr Sudheer Kunkunuru

·        Indications
1.   Primarily for Rotator cuff tear suspicion or evaluation
2.   Cartilage evaluation
3.   All the internal structures including glenohumeral ligaments



·        Technique

PreArthrography  Xray shoulder AP with external and internal rotation views to look for presence of hydroxyl apatite crystals/calcification (which could be confused with rotator cuff  tear producing contrast leak)

-Supine and external rotation
-Mark the joint lateral to humeral head cortex
-20 to 22gauge LP needle perpendicular to fluoroscopy beam. Testing the safe INJOINT position with local anaesthetic after aspiration to test for blood vessels
-Confirm position with iodinated  contrast
- Dilute gadolinium injected to the comfort level usually
10 to 16 ml (Cocktail made of 0.1 ml Gadolinium+10ml Iohexol+10ml 0.9%saline+0.3ml of epinephrine of 1:1000 in 20 ml syringe )

Tuesday, June 14, 2011

Jose Rizal: Komikero

Jose Rizal (1861-1896)

In 1884, Dr. Reinhold Rost, editor of Trubner’s Record, a magazine devoted to Eastern literature, asked Jose Rizal to contribute some Asian fables. Rizal was more than delighted to comply and he submitted to Dr. Rost “Two Eastern Fables." One of the fables was titled “Matsing at Pagong”, which Dr. Rost published in Trubner’s Record issue No. 245 in 1885.

To complement his article, Rizal created the “Matsing at Pagong” in comic form, using the back of Paz Pardo de Tavera’s notebook to draw the originals. The original drawings still exist to this day, owned by the descendants of Paz Pardo de Tavera. If you must know, Paz was the wife of Juan Luna, and Rizal used to “tambay” in Luna’s atelier in Paris.

To my knowledge, this “Matsing at Pagong” comic strip was the very first known comic strip created by a Filipino—prompting the historian Ambeth Ocampo to regard Rizal as the Father of Philippine Comics.

I recently browsed my library and pulled out a 1913 book called Lineage, Life and Labors of Jose Rizal, authored by the American historian Austin Craig. Considered the first English biography of the National Hero, the book is illustrated throughout with many drawings and sketches by Rizal. Towards the very end of the book is found the complete “Matsing at Pagong” comic strip as reprinted directly from the originals, and with the original letterings of Rizal.

In this comic strip, Rizal did not use talk balloons for the dialogues of Matsing and Pagong. He instead wrote their “talks” below each of the panels, which was standard practice among comic artists during the 19th century. It seemed that the early cartoonists avoided talk balloons because they too often clutter in the panel and get in the way of the drawings. Although invented as early as 17th century, talk balloons came into general use only in the 20th century.

Interestingly, very much later, Rizal adopted talk balloons in his “Mangkukulam” cartoon strip, although this remained unpublished during his lifetime. It was finally put out by the Jose Rizal Centennial Commission in the 2-volume Facsimiles delos Escritos de Rizal in 1961.

Undoubtedly, Rizal was a genius. He was a poet, novelist, a humorist, songwriter, linguist, sculptor, inventor, an illustrator, and maybe more than a hundred more things that we even do not know of. He was a polymath, a curious man who was into trying everything. Inactivity and complacency bored him and he used his tremendous talent to satisfy his desire to understand the world he lived in.

Drawing was a favorite past time of our national hero. He wanted to keep a visual record of the things he saw or the people he met. There were no portable cameras during the 19th century, so Rizal just drew scenes and views while standing on ships’ decks or while idly waiting for trains’ arrivals.

One could only imagine how lonely our hero had been during his travels to Europe and America. To escape boredom and homesickness, he carried notebooks which he filled with drawings and sketches: a view of the Manila coastline as it receded from view, a picture of a funny man, Voltaire’s head, a Chinese man, or just about anything that caught his attention and piqued his interest. Rizal would spend days and nights drawing humorous panels we now called comics. Fortunately for us, many of these drawings still exist and can give us a view of what Rizal may have seen at a given time.

In Germany, Rizal illustrated a hilarious panel in which he showed a gentleman curtsying to a lovely woman. While doing so, the gentleman accidentally emitted a fart resulting in chaos all around him!

While Rizal was staying with the Ullmer family in Wilhelmsfeld, he created a comic strip called “The Two Brothers,”which he gave Friedrich "Fritz" Ullmer as a gift. Fritz was the young son of his friend and host Pastor Ullmer. These comic strips, along with several other drawings and sketches done by Rizal during his stay with the Ullmers, are intact to this day. The Ullmer descendants kept these precious mementoes and were eventually discovered by Mrs. Paz Mendez (of the Jose Rizal National Centennial Commission), while she was traveling to Germany to retrace Rizal’s footsteps.

By a stroke of good fortune, the great-grandsons of Pastor Ullmer—Fritz and Hans Hack—generously donated the drawings to the Filipino people during their visit to the Philippines in March 1960 (upon invitation of the Philippine government), a year prior to Rizal’s centenary in 1961. These drawings are now part of the precious Rizaliana collection in the National Library.

While living as an exile in Dapitan in 1892, Rizal was asked by his friend Benito Francia to write something about Visayan witchcraft. In compliance, Rizal wrote an excellent article entitled “Notes on Witchcraft in the Philippines,” and even created a four-paneled comic strip to accompany the article. When looking at the originals, I noticed some bluish tint on the drawings. Rizal may have used a blue pen to make his work more attractive—making it the first comics in thePhilippines with color (so what if it is only one color?).

Now, I am not sure if this comic strip is to be read horizontally or vertically, since Rizal did not provide a number guide on the panels. I believe though that the panels do not conform to a continuing story. They are more of vignettes that have relation to witchcraft.

What is fascinating about this comic strip is that it was the only one written by Rizal in Tagalog. Rizal knew at least 22 languages, and he was fluent in some twelve of them, including, of course, Tagalog. Not only was Rizal the first Filipino to create a comic strip, he was also the very first one to create a Tagalog komiks!

I had the rare chance to examine many Rizal original drawings kept in the National Library. Seeing them close was such a thrilling experience that I when I went to sleep that night, I dreamed Rizal was drawing for Aliwan Komiks!

Meanwhile let us see what we can understand from these panels. Notes within parentheses are my translations as well as some of my own comments:


FIRST PANEL: -Ay inang mamatay aco! (Oh, mother!, I’m dying!) -Huag po cayo matacot at aco man ay bata, ay isang bantog na hilot (Be not afraid, I maybe a child but I am a good healer)

SECOND PANEL: -Itong cuto na ipinunla sa aquin toong malago ang pagdame (The lice planted on my hair are rapidly multiplying) -Tag-anas namang pirit(?) pati mga cuto mo a (Your lice are all like birds!)

THIRD PANEL: -Caeng, at cayo calvo!! (Caeng, you are bald!!) -Aa aa! Puga, puga ca! (the Tagalog word Puga means escape. The bald man may be saying to the boy to get lost for teasing him as bald!)

FOURTH PANEL: -Jesus! Aco’y nanglalata. Cung ano po ang naroroon sa loob, aswang yata (Jesus, I’m very weak. Whatever thing is that inside, maybe a vampire.)

In retrospect, Rizal’s drawings may be amateurish by today’s standards (although I found them cute). But one should remember that Rizal was not a professional illustrator. Also, he drew cartoons more as a hobby and distraction, in between doing several things of national importance such as writing his immortal novels and defending our country against the Spanish oppressors. The important thing was that he was the very first known Filipino to have drawn comic strips.

These drawings, sketches and comic strips are all proof of Rizal’s universal talent, which led the historian Ambeth Ocampo to marvel: "No wonder Rizal is the Father of this or the father of that. Rizal was into everything”. Yes indeed, except that Rizal was not the father of Hitler.


Rizal's self-portrait circa early 1880s

**This article was originally published by the author Dennis Villegas in the website MyRizal150.com. Please visit our web tribute to our national Hero here.

Monday, June 13, 2011

Teleradiology Providers-Interview in Medindia


Lakshmi Gopal of Medindia spoke to Sumer Sethi, MD, Sr Consultant Radiologist and Director of Teleradiology Providers, a unit of Prime Telerad Providers Pvt Ltd. An author of many academic papers and books on radiology, Dr Sethi specializes in musculoskeletal and neuroradiology.  The demand for radiologists is great in India and abroad - they are, however, in short supply. 


Teleradiology helps adjust this imbalance. India has a lot of talent and our doctors have emerged as one of the major providers of teleradiology services in the Indian subcontinent, the US, Africa, and the Middle East. Its key strength is that we have extensive experience working across both public and private hospital facilities. We have sub-specialist abilities and experience in the areas of neuroradiology, breast and cardiac imaging.  We also provide our own customized teleradiology software along with a dedicated web-based server platform and have the ability to link up with any centre in the world irrespective of the Internet speeds available. 

 Interview is featured here- 

Thursday, June 9, 2011

Anterior Cruciate ligament Reconstruction – what the Radiologist needs to know?

Young male with history of ACL reconstruction about 1 year back shows good positioning an ligamentization of the  the graft, normal PCL and menisci with subtle free fluid  with too anterior placement of tibial tunnel, post bioabsorbable screws. Case submitted by Dr MGK Murthy, Mr Hari Om, Mr Sahadev Gupta. 


Healthy Graft on MRI should be:
-Low signals if intact unimpinged graft
- Posterior to but not in contact with intercondylar roof
- T1 shows the structure better than T2 because of inherent heterogeneity on T2
-Tibial tunnel should not be too anterior
-Posterior cruciate ligament signals should not be gray/ heterogeneous






(A)        Technical factors evaluation

On X –ray
-fractures/screws integrity or position/union of bony portion/tunnel placement/size of screw tunnel

On MRI
 -Tunnel positioning (common failure is far too anterior placement at tibia )
-Tunnel widening(harmless)
-Graft integrity(heterogeneous signals sign of tear) other soft tissues evaluation
-Femoral insertion  should be at intersection of blumensaat line (intercondylar roof)and extended line from posterior femoral cortex
-Tibial  tunnel should  be posterior and parallel  to tibial intersection of blumensaat line

(B)        Biological factors
-failed ligamentization—not well seen on MRI
-infection
-Arthrofibosis—seen as low signal nodule surrounded by fluid , anterolateral to tibial tunnel called Cyclops lesion on MR (consists of debris of remnant ACL and graft )
-infrapatellar contracture syndrome