Radiology Museum

Came across this interesting link while surfing and showcases pictures of radiology related antique medical instruments.  Worth  a visit to see this fascinating collection.

Radiology Museum

Iliopsoas Bursitis/ Tenditis-MRI

The iliopsoas bursa is the largest bursal sac in the body; in 15% of normal individuals, it communicates with the hip joint between the iliofemoral and pubofemoral ligaments.  Iliopsoas bursitis can be caused by various hip joint abnormalities such as joint degeneration, rheumatoid arthritis, PVNS, synovial osteochondromatosis, gout, joint infection, or avascular necrosis. Other possible causes include sacro-iliac joint and adjacent spine pathology.

Tondo's Ulingan: Life in Manila's Inferno (2)

Ulingan is a small squatter community in Vitas, Tondo Manila located near the North Harbor where the Manila Bay and the Pasig River meet. Also known as Sitio Damayan--a rather anachronistic name for an impoverished slum community that doesn't receive any subsidy from the government--Ulingan came from the Tagalog word uling (charcoal), and it means “a place where charcoal is made.”

The workers of Ulingan, called ulingeros, rely on the charcoal industry for their daily bread: they work here as wood burners and charcoal packers. The average income per day, however, is way below the minimum wage standards in the Philippines. Many workers earn just around 40 to 70 pesos a day, a fraction of the standard 400 pesos (roughly, 9US$) as mandated by the law.

The ulingeros, however, seemed content enough. They are not looking for other jobs outside of Ulingan; indeed, they even feel complacent they are employed and have some source of income to somehow mitigate their wretched existence. The pay, however meager it may be, gives them assurance that they will have something to eat on the next day. P40 can buy a kilo of poor-quality rice and maybe a 10-peso bowl of pagpag— discarded left-over foods from city restaurants that have been collected and offered for sale by entrepreneurial scavengers.

Aside from the charcoal industry, another source of income for the Ulingan people is the Pier 18 garbage dump site nearby*. The refuse of Metro Manila goes here every day and becomes sustenance for the Ulingan people who sift through tons of Manila’s garbage and find something useful that can still be sold to the junk shops. These include scrap metals, plastics, cardboards, electrical wirings, and so on. After a whole day of digging and sifting through the mountains of garbage, the average scavenger just earns enough money for a day’s worth of food.

A Surreal Place

Ulingan is a place that challenges man’s notion of a normal existence. Outsiders who visit Ulingan are appalled by the inhuman conditions of the community. Sidney Snoeck, the famed Belgian photojournalist, visited Ulingan with me several times. He witnessed first hand how the people lived in terrible condition. “This place”, says Mr. Snoeck, “is surreal."

Indeed, Ulingan is a surreal place, as it breaches our normal notion of a community, even that of a slum environment. We know that a slum is supposed to be a poor community where people live in poverty and squalor. But even here, the word slum is an understatement. Everything in Ulingan is an anomaly. The whole place is laden with garbage piles, dirt, and flies. The rats easily outnumber the people. And as if these were not enough, the whole neighborhood shimmers with waves of fumes, heat, and black smoke. In some places nearest the charcoal factory, visibility is zero. Fire and smoke is perpetually present here.

But Aling Mercedita, 46, and her nine children have long regarded fire and smoke to be their benefactor. “Without the charcoal ovens”, she says, “We would not have survived as we have. Ulingan gives us our daily bread”.

Aling Mercedita, like the many women I met in Ulingan, is a widow (many other Ulingan wives were separated from their husbands who ran away). Her husband, an ulingero, died of tuberculosis a few years ago, succumbing to the long-term effects of smoke inhalation.

Now, working as ulingera herself, she has to support her nine children. To lessen the burden, she was forced to send the three youngest to an orphanage for the simple reason that-- to use her own words--“they will just die here.” Her remaining children had to work too, digging through garbage or sifting through charcoals.

Aling Mercedita smiled while wiping the tears that instantly welled in her wrinkled eyes as she remembered her lost children. Most people can smile in adversity, but one cannot successfully mask the pain, and the tears are the sign of internal suffering. “It gnaws on me”, she continues “I feel guilty whenever I think of my other children. But what can I do?”

In general, fortitude is an admirable trait. But the poor who bear this characteristic do not strive for admiration. They didn’t want to suffer as no people would. What they needed is our understanding and compassion. Theirs is a brutal existence, and we cannot know exactly the extent of brutality unless we are brave enough to enter their world.

Inside the Charcoal Factory

The charcoal factory is the very center of Ulingan. Divided into small shallow pits in the earth enclosed by makeshift fences, the factory is where wood is burned to become charcoal. Each of the pits is filled with neat stacks of wood. The fire is ignited at the top of the wood stack and then covered with yero or iron sheet. Everything is then covered with moist soil. Beneath the piles of wood are small shafts of tubes called tambutso-- flues that act as the exhaust or chimneys of the fire and smoke from within the wood stacks. There are eight or more flues in each charcoal oven, depending on its size.

The combination of dust, smoke and fumes make Ulingan seem like an inferno—which in a way it is. The acrid smoke and the sweltering heat are overpowering. The people of Ulingan have been burning charcoal for over three days now. Looking haggard and restless, they vigilantly monitor the fire, making sure it is under control. The wood must be burned through slow pyrolysis. If the fire grew any stronger, the wood would be reduced into worthless soot.

On the other charcoal ovens of the factory, some workers are already through burning their wood. After three days, it is now time to harvest the charcoals from the ovens. With shovels, they carefully lift the charcoals piece by piece to put them on a dry ground. This too must be done carefully so as not to damage the precious charcoal.

Many of the workers in Ulingan are small children. Some are teenagers and a few are even as young as six or seven. Unable to attend school because of poverty, they are “no read no write” children. Most of them have very low self-esteem and have developed the kind of sullen and taciturn behavior common to children who have endured long-term suffering.

Nonetheless they are here to survive, even if they do not know until when. Instead of pencils and pens, they have shovels in their hands, taking turns scooping the charcoals into sacks, collecting the nails that could be sold to the junk shops, or packing the charcoals into little plastic bags. All the kids work without protective masks, gloves, and boots. Some are naked.

At the end of each grueling working day, the Ulingan people look bedraggled, gaunt weary figures who seem to have just come from a conflagration--which essentially is where they had been. Their eyes look sullen, hair singed with fire, faces masked with soot, and their bodies layered by thick grime.

But the polluted Manila Bay is just a step away, and after their grueling work, many dip into the bay to remove the grime on their bodies, and most importantly, to cool and relax themselves—a welcome respite after spending a day’s work in hell.

*The Pier 18 is actually a garbage transfer point rather than a dumpsite. Nevertheless the people regard it as such.



This article is published originally at The Philippine Online Chronicles, now one of the world's leading web resource site about the Philippines. Please check our website here!

IRIA-2011, Teleradiology Panel Discussion

For all those interested in Teleradiology, IRIA 2011, Delhi,  largest Radiology Congress in Indian subcontinent has organised panel discussion-symposia on this topic with may distinguished speakers, including yours truly, who was invited to do similar talk in IRIA 2008. This year my topic is Asian-African Perspective- Teleradiology.  Schedule for the event is given below. All attending the conference are welcome to meet me around this event, to be held in Hotel Ashok and my talk is scheduled for 29, Jan 2011, 16.40pm. Any suggestions for the talk or comments are welcome.

Gliosarcoma-MRI

Gliosarcoma is a rare highly malignant (WHO grade IV) primary intra axial neoplasm. It is often considered a histological variant of glioblastoma multiforme (GBM).  Pathologically, the tumour is very similar to a glioblastoma multiforme (GBM) but with an added sarcomatous component (the tumour comprises of both glial and mesenchymal elements). This is a histologically proved case of gliosarcoma.

Tree-In-Bud Appearance-CT Sign

The tree-in-bud sign is a finding seen on thin-section computed tomographic  images of the lung . Peripheral, small, centrilobular, and well-defined nodules of soft-tissue attenuation are connected to linear, branching opacities that have more than one contiguous branching site, thus resembling a tree in bud. The tree-in-bud sign has primarily been used as a descriptive term for abnormalities found on CT scans of the lung in patients with endobronchial spread of Mycobacterium tuberculosis.

Distal Radioulnar Joint Subluxation

The radius and ulna constitute a bicondylar joint, articulating at distal and proximal radioulnar joints. Between these two joints, the interosseous membrane functions as a suspension bridge. The stability of proximal and distal radioulnar joints is provided by the thick and complex ligamentous structures, known as the annular ligament and the triangular fibrocartilage complex, respectively. The distal radioulnar joint consists of two articular surfaces that are dissimilar in their radius and curvature, the sigmoid notch and the ulnar seat. MRI is useful to evaluate for TFCC injury and to assess DRUJ subluxation.  Note the positive ulnar variance and widening of the DRUJ space is this case.

Pancreatic Transection-MRI

Complete pancreatic transection is rare and usually occurs in the line of superior mesenteric vessels at the neck of the gland, though it has been reported to occur in the body or tail of the pancreas.  These patients may have associated injury to superior mesenteric portal vein axis and pancreatic ducts.  Early surgical intervention in patients with pancreatic neck transection and ductal disruption reduces pancreas related morbidity.Note the complete transection between head and neck of pancreas with a rounded fluid collection separating the two fractured fragments.

Tondo's Ulingan: Life in Manila's Inferno

Aling Nelia Gumapac, 45 years old, and her brood of five live a quiet but difficult life in their shanty in Vitas, Tondo, Manila. The word shanty, however, may be an understatement to describe their abode. Built with scrap wood, discarded tarpaulin, Styrofoam, and other scavenged materials from the garbage dumpsite, it is nothing but a withered old tent--covered with soot as a charcoal factory is a whiff away-- a makeshift ramshackle shack if you will, some four feet in height and around five square meters in size. But Aling Nelia and possibly her children seem content enough, even if they have to crouch in order to get in or out of their shack. “At least,” Aling Nelia says,”we have something to sleep in. It’s very hard to sleep in the streets."

Their rickety shack is located right on the dumpsite and near the charcoal factory just aft the new Smokey Mountain. Thus they have to contend all day with the heat, fumes, dust, stench, the flies and, at night, the mosquitoes and the vermin. Aling Nelia and her children have grown accustomed to these hazards, however. For them, these are the features of ultimate poverty which they accept to be their lot. “It’s just a matter of adjusting yourself to the situation. We are poor, so we have to live like this,” she says, sounding resigned to their fate.

Aling Nelia with her five brood, and with some friends

Aling Nelia works in the charcoal factory of Ulingan which is a few blocks away from their house. She is a widow; her husband, a trash scavenger, was killed in Smokey Mountain when one of the cranes carrying trash accidentally fell on him. The husband’s death in 2007 was a big blow to the family.

“Every night,” Aling Nelia laments, “I sleep with my one eye open, wondering if I would be able to support my children, and whether there will be food for them tomorrow. Ang hirap ng tinitiis naming mga mahirap! Hirap na hirap talaga ako. Kung ako naman ang mawawala, ano na ang mangyayari sa mga anak ko?”

In order to survive and make ends meet, Aling Nena works as coal packer. She puts the uling inside small yellow plastic bags. For eight hours of work, she gets paid forty pesos, just enough to buy a kilo of poor-quality rice and a few pieces of dried sardines.

At the end of each work day, Aling Nelia comes home with her face and body covered with soot. Oh, yes, her children still recognize her under the thick grime, she says laughing. More than that, they must see in her the means to survival: the rice that will be their sustenance for the morrow.

Her children—who never attended school-- help augment the meager family income by collecting trash in the nearby dumpsite and selling their collection to the junk shops. At the end of a busy day rummaging through piles of garbage, the children are happy to bring a few more pesos so that they will have money for a lugaw (rice porridge) in the morning. The lugaw assures them that they will be not go hungry for the next two to three days.

But it is not every day that they can eat three square meals. There are days when it is worse -- when the charcoal ovens didn’t have wood to burn and Aling Nelia would be out of work. To make matters worse, the children would go home empty handed. The garbage trucks may have brought only useless trash. With no money and food to eat, they would spend the night sleeping with empty stomachs, dreaming about food, and hoping that the morrow would bring in sustenance.

As a last resort, they dig into trash cans for left-over foods. These discarded foods—known as pagpag in the slums-- are trash to well-off people but manna from heaven to Aling Nelia and her brood--even if these stinking foods are already infested with maggots. The poor has a way to kill the maggots by boiling the food in cooking oil. But it is not everyday there is pagpag. Sometimes all they find are empty food packs. The rats—so numerous in the dump site-- have already beaten them to it.

In a neighboring shack nearby, Mang Julio Dela Cruz, his wife Linda and two small children live. Mang Julio is employed as a wood burner in the same charcoal oven where Aling Nelia works. When Mang Julio first saw me, he shyly asked for a picture with his youngest daughter, Tin, barely two years old. Apparently, he has never had a photo before with her daughter. But Little Tin was afraid of the camera. When I was about to click the shutter, she began to wail. Embarrassed, Mang Julio apologizes to me. I have already taken the shot, however, and the picture that emerged showed a father and daughter smeared with soot and grime.

Mang Julio is a very poor man. He has yet to receive his pay for five days of work (100 pesos a day, or roughly, US$2 ). The scrap woods must be burned slowly—around three to four days of continuous slow burning to become good quality charcoal. It could not be done quickly. Increasing the fire can reduce the wood into powdery soot and therefore render it worthless. Afterwards, when the wood has turned into good charcoal, it is packed by workers like Aling Nelia. Once packed, the uling (charcoal) is then sold wholesale to a market retailer. Thus, Mang Julio must agonizingly wait for a few days in order to get his pay. Meanwhile, penniless, he momentarily relies on the neighborhood sari-sari store to give him a short-term loan of provisions like rice and canned sardines.

Aling Nena’s and Mang Julio’s are just two of the more than 1,600 families living a subhuman existence in a place called Sitio Damayan a six-hectare slum area in Vitas, Tondo, Manila. Sitio Damayan, also called “Ulingan” because of the charcoal industry in the area, may just happen to be the most depressed of all the depressed slums area in all of Metro Manila. It is located just a few meters away from the infamous Smokey Mountain.

During the course of several months, I kept coming back to Ulingan, to immerse myself on the condition of extreme poverty, to study and photograph how the people in this most depressed slum area exist, so that I can report faithfully what they go through everyday. I have been brought up in a middle- class family and the condition of extreme poverty is strange to me.

It is not a very encouraging work. Each time I visit Ulingan, my heart breaks as I witness how people live in a destitute state. It is not easy to see small naked children running around barefooted begging for money so that they can buy food, or to see their fathers carry multiple sacks of garbage and charcoal on their shoulders to earn a few pesos. I know that in general life is hard indeed, but no one needs to live in utter destitution. Indeed, some animals live better.

As a photojournalist, I consider it my duty to expose the social illnesses afflicting the poor, the very social cancer that everybody else neither wants to see nor touch. But photography has a stark way to force people to look into a subject that we have long thought to deny. We can no longer ignore the facts. The truth is staring us in the eye.

This is my first article on my series on Tondo's Ulingan.

This article is published originally at The Philippine Online Chronicles, now one of the world's leading web resource site about the Philippines. Please check our website here!

Carcinoma Prostate-Osteoblastic Metastases

The balance between the activities of osteoblasts  and osteoclasts determines the phenotype of metastatic bone lesions, and both osteoblasts and osteoclasts have been implicated — directly or indirectly — in bone metastasis.  Metastases from prostate cancer, most of which are adenocarcinomas, nearly always form osteoblastic lesions in bone; by contrast, bone metastases from kidney, lung or breast cancers more often are osteolytic. This is 61 year old male known case of ca prostate with extensive osteoblastic secondaries seen in plain film and CT sections clearly.  Other causes of osteoblastic secondaries are breast, stomach, carcinoid, TCC bladder.

Chronic Trauma with Diffuse Axonal Injury-MRI

During the chronic stage of traumatic brain injury, T2*-weighted gradient-echo imaging at high field strength is superior to T1- and T2-weighted MR imaging in the detection of lesions suspicious of diffuse axonal injury. Based on the signal intensity characteristics on T2*-weighted gradient-echo images, most of these lesions are hemorrhagic.

 This is young male patient with old history of RTA and persitent vegetative state. GRE images shows punctate blood products in the bifrontal and left temporal white matter. Focal bleed is also noted in the rostral midbrain and superior cerebellar peduncle, along with cerebellum. Findings in his clinical setting are consistent with diffuse axonal injury.

Who earns from Radiology more?

This question is often asked in the radiology circles these days. Is it true that non-radiologists are earning more from radiology than radiologists themselves? Answer to this unfortunately, is true for India atleast. Diagnostics forms a major cash cow in the healthcare industry.  Diagnostic centres,  along with pathology labs is usually regarded as one of the cleaner business in healthcare. No surgeries, negligible mortalities further add to the charm of this business.  This would have made most of the radiologists millionaires in India, however, truth is to the contrary.  Leading business houses and investors like Ranbaxy, Piramal, and even Lal Pathology labs have been attracted to this segment in recent past.  Radiologist owned centres are getting fewer by the day.  We need more entrepreneur radiologists in India to prevent radiology to be totally taken over by businessmen like hospitals and corporate have taken over nursing homes and small time clinics. Another factor that is eating into radiologists money is incentives offered to the referring physicians, which are particularly higher in Northen India segment.  If these things are not taken into account and younger enterprising radiologists don’t come forward to keep control of this business, it will be difficult to  remain biggest shareholder in the diagnostics business. 

AIPG 2011 Radiology Recall Questions

Aortic knuckle shadow on PA CXR, obliterated by consolidation of which portion of lung?
upper lingula 
lower lingula 
apex of lower lobe 
posterior part of upper lobe

Answer- Posterior part of upper lobe.

CT least accurate for: 
a. 1 cm of aneurysm in hepatic artery 
b.1 cm of lymph node in para-aortic region
c.1 cm of pancreas mass in tail
d. 1cm gall stone

answer-d) 1cm gall stones

Dose of radiation reqd for haematological syndrome: 
a. 2.5 cGY 
b. 10 cgy 
c. 100 cgy 
d. 200 cgy

Answer- 100cGy

Best investigation for bone metastases:
a.MRI 
b.CT 
c.bone scan 
d. x ray

Answer- c) Bone scan

Answers by Delhi Academy of Medical Sciences (P) Ltd

Quiapo Procession of the Nuestro Padre Jesus Nazareno 2011

A partial movie clip of the more than 1 million devotees who flocked to Quiapo yesterday January 9, 2011 for the 404th Feast Day of the Nuestro Padre Jesus Nazareno. Despite all the frenzy and the shouting, no one is fighting here. Everyone just wanted to touch the Nazareno or the rope that is pulling the carossa.Hundreds were injured though while trying to jockey for position.

A Blind Singer at Quiapo Nazareno Fiesta 2011

A blind man with a beautiful voice serenading the devotees at the Quiapo Fiesta, while waiting for the procession on January 9, 2011.

NAG-IISANG IKAW

Lyrics by Louie Heredia

Araw-araw na lang
Ay naghihintay sa 'yo
Nananabik na mahagkan at mayakap ka
Iniwan mong alaala
Ang s'yang lagi kong kasama
Bakit kapag wala ka
Sadya bang kulang pa

Bakit kaya gano'n
Ang s'yang nadarama
Sa bawat sandali hanap ka ng aking mata
Marahil ay ikaw na nga
Sa akin puso ang ligaya
Dahil sa 'yo ako'y wala nang hahanapin pa

Ikaw ang pag-ibig ko
Ang tawag ng damdamin
Ang mabuhay nang wala ka
Ay hindi sapat
Dahil kailangan ko
Ay laging ikaw
Nasa t'wina'y nagtatanaw
Sa aking puso'y may tinatangi
Ang nag-iisang ikaw

Bakit kaya gano'n
Ang s'yang nadarama
Sa bawat sandali hanap ka ng aking mata
Marahil ay ikaw na nga
Sa akin puso ang ligaya
Dahil sa 'yo ako'y wala nang hahanapin pa

Ikaw ang pag-ibig ko
Ang tawag ng damdamin
Ang mabuhay nang wala ka
Ay hindi sapat
Dahil kailangan ko
Ay laging ikaw
Nasa t'wina'y nagtatanaw
Sa aking puso'y may tinatangi
Ang nag-iisang ikaw

Kahit na ano'ng mangyari
Magmamahal pa rin sa yo
At ang lagi kong iisipin
Mahal mo rin ako

Ikaw ang pag-ibig ko
Ang tawag ng damdamin
Ang mabuhay nang wala ka
Ay hindi sapat
Dahil kailangan ko
Ay laging ikaw
Nasa t'wina'y nagtatanaw
Sa aking puso'y may tinatangi
Ang nag-iisang ikaw

Carpal Tunnel Lipoma-MRI

There is evidence of mixed signal intensity oblong lesion with fatty and low signal intensity areas in the carpal tunnel with bulging of the flexor retinaculum. Differentials include perineural lipomatous lesion of the median nerve. This is a 25 year old female patient.

Optic Neuritis-MRI

Optic neuritis is defined as inflammation of the optic nerve. It is one of the causes of acute loss of vision associated with pain. Optic neuritis can be the initial episode for a patient who will subsequently develop multiple sclerosis.  Thin fat-suppressed T2-weighted images, such as short tau inversion recovery sequences, through the optic nerves may show characteristic high-signal intensity foci in the minimally or nonexpanded nerve. These lesions frequently enhance following intravenous contrast administration, which is not seen in a healthy optic nerve.  In our case DWI was also used which shows expanded left optic nerve with bright signal on DWI and enhancement on CEMRI. In this patient MRI brain had no evidence of MS.

The Senyor Nazareno: Lord of Quiapo

When I was a small boy, I always knew the Pista ng Quiapo was drawing near whenever I saw colorful buntings and banners being hung around the streets of downtown Manila. Back then, I was afraid of the Pista ng Quiapo because that meant my father would hold me aloft once more amidst the line of supplicants in Quiapo Church -- for me to touch the statue of the Nuestro Padre Jesus Nazareno, a statue that frightened me because of its bloody face and black skin.

Afterwards, we would line up once more, this time to kiss the foot of the huge Santo Entierro, the Dead Christ, inside his glass coffin. You can just imagine how scared I was at that time. In fact, big statues of saints always gave me the creeps, and we have a few of those in our devoutly Catholic home prominently displayed in the huge altar of our living room. I thought that the mannequins always looked at me straight in the eye, and I imagined them moving during midnight hours.

The 9^th of January is the Feast Day of the Nuestro Padre Jesus Nazareno, the grandest fiesta in all of Manila. On this day, tens of thousands of barefooted devotees flock to Quiapo to pay homage to the Senyor Nazareno, the Black Christ and the Lord of Downtown. For several years, I have been one of the multitudes who participate in the grand procession of the Senyor Nazareno.

The ultimate task of the devotee is to climb the carossa which bears the Senyor Nazareno, and to touch the statue with hand and towel while asking the Senyor to grant his fervent wish. It is a formidable undertaking as there are the other thousands bent to do the same. The strategy is to jockey for position, elbow and squeeze your way through the humongous crowd, and then with sheer muscle and brawn muster your acrobatic skills to swim on top of a sea of people in order to climb the carrosa.

Not everyone can do this stunt successfully. There were many in the past who got trampled and either injured or killed in the stampede. Those who lacked the daring and the physical agility, and who do not have the desire to be injured or killed, have to be contented to throw their shirts and towels to the guardians surrounding the Senyor Nazareno, the Hijos del Nazareno, who will wipe it for them on the Nazareno’s sacrosanct image.

The frenzy surrounding the procession lies in the supplicants’ belief that the statue of the Senyor Nazareno is miraculous. Many people believe that if they do a panata (vow) to follow the procession every January 9 for an exact number of years, the Senyor Nazareno will repay their devotion by granting whatever wish they have, be it material or spiritual.

Stories of people whose wishes have been granted by the Senyor abound. There was, for instance, the story of Aling Norma Lapuz, who suffered from brain cancer and decided to fight her way to touch the Black Nazarene during the 2007 procession. She was successful, thanks tothe help of the macho men who carried her aloft while the Senyor paraded in front of her. Afterwards she went to have a brain scan, and lo and behold, the tumor was gone—to the amazement of her doctors. Aling Norma attributes the miracle to the Senyor Nazareno.

There is also the story of Mr. Antonio Lucio who won in the Sweepstakes after following the procession for exactly nine years of devotion. The prize money made him a multi-millionaire, and of course, he attributes his great luck to the blessings of the Senyor Nazareno. In gratitude, he made huge donations to the Quiapo Church and ordered new robes for the Senyor. He also became one of the huge money contributors to the Comite de Festejos whenever the Pista ng Poong Nazareno approaches.

And, of course, there is the unforgettable story of a radio announcer who became Vice President of the Philippines because he vowed to follow the procession every January 9 of his life. Up to now that he is back to radio and television, he continues his panata to follow the Senyor Nazareno’s procession.

But there are also those whose wishes have not come true—yet, but who believe, in time, the Senyor Nazareno will grant these. After all, the Senyor Nazareno knows their sufferings and will, if they are steadfast in their devotion, sooner or later grant their heart's desire.

Aling Leticia Mendoza, 54 years old, has been following the procession of the Senyor Nazareno ever since she arrived in Quiapo some 12 years before. Born in Samar, she made it a vow to follow the Senyor Nazareno. Now paralyzed with stroke, she doubled her efforts to please the Senyor, going to church every Friday in a wheelchair, begging the Senyor to heal her. But her condition is no better. She believes, however, that the Lord will answer her prayer soon. “I have faith in the Senyor Nazareno. Even to the last breath I will follow the Senyor,” she insists.

My late maternal grandmother was not a Quiapo devotee, but in August 1944, she suddenly became one. Her husband and my Lolo, Alfredo Santos, a guerilla, was captured by the Japanese Army. Rumor had it that he was executed by the Japanese for his resistance to the invaders. My Lola went to Quiapo Church and knelt all day and night by the altar, asking the Senyor to bring her husband back. But my Lolo never came back. Of course my Lola never blamed the Senyor, but she was angry with the Japanese all her life.

The veneration of statues as true representations of God and saints is a long and deep-seated tradition of the Roman Catholic Church. Through the centuries, the Roman Catholics have created many different versions of statues for one saint. The Virgin Mary, for instance, has various representations. In the Philippines alone, she is variously depicted as the Lady of Penafrancia in Naga, the Lady of Peace and Good Voyage in Antipolo, the Lady of Manaoag in Pangasinan, and so on.

The same thing goes for the Roman Catholics' devotion to the Lord Jesus Christ. He is variously depicted in statues as a sleeping baby (Santo Nino Dormido), as a young boy (Senyor Santo Nino), or as the suffering Christ (Senyor Nazareno). The Senyor Nazareno is depicted in four different statues inside the Quiapo Church alone. The most famous one, of course, is the genuflecting, bleeding Christ in maroon-colored robe carrying a huge cross—its head with a crown of thorns and a diadem forming three golden rays. The three other statues depict the Senyor Nazareno as the crucified Christ, the Santo Entierro (dead Christ), and finally, the triumphant resurrected Christ.

Devotees from all walks of life spend enormous time and energy to queue every Friday to touch the Senyor Nazareno statues so that they may be blessed. Many small children, however, are quite afraid of the Senyor Nazareno statues, especially the Santo Entierro-- the statue of the dead Christ lying inside the glass coffin.

The veneration of the Senyor Nazareno in Quiapo started in the 17^th century when the Augustinian Recollects brought its image to the Philippines. According to legend, the original statue was carved by an Aztec sculptor and, when it was brought to the Philippines in 1606 by way of the Pacific Ocean, the galleon that carried it caught fire, charring the statue and rendering its color black. The statue was initially enshrined in the first Recollect church in Bagumbayan (now part of Luneta Park). That is why the statue is being paraded from Quiapo to Luneta, and then back to Quiapo. Between 1767 and 1790, the Archbishop of Manila, Basilio Sancho de Santas Justa y Rufina, ordered the transfer of the Black Nazarene to its present location inside the Quiapo Church.

*This article was originally published at the Philippine Online Chronicles, now one of the world's leading news and article magazines in the web. For other more interesting articles log on to Thepoc.net here.

Schizophrenia with Arachnoid cyst-Doubtful Association

This is 45 year old male with schizophrenia and reveals prominent anterior temporal CSF space which may indicate arachnoid cyst along with  asymmetric atrophy of the temporal lobes. It is difficult to tell whether the lesion was innocent or not regarding this patient's overall psychiatric picture.  Although, literature review has revealed some cases of arachnoid cyst associated with psychosis.

" Arachnoid cysts are rare, benign space-occupying lesions formed by an arachnoid membrane containing cerebrospinal fluid (CSF). In most cases they are diagnosed by accident. Until recently, the coexistence of arachnoid cysts with psychiatric disturbances had not been closely covered in the literature. However, the appearance of some references that focus on a possible link between arachnoid cysts and psychotic symptoms has increased the interest in this subject and raised questions about the etiopathogeny and the therapeutic approach involved." [2]

"Studies have demonstrated various other structural abnormalities. Most studies do not find abnormalities of whole brain/intracranial contents, while lateral ventricle & third ventricle enlargement is frequently reported. The temporal lobe was the brain parenchymal region with the most consistently documented abnormalities. Volume decreases especially involving the superior temporal gyrus. About two thirds of the studies of subcortical structures of thalamus, corpus callosum and basal ganglia show positive findings, as do almost all studies of cavum septi pellucidi (CSP). " [1]

Reference --

1. Biol Psychiatry. 1999 May 1;45(9):1099-119. MRI anatomy of schizophrenia.
2. Arachnoid cyst in a patient with psychosis: Case report. Annals of General Psychiatry 2007, 6:16

Rheumatoid Arthritis- Hip

There is marrow edema and synovial collection involving the right hip in a 70 year old female. Pathological examination of the surgery specimens revealed significant synovial hypertrophy and diagnosis of Rheumatoid arthritis was made.

Ulnar Variance

A short ulna, or minus ulnar variance, leads to increased application of force to the radial side of the wrist and to the lunate bone, which may underlie the association of negative ulnar variance and Kienbocks disease. This is a case showing short ulna or negative ulnar variance.  On the other hand, long ulna, or positive ulnar variance, causes the ulnar impaction syndrome.