Say It Ain't So Bob!

It's Halloween time again.....woo hoo....For those of you who won't be seeing Noah tonight, he's going to be Pablo from the Backyardigans. I'll try to post some pictures tomorrow.


If you haven't seen "Balloon Manor", go check it out...They used over 100,000 balloons to make this Halloween house. Take the interactive tour too... It's kind of fun...

Balloon Manor

Also....if you enjoy games....try this dark M & M's game...You can save your progress and finish later if you want. It's full of pictures depicting horror movie titles.

M and M's Dark Chocolate Game

Bob Barker is retiring after 35 years as the host of the "Price Is Right", and 50 total years on television! At 83 years old, he looks like a young 78 year old! Apparently they've been looking for his replacement for the last couple of years. When interviewed, he creepily and funnily said "he'd take on a movie role if the right one came along, but filmmakers, take note: "I refuse to do nude scenes. These Hollywood producers want to capitalize on my obvious sexuality, but I don't want to be just another beautiful body." Well, at least your pets are spayed and neutered....

I've got to go get Noah and Colleen, so I'll leave you with one final, and probably the best link of the day. This video completely mesmerized me for two minutes...

St. Louis

Woo hoo....I'm back from New York! I was flown to New York City to be an alternate in the AOL Goldrush Game. I got to sit in my hotel room while the three finalists got to compete in Trump Tower, and then on the Early Show. Oh well, I'll try again for the million dollar round, and I did win one of these really cool $600.00 gold coins!

A lot of my blog readers are from Maryland....Let's see how well you know your home state.....What is the official sport of Maryland? The answer is coming up....

The St. Louis Cardinals recently beat the Detroit Tigers in the 2006 World Series. I, along with most everybody else in the country, paid no attention to the series, however, some interesting nuggets of information have risen to the surface.

David Eckstein, shortstop for the St. Louis Cardinals, and the 2006 World Series' Most Valuable Player, now has two world series rings. He was also on the Anaheim Angels in 2002 when they had their amazing world series run. So not only does he have two rings from two different teams in two different leagues, he set a new record this week. At 5'7" tall, David Eckstein is the shortest World Series MVP ever!

The other tid bit of information? St. Louis was recently designated as the country's most dangerous city.

Ok all you Marylanders....I hope you all knew that the state sport of Maryland is jousting!

Consumers Dont Check the Source & Date of Health Information Online

Online Health Search 2006 reveals some surprising but predicatble results.

"Most internet users start at a search engine when looking for health information online. Very few check the source and date of the information they find. "

Full Report on Pew Internet

Calbayog City: A Glimpse of Rural Town

Calbayog is a very small city located in the coast of northwestern Samar. I have fallen in love with this small town because of its people and its beauty. During my frequent visits to Calbayog, I always bring along my camera for wanting to share with you how in a far corner of the Philippines live a precious little town with its lovely and hospitable people. I have fallen in love with one of their kind, and feel blessed that I do. When I grow old, I'd like to build a little house on a hill overlooking one of the lovely beaches in Calbayog. Then I'd spend the rest of my days looking at those lovely seas, to wonder at the beautiful sunset while waiting for the herald of the moonlit bay.

Calbayog City at early morning, seen from a distance while I was riding in one of the bancas.

A typical morning scenery at Calbayog Port

The street musicians of Calbayog. A few coins will be very much appreciated.

Roadside cafe near the Calbayog Port. Isn't this scene lovely? You can order brewed native coffee for 8 pesos and a freshly baked suman for 5pesos.

One of the old houses in the city. Calbayog is still filled with century old houses like this. In the upper floor still live the owner of the house, while the lower floor has been converted to accomodate modern amenities like internet cafes, or beauty parlors.

This is the road that will take you to the deep villages in Calbayog.

One of the main roads. As you can see, automobiles are still rare in Calbayog. It is really a small city so most residents prefer to ride in the trikes to go around the city.

Dusk at Maharlika Hi-Way, Calbayog City. This is the main road of Calbayog City(now renamed Avelino Street).

Calbayog is a very clean city. Now you know why. (Translation of the sign: Anyone who will throw garbage is dead). Hehehe.

NIGHT SCENES

Dusk at Calbayog Market

Carlos and Carmelo's Burger and Pizza, one of my favorite dining places in Calbayog City.

A trycicle is needed if you want to go to the deep villages in Calbayog. These local taxis can carry some eight people and charges 10 pesos.

Along Nijaga Street in Calbayog.

Popcorn stall near Navarro Street.

The refreshment seller. The mango juice is 5 pesos per plastic cup.

Trike Terminal. Each ride around the city is 5 pesos. Believe it or not!

Along J.D. Avelino Street

Riding the trike around the city is one great experience. I don't understand Waray language, but the Warays understand Tagalog, so no problem! I just tell my trike driver,"Ipasyal mo ko sa buong Calbayog". Off we go!

Going home and buying for pasalubong of "Lechon Manok".

Radiology Grand Rounds-V

Welcome to the Fifth Edition of the monthly summary of the best in the Radiology Blogsosphere known as “ Radiology Grand Rounds”. Grand Rounds is an old tradition that doctors have. Once a week, they get together and talk about one case in detail. Keeping up with this tradition this Carnival of Medical Imaging has been named “Radiology Grand Rounds”. Every physician would agree that Subspecializtion is the need of the hour in medical field, hence the concept of a specialized Radiology Grand Rounds. Radiology Grand Rounds will be hosted on last Sunday of each month, the schedule and archive will be available at- Radiology Grand Rounds. I would like to thank all the contributors for this edition of Radiology Grand Rounds.

This Edition I will start with a tribute to the person responsible for the discovery of the science of Radiology Or X-Rays and the story associated with the X-ray discovery.

The Beginning Of The Science Of Radiology




"On the evening of November 8, 1895, Wilhelm Conrad Röntgen found that, if the discharge tube is enclosed in a sealed, thick black carton to exclude all light, and if he worked in a dark room, a paper plate covered on one side with barium platinocyanide placed in the path of the rays became fluorescent even when it was as far as two metres from the discharge tube. During subsequent experiments he found that objects of different thicknesses interposed in the path of the rays showed variable transparency to them when recorded on a photographic plate. When he immobilised for some moments the hand of his wife in the path of the rays over a photographic plate, he observed after development of the plate an image of his wife's hand which showed the shadows thrown by the bones of her hand and that of a ring she was wearing, surrounded by the penumbra of the flesh, which was more permeable to the rays and therefore threw a fainter shadow. This was the first "röntgenogram" ever taken. In further experiments, Röntgen showed that the new rays are produced by the impact of cathode rays on a material object. Because their nature was then unknown, he gave them the name X-rays."
Reference- Nobelprize.org

Patient Information

Dr. Kavokin presents Patient Information on Medical Imaging technique known as Ultrasound followed by a Quiz.

"Let's say you have a belly pain. Did you ever get it?Let's say this time the pain is really unbearable. What will you do? Where would you go? You should rush to a doctor.When you arrive to ER, doctor asks you lots of questions. How bad is pain, where is it located, where does it refer (go)? Any nausea, vomiting, defecation problems and so on. He will also ask about your history. Then he looks up for your past problems in your written history or history stored on computer.He will listen your lungs, palpate your belly, sometime even causing more pain by touching. Eventually he suspects a disease and confirms it with some type of the tests. What tests will he choose? There will be blood work, urinalysis and some other analysis.Eventually you will probably go into the radiology department to get some imaging test. Abdominal US"


Featured Cases

Mikhail Serebrennik of Filmjacket.com has submitted this case. Its Scary for Sure!

Case Details-One (relatively senior!) surgical resident at our hospital, who no longer works here, has punctured the left chest wall with a trochar in an attempt to place a left thoracic pigtail drainage catheter. You can be the judge of the resulting situation. The chest tube ended up in the left ventricle!

Bhavin's Blog Features an interesting case of Subependymal heterotopia

The MRI images show a smooth, nodular area, isointense to grey matter, on all pulse sequences, along the margin of the atrium of the right lateral ventricle.

Hot Discussion Topics From Sumer's Radiology Site
(comments and suggestions on each topic are welcome)




Seems like Canada is also looking towards Teleradiology

Will Radiologists Keep Control Over Ultrasound?

Medical Tourism

Radiologists Shortage

Who should read a Coronary CT angiogram?



What is New In the Top Radiology Journals





Am J Roentgenol

Clinical Radiology

Radiographics

Radiology

Film Jacket.com now offers New Radiology Video Database - the Video Jacket.

That wraps up this month's highlights of the Radiology blogosphere. Hope the readers enjoyed the Fifth edition of the Radiology Grand Rounds. If you liked any of these blogs, keep visiting them. Please email me at sumerdoc@yahoo.com if you are interested in hosting future Radiology Grand Rounds. Archive for the Radiology Grand Rounds here-Radiology Grand Rounds. Be sure to tune in Next Month Last Sunday 26th November, when Grand Rounds will be hosted at- Spot Diagnosis Send the Submissions to- bhavin@jankharia.com

Now You Can Control MRI Over The Internet

Software, developed by UCLA radiologists and Siemens Medical Solutions, has been shown to be quite capable in helping to control MRIs remotely and to deliver high quality images to a clinician's home or call room.

Full Text-UCLA News

Hat Tip- Medgadget

Facial nerve schwannoma

Findings

Figure 1: An axial CT image in bone windows demonstrates enlargement of the left labyrinthine, geniculate ganglion, and anterior tympanic segments of the facial nerve by a soft tissue mass.
Figure 2: A coronal CT image in bone windows also shows bony expansion in the course of the left facial nerve.
Figure 3: A coronal CT image in soft tissue windows shows that there is an ovoid soft tissue mass within the geniculate fossa.
Figure 4 (T1 axial), Figure 5 (T1 axial postgadolinium) and Figure 6 (T1 coronal postgadolinium) thin slice MR images through the internal auditory canals demonstrate a tubular soft tissue mass in the geniculate fossa. Following the administration of intravenous gadolinium, this mass demonstrates avid homogenous enhancement (Figure 5).


Diagnosis: Facial nerve schwannoma


Facial nerve schwannomas (also called facial nerve neuromas) are rare benign tumors of the Schwann cells of the seventh cranial nerve. They may arise along any portion of the facial nerve, including within the internal auditory canal, the labyrinthine portion, the tympanic portion, the mastoid portion, or within the parotid gland. However, the most common location for a facial nerve schwannoma is the geniculate ganglion. Patients present most frequently with hearing loss (70%) and with slowly progressive facial nerve paralysis (50%). These lesions are slow growing, but eventually most will enlarge and cause hearing loss. The treatment may be conservative if the schwannoma is asymptomatic; these lesions may be followed until symptoms develop. Surgical treatment is also an option, with the aim being preservation of facial nerve function if possible, and facial nerve grafting if necessary. The mean patient age at presentation is 35 years. If multiple schwannomas are present, the diagnosis of neurofibromatosis type II may be considered.

Imaging of facial nerve schwannomas includes both MRI and CT. On noncontrast temporal bone CT, the findings include a tubular soft tissue mass along the course of the facial nerve with enlargement of the facial nerve canal. The bony margins are usually smooth and benign-appearing. On MRI, these lesions have intermediate to low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging. Following the administration of intravenous gadolinium, facial nerve schwannomas enhance homogenously. The differential diagnosis includes normal intratemporal facial nerve enhancement, Bell's palsy, facial nerve hemangioma, and facial nerve perineural parotid malignancy. Based on clinical presentation, facial nerve schwannoma can be distinguished from Bell's palsy and a hemangioma by a more gradual onset of facial nerve paralysis vs an acute onset in these other entities. Normal facial nerve enhancement is asymptomatic, and facial nerve perineural parotid malignancy is associated with a known or recurrent parotid gland malignancy. Depending on the location, facial nerve schwannomas may be indistinguishable from vestibular schwannomas in the internal auditory canal or glomus tumors within the tympanic cavity.

Spinal cord injury without radiographic abnormality (SCIWORA)

History: A 2-year-old girl presents to the emergency department status post motor vehicle collision. She was restrained appropriately in a car seat and has no obvious injury on initial exam. CTs of the head, cervical spine, chest, abdomen, and pelvis were performed. The initial CT exams demonstrated a minimally displaced iliac wing fracture, but were otherwise normal. A detailed neurological examination of the patient revealed bilateral lower extremity paralysis and sensory deficit. The head and neck CT scan was negative.


Findings

Figure 1: The sagittal T2 weighted image shows an interruption in the cord below the cervicothoracic junction with edema extending above and below the level of transection.


Diagnosis: Spinal cord injury without radiographic abnormality (SCIWORA)


SCIWORA was initially described as a distinct disease in 1982, when MRI was not routinely utilized in evaluation of spinal cord injury (SCI). Pang and Pollack’s criteria for SCIWORA are: objective, posttraumatic myelopathy without vertebral subluxation or fracture as seen on plain x-ray films. Typically, there is no identifiable c-spine injury on CT imaging as well. In patients older than 16, SCI is usually associated with vertebral fracture. From infancy to age 16, SCI injury is rare, but frequently occurs without vertebral trauma. Outcomes are typically poorer with children under 8.

The phenomenon is thought to be related to weaker paraspinal muscle control, larger relative head size, and a more horizontal positioning of the facets in children. Also, in the thoracolumbar spine, there is a mismatch in the elasticity of the tissue comprising the spinal column vs the elasticity of the cord itself; the former can endure much greater distraction than the latter.

Currently with MRI, we are able to image the cord pathology in SCIWORA. Several different injury patterns are recognized on MR imaging: transection, contusive hemorrhage, traumatic edema, and concussion. Transection is seen as a complete disruption in the cord. Contusive hemorrhage and traumatic edema appear as focal, intramedullary signal abnormalities. Concussion is diagnosed when the cord appears normal or if there is equivocal, intramedullary, heterogeneous T2 signal corresponding to the level of clinical deficit. The severity of injury depicted on MRI correlates with long-term neurologic dysfunction with transection corresponding to complete and permanent deficit, and concussion corresponding to complete neurologic recovery.

Will Radiologists Keep Control Over Ultrasound?

Diagnsotic Imaging Online talks about The seminar, Strategic Planning for the Future of Ultrasound in Radiology, took place at the 2006 Society of Radiologists in Ultrasound meeting in San Francisco.

Radiologists pledge to recapture sonography

"Going from gloom to bloom at a seminar yesterday, radiology luminaries dissected the latest practice trends, technological developments, and clinical applications in ultrasound use and turf. Their conclusions, to be published in a major radiology journal, should indicate if radiologists will choose to relinquish control of ultrasound for good or reclaim a modality that could thrive in the hands of experts through the next decade.

The shortage of radiologists, an obesity epidemic that curtails ultrasound's utility, a payment system that excessively rewards CT and MRI, and the multislice CT revolution may have facilitated the migration of ultrasound to other specialties. Cronan recently wrote an editorial expanding on these and other related issues (JACR 2006 Sept. 3;[9]:645-646). "

Everybody Loves Peter

Peter Boyle, best known for his role as Frank Barone in the "Everybody Loves Raymond" television show, recently enjoyed a birthday. Did you know that in 1990, Peter suffered a stroke and was unable to talk for 6 months? Ok, trivia question of the day.....Who was the best man at Peter Boyle's wedding to Loraine Alterman, his wife of 29 years?

Well, Jerry and I visited a corn maze is Los Angeles this weekend. Between getting lost, traffic, and not being able to find a gas station in Orange County, it took us about 3 hours to get to the stupid maze. We entered the haunted corn maze behind a group of five teenagers.... The actors would jump out at the teenagers, they would scream and let Jerry and I know that the guy was around the corner. It took all the fun out of the maze. However, if any of those teenage boys in front of us read my blog....you looked really cool when you screamed like girls whenever somebody jumped out of the corn. What made the night fun was watching one of the teenage gentlemen, scared by one of the actors, run backwards and fall on his ass.... Good times.

Interesting news story today....Mr. Lawrence Roach had been married for 18 years when his wife decided that she wanted to have a sex change. So, his wife left him, changed her sex on her driver's license and has been living as a man since she left in preparation for her sex change surgery. Mr. Roach now has $1,200.00 taken out of his paycheck every month to pay his wife alimony. So, unless his ex-wife, ex-husband, whatever you want to call her or him, gets remarried, he has to pay her $1,200.00 a month for the rest of her life.

To answer the question above, "The Beatles" John Lennon was best man at Peter Boyle wedding. Peter's wife was a reporter for "Rolling Stone", when she met and became good friends with Yoko Ono. Through that relationship, Peter met and became best friends with Mr. Lennon.

The Funniest Joke In The World!

Scientists in London have tested over 40,000 jokes and have found what apparently is the world's funniest joke...

"A couple of New Jersey hunters are out in the woods when one of them falls to the ground. He doesn't seem to be breathing; his eyes are rolled back in his head.

The other guy whips out his cell phone and calls 911. He gasps to the operator, "My friend is dead! What can I do?" The operator, in a calm, soothing voice, says, "Just take it easy. I can help. First, make sure he's dead." There is silence, then a gunshot is heard. The guy's voice comes back on the line. He says, "Okay, now what?"

What is your funniest joke?

Recent Manila Snapshots

One of my favorite pastimes is to walk on late afternoons in downtown Manila. It's fun, it's a good exercise. Usually, I just walk where my feet would bring me.
From a recent walk in downtown, here's some photos I captured with my new camera Nikon D80 and my favorite lens the Sigma 14mm. Kindly click on each picture to enlarge.

The old Post Office Building in Lawton


The side of the Post Office

Shanty rooftops..this was taken from above the Recto Terminal LRT Station.

The Jones Bridge over the Pasig River

The Oracles of Quiapo
The Blind Musicians of Avenida

The Dama Players

The Candle Sellers of Quiapo

The sidewalk masseuses in Quiapo


Calesa Terminal in Dasmarinas St., Binondo


The old Binondo Church