New Year's Eve: December 31, 2006

Small firecrackers that I will use tonight to celebrate the New Year. I'm afraid of the big ones, such as 5-star or Super Lolo, and I don't want to be a statistic in this year's firecrackers victims who lost a finger or two. When I was a kid, I used to buy Watusi during New year's eve but it is now banned because it was found to be poisonous.

Last minute shoppers at New Year's Eve in Avenida Rizal. Everyone wants to have some nice Media Noche, to celebrate the coming 2007 year.

A stall where you can buy "Good Luck" items for 2007.

New Year's Eve or not, this man will sell his candies and cigarettes

This is the stall where I bought my miniature firecrackers

Celebration of New Year will not be complete without the traditional and harmless Torotot!

Torotot Vendors. 10 pesos for small torotot, and 20 pesos for the big one, which also doubles as a funny hat.

More firecrackers and fireworks for sale!

More torotots and masks!

Filipinos believe that round objects bring good luck to the coming new year, so round fruits are very popular, as additional "handa" in the Media Noche. These fruits are locally known as Chico

Mangosteens!

Dalanghita! A Philippine version of Oranges

Chestnuts roasting on an open fire.

HAPPY NEW YEAR TO ALL!

Kastanyas na bagong luto. Masarap, malinamnam, at mahal!

Marca Pina Keso de Bola

Hamon Excelente sa Quiapo

Siksikan ang mga tao dahil paborito nila lahat ang hamon dito. Hindi namn magkanda-ugaga sa pagtitinda ang mga tindera.

Masarap na Hamon Excelente. Maniwala kayo, isang binti ng hamon ay nagkakahalaga ng humigit-kumulang sa isang libo limang daan, depende sa laki. Sulit naman sa palagay ko dahil masarap talaga!

Globe Lumpia House sa Raon, Quiapo. Masarap ang sariwang lumpia dito na nagkakahalaga ng dies y sais pesos bawat isa.

Siyempre nagsimba muna ako sa Quiapo upang humingi ng pagpapala sa paparating na taong 2007

"La Sonrisa" o Kalendariong Tagalog sa taong 2007. Ito ang tunay na Almanak Pilipino na ginawa ng aking lolo sa tuhod na si Don Honorio Lopez. Unang inilimbag ang kalendaryong ito noong taong 1898 at patuloy pa ring ipinalilimbag sa ngayon.

Radiology Grand Rounds VII Are Up

Radiology Grand Rounds VII are up at Filmjacket.com and look at the interesting images of MRCP showing biliary ascariasis and a quiz also showing a typical findings of a congenital abnormality. We have some new rad-blogs also submitting in edition...

Way to go....

The next edition will be hosted by me at Sumer's Radiology Site on last sunday of January

28-12-06, so send your submissions for the edition to me at sumerdoc-AT-yahoo-DOT-com

If you have a medical or radiology blog/site and wanting to be the host of the future editions feel free to contact me we are on a look out for future hosts.

Also, visit our sister concern at- Teleradiology Providers

Time for celebration-100,000 plus visitors

Sumer's Radiology Site, Top Radiology Magazine celebrates 100,000 plus visitors.

Thanks to all the visitors and readers for continued support.

Happy new year 2007 to all the visitors and donot forget to submit to the latest isssue of Radiology Grand Rounds coming up on 31-12-2006 on Filmjacket.com

Also visit our sister concern at Teleradiolgy Providers ,The Online Radiology Consult.

Web 2.0 and Medicine

Interesting article by Dean Giustini in BMJ
How Web 2.0 is changing medicine, BMJ 2006; 333: 1283-1284
[Full text]

"Few concepts in information technology create more confusion than Web 2.0. The truth is that Web 2.0 is a difficult term to define, even for web experts. Nebulous phrases like "the web as platform" and "architecture of participation" are often used to describe Web 2.0. Medical librarians suggest that rather than intrinsic benefits of the platform itself, it's the spirit of open sharing and collaboration that is paramount. The more we use, share, and exchange information on the web in a continual loop of analysis and refinement, the more open and creative the platform becomes; hence, the more useful it is in our work."

Read the response to the editor including mine-

Blogs and Radiologists
Sumer Kumar Sethi (28 December 2006)

Post radiation white matter injury. Metastatic disease to the calvarium.

Findings

Initial MRI of the brain shows numerous enhancing lesions scattered throughout the calvarium, consistent with metastatic bony involvement. There is also diffuse enhancement of the pachymeninges. There are no enhancing parenchymal lesions. Newer MRI of the brain shows confluent periventricular deep white matter FLAIR and T2 hyper intensities. There are no abnormal parenchymal lesions or enhancement. There is mild volume loss. There was no restricted diffusion (images not shown) to suggest infarct. Again seen are heterogeneous and enhancing calvarial lesions.

Differential diagnosis:
- Post radiation white matter disease
- Microvascular disease
- Age related white matter changes
- Tumor edema from metastatic or primary neoplasm
- Diffuse infectious process
- Diffuse inflammatory process


Diagnosis: Post radiation white matter injury. Metastatic disease to the calvarium.

Diagnosis is presumed based on this history: The patient has a history of widely metastatic breast cancer, with dural and calvarial involvement. The patient received chemotherapy and underwent whole brain radiotherapy. The white matter changes are nonspecific. However, given the history of radiotherapy, the abnormalities are likely sequelae of radiation treatment:


Key points - Radiation injury to the brain

Clinically:
- Many patients are asymptomatic
- Common complaints include confusion, personality changes, memory loss, and dementia
- Injury occurs in 38% to 50 % of patients after whole brain radiation
- Poor correlation of clinical symptoms with severity of imaging findings
- Amount of injury depends on dose and fractionation methods
- Latent period for appearance on injury on imaging is 6 to 8 months


Radiology

Changes of symmetric white matter injury
Periventricular white matter is particularly susceptible
Long term results is cerebral atrophy

CT:
- Confluent white matter hypo densities
- Usually no enhancement

MRI:
- More sensitive than CT
- T2 and FLAIR white matter prolongation
- Ranges from punctate periventricular foci to confluent changes extending from the ventricles to the corticomedullary junction
- May show ring enhancement if there is radionecrosis
- Usually no significant mass effect or enhancement

Septo-optic dysplasia/de Morsier's syndrome

Findings

Figure 1: Axial T2 image shows micro-ophthalmia with an irregular-appearing left globe, suggesting a colobomatous deformity.
Figure 2: Axial FLAIR shows absence of the septum pellucidum.
Figure 3: Coronal T1 postcontrast shows absence of the septum pellucidum, a “point-down” appearance to the inferior aspect of the frontal horns of the lateral ventricles.
Figure 4: Axial SPGR: Bilateral atretic optic nerves are seen.
Figure 5: Sagittal T1 FLAIR sequence shows atretic optic chiasm.


Diagnosis: Septo-optic dysplasia/de Morsier's syndrome


Septo-optic dysplasia is characterized by malformations of the optic nerves and tracts, pituitary deficiency, and absence of the septum pellucidum. A small pituitary gland is often identified with an ectopic posterior lobe. Embryologically, the disease is a disorder of midline prosencephalic development. There is secondary degeneration of optic nerve fibers due to cerebral lesions.

The epidemiology of the disease is 1:50,000, with the affected male:female ratio equal to 1. The genetic pattern of inheritance may be either autosomal dominant or recessive.

The most common signs and symptoms in newborns include: hypoglycemia, seizures, apnea, cyanosis, hypotonia, and prolonged conjugated jaundice. Multiple pituitary hormone deficiencies can lead to various presentations. For example, short stature may result from deficiency of growth hormone. Other corresponding endocrinopathies are seen, depending on which hormone is absent. Symptoms may also include color blindness, visual loss, nystagmus, strabismus, mental retardation, spasticity, microcephaly, and anosmia.

Septo-optic dysplasia is frequently associated with other cerebral anomalies. The most commonly associated entity is schizencephaly. Others include perisylvian cortical dysplasia, midline malformation (callosal dysgenesis), ocular malformation (coloboma, anopthalmia, micropthalmia), olfactory tract/bulb hypoplasia and hypoplasia, of the pituitary and olfactory lobes.

CT findings of septo-optic dysplasia include absent septum pellucidum, large lateral ventricles, and small bony optic foramina. MRI is the best imaging tool for diagnosis. Imaging in three planes is crucial to identify all findings. Coronal MRI images demonstrate absent septum pellucidum, flat roof of frontal horns, and a “point down” appearance of the inferior aspect of frontal horn. A small optic chiasm/nerve, thin pituitary stalk, and posterior pituitary ectopia can also be seen when fat saturation sequences are used. T1 postcontrast imaging demonstrates enhancement of infundibulum and an ectopic posterior pituitary lobe.

Differential diagnosis includes syndromes overlapping with septo-optic dysplasia, such as optic infundibulum dysplasia (OID) with schizencephaly but normal septum pallucidum, Kallmann's syndrome, and lobar holoprosencephaly.

Untreated septo-optic dysplasia can lead to hypothalamic and pituitary crisis or sudden death from hypocortisolism. Treatment of septo-optic dysplasia consists of hormonal replacement therapy.

DICOM email

Standardization of teleradiology using Dicom e-mail: recommendations of the German Radiology Society.

Saw this article in "European Radiology" Dicom email looks like a revolutionary idea..

Reference-Eur Radiol 2006 Mar;16(3):753-8. Epub 2005 Oct 15.

"Until recently there has been no standard for an interoperable and manufacturer-independent protocol for secure teleradiology connections. This was one of the main reasons for the limited use of teleradiology in Germany. Various teleradiology solutions have been developed in the past, but the vast majority have not been interoperable. Therefore an ad hoc teleradiology connection was impossible even between partners who were already equipped with teleradiology workstations. Based on the evaluation of vendor-independent protocols in recent years the IT Working Group (AGIT) of the German Radiology Society set up an initiative to standardize basic teleradiology. An e-mail based solution using the Dicom standard for e-mail attachments with additional encryption according to the OpenPGP standard was found to be the common denominator. This protocol is easy to implement and safe for personalized patient data and fulfills the legal requirements for teleradiology in Germany and other countries. The first version of the recommendation was presented at the 85th German Radiology Convention in 2004. Eight commercial and three open-source implementations of the protocol are currently available; the protocol is in daily use in over 50 hospitals and institutions."

"Teleradiology Providers"-Press Release

"Welcome to Teleradiology Providers the company that provides a complete radiology diagnostic support to your setup. As Teleradiology steps into it's infancy in India our company emerges as the pioneer in providing you the latest services at the best of costs.Teleradiology exploits the latest of technological advancements bringing radio diagnosis at your doorstep. It excels on simple principles of communication augmented by the latest and the most advanced image acquiring techniques. Teleradiology manages it's input resources from digital images acquired through CT scans, digital X-rays, MRI etc which are transferred to the radiologist through a secure web encrypted system. The radiologist then gives a report to the findings observed based on the quality of images and his expertise. Teleradiology aims at providing the radiological support that small setups require and also makes available the best of radiology expertise to apex institutes. Teleradiology is indeed the latest in what medical services can offer to your institute and your patients at very economical rates. Even if you are a radiologist with a extremely busy practice we offer service in form of preliminary reads (in places where licensing is a problem) and final reads. Every now and then you get a case where you want a second opinion, we are there to support you.

Teleradiology Providers is a web based consultancy service which aims at providing an accurate radiological diagnosis instantly and at very economical costs. We are a group of established radiologists practicing in Delhi with extensive experience in radiology, all modalities including CT, MRI, Ultrasound and Doppler. Our endeavor is to make available a highly accurate diagnosis through online consultancy to all practicing clinicians so that the patient management can be initiated promptly and with confidence. This means of online consultancy can also help you cut down the cost of patient care by providing the right and immediate diagnosis which is reached on to after a panel discussion by our team. Our Teleradiology practice provides a virtual dedicated radiology department for your setup available to you all time. Few of eminent Radiologists in our team include:

Dr. Lt Col(Retd) MGK Murthy
Dr. Sumer Sethi
Dr. Sunita Sangwan

ABOUT US-
CEO-DR SUMER K SETHI, MBBS, MD
WEBSITE- http://www.teleradproviders.com
Contact at-
sumerdoc@yahoo.com
sumerdoc@gmail.com
Phone- +91-9811181359"

Meningioma

Findings

CT Head demonstrates a calcified mass within the left frontal region with adjacent hyperostosis of the bone. MRI demonstrates an enhancing extra-axial dural-based mass over the left frontal lobe with minimal focal mass-effect on the adjacent cortex. No edema. There are associated dural tails and focal hyperostosis of the calvarium.


Diagnosis: Meningioma


Key poins

Nearly all meningiomas are benign, but that does not mean that they do not harm the patient. The tumors arise from arachnoid cap cells, which are cells of the meninges. Most meningiomas (90%) are categorized as benign tumors, with the remaining 10% being atypical or malignant. Meningiomas produce symptoms in many ways. They may irritate the underlying cortex, compress the brain or the cranial nerves, producing hyperostosis, invade the overlying soft tissues, or induce vascular injuries to the brain. The symptoms include seizures, headaches, and focal neurological defects, such as arm or leg weakness, or vision loss. Meningiomas may produce increased symptoms during pregnancy, but they often subside after the birth of the child.

Meningiomas are more common in females and more common in Africa. In the US they are responsible for about 20% of all primary intracranial neoplasms. The neoplasms are most often detected in middle age. Earlier detected meningiomas are often malignant. They are often associated with neurofibromatosis. Exposure to radiation has been found to be associated with a higher incidence of meningiomas. Meningiomas may occur intracranially or within the spinal canal.

Treatment options include surgery, radiation therapy, a combination of the two, or observation with periodic scans and examinations are then evaluated.


Radiology

Plain skull x-ray may reveal hyperostosis and increased vascular markings of the skull as well as intracranial calcifications.
On plain head CT scan, meningiomas are usually dural based, isodense to slightly hyperdense tumors. Homogenous and intense enhancement pattern. Perilesional edema may be present. Hyperostosis and calcification can be seen. They can have mass affect.
On MRI, the T1- and T2-weighted signals are variable. Giving contrast is key. Meningiomas enhance intensely and homogeneously after injection of gadolinium gadopentetate. Perilesional edema may be present. Enhancing dural tail is very helpful.

Endovascular angiography allows the surgeon to determine preoperatively the vascularization of the tumor and its encroachment on vital vascular structures. Angiography can be used to embolize feeding vessels prior to surgery. Blood supply is sunburst in appearance and is from external circulation.

Maligayang Pasko Mula sa Pilipinas!

At last, the long awaited Christmas is here! Merry Christmas to everyone and especially to all my fellow bloggers!

It had been a hectic week as I've tried to prepare for Christmas Day. As you may already have seen in my previous photos, I did some shopping for all my godchildren, nioeces, nephews, loved ones, and friends. At the end of it all, I was exhausted and depleted of cash!

But no big deal, as I've already prepared for a penniless Christmas...:)

Indeed, I agree with the general consensus that we need at least one more week to prepare for Christmas ( or at least to postpone it a week later)

A month before Christmas, my wife and I (with the help of our little daughter JM), decorated our house with Yuletide adoornments. I bought a small Christmas tree and fitted it with little angels and candies. I also hung a nice Parol in front of our house because nothing signifies Philippine Pasko better than a nice lighted Parol.

To keep the tradition going, I heard the customary Simbang Gabi mass at Quiapo starting December 16. It is something I always do every Christmas holiday. After hearing mass, I didn't forget to eat my favorite Bibingka and Puto Bumbong ...

The Bibingka is my favorite especially if it is freshly baked with butter and sliced salted egg on top. I used to dip my Bibingka into a hot tea and by Gad, that feels very delicious and refreshing at early morning!

Every night since December 16, little kids form themselves in front of my house, and with Tambols(made from empty Bonna Milk can) tambourines(made out of alambre and flattened tansans) and sing out-of-tune Christmas songs. I prepared small coins for them, hoping that 10 pesos would be enough...but I found that they come back every night....with the same Tambols and out-of-tune carols. Those kids!

I really miss being a kid during Christmas, though. I remember my Nanay bringing us all to Avenida Rizal to shop for new clothes. We used to shop in Good Earth, SM Carriedo, or Syvel's( now closed). Back then, I prefer Texwood jeans or Mr. Lee, while my older siblings prefer Levi's or Wrangler.

My Tatay worked abroad so he was almost never home during Christmas. Instead, he just sends a tape recording of his messages for us. Well, back then, with the absence of the internet, that's already high tech! (Now that he's retired, we all have our family reunion every Christmas, to make up for those earlier Christmas witout him)

Anyway, after shopping, Nanay would bring us to eat in either Panciteria Ramon Lee or Panciteria Manosa in Ongpin, where would order delicious Spiced Ham, Pancit, and Fried Chicken. Oh those were the good 'old days!

Now, it's already me guiding my kid in Avenida to shop and I felt the same responsibility of my loving parents towards me as a child back in the olden days. I accompanied my daughter to Avenida a few days ago to shop for her presents.
At age five, she just chooses the toys over the clothes. Good thing her mother already shopped for her new shoes and overalls. She chose a nice Barbie doll and Toy Kitchen set, which I approved.

I wanted to eat at Panciteria Ramon Lee but she refused...pointing instead to MacDonalds. Anyway, I just took out Pancit from Ramon Lee and proceeded to MacDonalds for my daughter's lunch. I almost failed to realize that kids nowadays indeed prefer fast foods and those that they see advertised on the television.

Before going home, I bought a whole leg of ham from Hamon Excellente in Quiapo. It was something that we always have at Noche Buena, and man, it's really delicious! I couldn't wait to go home to have it sliced and served to my family.

Before Noche Buena, the whole family went to Quiapo to hear mass. Afterwards, we proceeded home and partook of the traditional Noche Buena. I was glad to see some of my nieces and nephews arriving, as it had been quite sometime that we hadn't seen each other due to each's own work and busy schedule. It was a joyous feast as we exchanged gifts to one another.

Early morning as I was writing this, my inaanaks (godchildren) came to my house one by one. They didn't surprise me, though, as I've already prepared something for them. Good thing I encashed newly-printed 100 peso bills from the bank and I distributed it to them. After the last inaanak went out, I found that all my cash was gone!

Anyway..that's Christmas..a time of giving..a time of merriment for young children..and a time for penniless ninongs!

Mery Christmas to all!

Christmas in the Philippines (2)

Calle Raon is a busy street in downtown Manila, and more so during Christmas time, where everyone goes to shop for more affordable gifts to loved ones.

Cheap dvd players from China are very popular because most people can afford them. For as cheap as 1,200 pesos, one can already own a dvd player. Some have very unusual brand names: Suny(imitation of Sony), Sanyi(imitation of Sanyo), or Phelips (imitation of Philips). They work well, though...I have tried one and it works great...

...the dvd discs are very cheap,too...because they are just pirateds...the average price per disc is 35-50 pesos. I didn't want to patronize fake products so I just limited myself to buy only 20 pieces pirated dvds every week.

A tiangge stall in Avenida sells very affordable toys. For as cheap as 20 pesos, you can give a nice toy truck as Christmas gift to your beloved nephew, or a nice doll for a niece...won't you buy one for your inaanak also?

Bargain apparels are all over Avenida sidewalk...

The Parol is an obiquitous presence in many Filipino homes during Christmas holidays

Avenida Rizal is a haven for those wanting to have a nice afternoon stroll, or those hunting for any cheap buys..

A lovely Christmas store window display I found in one of Avenida Rizal's posh bazaars.

Shopping for Christmas gift wrappers along Avenida Rizal

Sidewalk Toy vendors in Plaza Miranda Quiapo. They sell lighted toys that kids go crazy about. I was a little crazy, too...so I bought one for myself for only 30 pesos(I'm actually giving it as gift to my daughter)

A Philippine Christmas is not complete without the delicious Puto Bumbong and Bibingka served after the Simbang Gabi.

Christmas in the Philippines

Avenida street scenery

Sidewalk grill in Avenida Rizal to accomodate late afternoon shoppers

Tiangges in Avenida are always a good source of cheap gifts for friends and inaanaks

Calle Raon near Quiapo

Ukay-ukay can be a haven for those who wish to wear DKNY or Versace but cannot afford to buy in the malls.

Simbang Gabi in Quiapo. This is the part of Manila that never sleeps.

Eating the traditional Puto Bumbong and Bibingka(matched with steaming hot tea) can be a very refreshing experiewnce after hearing mass at five in the morning.

Candle sellers in Quiapo.

Plaza Miranda after the Simbang Gabi in Quiapo. December 17, 2006.