The Ruby Tower Earthquake Memorial

Built in 1974, the Ruby Tower Memorial is dedicated to the Chinese-Filipinos who perished during the deadly August 2, 1968 earthquake that hit Manila. Two hundred and sixty people died during the collapse of the 6-story Ruby Tower, located near the corner of Teodora Alonso and Doroteo Jose streets in Sta. Cruz, Manila. The entire building, save for a portion of the first and second floors at its northern end, was destroyed. Allegations of poor design and construction, as well as use of low-quality building materials, arose.

The memorial is located just in the rear of the famous Lee See Tong Martyr's Hall inside the Manila Chinese Cemetery.




They all perished inside the collapsed tower. Witnesses said the condominium fell like a house of cards. Whole families, women, and many little children perished. For several days, rescuers can still hear voices coming from inside the rubble asking for help.


The history of the Ruby Tower disaster is sculpted in this marble memorial.



This last photo courtesy of Phivolcs.dost.gov.ph

The Uy de Tee Mausoleum

Another elegant Art Deco Mausoleum found in the north section of the Manila Chinese Cemetery is the Familia Maria Uy de Tee mausoleum. A beautiful quadragonal style typical of the elegant gothic pantheons found in Rumania and Moldavia.
Exif: D300, Nikon 17-55 @17 mm f8. iso 100 Custom White Balance. Ambient lighting.

A Gothic Tomb

Considered one of the oldest mausoleums inside the Manila Chinese Cemetery, this now forgotten tomb dates back to the late 19th century. This is more Gothic architecture than Art Deco.

Microtia

Findings

Figure 1: On the right, the mastoid air cells are under pneumatized. There is no identifiable external auditory canal.
Figure 2: A thick bony plate is visualized in the expected area of the external auditory meatus.
Figure 3: The facial nerve is identified.
Figure 4: There is a small amount of bone in the attic of the middle ear cavity but no formed malleus or incus is identified. This suggests rudimentary and/or hypoplastic ossicles. However, a normal morphology and location of the stapes is seen. The internal auditory canal is normal in caliber.
Figure 5: The apical and basal turns of the cochlea are within normal limits.


Diagnosis: Microtia


Microtia, which is a congenital deformity of the pinna and occurs more commonly in boys, is seen 1 in 8,000-10,000 births. It can be unilateral or bilateral. The etiology is unknown, but related to a variety of genetic factors. It is associated with other congenital syndromes, such as Townes-Brocks syndrome, Nager syndrome, and Miller syndrome. Some clinicians consider microtia to be a manifestation of the oculo-auriculo-vertebral spectrum (OAVS), where there are also facial, vertebral, and renal abnormalities. Renal abnormalities usually warrant a renal ultrasound, looking for abnormalities such as renal agenesis, hypoplasia, and crossed ectopia.

Microtia can be graded as follows:
- Grade I: A slightly small ear with identifiable structures and a small but present external ear canal
- Grade II: A partial or hemi-ear with a closed off or stenotic external ear canal producing a conductive hearing loss
- Grade III: Absence of the external ear with a small peanut vestige structure and an absence of the external ear canal and ear drum
- Grade IV: Absence of the total ear or anotia

Imaging of microtia is largely performed to form a template for further management options. Initially, a CT scan of the head (and/or temporal bones) is used to evaluate the exact middle and inner ear anatomy. Further staging by CT is recommended in order to avoid lesions to the facial nerve which most often can be displaced from its original location in patients with microtia, and also to assess for prognosis. In those patients being evaluated for surgical intervention, the following structures should be evaluated for planning surgery: the external auditory canal, bones (temporal, zygomatic, and the mandibular condyle), vessels (carotid canal, sigmoid sinus, and the jugular bulb), tensor tympani muscle and grade of mastoid pneumatization, ossicles, cochlear turns, vestibule, semicircular canals, facial nerve canal, and finally, the internal auditory canal. These pre-operative images substantially reduce the risk of facial nerve palsy, bleeding and worsening of hearing.

On axial CT images of the head, one can evaluate for either stenosis or complete atresia of the external auditory canal. At the same time, bone erosion by a secondary cholesteatoma or epidermoid cyst can be identified. One study showed the tympanic and/or mastoid portions of the temporal bone as commonly hypoplastic on CT images of patients with microtia. Dysplasia of the mandibular condyle and the zygomatic arch were also shown. Changes of the ossicles are frequently present and include dysplastic shape, diminution, thickening, axis rotation, or complete absence. Occasionally, the lateral semicircular canal is hypoplastic in patients with severe middle ear involvement. The internal auditory canal is rarely dysplastic in patients with microtia.

Microtia repair is complex. Testing is done initially to determine whether hearing is normal. If hearing is normal and a canal is not visible externally, a CT will be done to determine whether a rudimentary canal exists. The earliest age surgery can be attempted is three years, but will vary according to the graft material used. In some cases, patients may have to wait as long as 6 years of age. Exploration involves cautiously avoiding the facial nerve while drilling a canal through solid bone. A cartilage framework, usually derived from costal cartilage, is created and anchored beneath the skin of the mastoid area. Once it is well attached to the surface skin, a post-auricular crease is created in a second operation.

Gocheco Mausoleum

The beautiful and elegant Gocheco Family mausoleum in the north section of the Manila Chinese Cemetery.

A Swastika Tomb

I wonder why this memorial has a swastika sign on top of its tomb. Found in the north section of the Manila Chinese Cemetery, the tomb is owned by the Chamsanco Family and dated 1947, two years after the end of the Second World War.
Exif: Nikon D300, Nikkor 17-55 2.8 Lens at 17mm f8. ISO 100, Ambient lighting, Auto White Balance.

The "Sarah Palin Joke"

What is the difference between Sarah Palin's mouth and Sarah Palin's vagina?

Not everything that comes out of Sarah Palin's vagina is retarded!

Only Really Funny Political Stuff

I know that everyone is really really tired of all this politics garbage. You all know that McCain is really old. You all know that Obama is black. Lots of jokes can be told. Very funny. HA HA HA HA HA!!!!!

I promised myself that I would only blog about politics if I found the jokes or information really really really funny.

So, I'm going to post two blogs today. Both regarding Mrs. Sarah Palin. Now, remember, I'm only posting these because I think they're very funny.

This first blog includes a link to a site depicting Sarah Palin as President. Go to the site, maximize it on you screen, turn on your sound and click on things throughout the Oval Office.

http://www.palinaspresident.us/

The second blog includes the "Sarah Palin Joke". It's a very funny joke, however, it's very crude. So funny, that I felt the need to call many of you to tell you the joke. So, if you like really really funny jokes, and are not easily offended, go check out the other blog.

Vanderknaap disease - Megaloencephalic leukoencephalopathy with subcortical cysts (MLC)

Findings

Figure 1: Subcortical CSF intensity cyst in superior frontal and parietal lobe. Normal cerebellum.
Figure 2: CSF intensity subcortical cyst in superior parietal and anterior temporal lobe.
Figure 3: Diffusely swollen white matter (blue arrow). Preserved gray matter. CSF intensity subcortical cyst in anterior temporal lobe.
Figure 4: Diffusely swollen white matter. Preserved gray matter.
Figure 5: Cavum septum pellucidum. CSF intensity subcortical cyst in superior frontal and anterior temporal lobe. Normal basal ganglia.
Figure 6: Cavum septum pellucidum. CSF intensity subcortical cyst in superior frontal and anterior temporal lobe. Normal basal ganglia.


Diagnosis: Vanderknaap disease - Megaloencephalic leukoencephalopathy with subcortical cysts (MLC)


Vanderknaap disease is newly described rare leukoencephalopathies includes:
- 1. MLC - Megaloencephalic leukoencephalopathy with subcortical cysts
- 2. VWM - Leukoencephalopathy with vanishing white matter
- 3. WML - White matter disease with lactate
- 4. H-ABC- Hypomyelination with atrophy of the basal ganglia(BG) and cerebellum

Megaloencephalic leukoencephalopathy with subcortical cysts (MLC) is a rare leukoencephalopathy with an autosomal recessive mode of inheritance. The disease is relatively prevalent among Turkish people and in a certain Asian-Indian community, the Agarwal ethnic group.


MRI Features

In MLC the cerebral hemispheric white matter is diffusely abnormal and swollen. There are almost invariably subcortical cysts in the anterior temporal region, often also in the frontal and parietal subcortical regions The cysts are bilateral. The cysts tend to become larger with age and may increase in number. In some patients they become very large, The signal intensity of the contents of the cysts is always similar to that of CSF. Cortical gray matter structures,corpus callosum and basal nuclei are always normal. A patent and enlarged cavum septi pellucidum and cavum vergae are often present.

Similar white matter changes with swelling have been reported in Canavan disease, Alexander disease, L-2-hydroxyglutaric aciduria, and merosin-deficient congenital muscular dystrophy. However, in Canavan disease, as a rule, MRI demonstrates additional involvement of the thalamus and globus pallidus, not found in MLC patients. Special MRI findings in Alexander disease are a more prominent sparing of parieto-occipital white matter and often also sparing of the U fibers throughout. Basal ganglia and brain stem structures are typically involved. Cavitation starts in the deep frontal white matter. None of these features is present in MLC. In L-2-hydroxyglutaric aciduria MRI shows additional involvement of caudate nuclei, putamen, dentate nuclei, and severe atrophy of the cerebellar vermis, not observed in MLC. The MRI abnormalities observed in merosin-deficient congenital muscular dystrophy are very similar to those observed in MLC.

Medical Blogs-in context of a connected world

Sumer's Radiology Site is cited by Joanna Lynn Karpinski, MLIS (karpinsj@mail.nih.gov) is Associate Fellow, National Library of Medicine (NLM), in Medical Reference Services Quarterly, Vol. 27(1), Spring 2008 Available online at http://mrsq.haworthpress.com

According to the article, titled Disconnected in a Connected World: Knowledge and Understanding of Web 2.0 Tools at the University of Pennsylvania Medical Center

"Radiology, a medical field that is highly dependent on image-based examples for teaching, is experiencing a growth of blogs. Sumer Sethi, M.D., uses his blog to post interesting cases from his routine practice and abstracts related to his day-to-day work. The site is visited by more than 30,000 visitors each year and is a focal point for queries from his students and patients. The blog features not only a means of commenting on Dr. Sethi’s posts, but also a small section called a “shoutbox,” where users can post messages or questions on any topic for Dr. Sethi and other readers to see. Dr. Sethi can respond using the shoutbox."

Festival Day

Dear Friends
May god bless you with his choicest blessings this diwali, hope you have a happy and prosperous diwali. Diwali is the festival of lights and prosperity in India.


Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS
CEO-Teleradiology Providers http://teleradproviders.com
Blog- Sumer's Radiology Site http://sumerdoc.blogspot.com
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences) http://www.damsdelhi.com
Ph- +91-9811181359

The Manila Chinese Cemetery

The Manila Chinese Cemetery (founded in 1879) is the second oldest cemetery in Manila after the La Loma Cemetery, and was designated as the resting place for the Chinese citizens who were denied burial in Catholic cemeteries during the Spanish colonial period. In later times, however, even the Chinese who had converted to Catholicism were allowed to be buried here. It was also designated as a cemetery for people who died of communicable diseases.

Through the years, as more of the Chinese rich interred their dead here, the cemetery was acquired by the Chinese-Filipino Association, and became a private cemetery. It is one of the three cemetery complexes in the area that includes the La Loma and the North Cemetery.

During the Second World War, the Japanese turned it into a bloody execution spot--a killing field. My grandfather, the late Alfredo Santos, was executed by the Japanese as the American forces were on the drive for the liberation of Manila in 1945. He was one of the many Filipino and Chinese martyrs whose bodies were interred here.

Chong Hock Tong Buddhist Temple. Built in the 1850s, this is the oldest Chinese temple in Manila. Two Chinese stone lions serve as permanent guardians, typical of Chinese temples and pantheons.



Lee See Tong Martyrs Hall. Built in the early 1950s in honor of the Chinese community leaders who were executed by the Japanese during World War II. Japan invaded the country in 1941 and one of the first things they did was to round up prominent Chinese community leaders and executed them. Having been enemies even before World War II commenced, the Japanese were wary of the trouble the Chinese community would cause on the plans when they invaded the Philippines.



I am not sure to whom this memorial belongs, but asking the tomb caretakers around, I was told that it was the tomb of one of the early presidents of the Chinese Cemetery.



The Tanunliong Family Mausoleum



Ma Mon Luk's mausoleum. I am proud to say that my father built this mausoleum in the 1970s (It was actually built even before Ma Mon Luk's death). His son Robert now manages the two remaining Ma Mon Luk stores in Quiapo and Quezon Avenue. A crown on top of the mausoleum signifies his being the original Mami King.



A typical look of the inside of a Chinese mausoleum


....and another.....with a Yin-Yang symbol in its gate



This whole family perished during the deadly August 2, 1968 earthquake in Manila. Also known as the Ruby Tower Earthquake. I offered a prayer for them.



The original resting place of our Sublime Paralytic, Apolinario Mabini . I always think of him as the greatest hero of our country. His remains was later transferred to Tanauan, Batangas, his hometown.



The grave's historical marker



A row of Mausoleums



On All Souls Day, a lavish feast is offered by living Chinese relatives to their beloved dead



The Tankeh Family Mausoleum: HDR version (thanks to Photomatix Pro for the free software version)

Red Columns

An antique mausoleum inside the Manila Chinese Cemetery. The paintings of the family patriarch and matriarch are rumored to have been done by the great Fernando Amorsolo. This mausoleum is so old no one among the old tomb caretakers around know when it was built. Maybe it's about time for me to research on the old mausoleums inside the Manila Chinese cemetery. It would really be interesting!
Exif: Nikon D80 with Nikkor 14-24 mm 2.8 set at 14mm @ 5.6 iso 100. Three exposures merged in Photoshop. Ambient lighting.

An Art Deco Mausoleum

I am an admirer of old-style architecture, and it's not limited to beautiful urban dwellings and edifices. In fact some of the most beautiful Art Deco buildings I have ever seen are actually mausoleums. In the old north section of the Manila Chinese Cemetery can be found several of these magnificent mausoleums. They are the earthly homes to the departed ones of the rich Chinese in Manila. And since the Chinese practice ancestor worship, most of these mausoleums were built extravagantly, as a way to honor their dead. The mausoleum may also be a reflection of the family's power and social status. In effect, the larger and more beautiful structures belong to the wealthier and more affluent families.
One such grand mausoleum is The Familia Eusebio Tankeh, a glorious edifice of elegant Art Deco proportions. I admire its rich attention to the magnificent style reminiscent of the ancient gothic pantheons of Eastern Europe.
Built in 1948, the mausoleum's two front columns and vases suggest an elegant Greek influence, and inside, marble busts and angelic statues of superhuman proportions echo the Romanesque tradition. The two gothic dragons--instead of the traditional Chinese lions--serve as perpetual sentinels as if to guard the edifice from a foreign invasion. It was beautiful, a masterful creation, and a forgotten contribution to authentic high Art Deco architecture.

A Child's Forgotten Tomb

One of the forgotten tombs inside the old section of the Manila Chinese Cemetery is for this very young child. I always feel sad whenever I come across a child's grave. I myself lost a new-born child three years ago and I have also experienced the grief felt by Victoria's parents when she died in 1950. I kind of think that a child's death can be the most shattering ordeal any parent can experience. It just destroys the natural order of things: parents should be buried by their children and not the other way around. I offered little Victoria's grave a small flower and whispered a silent prayer for her soul.

Dr. Yang Kuang Sheng Memorial

This is the Dr. Yang Kuang Sheng Memorial, found inside the Manila Chinese Cemetery. Dr. Yang Kuang Sheng was the Chinese Consul-General to the Philippines during the Second World War. He refused to collaborate with the Japanese Occupation Forces, and was tortured and executed by the Japanese in 1942 right on this spot where this memorial now stands. His heroism and martyrdom (together with his eight staff), was recognized by the Chinese and Philippine Government who cooperated to erect this magnificent memorial.

Fallen Heroes Memorial

After visiting my Lolo's grave at the Manila Chinese Cemetery in preparation for our family visit on November 1, I decided to walk around and visited some of the memorial landmarks erected for the fallen heroes of the Second World War.
This memorial landmark is one of the few found inside the Chinese cemetery, dedicated to the Filipino-Chinese heroes who fought the Japanese Imperial Army in Manila during the Second World War. It is a noble monument to the bravery of the men who perished to defend our country against the foreign invaders.

Lonely Boats on Empty Harbor

I took this photo this evening, while on a relaxing stroll at the Manila Baywalk. I noticed how few people come nowadays to the bay boulevard. It was also relatively silent, with all the bars and restaurants removed by Mayor Lim.
Here and there some lovely couples make promises of eternal love to one another, as they sweetly embrace on the benches, their silhouettes creating romantic scenes in a lovely sunset.
I was alone, but I stayed awhile nevertheless to enjoy the harbor views, and to watch the gentle waves as they toss themselves into the rocks below.
I also photographed some sceneries, and I came across this boat scene. These boats remind me of the beautiful book of poems by Joe Pintauro, "Kites at Empty Airports". It was one of my favorite books and it taught me so much about gentleness, love, peace and serenity. And these boats reminded me that I can find something even in emptiness....in nothingness there is peace....there is serenity...

Manila Jumbo Floating Restaurant

This magnificent restaurant is permanently berthed at the Manila Bay and opens everyday from 6 in the evening up to the little hours of the morning. The food and service are excellent and the price is reasonable. You can enjoy fine dining while basking in the scenic view of Manila's harbor at night.

This photo was taken October 24, 2008, at 6:20 pm. Nikon D80, with Sigma 14mm 2.8 lens. I set the camera to Aperture Priority @f 3.5. Iso 200. Handheld and no flash was used.
(This picture is being posted for this blog only. If you wish to use it in other blogs/websites/publications, kindly credit the photo to my name or my blog's name. )

The Black Is Taking Over

A reporter for Al Jazeera interviewed residents in Ohio, the state that won it for Bush, after a Sarah Palin rally. Just remember that their vote counts just as much as yours.

Subependymal giant cell astrocytoma (SEGA)

Findings

Figure 1: Axial noncontrast CT image shows an intraventricular mass near the foramen of Monro with foci of calcification, as well as several calcified subependymal nodules along the lateral ventricular surface. Hydrocephalus is also present with enlargement of the right lateral ventricle.
Axial T2-weighted and FLAIR MR images demonstrate a mass near the foramen of Monro with heterogenous, somewhat hyperintense signal compared to white matter. Intense homogeneous enhancement is seen on contrast-enhanced axial and coronal T1 weighted images. Subependymal nodules are seen along the lateral ventricles. Multiple foci of increased signal are seen on FLAIR images in the subcortical regions representing parenchymal tubers.


Diagnosis: Subependymal giant cell astrocytoma (SEGA)


Subependymal giant cell astrocytomas are intraventriclar neoplasms that occur in 15% of patients with tuberous sclerosis. Tuberous sclerosis (Bourneville’s disease) is a neurocutaneous phakomatosis characterized by an autosomal dominant pattern of inheritance presenting with the classical clinical triad of mental retardation, seizures, and adenoma sebaceum (although only 30% present with all three features).

The disease is characterized by hamartomatous tumors and malformations affecting multiple organ systems, the CNS being the most commonly involved, with seizure being the most frequent presenting clinical sign of the disorder. Other than the CNS manifestations, patients may present with renal angiomyolipomas, cardiac rhabdomyomas, and cystic lung disease indistinguishable from lymphangiomyomatosis.

Hamartomatous brain lesions include cortical tubers, white matter heterotopias, subependymal nodules, and the subependymal giant cell astrocytoma. Histologically, cortical tubers, white matter lesions, and subependymal nodules are identical lesions composed of disordered neurons, glia, and giant cells mostly of the astrocyte type, only differing in size and location. Subependymal nodules are usually easily identified with CT due to frequent calcification (>90%) and usually do not enhance thus helping to distinguish, but not entirely exclude a SEGA from a subependymal nodule. Cortical tubers are less likely to calcify and appear as low attenuation lesions at CT, demonstrate increased signal intensity on T2-W images, and rarely enhance. White matter lesions are seen as curvilinear or straight bands of increased T2 signal extending from the ventricles. SEGAs are characterized by slow growth and a benign biological behavior (WHO grade I), likely arising from the degeneration of subependymal nodules. On CT, SEGAs are iso-to slightly hypoattenuating intraventriuclar masses located near the foramen of Monro, with calcification and secondary hydrocephalus being common findings. On MR imaging, SEGAs exhibit hypointense signal compared to white matter on T1-weighted images, heterogenous hyperintensity on T2-weighted images, with intense homogenous enhancement (except for calcified areas). Because MR enhancement cannot always reliably distinguish between subependymal nodules and a SEGA, larger size (>1cm) and interval growth of a mass on annual follow-up CT or MR are considered better indicators of a SEGA rather than a benign subependymal nodule. Therefore, annual surveillance MR imaging is recommended in patients with tuberous sclerosis.