Twitter?

I know this is kind of the pot calling the kettle black. I have a blog that no one reads, and I'm not complaining about that. I write this thing because I think the topics are funny and interesting, hence the title "I Think It's Interesting". A lot of people think that blogs are horribly lame. Which takes me to my topic.

I don't understand Twitter. Twitter.com is a site where you can concisely (less than 140 characters) update your status about what you are doing or what you're thinking about, similar to the status updates at MySpace or Facebook. I don't care what I'm doing all day, why would anyone else?

By The Way....

Now people have started to use Twitter to hurl insults at each other. This has been referenced, in more than one place, mind you, as "Taking It To The Tweets".

And when you find a Twitter that you like and would like to follow, they call that "Finding The Tweet Spot."

Am I the only one that doesn't understand why this is popular?

My Valentines Post

Finally, my Post-Valentine entry. It's still the month of February, and although a bit late, it's still the Valentines month. I wish to share with you some of the Valentine photographs I took while on a lonely walk in Manila Bay on sunset hour of February 14, 2009. I would like to thank the anonymous lovers who gave me permission to shoot their silhouettes against a romantic background of a lovely setting sun.

I can only smile and reminisce the time when I myself was a young sweet lover many many sunsets and Valentines ago.

I greet everyone a Happy Valentines Day today, always and forever.

The Butter Queen

All of you know the ever-so-sexy Paula Deen. Now you can get to know more of her, as her moon pie is bared to a live audience at The South Beach Wine and Food Festival. You know that when I say 'moon pie', I mean butt, right?

Madoff Made Off With A Lot Of Money

It came to my attention the other day that everyone knows that Bernard Madoff is a bad man that took a lot of money from a lot of people. And some people even know that he's accused of masterminding a $50 billion Ponzi Scheme, mostly because Bernard Madoff and Ponzi scheme have been uttered in the same sentence by every news broadcaster in the world. But not many people know exactly what Bernard Madoff did.... What is a Ponzi Scheme?

A Ponzi scheme, named after Charles Ponzi, starts with a promoter. The promoter will go out and entice some small investors, usually investors with little knowledge about finance, and promise them huge returns on their invested funds. These investors are usually lured by the confidence and knowledge of the promoter, but typically won't be informed of the types of investments that will provide such high returns. The promoter will take the money from the investors, and provide them with the original investment plus the promised high returns in a reasonable amount of time.

The original investors now have confidence in the promoter and his ability to choose investments that provide high returns, so they are more likely to invest additional money and the returns that they recently earned. Also, word will have spread, and new investors will want to invest with the promoter. Now, the Ponzi scheme is in play, the profits that are to be paid to the original investors are not actually profits, they are the funds that are invested by the new investors as word spreads of the promoter's ability to achieve such a high return on investment.

The promoter rarely has to pay out in cash. All the promoter has to do is send statements to investors, showing them how much the investor has earned by keeping the money in the promoter's investments, in order to continue deceiving the investors into believing that the investments are providing high returns.

Bernard Madoff did this on a huge scale, taking tens of billions of dollars from regular schmoes like you and me to charities to gigantic financial institutions. However, Madoff didn't promise huge returns, the statements he provided to his investors showed modest and steady returns to his customers until the market crashed in 2008. After the market crashed, people tried to pull a lot of money out of the Madoff investments, and that's when they realized that Madoff was pulling the wool over the investors' eyes.

Rugby Session

It was a ghastly sight, youths in their teens inhaling rugby and acetone in a darkened alley on a little sidewalk in downtown Manila. Some people passing by averted their eyes, shook their heads in disgust, their lives momentarily disturbed by the sight of youthful drug addicts openly sniffing malodorous substances in public, in open defiance of authority.

Through pooled contributions, the rugby boys managed to buy a bottle of rugby from a nearby hardware store. Then each with a plastic container, they divided the contents equally, not a drop less or more; "hating-kapatid" (brotherly partition). One of them was a girl. "Siya ang muse namin."(She's our muse). I asked the girl her name but she wouldn't answer. She was, I found out, deaf and mute.

The rugby is the cheapest of all the substances that these kids sniff so that they can get "high." At 35 pesos a bottle, the rugby "solves" them for the night. Sometimes the boys also use solvent (contact cement), an expensive rare treat that has stronger "getting high" effect and emits a "heavenly" more pungent odor. They are in "heaven" within a few minutes of inhaling the substance. But at 65 pesos a bottle, the substance is hardly affordable to these youngsters.

"Mahal e," one of the rugby boys told me, "65 ang isang bote, kaya pag may malaking kita lang ang ka-tropa tsaka kami bumibili ng solvent" (It's expensive, 65 pesos a bottle, so we just buy when we have big earnings"). "Di kami nag-sa-shabu, Kuya, mahal yun...dehins yaka ng bulsa." (We don't use shabu. Too expensive.)

Rugby has the same effect as solvent, however. Rugby only acts slower, and the users experience the "kick" a few minutes later. But then again, it is enough to forget hunger and the misery of their condition. When they reach the "drugged" condition, the pupils of their eyes dilate, and their consciousness enter into a drifting state as if they have reached heaven, nirvana, and the state of blissful consciousness or semi-consciousness. For them, it is a place where problems do not exist. No longer would they worry about food, family problems, and their wretched state. They smile and banter with one another, momentarily escaping the hard realities of being poor and maligned.

For a few pesos, the rugby solves all their problems.

Acetone is also a substance that these kids abuse, and they mix it with the rugby for a more powerful "kick."

"Dapat hindi kayo gumagamit niyan" I said, "Di lang niyan sisirain ang baga ninyo, pati na rin ang inyong kinabukasan." (You shouldn't be doing this. It will not only destroy your lungs, but also your future.)

"Wala na kaming kinabukasan, Kuya" (We don't have a future anymore). "Ito lang ang ligaya namin at di naman kami nanggugulo." (This is our only happiness. And we do not bother anyone).

Aged 14 to 19, these kids are either stow-aways, or have been neglected or abused by their families. They somehow manage to survive without parental supervision. Some of them earn a few coins a day by being "jeepney barkers," calling passengers to fill up a jeepney. Others are paid running errands for the stall owners in the Quinta Market. Some others earn by stevedoring. And a few of them sell sex to the pedophiles.

Of course, selling sex for drugs is the easiest thing to do. But lately, their sex clients come less frequently. Apparently, they prefer cleaner and younger boys. At sixteen, these kids are too old.

Nevertheless, no one among them gets involved in serious criminal offenses. "Di kami mandurukot, Kuya. Kalaboso at bugbog ang lagpak namin doon," one of the older boys said. (We are not pick-pockets. We do not want to be flogged or thrown to jail.) Except for a few fist fights against rival gangs, these youths live peacefully, sharing meals, camaraderie, and substances.

I felt great pity towards these youngsters, and by extension, towards our society. The youth is the vision of hope for a country. But with young people like them, we only see the ills of our society, the malignant cancer Rizal spoke of a century before.

As I looked on each of their hardened faces, I see a lost and devastated future instead of a bright and shining one. A lost promise. What would become of them five or ten years from now? Cellphone snatchers? Hardened criminals? Psychopaths? Street robbers? Killers? Dead?

As I began to walk away, one the boys -- now in in high "drugged" condition -- shouted, "Kuya picture naman o! Subenir lang, hehehe."

"Tsaka Kuya huwag mo kami isumbong sa pulis, ha!" (Please do not report us to the police).

I didn't. The police would just arrest them, beat them, and then let them go. For the police, these kids are just a nuisance.

Curses

A gentleman named Victor Solomon was in the hospital, and started watching "The Sopranos" on A&E. When you watch "The Sopranos" on HBO, the show is filled with curse words, and when you watch "The Sopranos" on A&E the show is filled with bleeps. Victor Solomon took 9 months of his life to make a video of all of the curse words in "The Sopranos" to show you what you're missing when you watch the show on A&E. The clip is 27 minutes and 18 seconds long! This is one of the most amazing videos I've ever seen!

Mang Lando's Only Friend

Mang Eduardo Dela Cruz, 59 years old, a street pauper in Plaza Sta. Cruz, is the only considered friend of Mang Lando. They have known each other for two years now, but they rarely meet with each other, as being a pauper is a lonely business--no one shares the misfortune of another. It is every man for himself in the grimy world of paupery in midnight Manila downtown.

Unlike Mang Lando, however, Mang Eduardo is still in denial of his leprosy illness. He considers his severe skin lesions as keloids. As such, he continually refuses to accept any medications to treat his leprosy. I noticed some of his fingers and toes becoming shorter, the classic symptoms of leprosy.

I drove straight to the point saying that he had leprosy. His nice demeanor suddenly changed into one of anger."Hindi! Wala akong ketong! Keloids lang ito!" he said smirking. (No! This is not leprosy! This is just keloids!)

I told him I would assist him to San Lazaro Hospital* so he could be treated right away, but he refused, saying that he doesn't need doctors. I would have argued with him, but he walked away immediately to seek shelter in his grimy sidewalk home in Gandara Street.

He vanished quickly in the darkness.

*San Lazarao is a government hospital in Avenida Rizal. Every public hospital/local health center has a supply of free leprosy medications (all anti-biotics). That is, if they are not hoarded by corrupt government officials.

"Being Employed" Is The New Raise

Hundreds of thousands of people are being laid off every month and it doesn't look like it's going to stop anytime soon. Companies can't afford to keep their workforce, and they're making cuts left and right.

Layoffdaily.com gives updates on the many companies that are reporting layoffs. I have been glued to this website for about a month now! It's kind of like an automobile accident on the freeway, you don't want to see it, but for some strange reason your eyes are diverted towards the fiery wreckage.

So far, my favorite story posted on their site is about the Martinez Unified School District laying of John Muir Elementary School teacher Gina Graziano, who was named Teacher Of The Year by the District for the 2007-2008 school year and has taught in the district for 12 years.

http://www.layoffdaily.com/

Vestibular schwannoma (with communicating hydrocephalus)

Differential diagnosis:
- Vestibular schwannoma
- Meningioma
- Epidermoid cyst
- Facial nerve schwannoma
- Arachniod cyst


Differential overview

Meningioma is the second most common CPA mass and may mimic a vestibular schwannoma. They are benign, unencapsulated neoplasm arising from meningothelial arachnoid cells of CPA-IAC dura. On CT, meningiomas will appear as a calcified dural based mass eccentric to the IAC with a positive meningeal sign, i.e. enhancement of the meningeal tail. 90% will have strong, uniform enhancement on contrasted CT studies. Vestibular schwannomas will not calcify and are centered on the IAC. On MR imaging, menigiomas will show a broad dural-base with an associated dural tail. Also, a CSF-vascular cleft can be seen between the tumor and brain parenchyma.

An epidermoid cyst is a congenital intradural lesion arising from inclusion of ectodermal epithelial elements during neural tube closure and is the third most common CPA mass. The main way to differentiate an epidermoid cyst from vestibular schwannoma, is that it appears as a nonenhancing CPA mass on T1 MRI with contrast, unlike vestibular schwannoma which will enhance. Epidermoids are insinuating masses with scalloped irregular margins that usually engulf cranial nerves (7th & 8th), vessels (AICA, vertebral artery). Other imaging findings on MRI is partial or absent attenuation on FLAIR imaging and diffusion restriction (high signal) DWI. 20% of epidermoids have calcification along the cyst-CPA margin on CT. Epidermoid cysts are also known as primary cholesteatoma or epithelial inclusion cyst.

An arachnoid cyst is an arachnoid or collagen-lined cavity that does not communicate directly with ventricular system or subarachnoid space. They commonly will push on the CPA angle but not enter the IAC. Imaging findings that distinguish it from vestibular schwannoma are lack of contrast enhancement and following CSF signal on all MR sequences. Arachnoid cysts also have an imperceptible cyst wall even with contrast enhanced MR or CT sequences.

Facial nerve schwannoma is a rare benign tumor of schwann cells that invest the peripheral facial nerve and can look exactly like a vestibular schwannoma. The best way to differentiate the two is to look for a labyrinthine segment tail in the facial nerve canal. When lesions are large they can appear as "ice cream on ice cream cone" with comma-shaped "tail."


Actual diagnosis: Vestibular schwannoma (with communicating hydrocephalus)


Key points

Vestibular schwannomas (also known as acoustic schwannomas) are benign intracranial extra-axial tumors that arise from Schwann cell sheaths that invest the vestibular or cochlear nerve in cerebellopontine angle-internal auditory canal (CPA-IAC). Acoustic neuromas account for approximately 80% of tumors found within the CPA. The remaining 20% are principally meningiomas. In rare cases, a facial nerve neuroma, vascular tumor, lipoma, or metastatic lesion is found within the cerebellopontine angle.

Acoustic tumors, like other space-occupying lesions, produce symptoms by any of 4 recognizable mechanisms: (1) compression or distortion of the spinal fluid spaces, (2) displacement of the brain stem, (3) compression of vessels producing venous or arterial infarction, or (4) compression and/or attenuation of nerves.

Because the CPA is relatively empty, tumors can continue to grow until they reach 3-4 cm in size before they come in contact with important structures. Growth is often sufficiently slow that the facial nerve can accommodate to the stretching imposed by tumor growth without clinically apparent deterioration of function. Tumors that arise within the IAC may produce relatively early symptomatology in the form of unilateral sensorineural hearing loss or vestibular disturbance by compressing the cochlear nerve, vestibular nerve, or labyrinthine artery against the bony walls of the internal auditory canal.


Imaging findings

MRI

Gold standard for diagnosis is gadolinium enhanced T2 MRI of the brain and CPA-IAC.
MRI can detect masses as small at 2 mm.
T1WI: lesion will appear as an intermediate signal most commonly; a high signal foci will be present if there is a hemorrhagic lesion (which is rare).
T2WI: lesion will appear as a "filling defect" in high signal CSF of CPA-IAC cistern. Small lesions will appear as ovoid filling defect, where as larger lesions have an "ice cream on cone" shaped filling defect.
T1 C+: Focal, enhancing mass of CPA-IAC cistern.
ther MR findings: 0.5% associated arachnoid cyst.


CT with contrast

Well-delineated, enhancing mass of CPA-IAC cistern with no calcification.
Smaller intracanalicular lesions < 6 mm may be missed.

Susac syndrome

Findings

Figure 1 and Figure 2: FLAIR images reveal multiple punctate T2 signal hyperintensities in the cortical, subcortical white matter and bilateral centrum semiovale.
Figure 3: Coronal T2 weighted image demonstrates a focus of abnormal T2 signal in the of the corpus callosum (yellow arrow).
Figure 4: Axial T1 post contrast image demonstrates punctuate enhancement of lesions within the centrum semiovale.

Differential diagnosis
- Susac syndrome
- Multiple sclerosis (MS)
- Acute disseminated encephalomyelitis (ADEM)
- Transient ischemic attacks
- Systemic vasculitis
- Thrombophilic disorders
- Mitochondrial encephalopathy


Diagnosis: Susac syndrome


Susac syndrome is a rare microangiopathy characterized by a clinical triad of encephalopathy, branch retinal artery occlusions, and hearing loss. The syndrome predominantly affects women in their third and fourth decades of life, between the ages 18 and 42. Though the exact pathogenesis of this disorder is unknown, the findings of retinal microangiopathy and brain biopsies suggest a small vessel vasculitis leading to arteriolar occlusion and microinfarction of cerebral, retinal and cochlear tissue.

If a patient with a history of acute encephalopathy also develops hearing loss or acute visual loss, Susac syndrome should be considered.

The neuroimaging study of choice is the MRI, which typically demonstrates a pattern of punctuate, multifocal supratentorial lesions. The disease invariably involves the corpus callosum and affects both white and grey matter. Leptomeningeal enhancement may occur.

Multiple sclerosis (MS) and acute disseminated encephalomyelitis (ADEM) can mimic the MRI changes seen in patients with Susac syndrome. However, the callosal lesions in Susac syndrome are centrally located while patients with MS and ADEM typically have lesions involving the undersurface of the corpus callosum. Deep gray matter involvement commonly occurs in ADEM but is very rare in MS. Leptomemingeal involvement is not typical of either MS or ADEM. Demyelination is not a typical feature of Susac syndrome.

Treatment currently consists of intravenous methylprednisolone, followed by oral steroids in conjunction with the use of intravenous immunoglobulin (IVIG). The condition is typically self limiting, but can take up to five years to resolve.

Hugh Jackman Was Really Funny

If you didn't see the Academy Awards last night, you missed a really good performance by Hugh Jackman. He performed a very funny monologue, then did an amazing musical medley about the Best Picture nominees. His interpretation of "The Reader" was especially funny. It's 8 minutes long, but worth it!

It's Not An I.O.U, It's An F.U.!

Our accountant prepared our taxes yesterday, and we should be getting small returns from both the federal government and the state. However, since our state (California) does not have any money, and does not know when it will get more money, we're not going to receive the money from the State of California anytime soon. As the accountant said, "It's Not An I.O.U, It's An F.U.!"

The State of California has said that if you owe the state money, you better pay them before April 15, but if they owe you, they have no responsibility to make sure you get paid anytime soon.

The state government also raised sales tax, doubled the vehicle registration fees, and cut funds for education and health care programs.

I remember when Gray Davis was being ousted as governor because he tripled the vehicle registration fees. Arnold Schwarzenegger ran on a platform that he would not raise taxes, especially the vehicle registration fees. Are we supposed to spend another billion or so dollars to recall Schwarzenegger?

Is Obama going to be able to get us out of this recession? Is the commercial mortgage market going to crash? Is the credit card market going to crash? What is going on with America?

Maybe it's time to move to Canada!

Scrofula

Findings

Figure 1 and Figure 2: Contrast-enhanced CT coronal reformatted images demonstrating bilateral, bulky cervical lymph nodes that are centrally hypodense, representing necrosis, with peripheral enhancement.
Figure 3, Figure 4, and Figure 5: Axial images showing the extensive volume of necrotic lymphadenopathy and medial displacement of major vascular structures.
Figure 6: A sagittal reconstruction highlights the confluent nature of the necrotic lymph nodes.


Diagnosis: Scrofula (infectious cervical lymphadenitis) caused by mycobacterium tuberculosis


Scrofula, or infectious cervical lymphadenitis, is a term predominantly applied to tuberculous and non-tuberculous mycobacterial infections (NTM) affecting the cervical lymph nodes. Humans are the only reservoir for M. tuberculosis. Other tuberculous bacilli that cause disease in humans are M. bovis, and M. africanum, which most often cause extrapulmonary disease. NTM are ubiquitous, and reside in the soil. They can be found in contaminated water, dairy products, eggs, dust, and even tap water. Approximately 95% of adult scrofula cases are caused by mycobacterium tuberculosis, while the remaining 5% are caused by NTM, such as M avium intracellulare, M scrofulaceum, M kansasii and M chelonei. In children, this statistic is reversed, with NTM responsible for up to 92% of scrofula cases.

Scrofula produces lymph nodes that are discrete, firm, and typically nontender, in contrast with the lymphadenopathy associated with acute infection that is often tender. A firm mass of matted nodes may become apparent with disease progression, and if untreated, lymphadenopathy can become fluctuant with draining fistulas. Enlarging nodes may compress the esophagus causing dysphagia. The presence of systemic symptoms is variable and more likely in immunocompromised patients.

Scrofula presents with a variable imaging appearance depending upon the stage of the disease. Tuberculous lymphadenitis may be unilateral (90% in adults) or bilateral and is usually found in the internal jugular nodal chains (levels 2 - 4) and the spinal accessory chains (levels 5a and 5b). In the early infectious phase, non-necrotic nodes have homogeneous signal intensity and enhance homogeneously with contrast on both CT and MR. As the disease progresses and nodes become necrotic, CT images demonstrate characteristic central low density, representing necrosis, with a thick rim of enhancement. Peripheral contrast enhancement reflects hyperemia of the inflamed lymph node capsule or increased lymph node vascularity. On MR images, the necrotic center of the nodes will show intermediate signal intensity on T1-weighted images, low signal intensity on T2-weighted images, and will enhance with contrast. The surrounding granulation tissue, with its inflammatory hypervascularity and increased vascular permeability, will be markedly hyperintense on T2-weighted images. The nodes may become multiloculated and matted, simulating metastatic cervical disease both on imaging and clinically. Despite extensive necrosis, infiltration of adjacent fat planes is minimal, which may differentiate this process from other infections or malignant nodal disease. Chronic or post-treatment nodes are characterized by fibrous and calcific elements that are easily identified on CT. Calcification can also be seen in scrofula caused by NTM. On MR, treated nodes are homogeneously hypointense on both T1 and T2-weighted images, and do not enhance with contrast.

Cervical lymph nodes enlarge in response to neoplastic, inflammatory, and systemic disease. The broad differential diagnosis of enhancing cervical lymphadenopathy in an adult includes, but is not limited to, metastatic squamous cell carcinoma, metastatic papillary thyroid carcinoma, lymphoma, tuberculous and nontuberculous mycobacterial lymphadenitis, cat-scratch disease, Kaposi sarcoma, AIDS-related lymphadenopathy, acute septic infection, Kimura disease, Castleman disease, and Kikuchi disease. Fungal infections and viral infections, such as Epstein-Barr virus, herpes simplex virus, cytomegalovirus, and rubella also may present with bilateral diffuse lymphadenopathy.

Diagnosis usually requires fine needle aspiration (FNA) for histologic examination and culture. Once scrofula is diagnosed, it is important to determine the exact etiology, as tuberculous scrofula is treated medically and NTM infections are treated surgically. Lymphadenopathy may initially worsen during antituberculous therapy, representing an immune response to killed mycobacteria. Surgical intervention is reserved for complications such as abscess formation and draining sinuses. The treatment of choice for NTM infections is complete surgical excision of all affected tissue.

A Leper's Story

During one of my late and lonely walks in the streets of Manila, I noticed a gaunt and hunched figure trying to take refuge in one of the dark sidewalks of Avenida Rizal. Sleepless and listless, he settled into a darkened alley and slumped there. As I walked near him, he held out his hand and begged for a few coins.

He was Mang Lando, 39 years old, one of the paupers who made Plaza Sta. Cruz their permanent home. Six years ago, Mang Lando suffered from a numb sensation in his skin. Shortly afterwards, he developed severe skin lesions. He didn't know what was wrong, until his fingers began to "falloff". The local doctor who first saw his condition, immediately knew what was wrong. All the symptoms are the tell-tale signs of history's most dreaded disease: leprosy.

Mang Lando's family, fearing he may infect them, immediately sent him to Tala Leprosarium* in Caloocan so that he could be quarantined—and maybe treated if there was cure. No one dared accompany him.

But Mang Lando didn’t like Tala—it was an unpleasant place filled with sick and disabled people. It was a government institution, and as usual, ill-funded. In fact, according to Mang Lando, the government stopped supporting the leprosarium, and many patients were no longer receiving their doses of medications. The living quarters stank and so was the food.

Mang Lando escaped from the leprosarium, returned home, but was promptly rejected by his family. He settled in Plaza Sta. Cruz from then on. His condition worsened: he developed severe skin lesions, followed by losing his fingers and toes. His left eye was blinded. He was being rapidly ravaged by the disease. Fortunately, a few generous souls noticed his condition and gave him a regular supply of medications. Thanks to modern science, leprosy can now be cured, although its effects can no longer be reversed. Mang Lando’s skin lesions will be there forever—his fingers and toes will no longer regenerate. His left eye will be blind forever.

Mang Lando loved the darkness the night brings. For then, he could escape the social curse brought about by the disease. Many people didn’t want him near them. Children mock him calling him names “ketongin!” , “ketongin!, lumayo ka sa amin!” (Leper, leper! Get away from us!”) Even fellow paupers refused to be near him, and when he sleeps, he was far from the other street-sleepers of downtown.

But Mang Lando was already cured of the disease. Lepers who received even just a few days’ medication are no longer infectious. The medication also stops the progression of the damaging effects of the disease (such as skin lesions, falling fingers and toes)**

Moreover, ninety-five percent of people are immune to the virus that causes leprosy, and those remaining five percent can now easily be cured even if they were infected. Early detection is essential so that the debilitating effects will not take place. Gone were the days when leprosy was considered the “dreaded” disease. In fact, the World Health Organization has already “numbered” the days of leprosy as a public health hazard.

This was the reason why the Tala Leprosarium already ceased to be given funds by the government. In fact, leprosariums and so-called “leper colonies” were now being closed down because the disease can easily be cured even at home without risking the infection of family members.

Thus the social stigma marked by leprosy is all that has remained to be battled. The government should make an effort to erase this cursed stigma so that unfortunate people like Mang Lando can live and interact with society more freely, and no longer take asylum in the weary darkness of the night.

Mang Lando poses in front of the Carriedo Fountain. Some people sitting there went away quickly when Mang Lando and I sat there.

Related post:

Mang Lando's Only Friend

*Founded in 1940, the Tala Lerosarium is Asia's oldest leprosarium. It is now closed, and in its place, a housing project was started by Vice-President Noli de Castro to house the previous patients. NGOs now help to build the community for the former patients.

**If only Mang lando recognized the early symptoms of leprosy, he would not have suffered its debilitating effects

Academy Awards

Tonight, ABC will broadcast the 81st Annual Academy Awards. There's a new company running things over there, and they're trying to mix things up a little bit.

First of all, they've chosen someone who is not a professional comedian to host the show. That hasn't happened for a very long time. From the interviews that Hugh Jackman has done before his performance, he seems to be pretty funny. I hope he hosts the show "drunk and nude" like he said he would.

The largest, well, the most interesting changes, include not revealing the identity of the celebrities presenting the awards and asking some celebrities to avoid the red carpet so people will tune in to the show to see what, or who they are wearing. I have to admit, I'm interested in seeing what happens.

Here's a couple did you knows.....

Heath Ledger is a lock to win a Best Supporting Actor Award for his performance as the Joker in The Dark Knight. Only two people, Sidney Howard for the Best Screenplay Award for Gone With The Wind and Peter Finch for the Best Actor Award for The Network, have won an award posthumously.

Bob Hope holds the record for hosting the Academy Awards 18 times. Billy Crystal comes in second, having hosted 8 times.

Three actors, Jane Wyman in Johnny Belinda in 1948, John Mills in Ryan's Daughter in 1970 and Holly Hunter in The Piano in 1993, have won an Academy Award for playing characters that do not utter a single word throughout their respective films.

Oscar is just a nickname given to the award received by the actors. The Academy Award of Merit is the official name of the statue given to the winners.

Oscar Hammerstien II won Best Song Academy Award for his song "The Last Time I Saw Paris" in the movie Lady Be Good in 1941. P.S. Hugh Jackman has a son named Oscar.

The only X-Rated movie to receive an Academy Award was Midnight Cowboy in 1969 for Best Picture.

Robert Opal streaked (naked) across the stage while David Niven was presenting the Best Picture Award during the ceremony in 1974.

Until 1989, every award was presented with the phrase "And the winner is.....". The phrase was changed in 1989 to "And the Oscar goes to.....".

All Right Mr. President! I'll Get My Own Fries!

You are a potty mouth Mr. President! Before I heard these, I would never have read any of Barack Obama's books, but now I want to read every single one! Here are some clips of Barack Obama reading from his book "Dreams From My Father". Apparently he's quoting a close friend from his youth. These are going to be my ring tones for a long time!

P.S. If you do not like foul language, do not listen to these clips.

Way Too Complicated

Sure You Can Have My Number

Sorry Ass Mother-@#$#@

Buy Your Own Damn Fries

Ignorant Mother-@#$#@#

Radiology Practise-which way to go?

Now with times moving fast ahead there is this dilemma all the time. On one end is the fast evolving radiology practise wherein you report your cases based on the clinical details provided sitting remotely via teleradiology, which looks like the only logical way to increase your output and meet the increasing shortage of radiologists. On the other hand every few days now i have a feeling it is much better for your practise to talk to patient directly, convey the result to him so that he understands what you have written and limitations of the same. Same applies to the talking to referring physicians but where is the time and it takes productivity for ride. May be we will see a balance in times to come.

Spinal schwannoma

Findings

61-year-old male with a multilevel intradural extramedullary lesion demonstrating isointensity on sagittal T1 (Figure 1), intense enhancement on sagittal T1 post gad (Figure 2) and sagittal T1 post gad fat sat (Figure 3), and high signal intensity on sag STIR (Figure 4).
Axial T1 pre contrast (Figure 5) post contrast (Figure 6) and post contrast with fat saturation (Figure 7) demonstrate an intradural extramedullary lesion compressing and displacing the thoracic cord to the left.

Differential diagnosis for intradural-extramedullary spinal mass lesions:
- Nerve sheath tumor
- Meningioma
- Metastasis
- Paraganglioma
- Vascular malformations
- Inflammatory process
- Developmental lesions


Diagnosis: Spinal schwannoma


Nerve sheath tumors and meningiomas are the two most common intradural-extramedullary spinal tumors, representing 30 and 25% of presenting lesions, respectively. Both are typically benign, slow-growing tumors which may be present for years before there is functional impairment. MRI is the modality of choice in distinguishing these pathologies.

Nerve sheath tumors compromise schwannomas and neurofibromas, most often present in the fourth and fifth decades of life, and may be associated with neurofibromatosis. Schwannomas arise from dorsal sensory roots, more commonly in the lower thoracic and lumbar areas. Neurofibromas, unlike schwannomas, involve the parent nerve, and are unencapsulated.

Meningiomas are the second most common intradural-extramedullary spinal tumor and are more common in women. Multiple meningiomas may also be associated with neurofibromatosis. Meningiomas are predominately located in the upper and mid- thoracic areas, different from schwannomas, but are in a similar distribution in the anterior-posterior plane. Both nerve sheath tumors and meningiomas can be found in a “dumbbell shape,” with both extra- and intradural components.

MRI is the modality of choice in the evaluation of intradural-extramedullary spinal tumors. Nerve sheath tumors and meningiomas demonstrate characteristics of craniocaudal location divergence, hyperintensity and heterogeneity of T2W images, intensity and heterogeneity of enhancement, and the presence or absence of the “dural tail sign”. Schwannomas are typically hyperintense and heterogeneous compared to meningiomas on T2W images. The tumors show different contrast enhancement- meningiomas enhance moderately and homogenously, while schwannomas enhance strongly and irregularly. The “dural tail sign,” a reactive thickening of dura tapering away from the tumor, is associated with meningiomas, though this is not a specific sign. Additionally, neural foraminal extension and foraminal widening is suggestive of schwannoma, while bony sclerosis surrounding the mass is suggestive of meningioma.
Vascular tumors may necessitate pre-operative angiography and embolization.

Manila Downtown: Street Sleepers

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Avenida Rizal 12:15 a.m., I was sitting in one of the quaint little cafes of Manila downtown, trying to empty a little cup of black coffee that somehow regenerated my weary soul after photographing some of the ugly and sickening sceneries of urban street living.

The street sleepers that I have photographed earlier have somewhat shaken my notion of portrait photography. These are not fun to shoot: there are too many sad and disturbing sceneries: old neglected people, beggars, stow-aways, garbages, orphaned children, ill and disabled people. Yet, these scenes revealed the true meaning of photography: to expose what the human eyes neglect to see. We knew these things exist, but we need the photographs to somehow prove they do really exist.

Just imagine how difficult it would be to sleep in the grimy sidewalk, under a hard makeshift bed made of flattened cardboard box, without the comfort of pillow or blanket to protect against the cold and the insects, and without a roof and walls as protection against the elements.

Too poor to buy even a cardboard box

Lolo used the sidewalk step as a pillow

Sleepless