Birthday Video

My Aunt Mary sent me this video on my birthday... Is there any way it could be real?



By the way.... She also introduced me to the "Lion Hug"...

Internet Journal Of Radiology- Current Issue

Here is the table of contents for current issue of Internet Journal of Radiology
Original Articles
Problems Of Diseases Manifested By X-ray Local Opacity Syndrome, And Differential Diagnostic Algorithm For Its Solution - L. B. Naumov
Standards of angiography & percutaneous transluminal angioplasty and their application to current practice - N. Khandanpour, S. Girling, P. A. Wilson, F. J. Meyer, M. P. Armon & J. F. Cockburn
Reviews
Normal variants of the middle glenohumeral ligament in MR imaging of the shoulder - P. Chatterjee & J. Sureka
Normal variants of the bicipitolabral complex in MRI of the shoulder - P. Chatterjee & J. Sureka
Case Reports
Symptomatic epidural gas accumulation originating from vacuum phenomenon in the intervertebral disc: CT imaging findings - B. Battal, U. Bozlar, H. T. Sanal, M. Saglam, N. Bulakbasi & B. Ustunsoz
Dysphagia Lusoria - A. K. Singh, B. Baruah, U. Garga & R. Tiwari
A Rare Case Of Dermoid Cyst Originating From The Submandibular Gland - C. Akgul Ozmen, H. Nazaroglu, M. Yildirim, H. Akay, A. Bayrak & S. Şentürk
Subacute Combined Degeneration Of The Cord - G. Chand & V. Maller
Double Testicular Epidermoid Cysts in a young adult: A case Report - M. Baj
Krukenberg Tumor from Gastric Adenocarcinoma: CT findings - T. Bartalena, M. F. Rinaldi, C. Alboni, G. Giannelli, C. Leoni & G. Rinaldi
Subacute Combined Degeneration Of The Cord: Lateral Column Involvement Seen On Mri –An Uncommon Finding - L. Malhotra, S. Sethi, J. Shankar & T. Mehta
Lipoma of the Quadrigeminal Plate Cistern - M. Senoglu & I. Altun
Editorial
Radiology in 2101: Future of a Radiologist or Radiology Practice - S. K. Sethi
Images in Radiology
Radiology Quiz - Breast - M. Baj
Fahr disease - V. Wadhwa & A. Patel
Quiz
Pulmonary metastasis in Chorio-carcinoma: “Before and After Chemotherapy” - S. Singla, S. Kumar, K. Roy, J. Sharma & N. Singh

All In One Basket!

I wanted to post this just because I think it's awesome! Simple and fun! That's all I need to be happy.... This is eggstra eggciting! Square eggs!

This is the Peter Petrie egg separator. The yolks get blocked by the nose and the white drip through the nostrils.


Check out how this guy peels a hard-boiled egg in 10 seconds.....

45 Letters!

Pneumonoultramicroscopicsilicovolcanoconiosis is an obscure term ostensibly referring to a lung disease caused by silica dust. This word has been cited as one of the longest words in the English language.

Views from a Dead River

Ever since time immemorial, people chose to live beside a river. The river serves many purposes: a source of food and water, a means of transportation, a way of livelihood and trade. Generally, the soil near the river is considered more fertile and people time and again benefit from this by raising farms and animals near the riverbanks. Through the years, people rely on the river for these important functions.

In the 20th century, the increase in population and urbanization has resulted in a downright abuse of the river. In the Philippines, the economic situation has affected the landscape along the river systems. Being a Third World country, many poor people squatted along the banks of major river systems in Manila, building make-shift houses and shanties without proper garbage disposal system, drainage system, and private lavatories.

Being poor, these squatters are largely ignorant of the eventual degradation of the rivers and esteros. Their main concern lay within the survival and well-being of the family and not those surrounding them. The government, for its part, failed to check this problem and allowed the squatters to multiply along the river banks. Furthermore, funds supposedly allotted to rehabilitate the river was pocketed by some corrupt government officials.

The increase in urbanization made the rivers and creeks serve other purposes, like becoming the dump site for the household refuse, a gigantic public lavatory, and eventually, sewerage and drainage system. The problem has remained unchecked until some civil and environmental groups started to notice the eventual degradation of the Manila river systems. The pressure from these groups led the local governments to take a first look into the already humongous problem.

By then, it was already too late.

The households account for a major part of the pollution of the rivers. They throw their garbage to the river. The factories and refineries also account as major contributors to the pollution.

The Pasig River, for example, began to darken in the 1960s and people no longer use the water for drinking purposes since that time. By the 1970s, the Pasig began to emit a foul smell, and by the 1980s, fishing was already considered nonviable. In the 1990s, the Pasig River is considered one of the most polluted rivers in the world, and officially declared "biologically dead". In its death throes, the Pasig River became nothing more that a dark and foul waterway. It is now a stark reminder of human neglect, abuse and apathy.

The creeks that flowed to the Pasig River are no less polluted. The Estero de Paco creek that winds its course along the districts of Paco and Sta. Ana, is considered one of the worst esteros in the world. Not only is it "biologically dead", it is also now "biologically deadly". It has now become a source of disease and death. The piles of garbages, mixed with chemicals, human and animal excrements, have become a toxic environment for those living along it.

Hence, the river that once gave life to people, has already become its nemesis.

Kalakal Children














Who cares? If all we leave our children is a dead river?

*All my photos are copyrighted. Please do not reproduce my photographs without my consent.

Spike Jonze

For those of you not excited about the new "Where The Wild Things Are" movie directected by Spike Jonze, check out this short commercial he directed for IKEA....

Fifth Third Burger

The West Michigan Whitecaps are offering a huuuuuuge burger with tons of toppings, that might be a wee bit excessive.

The "Fifth Third Burger", named after the Fifth Third Bank (the sponsor of their stadium), is 5/3 pounds of grilled hamburger topped with lettuce, tomato, american cheese, nacho cheese, chili, salsa, sour cream and crunched tortilla chips. Saddled with the heroic task of holding it all together is an eight-inch sesame seed bun.


The burger will cost you a measly $20.00, and eating the burger all by your lonesome will earn you a free t-shirt....

Here are some crazy stats for this immense heart stopping creation...

		DAILY VALUE
Calorie	4889	244%
Total Fat	299g	460%
Sat. Fat	199g	597%
Cholesterol	744mg	248%
Sodium	10,887mg	454%
Total Carbs	354g	118%
Protein	198g	105%

Here's a video of the creation of a massive Fifth Thirds Burger!

Ascariasis-CT abdomen

These are CT images showing ascariasis. Rare to see such CT pictures. This is a 8yr old child with abdominal pain.

Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences)

CNS fungal aspergillosis

Findings

T2 weighted intraparenchymal masses in the right temporal lobe and in the right superior frontal gyrus extending across the corpus callosum. There is ependymal enhancement of the right lateral ventricle. There is very minimal enhancement of the masses.

Differential diagnosis:
- CNS leukemia
- CNS aspergillosis
- CNS bacterial infection
- Metastasis
- Septic emboli


Diagnosis: CNS fungal aspergillosis


Key points

Aspergillosis is the 2nd most common fungal CNS infection in an immunocompromised host after cryptococcus.

Risk factors:
- Transplant recipients: renal >liver > heart.
- 1-4 months post transplant.
- Recent transplant rejection +/- retransplantation.
- Leukopenia.
- Associated with CMV infection.
- Reported nosocomial spread in some cases.
- Lung is commonest source then sinuses.


Imaging

Best finding: Multiple lesions with infarction or hemorrhage in a random distribution due to the angioinvasive nature of the infection. Hemorrhage occurs in approximately 25% of lesions.
Low signal intensity is often seen in the periphery of the lesions on T2-weighted MR images. This finding corresponds at least partially to areas of hemorrhage.
Multiple ring enhancing lesions, although more commonly there is mild/vague enhancement.
Dural enhancement with enhancement in adjacent paranasal sinus.
Mycotic aneurysms may be seen on angiography.
Locations of involvement a felt to be secondary to predilection for the lenticulostriate and thalamoperforator vessels: basal ganglia and thalamus, corpus callosum. The corpus callosum is involved in relatively few other processes (e.g., high-grade astrocytoma, cerebral lymphoma, multiple sclerosis, and Marchiafava-Bignami disease). Metastasis and pyogenic abscess do not commonly involve the corpus callosum.

Differential diagnosis in the immunocompromised patient includes
- Lymphoma
- Metastatic disease
- Septic emboli
- Multiple infarcts

Lack of enhancement may suggest the diagnosis of aspergillosis, since most brain tumors enhance. A prospective diagnosis should be suggested in the setting of early infarction and hemorrhage in the brain of an immunocompromised patient, so that antifungal therapy may be instituted.
Definitive diagnosis obtained with biopsy. Neuropathology shows invasion of blood vessels causing hemorrhagic infarction usually subcortical Meningeal infection usually focal & adjacent to infected cerebral region Angular dichotomously branching septate hyphae infiltrates tissue in centrifugal pattern. Hyphae structure tend to be found on borders of large abscesses.


Prognosis is poor with approximately 35% complete or partial response, although improved from previously 90% mortality. Treatment with Amphotericin B iv (liposomal form avoids nephrotoxicity) +/- 5 fluorocytosine often combined with itraconazole.

I Know Where The Wild Things Are!

I'm sooooooo excited! One of my favorite books from my childhood, "Where The Wild Things Are" is going to be released as a 'live-action' movie, directed by Spike Jonze, and will arrive in theaters on October 16, 2009.

The original book, written by Maurice Sendak and winner of the Caldecott Medal in 1964, tells the story of Max, who one evening plays around his home, "making mischief" in a wolf costume (chasing the dog with a fork, and growling at his mom, etc.). As punishment, his mother sends him to bed without supper. In his room, a mysterious, wild forest grows out of his imagination, and Max journeys to the land of the Wild Things. The Wild Things are fearsome-looking monsters, but Max conquers them "by staring into their yellow eyes without blinking once," and he is made "the King of all Wild Things." However, he soon finds himself lonely and homesick, and he returns home to his bedroom, where he finds his supper waiting for him, still hot.

The first trailer has been released, and it is looks awesome! If the movie is as heartwarming, touching and emotional as the trailer, it's going to be great.

So here's two videos..... For those of you that don't know the story of "Where The Wild Things Are", the first video is an animated video of the storybook.

The second video is the trailer for the much anticipated film.....

Craniovertebral Tuberculosis-CT

Some CT images showing destruction of the left lateral mass and odontoid tip. Patient is k/c/o of tuberculosis.

Dr.Sumer K Sethi, MD

Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences)

Reflex sympathetic dystrophy (RSD)

Findings

Three phase technetium 99m labeled MDP bone scan is shown. There is abnormal radiopharmaceutical uptake in the periarticular regions of the left hand and wrist on both immediate and delayed images.

Differential diagnosis:
- Reflex sympathetic dystrophy
- Inflammatory arthritis


Diagnosis: Reflex sympathetic dystrophy (RSD)


Key points

RSD is a poorly understood chronic abnormality of the sympathetic nervous system in a regional distribution (usually the distal extremities) that follows trauma, surgery, infection, casting, or splinting.
Clinically, it presents as severe, protracted pain in the affected limb that is out of proportion to the original injury. Additionally, there may be vasomotor disturbances. Progresses to skin and muscular atrophy.
Synonyms: Sudeck's atrophy, Complex regional pain syndrome type 1, Causalgia.

Three phases have been described:
1) Non focal pain with decreased range of motion, soft tissue edema, and increased skin temperature (lasts weeks to months)
2) Decreasing pain and skin temperature with skin thickening. Atrophy and osteoporosis may become apparent (lasts 3-6 months)
3) Continued pain with increasing atrophy and joint stiffness. Contractures may occur.

May occur in up to 5% of all injuries; most often in the upper extremity.
Typically, affects females more, often less than 50 years of age.
Plain radiographs only 60% sensitive and non-specific, showing osteoporosis of the affected limb with associated soft tissue swelling or atrophy (depending on the stage).
CT also insensitive and non-specific.
MR may show patchy bone marrow edema with stage dependent soft tissue changes.
Nuclear medicine three phase bone scan is the best study for diagnosis of RSD, showing diffuse increased uptake in the affected region on flow images; continued diffuse uptake on blood pool images, beginning to localize to periarticular regions; and continued uptake in the periarticular regions on delayed images.
Delayed images are the best for diagnosis, with a reported sensitivity of near 100%.
A "reversed" pattern of decreased relative uptake in the affected extremity may be seen on bone scan, however. This is most common, but not exclusively, in pediatric patients.
Treatment: medications (steroids, opiates, anti-epileptics, etc.); physical therapy; sympathetic nerve block; surgical sympathectomy.

Tony

Check out this fantastic film about the love and dedication that a father has for his children and the good in everyday people. It's emotional, heart-warming and pretty funny....

The short film stars Tate Donovan as the loving father and is directed by Grant Heslov and George Clooney.

Gas producing otogenic brain abscess with cerebral edema and pseudosubarachnoid hemorrhage sign

Findings

Figure 1: Soft tissue windows demonstrate generalized cerebral edema with loss of grey-white differentiation and near total obliteration of the CSF spaces. An ill-defined hypodense gas containing region is present within the left temporal lobe consistent with abscess formation. The subarachnoid spaces are hyperdense especially in the suprasellar region representing pseudosubarchnoid hemorrhage associated with cerebral edema and/or pyogenic leptomeningitis, not true hemorrhage.
Figure 2: Nondependently layering air is present within the anterior horn of the left lateral ventricle indicating communication between the left temporal lobe abscess and the left lateral ventricle and CSF spaces. On soft tissue windows, normal subcutaneous fat is seen confirming that this is intraventricular air, not fat.
Figure 3 and Figure 4: Bone windows demonstrate total opacification of the middle ear cavity and mastoid air cells consistent with otitis media and mastoiditis. There is subtle bony sclerosis and remodeling which along with the patient’s history is consistent with chronic otitis media with mastoiditis. Also note that there is no evidence of fracture to suggest penetrating trauma as an etiology for these findings. Bone window confirms the presence of air, not fat, in the frontal horn of the right lateral ventricle.


Diagnosis: Gas producing otogenic brain abscess with cerebral edema and pseudosubarachnoid hemorrhage sign


Complications of chronic supurative otitis media include (in order of decreasing frequency):
- mastoid abscess
- meningitis
- postauricular fistula
- lateral dural venous sinus thrombosis
- facial palsy
- cerebellar abscess
- Bezold’s abscess (involving sternocleidomastoid muscle)
- internal jugular vein thrombosis
- epidural abscess
- perisinus abscess
- Gradenigo’s syndrome (due to petrous apicitis)
- interhemispheric abscess
- temporal lobe abscess
- subdural abscess
- serous labyrinthitis
- Luc’s abscess (subperiosteal temporal bone without mastoiditis)

Otitic meningitis is the most common intracranial complication and can occur as a result of direct disease extension from the mastoid through a cortical defect or due to retrograde thrombophlebitis despite an intact appearance of the bone. Otogenic brain abscesses usually occur in the temporal lobe and cerebellum (2:1). Nearly all otogenic brain abscesses have underlying chronic suppurative otorrhea. More than half of all otogenic brain abscesses have an associated cholesteatoma.

Although the relative incidence of complications related to chronic otitis media is debated within the literature, many authors agree that the most dangerous complication is intracranial abscess formation which carries a 40-50% mortality rate. According to Nunez et al, 1.5 % of adults have active chronic otitis media and in an adult with active chronic otitis media, the annual risk of developing an intracranial abscess is about 1:10,000 with a male to female risk ratio of approximately 3:1. Though at first glance this risk appears relatively low, the lifetime expectancy of a 30 year old person with active chronic otitis media developing an abscess is 1:200. Intracranial complications in patients with active chronic otitis media are also more prevalent in adolescents and young adults.

Radiologic evaluation of a patient suspected of having intracranial complications related to active chronic otitis media is crucial to diagnosis and management. Axial CT with contrast is the usual modality of choice preferably with thin cuts, which can demonstrate the presence or absence of an abscess as well as details regarding its size and location. An intraparenchymal mass may show parenchymal low density with mass effect with or without an enhancing capsule. CT may be limited in the setting of acute infections. MRI may improve diagnostic accuracy, with increased sensitivity and specificity.

Etiologic agents usually include anaerobes, Proteus mirabilis, Pseudomonas aeruginosa, Streptococcus, and Staphylococcus. Anaerobic and gram negative bacteria appear to be the most common causes. Consequently, in addition to surgical management, initial treatment should include broad spectrum antibiotics with good cerebrospinal fluid penetration as well as anaerobic coverage. A team approach including an otolaryngologist, radiologist, anesthesiologist, and an infectious disease specialist among others is recommended for optimal outcome.


Pseudosubarachnoid Hemorrhage Sign

A pseudosubarachnoid hemorrhage sign is an unusual neuroradiologic finding which may be present in cases of diffuse cerebral edema and/or pyogenic leptomeningitis. In addition to increased attenuation of the otherwise normal subarachnoid spaces, the falx and tentorium can also appear dense. The etiology of this presentation is unknown. Current theories include: 1) blood-brain-barrier breakdown from microorganism toxins in pyogenic meningitis allowing leakage of dense proteinaceous material into the subarachnoid spaces; 2) cerebral edema causes displacement of CSF from the subarachnoid spaces with engorgement of the superficial pial structures creating a predominantly vascular space with relatively dense intravascular blood. Since management of the causes of subarachnoid and pseudosubarachnoid hemorrhage is quite different, it is important to be able to recognize this relatively rare sentinel neuroradiologic sign.

The Beatles

Paul McCartney and Ringo Starr, the two remaining members of "The Beatles", will be performing at the Radio City Music Hall in New York City on April 4th, 2009. This will be the first reunion of the remaining Beatles since 2002.

Tickets for the show allegedly sold out in nine seconds.

The concert will raise funds for "The David Lynch Foundation" promoting Transcendental Meditation in schools. NOT A JOKE.

Oh My God! Oh My God! Oh My God!

This video, titled 'Married To The Eiffel Tower', covers the strangest/saddest topic ever. It's a documentary about Objectum Sexuality, covering people who fall in love with inanimate objects.

The filmmaker follows three different women.

The first woman profiled is Erika La Tour Eiffel, whose last name was changed after she was married, in a ceremony with an officiant, to the Eiffel Tower. Throughout the film, she confesses her love for the Golden Gate Bridge, an archery bow, random fences and bridges, her wife Mrs. Eiffel Tower, and the Berlin Wall.

The second woman, Amy, is in love with a chuch pipe organ that she named 'Paul', a bannister in her church, and a carnival ride in Germany. The narrator even follows her and films a super awkward scene in which Amy spreads the grease from the carnival ride all over her hands and face and proceeds to make out with the carnival ride.

The third woman is Eija-Riitta Berliner-Mauer, which translates to Mrs. Wall. Of course her name was changed after she was married to the Berlin Wall. But she didn't get married to the Berlin Wall until after she ended her relationship with a guillotine.

It's amazing how the documentary covers their intimate experiences with these objects. It's a total of 45 minutes long, however, it's gripping and if you can ignore the interviews about the past experiences that caused damage to the lives of these women, then you'll see a very funny documentary.

If you're thinking that you don't want to watch the videos, let me restate this point, IT'S A MOVIE FOLLOWING WOMEN WHO LOVE AND HAVE SEX WITH INANIMATE OBJECTS!!!!!

Calendar

All right, one more..... Did you know that in any given year, the dates 4/4, 6/6, 8/8, 10/10, and 12/12 fall on the same day of the week. This year it's a Sunday.

Barack-ets

Every time I see this guy, I'm more and more impressed with the fact that he doesn't seem like a smarmy douchebag politician.

This video is eleven minutes of Barack Obama talking to ESPN's Andy Katz about his bracket picks for the NCAA basketball tournament. It's very long and very boring, but it displays Obama as a regular likeable guy. There's something about him that makes me feel comfortable, and I don't get that knot in my stomach that I get when I see other politicians speak.

I picked UNC to win it all too, so I hope he's as good at choosing the winners as he is at running the country.

Levitating Water

It was my anniversary last night, so all I'm posting today is this short video showing what seems to be droplets of water moving up and down in mid air, however, it's just an effect using strobe lights and streams of water. It's like magic!

Medial Tibial Stress Syndrome-MRI & CT

Medial Tibial Stress Syndrome, also known as “shin splints”, is an early stage in the continuum that culminates in a stress fracture. The pain is typically posteromedial soreness and the diagnosis is usually made clinically without the need for further imaging assessment. On a microscopic level, repetitive stress leads to osteoclastic resorption exceeding osteoblastic bone regeneration. The associated edema along the periosteum and endosteum of the bone is visible on MRI. Periostitis may be directly caused by traction at muscle or fascial attachments, or may be a response to developing changes in the underlying bone. The relative roles of compressive versus torsional forces in the development of Medial Tibial Stress Syndrome and ultimately stress fractures, has been debated. Recent work appears to favor the latter. Compressive forces account for the transverse, often subchondral, stress fractures in the proximal tibia. Torsional forces may be of greater significance in the tibial shaft, and may account for the higher number of longitudinal fractures.

Clinical histories in patients with stress fractures may be atypical. This case for example had history of pain and was being labelled as normal or non-specific. Clues to the MRI diagnosis of longitudinal fracture of the tibial shaft include edema distribution along the endosteum and periosteum of one cortex, most often posteriorly or anteromedially. The axial images are frequently diagnostic, demonstrating a linear lucency on multiple sequential images, and often endosteal and periosteal callus formation. The sagittal or coronal sequences are helpful in demonstrating the length of involvement and the site of greatest edema, which indicates the most likely fracture site. A fracture line is occasionally visible on the coronal or sagittal sequences, depending on fortuitous positioning of the image slice relative to the affected cortex. MRI is well suited for distinguishing between stress fractures and pathologic fractures. Well-demarcated T1 signal abnormality, endosteal scalloping, and an adjacent soft tissue mass are each indicators of neoplasm rather than stress fracture.

Dr.Sumer K Sethi, MD
Sr Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences)

One Second Ad

Did you guys see the one second ad during the Super Bowl? There was apparently a huge amount of hype behind it....

Here are three videos, the first video shows the hype for the one second commercial, the second video shows the one second commercials that they decided not to use, and the third video shows the one second commercial that appeared during the Super Bowl.....Enjoy!

Happy Anniversary

Happy Anniversary to my beautiful wife..... I would be nothing without you! I love you!

Let me not to the marriage of true minds
Admit impediments. Love is not love
Which alters when it alteration finds,

Or bends with the remover to remove:
O no! it is an ever-fixed mark
That looks on tempests and is never shaken;
It is the star to every wandering bark,
Whose worth's unknown, although his height be taken.
Love's not Time's fool, though rosy lips and cheeks
Within his bending sickle's compass come:
Love alters not with his brief hours and weeks,
But bears it out even to the edge of doom.
If this be error and upon me proved,
I never writ, nor no man ever loved.

Shakespeare Sonnet 116

Why Don't We Call Them Stewardesses Anymore?

I flew back home from Seattle Washington last night. The flight attendant started the announcements by asking if anyone had lost a wallet, and she said she was holding it at the front of the plane. As everyone looked up to see what the wallet looked like, the flight attendant said, "Now that I've got your attention, here are the safety announcements". What a tricky lady.

I hope to get this guy on my next flight! He's fun and he can find words that rhyme with flotation device. All I could come up with is 'schmotation reschmice"

Inramuscular Cysticercosis-CT

Note the bulky left sternocleidomastoid muscle along with cyticercosis cyst showing an eccentric scolex. Patient had been worked up for neck swelling with no conclusion.

Retinoblastoma

Findings

Large calcified mass in the left lobe optic globe posteriorly in contact with the optic nerve. Left optic globe size near symmetric with the right.

Differential diagnosis:
- Retinoblastoma
- Persistent hyperplastic primary vitreous
- Coat's disease
- Toxocara infection
- Phthisis bulbi


Diagnosis: Retinoblastoma


Discussion

Retinoblastoma arises from a cell of neuroepithelial origin, usually in the posterior retina. It is the most common malignant eye tumor of childhood and is responsible for 1% of all deaths from cancer in the age group of newborns to 15 years. Retinoblastoma can be multifocal and bilateral (30%); it undergoes spontaneous regression more frequently than other tumors; has a high incidence of second primary tumors; and occurs as a congenital tumor.

Retinoblastoma affects all racial groups. It occurs in approximately 1:15,000 to 1:34,000 live births. The majority of cases are diagnosed before the age of four and the incidence declines with age. It affects males and females with equal frequency.

Retinoblastoma occurs in both familial (40%) and sporadic (60%) patterns. Familial cases typically develop multiple and bilateral tumors, although they may be unifocal and unilateral. Sporadic cases are always unilateral and unifocal.

Retinoblastoma serves as prototype for a group of cancers caused by recessive loss of suppressor cancer genes. These include osteosarcoma, Wilm's tumor, hepatoblastoma, rhabdomyosarcoma, uveal melanoma, bladder cell carcinoma, acoustic neuroma, and meningioma. Retinoblastoma and osteosarcoma arise after the loss of the same genetic locus (13q14 band).

Tumor cells may disseminate through the choroidal vasculature or may spread beyond the eye through the optic nerve or subarachnoid space. In advance cases, the tumor may penetrate through the sclera and grow in the orbit. Metastases to the preauricular and cervical lymph nodes commonly follow over extraocular extension. The most common sites of distant metastases are the CNS, skull, distant bones, and lymph nodes. Spontaneous regression occurs in 1% of cases.


Diagnosis

The diagnosis is usually made before age 2 when a white reflex from the pupil ("cat's eye") or leukokoria, strabismus, or eye pain is investigated. Ophthalmoscopy and CT scans are helpful.


Therapy

If diagnosed when the tumor is intraocular, >90% can be cured. Enucleation and removal of as much optic nerve as possible usually manage unilateral cases. In asymmetric bilateral cases, the more involved eye is enucleated and the other eye is treated by photocoagulation, cryotherapy, radiation, and systemic antimetabolites- often in combination. Spinal fluid and bone marrow aspirated should be examined for metastases. Family members should be examined.


Radiology

CT demonstrates a solid retrolental hyperdense mass with associated retinal detachment. Associated findings include extraocular extension, optic nerve enlargement, and partial or complete calcification. Calcification is commonly seen and is a good prognostic indicator; contrast enhancement is a poor prognostic indicator.

36 Songs - Four Chords

I'm in Lake Stevens, Washington to look at some apartment complexes for work this week and I want to write a blog about how incredibly cold it has been.... However, I am sitting in my hotel room while the guests in the room next to me are screaming, giggling and throwing themselves against the wall.

So here you go, this is all you get.... A comedy band from Australia called 'Axis Of Awesome' put together a medley of 36 songs that use the same four chords.

Literally?

Do they still make music videos anymore? I grew up in the music video generation, and most videos sucked.... Michael Jackson occasionally released a music video that would amaze everyone, like he did with the 'Thriller' video....

Do you ever wonder why the actions in music videos typically have nothing to do with the lyrics in the song? Ever wish songs just sang what was happening in the music video?

Well, someone took the music videos for the Tears For Fears' song 'Head Over Heels' and a ha's song 'Take On Me' and made the lyrics match the actions in the videos.

Suspected Homocystinuria-MRI

Dorso lumbar curvature is altered with kyphotic-deformity in the lower dorsal spine. There is mild scoliosis with concavity to right. There is mild anterior wedging of D12 & L1 vertebral body with degenerative changes in form of marginated osteophytes, endplates irregularity, multi-level schmorl’s nodes & disc space narrowing. Disc dessication is seen as loss of T2 bright signal of nucleus pulposus. Also noted is dural ectasia involving the sacral canal along with bilateral lateral meningocele in the sacral region.

Opinion- 24 yrs old male with kypho-scoliotic deformity with disco-vertebral degenerative changes, mild D12/L1 anterior wedging, multi-level Schmorl’s nodes & sacral dural ectasia & lateral meningoceles. D/ D includes homocystinuria, scheurmann’s disease (may be associated NF-1)