Another Reason To Not Go To Florida

CBS News reported today that a wild 17-foot long Burmese Python was captured in Okeechobee County. The snake wieghed in at 207 pounds and was 26 inches in diameter.... WILD GIANT MAN EATING SNAKES!!!! No thank you....

New Redskins Rookie Can Jump

The Washington Redskins might be fun to watch this year.... The Redskins signed rookie wide receiver Keith Eloi from the University of Nebraska - Omaha in May. This guy is awesome! Not only can he jump into a truck....

He can jump out of a pool.... BACKWARDS!

4 Years Old!

Noah turns four years old today! I know! Crazy right? It might not sound like a huge accomplishment, but seriously, I'm like Lennie from "Of Mice and Men". All my well read readers are laughing right now....

Lateral Patellar Tilt

The role of patellofemoral malalignment in anterior knee pain has been shown by many investigators. Detection of lateral displacement was the sole purpose of earlier studies until Laurin et al. introduced the concept of patellar tilt as a form of malalignment. This tilt could be observed even with the patella completely reduced in the femoral groove, and was therefore independent of the mediolateral position of the patella.

Reported bt Teleradiology Providers

People, We Live In California, This Is Our Home

Pack up the bags my dear, we're moving to Santa Cruz! I originally titled this blog "The Iraq, And Such As", because there's no way you can watch this video without thinking of Miss South Carolina.... This woman should really go to work for the State of California, the budget issues would have been solved a long time ago....

Now if you'll excuse me, one of the east coast slaves just stopped tending to the vegetable trees....

Hole In One

This is literally the most awesome hole in one ever!



And just for good measure.... Here's the second most awesome hole in one ever!

Unusual pancreatitis causes and appearances in Radiographics 2009

Alampady Krishna Prasad Shanbhogue, Najla Fasih, Venkateswar R. Surabhi, Geoffrey P. Doherty, Divya Krishna Prasad Shanbhogue, and Sumer K. Sethi
A Clinical and Radiologic Review of Uncommon Types and Causes of Pancreatitis. The clinical and radiologic features of various uncommon types of acute and chronic pancreatitis, congenital pancreatic anomalies associated with pancreatitis, and some unusual causes of pancreatitis are discussed and illustrated.

RadioGraphics 2009 29: 1003-1026 (DOI: 10.1148/rg.294085748); [Abstract] [Figures Only] [Full Text] [PDF]

This site is number 11 in Top 50 Blog (radiológia)

This blog is rated as number 11 in top 50 of the Radiology blogs in Top 50 Blog (radiológia)

All Obama Has To Do

Albert Einstein

This is Albert Brooks. He's an amazingly talented comedian and actor. You've seen him everywhere. He's the voice of Marlin, Nemo's father, in "Finding Nemo". He was nominated for a "Best Supporting Actor" Academy Award in 1987 for his role in the movie "Broadcast News"....

Did you know that his real name is Albert Einstein? He changed it before he started his career, so he wouldn't be mixed up with the famous physicist.

Also, did you know he is the older brother of Bob Einstein? Better known as MR. SUPER DAVE OSBORNE!!!!

A Cruise Along the Pasig River

I have always wanted to ride on the Pasig River ferry boat to experience what it would be like to cruise on Manila's most famous and most polluted river. More importantly, I want to see for myself the extent of the river's pollution, and what the Pasig River Rehabilitation Commission (PRRC) had done so far to clean and resurrect it. As you may know, the Pasig River has been officially declared as a dead river, which means it can no longer sustain any kind of marine life, maybe except for the catfishes and the janitor fishes which even thrive on murky polluted waters.

And so one clear Saturday afternoon, I went to the ferry terminal in Quiapo (under the Quezon Bridge), and paid forty pesos for the one-hour trip from Quiapo to Nagpayong, the last station of the ferry. The ferry's captain and stewards allowed me to photograph views while I was standing on the front deck of the ferry's bow. However, the kindly captain warned me that photographing anything near or on the vicinity of the Malacanang Palace is prohibited. Or else, Palace guards on boats may confiscate my camera and charge me with espionage. I said that it was fine, since I didn't want to photograph the President or her palace. I prefer photographing the common people.

When the ferry accumulated enough passengers, we began our Pasig River cruise. It was fascinating to observe Manila from the Pasig River. The cruise was relaxing as the ferry glided quietly along the river. Here and there, birds would flock on the clear sky while a few would rest or pluck something from the water lilies that abound floating on the river.

Although this cruise offered an escape from the hub and noise of Manila city life, yet I quickly realized that this was not sightseeing. There were just too many distressing sights. The river's waters in itself was a disturbing spectacle. It was colored dark brown and there were many refuse and trash floating around. Here and there youths in their teens were swimming in the river despite the public warnings that the Pasig's waters was contaminated with chemicals and pollutants.

Through the years, factories and human dwellings have polluted the Pasig River. In the beginning, the river provided a source of food and clean water to the people living along its banks, but in the more recent industrialized times it had also become a gigantic garbage dumpsite, chemical refuse site of factories, and a sewerage and public lavatory of people.

Yet, there is still hope to revive the Pasig River. No matter if it will take decades or even a century to clean it up, with our joint efforts, we can still make this polluted river a flourishing and life-giving river.

At this point I would just let the pictures paint the proverbial "thousand words"--although I must add a few more words of my own.

A "kalakal" boy in his makeshift boat made of styrofoam gathering kalakal--any trash or refuse that can be sold to the junk shops

Although the Pasig Coast Guards and the PRRC have already banned public swimming in the river, many youngsters still bath and swim in the polluted river. For the boys it was great fun, while they were unaware that they were exposing themselves to the deadly bacteria and chemicals of the polluted river.

The PRRC has vowed to remove all human habitations three meters from the river banks. But I observed that there are still houses that remained jutting out in the river. The people use the river as their lavatory.



And more houses. You can see at the bottom of the picture the drainage from the sewerage flowing directly to the river. The smell of the waters is not so nice here.



The river bank is also home to the giant oil refineries and repositories, such as this one.



"Kalikasan Mahal Ko, Ilog Pasig Aalagaan Ko". A bridge that is literally over troubled waters. The dirty signage literally and ironically means in English: I love the environment. I will take care of the Pasig River".



Another group of boys enjoying the cool polluted waters amidst the heat of afternoon sun.

The Nagpayong Terminal in Pasig, the last terminal of the Pasig River Ferry.



Kalakal boys after a hard day's work gathering refuse from the river--using this raft of bamboo. They were very happy because each of them earned 35 pesos (about $0.75) for a whole day of collecting refuse in the Pasig. A nice day's earnings according to the boys.


We may no longer be alive when the dream of a clean Pasig River comes true--but our children and grandchildren may be, and for that we will be remembered for eternity.

Radiology 2.0-- An Update

Webicina.com has come up with extensice collection about web 2.0 resources in radiology. My blog also features in the blogosphere link. Do check out for the best in the world of radiology 2.0 in one location.

Turtle Love

I've been debating for about a week about whether or not I wanted to post this video. After watching it about thirty times (and laughing every single time), I've come to the conclusion that it's worth posting.... It funny, cute and disturbing all at the same time....

Brain abscess

Findings

There is an intra-axial mass, located in the posterior left frontal lobe, in the superior frontal gyrus just anterior to the precentral gyrus. There is surrounding vasogenic edema, which expands the left precentral gyrus. Mass shows a well-defined rim on MR, somewhat irregular, consistent with a capsule. Central portion shows pronounced diffusion restriction.

Differential diagnosis:
- Abscess
- Metastasis
- Glioblastoma
- Infarct
- Demyelinating disease


Diagnosis: Brain abscess


Key points

A brain abscess is a focal, suppurative infection within the brain parenchyma, typically surrounded by a vascularized capsule.
The most common symptom in patients with a brain abscess is headache, occurring in >75% of patients.
MRI is better than CT for demonstrating abscesses in the early (cerebritis) stages and is superior to CT for identifying abscesses in the posterior fossa.
On contrast-enhanced T1-weighted MRI, a mature brain abscess has a capsule that enhances surrounding a hypo dense center and surrounded by a hypo dense area of edema.
On T2-weighted MRI, there is a hyper intense central area of pus surrounded by a well-defined hypo intense capsule and a hyper intense surrounding area of edema.
The distinction between a brain abscess and other focal CNS lesions such as primary or metastatic tumors may be facilitated by the use of diffusion-weighted imaging sequences on which brain abscesses typically show increased signal and low apparent diffusion coefficient.

Ring-enhancing lesion differential (MAGIC DR) :
- Metastasis
- Abscess
- GBM
- Infarct
- Contusion
- Demyelination
- Radiation necrosis

Serial MRI or CT scans should be obtained on a monthly or twice-monthly basis to document resolution of the abscess.

Quote Unquote

Did you know that Darth Vader never said "Luke, I am your father."? In a recent poll, that line was voted as the "#1 Misquoted Movie Line Of All Time". What he actually says is "No, I am your father." And did you know that "Beam me up, Scotty!" was never used in the Star Trek television or movie series? Here are a few other commonly misquoted movie lines....

From Snow White and The Seven Dwarfs:

Misquoted: "Mirror, Mirror on the wall, who is the fairest one of all?"
Quoted: "Magic Mirror on the wall, who is the fairest one of all?"

From Dirty Harry:

Misquoted: "Do you feel lucky, punk?"
Quoted: "You've got to ask yourself one question: 'Do I feel lucky?' Well, do ya, punk?"

From Casablanca

Misquoted: "Play it again, Sam."
Quoted: ""You played it for her, you can play it for me. If she can stand it, I can. Play it!"
(Ingrid Bergman says "Play it, Sam!")

From Silence of the Lambs:

Misquoted: "Hello, Clarice."
Quoted: "Good evening, Clarice."

From The Wizard Of Oz:

Misquoted: “I don’t think we’re in Kansas anymore, Toto”
Quoted: "Toto, I've a feeling we're not in Kansas anymore."

Matter Of Minds

"Be who you are and say what you feel,

because those who mind don't matter,

and those who matter don't mind."

Dr. Theodor Geisel

Dr. Seuss

Alice In Wonderland Trailer

Here's the first trailer for Tim Burton's Alice In Wonderland movie. Don't get me wrong, I like Johnny Depp, but they appear to be marketing the movie as if he's the only actor in the movie.... By the way, did you know that Christian Bale stars in Public Enemies alongside Johnny Depp?

UPDATE: Wow.... Disney has apparently waved their magic wand and put the kabash on the trailer.... Here's a few more pictures to enjoy.....

UPDATE #2: It's back.... Ok... Watch it while you can.... Until Disney decides to take this one down too....

Yo Quiero Gidget

I don't know if I'm going to be able to stay at work today. I am heartbroken.... Gidget the Chihuahua died last night at the age of 15.

She is best known for her role as the Taco Bell Chihuahua, however, you may know her from her role in the Geico commercials alongside the Geico gecko, or how she stole the scenes away from Reese Witherspoon in "Legally Blonde 2: Red, White and Blonde"!

Always know Gidget, "Yo still quiero Taco Bell"..... Does anyone know how to say the word "still" in spanish?

Paraduodenal Hernia-CT

Intestinal obstruction is a common clinical condition that is usually suspected on the basis of clinical signs and patient history. Internal hernias are rare cause for intestinal obstruction. Para duodenal hernias constitute approximately 53% of all internal hernias

Lesser Of Two Evils

"Constantly choosing the lesser of two evils, is still choosing evil."

Jerry Garcia

Chiari II Malformation

Findings

T1-weighted sagittal images (Figure 1 and Figure 2) and T2-weighted axial images (Figure 3, Figure 4, and Figure 5) of the brain demonstrate a small posterior fossa with herniation of the cerebellar tonsils through the foramen magnum and a beaked appearance of the tectum. There is associated hydrocephalus.

T2-weighted sagittal (Figure 6 and Figure 7) and axial (Figure 8 and Figure 9) images of the spine demonstrate a myelomeningocele at the level of the lower lumbar spine.


Diagnosis: Chiari II Malformation


The Chiari II malformation is a complex anomaly with skull, dural, brain, spinal and spinal cord manifestations. It is regarded as a disease of primary neurulation and is almost invariably associated with a myelomeningocele. There are multiple associated findings, to include; protrusion of the cerebellar tonsils through the foramen magnum, extension of the cerebellar hemispheres and vermis above the incisura of the tentorium, beaked appearance of the tectum, fenestration of the falx, hydrocephalus, a prominent massa intermedia, colpocephaly, and dysgensis of the corpus callosum.

The Chiari II malformation is the most common serious malformation of the posterior fossa, with a frequency of approximately 1 case per 1000 population. Hindbrain dysfunction is the major cause of mortality. The mortality rate is 15% in the first few years of life and is reported to be as high as 50% for the long term rate, regardless of the treatment strategy.

MRI is currently the best diagnostic method for detecting the full constellation of findings associated with Chiari II malformations. CT scans are commonly performed to assess for hydrocephalus as well as to follow up infants who have undergone a ventriculoperitoneal shunt procedure. Many of the typical findings described by using cranial CT scans and MRIs also can be demonstrated on cranial sonograms. Ultrasound has the benefit of not using ionizing radiation, however it is heavily operator dependent and some of the associated abnormalities may be missed.

F-Minus

I was reading the comics page in the Orange County Register last week, and wondered to myself, "When did comics become so unfunny?" Well, here's a really funny comic, well, the strips I posted here are pretty funny. Why isn't this comic strip in the OC Register? I guess they can't find room between the HI-larious Garfield and B.C....

Subacute combined degeneration

Findings

MRI of the thoracic and cervical spine show increased T2 signal within the posterior columns and the lateral corticospinal tracts on axial imaging. On sagital imaging, a longitudinal T2 signal abnormality is noted within the dorsal cord. There was no significant contrast enhancement status post gadolinium administration.

Differential diagnosis:
- Subacute combined demyelination
- Multiple sclerosis
- Astrocytoma
- Spinal cord infarction
- Infectious myelitis


Diagnosis: Subacute combined degeneration.


Vitamin B12 deficiency is the result of a malabsorption syndrome and can affect the brain, optic nerves, peripheral nerves and spinal cord. When patients present with myelopathy, such as sensory disturbances, weakness, and spasticity, it is known as subacute combined degeneration (SCD).

Clinical presentation of SCD is caused by dorsal column, lateral corticospinal tract, and sometimes lateral spinothalamic tract dysfunction. Patients initially present with paresthesia in the hands and feet, which can progress to sensory loss, gait ataxia, and distal weakness particularly within the legs. If the disease goes untreated, ataxic paraplegia may evolve. On physical exam, there is a loss of vibratory and joint position sense, weakness, spasticity, hyperreflexia, and extensor plantar responses. The diagnosis of B12 deficiency is made by serologic studies showing low serum B12 level; if the B12 level is borderline, elevated levels of homocysteine and methylmalonic acid help cinch the diagnosis.


Neuroradiology

Radiologic manifestations of SCD may be seen on MRI imaging, primarily within the cervical and thoracic spine, and include the following spinal manifestations:
- Mild spinal cord expansion and hypointensity on T1 weighted imaging.
- Increased T2 signal intensity primarily within the dorsal columns +/- lateral columns.
- Longitudinal dorsal cord T2 signal abnormality.
- Inverted "V" or "rabbit ears" T2 signal intensity within the dorsal spinal cord on axial imaging.
- Possible mild dorsal column contrast enhancement, with enhancement signifying breakdown of the blood nerve barrier.


Differential considerations

Although these MRI findings are consistent with SCD, they are nonspecific and include a broad differential diagnosis: demyelinating disorders, infectious etiologies, inflammatory conditions, ischemia, contusion, and neoplasms. However, SCD can be distinguished from other differentials given its bilateral nature of T2 signal abnormality over multiple levels that is confined to specific white matter spinal tracts. There can be partial to full reversal of MRI abnormalities following B12 therapy, with fifty percent of patients fully recovering and with the greatest recovery occurring when treatment is began in the early stages of the disease.

Multiple sclerosis is a demyelinating disorder with multiple lesions separated in time and space. MRI spine findings included increased T2 signal intensity and hypo or isointense T1 signal within lesions. These lesions, however, are more focal and well-circumscribed in nature compared to the contiguous lesions of SCD and show homogenous, nodular, ring enhancement of acute and subacute lesions status post contrast administration. Multiple sclerosis lesions rarely spans more than one or two vertebral segments and are usually not symmetric in nature.

Astrocytoma of the spine is an intramedullary glioma, more often located in the cervical than thoracic spine. This lesion presents as a hyperintensity on proton density and T2 weighted imaging, and almost always enhances. On T1 imaging, there is cord expansion, usually less than four segments. Again this is distinguished from SCD by location (intramedullary T2 signal intensity versus dorsal and lateral columns) and contiguity (SCD is contiguous over multiple vertebral segments).

Spinal cord infarction causes permanent tissue loss in the spinal cord secondary to vessel occlusion and usually presents hyper acutely. On MRI imaging, focal T2 hyperintensities can be seen in the gray matter, gray matter with adjacent white matter, or an entire cross section of the cord. These lesions are usually within the thoracic cord as it is an arterial border zone. T2 hyperintensities may also bee visualized within the anterior vertebral body bone marrow or deep medullary portion near the endplate secondary to vertebral body infarction. Diffusion weighted imaging shows restricted diffusion in the affected areas of the cord. Slight cord expansion and decreased signal is noted on T1 imaging. The MRI lesion distribution, bony involvement and diffusion changes differentiate spinal cord infarction from SCD.

Infectious myelitis can be secondary to HIV vacuolar myelopathy, varicella-zoster/herpes, or Lyme disease. On T1 imaging, there is cord expansion that nearly fills the spinal canal and variable, nonfocal enhancement status post contract administration. On T2 imaging, there is diffuse increased signal intensity throughout the involved segment, secondary to a swollen edematous cord. Unlike SCD, the signal abnormalities are not limited to the spinal tracts. However, MRI imaging findings may be identical to B12 deficiency and in such cases, can be distinguished by clinical presentation and laboratory findings.