New Year's Eve!

It's New Year's Eve! 2009 brought us our little Lucy, so I can't say that it's been a bad year.....

Anyway, I've been sitting here for the past hour trying to think of some of the big, exciting things that have happened in 2009, and a way to make them funny and entertaining.... So much happened last year that it's hard to keep it all straight.... So instead of writing a blog with random list of mostly unfunny jokes about what happened in 2009, I'll leave you with a succinct, funny and complete recount of 2009 from JibJab.... I had to watch it a couple of times to see everything in the video....

Well, here's one thing.... Barack Obama was inaugurated as President of the United States.... Can you believe that it hasn't even been a whole year since he's been the President? It feels like he's been the President for the past ten years! See it could have been a whole post with jokes like that.... Don't worry, you can put away your drum set.... No rim shot today.

New Year Firecrackers and Fireworks

For many Filipinos, welcoming the New Year would not be complete without lighting firecrackers or fireworks, a long-held tradition that has, however, produced unfortunate outcomes. There are several cases of human injuries as a result of mishandling firecrackers, especially the big ones called Pla-Pla, Bawang, Super Lolo-- firecrackers that almost resembled small bombs. Just how many fingers have already been lost because of these dangerous firecrackers I have no idea, but go ask Vice-President Noli De Castro who in his days as Magandang Gabi Bayan anchor has intrepidly reported the very worst of injured cases. Yet, these firecrackers still continue to be produced in mass quantities, despite the ban on them by government laws.

But there are also many Filipinos who prefer the fireworks display, which although safer, also has its dangers. If handled correctly, these fireworks produce amazing displays of lights in the sky, and many people wanted to view and photograph them (including me).

And then lastly, there are those Filipinos who just prefer honking the horns of their vehicles, or clanging batyas, or, as in my case, I would just be blowing on the very simple and kid-friendly torotot to celebrate the coming of the New Year.

Meanwhile, here are some New Year's Eve photos of Bocaue, Bulacan, fireworks-producing capital of the Philippines, and the brisk business of the fireworks industry in the Philippines.

HAPPY NEW YEAR!!!

Nephro-radiology Rounds

Our case of massive renal angiomyolipomas is featured on Pediatric Nephrology Site.

Nephrorad Case Files. Check out the site for many more updates in Pediatric Nephrology.

United State Of Pop 2009 - Blame It On The Pop

DJ Earworm is back! Don't let the name fool you, he's very talented.... Last year, he took every one of the songs from the Top 25 Billboard Hits in 2008 and made a Mashup with a video called the 'United State of Pop 2008 - Viva La Pop'.

He's at it again, taking ALL 25 songs from the Top 25 Billboard Hits in 2009 and made a Mashup with a video called the 'United State of Pop 2009 - Blame It On The Pop'. 25 songs, 25 videos, and somehow they all fit together in a flawless stream of artistic madness.


Here's the list of the songs he includes in the mashup:

The Black Eyed Peas - Boom Boom Pow

Lady Gaga - Poker Face

Lady Gaga Featuring Colby O'Donis - Just Dance

The Black Eyed Peas - I Gotta Feeling

Taylor Swift - Love Story

Flo Rida - Right Round

Jason Mraz - I'm Yours
Beyonce - Single Ladies (Put A Ring On It)
Kanye West - Heartless
The All-American Rejects - Gives You Hell
Taylor Swift - You Belong With Me
T.I. Featuring Justin Timberlake - Dead And Gone
The Fray - You Found Me
Kings Of Leon - Use Somebody
Keri Hilson Featuring Kanye West & Ne-Yo - Knock You Down
Jamie Foxx Featuring T-Pain - Blame It
Pitbull - I Know You Want Me (Calle Ocho)
T.I. Featuring Rihanna - Live Your Life

Soulja Boy Tell ‘em Featuring Sammie - Kiss Me Thru The Phone
Jay Sean Featuring Lil Wayne - Down
Miley Cyrus - The Climb
Drake - Best I Ever Had
Kelly Clarkson - My Life Would Suck Without You
Beyonce - Halo
Katy Perry - Hot N Cold

And here's the awesome video!

He's not paid to put these together, so you can download the music mashups from his site for free!

Click on the banner below to go see his mashup site:

Labyrinthine ossificans

Findings

On the left, there is severe ossification and encroachment of the cochlea with extension to the vestibule and semicircular canals, which are also severely involved. The cochlear aqueduct is slightly stenotic. On the right, there is peripheral osseous hyper density of the cochlea with mild encroachment.

Differential diagnosis:
- Labyrinthine ossificans
- Cochlear aplasia
- Intravestibular schwannoma
- Cochlear otosclerosis
- Labyrinthine schwannoma


Diagnosis: Labyrinthine ossificans


Key points

Most common cause of acquired childhood deafness
Most common clinical presentation – bilateral sensorineural hearing loss 2-18 months after meningitis
May also occur after other infectious, inflammatory, trauma, or surgery
After meningitis or hematogenous infection – bilateral
After otitis media – unilateral
Rarely – severe vertigo
Suppurative membranous labyrinthitis starts inflammatory cascade which leads to fibrosis and eventually ossification
Dedicated IAC/temporal bone CT best for detection
Mild – mild increased haziness in the fluid spaces of the membranous labyrinth and prominent modiolus
Severe – complete obliteration of the membranous labyrinth with bony replacement of the fluid spaces
On MR, low signal bone encroaches (mild) or obliterates (severe), high signal fluid spaces of the membranous labyrinth
Importance – must identify cochlear labyrinthitis ossificans before cochlear implant so that it may be surgically treated
Treatment – cochlear implant, or labyrinthectomy for severe vertigo

MVPuppets 10

I'm not quite sure where Nike plans to go with these MVPuppets commercials, but you've seen all of the other MVPuppets videos here..... Why not keep the tradition going.....

I understand the Kobe and LeBron relationship. Two of the best players in the NBA, both very popular and both polarizing figures.... The Kobe and LeBron puppet commercials are pretty funny, and I know you've been dying to find out who took LeBron's new shoes....

I'm not sure if I understand Nike's intentions with the Santa and Blitzen puppet commercials (Yes, I realize I'm a little late to the game with the Santa commercials).... I think someone had some extra puppet making material that he didn't know what to do with.... Who came up with the idea to make a menacing Santa and reindeer who want to throw down on the basketball court?

Small Airway Disease on Dynamic HRCT

Small airway disease is manifested by mosaic appearance on inspiratory film with areas of low attenuation and patchy ground glass haze. These low attenuation areas become more prominent on expiration indicating air trapping because of underlying small airway disease. This is a 40 year old female with tuberculosis.

Upular Remix

Last month, I posted a 'Hook' remix video from a talented young DJ from Australia. He uses video clips and sounds from movies, and adds some synthesizers, drums and bass to make amazing remix videos, and he's created another awesome remix video from Pixar's movie 'UP'.

By the way, you should really see 'UP' if you haven't already.... And if you have seen 'UP', how good was the first 15 minutes of the movie?

By the way.... If you click on the banner below, it will take you directly to his YouTube channel where you can see the rest of his videos. Do yourself a favor and check them out.... They're awesome!

Colloid cyst

Findings

The CT of the paranasal sinus shows a circumscribed hyper dense homogenous mass at midline anterior to third ventricle. The MRI of the brain shows an approximately 1 cm circumscribed mass location as above. Isointense on T1. Iso/slight hyper intense on T2. Hyperintense on FLAIR. No diffusion restriction or enhancement. Some heterogeneity of inferior margin (seen on sagittal). There is hydrocephalus of the left lateral ventricle.

Differential diagnosis:
- Colloid cyst
- Pseudocyst (CSF flow artifact)
- Choroid plexus papilloma
- Glioma
- Hamartoma
- Neurocysticercosis
- Granulomatous disease


Diagnosis: Colloid cyst


Colloid cyst

Not a true neoplasm; rather a remnant from embryonic endoderm
Contains variable contents including mucinous secretions and desquamated epithelial cells. This variability accounts for variable MRI signal characteristic
Usually present in 3rd to 4th decade
2% of all intracranial masses, 15-20% of all intraventricular masses
Only 10% show growth
Classic clinical scenario is acute onset headache (duet to acute obstruction and hydrocephalus) which is reproduced with tilting head forward (Brun phenomenon)
Fatalities reported due to this lesion (though not common)


Radiologic overview of the diagnosis

The location of this lesion is nearly pathognomonic = Attached to anterior/superior 3rd ventricular roof, wedged into foramen of Monro, with pillars of fornix draped around cyst.
Variable size at presentation, mean size = 15 cm
May be associated with ventriculomegaly

CT:
- 2/3 hyper dense, 1/3 iso- to hypo- dense (dependent on hydration state)
- Usually no enhancement, rarely rim enhances

MRI:
- T1WI usually hyper intense (2/3), 1/3 isointense
- T2WI majority isointense, but more variable, reflects hydration content of internal materials
- Can see fluid-fluid levels
- FLAIR: Does not suppress (hyper intense)
- DWI: No restriction
- Rare rim enhancement

Os styloideum (carpe bosse disease)

The os styloideum is an ununited bony protuberance, located on the dorsum of the wrist at the base of the second and third metacarpals. The association between dorsal wrist pain or fatigability and an os styloideum is known as carpal bossing (carpe bossu disease). There is an accessory ossicle between capitate and trapezoid with marrow edema in the ossicle and trapezoid. This may indicate a symptomatic os styloideum.

Second opinion by- Teleradiology Providers

Posterior reversible encephalopathy syndrome (PRES)

Characteristic imaging pattern in PRES is the presence of edema involving the white matter of the posterior portions of both cerebral hemispheres, especially the parieto-occipital regions, in a relatively symmetric pattern that spares the calcarine and paramedian parts of the occipital lobes. Recently, studies with diffusion-weighted sequenceshave shown increased apparent diffusion coefficients (ADCs) in the involved regions which suggests reversible vasogenic edema as an underlying pathophysiology. This is a 7 year old girl with classical MRI findings

Reported by Teleradiology Providers

DAMS Best for MD/MS/MCI Screening preparation

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Dear Doctor
At the outset we will introduce ourselves as the leaders in post graduate entrance business country wide. We understand that the students in the state have two main concerns one is the AIPG and other, probably the more important one is State Entrance. We have seen over the years there is some difference between the preparations for the two and there is some variance in the performance of candidates in these examinations. Some students despite not doing so well in the All India PG entrance exams excel in the state exam and vice versa.What is the difference between the two and how as a student should I approach these. In other words can any institute give me a step by step approach for my state pg exam? Let me introduce myself, I have been a Top ranker in AIPG, AIIMS, PGI examinations before and I have authored more than 10 books for PG entrance including the best selling Review of Radiology, which is a country wide best seller. I am the Director of DAMS, Delhi Academy of Medical Sciences which is by far the most consistent result giver in the last 10 yrs or so.Lets come back to the main issue once we have formed some trust that this not just another advertisement, it will change your idea of PG entrance examination and definitely make a change in the end result. Number one thing of importance to understand is the value of positive thinking. That sounds so basic, but we insist the first thing for any student of DAMS is think positive. I don’t want you to say anytime that you can’t do it. That’s the step number-1. Then for the last AIPG, the make or break idea was to read AIIMS Nov 2009 solutions. Anyone who didn’t do the November AIIMS thoroughly is bound to loose out on the AIPG. In that aspect DAMS lead by me and with question recall by this years topper DAMS Student has released an extensive review of the November AIIMS. We bet anyone who doesn’t read our review before AIPG is at a loss. Well you may say we are marketing but the book has gone out of print three times in last two weeks!!This AIPG 2009 was a peculiar paper with say 50 almost unsolvable questions but it would not be preposterous to say that DAMS students had an edge because we not only do repeat questions our teachers predict the pattern also. Some of the questions we must admit were tough like IDEAS, STEPS and amifostine etc that makes us enjoy the challenge of predicting even more and our teachers are spurred to make more predictions in the coming years.Other important thing to do for AIPG is repeat questions and almost all institutes ask you to do this but do they actually make you remember? we at DAMS in addition to our All India Grand test run an exclusive Bounce Back Series popularly called as BB series with repeat questions from various exams and we make you do them again and again. Our Grand Tests have an exclusive feature of new questions we don’t copy and paste from USMLE questions banks, we make new questions. The joke in the PG entrance business is that only DAMS and AIIMS make new questions? We provide authentic references to Grand test which is not so in any other coaching and we give Harrison based supplement with every GT. We understand what you need and we give it. In our classroom series we have the best faculty drawn from AIIMS, MAMC, LHMC and other major colleges. Most of them are popular authors and extremely high yielding teachers. With us being the pioneers in the Regular course and Test and discussion concept, we are a natural choice for students preparing for PG entrance.For state entrance again we recommend doing of repeat questions, and factual questions. On the other hand AIPG and AIIMS we have more number of newer questions and lots of conceptual questions. So the idea is Conceptual questions in AIPG versus Factual in state PG examinations. Once again emphasizing the importance of Bounce Back Series, Exclusive DAMS product. Our notes are based on standard books. For example my students sometimes ask me what books do we need to read these Mudit Khanna and AA quote all the high end books then what? We say supplement your standard books with our notes our notes are based on or are condensed version of the highest order books. Like our medicine is based on Harrison, Surgery is combination from Schwartz, Sabsiton and Bellie, Obs from Williams and Pediatrics from Nelson. Hence our students have the extra edge of the ready made food or The Fast Food.Our classroom centres are running in Delhi, Mumbai, Pune, Nagpur, Chandigarh, Jaipur, Jodhpur, Indore, Bhopal, Baroda, Ahmedabad, Lucknow, Hyderabad with more than 40 GT centres across the countries. We are also now lauching Subject wise Test and Explanation Series country wide, with detailed questions and answers to all subjects. If you cant join our famous class room series join us for “The Ultimate Test Series Combo”.

Dr Sumer Sethi, MD Radiology
• Director DAMS and topper in AIPG, AIIMS and PGI previously.
• Author of review of radiology and many more books for PG entrance.
• Faculty of national and international fame
About the Director DAMS
Sumer Sethi, MD, is Director of Delhi Academy of Medical Sciences Pvt Ltd, and is a very popular teacher, author and motivator. He himself was a topper in previous AIIMS, AIPG and PGI examinations. He also leads Teleradiology ProvidersTM (Prime Telerad Providers Pvt Ltd, http://teleradproviders.com), a company that provides teleradiology services to India and abroad. Dr. Sethi is a senior consulting radiologist at VIMHANS, Delhi. He is a visiting international faculty member of Tripoli Universities, Libya. He has also been an invited faculty member at various conferences, including Teleradiology in IRIA, Hospital Build Middle East, and Congress of the Brain Tumor Radiology in Neuro-oncology Society. Dr. Sethi is Editor-in-Chief of Internet Journal of Radiology. He has a keen interest in Web 2.0 technologies and in maintaining his radiology blog, Sumer's Radiology Site (http://sumerdoc.blogspot.com), which has been featured in multiple international journals. To date, Dr. Sethi is the author of approximately 50 publications, and the fourth edition of his book Review of Radiology is a best-seller among medical students.

Is It Christmas?

Just in case you were unsure whether or not it was Christmas today.... Click the chalkboard.

Click it tomorrow and you will be sadly disappointed....

Classic Video Games For Christmas

Do you remember playing the Nintendo Entertainment System, Gameboy, or Sega games? There's a great emulator on the internet, there are hundreds of games for each system, and it's almost like playing the real thing....

If you love the old systems, give them a try.... You won't be disappointed. There's nothing like playing Kid Niki, Metroid, Galaga or any of the original Mario Brothers games on the old 8-bit systems.... If you click on the Nintendo cartridge, it'll take you to the list of games to play on the Nintendo emulator.... If you click on the Gameboy cartridge, it'll take you to the list of games to play on the Gameboy emulator.... And so on, and so forth.... It's worth taking a little time this holiday weekend to check out the classics.... Merry Christmas Eve!

I tried entering the 'Konami Code' before I played Contra, unfortunately, it didn't work....

Pituitary stalk interruption syndrome (PSIS)

Findings

Figure 1: Coronal T1-weighted non-contrast of the pituitary gland demonstrates complete absence of the anterior pituitary gland. The posterior pituitary gland is ectopic in location.
Figure 2: Sagittal T1-weighted noncontrast of the pituitary gland demonstrates complete absence of the anterior pituitary gland. The posterior pituitary gland is ectopic in location.
Figure 3: Contrast enhanced sagittal T1-weighted of the sella turcica demonstrates complete absence of anterior pituitary gland, truncated pituitary stalk and ectopic posterior pituitary gland.


Diagnosis: Pituitary stalk interruption (PSIS) syndrome


Pituitary stalk interruption syndrome, also known as pituitary stalk transection syndrome, is characterized by an (1) absent or hypoplastic adenohypophysis, (2) ectopic neurohypophysis, and (3) absent or hypoplastic pituitary stalk.

There are two proposed hypotheses for PSIS. The first one proposes that PSIS is an acquired injury caused by neonatal hypoxia, since there is a high association of PSIS with breech presentation and cesarean section delivery. This unexplained high incidence of breech deliveries associated with PSIS patients supports the traumatic hypothesis. However, high frequency of associated CNS malformations, such as coloboma, microcephaly, Arnold Chiari, microophthalmia, septooptic dysplasia, and corpus colossal agenesis, argues against a traumatic hypothesis. The alternative explanation is that there is failure of normal inductive events of the rostromedial neural fold during pituitary gland organogenesis and the high incidence of breech presentation can be explained by in utero hypotonia due to hormonal deficiency.

Clinically, presentation will depend on the extent of the hormonal deficiencies. Neonatal patients usually present with hypoglycemic seizure. Pediatric patients with isolated growth hormone deficiency present with variable delay in growth, while those with greater degree of hypoplasia of the pituitary stalk and anterior pituitary gland present with symptoms associated with panhypopituitarism early in life. Clinical suspicion of this syndrome is based on laboratory tests of low GH level, cortisol level, abnormal GH stimulation test, low FSH, LH, TSH and free T4. There is a high incidence of microphallus and cryptoorchidism in PSIS patients, which can be explained by the low levels of gonadotropins.

There is a male predominance with a male:female ratio of 3:1.

Imaging findings include an absent or hypoplastic anterior pituitary gland, most conspicuously seen on sagittal T1 or T2 weighted images. The pituitary infundibulum is either absent or truncated. In addition, the bright spot of the posterior pituitary gland, seen on T1 weighted sequence, is ectopic in location. The brightness of the posterior lobe does not change on a fat-suppression T1-weighted image.

Treatment consists of hormonal replacement.

Jimboy the Street Caroler

A common sight in the streets of Manila during the Christmas season is this image of a street child tapping a makeshift drums made from empty Bonna milk cans, and singing an out-of-tune Christmas carol while hanging on to the rear of rushing jeepneys.

This particular boy you are looking at now is Jimboy, 10 years old, an orphan, and very determined to earn some real money and enjoy a bit of this year's Christmas. For nine straight days of doing street caroling, Jimboy had already accumulated some 287.50 pesos in coins, something that will be enough to buy some nice bread and butter for tonight's Noche Buena. Although homeless, Jimboy enjoys the company of other homeless children and paupers in Avenida Rizal, camping inside makeshift karitons and tents in many street corners. Meanwhile, he keeps his money safely tucked inside his short pockets, which he doubly protected with rubber bands.

A new shirt and a pair of shoes are not so important for Jimboy because he couldn't afford them anyway even how many Christmas carols he sing this season. But then, he dreams that someday he would be able to buy a new pair of tsinelas (flip-flop sandals/havaianas). His old pair has been worn down in time for Christmas and the boy was quite sad he would not have a new pair for Christmas.

I am not a rich man, but one of the few things that I really enjoy doing is to help poor children like Jimboy, and so, after telling me his dream of owning a pair of tsinelas, I handed him some cash and told him to buy a Spartan ( a good local brand of tsinelas which is useful rather than stylish). It would have been wonderful if I could just buy him a pair rather than give him the money, but alas, my time was very limited! Anyway, I am looking forward seeing him again soon wearing his new pair of tsinelas.

It is a wonderful experience to see this kid realize his dream, and you can see it now in his eyes. The kindness that he gets from strangers can give him a good idea that the world isn't cruel after all. That the world is a good place to live in, despite the harsh realities of everyday living. And it is because the well-off can share their blessings with the poor, and most especially the children. Christmas is, after all, for children, and as we have all been children once in our lives, then it is for all of us.

Merry Christmas!

For A Limited Time Only

Another day, another drive to Fillmore, California and back.... I placed radon measurement canisters at an apartment complex on Monday, and today I have to go pick up the canisters and send them to the lab.... Two hours of driving there, and two hours back.... Did you know that, behind smoking, inhalation of radon gas is the second leading cause of lung cancer?

Anyway, back in February, I posted a blog about the Disney movie 'The Little Match Girl', based on the short story with the same name written by Hans Christian Anderson. It's a beautifully magical and tragic tale that I would recommend everybody watch.... And.... It's the perfect segue into today's topic.....

Animator Rodrigo Blaas, has taken some time off from his gig at Pixar to do some independent work. His first film, 'Alma', is fantastically beautiful and unbelievably creepy all at the same time.... While you're watching this, don't forget that it's created by one of the guys who helped animate 'Up' and 'Finding Nemo' (Have you seen the first fifteen minutes of 'Up' yet? I'm glad I was wearing the 3D glasses).... 'Alma' has won many awards, and Mr. Blaas has made it available to the public for a short time during the Christmas season.... Enjoy it, before it's taken away from us....

Lip Dub Battle

The 'Lip Dub' has become one of the hottest trends on YouTube.... The most popular 'Lip Dubs' include one person with one camera, in constant motion, shooting an unedited video of a group of people as they lip sync to a popular song (typically a different person sings each line...).

Trent Mitchell, the video production class teacher at Shorecrest High School in Shoreline, Washington, organized over 200 student to shoot a 'Lip Dub' video of the popular song 'Hey Ya' by Outkast.

Not to be outdone, Marty Ballew, the video production class teacher at Shorewood High School, Shorecrest's crosstown rival, organized over 500 students to shoot a 'Lip Dub' video of the oldie, but goodie, 'You Make My Dreams Come True' by Hall and Oates. Shorewood's video had a significant twist, the video was shot in reverse! Not only did they shoot the video in reverse, the students learned how to sing the song backwards! It's incredible! At the end of the Shorewood High School 'Lip Dub' video, a challenge is proposed: 'Try and beat that Shorecrest!'

Turns out, both teachers are childhood friends.... I can't wait to see what comes next!

Extramedullary hematopoiesis

Findings

There are at least three non-enhancing T1 mildly hypo intense, T2 hypo intense masses in the posterior epidural space of the mid thoracic spinal canal causing mass effect on the adjacent spinal cord. There is also abnormal T1 and T2 hypo intensity of the vertebral body marrow.

Differential diagnosis:
- Extramedullary hematopoiesis
- Epidural hematoma
- Epidural abscess
- Neurogenic tumor
- Lymphoma
- Metastases


Diagnosis: Extramedullary hematopoiesis


Key points

Extramedullary hematopoiesis (EH) is a compensatory response to deficient bone marrow blood cell production.
Either in response to continued RBC destruction (e.g. sickle cell disease, thalassemia, spherocytosis) or inability of normal RBC precursor to produce cells (e.g. iron deficiency, pernicious anemia, myelofibrosis, leukemia, lymphoma, diffuse osseous mets).
Liver and spleen most common sites followed by the spine. Other common sites include thymus, cardiac, adrenals, kidneys, lymph nodes, and GI tract.
Spinal involvement most common with thalassemia.
Epidural EH thought to arise from primitive rests in the dura mater or epidural space. Another theory attributes it to direct extension from vertebral bone marrow.
Typical imaging appearance is of a lobular multi-segmental mass in the mid thoracic posterior epidural space that is T1 isointense and T2 hypo intense to the cord with variable enhancement.
Cord and nerve root compression can occur.
Treatment: EH very radiosensitive with prompt response; surgery considered when severe symptoms or failed radiotherapy. Hydroxyurea and blood transfusions may also be used.

Possible Trigeminal Neuritis-MRI

This patient presents with relatively recent onset of right sided hemifacial pain. There is altered signal intensity along with enhancement in the root entry zone of the right Vth nerve and the nerve root. Possibilities are Trigeminal neuritis. Less likely is the possiblity of nerve root origin mitotic etiology. Follow was suggested.