Wednesday, June 30, 2010

Diving Ranula





Findings

Figure 1 and Figure 2 Axial contrast-enhanced CT demonstrates a thin-walled, well-defined hypodense lesion in the right sublingual space (Figure 1) which herniates posteriorly into the submandibular space (Figure 1). This lesion also tracks into the sublingual space lateral to the right genioglossus muscle (Figure 2). It is located anterior and lateral to the right internal and external carotid arteries and effaces the submandibular gland.


Diagnosis: Diving Ranula


A diving ranula is an extravasation pseudocyst of a simple ranula in the sublingual space rupturing out into the submandibular and or parapharyngeal space. It originates from trauma or inflammation of the sublingual gland or minor salivary glands in the sublingual space. With obstruction of the gland duct, the duct dilates and eventually ruptures, allowing its secretions to leak into the surrounding soft tissue.

CT is the imaging study of choice. On CT, the lesion demonstrates water content and thin walls with subtle or no wall enhancement. If the lesion is infected, it may show thick, enhancing walls. The characteristic shape is a collapsed cystic portion in the sublingual space - “tail sign,” with its head extending into the submandibular space. The sublingual spaces are located on the floor of the mouth on either side of the midline genioglossus muscles. They are separated from the submandibular space by the mylohyoid muscle that extends from the medial inferior aspect of the mandible to the hyoid bone. Thus, the sublingual space is superomedial to the mylohyoid muscle and the submandibular space is inferolateral to the muscle. Ultrasound and MR can also be used to characterize these lesions. Ultrasound demonstrates a well-defined hypoechoic mass in the sublingual and submandibular space. MR images show the lesion with signal intensity of water, though if infected, signal intensity can vary according to the protein content or presence of hemorrhage with some wall enhancement.

The differential diagnosis would include epidermoid or dermoid cyst, lymphangioma or cystic hygroma, abscess, submandibular gland cyst (mucocele), and second branchial cleft cyst. These lesions differ in appearance on CT.

The treatment of a diving ranula is removal of the ipsilateral sublingual gland via the cervical or intraoral approach. It is not necessary to excise the pseudocyst since it puts the surrounding structures at risk for damage. Biopsy can be done to confirm the diagnosis.

Tuesday, June 29, 2010

Subspeciality Practise in Radiology

Has the time come for the radiologists to now look into subspecialisation?

 Very often nowadays, we see clinicians, and by clinicians, i am implying good specialists in their own branches like neurology and orthopaedics, commenting-- i can see the study better than the radiologists and reports are just a formality for the insurance and claims settlement.

Further, in our own teleradiology practise, we have noticed that we have a distinct edge over other because of our subspecialty exposure in neuroradiology and musculoskeletal imaging. Further with addition of people with exposure in cardiac radiology and breast imaging we could get more work. This is probably because of peculiar way radiology practise is based in India. Although it is difficult to get fully trained radiologist at most places, getting a general radiologist is not so much of an issue. So, with most of the imaging centres looking to get things done in cost effective manner to say the least, getting routine work via teleradiology/ outsourcing has become difficult.

However, there is still a room for doubt solving wherein you get an atypical case and specialists want specific answers. I don’t know if it is a trend but sooner rather than later we might see a growing trend towards fellowships and subspeciality training in radiology also.

What are your thoughts on this?

Primary osteosarcoma of the mandible






Findings

There is destruction of the vertical ramus of the mandible on the left side with associated periosteal reaction and osteoid matrix (Figure 2 and Figure 3). Multiple lamellae are seen radiating from the lesion giving it a sunburst appearance. Also there is extension into the soft tissue of the face (Figure 1).


Diagnosis: Primary osteosarcoma of the mandible


Malignant tumors of the mandible can be grouped as odontogenic and non-odontogenic. Examples of non-odontogenic solid malignant tumors include sarcomas, metastases, multiple myeloma, lymphoma/leukemia, and squamous carcinomas. Osteosarcomas of the mandible are rare non-odontogenic tumors and account for 5-13% of all osteosarcomas.

Osteosarcomas of the jaw generally peak during the 3rd or 4th decade, as opposed to osteosarcomas of long bones which peak during adolescence. There is no conclusive gender predilection. It can be secondary to Paget disease, fibrous dysplasia and irradiation to the jaw. Clinically the patients present with painful jaw swelling.

Typical osteosarcomas show matrix mineralization, which may be osteoid or chondroid, with associated bone destruction and soft tissue extension. With large tumor size these signs are identified on a plain radiograph, and CT scan helps in describing the extent of involvement. For cases presenting early CT helps in identifying those missed with conventional radiography. Differentiating osteosarcomas from chondrosarcomas can be troublesome radiologically and sometimes even histopathologically; however chondrsarcomas are even rarer in the head and neck region.

Histologically, this tumor is less aggressive and less frequently high grade as compared to its conventional counterpart in the long bones. The spread of the disease to the cervical lymph nodes is seldom seen.

Osteosarcoma of the jaw should be treated with radical surgery as the primary modality. The single most important factor in curative therapy for osteosarcoma of the jaw is its amenability to radical resection with clear margins. Neoadjuvant chemotherapy is not used as a routine as against osteosarcoma of long bones. There is no general consensus over the role of radiation therapy in management of patients. In one study Delgado, et al. reported that when surgical margins are not free of disease, the use of radiation does not improve the outcome.

Pneumocele-Frontal Sinus with Proptosis

Note the expansion of the frontal and ethmoid sinuses with resultant axial proptosis.
Reported by -- Teleradiology Providers

Diffuse Axonal Injury-MRI


Diffuse axonal injury (DAI) is a frequent result of traumatic deceleration injuries and a frequent cause of persistent vegetative state in patients. DAI typically consists of several focal white-matter lesions measuring 1-15 mm in a characteristic distribution. The most common MRI finding is the presence of multifocal areas of abnormal signal (bright on T2-weighted images) at the white matter in the temporal or parietal corticomedullary junction or in the splenium of the corpus callosum.

Ataxia-telangiectasia-MRI


Ataxia-telangiectasia also known as Louis-Bar syndrome, is a hereditary autosomal recessive progressive multisystem disease. The vermian atrophy is more prominent than the atrophy of the cerebellar hemispheres and is characteristic of the type of anatomic appearance seen in ataxia-telangiectasia. Also with age the degree of atrophy progresses, there are two siblings with more marked atrophy in later age group.

Friday, June 25, 2010

Is CT head relevant in current scenario?

This is what i read as a comment in yahoo news by my friend Dr Philip Chao who has worked in Delaware to produce the best MRIs possible since 1990. He has monitored hundreds of thousands of MRIs over his career at the University of Pennsylvania and working for the people of Delaware. He is a board certified neuroradiologist and recently passed his maintenance of certification examination in 2006. He is also trained in body MRI and was the body MRI fellow at the University of Pensylvania from 1988 through 1990.

This what he says
 "CT of the head is almost useless. This is a fact I tried to teach residents for years. Usually they do a CT scan of the head non contrast - this is woefully inadequate to pick up stroke, tumor or meningitis. In fact it misses bleeding in the brain if it is older than 24 hours old. The funny thing is that if the CT is negative you get an MRI because a negative CT does not rule out significant intracranial pathology. If the CT is positive you STILL get an MRI because you see the lesion margins better and additional lesions with MRI. So... in both cases a negative and a positive CT does not prevent you from getting further testing. "



Sounds like soon we will not see the plain CT anymore. Thinking of it now, how may times we have actually recommended MRI after CT, kind of makes sense. Other than head injury this logiq seems quite valid, what are your views?

All comments and discussions are welcome.

Wednesday, June 23, 2010

Trigonocephaly





Findings

CT 3D surface reconstructions show near-complete fusion of the metopic suture with trigonocephaly and "beaking" of the frontal bone along the midline. The sagittal, lambdoid, and coronal sutures are normal.


Diagnosis: Trigonocephaly


Craniosynostoses are calvarial dysmorphsims that result from premature closure of one or more sutures. Trigonocephaly, which involves the metopic suture, comprises less than 10% of all forms of craniosynostoses. It manifests prominent frontal keel, narrow forehead, and hypotelorism, which produces the appearance of a triangular skull. 3D CT reconstructions of the skull are well-suited for imaging the cranial sutures and osseous deformities. Trigonocephaly usually only poses an aesthetic concern and is amenable to reconstructive surgery. This craniosynostosis is infrequently associated with intracranial pathology or genetic disease such as Opitz "C" syndrome.

Monday, June 21, 2010

Hepatic Tuberculomas-CT


TB is a growing problem worldwide; consequently, it is vital to recognize the more unusual presentations of this disease. Intra-abdominal TB has a high mortality, but it is a difficult diagnosis to make, often requiring laparotomy. Liver tuberculoma is, in particular, rare, with fewer than 100 cases reported in the literature, most of which are secondary and associated with miliary TB. This is a case of 32 year old female with caviating right upper lobe lesion with miliary mottling and hepatic tuberculomas. Mediastinal lymphnodes are also seen.

Friday, June 18, 2010

Gone Fishing


After more than a year of Monday through Friday posts here at 'I Think It's Interesting', ASBLACKASOBAMA is giving himself and the news crew at 'ITII' a much needed vacation.

We appreciate all your wonderful comments and taking the time out of your day to read our little musings.... As Paul Rudd famously said in 'I Love You, Man' - 'I will see you there or I will see you on another time'.... 'Laters on the menjay'.


Thursday, June 17, 2010

Busboy Beats NBA Stars At Pop-A-Shot


Jimmy Kimmel has discovered a busboy with an amazing talent. Ricardo, employed at the poplar eatery 'Barney's Beanery', is the master of 'Pop-A-Shot'.... During the NBA playoffs, Jimmy Kimmel has had Ricardo compete and demolish the BIGGEST STARS in the NBA.... LeBron James, Charles Barkley, Kobe Bryant, Lamar Odom and Carmelo Anthony.... All of them crushed by the 'Pop-A-Shot' skills of Ricardo the Busboy.

After destroying Carmelo Anthony rather handily at a game of 'Pop-A-Shot' after Game 6 of the NBA Finals, Ricardo was led out of the 'Jimmy Kimmel Live!' studios and presented with his brand new 2011 Ford Mustang!

Enjoy Game 7 of the NBA Finals tonight! Either the Lakers or the Celtics will be the NBA Champions tonight!










Like OMG Baby

DJ Earworm is back! Don't let the name fool you, he's very talented.... I've posted a couple of his mashups before, his end of the year mashups in 2008 (Viva La Pop) and 2009 (Blame It On The Pop), where he takes the Top 25 Billboard Hits and their videos in their respective years and 'mashes them together'.

This time, he's created a 'mashup' for Capital FM’s Summertime Ball in London, titled 'Like OMG.... He took the music of all fifteen artists performing at the venue and 'mashed them'....It should just be a giant ball of sound, but it all comes out quite nicely.


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

Alexandra Burke - All Night Long
Cheryl Cole - Fight For This Love
Chipmunk feat. Esmee Denters - Until You Were Gone
Dizzee Rascal - Bonkers
Ellie Goulding - Starry Eyed
Jason Derulo - In My Head
JLS - One Shot
Justin Bieber - Baby
Ke$ha - Tik Tok
Pixie Lott - Mama Do
Rihanna - Rude Boy
Scouting For Girls - This Ain’t a Love Song
Tinie Tempah - Pass Out
Usher feat. Will.I.Am - OMG
The Wanted - All Time Low

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:

Wednesday, June 16, 2010

Toyz Noize Is The Bees Knees

I know I post about this guy too much, but love the videos he makes! I posted the 'Hook', 'Up', 'Terminator 2' and 'Gardyn' remixes from from Fagottron and POGO here at 'I Think It's Interesting' here before.... (Hint: Click the names of the previous remixes to see those posts....)

In this new video, he takes video and sounds from 'Toy Story' and adds a few extra cymbals and a sine wave bass (I'm not sure what a sine wave bass is, but is sounds cool) to make another amazing remix. Just in time, as Disney Pixar's 'Toy Story 3' opens in theaters this weekend!

This man is ridiculously talented, and I highly recommend you check out all his videos!


Tuesday, June 15, 2010

Hidden Messages In Logos That I Should Have Noticed

I've been on this Earth for 30 years, and I must admit that I'm not the sharpest knife in the drawer.... How have I missed so many things that have been staring right back at me?

I give myself credit, I noticed the arrow in the FedEx logo.... Not at first, but now I never miss the arrow.... See it? Right there.... Between the E and the x.... Now that I've recognized the arrow, almost every time I see a FedEx truck, I see the arrow and have to adjust my eyes/brain to notice the FedEx logo....

After doing a wee bit of research, I found a couple of other hidden things in logos that I've never noticed....

How did I never see these?

Toblerone Chocolate - I enjoy chocolate.... I have a 4 foot tall Toblerone chocolate bar, the thing is huge, and I never noticed the bear in the logo.... He's in the mountain.... I've literally seen this logo my entire life.... I've never seen the bear.


Hershey's Kisses - There's a chocolate kiss between the K and the I in the word KISSES.... How have I been so blind?


Goodwill - The smiley face is a lowercase g? My mind is blown.


Milwaukee Brewers - I've watched baseball my entire life. MY ENTIRE LIFE! I've actually been to see the San Francisco Giants play the Milwaukee Brewers at Candlestick Park in San Francisco when I was younger.... I have never, NEVER, noticed that the Milwaukee Brewers baseball mitt logo is actually an 'm and a b'....


I'm going to go hang my head in shame....

Monday, June 14, 2010

Will BP Ever Stop The Oil Spill?

I'm sure you've all heard about the tiny oil spill in the Gulf of Mexico.... The news media reports that even though BP is currently capturing approximately 630,000 gallons of oil a day, hundreds of thousands of gallons of oil are still being released into the ocean....

Since it's been incredibly busy around here (knock on wood), I'm going to leave you with two videos....

The first video is a funny little sketch from the Upright Citizens Brigade comedy group showing how BP deals with 'spills'.... The second video is a montage of amazing photos of the oil spill, while politicians are shown screaming 'Drill Baby, Drill'!




Friday, June 11, 2010

Can You Guess This TV Theme? #49 - Answer

Congratulations to Patrick Tillett from 'Patrick Tillett - Extremely Overdue' for correctly guessing that this week's TV theme is from 'Felicity'! I don't mean to offend you in any way Pat, but when you posted the answer, I had to do a double take when I saw your name.... 'Pat Tillett watched Felicity? I did not see that coming....' I think you may have been the only Vietnam Veteran to have watched 'Felicity'.... By the way people.... If you haven't check out Pat's blog, do it.... It's amazing! His amazing stories about the life he's lived, the amazing Vietnam posts, and the amazing photography are.... well, amazing. The man knows how to tell a story.... Ok, now, onto this week's theme....

'Felicity' was a powerhouse from the get-go.... Created by two of the brightest minds in Hollywood, J.J. Abram`s and Matt Reeves, and produced by two of the biggest names in Hollywood, Ron Howard and Brian Grazer, 'Felicity' ran for only four seasons, following Felicity throughout her college years....



Keri Russell plays Felicity Porter, a young high school graduate who decides to go against her parents' dreams of a fully paid Stanford Pre-Med education to follow a boy, Ben Covington (Scott Speedman), to the University of New York.



Felicity gets to New York and learns about herself, and develops relationships and friendships throughout her four years in college. Struggling in a love triangle with Ben and Noel (Scott Foley, originally playing Felicity's Resident Advisor).... Creating friendships with friends
Julie and Elena (played by Amy Jo Johnson and Tangi Miller).... P.S. For those of you who recognize the name Amy Jo Johnson, but just can't remember who she is, she's the original Pink Power Ranger!

During the series, you're introduced to Sean Blumberg (played by Greg Grunberg, who on a side note is a childhood friend of the great J.J. Abrams, and has been cast in many of Abrams' projects.... He was in Alias, Mission Impossible III, and he was the pilot who crashed the plane into the island on 'LOST'! All three are Abrams' works....), Ben's original roommate and the guy who comes up with all sorts of crazy new ideas (e.g. The Before and After Restaurant - Where they only serve appetizers and desserts)....

I could go on, but there were so many characters, and each character plays such a pivotal role in the show.... I've already put most of you to sleep.... I'm not even going to talk about Donald Faison and
Jennifer Garner being on the show.... Or even Tyra Banks' short run on the show....

Anyway.... On to what everybody knows about the show.... The controversy about what killed the ratings. The Haircut vs. The Network's Decision To Move The Show To A New Night.... The producers had the idea to snip Keri's lovely locks, to symbolize a fresh new start after a breakup with Ben.... After the 'haircut heard around the world', and the time change, the ratings decreased significantly and never fully recovered.

Can You Guess This TV Theme? #49 - Update

Everybody was stumped by the first theme.... So, as promised, here's the second theme.... Don't forget, these themes were both for the same show. Is the second theme any more recognizable?

Can You Guess This TV Theme?

Can You Guess This TV Theme? #49

Happy Friday everybody! Here's today's deal with 'Can You Guess This TV Theme'.... This show had two different themes. Both themes had a good run, and should be recognizable, but the show's first theme had no lyrics.... I'm posting the show's first theme at 7:00 a.m., and if nobody can guess the name of the show from the first theme, I'll post the show's second theme at 12:00 p.m. (all PST).... As always, the answers will be posted at 3:00 p.m.

Can You Guess This TV Theme?

Thursday, June 10, 2010

SuperHumans!

Did anybody else see 20/20 two weeks ago? It was an episode on 'Superhumans'.... Real humans with Superhero abilities....

They profiled the following people:

Alain Robert, a real life Spiderman that climbs high rises without any safety equipment and can hang from his ceiling for 20 minutes at a time!

Jeff Corliss, a man who jumps off the sides of mountains and out of planes in a synthetic wing suit at speeds up to 300 miles per hour!

Anna Frasier, a woman (dressed in a mermaid tail) who can free dive 50 feet below the sea and return to the surface with only one breath of air!

Lyndon Whalberg, another 'mermaid' that can hold her breath underwater for up to five minutes and can dive 91 feet below the surface or the water and back with only one breath of air!

Daniel Tammet (Brain Man), an autistic savant who looked at pi to 22,500 digits ONE TIME, and then recited it to a panel of experts from memory.... They showed him learn the Icelandic language in one week!

Wim Hof (Ice Man), a man who can submerse himself in snow for an hour and twelve minutes.... He runs in sub-zero temperatures wearing only shorts.... No shirt! No shoes! No socks! Just shorts!

Dean Karnazes (UltraMarathon Man), a man who has run 50 marathons in 50 days.... He's known to run 30 miles to a marathon, then run the marathon.... He decided to run 30 miles on his 30th birthday, and fell in love with running....

You can see the entire episode by clicking on the sign below!

Wednesday, June 9, 2010

Pagpag: Survival Food for the Poorest of the Poor

Have you ever wondered whatever happened to the left-over food you did not finish in fast food restaurants? You may think they would have been thrown away and discarded for good. For sure they are headed to the trash bin after people leave them on the table. But what happens next is something you ought to know. The morsels of unfinished Chickenjoy in Jollibee or the left-over spaghetti in McDonald’s might yet save a family from hunger.

The leftover food stuffs are thrown in large black plastic bags and collected by a garbage truck. The truck travels towards a garbage dumpsite, either in Payatas in Quezon City or Smokey Mountain in Tondo, Manila. After the truck has dumped the trash in these garbage sites, the leftovers begin to change its nature: from trash to food. Scavengers would swarm on these morsels like they were gadflies, sometimes even fighting over them.The food we consider trash becomes for them sustenance.

You may think that it is cruel and inhuman to let people eat food thrown away by others. But that’s the way it is in the poorest slums of Metro Manila. Whatever that can be eaten will be eaten. It is the law of nature. It may be harsh but it is the reality. After all, who cares?

These food discards are called pagpag, an ukay-ukay term that has taken a new meaning. Pagpag in this context is to shake away the dirt and maggots in the food. The scavengers would smell the food to determine if it is still good or has started to spoil. If it still smells fine, more or less, then they will eat it right there in the dumpsite. Bringing it home may spoil it some more. Time is of the essence. Hence when a truck unloads some "fresh pagpag" in the dumpsite, an instant feast takes place. The scavengers do not mind the malevolent stench of the garbage that surrounds them while eating.

If the pagpag smells bad, they would simply bring it home to wash in a bucket of water. Some even re-fry the food for good measure. They think recooking would kill the fly larvae already infesting it.

Pagpag is an essential survival food in the poorest slums of Metro Manila. No matter if it is already spoiled, the empty stomach will still appreciate it. In fact, many scavengers consider pagpag as comfort food, much better than the gulay at asin they are accustomed to eat everyday. On a lucky day, they would find whole unsold Shakey’s pizzas or whole Max's fried chicken. A cause for royal celebration!

Indeed, living in the slums is like living in the jungle; the only difference is that there is already cooked food to be hunted in the mounta ins of trash. In this case, a scavenger needs all the survival techniques he has learned: jockeying for position, digging, clawing, shaking, and eventually developing the taste for discarded food. It does not matter. It is still food anyway.

There are also some very enterprising scavengers who dig for pagpag as a small business. They would collect pagpag from the trash a nd sell it fo r 20 peso s for each small plastic bag. Mary Ann, 15 years old, of Smokey Mountain, Tondo, is a pagpag entrepreneur. She wakes up early at six a.m. and waits for the garbage trucks that bring in yesterday’s discarded foods. At seven in the morning, the trucks start to pull in. These scavengers would be alerted which trucks carried pagpag, because the truck drivers would raise a hand and make an "OK" sign. Mary Ann and her friends would then wait for the trucks to unload the garbage and scamper to hunt for the food items. Today is a good day. The trucks unloaded tons of garbage from the fast food restaurants including of course, food discards.

Today, Mary Ann collected some five bags of pagpag, which she would sell for twenty pesos each. Each bag contained some leftover chicken (chicken bones with some meat still attached to it) burger patties, and spaghetti. But still twenty pesos is hard to come by in Smokey Mountain. If the pagpag bags she collected would not be sold, Mary Ann and her family would feast on them for lunch.

In another garbage dumpsite, Jennifer Cordero, 28, and her family live everyday on discarded food. Jennifer is married with three young children. She is a scavenger in the Payatas dumpsite in Quezon City. She is a little more fortunate compared to the other scavengers in Payatas. She keeps a job guarding a trash bodega owned by a Chinese businessman who contracted some garbage trucks to directly dump their trash in his bodega. Jennifer’s job is to sort out the dumped trash: plastic bottles, Styrofoam boxes, plastic cups, plastic spoons and forks, cardboard boxes, and the like. In exchange for her work, Jennifer helps herself to the pagpag that is dumped in the bodega. The pagpag she collected would be her pay plus free lodging in the bodega. She also gets fifty pesos a day sifting "kalakal."

Jennifer found one of the huge black plastic trash bags from Pizza Hut, containing pagpag of many kinds: chicken morsels, spaghetti, and slices of pizza. She smelled each of the pagpag and set aside those that can still be eaten. Afterwards, she washed these inwater and re-fried them in boiling oil “to ensure”, she says, “that all the bacteria are killed." She then served the meal to her three excited children.

The pagpag is food not only for the people of Smokey Mountain and Payatas. There are also many beggars and homeless people in the streets that rely on pagpag for their daily meals. They would open garbage cans scattered all over the metro to hunt for any food that can still be eaten.

Some beggars in Ermita even have a regular supply of pagpag coming from the garbage of restaurants and hotels there. The management of these establishments may have willingly given these leftovers to the beggars rather than deal with their disposal.

In crowded Hidalgo Street in Quiapo, I chanced upon a man who was raking a trash can with his bare hands. He found some discarded food which he ate right there beside the trash can, eliciting varied reactions from spectators. One woman was touched: “tsk, tsk, kawawa naman o;" another was aghast: “kadiri naman yan, eeeew;" and yet another felt awe: “grabe ang galing nung mama, kumakain ng basura!

These varied reactions show how ordinary folks misunderstand the poor scavenger’s plight. Certainly, they did not grow up in the poorest slums of Manila, nor are they vagabonds without food to eat or shelter to go home to, nor have they experienced going to bed on an empty stomach, not sure if the morrow would bring in provenance. In short, they would never understand why the scavenger eats spoiled or spoiling food direct from the trash can.

“Iba ang nararamdaman ng taong gutom," said the scavenger to me after he feasted on the pagpag. “Makikipagpatayan ka nga para makakain lang eh. Iba-iba na ang pumapasok sa isip. Pag nalilipasan ka na ng gutom, parang gusto mong pumatay. Alam ko rin na marumi yun at nakakahiya, pero mabubuhay ba ako sa hiya?. Mabubuhay ba ako sa awa kung laging kumukulo naman ang aking sikmura?”

Pagpag may indeed be disgusting to most of us who eat well-prepared, freshly-cooked, and delicious foods at home and in restaurants. But to understand the nature of the pagpag, one must look at it from the viewpoint of the scavenger. It is only natural for common people to regard pagpag as “kadiri”, but one must not condemn the beggars and scavengers who eat them as callous or “patay-gutom."

To understand better their situation, I interviewed one of the pagpag scavengers in Smokey Mountain. Boyet, 23 years old, from Tondo, has been eating pagpag for as long as he can remember. He agreed to be interviewed to share his experience eating the pagpag.

Bakit ka kumakain ng pagpag?

Masarap ang pagpag, kahit paano nakakatikim din kami ng manok, baboy, at minsan pizza at spaghetti. Tsaka pag gutom ka na, wala ka nang sisinuhin eh. Lahat ng pwedeng kainin, kakainin.

Kailan ka nagsimulang kumain ng pagpag?

Matagal na, batang-bata pa ako. Di ko na matandaan. Basta matagal na yun.

Lahat ba kayo sa pamilya niyo ay kumakain ng pagpag?

Oo, lahat kami. Minsan nga kulang ang nakukuha naming pagpag. Lima kaming magkakapatid. Tapos nanay ko pa. Kaya hati-hati na lang.

Nasaan ang tatay mo?

Patay na.

Ano ikinamatay?

Matagal nagkasakit. Tomador kasi kaya namatay sa pag-inom ng alak.

Mabalik tayo sa pagpag. Kinakain ba ninyo kahit marumi na ito, o ang kinakain ninyo ay yung mga sa palagay nyo ay malilinis lang?

Ganito yun eh. Pinapagpag muna namin para maalis kahit paano yung dumi. Tapos inaamoy namin. Kung wala pa namang mabahong amoy pwede nang kainin ng diretso. Kung may amoy na, huhugasan namin ng tubig tapos minsan piniprito uli.

Kung may uod na, kakainin nyo pa rin ba?

Depende kung talagang gutom. Sa amin kasi kapag idinarang mo sa apoy, sigurado patay na lahat ng mikrobyo, di ba? Ganoon din mga uod, mamamatay lahat sa apoy. Pwede nang kainin pag idinarang na sa apoy.

May mga bacteria na minsan hindi namamatay sa init, tulad ng Salmonella. Baka magkasakit kayo kung mayroon noon.

Hindi naman siguro. Ano ba yung salmonella?

Ito’y isang uri ng mikrobyo na maaring pagmulan ng sakit tulad ng tipus. Kailan ka huling kumain ng pagpag?

Kahapon. May nakuha kaming spaghetti galing sa Pizza Hut. Maayos pa naman kaya di na namin ininit. Tamang-tama nga eh, dahil ilang araw na kaming walang nakuhang pagpag.

Bakit?

Minsan kasi walang natitira yung mga kostumer. Puro buto na lang naiiwan. Minsan naman yung mga naghahakot ng basura sila na rin kumakain ng pagpag. Kaya pagdating dito sa dumpsite wala na halos natitira.

Hindi ba kayo nagkakasakit kung nakakakain kayo ng maruming pagkain?

Nagkakasakit din. Minsan sumasakit ang tiyan. Pero pinakamalala na yung nagsusuka at nagtatae.

Food poisoning ang tawag doon. Nagpa-chek up na ba kayo sa doctor?

Wala kaming pera para magpadoktor. Kung suka’t tae lang e ilang araw lang maayos na rin naman. Pinapainom lang kami ng apdo ng manok, tapos ayos na.

Sa ngayon ba ay mayroong maysakit sa inyo?

Wala naman.

May nabalitaan ka na bang namatay dahil sa pagkain ng pagpag?

Wala naman po.

***

The pagpag is one of the most blatant symbols of extreme poverty in the Philippines. It may be easy for most of us to dismiss pagpag as “kababuyan” o “kadiri "-- two powerful Tagalog words that have no equal in the English language. But we have to remember that thousands of people rely on the pagpag for their daily survival. The pagpag exists not because there are desperate people who feed on them, but because poverty has forced them to do so. The sight of people feeding on the trash may be disturbing and even disgusting to many of us, but once we look at the problem from the perspective of the poor, then the pagpag becomes manna from heaven.


Honda U3-X - For The Person Who Finds Walking Unneccesary

Are we making life too simple? Are we going to have computers and robots feed and entertain us all day while we lounge in comfortable chairs until modern civilization and all plant life on Earth are decimated? Are 'they' creating an environment similar to the spaceship environment on Wall-E?

Did somebody at Honda say: "All this standing on my Segway Personal Transporter is making me sooooooo tired.... I wish there was a machine, similar to the segway, that could take me wherever I want to go, but I want to remain seated the entire time...."?

Honda has created the U3-X.... The Seated Segway.... For the person who finds walking unnecessary.... By the way, I have never seen one person look cool while riding a segway. I can't imagine they're going to look cool while riding the U3-X....


Bad Radiology Practise




1) Using the term "if clinically consistent or if clinically indicated"
2) Further evaluation is "advisable", advisable often gives an unsure interpretation of the findings, and creates the confusion whether added investigation is required or not. Ideal practise should have a note justifying your choice for the further investigation
3) Where "impression is as long as the findings description". Good report will have a long description with a brief impression.
4) Being judgemental like using the words "poorly aligned fracture"
5) Not comparing with previous films or not going through old films. Mammograms especially, cannot be read without comparison and error rates for people who dont compare are very high.
6) Not communicating urgent findings to the referring physician.
7) Never refusing a study even when you feel it is totally irrelevant. Debatable!
8) Not reading.

Tuesday, June 8, 2010

Is No New News Good News?

This was posted a few days ago by Cal from 'Cal's Canadian Cave Of Coolness', and recommended to me a few days ago by Cotton Blossom from 'Wit Behind The Ears'.... You should check them both out.... They're both fantastic bloggers!


It fascinates me that no one has noticed this before.... It's almost as good as the 'Mall Name Change In 'Back To The Future''. The same newspaper prop (presumably a new newspaper with the same stories) used over and over and over again.... Doesn't Ed O'Neill get tired of reading the same stories all the time? Is no new news good news?


Sturge Weber Syndrome-MRI

MRI reveals a pial, enhancing, angiomatous malformation, often in the occipital or posterior temporoparietal region ipsilateral to the facial angioma. Gadolinium enhancement improves visualization of the angiomatous malformation.
Reported by Teleradiology Providers

Monday, June 7, 2010

Mister Rogers And Me


While on vacation in Nantucket, Massachusetts, MTV News executive Benjamin Wagner had the ultimate neighbor, Mister Fred Rogers owned the house next door....
Mister Rogers.....

The man with the cardigan (all of them were knit by his mother), who welcomed us into his home everyday to teach us simple lessons about life....


The man who created the 'Neighborhood of Make-Believe', and made us desperate with the need to jump on that little trolley that traveled through his living room...
.

The man who taught me how to tie my shoes....

The man who made us all feel welcome in his home, with a simple tune telling us that 'It's a beautiful day in the neighborhood', and asking 'Won't you be my neighbor?'.

(Yeah, I'm not going to go into a huge diatribe about how he pretty much single-handedly saved both public television and the VCR. Or how he meticulously kept his weight at 143, because 143 meant 'I Love You'. Or how he wrote and composed all the songs on the show.)

I'm going to tell you about the new documentary, Mister Rogers & Me. I can't wait to see this! Mister Rogers played such a giant role in my life....

'On the afternoon of their first meeting, “America’s Favorite Neighbor” asked the young journalist about his job as an MTV News producer. Wagner felt exposed and embarrassed, a PBS mind in a jump-cut, sound-bit MTV world.

Mister Rogers said warmly, “I feel so strongly that deep and simple is far more essential than complex.”

Later, Rogers said simply, "Spread the message, Benjamin.”'

After Mister Rogers' death in 2003, Benjamin Wagner traveled across the country to interview friends of Mister Rogers to find out more about the man in the cardigan. In the end, the brothers come to know more than just the man and his luminous legacy. They unmask the forces acting against depth and simplicity, and develop the means to lead deeper, simpler lives.



If you love Mister Rogers as much as I do, you should definitely check out the PBS site for his show.... You can see videos of Mister Rogers singing 'Won't You Be My Neighbor' and 'You Can Never Go Down The Drain'! It sounds simple, but nobody else ever took the time out to tell me that I was 'bigger than any bathroom drain', and that I wouldn't be sucked into a world where Teenage Mutant Ninja Turtles fight to keep our city safe.... Oh, and you can see the video of Mister Rogers and the crayon factory!

Click on the card below to go to the site!

Appendicitis-CT


Specific CT scan findings of appendicitis include enlargement of the appendix ( more than 6 mm in the outer diameter), enhancement of the appendiceal wall, lack of opacification in an enlarged appendix, fat stranding in the periappendiceal region, and the presence of an appendicolith within the appendix.

Reported by Teleradiology Providers