Asymmetric closure of ischiopubic synchondrosis

Lucency in relation of right ischipubic ramus. This likely represents asymmetrically enlarged ischiopubic synchondrosis is a well-known and frequent finding on radiologic workup of prepubertal children, and is a normal variant which can be misinterpreted.

 Reference - Am J Roentgenol. 2004 Feb;182(2):361-5. Asymmetric closure of ischiopubic synchondrosis in pediatric patients: correlation with foot dominance.

Basilar Artery Dissection-MRI

The MRI findings of dissection include an intramural hematoma, an intimal flap, and the enhancement of the artery wall and septum. MRA can clearly show abrupt luminal stenosis and the disappearance of flow signal at end distal to the dissection. This is 35 year old male with sudden onset posterior circulation infarct seen on DWI and intimal flap in the course images. Note the distal tapering in the basilar artery.

Quality Control in Radiology Department

In this issue of Radiographics, Lane F. Donnelly and co-authors have discussed a method for departments quality control. They have created a scorecard that is presented quarterly to the institutional leadership and is available to all radiology employees on the institutional intranet. The scorecard currently has 33 measures in six areas: clinical services (safety, quality, timeliness); education; research; professionalism, communication, and user satisfaction; finances and administration; and staffing.


Seems like all our departments in India desperately need something like this to ensure quality control in terms of all parameters mentioned.

Germinal matrix hemorrhage

Findings

Hyperechogenic mass like hemorrhage into the right caudothalamic groove with ventricular extension, extension into the septum pellucidum, and resultant hydrocephalus; Grade 3 intraventricular germinal matrix hemorrhage.


Diagnosis: Germinal matrix hemorrhage


Key points

Risks for germinal matrix hemorrhage:
- Less than 32 weeks gestational age
- Under 1500g
- 20-25% risk in premature, low birth weight infant

Germinal matrix
- Proliferating cells; lines the periventricular spaces of the lateral ventricles and third ventricle
- Largest at 24-26 weeks, then involutes
- Begins involuting at the level of the third ventricle
- Involuted completely at 36 weeks

Mechanisms behind germinal matrix hemorrhage-
- Venous bleed
- From cardiovascular instability from lack of autoregulatory mechanism in the preterm infant
- Watershed bleed
- Nearly exclusively occurs in the first 1 wk of life, 50% on day 1
- Identifying and grading germinal matrix hemorrhage
- Blood is always as dense as choroid plexus
- Classic hemorrhage in the caudothalamic groove looks like a mass. May extend into the ventricles

Classification:
- Grade 1: Classic case caudothalamic groove looks like a mass
- Grade 2: Intraventricular extension, usually no long term sequelae
- Grade 3: Dilated ventricles
- Grade 4: Parenchyma, actually from venous hemorrhagic infarct

Gold Nanoparticles for Vulnerable Plaque-Radiology Update

"Researchers at Mount Sinai School of Medicine have used gold nanoparticles to visualize plaque which they believe will revolutionize cardiac imaging. They have for the first time developed a way to visualize coronary artery plaques vulnerable to rupture using multi-color computed tomography (CT), an innovation that will lead to better and earlier diagnosis of cardiovascular disease. The data are published in the September issue of Radiology."

Full report on Mount Sinai Website

You Shall be as Gods: The Enigma of Anting-anting

Deep in the night of May 20, 1967, around four hundred curiously attired men congregated in Taft Avenue in Manila, near what is now Vito Cruz, with the intent to march to Malacanang Palace to ask for President Marcos’ resignation. The men wore anting antings and colorful vests with mixed Latin and Tagalog inscriptions in them. Despite their odd appearance, they were also wielding daggers and three-foot long jungle bolos signifying their rebellious intent. They were part of the of the millenarian sect called Lapiang Malaya (Freedom Society), a quasi-religious political society led by the charismatic eighty-six year old Supremo Valentin delos Santos, a former Catholic priest, auto mechanic, one-time circus performer, and failed candidate in the three past presidential elections at that time.

Early in May 1967, Tatang Valentin, as the Supremo was called, demanded Marcos to step down. He also demanded that the Philippine Armed Forces surrender their arms to him. Deeply disillusioned by what he termed as the oppression of the poor, and the continuing evil influence of Western powers in the Philippines, Tatang Valentin now decided that it was time to establish the new government with him as the new Supreme Commander, Commander-in-Chief, and President of the Republic of the Philippines. President Marcos promptly rejected Tatang Valentin’s demand.

As the Lapiang Malaya kapatid (as members of the Lapiang Malaya were called) started to arrive from the provinces to gather in the society’s compound in Taft Avenue, the Philippine Constabulary cordoned off the area to prevent more members from joining the already frenzied group.

Then at around 12:30 in the morning of May 21 ( a Sunday), as the volatile tension between the Lapiang Malaya members and the constabulary heightened, a prankster reportedly fired a mock gunfire in the air. A violent skirmish between the kapatid and the constabulary followed. The result of the skirmish was one-sided as to be considered a massacre. As the constabulary opened fire, thirty two kapatid were killed and some forty seriously wounded. The constabulary had one death toll: a constabulary who was hacked to death. In addition, five constabularies were wounded by bolo hacks, and three civilians hit by stray bullets.

This massacre of the Lapiang Malaya was one of the bloodiest episodes in recent Philippine history. As the front line members of the Lapiang Malaya fell to gunfire, many other members realized that their anting-antings have failed to protect them. Dispersing in all directions, they were later arrested and charged with rebellion.

One of the Lapiang Malaya kapatid who was killed on the bloody Sunday of may 21, 1967. Note the magical vest that he was wearing that offered no protection against gunfire.

Later in the morning, Tatang Valentin surrendered to the constabulary. He was brought to the National Mental Hospital, together with eleven of his high-ranking lieutenants. All were subjected to psychiatric evaluation and were all pronounced lunatic.

Following his diagnosis, Tatang Valentin was confined to a cell together with a violent schizophrenic, who allegedly mauled the old man into coma. He never regained consciousness and was declared dead on August 1967. The official medical report stated that he died of pneumonia.

Tatang Valentin surrenders.

After Tatang Valentin’s death, the Lapiang Malaya was officially dissolved by the government, with most kapaitd either pardoned or sent back to their respective provinces. Most kapatid of the sect were peasants, laborers, and common folks from Southern Tagalog who believed in Tatang Valentin’s promise of a new government based on “true equality and true liberty”. They also subscribed to Tatang Valentin’s promise of supernatural powers once they wore their anting antings and sacred vests. He said that the bullets of the enemies would turn to snakes and just fall around them But as it happened, and as proven in the bloody early morning of May 21, their anting antings were no match for the automatic gunfire of the constabulary. The bullets easily tore through their vests, flesh and bones.

The magical vest of Tatang Valentin delos Santos. Author's collection.

In retrospect, the Lapiang Malaya massacre was just one of the many episodes in the history of the Filipino mass movements whose combined desire for freedom and faith in the anting antings led them to fight the abuse or oppression of those in power. The revolt of the Cofradia de San Jose in 1840, the Katipunan in 1896, the Colorum rebellions of Southern Tagalog in 1897, the Philippine Revolution of 1899, the Makario Sakay and Felipe Salvador rebellions during the early years of American occupation, the Sakdal and the Hukbalahap, are examples of uprisings that have their base on the mass movements that are driven not only by nationalistic fervor but by religious and superstitious beliefs as well.

The leaders and members of these movements invariably kept anting antings to protect them in their battles against the enemies. General Emilio Aguinaldo was known to possess the medallion of the Santisima Trinidad, Andres Bonifacio used the Santiago de Galicia amulet, Felipe Salvador used the medallion of Christ’s resurrection, and General Macario Sakay used an anting anting vest with the inscribed Caravaca cross design. In addition, General Antonio Luna, Bishop Gregorio Aglipay, and Gen. Miguel Malvar were also known to possess anting antings.

Aside from them, the anting anting also figured prominently in the lives of folk heroes and bandits, such as Tiagong Akyat, Nardong Putik, Kapitan Eddie Set whose real-life stories were made into popular movies. But for all the supposed effectiveness of their anting-antings, most of these folk heroes and villains ended up being killed by gunfire, in encounter with the authorities.

Even former President Marcos, the man Tatang Valentin wanted to overthrow, was known to possess anting-antings. Bishop Gregorio Aglipay, a firm believer in anting-anting, embedded an anting anting into the skin of Marcos. Could it be that Marcos’ anting anting was more powerful than Tatang Valentin’s?

Did Tatang Valentin and his men truly believe that their anting antings have the power to turn bullets into snakes? If so, why did the anting-antings fail to stop the bullets from penetrating through cloth and flesh? Was Tatang Valentin truly a messiah from God as he claimed? Or was he simply, as the government claimed, a madman? What is it in the anting-anting that attracts many Filipinos into believing in them? Where did it come from? What is its history? More importantly why would some Filipinos reject logic and place their lives in peril just because they possess an anting anting?

The Myth and Promise of Anting anting

Every culture has produced its own set of talismans and amulets, and the Philippines is no exception. While some cultures may regard amulets to be as mere magical accessories to protect one against harm and bad luck, the culture of the Filipino anting anting is different, as it goes further as to be regarded as a religion in itself. The anting anting is interestingly unique in that it invariably contained mixed symbols of the ancient Filipino religion, Roman Catholicism, the Christian Orthodox, and Judaism.

For those who believe in its divine properties, the amulet is one of the few man-made objects that can make man closer to God or even achieve the qualities of God. It is a long-held belief among the mystics, both in the East and the West, that amulets serve as temporary or even constant habitation of God and other divine spirits. The animist belief that inanimate objects can become receptacles of dwelling of the divine is shown through the ancient worship of statues, relics, beads, portraits, tombs, and amulets. (H.P. Blavatsky, Collected Writings, Vol. VIII).

The early Filipinos, before the coming of the Spaniards were already known to keep amulets, talismans, charms, and various other objects to protect them from harm, the elements, and the evil spirits. Crocodile tooth, gems, odd-shaped stones, and even fossilized remains of animals were the earliest known examples of anting-antings used by the early Filipinos.

Filipinos call anting anting in a variety of ways: bertud, agimat, gamit, talisman, mutya, or galing. Like its many different names, it also comes in many different forms. It can be a medallion, a small book, a piece of paper, a tattoo, a crocodile tooth, a meteorite, a vest or scarf inscribed with mantras, and many other forms. No one is quite sure how the word anting anting came to be. According to Lorna Montilla, anting-anting may have evolved from the Latin word “anti”, and thus means anti-anti, or against-against (G.F.Fernando).

Indeed if the present belief in the popular use of anting-anting is to be considered, it may be correct, since the anting-anting is mostly used to protect its wearer against harm and illness. But there are also some who put forward the theory that the term is actually derived from the Javanese “anting anting” which means ear pendants. Anting-anting may also have been derived from the Bahasa Melayu word “anting” that means “dangling” or “swinging”.

The anting anting is steeped in legend and lore. Many of the people who put their faith in the anting-anting, such as the kapatid of the Lapiang Malaya, held the notion that they gain supernatural powers thru the anting anting. Through the powers of the anting-anting they can become invisible to enemies, they can be impervious to bullets and knives, they can escape mortal dangers, they can be at two places at the same time, and so on. Therefore, the anting anting gives them the attributes of the gods, and that thru these magical objects, they can be like gods.

Most anting antings are puzzling because of their cabalistic figures, mysterious mantras, and hidden initials. Many people who keep anting antings are very secretive and would not want to reveal what they keep, except maybe those which they wear around. They believed that the mystical nature of the anting anting, their own covenant with the gods, is what makes it powerful. Once revealed, its power diminishes or disappears altogether.

The secret symbols and initials are part of the original mystical theogony of the Tagalogs. The oracion (mantras)—the prayers summoning the divine—are mostly hidden in initials. I found that many of these initials are the numerous names of God and the words He had spoken. For instance, the initials M.M.M. (Mitam, Micam, Macmamitam or Magob, Mariagob, Magogab) and A.A.A. (Avelator, Avetillo, Avetemit) appear on many medallions which, according to the anting-anting believers, are the initials of the true names of the Santissima Trinidad (Holy Trinity)

Many of the symbols are connected with the Filipinos’ concept of God. The one most commonly seen symbol is the Eye contained in a triangle, which is the symbol of the Bathala or the Infinito Dios, the ancient Filipino God. The connection of God to the anting anting therefore plays an important role in trying to understand its very nature. To unlock the secrets of the anting anting’s hidden meanings, myths, and symbolisms, one must be able to understand the Filipino’s concept of God. The anting anting is the Filipino’s way to approach God, and to contain God within a medallion or vest, and thereby achieve a divine connection which will give him the qualities of God.

The Theogony of the Anting anting

The ancient Filipinos believed in the existence of God. In Tagalog mythology, God is the Bathalang Maykapal or Bathala, the creator of the universe. Although the name Bathala may be Tagalog, it has counterparts in other parts of the Philippines. Bathala rules the world. He provides man his needs and protects the world against evil. There are other deities in the ancient religion of the Tagalogs, but Bathala is the highest and most powerful.

The arrival of the Spaniards in the Philippines changed the Filipinos' belief in Bathala. To make the conquest easy and make the Filipinos easily believe and convert into the new religion, the friar missionaries interpreted Bathala to be the same Spanish God of the Roman Catholic religion. There was no effort on the part of the friars to erase the old belief on the Bathala but rather to adapt the Bathala into the new religion. It may even be said that the friars may have encouraged the belief in Bathala as well as other Filipino local beliefs and superstitions, including the belief in anting antings to create an industry to sell to them similar objects like scapulars, scarves, relics, medallions and rosaries. This fusion of folk beliefs and Roman Catholicism is what we may now call as Folk Catholicism.

The proliferation of material objects to venerate, long a tradition among the Filipinos, has thus been encouraged and fused with Roman Catholicism. The Filipinos created their own interpretations of these objects to suit their beliefs. Thus many of the symbols that can be seen on the anting antings have the fusions of the Roman Catholic and the early religion of the Filipinos.

The important change instituted by the friar missionaries was with regards to the concept of God among the Filipinos. Although Bathala is interpreted by the friars as to be the same Spanish God of Roman Catholicism, Bathala’s monotheistic being changed as he was now viewed as consisting of three persons, or the Doctrine of the Santissima Trinidad (Holy Trinity of God the Father, God the Son, and God the Holy Spirit).

This doctrine is the most important dogma of Catholicism. In the book Catechism of the Roman Catholic Church published by the Vatican, the doctrine is stated:

"The Trinity is One. We do not confess three Gods, but One God in three persons. The divine persons do not share the one divinity among themselves but each of them is God whole and entire".

The early Filipinos may have difficulty understanding this concept of the Santissima Trinidad. How can the Bathala be One and Three at the same time? To solve this theological crisis, and to retain the easier concept that the God is only One, the Tagalogs created the mythology of the Infinito Dios. In this new theogony, Bathala is again One, but his name has become the Infinito Dios, and immediately below him—but also Gods on their own—are the Santissima Trinidad: the God the Father, God the Son, and God the Holy Spirit.

The concept of the Bathala/Infinito Dios existing before the Santissima Trinidad may seem easier to understand for the early Filipinos. Here, the line is clear: the Infinito Dios is the One and Only God. He retains his role as the creator of the universe, the provider of mankind, and the protector against evil.

The later arrival of the Santissima Trinidad into the Filipino theogony, created the myth that the Santissima Trinidad, a newcomer in Filipino theogony, wanted to baptize, i.e., convert, the Infinito Dios, not knowing that the Infinito Dios was already existing even before they—the Santissima Trinidad-- existed.

Altar of the religious samahan Tres Personas Solo Dios. The Bathala/Infinito Dios is higher than the Santissima Trinidad.

Tha Infinito Dios anting-anting

The world of Philippine anting-antings is mainly based on the mythology of the Infinito Dios. The Infinito Dios is figured as the single eye in a triangle. This symbol is still widely used in many folk Catholic religions in the Tagalog region, such as the Iglesia Watawat ng Lahi, Ciudad Mistica De Dios, Tres Personas Solo Dios, to name a few. Even the Katipunan of Andres Bonifacio and later the revolutionary government of General Aguinaldo—both of whom were known to keep anting-antings-- used this symbol in many of their official seals and banners.

The Mythology of the Infinito Dios

In the beginning, there was a bright light that covered the entire universe. This light was called the Infinito Dios. There is no God other than the Infinito Dios. He was the Animasola (Lonely Soul), a winged eye wrapped in shawl, forever changing his form while floating in space. Soon the Infinito Dios decided to create the world. He pulled the light in order to give way to the darkness. His light receded until it became a small ball of light. The ball of light suddenly had a gash on the lower portion that became mouth. On top of the mouth a line appeared that became the nose. On top of the nose emerged two holes that became eyes. From these eyes came forth bursts of flame. Parallel to the eyes, on the sides, two holes appeared that became the ears. In short, the Infinito Dios, the ball of light, became a figure resembling a man’s head.

The Infinito Dios decided to create beings to assist him in his task of creation. While thinking, the Infinito Dios suddenly had perspiration on his right side. When he wiped his right side, the droplets became sixteen spirits. Two of these spirits became Uph Madac and Abo Natac, the two elders who reside in the two corners of the Earth and are the guardians of the Sun and the Moon. The next six spirits became the beings who reside outside the earth. They did not want to receive any blessings from the Infinito Dios. Their names are Elim, Borim, Morim, Bicairim, Persulatim and Mitim. The next seven spirits became the unbaptized Archangels named Amaley, Alpacor, Amacor, Apalco, Alco, Arago, and Azaragoe.

The last spirit was called Luzbel, a spirit whose name means light of heaven. His name is Becca, the being who will later rebel against the Infinito Dios.

Meanwhile, the Infinito Dios decided to create other beings. While thinking, he suddenly perspired on his left side. Wiping the perspiration, the droplets became eight spirit beings. Five of them became the beings who went to Jesus Christ while he was nailed to the cross to ask for his blessing. But before he could give his blessing to these five spirits, Jesus expired. The five spirits never received their blessings and therefore retained their original names of Istac, Inatac, Isnatac, Tartaraw, and Sarapao.

The last three spirit beings became known as the Tres Personas, or the Santisima Trinidad. The Infinito Dios gave them the task to create the world and its inhabitants. On each of the eyes of the Tres Personas can be seen the letter M, which is the initial of their names: Magob, Mariagob, Magogab.

The sixteen spirit elders that emanated from the right wing of the Infinito Dios.

In the above mythology, one can gather that the Infinito Dios was the beginning of everything. No one created the Infinito Dios. He was there from the start, a floating Eye within a triangle wrapped in a shawl. From him emanated the other spirit elders, the archangels, Luzbel (who later rebelled and became Lucifer), and the Santissima Trinidad.

The Infinito Dios is the highest God in the theogony of the anting anting. Sometimes He was called the Nuno or the oldest being from whom everything came forth. For this reason, the Infinito Dios was a separate entity from the Santissima Trinidad (Father, Son, Holy Spirit), although the latter emanated from his body as perspiration, along with the other first beings of the universe. The Infinito Dios gave the authority to create the world to the Santissima Trinidad.

Trespico medallion. Note again that the Infinito Dios is higher than the Santissima Trinidad (Dios Ama, Dios Anak, Dios Espiritu Santo)

The arrival of the Spaniards in the Philippines in the 16^th century proselytized the Filipino’s concept of God. To easily conquer the archipelago, and safely introduce the Roman Catholic religion without antagonizing the superstitious and religious beliefs of the Filipinos, the Spanish friar missionaries adapted Bathala to be the same Spanish God of Roman Catholicism.

The trinitarian doctrine gave way to the mythology that God, a spirit being, is an eye contained in a triangle. The triangle (or in anting anting parlance, trespico), is the perfect representation of God, as it contained three equal sides or three equal corners, consistent with God’s three equal personalities. The triangular medallion, therefore, becomes one of the most popular of all the anting antings. It symbolizes the oneness of the Infinito Dios and the Santissima Trinidad. To those who keep and faithfully believe in it, they can achieve oneness with the Infinito Dios and the Santissima Trinidad.

Revolutionary seal of the Philippine government under Gen. Emilio Aguinaldo used during the Philippine-American War 1899-1901

The Mythology of the Infinita Dios

God’s plan for the world is to save it from the clutches of the Devil. For this reason, one of the Santissima Trinidad has been assigned to go down to earth to save humankind. Only through his sacrifice and death can humankind be saved. But since God is immortal and cannot die, he must assume a human form, and before he must be born a human, he should be conceived by a woman.

God being born as a human by a human mother is again one of those concepts that cannot easily be understood, especially among the early Filipinos who have a simple pre-colonial belief in the existence of God who is the first being in the universe. But for God to become human, and for God to be born by a woman, is something complex, especially if Catholicism teaches that the woman is the Mother of God, instead of just a blessed human person assigned by God to bear his human form.

The woman, the Virgin Mary, conceived God in her womb. The official Catholic doctrine on her personality is stated clearly in the official book Catechism of the Roman Catholic Church published by the Vatican:

Mary is truly “Mother of God” since she is the mother of the eternal Son of God made man, who is God himself.

The image of a Mother God therefore plays an important role in the theogony of the anting anting. The Virgin Mary, as taught by the friar missionaries, is the Mother of God and therefore plays an important role in governing the universe.The veneration of the Virgin Mary as the Mother of God is accepted by the early Filipinos as a given that Mary is an important God in the pantheon of the Gods. Monotheistic though the Catholic religion is claimed by the friar missionaries, to the simplistic views of the pre-colonial Filipinos, the Infinito Dios, the Santissima Trinidad, and now, the Virgin Mary constitute a polytheistic religion. In the theogony of the anting anting, the Virgin Mary must be elevated from her role as a simple bearer of God in her womb, to become the Infinita Dios, the female equality and counterpart of the Infinito Dios.

Thus the myth of the Infinita Dios was established:

Before God created the universe, He decided to have someone help him in his task of creation. While thinking, five shining letters sprang forth from His mind that became the five petals of a beautiful flower (mayuming bulaklak). This flower is called the Gumamela Celis which means the Flower of Heaven or Flower of the Earth (Rosa Mundi). The five letters are none other than the beautiful name M-A-R-I-A, which in Syrian language is Miriam, which means the highest. The original name of Maria before God created anything was Bulaklak.

Maria was thus the first being that emanated from God. In short, Maria was even first to appear than the 16 spirits, the Archangels, Luzbel (Lucifer), and the Santissima Trinidad. The Virgin Mary was thus elevated from her former status as bearer of God in the flesh, into a God that first sprang forth from the mind of God.

Then again, one should not be confused. The Infinito Dios, the Santissima Trinidad, and the Virgin Mary all share in the equality of their divinity. No one is more or less than the other. This is quite difficult to understand, so one can imagine how the early Filipinos had a hard time embracing this set of beliefs about God. Clearly, even a child can understand that there are five Gods being spoken here: the Infinito Dios, the Santissma Trinidad that is composed of three persons, and the Virgin Mary.

The Infinita Dios

But another theological crisis arises: God is One even though clearly there are five of them sharing the one divinity. To simplify this complex matter, the early Tagalogs invented the God called Cinco Vocales: A-E-I-O-U.

A is Bathala/Infinito Dios

E is Mother God (Virgin Mary)

I is God the Father

O is Jesus Christ

U is the Holy Spirit.

The Gods A-E-I-O-U or Cinco Vocales

The Cinco Vocales is the final enumeration of the pantheon of Filipino Gods as a result of the synthesis of the complex doctrine of the Roman Catholic religion and the simplistic pre-colonial religion of the Tagalogs.

The emergence of the Infinita Dios in anting anting symbols also gave way to the belief that God does not have a sexual gender preference. He or she can be revealed as a masculine or a feminine.

To this pantheon of Gods, however, we must add a newcomer: Amang Gat Dr. Jose Rizal, whose name among anting-anting believers is Jove Rex Al, meaning, God King of All. To many anting-anting believers, Rizal is the second incarnation of God. The first was Jesus Christ. Most, if not all, Rizalistas are also believers in anting-anting. Inversely, many anting-anting believers are also Rizalistas.

The anting-anting in the 21st century

A casual visit to Quiapo Church on any given day can give anyone an idea of the superstitious nature of the typical Filipino. Here and there around the vicinity of the church can be seen the various traders of religion and occult. In this motley array of vast and rich cultural traditions, the scapular and rosary vendors, the fortune tellers, and the amulet sellers mixed together to make this part of Manila the center of divination and mysticism in the Philippines. Indeed, in the deelpy religious and superstitious nature of Filipino culture, it is hard to tell where religion and occult divides.

Sagrada Familia anting anting. This medallion offers good luck for business and protection against ghouls like tikbalang, itim na dwende, kapre, and aswang.

The occult merchants occupy a huge space around the Quiapo Church . Most sellers have a makeshift stall composed of a small table and small baskets where they put all their occult merchandise that cater to the Filipino curiosity: from amulets, to herbal medicines, books on folk healing, love potions, elixirs, and various other objects such as odd-shaped stones, gems, crystals, and other freaks of nature called the mutya.

From my own interviews with several of these occult vendors, I found that the anting anting (amulets), are the bestsellers among the various magical objects that they sell. Many people buy them: men and women, young and the old. The anting antings are priced according to their size and the materials used. Generally, the bigger the size the more expensive it would be. Of course, the material used also determines the price: anting anting that is cast in expensive red bronze commands a slightly higher price than the cheaper yellow bronze. The anting antings range in price from anywhere between 20 pesos to 700 pesos.

A group of anting-anting believers in Quiapo

There are hundreds of design to choose from, ranging from the medallion of the Infinito Dios, the Santissima Trinidad, the Infinita Dios, to that of the various other lesser gods, angels, and saints of Folk Catholic mythology. The anthropomorphic figures of the Gods are often accompanied by mysterious initials and cabalistic inscriptions in Latin and Tagalog. Many of these initials are actually the numerous names of God and the power words (oraciones) that he had spoken. They are written in initials because they are meant to be secret and not spoken or uttered, not unlike the belief of the Jews who wanted God’s name hidden, and thus removed the vowels of God’s name in the scriptures, leaving it to be read as YHWH or YHVH, which cannot be pronounced because of the absence of vowels.

In the anting anting, the removal of vowels is no longer deemed necessary. It was already enough to put just the initials of God. Thus many initials that can be found on the anting anting are read as A.A.A, M.M.M., L.M., H.A.H., J.A.H., O.I.A., and so on, which are all the various names of the Infinito Dios, the Infinita Dios, or the Santissima Trinidad.

At present the anting antings are still popular and many people still buy them. It is hard to tell if people buy them because they genuinely believe in them, or because they are just curious about them. But for the faithful, the anting anting have a variety of purpose: there are anting antings that would make one impervious to bullets and knives (kabal at kunat); there are those that can make one invisible to enemies (tagabulag); there are those that can give one powers to control the elements (impasibilidad); there are anting anting that can make one be attractive to the opposite sex (gayuma); there are the anting-antings that can make one lucky in business and gambling; there are those that give protection against illnesses; and there are also the anting antings that can protect one against the ghouls and evil elementals of Philippine folklore: the tikbalang, kapre, mangkukulam, nuno sa punso and the itim na dwende.

The Filipino philosophy of “wala namang mawawala kung maniniwala” plays an important role in the culture of the anting-anting. There is nothing wrong in believing something that one cannot prove to be effective or ineffective, unless one is hacked by a bolo and either survived or killed. But there is no shortage of genuinely honest people who swear in their honor that the anting-anting saved their lives or made their lives worthwhile. In Cavite and Batangas for instance, I met many aged anting-anting people who told me fascinating stories about how they survived assassinations, accidents, and life-threatening illnesses because their anting-antings protected them. One only has to have faith in the anting-anting to achieve its powers.

I myself subscribe to the concept of “wala namang mawawala kung manininiwala”. There is nothing wrong in believing unless the belief limits your abilities as an individual. The anting anting does the otherwise by providing inspiration that God is with the common people, and that in this modern time of high technology, the anting anting still provides hope and faith to the oppressed people. God would reward their faith and devotion with His protection and blessing.

Indeed my friends and colleagues started treating me differently when they discovered that I was keeping a collection of anting-antings. They thought that anting-antings are only worn by superstitious and weird people. But what if the anting-anting really has the power to save me from harm, illness, and other evil things? What if by a freak accident I get hit by a truck and survive? One thing is for sure, however. I always cross the street with extreme caution, even though I may carry an anting-anting in my pocket. I will never test the power of the anting-anting as it is tantamount to challenging the power of God.

Anting anting scarf of Infinito Dios in battle formation. This scarf is an effective protection against gun and other weapons.

During the Philippine-American War (1899-1901), the so-called Filipino “insurrectos” fought the superior-armed Americans with only their bolos and anting antings. One of those killed was featured in the book “Harper’s History of the War in the Philippines ” in 1899, an “insurrecto” who was wearing an anting-anting vest of the Infinito Dios that proved no match for the gunfire of the Americans.

It astonished the Americans that the “insurrectos” had the courage to face the superiorly armed U.S. Army:

“Why did not these men surrender? It was an exhibition of solid heroism, the like of which I shall not see again. At least over the graves of these men, whose actions we cannot quite understand, should be written the word “heroes”. Many of these men wore anting antings or charms to preserve life….”

The anting-anting therefore served as the vital object with which the Filipinos pinned their hopes in order to gain an edge in the war against the superior-armed American troops. Nevertheless, the psychological impact of possessing the anting anting could have made the war more blooodily contested. Without the anting-antings, one could hardly say if the war lasted as long as it did. The anting-anting is an important part of the Filipino battle gear, along with his bolo and crude firearm.

More recently, during the Lapiang Malaya massacre of 1967, those killed were found to be wearing the supposedly magical vests that could turn bullets into snakes and just fall harmlessly around them. But as it happened, the bullets easily tore through the vests and flesh of the Lapiang Malaya kapatid. Tatang Valentin Delos Santos, the spiritual leader of the Lapiang Malaya also died violently—allegedly beaten by an inmate in the National Mental Hospital where the Supremo was confined as a lunatic.

I think that the reason why the anting-anting failed is that Filipinos who used them become very fatalistic. Their utter disregard for safety and caution led into their own doom. Here comes into mind another one of those old Filipino sayings that may have significance to the anting-anting: “nasa tao ang gawa, nasa Diyos ang awa”.

People who believe in the power of the anting-antings must also exercise caution and discipline and not become foolish and defy logic. Imagine what faith, reason, and hard work can do to defeat evil.

Santissima Trinidad anting-anting. Excellent protector against all evil.

Be that as it may, the anting anting still plays a significant role in the social psychology of the Filipino people. Most people who believe them come from the lower strata of society, the common folk who are deprived of wealth and social power but who nevertheless gain spiritual and psychological powers through the anting anting.

The anting anting evolved from being a magical object that protects the Filipinos from evil and harm to religious objects that serve as temporary or even permanent receptacles of God. The anting anting is thus worshipped as God itself, or his various forms and representations. In this conceptual framework, God becomes a genie which, through proper devotion, faith, and mysterious incantations, can be summoned to protect the believer from evil and harm.

Through the oraciones, the believer achieves a unity, a oneness with the Infinito Dios and is thus able to gain God’s qualities that can make him a superman—a man bearing the powers of God, because through his faith and hard work, the old Bible saying is thus applied to him: You shall be as gods.

Amang Gat Dr. Jose Rizal included in the pantheon of the Gods in Filipino Folk Catholicism.

Rizal anting-anting

Note: This article originally appeared in the Online Magazine Philippine Online Chronicles.

Florid Cemento Osseous Dysplasia

Findings

Figure 1, Figure 2, Figure 3, and Figure 4: Mandibular and maxillary cystic lesions with central calcification, bony expansion and selective involvement of the periapical regions are noted.


Diagnosis: Florid Cemento Osseous Dysplasia


Florid cemento-osseous dysplasia is a slow growing benign lesion which is extremely aggressive and infiltrative. It involves the periapical regions of both the maxilla and mandible with a diffuse distribution of mixed lucent-opaque osseous changes. The lesions are benign fibro-osseous lesions, which histologically, represent normal bone replaced by highly cellular fibrous connective tissue and cementum. Cemento-osseous dysplasia predominantly affects females greater than males (10-14:1) with a predilection for African American patients. Treatment of these lesions should be further radiographic follow-up without surgery unless the lesions become symptomatic, necrotic, or super-infected. Odontoma would also be in the differential as it is a hamartomatous malformation composed of odontogenic tissues. These lesions are usually discovered in the 2nd decade of life and can cause impaction, malpositioning or resorption of adjacent teeth. Ameloblastoma is the most common odontogenic tumor arising from follicular epithelium, dental lamina or enamel. It is a benign lesion but extremely aggressive and infiltrative. It most commonly occurs as an expansile lesion in the posterior mandible in the region of the third molar within the 3rd to 5th decades of life. The unicystic variant occurs in adolescents and has a soap bubble like appearance and involves the ramus and posterior body of the mandible. Large tumors may erode the bony cortex and infiltrate adjacent soft tissues. More malignant processes such as osteosarcoma exhibit a more pronounced periosteal reaction, bone destruction and the presence of a soft tissue mass. Multifocal osteosarcoma is rare. Also, chronic diffuse osteomyelitis is less likely, as it is usually unilateral, associated with pain and fever, exhibits poorly defined borders and would not be exclusively confined to tooth bearing areas.

Non-hemorrhagic pituitary apoplexy

Findings

A mixed signal (mildly hyper intense on T1-weighted and mixed hyper/hypo intense on T2 weighted sequences) lobular mass with thin rim-enhancement arises from the sella, extending superiorly above the diaphragm sellae (“snowman sign”), deviating the optic chiasm upwards. There is no diffusion restriction, and no susceptibility artifact (on B0 DWI sequences) to suggest hemorrhage. The clivus, and bony sella are intact. A thick rim of dural enhancement dorsal to the clivus is noted.


Diagnosis: Non-hemorrhagic pituitary apoplexy (with underlying macroadenoma)


Key points


Pituitary apoplexy (PA) (e.g. "necrosis") refers to hemorrhage or infarction of the pituitary.
Commonly there is a pre-existing macroadenoma (65-90%).
Acute clinical syndrome includes HA, visual defects/ophthalmoplegia, AMS, and variable endocrine deficiencies.
Acute imaging features show enlarged gland (T1/T2 isointense) with peripheral enhancement, with or without hemorrhage.
Subacutely – gland T1/T2 hyper intense, and chronically – appears as "empty sella" (filled with CSF) with T1 hypo / T2 hyper signal
T2*GRE sequence is very sensitive in looking for hemorrhagic products.
Sometimes there is subarachnoid hemorrhage.
Thickening/enhancement of adjacent dura (50%) and sphenoid mucosa (80%)
Differential diagnosis includes: Pituitary macroadenoma (non-hemorrhagic), craniopharyngioma, Rathke's cleft cyst, pituitary abscess, primary intrapituitary hemorrhage, or giant thrombosed intrasellar aneurysm.
Patients often suffer from long-term pituitary hormonal insufficiency.
Treatment of PA includes: Steroids, fluid/electrolyte replacement, and sometimes surgical decompression.


Discussion of disease

Pituitary adenomas are benign, slow-growing tumors which arise from the adenohypophysis, classified as either micro (< 10mm, 40 %) or macro (> 10 mm, 60%). However, occasionally leptomeningeal metastases can be seen. Patients present with indolent onset of headache, bitemporal hemianopsia (from optic chiasm compression), endocrinologic symptoms.

Pituitary apoplexy (PA), or pituitary necrosis, is usually caused by hemorrhage or infarction of the gland. There can, however, be bland necrosis (without either). The clinical syndrome is of somewhat acute onset with headache, visual defects/ophthalmoplegia, altered mental status, and variable endocrine deficiencies. Pre-existing macroadenoma is very common (65-90%). There is often associated subarachnoid hemorrhage. Thickening / enhancement of the adjacent dura and sphenoid sinus mucosa is very common. Sheehan’s syndrome is a rare peri-partum or post-partum (can be up to 15-20 yrs after index pregnancy) infarction of the pituitary with loss of anterior pituitary hormonal function. Long-term pituitary insufficiency is very common after PA. Treatment may include steroids, fluid/electrolyte replacement, or even surgical decompression.


Radiologic overview

CT (macroadenoma) – isodense to grey matter; fill and expand the sella turcica. CT is excellent for evaluating for sphenoid sinus invasion / bony destruction. Hemorrhage 10%, rarely calcify; pituitary apoplexy appears as hyper dense (acute), or as an "empty sella" if chronic, and very characteristic rim-enhancement.

MR – sellar mass without separate identifiable gland (mass is the gland) with "figure of 8" or "snowman" configuration (coronal), from constriction is caused by diaphragma sellae. Pituitary apoplexy has similar findings, with signal changes based presence/age of hemorrhage. Chronic PA will appear as an "empty sella" (T1 hypo, T2 hyper = filled with CSF). There is thickening / enhancement of adjacent dura in 50% of cases (seen in the presented case), and thickening / enhancement of sphenoid sinus mucosa 80% of the time.

Changed my email

Hi Everyone!

Just to let you know guys, that I no longer use my dennis_villegas@skydsl.com.ph email. Please ignore any emails coming from this.

My old and reliable philippinecollectibles@yahoo.com is my official communications email. If you have any inquiries, kindly forward it to this mail.

Many thanks,

Dennis Villegas

Posterior Shoulder Dislocation-3D CT

Posterior Shoulder Dislocation- posterior dislocation is rare & should raise possibility of seizure as cause; other causes include an electric shock or ECT without muscle relaxants. Radiographs may reveal Reverse Hill Sach Lesion - compression fracture of the anteromedial portion of the humeral head is produced by the posterior cortical rim of the glenoid as in this case of 28 year old male, with posterior dislocation seen on 3D CT images.

Joubert syndrome

Findings

There is agenesis of the vermis. The interpeduncular fossa is deep. There is a cerebellar cleft. There is prominence and thickening of the superior cerebellar peduncle. There is a bat wing configuration of the fourth ventricle.


Diagnosis: Joubert syndrome


Key points

Joubert syndrome is an autosomal recessive genetic disorder that affects the cerebellum and midbrain. There is agenesis/hypogenesis of the cerebellar vermis and malformation of the midbrain and brainstem.

With poor development of the cerebellar vermis and brainstem, patients can present with ataxia, hypotonia, and hyperpnea. One of the first clinical signs of Joubert is episodic hyperpnea or apnea in an infant. Breathing can reach upwards of 160 breaths/minute. Mild mental retardation is often seen, though some may have normal intelligence. Patient health and growth are usually not affected. Patients with Joubert benefit from physical, occupational, and speech therapy. Infants with respiratory abnormalities require respiratory monitoring.


Radiologic overview of the diagnosis

The initial radiologic manifestations are often seen on fetal ultrasound with increased nuchal lucency being the most apparent finding. Fetal or Brain MR is the best modality to evaluate the presence of Joubert syndrome.

The classic findings are a hypoplastic/aplastic vermis, thick superior cerebellar peduncles, a deep interpeduncular fossa, and an abnormal midbrain. This configuration resembles a molar tooth and is often referred to as the "molar tooth" sign. The fourth ventricle also takes on a bat wing configuration. The midbrain is usually decreased in AP dimension. In this case, there is complete agenesis of the vermis and the molar tooth sign can be seen with thickening of the superior cerebellar peduncles. The corpus callosum and pars intermedia is thickened and may reflect a compensatory response by the brain adapting to the lack of a vermis.

Spinal Cavernous Angiolipoma

Findings

Figure 1: Sagittal T1 image of the thoracic spine demonstrates a mixed signal soft tissue epidural mass posterior to the cord at the T4-T5 level causing posterior impression upon the thecal sac. There is also a T1-bright infiltrating lesion within the T5 vertebral body.
Figure 2 and Figure 3: Sagittal post-contrast T1 imaging shows an enhancing lesion with both bony and soft tissue components. This was localized to the right paraspinal soft tissues and there is compression of the cord. Bony involvement is seen in the vertebral bodies of T11 and L1 and in the posterior elements of multiple other thoracic levels.


Diagnosis: Spinal Cavernous Angiolipoma


Spinal angiolipomas are a rare entity that are histologically benign. These fatty tissue lesions have been quoted in the literature as representing 0.14-1.2% of all spinal axis tumors. Spinal angiolipomas are typically found in the thoracic vertebrae owing to the spine's regional variation in blood supply. The vast majority of epidural noninfiltrating angiolipomas are posterior or posterolateral in location. Patients are more commonly female and usually present in the fourth or fifth decades of life. Symptoms are slow and progressive over several months, with cord compression commonly seen at presentation. Other commonly seen symptoms include: back pain, sphincter dysfunction, progressive paraparesis, lower extremity paresthesias, and hyperreflexia. In rare cases, symptomatology may be acute due to factors such as spontaneous hemorrhage, venous thrombosis, or “steal” phenomenon.

Spinal angiolipomas are divided into two subtypes: the more common noninfiltrating type and the more aggressive (but still histologically benign) infiltrating type. An angiolipoma is termed infiltrating based on bony involvement.

Classically, spinal angiolipomas are T1 hypointense enhancing epidural lesions with or without bony involvement. The intraosseous component is usually heterogenous on T1 imaging. MR is frequently obtained due to patients symptoms of possible cord compression, and it is important to rule this entity out. Differential diagnosis would include hemangiomas, metastatic melanoma and lipid-rich metastases like liposarcoma and the clear cell variant of renal cell carcinoma. On CT, these are indistinguishable from hemangiomas. When viewed in bone windows, the typical “corduroy” appearance with linear streaks of high attenuation can be seen as well as the more stippled foci of increased density seen on axial imaging. To distinguish the two, a pathologic diagnosis is essential

The mainstay of treatment for patients with neurologic symptoms is cord decompression. When possible, surgical excision is preferred with an excellent prognosis for these patients. Heavy bleeding is typical, especially with the infiltrating type owing to the rich vascularity of these lesions. Typically, the neurosurgeon will have multiple blood products available at the time of surgery. For the case discussed above, the estimated blood loss at the time of surgery was 1800cc with 5 units of packed red blood cells administered.

Teleradiology Providers-India

Again another animated FAQs on Teleradiology Services, specially created to answer the queries for our prospective clients.

PG MEDICAL ENTRANCE-DAMS

This is a video clip simulating basic information on our insitute DAMS regarding PG medical entrance. We used basic animation to cover the FAQs asked by students.

Aneurysm of the right cervical internal carotid artery causing vocal cord paralysis

Findings

CT imaging through the neck demonstrates findings suggestive of right vocal cord paralysis.
Figure 1 shows dilation of the right pyriform sinus.
Figure 2 shows thickening and medial positioning of right aryepiglottic fold.
Figure 3 shows dilation of the laryngeal ventricle.
Figure 4: CT through the skull base reveals a rounded well defined brightly enhancing mass in the right carotid space displacing the carotid and internal jugular vein.
Figure 5: MR images demonstrate flow void on T2 weighted images.
Conventional angiography confirms an aneurysm of right internal carotid artery.


Diagnosis: Aneurysm of the right cervical internal carotid artery causing vocal cord paralysis


Unilateral vocal fold paralysis (UVFP) occurs from a dysfunction of the recurrent laryngeal or vagus nerve innervating the larynx. Clinical presentation includes characteristic hoarseness often accompanied by swallowing disabilty, weak cough, and sometimes shortness of breath. Its is important to note that a high vagal lesion results in both a recurrent laryngeal nerve and superior laryngeal nerve palsy with the latter resulting in significant anesthesia of the pharynx and increasing the risk for aspiration

CT scanning or MRI should be performed as part of a workup for a unilateral vocal fold paralysis (UVFP) of unknown etiology. The imaging should include the entire path of the vagus/recurrent laryngeal nerve involved. For left unilateral vocal fold paralysis (UVFP), imaging should extend from the base of skull to the mid chest (arch of the aorta) with right sided vocal fold paralysis including the base of the skull to the clavicle.

Unilateral vocal cord paralysis can be reliably identified on cross sectional imaging. Characteristic findings include:
1. Medial positioning and thickening of the ipsilateral aryepiglottic fold.
2. Ipsilateral pyriform sinus dilatation.
3. Ipsilateral laryngeal ventricle dilatation.
4. Fullness of the ipsilateral true vocal cord.
5. Anteromedial positioning of the ipsilateral arytenoid cartilage.

Causes of vocal cord paralysis are varied with nearly 25% classified as toxic or idopathic. Post-surgical cord paralysis is another important consideration often without specific imaging findings. Identifiable causes include mass compression and or malignant invasion. Although rare, aneurysm or pseudoaneurysm of the cervical internal carotid artery should be considered in the differential diagnosis of a carotid space mass. Because of the intimate proximity of structures within the carotid space, it is sometimes difficult to definitively determine the epicenter of an enhancing lesion. However, as the resolution of cross-sectional imaging improves, preoperative characterization is increasingly possible. A demonstrable arterial connection, arterial enhancement, peripheral calcification, and flow void on MR imaging is suggestive of the diagnosis.