Nostalgia Trip:Jackie Chan and Teresa Teng

This video brings back so many beautiful memories of the past when I was hooked on Chinese love songs (well, actually up to now). I started listening to Chinese songs when I was teaching in St. Stephen's Chinese High School in Binondo way back when I was a freshman teacher. A student of mine gave me a gift of Teresa Teng cassette tape, which I find weird because I only knew very few Chinese phrase and words. But the cassette got me hooked and I started learning cantonese and mandarin. I also started collecting several Cd's of Teresa and Jackie Chan. Back then, I had a whole afternoon of free time (our classes were up to 12pm only), and every day I raided the old music shops in Ongpin, Chinatown to look for Teresa Teng cassettes. I eventually managed to collect virtually every Teresa Teng's tapes (and cd's later). I literally cried when I heard the news of her tragic death in 1995 at the age of 43.

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My friends also usually find it weird that I have a penchant for old Chinese songs (although later they were borrowing my CDs). Well maybe I love music, and that's important. Music transcends language barriers. That's the reason I enjoy listening to a variety of songs in Japanese, Chinese, Spanish and even Indian songs. But I guess I love more the sweet mellow sound of Chinese love songs. And especially so if they were sung by Teresa Teng and Jackie Chan.

In this music video, Jackie Chan pays tribute to Teresa Teng, and this tribute could not have been better than to sing one of her favorite songs. Probably, Jackie still misses Teresa Teng. They had been lovers for quite sometime and Jackie admits that he still loved her. They could have been the ideal couple, both being superstars in Hongkong, China and Japan. But fate has willed differently.

Persistent Trigeminal Artery

Embryologic development of the basilar artery occurs along two axis systems: longitudinal fusion and axial fusion. Longitudinal fusion consists of midline fusion of paired ventral arteries and reflects the simplified pattern of arterial anatomy found in the spinal cord. Axial fusion consists of fusion of the distal basilar artery, which arises from the caudal division of the internal carotid artery, to the midbasilar agenesis to the posterior inferior cerebellar artery termination of the vertebral arteries. Persistent longitudinal nonfusion (or complete duplication) of the basilar artery is very rare, and persistent axial nonfusion is even rarer.The trigeminal artery appears embryologically at the 4-mm stage and involutes at the 7–12-mm stage. It arises from the basilar artery, unlike the posterior communicating artery, another of the carotid-basilar anastomosis, which arises from the posterior division of the internal carotid artery . A persistent trigeminal artery is estimated to occur in 0.1–0.2% of the population and, in most cases, is an incidental finding.

Case by Dr MGK Murthy, Sr Consultant Radiologist

Teleradiology Providers

CNS tuberculosis

Findings

Figure 3, Figure 4, and Figure 5: Post contrast MR images show multiple coalescent ring-enhancing lesions in the left side of the midbrain and pons and in the interpeduncular and suprasellar cisterns.
Figure 1 and Figure 2: These lesions are markedly hypointense on T2-weighted images with surrounding perilesional edema.


Diagnosis: CNS tuberculosis


Tuberculous meningitis is the most common manifestation of CNS tuberculosis across all age groups.
The combination of brain parenchymal lesions and meningeal enhancement is highly suggestive of tuberculosis.
Central areas of hypointensity on T2 WI should suggest tuberculosis or fungal disease.
CNS involvement is seen in 5 % of patients with tuberculosis (TB) but prevalence increases in immunocomprised patients, being seen in up to 15% of cases of AIDS- related TB. Approximately 30 % of TB patients are HIV positive.

The disease is found primarily in children and young adults. A history of previous extracranial TB is elicited in 60%, but only 30% have concomitant manifestations of TB outside the CNS at presentation.

CNS tuberculosis usually results from hematogenous spread, often from a pulmonary source. However, it may result from direct rupture or extension of a subependymal or subpial focus (Rich focus) and may be located in the meninges, brain, or spinal cord.

CNS tuberculosis can manifest in a variety of forms, including:
- tuberculous meningitis
- tuberculomas
- tuberculous abscesses
- osteomyelitis of the skull or spine, often with associated epidural abscess

Tuberculous meningitis is the most common manifestation of CNS tuberculosis across all age groups. The typical radiographic finding is abnormal meningeal enhancement, usually most pronounced in the basal cisterns. This is best seen at gadolinium-enhanced MR imaging. Appearances usually resolve relatively quickly with adequate treatment; however, radiographic resolution is delayed if there are thickened exudates. The common complications of tuberculous meningitis are communicating hydrocephalus, ischemic infarcts or cranial nerve involvement, most commonly affecting the second, third, fourth, and seventh cranial nerves.

The acid-fast bacilli disseminate hematogeneously and lodge at the gray- white matter junction and form tuberculous granulomas. Tuberculous abscess formation with central liquefaction is rare and reflects a poor host immune response.

There are 4 stages in the evolution of tuberculomas:
- 1. Cerebritis stage: non specific edema, ill-defined enhancement
- 2. Solid, granulomatous stage: enhancing nodules with surrounding edema
- 3. Central caseation stage: central hypointensity on T2- peripheral enhancement
- 4. Involution stage- multiple calcified lesions

CNS tuberculosis has a mortality rate as high as 30 %; in HIV positive patients, it is up to 80 %. Serial imaging is useful to assess response to therapy.

Blogging for Health

For many people with serious illnesses, blogging offers a way to cope and share their stories. Joanna Moorhead in The Hindu discusses the benfits and risks involved with patients especially critically ill patients blogging about their health conditions.

Osteochondral Defect

Berndt and Harty radiographic classification of osteochondral lesions of the talus is as follows:
Stage I - Normal radiograph (subchondral compression fracture of the talus with no ligamentous sprain)

Stage II - Partially detached osteochondral fragment
Stage III - Complete, nondisplaced fracture remaining within the bony crater
Stage IV - Detached, loose osteochondral fragment



Anderson MRI classification of osteochondral lesions of the talus is as follows:
Stage I - Bone marrow edema (subchondral trabecular compression; radiograph results are negative with positive bone-scan findings)
Stage IIa - Subchondral cyst
Stage IIb - Incomplete separation of the osteochondral fragment
Stage III - Fluid around an undetached, undisplaced osteochondral fragment
Stage IV - Displaced osteochondral fragment

Case by Dr MGK Murthy, Sr Consultant Radiologist

Carriedo: Then and Now

This photo dates back to the 1950s and was photographed by then Manila Times photographer Teodulio Protomartir. Protomartir was one of the Philippines greatest photographers.


This is my recent September 13, 2008 photo of Carriedo.

These two pictures of Carriedo in downtown Manila looks like a game out of the page in a newspaper entertainment section called "Spot the Differences". The Carriedo then looks clean and less populated. The Carriedo now looks so much crowded, what with all the figures of humanity going to and fro in different directions.

Yet, Carriedo today still has the the old edifices of the post-war era. Amazingly, some of the old bazaars and shoe stores still exist, a constant reminder that remnants of old Manila still survives to this day.

Actually, the two photos above are just previews of a forthcoming book I am preparing entitled "Manila: Then and Now", which will show Manila both in the past and as it is now.

Carriedo is the most crowded part of downtown Manila, being the street that bridges Quiapo and Sta. Cruz. In any normal day you will see a lot of interesting things: Old ladies coming from Quiapo Church, young men in tight jeans on the way to buy personal accessories, vendors trying to sell their wares, people looking for bargain clothing, or cheap Chinese-made products, pirated cds and dvds, or just plain folks trying to stroll around for an afternoon walk.
One must always be careful though, as any crowded place is a favorite hang-out of thieves and pickpockets.

Carriedo may not be a beautiful place to someone looking for a beautiful scenery like a well-manicured garden or sunset on the beach. Yet, it can also be beautiful, especially if one is more at home with the rowdy crowd of Manila downtown.

Is raised choline on MRS a non-specific finding?

This is a biopsy proven case of tuberculomas which improved dramatically with ATT. However, MRS findings of raised choline and lipid-lactate peak was seen which is traditionally associated with neoplastic etiologies. Review of literature revealed an article in J. Magn. Reson. Imaging 2001;14:8-15. which also questioned specificity of this finding.