Imaging findings in patients with myelofibrosis

The purpose of this review is to illustrate the wide range of radiological abnormalities in myelofibrosis. Myelofibrosis, also called myeloid metaplasia, is a myeloproliferative disorder of unknown etiology. The common imaging findings in patients with myelofibrosis are osteosclerosis, hepatosplenomegaly, and lymphadenopathies. In addition, extramedullary hematopoiesis may develop in multiple sites such as chest, abdomen, pelvis, and central nervous system, simulating malignant disease. Selected plain-film, CT, and MR images in patients with myelofibrosis are shown as pictorial essay to allow ready recognition of the most common imaging abnormalities of the disease. Received: 6 August 1998; Revision received: 15 October 1998; Accepted: 20 November 1998     

Utilization of radionuclide therapy facility and assembly-temporary type therapeutic facility for medical treatment of radioactivity contaminated patients in nuclear emergency

Medical management of patients internally contaminated in nuclear emergency needs, in addition to general medical treatment, to evaluate doses due to intakes of radioactive materials, to conduct effective treatment with stable isotopes and chelating agents and to keep public away from radioactive materials in and excreted from patients. The idea of medical treatment for internal contamination is demonstrated in the general principles on medical management of victims in nuclear emergency issued by the Cabinet Office in Japan. However, if impressive number patients with internal contamination are generated, the current medical management scheme in nuclear emergency is not able to admit them. The utilization of radionuclide therapy facilities where patients with thyroid diseases are treated with radioisotope and assembly-temporary housing type treatment facilities dedicated for internal contaminated patients may be expected to complement the medical management scheme in nuclear emergency. The effect or more medical management system for patients internally contaminated may become one of the safety nets in the contemporary society that inclines to use nuclear energy on account of accessibility.     

Medical management of patients internally contaminated with radionuclides in radionuclide therapy facility and assembly-temporary type therapeutic facility in nuclear emergency

The utilization of radionuclide therapy facility and temporary therapeutic facility has been proposed for securing the effectiveness of the higher medical management of patients internally contaminated in nuclear emergency. However it is not then practical to conduct all of the medical management. The purpose of the medical management of contaminated patients in the facilities is to continue the medical treatment of the patients who already undergo medication in order to decrease the amount of radionuclides inside of the bodies and reduce possible cancer risks and, from the view point of radiation protection, to prevent the proliferation of radionuclides from the patients and the expansion of secondary radiation exposure from them to the general public. It is here described a basic idea for medical management for contaminated patients in the radionuclide therapy facility and temporary therapeutic facility to complement the current medical management scheme in nuclear emergency.     

Imaging of orbital disorders in pediatric patients

The spectrum of orbital lesions occurring in childhood is wide, including a variety of both benign and malignant disorders. Although physical examination and fundoscopy may aid in establishing the diagnosis of retro-ocular lesions, imaging remains a critical step in the evaluation of the pediatric orbit. Ultrasonography, CT, and MR imaging are the primary modalities for the evaluation of the diseased orbit, and careful observation of the characteristic radiological features usually leads to correct diagnosis; however, some of the lesions look very similar and are difficult to differentiate from each other. The purpose of this article is to review the common and unusual entities that may involve the pediatric orbit, to describe the radiological features, and to evaluate the efficacy of US, CT, and MRI in the diagnosis and management of these conditions.     

糖尿病患者急腹症影像特点探讨

肠梗阻(intestinal obstruction,Ileus)指肠内容物在肠道中通过受阻,为常见急腹症,由多种因素引起.起病初,梗阻肠段先有解剖和功能性改变,继则发生体液和电解质的丢失、肠壁循环障碍、坏死和继发感染,最后可致毒血症、休克、死亡.当然,如能及时诊断、积极治疗,大多能逆转病情的发展.糖尿病患者肠梗阻有其自身的特点,它是由于长期高血糖内分泌失调,使胃肠道植物神经功能紊乱和微血管病变引起的并发症.     

Imaging findings in patients with clinical anophthalmos.

PURPOSETo review the intracranial and facial imaging features in children with congenital anophthalmos.METHODSWe retrospectively studied eight children with anophthalmos with respect to intraorbital, intracranial, and craniofacial anomalies (six had CT examinations, including the face, orbits, and brain, and four had MR imaging, including the orbits and brain).RESULTSThree patients had primary bilateral anophthalmos on CT (n = 1) and MR (n = 3) studies. In these patients, MR images showed hypoplasia of the optic chiasm and posterior visual pathways (n = 3), agenesis (n = 1) or dysgenesis of the corpus callosum (n = 2), and a mass in the tuber cinereum region (n = 1). One patient had incontinentia pigmenti. Five patients had unilateral anophthalmos on CT (n = 5) and MR (n = 1) studies. One of these patients had a contralateral congenital cystic eye and one had contralateral severe microphthalmia and absent optic chiasm. All had craniofacial anomalies that consisted of midline facial clefts (n = 2) and concomitant hemifacial hypoplasia (n = 2). One had a craniosynostosis. All five had normal-appearing brains.CONCLUSIONPatients with bilateral anophthalmos represent a distinct group from those with unilateral anophthalmos. In our patients, bilateral anophthalmos was associated with absence of the optic chiasm, diminished size of the posterior optic pathways, and agenesis or dysgenesis of the corpus callosum. Patients with unilateral anophthalmos had severe craniofacial anomalies. Imaging of the face is helpful in patients with unilateral anophthalmos.     

Imaging patterns of fatty liver in pediatric patients

Fatty liver can present as focal, diffuse, heterogeneous, and multinodular forms. Being familiar with various patterns of steatosis can enable correct diagnosis. In patients with equivocal findings on ultrasonography, magnetic resonance imaging can be used as a problem solving tool. New techniques are promising for diagnosis and follow-up. We review imaging patterns of steatosis and new quantitative methods such as proton density fat fraction and magnetic resonance elastography for diagnosis of nonalcoholic fatty liver disease in children.Nonalcoholic fatty liver disease (NAFLD) is as widely encountered in children as in adults, with an estimated prevalence of 9.6% (1). It occurs due to accumulation of triglyceride in hepatocytes without alcohol ingestion. Nonalcoholic steatohepatitis (NASH) was first defined in children in 1983 (2). NAFLD includes a broad range of clinicopathologic features ranging from simple steatosis (fat with inflammation and/or fibrosis), steatohepatitis/NASH to cirrhosis. Some other diseases of liver can also cause hepatic steatosis including hepatitis B and C, Wilson’s disease, α-1-antitrypsin deficiency, autoimmune hepatitis, drug-induced liver injury (valproate, methotrexate, tetracycline, amiodarone, and prednisone), and total parenteral nutrition (3). Furthermore, fatty liver is a risk factor for cirrhosis, diabetes, and cardiovascular disease.In clinical practice, the diagnosis of NAFLD is made by increased serum ALT and/or presence of enlarged echogenic liver in ultrasonography. Being overweight or obese, and/or insulin resistance are highly indicative but not absolutely necessary for diagnosing NAFLD (4). The gold standard for diagnosis is liver biopsy, which additionally provides semi-quantitative analysis of NASH damage in children (5). It is an expensive, invasive procedure with a risk of morbidity (0.06%–0.35%) and mortality (0.01%–0.1%) (6).The evaluation of liver fat in children via noninvasive imaging modalities is needed to avoid complications of biopsy and for follow-up. Main imaging modalities for the assessment of pediatric NAFLD are ultrasonography (US) and magnetic resonance imaging (MRI). Computed tomography is the other imaging method for liver fat assessment, but ionizing radiation is a major drawback in children (7). Assessment of fat accumulation may cause diagnostic dilemmas and confusion due to manifestations with unusual structural patterns and imaging appearance of the liver. This article reviews the histopathology of pediatric NAFLD, radiologic evaluation and different structural patterns of childhood NAFLD/NASH on US and MRI. We also discuss diagnostic pitfalls and briefly review new imaging techniques.     

Imaging features of Burkitt lymphoma in pediatric patients

Burkitt lymphoma is an aggressive and rapidly growing tumor that is curable and highly sensitive to chemotherapy. It can affect almost every tissue in the body, producing various clinical presentations and imaging appearances, according to the predilection of the different subtypes for certain sites. Awareness of its diagnostically specific imaging appearances plays an important role in rapid detection and treatment. In this pictorial review, we aimed to identify the most common imaging features of Burkitt lymphoma in pediatric patients.Burkitt lymphoma (BL) is an aggressive subtype of non-Hodgkin lymphoma (NHL) with a doubling time of 24–48 h. Even with its aggressive character, BL is curable and highly sensitive to chemotherapy. Thus, early diagnosis and treatment are critical before life-threatening complications, such as airway compromise or spinal cord compression, set in. Knowledge about the imaging appearances assists in rapid detection and treatment. In this pictorial review, we illustrated the most common imaging features of BL.In 1958, Denis Burkitt first described BL in Uganda, after encountering many children with rapidly growing jaw tumors. In 1964, some viral particles, termed Epstein-Barr virus (EBV), were identified in the tumor (1, 2). Since then, BL has been classified into three main clinical variants: endemic, sporadic, and immunodeficiency-associated. The endemic variant is linked to EBV infection and is observed particularly in Africa, where malaria is also endemic. The sporadic variant is the most common form in the rest of the world, where malaria in not endemic. The immunodeficiency-related type is observed after organ transplantation and in patients with human immunodeficiency virus infection or congenital immunodeficiency diseases, including Wiskott-Aldrich syndrome, ataxia telangiectasia, and X-linked lymphoproliferative disease (1–5).The least common type of lymphoma in all age groups is generally BL with an incidence of 1%. During childhood, it is the most frequent subtype of NHL with an incidence of 40%. As BL can involve various sites of the body, the clinical presentation and radiologic appearances differ; it may be localized or disseminated and can affect a wide variety of locations. In the endemic variant, head and neck involvement is more common; however abdominal involvement is more commonly observed in the sporadic form (1, 6).     

AIDS合并神经梅毒的影像学表现

_目的：探讨 AIDS 合并神经梅毒（NS）的影像学特点,提高对 AIDS 合并神经梅毒的认识。方法：回顾性分析经临床证实的10例 AIDS 合并神经梅毒患者的临床及影像资料。结果：10例患者中脑膜血管型5例,脑膜型、麻痹性痴呆各2例,树胶肿型1例。脑内共发现23处病灶,其中病灶分布于额叶和颞叶各5处,半卵圆中心4处,顶叶、枕叶和基底节各3处,4例存在脑萎缩。增强扫描脑膜型 NS 呈脑回样脑膜强化,脑膜血管型病灶呈斑片样及脑回样强化,树胶肿型病灶呈结节状不均匀强化,麻痹性痴呆患者伴有脑萎缩。经过正规抗梅毒治疗后10例患者症状均有所好转。结论：AIDS合并神经梅毒的影像表现多样,早期诊断需综合分析影像及实验室检查资料。     

Forensic investigation of suicide cases in major Greek correctional facilities

IntroductionAccording to Greek legislation the medico-legal investigation of deaths occurring in prisons is mandatory. Furthermore, in cases of suicide or of suspected suicide the contribution of medico-legal investigation is of grave importance. The current paper addresses the medico-legal investigation of suicide cases in Greek correctional facilities and aims to describe the current situation.Materials & methodsOur study consists of the meticulous research in the data records of major Greek correctional facilities, for the time period 1999–2010. Official permission was obtained by the Hellenic Ministry of Justice, which provided us the access to the records. Data was also collected from the Piraeus Forensic Service, from the Department of Pathological Anatomy of the University of Athens and finally from our own records. Measures were taken to respect the anonymity of the cases. Data was collected for the social, penal, medical history as well as for the medico-legal investigation.Results–conclusionsIt appears that 85.7% of suicide cases were transferred to the Prisoner's Hospital (p < 0.0001), the forensic pathologist who conducted the PME did not perform scene investigation in none of the 70 suicide cases. In a total of 70 cases, histopathological examination, was requested only in 30 cases (42.9%). Hanging was the preferred method for those who committed suicide, followed by the poisoning due to psychoactive substances.Understanding the mistakes made during the forensic investigation of suicide cases inside correctional facilities is necessary, in order to prevent them from occurring again in the future, by implementing appropriate new policies and guidelines.