Cholangiography and interventional biliary radiology in adult liver transplantation

Radiographic assessment of the biliary tract is often essential in patients who have undergone liver transplantation. T- or straight-tube cholangiography, percutaneous transhepatic cholangiography, and endoscopic retrograde cholangiography all may be used. A total of 264 cholangiograms in 79 adult liver transplant patients (96 transplants) was reviewed. Normal radiographic features of biliary reconstructive procedures, including choledochocholedochostomy and choledochojejunostomy, are demonstrated. Complications diagnosed by cholangiography included obstruction, bile leaks, and tube problems, seen in eight, 24, and 12 transplants respectively. Stretching and incomplete filling of intrahepatic biliary ducts were frequently noted and may be associated with rejection and other conditions. Transhepatic biliary drainage, balloon catheter dilatation of strictures, replacement of dislodged T-tubes, and restoring patency of obstructed T-tubes using interventional radiologic techniques were important in avoiding complications and additional surgery in selected patients.     

Prolonged drip-infusion cholangiography.

Previous experimenttal work in animals has shown that the hpatic excretion of iodipamide and ioglycamide is subject to a transport maximum (TM). Doses in excess of this TM are largely excreted in the urine. In the present study the TM for man was estimated in three subjects with indwelling T-tubes: figures of 19-23 mg/minute for ioglycamide were obtained. It was thought that prolonged administration of contrast at levels slightly above the TM might have advantages in patients with impaired liver function. In obstruction the gradual excretion of contrast could improve the chances of filling the ducts completely, while in hepato-cellular disease the gall bladder might have time to concentrate the contrast. Ioglycamide was therefore given by slow overnight infusion, equivalent to 35 mg/minute, to patients in whom standard cholangiography had been unsuccessful. The overall success rate was 75 per cent with similar improvement in obstructive and hepatocellular disease.     

Comparison of percutaneous and endoscopic retrograde removal of postoperatively retained bile duct stones

Forty-one patients underwent nonsurgical removal of postoperatively retained bile duct stones in two nonrandomized groups. The endoscopic-retrograde technique was used in 21 patients, and succeeded in 19. The percutaneous approach through the T-tube tract was used in 22 patients, including the two in whom endoscopic stone removal had failed, and was successful in 21 patients. Individual preferences and prior history introduced a selection bias against the percutaneous technique. Auxiliary extracorporeal shockwave lithotripsy (ESWL) was used in 2 patients whose stones could not be fragmented mechanically by the percutaneous basket technique. ESWL was successful in one patient but failed in the second. Because endoscopy had also failed in this case, the patient subsequently underwent repeat surgery. Procedure-related complications were minor with both techniques and were readily treated by conservative measures. We conclude that both the retrograde and the percutaneous approaches are effective and safe. The endoscopic approach appears convenient because there is no need to await maturation of the percutaneous tract, but sphincterotomy carries a small but distinctive risk. Because the percutaneous approach uses an existing tract, is only minimally invasive and leaves the sphincter of Oddi intact, it is preferable in those patients who have T-tubes of approapriate size and position in place.     

Editor and authors' psychology and the chance of teaching

It is the duty of the editor to communicate with the authors who submit their scientific work for publication. The question arises as to the best way to perform this communication. The goal is to publish papers that would make their authors proud and the readers of the journal, satisfied. This goal is expressed with honesty, kindness, politeness, diplomacy and when the editor communicated with authors from other Countries, the advice of a person familiar with the traditions of these Countries may be welcome. The unpleasant editor's duty to inform the authors of their paper being rejected, can be expressed either by writing a brief straight forward letter or by giving a more detailed answer or finally, by explaining to the authors their errors in a detailed manner, in other words, by giving them advice and consultation. In his reply to the authors whose paper has been rejected, the editor may touch a sensitive part of their behavior. Authors may consider their paper as "their intellectual child". Some times authors make unacceptable mistakes that may or may not be revealed by the reviewers. Explaining in detail errors and thus counseling the authors, is hard work for the editor but not always appreciated by the authors. The value of counseling and teaching has been emphasized even by ancient philosophers but nowadays enthusiasm in learning is sometimes lacking. Is there a solution to the above? Perhaps if "the instructions to authors" of a journal specified clearly the "submission terms" for accepting a paper for publication, then the authors could be self-evaluated and perhaps all parties concerned would be happier.     

Varices of the colon in the roentgenologic picture

The authors describe a double contrast X-ray picture of varicosities of the large intestine. In the literature so far irrigoscopic changes specific for varicosities were not described. The authors observed that the defect of the filling increased after Valsalva's manoeuvre. The authors consider this symptom specific for varicosities.     

Rethinking Normal: Benefits and Risks of Not Reporting Harmless Incidental Findings

The authors explore the benefits and risks of not reporting imaging findings that do not have clinical relevance, with the goal of developing recommendations to reduce their reporting. The authors review the example of incidentally detected, simple renal cysts (Bosniak category I), including medicolegal conditions required for such a shift in reporting practices to be acceptable. The authors propose four potential criteria for not reporting clinically unimportant findings and recommend that these criteria be debated in other contexts, so that they can be refined and implemented.     

2004-2013年《中华航空航天医学杂志》核心作者分析

目的 探讨近年来《中华航空航天医学杂志》发文作者、作者单位及作者地区分布情况,了解该杂志作者科研合作情况,确定其核心作者群、核心作者分布机构及核心作者所在地区. 方法 利用中国人民解放军医学图书馆所开发的中国生物医学期刊引文数据库（Chinese medical citation index,CMCI）及万方生物医学全文数据库,运用文献计量学相关方法,对《中华航空航天医学杂志》2004-2013年所有发文作者发表论文数量、合作论文情况、核心作者分布情况、作者地区分布、作者所在机构和论文多产单位分布等进行统计分析. 结果 《中华航空航天医学杂志》2004-2013年10年间发表论文1 451篇,第1作者人数852人,其中发表论文1篇的作者582人,占第1作者总人数的68.31％.作者合作论文1 317篇,合作率90.76％.医院发表论文489篇,科研院所发表论文421篇,高等院校发表论文213篇.核心作者共124人,发表论文575篇.论文多产单位15个.北京地区发表论文748篇居第1位. 结论 《中华航空航天医学杂志》拥有的作者数量较多,分布较广,合作率较高.其中医院、科研院所和高等院校发文量最多,成为航空航天医学研究的重要组成力量.核心作者撰写的论文数量超过总论文数的一半.表明期刊核心作者群已经完全形成.     

Mr contrast due to intravascular magnetic susceptibility perturbations

A particularly powerful paradigm for functional MR imaging of microvascular hemodynamics incorporates paramagnetic materials that create significant image contrast. These include exogenous (lanthanide chelates) and endogenous (de-oxygenated hemoglobin) agents for mapping cerebral blood volume and neuronal activity, respectively. Accurate interpretation of these maps requires an understanding of the bio-physics of susceptibility-based image contrast. The authors developed a novel Monte Carlo model with which the authors quantified the relationship between microscopic tissue parameters, NMR imaging parameters, and susceptibility contrast in vivo. The authors found vascular permeability to water and the flow of erythrocytes to be relatively unimportant contributors to susceptibility-induced ΔR2. However, pulse sequence, echo time, and concentration of contrast agent have profound effects on the vessel size dependence of ΔR2. For a model vasculature containing both capillaries and venules, the authors predicted a linear volume fraction dependence for physiological volume changes based on recruitment and dilation, and a concentration dependence that is nonlinear and pulse sequence dependent. Using the model, the authors demonstrated that spin echo functional images have greater microvascular sensitivity than gradient echo images, and that the specifics of the volume fraction and concentration dependence of transverse relaxivity change should allow for robust mapping of relative blood volume. The authors also demonstrated excellent agreement between the predictions of their model and experimental data obtained from the serial injection of superparamagnetic contrast agent in a rat model.     

Gastroesophageal reflux and peptic esophagitis in childhood. What is the role of traditional radiology?

The authors studied 52 patients aged from 1 month to 8 years with symptoms consistent with gastro-esophageal reflux and esophagitis. The employed methods were radiological examination, esophageal manometry, acid reflux test, endoscopy. The gastro-esophageal reflux was diagnosed in 38 children. The authors compare the results of radiological examination to those of the other methods. The analysis of the results led the authors to believe that the association of every methods is necessary to define the diagnostic picture. However, the authors emphasize that the conventional X-rays examination is the first stage that cannot be substituted in the management of children with non acute gastro-esophageal disease.     

Intracortical osteosarcoma: Rare entity or early manifestation of classical osteosarcoma?

The authors present a case, the fourth in the literature, of an intracortical osteosarcoma. On the basis of histological and clinical discussion, the authors conclude that this intracortical form probably represents an early manifestation of classical osteosarcoma.     

CT-guided percutaneous transpedicular biopsy of the spine

Occasionally, vertebral body lesions are encountered that are ill suited to the standard posterolateral approach to biopsy. The authors used a transpedicular approach to spine biopsy in six such cases. The authors suggest that this approach be used when the location of the lesion does not allow easy access by means of the posterolateral approach.     

Percutaneous vertebroplasty in the treatment of metastases. Technic and results

The authors studied 20 patients with vertebral metastases. They injected in these metastases orthopaedic cement by a percutaneous technique under local anesthesis. The results are good for 16 patients, nul for 2 patients and we observed 2 complications. The authors conclude that the best indication is the painy somatic lysis of a vertebra without peri-radicular tumor.     

Exertional compartment syndrome in a Marine grunt.

Exercise-induced exertional compartment syndrome was first described by Vogt in 1945 as "march gangrene." The authors report a case of a 20-year-old United States Marine presenting with the florid findings of acute crural compartment syndrome. The patient's history of prior episodes of crural pain following long hikes led the authors to conclude that this patient had a chronic exertional compartment syndrome.     

矽肺肺野淋巴组织钙化的X线表现及其临床意义

作者从１０４６例矽肺患者中检出于胸片出现明确矽肺影像前，肺野有淋巴组织钙化１４７例。胸片上表现为圆形或卵圆形，呈空心和实体钙化灶二种改变，直径多在３～６ｍｍ之间。本文着重对这种特殊形态的钙化灶的Ｘ线表现进行动态观察，对其形成的机理、命名、鉴别诊断及其临床意义作简要的分析讨论。认为矽肺肺野淋巴组织钙化是接尘作业工人、０＋及矽肺病人特有的一种早期病理反应，值得引起重视的一种Ｘ线征象。     

Calcifications of the prostate: a transrectal echographic study

Prostatic lithiasis is a well know phenomenon. It has little clinical significance and is not easily shown by conventional radiography, which has poor sensitivity and specificity. The authors have studied 612 patients with both suprapubic and transrectal US in order to 1) assess US sensitivity and specificity and 2) report the frequency, spatial distribution, number and features of prostatic calcifications with special emphasis on differential diagnosis between prostatic neoplasms and chronic prostatitis. The authors have also studied the relationship between morphology and symptoms and the results agree with those reported in the scanty literature. The authors conclude that the parameters studied are directly related to age, except for a younger group with clear evidence of genital inflammation. The authors emphasize the impossibility to correlate morphology of prostatic calcifications with pathologic conditions: there are no specific symptoms clearly connected with calcification even though the inflammation is often associated with calcifications.     

Dementing disorders: volumetric measurement of cerebrospinal fluid to distinguish normal from pathologic findings -- feasibility study

The authors describe a magnetic resonance (MR) imaging technique to quantify the severity and distribution of cerebral atrophy by using automated volumetric analysis of the distribution of cerebrospinal fluid. The MR imaging technique demonstrated high diagnostic sensitivity and specificity in a group of healthy subjects and patients with dementing diseases. The authors conclude that this approach provides valuable clinical information that is complementary to information acquired with standard diagnostic practices.     

Motivation and productivity in the radiology department.

The successful motivation of employees is often seen as a way to reach a maximum level of productivity. The authors attempt to identify the components of personal motivation, define motivation theories, and explore motivation strategies that can be utilized in a radiology department. The purpose is to discover the relationship between motivation and increased productivity. The authors also examine productivity measurement systems currently being used in radiology departments.     

Is osteoid osteoma an iodophilic lesion?: pathologically proved osteoid osteoma of nasal bone first seen on whole-body iodine-131 scan

The authors present a case of pathologically proved osteoid osteoma that was visualized randomly on an I-131 whole-body scan. Search of the medical literature did not reveal any mention of radioactive iodine uptake by osteoid osteomas. Therefore, the authors concluded that this pathology must be included in the differential diagnostic list of positive findings on I-131 scans.     

Spinning top urethra: not a normal variant

Spinning top urethra (STU) is a term used to describe a widened posterior urethra seen mainly in girls. It is commonly regarded as a normal variant. The authors studied 30 girls with STU using videourodynamics. Twenty-eight showed bladder instability; 21, a congenital wide bladder neck anomaly; and 20, both instability and a wide bladder neck. One patient had a sensitive bladder. All patients had a urodynamic abnormality. The authors believe that the STU is nearly always an indication of bladder instability or wide bladder neck anomaly. The most common mechanism for the dilatation of the posterior urethra is that unstable contractions are resisted by a voluntary increase in distal sphincter tension so as to prevent leakage of urine. The resulting pressure rise produces distention of the posterior urethra, which will be maximal in subjects with a weak bladder neck mechanism as in the congenital wide bladder neck anomaly. The authors believe that STU is seldom if ever a normal variant.