The invisible sentry

Radiological imaging may enable the recognition and documentation of acts of terror. Search by X-rays can assist in the detection of weapons, drugs, contraband, and hidden persons. Fluoroscopy, backscatter imaging, and computed tomography are being employed for the evaluation of luggage, humans, trucks, and containers. The identification of drugs and explosives is possible by additional spectral analysis. The images can show individuals nearly naked, which may lead to a discussion on violation of privacy and dignity. There are, however, clinical questions raised about the exposure to X-rays and the possible absence of informed consent. Finally, although the use of X-rays is part of terror prevention, it has been part of the terror, too. The Stasi, the secret service of the German Democratic Republic, used diagnostic X-rays and ionizing radiation in order to control opponents of the political system.     

Image quality, lesion detection, and diagnostic efficacy in digital mammography: full-field digital mammography versus computed radiography-based mammography using digital storage phosphor plates

OBJECTIVE: To compare image quality, the lesion detection, and the diagnostic efficacy of full-field digital mammography (FFDM) and computed radiography-based mammography using digital storage phosphor plates (DSPM) in the evaluation of breast lesions. MATERIALS AND METHODS: In this prospective study, 150 patients with suspicious breast lesions underwent FFDM and DSPM. Nine aspects of image quality (brightness, contrast, sharpness, noise, artifacts, and the detection of anatomic structures, i.e., skin, retromamillary space, glandular tissue, and calcifications) were evaluated by five radiologists. In addition, the detection of breast lesions and the diagnostic efficacy, based on the BI-RADS classification, were evaluated with histologic and follow-up correlation. RESULTS: For contrast, sharpness, and the detection of all anatomic structures, FFDM was rated significantly better (p<0.05). Mass lesions were equally detected, whereas FFDM detected more lesions consisting of calcifications (85 versus 75). DSPM yielded two false-negative results. Both lesions were rated BI-RADS 4 with FFDM, but BI-RADS 2 with DSPM. Both were invasive carcinoma at histology. The sensitivity, specificity, PPV, NPV, and accuracy of FFDM were 1.0, 0.397, 0.636, 1.0, and 0.707, compared to 0.974, 0.397, 0.630, 0.935, and 0.693 of DSPM. CONCLUSION: Based on image quality parameters, FFDM is, in part, significantly better than DSPM. Furthermore, the detection of breast lesions with calcifications is favorable with FFDM. However, the diagnostic efficacy of FFDM and DSPM was equal. The interpretation of the false-negative results suggests that the perception and characterization of breast lesions is not defined solely by the digital mammography system but is strongly influenced by the radiologist, who is one of the determinants in the interpretation of breast imaging.     

Interpretation and reporting of myocardial perfusion SPECT: a summary for technologists

Interpretation of cardiac perfusion SPECT images, and the subsequent reporting of results to referring physicians, are sometimes taken to be outside the sphere of the nuclear medicine technologist. However, all personnel involved with nuclear medicine procedures contribute to the timeliness and usefulness of the final report. The goal of this article is to review the principles of scan interpretation and reporting, from the standpoint of what technologists need to understand about these processes. In addition, software tools to aid these processes will be discussed, including quantitative image analysis, telemedicine, computer-aided scan interpretation, databases, computer-aided reporting, and Internet-based reporting. Finally, the accuracy of the scan report will be related to the tasks normally performed by technologists, such as the acquisition and processing of images and the entry, transfer, and networking of data. After reading this article, the reader will be able to describe the principles of scan interpretation and reporting, the software tools for telemedicine and computer-aided interpretation, and the role of the technologist in this process.     

A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings

BACKGROUND AND PURPOSE: The sphenoid sinus is rarely implicated as a site of spontaneous CSF fistula. We undertook this study to evaluate the potential etiopathogenesis of spontaneous CSF fistula involving the sphenoid sinus and to review the imaging findings. METHODS: We retrospectively reviewed the imaging findings of 145 cases of CSF fistula from our departmental archives (August 1995 through August 1998). Fifteen (10%) patients had CSF fistulas involving the sphenoid sinus. Eleven (7%) patients had spontaneous CSF fistulas, whereas in four patients, the CSF fistulas in the sphenoid sinus were related to trauma. Of the 11 patients, nine underwent only plain high-resolution CT and MR cisternography. One patient additionally underwent contrast-enhanced CT cisternography, and one other patient underwent MR cisternography only. For each patient, the CSF fistula site was surgically confirmed. The MR imaging technique included T1-weighted and fast spin-echo T2-weighted 3-mm-thick coronal sequences obtained with the patient in the supine position. The plain high-resolution CT study included 3-mm-thick, and sometimes 1- to 1.5-mm-thick, coronal sections obtained with the patient in the prone position. Similar sections were obtained after injecting nonionic contrast material intrathecally via lumbar puncture for the CT cisternographic study. We evaluated each of the 11 patients for the exact site of CSF leak in the sphenoid sinus. We also determined the presence of pneumatization of lateral recess of the sphenoid sinus, orientation of the lateral wall of the sphenoid sinus, presence of arachnoid pits, presence of brain tissue herniation, and presence of empty sella in each of these patients. RESULTS: The exact sites of the CSF fistulas were documented for all 11 patients by using plain high-resolution CT, MR cisternography, or CT cisternography. In nine (82%) patients, the sites of the CSF fistulas were at the junction of the anterior portion of the lateral wall of the sphenoid sinus and the floor of the middle cranial fossa. In the remaining two (18%) patients, the sites of the CSF fistulas were along the midportion of the lateral wall of the sphenoid sinus. Of these 11 patients, one had bilateral sites of the CSF fistula at the junction of the anterior portion of the lateral wall of the sphenoid sinus with the floor of the middle cranial fossa. In nine (82%) patients, the presence of brain tissue herniation was revealed, and this finding was best shown by MR cisternography. Ten (91%) patients had extensive pneumatization of the lateral recess of the sphenoid sinus, with an equal number having outward concave orientation of the inferior portion of the lateral wall of the sphenoid sinus. In seven (63%) patients, the presence of arachnoid pits, predominantly along the anteromedial aspect of the middle cranial fossa, was shown. In seven (63%) patients, empty sella was shown. For comparison, we reviewed the CT studies of the paranasal sinuses in 100 age-matched control subjects from a normal population. Twenty-three had extensive lateral pneumatization of the sphenoid sinus along with outward concavity of the inferior portion of the lateral wall. None of these 23 patients had arachnoid pits. CONCLUSION: The sphenoid sinus, when implicated as a site of spontaneous CSF leak, yields a multitude of imaging findings. These are extensive pneumatization of the lateral recess of the sphenoid sinus, outward concave orientation of the inferior portion of the lateral wall of the sphenoid sinus, arachnoid pits, and empty sella. Considering the normative data, we speculate that this constellation of findings could play a role in the etiopathogenesis of spontaneous sphenoid sinus fistulas. Our findings also show the efficacy of noninvasive imaging techniques, such as plain high-resolution CT and MR cisternography, in the evaluation of sphenoid sinus CSF leak. Our data also suggest that spontaneous sphenoid sinus CSF leak is not an uncommon occurrenc     

游离组织瓣移植血供障碍原因分析与防治对策(附305例报告)

目的 探讨游离组织移植血供障碍的原因和防治对策.方法 回顾性分析1983年6月～2006年12月游离组织瓣移植手术血循环障碍病例305例,根据组织瓣类型和修复部位的不同,从手术设计、切取组织瓣、血管变异、切取技术、手术时机、血管搭配、血管清创、血管张力、血管吻合、血管危象处理和感染等11个方面研究组织瓣血供障碍的原因.结果 本组305例中动脉供血不良270例.组织瓣切取后动脉供血不良10例,其中组织瓣营养血管损伤6例,修复损伤的血管后皮瓣成活,其余4例组织瓣动脉供血不足,组织瓣移植后远端坏死,切除坏死的组织瓣,采用局部旋转皮瓣和游离植皮覆盖创面.其余260例经血管探查,成活213例,坏死47例.静脉回流障碍35例,成活5例,部分坏死10例,坏死20例.结论 游离组织瓣移植发生血循环障碍是导致组织瓣坏死的主要原因.临床上根据引起血循环障碍的原因,有针对性地采取措施,可有效地防止组织瓣坏死.静脉回流障碍是组织瓣失败的主要因素.     

Helical CT of the local spread of carcinoma of the gallbladder: evaluation according to the TNM system in patients who underwent surgical resection

OBJECTIVE: Our aim was to evaluate the performance of helical CT as an aid in the preoperative diagnosis of the spread of carcinomas of the gallbladder. MATERIALS AND METHODS: Two radiologists retrospectively reviewed both hard-copy and soft-copy (on a monitor with multiplanar reconstruction capability) versions of helical CT scans (3-mm collimation and 3-mm reconstruction) of 21 patients who had undergone surgical resection for carcinomas of the gallbladder. The local spread of the disease was evaluated according to the TNM system, and the results were correlated to the pathologic findings. Inter- and intraobserver differences were checked with kappa statistics. Results of the consensus interpretations were used to calculate sensitivity, specificity, and accuracy of helical CT. RESULTS: No significant inter- or intraobserver differences were found in any T category evaluation. The sensitivities of the hard-copy consensus interpretations in the diagnosis of T1, T2, T3, and T4 lesions were 33%, 64%, 80%, and 100%, respectively; specificities of hard-copy interpretations were 94%, 80%, 81%, and 95%, respectively. For soft-copy (monitor) consensus interpretations, the sensitivities for the diagnosis of T1, T2, T3, and T4 lesions were 33%, 73%, 80%, and 100%, respectively; the specificities of soft-copy interpretations were 94%, 80%, 88%, and 95%, respectively. Overall accuracy of the hard-copy interpretation was 83%; the overall accuracy of the soft-copy interpretation was not significantly different-86%. CONCLUSION: Helical CT provided 83-86% accuracy in the diagnosis of the local extent of carcinomas of the gallbladder, showing acceptable sensitivity and specificity for the T2 and more advanced lesions but poor sensitivity for the T1 lesions. Use of a monitor with multiplanar reconstructions of the CT data did not significantly improve the diagnostic accuracy.     

Dose of tissue tolerance, dose of tumour sterilisation in continuous and discontinuous irradiation (author's transl)]

In the radiotherapy of cancer, two conditions are necessary:-- 1 degree sterilisation of the tumor; 2 degrees safeguard of surrounding tissues. In discontinuous irradiation, sterilisation depends on the administration of a certain tumour-dose within a suitable period or number of sessions. At the rate of 5 sessions weekly, the following dose-number law may be formulated (ELLIS): DT = 2,500.N0,22. Perfect tolerance of the connective tissue is in fact obtained if the total dose is equal or less than: N.S.D..N0,24.T0,11. The nominal standard dose of ELLIS, is a limiting dose of about 1,800 rads. ORTON and ELLIS have published tables which permit one to obtain, without an index of saturation of the supporting tissue by means of a series of double entry tables corresponding each to a frequency of 1, 2, 3, 4, 5 sessions per week. Each table provides the T.D.F. factor in relation to the number of sessions and the elementary dose. The T.D.F. factor is about 100 whatever the periodicity, and whatever the subdivisions of the dose when ELLIS' equation is satisfied, i.e. when one is at the limit of tolerance. Furthermore, the T.D.F. factor of two parts, of treatment under various regimens may be added together. It is sufficient for the sum to be equal to 100 to ensure full tolerance, which eliminates all difficulty of manipulation of a fractionated formula. The conditions of obtention of continuous irradiation do not permit one to separate the doses of sterilisation and tolerance, as was the case with discontinuous irradiation but, generally speaking, both in continuous and discontinuous administration the shorter the period of treatment the more the sterilising dose exceeds the tolerance dose, whereas with very small tumours, one may obtain tumour sterilisation within the limits of tolerance of the supporting tissues. For very large or radio-resistant tumours, one may have to, in order to obtain sterilisation, exceed more or less the perfect tolerance defined by T.D.F. 100 or its equivalent using ELLIS' equation. The latter is, moreover, only an approximation : the effective tolerance, if one takes into consideration late fibrosis, is very much less than that defined by T.D.F. 100, in particular for high partial dose irradiations. The author insists, after others, on the absolute necessity of taking into consideration the time factor as defined by ELLIS' relationship recalled above. There is no sense in obtaining strict physical dose measurement if one does not also take into consideration the time factor, the biological importance of which is considerable.     

免疫组化在肺肿瘤穿刺活检诊断中的应用

目的探讨免疫组化标记在CT引导下肺肿瘤穿刺活检病理诊断中的应用及意义。方法收集海军总医院病理科近2年来的肺穿刺标本,对进行过免疫组化标记的广谱细胞角蛋白（CKPAN）、细胞角蛋白7（CK7）、p63蛋白（p6）、表面活性蛋白B（SP-B）、甲状腺转录因子-1（TTF-1）、CD56蛋白（CD56）、突触素（Syn）、嗜铬颗粒A（CgA）及白细胞共同抗原（LCA）的病例表达情况进行分析及对比。结果 111例进行了免疫组化标记的肿瘤性病变中,结合组织病理学形态,最终诊断支持肺原发性恶性肿瘤的共有99例（鳞癌20例、腺癌65例、小细胞癌12例、特殊类型2例）,3例为转移性肿瘤,良性肿瘤2例,确定为恶性肿瘤但无法分型的7例。结论肺鳞癌表达p63,腺癌多表达CK7和TTF-1,小细胞癌常表达CD56、Syn和TTF-1。免疫组化联合应用能够有效辅助常规病理检查下对肺穿刺肿瘤的诊断及鉴别诊断。     

一起暴发麻疹的临床特征和流行病学特征分析及防控处理

 目的 分析某学院15例聚集麻疹患者发病的流行病学和临床特征及防控处理,有利于防止麻疹暴发。方法 对15例麻疹患者聚集发病的流行病学资料和临床资料进行调查分析、采样,对聚集发病原因、流行病学特点、临床特点及采取的防控措施进行分析。结果 15例麻疹患者春季聚集发病,临床特征为发热、皮疹、咽痛、咳嗽、流涕、鼻塞,口腔黏膜斑、发热、皮疹,合并肺部感染及结膜炎1例,心肌炎1例,麻疹病毒核酸13例阳性。流行病学特征:首发病例发生于2015-04-01,疫情高峰在4月13日至4月17日,4月17日结束,二代感染病例集中于该病的最长潜伏期内。有明确的流行病学接触史11例,占73%,主要集中在同一层楼的3个宿舍,呈现聚集性分布。均为男性学员,年龄19～25岁。结论 麻疹暴发与季节、疫苗接种、发病年龄、防控措施是否及时实施有关。建议各大专院校及居住比较密集单位的临床医师注意春季麻疹散发病例,立即隔离麻疹患者,密切接触者及时进行预防接种,防止麻疹暴发。     

异氟烷对幼龄小鼠生长和学习记忆的影响

目的：探究异氟烷对幼龄小鼠生长和学习记忆的影响。方法：按分层随机分组将64只幼龄小鼠分为两大组,每大组各分为4小组（n=8）,即NS组（生理盐水组）、Iso1组、Iso2组和Iso3组（后3组异氟烷剂量分别为0．05、0．1、0．2mL／kg）．用跳台实验和避暗实验分别测定给药后1、2、3、5d的错误次数和潜伏期以及注药前基础体重和注药后1d至6d各组幼龄小鼠体重。结果：在跳台实验中,与NS组相比,Iso1组和Iso2组在1、2、3、5d错误次数略增;Iso1组、Iso2组和Iso3组潜伏期在1、3、5d缩短,尤其在1d,Iso2组和Iso3组潜伏期明显缩短（P〈0．05或P〈0．01）;各组幼龄小鼠在1～6d体重大致呈增长趋势（P〈0．05或P〈0．01）,与NS组相比,Iso1组、Iso2组和Iso3组在1—4d体重变化量呈降低趋势,尤其在1d有明显降低（P〈0．01）。在避暗实验中,与NS组相比,Iso1组、Iso2组和Iso3组错误次数在1—3d略增;Iso1组在1、2、3、5d潜伏期略缩短,Iso2组在3d潜伏期略缩短,Iso3组在1、2、3d潜伏期略缩短。与NS组相比,Iso2组和Iso3组在1～4d幼龄小鼠体重增长速度在2～3d降低（P〈0．05或P〈0．01）。结论：异氟烷可在短期内损害幼龄小鼠学习记忆能力和生长,对长期学习记忆能力和生长均无明显影响。     

我国重要自然疫源地地理信息系统的建立

目的：建立我国重要自然疫源地地理信息系统。方法：系统地收集我国存在的各种自然疫源地及其相关因素的资料，整理分析后建立数据库。以地理信息系统软件MapInfo为平台，构建自然疫源地地理信息系统，将建立的数据库与中国电子地图相连接，并实现用户对信息管理、分析、操作、显示等方面的要求。结果：建立的我国重要自然疫源地地理信息系统具有地图管理、信息维护、检索查询、数据分析、专题地图、辅助决策等功能，汇集了我国22种重要自然疫源性疾病的疫源地类型、分布、发病情况、流行特征、防治对策、主要宿主媒介的分布以及与疫源地有关的地理、气象、土地利用和人口等方面的数据，可以按不同的地理范围，从地区、病种、宿主媒介分别查询和显示疫源地相关信息，将结果以文字、表格、图形(包括统计图和专题地图)不同方式显示出来，可对疫源地的分布、发病情况与相关的地理环境因素制作专题地图并进行叠加分析。结论：本系统的建立为我国自然疫源地的管理、研究和控制提供了一种新的技术手段。     

SPECT imaging in the diagnosis of pulmonary embolism: automated detection of match and mismatch defects by means of image-processing techniques.

SPECT of ventilation/perfusion (V/Q) lung scans not only improves the diagnostic accuracy of the method but also facilitates the application of advanced image-processing techniques. On the basis of such techniques, our study aimed at developing a procedure that automatically analyzes V/Q lung scans with regard to match and mismatch defects. METHODS: Fifty-three patients with suspected pulmonary embolism had lung scans using the SPECT technique as well as 16-slice multidetector-row spiral CT within an interval of 48 h. After iterative image reconstruction and computerized linear registration of the V/Q scans, the ventilation was normalized to the perfusion. For the automated detection of mismatch defects, the perfusion was subtracted from the ventilation, whereas for the detection of match defects, the perfusion was subtracted from the inverted ventilation. Two experienced referees assessed all images. The final diagnosis was made at a consensus meeting while taking into account all of the imaging modalities, laboratory tests, clinical data, and evaluation of a follow-up period. RESULTS: The sensitivity, specificity, and accuracy of the conventional visual assessment were 0.91, 0.97, and 0.94, respectively, compared with 0.95, 0.84, and 0.89, respectively, for the automated algorithm. Artifacts imitating mismatch defects in the pulmonary recesses accounted for the relatively low specificity of the automated analysis. Artifacts of that kind were found in 15 patients and led to a false-positive diagnosis in 5 patients. However, by combining the visual and the automated approach, all artifacts could be easily identified leading to a sensitivity, specificity, and accuracy of 0.95, 1.0, and 0.98, respectively. Additionally, in all 12 patients of the cohort with highly heterogeneous ventilation and perfusion, the automated analysis made correct diagnoses. CONCLUSION: Because of the 3-dimensional properties of the SPECT data, the analysis of lung scans can be automated and objectified. The algorithm produces images that are easy to read and well suited for demonstration. Because of artifacts in the pulmonary recesses introduced by the automated approach, its diagnostic accuracy does not reach the level of the conventional analysis yet. Could these artifacts be overcome, the efficiency of the automated algorithm would be at least equivalent to that of conventional image interpretation. At present, best results can be achieved by combining both approaches.     

George W. Holmes Lecture. Deep venous thrombosis and pulmonary embolism: correlative evaluation and therapeutic implications.

Deep venous thrombosis and pulmonary embolism are significant causes of morbidity and mortality in the United States; estimates range from 120,000 to 150,000 deaths annually. Although usually symptomatic, deep venous thrombosis can be clinically occult, in part due to incomplete obstruction or in part related to duplication, triplication, and fenestration anomalies, primarily of the superficial femoral or popliteal vein. Additionally, pulmonary emboli caused by deep venous thrombosis may be clinically silent. Because of therapeutic implications, especially indications for insertion of inferior vena caval filters, comprehensive assessments of both the disease process (i.e., deep venous thrombosis) and the complication (i.e., pulmonary emboli) are important. Thus, when a pulmonary embolus is the presenting process, correlative assessment of deep venous thrombosis, even in the absence of symptoms or signs in the lower extremity, may be of therapeutic significance. Conversely, when deep venous thrombosis of the lower extremities involving the popliteal or superficial femoral vein is the presenting process, correlative assessment of the pulmonary circulation, even when no pulmonary symptoms or signs are present, may be of therapeutic significance. Relative to the diagnosis of pulmonary embolism, the roles of assays of D-dimer, ventilation-perfusion lung scans, and segmental occlusion studies of the pulmonary circulation are discussed. Finally, the indications for insertion of inferior vena caval filters above the renal veins are presented and examples are shown.     

Autonomía,consentimiento y responsabilidad. Parte II. El consentimiento informado en la medicina asistencial y en la jurisprudencia

Legal recognition of patient's rights aspired to change clinical relationship and medical lex artis. However, its implementation has been hampered by the scarcity of resources and the abundance of regulations. For several years, autonomy, consent, and responsibility have formed one of the backbones of the medical profession. However, they have sparked controversy and professional discomfort. In the first part of this article, we examine the conceptual and regulatory limitations of the principle of autonomy as the basis of informed consent. We approach the subject from philosophical, historical, legal, bioethical, deontological, and professional standpoints. In the second part, we cover the viability of informed consent in health care and its relationship with legal responsibility.     

局麻关节镜下选择性清理术治疗膝骨性关节炎的疗效

本文对260例（296个膝）膝关节骨性关节炎（OA）局麻下选择性关节镜清理术的疗效进行了总结,OA关节镜下的病理改变包括滑膜组织增生肥厚、股骨髁及髌骨应力区软骨剥脱、软骨下骨裸露和半月板磨损等,关节镜下选择性清理包括刨削增生肥厚的滑膜组织、清理关节软骨肃脱区创面和软骨碎片、切除破裂的半月板、取出体和磨削骨性阻挡。影响疗效的因素有高龄、手术适应证选择不当、关节严重退变、膝内外翻畸形力线改变等。关节镜下选择性、有限化的关节清理术创伤轻、痛苦小,可有效的缓解症状、改善功能,提高患者生活质量,延缓病程的发展。术后优良率达74.7%。     

外科微创化:21世纪的趋向

由中国工程院主办的 2 0 0 1年工程科技论坛“微创外科新概念”学术研讨会于 2 0 0 1年 10月在北京中国科技会堂召开。参加会议的有黄志强、盛志勇、黎介寿、吴孟超、汤钊猷、王正国等中国科学院、工程院院士以及相关前沿科学领域有造诣的专家 10 0多人。与会专家对微创外科的内涵、发展方向及在外科领域中的地位和作用进行了热烈讨论 ,并就许多问题达成了共识。裘法祖院士给会议发来了贺信。此次会议是一次高层次、高水平的学术会议 ,相当于国外的”GoldenConference” ,对于我国科学与工程技术的发展具有重要意义。为了让更多的读者了解微创外科研究的新进展 ,本刊从与会专家的发言中遴选了部分文稿在此刊出 ,以飨读者。     

Soft-tissue abnormalities of the external auditory canal: subject review of CT findings

We review the normal anatomy and discuss characteristic findings of soft-tissue abnormalities of the external auditory canal (EAC). The indications for computed tomography (CT) of the temporal bone have been significantly expanded with the inclusion of soft-tissue abnormalities of the external ear and the auditory canal. Soft-tissue abnormalities of the EAC that can be evaluated with CT include atresia, edema, hemorrhage, fracture, posttraumatic or infection-caused keloid, malignant external otitis, hemangioma, lymphangioma, papilloma, keratosis obturans, acquired cholesteatoma, adenoma, ceruminoma, fibroma, mixed tumor, sarcoma, and basal cell, squamous cell, or adenocystic carcinoma. CT scans of 25 patients who had soft-tissue abnormalities of the EAC were reviewed. The clinical data were correlated with the radiographic findings. We conclude that CT is the best overall radiographic modality for evaluating the extent and character of soft-tissue abnormalities of the EAC. Significant clinical information that is helpful in patient management decisions is added by this technique.     

Fatal 'Bhang' poisoning.

A young adult male of about 25 years of age consumed a glass (about 300 ml) of Bhang on the holy occasion of ShivRatri. The deceased died within 24 hours of consuming the Bhang. The deceased had suffered from rheumatic heart disease with multiple valvular involvements. He had also undergone open-heart surgery in the past. Fatality due to Bhang is extremely rare and therefore the case is presented. An attempt is made to review the literature. Bhang is one of the Indian preparations of Indian hemp (Cannabis sativa). It is prepared by the wet grinding of the leaves of the plant. The bolus is then consumed in various ways. Water is used as a vehicle. In the present case a bolus of about 1 to 2 gm was mixed in a glass of water. ShivRatri is a Hindu festival. On this day prayers are offered to Lord Shiva, who is the god of all evils and poisons. Bhang is a special article, which is offered to Lord Shiva on this auspicious day. Then, the devotees consume it as the God. Gujrat is a dry state (possession, consumption, sale, etc. of alcohol, Bhang, opium and other psychotropic substance, etc. is governed by particular laws), but on the holy occasion of ShivRati, for a day, the law is relaxed for the use of Bhang. In most other parts of the country, particularly, in northern India, it is a common practice to consume various preparations of Indian hemp like Bhang, Charas, Ganja, sweetmeat, etc. The bolus mentioned above is probably the minimum single dose.