Intrahepatic bile duct and portal vein anatomy revisited

Seventeen normal cadaver livers were studied to assess the anatomic relationship of bile ducts to portal veins. The common bile duct, main portal vein, and hepatic artery were cannulated and injected with air, dilute contrast medium, and mineral oil, respectively. The livers were placed in anatomic position and examined with computed tomography. In the lateral segment of the left hepatic lobe, the bile ducts were anterior to the portal vein in seven cases, posterior in seven, and tortuous (ie, both anterior and posterior) in three. In the medial segment of the left lobe, the bile ducts were anterior in four cases, posterior in four, tortuous in three, and not seen in six. In the right lobe, the bile ducts were anterior in nine cases, posterior in five, tortuous in one, and not seen in two. In the porta hepatis, the bile ducts were anterior in ten cases, posterior in one, tortuous in five, and not seen in one. Histologic findings confirmed the anterior and posterior location of the bile ducts relative to the portal veins. These findings contradict the commonly held view of intrahepatic bile ducts being anterior to the portal vein and are clinically significant for techniques such as bile duct drainage.     

The angiomatous polyp and the angiofibroma: two different lesions

Five cases of angiomatous polyps that were initially interpreted as angiofibromas are presented. Although they are similar to angiofibromas, angiomatous polyps have a distinctly different pattern of growth on computed tomography and a different angiographic appearance. In addition, they are more easily extirpated at surgery than are angiofibromas.     

Expectation and evaluation of occupational health nursing services, as perceived by occupational health nurses, employees and employers in the United Kingdom

A structured questionnaire was used to investigate the relationship between expectation and evaluation of occupational health nursing services as perceived by providers (nurses) and receivers (employers and employees) in the United Kingdom The response rate was 66·55% (254) from nurses, 5132% (194) from employees and 44 97% (170) from employers Data from 144 triads of nurse, employer and employee were used to test 13 null hypotheses, which were all rejected The strong positive correlation between nurses', employers' and employees' expectations and evaluations indicates that, on the whole, their expectations were met However, there were differences in the extent to which this was so and the level of expectation varied between groups Nurses perceived themselves as not meeting their high expectations as well in non-traditional (care-supportive) as in traditional (care-orientated) services On the whole, employers had significantly lower expectations than nurses, except in the area of care and treatment Employees had high expectations of preventive services, but their lower evaluations indicate that these were not met Discussion of these and other findings suggests that employers need education on the value and scope of occupational health nursing, and a model may assist nurses' conceptual understanding of it     

Subtle lung cancers: impact of edge enhancement and gray scale reversal on detection with digitized chest radiographs

The authors studied the impact of edge enhancement and gray scale polarity reversal on the detection of subtle lung cancers. Three experienced readers reviewed 46 biopsy-proved subtle lung cancers and 46 normal controls on chest radiographs that had been digitized into a 1,024 X 1,536-pixel matrix 8 bits deep. Receiver-operating characteristics (ROC) analysis of 1,656 pooled observations indicated that performance was best with the unmodified images (ROC area = 0.83), degraded by moderate enhancement of medium frequencies (ROC area = 0.80), and markedly impaired by severe enhancement of low frequencies (ROC area = 0.69). Gray scale polarity reversal further degraded performance (unenhanced ROC area = 0.74; moderately enhanced ROC area = 0.76; severely enhanced ROC area = 0.76). The authors conclude that edge enhancement and gray scale polarity reversal can impair the detectability of subtle lung cancers on digitized radiographs of medium resolution.