2002 Australian Radiology Workforce Report

This paper describes the current status of radiologist provision in Australia, and explores issues relating to its current adequacy, as well as analysing projections of supply and requirements, and their balancing. Data are drawn from several sources including the results of the Royal Australian and New Zealand College of Radiologists Workforce Survey 2000, and the report of the Australian Medical Workforce Advisory Committee Radiology Working Party 2001. The main conclusions to be drawn are that: (i) there is a current shortfall of radiologist supply in Australia; (ii) future requirements (taking all factors into consideration) are expected to grow at a greater rate than projected supply (based on the status quo); and (iii) supply of radiologists should therefore be increased. These conclusions are roughly in line with those from other countries, such as the UK, Canada and USA. Radiologists practising in Australia also appear to have relatively high productivity, including by some international comparisons. These findings are presented in the context of current issues in Australian medical imaging, including provider consolidation and corporatization, globalization and funding.     

A 5-year review of a lympbhoedema service

Data for 714 patients referred during a 5-year period to a specialist lymphoedema service in Oxford, UK, have been recorded on a database. The annual number of new patients almost doubled from 103 to 195. In addition to initial assessments, there were over 1000 follow-up appointments per year. Most patients were seen as out-patients. Fifty-six per cent of the referrals were from Oxfordshire and the rest from further afield. The two largest groups referring patients to the service were general practitioners (43%) and the radiotherapy department (26%). Most referrals were female (84%), and the main cause of lymphoedema was cancer and cancer treatments (68%). After 2 years, only 15% of patients were still attending the clinic regularly. The number of patients receiving intensive treatment increased by almost 40%. These findings emphasize the need to target resources and expertise selectively in order to provide an optimal sericice to patients needing specialist help.     

Site and sequence specific DNA methylation in the neurofibromatosis (NF1) gene includes C5839T: the site of the recurrent substitution mutation in exon 31

CpG dinucleotides provide hotspots for transitional mutations in a variety of genes, some leading to genetic diseases in humans. Although this phenomenon is attributed to cytosine methylation at such sites, direct and specific observations of CpG methylation at the sites of recurrent mutations are lacking. We have used a bisulfite genomic sequencing method to analyze DNA methylation within three representative exons from the neurofibromatosis type 1 (NF1) gene, well recognized for its high frequency of spontaneous mutations. We observed that the cytosine methylation within NF1 exons 28, 29, and 31 is restricted to CpG dinucleotides, including the CpG dinucleotide present at the site of the recurrent NF1 mutation (C5839T; also referred to as R1947X). At several sites, clone-specific methylation differences were also observed. Our results provide experimental evidence for the hypothesis that methylatable CpGs in the NF1 gene contribute to spontaneous germline mutations associated with this gene, by showing that DNA methylation does occur at all CpGs contained within these representative NF1 exons. As well, the DNA methylation seen at the common mutation site in exon 31 may explain why this site is frequently mutated. Methylation-dependent mutagenesis may also provide a basis for some somatic (second hit) mutations which disable the normal allele and result in the development of NF1 associated symptoms.      

A new manifestation of thrombocytopenia: myocardial haemorrhage with symptomatic arrhythmia

We describe a patient with thrombocytopenia who developed episodes of dyspnoea due to recurrent cardiac arrhythmia. Necropsy revealed that the apparent mechanism was extensive myocardial haemorrhage.     

Pulmonary lymphangitic carcinomatosis: CT and pathologic findings

The authors retrospectively reviewed the computed tomographic (CT) scans, biopsy specimens, autopsy results, and lobectomy specimens of 21 patients who had lymphangitic carcinomatosis. Ten-millimeter collimation CT scans were obtained from all patients, and selected 1.5-mm CT scans were obtained from ten patients. In five patients, the diagnosis was established with open lung biopsy, lobectomy, or autopsy; in nine, with bronchial biopsy or transbronchial biopsy; and in seven, with clinical and radiologic criteria. Certain characteristic findings on CT scans were evident: uneven thickening of bronchovascular bundles, thickening of isolated interstitial lines, and the presence of polygonal lines. These findings may be seen on CT scans even if the findings on chest radiographs are normal or nonspecific. The pathologic basis for these characteristic CT findings may relate to tumor thrombi in lymphatic vessels rather than edema and fibrosis, at least in the early stages of disease.     

Stabilization of thrombin-activated porcine factor VIII:C by factor IXa phospholipid

The activation of porcine factor X by an enzymatic complex consisting of activated factor IX (factor IXa), thrombin-activated factor VIII:C (factor VIII:Ca), phospholipid vesicles, and calcium was studied in the presence of an irreversible inhibitor of factor Xa, 5-dimethylamino- naphthalene-1-sulfonyl-glutamyl-glycyl-arginyl- chloro met hyl ketone ( DEGR -CK). The formation of factor Xa was measured continuously by monitoring the increase in solution fluorescence intensity that occurs upon formation of DEGR -factor Xa. Omission of any component from the enzymatic complex reduced the reaction rate to a negligible level. In the presence of fixed excess factor IXa, the velocity of factor X activation was linearly dependent on the concentration of factor VIII:C, and thus, provided a plasma-free assay of factor VIII:C. Activation of factor VIII:C by 0.1 NIH U/ml thrombin in the presence of factor IXa, phospholipid vesicles, and calcium, followed at variable time intervals by the addition of factor X and DEGR -CK, was complete within 5 min, as judged by the fluorometric assay, and resulted in little or no loss of factor VIII:C activity over a period of 20 min; whereas, activation in the absence of either IXa or phospholipid vesicles decreased the half-life of factor VIII:C to approximately 5 min. Analysis of 125I-factor VIII:C-derived activation peptides by sodium dodecyl sulfate polyacrylamide gel radioelectrophoresis revealed identical results, regardless of whether factor IXa and/or phospholipid vesicles were included in the activation, suggesting that the lability of factor VIII:Ca is not due to a major alteration of its primary structure. We conclude that the activated porcine factor VIII:C molecule is stabilized markedly because of its interaction with factor IXa and phospholipid.     

Musculoskeletal tumors: improved depiction with linear combinations of MR images

With postprocessing, the authors produced a single hybrid image that combines the complementary information in conventional T1- and T2-weighted magnetic resonance (MR) images. A 1-T MR imager was used to produce T1- and T2-weighted images (repetition time, msec/echo time, msec: 500/30, 1,500/120) of patients with various primary bone tumors. Various weighted sums and differences of these images were then formed. Weighted subtraction allowed formation of hybrid images with high contrast between tumor and all adjacent normal tissues (muscle, fat, bone marrow), unlike the original T1- and T2-weighted images. Certain weighted sums of the acquired images simultaneously display the high signal-to-noise and clear anatomic detail of the T1-weighted technique along with the high contrast between extraosseous tumor and muscle of the T2-weighted image. A single hybrid MR image can contain useful characteristics both of T1- and T2-weighted images, making it easier for one to detect the extent of an abnormality.     

The implementation of Project 2000 in the community: a new perspective on the community nurse's role

This paper considers some of the initiatives taken by community nurses in England in implementing Project 2000 placements The data were obtained during an English National Board funded study in two phases The first phase involved a series of exploratory interviews, a postal questionnaire survey, and semi-structured interviews with 15 managers In phase two, one Project 2000 demonstration district was studied in depth by means of interviews complemented by small-scale questionnaire studies Community nurses had confronted a number of difficulties in implementing Project 2000 Among the most serious of these were shortage of time, poor communication with the colleges of nursing and lack of preparation As a consequence, community nurses took what they saw as independent approaches to students' placements Many set their own aims and objectives for placements and produced written guidelines and teaching plans for students Many also asserted the importance of their role in the assessment of students' practical work