Abstract: Transverse images of cirrhotic livers revealed specific morphological changes. The right lobe exhibited relatively greater shrinkage, while the caudate lobe underwent relative enlargement. Sonograms or CT scans of 25 proved cirrhotic livers, 25 normal livers, and 15 livers with diffuse disease other than cirrhosis were analyzed using a number of measurements and ratios to evaluate and quantify the frequency and possible diagnostic value of these alterations. Using the ratio of transverse caudate lobe width to transverse right lobe width, cirrhotic livers could be separated from noncirrhotic liver (both normal and abnormal) with a sensitivity of 84%, a specificity of 100%, and an accuracy of 94%. Another ratio revealed relative widening of the porta hepatis in 84% of cirrhotic livers, but this was not specific for cirrhosis. Pathological analysis of 11 cirrhotic cadaver livers revealed greater fibrosis in the right lobe than in the caudate lobe.

Abstract: A constant relationship was found between the mean CT numbers of the liver and spleen in 100 normal adults. This relationship was characterized by a mean CT number consistently higher for the liver (24.9 +/- 4.6) than for the spleen (21.1 +/- 4.1). The range for liver CT numbers was 16.7-37.2, and for the spleen it was 14.9-34.3. The mean liver-spleen CT number difference for all subjects was 3.8 +/- 2.1 (p < 0.001); in every instance, the livers exhibiting the high mean CT numbers were in subjects with high mean spleen CT numbers, with the same concordance for low mean CT numbers. This relationship between liver and spleen may be useful in the clinical setting in which a normal liver with low CT numbers must be differentiated from one in which the CT number is low because of fatty infiltration; the fatty liver will exhibit a lower mean CT number than the spleen.

Abstract: Over a period of 38 months, diagnostic needle aspiration of 400 (293 malignant and 107 benign) pulmonary lesions was performed with 20-gauge needles. Deep as well as peripheral nodules and masses were routinely biopsied. Positive diagnostic accuracy was 96.5%. There were 9 (2%) incorrect diagnoses with 5 false negatives and 4 false positives. In almost all patients with malignant pulmonary neoplasms, the specific cell type was identifiable. Pneumothorax was a frequent complication, but there were no fatalities, and no episodes of major bleeding or hemoptysis. A new slotted 20-gauge thin wall needle was used in 258 patients which enabled aspiration of larger amounts of material than had been possible with the standard 20-gauge thin wall needle, and in approximately 50% of patients, enough material was obtained to perform tissue sections as well as smears for cytology. In 77 patients with benign lesions and in 114 with unresectable neoplasms, needle aspiration established the diagnosis and made it unnecessary to perform surgery and/or mediastinoscopy.

Abstract: More than 300,000 case reports have been collected in a prospective survey of adverse reactions to intravascular contrast media. The reports were provided by radiologists in the United States, Canada, Europe, and Australia and represent the largest survey of its type to date. The overall incidence of reactions was about 5%, lower than any rate reported in the recent literature, and was strikingly similar in all participating countries.

Abstract: Editorial Note Taking issue with the 'Vancouver style' into the twenty-first century The Ulster Medical Journal has, formanyyears, been a proponent of 'Vancouver style', as described in Uniform Requirements forManuscripts Submittedto Biomedical Journals I-devised by the International Committee ofMedical Journal Editors.2 A standard journal article is referenced with the authors/editor, followed by the title, journal name (as abbreviated in Index Medicus), year, volume, month, issue number (in brackets) and pages as illustrated in the following example: O'Neill SB, McCann JP. Unrecognised spinal cord compression as a cause of morbidity. The Vancouver system of referencing allows that a journal with continuous pagination throughout a volume (as most journals do), may omit the month and issue. In the Ulster Medical Journal, the sub-editor checks all references for accuracy, and (although not written policy) inserts the issue number after the volume (if not added already by the author). We have, from this issue, updated our instructions to authors to inclusion of the issue number as journal policy. What difference does adding the issue number make? Until recently, when manually searching for articles using hard copy bibliographic references such as Index Medicus, or the bound copies of the journals themselves, inclusion or omission of the issue numberwas immaterial-continuous pagination enabled the reader to quickly find the article in question in a specific volume. The advent of online journals and digital searching media has changed how articles are published. Manyjournals are available online, and are accessed using menu selection. Initially the required year is selected, followed by the issue and thereafter the page numbers. Often menu selection does not include page numbers, though invariably the issue number is included instead. In the Ulster Medical Journal, we are updating ourselves in line with other journals (at present mostlythose published on line but increasingly those which publish both online and print versions). This small alteration in the policy should assist writers locate their source material more easily. The Vancouver system includes instructions on referencing other material obtained from the Internet.I These follow the principles behind citing print sources, namely, a reference is a detailed description of the item from which you obtained your information and is used to acknowledge the work of others. Lastly, it should contain sufficient information for someone else to trace the item. Thus quoting a website's address e.g. www.nap.edu is similar to quoting a journal title alone. The proper reference may be as …

Abstract: Blood flow in rat skin and muscle increased three- to fourfold during heating at 43 degrees C for one hour, while that in Walker tumors did not change significantly; however, blood flow in the tumors decreased a few hours after heating at 45 degrees C. The temperature of Walker tumors was significantly higher than in the muscle during heating, probably due to inefficient heat dissipation caused by the sluggish blood flow. Severe vascular occlusion occurred in SCK tumors in mice after heating at 41.5-45.0 degrees C. Upon heating, the pH in the tumors significantly decreased, while that in the muscle increased. The clonogenic cell number continuously decreased when SCK tumors were left in situ after hyperthermia. The vascular occlusion and increase in acidity may account for the progressive death of tumor cells after heating.

Abstract: Lung density patterns in a group of randomly selected, normal individuals were determined by computed tomography, using two methods: one measuring the density of the peripheral lung (parenchyma), and the other determining the density of the whole lung field. The effects of body position and respiratory phase, as well as patient age were assessed. The potential use for this information in clinical settings and in physiological investigation is suggested.

Abstract: The effects of hyperthermia on pH, local blood flow (LBF) and tissue oxygen tension (TpO2) in several normal and tumor tissues were studied. It was found that TpO2, local blood flow and pH are inhomogeneous in tumor tissue. TpO2 is very low in certain areas which also seem deprived of blood flow and are at very low pH. Hyperthermia has a dual effect: at temperatures below 41 degrees C, it increases blood flow and TpO2 while above 41 degrees C, it causes a collapse in blood flow, lower TpO2 and a shift of the tissue pH towards acidosis from the already low pH values found in tumors.

Abstract: From January 1962 to May 1979, 23 patients with biopsy-proved intramedullary spinal cord tumors were treated initially with total resection, subtotal resection, irradiation, or subtotal resection and irradiation. Local control was achieved in 1/2 patients after total resection, 1/3 after subtotal resection, 8/9 after subtotal resection and radiation therapy, and 5/8 after radiation therapy alone. The patients with ependymomas exhibited a radiation dose-response relationship; of eight patients followed five or more years postirradiation, local control was achieved in 2/3 with time dose fraction (TDF) less than 55, 2/3 with TDF 55-65, and 2/2 with TDF greater than 65. The actuarial 5- and 10-year survival rates were 58% and 23% for astrocytoma, and 100% and 73% for patients with ependymoma, respectively. Neurological deficits improved or became totally normal after initial irradiation. Patterns of failure, management of recurrences, and radiotherapeutic techniques and dose recommendations are discussed.

Abstract: Two hundred and twenty-eight deaths due to the use of contrast media are reported, including 15 from intravenous cholangiography, 69 from angiography, 140 from urography and four other. The causes are analyzed and the various explanations for reactions to contrast media are considered. Data concerning the high incidence of cardiac death, the large number of deaths due to pulmonary edema, and the known transgression of the blood-brain barrier by contrast media are used to construct a theory that bases all reactions on the effect of contrast media on the central nervous system.

Abstract: The diagnosis and follow-up of 20 cases of intracranial abscess are analyzed, with particular attention to the role of computed tomography (CT). the differential diagnosis of the CT appearance is presented, and the value of clinical and laboratory findings is discussed. Of special interest is the potential effect of steroids on CT findings as well as the frequent observation of a residual enhancing focus seen on the scan obtained at hospital discharge.

Abstract: The findings at autopsy were correlated with the computed tomographic (CT) diagnosis in 90 neonates that had suffered perinatal hypoxia and had CT within 10 days before autopsy. CT was accurate in the diagnosis of supratentorial hemorrhage whether it was subependymal, intraventricular, or intracerebral. Infratentorial hemorrhage was difficult to detect or localize with accuracy. Correlation between areas of hypodense brain tissue seen on CT and areas of ischemic brain damage other than hemorrhage at autopsy was poor. Diagnosis of generalized cerebral edema by CT, however, was very good.

Abstract: Sequential computed tomography (CT) scans were obtained in 30 patients with acute cerebral infarction. In some cases, infarction was seen on the scans as early as three to six hours after onset of symptoms. Although small areas of petechial hemorrhagic infarction are not easily detected by currently available equipment, positive contrast enhancement helps locate petechial hemorrhagic infarction, which is usually in the cortical gray matter of the cerebral mantle and the central gray matter of the deep central gray matter. Contrast-enhanced CT scans are a useful method for detecting small infarctions. However, when a CT scan is performed within five days of ictus, contrast enhancement is usually not required.

Abstract: The superior frontal, precentral, and central sulci of fixed brain specimens were marked and then scanned by computed tomography. A constant relationship between the posterior ends of the superior frontal and precentral sulci facilitated accurate identification of the anterior border of the precentral gyrus in both unmarked fixed brains and patients. Precise localization of this gyrus can aid in localization of lesions and correlation with functional changes.

Abstract: Intracranial meningiomas were detected in 164 of the 2,928 patients in the National Cancer Institute study of computed tomography (CT) in the diagnosis of intracranial tumors. The comparative effectiveness of contrast-enhanced and noncontrast CT scanning and other radiological modalities--plain skull radiography, angiography, radionuclide studies, and pneumoencephalography--was assessed. CT was demonstrated to be the most accurate method for detecting intracranial meningiomas (accuracy of 84.8% for noncontrast and 96.2% for contrast-enhanced CT). It was significantly more accurate than radionuclide studies and plain radiography, and was slightly more accurate than angiography. Pneumoencephalography was performed in only five cases, and identified a mass in four. Angiography was useful for increasing the percentage of specific diagnoses.

Abstract: An instrument for clinical measurement of bone mineral content in the axial skeleton was constructed. Components include a modified dual probe scanner, a PDP-11 computer, a 153Gd source, and a NaTI) detector. The results were accurate and highly reproducible, and distinction of osteoporotic women from normal age-matched women was superior to that accomplished with single photon absorptiometry in the radius.

Abstract: CT scans and angiograms in patients with renal cell carcinoma were reviewed to determine their accuracy in predicting perinephric, retroperitoneal lymph node, renal vein and inferior vena caval involvement by tumor. Results were correlated with pathologic diagnoses from open biopsy or nephrectomy specimens in 62 cases. Computed tomography was more accurate and sensitive than angiography in detecting perinephric extension, more sensitive in assessing lymph node involvement, and equally accurate in detecting main renal vein and vena caval involvement. Based upon this experience, preoperative angiography is not routinely recommended in patients with renal cell carcinoma but may be necessary in selected cases when CT is equivocal or when better definition of vascular anatomy is required.

Abstract: Fluoroscopically controlled intra-articular facet joint block is a reliable method of diagnosing low back pain and sciatica caused by lumbar facet arthropathy. Of 20 patients studied, 13 had complete and immediate relief of pain, confirming the diagnosis, Six patients have been free of pain for more than six months following a single facet joint block with injection of a local anesthetic and corticosteroid suspension. Preliminary findings suggest that computed tomography has an important role in diagnosing symptomatic facet arthropathy.

Abstract: Chinese hamster ovary (CHO) cells in culture were exposed in a nuclear magnetic resonance (NMR) imaging apparatus to a strong magnetic field, pulsed field gradients, and radio frequency emissions No chromosomal aberrations were induced even after an exposure of approximately 14 hours No sister chromatid exchanges were induced by four-hour exposures to either low (average 72 mW) or high (average 612 mW) radio frequency power When HeLa cells were exposed for 16 hours to an average radio frequency power of 612 mW, no inhibition of DNA synthesis was detectable These data indicate that the conditions used for NMR imaging do not cause genetic damage which is detectable by any of these methods

Abstract: In a preliminary demonstration of cranial intraoperative real-time ultrasound, both supratentorial and posterior fossa scans displayed the pertinent anatomy. A grade III astrocytoma was visualized on the supratentorial scan as well. Ultrasound may be valuable for surgical planning and biopsy procedures because of its reliable depiction of intracranial anatomy and ease of use.

Abstract: Computed tomography (CT) detected enlarged pelvic nodes in 32 of 127 patients (25%) with carcinoma of the cervix, bladder, or prostate. Pelvic or inguinal lymph nodes were confirmed pathologically in 35 patients. CT was true-positive in 17 of 20 patients with lymph-node metastases (sensitivity, 85%), false-negative in 3 or 20 patients (15%) with metastases, true-negative in 10 or 15 patients without metastases (specificity, 67%), and false-positive for lymph-node metastases in 5 of 15 patients (33%). CT was correct in 27 of 35 patients (77%). Detection of external iliac-, obturator-, and inguinal-node metastases by CT is discussed.

Abstract: Physiological calcification of the globus pallidus was visualized by computed tomography in 32 patients. The frequency of visualization increased with increasing age. Patients under the age of 40 with calcification of the globus pallidus should be evaluated for disorders associated with pathological calcification of the basal ganglia. Patients of any age with calcification in the lenticular nucleus and elsewhere in the basal ganglia, dentate nucleus, or multiple areas of the cortex should also be evaluated for these disorders.

Abstract: Radionuclide images and skeletal radiographs of 51 patients with multiple myeloma were compared to assess the sensitivity of scintigraphy in detecting radiographically evident disease. Comparable studies were available for 562 sites. The radionuclide image was relatively insensitive in detecting myeloma; it failed to show radiographically evident disease or underestimated its extent at 27% of the sites. On a limited number of serial images there were 7 sites at which a scintigraphic abnormality preceded the radiographic abnormality. No definite correlation was found between scintigraphic findings and hematologic parameters of myeloma activity. Although the radionuclide image may demonstrate a few sites of myeloma before the radiograph, radiography remains the primary method of evaluating skeletal involvement by myeloma.

Abstract: On a supine chest radiograph, the only sign of pneumothorax may be a deep lateral costophrenic angle on the involved side. Seven cases where this finding was present are reviewed and the importance of this sign to radiologists and clinicians is stressed.

Abstract: Lumbar facet joints are difficult to image with conventional radiographic techniques. A series of 100 consecutive cases of low back pain and sciatica was examined with CT. Abnormal facet joints were found in 65. Abnormalities demonstrated by CT included osteophyte formation, hypertrophy of articular processes, articular cartilage thinning, vacuum joint phenomenon, and calcification of the joint capsule. In patients with sciatic or low back pain, CT is indicated to demonstrate treatable abnormalities of the facet joints.

Abstract: A real-time transducer for ultrasonically guided puncture was used for percutaneous contrast medium injection and aspiration biopsy in 160 patients with various diseases of the abdomen. Opacification of the bile ducts, pancreatic duct and the portal vein was accomplished in 157 patients. Percutaneous aspiration biopsy provided cytological proof of malignancy in 56 of 64 patients with suspected carcinoma. Ducts or vessels less than 10 mm wide on ultrasound images were successfully opacified, and biopsy confirmed at 2 X 2.5-cm carcinoma.

Abstract: A mass associated with the gastrointestinal tract was detected by sonography in 33 patients. Etiologies included primary or metastatic tumor; intussusception; inflammation secondary to bowel infarction, pancreatitis, or irradiation; and a dilated, fluid-filled gut related to retained gastric contents, obstruction, ileus, or an ileal bypass. Mesenteric or omental changes were identified with inflammation and frequently with metastatic disease. The diagnosis was confirmed by repeat sonography, abdominal radiography, barium examination of the small bowel, computed tomography, surgery, or autopsy. Ultrasound patterns are characteristic in tumor, intussusception, and inflammation; specific features allowing differentiation between tumor and inflammation are described. Colonic haustra, valvulae conniventes, or bowel contours and peristalsis on real-time sonography are helpful in identifying fluid-filled bowel loops.

Abstract: The findings at autopsy were correlated with the computed tomographic (CT) diagnosis in 90 neonates that had suffered perinatal hypoxia and had CT within 10 days before autopsy. CT was accurate in the diagnosis of supratentorial hemorrhage whether it was subependymal, intraventricular, or intracerebral. Infratentorial hemorrhage was difficult to detect or localize with accuracy. Correlation between areas of hypodense brain tissue seen on CT and areas of ischemic brain damage other than hemorrhage at autopsy was poor. Diagnosis of generalized cerebral edema by CT, however, was very good.