The retained intrapericardial sponge: value of the lateral chest radiograph

OBJECTIVE: Our objective was to identify reasons for the difficulty in diagnosing retained intrapericardial sponges and to determine ways to improve diagnostic accuracy. CONCLUSION: All three intrapericardially retained sponges were in the posterior pericardium, a region not visible to the surgeon. Radiographic detection of the sponges on standard anteroposterior projections is difficult because of exposure factors, other confusing linear markers, and metallic densities such as sternal sutures. However, knowledge of the typical location of a lost sponge and use of lateral radiographic projections may aid in early detection of this rare complication.     

Philosophy of life and human health

In order for people to survive on the Earth, they have to learn to live one with others again. The time when our future was simply given to us has already passed. We have to reach our future again, and to become "the farmers of the time". Appropriate life style is without any doubt the crucial factor in people [symbol: see text] s health protection. Beside high-quality medicine and its movement to health prevention, (and not just taking care of illness) human beings need to know how to live. This is important because it is in the range of our own possibilities and willings. Sooner or later, we will have to be aware of that.     

Ethnocentrism and the value of a human life.

Drawing on theories of intergroup prejudice and decision making, the authors examined how much participants valued lives of conationals and enemy civilians. Using decisions made under risk, Experiment 1 showed that Americans valued Iraqi and American lives equally when outcomes for those nations did not compete but valued American lives more under outcome competition. Experiments 2 and 3 extended this finding by illustrating ethnocentric valuation even when large numbers of lives were at stake: The number of lives at stake mattered less for enemy civilians than it did for conational combatants. Experiment 4 provided additional evidence of this ethnocentric indifference to magnitude, regardless of combatant status of the conationals' lives. In all experiments, individual difference measures associated with prejudice (e.g., group identification and prejudice, empathy, social dominance orientation, social attitudes) corresponded to ethnocentric valuation measured in decisions. Results demonstrate that categorization, competitive context, and individual propensities for prejudice influence how much one values lives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnosis of Rett syndrome: can a radiograph help?

Rett syndrome (RS), a neurodevelopmental disorder almost exclusively affecting girls, is associated with severe intellectual and motor disability. In the absence of biological markers, diagnosis is determined by a set of clinical criteria. In a previous study in Scotland, shortening of the fourth metatarsal was reported clinically in 20% of classical RS cases aged 5 years or older. The Australian Rett Syndrome Study database has facilitated a population-based radiological study of the hands and feet of girls with RS. Straight radiographs of hands and feet were available from 94 cases, representing 70.1% of the known RS population in Australia. Control radiographs were matched for age, sex, and laterality. Relative shortening of the fourth metacarpal/metatarsal was assessed using the sign method. A short ulna (negative ulna variance) was defined as the distal articular surface of the ulna being at least 5mm proximal to the distal articular surface of the radius. A positive metacarpal sign was twice as common in verified cases of RS than in controls in the right but not the left hand. A short ulna was more common in subjects with RS than in controls. A short fourth metatarsal was also more common among subjects with RS. More than half (56.6%) the girls with RS over the age of 4 years had a negative ulnar variance in either wrist or a metatarsal sign in either foot. These findings will assist with the diagnosis of RS and may help direct research towards the location of the molecular defect.     

The lateral chest radiograph in the detection of pericardial effusion: a reevaluation

The purpose of this study was to evaluate the usefulness of 10 previously published plain film signs for diagnosing pericardial effusion and to determine whether the posteroanterior (PA) or lateral chest radiograph was the better view for detecting pericardial effusion. A retrospective study of 100 consecutive adult patients with pericardial effusions confirmed by echocardiography and/or computed tomography was undertaken. Five signs were found to be useful in detecting pericardial effusion on plain films, and the lateral chest radiograph was found to be better than the PA view in detecting pericardial effusion. The water-bottle configuration, widening of the carinal angle, and the differential-density sign were helpful in diagnosing pericardial effusion on the PA view. However, these signs were only seen in moderate-to-large effusions. The displaced epicardial fat pad sign and the posteroinferior bulge sign on the lateral view improved the detection of moderate-to-large pericardial effusions, and were also present in many of the cases with small pericardial effusions. Recognition of specific signs of pericardial effusion on the lateral chest radiograph may significantly improve the plain film detection of pericardial effusion.     

Melanoma and occupation: results of a case-control study

OBJECTIVES: Associations between occupational exposures and the occurrence of cutaneous melanoma were examined as part of a large population based case-control study of 19 cancer sites. METHODS: Cases were men aged 35 to 70 years old, resident in Montreal, Canada, with a new histologically confirmed cutaneous melanoma (n = 103). There were two control groups, a randomly selected population control group (n = 533), and a cancer control group (n = 533) randomly selected from among subjects with other types of cancer in the large study. Odds ratios for the occurrence of melanoma were calculated for each exposure circumstance for which there were more than four exposed cases (85 substances, 13 occupations, and 20 industries) adjusting for age, ethnicity, and number of years of schooling. RESULTS: Significantly increased risk of melanoma was found for exposure to four substances (fabric dust, plastic dust, trichloroethylene, and a group containing paints used on surfaces other than metal and varnishes used on surfaces other than wood), three occupations (warehouse clerks, salesmen, and miners and quarrymen), and two industries (clothing and non-metallic mineral products). CONCLUSIONS: Most of the occupational circumstances examined were not associated with melanoma, nor is there any strong evidence from previous research that any of those are risk factors. For the few occupational circumstances which were associated in our data with melanoma, the statistical evidence was weak, and there is little or no supporting evidence in the scientific literature. On the whole, there is no persuasive evidence of occupational risk factors for melanoma, but the studies have been too small or have involved too much misclassification of exposure for this conclusion to be definitive.     

The role of the darkroom in radiograph quality control

Quality is key to being able to read radiographs. If it is lacking or poor, it is impossible to make a proper diagnosis. This article describes simple techniques and provides answers to problems encountered in the production of quality radiographs, such as, darkroom management, correct safelights, fresh chemistry and clean equipment. It includes a problem-solving guide to causes and solutions for film marks, density and drying, as well as a simple method for evaluating when to change chemical solutions. Using these techniques should greatly improve quality without a large expenditure of time or money.     

Grandmothering, menopause, and the evolution of human life histories

Long postmenopausal lifespans distinguish humans from all other primates. This pattern may have evolved with mother-child food sharing, a practice that allowed aging females to enhance their daughters' fertility, thereby increasing selection against senescence. Combined with Charnov's dimensionless assembly rules for mammalian life histories, this hypothesis also accounts for our late maturity, small size at weaning, and high fertility. It has implications for past human habitat choice and social organization and for ideas about the importance of extended learning and paternal provisioning in human evolution.     

Erdheim-Chester disease demonstrated by bone radiograph and scans

The development of blunt liposuction by Illouz [1] in 1978 ushered in a new era in body sculpting. For the first time it had become possible to dependably remove large amounts of subcutaneous fat and decrease saddlebags and bulges to provide a smoother contour. Refinements in liposuction techniques have made it possible to dramatically resculpt the subsurface plane and improve body contour virtually from head to toe -2-4-. Mark Gilliland first performed abdominal etching by removing specific grooves of subcutaneous fat to accentuate the appearance of the abdominal musculature [5-8]. We have developed a new cannula for precision etching. This technique has been used in 25 patients with good results and has resulted in only one complication, which was the result of placing one of the horizontal etching lines at the level of the umbilicus. This created an unseemly fold that is best avoided.     

alpha-Melanocyte-stimulating hormone during human perinatal life

To obtain information on human pituitary intermediate lobe activity throughout the perinatal period, plasma alpha MSH immunoreactivity (IR) was measured in 106 newborns at delivery and during the first week of postnatal life. Subjects were divided into groups according to gestational age at birth, mode of parturition, and antenatal state of health. Plasma alpha MSH IR decreased progressively from severe preterm to fullterm neonates born by vaginal delivery (VD; P < 0.001) or cesarean section (CS) with and without prenatal distress (P < or = 0.001 in both cases). alpha MSH IR was due, in all studied conditions, to three major forms: desacetyl alpha MSH, alpha MSH, and diacetyl alpha MSH. Desacetyl alpha MSH was always the most represented form, but it decreased from 75-80% of the total in severe premature to 40-45% in mature infants. In term neonates, total alpha MSH IR values were higher in subjects born by normal VD than by elective CS (P < or = 0.05), in complicated than in normal VD (P < or = 0.01), and in CS performed because of fetal distress than in elective CS (P < or = 0.01). No significant difference was detectable in mature subjects in the percentages of the three alpha MSH forms in relation to the mode of delivery and fetal state during antenatal life or at parturition. Twelve hours after birth, total alpha MSH IR significantly decreased in all groups of term newborns, reaching a plateau of 0.8-1.4 pmol/L. In premature infants, similar concentrations were detectable by the fourth postnatal day. We conclude that 1) alpha MSH IR intermediate lobe secretion progressively decreases throughout the third trimester of pregnancy; 2) stress, including that pertinent to parturition, stimulates alpha MSH IR release; and 3) pituitary intermediate lobe activity declines shortly after birth independently of the maturity reached by the fetus, the mode of parturition, and the presence of antenatal chronic distress, although the process is slightly retarded in premature newborns.     

Melanoma arising from the mucosal surfaces of the head and neck

Oral mucosal malignant melanoma is a rare disease. We reviewed 30 years of data from a tumor registry and identified 65 patients who had head and neck melanomas. Two thirds (43) of the 65 patients were identified as male, with the mean age in the sixth decade. Of the 65 patients, only 6 had melanoma that arose from the oropharyngeal mucosa. Of the lesions involving the oral mucosa, each lesion manifested itself as a mass or was associated with symptoms of discomfort; only one third (2) of the lesions were pigmented. The clinician must carefully examine the head, neck, and oral cavity, and any pigmented lesion that is not recognized as a specific entity, such as amalgam tattoo, should be biopsied. The more common presentation of amelanotic malignant melanoma requires a high index of suspicion for masses identified in the mouth and requires biopsy for definitive diagnosis. The prognosis for oral mucosal malignant melanoma is poor.     

Extraterrestrial life: life on Mars--then and now

The recent claim to have discovered evidence of extraterrestrial life on a meteorite from Mars is not compelling, but the study nevertheless has useful heuristic value.