Superior Vena Cava Syndrome

Clinical History: Patient with known pulmonary metastatic disease.
Findings: Serial axial images were obtained through the chest after administration of IV contrast. Multiple serpentine vessels are visualized in the left anterior and posterior chest walls. Contrast is also visualized within the azygos vein, there is also dilatation of the azygos vein. There is no contrast visualized in the superior vena cava and there appears to be a hypodense abnormality within the lumen. This most likely represents thrombus. A catheter tip is visualized passing through the center of this thrombus. Metaport catheter is visualized in the subcutaneous tissue of the left anterior chest wall. There were numerous pulmonary nodules visualized in both lung fields. Evidence of bilateral pleural effusions.
Diagnosis: Superior Vena Caval (SVC) Syndrome
Discussion: Superior vena caval obstruction otherwise known as SVC syndrome which is secondary to obstruction of the SVC with development of collateral pathways. The etiology is either a malignant or benign lesion. Malignant lesions account for (80% to 90%) of such occurrences with bronchogenic carcinoma accounting for greater than (50%) followed by lymphoma. Benign causes include granulomatous mediastinitis (usually histoplasmosis, sarcoidosis, TB). Other benign etiologies include substernal goiter, ascending aortic aneurysm, and constrictive pericarditis.
Collateral routes include esophageal venous plexus which are also known as (downhill varices). In addition, azygos and hemiazygos veins. Also accessory hemiazygos and superior intercostal veins. Lateral thoracic veins and umbilical veins can also be visualized. In addition, vertebral veins. Patients may present with head and neck edema, cutaneous enlarged venous collaterals, headache, dizziness, syncope. With benign etiology there is a slower onset and progression. With malignancy, there is rapid progression within weeks. Radiographic manifestations include superior mediastinal widening. In addition, encasement, compression, and occlusion of the superior vena cava. One may see dilated cervical and superficial thoracic veins. In addition, thrombus within the superior vena cava as in this case may also be present.
References:Dahnert, Wolfgang: Radiology Review Manual, SecondEdition, 1993, Pg 409, Williams and Wilkins.

Pregnancy & Influenza Vaccination

Industry Recognition Underscores Importance of Educating Pregnant Women About Influenza (Flu) Vaccination
Date: April 8, 2009Media Contact: Kristin Mellon, 202-296-2002 or klm@ecius.net
Washington, DC ­ "Flu-Free and a Mom-to-Be: Protect Yourself, Protect Your Baby, Get a Flu Shot!,” an educational campaign geared towards increasing awareness of influenza vaccination in pregnant women, was awarded the National Influenza Vaccine Summit Immunization Excellence Award ­ 2008-2009 Corporate Campaign. Launched by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the National Women's Health Resource Center (NWHRC) and supported by an educational grant from CSL Biotherapies, the "Flu Free and a Mom-to-Be”program focuses on providing tips andinformation about the flu vaccine for women who are pregnant or planning to conceive during the flu season.
"As a nursing organization representing professionals dedicated to women's health, AWHONN recognizes the role we and partner organizations play in providing nurses and the women they serve with the support and information they need,” said Catherine Ruhl, CNM, MS, associate director of women's health programs at AWHONN. "We're pleased with the recognition this campaign has received and look forward to continuing efforts to eliminate barriers to vaccination for pregnant women during the upcoming flu season.”
"Flu Free and a Mom-to-Be” is a motivational campaign designed to encourage pregnant women to protect themselves and their unborn child by getting a flu shot. Pregnant women are considered a priority group for influenza vaccination by the Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) because of health risks it poses to moms-to-be. Selection for the award was based upon the organizations' outreach efforts through media, communities, coalitions and involvement of other stakeholders to deliver the message to mothers-to-be regarding the importance of influenza vaccination. The "Flu Free and a Mom-to-Be” campaign reached more than 82 million individuals via print, online and broadcast outlets and nearly 30,000 healthcare professional and their patients via a direct mail distribution.
"The National Women's Health Resource Center is dedicated to educating women on issues that can impact their health during their lifetime,” said Elizabeth Battaglino Cahill, RN, executive director of NWHRC. "Influenza vaccination is a public health priority and this award highlights the value of campaigns like 'Flu Free and a Mom-to-Be' in arming women with the information they need to make informed decisions.”
"At CSL Biotherapies, we're committed to addressing unmet public health needs in influenza,” said Paul Perreault, Executive Vice President of CSL Biotherapies Worldwide Commercial Operations. "Recognition such as the National Influenza Vaccine Summit Award highlights the importance of improving influenza vaccination rates among pregnant women and new mothers and we're pleased to have supported NWHRC and AWHONN on this initiative.”
The National Influenza Vaccine Summit is co-sponsored by the American Medical Association and the Centers for Disease Control and Prevention (CDC). The award presentation was held during the CDC's National Immunization Conference on Monday, March 30, 2009. In addition, NWHRC will present the program to attendees of the National Influenza Vaccine Summit meeting to be held on May 18-20, 2009.
For more information about Flu-Free and a Mom-to-Be and to learn more about the latest developments in women's health and wellness, visit healthywomen.org.
About Association of Women's Health, Obstetrics and Neonatal Nurses (AWHONN) The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) is the foremost nursing authority that advances the health care of women and newborns through advocacy, research and the creation of high quality, evidence-based standards of care. AWHONN's 23,000 members worldwide are clinicians, educators and executives who serve as patient care advocates focusing on the needs of women and infants.
A leader in professional development, AWHONN is the first and only association to be awarded the designation Premier Provider by the American Nurses Credentialing Center for innovation and excellence in Continuing Nursing Education.
In 2009 AWHONN celebrates its 40th anniversary of promoting the health of women and newborns.Founded in 1969 as the Nurses Association of the American College of Obstetrics and Gynecology, the association became a separate nonprofit organization called the Association of Women's Health and Neonatal Nurses in 1993. For more information visit www.awhonn.org
About NWHRCThe not-for-profit National Women's Health Resource Center is the leading independent health information source for women. NWHRC develops and distributes up-to-date and objective women's health information based on the latest advances in medical research and practice, all of which is reviewed by leading medical specialists in the field. NWHRC believes all women should have access to the most trusted and reliable health information. Information empowers women to make the best decisions to maintain and improve their health and the health of their families. For more information, visit www.healthywomen.org.
About CSL BiotherapiesThe U.S. headquarters of CSL Biotherapies are located in King of Prussia, Pa. Its parent company, CSL Limited, in Melbourne, Australia, operates one of the world's largest thimerosal-free influenza vaccine facilities for global markets. CSL Biotherapies, which shares its U.S. headquarters with its sister company, CSL Behring, is commercializing influenza vaccine products globally.
At CSL Biotherapies, delivering vaccines is our mission, protecting lives our passion. The CSL Group, which also includes CSL Research & Development, CSL Bioplasma, and CSL Behring, has more than 9,000 employees and operates in 27 countries worldwide. For more information, visit us at http://www.cslbiotherapies-us.com, or call 1-888-435-8633.
Reference:Obgyn.net

Lymphadenopathy

Pleural Effusion

Interlobular Septal Thickening

Psoriatic Arthropathy

There is deformity, particularly of the distal interphalangeal joints of the fingers and the interphalangeal joint of the thumbs. The joints are narrowed and subluxed with sclerosis and overgrowth of the joint margins. There is some fragmentation of the hypertrophied bone at the joint margins. All the proximal interphalangeal joints and the metacarpo-phalangeal joint of the ring finger show some narrowing. There is no visible erosion and the carpus is spared.

Rickets

Two and a half year old asian child, failure to walk and thrive.
There is widening of the epiphyseal plate with visible soft tissue swelling separating epiphyses and metaphyses. The metaphyses are broadened and cupped around the epiphyses, particularly of radius ulna and metacarpals. The provisional zone of sclerosis in the metaphyses is widened amd more instense than normal. The bone trabecular detail is blurred. A line of 'lucency' in the cortex on the medial side of the distal ulna on the right resembles sub-periosteal bone resorption.

Osteo-arthritis

Radiological signs of osteoarthritis:

1-Irregular or asymmetric narrowing of the joint space.

2-Increased density of subchondral bone.

3-Formation of osteophytes.

4-Formation of pseudo-cyst in subchondral bone marrow.

Osteoarthritis

Osteoarthritis

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Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease in which the body's immune system attacks itself. The pattern of joints affected is usually symmetrical, involves the hands and other joints and is worse in the morning. Rheumatoid arthritis is also a systemic disease, involving other body organs, whereas osteoarthritis is limited to the joints. Over time, both forms of arthritis can be crippling.

Gout

- Radiographs:

- in the hand look for oval periarticular erosions;

- multiple erosions will be distributed throughout the carpi and phalanges bilaterally;

- erosions have sclerotic borders and will often have overhanging edges;

- unlike classic RA, in early gout, hand and wrist joints will have preserved joint spaces and normal mineralization;

- example: - case of histologically proven gout involving the proximal 5th metatarsal: (see above foot image).

Osteomyelitis

Septic arthritis. Anteroposterior view of the shoulder demonstrates subchondral erosions and sclerosis in the humeral head. These are relatively late findings of septic arthritis. Periosteal reaction due to coincident osteomyelitis is present adjacent to the surgical neck of the humerus.



Age:At any age.
Location:Metaphyseal,central.
Bone destruction pattern:Permeative.
Tumor matrix pattern:Present,unilamellated pattern.
D.D.:Round cell lesions.
Diagnosis:Osteomyelitis.

Osteomyelitis

Acute osteomyelitis
Acute Osteomyelitis presents with an acute pyrexia illness. The child is toxic and ill and complains of bone pain. In South Africa osteitis is common, and must be suspected in any child who presents with a painful limb together with a pyrexia illness. In a late case the limb may be swollen, with pitting oedema resembling cellulitis. Children seldom develop cellulitis without an underlying cause - consider osteomyelitis in all children with "Cellulitis". Before antibiotics the mortality from this illness we 20-30%, but today fatalities are rare. There is, however much morbidity, especially if the diagnosis is delayed and chronic osteomyelitis develops.
Pathogenesis
The primary septic focus is often a septic skin lesion such as scabies, a septic tooth or other lesion. The child is often undernourished and the disease is often associated with poverty. There may be a history of minor trauma, the organisms seed to the metaphysis and form a small abscess, perhaps in the pre-existing haematoma. The pus builds up in the metaphysis and later escapes under the periosteum.

By this time there is a general septicemia and the child is toxically ill.In some areas such as the hip and knee the metaphysis is partially intra capsular and escape of this pus can cause a septic arthritis to complicate the original osteomyelitis. The growth plate acts as a barrier and the pus cannot cross it directly into the joint.
Acute Osteomyelitis is a disease of children. In adults only the vertebrae can be infected. In children all long bones can be affected especially the proximal femur and about the knee. The pelvis and vertebrae are also often affected in children.
The septicemia can seed organisms to other bones and other systemic complications such as meningitis, bronchopneumonia and pericarditis are common. The child may present primarily to the paediatric casualty with these complaints and the bone infection can be overlooked.

The causative organism in 95% of cases is Staphylococcus aureus. Haemophyllis influenza is common under 2 years of age. In the immune suppressed, virtually any organism can be the cause.

The first X Ray signs of osteomyelitis begin at about day 10,when a periosteal reactionwill be seen

Early OsteomyelitisThe right hip joint space is widened due to septic arthritis.In the hip, pus can cross from the metaphysis into the jointspace, as the synovial space partially crosses over the metaphysis.The metaphyseal area is osteopaenic and three drill holes are notedfrom a surgical drainage.

Clinical
By the time most children present to casualty they are ill and dehydrated. There is bone pain and tenderness. Percussion over a bony prominence near the infected area produces acute pain.
Remember to examine the child thoroughly for other areas of osteomyelitis as well s to move the joints for sighs of septic arthritis. If the child has been on oral antibiotics the above signs may be masked and the diagnosis is thus more difficult. Check the neck for signs of meningism. Listen to the lungs and heart for signs of pneumonia or a pericardial friction rub.

Special Investigations
The white cell count and ESR are raised. Take blood for a blood culture - positive in 80%. A Technetium scan will be positive, but is time consuming and is not usually necessary as the diagnosis can be made without it. There is more urgency to get the child to theater and drain the bone.
X Rays are normal, except for possible soft tissue swelling. Check for effusions in adjacent joints - this may denote septic arthritis or a sympathetic effusion secondary to the inflammation caused by the osteitis. After about 10 days signs such as a periosteal reaction will appear. If treatment does not abort progress of the infection, signs of chronic osteitis such as invulucrum and sequestrum will become visible on x ray.

The same child as above at about 1 month after presentation. A periosteal reaction can be seen and the femur is osteopaenic. The osteomyelitis has not resolved despite drainage and antibiotics and is becoming chronic. At this stage there is a real danger of femur fracture



X Ray of right femur of the above child 1 year later. Chronic osteomyelitis has developed and the femoral shaft has become sclerotic with invulucrum (new bone) formation. A sequestrum can be seen in the upper third of the shaft.




Lateral x ray.
Note the sequestrum appearing as a 'bone - within - a - bone'

Chronic osteomyelitis of right humerus

Reference:Acute Osteomyelitis
Department of Orthopaedic Surgery - Stellenbosch University

Age:in adolescents or young adults;

Location:Metaphyseal and central.

Bone destruction pattern:Geographic type1 b.

Tumor matrix pattern:coarse dot-like, popcorn-like mineralization of chondroid matrix.

Periosteal reaction:not present.

D.D. according to location

-Fibrous dysplasia.

-Enchondroma.

-Simple bone cyst.

-Pyogenic osteomyelitis.

Diagnosis:Characteristic appearance of enchondroma of long bone(most common site is proximal hemerus).

simple bone cyst

Location:Metaphyseal,central.

Age:Children(6-10).

Pattern of bone destruction:Geographic type 1 b-lytic lesion

D.D. according to location and age

-Fibrous dysplasia.

-Pyogenic osteomyelitis.

-Enchondroma

-Simple bone cyst.

Discussion:The pattern of bone destruction (geographic) can exclude pyogenic osteomyelitis,while appearance as a lytic lesion could exclude enchondroma due to abscense of chondral matrix,also abscense of internal septation could exclude fibrous dysplasia.

Diagnosis:Simple bone cyst.

Fibrous Dysplasia

Age:Young girl-23 years old.

Complaint: Pain in the right shoulder.

Type of examination:X-ray right shoulder.

Findings:

1-Location:Metaphyseal,diaphyseal and seems to be central.

2-Type of bone destruction:Geographic(type 1 b).

2-Type of lesion:Lytic lesion with Multiple septae are visible and outer cortical rim of the bone is maintained, suggesting a benign pathology.

3-Periosteal reaction:No periosteal reaction.

D.D. according to location as follow

-Enchondroma:In long bone usually shows chondral calcification.

-Pyogenic osteomyelitis:Usually shows permeative pattern rather than geographic.

-Simple bone cyst.

-Fibrous dysplasia.

Diagnosis:Fibrous dysplasia.

Trying for a baby

Trying for a baby? Lying down may boost pregnancy
Women who lie down for 15 minutes after artificial insemination boost their chances of getting pregnant, new research suggests.
Researchers from the Netherlands found that 27% of women who laid down after being artificially inseminated went on to have a baby compared with only 17% who stood up and moved around after the procedure.
In the study, 391 couples having fertility treatment were monitored to find out if lying down immediately after artificial insemination improved pregnancy rates. All women underwent intrauterine insemination which involves the partner's sperm being placed directly into the uterus.
Around half of the women were asked to lie down for 15 minutes after insemination, and the other half allowed to move around immediately after treatment.
The results, published online in today's British Medical Journal, showed that pregnancy and birth rates in women who laid down were "significantly higher" than in the women who moved around.
However, if fertility clinics decided to adopt this method, they would need to provide more time and space for women undergoing treatment.
Study leader Dr. Inge Custers from the Academic Medical Centre in Amsterdam said: “Although immobilisation takes more time and occupies more space in busy rooms, the intervention will be economic in the long run, as pregnant patients will not return in subsequent cycles.”
The scientists say it is not clear why lying down improves the success of artificial insemination but thought that moving around after treatment may cause "leakage".
In an accompanying editorial, Professor William Ledger from the University of Sheffield said that while the results showed promise, further research was needed.
He suggested that fertility units carry out their own evaluation to test the hypothesis in the “real world and that “if successful, more couples could be spared the rigorous and costly process of in vitro fertilisation.”
This article was published on Fri 30 October 2009Image © © Spectral-Design - Fotolia.com

People shamed into hand washing

People shamed into hand washing Most men don't soap!
People are more likely to wash their hands when they have been shamed into it, according to a new study.
The study, published in the American Journal of Public Health, looked at responses to electronic hygiene messages displayed in UK service station toilets.
Handwashing is one of the most effective and cheapest ways of preventing illness caused by poor hygiene which causes the deaths of a million people worldwide each year.
It also prevents the spread of flu, and hospital-acquired infections such as Clostridium difficile.
However, scientists at the London School of Hygiene and Tropical medicine wanted to find out the best way to get people to adopt good hand washing habits.
"It's difficult to know what kind of message is most effective at changing this everyday behaviour, so it's important to experimentally test what works best in a real setting, " said Robert Aunger, who led the study.
In the study, researchers looked at how people responded to electronic hygiene messages displayed over the entrance to toilets at UK service stations.
A quarter of a million people were counted using the toilets and their use of soap was monitored by on-line sensors.
They discovered that only 32% of men used soap to wash their hands compared with 64% of women.
Men and women also differed in the way they responded to the electronic messages on display. Women tended to respond to reminders to use soap, but men were found to respond to a more direct message such as "soap it off or eat it later."
However, the message which worked best was "Is the person next to you washing with soap?" suggesting that people were most likely to change their behaviour if they thought others were watching.
Gaby Judah, who ran the study said: "Our findings are particularly important on Global Handwashing Day, when many agencies concerned with improving health worldwide by encouraging people to wash their hands with soap will be looking to use best practice."
Global Handwashing Day is on 15th October.
This article was published on Thu 15 October 2009Image © © Vladimir Voronin - Fotolia.com

Curry spice kills throat cancer cells

Curry spice kills throat cancer cells Triggers cancer cell death
Curries may not be the healthiest of foods, but a chemical found in the curry spice tumeric can kill cancer cells, new research has found.
Past studies have shown curcumin, found in turmeric and the chemical that gives curry its mustard-yellow colour, may have anti-cancer properties.
Now scientists from the Cork Cancer Research Centre have found that it can kill oesophageal cancer cells in the laboratory.
Dr Sharon McKenna, who led the study, said: “Scientists have known for a long time that natural compounds have the potential to treat faulty cells that have become cancerous and we suspected that curcumin might have therapeutic value."
They found that curcumin started to kill cancer cells within 24 hours. The cancer cells also began to digest themselves.
Additionally, the results, published in this month's British Journal of Cancer, showed that curcumin kills cells by triggering lethal cell death signals.
“These exciting results suggest scientists could develop curcumin as a potential anti-cancer drug to treat oesophageal cancer," Dr McKenna said.
Each year around 7,800 people are diagnosed with oesophageal cancer in the UK. It is the sixth most common cause of cancer death and accounts for around five per cent of all UK deaths due to cancer.
Dr Lesley Walker, director of cancer information at Cancer Research UK, said: “This is interesting research which opens up the possibility that natural chemicals found in tumeric could be developed into new treatments for oesophageal cancer.
“Rates of oesophageal cancer rates have gone up by more than a half since the 70s and this is thought to be linked to rising rates of obesity, alcohol intake and reflux disease so finding ways to prevent this disease is important too.”
This article was published on Wed 28 October 2009Image © jscalev - Fotolia.com

How fish oils can help fight arthritis

How fish oils can help fight arthritis Omega-3 compound identified
Scientists have discovered why taking fish oils can help with rheumatoid arthritis and other conditions linked to inflammation such as stroke, sepsis and arthritis.
Although past studies have shown that fish oils can be of benefit to people with arthritis, this latest research explains how this occurs. The research is published in the journal Nature.
In a joint collaboration, scientists from Queen Mary London and Harvard Medical School discovered that the body converts an omega-3 fatty acid found in fish oils into Resolvin D2, a chemical which has strong anti-inflammatory properties.
Unlike other anti-inflammatory drugs currently in use, Resolvin D2 does not seem to suppress the immune system, the researchers noted.
Mauro Perretti, Professor of Immunopharmacology at Queen Mary, University of London, who led the UK team said: "We have known for some time that fish oils can help with conditions like arthritis which are linked to inflammation.
"What we've shown here is how the body processes a particular ingredient of fish oils into Resolvin D2. It seems to be a very powerful chemical and a small amount can have a large effect.
"This research is important because it explains at least one way in which fish oils can help in different types of arthritis.
"We can also work on this chemical and see if it can be used not only to treat or even prevent arthritis, but also as a possible treatment for a variety of other diseases associated with inflammation."
Arthritis, and many other diseases, are caused by inflammation. This means that the body's natural defences against infections are mistakenly directed at healthy tissue.
A crucial step in inflammation occurs when white blood cells from the immune system stick to the inner lining of blood vessels.
In lab tests scientists found that cells lining the blood vessels produced small amounts of nitric oxide which discouraged the white blood cells from sticking and so preventing inflammation.
Omega - 3 is an essential fatty acid. As your body cannot make it, omega-3 has to be sourced from your diet. Oily fish such as tuna (fresh, not canned), salmon, sardines, herring, mackerel, pilchards and crab are all rich in omega-3, including DHA.
This article was published on Thu 29 October 2009Image © Tomo Jesenicnik - Fotolia.com