Sezary syndrome.

Sezary syndrome is a rare form of primary cutaneous T cell lymphoma. A male patient of 37 years old was reported with multiple subcutaneous swelling at different parts of the body which were asymptomatic for the last 2 years. But he had persistent generalized itching, induration in skin surface and erythema for months. The disease was diagnosed by the presence of Sezary cells in the skin biopsy, peripheral blood smears and epidermotrophism of lymphocytes. The patient was treated by CHOP (Cyclophosphamide, Doxorubicin, Vincristine and Prednisolone) therapy.

Cerebral white matter changes and rate of progression of dementia during cholinesterase inhibitor treatment: a retrospective cohort study.

BACKGROUND: Cerebral white matter changes (WMC) represent cerebrovascular disease (CVD) and are common in dementia. Cholinesterase inhibitors (ChEIs) are effective in Alzheimer's Disease (AD) with or without CVD, and in Dementia with Lewy Bodies (DLB). Predictors of treatment response are controversial. OBJECTIVE: To investigate the effect of WMC severity on rate of progression of dementia during treatment with ChEIs. METHODS: CT or MRI brain scans were rated for WMC severity in 243 patients taking ChEIs for dementia. Raters were blind to patients' clinical risk factors, dementia subtype and course of illness. Effects of WMC severity on rates of decline in cognition, function and behaviour were analysed for 140 patients treated for 9 months or longer. Analysis was performed for this group as a whole and within diagnostic subgroups AD and DLB. The main outcome measure was rate of change in Mini Mental State Examination (MMSE) score. Secondary measures were rates of change in scores on the Cambridge Cognitive Examination (CAMCOG), Instrumental Activities of Daily Living (IADL) and Clifton Assessment Procedures for the Elderly - Behaviour Rating Scale (CAPE-BRS). RESULTS: There was no significant association between severity of WMC and any specified outcome variable for the cohort as a whole or for patients with AD. In patients with DLB, higher WMC scores were associated with more rapid cognitive decline. CONCLUSIONS: Increased WMC severity does not influence clinical response to ChEI treatment in AD, but may hasten deterioration in ChEI-treated patients with DLB.

Magnetic resonance imaging of scoliosis.

The introduction of magnetic resonance imaging (MRI) has greatly improved the evaluation of patients with scoliosis allowing assessment of any underlying intraspinal abnormalities. The aim of this pictorial review is to illustrate the magnetic resonance appearances of various abnormalities encountered when imaging developmental spinal deformity. Redla, S.et al. (2001). Clinical Radiology56, 360-371.

Selection of patients for carotid endarterectomy.

OBJECTIVE: The aim of this study was the definition of the duplex scan parameters that best select patients for carotid endarterectomy. METHODS: This study was set in a regional vascular unit. Duplex scanning and angiography were performed prospectively on 50 patients who were symptomatic (100 carotid bifurcation) to identify the most accurate and sensitive duplex scan criteria to identify an 80% to 99% stenosis according to the European Carotid Symptomatic Trial. With data from the European Carotid Symptomatic Trial, we estimated the effect of three different approaches used to select patients for carotid endarterectomy. The first approach was the selection of patients for carotid surgery on the basis of duplex scanning alone with the most accurate duplex scan criteria (approach I). The second approach was the selection of patients for carotid surgery on the basis of duplex scanning alone with a 100% sensitive duplex scan criteria (approach II). The third approach was the selection of patients for angiography with duplex scanning (100% sensitive criteria) and then the use of angiography to define which patients should undergo surgery (approach III). RESULTS: All three approaches appeared to have a similar potential in stroke reduction. However, approach I, which minimized the number of patients who underwent surgery (19% less than approach II) or invasive imaging (65% less than approach III), appeared to be the most appropriate. CONCLUSION: These data support the selection of patients for carotid endarterectomy on the basis of duplex scanning alone. The duplex scan criteria should be validated against angiography.

Imaging features of cervical spondylolysis--with emphasis on MR appearances.

AIM: To describe the imaging features of cervical spondylolysis, with emphasis on magnetic resonance imaging (MRI) appearances. MATERIALS AND METHODS: The clinical and imaging features (plain radiographic, CT and MRI) of three patients with cervical spondylolysis were reviewed. RESULTS AND CONCLUSIONS: Three cases of C6 cervical spondylolysis have been described and the world literature reviewed. The plain radiographic features in two cases with bilateral defects showed spondylolisthesis and abnormalities of the pars and adjacent facet joints. CT demonstrated well corticated defects and associated spina bifida occulta in all cases. The defects were seen in only one case on MRI but in all cases, absence of the spinous process of C6 was noted on sagittal sequences due to the spina bifida occulta. Cervical spondylolysis is an uncommon condition that must be distinguished from an acute fracture and diagnosed radiologically to prevent mismanagement. Although the defect may be difficult to identify on MRI, absence of the spinous process on sagittal sequences should raise the suspicion of the abnormality.

Pneumomediastinum complicating bleomycin related lung damage.

We describe two patients who developed spontaneous pneumomediastinum without pneumothorax against a background of bleomycin-induced pulmonary interstitial disease whilst on treatment for metastatic germ cell tumours of the testis. Pneumomediastinum is a rare but recognized complication of bleomycin-induced lung toxicity, which has previously only been described in association with pneumothorax.

Radiation protection awareness in non-radiologists.

The outcome of teaching the core of knowledge to clinicians and the impact of the POPUMET regulations was assessed using an anonymous questionnaire. 82 of 120 (76%) of non-radiologists responded, of these 37% had attended a radiation protection course. Course attendance improved knowledge of the existence of the POPUMET regulations (p < 0.0001) and the ALARA principle. Course attendance made no difference to knowledge of the relative radiation dose of various radiological procedures. An underestimation of radiation dose was made by all responders (p < 0.001). The majority of responders were not aware that patients have no annual dose limit and the majority did not know the relative radiosensitivity of different organs. We have shown that despite the POPUMET regulations the majority of clinicians have not received adequate radiation protection teaching and that even if a course has been attended overall knowledge is still poor. We propose that formal compulsory teaching at undergraduate level may correct this in the future.

Serum electrolytes and capillary blood gases in the management of hypertrophic pyloric stenosis.

The purpose of this study was to assess whether the concentration of serum chloride and other variables, namely serum sodium, potassium and bicarbonate, can be used to predict metabolic acid-base status in infants with hypertrophic pyloric stenosis (HPS) and to assess whether such a prediction is influenced by the state of hydration. One hundred and sixty-three infants with HPS who had at least one set of serum electrolyte and capillary blood gas estimations performed after admission were studied retrospectively. A further 25 infants who had their electrolyte and blood gases measured after at least 12 h of rehydration and correction of the serum sodium and chloride abnormalities were studied prospectively. Stepwise multiple regression analysis, using standard bicarbonate as the dependent variable, revealed serum chloride concentration to be the most powerful independent predictor of standard bicarbonate level (r = -0.69, P less than 0.0001). Other variables did not improve the correlation significantly. In the retrospective study of untreated patients, the calculation of a 90 per cent prediction interval for the model indicated that if the serum chloride level is less than 96 mmol/l, one could be 95 per cent confident (one tail) that the patient was alkalaemic. To be 95 per cent confident that the patient was not alkalaemic, the serum chloride level would have to be greater than 121 mmol/l. The prospective study found that following rehydration a serum chloride level greater than or equal to 106 mmol/l more accurately predicted absence of alkalaemia. We conclude that predictability of acid-base status from measurement of serum chloride depends on the state of hydration of the patient.