The British journal of radiology
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Case Reports
The vanishing heart--deterioration on chest radiography with clinical improvement during prone position ventilation.
Prone position ventilation is used in the treatment of ARDS. Its beneficial effects are due to increased ventilation of the dorsal lung areas. ⋯ The latter may be misinterpreted as a worsening of the cardiopulmonary condition while, in fact, gas exchange and ventilation may be markedly improved. These features are illustrated in the case presented.
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A single line source brachytherapy (BT) technique has been developed at Clatterbridge to boost the dose to the primary tumour after whole pelvis external beam radiotherapy (EBRT) for the radical treatment of carcinoma of the cervix. 226 patients with invasive carcinoma of the uterine cervix were treated with radiotherapy alone using this technique (median age 57 years; range 25-87 years). 49 patients had Stage IB disease, 97 had Stage II, 73 had Stage III and seven patients had biopsy confirmed Stage IVA disease. Patients with low bulk disease were given 40-42.5 Gy in 20 fractions while those with bulky disease received 45 Gy in 20 fractions or 50 Gy in 25 fractions. On completion of EBRT, 186 patients (82.3%) proceeded to intracavitary BT using a linear arrangement of sources with the Selectron (Nucletron) remote afterloading unit. ⋯ The actuarial rate of Grade 2 late radiation morbidity was 2.7% and 4.3% for the urinary tract and bowel respectively while that of Grade 3 morbidity was only 0.6% and 1.4%, respectively. Good local control can be achieved for patients with nonbulky tumours using relatively low biological doses while minimizing the risk of late treatment related toxicity. Several changes in treatment policy have been made in an attempt to improve local tumour control and possibly survival, particularly for Stage III patients and patients with bulky disease.
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The ileoileocolic type of childhood intussusception is difficult to diagnose pre-operatively and is associated with increased morbidity. This study describes the clinical and imaging features of 10 consecutive ileoileocolic intussusceptions diagnosed ultrasonically in 10 patients over a 36 month period. Ultrasound-guided hydrostatic reduction using Hartmann's solution was attempted in all 10 patients. ⋯ All unsuccessfully-reduced cases underwent surgery, with surgical confirmation of the intussusception type in all cases. Only one patient was found to have a lead point, caused by a Meckel's diverticulum. In conclusion, the diagnosis of ileoileocolic intussusception can be made pre-operatively and these patients require surgical management.