Protean appearance and behaviour of liver hydatids

A 12-year-old boy was first seen in May 2003 for a tympanoplasty, when a peri-operative chest radiograph showed a calcified granuloma in the right lung (Figs 1a and 1b), but no other abnormality. In September 2003 he was seen again, referred by his rural general practitioner, with a 3-week history of right upper quadrant pain, fever, anorexia and weight loss. He had had a non-productive cough for a week, was pyrexial (37.8°C) and tachypnoeic, with dullness to percussion and decreased breath sounds at the right pulmonary base. He had marked right upper quadrant abdominal tenderness with guarding and a 3 cm hepar, but was not jaundiced. His white cell count was 14.9 x 109 /ml and his erythrocyte sedimentation rate (ESR) 140 mm/hour. Chest radiography revealed a markedly elevated right hemidiaphragm, with loss of clarity in its mid-portion and some right fissural thickening (Figs 2a and 2b). An ultrasound examination showed three mixed echogenicity liver lesions interpreted as abscesses (Fig. 3). One was located in the left lobe (6 cm diameter), and two were in the right lobe, measuring approximately 8 cm and 10 cm in diameter respectively. The abscess in segments 7 - 8 showed transdiaphragmatic rupture into the right pleural space (Fig. 4). During respiratory excursion, ultrasound showed abscess contents moving across this defect. A contrast-enhanced computed tomography (CT) scan of the liver (Figs 5a and 5b) showed thick fluid and septations in the lesion in segments 7 - 8, while homogeneous thick fluid was demonstrated in the other two. The presence of septations in one of the cysts raised the possibility of complicated hydatid disease

An empirical study of electricity and gas demand drivers in large food retail buildings of a national organisation

AbstractFood retail buildings account for a measurable proportion of a country's energy consumption and resultant carbon emissions so energy-operating costs are key business considerations. Increased understanding of end-use energy demands in this sector can enable development of effective benchmarking systems to underpin energy management tools. This could aid identification and evaluation of interventions to reduce operational energy demand. Whilst there are a number of theoretical and semi-empirical benchmarking and thermal modelling tools that can be used for food retail building stocks, these do not readily account for the variance of technical and non-technical factors that can influence end-use demands.This paper discusses the various drivers of energy end-uses of typical UK food retail stores. It reports on an empirical study of one organisation's hypermarket stock to evaluate the influence of various factors on annual store electricity and gas demands. Multiple regression models are discussed in the context of the development and application of a methodology for estimating annual energy end-use demand in food retail buildings. The established models account for 75% of the variation in electricity demand, 50% of the variation in gas demand in stores without CHP and 77% of the variation in gas demand in stores with CHP

Sea Otter, Enhydra lutris, Sightings off Haida Gwaii / Queen Charlotte Islands, British Columbia, 1972-2002

On 27 June 2001 we observed and photographed a Sea Otter (Enhydra lutris) adjacent to a Steller Sea Lion (Eumetopias jubatus) haulout near Sgang Gwaay (Anthony Island), Haida Gwaii / Queen Charlotte Islands. This is one of only eight documented sightings of Sea Otters in these waters during the past 30 years. These sightings may represent the beginning of the expansion of Sea Otters to their former range off Haida Gwaii

Analysis of licensed South African diagnostic imaging equipment

Introduction: Objective: To conduct an analysis of all registered South Africa (SA) diagnostic radiology equipment, assess the number of equipment units per capita by imaging modality, and compare SA figures with published international data, in preparation for the introduction of national health insurance (NHI) in SA.Methods: The SA Radiation Control Board's database of registered diagnostic radiology equipment was analysed by modality, province and healthcare sector. Access to services was reflected as number of  units/million population, and compared with published international data.Results: General X-ray units are the most equitably distributed and accessible resource (34.8/million). For fluoroscopy (6.6/million), mammography (4.96/million), computed tomography (5.0/million) and magnetic resonance imaging (2.9/million), there are at least 10-fold discrepancies between the least and best resourced provinces. Although SA's overall imaging capacity is well above that of other countries in sub-Saharan Africa, it is lower than that of all Organisation for Economic Co-operation and Development (OECD). While SA's radiological resources most closely approximate those of the United Kingdom, they are substantially lower than the UK.Conclusion: SA access to radiological services is lower than that of any OECD country. For the NHI to achieve equitable access to diagnostic imaging for all citizens, SA will need a more homogeneous  distribution of specialised radiological resources and customized imaging guidelines.Key words: Diagnostic imaging equipment, resource-limited environment, national health insuranc

Congenital lung mass in an asymptomatic patient

No Abstract. South African Medical Journal Vol. 96(6) 2006: 512-51

Extrinsic bronchial compression by primary tuberculous adenopathy, simulating foreign-body aspiration

A 5-month-old boy was well until the day before admission, when he developed a cough. On the morning of admission he was irritable and his mother noticed a blue tinge to his lips during episodes of crying. This prompted her to bring him to the emergency unit at Red Cross Children's Hospital, where he was found to be distressed and cyanosed, with a respiratory rate of 60 beats per minute, a heart rate of 200/minute and alar flaring. His left chest showed decreased air entry, bronchial breathing and dullness to percussion. Oxygen saturation was 66%, improving to 88% on face-mask oxygen. His weight was on the 50th percentile. He was well hydrated, well perfused and had no significant background medical history. A mobile chest radiograph (Fig. 1) showed complete opacification of the left hemithorax, mediastinal deviation to the left and overexpansion of the right lung, which had herniated across the midline. A penetrated anteroposterior (AP) chest radiograph (Fig. 2) showed abrupt 'cut-off' of the left main bronchus

Simultaneous ultrasound identification of acute appendicitis, septic thrombophlebitis of the portal vein and pyogenic liver abscess

A 17-year-old youth from a rural background presented to a secondary hospital with a 3-week history of epigastric pain, constipation and weight loss. He had a temperature of 40°C, marked right upper quadrant tenderness and a white cell count of 21.1 ´ 109/l. The chest and abdominal radiographs were normal, but an abdominal ultrasound scan showed two small areas of low echogenicity in the left lobe of the liver consistent with abscesses (Fig. 1). The main portal vein was distended, measuring 16 mm in diameter, and contained echogenic material indicative of thrombus (Fig. 2). In the right iliac fossa there were features of an inflamed appendix, as demonstrated by an 8 mm diameter tubular, non-compressible, fluid-filled viscus, with a distal blind end and an echogenic focus filling the lumen proximally (Fig. 3). A diagnosis was made of acute appendicitis, complicated by septic thrombophlebitis of the portal vein (pylephlebitis) and pyogenic liver abscesses. Appendicectomy was performed later that day, revealing an inflamed appendix, confirmed histologically. The patient was treated with perioperative intravenous triple antibiotics and commenced on anticoagulants following surgery. Discharge was on the 10th postoperative day. Regular out-patient follow-up documented progressive decrease in the size of the portal vein thrombus and the liver abscesses. The abdominal ultrasound scan 4 months post-surgery demonstrated a completely normal upper abdome

Congenital lung mass in anasymptomatic patient

A routine 20-week antenatal ultrasound scan showed a congenital lesion of the left fetal lung, measuring approximately 25 mm x 25 mm x 30 mm. The mass showed no sonographic change through the remainder of an uneventful pregnancy. The baby was delivered by elective caesarean section at 38 weeks' gestation, with a birth weight of 2 900 g, and had no postnatal complications. A chest radiograph performed in the early neonatal period was normal, but a contrasted single-slice helical computed tomography (CT) chest scan at age 6 weeks demonstrated the small, oval, solid mass in the left lower lobe, with no associated mediastinal shift (Fig. 1). The vascular supply of the lesion could not be identified on this scan