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Modern lifestyle and advanced technology have given life easier, but this has led to many diseases. In advanced lifestyle irregular eating habits, eating unhealthy foods and eating spicy fast food has become a fashion and alcohol consumption is increasing day by day. All of these factors lead to different disorders. Kamala is one among the diseases which are caused due to excessive intake of sour food, alcohol, unhealthy food and when a person with Panduroga continues intake of Pittakara Aahara then he may develop Kamala. According to modern science, Kamala can be correlated with Jaundice. Clinically the Jaundice is a sign of an ongoing disease process with common signs and symptoms like yellowish discolourations of the skin, mucous membranes, the eyes, urine etc. It is characterized by increase deposition of bile pigments in body fluids and tissues. It is perceptible only when the bilirubin level and its conjugates exceeds 1.5 mg/ 100ml plasma. Here is the case study of a patient who appeared to Parul Ayurved Hospital with the history of oedema over the bilateral lower limbs, heaviness in abdomen and chest region in the last 1 year, fever since 4-5 months and yellowish discolourations of eyes, nails and urine are present. In the present study, the patient was treated with Ayurvedic treatments i.e. Virechana Karma and Shamana Chikitsa.

Summary Deep brain stimulators (DBSs) are sometimes used to treat refractory movement disorders such as Parkinson's disease. When DBSs are implanted in a subcutaneous pocket in the chest region, breast reconstruction becomes a challenge because monopolar electrocautery can lead to DBS dysfunction or brain tissue damage caused by heat. We report a patient with a DBS who underwent one-stage implant-based breast reconstruction. We switched off the DBS before surgery and used monopolar electromagnetic cautery with minimum power settings to undermine the subcutaneous pocket for the breast implant. The DBS was switched back on immediately after completion of the surgery. The patient's postoperative recovery was uneventful with the DBS fully functional.

Image in medicine Five (5) years old male patient came to outpatient department with complain of multiple swelling over chest region with upper extremities. The clinical examination revealed that there is chest multiple mass growth of about 3-4 cm bilaterally each over chest, upper extremities and forehead. The development of multiple benign osteocartilaginous masses (exostoses) begins with the relation with the ends of long bones of the lower limbs such as the femurs and tibias and of the upper limbs such as the humerus and forearm bones with chest region. The patient also had complains of difficulty in eating, finger grips, as well as loss of functional independence. On clinical examination the patient was diagnosed with a rare case of hereditary multiple osteochondromas (HMO). Figure 1 A) anterior view of the patient; B) multiple osteochondromas showing in the chest region

Previous studies have indicated that there is no consensus on the effects of extremely low-frequency electromagnetic (ELF-EMF) exposure on the cardiovascular system. This study aimed to explore the short-term effect of ELF-EMF exposure on heart rate (HR) and HR variability (HRV). The sample consisted of 34 healthy males aged 18-27 years. The participants were randomly assigned to the EMF (n = 17) or the Sham group (n = 17). We employed a double-blind repeated-measures design consisting of three 5 min experimental periods. The chest region of each individual in the EMF group was exposed to 50 Hz, 28 mu T, linear polarized, continuous EMF during the EMF exposure period. HR and HRV data were recorded continuously by using a photoplethysmography sensor. Within-subject statistical analysis indicated a significant HR deceleration in both the EMF and Sham groups. However, the standard deviation of the NN intervals (SDNN), root mean square of successive differences (RMSSD), low-frequency (LF), and high-frequency (HF) powers increased only in the EMF group and remained stable in the Sham group. We also compared the same HRV indices measured during the EMF and Sham periods between the two experimental groups. The between-subject analysis results demonstrated significantly higher SDNN, RMSSD, LF, and HF values in the EMF group than in the Sham group. The LF/HF ratio did not change significantly within and between groups. on the basis of these results, we concluded that short-term exposure of the chest region to ELF-EMF could potentially enhance parasympathetic predominance during the resting condition. (c) 2020 Bioelectromagnetics Society., Ege University Scientific Research Project Coordination UnitEge University; Ege University Planning and Monitoring Coordination of Organizational Development; Directorate of Library and Documentation, We thank the Ege University Scientific Research Project Coordination Unit for their support. We are also grateful to Ege University Planning and Monitoring Coordination of Organizational Development, and Directorate of Library and Documentation for their support in editing and proofreading service of this study.

Sexual desire can be triggered by external (visual, tactile, auditory, olfactory) or internal (memories, fantasies) stimuli. However, few studies have investigated these different components of sexual desire. In our investigation, we focused on visual stimuli with the aim of establishing whether or not there exists a specific pattern of visual exploration linked to sexual desire among male and female subjects. In another words, we wanted to investigated what parts of the body visually explored are the more relevant to feel sexual desire. To assess this question, we conducted an eye-tracking study in which participants made a judgment of sexual desire, during the visualization of explicit visual stimuli. The main results for male viewers revealed that they explored the body longer than the face (P = .05). Within the body area, the chest region was scanned more extensively than the abdomen (P = .014) and the genital area (P = .003). There were no difference between the abdomen and the genital area. For female viewers, the pattern of exploration showed they explored the body longer than the face (P = .05). Inside the body area, the abdomen was scanned more extensively than the chest/pectoral region (P

Purpose: This study examined tackle characteristics and their relationships with match-play tackle outcomes, tackling ability, and physical qualities in rugby league players. Methods: Fifteen rugby league matches were analysed, with the tackle characteristics and outcomes of 2355 tackle events coded. Muscle strength and power tests, and a standardized assessment of tackling ability were performed in 16 players. Results: Medium body position, utilizing a shoulder or smother tackles, and producing leg drive upon contact decreased the odds of a missed tackle. Performing a front-on tackle, with a contact zone at the chest region reduced the odds of an offload. Tackling ability was significantly related to defenders moving forward prior to contact (rs = 0.60, 95% CI 0.15–0.85, P = 0.02), front-on tackles (rs = 0.53, 95% CI 0.05–0.81, P = 0.04), and displaying medium body height (rs = 0.57, 95% CI 0.10–0.83, P = 0.02) in match-play tackles. Lower-body strength was significantly related to defenders exhibiting a medium body position (rs = 0.60, 95% CI 0.15–0.85, P = 0.01) and the ball-carrier being placed on their back (rs = 0.72, 95% CI 0.35–0.90, P = 0.002). Conclusion: The findings suggest that match-play tackle performance is related to both tackle characteristics and physical qualities.

A 70-year-old female patient presenting with swelling and subcutaneous nodule formation localized to the knee scars over a two-month period is presently reported. Dermatological examinations found erythematous swelling and small papules on the patient's knee scars, along with subcutaneous nodules beneath and around the scars. Computer tomography of the chest region identified multiple obscure tubercles in the lungs and swollen lymph nodes in the hilum pulmonis and mediastinum. Skin biopsy revealed multiple non-caseating granulomas, which had infiltrated the dermis. The patient was diagnosed with scar sarcoidosis as a result of these observations. The onset of scar sarcoidosis is rare and, therefore, not well understood; however, inflammatory alterations in preexisting scars may be important indicators for disease onset.

Objective: The aim of this study was to evaluate the complementary and alternative medicine (CAM) methods, the prevalence of their use, and to assess the factors that influence using these methods in children with asthma and/or allergic rhinitis in Van. Material and Methods: The study was conducted between June 2015 and January 2016. A survey form consisting of 15 questions was prepared. These questions were posed to the parents of the children with asthma and/or allergic rhinitis who were being followed-up at the pediatric allergy and immunology outpatient clinic. Results: The study included 127 parents of children aged 2-17 years. The mean age of the patients was 7.9 ± 3.6 years. 62 (48.8%) of the 127 parents stated that they had used CAM methods at any time of their life. 9 (14.5%) of the CAM users thought that they had benefited from these methods. The most common modality was molasses used in 45 (72.5%) of the patients. 44 (70%) of the patients used herbs and spices (linden, rosehip, mountain thyme, black pepper, cinnamon, etc.), 23 (37%) used honey, 13 (20%) used quail eggs, 10 (16.1%) used olive oil, 6 (9.6%) used cow’s milk, 1 (1.6%) used bee milk, 1 (1.6%) used bee pollen and 1 (1.6%) used Vicks application to the chest region. Most of the parents had accessed information about CAM methods through a herbalist and the media. Conclusion: In conclusion, the prevalence of reported CAM use among patients with diagnosed asthma and/or allergic rhinitis in Van was found to be high (48.8%) and at a similar rate with other regions of our country, with molasses (72.5%) being the most popular modality. The pediatric allergy specialist should have knowledge about these methods and inform parents about their possible side effects.

Localized scleroderma in the chest region of adolescent girls leads to incomplete breast development and breast asymmetry, for which patients may require treatment. The site of localized scleroderma, its activity, the surgeon, and the patient's desires influence the selection of treatment method. There have been few reports on surgical treatment of this disease. In the current report, we present a case in which improved breast asymmetry was achieved through multiphased surgery, and we review treatment methods and indications of this disease. Level of Evidence: 5 ![Graphic][1] [1]: /embed/inline-graphic-1.gif

This study presents comparison results between axial and spiral scanning in the head and chest region with 64 MDCT to evaluate organ doses in infants and toddlers, who ar e more radiosensitive to radiation than adults and rise in the number of CT examinations, during CT scanning. Organ doses were significantly lower in spiral scanning than axial scanning regardless of scanned regions. The average organ dose for the chest scan using pitch of 1.355 was found to be significantly higher(average -12 .03%) than for the other two pitch settings(0.525 and 0.988) in the spiral scanning mode compared with the axial one. Organ doses in the spiral scanning mode were lower by average 20.54% than the axial scann ing mode. The results of the study that evaluated organ doses with an anthropomorphic phantom will help to demonstrate the result values of Monte Carlo simulations and make a contribution to more accurate eval uations of organ doses in toddlers undergoing a CT examination. Key Words : Infants and Toddlers, Axial Scan, Spiral Scan, Organ dose, demonstrate

Objectives This study aimed to measure the absorbed doses in selected organs for prospectively ECG-triggered coronary computed tomography angiography (CCTA) using five different generations CT scanners in a female adult anthropomorphic phantom and to estimate the effective dose (HE). Materials and Methods Prospectively ECG-triggered CCTA was performed using five commercially available CT scanners: 64-detector-row single source CT (SSCT), 2 × 32-detector-row-dual source CT (DSCT), 2 × 64-detector-row DSCT and 320-detector-row SSCT scanners. Absorbed doses were measured in 34 organs using pre-calibrated optically stimulated luminescence dosimeters (OSLDs) placed inside a standard female adult anthropomorphic phantom. HE was calculated from the measured organ doses and compared to the HE derived from the air kerma-length product (PKL) using the conversion coefficient of 0.014 mSv∙mGy-1∙cm-1 for the chest region. Results Both breasts and lungs received the highest radiation dose during CCTA examination. The highest HE was received from 2 × 32-detector-row DSCT scanner (6.06 ± 0.72 mSv), followed by 64-detector-row SSCT (5.60 ± 0.68 and 5.02 ± 0.73 mSv), 2 × 64-detector-row DSCT (1.88 ± 0.25 mSv) and 320-detector-row SSCT (1.34 ± 0.48 mSv) scanners. HE calculated from the measured organ doses were about 38 to 53% higher than the HE derived from the PKL-to-HE conversion factor. Conclusion The radiation doses received from a prospectively ECG-triggered CCTA are relatively small and are depending on the scanner technology and imaging protocols. HE as low as 1.34 and 1.88 mSv can be achieved in prospectively ECG-triggered CCTA using 320-detector-row SSCT and 2 × 64-detector-row DSCT scanners.

Death due to ice pick injury rarely reported in forensic literature. We report death of a 16-year old male, who was allegedly assaulted on chest, back and thigh by his school-mate, with an ice pick. The accused had got the ice pick from his father's ice shop to attack the victim. The multiple stabs to the chest region had perforated the lung and penetrated the heart chambers. The victim succumbed to death on the way to hospital and medico-legal autopsy was conducted. The injuries inflicted by the ice pick are highlighted and its pattern is discussed in this article, owing to the peculiar nature of the wounds produced by the ice-pick.

Gunshot trauma is an important, but often overlooked, avenue for interpreting the historic past. Ten skeletons of Seventh Cavalry troopers, killed during the Battle of the Little Bighorn in 1876, are analysed osteologically. Six of the ten specimens have gunshot wounds, including three to the cranial vault. The other wounds are to postcranial remains, including one in an innominate. This wound location aids the identification of the individual, confirming and complementing historic accounts. Of the remaining two, one is to the humerus and the other to the chest region. These wounds provide insights into the nature of perimortem injuries, weapons used in the battle, and interpretations of the battle.

1. 1. Eight male Japanese Brazilians and 11 male Japanese volunteered for this study. Each one sat on a chair for 45 min at 40°C (r.h. 50%). 2. 2. Then, they exercised using a bicycle ergometer in a semi-reclining position for 45 min at 40% of maximal oxygen uptake. 3. 3. Thermal and comfort sensation confirmed that Japanese Brazilians felt cooler and more comfortable in 40°C environment than the Japanese. 4. 4. Oxygen uptake, sweat rate and body weight loss for both groups were not significantly different. 5. 5. Forearm blood flow and heart rate for Brazilians were significantly lower than those for Japanese. 6. 6. Skin temperature at chest region for Brazilians was found to be significantly higher than that for Japanese. 7. 7. Thus the thermoregulatory responses observed in Japanese Brazilians may be largely attributed to the climate in their native places located on the Tropic of Capricorn. 8. 8. These results may indicate that environment condition is the important factor in determining the thermoregulatory responses.

With development of endoscopic surgery and medical robotics, surgery using endoscope robots has become a representative of robotic surgery. This chapter describes classification, design methods and evaluation methods of endoscope robots. Expectations for a minimally invasive surgery have increased year by year with the dramatic advancement of image diagnosis technology, including CT and MRI. A camera (endoscope) and surgical instruments are inserted into tiny holes made in the patients’ abdomen or chest region for surgical procedures. Compared to abdominal or open chest surgery, endoscopic surgery has less pain and has a greater advantage in cosmetic appearance as well as the economic advantages, resulting in its growing popularity. The most distinctive feature of endoscopic surgery is that the surgical field is observed through images taken by an endoscope, rather than the naked eye. The most important element to surgical safety and efficient operating is how well an endoscope reveals the field of view during surgery. Generally, a camera assistant operates the endoscope. The operation of the endoscope needs fine adjustment for the angle of the field of view and the distance of the surgical area as well as correct aiming of the endoscope at the surgical field. Camera assistants sometimes operate the endoscope according to instructions of a surgeon; however, camera assistants need to operate the endoscope using their judgment in understanding the surgeon’s intentions so that they can move the endoscope according to how the surgery is progressing moment to moment. The operation of an endoscope by camera assistants requires as much proficiency as that of surgeons. There are not many surgeons who have sufficient proficiency in endoscopic surgery, which requires special techniques. In fact, it is not unusual for surgery to be interrupted due to a camera assistant not being sufficiently proficient in using the endoscope and is unable to obtain the exact field of surgery required. To solve this problem, "endoscope robots that can hold and position an endoscope instead of a human camera assistant" (Fig. 1) have been developed. Fig. 1(a) shows a usual endoscopic

Eight male Japanese Brazilians (20-32 yrs) and 11 male Japanese (22-24 yrs) volunteered for this study. The Brazilians had been staying for about 2-21 weeks in Japan. Their physical characteristics are not significantly different from those of the Japanese. Each one of them sat on a chair for 45 min at 40 degrees C (R.H. 50%) in a climatic chamber. Then, they exercised using a bicycle ergometer in a semi-reclining position for 45 min at 40% of maximal oxygen uptake. Forearm blood flow (FBF), oxygen uptake (VO2), heart rate (HR), skin temperature (Tsk), sweat rate (SR) at chest region and body weight loss (delta Wt) were measured. Thermal sensation and thermal comfort were also measured. Thermal and comfort sensation confirmed that Japanese Brazilians felt cooler and more comfortable in 40 degrees C environment than the Japanese. VO2, SR and delta Wt for both groups were not significantly different. FBF and HR for Brazilians were significantly lower than those for Japanese. Tsk at chest region for Brazilians was found to be significantly higher than that for Japanese. Thus the thermoregulatory responses observed in Japanese Brazilians may be largely attributed to the climate in their native places located on the Tropic of Capricorn.

Key Clinical Message A 55-year-old man of dark complexion presented with multiple extensive swellings over the chest, right upper arm, and left shoulder for 10 years. Swellings were hyperpigmented, firm, and intensely pruritic especially over the chest region. The swellings progressed in size, extended, and developed satellite lesions over its 10 years history.

In this work the investigations of the electrical field generated by the heart, carried out using a computer simulation method are presented. Two models have been constructed approximating the chest region for the following conditions: (a) normal heart activity, and (b) open chest during the cardiac surgery. For the above models the distribution of potentials on the heart surface are determined. The source field investigated takes the following forms: dipole, multidipole, and multipole. Numerical experiments for these models show a difference between normal heart activity and of the heart in the condition when the chest is open during surgery.

particularly important in causing melanoma and we have reported the results of large-scale studies of the outdoor ultraviolet (UV) exposure in schoolchildren in England and Queensland. In the English study, 90 primary schoolchildren (aged 9–10 years) were monitored with UV-sensitive polysulphone film badges over a 3-month period from midApril to mid-July, 1994, in Durham (55°N), Wallingford (51°N), and Plymouth (50°N). Corresponding monitoring in Queensland took place in 112 schoolchildren (aged 11–12 years) over a 2-week period at each site from late spring to early autumn during 1991/92 in Brisbane (27°S), Toowoomba (27°S), and Mackay (21°S). Badges were attached to clothing in the shoulder/chest region. Participants were instructed not to cover badges by clothing, and to transfer badges whenever clothing was changed. Ambient UV radiation was monitored throughout the study periods at all sites in England and Queensland. The average diurnal ambient values recorded were 14 SED (Durham), 19 SED (Wallingford), and 16 SED (Plymouth); 22 SED (Toowoomba), 38 SED (Mackay), and 54 SED (Brisbane). (The SED [standard erythema dose] is a measure of sunburning radiation: minimum erythema on the unacclimatised skin of subjects who always burn and never tan would require an exposure of about 1·5 SED, whereas in people who tan easily and rarely burn, an exposure of about 6 SED would be needed to cause minimum erythema). Although the studies were planned and executed independently and at different times, in both studies children were monitored whilst at school and at weekends, and remained in the vicinity of the radiometer sites throughout the monitoring periods. Polysulphone film photodegrades on exposure to UV and will saturate if over-exposured. Because of differences in ambient UV between Queensland and England, new badges were worn by the Australian children on each day of the monitoring period, whilst in England each child wore two badges per week, one badge Monday to Friday and another badge on Saturday and Sunday. This methodological difference ensured that badges worn by all children in the study received insufficient UV to saturate their response. In each study about 40% of badges were either not returned or rejected due to damage. Missing badges were distributed fairly evenly across all locations and both sexes minimising the likelihood of bias in the reported results. Frequency histograms of daily exposures received by the children in each study are shown in the figure. Whilst the RESEARCH LETTERS

This paper presents the results of in vivo measurements on a worker from a fuel reprocessing plant who was involved in an actinide intake. The results revealed that false indications of an actinide lung burden could arise from a contaminant present elsewhere in the chest region. Consequently, it is important that lung monitoring programs for occupational workers handling actinides are conducted with this caution in mind and that due consideration is given even in cases of minor cuts/wounds in order to rule out substantial overestimation of internal radiation doses.

A 71-year-old lady was referred by her general practitioner to an orthopaedic clinic for management of shoulder pain. The patient complained of pain in the shoulder and chest region but also described reduced sensation and power in her arm and a worsening of her respiratory symptoms. These prompted further investigation with an isotope bone scan which showed a large soft tissue mass posteriorly in the apex of the right lung with chest wall extension and destruction of adjacent ribs. A subsequent CT scan identified Pancoast's tumour. This case highlights the importance of considering non-musculoskeletal causes of shoulder region pain.

Purpose: compare two optimization methods using brachyvision and compare the dosimetry between multimen‐lumen and single‐lumen catheters used for partial breast brachytherapy Methods: Single‐lumen catheter is the Mammosite device. Two multi‐lumen devices are used: contura 5‐lumen and Hologic 4‐lumen devices. The planning system is Brachyvision. PTV is constructed by expanding the balloon by 1cm, and shaping the volume to exclude the pectoralis muscle and leave a 0.5cm margin from the skin. PTV_EVAL is defined as PTV subtracts the balloon. We also define two critical‐organ ROIs: skin region and chest region, where skin region is the skin side to PTV excluding PTV and the chest region is the chest side to PTV excluding PTV. One optimization method is to achieve uniform 3.4 Gy/fx on the PTV surface, and the other method is an inverse optimization method to achieve at least 95% of PTV receive dose higher than 3.4 Gy/fx and less than 10% of PTV receive more than 5Gy/fx with upper bound to skin region and chest region. Patients are grouped into 4 categories: (a) Skin and chest wall are within 1cm from the balloon; (b) only skin (c) only chest wall is within 1cm from the balloon and (d) both skin and chest wall are within 1cm from the balloon. Results: For category (a) patients, both optimization methods give similar satisfactory Results: 98% and 99% of PTV_EVAL receive 3.4 Gy/fx for single‐lumen and multi‐lumen catheters, respectively; while the skindose are less than 3.4Gy/fx. For patients in categories (b) and (d), the inverse optimization method and multi‐lumen catheter gives significant lower skindose. Conclusions: single‐lumen, multi‐ lumen device provide similarly satisfactory result for patients with skin and chest at least 1cm from the balloon; for other patients, the inverse optimization method and multi‐lumen catheter device give significantly less skindose.

Purpose: To compare radiation doses to five year old pediatric patients with Cystic Fibrosis (CF) undergoing chest CT examinations at five North American imaging centers. Method and Materials: A questionnaire was sent to five facilities participating in a CF research study (Chapel Hill NC; Washington WA; St Louis Mo; Denver Co; Toronto ON) to obtain their protocols for chest CT examinations on a five year old child with Cystic Fibrosis. The ImPACT CT dose calculator was used to determine adult effective doses for techniques used at each facility (i.e., kV/mAs/pitch). Adult effective doses were scaled to those for five year olds to account for differences in scan length, patient size and energy imparted. Results: The five facilities used four different models of CT scanner from two vendors. CT techniques for five year old patients with CF were generally 120 kV, 60 mAs, and an average pitch ratio of ∼ 1.2. Adult scan lengths were 30 cm whereas those for 5 year olds were 15 cm. Adults weigh 70 kg compared to 18.5 kg for a 5 year old. For a single 360 ° x‐ray tube rotation, energy absorbed in the chest region of a five year old is only 55% of that for an adult. Three facilities had effective doses of ∼ 2.4 mSv, whereas two facilities had lower doses of ∼1.25 mSv. The main reasons for the lower doses were the use of lower x‐ray technique (i.e., 30 mAs) or a lower x‐ray tube voltage (i.e., 100 kV). Conclusion: Effective doses to 5 year old CF patients can be obtained by scaling adult effective doses, and average to 2 mSv per patient examination.

Purpose: Hitherto, the Radiology community has assumed that scatter radiation in CT originates within the patient, and that any use of lead aprons would have no measurable effect on patient (scatter) doses. In this study, we investigated the validity of this assumption, and quantified the potential for reducing patient (scatter) doses in CT when lead aprons are placed adjacent to the directly irradiated region. Method: Thermoluminscent dosimeters(TLDs) were used to measure dose distributions in three anthropomorphic phantoms (newborn, 10‐year old, and adult male). Phantoms were scanned on a 4‐slice GE Lightspeed CT scanner using 140 kV, 900 mAs, and contiguous axial scanning. We performed a chest CT scan of each phantom with approximately 45 TLDs distributed through the directly irradiated chest region, and distal regions (head and abdomen). A second CT was also performed with the head and abdomen regions wrapped with a 0.5 mm equivalent lead apron. We estimated the effect of the lead apron on regional doses, as well as the change in total energy absorbed. Results: As expected, the addition of a lead apron had no effect on doses in the directly irradiated chest region. The addition of a lead apron reduced head doses by about 40%, and abdominal doses by about 25%. However, the scatter radiation in the “head” accounts for ∼3% of the total energy imparted to the patient, and the corresponding value for the abdomen is ∼7%. As a result, the reduction in total energy imparted to the patient from the introduction of lead aprons was only ∼5%. Conclusions: Our results show that lead aprons reduce patient doses from “external scatter” by about 5%. The origin of “external scatter” in CT merits additional study.

Experimental studies have shown that a pneumothorax (collapsed lung) substantially alters the propagation of sound introduced at the mouth of an intubated subject and measured at the chest surface. Thus, it is hypothesized that an inexpensive diagnostic procedure could be developed for detection of a pneumothorax based on a simple acoustic test. In the present study, theoretical models of sound transmission through the pulmonary system and chest region are reviewed in the context of their ability to predict acoustic changes caused by a pneumothorax, as well as other pathologic conditions. Such models could aid in parametric design studies to develop acoustic means of diagnosing pneumothorax and other lung pathologies. Extensions of previously developed simple models of the authors are presented that are in more quantitative agreement with experimental results and that simulate both transmission from the bronchial airways to the chest wall, as well as reflection in the bronchial airways. [Research supported by NIH NCRR Grant No. 14250 and NIH NHLBI Grant No. 61108.]

To the Editor: Tonsgard et al.1 performed CT imaging in 91 adult (≥16 years) NF1 patients; paraspinal neurofibromas occurred in 18.7% of patients in the chest region and in 25.3% of patients in the abdominal or pelvic region. The majority of patients were asymptomatic. We wondered whether the presence of plexiform neurofibromas that are apparent on the surface of the body could be used to identify NF1 patients who are at high risk of having paraspinal neurofibromas as well. We therefore examined the association between NF1 superficial plexiform and paraspinal neurofibromas in both the National Neurofibromatosis Foundation International Database (NNFFID; 2,638 patients)2,3 and an English series (288 patients). Superficial plexiform neurofibromas occurred in 23.2% of NNFFID patients and 24.0% of English patients. Paraspinal neurofibromas occurred in 1.7% of NNFFID patients and 4.2% of English patients. The low frequency of paraspinal tumors is …

During acupuncture in the chest region a right-sided pneumothorax developed in a 53-year-old woman which necessitated emergency admission to hospital. A reinflation of the lung could be achieved with two Bulau drains. The increasing frequency of acupuncture must remind one of the feasibility of lesions of internal organs including those of the abdomen. Complications due to insufficient disinfection of acupuncture needles may also arise.

Traumatic pulmonary pseudocyst (TPP) is a rare complication following blunt trauma. We report a 26-year-old male patient who presented to the emergency room with internal bleeding and shock. Huge TPP (14 cm in diameter) was seen on whole-body computed tomography scan and complicated with bronchial bleeding. He deteriorated to respiratory failure soon after arriving at the emergency room. TPPs imply high-energy impact on the chest region and frequently complicated with pulmonary contusions, hemo- and pneumo-thorax, multiple rib fractures, flail chest, and concurrent with abdominal injuries. Emergency physicians should be aware of such rare entity and manage correctly.

Computerized Tomography (CT) images reflect the x-ray absorptive properties of the patient. CT images of the chest region, however, are difficult to display. Due to the large density differences between the tissue region of the heart and the air filled region of the lung, the lung appears nearly black if the heart is viewed at normal contrast. Similarly, if the image is adjusted to view the lungs at reasonable contrast, the heart region becomes saturated and featureless. A standard technique for viewing the two regions remaps the darker lung gray-level to values comparable to that of the heart region. The "dark-line artifact" results for those pels of intermediate value between the heart and lung. This apparent line surrounds the lungs and gives the entire image an objectionable piecemeal appearance. A software system, CTIP, written in FORTRAN is discussed which remaps CT image gray-level so that both the lung and heart regions are clearly visible with a more natural anatomical appearance. The system is adaptive to image statistics derived from the gray level histogram and is completely automated. The processed and the standard approach images were compared by twenty-two radiologists with 82% preferring the processed images. All of the respondents agreed that the processed images possessed a more anatomical appearance than the standard approach.

About 10:30 a. m., the morning of Jan. 9, 1958, a 56-year-old white man was brought to the emergency room of the Ruston Hospital. He had been transported in the back seat of a car, sitting erect, by two of his fellow workers. The patient and his friends described that he had been injured by a falling log. The patient was a woodsman engaged in securing pine logs for pulpwood. Apparently, the log had fallen from a truck and hit him across his back. He was completely conscious and talked coherently but complained bitterly of pain in his left chest region. He was having marked respiratory difficulty. A hurried examination, together with a portable x-ray of his chest revealed a complete collapse of his left lung. Despite this, the patient assisted in the examination and cooperated to the extent of rising from the wheel chair and seating himself on the