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La sociologie amerieaine des relations ethniques, aux niveaux de la theorie et de la decision politique, est fondee sur l'experience de l'immigration europeenne et sur celle des rapports avec la population afro-americaine. Ces deux cas y ont introduit, respectivement, les notions de pluralisme et d'integration. L'examen des phenomenes du pluralisme et de l'assimilation chez les Chinois et les Japonais aux U.S.A., deux groupes raciaux defavorises, met en lumiere les conditions favorables a chacun de ces deux modes d'adaptation. La formation de eommunautes isolees et plutot autonomes par le groupe chinois n'est pas surtout due a une aversion hostile du milieu ambiant; elle resulte davantage de dettes contractees lors de I'emigration, de la repartition de la population selon le sexe, des attitudes a l'endroit du travail en milieu urbain et de conllits interpersonnels au sein du groupe. L'idee si repandue de l'assimilation facile du Japonais tiendrait, au contraire, au caractere volontaire de Iemigration de celui-ci, a son isolement et a sa segregation en milieu rural, a la possibilitye qu'il a de contracter un mariage endogame et a l'instabilite des controles communautaires importes du pays d'origine. Les personnes d'origines chinoise et japonaise nees aux U.S.A. ont maintenant de meilleures possibilityes que naguere de s'integrer a la societe globale. Certains Japano-Americains eprouvent pourtant une desillusion silen-cieuse face a la destruction inevitable des moeurs et de la culture japonaises. L'etude du contraste entre les communautes chinoise et japonaise d'Amerique devrait nous amener a modifier la theorie de Park sur le processus des relations raciales et a donner plus d'importance aux conditions qui permettent la surviv-ance des civilisations-meres dans un nouveau milieu.

Les etudes sur la societe secrete chinoise en Occident fournissent des materiaux pour le developpement d'une sociologie des activites secretes. En general ce sont des non-sociologues, avec des buts autres qu'academiques, qui se sont interesses a ces societes. Cependant beaucoup de donnees valables sont disponibles et peuvent faire 1'objet d'une analyse sociologique. Les paralleles entre les franc-macons occidentaux et les societes secretes chinoises suggerent la possibilitye de developper une typologie des societes secretes qui utilise comme criteres leurs attitudes vis-a-vis les normes de la societe dominante et le mode d'expression de ces attitudes. Un modele a quatre dimensions suggere que les distinctions conformite-alienation, instrumental- “expressif” caracterisent de telles societes. Quoique les rites des societes secretes se ressemblent, ils peuvent remplir des fonctions differentes selon les buts et les activites des societes. La societe secrete en Chine meme a ete un instrument de rebellion non-ideologique. Elle ne fut pas fortement revolutionnaire mais elle a attire des revolutionnaires. Les theories recentes de la sociologie politique sur le “brigandage social” et la rebellion non-ideologique pourraient etre confirmees ou modifyees par l‘etude des sources chinoises. Les Chinois a l'exterieur de l'Asie ont organise des societes secretes pour se proteger, pour s'entraider, pour fournir des biens et services illicites et pour exprimer leur interet dans l'avenir politique de la Chine. II semble que l'assimilation de ces Chinois met en danger la survie des societes secretes mais il faudrait plus de recherches sur ce sujet. Les donnees sur les societes secretes chinoises en Occident suggerent la necessite de modifier le modele de Freedman pour l'etude du changement dans les communautes chinoises hors de l'Asie.

Retrograde urethrography and voiding cystourethrography are the modalities of choice for imaging the urethra. Cross-sectional imaging modalities, including ultrasonography, magnetic resonance (MR) imaging, and computed tomography, are useful for evaluating periurethral structures. Retrograde urethrography is the primary imaging modality for evaluating traumatic injuries and inflammatory and stricture diseases of the male urethra. Sonourethrography plays an important role in the assessment of the thickness and length of bulbar urethral stricture. Although voiding cystourethrography is frequently used to evaluate urethral diverticula in women, MR imaging is highly sensitive in the demonstration of these entities. MR imaging is also accurate in the local staging of urethral tumors.

Objectives: This article will define the current controversies and concepts in the classification, clinical presentation, imaging approaches and management of upper urinary tract trauma. Materials and methods, results: This review will include the experience of the authors in the field of renal trauma over a 32-year period. Current thinking accepts the view that significant renal trauma is generally present when there is gross hematuria, signs of shock, or other clinical signs of severe injury. In most patients, suspected renal injury will be evaluated as a part of the overall assassment of the patient for suspected intraperitoneal injury. The authors will stress some exceptions to the rule. Conclusions: Most trauma experts now advocate conservative management, unless the patient is unstable or a renal vascular thrombosis or avulsion is suspected. Similarly, penetrating trauma to the kidney in and of itself no longer requires mandatory surgery. In the United States, computed tomography (CT), especially spiral CT, is considered the best diagnostic study, if available. Intravenous pyelography (IVP) is adequate if this is the only imaging modality available and if no concomitant injuries to the abdominal structure are suspected. Ultrasound, although strongly advocated in some countries, can lead to some significant false negatives. The diagnosis and management of unusual problems such as the traumatic AV fistula, the patient with an absent kidney or injury to the congenitally abnormal kidney, the serendipitous renal tumor in a patient with trauma, or serious bleeding after an apparent minor injury (i.e., spontaneous hemorrhage) are also reviewed in this article.

This article, based on the Distinguished Lecture presented on August 21, 2001, at the annual meeting of the Society for the Study of Symbolic Interaction in Anaheim, California, proposes a synthesis of Herbert Blumer’ s macrosociological perspective on the race question with Roscoe Pound’ s philosophy and science of law (i.e., his so-called sociological jurisprudence), Joseph Tussman’ s and Jacobus tenBroek’s juridical methodology, and Philip Selznick’s sociology of responsive law. The compound so produced will help to establish a foundation for a praxiological sociology of American constitutional law. The article focuses on the problem of legislativemade “ classie cations” and their relations to the legitimate public purposes entailed in the enactment of statutes, laws, and decrees. Such classie cations become problematic when they are said to be “ underinclusive,” “ overinclusive,” or both in seeking to effect their aims. Strategic research sites for this issue are racial and ethnic classie cations that single out one or a limited cluster of racial or ethnic groups for special benee ts (“ afe rmative action” ) or restitution (“ reparations” ). Calling for a reinvigoration of Pound’ s pragmatic approach to sociological jurisprudence, I show how Blumer’ s analysis of the “ color line” — when seen in relation to the original intent of the makers of the Thirteenth, Fourteenth, and Fifteenth post‐ Civil War Amendments to the U.S. Constitution and, using Tussman’ s and tenBroek’ s showing of how such categorizations might be both methodically evaluated and applied to the challenged classie cations— provides grounds for reconsidering whether the latter are instances of “ reverse discrimination” and, hence, violations of the constitutional requirement of “ equal protection of the law.”

Computed tomography plays an important role for the evaluation of most patients with suspected renal injury after trauma. Intravenous urography is used for gross assessment of renal function in hemodynamically unstable patients. Renal injuries can be classified into four large groups: (1) minor renal contusion, lacerations, subcapsular hematoma, and small cortical infarcts; (2) major renal lacerations extending to the medulla with or without involvement of the collecting system; (3) catastrophic renal injuries including fragmentation of the kidney and renal pedicle vascular injuries; and (4) ureteropelvic junction injuries. Integration of the imaging findings of renal injury with clinical information is important to developing a treatment plan.

Computed tomography (CT) plays an important role in evaluation and management of primary renovascular disease. Nonenhanced CT is useful for demonstrating renal hemorrhage, renal parenchymal or vascular calcifications, and masses. Contrast material-enhanced CT is essential to identify global or regional nephrographic abnormalities resulting from the vascular process (eg, renal infarcts, ischemia secondary to renal artery stenosis, arteriovenous communications). In addition, renal manifestations of a systemic disease (eg, vasculitis, thromboembolic disease) can be seen at CT. In trauma, occlusion of the main renal artery can be accurately diagnosed with contrast-enhanced CT. In cases of spontaneous renal hemorrhage without an apparent cause (eg, vasculitis, coagulopathy), a careful CT study should be performed to exclude renal cell carcinoma. The presence of fat in a hemorrhagic renal mass larger than 4 cm in diameter is characteristic of angiomyolipoma complicated by hemorrhage. Acute renal vein thrombosis appears as a clot in a distended renal vein, whereas renal vein retraction with collateral vessels is highly indicative of chronic thrombosis. Helical CT, especially with multiplanar two-dimensional and three-dimensional reconstruction following an intravenous injection of iodinated contrast material, has greatly improved our ability to directly image the proximal renal arteries and detect vascular lesions.

Both traumatic and nontraumatic acute emergencies are seen in hospitals in women of childbearing age. The effects of radiation are theoretically most deleterious from 10 days after conception until roughly the end of the first trimester. However, there should be no hesitation about performing appropriate emergency imaging studies at any time during pregnancy. If time permits, the presence and age of the fetus should be determined through physical examination, appropriate laboratory studies, and the obtaining of adequate medical historical information. Imaging studies can be roughly classified into two main categories, those with minimal radiation effect and those that may expose the fetus to significant potential ionizing energy. The radiologist must be responsible for the determination of the most appropriate studies needed and in what sequence. Traumatized pregnant patients especially require maternal and fetal monitoring prior to arrival at the hospital and throughout the hospital stay. Fetal demise is a significant risk in case of both minor and major trauma. Maternal survival is the most significant factor in fetal well-being, with a fetal death approaching 80 % in cases of maternal shock and almost 100 % where there is partial or complete abruptio placentae. Properly performed imaging of the pregnant female, where the uterus is not likely to be exposed to ionizing radiation, should be cause little concern. Depending on the clinical presentation, appropriate first images might include a cervical spine, a portable chest film, an abdominal film, and a lateral decubitus view to check for suspected bowel perforation. This should be rapidly followed by fetal and then maternal ultrasonography. Overall, CT may be the best single abdominal study for severe abdominal problems where multiple organ damage is suspected. MRI for neurological disease and carefully monitored of selective vascular embolization for life-threatening abdominal bleeding are other important legitimate imaging studies.

During the past 40 years, there has been a dramatic evolution in genitourinary imaging. This evolution has resulted in fundamental changes in the subspecialty. Uroradiology initially focused on radiographic imaging of the urinary tract and was practiced primarily by urologists. After the development of safe intravenous contrast materials, radiologists who focused on the urinary tract and worked closely with urologists forged major advances in urinary tract imaging and intervention. More recently, imaging of the extraurinary genital organs has been added to the subspecialty. Cross-sectional imaging techniques have supplanted radiographic imaging for both urinary and genital imaging. The emergence of the cross-sectional techniques, however, has blurred the traditional organ system-based distinction between gastrointestinal radiology and genitourinary radiology, as both organ systems are imaged simultaneously, and has resulted in a new amalgamation, abdominal radiology, with roots in both specialties. The challenge for the new generation of abdominal radiologists, trained predominantly in cross-sectional techniques, will be to maintain the close interaction with our clinical colleagues that the traditional organ system orientation fostered.

Trauma surgeons must balance the risk and benefits of diagnostic radiographic procedures on potentially pregnant patients and should know the range and likelihood of effects that radiation might have on pregnancy.We present guidelines for assessing such radiation risks. Knowledge of a patient's pregnancy status and an estimate of radiation dose to the conceptus (low,10 mGy [milligray]; intermediate, 10-250 mGy; high,250 mGy) allow provisional assessment of radiation-induced risks.Dose estimates may be estimated at 2 mGy per exposure (radiographs), 5 mGy per slice (computed tomography), and 10 mGy per minute of fluoroscopy, when the conceptus is within the x-ray field. A formal radiation exposure assessment is appropriate when provisional estimates exceed 10 mGy.A simple qualitative dose assessment can inform clinical decisions and guide appropriate triage to more formal quantitative assessment.

(BUFFOLANO W, COLLABORATOR)

Computed tomography (CT) plays a leading role in the evaluation of nonmalignant disease of the adrenal gland. CT is highly accurate in the localization of adrenal masses in patients with diseases associated with hyperfunctioning adrenal glands such as Cushing syndrome and Cushing disease, Conn syndrome, adrenal tumors leading to virilization or feminization, and pheochromocytomas. CT permits a specific diagnosis of acute or subacute adrenal hematoma and myelolipoma. Hematomas are round to oval and have increased attenuation (50-90 HU) that decreases on follow-up CT scans. Myelolipomas typically manifest as a well-defined suprarenal mass with an attenuation of-30 to -115 HU. Adrenal cysts are usually round to oval and manifest as a hypoattenuating mass with a smooth, thin wall. CT is useful in the evaluation of patients with Addison disease, particularly the subacute form secondary to tuberculosis or disseminated histoplasmosis. Findings typically include bilateral adrenal enlargement with a central necrotic area of hypoattenuation and peripheral enhancement. Thin-section unenhanced CT permits accurate measurement of attenuation and can be used to differentiate adrenal adenoma from metastasis in a cancer patient with an indeterminate mass: Attenuation of 10 HU or less usually indicates adenoma rather than cancer. If the mass is found incidentally at contrast material-enhanced CT, delayed scans obtained as early as 5-15 minutes after intravenous administration of contrast material appear to have comparable accuracy.

The current roles and controversies in imaging of the kidneys for the evaluation of patients with acute renal infection are reviewed. The nomenclature used in describing the extent of the renal imaging findings in acute pyelonephritis suggested by the Society of Uroradiology to help avoid confusion in terminology in the past literature is briefly described. Computed tomography (CT) is superior to urography and renal sonography for the evaluation and management of adults with acute renal infection. [99mTc]-dimercapto succinic acid (DMSA) cortical scintigraphy is the imaging study for the evaluation of children with acute pyelonephritis investigated by some, although power Doppler ultrasound, and even CT, can be considered as a possible alternative.

This article reviews and illustrates bladder and urethral injuries, including their mechanisms of injury, imaging diagnosis, systems for classification, and the accuracy/pitfalls of the diagnostic methods. The bulk of this review will focus on lower urinary tract injuries caused by high speed, wide impact blunt trauma which is the most common mechanism of lower urinary tract injury encountered in civilian practice.

Noncontrast helical computed tomography (CT) has recently been found to be superior to excretory urography (IVU) in the evaluation of patients with suspected ureterolithiasis. Noncontrast helical CT does not require the use of intravenous contrast material with its associated cost and risk of adverse reactions and can be completed within 5 min, in most cases. Noncontrast CT often detects extraurinary pathology responsible for the patient's symptoms. CT is also more sensitive than IVU in detecting the calculus, regardless of its size, location, and chemical composition. However, confidently differentiating ureteral calculi from phleboliths along the course of the ureter may, at times, be difficult. The "tissue-rim" sign, a rim of soft tissue attenuation around the suspicious calcification, is helpful in making this distinction. Noncontrast CT does not provide physiological information about renal function and the degree of obstruction. A pilot study has suggested a proportional relationship between the extent of perinephric edema and the degree of obstruction. The cost of the examination and the radiation dose delivered to the patient may be higher with CT. Despite these limitations, noncontrast helical CT has quickly become the imaging study of choice in evaluating patients with acute flank pain.

In what follows I present a sociological interpretation of the mythohistorical legend of the Lost Tribes of Israel. Ten of the original 12 tribes that comprised the ancient Hebrew people disappeared from conventional history and other secular annals sometime immediately before and shortly thereafter 721 B.C.E., when the Northern Kingdom of Israel was overrun by the Assyrians and its people sent into exile. Sacred histories and biblical prophecies hold that the 10 Lost Tribes will be reunited with their tribal brethren descended from the Southern Kingdom of Judea just before, or as a signal of, the coming messianic age. A quest for the descendants of the lost tribes has been begun many times, usually associated with the resolution of immediate, local, secular, or sacred issues that emerged in a particular era and at a particular place. Various peoples (e.g., the Falasha of Ethiopia, the Lemba of Zimbabwe, the Pachucans of Mexico, various tribes of the American Indians, the imperial family of Japan, and the British Israelites) have proclaimed themselves to be, or have been designated as, the saving remnants of the lost tribes. I have carried out this investigation of an allegedly scattered peoplehood within aspects of the emerging but still inchoate tradition of postmodernist social science.1 Every aspect of the history—and the very existence—of the ten tribes of Israel is fraught with existential controversy and epistemological conundrums. The fatefulness of the original tribal monarchical confederation—the society of ancient Hebrews inhabiting the Northern Kingdom of Israel—is largely dependent on religious sources and a few other ancient documents whose accuracy is disputed and whose usefulness for social scientific research remains a topic of intense debate.2 As J. Maxwell Miller observes, “Given the uncertainties that arise from the biblical story, the paucity of references to Israel or Israelites in extrabiblical docu

Spontaneous pyelosinus extravasation (SPE) occurs rarely. It is observed on intravenous urograms performed for the evaluation of “obstructive” processes. SPE is hypothesized to be caused by an acute or subacute increase in renal pelvic pressure secondary to a urinary calculus or other processes that leads to a sudden increase in hydrostatic pressure. Only two cases of SPE secondary to blunt abdominal trauma have been described. We report three additional cases, all of which demonstrated pyelosinus extravasation on their initial intravenous urograms. All patients were followed conservatively without surgical intervention, and each had a benign course without complication. Herein, we present the radiographic findings, pathophysiologic mechanisms, and treatment implications of SPE with the emphasis on expectant management.

Although computed tomography (CT) is not routinely indicated in uncomplicated renal infection, it is of value in establishing the diagnosis in equivocal cases, in evaluating high-risk patients, and in determining the extent of disease. Unenhanced CT is useful in demonstrating gas, calculi, parenchymal calcifications, hemorrhage, and inflammatory masses. However, a contrast material-enhanced study is essential for complete evaluation of patients with renal inflammatory disease to demonstrate alterations in renal excretion of contrast material that occur as a result of the inflammatory process. In severe acute pyelonephritis, enhanced CT scans obtained during the cortical nephrographic phase typically demonstrate solitary or multifocal areas of hypoattenuation with loss of the corticomedullary interface. Delayed CT scans obtained during the excretory phase are frequently more helpful than early CT scans in defining the extent of the disease process, identifying complications such as renal abscess, and confirming the presence of urinary obstruction.

Ten of the original 12 tribes that comprised the ancient Hebrew people disappeared from conventional history and other secular annals in 722 B.C.E., when the Northern Kingdom of Israel was overrun by the Assyrians and its people sent into exile. However, sacred histories and biblical prophecies held that the 10 Lost Tribes would be reunited with their tribal brethren descended from the Southern Kingdom of Judea in the coming messianic age. A quest for the descendants of the lost tribes has begun many times, usually associated with the resolution of immediate, local, secular, or sacred issues that emerged in a particular era and at a particular place. Various peoples (e.g., the Falasha of Ethiopia, the Lemba of Zimbabwe, the Pachucans of Mexico, the imperial family of Japan, the British Israelites) have proclaimed themselves to be, or have been designated as, the saving remnants of the lost tribes. Among these are the aborigines of Ecuador, Florida, western Georgia, and New England, each group of which has...

We propose a simple, anatomically based classification of blunt urethral injury as a replacement for currently used classifications, which are not comprehensive, anatomically inconsistent or based on a mixed anatomical/mechanistic formula. The latter are difficult to learn and use, and have not been universally adopted.We reviewed most of the currently used general uroradiological, emergency radiological and urological textbooks to define the classification of urethral injuries that is most widely accepted. Most authors use the Colapinto and McCallum classification, modifications thereof or the older surgical classification of urethral injuries, which simply divides such injuries anatomically into anterior and posterior. However, there is little consensus about the best classification and none includes all of the blunt injuries of the urethra. To correct these difficulties we devised a comprehensive and anatomically consistent classification.The proposed classification categorizes blunt urethral trauma as I-posterior urethra intact but stretched (Colapinto and McCallum type I), II-partial or complete pure posterior injury with tear of membranous urethra above the urogenital diaphragm (Colapinto and McCallum type II), III-partial or complete combined anterior/posterior urethral injury with disruption of the urogenital diaphragm (Colapinto and McCallum type III), IV-bladder neck injury with extension into the urethra, IVA-injury of the base of the bladder with periurethral extravasation simulating a true type IV urethral injury and V-partial or complete pure anterior urethral injury.The proposed classification is anatomically valid and includes all of the common types of blunt urethral injuries. Universal adoption of this system should permit comparison of various management/treatment modalities at various institutions.