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Hydrogen will play a major role in the decarbonisation of the global economy. Energy companies are likely to extend interests in hydrogen exports and will need a credible hydrogen supply chain. Patent intensity, coupled with recent hydrogen production technology reviews and commercial activity by companies such as Kawasaki, provides support for forecasting a hydrogen supply chain that will include the following steps: Steam reforming of methane or coal, preferably methane, to produce hydrogen; hydrogen liquefaction (LH2) in preference to ammonia or liquid organic hydrogen carriers (LOHC) such as toluene (though this methodology has been trialled for Brunei produced hydrogen); shipping of LH2 to export markets; hydrogen gasification by end users. Given the 20 year lifecycle of patents, this forecast is anticipated to hold until 2030–40. The forecast does not exclude other technical options for hydrogen production and shipping but cost and technical risk will need to be minimised below the mature technologies of steam reforming and hydrogen liquefaction.

Innovation and corresponding patent activity in the liquefied natural gas (LNG) production field grew strongly over the period 1997–2016, reaching a peak in 2013–14. A patent landscaping analysis enabled a preliminary investigation of innovation foci, by technical subject matter, and those companies driving such innovation. Floating LNG (FLNG) innovation so far forms a small proportion of this activity, yet shipbuilding companies like Daewoo Shipbuilding and Marine Engineering, Samsung Heavy Industries and Hyundai Heavy Industries are relatively dominant innovators, as measured by patent intensity, likely collaborating – for FLNG projects – with operating companies like Shell and ExxonMobil which are also significant, although statistically less dominant, innovators in the LNG production field. Patent landscaping analysis also showed that key foci for innovation appear in the fields of LNG storage tanks, carbon dioxide and boil-off gas management. Further investigations would provide more specific information about innovation occurring in these fields of LNG production.

Tumour perfusion has been assessed in patients with advanced head and neck cancer using dynamic contrast enhanced MRI prior to and at completion of accelerated radiotherapy, and related to local tumour control. Sequential MRI scans, at 3 s intervals after intravenous injection of gadolinium using a dynamic scan sequence through a tumour region of interest (ROI), were performed in 13 patients with advanced head and neck cancer before and on completion of radiotherapy. The scans have been analysed in terms of maximum tumour enhancement (E), slope of the enhancement versus time curve and the time taken to reach maximum tumour enhancement (Tmax), and these parameters related to tumour outcome after radiotherapy. Local tumour control was related to the value of E on a post-radiotherapy scan and the difference in Tmax between a pre- and post-radiotherapy scan. Durable local control was seen in those tumours with a post-radiotherapy value for E of less than 8 and a mean fall in Tmax of 27.3 s. These results imply that tumours with diminished tumour perfusion at the end of radiotherapy are those most sensitive to treatment and that those tumours which show greater tumour enhancement after accelerated radiotherapy are likely to fail locally. This may reflect the persistence of viable perfused tumour at completion of radiotherapy.

Purpose: Gradient-Recalled Echo (GRE) Magnetic Resonance Imaging (MRI), which detects changes in blood vessel deoxyhaemoglobin content, has been investigated as a noninvasive monitor of changes in human tumor oxygenation and blood flow, in response to carbogen (95% 02, 5% CO*) breathing. Methods and Materials: GRE images (TE = 60 ms, TR = 200 ms, (Y = 40”, 256’ matrix) were acquired from 31 patients with primary and metastatic disease, prior to and during carbogen breathing. Three patients underwent a follow-up examination after radiotherapy. Results: Seventeen out of 34 tumors showed enhanced image intensity, consistent with an improvement in tumor oxygenation and blood flow, while 11 showed no response; 6 studies were technical failures. In one patient a metastatic node that had eluded orthodox investigation was visualized. A reduction in response was observed in the three patients studied postradiotherapy. Conclusion: This method, which can be performed on a standard clinical MRI instrument, provides a noninvasive measurement of tumor response to oxygenation/blood flow modification. In principle, this should enable the clinician to optimize treatment protocols, such as carbogen breathing, for individual radiotherapy patients. 0 1997 Elsevier Science Inc.

The main aim of the study was to evaluate the use of positron emission tomography using fluoro-deoxyglucose (PET-FDG) imaging for the detection of squamous cell carcinoma of the head and neck. Fifty-four consecutive patients with malignancies involving the head and neck were studied prospectively. Thirty-one patients presented with primary disease and 23 were suspected of recurrent or residual disease. All patients underwent full clinical staging, PET-FDG scans and anatomical imaging, 37 underwent computed tomography (CT), 13 magnetic resonance (MR) and four had both CT and MR. Clinical assessment, CT/MR, PET-FDG and histological examination were all evaluated independently of each other. All 31 primary head and neck malignant tumours were detected by PET-FDG. Based on 16 patients who underwent neck dissections, the sensitivity and specificity of PET-FDG for detecting nodal disease was 67% and 100% respectively, compared with clinical assessment of 58% and 75% and CT/MR of 67% and 25%. In all 12 patients, PET-FDG correctly identified the presence or absence of recurrent or residual disease. PET-FDG staged 13 post-treatment necks with an accuracy of 100%, as compared to CT/MR which was accurate in 7 of 13 and clinical assessment which was accurate in eight. Three sites of abnormal tracer uptake unrelated to malignancy were recorded as incidental findings (mandibular osteomyelitis, 1; post glossectomy site, 2). PET-FDG was more accurate than CT/MR for identifying primary and recurrent tumours as well as metastatic lesions in the neck. If these diagnostic properties of PET-FDG are confirmed in further prospective studies, it could prove a valuable adjunct for the management of head and neck cancer.

Recent trends in the management of bone metastases include the use of prophylactic bisphosphonates and low dose single fraction radiotherapy in favour of high dose fractionated radiotherapy. A recent animal model [1] suggests that cord compression is often associated with predominant soft tissue epidural disease, with bone collapse as a late event. In the present study, potential implications were investigated by retrospective evaluation of the pattern of disease on MRI scans of patients with spinal cord compression. The dominant component of spinal cord compression was determined in 62 patients. Two main patterns were identified, 45 (73%) had predominant soft tissue epidural disease and 15 (24%) had bone collapse. There were two with intrathecal deposits. The patterns were correlated with response to radiotherapy. Positive response was observed in 64% of those with soft tissue epidural disease and 27% of those with bone collapse. These data support the animal model, suggesting soft tissue epidural disease rather than collapse as the predominant cause of cord compression. This implies that prophylactic bisphosphonates alone would be unlikely to reduce the incidence of spinal cord compression. It also introduces concern about the long term safety of low dose single fraction radiotherapy for bone metastases in patients with a medium term life expectancy (e.g. > 2 years). These patients may benefit from more than a single fraction of radiotherapy to produce longer growth delay for sub-clinical epidural disease.

Arthrotomography and magnetic resonance imaging (MRI) were carried out on 50 temporomandibular joints (TMJs) in 48 patients who were being considered for surgery for clinically diagnosed internal derangement. The patients presented over a 4-year period with pain and dysfunction which had failed to respond to conservative management. Open surgery was carried out on all TMJs and operative findings compared with the results of imaging. The clinical diagnosis of internal derangement was confirmed in every case by imaging and at surgery. Arthrotomography over-diagnosed non-reducibility of an anteriorly displaced meniscus and perforation. MRI over-diagnosed non-reducibility to a lesser extent and under-diagnosed perforation. MRI demonstrated neither bony changes nor adhesions. Dynamic arthrotomography produced the best images of meniscal derangement in function and the pre-arthrogram tomograms were the best indicator of osseous abnormality. Arthrotomography was the preferred imaging technique.

Eighty-three MR studies for primary bone tumors, performed with both spin echo and short time inversion recovery (STIR) sequences, were reviewed. Twenty-six patients underwent surgery within 10 days after MR imaging. Specimens were cut and directly compared with MR images. In the remainder, pathologic slides were compared in order to obtain a better understanding of MR pattern. All MR images were examined with a traditional morphologic approach and, upon comparison with surgical macroslides and with pathology samples, some MR distinctive patterns were identified: the bulky appearance of osteosarcoma surrounded by muscle edema, the multilobular high signal intensity (SI) chondroid lesions, the subtle infiltration of Ewing's sarcoma, rarely accompanied by muscle edema and prone to MR underestimation, the well defined “multiple shells” pattern of giant cell tumor, and the ill defined “storiform” appearance of malignant fibrous histocytoma are all typical MR features strictly corresponding to pathologic findings. The chondroid origin tumors may be identified based on the lobular high SI pattern whereas a benign fibrous lesion was the only one in this series to be distinguished relying on the SI. Peritumoral soft tissue edema was found by the STIR sequence only in malignant tumors (69%) of this series, and particularly in osteosarcoma (96%), chondrosarcoma (83%), and giant cell tumor (100%): this associate finding may further contribute to the diagnosis.

Capnometer measurements during 46 evaluable treatments in which patients were administered carbogen (95% O 2 , 5% CO 2 ) have demonstrated that the mean inspired carbon dioxide level was 3.1% (range 0–4.7) and the mean inspired oxygen concentration was 70.6% (range 26.4–94). The explanation for this observation is leakage of air into the breathing system during radiotherapy.

Sixty patients with primary bone tumours were evaluated with magnetic resonance imaging (MRI) at 0.5 T with both conventional spin-echo (SE) and short inversion time inversion recovery (STIR) sequences. The results have been reviewed in order to evaluate the accuracy of STIR and conventional SE sequences in the detection of tumours, the definition of intramedullary extent and soft-tissue involvement. The intraosseous neoplastic extent has been compared with macroslides of surgical specimens in 24 cases. The role of the STIR sequence in detection of recurrences in the post-surgical follow-up was also evaluated. The STIR sequence, designed to suppress signal from fat, also enhances the signal from tissue with long T1 and T2 relaxation times, such as neoplastic and inflammatory tissue. The STIR sequence with T1 of 120-130 ms in all cases suppressed the high signal from fatty bone marrow, giving a clear depiction of tumour extent, in both its intramedullary and soft-tissue components, and is superior to conventional SE images. The high sensitivity (100% of our cases) of this technique is counterbalanced by its lack of specificity: on STIR sequences both tumour and peritumorous oedema give an increase of signal intensity, limiting assessment of tumour extent. Peritumoral oedema, only present in our series in malignant neoplasms, may however be differentiated on the basis of the configuration of the abnormal areas, and by comparing STIR images with short repetition time/echo time sequence results.

An MRI method is described for demonstrating improved oxygenation of human tumors and normal tissues during carbogen inhalation (95% O2, 5% CO2). T2*-weighted gradient-echo imaging was performed before, during, and after carbogen breathing in 47 tumor patients and 13 male volunteers. Analysis of artifacts and signal intensity was performed. Thirty-six successful tumor examinations were obtained. Twenty showed significant whole-tumor signal increases (mean 21.0%, range 6.5-82.4%), and one decreased (-26.5 +/- 8.0%). Patterns of signal change were heterogeneous in responding tumors. Five of 13 normal prostate glands (four volunteers and nine patients with nonprostatic tumors) showed significant enhancement (mean 11.4%, range 8.4-14.0%). An increase in brain signal was seen in 11 of 13 assessable patients (mean 8.0 +/- 3.7%, range 5.0-11.7%). T2*-weighted tumor MRI during carbogen breathing is possible in humans. High failure rates occurred due to respiratory distress. Significant enhancement was seen in 56%, suggesting improved tissue oxygenation and blood flow, which could identify these patients as more likely to benefit from carbogen radiosensitization.

The gas mixture carbogen may be breathed by patients to enhance the oxygenation level and therefore the radiosensitivity of tumours. However, owing to the high CO2 content, its inhalation is associated with patient intolerance. Our aim was to determine a suitable carbon dioxide and oxygen gas mixture with similar enhancement of arterial oxygenation to 5% carbogen and with improved patient tolerance. 14 patients entered the study; of those 14, 8 were able to tolerate 2%, 3.5% and 5% carbogen mixtures as well as a control gas for sufficient time to allow successful arterial blood gas sampling. Gas exchange parameters were measured using a carbon dioxide monitor and a blood gas analyser. Arterial carbon dioxide tension ranged from 2.9 kPa to 6.82 kPa whilst breathing the carbogen mixtures, and arterial oxygen tension increased at least three-fold from basal values. There were no significant changes in the respiratory rate, heart rate and blood pH. The results suggest that 2% CO2 in O2 enhances arterial oxygen levels to a similar extent as 3.5% and 5% CO2 and that it is well tolerated.

BACKGROUND: Positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose (PET-FDG) improves the detection of head and neck squamous cell cancer (HNSCC), but lacks anatomical detail. The accuracy of registered computed tomography/magnetic resonance (CT/MR) and PET-FDG in delineation of HNSCC at the primary site and its clinical application was investigated. METHOD: Preoperatively 30 patients were staged clinically and each had either CT (23), MR (5), or both CT and MR (2) scans, as well as CT/MR-PET-FDG registration. Tumor margins or infiltration of specific anatomical landmarks on the different scans were compared and judged against histology. RESULTS: For primary tumors CT-PET-FDG (97%) and MR-PET-FDG (100%) delineated the tumor more accurately than CT (69%) or MR (40%) alone. Similarly, CT-PET-FDG (98%) and MR-PET-FDG (100%) were better than CT (70%) and MR alone (80%) in identifying tumor invasion of specific anatomical structures. Management was altered in 7 of 30 patients. The registered images were particularly useful in delineating tumor extension in the infratemporal fossa, maxilla and mandible, and identifying recurrences obscured by scar tissue. CONCLUSIONS: It is possible to accurately register CT, MR, and PET-FDG data sets in the head and neck. The initial results show that registered CT/ MR-PET-FDG images provide additional clinically relevant information over that obtained from clinical evaluation or conventional CT/MR imaging.

Eighty-three MR studies for primary bone tumors, performed with both spin echo and short time inversion recovery (STIR) sequences, were reviewed. Twenty-six patients underwent surgery within 10 days after MR imaging. Specimens were cut and directly compared with MR images. In the remainder, pathologic slides were compared in order to obtain a better understanding of MR pattern. All MR images were examined with a traditional morphologic approach and, upon comparison with surgical macroslides and with pathology samples, some MR distinctive patterns were identified: the bulky appearance of osteosarcoma surrounded by muscle edema, the multilobular high signal intensity (SI) chondroid lesions, the subtle infiltration of Ewing's sarcoma, rarely accompanied by muscle edema and prone to MR underestimation, the well defined "multiple shells" pattern of giant cell tumor, and the ill defined "storiform" appearance of malignant fibrous histocytoma are all typical MR features strictly corresponding to pathologic findings. The chondroid origin tumors may be identified based on the lobular high SI pattern whereas a benign fibrous lesion was the only one in this series to be distinguished relying on the SI. Peritumoral soft tissue edema was found by the STIR sequence only in malignant tumors (69%) of this series, and particularly in osteosarcoma (96%), chondrosarcoma (83%), and giant cell tumor (100%): this associate finding may further contribute to the diagnosis.

The accuracy of preoperative MRI in detecting tumor extent has been evaluated in 35 patients with primary bone neoplasms; intra-osseous extent was measured on MR images and compared with macroslides of surgical specimens in 26 cases. An almost completely accurate prediction of tumor size was obtained with the combined employment of Spin-Echo (SE) and Short Inversion Time Inversion Recovery (STIR) sequences in the various tumors, with the exception of two Ewing's sarcomas. Changes in Signal Intensity (SI) and tumor morphology were identified in those cases which had undergone presurgical chemotherapy: the reduction in SI and in tumor size or the appearance of a more homogeneous signal was correlated with a positive response to cytotoxic therapy. MR imaging fully satisfies surgeon's preoperative requirements in the assessment of therapy-responding neoplasms as well as in local tumor staging in all types of neoplasms, with the exception of Ewing's sarcoma.

A number of techniques (I) are available for the elimination of an unwanted signal (usually the ‘H signal from water) from a spectrum. Unless the unwanted signal is removed before the preamplifier and ADC are encountered in the signal detection pathway, difficulties are experienced in the observation of very weak signals because of dynamic range problems. O f the available techniques the most efficient appears to be the 1331 method developed by Hore (I, 2); however, as Hore points out, this technique is only of limited value if the water resonance is broad. This is the situation often encountered in vivo where very broad water signals are observed, the broadness usually being the result of magnetic field inhomogeneity. In general, for signal elimination the most successful methods have in the past relied on overall nonexcitation of the unwanted resonance, the aim being to leave the unwanted spin coherence along the z axis and away from the detection plane. The alternative procedure would be to destroy selectively the unwanted spin coherence and it is this strategy which has led to the application of reverse polarization transfer methods (3) as probably the most efficient water signal elimination method yet devised. In this paper we develop a method for selectively destroying the water signal, applicable to in vivo NMR studies where broad water signals are often encountered. We call the technique SUBMERGE. The method eliminates transverse water spin coherence over a wide but controllable frequency band. The significant point is that the water spin coherence is destroyed, thus eliminating the signal from the preamplifier and ADC, allowing the efficient detection of weak signals. As a test, we attempt to observe the methyl signal from lactic acid at a concentration of 10 mM in neat HzO. The water signal is thus about 3700 times more intense than the signal of interest. A 250 ml round-bottom flask was used as the sample container. A water signal having a half-height width of 10 Hz was typically detected in a single pulse experiment. In Fig. 1 is shown the experimentally determined excitation profile from a 10 ms 7r/2 sine pulse. The excitation profile from a 10 ms 7r/2 gaussian pulse is also shown for comparison. At a ‘H resonance frequency of 100 MHz (field strength 2.4 T) the chemical-shift separation between the two resonances of interest is about 345 Hz. Thus, by use of such shaped pulses, it is possible to excite the water signal but not the

Paragonimiasis is an infection caused by the lung fluke Paragonimus westermani and related species. Although the lung is the primary site of infection, other organs, notably the central nervous system, may be involved. Human disease is caused by consumption of improperly cooked crustaceae infected by a larval stage of the parasite. The parasites excyst in the small intestine, penetrate the intestinal wall and enter the peritoneal cavity. They then proceed to the diaphragm, pleural cavity and the lung (Noble & Noble, 1982). Paragonimiasis is endemic in South East Asia and the Far East and cases have occurred in Africa and South America. Recently, several cases of paragonimiasis have been found in Indo-Chinese refugees in North America (Taylor & Swett, 1982; Johnson et al, 1982; Johnson & Johnson, 1983). Radiological findings in pulmonary paragonimiasis have been well described (Miller & Walker, 1955; Suwanik & Harinsuta, 1959; Ogakwu & Nwokolo, 1973; Reeder & Palmer, 1981). The purpose of this paper is to ...

The clinical and radiological findings in four patients with primary sclerosing cholangitis one of whom had coexistent cholangiocarcinoma, are reported. The need for surgical exploration to make the diagnosis was averted by the use of endoscopic retrograde cholangiography in one patient who was managed initially with medical treatment alone. Endoscopic cholangiography may be used to monitor the progress of the sclerosing lesions; but failure to fill the intrahepatic ducts is associated with a poor prognosis due either to the severity of the sclerosing process or the presence of coexistent cholangiocarcinoma.

One hundred twenty-five patients investigated at the Royal Brisbane Hospital, who underwent both hepatic ultrasonography and liver biopsy between 1980 and 1983, were scored quantitatively for ultrasound features of loss of detail, echogenicity, and attenuation, as well as for histologic features of fat, fibrosis, and inflammation. Strong correlations were found between the score for fat content and each of the three ultrasound features, and between the score for hepatic fibrosis and loss of detail and echogenicity, but there was no strong correlation with attenuation. Hepatic inflammation did not correlate with any of the ultrasound features. The correlations for fat were strongest when the interval between ultrasonography and liver biopsy was less than or equal to 7 days. Although ultrasonography had a positive predictive value of 98% in the diagnosis of diffuse parenchymal abnormality, it did not distinguish fat from fibrosis nor reliably diagnose cirrhosis. Ultrasonography gave false-positive results in only 2 patients, but in 17 patients, false-negative ultrasound examinations were encountered. These findings indicate that ultrasound is not a useful screening investigation for parenchymal liver disease, nor is it useful in gauging hepatic pathology. However, abnormal hepatic ultrasonography in patients with suspected liver disease strongly suggests the presence of diffuse liver disease.

Barium examination of the small bowel revealed fixation, dilation, separation of bowel loops and delayed small intestinal transit in nine patients with practolol induced peritonitis. The diagnosis may be first suggested by this examination, and a history of prolonged therapy with beta-blocking agents should be sought in patients showing these changes where no other cause for them can be found. Symptoms may develop up to a year following cessation of therapy so that further cases may still come to light despite the withdrawal of practolol for long-term use. Small bowel barium examination is indicated in patients who have received practolol therapy and who develop suspicious alimentary symptoms.

Sonographic findings in ten cases of primary sclerosing cholangitis are described. Thickening of the extra‐hepatic bile ducts is the most common finding. Other features are intra‐hepatic duct wall thickening and mild irregular dilatation, hepatic parenchymal change and evidence of portal hypertension. Two patterns of hepatic parenchymal change are noted: a) diffuse liver change and, b) patchy areas of increased echogenicity. Dilatation of the extra‐hepatic bile ducts is uncommon. Recognition of these findings will lead to the use of the more definitive procedures such as endoscopic retrograde cholangiography and will avoid a delay in diagnosis.

Small fractures in the posterior elements of the spine were identified by stereoscopic radiography in 7 patients suffering from back pain. The clinical data on these 7 patients are presented.

Nine patients with an unusual and serious intraabdominal complication of the beta-adrenergic blocking agent practolol seen since 1973 are reported. The striking and bizarre peritoneal changes induced by the drug have distinctive features that are not shown by other forms of peritoneal disease. The cases presented with small bowel obstruction, usually chronic in type and often associated with profound weight loss and an abdominal mass. Characteristic radiological features were present. The abnormalities at laparotomy were impressive, with a gross proliferation of the visceral peritoneum which formed a dense white cocoon which encased, constricted and markedly shortened the small bowel, usually from the duodenojejunal flexure to the ileocaecal valve. The obstruction was relieved by mobilizing the small bowel from the ensheathing tissue. Restoration of alimentary function after surgery was delayed but the long term result was satisfactory with full relief of symptoms and the absence of recurrent obstruction during the follow-up period. This complication may arise after treatment with the drug has been stopped, and although long term oral therapy has been discontinued, further cases will almost certainly present for some time to come.

Chronic renal failure with gout: A marker of chronic lead poisoning. EDTA (calcium disodium edetate) lead mobilization and x-ray fluorescence (XRF) finger bone lead tests were done in 42 patients with chronic renal failure and without persisting lead intoxication. Nineteen of 23 patients with gout and 8 of 19 without gout had positive EDTA lead mobilization tests. Those patients with gout excreted significantly more excess lead chelate than those without gout. In the gout group 17 patients denied any childhood or industrial exposure to lead. They had a greater number of positive tests and excreted significantly more excess lead chelate than 14 patients with neither gout nor lead exposure. These results confirm that gout in the presence of chronic renal failure is a useful marker of chronic lead poisoning. Of 27 patients with positive lead mobilization tests, only 13 had elevated XRF finger bone lead concentrations (sensitivity 48%). Three of 15 patients with negative lead mobilization tests had elevated XRF finger bone lead concentrations (specificity 80%). Although the XRF finger bone lead test is a convenient noninvasive addition to the diagnostic evaluation of patients with chronic renal failure and gout, its application is limited due to the lack of sensitivity of the method.Insuffisance rénale chronique avec goutte: Un marqueur de l'intoxication chronique au plomb. Des tests de mobilisation du plomb par l'EDTA (edétate calcique disodique) et de fluorescence aux rayons X (XRF) du plomb dans une phalange ont été entrepris chez 42 malades en insuffisance rénale chronique sans intoxication persistante au plomb. Dix neuf sur 23 malades atteints de goutte et 8 sur 19 sans goutte avaient un test de mobilisation du plomb par l'EDTA positif. Les malades goutteux excrétaient significativement plus de plomb chélaté que les non goutteux. Dans le groupe atteint de goutte, 17 malades n'avaient eu aucune exposition au plomb dans l'enfance ou dans l'industrie. Ils avaient un plus grand nombre de tests positifs et excrétaient significativement plus de plomb chélaté que les 14 malades sans goutte ni exposition au plomb. Ces résultats confirment que la goutte au cours de l'insuffisance rénale chronique est un marqueur utile de l'intoxication chronique au plomb. Parmi les 27 malades ayant des tests de mobilisation du plomb positifs, seulement 13 avaient une élévation des concentrations de plomb dans la phalange par XRF (sensibilité 48%). Trois des 15 malades avec des tests de mobilisation du plomb négatifs avaient des concentrations de plomb dans la phalange par XRF élevées (spécificité 80%). Bien que le test XRF pour le plomb dans la phalange soit un complément pratique et non invasif pour l'évaluation diagnostique des malades atteints d'insuffisance rénale chronique avec goutte, son application est limitée en raison du manque de sensibilité de la méthode.

Peritoneal disease, apart from the post-operative variety, is rare, but three female patients, who presented with abdominal symptoms and in whom an unusual peritoneal lesion was found at operation, had one factor common to their medical histories—namely, previous treatment with the β-adrenergic-blocking drug practolol. The main finding at laparotomy was a pattern of massive peritoneal adhesions, but one patient had no history of abdominal surgery, and the findings at laparotomy were unusual. Other possible causes of this sclerosing peritonitis can be excluded, and the possible involvement of practolol in these cases is supported by the identification, via the Committee on Safety of Medicines, of four similar cases.

A system designed for the in vivo measurement of the cadmium content of the liver or kidneys is described. Performance characteristics are given and compared with those of two other portable systems reported in the literature. The present system uses a new source-subject-detector arrangement and incorporates considerably cheaper shielding materials. The system is in use to measure liver and kidney levels in industrially exposed workers and in persons with diseases in which cadmium may be involved.

A group of 200 Queensland adults without known health problems had in-vivo estimation of finger bone lead concentrations using X-ray fluorescence analysis (XRF). Forty of these subjects had elevated levels of bone lead of 25 ppm or more, consistent with exposure to the metal. Although the correlation between Queensland residence during childhood and raised bone lead levels was not significant, there were significant correlations between childhood residence in a painted wooden house and raised levels, and between occupational exposure and raised levels. Of the 40 subjects with elevated lead levels only two had neither a history of occupational exposure or childhood residence in a wooden house, whereas 11 of the 25 who had a history of both occupational and residential exposure were positive. The data are consistent with lead in housepaint, or absorbed during occupational exposure, being the two major sources of raised bone lead concentrations.

A new approach to volume‐selected in vivo NMR spectroscopy uses two frequencyshifted sinc pulses, in conjunction with pulsed field gradients, to destroy the coherence of the unwanted signals. A hard π/2 pulse can then be used to read the z magnetization in the region of interest. This method is independent of T, provides complete volume selection in a single acquisition, and can be readily implemented on most high‐field commercial imaging/spectroscopy systems. © 1986 Academic Press, Inc.

X-ray mammography was performed on 446 patients with suspected breast disease and 23 breast carcinomas were detected of 26 (sensitivity: 88.5%) that were ultimately diagnosed in the 12–24 months' period following examination. Ultrasound mammography was used as an additional procedure in 183 patients because the radiographic findings were considered to be indeterminate and it detected an additional two carcinomas, to give an overall sensitivity of 96%. X-ray mammography identified 40 benign lesions and subsequent ultrasound mammography characterised 38 of these as being either cystic or solid. Ultrasound also detected an additional 32 benign lesions (28 cysts and 4 fibroadenomas) which had not been evident on X-ray mammography. It is concluded that ultrasound mammography is a useful complementary procedure for those patients who have radiodense breasts or indeterminate radiographic findings on X-ray mammography.

The lymphographic findings in 14 patients with Kaposi's sarcoma are described. Four patients with localized disease and oedema showed peripheral vessel blockage probably by tumour. Ten patients with widespread disease showed nodal abnormalities:— Filling Defects which correspond to tumour histologically; Foaminess which corresponded to ‘follicular hyperplasia’. The presence of a lymphatic circulation in skin nodules was shown in 3 patients. The lymphographic findings suggest that:— (1) Involvement of the lymphatic system by Kaposi's sarcoma is commoner than previously recognized. (2) Gland enlargement and foaminess are not necessarily due to tumour. Filling defects are the only criteria for diagnosing the presence of Kaposi's sarcoma in nodes. (3) Oedema in Kaposi's sarcoma is due in the main to lymphatic obstruction. (4) Tumour nodules may arise in small interstitial lymphatic vessels rather than in blood vessels.

Xeroradiography, that is, the use of photo-conducting selenium plates instead of film as recording medium, allows one to obtain good arteriograms and venograms at considerably lower concentration of contrast medium than is normally used, and thus reduces the pain to the patient. The advantages and limitations of this new technique are described and illustrated.

The reports of 58 patients who had water delay echography and sulphur colloid scintigraphy of the liver from July‐December, 1980, were evaluated and correlated. Scanning with ultrasound was shown to have greater sensitivity and specificity than that of sulphur colloid scintiscanning. When sonographic and scintigraphic findings were concordant diagnostic reliability was 97%.

Ninety-four patients with non-specific lumbar pain referred to hospital rheumatology and orthopaedic clinics participated in a double-blind controlled trial comparing mobilisation and manipulation with placebo physiotherapy. Results were assessed immediately after the tratment course, two months later, and at one year. Many patients showed improvement, but in contrast to a study on general-practitioner patients with nonspecific back pain no definite advantage could be associated with mobilisation and manipulation. The benefits of mobilisation and manipulation for low back pain are probably restricted to hastening recovery in patients likely rapidly to improve spontaneously. Hence patients whose severity and duration of symptoms warrant specialist referral are less likely to benefit from the technique.

Cervical spine movements were compared in 35 patients with ankylosing spondylitis (AS) and matched controls. In AS there were limitations of all movements and particularly of lateral flexion. These limitations could not be correlated with any particular features of AS except radiological involvement of the lower apophyseal joints. In 25 patients there were significant improvements in all measurements after 3 weeks of intensive inpatient physiotherapy. After discharge the patients were encouraged to perform unsupervised physiotherapy and in 11 patients seen at 3 months the improvements in neck movements were either maintained or increased further. In contrast no changes in movements were found in 9 patients assessed 3 weeks and immediately before starting physiotherapy.