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Here we describe the design and management of Indiana Blood Center's 10-year Iron For Women program, an ongoing community blood center-based program with continual program and donor management providing iron supplements to healthy women blood donors. Donor iron supplementation has typically been limited to research study protocols, for a defined period, with the associated resources and funding. The results of studies have supported the utility of iron supplementation: iron supplementation will enhance dietary iron for increased gastrointestinal absorption triggered as a normal homeostatic response to blood loss, thereby providing a suitable dietary iron source in the event the donor's usual diet lacks sufficient iron. Despite proven results, blood centers have been reluctant to adopt the practice due to barriers such as donor selection, ensuring the appropriateness of iron supplementation relative to the health of the donor, supplement costs, provision logistics, and program management costs. We present here how we designed our program and why it is in the Blood Center's interest to help willing women participate in volunteer blood donation by attempting to mitigate associated iron loss., (© 2014 AABB.)

Objective: To assess the usefulness of current diagnostic criteria in the understanding of neonatal respiratory distress in a tertiary care hospital., Methods: We prospectively studied 2824 consecutive deliveries to determine the frequency of respiratory disorders of all types. We used definitions based on standard texts, with borderline cases being classified as having the disease in question., Results: Somewhat less than half of all symptomatic infants met textbook criteria for a respiratory diagnosis. Of this subset, the most common diagnosis was respiratory distress syndrome (RDS), followed by transient tachypnea of newborn (TTN), meconium aspiration syndrome (MAS), pneumonia and others. The 323 infants who fit no standard diagnosis all had self-limited conditions similar to TTN. Most (52%) were well in less than 12 hours. Those still symptomatic after 12 hours differed from the definition of TTN by having a clear chest film (38%) and/or by requiring mechanical ventilation (10%). A slight revision of the traditional diagnostic criteria allowed classification of all these cases., Conclusion: More than 50% of newborns with acute respiratory symptoms do not fit textbook definitions, even broad definitions which include borderline cases. The concept of TTN should be expanded to include cases with a normal chest film. In addition, we suggest adding the category "transient respiratory insufficiency of the newbom" (TRIN) for babies ventilated briefly but not demonstrably surfactant deficient or infected. This category probably includes infants with many contributing etiologies.

Purpose: To compare the results and costs of three different means of achieving direct percutaneous gastroenteric access., Methods: Three groups of patients received the following procedures: fluoroscopically guided percutaneous gastrostomy/gastrojejunostomy (FPG, n = 42); percutaneous endoscopic gastrostomy/gastrojejunostomy (PEG, n = 45); and surgical endoscopic gastrostomy/gastrojejunostomy (SEG, n = 34). Retrospective review of the medical records was performed to evaluate indications for the procedure, procedure technical success, and outcome. Estimated costs were compared for each of the three procedures, using a combination of charges and materials costs., Results: Technical success was greater for FPG and SEG (100% each) than for PEG (84%, p = 0.008 vs FPG and p = 0.02 vs SEG). All patients (n = 7) who failed PEG subsequently underwent successful FPG. Success in placing a gastrojejunostomy was 91% for FPG, and estimated at 43% for PEG and 0 for SEG. Complications did not differ in frequency among groups. For gastrostomy, the average cost per successful tube was lowest in the PEG group ($1862, p = 0.02); FPG averaged $1985, and SEG $3694. SEG costs significantly more than FPG or PEG (p = 0.0001). For gastrojejunostomy, FPG averaged $2201, PEG $3158, and SEG $3045., Conclusion: Technical success for gastrostomy is higher for FPG and SEG than PEG. Though PEG is the least costly procedure, the difference is modest compared with FPG. For gastrojejunostomy, FPG offers the highest technical success rate and lowest cost. Due to high costs associated with the operating room, SEG should be reserved for those patients undergoing a concurrent surgical procedure.

Purpose: To determine whether silver-coated tunneled hemodialysis catheters reduce infection and to determine the frequency of central venous thrombosis and stenosis with percutaneous placement of right internal jugular vein dialysis catheters by interventional radiologists., Materials and Methods: Ninety-one patients were randomly assigned to a treatment (silver-coated catheter; n = 47) or control (identical catheter without silver coating; n = 44) arm. Baseline venography was performed. Catheter tips were cultured and venography was repeated at catheter removal., Results: Mean duration of catheter placement was 92 days. Infection occurred in 11 patients (five in the treatment group, six in the control group). Tip cultures in 15 patients (eight treatment, seven control) were positive without clinical infection. Infection and colonization rates were slightly but not significantly higher in the treatment group than in the control group. Silver-coated catheters in two (4%) patients were removed due to reaction to the coating. Completion venograms (n = 72) showed new minor abnormalities in four (6%) patients and major abnormalities (stenosis, thrombosis) in three (4%) patients. Permanent venous abnormalities occurred in two (3%) patients., Conclusion: Silver coating does not confer a benefit against clinical infection or colonization. Interventional radiologic placement of tunneled dialysis catheters yields a low frequency of permanent central venous thrombosis and stenosis.

Purpose: To determine whether intraarterial digital subtraction angiography (DSA) is as accurate as cut-film (film hard-copy) angiography (CFA) in the evaluation of suspected pulmonary embolus., Materials and Methods: Under a protocol approved by the institutional review board, CFA and DSA images were obtained in identical posteroanterior and oblique projections in one lung of each patient undergoing pulmonary angiography (n = 80). Diagnoses based on results of blinded review of each study (CFA vs DSA) by three separate reviewers (80 patients x three reviewers = 240 diagnoses for each modality) were compared with the diagnoses made by the physician who performed the procedure on the basis of CFA, DSA, and clinical data and with the consensus diagnoses obtained by means of group review of both studies together if necessary. The reviewers' confidence in their diagnoses was graded from 1 (certain) to 10 (uncertain)., Results: Pulmonary emboli were present in 13 (16%) of 80 patients. Two hundred thirty-six (98.3%) of 240 DSA diagnoses and 231 (96.3%) of 240 CFA diagnoses were correct. The sensitivity (correct identification of emboli by all three reviewers) of DSA was 92% and of CFA was 69% (P = .083). The specificities of the modalities were not statistically significantly different. The reviewers' confidence was significantly better in their DSA diagnoses than in their CFA diagnoses (P < .004)., Conclusion: DSA allows more confident detection of pulmonary embolus than does CFA, with no loss in diagnostic accuracy.

Purpose: To determine whether intraarterial digital subtraction arteriography (DSA) is as sensitive and specific as cut film arteriography (CFA) in the evaluation of suspected aortic injury resulting from blunt chest trauma., Materials and Methods: Both CFA and DSA images of the thoracic aorta were obtained in the right posterior oblique (RPO) projection in 100 of 103 consecutive patients undergoing arteriography after blunt chest trauma. Diagnoses based on blinded separate review of both studies (CFA vs DSA) by four independent reviewers were compared. Reviewers graded their confidence in their diagnoses from 1 (certain) to 10 (uncertain)., Results: Eleven of 100 patients had aortic or great vessel injuries confirmed by operation (n = 10) or transesophageal echocardiography (n = 1). Three hundred eighty-eight of 400 diagnoses based on RPO CFA and 390 of 400 diagnoses based on RPO DSA agreed with the correct diagnoses. The sensitivity, specificity, and diagnostic accuracy of CFA versus DSA were not significantly different. The reviewers' confidence in their diagnoses was equivalent between CFA (average confidence score, 1.373) and DSA (average confidence score, 1.375)., Conclusion: DSA and CFA yield equivalent sensitivity, specificity, and diagnostic accuracy in the evaluation of blunt chest trauma.

Purpose: To assess the outcome of interventional radiologic placement of tunneled hemodialysis catheters via the right internal jugular vein., Materials and Methods: In 194 patients, the catheter was placed via the right internal jugular vein unless thrombosis was present. Real-time ultrasound-guided puncture and fluoroscopic guidance were used. Patients were followed up until catheter removal or death. Outcomes evaluated included infection, thrombosis, and catheter malfunction., Results: In 175 patients, 250 consecutive catheters were placed via the right internal jugular vein with 100% success. All catheters functioned immediately after placement. Procedural complications were limited to clinically unimportant air embolus (n = 2). No instances of pneumothorax, hemothorax, or substantial bleeding complications occurred. Follow-up was available in 173 (99%) patients. Mean and median "catheter duration" were 87 and 56 days, respectively. Catheter-related symptomatic venous thrombosis or stenosis was not observed. The rate of infection was 0.08 per 100 catheter days, and the rate of malfunction that necessitated removal was 0.22 per 100 catheter days. Definite or possible catheter thrombosis that necessitated removal occurred at a rate of 0.16 per 100 catheter days., Conclusion: Interventional radiologic placement of tunneled hemodialysis catheters via the right internal jugular vein showed equal or better long-term results than those reported for surgical placement. Interventional radiologic placement should be the method of choice.

Purpose: To compare results of transjugular intrahepatic portosystemic shunt (TIPS) placement with 10- and 12-mm Wallstents., Materials and Methods: Forty-six TIPS procedures in 47 patients were retrospectively reviewed. Wallstents that were 10 mm in diameter were used in 23 patients, and those that were 12 mm in diameter were used in 23 patients. Immediate results were compared, which included initial portosystemic gradient and Doppler measurements of blood flow velocity through the shunt at 1 day. Long-term patency and velocities were also assessed., Results: TIPS were successfully created in 46 of 47 patients (98%). In one patient in the 10-mm group, the portal vein could not be accessed. When compared with TIPS in the 10-mm group, TIPS placed in the 12-mm group required dilation to larger diameters (mean, 11.1 vs 9.2 mm; P < .0001) to achieve an identical target gradient of 10 mm Hg and exhibited lower 1-day velocities (mean, 1.3 m/sec vs 1.7 m/sec; P < .03). The 1-day occlusion rate was 17% (four of 23 patients) in the 12-mm group versus 0% in the 10-mm group (P < .02). Patient survival was statistically significantly less in the 12-mm group (P < .03)., Conclusion: Twelve-millimeter Wallstents yield statistically significantly poorer short- and long-term results in TIPS procedures. This is most likely due to the decreased radial strength of the larger stent, which is 50% less than that of the 10-mm stent.

Purpose: To evaluate the use of a small choledochoscope and laser lithotripsy in the treatment of complex biliary stone disease., Materials and Methods: Twenty-five consecutive patients with complex biliary stone disease not amenable to surgical therapy, peroral endoscopic removal, or simple percutaneous retrieval techniques underwent 35 stone-removal procedures. A 3.4-mm endoscope and a pulsed dye coumarin green laser were used to pulverize and remove stones through preexisting, mature transhepatic biliary drain tracts (n = 18), t-tube tracts (n = 3), cholecystostomy tube tracts (n = 3), and a hepaticocutaneous enterostomy (n = 1). Procedures in 14 of the 25 patients (56%) were performed on an outpatient basis., Results: Twenty-four of the 25 patients (96%) were cleared of their stone burden and underwent subsequent catheter therapy of strictures or abscesses as necessary. Complications of the stone removal included fever and chills in six patients (24%) and mild bleeding from a bile duct wall during removal of an adherent stone in one patient., Conclusion: Use of a small choledochoscope and a coumarin green pulsed dye laser is safe and effective in the management of complex biliary stone disease.

Purpose: To develop a magnetic resonance (MR) angiography protocol, with use of breath-hold techniques, for simultaneous aortoiliac inflow assessment and renal artery screening in patients with lower extremity ischemia or aortic aneurysm., Materials and Methods: Breath-hold three dimensional gadolinium-enhanced MR angiography was performed in 50 patients (conventional arteriography in 47 was the standard of reference). After multiple strategies were tested in the first 18 patients, a final protocol was formulated and tested in the subsequent 32 patients., Results: The final protocol comprised a single-slab (28 3-mm-thick partitions) coronal acquisition (repetition time, 7 msec; echo time, 2.8 msec; flip angle, 60 degrees) during a single breath hold, enhanced with 30 mL gadoteridol. In the final 32 patients, sensitivity and specificity, respectively, for obstructive lesions were 100% and 100% for the aorta, 100% and 98% for common iliac arteries, 100% and 89% for external iliac arteries, 100% and 89% for main renal arteries, and 100% and 62% for accessory renal arteries., Conclusion: This breath-hold protocol improves the accuracy of aortoiliac inflow assessment, but low resolution limits evaluation of small renal arteries.

Purpose: To determine the accuracy of two-dimensional (2D) time-of-flight (TOF) magnetic resonance (MR) angiography, performed with state-of-the-art equipment, in the evaluation of the iliac arteries., Materials and Methods: The iliac arteries of 50 patients undergoing conventional arteriography for evaluation of lower-extremity ischemia or abdominal aortic aneurysm were also imaged with axial 2D TOF MR angiography. Blinded interpretations of conventional arteriograms and MR angiograms were compared. MR angiography was performed with a 1.5-T system with 2-mm contiguous axial sections, 60 degrees flip angle, 28-msec repetition time, and 7.4-msec echo time., Results: Blinded interpretations of 2D TOF MR angiograms matched those of conventional arteriograms in 26 of 50 patients (52%). For the diagnosis of obstructive iliac artery lesions, sensitivity and specificity with MR angiography were 85% and 59%, respectively. Two of three saccular iliac artery aneurysms escaped detection with MR angiography., Conclusion: Iliac artery evaluation with axial 2D TOF MR angiography is not sufficiently accurate to warrant its use as a replacement for conventional arteriography in patients who lack contraindications to the latter.

Renal and visceral artery images obtained concurrently with spiral CT and conventional arteriography were compared for 32 patients. Indications for imaging were occlusive disease (n = 12), aneurysmal disease (n = 9), and renal or visceral artery disease (n = 11). Conventional arteriography enabled visualization of 64 renal arteries and 15 accessory renal arteries. Lateral aortograms obtained in 15 patients enabled visualization of 14 superior mesenteric (SMA) and 14 celiac arteries. Spiral CT enabled visualization of 60 renal arteries, 12 accessory renal arteries, 27 SMAs, and 22 celiac arteries. Calcification or a disparity in timing of contrast material injection and scanning prevented visualization of the celiac artery in 10 patients and the SMA in four patients. With conventional arteriography as the standard for comparison, spiral CT had a sensitivity of 67% and a specificity of 95% for depiction of at least 75% stenosis in the main renal artery. By means of the Pearson correlation coefficient, significant correlation (p < 0.001) was confirmed between spiral CT and arteriography for evaluation of stenosis of the main renal artery, SMA, and celiac artery. This early experience suggests that spiral CT may be useful in evaluation of renal and visceral arteries and their relationship to aortic disease.

Background: Thirty-eight limbs with iliac occlusive disease were treated with Palmaz stents from 1987 through 1991., Methods: Indications for stent utilization included dissection induced by percutaneous transluminal balloon angioplasty (PTA) (10), restenosis after PTA (nine), post-PTA residual stenosis (nine), multiple stenoses or occlusion (five), and unfavorable location (five)., Results: The ankle/brachial pressure index increased from 0.53 +/- 0.27 to 0.8 +/- 0.26 after stent deployment. The intraluminal pressure gradient decreased from 31.9 +/- 16.3 to 0.9 +/- 2.2 mm Hg after stent deployment. Complications included pseudoaneurysm (one), arteriovenous fistula (one), iliac perforation (one), groin hematoma (two), and occlusion (two). Follow-up arteriogram showed stenosis proximal or distal (n = 4) or within the stents (n = 4). These were treated with PTA or stents. Two patients required an aortobifemoral graft. Nine patients have died. Life table analysis showed a 1-, 3-, and 5-year primary and secondary cumulative patency of 87% +/- 5.9%, 74% +/- 8.2%, and 63% +/- 10% and 91% +/- 5.1%, 91% +/- 5.6%, and 86% +/- 7.6%, respectively., Conclusions: Palmaz stents, often required to salvage a PTA failure, appear to maintain overall patency at a high level. However, intimal hyperplasia and the progression of atherosclerotic disease may result in a need for additional procedures to obtain this favorable outcome.

Purpose: To determine if a three-dimensional (3D) gadolinium-enhanced technique is useful for improving the accuracy of magnetic resonance (MR) angiography., Materials and Methods: Prospectively, two-dimensional (2D) time-of-flight (TOF) and 3D gadolinium-enhanced MR angiography was performed in 23 patients. Conventional arteriography, the reference standard, was performed in all but five patients. Images from each examination were interpreted blindly by two observers., Results: For common and external iliac arteries, interpretations of dynamic 3D gadolinium-enhanced MR angiograms matched those of conventional arteriograms in 12 of 18 patients (67%) for both observers. Interpretations of 2D TOF images matched those of conventional arteriograms in six (33%) and seven (39%) patients for the two observers respectively., Conclusion: Preliminary results suggest that iliac artery MR angiography can be improved by complementing standard 2D TOF acquisitions with 3D gadolinium-enhanced acquisitions.

Purpose: To determine the frequency with which treatment plans based on findings at magnetic resonance angiography (MRA) match those based on findings at conventional x-ray arteriography (XRA) in the evaluation of symptomatic lower extremity ischemia., Patients and Methods: Two-dimensional time-of-flight (TOF) MRA was performed in 42 patients undergoing XRA for evaluation of symptomatic lower extremity ischemia. The blind interpretations and treatment plans based on MRA findings were compared with those based on XRA findings, with use of XRA as the standard of reference., Results: For identification of hemodynamically significant stenosis or occlusion, the sensitivity and specificity of MRA was 100% and 23% for iliac segments, 100% and 82% for common femoral segments, 89% and 67% for superficial femoral segments, 100% and 88% for popliteal segments, and 92% and 91% for tibioperoneal segments, respectively. The treatment plan based on MRA findings matched that based on XRA findings in 41% of patients., Conclusion: For evaluation of symptomatic lower extremity ischemia, two-dimensional TOF MRA cannot be considered a reliable substitute for XRA in patients who lack contraindications to XRA.

Purpose: The authors sought to develop a safe, efficacious technique for percutaneous transhepatic drainage of nondilated biliary systems., Patients and Methods: Twenty-three drainage procedures were performed on 14 consecutive patients with nondilated ducts. Fourteen procedures were carried out for primary placement of a transhepatic biliary drain, eight for placement of a second drain, and one for placement of a third drain. Drainage catheter access into the biliary tree was gained via direct puncture of a peripheral duct (fourth order or smaller branch) in four procedures. In the remaining 19 procedures, peripheral duct punctures were facilitated by retrograde passage of a 5-F catheter from a previous, remote percutaneous access site into the fourth-order duct to be punctured. Nine of these 19 duct punctures were facilitated by the use of a nitinol Goose Neck snare passed through the intraductal catheter., Results: Of the access methods used, the nitinol snare technique was the fastest. Successful peripheral access was achieved in all patients without bleeding complications. One patient developed symptoms of bacteremia, which resolved within 12 hours with antibiotic therapy and external biliary drainage., Conclusion: Percutaneous peripheral access can be achieved safely in the nondilated biliary tree and can obviate surgery for some patients and facilitate future interventions.

Transjugular catheterization of the portal vein can be used to form a portosystemic shunt. Conventionally, the passage of a needle from the hepatic vein into the portal vein is performed with fluoroscopic monitoring only. Several methods to target the portal vein have been previously reported, including transhepatic venous catheterization, indirect portography (arterial catheterization), or skin marking based on ultrasound (US) mapping of portal landmarks. The authors used realtime US guidance to percutaneously place a small marking wire in the parenchyma next to the portal bifurcation. A 0.018-inch-diameter, 5-mm-long platinum wire is delivered through a 22-gauge echo-tipped needle placed adjacent to the right portal vein. This marking wire enabled rapid entry into the portal vein, helped avoid extrahepatic puncture, and was useful during stent deployment and positioning.

We report a 4 1/2-year-old boy who presented with a 4-week history of frontal headaches and fever, and generalized convulsion 5 months previously. Papilledema, an abnormal EEG and a brain scan with a frontal mass and 'doughnut' sign were found. The association of the clinical history with brain scan findings strongly suggested a brain abscess. At surgery the lesion proved to be an encapsulated hematoma; Histological findings suggest underlying microangiomata.

Of 14 patients whose final diagnosis was upper airways obstruction associated with heart failure, 3 presented with systemic hypertension (up to 200/100 mmHg). In 2 the hypertension was so severe that at first it had to be considered as a possible cause of the presenting symptoms. The subsequent history indicated that it was an effect of the upper airways obstruction with heart failure.

The authors studied skull radiographs of 66 infants with cephalohematoma. Twenty-three (35%) had radiolucencies in the skull; most of the radiolucent defects were associated with beginning or extensive ossification over the cephalohematoma. Radiolucency associated with cephalohematoma is a frequent finding and rarely indicates local infection.

Chest radiographs on 73 neonates with early-onset group B Streptococcus (GBS) infection were reviewed. Eighty-six percent of the infants were premature (less than 38 weeks); 68% weighed less than or equal to 1,500 g. In infants weighing less than or equal to 1,500 g, the predominant radiographic pattern was hyaline membrane disease (HMD) (80%). There was a significant increase in radiographic HMD in 1,000 to 1,500-g neonates with GBS infection (77%) when compared to a control group of infants without GBS infection (44%). Mortality in 1,000 to 1,500-g infants with GBS infection and radiographic HMD (95%) was also significantly higher than in the control group of infants with hmd HMD and no GBS infection (38%). In larger premature and full-term infants, the radiographic findings were not specific and also were not helpful in distinguishing GBS infection from other newborn respiratory disorders.

Three young children with advanced cavitary pulmonary tuberculosis died between 1974 and 1978. Two of the patients had tuberculous meningitis as well. All diagnoses were verified at autopsy; however, all tuberculin skin tests were negative. These instances emphasize the difficulty of establishing the diagnosis of tuberculosis in young children. Tuberculosis should be considered in the differential diagnosis of cavitary chest disease in young children, even those with negative tuberculin skin tests.

The preoperative diagnosis of cervical pregnancy by ultrasound is described. To the authors' knowledge, this is the third such diagnosis that has been reported in the literature. Ultrasound examination showed a gestational sac with smooth margins occupying the entire cervix in a 23-year-old woman. It is suggested that this diagnosis be considered in the appropriate clinical setting of painless first trimester vaginal bleeding in a patient who has had an abortion or other gynecologic surgery.

The authors report a case of congenital syphilis with involvement of a joint space and adjacent bony surfaces in a newborn infant. Although similar findings have been reported in older children, this appears to be the first such case in a newborn.

Congenital absence of a main pulmonary artery is a rare anomaly. Most patients without associated congenital cardiac abnormalities are asymptomatic, and the diagnosis is first suggested by the appearance of the involved lung on a routine chest roentgenogram. The ipsilateral lung will be smaller than normal, and the contralateral lung will be overinflated and may herniate across the midline. We describe eight children with unilateral pulmonary arterial atresia (seven on the right side, four of whom were without associated cardiac anomalies).

Empyema developing from retropharyngeal abscess is a rare complication. Two infants with clinical symptomatology and inital chest radiographic findings of pleural fluid which suggested the possibility of retrophoryngeal abscess are described. A child with submandibular and cervical abscesses is also reported; pleural fluid and mediastinal abscess developed less than 24 hours after admission. Pathological processes in the neck can spread into the chest or conversely, either by direct continuity or by dissection through the fascial planes enveloping the cervical compartments. The middle or visceral space which is in direct continuity with the mediastinum is generally the area in which cervicothoracic disease inter-relates.

This paper describes an infant with Caffey's disease who presented with swelling of the first metatarsal shown as hyperostosis histologically. He then developed scapular sclerosis and new bone formation. The mandible became involved 26 days after onset. A review of a 12 year experience with Caffey's disease (33 patients) disclosed a definite decrease in the number and percentage of patients seen since 1968.

A newborn with congenital syphilis presented radiographically with a lack of ossification of the medial portions of several ribs and massive sclerosis and decalcification of scapulae. The uniqueness of syphilitic scapular and rib involvement is discussed. The infant also went on to develop skin lesions which appeared following penicillin therapy and also developed an extrahepatic biliary atresia.

In our hospital Haemophilus influenzae type B seems to be a common cause of acute childhood pneumonia. In the past five years, 34 children with acute Haemophilus pneumonia were identified. Although these children generally had an uncomplicated segmental pneumonia associated with a bacteremia, 13 of the children had pneumonia with a pleural effusion. These children with Haemophilus pneumonia represented 18% of the children hospitalized with systemic Haemophilus disease and almost a third of those hospitalized with acute bacterial pneumonia from whom the causal agent was isolated.

Bone infarction in the sickle cell syndromes (sickle cell anemia, sickle beta thalassemia, and sickle C disease) is common in the long bones, but the facial bones, particularly the orbits, are infrequently involved. In a review of the literature, only 13 cases of facial bone infarcts in sickle cell syndromes were found. Seven episodes of facial bone infarcts--four orbital, two mandibular, and one in the zygomatic arch--in six patients encountered at the authors' institution are reported. Five patients had hemoglobin SS, and one had hemoglobin SC. Bone marrow scans were positive for infarction in five of the six episodes during which they were obtained, which highlights the usefulness of this technique in the diagnosis of facial bone infarction.