Search

AIM Differentiated thyroid cancer (DTC) in children and adolescents is rare and data about its presentation and management are not well known. The aim of this study was to provide evidence of the current practice in the United Kingdom before the launch of the Rare National Paediatric Endocrine Tumours Guidelines (to be published in 2020). METHODS Seventy-two children and adolescents with DTC (

INTRODUCTION Whilst excision biopsy is traditionally preferred, advances in radiological and histological techniques warrant a re-look at core biopsy as a viable primary diagnostic method. METHOD Over a 3-year period, all patients who underwent core biopsy to investigate lymphoma at our centre were included. RESULTS 554 consecutive patients were included (40.1% prior lymphoma and 59.4% new presentations). Three or more cores were taken in 420 (75.8%) cases. Median time from request to biopsy and biopsy to histology report was 2 (0-40) days and 7 (1-24) days, respectively. 510/544 (93.8%) biopsies were diagnostic. There was no difference in whether the biopsy was diagnostic based on indication (new vs. relapsed lymphoma) (P = .445), whether biopsy was PET-directed (P = .507), for T-cell lymphoma (P = .468) or nodal vs. extra-nodal (P = .693). Thirty-eight patients (6.9%) required a second biopsy due to inadequate tissue. In a patient experience survey, only 13.9% reported any complications (1 self-limiting minor bleeding, 4 bruising) whilst 16.7% reported any discomfort beyond 12 hours. CONCLUSION Core biopsy performed by experienced radiologists and analysed by expert haemato-pathologists is a reliable, well-tolerated method for diagnosing lymphoma and confirming relapse. Multiple cores can be obtained under local anaesthetic yielding sufficient material in the majority of cases.

This Special Issue of Journal of Contemporary Painting does not aim to be broadly international in its explorations of transcultural dialogue within modern and contemporary painting. Instead, we focus mostly on China, Taiwan, Japan and Korea, with a notable detour down towards the Philippines. The essays comprise a series of ‘snap-shots’ which together give a sense of the richness of the global dialogue in painting. We also take a couple of trips into the deeper past to visit Qing Dynasty landscape painting in China, and to the more recent past to explore of the impact of Zen on western monochrome painters in the 1950s and 1960s.

I look at the impact of Zen Buddhism on western painters during the 1950s and 1960s, focusing on the monochrome in particular, in order to create a historical context for the consideration of transcultural dialogue in relation to contemporary painting. I argue that a consideration of Zen can offer a ‘middle way’ between conceptions of the monochrome (and art in general) often hobbled by models of interpretation that function within a binary opposition between ‘literalist/sensory’ on the one hand, and ‘intellectual/non-sensory’ readings on the other.

Alongside his studio practice, the Korean artist Lee Ufan (b.1936) has consistently published writings that are intended to both elucidate his own practice and to address much broader issues relating to art and culture. Through his writing and art, Lee has sought the grounds from which to both assimilate and challenge Westernizing hegemony, based on a deep understanding of both East Asian and Western art and philosophy. Lees work maps the conventions of modernist Western abstraction onto traditional East Asian concepts of painting, most especially in relation to the role of the body, circulating energy, void and the ‘untouched’. The selection below is a small sample of his writings, and they are preceded by an introduction to Lee Ufan, and a brief interview with the artist conducted by email with Simon Morley in 2017.

Although US is one of the most used modalities for head and neck imaging, its use in the diagnosis of laryngeal abnormalities is much less widespread. The standard assessment of laryngeal abnormalities currently involves direct laryngoscopy and cross-sectional imaging (either CT or MRI) but rarely US. US is readily available, noninvasive, and radiation free, and it allows real-time imaging (with video for dynamic assessment), higher resolution than that of cross-sectional imaging, and the performance of targeted fine needle aspiration cytology or biopsy. This modality, particularly with the advent of high-resolution US, has been found to be at least comparable to CT or MRI for diagnosis of malignant lesions and benign abnormalities such as vocal nodules, polyps, cysts, and Reinke edema. Furthermore, it has been found to be more sensitive for diagnosis of abnormalities such as small glottic tumors, and its dynamic capability can be used to identify functional abnormalities such as vocal cord palsy. The authors outline the technique of laryngeal US, which includes strategies to avoid calcified laryngeal cartilage by imaging through the thyrohyoid and cricothyroid membranes with a five-sweep strategy supplemented by cine film of the technique. They also provide US images of common laryngeal abnormalities such as tumors with and without extralaryngeal extension; vallecular, thyroglossal, and vocal cord cysts; laryngeal mucoceles; and vocal cord palsy.

Diffusion MRI characteristics assessed by apparent diffusion coefficient (ADC) histogram analysis in head and neck squamous cell carcinoma (HNSCC) have been reported as helpful in classifying tumours based on diffusion characteristics. There is little reported on HNSCC lymph nodes classification by diffusion characteristics. The aim of this study was to determine whether pretreatment nodal microstructural diffusion MRI characteristics can classify diseased nodes of patients with HNSCC from normal nodes of healthy volunteers. Seventy-nine patients with histologically confirmed HNSCC prior to chemoradiotherapy, and eight healthy volunteers, underwent diffusion-weighted (DW) MRI at a 1.5-T MR scanner. Two radiologists contoured lymph nodes on DW (b = 300 s/m2 ) images. ADC, distributed diffusion coefficient (DDC) and alpha (α) values were calculated by monoexponential and stretched exponential models. Histogram analysis metrics of drawn volume were compared between patients and volunteers using a Mann-Whitney test. The classification performance of each metric between the normal and diseased nodes was determined by receiver operating characteristic (ROC) analysis. Intraclass correlation coefficients determined interobserver reproducibility of each metric based on differently drawn ROIs by two radiologists. Sixty cancerous and 40 normal nodes were analysed. ADC histogram analysis revealed significant differences between patients and volunteers (p ≤0.0001 to 0.0046), presenting ADC distributions that were more skewed (1.49 for patients, 1.03 for volunteers; p = 0.0114) and 'peaked' (6.82 for patients, 4.20 for volunteers; p = 0.0021) in patients. Maximum ADC values exhibited the highest area under the curve ([AUC] 0.892). Significant differences were revealed between patients and volunteers for DDC and α value histogram metrics (p ≤0.0001 to 0.0044); the highest AUC were exhibited by maximum DDC (0.772) and the 25th percentile α value (0.761). Interobserver repeatability was excellent for mean ADC (ICC = 0.88) and the 25th percentile α value (ICC = 0.78), but poor for all other metrics. These results suggest that pretreatment microstructural diffusion MRI characteristics in lymph nodes, assessed by ADC and α value histogram analysis, can identify nodal disease.

Augmented reality (AR) was first described in the literature in the 1990s. It has been shown as a futuristic concept in television, film and media, and now in the twenty-first century has become a reality. AR is defined as an interactive experience of a real-world environment where the object that resides in the real world is enhanced by computer-generated perceptual information.Microsoft HoloLens is a mixed reality device which has the capability to provide a real-time, three-dimensional platform using multiple sensors and holographic processing to display information and even simulate a virtual world. With rapidly evolving technology and virtual learning on the increase, the HoloLens technology can be used as a vital tool for dental education and surgical planning. However, within dentistry at present, there is limited research regarding its benefits and potential.The authors would like to demonstrate the use of HoloLens in three common oral surgery procedures and how it can be used to distinguish anatomy and benefit surgical planning, aid in patient communication and play a role in dental education.

Microplastics have been recognised as persistent marine contaminants and mounting evidence supports their designation as anthropogenic stressors to marine organisms. Despite the remoteness of Antarctica, microplastics contamination has been reported in every marine environment investigated in this area to date. Due to ocean currents and frontal systems, microplastics may become entrapped within polar regions and increase bioavailibilty to inhabiting fauna. Antarctic marine benthic invertebrates represent a research priority due to their sensitivity to change as well as contribution to ecological functioning and food webs. The current study investigated microplastics ingestion by the epifaunal, carnivorous polychaete Barrukia cristata and the infaunal, filter-feeding bivalve, Laternula elliptica. Animals were collected by SCUBA adjacent to Rothera research station, Adelaide Island. After digestion in 10 % potassium hydroxide (KOH) followed by filtration, microplastics ingested by individual animals were separated. Microplastics were then counted and characterised by shape, colour, size and polymer type by Micro-Fourier transform Infrared spectroscopy. Polyethylene terephthalate (PET) was the most abundant polymer type, followed by polyacrylonitrile (PAN) and ethylene-vinyl acetate (EVA). Congruent to earlier reports, fibres were found to be the most abundant source of microplastics contamination. However, it must be highlighted that fragments were also recovered from the animals analysed. Results determined the current level of microplastics ingestion by two benthic marine invertebrates of different feeding strategies in coastal environments of the Antarctic Peninsula. These findings indicated the bioavailability of microplastics and highlighted the potential of trophic transfer throughout the Antarctic marine food web.

AIM Current guidelines advocate ‘one-stop’ neck lump assessment for cancer referrals. We pilot a novel pre-clinic ultrasound pathway, present the outcomes and discuss strengths and limitations especially in view of the current COVID-19 pandemic. METHODS Patients referred by the GP on a two-week-wait cancer pathway with a ‘neck lump’ were allocated pre-clinic ultrasound scans followed by an ENT clinic appointment. Demographics, patient journey details and outcomes were collected and analysed. RESULTS 99 patients underwent pre-clinic ultrasound assessment by a specialist consultant radiologist an average of 8.02 days after referral with 30 (30.3%) also undergoing biopsy. Patients were followed-up 14.1 days (range 2 – 26 days) after initial referral. In 92.9% of patients, a positive impact was achieved; at the first clinic appointment 45 patients were discharged (45.5%), ten were listed for surgery (10.1%), a cancer diagnosis was made in a further 12 patients (12.1%), 6 patients (6.1%) were referred onwards to another speciality and 19 patients (19.2%) were taken off the cancer pathway and followed up routinely. In four patients, it was retrospectively felt that ultrasound was not indicated as the referral did not accurately reflect the patient’s presenting complaint or examination findings. Repeat ultrasound was inadvertently requested for one patient. Two patients were reviewed prior to biopsy results being available leading to an additional appointment being required. CONCLUSION Pre-clinic ultrasound scanning is an alternative to the current ‘one-stop’ neck lump pathway. Our results demonstrate a reduction in clinic visits, quicker diagnosis and low proportion of unnecessary scans. Our proposed pathway requires minimal service restructuring and has added potential cost savings. We have found it to be effective during the COVID-19 pandemic in minimising the face-to-face consultations and the number of aerosol generating procedures (AGPs). Further refinement is needed to streamline and make the process more robust. A larger study with direct comparison to the ‘one-stop’ clinic is required to assess further strengths and limitations.

The success of minimally invasive parathyroidectomy (MIP) relies on accurate localization of the abnormal parathyroid glands. Concordant findings on ultrasound (US) and 99mTc-scintigraphy (sestamibi) are currently considered the ‘gold standard’. Computed tomography (CT) has also recently been used in preoperative planning. We sought to assess the accuracy of CT for localization of abnormal parathyroid glands in such patients. An audit of 75 patients with primary hyperparathyroidism (PHPT) who underwent neck US and CT between 2017 and 2019 at our center as their first-line imaging. All 75 patients underwent US and CT and 54 (72.0%) also had sestamibi. CT alone identified a potential target in all patients, of which the location was correct in 63 (84.0%). The overall combined sensitivity of US and CT was 88% (95% CI 78–94) and was higher than the combined sensitivity of US and sestamibi (65% [95% CI 53–76]; p 0.99). The combination of US and CT was able to correctly identify the location of the abnormal parathyroid in 88% of patients and, in comparison with US and sestamibi, had better diagnostic accuracy, especially for smaller and ectopic adenomas. This finding suggests that US and CT could be considered as a first-line imaging modality in patients with PHPT considered for MIP.

Intraoperative parathyroid hormone (IOPTH) monitoring during surgery for primary hyperparathyroidism (PHPT) could improve cure rate and simplify current care pathways. This study assesses the performance of US, MIBI and IOPTH monitoring and their impact on outcomes and perioperative strategy.This is a retrospective study of a prospectively maintained database of patients who underwent parathyroidectomy guided by preoperative US, MIBI and IOPTH monitoring. Test performance (sensitivity, specificity, PPV, NPV, accuracy) and IOPTH added value (percentage of patients in whom test contributed to achieving cure) were calculated.A total of 617 patients (median age 59 years, 75% females), 603 (97.7%) of them cured, were included in analysis. Sensitivity of US was higher than MIBI (78.2% vs 70%, P 0.05), but both were inferior to IOPTH (98.6%, P 0.05). US and MIBI were more sensitive at detecting single gland disease (SGD) than multigland disease (MGD) (85% vs 55% and 77.5% vs 45.5%, respectively, P 0.05), while IOPTH performed well in both situations (98.8% vs 96.7%, P 0.05). In 41 patients with incorrect US predictions, MIBI gave correct result only in 12 (29.3%) cases, while IOPTH gave correct predictions in all but one patient (97.6%). Minimally invasive parathyroidectomy (MIP) was completed in 409 patients, with a similar completion rate regardless whether both or one scan was positive. IOPTH added value was significant in whole cohort (14%) and in subgroups of patients with concordant vs discordant scans, minimally invasive vs conventional surgery, and initial vs reoperative surgery.Intraoperative parathyroid hormone monitoring is more accurate at predicting cure than US and MIBI are at identifying abnormal glands in patients undergoing parathyroidectomy for PHPT and significantly contributes to cure rate in range of clinical scenarios. This implies that its routine use could facilitate successful surgery in patients with single positive imaging and increase number of MIPs while maintaining high cure rate.

I address the perceptual phenomenon of indistinctness and its connection to abstract concepts. The paradox that interests me is how a situation of diminished clarity and ambiguity problematizes and undermines normal vision while making way for another kind of seeing and knowing where we seem to inhabit a slippery moment of change or action, and are engaged in mobile, transitory and spontaneous negotiations of space and time. My discussion relates to the shift in theory and practice towards the exploration of the elusive middle, in-between or nondichotomous relation. Applying conceptual metaphor theory, I argue that the ‘indistinct’ serves the function of experiential ‘source domain’ for the abstract ‘target domain’ concepts of non-duality, limitlessness, infinity and existential immersion. I use a comparative methodology by exploring intercultural aesthetics and draw attention to an alternative paradigm. I look at a recursive orientation in which the ‘indistinct’ carries a more positive ontologica...

Dansaekhwa, which means ‘one-colour painting’ in Korean, is a stylistic term now employed as a way of drawing attention to a tendency in Korean art that came to the fore in the 1970s. While Dansaekhwa artists adopted procedures and underlying assumptions from the modern Western tradition, they also sought to cleave to what they understood to be key characteristics of a traditional Korean culture that was fast disappearing. I discuss Walter Benjamin concept of the ‘dialectical image,’ and through drawing on Jorn Rusen’s work on historical consciousness and the ‘Tao’ of history, and the writings of the Korean artist, Lee Ufan, I make an argument for Dansaekhwa as the transhistorical re-visioning of temporality in terms not of the historical categories ‘past’ and ‘present’ but rather as a more subjectivized ‘then’ and ‘now’ grounded in somatic experience.

The emphasis on textual or oral supplements grounded in objective metacognitive analysis, and drawing on theoretical ideas and concepts, is now an acknowledged part of Fine Art pedagogy. But many involved in art education would agree that there is often a problem finding a good ‘fit’ between the theoretical and the practical. I draw on my experience as an artist and a teacher of Fine Art in the Republic of Korea in order to suggest how a positive evaluation of ‘vagueness’ within the cognitive style displayed by Korean students as part-and-parcel of their cultural mindset signals the fact that they are familiar with a analogical cognitive style in which ‘the incoherence associable with images and metaphors are carried over into the more formal elements of thought’ [Hall, David L., and Roger T. Ames. 1995. Anticipating China: Thinking Through the Narratives of Chinese and Western Culture. Albany: State University of New York: 124]. I relate this to the research of Barbara Stafford on analogy and sug...

A 70-year-old woman presented with a 10-month history of an irregular mass in the left lateral nape of her neck which had recently increased in size rapidly. Ultrasound-guided core needle biopsy was obtained, and the tumour was diagnosed as a well-differentiated squamous cell carcinoma. Further imaging studies failed to demonstrate additional malignant characteristics. In view of these findings, a wide local excision of the tumour was performed. Histopathological assessment of the resected tumour revealed a proliferating trichilemmal tumour with well-differentiated features and smooth invasion front. This article serves as an important reminder of the challenges associated with pathological evaluation of core needle biopsies of adnexal tumours. It emphasises the importance of clinical-radiological-pathological correlation preferably in a multidisciplinary team setting prior to agreeing on a definitive management plan.

I examine the impact of East Asian ideas on the paintings and writings of the American artist Agnes Martin (1912–2004), arguing that her relationship to such ideas was complex and often contradictory – at least on the level of the discourse she herself erected around her painting. I argue that while in practice her paintings express a view of subjectivity that is more familiar and more valued within East Asian culture, in her theory Martin nevertheless remained bound by Western dualistic thinking. The difference between the discursive nature of her writings and the nature of her writings and thinking, and the modality of her paintings draws attention to a more general problematic: the relationship between, on the one hand, the hermeneutic mode of awareness in art, and, on the other hand, the non-discursive mode of awareness in art practice. I draw attention to the latter mode, which foregrounds corporeal expansions and extensions of the borders of the material body. The experience Martin sought to convey ...

Burkitt-like lymphoma, also known as (B-Cell lymphoma, Unclassifiable) is a rare extra-nodal B-cell lymphoma with features intermediate between Burkitt's lymphoma and diffuse large B-cell lymphoma. A 73-year-old Caucasian female presented to our Emergency Department with orbital pain, deterioration of vision, nausea and vomiting. General examination revealed right orbital proptosis and reduction in visual acuity; and computed tomography confirmed the presence of a right retro-bulbar mass. Tissue samples were obtained using ultrasound-guided core needle biopsy. An experienced head and neck radiologist (SM) undertook the procedure under general anaesthesia, using a lateral orbital approach. The instrument used was the Toshiba Aplio. The procedure was without complication. Results from histopathological, immunohistochemical and genetic analyses confirmed the diagnosis of stage IV orbital Burkitt-like lymphoma with atypical features. Despite the ambiguity of immunohistochemistry and cytogenetic results, the patient was treated for Burkitt's lymphoma. The treatment had to be re-adjusted after two rounds of chemotherapy as the patient developed chemotherapy-induced encephalopathy. The patient remained symptom-free for 8 months. This case demonstrates the application of ultrasound-guided core needle biopsy for rapid and accurate lymphoma diagnosis and sub-classification.

Quantifying how railway track responds to passing trains in terms of displacement, velocity or acceleration, can provide insights into both the performance and the condition of the track. A number of trackside monitoring technologies have been shown to be capable of providing this information; however these are primarily research tools and tend to be costly hence actual deployments are relatively limited in scope. To assess systematically the changing health of railway track, more cost-effective continuous approaches to monitoring are required. Micro electrical mechanical systems (MEMS) are commonplace sensors in consumer electronics, low cost and can be used to measure acceleration. Thus they have the potential to provide the kind of data required to assess railway track behaviour at a much lower cost and in an environmentally robust small deployment package. However confidence in the quality of the data is required. This paper discusses the criteria for the selection of MEMS devices for this application. Laboratory trials and direct comparison of trackside measurements with well-established monitoring techniques demonstrate the effectiveness of the selected MEMS devices, and show their potential for use in continuous monitoring schemes to evaluate changes in track performance. The paper thus provides evidence that these kinds of low cost technologies are suitable for railway applications, building confidence in their use and enabling their adoption in self-monitoring smart infrastructure.

We report two patients with increased central skull base and craniocervical junction bone pneumatisation complicated by extra-osseous gas. One patient presented with symptoms of increasing nasal blockage and 'sinus pressure' on a background of extensive nasal polyposis. He was subsequently found to have a history of repeated Valsalva's manoeuvre, the cessation of which resulted in a rapid decrease in the amount of extra-osseous gas on imaging. The second patient presented following a minor head trauma with dysarthria from a hypoglossal nerve palsy and neck pain, with extensive intra- and extra-cranial gas including within the spinal canal (pneumorrhachis). These radiological findings have been reported previously in patients with Eustachian tube dysfunction and/or activities leading to frequently raised middle ear pressures. We review the possible aetiologies, reported risk factors, and the range of associated imaging abnormalities that may be encountered with this rare appearance.

The Korean artist Yun Hyong-keun (1928–2007) made works that do and do not look like the Western abstract paintings that now belong firmly within the canon of modern art. But seeking to locate Yun’s work within a ‘grand narrative’ – however globalised – is fraught with difficulties. The author discusses the relationship between Yun’s paintings and the Western concept of the Sublime, bringing this into confrontation with very different concepts arising from Yun’s critical engagement with the cultural traditions of Korea, and East Asia in general. The article describes Yun’s paintings in relation to patterns of cultural influence, transfer and diffusion, and applies the ‘cognitive blending’ theory of Gilles Fauconnier and Mark Turner to argue that Yun’s paintings are ‘blended emergent structures’. As a result, they present themselves as open, relational, contextual, analogical or correlative works, rather than as closed, fixed, discursive or ideologically determined.

During the second half of the 1970s a monochromatic style of painting emerged in South Korea called Dansaekhwa, which means literally ‘monochrome painting’ in Korean. An exhibition at the National Museum of Contemporary Art in Seoul in early 2012 served to connect the art of that period to contemporary practices. Dansaekhwa emerged in a period in which the need for strong social and political control and the wish to guarantee the nation's protection by the United States from a belligerent neighbour co-existed uncomfortably with the powerful drive to sanction and encourage rapid economic development. Dansaekhwa seems to present itself visually as a site of rupture with its culture's past, and the emergence of this new stylistic tendency in the 1970s, and in South Korea in particular, suggests a context within which Korean artists encountered the liberating example of Western modernism and sought to break with their own heritage and to assimilate and emulate Western modernism's styles. But a reading of Dans...

Palatal tumours are relatively rare and of variable aetiology, rendering radiological evaluation a daunting process for many. A systematic approach to the imaging of a palatal lump is therefore essential. The hard and soft palates are oral cavity and oropharyngeal structures, respectively. They have different tissue compositions, and therefore, lesions occur with different frequencies at each site. The hard palate has the highest concentration of minor salivary glands in the upper aerodigestive tract and most tumours here are salivary in origin, whereas most tumours at the soft palate are epithelial in origin, i.e., squamous cell carcinomas, in line with other oropharyngeal subsites. The most common malignant tumours of the palate, after squamous cell carcinoma, are minor salivary gland tumours, predominantly adenoid cystic and mucoepidermoid carcinomas. These tumours have a propensity to spread perineurally; understanding the anatomy and imaging features of perineural spread is vital, as it can have significant implications for patient management and tumour resectability. When confronted with a palatal lump, it is important to consider the following: its location on the hard or soft palate; whether it is mucosal or submucosal; the frequently occurring lesions at that site; the most suitable imaging techniques (ultrasound, computed tomography, magnetic resonance imaging); whether there are typical imaging features for any of the common lesions; and whether there are aggressive features, such as bone erosion or perineural spread. This approach allows the radiologist to narrow the differential diagnosis and assist the clinicians with planning treatment.