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Primary myelofibrosis is a chronic clonal stem cell disorder that results in a build-up of marrow fibrosis and dysfunction, hypermetabolic states, and myeloid metaplasia. The clinical and radiological consequences can be quite diverse and range from the manifestations of osteosclerosis and extramedullary haematopoiesis to thrombohaemorrhagic complications from haemostatic dysfunction. In addition, there is the challenge of identifying less well-recognised sites of extramedullary haematopoiesis and their site-specific complications. The intent of this article is to illustrate the spectrum of primary myelofibrosis as declared though multimodality imaging, with examples of both common and rarer disease manifestations.

Objective To assess the feasibility and safety of stereotactic ablative body radiotherapy (SABR) for renal cell carcinoma (RCC) in patients unsuitable for surgery. Secondary objectives were to assess oncological and functional outcomes. Materials and Methods This was a prospective interventional clinical trial with institutional ethics board approval. Inoperable patients were enrolled, after multidisciplinary consensus, for intervention with informed consent. Tumour response was defined using Response Evaluation Criteria In Solid Tumors v1.1. Toxicities were recorded using Common Terminology Criteria for Adverse Events v4.0. Time-to-event outcomes were described using the Kaplan–Meier method, and associations of baseline variables with tumour shrinkage was assessed using linear regression. Patients received either single fraction of 26 Gy or three fractions of 14 Gy, dependent on tumour size. Results Of 37 patients (median age 78 years), 62% had T1b, 35% had T1a and 3% had T2a disease. One patient presented with bilateral primaries. Histology was confirmed in 92%. In total, 33 patients and 34 kidneys received all prescribed SABR fractions (89% feasibility). The median follow-up was 24 months. Treatment-related grade 1–2 toxicities occurred in 26 patients (78%) and grade 3 toxicity in one patient (3%). No grade 4–5 toxicities were recorded and six patients (18%) reported no toxicity. Freedom from local progression, distant progression and overall survival rates at 2 years were 100%, 89% and 92%, respectively. The mean baseline glomerular filtration rate was 55 mL/min, which decreased to 44 mL/min at 1 and 2 years (P < 0.001). Neutrophil:lymphocyte ratio correlated to % change in tumour size at 1 year, r2 = 0.45 (P < 0.001). Conclusion The study results show that SABR for primary RCC was feasible and well tolerated. We observed encouraging cancer control, functional preservation and early survival outcomes in an inoperable cohort. Baseline neutrophil:lymphocyte ratio may be predictive of immune-mediated response and warrants further investigation.

Background: Recently an intraocular lens (IOL) has been introduced which blocks blue light. As blocking blue light may be to the patient's detriment, this study was designed to evaluate visual function following implantation of a blue-blocking (Acrysof Natural) IOL. Methods: Patients were recruited for this non-randomized controlled interventional study, from those attending a private rural ophthalmology clinic for cataract surgery (n = 93). Only those who had previously had a conventional IOL implanted into one eye were offered an Acrysof Natural IOL for the second eye. Postoperatively patients underwent refracted Snellen visual acuity, contrast sensitivity using a CSV-1000E instrument and colour vision testing using a Farnsworth D-15 test, with a subset (n = 20) undergoing a Farnsworth–Munsell 100-Hue test. Results were then compared between eyes. Finally, a subset (n = 63) completed a survey designed to assess the subjective impact of the Acrysof Natural IOL. Results: There were no statistically significant differences between eyes implanted with conventional IOLs compared with Acrysof Natural IOLs for visual acuity (t = 0.57; P = 0.57), contrast sensitivity (t = 0.43; P = 0.67 for 3 cycles per degree [cpd], t = 0.56; P = 0.58 for 6 cpd, t = 0.09; P = 0.93 for 12 cpd and t = 0.16; P = 0.87 for 18 cpd) or colour vision with the Farnsworth D-15 (χ2 = 0.38; P = 0.55) or the Farnsworth–Munsell 100-Hue test t = 0.34; P = 0.74). Most subjects reported that they could not tell a difference between the two IOLs subjectively or that any difference experienced was not significant. Conclusion: Our sample did not show any significant differences between eyes implanted with conventional IOLs and the Acrysof Natural IOL. We would suggest that the Acrysof Natural IOL may be used without any significant difference in visual function.