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Looking deeper: An investigation of soil carbon losses following harvesting from a managed northeastern red spruce (Picea rubens Sarg erectile dysfunction treatment ginseng buy genuine vigrx plus online. Forest carbon storage in the northeastern United States: Net effects of harvesting frequency best erectile dysfunction pills over the counter order vigrx plus 60caps amex, post-harvest retention erectile dysfunction bipolar medication order vigrx plus 60 caps free shipping, and wood products erectile dysfunction and icd 9 buy 60 caps vigrx plus with mastercard. Mineral soil carbon and nutrient still low three decades following clearcut harvesting in a typical Acadian Forest stand. Local-level criteria and indicators: an Aboriginal perspective on sustainable forest management. Procedural Guide For Ecological Landscape Analysis An Ecosystem Based Approach to Landscape Level Planning in Nova Scotia. Carbon storage in a chronosequence of red spruce (Picea rubens) forests in central Nova Scotia, Canada. Criteria and Indicators for the conservation and sustainable Management of Temperate and Boreal Forests. Special thanks are extended to members of the Dairy Scientific Advisory Panel for their commitment, guidance and advice throughout the risk assessment process, and to Australian dairy industry personnel who graciously authorised access to industry information and State authorities for the provision of microbiological data. The assessment was undertaken to answer the following questions: (1) What are the risks to public health and safety posed by the consumption, in Australia, of raw cow milkfi The risk assessment considered domestic and international information from published and unpublished sources on: milk production systems, prevalence and levels of pathogens in raw cow milk and in cattle, consumption data, and epidemiological data. This information provided an overall picture of the public health risks associated with consumption of raw cow milk. In order to estimate the likelihood of illness for Australian consumers following consumption of raw cow milk, quantitative microbiological modelling was undertaken. The modelling predicted the number of illnesses per 100,000 servings of raw milk consumed directly from the bulk milk tank, after farm-gate sale, and retail sale for four identified key milkborne pathogens: Campylobacter spp. The key findings of the risk assessment can be summarised as: • Raw cow milk is associated with foodborne illness internationally, and has been linked to illnesses in Australia • Four key pathogens are associated with outbreaks of foodborne illness implicating raw cow milk, these are Campylobacter spp. Indirect contamination may arise from (i) a cow’s own faecal matter contaminating the udder and teats, (ii) faecal matter of other cows contaminating the udder (iii) milking clusters contacting surfaces with faecal contamination, and (iv) post-harvest environmental contamination. An intensive search of published and unpublished literature shows that internationally, raw cow milk is often contaminated with pathogens and, whilst data is scarce for Australia, the data which is available confirms that raw cow milk is a source of low levels of pathogenic microorganisms. Consumption of raw cow milk on school camps, during farm visits or via consumption of products marketed as pet or cosmetic milk, has been implicated in eight outbreaks of illness between 1998 2003 in Australia. Other than the burden of illness data, the quantitative modelling determined that: • Increased consumption of raw cow milk corresponds to an increase in the predicted number of illnesses • Inclusion of spoilage in the model resulted in an overall decrease in the number of predicted illnesses • Growth of pathogens occurred predominantly during domestic transportation and storage of raw milk • the occurrence and persistence of infection within herds or individual animals is often intermittent, which proves difficult to detect and routinely monitor • the ability to detect low levels of pathogens in raw milk is limited unless comprehensive sampling plans are used Understanding the extent to which cows in the herd carry pathogens in their gut, and shed them in their faeces, provides an important means of eliminating carrier animals and reducing the pathogen load in the farm and milking environment. Effective management of this would require high-level veterinary supervision and ongoing surveillance of individual animals in a herd. Such measures involve significant and often intensive interventions with concomitant enforcement authority oversight. Pathogen contamination of raw milk may be reduced by exercising enhanced hygienic control throughout the milk harvesting stage. Practices such as teat washing and dipping, foremilk stripping, and good milking hygiene will reduce the number of organisms (pathogenic and spoilage) that may enter the milk from environmental sources. For example, pre-milking udder washing with clean water and drying using hand towels reduces milk contamination by transient bacteria located on the exterior surfaces of the udder. Test and hold practices, pending negative test results, is a commonly practised strategy for high risk, perishable foods. Raw milk is highly perishable, with both pathogenic and spoilage organisms expected to proliferate pending the receipt of test results. Furthermore, even low levels of pathogens in raw milk present a risk to consumers, and frequently these are below the levels of detection of current microbiological sampling regime prescribed in the Australia New Zealand Food Standards Code. Test and hold regimes may therefore be inadequate to determine with any confidence that contaminated raw milk will not reach consumers. Based on the available data, more than 200 sets of 5 x 25ml samples from every batch would be required to detect low level contamination in raw milk with 95% confidence. Control of animal health, adherence to good milking practices, and control over milking parlour hygiene are important in reducing the microbial load in raw milk. The modelling undertaken demonstrates that although the pathogen level may be very low in raw milk, there remains a risk of causing illness if consumed. The ability to detect pathogens in raw milk depends on the accuracy of testing, skill of personnel and the limit of detection for specific testing methodologies and pathogens. A key finding of the Profile was that Australian dairy products have an excellent reputation for food safety, as the majority of dairy products available for sale in Australia are made using pasteurised milk. This finding was supported by the paucity of evidence attributing foodborne illness to dairy products. The Profile did not specifically examine the risks to public health and safety associated with the consumption of raw cow milk; however it did confirm that internationally, unpasteurised dairy products are the most common cause of dairy associated foodborne illness. This document seeks to assess the risks to public health and safety resulting from consumption of raw cow milk. It utilises available scientific data and addresses uncertainty and variability in the conclusions drawn from the data. For example, the relevance and quality of data, the veracity of its source, and the assumptions made in the quantitative modelling are taken into consideration. The output of this risk assessment provides an estimate of risk to Australian consumers from specific pathogens following the consumption of raw cow milk. The assessment is undertaken in the context of the existing food safety management practices in the Australian dairy industry, and addresses the risk management questions: 1. What are the risks to public health and safety posed by the consumption of raw cow milk in Australiafi What are the factors that would have the greatest impact on public health and safety along the production chain for raw cow milkfi The assessment considers specific microbiological hazards, and evaluates epidemiological and other scientific and technical data to determine whether these hazards have presented, or are likely to present, a public health risk in raw cow milk. The assessment also aims to identify where in the production and supply chain these hazards may be introduced, decreased or amplified. Assessing the risks resulting from consumption of further processed raw milk products, such as yoghurt and kefir, is outside the scope of this risk assessment. Although further processed products are outside the scope of this risk assessment, the findings may be used to determine the risks associated with the raw milk intended for processing into other raw milk products. The risk to public health and safety from consumption of selected 2 raw milk cheeses has been undertaken separately. It has therefore been assumed that at a minimum, practices, procedures and regulations pertaining to the existing bovine dairy industry would also apply to the production of raw cow milk. The assessment discusses microbiological hazards associated with raw cow milk, their attribution to raw milk mediated foodborne illness and the primary production and processing factors which impact on raw milk safety. The model utilises data encompassing all stages from milking through to consumption. Hazard Identification Pathogens associated with raw cow milk Epidemiological data Hazard Characterisation Dose response Severity of illness Exposure Assessment Quantitative evaluation of exposure to Enterohaemorrhagic E. The system for producing raw milk would be expected to be similar to that used for producing cow milk for pasteurisation. Packaging of raw milk would be expected to occur on farm or at facilities close to the production environment with a capacity for segregating milk intended for raw or pasteurised product. The assessment identifies and describes the process and risk factors associated with production of cow milk. These include industry best practice regimes such as mastitis control programs, pre and post milking udder treatment practices and milking parlour hygiene programs. Generally, consumption data can be calculated from production statistics which provide information on the amount of a food commodity available to the population, or detailed information on the types and amounts of foods consumed by individuals via consumption surveys. It is probable that raw cow milk consumption is very low among the general population in Australia because it is currently not permitted and access is extremely limited. Even with limited availability, there are consumers of raw cow milk within Australia who purchase milk in the form of “pet milk” or via “cow share” programs. Unpublished research indicates that these consumers have very strong beliefs regarding the health benefits attributed to raw milk and their right to consume such products, and subsequently raw milk is their milk of choice. Other studies undertaken internationally indicate generally low consumption of raw milk within the population. Consumption of raw milk is also practiced by dairy producers who have ready access to raw milk. In the absence of reliable data for raw milk consumption within Australia, data on the consumption of pasteurised milk was used to estimate consumption of raw milk.
See also allergic allograft the transplant of an organ or tissue conjunctivitis; allergic rhinitis; anaphylactic from one individual to bph causes erectile dysfunction vigrx plus 60 caps overnight delivery another of the same species shock; asthma erectile dysfunction symptoms causes and treatments purchase vigrx plus visa. For example erectile dysfunction what kind of doctor purchase cheap vigrx plus on-line, a transplant from one person to impotence qigong discount 60 caps vigrx plus another, but not an identical allergic rhinitis Medical term for hay fever, an twin, is an allograft. Also nose, sneezing, nose and eye itching, and tearing of known as an allogeneic graft or a homograft. Postnasal dripping of clear mucus frequently causes a cough, loss of smell is common, and occa- allopath A term sometimes applied to a physi- sionally loss of taste. Also cian who practices allopathy, or conventional medi- known as June cold and summer cold. The term “allopathy” was person with allergic rhinitis: rubbing his or her coined to designate conventional medicine as nose with the index finger. Allopathy is also known as con- allergy Hypersensitivity of the body’s immune ventional medicine. This form of alopecia capitis totalis; alopecia universalis; treatment is very effective for allergies to pollen, alopecia, traumatic. Common causes include the use of caustic hair straighteners, especially those that allergy scratch test See allergy skin test. Treatment options include, for lung dis- begins with rapid hair loss on discrete areas of the ease, replacement of the missing alpha-1 antit- scalp and sometimes progresses to complete bald- rypsin. It seems to be caused by an alpha-fetoprotein A plasma protein normally autoimmune mechanism, wherein the body’s own produced by a fetus, principally in the fetus’s liver, immune system attacks the hair follicles and dis- the fetal gastrointestinal tract, and the yolk sac, a rupts normal hair formation. Alopecia areata is structure temporarily present during embryonic sometimes associated with allergic disorders, thy- development. The longer the the fetal circulation and appears in the mother’s period of time of hair loss, the less chance that the blood. Alport syndrome involves inflammation alpha cell, pancreatic A type of cell found in of the kidney (nephritis), often progressing to kid- areas within the pancreas called the islets of ney failure, and sensory nerve hearing loss. Alpha cells make and release glucagon, Progression to kidney failure is gradual and usually which raises the level of glucose (sugar) in the occurs in males before 50 years of age. The other two main classes is using a special diet to treat cancer instead of are called beta interferon and gamma interferon. Complementary medicine is different from Alpha Omega Alpha An honor society, the med- alternative medicine. Whereas complementary med- ical school equivalent of Phi Beta Kappa of under- icine is used together with conventional medicine, graduate school. Alpha-1 antitrypsin deficiency leads to damage of various organs, espe- altitude illness See altitude sickness. At sea level the concentration of oxygen is about 21 per- amaurosis fugax A symptom that is often cent, and the barometric pressure averages 760 mm described as a shade coming down over the eye. As altitude increases, the concentration remains Amaurosis fugax is a partial or complete loss of the same, but the number of oxygen molecules per sight that is temporary. At 5,400 meters (approximately caused by arteriosclerosis in the blood vessels that 12,000 feet) above sea level, the barometric pres- supply the brain. It can also occur with excessive sure is only 483 mm Hg, so there are roughly 40 acceleration, as in flight, and with ophthalmic percent fewer oxygen molecules per breath. Because the amount of oxygen required for activity is the same at high alti- amazia A condition wherein the breast tissue is tude as at sea level, the body must adjust to having absent, but the nipple is present. The amblyopia, nocturnal Night blindness, also acclimatization process is inhibited by dehydration, known as day sight. Preventive medications include acetazo- ambulance A vehicle equipped with medications lamide (brand name: Diamox) and dexamethasone and devices intended to stabilize patients while (a steroid). On a cel- lular level, Alzheimer’s disease is characterized by ameba A single-celled, protozoan organism that the finding of unusual helical protein filaments in constantly changes shape. Alzheimer’s disease involves degeneration of the cortical regions, especially the frontal and temporal amebiasis the state of being infected with ame- lobes. There is currently no cure for Alzheimer’s bae, especially with the ameba Entamoeba histolytica. Amebic dysentery can be accompanied by ame- bic infection of the liver and other organs. A skin lesion that is Unilateral amastia (absence of one breast) is often amelanotic lacks the pigment melanin and, there- associated with absence of the pectoral muscles. This fluid can anorexia nervosa, disease of the female reproduc- be used for genetic and other diagnostic tests. American Type Culture Collection the world’s premier biological culture repository, and a key amniotic fluid the fluid bathing a fetus within resource for medical research. The street term “speed” refers to stimulant drugs amino acid One of the 20 building blocks from such as amphetamine. Gene the human body cannot make them and they must amplification plays a role in cancer. Amino acids are sometimes can occur in vivo (in the living individual) or in taken orally in supplement form. An amino acid screen is useful in diag- secretions flow to mix with food for digestion. Amputation can occur at an accident site, the scene of an animal attack, or a bat- aminotransferase An enzyme that catalyzes the tlefield. Amputation is also performed as a surgical transfer of an amino group from a donor molecule procedure. The donor molecule is usu- spread of gangrene as a complication of frostbite, ally an amino acid and the recipient molecule is injury, diabetes, arteriosclerosis, or any other ill- usually an alpha-2 keto acid. Sometimes the location of a cut may depend in part anaerobic Not requiring oxygen. Anaerobic bac- on its suitability to be fitted with an artificial limb, or teria, for example, do not require oxygen to grow. These structures were so the intensity of anal itching is increased by mois- named because they appeared to be shaped like an ture, pressure, and abrasion caused by clothing and almond. Amyloid protein that increase the possibility of yeast infections; and can be deposited in a localized area, and it may not psoriasis. Other causes of anal itching include hem- be harmful or it may affect only a single tissue of the orrhoids, anal fissures, abnormal local growth of body. This form of amyloidosis is called localized anal skin (anal papillae), and skin tags. Amyloidosis that affects tissues is directed first toward relieving the burning and throughout the body is referred to as systemic amy- soreness, including cleaning and drying the anus loidosis. Systemic amyloidosis can cause serious thoroughly, avoiding leaving soap in the anal area, changes in organs throughout the body. Amyloidosis showering gently without directly rubbing or irritat- can occur as its own entity or secondarily, as a ing the skin, and using moist pads rather than toilet result of another illness, including multiple paper to clean the anus after bowel movements. It is sometimes called Lou Gehrig’s serious allergic reaction that can result in death. Immediate emergency sample is microscopically evaluated using special treatment is required, for example, administration cellular stain methods. Anaphylactoid purpura illness, certain illnesses can more frequently be frequently follows a bacterial or viral infection of the associated with some patterns. For example, the throat or breathing passages, and it is an unusual nucleolar pattern is commonly found in the disease reaction of the body’s immune system to this infec- scleroderma. Treatment is androsterone A male sex hormone that is found directed toward the most significant area of involve- in the blood and urine of men and women. In severe normal number of red blood cells or quantity of cases, anaphylaxis can include potentially deadly hemoglobin. Children with anastomosis the connection of normally sepa- chronic anemia are prone to infections and learning rate parts. The main causes of anemia are bleeding, ring or it may be created during embryonic hemolysis (excessive destruction of red blood development, surgery, or trauma, or by pathological cells), underproduction of red blood cells (as in means. An anastomosis may, for example, connect bone marrow diseases), and underproduction of two blood vessels, or it may connect the healthy sec- normal hemoglobin (as in sickle cell anemia and in tions of the colon or rectum after a cancerous or iron deficiency anemia). Women are more likely otherwise diseased portion has been surgically than men to have anemia because of menstrual removed. Aplastic anemia frequently Known among medical students studying human occurs without a known cause. Iron is necessary to make hemoglobin, production is stimulated by the hormone testos- the molecule in red blood cells that is responsible terone. Known popu- of iron include meat, poultry, eggs, vegetables, and larly as andro, it has been used as a supplement to certain cereals.
Using a six-column format erectile dysfunction medications causing buy discount vigrx plus 60caps on-line, the yield data tables provide the following information: 1 erectile dysfunction drugs nz order vigrx plus 60caps line. To assist child care facilities with determining the proper amounts of foods to impotence while trying to conceive purchase vigrx plus paypal purchase impotence when trying for a baby buy vigrx plus 60 caps otc, Team Nutrition and the National Food Service Management Institute have created the Food Buying Guide Calculator for Child Nutrition Programs at: fbg. Short, self-tutorial videos are available on the site to assist you in learning how to use the calculator. Scroll down to Beef, ground, fresh or frozen and click on the type of beef you plan to buy. You are serving 5 1-2 year olds, so type in 5 in the box under Number of Servings. Your Shopping List will show that you will need to purchase fi pound of fresh or frozen ground beef with no more than 15% fat to serve 5 1-2 year olds at your facility. You still need to determine the amount to purchase for the 3-5 year-olds, 6-12 year olds, and adults. You are serving 15 3-5 year olds, so type in 15 in the box under Number of Servings. Your Shopping List will now show that you will need to purchase 2 pounds of fresh or frozen ground beef with no more than 15% fat to serve 15 3-5 year olds at your facility. You still need to determine the amount to purchase for the 6-12 year olds and adults. You are serving 5 6-12 year olds, but let’s assume for ease of food preparation that the 5 adults are eating the same serving size, so type in 10 in the box under Number of Servings. You can now either click on Add More Items if you want all of the foods for this meal on one shopping list or you may Print List or Email List if you want to have a shopping list for just ground beef. Note: You will need to manually add the ground beef amounts together when you do your actual shopping. Repeat the steps above for each of the other items on the menu – brown rice, broccoli, peaches, and milk. Transitional activities and projects relating to food, nutrition, and good eating help the children get ready for meals. Arts and Crafts About Good Eating Use these fun arts and crafts activities to teach children about foods. The activities can be planned for the hour before lunch or snack is served to bridge the time between active play and mealtime. Allow children to cut or tear pictures of foods they like from the magazine with adult supervision. Story Time Visit your local library to find books with a food growing or eating theme. Look for the Very Hungry Caterpillar by Eric Carle, Cooking Up a Story by Carol Elaine Catron and Barbra Catron Parks, or some old favorites like Goldilocks and the Three Bears, or Peter Rabbit. Read a story to give children a quiet transitional time from active play to mealtime, followed by a meal 1 National Food Service Management Institute 83 Happy Mealtimes Grab and Go Lesson Using Bridging Activities to Make Mealtimes Special featuring a food from the story. The Glory of Gardening Teach children where foods come from and how food plants grow. Learning about growing food is a great way to increase interest in food and eating. Gardens can be as big as an outdoor plot or as simple as sprouting seeds in a plastic bag. Ask a local gardener for advice on container-hearty vegetables like tomatoes, green peppers, and herbs that the children can watch grow and then eat. Tasty Toast Allow children to use cookie cutters to cut special shapes out of toast. Decorate the cut shapes with lowfat toppings like apple butter, jam, and cooked, dried fruits. Cereal Sundae Have available a variety of cereals, cut fresh fruits, and lowfat yogurt. Encourage children to be creative and artistic as they arrange their cereal sundae in a bowl or small plastic cup. Always remember to wash hands with warm water and soap before and after handling food! When kids have the opportunity to help in the kitchen, they develop a sense of pride. They also learn: fi Reading skills – as recipes are read, followed, and prepared fi Math skills – through counting, measuring, and following step-by-step directions fi Science skills – as food changes during cooking, and they learn about hot and cold, dissolving, melting, and freezing fi Thinking skills – as they compare and make relationships in food preparation. For example, they learn about proportion when they double the ingredients in a recipe and get double the cookies! They also learn about other cultures as they prepare foods from various cultural groups. Kids who learn to love gardening at an early age grow into adults with a passion for plants and respect for the environment. Gardens allow children: fi To be active and engaged in learning fi To build on prior learning and experiences with their environment fi To develop a relationship with nature fi To explore at their own pace Gardens can be as small as a container garden in a window or as large as a school habitat. If you are new to gardening with preschoolers, start small and then expand as your confidence and experience increases. Tips for container gardening fi Get enough containers with drainage holes for each child. Suitable containers can be: milk cartons or jugs; paper, plastic or Styrofoam cups; egg cartons; yogurt cups; coffee cans; flour or sugar sacks. Sweet peas grow fast, smell nice, and are a good choice for a first gardening experience. Tips for outdoor gardens fi Involve kids in all stages that are reasonable for their age. Hands-on activities like collecting, touching, tasting, and smelling help them learn through discovery. Most garden work can be completed with a child-sized trowel if the soil is well-prepared. To reinforce lesson concepts, the children will be served radish slices and For the craft activity: carrot strips at snack time. Examples are fi Reduced fat ranch dressing fi String cheese vegetables, fruits, beans, herbs, and grains. Studies show that children who participate in fruit, vegetable, and herb gardening are more likely to try these foods. If you already have a garden, allow children to help with garden tasks such as planting, weeding, watering, and harvesting. If you do not have space for a garden, an easy way to start is by using containers that you can place on your patio or deck. Explain that the children will plant a radish seed, care for it, and observe it as it sprouts and grows. Ask the children if they know which part of the plant will eventually become a radish (the root). Encourage parents to place the entire peat pot in the home garden or an outside container filled with planting soil. Carrots normally take 2 weeks or more to germinate so this is a good exercise in patience (a lesson presented in the book, the Carrot Seed. Make sure all children wash hands with warm water and soap for at least 20 seconds. Offering 1/2 ounce of string cheese (1 ounce for ages 6–12) will result in a reimbursable snack. Leader: fi For more information on gardening with children, check out the following web sites: N My First Garden, located at. Having fresh nutritious foods at hand is just one of many reasons to have a garden. The process of planting, watching over, and harvesting a garden provides daily opportunities for young children to learn valuable lessons, enjoy physical activity, and reap the fruits and vegetables of their labor. Many education activities, such as art, reading, and math skills, can be part of a garden project. Tips from the Experts on Successful Gardening with Young Children Start small with a salad bowl garden.
Optic chiasm glioma – if chiasmatic sulcus very depressed (W- or omega-shaped sella) erectile dysfunction medications cost vigrx plus 60caps cheap, glioma may be bilateral erectile dysfunction drugs not working buy vigrx plus 60 caps cheap. Pituitary microadenoma – <10 mm; enhance more slowly than normal pituitary erectile dysfunction in young generic vigrx plus 60caps line, therefore low signal on enhanced studies (will 12 show enhancement if imaged late); often different signal to erectile dysfunction family doctor buy vigrx plus pills in toronto normal gland on unenhanced scans; distort outline of gland. Pituitary (pars intermedia) cyst – similar to microadenoma but may be lower T1; higher T2 signal. Rathke’s cleft cyst – may be intrasellar, suprasellar or involve both compartments. Lymphocytic hypophysitis – lymphocytic infltration of anterior pituitary, infundibulum and foor of hypothalamus; typically during pregnancy and peripartum period but also occurs in males; enhances postcontrast with hypothalamic tail. Germinoma – involvement of infundibulum, anterior recesses of third ventricle and hypothalamic region; homogeneous avidly enhancing mass; check for pineal region involvement; transependymal spread common. Sarcoidosis – involvement of optic pathways, foor of third ventricle and infundibulum very suggestive of sarcoidosis. Meningioma – arising in and extending from anterior cranial fossa, sphenoid wing or diaphragma sella: homogeneous mass with uniform enhancement (unless cystic); pituitary should be visible as separate structure. Hypothalamic hamartoma – uniform mass in patients with precocious puberty or gelastic seizures. Dermoid – midline mass with fat and calcifcation; rupture gives rise to disseminated small areas of high T1 signal fat in subarachnoid space. Trigeminal schwannoma – if large may involve cerebellopontine angle, Meckel’s cave, cavernous sinus and pterygomaxillary fssure; extension through foramen ovale if present helps to differentiate between schwannoma and meningioma. Cavernous sinus thrombosis – sinus expanded, abnormal signal; usually secondary to perifacial/orbital sepsis. Caroticocavernous fstula – direct (via internal carotid artery) or indirect (via dura) causes enlargement of sinus and draining veins (especially superior ophthalmic vein) leading to ophthalmoplegia, proptosis and chemosis. Drainage routes other than orbit may predominate (therefore normal orbit does not exclude caroticocavernous fstula). Tolosa–Hunt syndrome – painful ophthalmoplegia caused by non-specifc granulomatous infltration of cavernous sinus and superior orbital fssure; usually steroid responsive. Teratoma – second commonest pineal germ cell tumour: heterogeneous mass (fat, calcifcation, cystic change); spectrum of malignant potential. Parenchymal pineal tumours (a) Pineocytoma: commoner in older adults; slow growing. Vestibular schwannoma (acoustic neuroma) – commonest (90%); intracanalicular component often expands porus acousticus of internal auditory meatus but may be all extracanalicular; may cause distortion of brainstem (middle cerebellar peduncle) and obstructive hydrocephalus (but hydrocephalus may be present in absence of obstruction). Meningioma (9%) – broad base against petrous bone, may extend into but usually do not expand porus. Acquired cholesteatoma – expanding mass of epithelial debris in epitympanum of middle ear cavity; erodes and invades surrounding bone leading to: (a) Cerebral abscess/meningitis by erosion of tegmen. Malignant otitis externa – acute osteomyelitis of temporal bone in elderly, diabetics, immunocompromised: local bone erosion and extensive soft-tissue swelling. Cholesterol granuloma – non-specifc chronic infammation of middle ear and mastoid; high signal T1 and T2. Masses and disease entities of the external auditory canal: radiological and clinical correlation. Rhabdomyosarcoma – commonest soft-tissue sarcoma in children; usually involves orbit, paranasal sinuses and pharynx. Carcinoma of the parotid – direct extension into foor of external auditory meatus/mastoid; infltration along facial nerve. Otosclerosis – condition characterized by periods of demineralization followed by sclerotic repair; ill-defned bone resorption around oval window or cochlea (lucent halo around cochlea) followed by irregular bone deposition; both processes may be simultaneous rather than sequential. Paget’s disease – initial changes at petrous apex with demineralization and irregular bone deposition leading to hypertrophied, irregularly mineralized bone; can involve otic capsule, labyrinth and internal auditory canal. Fibrous dysplasia – thickening of outer table of squamous temporal bone with obliteration of mastoid air cells. Osteopetrosis – homogeneous sclerotic temporal bone with obliteration of air cells; progressive narrowing of internal auditory meatus can cause facial palsy. Large/dehiscent jugular bulb – normal fow may be perceived especially if thin plate of bone normally between wall of jugular vein and middle ear absent; may also give rise to protrusion of jugular bulb into middle ear (not to be mistaken for glomus). Aberrant carotid artery – inferior compartment of middle ear flled by carotid running posterior and lateral to its normal course. Persistent stapedial artery – failure of regression of embryonic stapedial artery runs through lumen of stapes. Venous sinus thrombosis – incomplete thrombosis of lateral sinus may lead to turbulent fow. Schwannoma – foramen enlarged but no erosion or lysis; well- defned, lobulated tumour which enhances postcontrast. Infammatory arthropathies – rheumatoid with soft-tissue pannus eroding odontoid peg. Metastases – commonest = breast, bronchus, prostate; four common clinical syndromes: (a) Orbital: pain, diplopia, proptosis, external ophthalmoplegia. Parietal foramina – usually bilateral and symmetrical anterior to lambdoid suture. Myeloma – multiple lytic lesions (pepper-pot skull); can involve mandible (where metastases very rare). Hyperparathyroidism – solitary brown tumour or multiple lucencies (pepper-pot skull). Acute pyogenic – complication of sinusitis, mastoiditis, penetrating head trauma, postsurgical. Sinus pericranii – abnormally large communication between intracranial and extracranial venous circulations; congenital, traumatic or spontaneous; presents as: (a) Numerous small localized defects. Osteoporosis circumscripta – lytic phase of Paget’s disease; usually inferior frontal and occipital bones; rarer at vertex; can cross sutures. Paget’s disease – multiple islands of dense bone, loss of differentiation of inner and outer tables, thickening of skull vault; basilar invagination can occur. Acromegaly – enlarged frontal sinuses, prognathism, enlarged sella, thickened skull vault. Lacunar skull – bone dysplasia of membranous skull; indentations or pits in frontal and parietal regions that may be full thickness; defects separated by thin rims of bone; usually disappear by 6 months; not associated with raised intracranial pressure. McGregor’s line lies between posterior tip of hard palate and base of occiput; odontoid tip should lie < 5 mm above line. Sickle-cell anaemia – initially in frontal region but can involve whole skull where diploic space present (marrow cavity), i. Most venous infarcts show similar changes to arterial infarcts Acute May be high signal Decreased/normal in haemorrhage in hyperacute and hyperacute stage late subacute (deoxyhaemoglobin and extracellular methaemoglobin) Increased in late subacute stage Often variable but T2* Often variable imaging will often show low signal rim Acute Variable signalfi Combined assessment with radiological fndings infuences prognosis and treatment decisions. Tumour normally hyperintense compared to myometrium and cervical stroma on T2 scans. A T2 scan, coronal to plane of uterus, is useful to evaluate uterine/ endometrial abnormalities. Leiomyosarcoma (a) Thought to arise from pre-existing fbroid, usually but not exclusively postmenopausal. Normal endometrium varies across the menstrual cycle with most prominent thickening in the secretory phase. Endometrial hyperplasia can occur pre- and postmenopausally due to prolonged oestrogen exposure. Sometimes diffcult to differentiate between an endometrial polyp and a submucosal fbroid. High-resolution scanning required using T2 sequences in the axial, sagittal and coronal planes, with a specifc sequence axial to the plane of the uterus to assess the endometrium/myometrial junctional zone. The depth of the myometrial invasion is critical to staging and subsequent surgical management. Postgadolinium T1W sequences are sometimes useful to defne the depth of myometrial invasion. Tumour appears slightly hypointense compared to endometrium but hyperintense compared to myometrium. Most cysts are relatively asymptomatic until they become space occupying, although torsion, haemorrhage and rupture may be very painful. Haemorrhage into a cyst alters the appearance and sometimes makes it diffcult to exclude a more sinister lesion. Post-bilateral oophorectomy a pelvic cyst may be due to a small amount of residual functioning ovarian tissue.
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