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Papers by Richard Pitcher

Background: The role of the radiology information system in streamlining imaging workflow and enh... more Background: The role of the radiology information system in streamlining imaging workflow and enhancing efficiency in digital radiology departments is now well established. Although there is increasing use of systems with the capacity for computerized physician order entry, there has been limited work on the quality of clinical data provided on electronic diagnostic imaging requests. Purpose: To assess the quality of clinical details provided on electronic diagnostic imaging requests (DIR) for emergency non-trauma abdominal computed tomography (CT) scans, and the impact of such data on radiological outcomes. Material and Methods: We conducted a retrospective analysis of 100 consecutive electronic DIRs for emergency non-trauma abdominal CT scans for patients with an acute abdomen in a tertiary-level public-sector hospital. The quality of clinical data was assessed using the Royal College of Physicians' referral guidelines and correlated with radiological outcomes, defined as a definitive CT diagnosis. Results: Eighty-eight percent of requests presented a clear clinical question, 48% recorded clinical examination details, 29% had adequate clinical histories, and 17% included laboratory investigations, while only 2% of requests were complete in all respects. Although 88% of scans yielded a definitive radiological diagnosis, there was no association between the adequacy of DIR details and a definitive radiological outcome. Conclusion: Our findings underscore the non-specific clinical presentation of non-trauma-related abdominal emergencies and the pivotal role of CT in providing a definitive diagnosis in this setting. We suggest that the appropriate triage of patients presenting with an acute, non-trauma abdomen is the overriding clinical imperative.

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2007

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2004

for a tympanoplasty, when a peri-operative chest radiograph showed a calcified granuloma in the r... more for a tympanoplasty, when a peri-operative chest radiograph showed a calcified granuloma in the right lung , but no other abnormality.

South African Journal of Radiology, 2014

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2003

Pediatric Radiology, 2013

Anorectal malformations are often associated with rectal pouch fistulas. Surgical correction requ... more Anorectal malformations are often associated with rectal pouch fistulas. Surgical correction requires accurate evaluation of the presence and position of such fistulas. Fluoroscopy is currently the chosen modality for the detection of fistulas. The role of MRI is unexplored. To compare the diagnostic accuracy of MR versus fluoroscopic fistulography in the pre-operative evaluation of infants with anorectal malformation. We conducted a pilot study of infants requiring defunctioning colostomy for initial management of anorectal malformation. Dynamic sagittal steady-state free-precession MRI of the pelvis was acquired during introduction of saline into the mucous fistulas. Findings were compared among MR fistulography, fluoroscopic fistulography and intraoperative inspection. Eight children were included. Median age at fistulography was 15 weeks, inter-quartile range 13-20 weeks; all were boys. There was full agreement among MR fistulography, fluoroscopic fistulography and surgical findings. The pilot data suggest that MR fistulography is promising in the pre-operative evaluation of children with anorectal malformation.

Emergency Radiology, 2007

A pilot study evaluating the use in paediatric polytrauma of the STATSCAN, a low-radiation dose, ... more A pilot study evaluating the use in paediatric polytrauma of the STATSCAN, a low-radiation dose, fanbeam digital radiography unit (Lodox Systems, Sandton, South Africa). Over 3 months, 23 polytrauma patients treated at the Emergency Unit of the Red Cross Children's Hospital in Cape Town, South Africa, were imaged on the STATSCAN. Image quality, diagnostic equivalence and clinical efficiency were compared with a computed radiog-raphy (CR) system (Fuji FCR 5000, Fuji Photo Film, Tokyo, Japan). The STATSCAN antero-posterior bodygram correlated well technically and diagnostically with CR, showing 96% of the fractures in the cohort. It allowed superior visualisation of the trachea and main bronchi and imaging was, on average, 13% faster than CR. The STATSCAN could play an important role in paediatric polytrauma. The clinical significance of its superior demonstration of the trachea and main bronchi requires further evaluation.

South African Journal of Radiology, 2009

... 1990. Ann ICRP 21: 1-201. 6. Maree GJ, Irving BJ, Hering ER. Paediatric dosemeasurement in a ... more ... 1990. Ann ICRP 21: 1-201. 6. Maree GJ, Irving BJ, Hering ER. Paediatric dosemeasurement in a full-body digital radiography unit. Pediatr Radiol 2007; 37(10): 990-997. 7. Irving BJ, Maree GJ, Hering E, Douglas TS. Radiation ...

Thorax, Jan 9, 2015

There is limited knowledge of chest radiographic abnormalities over time in HIV-infected children... more There is limited knowledge of chest radiographic abnormalities over time in HIV-infected children in resource-limited settings. To investigate the natural history of chest radiographic abnormalities in HIV-infected African children, and the impact of antiretroviral therapy (ART). Prospective longitudinal study of the association of chest radiographic findings with clinical and immunological parameters. Chest radiographs were performed at enrolment, 6-monthly, when initiating ART and if indicated clinically. Radiographic abnormalities were classified as normal, mild or moderate severity and considered persistent if present for 6 consecutive months or longer. An ordinal multiple logistic regression model assessed the association of enrolment and time-dependent variables with temporal radiographic findings. 258 children (median (IQR) age: 28 (13-51) months; median CD4+%: 21 (15-24)) were followed for a median of 24 (18-42) months. 70 (27%) were on ART at enrolment; 130 (50%) (median ag...

Pediatric pulmonology, 2011

To describe the radiographic features of PCP in South African children, including the progression... more To describe the radiographic features of PCP in South African children, including the progression of changes and the impact of HIV-infection and respiratory co-infections. A paediatric radiologist blinded to clinical details retrospectively reported the chest radiographs of children diagnosed with PCP at a South Africa paediatric hospital between January 2003 and June 2006 inclusive. Radiographic features were correlated with clinical findings and compared using Fisher's exact test and Wilcoxon's ranks-sum test. Institutional ethics approval was obtained. Of 113 cases of PCP, 110 (97.3%) had presenting and 96 (84.9%) follow-up radiographs; 88 (82%) were HIV-infected; 65 (59%) had respiratory co-infection; 48 (43%) died in hospital. The commonest presenting radiographic findings were increased lung volumes (n = 86; 78%) and diffuse parenchymal opacification (n = 70; 64%); 89 (92.7%) ultimately progressed to diffuse alveolar opacification. Median time to maximum pulmonary opac...

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2005

A 5-month-old boy was well until the day before admission, when he developed a cough. On the morn... more A 5-month-old boy was well until the day before admission, when he developed a cough. On the morning of admission he was irritable and his mother noticed a blue tinge to his lips during episodes of crying. This prompted her to bring him to the emergency unit at Red Cross Children's Hospital, where he was found to be distressed and cyanosed, with a respiratory rate of 60 beats per minute, a heart rate of 200/minute and alar flaring. His left chest showed decreased air entry, bronchial breathing and dullness to percussion. Oxygen saturation was 66%, improving to 88% on face-mask oxygen. His weight was on the 50th percentile. He was well hydrated, well perfused and had no significant background medical history.

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2004

... Mohammed Thandar is a consultant otolaryngologist at New Somerset Hospital in Cape Town and a... more ... Mohammed Thandar is a consultant otolaryngologist at New Somerset Hospital in Cape Town and an honorary lecturer and consultant at Groote Schuur Hospital and the University of Cape Town. ... 2. Emmett JR, Fisher ND, Biggers W. Tuberculous mastoiditis. ...

Pediatric Critical Care Medicine, 2012

To investigate the effect of closed-system vs. open endotracheal suctioning on the frequency of v... more To investigate the effect of closed-system vs. open endotracheal suctioning on the frequency of ventilator-associated pneumonia and outcome in a pediatric intensive care unit in a developing country.

Emergency Radiology, 2007

A pilot study evaluating the use in paediatric polytrauma of the STATSCAN, a low-radiation dose, ... more A pilot study evaluating the use in paediatric polytrauma of the STATSCAN, a low-radiation dose, fanbeam digital radiography unit (Lodox Systems, Sandton, South Africa). Over 3 months, 23 polytrauma patients treated at the Emergency Unit of the Red Cross Children's Hospital in Cape Town, South Africa, were imaged on the STATSCAN. Image quality, diagnostic equivalence and clinical efficiency were compared with a computed radiog-raphy (CR) system (Fuji FCR 5000, Fuji Photo Film, Tokyo, Japan). The STATSCAN antero-posterior bodygram correlated well technically and diagnostically with CR, showing 96% of the fractures in the cohort. It allowed superior visualisation of the trachea and main bronchi and imaging was, on average, 13% faster than CR. The STATSCAN could play an important role in paediatric polytrauma. The clinical significance of its superior demonstration of the trachea and main bronchi requires further evaluation.

Pediatric Radiology, 2009

Respiratory infections are the commonest cause of pulmonary change on chest radiographs of HIV-in... more Respiratory infections are the commonest cause of pulmonary change on chest radiographs of HIV-infected children. However, HIV-related neurological, oropharyngeal, oesophageal, cardiac and haematological abnormalities may also manifest with pulmonary changes and must be considered in the interpretation of the chest radiograph in HIV-infected children.

Pediatric Radiology, 2009

We present a 3-year review of clinical paediatric experience with the Statscan (Lodox Systems, Jo... more We present a 3-year review of clinical paediatric experience with the Statscan (Lodox Systems, Johannesburg, South Africa), a low-dose, digital, whole-body, slitscanning X-ray machine. While focusing on the role of the unit in paediatric polytrauma, insight into its applications in other paediatric settings is provided.

Pediatric Pulmonology, 2014

The chest X-ray (CXR) abnormalities of human immunodeficiency virus (HIV)-infected children in lo... more The chest X-ray (CXR) abnormalities of human immunodeficiency virus (HIV)-infected children in low/middle income countries (LMIC's) have not been well studied. To describe the CXR abnormalities and associated clinical/immunological features in HIV-infected South African children. A prospective study of HIV-infected children who underwent baseline chest radiography and clinical and immunological HIV-staging. CXR abnormalities were stratified as grade 1 (mild) or grade 2 (moderate/severe). Univariate and multiple logistic regression analyses assessed associations between radiological severity and clinical/immunological parameters. Three hundred thirty children (53% male), median age 23.8 months, were included; 303 (92%) had moderate/severe clinical disease and 225 (68%) moderate/severe immune suppression; 52 (16%) had a normal CXR; 169 (51%) had grade 2 CXR abnormalities, manifesting as: confluent opacification (n = 91, 28%), nodules (n = 37, 11%), or nodules with opacification (n = 41, 12%) Grade 2 abnormality was associated with more advanced clinical HIV disease (OR: 6.9; 95% CI: 1.9-25.6), CD4+ less than 20% (OR: 1.8; 95% CI: 1.0-3.0) and age over 24 months (OR: 4.1; 95% CI: 2.1-8.0). CXR abnormalities are common in HIV-infected children in LMIC's. The extent of radiological abnormality correlates with age and clinical and immunological severity of HIV-disease.

Pediatric Pulmonology, 2005

The Pediatric Infectious Disease Journal, 2006

Tuberculous (TB) meningitis is sometimes difficult to diagnose in young children. The decision to... more Tuberculous (TB) meningitis is sometimes difficult to diagnose in young children. The decision to start anti-TB treatment of TB meningitis is usually made on clinical grounds and results of special investigations, such as cerebrospinal fluid examination and cranial computerized tomography (CT), because bacteriologic yield is low and the results delayed. To determine whether the clinical, laboratory, and radiologic criteria used in the diagnosis of TB meningitis in human immunodeficiency virus (HIV)-uninfected children apply to HIV-infected children. Retrospective, case-control study. Clinical, laboratory, and radiologic features of TB meningitis were compared in 34 HIV-infected and 56 HIV-uninfected patients matched for age and stage of TB meningitis. All clinical differences found between the 2 groups at admission were related to the underlying HIV disease. Neurologic presentation and cerebrospinal fluid findings at admission did not differ significantly between the 2 groups. Significantly more HIV-infected than HIV-uninfected children had evidence of TB on chest radiography. The classic CT signs of TB meningitis (obstructive hydrocephalus and basal enhancement) were significantly less prominent in the HIV-infected group (P < 005). The diagnostic criteria for clinical diagnosis of TB meningitis apply to HIV-infected children. However, cranial CT findings in this group may be misleading and delay the diagnosis of TB meningitis.

Background: The role of the radiology information system in streamlining imaging workflow and enh... more Background: The role of the radiology information system in streamlining imaging workflow and enhancing efficiency in digital radiology departments is now well established. Although there is increasing use of systems with the capacity for computerized physician order entry, there has been limited work on the quality of clinical data provided on electronic diagnostic imaging requests. Purpose: To assess the quality of clinical details provided on electronic diagnostic imaging requests (DIR) for emergency non-trauma abdominal computed tomography (CT) scans, and the impact of such data on radiological outcomes. Material and Methods: We conducted a retrospective analysis of 100 consecutive electronic DIRs for emergency non-trauma abdominal CT scans for patients with an acute abdomen in a tertiary-level public-sector hospital. The quality of clinical data was assessed using the Royal College of Physicians' referral guidelines and correlated with radiological outcomes, defined as a definitive CT diagnosis. Results: Eighty-eight percent of requests presented a clear clinical question, 48% recorded clinical examination details, 29% had adequate clinical histories, and 17% included laboratory investigations, while only 2% of requests were complete in all respects. Although 88% of scans yielded a definitive radiological diagnosis, there was no association between the adequacy of DIR details and a definitive radiological outcome. Conclusion: Our findings underscore the non-specific clinical presentation of non-trauma-related abdominal emergencies and the pivotal role of CT in providing a definitive diagnosis in this setting. We suggest that the appropriate triage of patients presenting with an acute, non-trauma abdomen is the overriding clinical imperative.

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2007

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2004

for a tympanoplasty, when a peri-operative chest radiograph showed a calcified granuloma in the r... more for a tympanoplasty, when a peri-operative chest radiograph showed a calcified granuloma in the right lung , but no other abnormality.

South African Journal of Radiology, 2014

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2003

Pediatric Radiology, 2013

Anorectal malformations are often associated with rectal pouch fistulas. Surgical correction requ... more Anorectal malformations are often associated with rectal pouch fistulas. Surgical correction requires accurate evaluation of the presence and position of such fistulas. Fluoroscopy is currently the chosen modality for the detection of fistulas. The role of MRI is unexplored. To compare the diagnostic accuracy of MR versus fluoroscopic fistulography in the pre-operative evaluation of infants with anorectal malformation. We conducted a pilot study of infants requiring defunctioning colostomy for initial management of anorectal malformation. Dynamic sagittal steady-state free-precession MRI of the pelvis was acquired during introduction of saline into the mucous fistulas. Findings were compared among MR fistulography, fluoroscopic fistulography and intraoperative inspection. Eight children were included. Median age at fistulography was 15 weeks, inter-quartile range 13-20 weeks; all were boys. There was full agreement among MR fistulography, fluoroscopic fistulography and surgical findings. The pilot data suggest that MR fistulography is promising in the pre-operative evaluation of children with anorectal malformation.

Emergency Radiology, 2007

A pilot study evaluating the use in paediatric polytrauma of the STATSCAN, a low-radiation dose, ... more A pilot study evaluating the use in paediatric polytrauma of the STATSCAN, a low-radiation dose, fanbeam digital radiography unit (Lodox Systems, Sandton, South Africa). Over 3 months, 23 polytrauma patients treated at the Emergency Unit of the Red Cross Children's Hospital in Cape Town, South Africa, were imaged on the STATSCAN. Image quality, diagnostic equivalence and clinical efficiency were compared with a computed radiog-raphy (CR) system (Fuji FCR 5000, Fuji Photo Film, Tokyo, Japan). The STATSCAN antero-posterior bodygram correlated well technically and diagnostically with CR, showing 96% of the fractures in the cohort. It allowed superior visualisation of the trachea and main bronchi and imaging was, on average, 13% faster than CR. The STATSCAN could play an important role in paediatric polytrauma. The clinical significance of its superior demonstration of the trachea and main bronchi requires further evaluation.

South African Journal of Radiology, 2009

... 1990. Ann ICRP 21: 1-201. 6. Maree GJ, Irving BJ, Hering ER. Paediatric dosemeasurement in a ... more ... 1990. Ann ICRP 21: 1-201. 6. Maree GJ, Irving BJ, Hering ER. Paediatric dosemeasurement in a full-body digital radiography unit. Pediatr Radiol 2007; 37(10): 990-997. 7. Irving BJ, Maree GJ, Hering E, Douglas TS. Radiation ...

Thorax, Jan 9, 2015

There is limited knowledge of chest radiographic abnormalities over time in HIV-infected children... more There is limited knowledge of chest radiographic abnormalities over time in HIV-infected children in resource-limited settings. To investigate the natural history of chest radiographic abnormalities in HIV-infected African children, and the impact of antiretroviral therapy (ART). Prospective longitudinal study of the association of chest radiographic findings with clinical and immunological parameters. Chest radiographs were performed at enrolment, 6-monthly, when initiating ART and if indicated clinically. Radiographic abnormalities were classified as normal, mild or moderate severity and considered persistent if present for 6 consecutive months or longer. An ordinal multiple logistic regression model assessed the association of enrolment and time-dependent variables with temporal radiographic findings. 258 children (median (IQR) age: 28 (13-51) months; median CD4+%: 21 (15-24)) were followed for a median of 24 (18-42) months. 70 (27%) were on ART at enrolment; 130 (50%) (median ag...

Pediatric pulmonology, 2011

To describe the radiographic features of PCP in South African children, including the progression... more To describe the radiographic features of PCP in South African children, including the progression of changes and the impact of HIV-infection and respiratory co-infections. A paediatric radiologist blinded to clinical details retrospectively reported the chest radiographs of children diagnosed with PCP at a South Africa paediatric hospital between January 2003 and June 2006 inclusive. Radiographic features were correlated with clinical findings and compared using Fisher's exact test and Wilcoxon's ranks-sum test. Institutional ethics approval was obtained. Of 113 cases of PCP, 110 (97.3%) had presenting and 96 (84.9%) follow-up radiographs; 88 (82%) were HIV-infected; 65 (59%) had respiratory co-infection; 48 (43%) died in hospital. The commonest presenting radiographic findings were increased lung volumes (n = 86; 78%) and diffuse parenchymal opacification (n = 70; 64%); 89 (92.7%) ultimately progressed to diffuse alveolar opacification. Median time to maximum pulmonary opac...

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2005

A 5-month-old boy was well until the day before admission, when he developed a cough. On the morn... more A 5-month-old boy was well until the day before admission, when he developed a cough. On the morning of admission he was irritable and his mother noticed a blue tinge to his lips during episodes of crying. This prompted her to bring him to the emergency unit at Red Cross Children's Hospital, where he was found to be distressed and cyanosed, with a respiratory rate of 60 beats per minute, a heart rate of 200/minute and alar flaring. His left chest showed decreased air entry, bronchial breathing and dullness to percussion. Oxygen saturation was 66%, improving to 88% on face-mask oxygen. His weight was on the 50th percentile. He was well hydrated, well perfused and had no significant background medical history.

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2004

... Mohammed Thandar is a consultant otolaryngologist at New Somerset Hospital in Cape Town and a... more ... Mohammed Thandar is a consultant otolaryngologist at New Somerset Hospital in Cape Town and an honorary lecturer and consultant at Groote Schuur Hospital and the University of Cape Town. ... 2. Emmett JR, Fisher ND, Biggers W. Tuberculous mastoiditis. ...

Pediatric Critical Care Medicine, 2012

To investigate the effect of closed-system vs. open endotracheal suctioning on the frequency of v... more To investigate the effect of closed-system vs. open endotracheal suctioning on the frequency of ventilator-associated pneumonia and outcome in a pediatric intensive care unit in a developing country.

Emergency Radiology, 2007

A pilot study evaluating the use in paediatric polytrauma of the STATSCAN, a low-radiation dose, ... more A pilot study evaluating the use in paediatric polytrauma of the STATSCAN, a low-radiation dose, fanbeam digital radiography unit (Lodox Systems, Sandton, South Africa). Over 3 months, 23 polytrauma patients treated at the Emergency Unit of the Red Cross Children's Hospital in Cape Town, South Africa, were imaged on the STATSCAN. Image quality, diagnostic equivalence and clinical efficiency were compared with a computed radiog-raphy (CR) system (Fuji FCR 5000, Fuji Photo Film, Tokyo, Japan). The STATSCAN antero-posterior bodygram correlated well technically and diagnostically with CR, showing 96% of the fractures in the cohort. It allowed superior visualisation of the trachea and main bronchi and imaging was, on average, 13% faster than CR. The STATSCAN could play an important role in paediatric polytrauma. The clinical significance of its superior demonstration of the trachea and main bronchi requires further evaluation.

Pediatric Radiology, 2009

Respiratory infections are the commonest cause of pulmonary change on chest radiographs of HIV-in... more Respiratory infections are the commonest cause of pulmonary change on chest radiographs of HIV-infected children. However, HIV-related neurological, oropharyngeal, oesophageal, cardiac and haematological abnormalities may also manifest with pulmonary changes and must be considered in the interpretation of the chest radiograph in HIV-infected children.

Pediatric Radiology, 2009

We present a 3-year review of clinical paediatric experience with the Statscan (Lodox Systems, Jo... more We present a 3-year review of clinical paediatric experience with the Statscan (Lodox Systems, Johannesburg, South Africa), a low-dose, digital, whole-body, slitscanning X-ray machine. While focusing on the role of the unit in paediatric polytrauma, insight into its applications in other paediatric settings is provided.

Pediatric Pulmonology, 2014

The chest X-ray (CXR) abnormalities of human immunodeficiency virus (HIV)-infected children in lo... more The chest X-ray (CXR) abnormalities of human immunodeficiency virus (HIV)-infected children in low/middle income countries (LMIC's) have not been well studied. To describe the CXR abnormalities and associated clinical/immunological features in HIV-infected South African children. A prospective study of HIV-infected children who underwent baseline chest radiography and clinical and immunological HIV-staging. CXR abnormalities were stratified as grade 1 (mild) or grade 2 (moderate/severe). Univariate and multiple logistic regression analyses assessed associations between radiological severity and clinical/immunological parameters. Three hundred thirty children (53% male), median age 23.8 months, were included; 303 (92%) had moderate/severe clinical disease and 225 (68%) moderate/severe immune suppression; 52 (16%) had a normal CXR; 169 (51%) had grade 2 CXR abnormalities, manifesting as: confluent opacification (n = 91, 28%), nodules (n = 37, 11%), or nodules with opacification (n = 41, 12%) Grade 2 abnormality was associated with more advanced clinical HIV disease (OR: 6.9; 95% CI: 1.9-25.6), CD4+ less than 20% (OR: 1.8; 95% CI: 1.0-3.0) and age over 24 months (OR: 4.1; 95% CI: 2.1-8.0). CXR abnormalities are common in HIV-infected children in LMIC's. The extent of radiological abnormality correlates with age and clinical and immunological severity of HIV-disease.

Pediatric Pulmonology, 2005

The Pediatric Infectious Disease Journal, 2006

Tuberculous (TB) meningitis is sometimes difficult to diagnose in young children. The decision to... more Tuberculous (TB) meningitis is sometimes difficult to diagnose in young children. The decision to start anti-TB treatment of TB meningitis is usually made on clinical grounds and results of special investigations, such as cerebrospinal fluid examination and cranial computerized tomography (CT), because bacteriologic yield is low and the results delayed. To determine whether the clinical, laboratory, and radiologic criteria used in the diagnosis of TB meningitis in human immunodeficiency virus (HIV)-uninfected children apply to HIV-infected children. Retrospective, case-control study. Clinical, laboratory, and radiologic features of TB meningitis were compared in 34 HIV-infected and 56 HIV-uninfected patients matched for age and stage of TB meningitis. All clinical differences found between the 2 groups at admission were related to the underlying HIV disease. Neurologic presentation and cerebrospinal fluid findings at admission did not differ significantly between the 2 groups. Significantly more HIV-infected than HIV-uninfected children had evidence of TB on chest radiography. The classic CT signs of TB meningitis (obstructive hydrocephalus and basal enhancement) were significantly less prominent in the HIV-infected group (P < 005). The diagnostic criteria for clinical diagnosis of TB meningitis apply to HIV-infected children. However, cranial CT findings in this group may be misleading and delay the diagnosis of TB meningitis.

Cervical carcinoma is the third most common carcinoma found in women. Even though metastases to ... more Cervical carcinoma is the third most common carcinoma found in women. Even though metastases to the skeleton is common for cancers in general, the clinically documented prevalence of skeletal metastases in cervical cancer patients range from 3% to 4.6%. This prevalence is lower than what is observed in post-mortem studies. The aim of this study was to determine the prevalence of skeletal metastases from cervical carcinoma in a Western Cape skeletal population.
Skeletal samples (n=14) from the Kirsten Skeletal Collection at
Stellenbosch University (Western Cape, South Africa), with an
ante-mortem diagnosis of cervical carcinoma, were examined.
Macroscopic analysis was done using low magnification to examine each skeletal element for signs of disease. Skeletons were also x-rayed using the Lodox® Statscan® Imaging system and the scans evaluated by a musculoskeletal radiologist. All signs of skeletal metastases were documented.
Three out of the fourteen skeletons (21%) showed lytic or lytic
combined with sclerotic lesions suggestive of metastases, with the os coxae and lower vertebral column affected in all three cases. Furthermore, lesions occurred in the scapulae and ribs in two of the cases and in one case the skull, mandible and long bones were affected. Additionally, three skeletons without evidence of skeletal metastases presented with a periosteal reaction on the os coxae in response to the diseased adjacent soft tissue. The findings of the present study correlates with previous postmortem studies which observed that skeletal metastases from cervical carcinoma is more common than what is diagnosed antemortem with the axial skeleton most commonly affected. It also illustrates the effectiveness of the Lodox® Statscan® imaging system in diagnosing of metastases in skeletal material. This study
emphasizes the importance of radiological analysis in patients with cervical carcinoma in order to diagnose skeletal metastases.