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Polls are open at medGadget for the 2008 Medical Weblog Awards.

I am a finalist in the Best Clinical Weblog Category (I’m still not sure if that isn’t a mistake). You can vote for me here if you wish.

Please vote for the finalists in other categories here.

First I get a new scanner to work toy to play with.

Then I find out that my blog made it to the final list of nominees in the 2008 Medical Weblog Awards.

All in the first week of the year.

Wow!! A great start to 2009. Hope the tempo keeps up :D

Update: Sincere thanks to Paul Levy for nominating my blog.

Change and transition are evocative words in the world at present. It thus seems appropriate or even destined that there are changes in my little world too as we enter the new year.

We are taking a giant leap at work: upgrading from this…

…a basic 4 slice CT scanner which used to scan at a speed of 8 slices/second; to this…

[Image Credit]

…a state-of-the-art 128-slice CT scanner that scans at a mindboggling speed of about 426 slices/second!

The scanner got installed over the weekend and we did a few test cases on Sunday evening. Today will be the first day of actual clinical work on the new scanner. My excitement is tinged with more than a bit of irritation that I am yet to receive the image processing workstation that is supposed to accompany this scanner. Apparently it was forgotten while being shipped. As it was the holiday week, nothing moved - even in super efficient Germany. So the workstation will probably arrive sometime this week. Till then I cannot do fancy-shmancy stuff like coronary CT angiography or get images like this…

[Image Credit]

It would be an understatement to say I will be like a kid in a candy store

Blogging probably will be sporadic and I want to warn to my few readers to expect a lot of CT images from my new scanner in the ensuing weeks.

You can, of course, follow me on twitter if you want to avoid the radiology stuff and just have a conversation.

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Interesting and relevant article that shows there is a neurophysiological basis for my inability to stick to New Year’s resolutions (to be published today, December 31, 2008) in the Journal of Neuroscience.

DOTmed.com - New Year’s Resolutions Are Even Harder for Risk-Takers to Keep.

For risk-takers and impulsive people, New Year’s resolutions often include being more careful, spending more frugally and cutting back on dangerous behavior, such as drug use. But new research from Vanderbilt University finds that these individuals–labeled as novelty-seekers by psychologists–face an uphill battle in keeping their New Year’s resolutions due to the way their brains process dopamine.

The researchers used PET scans to view the levels of dopamine receptors in 34 healthy people who had taken a questionnaire measuring the novelty-seeking personality traits. The questionnaire measured traits such as an individual’s preference for novelty, decision-making speed, readiness to freely spend money, and the extent to which a person is spontaneous and unconstrained by rules and regulations. The higher the score, the more likely the person was to be a novelty-seeker.

The research reveals that novelty-seekers have less of a particular type of dopamine receptor, which may lead them to seek out novel and exciting experiences, such as spending lavishly, taking risks and “partying like there’s no tomorrow”, Vanderbilt researchers say.

What this means is that I do not have to feel guilty anymore that I have not made any New Year’s resolutions these past few years.

My will power (or lack thereof) is not at fault. It’s built into my brain

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This is for the few people who stumble in here this week.

The reason my blog looks it’s usual unremarkable self (and loads as slow as ever*) is because I got an unexpected Christmas present from a dear friend. I screwed up. Rather, a horribly iffy internet connection screwed up a fairly routine WordPress upgrade from version 2.6.5 to the newly-released-and-being-universally-raved-about 2.7

The abandon upgrade and roll back to status quo ante manoeuvre that I attempted did not quite work. I was left with some horrid header code issue that prevented me from logging in. It probably was not an insurmountable issue. I could probably have corrected this via ftp or from the control panel at the hosting site with instructions gleaned via twitter and Google. But it would have taken time, patience and effort. All three were in short supply this weekend.

Enrico, my erstwhile buddy, now transformed to ‘Benevolent Saviour’ saved me. He offered to do the upgrade for me and I jumped on the chance. I don’t think he did the easy-looking but steeped in UNIX-maven-level-geekery subversion-shell uprade. I don’t think my hosting plan offers that service. Enrico worked His magic, it probably took a twitch of his little finger and I now have an upgraded blog. Merry Christmas Enrico, I owe you. (For the two of you who don’t know, Enrico is on twitter as medpiano).

The reason I was hard pressed for time is because I am leaving to Mumbai today for a week to attend a cardiac CT training programme. My hospital is upgrading it’s CT scanner to a better multislicer capable of doing Coronary CT Angiography. We are taking a humongous leap from a 4-slicer to a 128-slicer! To be honest, I am more excited about all the cool new stuff this scanner can do in terms of whole body CT. The fact that it does great coronary CTA is undeniable, but that does not excite me as much as that is going to be only a small part of my overall workload. I honestly admit to being a near-total-ignoramus with regard to cardiac/coronary imaging of any kind. The most I have seen of the adult heart is as a part of chest CT. I am actually more acquainted with the fetal heart which I see a great deal of screening for anomalies during antenatal ultrasonography. So this training programme is going to be very useful.

Paul Levy, the author of the hugely popular blog Running a Hospital was kind enough to nominate this blog for a Medical Weblog Award under Best Clinical Sciences Weblog. My chances of winning are non-existing considering the other worthy nominees. Paul recently crossed a thousand posts (in 28 months of blogging) in his blog and has been on twitter for about two months as paulflevy.

Many thanks to my friend Rob for generously awarding me a Golden Llama Award in spite (or because) of my *slow-loading blog.

I submitted a bunch of posts which may make an appearance in the latest edition of SurgeXperiences, the surgical blog carnival hosted this week by IntraOperate.

Welcome to those of you who come here during this week from twitter, medGadget and SurgeXperiences. I apologise in advance for not moderating or responding to comments. I promise to do so at the first available opportunity.

* Note: These images are obviously not from a single patient. I included all of them in one ‘case’ to continue with the ongoing theme of ultrasonography & scrotal swelling.

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Transverse section of right side of scrotum showing anechoic peritesticular fluid collection displacing the testis medially.

Diagnosis: Hydrocele.

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Longitudinal section of the scrotum showing a large heterogeneously echogenic peritesticular fluid collection (with mobile internal echoes on dynamic scanning). Testis is displaced posteriorly and appears compressed.

Diagnosis: Hematocele (acute).

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Longitudinal section of the scrotum showing a large heterogeneous hypoechoic peritesticular fluid collection with internal septations (fishnet weave pattern, similar appearance as in hemorrhagic Ovarian cysts). Testis is displaced posteriorly and appears compressed. Power Doppler shows normal testicular blood flow.

Diagnosis: Hematocele (subacute/organizing).

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Transverse section at the midline of scrotum in the same patient as above showing an anechoic (clear) hydrocele on the right side and the fishnet appearance of subacute hematocele.

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Longitudinal section of the scrotum showing a large heterogeneous hypoechoic peritesticular fluid collection with thin internal septations and fine low level internal echoes (no mobility on dynamic scanning). Testis is displaced medially. Epididymis is enlarged with heterogeneous nodular appearance. Known case of genitourinary tuberculosis.

Diagnosis: Pyocele.

…

References & Further Reading:

1. Mayo Clinic article on Hydrocele.
2. Chen P, John S. Ultrasound of the acute scrotum. Appl Radiol 2006;35: 9-17 [Full text article. Subscription required, free]
3. Dogra VS, Gottlieb RH, Oka M, Rubens DJ. Sonography of the Scrotum. Radiology 2003 227: 18-36 [Full text article, free]
4. Ragheb D, Higgins JL. Ultrasonography of the Scrotum: Technique, Anatomy, and Pathologic Entities. J Ultrasound Med 2002 21: 171-185. [Full text article, free in India. Subscription required for others.]
5. Winter T. Ultrasonography of the scrotum. Appl Radiol 2002;31: 9-18 [Full text article. Subscription required, free]
6. Woodward PJ, Schwab CM, Sesterhenn IA. From the Archives of the AFIP: Extratesticular Scrotal Masses: Radiologic-Pathologic Correlation. RadioGraphics 2003 23: 215-240 [Full text article, free]
7. Goldman SM, Sandler CM. Genitourinary Imaging: The Past 40 Years. Radiology 2000 215: 313-324 [Full text article, free]

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I expect my blog to get it’s one hundred thousandth visitor by today going by Statcounter, the very first blog stat application that I installed back in 2006 when I started out.

That’s not a big number after nearly thirty-four months of irregular blogging. Especially compared to some of the more famous medbloggers that I am fortunate to call my friends.

It still far exceeds any expectations that I had when I began blogging. And it strengthens my resolve to continue in whatever fashion that I can.

The most popular post on my blog still remains the one about the high cost of CT scans in the USA.

The next milestone that I look forward to is for the number of ‘Returning Visitors’, currently near six thousand to reach ten thousand.

My heartfelt thanks to all of you who visited, are continuing to vist and are going to visit my blog and to those of you who think that what I write is interesting enough to subscribe to through your feed readers.

Note: The inspiration to try this experimental mind map comes from the excellent collection of allergy and immunology related mind maps created by my blog & twitter friend Dr. Ves Dimov, author of the Clinical Cases and Images Blog. It might help to see my previous two casebook posts - Testicular Torsion and Acute Orchitis before you see the mind map. I made this with bubbl.us following Ves’s recommendation in this post (you can check out the features offered by bubbl.us in this mind map) and mildly modified it with Skitch. Many thanks to Enrico for telling me about Skitch, an amazing application (it works only in Mac OS X). Quite possibly the last word in simple intuitive screen grabbing and image manipulation software. Ideal for manipulating image sizes, doing simple annotations, etc. And it comes with web posting ability. I never thought I’d say this, but this is better than ImageWell.

Testicular Torsion

[click on the image to open a larger version in a new window]

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