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SETTING: In 2009, the World Health Organization (WHO) conducted a survey of the quality of four anti-tuberculosis drugs in the former Soviet Union countries. Kazakhstan had the highest proportion of substandard drugs. OBJECTIVE: To assess the quality of anti-tuberculosis drugs used in Kazakhstan in 2014. DESIGN: Fourteen anti-tuberculosis drugs from the Almaty Interdistrict TB Dispensary were randomly selected and screened for quality using Global Pharma Health Fund Minilab™ testing. First, the product and packaging were physically inspected to determine whether tablets/capsules were intact (i.e., whether they contained the full amount of the drug, and whether the packaging was genuine). Second, the tablets/capsules were dissolved in water to test whether they could be adequately absorbed by the body. Finally, semi-quantitive analyses were undertaken using thin-layer chromatography to verify the presence and concentration of the active pharmaceutical ingredient and to detect impurities. RESULTS: We discovered no counterfeit medicines. However, 163 (19%) of the 854 anti-tuberculosis drugs sampled failed at least one of the three tests. These samples were found among 24/50 (48%) batches of 14 anti-tuberculosis drugs. CONCLUSION: Our study identified a high proportion of poor-quality first- and second-line anti-tuberculosis drugs. Use of these medicines may lead to treatment failure and the development of drug resistance. Confirmatory testing should be performed to determine if they should be removed from the market.

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While IntCECT is still considered by many to be the optimal modality in cervical spine imaging, it is the most invasive of the techniques considered here. MR imaging may have nearly equivalent diagnostic capability in many cases of degenerative disc and spine disease. The value of unenhanced CT essentially is limited to the demonstration of bony changes. In the evaluation of radiculopathy, either MR imaging or IvCECT is useful for the initial screening and may be the only study needed. MR imaging is the study of choice for diseases of the spinal cord. With continuing progress in MR capability, IntCECT is shifting more toward a supplemental or confirmatory role. A rigid neurodiagnostic algorithm for this common radiologic problem is not possible. Rather, each step of the diagnostic process is influenced by the individual patient. Specific patient characteristics may affect the selection of an imaging modality. Modification of routine studies, such as use of gadolinium or oblique MR imaging, may be indicated in some patients. Finally, because of the high prevalence of asymptomatic disc and spine changes, knowledge of clinical findings is essential in the accurate interpretation of anatomic findings.

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Intraspinal synovial cysts probably originate from herniation of synovium through a weakened facet joint capsule. The computed tomographic (CT) findings of such lesions were recently reported. An additional characteristic is gas within the cyst as demonstrated by CT. We postulate the source to be an adjacent diseased facet joint with a vacuum cleft with consequent dissection of gas into the cyst.

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The author describes a new computed tomographic finding associated with disk herniation--a low density in the posterior aspect of the disk, usually having a crescentic shape. This low density probably represents an area of fluid or blood accumulation within the annulus fibrosus caused by tearing of fibers in the annulus and an associated injury to the adjacent cartilage plate which opens into the spongiosa. Observation of this finding should support the diagnosis of a herniated nucleus pulposus.

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Noninvasive characterization of renal artery blood flow variables in the human has not been reported. Using a unique dual-frequency real-time two-dimensional echo Doppler (Duplex scanner) that was calibrated in vitro, we characterized renal artery blood flow patterns in 16 normal subjects (6 females). Calculated mean values of systolic diameter (Ds), maximal spatial average blood velocity (Vmsa), and volume flow rate (Q) were as follows: 4.5 +/- 0.6 mm right, 4.4 +/- 0.6 mm left; 67.6 +/- 9.4 cm . sec-1 right, 69.6 +/- 12.0 cm . sec-1 left; and 403 +/- 127 ml . min-1 right, 395 +/- 98 ml . min-1 left; respectively. Direct linear regression correlation of body surface area (BSA) with Ds and Q were statistically significant (P less than 0.01, r = 0.70; and P less than 0.01, r = 0.72, respectively). In a blind prospective series, six of seven angiographically normal renal arteries were noninvasively identified by normal geometry and blood velocity patterns. One angiographically normal artery was incorrectly classified as mildly stenotic. Eleven angiographically documented abnormal renal arteries were noninvasively identified by their abnormal blood flow patterns and/or geometry. This study suggests that dual-frequency Duplex scanning with careful sample volume control and Doppler audio spectra/blood velocity waveform analysis can be used to characterize blood flow variables in normal and diseased human renal arteries.

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Two patients who developed large intracranial vessel occlusion after standard radiation therapy for brain tumor are described. This form of vascular occlusion is usually seen in patients who have previously been treated by radiotherapy for intracranial tumor who then develop a relatively acute change in neurologic status. Histology of the lesion mimics accelerated focal arteriosclerosis. The clinical and radiographic manifestations of one case were highly atypical. The vasculopathy became evident shortly after termination of radiation therapy for a fourth ventricular ependymoma, and the angiographic picture stimulated a diffuse arteritis. The second patient was more typical, with clinical symptoms developing 12 years after radiation therapy for an oligodendroglioma. Occlusion of a proximal vessel that had been included in the radiation port was demonstrated radiographically and confirmed by pathologic examination. The clinical, angiographic, and histologic features of these two cases are discussed and previously reported cases are reviewed.

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The radiographic triad of a calcified pancreatic mass, duodenal ulcers, and nephrocalcinosis should suggest the Zollinger-Ellison syndrome, as part of the multiple endocrine adenomatosis complex. The clinical and radiographic features of the entity are described in this case report.

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Ipsilateral elevation and contralateral suppression of renin secretion have been established in a patient with a post-traumatic renal arteriovenous fistula associated with diastolic hypertension. This finding is rare because of the dilutional effect of arterial blood shunted in the renal vein. Increased renin secretion in this instance supports the proposed mechanism of diastolic hypertension with renal arteriovenous fistula.

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