#Medical CT Scanners

[nelpretechc]

Differences Between Industrial vs. Medical CT Scanners

Industrial and medical CT scanners differ in several key aspects. Industrial CT scanners are designed for non-destructive testing in manufacturing, focusing on high-resolution imaging of objects ranging from small electronic components to large machine parts. They emit higher radiation levels for deep penetration and precision in capturing internal and external geometries, identifying flaws in structures. In contrast, medical CT scanners prioritize patient safety, using lower radiation doses to diagnose conditions like tumors and fractures. Medical scanners rely on a gantry system to rotate the X-ray source, while industrial systems often use a more precise rotation stage for accuracy.

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[gaykamenridermemes]

[feminist-space]

"Officers raided the facility on Oct. 18, 2023, and detained the lone female employee while they searched the business, the lawsuit said. However, they didn’t find a single cannabis plant and only saw a typical medical facility with rooms used for conducting x-rays, ultrasounds, CT scans and MRIs, the owners said.

The officers then released the employee and told her to call a manager, the lawsuit said, while they continued to wander around various rooms of the facility. The plaintiffs say the officers’ behavior was “nothing short of a disorganized circus, with no apparent rules, procedures, or even a hint of coordination.”

At one point, an officer walked into an MRI room, past a sign warning that metal was prohibited inside, with his rifle “dangling… in his right hand, with an unsecured strap,” the lawsuit said. The MRI machine’s magnetic force then allegedly sucked his rifle across the room, pinning it against the machine. MRI machines are tube-shaped scanners that use incredibly strong magnetic fields to create images of the brain, bones, joints and other internal organs.

An officer then allegedly pulled a sealed emergency release button that shut the MRI machine down, deactivating it, evaporating thousands of liters of helium gas and damaging the machine in the process. The officer then grabbed his rifle and left the room, leaving behind a magazine filled with bullets on the office floor, according to the lawsuit."

Read the full article here: https://www.sfgate.com/cannabis/article/lapd-cannabis-mri-raid-19789448.php

[phoebepheebsphibs]

Double-Mutated Mikey

Chapter 40: Biofilm

Continued from the short story written by @boots-with-the-fur-club

Prev || Next

Donatello races down the hallway, checking his trackers every few minutes to make sure everything is going smoothly with the others. After this is over, he's thinking of adding hidden cameras to their masks as well, so he can also see where they are, not just know their longitude and latitude. What good is knowing where a person is if you can't know what's going on?

Donnie started getting into the trackers phase when they'd first come up against the Foot Clan, and Raph had accidentally eaten a tracker meant for a salami paper stack. That had been the inspiration to start tagging his family. He'd installed the subdermal trackers sometime after then, working on different updates and methods of inserting them under the skin or under their shells when they weren't looking or conscious or aware or -- well, you get the idea.

But as time went on, he'd started thinking maybe adding a visual or audio aspect to the tracers was a good idea. It was starting to annoy him that his brothers and father would go places alone for long periods of time and he wouldn't know why or what was happening. Donnie would never consider himself 'clingy'. Or at least, he'd never admit that he was. Donnie was just... concerned for their well-being. And it always seemed like their well-being was coming into question whenever he was not with them. He should have added the video/audio feed to the trackers a long time ago.

He'd have known what was taking Leo so long to get them back after they'd been portaled to Tahiti.

He'd have known what Leo and Papa were doing with Big Mama while they dealt with the Shredder.

He'd have known where the Shredder and the Foot Lieutenant and Foot Brute and Cassandra took Splinter and Barry when they attacked their old lair.

He'd have known what the Krang were doing with Raphael when he was captured.

He'd have known what happened to Leo in the Prison Dimension.

He'd have known about Mikey's captivity and recapture.

He'd have known how to be the genius they all needed him to be.

He'd have known how to be a better brother...

Donnie swallows the thoughts and keeps on moving. He turns a corner and sees a strange laboratory, filled with machines and mechanisms and lasers and weird gadgets that Donnie would be more than happy to take home with him... But it also has what looks like a few medical devices stored in there as well. A CT scanner, an X-ray machine, other devices that Donatello recognizes from science-fiction films and spy movies that definitely won't be found in any normal hospital.

This looks like the kind of place that a man specialized in engineering and robotics would be hiding in...

Donnie sneaks over to the room, not caring about dodging cameras. The building's been evacuated, and even if it hadn't been, everybody already knows that they're here.

The door was left open by a careless employee trying to leave in a hurry. Perfect! Donnie's ninpo can create all kinds of stuff, but making small items to hack into things like security systems takes a lot of brainpower. And -- you didn't hear it from him -- it's difficult. His ninpo works like his mind, building the items piece by piece, engineering the weapons or defense mechs however he sees it in his head. And while he is a genius, even geniuses have trouble keeping track of hundreds of thousands of lines of programming. Even a small item like the USB flash drive he gave April earlier would take a lot of internal interfacing and coding... it's exhausting. But not impossible.

But fortunately, it isn't necessary.

Donatello sneaks in cautiously. It's strange how the room is a Frankenstein mashup between a doctor's office and a robotics lab. Secretly, Donnie is taking mental notes on how to incorporate some of these ideas and designs into his own lab.

There are desks covered with tools and blueprints. Cabinets with vials and liters of mysterious multi-coloured liquids. Tables with a few unpacked boxes stuffed with strange items and labels scribbled messily onto the cardboard. On one said table is a crate. Poking out of said crate, Donatello can see a wooden staff with purple wraps, two familiar blue hilts for what he can assume are twin katanas, and the edges of a battleshell.

"Our stuff!" he whispers to himself. They definitely need to get those back...

Donnie rushes to the box and starts rummaging through it. Yep, it's all here... Dee's gear, Leo's swords, Raph's sai. He reaches in and retrieves the weapons, looking them over for anything like tags or trackers that the TCRI or EPF would have placed on them. They look fine...

"My goggles!" Dee cheers, grabbing them quickly and placing them over his eyes to inspect the software. "Oh, thank God they didn't mess with my babies..."

"Don't thank Him just yet!" a voice cries out from behind him.

Donnie yipes before ducking, narrowly avoiding a swing from a madman behind him. He doesn't look like a guard, but instead wears a standard white lab coat. His hair is wild and unkempt, dark eyebags sag on his face, his chin is stubbled with untended scruff. By the looks of it, his only diet is caffeine and the suffering of others. He must be a scientist, then. His voice sounds familiar; Donnie's sure he's seen or heard him before...

"You were on the video files from the previous building!" he realizes, quickly grabbing his bō from the box and readying himself. "You made Mikey fight monsters in the Interaction room..."

"I see someone's been doing some research!" the man chuckles, his eyes wide and firey. "I'm flattered you recognized me. The name's Dr. Rod Timothy, not that you'll have much of a mind to recall that after I finish with you!!"

Donnie dodges as Dr. Timothy grabs a futuristic weapon from the table and fires it at him. Burning red blasts of light fly through the air. Dee ducks quickly, jumping to the side as he tries to come up with a weapon of his own. His mind always goes straight to the extreme -- 'go big or go home,' 'more bang for your buck', etc. Typically, the villains he fights are durable and super-strong mutants, they require bigger weapons like missiles and giant drills or hammers, etc. Humans are small, easy to break, but fierce and determined. They're harder to gauge, and Donnie has to search his mind for a weapon he can use against him without actually causing too much damage. Not just to the human, but also to the building itself. So missiles are off the menu.

Donnie's palm fills with parts and pieces that instantly grow together and attach in method and order, creating a mini grenade. He taps a button and sends the round object flying towards the scientist. It lands just a few feet in front of him and -- BOOM -- the flash grenade goes off, blinding the man as Dee uses his goggles to guide him through the room and find a place to hide.

"AGH!" Timothy screams, covering his watering eyes as he staggers around. "Y-you... you see, this is exactly why I was hoping you'd come here..."

Donnie peeks out from behind a giant scanner, watching as the mad scientist stumbles around chuckling.

"You creatures always have such a strange tolerance... it's superhuman...!"

The man looks up and looks around, pupils dilating like crazy as he frantically flails his arms and hands, feeling for something.

"And soon, I will be too..."

He really is insane, Donnie thinks to himself.

"If you're so keen on mutants, why'd you experiment on my brother?!" Donnie snarls.

Dr. Timothy reels around and stares blindly in Dee's direction, trying to listen as Donnie ninjas away to a new location to watch Timothy... and lure him into a trap.

"Oh, yes," Timothy laughs, the tears from his watering eyes streaming down his face. "You're brother was loads of fun. I enjoyed our little exercises and examinations thoroughly... Such a fun little plaything, a wonderful puzzle to take apart and put back together."

"Anyone ever tell you to get psychiatric help?" Donnie growls.

"More often than you'd think," Timothy cackles. "But they don't see the necessity of my methods! The vision! They're all sniveling, spineless, mindless plebeians who cannot understand the future..."

"What future is that?" Donnie asks, purposefully directing the man towards the far back of the room.

"Oh, one that you'd approve of!" Timothy laughs, blinking quickly, eyes darting back and forth. "A future free of humans. A future of mutants."

"What are you talking about?" Donnie asks, genuinely confused. "Chaplin wants to eradicate the mutants, why --"

"Oh, he's nothing more than a COWARD!!" Timothy bellows, fist pounding on the side of the table and sending small items flying. "He's a pathetic hatemonger who can't see that the only way for humanity to advance is to literally advance as a species and evolve! He thinks that what we need is to take out the competition!"

Dr. Timothy smiles so wide, his face contorts as though it's made of flabby plastic.

"I say we need to switch flags."

Donnie purposely knocks over small rolling cart of supplies, causing Dr. Timothy to stagger towards the sound.

"Chaplin is a visionary, though. And a golden goose. I never would have been able to pursue my research without his funding..."

"Well, the golden goose won't be laying anymore eggs for you psychopaths," Donnie huffs. "Chaplin's dead."

Timothy grunts at the news. Donnie can't tell if he's laughing, or making strange sad noises. The deranged fiend turns to stare blankly at the table, almost wistfully, reminiscing his fellow evil scientist.

"Well... he was a very significant man. Powerful, resourceful, determined... but I can't say that I'm not a little glad that he's gone."

"Oh?" Donnie chuckles. "No love lost between coworkers?"

"I had respect for the man, it's true," Timothy grumbles, reaching across the table strewn with supplies as he feels his way around. His fingers curl over a few of the objects laid before him as he moves forwards. "But his values and ideals were misguided and foolish. Only the strong come out on top."

"I'd like to think the smart ones have a pretty good chance, too..." Donnie remarks, stepping into a side room and waiting for Dr. Timothy to tag along.

"Oh, I agree!" he laughs, following Donnie's voice into the dark room. "Which is why I hate to see you die."

Timothy grips one of the items pulled from the table and clicks a button. A long laser-weapon activates, and he laughs as he runs in after the softshell.

"Nice sword-axe-laser-combo," Donnie smirks. "Where'd you get it? Hollywood Studios in Florida?"

"Do you like it?" Dr. Timothy grins sarcastically. "It's just one of the few things I thought to bring with me for this climactic stand-off..."

He presses a button and the door behind him slams shut with a mechanical hiss. Dr. Rod Timothy brandishes the weapon casually at the mutant teen who cooly holds his bō staff out at the man as well, ready for a duel.

"Does this room look familiar?" Timothy cackles. "If you really did the research, then it should. It's the same as the one your sweet little science experiment of a sibling was made to fight in! Only right we made another one for the experiments to follow... And I can't wait to see what happens to you in it."

Donatello smiles.

"You want me to fight you? The same way you made my baby brother fight your mutant monsters?"

"Oh, you can fight one of my monsters too if you want!" Timothy shrieks with laughter, holding up a small remote control. "With a push of a button, they can come pouring in. But for now, I want to see what you can do. See what parts of you to keep and what to... scrap."

Donnie sneers.

"So this is an assessment, then."

"I suppose so," Dr. Timothy shrugs. "But we'll see who wins."

Timothy charges, laser weapon at the ready. Donatello grips his bō staff and swings it, blocking Timothy's attack. A purple shield forms and pushes him back. Timothy grunts with effort as his feet skid across the tiles. He laughs hysterically, eyes growing ever wider.

He charges again, swinging the battleaxe around before striking again. Donnie's battleshell opens up and reveals a small jetpack, which takes him up into the air. He launches over Timothy and lands behind him, clicking a hidden button on the shoulder pad and activating a wire that wraps around the mad scientist. Dee launches again and prepares to strap the man from the ceiling and literally leave him hanging.

Dr. Timothy squirms about and manages to pull an arm out, fumbling with the laser device and cutting the line. As Timothy freefalls, Donnie's jetpack crashes him into the ceiling as it attempts and fails to compensate for the sudden loss of weight. Timothy pulls another device he'd taken from the table and points it at Donnie. A small gun, almost like a pistol, which fires out a sudden blue blast at Dee's jetpack. The rotors freeze, ice covers the exhaust ports, and the whole jetpack itself malfunctions and sends Dee crashing to the ground.

"Your brother showed a severe aversion to cold, so in order to keep him in line we created a series of ice-generating weapons like this handy little prototype," Timothy boasts, twirling the pistol around like it's a toy.

Donnie growls in fury. Timothy fires a few more shots, blasting the turtle in the arm and leg as he tries to get back up from the fall. Donnie yells in pain as his limbs suffer from ice burn and start to turn red and swollen from the cold blasts. Shards of frost and ice crystals form on the skin. Donnie gasps from the pain and starts rubbing his limbs, careful not to let the injuries turn into frostbite. Timothy fires another shot, but this time Donnie is careful to dodge it, jumping out of the way despite the pain. Timothy fires again. Dee swings his bō at the man, creating shield that blocks the blast. He swings again, dissolving the shield and reforming it to create a replica pistol that fires directly at the weapon, clogging the barrel of Timothy's gun with ice.

"That was good!" Timothy laughs, dropping the gun before his fingers freeze to the metal. "Nice deflection! And it's clear that I could not defeat you physically. Your mutant genetics must have enhanced your bone structure and muscle mass, yes?"

"That's one theory," Donnie snarks at him. "Or you could just be a weak old guy with a pathetic toy gun."

Dr. Timothy laughs again.

"I'm technically not old, I'm 36."

"That's old, dude."

"Kids these days..." Dr. Timothy sighs. "If brawn cannot win, then perhaps brains shall..."

Dr. Timothy starts clicking buttons on the remote, setting off a few movement-tracking firearms. Donnie recognizes the sleek black metal machine guns from some of Mikey's recorded sessions in the Interaction Room. Dee creates another shield and avoids the torrent of bullets and darts that fly as Dr. Timothy advances again.

"Let's see how you fare against two threats at once!"

Donnie ducks back, hand and staff flying forward as he thinks up a quick weapon to make for his defense. A purple ninpo hologram forms over the wood, creating an imitation of his old tech-bo. A giant mechanical fist ignites at one end, and Dr. Timothy and Donatello exchange blow for blow, guarding and attacking as the two simultaneously dodge bullets from above.

"Where do you come up with these weapon ideas? Jupiter Jim's 19th Return to the Moon?"

"Two distractions at once, and he still finds the mental capacity for a rib!" Timothy laughs. "I should spar with my creations more often..."

"I am not your creation!" Donnie yells. "AND NEITHER IS MY BROTHER!!!"

Donnie suddenly snaps, kicking Dr. Timothy in the chest and sending him back into the wall. Timothy's weapon knocked from his hand, Donnie grabs it and flings the laser cutter towards the turrets, tearing them in half and destroying them completely.

"Very well done!" Timothy chuckles nervously, as he half-struggles to get up. "Well done indeed! You are quite the adversary. But, I would wonder how well you'd fare after I become one of YOU!"

Donnie watches in confusion as the scientist pulls a syringe from his pocket. It's glowing green.

"This is a mutation formula that I've reverse-engineered from some samples I found over the years. Your brother is one of them, true... but the majority of the formula comes from a few mosquitos we found buzzing around..."

"Draxum's ooze," Donnie gapes, his voice a horrified hush. "You're going to mutate yourself?!"

"It's about time I evolved into the higher species!" Timothy cackles madly, his mind fully gone. "And now with Chaplin out of the way, there's no stopping me!!"

"Wait!" Donnie tries to warn. "You don't know what that will do to you!!"

"I know exactly what will happen!" Timothy screams back. "I will finally be the apex predator!! Now watch as I become a random creature of mass destruction!!"

Timothy stabs the syringe into his arm, the re-created ooze seeping into his veins.

"Random?" Donnie questions. "No, you'll just turn into the last biological organism you came into contact with."

"Wait, what?" Timothy questions, sobering for one second. "What do you mean, the last thing biological organism?"

"The ooze combines your DNA with that of whatever you touched last. Didn't you know that?"

"No! How would I know that?!" Timothy screeches, gripping his sides in pain as the ooze starts to recreate him.

"Looks like somebody didn't do their homework after all..."

"What am I going to become?!" Timothy shrieks, his whole frame shaking.

"Well, what did you touch last?"

"YOU!"

"No, you never actually touched me," Donnie clarifies. "You're wearing gloves, and your weapons hit mine, but we never came into actual contact -- details matter in science, you know..."

"W-WHAT'S HAPPENING TO M-M-MEEEEEE?!?!" Timothy screams, his voice fluctuating and gargling as he begins to sweat profusely.

It's not sweat.

His skin is melting.

Donnie watches with a sickened expression as Dr. Timothy's body begins to turn into a sludge, the skin tone changing into a slimy fungus-green, every part of him slowly dissolving and gooping together in a way that turns Donnie's stomach. He looks away, and forces himself to keep away even as the man screams and pleads for mercy and help. His voice is literally drowned out as his vocal chords liquify along with the rest of him.

It goes quiet. Donnie shakily turns to see what has become of the poor deranged man. Nothing remains but a puddle of gelatinous ooze wobbling on the floor several feet ahead of him.

"L-looks like your reverse-engineered formula wasn't complete," Donnie gulps. "Or maybe the ooze really did transform you into the last thing you touched... which would have been the ooze itself. Whatever the solution, I'm not going to stick around for --"

A gurgling scream tears the room apart, as the gelatinous blob starts moving, shifting, and reforming into a sloppy mess of a man.

"Lₒₒₖ wₕₐₜ yₒᵤ'ᵥₑ dₒₙₑ ₜₒ ₘe!" Timothy shrieks, his voice a wobbly, watery mess as he slowly pulls himself together. "I wₐₛ mₑₐₙt ₜₒ ᵇe ₐ fᵢₑᵣcₑ ₘᵤₜaₙt! Nₒₜ ₐ ᵇₗᵤbᵇeᵣᵢₙg … ₜhᵢₙg!!"

The newly transformed Timothy charges at Donnie, his arm elongating and stretching like those slappy hand things Mikey was obsessed with at the age of six. Donnie dodges it at the last second, the hand slinging across the room and sticking to a panel on the wall. It rips the panel straight off, revealing a section of machinery hidden behind it.

"Whoah!" Donnie yells, dodging once again as the arm comes slinging back.

"I dᵢdₙ'ₜ wₐₙₜ ₜhiₛ!" Timothy screeches as he continues his tantrum. "I wₐₛ sᵤpₚₒₛₑd ₜₒ bₑ ₜₕₑ ₐₚeₓ ₚᵣₑdₐₜₒᵣ, ₙoₜ ₛₒₘe ₚₐₜₕₑₜᵢc ₛₗᵤdgₑ fᵣₒₘ ₜₕₑ ᵇoᵗₜₒₘ ₒf ᵗₕₑ fₒₒd cₕaᵢₙ! ᴺᵒᵗ a gˡoʳⁱᶠᵢₑᵈ aₘebₐ! ₙₒₜ ₐ Lᵢvᵢₙg Wₐₗₖᵢₙg MUD PUDDLE!!"

Timothy's body morphs again, his form splattering in twenty different directions and splashing onto several frames and tiles from the walls, ceiling, and floor. He pulls them apart, releasing a robotic arm that reaches down and attempts to attack the two of them. Donnie slides to the side and avoids the robo-arm. Dr. Timothy's tentacle releases from a section of the wall and accidentally tangles around the mechanism, getting stuck inside the gears and causing it to malfunction. The arm swings back and forth, trying to catch Donnie or Dr. Timothy before becoming hopelessly trapped in the glue-like goo that the scientist has become.

"Wₕₐₜ ₕₐᵥₑ yₒᵤ ᵈᵒₙₑ! ᵂₕₐₜ ₕᵃᵛe yoᵤ dₒₙe! Wₕₐₜ ₕₐᵥₑ yᵒu ᵈoₙₑ!" Timothy wails as he flails about the room.

His arms knock loose the devices hanging from the ceiling. They come crashing down, splatting Timothy flat and trapping him momentarily.

"Sorry doc, but this was all you," Donnie states, dodging one of the slimy appendages before tuck and rolling towards the door. "And no offense, but I've had enough slimy tentacle-induced sensory issues for one year, so I'll just see myself out..."

"Yᵒᵤ ₕₐᵥₑ ₜo ₕeˡ�� ₘₑ!" Timothy screams, reaching out for the ninja in desperation.

"There's nothing I can do for you now, Tim," Donnie scoffs as he picks up the remote from the floor, avoiding Timothy's sludge and slime. "You wanted to be a mutant, so now you're a mutant. Congrats, welcome to the family."

Donnie stares down at the remote and all the little buttons it comes equipped with. He presses one, and the door opens.

"But don't worry. After everything you did to my brother, I won't just leave you here alone to rot..."

Donnie turns to face the mutant man, and gives him a cold smile before pressing every button on the remote.

"You said something about 'monsters flooding in at the push of a button,' right?" Donnie asks, his smile becoming almost like a snarl. "How about I leave you with some company?"

Every trapdoor in the room opens up, and hundreds of glowing red eyes appear from the darkness. The sounds of snarling and growling and howling and yowling starts to fill the enclosure.

"ᴺᵒ… ʸᵒᵘ caₙ'ₜ ₗₑₐᵥₑ ₘe ₗiₖₑ ₜₕiˢ!" Dr. Timothy begs.

"You said you wanted to be a mutant," Donnie sighs, clicking the button to close the door. "You can chill with your own kind now. See how long you last."

"Nᴺᴼ0oₒo0Oᴼ--!!!"

The doors close just as the monsters creep in and pounce for the slime man.

Donnie blinks for a moment before exhaling loudly.

"...Karma... is absolutely insane."

Prev || Next

[shithowdy]

just here to suggest the possibility that your gas pain was actually [unpleasant description of a medical event follows] a ruptured ovarian cyst (if you have those, if not disregard). i thought /my/ ovarian cyst was gas since i felt incredibly bloated and it felt identical to bad gas but actually it was just my abdominal lining swelling so much from the bleeding. i'd be even more sus if the pain was mostly in your lower tummy, you were vomiting, had an extremely dry mouth, or felt extremely hot. or if it came on after vigorous activity. i got a ct with contrast at the ER and that dxed it - if stuff like this happens to you regularly you might consider asking a gyno for some imaging, since they can prevent it with hormonal birth control.

At the risk of embarrassing myself a little here, it was definitely gas-- after about 8 hours of suffering and right before finally getting into the CT scanner, the pain was instantly relieved with a colossal fart.

[thelastmemeera]

Excuse me WHAT

Officers allegedly raided the diagnostic center, located in the Van Nuys neighborhood of Los Angeles, thinking it was a front for an illegal cannabis cultivation facility, pointing to higher-than-usual energy use and the “distinct odor” of cannabis plants, according to the lawsuit.  Officers raided the facility on Oct. 18, 2023, and detained the lone female employee while they searched the business, the lawsuit said. However, they didn’t find a single cannabis plant and only saw a typical medical facility with rooms used for conducting x-rays, ultrasounds, CT scans and MRIs, the owners said.  At one point, an officer walked into an MRI room, past a sign warning that metal was prohibited inside, with his rifle “dangling… in his right hand, with an unsecured strap,” the lawsuit said. The MRI machine’s magnetic force then allegedly sucked his rifle across the room, pinning it against the machine. MRI machines are tube-shaped scanners that use incredibly strong magnetic fields to create images of the brain, bones, joints and other internal organs. An officer then allegedly pulled a sealed emergency release button that shut the MRI machine down, deactivating it, evaporating thousands of liters of helium gas and damaging the machine in the process. The officer then grabbed his rifle and left the room, leaving behind a magazine filled with bullets on the office floor, according to the lawsuit.

[anotherdayforchaosfay]

Anyone here specialize in medical stuff for ears?

I've been dealing with an ongoing issue regarding my ears since having covid19 two years ago. It's taken two years for any imaging to be done because the ENT specialist I was sent to couldn't see anything and said I was imagining it. It was only after being stubborn and standing up for myself that he agreed imaging would be useful. Here's what was put in my patient profile regarding today's scan. If you have experience working with ears, please explain what this stuff means.

What it looks like to me is I have the same condition my baby sister has: SCDS or Superior Canal Dehiscence Syndrome. She was told hers is cause by too much swimming (she calls bullshit), and correcting it will require brain surgery (to plug the holes, the brain needs to be slightly lifted out of the way of the bones).

CT Mastoids (Temporal Bones) wo Contrast

IMPRESSION:

Osseous thinning and likely dehiscence along the bilateral superior semicircular canals.

Unremarkable appearance of the mastoid air cells which are well aerated bilaterally. No significant mastoid effusion or opacification.

COMPARISON: None.

TECHNIQUE: Axial CT images of the temporal bones were obtained at 1 mm intervals. Coronal reconstructions were subsequently performed.

The CT scanner utilized a dose reduction technique.

CT Dose: 480.26 mGy.cm

The external auditory canal is patent.

FINDINGS:

Right temporal bone:

The middle ear cavity is well aerated.

The ossicles are intact.

The scutum is sharp.

There is no evidence of tegmen tympani dehiscence.

The facial nerve demonstrates normal for course and morphology within the temporal bone.

The inner ear structures demonstrate normal density and morphology.

Osseous thinning and likely dehiscence along the right superior semicircular canal.

The internal auditory canal is symmetric in size.

There is no evidence of an enlarged vestibular aqueduct.

The jugular bulb is not dehiscent.

Left temporal bone:

The mastoid air cells are well aerated.

The external auditory canal is patent.

The middle ear cavity is well aerated.

The ossicles are intact.

The scutum is sharp.

There is no evidence of tegmen tympani dehiscence.

The facial nerve demonstrates normal for course and morphology within the temporal bone.

The inner ear structures demonstrate normal density and morphology.

Osseous thinning and likely dehiscence along the left superior semicircular canal.

The internal auditory canal is symmetric in size.

There is no evidence of an enlarged vestibular aqueduct.

The jugular bulb is not dehiscent.

The mastoid air cells are well aerated.

[macgyvermedical]

I really wish more clinicians (basically anyone in the medical field) would read Improvised Medicine by Kenneth V. Iserson.

I say this because there’s so many low tech interventions that have been studied that are not in medical use in high-resource areas that really should be.

High resource med has its place, but generally that place is in very specific situations when the low tech stuff has been exhausted and the high tech stuff is all that could possibly do the job.

What I am saying is a medium-sized hospital should not have 4 CT scanners and descend into chaos when one of them needs repaired.

[news-wtf]

LAPD raid goes from bad to farce after gun allegedly sucked onto MRI machine

Officers raided the facility on Oct. 18, 2023, and detained the lone female employee while they searched the business, the lawsuit said. However, they didn’t find a single cannabis plant and only saw a typical medical facility with rooms used for conducting x-rays, ultrasounds, CT scans and MRIs, the owners said. 

The officers then released the employee and told her to call a manager, the lawsuit said, while they continued to wander around various rooms of the facility. The plaintiffs say the officers’ behavior was “nothing short of a disorganized circus, with no apparent rules, procedures, or even a hint of coordination.”

At one point, an officer walked into an MRI room, past a sign warning that metal was prohibited inside, with his rifle “dangling… in his right hand, with an unsecured strap,” the lawsuit said. The MRI machine’s magnetic force then allegedly sucked his rifle across the room, pinning it against the machine. MRI machines are tube-shaped scanners that use incredibly strong magnetic fields to create images of the brain, bones, joints and other internal organs.

An officer then allegedly pulled a sealed emergency release button that shut the MRI machine down, deactivating it, evaporating thousands of liters of helium gas and damaging the machine in the process. The officer then grabbed his rifle and left the room, leaving behind a magazine filled with bullets on the office floor, according to the lawsuit. 

[risingscorchingsuns]

hi guys im homw !!!! i have been for a few hours but ive been fucked up on sedatives lmao. im still sorta fucked up but im mostly lucid, just groggy as HELL lmao

the procedure went well!!! there were a couple mishaps so minor tw for medical mentions + needlesbelow the cut if you’re curious! dw tho im perfectly safe and well!!!

so basically they had me on my stomach, and throughout the course of the procedure theyd stick me in and out of a CT scanner to check where they needed to inject. they had these long ass fucking needles and they were kinda fucking terrifying lmao, they had to sedate me pretty good bc of my severe needle phobia

my letft side went well, they numbed me, neutralized all my nerves and i barely felt a thing. but when they put the needle in my back on my right side, i inhaled when they put it in and they punctured my lung a little bit lmaoo

im okay tho !!! i was in a CT machine for most of the procedure so they would have been able to tell immediately if it was anything serious. to be safe they monitored me, and the procedure took about 2 hours instead of the expected 30 💀

overall im fine!!!! im very sleepy and my side hurts a little bit when i inhale, but the procedure was a success and im doing well!!! i had a big dinner and it didn’t even hurt at all :D

thank you guys so very much for the well wishes!!! i appreciate it so much 🫶💜🪲

[fleshengine]

I think medical scanners are some of the greatest inventions of the contemporary era. We haven’t even known about xrays for 200 years, let alone the other types of imaging we do. Ultrasound, Xrays, CT, cat, pet, mri, and probably more that I can’t recall! Wr have developed so many ways of looking into the human body without cutting it open or sticking anything in it! (I’m not counting imaging contrast.) I remember when an xray at the dentist’s was a big chunky emitter that you wore a lead vest for and the tech had to leave the room to use it. Now it’s a handheld device and a thing that goes in your mouth. That’s it. With progression in compactness and safety always happening, it’s fascinating to think about where such things will be at in 100 years. We are not nor will ever be the pinnacle of technology. The cutting edge will invariably be dulled by time.

[jeanniebug623]

🕸️🕷️ Weaving the Web 🕷️🕸️

Chapter 2: Something's Missing…

The evac was taking too damn long according to Quaritch. When he was head of security, and still human, emergency air evacuation would have been completed in less than 45 minutes given their close proximity to Bridgehead. He was pacing angrily, his tail flipping wildly with every turn. The squad had the camp repacked in less than 10 minutes. At least he could rely on someone.

“Don’t worry, boss, won’t be long now.” Wainfleet said, checking his watch and glancing at Zdinarsk, who nodded to confirm the Samson was close while staring at her radar. Even Z-Dog had abstained from snapping her bright pink gum bubbles so as not to annoy the colonel.

Quaritch wanted to go off on a tirade about how they’d be halfway to base if he were still in charge, but his squad didn’t deserve that. He had loyal soldiers in his unit. Ja had immediately dropped the marine mode and worked on Spider. With the boy unconscious, the good doctor couldn’t remove his mask to even clean the bloody nose. He’d checked his heart rate, breathing, and done a quick brain scan with the rudimentary equipment he could carry in the field.

“He’ll need an MRI, CT, and neuroimaging.” Ja said, the only time Quaritch stopped leaving a path in the underbrush, “To start. And if you could get me the monitor reports from his…” He paused and his ears went back. “Questioning, it would-…”

“Consider it done.” Quaritch interrupted with a gruff tone. Anything to help Ja and the medical staff at Bridgehead figure out what brought on Spider’s sudden outburst. Outburst was a kind term for what they just witnessed.

Quaritch remembered a technician calling Spider ‘completely feral’ when he was first captured by the RDA. He screamed and cursed in English and Na’vi, tried to break the one-way mirror with the chair he’d been graciously offered then had taken away right after, and attempted to force open a security door that not even a dozen Na’vi could do. Quaritch saw that anger, but that was child’s play compared to the manic look in the boy’s eyes during the verbal assault.

“About goddamn time…” Quaritch growled when they heard the Samson coming inbound. They’d carefully moved Spider to a clearing so the aircraft could land instead of slinging him over his shoulder like the last time he transported the kid against his will.

“Someone grab the backboard.” Ja said to anyone close as he tucked the handheld brain scanner into a cargo pants pocket. But he was shouldered aside before anyone reached the aircraft to retrieve the stretcher.

“No time. Move out!” Quaritch said as he slid an arm under Spider’s back and knees, scooping him up easily and jogging over to the open side doors. He ducked as he shuffled towards the back of the Samson where there was more space to kneel on one knee and still hold the boy in his arms. He didn’t have many memories of holding the kid when he was an infant. Never thought he would get another chance...

The rest of the squad jumped on board and they were off. Back to the place Quaritch promised he’d keep Spider away from…

~~~~~~~~~~~~~~~~~~

As much as Quaritch didn’t want to give him up, Wainfleet and Ja convinced their commanding officer to allow the hospital staff to take over Spider’s care when they reached the med bay. He didn’t want the boy out of his sight but what could he do at that moment?

Well, there was one thing.

“Lyle, with me.” Quaritch said as he started walking away. He kept going as he turned to point back at Ja. “Stay here and report as SOON as you get somethin’ from the kid or the doctors.”

Ja saluted and stood at attention in the entrance that doubled as a classic hospital waiting room, complete with terribly boring artwork on the wall.

Quaritch and Wainfleet marched right to the heart of Bridgehead City: the Sec-Ops command center. Until it had more civilian citizens, Bridgehead was just another military base. Even if he didn’t have security clearance, Quaritch wouldn’t be stopped as he walked straight into a conference room Ardmore was heading with other high ranking officers, RDA superiors, and holographic displayed representatives still back on Earth.

“Colonel Quaritch.” Ardmore said with a hint of feigned surprise. When it came to the city and the RDA, nothing happened on Pandora that the general didn’t know about. “Tired of the kid already?”

Whether it was coincidence or not that Ardmore asked about Spider, Quaritch steeled himself and kept a calm composure as he dutifully saluted his superior officer.

“Not exactly the issue, General Ardmore.” Quaritch said with such a cool tone that even Wainfleet was surprised considering how fired up he was from the forest until they crossed the threshold into the conference room. “The boy suffered a severe nosebleed and collapsed unconscious. An emergency evacuation seemed necessary for an asset in custody of the RDA, ma’am.”

Ardmore narrowed his eyes slightly. Well spoken and well played. She looked to her mix of real and holographic audience, “If you will excuse me, I apologize for this interruption. Colonel.”

She nodded as she turned towards her office door and led Quaritch in. Wainfleet stayed back, crossing his arms and scanning the rooms. He wasn’t sure he'd seen more stuffed shirts in one room before.

“You say the boy collapsed?” Ardmore asked as she casually rounded her desk to sit down and look at the colonel, “That’s unfortunate to hear. I suggest you consider leaving Mr. Socorro in the capable hands of our medical staff while you continue your field missions.”

“With all due respect, General, I took responsibility for him for a reason. I’m not about to abandon my responsibilities due to a little mishap. I’m still at your disposal, ma’am, but one mission at a time.” Quaritch said coolly though he was boiling inside. He didn’t expect the general to give a damn about some wild child raised by the enemy who beat even her toughest interrogation methods. Yet, he was still angered by her lack of concern. Or dare you think it…compassion?

Ardmore didn’t respond just yet. Loyalty, responsibility, mission. Quaritch was playing all the right cards, and he wasn’t in a place where she could question it.

“Is the boy’s condition stable?” Ardmore asked with very little interest.

“To be determined, ma’am.” Quaritch started, trying not to bite off his tongue with his sharp teeth every time he showed her extra respect, “That’s why I so rudely interrupted your meeting. My apologies.”

“You saved me really.” Ardmore said, sounding bored, “I’m sure you remember how tedious it can be explaining living on Pandora to those who’ve never set foot here. So how can I help with the asset, Miles?”

Hearing his own name shouldn’t make Quaritch feel an anxious twinge in his chest. He’d lived with it his whole life. But now…having heard the way Spider said it…this alter ego or whatever the hell Quaritch was dealing with. He had never heard his name spoken with such malice.

“My medic did a check on the boy out in the field but it’s hard to determine the correct treatment without knowing all possible triggers. I would like to have a full report of the boy’s medical reports from his interrogations.” Quaritch explained. He made the request without actually asking. Making it clear he wasn’t ASKING for anything.

The general went quiet and appraised the ten-foot-tall reincarnation of one of Pandora’s most reputable and ruthless past inhabitants. Of course she knew the human Miles Quaritch had a son. She had taps on every human that stayed behind on the moon, including the ones born there.

Miles ‘Spider’ Socorro was practically the poster child for humanity’s successful transition to life off planet Earth. The first human born on Pandora; an intergalactic celebrity. But Ardmore didn’t have time for “celebrities”, the RDA could deal with the PR concerns. She needed her soldiers in line to keep the hostiles in line. If the head of her greatest tactical unit was distracted, it could cause a ripple effect through the ranks.

“Consider it done, Colonel.” Ardmore said, surprisingly agreeable considering Quaritch would likely respond negatively to what he learned, “So long as I can continue to count on your assistance with the hostiles. You’re not here to babysit, Miles, you’re here to finish what you started.”

“Understood, General Ardmore.” Quaritch said with another salute. Until the RDA found some hostiles to pacify, he would focus on Spider.

Ardmore kept her word when she said Ja would have the full medical report by the time Quaritch and Wainfleet returned to the medical wing. Sure enough, they entered the waiting area to see Ja crouched down against the wall and staring intently at a tablet. The colonel noticed how his medic, who was the calmest under pressure of the whole squad, looked unsettled.

“Ja, everything good?” Quaritch asked as he and Wainfleet approached. The medic looked up, his ears perking straight up from pinned back against his head.

“Sir, can we speak privately?” Ja said in a quiet, rushed voice.

Quaritch felt that twinge of anxiety come back and it was spreading through his chest. The three recoms ducked uncomfortably into an empty triage room and waited until their sensitive ears heard no one nearby. Quaritch looked back to Ja, he was crouched down and staring at the tablet again.

“Don’t leave me hangin’, doc.” Quaritch said with narrow eyes. He exchanged a look with Wainfleet, who just shrugged at Ja’s continued silence, before looking back to Ja. “Corporal. Speak up.”

“Sir, may I speak freely?” Ja said as he looked up to Quaritch. He received a prompt nod from his commanding officer and let out a sigh before asking, “What the fuck?”

“You’re gonna have to elaborate.” Quaritch growled, ears going back and tail flipping. Just what the hell did that report say to make one of his men speak so bluntly?

“Sir, how many of Spider’s interrogations did you witness?” Ja asked as he was swiping around on the tablet’s holographic screen.

“Two.” Quaritch said, eyes roving over Ja’s quick moving hands, “First interrogation lasted all of three minutes before he passed out. Second one lasted almost an hour and they didn’t get jack from the neuroscanner.”

“I’m not surprised…” Ja said as he turned the tablet around for the other recoms to look at. There were four separate images of top view brain scans. From left to right and top to bottom, the amount of bright oranges and red increased in the frontal lobe. Ja went on to explain, “Sir, each of these scans are a follow-up from a different session in the neuroscanner. They threw him in there four times, I’m guessing two more times between the first session when he passed out and the last one before you took custody. That’s twice the legal limit for this type of intensive interrogation per the UN’s Humane Treatment of POW Act.”

Quaritch stared at the scans, listening to Ja’s words. Spider had been interrogated while hooked up to the neuroscanner four times. FOUR times. And he only knew about two of them! He insisted on being present for the interrogations to make sure they went smoothly.

He felt himself feeling sick by how quickly anger was bubbling up inside him. Ja was continuing to explain the risks while Wainfleet stared at Quaritch, who was completely detached from the conversation. Eventually, the second in command told the medic to hold off on the explanation.

“Boss?” Wainfleet asked cautiously. He cleared his throat and spoke louder, “Colonel.”

“How’d this get past medical approval?” Quaritch asked quietly. He didn’t doubt for a second what the RDA was willing to do to get results. Hell, he’d invented most of the carrot and stick techniques used on Pandora!

“All these records have ‘Restrictions Omitted’.” Ja answered.

“How does that happen?” Quaritch felt the anger in his gut prompting his heart rate to pick up.

“I don’t know for sure, sir, but to bypass medical restrictions for something like this?” Ja theorized, though the politics of the situation weren’t his specialty, “You’d have to…not be protected by them.”

[therisingdarkness]

Fortunate Son

So this is a Ghoul fic in his pre-Ghoul days, written for @cloned-eyes. It's very dark, deals with war trauma, gore, and medical trauma, death, etc. I wouldn't call it Dead Dove, but it comes close I suppose. There is nothing happy about it tbh. But I LOVE writing this stuff and I love disintegrating my friends by tormenting their OCs. This is pure, indulgent Ghoul Whump, and also the introduction of three of our shared babies.

If you read, I hope you enjoy!

~~~ ~~~ ~~~

 The world was black.

That was fine though. Jenot didn’t want to open his eyes. He was so tired of the blinding white lights of the medbay, so tired of the way the longnecks and medical droids swarmed him the instant they knew he was awake, poking him and prodding him with needles and scanners, asking him questions he didn’t have answers for—How does your prosthetic feel? Is it too heavy? How is the movement? Can you see? Look at this chart. Look over here. Open your mouth. Wider. Wider. 

It had been easier when he couldn’t hear. Deafness had been a blessing at the time, but long fingers had pulled at the ragged remains of his ears, measuring and sticking things in the canal until they wedged something hard and foreign inside each one. There was a ringing noise, a piercing buzz that felt like it lived inside his brain, and then he could hear the low murmur of voices all around him, followed by the incessant beep and hum of medical machinery. More stimulation that he had been better off without, but how was he supposed to follow orders when he couldn't hear? 

The crook of his arm ached from the thick needle feeding fluids into his veins. It was the only thing he could feel, the only thing he had to remind him he was still alive. They had only spared him so many painkillers before deciding it'd be more efficient to simply fry his nerve endings. Back-to-back surgeries, countless hours spent edging in and out of consciousness, sometimes aware of a tube fed down the remains of his throat as they pieced him back together, and other times so disoriented he thought he was back on the battlefield. 

He didn't have the strength to fight. Those first nights were filled with pain, with blood, with darkness and the dying screams of the few unlucky brothers pulled from the muck and the mire. It had almost given him hope to know he wasn't the only one who had been saved…but that hope had lasted only so long as he was blind. 

They did something to him, scraped out the ruined, gelatinous mess of his eyes and replaced them with cybernetic implants that allowed him to see better than he ever had before…and the first thing he saw, after opening his eyes and turning his head to the berths next to his were the other survivors of his unit. 

The sight of them made him want to tear his implants back out.

His brothers laid there, pale and still, eyes open and glassy, their bodies wrapped in a network of thin hoses. Jenot didn't have to crane his neck too far to see that those hoses were also hooked up to him. 

Blood.

They were using his brothers…as living blood transfusions, killing them slowly by bleeding them dry. He watched the life drain out of one of them—he couldn’t remember his name, couldn’t even remember his CT number—listened to his last rattling gasps of breath and saw the tears leaking out of his eyes as the light in them dimmed. Jenot wished there was something he could have said to them, something that would have let them know that he was there, he saw them and was with them. They weren’t alone…he wasn’t going to let them die alone….

But it didn’t matter.

They still died.

They died for him—a choice they hadn’t been allowed to make, but a fate decided for them by the longnecks. He couldn’t stop it from happening, couldn’t protect them or offer them any words of comfort in their last moments. All he could do was just…lie there, hooked up to a dozen machines, and watch his brothers fade away.

“No point in trying to save these units,” he overheard one of the longnecks whisper to their colleague. “They’re too far gone as it is. Salvage what you can from them to ensure the commander pulls through, then dispose of the remains. They’re expendable.”

“The commander is worse off than the other ones we managed to retrieve…why is priority given to him?”

“Orders came through from higher up. I don’t intend to question them. Besides, it gives us the opportunity to…experiment.”

“True. I’ve been meaning to run a few tests. It’ll be easier to use these units as subjects. Less paperwork.”

Resistance was futile. Jenot wasn’t even sure he had it in him to struggle, not when his limbs felt like they were filled with lead. He couldn't even speak to tell them 'no'...the prosthetic jaw and tongue felt too strange. He couldn't get it to work the way he wanted, couldn't feel anything to indicate things moved the way they were supposed to. The few words he had been able to grate out on their demand to make an attempt didn't sound anything like the usual smooth cadence of his voice. 

It was all too much.

It was too much.

He couldn't cry, couldn't scream or shout the way he wanted to. His chest felt tight, filled with some emotion that buried itself beneath his ribs, taking hold like thorny vines, choking his lungs until he felt like he couldn't breathe, ensnaring his heart until everything went numb, until the only thing he could feel was the slow crawl of time ticking by, driving him crazy. 

He didn't want to die…but was this any better?

What existence he had been forced into…it was a mistake. He wasn't meant to be there, alive, broken and scarred but on the mend, tended to like he was somehow more worthy of being saved than his brethren just because of his rank—the same rank he had been so proud to receive alongside Wolffe and Fox, the same rank he had celebrated at 79's, partying like the world was ending the next day and getting so drunk it was a miracle they had made it back to base unscathed…now the same rank he cursed for drawing an arbitrary line between himself and his men, marking him as somehow better than them.

He couldn't unsee their eyes, unblinking and tear-filled as they exhaled their last, the subtle movements of their pale, chapped lips as they begged not to die, for someone to save them. 

“Hurts,” one of them had whispered. “It hurts, Commander.”

Jenot closed his eyes, trying to forget.

“They got us good, didn’t they,” the trooper had kept on, delirious, his voice raspy. “I wish…I wish we coulda died out there…on the battlefield. Bombs on our heads an’ kark…better than…than wasting away here. I don’t…I don’t feel any better.”

Because they hadn’t been trying to make him better…not that Jenot could have told him. The prosthetic jaw and tongue had been too new, and he had been so weak, so tired—all he could have done was lie there, listening to his brother’s voice grow fainter and fainter.

“Commander…I don’t feel good. Th–they gave me somethin’, didn’t they. M’ skin’s burnin’.... Feels hot. I don’t…I don’t think….”

He never got to finish his sentence. His next exhale was his last, his breath tapering off into a thin whine as his lungs deflated for the last time. Jenot couldn’t turn his head, but he had felt tears in his eyes, slipping down the sides of his head as he squeezed them tight, wishing he could have blocked out the sound—and what a shameful wish it was. The least he could do for them was bear witness to their last moments. 

That was his duty, as Commander. They had looked up to him, followed him with the trust and loyalty that was baked into them from birth. Every decision he made they had followed, blindly, because he had never steered them wrong before and they had no reason to believe this time would be any different. 

…and they had been wrong.

Jenot forced his eyes open again, gasping like he had been punched in the gut. There was no escaping what he had done…what had been done to them.

Even with his eyes closed he could see them, their bright faces and their roguish, familiar smiles. He hadn’t deserved them…he couldn’t save them, not a single karkin’ one of them. 

Outside, a storm raged and waves hundreds of meters high crashed against the massive pillars supporting Tipoca City. The structures were secure, the noise muted through many layers of durasteel…but he knew the sound of the storm. It brought a strange sort of comfort amidst everything. The wind, rain, even the waves…all were constant, steady. His earliest memories as a cadet were filled with warmth, packed into a room with the rest of his batchmates, curled up in his bunk and listening to the roar of the sea outside.

He wished he could go back to that time, when his future was still undecided. Maybe…maybe there was something he could have done differently, some choice he could have made that would have changed things. Maybe if he hadn’t been a commander…maybe if he had been anyone else this wouldn’t have happened. Maybe his unit would still be alive and he wouldn’t be left reeling with guilt over being the only man to survive the Massacre of Toydaria.

With a groan, Jenot pushed himself into a sitting position. The aches and pains he expected were so dull they may as well have not been there. What should have been a blessing was only another annoyance; he didn’t like not being able to feel. With some effort, he managed to swing his legs over the side of the medical bed and felt around until he felt the solid floor beneath his feet. Pins and needles slid under his soles and toes, but the sensation was as fleeting as it was sharp. He didn’t even have time to cling to it.

He sat on the edge of the bed for a moment, gathering his wits and summoning the strength to stand. His body felt so heavy; the weight of his new prosthetic arm dragged his shoulder down until he felt lopsided. It wasn’t hooked up all the way—the longnecks had mentioned something about needing more time to integrate all the nerve endings. His other hand, swathed in thick bandages, was missing fingers, but at least the prosthetics they had grafted onto his hand actually worked; he couldn’t remember how it happened, couldn’t feel anything anyway. They moved when he wanted them to and that was the only bit of silver lining.

Don’t think about it. Don’t think about it. They’ll keep putting you back together. 

Inhaling deeply, he forced himself to stand, swaying in place before grabbing hold of the IV stand he was still hooked up to. He thought about finding a way to rip the needles out of his arm, but…maybe it was better not to push his luck.

The medical wing was fully dark; a chronometer on the wall put the time at a little bit past 2am. Right between the shift change, if he remembered correctly. He only had a small window of time to escape before he’d be missed. They’d find him eventually, drag him back, threaten to strap him down…but it was worth the risk.

The halls were longer than he remembered as he dragged himself and the stand along, its wheels squeaking in protest as he leaned on it for support. Even if he couldn’t feel anything, his body knew that he was injured, knew that he needed rest. Labored breathing escaped through his mouth, hot breath moistening the tongue that he was still trying to figure out how to use. He knew he shouldn't push himself, but the medbay was too quiet and its ghosts too loud. He needed relief that drugs couldn't give him.

Step by step Jenot followed the familiar corridors and passageways until he reached one of the observation decks, where the windows, made of the same thick glass as ship cockpits, stretched from floor to ceiling. Hurricane strength winds lashed against them, hurling rain and waves over and over, but the glass held firm. Jenot stood in the entryway, watching tiredly before shuffling over to one of the windows; he leaned against it almost immediately, hoping to feel the chill from outside…but there was nothing.

Just the sound.

The noise.

His new hearing aids crackled with the low rumble of thunder and he winced as a loud whine shot through his skull. He could scarcely feel anything else, but he sure as hell felt that. With some effort, he managed to sit down, putting his back against the steel wall and sliding until he felt the floor beneath his ass. The hoses attached to the needle in his arm pulled taut, bidding him to tug the IV stand close. It was a relief to be off his feet; the walk, while not far from the medbay, had taken its toll on him. He wanted nothing more than to lean his head against the glass, close his eyes and let the familiar sounds of the storm lull him to sleep.

“Go talk to him.”

“No, you go talk to him, you’re th’ one who wanted to!”

“Then why’d you two follow, huh?”

“‘Cause you’re gonna get in trouble!”

“Don’t be dumb, everyone’s asleep.”

“So? Go talk to him.”

Jenot cracked open an eye and moved slowly, turning his head toward the sound of barely disguised whispering emanating from the entryway. He knew the sound of disobedient cadets when he heard them, having snuck out of his bunk with Wolffe and Fox enough times to understand the allure of defying curfew. There were three of them, he realized as his cybernetic eyes automatically compensated for the low light, enhancing his sight until he could see just as clearly as if it were fully lit.

Three sets of brown eyes stared back at him, continuously shuffling to push one cadet to the forefront of their trio. Shock registered on their faces, still rounded with baby fat they wouldn’t outgrow for another two years or so, before they slowly filtered into the room, hands tucked behind their backs and eyes cast down to the floor like they expected to be reprimanded. 

Why should I? 

In another time and place…yeah, he might’ve given them a good scolding and sent them back to their bunks on the wings of a light-hearted threat…but why bother? What good did it do him? 

I shouldn’t be responsible for anyone else…look where it got me.

Guilt stabbed into his chest, but he was tired—too tired to pull himself off the ground to deal with the cadets, who now stood close enough to reach out and touch, if he had wanted to. One of them, missing one of his front teeth and sporting a little stain on the front of his sleepwear, took a step forward and kept his head bowed.

“Sorry,” he mumbled to his socked feet. “We didn’t mean t’ disturb you or nothin’...we couldn’t sleep.”

“That’s your fault,” one of the other cadets said. “You always keep us up!”

“Shhhh!” hissed the third, shoving at his batchmates. “Not so loud!”

Jenot watched them with waning disinterest. They were trying not to stare at him and failing miserably. Their big brown eyes kept darting up and down, fixating on his face before shifting elsewhere. They weren't subtle about it either, but cadets didn't know any better. Not this young, at any rate.

He knew why they were looking.

The edges of his neck and jaw stretched tight against the prosthetic, skin red and raw where blood crusted against the seam. It would be slow to heal, slow to integrate, they had told him. He was lucky, they said, that he had been brought back to the facility. Who knows what would have become of him had a battlefield medic gotten his hands on him.

The black carbon metal stood in stark relief against his skin, ugly and frightening. Unnatural. He didn't like catching his reflection anymore. It was surreal, to see the metal and silicone in place of where he once proudly wore a mustache and beard (because he looked good with it, and because it set him apart from his brothers, most of whom chose to remain 

clean shaven).

So yeah, he knew why they stared…and though he didn't blame them, it rankled something inside of him, inspiring a special brand of annoyance that curdled into something deeper, darker. It hit him, suddenly, the striking desire to reach out and tap the three of them against the top of their heads, flick their noses, hurt them in a way that would make them stop.

Make them leave.

It faded as soon as it came, leaving him with more guilt—he would never hurt his brothers, not on purpose.

But…they wouldn't stop staring.

"Th' hell d'you want?" Jenot rasped, finally focusing enough to force the prosthetics to work. He couldn't feel them, but the medical droids had coached him to just…move by instinct. Just don't think about it. Talk like you were whole.

Good advice…but easier said than done.

The three cadets flinched as though he had snapped at them, even though his voice amounted to little more than an aggressive whisper. For some reason their fear registered as cowardice—ugly and pathetic, what were they fuckin’ teaching the cadets these days, where was their fuckin’ spine—and Jenot sneered to himself. He would have given anything for a pack of smokes, anything to quell the irritation quickly rising inside of him.

On some level he knew it wasn't normal, feeling the way he did; he had never snapped at cadets before, had never given himself over to the minor annoyances they caused. It was just bad timing…he had wanted to be left alone, just for a moment, just long enough to gather his thoughts and wrestle his emotions back under control. He had just wanted some peace and quiet…and he couldn't even get that.

It wasn't their fault, though. 

They were…fuck, they were just kids. 

They won't be kids for long, a mean little voice whispered inside his head, distinct from the other tumultuous thoughts running rampant. A few more years and they'll be grown, kitted up and on their way to die on some backwater planet for a cause they don't really believe in. 

Jenot closed his eyes, but in the darkness he saw the mutilated faces of his brothers, bloodied and broken, eyes wide and pale as they stared back at him, waiting for him to give their next orders.

“Are you okay?” one of the cadets asked. There was a slight pressure on his shoulder, barely perceptible, and when he looked the cadet gasped and yanked back his hand, his eyes just as wide as those of Jenot's dead troops. Bile rose to the back of his throat and he forced himself to swallow it back down, forced himself to look away, back out at the storm raging just outside the window.

His translucent reflection stared back at him, his new cybernetic eyes glowing faintly. They had shaved his head to attach electrodes to monitor his brain activity while he had been in a medically induced coma prior to and following the extensive surgery required to clean up his jaw and throat and attach the prosthetic. Sticky residue clung to his skin where some of the patches had been.

He felt…different.

He looked different.

He…he wasn't okay. 

He wasn’t okay and he was never gonna be okay ever again.

“Either tell me what you want,” Jenot growled, “or get lost.”

The cadets huddled together closer, two of them clinging to the brassy one Jenot mentally labeled as the ringleader of their little trio. He gulped, throat working hard to swallow past the ball of nerves stopping his words, before stammering out a small apology.

“We just w-wanted t’ know what it's like….out there….”

Jenot made a noise that wasn't a laugh, but wasn't really anything else. 

“Out there?” he asked, nodding toward the window. “Or you mean th’ war.”

Silence, but three pairs of big eyes watching him closely gave him the answer he was looking for.

“Eager t’ get out there and’ show th’ world what you're made of?”

“Y-yessir. We wanna do our part.”

Do our part.

It struck him, suddenly and with a clarity that bordered on blinding, that there was a madness to this war that he had overlooked until now.

Or maybe…maybe that was just the way he had been brought up, trained—conditioned—the way all of them were taught not to question things. Regardless, the idea that they had any ‘part’ in the war beyond the fact that they were, quite literally, made for it, was laughable. 

The Republic he and so many others were so proud to serve remained just out of reach. As clones they had no birth certificates, no citizenship, nothing beyond their CT numbers cataloging their decanter dates. What identities they forged among themselves held tenuous, at the mercy of sympathetic Jedi and the odd senator who referred to them by chosen name rather than number; there was always the sense, deep down, that despite the courtesy they were sometimes shown, they were still just tools of war.

Their ‘part’ was in their existence. Their ‘part’ was the armor on their backs and the blasters in their hands, their blood on the ground as they pushed back against the Separatist armies, fighting a war for a government they had no part in, fighting for worlds they'd never belong to.

“Careful what you wish for,” Jenot said, looking back out the window. “It's not th’ honor you think it is.”

“But…the Republic needs us,” the biggest cadet spoke up. His hair was a little wild and his teeth looked a little too big for his mouth. Despite his size he stood firmly behind the ringleader, hand fisted up in the other’s tunic. Jenot stared at him and watched as the kid dropped his eyes to the floor, unable to meet his intense gaze. 

“You think they need you?” Jenot asked, unable to stop himself from sneering. “Like it just won’t end without you? Like you’re special?”

Uncertainty crossed his face, because why wouldn’t it? They were taught to respect their superiors, both those who came before them and outranked them. Jenot knew their natural instinct would be to believe every word he said, regardless of how treasonous it sounded. Funny…not even a month ago he had always made sure to watch what came out of his mouth. The longnecks had impressed upon him and others that they had a responsibility to the cadets, to set good examples for the kind of soldiers they were meant to be. 

Now though…he just couldn’t think of a good reason why he should bother.

What was he supposed to do while sitting there, looking like a freak? 

“You’re not special,” he said before the cadets could protest. “Not a single one of you. You’re nothing more than numbers t’ them. All th’ kark they feed you during’ training sessions doesn’t mean a thing. Not a damn thing.”

“You’re a liar,” the third cadet finally spoke up, his eyebrows drawing together angrily as he bravely scowled. “Suda Mo says we’ve all got potential. We could become Arc Troopers if we train hard!”

“‘Course they want you t’ train—th’ harder you work th’ better you make them look. You die out there in th’ field they gotta start all over from scratch. But they don’t care, that’s why…that’s….”

They’ll just make more of us, Commander. 

Jenot shook his head, trying to rid himself of the ghostly whispers of his dead comrades. His stomach twisted with every word he said, like something inside of him was still decent and unspoiled by all he had seen…all that had happened. That part of him that kept fighting was the part he wished would just give up and die. He didn’t want to owe the Republic for saving him. Hell, he hadn’t asked to be saved and still didn’t know why, out of all his brothers, he was the one they thought worth the effort with half his body blown away.

You know why.

You know exactly why.

No…stop…don’t think about it.

“I used t’ think th’ same,” he growled, forcing to speak in the hope it would drown out his thoughts. “I used t’ be like you, daydreaming how I’d make a difference if only I could get out there sooner. You see what that kinda thinking got me?”

He gestured roughly to his jaw with his bandaged hand. The cadets flinched, but couldn’t stop themselves from staring in the face of an open invitation.

“What…what happened?” the ringleader asked, taking a step closer. He tilted his head to the side and wrinkled his nose, unable to hide what had to be…it was disgust, wasn’t it?

“Bad orders,” Jenot said. “Intel was wrong. You’ll be surprised how often it is. But we were arrogant. We had Jedi with us an’ thought nothing could go so wrong that we couldn’t make it out alive. We were wrong.”

“You were ambushed?”

“Slaughtered. Like animals. It wasn’t even a fair fight. Not even th’ fuckin’ Jedi could save us.”

“That’s…that’s kark.”

The other two cadets gasped as their fearless little leader cursed back, clinging harder to him like they had half a mind to drag him off. He stood there, anger radiating off of him with his hands balled up into fists as he stared at Jenot, his expression openly defiant.

It was a good look. Maybe he should have just let the kid impress him a little and been the bigger person. He could have just let it go because at the end of the day, they were still snot-nosed cadets who knew nothing about anything and especially not about the world beyond the safety of Tipoca City. All they had to go on was rumor and simulations.

“Say that again?” Jenot hissed, leaning close. He didn’t care about being the bigger person. His heart was pounding, blood rushing through his ears at the thrill of going against everything he had ever been taught. The longnecks would send him straight to reconditioning if they could hear the way he was talking, and he didn’t give a damn. He wasn’t going to keep their precious secrets. He wasn’t going to protect their ‘investments’ any longer. He owed them nothing. He never asked to be born and he didn’t ask to be saved. They had gone and made a monster out of him so that was how he was going to act—monstrous, until someone came to shut him up for good.

“I said you’re full of k-kark!”

“2020, shut up!”

“Man, you’re gonna get us in trouble!”

“Yeah, Cadet 2020,” Jenot jeered, “you should listen t’ your friends. Would hate for your precious caretakers t’ find you wanderin’ out of bed so late.”

“Y-You’re out of bed too!” the one called 2020 shot back. “You won’t say nothin’ ‘cause you’ll get in trouble!”

He had guts to talk back like that. His peers weren’t cowering either, though they weren’t exactly backing him up. At least they had the good sense to keep their traps shut. As much as he wished he could rip them a new one and send them back to their bunks, he didn’t want to run the risk of attracting attention himself; not only would he have to listen to their inane lectures, they’d probably sedate him again. He was so tired of the drugs.

Jenot reached out and snagged the front of 2020’s tunic, dragging him close; the others, hanging on for dear life, stumbled forward as well.

“You got a lotta nerve telling me I don’t know what I’m talking about,” he said, his voice eerily soft and calm. “You think th’ Republic’s so great? You think th’ Jedi are so powerful? Look at me. They wouldn’t let me die.”

2020 blinked hard and fast, leaning away but not quite resisting, still trapped in his training that forbade him from disobeying a direct order, or fighting back against his superiors, who’d only ever try to better him. Stupid, naive little fools, all three of them.

“Y-You should be grateful they s-saved you! They’re only tryin’ to help!”

Something inside Jenot went numb with that—whatever had been burning inside him, keeping him from diving too deeply into territory he’d come to regret, was suddenly snuffed out. 

“Grateful?” he seethed, ignoring the burning numbness in his hand as he dragged 2020 closer, til they were almost nose to nose. “You think I should be grateful? For making me look like a monster? I can’t feel anything anymore! I had t’ lay there an’ listen…listen t’ them kill my brothers!”

“Th-they wouldn’t do that!” 2020 insisted, pushing back finally. “They wouldn’t! The Jedi wouldn’t allow it!”

“SHE’S TH’ ONE WHO GAVE TH’ FUCKIN’ ORDER!!”

He hadn’t meant to yell—rather, he hadn’t been able to control himself. His voice echoed off the arched ceiling of the observation room and back down the hallway leading back to the medbay. The cadets were practically cowering, but he didn’t have it in him to care, not when they had the gall to act so condescending to him. 

Jenot had spent days slipping in and out of consciousness. Before they had fitted him with hearing aids his world had been dark. Sleep was the only escape he had, yet he could only pretend for so long before the murmur of voices woke him.

He couldn’t unhear the things whispered between the doctors and aides. Had they known he was listening in, perhaps they would have taken their gossip elsewhere, but what better place to trade secrets than a ward of death? It was there he heard them admit the only reason he was alive was because the Jedi who had accompanied his unit—even the thought of her name made him want to retch; what good were they if they couldn’t keep his men safe—the one who had kept him alive through the mystical powers of ‘the Force’ or whatever, had ordered the longnecks to do everything in their power to make sure he pulled through. 

She was the reason he was still alive, but she was also the reason he had to lie on a bed surrounded by his dying brethren, listening to their tearful pleas for the pain to stop, listening as they slowly lost their minds to the agony wracking their bodies after being denied painkillers, or the drugs pumped into them when the ‘doctors’ decided they were no longer worth keeping alive even as experiments. The moment they lost their worth was the moment they became nothing more than faulty products.

Jenot stood up, ignoring the protest his body made. 

He couldn’t stand it, couldn’t fucking stand the way these brats thought they knew better, because they couldn’t comprehend a world in which the shiny reputations of the Jedi were so tarnished. They were still too young to fully understand what they were, that the Kaminoans didn’t regard them with fondness or affection. They sat in their bunks, warm and dry and well-fed, complaining about the minor aches and pains of training, with no idea of the horrors they would face on the outside.

“You wanna know th’ truth?” he asked, releasing 2020 to grab hold of his IV stand. “Follow me. I’ll show you…since you think I’m a liar.”

“2020, no,” the small one whispered fiercely. “We hafta get back to the bunks! Suda Mo is gonna do his rounds soon….”

“Yeah, forget about ‘im, he’s just a mean ol’ clone mad ‘cause he lost a fight!”

“No,” 2020 said firmly, “I wanna see for myself. I don’t believe anything he says, so I hafta go. If he’s wrong, then I’ll know.”

“And if he’s right?”

“...then I guess I’ll know that too.”

To their credit, the other two refused to leave their batchmate’s side. They kept close, creeping along the wall in complete silence as Jenot dragged himself back to the medbay. He kept imagining he heard footsteps behind them, the gentle swish of fabric and the slow breathing of their ‘keepers’. He knew shouting would bring security down on their heads sooner rather than later, but rage filled the void left behind by propriety and he didn’t give a flying kark who had heard. They were bound to get caught eventually, but he wasn’t gonna let those brats go without teaching them a lesson the only way he knew how.

The corridor grew darker the closer they got; staff turned the lights off in order to make the patients more ‘comfortable’, but he was beginning to think it was probably to conserve energy. It’s not like they actually cared. Jenot paused to listen, but the only sound was his own labored breathing and the sniffing from one of the cadets—just a little further, however, he picked up the faint beeping of medical equipment.

“We’re not supposed to be here,” the smallest cadet whispered, squeezed as tight as he could possibly be to the larger one, who was shivering in place. 2020 swallowed nervously and Jenot noticed the way he glanced up, but said nothing.

“No one’s gonna know,” he said raspily, just as the doors slid open.

He stepped inside, dread washing over him as the unfortunate familiarity of the room caught up to him. Behind him, the trio hesitated. They couldn’t see inside from where they were standing…which, if he was still the kind of man who wanted to protect the younger clones from the harsh realities of the world for a while longer, he might have stopped them there, told them he was only kidding and they should head back to their room now.

But he was angry, and they had hurt him with their accusations, sharpened their words into little blades and stuck them deep, into the soft parts of him that were still vulnerable and fragile. The parts of himself he’d have to kill before he ever let anyone else use them against him in this way.

“What’s th’ matter?” he asked. “Too scared?”

“I-I don’t wanna go in,” the big one stammered. “I’m good.”

“Y-yeah, me neither. I-I’ll believe anything he says.”

One of the machines kicked off, buzzing as an EKG monitor spat out a printout of one of its patients’ heart rate from the past hour. The cadets gasped as a single unit and jumped in place, looking for all the world like they were ready to bolt back down the hall. The only thing keeping them there was 2020, who stared with wide eyes at Jenot, his face pale and drawn and his expression one of pure, childish regret.

“Coward,” Jenot hissed. “And you think th’ Republic needs a big hero like you?”

His taunting did the trick.

2020 took a deep breath and took hold of his brothers by each of their hands.

“C’mon, I’ll protect you,” he whispered, meant only for their ears; Jenot heard everything though, heard the smaller one’s little whimper and the way the big one swallowed. He grinned, though it didn’t feel like the right kind of smile. The prosthetic was still too stiff, didn’t let his lips move the way he wanted them to. He watched, waiting patiently as the kids took their first few tentative steps past the threshold of the medbay and into the dimly lit room.

“Over here,” he said, gesturing as he released his IV stand to let it trail after him, holding fast by the hoses still attached to his arm. They pulled again but he didn’t feel it and so didn’t care. The berth he led the cadets to was still occupied, one of his men clinging to life with the help of machines.

Fetch, Jenot remembered, so named because of how eager he was to help, so willing to run and fetch anything anyone asked for. 

“Hu-who’s that?” 2020 asked as he crept closer. 

“One of mine,” Jenot said. “One of th’ ones who wasn’t so far gone he couldn’t be of use.”

“What d’you mean?”

He should have just let Fetch die with dignity. He should never have brought the kids into the medbay, and maybe later he’d regret his actions…but in the moment, Jenot pulled back the thin sheet covering his squad mate, revealing the extent of the carnage underneath. 

The ‘wound’, if it could be called that, had been cauterized and sterilized in the field—ropes of intestine laid across the bottom half of the berth, resting over the remains of his hips and legs. Melted armor fused with blackened skin and bone, skeletonizing his lower half and the only sign of life was the shallow rise and fall of Fetch’s chest; just inside the cavity of of his torso his lungs inflated and deflated with the help of the surgically attached ventilator. They hadn’t bothered closing him up, declaring he was too far gone upon arrival…but that hadn’t stopped them from bringing him back anyway at the first sign of life. He still had something to give after all.

The cadets screamed and scrambled back, or tried until Jenot snatched 2020 by his arm and shoved him closer, forcing him against the edge of the bed.

“Take a good long look,” Jenot snarled. “This is what they do t’ you when they’re not ready for you to die. Th’ only thing keeping him alive right now is that machine, an’ it’s doing’ all th’ work. Th’ second they take him off th’ oxygen, he’ll die.”

2020 thrashed in his hold, but even injured Jenot was bigger and stronger, and filled with so much righteous fury that he didn’t think there was any way any of the kids could have stopped him. He had a point to prove after all.

“Let me go!” 2020 yelled, digging his fingers into the bandages wrapped around Jenot’s forearm. “What’s wrong with you?! Let me go!”

“You wanted proof,” Jenot snapped, shoving him against the bed even further, his hand on the back of 2020’s neck, practically rubbing his face into the bare skin of Fetch’s chest. “Here’s your karkin’ proof. They won’t let him die ‘til they’re done with him. They won’t stop ‘til they’ve bled him dry of every resource they can scavenge. How else do you think they keep th’ rest of us alive when we fuck up?”

2020 screamed again—it would have been a little funny if Jenot hadn’t been so furious. He didn’t notice how the other cadets fled, abandoning 2020 to his fate. He didn’t notice anything at all until he looked up at Fetch’s face and saw the skin around his eyes, wet from something—tears? Was it possible for a man to be aware when he was so far gone? Was he scared of dying? Did it hurt? 

He looked down at 2020, still struggling against his hold and crying hysterically, begging now to be released.

“I’m sorryI’msorry’msorryplease–pleaseplease lemme go I’m sorry,” the boy sobbed, twisting and squirming. 

In that moment he looked…he looked so young. So vulnerable. He was…he was just a child.

What am I doing?

The lights came on and Jenot looked up, blinking as two of the medical droids floated over, followed by the on-duty aide. She looked him up and down, making him feel so very small and worthless, before reaching for 2020. He released the cadet immediately, and watched as the kid flew into aide’s legs, hugging her tightly and wailing into her skirt.

“What…is going on here?” she asked calmly, resting a long fingered hand on top of 2020’s head.

Jenot opened his mouth, but his words had dried up. Anything he could have said in his defense would have only incriminated him more. He never should have left the medbay, never should have engaged with the cadets, and he certainly shouldn’t have allowed his petty rage to take over in bringing them back. He stood there, silent, blood pounding through his head and in his ears in a way he didn’t need his hearing aids to be able to hear. It was an ache that transcended pain, but at least it was something he could feel.

“He brought us here!” one of the other cadets yelled from the medbay entrance, peeking around the corner with tears running down his cheeks. “He said he had somethin’ ta show us!”

“Is this true, CC-1313?”

His number hit him like a sledgehammer to the gut. What wind he had left in his sails was stripped away, leaving him feeling weak. Blindly he reached back for the railing on his bed, set up next to Fetch’s, and sat down heavily on the edge of the thin mattress.

“Y…yes,” he said, staring at the floor. 

“I see. There is no excuse for this behavior. You are expected to set an example for the cadets. I will be speaking with the prime minister about this ghoulish incident.”

“I understand,” Jenot said robotically. 

The medical droids fussed, one of them carefully rearranging the sheets to cover Fetch back up while the other hovered around the electrodes still attached to Jenot’s chest and head, taking measurements with its instruments. He sat there and let it happen, wishing there was a way he could have just…ended it, out there in the field. He…he didn’t want this life, didn’t want to share a room with Fetch, watching him die slowly. He didn’t want to face his reflection in the mirror everyday, knowing he looked like…like that. He didn’t want to face her again, knowing she had survived Toydaria as well.

But he would.

He didn’t have a choice. 

They’d make him.

[sarajcsmicasereports]

Brachytherapy for Bowen's disease of the palm by Ting-Yu Tsai in Journal of Clinical Case Reports MedicaI Images and Health Sciences 

INTRODUCTION

Bowen's disease, or squamous cell carcinoma (SCC) in situ, has been regarded as a cutaneous marker for internal malignancy. The most common option is surgical removal. Surgery is usually indicated for smaller lesions. However, Bowen’s disease occurs more often in elderly patients (with a higher risk of comorbidities) and is frequently located on body sites with poor wound healing. Therefore, there is a need for non-invasive but effective treatment options.

Case report

A 70-year-old patient with an ulcer and lump on her hand visited Liou Ying Chi Mei Hospital in September 2020 . The patient was unable to open her hand due to dermal inflammatory infiltrates. A biopsy confirmed nodular SCC. She was evaluated jointly by a radiation oncologist and a surgical oncologist. Considering the large lesion size, cosmetic and reconstructive issues, and the patient’s unwillingness, surgery was deferred. After discussion with the patient, treatment via radiotherapy was decided and informed consent was signed.

Images were acquired from the patient on a 16-slice CT scanner (Discovery CT590 RT, GE Medical Systems, Amersham, UK) with a thickness of 3.75 mm. Brachytherapy treatment planning was done using the Oncentra treatment planning system OTP V4.6.0.16 (Nucletron, an Elekta company, Elekta AB, Stockholm, Sweden). We prescribed 40 Gy in 8 fractions at a depth of 5 mm from the skin surface, using 4 catheters. The target size was 3 cm x 2.5 cm. Treatment was delivered using an Ir-192 source. For this patient, the maximum skin surface dose was 571.48 cGy/fraction. Treatment time was 15 minutes per fraction including treatment set-up time.

The patient tolerated the treatment well without any interruption.  shows the clinical picture on the first day of brachytherapy. During radiotherapy, increased discharge was noted at the site of ulceration (requiring regular dressing changes). The area appeared also erythematous and scabbing, with patchy moist desquamation . These effects were classified as Grade 2 toxicities. At two weeks after treatment , healthy granulation tissue with partial resolution of the lesion was observed along the adjacent area.  shows the site one month after brachytherapy. At 45 days post-brachytherapy, the lesion completely resolved . The treated skin was mildly pink with no ulceration, ischarge, or skin atrophy. The patient was happy with the cosmesis and outcome.

DISCUSSION

While surgery remains the standard of care for many patients with SCC, brachytherapy provides an option for cases where surgery is not a viable or patientpreferred therapy. High dose brachytherapy is a powerful way of treating skin cancers in elderly patients.

[thoughtportal]

Theodore Nash sees only a few dozen patients a year in his clinic at the National Institutes of Health in Bethesda, Maryland. That’s pretty small as medical practices go, but what his patients lack in number they make up for in the intensity of their symptoms. Some fall into comas. Some are paralyzed down one side of their body. Others can’t walk a straight line. Still others come to Nash partially blind, or with so much fluid in their brain that they need shunts implanted to relieve the pressure. Some lose the ability to speak; many fall into violent seizures.

Underneath this panoply of symptoms is the same cause, captured in the MRI scans that Nash takes of his patients’ brains. Each brain contains one or more whitish blobs. You might guess that these are tumors. But Nash knows the blobs are not made of the patient’s own cells. They are tapeworms. Aliens.

A blob in the brain is not the image most people have when someone mentions tapeworms. These parasitic worms are best known in their adult stage, when they live in people’s intestines and their ribbon-shaped bodies can grow as long as 21 feet. But that’s just one stage in the animal’s life cycle. Before they become adults, tapeworms spend time as larvae in large cysts. And those cysts can end up in people’s brains, causing a disease known as neurocysticercosis.

“Nobody knows exactly how many people there are with it in the United States,” says Nash, who is the chief of the Gastrointestinal Parasites Section at NIH. His best estimate is 1,500 to 2,000. Worldwide, the numbers are vastly higher, though estimates on a global scale are even harder to make because neurocysticercosis is most common in poor places that lack good public-health systems. “Minimally there are 5 million cases of epilepsy from neurocysticercosis,” Nash says.

He puts a heavy emphasis on minimally. Even in developed nations, figuring out just how many people have the illness is difficult because it is easy to mistake the effects of a tapeworm for a variety of brain disorders. The clearest proof is the ghostly image of a cyst in a brain scan, along with the presence of antibodies against tapeworms.

The closer scientists look at the epidemiology of the disease, the worse it becomes. Nash and other neurocysticercosis experts have been traveling through Latin America with CT scanners and blood tests to survey populations. In one study in Peru, researchers found 37 percent of people showed signs of having been infected at some point. Earlier this spring, Nash and colleagues published a review of the scientific literature and concluded that somewhere between 11 million and 29 million people have neurocysticercosis in Latin America alone. Tapeworms are also common in other regions of the world, such as Africa and Asia. “Neurocysticercosis is a very important disease worldwide,” Nash says.

Cyst Attack

The alarming illness occurs when tapeworm larvae lose their way. Normally, Taenia solium has a life cycle that takes it from pigs to humans and back to pigs again. Adult tapeworms, living in the intestines of humans, produce up to 50,000 eggs apiece. The eggs are shed in the infected person’s feces. Pigs swallow these eggs accidentally as they rummage for food on the ground. When the parasite eggs reach a pig’s stomach, larvae hatch and burrow their way into the animal’s bloodstream. Eventually they end up lodged in small blood vessels, typically in the animal’s muscles. There they form cysts and wait until their host is eaten by a human. (Pork has to be undercooked for the tapeworms to complete their journey.)

But sometimes tapeworms take a wrong turn. Instead of going into a pig, the eggs end up in a human. This can occur if someone shedding tapeworm eggs contaminates food that other people then eat. When the egg hatches, the confused larva does not develop into an adult in the human’s intestines. Instead, it acts as it would inside a pig. It burrows into the person’s bloodstream and gets swept through the body. Often those parasites end up in the brain, where they form cysts.

The tapeworm larvae often get stuck in ventricles, or fluid-filled cavities, in the brain, sprouting grapelike extensions. In this way the worm actively cloaks itself from immune cells. Protected and well fed, its cysts can thrive there for years.

As a tapeworm cyst grows, it may push against a region of the brain and disrupt its function. It may get stuck in a passageway, damming the flow of cerebrospinal fluid. This impasse can cause hydrocephalus, or water on the brain, along with dangerously high pressure. A resulting brain hernia can result in stupor, coma, or death.

If a tapeworm cyst doesn’t cause big troubles, it may go unnoticed for its entire life. Eventually a tapeworm cyst that can’t move on to its adult stage will die; this signals the host’s immune system, eliciting a powerful attack and bringing its covert deception to an end. In many cases, the immune cells swiftly annihilate the revealed cyst, but often damage occurs. The immune system’s attack on the cyst can cause the surrounding brain tissue to swell with inflammation. For reasons unknown, a calcified cyst can keep triggering these immune reactions for years after the parasite’s death.

Although any cyst in a susceptible area of the brain can cause seizures, those lodged near regions that issue commands to muscles can trigger violent convulsions. One of Nash’s patients suffered from tapeworm cysts that twisted around his brain stem. After the tapeworms died, the inflammation that followed was so severe it put the man in a coma.

“Thirty or 40 years ago, these patients just died. Surgeons would go in and see this mess and couldn’t do much,” Nash says. Fortunately, the situation is improving. Even his comatose patient woke up and, after a few years of off-and-on treatment, completely recovered. “Now the guy is doing quite well.”

Breaking the Cycle


A great step forward came in the mid-1980s when praziquantel, the first drug able to kill tapeworm larvae in the brain, became widely available. But praziquantel proved too effective. It not only kills tapeworms but also triggers an immune reaction that causes brain swelling. “Paradoxically, we produce the disease we want to treat,” Nash says.

Over the years Nash and others refined the treatment by combining praziquantel with other drugs that tamp down the immune system. It is far from a perfect solution, though. Sometimes the immune system still overreacts, requiring years of care for seizures and other symptoms. And immune-suppressant drugs like steroids have side effects of their own.

The hunt for better drugs to fight neurocysticercosis is not an easy process. The best way to test potential medicines on tapeworms is to get living cysts out of infected pigs. Nash and his colleagues recently set up a lab in Peru, where infected pigs are abundant, to do just that.

Although finding a better cure is important, Nash is more interested in preventing tapeworms from getting into human brains in the first place by breaking their life cycle. A favored strategy is identifying people who have adult tapeworms in their bodies and giving them drugs to kill the parasites. It is also possible to vaccinate pigs so that they destroy tapeworm eggs as soon as they ingest them.

None of this is rocket science — which makes Nash all the more frustrated that so little is being done. “I see this as a disease that can be treated and prevented,” he says. But there are precious few resources available for treatment and little recognition of the problem. “All of this seems to be very feasible, but nobody wants to do anything about it.” {read}