...if Tom Stoppard can start “The Real Inspector Hound” with a pause
("It's chaos back there!" ) why can’t I start my own
web page with a digression? No,
don’t answer that, this is a philosophical digression,
not a philosophical discussion…
The reason I chose to open the site with this digression is to distract
you from the lack of content on the main web page. In fact the lack of content on the entire
world wide web for that matter, but that is neither here nor there…
(yeah, yeah, it's in cyber-space...)
The whole idea for this site was to put my probably justifiably
under-read choroid-plexus thesis out for public dissemination. However rather than just throw it out to
the wolves (i.e. you, vulpine creatures), I thought I’d better
give it a framework, and a context.
The idea struck me about 1am, lying in a sweat in the humid
Hong Kong night not being able to sleep. How many ideas are lost
when we fall asleep before writing them down? F'kuk'd if I know. I
didn’t write anything down myself, and this has yet to be confirmed
as a good idea at all. But
still, I got up and wrote...
Truman Capote on Jack
Kerouac and The Beats
…well, OK I typed. But mostly I pushed the freaking mouse around to
try and find my only existing back-up zip copy of the three year
old files, and clicked things on the Front Page menu.
The best one was Help.
Must get a manual! Must
get a legit copy of Front Page!
Must get out of Hong Kong!
Results? – well, you judge. (p.s. have since revised the
site using Dreamweaver.)
So I have also taken the opportunity to load the ISP’s hard-disk with
a lot of other stuff that was slowing my boot-up time. Things like photos from my trips around
Asia. Also some stories emailed home about some impressions and
adventures. Be warned
that I am pretty much the accidental tourist here and do not necessarily
go out my way to experience the lifestyle of the as-yet-untouched-by-commercialism
last-of-the-mountain-people type thing, primarily as that would
entail being in a non-air-conditioned environment. To those saints, mystics and martyrs of the smell-the-incredible-body-odour
tourist ethic, good luck to ya. (I get that anyway in parts of well-dressed
urban-consolidated Asia.) Maybe
when I was younger, I could have been you. I think my son is that kind of tourist,
but only cause his stingy dad won’t fork out for him. Well, work pays for my travels and accommodation,
so why shouldn’t I take advantage of the opportunity to stay in
good hotels? I certainly
couldn’t afford it before I started work here in Hong Kong.
Well I feel justified now. Sorta.
Choroid Plexus Cyst Controversy - The Paradigm of Cyst Criteria
For those of you who don't know, and have read this far, the choroid
plexus is that part of the fluid chambers inside the brain which
produces most of the spinal fluid. One of the great debates
in modern obstetrics has been around the reliability of findings
on pregnancy ultrasound examinations. Some big big research
has been done which shows quality is pretty low, particularly
in the big old US of A. The choroid plexus in the fetus,
at about 15 to 22 weeks (3 1/2 to 5 months) has a tendency
to develop pockets of spinal fluid within it, and these look like
cysts (pockets of fluid) on ultrasound. Someone had the
temerity to say, hey, these things are more common in fetus with
a certain chromosomal abnormality, and then the argument took
So my research tries to follow the development of various arguments
concerning this appearance, and its ramifications. Therefore
I had to address such themes as the quality of scanning around
the world, the numbers behind the various decisions we make on
ultrasound findings, the ethics of fetal diagnosis through amniocentesis,
what a lot of other "soft signs" of fetal chromosomal
abnormality might mean, as well as the more obscure topic of how
otherwise intelligent people became focused on the essentially
red-herring aspects of the cysts size, shape and number.
They were caught in a criteria paradigm, for want of a better
My thesis was conceived as part of my submission for the Fellowship
of the Australian Institute of Radiography. It comes to about 30,000 words. It took 5 years to complete and represents about 12 months solid
work. Figure that. No, second thoughts, don't. Much of the 12 months was spent in getting
the page numbering right. Joking!
I still missed some spelling errors.
It was based on a review of 50 odd cases we had while I
was working as the Chief Sonographer at the Geelong Hospital in
Victoria, Australia. None of us knew what to think of these things. Being good Medical Imaging Technologists,
we only ever read the Radiology based journals and therefore missed
a lot of what was happening in Obstetrics, etc. This was in 1989
through to the early 90's. We
had one case of a fetus with these cysts in which I also found
a cardiac defect (my first! and I only got it part right) and
I was suspicious of a small mandible as well.
I didn’t follow up the case until much later but then discovered
it was a case of Trisomy 18.
Around this time the waves of debate were crashing around
the lighthouse of the choroid plexus, as I discovered.
By the time I managed to complete writing up my thesis and also get
the rest of my Fellowship submission in order (based on vascular
and musculo-skeletal ultrasound presentations) it was the end
of 1996, and I was Chief Sonographer at the Fetal Welfare Lab
at Westmead Hospital in Sydney, Dopplering everything that pulsed,
all day. Wasn’t the issue pretty much resolved,
the Fellowship board wanted to know?
My new employer pretty much thought so. Hopefully my thesis was not presumptuous enough to attempt to
give the last word.
What I ended up with in the thesis is a review of the literature up
about mid 1996, a review of the common findings of fetuses with
Trisomy 18, and some detailed discussion on the merits and quality
of obstetrical scanning in general.
I end up echoing some of the commentators of the RADIUS
trial alluded to above. Obstetrical
ultrasound is only “worth” doing if it is done well. They were talking about a cost value “worth”
– money. I also argue
for what I called an ethical “worth” as well, in terms of fetal
lives lost due to unnecessary intervention.
I have no training in philosophy, and am not even sure
what I mean by ethics, but if 20 normal fetuses are lost after
amniocentesis for every trisomy-18 birth prevented, that is too
great a "cost" for my ethical bottom line.
Ah, read it for yourself. Feel
free to use it for research, but please cite me where I am speaking
in my own words. The anatomy
section is pretty much from Gray's and from the articles quoted
– hey, I have nothing new to add there, I was only passing on
background information, so don’t call me for plagiarism! Everywhere else, if it isn’t between quotation marks, its mine.
The charts and the statistics I worked out myself, and
the ultrasound images are my own scans. You should have seen the rigmarole it took
to digitize some of those scans on my old Amiga 2000 back in 1993!
Now there was a computer operating system!
Great for games, as they used to say...
If you wish to take anything up with me, drop me an email at Expat@Large or if you are a sonographer
or health professional, try the Australian Sonographers Association
Whether this digression was actually philosophical or not, I am not
sure (see above re: no training in philosophy), but anyway, its
so Get back to work!