How To Use This DVD

The authors have made every attempt to make this DVD as user-friendly as possible. Please take a few minutes to read the Introduction and Preface before seeking information on specific diseases. Clicking on the Table of Contents bar under the DVD title brings up more than 70 individual tropical diseases that have imaging findings. Scan through this Index to quickly identify the numerous diseases included in this work. When specific information is desired for a particular disease, click on the appropriate subheading under that disease (eg, imaging findings in Amebiasis, or epidemiology of AIDS) to instantly bring up that subsection with its accompanying text and images. To move sequentially through a section click “Next” at the top or bottom of each screen to access the next screen. Conversely, if you wish to go back one or two screens, click the “Previous” button at the bottom of each screen. If you wish to return to the main index, click the Table of Contents button at the bottom of each screen. This will allow you to bring up a new subsection of the disease you are interested in or access an entirely new disease by scrolling to that particular disease. Since the discussion of some of the Major Multi-System Diseases is quite extensive, comprising dozens of screens, the Index has been modified at times to indicate the different forms or species of a particular parasitic disease (eg, schistosomiasis mansoni, haematobium, or japonica) or the different organ systems involved in a major disease such as tuberculosis (eg, chest, abdomen, spine, brain, etc).

Information concerning the Tropical Medicine Central Resource and the International Registry of Tropical Imaging at USUHS can be obtained by clicking the TMCR Mission bar.

Introduction and Acknowledgements

The DVD version of the textbook “The Imaging of Tropical Diseases, with Epidemiological, Pathologic, and Clinical Correlation” has been successfully developed by Mr. Chris Quarles, a computer technologist in the Department of Radiology at the Uniformed Services University for the Health Sciences (USUHS) in Bethesda, Maryland. The second, 2 volume edition was published by Springer-Verlag Heidelberg in late 2001, and was said to be an artistic and professional success, drawing high praise from reviewers and buyers. The prestigious journal Lancet referred to it as a “masterpiece” and wondered, as did others, how two radiologists from different backgrounds and parts of the world could, together with their colleagues, develop such an exhaustive and seminal work covering virtually all aspects of the more than 70 tropical diseases that have imaging findings and which together ravage over 2.5 of the world’s 6 billion people. The high technical quality is attributable not only to the authors but also to the many hours of hard work put into its production by Dr.Ute Heilman and her staff at Springer. We all suspected from the beginning that this would be a boutique book with limited audience since the vast majority of the diseases, covered in its 1700 pages and 2500 illustrations, occur primarily in the countries of the tropical world, but they are spreading beyond the tropics. Because the cost of the book was too high for most of the radiologists and physicians practicing in those countries, most sales were to major medical centers and libraries in North America and Europe, rather than in the countries of Latin America, Asia, and Africa where it would be most useful.

Early on, the U.S. Military Medical Dept. represented by TATRC (Telemedicine and Advanced Technology Research Center) at Fort Dietrich, Maryland) recognized the value of the material within this text for members of the Armed Forces, especially those deployed in the Middle East and Asia who would come in contact with some of these diseases, primarily among the local populace. They therefore contracted to develop a CD-ROM or internet version of the text to be distributed cost-free to all U.S. military radiologists and tropical medicine physicians. This work was completed at the USUHS Dept of Radiology under the guidance of Dr. Maurice Reeder, with administrative support from Dr. James Smirniotopoulos, the department Chairman. Within 2 years an internet-ready version with digitized illustrations was completed, as was an International Registry of Tropical Imaging based largely on the extensive imaging collections of Drs. Palmer and Reeder. The internet version came on line via the USUHS website in 2005 (tmcr.usuhs.edu) and by 2007 the material was also available in its entirety on the American College of Radiology website (acr.org---see Education portal).

Since the recent development of the DVD, multiple organizations have been interested in reproducing thousands of copies for free distribution around the world to interested radiologists and physicians, especially those in poorer nations with access to a computer. Specifically, the American College of Radiology, represented by Dr. Harvey Neiman, their Executive Director, will reproduce and distribute free copies to its members who indicate in writing a desire to obtain this DVD. Also, the International Society of Radiology (represented by Mr. Otha Linton, their Executive Director), will mail hundreds of copies to all member organizations, especially those in the Developing World. Dr. Barry Goldberg, Chair of the RSNA International Committee on Education, and President of the Radiological Outreach Foundation programs will organize the distribution of several hundred more copies. USUHS will distribute the DVD to U.S. military radiologists and physicians.

After conferring with Dr. Palmer regarding this sudden surge in interest for a DVD version of our book, he was in full agreement that we should, as a strictly humanitarian gesture, make our 40 years work in this often neglected area of Radiology available to all who can use this information to better serve and treat their patients, millions of whom die annually from these diseases. Many are treatable and curable if properly diagnosed, often with the aid of modern imaging. The authors will accept no royalties and no organization involved in the reproduction or distribution of these DVDs will gain monetarily. We would like to acknowledge Mr. William Curtis, President of Springer, for his kindness in reverting the book’s copyright to the authors, thus permitting us to proceed with its electronic reproduction. Springer also receives no compensation, except for the gratitude the company should receive as a partner in this worthy humanitarian effort.

The external labeling of the DVD appears as follows: “The Imaging of Tropical Diseases” by Philip Palmer, MD and Maurice Reeder, MD
Reproduced from the Original Text by The Uniformed Services University of the Health Sciences, and Distributed by The American College of Radiology, the RSNA, the Radiology Outreach Foundation, and The International Society of Radiology With the Kind Permission of Springer Publishing, the Authors, and the Above Institutions This Work is Copyrighted and is to be Distributed Free of Charge. It is Not for Sale.

Although the text is now 7 years old, there have been no major developments regarding the imaging findings or techniques pertaining to the covered diseases over this period and indeed the book is quite up-to-date with all manner of CT, MRI, Ultrasound and Interventional illustrations as well as the time-honored general radiology studies. To our knowledge it is still the only comprehensive text on the subject in the English language available today. Dr. Palmer and I are retired and neither of us is likely to pursue a new edition of our work. Thus this text, in written form or in its internet and DVD versions, is likely to be the principal source of information concerning the Imaging of these commonplace but often misdiagnosed diseases for some years, except for occasional journal articles. It is our hope that eventually a new generation of radiologists will be motivated to update our work. The subject should not be neglected: these diseases affect billions of people around the globe.

MAURICE M. REEDER, MD, FACR

Preface

This DVD contains the 1700 page, 2 volume textbook "The Imaging of Tropical Diseases, with Epidemiological, Pathological and Clinical Corrilation". This project is presented with the gracious permission of the authors, Philip E.S. Palmer MD, FRCR, FRCP, and Maurice M. Reeder MD, FACR, and of the publisher Springer-Verlag, Berlin, Heidelberg, New York, who previously held the copyright to the book. All physicians and radiologists who labor in developing countries of the tropical or so-called Third World and who cannot afford the cost of expensive textbooks, as well as their counterparts in the U.S. Military services, are welcome to take advantage of this remarkable collection of images and background information gathered over a 40 year period by the authors from all regions of the world. It is the hope of the authors and publisher that the provision of this treatise freely to those who see and treat patients with these myriad tropical maladies will result in earlier and more accurate diagnosis and subsequent diminution in their morbidity and mortality.

It was the late Professor Benjamin Felson who was the catalyst for the first edition of the book "The Radiology of Tropical Diseases". We have not changed the Foreword which he was kind enough to write when, after about ten years of work, the book was published by Williams & Wilkins Co. in 1981. It was Ben Felson's and our great friend and colleague, Professor Harold Jacobson, who later enthusiastically persuaded us that we should update the book and incorporate all the advances which had occurred since then. He freely gave to us his unparalleled experience and advice in the early stages of the next edition. We assured our new publisher, Springer-Verlag, in 1991 that this time it would only take a few years before we would be ready ... that was ten years before the eventual publication of the second edition in 2001, upon which this DVD is based.

We have learned a lot in that time. While much is unchanged, tropical medicine has in some ways become quite different. We had been fascinated as we wrote the first edition and reviewed a vast amount of material, to find how much diseases vary in different parts of the world. We learned then that there are many diseases that affect untold millions of men, women, and children and yet are often poorly understood. We found it difficult to reconcile the differing opinions of "tropical pathologists" and other experts and tried to take the middle view when differences seemed insoluble. None of that has changed. A few, but very few diseases are lessening. Smallpox has, we hope, disappeared entirely. Onchocerciasis, poliomyelitis, and perhaps guinea worm (dracunculiasis), filariasis, and even leprosy may soon be under control. There are successful vaccines for measles, typhoid, and pneumococcal and other infections, and if these vaccines can be delivered worldwide then these diseases, too, will become less important. Many infectious and parasitic diseases can now be successfully treated with new drugs.

But at the other end of the scale, tuberculosis and malaria have spread and become more resistant to treatment. Malaria kills more than 2 million people every year, 1 million in Africa alone. As another example, the various forms of schistosomiasis infect the same number of people as the whole population of the United States. AIDS has become a major worldwide scourge and is changing the lifestyle, longevity, and population statistics of many countries. With it have come infections which previously were seldom seen in the tropics and even less often in the rest of the world. Another major source of injury and death is trauma, especially from motor vehicles; this is increasing rather than lessening. Malnourishment has brought with it a staggering toll of infectious and chronic disease: worldwide, pneumonia is the cause of death of about one-third of the many thousands of children who do not live to be five years old.

Tropical diseases are spreading into the subtropics and temperate climates. Tourism and military intervention or rescue have rapidly increased, and many people visiting or returning by air or sea bring with them diseases previously known only in the tropics. Millions have been forced to migrate and whole families of refugees have spread infections into different climates: the climates themselves appear to be warming, allowing these tropical infections and parasites to survive in previously hostile surroundings. And, in the tropics, the many recent diagnostic and therapeutic advances are only too often unavailable to those who need them most.

Images from ultrasonography and computed tomography were just appearing when we wrote the first edition. Now both, particularly ultrasonography, are readily available over much of the world, and magnetic resonance imaging is adding further information in developed countries. Although applied less widely, various radionuclides are providing helpful images of some tropical diseases. One of the main reasons for this 2nd edition has been the need to bring all these images together. Much that we knew only from autopsy and histopathological studies can now be seen with imaging. In many patients this has improved the accuracy of diagnosis. It is not really that tropical diseases have changed intrinsically, but that we can see and understand them so much better, particularly those which attack the central nervous system, abdominal and pelvic organs, and soft tissues, which could not be imaged successfully before.

But the growth of knowledge has not only been in imaging. Enormous strides have been made in unraveling the natural history of many tropical diseases: new laboratory techniques are available for the differential diagnosis of many of the infectious diseases, and there is a better understanding of genetic variations and of the effect of the environment, including nutrition, on patients with these diseases. The information gained from "geographic pathology" (now often known as geomedicine) has increased and includes far more than the incidence of cancer, which had provided the original impetus. Learning of all these advances and concentrating on those of importance to diagnostic imaging meant that the completion of the second edition took much longer than we anticipated.

We have again been extremely fortunate to have very experienced colleagues to guide us. Dr. Daniel Connor has for decades been an acknowledged expert on the pathology and indeed the clinical aspects and geography of tropical diseases. His own contributions to this field are unique and based on many years of personal experience in tropical Africa as well as at the Armed Forces Institute of Pathology (AFIP) and elsewhere. We were fortunate to be joined by Dr. Ian Dunn, from the University of British Columbia, who originally trained and had wide experience in parasitology but later became a radiologist. Virtually all that is written in this book has been reviewed by both Dan Connor and Ian Dunn and they have shared their knowledge with us. In the field of ultrasonography, we have had the advice and help of two experienced tropical sonologists, Dr. Sam Mindel, who for years was on the faculty of the University in Harare, Zimbabwe and Dr. M. Wachira, former Chairman of Radiology at the University of Nairobi, Kenya. As is shown by the list of contributors, we have worked with many other colleagues on different chapters: they all provided us with information and illustrations based on their own wide personal experiences, and added immensely to our knowledge.

The format of the 2001 book remains as it was in the first 1981 edition, combining the epidemiology, pathology, laboratory and clinical information to provide the background without which diagnostic images cannot be fully understood. We have tried to simplify and record the pathophysiology of these tropical diseases because many radiologists and other physicians do not have ready or immediate access to all this information. As in the first edition, we have seldom attempted to offer advice on treatment because it is changing and improving rapidly and is usually well beyond our personal expertise. But once the diagnosis has been established, it should not be difficult to learn of up-to-date treatment: imaging then can often record progress ... or failure.

We still owe a considerable debt to those who helped us with the first edition and we have built on the work of Dr. Herman Zaiman and Dr. A. C. Johnson. While most of the chapters have been rewritten, they incorporate much of what we wrote before, because the underlying basics of tropical diseases have not changed. Credit has been given throughout the text for numerous illustrations of gross specimens and photomicrographs from the collection of the AFIP. Many parasitology illustrations from the first edition were provided by Dr. Zaiman. Others for this second edition have come from Drs. Connor and Dunn; this has allowed us to present excellent radiological, pathological, and parasitology correlations, making it much easier to understand and then interpret the images.

Because their contribution was and is so valuable, it is a pleasure to repeat our acknowledgment to those who gave us helpful material and advice for the first edition; many have generously helped us again. We have attempted to list all those who assisted with this new edition and gave us pathological, clinical, and radiographic illustrations, but we suspect that we may not have succeeded completely because we have received so much help from so many throughout the world that some will inevitably have been overlooked. For this we must apologize: we have at times been overwhelmed with information and images, and it is misplaced records, not ingratitude, which must be blamed if we have failed to acknowledge help.

Bearing patiently and cheerfully with the vicissitudes of production, as well as the delays and problems which we gave them, have been our friends and colleagues at Springer-Verlag, who have taken all the information, illustrations, and bibliography and welded it into a whole. Inevitably we added late paragraphs, new images, or new references well after claiming to have "finished" a particular chapter or section. We have again received skilled help from the Department of Medical Illustration of the University of California at Davis, and have benefited from the ability of Springer to take a vast number of images in different formats, including prints, negatives, scans, slides, and original radiographs, and from them produce high quality illustrations. Their team has been led by Dr. Ute Heilmann, who was responsible for the project from the very beginning. The medical desk editor, Ms. Ursula Davis, provided immense support, not only by her knowledge but also through her willing understanding of the difficulties and constraints which we faced. Mr. Rick Mills has been our superb copy editor and Ms. Ingrid Haas had the arduous task of designing and laying out the book. Both added the wisdom of their years in the publication business and worked closely with us to obtain the best end result.

Mrs. Roberta Howering in California typed about half the chapters in the book and retyped them many times until we were all satisfied. They often then had to be retyped again when some new information became available. Her willing help has been much appreciated. The authors wish to thank especially Mr. Chris Quarles of USUHS for developing this DVD, and also Dr. James Smirniotopoulos, Mr. Robert Reeder, Ms. Sandra Morales, and Mr. Micheal Usera for their considerable efforts and computer expertise.

And in the end, we find it difficult to improve on the final paragraph of the Preface we wrote for the first edition: "We have, of course, learned much in the process of putting this book together and, perhaps even more obviously, we have discovered how little we actually know and how much more there is to be learned concerning the radiology (imaging) of tropical diseases. Hopefully this book will be a stimulus to others to correct or amplify our thoughts and thus add to our knowledge. Radiology (imaging) has much to offer everyone, not least in tropical and developing countries. It does not have to be sophisticated and complex to bring benefit to millions of patients. More important is its contribution to the understanding of diseases, the clinical syndromes that result, and the radiographic (imaging) changes which they cause. We hope that in the immense field of tropical medicine this book will play some small part: there is still so much more to do and, so far, so little done".

PHILIP E.S. PALMER, MD, FRCP, FRCR

While wholeheartedly endorsing this Preface, which my friend and long time colleague, Philip Palmer, wrote for us both, I would like to add some personal remarks.

From the earliest days of man's habitation of the earth he has been forced to adapt to an ever-changing and often hostile environment. Paramount among these adaptations has been his struggle through the ages with the countless parasites and infectious organisms passed down by his animal ancestors. The fact that he has survived and even prospered in the face of such adversities is a tribute to his tenacity and adaptability. Even so, after 6000 years of recorded history, and considering the enormous strides mankind has made in the past century in the areas of medicine and public health, one's complacency must be staggered by the immense toll of human life and suffering still inflicted today by these same ageless organisms, particularly in the tropical regions of the world.

The astute physician in the modern era must recognize not only diseases endemic to his locale, but also those that can be imported from faraway places. Extensive civilian travel and military deployment, as well as increasing immigration, have brought millions of North Americans and Europeans into potential contact with parasitic and other tropical diseases. Most of these ailments require special alertness on the part of the clinician and the radiologist since they are often initially misdiagnosed, simulating other more common indigenous illnesses. In many of these diseases an unfortunate delay in institution of appropriate treatment prolongs illness and may prevent a complete cure or even contribute to a fatal outcome.

Sadly, the vast majority of Tropical Medicine and Tropical Pathology textbooks and articles fail to mention the important role that conventional Radiology and the modern imaging modalities of CT, MRI and Ultrasonography play in the diagnosis and, in some diseases like cystic echinococcosis, even the treatment of these maladies. Hopefully, this DVD will serve as a reminder to all those who write about, and more importantly, treat tropical and parasitic diseases that modern Radiology has a pivotal role to play in the diagnosis of over 70 of these diseases that affect more than two-fifths of the world's population.

I want to express my sincere appreciation to our contributing authors, and to all those radiologists, clinicians, surgeons and public health workers who have toiled, and continue to labor, ceaselessly in the tropics, for their superb investigations now and in the past which have contributed so greatly to the understanding of the myriad of parasitic diseases which continue to ravage over two billion of the world's populace even as we have begun a new millennium in the history of mankind. To them and to my esteemed colleague, Dr. Philip Palmer, and the other great British radiologists of a prior era, Professor Sir Howard Middlemiss and Professor Peter Cockshott, who elaborated so brilliantly the radiological aspects of so many tropical diseases found on the continent of Africa and elsewhere, we all owe a great debt of gratitude which will only be repaid as we continue to make significant advances in the eradication of these timeless illnesses in the next century.

MAURICE M. REEDER