Report of a national neurosurgical emergency teleconsulting system.

OBJECTIVE: The goal was to develop a low-cost, national, neurosurgical emergency teleconsulting system that is independent of vendor computed tomographic (CT) or magnetic resonance imaging (MRI) scanner type. METHODS: Charge-coupled device scanners are used to digitize hard copies of CT and MRI scans. An enhanced optical density range is achieved by using an algorithm to fuse data from multiple exposures at different integration periods. The system is based on personal computers using Microsoft Windows 3.11. Data are transmitted on a wide-area network at 128 kilobits/s, over Integrated Systems Digital Network lines. The network connects both neurosurgical departments in Ireland to all major hospitals with CT/MRI scanners. RESULTS: The scanner optical density is 0.05 to 3.0, with 2.24 to 2.5 line pairs/mm. Five-megabyte images are transmitted uncompressed in 6 minutes. To date, more than 750 CT and MRI scans have been transmitted. The system is completely automated, and operator acceptance has been very high. Images are automatically stored and displayed at the receiving workstation, where the images can be viewed and manipulated on-screen. This system has significantly enhanced acute neurosurgical patient care. CONCLUSION: The system is cost effective and simple to use, has gained widespread physician acceptance, and delivers an image quality superior to that of many commercially available systems.

Report of a national neurosurgical teleradiology system.

An emergency neurosurgical teleradiology system was initially installed in two referring hospitals in ireland to transmit images to the neurosurgical department in Cork. It was subsequently expanded to six major referring hospitals transmitting to both neurosurgical departments in ireland serving the entire population of 3.5 million people, effectively becoming a national teleradiology system. The system was based on PCs interconnected by leased data circuits and ISDN. The network was operational 24 hours a day. Over 750 emergency computerized tomography scans were transmitted and transmission failures occurred in only 6% of cases. We conclude that current PC technology can be used to form a peer-to-peer wide-area network upon which a robust emergency teleradiology system can be based.

Extradural haematoma in the Irish Republic: an analysis of 82 cases with emphasis on 'delay'.

Eighty-two cases of extradural haematoma were analysed to elucidate the factors contributing to delay in treatment and poor outcome. The majority of cases occurred in the first three decades of life with falls being the commonest aetiological factor. Five distinct modes of presentation are described. Excessive delay occurred in recognizing the condition and in subsequent transfer of patients. This resulted in many patients being operated on while in coma. Associated intracranial and extracranial injury occurred in a significant number of cases. Recommendations for the management of these patients are outlined.

Paraganglioma of the cauda equina: a case report and review of the literature.

A rare slowly growing paraganglioma of the cauda equina is described, with characteristic immunocytochemical and electron microscopic appearances. Twenty-one cases of similar tumours have been reported at this site. The literature is reviewed and the main features discussed.

Non-neurosurgical operative intervention in head-injured patients.

Guidelines relating to non neurosurgical operative intervention in head-injured patients are not available for the British Isles. We present a series of seven patients with extradural haematoma operated upon in the referring hospital prior to transfer to our unit. The cases were analysed in an attempt to elucidate the efficacy of the emergency procedures and the associated problems. Recommendations are made in order to generate discussion on this aspect of head injury management.

Recurrent lumbar disc protrusion.

Seventy-six patients who underwent re-operation for recurrent lumbar disc protrusion were analysed to define the pattern of disc recurrence and the outcome following the operation. Whereas recurrence after an L4/5 discectomy occurred at the same level in 66%, recurrence after an L5/S1 discectomy was as likely to occur at L4/5 as at L5/S1. Outcome was inversely related to the number of operations. A satisfactory outcome after the first procedure was usually associated with a satisfactory ultimate outcome. Associated complications were few but of a severe nature.

Management of spontaneous intracranial haemorrhage.

One hundred and six patients with suspected or confirmed spontaneous intracranial haemorrhage were analysed to determine the management and referral patterns. The cases were classified into six groups on the basis of the computerised tomography (CT) scan/lumbar puncture (LP) findings. Subarachnoid haemorrhage was the commonest lesion. Thirty-four point four per cent of these were complicated. LP was performed inappropriately in a large number of cases. Late referral was a problem in some instances. In suspected intracranial haemorrhage CT scan is the investigation of choice. Lumbar puncture should be deferred and only performed following consultation with a neurosurgeon.

Association of reactive arthropathy and Morganella morganii cross reacting with Yersinia enterocolitica.

Two patients exhibited reactive arthropathy in association with chronic diarrhoea and abdominal pain. Rising titres of agglutinating antibody to Yersinia enterocolitica O3 were observed in association with arthropathy. Morganella morganii was isolated from faeces of one patient in heavy growth. In both patients, absorption of the sera with morganella antigen abolished yersinia reactivity. Morganella titres were more than 8 times the yersinia titres and were unaffected by absorption with Yersinia. Neither patient had detectable antibody to the predominant enterobacterial species present in faeces. One patient developed acute cystitis with Proteus mirabilis and had no serological response to the proteus isolate. We conclude that the elevated morganella titres were specific. The role of M. morganii in intestinal disorders remains to be established, but from our findings, it should be added to the list of organisms associated with reactive arthropathy.

Yersinia infection and acute abdominal pain.

In 194 patients presenting with acute abdominal pain from whom sequential serum samples were taken, the frequency of yersiniosis, established serologically, was significantly higher (23%) than in 320 control subjects (2%). Yersiniosis occurred in 31% of patients with acute appendicitis. Acute-phase serum samples only, obtained in a further 307 patients, yielded a falsely low frequency of yersiniosis (4%). Y pseudotuberculosis was five times more common than Y enterocolitica, and Y pseudotuberculosis type IV was the most common serotype, accounting for 43% of Yersinia infections. Yersinia may play a more important part in the aetiology of acute abdominal pain, and particularly acute appendicitis, than has been previously appreciated. Antibody titres to both Y enterocolitica and Y pseudotuberculosis frequently rise late in infections causing abdominal pain. Consequently analysis of acute-phase serum samples alone leads to underdiagnosis of yersiniosis.

First thoracic disc protrusion.

First thoracic disc protrusion is rare. Only 12 cases have been described. The rarity of the condition is probably due to relative immobility of the spine at this level. The disc protrusion is invariably lateral causing radiculopathy. Antecedent trauma is rare. Horner's syndrome may be an associated feature. Good results follow disc excision using a posterior approach.