The influence of military threats on the design and use of the Royal Naval Hospital Haslar.

The twin demands of the medical and security requirements influenced the original design of RNH Haslar. Over time the structure was altered to accommodate changes in the military threat and these changes can be identified from original plans and the extant structures. The use of spatial analysis, through the use of justified access graphs, can provide insights into the way the building was used and how it influenced the relationships between the staff and the patients.

The magnetic resonance imaging appearances of the brain in acute carbon monoxide poisoning.

AIMS: To describe the magnetic resonance imaging (MRI) appearances of the brain in acute carbon monoxide poisoning, the commonest cause of accidental poisoning in Europe and the U.S.A. To attempt to correlate the imaging findings with patient outcome as an aid to prognosis. MATERIALS AND METHODS: Brain MRI was performed on 19 consecutive patients, who had sustained acute carbon monoxide poisoning, as soon as possible after their referral to the regional Hyperbaric Unit at the Royal Hospital, Haslar. All patients were unconscious on arrival, and had received at least one treatment with hyperbaric oxygen by the time of first MR. The imaging findings were analysed independently by two experienced MR radiologists, with a third radiologist arbitrating on discrepant results. RESULTS: Thirteen male and six female patients, age range 21-70 years (mean 38.7 years) underwent MR an average of 35.6 h (range 6-126 h) following presentation at the referring centre. MR (at 0.5T) revealed abnormalities in the following areas: globus pallidus (n = 12); other basal ganglia [ n = 5: entire lentiform (globus pallidus and putamen), putamen alone, caudate nucleus, thalamus]; white matter (n = 6: periventricular, subcortical, other); cerebral cortex (n = 5), either localized or general; medial temporal lobe in the region of the hippocampus (n = 4). The majority of the patients with hyperintensity in the region of the hippocampus (n = 3) had no other area of cortical involvement. Two patients showed abnormalities in the cerebellum. Normal appearances were seen on the initial MR in seven patients. CONCLUSION: The appearances of the brain following acute CO poisoning are varied, and have previously been the subject of case reports or small studies, most of which have have addressed the delayed sequelae of this condition. This study, the first large series undertaken in the acute phase, confirms that, although the globus pallidus is the commonest site of abnormality in the brain, the effects of CO poisoning are widespread. The extent of damage correlates with clinical outcome, and therefore aids management and prognosis.

Teleradiology--practical aspects and lessons learnt.

Teleradiology is the most widely practised form of telemedicine and the necessary equipment is readily available. The limiting technical factor is often the communication links between the two sites. A balance must be struck between the degree of image compression and the transmission time. Non technical issues such as organisation of staff and medico-legal aspects must also be considered. Many problems can be avoided by written protocols and agreements.

The first telemedicine link for the British Forces.

In January 1998 a telemedicine link was established between the Hospital Squadron (from 22 Field Hospital) in Sipovo, Bosnia and the Royal Hospital Haslar, United Kingdom (UK). This link uses a high resolution digital camera, laptop computer, satellite telephone and a landline to obtain specialist opinions in radiology, dermatology, plastic surgery, orthopaedics, urology, ophthalmology, pathology and maxillo-facial surgery. This is the Defence Medical Services' first such link from an operational scenario. As such, this pilot study provides a useful testbed to enable clinicians in the three services to gain experience in this developing field, and to help determine the military applications of telemedicine.

Thorotrast associated nodular regenerative hyperplasia of the liver.

A case of nodular regenerative hyperplasia (NRH) of the liver is described in association with exposure to the radiographic contrast medium Thorotrast. This is the first case in which the pathological findings have been fully documented. It is suggested that NRH may have developed through Thorotrast induced damage to portal vein radicles.

Operational telemedicine.

A simple, effective digital camera and E-mail-based telemedicine system has been developed using commercially available equipment. Initial trials were successful and this system is now deployed in several operational units. A retrospective audit has shown it to be of value in 50% of referrals.

Short communication: the use of sodium ironedetate (Sytron) as an MRI rectal contrast agent.

The use of bowel contrast medium in abdominal and pelvic MRI examinations is increasingly being recognized as a useful adjunct. A contrast agent which produces a negative contrast effect with T2 weighted (T2W) sequences might help distinguish bowel pathology, which has increased signal intensity, from bowel content. A solution of 7.6 mg ml-1 of sodium ironedetate (Sytron, Link Pharmaceuticals) produces positive contrast on the first (proton density) echo and negative contrast (signal void) on the second (T2W) echo of a dual echo sequence at 0.5 T. When administered rectally it provides a negative contrast bowel marker for pelvic examinations.

Characterisation and development of 'the shield' in male pigs.

A project was undertaken to characterise boar shield, study its development and determine whether it presents carcass quality problems in young boars used for meat production. In two old boars (>2·5 years) 'backfat' from the scapular region consisted mainly of a dense white tissue with a high collagen content (>20% of fresh weight) and a low lipid content (<10%) compared with normal backfat. Histologically and chemically it resembled the dermis of skin. In a development study in boars and castrates from the Large White and Pietrain breeds, collagen concentration in scapular backfat increased between 91 and 118 kg liveweight in all pigs but the increase was greater in boars than castrates and especially marked in Pietrain boars in which the mean collagen concentration was 18% at 118 kg. This was probably because of the older age of Pietrains since there was a high correlation between age and collagen concentration (r = 0·93). The results suggest that, at 'heavy hog' weights, boar shield could present a carcass quality problem in slow-growing breeds such as the Pietrain.