Recurrent malignant peripheral nerve sheath tumour in a patient with neurofibromatosis Type 1: a case report.

Malignant peripheral nerve sheath tumour (MPNST) is a rare, albeit well-described, complication of neurofibromatosis. We report a 58-year-old patient with known neurofibromatosis Type 1 (NF-1) who presented with an aggressive recurrent malignant peripheral nerve sheath tumour and spinal cord compression 5 weeks after undergoing tumour excision with thoracic (T)6-7 laminectomy. The case and literature review are instructive to those following NF-1 patients with regards to screening for, and management of, malignant conversion of plexiform neurofibroma.

Telemedicine and neurosurgery: experience of a regional unit based in South Africa.

We carried out a retrospective analysis of all emergency referrals to the neurosurgery department of the Wentworth Hospital from 1996 to 1999. The hospital provided a service to seven peripheral hospitals with computerized tomography (CT) scanners and 46 hospitals without, in the province of KwaZulu Natal. By the end of the study, six of the hospitals with CT scanners had facilities for teleradiology and the mean patient return rate had fallen to 17%. In comparison, almost half the patients seen from the hospitals with no CT scanners were returned to hospital after assessment at the Wentworth Hospital. We also carried out a prospective analysis of 100 consecutive teleradiology-assisted consultations from January to March 2000. Of the 57 patients (79%) who remained at their referral hospitals, 45 had a good outcome, while the other 12 (21%) patients had a poor outcome. The implementation of teleradiology-assisted consultation decreased the number of inappropriate inter-hospital transfers while maintaining appropriate patient care and improving outcome.