Traumatic open brachial plexus injuries: The importance of interdisciplinary collaboration.

Open traumatic brachial plexus injuries are rare, yet can be life threatening and require rapid clinic assessment. Early interdisciplinary collaboration is critical to achieve superior patient outcomes. This case of a 24-year-old female of a traumatic neck injury with contralateral brachial plexus injury demonstrates the limitations of early clinical assessment due to the potential for haemodynamic instability and highlights the priority of patient stabilisation. Early and active interdisciplinary collaboration in this case demonstrates its importance in accurate diagnosis and timely intervention to achieve better patient outcomes. As published in recent guidelines, this report shows the importance of early interdisciplinary involvement following stabilisation and resuscitation of the patient.

Rapid diffusion-weighted MRI for the investigation of recurrent temporal bone cholesteatoma.

BACKGROUND: Suspected cholesteatoma recurrence is commonly investigated with magnetic resonance imaging (MRI) of the temporal bone. Non-echo planar diffusion-weighted imaging (non-EP DWI) has become the sequence of choice. PURPOSE: To assess the agreement between an MRI protocol incorporating both non-EP DWI and contrast-enhanced sequences, and a shortened protocol without contrast-enhanced sequences in the assessment of suspected cholesteatoma recurrence. MATERIALS AND METHODS: One hundred consecutive MRIs, consisting of T2-weighted, non-EP DWI and pre- and post-contrast T1-weighted sequences, were reviewed by two radiologists at a tertiary referral centre. Agreement between the two protocols was assessment by means of a weighted Cohen kappa coefficient. RESULTS: We found a near perfect agreement between the two protocols (kappa coefficient with linear weighting 0.98; 95% confidence interval 0.95-1.00). There were two cases in which the two protocols were discordant. In both cases, the lesion measured <3 mm and images were degraded by artefact at the bone-air interface. The shortened protocol without post-contrast sequences yielded a 32% reduction in acquisition time. CONCLUSION: When non-EP DWI is available, contrast-enhanced sequences can be omitted in the vast majority of cases without compromising diagnostic accuracy. Contrast-enhanced sequences may provide additional value in equivocal cases with small (<3 mm) lesions or in cases where images are degraded by artefact.

Tackling the case report.

OBJECTIVE: Resuscitative measures are required to ensure the survival of the case report in medical writing. The aim of this study was to assess a series of case reports for quality improvement. METHODS: All articles pertaining to a single patient published in Auris Nasus Larynx and The Journal of Laryngology and Otology from January to December 2000 inclusive were examined. Data recorded included authorship numbers and origin of the report, pertinence of the accompanying abstract, length of the article, claims of a first and the number of references included in the bibliography. RESULTS: Twelve different countries produced 129 papers in the two journals. Author numbers ranged from 2 to 7 (mean 4.56) in Auris Nasus Larynx, and were 1 to 11 (mean 2.63) in The Journal of Laryngology and Otology. Overall, there were 45 articles of two pages or less. An appropriate summary existed in 79.6% of articles published in Auris Nasus Larynx and in 33.9% of abstracts located in The Journal of Laryngology and Otology. A unique occurrence was reported in 14 and 27.82%, respectively. The number of citations ranged from 3 to 28 (mean 12.4) in Auris Nasus Larynx and 2 to 28 (mean 10.2) in The Journal of Laryngology and Otology. CONCLUSION: Case reports require a more applicable summary with a limit on authors, pages and references.