Botulinum Toxin in the Management of Sialorrhoea in Acquired Brain Injury.

Sialorrhoea as a consequence of severe acquired brain injury can significantly negatively impact on quality of life. Medications used in its management have many side effects which can cause problems in the severely disabled. Botulinum toxin is an effective treatment of sialorrhoea in a number of neurological conditions but may also have a role to play in the management of sialorrhoea following severe ABI. We report on 4 cases of sialorrhoea following acquired brain injury causing a variety of problems, whose parotid glands were injected with Botulinum toxin type A (Dysport) 50mu each, under ultrasound guidance. All cases had a clinically and statistically significant reduction in drooling as measured by the teacher drooling scale (p=0.005) and carers Visual Analogue Scale (p=0.012). There were no side effects reported. Botulinum toxin is an effective treatment for sialorrhoea associated with acquired brain injury.

High grade splenic rupture in an elite Rugby Union player.

The authors present the case of an amateur under-18 international squad Rugby Union player who sustained a Grade III splenic rupture while scoring a try. He was admitted to hospital and treated with strict bedrest following initial computed tomography (CT) evaluation. He maintained hemodynamic stability throughout and registered no drop in hemoglobin. A repeat CT scan five days later showed no radiological progression and he was discharged with instructions to avoid exercise for three months. A follow-up CT scan performed at 10 weeks after the injury showed radiological resolution but the decision was made to avoid physical contact for a further three months. The player made a full recovery and is now back playing representative rugby. This report reviews the management and raises the question as to when players should be allowed back to play contact sports following a splenic rupture.

Obesity in Ireland in 2008: what radiological equipment is available to image the obese patient?

Obesity is a global epidemic, responsible for 2000 premature deaths in Ireland each year. The extent of this epidemic was quantified by the National Taskforce on Obesity (IOTF), whose report, published in 2005, found that 39% of adults in Ireland were overweight and 18% obese with obesity in adults predicted to increase by 1% per year. In light of the clear evidence that we, as a nation, are quite literally expanding, how well equipped are Irish hospitals and, in particular, radiology departments, to deal with patients of increasing size and weight? The purpose of this study was to quantify the weight limits and girth restrictions of the radiology equipment, in particular CT, MRI and fluoroscopy, in hospitals, both public and private, in Ireland in an attempt to answer this question.

The use of nuclear medicine techniques in the emergency department.

Nuclear medicine techniques have received little attention in the practice of emergency medicine, yet radionuclide imaging can provide valuable and unique information in the management of acutely ill patients. In this review, emphasis is placed on the role of these techniques in patients with bone injuries, non-traumatic bone pain and in those with pleuritic chest pain. New developments such as single photon emission computed tomography (SPECT) in myocardial infarction are outlined and older techniques such as scrotal scintigraphy are reviewed. Radionuclide techniques are discussed in a clinical context and in relation to alternative imaging modalities or strategies that may be available to the emergency medicine physician. Aspects of a 24 hour nuclear medicine service are considered.

Pelvic digit: an uncommon developmental anomaly.

The radiological features of seven cases of pelvic digit discovered incidentally on plain radiographs are described and differentiation from other causes of new bone formation is discussed. Its recognition as a benign anomaly is important to avoid unnecessary investigation or intervention. An embryological theory of development of pelvic digit is proposed.

Treatment of Robin sequence with nasal CPAP.

A 12-year-old schoolgirl presented with severe obstructive sleep apnoea due to the Robin sequence. The sleep apnoea, together with the associated findings of daytime sleepiness, nocturia, right heart strain and growth retardation, were successfully reversed by nasal CPAP therapy. This therapy allows postponement of a decision concerning corrective surgery until after full growth has occurred.