Effect of teleradiology upon pattern of transfer of head injured patients from a rural general hospital to a neurosurgical referral centre: follow-up study.

INTRODUCTION: The optimal management strategy for patients with head injury admitted to a non-specialist hospital is uncertain. The aim of this study was to evaluate the outcomes of victims of head injury requiring hospitalisation but initially admitted to a rural level II trauma centre without a neurosurgical facility but with a system for neurosurgical consultation via teleradiology. METHODS: Patients admitted for head injury during 2006-2011 were included. Late transfer of patients initially hospitalised in the level II trauma centre was evaluated for treatment failure, defined as clinical or radiological deterioration. RESULTS: Five hundred and sixty-two patients were initially hospitalised in the level II trauma centre. Evaluation of late transfers showed that only 23 (4.1%) represented real treatment failures due to clinical or radiological deterioration. The clinical course was altered by primary intent to hospitalise patients in the level II trauma centre in only one patient. CONCLUSIONS: Selected patients with head trauma who have a pathological CT scan may be safely managed in level II trauma centres following neurosurgical consultation using teleradiology. Review of treatment failures is necessary to ensure proper ongoing management of a system in which neurosurgical patients are selectively transferred to trauma centres with neurosurgical capacity.

Perforation of the gallbladder into the abdominal wall: A rare manifestation of biliary disease.

A 54-year-old man was admitted to our surgery department complaining of right upper quadrant abdominal pain. The working diagnosis of acute cholecystitis was based on the clinical picture, laboratory tests, and ultrasound findings. Because of the uncommon course of the disease, computed abdominal tomography was performed, showing multiple stones in the anterior abdominal wall. On surgery, the fistula, containing stones and pus connecting the gallbladder and the abdominal wall muscles, was found.

Does prophylactic stent insertion to the common bile duct during endoscopic retrograde cholangiopancreatography (ERCP) before cholecystectomy have any impact on the rate of biliary complications?

BACKGROUND: Patients with choledochocystolithiasis generally undergo endoscopic sphincterotomy (ES) followed by elective cholecystectomy. They can experience the development of recurrent biliary events while waiting for their scheduled surgery. AIM: This study investigated whether stent insertion before cholecystectomy influences the rate of complications. METHODS: The study compared retrospective and prospective groups of patients with choledochocystolithiasis who underwent ES with or without prophylactic common bile duct stent insertion before cholecystectomy. The rate of emergency cholecystectomies and biliary complications during the waiting period before the elective procedure was analyzed. RESULTS: For the study, 162 patients with choledochocystolithiasis who underwent endoscopic retrograde cholangiopancreatography (ERCP) with ES were divided to two subgroups. Group A included 52 patients with stent insertion (mean age, 58.3 ± 19.4 years), and group B included 110 patients with no stent insertion (mean age, 61.4 ± 17.7 years) (p = 0.32). Males made up 33.3% of group A and 53.7% of group B (p = 0.018). The median time to elective cholecystectomy (open or laparoscopic) was 41.5 days for the patients without bile duct stent insertion before cholecystectomy and 53.5 days for the patients who had the stent insertion before cholecystectomy (p = 0.63). Repeat emergency ERCP due to acute cholangitis was 5.6% in group A and 1.0% in group B (p = 0.43). Emergency cholecystectomy rates due to acute cholecystitis after ES were 15.4% in group A and 14.5% in group B (p = 1.00). No mortality occurred. CONCLUSIONS: According to the study findings, prophylactic stent insertion during ERCP before cholecystectomy has no impact on biliary complications.

Congenital coronary artery anomalies in adults: non-invasive assessment with multidetector CT.

Congenital coronary anomalies (CCAs) are uncommon but can cause sudden cardiac death or other symptoms of myocardial ischaemia, especially in young healthy subjects. Conventional coronary angiography (CA) is an invasive and expensive procedure, and cannot provide three-dimensional data on the anomalous vessel. Electrocardiographic gated multidetector CT (MDCT) has been reported to be useful for non-invasive evaluation of CCAs. The purpose of this pictorial review is to discuss and illustrate different CCAs in terms of clinical importance, type and manifestations using MDCT. Knowledge of the CT appearances and an understanding of the clinical significance of these anomalies are essential for making the correct diagnosis and planning patient treatment.

Acute myocardial infarction in a young woman with normal coronary arteries and myocardial bridging.

Myocardial bridging (MB) is defined as an intramural segment of a coronary artery that normally courses epicardially. MB is usually a benign condition; however, some cases resulting in myocardial ischaemia, infarction and sudden death have been reported. We describe a case of myocardial infarction related to MB in a young healthy woman with no risk factors for coronary artery disease. The bridge was demonstrated in detail by coronary CT angiography using multiplanar reconstruction and three-dimensional volume-rendered techniques.

Coronary-pulmonary artery fistula diagnosed by multidetector computed tomography.

Coronary-pulmonary artery fistula is an uncommon cardiac anomaly, usually congenital. Most coronary-pulmonary artery fistulas are clinically and haemodynamically insignificant and are usually found incidentally. This report describes a case of complex coronary-pulmonary artery fistula with two feeding vessels of separate origins: one from the proximal part of the left anterior descending artery and another arising from the right aortic cusp. The complex anatomy of the fistula was shown in detail by multidetector computed tomography using multiplanar reconstruction and 3D volume rendering techniques.