Major vascular neck injury from a handgun cartridge casing.

We present a case from the Johannesburg General Hospital of a zone II low-velocity penetrating neck injury with involvement of the ipsilateral subclavian artery. When the "bullet" was retrieved, it was noted not to be an actual bullet but rather a cartridge casing. We speculate that this injury represents one of several possible misfiring scenarios from a homemade firearm. Injuries from homemade firearms are infrequent in the literature, and only one other similar case of a cartridge casing causing a penetrating injury was found. A brief review of homemade handheld firearms is offered.

Trial telemedicine system for supporting medical students on elective in the developing world.

RATIONALE AND OBJECTIVES: The authors sought to create a simple, versatile, and effective store-and-forward telemedicine system to facilitate consultation between medical students pursuing elective study at remote locations in the developing world and specialists at the central institution. MATERIALS AND METHODS: A trial telemedicine system was established between Gizo Hospital (Gizo, Solomon Islands) and Emory University Hospital (Atlanta, Ga). At Gizo Hospital, the system consisted of a commercially available digital camera and a locally available personal computer with a modem providing low-bandwidth (dial-up) Internet access. A visiting British medical student at Gizo Hospital used this equipment to relay digital photographs of patients, as well as the results of relevant tests, such as electrocardiograms, radiographs, and ultrasound images, to Emory University Hospital via the Internet for review by a specialist. RESULTS: The medical student, who had received minimal training (approximately 1 hour) in the use of this telemedicine system, used it successfully to perform eight referrals during the elective course period. Following the student's return home, his local preceptors at Gizo Hospital and a physician at Helena Goldie Hospital on New Georgia Island used the same system for more than 60 additional referrals. CONCLUSION: The telemedicine system is a low-cost, robust, and sustainable means of providing expert support to medical students and other health care providers in remote locations.