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PubMed1998

Can x rays be accurately interpreted using a low cost telemedicine system?

OBJECTIVE: To assess whether the quality of x ray films transmitted via a low cost (low resolution) telemedicine link was satisfactory for clinical diagnosis. METHODS: A retrospective study of a set of consecutive accident and emergency (A&E) radiographs. An A&E registrar viewed these directly on a standard x ray viewing box and via a telemedicine link. RESULTS: There were 81 abnormalities out of 234 x ray films. Three abnormalities were missed both on the x ray viewing box and telemedicine link, one of which was significant. There were five additional abnormalities missed on the telemedicine link but detected on the x ray viewing box, of which two were significant. One normal x ray film was interpreted as abnormal on the telemedicine link. There were no false positives on direct viewing. CONCLUSION: Transference of plain radiographs using a low cost/low resolution telemedicine link by A&E doctors is adequate for clinical interpretation.

Emergency Service, Hospital↗

PubMed1997

GPs in A&E.

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Cost-Benefit Analysis↗

PubMed1992

Severe hypercalcaemia four months after acute oliguric renal failure--successful treatment with intravenous clodronate.

A 33 year old man developed acute oliguric failure lasting 66 days, eight days after admission with multiple gun shot wounds. On day 99 after admission, serum calcium was elevated mildly at 2.54 mmol/l (normal range 2.1-2.5 mmol/l). Serum parathormone was undetectable. He was discharged soon afterwards. He presented again on day 164 with nausea, vomiting and blurred vision. Fundoscopy revealed an ischaemic retinopathy and extensive keratopathy. Serum calcium was 3.48 mmol/l and serum creatinine 262 umol/l (normal range 40-110 umol/l). Repeat parathormone was undetectable and there was no evidence of myeloma, sarcoidosis or malignancy. Following treatment with intravenous saline and frusemide, serum calcium fell to a nadir of 3.05 mmol/l. On day 168 an infusion of sodium clodronate 300 mg was given. Twenty-four hours later serum calcium was 2.65 mmol/l and 48 hours later calcium was 2.26 mmol/l. Normocalcaemia was maintained for 17 days and severe hypercalcaemia never recurred. This is the first report in which biphosphonates have been successfully used to treat hypercalcaemia following acute renal failure thus obviating the need for further dialysis.

Acute Kidney Injury↗