Use of out of Hours Mri in the Royal Victoria Hospital – a 6 Month Retrospective Review

Intravenous antibiotics were stopped and high dose prednisolone was commenced in addition to the already prescribed somatostatin (Octreotide ®). The patient was maintained on azathioprine (Imuran ®) once the prednisolone had been tapered. His large abdominal defect was dressed with Activon tulle ® honey dressings. He progressed well and was discharged. Follow up revealed satisfactory recovery of the wound. discussion The literature yields only one other case connecting PG with carcinoid tumour 1 , while most reports correlate the occurrence of PG to trauma, typically surgery 2. The delay in the recognition of this serious dermatological condition was associated with increased morbidity for our patient. PG is a serious and potentially fatal skin condition when correct treatment is not quickly commenced. Management is relatively simple once recognised with the use of corticosteroids and immunosuppressant. Surgery is not thought to be beneficial and in many circumstances can worsen the condition 3. We recommend that in any significant skin condition, particularly post-operatively or in one not responding to treatment effectively, one must seek the early advice of a dermatologist and not be guided primarily by histology. use of out of hours mri in the royal victoria hospital – a 6 month retrospective review editor Through the ongoing development of the Critical Care Centre, it is anticipated that the region's principal trauma receiving unit at the Royal Victoria Hospital will attain Level 1 Trauma Centre status. However an essential criterion for this is the provision of 24 hour access to MRI, as stipulated by the American College of Critical Care Medicine 1. Out of hours MRI is currently provided as a time-limited, daily service on a consultant to consultant referral basis. Within the UK, it has been reported that only 32 out of 88 (36.3%) trauma units with MRI provide an out of hours service 2. We undertook a 6 month retrospective review of all patients requiring out of hours MRI between November 2007 and May 2008. Records were assessed for referral information, imaging result and clinical outcome. 74 patients in total had out of hours MRI. Of these, 48 were regarded as emergency (scan performed <24 hours from referral). Of the 48 emergency requests, the majority came from neurosurgery (n=27) and neurology (n=14), with orthopaedics (n=5), general medicine (n=1) and A&E (n=1) making up the remainder. Figure 1 illustrates the categories of clinical referral, with the majority for either suspected cauda equina …