TOXBASE: Poisons information on the internet

Objectives: To assess the uptake, usage and acceptability of TOXBASE, the National Poisons Information Service internet toxicology information service.

Methods: An observational study of database usage, and a questionnaire of users were undertaken involving users of TOXBASE within the UK between August 1999, when the internet site was launched, and May 2000. The main outcome measures were numbers of registered users, usage patterns on the database, responses to user satisfaction questionnaire.

Results: The number of registered users increased from 567 to 1500. There was a 68% increase in accident and emergency departments registered, a 159% increase in general practitioners, but a 324% increase in other hospital departments. Between January 2000 and the end of May there had been 60 281 accesses to the product database, the most frequent to the paracetamol entry (7291 accesses). Ecstasy was the seventh most frequent entry accessed. Altogether 165 of 330 questionnaires were returned. The majority came from accident and emergency departments, the major users of the system. Users were generally well (>95%) satisfied with ease and speed of access. A number of suggestions for improvements were put forward.

Conclusions: TOXBASE has been extensively accessed since being placed on the internet (http://www.spib.axl.co.uk). The pattern of enquiries mirrors clinical presentation with poisoning. The system seems to be easily used. It is a model for future delivery of treatment guidelines at the point of patient care.

     

Radial recession osteotomy for early Kienböck's disease

Between 1995 and 1999, ten patients with Lichtman stage II and III Kienböck's disease with negative ulnar variance underwent a joint-levelling radial recession osteotomy in our unit. The procedure was performed by the senior author in all cases. Eight patients were available for follow-up (average 31 months). Based on the Mayo Clinic modification of the Green wrist score, there were three excellent, three good and two fair results. Radiologically, there was improvement in lunate density in five of eight patients and evidence of healing in two of five patients with lunate fractures. We found that simple radial recession osteotomy for Lichtman stage II and III Kienböck's disease offers excellent early results. Résumé. Entre 1995 et 1999, 10 patients porteurs d'une maladie de Kienböck, stades II et III de Lichtman, avec une valeur négative de l'indice ulnaire, bénéficièrent dans notre service d'une ostéotomie d'accourcissement radial. L'intervention a été effectuée par l'opérateur sénior dans tous les cas. 8 patients purent être joints pour l'étude du suivi (recul moyen de 31 mois). Selon le score de Green pour le poignet modifié par la Mayo Clinic, nous relevons 3 résultats excellents, 3 bons résultats et 2 résultats assez bons. Radiologiquement, nous trouvons une diminution de la densité du semi-lunaire dans 5 cas sur 8 et une guérison de la fracture dans 2 cas sur 5. Nous trouvons que l'ostéotomie d'accourcissement du radius dans les stades II et III de Lichtman de la maladie de Kienböck offre d'excellents résultats précoces.     

Pyogenic abscess complicating a resolving cerebral haematoma secondary to a cavernous haemangioma: Computed tomography and magnetic resonance imaging findings

A case is discussed of a brain abscess complicating an intracerebral haemorrhage occurring in a cavernous haemangioma. A young child presented with focal seizures as a result of a large intracerebral haemorrhage, occurring in a cavernous haemangioma. The only clue to the underlying vascular malformation was the presence of an associated developmental venous anomaly. The case was complicated by the development of a brain abscess at the site of the intracranial haematoma. The CT and MRI findings are discussed.     

Hepatic,pulmonary, and CNS involvement by histiocytosis X in an adult: MRI and CT appearance

Histiocytosis X (HX) is a disease of the lymphoreticular system characterized by histiocytic infiltration of one or more tissues. We present a case with extensive hepatic involvement in an adult visualized on ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). The findings on MRI are strongly suggestive of the correct diagnosis. Correspondence to: T. C. Winter