Integration of emergency medicine into the undergraduate medical curriculum at the Christchurch School of Medicine

Emergency medicine has been integrated into the undergraduate curriculum of the Christchurch School of Medicine. Vertical integration has been achieved by consideration of the five stages of medical education, with the undergraduate emergency medicine contributions coming in the junior clinical student and senior clinical student stages. Horizontal integration has been achieved by defining the complete emergency medicine undergraduate curriculum and identifying those parts not adequately covered elsewhere. This paper describes how this process was achieved at the Christchurch School of Medicine.     

Central nervous system lesions in pediatric patients: Gd-DTPA-enhanced MR imaging

Twenty pediatric patients, aged 2-18 years, with known or suspected masses in the brain and/or spinal cord were studied with magnetic resonance imaging at 0.6T with and without use of 0.1 mmol/kg gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA). The multisection, multiecho imaging mode was utilized. Surgically proved mass lesions included astrocytoma (n = 6), medulloblastoma (n = 2), ependymoma (n = 1), craniopharyngioma (n = 1), oligodendroglioma (n = 1), germinoma (n = 1) and fibrosarcoma (n = 1). Presumptive diagnoses included astrocytoma (n = 3), arachnoid cyst (n = 1), tuberous sclerosis (n = 1), cryptic vascular malformation (n = 1), and normal (n = 1). There was dramatic enhancement in 11 of 20 patients, with improved definition of the presence and extent of lesions in six patients. No adverse effects were noted in any of the 20 patients. It is concluded that Gd-DTPA is useful in delineating the presence, extent, and number of certain lesions of the central nervous system in children.     

Radionuclide ventriculography: evaluation of automated and visual methods for regional wall motion analysis

Regional wall motion (RWM) abnormalities are sensitive indicators of left ventricular (LV) dysfunction, but quantitation of RWM with gated radionuclide ventriculography (RVG) has been limited, particularly in the left anterior oblique (LAO) projection. Regional LV performance was studied in 18 patients undergoing LAO RVG immediately prior to contrast ventriculography (CVG). Wall motion was analyzed by semiautomated and visual methods using several coordinate systems. For semiautomated methods, RVG and CVG wall motion were closely related in the two 90 degrees polar sectors at the apex and posterior wall (r = .85) and in the five 45 degrees polar sectors from midseptum through posterior wall (r = .82). The basal sectors on RVG had weak relationship to CVG, due to adjacent vascular structures. Semiautomated and visual grades for polar sectors on both CVG and RVG were closely related (r = .88- .94). Measured regional wall motion on LAO RVG compared favorably with near-simultaneous CVG in nonoverlapping portions of the LV and allowed objective quantitation of regional LV performance.