Serum neurone-specific enolase (NSE) and computerized tomography (CT) stroke volume were compared in patients admitted within 24 h of an acute stroke. Serum samples were obtained on admission and daily for the next 4 days. Of 163 patients, CT scans revealed 25 with intracerebral haemorrhages, one haemorrhagic infarct and 83 measurable acute infarcts. The serum NSE levels of those with infarcts was significantly higher than in those with haemorrhages at 48 (P = 0.0003) and 72 h (P = 0.04). The maximum serum NSE value tended to occur later in those with large infarcts (P = 0.0035). There was a significant correlation between infarct volume and serum NSE at 48 h (r = 0.27, P = 0.015) and 96 h (r = 0.27, P = 0.015) and with the maximum serum NSE over the 4 days (r = 0.36, P = 0.001). There was no significant correlation between haemorrhage volume and NSE. In conclusion, serum NSE may be a useful marker of infarct volume in studies of therapy in acute stroke. Sampling for NSE should continue, at least in those with large infarcts, for longer than 4 days. Serum NSE cannot be used to distinguish between haemorrhage and infarction in patients with an acute stroke.

No abstract

Cochlear implantation with a multi-channel electrode array which provides stimulation via the auditory nerve has become a standard treatment for profound deafness. Postoperative radiography demonstrates electrode position and enables confirmation of satisfactory intra-cochlear electrode placement. The number of active electrodes which have been inserted can be determined and possible complications such as electrode kinking or slippage can be assessed. We evaluated digital radiography with confirmation of electrode position by intermittent fluoroscopy and assessed the relative radiation dose of the digital technique, conventional radiography and CT scanning. Radiation dose for this method usually ranges between 40 microGy and 440 microGy compared with a single exposure on the skull stand which produces a dose to the region of the cochlea of 470 microGy and a CT exposure of 950 microGy. The digital technique is comfortable for the patient, easily reproducible and provides images of high diagnostic quality enabling each electrode to be identified, which is especially valuable in association with postoperative electrode mapping. It also involves a lower radiation dose than conventional radiography. We now use digital radiography for all postoperative cochlear implant assessment.

In a prospective 3-year study herniography was used to assess patients with unexplained groin pain in whom clinical signs were inconclusive. Fifty-two patients were studied. No serious complications were observed. Twenty-two hernias were identified in 18 patients. The positive herniographic findings were confirmed at operation in 12 patients. Of 34 patients with a negative herniogram, none has developed a hernia. Pain settled spontaneously in 29 patients and five were referred to a pain clinic for further management.

place much reliance on om tie infection rates from difet hospitals because of differences in methods of treatment and in prevalent strains of bacieria. Thes are by no means the only variables. We have been studying wound infections at this hospit for the past two years and have ied out ontinuous monitorig of all infections for over a year. An initial difficulty was to define what constitutes a wound infection. When a wound discare