Emergency Department Digital Radiology: Moving from Photos to Pixels

Emergency department (ED) patient care relies heavily on radiologic imaging. As advances in technologic innovation continue to present opportunities to streamline and simplify the delivery of care, emergency medicine (EM) practitioners face the challenge of transitioning from a system of primarily film-based radiography to one that utilizes digitized images. The move to digital radiology can result in enhanced quality of patient care, reduction of errors, and increased ED efficiency; however, making this transition will necessarily involve changes in EM practice. As the technology evolves, digital radiology will gradually become ingrained into everyday practice because of these and other notable benefits; however, EM practitioners will need to overcome several challenges to make the transition smoothly and consider the potential impacts that this change will have on ED workflow. The authors discuss the benefits, challenges, and other operational considerations involved with the ED implementation of digital radiology and close by presenting guiding principles for current and future users. Despite the unresolved issues, digital radiology will mature as a technology and improve EM practice, making it one of the great information technology advances in EM.     

EEG sLORETA Functional Imaging During Hypnotic Arm Levitation and Voluntary Arm Lifting

This study (N?=?37 with high, medium, and low hypnotizables) evaluated depth reports and EEG activity during both voluntary and hypnotically induced left-arm lifting with sLORETA functional neuroimaging. The hypnotic condition was associated with higher activity in fast EEG frequencies in anterior regions and slow EEG frequencies in central-parietal regions, all left-sided. The voluntary condition was associated with fast frequency activity in right-hemisphere central-parietal regions and slow frequency activity in left anterior regions. Hypnotizability did not have a significant effect on EEG activity, but hypnotic depth correlated with left hemisphere increased anterior slow EEG and decreased central fast EEG activity. Hypnosis had a minimal effect on depth reports among lows, a moderate one among mediums, and a large one among highs. Because only left-arm data were available, the full role of the hemispheres remains to be clarified.     

Poor dietary diversity and low nutrient density of the complementary diet for 6‐ to 24‐month‐old children in urban and rural KwaZulu‐Natal,South Africa

Infants and toddlers have high nutritional requirements relative to body size but consume small amounts of food and therefore need nutrient‐dense complementary foods. A cross‐sectional study included children aged 6–24 months, stratified in three age categories (6–11 months, 12–17 months and 18–24 months) and randomly selected from an urban (n = 158) and a rural (n = 158) area, both of low socio‐economic status, in the KwaZulu‐Natal Province of South Africa. Dietary diversity and nutrient density of the complementary diet (excluding breast milk and formula milk) based on a repeated 24‐h dietary recall was assessed. For breastfeeding children, nutrient density of the complementary diet was adequate for protein, vitamin A and vitamin C; and inadequate for 100% of children for zinc, for >80% of children for calcium, iron and niacin; and between 60% and 80% of children for vitamin B6 and riboflavin. Urban/rural differences in density for animal and plant protein, cholesterol and fibre occurred in 18–24‐month‐old children. Fewer than 25% of children consumed ≥4 food groups, with no urban/rural differences. Higher dietary diversity was associated with higher nutrient density for protein and several of the micronutrients including calcium, iron and zinc. The poor nutrient density for key micronutrients can probably be ascribed to lack of dietary variety, and little impact of mandatory fortification of maize meal/wheat flour on infants/toddlers' diet. Targeted strategies are needed to enable mothers to feed their children a more varied diet.     

Quantification of first tarsometatarsal joint stiffness in hallux valgus patients

OBJECTIVE: Comparison of the clinical mobility test of the first tarsometatarsal joint with Doppler Imaging of Vibrations measurement of the stiffness of this joint in hallux valgus patients. DESIGN: Clinical testing of first tarsometatarsal joint mobility was related to independent Doppler Imaging of Vibrations measurement of first tarsometatarsal joint stiffness. BACKGROUND: Hypermobility of the first tarsometatarsal joint has consequences for the surgical treatment of hallux valgus deformity. However, the clinical test is subjective. Doppler Imaging of Vibrations could be helpful in quantification of the stiffness of this joint. METHODS: Clinical examination of the mobility of 32 first tarsometatarsal joints in 20 hallux valgus patients was compared with Doppler Imaging of Vibrations stiffness measurements performed by an independent observer. RESULTS: There was a statistically significant relation between the clinical test and the stiffness measurement by Doppler Imaging of Vibrations. CONCLUSION: Doppler Imaging of Vibrations proves to be a method to quantify first tarsometatarsal joint stiffness and could contribute to a rational policy for the surgical treatment of hallux valgus deformity. RELEVANCE: The clinical test to establish hypermobility of the first tarsometatarsal joint is subjective. Doppler Imaging of Vibrations offers objective criteria and quantification of first tarsometatarsal joint stiffness. This provides additional information for the choice of the surgical procedure to correct hallux valgus deformity.     

Rapid pain relief and remission of sternocostoclavicular hyperostosis after intravenous ibandronate therapy

Sternocostoclavicular hyperostosis (SCCH) is an infrequent but painful, localized disturbance of bone metabolism of unknown etiology. The diagnosis of SCCH is generally one of exclusion, and it is therefore frequently missed or delayed, leaving patients with pain that frequently fails to respond to standard analgesic therapy. Consequently, SCCH leads to significantly impaired quality of life. Characteristic increased localized bone turnover and inflammatory osteitis provide a strong rationale for using intravenous bisphosphonates to treat the condition. We report on three patients with long-standing, treatment-refractory SCCH in whom intravenous ibandronate injections (a single administration of 4 mg followed by 2 mg every 3 months for up to a year) produced prompt, dramatic, persistent pain relief and resolution of the other symptoms of the disease. We also review recent evidence suggesting that SCCH is more common than generally believed and that technetium-99 bone scanning can aid in making an accurate diagnosis.     

Pituitary Tumors and the Ophthalmologist

The authors examined 200 consecutive patients with pituitary adenomas admitted to the neuroendocrine service at the Montreal General Hospital between 1976 and 1981. The main presenting signs and symptoms were amenorrhea/impotence (70%), headache (46%), and typical acromegalic or cushingoid features (28%). Only 9% had visual field defects, 2% had optic atrophy, and 1 % had ocular motility problems. A comparison of our findings with four previous studies has demonstrated an increasing incidence of reproductive system abnormalities and a decreasing incidence of visual abnormalities in patients with pituitary tumor. The reasons for this changing pattern are discussed and the role of the ophthalmologist in the care of these patients is redefined.     

Thalidomide Therapy

Abstract: In an open trial, 35 patients suffering from a variety of dermatologic conditions were treated with thalid-omide. The drug was shown to be a valuable addition to the therapeutic armamentarium; however, the occurrence of a peripheral neuropathy will limit its use just as its teratogenic side effects have done for many years.     

Psychological and social problems in burn patients after discharge. A follow-up study

Approximately 18 months after discharge we were able to screen 42 burned adult patients for psychological and social problems. Using independent semi-standardized interviews, validated psychological questionnaires and standardized self-reports of the patients, we obtained three separate evaluations. The interreliability between the three different 'judges' varied from poor to moderate. Research suggests that 40% of burned adult patients have psychological problems. The cycle of recovery is dynamic. Only 21% need psychological help 18 months after discharge, but half of these are in danger of becoming 'drop-outs' because they do not receive the necessary treatment. A follow-up consisting of psychological questionnaires six months post-discharge appears to be a good and efficient instrument in limiting the drop-out risk.