Three cases of glycogenic hepatopathy mimicking acute and relapsing hepatitis in type I diabetes mellitus

Glycogenic hepatopathy (GH) is an uncommon cause of serum transaminase elevation in type I diabetes mellitus (DM). The clinical signs and symptoms of GH are nonspecific, and include abdominal discomfort, mild hepatomegaly, and transaminase elevation. In this report we describe three cases of patients presenting serum transaminase elevation and hepatomegaly with a history of poorly controlled type I DM. All of the cases showed sudden elevation of transaminase to more than 30 times the upper normal range (like in acute hepatitis) followed by sustained fluctuation (like in relapsing hepatitis). However, the patients did not show any symptom or sign of acute hepatitis. We therefore performed a liver biopsy to confirm the cause of liver enzyme elevation, which revealed GH. Clinicians should be aware of GH so as to prevent diagnostic delay and misdiagnosis, and have sufficient insight into GH; this will be aided by the present report of three cases along with a literature review.     

Closing the loop between evidence-based medicine and care delivery: a possible role for clinical audits in spinal surgery

Background contextEvidence-based medicine (EBM) should be the ultimate force driving change in clinical practice. This process generally occurs through a trickle-down phenomenon by which practice recommendations are revised, modified, and/or changed based on the best published data. Recommendations are subsequently incorporated by individual physicians. The fundamental assumption that drives this paradigm is that adopting evidence-based recommendations and/or treatment guidelines will result in improved outcomes. Unfortunately, to date, the paradigm does not have an effective feedback loop that would then evaluate whether the changes did, in fact, improve outcomes.PurposeTo explore the process of clinical audits as a mechanism by which to provide a feedback loop to evaluate the results of spinal surgery on an individual basis and whether those results can be improved.Study designReview article, discussion.MethodsA literature review of the current data regarding clinical audits was performed, and a discussion of how they may apply to spinal surgery is offered.ResultsClinical audits have been used outside the United States, particularly in the United Kingdom, to fulfill this function. A clinical audit would allow a practicing spinal surgeon to examine his or her individual experience and determine if it is achieving the expected outcome based on published results. In the most important feature of a clinical audit, the reaudit, if an individual's results are found to be inconsistent with published results, it presents an opportunity to identify if there are reconcilable differences from which potential improvements can be made. Effectively, this “closes the loop” between EBM and actual clinical practice.ConclusionsDocumenting improved outcomes through the audit process can impact spinal care in several ways. Patients would receive a clear message that their doctors are interested in improving care. Hospitals will use the information to optimize treatment algorithms. Finally, insurers might make the audit process more tenable or attractive by indicating a physician's voluntary participation as a criterion to be a preferred provider.     

Perceived color shift of ceramics according to the change of illuminating light with spectroradiometer

PURPOSE

Perceived color of ceramics changes by the spectral power distribution of ambient light. This study aimed to quantify the amount of shifts in color and color coordinates of clinically simulated seven all-ceramics due to the switch of three ambient light sources using a human vision simulating spectroradiometer.

MATERIALS AND METHODS

CIE color coordinates, such as L*, a* and b*,of ceramic specimens were measured under three light sources, which simulate the CIE standard illuminant D65 (daylight), A (incandescent lamp), and F9 (fluorescent lamp). Shifts in color and color coordinate by the switch of lights were determined. Influence of the switched light (D65 to A, or D65 to F9), shade of veneer ceramics (A2 or A3), and brand of ceramics on the shifts was analyzed by a three-way ANOVA.

RESULTS

Shifts in color and color coordinates were influenced by three factors (P<.05). Color shifts by the switch to A were in the range of 5.9 to 7.7 ΔE*_abunits, and those by the switch to F9 were 7.7 to 10.2; all of which were unacceptable (ΔE*_ab > 5.5). When switched to A, CIE a* increased (Δa*: 5.6 to 7.6), however, CIE b* increased (Δb*: 4.9 to 7.8) when switched to F9.

CONCLUSION

Clinically simulated ceramics demonstrated clinically unacceptable color shifts according to the switches in ambient lights based on spectroradiometric readings. Therefore, shade matching and compatibility evaluation should be performed considering ambient lighting conditions and should be done under most relevant lighting condition.