Can we measure the ankle-brachial index using only a stethoscope? A pilot study

Background. Ankle-brachial index (ABI) is an excellent methodfor the diagnosis of peripheral arterial disease (PAD) whenit is performed with Doppler. However, this device is not alwaysavailable for primary care physicians. The ABI measured withstethoscope is an easy alternative approach, but have not beenproved to be useful. Objective. To assess the accuracy of the ABI measured usinga stethoscope comparatively to that of the current eligiblemethod for the diagnosis of PAD, the Doppler ABI, and describethe characteristics of this new approach. Methods. We conducted a diagnostic study of ABI measured witha stethoscope and a Doppler probe and compared the results.Eighty-eight patients were accessed by both methods. Results. Mean stethoscope ABI, 1.01 ± 0.15, and meanDoppler ABI, 1.03 ± 0.20, (P = 0.047) displayed a goodcorrelation. Measurements of stethoscope ABI diagnostic accuracyin recognizing a Doppler ABI are described. The comparison ofthis data with the current gold standard method results gavea sensitivity of 71.4% [95% confidence interval (CI), 41.9–91.6]and specificity of 91.0% (95% CI, 81.5–96.6), with predictivepositive value of 62.5% (95% CI, 38.6–81.5) and negativepredictive value of 93.8% (95% CI, 85.2–97.6). The studyaccuracy was 87.7%. The area under the ROC curve was 0.895 (95%CI, 0.804–0.986, P < 0.0001). Conclusions. According to our study, the stethoscope ABI isa useful method to detect PAD and it may be suitable for itsscreening in the primary care setting. Keywords. Ankle-brachial index, peripheral arterial disease, stethoscope.     

Pilot study of ‘Feiji recipe’ in conjunction with chemotherapy on QoL in non‐small cell lung cancer patients. Larger controlled clinical trials are necessary to determine whether the Feiji recipe benefits overall non‐small cell lung cancer

Jian‐Hui Tian, Ling‐Shuang Liu, Zhi‐Ming Shi and Zhi‐Yi Zhou. A randomized controlled pilot trial of ‘Feiji recipe’ on quality of life on non‐small cell lung cancer patients. Am J Chin Med 2010; 38: 15–25.     

Routine Ultrasound and Limited Computed Tomography for the Diagnosis of Acute Appendicitis

Background  

Acute appendicitis continues to be a challenging diagnosis. Preoperative radiological imaging using ultrasound (US) or computed tomography (CT) has gained popularity as it may offer a more accurate diagnosis than classic clinical evaluation. The optimal implementation of these diagnostic modalities has yet to be established. The aim of the present study was to investigate a diagnostic pathway that uses routine US, limited CT, and clinical re-evaluation for patients with acute appendicitis.     

Peritoneo–scrotal communication: Demonstration by 99mtechnetium sulphur colloid scintigraphy

Continuous ambulatory peritoneal dialysis is a widely used and convenient alternative to haemodialysis in patients with renal failure. Occasionally, a scrotal swelling may develop during this procedure because of fluid passing through a patent processus vaginalis. We present a case report to illustrate the diagnostic use of radionuclide scintigraphy in this group of patients.     

Conservative treatment of a spontaneous splenic rupture in a patient with infectious mononucleosis

A 30-year-old man with flu-like symptoms for several weeks presented at the emergency room with pain in the left upper abdomen. There was no history of trauma. The patient had a spontaneous rupture of the spleen due to mononucleosis infectiosa. He was successfully treated with conservative management during a 7-day period of hospitalisation. Spontaneous splenic rupture is a rare but potentially lethal complication of infectious mononucleosis. Alarming symptoms are left upper abdominal pain, worsening during inspiration, and haemodynamic instability. Although splenectomy is the accepted treatment for haemodynamically unstable patients, some patients, may be adequately treated with conservative management. They should be observed during the critical phase and must comply to a period of restricted physical activity after they are discharged from the hospital. There is no consensus about the length or content of this restriction period.     

MEASUREMENT OF ROOT CANAL LENGTH – USE OF AN ELECTROMETRIC DEVICE

The measurement of root canal length is a pre-requisite for successful pulpectomy. The conventional manual and radiographic methods are not very accurate. In the present study, odontometer was used [Group B) to assess its efficacy over the conventional methods (Group A) for recording root canal length. In group A, 36 teeth were treated with pulpectomy while in group B, 51 teeth were managed by the same treatment. It was observed that post operative complications in group B were significantly less (p < 0.05). The odontometer proved to be an excellent device for rapid and accurate measurement of root canal length.KEY WORDS: Pulpectomy, Root canal length, Odontometer     

Mutations of the flavin-containing monooxygenase gene (FMO3) cause trimethylaminuria, a defect in detoxication

Individuals with the recessive condition trimethylaminuria exhibit variation in metabolic detoxication of xenobiotics by hepatic flavin- containing monooxygenases. We show here that mutations in the human flavin-containing monooxygenase isoform 3 gene ( FMO3 ) impair N - oxygenation of xenobiotics and are responsible for the trimethylaminuria phenotype. Three disease-causing mutations in nine Australian-born probands have been identified which share a particular polymorphic haplotype. Nonsense and missense mutations are associated with a severe phenotype and are also implicated in impaired metabolism of other nitrogen- and sulfur-containing substrates including biogenic amines, both clinically and when mutated proteins expressed from cDNA are studied in vitro . These findings illustrate the critical role played by human FMO3 in the metabolism of xenobiotic substrates and endogenous amines.