Reliability of carotid doppler performed in a dedicated stroke prevention clinic

INTRODUCTION: Doppler ultrasound (DUS) is used as a screening tool to assess internal carotid artery (ICA) disease. Recent reports suggest that the DUS may be inaccurate in over 28% of patients. We sought to evaluate the accuracy of DUS, when performed in a dedicated stroke prevention clinic (SPC). METHODS: We retrospectively reviewed the charts of patients who had a DUS performed in our SPC, followed by conventional cerebral angiography. Three groups of patients were defined. Group 1 had DUS measured ICA stenosis of >50%; Group II had a DUS measured ICA stenosis of <50%; Group III had complete ICA occlusion on DUS. RESULTS: Sixty-seven patients (69 arteries) were included in the study. There were 45 patients in Group I and based on the findings of cerebral angiography, carotid endarterectomy was considered inappropriate in only one patient--a misclassification rate of 2.2% (95% CI: 0 - 6.5%). Group II consisted of 19 patients and on cerebral angiography, none of these patients had a stenosis of >50%--a misclassification rate of 0%. Group III consisted of five patients in whom DUS showed complete ICA occlusion. The angiogram confirmed the occlusion in all five patients--a misclassification rate of 0%. Overall, misclassification rate was 1.45% (95% CI: 0 - 4.3%). CONCLUSIONS: Doppler ultrasound when performed in a stroke prevention clinic (SPC), has a high accuracy in measuring ICA stenosis of >50%. Doppler ultrasound is reliable in detecting complete ICA occlusion and finally DUS is a reliable screening tool to rule out clinically significant ICA stenosis.     

Anatomic study of the tendinous insertion lamina of the temporalis muscle

Lengthening temporalis myoplasty is indicated in long-standing and congenital facial paralysis. Its principle is the transfer of the coronoid tendinous insertions onto the lip and the nasolabial fold. Knowledge of the anatomy of this strong and wide tendon is necessary for successful use of its anatomic advantages. A study on 10 cadavers (20 temporalis muscles) confirmed the surgical anatomy found during lengthening temporalis myoplasty procedures: the strong tendon, when freed from the coronoid process, is 4–6 cm wide.     

The impact of functional endoscopic sinus surgery on health status

Functional Endoscopic Sinus Surgery (FESS) is a procedure routinely performed for chronic rhinosinusitis. The Glasgow Benefit Inventory (GBI), a post interventional questionnaire with General, Social support and Physical Health subscales, was posted to 121 patients. Seventy seven replies were received (63.6%), 31 of the respondents were female and 46 male. Forty four procedures were performed for nasal polyposis and 33 for sinusitis. Overall 14 patients had unilateral sinus surgery, 63 had bilateral procedures and the mean follow up period was 28 months (range 6 to 55 months). The GBI scores were mainly positive, indicating a benefit from the procedure. On comparing polyposis and sinusitis scores, the difference in the Total GBI and General Subscale scores indicated a greater benefit for polyp disease (p = 0.045 and 0.022). No statistical difference was seen on comparing the scores for female vs. male, by age, bilateral vs. unilateral or by follow up period. This study validates FESS as a procedure for rhinosinusitis as it leads to an improvement in quality of life of patients.     

Impaired performance in a working memory binding task in patients with schizophrenia

This study investigated feature binding in a working memory task in patients with schizophrenia and in normal controls. Twenty-five patients and 25 controls participated. On each trial, three drawings of familiar objects were presented sequentially, each in a different cell of a 3 x 3 grid. In different blocks of trials, participants remembered either individual features (object and location conditions) or an object and its location (combination condition). The results showed that patients were slower and less accurate than controls under all conditions. Accuracy of both groups was reduced in the combination condition relative to the single-feature conditions, but patients showed disproportionately poorer performance in the combination condition than in the object and location conditions. Thus, patients with schizophrenia exhibit deficits in working memory, particularly when the task requires binding objects to their locations. This finding demonstrates that processes that establish coherent and temporary episodic representations in working memory are impaired in schizophrenia.     

Clinical trials evaluating angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the setting of acute myocardial infarction

There is strong evidence from controlled clinical trials that in the setting of acute myocardial infarction complicated by heart failure or isolated left ventricular dysfunction, angiotensin-converting enzyme inhibitors started late during hospitalisation and continued in the long term, significantly reduced mortality and improved the prognosis. On the other hand, administration of angiotensin-converting enzyme inhibitors during the first 24 h in unselected patients with acute myocardial infarction provided only a slight benefit in terms of mortality. Angiotensin-II receptor blockers have and are being examined in the setting of acute myocardial infarction with left ventricular dysfunction and can provide an alternative for patients who cannot tolerate angiotensin-converting enzyme inhibitors. In this article, an evidence-based review of these major trials and suggestions for clinical application are presented.     

Anatomical study of the temporalis tendon. Value in temporalis lengthening myoplasty

The lengthening temporalis myoplasty is indicated in long standing and congenital facial paralysis. Its principle is the transfer of the coronoid tendinous insertions onto the lip and the nasolabial fold. The knowledge of the anatomy of this strong and wide tendon is necessary to use successfully their anatomical advantages. A study of ten cadavers (20 temporalis muscles) confirmed the surgical anatomy found during lengthening temporalis myoplasty procedure: the strong tendon, when liberated from the coronoid process, is from 4 to 6 cm long.