Electrodiagnostic studies: Are they useful in clinical practice?

Objective: Electrodiagnostic testing (electromyography [EMG] and nerve conduction studies [Ncs]) may result in some patient discomfort. The justification for such testing should be based on the expectation that the results will affect patient management. This study was conducted to determine how frequently the results of EMG/NCS change the clinical management of the patient.Methods: One investigator (MB) spoke to each referring physician after EMG/NCS to determine if any management decisions were altered by the test.Results: One hundred forty consecutive EMG/NCS records were obtained. Follow-up was available on 100 patients. Of 78 patients with abnormal findings on EMG/NCS, 29 (37%) had a diagnosis different from the referring diagnosis. For 43 of the 78 (55%), the physician reported that additional diagnostic testing was undertaken or treatment plans were altered.Conclusion: EMG/NCS are useful, informative, and diagnostic in the management of various neurologic disorders.     

The National Trauma Data Bank story for emergency department thoracotomy: How old is too old?

Background

The fastest growing segment of the American population is the elderly (>65 years). This change in demographics also is being seen in trauma centers. Emergency department thoracotomy is utilized in an attempt to restore circulation for patients arriving in extremis. The purpose of this study was to investigate the relationship between clinical variables, particularly age, and outcomes for injured patients receiving an emergency department thoracotomy.

Quality of Life After Ileoanal Pouch: A Comparison of J and W Pouches

Introduction  Standard treatment for ulcerative colitis and prevention of malignancy is total proctocolectomy with a neoileal pouch. The ideal configuration of the pouch has been debated. We hypothesized that there was no difference in quality of life between the J pouch and the W pouch. Material and Methods  We retrospectively reviewed the medical records of all patients undergoing ileoanal anastomosis with pouch construction at a single community-based teaching hospital over an 11+-year period. We collected demographic, operative, and postoperative data and then developed and distributed a survey designed to assess patient quality of life following pouch construction. The data of patients who had J pouches were then compared with those of patients who had W pouches. Forty-nine patients were identified; 30 had J pouches and 19 had W pouches. Results  The groups did not differ significantly in age, sex, or indication for surgery. Significant differences were detected in readmission rates (J = 63%, W = 21%; p = 0.004) and length of follow-up (J = 61 months, W = 117 months; p = 0.001). Complication rates, length of stay, and conversion to end ileostomy rates were similar between groups. Self-reported health status, activity restrictions, urgency, seepage, protective pad use, and number of bowel movements at night were also similar. A significant difference existed in number of bowel movements per day (J = 6, W = 4.5, p = 0.041). No difference in quality of life was found between groups. Subgroup analysis of ulcerative-colitis-only patients had no effect on results. Conclusion  Because the J pouch is less technically demanding, it should be the preferred configuration.     

Acute cholecystitis: MR findings and differentiation from chronic cholecystitis

PURPOSE: To retrospectively determine the sensitivity and specificity of magnetic resonance (MR) imaging for differentiation between acute and chronic cholecystitis, with histopathologic analysis as the reference standard. MATERIALS AND METHODS: Institutional review board approval with waived informed consent was obtained for this HIPAA-compliant study. Four reviewers blinded to the cholecystitis type but aware that cholecystitis was present retrospectively evaluated MR images for predetermined findings in 32 patients (15 male, 17 female; mean age +/- standard deviation, 55 years +/- 20) with histopathologically proved acute or chronic cholecystitis. The final MR diagnoses and MR findings in both groups were compared with each other and with the histopathologic diagnoses to determine the sensitivity and specificity of MR imaging. Chi(2) tests were used to detect differences in MR findings between the acute and chronic cholecystitis groups. RESULTS: MR imaging sensitivity and specificity for detection of acute cholecystitis were 95% (18 of 19 patients) and 69% (nine of 13 patients), respectively. The sensitivities of increased gallbladder wall enhancement and increased transient pericholecystic hepatic enhancement were 74% (14 of 19 patients) and 62% (10 of 16 patients), respectively. Both findings had 92% (12 of 13 patients) specificity. Sensitivities of increased wall thickness, pericholecystic fluid, and adjacent fat signal intensity changes were 100% (19 of 19 patients), 95% (18 of 19 patients), and 95% (18 of 19 patients), respectively; specificities were 54% (seven of 13 patients), 38% (five of 13 patients), and 54% (seven of 13 patients), respectively. Pericholecystic abscess, intraluminal membranes, and wall irregularity or defect each had 100% (13 of 13 patients) specificity; sensitivities were 11% (two of 19 patients), 26% (five of 19 patients), and 21% (four of 19 patients), respectively. Increased gallbladder wall enhancement (P<.001) and increased transient pericholecystic hepatic enhancement (P=.003) were the most significantly different between acute and chronic cholecystitis. CONCLUSION: Increased gallbladder wall enhancement and increased transient pericholecystic hepatic enhancement had the highest combination of sensitivity and specificity for the diagnosis and differentiation of acute and chronic cholecystitis.     

Multi‐Component Synthesis of Dihydropyrimidines by Iodine Catalyst at Ambient Temperature and in‐vitro Antimycobacterial Activity

An efficient and simple three‐component domino synthesis of some new dihydropyrimidines (DHPMs) from aromatic aldehydes, 1,3‐dicarbonyl compounds and N‐(3‐chloro‐4‐fluorophenyl)urea using molecular iodine as catalyst is described. The 1‐substituted dihydropyrimidines were isolated in good to excellent yields (78‐90%) within a short reaction time (4‐6 h) at ambient temperature. The biological evaluation revealed that the newly synthesized compounds ( 4a ‐ i and 5a ‐ i ) exhibited moderate antimycobacterial activity against Mycobacterium tuberculosis H₃₇ RV.