Incidence of Extensor Digitorum Brevis Manus Muscle

The extensor digitorum brevis manus, a supernumerary muscle in the fourth extensor compartment of the dorsum of the wrist, is a relatively rare anomalous muscle. Extensor digitorum brevis should be included in the differential diagnosis of soft tissue masses on the dorsal aspect of the hand as it may mimic cystic, neoplastic, inflammatory, and infectious masses arising in the dorsum of the wrist. Seventy-two upper limbs of male and female cadavers were dissected and examined to study the pattern of extensor tendons of the index finger. In the present study, we observed three cases (4.2%) of the extensor digitorum brevis manus on the left side. In one cadaver (0.72%), there was an additional tendon arising from the extensor indices which was inserted to the radial side of the dorsal digital expansion of the index finger. The extensor digitorum brevis manus muscle (EDBM), an anatomic variant of the extensor muscle of the dorsum of the hand, is found in approximately 2% to 3% of the population. This variation is, therefore, clinically and surgically relevant because the EDBM may be the only muscle responsible for the independent extension of the second digit. The aim of the present study is to report the incidences of this muscle thereby creating awareness of its existence and of its characteristic appearance to surgeons.     

Decision support tool for differential diagnosis of Acute Respiratory Distress Syndrome (ARDS) vs Cardiogenic Pulmonary Edema (CPE): a prospective validation and meta-analysis

Introduction

We recently presented a prediction score providing decision support with the often-challenging early differential diagnosis of acute lung injury (ALI) vs cardiogenic pulmonary edema (CPE). To facilitate clinical adoption, our objective was to prospectively validate its performance in an independent cohort.

Methods

Over 9 months, adult patients consecutively admitted to any intensive care unit of a tertiary-care center developing acute pulmonary edema were identified in real-time using validated electronic surveillance. For eligible patients, predictors were abstracted from medical records within 48 hours of the alert. Post-hoc expert review blinded to the prediction score established gold standard diagnosis.

Results

Of 1,516 patients identified by electronic surveillance, data were abstracted for 249 patients (93% within 48 hours of disease onset), of which expert review (kappa 0.93) classified 72 as ALI, 73 as CPE and excluded 104 as “other”. With an area under the curve (AUC) of 0.81 (95% confidence interval =0.73 to 0.88) the prediction score showed similar discrimination as in prior cohorts (development AUC = 0.81, P = 0.91; retrospective validation AUC = 0.80, P = 0.92). Hosmer-Lemeshow test was significant (P = 0.01), but across eight previously defined score ranges probabilities of ALI vs CPE were the same as in the development cohort (P = 0.60). Results were the same when comparing acute respiratory distress syndrome (ARDS, Berlin definition) vs CPE.

Conclusion

The clinical prediction score reliably differentiates ARDS/ALI vs CPE. Pooled results provide precise estimates of the score’s performance which can be used to screen patient populations or to assess the probability of ALI/ARDS vs CPE in specific patients. The score may thus facilitate early inclusion into research studies and expedite prompt treatment.

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-014-0659-x) contains supplementary material, which is available to authorized users.     

An unusually lengthy styloid process

The close proximity of the styloid process to many of the vital neurovascular structures in the neck makes it clinically significant. Abnormal elongation of the styloid process may cause compression on a number of vital vessels and nerves related to it, producing inflammatory changes that include continuous chronic pain in the pharyngeal region, radiating otalgia, phantom foreign body sensation (globus hystericus), pain in the pharyngeal region, and dysphagia. The normal length of the styloid process is usually 2.0-2.5 cm long. We report a dry human skull that showed bilateral styloid processes measuring 6.0 cm on the right side and 5.9 cm on the left side. The variation in dimension of the process and its clinical implication are discussed.     

Pterygospinous bar and foramina in Indian skulls: incidence and phylogenetic significance

Incomplete or complete ossification of the pterygospinous ligament is uncommon. Entrapment of mandibular nerve and its branches was reported due to this anatomical variation, when found. The aim of the present study is to investigate the incidence of the pterygospinous bony bridges in Indian dry skulls. A total of 416 adult dry skulls of Indian origin were studied. In 9.61% of the samples the pterygospinous bony bars were found, out of which 5.76% was complete and 3.84% was incomplete. Such variations are of clinical significance while dealing with mandibular nerve and its branches and various clinical symptoms related to it.     

Safety and Feasibility of 48 h Discharge After Successful Primary Percutaneous Coronary Intervention

BackgroundThe aim of the current study is to determine the safety of early discharge (ED) within 48 hours (h) for ST-elevation myocardial infarction (STEMI) patients who underwent primary percutaneous coronary intervention (PPCI) and to define the criteria of low-risk patients that can be considered for ED.MethodsThis is a single-center retrospective study that took place at Mohammed bin Khalifa Cardiac Centre in the Kingdom of Bahrain. 301 patients who underwent PPCI between January 2018 and March 2019 were included. Endpoints at 30 days follow-up comprised cardiac re-admission, cardiovascular death, non-fatal myocardial infarction, stroke, and major adverse cardiovascular and cerebrovascular events.ResultsOf the 301 patients included in our study, 74 (24.5%) were discharged within 48 h (group 1) compared with 227 (75.5%) hospitalized for more than 48 h after PPCI (group 2) (<0.0001). In terms of baseline characteristics, group 2 had higher proportions of chronic kidney disease (P = 0.051), mean HbA1c (P = 0.016) and mean CPK (P < 0.0001) compared to their group 1 counterparts. The prevalence of anterior STEMI was twice as high among group 2 (P < 0.0001), with a significantly higher prevalence of left main stenting (P = 0.025). Additionally, larger proportion of group 2 required inotropic therapy (P = 0.031), oral anticoagulation (P = 0.005) and had a significantly lower ejection fraction (LVEF) (P < 0.0001) with more procedural complications (P = 0.005). LVEF exerts a large effect on ED, as reflected by a high deviance R² = 20.4%, and was able to correctly classify the subjects into their pertaining discharge group with an accuracy of 80.4%, a specificity of 82.7%, and a sensitivity of 71.2%. According to the fitted LVEF values using the logistic equation, each 1% increase in LVEF is associated with a 3.5% increase in the chance of ED. The two groups recorded fairly similar clinical outcomes at 30-day.ConclusionPreserved LV systolic function is a good predictor of early and safe discharge after successful PPCI. The presented data support the practice of ED, with length of stay even shorter than current guidelines recommendation in selected low-risk patients.     

Spontaneous left atrial multiseptated intramural dissecting hematoma

Our case was initially admitted with chest discomfort and congestive heart failure with a presumptive diagnosis of non-ST segment elevation myocardial infarction and was later found to have a large left atrial (LA) mass. In addition to a complete echocardiography study, multimodality imaging was utilized to better characterize the LA mass. Despite this, the diagnosis could not be confirmed. It was decided to proceed to cardiac surgery, and surprisingly, this revealed a large LA mass with pockets of fresh blood within the LA. Pathological specimen examination confirmed a diagnosis of thrombus, effectively outruling other atrial neoplasms. Although contrast echocardiography and cardiac magnetic resonance imaging suggested this diagnosis, in the absence of any predisposing factors, the final diagnosis was made at surgery and histopathological examination.