Southern medical journal
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Southern medical journal · Oct 2013
Mediastinoscopy: trends and practice patterns in the United States.
Historically, mediastinoscopy has been the gold standard for the staging of lung cancer. A practice gap exists as the result of a variation in knowledge concerning current trends and practice patterns of mediastinoscopy usage. In addition, there are regional variations in practice-based learning and patient care. Lessons learned during surgeries performed on patients with lung cancer and other advances such as positron emission tomography and endobronchial ultrasound could be universally applied to improve surgeons' management of patient care. The purpose of this study was to assess contemporary practices in the staging of lung cancer. ⋯ With advances in minimally invasive procedures and imaging, mediastinoscopy usage has declined significantly. Our findings are likely to be relevant to both clinical practice and practice guidelines.
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Acute fatty liver of pregnancy is a rare but serious and potentially fatal complication of pregnancy. It typically presents in the third trimester with microvesicular fatty infiltration of the liver and can lead to multiorgan failure and death. Differentiation from hemolysis-elevated liver enzymes-low platelets syndrome can guide management. ⋯ Defects in fatty acid oxidation secondary to various enzymatic deficiencies have been associated with acute fatty liver of pregnancy. Women or couples with known defects in fatty acid oxidation and women with a history of previous liver disease during pregnancy or sudden death of a child within the first 2 years of life should be assessed for a defect in fatty acid oxidation and monitored carefully. Our review summarizes the current knowledge in pathophysiology, diagnostic approach and management of this disorder.
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Southern medical journal · Oct 2013
Clinical TrialSharpening the tandem walking test for screening peripheral neuropathy.
Few tests of functional motor behavior are useful for rapidly screening people for lower extremity peripheral neuropathy. The goal of this study was to improve the widely used tandem walking (TW) test. ⋯ Although not ideal for screening patients who may have PN, counting the number of steps during TW is a quick and useful clinical test. TW is most sensitive to patients with PN when they are tested with eyes closed.