Behcet colitis.

Behcet disease (BD) is a chronic, multisystem, inflammatory disease characterized by variable clinical manifestations involving systemic vasculitis of both the small and large blood vessels. The majority of BD patients present with recurrent oral ulcers in combination with other manifestations of the disease, including genital ulcers, skin lesions, arthritis, uveitis, thrombophlebitis, gastrointestinal or central nervous system involvement. Gastrointestinal BD occurs in 3 to 25% of the BD patients and shares many clinical characteristics with inflammatory bowel disease (IBD). Consequently, the differentiation between IBD and gastrointestinal manifestation of BD is very difficult. Intestinal BD should be considered in patients who present with abdominal pain, diarrhea, weight loss, and rectal bleeding who are susceptible or at a risk for intestinal BD.

Laparoscopic-assisted versus open pancreaticoduodenectomy: early favorable physical quality-of-life measures.

BACKGROUND: We compared outcomes and postpancreatectomy quality of life (QOL) in paired cohorts of patients undergoing conventional open pancreaticoduodenectomy (OPD) or laparoscopic-assisted pancreaticoduodenectomy (LAPD). METHODS: Comparative analysis of QOL was performed in a matched cohort of 53 patients after OPD or LAPD between 2010 and 2013. The Medical Outcomes Study Short Form-36 Health Survey and the Karnofsky score were used. RESULTS: Physical component score, mental component score, and Karnofsky scores were calculated at multiple time points for OPD (n = 25) and LAPD (n = 28). Operative times, complications, and readmission rates were equivalent. Time to starting adjuvant therapy trended toward clinical importance in LAPD (61 vs 110 days, P = .0878). Duration of stay was less in LAPD (7.10 vs 9.44 days, P = .02). LAPD had a superior QOL centered on functional status compared with OPD (physical component score 49.09 vs 38.4, P = .04; Karnofsky 92.22 vs 66.92%, P = .003). These statistical differences were not observed beyond 6 months. CONCLUSION: LAPD provided a more favorable QOL within the first 6 months and shorter length of stay compared with conventional OPD. LAPD may serve as an alternative operative therapy to potentially minimize delays in receipt of and enhance tolerability of adjuvant therapies.

Discriminating neurogenic from myopathic disease via measurement of muscle anisotropy.

Skeletal muscle is electrically anisotropic, with a tendency for applied electrical current to flow more readily along muscle fibers than across them. In this study, we assessed a method for non-invasive measurement of anisotropy to determine its potential to serve as a new technique for distinguishing neurogenic from myopathic disease. Measurements were made on the biceps brachii and tibialis anterior muscles in 15 normal subjects and 12 patients with neuromuscular disease (6 with amyotrophic lateral sclerosis and 6 with various myopathies) using 50 kHZ applied current. Consistent multi-angle anisotropic patterns were found for reactance and phase in both muscles in normal subjects. Normalized anisotropy differences for each subject were defined, and group average values identified. The amyotrophic lateral sclerosis (ALS) patients demonstrated increased and distorted anisotropy patterns, whereas myopathic patients demonstrated normal or reduced anisotropy. These results suggest that non-invasive measurement of muscle anisotropy has potential for diagnosis of neuromuscular diseases.

Optimizing measurement of the electrical anisotropy of muscle.

Skeletal muscle is electrically anisotropic, with applied high-frequency electrical current flowing more easily along than across muscle fibers. As an early step in harnessing this characteristic for clinical use, we studied approaches for maximizing the measured anisotropy by varying electrode size and applied current frequency in the tibialis anterior of 10 normal subjects. The results were compared to those from two patients with amyotrophic lateral sclerosis (ALS). Current was applied percutaneously, first parallel and then perpendicular to the major fiber direction of the muscle at frequencies ranging from 20 kHZ to 1 MHZ, using a fixed voltage-electrode length and varying the current-electrode length. The measured anisotropy was most pronounced using the longest length current electrodes and with a 125-kHZ applied frequency for the major outcome parameter phase. In addition, the two ALS patients showed very distinct anisotropic patterns. These results support the belief that, with the appropriate measurement technique, non-invasive assessment of electrical anisotropy of muscle may have useful clinical application.

Electrical impedance myography to assess outcome in amyotrophic lateral sclerosis clinical trials.

OBJECTIVE: Standard outcome measures used for amyotrophic lateral sclerosis (ALS) clinical trials, including the ALS functional rating scale-revised (ALSFRS-R), maximal voluntary isometric contraction testing (MVICT), and manual muscle testing (MMT), are limited in their ability to detect subtle disease progression. Electrical impedance myography (EIM) is a new non-invasive technique that provides quantitative data on muscle health by measuring localized tissue impedance. This study investigates whether EIM could provide a new outcome measure for use in ALS clinical trials work. METHODS: Fifteen ALS patients underwent repeated EIM measurements of one or more muscles over a period of up to 18 months and the primary outcome variable, theta(z-max), measured. The theta(z-max) megascore was then calculated using the same approach as has been applied in the past for MVICT. This and the MMT data were then used to assess each measure's statistical power to detect a given effect on disease progression in a hypothetical planned clinical therapeutic trial. RESULTS: theta(z-max) showed a mean decline of about 21% for the test period, averaged across all patients and all tested muscles. The theta(z-max) megascore had a power of 73% to detect a 10% treatment effect in our planned hypothetical trial, as compared to a 28% power for MMT. These results also compared favorably to historical data for ALSFRS-R and MVICT arm megascore from the trial of celecoxib in ALS, where both measures had only a 23% power to detect the same 10% treatment effect. CONCLUSIONS: The theta(z-max) megascore may provide a powerful new outcome measure for ALS clinical trials. SIGNIFICANCE: The application of EIM to future ALS trials may allow for smaller, faster studies with an improved ability to detect subtle progression of the disease and treatment effects.

Electrical impedance in bovine skeletal muscle as a model for the study of neuromuscular disease.

Electrical impedance myography (EIM) consists of a set of bioimpedance methods configured for neuromuscular disease assessment, in which high-frequency electrical current is applied to a limb and the consequent surface voltage pattern over a muscle is evaluated. Prior human work has shown that the EIM parameters of resistance, reactance and phase change in different neuromuscular disease states including neurogenic and myopathic conditions. These parameters are also sensitive to the angle at which current is applied and measured relative to muscle fiber direction, a characteristic known as anisotropy. In order to obtain insights into the impedance characteristics of mammalian skeletal muscle without the confounding effects of an overlying skin-fat layer, bone and irregular muscle shape, we performed EIM on three 'nearly ideal' round 16 cm diameter, 1 cm equal thickness pieces of bovine rectus abdominis muscle. Using a standardized tetrapolar electrode array with 50 kHz electrical current, we identified strong anisotropy in the measured reactance and phase, with weaker anisotropy identified for resistance. We also found that increasing amounts of muscle maceration, a rough model of myopathic or traumatic muscle fiber injury, reduced phase and muscle anisotropy when current was injected perpendicular to the muscle fibers. These findings support that EIM parameters, including muscle anisotropy, are likely to be sensitive to the pathological changes that occur in neuromuscular disease states.

Electrical impedance myography: transitioning from human to animal studies.

OBJECTIVE: To determine the feasibility of performing electrical impedance myography (EIM) in rats. METHODS: EIM was performed on the hamstring muscles of 6 healthy adult rats with applied frequencies of 2-300 kHz. Studies were performed over a 6-week period, with 3 rats having recordings made from the skin (surface EIM) and 3 with recordings directly from the muscle (direct-muscle EIM). In addition, sciatic nerve crush was performed on one rat and comparisons made pre- and post-injury. Reactance and resistance were measured and the primary outcome variable, the phase angle (theta), calculated. RESULTS: EIM patterns in the rat hamstring muscles were qualitatively similar to those observed in human subjects. This held true for both surface and direct-muscle recordings, although direct-muscle data appeared less repeatable. Sciatic nerve crush data in the single rat showed a dramatic reduction in phase and a relative loss of frequency-dependence. CONCLUSIONS: EIM data similar to that obtained from human subjects can be acquired from rat muscles with surface recordings proving more consistent and easier to obtain than direct-muscle recordings. Changes seen with sciatic nerve crush mirror those seen in patients with neurogenic injury. SIGNIFICANCE: These results support the possibility of performing EIM on rat models of neuromuscular disease.