Transesophageal echocardiography - sound diagnostic technique or two-edged sword?

Article Abstract:

As with most ''new'' techniques, transesophageal echocardiography has, in fact, been in use for many years, but only slowly has sufficient data accumulated to bring the method into the mainstream of medical practice. In transesophageal echocardiography, the ultrasonic imaging device is lowered into the esophagus to the level just behind the heart. An exceptionally clear image can be obtained, since only a small amount of soft tissue lies between the sensor and the heart itself. By contrast, transthoracic echocardiography - placing the device on the chest - forms an image after the ultrasonic waves have penetrated disrupting bone, and air within the lungs. In the March 21, 1991 issue of The New England Journal of Medicine, Daniel et al. demonstrate that transesophageal echocardiography produces excellent images of abscesses within the hearts of patients with infective endocarditis. Previously, the same researchers had demonstrated the benefits of transesophageal echocardiography in visualizing valvular vegetations, or the rich growth of bacteria on the heart valves. For these purposes, the transesophageal approach is demonstrably superior to the transthoracic approach. It might be assumed, therefore, that time and effort might be saved by abandoning transthoracic echocardiography and moving directly to the superior method. This would not be correct. Transesophageal echocardiography is a mildly invasive technique, and complications can occur. Most complications are minor, but major complications, though rare, are possible. Furthermore, the perspective from which the transesophageal image is obtained is not ideal for all purposes, and the problems caused by this perspective may become worse when a mitral valve prosthesis is present, or when the valves are calcified. Transesophageal echocardiography can produce excellent results, but it should not be considered a screening technique. It should be performed only by experienced echocardiographers with special training and only in appropriate cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Complications and side effects, Heart, Echocardiography, Endocarditis, Bacterial, Bacterial endocarditis, Abscess, Transesophageal echocardiography, editorial

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Serum mullerian inhibiting substance assay - a new diagnostic test for disorders of gonadal development

Article Abstract:

Measuring blood levels of mullerian inhibiting substance may assist physicians in diagnosing some congenital sex disorders. This substance is produced in the fetal testis to suppress the development of female sex organs. A 1997 study found that measuring blood levels of mullerian inhibiting substance could diagnose testicular abnormalities. However, the normal range for this substance is very wide, which could make diagnosis difficult. Measurement of the substance also could be useful in identifying XX males prenatally.

Editorial, Diagnosis, Measurement, Hypogonadism, Hormones, Sex, Sex hormones

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Educational strategies to promote clinical diagnostic reasoning

Article Abstract:

The practical approaches that clinical teachers could use to promote the development of strong diagnostic reasoning skills in their students are presented. Clinical teachers could promote the development of diagnostic reasoning while simultaneously diagnosing both the patient's disorder and the learner's abilities which requires the teacher to accompany the learner to the bedside or examination room and perform an independent assessment of the patient.

United States, Study and teaching, Reasoning, Medical education

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