Semont maneuver is shown to resolve PC-BPPV effectively, and patients should receive Semont maneuver once the PC-BPPV diagnosis was confirmed.

Objective To determine whether clinical scoring systems or physician gestalt can obviate the need for CT in patients with possible appendicitis. Methods Prospective, observational study of patients with abdominal pain at an academic emergency department from 2/2012–2/2014. Patients over 11 years old who had a CT ordered for possible appendicitis were eligible. All parameters needed to calculate the scores were recorded on standardized forms prior to CT. Physicians also estimated the likelihood of appendicitis. Test characteristics were calculated using clinical follow up as the reference standard. ROC curves were drawn. Results Of the 287 patients (mean age [range], 31 [12–88] years; 60% women), the prevalence of appendicitis was 33%. The Alvarado score had a positive likelihood ratio [LR(+)] (95% confidence interval) of 2.2 (1.7–3) and a negative likelihood ratio [LR(−)] of 0.6 (0.4–0.7). The modified Alvarado score (MAS) had LR(+) 2.4 (1.6–3.4) and LR(−) 0.7 (0.6–0.8). The RIPASA score had LR(+) 1.3 (1.1–1.5) and LR(−) 0.5 (0.4–0.8). Physician-determined likelihood of appendicitis had LR(+) 1.3 (1.2–1.5) and LR(−) 0.3 (0.2–0.6). When combined with physician likelihoods, LR(+) and LR(−) was 3.67 and 0.48 (Alvarado), 2.33 and 0.45 (RIPASA), and 3.87 and 0.47 (MAS). The AUC was highest for physician-determined likelihood (0.72), but was not statistically significantly different from the clinical scores (RIPASA – 0.67, Alvarado 0.72, MAS 0.7). Conclusions Clinical scoring systems performed equally well as physician gestalt in predicting appendicitis. These scores do not obviate the need for imaging for possible appendicitis when a physician deems it necessary.

A pincer nail is a common nail deformity of toenails and is characterized by nail thickening and nail plate deformation. It often causes severe pain for patients. We perform a thorough literature review and an additional review of pertinent clinical cases, aiming to provide a comprehensive review of the etiology, pathogenesis, clinical classification, differential diagnosis, and treatment of pincer nail deformity (PND). Understanding the clinical characteristics and treatment progress of a pincer nail will provide clinicians with comprehensive and evidence-based information about PND, thus allowing the selection of an appropriate treatment according to the patient’s request and the clinical manifestations of PND, which should maximize patient satisfaction.

Pincer nail deformity is characterised by an excessive transverse curvature of the nail plate that increases along the longitudinal axis of the nail. Although various corrective techniques have been described, there is, no consensus regarding the optimal correction method. We report a novel surgical technique for correcting pincer nail deformity in a 45-year-old male with bilateral omega-shaped pincer nail deformity of the great toes. The nail matrix on the side showing the more severe curvature was removed, and a flattened nail bed was achieved after suturing. An L-shaped skin and subcutaneous tissue flap was also created 5 mm from the junction between the side of the nail with the milder curvature and the distal nail fold. After healing, the pincer nail deformity was successfully eliminated. At the 1-year follow-up, recurrence was not observed and the appearance of toes was satisfactory. This novel surgical technique is simple, minimises damage to the surrounding tissue, avoids injuring the nail bed blood supply and has few postoperative complications.