Low-dose heparin for prevention of venous thromboembolism in total hip arthroplasty and surgical repair of hip fractures.

Sixty-seven hip-arthroplasty and fifty-two hip-fracture patients participated in a placebo-controlled randomized double-blind study on the effects of low-dose heparin prophylaxis in the prevention of venous thromboembolism. In this study, a positive thromboembolic event meant a positive test by: (1) daily 125I-fibrinogen scanning, (2) contrast venography on the tenth postoperative day, or (3) radionuclide perfusion lung scan in confirmation of suspected clinical pulmonary emboli. Nineteen (59.4 per cent) of thirty-two placebo-treated arthroplasty patients showed evidence of a thromboembolic event in contrast with eight (22.9 per cent) of thirty-five heparin-treated patients (p less than 0.003). Heparin-treated arthroplasty patients required mean blood transfusions of 4.7 units, contrasted with a mean 3.2-unit transfusion requirement for placebo-treated patients (p less than 0.05). The incidence of observed bleeding complications was higher among the heparin-treated patients. Of the twenty-three placebo-treated patients with fracturs, 39.1 per cent had a thromboembolic event, while 41.4 per cent of the twenty-nine who received heparin showed evidence of thromboembolism, demonstrating that low-dose heparin afforded no protection, nor did it affect the incidence of bleeding complications or transfusion requirements in fracture patients.     

Axillary web syndrome after axillary dissection.

BACKGROUND: Some patients undergoing axillary lymph node dissection (ALND) experience postoperative pain and limited range of motion associated with a palpable web of tissue extending from the axilla into the ipsilateral arm. The purpose of this study is to characterize the previously undescribed axillary web syndrome (AWS). METHODS: To identify patients with AWS, a retrospective review was performed of all invasive breast cancer patients treated by a single surgeon (REM) between 1980 and 1996. Records were also reviewed of 4 more recent patients who developed AWS after undergoing sentinel node lymph node dissection (SLND) without ALND. RESULTS: Among 750 sequentially treated patients, 44 (6%) developed AWS between 1 and 8 weeks after their axillary procedure. The palpable subcutaneous cords extended from the axillary crease down the ipsilateral arm, across the antecubital space, and in severe cases down to the base of the thumb. The web was associated with pain and limited shoulder abduction (< or = 90 degrees in 74% of patients). AWS resolved in all cases within 2 to 3 months. AWS also occurred after SLND. Tissue sampling of webs in 4 patients showed occlusion in lymphatic and venous channels. CONCLUSIONS: AWS is a self-limiting cause of morbidity in the early postoperative period. More limited axillary surgery, with less lymphovenous disruption, might reduce the severity and incidence of this syndrome, although SLND does not eliminate its occurrence.     

Dentists' attitudes toward discussing Internet health information with their patients – does professional self‐efficacy matter?

Objective: The present study explored the relation between professional self‐efficacy and the attitudes of dentists toward discussing Internet dental health information with their patients. Methods: Fifty‐seven dentists answered a questionnaire examining professional self‐efficacy and attitudes toward patients wishing to discuss dental health information obtained through the Internet. Results: A correlation was found between professional experience (in years) and professional self‐efficacy [r point by serial (rpb) = 0.27, P < 0.05]. No statistically significant correlation was found between specialty and professional self‐efficacy (rpb = 0.11, P < 0.4), and between professional self‐efficacy and attitudes toward patients who wish to discuss dental health information (rpb = 0.22, P > 0.1). Specialists were more willing to converse with their patients than nonspecialists. Most participants did not find discussing information from the Internet to be time‐consuming. Conclusions: This pilot study's results indicate that a) Specialists in dentistry were more willing to discuss Internet dental health information with their patients than nonspecialists; b) Dentists with high professional self‐efficacy had a positive attitude toward patients who wish to discuss Internet dental health information with them; and c) Further studies are needed to investigate and validate the results of the present study. Practice Implications: High professional self‐efficacy may improve general dentists' attitudes toward patients who wish to discuss Internet dental health information. The dental community should seek to expand the professional self‐efficacy of its members in order to enable them to adequately deal with patients' needs.     

Pegfilgrastim overdose: case report and review of the literature

Single-dose pegfilgrastim is commonly used for the prophylaxis of neutropenia in patients receiving myelotoxic chemotherapy. We report a case of a 69-year-old man who was treated with chemotherapy for small-cell lung cancer and mistakenly self-administered a 36 mg overdose of pegfilgrastim, a sixfold increase over the scheduled dose.     

Newer horizons in the etiology of pancreatitis: Metabolic and endocrinologic factors

Digestive Diseases and Sciences - 1. Pancreatitis associated with alcoholism and biliary-tract disease account for etiology in only approximately two-thirds of the cases of chronic pancreatitis....     

Incidence of colectomy during long-term follow-up after cyclosporine-induced remission of severe ulcerative colitis.

BACKGROUND & AIMS: Cyclosporine (CSA) has been shown to be effective in steroid-refractory ulcerative colitis (UC) and as an alternative to glucocorticosteroids in patients with severe attacks of UC. Our aim was to investigate the long-term efficacy of CSA. METHODS: We conducted a retrospective cohort study of all patients admitted to our institution with an attack of UC treated with intravenous CSA between November 1992 and October 2004. Patients who responded to intravenous CSA were switched to Neoral for 3 months. Kaplan-Meier curves were used for survival analysis with quantitative variables compared using a 2-tailed Student t test with qualitative variables and differences compared with a chi(2) analysis. RESULTS: A total of 118 (83%) of the 142 patients had an initial response to CSA and avoided colectomy during hospitalization. Of the 118 patients, 41 (35%) [corrected] required a future colectomy. The rate of colectomy in those already on azathioprine compared with those starting azathioprine concurrently with CSA was 59% vs 31%, respectively (P < .05). Also, 88% of patients already on azathioprine and requiring colectomy underwent surgery within the first year of receiving CSA. Life-table analysis shows that although only 33% of patients require colectomy at 1 year, 88% will require colectomy at 7 years. CONCLUSIONS: CSA is an effective short- to medium-term treatment for patients with severe UC but at 7 years, 88% of patients will require a colectomy. Azathioprine-naive patients have better outcomes.