Superficial femoral vein transposition in Klippel-Trenaunay syndrome

Use of a superficial femoral vein in competent profunda vein transposition is appropriate in selected cases of Klippel-Trenaunay syndrome; this allows for improvement of venous insufficiency and relief of symptoms secondary to venous stasis.     

Experimental prosthetic vein valve

Medical and surgical management of venous insufficiency syndrome (VIS) has produced disappointing results despite the recent introduction of new surgical techniques. This has prompted the investigation of a sutureless prosthetic vein valve. Ten prosthetic sutureless vein valves have been tested to date. The valves are of two types, one constructed of platinum, the other of titanium. Fourteen to eighteen months post-insertion into the femoral vein or vena cava of mongrel dogs, five valves remain patent as shown be venography. The sutureless prosthetic vein valve is a promising development in the treatment of venous insufficiency.     

An empirical analysis of eating disorders and anxiety disorders publications (1980-2000)--part II: Statistical hypothesis testing

OBJECTIVE: The current study compared the eating disorder literature and the anxiety disorder literature in terms of statistical hypothesis testing features in 1980, 1990, and 2000. METHOD: Computer literature searches were conducted using PubMed and PsychInfo databases to identify relevant eating disorder and anxiety disorder articles published at each of the three time points. A total of 456 articles were randomly selected, including 228 articles each from the fields of eating disorders and anxiety disorders. Within each field, one third (76) of the articles were selected from each of the three time points. Two raters, from a team of eight trained raters, were randomly assigned to independently rate each article in terms of 75 separate methodologic features. In the current article, we will emphasize the findings about hypothesis testing and statistical analysis. Disagreements in ratings were resolved via consensus. Ratings were tabulated separately by field across the three time points. RESULTS: Few differences were observed between eating disorder and anxiety disorder publications in terms of statistical hypothesis testing features. Although increases were observed in both fields in a number of areas from 1980 to 2000, there remains a pervasive absence of many of the statistical hypothesis testing features recommended by the American Psychological Association Task Force on Statistical Inference. CONCLUSION: These results are discussed in terms of their implications for the fields of eating disorders and anxiety disorders, for researchers, for reviewers, and for professional journals and editorial boards.     

An empirical analysis of eating disorders and anxiety disorders publications (1980-2000)--part I: Research methods

OBJECTIVE: The current study compared the eating disorder and anxiety disorder literature in terms of research design and methodologic features in 1980, 1990, and 2000. METHOD: Computer literature searches were conducted using PubMed and PsychInfo databases to identify relevant eating disorder and anxiety disorder articles published at each of the three time points. A total of 456 articles were randomly selected, including 228 articles from the eating disorder literature and the anxiety disorder literature. Within each specific literature, one third (76) of the articles were selected from each of the three time points (1980, 1990, 2000). Two raters, from a team of eight trained raters, were randomly assigned to independently rate each article in terms of 75 separate methodologic features. Disagreements in ratings were resolved via consensus. Ratings were tabulated separately for eating disorders and anxiety disorders across the three time points. RESULTS: Although there were some differences between anxiety disorders and eating disorders, most of the variables did not substantially differ between these two fields. There was a consistent trend for both fields to show increases in more rigorous methodologies over time. However, both the eating disorder literature and the anxiety disorder literature were characterized by a pervasive absence of many recommended methodologic procedures across the past two decades. CONCLUSION: Although the eating disorder literature and the anxiety disorder literature are increasingly characterized by improved reporting of rigorous methodologic procedures, there is still a pervasive absence of such procedures in both literatures, which limits the strength of inference in these studies.     

Use of computerized ICU documentation to capture ICU core measures

BACKGROUND: Intensive care unit (ICU) core measures that target the prevention of catheter-related bloodstream infections (CRBSIs) and ventilator-associated pneumonia (VAP) in ventilated ICU patients are underway across the United States. Implementation often requires additional personnel to educate providers and collect the data. We hypothesized that use of our current computerized ICU flowsheet could provide timely, accurate data on ICU core measures without additional personnel dedicated to data capture. METHODS: In a 10-bed, closed surgical ICU with existing protocols for deep vein thrombosis (DVT) prophylaxis, stress ulcer bleeding prophylaxis (SUP), ventilator weaning parameters, and glucose control, we created a reporting tool that would document daily weaning parameters, head of bed (HOB) at 30 degrees , glucose levels, DVT prophylaxis, and SUP. Our glucose protocol targeted <150 mg/dL, with all daily glucose values reported rather than just the morning value. The results from the previous 12 am to 11:59 pm were available to the rounding team at 7 am. We examined compliance at the start and after education of medical staff (March/April for HOB up, DVT, and SUP; May/June for glucose control). RESULTS: During 2005, compliance with all protocols improved. Percent compliance for DVT prophylaxis, SUP, and HOB up rose from as low as 32% at the start of the documentation process to consistently higher than the target level of 95%. Compliance for glucose control increased after intensive education of nursing and physicians with the mean glucose falling from 144 to 122 mg/dL. There was increased nursing workload for checking glucose levels in which the mean number of glucose checks rose from a low of 1.5 per patient to as high as 8.2 per patient per day. CRBSI and VAP rates did not decrease during this period compared with the prior year. Length of stay and mortality were unchanged. CONCLUSIONS: Reporting of ICU core measures to treating staff can be done accurately and promptly with a computerized system. Education was effective in improving compliance levels. No additional personnel were required to create reports, capture data, or improve compliance after initial development and testing. Although compliance with core measures met target levels at the end of the year, we did not observe improved outcomes in terms of CRBSI, VAP, mortality, or length of stay.     

Brachial jugular autogenous spiral vein bypass for obstruction of subclavian vein

Recent advances in venous reconstruction allow the surgeon to bypass obstructive lesion of the venous system successfully. Because of low pressure and low velocity flow in the venous system, and adjunct temporary arteriovenous fistula appears to be essential for patency of the venous bypass. The existing data has shown that autogenous vein is superior to prosthetic material for bypassing venous obstruction. We are presenting a 44-year-old patient who has failed medical treatment and successfully been treated by this method.     

Effect of oral naltrexone on pruritus in cholestatic patients

AIM:To determine the efficacy and potential complica-tions of oral naltrexone used in the treatment of pruritusin cholestatic patients and to compare them with otherstudies.METHODS:Thirty-four enrolled cholestatic patientscomplaining of pruritus were studied.In the initial phase,pruritus scores during day and night were evaluated.Sub-sequently,patients were given a placebo for one weekfollowed by naltrexone for one week.In each therapeuticcourse(placebo or naltrexone)day and night pruritusscores were distinguished by a visual analogue scale(VAS)system and recorded in patients'questionnaires.RESULTS:Both naltrexone and placebo decreased VASscores significantly.Naltrexone was more effective thanplacebo in decreasing VAS scores.Both day and nightscores of pruritus decreased by half of the value priorto therapy in thirteen patients(38%).Daytime pruritusimproved completely in two patients(5.9%),but no im-provement in the nighttime values was observed in anypatient.Sixteen patients(47%)suffered from naltrexonecomplications,eleven(32%)of them were related to itswithdrawal.Complications were often mild.In the caseof withdrawal,the complication was transient(withinthe first 24-28 h of therapy)and self-limited.We had tocease the drug in two cases(5.9%)because of severewithdrawal symptoms. CONCLUSION:Naltrexone can be used in the treatmentof pruritus in cholestatic patients and is a safe drugshowing few,mild and self-limited complications.