Comparative effectiveness of one-stage versus two-stage basilic vein transposition arteriovenous fistulas

Objective

Basilic vein transposition (BVT) fistulas may be performed as either a one-stage or two-stage operation, although there is debate as to which technique is superior. This study was designed to evaluate the comparative clinical efficacy and cost-effectiveness of one-stage vs two-stage BVT.

Association of time-to-surgery with outcomes in clinical stage I-II pancreatic adenocarcinoma treated with upfront surgery

Background

Time-to-surgery from cancer diagnosis has increased in the United States. We aimed to determine the association between time-to-surgery and oncologic outcomes in patients with resectable pancreatic ductal adenocarcinoma undergoing upfront surgery.

Sublingual L-hyoscyamine for duodenal antimotility during ERCP: a prospective randomized double-blinded study

BACKGROUND: ERCP is often made difficult by duodenal motility. Glucagon is typically used to inhibit this motility. L-hyoscyamine is an antimuscarinic, anticholinergic agent shown to be a feasible intravenous alternative to glucagon. OBJECTIVE: Demonstrate whether pre-ERCP sublingual L-hyoscyamine reduces the amount of glucagon required to complete ERCP. DESIGN: Randomized, double-blinded clinical trial of 200 participants assigned to receive L-hyoscyamine 0.5 mg or a placebo sublingually before ERCP. Comparative costs were determined. SETTING: Tertiary referral university hospital in the intermountain west. PATIENTS: Mix of inpatients and outpatients. MAIN OUTCOME MEASUREMENTS: The amount of supplemental glucagon required to complete ERCP was recorded, along with procedural outcomes and adverse effects. RESULTS: The 2 groups (101 L-hyoscyamine, 99 placebo) were equally matched in terms of patient and procedure characteristics. There was a decrease in the amount of glucagon required to complete ERCP in the L-hyoscyamine group versus the placebo group, but the reduction was not statistically significant. No differences in complication rates, procedural difficulty, success rates, adverse drug effects, or patient disposition existed between the L-hyoscyamine and placebo groups. LIMITATIONS: Procedures were performed by more than 1 endoscopist, and rescue glucagon was administered at the sole discretion of the endoscopist; this introduced variation in glucagon administered among the participants. CONCLUSIONS: Preprocedure administration of sublingual L-hyoscyamine did not reduce the amount of glucagon required to complete ERCP.     

Familial effects on plasma sex-steroid content in man: Testosterone,estradiol and sex-hormone-binding globulin

We investigated whether familial factors influence the plasma content of sex-steroids and sex-hormone-binding globulin (SHBG) in 98 adult males of 66 families. They had no apparent endocrine dysfunction. The 0800–1100 hr plasma levels of testosterone, 5α-dihydrotestosterone (DHT), estradiol-17β (E₂) and estrone (E₁) were measured by radioimmunoassay. The free fractions of E₂ and testosterone were determined by equilibrium dialysis, and the binding capacity of SHBG w as also calculated. The data were analyzed by analysis of variance. We observed that the differences in the plasma content of testosterone (p = .02), SHBG binding capacity (p = .01), and E₂ (p = .03), free E₂ index (p = .05) were all substantially less variable within groups of brothers than among non-brothers. The variability of the plasma concentration of DHT, free testosterone and E₁ was not significantly less within brothers than among non-brothers. The correlation between either plasma testosterone content (r = .14) or SHBG binding capacity (r = .12) and percent of ideal body weight was not significant statistically. Age had no effect on the results. Our data suggest that genetic and/or environmental factors may affect the plasma content of testosterone, E₂ and SHBG binding capacity.     

A proposal for the clinical use of flecainide

Effective antiarrhythmic therapy requires a carefully considered approach, including an understanding of the arrhythmia, the underlying cardiac disease and the drug's pharmacokinetics. Flecainide is a new antiarrhythmic drug that may soon be released for general use. Flecainide demonstrates unsurpassed efficacy in chronic ventricular arrhythmias in stable patients and may become a first-choice drug because of its ease of administration, efficacy and favorable tolerance. Twice-daily dosing with 100 to 200 mg usually provides effective therapy. Clinical experience suggests flecainide to be indicated in the treatment of uniform and multiform ventricular premature complexes, coupled ventricular premature complexes, and episodes of nonsustained ventricular tachycardia. A lower response rate is observed in preventing induction of sustained ventricular tachycardia, and these patients should be carefully selected. Flecainide is promising in the treatment of supraventricular tachycardias using atrioventricular nodal or extranodal reentrant pathways, although this use is still investigational in the United States. The drug's use for arrhythmias during acute myocardial infarction requires further study. Flecainide possesses modest negative inotropic potential. Proarrhythmic or other adverse reactions have occurred primarily in settings of high drug level, poor ventricular function or refractory, malignant arrhythmias, suggesting caution in these groups.