Archive for July 2009

Early ERCP in acute biliary pancreatitis

In this non-randomized trial of patients with acute biliary pancreatitis (without cholangitis), patients received either ERCP (within 72 hours) or conservative treatment (at the discretion of the treating physician). Patient characteristics were similar between the groups, and about half received ERCP. The patients were compared in groups by whether or not they had cholestasis (bili>2.3 or common bile duct dilation). Patients with cholestasis had fewer complications with ERCP (adjusted OR=0.35), but there was no significant difference in those without cholestasis. Although not randomized, patients with acute biliary pancreatitis and cholestasis appear to benefit from early ERCP (abstract).

Value of tests in syncope work up

In this large observational study of 2106 patients >65 years admitted for syncope, researchers evaluated the frequency, yield, and cost of common diagnostic tests. The most commonly performed tests included EKG (99%), telemetry (95%) and cardiac enzymes (95%). All of the following tests affected diagnosis, management, or determined etiology in <5% of cases: Echo, cardiac enzymes, CT scans, carotid USG, and EEG. Postural BP affected diagnosis or management or etiology between 15-30% of cases. EEG, CT scans and cardiac enzymes were the least cost effective, and postural BP was the most cost effective (but was only performed in 38% of cases). A step-wise approach to diagnostic testing (after careful history, exam, and postural BP testing) should be utilized in older patients with syncope (abstract).

Adverse outcomes after bariatric surgery

In this large prospective cohort of 4776patients who underwent bariatric surgery, 30-day adverse outcomes (death, thromboembolism, reintervention, or continued hospitalization) occurred in 4% (30-day death was only 0.3%). Higher risk was associated with prior thromboembolism, sleep apnea, higher BMI, and impaired functional status. Overall, adverse outcomes are uncommon in most bariatric surgery patients. (abstract)

ACIP recs for novel H1N1 vaccine

The ACIP recommendations for who should get priority to receive the novel H1N1 vaccination includes 50% of the US population: Young persons age 6mo - 24 years, household contacts of those <6 mo, pregnant women, healthcare workers, and adults age 25-64 with underlying risk conditions (such as immunosuppression or other chronic diseases such as diabetes / chronic lung disease) (website)

ACIP recs for seasonal influenza

The ACIP recommendations for who should receive this year's seasonal trivalent influenza vaccine includes 85% of the US population: Children age 6mo-18 years (and household contacts of children <6 months), all adults >50 years, and all patients at risk of medical complications of influenza (including their care takers or house hold contacts) (website)