Systematic Review and Meta-Analysis of Major Cardiovascular Outcomes for Radial Versus Femoral Access in Patients With Acute Coronary Syndrome

Objectives: Radial artery access (RA) for left heart catheterization and percutaneous coronary interventions (PCIs) has been demonstrated to be safe and effective. Despite consistent data showing less bleeding complications compared with femoral artery access (FA), it continues to be underused in the United States, particularly in patients with acute...

Risk Factors for Complications during Outpatient Parenteral Antimicrobial Therapy for Adult Orthopedic and Neurosurgical Infections

Objectives: Outpatient parenteral antimicrobial therapy (OPAT) is an effective way of treating infections, but complications are common. We identified patient characteristics and OPAT treatment factors associated with increased risk of OPAT-related complications. Methods: We used a retrospective cohort design that assessed 337 adult patients treated with OPAT for orthopedic...

Commentary on “The View from Outside”

Many physicians are contemplating, or have already contemplated, their retirement from the active practice of medicine. Commensurate with this decision will be a decision regarding how to fill the time that was previously occupied by clinical medicine. Some may consider engaging in some aspect of their former career, such...

Enteral Nutrition Support Reduces the Necessity of Total Parenteral Nutrition to Reach Patient-Specific Caloric Goals Postpancreaticoduodenectomy

Objectives: Pancreaticoduodenectomy (PD) is associated with significant rates of postoperative complications. Although there is evidence that enteral nutrition support (ENS) may reduce postoperative sepsis, the true value of ENS in the abrogation of septic complications remains controversial. The aim of our study is to investigate the postoperative outcome of...

Chronic Opioid Users Are More Difficult to Sedate than Alcoholics and Controls

Objectives: Diagnostic and therapeutic colonoscopy is performed using conscious sedation. Excessive alcohol users, chronic benzodiazepine and opioid users, and polysubstance users are commonly cited as difficult to sedate. Few studies have compared and analyzed medication dosages to achieve sedation in these groups. Methods: The endoscopic database was searched for...

Open-Access Single Balloon Enteroscopy: A Tertiary Care Experience

Objectives: To compare single balloon enteroscopy (SBE) between patients seen in consultation by a member of our gastroenterology team with those performed as open-access cases. Methods: Retrospective study of all patients who underwent SBE at a single tertiary care center from April 2008 to January 2012. Open- and closed-access...

Is Early Reperfusion a Good Thing? Optimal Timing of CABG Surgery Postacute Myocardial Infarction

Objectives: The optimal timing of coronary artery bypass grafting (CABG) following an acute myocardial infarction (AMI) is a topic of debate. The present study was designed to evaluate patients undergoing CABG both early (5 days) after AMI in the era of percutaneous coronary intervention. Methods: The medical records at...

Outcomes of Lobar and Sublobar Resections for Non–Small-Cell Lung Cancer: A Single-Center Experience

Objectives: Lung cancer is the leading cause of cancer-related mortality in the United States. Kentucky has the highest age-adjusted lung cancer rate and has one of the highest death rates from lung cancer in the country. Lobectomy is considered the standard therapy for non–small-cell lung cancer (NSCLC), whereas sublobar...

Uveal Melanoma in the First 4 Decades of Life

Objectives: According to reports in the clinical literature, metastatic uveal melanoma in young adults has not been well studied. This article describes the clinical characteristics and natural history of patients who were diagnosed as having uveal melanoma in the first 4 decades of life. Methods: This was a chart...

Early Laparoscopic Cholecystectomy for Acute Cholecystitis: Is It Safe for Patients?

To the Editor: There is still controversy in the literature about the best timing for surgery in treating acute cholecystitis. Proponents of early laparoscopic cholecystectomy argue that this technique may reduce morbidity, conversion rates, mortality, and hospital costs.1 Others favor delayed surgery (>7 days) because there is a belief...

Modern Management of Thoracic Empyema

Objectives: Historically, surgical management of empyema was performed predominantly via open thoracotomy; however, during the past decade the use of video-assisted thoracoscopic surgery (VATS) as an alternative has increased. This study retrospectively compared the outcomes and management of patients with empyema at the University of Kentucky Medical Center who...

CME Article: Airway Assessment of Patients Undergoing Endoscopic Procedures

Objectives: In advance of endoscopic procedures, an evaluation to assess the risk of sedation is performed by the gastroenterologist. Based on regulations, gastroenterologists are required to perform an airway assessment. At this time, data supporting this regulation are limited; therefore, we evaluated airway assessment accuracy by gastroenterologists before endoscopic...

Commentary on “Cholecystectomy for Biliary Dyskinesia in Gastroparesis: Mimic or Misfortune?”

Functional syndromes of the gastrointestinal tract can be challenging in both diagnosis and management. This is yet another example of the crossroads of art and science in medicine. Gastroparesis is a syndrome that can be objectively defined by delayed gastric emptying in the absence of mechanic obstruction.1 Gastroparesis also...

Cholecystectomy for Biliary Dyskinesia in Gastroparesis: Mimic or Misfortune?

Objectives: Biliary dyskinesia and gastroparesis are associated with upper abdominal discomfort and dyspeptic symptoms in the absence of structural abnormalities. We hypothesized that the similarity in symptoms would trigger testing and surgical treatment for biliary abnormalities in a significant number of patients, with refractory symptoms ultimately demonstrating impairment of...

Screening People in the Waiting Room for Vestibular Impairments

Objective: Primary care physicians need good screening tests of the vestibular system to help them determine whether patients who complain of dizziness should be evaluated for vestibular disorders. The goal of this study was to determine whether current, widely used screening tests of the vestibular system predict subsequent performance...

A Comprehensive Approach to Glenohumeral Arthritis

Arthritis of the glenohumeral joint is a common cause of debilitating shoulder pain, affecting up to one-third of patients older than 60 years. It is progressive in nature and characterized by irreversible destruction of the humeral head and glenoid articular surfaces. Inflammation of the surrounding soft tissues is often...

Hunting Stand-Related Injuries in Orthopedics

Hunting remains an extremely popular recreational activity, with nearly 15 million Americans receiving a hunting license annually. Precautions have helped decrease accidents, but hunting-related accidents involve either a fall from a hunting platform or an accidental shooting. Both of these mechanisms frequently result in orthopedic injuries, many of which...

Spinal Injections: Trends in the US Outpatient Population

Chronic low back pain is one of the most common complaints addressed by primary care physicians. When conservative approaches fail, minimally invasive interventional procedures such as epidural steroid injections are often used. These injections are generally well tolerated; however, serious adverse effects can occur. The outbreak of fungal meningitis...

Anatomical Distribution of Colorectal Cancer in a Veterans Affairs Medical Center

Objectives: The incidence of sporadic colorectal cancer (CRC) among individuals younger than 50 years of age and the incidence of proximal cancers has varied based on demographic factors in previous studies, and multisociety screening guidelines advise various modalities for average-risk individuals beginning at age 50. We studied the incidence...

Commentary on Does Melatonin Have Therapeutic Use in Tinnitus?

Tinnitus is a common complaint, affecting >16 million adults in the United States.1 It is typically linked to acoustic trauma, head injury, medications, noise, or natural hearing loss. Tinnitus often is more than just an annoyance to patients; it can significantly affect their sleep, concentration, and mood. The economic...