EUS vs CT for pancreatic cancer

The November 16 Annals has an article from Indiana University comparing endoscopic ultrasound with multidetector CT scanning for the evaluation of suspected pancreatic cancer. 104 patients with suspected non-metastatic pancreatic malignancy underwent both EUS and high-resolution multidetector CT scanning. Of these patients, 41 were managed medically, and 63 underwent surgery. The two modalities were then […]

Stretching the flu vaccine?

In this flu-vaccine shortage year, any means of extending the vaccine supply is worth examining. There is evidence that giving vaccines intradermally rather than intramuscularly is more effective. In last week’s NEJM are two articles examining the effect of administering a lower dose of the flu vaccine intradermally. There is also a letter to the […]

Six articles on postmarketing drug surveillance from JAMA

The pharmaceutical industry and the FDA are being battered by testimony and discussion in the wake of Vioxx. Presumably this will soon die down: news stories appear, flare up and soon fizzle out when their energy (and the public’s interest) is spent. For now, however, the drug surveillance story is still burning bright. David Graham, […]

Ultrasound enhanced tPA for stroke

An article in yesterday’s NEJM on Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke was the first I had seen on thrombolysis for CVA in quite a while (the last major trial on t-PA for stroke published in the NEJM, which I reviewed here, was 9 years ago). And a quick PubMed search yielded this study […]

Carvedilol vs. metoprolol

In the continuing effort to demonstrate carvedilol’s superiority over metoprolol, comes a study in this week’s JAMA looking at metabolic side-effects of these two beta-blockers in diabetic hypertensives. Patients with diabetes and hypertension, but without major cardiac disease, who were receiving ACE inhibitors or ARB’s, were first taken off their other anti-hypertensives (if any), but […]

A new patent for an old drug in a new population

In a much discussed (see Kevin MD and Medical rants) study presented at the AHA meetings in New Orleans and just being published in this week’s NEJM, a fixed dose combination of hydralazine and isosorbide dinitrate, BiDil, was found to significantly reduce morbidity and mortality in African American patients with congestive heart failure. BiDil (vs […]

Vioxx, the FDA and the Lancet

On November 2, the FDA published the text of a study looking at the cardiovascular risk of Vioxx compared to Celebrex and other NSAIDS. It found a 3.7-fold increase in cardiovascular risk when high dose Vioxx (>25 mg/day) was compared to Celebrex, and a 1.5-fold increase when the standard dose of Vioxx was compared with […]