Defibrillators post-MI — a note of caution

The use of implantable cardioverter-defibrillators for the prevention of sudden death in patients who are at high risk for but have not yet had cardiac arrest (primary prevention) is gradually expanding. A number of trials have shown mortality benefit in different populations: MADIT: benefit in patients with coronary disease, ejection fraction less than 35%, spontaneous […]

D-dimer for the diagnosis of recurrent DVT

Diagnosing recurrent venous thromboembolic disease of the legs is more difficult than diagnosing a first episode of DVT. Patients who have had an initial DVT are often left with some degree of post-phlebitic syndrome, which can mimic the symptoms of recurrent disease. Duplex ultrasound often remains abnormal after a DVT, making the distinction between recurrent […]

Better living through electricity?

Atrial fibrillation is associated with increased morbidity and mortality, in part because AF is a marker for other cardiovascular risk factors such as hypertension, valvular disease and left ventricular dysfunction. AF is also deleterious in its own right, due to the rapid, irregular heart rate, loss of atrial systole and atrial thromboembolism. Thus, there is […]

Authors’ replies

Dr. Lucy Yardley, corresponding author for the paper on vestibular rehabilitation, has posted comments directly addressing my critiques. Dr. Robert Belshe, corresponding author of the first of the two NEJM articles on intradermal flu vaccination, emailed several corrections to statements I had made. These are important points. Dr. Mathew Hotopf, corresponding author of the article […]

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 […]