Perioperative and postoperative venous thrombosis are common in patients undergoing elective hip surgery. Current prophylactic regimens include oral anticoagulants and subcutaneous low-molecular-weight heparin initiated 12 hours or more before or after surgery. Recent clinical trials suggest low-molecular-weight heparin initiated closer to surgery is more effective than current clinical practice. Hull et al performed a systematic review of the literature to assess the efficacy and safety of low-molecular-weight heparin administered at different times in relation to surgery vs oral anticoagulant prophylaxis. The results indicated that low-molecular-weight heparin initiated in close to surgery resulted in absolute risk reduction of 11% to 13% for deep vein thrombosis, corresponding to relative risk reduction of 43% to 55% compared with oral anticoagulants. Low-molecular-weight heparin initiated remote from surgery (12 to 24 hours postoperatively or 12 hours preoperatively) was not more effective than oral anticoagulants. Low-molecular-weight heparin initiated soon after surgery at half the usual dose was not associated with a significant increase in major bleeding rates.
The rapid assay developed in this study is equally sensitive and more specific than a commercial whole cell enzyme-linked immunosorbent assay, which is frequently used as a first-tier assay for the serodiagnosis of Lyme disease. It is suited for the physician's office, which streamlines the 2-tier system recommended by the Centers for Disease Control and Prevention by allowing the physician to determine if a Western blot is indicated at the time of the initial office visit.
Gastrointestinal symptoms are reportedly common in diabetes mellitus, but the available epidemiological data are conflicting and can be challenged on methodological grounds. In this cross-sectional study of 15 000 adults in Sydney, Australia, the authors examined the relationship between diabetes mellitus and troublesome gastrointestinal symptoms. Unlike most previous studies, the survey was done in a community setting and incorporated both an adequate control group and a representative diabetic population of all ages and grades of severity. The diabetic population comprised 4.9% of the total population. The authors found that for all gastrointestinal symptoms, occurrence was significantly more frequent in individuals with diabetes compared with controls, even when they adjusted for potential confounding factors. Gastrointestinal symptoms were strongly associated with poor glycemic control but not with the duration of diabetes or the type of diabetic treatment. The study suggests that irreversible autonomic nerve dysfunction is unlikely to be the only factor that explains the observed higher prevalence of gastrointestinal symptoms in diabetes mellitus.
A retrospective review of emergency department visits for headache complaints confirmed that migraine remains underdiagnosed and undertreated. Of 174 patients diagnosed as having migraine, 26% received migraine-specific care. Of 90 patients not diagnosed as having migraine, only 33% had adequate history documented to exclude migraine as the diagnosis. Follow-up interviews of 86 patients found that 18 (67%) of 27 patients not diagnosed as having migraine had migraine, and 39 (66%) of 59 patients diagnosed as having migraine had associated medication overuse (drug rebound).
Rattlesnake envenomation is a limb- and life-threatening illness. The current mainstay treatment of snakebite is antivenom; however, current products are prone to cause serious allergic reactions. A new antivenom that is composed of highly purified Fab fragments has been introduced. The results indicate that it is safe and effective for the treatment of crotaline snakebite in the United States, but likely needs to be administered differently than previous antivenoms.
Schematic diagram of study.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2001;161(16):1951. doi:10.1001/archinte.161.16.1951