Gastroesophageal varices are present in 50% of patients with cirrhosis, and variceal hemorrhage develops in up to one third of these patients.
Background Patients with cirrhosis in Child–Pugh class C or those in class B who have persistent bleeding at endoscopy are at high risk for treatment failure and a poor prognosis, even if they have undergone rescue treatment with a transjugular intrahepatic portosystemic shunt (TIPS). This study evaluated the earlier use of TIPS in such patients.
Background There are few data on the comparative epidemiology and virology of the pandemic 2009 influenza A (H1N1) virus and cocirculating seasonal influenza A viruses in community settings.
To the Editor: In his Perspective article regarding the performance of futile cardiopulmonary resuscitation (CPR), Truog (Feb. 11 issue)1 calls attention to complexities in end-of-life care and in communicating with loved ones.
Hospital-acquired infections are a major challenge to patient safety. It is estimated that in 2002, a total of 1.7 million hospital-acquired infections occurred (4.5 per 100 admissions),1 and almost 99,000 deaths resulted from or were associated with a hospital-acquired infection,1 making hospital-acquired infections the sixth leading cause of death in the United States2; similar data have been reported from Europe.3 The estimated costs to the U.S. health care budget are $5 billion to $10 billion annually.4 Approximately one third or more of hospital-acquired infections are preventable.5
The widespread adoption of increasingly sophisticated forms of information technology has paralleled the increase in rapid and far-reaching international travel.
During the spring of 2009, a novel influenza A (H1N1) virus of swine origin caused human infection and acute respiratory illness in Mexico.1,2
Acute pancreatitis in most patients is self-limited and resolves without complications or the need for invasive procedures or surgical intervention. In a minority of patients, perhaps 10%, necrosis of the pancreatic and peripancreatic tissues opens the door to multiple organ failure, infection of the necrotic tissue, or both, with a greatly increased risk of death; this risk has been estimated to be 20 to 30%.
Background Necrotizing pancreatitis with infected necrotic tissue is associated with a high rate of complications and death. Standard treatment is open necrosectomy. The outcome may be improved by a minimally invasive step-up approach.
2010 Apr 11 - Endovascular Repair of Aortic Aneurysm in Patients Physically Ineligible for Open Repair: The United Kingdom EVAR Trial Investigators
Background Endovascular repair of abdominal aortic aneurysm was originally developed for patients who were considered to be ineligible for open surgical repair. Data are lacking on the question of whether endovascular repair reduces the rate of death among these patients.
2010 Apr 11 - Endovascular versus Open Repair of Abdominal Aortic Aneurysm: The United Kingdom EVAR Trial Investigators
Background Few data are available on the long-term outcome of endovascular repair of abdominal aortic aneurysm as compared with open repair.
Twenty years ago, Congress passed the Patient Self-Determination Act, hoping to improve end-of-life care through the use of advance directives. The statute stimulated the development of a cornucopia of planning documents.
Background Recent discussions about health care reform have raised questions regarding the value of advance directives.
Tetsuhisa Kitamura, M.D., Taku Iwami, M.D., Takashi Kawamura, M.D., Ken Nagao, M.D., Hideharu Tanaka, M.D., Atsushi Hiraide, M.D., for the Implementation Working Group for the All-Japan Utstein Registry of the Fire and Disaster Management Agency. NEJM, Volume 362:994-1004 March 18, 2010 Number 11Figure. An automatic external defribrillator (AED) in a Japan railway station
Background It is unclear whether dissemination of automated external defibrillators (AEDs) in public places can improve the rate of survival among patients who have had an out-of-hospital cardiac arrest.
Circulatory shock is a medical emergency that is characterized by hypotension and decreased tissue perfusion; if left untreated, it can lead to irreversible cellular injury and death.
Figure. The catecholamines pathway (Click image to enlarge)
Background Both dopamine and norepinephrine are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other.
Background We conducted a trial of prophylactic platelet transfusions to evaluate the effect of platelet dose on bleeding in patients with hypoproliferative thrombocytopenia.
Although there is currently much debate about the types of care to which patients are entitled, one thing on which everyone can agree is that nonbeneficial care should be eliminated. Although such care can be hard to define, in some circumstances experienced clinicians can be virtually certain that attempts at resuscitation will fail. In these cases, many argue that hospitals should adopt policies that allow physicians to refuse when families demand futile cardiopulmonary resuscitation (CPR).
To the Editor: In the Randomized Evaluation of Normal versus Augmented Level (RENAL) Replacement Therapy Study (Oct. 22 issue),1 investigators compared low-intensity versus high-intensity renal-replacement therapy. One of the secondary outcomes was the development of new organ failure. However, the criteria for "nonrenal organ failure" were not provided.