Role of ultrasonography in the diagnosis of temporal arteritis.

Br J Surg. 2010 Dec;97(12):1765-71

Authors: Ball EL, Walsh SR, Tang TY, Gohil R, Clarke JM

Temporal artery (TA) biopsy is the current standard for diagnosing temporal arteritis, but has limited sensitivity. Colour duplex ultrasonography is a newer, non-invasive method of diagnosing temporal arteritis.

PMID: 20799290 [PubMed - indexed for MEDLINE]

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Systematic review of endoscopic ultrasonography versus endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis.

Br J Surg. 2009 Sep;96(9):967-74

Authors: Petrov MS, Savides TJ

BACKGROUND: Endoscopic ultrasonography (EUS) has emerged as an accurate diagnostic alternative to endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to perform a systematic review of all randomized controlled trials of EUS-guided ERCP versus ERCP alone in patients with suspected choledocholithiasis. METHODS: The search for eligible studies was carried out using the MEDLINE, Cochrane Central Register of Controlled Trials, and Science Citation Index electronic databases. Meta-analysis was conducted using a random-effects model. RESULTS: Four trials containing 213 patients randomized to EUS-guided ERCP and 210 to ERCP alone were selected. In the EUS-guided ERCP group, ERCP was avoided in 143 patients (67.1 per cent) when EUS did not detect choledocholithiasis. The use of EUS significantly reduced the risk of overall complications (relative risk 0.35 (95 per cent confidence interval (c.i.) 0.20 to 0.62); P < 0.001) and post-ERCP acute pancreatitis (relative risk 0.21 (95 per cent c.i. 0.06 to 0.83); P = 0.030). CONCLUSION: By performing EUS first, ERCP may be safely avoided in two-thirds of patients with common bile duct stones. Application of EUS in the selection of patients for therapeutic ERCP significantly reduces the complication rate.

PMID: 19644975 [PubMed - indexed for MEDLINE]

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Management of surgical patients receiving anticoagulation and antiplatelet agents.

Br J Surg. 2008 Dec;95(12):1437-48

Authors: Thachil J, Gatt A, Martlew V

BACKGROUND: Temporary interruption of long-term anticoagulation and antiplatelet therapy during surgical procedures exposes patients to thrombotic risk. Continuation of these agents, however, is associated with an increased risk of bleeding. Managing anticoagulation can be a particular challenge in the emergency setting. METHODS: A literature review of published articles sourced using the keywords heparin, warfarin, perioperative, antiplatelet, aspirin and surgery was undertaken. A management plan for all likely situations was developed. RESULTS AND CONCLUSION: Based on an individual assessment of risk factors for arterial or venous thromboembolism and the risk of perioperative bleeding, it is possible to form an anticoagulant and antiplatelet management plan likely to achieve a low incidence of bleeding and thrombosis. A multidisciplinary approach is desirable.

PMID: 18991253 [PubMed - indexed for MEDLINE]

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