Ankle-Brachial Index

Helpful in diagnosis of peripheral arterial disease Also, decreased ABI associated with high-risk CAD, stroke, TIA, renal insufficiency and all-cause mortality. Normal:  0.9 - 1.3 > 1.3 = calcified, sclerotic vessels < 0.9 if occlusive arterial disease (95% sens, 100% spec) < 0.4 suggestive of multilevel disease (iliac, femoral, tibial) and associated with non-healing ulcers… Continue reading Ankle-Brachial Index

Some Indications for Tonsillectomy

Obstructive sleep apnea / sleep disordered breathing Tonsillitis  Paradise Criteria:  7 strep infections in a year (see the AAO/HNS 2011 guidelines for details: or 5 infections / 2 years or 3 infections / 3 years. Post-op pain usu lasts 7-14 days - can be controlled with NSAIDs/APAP and cold foods.  Caution with opioids, esp… Continue reading Some Indications for Tonsillectomy

Alpha-blockers aid in passage of kidney stones (meta-analysis)

Meta-analysis: alpha blockers effective for kidney stonesClinical Question:In patients with kidney stones (ureteric calculi), is treatmentwith an alpha blocker effective in improving passage rate and decreasingpain?Bottom Line:Although a recent large study found no benefit to alpha blocker treatment (Lancet 2015;386:341-49), this meta-analysis of 55 studies found a benefit to using alpha blockers to increase the… Continue reading Alpha-blockers aid in passage of kidney stones (meta-analysis)

Yet Another Risk of Testosterone Therapy – Thromboembolism

BMJ 2016 Nov 30;355:i5968 Population-based, case-control study of 19,200 men with confirmed VTE:  8400 with DVT, 10,800 with PE. All were matched by age and risk factors to 910,000 controls.  Mean age 65. Risk for VTE was 25% higher with current testosterone use vs no testosterone use. Current testosterone use for ≤ 6 mos was associated… Continue reading Yet Another Risk of Testosterone Therapy – Thromboembolism

Nasal Irrigation Better Than Steam Inhalation for Chronic Sinus Symptoms

Chronic sinusitis symptoms helped by nasal irrigation, but not steam inhalation - the cleverly named SNIFS trial. From EE+ Daily POEMs: Nasal irrigation, but not steam inhalation, beneficial for chronic sinus symptoms (SNIFS)Clinical Question:In patients with chronic or recurrent sinus symptoms, does nasal irrigation or steam inhalation improve symptoms?Bottom Line:This study confirms the benefit of… Continue reading Nasal Irrigation Better Than Steam Inhalation for Chronic Sinus Symptoms

Active Surveillance for Localized Prostate Cancer: No increased mortality, but higher progression

Active surveillance for localized prostate CA: no increased mortality, buthigher rates of clinical progression (ProtecT)Clinical Question:What is the best approach to the management of localized prostate cancer? Bottom Line:This landmark study compared active surveillance (AS) with radical prostatectomy or radiation therapy for patients with T1c or T2 prostate cancer. The benefits of AS include avoiding… Continue reading Active Surveillance for Localized Prostate Cancer: No increased mortality, but higher progression

Subclavian Steal Syndrome – Diagnosis

Etiology:  stenosis of (usually) L subclavian artery --> reversal of flow through the "vertebral artery loop" to supply blood to distal L subclavian. Exam: Carotids:  bruits, pulse quality Subclavians:  bruits, pulse quality, pulse delays Vertebrals:  auscultate suboccipital region for bruits Thoracic outlet syndrome:  Adson test (abduction and external rotation of arm causes decrease in radial… Continue reading Subclavian Steal Syndrome – Diagnosis