An unusual presentation of a carcinoid tumor of the common bile duct.

Context: Carcinoid tumors arising from the bile ducts account for only a small fraction of biliary tract cancers.

Case Report: We report herein a 42-year-old man with a carcinoid tumor of the common bile duct. He presented with abdominal pain, bloating and dyspepsia.

EUS-guided FNA of solid pancreatic masses: a prospective, randomized trial comparing 22-gauge and 25-gauge needles.

Background: There is a lack of prospective, randomized studies comparing the diagnostic yield and complication rates of 22-gauge and 25-gauge needles during EUS-FNA of solid pancreatic masses.

Objectives: Our primary aim was to compare the diagnostic yield of 22-gauge and 25-gauge needles. Secondary aims included determining the number of needle passes performed, ease of needle passage, and complications.

Biliary disease in pregnancy with an emphasis on the role of ERCP.

The incidence of gallstones during pregnancy is estimated to be between 3% and 12%. About one-third of pregnant patients with cholelithiasis become symptomatic and may require surgical intervention. Choledocholithiasis during pregnancy although infrequent usually requires therapeutic intervention.

Fluid balance and weaning outcomes.

Objective: To examine the relationship of fluid balance and weaning outcomes.

Methods: We prospectively collected demographic, physiological, daily fluid balance (measured inputs minus outputs), and weaning data from 87 mechanically ventilated patients.

Patients: We examined 87 patients, a median age of 66 years, APACHE II of 22, and performed 205 breathing trials (BT); 38 patients (44%) were successfully extubated after their first BT with minimal or no pressure support.

Anticoagulation in hospitalized patients with renal insufficiency: a comparison of bleeding rates with unfractionated heparin vs enoxaparin.

Objectives: To compare the rates of bleeding complications in patients with renal insufficiency who receive anticoagulation therapy with the full therapeutic dose, unfractionated heparin (UFH), or with twice-daily enoxaparin.

Setting: A 325-bed community teaching hospital.

Study Type: Retrospective cohort study.

Patient, physician, and family member understanding of living wills.

This study examines understanding of living wills by patients, family members, and physicians. Questionnaires were used to examine whether each cohort understood patients' living wills regarding endotracheal intubation and cardiopulmonary rescuscitation (CPR). Of 4,800 patients admitted during the study period, 206 reported having living wills, all of which precluded intubation and CPR for "terminal conditions.