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Journal and News Scan
Quite interesting to see that the incidence of revascularisation after multivessel PCA (the additional element on the second co-primary outcome) appears to have occured in more than 1% of the patients within three years...
Using data from the FREEDOM (Future Revascularizaiton Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease) trial, the authors developed an 8 variable model that predicts individual risk of major acute cardiovascular events in diabetic patients with multivessel disease. Percutaneous coronary intervention (PCI) never outperformed CABG; the latter was superior to PCI in 54% of patients overall and in 100% of those who smoked.
This review offers data suggesting that intermediate-term outcomes for saphenous vein grafting are similar to those for radial artery grafts used for CABG.
A coalition of international organizations dealing with cancer and sports medicine have updated recommendations, stating that exercise may help prevent cancer and can improve survival in patients with cancer. Methods of implementation are discussed.
Patients with proton-pump inhibitor refractory heartburn have a multitude of underlying causes. In this randomized trial of patients with refractory heartburn, only 21% had symptoms related to gastroesophageal reflux disease. Treatments included fundoplication vs omeprazole and baclofen vs omeprazole. Success at one year was higher in the surgery group than either of the medical therapy groups (67% vs 28% vs 12%).
Using gender specific thresholds for abnormalities in cardiac troponin I, the rate of injury among women increased by 42%. This did not translate into improved management of women, who remained about half as likely to undergo revascularization, receive dual antiplatet therapy, or undergo other interventions.
A narrative review offering an intensivists' viewpoint on specific cardiovascular sequela of double-lumen anaesthesia for pulmonary resections (and by extension, implantation of donor lungs) and other cardiothoracic and vascular operations.
An extremely interesting research question abutting cardiac physiology, and a manuscript that may generate future additional clinical research.
Interesting sizeable series, and a commentary that follows, on what is effectively a thoracic example of Natural Orifice Transluminal Endoscopic Surgery (NOTES).
These incredible findings are the result of an analysis of the New York State Department of Health Statewide Planning and Research Cooperative database. They represent over 99,000 major lung resections from 1995 to 2014. Surgeons performing more than 30 lobectomies per year have a mortality of 1% and surgeons performing less than 12 per year have a mortality of 2.8%. But the most surprising fact is that the low-volume surgeons performed 90% of the lobectomies. Do you agree with the results of this very large study and if you do, what do you think should happen about this?