Journal Club. NEWS.

и ангиология

Модератор: Pyankov Vasily

ostroumov
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Зарегистрирован: Ср окт 10, 2007 3:48 am

Сообщение ostroumov »

Абугов писал(а):
А вот это уже нападки на уважаемого Евгения Николаевича:

Perfusion CMR 'alternative to SPECT' for CAD detection
Cardiac magnetic resonance stress perfusion imaging may offer a valuable alternative to single-photon emission computed tomography for the detection of coronary artery disease, results of a large, multicenter trial indicate.
Eur Heart J 2008; 29: 480-489
Не вижу никаких наездов, не менее уважаемый Сергей Александрович! Был бы только рад, если бы в каждом отделении неотложной кардиологии у нас появились бы "the high spatial resolution of perfusion-CMR allows detection of small, even subendocardial perfusion deficits." Надеюсь, что экономическая эффективность этих исследований не будет уступать уже давно доказанной экономической эффективности SPECT
Hachamovitch R, et all, “Stress Myocardial Perfusion Single-Photon Emission Com-puted Tomography Is Clinically Effective and Cost Effective in Risk Stratification of Patients With a High Likelihood of Coronary Artery Disease (CAD) But No Known CAD” JACC 2004;43:200–208
Shaw LJ, “Myocardial perfusion imaging in the evaluation of chest pain in the acute care setting: Clinical and economic outcomes” J Nucl Cardiol 2007;14:S133-138.
Gottschalk A, “International Perspectives on Nuclear Cardiology” J.Nucl.Med.,, 2004,v 45,№ 3,19N-20N, 26N...

А, также, они не будут страдать известными ограничениями or CMR examination (implanted electronic devices, metallic foreign bodies in the eye, severe claustrophobia, and others according local regulations and manufacturer’s recommendations).
И само контрастное в-во используемое при CMR не будет страдать нефро - либо другой какой-нибудь токсичностью.
И, наконец, хотел бы отметить что метод, результаты которого я предоставляю на Вальсальве - It is important to note that gated-SPECT was not available in approximately half of patients. не был использован у половины больных в этом исследовании. То есть взяли новую технологию МРТ и сравнили с устаревшими технологиями SPECT. Их право...
С уважением, ваш ОЕН.
Ren_Yumi
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Сообщение Ren_Yumi »

Practice Guidelines Issued for Screening, Diagnosing, and Treating Diabetes CME/CE
http://www.medscape.com/viewarticle/568 ... &src=top10
Абугов
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Откуда: Москва, РНЦХ им. акад. Б.В. Петровского РАМН
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Сообщение Абугов »

Ну вот и найдена панацея от ИБС:

у хозяев кошек риск смерти от инфаркта был на 30% ниже:

http://www.medportal.ru/mednovosti/news/2008/02/26/cat/
С.А. Абугов.
drSerg
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Зарегистрирован: Вс июн 17, 2007 12:15 am
Откуда: Красногорск

Сообщение drSerg »

А у меня две кошки. Значит риск меньше на 60%!!! :lol:
Абугов
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Сообщение Абугов »

drSerg писал(а):А у меня две кошки. Значит риск меньше на 60%!!! :lol:
Эффект не суммируется, а умножается. У тебя - на 900%.
С.А. Абугов.
Максим Осипов
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Откуда: Таруса, Москва

Сообщение Максим Осипов »

А теперь, внимание, правильный ответ: если риск инфаркта равен a, то риск инфаркта у владельца одной кошки равен 0,7a, а у владельца двух кошек -- 0,7*0,7a = 0,49a, т.е. риск уменьшается примерно вдвое, при условии прямой зависимости между количеством кошек и риском инфаркта. Но ведь тут может оказаться, как с алкоголем: одна рюмочка хорошо, а две уже плохо...
Ren_Yumi
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Сообщение Ren_Yumi »

Ну вот, опять все усреднили, обезличили. ЕВМ понимаешь ли. Здесь индивидуальный подход нужен. Какие кошки, какого цвета, пушистости. Характер опять же. Все ведь надо учитывать.
Абугов
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Сообщение Абугов »

Доброе слово лечит:


Information, reassurance, and support aid post-CABG recovery
The results of a small, qualitative UK survey show that patients undergoing coronary bypass grafting surgery who may feel anxious or depressed about their recovery can be helped if they remain optimistic and are given information, reassurance, and support from the healthcare team and their social network.
Eur J Cardiovasc Nurs 2008; 7: 36-42

Когда реперфузия уже не нужна, делайте пластику, а не ТЛТ:

Meta-analysis shows PCI beats medical therapy for late reperfusion
Patients who undergo percutaneous coronary intervention more than 12 hours after suffering an acute myocardial infarction have improved cardiac function and survival compared with those who receive medical management, a meta-analysis indicates.
J Am Coll Cardiol 2008; 51: 956-964


Если уж в груди заболело, ничего не объяснишь:

Chest pain causes sustained psychological distress
Chest pain causes significant anxiety and depression even after people have been told that is not due to cardiovascular disease, say UK researchers.
Heart 2008; 94: e12


Богатые ездят на велосипеде лучше, чем бедные:

Low socioeconomic status link with reduced exercise capacity examined
The effect of socioeconomic status on exercise capacity in patients with stable coronary heart disease is unrelated to known cardiovascular risk factors or health behaviors, US researchers report.
Am J Cardiol 2008; 101: 462-466
С.А. Абугов.
Igor Bulatov
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Сообщение Igor Bulatov »

http://www.medscape.com/viewarticle/571199
What Is Internet Addiction?

Currently, about 71% of the US population has access to the Internet, and this new medium has revolutionized such life aspects as shopping, entertainment, and political campaigns, said Dr. Aboujaoude, but for some individuals, Internet use can become problematic.

Kimberly S. Young, PhD, from the University of Pittsburgh, in Bradford, Pennsylvania, has defined Internet addiction, based on criteria from the DSM-IV for pathological gambling, as having 5 or more of the following symptoms: preoccupation with the Internet, a need to spend more time online to get the same satisfaction, unsuccessful attempts to decrease use, feeling restless or irritable when attempting to cut back, often staying online much longer than intended, secretive behavior/lying about online pursuits, distress or dysfunction as a result of this behavior, or use of the Internet to self-medicate (eg, to overcome depression).

Internet addiction shares features in common with impulse control, substance abuse, and obsessive-compulsive disorders, Dr. Aboujaoude noted.

It is similar to impulse control disorder, in that people experience a surge in anxiety and an urge to perform an act that is pleasurable in the moment but leads to long-term distress. The DSM-IV recognizes some impulse control disorders (trichotillomania, kleptomania, pyromania, and impulsive gambling), while others (impulsive skin picking, compulsive cruising for sex, and compulsive shopping) fall into the not-otherwise-specified (NOS) category, which is where Internet addiction might fit, he said.

Like substance abuse, problematic Internet use results in a dopaminergic surge in the brain. More and more Internet use is needed to achieve a high, and when going without the Internet, the person might suffer from withdrawal symptoms.

Like obsessive-compulsive disorder (OCD), Internet addiction can include ritualized, repetitive behavior. However, unlike OCD, it offers a pleasurable high, and people can lose track of time.
Igor
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Откуда: Новосибирск.Клиника ГУ НИИ физиологии СО РАМН

Сообщение Igor »

Всё так. Особенно теряешь track of time. А ведь так жизнь и уходит.
С уважением, д-р Шевченко.
Абугов
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Сообщение Абугов »

Лениться не надо, надо работать:

Minimally interrupted cardiac resuscitation improves survival after cardiac arrest
Patients with out-of-hospital cardiac arrest who receive minimally interrupted cardiac resuscitation are more likely to survive than those receiving the standard emergency medical services protocol, US study findings indicate.
JAMA 2008; 299: 1158-1165, 1188-1190

Всегда любил прямое стентирование, правда за другое:

Direct stenting gives improved microvascular outcome in angina
Research indicates that patients with stable angina who undergo direct stenting have reduced microvascular dysfunction after percutaneous coronary intervention compared with those who undergo conventional stenting involving predilation.
J Am Coll Cardiol 2008; 51: 1060-1065

Даже абститенты должны придерживаться медицинских рекомендаций (и немедленно выпил):


Starting to drink alcohol in middle age has heart benefits
People who begin drinking moderate amounts of alcohol in middle age have lower rates of cardiovascular disease morbidity than nondrinkers who continue to abstain from drinking alcohol, findings from the ARIC study show.
Am J Med 2008; 121: 201-206


Шире используйте коронарные леденцы:


Bioabsorbable drug-eluting stent use 'feasible'
Bioabsorbable everolimus-eluting coronary stent implantation is feasible, with acceptable rates of in-stent late-loss, minimal intrastent neointimal hyperplasia, and low stent area obstruction, conclude researchers in The Lancet.
Lancet 2008; 371: 899-907
С.А. Абугов.
евгений хоменко
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Сообщение евгений хоменко »

Drug-Eluting Stents vs. Coronary-Artery Bypass Grafting in Multivessel Coronary DiseaseVolume 358:331-341January 24, 2008

The New England Journal of Medicine
Original Article
PreviousPrevious
Volume 358:331-341 January 24, 2008 Number 4
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Drug-Eluting Stents vs. Coronary-Artery Bypass Grafting in Multivessel Coronary Disease
Edward L. Hannan, Ph.D., Chuntao Wu, M.D., Ph.D., Gary Walford, M.D., Alfred T. Culliford, M.D., Jeffrey P. Gold, M.D., Craig R. Smith, M.D., Robert S.D. Higgins, M.D., Russell E. Carlson, M.D., and Robert H. Jones, M.D.

ABSTRACT

Background Numerous studies have compared the outcomes of two competing interventions for multivessel coronary artery disease: coronary-artery bypass grafting (CABG) and coronary stenting. However, little information has become available since the introduction of drug-eluting stents.

Methods We identified patients with multivessel disease who received drug-eluting stents or underwent CABG in New York State between October 1, 2003, and December 31, 2004, and we compared adverse outcomes (death, death or myocardial infarction, or repeat revascularization) through December 31, 2005, after adjustment for differences in baseline risk factors among the patients.

Results In comparison with treatment with a drug-eluting stent, CABG was associated with lower 18-month rates of death and of death or myocardial infarction both for patients with three-vessel disease and for patients with two-vessel disease. Among patients with three-vessel disease who underwent CABG, as compared with those who received a stent, the adjusted hazard ratio for death was 0.80 (95% confidence interval [CI], 0.65 to 0.97) and the adjusted survival rate was 94.0% versus 92.7% (P=0.03); the adjusted hazard ratio for death or myocardial infarction was 0.75 (95% CI, 0.63 to 0.89) and the adjusted rate of survival free from myocardial infarction was 92.1% versus 89.7% (P<0.001). Among patients with two-vessel disease who underwent CABG, as compared with those who received a stent, the adjusted hazard ratio for death was 0.71 (95% CI, 0.57 to 0.89) and the adjusted survival rate was 96.0% versus 94.6% (P=0.003); the adjusted hazard ratio for death or myocardial infarction was 0.71 (95% CI, 0.59 to 0.87) and the adjusted rate of survival free from myocardial infarction was 94.5% versus 92.5% (P<0.001). Patients undergoing CABG also had lower rates of repeat revascularization.

Conclusions For patients with multivessel disease, CABG continues to be associated with lower mortality rates than does treatment with drug-eluting stents and is also associated with lower rates of death or myocardial infarction and repeat revascularization.
Евгений Хоменко, ЛОКБ
Абугов
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Сообщение Абугов »

Чаще смотрите в себя:

Transcendental meditation may give 'clinically meaningful' BP reductions
Regularly practicing Transcendental Meditation can provide clinically meaningful reductions in systolic and diastolic blood pressure, say US researchers.
Am J Hypertens 2008; 21: 310-316

На шаг ближе к прямому переливанию:

Transfusion of 'old blood' linked to cardiac surgery complications
Patients undergoing cardiac surgery who receive a transfusion of red cells stored for more than 2 weeks are at increased risk for postoperative complications and reduced survival, a study published in the New England Journal of Medicine indicates.
N Engl J Med 2008; 358: 1229-1239

Тропонин - ацтой, BNP - форева:

Brain peptide marker helps identify high-risk ACS patients
High levels of N-terminal pro-brain natriuretic peptide above a certain threshold identify patients with suspected acute coronary syndromes and normal troponin levels who have a poor prognosis, a team reports.
J Am Coll Cardiol 2008; 51: 1188-1195


Бельишко по сезону, ботинки на толстой подошве:


QoL influences outcomes after cardiac arrest, ventricular tachycardia
Patients' recovery after cardiac arrest or ventricular arrhythmias is more successful if they have a good quality of life, study findings indicate.
Heart Rhythm 2008; 5: 361-365


Теперь монотерапия?:

Prior PCI 'worsens CABG outcome'
Stable coronary artery disease patients undergoing coronary artery bypass graft surgery have a worse outcome if they have a history of percutaneous coronary intervention, say researchers.
Eur Heart J 2008; 29: 673-679

Черным и слепым живется плохо:

Black patients with glaucoma at higher risk for cardiovascular death
Black patients previously diagnosed and treated for open angle glaucoma and ocular hypertension are at higher risk for cardiovascular mortality than those without these conditions, research shows.
Arch Ophthalmol 2008; 126: 365-370

Кардиовертеры не так полезны, как кажется:

ICD mortality rate higher than trials suggest
The mortality rate among patients receiving an implantable cardioverter-defibrillator in clinical practice is higher than that seen in trials, say US scientists, who note that left ventricular fraction remains a potent predictor of mortality.
Am J Cardiol 2008; 101: 861-864
С.А. Абугов.
rsp
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Сообщение rsp »

Абугов писал(а): Теперь монотерапия?:

Prior PCI 'worsens CABG outcome'
Stable coronary artery disease patients undergoing coronary artery bypass graft surgery have a worse outcome if they have a history of percutaneous coronary intervention, say researchers.
Eur Heart J 2008; 29: 673-679

дружба дружбой, а табачок врозь :D
Думаю даже бессмысленно проводить контр-исследование и так очевидно, что ранее шунтированные пациенты существенно ухудшают результаты последующих ангиопластик :!:
rsp
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Сообщение rsp »

:!: FDA Public Health Notification: Updated Data on Mortality Associated with the Medtronic AneuRx® Stent Graft System :!:

Issued: March 17, 2008
http://www.fda.gov/cdrh/safety/031808-medtronic.html
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