It seemed to be a slow week in the medical literature, but that will likely change as the 2007 American College of Cardiology Scientific Session is now underway. Theheart.org has an excellent summary about what to expect from the meetings. (free registration required).
The annals has an interesting prospective observational study that looks at a prediction rule to determine whether a patient with a minor head injury with or without loss of consciousness should have a catscan done. The prediction rule includes age, glasgow coma scale, skull fracture, post-traumatic vomiting, amnesia or seizure. Sensitivity of the prediction rule for intracranial traumatic ct findings approached 95% with a sepcificity ~30%. Annals Link.
The same issue of the Annals also has a perspective piece (not a guideline) on the use of clopidogrel in managing atherothrombotic cardiovascular disease. It nicely summarizes the available evidence for its use in acute coronary syndromes before and after stenting and discusses what we don’t know-the dose and duration before and after stenting, administration with platelet glycoprotein IIb/IIIa inhibitors and others. Annals Link.
Something that we may see in the future of degenerative spine disease is disc transplantation. A case series of 5 patients underwent transplantation of fresh-frozen disc allografts for cervical disc herniation. Patients after 5 years had mild disc degeneration, but the motion and stability of the spine were preserved. Lancet Link: http://sfx.med.nyu.edu/sfxlcl3?genre=article&id=pmid:17382826&_char_set=utf8
The British Medical Journal adds to the current debate about revascularization with 2 companion pieces-a meta-analysis and a cost effective analysis both concluding that minimally invasive internal thoracic artery bypass has better outcomes and is more cost effective that percutaneous revascularization for isolated left anterior descending lesions. Meta-analysis link. Cost-effective analysis link.
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