jeudi 12 septembre 2013

Type 2 diabetes patients: MRI is worth the price

Diabetes Mellitus: Long-term Prognostic Value of Whole-Body MR Imaging for the Occurrence of Cardiac and Cerebrovascular Events

  1. Sabine Weckbach, MD
  1. From the Department of Clinical Radiology (F.B., E.L., R.P.M., D.T., M.F.R., S.W.) and Department of Internal Medicine II (K.G.P.), Ludwig Maximilians University, Klinikum Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany (F.B., H.M.F.); Cardiac MR PET CT Program, Division of Cardiology and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (U.H., C.L.S.); Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Mannheim, Germany (S.O.S.); and Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany (S.W., C.L.S.).
  1. Address correspondence to
    F.B. (e-mail:
  1. Author contributions: Guarantors of integrity of entire study, F.B., S.W.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; manuscript final version approval, all authors; literature research, F.B., E.L., D.T., U.H., S.O.S., M.F.R., S.W.; clinical studies, F.B., K.G.P., E.L., R.P.M., D.T., H.M.F., S.O.S., M.F.R., S.W.; statistical analysis, F.B., D.T., U.H., C.L.S.; and manuscript editing, F.B., K.G.P., E.L., R.P.M., D.T., U.H., S.O.S., C.L.S., M.F.R., S.W.


Purpose: To study the predictive value of whole-body magnetic resonance (MR) imaging for the occurrence of cardiac and cerebrovascular events in a cohort of patients with diabetes mellitus (DM).
Materials and Methods: This HIPAA-compliant study was approved by the institutional review board. Informed consent was obtained from all patients before enrollment into the study. The authors followed up 65 patients with DM (types 1 and 2) who underwent a comprehensive, contrast-enhanced whole-body MR imaging protocol, including brain, cardiac, and vascular sequences at baseline. Follow-up was performed by phone interview. The primary endpoint was a major adverse cardiac and cerebrovascular event (MACCE), which was defined as composite cardiac-cerebrovascular death, myocardial infarction, cerebrovascular event, or revascularization. MR images were assessed for the presence of systemic atherosclerotic vessel changes, white matter lesions, and myocardial changes. Kaplan-Meier survival and Cox regression analyses were performed to determine associations.
Results: Follow-up was completed in 61 patients (94%; median age, 67.5 years; 30 women [49%]; median follow-up, 70 months); 14 of the 61 patients (23%) experienced MACCE. Although normal whole-body MR imaging excluded MACCE during the follow-up period (0%; 95% confidence interval [CI]: 0%, 17%), any detectable ischemic and/or atherosclerotic changes at whole-body MR imaging (prevalence, 66%) conferred a cumulative event rate of 20% at 3 years and 35% at 6 years. Whole-body MR imaging summary estimate of disease was strongly predictive for MACCE (one increment of vessel score and each territory with atherosclerotic changes: hazard ratio, 13.2 [95% CI: 4.5, 40.1] and 3.9 [95% CI: 2.2, 7.5], respectively), also beyond clinical characteristics as well as individual cardiac or cerebrovascular MR findings.
Conclusion: These initial data indicate that disease burden as assessed with whole-body MR imaging confers strong prognostic information in patients with DM.

© RSNA, 2013

mardi 10 septembre 2013

Is surgical skill falling?

Conclusions and Relevance   Total CR cases declined especially acutely following implementation of the 80-hour work week but have since rebounded. Chief resident cases contribute less to overall experience, although this proportion stabilized before the 80-hour work week. Case mix has narrowed, with significant increases in alimentary and intra-abdominal cases. Broad-based general surgery training may be jeopardized by reduced case diversity. Chief resident cases are crucial in surgical training and educators should consider these findings as surgical training evolves.

The fallacy of reducing work hours for happiness

Herpes virus transmission from parents to children

Strikes on Syria: a simple explanation

In this crisis some european people cheers Poutine and Lavrov. Republicans are divided. Among antisionists the rumor is that Israel is behind Obama to strike Assad and BTW weaken terrorists groups.
I just don't think so. 

Israel is by far more confident in the status quo... Arab countries don't need to be struck, they are destroying themselves.

So is there a simpler and straight explanation?

Obama is not a fan of Israel but on the other hand he is a fan of "progressism" like Hollande, BHL and also Sarkozy. In their perspective an Islamist fighting Assad is a progress!  It is a pity that these guys don't look at the tragic reality: arab spring is indeed a terrific glaciation. 
On the other hand Obama need to revamp his own figure and send weapons to Republicans who don't accept to free the debt ceiling and celebrate Obamacare.
In this setting Obama wants to justify his NP and to build his stature for history. For doing this a war based on moral arguments would have been perfect and in keeping with all these liberals in Washington as in Paris. More it would have not look like a Bushian metamorphose.

A snag derailed this magnificent dream.

He hadn't the balls to go alone with his french caniche and now it's too late.

In the same topic I don't share the European enthusiasm for Putin and Assad. Assad should have been struck ASAP when the proofs of neurotoxic gas bomb accumulation were obtained by the west as Iran with uranium and atomic bomb.
Too late is criminal. The recent days were full evidence of this terrific misconduct of UNO, NATO, US and Europe.

When Israel will establish a threat it will strike by itself as usual, without warning nor Obama's approval.

Just my opinion.

lundi 9 septembre 2013

Is clopidogrel better than aspirin? An unclear choice

The issue with antiplatelet therapy is huge because a lot of patients are treated by these drugs and by the fact a lot of them do have side effects or inefficacy.
1/ one or two?
Despite the answer to this question by CHARISMA trial a dual antiplatelet is still prescribed to patients who are not bearing DES or are at high risk of arterial thrombosis.
So except for DES or a short period (usually 3 months) after implanting long bare stents there is no indication to prescribe a dual antiplatelet therapy because the risks outweigh the benefits.

2/ Efficacy
A lot of studies emphasized that either aspirin or clopidogrel could be inefficient in a patient for several reasons:
- genetics
- other drugs
- thrombophilia
- high risk profile of metabolic markers (D2, high Lpa, high TG...).
The solution is not to prescribe the two drugs in case...
In order to identify the precise reason of inefficacy one must prescribe in Vitro tests like platelet aggregation, platelet filtration sensitized by platelet activators or drugs. Those tests could be completed by a genetic analysis of CYP2 genes.

3/ Side effects

The major side effect of antiplatelet therapy is bleeding or ecchymosis or a hematomas. These side effects could be fretful especially for G.I. bleeding or intracranial hemorrage. There is no convincing data in favor of either aspirin or clopidogrel according to the risk of bleeding.
One must be aware of the risk of less efficiency of clopidogrel a prodrug with H+ pump inhibitors.