Central arteriovenous anastomosis for the treatment of uncontrolled hypertension

Although renal denervation didn’t go down so well for the management of refractory hypertension, that doesn’t mean the problem has gone away. This new randomised controlled trial is about trying something a little different – and the early results look promising. Check it out at the Lancet, here.

review | multiple sclerosis

Multiple sclerosis is a field that has really exploded in the last ten years, with a myriad of new immunologically based therapies being used. These include alemtuzumab, daclizumab, and various other antibodies – if these don’t sound familiar or you’re just interested in this area, then have a look at this new Rapid Review in The Lancet Neurology.

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review | asthma

The Lancet has often got great reviews in its Seminar series, and this month is no different. Prof. Martinez and Prof. Vercelli from Arizona have provided us with a nice summary of the old and the new when it comes to asthma, with some nice insights into severe asthma. Read it here.

 

source | The Lancet

image | NIAID

Using optical coherence tomography to see inside the artery

There’s a cute clinical picture over in the Lancet – the team at Monash down in Melbourne using optical coherence tomography (OCT) to visualise a patient with a ruptured plaque with thrombus overlying. A very nice image to demonstrate the pathology of the acute coronary syndrome.

See it here.

 

 

source | The Lancet

Clopidogrel without aspirin in patients on warfarin undergoing percutaneous coronary intervention

File:PTCA stent NIH.gif

This is an article from a few months ago but one that needs to go in the archive – a patient already on warfarin (say for AF or a mechanical heart valve) comes to you and requires percutaneous coronary intervention. Do you put them on aspirin and clopidogrel, or just either agent on its own, in addition to the warfarin? The WOEST study looks at this.

Dewilde and colleagues performed an RCT across 15 centres in Belgium and the Netherlands, between the Novembers of 2008 and 2011.  These were all patients receiving PCI (with about a quarter being those with acute coronary syndromes), except those in cardiogenic shock, or with either a recent (within 6 months) peptic ulcer, major bleeding previously, or platelet count < 50. Anticoagulation was continued periprocedurally, with a target INR of 2. The majority of patents were done with femoral access, with around 25% using the radial approach. A mix of drug eluting and bare metal stents were also included.

Overall, there was significantly less bleeding in the triple therapy group, with no significant increased thrombotic risk. A great practical article, and definitely worth a read. Check it out here.

source | The Lancet

image | National Institute of Health, via Wikimedia Commons

review | pulmonary embolism and deep venous thrombosis

Prof. Goldhaber from Harvard gives a review in this month’s Lancet on DVT and PE. The review touches on a few key areas in particular, including prophylaxis in hospitalised patients, advanced therapies (such as thrombolysis or embolectomy), and the use of newer drugs.

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review | silicosis

File:8.- Miner's lung with silicosis and tuberculosis.jpg

When you auscultate the chest and hear crackles consistent with pulmonary fibrosis, the first thing that should go through your mind is the differential list – which usually gets broken up into upper and lower lobe causes. Although ankylosing spondylitis, radiation, and even tuberculosis are familiar – but silicosis isn’t usually. So luckily, here’s a review from the Lancet to update you.

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