Women and non-smokers need not apply

The new USPSTF recommendations concerning screening for AAA appear in this week’s Annals of Internal Medicine, and are being quoted in the press. Bottom-line: screen men who have ever smoked, once between the ages of 65 and 75. Under 65: too low morbidity/mortality to make screening worthwhile Over 75: too high co-morbidities to make a […]

Aspirin vs. Plavix after upper GI bleeding

What a frustrating paper. In last week’s NEJM is a study from the Prince of Wales Hospital in Hong Kong looking at clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding. More precisely, the authors studied patients who had been on 325 mg aspirin or less, who presented with upper GI bleeding and who […]

More on CRP

The two NEJM articles on C-Reactive Protein which I commented on yesterday have raised quite a stir. Gina Kolata’s headline in the NY Times that I saw in my print paper yesterday blared: “Two Studies Suggest a Protein Has a Big Role in Heart Disease“. Today, I went to the Times website to find the […]

CRP and statins

Today’s NEJM has two articles on statin therapy and achieved LDL and CRP levels in relation to coronary disease. The first article, from Harvard, is a substudy of the Pravastatin or Atorvastatin Evaluation and Infection Therapy – Thrombolysis in Myocardial Infarction 22 study (I challenge you to reread the name of this study once and […]

Coronary revascularization before vascular surgery

Patients undergoing vascular surgery are at higher risk for cardiovascular events. Despite published guidelines, the exact approach to pre-operative cardiac evaluation for these patients varies significantly. The report of a VA cooperative study in last week’s NEJM looked at the value of prophylactic coronary-artery revascularization before elective major vascular surgery. Patients undergoing elective AAA repair […]

Accupuncture for knee pain (and two other articles)

In the Annals of Internal Medicine due out on December 21 are three “alternative medicine” articles. The lead article, effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee, randomized 570 patients with osteoarthritis of the knee to one of three interventions: a 26 week tapering schedule of acupuncture, sham acupuncture, or six 2-hour […]

MRI for breast imaging

Last week’s JAMA had an article on magnetic resonance imaging of the breast prior to biopsy, which evaluated the performance of MRI imaging in evaluating patients with breast abnormalities. This study found that MRI had good sensitivity but only moderate specificity for detecting cancer. The negative predictive value of MRI was only about 85%, not […]