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zaterdag 4 november 2017

The Lancet: [Comment] Last nail in the coffin for PCI in stable angina?

[Comment] Last nail in the coffin for PCI in stable angina?
Interventional cardiology began in Switzerland in 1977, when Andreas Gruentzig performed the first successful percutaneous transluminal coronary angioplasty (PTCA) on a 38-year-old man with angina and a focal proximal stenosis of the left anterior descending coronary artery. Despite numerous subsequent randomised trials and meta-analyses of these trials, which have shown no reduction in death or myocardial infarction,1 the use of percutaneous coronary intervention (PCI) has grown exponentially. Some of this growth was driven by data from clinical trials suggesting that PCI was more effective in relieving angina than medical therapy alone.
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[Comment] Ireland's Public Health Bill: crucial to reduce alcohol harm
Ireland has become the fourth heaviest drinking nation in the Organisation for Economic Co-operation and Development in terms of quantity of alcohol consumed,1 and ranked joint third for binge drinking in an analysis of 194 nations by WHO.2 Irish adults consume on average 11·5 L of pure alcohol per person every year, an increase of more than 100% compared with 60 years ago.3 Most alcohol in Ireland is now consumed at home and alcohol retailing off licences have increased by five-fold since 1990.
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[Comment] Surgery versus endoscopy for patients with infected pancreatic necrosis
Acute pancreatitis remains a commonly encountered clinical entity. The most florid form of the disease is seen when pancreatic necrosis develops and when this necrotic pancreatic tissue becomes infected. Bacterial or fungal infections in this space can result in severe morbidity and in mortality.1 Historically, patients with infected pancreatic necrosis were treated via open surgical debridement—a highly invasive and risky procedure in already compromised individuals—and multiple trips to the operating room for subsequent debridement were not unheard of.
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[Articles] Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial
In patients with infected necrotising pancreatitis, the endoscopic step-up approach was not superior to the surgical step-up approach in reducing major complications or death. The rate of pancreatic fistulas and length of hospital stay were lower in the endoscopy group. The outcome of this trial will probably result in a shift to the endoscopic step-up approach as treatment preference.
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[Review] Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition
Cardiovascular, respiratory, and related disorders (CVRDs) are the leading causes of adult death worldwide, and substantial inequalities in care of patients with CVRDs exist between countries of high income and countries of low and middle income. Based on current trends, the UN Sustainable Development Goal to reduce premature mortality due to CVRDs by a third by 2030 will be challenging for many countries of low and middle income. We did systematic literature reviews of effectiveness and cost-effectiveness to identify priority interventions.
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