Indispensable Reads - Archive: 2012

RICHARD FRIEDLAND, MD

Safety of Iodinated Intravenous Contrast Medium Administration in Sickle Cell Disease  

Diagnostic imaging can now be performed for sickle cell disease patients without an increased risk of serious complications. Dr. Friedland cited this as an important study he'd recently read showing that “adverse events related to IV contrast in sickle cell disease patients occur at a rate similar to the general population.” In the past, diagnostic imaging has been avoided in sickle cell patients due to increased sickling following IV contrast administration and the potential for contrast-induced nephropathy. With the second-generation low- and iso-osmolar agents, there is less sickling of erythrocytes.

EVAN GOLDFISCHER, MD

"Efficacy and Safety of Oxybutynin Topical Gel (84 mg or 56 mg/day) in Patients With Urgency and/or Mixed Urinary Incontinence: Results of a Randomized, Double-Blind Placebo-Controlled Study" was selected by the American Urological Association as the 2012 Best of AUA/Japan Annual Meeting to be held in Tokyo, October 12-14, 2012. Whereas many overactive bladder agents have constipation as a side effect, there is minimal constipation with this new gel.  

 DAVID STAMER, MD

Specialty Update: What’s New in Orthopaedic Trauma.

 According to Dr. Stamer, this up-to-date, comprehensive article reviews the most controversial as well as the gold standard techniques regarding care of the orthopaedic trauma patient based on the most clinically relevant studies available.

Nutrition and physical activity guidelines for cancer survivors.

Dr. Torres recommends this article to help physicians of all specialties answer questions that cancer survivors have after completion of treatment. It describes the different nutritional and physical activities issues related to the most common cancer diagnoses. The authors also tackle the controversial question of the need for dietary supplements after a diagnosis of cancer. The most common questions about antioxidants, fat, sugar and other dietary concerns are answered. The article reviews current data and provides a guideline as to what patients should be eating and how much exercise they should engage in.

Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events

Dr. Choi was intrigued by the conclusion:

Overall, omega-3 PUFA supplementation was not associated with a lower risk of all-cause mortality, cardiac death, sudden death, myocardial infarction, or stroke based on relative and absolute measures of association.

R.Shahani, MD

Reduced lung-cancer mortality with low-dose computed tomographic screening - “Even though this article is from last year, it is probably one that will likely guide the future course for lung cancer screening.”-Dr. Shahani

The conclusion is just a single line: “Screening with the use of low-dose CT reduces mortality from lung cancer.”

As a scientific reader, it is important, however, to read between the lines  -   96.4% of the results were FALSE POSITIVE !! 90% of these positive screens led to a diagnostic evaluation. The number needed to screen with low dose CT to prevent one death from lung cancer was 320.

Although the article quotes a 20% decrease in mortality from lung cancer in the low dose CT group (compared to chest XRAY), it must be weighed against the harms from false positive screening results and over-diagnosis, as well as costs.  Smoking cessation as an alternative competing intervention should probably be looked at more critically!

Sankar Varanasi, MD

"Magnetic Resonance imaging in patients with a pacemaker system designed for the magnetic resonance environment" by Wilkoff et al

Presence of a pacemaker has long been considered a contraindication for safe performance of MRI studies.  This study highlights the safety and efficacy of performing MRI studies in patients with a permanent pacemaker system specifically designed to facilitate safe performance.

Michael Sama, MD

Filling A Gap Between ER and Inpatient Rooms

Brigham and Women's Hospital has embraced observation units as a way to treat patients without an inpatient admission. "Patients who show up with complaints that can't be quickly or conclusively diagnosed are more frequently being shifted to observation units adjacent to or close by emergency rooms. Not only does this reduce crowding in harried ERs, but the units allow emergency staff to closely monitor at-risk patients and conduct tests more quickly and cheaply than by admitting them as an inpatient to a hospital room."  

Melissa Shah, MD

 "Peripheral Artery Disease: Detection, Awareness and Treatment in Primary Care"   To Quote Dr. Shah:  "The PARTNERS program highlights the significance of even asymptomatic peripheral arterial disease (PAD) regarding cardiovascular risks. We must focus on the whole patient and not just PAD, especially when non-limb-threatening."

Ariel Fischer, MD

Ann Surg Oncol (2012) 19:1206-1212

Most American oncologists routinely give adjuvant chemotherapy after neoadjuvant chemotherapy and radiation, followed by surgery.  However, the evidence to support this is lacking. This study from the Cleveland Clinic examined 128 patients who were node negative after neoadjuvant chemoradiation followed by surgery who were found to be node negative on pathology.  58 patients received adjuvant chemotherapy and 70 did not. Rates of local recurrence, disease-free survival and overall survival were not statistically different in the two groups.