Dr. Au gives her typically hilarious, off-the-cuff response to the laughably ignorant NY Times piece on the cardiac surgery death rate at Columbia-Presbyterian.

With former President Clinton's successful CABG, this NY Times article cites the higher than normal mortality rate for this procedure at Columbia-Presbyterian:

The hospital where former President Bill Clinton awaits bypass surgery has the highest death rate for the operation in New York State, according to the state's Health Department. While the death rate is quite low - fewer than 4 percent of all bypass operations - it is ...

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With media focus on Bill Clinton's impending bypass surgery, the INTERHEART study that I briefly alluded to recently has received an early-release from the Lancet.

Some observations:
1) Smoking and a poor cholesterol ratio accounts for the majority of risk.
2) Psychosocial factors ("stress") plays a significant role.
3) The cholesterol ratio they used was the ApoB/ApoA1 ratio. What does this mean? From UptoDate:

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New scutmonkey comics

For those who haven't been following Michelle Au's Scutmonkey Comics, they are witty and hilarious - I can certainly relate to many of the experiences. A new batch were released today, dealing with her surgery rotation. Check it out!

That lovely ear . . .

. . . from yesterday - certainly looks like a cholesteatoma to me. The patient was sent to an ENT physician. Here is some more information from Medline Plus:

Cholesteatoma can be a congenital defect, but it more commonly occurs as a complication of chronic ear infection. Long-term inflammation and malfunction of the eustachian tube leads to chronic negative pressure in the middle ear. ...

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In the article, Why do doctors use treatments that do not work?, several interesting points were made. It is making a case that we need to continually rely on the evidence, and less on empiricism. This is why it is so frustrating when I hear stories where EBM is tossed around like a "dirty word" and when physicians are making treatment decisions that are evidence-bereft.


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Hiccups

Medpundit wrote about hiccups today. It reminded me about one of my patients who had protracted hiccups for 5 years - you could only imagine how frustrating this was. He was a 70-yo male who started having hiccups after surgery. Multiple medications were not successful: PPIs, H2 blockers, Thorazine, Reglan, Compazine, Neurontin and Dilantin were given without success. Endless GI and neurology consults were not ...

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A laparoscopic approach to colon cancer was initially explored in the early 1990's, but then abandoned due to questions regarding the efficacy for achieving appropriate resection. A recent study from the NEJM, did a controlled trial which concluded similar rates of cancer recurrance between open and laparoscopic resection.

Here is an excerpt from the accompanying editorial:
Approximately 250,000 colonic resections are performed each year in ...

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I'm flying soon, and thought this would be a relevant article to share.

Prescriber's Letter:
Practical Tips for Avoiding "Economy Class Syndrome"

What Is Economy Class Syndrome?

Economy class syndrome is a condition that can happen after sitting in a cramped space, such as the economy class section of an airplane. This can lead to blood clots in the legs and sometimes the ...

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