GLG News by Physicians who Implant Both Cypher and Taxus Stents

Goran OlivecronaConsulting CardiologistSkåne University Hospital

Are all statins equal ?

December 15, 2008

Analysis of:Patients Taking Lipitor Had a Significantly Reduced Risk of Cardiovascular Events Compared with Patients Taking Simvastatin, New Observational Study Shows | pharmalive.com

Retrospective studies should be viewed with caution. Most retrospective studies which may contain a bias in the prescribed treatment should be anlysed with matched propencity score. To confirm the results a randomized trial would essentially be needed.

Forrest RubensteinCardiac, Thoracic and Vascular SurgeonST. MARY'S HOSPITAL, STREATOR, OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS

Preventing Bariatric Surgery Deaths

January 25, 2008

Analysis of:Pinning Down Mortality Rates After Bariatric Surgery | www.medscape.com

 Bariatric surgery is a major operative procedure that caries significant morbidity and mortality risks due to the comorbid diseases seen in this patient population.  This procedure is increasing in frequency as more patients are willing to have it and more surgeons are becoming proficient. The mortality rate is ~ 1 % at 1 year and 6% at 5 years which is greater than the population at large.

Ramin EbrahimiDirector of Cardiac Catheterization LabWadsworth VA Medical Center

Risk Versus Benefit

November 23, 2007

Analysis of:Study Shows Weight-Loss Drug Rimonabant is Associated with Severe Adverse Psychiatric Events | pharmalive.com

The pooled analysis of Rimonabant trials point to a significant increase in psychiatric disorders. These studies also point to significant improvements in markers of cardiovascular risk. Risks versus benefits must be considered before the final decision is made on this class of medications.

Goran OlivecronaConsulting CardiologistSkåne University Hospital

A user friendly femoral access closure device with a fast learning curve

October 15, 2007

Analysis of:St. Jude Medical Announces Japanese Approval Of The Angio-Seal STS Plus Vascular Closure Device | www.medicalnewstoday.com

1. Angioseal is a very user friendly closure device which saves staff time spent with the patient and reduces he number of pseudoaneurysms, but it does not reduce the overall number of bleeding complications. 2. Angioiseal will probably continue to increase its market share in centers not moving to the radial access approach.

Goran OlivecronaConsulting CardiologistSkåne University Hospital

A new tool to improve survival rates in cardiac arrest victims?

October 15, 2007

Analysis of:Physio-Control Announces Availability Of LUCAS™ Chest Compression System In United States | www.medicalnewstoday.com

1. LUCAS can effectively sustain circulation in spite of cardiac arrest through external mechanical chest compressions thus maintaining a sustenance of blood flow to the brain during CPR. 2. Effective external mechanical chest compression devices like LUCAS, offer a new tool to aid in the treatment of cardiac arrest victims.

Goran OlivecronaConsulting CardiologistSkåne University Hospital

A New DES with less efficacy but maybe a better saftey profile is on the way.

October 11, 2007

Analysis of:FDA Panel Recommends Approval Of Medtronic Drug-Coated Stent | online.wsj.com

1. ENDEVOR subscribes to cardiologist concerned about the saftey profile of Current DES sold in the US (Cypher and TAXUS). 2. ENDEAVOR seems to carry a higher rate of binary restenosis than Cypher, but may have a lower rate of late stent subacute thrombosis (SAT) than either Taxus or cypher. 3. The impact on J&J and Boston will depend upon what results are seen in the forthcoming results of the ENDEAVOR IV study and also how the issue of Late Stent SAT will develop. 

Ramin EbrahimiDirector of Cardiac Catheterization LabWadsworth VA Medical Center

Good device but not much improvement.

August 31, 2007

Analysis of:St. Jude Medical Announces Japanese Approval Of The Angio-Seal STS Plus Vascular Closure Device | www.medicalnewstoday.com

The repositioning of the hole, also present with the VIP version is a mild improvement to decrease sheath manipulation. Otherwise the device has not changed much in the past few years. While a very good device in general, its primary limitaions listed below still remain. 1. not allowing re-access at the previous access site within 90 days of the index procedure  2. inability to promote means for primary healing of the arteriotomy site (primary healing results in much less scar formation and secondary healing that angioseal provides) and 3. relying on an intravascular component for deployment that stays within the vessel for weeks prior to its resolution  Newer devices such as the STARCLOSE that also are easy to deploy, rely on no intravascular components and potentially provide much better healing process may be the way of future.   

Forrest RubensteinCardiac, Thoracic and Vascular SurgeonST. MARY'S HOSPITAL, STREATOR, OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS

CMS regulations penalize hospitals for taking care of sickest patients

August 28, 2007

Analysis of:New Medicare Regulations Adopted To Reduce Certain Hospital Infections And Medical Errors | www.medicalnewstoday.com

This article presents the new CMS guidelines that deny higher payments for the additional costs associated with treating patients for certain hospital - acquired infections and medical errors. While these are laudable goals, to assume that all infections are the result of poor medical practice is an oversimplification. The development of nosocomial infections also has to do with the patients disease processes such as diabetes, morbid obesity, immunosuppression, tobacco abuse, etc. While few physicians would argue against enforcing these rules for documented mistakes (medication errors, transfusion mistakes, and objects left in patients bodies), most recognize there is a certain baseline of these other infections which cannot be avoided. Hospitals should only be penalized when their risk adjusted incidence exceeds a standardized baseline.

Forrest RubensteinCardiac, Thoracic and Vascular SurgeonST. MARY'S HOSPITAL, STREATOR, OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS

Retail drugstore clinics - filling a niche ?

August 28, 2007

Analysis of:Drugstore Clinics Spread, and Scrutiny Grows | www.nytimes.com

   Several large drugstores are establishing retail medical clinics within their stores much as eyeglass stores have had optomitrists on site.  There is no problem with these clinics per se as long as they practice within the scope of the practitioners license and skill.  There are concerns that those clinics staffed by non physicians will be practicing inferior medicine beyond the scope of the practitioner.  As these clinics become more widespread, they will certainly come under greater scrutiny.

Forrest RubensteinCardiac, Thoracic and Vascular SurgeonST. MARY'S HOSPITAL, STREATOR, OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST. FRANCIS

The drug patent "shell game"

August 28, 2007

Analysis of:New antihistamine gets FDA green light.(RX CARE)(Levocetirizine (Xyzal) by UCB Inc. and Sanofi-Aventis ) | www.therapeuticsdaily.com

   Zyrtec (cetirizine) is a second generation nonsedating antihistamine that has enjoyed wide popularity.  Zyrtec will become available generically in late 2007 and the generic form is expected to be significantly cheaper.  To virtually extend the patent, the manufacturer is marketing the active enantiomer, levocitirizine (Xyzal) as a replacement for Zyrtec. This required only a fraction of the R&D costs that developing a new drug would entail.  While this could be a boon to the pharmaceutical companies involved in the release, patients have little to benefit from the increased cost.

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