New‐Generation Drug‐Eluting Stents: Focus on Xience V® Everolimus‐Eluting Stent and Resolute® Zotarolimus‐Eluting Stent

Compared to bare metal stent angioplasty, first‐generation drug‐eluting stents (DES) have markedly reduced the incidence of in‐stent restenosis. However, given the increased concerns over late and very late stent thrombosis, newer‐generation DES were developed. To date, these DES have virtually replaced the use of first‐generation DES worldwide. In this review article, we carefully consider the pre‐clinical and clinical trials that have been performed with currently available, european conformity‐marked and Food and Drug Administration–approved new‐generation Resolute^® and Xience V^® DES. (J Interven Cardiol 2013;26:278–286)

     

Clinical Advances in the Management of Severe Nausea and Vomiting During Pregnancy

The nutritional status of the woman with hyperemesis of pregnancy has been compromised by decreased food intake and increased nutrient loss. Depending on the severity of symptoms, interventions may begin with dietary and lifestyle alterations, proceed to oral nutritional supplementation or pharmacologic preparations, and continue on to intravenous vitamin-mineral therapy and either enteral tube feedings, parenteral nutrition, or both. These therapies, and the role of the nurse in initiating or supporting them, are described.     

Intramedullary spinal cord tumors: Patterns of care in Victoria from 1998–2000

Aim:   This study describes the management of and outcomes for adult patients with newly diagnosed intramedullary spinal cord tumors during 1998–2000 in Victoria.
Methods:   The adult patients were identified in a retrospective cohort study conducted by surveying doctors involved in managing incident glioma cases identified from the population-based Victorian Cancer Registry.
Results:   Sixteen patients were considered eligible for this review. Of these 15 (94%) had a histological diagnosis: an ependymoma was diagnosed in 13 patients (81%). A complete macroscopic resection was achieved in eight patients (50%). A variety of tumor types and grades were observed with surgery and radiotherapy the mainstays of therapy. One patient received chemotherapy (7%). One patient died from disease within six months of diagnosis. Of the remaining 15 patients, all were alive at 5 years and 10 (63%) remain disease free.
Conclusion:   This review documents characteristics of a rare condition and suggests that, overall, prognosis is excellent.     

ACTH, LPH AND RELATED PEPTIDES IN THE ECTOPIC ACTH SYNDROME

Adrenocorticotrophin, lipotrophin and the related peptides alpha-MSH, CLIP, beta-endorphin and met-enkephalin have been measured, and characterized chromatographically in tumour extracts from seven patients with the ectopic ACTH syndrome. Four of the seven tumours contained the complete family of peptides, although the proportion of one to another varied between tumours. In addition, large molecule weight forms of ACTH and met-enkephalin were seen. The potential clinical importance of these observations is discussed.     

STUDIES ON CIRCULATING MET-ENKEPHALIN AND β-ENDORPHIN: NORMAL SUBJECTS AND PATIENTS WITH RENAL AND ADRENAL DISEASE

Studies were performed to define the responses of plasma met-enkephalin to various endocrine and pathological stimuli and to determine the relationship between plasma β-endorphin and met-enkephalin. During insulin-induced hypoglycaemia ACTH, β-LPH and β-endorphin immunoreactivity rose in parallel, but plasma met-enkephalin did not change significantly. Sephadex G75 chromatography of samples taken at the time of the peak response (45 min) confirmed the rise in both β-LPH and β-endorphin. During administration of dexamethasone, 0·5mg 6 hourly for 48 h, plasma cortisol and ACTH became undetectable at 24 h, and β-LPH and β-endorphin fell significantly by 24 h and were undetectable by 48 h; plasma met-enkephalin, however, showed no significant change. Nine adrenalectomized patients with Cushing's disease and four patients with Addison's disease had elevated plasma ACTH, β-LPH and β-endorphin but normal plasma met-enkephalin levels. Each of ten patients with renal failure had markedly elevated plasma met-enkephalin immunoreactivity which co-eluted with synthetic met-enkephalin on BioGel P4 chromatography. Trypsin and carboxypeptidase-B digestion of the P4 chromatography fractions generated met-enkephalin immunoreactivity in earlier fractions, indicating the presence of a potential high molecular weight met-enkephalin precursor. The results imply that different control mechanisms govern β-endorphin and met-enkephalin plasma levels and that the adrenal is not the only source of plasma met-enkephalin. The elevated levels of met-enkephalin in renal failure may be due to impaired clearance of met-enkephalin or of its precursor or to increased met-enkephalin production.     

Different professionals' knowledge and perceptions of the management of people with pancreatic cancer

Background: Pancreatic cancer is generally associated with a very poor prognosis. The knowledge, beliefs and opinions of clinicians caring for people with pancreatic cancer may affect preferences for particular therapies and may impact upon patient outcomes. The aim of this study was to conduct a postal survey of clinicians who consult patients with pancreatic cancer to assess their knowledge regarding the disease itself and the effectiveness of various treatments, and to gauge their opinions regarding aspects of management. Methods: A 20‐item multiple‐choice questionnaire was mailed to medical and radiation oncologists, gastroenterologists, general surgeons and hepatopancreatobiliary (HPB) surgeons in Australia. Questions assessed knowledge of survival following surgery for resectable disease, and survival and response rate following chemoradiation for locally advanced disease and chemotherapy for advanced disease. Beliefs regarding the need for tissue diagnosis and perceptions of benefit of various treatment strategies were also sought. Results: Overall, knowledge was fair (average knowledge score 4.1 out of 8); 56% of HPB surgeons and 55% of medical oncologists had good knowledge, compared with 39% of gastroenterologists and general surgeons. There were marked differences in opinion regarding requirement for tissue diagnosis before further management. There was considerable variation in opinion regarding the benefit of postoperative adjuvant chemotherapy. Conclusion: These findings argue strongly for the development of evidence‐based guidelines. Multidisciplinary management teams may help educate individual clinicians and professional groups and are likely to result in improved outcomes for patients.     

Preclinical students' views on knowing cancer diagnosis: a data-based class exercise

One way of tackling the problems of demonstrating the relevance of psychology to medical practice as well as to medically-inexperienced preclinical students is to elicit their views on topical issues and present them with a comparison of their own data and any available in the medical literature. In a survey of preclinical students' views on being told their diagnosis and prognosis in the hypothetical case of cancer, high agreement in the proportions wanting to be or not to be told was found between the responses of students and a sample of cancer patients reported by Kelly & Friesen (1950) . The exercise served to demonstrate that the 'to tell or not to tell' debate is one in which students can also be involved.