Methodist DeBakey cardiovascular journal
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Methodist Debakey Cardiovasc J · Oct 2011
Review Case ReportsBalancing hemostasis and thrombosis in interventional vascular medicine and surgery.
Antithrombotic therapy and revascularization are critical factors in managing patients presenting with acute coronary syndromes and are described in multiple guidelines documents. In addition to preventing intravascular thrombosis, they increase the risk of bleeding, which has been implicated as a risk factor in short- and long-term mortality. Randomized controlled trials provide useful aggregate information comparing the risks and benefits of various therapies. In this paper, we will use a case-based format to discuss optimal individualized antithrombotic treatments.
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Methodist Debakey Cardiovasc J · Oct 2011
Facts and frictions: conflicts of interest in medical research.
I'm going to give you a bird's eye view, as an editor-in-chief, of why conflict of interest in medical research is such a vital problem today in medicine. By the time I am finished, I hope that I will convince you that we physicians and medical scientists need to make sure we take control of our profession to protect our patients in a way that only we can do. The first definition of "conflict of interest" that I could find goes back to 1850 in Webster's Dictionary: "To conflict between the private interests and the official responsibility of a person in a position of trust." That sounds familiar to all of us in medicine, because that's who we are. ⋯ It is the most manipulative thing in the world because journal editors have to live by it, and departments use the impact factor as a mechanism for promotion. Editors also want to increase subscriptions and increase the financial profitability of their journals; sometimes, they have a conflict of interest because they're trying to eliminate or decrease stress, hostility, or harassment. In fact, I invite anyone who doesn't think a journal editor deals with stress, hostility, or harassment to spend a day with me.
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The biology of aortic aneurysm and dissection has evolved to where we now understand the genetic implications of changes in extracellular matrix proteins, smooth muscle cells, and growth factors and how they affect aortic wall homeostasis. These predeterminants are influenced by smoking, hypertension, and atherosclerosis, and the result in an inflammatory response coupled to an accelerated proteolytic cascade that disrupts both elastin and collagen in the aortic wall.
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Methodist Debakey Cardiovasc J · Jul 2011
ReviewAortic arch debranching: advanced and hybrid techniques.
Aortic arch procedures have traditionally involved complex surgery with increased risk of mortality and morbidity. Throughout the last decade, however, novel and safe surgical approaches aimed at debranching the great vessels with definitive aortic arch repair have been developed. ⋯ In the future, aortic pathology may also benefit from the development of branched and fenestrated endografts that would be deployed in a modular fashion. This article describes the rationale, procedural steps, and recent outcomes data of novel aortic arch procedures.
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Acute aortic syndromes are a life-threatening set of conditions that require rapid triage and intervention to obtain satisfactory outcomes. The Methodist Hospital is the first institution to establish an Acute Aortic Treatment Center (AATC) based on a clinical care pathway that expedites the care of acute aortic syndromes. This pathway has resulted in a 64% reduction in time to definitive therapy and a reduction in intensive care unit (ICU) length of stay. Establishment of a multidisciplinary pathway to treat acute aortic syndromes improves efficiency and enhances outcomes.