The Efficacy of Drug-Eluting Stents and Bare Metal Stents in Heart Transplant Recipients with Coronary Artery Disease

A recent study published in Kardiologia Polska (Poland) compared the long-term results of drug-eluting stents and bare metal stents in heart transplant patients. Various stents are routinely used in patients post heart transplant surgery to correct blood flow abnormalities caused by coronary artery disease. Coronary artery disease is generally defined as the build-up of plaque on the interior wall of coronary arteries causing decreased or obstructed blood flow to the heart.  Despite the routine use of stents in heart transplant recipients, there is very little scientific research tracking the efficacy of drug-eluting stents vs. bare metal stents in this population.

The study in question retrospectively evaluated the long-term impact of all available coronary stents used to correct transplanted heart coronary artery disease. Researchers focused on 23 patients. The goal of the study was to identify the mortality rate and the rate of restenosis in this population of patients. Researchers found that 7% patients with drug-eluting stents had restenosis vs 61% of restenosis in patients with bare metal stents. Researchers also found that there was an 18% mortality rate in patients with drug-eluting stents vs. a 31% mortality rate in patients with bare metal stents.

Contributing author: Jon Stefanuca

Strokes – Family History a Significant Risk Factor

According to an article published by WebMD, individuals whose parents have had a stroke by age 65 are more likely to have a stroke.

Strokes are generally defined as disturbances of blood flow in the brain as a result of a ruptured blood vessel, a blockage within the lumen of the blood vessel, or some other ischemic process. The ischemic process can cause brain tissue to die, resulting in death or permanent brain injury. In all respects, strokes represent medical emergencies.

Among other things, the following are generally considered to be risk factors for developing a stroke: previous history of strokes, brain trauma, advanced age, increased lipid levels, increased blood pressure, diabetes, atrial fibrillation, and smoking.

The results of the study suggest that a person’s family history of strokes should also be considered in assessing the risk for developing a stroke.

Researchers studied 3,443 people who initially were stroke free and second-generation participants in the Framingham Heart Study. The participants’ parents had reported 106 strokes by age 65, and offspring 128, over the 40-year study. People with a parent who had a stroke by age 65 had twice the risk of having a stroke at any age and four times the risk by 65, after adjusting for conventional risk factors.

Contributing author: Jon Stefanuca

USA Today: UM Poll Shows That 25% of Parents Still Believe Vaccines Cause Autism.

A report just out in USA Today, reflects that 25% of parents are still concerned that vaccines cause autism.  You are no doubt aware by now that the genesis of this fear was a 1998 article in the leading British journal, The Lancet. The author of  that article,  Dr. Andrew Wakefield, was found earlier this year to have acted dishonestly and unethically by the General Medical Council, the body that regulates doctors in England.  The Lancet retracted the article on February 6, 2010.  Dr. Wakefield presently resides in Texas and is performing research into possible treatments for autism.  In an email to The Los Angeles Times, he has denied that he ever stated a link between vaccinations and autism.

In addition to a whole new body of litigation that arose as a result of this article, a more discouraging event took place –many parents, afraid that there were exposing their children to autism through receiving the MMR (measles-mumps-rubella) vaccine, elected not to have their children vaccinated.  As one example, the USA Today article provides the following:

In 2008, unvaccinated school-age children contributed to measles outbreaks in California, Illinois, Washington, Arizona and New York, said Dr. Melinda Wharton of the U.S. Centers for Disease Control and Prevention. Thirteen percent of the 140 who got sick that year were hospitalized.

USA Today’s report relates to an online survey of parents with children under the age of 17.  There were 1,552 responders.

Twenty-five% of the parents said they agreed “some vaccines cause autism in healthy children.” Among mothers, 29% agreed with that statement; among fathers, it was 17%.

Nearly 12% of the parents said they’d refused a vaccine for their children that a doctor recommended. Of those, 56% said they’d refused the relatively new vaccine against human papillomavirus, or HPV, which can cause cervical cancer. Others refused vaccines against meningococcal disease (32%), chickenpox (32%) and measles-mumps-rubella (18%).

Now that Dr. Wakefield’s study has been retracted, physicians are hoping that as the word spreads, more parents will have their children vaccinated.  Some physicians, however,  are taking a more aggressive approach.  One practice group outside Philadelphia has written a ‘manifesto.’

[It] outlines its doctors’ adamant support for government recommended vaccines and their belief that “vaccines do not cause autism or other developmental disabilities.”

“Furthermore, by not vaccinating your child you are taking selfish advantage of thousands of other who do vaccinate their children … We feel such an attitude to be self-centered and unacceptable,” the statement says, urging those who “absolutely refuse” vaccines to find another physician.

“We call it the manifesto,” said Dr. Bradley Dyer of All Star Pediatrics in Lionville, Pa.

Even though it now appears that Dr. Wakefield and his colleagues are fighting back, it would appear that absent true scientific evidence of a link between autism and vaccinations, parents would be well-advised to be aware of the risks they run by not having their children vaccinated and would be further well-advised to familiarize themselves with the history of the so-called science, now held in disrepute throughout the world, that led to this dangerous avoidance of vaccinations.

Medical News: Survival Rates Vary with Congenital Anomalies – in Pediatrics, General Pediatrics from MedPage Today

Over the course of my career in litigating  catastrophic newborn injury cases, a rather common  ‘defense tactic’ involves trying to prove a limited life expectancy for these catastrophically injured children.  Essentially, defense lawyers attempt to convince a jury that such children have a very limited chance of survival for more than 8 to 15 years of life.  The reason for this approach is  quite simple – the shorter the period of time that such children survive, the lower the potential damage award for future care needs and future pain and suffering.

Lawyers for the inured child and family, on the other hand, contend that with appropriate medical care, such children will live a relatively normal life expectancy – therefore, there is an absolute need for a substantial amount of money for future care needs.

The issue often becomes:  given a certain type of injury, what is the ‘probable’ life expectancy for such children?

A recent study published in the British medical journal, The Lancet, and reported in MedPage Today on January 19, 2010,  provides some further insight into this issue.   Medical News: Survival Rates Vary with Congenital Anomalies – in Pediatrics, General Pediatrics from MedPage Today.

It has long been suspected that if a child is unable to protect his/her airway because of an inability to roll-over and clear secretions, that child is at increased risk for breathing complications – potentially leading to early death.  A number of limited studies are cited for other ‘factors’ leading to limited life expectancy.

This new study offers some interesting insights into various types of anomalies and the probability of survival for children suffering from them.

Just a sampling of the data (see the article for more details) gives a sense of the ‘predictability’ of survival based on specific defects:

The investigators analyzed survival among specific subtypes of anomalies and found rates of 20-year survival exceeding 95% for the following:

Ventricular septal defects, 98.3% (95% CI 96.6 to 99.1)

Pulmonary valve stenosis, 98.1% (95% CI 96.1 to 99.1)

Cleft lip and palate, 97.7% (95% CI 94.6 to 99.1)

Atrial septal defects, 96.3% (95% CI 93.3 to 98)

Cleft palate, 96.3% (95% CI 92.8 to 98.1)

In contrast, subtypes with less than 50% one-year survival included arhinencephaly/holoprosencephaly, common arterial trunk, and hypoplastic left heart.

What the study also goes on to say, however, is that certain conditions, survivability is contingent on the quality of care being provided to these children.

What is obvious and beyond any argument is that funding is desperately needed for further long-term studies to clarify this issue for not only the physicians rendering care to these children, but also for the parents seeking a clearer picture of what the future holds for their families in terms of financial needs and planning.