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NEJM -- Recent Issues

20 Oktober 2007

Update in Unstable Angina

From Basic To Clinical Practice and Ther Role of Molecular Weigh Heparin

unstable angina is currentyl one of teh leading causes of hospital admission for coronary arterial disease (CAD). It is described as heterogeneous disease refering to a wide spectrum of clinical manifestation from stable angina to myocardial infarction (MI). This angina attac is a clinical manifestation of an imbalece between myocardial oxygendemand and supply. Unstable angina and myocardial infarction are closely related with respect to theri etiology and pathogenesis.

The diagnosis of unstable angina implies recognation of sysmtom of myocardial ischemia like the usual pattern of chest pain. Elevation of plasma level biomarkers including CK-MB, troponin I And Troponin T are sensitive markers to differentiate between unstable angina and non ST Elevation myocardial infarction (NSTEMI). Although many episodes of unstable angina and acute MI are caused by plaque disruption, coronary vasoconstriction plays also an important role as a response of dysfuntional endothelium. In unstable angina, a releatively small erosion of atherosclerotic plaque may lead to reduction in coronary blood flow resulting in exacerbation of angina.

the target of medical management in unstable angina and NSTEMI are control symtoms of myocardial ischemia and prevention of MI and Death as the end poin. the involvement of platetet activation and trombus formation has been well established in patients with unstable angina and has led to teratmen strategies tat include aspirin, antiplatelet aggregation and antithrombitic. in the las Decades, some subcunaeous low moleculer weight (LMWH) ware administrered. pernaarin is a relatively new LMWH available with a high bioavaility and prolonged hal live whose efficacy and safety has already been established. The Prime care study is showing that a uniform dose of parnaparin was adequate for all the patients irrespective ther body weight.

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18 Oktober 2007

Video Games Hone Surgical Skills

Recant study has found that one or more important surgical training tools can be purchased over the counter and from the chlideren departement, no Less !

whether the choice is microsoft Xbox, Sony Playstation 3 or Nitendo Wii, joining the kids for regular gaming sessioan apperrs to increase laparoscopic surger skliss, assessed via a simulated surgery coury courese.



researcher from beth israel medical center in new york established that the top one - thrid of sugeons with superior vidwo gaming sklills ware less likely to comit errors while performing laparoscopic surgery. they were also faster than the bottom one-third. [Arch Surgery 2007;142:181-6]
surgeons with superior skills made 47% fewer errors, compliceted procedures 39% faster earned a 41 % superior overall score.
Dr. James C Rosser Jr led his colleagues on an assessment of 33 surgeons : 21 resident and 12 attending based on the rosser top gun laparoscopic sklils and auturing program.
in comprasion with non players, current players ware 24 % faster, coomiteed 32% fewer erros and had 26 % higer overall score.
Rosser Jr concluded thet video games would be a valuable teaching tool, adding "traning curicula that include video games may help thim the technical interface between sugeons and screen mediated application, such as laparoscop surgery.
Original Articel from Medical Tribune 04|2007


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