Abstract
Gray WA, Macdonald S, Schneider PA
Vascular 2012;
and
Abbott AL, Adelman MA, Alexandrov AV et al.
Vascular 2012;
Currently fierce controversy exists over which patients with asymptomatic carotid stenosis should be subjected to aggressive interventional or surgical treatment with carotid stenting (CAS) or endarterectomy. Views range from those who advocate aggressive treatment for all high-grade stenoses to those who advocate only medical treatment for all patients with carotid stenosis. These views and the facts and reasoning supporting them are fully aired in these two articles in the February 2012 issue of Vascular.
These two articles were solicited around the time US Medicare (CMS) was considering whether or not to expand reimbursement for CAS to include low and standard risk patients with carotid stenosis. Although Medicare has not made a final decision and although the controversy continues unabated, it behooves all with an interest in this important area to read these summaries of the data and logic underlying these two opposing points of view. Only in that way can they make a rational decision on what to recommend to their patients with the frequent problem of a symptomatic carotid stenosis.
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Firoz T, Magee L.
Obstetric Medicine 2012;
The changing age and health profile of pregnant women have presented clinicians with many new challenges. Acute myocardial infarction is an uncommon but very worrying complication in pregnancy which requires a specialized approach to diagnosis, investigation and management. In this group, non-atherosclerotic causes of myocardial infarction, e.g. coronary artery dissection must be considered more carefully. An understanding of the altered cardiac physiology, electrocardiogram changes and biochemistry, particularly around the time of delivery is required. Concerns regarding radiation exposure and pharmacological interventions must be addressed with consideration of both mother and fetus. Tabassum Firoz and Laura Magee review all aspects of acute myocardial infarction in pregnancy in this up-to-date review, identifying a number of areas for future research.
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Barbour LA
Obstetric Medicine 2012;
Eating for two may not be such a good idea. In pregnancy, obesity is a leading health risk resulting in both maternal and neonatal morbidity and even mortality. In this review, Lyn Barbour examines the difficult topic of recommended weight gain in pregnancy. Despite well intentioned guidelines, women continue to receive contradictory advice about recommended weight gain in pregnancy and/or fail to adhere to these recommendations. The evidence for and against more restrictive weight gain recommendations is expertly critiqued. More stringent recommendations regarding ideal weight gain or even supervised weight loss for high body mass index individuals could have a significant impact on the obesity epidemic both now and in the future.