Journal and News Scan

Prospective observational cohort study of 106 patients undergoing repair of giant paraesphageal hernia (GPEH) with near complete follow-up at 1 year. Outcomes measured at the first postoperative visit and at one year were radiographic recurrence, patient satisfaction and GERD-HRQL score. Importantly, this study compared patients with small radiographic recurrence (<2cm) to those with a commonly used definition of radiographic recurrence (classified as large recurrence for this cohort): >2cm or 10% of the stomach above the diaphragm. Most patients underwent laparoscopic repair (80.2%) and 66% had an esophageal lengthening procedure. The overall recurrence rate at one year was 32.7% versus 18.8% using the commonly used definition (>2cm or 10% of the stomach above the diaphragm). Patient satisfaction increased from 2.9% preoperatively to 85% at 1 month and 71.4% at one year. There was no difference in patient satisfaction between those with small and large recurrences (57.1% versus 52.6%). The median GERD-HRQL score was 22.5 preoperative,  3.0 at one month, and 7.0 at one year. There was no difference in GERD-HRQL scores between patients with small and large recurrences (12.0 versus 14.0). The authors concluded that any recurrence, whether small or large, has a negative effect on patient satisfaction and control of symptoms and that there is a need for further investigation of patients with small recurrences to determine their clinical importance. 

A succinct review of cardiac amyloidosis, particularly relevant to transplant surgeons that are expected to see more patients with the condition

Dozens of recent clinical trials contain suspicious statistical patterns that could indicate incorrect or falsified data, according to a review of thousands of papers published in leading medical journals.

The analysis was carried out by John Carlisle, a consultant anaesthetist at Torbay Hospital, who previously used similar statistical tools to expose one of the most egregious cases of scientific fraud on record, involving a Japanese anaesthesiologist who was found to have fabricated data in many of his 183 retracted scientific papers. 

The latest study identified 90 trials that had skewed baseline statistics, 43 of which with measurements that had about a one in a quadrillion probability of occurring by chance.

This study is published in Anaesthesia and it names the papers concerned - go here to read the paper 

http://onlinelibrary.wiley.com/doi/10.1111/anae.13938/full

Outcomes of surgery for congenital heart defects in children with trisomy 13 or 18 were evaluated in 98 pts the Pediatric Cardiac Care Consortium 1982-2008.  Hospital mortality was 28% and 13%, respectively.  Median survival was 15 years and 16 years, primarily related to cardiac  and respiratory causes.