Journal and News Scan

There is growing fear in the medical community and the pharmaceutical industry that an increasing number of people who participate in clinical trials may indeed compromise research by chatting about treatments, side effects and enrollment tips on Facebook, online forums and blogs, according to The Wall Street Journal.

To what extent this is a problem is unclear. But the paper illustrates the issue with an anecdote involving a woman named Jeri Burtchell. She was enrolled in a trial for an experimental multiple sclerosis drug and convinced she was getting the new medicine, which was not the standard therapy that some patients were randomly assigned to receive.

Using a retrospective analysis of pts undergoing VATS for suspected pleural malignancy, the authors assessed the utility of CT in diagnosing pleural malignancy.  Of 370 pts studied, 211 had a pleural malignancy diagnosis established by biopsy.  The sensitivity of CT for detecting malignancy was 68%, and the negative predictive value was 65%.  CT alone is not highly effective in determining which patients should have invasive pleural biopsies.

Using data from 2 centers in London, outcomes after induction therapy and resection for esophageal cancer were analyzed according to the pathological response to induction therapy.  Downstaging was the strongest predictor of survival (HR 0.43).  Downstaging was also associated with a lower rate of local recurrence (6% vs 13%) and systemic recurrence (19% vs 29%).  Pathologic stage after induction therapy was a stronger predictor of survival that was pretreatment clinical stage.

The authors deal with a dramatic complication of acute Type A aortic
dissection - mesenteric malperfusion. They reviewed 309 papers on acute
aortic dissection and concluded that initial interventional management of
mesenteric malperfusion followed by delayed proximal aortic repair is a
reasonable strategy, since the prognosis of those immediately operated on
the ascending aorta was extremely poor.