http://pcbasedmedical.digi2.jp/realbody/
2009年12月29日火曜日
2009年12月25日金曜日
2009年12月23日水曜日
CTなどが引き起こす放射線による被害
The authors estimated the frequency of different types of CT scans performed in the United States in 2007 using Medicare claims data and the IMV Medical Information Division survey of CT scan use in 2,451 US facilities in 2007. The age and sex distribution for each CT scan type was estimated using a large national commercial insurance database. These estimates were projected to the age-sex distribution of the US population. Patients dying within 5 years of CT scan were excluded from the analysis.
Results: The authors estimated that CT scans performed in 2007 may result in 29,000 (95% UL 15000-45000) excessive malignancies in the United States. The largest risk was from scans of the abdomen and pelvis (n = 14,000) (95% UL, 6,900-25,000), followed by chest (n = 4,100) (95% UL, 1,900-8,100), and head (n = 4,000) (95% UL, 1,100-8,700), and chest CT angiography (n = 2,700) (95% UL, 1,300-5,000). Lung cancer was the most common projected radiation-related cancer (n = 6,200) (95% UL, 2,300-13,000) followed by colon cancer (n = 3,500) and leukemia (n = 2,800). Approximately a third of the projected cancers were due to scans performed between the ages of 35 to 54 years compared with 15% due to scans performed in those younger than 18 years. The projected malignancies related to CT use were expected to be more common in females (66%).
Conclusions: Current CT scan use is expected to contribute to a large number of future malignancies.
Perspective: This study adds to the growing awareness of radiation risks associated with medical procedures (Fazel R, et al., N Engl J Med 2009;361:849-57). Greater awareness of this has resulted in lower use of radiation-based imaging in the pediatric population, but more needs to be done to lower radiation use in young and middle-aged adults. Dedicated quality improvement initiatives have been successful at reducing radiation dose associated with CT angiography (Raff GL, et al., JAMA 2009;301:2340-8), and similar efforts are needed to minimize the risk associated with all types of CT scans. Hitinder S. Gurm, M.B.B.S., F.A.C.C.
Results: The authors estimated that CT scans performed in 2007 may result in 29,000 (95% UL 15000-45000) excessive malignancies in the United States. The largest risk was from scans of the abdomen and pelvis (n = 14,000) (95% UL, 6,900-25,000), followed by chest (n = 4,100) (95% UL, 1,900-8,100), and head (n = 4,000) (95% UL, 1,100-8,700), and chest CT angiography (n = 2,700) (95% UL, 1,300-5,000). Lung cancer was the most common projected radiation-related cancer (n = 6,200) (95% UL, 2,300-13,000) followed by colon cancer (n = 3,500) and leukemia (n = 2,800). Approximately a third of the projected cancers were due to scans performed between the ages of 35 to 54 years compared with 15% due to scans performed in those younger than 18 years. The projected malignancies related to CT use were expected to be more common in females (66%).
Conclusions: Current CT scan use is expected to contribute to a large number of future malignancies.
Perspective: This study adds to the growing awareness of radiation risks associated with medical procedures (Fazel R, et al., N Engl J Med 2009;361:849-57). Greater awareness of this has resulted in lower use of radiation-based imaging in the pediatric population, but more needs to be done to lower radiation use in young and middle-aged adults. Dedicated quality improvement initiatives have been successful at reducing radiation dose associated with CT angiography (Raff GL, et al., JAMA 2009;301:2340-8), and similar efforts are needed to minimize the risk associated with all types of CT scans. Hitinder S. Gurm, M.B.B.S., F.A.C.C.
2009年12月20日日曜日
腎疾患と冠疾患の相関性が低いとの文献
Chronic kidney disease (CKD) is a risk factor for poor outcomes in patients with coronary artery disease (CAD), but it is unknown whether CKD influences the efficacy of alternative CAD treatment strategies. Thus, we compared outcomes in stable CAD patients with and without CKD randomized to percutaneous coronary intervention (PCI) and optimal medical therapy (OMT) or OMT alone in a post hoc analysis of the 2,287 patient COURAGE study. At baseline, 320 patients (14%) had CKD defined as a glomerular filtration rate of <60 mL/min/1.73 m2, as estimated by the abbreviated 4-variable Modification of Diet in Renal Disease equation. The patients with CKD were older (68 ± 9 vs 61 ± 10 years; p <0.001) and more often had diabetes mellitus (42% vs 33%; p = 0.002), hypertension (81% vs 65%; p <0.03), heart failure (13% vs 3.4%; p <001), and three-vessel CAD (37% vs 29%, p = 0.01). After adjustment for these differences, CKD remained an independent predictor of death or nonfatal myocardial infarction (hazard ratio 1.48, 95% confidence interval 1.15 to 1.90). PCI had no effect on these outcomes. Furthermore, at 36 months, a similar percentage of patients with CKD treated with OMT (70%) and PCI plus OMT (76%) were angina free compared to patients without CKD. In conclusion, CKD is an important determinant of clinical outcomes in patients with stable CAD, regardless of the treatment strategy. Although PCI did not reduce the risk of death or myocardial infarction when added to OMT for patients with CKD, it also was not associated with worse outcomes in this high-risk group.
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