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CMAJ. 2010 September 21; 182(13): 1393.
PMCID: PMC2942907

Highlights

Revascularization and outcomes after acute myocardial infarction among the very elderly

Use of revascularization procedures after acute myocardial infarction in very elderly patients has grown rapidly in recent years, according to a provincial cohort study by Pagé and colleagues. The authors found that such procedures were strongly correlated with good long-term outcomes. See Research, page 1415

No particular chronologic age, of itself, is a contraindication to surgery, says Katlic. Guided by a few general principles of geriatric surgery, we need to broaden our surgical care of the elderly population. See Commentary, page 1403

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Short-term mortality and failure to receive home care

Patients who receive home care after hemiarthroplasty have a lower risk of death in the first three months after discharge from hospital. Rahme and colleagues used administrative data to study 11 326 patients who had had the operation and found that less than 16% received home care. More research is needed to define the effects of home care and the appropriate level of provision after hip surgery. See Research, page 1421

Hypertriglyceridemic-waist phenotype and the risk of coronary artery disease

The combination of elevated triglyceride levels and large waist circumference was associated with an increased risk of coronary artery disease. This finding by Arsenault and colleagues was based on data from more than 21 000 people without coronary artery disease at baseline who were followed for nearly 10 years on average. There was an associated risk even among people classified as low risk using traditional risk scores. The authors suggest intra-abdominal adiposity may be an important area for further research. See Research, page 1427

Adverse outcomes among Aboriginal patients receiving peritoneal dialysis

Compared with non-Aboriginal patients, Aboriginal patients on peritoneal dialysis had higher mortality and shorter time to peritonitis independent of co-morbidities and demographic characteristics. This is the finding of a cohort study involving 727 patients from Manitoba. See Research, page 1433

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Vancouver’s supervised injection facility and Canada’s drug laws

A clash of values about harm reduction and the role of Insite, Vancouver’s supervised injection facility, have led two courts in British Columbia to decide in favour of Insite. The federal government’s appeal to the Supreme Court of Canada is slated to be heard in the fall or winter of 2010. See Analysis, page 1440

Contrast-induced nephropathy

In a patient with risk factors for contrast-induced nephropathy, renal function should be assessed before contrast-enhanced imaging. Baerlocher and colleagues recommend that alternative imaging tests be considered. See Practice, page 1445

Septic arthritis and Clostridium septicum: a clue to colon cancer

Clostridium septicum is a gram-positive aerotolerant rod not usually present in the normal intestinal flora of humans; infection with this organism is most commonly associated with spontaneous gas gangrene. Physicians should search for underlying colon cancer. See Practice, page 1446

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Articles from CMAJ : Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association