NEJM Audio Summary - May 3, 2012

Excerpted Script

0:48| "Strategies of Radioiodine Ablation in Patients with Low-Risk Thyroid Cancer",
by Martin Schlumberger, from Institut de Cancérologie Gustave Roussy, Villejuif, France. This trial compared two thyrotropin-stimulation methods and two 131I doses for postoperative ablation in patients with low-risk thyroid cancer.  In the 684 patients with data that could be evaluated, ultrasonography of the neck was normal in 652 (95%), and the stimulated thyroglobulin level was 1.0 ng per milliliter or less in 621 of the 652 patients (95%) without detectable thyroglobulin antibodies. Thyroid ablation was complete in 631 of the 684 patients (92%). The ablation rate was equivalent between the 131I doses and between the thyrotropin-stimulation methods. The use of recombinant human thyrotropin and low-dos(1.1 GBq) postoperative radioiodine ablation may be sufficient for the management of low-risk thyroid cancer.
4:40| "Two-Year Outcomes after Transcatheter or Surgical Aortic-Valve Replacement", by Susheel Kodali, from Columbia University Medical Center and New York Presbyterian Hospital, New York. This study provides 2-year data from the PARTNER trial, in which patients with aortic stenosis received transcatheter aortic-valve replacement (TAVR) or surgical replacement. The rates of death from any cause were similar in the TAVR and surgery groups (hazard ratio with TAVR, 0.90) and at 2 years were 33.9% in the TAVR group and 35.0% in the surgery group. The frequency of all strokes during follow-up did not differ significantly between the two groups. At 30 days, strokes were more frequent with TAVR than with surgical replacement (4.6% vs. 2.4%); subsequently, there were 8 additional strokes in the TAVR group and 12 in the surgery group. Improvement in valve areas was similar with TAVR and surgical replacement and was maintained for 2 years. Paravalvular regurgitation was more frequent after TAVR, and even mild paravalvular regurgitation was associated with increased late mortality. This 2-year follow-up of patients in the PARTNER trial supports TAVR as an alternative to surgery in high-risk patients. The two treatments were similar with respect to mortality, reduction in symptoms, and improved valve hemodynamics, but paravalvular regurgitation was more frequent after TAVR and was associated with increased late mortality.

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