Effect of aspirin in vascular surgery in patients from a randomized clinical trial (POISE-2).

BACKGROUND: In the POISE-2 (PeriOperative ISchemic Evaluation 2) trial, perioperative aspirin did not reduce cardiovascular events, but increased major bleeding. There remains uncertainty regarding the effect of perioperative aspirin in patients undergoing vascular surgery. The aim of this substudy was to determine whether there is a subgroup effect of initiating or continuing aspirin in patients undergoing vascular surgery. METHODS: POISE-2 was a blinded, randomized trial of patients having non-cardiac surgery. Patients were assigned to perioperative aspirin or placebo. The primary outcome was a composite of death or myocardial infarction at 30 days. Secondary outcomes included: vascular occlusive complications (a composite of amputation and peripheral arterial thrombosis) and major or life-threatening bleeding. RESULTS: Of 10 010 patients in POISE-2, 603 underwent vascular surgery, 319 in the continuation and 284 in the initiation stratum. Some 272 patients had vascular surgery for occlusive disease and 265 had aneurysm surgery. The primary outcome occurred in 13·7 per cent of patients having aneurysm repair allocated to aspirin and 9·0 per cent who had placebo (hazard ratio (HR) 1·48, 95 per cent c.i. 0·71 to 3·09). Among patients who had surgery for occlusive vascular disease, 15·8 per cent allocated to aspirin and 13·6 per cent on placebo had the primary outcome (HR 1·16, 0·62 to 2·17). There was no interaction with the primary outcome for type of surgery (P = 0·294) or aspirin stratum (P = 0·623). There was no interaction for vascular occlusive complications (P = 0·413) or bleeding (P = 0·900) for vascular compared with non-vascular surgery. CONCLUSION: This study suggests that the overall POISE-2 results apply to vascular surgery. Perioperative withdrawal of chronic aspirin therapy did not increase cardiovascular or vascular occlusive complications. Registration number: NCT01082874 ( http://www.clinicaltrials.gov).

Laser therapy for an obstructing primary tracheal lymphoma in a patient with AIDS.

A patient with AIDS presented with progressive dyspnea leading to respiratory failure with near complete airway obstruction due to primary tracheal lymphoma. Laser therapy was used locally to debulk the tumour, which facilitated extubation and led to definitive treatment with chemotherapy. Alternatives for local airway control are discussed.

Laser facial resurfacing: patient survey of recovery and results.

OBJECTIVE: To determine patient satisfaction with the postoperative recovery period and surgical outcome after facial laser resurfacing. DESIGN: Survey. PATIENTS: Patients who underwent facial laser resurfacing by two of the authors (PAA or DAFE) between 1995 and 1996. Questionnaires were completed by 47 of 100 patients. INTERVENTIONS: Facial laser resurfacing with the Sharplan CO2 laser and SilkTouch Scanner. MAIN OUTCOME MEASURES: Questionnaire. Statistical analysis was generated from a 5-point analogue scale. RESULTS: The overall side effects were moderate in severity, were well tolerated, and met the expectations of our patients. Redness was the most frequent side effect with an average duration of 3 months. Most patients returned to occupational and social activities at 2.5 weeks. Moderate lifestyle disruption was more frequent after full-face laser resurfacing than partial-face laser resurfacing. Excellent improvement was achieved for removal of fine wrinkles, improvement of skin quality, and sun-damaged skin. Good improvement was obtained for acne scarring and deep rhytids. Overall goals were attained in 89% of patients. CONCLUSIONS: Laser resurfacing produced excellent results for fine rhytids, skin quality, and sun-damaged skin. Return to social and occupational activities may occur early in recovery with the use of camouflage make-up. Patient education and close follow-up are necessary in the postoperative period.