Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

The thoracic approach for cardiac surgery in a patient with a tracheostoma can result in difficult problems, such as mediastinitis, stoma necrosis or inadequate operative exposure. We present a distinct approach consisting of an incision at the second intercostal space, transverse sternum transection and longitudinal median sternotomy to the xiphoid process, performed for coronary artery bypass grafting and aortic valve replacement, in a patient with previous tracheotomy. This approach permitted adequate surgical exposure for cardiopulmonary bypass, aortic valve replacement and coronary revascularization procedures.

BackgroundEndovascular treatment (EVT) by percutaneous transluminal angioplasty (PTA) or stent is the first‐line treatment for hepatic artery stenosis (HAS) after liver transplantation, but there are no guidelines to help choose between PTA and stent.MethodsRetrospective review of HAS EVT after liver transplantation, between 1999 and 2017. HAS was treated by PTA or stent. We report EVT primary effectiveness, arterial patency after 1 year of follow‐up, complications, HAS recurrence rate; comparing PTA to stent.ResultsFifty‐two HAS were diagnosed in 42 patients. We performed 51 EVT; 34 PTA (66.7%) and 16 stents (31.4%). Global primary EVT effectiveness was 86.3%: 82.3% after PTA and 100% after stent (P = 1.00 after propensity score matching). Recurrent HAS was found in 22.0% of cases: 29.4% after PTA and 6.2% after stenting, (P = .053 after propensity score matching). Patency rate without recurrent HAS or HAT at 12 months was 73.5% with PTA and 93.8% with stent (P = .09), and globally this was 92.8%. There were 7.8% complications: 2.9% after PTA, 12.5% after stenting (P = .23).ConclusionPrimary effectiveness was the same for PTA and stenting. There was a strong trend toward more HAS recurrence after PTA than after stenting suggesting that HAS should benefit from primary stenting.

Fifty-four patients with blunt renal trauma underwent abdominal ultrasound as their initial diagnostic exploration if their hemodynamic status and associated injuries did not contraindicate unnecessary delays. Renal ultrasound allowed us to diagnose the injuries and to identify which patients required a more aggressive radiological exploration to obtain a diagnosis of certainty. At the same time we were able to certify that this technique is highly accurate in the diagnosis of lesions associated with gross hematuria. The noninvasiveness and low cost of this procedure makes it, in our experience, the technique of choice in the initial workup of blunt renal trauma.

The shortage of ideal donor hearts has led to an extension of the classical donor criteria of age. Higher incidence of focal coronary artery disease has been found in this older donor population requiring conventional angioplasty therapy. The authors present two patients with early coronary angiogram post transplantation, requiring angioplasty and stent in the lesions found.