Charité Clinical Journal Club (English) by Fred Luft - 23.10.2019

The N Engl J Med image of the week concerns a 64-year-old man who presented to the oral medicine clinic with a painful, smooth, red tongue and a burning sensation around his lips that had developed 6 months earlier. No deficits were found on neurologic examination. What is the most likely diagnosis? You are offered oral lichen planus, Sjörgren’s syndrome, squamous cell carcinoma, pernicious anemia, and amyloidosis. Only one diagnosis would fit. How should multivessel disease be handled in patients with acute myocardial infarction (STEMI) who have multivessel disease? Should only the “culprit” lesion be managed or should everything else lying around be fixed? Earlier trials were not sufficiently powered to answer this question directly. Whether or not PCI of nonculprit lesions further reduces the risk of such events is unclear. Investigators randomly assigned patients with STEMI and multivessel coronary artery disease who had undergone successful culprit-lesion PCI to a strategy of either complete revascularization with PCI of angiographically significant nonculprit lesions or no further revascularization. The first coprimary outcome was the composite of cardiovascular death or myocardial infarction; the second coprimary outcome was the composite of cardiovascular death, myocardial infarction, or ischemia-driven revascularization. The study showed that among patients with STEMI and multivessel coronary artery disease, a strategy of routine nonculprit-lesion PCI with the goal of complete revascularization, performed either during the index hospitalization or soon after discharge, was superior to a strategy of culprit-lesion-only PCI in reducing the risk of death from cardiovascular causes or new myocardial infarction, as well as the risk of death from cardiovascular causes, new myocardial infarction, or ischemia-driven revascularization, at a median follow-up of 3 years. Macular telangiectasia is fortunately rare; the condition leads to blindness in older adults. The disease is divided into three types (1, 2, and 3). Identifying mechanisms of diseases with complex inheritance patterns, such as macular telangiectasia type 2, is challenging. A link between macular telangiectasia type 2 and altered serine metabolism has been established previously...