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Michael P Marks, Mary L Marcellus, Huy M Do, Gary K Steinberg, David C Tong, Gregory A Albers; Stanford Univ Med Ctr, Palo Alto, CA Introduction: Endovascular therapy for intracranial disease is growing in use. It can be performed as primary angioplasty or stenting. Proponents of stent placement have suggested that there is little residual stenoses and complications such as dissection are well treated. This study was done to evaluate the long-term outcome of primary angioplasty alone for symptomatic intracranial stenosis. Results: Thirty-six patients with 37 symptomatic stenoses were included in the study. All patients had failed medical therapy. Twenty-one lesions were in the posterior circulation and 16 were in the anterior circulation. Thirty-six of the lesions were successfully angioplastied. Eighteen of 36 50% ; had residual stenoses of 50 75%. Eleven showed evidence of an intimal flap post-angioplasty. Mean pre-treatment stenosis was 84.2% 10.7% ; . Mean stenosis post-treatment was 43.3% 18.9% ; . There was one ischemic stroke at the time of angioplasty manifest as a focal brain stem lacune, which resulted in full recovery. No other ischemic strokes were seen in the periprocedural period 30 days ; . Two deaths occurred in the periprocedural period, one due to reperfusion hemorrhage and one due to vessel perforation. Follow-up was available in 34 patients and varied between 4 and 128 months mean follow-up time 52.9 38.4 months ; with 29 patients 85.3% ; having greater than 24 months follow-up. The annual stroke rate in the territory of angioplasty was 3.36% 1.15, 3.37; CI ; . The annual stroke rate for all strokes was 5.38% 2.00, 8.75 ; . In that subgroup of patients with residual stenosis of 50 75%, the annual stroke rate was 3.0%. No patient with an intimal flap had recurrent symptoms TIA or stroke ; . Conclusion: Long-term follow-up suggests that primary angioplasty alone will reduce the risk of further stroke in patients with symptomatic intracranial stenosis. Patients with moderate degrees 50 75% ; of residual stenosis and patients with intimal flaps post-procedure do not have a higher risk of ischemic stroke in follow-up and lotrel.
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It is worth considering how well a drug's safety is defined prior to its approval and marketing. This will indicate how confident practitioners can be that a new drug's safety profile has been fully defined. Most new drugs are approved with an average of 1, 500 patient exposures and usually for only relatively short periods of time. However, some drugs cause serious ADRs at very low frequencies and would require many more exposures to detect the reaction. For example, bromfenac Duract ; was a non-steroidal anti-inflammatory agent NSAID ; that was removed from the market in 1998, less than 1 year after it was introduced. Bromfenac caused serious hepatotoxicity in only 1 in 20, 000 patients taking the drug for longer than 10 days.1 To reliably detect the toxic effects of a drug with a 1 in 20, 000 adverse drug reaction frequency, the new drug application database would have to include 100, 000 patient exposures. A drug that is tested in a few thousand people.
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Dr. Merrill represents the American Society for Nutritional Sciences on the Federation's board. He is also a member of another FASEB Society: the American Society for Biochemistry and Molecular Biology. The Science Policy Committee serves as a think tank for FASEB, examining science policy issues and recommending courses of action for the Federation. "As VP for Science Policy, I will continue the current areas of emphasis of the Science Policy Committee, which include human subjects and bioethics; animal subjects, training and career opportunities, NIH issues such as peer review, the Breakthroughs in Bioscience series, and an ongoing dialog about the future of biomedical science, " said Dr. Merrill. In addition, he said, he hopes to explore mechanisms to better educate and empower scientists regarding the decisionmaking groups that influence science, and to increase participation of scientists in the science policy process. Dr. Merrill received a Ph.D. in biochemistry from Cornell University in 1979 and, after a post-doctoral fellowship at Duke University, joined the faculty of the Department of Biochemistry at Emory in 1981. He was promoted to full Professor in 1992. He received the Emory Williams Teaching Award for Natural Sciences 1985 ; , the Outstanding Teacher Award in Biochemistry from the Emory University Medical Class of 1993, and helped found the Emory University Center and Graduate Program in Nutrition and Health Sciences, which promotes multidisciplinary training and research beginning with a strong foundation in the basic sciences. His research has helped characterize the metabolism and biological functions of a diverse family of compounds called sphingolipids. Sphingolipids influence cell growth and other behaviors, including the "programmed" pathways for cell death called apoptosis ; . In collaboration with scientists at the U.S. Department of Agriculture, Dr. Merrill has established that diseases caused by a food contaminant fumonisins ; are due to FASEB News.
In a comparative study, the agreement of the CyFlow results with that of other conventionally used flow systems FACS-Calibur, EPICS ; have been investigated. Five different hospital laboratories were involved in this study and each measured aliquods of the same eight samples of healthy and HIV-infected blood donors. The data were very promising and show the accuracy of the new protocol see Figure 3 ; . The correlation and
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Gene plays a pivotal role in keeping dopamine cells healthy. The authors point out that if the cells are subjected to oxidative stress, then the DJ-1 gene turns on the production of the antioxidant peptide, glutathione. When acting in this way, the DJ-1 protein can also modify itself and absorb the damage caused by oxidative stress, thus protecting other important cellular function in the process.On the other hand, if damaged proteins are accumulating and harming the cells, then DJ-1 turns on the production of a different protein called Hsp70 to help clean up the abnormal proteins. "Our research shows how a genetic cause of Parkinson's disease works, " said Curt Freed, MD, professor and division head of clinical pharmacology and toxicology at the CU School of Medicine and coauthor of the study."We show how the normal function of the gene keeps dopamine cells from dying. If the gene is abnormal, these protective mechanisms cannot be and methylphenidate.
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May, D., Nayak, U.S.L., Isaacs, B. 1985 ; . The life-space diary: a measure of mobility in old people at home. International Rehabilitation Medicine, 7, 366-3 77. McDonald, C.J., Hui, S.L. 199 1 ; . The analysis of humongous databases: problems and promises. Statistics in Medicine, 10, 5 1 McDonald, C L , Overhage, J.M., Dexter, P., Takesue, B-Y., Dwyer, D.M. 1997 ; . A framework for capturing clinical data sets fiom computerized sources. Annals of lnternal Medicine, 12 7, 675-682. McDowell, I., Kristjansson, B., Hill, G.B., Hbert, R. 1 997 ; . Community screening for dementia: the Mini-Mental State Exam MMSE ; and Modified Mini-Mental State Exam 3MS ; compared. Journal of Clinical Epiderniology, 50. 377-383. McDowell, I., Newell, C. Measuring Health: A Guide to Rating Scales and Questionnaires, 2nd edition. New York: Oxford University Press, 1996. McFarland, B.H., Johnson, R.E., Hombrook, MC. 1996 ; . Enrollment duration, service use, and costs of care for severely mentally il1 members of a health maintenance organization. Archives of General Psychiutry, 53, 938-944. McHorney, C.A., Ware, J.E., Raczek, A.E. 1993 ; . The MOS 36-item Short-Form Health S w e SF-36 ; : II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Cure, 31, 247-263. McMahon, L.F., Smits, H.L. 1986 ; . Can Medicare prospective payrnent survive the ICD-9-CM disease classification system? Annals of Infernal Medicine, 104, 562-566.
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