Pedicled omental grafts in the revascularization of ischemic lower limbs in Buerger's disease

Pedicled omentum, after lengthening, was transferred to the ischemic lower limbs of 12 patients with Buerger's disease to assess its capacity to improve the blood supply to these compromised extremities. The immediate (after one month) and long-term (9-12 months) results were encouraging. After one month, rest pain had diminished in 83% of cases, claudication was relieved in 75% of cases, temperature became normal in all cases (100%) and ischemic ulcers either healed or showed signs of healing in 83% of cases. During long-term follow up (after 9-12 months), the results deteriorated slightly, but they remained promising. Rest pain had disappeared in 80% of cases. Claudication was still relieved in 70% of cases, temperature was still improved in 60% and ulcers had healed completely in 67% of cases.     

The effects of memory scanning on the late Nd and P300: an interference study

Singhal and Fowler (2004) showed that the late negative difference (Nd) waveform elicited during dichotic listening was attenuated by concurrent visual short term memory (STM) scanning, but not long term memory (LTM) scanning. P300 was reduced by both tasks. The present study compared the effects of STM load on the late Nd and P300 by combining dichotic listening and visual memory scanning with varying set sizes. The results showed that the late Nd was sensitive to the introduction of the scanning task, but not to an increase in load. Furthermore, both the auditory and visual P300s were reduced when a second task was introduced, but only the visual P300 decreased as a function of memory-set size. These data suggest that (a) the auditory late Nd reflects working memory, but not memory scanning, (b) late Nd and P300 reflect parallel but distinct working memory processes, and (c) stimulus modality is an important determinant of P300 amplitude.     

Effect of repaglinide and gliclazide on postprandial control of endogenous glucose production

The effect of repaglinide and gliclazide on postmeal suppression of endogenous glucose production (EGP) has been studied using a variable-rate tracer methodology. Groups of age-, sex-, and weight-matched type 2 diabetic subjects randomized to gliclazide or repaglinide were studied after ingesting a standard mixed meal (550 kcal; 67% carbohydrate, 19% fat, 14% protein). Plasma glucose profiles were similar in each group and markedly different from that of a nondiabetic control group. Endogenous glucose production was similar basally (3.01 +/- 0.30 vs 3.06 +/- 0.19 mg/kg per minute, gliclazide and repaglinide, respectively). After glucose ingestion, EGP declined rapidly in both the groups until 30 minutes and the greatest suppression was reached earlier in the repaglinide group [0.88 mg/kg per minute at 120 minutes vs 0.77 mg/kg per minute at 210 minutes in gliclazide group (P < .05); median time, 85 vs 195 minutes, respectively (P < .05)]. The area under the curve (30-150) for EGP was significantly greater in the gliclazide group than in the nondiabetic control group (109 +/- 11 vs 198 +/- 22 mg/kg per min 2 ; P > .02) but not significantly different in the repaglinide group (153 +/- 25 mg/kg per min 2 ; P = .17). Repaglinide has minimal physiological advantage over gliclazide, but both therapies for type 2 diabetes fall far short of correcting the endocrine and metabolic abnormalities.     

Normobaric hyperoxia extends the reperfusion window in focal cerebral ischemia

A major limitation in thrombolysis for acute ischemic stroke is the restricted time window for safe and effective therapy. Any method that can extend the reperfusion time window would be important. In this study, we show that normobaric hyperoxia extends the time window for effective reperfusion from 1 to 3 hours in rats subjected to focal cerebral ischemia. Normobaric hyperoxia did not increase cellular markers of superoxide generation or brain levels of matrix metalloproteinase-9. Normobaric hyperoxia may be a clinically feasible adjunct method for significantly increasing the time window for effective thrombolytic therapy in acute ischemic stroke.     

An evidence-based causative classification system for acute ischemic stroke

Regular, evidence-based assignment of patients to etiologic stroke categories is essential to enable valid comparison among studies. We designed an algorithm (SSS-TOAST) that incorporated recent advances in stroke imaging and epidemiology to identify the most probable TOAST category in the presence of evidence for multiple mechanisms. Based on the weight of evidence, each TOAST subtype was subdivided into 3 subcategories as "evident", "probable", or "possible". Classification into the subcategories was determined via predefined specific clinical and imaging criteria. These criteria included published risks of ischemic stroke from various mechanisms and published reports of the strength of associations between clinical and imaging features and particular stroke mechanisms. Two neurologists independently assessed 50 consecutively admitted patients with acute ischemic stroke through reviews of abstracted data from medical records. The number of patients classified as "undetermined-unclassified" per the original TOAST system decreased from 38-40% to 4% using the SSS-TOAST system. The kappa value for inter-examiner reliability was 0.78 and 0.90 for the original TOAST and SSS-TOAST respectively. The SSS-TOAST system successfully classifies patients with acute ischemic stroke into determined etiologic categories without sacrificing reliability. The SSS-TOAST is a dynamic algorithm that can accommodate modifications as new epidemiological data accumulate and diagnostic techniques advance.