Global experience in cervical carotid artery stent placement.

The purpose of this article is to review and update the current status of carotid artery stent placement in the world. Surveys to major interventional centers in Europe, North and South America, and Asia were initially completed in June 1997. Subsequent information from these 24 centers in addition to 12 new centers has been obtained to update the information. The survey asked the various questions regarding the patients enrolled, procedure techniques, and results of carotid stenting, including complications and restenosis. The total number of endovascular carotid stent procedures that have been performed worldwide to date included 5,210 procedures involving 4,757 patients. There was a technical success of 98.4% with 5,129 carotid arteries treated. Complications that occurred during the carotid stent placement or within a 30-day period following placement were recorded. Overall, there were 134 transient ischemic attacks (TIAs) for a rate of 2.82%. Based on the total patient population, there were 129 minor strokes with a rate of occurrence of 2.72%. The total number of major strokes was 71 for a rate of 1.49%. There were 41 deaths within a 30-day postprocedure period resulting in a mortality rate of 0.86%. The combined minor and major strokes and procedure-related death rate was 5.07%. Restenosis rates of carotid stenting have been 1.99% and 3.46% at 6 and 12 months, respectively. The rate of neurologic events after stent placement has been 1.42% at 6-12-month follow-up. Endovascular stent treatment of carotid artery atherosclerotic disease is growing as an alternative for vascular surgery, especially for patients that are high risk for standard carotid endarterectomy. The periprocedure risks for major and minor strokes and death are generally acceptable at this early stage of development and have not changed significantly since the first survey results. Cathet. Cardiovasc. Intervent. 50:160-167, 2000.     

Carotid artery revascularization in high surgical risk patients with the NexStent and the Filterwire EX/EZ

Coronary no‐reflow occurs commonly during acute percutaneous coronary intervention, particularly in patients with acute myocardial infarction and those with degenerated vein grafts. It is associated with a guarded prognosis, and thus needs to be recognized and treated promptly. The pathophysiology originates during the ischemic phase and is characterized by localized and diffuse capillary swelling and arteriolar endothelial dysfunction. In addition, leukocytes become activated and are attracted to the lumen of the capillaries, exhibit diapedesis and may contribute to cellular and intracellular edema and clogging of vessels. At the moment of perfusion, the sudden rush of leukocytes and distal atheroemboli further contributes to impaired tissue perfusion. Shortening the door‐to‐balloon time, use of glycoprotein IIb/IIIa platelet receptor inhibitors and distal protection devices are predicted to limit the development of no‐reflow during percutaneous interventions. Distal intracoronary injection of verapamil, nicardipine, adenosine, and nitroprusside may improve coronary flow in the majority of patients. Hemodynamic support of the patient may be needed in some cases until coronary flow improves. © 2008 Wiley‐Liss, Inc.     

Emerging allied dental workforce models: considerations for academic dental institutions

The U.S. surgeon general defined the national oral health care crisis in 2001 in Oral Health in America: A Report of the Surgeon General. The report concluded that the public infrastructure for oral health is not sufficient to meet the needs of disadvantaged groups and is disproportionately available depending upon certain racial, ethnic, and socioeconomic factors within the U.S. population. Now, several new workforce models are emerging that attempt to address shortcomings in the oral health care workforce. Access to oral health care is the most critical issue driving these new workforce models. Currently, three midlevel dental workforce models dominate the debate. The purpose of this report is to describe these models and their stage of development to assist the dental education community in preparing for the education of these new providers. The models are 1) the advanced dental hygiene practitioner; 2) the community dental health coordinator; and 3) the dental health aide therapist.     

Monitoring lithium in breast milk: an individualized approach for breast-feeding mothers

Lithium is a drug of choice for the management of bipolar disorder, a disease frequently affecting women in their childbearing years. Unfortunately, this drug has typically been contraindicated in nursing women. Data in humans are limited with respect to the use of this drug in lactating women, and early reports suggest high excretion into milk. The purpose of this report was to verify the excretion of lithium into human milk and to assess infant safety after breast-feeding. The authors found wide interpatient variability in lithium dose offered to the infant through breast milk (from 0% to 30% of maternal weight-adjusted dose), indicating that therapeutic drug monitoring of lithium in milk and/or in infant's blood, coupled with close monitoring of adverse effects, is a rational approach. Since therapeutic drug monitoring of lithium is routine, physicians caring for these women and infants should be encouraged to individualize their recommendations.     

Esorubicin (deoxydoxorubicin) has low grade activity in malignant melanoma

Summary In this phase II trial, twenty patients with advanced, measurable melanoma from ECOG institutions were treated with esorubicin 30 mg/m² iv every three weeks. Doses were escalated or reduced based on nadir counts. The dose limiting toxicity was leukopenia with no significant thrombocytopenia or anemia. Other toxicities were mild. One patient had skin necrosis with extravasation. Two patients with soft tissue disease had partial remissions and were treated with 9 and 17 courses. One patient was stable for 8 courses. No cardiac toxicity was seen in three patients receiving more than 150 mg/m². The response rate was 10% (90% CI = 2 to 30%). Low level activity was seen, but it is unlikely that this drug has sufficient activity to warrant further development in melanoma.Other participating institutions include: Albany Medical College, Albany, NY (CA 06594); Charleston Area Medical Center, Charleston, WV; Fox Chase Cancer Center, Philadelphia, PA (CA 18281); Indiana University Medical Center, Indianapolis, IN; Medical College of Ohio, Toledo, OH; University of Minnesota, Minneapolis, MN (CA 20365); Rush-Presbyterian-St.Luke's Medical Center, Chicago, IL (CA 25988); University of Pretoria, Pretoria, South Africa (CA 21692); Natalie Warren Bryant Cancer Center, Tulsa, OK; University of Wisconsin Clinical Cancer Center, Madison, WI (CA 21076); West Virginia University, Morgantown, WV.Dr. Hochster is a recipient of an American Cancer Society Cancer Development Award and is supported in part by the Kaplan Cancer Center grant CA 16087.     

Oxygen cost of treadmill and over-ground walking in mildly disabled persons with multiple sclerosis

Walking impairment is a ubiquitous feature of multiple sclerosis (MS) and the O₂ cost of walking might quantify this dysfunction in mild MS. This paper examined the difference in O₂ cost of walking between persons with MS who have mild disability and healthy controls and the correlation between the O₂ cost of walking and disability. Study 1 included 18 persons with mild MS and 18 controls and indicated that the O₂ cost of walking was significantly higher in MS than controls and that disability was significantly associated with the O₂ cost of slow, moderate, and fast treadmill walking. Study 2 included 24 persons with mild MS and indicated that disability was significantly correlated with O₂ cost of comfortable, fast, and slow over-ground walking. We provide evidence that the O₂ cost of walking is an indicator of walking dysfunction in mildly disabled persons with MS and should be considered in clinical research and practice.