Efficacy of aspirin plus extended-release dipyridamole in preventing recurrent stroke in high-risk populations

OBJECTIVE: To assess the efficacy of aspirin plus extended-release dipyridamole compared with aspirin alone for the prevention of recurrent stroke among high-risk groups. DESIGN: A post hoc analysis was conducted using data from the European Stroke Prevention Study 2. Rates of annual strokes and vascular events were determined for the aspirin plus extended-release dipyridamole group (n = 1650) and the aspirin-only group (n = 1649), and were stratified by risk subgroup and univariate risk factors. Stroke models from the Framingham Study and the Stroke Prognostic Instrument II were applied to subjects in the European Stroke Prevention Study 2 to categorize patients into risk groups. RESULTS: Compared with aspirin alone, aspirin plus extended-release dipyridamole demonstrated a more pronounced efficacy in reducing the risk for stroke and vascular events among patients younger than 70 years; those with hypertension, prior stroke, or transient ischemic attack; current smokers; and those with any prior cardiovascular disease. Relative hazard reductions favored the combination of aspirin plus extended-release dipyridamole, and were greatest for the high-risk Framingham Study group and the moderate-risk Stroke Prognostic Instrument II subgroup. CONCLUSION: Aspirin plus extended-release dipyridamole is more effective than aspirin alone at preventing stroke, and the difference in efficacy increases in higher-risk patients.     

Culture of cells harvested with nasal brushing: a method for evaluating ciliary function

OBJECTIVES: Usefulness and reliability of nasal brush samples in a monolayer cell culture was studied for evaluation of ciliary movement. METHODS: Cells for cultures were harvested under the middle turbinate from patients with chronic sinusitis and from controls. Ciliary function was analysed using a microscope equipped with a high-speed video camera. Ciliary beat frequency (CBF), ciliary amplitude, waveform and coordination were analysed from the cultures 4-6 h after the harvest of brush samples and 3 days after the culture. RESULTS: The average success rate of cell cultures was 82.5%. There were not statistically significant differences in CBF between patients and controls but there was significant difference between brush biopsy and cultured brush biopsy in controls. The ciliary beat amplitude and the waveform were normal in all samples in both groups. CONCLUSIONS: Miniculture method for culturing nasal cells from brush biopsies proved reliable and non-invasive for detailed analysing of ciliary function and for excluding possible secondary ciliary dyskinesia. Compared to conventional mucosal cell cultures where thick and invasive specimens are needed for successful cultures, it is easier and quicker to perform and well tolerated by patients. Thin monolayer cultures enable the evaluation of frequency, amplitude and the waveform of the cilia beat under the microscope whereas floating cells and cell clusters do not give this opportunity.     

Recovery after tonsillectomy in adults: a three-week follow-up study.

OBJECTIVE: To evaluate recovery after tonsillectomy and safety and efficacy of ketoprofen in pain treatment after discharge. STUDY DESIGN: A prospective, longitudinal study of 102 patients undergoing tonsillectomy. METHODS: All patients underwent tonsillectomy (or adenotonsillectomy) under general anesthesia. In the hospital, 77 patients received a bolus of 0.5 mg/kg ketoprofen intravenously, followed by a 3-mg/kg continuous infusion over 24 hours, and oxycodone for rescue analgesia. Twenty-five patients received normal saline and oxycodone. At discharge, all patients were prescribed ketoprofen capsules at a dose of 3 to 5 mg/kg per day for postoperative pain control at home, with paracetamol-codeine tablets for rescue analgesia. At home, the patients recorded pain and analgesic consumption each day for the first week after surgery. At 3 weeks, patients recorded the total analgesic requirement, duration of pain, all adverse events during recovery, and return to normal daily activities. RESULTS: No pre-emptive effect of ketoprofen was noticed because there was no significant difference in recovery after discharge between patients who had received ketoprofen or placebo during the first 24 hours after surgery. In the whole study group, the median of pain cessation was 11 days (range, 3-24 days) and the median of analgesic treatment was 12 days (range, 5-25 days). More than 50% of the patients needed 1 to 3 rescue analgesic doses daily during the first week after tonsillectomy. A return back to normal daily activities took place after 12 days (range, 2-24 days). Nine patients needed electrocautery to stop postoperative bleeding. No other serious adverse events occurred. CONCLUSIONS: The main problem after tonsillectomy is significant pain that can last 11 to 12 days after surgery. Ketoprofen combined with paracetamol-codeine provided sufficient analgesia for most patients at home, but because ketoprofen may cause an increase in the secondary hemorrhage rate, it should be prescribed with caution.     

The value of MRI in early Perthes' disease: an MRI study with a 2-year follow-up

Eleven hips in nine patients with Perthes' disease were studied by plain radiography at 3-month and MRI at 6-month intervals over a period of 2 years. The aim was to clarify the value of MRI in estimating epiphyseal involvement and in predicting uncoverage of the epiphysis. Signal intensities of the epiphysis and metaphysis were visually evaluated from T1- (T1W) and T2-weighted (T2W) images. The extent of decreased signal intensity (DSI) in the epiphyses was volumetrically calculated from T1W images and then compared with follow-up radiographs. The area of epiphyseal DSI corresponding best with Catterall's classification was seen by MRI 3–8 months after the first symptoms. MRI images obtained earlier usually showed less involvement than the follow-up radiographs. However, two features predicting extensive epiphyseal necrosis were: (1) DSI on both T1W and T2W images covering over two-thirds of the epiphysis and (2) diffuse bone marrow oedema of the femoral neck and metaphysis. When T1W images showed a reappearance of high signal intensity patches in the lateral quarter of the epiphysis, no clinically significant uncoverage was seen during the follow-up. Extensive epiphyseal necrosis can, therefore, sometimes be predicted by MRI even within the first 3 months, but MRI visualises epiphyseal involvement more clearly 3–8 months after the first symptoms. Received: 27 March 1996 Accepted: 26 October 1996     

Nuclear and cytoplasmic p53 expression in pharyngeal squamous cell carcinoma: prognostic implications

BACKGROUND: The role of p53 expression in human neoplasms is still controversial, and it has been associated with both favorable and unfavorable outcome of the patients. Also cytoplasmic expression of p53 protein has been reported to affect survival in some cancers. Furthermore, an association between p53 and beta-catenin expression has been demonstrated. We studied the expression of p53 in a large group of oropharyngeal and hypopharyngeal squamous cell carcinomas and its relation to catenin expression, histologic differentiation, clinical data, and prognosis. METHODS: Primary tumors for analyses were obtained from 123 patients diagnosed with squamous cell carcinoma of the oropharynx or hypopharynx between 1975 and 1998 in Eastern Finland. Immunohistochemistry was used to evaluate the expression of p53 as well as alpha-, beta-, and gamma-catenins. RESULTS: In the primary tumors (n = 123), the nuclear p53 expression index was low in 42 (34%), intermediate in 38 (31%), and high in 43 (35%) cases. Cytoplasmic p53 expression was present in 56 (46%) and absent in 67 (54%) tumors. In univariate analyses (Kaplan-Meier), hypopharyngeal primary site (p =.02), high T class (p <.0005), presence of distant metastases (p =.02), low Karnofsky performance index (p <.0005), high nuclear p53 expression index (p =.01), and positive cytoplasmic p53 expression (p =.04) predicted poorer overall survival (OS). In Cox proportional hazards model, only T class (p =.0005), Karnofsky performance index (p =.005), and nuclear beta-catenin expression (p =.038) predicted poorer OS. CONCLUSION: Positive cytoplasmic p53 expression and nuclear p53 overexpression seem to relate to more aggressive features and unfavorable outcome in pharyngeal squamous cell carcinoma (PSCC). However, unlike more traditional variables, p53 expression is not an independent predictor of disease outcome in PSCC.     

Effect of cold exposure on older humans

Epidemiological studies have shown excess winter mortality particularly in older age groups. A question is how much these statistics are affected by age-related physiological changes in cold thermoregulation and how much due to other factors related to aging. In experimental studies concerning age and cold stress both whole-body and local exposures have been used mostly in resting subjects with minimal clothing. Older persons, particularly men over ca. 60 years, are less able to maintain core temperature during a given cold challenge compared to younger individuals. Older persons have a reduced cutaneous thermal sensitivity, and a reduced subjective thermal perception during cooling. Thus, older people may require a more intense stimulus to perform protective actions against cold stress. Older persons' skin vasoconstrictive response to cold is diminished compared to younger persons, which seems partly related to a reduced skin vasomotor sensitivity to sympathoneuronal stimuli. The cold-induced rise in metabolic rate is attenuated in older persons, but the mechanism is unknown. Both central and peripheral components seem to be involved in the age-related changes in regulatory effector functions. Enhanced aerobic fitness may not give added protection against core cooling during cold stress in the elderly, but seems to attenuate older subjects' heightened blood pressure response to cold. Bronchial responsiveness to face cooling may increase with age. Further studies are needed to examine the age-related changes in non-thermoregulatory responses to cold (e. g. hemodynamics, cardiac function, respiration, autonomic nervous function), and the modifying effects of acute exercise and physical training.     

Cerebral signs of altered adaptability in females with acute psychosis

In psychosis, behavior is not guided by sensory cues from surroundings. Novel, meaningful behaviors require intact integrative functions such as short-term memory and motor planning, as well as an optimized level of arousal. In this study, we monitored markers of automatic auditory processing in 15 female never-medicated psychotic patients. Fifty-eight channels of EEG were recorded simultaneously with sympathetic skin responses while arousing auditory stimuli were delivered. Neuropsychological tests concentrating on frontal lobe functions were also performed. Prominent neurophysiological and behavioral signs of increased cortical activation were observed in psychotic patients. This widespread disinhibition may attempt to compensate for the impairment of neuronal processing of sensory input from surroundings in the earliest stages of a psychotic illness.     

Vaccination against infections in chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is a well-defined mature B-cell neoplasm associated with increased susceptibility to infections. Two major options in prevention of infections in CLL, intravenous gammaglobulin treatment and antimicrobial chemoprophylaxis, have not resulted in satisfactory outcome. A third strategy, antimicrobial vaccination, is the topic of this minireview. We collected articles and their references concerning CLL vaccination from the Medline database starting from 1966 and thirteen relevant studies were found. Plain bacterial polysaccharide vaccines would seem to be ineffective in antibody formation in patients with CLL. However, protein and conjugate vaccines appear to be more immunogenic and their responses may be further enhanced with ranitidine adjuvant treatment. New well-designed investigations are needed to develop appropriate vaccination strategies and evaluate vaccination efficacy in infection morbidity and mortality in CLL.