Endovascular treatment of peripheral artery disease with expanded PTFE-covered nitinol stents: interim analysis from a prospective controlled study

Purpose: Current covered peripheral stent designs have significant drawbacks in terms of stent delivery characteristics and flexibility. The aim of this study was to analyze the technical performance, safety and initial clinical efficacy of expanded polytetrafluoroethylene (PTFE)-covered nitinol stents for arteriosclerotic peripheral artery disease. Methods:Eighty-two patients underwent implantation of PTFE-covered nitinol stents for iliac and/or femoral obstructions. The study was conducted prospectively in seven European centers and one Canadian center. Patients were controlled clinically and by duplex ultrasound follow-up. Data up to discharge were collected in 79 patients. Seventy-four patients have thus far received 1 month follow-up and 32 patients, 6 month follow-up examinations. Results: The average lesion length measured 47 mm for the common and external iliac arteries and 50 mm for the femoral arteries. The mean severity of the stenoses was reduced from 94% to 4% in the iliac arteries and from 98% to 7% in the femoral arteries after stent placement and dilatation. One device deviation (inadvertent stent misplacement) and one puncture-related severe adverse event with formation of a pseudoaneurysm occurred. There were occlusions of the stent in five patients. No infections were noticed. Conclusion: The interim analysis of this trial using PTFE-covered nitinol stents indicates that a strategy using primary implantation of this stent type is technically feasible, has an acceptable safety profile and is effective from a short-term perspective.     

Significant association between the tau gene A0/A0 genotype and Parkinson's disease

A significant association between the tau gene A0/A0 genotype and progressive supranuclear palsy has been reported recently. To determine if the presence of a tau polymorphism could constitute a risk factor for the development of sporadic and familial Parkinson's disease, a dinucleotide repeat marker at intron 11 was genotyped in 152 patients with PD, 52 patients with Alzheimer's disease, and 150 healthy controls. We detected a significant difference in A0 allelic frequency in the Parkinson's disease group (79.27%) compared with the control group (71%) and the Alzheimer's disease group (73.07%). Individuals homozygous for the A0 allele were also detected significantly more frequently in the Parkinson's disease group (63.8%) compared with the control group (52.66%) and the Alzheimer's disease group (48.07%). These results suggest a possible involvement of the tau gene in the pathogenesis of some cases of Parkinson's disease.     

Genetics of frontotemporal dementia and alterations of the tau gene

The prevalence of fronto-temporal dementia may be estimated in 10-20% of all dementia's. In 40 to 50% of the cases it is possible to detect familial antecedents and in some of the families it is possible to identify multiple affected individuals. The study of these familial cases has allowed to narrow the responsible genomic region to chromosome 17 and to identify mutations in the tau gene as responsible for the disease. At present more than 100 cases of the disease due to mutations in the tau gene have been described in which it has been possible to detect 24 different mutations. In order to search for mutations in the tau gene in a patient all it is needed is a sample of venous blood with which it is possible to extract the genomic DNA, amplify the tau gene through PCR and to sequence it. The information obtained provides a very precise diagnosis in patients with fronto-temporal dementia, may be useful in the differential diagnosis with other types of dementia, and may allow a pre-symptomatic diagnosis in relatives from patients. At a more basic level, the detection of mutations in the tau gene allows to identify the pathogenic mechanisms involved opening up the possibility to develop new therapeutics strategies.     

Two episodes of ifosfamide-related neurotoxicity in the same patient following different schedules and doses of the drug. A case report

We report the first case of recurrent ifosfamide-related neurotoxicity in the same patient following two distinct administrations of the drug at different doses and schedules and with a long interval between the two episodes. Remarkably, the first event was characterized by confusion and hallucinations, while the second, 29 months later, was characterized by partial and generalized seizures. Between the two episodes the patient had received high-dose cyclophosphamide, an oxazophoshorine agent closely related to ifosfamide, without any neurological side effects. We briefly discuss the diagnosis and management of ifosfamide-related encephalopathy.     

Evaluation of novel compounds interacting with H2-histamine receptors: Effect on histamine-sensitive adenylate cyclase activity in guinea-pig gastric mucosa

The activity of a number of compounds belonging to the novel class ofN-imidazolylphenyl-N'-alkyl-formamidines on histamine-sensitive adenylate cyclase was evaluated. All substances inhibited histamine-dependent adenylate cyclase activation. The compounds which were investigated in a wider concentration range, i.e. DA 4360, DA 4577, and DA 4626, behaved as simple competitive antagonists, yielding apparentK _B values comparable with those estimated in conventional H₂-receptor assays. These results provide further evidence for the highly selective H₂-receptor antagonism of these new molecules, and confirm the suitability of the histamine-stimulated adenylate cyclase assay in guinea-pig gastric cells as a functionally reduced system for the study of H₂ antagonists.     

Trends in avoidable causes of infant mortality in Belo Horizonte, Brazil, 1984 to 1998

OBJECTIVE: To analyze the infant mortality trend in a metropolitan area, from 1984 to 1998. The main focus was on avoidable causes of neonatal and post-neonatal mortality. METHODS: Sources of data were the Sistema de Informacoes em Mortalidade do Ministerio da Saude (SIM-MS) [Mortality Information System of the Ministry of Health] and Fundacao Instituto Brasileiro de Geografia e Estatistica (IBGE) [Brazilian Institute of Geography and Statistics Foundation] (official live birth and death records) for the metropolitan region of Belo Horizonte, in the State of Minas Gerais. A simple linear regression model was used to evaluate time-trends of mortality rates. Statistical significance of the inclination of the regression curves was considered for the p<0.05 level. RESULTS: During the 15 year period in question, the infant mortality rate declined from 48.5 to 22.1/1,000 live births. However, the most accentuated decrease was observed during the last four years of the study period. The post-neonatal group was greatly responsible for this decline both in the capital and in the other districts within the metropolitan region of Belo Horizonte. CONCLUSIONS: Although a significant decrease in the infant mortality rate has been observed, particularly in the post-neonatal mortality, it is still larger than the rates found in developed countries. Deaths due to perinatal morbidities as well as the group of causes represented by diarrhea-pneumonia-malnutrition still present an important potential for reduction. The authors discuss the role of the health services in improving the rates of these avoidable causes of infant mortality.