The effect of radiation on carotid arteries. A review article.

The effects of irradiation on blood vessels supplying the brain are reviewed. Short-term and long-term effects on large arteries result in an atheroscleroticlike disorder. The response may have a latency up to 20 years before the onset of symptoms and signs.

Changes in survival following stroke in five North Carolina counties observed during two different periods.

We evaluated survival following stroke for patients from a five-county area of rural North Carolina enrolled in either of two community hospital-based stroke survey programs. In this area, the first program enrolled 843 stroke patients between 1970 and 1973 and the second program enrolled 786 stroke patients between 1979 and 1980. One-year survival increased from 49% in the first program to 62% in the second for all stroke patients, from 54% to 68% for patients with cerebral infarction, and from 18% to 55% for patients with cerebral hemorrhage.

Cerebral infarction in patients with transient ischemic attacks.

Cranial computed tomography of 284 patients with transient ischemic attacks (TIAs) and without previous stroke was evaluated. The sample population included patients with carotid and/or vertebrobasilar TIAs. Computed tomography revealed cerebral infarction in 34 patients, including 5 with multiple infarctions.

Cigarette smoking cessation and extracranial carotid atherosclerosis.

Using B-mode ultrasonography, cigarette smoking was found to be a strong, independent risk factor for extracranial carotid atherosclerosis in 1692 black and white men and women admitted for diagnostic evaluation of the carotid arteries. We found that the difference in mean plaque thickness was smaller between past smokers and nonsmokers than between current smokers and nonsmokers, suggesting that the rate of progression of carotid atherosclerosis may be slower in people who quit smoking compared with people who continue to smoke.

Cause specific mortality following cerebral infarction.

Mortality from four causes (index stroke, subsequent stroke, cardiac disease and non-cardiovascular causes) was examined during a 5 year follow-up of 1694 cerebral infarction patients admitted to 25 community hospitals between 1969 and 1973. The hazard for mortality from the index stroke was high initially, but declined to a negligible level by 6 months post-stroke. In contrast, hazards for mortality from subsequent strokes, cardiac diseases and non-cardiovascular causes each peaked midway through the first year, declined during the remainder of that year, and then increased in the latter part of the follow-up.

Carotid endarterectomy: what is its current status?

The plethora of recent articles regarding carotid endarterectomy has tended to confuse rather than clarify its indications, efficacy, and acceptability. The National Institutes of Health has recently funded two large multicenter controlled clinical trials, one including asymptomatic persons with carotid stenoses, and the other, patients having transient ischemic episodes or minor strokes. Eight academic professors of neurology (four), neurosurgery (two), and vascular surgery (two) with a long and abiding interest in cerebrovascular disease prepared a statement delineating acceptable levels of mortality and morbidity from this procedure.

Identification of a putative regulator of early T cell activation genes.

Molecules involved in the antigen receptor-dependent regulation of early T cell activation genes were investigated with the use of functional sequences of the T cell activation-specific enhancer of interleukin-2 (IL-2). One of these sequences forms a protein complex, NFAT-1, specifically with nuclear extracts of activated T cells. This complex appeared 10 to 25 minutes before the activation of the IL-2 gene.

Individual variation in susceptibility to extracranial carotid atherosclerosis.

Risk factors for coronary disease were assessed and noninvasive methods were used to quantitate the extent of extracranial carotid atherosclerosis in 382 patients free of cerebrovascular symptoms. The ages of the participants ranged from 27 to 80 years. There were 183 men and 199 women, 30 black and 352 white persons.

Information management: emergence of a new deal. Roundtable on information management.

Is a new position in healthcare management--the chief information officer (CIO)--emerging? As yet, there is no clear answer. However, if such a management position were to emerge, it could be one that facilitates and coordinates the informational interests of the CEO, CFO, and others in the healthcare organization. This position and others on the management team could work together in a cooperative and mutually supportive relationship.

Risk factors for extracranial carotid artery atherosclerosis.

We related risk factors, cardiovascular symptoms, and coronary status to the extent of extracranial carotid atherosclerosis as measured by B-mode ultrasonography in 376 volunteers hospitalized for elective coronary angiography. In a first analysis, we correlated risk factors and cardiovascular symptoms with carotid atherosclerosis. Univariate analysis showed that relations between many continuous risk factors and carotid atherosclerosis were graded and consistent for men and women.

Measurement variability of carotid atherosclerosis: real-time (B-mode) ultrasonography and angiography.

To quantify the within- and between-reader agreement of carotid B-mode ultrasonography and angiography interpretation, images from 117 patients examined by both modalities were read multiple times. Angiographic measurements were more reproducible than those of B-mode scans for all parameters except lesion width, but variations for B-mode scan measurements were similar to those for angiographic measurements. Within-reader agreement on the presence of ulceration was substantial for both modalities, whereas between-reader agreement was poor for B-mode scan and only moderate for angiography.

Multicenter validation study of real-time (B-mode) ultrasound, arteriography, and pathologic examination.

The ability of high-resolution ultrasound, angiography, and pathologic examination of endarterectomy specimens to identify and quantitate atherosclerosis was compared in a five-center study. The carotid bifurcation in 900 patients was evaluated by angiography and ultrasound. In 216 cases, high-quality endarterectomy specimens were available for comparison with the preoperative images.

Information technology challenges the future of health care.

Information technology is evolving rapidly, and opportunities exist for healthcare organizations to exploit the development of new technologies. The challenge will be to incorporate this technology in a manner that is economically sound and at a pace that will be the most beneficial.

Declining morbidity and mortality of carotid endarterectomy. The Wake Forest University Medical Center experience.

The 30-day mortality as well as morbidity for stroke and myocardial infarction were determined by review of the charts for every carotid endarterectomy (N = 389 operations on 356 patients) performed at Wake Forest University Medical Center from 1979 through 1983 to ascertain whether the 16% morbidity and 6% mortality documented in our previous report of 1978 had changed over time. For endarterectomies performed on asymptomatic patients (n = 155), major morbidity included 2 myocardial infarctions and 1 stroke (1.9%).

Extracranial carotid arterial disease in patients with familial hypercholesterolemia and coronary artery disease treated with colestipol and nicotinic acid.

Carotid bifurcation atherosclerosis was demonstrated in 34 of 108 patients with familial hypercholesterolemia and coronary artery disease by B-scan, continuous-wave Doppler sonography, and intravenous digital subtraction angiography. An intensive combined therapy of diet, colestipol, and nicotinic acid was mounted to control the hypercholesterolemia of these patients. Their serial sonographies and digital subtraction angiography were evaluated independently by technical specialists who served as coinvestigators.

Complete cDNA and derived amino acid sequence of human factor V.

cDNA clones encoding human factor V have been isolated from an oligo(dT)-primed human fetal liver cDNA library prepared with vector Charon 21A. The cDNA sequence of factor V from three overlapping clones includes a 6672-base-pair (bp) coding region, a 90-bp 5' untranslated region, and a 163-bp 3' untranslated region within which is a poly(A) tail. The deduced amino acid sequence consists of 2224 amino acids inclusive of a 28-amino acid leader peptide.

Factors influencing the survival of 451 transient ischemic attack patients.

Four hundred fifty-one patients with transient ischemic attacks (TIA) occurring within 1 month of hospitalization, admitted during 1977-1983, were analyzed to establish the effect on survival of age, race, sex, distribution of TIA, cigarette smoking, previous cerebral infarction or hemorrhage, previous TIA, or history of ischemic heart disease, valvular heart disease, cardiac dysrhythmia, hypertension, and diabetes mellitus. Proportional hazards analysis revealed that decreased survival was associated with increasing age, carotid artery distribution TIAs (compared with vertebrobasilar distribution TIAs), cigarette smoking, previous contralateral stroke, ischemic heart disease, and diabetes mellitus. We found great variation in the estimated survival of TIA patients, ranging from 5-year survivals of greater than 95% for 60-year-old patients with none of these risk factors to less than 25% for patients with all of these risk factors.

Lumbar puncture and stroke. A statement for physicians by a Committee of the Stroke Council, American Heart Association.

This statement for physicians redefines the use and importance of lumbar puncture to suspected stroke mechanisms. It also identifies neurologic conditions in which newer imaging techniques are safer and more effective diagnostic tools than lumbar puncture.

Middle cerebral artery stenosis--a neglected problem?

Transcranial Doppler ultrasonography has great potential for clinical investigations that evaluate flow through the middle cerebral artery in health and disease. This technique will help to elucidate the syndromes of middle cerebral artery stenosis and occlusion, which have been overshadowed by the syndromes of internal carotid artery disease in the past.