Possible short-term amelioration of basilar plaque by high-dose atorvastatin: use of reductase inhibitors for intracranial plaque stabilization.

Regression of symptomatic intracranial atherostenosis is not known to be a common occurrence. In this case, delay of basilar reconstruction by endovascular means permitted serial angiographic assessment of plaque change. The use of high-dose atorvastatin over a 2-week period was associated with marked angiographic improvement. Medical programs of plaque stabilization may provide adjunctive benefit in patients with symptomatic intracranial disease.

A clinical comparison of the safety and efficacy of MultiHance (gadobenate dimeglumine) and Omniscan (Gadodiamide) in magnetic resonance imaging in patients with central nervous system pathology.

RATIONALE AND OBJECTIVES: The safety and diagnostic efficacy of MultiHance (gadobenate dimeglumine) in the central nervous system (CNS) were evaluated in a double-blind, multicenter, phase III clinical trial. METHODS: Two hundred five patients highly suspected of having a CNS lesion (by previous imaging exam) were enrolled at 16 sites in the United States. Patients were randomized to one of three incremental dosing regimens. Magnetic resonance imaging with Omniscan (gadodiamide) at doses of 0.1 and 0.3 mmol/kg was compared with MultiHance (gadobenate dimeglumine) at doses of 0.05 and 0.15 mmol/kg and at 0.1 and 0.2 mmol/kg. RESULTS: Compared with predose images alone, efficacy was demonstrated in each of the gadobenate dimeglumine and gadodiamide groups (single and cumulative doses) as indicated by the level of diagnostic information, number of lesions detected, and contrast-to-noise ratio measurements. The level of diagnostic information from gadobenate dimeglumine at 0.1 mmol/kg was equivalent to that with gadodiamide at the same dose. One of the two blinded reviewers found equivalence between the gadobenate dimeglumine 0.05 mmol/kg dose and gadodiamide at 0.1 mmol/kg. Both reviewers found the level of diagnostic information to be equivalent after the second dose of contrast for all three dosing regimens. The cumulative doses of gadobenate dimeglumine were well tolerated and as safe as gadodiamide. CONCLUSIONS: Gadobenate dimeglumine is comparable to gadodiamide in terms of safety and efficacy for imaging of CNS lesions, with a possible advantage in imaging applications owing to enhanced T1 relaxivity.

Basilar artery endoprosthesis placement: rescue therapy for recurrent thrombosis.

Hyperacute thrombosis of the basilar artery accompanied urgent treatment of basilar thrombosis with local thrombolytics and arterial reconstruction by balloon angioplasty. Successful placement of an endoprosthesis into the basilar artery permitted sustained restoration of blood flow. To the authors' knowledge, this is the first successful report of intracranial endoprosthesis deployment.

Balloon angioplasty of intracranial arteries for stroke prevention.

Stroke from surgically inaccessible intracranial atherostenosis remains a formidable clinical challenge. While antithrombotic or antiplatelet therapy may prevent distal embolism, there is no effective program for plaque stabilization preventing progression of atherosclerotic stenosis. In patients with isolated circulations (single vertebral with absent posterior communicating arteries, single carotid with contralateral internal carotid artery occlusion, or single carotid with an absent anterior communicating artery), occlusion of the stenotic vessel may produce a low flow-mediated stroke. Fifteen patients with atherosclerotic intracranial stenoses were treated by balloon angioplasty after medical therapy with warfarin failed. Treated territories included the distal internal carotid, proximal middle cerebral, distal vertebral, and basilar arteries. Dilation was successful in all vessels, with residual stenoses averaging less than 30%. Two complications included one paramedian pontine stroke and a single vessel rupture that proved fatal. There was no recurrence of transient ischemic attacks and no restenosis at the angioplasty site over a follow-up period of more than 24 months. In this small series, balloon angioplasty of intracranial vessels provided a therapeutic option for secondary stroke prevention in highly selected patients. Further studies will be necessary to establish the efficacy and safety of endovascular treatment in larger series.

Performance contracting: the Colorado model.

Through a process of negotiation between a community mental health centers association (CMHCA) and the state division of mental health (DMH), a performance contracting system has created entrepreneurial freedom for the mental health centers while still providing adequate controls by the DMH.

Mercury, arsenic, lead, cadmium, and selenium residues in fish, 1971-73--National Pesticide Monitoring Program.

As part of the National Pesticide Monitoring Program, the Fish and Wildlife Service, U.S. Department of Interior, analyzed selected fish samples from 100 monitoring stations for residues of mercury, arsenic, lead, cadmium, or selenium in 1971-73. At most stations, detectable residues of all metals were present in more than 95 percent of the composite samples. Fishes with mercury residues exceeding 0.5 mg/kg wet weight in the whole fish were mainly predators. Fishes with residues of arsenic, lead, cadmium, and selenium exceeding 0.5 mg/kg included predatory and nonpredatory species. The number of composite samples in which residues of these elements exceeded 0.5 mg/kg decreased from 1971 to 1973, whereas the percentage of samples with detectable residues increased slightly. Only selected samples were analyzed in 1973; therefore, these figures should be used only cautiously as trend data. Species of fish collected varied considerably between geographic regions but were similar from year to year within each region.