By Mary Jane Dittmar
Study: Intensive Medical Treatment vs. Brain Stent
Patients at a high risk for a second stroke who received intensive medical treatment had fewer strokes and deaths than patients who received a brain stent in addition to the medical treatment. This was the finding of the nationwide clinical trial . “The National Institutes of Health (NIH) Stenting vs. Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS)” in which 451 patients at 50 sites across the United States were enrolled. The National Institute of Neurological Disorders and Stroke (NINDS), part of the NIH, funded the study. The medical regimen included daily blood-thinning medications and aggressive control of blood pressure and cholesterol.
Walter Koroshetz, M.D., deputy director of NINDS, explains: “This study provides an answer to a longstanding question by physicians--what to do to prevent a devastating second stroke in a high-risk population. Although technological advances have brought intracranial stenting into practice, we have now learned that, when tested in a large group, this particular device did not lead to a better health outcome.”
Patients in the study were between 30 and 80 years old and had experienced a recent transient ischemic attack, a type of stroke that resolves within 24 hours, or another type of non-disabling stroke, caused by a large degree of stenosis in a cerebral artery.
Half of the patients in the study received “an intervention of a self-expanding stent that widens a major artery in the brain and facilitates blood flow” in addition to the intensive medical program, according to the study report. The study authors stress that the study participants were in the highest risk category, with blockage or narrowing of arteries of 70 to 99 percent. Stroke patients with moderate cerebral arterial blockage (50 to 69 percent) were excluded because their risk of stroke is low with usual medical management and because researchers thought this group probably would not benefit from stenting.
The investigators looked at whether patients had a second stroke or died within 30 days of enrollment, or had a stroke in the same area of the brain from 30 days to the end of follow-up. The researchers had hypothesized that compared to intensive medical therapy alone, the addition of an intracranial stenting system would decrease the risk of a stroke or death by 35 percent over two years. Instead, they found that 14.7 percent of patients (33) in the stenting group experienced a stroke or died within the first 30 days after enrollment, compared with 5.8 percent (13) of patients treated with medical therapy alone.
"The SAMMPRIS study results have immediate implications for clinical practice. Stroke patients with recent symptoms and intracranial arterial blockage of 70 percent or greater should be treated with aggressive medical therapy alone that follows the regimen used in this trial as closely as possible," said Marc Chimowitz, M.B.Ch.B., of the department of neurosciences at the Medical University of South Carolina in Charleston, and first author of the NEJM article. This NIH News Release is available online at www.nih.gov/news/health/sep2011/ninds-07.htm.
Chocolate may be a “plus” factor for the heart
Dr. Oscar Franco and his team of researchers from the University of Cambridge in England have found that eating chocolate appears to help improve heart and vascular health. The researchers reviewed data from seven studies involving 114,000 patients. They found that the people who consumed the most chocolate had a 37 percent lower risk of developing heart disease and 29 percent less risk of suffering a stroke than those who consumed less chocolate, according to the University of Cambridge. Researchers included the consumption of dark and milk chocolate and other chocolate snacks such as biscuits and beverages.
“Chocolate may be beneficial, but it should be eaten in a moderate way, not in large quantities and not in binges,” cautions Dr. Franco. “If it is consumed in large quantities, any beneficial effect is going to disappear,” he adds. Research News,
Women with BRCA Gene Mutations
Women who inherit BRCA gene mutations develop breast and ovarian cancer at younger ages than women in the previous generation, suggests an analysis conducted by Jennifer Litton, MD, of the University of Texas MD Anderson Cancer Center in Houston and her colleagues. Looking at trends in the ages of cancer diagnosis between generations in families with a history of BRCA-related cancer, they found that of the 132 women in the study who had breast cancer and BRCA gene mutations, 106 had a family member in the previous generation diagnosed with a BRCA-related cancer (either breast or ovarian), according to CANCER (online), a peer-reviewed journal of the American Cancer Society.
The research also showed that the average age of cancer diagnosis in the second generation was 42 years, which is six years earlier than those diagnosed in the first generation. A separate, more inclusive analysis of the entire study group revealed that the expected age of onset of cancer went down by 7.9 years from the first generation to the second.
National Comprehensive Cancer Network guidelines suggest initiating screening for hereditary breast cancer at 25 years of age, five to 10 years earlier than the age of the earliest diagnosis in a family. Dr. Litton explains that it is necessary to initiate screenings at least 10 years prior to the earliest cancer diagnosis: “Because we do not have the BRCA mutation status of affected individuals from previous generations, when testing may not have been available yet, it is vital that we continue to collect family information.”
http://wileyonlinelibrary.com/journal/cancer. “Earlier age of onset of BRCA mutation-related cancers in subsequent generations.” Jennifer K. Litton, Kaylene Ready, Huiqin Chen, Angelica Gutierrez-Barrera, Carol J. Etzel, Funda Meric-Bernstam, Ana M. Gonzalez-Angulo, Huong Le-Petross, Karen Lu, Gabriel N. Hortobagyi, and Banu K. Arun. CANCER; Published Online: September 12, 2011 (DOI: 10.1002/cncr.26284). Author Contact: Laura Sussman of the University of Texas MD Anderson Cancer Center’s Media Relations Office at firstname.lastname@example.org or +1 (713) 745-2457.
Jensen Farms recalls Rocky Ford Cantaloupes
The U.S. Food and Drug Administration has warned consumers not to eat Rocky Ford cantaloupes shipped by Jensen Farms of Granada, Colorado, because of a potential link to a multistate outbreak of Listeria monocytogenes. The melons were shipped between July 29 and September 10, 2011, and distributed to at least 17 states: Illinois, Wyoming, Tennessee, Utah, Texas, Colorado, Minnesota, Kansas, New Mexico, North Carolina, Missouri, Nebraska, Oklahoma, Arizona, New Jersey, New York, Pennsylvania, and possibly others. If you have purchased cantaloupes during this time period and are not source of their place of origin, check with the management at your place of purchase. If you have any of this brand of cantaloupes, wrap them in plastic and discard them.
At least 22 people in seven states were infected with the outbreak-associated strains of L. monocytogenes as of September 14. The Listeriosis infection usually causes fever and muscle aches. It can be fatal, especially in certain high-risk groups such as older adults, people with compromised immune systems and certain chronic medical conditions, and unborn babies and newborns. If you think you have been infected, consult your healthcare professional.
Mary Jane Dittmar is senior associate editor of Fire Engineering and conference manager of FDIC. Before joining the magazine in January 1991, she served as editor of a trade magazine in the health/nutrition market and held various positions in the educational and medical advertising fields. She has a bachelor’s degree in English/journalism and a master’s degree in communication arts.