Faculty Bibliography

BACKGROUND: Intravascular ultrasound (IVUS) imaging parameters have been suggested as criteria to determine coronary lesion significance before intervention. However, there has not been a systematic examination of combined anatomic and physiologic data in the same patients with coronary artery disease. METHODS AND RESULTS: To examine the relation between coronary flow reserve and IVUS parameters, 41 patients with intermediately severe coronary artery stenoses had measurements of coronary flow velocity (0.014-inch Doppler flow wire), coronary flow velocity reserve (CVR) (hyperemic/basal mean flow), IVUS imaging (2.9F, Cardiovascular Imaging Systems, Inc.), and quantitative coronary angiography before intervention. Correlations between physiologic and anatomic parameters were performed by simple regression. Results were also examined by patient subgroups with CVR > 1.8 or < 1.8 to assess differences in IVUS parameters. The angiographic percent diameter stenosis was 52% +/- 17% (range 18% to 95%). Mean CVR was 1.88 +/- 0.56 (range 0.9 to 3.18). IVUS minimal luminal diameter (r = 0.312, p = 0.047) and angiographic percent stenosis (r = 3.05, p = 0.052) were weakly related to poststenotic CVR. Comparing patients with CVR < 1.8, IVUS reference segment area, IVUS lumen area, and angiographic percent diameter stenosis was higher (17.7 +/- 0.3 vs 12.9 +/- 4.4 mm2, p < 0.05; 6.20 +/- 3.76 vs 4.34 +/- 2.00 mm2, p < 0.05; and 60% +/- 14% vs 46% +/- 17%, p < 0.01, respectively) than in the group with CVR > 1.8. CONCLUSIONS: Despite a precise determination of cross-sectional vessel areas and absolute dimensions by IVUS, single tomographic measurements did not correlate well with coronary physiologic responses. These data suggest that the physiologic data may be complementary to anatomic quantitative IVUS, enhancing information for coronary interventional decision making

Background: Several molecular methods potentially useful in the detection of Mycobacterium tuberculosis mutations, specifically in rpoB and katG, were compared. Methods and Results: DNA from 24 M. tuberculosis clinical isolates, with mutations associated with resistance to rifampin and/or isoniazid, was analyzed. A 128 bp amplicon, spanning the 81 bp rpoB region containing most mutations leading to rifampin resistance, was analyzed by polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) and a recently introduced mutation scanning method, cleavase fragment length polymorphism (CFLP) analysis. Also, a 350 bp amplicon encompassing that region was analyzed by the CFLP method. CFLP analysis of the 350 bp amplicon (23 isolates) identified 14 of 17 mutants; however, CFLP analysis of the 128 bp amplicon accurately identified all mutants as did PCR-SSCP with interpretative difficulty for two codon 513 mutations. CFLP and PCR-restriction fragment length polymorphism (RFLP) analyses of a 623 bp amplicon encompassing katG codons 315 and 463 showed that the CFLP method identified single and dinucleotide codon 315 substitutions with or without codon 463 (CGG-->CTG) changes, whereas PCR-RFLP (MspI) missed one codon 315 polymorphism (AGC-->ACA) in three isolates. Conclusion: Both PCR-SSCP and CFLP analyses were sensitive in identifying all mutations on short sequences in the rpoB mutants. CFLP appears to be more efficient than SSCP and RFLP for the detection of mutations in large amplicons

Lamm and Couzens discuss impotence and some of the new medication that can help with the problem. More and more, impotence is occurring in younger men due to stress

Lyme disease is the most common tick-borne illness in the United States, and its sometimes debilitating symptoms -- arthritis and damage to the nervous system and heart -- underscore the need for a vaccine

BETHESDA, Md. - An advisory committee of the Food and Drug Administration recommended approval Thursday of the first drug specifically for Crohn's disease, an often debilitating bowel ailment that afflicts about 100,000 Americans. The drug, infliximab, is manufactured from mouse and human cells by Centocor Inc. of Malvern, Pa. Researchers are also testing it to treat rheumatoid arthritis. But the FDA limited the committee's Thursday deliberations on infliximab to Crohn's disease, although information on the drug's safety included the results of testing in rheumatoid arthritis patients

An advisory committee of the Food and Drug Administration recommended today approval of the first drug specifically for Crohn's disease, an often debilitating bowel ailment that afflicts some 100,000 Americans. The drug, infliximab, is manufactured from mouse and human cells by Centocor Inc. of Malvern, Pa. Researchers are also testing it against another disease, rheumatoid arthritis. But the F.D.A. limited the committee's deliberations on infliximab today to Crohn's disease, although information on the drug's safety included the results of testing in rheumatoid arthritis patients. Infliximab, administered by injection, is not a cure for Crohn's disease. It was recommended today as a therapy to relieve the symptoms and improve the condition of people with moderate to severe cases in which standard therapy is inadequate. The panel also found that it helped heal a complication called draining fistula -- tracks that drain pus from the bowel through the skin, bladder, vagina and rectum

BETHESDA, Md. -- An advisory committee of the Food and Drug Administration on Tuesday recommended approval of the first vaccine against Lyme disease but expressed concerns about its safety and effectiveness. The 23-member panel said the vaccine, which must be taken in three doses over a year, met federal standards for marketing. But it called on the manufacturer, SmithKline Beecham, to continue testing the vaccine. The panel recommended that the vaccine be approved for use only for people 18 to 70. The committee's unanimous recommendations are not binding, but the FDA usually follows the advice of its expert panels. Until the agency acts, the vaccine, Lymerix, will not be available to the public. FDA officials said they considered the vaccine a priority but would not say how soon it might be available

An advisory committee of the Food and Drug Administration recommended approval of the first vaccine against Lyme disease tonight, but expressed serious concerns about its safety and effectiveness. The 23-member panel said the vaccine met Federal standards for marketing. But it called on the manufacturer, SmithKline Beecham, to continue testing the vaccine. The panel recommended that the vaccine be approved for use just for people 18 to 70. Lyme disease, which is spread by ticks, is a cause of great concern each summer for parents and those who spend a lot of time outdoors. Over 16,000 cases of Lyme disease were reported to the Federal Centers for Disease Control and Prevention in 1996, the most recent date for which figures were available

For weeks, a barrage of good news about cancer in people has come from scientists and public health officials. The number of new cancer cases has dropped for the first time since the 1930s, and there is a continued decline in cancer deaths. Additionally, new drugs have shown promise for reducing the risk of or treating cancer. Taken together, these findings provide important guideposts for the next skirmishes in the decades-old war on cancer

The problem has increased significantly in recent years following wider use of drugs for common cancers. A partial list includes tamoxifen and taxol for breast cancer, adriamycin for cancer of the lymph system, and 5-fluorouracil for colon cancer. But with expanding use, there has been scarce discussion of the safety and effectiveness of such drugs in patients older than 65, who account for more than half the total number of cancer cases in this country each year, said Dr. Frank Haluska, a cancer expert at the Massachusetts General Hospital in Boston. He moderated a news conference at the annual meeting of the American Society of Clinical Oncology that ended here Tuesday. Now, oncologists are belatedly recognizing that they have included too few older cancer patients in the clinical trials that they conduct to determine the most effective therapies for all cancer patients