Re: FW: Ultrasound here
From: art fougner, md (evsono@pipeline.com)
Thu Nov 18 12:52:43 2004
Terry
i'm unclear as to whether the two hours of cw doppler monitoring
involved a sonographer standing there for two hours, pencil probe in
hand. this might seem difficult to replicate in a clinical setting.
art
At Thu, 18 Nov 2004, DuBose, Terry wrote:
>
>http://www.cnn.com/2004/HEALTH/conditions/11/17/stroke.busting.ultrasoun
>d.ap/index.html
>
>Study: Sound waves help stroke victims
>
>Technique could one day help 15 percent of stroke victims
>
>Wednesday, November 17, 2004 Posted: 5:30 PM EST (2230 GMT)
>
>BOSTON, Massachusetts (AP) -- The same type of sound waves that pulsate
>from sonar fish-finders and ultrasound fetal monitors can dramatically
>boost the power of anti-clotting medicine and help it dissolve brain
>blockages in stroke patients, a study suggests.
>
>This technique may one day offer a safe accessory for helping up to
>100,000 U.S. patients a year, or 15 percent of the nation's stroke
>victims, doctors said.
>
>Imaging specialist Dr. Joseph Polak at New England Medical Center in
>Boston said more doctors should now consider adopting the technique.
>
>"It's a relatively big impact for a disease where we don't have many >options," he said.
The study and Polak's commentary appeared Thursday in The New England
>Journal of Medicine. The research was conducted by the University of
>Texas Medical School at Houston with partners in Canada and Spain.
>
>About 700,000 people suffer strokes each year in the United States,
>making it the leading cause of serious, long-term disability, according
>to the American Stroke Association. About 163,000 died from a stroke in
>2001, third only to heart disease and cancer.
>
>Like a heart attack within the brain, a stroke happens when a clot gets
>stuck in a blood vessel and cuts off circulation. The anti-clotting drug
>TPA is sometimes given to break up the clot before brain tissue starves
>for lack of blood.
>
>Ultrasound has long been used to diagnose strokes. In recent years,
>research has intensified on whether it can also supercharge the
>clot-breaking medication.
>
>In this experiment on 126 patients, it did just that -- and impressively
>so. Within two hours, almost half of the ultrasound patients with
>blockage of the middle cerebral artery showed restored blood flow or
>dramatic recovery from symptoms. With TPA alone, only 30 percent of
>patients did.
>
>Longer-term results were also favorable -- though not statistically
>significant in this study, because of the way it was designed. After
>three months, 42 percent of ultrasound patients were symptom-free or
>living independently, compared with only 29 percent of those treated
>with TPA alone.
>
>The risk of bleeding in the brain appeared to be small and no greater
>than with TPA alone.
>
>Exactly how the ultrasound works is not well understood. But researchers
>believe it may stir up blood near the clot, like a sonic spoon, and thus
>help mix in the drug. It may also help the drug bind directly to the
>clot.
>
>"Think about the clot being inside a closed box, and the ultrasound has
>somehow opened it a bit more," Polak said.
>
>Researchers said it is also possible that the sound waves shake up the
>clot and help break it up.
>
>The technique, as it is being tested now, is used only in patients who
>are treated with TPA. And TPA cannot be given to patients suffering
>bleeding in the brain, and must be administered within three hours of
>the onset of a stroke.
>
>Researchers in this study hope to take part soon in a more definitive
>test of the technique.
>
>Dr. Robert Adams, a neurologist at the Medical College of Georgia and
>adviser to the American Stroke Association, said the findings are
>especially impressive for the first few hours of recovery, but he would
>wait for more research on the effects months later before backing wider
>use of the technique.
>
>The ultrasound equipment, known as transcranial Doppler, is fairly
>common at major hospitals for diagnosing strokes but is rarely employed
>as a treatment. That is partly because it can take months to learn how
>to pinpoint clots with the lipstick-size wand.
>
>The study's lead researcher, Dr. Andrei Alexandrov at the University of
>Texas Medical School at Houston, is working on a simpler-to-operate
>device. "There are too few skilled operators to bring this technique to
>the emergency department where it's necessary," he said. "That's the
>major problem."
>
>Some scientists are also looking into whether ultrasound, at higher
>power, can safely blast away clots by itself, without medication.
--
art fougner, md
ich bin ein New Yorker
