The timing of carotid endarterectomy post stroke.

The timing of carotid endarterectomy (CEA) post stroke remains a controversial area. Most authorities have advocated waiting at least 2 to 6 weeks after stroke before performing a CEA. More recently, these recommendations have been challenged. This article reviews the background leading to advocacy of delayed CEA after stroke, current literature recommendations regarding CEA after subacute stroke, current literature regarding neuroradiologic imaging findings and their implications in decision making regarding CEA after stroke, and the role of CEA for stroke in evolution.

Synthesis and evaluation of antitumor activity of novel N-acyllavendamycin analogues and quinoline-5,8-diones.

A series of 7-N-acyllavendamycins with zero, one or two substituents at the C-2', C-3', and C-11' were synthesized through short and efficient methods. Pictet-Spengler condensation of 7-N-acylamino-2-formylquinoline-5,8-diones with tryptamine or tryptophans produced the desired lavendamycins. Screening data on a panel of three ras oncogene-transformed cell lines and the non-transformed parent cell line showed that a significant number of these analogues are potent antitumor agents and appear to be particularly active against K-ras transformed cells. Compared with the corresponding quinolinediones, these novel lavendamycins are much more inhibitory toward the transformed cells indicating that the beta-carboline moiety of the lavendamycin analogues plays an important role in its potency and selective toxicity.

The timing of carotid endarterectomy post stroke.

Despite the earlier accepted notion that CEA should be delayed 4 to 6 weeks after a stroke, current evidence suggests that CEA may be performed safely earlier than this in most patients who have mild to moderate deficits once symptoms stabilize. The gray areas, however, remain gray, as outlined. Crescendo TIAs are urgent cases in the authors' practice; others advocate a more moderate delayed approach in such cases. Almost everyone agrees that propagating intraluminal thrombus is treated best with a moderate delayed approach that allows the thrombus to resolve first with anticoagulants. Acute carotid occlusion must be assessed on an individual basis: cases that occlude under observation should be explored immediately; cases that come from the field with profound deficits have dismal outcomes, but even here surgery may be effective in salvaging a small group of good functional survivors, and the natural history without surgery is atrocious. Surgery for stroke in evolution is associated with higher morbidity and mortality rates; selected patients may benefit from emergency surgery. A final thought is that for patients who have routine TIA or small stroke, with minimal imaging evidence of infarction or mass effect, a stable deficit, and a normal level of consciousness, there is no reason to empirically delay carotid reconstruction, and patients are served best by a fast-track approach to surgical treatment.

Cladophialophora bantiana brain abscess in a solid-organ transplant recipient: case report and review of the literature.

Cerebral phaeohyphomycosis caused by Cladophialophora bantiana is a rare disease. We describe a heart and bilateral lung transplant recipient who was unsuccessfully treated for a C. bantiana brain abscess. This report compares the present case to those of other solid-organ transplant recipients with the same infection and to those of patients who did not receive transplants.