Adjunctive therapy with poloxamer 188 resulted in substantial benefit in this randomized trial, including significantly smaller infarcts, greater myocardial salvage, better left ventricular function, and a lower incidence of in-hospital reinfarction. Although the mechanisms are unproven, poloxamer 188 treatment may accelerate thrombolysis, reduce reocclusion, and ameliorate reperfusion injury.

SYNOPSIS A retrospective study of strokes due to ischemic cerebrovascular disease in young adults was undertaken, and the incidence of migraine as an etiologic factor was studied. Within the last five years, fifteen patients between the ages of twenty and forty were admitted to the USAF Medical Center Wright‐Patterson with the diagnosis of stroke due to ischemic cerebrovascular disease. These patients underwent extensive evaluations including CT scan and/or cerebral angiography. In four patients (27%), there was a previously documented history of classic migraine. Three patients experienced migraine attacks at the time of their stroke. The fourth had an antecedent history of classic migraine with basilar artery migraine symptoms, and suffered a lateral medullary syndrome. The remaining data are as follows: 3 patients (20%) had valvular heart disease, 1 patient had sickle cell anemia, 1 patient had a dural sinus thrombosis following infection and 6 patients (40%) had no discernible etiology. We conclude that migraine may represent a more common etiology of stroke in young adults than has been previously recognized.

Adenosine is an endogenously produced compound that has significant effects as a coronary and systemic vasodilator. Previous studies suggest that intravenous infusion of adenosine, coupled with thallium-201 scintigraphy, may have specific value as a noninvasive means of evaluating coronary artery disease. The purpose of this study was to compare the diagnostic value of adenosine thallium testing with that of standard exercise thallium testing. One hundred subjects were studied with exercise thallium imaging and thallium imaging after adenosine infusion, including 47 with angiographically proved coronary artery disease and 53 control subjects. The overall sensitivity of the thallium procedures was 81% for the exercise study and 83% for the adenosine study (p = NS); the specificity was 74% for the exercise study and 75% for the adenosine study (p = NS). The diagnostic accuracy of the exercise study was 77% and that of the adenosine study was 79%. Ninety-four percent of subjects had an adverse effect due to the adenosine infusion; however, most of these effects were mild and well tolerated. All adverse effects abated within 30 to 45 s of the termination of the study, consistent with the very brief half-life of the agent. Thus, thallium-201 scintigraphy after intravenous infusion of adenosine has a diagnostic value similar to that of exercise thallium testing for evaluation of coronary artery disease. Adenosine thallium testing may be particularly useful in evaluating patients unable to perform treadmill exercise testing.

No abstract