STEVEN GRINSPOON, Massachusetts General Hospital, Boston
COMMENT: JUDITH CURRIER, University of California, Los Angeles
REFERENCE: 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles February 25-28, 2007
Daily administration of an analog of growth hormone releasing factor to HIV patients receiving highly active antiretroviral therapy significantly decreased visceral fat and improved their lipid profiles. This development-stage drug, TH9507, was well tolerated and may help patients reduce central fat accumulation and abnormal lipid profiles, both of which are known cardiovascular risk factors. In addition, decreases in central fat may have a positive effect on patients’ self-image. Steven Grinspoon gave Dan Keller details during the 14th Conference on Retroviruses and Opportunistic Infections in Los Angeles.
PHILIPPE MAYAUD, London School of Hygiene and Tropical Medicine
REFERENCE: N Engl J Med 2007; 356: 790-9
In patients who are infected with both HIV and herpes simplex type 2 the activity of the AIDS virus may be diminished by therapy with one of the established anti-herpes drugs, according to the findings of a study published in the New England Journal of Medicine by authors in France, England and Burkina Faso. Philippe Mayaud talked about his results with Peter Goodwin in which HIV concentrations in the blood and vagina of patients co-infected with both herpes and HIV were found to be reduced by continuous treatment with the anti-herpes agent valacyclovir.
Withhold Trastuzumab in Low-Risk Patients with HER-2 Positive Breast Cancer?
REFERENCE: Abstract: 2090 RACHEL JOHNSON, Christie Hospital, Manchester
Some patients with HER-2 positive early breast cancer fare better if trastuzumab is withheld, according to the findings of a 1,000 patient study looking at the additional toxicity of adjuvant trastuzumab when combined with chemotherapy according to the current guidelines. In San Antonio, Rachel Johnson discussed the balance of risks among patients with node-negative mammographically detected breast cancer.
Early Breast Cancer: Exemestane Therapy Benefits After Five Years of Tamoxifen
REFERENCE: Abstract 49 TERRY MAMOUNAS, Aultman Cancer Center, Canton OH The use of the aromatase inhibitor exemestane after five years of tamoxifen therapy in postmenopausal patients with early breast cancer brought further benefits. Terry Mamounas told Peter Goodwin about his group’s results from the National Surgical Adjuvant Breast and Bowel Project B-33, which he presented in San Antonio.
Fulvestrant Or Exemestane When Aromatase Inhibition Fails Initially?
REFERENCE: SABCS 2006 Abstract: 12 WILLIAM GRADISHAR, Northwestern University, Chicago
Both fulvestrant and exemestane were found to be equally effective for treating patients with advanced breast cancer, after disease progression following initial aromatase inhibitor therapy. William Gradishar discussed the findings of the EFFECT trial with Karen Regester.
WADE SMITH, University of California, San Francisco
REFERENCE: Abstract No. LB5
Mechanical removal of the clot that’s causing an acute stroke is showing promising early signs, and is safe. The first of a new generation of the MERCI (Mechanical Embolus Removal in Cerebral Ischemia) devices for removing clots has compared favorably to its predecessors and can also be used in patients for whom the standard therapy, thrombolysis, has failed. Wade Smith on behalf of the MERCI investigators talked to Helen Morant about the results.
REFERENCE: Abstract No. LB2
Treating high blood sugar in the acute phases of stroke doesn’t reduce risk of death or severe disability, the GIST – UK (Glucose Insulin in Stroke Trial) has found. This is despite other trials reporting that high glucose levels are associated with increased risk of stroke. Investigators also found that treating glucose levels aggressively lowered blood pressure. To discuss this surprise result, and the background to the trial, Helen Morant talked to Chris Gray.
REFERENCE: Abstract 456
Two simple bedside tests could be added to the NIHSS to make it more accurate, researchers claim. The team from Johns Hopkins University evaluated a range of cognitive tests for stroke patients and found that two corresponded particularly well to the size of the stroke on MRI scan. Rebecca Gottesman spoke to Helen Morant about why she thinks the NIHSS needs changing.
REFERENCE: Abstract 434
Stroke patients may be going through pointless tests, according to a poster presented by researchers at the Trillium Health Centre in Ottawa. The Stroke clinic there looked at whether routinely ordered tests, trans thoracic echo and 24 hour rhythm monitoring, actually changed patients’ treatment, and found that generally, the results of these tests didn’t change a thing. Helen Morant talked to Nicole Pageau about their findings.
FELIPE ALBUQUERQUE, Barrow Neurological Institute, Phoenix
REFERENCE: Abstract 102
The Wingspan stent is a new approach to keeping open the atherosclerotic intracranial vessels of stroke and TIA patients. Early results presented to the San Francisco Conference suggest that it doesn’t harm patients, but that it seemed to block fairly quickly, Felipe Albuquerque talked to Helen Morant about these much anticipated results.
PETER SCHELLINGER, University Clinic of Erlangen, Germany
REFERENCE: Abstract 2
MRI scanning could make it possible to treat stroke patients safely and effectively with thrombolytics such as tPA beyond the recommended 3 hour window. The International Stroke Conference heard analysis of pooled data from five European Stroke Centers that compared CT and treatment within 3 hours with the use of MRI plus treatment either within 3 hours or longer than this. After his presentation in San Francisco Peter Schellinger explained the study to Helen Morant.
REFERENCE: Abstract No. 17
Patients with carotid artery stenosis run much lower risks of further events if treated aggressively with a statin, according to a study reported at the International Stroke Conference in San Francisco by Henrik Sillesen. Of 1,000 patients in the Stroke Prevention By Aggressive Reduction of Choleseterol Levels (SPARCL) study with documented carotid stenosis, those who received high-dose atorvastatin had a reduced need for endarterectomy in the follow up period. The aggressive statin treatment was as effective as endarterectomy at preventing future strokes. Helen Morant talked to Henrik Sillesen about the promise of this medical approach to treating such high-risk patients.
SADAF FAROOQI, Addenbrooke’s Hospital, Cambridge UK
REFERENCE: N Engl J Med 2007; 356:237-47
Gene defects and mutations could be markers for early onset obesity. This is according to a study published in the New England Journal of Medicine which concludes that the leptin receptor should be further explored as a cause of obesity, along with other genetic factors emerging from a multinational study called: the Genetics of Obesity Study. Sarah Maxwell heard the latest from Sadaf Farooqi in Cambridge, England.
REFERENCE: Lancet 2007; 369:208
A trial that randomised older adults to receive a folic acid supplement or placebo has shown that folic acid can significantly improve cognitive performance in older individuals. Jane Durga in Lausanne told Sarah Maxwell about the study findings and the hopes these may hold out.