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3067. Systematic review of evidence on thrombolytic therapy for acute ischaemic stroke.
Recent trials of thrombolytic therapy in acute ischaemic stroke have given apparently conflicting results. Only one trial, the National Institute of Neurological Disorders and Stroke trial of tissue plasminogen activator (tPA), suggested that thrombolysis was definitely beneficial. To make sense of these results, we have done a systematic review of all available randomised trials of thrombolysis in acute ischaemic stroke.
3070. Evidence-based diagnostic radiology.
The radiological community has a long track record of self-examination, starting well before evidence-based medicine came of age. It had to produce such evidence to prove the need for and win funds for its expensive gadgets. The assessment of new tests is easier than proving the value of well-established ones, and in scrutinising the evidence base for an imaging technique a balance must be struck between apparent (eg, diagnostic) benefit and real benefit to the patient. And even when there is a wealth of good evidence healthy debate continues. So radiology may be ahead of some other disciplines in considering the evidence for its daily practice. For example, where is the evidence for the routine clinical examination-and might the radiologist with a chest X-ray and abdominal ultrasound do better?
3072. Chronic infections and coronary heart disease: is there a link?
A large number of studies have reported on associations of human coronary heart disease (CHD) and certain persistent bacterial and viral infections. We review the epidemiological and clinical evidence on CHD and Helicobacter pylori, Chlamydia pneumoniae, and cytomegalovirus (CMV), as well as possible mechanisms. The association between CHD and H pylori may be accounted for by residual confounding from risk factors. Although the association between C pneumoniae and CHD is stronger, the sequence of infection and disease is uncertain. As regards CMV, a limited number of patients with classic atherosclerotic coronary artery disease have been studied. Further studies are needed to resolve these uncertainties.
3074. Interventional radiology.
One of the most interesting things about interventional radiology is how techniques have been borrowed from other areas. The lateral thinking which characterises this new specialty has allowed it to flourish even while it has lost "turf" to other specialties. Inevitably, primary referral to interventional radiologists will happen in the same way as referral to, say, surgeons or cardiologists dose already. Those who administer health funds and medical education will need to adjust to this new situation. This article provides examples of many treatment tasks that the interventional radiologist now tackles.
3076. Radiological sciences, past and present.
Few observations can have been as rapidly and widely disseminated in medicine as the diagnostic X-ray (radiograph). The first few decades after Röntgen's discovery saw technical developments that made radiography more practical, quicker, safer for both imager and patient, and able to achieve greater contrast. This article reviews the history of imaging but it also looks to the future and begins to open up some of the issues that radiology faces in the 21st century--issues that the next six articles in this Lancet series will enlarge upon. The conventional radiograph remains the most common medical image but a host of new techniques have come along. Are they research tools, clinical methods, or both--and how, in an age of sensitivity about the costs of health care, do they stand up?
3079. Conformational disease.
Several diverse disorders, including the prevalent dementias and encephalopathies, are now believed to arise from the same general disease mechanism. In each, there is abnormal unfolding and then aggregation of an underlying protein. The gradual accumulation of these aggregates and the acceleration of their formation by stress explain the characteristic late or episodic onset of the clinical disease. The understanding of these processes at the molecular level is opening prospects of more rational approaches to investigation and therapy.
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