Carotid reconstruction was first performed by Eastcott et al. at St. Mary's Hospital, London, in 1954. However, it took nearly four decades until trial evidence became available to show that carotid endarterectomy was better than best medical treatment in patients with amaurosis fugax or hemispheric symptoms, transient ischaemic attacks, or stroke who had made a good recovery and whose symptoms were caused by severe carotid bifurcation stenosis (>70% with the North American Symptomatic Carotid Endarterectomy Trial [NASCET] method or >80% with the European Carotid Surgery Trial [ECST] method). The two-year risk of stroke in the medical arm of NASCET was 26% compared with 9% in those who underwent endarterectomy. Subsequently, the NASCET trialists reported that endarterectomy reduces the five-year risk of stroke in moderate stenosis (50%�69%) from 22.2% to 15.7%. A recent meta-analysis of the NASCET and ECST trials showed that benefit from surgery was greatest in men, patients aged 75 years or older, and those randomised within two weeks after their last ischaemic event, and fell rapidly with increasing delay.
Surgery is usually performed at six weeks if there is good recovery, but there is a tendency to perform it earlier in patients with transient ischaemic attacks or strokes with good recovery when CT brain scan shows no infarct. Surgery reduces the risk of stroke by 50% even if the event occurred more than six months previously, as shown by the Medical Research Council Asymptomatic Carotid Surgery Trial .
While recovering from stroke and awaiting carotid endarterectomy, aspirin even at a low dose of 75 mg daily reduces the risk of recurrence. .

March 09, 2009

Researchers in London have discovered a way to stop cancer cells from spreading, which may prevent the spread of the disease in about 90 per cent patients.

Scientists at the Institute of Cancer Research, a constituent college of the University of London, say that rather than concentrating on stopping the formation on tumours, they focused on singling out the enzyme that allows cancer to spread throughout the body.

The researchers say that their groundbreaking study led to the discovery that an enzyme called LOX is crucial in promoting the spread of the disease throughout a patient's body.

Lead researcher Dr Janine Erler called her team's discovery "the crucial missing piece in the jigsaw we have been searching for".

She claimed that her team was the first to have identified any such key enzyme.

"This discovery provides real hope that we can develop a drug to fight it. If we can interrupt the body's ability to prepare new locations for the cancer to spread to, we can prevent metastasis," the Daily Express quoted her as saying.

While studying breast cancer in mice, Janine's team has found that in the absence of the LOX enzyme, full name lysyl oxidase, new environments in the body would be too hostile for the cancer to grow.

The research group, which includes scientists from Stanford University, are confident that it will apply to humans and other cancer types.

Janine and her colleagues now plan to use their findings to develop drugs that can block this enzyme.

She hopes that this discovery will lead to a potential new treatment for cancer within five years.

Dr R P Shukla MD
Consultant physician & Diabetologist
Nazareth Hospital
Allahabad UP
Phone-9415214008
website-www.rpshukla.vpweb.com




Diabetes foot care



Alternative Names
Foot care for diabetics

Information
If you have diabetes you are more prone to foot problems, because the disease can damage your blood vessels and nerves. This, in turn, may make you less able to sense injury or pressure on your foot. You may not notice a foot injury until severe infection develops.

Diabetes also changes the immune system, decreasing the body's ability to fight infection. Small infections may rapidly progress to death of the skin and other tissues (necrosis). Amputation of the affected limb may be needed to save the patient's life. Improved blood sugar control can help prevent foot problems.

If you have diabetes, you are at higher risk for developing foot problems if you:

Are male

Have eye, kidney, or heart problems

Have had diabetes more than 10 years

Have poor blood glucose control

If you have diabetes, get a foot exam at least twice a year by your health care provider and learn whether you have nerve damage.

To prevent injury to the feet, check and care for your feet EVERY DAY, especially if you already have known nerve or blood vessel damage or current foot problems. Follow the instructions below.

DAILY CARE ROUTINE

Check your feet every day. Inspect the top, sides, soles, heels, and between the toes.

Wash your feet every day with lukewarm water and mild soap. Strong soaps may damage the skin.

Test the temperature of the water before putting your feet in, because the normal ability to sense hot temperature is usually impaired in people with diabetes. Burns can easily occur.

Gently and thoroughly dry the feet, particularly between the toes. Infections can develop in moist areas.

Because of skin changes linked with diabetes, the feet may become very dry and may crack, possibly causing an infection. After bathing the feet, soften dry skin with lotion, petroleum jelly, lanolin, or oil. Do not put lotion between your toes.

Ask your health care provider to show you how to care for your toenails. Soak your feet in lukewarm water to soften the nail before trimming. Cut the nail straight across, because curved nails are more likely to become ingrown.

Exercise daily to promote good circulation. Avoid sitting with legs crossed or standing in one position for long periods of time.

If you smoke, stop. It decreases blood flow to the feet.

TIPS ON SHOES AND SOCKS

Wear shoes at all times to protect your feet from injury. Otherwise, if you have poor vision and less ability to feel pain, you may not notice minor cuts or bumps.

Wear comfortable, well-fitting shoes. Never buy shoes that do not fit properly, expecting the shoes to stretch with time. Nerve damage may prevent you from being able to sense pressure from improperly fitting shoes.

Check the inside of your shoes for rough areas or torn pieces that can cause irritation.

Change your shoes after 5 hours of wearing during the day to alternate pressure points.

Avoid wearing thong sandals or stockings with seams that can cause pressure points.

Wear clean dry socks or non-binding panty hose every day. Socks may provide an extra layer of protection between the shoe and your foot.

Wear socks to bed if your feet are cold. In cold weather, wear warm socks and limit your exposure to the cold to prevent frostbite.

MORE HELPFUL TIPS

Avoid using antiseptic solutions on your feet since these can burn and injure skin.

Avoid applying a heating pad or hot water bottle to the feet. Avoid hot pavement or hot sandy beaches.

Report sores, changes, or signs of infection to your doctor immediately. Report all blisters, bruises, cuts, sores, or areas of redness.

Remove shoes and socks during visits to your health care provider. This is a reminder that you need a foot exam.

Make an appointment with a podiatrist to treat foot problems or to have corns or calluses removed. Never attempt to treat these yourself using over-the-counter remedies.

If obesity prevents you from being physically able to inspect your feet, ask a family member, neighbor, or visiting nurse to perform this important check.

References
American Diabetes Asociation. Standards of medical care in diabetes—2007. Diabetes Care. 2007; 30(Suppl.1):S4-S41.

American Diabetes Asociation. Standards of medical care in diabetes -- 2008. Diabetes Care. 2008;31:S12-S54.

Hunt D. Foot ulcers and amputations in diabetes. Clin Evid. 2006;(15):576-584.

American Diabetes Asociation (ADA). Standards of medical care in diabetes. IV. Prevention/delay of type 2 diabetes. Diabetes Care. 2007;30:S7-S8.

Inzuchhi SE and Sherwin RS. Type 2 diabetes mellitus. In: Goldman L and Ausiello D, eds. Goldman: Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 248.




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Review Date: 6/17/2008
Reviewed By: Elizabeth H. Holt, MD, PhD, Asistant Profesor of Medicine, Section of Endocrinology and Metabolism, Yale University. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.



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Nothing is more stunning than a beautiful bride in a beautiful dress with a beautiful smile. If you are getting married, what better way to prepare for your big day than having your teeth whitened or smile designing if needed? Remember�those photos will last forever. Here are some of the most common dental procedures brides-to-be can consider;
� Smile designing using Bonding or Laminates
� Porcelain Crowns
� Teeth whitening (Zoom!)
Composite restorations and bonding Procedures in which decay is removed and the tooth is repaired with a material that closely matches your natural tooth color. Bonding is an effective method used to correct a malformation of otherwise healthy tooth structure.
Porcelain Veneers A custom-made porcelain sheath that is attached directly to the facial surface of teeth. Veneers are extremely effective in producing a uniformly white smile. Veneers are used to mask misshapen, stained, chipped or cracked teeth.
Zoom! Teeth whitening If you tired of your not-so-white teeth? The latest procedures are virtually pain-free, fast and easy. The most common procedure for brides looking for a quick fix. Teeth whitening is one of the hottest cosmetic dental procedures today. The Zoom! Whitening system, as is a good example of a product that ranks high in all of these areas. Zoom! has been proven to make your teeth about eight shades whiter in as little as 45 minutes, and the results are long-lasting.
Crowns and Bridges Sometimes one or more teeth are diseased or lost and need to be extensively repaired or replaced. A number of materials are available to meet each patient�s aesthetic and budgetary requirements. Recent launch for crown and bridge is LAVA (All- ceramic) for best strength, fit and esthetics.
Dr. Vinod Chandel MDS. (Prosthodontics) AIIMS New Delhi
Advanced Dental Care,Prosthodontic and Implant Centre
SCO 157/1 Sector 37-C, Chandigarh
Phone no. 2691001, 09815131898

A beautiful smile can dazzle and sparkle, charm and entice. It says let's talk - I care - Cheer up. A smile communicates your feelings about yourself and others. Like the lines, colours, and shapes in a painting, your teeth should work together to produce a pleasing effect. A bright smile projects warmth, approval, or self-confidence.

Are you satisfied with your smile?

When you look in the mirror, are you happy with what you see? If you answer yes to any of these questions, it's likely you can benefit from cosmetic dentistry:

Do you have any stained or discoloured teeth or fillings?
Are any of your teeth crowded, overlapping, or crooked?
Are your gums red, swollen, receded, or bleeding?
Are you missing any teeth or do you have large gaps between any of your teeth?
Do any of your teeth have uneven shapes due to chips, fractures, or rough edges?
Do your teeth seem out of proportion because they are uneven in length?
If you answered yes to any of the above questions, it is likely that you have a dental problem that can produce a dull smile.
Changes Possible to Enhance your Smile

Stains: old fillings, an injury, smoking, or some foods may cause stains. Brown or grey teeth, in particular, are often a side-effect of medications taken in childhood. These stains can be got ridden off easily by cosmetic dentistry procedures.

Discoloured Teeth: They will tend to stand out and the entire attention of the person speaking to you will be directed to that one tooth.

Crooked teeth: may develop during early childhood. Not having enough space to accommodate your teeth is most likley the result of your genetic heritage.

Red gums: inflammed, puffy, red gums may bleed and pull away from the edges of your teeth. Unhealthy gums are often caused by inefficient or inadequate cleaning.

Gaps: missing teeth, gum disease or teeth too small for your mouth can produce gaps between your teeth.

Rough shape: injury or daily wear and tear can cause chips and fractures. A worn, flat look may result from grinding your teeth.



Improve your smile

Dental laminate / veneers is often a thin shell of composite or ceramic material that's bonded to a tooth, generally covering only its front and top. Dental veneers have become more popular as a relatively quick way to cosmetically improve one's smile, just like many film stars have done this too. Veneers can beautify your smile by improving the position, color and shape of one or more of your teeth. This process removes less tooth structure than doing a crown, but depends upon sound tooth being there as they are not as strong as crowns. Veneers can be used to close spaces between your teeth, lengthen small, protruded teeth, or whiten darkened teeth. And if your teeth are chipped or beginning to wear, veneers can protect them from damage and even restore their original looks.

If teeth are really dark, they can be bleached lighter first, so Veneers don't suffer from "Dark" shine through!

The Veneer is only as good as the tooth to which it is being bonded. If the underlying tooth is weak or compromised, this is obviously more likely to have problems than a strong, sound underlying tooth. A heavy bite may also fracture a Veneer during use, but this may only be discovered after "functional" chewing usage. Many patients are willing to risk this, knowing they can usually progress to a stronger crown if needed, but not committing to crown preparations with the greater tooth removal, in the first instance. Where many filled teeth are in a heavy chewing forces, then it is wiser to go for the crowns. Specific procedures for correcting each of these defects - tooth whitening, veneers, crowns, bridges, bonding, etc.
Dr. Vinod Chandel MDS. (Prosthodontics) AIIMS New Delhi
Advanced Dental Care,Prosthodontic and Implant Centre
SCO 157/1 Sector 37-C, Chandigarh
Phone no. 2691001, 09815131898