017). Including perioperative events at 2 years, there were no differences between groups in ipsilateral stroke, any stroke, disabling stroke, death, or any stroke or death.Comment: The study is interesting in that it suggests that the choice of CEA technique may influence periprocedural events but not long-term ipsilateral stroke or overall death. The limitations of this study are obvious: it used a nonrandomized post hoc analysis, with no information about why one CEA technique was chosen over the other, and lacked a blinded outcome assessment. The authors also note that an infinite hazard ratio confidence interval for ipsilateral stroke Ͼ30 days and the wide odds ratio confidence intervals for death rates indicate that, statistically, a substantial technique-dependent effect has not truly been ruled out by this study. Nevertheless, this was an independently monitored, multicenter study and therefore may have more generally applicable and accurate data than a single-center study.

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Surgical revascularization for lower extremity native artery occlusions is more effective and durable than thrombolysis. Thrombolysis used initially provides a reduction in the surgical procedure for a majority of patients; however, long-term outcome is inferior, particularly for patients who have an FP occlusion, diabetes, or critical ischemia.

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Background and Purpose-Detection of large, hypoattenuated brain-tissue volume on hyperacute CT scan has been suggested as an exclusion criterion for early intravenous tissue plasminogen activator (IV-tPA) treatment. This study assessed the reliability of detection for these findings and their relationship to outcome. Methods-Fifty hyperacute CT scans (Ͻ6 hours after ictus) were selected from a randomized trial evaluating IV-tPA (ATLANTIS trial). Three neuroradiologists blinded to all clinical information evaluated scans for degree of MCA territory involvement (Ͻ33% or Ͼ33%) and the presence of a hyperdense MCA. Evaluations were compared with 24-hour scan results, 30-day infarct volumes, and baseline NIH stroke scale scores (NIHSS). Results-Readers reliably evaluated the degree of MCA territory hypodensity (intraclass correlationϭ0.53, PϽ0.001), with all 3 readers agreeing in 36 of 50 cases (72%). They correctly called Ͼ33% involvement with a sensitivity of 60% to 85% and a specificity of 86% to 97%. The baseline NIHSS was higher when Ͼ33% MCA hypodensity was seen (Pϭ0.021). Detection of significant hypodensity (Ͼ33%) correlated with poorer outcome. When Ͼ33% hypodensity was not detected, mean 30-day infarct volumes were 27.0 to 33.0 cm 3 , versus 84.3 to 123.1 cm 3 when Ͼ33% hypodensity was present (Pϭ0.002). Conclusions-Detection of MCA territory hypodensity on hyperacute CT scans is a sensitive, prognostic, and reliable indicator of the amount of MCA territory undergoing infarction. (Stroke. 1999;30:389-392.)

Some children with juvenile hypothyroidism exhibit unexplained precocious puberty. Interaction of TSH with the human FSH receptor (hFSH-R) is a possible pathophysiological mechanism for this syndrome that has not been explored due to the lack of hFSH-free TSH preparations and the scarcity of a suitable hFSH-R-based assay system. To devise an in vitro FSH bioassay suitable for exploring this mechanism, we expressed hFSH-R complementary DNA in COS-7 cells and stimulated them with recombinant hTSH (rec-hTSH). Rec-hTSH elicited a dose-dependent cAMP response in the in vitro hFSH-R bioassay; however, the concentration of rec-hTSH required for half-maximal stimulation was several logs greater than that of hFSH. Rec-hTSH acted as a competitive inhibitor of hFSH at the hFSH-R, indicating that hTSH and hFSH are acting through the same receptor, namely the hFSH-R. This provides a potential novel mechanism for the precocious puberty of juvenile hypothyroidism.

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Background: After removal of differentiated thyroid carcinoma (DTC), serum thyroglobulin (Tg) can indicate persistent or recurrent disease. We describe two novel two-step assays designed to measure low Tg concentrations. Methods: We evaluated prototypes of the new IRMA, DYNOtest® Tg-pluS, and the new immunoluminometric assay (ILMA), LUMItest® Tg-pluS. In the first step, a high-salt incubation buffer leads to dissociation of Tg-Tg antibody complexes in serum and is intended to reduce nonspecific interference and interference of potential Tg autoantibodies in the system. We studied recovery of human Tg (from thyroid glands) added to horse serum. We also studied 58 patients with DTC in whom Tg values under thyroid-stimulating hormone (TSH) suppression and TSH stimulation (without thyroxine) were available. Results: The detection limits were 0.04 μg/L Tg for the IRMA and 0.02 μg/L for the ILMA. Intraassay imprecision (CV) was <10% over the range of the calibration curve in both assays. The day-to-day CV was <20% at 0.2 μg/L for the IRMA and at 0.06 μg/L for the ILMA. No high-dose hook effect was seen with up to 200 000 μg/L added Tg or in dilutions of 12 patient sera with Tg values of 307–38 880 μg/L. Mean recovery of 50 μg Tg/L was 96% in those patients. Among 77 samples with Tg antibody values of 65.2–8150 kilounits/L, recovery by the IRMA was disturbed in 7 cases (9%) and by the ILMA in 9 cases (12%). Tg increased as measured in both assays in 50 of 58 patients after thyroxine withdrawal. Conclusions: The new assays have improved precision for Tg <1 μg/L, and even low measured Tg concentrations respond physiologically to thyroxine withdrawal. The assays are free of a high-dose hook effect up to a Tg concentration of at least 38 000 μg/L and may further reduce Tg antibody interference.