Showing papers by "Peter M. Rothwell published in 1999"

Seasonality of birth in children with diabetes in Europe: multicentre cohort study

Abstract: There is increasing evidence that environmental factors in early life, particularly viral infections, influence the risk of developing type 1 (insulin dependent) diabetes.1 The high incidence of diabetes in the congenital rubella syndrome suggests that intrauterine infection may be important,1 and the high incidence of enteroviral infection during pregnancy in the mothers of children who subsequently develop type 1 diabetes suggests that other viruses may also be involved.2 Since most common viral infections are seasonal, if a significant proportion of cases of childhood diabetes were caused by intrauterine infection it might be expected that the pattern of dates of birth of affected individuals would be abnormal. We previously reported abnormal seasonality of birth in three large independent populations of children with type 1 diabetes in the United Kingdom,3 and a similar pattern has since been reported in the Netherlands.4 To determine whether regional variation in …

Carotid endarterectomy for recently symptomatic carotid stenosis: consistent results from two large randomized controlled trials.

Abstract: Atherothrombotic stenosis at or around the carotid bifurcation is associated with an increased risk of ipsilateral carotid territory ischaemic stroke. This risk is reduced, in certain patients, by carotid endarterectomy. Approximately 140 000 operations are now performed each year in the U.S.A., and rates continue to rise in Europe. Two large randomized controlled trials of carotid endarterectomy plus best medical treatment vs best medical treatment alone have recently reported final results. Although there were some methodological differences between the trials, the overall results were remarkably similar. Broadly speaking, clinically important benefit from carotid endarterectomy appears to be limited to patients with severe carotid stenosis: 80–99% stenosis by the method of measurement used in the European Carotid Surgery Trial (ECST) and 50–99% by the method of measurement used in the North American Symptomatic Carotid Endarterectomy Trial (NASCET). Whether or not endarterectomy is beneficial is determined by the balance between the risk of ipsilateral ischaemic stroke without surgery and the risk of stroke and death due to the operation itself. Patients at greatest risk of stroke on medical treatment are likely to have the most to gain from surgery. The analyses of the recent randomized controlled trials of endarterectomy were therefore stratified by the degree of stenosis of the symptomatic carotid artery; a powerful predictor of stroke risk on medical treatment. However, comparison of the trial results is complicated by the use of different methods of measurement of the degree of stenosis on prerandomization angiograms; the NASCET method underestimating stenosis compared to the ECST method. Stenoses reported to be 70–99% in the NASCET trial were equivalent to 80–99% by the ECST method, and stenoses reported to be 70–99% by the ECST trialists were 50–99% by the NASCET method. There have, in fact, been five randomized controlled trials of endarterectomy in patients with