June 8, 2000
"Our findings reinforce the idea that the use of natural herbal medicine may not be without risk."		Urothelial Carcinoma Associated with the Use of a Chinese Herb A manufacturing error introduced a nephrotoxic and carcinogenic plant, aristolochia, into a mixture of Chinese herbs used in Belgium for weight reduction. Irreversible renal failure developed in some people who took this product. Indications that patients with Chinese-herb nephropathy are also prone to urinary tract cancers prompted the removal of the nonfunctioning kidneys and ureters from 39 such patients. Cancer of the ureter or renal pelvis was found in 18 of the 39.
		Stroke in Asymptomatic Carotid-Artery Stenosis In patients with asymptomatic stenosis of the internal carotid artery, the risk of stroke has not been carefully documented. Among 1820 patients without symptoms of carotid-artery stenosis, the risk of stroke over five years was relatively low but increased with the severity of stenosis. Nearly half of all strokes that occurred in these patients were lacunar or cardioembolic in origin and were not directly related to the carotid stenosis. These observations have implications for the use of carotid endarterectomy in patients with asymptomatic carotid stenosis.
"A transjugular intrahepatic portosystemic shunt can improve the chance of survival without the need for liver transplantation."		Paracentesis and Transjugular Intrahepatic Portosystemic Shunting for Ascites The outcome of large-volume paracentesis and the creation of a transjugular intrahepatic portosystemic shunt for severe ascites was compared in patients with cirrhosis. During several years of follow-up, many patients in both groups died and a few required liver transplantation. Treatment with the shunt was associated with a higher survival rate without the need for liver transplantation. The frequency of hepatic encephalopathy was similar in the two groups.
		Long-Term Follow-up of Pallidotomy in Advanced Parkinson's Disease Although the short-term benefits of posteroventral medial pallidotomy for advanced Parkinson's disease have been well documented, little is known about the long-term outcome. In this long-term follow-up study of 40 patients who underwent unilateral pallidotomy between 1993 and 1996, 20 patients could not be evaluated because they had a second procedure or for other reasons. A mean of 52 months after surgery, the other 20 patients still had significant reductions in contralateral parkinsonism and medication-related dyskinesia.