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Hyperbaric oxygen may reduce ischemic de cits temporarily but has no sustained effect Induced hypothermia limits the size of ischemic stroke, but it is technically dif cult to administer and often has serious side effects Calcium channel blockers of the types administered for cardiac disease have also been found to increase CBF and to reduce lactic acidosis in stroke patients However, several multicenter clinical trials that compared calcium channel blockers with placebo did not establish a difference in outcome in the two groups There has also been interest, as noted earlier in this chapter, in drugs that inhibit excitatory amino acid transmitters and free-radical scavengers such as dimethyl sulfoxide (DMSO) and growth factors, but so far none of these has been successfully applied to humans Despite some experimental evidence that certain vasodilators, such as CO2 and papaverine, increase CBF, none has proved bene cial in carefully studied human stroke cases at the stage of TIAs, thrombosis in evolution, or established stroke Vasodilators may actually be harmful, at least on theoretical grounds, since by lowering the systemic blood pressure or dilating vessels in normal brain tissue (the autoregulatory mechanisms are lost in vessels within the infarct), they may reduce the intracranial anastomotic ow Moreover, the vessels in the margin of the infarct (border zone) are already maximally dilated New discoveries regarding the role of nitric oxide in vascular control will probably give rise to new pharmacologic agents, which will have to be evaluated Surgery and Angioplasty for Symptomatic Carotid Stenosis Comments have already been made concerning the opening of an occluded carotid artery soon after a stroke Here we discuss the patient who has passed the acute period, when surgery is safer, or who has TIAs The region that most often lends itself to such therapy is the carotid sinus (the bulbous expansion of the internal carotid artery just above its origin from the common carotid) Other sites suitable for surgical management include the common carotid, innominate, and subclavian arteries Operation on the vertebral artery at its origin has proved successful only in exceptional circumstances In recent years balloon angioplasty and stenting of the carotid artery have become increasingly popular as an alternative to surgery (see below) Surgery and angioplasty, in our opinion, are as yet applicable mainly to the group of patients with symptomatic carotid artery stenosis (the asymptomatic ones are discussed below) who have substantial extracranial stenosis but not complete occlusion, and, in special instances, in those with nonstenotic ulcerated plaques Those with stenosis constitute less than 20 percent of all patients with TIAs (Marshall); but from the perspective of surgical therapy, the term symptomatic encompasses both TIAs and small strokes ipsilateral to the stenosis There is now convincing evidence that well-executed surgery in appropriately chosen cases arrests the TIAs and diminishes the risk of future strokes These views have received strong af rmation from two well-designed randomized studies the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST) The conclusion, reached in each of these studies, was that carotid endarterectomy for symptomatic lesions causing severe degrees of stenosis ( 70 to 80 percent reduction in diameter) is effective in reducing the incidence of ipsilateral hemispheral strokes These two trials differed in the method of estimating the degree of stenosis, but when adjustments are made, the results are comparable (Donnan et al) Patients in the European study with mild or moderate stenosis (up to 70 percent) did not bene t from endar-.

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the Dow can lose years worth of growth and value in a day or a week, the supportive technical capital becomes faithless and sidelined Support does not hold because the response to the threat of loss activates the ight instinct in us, and we tend to run away Technical trading has a place in the market and is an excellent draw for speculative capital and liquidity In today s marketplace managed index funds and hedge funds are chock full of technical analysts, which means that the majority of the markets capital power is focused on technical aspects to some degree Under normal market conditions certain technical indicators can be relied on because of the number and wealth of investors using those indicators It is important to study the popular indicators and to try and get an idea of what kind of investors are using them We don t put a signi cant number of indicators on our charts in this book because indicators are often trendy and change frequently, and these indicators are not necessarily relevant to our option discussion Some analysts base their trading decisions on several if not dozens of indicators If these analysts represent signi cant capital, their methodology may be hard to discover, so when you manage risk with competing capital large or small, you must understand the main characteristics of the technical trade and follow your own guidelines On the ip side of this you have fundamentalists who base their trading on hard evidence Fundamentals are things like balance sheets, price to earnings ratios, company news, weather, and so forth Fundamentalists believe rmly in the validity of their research and probably have a more substantial argument on the reality of their systems than technical traders Past performance is not an indicator of future results This disclaimer can apply to just about every product in the investment industry, and it is especially the case with technical and fundamental trading Can you realistically say that, since the weather.