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14 Vascular Disease Prevention, 2004, Vol. 1, No. 1 [91] [92] Gardner AW. The effect of cigarette smoking on exercise capacity in patients with intermittent claudication. Vasc Med 1996; 1: 1816. Cameron HA, Waller PC, Ramsay LE. Drug treatment of intermittent claudication: a critical analysis of the methods and findings of published clinical trials, 1965-1985. Br J Clin Pharmacol 1988; 26: 569-76. Diehm C, Kuhn A, Strauss R, Hubsch-Muller C, Kubler W. Effects of regular physical training in a supervised class and additional intravenous prostaglandin E1 and naftidrofuryl infusion therapy in patients with intermittent claudication--a controlled study. Vasa 1989; 28 Suppl: 26-30. Scheffler P, de la Hamette D, Gross J, Mueller H, Schieffer H. Intensive vascular training in stage IIb of peripheral arterial occlusive disease. The additive effects of intravenous prostaglandin E1 or intravenous pentoxifylline during training. Circulation 1994; 90: 818-22. Ernst E, Kollar L, Resch KL. Does pentoxifylline prolong the walking distance in exercised claudicants? A placebo-controlled double-blind trial. Angiology 1992; 43: 121-5. Ehrly AM. Improvement of the flow properties of blood: a new therapeutical approach in occlusive arterial disease. Angiology 1976; 27: 188-96. Angelkort B, Maurin N, Boateng K. Influence of pentoxifylline on erythrocyte deformability in peripheral occlusive arterial disease. Curr Med Res Opin 1979; 6: 255-8. Johnson WC, Sentissi JM, Baldwin D, Hamilton J, Dion J. Treatment of claudication with pentoxifylline: are benefits related to improvement in viscosity? J Vasc Surg 1987; 6: 211-6. Angelkort B, Kiesewetter H. Influence of risk factors and coagulation phenomena on the fluidity of blood in chronic arterial occlusive disease. Scand J Clin Lab Invest 1981; 156 Suppl: 185-8. Dawson DL, Zheng Q, Worthy SA, Charles B, Bradley DV Jr. Failure of pentoxifylline or cilostazol to improve blood and plasma viscosity, fibrinogen, and erythrocyte deformability in claudication. Angiology 2002; 53: 509-20. Di Perri T, Guerrini M. Placebo controlled double blind study with pentoxifylline of walking performance in patients with intermittent claudication. Angiology 1983; 34: 405. Roekaerts F, Deleers L. Trentl 400 in the treatment of intermittent claudication: results of long-term, placebo-controlled administration. Angiology 1984; 35: 396406. Strano A, Davi G, Avellone G, Novo S, Pinto A. Double-blind, crossover study of the clinical efficacy and the hemorheological effects of pentoxifylline in patients with occlusive arterial disease of the lower limbs. Angiology 1984; 35: 45966. Lindgarde F, Jelnes R, Bjorkman H, et al. Conservative drug treatment in patients with moderately severe chronic occlusive peripheral arterial disease: Scandinavian Study Group. Circulation 1989; 80: 154956. Porter JM, Cutler BS, Lee BY, et al. Pentoxifylline efficacy in the treatment of intermittent claudication: multicenter controlled double-blind trial with objective assessment of chronic occlusive arterial disease patients. Heart J 1982; 104: 66 Dettori AG, Pini M, Moratti A, et al. Acenocoumarol and pentoxifylline in intermittent claudi-cation: a controlled clinical study. The APIC Study Group. Angiology 1989; 40: 237-48. Reilly DT, Quinton DN, Barrie WW. A controlled trial of pentoxifylline 6rental 400 ; in intermittent claudication: clinical, haemostatic and rheological effects. N Z Med J 1987; 100: 445-7. Gallus AS, Gleadow F, Dupont P, Walsh J, Morley AA, Wenzel A, et al. Intermittent claudication: a double-blind crossover trial of pentoxifylline. Aust N Z J Med 1985; 15: 402 Girolami B, Bernardi E, Prins MH, Ten Cate JW, Hettiarachchi R, Prandoni P, et al. Treatment of intermittent claudication with physical training, smoking cessation, pentoxifylline, or nafronyl: a meta-analysis. Arch Intern Med 1999; 159: 337-45. Moher D, Pham B, Ausejo M, Saenz A, Hood S, Barber GG. Pharmacological management of intermittent claudication: a metaanalysis of randomised trials. Drugs 2000; 59: 1057-70. Hood SC, Moher D, Barber GG. Management of intermittent claudication with pentoxifylline: meta-analysis of randomized controlled trials. CMAJ 1996; 155: 1053-9. Ernst E. Pentoxifylline for intermittent claudication. A critical review. Angiology 1994; 45: 339-45. [113] [114]. Antipsyhotics, Anxiolytics except buspirone, tricyclics, barbiturates, meprobamate, older sedative hypnotics, metoclopramide, esp. polypharmacy, many anticonvulsants, Sinemet, Eldepryl, theophylline Trental, Permax, Requip, Mirapex and pheniramine. In the UK, a Police Elimination Database PED ; has been implemented. So far there are c.65, 000 contributors to this database. Samples from the crime scene are checked against the database but only against those officers who were investigating a given crime scene 5 ; A staff elimination database comprising staff working in the DNA unit has been implemented. All samples are checked against the database. This database is extended to visitors, maintenance staff etc. 6 ; Any `unexplained' profiles e.g. profiles appearing in negative controls or quality control checks also go onto a searchable database. 7 ; As part of automation, which uses micro-titre plate format, software is used to highlight potential `splash-over' events where aerosol from one well may occasionally affect adjacent wells - identified by profiles that contain matching alleles albeit in admixture ; . Nevertheless, no matter how many precautions are employed there is still a certain amount of background contamination that is inevitable. Low level contamination tends to be sporadic i.e. tube specific ; and partial. The logical consequence of this is that a negative control does not give confidence that the associated batch of extractions is contaminant free [23]. The only exception to this is when the contaminant is observed both in the negative control and in an associated extraction tube s ; , in which case the contamination is considered gross i.e. multiple events that are possibly reagent based. Gill and Kirkham [22] suggest that negative controls cannot be used to assign confidence that an associated extraction batch is contamination free. However, because negatives controls are effectively a microcosm of casework samples albeit supposedly DNAfree ; then by careful monitoring, they can be useful to measure the amount of contamination that is pervasive in the process. Thompson et al. [25] suggest that any error rate must reduce the likelihood ratio reported in a case. However, contamination rates do not equate to error rates. Each case is effectively associated with a probability of error [22] that is dependent upon multiple factors such as the quantity of DNA analysed; whether there are multiple stains; the kind of stain analysed. To build an analysis based on multiple variables requires a different approach. This can be accomplished by the use of probabilistic frameworks which are used to simplify the data analysis, otherwise known as `Bayes nets'; see for example [26] for an explanation and [27] for a practical illustration of its use in a forensic case that incorporated multiple probabilistic variables. Lowe et al [28, 29] showed that there is a difference between individuals in their tendency to deposit DNA on an item when it is touched. A good DNA-shedder may leave behind a full DNA profile immediately after hand washing, whereas poor DNA-shedders may only do so after their hands have not been washed for c. 6h. Secondary transfer was also demonstrated this is where a good shedder's-DNA individual A ; was transferred onto the hands of a poor shedder individual B ; , by hand-holding for 1 minute, and thence onto an object held by individual B i.e. transfer follows sequentially: ABobject. On analysis, DNA from individual A could be demonstrated, but usually always in admixture with individual B. The persistence of A's DNA was short-lived on B's hand such that periods of time 1hour after initial contact with B were sufficient to greatly reduce the propensity of secondary transfer. In reality, secondary transfer is unlikely to be realistic unless the contact of A with B has been immediately before the crimeevent itself, although [30] recently claimed the persistence of DNA for at least 10 days after initial contact after simulated strangulation of a living `victim'. Alessandrini et al. [31] compared recovery of fingerprint DNA from glass, wood, metal demonstrating that the "shedder status" ie the ability of the donor to shed DNA was the most important contributing factor to success rates. New extraction methods have been developed to remove DNA from latent fingerprints on ordinary paper after chemical enhancement [32]. Elliott et al. [33] have adapted a 141!

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Pay careful attention to fluid balance, if fluids are being given intravenously, in order to avoid over- and underhydration. Make a rapid initial check of the blood glucose level, and monitor frequently for hypoglycaemia. If this cannot be done, give glucose see page 18 ; . Examine the optic fundi by ophthalmoscope. This may help in differential diagnosis, and rarely will reveal papilloedema, which is a contraindication to performing a lumbar puncture. Retinal haemorrhages may be seen Fig. 3 ; , but these do not influence management. Make sure you look for other treatable causes of coma see page 18 ; . Meningitis should be excluded by lumbar puncture ; or covered by treatment see page 22 ; . Look for and manage any other complicating or associated infections. Record urine output and look for the appearance of black urine haemoglobinuria ; or oliguria which may indicate acute renal failure see pages 10, 16 and 25 ; . Monitor the core temperature preferably rectal temperature ; , respiratory rate and depth, blood pressure, level of consciousness and other vital signs regularly. These observations will allow you to identify the late onset of important complications such as hypoglycaemia, metabolic acidosis, pulmonary oedema and shock. Reduce high body temperatures 39 C ; by tepid sponging and fanning. Administer paracetamol as an antipyretic if necessary see pages 10, 24 and 29 ; . If the patient goes into shock, take blood cultures but start antibiotics without waiting for blood culture results. Monitor the therapeutic response, both clinical and parasitological, by regular observations and blood films and quinine.

Tabled values are mean SD ; . Readings after ESRD 10 patients in low-dose group, 8 patients in high-dose group ; are excluded. Medians presented for urine protein and triglycerides due to extreme skewness. Hgb, hemoglobin; Hct, hematocrit. b P 0.05 for significant change from baseline to 12 mo. There were no significant changes from baseline to 24 mo.

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