Young African-Americans Run Higher Risk of Stroke
Evidence Suggests Jefferson, Latrobe Influenced Davidge
Orioles, MBNA America Team Up with Shock Trauma to Reward "Saves"
Club Foot Treatment Does Not Require Major Surgery

Young African-Americans Run Higher Risk of Stroke

Black men under 45 are three to five times more likely to have a stroke than white men in the same age group, a University of Maryland neurology research team reported. The risk of stroke in black women under 45 is four times higher than in white women of comparable age, according to Steven J. Kittner, MD, associate professor of neurology at the School of Medicine.

The risk of stroke in black women under 45 is four times higher than in white women of comparable age.

He discussed the results from the Baltimore-Washington Cooperative Young Stroke Study at the 23rd International Joint Conference on Stroke and Cerebral Circulation, sponsored by the American Heart Association.

Dr. Kittner and colleagues studied 556 men and women between 15 and 44 who were treated for strokes at the 46 hospitals in central Maryland and Washington, D.C., during 1988 and 1991. They compared race, age, gender and type of stroke.

Of 386 people with ischemic stroke, 119 were white and 267 were black. People experiencing intracranial hemorrhage included 45 white and 125 black.

After adjusting for age and gender, African-American men ran a risk of ischemic stroke 3.2 times that of white men. Their risk of intracranial hemorrhage was 5.2 times that of their white counterparts. African-American women ran 4.1 times the risk for ischemic stroke and 3.6 times the risk for intracranial hemorrhage, compared with risks of white women.

Although death rates during hospitalization for stroke were similar in black and white patients, more African-Americans died because stroke occurs more commonly in that racial group, particularly at younger ages, Dr. Kittner says.

"More black people die or are disabled by strokes during their most productive years," he notes. "Now we need to focus on prevention."

Dr. Kittner heads a University of Maryland stroke prevention study, part of a five-year study sponsored by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health. The study, with 28 sites nationwide, will compare the benefits and side effects of aspirin and ticlopidine in preventing recurring strokes in 1,800 African-Americans who have undergone recent strokes.

Ticlopidine makes platelets in the blood less sticky to help prevent clotting. Both aspirin and ticlopidine proved effective in preventing recurrent strokes in studies conducted predominantly in white patients.

The University of Maryland is the only medical center in the state participating in the study, the first national study of stroke prevention in African-Americans.

"People have assumed that whatever works in whites also works in African-Americans," Dr. Kittner says. "That is not necessarily so. The disease is different in African-Americans, and we may need different preventive therapies too."

Jennifer Donovan

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Evidence Suggests Jefferson, Latrobe Influenced Davidge

New research by John G. Waite Assocs., Architects PLLC, of Albany, N.Y., indicates that the look and construction of the 186-year-old building incorporate unusual building technology and building techniques that both architects discussed and used in their projects.

"On the roof of the building we found downspout leaders that are made of tinplate, an innovative material that Jefferson used later for his architecture at Monticello and the University of Virginia," Waite says. "Also, we have discovered that the original skylights in the building are long and narrow, much like those of the U.S. Capitol [which Latrobe took charge of completing, and which was burned by the British in 1814]. It's fair to say that conversations and correspondence between Jefferson and Latrobe acted as seeds for the technology found in later buildings, in particular Davidge and Jefferson's campus of the University of Virginia." The news came just as Davidge was formally designated a National Historic Landmark on April 29 in a special ceremony in front of the building. The designation, bestowed by the U.S. Department of the Interior, puts the building in elite company in Baltimore, which has only 11 other National Historic Landmarks, including the Baltimore and Ohio Transportation Museum, the First Unitarian Church and St. Mary's Seminary Chapel.

Davidge Hall was first listed on the Register of National Historic Places in 1973.

For the past two years, Davidge, which contains what many experts believe is the oldest surviving anatomical theater in the English-speaking world, has undergone a careful reevaluation by Waite Assocs. in preparation for conservation and restoration. In October 1996, for instance, the Waite firm announced a reconsideration of the building's attributed architect Robert Cary Long Sr., and evidence that some of the building's characteristics can be found in only the most advanced architecture of the period in this country, particularly the architecture of Latrobe and Jefferson.

Long clearly was the contractor, but it is now believed that Latrobe advised Maximilian Godefroy, a Baltimore architect who was twice consulted on the project. Godefroy's father-in-law, John Crawford, taught courses at the new medical school. This relationship might explain why Latrobe did not seek the commission, but nevertheless was responsible for sketches and suggestions sent to Godefroy.

Waite explained that the relationship between designers and builders was markedly different 200 years ago -- that collaboration sometimes blurred the line between creator and maker.

"It is often difficult to attribute credit to the architect for historic buildings like Davidge," Waite says.

At the time of the hall's construction in the early 1800s, tinplate was made in Britain by pounding out wrought iron sheets and coating them in vats of molten tin. The product was highly durable and resistant to corrosion; in fact, the leader recovered by Waite is still durable though weathered. Tinplate was applied in small shingle-like "pans," meaning that Davidge, at one time, had a gleaming, silvery shingled roof.

British tinplate fell out of favor as a roofing material in the late 1800s when high tariffs in the United States stunted the import market. Its replacement, tinplate made from American steel, was never considered as durable as its iron predecessor, and copper roofs then came into vogue. Davidge's roof has since been covered by copper sheets.

Current plans call for further exploration of Davidge's building fabric to see if additional discoveries like the tinplate downspout can be made.

Adds Waite: "Davidge is one of the most significant buildings surviving from the Federal period -- our first generation as a nation."

Chris Hart

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Orioles, MBNA America Team Up with Shock Trauma to Reward "Saves"

To recognize Shock Trauma's extraordinary save rate -- 96 percent of patients admitted survive -- MBNA America Bank is donating $1,000 for each save by an Oriole reliever this season. Last year, the American League Eastern Division champion Orioles amassed
59 saves.

At an April 14 ceremony honoring the "MBNA America Bank Saves for the Shock Trauma Center" program, the game's first pitch was thrown by Baltimore County Executive C. A. "Dutch" Ruppersberger III, whose life was saved at Shock Trauma after a devastating automobile crash more than 20 years ago. The accident left him in critical condition with more than 20 broken bones and a crushed chest. Also participating in the ceremony was O's reliever Jesse Orosco, who had recorded five saves (at press time); Shock Trauma's Physician-in-Chief Thomas Scalea, MD, and Nurse Manager Pamela Deloach; the Hon. Frank Kelly, chairman of the Shock Trauma Board of Visitors; and Scott A. Hudson, regional executive vice president of MBNA.

"The drama and significance of what we do is apparent to fans at Oriole Park at Camden Yards every time they look up and see the State Police Med-Evac helicopter landing at Shock Trauma just over the left field fence," says University of Maryland Medical System President and Chief Executive Officer Morton I. Rapoport, MD. "We are proud of our association with our neighbors, the Orioles. The medical staff of the Shock Trauma Center -- and the people of Maryland -- are indebted to MBNA America Bank for their generosity. Every time the Orioles record a save, we will be in an even better position to save more lives."

Annually, there are about 6,000 admissions to the Shock Trauma Center.

Ellen Beth Levitt
Ira R. Allen
Barbara Crawford

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Club Foot Treatment Does Not Require Major Surgery

One of them is John E. Herzenberg, MD, an orthopedic surgeon at the University of Maryland's Center for Limb Lengthening and Reconstruction. In the past year, Dr. Herzenberg has used the Ponseti casting method on 12 with congenital club foot.

"The success rate has been a remarkable 100 percent."

"The success rate has been a remarkable 100 percent," he says. The procedure is inexpensive, is performed in the doctor's office and eliminates the need for major surgery and hospitalization, Dr. Herzenberg adds. The cost of treatment is about one-tenth of the cost of traditional club foot surgery.

The technique was developed by Ignacio Ponseti, MD, now age 83, a professor emeritus of orthopedic surgery at the University of Iowa.

"When my first article was published, I thought the club foot treatment question was solved, and I went on to research other problems," says Dr. Ponseti. But his less invasive technique did not catch on widely, and now he is on a mission to spread the word.

Club foot occurs in about one of every 1,000 newborns and is normally treated shortly after birth with weekly casting.

However, the usual cast methods are only partially successful in realigning the foot, Dr. Herzenberg explains.

"Invariably, after undergoing three months of casting, the child still needs major reconstructive surgery at 6 months of age," he says.

Dr. Ponseti devised a method of casting that is most successful immediately after birth. Dr. Herzenberg adds, however, that he has successfully treated one child who first came to his office at the age of 7 months.

The Ponseti method involves a specific manipulation and casting performed weekly in the doctor's office for six to eight weeks. At the end of that period, the child undergoes a surgical procedure under local anesthesia in the doctor's office to lengthen the heel cord. Then, a long cast is applied and kept on for three weeks. After that, children wear a special orthopedic device with a bar to keep their feet turned out. The device must be worn around-the-clock for two months, and then only at night for two years.

"This is a vital aspect of the treatment," Dr. Herzenberg says. "Failure to comply with the bracing regimen can lead to recurrence of the club foot deformity."

Although the Ponseti treatment requires a lot of follow-up care, Dr. Ponseti says the traditional surgical approach demands just as much effort in the months following the surgery, and repeat surgeries are often needed.

Studies spanning more than 30 years have shown that the feet of children treated with the Ponseti technique are as strong as normal feet and are generally more supple, mobile and flexible than feet that underwent major surgery.

About 30 percent of patients treated with the Ponseti method need to have their foot balanced when they are between 2 and 4 years old. Known as tendon transfer surgery, this is a fairly simple procedure that does not stiffen the foot, as would a major reconstructive foot procedure, Dr. Herzenberg says.

Ellen Beth Levitt
Ira R. Allen
Barbara Crawford

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