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Involvement is highly predictive of the severity and prognosis of GVHD.13 Erosive OLP and lichenoid drug reactions can be indistinguishable both histologically and clinically. Some of the drugs commonly associated with lichenoid reactions are nonsteroidal anti-inflammatory drugs, diuretics, angiotensin-converting enzyme inhibitors, beta-blockers and antimicrobials Table 1 ; .14 It is also necessary to distinguish isolated erosive or reticular lesions from lichenoid reactions to dental amalgam.15 Lichenoid reactions to amalgam do not migrate, they occur on mucosal tissue in direct contact with the restoration, and they resolve once the amalgam restoration is removed.16 Some studies indicate an increased risk of squamous cell carcinoma in patients with OLP lesions.17-20 This increased risk appears most common with the erosive and atrophic forms and in cases of lesions of the lateral border of the.
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Coq10 and lipitor share an important link and methylphenidate. 20mg of Lipitoor a day, two-thirds of the patients had absor of neurology at Columbia University. He has found normalities in the heart's "filling phase, " when the musthat patients with hereditary mitochondrial disease have a cle fills with blood. His explanation: Statins can cause a number of neurological problems, including dementia. Indose-related depletion in an essential nutrient known as deed, Golomb reports that cognitive problems are the secCoenzyme Q10. Without CoQ10, the cell's mitochondria ond most common statin side effect. can't produce energy. The shortage may cause muscle pain Pfizer denies a link between Llipitor and memory loss. and weakness, but the heart is especially susceptible be"We think that lowering cholesterol may have some sericause it uses so much energy. ous benefit in terms of cognition, " Palmer says. "There may Horton's tale is disturbing given the fact that patients be some benefits in patients with Alzheimer's disease." As with advanced heart failure are prescribed Lippitor every for aphasia, memory loss and total blackouts, "we have day. "We have not run a study specifically to look at the not seen any signals to indicate there's a causal relationeffects in heart failure, " Pfizer's Palmer says. "It's not an ship between taking [Lipitor] and any of those effects, " area where we can give a definitive answer." As for CoQ10 Palmer says. "That's not to say the odd case hasn't been depletion, Palmer says that it's just "one of the theories reported." Lipitor's label lists amnesia as a side effect ocaround muscle symptoms, and the mechanisms are not curring in under 2 percent of patients but makes no menclear." In Lipito trials, he adds, Pfizer was "unable to doction of other cognitive problems. ument any specific effect on CoQ10." Statins may cause cognitive problems simply because Canadian labeling for Lipitpr and other statins clearly they lower cholesterol. "Cholesterol is the main organic warns of CoQ10 depletion, and even notes that this nutrimolecule in the brain and constitutes over half the dry ent deficiency "could lead to impaired cardiac function in weight of the brain, " Golomb says. patients with borderline congestive heart failure." Some regA study conducted by Matthew Muldoon of the Uniulatory agencies "insist on certain wording, " Palmer says. versity of Pittsburgh showed that patients treated with statins "Sometimes an agency will want to insert words into the for six months compared poorly with patients on a placebo in label that don't necessarily relate to our data." solving complex mazes, psychomotor skills and memory tests. There's some indication that statin makers have known "Given the wide use of these drugs, any adverse cognitive efabout the nutrient depletion--and its dangers--for more fect might be interpreted as important, " Muldoon says. than 14 years. In 1989 Merck filed for two patents for a combination statin CoQ10 pill. The patent applications note that the compound can be a treatment for Lipitor's sales have grown more than sevenfold since it was launched in statin-associated myopathy, or muscle 1997. Shares of Pfizer, meanwhile, have returned more than 130 percent, sickness, and elevated transaminase en- 83 percentage points more than the Standard & Poor's 500. zyme levels, which are released into the Pfizer stock price Lipitor sales in billions ; blood as a result of liver damage. $50 $10 Michael S. Brown, the inventor listed on the first Merck patent, won a Nobel Prize for research that led to the devel8 40 opment of cholesterol-lowering drugs. Currently a Pfizer board member, he de6 clined to comment on the patent. Merck 30 spokesperson Janet Skidmore would say 4 only that the company never acted on the patent because "we thought we had more 20 promising routes of research." 2 Since CoQ10 depletion can restrict cells' energy production, it has an impact 10 0 on cognition that is "probably quite seri1997 1998 1999 2000 * ous, " says Salvatore DiMauro, a profes * Estimate. Sources: Bloomberg; company reports. Medications Subject to Decline: Many medications are very costly and present an increased underwriting risk. The risk categories within the medical guidelines include the added risk of prescription medications. Tween the individual's functional limitations, the family's assets and challenges, and the resources and limitations of the society in which the individual and his or her family are immersed. Just as simply surviving the pathophysiologic events causing cerebral palsy does not ensure a high quality of life, the presence of severe organic impairment does not predict a uniformly dismal outcome. Most children with cerebral palsy live at home with their families, attend regular classrooms at their neighborhood schools, and participate in a variety of natural community activities. As adults, most continue to live in community settings, but one third live at home with their parents, whose ability to continue caregiving may decrease as they age. Twenty percent of adults with cerebral palsy are ambulatory, and 40% can walk with assistance; the remaining 40% are nonambulatory. The horizon of opportunity for individuals with cerebral palsy has continued to expand with improvements in health care, developmental and educational services, and support for individuals and families in community settings. The primary care medical home is an organizing force for the provision of appropriate preventive health care and for the integration of care into the fabric of other important supports and services.
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