Search

Objections to the disclosure of information under section 38 of the Canada Evidence Act must be adjudicated in the first instance by the Federal Court even when they arise in proceedings before other courts or tribunals. This bifurcated process has come under serious criticism as inefficient and ineffective, especially in relation to criminal proceedings. This article examines the principal concerns that have been raised about the bifurcated process and argues that radical reforms to the current process are not warranted. Rather, with effective coordination between the Federal Court and the underlying proceeding, a bifurcated process in which the Federal Court adjudicates most if not all privilege claims under section 38 of the Canada Evidence Act is the optimal approach and should be preserved. [ABSTRACT FROM AUTHOR]

Context: The annual risk of ischemic stroke in patients with asymptomatic carotid artery stenosis is about 2% during the short-term (2-3 years), but the long-term risks of stroke and other vascular events are unknown, although they may affect surgical decision making. Objective: To evaluate the long-term risk of stroke and other vascular events in patients with asymptomatic carotid artery stenosis. Design: Cohort study with a median follow-up of 10 years (range, 5-18 years). Setting: The teaching hospital of the University of Toronto, Toronto, Ontario. Patients: From the initial cohort of 500 patients, 106 patients with asymptomatic carotid artery stenosis were selected because they had completed at least 5 years of follow-up. Main Outcome Measures: Ipsilateral stroke, myocardial infarction, and nonstroke vascular death. Results: The 10- and 15-year actuarial risks of ipsilateral stroke were 5.7% (95% confidence interval [CI], 0%-12%) and 8.7% (95% CI, 1%-17%), respectively, in patients with 0% to 49% internal carotid artery stenosis, and 9.3% (95% CI, 1%-18%) and 16.6% (95% CI, 1%-32%) in patients with 50% to 99% internal carotid artery stenosis. The 10- and 15-year risks of myocardial infarction and nonstroke vascular death were 10.1% (95% CI, 4%-16%) and 24.0% (95% CI, 14%-34%). Age (P = .02), diabetes mellitus (P = .02), and internal carotid artery stenosis of 50% or more (P = .04) were predictive of increased risks of myocardial infarction and nonstroke vascular death. Internal carotid artery stenosis of 50% or more did predict the risk of ipsilateral stroke (P = .003) when all 181 asymptomatic carotid arteries were included. Conclusions: The annual stroke risk in patients with asymptomatic carotid artery stenosis was low and remained stable during long-term follow-up. Any benefit from carotid surgery is therefore unlikely to increase significantly with long-term follow-up. The high long-term risks of myocardial infarction and nonstroke vascular death... [ABSTRACT FROM AUTHOR]

Examines the use of high dose steroid in treating cerebral infarction in Toronto, Ontario. Administration of high dose dexamethasone in double blind trial; Exclusion of embolic sources, diabetes and infection; Comparison between active drug group and the placebo.

Background and Purpose: Cervical arterial dissection is a major cause of stroke in young adults, yet despite standard treatment with anticoagulants or antiplatelet drugs, its management remains uncertain. The goal of this study was to assess the natural history of the disorder and to decide on the feasibility of a therapeutic trial., Methods: Collaborating members of the Canadian Stroke Consortium prospectively enrolled consecutively referred patients with angiographically proven acute vertebral or carotid arterial dissection. Data recorded included clinical and radiological details, recurrence of ischemic cerebral events, and medical or surgical treatment., Results: Of 116 patients, 67 had vertebral and 49 had carotid dissections, with no difference in age or sex. In 68 (59%), trauma occurred at the time of dissection. During the course of a 1-year follow-up, at least 17 patients (15%) had recurrent transient ischemic attacks, stroke, or death, mainly in the weeks immediately after the dissection. In 105 patients with complete follow-up, the event rate in those treated with anticoagulants was 8.3% and in those treated with aspirin was 12.4%, a nonsignificant difference of 4.1%. Using these data, we calculate that for a 2-arm trial (aspirin versus anticoagulants) with 80% power and 5% significance, 913 patients are needed in each group., Conclusions: From our data indicating an initial relatively high recurrence rate, a multicenter trial of anticoagulants versus aspirin involving a total of 2000 patients is feasible.