Where are the guidelines for treating hypertension in elderly patients?

three months after myoblast transfer in 18 subjects showed an increase in 30 of the 69 muscle groups measured, no change in 26, and a reduction in 13.Interpreting these results is difficult given the uncontrolled nature of the study and the short period of follow up.Blau and colleagues studied the tibialis anterior muscle from eight patients with Duchenne dystrophy, with a docu- mented deletion in the dystrophin gene, one month after the injection of lOOm cultured myoblasts into up to 100 injection sites.'Using the polymerase chain reaction they showed that in three patients dystrophin messenger RNA derived from the donor myoblast DNA was being expressed.Given the extreme sensitivity of this technique, this result presumably reflects the persistence of donor DNA from a few of the implanted myoblasts.The number of dystrophin positive fibres was only about 10 per 1000 fibres-no greater than the frequency of spontaneously occurring dystrophin positive "revertant" fibres in muscles on the control side.Despite being hailed by Nature as a transplant success it was an unequivocal clinical failure.So where do we stand in relation to myoblast transfer in Duchenne dystrophy?Could the essentially negative results merely reflect the birth pangs reminiscent of earlier transplantation procedures such as kidney, bone marrow, and heart?Simple technical problems may explain the failure, which further studies could resolve.Alternatively, cell transfer may turn out to be a non-starter in the treatment of muscular dystrophy, and other experimental approaches, such as introducing gene constructs either directly into the muscle" 12 or using viral vectors, may need to be pursued further.Meanwhile, it is imperative that the Duchenne boys are given optimal supportive care, including the provision of orthoses to maintain ambulation.We should also continue the search for drugs to influence the course of the disease.'3