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Table of Contents
To the Editor.— The article by Norris, "Steroid Therapy in Acute Cerebral Infarction" ( Arch Neurol 33:69-71, 1976), seems to have some tables mixed up. Table 1, "Data on Survivors in Steroid Group," has an average initial score of 115 and an average 29-day score of 64. Yet, these values are plotted for the placebo group in the graph on page 70 and included in the placebo group in Table 3. Table 2, "Data on Survivors in Placebo Group," has an average initial score of 135 and a 29-day score of 100. Yet, these values are graphed for the steroid group on page 70 and included in the steroid group in Table 3. Assuming that Tables 1 and 2 have been reversed and Table 3 is correct, the conclusion that patients treated with the steroid did not fare as well as those receiving placebo is still not justified by the data presented
Corticosteroids have been used as drug treatment for some time. Lewis Sarett of Merck & Co. was the first to synthesize cortisone, using a complicated 36-step process that started with deoxycholic acid, which was extracted from ox bile .  The low efficiency of converting deoxycholic acid into cortisone led to a cost of US $200 per gram. Russell Marker , at Syntex , discovered a much cheaper and more convenient starting material, diosgenin from wild Mexican yams . His conversion of diosgenin into progesterone by a four-step process now known as Marker degradation was an important step in mass production of all steroidal hormones, including cortisone and chemicals used in hormonal contraception .  In 1952, . Peterson and . Murray of Upjohn developed a process that used Rhizopus mold to oxidize progesterone into a compound that was readily converted to cortisone.  The ability to cheaply synthesize large quantities of cortisone from the diosgenin in yams resulted in a rapid drop in price to US $6 per gram, falling to $ per gram by 1980. Percy Julian's research also aided progress in the field.  The exact nature of cortisone's anti-inflammatory action remained a mystery for years after, however, until the leukocyte adhesion cascade and the role of phospholipase A2 in the production of prostaglandins and leukotrienes was fully understood in the early 1980s.