Summary:In a randomized double-blind placebo-con trolled study in 30 patients with acute ischemic stroke, the effect of the adenosine uptake blocker propentofylline on regional brain glucose metabolism (rCMRg1u) was in vestigated using repeated positron emission tomography (PET) with 2-[18F]fluoro-2-deoxY-D-glucose (FDG). Treatment was initiated within 48 h after onset of symp toms. The clinical course was followed for 3 months. In the propentofylline group, after 14 days rCMRgiu was in creased in the infarct by 37.3% and was practically un changed in other brain regions, whereas in the control group glucose metabolism had decreased in all regions
The extent of resection in pilocytic astrocytoma of the posterior fossa often remains undefined and the indications for further treatment in incompletely resected tumours are a matter of debate. It has been also realized that the problem of hydrocephalus in patients with pilocytic astrocytoma of the posterior fossa has not yet been solved and the diagnostic impact of postoperative CT findings remains questionable. We retrospectively reviewed the data from 33 patients harbouring a pilocytic astrocytoma of the posterior fossa to evaluate the impact of surgical technique in terms of radicality and of postoperative imaging results upon prognosis and adjunctive treatment. In addition, the issue of hydrocephalus was considered and related to different treatment modalities. Thirty patients underwent surgical treatment whereas 3 had open biopsy of the tumour. Macroscopically gross total resection of the tumour was performed in 20 patients, whereas resection was partial in 10. Follow-up was obtained in 29 patients for a period which ranged between 2 and 184 months (85 months +/- 56 months). Outcome was good in 24 patients who had only slight neurological deficit and poor in 3 patients, who were severely disabled. Two patients died during the follow-up period. Recurrent tumour growth occurred in 2 cases with incompletely resected tumours. From the series presented, it was concluded that long-term follow-up with CT seems mandatory in cases with contrast-enhancing residual tumour. Recurrent tumour growth should be assumed in postsurgical patients with an enlarging area of enhancement shown in follow-up CT studies. Permanent ventriculoperitoneal shunting is required in certain patients with pre- or postoperative hydrocephalus.(ABSTRACT TRUNCATED AT 250 WORDS)
In a retrospective study of 64 patients suffering from primary subarachnoid haemorrhage (SAH), the clinical grading according to Hunt and Hess as well as the initial findings of brainstem auditory evoked potentials (BAEP) and median-nerve somatosensory potentials (SEP) were correlated with each other and with disease outcome to determine the prognostic value of evoked potential testing in comparison to the initial clinical grading according to Hunt and Hess. All patients were treated in a neurological intensive care unit. Normal evoked potentials usually indicate a favourable course. Alterations of SEP and BAEP increase in parallel with the severity of clinical findings. Unilateral or bilateral loss of SEP or BAEP indicates a poor prognosis. Clinical and electrophysiological findings show a close correlation, but only BAEP provide prognostic information beyond Hunt/Hess grading. In SAH patients, clinical grading was well as evoked potentials correlate significantly with outcome. Use of both clinical and EP rating improves prognostic accuracy.
Using B-mode ultrasonography, the frequency of carotid atherosclerosis was investigated prospectively in 50 patients on maintenance haemodialysis compared to healthy controls. The patients showed significantly more atheromatous plaques at the carotid bifurcation, as well in the internal and external carotid artery (chi-square-test, p less than 0.05). There was no statistical difference between normotensive patients on haemodialysis and the control group, but hypertensive patients showed statistically significant more plaques of the cervical vessels (chi-square-test, p less than 0.05). Therefore, atheromatous plaques in haemodialysis patients appear to be due to hypertension rather than to maintenance dialysis.
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