Background Intracerebral hemorrhage (ICH) accounted for 9% to 27% of all strokes worldwide in the last decade, with high early case fatality and poor functional outcome. In view of recent randomized controlled trials (RCTs) of the management of ICH, the European Stroke Organisation (ESO) has updated its evidence-based guidelines for the management of ICH. Method A multidisciplinary writing committee of 24 researchers from 11 European countries identified 20 questions relating to ICH management and created recommendations based on the evidence in RCTs using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results We found moderate-to high-quality evidence to support strong recommendations for managing patients with acute ICH on an acute stroke unit, avoiding hemostatic therapy for acute ICH not associated with antithrombotic drug use, avoiding graduated compression stockings, using intermittent pneumatic compression in immobile patients, and using blood pressure lowering for secondary prevention. We found moderate-quality evidence to support weak recommendations for intensive lowering of systolic blood pressure to <140 mmHg within six-hours of ICH onset, early surgery for patients with a Glasgow Coma Scale score 9-12, and avoidance of corticosteroids. Conclusion These guidelines inform the management of ICH based on evidence for the effects of treatments in RCTs. Outcome after ICH remains poor, prioritizing further RCTs of interventions to improve outcome.

Objective-To examine the role of peak bone mass and subsequent postmenopausal bone loss in the development of osteoporosis and the reliability of identifying women at risk from one bone mass measurement and one biochemical assessment of the future bone loss.Design-Population based study. Setting-Outpatient clinic for research into osteoporosis.Subjects-178 healthy early postmenopausal women who had participated in a two year study in 1977. 154 of the women underwent follow up examination in 1989, of whom 33 were excluded because of diseases or taking drugs known to affect calcium metabolism.Main outcome measures-Bone mineral content of the forearm and values of biochemical markers of bone turnover.Results-The average reduction in bone mineral content during 1977-89 was 20%, but the fast losers had lost 10-0% more than had the slow loser group (mean loss 26-6% in fast losers and 16-6% in slow losers; p<0-001). Prediction of future bone mineral content using baseline bone mineral content and estimated rate of loss gave results almost identical with the actual bone mineral content measured in 1989. Seven women had had a Colies' fracture and 20 a spinal compression fracture. The group with Colies' fracture had low baseline bone mineral content (34.7 (95% confidence interval 31-3 to 38-1) units v 39*4 (38-1 to 40.8) units in women with no fracture) whereas the group with spinal fracture had a normal baseline bone mineral content (38-1 (35.0 to 41-1) units) but an increased rate of loss (-2-4 (-3 5 to -1-3)%/year v -1-8 (-2-1 to -1-5)%/year in women with no fracture).Conclusions-One baseline measurement of bone mass combined with a single estimation of the rate of bone loss can reliably identify the women at menopause who are at highest risk of developing osteoporosis later in life. The rate of loss may have an independent role in likelihood of vertebral fracture.

two cases. In the remaining patients who received analgesia no delay in definitive management occurred. Of equal importance was the observation that the surgical registrar's confidence in diagnosing and in deciding on management was not affected by previous administration of papaveretum.The correct management of patients presenting with acute abdominal pain includes diagnosis, resuscitation, and early operative intervention when indicated. Re Objective-To study the dose related response of salmon calcitonin (salcatonin) given intranasaily on bone mass and bone turnover and the effect of salcatonin on rates of fracture in elderly women with moderate osteoporosis.Design-Double blind, placebo controlled, randomised group comparison.Setting-Outpatient clinic for research into osteoporosis.Subjects-208 healthy women aged 68-72 years who had a bone mineral content of the distal forearm on average 30% below the mean value for healthy premenopausal women.Interventions-The 208 women were allocated randomly in blocks of four to two years of treatment with either salcatonin 50 IU, 100 IU, or 200 IU given intranasally or placebo. All groups received a calcium supplement of 500 mg. 32 of the women left the study before its end and 164 women complied with the study criteria throughout.Main outcome measures-Bone mineral content of the distal forearm and lumbar spine and rates of vertebral and peripheral fractures after two years of treatment.Results-The average changes in bone mineral content of the spine showed positive outcomes of 1% (95% confidence interval -0-1% to 1-5%) in the group treated with calcium (placebo) and 3% (1-8% to 4.2%) in the group treated with salcatonin 200 IU. There was a significant dose related response to salcatonin, manifested by an increase of 1-0%/100 IU (0-2% to 1-7%, p=0 008). The rate of patients with new fractures was reduced significantly in the women treated with salcatonin to about one third of that in the non-salcatonin treated women (relative risk 0-23 (0.07 to 0.77)).Conclusion-The results suggest that, compared with calcium alone, salcatonin given intranasally reduces the rates of fracture by two thirds in elderly women with moderate osteoporosis. Furthermore, it increases spinal bone mass in a dose dependent manner.

Early and systematic dysphagia screening by the Gugging Swallowing Screen method and intensified oral hygiene reduced the incidence of x-ray verified pneumonia.

No abstract

Background and Purpose-Antiplatelets (APs) may increase the risk of symptomatic intracerebral hemorrhage (ICH) following intravenous thrombolysis after ischemic stroke.

No abstract

Summary:The purpose of this study was the develop ment of a model of embolic stroke with high reproduci bility concerning infarct volume. In 37 male Sprague Dawley rats, the internal carotid artery was embolized with in vitro preformed suspensions of autologous micro emboli resembling arterial thrombi. With a method of continuous flow through the carotid arterial catheter, re flux of blood with uncontrolled clotting and embolization was avoided, thereby providing control animals free of ischemic damage. The embolized animals had arterial oc clusions on angiograms immediately after embolization and no spontaneous recanalization on angiograms 2 h later. The cerebral blood flow measured by the intra-A growing interest in thrombolytic therapy in acute cerebral ischemia has increased the need for an animal model of thrombotic embolization with reproducible infarcts. Experimental studies have demonstrated that neuronal damage does not occur in the first few minutes after the onset of ischemia (Hossman and Kleihues, 1973). The time interval between the onset of ischemia and neuronal death varies according to species, model (focal or global ischemia), and severity and duration of ischemia (Sundt et aI., 1969; Crowell et aI., 1970; DeGirolami et aI., 1984). It is unknown whether in human stroke institution of a treatment within that interval will result in a reduction in infarct size. It is important to test whether early recanalization with thrombolytic agents may result in neuronal recovery. Most of the knowledge, however, concerning the pathophysiol ogy of cerebral ischemia has been established from models of global ischemia and of focal ischemia by means of surgical occlusion of an intracranial ex tracerebral artery such as the middle cerebral artery (MCA). These models, however, are not suitable for the study of the pathophysiology of ischemic infarction treated by thrombolytic agents.In this report, we describe a model of embolic occlusion in rats. In the development of the model, we were inspired by Kudo et aI. (1982), who de scribed a model of embolization with autologous rat whole blood clots formed in vitro. A blood clot pro duced by extravascular coagulation is histologically different, more fragile, and softer than a thrombus formed in an artery during high pressure and normal circulation of blood (Robbins and Cotran, 1974). This might explain why distal fragmentation and spontaneous reperfusion frequently occurred in em bolization models using whole blood clots formed in