No abstract

Treatment of vertebral fractures with percutaneous PMMA vertebroplasty appears to be safe and results in substantial immediate pain reduction and improved functional status. A randomized controlled trial appears warranted to assess the efficacy and safety of vertebroplasty.

for the Brain Attack CoalitionBackground and Purpose-The formation and certification of Primary Stroke Centers has progressed rapidly since the Brain Attack Coalition's original recommendations in 2000. The purpose of this article is to revise and update our recommendations for Primary Stroke Centers to reflect the latest data and experience. Methods-We conducted a literature review using MEDLINE and PubMed from March 2000 to January 2011. The review focused on studies that were relevant for acute stroke diagnosis, treatment, and care. Original references as well as meta-analyses and other care guidelines were also reviewed and included if found to be valid and relevant. Levels of evidence were added to reflect current guideline development practices. Results-Based on the literature review and experience at Primary Stroke Centers, the importance of some elements has been further strengthened, and several new areas have been added. These include (1) the importance of acute stroke teams; (2) the importance of Stroke Units with telemetry monitoring; (3) performance of brain imaging with MRI and diffusion-weighted sequences; (4) assessment of cerebral vasculature with MR angiography or CT angiography; (5) cardiac imaging; (6) early initiation of rehabilitation therapies; and (7) certification by an independent body, including a site visit and disease performance measures. Conclusions-Based on the evidence, several elements of Primary Stroke Centers are particularly important for improving the care of patients with an acute stroke. Additional elements focus on imaging of the brain, the cerebral vasculature, and the heart. These new elements may improve the care and outcomes for patients with stroke cared for at a Primary Stroke Center. (Stroke. 2011;42:2651-2665.)

This review, aimed at current practitioners of vertebroplasty, highlights recent changes in patient work-up and procedural techniques that have streamlined the authors' clinical practice. Preprocedural work-up, including history, physical examination, and adjunctive imaging techniques, are discussed. Technical details are reviewed, including types of equipment, techniques of needle placement, and utility of venography. Postprocedural issues are noted, including risk of subsequent fracture after vertebroplasty, long-term outcome of cement in the vertebral body, and utility of prophylactic vertebroplasty. Finally, the current state of evidence in support of the efficacy of vertebroplasty are discussed, with particular attention to the need for ongoing clinical trials.

Most tumors that cause severe upper gastrointestinal bleeding are of a malignant histologic type and are already at an advanced stage. Endoscopic hemostasis of bleeding upper gastrointestinal tumors is safe and initially effective, and may provide time for elective surgical palliation. Regardless of therapy, upper gastrointestinal tumors with severe bleeding have a poor one-year survival.

Use of a unipediculate approach in percutaneous vertebroplasty allows filling of both vertebral halves from a single puncture site with no statistically significant difference in clinical outcome from that of bipediculate vertebroplasty.

No abstract

The prevalence of bilateral transverse sinus stenosis in the general population is not trivial. These data may be used as a reference for understanding the mechanistic role of stenoses in idiopathic intracranial hypertension, tinnitus, and refractory headaches.