Background: After acute ischaemic stroke (AIS) or transient ischaemic attack (TIA), the detection of peripheral arterial disease (PAD) as a marker of generalized atherosclerosis may improve the risk stratification and prevention of future atherothrombotic events. We aimed to determine the prevalence of PAD indicated by an ankle-brachial index (ABI) of ≤0.9 in a large cohort of patients with AIS/TIA. Methods: In this prospective, multicentre, Austrian, cross-sectional study (OECROSS), 759 patients with AIS or TIA were recruited for a systematic assessment of cardiovascular risk profiles and Doppler ultrasound at the ankle and brachial artery to calculate the ABI from systolic blood pressure readings. Results: 739 patients (97.4%) had a complete ABI assessment. The mean age was 69.5 (± 12.1) years, and 55.8% of the patients were men. 81.6% of the patients had AIS and 18.4% had TIA. Only 6.2% of the patients had a history of PAD, but an abnormal ABI of ≤0.9 was found in 44.9%. Patients with an ABI of ≤0.9 were more likely (p < 0.05) to be older and have a history of PAD, hypertension, diabetes and congestive heart failure. An ABI of ≤0.9 was significantly associated (p < 0.0005) with a presence of carotid stenosis of >50% and an Essen Stroke Risk Score of >2, indicating a risk of ≧4% per year of stroke recurrence. Discussion: A high proportion of patients with AIS/TIA have subclinical PAD, a cross-risk stroke physicians should be aware of. Large longitudinal studies are needed to elucidate whether the ABI can improve our estimation of the risk of future atherothrombotic events and help in optimizing secondary prevention.

Brain temperature depends on the balance of cerebral heat production and heat loss via cerebral circulation and head surface. We investigated whether brain temperature and heat loss via the head surface differed in neonates with abnormal cerebral metabolism or circulation. We measured the core temperature of the head noninvasively by the zero-gradient method, skin temperature of the head, the heat flux from the head, and esophageal and operative environmental temperature in seven healthy neonates, seven neonates with cerebral damage, and two neonates with cerebral hypoperfusion caused by an incurable congenital heart disease. Cerebral blood flow velocity in the anterior cerebral artery and systemic blood pressure were also measured. Brain temperature profile was measured in two premature infants with external ventricular drainage. Core temperature of the head, considered to represent brain temperature, was up to 1.5 degree C higher in infants with cerebral hypoperfusion than in normal neonates. The core temperature of the head was higher than the esophageal temperature in all except two infants with the most severe cerebral damage. The difference between core temperature of the head and esophageal temperature was 0.72 +/- 0.12 degree C in normal neonates, 0.16 +/- 0.4 degree C in infants with cerebral damage, and ranged from 0.9 to 1.2 degree C in infants with cerebral hypoperfusion. The relationship of core of the head to esophageal temperature discriminated between all 16 newborn infants according to their brain pathologic condition, except one infant with a mild ischemic-hypoxic encephalopathy. In conclusion, brain temperature depends on cerebral perfusion and level of brain injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Using a transvaginal 240 degrees "panorama" sector scanner (5.0 MHz) we performed a sonographic study in 106 women with postmenopausal bleeding before they had a diagnostic dilatation and curettage. Sonographic findings were classified as (1) normal thin endometrial echo, (2) pathologically thickened echo (i.e. more than 1/3 of the a.-p. diameter of the myometrial wall) and (3) spherical echoes representing myomas. We also looked carefully at the borders of the endometrium. 21 cases could not be included because of no histological specimen was available or because the vagina was too narrow for insertion of the probe. The histological and sonographic results were compared. Of 39 women with pathologically thickened endometrial echoes 12 had invasive carcinomas, 9 hyperplastic endometrium, 16 polyps and 2 had normal atrophic endometrium. In the 46 women with normal endometrial echoes 1 had a carcinoma (confined to the mucosa and obscured by a myoma), 1 had hyperplastic endometrium, 4 had small polyps (size below 5 mm) and 40 had normal atrophic endometrium.

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Although the efficacy of electronic foetal heart rate (FHR) monitoring and intermittent scalp blood sampling is well established, these methods still result in a considerable number of false positive and negative predictions. Consequently, methods, which improve the accuracy of prediction, are still under study. Heat flux measurements from the foetal scalp have been shown to relate to the metabolic condition of the foetus during delivery. In this study, we investigated the predictive power of measuring scalp heat flux and monitoring the FHR electronically, and the combination of both. In 136 foetuses the scalp heat flux was measured by means of a heat flux transducer, 2.5 cm in diameter, attached to the foetal scalp after the cervix had dilated to greater than 2.5 cm. Heat flux was regarded as abnormal, if the heat flux was less than 10 w/m2 or greater than 21 w/m2, or fell by more than 20% of its initial value during the last 30 min before delivery. FHR tracings were considered abnormal, if they resulted in therapeutic consequences like oxygen mask for the mother, scalp blood sampling or immediate operative delivery. Foetuses were considered acidotic, if their pH in the arterial cord blood was less than 7.20. Accuracy of prediction was described by appropriate parameters. The scalp heat flux method resulted in a higher specificity (80.4% vs. 72.5%), positive predictive value (59.2% vs. 51.7%), and overall accuracy (82% vs. 77%) than FHR monitoring. Sensitivity of FHR monitoring was slightly higher than the one of heat flux method (88.2% vs 85.3%). Combining both methods resulted in a sensitivity of 100% thus detecting all acidotic foetuses, but specificity fell to 62%.(ABSTRACT TRUNCATED AT 250 WORDS)