摘要:

Early determination of outcome after out-of-hospital cardiopulmonary resuscitation is a common problem with great ethical, economic, social and legal consequences. Although there has been a fulminant development of emergency medicine during the last three decades, severe cerebral damage sometimes cannot be avoided. For neurological outcome prediction after cardiac arrest clinical neurological signs, electrophysiological examinations, neuroimaging tests, and laboratory parameters in serum and cerebrospinal fluid are used today, nevertheless, there still remains a considerable degree of uncertainty. However, although prognostic criteria which enable the clinician to stop treatment cannot be given at the present time, useful applications of early prognostication after cardiac arrest range from counseling of families, triage decisions, and do-not-resuscitate decisions to future clinical investigations of brain resuscitative measures.

ISSN:0014-3022    

DOI:10.1159/000117426

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:0014-3022    

DOI:10.1159/000190993

出版商:S. Karger AG    

年代:1915

数据来源: Karger

摘要:

We studied 75 patients with severe intracranial vertebral artery (ICVA) occlusive disease from the New England Medical Center Posterior Circulation Registry to learn the etiologies and locations of the vascular lesions, the location and patterns of related ischemia and infarctions, and the outcomes. All patients had neuroimaging and vascular studies. Thirty-nine percent of patients had bilateral ICVA lesions. Twenty-four percent also had basilar artery disease and 36% had associated extracranial disease. The most common site of lesions was the distal ICVA after the origin of the posterior inferior cerebellar artery (PICA). Twenty-five percent of patients had only proximal intracranial posterior circulation territory infarcts (medullary and PICA cerebellar); 32% had infarcts that involved other intracranial territories in addition to the proximal territory. We found more distal intracranial territory infarcts resulting mainly from embolism from ICVA lesions than reported previously; this occurred in 17% of all patients. The ICVA was a recipient site for emboli in 8% of patients. Thirteen percent of patients died during follow-up. The outcome was favorable in most surviving patients. Three-fourths of them had no deficit or only slight disability. The patients with distal territory infarcts due to emboli from the ICVA had the worst outcome.

ISSN:0014-3022    

DOI:10.1159/000117427

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:0014-3022    

DOI:10.1159/000190994

出版商:S. Karger AG    

年代:1915

数据来源: Karger

摘要:

We studied 91 patients with proximal intracranial territory posterior circulation ischemia from the New England Medical Center Posterior Circulation Registry to learn their distribution, underlying cardiovascular causes and long-term outcome. All patients had imaging and vascular studies. Six patients had proximal territory TIAs. Among 85 stroke patients, 52% had infarcts limited to the proximal territory, while 48% also had infarcts in other intracranial posterior circulation territories. Eighty-five percent of proximal territory infarcts were posterior inferior cerebellar artery (PICA) territory cerebellar infarcts and 30% were lateral medullary infarcts. One patient had a hemi-medullary syndrome. Six patients had PICA territory cerebellar and lateral medullary infarcts. The most common vascular lesion in lateral medullary infarct patients was ipsilateral intracranial vertebral artery (ICVA) disease (38% isolated ICVA disease) and in PICA territory cerebellar infarcts, extra-cranial vertebral artery (ECVA) disease (29% isolated ECVA disease). Half of all lateral medullary infarcts were due to a hemodynamic mechanism, most often in situ thrombosis of an ICVA occlusive lesion. Half of all PICA territory cerebellar infarcts were due to intra-arterial embolism and one-fifth to cardiac origin embolism. Embolism was a more frequent cause of proximal territory posterior circulation infarcts than intrinsic ICVA disease. The etiological profiles of lateral medullary and PICA cerebellar infarcts were different. Seventeen percent of all patients died during follow-up (41 months) but mortality related to the acute stroke or new strokes was only 6 percent. The outcome was favorable in the surviving patients; 89% had no or only slight disability.

ISSN:0014-3022    

DOI:10.1159/000117428

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

To assess prognostic factors for absence epilepsy (AE), we analyzed data from 80 patients treated for childhood AE (CAE; n = 53) or juvenile AE (JAE; n = 27) in our epilepsy clinic between 1985 and 1992. All patients were classified according to the International Classification of Epileptic Syndromes which was proposed by the International League against Epilepsy in 1989. Patients were separated into two groups based on the course of disease under adequate treatment: Complete response group (CRG): disappearance of absence seizures (AS) or generalized tonic-clonic seizures (GTCS). Poor response group (PRG): persistence of AS and/or GTCS. Approximately 40% of both CAE and JAE patients had poor response. One parameter was associated with poor prognosis in CAE patients, the presence of polyspikes or polyspikes and waves during sleep. No statistical correlation was made for JAE patients. GTCS were frequent in JAE and GTCS occurrence in CAE patients was associated significantly with age at onset after 8 (p < 0.05). The fact that social and educational performance was poorer in the PRG of both types of AE underlines the importance of therapeutic response in patient rehabilitation.

ISSN:0014-3022    

DOI:10.1159/000117429

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:0014-3022    

DOI:10.1159/000190995

出版商:S. Karger AG    

年代:1915

数据来源: Karger

摘要:

To clarify the significance of intracellular lysosomal (cathepsins B, L and H) and extralysosomal (calpain) proteolytic systems in the process of muscle fiber degradation in inflammatory myopathies, biopsied muscle specimens were examined from patients with polymyositis (PM) and dermatomyositis (DM). Generally, in specimens from patients with PM and DM, but not in those from normal controls, muscle fibers surrounding inflammatory infiltrates or in the perifascicular regions, and occasionally mononuclear cell infiltrates demonstrated positive immunostaining for calpain and cathepsins B, L, and H. In addition, enzyme activities of cathepsins B and L increased in specimens with inflammatory myopathy. These results suggest that calpain and cathepsins play a significant role in the process of muscle fiber destruction in inflammatory myopathy.

ISSN:0014-3022    

DOI:10.1159/000117430

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

We evaluated the use of propranolol as an adjunct to carbimazole in the treatment of hyperthyroid tremor and tachycardia in a double-blind, cross-over and placebo-controlled study. Seven patients were given carbimazole plus either placebo or propranolol (40 mg) for 1 month and then switched to the alternative adjunct treatment for a further month. All patients showed significant improvements (p < 0.001) of heart rate and tremor amplitude after 1 or 2 months from baseline. One month after the baseline, the mean improvements of heart rate were 23% for the carbimazole + placebo group and 38% for carbimazole + propranolol group. Tremor also improved during the 1st month of the study by 31 % in the carbimazole + placebo group versus 59% in the carbimazole + propranolol group. Whereas further improvements were observed in both variables in those receiving propranolol as the second adjunct treatment, this was not the case in those who received placebo during the same period. These findings confirm that the β-blocker propranolol is a useful adjunct in the early treatment of both the tremor and tachycardia of hyperthyroidism

ISSN:0014-3022    

DOI:10.1159/000117431

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:0014-3022    

DOI:10.1159/000190996

出版商:S. Karger AG    

年代:1915

数据来源: Karger