Associations between cognitive impairment and computed tomography perfusion in different lobes in acute stroke of the anterior circulation / Associações entre déficit cognitivo e perfusão de tomografia computadorizada em diferentes lobos no AVC agudo da circulação anterior

Abstract Background Cognitive impairment (CI) during the acute phase of stroke should not be ignored. The present study analyzed the relationship between computed tomography perfusion (CTP) in different lobes and CI during the acute phase of stroke in patients with cerebral infarction. Methods The present study included 125 subjects: 96 in the acute phase of stroke and 29 elderly healthy subjects as a control group. The Montreal Cognitive Assessment (MoCA) was used to evaluate the cognitive status of the two groups. The CTP scans include four parameters: cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), and mean transit time (MTT). Results The MoCA scores for naming, language and delayed recall significantly decreased only in patients with left cerebral infarctions. The MTT of the left vessels in the occipital lobe and the CBF of the right vessels in the frontal lobe were negatively related to the MoCA scores of patients with left infarction. The CBV of the left vessels in the frontal lobe and the CBF of left vessels in the parietal lobe were positively linked to the MoCA scores of patients with left infarction. The CBF of the right vessels in the temporal lobe was positively related to the MoCA scores of patients with right infarction. Finally, the CBF of the left vessels in the temporal lobe was inversely correlated with the MoCA scores of patients with right infarctions. Conclusion During the acute phase of stroke, CTP was closely associated with CI. Changed CTP could be a potential neuroimaging biomarker to predict CI during the acute phase of stroke.

Resumo Antecedentes O comprometimento cognitivo (CC) durante a fase aguda do acidente vascular cerebral (AVC) não deve ser ignorado. O presente estudo analisou a relação entre perfusão por tomografia computadorizada (PTC) em diferentes lobos e CC durante a fase aguda do AVC em pacientes com infarto cerebral. Métodos O presente estudo incluiu 125 indivíduos: 96 na fase aguda do AVC e 29 idosos saudáveis como grupo controle. O Montreal Cognitive Assessment (MoCA) foi usado para avaliar o estado cognitivo dos dois grupos. Os exames de PCT incluem quatro parâmetros: fluxo sanguíneo cerebral (FSC), volume sanguíneo cerebral (VSC), tempo até o pico (TAP) e tempo médio de trânsito (TMT). Resultados Os escores do MoCA para nomeação, linguagem e recordação tardia diminuíram significativamente apenas em pacientes com infarto cerebral esquerdo. O TMT dos vasos esquerdos no lobo occipital e o FSC dos vasos direitos no lobo frontal foram negativamente relacionados aos escores MoCA de pacientes com infarto esquerdo. A VSC dos vasos esquerdos em o lobo frontal e o FSC dos vasos esquerdos no lobo parietal foram positivamente ligados aos escores MoCA de pacientes com infarto esquerdo. O FSC dos vasos direitos no lobo temporal foi positivamente relacionado com os escores MoCA de pacientes com infarto direito. Finalmente, o FSC dos vasos esquerdos no lobo temporal foi inversamente correlacionado com os escores MoCA de pacientes com infartos direitos. Conclusão Durante a fase aguda do AVC, a PCT esteve intimamente associada ao CC. O PCT alterado pode ser um potencial biomarcador de neuroimagem para prever CC durante a fase aguda do AVC.

Normal and Abnormal Development of Left Vertebral Artery and Its Implications in Cervical Region Surgery

Aortic arch (AA) anomalies occur in approximately 3-5% of cadavers, but these atypical branches remain a point of discussion in cervical region surgery. This case report describes a 73-year-old Caucasian female who died of renal failure following a complicated urinary tract infection whose left vertebral artery (LVA) originated from the AA between the left common carotid and subclavian arteries. The preforaminal part of the LVA was 5 mm in diameter and entered the C6 transverse foramen while the right vertebral artery (RVA) arose from the right subclavian was 6.5 mm in diameter and entered the C5. Embryologically, VAs are formed during weeks four through eight by development of longitudinal anastomoses linking the cervical intersegmental arteries (ISA). The ISA regress except the seventh, which becomes the proximal subclavian artery, the point of origin of the adult VA. Persons with LVA that arises from the AA may be asymptomatic; however, secondary dilatation of the RVA may be implicated in the development of cerebrovascular disorders and atherosclerotic changes due to increased blood flow. Additionally, the anatomical positioning of a left vertebral artery is important when considering an anterior approach for cervical spine surgery and other head-neck procedures when soft structures arteries, veins and muscles are retracted to reach the cervical spine.

Holographic elysium of a 4D ophthalmic anatomical and pathological metaverse with extended reality/mixed reality

Extended reality is one of the leading cutting-edge technologies, which has not yet fully set foot into the field of ophthalmology. The use of extended reality technology especially in ophthalmic education and counseling will revolutionize the face of teaching and counseling on a whole new level. We have used this novel technology and have created a holographic museum of various anatomical structures such as the eyeball, cerebral venous system, cerebral arterial system, cranial nerves, and various parts of the brain in fine detail. These four-dimensional (4D) ophthalmic holograms created by us (patent pending) are cost-effectively constructed with TrueColor confocal images to serve as a new-age immersive 4D pedagogical and counseling tool for gameful learning and counseling, respectively. According to our knowledge, this concept has not been reported in the literature before.

Manifestaciones neuroftalmológicas en pacientes con enfermedad cerebrovascular isquémica / Neuro-ophthalmological manifestations in patients with ischemic cerebrovascular disease

La enfermedad cerebrovascular isquémica tiene una elevada incidencia y prevalencia en Cuba, y constituye la tercera causa de muerte en el país. Existen diferencias anatómicas y clínicas entre el infarto de la circulación anterior y la posterior. En ocasiones, los elementos distintivos que ayudan al diagnóstico topográfico de la enfermedad cerebrovascular isquémica son las manifestaciones neuroftalmológicas. Con el objetivo de profundizar en el conocimiento actual sobre las alteraciones neuroftalmológicas que se asocian a la enfermedad cerebrovascular isquémica, se realizó una revisión bibliográfica, donde se consultaron un total de 69 fuentes de información digital de los últimos 5 años. La circulación cerebral se divide de manera general en anterior y posterior. Los síntomas y signos principales del ictus que afecta la circulación anterior son la desviación conjugada de la mirada, la afectación de las sácadas, la hemianopsia homónima, la heminegligencia y la apraxia de la apertura ocular; mientras que las alteraciones asociadas a la afectación de la circulación posterior son el nistagmo, las anormalidades en la alineación y los movimientos oculares, así como la hemianopsia homónima con conservación macular. Se concluye que en la enfermedad cerebrovascular isquémica aparecen síntomas y signos como consecuencia de la afectación, tanto de la vía visual aferente, como de la eferente. La hemianopsia homónima es el signo más frecuente reportado(AU)

Ischemic cerebrovascular disease has a high incidence and prevalence in Cuba, and it is the third cause of death in the country. A number of anatomical and clinical differences distinguish anterior from posterior circulation infarction. On certain occasions the distinguishing elements that aid in the topographic diagnosis of ischemic cerebrovascular disease are its neuro-ophthalmological manifestations. With the purpose of gaining insight into the current knowledge about the neuro-ophthalmological alterations associated to ischemic cerebrovascular disease, a bibliographic review was conducted based on the analysis of 69 digital information sources from the last five years. Cerebral circulation is generally divided into anterior and posterior. The main symptoms and signs of the stroke that affects anterior circulation are conjugate gaze deviation, altered saccades, homonymous hemianopsia, heminegligence and eyelid opening apraxia, whereas the alterations associated to posterior circulation involvement are nystagmus, eye movement and alignment abnormalities, and homonymous hemianopsia with macular preservation. It is concluded that ischemic cerebrovascular disease presents symptoms and signs related to both the afferent and the efferent visual pathways. Homonymous hemianopsia is the most common sign reported(AU)

Effect of Modified Bazhentang on Cerebrovascular Reserve and Hemorheology in Patients with Chronic Cerebral Circulation Insufficiency / 中国实验方剂学杂志

Objective: To observe the effect of modified Bazhentang on cerebrovascular reserve and hemorheology in patients with chronic cerebral circulation insufficiency. Method: Totally 80 patients treated at Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine from January 2018 to June 2018 in line with the inclusion criteria were randomly divided into the observation group (40 cases) and the control group (40 cases) using the random sequence of Stata 13.0. Both groups received basic treatments, such as antihypertensive, hypoglycemic and lipid-lowering. In addition to the therapy of the control group, the control group was also given nimodipine tablet treatment, and the observation group was given modified Bazhentang treatment, with a total course of 30 days. Before and after treatment, transcranial doppler ultrasonography (TCD) was used to detect the cerebrovascular reserve function of the two groups, so as to evaluate the clinical efficacy, and detect the hemorheology, blood routine, hepatic and renal function. Result: The effective rate of the observation group was 92.5%, and that of the control group was 80%. The clinical efficacy of the observation group was better than that of the control group (PPPPPConclusion: Modified Bazhentang can effectively treat chronic cerebral circulation insufficiency. By improving the function of cerebrovascular reserve and cerebral blood flow, it can alleviate clinical symptoms without safety problems, so as to provide a theoretical basis for the treatment of chronic cerebral circulation insufficiency with traditional Chinese medicine.

Dynamic cerebral autoregulation after confinement in an isolated environment for 14 days

BACKGROUND@#To develop human space exploration, it is necessary to study the effects of an isolated and confined environment, as well as a microgravity environment, on cerebral circulation. However, no studies on cerebral circulation in an isolated and confined environment have been reported. Therefore, we investigated the effects of a 14-day period of confinement in an isolated environment on dynamic cerebral autoregulation.@*METHODS@#We participated in an isolation and confinement experiment conducted by the Japan Aerospace Exploration Agency in 2016. Eight healthy males were isolated and confined in a facility for 14 days. Data were collected on the days immediately before and after confinement. Arterial blood pressure waveforms were obtained using a finger blood pressure monitor, and cerebral blood flow velocity waveforms in the middle cerebral artery were obtained using transcranial Doppler ultrasonography for 6 min during quiet rest in a supine position. Dynamic cerebral autoregulation was evaluated by transfer function analysis between spontaneous variability of beat-to-beat mean arterial blood pressure and mean cerebral blood flow velocity.@*RESULTS@#Transfer function gain in the low- and high-frequency ranges increased significantly (0.54 ± 0.07 to 0.69 ± 0.09 cm/s/mmHg and 0.80 ± 0.05 to 0.92 ± 0.09 cm/s/mmHg, respectively) after the confinement.@*CONCLUSION@#The increases observed in transfer function gain may be interpreted as indicating less suppressive capability against transmission from arterial blood pressure oscillation to cerebral blood flow velocity fluctuation. These results suggest that confinement in an isolated environment for 14 days may impair dynamic cerebral autoregulation.@*TRIAL REGISTRATION@#UMIN000020703 , Registered 2016/01/22.

Effect of Acupuncture of She Medicine on Cerebral Hemodynamics in Migraine Patients / 上海针灸杂志

Objective To evaluate the effect of acupuncture therapy of She medicine on cerebral hemodynamics in migraine patients, and to further verify its therapeutic efficacy and preliminarily reveal the action mechanism in treating migraine. Method 120 Eligible subjects were randomized into two groups. The treatment group was intervened by acupuncture of She medicine, while the control group was intervened by Western medication, 10 d as a treatment course, for 2 courses in total at a 2-day interval. Transcranial Doppler (TCD) was adopted to observe the average blood flow velocity of cerebral arteries before and after the treatment. Result The total effective rate was 82.8% in the treatment group versus 71.4% in the control group, and the difference was statistically significant (P<0.05) by rank-sum test. Before the treatment, the abnormity rate of cerebral artery blood flow was 62.8% in the treatment group versus 61.9% in the control group, and the between-group difference was statistically insignificant (P>0.05), indicating the comparability; after the treatment, the abnormity rate of cerebral artery blood flow was 25.9% in the treatment group versus 35.3% in the control group, and the between-group was statistically significant (P<0.05). Conclusion Acupuncture of She medicine is effective in treating migraine, and it can significantly improve the cerebral hemodynamics.

Clinical Observation of Electroacupuncture at the Governor Vessel Points for Chronic Cerebral Circulation Insufficient / 上海针灸杂志

Objective To observe the therapeutic efficacy of electroacupuncture at the Governor Vessel points in treating chronic cerebral circulation insufficiency (CCCI).Method Sixty CCCI patients were randomized into a treatment group and a control group, 30 cases in each group. The treatment group was intervened by electroacupuncture at the Governor Vessel points [Baihui (GV20), Shenting (GV24), Fengfu (GV16) and Dazhui (GV14)] plus Betahistine hydrochloride tablets, while the control group was intervened by Betahistine hydrochloride tablets alone, 8 mg at each dose, 3 times a day. Two-week treatment was taken as a course, and 2 courses were conducted in total, followed by a 3-month follow-up study. The two groups were observed after the intervention to measure the improvement, meanwhile, both short-term and long-term therapeutic efficacies were evaluated.Result The total effective rate was 93.3% in the treatment group versus 86.7% in the control group, and the between-group difference was statistically significant (P<0.05).Conclusion Electroacupuncture at the Governor Vessel points is an effective approach in treating CCCI, and it can produce a more significant therapeutic efficacy when used together with Betahistine hydrochloride compared to the use of Betahistine hydrochloride alone.

Clinical Study on Bushen Huoxue Decoction for Elderly Patients with Chronic Cerebral Circulation Insufficiency / 中国中医药信息杂志

Objective To observe the effects of Bushen Huoxue Decoction on clinical symptom, vertigo degree and cognitive function for elderly patients with chronic cerebral circulation insufficiency (CCCI); To explore its possible mechanism. Methods Totally 70 cases were randomly divided into observation group and control group according to the random digits table method, with 35 cases in each group. The two groups were given Western medicine consisting of blood pressure control, glucose control and blood lipid control. Based on this, the control group was given Flunarizine Hydrochloride capsules, 5 mg once a day orally before sleeping. The observation group was given Bushen Huoxue Decoction, one dose a day and taken twice a day. The treatment lasted for 30 days. The TCM symptom score, Chinese version of dizziness handicap inventory (DHI) and Montreal cognitive assessment (MoCA) score were observed. The mean blood flow velocity (Vm) of basilar artery (BA), bilateral vertebral artery (VA), bilateral middle cerebral artery (MCA) and the content of plasma acid phospholipid (AP) were detected, and the clinical efficacy was evaluated. Results The total effective rate of the observation group was 94.3％ (33/35), which was significantly higher than that of 82.9％ (29/35) in the control group, with statistical significance (P<0.05); after treatment, the TCM symptom score, DHI score, and the content of plasma AP were significantly lower than those of pre-treatment in the same group (P<0.05); the MoCA score and the Vm of VA, LBA, RBA, LMCA, RMCV were significantly higher than those of pre-treatment in the same group (P<0.05); the TCM symptom score, DHI score, MoCA score, the Vm of LVA, LMCA, RMCA and the content of plasma AP in the observation group were improved better than those in the control group, with statistical significance (P<0.05). Conclusion Bushen Huoxue Decoction has an obvious therapeutic effects for elderly patients with CCCI, which can improve clinical symptom, vertigo degree and cognitive level, which possible mechanism is related to increasing the cerebral blood flow velocity and reducing the content of plasma AP.

Changes of Cerebral Blood Flow by the Weak Trans-Cranial Ultrasound Irradiation in Healthy Adult Volunteers / 日本補完代替医療学会誌

In the recent aging society, many strategies against cerebral diseases including dementia are needed.As hand massage treatments promote blood flow for muscle fatigue and other disorders, ultrasonic vibration may promote cerebral blood flow.A novel, long wavelength ultrasonic vibration device with high permeation (less than 30 kHz, 2 mW/cm2) was applied to investigate cerebral blood flow before and after the frontal or occipital trans-cranial irradiation. In this study, the frontal or a mixture of the frontal and the occipital irradiation were conducted respectively on Xe gas X-ray CT, and SPECT experiments in healthy adults who did not have any excluding criteria. From the results, we confirmed that the low mill watt ultrasonic vibration emitted by the device promoted cerebral blood flow.

Comparative Study by TCD on the Realtime Effect of Scalp Cluster Acupuncture versus Nape Cluster Acupuncture for Vertigo Due to Cerebral Circulation Insufficiency / 上海针灸杂志

Objective To compare the realtime effects of scalp cluster acupuncture versus nape cluster acupuncture on the cerebral blood flow in patients with vertigo due to cerebral circulation insufficiency (CCI). Methods Fifty-seven patients with vertigo due to CCI were randomized into a treatment group of 29 cases and a control group of 28 cases. The treatment group was intervened by scalp cluster acupuncture, while the control group was by nape cluster acupuncture. The systolic blood flow velocity (Vs), diastolic blood flow velocity (Vd), and mean blood flow velocity (Vm) of the middle cerebral artery (MCA), internal carotid artery (ICA), basilar artery (BA), posterior inferior cerebellar artery (PICA), and vertebral artery (VA) were observed before and after intervention by Transcranial Doppler (TCD). Results After intervention, the Vs, Vd, and Vm of MCA, ICA, BA, PICA and VA were significantly changed in the treatment group (P＜0.01, P＜0.05). The blood velocities of MCA, ICA, VA, and PICA were significantly changed after intervention in the control group (P＜0.01). The Vs and Vm of BA were significantly changed in the control group after intervention (P＜0.05). There were no significant differences in comparing the blood velocities of the observed arteries between the two groups after intervention (P>0.05). Conclusion Scalp cluster acupuncture and nape cluster acupuncture both can improve the Vs, Vd, and Vm of the low-velocity cerebral arteries.

Clinical analysis of nicergoline in treatment for 80 patients with chronic cerebral circulation insufficiency / 局解手术学杂志

Objective To observe the curative effect of nicergoline in the treatment of chronic cerebral circulation insufficiency ( CC-CI) . Methods 160 cases with CCCI were randomly divided into the treatment group which were administered 10 mg of oral Nicergoline, three times per day for one month,and the control group which were given 20 mg of oral nimodipine,three times per day for one month. The clinical effective rate and the transcranial Doppler ultrasound ( TCD) between the two groups before and after treatment were observed. Results There were significant difference in clinical effective rate and TCD index assessment between the two groups(P<0. 05). Conclu-sion Nicergoline is an effective and safe treatment for chronic cerebral circulation insufficiency.

Evaluation on the clinical effects for asynchronous cerebral arterial thrombosis with treatment of cerebral circulation therapeutic equipment / 中国医学装备

Objective: To investigate the effect about the treatment in asynchronous cerebral arterial thrombosis of cerebral circulation therapeutic equipment with disease function rehabilitation and the trigger factor of stroke and cerebral blood flow in 108 cases. Methods:Treatment group on the basis of conventional drug treatment plus brain circulation function therapeutic apparatus (KJ-3000-a) treatment in patients with stroke in different disease period. Using the neural function defect score and controllable risk factors of stroke and TCD determination of internal carotid artery and vertebral artery blood flow changes in evaluation of cerebral circulation function therapeutic equipment therapy in treatment group and control group is effective and feasible. Results:Different stages of stroke treatment group after treatment of acute phase of the neural function defect score in the control group (t=-13.26, P<0.05), and factors caused troke such as blood pressure and cholesterol leels also declined significantly than control group (t=7.39, t=7.75, P<0.05), cerebral blood flow between treatment group and the control group after treatment mainly reflected in the increased blood flow of part of left and right internal carotid artery and Vertebral Artery ,as Vd, Vs and Vm. Conclusion:Against the illness severity stroke with drug therapy on the basis of brain circulation function therapeutic instrument to stimulate rehabilitation treatment is convenient, economic, safe, effective, can be applied to stroke periods with high blood pressure, cholesterol levels, but acute stage used the best, after post-stroke patients vital center smoothly, can take early used cerebral circulation function therapeutic equipment for rehabilitation.

The AMA study (Multi-Arterial Atherosclerosis): correlation ofmalformation of cardiac and cerebral arteries

We are performing a study on the distribution of atherosclerosis in the arteries and during our dissectionswe have found arterial malformations in the brain and heart. Of these, 6 are related to the posterior cerebralarteries and 3 are related to the posterior Interventricular artery of the heart. In all these three cases, suchaforementioned abnormality in the circle of Willis also occurred. It is an interesting and unexpected findingand we are still waiting for further development in our work in order to clarify these “related” malformations.

The relationship between the cerebral circulation time and disease condition and prognosis in patients with subarachnoid hemorrhage / 中国综合临床

Objective To investigate the relationship between the cerebral circulation time and disease condition and prognosis in patients with acute subarachnoid hemorrhage. Methods DSA were performed to determine the cerebral circulation time (CCT) in 60 patients who had subarachnoid hemorrhage (SAH) within 3 days. The patients were divided into different groups according to the severity of the disease condition,patients with CSC score as 13-15 were assigned as group Ⅰ ,whose CCT was (13.45 ± 1. 89) s. Twenty two patients with GSC score as 3-12 were assigned as group Ⅱ ,whose CCT was (16.79 ± 2. 07) s. There were significant difference between the CCT of the two groups (t =3. 76,P = 0. 001). (2)Twenty-nine patients with Hunt-Hess grade as 1-2 were assigned as group 1,whose CCT was (13.06 ± 1. 83) s. Thirty one patients with Hunt-Hess grade as 3-5 were assigned as group 2, whose CCT was (15. 89 ± 2.06) s. There were significant difference between the CCT of the two groups (t = 3. 39, P =0. 003). (3) Seventeen patients with delayed ischemic damage were assigned as group A, whose CCT was (16. 84 ±1.91) s. Forty three patients without delayed ischemic damage were assigned as group B, whose CCT was (12.94 ± 1. 67) s. There were significant difference between the CCT of the two groups (t = 2. 23, P =0.025). (4)Forty-six patients with GOS score as 4-5 were assigned as group a,whose CCT was (13.07 ±1. 89)s. Fourteen patients with GSC score as 1-3 were assigned as group b,whose CCT was (17.11 ± 1. 71)s. There were significant difference between the CCT of the two groups (t = 3. 27, P = 0.008). Conclusion CCT may reflect the severity of the SAH in early onset patients and has prognostic value.

Evaluation of cerebral circulation time by contrast-enhanced ultrasound in healthy adults / 中华超声影像学杂志

Objective To measure cerebral circulation time(CCT) of a group of normal adults by contrast-enhanced ultrasound. Methods Forty-seven cases of healthy volunteers without any cardio-cerebral disease history were enrolled in the study. Internal carotid artery and vertebral artery were observed and the blood flow was measured with high frequency probe. Contrast-enhanced agent SonoVue was injected bolus into median cubital vein. CCT was measured and calculated according to the contrast curve analysis. Contralateral CCT measurement was repeated when the blood flow signal resume to the baseline intensity. Cerebral blood volume was then calculated according to CCT and cerebral blood flow. Results All the imaging of carotid vessels was presented clearly in all objects. Cerebral blood flow was 603 ～ 990 ml/min with an average (778 ± 171)ml/min. Bi-lateral CCT was measured successfully,the value ranged 4. 1 ～ 10.2 s with average (6.22 ± 1.47) s. There were no significant differences both in contrast of left and right side of the carotid vessels and in contrast of three dosage groups ( P ＞0.05). The cerebral blood volume was 54～96ml with average (76 ± 27)ml. Conclusions Contrast-enhanced ultrasound can be useful in measurement and calculation of CCT and cerebral blood volume.

Morbimortalidad de la endarterectomía carotídea en centros de bajo volumen quirúrgico / Morbimortality of the carotid endarterectomy in centers of low number of surgeries

La indicación de endarterectomía carotídea depende del riesgo perioperatorio de muerte y/o stroke de los centros donde se realiza. El objetivo de este trabajo es evaluar la morbimortalidad de la misma en centros públicos y privados calificados como de bajo volumen quirúrgico. Se analizaron retrospectivamente 173 registros médicos en cinco centros con un volumen quirúrgico inferior a 150 pacientes en el cuatrienio. Se evaluó: estado previo a la cirugía, incidencia de stroke, muerte, complicaciones médicas y quirúrgicas posoperatorias inmediatas y a los 30 días. Del total de la población fallecieron tres (1.7%), dos por causa neurológica y uno por cardiovascular, cuatro (2.3%) presentaron stroke en el posoperatorio, siendo la morbimortalidad global a los treinta días de 4.1%. Dos pacientes presentaron infarto agudo de miocardio y dos (2,3%) angor. La inestabilidad hemodinámica posoperatoria fue la complicación más frecuente (33,3%). De 42 pacientes con hipertensión arterial posoperatoria, tres (7.1%) presentaron síndrome de hiperperfusión cerebral posoperatoria, diferencia significativa respecto a quienes no tuvieron hipertensión arterial posoperatoria. (p<0.01). Las diferencias de acuerdo a la procedencia de estos pacientes mostraron que en Instituciones de Asistencia Médica Colectiva (IAMC) se intervino mayor porcentaje de pacientes asintomáticos con menor riesgo cardiovascular, se usaron más betabloqueantes y se presentó con más frecuencia hipotensión posoperatoria. La morbilidad y mortalidad global se ajustan a las recomendaciones internacionales para centros de bajo volumen. La inestabilidad hemodinámica fue la complicación más frecuente. La principal causa de muerte fue neurológica. Se encontró un mayor porcentaje de enfermos sintomáticos en el sistema público. La hipotensión arterial y el uso de betabloqueantes fueron más frecuentes en centros privados.

The indication of carotid endarterectomy depends on the risk of death or stroke resulting from surgery in hospitals where they are performed. The aim of this study was to assess morbimortality resulting from these patology in public and private hospitals with low volume of surgeries. In 5 hospitals which over the last four years had a surgical volume of 150 patients or less, 173 medical records were analyzed retrospectively. The following were considered: health conditions prior to surgery, incidence of stroke, death rate, medical complications which occurred in the first 30 days. Of the studied patients, 3 died (1.7%), 2 for neurological reasons and 1 for cardiovascular reason, 4 (2.3%) suffered a stroke after surgery, being the global morbimortality rate over 30 days, 4.1%. Two patients suffered an acute myocardial infarction and 2 (2.3%) developed angina pectoris. Hemodynamic instability after surgery was the most frequent complication (33.3%). Three patients suffered cerebral hyperperfusion syndrome after surgery, related to arterial hypertension (p<0.01%). In Collective Medical Assistance Institutions there was a higher rate of surgeries involving asymptomatic patients at low cardiovascular risk, a greater use of beta blockers, and a higher incidence of hypotension suffered after surgery when compared with public institutions.Global morbility and mortality are consistent with international standards for low-volume hospitals. Hemodynamic instability was the most common complication. The major causes of death were neurological complications. A higher rate of symptomatic patients was found in public servicies. Arterial hypertension and use of beta blockers were more common in private centers.

A indicação de endarterectomia de carótida depende do risco perioperatório de morte e/ou Stroke dos centros onde se realiza. O objetivo deste trabalho é dimencionar a morbimortalidade da mesma em centros públicos e privados qualificados como de baixo volume cirúrgico. Foram analisados retrospectivamente 173 registros médicos em 5 centros com um volume cirúrgico inferior a 150 pacientes nos últimos 4 anos. Valorizou-se: estado prévio à cirurgia,incidência de Stroke, morte, complicações médicas e cirúrgicas pós-operatórias imediatas e aos 30 dias.Do total da população,faleceram 3 (1,7%),dois por causa neurológica e um cardio-Vascular, 4(2,3%)apresentaram Stroke no pós-operatório,sendo a morbimortalidade global aos trinta dias de 4,1%. Dois pacientes apresentaram infarto agudo do miocárdio e dois(2,3%)angina. A instabilidade hemodinâmica pós-operatória foi a complicação mais freqüente(33,3%). Três pacientes apresentaram síndrome de hiperperfusão cerebral pós-operatória,associada à hipertensão (p menor que 0.01). As diferensas relativas a procedência mostraram que em instituições de assistência médica coletiva interviu-se em maior porcentagem de pacientes assintomáticos com menor risco cardiovascular, usou-se mais betabloqueadores e apresentaram com mais freqüência hipotensão pós-operatória. A morbidade e mortalidade global ajustan-se as recomendações internacionais para centros de baixo volume. A instabilidade hemodinâmica foi a complicação mais freqüente. A principal causa de morte foi neurológica. Encontrou-se uma maior porcentagem de pacientes sintomáticos no sistema público...

Effects of Foot Bath on Cerebral Circulation and Mental Function in Elderly Persons / 日本温泉気候物理医学会雑誌

  The purpose of this study was to clarify effects of foot bath at 42°C for 10 min on cerebral circulation and mental function in elderly persons. The subjects of this study were 12 elderly persons (average 83.1 years old). Tissue hemoglobin concentration and blood flow at the cerebral frontal cortex were measured using near-infrared spectroscopy and blood pressure and heart rate using an autonomic spygmomanometer during for each 10 minutes before foot bath, during foot bath, and after foot bath. We measured subject's arithmetic speed and mistaken numbers as mental function. During foot bath the blood flow and after foot bath oxyhemoglobin at frontal cortex were significantly increased. Heart rate was significant increased after foot bath. But deoxyhemoglobin and blood pressure did not changed during foot bath. In addition to arithmetic speed and mistaken numbers were same before and after foot bath. These findings suggest that cerebral circulation is changed by foot bath, but mental functions is not before and after foot bath.

Effects of Hyperbaric Oxygen Combined with Fastigial Nucleus Stimulation on Chronic Cerebral Circulation Insufficiency with Transcranial Doppler and Electroencephalography / 中国康复理论与实践

@#Objective To observe the of changes of cerebral blood flow and electroencephalography in chronic cerebral circulation insufficiency (CCCI) treated with fastigial nucleus stimulation (FNS) and hyperbaric oxygen (HBO). Methods 144 cases of CCCI were divided into 4 groups: 36 cases were treated with FNS and HBO, 36 cases with FNS, 36 cases with HBO, 36 cases without any treatment as control group. The blood velocity of anterior, middle, posterior cerebral arteries, vertebral artery and basilar artery were measured with transcranial Doppler (TCD) and the brain waves （α, β, δ, θ） were recorded with electroencephalography (EEG) before and after the treatment. Results Compared with the control, the brain blood velocity and α wave increased in all the treatment groups, especially in the HBO+FNS group, while β, δ, θ waves decreased (P<0.05). Conclusion FNS and HBO can increase cerebral blood flow and improve the cerebral function respectively.

Advance in Chronic Cerebral Circulation Insufficiency (review) / 中国康复理论与实践

@# Chronic cerebral circulation insufficiency (CCCI) was preferred as a new disease name in recent years. It can cause ischemic and different degrees patho-damage in brain tissue. Accordingly, it lead to decrease the function in perception and cause aphronesia. It had attracted great attention for native and foreign researchers. In this article, the authors will summarize recent research province on empirical research, clinic auxiliary diagnosis and treatment status in the CCCI.