Internal carotid artery stent placement without emboli protection: results and long-term outcome.

Patients with symptomatic > or = 60% (n = 134), asymptomatic > or = 80% (n = 143), and asymptomatic progressive > or = 60% (n = 25) internal carotid artery stenosis underwent stenting and were followed clinically and by Doppler-assisted duplex imaging for 27.1 +/- 15.6 months. Stroke and death from stroke occurred within 30 days after stenting in 4.7% of the symptomatic and in 3.0% of the asymptomatic patients and in the follow-up period in 2.3% of the symptomatic and in 1.2% of the asymptomatic patients.

A novel and rapid assay for the detection of neutralizing antibodies against interferon-beta.

There is evidence that neutralizing antibodies (NAB) have a negative influence on the clinical and magnetic resonance imaging effects of interferon-beta (IFNbeta) in multiple sclerosis (MS) patients. The current methods for NAB detection are restricted to specialized laboratories because they require a cell culture and sometimes a viral culture. Results are typically obtained after several weeks. Therefore, the development of a simple and rapid assay for the detection of NAB was sought. Whole blood samples from 28 NAB-positive patients and 110 NAB-negative patients (52 with IFNbeta and 58 without IFNbeta therapy) were incubated with IFNbeta 976 IU/mL for 24 hours. MxA protein levels--a specific marker of class I IFN bioactivity--were measured in paired samples with and without IFNbeta incubation and the difference in MxA levels was calculated. The mean increase of MxA levels after stimulation with IFNbeta in the NAB-positive group was 8 ng/mL (range 0-44 ng/mL) and in the NAB-negative group was 84 ng/mL (range 0-302 ng/mL). Using an increase of 22.5 ng/mL as cut-off) the specificity of the MxA stimulation assay was 81.2% and the sensitivity was 96.4%. The whole blood MxA stimulation assay is virtually as sensitive as the conventional NAB assay but somewhat less specific. However, this is outweighed by the procedural advantage of the assay, which is simpler, quicker and much less expensive.

Monitoring intravascular volumes for postoperative volume therapy.

BACKGROUND AND OBJECTIVE: The feasibility of monitoring measured intravascular volumes and the cardiac filling pressures were compared to reflect the optimal volume status of postoperative patients. METHODS: In a prospective clinical study, 14 hypovolaemic adult patients were included after cardiac surgery. All patients received 1,000 mL hydroxyethyl starch after meeting the authors' criteria for hypovolaemia. Pressures were measured by use of a pulmonary artery catheter and volumes were determined by double-indicator dilution technique. RESULTS: Stroke volume index (SVI), central venous pressure (CVP), pulmonary artery occlusion pressure (PAOP), intrathoracic blood volume index (ITBVI) and total circulating blood volume (TBVIcirc) increased significantlyaftervolumeloading(30.7 +/- 9.8 to 41.7 +/- 9.6 mLm(-2), 4.9 +/- 1.7 to 9.1 +/- 2.3mmHg, 6.6 +/- 1.3 to 10.6 +/- 1.9 mmHg, 858 +/- 255 to 965 +/- 163 mLm(-2), and 1,806 +/- 502 to 2,110 +/- 537 mLm(-2), respectively). During the subsequent 1 h steady-state period, CVP and PAOP decreased significantly (9.1 +/- 2.2 to 7.4 +/- 2.2 mmHg and 10.6 +/- 1.9 to 9.2 +/- 2.0 mmHg, respectively), whereas SVI and intravascular volumes remained unchanged. The changes of CVP and PAOP did not correlate with changes in stroke volume during volume loading (r2 = 0.06 and 0.03, respectively) and during steady-state (r2 = 0.17 and 0.00 respectively). On the other hand, a significant correlation was found between changes of the intrathoracic blood volume and changes in stroke volume during the volume loading (r2 = 0.67) and also during the steady-state phase (r2 = 0.83). CONCLUSIONS: Intrathoracic blood volume reflects more accurately the preload dependency of cardiac output in postoperative patients than left/right-sided cardiac filling pressures.

[Carotid stenting: acute results and complications]. / Karotisstent: Akutergebnisse und Komplikationen.

The treatment of carotid stenoses with balloon angioplasty and stenting is a new and not generally established method. During a one year period 65 patients (22 female, 43 male, mean age: 73 years, 47 with neurologic symptoms, 8 with contralateral carotid occlusion) with significant (>70%) carotid stenosis were treated with balloon angioplasty and balloon expandable stents. The primary technical success rate was 98% (65/66 patients) respectively 99% (69/70 stenoses). A combined procedure was performed in 11 /17%) patients with stenting in both carotid arteries in 4 patients with additional coronary interventions in 6 patients and stenting of the origin of the common carotid artery in one patient.Severe neurologic complications occurred in 4 (6.2%) patients (1 death, 1 major stroke, 2 minor strokes) and short lasting neurologic deficits in additional 4 (6.2%) patients. Cardiovascular complications were not observed. Local (inguinal) problems occurred in 3 (4.5%) patients (2 aneurysma spuria, 1 transfusion for hematoma). Frequently, balloon insufflation was associated with bradycardia (40%) and additional hypotension (11%). In summary, carotid stenting can be performed with technically high success rates (99%), but it is adversely influenced by not infrequent thromboembolic cerebral events (12.4%). The possibility to perform combined procedures with interventions in other vessels (both carotid arteries, coronary arteries, aortic arch arteries) is advantageous.

[Long-term outcome of monoradicular lumbosacral compression syndromes-a comparison of pain and neurological deficits with lumbar CT scan.]. / Monoradikuläre, lumbosakrale Wurzelkompressionssyndrome in Längsschnitt : Eine Korrelation der Schmerzen und neurologischen Ausfälle mit den Ergebnissen der lumbalen Computertomographie.

A total of 97 patients with an acute monoradicular lumbosacral compression syndrome and a herniated disc at the same level were reinvestigated an average of 25 months after the acute event. Assessment was based on CT investigation and "root score", which was compiled from reports of subjective complaints and neurological deficits. All patients had initially undergone conservative treatment as inpatients. At the time of reinvestigation CT examination of the herniated discs revealed that they were unchanged in 56.7%, some-what smaller in 34%, no longer visible in 4.1% and larger in 5.2%. Nevertheless, 53.6% of patients were free of complaints, while 23.7% had improved clinically by more then 75%. The remainder showed improvement by about 25-75%. In no patient was the score unchanged or worse. In 69% of the patients neurological deficits were no longer demonstrable, and the remaining patients were not aware of deficits or did not feel any impairment from deficits that were obvious on clinical example. In 22.7% impairment was caused solely by local radicular or pseudoradicular pain. From these results it can be concluded that herniation of the disc precipitates the acute event but is not the sole source of the pain. In the majority of cases, during the further course of the disease the herniated disc causes no pain. It appears, therefore, that the course of disease following a disc herniation can be influenced very favourably by non-operative treatment and that in more than 50% of cases the condition becomes clinically silent. It follows that in neuroradicular compression syndromes a neurological deficit associated with the acute event does not mean operative intervention is indicated.

[Therapy of idiopathic facial nerve paralysis]. / Zur Therapie der idiopathischen Fazialisparese.

The aim of this study was to determine the influence of the time of onset of therapy with cortisone, antirheumatics and diuretics with respect to successful prevention of secondary lesions by compression of the nerve fibres. Onset of therapy was considered to be "in time" on all cases with incomplete facial paralysis without appearance of electromyographic signs of denervation within the subsequent three days. The results are based on 90 patients with follow-up examination out of a total of 130 patients treated. 94% of the patients thus treated "in time" showed full or almost complete remission. Only 59% of those patients in whom the therapy was not initiated "in time" showed satisfactory results. It may be concluded that the therapy of an idiopathic facial paralysis should commence at the very first clinical signs. The differing therapeutic results reported in the literature are in part due to the problem of the sufficiently early onset of therapy.