[Early rehabilitation in Baden-Wurttemberg--a study of all Baden-Wurrtemberg early rehabilitation centers]. / Frührehabilitation in Baden-Württemberg--Eine Untersuchung aller Frührehabilitationseinrichtungen Baden-Württembergs.

Over a period of 12 months, all persons among the 10.4 million inhabitants of the state of Baden-Württemberg were included in the study who had suffered severe brain damage and were treated in special early rehab units, comprising 147 beds for adults and 43 for children. With 830 patients admitted, the incidence of severe brain damage was 7.98/100.000 in adults and 1.11/100.000 in children. 50 to 70 year old patients were over-represented, those older than 70 years were underrepresented due to geriatric rehab facilities for the latter. Male patients dominated, while female were somewhat younger. 54% of the patients were admitted from the hospital which had performed primary care, with an average stay of 67 days. Average early rehab duration was 53 days (arithmetic average; median 40 days, some patients required up to one year). 32.8% of the patients had suffered traumatic brain damage (ICD 851, 852, 854) and 40.9% non-traumatic brain affection (ICD 430, 431, 433-438, 310, 348), including 12.2% CVA (ICD 433-438), 8.5% subarachnoid and 12.3% intracerebral hemorrhage. Severity as indexed by the early rehab Barthel index improved from an initial average of -119 to -34 at discharge. 80% of the patients showed an overall improvement (71% of them by up to 200 points and 46% by up to 100 points).

Transvenous embolization of small patent ductus arteriosus with single detachable coils in dogs.

Transvenous embolization of small patent ductus arteriosus (PDA; < or = 4 mm) with a single detachable coil was attempted in 24 dogs (median age 5.7 months, range, 2.6-65.5 months; median body weight 5.5 kg, range, 1.5-30.0 kg). Angiographic imaging of the duct and pressure measurements were made before and after embolization. The minimal ductal diameter was 2.7 +/- 0.7 mm. In all dogs, a single coil was employed regardless of residual shunting. Ten dogs (PDA minimal diameter range, 1.5-2.2 mm) received a 5-mm coil, and 14 dogs (PDA minimal diameter range, 2.9-3.6 mm) received a 8-mm coil. After coil embolization the angiographic shunt grade decreased significantly (n = 20, P < .001). Residual shunts were assessed by angiography 15 minutes after and by Doppler echocardiography 1-3 days and 3 months after the intervention. In the dogs treated with the 5-mm coils the residual shunt rate was low (0%, 10%, and 0% for angiography and Doppler echocardiography at 1-3 days and 3 months, respectively), in contrast to the dogs treated with the 8-mm coils (91%, 79%, and 67% for angiography and Doppler echocardiography at 1-3 days and 3 months, respectively). After 3 months, no residual murmur was found in dogs treated with the 5-mm coils (0/7), in contrast to murmurs in 5 of 12 (42%) dogs treated with the 8-mm coils. Despite incomplete closure in these dogs, volume loading of the left heart decreased in all dogs. Pulmonic or aortic coil embolism did not occur. Analysis of initial results shows that single detachable coil embolization is possible in all dogs with a small PDA (< or = 4 mm), but only very small PDA (< or = 2.5) could be treated effectively, and for the moderate PDA (2.6-4.0 mm) longer coils or multiple coils may be necessary to achieve complete occlusion.

Systematic EEG follow-up study of traumatic psychosis.

A systematic 2 year follow-up study of EEG in 100 patients suffering from traumatic psychosis with amnesia lasting more than 1 week led to the following results. (1) EEG foci were demonstrated in 95% of cases, and bilaterally in 70%. Normalization occurred within 3 months in 48% of patients, with foci persisting for more than 2 years in 22% mostly in patients with traumatic epilepsy. Focal signs initially consisted of delta foci (85%) and finally of focal dysrhythmia (72%), with temporal localization increasing from 58% to 82%. EEG foci were associated with neurological focal symptoms in 49% of cases and skull fractures in 78%. (2) During psychosis a general slowing of EEG was constantly observed. Normalization occurred within 3 months in 28% of patients. Rarely slowing lasted longer than 6 months. (3) It took longer to normalize general slowing than EEG foci, but slowing disappeared more completely. The left preponderance of EEG foci in traumatic psychosis could not be confirmed, the hypothesis of a pathoplastic role of the speech dominant hemisphere was not proved.

Congenital arteriovenous fistula between the subclavian artery and the portal vein.

We report an arteriovenous fistula between the right subclavian artery and the portal vein in a 6 year old girl. Till now only two cases of similar anatomy have been described in literature to our knowledge. The operative and postoperative course were uneventful.