Clinical presentation of posterior cerebral artery occlusions - Clinical rationale for a more aggressive therapeutic strategy?

INTRODUCTION: A proximal occlusion of the posterior cerebral artery (PCA) can affect patients severely and clinical outcome might be poor. Aim of this paper is to describe clinical presentation, diagnostic findings and outcome of patients suffering from ischemia in the PCA territory. METHODS: We conducted a retrospective analysis of clinically affected patients with imaging-based evidence of ischemia within in the PCA territory at a comprehensive stroke center over a six-year period. Clinical (including demographics, National Institutes of Health Stroke Scale, NIHSS, modified Rankin Sclae, mRS), imaging (including occlusion site and brain infarction) and therapeutic data were evaluated. A favorable outcome was defined as an mRS ≤2. RESULTS: Two hundred thirty-five patients were clinically affected with evidence of PCA ischemia detected by cross-sectional imaging. One-hundred fourty-five patients demonstrated an occlusion of the PCA including 43/145 (30%) with P1 occlusion, 80/145 (55%) with P2 and 22/145 (15%) with P3 occlusion. The most frequent symptom was hemi-/ quadrantanopsia (181/235, 77%). Sixty-eight patients (29%) suffered from hemiparesis. The occurrence of a hemiparesis was associated with a P1 occlusion (27/43, 63% vs. 41/192, 21%; p < 0.0001). Hemi-/quadrantanopsia was less frequently associated with a P1 occlusion (26/43, 61% vs. 155/192, 81%; p = 0.0043). P1 occlusions more frequently showed thalamic infarction (28/43, 65% vs. 65/192, 34%; p < 0.0001). At discharge, patients with P1 occlusion more often showed a poor outcome (mRS > 2, 30/43, 70% vs. 55/192, 29%; p < 0.0001). CONCLUSION: Hemiparesis due to P1 occlusion is a common phenomenon in stroke patients and associated with a poor clinical outcome.

[Abraham Vater and the Papilla of Vater - From publication to medical term]. / Abraham Vater und die Vatersche Papille ­ Von der Veröffentlichung bis zum medizinischen Begriff.

The name Abraham Vater is internationally associated with the confluence of the common bile duct and the pancreatic duct. Vater's writings were published 300 years ago along with the most important anatomical publications of that time. In his experiments, he examined in particular the merging of both ducts and their physiological significance. The major duodenal papilla is neither part of the experiments in this publication, nor does Vater describe it in detail. Rather, Abraham Vater collects and discusses the knowledge of this anatomical region in his writing.

Early polyethylene wear and excessive acetabular granuloma in an uncemented HA-coated total hip arthroplasty--midterm results of a prospective study.

This is a prospective review of 135 HA-coated ABG I total hip arthroplasty (THA) systems with a mean clinical and radiographic follow-up of 8.5 years. The 5-year survival rate was 85%, but 22% of the patients were dissatisfied. Revision THA was already indicated in 28% of the patients, with 26% indicated for cup loosening. PE wear was detected by x-ray in 42%. Disproportionate substantial wear with an average linear loss of 2.6 mm at the inner rim of the insert was observed in 23% of the cases. The mean annual wear rate was calculated 0.1-0.25 mm/year. Laboratory examination of the retrieved PE revealed polishing, cracks, and subsurface delamination. Radiographic evidence of acetabular cysts were found to be excessive granuloma during surgery. Polarization microscopy revealed debris particles phagocytized by reticuloendothelial cells. Results confirm the general opinion that aseptic osteolysis is a cell-mediated process driven by the presence of particles generated from wear debris. The findings also suggest that the main reasons for the failure of the first-generation ABG hip system were an insufficient locking mechanism and poor PE congruency, and not solely poor PE quality.