Erythropoietin in patients with aneurysmal subarachnoid haemorrhage: a double blind randomised clinical trial.

BACKGROUND: Erythropoietin (EPO) is neuroprotective in experimental models of stroke and subarachnoid haemorrhage (SAH) and possibly in patients with thromboembolic stroke. We studied the efficacy and safety of EPO in patients with SAH. METHODS: A larger scale clinical trial was planned but preliminarily terminated because of a lower than expected inclusion rate. However, 73 patients were randomised to treatment with EPO (500 IU/kg/day for three days) or placebo. The primary endpoint was Glasgow Outcome Score at six months. We further studied surrogate measures of secondary ischaemia, i.e. transcranial Doppler (TCD) flow velocity, symptomatic vasospasm, cerebral metabolism (microdialysis) and jugular venous oximetry, biochemical markers of brain damage (S-100beta and neuron specific enolase) and blood-brain barrier integrity. FINDINGS: The limited sample size precluded our primary hypotheses being verified and refuted. However, data from this study are important for any other study of SAH and as much raw data as possible are presented and can be included in future meta analyses. On admission the proportion of patients in a poor condition was higher in the EPO group compared with the placebo group but the difference was statistically insignificant. In the EPO-treated patients the CSF concentration of EPO increased 600-fold. Except for a higher extracelullar concentration of glycerol in the EPO group probably caused by the poorer clinical condition of these patients, there were no statistically significant group differences in the primary or secondary outcome measures. EPO was well tolerated. CONCLUSIONS: Beneficial effects of EPO in patients with SAH cannot be excluded or concluded on the basis of this study and larger scale trials are warranted.

Hearing preservation after classical translabyrinthine removal of a vestibular schwannoma: case report and literature review.

The translabyrinthine approach is one of the favoured access routes for removal of vestibular schwannomas; however, total hearing loss in the operated ear is a predictable consequence. Here, we report a case in which a patient maintained serviceable hearing almost six years after classic translabyrinthine surgery. Possible explanations for the hearing preservation are discussed, as well as the feasibility of a modified translabyrinthine approach in attempting preservation of hearing following vestibular schwannoma surgery.

Trends in monitoring patients with aneurysmal subarachnoid haemorrhage.

After aneurysmal subarachnoid haemorrhage (SAH), the clinical outcome depends upon the primary haemorrhage and a number of secondary insults in the acute post-haemorrhagic period. Some secondary insults are potentially preventable but prevention requires prompt recognition of cerebral or systemic complications. Currently, several neuro-monitoring techniques are available; this review describes the most frequently used techniques and discusses indications for their use, and their value in diagnosis and prognosis. None of the techniques, when considered in isolation, has proved sufficient after SAH. Furthermore, the use of multi-modality monitoring is hampered by a lack of clinical studies that identify combinations of specific techniques in terms of clinical information and reliability. However, ischaemia at the tissue level can be detected by intracerebral microdialysis technique. Used together with the conventional monitoring systems, for example intracranial pressure measurements, transcranial Doppler ultrasound and modern neuro-imaging, direct assessment of biochemical markers by intracerebral microdialysis is promising in the advancement of neurointensive care of patients with SAH. A successfully implemented monitoring system provides answers but it also raises valuable new questions challenging our current understanding of the brain injury after SAH.

Efficacy and safety of a new combination of calcipotriol and betamethasone dipropionate (once or twice daily) compared to calcipotriol (twice daily) in the treatment of psoriasis vulgaris: a randomized, double-blind, vehicle-controlled clinical trial.

BACKGROUND: Calcipotriol and betamethasone dipropionate are both widely used, effective treatments for psoriasis. Vitamin D analogues and topical corticosteroids have different mechanisms of action in the treatment of psoriasis. A new vehicle has been developed in order to contain both calcipotriol (50 micro g g-1) and betamethasone dipropionate (0.5 mg g-1) in an ointment form. By using calcipotriol and a corticosteroid together, greater efficacy may be achieved than by using either compound alone. OBJECTIVES: The present study was conducted in order to compare the clinical efficacy and safety of the combined ointment formulation used once daily with the vehicle ointment used twice daily, calcipotriol ointment used twice daily and the combined formulation used twice daily in psoriasis vulgaris. METHODS: This was an international, multicentre, prospective, randomized, double-blind, vehicle-controlled, parallel group, 4-week study in patients with psoriasis vulgaris amenable to topical treatment. Patients were randomized to one of four treatment groups: combined formulation once daily, combined formulation twice daily, calcipotriol twice daily or vehicle twice daily. Efficacy and safety were assessed. RESULTS: There was no statistically significant difference in the mean percentage change in the Psoriasis Area and Severity Index (PASI) from baseline to end of treatment between the two combined formulation groups, but the difference in PASI reduction was significantly higher in the combined formulation groups (68.6% once daily, 73.8% twice daily) than in both the twice daily calcipotriol group (58.8%) and the vehicle group (26.6%). Safety data showed the frequency of adverse events to be less in the combined formulation groups than in both the calcipotriol group and the vehicle group. The proportion of patients with lesional/perilesional adverse reactions was less in the combined formulation groups and vehicle group than in the calcipotriol group (9.9% combined formulation once daily, 10.6% combined formulation twice daily, 19.8% calcipotriol, 12.5% vehicle). CONCLUSIONS: No statistically significant nor clinically relevant difference in efficacy was seen between the combined formulation used once daily and twice daily. When compared to vehicle ointment or calcipotriol ointment alone, the combined formulation was shown to be clearly more efficacious.

Cobalt(III) complexes of [3(5)] adamanzane, 1,5,9,13-tetraazabicyclo[7.7.3]nonadecane. Report of an inert, chelate hydrogen carbonate ion.

Three cobalt(III) complexes of the macrocyclic tetraamine [3(5)]adamanzane (1,5,9,13-tetraazabicyclo[7.7.3]nonadecane) were isolated as salts. The X-ray crystal structures were solved for the compounds [Co([3(5)]adz)(CO(3))]AsF(6) (1b), [Co([3(5)]adz)(HCO(3))]ZnBr(4).H(2)O (2a), and [Co([3(5)]adz)(SO(4))]AsF(6).H(2)O (3a). The coordination geometry around the cobalt(III) ion is a distorted octahedron with the inorganic ligands at cis-positions. Complex 2 is the second example of a cobalt(III) complex for which the X-ray structure shows a chelate binding mode of the hydrogen carbonate entity. The pK(a) value of the [Co([3(5)]adz)(HCO(3))](2+) ion (2) was determined spectrophotometrically to be 0.27 (25 degrees C, I = 5.0 M). The protonation appears to occur at the noncoordinated carbonyl oxygen atom of the carbonate group, with hydrogen bonding to the crystal water molecule. Evidence is presented for this oxygen atom as the site of protonation in solution as well. In 5.0 M CF(3)SO(3)H a slow reaction of the carbonato complex, quantitatively yielding the [Co([3(5)]adz)(H(2)O)(2)](3+) ion, was observed. k(obs) = 7.9(1) x 10(-)(6) s(-)(1) at 25 degrees C.

Cobalt(II), nickel(II), copper(II), and zinc(II) complexes with [3(5)]adamanzane, 1,5,9,13-tetraazabicyclo[7.7.3]nonadecane, and [(2.3)(2).2(1)] adamanzane, 1,5,9,12-tetraazabicyclo[7.5.2]hexadecane.

Isolation of the free bicyclic tetraamine, [3(5)]adamanzane.H(2)O (1,5,9,13-tetraazabicyclo[7.7.3]nonadecane.H(2)O), is reported along with the synthesis and characterization of a copper(II) complex of the smaller macrocycle [(2.3)(2).2(1)]adamanzane (1,5,9,12-tetraazabicyclo[7.5.2]hexadecane) and of three cobalt(II), four nickel(II), one copper(II), and two zinc(II) complexes with [3(5)]adamanzane. For nine of these compounds (2-8, 10b, and 12) the single-crystal X-ray structures were determined. The coordination geometry around the metal ion is square pyramidal in [Cu([(2.3)(2).2(1)]adz)Br]ClO(4) (2) and trigonal bipyramidal in the isostructural structures [Cu([3(5)]adz)Br]Br (3), [Ni([3(5)]adz)Cl]Cl (5), [Ni([3(5)]adz)Br]Br (6), and [Co([3(5)]adz)Cl]Cl (8). In [Ni([3(5)]adz)(NO(3))]NO(3) (4) and [Ni([3(5)]adz)(ClO(4))]ClO(4) (7) the coordination geometry around nickel(II) is a distorted octahedron with the inorganic ligands at cis positions. The coordination polyhedron around the metal ion in [Co([3(5)]adz)][ZnCl(4)] (10b) and [Zn([3(5)]adz)][ZnCl(4)] (12) is a slightly distorted tetrahedron. Anation equilibrium constants were determined spectrophotometrically for complexes 2-6 at 25 and 40 degrees C and fall in the region 2-10 M(-1) for the halide complexes and 30-65 M(-1) for the nickel(II) nitrate complex (4). Rate constants for the dissociation of the macrocyclic ligand from the metal ions in 5 M HCl were determined for complexes 2, 3, 5, 8, 10, and 12. The reaction rates vary from half-lives at 40 degrees C of 14 min for the dissociation of the Zn([3(5)]adz)(2+) complex (12) to 14-15 months for the Ni([3(5)]adz)Cl(+) ion (5).

[Endoscopic decompression of the carpal tunnel]. / Endoskopisk dekompression af karpaltunnelen.

The aim of the study was to evaluate the efficiency and safety of endoscopic carpal tunnel release using the Wolf one-portal system. The case records for all decompressions performed between January 1995 and June 1998 were reviewed retrospectively. Preoperative complaints, intraoperative findings and postoperative results were recorded for a total of 168 procedures in 138 patients. The median follow-up period was 10.4 weeks (1.1-170.9). An improvement in symptoms was noted after 82.9% of the procedures. The complication rate was 8.9% at the time of follow-up. Nine procedures were converted to open release. No patients sustained nerve or vascular injury. The findings in this study indicate that carpal tunnel release performed using the Wolf one-portal system provides a safe and effective treatment for carpal tunnel syndrome. The technique is today used as a routine in the department in uncomplicated cases of carpal tunnel syndrome.

Kinetics and thermodynamics of the reaction of deoxyhemerythrin with nitric oxide.

Deoxyhemerythrin reacts with NO to form a 1:1 adduct shown spectrophotometrically. The kinetics of the formation have been studied directly by stopped-flow measurements at four different temperatures (0.0-23.6 degrees C). The kinetics of the dissociation have been studied, also by stopped-flow techniques, at five different temperatures (4.0-35.1 degrees C) using three different scavengers [Fe(II)(edta)2-, O2 and sperm whale deoxymyoglobin], which gave similar values. For the formation kf = (4.2 +/- 0.2) x 10(6) M-1 s-1, delta Hf not equal = 44.3 +/- 2.3 kJ mol-1, delta Sf not equal to = 30 +/- 8 J mol-1 K-1 and for the dissociation kd = 0.84 +/- 0.02 s-1, delta Hd not equal to 95.6 +/- 2.1 kJ mol-1 delta Sd not equal to = 74 +/- 7 J mol-1 K-1 (25 degrees C, I = 0.2 M and pH 7-8.1). From the kinetic data the thermodynamic data for the formation of HrNO were calculated: Kf = (5.0 +/- 0.3) x 10(6) M-1, delta H = -51.3 +/- 3.1 kJ mol-1 and delta S = -44 +/- 11 J mol-1 K-1 (25 degrees C). The kinetic data suggest that NO occupies the same iron(II) site in deoxyhemerythrin as oxygen does. The equilibrium constant for the formation of Fe(II)(edta)(NO)2- has been redetermined: K1 = (1.45 +/- 0.07) x 10(7) M-1, delta H = -77.5 +/- 1.5 kJ and mol-1 and delta S = -123.5 J mol-1 K-1 (25 degrees C).