Percutaneous transluminal angioplasty (PTA) of supra-aortic arteries especially the internal carotid artery.

We present our experience with 105 patients in whom percutaneous transluminal angioplasty was performed in 112 stenosed or occluded supra-aortic arteries. Symptoms of cerebrovascular and/or vertebrobasilar insufficiency were present in 104 of the 105 patients. The angioplasty was successful in 35 stenoses of the internal carotid artery, 2 stenoses of the common carotid artery, 1 stenosis of the external carotid artery, 15 stenoses of the vertebral artery, 3 stenoses of the innominate artery and 44 stenoses of the subclavian artery. There were only 4 minor-complications (2 haematomas, 1 transient ischemic attack, 1 small thrombus of the internal carotid artery which was detected by 111-indium platelet scintigraphy and treated by thrombendarterectomy before the appearance of neurological symptoms). All patients were symptom free after angioplasty. During the observations period of 3 to 109 months (average 58 months) there were only two cases with re-stenosis after subclavian angioplasty. The results of more than 700 personal and international published percutaneous transluminal angioplasties of supra-aortic arteries are presented. The results suggest that angioplasty of supra-aortic arteries is an effective method. On strict definition of the indications, the complication rate for angioplasty of the supra-aortic arteries is not likely to be higher than that for operative treatment.

Alterations of coagulation and fibrinolysis in cerebrospinal fluid in subarachnoid haemorrhage.

The authors analyze the mechanism of CSF in fibrinolytic activity in the cause of subarachnoid haemorrhage. The intrathecal administration of antifibrinolytic agents is proposed to avoid ischaemic cerebrovascular complication of systemic therapy.

[Current status of intrathecal antifibrinolytic therapy with p-aminomethylbenzoic acid (PAMBA) in subarachnoid hemorrhages]. / Gegenwärtiger Stand der intrathekalen antifibrinolytischen Therapie mit p-Aminomethylbenzoesäure (PAMBA) bei Subarachnoidalblutungen.

The blood-brain barrier is barely affected by slight or moderate subarachnoidal bleeding so that the p-aminomethylbenzoic acid (PAMBA) administered systemically for antifibrinolytic therapy does not attain the continuous level necessary in the cerebrospinal fluid. Thus the antifibrinolytic agent should be applied intrathecally because this would totally inhibit fibrinolytic activity in cerebrospinal fluid containing blood and during the wound healing of ruptured aneurysmas. The improvement in wound healing reduces the occurrence of rebleeding, especially during the first 10 days, and improves conditions for successful surgical intervention.

Haemostasis in cerebrospinal fluid. Basic concept of antifibrinolytic therapy of subarachnoid haemorrhage.

Among the reasons for intensified research into the CSF haemostatic pathway were the clinical case reports stating that special importance must be attached to the CSF for the high incidence of rebleeding and the intraoperative haemorrhage rate in SAH patients, which, among other things, may be regarded as the reasons for mortality. Extensive analyses of the coagulation and fibrinolysis enzyme systems were carried out and constitute the basic concept for the conservative AFT aiming at restoring to normal haemostasis and wound healing which had been disturbed by local fibrinolytic activity in the area of operation or trauma. The programme of investigation, first served as basic research and was then directed towards the clinical situation for recording the partly contradictory or still unknown haemostasis values in the CSF. This necessitated that the immunochemical, enzymatic, enzymatic-fluorometric, biophysical and chromogenic substrate methods should be adapted to low quantities of protein for the quantitative determination of activators, inhibitors, zymogens, enzymes, the fibrin substrate and its degradation products. The results obtained with the prospective series of tests applying selective methods with objective data recording confirm the operating hypothesis that, on principle, a distinction must be made between the proteins of normal CSF in cases of intact BBB and the pathological protein patterns, not typical of CSF, caused by disturbances of permeation. The CSF space, therefore, must be regarded as a compartment largely insulated by the BBB. That is why the unqualified interpretation is wrong, when it states that the CSF, in general, shows a fibrinolytic activity, no matter whether the CSF is formed under physiological or pathological conditions, or whether it represents a mixture of blood and CSF. CSF formed when the BBB is normal has no fibrinolytic activity. The plasminogen activator antigen always present in CSF does not become effective because the quantity of plasminogen in CSF is well below normal for the measurable fibrinolytic activity. In the case of diseases accompanied by disturbance of the BBB, the proteins of the fibrinolytic system in the CSF increasingly penetrate in proportion to the disturbance of BBB, and thus enable the CSF to some extent to become a fibrinolytically active fluid. A temporarily limited breakdown of the BBB in the case of bleeding into the CSF space permits the unhampered transfer of all the factors required for the fibrinolytic system, as well as the inhibitors.(ABSTRACT TRUNCATED AT 400 WORDS)

[Experimental thromboses of the internal carotid artery in animal experiments as a prerequisite for model studies of acute cerebral ischemia]. / Experimentelle Thrombosen der A. carotis interna im Tierversuch als Voraussetzung für Modellstudien der akuten Hirnischämie.

Thrombotic occlusions of the cerebral arteries are in a high degree participating in the development of cerebral infarction. Their treatment is problematic because the use of thrombolytics may be detrimental to the cerebral tissue. In many cases, these thromboses cannot be reached surgically. Suitable animal models are necessary for achieving advances in this acute life-threatening disease. An animal-experimental model of a thrombosis of the arteria carotis interna is presented. For producing a coagulative thrombosis, autologous blood is used after previous electric activation in vitro which after re-injection behaves like a thrombogenic substance.

[Coagulation physiological controls in subarachnoid hemorrhages and their therapeutic implications]. / Gerinnungsphysiologische Verlaufskontrollen bei Subarachnoidealblutungen und deren therapeutische Koinsequenzen.

Every wound healing of a vascular lesion requires optimum values in an intact coagulation system. The high rate of secondary haemorrhages in subarachnoid haemorrhages induced us to carry out checks of the behaviour of various coagulation parameters. Increases in fibrinogen and reduced thromboplastin time values were the most marked changes of the haemostatic potential. Normal thromboplastin time values are reached by a vitamin K1 therapy.

[Experimental studies on the diffusion of antifibrinolytic agents in fibrin thrombi. A contribution to intrathecal antifibrinolytic therapy in subarachnoid hemorrhages]. / Experimentelle Untersuchungen zur Diffusion von Antifibrinolytika in Fibrinabscheidungsthromben. Ein Beitrag zur intrathekalen antifibrinolytischen Therapie bei Subarachnoidealblutungen.

The diffusion behaviour and the diffusion coefficients of antifibrinolytics in fibrin thrombi were determined by in vitro incubating attempts with tritium marked compounds of PAMBA, AMCA, and ECA as well as by chromogenic substrate determination for contrykal. The great diffusion ability of PAMBA supports the usefulness of intrathecal therapy of subarachnoidal bleeding for blocking endogenous fibrinolysis, whereas the exogenous fibrinolysis of the fibrin thrombus closing aneurysm is inhibited by the intrathecal application.

[Antifibrinolytic therapy of subarachnoid hemorrhage. Permeation of oral paraaminomethylbenzoic acid in the cerebrospinal fluid]. / Beitrag zur antifibrinolytischen Therapie bei Subarachnoidealblutungen. Untersuchungen über die Permeation der oral applizierten para-Amino-methylbenzoesäure in den Liquor.

Studies of the permeation of PAMBA in the cerebrospinal fluid of patients with intact or disturbed BBB function after oral administration of 6 g and withdrawal of the spinal fluid after 120 minutes exclusively showed concentrations which were below the identification threshold of the method using 1 micron per millilitre. Patients suffering from subarachnoidal haemorrhages mainly showed a permeation of PAMBA in the cerebrospinal fluid which, however, only rarely reached the lower therapeutically necessary concentration.

[In vitro studies on the determination of the coagulating activity of normal, inflammatory and bloody cerebrospinal fluids]. / In-vitro-Versuche zur Bestimmung der Gerinnungsaktivität in normalen, entzündlich veränderten und blutigen Liquores.

Selective analyses of the coagulation factors II, V, VIII, and X in cerebrospinal fluid resulted in activity values ranging from 0.01-0.05 as a portion of the relative ratio 1 pertaining to the plasma activity. The increase of activity did not correlate with the protein increase in cerebrospinal fluid at F-VIII, and only to a slight extent at F-II, F-V,, and F-X. As compared with plasma a stimulating effect on coagulation can be recorded thromboelastographically in plasma mixtures.

[Rest and function rheoencephalographic parameters for the identification of cerebral vasculopathy]. / Ruhe- und funktionsrheoenzephalographische Parameter zur Identifikation der zerebralen Vaskulopathie.

In patients with a cerebral vascular process, parameters for the loss in distensibility and the remaining regulation with of sclerotically changed cerebral vessels were obtained by employing a special complex rest and function rheoencephalographic investigation method.

[Space-demanding intracranial processes in puerperium (author's transl)]. / Raumfordernde intrakranielle Prozesse im Wochenbett.

Reference is made to aspects of differential diagnosis in the context of three space-demanding intracranial processes in puerperae. Puerperal psychosis with no organic cause had been the primary appraisal due to the absence or only discrete appearance of neurological symptoms and the superficial, apparent presence of psychopathological phenomena. --Comprehensive neurological testing is required, if cerebroorganic disorders are to be ruled out safely. Neuroradiological methods, such as cerebroscintigraphy and cerebral angiography, may be necessary. Close interdisciplinary cooperation will be essential to effective diagnosis with minimum stress on mother and child.

[Arteriovenous malformations in the region of the external carotid artery]. / Arteriovenöse Fehlbildungen im Bereich der Arteria carotis externa.

This article reports two cases of extracranial angiomatous vascular malformation, with blood being conveyed thereto by the external carotid artery. Visible and palpable clusters of dilated and pulsating vessels in the scalp or jugular region as well as vascular murmur are of major importance for clinical diagnosis. Conditions of flow may be objectified with the use of angiography. Therefore, the radiography of vessels should always be used to reliably determine the absence of combined extra- and intracranial vascular malformations.

Antifibrinolytic therapy of subarachnoid hemorrhage by intrathecal administration of p-aminomethylbenzoic acid.

In patients suffering from subarachnoid hemorrhage (SAH), intrathecal administration of p-aminomethylbenzoic acid (PAMBA) was found to produce hemostatically effective concentrations of the antifibrinolytic agent in the cerebrospinal fluid (CSF). The early clinical findings speak in favor of this mode of administration.

[Neuropsychiatric and electroencephalographic studies of the course of patients accidentally struck by lightning]. / Neuropsychiatrische und hirnelektrische Verlaufsuntersuchungen nach Unfällen durch Blitzschlag.

Five patient (one adult and four children) hit by lightning strokes were examined clinically and electroencephalographically. One child died immediately after the accident. For the four survivors, data are available which were collected during several years' examinations. It was possible to confirm the results of previous investigations which showed that pathologic EEG changes can be associated with a weak neuropsychiatric symptomatology following the gradual disappearance of the acute lightning-stroke syndrome and can be observed even in the case of freedom from complaints and symptoms. Finally, the authors also deal with the problems associated with the making of statements by medical experts.

[Episodic psychoses in epileptic juveniles with reference to electroencephalographic findings]. / Episodische Psychosen bei Jungendlichen mit einer Epilepsie unter Berücksichtigung hirnelektrischer Befunde.

The present paper describes three juveniles affected with epilepsy, who suffered from episodic psychoses. Such disorders are a very rare occurrence in young persons. The patients had grand mal epilepsy with "secondary temporalization". Clinical and electroencepholographic aspects are discussed by reference to these particular cases. Also, the authors deal with questions of classification and etiopathogenesis. Finally, possible causes producing such psychoses and giving rise to the psychopathological character thereof are pointed out within the framework of a multiconditional approach.

[Rheoencephalographic examinations of a patient with "coughing syncopes"--a contribution to etiology]. / Rheoenzephalographische Untersuchungen eines Patienten mit "Hustensynkopen" - ein Beitrag zur Atiologie

This is a report of a patient showing the clinical picture of syncopes due to coughing, who has been examined by rheoencephalography. Three different varitions of syncopes due to coughing are discussed with particular reference to the factors involved.