Distal radial artery pressures predict angiographic result and short-term patency outcome in hemodialysis patients with juxta-anastomotic inflow stenosis of radiocephalic fistula undergoing transradial angioplasty.

Distal radial artery pressure (RAP) was observed to be reduced after transradial percutaneous transluminal angioplasty (PTA) on the juxta-anastomotic venous stenosis of radiocephalic arteriovenous fistula (RCAVF). Distal RAPs are easily obtained from a pressure transducer connected with an introducer retrograde inserted into distal radial artery. The clinical role of distal RAP in the setting of transradial PTA remains unknown. This prospective and observational study aimed to explore the relationship between distal RAPs and clinical outcomes. This study recruited hemodialysis patients with RCAVF juxta-anastomotic venous stenosis undergoing transradial PTA. RAP-related variables and procedural data before PTA (pre-PTA) and after PTA (post-PTA) were analyzed. The study endpoint was dysfunction-driven re-PTA during the 1-year follow-up. Overall, 73 PTAs significantly reduced the mean of systolic RAPs from 159.6 ± 41.4 to 108.4 ± 41.5 mm Hg; P < 0.0001. Post-PTA systolic RAP was associated with angiographic outcome (P = 0.004) and unassisted patency at 3 months (P = 0.036), but not at 6, 9, or 12 months (P > 0.05). The group with angiographically successful PTAs had a significantly lower mean of post-PTA systolic RAPs compared with that with unsuccessful PTAs (98.4 ± 35.4 vs. 128.7 ± 46.1 mm Hg; P = 0.003). The post-PTA systolic RAP may be seen as a predictor for 3-month unassisted patency (AUC = 0.669; P = 0.048). In conclusion, this study provides the RAP profile to help guide transradial PTA on RCAVF juxta-anastomotic venous stenosis and predict 3-month unassisted patency in a hemodynamic manner.

Increased total TAU but not amyloid-beta(42) in cerebrospinal fluid correlates with short-term memory impairment in Alzheimer's disease.

Given the need for tools for early and accurate diagnosis, prediction of disease progression, and monitoring efficacy of therapeutic agents for AD, the study of cerebrospinal fluid (CSF) biomarkers has become a rapidly growing field of research. Several studies have reported conflicting data regarding the relationships between CSF biomarkers and dementia severity. In this study, we have focused on the identification of CSF biomarkers and their correlations with the impairment of different cognitive domains measured using the Cognitive Abilities Screening Instrument (CASI). Patients with AD (n=28), non-AD dementia (n=16), other neurological disorders (OND, n=14), and healthy controls (HC, n=21) were enrolled. Our results revealed significantly higher CSF total tau (t-tau) and lower amyloid-beta(42) levels in AD patients compared with those in HC and OND groups. Moreover, our data show that CSF t-tau levels, but not Abeta(42) levels, have an inverse correlation with the score of short-term memory in CASI for patients with AD (Spearman: r=-0.444; p=0.018). This data might indicate that the higher CSF t-tau level is associated with more NFT pathology and more severe impairment of short-term memory in AD patients.

Recurrent primary intracerebral hemorrhage: a hospital based study.

BACKGROUND: Primary intracerebral hemorrhage (ICH) occurs more commonly in Taiwan than in other western countries. Recurrence of primary ICH after a first episode is not rare. The purpose of this study is to investigate the incidence, risk factors, and prognosis of recurrent primary ICH. METHODS: From the stroke registration data of Kaohsiung Veterans General Hospital (KSVGH), all patients admitted between Jan. 1999 and Dec. 2003 with the discharge diagnosis of ICH were identified. The hospital records and images of each ICH patient were carefully reviewed and the diagnosis was confirmed by one of the investigators. For those patients admitted in this study period with the diagnosis of acute primary ICH who also had past medical history of ICH, the record and image of the past admission were also obtained for review, either from KSVGH or other hospitals. Patients with ICH due to secondary causes were excluded. RESULTS: 585 patients with primary ICH were reviewed. Among them, 34 (5.8%) patients were found to have recurrent primary ICH. The medical records of these 34 patients were obtained for further analysis. Cerebral amyloid angiopathy was diagnosed in 4 (11.7%) patients. Mean ages at the onset of the first and second hemorrhages were 64 +/- 13 and 66 +/- 13 years, respectively. The mean interval between first and second hemorrhages was 33 months (from 1 month to 10 years). The most common location of first-second bleeding was basal ganglion-basal ganglion. The mortality rate in this group was 23.5%. Fifteen (38.2%) patients became totally dependent or vegetative after the second ICH. CONCLUSIONS: Recurrent primary ICH is not uncommon. The main location of recurrent bleeding was basal ganglion. This may implicate hypertension as the main cause of ICH. Hypertension is an important risk factor of recurrent primary ICH. Amyloid angiopathy is another cause of recurrent primary ICH. The prognosis after the second hemorrhage is worse, while the mortality and morbidity after first ever primary ICH were 15.6% and 17.9%, respectively.

Central vasomotor failure in a patient with medulla arteriovenous fistula.

We report on the case of a 60-year-old man who suffered from hiccup, dysphagia and unsteady gait for three months. He was diagnosed with intracranial dural arteriovenous fistula in medulla with retrograde perimedullary vein drainage. He developed quadriplegia, persistent shock status and symptomatic bradycardia immediately after a conventional cerebral angiography study. After excluding cardiogenic, hypovolemic, anaphylactic and septic shock, central vasomotor failure caused by venous thrombosis of the lesion was considered. The patient's central vasomotor failure recovered after continuous dopamine infusion treatment for 42 days. We concluded that venous hypertension with venous thrombosis in rostral ventrolateral medulla (RVLM), a major vasomotor center in the brainstem, was the lesion site. In our case, vasomotor dysfunction caused by an RVLM lesion related to venous thrombosis is considered as causative.