[Immediate and long-term results of carotid endarterectomy: the Zurich experience]. / Résultats immédiats et à long terme de l'endartérectomie carotidienne: l'expérience Zurichoise.

Extracardial carotid artery disease is a frequent cause of transient ischemic attack and of cerebral infarction. The records of 485 patients who underwent carotid endarterectomy between 1978 and 1991 were reviewed, with special attention to both cardiac and neurological complications. 432 patients had symptomatic carotid disease whereas 53 were asymptomatic but presented with significant carotid stenosis or a large ulceration at doppler-duplex examination and/or angiography. These examinations showed the following lesions in symptomatic patients: unilateral stenosis > 75% (331; 68.5%), ulceration (41; 8.5%), bilateral stenosis (61; 12.5%) and unilateral stenosis with contralateral occlusion (51; 10.5%). Intraluminal shunt was used in nearly all patients whereas special management of cerebral metabolism (intraoperative electroencephalogram, somatosensory evoked potentials) were used in high-risk patients only. Overall early mortality was 1.8%. Three patients died from the sequelae of a neurologic injury, whereas six patients died from myocardial infarction or intractable arrhythmia. Mortality decreased from 2.4% between 1978 and 1984 to 0.8% between 1985 and 1991. At 6 and 8 years, actuarial survival rates of 88.1% and 76.1% and stroke-free survival rates of 86% and 81.5% were observed. Late mortality was essentially due to ischemic cardiac complications (38.5% of the actuarial late mortality at 8 years). Review of the literature shows that carotid endarterectomy is the treatment of choice for symptomatic high-grade extracranial carotid stenosis in patients who are not high-risk candidates.(ABSTRACT TRUNCATED AT 250 WORDS)

[Brain abscess as a complication of Osler's disease with lung involvement]. / Hirnabszess als Komplikation des Morbus Osler mit Lungenbeteiligung.

Eight months after sustaining a reversible left motor hemisyndrome, predominantly of the arm, a 47-year-old man known to have hereditary haemorrhagic telangiectasia (Osler's disease) again developed neurological symptoms (headache, vertigo, unsteady gait) with fever (up to 38.5 degrees C). Clinical features and findings on computed tomography indicated a cerebellar abscess. This was resected because it continued to enlarge despite antibiotic treatment with daily 2 g ceftriaxone and twice daily 0.5 g ornidazole. As another manifestation of Osler's disease further tests revealed an arteriovenous malformation (2.5 x 2.0 cm) in the right upper lobe of the lung, presumably the cause of the cerebral abscess. After wedge resection of the anterior upper lobe segment the further course was without complications.

[Neurosyphilis 1982-1989]. / Neurolues 1982-1989.

We report the signs, symptoms, serological and CSF findings in 27 patients with syphilis and inflammatory involvement of the central nervous system. In 24 patients the neurosyphilis was symptomatic. Most patients did not report previous signs of early syphilis. A CSF pleocytosis was present in 25 patients (greater than 90%) and the CSF VDRL was reactive with a titer of 1:2 or above in 19 patients (70%). The symptomatology seemed not to be atypical for neurosyphilis although a precise classification was often not possible and the diagnosis was seldom suspected on clinical grounds. In most patients the clinician can monitor the effectiveness of antibiotic therapy by simple laboratory parameters which reflect the activity of the inflammatory process. It is disquieting, however, to note how inconsistently this follow-up was performed.