Malignant middle cerebral artery (MCA) infarction in people over 85 years old – Diagnosis,management and risk factors

Introduction

Malignant ischemic stroke of the middle cerebral artery (MCA) territory causes neurological deterioration due to the effects of space occupying cerebral edema. The prognosis is poor, and death usually occurs as a result of brainstem compression. There is no information on ischemic stroke, especially the malignant ones, in patients over 85 years old.

Quantitative coronary arteriography: design and validation

The authors assessed the performance of an automatic and rapid coronary quantification method by evaluating its accuracy in a stenosis phantom. Measurements were obtained with a lucite phantom with 2-, 3-, and 4-mm vessel diameters and concentric stenoses of 33%, 50%, 67%, and 75%. Direct digital angiographic images as well as 10 X 10 spot films and 35-mm cine angiography films were acquired with and without structural noise and mask subtraction. The films were digitized with magnification factors of one and two. An interactive analysis program was used to automatically determine the vessel edges with a Gaussian fit to the cross-sectional density profiles perpendicular to the center line of the vessel. Relative changes of the densitometric cross-sectional area along the vessel were used to assess the percentage of stenosis. Densitometric measurements were comparable in both digital and cine angiograms (r = .99 and r = .98, respectively); however, diameter measurements showed a higher variability and were dependent on the amount of magnification applied to the images.     

Difficulties in stereotactic biopsies of brain tumors

MATERIAL: 28 stereotactic biopsies of organic brain processes (brain tumours) were performed in the years 1997-2000 in the Department of Neurosurgery, Medical University of Warsaw. In this series the lesions were located in corpus callosum in 5 patients, in basal nuclei in 9, and deeply in the white matter of cerebral hemispheres in 14. METHOD: The Baklund biopsy kit and Leksell's stereotactic frame were used, target localisation was based on the CT scan. Histological verification was based on hematoxillin--eosin staining, completed with histochemical evaluation if necessary. In 9 patients intraoperative smear evaluation was performed. RESULTS: Sensitivity of stereotactic biopsies was 86% (24/28), although the rate of conclusive biopsies was lower, being 60% (17/28). False negative results were observed in 14% of the patients (4/28). Analysis of the results revealed, that the sensitivity was not dependent on the size, neither on the location of the tumour, but was related to its morphology. The false negative results were obtained in the tumours with significant necrosis (as seen on CT scans). There were no surgical complications in this series. CONCLUSIONS: 1. Difficulties in stereotactic biopsies of brain tumours are associated mainly with tumour morphology. In tumours with marked necrosis, other degenerative changes or cystic ones, higher risk of non-conclusive biopsy may be expected. 2. Size of the tumour and its location do not affect the diagnosis based on the stereotactic biopsies. 3. In the polymorphic tumours, the policy to take biopsy material from different tumour sites, should be a rule, as different parts of the lesion may represent different stages of malignancy and histological evaluation of separate parts of the tumour may lead to inadequate oncological treatment.     

Evaluation of attempted prevention of unexpected infant death in very high-risk infants by planned health care

Three hundred and ninety-six babies born in Sheffield between 1982 and 1990 identified as being at "very high risk" of unexpected infant death by means of a scoring system, received an intensive programme of health care including a case discussion between a paediatrician, the GP and the health visitor held in the family doctor's surgery, weekly visits from the health visitor and informal hospital admission. Significantly fewer sudden unexpected infant deaths occurred in this group than were expected by logistic regression anlysis or occurred in the best available control group with comparable scores ( p = 0.024). Problems in evaluation include identification of an adequate control population, ethical difficulties in introducing a controlled study when the programme is already perceived as effective, and the calculation of "expected death rates". The results of this study indicate that very energetic programmes of intervention may prevent some deaths in vulnerable infants.