Empfehlungen der European Stroke Initiative für Diagnose und Behandlung spontaner intrazerebraler Blutungen

Zusammenfassung Dieser Artikel stellt eine Übersetzung der im Jahr 2006 herausgegebenen Empfehlungen zur Behandlung von Patienten mit spontaner intrazerebraler Blutung der Europäischen Schlaganfallinitiative (EUSI) für das Europäische Schlaganfall-Council (ESC), die Europäische Neurologische Gesellschaft (ENS) und die Europäische Förderation Neurologischer Gesellschaften (EFNS) dar.Diese EUSI-Empfehlungen werden von dem European Stroke Council (ESC), der European Neurological Society (ENS) und der European Federation of Neurological Societies (EFNS) unterstützt.     

Repetitive transcranial magnetic stimulation (rTMS): a new therapeutic approach in subjective tinnitus?

Subjective (non-recordable) tinnitus is the conscious perception of a phantom sound, and a very frequent, sometimes disabling, condition. Even if subjective tinnitus is often related to peripheral hearing loss, neurophysiological and functional imaging studies provide increasing evidence for an involvement both auditory and non-auditory central nervous pathways in the generation of tinnitus and related distress. Repetitive transcranial magnetic stimulation (rTMS) has been proposed to relieve tinnitus by reducing auditory cortex hyperexcitability associated with this condition. This paper will review the first clinical results reported in auditory cortex rTMS studies, with special reference to the pathophysiology of tinnitus processing and the mechanisms of action of rTMS. Although rTMS appears to be a very promising tool for the diagnosis and the treatment of tinnitus patients, available knowledge is still very limited at the moment. Further basic research and clinical studies are needed in order to optimize the parameters of stimulation (stimulus frequency, cortical target definition) and to validate the application of this technique in the management of patients with disabling tinnitus.     

Towards performance measurement in reconstructive surgery: a multicentre pilot study of free and pedicled flap procedures.

OBJECTIVES: To pilot the acceptability and feasibility of clinical audit in free and pedicled flap reconstruction. To establish a baseline flap failure rate in participating units, so that a sample size calculation could be performed for future national audit. METHODS: A proforma was piloted over a 3-month period in four participating units, during which time data on 93 reconstructive procedures involving free and pedicled flaps was collected. The patients included those where large transfers of tissue were required such as for coverage of grade IIIb compound tibial fractures and breast reconstruction after mastectomy, and also smaller flap transfers such as after skin cancer excision. RESULTS: The proforma was found to be acceptable to clinicians and the feasibility of the data collection process was established. Overall there was a total flap survival of 89% and secondary operations to the donor or recipient sites were required in 11% of patients. CONCLUSIONS: This study demonstrates the feasibility of comparative audit for free and pedicled flap procedures using the methods proposed. Based on the incidence of flap failure observed in this pilot study, at least 18 months of prospective data collection on consecutive patients is required to fulfil the statistical requirements of comparative audit. The establishment of a routinely collected minimum dataset is proposed as one means of meeting these requirements.     

Posttraumatic stress disorder and associated risk factors in Canadian peacekeeping veterans with health-related disabilities.

OBJECTIVES: This study investigates posttraumatic stress disorder (PTSD) and its associated risk factors in a random, national, Canadian sample of United Nations peacekeeping veterans with service-related disabilities. METHODS: Participants included 1016 male veterans (age < 65 years) who served in the Canadian Forces from 1990 to 1999 and were selected from a larger random sample of 1968 veterans who voluntarily and anonymously completed a general health survey conducted by Veterans Affairs Canada in 1999. Survey instruments included the PTSD Checklist-Military Version (PCL-M), Center for Epidemiological Studies-Depression Scale (CES-D), and questionnaires regarding life events during the past year, current stressors, sociodemographic characteristics, and military history. RESULTS: We found that rates of probable PTSD (PCL-M score > 50) among veterans were 10.92% for veterans deployed once and 14.84% for those deployed more than once. The rates of probable clinical depression (CES-D score > 16) were 30.35% for veterans deployed once and 32.62% for those deployed more than once. We found that, in multivariate analyses, probable PTSD rates and PTSD severity were associated with younger age, single marital status, and deployment frequency. CONCLUSIONS: PTSD is an important health concern in the veteran population. Understanding such risk factors as younger age and unmarried status can help predict morbidity among trauma-exposed veterans.     

Gender ratio of migraine without aura: observations over time

Abstract Migraine without aura is typically considered a female condition. The purpose of this study was to determine if there have been any changes in the female-to-male ratio of the disease over time. We included in the study all patients with migraine without aura (n=3457) referred to the Parma University Headache Centre between 1976 and 1995. They were divided into subgroups with respect to gender and year-range of onset of migraine (before 1960, in the 1960s, in the 1970s, in the 1980s, and between 1990 and 1995). Gender ratio ranged from 3.6:1 (in patients with onset before 1960) to 2.8:1 (in patients with onset in the 1980s), with no statistically significant changes during the observation period.     

Social phobia, fear of negative evaluation and harm avoidance.

This naturalistic, prospective investigation examined the role of fear of negative evaluation and the personality trait of harm avoidance in the anxiety levels of treated social phobia patients. One hundred and fifty-seven patients with DSM-IV social phobia were assessed before starting treatment and were then followed for up to two years. As expected, greater fear of negative evaluation and higher scores of harm avoidance were associated with greater anxiety at the 6 month follow-up, and harm avoidance remained a significant predictor at 24 months. However, no evidence was found for an interaction between the personality and cognitive variables examined. The findings are discussed in terms of the relative independence of these factors, as well as their potential implications for the treatment of this disorder.     

The effects of KATP channel modulators on counterregulatory responses and cognitive function during acute controlled hypoglycaemia in healthy men: a pilot study.

AIMS: To examine the effects of agents that alter potassium adenosine triphosphate (KATP) channel activity in beta-cells on cognitive function and counterregulatory hormone responses during acute hypoglycaemia, given the physiological similarities between the pancreatic beta-cell and the hypothalamic glucose-sensitive neurones (GSN) and the widespread distribution of sulphonylurea receptors in neuronal cells throughout the brain. METHODS: Ten healthy males were studied on four occasions and in random order underwent three stepped hypoglycaemic (plasma glucose aims: 3.4, 2.8, 2.4 mmol/l) and one euglycaemic (plasma glucose aim: 5 mmol/l) insulin clamps. Prior to each hypoglycaemic study, volunteers received either 10 mg glibenclamide, or 5 mg/kg diazoxide or placebo orally. Cognitive function, symptom scores and counterregulatory hormone responses were measured at each glycaemic level. RESULTS: There was no statistically significant effect of either drug on the symptoms generated or the counterregulatory hormonal response during hypoglycaemia. However, cognitive function was better preserved during hypoglycaemia in the glibenclamide-treated arm, particularly four-choice reaction time which deteriorated at a plasma glucose 2.5 mmol/l compared with 3.0 mmol/l with diazoxide (P = 0.015) and 2.9 mmol/l with placebo (P = 0.114). CONCLUSIONS: Single doses of pharmacological agents which alter membrane KATP channel activity do not affect the counterregulatory response to hypoglycaemia but may modify cognitive function during cerebral glucopenia. The unexpected effects of glibenclamide on cortical function suggest a novel action of sulphonylureas that warrants further investigation.     

妊娠性肝内胆汁淤积症：一项地塞米松和熊脱氧胆酸的随机、对照试验

妊娠性肝内胆汁淤积症（ICP）的主要特征是：母体难以忍受的瘙痒症，血清胆汁酸升高（≥10μmol／L）以及胎儿死亡风险的增加。最近，确定了一个与影响胎儿损害相关的界值，即血清胆汁酸≥40μmol／L。在一项双盲、安慰剂对照试验中，作研究了熊脱氧胆酸（UDCA）和地塞米松对瘙痒症、胆汁淤积的生化指标和胎儿并发症发生率的影响。为此，选取了130例患有ICP的妇女，随机分到UDCA组（1g／d，使用3周），地塞米松组（12mg／d使用1周，第2周、第3周使用安慰剂）和安慰剂组（使用3周）进行治疗。在治疗期间和治疗3周后对瘙痒症和胆汁淤积的生化指标进行分析。在分娩时记录胎儿的并发症（自发性早产，新生儿窒息，羊水、胎盘、胎膜的胎粪染色）。意向治疗分析显示仅在UDCA组中，丙氨酸转氨酶（ALT）（P=0．01）和胆红素（P=0．002）明显减少。在血清胆汁酸≥40μmol／L的ICP妇女的亚群分析中发现（n=34）UDCA对瘙痒症（减轻75％）、胆汁酸（下降79％）、ALT（降低80％）和胆红素（降低50％）也有明显效果，但对胎儿并发症发生率无影响。地塞米松并无减轻瘙痒症或降低ALT的作用，在降低胆汁酸和胆红素方面比UDCA效果差。     

Antiproliferative, cytotoxic and apoptogenic activity of Indian toad (Bufo melanostictus, Schneider) skin extract on U937 and K562 cells.

The antiproliferative, cytotoxic and apoptogenic activities of Bufo melanostictus (Indian common toad) skin extract (TSE) on U937 and K562 leukemic cell line has been investigated. TSE significantly (P<0.001) reduced the time-dependent cell proliferation and decreased MTT values in U937 and K562 cells. TSE (IC50 doses) suppressed the proliferating cell nuclear antigen expression in both the cells. It was demonstrated that, TSE (IC50 doses) primarily arrested the U937 and K562 cells at G1 phase of the cell cycle. Confocal microscopy showed the altered fragmented nuclei and apoptotic bodies formation in TSE (IC50 doses) treated U937 and K562 cells. Membrane blebbing, cell surface shrinkage and perforation were observed through scanning electron microscope. TSE-induced DNA fragmentation in U937 and K562 cells was reflected in single-cell gel electrophoresis. TSE significantly (P<0.001) increase the length-width ratio of DNA mass as compared to control in comet assay. The flow cytometric analysis of annexin-V binding to the cancer cells further supported the apoptotogenic activity of TSE. The effect of TSE on normal human peripheral blood mononuclear cells viability and cytotoxicity was studied in culture and found to be less cytotoxic than on the U937 and K562 cells. The findings from the present study suggested that TSE might possess potent antineoplastic agent having antiproliferative, cytotoxic and apoptogenic activity against U937 and K562 myeloid leukemic cells.