Transient ischemic attacks: their frequency in the Lehigh Valley

The incidence of transient ischemic attacks (TIAs) in the Lehigh Valley was analyzed using the Lehigh Valley Stroke Register based on data collected between July 1, 1982, and June 30, 1986. The overall average annual incidence rate was 22.9 per 100,000 population, and 23.2 and 22.5 per 100,000 population in men and women, respectively. Men had a statistically significant higher age-specific rate of TIAs than women. Our incidence appears to be lower than that reported in earlier studies but, because of methodologic differences, only continued observations in our population and in similar populations using a standardized methodology will resolve the question of whether TIA frequency is, in fact, declining.     

7-(4,7-二取代香豆素-3-乙酰氨基)头孢菌素的合成

本文根据构效关系,设计并合成了17个7-(4,7-二取代香豆素-3-乙酰氨基)头孢菌素衍生物。其缩合方法采用酰氯法、Vilsmeier试剂法及混合酐法。初步体外抑菌试验表明,化合物对革兰氏阳性菌和少数革兰氏阴性菌有较强的抗菌作用。进一步药理试验尚在进行。     

Epidemiology of pneumococcal disease in children in Germany

Recently published and as yet unpublished data allow a reasonable estimate of the annual burden of pneumococcal disease in Germany. At least 277000 episodes of otitis media and at least 2000 episodes of sinusitis occur in children under the age of 5 y. Pneumococcal meningitis was found in 200 children under the age of 16 y; the estimate for all age groups ranges from 450 to 1100 cases. Of approximately 150000 cases of ambulatory pneumococcal pneumonia, at least 63 000–105000 patients are hospitalized each year.
Conclusion: Further studies of pneumococcal epidemiology in Germany are needed, and continued surveillance will be necessary for a better understanding of the overall burden of pneumococcal disease in children as well as adults.     

Systemic recombinant alpha-2 interferon therapy in relapsing multiple sclerosis

This report describes the first use of recombinant-DNA-produced human interferon in patients with multiple sclerosis (MS). Ninety-eight patients who were clinically definite for MS with two or more documented exacerbations during the preceding two years were admitted to this placebo-controlled double-blind randomized trial. Although both groups were similar, placebo patients had later MS onset. Patients injected themselves with 2 X 10(6) IU of alpha-2 interferon or placebo three times each week for up to 52 weeks. This dose of interferon was well tolerated in that side effects were minimal. During the trial, the exacerbation rate was sharply reduced in both groups. In the three-month follow-up period after stopping treatment, more patients who were receiving interferon than placebo became worse neurologically. More patients who were receiving interferon than placebo changed from exacerbating MS to progressive MS during the trial. Thus, no clear therapeutic benefit of alpha-2 interferon for MS was detected.     

Standardized incidence ratios of stroke: a worldwide review

Comparison of stroke incidence in various parts of the world is difficult because differences in diagnostic criteria, medical facilities and age-sex distributions are often not taken into account. We calculated age-sex standardized incidence ratios (SIR) of stroke in 37 regions based on recent reports. The USA (1976) was taken as the standard population. In western countries SIRs varied from 0.8 to 2.1. In China and Japan, SIRs varied from 0.7 to 3.6. While the lowest and highest SIRs differed by a factor of 5, only 6 of the 37 studies yielded a SIR of more than 2.0 or below 0.75. Of these, 4 were from China and Japan. The highest ratios were based on a very intensive door-to-door survey and probably should not be compared to less intensive studies. We conclude that world-wide variation in age-sex adjusted stroke rates is relatively small.     

Theoretical and methodological considerations in the measurement of spasticity

Purpose: To discuss the measurement of spasticity in the clinical and research environments, make recommendations based on the SPASM reviews of biomechanical, neurophysiological and clinical methods of measuring spasticity and indicate future developments of measurement tools. Method: Using the results of the systematic reviews of the biomechanical, neurophysiological and clinical approaches, methods were evaluated across three dimensions: (1) validity, reliability and sensitivity to change; (2) practical quality such as ease of use and (3) qualities specific to the measurement of spasticity, for example ability to be applied to different muscle groups. Methods were considered in terms of applicability to research and clinical applications. Results: A hierarchy of measurement approaches was identified from highly controlled and more objective (but unrelated to function) to ecologically valid, but less objective and subject to contamination from other variables. The lack of a precise definition of spasticity may account for the problem of developing a valid, reliable and sensitive method of measurement. The reviews have identified that some tests measure spasticity per se, some phenomena associated with spasticity or consequential to it and others the effect of spasticity on activity and participation and independence. Conclusions: Methods appropriate for use in research, particularly into the mechanism of spasticity did not satisfy the needs of the clinician and the need for an objective but clinically applicable tool was identified. A clinical assessment may need to generate more than one 'value' and should include evaluation of other components of the upper motor neurone syndrome. There is therefore a need for standardized protocols for 'best practice' in application of spasticity measurement tools and scales.     

Rezidivierende Synkopen bei Linksschenkelblock mit normaler PQ-Zeit

Wir berichten den Fall einer 53-j?hrigen Patientin, die sich wegen rezidivierender Synkopen zur station?ren Aufnahme vorstellte. Im Oberfl?chen-EKG fand sich ein Sinusrhythmus mit normaler PQ-Zeit und komplettem Linksschenkelblock. Echokardiographisch wurde eine auf ca. 45% reduzierte Pumpfunktion ermittelt. Unter dem Verdacht einer entzündlichen Herzmuskelkrankung wurde eine Herzkatheteruntersuchung mit Endomyokardbiopsie durchgeführt, deren histologische und immunhis-tologische Untersuchung keinen Anhalt für eine Myokarditis oder Speichererkrankung ergab. Die elektrophysiologische Untersuchung zeigte ein stark verl?ngertes HV-Intervall von 101 ms (normal 35–55 ms). Daraufhin wurde ein Zweikammerschrittmachersystem (DDD) implantiert. Eine Untersuchung nach 3 Monaten zeigte die bereits eingetretene Schrittmacherabh?ngigkeit der Patientin bei komplettem AV-Block ohne ausreichenden Ersatzrhythmus.