Lipid profile,statin use,and outcome after intravenous thrombolysis for acute ischaemic stroke

BACKGROUND: Low cholesterol levels have been associated with an increased risk of haemorrhagic stroke. This study investigated whether lipid levels or prior statin use influence outcome in patients with acute ischaemic stroke treated with IV thrombolysis. METHODS: The relation between admission lipid levels or statin use and both the development of symptomatic intracerebral haemorrhage (sICH) and 3-months functional outcome was assessed in a prospective hospital-based stroke registry comprising 252 patients treated with IV tissue plasminogen activator (tPA). The fasting status of the patients was unknown. Favourable outcome at 3 months was defined as a modified Rankin scale score 相似文献   

Variations in functioning and disability in multiple sclerosis

The aim of the present study was to explore variations in functioning and disability--with regard to cognition, manual dexterity, walking, energy, mood, activities of daily living and social/ lifestyle activities--every six months during a 2-year period, in 200 people with MS (PwMS) at an outpatient MS specialist clinic. Symbol Digit Modalities Test, Nine Hole Peg Test, Timed 25 Foot Walk, Fatigue Severity Scale, Beck Depression Inventory, Katz ADL Index Extended and Frenchay Activities Index were used to collect data. For analyses of statistically significant changes in scores during the study period, repeated measures ANOVA was used for ratio data and Friedman ANOVA for ordinal data. In addition, effect size as well as the mean/median change in score during the study period were determined for each functioning. Nearly all functioning studied varied significantly but there was no general deterioration in the sample. Small effect sizes were mainly found for the Frenchay Activities Index and a plausible practice effect was detected for the Symbol Digit Modalities Test. As many as 63% with regard to walking and 46% with regard to manual dexterity demonstrated >20% mean change in scores which has proved to be a reliable and clinically meaningful change. This study illustrates the importance of systematic and regular multidimensional assessment of functioning and disability in PwMS aiming to identify disabilities that could be minimized through timely and appropriate evidence-based interventions. The fluctuation in functioning and the conceivable learning effect inherent in instruments used should be taken into consideration when designing studies and interpreting the results.     

Patienten mit Migrationshintergrund in stationär-psychiatrischen Einrichtungen

The work group on psychiatry and migration of the Conference of Directors of Psychiatric Hospitals in Germany conducted a study on the use of inpatient psychiatric services by migrants in 12 psychiatric and psychotherapeutic hospitals and hospital departments. In contrast to previous studies the proportion of migrants in psychiatric hospitals (17.4%) equaled that of migrants in the general population. However there still was a high rate of diagnostic and treatment problems resulting from cultural differences and, to a lesser extent, from language problems. A high proportion of migrants suffered from delusional and schizophrenic disorders, while there were considerable differences in the distribution of diagnoses between different groups of migrants, e.g. those from Turkey and eastern Europe, respectively. Roughly half of all migrants studied had German citizenship. Among the migrants of Turkish background, a high proportion was born in Germany. The number of asylum seekers and refugees was disproportionately high.     

Longitudinal variations and predictors of increased perceived impact of multiple sclerosis, a two-year study

OBJECTIVE: To explore variations and the capacity of selected factors - contextual factors, disease-related characteristics, cognition, fatigue, mood and time - to predict an increase in the perceived physical and psychological impact of multiple sclerosis (MS) over a two-year period. METHODS: At an MS specialist clinic, 219 outpatients were included in the study and data were collected every 6 months. The Multiple Sclerosis Impact Scale was used for assessment of the perceived physical and psychological impact of MS. For statistical analysis of changes in impact during the study period, Friedman ANOVA was used and predictors of increased impact were explored with Generalized Estimating Equations employing proportional odds models. RESULTS: The majority had changes in perceived physical impact of established important magnitude and the psychological impact varied significantly. A period of more than 10 years since diagnosis, cognitive disability, fatigue and signs of depression were independent predictors of increase in physical impact. Weak or moderate sense of coherence, absence of immunomodulatory treatment, fatigue and signs of depression were independent predictors of increase in psychological impact. CONCLUSION: The fluctuation in perceived impact should be taken into account in clinical decision-making and when designing studies and interpreting the results. This study identifies the predictors of increased perceived physical and psychological impact that health-related services should pay special attention to, in order to provide interventions aimed at minimizing the perceived impact of MS.     

Impaired reproduction of second but not millisecond time intervals in Parkinson's disease

The basal ganglia have been associated with temporal processing in ranges of milliseconds and seconds. However, results from PD patient studies are elusive. Time perception in these patients has been tested with different approaches including repetitive movement tasks (i.e. finger tapping) and cognitive tasks (i.e. time reproduction), and both abnormal and normal performances have been reported for different time intervals. Furthermore, when PD patients were required to learn two target durations in the same session when they were off medication, they overestimated the short duration and underestimated the long duration in the seconds range. This pattern of temporal accuracy was described as a “migration effect” and was interpreted as a dysfunctional representation of memory for time (Malapani, C., Rakitin, B. C., Levy, R., Meck, W. H., Deweer, B., Dubois, B., et al. (1998). Coupled temporal memories in Parkinson's disease: A dopamine-related dysfunction. Journal of Cognitive Neuroscience, 10, 316–331). Here, we controlled the emergence of similar behaviour also during millisecond time processing in PD patients. A time reproduction task was employed in which subjects were required to estimate intervals in millisecond (500 ms) and few second (2000 ms) ranges. In the first experiment, these intervals were tested in the same session to verify whether the migration effect was present also between time intervals in different millisecond and few second ranges. In a second experiment, they were not intermingled but were tested in two separate sessions to verify whether abnormalities depended on a selective perceptual deficit of the time intervals tested (i.e. millisecond or second ranges). All experiments were performed in both off and on therapy conditions. Our results demonstrated that PD patients showed no deficits in time estimation for time intervals in either the millisecond or few second range when the different time intervals were tested in separate sessions. This negative finding was obtained in both on and off conditions. However, when the different ranges were tested in the same session, we found that PD patients were impaired selectively for time intervals in the seconds range. Our data seem to indicate that time processing in PD patients for time intervals spanning up to 2 s is unimpaired and that abnormalities in such temporal scale may emerge only when patients have to deal with different durations, when timing involves further cognitive processes such as memory and attention.     

Seizures in multiple sclerosis

Seizures have long been recognized to be part of the disease spectrum of multiple sclerosis (MS). While they occur in only a minority of patients with MS, epileptic seizures can have serious consequences. The treatment of MS can be epileptogenic, and antiepileptic treatment can conversely worsen the symptoms of MS. In this article we present an overview of the current literature on the epidemiology, clinical presentation, pathology, imaging, prognosis and treatment of epileptic seizures in MS.     

Percutaneous ultrasound-guided renal biopsy in children - safety, efficacy, indications and renal pathology findings: 14-year Brazilian university hospital experience

INTRODUCTION: Pediatric percutaneous renal biopsy (Bx) is a routine procedure in pediatric nephrology to obtain renal tissues for histological study. We evaluated the safety, efficacy, indications and renal findings of this procedure at a tertiary care pediatric university hospital and compared our findings with the literature. METHODS: Retrospective study based on medical records from January 1993 to June 2006. RESULTS: In the study period, 305 Bx were performed in 262 patients, 127 (48.5%) male, aged 9.8 A+/- 4.2 years. A 16-gauge needle was utilized in 56/305 Bx, an 18-gauge needle in 252/305 Bx (82.6%). 56.1% Bx were performed under sedation plus local anesthesia, 43.9% under general anesthesia. The number of punctures per Bx was 3.1 A+/- 1.3. Minor complications occurred in 8.6% procedures. The 16-gauge needle caused a higher frequency of renal hematomas (p = 0.05). The number of glomeruli per puncture was >or= 5 in 96.7% and >or= 7 in 92%. Glomeruli number per puncture and frequency of complications were not different according to the type of anesthesia used. A renal pathology diagnosis was achieved in 93.1% Bx. The main indications of Bx were nephrotic syndrome (NS), lupus nephritis (LN) and hematuria (HE). The diagnosis of minimal change disease (MCD) (61.3%), class V (35.6%) and IgA nephropathy (26.3%) predominated in NS, LN and HE patients, respectively. CONCLUSION: Pediatric real-time ultrasound-guided percutaneous renal biopsy was safe and effective. The main clinical indications for Bx were NS and LN, the predominant renal pathology diagnoses were MCD and class V LN.     

Interstitial leukocytes in right ventricular endomyocardial biopsies after heart transplantation in patients with complicated versus uneventful postoperative course

BACKGROUND: Infections and rejections play key roles in morbidity and mortality in the early postoperative period after orthotopic heart transplantation (HTX). The aim of this study was to evaluate whether qualitative and quantitative analyses of various interstitial leukocytes in endomyocardial biopsies during the first 2 weeks after HTX provided early information on these complications. PATIENTS AND METHODS: During and after HTX, endomyocardial biopsies were obtained in 51 patients. By immunohistochemistry we determined the CD3-, CD4-, CD8-, CD15-, CD20-, CD57-, and CD68-positive cell numbers projected to planimetrically measured areas. To compare morbidity in the postoperative course, the patients were subdivided into complicated versus uncomplicated after 3 months. RESULTS: In the uncomplicated group, the cell counts of CD3-, CD8-, CD57-, and CD68-positive cells were significantly lower than in the complicated group. CD3-, CD4-, and CD8-positive cell numbers showed a significant decrease in the first week among the uncomplicated group. In the complicated group, the cell counts increased significantly in the second week. The numbers of CD57-positive cells were significantly lower during the first and second weeks among the uncomplicated group. CONCLUSIONS: Increased T lymphocytes, natural killer cells, and macrophages observed in the second week after HTX indicated increased morbidity. A reduction in CD3-positive cells in the first week indicated a low morbidity risk; an increase indicated a higher risk.     

Changing comorbidity classification patterns at radical prostatectomy during a 10-year period

OBJECTIVE: To investigate the consistency of several comorbidity classifications and concomitant diseases at radical prostatectomy (RP) during a 10-year period. METHODS AND MATERIALS: In 1,297 patients who underwent RP between 1993 and 2002, age and several comorbidity classifications were derived from patient records and assigned to the year of surgery. Trends were evaluated using the Cochran-Armitage trend test. RESULTS: Parallel to an increasing frequency of RPs and a shift toward more organ-confined tumors (P = 0.0094), the proportion of patients aged > or =70 years increased (P = 0.0077). The proportion of the American Society of Anesthesiologists (ASA) Physical Status class 3 increased (P < 0.0001), whereas that of ASA class 1 decreased (P < 0.0001). A Charlson score > or =1 has been assigned with an increasing frequency (P = 0.0008), whereas the trend with a Charlson score of > or =2 did not reach statistical significance (P = 0.07). In contrast to the latter 2 classifications, no significant trends were observed with classifications related to diabetes mellitus and heart disease. CONCLUSIONS: This study shows that the application of the ASA classification may change significantly over time, whereas cardiac and diabetes-related conditions, as well as the Charlson score were apparently less sensitive to changing classification standards in the RP setting.