New mechanical thrombectomy model in the rabbit: A feasibility study.

BACKGROUND AND PURPOSE: Thrombolytic therapy represented the gold standard for the treatment of ischemic stroke. Its drawbacks include increased bleeding risk and low recanalization rates. Mechanical thrombectomy is a new promising therapy option. Devices used for this procedure were substantially improved during recent years. New devices require extensive preclinical invivo testing. We therefore sought to translate the commonly used pig model to a simplified and cheaper rabbit model. MATERIALS AND METHODS: We performed thromboembolisation in eight intubated and sedated adult female New Zealand white rabbits. The thrombus was created by careful rotation of autologous blood in a silicone tube and addition of barium sulfate for radiopacity. We injected the artificial thrombus via a catheter through the cannulated femoral artery. After thromboembolisation, 2D-DSA was performed to evaluate location and thrombus dimensions. COMPARISON WITH EXISITING METHOD(S): None. RESULTS: No complications or mortality were observed in our series. In seven cases (87.5%) the location of the thromboembolism was the maxillary artery and in one case (12.5%) the thrombus reached the occipital artery. The radiopaque thrombus had a length of 7.0±4.55mm invivo. Vessel diameters in angiographic evaluation were 2.44±0.21mm for the common carotid artery and 2.1±0.16mm for the maxillary artery. CONCLUSIONS: The novel small animal model for mechanical thrombectomy in rabbit is technically feasible and cheap. It offers comparable vessel diameters to cranial arteries and closely mimics human coagulation system.

3D computerized occlusion rating of embolized experimental aneurysms using noninvasive 1.5T MR imaging.

BACKGROUND AND PURPOSE: For embolized cerebral aneurysms, the initial occlusion rate is the most powerful parameter to predict aneurysm rerupture and recanalization. However, the occlusion rate is only estimated subjectively in clinical routine. To minimize subjective bias, computer occlusion-rating (COR) was successfully validated for 2D images. To minimize the remaining inaccuracy of 2D-COR, COR was applied to 1.5T 3D MR imaging. MATERIALS AND METHODS: Twelve experimental rabbit aneurysms were subjected to stent-assisted coil embolization followed by 2D DSA and 3D MR imaging. Subjective occlusion-rate (SOR) was estimated. Linear parameters (aneurysm length, neck width, parent vessel diameter) were measured on 2D DSA and 3D MR imaging. The occlusion rate was measured by contrast medium-based identification of the nonoccluded 2D area/3D volume in relation to the total aneurysm 2D area/3D volume. 2D and 3D parameters were statistically compared. RESULTS: There were no limiting metallic artifacts by using 3D MR imaging. Linear parameters (millimeters) were nearly identical on 2D DSA and 3D MR imaging (aneurysm length: 7.5 ± 2.6 versus 7.4 ± 2.5, P = .2334; neck width: 3.8 ± 1.0 versus 3.7 ± 1.1, P = .6377; parent vessel diameter: 2.7 ± 0.6 versus 2.7 ± 0.5, P = .8438), proving the high accuracy of 3D MR imaging. COR measured on 3D MR imaging was considerably lower (61.8% ± 26.6%) compared with the following: 1) 2D-COR (65.6% ± 27.1%, P = .0537) and 2) 2D-SOR estimations (69.2% ± 27.4%, P = .002). These findings demonstrate unacceptable bias in the current clinical standard SOR estimations. CONCLUSIONS: 3D-COR of embolized aneurysms is easily feasible. Its accuracy is superior to that of the clinical standard 2D-SOR. The difference between 3D-COR and 2D-COR approached statistical significance. 3D-COR may add objectivity to the ability to stratify the risk of rerupture in embolized cerebral aneurysms.

[Analysis of the Educational Program for Self-Care in the Elderly (PECA) for improving the quality of life of the elderly]. / Análisis del programa educativo PECA para mejorar la calidad de vida de las personas mayores.

OBJECTIVE: To determine the efficacy over 12 months of the educational programme on self-care of the elderly (PECA), which covers quality of life, nutritional status, and perceived social support of people over 65 living in their own homes. DESIGN: Pre-test/post-test experimental study with control group. SETTING: Urban population in the Manso Health District (Example, Barcelona), Spain. PARTICIPANTS: Persons over 65 living in their own homes, healthy or with chronic illnesses characteristic of their age, who had a normal score in the Pfeiffer test. A total of 70 subjects (35 per group) were selected and 5 of the control group left the study. INTERVENTION: Programme on self-care of the elderly, including education on physical activity, nutrition, and social support. MEASUREMENTS: Dependent variables were quality of life, measured by the Nottingham Health Profile; nutritional status, measured by the Mini-Nutritional Assessment (MNA); and social support, measured by the Duke-Unk Functional Social Support Scale. RESULTS: The study sample had an average age of 70.9 (SD, 3.1); 88.2% had self-perception of good health; and 21% lived alone. We only found statistically significant differences between pre- and post-intervention observations in nutritional status (P=.001). CONCLUSION: Despite a statistically significant difference in the variable of nutritional status, the difference was not "clinically" relevant. The ineffectiveness of the intervention is due to our starting from a very homogeneous sample, which had good health status and well-established social networks.

Análisis del programa educativo PECA para mejorar la calidad de vida de las personas mayores

Objetivo. Determinar la eficacia, a lo largo de 12 meses, del programa Educativo de Autocuidado del Anciano (PECA) sobre la calidad de vida, el estado nutricional y el apoyo social percibido de personas mayores de 65 años que viven en su propio domicilio. Diseño. Ensayo clínico aleatorizado. Emplazamiento. Área básica de salud (ABS) de Manso. Barcelona. Participantes. Personas mayories de 65 años que viven en sus propios domicilios, sanas o con enfermedades crónicas propias de la edad y que obtienen una puntuación normal en el test de Pfeiffer. Se seleccionó a un total de 70 sujetos (35 por grupo) y abandonaron 5 del grupo control. Intervención. Programa PECA que incluyeeducación sobre la actividad física, la nutrición y el apoyo social. Mediciones. Las variables dependientes son la calidad de vida, medida con el Perfil de Salud de Nottinham (PSN); el estado nutricional, medido con el Mini Nutritional Assessment (MNA), y el apoyo social, medido con la escala de Apoyo Social Funcional Duke-UnK. Resultados. La muestra tenía una edad media ± desviación estándar de 70,9 ± 3,1 años, tenía una buena percepción de su salud (88,2 por ciento) y el 21 por ciento vivía solo. Únicamente se observaron diferencias estadísticamente significativa s entre las observaciones preinterveción y postintervención en la variable estado nutricional (p = 0,001). Conclusión. La diferencia observada en la variable estado nutricional no es clinicamente relevante. La ausencia de efecto de la intervención podría deberse a que la muestra es muy homogénea, con un buen estado de salud y con una red social bien estabelecida.(AU)

Infusion phlebitis in post-operative patients: when and why.

BACKGROUND: The most common complication of intravenous therapy is infusion phlebitis. This study was done to prospectively assess its frequency in a series of consecutive patients who will undergo surgery, and to identify which variables may predict an increased risk for phlebitis. PATIENTS AND METHODS: 400 consecutive patients who will undergo surgery in a general surgery department were included. Only the first catheter, inserted the day before surgery, was taken into account. Eighteen variables (from the infusion, the catheter and from the patient) were prospectively evaluated for their contribution to the occurrence of phlebitis. RESULTS: 60/400 patients (15%) developed phlebitis, and most of them needed insertion of a further catheter. The univariate analysis showed that patients who developed phlebitis were older, and their pre-operative levels of both blood haemoglobin and neutrophil cound were significantly higher than those in patients who did not develop phlebitis. However, the multivariate analysis only confirmed the association with blood haemoglobin levels: the risk of phlebitis sharply increased in the patients with the highest haemoglobin levels. As to the influence of time on phlebitis development, there was a significant decrease in the day-specific risk, from the 5th day on. COMMENTS: In our series, blood haemoglobin levels were found to be the only variable associated to a higher risk of phlebitis. Besides, in contrast with the recommendations by the Centers for Disease Control, no significant increase in the day-specific risk of phlebitis was found. Thus, a guideline to select the type of catheter to be inserted in an individual patient is suggested.

[Therapeutic efficacy of low-dose alpha interferon therapy in liver cirrhosis associated with HBV]. / Skutecznosc terapeutyczna niskich dawek interferonu alfa w wyrównanej marskosci watroby zwiazanej z zakazeniem HBV.

The aim of this study was the assessment the efficacy and safety of therapy with interferon alpha (Intron A) administered s.c. 3 MU x 3/week for 12 weeks for patients with HBV related liver cirrhosis (Child's class A). Fifteen patients completed therapy and 12 months follow-up. At the end of follow-up sustained response to the therapy, defined by clearance of HBV-DNA, normalization of ALAT activity in serum and improvement in the liver histology was achieved in 46.6% of treated patients. Moreover, among few patients from group of nonresponders (patients without sustained clearance of HBV-DNA) decrease of HBV-DNA level, ALAT activity in serum and improvement in the liver histology were observed. Adverse effects of IFN alpha therapy were typical, but in any case were no necessity terminate the therapy.

[Treatment of chronic hepatitis B with interferon alpha (Wellferon) with and without previous corticosteroid therapy -- results of a multicenter, double blind study]. / Leczenie przewleklego zapalenia watroby typu B interferonem alpha (Wellferon) z poprzedzajaca i bez poprzedzajacej terapii kortykosteroidami--wyniki wieloosrodkowej, podwójnie slepej próby.

The present study was aimed to test the efficacy and safety of interferon alpha (Wellferon-Wellcome Foundation Ltd.) either alone, or in combination with short-term corticosteroid pretreatment in the therapy of chronic hepatitis B. 44 patients with documented chronic hepatitis type B (12 women and 32 men; mean age 37.5 years, range 23-59 years) and satisfying the entry criteria were subjects of the study. 30 patients had chronic active hepatitis on liver biopsy, while 14 had chronic persistent hepatitis. Consecutive patients were given either placebo or prednisone in a double-blinded manner for 4 weeks (0.6 mg/kg/day in the first two weeks, 0.45 mg/kg/day in the third week and 0.25 mg/kg/day in the last week), and then, after a 2 week pause, therapy with interferon was instituted for a total of 12 weeks. Interferon was given by intramuscular injection in a single daily dose of 10 x 10(6) IU for 5 days and three times weekly thereafter. However, because of side effects, the dose of interferon was occasionally reduced to 5 x 10(6) IU in most patients. Interferon induced a sustained cessation of HBV replication as judged by loss of DNA-polymerase activity in 26 (59%) patients, 20 (45%) patients seroconverted to anti-HBe. Additionally, 6 (14%) cases lost HBsAg and seroconverted to anti-HBs. Prednisone pretreatment did not seem to improve the efficacy of interferon therapy. The outcome of the treatment was unrelated to gender and pretreatment activity of transaminases, however, patients with low activity of HBV replication were more likely to respond to therapy than patients with high HBV replication.

[Recurrent jaundice in the course of natural and iatrogenic estrogen metabolism disorders]. / Nawracajaca zóltaczka w przebiegu naturalnych i jatrogennych zaburzen estrogenowych.

PIP: The authors report about a woman who had several recurrences of jaundice between 1974 and 1977. Jaundice was connected with pregnancy and administration of female steroid hormones. (Authors' modified)^ieng