Thrombectomy vs. Systemic Thrombolysis in Acute Embolic Stroke with High Clot Burden: A Retrospective Analysis.

PURPOSE: The efficacy of i. v. thrombolysis in acute stroke with high clot burden is limited. Successful recanalization is very unlikely if the thrombus length exceeds 7 mm. Thus this retrospective controlled study evaluated the efficacy and safety of neurothrombectomy in the treatment of acute embolic stroke in patients selected by a thrombus length of ≥ 8 mm using the stent retriever Trevo(®) device. MATERIALS AND METHODS: 40 patients with acute occlusion of the anterior intracranial arteries with a thrombus length of ≥ 8 mm were treated with neurothrombectomy. We compared the outcome with a historical cohort of 42 patients with a thrombus length of ≥ 8 mm that received i. v. thrombolysis only. Clinical outcome was assessed by modified Rankin scale in both groups at discharge and on day 90. RESULTS: Patients did not differ in age, mRS on admission, thrombus length or time from symptom onset to i. v. thrombolysis, but the thrombectomy group had higher NIHSS on admission. Successful recanalization was achieved in 33/40 patients (83 %) with neurothrombectomy. 15 patients received i. v. thrombolysis prior to neurothrombectomy. Median mRS at discharge was 3.5 (1.25 - 5) vs. 5 (4 - 6; p < 0.01) and on day 90 3 (1 - 4) vs. 5 (4 - 6; p < 0.01). Symptomatic hemorrhage occurred in 3 vs. 7 patients. 3 vs. 17 patients died within 90 days (thrombectomy vs. control each). There were only a few intervention-related complications. CONCLUSION: Thrombectomy in acute stroke with high clot burden using the Trevo(®) device has a low risk and improved clinical outcome compared to i. v. thrombolysis alone. Treatment selection by a clot length of ≥ 8 mm might be a powerful approach to improve the outcome of mechanical thrombectomy. KEY POINTS: • Clot length of ≥ 8 mm might be a valuable criterion for indicating neurothrombectomy. • Thrombolysis only in high clot burden is associated with poor clinical outcome. • Thrombectomy using the Trevo(®) stent retriever is safe and effective.

Depression, anxiety and adjustment in renal replacement therapy: a quality of life assessment.

OBJECTIVES: To measure the quality of life (QOL) of patients on RRT with regard to depression, anxiety, and adjustment to illness. MATERIAL: The study was conducted between 1996 and 1998 at a teaching hospital in Porto Alegre, Brazil. The study population included 125 patients (transplant n = 64, hemodialysis n = 42 and continuous ambulatory peritoneal dialysis [CAPD] n = 19). METHODS: The Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), and the Psychosocial Adjustment to Illness Scale (PAIS) were used for patient assessment. Results were analyzed using the Kruskall-Wallis, Mann-Whitney and ANOVA tests. RESULTS: Depression scores were higher for hemodialysis patients compared with transplant patients (H = 15.22; p < 0.005). CAPD patients had intermediate scores (no statistical difference). As far as anxiety was concerned, no statistical difference was observed when the groups were compared. In terms of adjustment to illness, hemodialysis patients were significantly less well adjusted than transplant patients (H = 23.34; p < 0.001). Patients on CAPD had intermediate scores, with no significant difference compared with the other two groups. CONCLUSION: The overall quality of life of transplant patients is higher than that of hemodialysis patients.

Synthesis of 5- and 6-fluoro derivatives of 5,8,14-eicosatrienoic and 5,8,11,14-eicosatetraenoic acids. Effects of fluorinated arachidonic acids on leukotriene C4 production by macrophages.

The total syntheses of the 5- and 6-fluoro derivatives of 5,8,14-eicosatrienoic (ETA) and arachidonic (AA) acids are described. The fluorinated double bond was introduced using (E)-1,4-dihydroxy-2-fluoro-2-butene obtained through diisobutylaluminium hydride reduction of dimethylfluoromaleate. Recently, 5-fluoro and 6-fluoro arachidonic acids (5-F-AA and 6-F-AA) were found to be effective inhibitors of 5-lipoxygenase in vitro (Nave, J. F.; Jacobi, D.; Gaget, C.; Dulery, B.; Ducep, J. B., Biochem. J. 1991, 278, 549). The effect of these compounds on leukotriene C4 (LTC4) production by intact cells was investigated. Mouse peritoneal macrophages were cultured in the presence of 5-F-AA or 6-F-AA under conditions where AA was found to be efficiently incorporated into cellular phospholipids. Following stimulation with zymosan, macrophages treated with 20 microM 6-F-AA released 30 to 35% less LTC4 than control cells. In contrast, macrophages treated with 20 microM 5-F-AA released 1.5 to 1.8 times more LTC4 than control cells. In competition experiments with [14C]-AA, 5-F-AA modified the distribution profile of [14C]-AA within the various classes of lipids in a way similar to AA. 6-F-AA had a distinct behaviour, producing a more important incorporation of [14C]-AA into the neutral lipid fraction at the expense of the phospholipid fraction than AA and 5-F-AA. 6-F-AA is expected to be an important tool in further studies of the arachidonic acid pathway in vivo.

[Co-morbidity of affective disorders and personality disorders]. / Estudio de comorbilidad de enfermedades afectivas y disturbios de personalidad.

The present study intends to investigate selected factors related to comorbidity of affective and personality disorders. The authors studied a group of in-patients from the Psychiatric Unit of the Hospital de Clinicas de Porto Alegre, who were hospitalized during 1985 to 1989. The factors selected were: age, gender, level of education, marital status, age at the beginning of the affective disorder, number of previous hospitalizations, suicide attempts, drug abuse and length of hospitalization. A non-paired case-control study was performed. The results of this study revealed that patients with comorbidity tended to be companionless, to have more suicide attempts and to show unipolar affective disorder. These factors yielded statistical significance. The remainder of the factors that were studied did not convey any statistical significance.