A comparative study between a calcium channel blocker (Nicardipine) and a combined alpha-beta-blocker (Labetalol) for the control of emergence hypertension during craniotomy for tumor surgery.

We compared the efficacy of the combination of enalaprilat/labetalol with that of enalaprilat/nicardipine to prevent emergence postcraniotomy hypertension. A prospective, randomized open labeled clinical trial was designed to compare the incidence of breakthrough hypertension (systolic blood pressure [SBP] > 140 mm Hg) and adverse effects (hypotension, tachycardia, and bradycardia) between the two drug combinations. Secondarily, the effects of the drugs on SBP, mean blood pressure, and diastolic blood pressure were evaluated over the course of the study. Forty-two patients received enalaprilat 1.25 mg IV at dural closure followed by either multidose nicardipine 2 mg IV or labetalol 5 mg IV to maintain the SBP below 140 mm Hg. SBP was similarly controlled in both groups. There was a marginally smaller incidence of failures and adverse effects with labetalol. Blood pressure profiles were similar for both groups.

["Typical" and "less typical" sports injuries in the field of neurology]. / "Typische" und "weniger typische" Sportschäden im neurologischen Bereich.

In times of increasing "sparetime pathology" sequels of sports are getting a new meaning in medicine. Surgeons are mainly involved in this issue but it also contacts neurologists. We differentiate between direct sequels of sports and concomitant incidents of sports. Besides the typical head injuries we saw a number of atypical traumatic damages such as a hit by a golf ball, fall on the buttocks and the header in football. Discprotrusions are mainly understood as concomitant incidents at sports because in most cases one has to consider preexisting disc lesions. Though there are typical motions in sports which rather lead to discprotrusions such as strong torsions of the body in football, serving in tennis, heavy lifting in wrestling or an unexpected fall into a hollow in skiing. In cerebrovascular events, sports is usually only one additive etiological component. Nevertheless the lack of adequate acclimatisation and the brisk beginning of stressing sports in high mountain areas (which is enabled through modern technic) can contribute a great deal to decompensation of cerebrovascular disorders. In this respect doping can have a serious influence since protecting physiological mechanisms are eliminated. Diving accidents are able to give rise to spinal, cerebral and cerebellar gasembolisation. Warning early symptoms of great value are TIA, vertigo and fits. Sport practice can figure as an unspecific test situation in order to provoke these events. Diagnostic investigation of the cardiovascular system and the CNS has to be performed in those cases. Particular regard should be paid to expert situations which tend to distort the clinical pictures.(ABSTRACT TRUNCATED AT 250 WORDS)