Ischaemic stroke--impact of renal dysfunction on in-hospital mortality.

Renal dysfunction predicts mortality in patients with myocardial infarction but less is known about the impact of renal dysfunction on in-hospital mortality after ischaemic stroke. All 361 patients (185 men, 176 women; mean age 72.1 years) with ischaemic stroke and glomerular filtration rate (GFR) <90 ml/min/1.73 m2 were followed-up. GFR was calculated according to abbreviated modification of diet in renal disease (MDRD) formula. Stroke severity was determined by National Institutes of Health Stroke Scale (NIHSS). The mean GFR was 61.5 +/- 16.6 ml/min/1.73 m2. There were 49 (13.6%) in-hospital deaths. Patients who died had higher NIHSS (P = 0.0001), were older (P = 0.024), had lower GFR (P = 0.028), higher hs-C-reactive protein (P = 0.001) and lower albumin (P = 0.048). No differences in presence of diabetes and hypertension, cholesterol (total, HDL and LDL), triglycerides and BMI between patients who died or survived were found. With univariate analysis association between in-hospital mortality and NIHSS (P = 0.0001), GFR (P = 0.041), total cholesterol (P = 0.021) and LDL cholesterol (P = 0.034) was found. With Cox multivariable regression analysis of risk factors, NIHSS (P = 0.0001), GFR (P = 0.018), total cholesterol (P = 0.008) and LDL cholesterol (P = 0.011) were only predictors of in-hospital mortality. In patients with ischaemic stroke, decreased GFR was associated with higher in-hospital mortality.

Three-dimensional ultrasonography for the evaluation of atherosclerotic stenoses of the carotid trunk.

Three-dimensional ultrasonography is a significant novelty in neurosonology as it offers the possibility of an even more successful evaluation of atherosclerotic stenoses of the carotid trunk than previous ultrasonographic investigations. In 37 patients with signs of transitory ischemic attack and in 5 patients with reversible ischemic neurologic deficit we compared the findings of three-dimensional ultrasonography of carotid arteries on the neck with those of three-dimensional CT angiography. In 20 of these patients in which carotid thrombendarterectomy had been carried out, the findings of both diagnostic methods were also compared with the angiographic and operative findings. In 2 out of the total of 42 compared findings of three-dimensional ultrasonography, three-dimensional CT angiography and angiography of the carotid trunk, we assessed a difference in the evaluation of the degree of carotid stenosis while all other findings were in accordance as regards the evaluation of the degree of stenosis and plaque analysis. Of 20 operative findings, one showed insignificant deviations from the findings of both diagnostic methods. It is our opinion that three-dimensional ultrasonography is a reliable diagnostic method in evaluating atherosclerotic stenoses of carotid arteries. Every subtotal stenosis or internal carotid artery occlusion established by three-dimensional ultrasonography must be compared with three-dimensional CT angiography or classic angiography due to the objective possibility of false ultrasonographic interpretation and the significance of carotid thrombendarterectomy.

Carotid body tumour surgery. A report of seven patients.

The purpose of the present paper is to analyse diagnostic and therapeutic aspects of carotid body tumours. Seven patients with carotid body tumour underwent surgery at our department between 1982 and 1998. All of them had an asymptomatic cervical lateral mass. The preoperative evaluation included angiography in 7 patients, duplex scanning in 2 patients and computed tomography in one patient. Tumour excision was performed in 5. Carotid artery resection with the tumour was required in 2 patients and in both, interposition of a 5-mm polytetrafluoroethylene graft was performed. During the resection, temporary carotid shunt was required in one patient. Perioperative transcranial Doppler was used once; the use of a shunt during carotid artery resection was not required in the second case. All tumours were identified as carotid paragangliomas without evidence of malignancy. There was no mortality and no hemiplegia. After surgery, temporary cranial nerve dysfunction was noted in 2 cases. In the follow-up period of 2 to 14 years (mean, 7 years), no recurrent disease occurred. Patency of the grafts was good at 4 and 7 years after carotid artery reconstruction. We conclude that with non-invasive investigation and arteriography it is possible to obtain an early and precise diagnosis. The decision to perform simple tumour excision or additional arterial resection is based on diagnostic preoperative as well as intraoperative evaluation of the individual tumour. As demonstrated in our cases, after resection of the internal carotid artery a polytetrafluoroethylene graft may be used for carotid reconstruction. Early surgery is recommended because it minimises the risk of complications associated with large tumours.

Surgical aspects of fusiform and saccular extracranial carotid artery aneurysms.

The purpose of this paper is to analyse surgical aspects of aneurysms of the distal extracranial internal carotid artery. Nine cases of extracranial carotid artery aneurysm are reported. Five were fusiform, located at the carotid bifurcation, and four were saccular, confined to the internal carotid artery. An end-to-end plication technique and Dacron patch angioplasty were employed for all fusiform aneurysms. In three saccular lesions, resection and 4-mm polytetrafluoroethylene (PTFE) graft interposition were carried out. In one case with a high lesion, ligation of the carotid artery was performed. Ligation resulted in severe postoperative stroke and fatal outcome. One patient with a saccular lesion developed a transient ischaemic attack after the operation. In other patients no central neurological deficit was produced by the surgery itself. Transient cranial nerve damage occurred in four patients (two hypoglossal nerve: two superior laryngeal nerve). As demonstrated by these cases, synthetic material may be used in restoration of the carotid artery. It is concluded that, according to type, location of the aneurysm and adequacy of contralateral cerebral blood flow, selective management is necessary.

[Computer tomography and spinal angiography in the diagnosis of spinal angioma]. / Ein Beitrag der Computertomographie und der spinalen Angiographie zur Diagnostik eines Wirbelangioms.

The computer tomographic and angiographic features of spinal angiomas are described. The authors observed 21 cases and, on the basis of this material, they deal with the clinical features, radiological appearances, disease patterns, forms of treatment, and prognosis. CT and angiography produce a fairly uniform and typical appearance, permitting diagnosis before therapy. Problems in differential diagnosis and errors in interpretation are enumerated.