Emergency Stenting of the Extracranial Internal Carotid Artery in Combination with Anterior Circulation Thrombectomy in Acute Ischemic Stroke: A Retrospective Multicenter Study.

BACKGROUND AND PURPOSE: Several small case series reported a favorable clinical outcome for emergency stent placement in the extracranial internal carotid artery combined with mechanical thrombectomy in acute stroke. The rate of postinterventional symptomatic intracranial hemorrhages was reported to be as high as 20%. Therefore, we investigated the safety and efficacy of this technique in a large multicentric cohort. MATERIALS AND METHODS: The data bases of 4 German stroke centers were screened for all patients who received emergency stent placement of the extracranial internal carotid artery in combination with mechanical thrombectomy of the anterior circulation between 2007 and 2014. The primary outcome measure was the rate of symptomatic intracranial hemorrhage according to the European Cooperative Acute Stroke Study III criteria; secondary outcome measures included the angiographic revascularization results and clinical outcome. RESULTS: One hundred seventy patients with a median age of 64 years (range, 25-88 years) were treated. They presented after a median of 98 minutes (range, 52-160 minutes) with a median NIHSS score of 15 (range, 12-19). Symptomatic intracranial hemorrhages occurred in 15/170 (9%) patients; there was no statistically significant difference among groups pertaining to age, sex, intravenous rtPA, procedural timings, and the rate of successful recanalization. In 130/170 (77%) patients, a TICI score of ≥ 2b could be achieved. The in-hospital mortality rate was 19%, and 36% of patients had a favorable outcome at follow-up. CONCLUSIONS: Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is effective and safe. It is not associated with a significantly higher risk of symptomatic intracranial hemorrhage compared with published series for mechanical thrombectomy alone.

Phthiriasis palpebrarum: 2 case reports.

Phthiriasis palpebrarum, caused by the phthirus pubis, is a rare cause of blepharoconjunctivitis, and is therefore often neglected. We present 2 patients who suffered itching and irritation at the right upper eyelid. Biomicroscopic examination showed a few lice and nits anchored to the eyelashes. Dermatologic examination revealed the presence of numerous lice and nits at the trunk and pubic area. The lice and nits were manually removed if possible, and the patients were asked to put vaseline on the eyelid margins. The patients were also treated with malathion 0.5% lotion. After control, two weeks later, no more lice nor nits were present in the first patient.

The long-term effect of Yag laser posterior capsulotomy on intraocular pressure after combined glaucoma and cataract surgery.

In order to evaluate the long-term effect of Yag laser posterior capsulotomy on intraocular pressure (IOP) after combined cataract and glaucoma surgery, we retrospectively studied 20 patients who underwent posterior capsulotomy after single-site combined phacoemulsification and trabeculectomy. We assessed mean IOP and number of glaucoma medications. The mean follow-up was 3 months (range 1 to 6 months). Mean IOP's remained almost unchanged, and were 13.9 +/- 2.7 before and 14.8 +/- 3 mmHg after capsulotomy (p = 0.115). The mean number of medications (0.4) remained unchanged. We conclude that Yag laser posterior capsulotomy does not significantly affect bleb function or glaucoma medication use in patients who underwent combined phacoemulsification and trabeculectomy.

Comparison of the effect of Healon vs. Viscoat on endothelial cell count after phacoemulsification and posterior chamber lens implantation.

To evaluate the protective effect of 1% sodium hyaluronate (Healon) vs. a mixture of 4% chondroitin sulfate and 3% sodium hyaluronate (Viscoat) on the central corneal endothelium during surgery, we prospectively examined 20 eyes of 20 patients who underwent clear corneal phacoemulsification and implantation of an intracapsular posterior chamber intraocular lens (PC-IOL) with either Healon (10 eyes) or a combined use of Viscoat and Healon (10 eyes) as viscoelastic material. We compared the central endothelial cell counts, recorded by specular microscopy, preoperatively and 6 weeks postoperatively. Our results suggest that Viscoat offers no significant better endothelial cell protection during phacoemulsification than Healon.

Attenuation of the virulence of the M strain of Plasmodium cynomolgi during prolonged multiplication in splenectomized rhesus monkeys.

The primary data in this report showed that prolonged multiplication of the M strain of Plasmodium cynomolgi in splenectomized rhesus monkeys led frequently to emergence of parasites whose virulence for monkeys with intact spleens was markedly attenuated while that for splenectomized monkeys was unimpaired. Expressions of attenuation regularly included reductions in the height of the peak parasitemia and in some instances failure to induce infection with inocula 1,000-fold those infective for splenectomized monkeys. Attenuation of virulence, once established, was maintained through as many as 17 serial passages in intact monkeys and more than 100 such transfers in splenectomized monkeys. Not only asexual blood stages, but also sexual stages (gametocytes) carried the attenuated characteristic, as indicated by its ready passage through mosquitoes. Studies in monkeys with sporozoite-induced infections showed that the persisting exoerythrocytic stages did not participate in the attenuation phenomenon; for when erythrocytic parasites of reduced virulence were cleared from the blood by either immune processes or chemotherapy, they were replaced upon relapse with parasites of unimpaired virulence. A major effort to determine whether splenectomized monkeys carried plasma or erythrocyte factors responsible for displays of attenuated virulence was nonproductive. An intact spleen was the essential element in these displays, for they disappeared immediately upon removal of this organ. The attenuation phenomenon probably reflects selection of spontaneously occurring mutants with limited capacity to escape normal splenic clearance mechanisms and unimpaired or even enhanced capacity to multiply in splenectomized monkeys.