RESUMO
AIM. To study the frequency, safety and efficacy of perfusion computed tomography (PCT), through identification of brain tissue-at-risk, to guide intravenous thrombolysis in stroke patients with regulatory exclusion criteria (SITS-MOST and ECASS-3). PATIENTS AND METHODS. We studied consecutive acute non-lacunar ischemic stroke patients. After conventional CT was considered eligible, PCT was performed in the following circumstances: 4.5 to 6 h window, wake-up stroke or unknown time of onset; extent early infarct signs on CT; minor or severe stroke; seizures or loss of consciousness. Intravenous 0.9 mg/kg alteplase was indicated if: cerebral blood volume lesion covered < 1/3 of middle cerebral artery territory; mismatch > 20% between mean transit time and cerebral blood volume maps existed; and informed consent. SITS-MOST safety-efficacy parameters were used as endpoint variables. RESULTS. Between May 2009-April 2010, 66 hyperacute ischemic stroke patients a priori not eligible for intravenous thrombolysis underwent PCT. Indications were: > 4.5 h in 18 patients, wake up stroke or unknown onset in 25, extent infarct signs in 6, seizures at onset in 11, and minor stroke (NIHSS < 4) in 6. Twenty-nine (44%) of them finally received intravenous thrombolysis. Symptomatic hemorrhagic transformation occurred in 2 (6.9%) patient and 18 (62.1%) achieved a modified Rankin scale score equal or less than 2 on day 90. CONCLUSION. A high proportion of acute stroke patients with SITS-MOST and ECASS-3 exclusion criteria can be safely and efficaciously treated with intravenous thrombolysis using a PCT selection protocol. However randomized control trials will be needed to confirm our results.
Assuntos
Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
OBJECTIVE: The aim of this paper is to evaluate the effect of atorvastatin on bone mineral density in patients with acute ischemic heart disease. MATERIAL AND METHODS: Eighty-three patients (52 male and 31 female) with acute coronary syndrome were studied. They received treatment with atorvastatin using low doses (20 mg) and high doses (40 mg-80 mg). Initial and final cholesterol, triglyceride, calcium, phosphorus, 25-hydroxyvitamin D were obtained from every patient. Spine and hip bone mineral density were performed at the beginning and one year later. RESULTS: Atorvastatin treatment increases vitamin D (33%, p = 0.007) and decreases the individuals with vitamin D insufficiency. Bone mineral density increased in the spine (1.31%, p = 0.02), but it was significant only in male and patients presenting vitamin D levels higher than 30 nmol/l. CONCLUSION: Atorvastatin has a beneficial effect on bone metabolism in patients with acute ischemic heart disease (mainly males) by incrementing bone mineral density in which vitamin D levels are required to be higher than 30 nmol/l for the drug to be effective.
Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Densidade Óssea/efeitos dos fármacos , Ácidos Heptanoicos/farmacologia , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Pirróis/farmacologia , Idoso , Atorvastatina , Feminino , Colo do Fêmur/efeitos dos fármacos , Colo do Fêmur/metabolismo , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Coluna Vertebral/efeitos dos fármacos , Coluna Vertebral/metabolismo , Vitamina D/sangue , Deficiência de Vitamina D/prevenção & controleRESUMO
Abnormalities of the floor of the carotid canal have been studied in 538 skulls. These abnormalities range from a fissure to total absence of the floor. This variation may be caused by abnormalities of the internal carotid artery or deficiencies in ossification of the skull base. CT suggests that these changes should be taken into account by surgeons working on the skull base.
Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Osso Petroso/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Objective tinnitus usually has a vascular origin, but dural arteriovenous fistulas are rarely the cause of this sign. We report a case of arteriovenous meningeal fistula (AVMF) of the lateral sinus, origin of pulsatile objective tinnitus. Etiology, pathophysiology, symptoms, diagnosis, differential diagnosis and treatment of these fistulas are reviewed.