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  • 1
    ISSN: 0942-0940
    Keywords: Cerebral aneurysms ; antifibrinolytic therapy ; cerebral ischaemia ; hydrocephalus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 350 patients with subarachnoid haemorrhage from aneurysmal rupture—admitted in the years 1966–1983—were selected for a retrospective controlled study on the efficacy of antifibrinolytic therapy (AFT). Patients treated with antifibrinolytics were divided into two groups, according to the day of hospital admission and onset of therapy, respectively between 0 and 3 days (SG 1) and between 4 and 7 days from SAH (SG2); treated patients (260 cases) received i.v. tranexamic acid (6gr/day) for at least two weeks. Patients admitted before 1974, not receiving antifibrinolytics (90 cases), were selected as controls and divided into two groups (CG 1 and CG 2), according to the day of admission. In the first study group (admission 0–3 days) the rebleeding rate within 2 weeks was 9% versus 23% in controls (p〈0.01). The incidence of rebleeding within 3 and 4 weeks was also significantly lower (p〈0.05) than in controls. No significant difference was observed in the rebleeding rate in treated and untreated patients with late admission (4–7 days). Mortality from rebleeding was 16% in the first study group versus 17% in controls; in the second study group the figure was 6% versus 8% in controls. Seventy-five cases of ischaemic disorders (29%) were registered in treated patients versus 13 cases in controls (14%; p 〈 0.01). Thirty-seven patients receiving AFT (14%) developed significant ventricular dilatation requiring shunt insertion, versus one patient in the control groups (1%; p〈0.001). Final outcome was similar in the 4 groups. In conclusion—according to our data—AFT modifies the behaviour of rebleeding and the patients' course, although it does not modify the outcome after SAH. Clinical use of antifibrinolytic therapy appears still justified in those patients who cannot be operated on in the acute stage after SAH, provided that an associated anti-ischaemic therapy is undertaken.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1435-4373
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In a retrospective study conducted in an Italian tertiary care hospital, the incidence of nosocomial candidemia was evaluated together with causative pathogens, treatment, and risk factors for death. Over a 6-year period (1992–1997), a total of 189 episodes of candidemia occurred in 189 patients (mean age 58±19 years), accounting for an average incidence of 1.14 episodes per 10,000 patient-days per year. The most common reasons for hospitalization were solid neoplasia (21%), trauma (17%), abdominal diseases requiring surgery (13%), and cardiovascular diseases (13%). No patient was neutropenic within 3 weeks prior to the onset of candidemia. One hundred thirty patients were hospitalized in intensive care units, 47 patients in surgical wards, and 12 patients in medical wards. Candida albicans was the most frequently isolated pathogen, accounting for 54% of fungal isolates, followed by Candida parapsilosis (23%), Candida glabrata (7%), Candida tropicalis (5%), Candida pelliculosa (4%), Candida lusitaniae (1%), Candida humicula (1%), and other non-albicans Candida spp. (5%). Seventy-six (41%) patients received adequate antifungal therapy. Seventy-one (58%) of the 123 evaluable patients with central venous catheters underwent line removal; 51 of them had catheter-related candidemia. The 30-day crude mortality rate was 45%. Older age, hospitalization in an intensive care unit, a longer duration of candidemia, retention of central lines, and inadequate antifungal therapy were significantly associated with poor outcome. In the present study, nosocomial candidemia was a frequent and relatively underestimated illness. Adequate antifungal therapy and central line removal independently reduced the high mortality of the disease.
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Neurosurgical review 2 (1979), S. 113-116 
    ISSN: 1437-2320
    Keywords: CT scan ; Head injury ; Intracerebellar hematoma ; Posterior fossa ; Computer-Tomographie ; Kopf Trauma ; intracerebellares Hämatom ; hintere Schädelgrube
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Eine traumatische intraparenchymale Blutung in das Kleinhirn ist eine seltene, aber gefährliche Krank-heitseinheit, die sofortige diagnostische Maßnahmen erfordert. Die Autoren berichten hier über einen Fall eines subakuten cerebellären Hämatoms, das durch Computer-Tomographie diagnostiziert wurde und danach durch Entfernung des Blutkoagulums erfolgreich behandelt werden konnte.
    Notes: Summary Traumatic intraparenchymal hematoma of the cerebellum is a rare and dangerous entity which requires prompt diagnosis. The authors report a case of subacute cerebellar hematoma, diagnosed by CT scan examination and treated successfully by removal of the blood clot.
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  • 4
    ISSN: 0942-0940
    Keywords: Intracranial arterio-venous malformation ; spontaneous thrombosis ; haemorrhage ; epilepsy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 4 cases of spontaneous disappearance of intracranial arteriovenous malformations are reported. All the malformations were in the rolandic-parietal area, and fed in most cases by the MCA. In one case, the malformation was associated with a proximal aneurysm. One malformation was large, one medium-sized, and two small. Venous drainage was towards the longitudinal sinus in all cases. Presenting symptoms consisted of epilepsy in 2 cases, and intracerebral haemorrhage in 2 cases. Disappearance of the AVM was documented by angiography from 1 to 15 years after diagnosis, and was preceded by a new haemorrhage in 2 cases. Acute or gradual thrombosis of the AVM is suggested as the most likely cause of the disappearance of an AVM. Spontaneous thrombosis of an AVM should be considered as an aspect of the pathological entity known as “thrombosed AVM”. Guidelines for the management of patients exhibiting spontaneous disppearance of an AVM are briefly discussed.
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  • 5
    ISSN: 1432-1459
    Keywords: Dementia ; CSF shunt ; Hydrocephalus ; Amipaque CT scan ; Isotopic cisternography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bericht über 18 Patienten, welche an einer Demenz, verursacht durch einen chronischen Hydrocephalus, leiden und mit einem ventrikulo-arterialen oder ventrikulo-peritonealen Shunt behandelt wurden. Es wird die Indikation zur Operation dieses besonderen Typs von Demenz auf der Basis klinischer und instrumentell erhaltener Untersuchungsergebnisse diskutiert und über die postoperativen Resultate berichtet.
    Notes: Summary Eighteen patients with chronic hydrocephalic dementia who had a ventriculo-atrial or ventriculo-peritoneal shunt are reported. The indications for operating on this type of dementia are discussed on the basis of the clinical and instrumental protocol and the postoperative results.
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  • 6
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The Authors report on nine cases of thoracic disc hernia operated on through Carson's posterolateral approach. Several steps were taken to protect the spinal cord, and to remove completely disc fragments and any calcifications. The importance of the combined use of the operating microscope and the posterolateral approach are emphasized, and the longterm results are evaluated.
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