Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Given the high prevalence of sleep-disordered breathing (SDB) in stroke and its importance as a vascular risk factor, a clinical instrument to assess its incidence would be useful. Acute stroke patients (n=121) were stratified into high- and low-risk groups for SDB using a modified Berlin Questionnaire (BQ) administered to the informants who were living with the patient. ⋯ On stratifying risk of obstructive sleep apnea (OSA) in these patients based on the BQ, 53% belonged to the high-risk group and 47% belonged to the low-risk group. There was poor correlation between the clinical questionnaire results and PSG findings, with sensitivity of 66.7%, specificity of 55.6%, a positive predictive value of 63.4%, and a negative predictive value of 58.8%.
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Timely recanalization of the occluded artery is the only effective treatment for acute ischemic stroke. Intravenous tissue plasminogen activator (i.v. tPA), administered within 3 hours of symptom onset, is the only United States Food and Drug Administration-approved treatment. This short window often precludes effective intervention, and i.v. tPA often fails to recanalize major and mid-sized arteries. ⋯ Recently, new mechanical neuroendovascular devices have shown high recanalization rates with acceptable safety in early studies. Multi-modal reperfusion therapy (MMRT)--including intra-arterial infusion of thrombolytics and/or antiplatelet agents, mechanical clot disruption and retrieval, and balloon angioplasty with stent placement--is the prevailing concept for the management of major acute stroke. Recent results suggest that MMRT results in higher chances for both recanalization of the occluded artery and reperfusion of the ischemic tissue.
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Endovascular techniques for acute stroke have evolved from a pharmacological to a mechanical approach. We report illustrative cases of successful anterior circulation recanalization in patients with large arterial occlusions, using a stent-based technique to perform arterial recanalization and thrombectomy, without permanent stent implantation. Four patients (mean age 59 years), presented with National Institutes of Health Stroke Scale (NIHSS) scores of 18 to 24, from 2 hours to 6 hours after stroke onset, with middle cerebral artery (MCA), MCA branch, internal carotid artery (ICA) terminus, or tandem ICA-MCA occlusions. ⋯ One week after treatment patients achieved NIHSS scores of 2 to 5, with no hemorrhagic complications. This approach allowed rapid endovascular revascularization and thrombectomy, without permanent stent implant. Stent-based thrombectomy devices may become a valuable tool in the management of acute ischemic stroke.
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The formation of bacterial biofilm on the surface of implanted metal objects is a major clinical problem. The antibacterial and antifungal effect of silver ions has been long known, and seems to give silver the capability to inhibit biofilm formation. To test the effect of silver ions, 20 New Zealand rabbits had bacteria applied to a screw insertion site at the iliac crest, and were then randomly divided into two groups: Group I, which had silver-coated screws applied, and Group II, which had uncoated titanium screws. ⋯ All tissue samples appeared ultrastructurally normal in both groups. Biofilm formation was inhibited on all silver-coated screws, but all uncoated screws developed a biofilm on their surfaces. Our findings suggest that nanoparticle silver ion-coated implants are as safe as uncoated titanium screws and that they can help prevent both biofilm formation and infection.