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  • 1
    Electronic Resource
    Electronic Resource
    Schlaganfallversorgung in einer Stroke Unit mit ländlichem Einzugsgebiet (2000)
    Springer
    Der Nervenarzt 71 (2000), S. 829-834 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Stroke Unit ; Schlaganfalltherapie ; Frührehabilitation ; Integratives Behandlungskonzept ; Keywords Stroke Unit ; Acute treatment ; Rehabilitation ; Integrative treatment concept
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The experiences of a rural stroke unit since 1997 are reported. A special referral concept was developed with the emergency services and hospitals of the region. As a result, 35% of patients arrived in the stroke unit within 3 hours after onset of stroke symptoms. This corresponds with the data from larger cities. The major peculiarity of the Günzburg Stroke Unit is that, after emergency diagnostic and therapeutic procedures, 41% of the patients with mainly internistic problems were transferred to another regional hospital and only 40% were admitted to the inpatient stroke unit. Moreover, among these were an above-average proportion of patients with intracerebral hemorrhage (24% of the inpatients in 1998), and complete acute treatment and rehabilitation were carried out in the same hospital according to an integrative treatment concept. Since 1997, the average hospitalization duration decreased from 11.4 days to 5.9 days and the number of patients per month increased to an average of 22.3. The total hospitalization duration – including inpatient rehabilitation – was 33.9 days. All in all, a comparably good stroke treatment thus is possible outside urban regions.
    Notes: Zusammenfassung Die Erfahrungen einer seit 1997 bestehenden Stroke Unit im überwiegend ländlichen Raum werden berichtet. Im Rahmen eines speziellen Zuweisungskonzeptes erreichten 35% der Patienten die Klinik innerhalb von 3 h nach Symptombeginn, was den Angaben aus Ballungszentren entspricht. Wesentliche Besonderheit der Günzburger Stroke Unit ist, dass nach der “präklinischen” Notfalldiagnostik und -therapie 41% der Patienten mit im Vordergrund stehenden internistischen Problemen in die umliegenden Krankenhäuser eingewiesen und nur 40% auf der Stroke Unit aufgenommen wurden. Darüber hinaus wurden relativ viele Patienten mit intrazerebralen Blutungen (24% der stationären Patienten im Jahr 1998) versorgt, und entsprechend einem integrierten Konzept erfolgte die Akutversorgung und Frührehabilitation im Hause. Seit 1997 konnte die durchschnittliche Verweildauer auf der Stroke Unit von zunächst 11,4 auf 5,9 Tage verkürzt werden bei gleichzeitigem Anstieg der Fallzahl auf 22,3 Patienten/Monat. Die Gesamtverweildauer einschließlich Frührehabilitation lag bei 33,9 Tagen. Die Erfahrungen belegen, dass auch außerhalb von Ballungszentren eine gut vergleichbare Schlaganfallversorgung möglich ist.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050671
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  • 2
    Electronic Resource
    Electronic Resource
    Zur Schlaganfall-Vorbeugung: Welches sind die besten Methoden zur Fahndung auf Carotis-Stenosen? (1980)
    Springer
    European archives of psychiatry and clinical neuroscience 228 (1980), S. 11-20 
    Details
    ISSN: 1433-8491
    Keywords: Ultrasound ; Doppler sonography ; Doppler angiography ; Plate thermography ; Stroke ; Carotid stenoses ; Ultraschall ; Doppler-Sonographie ; Doppler-Angiographie ; Plattenthermographie ; Schlaganfall ; Carotisstenosen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die frühzeitige Diagnostik von Stenosen und Verschlüssen im extrakraniellen Teil der A. carotis ist aufgrund der großen Häufigkeit des damit verbundenen Krankheitsbilds „Schlaganfall“ und der Möglichkeit einer chirurgischen Therapie von großer Bedeutung für die Vorsorgemedizin. Acht ausgewählte Verfahren zur unblutigen, risikolosen Früherfassung von obliterierenden Prozessen der A. carotis wurden in einer direkten Vergleichsuntersuchung an 550 Patienten auf ihre Brauchbarkeit untersucht. Es waren dies Auskultation, Plattenthermographie, Doppler-Sonographie der A. frontalis medialis, Doppler-Sonographie und -Angiographie der Carotisbifurkation, supraorbitale Plethysmographie, Ophthalmodynamometrie und -graphie sowie Arm-Retina-Zeitmessung. Die Ergebnisse zeigen ausschließlich für die Doppler-sonographischen und -angiographischen Verfahren eine Treffsicherheit von mehr als 80% bei Vergleich der Ergebnisse mit den Resultaten von insgesamt 113 meist beidseitig angiographierten Fällen. Aus Kosten- und Zeitgründen wird eine Untersuchungs-Trias für verschiedene diagnostische Einheiten empfohlen: Auskultation und Plattenthermographie als Zusatz zur allgemeinen Vorsorgeuntersuchung für den Allgemeinarzt, zusätzlich Doppler-Sonographie der A. frontalis medialis und manuelle Direktbeschallung der Carotisbifurkation zum Stenoseausschluß für niedergelassene Ärzte mit größerem Schlaganfall-Patientengut sowie die genauere Abklärung mit durch Registrierung ergänzter Doppler-Angiographie in Krankenhäusern und Kliniken mit neuroradiologischer Abteilung.
    Notes: Summary A stroke is often caused by extracranial stenosis of the carotid artery. Since strokes may be prevented by surgery, early diagnosis of carotid stenosis is essential. The following methods for the noninvasive detection of carotid stenosis have been compared in a group of 550 patients: auscultation for bruit in the neck, plate thermography, Doppler sonography of the medial frontal artery, Doppler sonography and Doppler angiography of the carotid bifurcation, supraorbital plethysmography, ophthalmodynamometry, ophthalmodynamography, and measurement of the arm-retina-time. The results show that only Doppler sonography and Doppler angiography yield accurate results in more than 80% of the cases in comparison to radiologic angiography (113 cases). If the time and cost of the methods are also evaluated, the following sequence is recommended for mass screening: For general practitioners, auscultation and plate thermography of the forehead (an inexpensive and easy method); for practicing neurologists and other physicians with a high proportion of cerebrovascular risk patients, Doppler sonography of the medial frontal artery and simple direct manual application of the Doppler ultrasound method on the carotid bifurcation (in addition to auscultation and plate thermography); for hospitals, noninvasive Doppler angiography is also recommended.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00365739
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  • 3
    Electronic Resource
    Electronic Resource
    Transcranial doppler CO2 test for the detection of hemodynamically critical carotid artery stenoses and occlusions (1986)
    Springer
    European archives of psychiatry and clinical neuroscience 236 (1986), S. 162-168 
    Details
    ISSN: 1433-8491
    Keywords: Carotid artery ; Cerebral ischemia ; Transcranial Doppler sonography ; Hypercapnia ; STA-MCA bypass
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Cerebral CO2-reactivity was tested by transcranial Doppler sonography (Doppler CO2 test) in 232 patients. Time averaged flow velocity in the middle cerebral artery at the 40 mm Hg blood PCO2 level was taken as a reference point, and the relative increase of flow in hypercapnia of 46.5 mm Hg pCO2 was defined as “Normalized Autoregulatory Response” (NAR). A total of 82 patients with no evidence of cerebrovascular disease gave “normal” values for NAR (23.2 ± 5.2 SD). In 150 patients with 233 stenoses and occlusions of the internal carotid artery NAR was significantly decreased in highergrade stenoses (P = 0.01 for 80% diameter reduction, P 〈 10−6 for 90% or more). In such stenoses, patients with NAR 〈 14 had suffered more frequently (P 〈 0.01) from ipsilateral transient ischemic attacks and/or stroke during the previous 6 months than patients with “normal” NAR. Preoperative NAR 〈 14 always improved to “normal” values following carotid surgery, while preoperative NAR 〉 19 remained unchanged (60 cases). The transcranial Doppler CO2 test is thought to be a reliable noninvasive method to detect hemodynamically critical carotid stenoses and occlusions. This may be of interest in selecting patients for superficial temporal artery-middle cerebral artery bypass and carotid surgery. For practical use 4 categories of NAR are suggested.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00380944
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  • 4
    Electronic Resource
    Electronic Resource
    The measurement of residual urine by means of ultrasound (Sonocystography) in neurogenic bladder disturbances (1980)
    Springer
    European archives of psychiatry and clinical neuroscience 228 (1980), S. 1-6 
    Details
    ISSN: 1433-8491
    Keywords: Residual urine ; Ultrasound ; Urinary bladder dysfunction ; Multiple sclerosis ; Rehabilitation ; Restharn ; Ultraschall ; Harnblasenstörungen ; Multiple Sklerose ; Rehabilitation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Harnwegsinfekte infolge von neurogenen Blasenstörungen sind eine häufige und schwerwiegende Komplikation zahlreicher Nervenkrankheiten, besonders der Multiplen Sklerose. Eine regelmäßige Restharnkontrolle bei diesen Patienten ist erforderlich, auch in der dezentralen symptomatischen Therapie und Rehabilitation. Es wird nachgewiesen, daß Restharnmessung mit Hilfe der Ultraschall-B-Mode-Technik möglich ist und auch beim Erwachsenen für kleine Blasenvolumina hinreichend exakte Meß werte ergibt. Da sich mit dem Linear-Array-Scan vor allem bei weiblichen Patienten der untere (caudale) Blasenrand aufgrund des vorgelagerten Schambeins oft nicht darstellen läßt, wurde ein Sektor-Scan verwendet. 144 Ultraschallmessungen bei gesunden Versuchspersonen und Patienten ohne Restharn bei verschiedenen Blasenfüllungen sowie 19 Messungen bei Patienten mit Restharn über 20 ml wurden mit dem Miktionsvolumen bzw. mit der durch Katheter bestimmten Restharnmenge verglichen. Das Blasenvolumen wurde aus den sagittalen und transversalen Schnittbildern in Anlehnung an die Rotationsellipsoidformel berechnet. Der empirische Regressionskoeffizient betrug mit unserem Gerät 0,75 (im Gegensatz zum theoretischen 0,52 für das Rotationsellipsoid). Der Korrelationskoeffizient ist 0,94 für Blasenvolumina zwischen 0 und 200 ml. Die Standardabweichungen der errechneten Blasenvolumina von der gemessenen Harnmenge betrug 10,5ml bei Harnvolumina zwischen 0 und 100 ml und 16,2 ml zwischen 101 und 200 ml.
    Notes: Summary The measurement of residual urine is important for bladder training in cases with neurogenic bladder dysfunction, especially in multiple sclerosis and in non-neurogenic retention. It is possible to measure the bladder volume precisely enough for even small amounts of residual urine by means of the ultrasound B-mode technique. A sector scan was used since with a linear array scan, the caudal part of the bladder cannot be visualized in female patients because of the pubic bone. The 144 volume data taken by ultrasound from normal persons and from patients without residual urine and the 19 measurements made in patients with residual urine more than 20 ml were compared with the urine volume determined by micturation or catheterization. The bladder volume was calculated from the maximum sagittal and transversal planes using an ellipsoid formula. The regression coefficient was 0.75. The correlation coefficient was 0.94 for bladder volumes between 0 and 200 ml. The standard deviation of the calculated residual urine as compared to the measured urine was 10.5 ml for a volume between 0 and 100 ml and 16.2 ml for a volume between 101 and 200 ml. Thus, ultrasound determination of residual urine may be recommended as a simple and reliable method when using a sector scan.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00365737
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  • 5
    Electronic Resource
    Electronic Resource
    Tissue characterisation of atherosclerotic carotid plaques by MRI (1995)
    Springer
    Neuroradiology 37 (1995), S. 631-635 
    Details
    ISSN: 1432-1920
    Keywords: Tissue characterisation ; Carotid artery ; Atheromatous plaque ; Intramural haemorrhage ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Carotid artery plaques with intraplaque haemorrhage or atheromatous debris have been found to be associated with an increased risk of embolic stroke. Other methods have failed to detect plaque morphology, and it is not clear whether MRI allows differentiation between prognostically and therapeutically relevant plaque types. We examined 17 carotid bifurcation plaques which had been removed in toto by MRI. For quantifying MR signal intensities (I) the contrast-to-noise ratio (CNR) was used: (ITissue-IRef)/SDRef, with normal saline (0.9%) as reference (Ref) and the standard deviation (SD) of the noise. Measurements were correlated with the histopathological appearance of “simple plaques”, consisting of fibrous intimal thickening, lipid deposits and/or atheromatous tissue with cholesterol crystals, largely calcified plaques, and “complicated plaques”, containing recent intramural haemorrhage or friable atheromatous debris. Significantly different mean CNR could be measured in the three plaque types on T1- and T2-weighted sequences (p〈0.00001) and using the FLASH pulse sequence with a flip angle of 15° (p〈0.001). With the T1-weighted sequence simple plaques showed a CNR of 4.4±2.3, calcified plaques −4.8±2.5 and complicated plaques 15.1±4.3. Using this technique, each single plaque could be correctly classified, an unalterable prerequisite for a clinical application. To date, motion artefacts due to patient movement or insufficiently triggerable vessel pulsation in combination with relative long acquisition times (6–7 min) have limited in vivo investigations. If these problems could be overcome, MRI might become a valuable technique for studying carotid plaque morphology.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00593376
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  • 6
    Electronic Resource
    Electronic Resource
    Tissue characterisation of atherosclerotic carotid plaques by MRI (1995)
    Springer
    Neuroradiology 37 (1995), S. 631-635 
    Details
    ISSN: 1432-1920
    Keywords: Key words Tissue characterisation ; Carotid artery ; Atheromatous plaque ; Intramural haemorrhage ; Magnetic resonance imaging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Carotid artery plaques with intraplaque haemorrhage or atheromatous debris have been found to be associated with an increased risk of embolic stroke. Other methods have failed to detect plaque morphology, and it is not clear whether MRI allows differentiation between prognostically and therapeutically relevant plaque types. We examined 17 carotid bifurcation plaques which had been removed in toto by MRI. For quantifying MR signal intensities (I) the contrast-to-noise ratio (CNR) was used: (ITissue– IRef) / SDRef, with normal saline (0.9 %) as reference (Ref) and the standard deviation (SD) of the noise. Measurements were correlated with the histopathological appearance of “simple plaques”, consisting of fibrous intimal thickening, lipid deposits and/or atheromatous tissue with cholesterol crystals, largely calcified plaques, and “complicated plaques”, containing recent intramural haemorrhage or friable atheromatous debris. Significantly different mean CNR could be measured in the three plaque types on T1- and T2-weighted sequences (p 〈 0.00001) and using the FLASH pulse sequence with a flip angle of 15 ° (p 〈 0.001). With the T1-weighted sequence simple plaques showed a CNR of 4.4 ± 2.3, calcified plaques −4.8 ± 2.6 and complicated plaques 15.1 ± 4.3. Using this technique, each single plaque could be correctly classified, an unalterable prerequisite for a clinical application. To date, motion artefacts due to patient movement or insufficiently triggerable vessel pulsation in combination with relative long acquisition times (6–7 min) have limited in vivo investigations. If these problems could be overcome, MRI might become a valuable technique for studying carotid plaque morphology.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340050166
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  • 7
    Electronic Resource
    Electronic Resource
    Verbesserter Nachweis extracranieller Stenosen und Plaques der A. carotis durch Kombination von B-Bild Echo-Arteriographie und Doppler-Sonographie (1982)
    Springer
    European archives of psychiatry and clinical neuroscience 231 (1982), S. 391-407 
    Details
    ISSN: 1433-8491
    Keywords: Ultrasound-diagnostic use ; B-mode arteriography ; Doppler sonography ; Carotid stenosis ; Ultraschall-Schnittbild-Untersuchung ; Echo-Arteriographie ; Doppler-Sonographie ; Carotisstenosen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung 850 Patienten mit Verdacht auf zerebrovaskuläre Durchblutungsstörungen wurden mit indirekter und direkter Doppler-Sonographie sowie anschließender Echo-Arteriographie mit einem hochauflösenden B-Bildgerät auf Carotisstenosen untersucht. 138 Carotiden von 78 Patienten dieses Kollektivs wurden angiographiert, in 62 Fällen wurde eine operative Ausschälung einer Carotisstenose vorgenommen. Während Doppler-sonographisch hochgradige Stenosen und Verschlüsse praktisch immer erkannt wurden, betrug die Treffsicherheit bei geringgradigen Stenosen unter 40% Lumeneinengung nur etwa 20%. Umgekehrt erreichte die Echo-Arteriographie ihre höchste Treffsicherheit von etwa 85% bei geringgradigen Stenosen, während weniger als 40% aller hochgradigen Stenosen und Verschlüsse erkannt wurden. Bei Kombination beider Verfahren betrug die Treffsicherheit bezüglich der Erkennung pathologischer Befunde im Vergleich zur Röntgen-Angiographie 95%, die Spezifität (richtig negative Diagnose) 89%. Da die Angiographie vor allem bei geringgradigen Stenosen selbst nur eine begrenzte Treffsicherheit im Vergleich zum anatomischen Substrat besitzt und die Echo-Arteriographie in manchen Fällen der Angiographie hinsichtlich der morphologischen Genauigkeit überlegen sein dürfte, wird für weitere Untersuchungen der Vergleich mit dem Operationsbefund empfohlen. Die kombinierte Doppler-Sonographie und Echo-Arteriographie ermöglicht eine gezieltere Indikationsstellung zur Angiographie und Gefäßrekonstruktion bei transitorischen ischaemischen Attacken, eignet sich für postoperative Kontrollen nach Carotis-Thrombendarteriektomien und bietet sich für Verlaufs- und Therapiekontrollen bei asymptomatischen Gefäßveraäderungen an.
    Notes: Summary Investigations for carotid stenoses were performed in 850 patients suspected of having cerebrovascular insufficiency. Indirect and direct Doppler sonography as well as high resolution B-mode ultrasonic arteriography were used. Angiography was performed in 78 patients (138 carotid arteries). Carotid endarterectomy was carried out in 62 cases. While almost all high grade stenoses and occlusions were correctly detected by Doppler sonography, accuracy decreased to approximately 20% in lower grade stenoses of less than 40% diameter reduction. On the other hand ultrasonic arteriography showed the highest accuracy of approximately 85% in low grade stenoses, while less than 40% of high grade stenoses and occlusions were correctly identified. Overall sensitivity of the combination of both methods was 95% as compared with the angiographic findings, specifity 89%. Because X-ray-angiography often fails in the correct detection of low grade stenoses, and because ultrasonic arteriography has some advantages in estimating the morphology of plaques, the surgical findings rather than the X-ray findings should be the standard for evaluation of the ultrasonic findings. Combination of Doppler sonography and ultrasonic arteriography results in more specific indications for angiography and carotid endarterectomy in transient ischaemic attacks. The proposed method is suitable for detailed controls after carotid surgery, and is the method of choice for follow-up studies in asymptomatic carotid arteriosclerosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00342720
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