The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

Aims 

The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.

Methods and results 

Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.

Conclusion 

The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.

Approaches to posterior circulation aneurysms and results of the operations

Surgical approaches and operative results in 32 operations of aneurysms of the vertebrobasilar system are presented. The orbitozygomatic and temporopolar approach was used for aneurysms of the bifurcation of the basilar artery lying high in the interpeduncular fossa. In aneurysm which neck was located less than 10 mm above or less than 5 mm below the anterior and posterior clinoid processes the pterional transylvian subtemporal and pterional anterior temporal approaches were performed. A large aneurysm with the neck lying 5 mm below the line connecting the anterior and posterior clinoid processes was operated on via pterional transcavernous approach. The used approaches made it possible to clip the aneurysms. Good and very good results were obtained in 82 per cent of cases. The perioperative mortality was 9 per cent.

[Tethered cord syndrome in adults]

The authors present a description of three patients in whom symptoms of spinal cord injury developed late after opening of the dural sac of the spinal canal. The material comes from two female and one male patients of age 37-47 years. In the first case the symptoms included increased paraesthesia, pain, paraparesis and sphincter disorders, which appeared 16 years after stab wound of meninges and the spinal cord at Th10. In the second patient, operated on for myelomeningocele at L3-4 at the age of five, sphincter disorders, trophic changes of feet and paraparesis appeared. The third patient was operated on for intra- and extramedullary lipoma at Th9-12. Seven months after the operation symptoms of sphincter disorders, pain, paraesthesia and paraparesis developed. The MR examination showed in all patients an adhesion of the posterior or posterolateral surface of the spinal cord with the dura mater at the sites of injury, which was confirmed intraoperatively. An operative treatment improved the clinical state. The tethering of the cord by the scar was the cause of a non-physiological stretching of the spinal cord on flexion of the body and head. It led to spinal circulation disorders and symptoms of myelopathy. It has been observed that the onset of the symptoms is often caused by sudden stretching of the spinal cord during fall or intense physical exercises. In such cases operative release of the spinal cord from the adhesion is a method of choice.

[A case of complex development anomalies and aneurysm of the anterior part of arterial circles of the brain]

A case of complex developmental anomalies and an aneurysm of the anterior part of arterial circle of the brain is reported. Every developmental anomaly was analysed separately. Views on their embryologic conditions are quoted. Haemodynamic disturbances are pointed out as a reason of the occurrence of the aneurysm.

Occlusion of radicular arteries - reasons, consequences and anastomotic substitution pathways

AIM OF STUDY

To investigate the cause of radicular artery occlusion.

METHOD

Fifty specimens of spinal cords were taken at postmortem from individuals in whom no symptoms of spinal cord and spine injuries were present in life. The spinal cord arterial system was filled with colour contrast material and then each radicular antery was studied individually at 5 - 25 operative microscope magnification.

RESULTS

Two hundred and fifty two anterior radicular arteries joining the anterior spinal artery and 525 posterior radicular arteries joining the posterior spinal arteries were examined. There were five obstructed vessels: four were anterior radicular arteries including the artery of Adamkiewicz and one of the initial branches of the spinal artery originating from the vertebral artery.

CONCLUSIONS

As the presented examples show, the formation of a fully efficient collateral circulation is possible.

[Surgical treatment of intramedullary tumors: preliminary results]

Since 1995 in the Department of Neurosurgery, Mining Hospital in Sosnowiec a surgical technique has been used of total or gross total removal of tumour. It includes the use of CO2 laser for myelotomy and tumour vaporisation as well as ultrasonic aspirator, microsurgical techniques and intraoperative monitoring of SSEP. Ten patients 11-61 years of age were operated on. Four tumours were located in the cervical part of the spinal cord, three in the cervico-thoracic area while the remaining three in the thoracic part. The condition of four patients before the operation was assessed as I-II degree on the McCormick scale, of one patient as--III degree--and of the other five patients as IV-V degree. Only in two cases the removed tumour was ependymoma; in six cases these were benign astrocytomas and in two other--anaplastic tumours. After the treatment, the clinical condition of almost all patients improved. Pain and trouble some paraesthesias subsided. Five patients are completely self-dependent and three other walk with the aid of handrails. The treatment proved unsuccessful in one patient with an anaplastic tumour in whom paralysis of lower limbs occurred before the operation. Six months after the operation the patient died of tumour metastasis. The observation period ranged from 6 months to 3 years. On the basis of our own observations it is suggested that total safe removal of even infiltrating intramedullary tumours is possible when proper surgical techniques are used. Best results are obtained in patients in good clinical condition irrespective of tumour extent.

[The use of pedicle periosteal flap in plastic surgery of anterior skull base]

In 12 cases of large traumatic defects of the anterior skull base plastic surgery was performed using large periostial flap to separate the nasopharynx from the extradural area. After a large biauricular scalp flap was formed, precise preparation of periostial flap was done. The bifronto-transfrontal sinus or transfrontal sinus approach was performed. Next cranialization of the frontal sinus was done and then it was filled with muscle. Afterwards the floor of the frontal sinus and skull base with defect were covered with periostial flap pedicled along supraorbital ridge. Finally irradiated homograft of dura or fascia lata was glued intradurally onto the place of the dural defect. In all of the patients CSF-rhinorrhea stopped immediately after surgery. Among patients observed from 2 to 4 years after surgery neither recurrent rhinorrhea nor infection appeared.

The accessory anterior cerebral artery: case report and anatomic analysis of vascular anomaly

BACKGROUND

The term "accessory artery" was formulated to describe one of the developmental anomalies of the middle cerebral artery. This anomaly consisted of the incidence of a vessel that branched off close to the anterior communicating artery and supplied a part of the cortex in the region of the middle cerebral artery vascularization.

METHODS

A panangiography of the cerebral vessels was carried out, using the subtraction method, on a woman who suffered from subarachnoid hemorrhage. An aneurysm of the anterior communicating artery and developmental anomaly of the right anterior cerebral artery were found. During the aneurysm operation, the existence of the developmental anomaly was confirmed. It was revealed also during a control angiography.

RESULTS

An atypical branch of the right internal carotid artery was found branching off from section C2, and passing below the right optic nerve and the anterior communicating artery. This branch ended with a division into the orbitofrontal and frontopolar artery.

CONCLUSIONS

The atypical branch of the internal carotid artery that partly performs the function of the existing proper right anterior cerebral artery, has been defined as the accessory anterior cerebral artery.

[Assessment of cerebral blood flow velocity changes by transcranial Doppler examination in patients with closed craniocerebral trauma]

24 patients after minor or moderate, closed isolated head injuries and 10 patients of control group were included to this study. Right after admission blood flow velocities of both middle cerebral arteries (MCAs) by using transcranial Doppler method (TCD) and blood flow velocities of both extracranial parts of internal carotid arteries (ICAs) by "duplex-scan method" were examined. Changes in mean flow velocities (MFVs) in MCAs and ICAs, VMCA/VICA ratio were analysed. 40% of patients who had minor or moderate head injury demonstrated increase of MCA velocity homolateral to the trauma or bilateral. We observed cerebral hyperemia in 16.7% of patients and posttraumatic vasospasm (TVSP) in 25% of patients. There is a high risk of occurring TVSP in patients with CT shows evidence of subdural or intracerebral hematoma.

[Views on the etiology and pathogenesis of intracranial saccular aneurysms]

The anatomical structure of intracranial arteries may favour the development of aneurysms because of poorly developed external elastic lamina and adventitia, gaps in the muscular layer and great number of collagenous fibres. However, the haemodynamic factor has the principal significance in initiation, growth and rupture of the aneurysms. The importance of this factor is especially great in cases of coexistence with developmental abnormalities of the arteries, arterial occlusion, hypertension, atherosclerosis or hereditary connective tissue disorders.

[Extramedullary erythropoiesis in cerebellar hemangioblastomas]

Three patients operated on for cerebellar haemangioblastoma are reported. Rarely observed extramedullary erythropoiesis was found in tumour tissue. One patient had erythrocytosis (solid form of the tumour), the remaining patients with cystic tumour had normal erythrocyte count.

[Vascular regions of the spinal cord]

In a material of 50 spinal cord specimens obtained from adults the radicular-anastomotic arteries were studied. After an analysis of the situation, diameter and connections of these arteries seven vascular regions were discerned in the cord: upper cervical region C1-C3, middle cervical region C4-C5, cervical intumescence region C6-C8, upper thoracic region Th1-Th3, middle thoracic region Th4-Th7, thoracolumbar intumescence region Th8-L4, and lumbosacral region L5-Co. Arterial systems found in these regions are described.

Zidovudine pharmacokinetics in HIV-positive women during different phases of the menstrual cycle

STUDY OBJECTIVE

To examine the pharmacokinetics of zidovudine during the menstrual cycle in human immunodeficiency virus- (HIV-) positive women.

DESIGN

Open, unblinded study.

SETTING

A women's clinic for acquired immunodeficiency syndrome (AIDS) at a large medical center.

PATIENTS

HIV-positive women with a CD4+ cell count above 200/mm3, receiving long-term zidovudine therapy, with a history of regular menstrual cycles.

INTERVENTIONS

All patients received a 100-mg dose of zidovudine in the fasted state on three occasions.

MEASUREMENTS AND MAIN RESULTS

Zidovudine and zidovudine-glucuronide plasma concentrations were measured with radioimmunoassay to determine the pharmacokinetic characteristics during each menstrual phase. The drug's mean peak plasma concentrations (range 233-808 ng/ml) were 556 +/- 145, 385 +/- 132, and 495 +/- 143 ng/ml during the menstrual, late follicular-ovulatory, and luteal phases, respectively. Initially, plasma concentrations declined in a linear fashion from 0 to 4 hours, with a prolonged elimination phase in many patients after 4 hours. The mean zidovudine area under the curve was 886 +/- 156, 845 +/- 268, and 775 +/- 167 ng.hour/ml. The mean percentage of dose recovered was 44.2 +/- 26.0, 56.9 +/- 19.1, and 42.2 +/- 16.6, respectively.

CONCLUSIONS

The pharmacokinetics of zidovudine were not different during the three phases of the menstrual cycle; however, considerable intrapatient and interpatient variability was noted for many of the values.

[A case of lumbar glomeruloma]

A case of the patient with atypical localization of glomus tumor in lumbar region is reported. Trigger pain of unusual intensity resistant to pharmacological treatment ceased immediately after the operation.

[Dissecting aneurysm of the posterior inferior cerebellar artery]

A 23 year old woman with dissecting aneurysm of the left posterior inferior cerebellar artery located distal to the branch feeding medulla oblongata is described. Trapping of the aneurysm with the aid of 2 clips was without any influence on neurological state of the patient and prevented recurrent hemorrhage.

[Acute spontaneous epidural hematoma of the thoracic segment of the spinal canal]

We describe a 60-year-old woman, in good health, who bending forward developed bleeding into the epidural space of the thoracic part of the vertebral canal. Epidural haematoma caused severe damage to the spinal cord. Immediately performed operation gave slight improvement in neurological status.

[Subacute epidural hematoma]

Eleven patients are reported who had subacute epidural haematoma diagnosed by CT 48 hours after craniocerebral trauma. These haematomas, most frequently, were located outside the temporal region. In some cases capsule of the haematoma could be recognized. The indication to surgical treatment was increasing intensity of intracranial pressure and development or persistence of the signs of focal CNS injury. Effective conservative treatment was given to patients with good general condition in whom CT showed no shifting of midline structures over 5 mm, and the fissure of the fracture was not lying transversely to the course of middle meningeal artery branches.

Chronic headache patients' marital and family adjustment

The purpose of this study was to compare the marital and family adjustment of headache patients and their spouses, before pain control treatment, to couples without chronic pain. Minuchin's (1978) family systems theory of psychosomatic illness was tested, using an adult sample. This sample consisted of 117 headache-patient-and-spouse couples and a control group of 108 married couples without chronic pain. A survey design was used with marital and family assessment instruments. Marital and family questionnaires were given to headache patients and their spouses before beginning treatment and were sent to couples without chronic pain. "Headache couples" reported greater differences in consensus, cohesion, affection, and sexual relationships than did control couples. Headache patients reporting greater marital adjustment were more likely to have continuous pain than those reporting less marital adjustment. Headache patients' pain per day correlated positively with greater family cohesion and adaptability. Headache patients' severity of pain correlated positively with greater marital affection. The spouses' marital cohesion, affection, and family cohesion and adaptability correlated positively with increased severity of patients' pain.

Anterior chamber lens implantation after vitreous loss

Vitreous loss is a serious complication of cataract surgery. Following vitreous loss it is common practice to perform a primary implantation of an anterior chamber lens (AC-IOL). We retrospectively analysed 642 consecutive cases of cataract extraction performed between 1983 and 1986 with special attention to those patients in whom vitreous loss occurred and an AC-IOL was placed. There were 27 such cases, and 24 of these were available for follow-up. Eighteen (75%) had visual acuity of 20/40 or better. All six patients (25%) who had a visual acuity of less than 20/40 in the operated eye had a functional visual acuity of 20/200 or less. Complications that occurred in this group are discussed. We are concerned that the complications associated with vitreous loss and with AC-IOLs may be acting in concert to cause visually disabling results.

Sexual headaches occurring in cluster headache patients

A number of classifications of headache have appeared in medical and professional journals. In addition to these formal diagnostic classifications, a number of articles have addressed the relationship of sexual functioning to headache etiology, course, and prevalence. To this end, many headache specialists have developed a classification for what are termed "sexual headaches." To date, these sexual headaches have been limited to migraine and muscle contraction (tension) headache patterns. We present, for the first time, two case studies documenting the role of sexual activity in both etiology and course of cluster headache.

Prevention, detection, and treatment of diabetic eye disease: an overview and demonstration project

The Diabetic Eye Care Program at the Lexington-Fayette County Health Department screened 2 70 clients for glaucoma, visual acuity, cataracts, and diabetic retinopathy. Of these, 120 were referred to ophthalmologists for follow-up examination, care and, if appropriate, treatment. The program offered evaluation, referral, follow-up, and individual and group education. Our experience suggests that many people will follow eye care advice if given it, although diabetic eye disease remains a problem. Reaching the at-risk population, offering a mechanism for detecting diabetic eye disease, and providing supportive education are essential in combatting this problem.

[A typical syndrome of the sulco-commissural arteries]

Flaccid tetraparesis was observed in a young woman which was caused by embolism of the anterior medullary artery. Topographic investigations of the spinal arteries were carried out, and pathological examination was done confirming the presence of embolic material which was the cause of medullary ischaemia.

More on the reliability of the kinesthetic aftereffects measure and need for stimulation

Recently, some have argued for a renewed interest in the kinesthetic aftereffects procedure (KAE) as a personality measure even though it may show low test-retest reliability. These arguments indicate that first-session KAE is valid but later-session KAE is not, due to the supposed appearance (in later sessions) of unwanted functional similarity between different aspects of the KAE procedure. Functional similarity leads to reduced reliability and validity of the retest. Data from two new studies do not support this functional similarity hypothesis, but these data do support the KAE by showing test-retest reliability. Also, the data show some new but tentative experimental evidence for the construct validity of second-session KAE as a measure of need for stimulation. These data do support the KAE as a personality measure but, when contrasted to arguments that only first-session KAE is valid, the data indicate that this is unresolved.