We prospectively studied 14 patients with acute cerebral infarctions using serial 133Xenon inhalation cerebral determination (133Xe-rCBF), scored neurological examinations, and neuropsychological testing. All patients underwent the same battery of tests at 3 days, 1 week, 2 weeks, and 4 weeks after cerebral infarction to determine the prognostic value of early rCBF studies and the chronological relationship of changes in rCBF to clinical status. Baseline rCBF within 3 days of symptoms of acute stroke did not correlate with clinical neurological outcome (r = -0.17, p less than 0.30; r = -0.18, p less than 0.28, for the two indices of rCBF used). Among the 11 patients demonstrating neurological recovery, 7 improved at 1 week, significantly before increases in rCBF (p less than 0.05). We conclude that early baseline rCBF does not predict clinical outcome in patients with acute cerebral infarctions and that return of neurological function precedes rather than follows increases in rCBF.

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Diaschisis with cerebral infarction.

Fifteen patients admitted to Philadelphia General Hospital with acute strokes had repeated measurements of cerebral blood flow measured by the 133Xenon inhalation method. A progressive decline in cerebral blood flow in both hemispheres was observed during the first week after infarction in twelve of these patients. This decline could be partially explained by loss of autoregulation, but could not be correlated with level of consciousness, clinical status of PCO2. This progressive decline in flow in the non-ischemic hemisphere indicates a process more complex than a simple destruction of axonal afferants to neurons as implied by the term diaschisis. The flow changes in the non-ischemic hemisphere are likely caused by a combination of the immediate effects of decreased neuronal stimulation modified by loss of autoregulation, release of vasoactive substances, cerebral edema, and other factors.

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Coronary artery-pulmonary artery communication diagnosis by coronary cineangiography and ascorbate dilution technic.

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Angiocardiography↗

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Consolidation radiation therapy following cytoreductive surgery, chemotherapy and second-look laparotomy for epithelial ovarian carcinoma: long-term follow-up.

BACKGROUND: From 1979-1987, 139 stage IC-IV ovarian cancer patients who had undergone cytoreductive surgery received 6-11 cycles of cisplatin and adriamycin. STUDY DESIGN: Eighty-four clinically complete responders underwent second-look laparotomy, and 60 of them received consolidation abdominal irradiation. The patients were then followed for a median follow-up of 39 months. RESULTS: Five- and 10-year actuarial survival for all patients was 43% and 24%, for no residuum at primary surgery, 80% and 35%, for residual tumor <2 cm, 45% and 35%, and for residual tumor >2 cm, 20% and 4%. Median survival for stage III-IV patients negative at second-look laparotomy was 72 months in irradiated compared to 25 months in non-irradiated patients (P = 0.14) and 77 months in irradiated patients with microscopic disease at second-look laparotomy. Median survival in patients with macroscopic disease at second-look laparotomy was 23.5 months if irradiated compared to 18 months if not (P = 0.05). CONCLUSIONS: Consolidation whole abdominal irradiation in advanced stages of ovarian cancer may be of value in patients with negative or microscopic disease at second-look laparotomy. Unfortunately, despite the initial survival advantage observed in irradiated patients, owing to late recurrences there was no significant difference in their long-term survival probability.

Adult↗

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