Thirteen patients (mean age 60.7 years; female:male ratio 10:3) with essential thrombocythaemia were treated with 3 million units (MU)/day interferon alfa-2b subcutaneously (s.c.) for 12 weeks, with all patients requiring a dose reduction after 4 weeks. The mean pretreatment platelet count was 1,400 x 10(9)/L and megakaryocytes were increased in all cases. Splenomegaly was present in six patients and haemorrhagic phenomena were observed in two. Nine patients (69.2%) had objective responses, including two (15.4%) complete responses (platelets less than 450 x 10(9)/L) which were then maintained with 5 MU interferon twice a week. Acute toxicity consisted of flu-like symptoms in 12 patients. Chronic toxicity (mainly leucopenia) was observed in nine patients. In conclusion, initial therapy and then requiring maintenance therapy at a reduced dose. However, the frequent side effects observed make it advisable to use a low dose of interferon alfa-2b, and to treat only those patients with significant symptoms and signs of thrombocytosis.

Adult↗

PubMedDate not supplied

Microembolic signal monitoring in hemispheric acute ischaemic stroke: a prospective study.

BACKGROUND AND PURPOSE: There are few data on the occurrence of microembolic signals (MES) in the acute phase of ischaemic stroke. The objective of our work was to systematically study the frequency of MES in non-selected patients with a first-ever hemispheric transient ischemic attack (TIA) or acute cerebral infarction, and to evaluate the clinical usefulness of MES detection. METHODS: 182 consecutive patients with hemispheric TIA or acute cerebral infarction, and 54-age-matched healthy controls were studied. Bilateral transcranial Doppler ultrasound (TCD) monitoring was performed for at least 30 min with a mean time from stroke onset to TCD of 69 h. Stroke severity on admission, early recurrent stroke and dependency on discharge were investigated. RESULTS: MES were detected in 20.5% of patients with arterial sources of embolism, 17. 1% of patients with potential sources of cardioembolism and 5% of patients with cryptogenic stroke. They were not registered, however, in lacunar infarctions (p < 0.001). Stroke severity on admission of patients with MES was greater than that of patients without MES (47. 1 vs. 19.4% with the Canadian Stroke Scale < or =6.5; p = 0.009). Early recurrent stroke was more frequent in patients with MES (11.8%) than in those without MES (4.2%) although the difference was not statistically significant. Multiple logistic regression analysis showed that MES increased the risk of dependency on discharge (odds ratio, 4.2; 95% CI, 1.2-14.9; p = 0.01) independently of age, stroke severity on admission and presence of an arterial or cardiac embolic source. CONCLUSIONS: There is a strong association of MES in the acute phase of stroke with known potential arterial and cardiac embolic sources. MES have an independent predictive value of poor outcome.

Acute Disease↗

PubMedDate not supplied

[Ultrasonography of the progression of atherosclerotic plaques].

INTRODUCTION: Severe carotid stenosis is the single most important aetiological factor in focal cerebral ischaemia. Carotid endarterectomy is indicated in stenosis of greater than 80% according to the results of the study ECST. DEVELOPMENT: Since the morbimortality associated with carotid endarterectomy in patients with moderate stenosis is similar to the incidence of stroke in patients treated with drugs, different criteria should be used to quantify stenosis for the detection of patients with a high risk of having a stroke. Ultrasound study (colour duplex) permits one to not only determine the degree of carotid stenosis, based on the characteristics of the flow curve, but also to analyse the structure of the atheromatous plaque. That is to say that one can distinguish between patients with a high risk of stroke and those with a low risk, independently of the degree of carotid stenosis. The ultrasound study has not only shown great precision in identification of the different components of the plaque of atheroma described in anatomopathological studies, but has also made apparent the association between certain characteristics of the atheromatous plaque, the risk of its progression and the risk of stroke. CONCLUSIONS: In this review we consider the ultrasound characteristics of the atheromatous plaque and the risk of stroke associated with it; the different ultrasound patterns and their correlation with anatomopathological findings; we review the mechanisms of progression of atheromatous plaques and finally describe their classification according to the recommendations of the second International Consensus.

Arteriosclerosis↗

PubMedDate not supplied

[Diagnosis of isolated pulmonary arterio-venous fístula using contrast transcranial Doppler].

We report the case of a young patient with an ischemic stroke due to a paradoxical embolism through a giant isolated pulmonary arterio-venous fistula and review the literature of similar cases. We argue that the use of contrast transcranial Doppler (c-TCD) may well help in redressing the likely situation of underdiagnosis of this condition. C-TCD is reliable and sensitive in the diagnosis of right-to-left shunt and allows us to suspect pulmonary arterio-venous fistula as the underlying mechanism. Furthermore, the qualities of non-invasiveness, ease of use, precision, reliability and inexpensiveness of c-TCD make it the ideal tool for checking the success of surgical or endovascular treatment and subsequent follow-ups.

Adult↗

PubMedDate not supplied

[The use of transcranial Doppler ultrasonography with contrast medium for the diagnosis of left-to-right shunt in young adults with cerebral infarction].

Paradoxical embolism by way of left-to-right shunt (LRSh) may be underestimated as a cause of stroke in young adults. We studied the prevalence of LRSh in 58 patients under 45 years of age. The sensitivity of transcranial Doppler ultrasound (TDU) with contrast medium and transthoracic echocardiography (TTE) with contrast for diagnosing LRSh, and the clinical and radiological signs of stroke are analyzed. TDU with contrast medium allowed shunt to be identified in 34.5%, whereas TTE identified 19%. The prevalence of LRSh was significantly higher in patients with cryptogenic stroke (p = 0.0043) and in patients without vascular risk factors (p = 0.0069). The group with shunt manifested less severe neurologic impairment both upon admission to the hospital and upon release. TDU with contrast medium is an excellent tool for diagnosing LRSh and a useful technique for studying cerebral infarction of uncertain origin.

Adult↗