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Berlin, Germany

Grond M.,Kreisklinikum Siegen | Jauss M.,Hainich Klinikum | Hamann G.,HSK Klinik | Stark E.,Klinikum Offenbach | And 8 more authors.
Stroke | Year: 2013

BACKGROUND AND PURPOSE - Adequate diagnosis of atrial fibrillation (AF), including paroxysmal AF, is an important part of stroke workup. Prolonged ECG monitoring may improve the detection of paroxysmal, previously undiagnosed AF (unknown AF). Therefore, we evaluated systematic 72-hour Holter ECG monitoring to detect unknown AF for the workup of patients with stroke. METHODS - Unselected survivors of a stroke or transient ischemic attack (TIA) without known AF were enrolled in a prospective, multicenter cohort study of 72-hour Holter ECG monitoring in 9 German secondary and tertiary stroke centers between May 2010 and January 2011. In addition to standardized workup of stroke pathogenesis according to the German Stroke Unit protocol, all patients underwent 72-hour Holter ECG monitoring directly after admission. All ECGs were centrally analyzed by 2 independent observers. We determined the proportion of unknown AF and compared the detection rates of 72- and 24-hour monitoring. RESULTS - A total of 1135 patients were enrolled (mean age, 67 years [SD, 13.1 years], 45% women, 29% TIA). Unknown AF was detected in 49 out of 1135 patients (4.3%, [95% confidence interval, 3.4-5.2%]) by 72-hour ECG monitoring. Unknown AF was diagnosed in 29 patients (2.6%) within the first 24 hours of ECG monitoring, and in 20 more patients only by 72 hours of ECG monitoring. The number needed to screen by 72-hour ECG was 55 patients (95% confidence interval [35-123]) for each additional AF diagnosis. Patients with unknown AF were significantly older and had more often a history of previous stroke. Patients with unknown AF were equally distributed within categories of pathogenesis according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. CONCLUSIONS - In unselected survivors of stroke or TIA, 72-hour ECG monitoring is feasible and improves the detection rate of silent paroxysmal AF. © 2013 American Heart Association, Inc. Source

Wollensak G.,Martin Luther University of Halle Wittenberg | Herbst H.,Vivantes Klinikum Neukolln
Cornea | Year: 2010

Purpose: The aim of the present study was to investigate the characteristic honeycomb hydration pattern after corneal cross linking using in vivo rabbit cornea. Methods: After removal of the central epithelium, the right corneas of 4 New Zealand white rabbits were cross-linked applying a photosensitizing 0.1% riboflavin-dextran solution and UV-A light of 370 nm wavelength with a surface irradiance of 3 mW/cm for 30 minutes. Two animals were euthanized 3 days postoperatively and another 2 were euthanized 6 weeks postoperatively. The corneas of the enucleated eyes were evaluated using 4-μm light microscopic sections with tangential en face and cross-sectional orientation. Results: By day 3 after treatment, complete apoptotic damage and loss of the stromal keratocytes and endothelial cells were found in the central irradiated area through the entire thickness of the stroma. There was marked lacunar edema in the former positions of the apoptotic keratocytes in the anterior 250 μm of the stroma and diffuse edema in the adjacent posterior and lateral zones. Lacunar edema was identified best on tangential sections. By week 6, the cytoarchitecture of the cornea appeared normal again, and complete resolution of both lacunar and diffuse corneal edema had occurred. Conclusion: After riboflavin/UV-A cross linking of in vivo rabbit cornea, a characteristic lacunar hydration pattern can be observed in the anterior stroma with maximum cross linking, whereas diffuse edema is present in the adjacent areas without significant cross linking. The lacunar edema may explain the temporary demarcation of the anterior stroma after cross linking on biomicroscopy because of increased light scattering. The network pattern of cross linking may contribute to the elasticity of the cornea after cross linking. © 2010 by Lippincott Williams and Wilkins. Source

Liebermann D.,Charite - Medical University of Berlin | Ostendorf F.,Charite - Medical University of Berlin | Kopp U.A.,Charite - Medical University of Berlin | Kraft A.,Charite - Medical University of Berlin | And 4 more authors.
Journal of Neurology | Year: 2013

Previous patient studies suggest that thalamic stroke may yield persistent deficits in several cognitive domains. At present, the subjective dimension and everyday relevance of these impairments is unclear, since many patients with thalamic stroke only show minor changes on physical examination. Here, we have studied subjective consequences of focal thalamic lesions. A sample of 68 patients with a history of ischemic thalamic stroke was examined by using established clinical self-report questionnaires assessing memory, attention, executive functions, emotional status and health-related quality of life. In order to control for general factors related to cerebrovascular disease, self-reports were compared to an age-matched group of 34 patients with a history of transient ischemic attack. Thalamic lesions were co-registered to an atlas of the human thalamus. Lesion overlap and subtraction analyses were used for lesion-to-symptom mapping. When both patient groups were compared, no significant differences were found for either questionnaire. However, when subgroups were compared, patients with infarctions involving the posterior thalamus showed significant emotional disturbances and elevated anxiety levels compared to patients with more anterior lesions. Our findings thus point to the existence of a persistent affective impairment associated with chronic lesions of the posterior thalamus. This syndrome may result from damage to connections between medial pulvinar and extra-thalamic regions involved in affective processing. Our findings suggest that the posterior thalamus may contribute significantly to the regulation of mood. © 2012 Springer-Verlag. Source

Oldgren J.,Uppsala University | Alings M.,Amphia Ziekenhuis | Darius H.,Vivantes Klinikum Neukolln | Diener H.-C.,University of Duisburg - Essen | And 8 more authors.
Annals of Internal Medicine | Year: 2011

Background: CHADS 2 is a simple, validated r Uppsala Clinical Research Center, Uppsala University, S-75185 Uppsala, Sweden; e-mail, Jonas.Oldgren@ucr.uu.se.isk score for predicting the risk for stroke in patients with atrial fibrillation not treated with anticoagulants. There are sparse data on the risk for thrombotic and bleeding complications according to the CHADS 2 score in patients receiving anticoagulant therapy. Objective: To evaluate the prognostic importance of CHADS2 risk score in patients with atrial fibrillation receiving oral anticoagulants, including the vitamin K antagonist warfarin and the direct thrombin inhibitor dabigatran. Design: Subgroup analysis of a randomized, controlled trial. (ClinicalTrials. gov registration number: NCT00262600) Setting: Multinational study setting. Patients: 18 112 patients with atrial fibrillation who were receiving oral anticoagulants. Measurements: Baseline CHADS 2 score, which assigns 1 point each for congestive heart failure, hypertension, age 75 years or older, and diabetes mellitus and 2 points for stroke. Results: Distribution of CHADS 2 scores were as follows: 0 to 1-5775 patients; 2-6455 patients; and 3 to 6-5882 patients. Annual rates of the primary outcome of stroke or systemic embolism among all participants were 0.93% in patients with a CHADS 2 score of 0 to 1, 1.22% in those with a score of 2, and 2.24% in those with a score of 3 to 6. Annual rates of other outcomes among all participants with CHADS 2 scores of 0 to 1, 2, and 3 to 6, respectively, were the following: major bleeding, 2.26%, 3.11%, and 4.42%; intracranial bleeding, 0.31%, 0.40%, and 0.61%; and vascular mortality, 1.35%, 2.39%, and 3.68% (P <0.001 for all comparisons). Rates of stroke or systemic embolism, major and intracranial bleeding, and vascular and total mortality each increased in the warfarin and dabigatran groups as CHADS 2 score increased. The rates of stroke or systemic embolism with dabigatran, 150 mg twice daily, and of intracranial bleeding with dabigatran, 150 mg or 110 mg twice daily, were lower than those with warfarin; there was no significant heterogeneity in subgroups defined by CHADS 2 scores. Limitation: These analyses were not prespecified and should be deemed exploratory. Conclusion: Higher CHADS 2 scores were associated with increased risks for stroke or systemic embolism, bleeding, and death in patients with atrial fibrillation receiving oral anticoagulants. Primary Funding Source: Boehringer Ingelheim. Source

Sarganas G.,Charite - Medical University of Berlin | Orzechowski H.D.,Charite - Medical University of Berlin | Klimpel A.,Charite - Medical University of Berlin | Thomae M.,Maria Heimsuchung Caritas Klinik Pankow | And 4 more authors.
Neuro-Oncology | Year: 2012

Glioblastoma multiforme (GBM) is the most frequent malignant brain tumor in adults. Its established first-line adjuvant treatment is radiotherapy in combination with temozolomide (TZM). Hematotoxicity is listed as a frequent adverse drug reaction in the US prescribing information and hepatotoxicity has been reported infrequently in the postmarketing period. We here present the case of a patient diagnosed with GBM who developed severe sustained cholestatic hepatitis following treatment with TZM. The cholestasis was not reversible after withdrawal of TZM during 6 months before the patients death. Another 2 published case reports of sustained cholestasis following TZM treatment were identified; however, the sustained nature of cholestasis was not emphasized in these reports. Sixteen cases of cholestatic hepatitis/cholestasis associated with TZM were identified in the FDA spontaneous reporting system between 2007 and 2010. Information on the course of the cholestasis in these cases could not be retrieved. In the literature there are other published reports of hepatotoxicity associated with TZM that have reported reversibility upon withdrawal of the drug. Thus, TZM appears to cause different types of hepatotoxicity. Particular attention should be paid to sustained cholestasis as a very serious type of TZM-associated liver toxicity. © 2012 The Author(s). Source

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