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Biomedical subjects

A Raabe

Publications and source records attributed to A Raabe.

At least 19 recordsLinked to original sources
PubMed2006

Active secretion of S100B from astrocytes during metabolic stress.

In patients suffering from cerebrovascular diseases and traumatic brain damage, increases in serum levels of protein S100B are positively correlated with the severity of the insult. Since high concentrations of S100B have been shown to exert neurotoxic effects, the objective of this study was to characterize the regulatory mechanisms underlying control of S100B release from astrocytes. To that end, we analyzed the kinetics and amount of S100B release in correlation with regulation of S100B gene expression in an in vitro ischemia model. Astrocyte cultures were treated with combined oxygen, serum and glucose deprivation, serum and glucose deprivation or hypoxia alone for 6, 12 and 24 h, respectively. While oxygen, serum and glucose deprivation triggered the most rapid release of S100B, serum and glucose deprivation provoked comparable levels of released S100B at the later time points. In contrast to oxygen, serum and glucose deprivation and serum and glucose deprivation, hypoxia alone elicited only marginal increases in secreted S100B. Parallel analysis of extracellular lactate dehydrogenase and the number of viable cells revealed only moderate cell death in the cultures, indicating that S100B was actively secreted during in vitro ischemia. Interestingly, S100B mRNA expression was potently downregulated after 12 and 24 h of oxygen, serum and glucose deprivation, and prolonged oxygen, serum and glucose deprivation for 48 h was associated with a significant reduction of S100B release at later time intervals, whereas lactate dehydrogenase levels remained constant. Our data suggest that secretion of S100B during the glial response to metabolic injury is an early and active process.

Animals↗
PubMed2005

Serum glial fibrillary acidic protein as a biomarker for intracerebral haemorrhage in patients with acute stroke.

BACKGROUND: Biomarkers of stroke are an evolving field of clinical research. A serum marker which can differentiate between haemorrhagic and ischaemic stroke in the very early phase would help to optimise acute stroke management. OBJECTIVE: To examine whether serum glial fibrillary acidic protein (GFAP) identifies intracerebral haemorrhage (ICH) in acute stroke patients. METHODS: A pilot study assessing 135 stroke patients admitted within six hours after symptom onset. Diagnosis of ICH (n = 42) or ischaemic stroke (n = 93) was based on brain imaging. GFAP was determined from venous blood samples obtained immediately after admission, using a research immunoassay. RESULTS: GFAP was detectable in the serum of 39 patients (34 of 42 (81%) with ICH, and five of 93 (5%) with ischaemic stroke). Serum GFAP was substantially raised in patients with ICH (median 11 ng/l, range 0 to 3096 ng/l) compared with patients with ischaemic stroke (median 0 ng/l, range 0 to 14 ng/l, p<0.001). Using receiver operating characteristic curve analysis, a cut off point of 2.9 ng/l provided a sensitivity of 0.79 and a specificity of 0.98 for the identification of ICH in acute stroke (positive predictive value 0.94, negative predictive value 0.91; p<0.001). CONCLUSIONS: Serum GFAP can reliably detect ICH in the acute phase of stroke. Further evaluation of the usefulness of GFAP as an early diagnostic marker of ICH is now required, with the aim of optimising cause specific emergency management.

Aged↗
PubMed2005

Risk stratification models fail to predict hospital costs of cardiac surgery patients.

BACKGROUND: The aim of this prospective study was to determine if commonly used risk stratification models can predict total hospital costs in cardiac surgical patients. METHODS: Between October 1st and December 31st 2003, all consecutive adult patients undergoing cardiac surgery on CPB at our institution were classified using seven risk stratification scoring systems: EuroSCORE, Cleveland, Parsonnet, Ontario, French, Pons, and CABDEAL. Total hospital costs for each patient were calculated on a daily basis including preoperative diagnostic tests, operating room costs, disposable materials, drugs, blood components, costs for personnel, and hospital fixed-costs. Linear regression analysis was used to determine the correlation between costs and the seven risk stratifications models as well as length of stay (LOS) on ICU. The Spearman correlation coefficient was calculated from the regression line, and an analysis of residuals was performed to determine the quality of the regression. RESULTS: A total of 252 patients were operated for CABG (n=175), valve (n=39), CABG plus valve (n=21), thoracic aorta (n=13) and miscellaneous (2 myxoma, 1 ASD, 1 pulmonary embolism). Mean age of the patients was 66.0+/-11.4 years, 29.4% were female. LOS on ICU was 3.3+/-6.3 days and the 30-day mortality rate was 6.7%. Spearman correlation between the seven risk stratification models and hospital costs was below r=0.32 (p=0.0001), but was r=0.94 (p=0.0001) between ICU LOS and costs. CONCLUSIONS: Total hospital costs can be identified by length of ICU stay. None of the common risk stratification models accurately predicted total hospital costs in cardiac surgical patients.

Aged↗
PubMed2005

Technique and image quality of intraoperative indocyanine green angiography during aneurysm surgery using surgical microscope integrated near-infrared video technology.

OBJECTIVE: To describe the technical integration of indocyanine green (ICG) near-infrared technology into the optical path of the surgical microscope and to report on the image quality achieved by this method. We hypothesized that ICG angiography permits a simple and quick intraoperative assessment of vessel patency and aneurysm occlusion after clip placement. METHODS: A special arrangement of filters was designed to allow the passage of near-infrared light required for the excitation of ICG fluorescence (700-850 nm) from a modified microscope light source into the surgical field and the passage of ICG fluorescence (780-950 nm) from the surgical field back into the optical path of the surgical microscope (Carl Zeiss, Oberkochen, Germany). Thus, ICG angiography could be completely performed with a surgical microscope. 20 patients with intracranial aneurysms were included in the technical evaluation of the new method. RESULTS: Image quality and spatial resolution were excellent and permitted a real-time assessment of vessel patency and aneurysm occlusion if the structures of interest were visible to the surgeon's eye under the microscope, including perforating arteries with a diameter of less than 1 millimeter. In 1 patient, vessel occlusion by the clip was found and in 1 case residual filling of the aneurysm was diagnosed. Both cases could be treated by clip correction within 2 minutes after primary placement of the clip. In all cases, the intraoperative findings correlated with the postoperative digital subtraction angiography. CONCLUSIONS: ICG angiography using a surgical microscope is valuable for the intraoperative imaging of arterial and venous flow in all visible vessels including small perforating arteries. The simplicity of the method and the speed with which the investigation can be performed indicate that this technique may help to improve the quality and outcome of surgical procedures and reduce the need for intra- or postoperative angiography in selected cases.

Adult↗
PubMed2005

[Recommendations for the management of patients with aneurysmal subarachnoid hemorrhage].

After SAH, primary and secondary complications are frequent and often require neurosurgical interventions to avoid secondary brain damage. The authors of the present paper have summarized the available data about the treatment modalities often used for patients with SAH. The present recommendations have been developed as a neurosurgical and neuroanestesiological consensus. Evidence from prospective, randomized, double blind, placebo-controlled studies support grade A recommendations (standard) for the prophylaxis and treatment of cerebral vasospasm with oral Nimodipine in good grade patients. For intravenous Nimodipine or for oral nimodipine treatment in poor grade patients, available data only support grade C recommendations (options). Despite the lack of data supporting standards (grade A) or guidelines (grade B), avoidance and rigorous treatment of hypotension and hypovolemia remains the mainstay in the prophylaxis and treatment of a delayed ischemic neurological deficit (DIND). Prophylactic hypervolemia or prophylactic hypertension and hypervolemia was shown to be ineffective in reducing symptomatic vasospasm and improving outcome (grade B). Therapeutic hypertensive hypervolemic hemodilution is recommended as a treatment of symptomatic vasospasm but no prospective studies are available (grade C recommendation). Suggested target values for moderate triple-H-therapy are CPP 80- 120 mmHg (MAP 90-130), CVP > 7 mmHg and Hk 0.25-0.40. Balloon angioplasty should be considered for treatment of DIND cause by focal, proximal cerebral vasospasm. There is no evidence supporting the routine use of antifibrinolyticals, steroids or anticonvulsive prophylaxis. Clinical data indicate that current prophylaxis and treatment of cerebral vasospasm is still insufficient and aggressive triple-H-therapy is associated with an increased incidence of complications.

Angioplasty, Balloon↗
PubMed2004

Robot-assisted navigated endoscopic ventriculostomy: implementation of a new technology and first clinical results.

BACKGROUND: Important landmarks in the evolution of advanced neurosurgical techniques during the past decades include microneurosurgery, neuro-endoscopy and its minimally invasive nature, as well as neuronavigation and advanced intra-operative imaging. With conventional neuroendoscopic techniques, e.g. free-hand endoscopy or the use of mechanical or pneumatic holding devices, a definitive and controlled movement of the endoscope within the brain does depend on the experience and manual skill of the individual neurosurgeon. Therefore, the development of robotic systems to assist surgeons in performing complex neurosurgical procedures is a growing field of interest. METHOD: With the precision robot "Evolution 1" (U.R.S. Universal Robot Systems, Schwerin, Germany) a new neurosurgical tool has just become available for the precise steering of instruments within the cranium. After preclinical anatomical as well as precision studies the system was used for robot-assisted navigated endoscopic third ventriculostomies in six patients with hydrocephalus related to aqueductal stenosis. FINDINGS: All robot-assisted navigated endoscopic procedures were successfully completed. The time for the registration procedure and setup of the robot decreased from 60 min. for the first procedure down to 30 min. The time for the surgical part of the neuro-endoscopic procedure itself ranged from 17 to 35 min. During all procedures no system-related complications occurred. INTERPRETATION: The use of robotic technology for neuro-endoscopic third ventriculostomies is a major step towards the controlled movement of the neuro-endoscope within the cranium. The start up procedure and calibration of the robot is still time consuming, but the real operation time is comparable to free hand neuro-endoscopy. The steering of the endoscope is facilitated and the precision of the endoscopic movements is noteworthy.

Adolescent↗
PubMed2004

Severe delayed diffuse cerebral vasospasm and cerebral infarctions following spinal subdural hemorrhage.

BACKGROUND: We report a rare case of severe delayed cerebral vasospasm with cerebral infarctions after spinal subdural hemorrhage. CASE REPORT: A 56-year-old woman presented with an acute onset of paraplegia. MR-imaging revealed an extensive intraspinal hemorrhage reaching from T1 to L1. The hematoma was evacuated via a T8-laminectomy. At the 7th postoperative day the patient developed visual disturbances. MR-scanning revealed extensive infarctions and cerebral angiography showed severe diffuse vasospasms. INTERPRETATION: This case demonstrates that cerebral vasospasm may be caused by a spinal subdural hemorrhage, supporting the hypothesis that cerebral vasospasm may be triggered by factors from a remote site and that a direct contact of blood clots with the vessel is not mandatory.

Cerebral Infarction↗
PubMed2004

Time benefit in the assessment of recurrences following fractionated radiotherapy in an experimental tumour system using positron-emission tomography with 18F-fluorodeoxyglucose.

PURPOSE: To determine the sensitivity and specificity of 18F-fluorodeoxyglucose-positron-emission tomography (FDG-PET) in the diagnosis of R1H tumours after fractionated radiotherapy, and the dependency of sensitivity and specificity on time after therapy. In addition, the time benefit of FDG-PET concerning early recognition of recurrences after fractionated radiotherapy was assessed. MATERIAL AND METHODS: Subcutaneously growing rat rhabdomyosarcoma R1H tumours were irradiated by applying total doses of 80 or 85 Gy after reaching a start volume of 0.8 cm3. Twenty animals were treated. Tumour volume was determined twice a week. FDG-PET was performed weekly before, during and for 6 months after therapy using a conventional full-ring whole-body PET scanner. In total, 600 PET results were evaluated qualitatively using a six-scale score. PET results and actual tumour volumes were compared. The sensitivity and specificity of tumour detection by PET was calculated for different times after the onset of therapy. The optimal score for tumour detection and the influence of time after therapy on the quality of PET (time benefit) was evaluated using receiver-operating characteristics. RESULTS: After irradiation, 8/20 tumours (40%) were locally controlled, while 12/20 recurred. In this tumour model, evidence of relapse is assured when a volume of 0.1 cm3 is reached. Sensitivity of tumour diagnosis by PET increases with time, i.e. with the volume of recurrent tumours after the onset of therapy, mounting to > 0.95 after 100 days. Specificities of 0.95-1.0 were determined after therapy, showing no increase with time. Tumour diagnosis by PET is highly accurate when performed 80 days after the start of treatment. On average, tumours were recognized by PET on 31, 62, 74 and 81 days (median) before approaching volumes of 0.2, 0.5, 0.8 or 1.0 cm3, respectively. CONCLUSION: An experimental system was implemented that allows reproducible detection of recurrent R1H tumours after radiotherapy using FDG-PET. The usefulness of PET as a diagnostic test for R1H tumours is very good and a reliable resolution for PET is demonstrated for volumes < 1 cm3. The results indicate that FDG-PET enables early recognition of recurrences after fractionated radiotherapy.

Animals↗
PubMed2004

Tissue at risk concept for endovascular treatment of severe vasospasm after aneurysmal subarachnoid haemorrhage.

OBJECTIVE: To report a case of severe vasospasm after subarachnoid haemorrhage (SAH) where "tissue at risk" was identified by magnetic resonance imaging (MRI), and to demonstrate the haemodynamic consequences with either resolution of the perfusion-diffusion mismatch by balloon angioplasty or evolution of an infarct. METHODS: A 45 year old women with SAH underwent surgical treatment of a ruptured middle cerebral artery (MCA) aneurysm. On day 3 she became obtunded and developed a right hemiparesis. Diffusion weighted (DWI) and perfusion weighted (PWI) imaging were done before and after transluminal balloon angioplasty (TBA) of multifocal proximal vasospasm. RESULTS: The initial MRI revealed no DWI lesion but PWI showed a severe perfusion deficit of 6.7 to 16.4 seconds in the complete left MCA territory. Digital subtraction angiography confirmed severe segmental narrowing of left C1 and M1. The spastic segments were successfully dilated by TBA. Follow up MRI showed that the PWI-DWI mismatch resolved in the anterior and middle MCA territory with no tissue infarction, whereas in the terminal dorsal MCA territory a severe mismatch remained and cerebral infarction evolved. CONCLUSIONS: PWI/DWI can identify tissue at risk for infarction in severe vasospasm following SAH. This may allow selection of patients for angioplasty and the monitoring of treatment effects.

Angioplasty, Balloon↗
PubMed2003

Conservative (labyrinth-preserving) transpetrosal approach to the clivus and petroclival region--indications, complications, results and lessons learned.

OBJECTIVE: Tumours or vascular lesions of the clivus and juxtaclival region present a unique challenge to neurosurgeons and a variety of techniques, with a wide spectrum of complexity, have been advocated. This report presents the use of a conservative transpetrosal approach which combines partial removal of the postero-lateral petrous bone with preservation of the labyrinth, with particular focus on efficacy and the reduction of complications. PATIENTS AND METHODS: Over 9 years, 52 patients underwent a conservative combined supra-infratentorial, labyrinth-preserving transpetrosal approach. There were 32 women and 20 men; 33 had tumour lesions including 22 patients with a clival or petroclival meningioma. Among the 19 patients with a vascular lesion, 12 patients had a basilar artery trunk aneurysm, including one giant midbasilar aneurysm. 3 Patients had vertebro-basilar junction aneurysms, and 4 patients had a pontine cavernoma. Data on the clinical features, investigations and operative techniques were extracted from the patient's case records. Outcome was assessed by serial examinations of the patients or by telephone interview with the treating physician, and in survivors graded as excellent, good or poor. RESULTS: 52 patients, 23 patients (44%) had an excellent outcome, in 21 patients (41%) the outcome was good and in 7 patients (13%) the outcome was poor. One patient with a complex fusiform basilar trunk aneurysm, operated upon as an emergency, died in the postoperative period. Total resection was achieved, as demonstrated by follow-up MRI in 20 of 33 patients with a tumour, including 15 of 22 patients with clival or petro-clival meningiomas. All vascular lesions were treated effectively and in 14 patients with a basilar or vertebro-basilar junction aneurysm, clipping of the aneurysm was achieved. In one patient, a giant calcified vertebro-basilar junction aneurysm was resected. New cranial nerve deficits or an accentuation of a pre-existing deficit, occurred in 8 patients with a tumour and 4 patients with a vascular lesion. Complications included: temporary conductive hearing deficit in 4 patients, a minor laceration of the sigmoid/transverse sinus in 4 and transient post-operative CSF leakage in 12 patients. Temporary lumbar drainage resulted in sealing of the CSF leak in 8 patients, but in 3 patients a permanent ventriculo-peritoneal shunt had to be implanted. CONCLUSION: When based on adequate experience in skull base surgery, the combined supra-infratentorial, conservative transpetrosal approach, with preservation of the labyrinth, allows direct and wide exposure of a large variety of tumour and vascular lesions located along the supra- and infratentorial juxta-clival area; little or almost no retraction of neurovascular structures is needed and with adherence to important principles, complications related to the approach can be minimised.

Adult↗
PubMed2003

Difference in configuration of ruptured and unruptured intracranial aneurysms determined by biplanar digital subtraction angiography.

There is an ongoing discussion about the risk of bleeding from unruptured intracranial aneurysms. Management guidelines were developed recently and some of the recommendations for decision making are based on the anatomical configuration of the aneurysm. The common assumption is that the presence of multiple lobes or a daughter sac indicates a higher risk of rupture. We have investigated the anatomical configuration of ruptured and unruptured intracranial aneurysms using biplanar digital subtraction angiography (DSA). The objective was to determine, whether there was a difference between ruptured and unruptured aneurysms regarding lobulation, the presence of a daughter sac or the shape as measured by the height/neck ratio. Biplanar DSA images of 124 patients were retrospectively analyzed. A total of 53 unruptured and 94 ruptured aneurysms were found (=147 aneurysms in total). Aneurysms of less than 10 mm diameter accounted for 82% of all aneurysms. Overall, 10% of unruptured aneurysm showed a multilobular appearance on DSA compared with 20% of ruptured aneurysms (Fisher's exact test, p=0.10). In the 5-9 mm aneurysm group, multiple lobes were found significantly more frequent in ruptured aneurysms (26% vs. 4%, Fisher's exact test, p<0.05). A height/neck ratio of less than 1.5 was not found in unruptured aneurysms (0/26) but in 21% (12/57) of ruptured aneurysms (p<0.05). Our data provide scientific support for using morphological features for the decision making process in the management of unruptured intracranial aneurysms. An irregular multilobar appearance was significantly more common in aneurysms of 5-9 mm size that ruptured.

Aneurysm, Ruptured↗
PubMed2003

[Frame-less and frame-based stereotaxy? How to choose the appropriate procedure].

In recent years, additional tools for image guided surgery have been developed. Devices are now available for frameless punction and biopsy of intracerebral lesions and the indications for frameless and frame-based stereotaxy are increasingly overlapping. The objective of our paper was to analyse the most important factors that influence the decision on when to use frameless and when frame-based stereotaxy. Criteria such as application accuracy, image information and ergonomics were investigated for different lesions. Frameless and frame-based stereotaxy are complementary systems with different indications. They are different in terms of image information and ergonomics. Image guided surgery is the standard for continuous 3-dimensional topographical orientation. With high quality images (1 mm slice thickness) and bone marker registration, frameless stereotaxy may achieve an application accuracy comparable to frame-based systems. However, when using adhaesively mounted skin fiducials for patient registration, frameless stereotaxy is less accurate than framebased systems. Therefore, the size of the lesion should exceed 10 mm for punction and biopsy with a frameless system. Frame-based stereotaxy remains the gold standard for accurate targeting of lesions < 10 mm and for functional procedures.

Ergonomics↗
PubMed2003

German Society of Neurosurgery Section on Vascular Neurosurgery: Position Statement on the International Subarachnoid Hemorrhage Trial (ISAT).

The outcome after a specific treatment (clipping or coiling) of ruptured intracranial aneurysms is determined by both the periprocedural complication rate and the success of preventing re-bleeding from the treated aneurysm. The latter is associated with a cumulative risk over many years, particularly in incompletely treated aneurysms. Incomplete occlusion of the aneurysm is not infrequently seen after endovascular coiling, even in cases with a perfect anatomical configuration. Therefore, we believe that the 1-year outcome as reported in the ISAT is not an appropriate endpoint for the comparison of both methods. There has also been a tendency to apply the 1-year ISAT data to all patients harbouring intracranial aneurysms. It is inappropriate and dangerous to be less critical when selecting the endovascular approach as the method of choice for treating an aneurysm. This will ultimately result in a higher complication rate of coiling. Another striking finding is the poor surgical outcome in the ISAT. This good-grade patient population (94 % were WFNS grade 1-3 and 89 % were WFNS grade 1-2) had an almost 10 % higher rate of poor outcome compared to other good-grade patients in large prospective surgical studies or the same outcome as trials that included up to 20 % poor-grade patients.[nl]Neurosurgeons should acknowledge that endovascular coiling is a safe method associated with less complications than clipping in experienced hands (Fig. ). Endovascular radiologists should acknowledge that the success of complete obliteration is higher after surgery, that incompletely occluded aneurysms have a higher rate of re-rupture and that the definitive long-term re-rupture rate still remains unknown. Therefore, we await with interest the angiographic and clinical follow-up data that will provide evidence about the final patient outcome.

Germany↗
PubMed2002

Palliative occipito-cervical stabilization in patients with malignant tumors of the occipito-cervical junction and the upper cervical spine.

BACKGROUND: Occipital-cervical stability may be impaired in patients with primary malignant or metastatic tumors of the cranio-cervical junction and the upper cervical spine. The purpose of this study was to evaluate occipital-cervical fixation with pre-bent titanium-loops and sublaminar wiring in order to achieve a rigid and safe stabilisation of the occipito-cervical region in this group of patients. METHOD: 20 patients with severe impairment of occipito-cervical stability due to primary malignant or metastatic cervical bone involvement were included in this study. For palliation of symptoms, resulting from destructive instability, a stabilization procedure using Ransford Loops with sublaminar cable fixation was used in these patients as a palliative therapeutic concept. FINDINGS: Pain which was the major symptom in all patients treated, showed good and immediate response to the stabilization procedures. All 20 patients were either pain free or had good improvement with less intake of analgesic drugs. Signs of spinal cord compression like spasticity and quadraparesis were less likely to improve after surgery. However in 3 of 5 patients neurological function improved after surgery whereas in 2 patients no improvement was achieved. INTERPRETATION: In all patients with impaired occipito-cervical stability due to primary malignant or metastatic tumors of the occipito-cervical junction and the upper cervical spine, immediate stabilization resulting in an improvement of pain was achieved. Occipito-cervical stabilization using contoured Ransford loops is a promising palliative therapeutic concept in this group of patients.

Adult↗
PubMed2002

Effect of endothelin-converting enzyme inhibitors on big endothelin-1 induced contraction in isolated rat basilar artery.

INTRODUCTION: The aim of this study was to investigate whether blocking functional endothelin-converting enzyme (ECE) activity may offer a new approach to inhibit the development of cerebral vasopasm after subarachnoid hemorrhage (SAH) by preventing transformation of big Endothelin-1 (big ET-1) to vasoactive Endothelin-1 (ET-1). METHODS: In vitro, the effect of potential ECE inhibitors was determined by measurement of isometric contractions, induced by big ET-1, in isolated rat basilar arteries. Endothelium intact (E+) and de-endothelialized (E-) segments were examined after pre-incubated with the putative ECE inhibitors: Phosphoramidon (10(-4) M), Captopril (10(-3) M and 10(-4) M) and [(22)D-Val] big ET-1 (16-38) (10(-5) M and 10(-6) M). RESULTS: Application of 10(-4) M Phosphoramidon resulted in a statistically significant decrease in big ET-1 induced contraction in endothelium intact (E+) and de-endothelialized (E-) segments; 10(-3) M Captopril in E- segments caused a statistically significant inhibitory effect; 10(-4) M and 10(-3) M Captopril in E+ segments showed no statistically significant effect; 10(-5) M and 10(-6) M [(22)D-Val] big ET-1 (16-38) in E- segments produced no statistically significant effect. The application of 10(-6) M [(22)D-Val] big ET-1 (16-38) in E+ segments caused increased contractions as shown by the shift to the left of the concentration-effect curve (CEC). CONCLUSION: The present study indicates the existence of functional ECE activity in rat basilar artery, which is different in the endothelium and the smooth muscle layer. This ECE-activity could be inhibited by Captopril and Phosporamidon, suggesting a potency for prevention and therapy of cerebral vasospasm. However, the structural analogue of big ET-1, [(22)D-Val] big ET-1 (16-38), was ineffective in reducing big ET-1 induced vasoconstriction and rather increased contraction in E+ vessels. Therefore further studies of the biochemical nature of the functional relevant cerebrovascular ECE activity are required for better understanding and development of other efficient ECE inhibitors.

Animals↗
PubMed2002

Stimulus-induced craving and startle potentiation in abstinent alcoholics and controls.

Abstinent alcoholics often deny craving for alcohol but still show a high level of relapse. The eyeblink response to startling noise was used as an indicator of the emotional response to alcohol-related, positive, negative and neutral visual stimuli in abstinent alcoholics, social drinkers and rarely drinking controls. The cognitive evaluation of the stimuli was assessed by ratings of subjective craving, valence and arousal. The startle response of the alcoholics to alcohol-related stimuli was significantly inhibited despite an aversive overt stimulus-evaluation. These findings indicate that alcohol-related stimuli may have appetitive incentive salience for alcoholics in spite of verbal reports of craving and valence to the opposite.

Acoustic Stimulation↗
PubMed2002

[Recommendations for the management of unruptured intracranial aneurysms].

Optimal management of patients with unruptured intracranial aneurysms (UIAs) remains controversial. Recent studies have found conflicting data regarding the natural history and the treatment outcome of UIAs. Based on the recommendations published by the American Heart Association, the Section of Vascular Neurosurgery of the German Society of Neurosurgery has formed a task force to summarize the available data and to develop a practical framework for the management of UIAs. For UIAs, only evidence from nonrandomized historical cohort comparisons and case series without control subjects are available, supporting only grade C recommendations (options), but no standards (grade A) and no guidelines (grade B). The present recommendations have been developed as a neurosurgical, neuroradiological and neurological consensus. They are based on the existing data of both treatment risks and the risks of the natural history of UIAs.

Autoradiography↗