Background Spontaneous supratentorial intracerebral haemorrhage accounts for 20% of all stroke- related sudden neurological deficits, has the highest morbidity and mortality of all stroke, and the role of surgery rema...Background Spontaneous supratentorial intracerebral haemorrhage accounts for 20% of all stroke- related sudden neurological deficits, has the highest morbidity and mortality of all stroke, and the role of surgery remains controversial. We undertook a prospective randomised trial to compare early surgery with initial conservative treatment for patients with intracerebral haemorrhage. Methods A parallel- group trial design was used. Early surgery combined haematoma evacuation (within 24 h of randomisation) with medical treatment. Initial conservative treatment used medical treatment, although later evacuation was allowed if necessary. We used the eight- point Glasgow outcome scale obtained by postal questionnaires sent directly to patients at 6 months follow- up as the primary outcome measure. We divided the patients into good and poor prognosis groups on the basis of their clinical status at randomisation. For the good prognosis group, a favourable outcome was defined as good recovery or moderate disability on the Glasgow outcome scale. For the poor prognosis group, a favourable outcome also included the upper level of severe disability. Analysis was by intention to treat. Findings 1033 patients from 83 centres in 27 countries were randomised to early surgery (503) or initial conservative treatment (530). At 6 months, 51 patients were lost to follow- up, and 17 were alive with unknown status. Of 468 patients randomised to early surgery, 122 (26% ) had a favourable outcome compared with 118 (24% ) of 496 randomised to initial conservative treatment (odds ratio 0.89 [95% CI 0.66- 1.19], p=0.414); absolute benefit 2.3% (- 3.2to 7.7), relative benefit 10% (- 13 to 33). Interpretation Patients with spontaneous supratentorial intracerebral haemorrhage in neurosurgical units show no overall benefit from early surgery when compared with initial conservative treatment.展开更多
Eighteen patients underwent stenting for symptomatic basilar artery stenosis. There were three major periprocedural complications(16.7%) without fatality. At a mean 26.7 ±12.1-month follow-up, 15 patients (83.3%)...Eighteen patients underwent stenting for symptomatic basilar artery stenosis. There were three major periprocedural complications(16.7%) without fatality. At a mean 26.7 ±12.1-month follow-up, 15 patients (83.3%) had an excellent lon g-term outcome.Only one patient (5.6%) had moderate disability from recurrent stroke, and two patients died of medical illness at 30 and 36 months after stent ing. In this uncontrolled study,stenting appeared to be effective in reducing st roke risk and death and worthy of further scrupulous trial.展开更多
BACKGROUND: Hypothermia is protective against brain injury after asphyxiation in animal models. However, the safety and effectiveness of hypothermia in term infants with encephalopathy is uncertain. METHODS: We conduc...BACKGROUND: Hypothermia is protective against brain injury after asphyxiation in animal models. However, the safety and effectiveness of hypothermia in term infants with encephalopathy is uncertain. METHODS: We conducted a randomized trial of hypothermia in infants with a gestational age of at least 36 weeks who were admitted to the hospital at or before six hours of age with either severe acidosis or perinatal complications and resuscitation at birth and who had moderate or severe encephalopathy. Infants were randomly assigned to usual care (control group) or whole-body cooling to an esophageal temperature of 33.5° C for 72 hours, followed by slow rewarming (hypothermia group). Neurodevelopmental outcome was assessed at 18 to 22 months of age. The primary outcome was a combined end point of death or moderate or severe disability. RESULTS: Of 239 eligible infants, 102 were assigned to the hypothermia group and 106 to the control group. Adverse events were similar in the two groups during the 72 hours of cooling. Primary outcome data were available for 205 infants. Death or moderate or severe disability occurred in 45 of 102 infants (44 percent) in the hypothermia group and 64 of 103 infants (62 percent) in the control group (risk ratio, 0.72; 95 percent confidence interval, 0.54 to 0.95; P=0.01). Twenty-four infants (24 percent) in the hypothermia group and 38 (37 percent) in the control group died (risk ratio, 0.68; 95 percent confidence interval, 0.44 to 1.05; P=0.08). There was no increase in major disability among survivors; the rate of cerebral palsy was 15 of 77 (19 percent) in the hypothermia group as compared with 19 of 64 (30 percent) in the control group (risk ratio, 0.68; 95 percent confidence interval, 0.38 to 1.22; P=0.20). CONCLUSIONS: Wholebody hypothermia reduces the risk of death or disability in infants with moderate or severe hypoxic-ischemic encephalopathy.展开更多
文摘Background Spontaneous supratentorial intracerebral haemorrhage accounts for 20% of all stroke- related sudden neurological deficits, has the highest morbidity and mortality of all stroke, and the role of surgery remains controversial. We undertook a prospective randomised trial to compare early surgery with initial conservative treatment for patients with intracerebral haemorrhage. Methods A parallel- group trial design was used. Early surgery combined haematoma evacuation (within 24 h of randomisation) with medical treatment. Initial conservative treatment used medical treatment, although later evacuation was allowed if necessary. We used the eight- point Glasgow outcome scale obtained by postal questionnaires sent directly to patients at 6 months follow- up as the primary outcome measure. We divided the patients into good and poor prognosis groups on the basis of their clinical status at randomisation. For the good prognosis group, a favourable outcome was defined as good recovery or moderate disability on the Glasgow outcome scale. For the poor prognosis group, a favourable outcome also included the upper level of severe disability. Analysis was by intention to treat. Findings 1033 patients from 83 centres in 27 countries were randomised to early surgery (503) or initial conservative treatment (530). At 6 months, 51 patients were lost to follow- up, and 17 were alive with unknown status. Of 468 patients randomised to early surgery, 122 (26% ) had a favourable outcome compared with 118 (24% ) of 496 randomised to initial conservative treatment (odds ratio 0.89 [95% CI 0.66- 1.19], p=0.414); absolute benefit 2.3% (- 3.2to 7.7), relative benefit 10% (- 13 to 33). Interpretation Patients with spontaneous supratentorial intracerebral haemorrhage in neurosurgical units show no overall benefit from early surgery when compared with initial conservative treatment.
文摘Eighteen patients underwent stenting for symptomatic basilar artery stenosis. There were three major periprocedural complications(16.7%) without fatality. At a mean 26.7 ±12.1-month follow-up, 15 patients (83.3%) had an excellent lon g-term outcome.Only one patient (5.6%) had moderate disability from recurrent stroke, and two patients died of medical illness at 30 and 36 months after stent ing. In this uncontrolled study,stenting appeared to be effective in reducing st roke risk and death and worthy of further scrupulous trial.
文摘BACKGROUND: Hypothermia is protective against brain injury after asphyxiation in animal models. However, the safety and effectiveness of hypothermia in term infants with encephalopathy is uncertain. METHODS: We conducted a randomized trial of hypothermia in infants with a gestational age of at least 36 weeks who were admitted to the hospital at or before six hours of age with either severe acidosis or perinatal complications and resuscitation at birth and who had moderate or severe encephalopathy. Infants were randomly assigned to usual care (control group) or whole-body cooling to an esophageal temperature of 33.5° C for 72 hours, followed by slow rewarming (hypothermia group). Neurodevelopmental outcome was assessed at 18 to 22 months of age. The primary outcome was a combined end point of death or moderate or severe disability. RESULTS: Of 239 eligible infants, 102 were assigned to the hypothermia group and 106 to the control group. Adverse events were similar in the two groups during the 72 hours of cooling. Primary outcome data were available for 205 infants. Death or moderate or severe disability occurred in 45 of 102 infants (44 percent) in the hypothermia group and 64 of 103 infants (62 percent) in the control group (risk ratio, 0.72; 95 percent confidence interval, 0.54 to 0.95; P=0.01). Twenty-four infants (24 percent) in the hypothermia group and 38 (37 percent) in the control group died (risk ratio, 0.68; 95 percent confidence interval, 0.44 to 1.05; P=0.08). There was no increase in major disability among survivors; the rate of cerebral palsy was 15 of 77 (19 percent) in the hypothermia group as compared with 19 of 64 (30 percent) in the control group (risk ratio, 0.68; 95 percent confidence interval, 0.38 to 1.22; P=0.20). CONCLUSIONS: Wholebody hypothermia reduces the risk of death or disability in infants with moderate or severe hypoxic-ischemic encephalopathy.
