Treating patients with 'wake-up' stroke: the experience of the AbESTT-II trial.

Background And Purpose: Approximately 10% to 20% of patients with a new stroke have symptoms present on awakening (wake-up stroke), but these persons are not treated with interventions to restore perfusion because the time of onset is not known. We elected to test the safety and possible efficacy of abciximab in treatment of enrolled subjects with wake-up stroke.

Methods: Abciximab in Emergency Stroke Treatment Trial-II (AbESTT-II) tested the usefulness of abciximab in improving outcomes after acute ischemic stroke and it prospectively tested an intervention in subjects that awakened with their stroke.

Rural-urban differences in acute stroke management practices: a modifiable disparity.

Acute stroke management practices in rural areas of the United States are suboptimal, which creates an unacceptable health disparity between urban patients with stroke and their rural counterparts. The existing gap between urban and rural stroke care may widen in the future as more urban-tested interventions are incorporated into the treatment of acute stroke. We conducted a PubMed search to identify all the articles published from 1997 to 2007 that addressed acute stroke, paramedics, ambulances, emergency services, and interhospital transportation pertaining to the US rural, urban, or nonurban environment.

Prevalence of amblyogenic risk factors in siblings of patients with accommodative esotropia.

Purpose: To prospectively describe the prevalence of amblyogenic risk factors in the siblings of patients with accommodative esotropia.

Methods: We examined 81 proband children with accommodative esotropia and 115 siblings ages 10 years or younger in our clinical practice. Criteria for significant ocular findings in siblings included any of the following: spherical refractive error > or = +3.

Leg-length inequality is not associated with greater trochanteric pain syndrome.

Introduction: Greater trochanteric pain syndrome (GTPS) is a common condition, the pathogenesis of which is incompletely understood. Although leg-length inequality has been suggested as a potential risk factor for GTPS, this widely held assumption has not been tested.

Methods: A cross-sectional analysis of greater trochanteric tenderness to palpation was performed in subjects with complaints of hip pain and no signs of hip osteoarthritis or generalized myofascial tenderness.

Muscle mass is more strongly related to hip bone mineral density than is quadriceps strength or lower activity level in adults over age 50 year.

This cross-sectional study examined whether reduced hip bone mineral density (BMD) is better explained by isokinetic knee extensor strength (KES), lower limb lean body mass (L-LBM), or Physical Activity Scale for the Elderly (PASE). Through population-based recruitment, 1543 adults without knee osteoarthritis were recruited. For men and women respectively, means+/-SD were age 60.

Effect of nitrous oxide on neurologic and neuropsychological function after intracranial aneurysm surgery.

Background: Laboratory studies suggest that nitrous oxide augments brain injury after ischemia or hypoxia. The authors examined the relation between nitrous oxide use and outcomes using data from the Intraoperative Hypothermia for Aneurysm Surgery Trial.

Methods: The Intraoperative Hypothermia for Aneurysm Surgery Trial was a prospective randomized study of the impact of intraoperative hypothermia (temperature = 33 degrees C) versus normothermia (temperature = 36.

Effects of postmenopausal hormone therapy on rheumatoid arthritis: the women's health initiative randomized controlled trials.

Objective: To study the effects of postmenopausal hormone therapy (PHT) on the incidence and severity of rheumatoid arthritis (RA).

Methods: The Women's Health Initiative randomized controlled trials evaluated the effects of unopposed estrogen (E-alone) and estrogen plus progestin (E+P) compared with placebo on a diverse set of health outcomes over 7.1 and 5.

Biomechanical comparison of single- and dual-lead pedicle screws in cadaveric spine.

Object: The pedicle screw (PS) is the cornerstone of spinal instrumentation, and its failure often entails additional surgery. Screw pullout is one of the most common reasons for screw failure, particularly in the elderly population. In this study the authors undertook a biomechanical comparison of the maximum pullout force (MPF) required for single- and dual-lead PSs in cadaver vertebrae.

Emergency administration of abciximab for treatment of patients with acute ischemic stroke: results of an international phase III trial: Abciximab in Emergency Treatment of Stroke Trial (AbESTT-II).

Background And Purpose: A previous randomized, placebo-controlled, double-blind study suggested that abciximab may be safe and effective in treatment of acute ischemic stroke. The current phase 3 study was planned to test the relative efficacy and safety of abciximab in patients with acute ischemic stroke with planned treatment within 5 hours since symptoms onset.

Methods: An international, randomized, placebo-controlled, double-blind phase 3 trial tested intravenous administration of abciximab in 2 study cohorts using stratification variables of time since onset and stroke severity.

In vitro biomechanical comparison of transpedicular versus translaminar C-2 screw fixation in C2-3 instrumentation.

Object: In instrumentation of the upper cervical spine, placement of pedicle screws into C-2 is generally safe, although there is the potential for injury to the vertebral arteries. Owing to this risk, translaminar screws into C-2 have been used. The aim of this study was to compare the stability of the in vitro cadaveric spine using C-2 laminar compared with C-2 pedicle screws in C2-3 instrumentation.

Improving prediction of outcome in "good grade" subarachnoid hemorrhage.

Objective: We hypothesize that subtle neurological signs at baseline could be present in some "good grade" subarachnoid hemorrhage (SAH) patients and that they would have negative prognostic implications.

Methods: We analyzed data from 1000 patients randomized to the Intraoperative Hypothermia for Aneurysm Surgery Trial (World Federation of Neurological Societies Grades I, II, and III). Nine hundred and forty-four patients had a complete National Institutes of Health Stroke Scale (NIHSS) examination performed at baseline.

Correlation of the development of knee pain with enlarging bone marrow lesions on magnetic resonance imaging.

Objective: Results of cross-sectional studies have suggested that bone marrow lesions (BMLs) visualized on magnetic resonance imaging (MRI) are related to knee pain, but no longitudinal studies have been done. This study was undertaken to determine whether enlarging BMLs are associated with new knee pain.

Methods: Subjects ages 50-79 years with knee osteoarthritis (OA) or at high risk of knee OA were asked twice at baseline about the presence of knee pain, aching, or stiffness (classified as frequent knee pain) on most days; absence of knee pain was the baseline eligibility criterion.

Greater trochanteric pain syndrome: epidemiology and associated factors.

Objectives: To describe the prevalence of greater trochanteric pain syndrome (GTPS); to determine whether GTPS is associated with iliotibial band (ITB) tenderness, knee osteoarthritis (OA), body mass index (BMI), or low back pain (LBP); and to assess whether GTPS is associated with reduced hip internal rotation, physical activity, and mobility.

Design: Cross-sectional, population-based study.

Setting: Multicenter observational study.

Effects of a rural trauma system on traumatic brain injuries.

The response of trauma systems in rural areas is uncertain since distances between injury scenes and trauma care are considerable. Timely arrival at definitive care is critical for persons with traumatic brain injury (TBI) since secondary damage can occur during the hours following injury. We evaluated how the implementation of a trauma system in a predominately rural state affected the triage of TBI patients and their risk for mortality.

Is it time for a cardiovascular primary prevention trial in the elderly?

Background And Purpose: Statins have been shown conclusively to reduce the risk of cardiovascular events in subjects with clinical cardiovascular disease or diabetes aged 65 to 80 years of age. However, few data are available for primary prevention of cardiovascular disease in those aged > or =70 years.

Summary Of Review: A moderate-dose statin was of little benefit in a population aged 70 to 82 years when given for 3 years in the setting of suboptimally treated blood pressure.

Nonadherence to depression treatment guidelines among veterans with diabetes mellitus.

Objective: To assess the adequacy of antidepressant dosage and duration among veterans with and without diabetes mellitus (DM), as well as provider-level and patient-level predictors of depression care quality, based on Veterans Health Administration (VHA) evidence-based clinical practice guidelines.

Study Design: Retrospective (1997-2005) cohort study of administrative, clinical, and pharmacy data from a midwestern VHA facility.

Methods: The sample included 2332 subjects (773 with DM) who had a new episode of depression, received antidepressant therapy, and had neither schizophrenia nor bipolar disorder.

Effects of intraoperative hypothermia on neuropsychological outcomes after intracranial aneurysm surgery.

Objective: Subarachnoid hemorrhage and surgical obliteration of ruptured intracranial aneurysms are frequently associated with neurological and neuropsychological abnormalities. We reported that intraoperative cooling did not improve neurological outcome in good-grade surgical subarachnoid hemorrhage patients, as assessed by the Glasgow Outcome Scale score or other neurological and functional measures (National Institutes of Health Stroke Scale, Rankin Disability Scale, Barthel Activities of Daily Living). We now report the results of neuropsychological testing in these patients.

Panic attacks, daily life ischemia, and chest pain in postmenopausal women.

Background: Chest pain is a common symptom of panic attacks, but little is known about the relationship in older women among panic attacks, chest pain, and daily life ischemia.

Methods: The authors conducted a cross-sectional survey of 3063 community-dwelling, generally healthy postmenopausal women enrolled between 1997 and 2000 in the Myocardial Ischemia and Migraine Study in 10 clinical centers of the 40-center Women's Health Initiative. Participants, ages 50 to 79 years, completed a questionnaire about occurrence of panic attacks in the previous 6 months and underwent 24-hour ambulatory electrocardiogram monitoring (AECG); 2705 women had valid AECG recordings and panic attack questionnaires.

Comparison of anterolateral and posterior approaches in the management of thoracolumbar burst fractures.

Object: The authors undertook a retrospective cohort study of patients with T11-L2 thoracolumbar burst fractures who underwent decompression and the placement of instrumentation via the anterolateral or posterior approach.

Methods: There were 63 thoracolumbar burst fractures in 45 male and 18 female patients. The instrumentation was placed posteriorly in 25 patients and anterolaterally in 38.

Physical activity augments bone mineral accrual in young children: The Iowa Bone Development study.

Objectives: This 3-year follow-up study examined associations between physical activity and bone mineral content (BMC) and whether physical activity augments BMC accrual.

Study Design: Participants were 370 children (mean age baseline 5.3 years, follow-up 8.

Effects of conjugated equine estrogen on stroke in the Women's Health Initiative.

Background: The Women's Health Initiative (WHI) Estrogen Alone trial assessed the balance of benefits and risks of hormone use in healthy postmenopausal women. The trial was stopped prematurely because there was no benefit for coronary heart disease and an increased risk of stroke. This report provides a thorough analysis of the stroke finding using the final results from the completed trial database.

Complications after therapeutic trauma laparotomy.

Background: Therapeutic trauma laparotomy (TTL) is a common emergency procedure after traumatic abdominal injury, but it can lead to complications and even death. We explored the role of the time from emergency department (ED) arrival to surgical intervention as a predictor of complications and mortality from TTL.

Study Design: This is a retrospective study of 175 patients receiving TTL between July 1997 and October 2003 in a Level I teaching hospital serving a primarily rural population.

Hospital volume-outcome relationships among medical admissions to ICUs.

Background: Positive relationships between hospital volume and outcomes have been demonstrated for several surgeries and medical conditions. However, little is known about the volume-outcome relationship in patients admitted to medical ICUs.

Objective: To determine the relationship between hospital volume and risk-adjusted in-hospital mortality for patients admitted to ICUs with respiratory, neurologic, and GI disorders.

Vulvar disease: a pelvic floor pain disorder?

Objective: The purpose of this study was to compare the rates of painful bladder syndrome and functional bowel disorders in women with vulvar disease and control subjects.

Study Design: In this cross-sectional survey, a questionnaire that contained validated outcome measures was administered to women who were seeking care in a vulvar disease clinic and in general gynecology clinics.

Results: Women who were seen at a vulvar disease clinic were 2.