Carotid artery stenting with filter protection in high-risk patients showing severe electroencephalographic alterations during carotid endarterectomy

Purpose: To describe the results and efficacy of stent treatment in patients with carotid stenosis who had aborted carotid endarterectomy procedures due to the appearance of severe electroencephalographic (EEG) alterations. Methods: A retrospective study was conducted of 18 patients (11 men; mean age 72 years, range 62–84) with symptomatic high-grade carotid artery stenoses ( 70%) who experienced severe EEG alterations during carotid endarterectomy, causing the procedure to be aborted. Twelve patients had shown no hemodynamic alterations during preoperative transcranial Doppler evaluation after external compression of the common carotid artery; the remaining 6 could not be evaluated. The patients were referred for carotid artery stenting (CAS); 7 had contralateral internal carotid artery stenosis and 5 had contralateral occlusion. Endovascular intervention was carried out using standard techniques under filter protection. Follow-up was scheduled at 3, 6, and 12 months. Results: All patients were successfully treated without immediate complications. The EEG did not display any significant alterations during the endovascular procedure. Mean followup was 43 months. Magnetic resonance imaging at 6 months showed no signs of cerebral ischemia. Color Doppler ultrasound imaging documented normal stent patency in all patients. Conclusion: Patients with symptomatic severe carotid stenosis ( 70%) who are considered at risk due to the appearance of severe EEG alterations during surgical treatment may benefit from CAS with respect to both major and minor complications. Larger studies are needed to confirm these findings. J Endovasc Ther 2006;13:451–456 Key words: carotid endarterectomy, carotid artery, stenosis, electroencephalography, cerebral ischemia, carotid angioplasty, sten

Virtual reality implementation as a useful software tool for e-health applications

Human hand and finger movements are of obvious importance. The possibility of recording all fingers joints movements during everyday life is then strategic for medical diagnosis, surgery and post traumatic rehabilitation. A proper presentation of recorded data can be really useful for doctors and therapists to correctly act in the occurrence of peripheral nerve injury, rigidities, camptodactyly (decline in permanent deformity of the interphalangeal junction), orthoses, tenolisi, congenital malformations, trauma, dexterity and/or muscular and/or articulate motility evaluations, thumb atros, syndromes, use of mentors, spasm, use of mechanical supports etc.. According to this context we report a virtual reality implementation on the basis of fingers movements recorded data, suitable for fingers joints movement analysi

Comparison of two different classifiers for mental tasks-based Brain-Computer Interface: MLP Neural Networks vs. Fuzzy Logic

This study is devoted to the classification of fourclass mental tasks data for a Brain-Computer Interface protocol. In such view we adopted Multi Layer Perceptron Neural Network (MLP) and Fuzzy C-means analysis for classifying: left and right hand movement imagination, mental subtraction operation and mental recitation of a nursery rhyme. Five subjects participated to the experiment in two sessions recorded in distinct days. Different parameters were considered for the evaluation of the performances of the two classifiers: accuracy, that is, percentage of correct classifications, training time and size of the training dataset. The results show that even if the accuracies of the two classifiers are quite similar, the MLP classifier needs a smaller training set to reach them with respect to the Fuzzy one. This leads to the preference of MLP for the classification of mental tasks in Brain Computer Interface protocols

Is autonomic nervous system involved in restless legs syndrome during wakefulness?

OBJECTIVE: To investigate cardiovascular autonomic function in patients with restless leg syndrome (RLS) by means of cardiovascular reflexes and heart rate variability (HRV) during wakefulness.METHODS: Twelve RLS patients and 14 controls underwent cardiovascular function tests including head-up tilt test (HUTT), Valsalva maneuver, deep breathing, hand grip, and cold face. HRV analysis was performed in the frequency domain using both autoregressive (AR) and fast Fourier transform algorithms in rest supine condition and during HUTT.RESULTS: There was a significant increase in systolic blood pressure values in supine rest condition and a trend toward a lower Valsalva ratio in RLS patients with respect to controls. The significant and physiological changes of HRV at HUTT detected in healthy subjects were not found in RLS patients. CONCLUSION: RLS patients exhibit a tendency toward hypertension, reduced amplitude of both sympathetic and parasympathetic responses at HUTT, as well as blunted parasympathetic drive to blood pressure changes. These findings, if confirmed by more controlled studies, might support the hypothesis of auonomic nervous system involvement during wakefulness and consequently an enhanced cardiovascular risk in RLS

Coma, alterazioni della coscienza e sonno

Coma - Stato simile al sonno di protratta non responsività dal quale il paziente non può essere risvegliato con appropriati stimoli sensoriali. - E’ la conseguenza di un insulto che interessa in maniera estesa gli emisferi cerebrali e/o la sostanza reticolare attivante. - Le cause del coma sono ascrivibili a problemi di tipo strutturale (traumi, lesioni occupanti spazio, ischemia ed emorragia cerebrale) o non strutturale (cause infettivo-infiammatorie delle meningi e dell’encefalo, encefalopatie tossico-metaboliche, anossia). - Tra un individuo in pieno stato di coscienza ed un paziente in coma profondo esiste un continuum di condizioni nelle quali può essere maggiormente compromesso lo stato di vigilanza, ossia il livello di coscienza piuttosto che il suo contenuto o viceversa

Coma, alterazioni della coscienza e sonno

Coma - Stato simile al sonno di protratta non responsività dal quale il paziente non può essere risvegliato con appropriati stimoli sensoriali. - E’ la conseguenza di un insulto che interessa in maniera estesa gli emisferi cerebrali e/o la sostanza reticolare attivante. - Le cause del coma sono ascrivibili a problemi di tipo strutturale (traumi, lesioni occupanti spazio, ischemia ed emorragia cerebrale) o non strutturale (cause infettivo-infiammatorie delle meningi e dell’encefalo, encefalopatie tossico-metaboliche, anossia). - Tra un individuo in pieno stato di coscienza ed un paziente in coma profondo esiste un continuum di condizioni nelle quali può essere maggiormente compromesso lo stato di vigilanza, ossia il livello di coscienza piuttosto che il suo contenuto o viceversa