Neuroprotective Treatment Strategies for Delayed Cerebral Ischemia after Subarachnoid Hemorrhage – Review of Literature and Future Prospects

This article reviews experimental and clinical data on the use of various neuroprotective agents and therapeutic measures after aneurysmal subarachnoid hemorrhage (SAH). While calcium antagonists have been used in the past and are still part of the standard treatment regimen in most departments involved in the treatment of SAH, other classes of drugs and various other methods have been tested for their potential to inhibit delayed ischemia after SAH. This article reviews the literature about clinical studies about the efficacy of various neuroprotective agents and methods including statins, steroids and Endothelin-antagonists and other - alternative - methods like cisternal lavage, intrathecal drug delivery and hypercapnia, offering future perspectives for the treatment of this hazardous disease

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Die vorliegende Diplomarbeit beschäftigt sich mit Fremdbildern gegenüber sogenannten Heiden im mittelalterlichen Kontext. Im Zuge der Arbeit wurde beforscht, welche Faktoren bei der Fremdmachung eine Rolle spielen, welche literarischen und rhetorischen Strategien zur Fremdmachung verwendet und welche Strategien im Umgang mit den sogenannten Heiden vorgeschlagen werden. Neben einer breiten Kontextualisierung, die die zeitlichen Umstände, Textsorten und Vorstellung bezüglich Heiden bespricht, liegt das Hauptaugenmerk auf der Quellenanalyse. Als Quellenbasis wurden drei Viten ausgewählt, welche um das Jahr 1000 erschienen sind. Im Zuge der Analyse der Quellen und des Vergleichs der Ergebnisse wurde herausgefunden, dass sich die konstruierte Fremdheit bezüglich der Heiden nicht nur auf religiöse Fremdheit stützt, sondern auch andere Aspekte von Bedeutung sind. Neben der Meinung, es handle sich bei den Heiden um Götzendiener, die in puncto Religion unterlegen seien, spielte in den Quellen auch eine kulturelle Überlegenheit der Christen im Vergleich zu den Heiden eine Rolle. Parallel dazu fanden sich auch bei Christen, die negativ und schlecht beschrieben wurden, Elemente des Heidentums, die bei der Konstituierung eines Fremdbilds eine Rolle spielten. Etwaige Unterschiede in den Ausprägungen der Fremdbilder wurden im Zuge der Arbeit analysiert und interpretiert. Weiters wurden die ermittelten Fremdbilder in der Arbeit in einen größeren Kontext der Fremdbilder der betrachteten Zeit eingeordnet. Die Hauptstrategie, die von den Quellen für den Umgang mit Heiden vorgeschlagen wird, ist die Missionierung, weshalb die Missionierung als eine Hauptintention der Quellen vorgeschlagen wurde. Diesbezüglich wurden die Quellen in den jeweiligen Kontext in die Missionspolitik zeitgenössischer Herrscher eingeordnet.This thesis discusses images of the others concerning so called pagans in the medieval context. The research had the goal to show which factors were important in making pagans strange, which rhetoric and literary strategies where used to do that and which strategies are shown when dealing with the pagans. Next to the contextualisation which discusses the historical circumstances, genres of the sources and perceptions concerning pagans, the main focus of the paper is the analysis of primary sources. These sources are three vitas which were written around the year 1000. Through the process of analysing the sources and comparing the results, it was pointed out that the constructed image of the others concerning pagans doesn’t only involve religious strangeness but also other factors. Next to the opinion that pagans would be idolators, which would be inferior concerning religious aspects, the opinion pagans were also culturally inferior becomes evident in the sources. Concerning Christians who are portrayed negatively some elements of paganism are included in the construction of images of the other. Differences between the sources in the manifestation of images of the other were also discussed in the paper. The knowledge concerning the images of the others used in the sources were compared to a greater context of images of the other in that time. The main strategy in coping with the pagans is regarding those sources to proselytize them. Proselytization can be seen as a main intention of the vitas. This factor was integrated in the missionary policy in the time of the origin of the sources

Intraoperative Myelography in Cervical Multilevel Stenosis Using 3D Rotational Fluoroscopy: Assessment of Feasibility and Image Quality

Background. Intraoperative myelography has been reported for decompression control in multilevel lumbar disease. Cervical myelography is technically more challenging. Modern 3D fluoroscopy may provide a new opportunity supplying multiplanar images. This study was performed to determine the feasibility and image quality of intraoperative cervical myelography using a 3D fluoroscope. Methods. The series included 9 patients with multilevel cervical stenosis. After decompression, 10 mL of water-soluble contrast agent was administered via a lumbar drainage and the operating table was tilted. Thereafter, a 3D fluoroscopy scan (O-Arm) was performed and visually evaluated. Findings. The quality of multiplanar images was sufficient to supply information about the presence of residual stenosis. After instrumentation, metal artifacts lowered image quality. In 3 cases, decompression was continued because myelography depicted residual stenosis. In one case, anterior corpectomy was not completed because myelography showed sufficient decompression after 2-level discectomy. Interpretation. Intraoperative myelography using 3D rotational fluoroscopy is useful for the control of surgical decompression in multilevel spinal stenosis providing images comparable to postmyelographic CT. The long duration of contrast delivery into the cervical spine may be solved by preoperative contrast administration. The method is susceptible to metal artifacts and, therefore, should be applied before metal implants are placed

Bone chips, fibrin glue, and osteogeneration following lateral suboccipital craniectomy: a case report

Background Suboccipital craniectomy is a conventional approach for exploring cerebellopontine angle lesions. A variety of techniques have been successfully employed to reconstruct a craniectomy. This is the first report about the histological findings after performing a cranioplasty by using a mixture of autologous bone chips and human allogenic fibrin glue. Case presentation A 53-year-old German woman underwent left lateral suboccipital retrosigmoidal craniectomy for treatment of trigeminal neuralgia in 2008. Cranioplasty was perfomed by using a mixture of autologous bone chips and human allogenic fibrin glue. Due to recurrent neuralgia, a second left lateral suboccipital craniectomy was performed in 2012. The intraoperative findings revealed a complete ossification of the former craniotomy including widely mature trabecular bone tissue in the histological examination. Conclusion A mixture of autologous bone chips and human allogenic fibrin glue seems to provide sufficient bone-regeneration revealed by histological and neuroradiological examinations