Chelsea Kidwell, Patrick D. Lyden, Lewis B. Morgenstern, Adnan I. Qureshi, Robert Brass, Anthony Furlan, Robert L. Grubb, Randall T. Higashida, Edward C. Jauch, Harold P. Adams, Jr, Gregory del Zoppo, Mark J. Alberts, Deepak L. Bhatt, Lawrence Guidelines for the Early Management of Adults With Ischemic Stroke : ISSN: 1524-4628 Copyright © 2007 American Heart Association. All rights reserved. Print ISSN: 0039-2499. Online Stroke is published by the American Heart Association. 7272 Greenville Avenue, Dallas, TX 72514 doi: 10.1161/STROKEAHA.107.181486 2007, 38:1655-1711: originally published online April 12, 2007 Stroke http://stroke.ahajournals.org/content/38/5/1655 located on the World Wide Web at: The online version of this article, along with updated information and services, is http://stroke.ahajournals.org/ http://stroke.ahajournals.org/ An erratum has been published regarding this article. Please see the attached page for:

/pdf/guidelines-for-the-early-management-of-adults-with-ischemic-3dcmwodyff.pdf

Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology

Purpose— Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included. Methods— Members of the panel were appointed by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee and represented different areas of expertise. The panel reviewed the relevant literature with an emphasis on reports published since 2003 and used the American Heart Association Stroke Council’s Levels of Evidence grading algorithm to rate the evidence and to make recommendations. After approval of the statement by the panel, it underwent peer review and approval by the American Heart Association Science Advisory and Coordinating Committee. It is intended that this guideline be fully updated in 3 years. Results— Managem...

/pdf/guidelines-for-the-early-management-of-adults-with-ischemic-16k5yjn0ic.pdf

Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists

Importance Cannabis and cannabinoid drugs are widely used to treat disease or alleviate symptoms, but their efficacy for specific indications is not clear. Objective To conduct a systematic review of the benefits and adverse events (AEs) of cannabinoids. Data Sources Twenty-eight databases from inception to April 2015. Study Selection Randomized clinical trials of cannabinoids for the following indications: nausea and vomiting due to chemotherapy, appetite stimulation in HIV/AIDS, chronic pain, spasticity due to multiple sclerosis or paraplegia, depression, anxiety disorder, sleep disorder, psychosis, glaucoma, or Tourette syndrome. Data Extraction and Synthesis Study quality was assessed using the Cochrane risk of bias tool. All review stages were conducted independently by 2 reviewers. Where possible, data were pooled using random-effects meta-analysis. Main Outcomes and Measures Patient-relevant/disease-specific outcomes, activities of daily living, quality of life, global impression of change, and AEs. Results A total of 79 trials (6462 participants) were included; 4 were judged at low risk of bias. Most trials showed improvement in symptoms associated with cannabinoids but these associations did not reach statistical significance in all trials. Compared with placebo, cannabinoids were associated with a greater average number of patients showing a complete nausea and vomiting response (47% vs 20%; odds ratio [OR], 3.82 [95% CI, 1.55-9.42]; 3 trials), reduction in pain (37% vs 31%; OR, 1.41 [95% CI, 0.99-2.00]; 8 trials), a greater average reduction in numerical rating scale pain assessment (on a 0-10-point scale; weighted mean difference [WMD], −0.46 [95% CI, −0.80 to −0.11]; 6 trials), and average reduction in the Ashworth spasticity scale (WMD, −0.12 [95% CI, −0.24 to 0.01]; 5 trials). There was an increased risk of short-term AEs with cannabinoids, including serious AEs. Common AEs included dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination. Conclusions and Relevance There was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity. There was low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV infection, sleep disorders, and Tourette syndrome. Cannabinoids were associated with an increased risk of short-term AEs.

/pdf/cannabinoids-for-medical-use-a-systematic-review-and-meta-2sf620jl57.pdf

Cannabinoids for Medical Use: A Systematic Review and Meta-analysis.

https://www.srcv.ro/ghiduri/Managementul%20pacientilor%20cu%20boala%20venoasa%20cronica%20-%20Ghidurile%20SVS%20-%20American%20Venous%20Forum.pdf

The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum

Placebo

https://www.jvascsurg.org/article/S0741-5214(07)01896-4/pdf

High ligation combined with stripping and endovenous laser ablation of the great saphenous vein: Early results of a randomized controlled study

RATIONALE: Ziel der Studie war die Uberprufung der Wirksamkeit und Sinnhaftigkeit einer Add-On-Therapie mit dem synthetischen Cannabinomimetikum Nabilone bei Patienten mit chronischen Schmerzzustanden. Dabei standen die Evaluierung des Therapieeinflusses auf Schmerzzustand und Lebensqualitat sowie die subjektive Abwagung von Wirkungen und Nebenwirkungen durch die Studienteilnehmer im Vordergrund. METHODEN: Die Placebo-kontrollierte doppelblinde Pilotstudie gliederte sich in einen 14-wochigen Cross-Over-Abschnitt (2-mal 4-wochige Medikationsphasen plus Wash-Out-Phasen) und einen anschliesenden 16-wochigen Medikations-Switch-Abschnitt mit freier Wahl der als Praparat A und Praparat B bekannten Prufmedikation durch die Studienteilnehmer. Vorrangiges Einschlusskriterium waren chronische therapierefraktare Schmerzzustande in kausalem Zusammenhang mit pathologischen Zustanden des Stutz- und Bewegungsapparates. Die Studienteilnehmer bestimmten die Prufpraparat-Dosierung (zwischen 1 und 4 Kapseln/Tag, entspricht bei Nabilone ¼–1 mg/Tag) selbst. Schmerzintensitaten wurden mittels einer visuellen Analogskala (VAS), die Lebensqualitat mittels des QOL-Scores von Mezzich & Cohen erhoben. ERGEBNISSE: Insgesamt wurden 30 Patienten in die Studie aufgenommen und ausgewertet. Die Ergebnisse zeigten im Cross-Over-Abschnitt durchwegs Vorteile der Nabilone-Therapie (Mediane [Quartile]: Nabilone/Placebo): Verringerung der durchschnittlichen Wirbelsaulen (WS)-Schmerzintensitat in den letzten 4 Wochen (ΔVAS) 0,9 [0,0; 2,0] / 0,5 [0,0; 1,7], Verringerung der aktuellen WS-Schmerzintensitat (ΔVAS) 0,6 [0,0; 2,5] / 0,0 [−1,0; 1,0] (p = 0,006), Verringerung der durchschnittlichen Kopfschmerzintensitat in den letzten 4 Wochen (ΔVAS) 1,0 [−1,0; 2,4] / 0,2 [−0,9; 1,0], Erhohung der Anzahl an kopfschmerzfreien Tagen in den letzten 4 Wochen 2,0 [0,0; 6,5] / 0,0 [−5,0; 4,0], Verbesserung der Lebensqualitat (ΔQOL-Score) 5,0 [0,8; 10,8] / 2,0 [−2,3; 8,0]. Im Medikations-Switch-Abschnitt wurde eine mehrheitliche Nabilone-Einnahme (≥85% aller Medikationstage) von mehr als viermal so vielen Studienteilnehmern gewahlt wie eine mehrheitliche Placebo-Einnahme. Die Anzahl der Tage mit Nabilone-Einnahme war klar hoher als jene mit Placebo-Einnahme (Mediane: 89% vs. 11% aller Medikationstage, p = 0,003). SCHLUSSFOLGERUNGEN: Insgesamt lassen die Studienergebnisse den Schluss zu, dass die Nabilone-Einnahme zusatzlich zur Standardtherapie von einer Mehrheit an Patienten mit chronischen Schmerzzustanden als eine Masnahme mit positiver individueller Nutzen-Risiko-Relation gesehen wird und somit eine interessante und attraktive Bereicherung des analgetischen Behandlungskonzepts darstellen kann.

Nutzen einer Add-On-Therapie mit dem synthetischen Cannabinomimetikum Nabilone bei Patienten mit chronischen Schmerzzuständen - eine randomisierte kontrollierte Studie

Background and Purpose—Experimental studies suggest a beneficial effect of hemodilution on acute ischemic stroke. This was not proven by previous multicenter trials in the clinical setting. Various reasons have been suggested for the failure of these studies, which we attempted to consider in the Multicenter Austrian Hemodilution Stroke Trial (MAHST). Methods—MAHST is a randomized, double-blind, placebo-controlled study of hypervolemic hemodilution (HHD) within 6 hours of a clinically first ischemic stroke localized in the middle cerebral artery territory. The treatment consisted of 10% hydroxyethyl starch 200/0.5 (HES) and was tested against pure rehydration with Ringer’s lactate over a period of 5 days. Our primary outcome measure was clinical improvement within 7 days as measured by the Graded Neurologic Scale (GNS). We performed an adaptive interim analysis to reevaluate the study goal after entering half of the projected number of patients (n=200). At least 600 patients per group would have been requ...

Hypervolemic Hemodilution in Acute Ischemic Stroke The Multicenter Austrian Hemodilution Stroke Trial (MAHST)

MDT *Department of Anaesthesiology, University of Tubingen, Tubingen, Germany; tInstitute of General and Experimental Pathology, University of Vienna, Vienna, Austria; $Clinic of Anaesthesiology, St. Josef Hospital, Ruhr University, Bochum, Germany; SInstitute of Systems Sciences, Johannes Kepler University, Linz, Austria; and IlDepartment of Physiology and PIInstitute of Anaesthesiology, Ludwig-Maximilians University, Munich, Germany Hydroxyethyl starch (HES) is a plasma expander used for perioperative IV fluid management, as well as for resuscitation from trauma and shock. HES is very well tolerated, and the incidence of anaphylactic reactions is lower than with dextran or gelatin. Dextran anaphy- laxis is caused by circulating dextran-reactive antibod- ies (ABs) of the immunoglobin G (IgG) class found in most adults. Histamine release from mast cells induces adverse reactions after gelatin infusion. The cause of adverse reactions due to HES is not yet clear. To inves- tigate AB formation due to HES, we collected sera of 1004 patients at least 14 days after starch administra- tion. Using a highly sensitive enzyme-linked immuno- absorbent assay technique, we found one patient with a low 1:lO titer of HES-reactive ABs (immunoglobin M [IgM] class). Despite repeated HES infusions, no clini- cal reaction could be detected in this patient. On the basis of a binomial distribution, a one-tailed confidence interval (99%) was used to calculate the percentage of the occurrence of ABs in general with maximum of 33 in 10,000 persons (IgM) and 23 in (IgG). We suggest that HES-reactive ABs are extremely rare and that they do not necessarily induce anaphylaxis. Other mechanisms may be responsible for adverse reactions due to HES. Implications: The frequency of antibody formation due to hydroxyethyl starch, a commonly used plasma expander, was prospectively investigated in 1004 patients. Only one patient showed transient an- tibody formation, which was not harmful to the patient. This low antigenicity could explain the excellent toler- ance of hydroxyethyl starch compared with other plasma expanders. (Anesth Analg 1998;86:1123-6)

Werner Pölz

Papers

High ligation combined with stripping and endovenous laser ablation of the great saphenous vein: Early results of a randomized controlled study

Nutzen einer Add-On-Therapie mit dem synthetischen Cannabinomimetikum Nabilone bei Patienten mit chronischen Schmerzzuständen - eine randomisierte kontrollierte Studie

Hypervolemic Hemodilution in Acute Ischemic Stroke The Multicenter Austrian Hemodilution Stroke Trial (MAHST)

Hydroxyethyl starch antibodies in humans: incidence and clinical relevance.

624 benefits of an add-on treatment with the synthetic cannabinomimetic nabilone on patients with chronic pain-a randomized controlled trial