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Stretching of the internal carotid artery during percutaneous transluminal angioplasty (PTA) may be associated with transient neck, facial or cranial pain. We report a series of 53 cases who received PTA. Cervical pain occurred in 51% of patients, with a radiation to face and scalp in 33%. Analysis focused on: (a) description of pain intensity, quality, timing and location; (b) investigation about the role of individual and technical parameters that could influence the relative risk of pain onset during PTA; (c) comparison with other available data on pain syndromes related to the carotid artery. Intimal flapping on post-angioplasty angiograms, bradycardia during the procedure and previous history of AMI were associated with a higher risk of painful angioplasty. PTA may also serve as a tool to investigate carotid pain and may add further knowledge to the evidence available about the role of the carotid wall in the pathogenesis of facial and cranial pain.

Preliminary reports on percutaneous transluminal angioplasty (PTA) of the internal carotid artery are promising. Our experience on 32 patients with symptomatic carotid stenoses is reviewed here. Successful dilation was obtained in 33 of 35 procedures, with an estimated patency rate of 85% at 1 year. In 3 cases, transient neurologic symptoms occurred within 2 days of angioplasty. Transient neck pain and bradycardia were the most commonly observed complications during carotid dilation. Carotid PTA may be considered as a valid alternative to endarterectomy, at least in selected cases.

Intraoperative monitoring of neuronal function, cerebral haemodynamics and cerebral oxygenation provides information to guide anaesthetic and surgical procedures in individual patients. The aim of neuroanaesthesia is to provide optimal intracranial operating conditions, maintain cerebral perfusion pressure (CPP), protect against ischaemic insults and prevent postoperative complications. The anaesthetic techniques and the anaesthetics used in neuroanaesthesia are all geared to these objectives. A neurophysiologically monitored surgical approach can decrease neuronal injury and neurological deficit related to cerebral ischaemia and improve long-term neurological outcome. Traditionally, electrocardiography, arterial blood pressure, pulse oximetry, end-tidal CO2 (ETCO2), body temperature and urine output are monitored during neuroanaesthesia in the operating room.

BACKGROUND Some clinical data have shown that glatiramer acetate (Copaxone), a synthetic amino acid polymer empirically found to suppress experimental allergic encephalomyelitis (EAE), an animal model of MS, might help improve the outcome of patients with multiple sclerosis (MS). OBJECTIVES We performed a Cochrane review of all randomised, placebo-controlled trials of glatiramer acetate in MS, whatever the disease course. SEARCH STRATEGY We searched the Cochrane MS Group trials register (June 2003), the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2, 2003), MEDLINE (PubMed) (January 1966 to June 2003), EMBASE (January 1988 to June 2003) and hand searching of symposia reports (1990-2002) from the neurological Associations and MS Societies in both Europe and America. SELECTION CRITERIA All randomised controlled trials (RCTs) comparing glatiramer acetate and placebo in patients with definite MS, whatever the administration schedule and disease course, were eligible for this review. DATA COLLECTION AND ANALYSIS Both patients with relapsing-remitting (RR) and chronic progressive (CP) MS were analysed. Study protocols were comparable across trials as to patient entry criteria and outcome definition. No major flaws were found in methodological quality. However, efficacy of blinding should be balanced against well-known side effects, including injection-site reactions in glatiramer acetate-treated patients. MAIN RESULTS A total of 646 patients contributed to this review, as it is summarised in Table 01. Glatiramer acetate did not show any significant effect on disease progression, measured as a sustained worsening in the Expanded Disability Status Scale (EDSS). On the other hand, a slight decrease in the mean EDSS score, driven by a major study, should be considered in the light of the limited validity of this outcome measure. No benefit was shown in CP MS patients (progression at two years: RR=0.69, 95% CI [0.33 to 1.46]). The frequency of reported adverse events does not support any major toxicity associated with glatiramer acetate administration. The most common systemic adverse event was a transient and self-limiting patterned reaction of flushing, chest tightness, sweating, palpitations, anxiety (relative risk = 3.40 (95% CI [2.22 to 5.21], p

For a fast return of investment, network providers have to offer new services for the upcoming 3G mobile communication systems. Unfortunately 3G systems suffer by high installation costs and low quality of services in terms of high delays and low bandwidth. These drawbacks exclude many promising services such as real-time video conferences and multiplayer gaming. Furthermore, high network installation costs inhibit quick growth and in turn slow down the recruiting of new customers. Therefore the convergence of 3G technologies with the beneficial wireless local area networks gained a lot of interest lately. Different architectures were introduced to combine these two technologies. The architectures differ in their security concepts. In this paper we give an overview of the discussed architectures and extend them by multihop capability in the WLAN network. Multihop will decrease the network installation costs furthermore and ease the installation of network components.

BACKGROUND Recombinant interferons have been shown to suppress both the clinical and magnetic resonance imaging (MRI) measures of disease activity in patients with relapsing remitting multiple sclerosis (RRMS). OBJECTIVES We performed a Cochrane review of all randomised, placebo-controlled trials of recombinant interferons in RRMS. SEARCH STRATEGY Of 208 articles identified by a predefined search strategy, seven of these, reporting randomised trials, met all the selection criteria and form the subject of this review. SELECTION CRITERIA The trials selected were double-blind, placebo-controlled, randomised trials of RRMS patients who were treated with recombinant interferon, given by the subcutaneous or the intramuscular route. DATA COLLECTION AND ANALYSIS The quality of the trials was variable, with substantial methodological inadequacies in allocation concealment, high proportion and incomplete description of dropouts and failure to adhere to the principles of intention to treat analysis. The baseline characteristics were largely comparable between treatment and placebo groups. Because of prominent treatment-associated side effects, which could be easily identified by patients, these trials could be considered as single blind rather than double-blind. MAIN RESULTS Although 1215 patients were included in this review, only 919 (76%) contributed to the results concerning exacerbations and progression of the disease at two years. Specifically interferon significantly reduced the occurrence of exacerbations (RR =0.80, 95% CI [0.73,0.88], p

Awareness during anesthesia is revealed by explicit or implicit memory of intraoperative events. Although large clinical surveys indicate an incidence of explicit awareness of less than 0.3% during anesthesia for general surgery, the possibility of awareness is still a major concern, because patients may develop posttraumatic stress disorder by the experience of being awake during surgery [1]. Successful litigation against the anesthesia professional has been increasing in number as failure to provide adequate anesthesia can be considered a breach of the unwritten contract between patient and anesthetist [2].

The Neurointensive Care has undergone a great evolution in the past twenty years and nowadays it has become a well defined area of special interest, where the fields of knowledge of Neurology, Neurosurgery, Critical Care and Anesthesiology are joint in a whole. As a result, an increasing number of Neuro-ICU (NICU) have opened in major hospitals allowing a more specific and specialistic approach to critical patients with neurological disorders.

This work presents a pilot study of a clustered building in the historic city centre of L’Aquila, Central Italy, damaged by the earthquake of April 6, 2009. This block was identified under an Ordinance issued during the emergency phase, which obliges the owners of interconnected buildings to constitute consortia to repair and/or re-construct their properties. The selected block has the problems and peculiarities of most of the built environment of the historic city centre of L’Aquila, and of many other old city centres. This study was based on historic search, survey and analysis of the structure with regard to proposals for repair and seismic strengthening. In particular, it describes problems encountered in the various levels of survey and damage interpretation and those of modelling and analysis of the structural behaviour of clustered masonry buildings. The proposed method is suitable for application to other clusters with similar characteristics, in L’Aquila and other historic city centres.