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Background Prompt endovascular care of patients with ischemic stroke due to large vessel occlusion (LVO) remains a major challenge in rural regions as primary stroke centers (PSC) usually cannot provide neuro-interventional services. Objective The core content of the Flying Intervention Team (FIT) project is to perform thrombectomy on-site at a local PSC after the neuro-interventionalist has been transported via helicopter to the target hospital. An important and so far unanswered question is whether mechanical thrombectomy can be performed as safely and successfully on-site as in a specialized comprehensive stroke center (CSC). Methods Comparison of 100 FIT thrombectomies on site in 14 different PSCs with 128 control thrombectomies at 1 CSC (79 drip-and-ship, 49 mothership) performed by a single interventionalist with respect to technical-procedural success parameters, procedural times, and complications. Results There were no significant differences between the two groups in terms of technical success (95.0% successful interventions in FIT group vs. 94.5% in control group, p = 0.60) and complications (3% major complications in FIT vs. 1.6% in control group, p = 0.47). Regarding time from onset to groin puncture, there was no difference between FIT and the entire control group (182 vs. 183 min, p = 0.28), but a trend in favor of FIT compared with the drip-and-ship control subgroup (182 vs. 210 min, p = 0.096). Conclusions Airborne neuro-interventional thrombectomy service is a feasible approach for rural regions. If performed by experienced neuro-interventionalists, technical success and complication rates are comparable to treatment in a specialized neuro-interventional department.

Summary Background and purpose Implementation of TeleStroke Units is one way to organize acute stroke care in underserved, mostly rural, areas. The Telemedical Project for Integrative Stroke Care (TEMPiS) is a TeleStroke Unit network in Bavaria, Germany. We aimed to determine quality of acute stroke care in TEMPiS TeleStroke Units. Methods All TEMPiS TeleStroke Units report quality data to the Bavarian Stroke Registry. Predefined national quality indicators are analyzed. Results for the year 2013 are reported. Results of quality indicators of TEMPiS TeleStroke Units were looked at regarding fulfillment of predefined national targets and compared to statewide and national results. Results In 2013, 15 TEMPiS TeleStroke Units treated 7386 patients with stroke and TIA (hospital range 240 to 892; mean 492; median 452). Documentation rate was 99.3%. In 12 of 13 indicators predefined targets were fulfilled. In comparison to all 154 hospitals participating in the Bavarian Stroke Registry, TeleStroke Units had better percentage levels in 14, worse levels in three and equal levels in one quality indicator. Conclusion Registry data of the TeleStroke network TEMPiS suggest a convincing acute care quality in TeleStroke Units.

Intracranial hemorrhages are associated with high rates of disability and mortality. Telemedicine in general provides clinical healthcare at a distance by using videotelephony and teleradiology and is used particularly in acute stroke care medicine (TeleStroke). TeleStroke considerably improves quality of stroke care (for instance, by increasing thrombolysis) and may be valuable for the management of intracranial hemorrhages in rural hospitals and hospitals lacking neurosurgical departments, given that surgical/interventional therapy is only recommended for a subgroup of patients. The aim of this study was to analyze the frequency, anatomical locations of intracranial hemorrhage, risk factors, and the proportion of patients transferred to specialized hospitals. We evaluated teleconsultations conducted between 2008 and 2010 in a large cohort of patients consecutively enrolled in the Telemedical Project for Integrated Stroke Care (TEMPiS) network. In cases in which intracranial hemorrhage was detected, all images were re-examined and analyzed with a focus on frequency, location, risk factors, and further management. Overall, 6187 patients presented with stroke-like symptoms. Intracranial hemorrhages were identified in 631 patients (10.2%). Of these, intracerebral hemorrhages were found in 423 cases (67.0%), including 174 (41.1%) in atypical locations and 227 (53.7%) in typical sites among other locations. After 14 days of hospitalization in community facilities, the mortality rate in patients with intracranial hemorrhages was 15.1% (95/631). Two hundred and twenty-three patients (35.3%) were transferred to neurological/neurosurgical hospitals for diagnostic workup or additional treatment. Community hospitals are confronted with patients with intracranial hemorrhage, whose management requires specific neurosurgical and hematological expertise with respect to hemorrhage subtype and clinical presentation. TeleStroke networks help select patients who need advanced neurological and/or neurosurgical care. The relatively low proportion of interhospital transfers shown in this study reflects a differentiated decision process on the basis of both guidelines and standard operating procedures.

Background and Purpose— Intravenous thrombolysis with tissue-type plasminogen activator (tPA) for acute ischemic stroke is more effective when delivered early. Timely delivery is challenging particularly in rural areas with long distances. We compared delays and treatment rates of a large, decentralized telemedicine-based system and a well-organized, large, centralized single-hospital system. Methods— We analyzed the centralized system of the Helsinki University Central Hospital (Helsinki and Province of Uusimaa, Finland, 1.56 million inhabitants, 9096 km 2 ) and the decentralized TeleStroke Unit network in a predominantly rural area (Telemedical Project for Integrative Stroke Care [TEMPiS], South-East Bavaria, Germany, 1.94 million inhabitants, 14 992 km 2 ). All consecutive tPA treatments were prospectively registered. We compared tPA rates per total ischemic stroke admissions in the Helsinki and TEMPiS catchment areas. For delay comparisons, we excluded patients with basilar artery occlusions, in-hospital strokes, and those being treated after 270 minutes. Results— From January 1, 2011, to December 31, 2013, 912 patients received tPA in Helsinki University Central Hospital and 1779 in TEMPiS hospitals. Area-based tPA rates were equal (13.0% of 7017 ischemic strokes in the Helsinki University Central Hospital area versus 13.3% of 14 637 ischemic strokes in the TEMPiS area; P =0.078). Median prehospital delays were longer (88; interquartile range, 60–135 versus 65; 48–101 minutes; P P P =0.45). Conclusions— A decentralized telestroke thrombolysis service can achieve similar treatment rates and time delays for a rural population as a centralized system can achieve for an urban population.

Die Behandlung auf TeleStroke-Units fuhrt im Vergleich zur unspezialisierten Schlaganfalltherapie zu einem verbesserten Patienten-Outcome. Diese Arbeit untersucht, wie sich dieses neue Behandlungskonzept auf die Kosten der stationaren und der nachstationaren Versorgung auswirkt. Analysiert wurden die stationaren Behandlungskosten und die Pflegeversicherungs-Leistungen von Schlaganfallpatienten (versichert bei der AOK Bayern), die im telemedizinisch unterstutzten Schlaganfall-Netzwerk TEMPiS (Telemedizinisches Projekt zur integrierten Schlaganfallversorgung) behandelt wurden, im Vergleich zu Schlaganfallpatienten aus gematchten Kliniken ohne spezialisiertes Therapieangebot und ohne Telemedizinanbindung. Die Kosten der Kranken- und Pflegeversicherung wurden uber 30 Monate nachbeobachtet. Zum Ausschluss von vorbestehenden Unterschieden zwischen den Kliniken wurde zusatzlich ein Zeitraum vor der Netzwerk-Einfuhrung untersucht. Im Zeitraum nach der Netzwerkeinfuhrung wurden 1 277 Schlaganfallpatienten (767 TEMPiS-Kliniken; 510 Vergleichskliniken) untersucht. Die Patienten der Interventions-Kliniken hatten uber 30 Monate einen signifikant gunstigeren Verlauf hinsichtlich der Pflegestufen-Einteilung. Diese Behandlung war zwar mit hoheren akutstationaren Kosten (5 309 € vs. 4 901 €, p=0,04), jedoch mit geringeren Pflegeversicherungs-Leistungen (3 946 € vs. 5 132 €; p=0,04) verbunden. Die erfassten absoluten Gesamtkosten im Beobachtungszeitraum waren in beiden Gruppen gleich – die Pflegeversicherungs-Leistungen pro uberlebtem Patientenjahr in der Interventionsgruppe niedriger (1 953 € vs. 2 635 €; p=0,005). Im Zeitraum vor TEMPiS-Einfuhrung ergaben sich keine signifikanten Outcome- und Kostendifferenzen zwischen den Klinikgruppen. Die erhohten Kosten fur die akute telemedizinische Schlaganfall-Behandlung im Netzwerk wurden durch niedrigere Folgekosten kompensiert.

In dieser Studie charakterisierten wir die beatmeten Patienten einer neurologischen Intensivstation (NITS) im Zeitraum 2006 bis 2008 in einer rein neurologischen Klink in einer sog. „Stand-alone-Situation. Zudem untersuchten wir die Langzeitprognose und Lebensqualitat der Uberlebenden. Diese retrospektive Studie umfasst alle beatmeten Patienten von 10/2006 bis 12/2008 einer neurologischen Intensivstation, analysiert mit prospektiv definierten Kriterien anhand der Aktenlage den Intensivaufenthalt und erfasst die aktuelle Lebensqualitat. Wir ermittelten unter anderem die endgultigen Diagnosen, Dauer der Intensivpflichtigkeit und Beatmungsdauer sowie den jeweils hochsten SAPS-II-Score und die Komplikationen wahrend des Aufenthaltes. Anhand der Diagnosen wurden die Patienten in Gruppen eingeteilt: vaskular, entzundlich, neurodegenerativ, hereditar, epileptisch und sonstige. Zusatzlich wurden die Patienten kontaktiert und per Fragebogen der Barthel-Index (BI) sowie die Werte auf der modifizierten Rankin-Skala (mRS) ermittelt. Insgesamt wurden im beobachteten Zeitraum 201 von 512 Patienten auf der NITS beatmet. Vaskulare Erkrankungen waren fuhrende Ursache fur die Therapie auf der Intensivstation (47,8%), gefolgt von entzundlichen Erkrankungen (22,8%) und Epilepsien (13%). Die Dauer der Beatmung betrug median 9 Tage bei einer mittleren Behandlungsdauer von 16 Tagen (Range 1–57). Bereits wahrend des Aufenthaltes verstarben 31 Patienten (entsprechen15,4% aller Behandelten). Weitere 32 der 170 uberlebenden Patienten (entsprechen 18,8% der entlassenen Patienten) verstarben im Median von 2 Monaten nach Entlassung. Outcomedaten konnten anhand von 67 von 170 versandten Fragebogen und 86 Rehabilitationsabschlussberichten erhoben werden, sodass letztendlich Nachuntersuchungsdaten von insgesamt 121 Patienten der 170 uberlebenden beatmeten Intensivpatienten vorlagen. Davon gaben 42,2% keine bzw. leichte Beeintrachtigungen/Pflegebedurftigkeit im Alltag, allerdings auch 38,0% schwere Beeintrachtigungen/dauerhafte Pflegebedurftigkeit laut BI an. Die Auswertung der mRS ergab, dass immerhin noch 49,6% der 170 nachuntersuchten Patienten subjektiv eine schwere Restsymptomatik aufweisen. Das impliziert, dass vorhandene Residuale nicht zwangslaufig zu einer entsprechenden Pflegebedurftigkeit fuhren. Mehr als ein Drittel der Patienten der hier analysierten NITS wurden beatmungspflichtig, wobei der Schwerpunkt bei den vaskularen Erkrankungen liegt und somit die Uberschneidung zwischen Stroke-Unit und Intensivstation verdeutlicht. Trotz langer Beatmungs- und Intensivdauer zeigt mehr als ein Drittel der uberlebenden Patienten nur leichte oder gar keine Beeintrachtigungen bei Aktivitaten des taglichen Lebens, wobei doch scheinbar ein Teil der Patienten trotzdem subjektiv unter einer nicht unerheblichen Restsymptomatik leidet. Ein weiteres Drittel uberlebte mit schweren Einschrankungen bis hin zur kompletten Pflegebedurftigkeit. Die Daten unterscheiden sich bez. den wenigen Publikationen uber NITS trotz der besonderen Stand-alone-Situation kaum. Der Case-Mix-Index betrug im Mittel 0,3/Tag und zeigt die wirtschaftliche Bedeutung im Vergleich zu anderen neurologischen Behandlungsformen an.

Telemedicine is increasingly being utilised for the remote evaluation of stroke patients, particularly in neurologically underserved areas. It is usually based on video examination and teleradiological evaluations of brain scans. Scientific analyses have demonstrated the reliability of neurological scores assessed via videoconference. Teleradiology using electronically transmitted original imaging data is potentially equivalent to onsite assessment. Intravenous thrombolysis can be indicated with similar results as in experienced stroke centres if both technological and professional quality standards are applied. However, improved clinical outcomes of stroke patients have only been shown when telemedicine was combined with the Stroke Unit concept based on specialised stroke wards and organised stroke care. More scientific evaluation is needed in the fields of cost effectiveness, quality management and implementation of further technological innovations. There are still insufficient data about the use of telemedicine in prevention, rehabilitation and post-stroke care and a comprehensive scientific evaluation is still needed.

Background. Telemedicine is increasingly used for acute stroke care, making neurological expertise available in nonspecialized hospitals. There are few data about telemedicine's acceptance by either medical staff or patients at treating hospitals. Methods. Telemedicine's acceptance was evaluated in the Telemedical Project for Integrative Stroke Care (TEMPIS), a network of two stroke centers and 12 community hospitals in the German state of Bavaria; the grading ofteleconsultation regarding video and audio quality, time consumption, and medical relevance was assessed in two periods, 2004 and 2007. Overall satisfaction with in-hospital treatment was compared between patients in telemedically-linked hospitals with specialized stroke care and patients treated in conventional community hospitals. With regard to sufficient follow-up rates, ratings were restricted to patients living at home without severe disability at 3 months after stroke. A second evaluation analyzed how the parameter"Telemedical assessment of patient"(36% of patients in TEMPIS hospitals) affected overall satisfaction. Results. Respectively, 140 and 127 uses of telemedicine were assessed in the two evaluation periods. Video quality, time consumption, and medical relevance were graded"excellent"by over 50% in both periods. Audio quality was rated"excellent"by only 22% in the first period but 69% in the second. Excellent overall satisfaction was expressed significantly more frequently by patients atTEMPIS hospitals (total number 1044) than by those at control hospitals (total number 484; 56% vs 47% respectively, P

Background: To test whether portable duplex ultrasound devices can be used in a prehospital ‘911’ emergency situation to assess intracranial arteries. Methods: Non-contrast-enhanced transcranial duplex ultrasound studies were performed either immediately at the site of the emergency (i.e. private home) or after transfer into the emergency helicopter/ambulance vehicle. Results: A total of 25 patients were enrolled. In 5/25 cases, intracranial vessels could not be visualized due to insufficient quality of the temporal bone window. In 20/25 cases, bilateral visualization and Doppler flow measurements of the middle cerebral artery could be assessed in a mean time less than 2 min. Conclusion: Emergency assessment of intracranial arteries using portable duplex ultrasound devices is feasible shortly after arrival at the patient’s site.

Therapeutic options to cure advanced, recurrent, and unresectable thymomas are limited. The most important factor for long-term survival of thymoma patients is complete resection (R0) of the tumor. We therefore evaluated the response to and the induction of resectability of primarily or locally recurrent unresectable thymomas and thymic carcinomas by octreotide Long-Acting Release (LAR) plus prednisone therapy in patients with positive octreotide scans. In this open label, single-arm phase II study, 17 patients with thymomas considered unresectable or locally recurrent thymoma (n = 15) and thymic carcinoma (n = 2) at Masaoka stage III were enrolled. Octreotide LAR (30 mg once every 2 weeks) was administered in combination with prednisone (0.6 mg/kg per day) for a maximum of 24 weeks (study design according to Fleming´s one sample multiple testing procedure for phase II clinical trials). Tumor size was evaluated by volumetric CT measurements, and a decrease in tumor volume of at least 20% at week 12 compared to baseline was considered as a response. We found that octreotide LAR plus prednisone elicited response in 15 of 17 patients (88%). Median reduction of tumor volume after 12 weeks of treatment was 51% (range 20%-86%). Subsequently, complete surgical resection was achieved in five (29%) and four patients (23%) after 12 and 24 weeks, respectively. Octreotide LAR plus prednisone treatment was discontinued in two patients before week 12 due to unsatisfactory therapeutic effects or adverse events. The most frequent adverse events were gastrointestinal (71%), infectious (65%), and hematological (41%) complications. In conclusion, octreotide LAR plus prednisone is efficacious in patients with primary or recurrent unresectable thymoma with respect to tumor regression. Octreotide LAR plus prednisone was well tolerated and adverse events were in line with the known safety profile of both agents. peerReviewed

Summary The significance of cerebrovascular disorders is steadily increasing due to the demographic changes in western industrial societies. Therefore the implementation of telemedical networks seems tempting to improve deliverance of specialised stroke care in non-urban areas. Networks like TEMPiS, located in the rural area of south-eastern Bavaria, have shown to deliver high experienced stroke therapy to underserved areas. Mandatory for a high quality of supply is the appropriate technical equipment. Moreover, beside the teleconsultations, a continuous training should be performed. Mobile solutions allow more flexibility for the teleconsultants.

Patient: Female, 78 Final Diagnosis: Cerebral hyperperfusion syndrome Symptoms: — Medication: — Clinical Procedure: Endovascular embolectomy Specialty: Neurology Objective: Unknown ethiology Background: Cerebral hyperperfusion syndrome (cHS) is a well known but rare complication after carotid endarterectomy, carotid angioplasty with stenting, and stenting of intracranial arterial stenosis. The clinical presentation may vary from acute onset of focal oedema (stroke-like presentation) and intracerbral hemorrhage to delayed (>24h hours after the procedure) presentation with seizures, focal motor weakness, or late intracerebral hemorrhage. The incidence of cHS after carotid endarterectomy ranges from 0–3% and defined as an increase of the ipsilateral cerebral blood flow up to 40% over baseline in ultrasound. Case Report: We present a case of a 78-year-old woman with an acute ischemic stroke due to left side middle cerebral artery territory with right sided hemiparesis and aphasia (NIHSS 16). After systemic thrombolysis embolectomy using a retractable stent (Solitaire® device) was performed and resulted in complete and successful recanalization of MCA including its branches about 210 minutes after symptom onset but, partial dislocation of thrombotic material into the anterior cerebral artery (ACA). Conclusions: Cerebral hyperperfusion syndrome should be considered in patients with clinical deterioration after successful recanalisation and the early diagnosis and treatment may be important for neurological outcome after endovascular embolectomy

Stroke is the second common cause of death and the primary cause of early invalidity worldwide. Different from other diseases is the time sensitivity related to stroke. In case of an ischemic event occluding a brain artery, 2000000 neurons die every minute. Stroke diagnosis and treatment should be initiated at the earliest time point possible, preferably at the site or during patient transport. Portable ultrasound has been used for prehospital diagnosis for applications other than stroke, and its acceptance as a valuable diagnostic tool "in the field" is growing. The intrahospital use of transcranial ultrasound for stroke diagnosis has been described extensively in the literature. Beyond its diagnostic use, first clinical trials as well as numerous preclinical work demonstrate that ultrasound can be used to accelerate clot lysis (sonothrombolysis) in presence as well as in absence of tissue plasminogen activator. Hence, the use of transcranial ultrasound for diagnosis and possibly treatment of stroke bares the potential to add to current stroke care paradigms significantly. The purpose of this concept article is to describe the opportunities presented by recent advances in transcranial ultrasound to diagnose and potentially treat large vessel embolic stroke in the prehospital environment.

Objective: The integrative telestroke network TEMPiS aims to provide high standard stroke care in non-urban areas by implementing a teleconsultation service and setting up telestroke units in the network hospitals (TSU). Since treatment in a neurological stroke unit (SU) rather than a TSU is the gold standard of stroke care in Germany, the objective of this study was to compare process and outcome parameters in TSU and accredited SU in Bavaria. Methods: The data are collected from the Bavarian Stroke Registry (BAQ). Quality indicators have been developed by the committee of the German Stroke Registry and reflect the quality of acute in-hospital treatment. The 2010 data of the 15 TSU are compared to those of the 19 Bavarian SU. Findings: All registered patients in 2010 (6634 in the TSU and 13.728 in the SU) were included in the study. Patients in TSU were slightly older than patients in the SU (76 vs. 74y.) and had the same stroke severity (NIH-Stroke Scale: 4). The results of the quality indicators are shown in table 1 . Five quality indicators (information, dysphagia screening, speech- and language therapy, early cerebral imaging, early platelet inhibitors) were significantly better in TSU, two (carotid artery diagnostic, rehabilitation) in the SU. All other quality indicators (9) showed no significant difference. Conclusion: A comparison of the hospitals of the integrative telestroke network TEMPiS and the accredited stroke units in Bavaria indicates equally high quality of the processes and outcome parameters. The integrative telestroke network is a concept that implements high standard stroke care in non-urban areas.

Background and Purpose— Cerebral amyloid angiopathy (CAA) is a degenerative disorder characterized by amyloid-β (Aβ) deposition in the blood–brain barrier (BBB). CAA contributes to injuries of the neurovasculature including lobar hemorrhages, cortical microbleeds, ischemia, and superficial hemosiderosis. We postulate that CAA pathology is partially due to Aβ compromising the BBB. Methods— We characterized 19 patients with acute stroke with “probable CAA” for neurovascular pathology based on MRI and clinical findings. Also, we studied the effect of Aβ on the expression of tight junction proteins and matrix metalloproteases (MMPs) in isolated rat brain microvessels. Results— Two of 19 patients with CAA had asymptomatic BBB leakage and posterior reversible encephalopathic syndrome indicating increased BBB permeability. In addition to white matter changes, diffusion abnormality suggesting lacunar ischemia was found in 4 of 19 patients with CAA; superficial hemosiderosis was observed in 7 of 9 patients. Aβ 40 decreased expression of the tight junction proteins claudin-1 and claudin-5 and increased expression of MMP-2 and MMP-9. Analysis of brain microvessels from transgenic mice overexpressing human amyloid precursor protein revealed the same expression pattern for tight junction and MMP proteins. Consistent with reduced tight junction and increased MMP expression and activity, permeability was increased in brain microvessels from human amyloid precursor protein mice compared with microvessels from wild-type controls. Conclusions— Our findings indicate that Aβ contributes to changes in brain microvessel tight junction and MMP expression, which compromises BBB integrity. We conclude that Aβ causes BBB leakage and that assessing BBB permeability could potentially help characterize CAA progression and be a surrogate marker for treatment response.

Background and Purpose: The primary aim of this study was to investigate the diagnostic accuracy and time frames for neurological and transcranial color-coded sonography (TCCS) assessments in a prehospital ‘911’ emergency stroke situation by using portable duplex ultrasound devices to visualize the bilateral middle cerebral arteries (MCAs). Methods: This study was conducted between May 2010 and January 2011. Patients who had sustained strokes in the city of Regensburg and the surrounding area in Bavaria, Germany, were enrolled in the study. After a ‘911 stroke code’ call had been dispatched, stroke neurologists with expertise in ultrasonography rendezvoused with the paramedic team at the site of the emergency. After a brief neurological assessment had been completed, the patients underwent TCCS with optional administration of an ultrasound contrast agent in cases of insufficient temporal bone windows or if the agent had acute therapeutic relevance. The ultrasound studies were performed at the site of the emergency or in the ambulance during patient transport to the admitting hospital. Relevant timelines, such as the time from the stroke alarm to patient arrival at the hospital and the duration of the TCCS, were documented, and positive and negative predictive values for the diagnosis of major MCA occlusion were assessed. Results: A total of 113 patients were enrolled in the study. MCA occlusion was diagnosed in 10 patients. In 9 of these 10 patients, MCA occlusion could be visualized using contrast-enhanced or non-contrast-enhanced TCCS during patient transport and was later confirmed using computed tomography or magnetic resonance angiography. One MCA occlusion was missed by TCCS and 1 atypical hemorrhage was misdiagnosed. Overall, the sensitivity of a ‘field diagnosis’ of MCA occlusion was 90% [95% confidence interval (CI) 55.5–99.75%] and the specificity was 98% (95% CI 92.89–99.97%). The positive predictive value was 90% (95% CI 55.5–99.75%) and the negative predictive value was 98% (95% CI 92.89–99.97%). The mean time (standard deviation) from ambulance dispatch to arrival at the patient was 12.3 min (7.09); the mean time for the TCCS examination was 5.6 min (2.2); and the overall mean transport time to the hospital was 53 min (18). Conclusion: Prehospital diagnosis of MCA occlusion in stroke patients is feasible using portable duplex ultrasonography with or without administration of a microbubble contrast agent. Prehospital neurological as well as transcranial vascular assessments during patient transport can be performed by a trained neurologist with high sensitivity and specificity, perhaps opening an additional therapeutic window for sonothrombolysis or neuroprotective strategies., OA-Komponente aus Allianzlizenz

Background and Purpose— Telemedicine is increasingly used to provide acute stroke expertise for hospitals without full-time neurological services. Teleconsulting through mobile laptop computers may offer more flexibility compared with hospital-based services, but concerns about quality and technical reliability remain. Methods— We conducted a controlled trial, allocating hospital-based or mobile teleconsulting in a shift-by-shift sequence and evaluating technical parameters, acceptability, and impact on immediate clinical decisions. Both types of telemedicine workstations were equipped with DICOM (Digital-Imaging-and-Communications-in-Medicine) viewer and videoconference software. The laptop connected by asymmetrical broadband UMTS (Universal-Mobile-Telecommunication-Systems) technology with a one-way spoke-to-hub video transmission, whereas the hospital-based device used landline symmetrical telecommunication, including a 2-way videoconference. Results— One hundred twenty-seven hospital-based and 96 mobile teleconsultations were conducted within 2 months without any technical breakdown. The rates per allocated time were similar with 3.8 and 4.0 per day. No significant differences were found for durations of videoconference (mean: 11±3 versus 10±3 minutes, P =0.07), DICOM download (3±3 versus 4±3 minutes, P =0.19), and total duration of teleconsultations (44±19 versus 45±21 minutes, P =0.98). Technical quality of mobile teleconsultations was rated worse on both sides, but this did not affect the ability to make remote clinical decisions like initiating thrombolysis (17% versus 13% of all, P =0.32). Conclusions— Teleconsultation using a laptop workstation and broadband mobile telecommunication was technically stable and allowed remote clinical decision-making. There remain disadvantages regarding videoconference quality on the hub side and lack of video transmission to the spoke side.

To test whether portable duplex ultrasound devices can be used in a prehospital '911' emergency situation to assess intracranial arteries.Non-contrast-enhanced transcranial duplex ultrasound studies were performed either immediately at the site of the emergency (i.e. private home) or after transfer into the emergency helicopter/ambulance vehicle.A total of 25 patients were enrolled. In 5/25 cases, intracranial vessels could not be visualized due to insufficient quality of the temporal bone window. In 20/25 cases, bilateral visualization and Doppler flow measurements of the middle cerebral artery could be assessed in a mean time less than 2 min.Emergency assessment of intracranial arteries using portable duplex ultrasound devices is feasible shortly after arrival at the patient's site.

7105 Background: The therapeutic outcome for unresectable, locally advanced, malignant thymoma is poor. Most important factor for long-term survival in thymoma patients is complete resection (R0) of the tumor. The study was performed to evaluate the efficacy of octreotide LAR plus prednisone in patients with primary inoperable or local recurrent thymoma to reduce tumor size. Methods: This was an open label, single-arm study in patients with inoperable or local recurrent thymoma. Patients were considered unlikely to achieve R0 resection at enrollment. Octreotide LAR was administered once every 2 weeks in combination with prednisone. Two stages were planned according to Fleming’s one sample multiple testing procedure for phase II clinical trials. The objective of the study was to show that octreotide LAR is effective in this patient population with respect to tumor shrinkage. Response was defined as decrease in tumor volume of at least 20% at month 3 as compared to baseline. Results: 17 thymoma patients at Masaoka stage III were recruited. Octreotide LAR showed a response in 15 of 17 patients (88.24%) at week 12. Two patients had discontinued the study before week 12 due to unsatisfactory therapeutic effect or adverse events. At Week 12, 5 patients (29.41%) operable for radical resection. 10 patients (58.82%) were not operable for radical resection. 16 of 17 patients (94.12%) experienced adverse events (AEs). The most frequent AEs were gastrointestinal disorders (70.59%), infections and infestations (64.71%), and blood/lymphatic system disorders (41.18%). Conclusions: Octreotide LAR was shown to be effective in patients with inoperable thymoma with respect to tumor shrinkage.Octreotide LAR was generally well tolerated. The reported AEs are in accordance with the known safety profile.