Multidisciplinary consensus on assessment of unruptured intracranial aneurysms: proposal of an international research group.

BACKGROUND AND PURPOSE To address the increasing need to counsel patients about treatment indications for unruptured intracranial aneurysms (UIA), we endeavored to develop a consensus on assessment of UIAs among a group of specialists from diverse fields involved in research and treatment of UIAs. METHODS After composition of the research group, a Delphi consensus was initiated to identify and rate all features, which may be relevant to assess UIAs and their treatment by using ranking scales and analysis of inter-rater agreement (IRA) for each factor. IRA was categorized as very high, high, moderate, or low. RESULTS Ultimately, 39 specialists from 4 specialties agreed (high or very high IRAs) on the following key factors for or against UIA treatment decisions: (1) patient age, life expectancy, and comorbid diseases; (2) previous subarachnoid hemorrhage from a different aneurysm, family history for UIA or subarachnoid hemorrhage, nicotine use; (3) UIA size, location, and lobulation; (4) UIA growth or de novo formation on serial imaging; (5) clinical symptoms (cranial nerve deficit, mass effect, and thromboembolic events from UIAs); and (6) risk factors for UIA treatment (patient age and life expectancy, UIA size, and estimated risk of treatment). However, IRAs for features rated with low relevance were also generally low, which underlined the existing controversy about the natural history of UIAs. CONCLUSIONS Our results highlight that neurovascular specialists currently consider many features as important when evaluating UIAs but also highlight that the appreciation of natural history of UIAs remains uncertain, even within a group of highly informed individuals.

(Ozrot Chajim) : Katalog der Michael'schen Bibliothek

hrsg. von den Michael'schen Erben. Nebst einem, vielfache Berichtigungen und Excerpte enthaltenden Register zum Verzeichnis der Handschriften von M. Steinschneider und einem Vorworte von L. Zunz

Michael Levy's gesammelte Aufsätze

hrsg. von A. Lewin

What is the frequency of nerve injuries associated with acetabular fractures?

BACKGROUND Acetabular fractures and surgical interventions used to treat them can result in nerve injuries. To date, only small case studies have tried to explore the frequency of nerve injuries and their association with patient and treatment characteristics. High-quality data on the risk of traumatic and iatrogenic nerve lesions and their epidemiology in relation to different fracture types and surgical approaches are lacking. QUESTIONS/PURPOSES The purpose of this study was to determine (1) the proportion of patients who develop nerve injuries after acetabular fracture; (2) which fracture type(s) are associated with increased nerve injury risk; and (3) which surgical approach was associated with the highest proportion of patients developing nerve injuries using data from the German Pelvic Trauma Registry. Two secondary aims were (4) to assess hospital volume-nerve-injury relationship; and (5) internal data validity. METHODS Between March 2001 and June 2012, 2236 patients with acetabular fractures were entered into a prospectively maintained registry from 29 hospitals; of those, 2073 (92.7%) had complete records on the endpoints of interest in this retrospective study and were analyzed. The neurological status in these patients was captured at their admission and at the discharge. A total of 1395 of 2073 (67%) patients underwent surgery, and the proportions of intervention-related and other hospital-acquired nerve injuries were obtained. Overall proportions of patients developing nerve injuries, risk based on fracture type, and risk of surgical approach type were analyzed. RESULTS The proportion of patients being diagnosed with nerve injuries at hospital admission was 4% (76 of 2073) and at discharge 7% (134 or 2073). Patients with fractures of the "posterior wall" (relative risk [RR], 2.0; 95% confidence interval [CI], 1.4-2.8; p=0.001), "posterior column and posterior wall" (RR, 2.9; CI, 1.6-5.0; p=0.002), and "transverse+posterior wall" fracture (RR, 2.1; CI, 1.3-3.5; p=0.010) were more likely to have nerve injuries at hospital discharge. The proportion of patients with intervention-related nerve injuries and that of patients with other hospital-acquired nerve injuries was 2% (24 of 1395 and 46 of 2073, respectively). They both were associated with the Kocher-Langenbeck approach (RR, 3.0; CI, 1.4-6.2; p=0.006; and RR, 2.4; CI, 1.4-4.3; p=0.004, respectively). CONCLUSIONS Acetabular fractures with the involvement of posterior wall were most commonly accompanied with nerve injuries. The data suggest also that Kocher-Langenbeck approach to the pelvic ring is associated with a higher risk of perioperative nerve injuries. Trauma surgeons should be aware of common nerve injuries, particularly in posterior wall fractures. The results of the study should help provide patients with more exact information on the risk of perioperative nerve injuries in acetabular fractures. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Die Amsterdamer Hagada : 18 Abb. aus d. Kupferstichdr. d. Passah-Hagada [ von Abraham Ber Jakob. Hrsg. Moses Wesel]

Mit Stempel der Bibliothek der Jüdischen Gemeinde Berlin

Michael Sachs und Moritz Veit : Briefwechsel

hrsg. von Ludwig Geiger

Michael Sachs : Festschrift zur Feier des 100. Geburtstages von Michael Sachs am 7. Sept. 1908

Vortrag von Josef Eschelbacher

Familien-Register und Stammtafel des Michael Isaac Bing und seiner Nachkommen : nebst beigef. Testamente seiner Enkelin Gütche Worms geb. Mendler-Oetingen, die Stiftung eines Brautvermächtnisses zu Gunsten ihrer Anverwandten betreffend

zsgest. von Elias Ullmann

Abraham, Isaak und Jakob : Auswahl aus den Sagen der Juden

hrsg. von M.J. bin Gorion

Der rettende Begleiter. Der Erzengel Michael ist mehr als nur der Engel, der mit dem Teufel kämpft

Ein Artikel über die Figur des Erzengels Michael und das theologische Engelsverständnis in einer kirchlichen Zeitschrift für ein allgemeines Publikum.

Ms. hebr. qu. 28 - Ḥidushim u-veʼurim ʻal ha-Torah

Vorbesitzer [mutmaßlich]: Neḥemjā Brüll

[Nicht-ärztliches Tagebuch: 1751]

Handschrift