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Röther J, Busse O, Berlis A, Dörfler A, Groden C, Hamann G, Jansen O, Meixensberger J, Müller O, Regelsberger J, Steinmetz H, Vatter H, Weber W, Hänggi D, Nabavi D. [Erratum to: Interdisciplinary neurovascular networks: state of the art]. Nervenarzt 2020; 91:1169. [PMID: 33156367 DOI: 10.1007/s00115-020-01016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- J Röther
- Kopf- und Neurozentrum, Neurologische Abteilung mit überregionaler Stroke Unit, Neurophysiologie und Neurologischer Intensivmedizin, Asklepios Klinik Hamburg Altona, Asklepios Campus Hamburg der Semmelweis Universität, Hamburg, Deutschland.
| | - O Busse
- Deutsche Schlaganfall-Gesellschaft, Berlin, Deutschland
| | - A Berlis
- Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklink Augsburg, Augsburg, Deutschland
| | - A Dörfler
- Neuroradiologische Abteilung, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Ch Groden
- Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - G Hamann
- Klinik für Neurologie und Neurologische Rehabilitation, Bezirkskrankenhaus Günzburg der Bezirkskliniken Schwaben, Günzburg, Deutschland
| | - O Jansen
- Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - J Meixensberger
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - O Müller
- Klinik für Neurochirurgie, Klinikum Dortmund, Dortmund, Deutschland
| | - J Regelsberger
- Neurochirurgische Klinik, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland
| | - H Steinmetz
- Klinik für Neurologie, Universitätsklinikum, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - H Vatter
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - W Weber
- Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Bochum, Deutschland
| | - D Hänggi
- Neurochirurgische Klinik/Department of Neurosurgery, Universitätsklinikum Düsseldorf/Düsseldorf University Hospital, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - D Nabavi
- Klinik für Neurologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
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Röther J, Busse O, Berlis A, Dörfler A, Groden C, Hamann G, Jansen O, Meixensberger J, Müller O, Regelsberger J, Steinmetz H, Vatter H, Weber W, Hänggi D, Nabavi D. [Interdisciplinary neurovascular networks: state of the art]. Nervenarzt 2020; 91:902-907. [PMID: 32930814 DOI: 10.1007/s00115-020-00991-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In order to treat the complete spectrum of neurovascular diseases at a high level of quality, which goes beyond the purely acute treatment of stroke, the German Stroke Society (DSG) together with the German Societies for Neurosurgery and Neuroradiology developed a certification procedure for neurovascular networks (NVN). Structurally, a NVN consists of a coordinating center with at least three neurovascular network partners with a certified stroke unit. From 2018 to 2020 a total of 15 NVN have so far been audited and certified according to this new standard. OBJECTIVE How efficient are the NVN? Are high standards maintained? MATERIAL AND METHODS The reports of the audits were analyzed. The data were taken from the period 2017-2019. RESULTS The 15 NVN treated a total of 86,510 stroke patients in the years examined and were networked with a total of 107 partner clinics, which were situated an average of 25 km from the coordinating center and transferred a total of 2726 patients. The coordinating centers performed 2463 thrombectomies and treated 2383 patients with nontraumatic intracerebral bleeding. In 712 patients with acute aneurysmatic subarachnoid hemorrhages endovascular treatment was carried out and clipping in 401. The audit was successful in the majority of the NVN. CONCLUSION The certification process of NVN has been successfully established and the audits proved to be a useful instrument for quality control and improvement. The 15 NVN are highly efficient and treat more than one quarter of stroke patients in German stroke units.
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Affiliation(s)
- J Röther
- Kopf- und Neurozentrum, Neurologische Abteilung mit überregionaler Stroke Unit, Neurophysiologie und Neurologischer Intensivmedizin, Asklepios Klinik Hamburg Altona, Asklepios Campus Hamburg der Semmelweis Universität, Paul-Ehrlich-Straße 1, 22763, Hamburg, Deutschland.
| | - O Busse
- Deutsche Schlaganfall-Gesellschaft, Reinhardtstraße 27C, 10117, Berlin, Deutschland
| | - A Berlis
- Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklink Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
| | - A Dörfler
- Neuroradiologische Abteilung, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6 (Kopfkliniken), 91054, Erlangen, Deutschland
| | - Ch Groden
- Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - G Hamann
- Klinik für Neurologie und Neurologische Rehabilitation, Bezirkskrankenhaus Günzburg der Bezirkskliniken Schwaben, Ludwig-Heilmeyerstr. 2, 89312, Günzburg, Deutschland
| | - O Jansen
- Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein Campus Kiel, Arnold-Heller Str. 3, 24105, Kiel, Deutschland
| | - J Meixensberger
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Leipzig AöR, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - O Müller
- Klinik für Neurochirurgie, Klinikum Dortmund, Münsterstr. 240, 44145, Dortmund, Deutschland
| | - J Regelsberger
- Neurochirurgische Klinik, Universitätsklinikum Hamburg Eppendorf, Martinistr 52, 20251, Hamburg, Deutschland
| | - H Steinmetz
- Klinik für Neurologie, Universitätsklinikum, Goethe-Universität Frankfurt, Schleusenweg 2-16, 60528, Frankfurt am Main, Deutschland
| | - H Vatter
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - W Weber
- Institut für Diagnostische und Interventionelle Radiologie, Neuroradiologie und Nuklearmedizin, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, In der Schornau 23-25, 44892, Bochum, Deutschland
| | - D Hänggi
- Neurochirurgische Klinik / Department of Neurosurgery, Universitätsklinikum Düsseldorf / Düsseldorf University Hospital, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - D Nabavi
- Klinik für Neurologie, Vivantes Klinikum Neukölln, Rudower Str. 48, 12351, Berlin, Deutschland
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Affiliation(s)
- M. Ritter
- Klinik und Poliklinik für Neurologie (Direktor: Univ.-Prof. Dr. med. E. Bernd Ringelstein), Universitätsklinikum Münster
| | - R. Dittrich
- Klinik und Poliklinik für Neurologie (Direktor: Univ.-Prof. Dr. med. E. Bernd Ringelstein), Universitätsklinikum Münster
| | - O. Busse
- Generalsekretär der Deutschen Schlaganfallgesellschaft, Berlin
| | - D. Nabavi
- Klinik für Neurologie, Vivantes Klinikum Neukölln, Berlin
| | - E. Ringelstein
- Klinik und Poliklinik für Neurologie (Direktor: Univ.-Prof. Dr. med. E. Bernd Ringelstein), Universitätsklinikum Münster
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Nabavi D, Sliwka U. Mikroembolusdetektion mittels transkranieller Dopplersonographie. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1060108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kuhlenbäumer G, Friedrichs F, Kis B, Berlit P, Maintz D, Nassenstein I, Nabavi D, Dittrich R, Stoll M, Ringelstein B. Association between single nucleotide polymorphisms in the lysyl oxidase-like 1 gene and spontaneous cervical artery dissection. Cerebrovasc Dis 2007; 24:343-8. [PMID: 17690546 DOI: 10.1159/000106980] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 04/13/2007] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Spontaneous cervical artery dissection (sCAD) is a common cause of stroke in patients below 55 years. Dermal connective tissue abnormalities have been observed in up to 60% of patients. A chromosomal locus for connective tissue abnormalities associated with sCAD has been mapped to chromosome 15q24 to a candidate region containing the lysyl oxidase-like 1 gene (LOXL1). LOXL1 an excellent candidate susceptibility gene for non-familial sCAD was investigated by mutation analysis and a genetic association study. METHODS We sequenced the whole coding region of the LOXL1 gene in 15 sCAD patients and performed a genetic association study in 157 sCAD patients using 12 single nucleotide polymorphisms (SNP). RESULTS The SNP rs3825942 (Gly153Asp) showed marginal association with sCAD on an allele basis and in the dominant genetic model, and intronic SNP rs893817 under a recessive model only. None of the SNP haplotypes was associated with sCAD. CONCLUSIONS Genetic variation in LOXL1 might play a role as a risk factor for sCAD.
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Affiliation(s)
- G Kuhlenbäumer
- Leibniz Institute of Atherosclerosis Research, University of Münster, Münster, Germany.
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Allroggen A, Prugger C, Wefers K, Weber T, Schilling M, Heuschmann P, Nabavi D. Vergleich zwischen der prähospitalen Los Angeles Schlaganfallskala und des Gesicht-, Arm- und Sprachtests zur Schlaganfallerkennung durch Rettungsassistenten. Akt Neurol 2007. [DOI: 10.1055/s-2007-987938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Crome O, Schönborn H, Reuter M, Jödicke A, Kretzschmar H, Zerr I, van Landeghem F, Nabavi D. Progressive Demenz mit Aphasie und passagerer Quadrantenanopsie – Variante einer sporadischen Creuztfeld-Jakob-Erkrankung. Akt Neurol 2007. [DOI: 10.1055/s-2007-987949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
We report on a female patient with brachioradial pruritus, in whom the cause could be verified by purposeful diagnostics (e. g., MRI). The clinical symptoms with localized itching result from circumscribed nerve root compression and hyperexcitation of the nerve fibers. Under treatment with gabapentin, an anticonvulsant with a very good analgesic and good antipruritic effect, the itch ceased and the skin changes healed. This case shows that this special form of neuropathic itch requires targeted therapy, which apart from symptomatic treatment should primarily focus on remedying the cause, if feasible.
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Kuhlenbäumer G, Konrad C, Krämer S, Kis B, Nabavi D, Dittrich R, Ringelstein EB. The collagen 1A2 polymorphism rs42524, which is associated with intracranial aneurysms, shows no association with spontaneous cervical artery dissection (sCAD). J Neurol Neurosurg Psychiatry 2006; 77:124-5. [PMID: 16361613 PMCID: PMC2117412 DOI: 10.1136/jnnp.2005.065847] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Völker W, Besselmann M, Dittrich R, Nabavi D, Konrad C, Dziewas R, Evers S, Grewe S, Krämer SC, Bachmann R, Stögbauer F, Ringelstein EB, Kuhlenbäumer G. Generalized arteriopathy in patients with cervical artery dissection. Neurology 2005; 64:1508-13. [PMID: 15883309 DOI: 10.1212/01.wnl.0000159739.24607.98] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To make an ultrastructural comparison of superficial temporal artery (STA) biopsy specimens from patients with spontaneous cervical artery dissection (sCAD) and controls. METHODS The authors used light microscopic examination of semithin sections and electron microscopic examination of ultrathin sections of STA biopsy specimens from patients with sCAD and controls. RESULTS STA biopsy specimens from patients with sCAD taken around the time of the dissection showed a zone of connective tissue weakening with fissuring at the junction between the tunica media (TM) and the tunica adventitia (TA) in seven of nine specimens and erythrocyte infiltration in eight of nine specimens but in none of the control specimens. Light microscopy demonstrated transparent circular spots that, on electron microscopy, turned out to represent erythrocytes and other cellular components at different stages of degradation. Occasionally, scattered immune cells were found in specimens from patients with sCAD. In addition, smooth muscle cells of the synthetic phenotype, some of them showing extensive vacuolation were more common in the TM of STA biopsy specimens from patients with sCAD than in control specimens. CONCLUSIONS Signs of tissue weakening along the TM/TA junction in STA biopsy specimens of patients with sCAD but not in controls suggest the presence of a generalized arteriopathy leading to impairment of the stability of the arterial wall in patients with sCAD. Limiting factors of the study are that some control biopsies were obtained from autopsies and that the anticoagulation status of patients and controls were not completely comparable.
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Affiliation(s)
- W Völker
- Institute of Atherosclerosis Research, University of Münster, Münster, Germany
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Abstract
OBJECTIVE The purpose of this study was to determine whether participation in sports by persons with spinal cord injuries (SCIs) affected level of community integration as defined by the World Health Organization and as measured by the Craig Handicap Assessment and Reporting Technique (CHART). METHOD Forty-eight participants were recruited from a camp for persons with physical disabilities as well as from SCI support groups. Participants were divided into groups of athletes (n = 30) and nonathletes (n = 18) on the basis of their self-reported level of sports participation. RESULTS Athletes scored significantly higher on four of five subsections of the CHART (physical independence, mobility, occupation, social integration), indicating greater levels of community integration than nonathletes. CONCLUSION These findings extend the literature outlining the physical and psychological benefits of sports. Occupational therapists have a unique opportunity to use the occupation of sports to integrate the roots of the profession with the cultural demands of society.
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Affiliation(s)
- C S Hanson
- Department of Occupational Therapy, University of Florida, PO Box 100164, Gainesville, Florida 32610, USA.
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Abstract
Stroke is the third most important cause of mortality, but the leading cause of severe handicap, dependency, and loss of social competence. Because of the high recurrence rate, active secondary prevention is mandatory once a stroke has occurred. Secondary prevention of stroke implies the primary prevention of cardiovascular disorders as well. Among the modifiable risk factors hypertension is worst and should be normalized according to recent WHO criteria, also in the elderly. Smoking is another major risk factor and hard to delete. Diabetes mellitus and hyperlipidaemia are also important risk factors and should be treated consequently by diet and medication. Moderate alcohol intake, normalization of body weight and regular physical activity also contribute considerably to prevention of stroke. Whether hyperhomocysteinaemia should be normalized has not yet been clarified. Cardiovascular disorders are an important source of ischemic strokes, particularly atrial fibrillation. Low dose anticoagulation can dramatically reduce stroke risk. Carotid endarterectomy in symptomatic stenoses is the most expensive means of stroke prevention. In less severe stenoses, or ICA occlusions, antiplatelet agents are the treatment of choice. Composite drugs with ASS and other antiplatelet agents seem to be superior to either compound alone. Dissections of the cervical arteries should not be operated on but may be treated by anticoagulation or antiplatelet agents in the acute and subacute phase. The potency of a consequent and comprehensive stroke prevention in preventing disability and death is much greater than any sophisticated acute stroke treatment.
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Affiliation(s)
- E B Ringelstein
- Klinik und Poliklinik für Neurologie, Westfälische Wilhelms Univerität Münster, Münster, Germany
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Schmid C, Wilhelm M, Rothenburger M, Nabavi D, Deng MC, Hammel D, Scheld HH. Effect of high dose platelet inhibitor treatment on thromboembolism in Novacor patients. Eur J Cardiothorac Surg 2000; 17:331-5. [PMID: 10758396 DOI: 10.1016/s1010-7940(00)00334-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Thromboembolism and bleeding are among the most hazardous complications following implantation of long-term left ventricular support systems. This report focuses on the effect of high dose platelet inhibitor treatment in patients with the Novacor system to prevent thromboembolic events. METHODS Thirty-eight (out of 58) Novacor patients (43+/-11 years old) were studied in a non-randomized manner. Postimplantation: 20 patients were treated with heparin only (control group), whereas in the other 18 patients aspirin (3x330 mg/day) and dipyridamol (3x75 mg/day) were added to the treatment protocol (aspirin group). RESULTS Age, body size, underlying heart disease and support interval were comparable among both groups, however, patients in the aspirin group were much sicker with regard to urgency status, postoperative right heart failure and hematologic disorders. Cerebral thromboembolic complications were lower in the aspirin group (33% of patients, 0.4+/-0.7 events) as compared to the control group (55% (P=0.18), 1.4+/-2.3 events (P=0. 048)). Non-cerebral thromboembolism of surgical relevance was rare. The incidence of bleeding complications was mildly increased in the aspirin group. CONCLUSION The addition of high dose platelet inhibitors seems to lower the incidence of thromboembolism in Novacor patients.
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Affiliation(s)
- C Schmid
- Department of Cardiothoracic Surgery, Westfälische Wilhelms-University Münster, Germany.
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Schmid C, Weyand M, Hammel D, Deng MC, Nabavi D, Scheld HH. Effect of platelet inhibitors on thromboembolism after implantation of a Novacor N100--preliminary results. Thorac Cardiovasc Surg 1998; 46:260-2. [PMID: 9885115 DOI: 10.1055/s-2007-1010235] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Left-ventricular assist device implantation (LVAD) is still associated with thromboembolism as the optimal anticoagulation is still unclear. We report on the effects of adding platelet inhibitors to our anticoagulation regimen in our Novacor LVAD program. METHODS Oral platelet aggregation inhibitors (aspirin 330 mg + dipyridamole 75 mg, three times per day) were added to the heparin/phenprocoumon treatment in 9 patients starting on postoperative day 3 to 7 (group A). Of the previous 41 patients, the last 20 patients served as a control group (group B), to reduce any learning curve effect. RESULTS The mean interval of mechanical support between the two groups was comparable (group A vs B: 148 +/- 127 vs 104 +/- 61 days, n.s.). Accordingly, the cumulative support was much lower in group A (1051 days) as compared to group B (2091 days). In group B, 10 patients (50%) developed clinically evident thromboembolism. The number of events ranged from 1 to 10 (mean 1.4 +/- 2.3), with a total of 32. With addition of platelet inhibitors, the incidence of cerebral embolism dramatically dropped, as only one patient presented with transient ischemic attacks in group A (p < 0.05). Thoracic bleeding as defined by excessive drainage losses requiring redo thoracotomy did not increase (group A vs B: 22% vs 20%, n.s.). CONCLUSION Addition of platelet inhibitors to heparin/phenprocoumon effectively prevents thromboembolism. However, platelet inhibitors should be postponed until sufficient hemostasis is achieved, since too early administration is associated with an increased risk of bleeding.
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Affiliation(s)
- C Schmid
- Department of Thoracic and Cardiovascular Surgery, Westfalian Wilhelms University, Münster, Germany
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Georgiadis D, König M, Zunker P, Nabavi D, Stögbauer F, Ringelstein EB. Microembolic signals inpatients referred for echocardiography. Stroke 1995; 26:525; author reply 526-7. [PMID: 7886738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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