Community attitudes to smoking in restaurants.
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Biomedical subjects
Publications and source records attributed to A Capon.
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BACKGROUND AND PURPOSE: Seasonal variation in the incidence of cerebral hemorrhage has been previously demonstrated. In this study, we sought to identify the climatological data best correlated with this seasonal variation. METHODS: In a retrospectively studied sequential series of 236 patients with nontraumatic cerebral hemorrhage observed in Brussels over a period of 8 years, we cumulatively grouped the dates of stroke occurrence into a single calendar year. RESULTS: We found marked seasonal variation in incidence, with the highest value (23%) observed in November-December and the lowest (10%) in July-August. Seasonal variations in incidence of cerebral hemorrhage were shown to be correlated not only with the inverse of ambient temperature, but also with the inverse of hours of sunshine and with ambient humidity. We found no difference between hypertensive and normotensive patients. CONCLUSIONS: Our study fails to bear out the hypothesis that the higher incidence of cerebral hemorrhage in late autumn and winter is due to the influence of low ambient temperature on blood pressure.
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In order to investigate functional cortical reorganization during recovery from conduction aphasia, regional cerebral blood flows (rCBF) were measured by the two-dimensional 133 Xenon inhalation method in ten stroke patients. rCBF measurements were performed at rest and during the performance of a linguistic task, one month and three months after onset. The analysis of flow changes from rest to test condition indicates an increasing contribution of the right hemisphere as time goes on. The absence of flow increase in Broca's region suggests that this region is definitively disconnected from posterior language "centers" by the arcuate fasciculus lesion.
In 539 consecutive stroke patients admitted to a rehabilitation department, we studied the possible role of atrial fibrillation as a risk factor for deep venous thrombosis and pulmonary embolism by analyzing a series of relevant clinical data in patients with and without atrial fibrillation and in patients with and without venous thromboembolic complications. Deep venous thrombosis as well as advanced age and cardiac disease were significantly (p less than 0.001) more frequent in patients with atrial fibrillation. However, in a model of simultaneous logistic regression carried out on the presence of absence of venous thromboembolic complications, atrial fibrillation was the only significant risk factor. In view of the morbidity and mortality linked to deep venous thrombosis, our findings argue for preventive anticoagulation therapy in stroke patients suffering from atrial fibrillation and merit further study.
We studied the effect of deep-seated left hemispheric lesions on cortical blood flow in 18 right-handed aphasic stroke patients. Regional cerebral blood flow was measured at rest and during the performance of a functional naming test using the two-dimensional xenon-133 inhalation method. Compared with 10 controls, at rest the patients showed regional cortical hypoperfusion in the left frontoparietal region. In the controls, activation patterns from the rest to the test condition involved mainly the left hemisphere areas. In the patients, a lack of blood flow change was observed in several areas that were usually hypoperfused at rest. However, in patients with slight verbal expression disorders there were obvious blood flow increases in other brain regions in both hemispheres. Such cortical functional reorganization and the presence of a remote cortical dysfunction could play a role in the pathophysiology of language disorders.
In 3 patients with a stroke limited to the posterior fossa, regional cerebral blood Flows were measured by the 133 Xe inhalation method (the first two cases) or by the SPECT with HMPAO method (the third case). The first patient had a median and paramedian hematoma of the left cerebellar hemisphere and the left dorsolateral portion of the pons. Remote cerebral hypoperfusion, measured 3 months later, was observed in both frontal premotor regions (but more marked in the right hemisphere) and in a circumscribed area of the right temporal region. The second patient had a right-sided ischaemic lesion of the anterior cerebellar lobe and the mesencephalic tectum. Contralateral parietal and rolandic hypoperfusion, measured 7 weeks after the stroke, was observed. The third patient had on old infarct of the right cerebellar hemisphere. The SPECT, measured 17 years later, showed a left fronto-parieto-temporal hypoperfusion and the absence of perfusion in the right cerebellar hemisphere. Preliminary data of neuropsychological assessment in our patients disclosed impairment in visuo-spatial and constructive organization, memory and learning compatible with the published findings in some patients and animals with predominantly cerebellar damage. These interesting findings should be confirmed in a large number of patients with age, sex, and sociocultural matched controls. In the absence of supratentorial insult, and during the hemodynamical stable phase, crossed cerebello-cerebral diaschisis is suggested in our 3 patients. Although it is too early to draw definite conclusions, our findings may: (1) confirm the functional interconnections between the cerebellum and the cerebrum in man and (2) provide functional basis for the behavioral function impairment reported in patients with cerebellar insult. Further rCBF, metabolism, and pathologic studies on this subject are required to elucidate this issue.
In order to study the pathophysiology of language disorders due to deep-seated left-hemisphere lesions not involving the cortex, a population of 43 right-handed stroke patients (29 aphasic) presenting with such lesions was studied clinically and by regional cerebral blood flow measurements (two-dimensional xenon-133 inhalation method). Most of the patients were studied sequentially between the 1st and 3rd months after stroke. Cortical diaschisis did not account for the whole clinical picture: the remote effect on the cortex could explain the occurrence of aphasia and its severity but not the type of aphasia. Furthermore, the clinical improvement observed in most cases was not accompanied by the disappearance of the diaschisis.
We measured regional cerebral blood flow using the xenon-133 inhalation method, at approximately 1 month after onset, in 60 stroke patients who had no evidence of major carotid artery stenosis or occlusion. Their single lesions (43 infarcts and 17 hematomas) were located in the capsulothalamolenticular region, sparing the cortex. Hemispheric mean cerebral blood flow was reduced on the side of the lesion in 25 patients and on both sides in 20. Regional hypoperfusion was observed in 46 patients (ipsilaterally in 34, bilaterally in 10, and contralaterally in two). Regional hypoperfusion was observed most frequently in the frontal lobe, particularly in the motor and premotor cortices of the prerolandic area. The 46 patients with regional hypoperfusion were compared with the 14 patients without regional hypoperfusion, considering the size and location of the lesion as well as the functional and analytic motor performances. As a rule, the lesion was slightly smaller and more posterior and the functional (p less than 0.001) and analytic (p less than 0.05) motor performances were significantly better in the 14 patients without regional hypoperfusion. Since the xenon-133 inhalation method examines cortical blood flow, we can attribute blood flow reductions resulting from deep-seated lesions to a functional depression akin to diaschisis. Interpretation of the clinical consequences and pathogenesis of this phenomenon requires further sequential and pathologic studies.
In a placebo-controlled, double-blind study, 82 patients in the subacute stage of a disabling stroke were studied to assess the effect on clinical improvement of 600 mg naftidrofuryl against placebo. Forty-two patients were treated with the drug and 40 with placebo, in each case administered for 60 days. All patients received 100 mg aspirin and 300 mg dipyridamole daily and entered a similar program of rehabilitation therapy. At the start and the end of the study, the motor functions of the upper and lower limbs, the ability to walk and to perform daily activities, the comprehension and expression of speech, and the mental progress were assessed with quantitative linear scales. In the group treated with active drug, a greater overall tendency of improvement was observed, reaching statistically significant levels for walking and activities of daily life when compared to placebo-treated patients. Overall improvement was negatively influenced by advancing age, but the statistically significant effect of treatment on walking and daily activities was not interfered with by age. Right-sided lesions showed better improvement under active drug than left-sided lesions. This may be due to a correctional effect of naftidrofuryl on hemispatial neglect.
We studied the mechanisms underlying the recovery of motor function of the hand using a bidimensional xenon-133 inhalation technique to measure regional cerebral blood flow at rest and during the performance of a motor task (test condition). The regional cerebral blood flow patterns under rest and test conditions were compared in normal control and in stroke patients with either a cortico-subcortical or a deep-seated lesion. Functional recovery appears to depend upon cortical reorganization involving both hemispheres, particularly in both parietal regions in the subgroup of patients with cortico-subcortical lesions.
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In a right handed patient with crossed aphasia, two atraumatic techniques (regional cerebral blood flow measurements during the performance of a linguistic task and dichotic listening test) were used to assess language lateralization. The prominence of rCBF activation patterns in the right hemisphere and the presence of a clear-cut right ear extinction on the dichotic listening test provide evidence that, is this case, the right hemisphere was dominant for language.
In order to evaluate the prognostic value of CT scan in aphasic stroke patients, a prospective study was performed during the first 3 months of the disease. The severity of the language disorders was assessed by means of a quantitative method. In cortico-subcortical lesions, the verbal expression recovery rate and the final verbal expression and comprehension status depended on the infarct size. No relation was observed between the latter and the verbal comprehension recovery rate. In deep-seated lesions, computed tomography provided no information concerning the prognosis.
Cerebral blood flow (133Xenon inhalation method) has been studied in 30 aphasic stroke patients at 15, 30, 60 and 90 days after onset. In total aphasia the CBF values are low and the regional hypoperfused areas are extensive. In Broca's, Wernicke's and nominal aphasias, resting CBF measurements do not provide the clinician with useful additional information and clinical improvement can by no means be attributed to a resting CBF rise during the observation period.
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