Biomedical subjects

A Terent

Publications and source records attributed to A Terent.

At least 19 recordsLinked to original sources

PubMed2006

Endothelium-dependent vasodilatation in forearm is impaired in stroke patients.

OBJECTIVES: To investigate endothelium-dependent vasodilatation (EDV) in stroke patients. DESIGN: Cross-sectional. SETTING: University referral hospital. SUBJECTS: We studied 23 stroke patients (65-75 years old) who did not have atrial fibrillation or Warfarin treatment. Forty-six age- and sex-matched healthy controls and another 32 controls matched also for hypertension and medication were used for comparisons. METHODS. Endothelium-dependent vasodilatation was measured with venous occlusive plethysmography of forearm blood flow during intra-brachial infusion of acetylcholine. Endothelium-independent vasodilatation (EIDV) was evaluated by infusion of sodium nitroprusside. RESULTS: Stroke patients showed significantly lower EDV (P < 0.001) compared with healthy controls when measured with acetylcholine-stimulated forearm blood flow. The difference between these groups remained significant also after correction for blood pressure, body mass index, blood glucose and cholesterol. There was also significant difference in EDV between hypertension-matched controls and healthy controls. However, EIDV was significantly reduced in stroke patients (P < 0.01), but not in the hypertensive group, when compared with healthy controls. CONCLUSION: An impaired EDV was seen in both stroke patients and hypertensive-matched controls, while an impaired EIDV was seen in the stroke patients only, suggesting a more severe vasodilatory dysfunction in stroke patients than could be explained by a high blood pressure only.

Acetylcholine↗

PubMed2005

Blood glucose in acute stroke, different therapeutic targets for diabetic and non-diabetic patients?

OBJECTIVES: To study the impact of blood glucose concentrations on early stroke mortality in diabetic and non-diabetic stroke patients, and to identify the optimal blood glucose concentration for each patient category. MATERIAL AND METHODS: A representative sample of 81 diabetic and 366 non-diabetic stroke patients was studied. Logistic regression analyses were performed in order to estimate the impact of blood glucose concentrations on admission and during hospital stay and other clinical parameters on 30-day case-fatality. Receiver operating characteristic curves were used to predict case-fatality by blood glucose. RESULTS: Blood glucose, body temperature and level of consciousness were independently related to early stroke mortality in diabetic and non-diabetic patients. The mean blood glucose concentration had a greater impact on 30-day case-fatality than the admission blood glucose, particularly in diabetic patients. A mean blood glucose concentration above 10.3 mmol/l predicted 30-day case-fatality in diabetic patients. The corresponding value was 6.3 mmol/l in non-diabetic patients. CONCLUSION: Improved blood glucose control has a potential to reduce early stroke mortality. The optimal glucose concentration seems to be higher in diabetic than in non-diabetic patients.

Acute Disease↗

PubMed2004

Detection and appearance of intraparenchymal haematomas of the brain at 1.5 T with spin-echo, FLAIR and GE sequences: poor relationship to the age of the haematoma.

The specific appearance of blood related to time at T1- and T2-weighted spin-echo (SE) sequences is generally accepted; thus, these sequences are classically used for estimating the age of haematomas. Magnetic resonance imaging at 1.5 T, including T1- and T2-weighted SE fluid-attenuated inversion recovery (FLAIR) and T2*-weighted gradient-echo (GE) sequences, was performed on 82 intraparenchymal haematomas (IPHs) and 15 haemorrhagic infarcts (HIs) in order to analyse the appearance at different stages and with different sequences, and to investigate how reliably the age of hematomas can be estimated. The IPHs had been previously detected by CT, were spontaneous ( n=72) or traumatic ( n=10) in origin and were of different sizes (2 mm to 7 cm) and ages (from 7.5 h to 4 years after acute haemorrhagic event). The age of the lesion was calculated from the moment when clinical symptoms started or the traumatic event occurred. The 15 patients with HIs were patients with ischaemic stroke in whom there was either a suspicion of haemorrhagic transformation on CT, or haemorrhage was detected as an additional finding on MR performed for other indications. Patients with conditions that could affect the SI of blood, such as anticoagulant therapy or severe anaemia, were excluded. The signal intensity pattern of the lesions was analysed and related to their ages without prior knowledge of the clinical data. All lesions were detected with T2*-weighted GE. T1-weighted SE missed 13 haematomas and T2-weighted SE and FLAIR sequences missed five. Haemorrhagic transformation was missed in three infarcts by T1-, T2-weighted SE and FLAIR. The signal pattern on FLAIR was identical to that on T2-weighted SE. For all sequences, a wide variety of signal patterns, without a clear relationship to the age of the haematomas, was observed. There was a poor relationship between the real MR appearance of IPHs and the theoretical appearance on SE sequences. T2*-weighted GE was effective for detecting small bleedings but was not useful for estimating the age of a lesion. The FLAIR does not provide any more information than T2-weighted SE.

Brain↗

PubMed2004

Rapid Emergency Medicine score: a new prognostic tool for in-hospital mortality in nonsurgical emergency department patients.

OBJECTIVES: To evaluate the predictive accuracy of the scoring system Rapid Acute Physiology score (RAPS) in nonsurgical patients attending the emergency department (ED) regarding in-hospital mortality and length of stay in hospital (LOS), and to investigate whether the predictive ability of RAPS could be improved by extending the system. DESIGN: Prospective cohort study. SETTING: An adult ED of a 1200-bed university hospital. SUBJECTS: A total of 12 006 nonsurgical patients presenting to the ED during 12 consecutive months. METHODS: For all entries to the ED, RAPS (including blood pressure, respiratory rate, pulse rate and Glasgow coma scale) was calculated. The RAPS system was extended by including the peripheral oxygen saturation and patient age (Rapid Emergency Medicine score, REMS) and this new score was calculated for each patient. The statistical associations between the two scoring systems and in-hospital mortality as well as LOS in hospital were examined. RESULTS: The REMS was superior to RAPS in predicting in-hospital mortality [area under receiver operating characteristic (ROC) curve 0.852 +/- 0.014 SEM for REMS compared with 0.652 +/- 0.019 for RAPS, P < 0.05]. An increase of 1-point in the 26-point REMS scale was associated with an OR of 1.40 for in-hospital death (95% CI: 1.36-1.45, P < 0.0001). Similar results were obtained in the major patient groups (chest pain, stroke, coma, dyspnoea and diabetes), in all age groups and in both sexes. The association between REMS and LOS was modest (r = 0.47, P = 0.0001). CONCLUSIONS: The REMS was a powerful predictor of in-hospital mortality in patients attending the ED over a wide range of common nonsurgical disorders.

Adolescent↗

PubMed2003

Effects of a perindopril-based blood pressure-lowering regimen on disability and dependency in 6105 patients with cerebrovascular disease: a randomized controlled trial.

BACKGROUND AND PURPOSE: We sought to quantify the effects of blood pressure lowering on long-term disability and dependency among patients with cerebrovascular disease. METHODS: We performed a randomized, double-blind, placebo-controlled trial. A total of 6105 participants with a history of stroke or transient ischemic attack in the past 5 years were recruited from 172 hospital outpatient clinics in 10 countries. Subjects were randomly assigned to the following groups: active treatment (angiotensin-converting enzyme inhibitor perindopril [4 mg/d] for all patients, with the diuretic indapamide added at the discretion of treating physicians) or matching placebo(s). Measurements were disability (defined as a Barthel Index score < or =99/100) and dependency (a positive response to the following question: "In the last 2 weeks has the patient required regular help with everyday activities?"). RESULTS: The median duration of follow-up was 4 years. At the last available assessment, 19% of the active treatment group and 22% of the placebo group were disabled (adjusted odds ratio, 0.76; 95% CI, 0.65 to 0.89; P<0.001). Twelve percent of the active treatment group and 14% of the placebo group were dependent (adjusted odds ratio, 0.84; 95% CI, 0.71 to 0.99; P=0.04). The effects of treatment appeared to be mediated primarily through the prevention of disability and dependency associated with recurrent stroke. Four-year treatment with the study drug regimen would be expected to result in the avoidance of 1 case of long-term disability for every 30 (95% CI, 19 to 79) patients. CONCLUSIONS: Among individuals with cerebrovascular disease, a perindopril-based blood pressure-lowering regimen not only reduced the risk of stroke and major vascular events but also substantially reduced the risks of associated long-term disability and dependency.

Activities of Daily Living↗

PubMed1999

Identification of incident stroke in Norway: hospital discharge data compared with a population-based stroke register.

BACKGROUND AND PURPOSE: The validity of hospital discharge diagnoses is essential in improving stroke surveillance and estimating healthcare costs of stroke. The aim of this study was to assess sensitivity, positive predictive value, and accuracy of discharge diagnoses compared with a stroke register. METHODS: A record linkage was made between a population-based stroke register and the discharge records of the hospital serving the population of the stroke register (n=70 000). The stroke register (including patients aged 15 and older and with no upper age limit), applied here as a "gold standard," was used to estimate sensitivity, positive predictive value, and accuracy of the discharge diagnoses classification. The length of stay in hospital by stroke patients was measured. RESULTS: Identifying cerebrovascular diseases by hospital discharge diagnoses (International Classification of Diseases, 9th Revision [ICD-9], codes 430 to 438.9, first admission) lead to a substantial overestimation of stroke in the target population. Restricting the retrieval to acute stroke diagnoses (ICD-9 codes 430, 431, 434, and 436) gave an incidence estimate closer to the "true" incidence rate in the stroke register. Selecting ICD-9 codes 430 to 438 of cerebrovascular diseases gave the highest sensitivity (86%). The highest positive predictive value (68%) was achieved by selecting acute stroke diagnoses (ICD-9 codes 430, 431, 434, and 436), at the expense of a lower sensitivity (81%). Accuracy of ICD codes 430 to 438.9 (n=678) revealed the highest proportion of incident strokes identified by the acute stroke diagnoses (ICD-9 codes 430, 431, 434, and 436). Seventy-four percent of hospital discharge diagnoses classified as first-ever stroke kept the original diagnosis. Only 4.6% of the discharge diagnoses were classified as nonstroke diagnoses after validation. The estimation of length of stay in the hospital was improved by selection of acute stroke diagnoses from hospital discharge data (ICD-9 codes 430, 431, 434, and 436), which gave the same estimate of length of stay, a median of 8 days (2.5 percentile=0 and 97.5 percentile=56), compared with a median of 8 days (2.5 percentile=0 and 97.5 percentile=51) based on the stroke register. CONCLUSIONS: Hospital discharge data may overestimate stroke incidence and underestimate the length of stay in the hospital, unless selection routines of hospital discharge diagnoses are restricted to acute stroke diagnoses (ICD-9 codes 430, 431, 434, and 436). If supplemented by a validation procedure, including estimates of sensitivity, positive predictive value, and accuracy, hospital discharge data may provide valid information on hospital-based stroke incidence and lead to better allocation of health resources. Distinguishing subtypes of stroke from hospital discharge diagnoses should not be performed unless coding practices are improved.

Cerebrovascular Disorders↗

PubMed1998

[Thrombolysis changes the care of stroke].

Thrombolysis using tissue plasminogen activator (tPA) is not the leading strategy in the development of pharmacological treatments for acute ischaemic stroke. The prospect of tPA becoming routine treatment in ischaemic stroke raises several issues the magnitude of the treatment load, the requisite neurological and neuroradiological diagnostic qualifications, identification of local reperfusion effects in the brain, and the pre-hospital and hospital management of acute stroke patients. The results of large randomised trials of intravenous tPA treatment are reviewed in the article, and the current state of our knowledge about interventional thrombolysis is reported. Recruitment for the second European intravenous tPA trail, ECASS II, has recently been completed, and the study findings will be available during the latter half of 1988. In the USA, tPA is already recommended treatment for acute ischaemic stroke within three hours after the onset of symptoms. In Europe, the formulation of guidelines awaits the results of ECASS II.

Cerebral Infarction↗

PubMed1997

Epidemiology of stroke in Innherred, Norway, 1994 to 1996. Incidence and 30-day case-fatality rate.

BACKGROUND AND PURPOSE: In Norway, as well as other industrialized countries, mortality from stroke has declined over the past decades. Data on stroke morbidity are lacking. This study was conducted to determine the incidence, case fatality, and risk factors of stroke in a defined Norwegian population. METHODS: During the period 1994 to 1996, a population-based stroke registry collected uniform information about all cases of first-ever and recurrent stroke occurring in people aged > or = 15 years in the region of Innherred in the central part of Norway (target population 70,000), where the prevalence of cardiovascular risk factors was screened in 1984 to 1986 and 1995 to 1997. RESULTS: During the 2 years of registration (September 1, 1994, to August 31, 1996), 432 first-ever (72.8%) and 161 recurrent (27.2%) strokes were registered. The crude annual incidence rate was 3.12/1000 (2.85/1000 for males and 3.38/1000 for females). Adjusted to the European population, the annual incidence rate of first-ever stroke was 2.21/1000. The annual incidence rate of cerebral infarction was 2.32/1000, intracerebral hemorrhage 0.32/1000, subarachnoid hemorrhage 0.19/1000, and unspecified stroke 0.38/1000. The 30-day case-fatality rate was 10.9% for cerebral infarction, 37.8% for intracerebral hemorrhage, and 50.0% for unspecified stroke. Fourteen percent of the patients were found outside the hospital, and only 50% of the suspected stroke cases in the hospital (at admission or reviewed discharge diagnosis of ICD-9 codes 430 to 438) fitted the final inclusion criteria. CONCLUSIONS: This first population-based stroke register in Norway revealed incidence rates of stroke similar to other Scandinavian countries, and comparison between other European countries did not indicate regional variations within Western Europe.

Adolescent↗

PubMed1995

Magnetic resonance imaging as an aid to the diagnosis and treatment evaluation of suspected myocardial sarcoidosis in a fighter pilot.

We present a case of possible myocardial sarcoidosis suspected by the presence of multiorgan sarcoidosis along with cardiac dysrhythmia. The diagnosis of a highly probable sarcoid infiltrate was made by magnetic resonance imaging, depicting a high intensity mass in the ventricular septum. Following corticosteroid treatment the mass disappeared, and remains absent after 3 years followup. Also, only minor dysrhythmia has been observed during this period. The aeromedical implications are discussed.

Adult↗

PubMed1987

A long-term study on the effect of pindolol on serum lipoproteins: a preliminary report.

1. Preliminary results are reported from a long-term study aimed at recording the concentrations of serum lipids and lipoproteins at 6, 12 and 24 months of treatment with pindolol in young/middle-aged males with moderate hypertension. 2. Seventy-three patients have been recruited, of whom 47 have completed 6 months treatment. After 6 months treatment 35/47 patients had attained the target blood pressure of less than or equal to 95 mm Hg and analysis of plasma lipid and lipoprotein concentrations revealed a tendency for an increase of serum triglycerides and a lowering of low density lipoprotein cholesterol.

Adult↗

PubMed1983

Eosinophil cationic protein (ECP) in the cerebrospinal fluid.

ECP (eosinophil cationic protein) has been measured by means of a specific radioimmunoassay in the cerebrospinal fluid (CSF) from 210 individuals with various diseases affecting the central nervous system. In the same specimens lactoferrin and albumin were measured as well, as indicators of neutrophil-involved inflammation and damage to the blood-brain barrier. From a patient reference group (n = 39) the upper "normal" limit for ECP was estimated to 1.7 microgram/l. In patients with acute cerebrovascular disease (n = 108) ECP levels were elevated in 38% of the cases which was a significantly (P less than 0.001) greater proportion than seen for lactoferrin (7%). In patients with acute infections of the CNS (n = 30) 67% had raised ECP levels with significantly higher levels (P less than 0.001) in those having bacterial infections. The ECP levels were significantly correlated (P less than 0.001) to the lactoferrin-levels in the whole infectious group. In patients with tumours (n = 25) raised levels of ECP were found in 67% of those with malignant and in 6% of those having benign tumours. This difference was statistically significant (P = 0.001). The ECP levels were closely related to those of lactoferrin (P less than 0.001) and albumin (P less than 0.005). Of the patients with multiple sclerosis (n = 19) 25% had raised ECP levels. This proportion was not significantly different from those having raised lactoferrin levels. In three patients extremely high ECP levels (70-455 micrograms/l) were found and a causal relationship between ECP and the brain tissue damage in these patients is suggested. In comparison with the neutrophil-related data the findings suggest a preferential involvement of eosinophils in some diseases affecting the central nervous system.

Adolescent↗

PubMed1983

Cerebrospinal fluid markers in relation to outcome in patients with global cerebral ischemia.

To investigate the possibility of improving the accuracy of prognostication in early hypoxic brain damage, 12 patients with global cerebral ischemia (GCI) due to circulatory arrest outside hospital were followed until death or for 1 yr. Five who survived for more than 2 weeks displayed better values on coma scoring from 16 h-3 days, compared to those who succumbed within 2 weeks. In 2 week-survivors, lumbar puncture revealed consistently lower adenylate kinase (AK) activity in cerebrospinal fluid (CSF) at 24 h than in the other patients, whereas glutathione and lactate values overlapped to some degree. The CSF-AK activity at 48--72 h was less correlated to clinical outcome. It is concluded that the results from coma scoring, based upon clinical observation, and from determination of AK activity in CSF at 24 h reinforce each other in discriminative power to predict prognosis in these patients.

Adenylate Kinase↗

PubMed1980

Cerebrospinal fluid ferritin in patients with cerebral infarction or bleeding.

By the use of a radioimmunoassay, ferritin was detected in the cerebrospinal fluid (CSF) of apparently healthy individuals at a mean concentration of 5.1 arb U/l, i.e. a level about 5% of the mean normal serum-ferritin concentration. Fourteen patients with acute cerebrovascular stroke or transient ischemic attacks (one case) were followed by serial determinations of CSF-ferritin during 2 weeks or more from onset of symptoms. After cerebral stroke all patients exhibited an increase of CSF-ferritin with peak levels between 4 and 6 days from admission. Those three patients in whom computed tomography showed cerebral bleeding had the highest peak CSF-ferritin was 28 +/- 11 arb U/l in the patients who had cerebral infarction without signs of bleeding. In seven patients CSF-ferritin returned to the control range after 2 weeks. The extent of the rise of ferritin in CSF could not be explained by damaged blood-CSF barrier. We suggest that the increment of ferritin in CSF of patients with cerebrovascular lesions may reflect an inflammatory response within the brain possibly mediated by macrophages.

Adolescent↗

PubMed1980

Cerebrospinal fluid markers of disturbed brain cell metabolism in patients with stroke and global cerebral ischemia.

Adenylate kinase activity was found in 32 of 34 samples of cerebrospinal fluid (CSF) from 21 patients with stroke and seven patients with global cerebral ischaemia (GCI). The light absorbance values of the spectrum 400-650 nm revealed the scanty occurrence of haemoglobin products in the CSF in some patients. No correlation was found between the absorbance values at 415 nm, reflecting oxyhaemoglobin, and the adenylate kinase activities. Thus, a main contribution to the adenylate kinase activity in CSF by leakage of this enzyme from erythrocytes could be ruled out. Instead increased leakiness of the brain cells, having an impaired metabolism due to insufficient supply of oxygen and glucose, was the most plausible cause of the findings. The quotient between the adenylate kinase activity and the light absorbance at 415 nm seemed to reflect the extent of ischaemically deranged brain tissue in the GCI patients, while the CSF-lactate values were not correlated to the clinical outcome. Glutathione, an intracellular tripeptide, was more often found in the CSF from GCI patients than from stroke patients.

Adenylate Kinase↗

PubMed1980

Laryngeal granuloma in the early stages of Wegener's granulomatosis.

Non-healing granulomata of the upper or lower respiratory tract often cause diagnostic and therapeutic problems. A case of Wegener's granulomatosis is reported, which during the first year of illness presented only with signs of a laryngeal granuloma. When severe renal disease developed and cytostatic therapy was prompted, the laryngeal lesion showed an excellent response to the treatment. The case illustrates the difficulties encountered in the management of patients with Wegener's granulomatosis.

Granuloma, Laryngeal↗

PubMed1979

A prospective epidemiological survey of cerebrovascular disease in a Swedish community.

A prospective epidemiological study of cerebrovascular diseases and transient ischemic attacks (TIA) is presented. During a three-year period the annual incidence of strokes was 2.90 and of TIA 0.45 per thousand population. This difference in incidence and the disparities in age characteristics favour the hypothesis that TIA precedes only a minority of the strokes. The short-term mortality is high among the stroke patients.

Adult↗

PubMedDate not supplied

Ischemic edema in stroke. A parallel study with computed tomography and cerebrospinal fluid markers of disturbed brain cell metabolism.

Thirteen patients with stroke and one with TIA had repeated examinations with computed tomography (CT) of the head, examination of the cerebrospinal fluid (CSF) for adenylate kinase, glutathione, lactate, and albumin and clinical evaluations during the first fortnight after onset. In 9 patients with cerebral infarction edema shown on the CT scans was maximal on days 2--5, after which it diminished. In 2 patients with intracerebral hemorrhage the edema appeared early as a zone of low-attenuation around the high-attenuation area. Most patients with large lesions deteriorated clinically during development of the edema. In 3 patients the CT scans were inconclusive, probably because the lesion was too small. Adenylate kinase activity was present in all CSF samples during the period 6 hours-5 days, while glutathione was occasionally present in the CSF in 12 of the 14 patients. These findings are believed to indicate cell swelling and a leak in the plasma membrane. Based on these observations, it is suggested that initial ischemic edema is intracellular in patients with cerebral infarction, and that adenylate kinase in CSF is a sensitive marker for this type of edema.

Adenylate Kinase↗

PubMedDate not supplied

Lactoferrin, lysozyme, and beta 2-microglobulin in cerebrospinal fluid. Elevated levels in patients with acute cerebrovascular lesions as indices of inflammation.

Serial determinations of beta 2-microglobulin, lactoferrin and lysozyme in CSF were performed in 14 patients with acute cerebrovascular lesions. Marked elevations were noted in patients with cerebral bleeding or hemorrhagic infarction. Patients with infarction without signs of bleeding or with cerebrovascular lesions undetectable by computed tomography also had an increase in these proteins. The increases in CSF of beta 2-microglobulin, lactoferrin and lysozyme could not be explained by a damaged blood-brain barrier but was believed to be a local product of the central nervous system. Peak levels of lactoferrin and lysozyme were noted on day 2-3 after onset of symptoms. Lactoferrin then declined while lysozyme remained elevated for another few days. beta 2-microglobulin gradually increased reaching peak levels on day 4-5 and remained elevated even 2 weeks after the onset of symptoms. We suggest that the increases of lactoferrin, lysozyme and beta 2-microglobulin reflect various inflammatory reactions mediated by granulocytes, macrophages and lymphocytes, respectively.

Acute Disease↗