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Biomedical subjects

C Helmers

Publications and source records attributed to C Helmers.

At least 37 records · Page 2Linked to original sources
PubMed1980

Hazards of therapy for excessive hypertension in acute stroke.

Six cases with acute onset of neurological symptoms and extremely high blood pressure (BP) are reviewed. Hypertensive crisis or stroke were the main differential diagnoses. According to what is advocated for both situations, prompt antihypertensive therapy was instituted. Although recommended doses of hydralazine, reserpine or furosemide were given, the systolic BPs fell to less than 100 mmHg. Intracerebral hemorrhage or infarction was subsequently established in all patients and only one survived. Convincing evidence for a beneficial effect of BP reduction in acute stroke is lacking. Our data indicate excessive response to therapy in some patients. Also, moderate lowering of BP might reduce cerebral blood flow in these patients, often chronically hypertensive and with raised intracranial pressure. Extreme caution with antihypertensive therapy seems therefore warranted if the diagnosis of hypertensive crisis is not certain and a stroke is suspected.

Aged↗
PubMed1980

The natural history of stroke in diabetic patients.

A five-year follow-up of 53 diabetic patients admitted for their first stroke in 1972--73 has been performed. They were compared with two groups of 53 non-diabetic patients each with cerebrovascular disease (CVD), one randomly selected and one matched with the diabetics for age, sex and diagnosis of CVD at discharge. All patients could be traced at follow-up. The mean age at the time of first stroke was 66.5 years in male and 73.2 years in female diabetics. Manifest diabetes was diagnosed in 19% during hospitalization for stroke; of the remainder, 74% had had diabetes since less than ten years. In 85% of the diabetics there were no signs of severe angiopathy affecting eyes, kidneys or lower extremities. The majority of diabetic as well as non-diabetic CVD patients had a history of hypertension and/or heart disease. Few were overweight. Case fatality rate was significantly higher in diabetics than in non-diabetics throughout the follow-up (p less than 0.01 for diabetics vs. matched non-diabetics, p less than 0.001 for diabetics vs. randomly selected non-diabetics). The presence of heart disorder predicted mortality in the diabetic subjects. Surprisingly, hypertension diagnosed before stroke involved a more favourable long-term prognosis in all three groups (p less than 0.05). The major causes of death in diabetic CVD patients were cardiac disorders (50%) and stroke (47%). Previous investigations have identified diabetes as a risk factor for stroke. This study shows that diabetes also adversely affects the short-term as well as the long-term outcome in stroke.

Age Factors↗
PubMed1980

Lack of effect of theophylline on the outcome of acute cerebral infarction.

In patients with acute ischemic stroke, dramatic but often transient improvements have been noticed after theophylline injections. Whether better results could be obtained by continuous infusion of the drug was evaluated in a double-blind study. Out of 46 patients with a mean age of 75 years, 22 got theophylline as aminophylline (bolus dose of 230 mg followed by 0.5 mg/kg/h) and 24 placebo during 3 days. The groups were comparable in all aspects at the outset of the trial. Serum theophylline concentrations were kept within the therapeutic range recommended for patients with asthma. No significant difference in outcome was noticed between the groups during the hospital period when repeated neurological assessments by two different scores and mortality were compared.

Aged↗
PubMed1980

Prognostication in acute cerebrovascular disease. Subjective assessment and test of a prognostic score.

Subjective assessment of the short-term outcome and functional state at discharge was made shortly after admission in 200 consecutive patients with acute cerebrovascular disease (CVD) treated in a stroke unit. The assessments proved correct in 59% of the patients. The accuracy of the predictions was not significantly better in patients with a correct preliminary disanosis than in those with a false. When a known prognostic score for prediction of hospital mortality was tested on 179 of the patients with cerebral haemorrhage or infarction, a correct trend was noted. The score was best applicable in patients with serious symptoms and those with only minor deficit on admission. A high sensitivity of the score was combined with a relatively low specificity. A true comparison between the predictive value of the score and the quality of the subjective assessments was difficult as the latter, in addition to prediction of mortality, also included predicton of the patient's functional state at discharge. The degree of neurological deficit rather than the type of cerebrovascular lesion seemed associated with the short-term outcome. Improvement of the quality of prognostic assessments in CVD is warranted.

Age Factors↗
PubMed1979

Early and sudden deaths after myocardial infarction. A report from the Swedish CCU study.

1329 patients were discharged alive after acute myocardial infarction initially treated in a CCU. In a five-year follow-up, 537 (40%) of the patients died. Routine data registered uniformly during the CCU period showed that, apart from age, the most important factors regarding long-term prognosis in general were previous ischaemic heart disease and direct or indirect signs of heart failure registered in the CCU. The possibilities to predict sudden death (130 patients died within 2 hours of onset of final symptoms during the follow-up period) were small, although a definite dominance of this mode of death was noted in patients below 60 years of age. The clinical profile of the majority of the 134 patients who died during the first half-year was distinguished by a history of prior myocardial infarction and signs of left heart failure during the CCU stay. However, in a significant number of patients dying early after discharge, none of the ordinary unfavourable prognostic signs had been registered.

Acute Disease↗
PubMed1979

Arrhythmias in patients with acute cerebrovascular disease.

Cardiac disease is common in patients with cerebrovascular disease (CVD) and cerebral lesions as such may influence cardiac activity and rhythm. To study the indication for continuous ECG surveillance of patients with CVD, 100 consecutive patients admitted to a medical stroke unit were investigated with 24-hour Holter recordings. The patients' mean age was 73 years and 70% of them had a history of heart disease. Twenty-three patients had chronic atrial fibrillation and 55% of the remainder showed ventricular ectopic activity. Serious ventricular arrhythmias were comparatively rare and mainly seen in association with signs of congestive heart failure and acute myocardial infarction. A prolonged Q-T interval was registered in two-thirds of the patients but there was no significant association between this finding and ventricular ectopic activity. Close observation for cardiac complications is important in patients with CVD and continuous ECG surveillance is indicated in selected high-risk patients.

Aged↗
PubMed1979

A stroke unit in a medical department. Organization and the first 100 patients.

A non-intensive stroke unit of 10 beds has been started in the Medical Department, Serafimerlasarettet, Stockholm. The aim is to make diagnostic and therapeutic studies in unselected stroke patients. Patients with suspect cerebrovascular disease in the Casualty Department are admitted to the unit non-selectively and without any age limit. Relevant physical findings and laboratory data are followed and registered by code on special charts to make evaluation by computer possible. A preplanned investigative programme is adhered to. Strict criteria for diagnosis and treatment are followed. The experience and results from the first 100 patients treated in the Stroke Unit indicate that the unit is a good basis for both education and research.

Acute Disease↗
PubMed1976

Mortality pattern among initial survivors of acute myocardial infarction using a life-table technique.

The 5-year pattern of mortality among 475 immediate survivors of acute myocardial infarction (AMI) (mean age 65 years on entry) is described by a life-table technique. The risk of death was highest during the early part of the follow-up. After 3-4 years, the prognostic influence of the AMI seemed to be overshadowed by the age effect. Special attention was paid to the incidence of sudden death, a fictive elimination of which was shown to reduce the risk of death by 9-22% during the different years of the investigation period. The absolute number of sudden deaths was highest during the early part of the follow-up period but the relative importance of this mode of death was approximately the same during the entire 5-year period after the AMI.

Acute Disease↗