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Biomedical subjects

E Díez-Tejedor

Publications and source records attributed to E Díez-Tejedor.

At least 19 recordsLinked to original sources
PubMed2005

Homeostasis as basis of acute stroke treatment: stroke units are the key.

INTRODUCTION: Several studies suggest that the control of blood pressure (BP), blood glucose level, body temperature, and oxygen saturation, when analyzed separately, is related with successful acute stroke outcome. However, in a biological system these parameters are interrelated and could influence the process. Recent studies highlight the importance of the appropriate maintenance of these variables that are involved in homeostasis in patients with stroke and the influence they have on outcome. METHODS: A review was conducted of published studies which analyzed the influence of control of these physiological variables in acute stroke, whether in isolation or combinations, and we have contributed our own data derived from observational studies. RESULTS: The maintenance of homeostasis forms the basis of acute stroke treatment, in what is termed nonpharmacological neuroprotection. Stroke units (SU) are the ideal environment for this therapeutic approach since their favorable influence on the correct management of BP, body temperature, oxygen saturation, and blood glucose in the progress of stroke patients have been proved. CONCLUSIONS: The proper management of physiological variables (homeostasis) such as BP, body temperature, blood glucose, and oxygen saturation is the basis of acute stroke treatment, and SU are the key to this approach.

Blood Glucose↗
PubMed2004

Acute care in stroke: the importance of early intervention to achieve better brain protection.

It is known that 'time is brain', and only early therapies in acute stroke have been effective, like thrombolysis within the first 3 h, and useful neuroprotective drugs are searched for that probably would be effective only with their very early administration. General care (respiratory and cardiac care, fluid and metabolic management, especially blood glucose and blood pressure control, early treatment of hyperthermia, and prevention and treatment of neurological and systemic complications) in acute stroke patients is essential and must already start in the prehospital setting and continue at the patient's arrival to hospital in the emergency room and in the stroke unit. A review of published studies analyzing the influence of general care on stroke outcome and the personal experience from observational studies was performed. Glucose levels >8 mmol/l have been found to be predictive of a poor prognosis after correcting for age, stroke severity, and stroke subtype. Although a clinical trial of glucose-insulin-potassium infusions is ongoing, increased plasma glucose levels should be treated. Moreover, insulin therapy in critically ill patients, including stroke patients, is safe and determines lower mortality and complication rates. Both high and low blood pressure levels have been related to a poor prognosis in acute stroke, although the target levels have not been defined yet in clinical trials. The body temperature has been shown to have a negative effect on stroke outcome, and its control and early treatment of hyperthermia are important. Hypoxemia also worsens the stroke prognosis, and oxygen therapy in case of <92% O(2) saturation is recommended. Besides, blood pressure stabilization avoiding falls of the diastolic pressure and the lowering of glycemia and temperature have been related to a better prognosis in stroke units patients, and homeostasis maintenance is associated with a better outcome. General care has become an emergent and first-line brain-protectant treatment that must be started at the prehospital level from the very beginning. This could help to save more brain tissue to get the best conditions for further specific stroke therapies such as the use of neuroprotective or thrombolytic drugs in the hospital.

Acute Disease↗
PubMed2004

[Spanish contribution to the clinical development of eletriptan: an analysis of controlled studies].

INTRODUCTION: Eletriptan is a recently marketed second-generation triptan with a potent agonist activity on 5-HT1B/ 1D receptors. Our aim has been to analyze the specific results from the Spanish participation in phase IIIa and IIIb clinical trials vs placebo and compare them with the results obtained in the global clinical development of eletriptan. PATIENTS AND METHODS: Analysis of the results obtained in 40 centers in Spain (358 patients) vs global sample 4,677 patients) for the first migraine attack in 6 controlled clinical trials with eletriptan 40 mg, eletriptan 80 mg and placebo. This ad hoc analysis was carried out for those treatment groups with more than 50 patients, which reduced the final number of patients from Spain to 250. RESULTS: The proportion of patients with relief at 2 hours (main endpoint) in the Spanish sample was 22 %, 59 % and 67 % for placebo, eletriptan 40 mg and eletriptan 80 mg, respectively. These values were significantly higher (p < 0.05) than those of placebo and similar to those from the total sample. The proportion of pain free patients at 2 hours in the Spanish sample was 10 %, 36 % and 41 % for placebo, eletriptan 40 mg and eletriptan 80 mg, respectively. These values were significantly better than those for placebo (p < 0.05) and about 15 %-20 % higher than those from the total sample. Recurrence rate in the Spanish sample was 50 %, 16 % and 25 % for placebo, eletriptan 40 and eletriptan 80 mg, respectively, and did not differ from that of the total sample. Sustained relief for the two eletriptan doses was 46 % for both eletriptan 40 and eletriptan 80, this being significant (p < 0.05) over placebo (11 %) for the Spanish sample and similar to that of the global sample. The results for other efficacy parameters, such as need of rescue medication, functional response at 2 hours, complete response for pain-freeness and acceptability followed a similar pattern. Eletriptan was, in general, well-tolerated. Adverse events were slight-moderate in intensity, transient and were not different, either in profile or proportion, from those from the global sample. CONCLUSIONS: These results confirm eletriptan 40 mg and 80 mg as an excellent option for the symptomatic treatment of migraine in our setting.

Clinical Trials, Phase III as Topic↗
PubMed2003

Does a relationship exist between carotid stenosis and lacunar infarction?

BACKGROUND AND PURPOSE: The presence of carotid stenosis (CS) in a patient with lacunar stroke is usually considered an indication of atherosclerosis and not directly related to the development of this infarction subtype. This study was designed to determine the relationship between CS and lacunar infarction (LI) and to assess the differences between single and multiple LIs. METHODS: We classified 330 patients with a first-ever cerebral infarction in the carotid territory into LI and non-LI (NLI) groups. In the LI group, patients with a single LI and those with multiple LIs were identified. In this last subgroup, 2 patterns were identified: 1 subtype with lacunar lesions distributed in both cerebral hemispheres, and another with lesions predominantly in 1 hemisphere. RESULTS: In the LI group, isolated CS was significantly more frequent on the homolateral side than on the contralateral side (odds ratio [OR], 5.5; 95% CI, 1.2 to 23; P=0.03). A significant relationship between the pattern of distribution of the infarctions in only 1 hemisphere and homolateral CS >70% was observed (OR, 4.4; 95% CI, 0.9 to 19; P=0.03). In a multivariate analysis, the following variables were found to predict unilateral multiple LI: left ventricular hypertrophy (OR, 9.1; 95% CI, 2.5 to 33.6) and homolateral CS >75% (OR, 14.4; 95% CI, 2.0 to 99.6). CONCLUSIONS: The significant incidence of isolated ipsilateral CS in patients with LI located in the carotid territory and the relationship of CS to ipsilateral multiple LI suggest that CS has a very important role in the development of LI.

Adult↗
PubMed2002

APOE genotype in cerebrovascular disease and vascular dementia.

BACKGROUND: The fact that the allele epsilon 4 of the Apolipoprotein E (APOE) gene could act like a risk factor not only in late-onset familial and sporadic Alzheimer's disease (AD) but also in cerebrovascular disease (CVD) and vascular dementia (VaD) is still controversial. METHODS: In order to study if epsilon 4 allele is overrepresented not only in AD but also in CVD and VaD, APOE genotyping was undertaken in a series of 247 patients: 26 cases with VaD, 41 cases with CVD but without cognitive impairment (CVD-C), 83 cases with AD and 97 aged-matched "healthy controls" (HC). RESULTS: Percentages of subjects bearing one or two copies of the epsilon 4 allele was much higher in AD patients (54%) than in either CVD-C (29%) (p<0.05), VaD (15%) (p<0.001) or HC (13%) (p<0.001). CONCLUSIONS: These results strengthen the hypothesis that involves the APOE epsilon 4 allele as a predisposing factor for AD, but not for CVD or VaD.

Aged↗
PubMed2001

Efficacy and safety of metamizol vs. acetylsalicylic acid in patients with moderate episodic tension-type headache: a randomized, double-blind, placebo- and active-controlled, multicentre study.

We assessed the efficacy and safety of oral single doses of 0.5 and 1 g metamizol vs. 1 g acetylsalicylic acid (ASA) in 417 patients with moderate episodic tension-type headache included in a randomized, double-blind, placebo- and active-controlled, parallel, multicentre trial. Eligibility criteria included 18-65 years of age, history of at least two episodes of tension-type headache per month in the 3 months prior to enrollment, and successful previous pain relief with a non-opioid analgesic. Treatment arms were metamizol 0.5 g (n = 102), metamizol 1 g (n = 108), ASA 1 g (n = 102) and placebo (n = 105). The analgesic efficacy of 0.5 and 1 g metamizol vs. placebo was highly statistically significant (alpha: 0.025; one-sided) for sum of pain intensity differences, maximum pain intensity difference, number of patients with at least 50% pain reduction, time to 50% pain reduction, maximum pain relief and total pain relief. A trend towards an earlier onset of a more profound pain relief of 0.5 and 1 g metamizol over 1 g ASA was noticed. All medications including placebo were almost equally safe and well tolerated.

Adolescent↗
PubMed2001

Cerebral ischemia: from animal studies to clinical practice. Should the methods be reviewed?

The development of experimental models of focal cerebral ischemia has allowed for a better knowledge of its pathophysiology and for testing therapeutic strategies. However, most neuroprotective substances giving favorable results in these models have later not been shown to be clinically effective. This could be explained by several reasons. First, the homogeneity obtained in animal models in order to achieve results is not seen in clinical practice in humans, in whom a given pathological condition may show a high variability depending on several parameters. This makes it difficult to achieve groups of patients sufficiently large and homogeneous to obtain valid conclusions in the clinical trials. The lack of agreement between the experimental studies and the clinical practice can also be explained by other reasons, such as the methods of the experimental model itself; by the fact that the methods to assess results in these models are not comparable to those used in clinical practice; by pathophysiological differences between experimental animals and man, and even by the fact that the substances tested have different pharmacological properties in the different species. These disadvantages must not invalidate preclinical neuroprotection studies. Rather, the knowledge of the reasons for divergences with the clinical situation can help to optimize experimental models so that both become actually comparable, and the laboratory results can be confirmed by clinical studies.

Animals↗
PubMed2001

Acute care in stroke: do stroke units make the difference?

The consideration of stroke as a medical emergency and the development of new specific treatments to be applied in a narrow therapeutic window have shown the need to establish an adequate organization system for the management of stroke. It should be considered as an integral process both outside and inside the hospital. General care is essential and must already start outside the hospital, and comprises respiratory and cardiac care, fluid and metabolic management, especially blood glucose control, avoiding the administration of glucose solutions, blood pressure control, early treatment of hyperthermia and prevention and treatment of neurologic and systemic complications. In the early 70s, the first stroke units (SU) were established as intensive-care SU, but failed to show improvement in terms of reduction of mortality-morbidity. Nowadays, the concept has changed to a non-intensive-care SU. The benefit of these SU has been amply demonstrated in terms of reduction in mortality and in long institutionalization, as well as better functional outcome compared with general wards, and the efficacy of a neurology ward compared to a general medicine department has also been shown, but at the moment there are no studies analyzing the differences between a stroke team (ST) in a department of neurology and a SU. In this regard, we have performed a sequential analysis comparing both SU and ST and demonstrated a reduction in length of stay, complications and acute care costs with an improvement in functional state at hospital discharge, a reduction in the discharge to nursing homes with an increase in patients translated into rehabilitation wards. With these data, we can conclude that SU, not ST are the most effective organizational model for acute stroke management. Definitely, the SU make the difference.

Acute Disease↗
PubMed2000

Results in 95 hemorrhagic stroke patients included in CLASS, a controlled trial of clomethiazole versus placebo in acute stroke patients.

BACKGROUND AND PURPOSE: Clomethiazole is a neuroprotective drug that enhances gamma-aminobutyrate type A (GABA(A)) receptor activity. Its efficacy and safety were tested in the CLomethiazole Acute Stroke Study (CLASS). The protocol allowed a CT scan to be done after randomization but within 7 days of stroke onset to minimize delays before start of treatment. Ninety-five of the 1360 patients randomized were diagnosed as having intracranial hemorrhage rather than ischemic stroke. Safety results for clomethiazole compared with placebo in this group are reported. METHODS: The study included patients with a clinical diagnosis of acute hemispheric cerebral infarction. Treatment was a 24-hour intravenous infusion of 75 mg/kg clomethiazole or placebo. Patients with intracranial hemorrhage discovered on a postrandomization CT were withdrawn from study treatment if treatment was ongoing, and all patients were followed up to 90 days. RESULTS: Ninety-four patients received treatment, 47 in each group. The hemorrhage was classified as intracerebral in 89 patients (94%). Mortality at 90 days was 19.1% in the clomethiazole group and 23.4% in the placebo group. Sedation was the most common adverse event, occurring at a higher incidence in clomethiazole-treated patients (clomethiazole 53%, placebo 17%), followed by rhinitis and coughing. The incidence and pattern of serious adverse events was similar between the treatment groups. The percentage of patients reaching relative functional independence on the Barthel Index (score >/=60) at 90 days was 59.6% in the clomethiazole group and 53.2% in the placebo group. CONCLUSIONS: Clomethiazole appears safe to administer to hemorrhagic stroke patients compared with placebo. These results would obviate the need for a CT scan before therapy is initiated in acute stroke. The safety of clomethiazole in hemorrhagic stroke patients will be further evaluated in a prospective study that is under way in North America.

Acute Disease↗
PubMed1999

Neurologic complications of type I aortic dissection.

BACKGROUND: Aortic dissection (AoD) is characterized by a transverse intimal tear that in most cases occurs in the right lateral wall of the ascending aorta. Neurological deficit is seen as an initial manifestation in about 20% of patients (8%-33%). OBJECTIVES: To analyze the frequency of these complications and the underlying pathogenic mechanisms. METHODS: Retrospective review of the neurologic complications of patients with type I AoD who underwent surgical treatment between January 1988/April 1996. RESULTS: We report 24 patients. Nine (37.7%) developed neurologic symptoms which we have classified as follows: Hypoxic encephalopathy, 5 (55.5%); ischemic stroke, 2 (22.2%); ischemic neuropathy, 2 (22.2%) and spinal cord ischemia, 1 (11.1%). One is included in both first and third group. CONCLUSIONS: Neurologic complications are frequent in type I AoD, mainly focal or global cerebral ischemia. The former could be due to advancement of the false channel towards the aortic arch vessels and the latter to global central nervous system hypoperfusion.

Adult↗
PubMed1999

[Spanish study of quality of life in migraine (II). Profile of medication consumption and subjective efficacy].

OBJECTIVES: The response to the different antimigraine medications is variable. In this study we have analysed the profile of prescription of these antimigraine medications, both preventive and symptomatic, by a group of spanish neurologists and examined the subjective efficacy of these compounds. PATIENTS AND METHODS: Neurologists from 7 hospitals in different spanish regions interviewed 305 patients (at least 40 per hospital) who met migraine diagnostic criteria. They used an ad hoc questionnaire in which the antimigraine medications, both symptomatic and preventive, taken by the patients, as well as their subjective response were registered. Patients with transformed migraine or tension-type headache more than 2 days per week were excluded. RESULTS: Analgesics, non-steroidal anti-inflammatory drugs, ergotics and sumatriptan had been taken by 99, 69, 54 and 40% of the 305 interviewed patients, respectively. A subjective good response was refered to by 9% of patients who had taken analgesics, 23% of patients who had taken non-steroidal anti-inflammatory drugs, 39% of those who had taken ergotics and 63% of patients with sumatriptan. The current symptomatic treatment was: analgesics 34% of cases, non-steroidal anti-inflamatory drugs 26%, ergotics 13% and sumatriptan 63%. Regarding preventive treatments, 108 patients (35%) had been treated with calcium-antagonists, 87 (29%) with beta-blockers, 55 (18%) with amitriptyline and only 7 (2.2%) with valproic acid. The percentages of good responses to these drugs were: 55% for beta-blockers, 42% for calcium-antagonists and 31% for amitriptyline. CONCLUSIONS: Our data confirm that analgesics are not efficacious in the majority of migraine patients and that the advent of sumatriptan has clearly improved the quality of migrane symptomatic treatment, even though about one-third of migraine patients do not respond to this drug. This study confirm that calcium-antagonists are the antimigraine preventive treatment most frequently prescribed in our country, even though their subjective efficacy is lower than that of beta-blockers.

Analgesics, Non-Narcotic↗
PubMed1998

[Physiopathology of vertebrobasilar ischemia].

Although most of the studies concerning physiopathology of ischemia refer to cerebral hemispheres, it seems reasonable to consider that cellular and biochemical changes due to ischemia are similar in cerebellum and brain stem, which receive blood flow from vertebral and basilar arteries. Anyway, it must be noted that arterial distribution and anatomical structure of this part of the brain are quite distinct, so there might be differences in tissue vulnerability according to severity and duration of ischemia. Cellular injury from ischemia results, at first, as a consequence of energy failure that leads to loss of ionic homeosthasis and membrane potential. This runs a cascade of reactions which is responsible of injury progression. Reperfusion may potentiate this reactions if it does not occur early enough. Main mediators of these reactions are acidosis, citoplasmic calcium overload and excess of free radicals. Development of an inflammatory response and injury to microcirculation contribute to perpetuate the process.

Acidosis↗
PubMed1998

[Autonomic and metabolic sequelae of global and focal cerebral ischemia in an experimental model].

INTRODUCTION: During the last decades the influence of cerebrovascular disease on heart and autonomic nervous system has been studied in numerous reports. Autonomic and metabolic changes have been described during brain ischemia. METHODS: We studied some parameters and its modifications during global (GBI) and focal brain ischemia (FBI). Ten Wistar rats were subjected to global ischemia and eleven to focal brain ischemia, during 20 and 90 minutes followed in both cases by reperfusion. Mean blood pressure, heart rate and glycaemia before, during and after brain ischemia were registered. pH, pO2 and pCO2 were maintained within normal range using endovenous tamponed solutions. RESULTS: During GBI the blood pressure rose and returned to normal in the reperfusion period. Heart rate decreased in both stroke models and hyperglycaemia was present from the beginning in two groups. CONCLUSIONS: GBI and FBI bring about autonomic changes as increased mean blood pressure (only in GBI) and decreased heart rate; probably these might be explained by an autonomic nervous system disorder or by intracranial hypertension. Hyperglycaemia could be related to cathecholamines secretion. These effects might influence in the pathophysiology of brain ischemia.

Animals↗
PubMed1998

[Treatment of embolic cerebral infarct via thrombolysis and cytoprotection with U-74389-G in rats].

INTRODUCTION: The best treatment for cerebral ischemic will probably comprise the association of inhibition of ischemia-reperfusion injury mediators and early reperfusion. OBJECTIVE: We tried to demonstrate if reperfusion by thrombolysis (rt-PA) and free radical scavenging (U-74389-G) reduces ischemic-reperfusion cerebral injury in a rat model of embolic brain infarction. MATERIAL AND METHODS: 39 female Long Evans rats were embolized in right hemisphere with an autologous clot. Three groups are considered; A: control (n = 15), B: rt-PA i.v., 20 mg/kg starting 90-120 minutes after embolization (n = 15), C: rt-PA, same dose, and U-74389-G i.v., 3 mg/kg before and after embolization (n = 9). Arterial blood pressure, gasometry, glycemia and temperature were controlled. Volume of cerebral lesion in surviving animals 24 hours was measured. Autopsy was performed to verify the cause of death in rats which died. RESULTS: Mortality: group A: 8/15; group B: 9/15; group C: 8/9. Early death was related to cerebral injury except for five rats which developed peritoneal bleeding. We found severe acidosis in rats from group C. Differences in mean volume of ischemic lesion in group A and B are nosignificant despite a tendency to a reduction after thrombolysis. CONCLUSIONS: In this model thrombolysis alone and in association with U-74389-G failed to reduce cerebral lesion and mortality.

Animals↗
PubMed1997

Pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis. A report of 50 cases.

This is the first large series, comprising 50 patients who suffered a total of 164 episodes, of pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis (PMP syndrome). Onset of PMP was between the ages of 14 and 39 years and was most frequent in males (68%). Eight males (24%) and five females (31%) had a personal history of migraine. One-quarter had had a viral-like illness up to 3 weeks prior to the onset of the syndrome. The clinical picture consisted of one to 12 episodes of changing variable neurological deficits accompanied by moderate-to-severe headache and occasionally fever. The headaches were described as predominantly throbbing and bilateral with variable duration (mean, 19 h). The mean duration of the transient neurological deficits was 5 h. Sensory symptoms were most common (78% of episodes), followed by aphasic (66%) and motor (56%) symptoms. Visual symptoms appeared in only 12% of episodes. The most frequent combinations were motor aphasia plus sensory and motor right hemibody symptoms (19% of episodes), motor aphasia plus right sensory symptoms (10%) and isolated right (9%) or left (9%) sensory symptoms. All patients were asymptomatic between episodes and following the symptomatic period (maximum duration 49 days). Lymphocytic pleocytosis ranged from 10 to 760 lymphocytic cells/mm3 CSF (mean, 199). In CSF, protein was increased in 96% of patients, IgG was normal in 80% of cases and oligoclonal bands were not found. Adensoine deaminase values were slightly above normal in two out of 16 patients tested. Extensive microbiological determinations, including viral HIV and borrelia serologies, were negative. Brain CT and MRI were always within normal limits, while EEG frequently showed focal slowing. Conventional cranial angiography was performed on 12 patients. In only one were there abnormalities suggestive of localized vascular inflammation, coincident with the focal neurological symptoms. Two patients developed PMP symptoms immediately after angiography. SPECT, performed on only three patients in the symptomatic period, revealed focal areas of decreased uptake consistent with the clinical symptoms. PMP aetiology remains a mystery; chronic arachnoiditis, viral meningoencephalitis or migraine are not plausible aetiological explanations. Because a number of patients had had a prodromic viral-like illness, we hypothesize here that such a viral infection could activate the immune system, thereby producing antibodies that would induce an aseptic inflammation of the leptomeningeal vasculature, possibly accounting for this clinical picture.

Adolescent↗
PubMed1997

[Duration and objectives of hospital admission to stroke units].

OBJECTIVE: The epidemiological importance of Acute Cerebrovascular Disorders (ECVA) has led to a need for specific units to care for these patients. We review the effect of these units on Neurology Departments. Development. In the 1970s Stroke Intensive Care Units were created. In the 1980s these units were replaced by Non-intensive or Intermediate Care Units (Acute Stroke Units). These Acute Stroke Units are more efficient than the previous units and were found to reduce mortality, morbidity, hospital stay and costs. Care was complemented by specific Rehabilitation Units. The design we propose takes into consideration the integration of a Stroke Unit in the Neurology Department, in the Hospital and in the Health Area. After one year results were compared with those of the previous year, when a specific team cared for such patients. There was an 18.5% reduction in total hospital stay and a 23.5% reduction for ECVA patients, with a 21% increase in admissions. The number of complications was reduced by 40.91%. CONCLUSIONS: Stroke Units are extremely useful in Neurology Departments. They lead to reduced morbi-mortality, sequelae, average hospital stay and costs. The functional condition of the patients also improves.

Acute Disease↗