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G Sagar

Publications and source records attributed to G Sagar.

At least 19 recordsLinked to original sources
PubMed2002

Sequential alterations in haemorheology, endothelial dysfunction, platelet activation and thrombogenesis in relation to prognosis following acute stroke: The West Birmingham Stroke Project.

Abnormalities of haemorheology (plasma viscosity, fibrinogen), endothelial function [von Willebrand factor (vWf)], platelet activation (soluble P-selectin) and thrombogenesis [plasminogen activator inhibitor (PAI), and fibrin D-dimer] are common in cardiovascular disease. We investigated changes in these markers in 86 patients (58 males) presenting with acute stroke (all age < 75 years, with ictus < 12 h), and sequential changes at six time points (baseline on admission, 48 h, 1 week, 2 weeks, 3 months and 6 months following the onset of stroke). Baseline plasma viscosity, haematocrit, fibrinogen, vWf, PAI, soluble P-selectin and fibrin D-dimer levels were increased in the acute stroke patients compared with 35 age-matched and sex-matched controls. Following admission, there were significant increases in haematocrit at 2 weeks, vWf at 48 h and 1 week, fibrinogen at 1 week, PAI at 48 h and 1 and 2 weeks, soluble P-selectin at 48 h, and fibrin D-dimer at 48 h and 1 week following admission. Using univariate 'time to event' analysis, high (> median) mean age (log-rank test, P = 0.0262), diastolic blood pressure (P = 0.01), haematocrit (P = 0.0234), PAI-1 (P = 0.0066) and fibrin D-dimer levels (P = 0.0356) were associated with a shortened event-free survival. Using a multivariate Cox survival analysis, only PAI-1 levels remained an independent predictor of survival (P = 0.0349). We conclude that acute stroke patients have marked baseline abnormalities of haemorheology, endothelial disturbance, thrombogenesis, platelet activation and abnormal fibrinolysis, with further changes over the subsequent follow-up period. Abnormal thrombogenesis and fibrinolysis may significantly influence survival in patients with acute stroke. These changes may have potential implications for the pathogenesis of stroke and its complications, although the possibility remains that we are documenting an acute phase response that previous studies, which included stroke patients with a wide time range since ictus onset, have neglected to consider.

Aged↗
PubMed2001

Abnormal haemorheology, endothelial function and thrombogenesis in relation to hypertension in acute (ictus < 12 h) stroke patients: the West Birmingham Stroke Project.

While the blood vessels are exposed to high pressures in hypertension, the main complications of hypertension (stroke and myocardial infarction) are paradoxically thrombotic rather than haemorrhagic. To investigate abnormalities of haemorheology (plasma viscosity, fibrinogen), endothelial dysfunction (von Willebrand factor), platelet activation (soluble P-selectin) and thrombogenesis (plasminogen activator inhibitor and fibrin D-dimer) in stroke and the effects of concurrent hypertension, we studied 86 consecutive patients (58 male, 28 female) aged < 75 years (mean age +/- SD, 64.2 +/- 9.2 years) with acute stroke (ictus < 12 h). Baseline blood tests on admission were compared with 46 'hospital controls' (patients with uncomplicated essential hypertension; mean age +/- SD, 65.9 +/- 3.8 years) and 24 healthy normotensive controls (mean age +/- SD, 65 +/- 14.0 years). Further comparisons were made between stroke patients with hypertension (systolic blood pressure > 160 mmHg and/or diastolic > 90 mmHg) on admission and those without hypertension. Mean plasma viscosity (one-way analysis of variance, P = 0.026) and fibrinogen levels (P = 0.016) were significantly higher in stroke patients and hospital controls, when compared with healthy controls. The von Willebrand factor, plasminogen activator inhibitor soluble P-selectin and fibrin D-dimer levels were highest in the acute stroke patients, intermediate in hospital controls and lowest in healthy controls (all P < or = 0.001). There were no significant differences in measured indices of haemorheology, endothelial dysfunction and thrombogenesis between the three stroke pathological subtypes (ischaemic/thrombotic, haemorrhagic or transient ischaemic attack). There were also no significant differences in the measured parameters for stroke patients with or without systolic blood pressure > 160 mmHg or diastolic blood pressures > 90 mmHg using clinical (manual) readings or mean daytime or night-time ambulatory blood pressure monitoring recordings. There were no statistically significant differences between the measured parameters on admission and at 3 months follow-up in 26 patients (all P = not significant). Plasma viscosity was significantly correlated with mean daytime systolic blood pressure (r = 0.314, P = 0.021) and mean night-time systolic blood pressure (r = 0.309, P = 0.025). This study of hypertension and haemostasis in acute stroke has demonstrated clear abnormalities of haemorheology, endothelial dysfunction, platelet activation and thrombogenesis, which do not appear to be affected by the height of the blood pressure or the presence of hypertension. This is despite the known hypercoagulable state found in hypertension and the relationship of haemostatic abnormalities to vascular complications.

Aged↗
PubMed2001

Primary intratesticular sarcoma.

Primary intratesticular sarcoma that is neither associated with germ cell elements nor paratesticular elements is a unique subset of intrascrotal sarcoma. It is a rare indolent tumor with potential for distant metastases. Although few data are available it is generally assumed to be quite uncommon. The definitive treatment recommendation are yet to be laid down. Four cases are reported.

Adult↗
PubMed1999

White coat hypertension and carotid atherosclerosis.

To investigate further the relationship between atherosclerotic vascular disease and blood pressure, and the phenomenon of white coat hypertension, we performed a cross-sectional study of patients referred for carotid Doppler scanning, to determine the relationship between ambulatory blood pressure monitoring (ABPM) and carotid atherosclerosis. We studied 79 patients (51 men, 28 women) undergoing Doppler ultrasound examination of the carotid arteries: 44 (56%) had evidence of carotid atherosclerosis on Doppler ultrasound examination ("disease group"), whilst 35 (44%) had normal carotid arteries ("controls"). "Adequate" ABPM recordings, defined by > 90% of recordings over the 24 h, were available in 51 patients (30 positive, 21 negative). There were no significant differences in mean daytime, mean night-time or mean 24 h ABPM recordings between those with and without carotid atherosclerosis. Mean manual clinic systolic blood pressure was significantly greater in those with carotid atherosclerosis than in controls (146.7 +/- 25.2 vs 131.1 +/- 35 mmHg, p < 0.005). In patients with carotid atherosclerosis, the first systolic blood pressure ABPM recording was not significantly different from the mean manual clinic recording (mean difference -1.5 mmHg, 95% confidence interval (CI) -7.9 to 4.8 mmHg). The initial diastolic blood pressure ABPM recording was significantly higher than the mean manual recording. Carotid atherosclerosis was identified in 53% of normotensive controls compared with 56% of white coat hypertensives and 75% of persistent hypertensives. One-third (9/27) of the patients with normal carotid arteries did not have nocturnal dipping ("non-dippers") compared with 50% (12/24) of the atherosclerotic patients. This study suggests that carotid atherosclerosis may be associated with white coat hypertension. Our study adds to the body of evidence that white coat hypertension is associated with end-organ damage and is not simply a benign disease. Such patients should be screened for other cardiovascular risk factors and should be monitored for the development of persistent hypertension.

Aged↗
PubMed1998

Prediction of resectability of pancreatic malignancy by computed tomography.

BACKGROUND: The accuracy of computed tomography (CT) in predicting resectability of pancreatic malignancy has been questioned recently and alternative methods have been recommended. METHODS: To determine the accuracy of CT for predicting resectability and its influence on survival, a standard protocol for performing CT and reporting the results was developed and then compared retrospectively with the ability of one surgeon to perform a resection during 1989-1994. Postoperative survival was determined. RESULTS: Of 88 consecutive patients 35 (40 per cent) had CT-resectable disease and 53 (60 per cent) had CT-irresectable disease. Twenty-one patients were excluded because of advanced disease or poor performance status. Of the remaining 67 patients, 47 (70 per cent) had pancreatic ductal adenocarcinoma and 20 (30 per cent) had ampullary adenocarcinoma, of whom 32 had a resection, 32 had a palliative bypass and three had only a staging laparoscopy. The sensitivity and specificity for computed tomographic prediction of resectability were 72 and 80 per cent respectively. The positive predictive value was 77 per cent and the negative predictive value 76 per cent. There were seven false-positive and nine false-negative findings. Survival was more dependent on whether or not resection was performed than on computed tomographic predictability of resection. CONCLUSION: CT was reasonably accurate in predicting resectability but cannot be relied on entirely, requiring an improvement in staging methods for pancreatic malignancy.

Adenocarcinoma↗
PubMed1998

Association of atherogenic low-density lipoprotein subfractions with carotid atherosclerosis.

Patients with carotid atherosclerosis are at increased risk of both stroke and ischaemic heart disease. Low-density lipoprotein (LDL) is a heterogeneous group of particles, with small, dense particles being more atherogenic. We studied 79 patients (51 men, mean +/- SD age 62.4 +/- 11.7 years) referred for Doppler ultrasound assessment of the carotid arteries. Evidence of carotid atherosclerosis, defined as the presence of atherosclerotic plaque, stenosis or occlusion in one or more of the six carotid artery segments examined, was found in 44 patients (56%). LDL subfractions were analysed by disc polyacrylamide gel electrophoresis with prior ultracentrifugation of serum to remove chylomicrons. This method produces a LDL score; the higher the score, the greater the proportion of the more atherogenic LDL subfractions. Mean LDL score was significantly higher in diseased patients (mean +/- SD, 1.56 +/- 0.61) than the normal group (1.26 +/- 0.65) (t = 2.12, p = 0.037). There was no significant association between LDL score and severity of carotid artery stenosis. Age (adjusted odds ratio 1.09, 95% CI 1.03-1.15) and smoking history (2.09, 95% CI 1.10-3.98) predicted carotid atherosclerosis in logistic regression analysis, with LDL score achieving borderline significance (2.20, 95% CI 0.91-5.29). Small, dense LDL subfractions are associated with carotid atherosclerosis and may be a modifiable risk factor for stroke as well as ischaemic heart disease.

Age Factors↗
PubMed1997

Ambulatory blood pressure monitoring in acute stroke. The West Birmingham Stroke Project.

BACKGROUND AND PURPOSE: Ambulatory blood pressure monitoring (ABPM) devices are increasingly used in the assessment of hypertension, but their value in patients after a stroke is unknown, despite the fact that hypertension is an important cause of stroke and many patients have relatively high blood pressure (BP) levels at presentation. We therefore investigated the clinical use of a 24-hour oscillometric ABPM device in patients after acute stroke. We also investigated ABPM in different types of stroke (thrombosis, hemorrhage, and transient ischemic attack) and ethnic and sex differences. METHODS: BP was measured manually with a standard mercury sphygmomanometer, and ABPM measurements were made with an oscillometric device. The first reading obtained with the ABPM device was compared with simultaneous manual BP measurements. Mean daytime and nighttime pressures were also analyzed to determine the frequency of nocturnal BP falls ("dipping"). RESULTS: We studied 86 patients (48 men; mean +/- SD age, 64.2 +/- 9.2 years) admitted with acute-onset stroke (ictus within 12 hours) in a district general hospital. Thirty-one patients (36.0%) had a previous history of hypertension. The median percentage of successful BP readings by ABPM was 92% (interquartile range, 72 to 98). There was no significant difference in manual BP levels compared with the first simultaneous systolic or diastolic ABPM measurements. Systolic BPs recorded by ABPM were significantly higher in black patients with acute stroke and in patients with intracerebral hemorrhage, who also showed a trend toward higher nocturnal BPs. There was no difference in BPs between men and women and those who were alive or dead 6 months later (P = NS). There was also no difference between mean day and night systolic BP (mean difference, 1.9 mm Hg; P = .08), although mean daytime diastolic BP was higher than mean nighttime diastolic BP (mean difference, 2.4 mm Hg; P = .01). Patients with stroke therefore demonstrated a loss of diurnal BP rhythm and may be considered "nondippers"; there was also a trend toward "reverse dipping" in patients with intracranial hemorrhage. CONCLUSIONS: This study demonstrates higher systolic BPs as recorded by ABPM (but not manually) in patients with intracerebral hemorrhage than in those with cerebral infarcts; higher levels were also found in blacks. ABPM recordings are useful in the assessment of BP in patients with stroke, who may be considered nondippers.

Black or African American↗
PubMed1996

Cystic renal cell carcinoma: radiological features and clinico-pathological correlation.

The radiological appearances of 11 cystic renal cell carcinomas (RCC) presenting over a 13-year-period are reviewed and correlated with their clinicopathological features. The tumours occurred in seven males and four females with a mean age of 59.1 years (range 27-87 years). Their ultrasound features were categorized according to Bosniak [5]. There were six category 3 or 4 cysts (indeterminate or malignant); three category 2 cysts and two category 1 cysts. Computed tomography scans (CT) demonstrated malignant features in all seven patients scanned. Cyst aspiration, intravenous urograms and arteriograms were generally unhelpful. Histological growth patterns of nine tumours were determined and all were staged by Robson's classification: eight were Stage 1, one was Stage 3 and two were Stage 4. Three of four deaths were related to tumour bulk, and the fourth patient died from an unrelated cause. All seven survivors had Stage 1 disease. No correlation existed between different histological subtypes and tumour aggression. Overall, the behaviour of cystic RCCs was similar to those of solid RCCs apart from the high percentage (72.2%) of Stage 1 disease. We conclude that any deviation from a simple cyst on ultrasound should be assessed by CT and/or surgery. Indeterminate lesions on CT including multilocular lesions should be surgically explored.

Adult↗
PubMed1996

Is admission chest radiography of any clinical value in acute stroke patients?

Chest radiographs are frequently requested on admission of patients with a clinical diagnosis of acute stroke. This study assesses their value in subsequent management of these patients. A retrospective analysis of 435 patients with a clinical diagnosis of acute stroke was made. All admission chest radiographs were reviewed to document both radiographic quality and any radiological abnormality. In those patients with an abnormal radiograph, clinical records were reviewed to assess their impact on clinical management. Eighty-six percent of patients had a chest radiograph performed on admission. 77.5% of these films were deemed to be technically unsatisfactory, the commonest problems being positioning and suboptimal inspiration. Radiological abnormality was demonstrated in 61 patients (16.4% of radiographs obtained). Clinical management was altered in 14 of the 61 patients (3.8% of the total number of patients radiographed). Radiological abnormality was missed by the admitting clinicians in four radiographs (1 hilar mass, 2 cases of consolidation, one of pulmonary oedema). One abnormality not clinically suspected was recorded (multiple metastases). We conclude that admission chest radiographs in patients with an acute stroke are not indicated in the absence of appropriate clinical indications.

Acute Disease↗
PubMed1996

Whiplash injury associated with acute bilateral internal carotid arterial dissection.

Internal carotid arterial occlusion, being a rare occurrence following whiplash injury, is frequently missed. We report an unusual case of a 41-year-old woman driver who was involved in a head-on collision with a truck. On admission she was noted to have sustained closed head and neck trauma with a severe whiplash injury and lower limb paraparesis. Subsequent investigations showed a right parietal lobe infarct and bilateral internal carotid arterial dissection. We conclude that acute whiplash injury can result in bilateral internal carotid arterial dissection and that clinicians treating these patients should be aware of this complication.

Acute Disease↗
PubMed1995

Reversible superior mesenteric vein thrombosis in acute pancreatitis. The CT appearances.

We describe the computed tomography (CT) appearances of four patients with acute or acute on chronic (case 3) pancreatitis which demonstrated isolated superior mesenteric vein (SMV) thrombosis. In three of the four cases follow-up CT scans showed the SMV thrombosis to have resolved with resolution of the underlying pancreatitis without anticoagulation or surgical intervention.

Acute Disease↗
PubMed1995

Endoscopy and computed tomography in the diagnosis and follow up of oesophageal leiomyoma.

Leiomyoma of the oesophagus, although the commonest benign oesophageal tumour, is still rare compared with malignant tumours of the oesophagus. Leiomyomas of the oesophagus are usually diagnosed on barium swallow or histological examination after section. Five cases of leiomyoma of the oesophagus are reported where diagnosis was made by the combination of barium swallow, upper gastrointestinal endoscopy, and computed tomography and all but one patient were followed up for one to four years. The endoscopic biopsy specimens were non-specific in all five patients but none showed any evidence of malignancy. None of the five patients had a history of dysphagia. This paper describes a conservative approach to medical treatment in asymptomatic oesophageal leiomyoma rather than surgical excision as commonly published. It also emphasises the importance of negative endoscopic pinch biopsy specimens and the role of computed tomography in the diagnosis of oesophageal leiomyoma.

Biopsy, Needle↗
PubMed1995

Body fat and stroke: unmasking the hazards of overweight and obesity.

STUDY OBJECTIVE: It has been frequently noted that overweight and obesity have a stronger relationship to hypertension and diabetes mellitus than to the risk of stroke. The reason for this observation has not been clear. This study aimed to examine the lifelong relation between body fat and stroke to shed light on why the public health risks of overweight and obesity have tended to be obscured in previous epidemiological studies. DESIGN: Case-control study. SETTING: Eleven general practices in west Birmingham. PARTICIPANTS: Altogether 125 men and women who had just had their first stroke and were aged 35-74 years and 198 controls frequency matched for age and sex were recruited over 24 months during 1988-90. MAIN RESULTS: Those in both the thinnest and fattest quartiles of subscapular skinfold thickness were at increased risk of stroke compared with those in the middle quartiles (age adjusted odds ratios 2.12 (95% confidence interval (CI) 1.2, 3.9) and 2.08 (1.1, 3.8) respectively). When lifelong maximum reported body mass index was assessed the hazards of obesity but not leanness were seen (odds ratio for the highest versus the lowest quartile were--age adjusted, 1.54 (0.8, 3.0) and multiple risk factor adjusted, 2.25 (1.1, 4.5). This lifelong pattern of risk seemed to be established early, the odds ratios for the highest versus the lowest quartile of reported body mass index aged 21 years were--age adjusted, 2.18 (1.1, 4.4) and multiple risk factor adjusted 2.13 (1.1, 4.2). The risks of both maximum reported body mass index and reported body mass index aged 21 years were more clear in those who had never smoked cigarettes (test for trend in odds ratio, p = 0.009 and p = 0.02 respectively). CONCLUSIONS: Potentially important risks of excessive body fat for stroke can be obscured by both a history of cigarette smoking and thinness associated with deteriorating health. The results seem to explain why excess body fat has previously been consistently related to hypertension and diabetes mellitus but less consistently to stroke. Avoiding overweight and obesity during adult life offers protection against stroke.

Adult↗
PubMed1994

Case report: spinal extradural haematoma in haemophilia-A--a diagnosis not to be missed.

A child with severe haemophilia-A is reported who developed an extensive spinal extradural haematoma. He was successfully treated with intensive replacement therapy after attempted surgical decompression failed. The importance of early diagnosis is stressed and the potential value of magnetic resonance imaging for monitoring haematoma maturity is discussed.

Child, Preschool↗
PubMed1993

Lifelong exercise and stroke.

OBJECTIVES: To examine the potential of lifelong patterns of increased physical activity to prevent stroke. DESIGN: Case-control study. SETTING: 11 general practices in west Birmingham. SUBJECTS: 125 men and women who had just had their first stroke and were aged 35-74 and 198 controls frequency matched for age and sex recruited over 24 months during 1988-90. Exclusion criteria were a previous history of stroke, mitral valvular heart disease combined with atrial fibrillation, primary or metastatic cerebral neoplasm, or coagulation disorder or myeloproliferative disease. MAIN OUTCOME MEASURES: Odds ratios for stroke related to lifetime history of exercise after 15 years of age. RESULTS: A history of vigorous exercise during the ages 15-25 appeared to protect from stroke: odds ratio adjusted for age and sex 0.33 (95% confidence interval 0.2 to 0.6). This effect was independent of other potential risk factors. Increasing years of participation in vigorous exercise between the ages of 15 and 55 produced an increasing protection from stroke (p < 0.001). In the 65 cases and 169 controls who were free of cardiac ischaemia, peripheral vascular disease, and poor health recent vigorous exercise and walking were protective against stroke: odds ratios of 0.41 (0.2 to 1.0) for recent vigorous exercise and 0.30 (0.1 to 0.7) for recent walking. CONCLUSIONS: Appreciable protection from stroke in later life is conferred by vigorous exercise in early adulthood. This increased level of physical activity should, if possible, be continued lifelong.

Adult↗
PubMed1993

Case report: rhabdomyolysis following grand mal seizures presenting as a delayed and increasingly dense nephrogram.

Rhabdomyolysis as a result of major trauma is a well recognized cause of acute renal failure. Non-traumatic rhabdomyolysis causing transient renal impairment may occur following generalized convulsions. We present a case in which rhabdomyolysis following epilepsy was first indicated at urography by a delayed and increasingly dense persistent nephrogram.

Acute Kidney Injury↗
PubMed1993

Radioimmunoscintigraphy of recurrent colorectal carcinoma using 111In-labelled murine monoclonal antibody B72.3: a comparison with contrast-enhanced computed tomography.

Ten patients underwent contrast-enhanced abdominal computed tomographic (CT) carcinoembryonic antigen (CEA) measurement and murine 111In-B72.3 monoclonal antibody radioimmunoscintigraphy for recurrent or residual colorectal carcinoma. All patients had undergone primary colorectal tumour resection at a median of 3 (range 1-18) months previously. Histological analysis of pelvic tissue biopsies confirmed that six patients had recurrent or residual colorectal cancer and that four were tumour free. Whilst scintigraphy correctly showed all six patients with recurrent or residual disease, both CT and CEA measurement were correct in only four patients. In the four patients without recurrent cancer, CT was correct in two patients whilst scintigraphy and CEA measurement were accurate in three patients. Six out of the 10 patients showed marked nonspecific colonic excretion of radiolabelled antibody which was correctly interpreted in five patients. Future prospective studies comparing CT scans, CEA estimation and B72.3 radioimmunoscintigraphy in a larger group of patients with suspected residual or recurrent colorectal adenocarcinoma may help to define the respective sensitivity and specificity of these techniques.

Aged↗