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Biomedical subjects

K Zeiler

Publications and source records attributed to K Zeiler.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Age and whole blood viscoelasticity. A risk factor study].

To assess whether the viscoelastic properties of whole blood might be influenced by age, we measured viscoelasticity of whole blood (VEWB) and plasma at different shear rates in 84 healthy adult subjects. Additionally, we examined the relations between VEWB and gender, cigarette smoking, and oral contraceptive use. VEWB (shear rates 10/s and 50/s, adjusted to a haematocrit of 45%), viscosity of plasma (shear rate 10/s), aggregation index, shear resistance and flexibility index of erythrocytes were measured with an oscillating capillary rheometer and densitymeter. By means of univariate analysis, age was found to increase whole blood elasticity at low shear rates and shear resistance of erythrocytes. Concerning high shear rates, this relationship could only be established in males. The rheologic values of women who had taken oral contraceptives for at least one year were not related to age. Multiple regression analysis demonstrated that whole blood elasticity at low shear rates and shear resistance of erythrocytes were significantly related to age and the intake of oral contraceptives. On the contrary, there was no relationship between age and whole blood and plasma viscosity as well as aggregation and flexibility indices.

Adolescent↗
PubMed1990

Spontaneous subarachnoid hemorrhage. Prognostic factors for social readjustment.

Sixty-seven patients surviving spontaneous subarachnoid haemorrhage (SAH) have been followed up for 2-12 years (mean: 7 years) in order to determine prognostic factors concerning the long-term disability in familial and social functioning. A correlation was found between the severity of the neurological deficit at the time of admission and the degree of familial and social disability at the end of the observation period. In addition, the Barthel-Index on discharge was shown to be of prognostic value for readjustment for social--but not for familial--functioning. Other clinical variables in the acute stage, however, including source of bleeding, sex, age, interval between SAH and admission, level of consciousness, cognitive functions, as well as initial Hunt and Hess grading and Glasgow Coma Scale scoring, did not influence the long-term social prognosis. Furthermore, residual neurological signs, cognitive dysfunctions, and the Glasgow Outcome score on discharge were not related to the extent of social handicap in the long-term outcome. At the end of the observation period, significant correlations were found between the presence of persisting neurological and cognitive deficits but also disability in ADL functions and occupational capacity and the decline in familial and social functioning.

Adolescent↗
PubMed1989

[Use of nicotine--a risk factor for stroke?].

The results of studies on cigarette smoking as a risk factor for stroke are more controversial than for cardiovascular disease. The CO-induced increase in the corpuscular elements of blood (erythrocytes), the influence on other parameters (such as RBC volume, haemoglobin, haematocrit, blood and plasma viscosity, tendency of erythrocytes and platelets to aggregate, fibrinogen level etc.), as well as the increase in catecholamine level are taken to be reversible. On the other hand, the association between cigarette smoking and probably irreversible morphological changes in the craniocervical vessels--possibly via lipid metabolism--is well documented. The following possible explanations for discrepant results in the literature are discussed: different extent of daily cigarette smoking, inhomogeneous populations, difficulties in diagnosing stroke, especially before the introduction of computed tomography and the common failure to consider other risk factors.

Cerebrovascular Disorders↗
PubMed1989

[Prognostic factors for long-term mortality and risk of stroke in patients with transient ischemic attacks].

The aim of the present study was to evaluate the natural course of patients with transient ischaemic attacks and to determine prognostic factors concerning long-term mortality and the incidence of stroke. 159 patients, who were hospitalized after transient ischaemic attacks at the Neurological University Department Vienna during the years 1976 to 1985, were asked about the further course of their illness using questionnaires. 22 patients had moved to unknown addresses and the return rate of the remaining questionnaires was 73.0%. Thus, the results of 100 patients were included in the present study. The follow-up period was 71 +/- 32 months (x +/- s; range: 19-135 months). During the follow-up period, 11 patients had died and 25 had eventually incurred full-blown cerebral infarction. The following variables were analyzed for their prognostic relevance with respect to long-term mortality and stroke occurrence: sex, age, vessel territority involved clinically, number of vessel territories involved clinically, number of strokes, and severity of clinical symptoms. The clinical symptoms (motor deficits, sensory deficits, speech disorders, visual field defects and organic mental syndrome) were graded semiquantitatively and added up to a "total score". Age had a significant influence on survival, but not on stroke occurrence. All other variables had no significant impact on long-term mortality and stroke occurrence. It is concluded that transient ischaemic attacks are warning symptoms of an impending stroke. However, prognostic assumptions cannot be made of the basis of clinical features in this subacute stage. Thus, all patients suffering from transient ischaemic attacks should have a comprehensive and thorough vascular investigation as soon as possible.

Adolescent↗
PubMed1989

[Considerations in hemodilution therapy of stroke].

Hemodilution therapy in patients with ischemic cerebrovascular disease has recently become increasingly controversial, since controlled prospective trials failed to prove unequivocal clinical effects. A general rejection of hemodilution, however, does not seem to be justified. Undoubtedly, there is a beneficial influence on some hemorheologically relevant parameters as well as on cerebral blood flow (CBF). In addition, there is no proof that subgroups of patients profiting from this kind of treatment do not exist. Hemodilution is not recommended for patients with cerebral hemorrhages or hemorrhagic infarctions. In cases with transient ischemic attacks or ischemic strokes, however, this treatment should be taken into consideration further on. The application of hemodilution therapy in patients with progressive strokes depends on clinical signs, the course, the CT scan result, and sonographical findings. Recently, hydroxyethyl-starch (HES) has increasingly been used as an hemodiluting agent. The application of Dextran 40 should be limited to young normotensive patients without cardiac or renal disease.

Cerebrovascular Disorders↗
PubMed1989

[Clinical aspects of treatment and preventive treatment with thrombocyte aggregation inhibitors in cerebrovascular diseases].

Inhibitors of thrombocyte aggregation are generally accepted in the therapy and prophylaxis of ischemic cerebrovascular disease. The frequency of re-infarction, morbidity and mortality after TIA, PRIND and minor stroke is influenced favourably. There are controversial opinions, however, about the usefulness for patients suffering from completed strokes. In patients with progressive stroke, cerebral embolism of cardiac source, or non-infective thrombosis of sinuses or cerebral veins, inhibitors of thrombocyte aggregation are used if anticoagulation therapy is not possible. Additionally, they are applied in cases of infective thrombosis of sinuses or cerebral veins, after termination of anticoagulation therapy, after cardiac valve replacement, and after surgical reconstructions of craniocervical vessels. Acetylsalicylic acid is the clinically best examined substance; its effect--especially in males--was proven by numerous prospective trials. A combined treatment with dipyridamole, sulfinpyrazone or other drugs seems to be unnecessary. A daily dose of not more than 300 to 325 mg acetylsalicylic acid is recommended for prophylaxis after ischemic cerebral events; in connection with that dose severe gastrointestinal side effects are hardly to be expected. Whether even lower doses would yield the same prophylactic effects will have to be clarified by further studies.

Aspirin↗
PubMed1988

[Persistent changes in tissue-type plasminogen activator and plasminogen activator inhibitor fibrinolytic parameters in patients following juvenile ischemic cerebral infarct].

In diseases associated with thrombotic or thromboembolic complications, a reduction in the fibrinolytic potential may contribute to the risk to develop thrombosis. To investigate whether juvenile cerebral infarction is associated with a permanent defect of the fibrinolytic system we measured the main components of the fibrinolytic system, tissue plasminogen activator (t-PA) and its fast acting inhibitor (PAI) in plasma samples of 21 patients (aged 21-44 years) 3-24 months after the acute event. The data obtained were compared to those from thirteen healthy young volunteers (22-46 years). A direct effect of known risk factors on the fibrinolytic system could be excluded because patients avoided their risk factors immediately after the ischemic cerebral attack. Hypertension and the combination of oral contraceptives and smoking had been the most striking original risk factors. Levels of t-PA antigen and t-PA activity before and after venous occlusion, or PAI activity were not different between patients and controls suggesting that at least a permanent decrease in the activity of the fibrinolytic system does not exist in these patients. However, our findings do not exclude that a temporary defect in fibrinolysis might have contributed to the acute onset of the thrombotic cerebral event possibly induced by the risk factors originally present.

Adult↗
PubMed1988

[Syncopal consciousness disorders and drop attacks from the neurologic viewpoint].

The most important neurological disorders leading to syncope and/or drop attack are presented. With respect to epilepsy it is important to consider generalized absence seizures (petit mal), generalized tonic-clonic seizures (grand mal) and some types of complex partial seizures. Additionally, some sleep and arousal disorders must be mentioned, such as narcolepsy, disorders of excessive somnolence associated with sleep-induced respiratory impairment, as well as the Kleine-Levin-Critchley syndrome. Vagotonic, asympathicotonic, sympathicotonic and central autonomic disorders are comprised in the group of autonomic attacks. Among other brain diseases manifesting syncope and/or drop attack, cerebrovascular disorders are of major importance in view of their high incidence. Psychogenic seizures also have to be taken into account in the differential diagnosis.

Brain Diseases↗
PubMed1988

[Does alcohol consumption promote the manifestation of strokes? Considerations on pathophysiology].

Arterial hypertension is the most important risk factor in all types of stroke. The significance of alcohol in the pathogenesis of stroke is less well defined. Chronic alcoholism leads to an elevation of blood pressure. Thus, the association between alcohol and stroke might be the blood pressure effect of alcohol. However, some studies have shown a significant influence of alcohol on the incidence of stroke--especially of intracerebral haemorrhage and subarachnoid haemorrhage--even after adjustment for blood pressure. Many possible pathomechanisms are discussed. Alcohol inhibits aggregation of thrombocytes, and chronic alcohol abuse may induce thrombocytopenia, which could lead to a haemorrhagic stroke. Alcohol withdrawal leads to rebound thrombocytosis. Acute alcohol ingestion induces a decrease in fibrinolytic activity and an increase in factor VIII activity, which enhances the thrombotic potential. Additionally, alcohol increases plasma osmolarity, erythrocyte aggregability, haematocrit and blood viscosity, and decreases deformability of erythrocytes. The effects of alcohol on cerebral blood flow are still under debate; there is a deterioration in autoregulation of cerebral blood flow anyway. In animal studies alcohol induced dose-dependent vasospasm of the cerebral blood vessels, which could be a possible pathomechanism in ischaemic, as well as in haemorrhagic stroke. Chronic alcoholism is the most common cause of secondary non-ischaemic cardiomyopathy, which can lead to cerebral embolism via rhythm disorders or intracardiac thrombus formation.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol Drinking↗
PubMed1988

The course of alcoholism. Long-term prognosis in different types.

The disease concept of alcoholism was first introduced into the medical literature by Magnus Huss in 1984. Since that time many authors have attempted to define therapy-related sub-groups of chronic alcoholics but have been unsuccessful until now because alcoholism represents a complex development and becomes apparent in various clinical pictures. As the method of cross-sectional investigations does not seem to be able to produce reliable results, we performed a prospective long-term study of 444 alcoholics. The methodological claims in literature were taken into consideration like selection criteria, programmes and goals of therapy, follow-up rate and time, etc. Careful observation of the pertinent parts of the pathogenetic pathway leading to chronic alcoholism enabled the authors to establish 4 sub-groups of alcoholics relevant for treatment.

Alcohol Drinking↗
PubMed1988

Is aphasia an additional prognostic factor in ischemic stroke with regard to the severity of hemiparesis in the subacute stage?

The outcome of 122 patients with ischemic stroke in the left carotid territory (ascertained by CT) was investigated using mailed questionnaires after a mean follow-up time of 60.7 months (SD 20.5 months). Patients who had had cerebrovascular accidents others than TIA prior to the stroke were not included in the study. The relationship between the degree of aphasia in the postacute stage and the long-term outcome was evaluated with regard to the severity of motor deficits. With respect to survival, recurrent stroke, single activities of daily living such as dressing, personal hygiene, walking, feeding, bowel management and overall self-care status, the outcome of patients was not dependent on the severity of aphasia. Aphasia did also not serve as a prognostic factor in returning to work after left hemispheric cerebral infarction. Our results indicate that in presence of motor deficits the severity of aphasia in the subacute stage does not additionally influence the long-term outcome after left hemispheric cerebral infarction.

Activities of Daily Living↗
PubMed1988

[Prognosis of social reintegration following stroke].

From the socio-economic point of view, early prediction of outcome after stroke is of essential value. The longterm prognosis of 310 patients suffering from ischemic stroke, was therefore investigated by means of questionnaires. The mean follow-up period was 62.5 (S.D. 21.9) months. The results of patients who had suffered cerebrovascular accidents other than ischemic stroke or only transient ischemic attacks were not included. It had been the aim of the study to determine the predictive value of some clinical variables and symptoms in the subacute stage as regards the familial and social functioning handicaps to be expected later on. Between the number of strokes as well as the severity of some clinical signs (motor deficits, sensory deficits, speech disorders, organic mental syndrome) on the one hand, and the restrictions experienced in familial functioning on the other hand, a clear cut correlation was found. As regards social functioning, two additional predictors of unfavourable outcome could be identified: age, and lesion within the left hemisphere. The findings indicate that some clinical variables and symptoms in the subacute stage are of great predictive value concerning the ensuing handicap in familial and social functioning. These variables may help to develop individual strategies as regards the further social management and support (e.g. discharge arrangements, care services, rehabilitation programs).

Adolescent↗
PubMed1987

Unilateral stenosis of the vertebral artery--secondary finding with no prognostic relevance?

The outcome of 142 patients suffering from ischemic cerebral circulation disorders was followed up over a period of 33 months on average. The spontaneous course of 25 patients with unilateral, hemodynamically ineffective stenoses of the vertebral artery was compared with that of 107 patients without vertebral artery stenoses. Within the first 12 months, novel clinically manifest cerebrovascular events were observed in 16.0% of patients without vertebral artery stenosis (deaths 5.0%), but in only 4.3% of the patients with vertebral artery stenosis (no deaths). Within 30 months, only 2 of the 13 patients with vertebral artery stenosis had suffered a new cerebrovascular attack. At the end of the observation period, 39.3% of the patients without vertebral artery stenosis and 48.0% of the patients with vertebral artery stenosis were significantly disabled in their social life or had died. An additional unilateral hemodynamically irrelevant vertebral artery stenosis did not influence the rate of reinfarction or the remission of neurological deficits, independently of age, the degree of the circulatory disorder, the vascular territory involved, the presence of an organic psychosyndrome, or of additional stenoses in the carotid arteries. Consequently, a vertebral artery stenosis narrowing the vessel diameter to less than 1/3 is without prognostic relevance.

Carotid Artery Diseases↗
PubMed1987

High-dose penicillin therapy in meningopolyneuritis Garin-Bujadoux-Bannwarth. Clinical and cerebrospinal fluid data.

Clinical data of 19 patients with meningopolyneuritis Garin-Bujadoux-Bannwarth (MPN-GBB), treated with 2 X 10 million units intravenous sodium penicillin for 10 days, were evaluated at the beginning of therapy, 3 weeks thereafter, and 6 months after onset of the neurological disease. Cerebrospinal fluid (CSF) was analysed in 14 patients at the onset of therapy and 3 1/2 weeks thereafter. At the same interval antibodies against B. burgdorferi were measured by enzyme-linked immunosorbent assay (ELISA) in the CSF and sera of 12 patients. Clinical data and all CSF results, with exception of specific antibody titers, were compared with those of patients who had suffered from MPN-GBB between 1979 and 1983, and who had not received antibiotic or corticosteroid therapy. Comparing the clinical data of all treated patients with those of all non-treated controls, no significant difference could be observed. A significant improvement could however be detected in those patients who had their treatment begun 5 weeks within onset of the neurological disease. Changes in CSF 3 1/2 weeks after onset of treatment showed slight differences when compared with controls.

Adolescent↗
PubMed1986

[Chronic alcoholism--alcohol sequelae--causes of death].

In this study 444 chronic alcoholic patients, hospitalized at the beginning of this study, were followed up for 4 to 7 years (31). During this time 101 patients died (23.2%), with whom severeness of disease as well as the extent of social depravation could be identified as factors influencing mortality. Beginning in January of 1982 we investigated mortality of the population of a village with a similar socio-cultural background (working situation, rural population, wine-growing area). As it was possible to cooperate with the local general practitioner, who has been living and working in this village since 1946, knowing all the troubles and sorrows, we could get data of each person having died. We collected data on each dead of this village until we had 101 definitely not alcohol addicted cases as control group. For getting this number of cases we had to investigate data of 116 dead, because 15 of them met the diagnostic criteria for chronic alcoholism. Sociodemographic data, social development, diseases and causes of death were recorded in all groups of investigation. In the group of formerly hospitalized chronic alcoholic patients we found a preponderance of men as well as a significantly shorter life-time (alcoholic group: 50 +/- 9.8 years, control group 73.9 +/- 12.5 years). Besides alcohol misuse other factors influencing mortality could be elaborated (e. g. stressing or discriminating working situation, incontinuous and/or unsatisfying partnership, additional criminal acts etc.) separating the chronic alcoholic group (with former hospitalisation) from the control group in a significant way. Concerning the disease leading to death, chronic alcoholic patients more frequently had suffered from liver damage (with break of oesophagus blood vessels) as well as from auto-destructive behaviour patterns (like suicide, masked accidents) compared to the non-alcoholic group. This control group died significantly more frequent because of cardio-vascular diseases, often accompanied by cerebral deficits.

Adult↗
PubMed1986

[Rare pathomorphologic findings in complicated migraine].

137 patients suffering from classical or complicated migraine were investigated in the Neurology Department of the University of Vienna between 1971 and 1984. 13 of these patients were found to have pathological alterations and their case histories are presented. Clinically, 11 patients suffered from migraine accompagnée (in 2 cases accompanied by epileptic seizures), 1 patient had ophthalmoplegic migraine and 1 had a subarachnoid haemorrhage imitating migraine. The underlying pathological findings were: 1 tumour, 4 arteriovenous malformations, 4 aneurysms, 1 arterio-venous shunt, 1 pathological vascular network, 1 Moya-Moya syndrome and 1 intracerebral haemorrhage without detectable source of bleeding. 8 of the patients underwent successful surgery and most of them showed subsequent clinical improvement. The family history was positive in only 2 patients. The time interval between the occurrence of the first symptoms and the establishment of the final diagnosis was up to 25 years. The neurologist should undertake extensive investigation of the patient, including cerebral angiography, if the following criteria apply: hemicrania consistently on the same side; change in type of headache after a number of years; uniform complicating neurological symptoms; additional occurrence of epileptic seizures; manifestation of neurological symptoms after the prodromal phase; persistent neurological signs without remission; negative family history; persisting diffuse or locally accentuated EEG changes; pathological CAT results.

Adult↗