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Biomedical subjects

L Candelise

Publications and source records attributed to L Candelise.

At least 37 records · Page 2Linked to original sources
PubMed1991

Mortality in acute stroke with atrial fibrillation. The Italian Acute Stroke Study Group.

We compared 211 consecutive patients who had acute ischemic hemispheric stroke and atrial fibrillation with 837 consecutive patients who had stroke without atrial fibrillation. The atrial fibrillation group included a higher frequency of women, older subjects, and those with a severe neurologic deficit, abnormal computed tomogram, and elevated heart rate. The 1-month case-fatality rate in the atrial fibrillation group was 27% while that in the group without atrial fibrillation was 14%. The 6-month case-fatality rates in the two groups were 40% and 20%, respectively. The risk of death attributable to atrial fibrillation, adjusted for the effect of other prognostic factors, was significant at 1 month (relative risk = 1.55) and at 6 months (relative risk = 1.74). The causes of death were equally distributed in the two groups during both the acute and subacute phases. We conclude that atrial fibrillation is a negative prognostic factor in patients hospitalized for acute stroke. Nevertheless, cerebral embolism alone does not completely explain the increase in mortality for stroke patients with atrial fibrillation. Other associated pathogenetic mechanisms must also be taken into account.

Acute Disease↗
PubMed1989

Cortical pathophysiology and clinical neurologic abnormalities in acute cerebral ischemia. A serial study with single photon emission computed tomography.

We studied brain cortical radioactive tracer activity in a consecutive series of nine patients with acute hemispheric ischemic stroke at their first cerebral ischemic stroke at their first cerebral ischemic episode. Results from N,N,N'-trimethyl-N'- (2-hydroxy-3-methyl-5-[123-I]-iodobenzyl)-1,3 propanediamine-2HCl (four patients) and technetium Tc 99m hexamethylpropyleneamine oxime (five patients) single photon emission computed tomographic studies were compared with x-ray computed tomography (CT) and clinical findings within the first 48 hours, on day 10, and on day 30 after the clinical ictus. Cortical hypoactivity agreeing with the clinical findings was found on all initial scans but not in the follow-up studies. Cortical activity on the affected side in patients with stroke was significantly lower when compared with cortical activity in sex- and age-matched controls (n = 21). Computed tomography (with contrast) was less sensitive in detecting the ischemic lesions. These studies demonstrate that in the acute phase of stroke there is a single photon emission computed tomographic cortical disturbance that agrees with clinical findings, even when computed tomography scan infarction is limited to subcortical structures.

Adult↗
PubMed1988

Protein C in acute stroke.

The plasma concentrations of protein C, an anticoagulant protein, and fibrinopeptide A were measured in 37 patients with acute hemispheric stroke and in age-matched controls with nonvascular neurologic diseases. In 11 stroke patients who died within 15 days after the onset (nonsurvivors) protein C antigen concentration on admission was lower than in the control group (p less than 0.005), with a mean value of 63% of the concentrations found in the 26 survivors (p less than 0.001). The difference in protein C concentrations was not associated with different prothrombin time ratios and serum albumin concentration in survivors and nonsurvivors of stroke and was independent of the size of the cerebral lesion. Increased fibrinopeptide A concentration on admission was found in all stroke patients (p less than 0.001), but it was higher in nonsurvivors than in survivors (p less than 0.01), suggesting that lower protein C concentrations in nonsurvivors might be due to increased thrombin-dependent protein C activation. In survivors, protein C concentration was slightly but significantly higher than in controls (p less than 0.05) and was unchanged 2 months after stroke, a time when fibrinopeptide A concentrations had returned to normal. These results show that protein C is involved in the hemostatic derangement caused by stroke and provide a rationale for clinical trials evaluating the therapeutic supplementation with protein C of patients with acute ischemic stroke.

Acute Disease↗
PubMed1987

Hypercoagulability in acute stroke: prognostic significance.

To evaluate the clinical significance of hemostatic abnormalities in acute stroke, we studied coagulation and platelet function in 70 patients with recent cerebral infarction or hemorrhage and in 45 age-matched controls. Higher levels of one-stage factor VIII coagulant activity, fibrinopeptide A (FPA), and beta-thromboglobulin were associated with the occurrence of stroke. All hemostatic test results were remarkably similar in patients with ischemic and hemorrhagic stroke. FPA levels and size of the lesion on CT were the only variables independently predicting mortality in a multivariate regression analysis. Our findings demonstrate that hypercoagulability is an important prognostic factor in stroke and lend support to clinical trials of drugs interfering with the coagulation system in the early phase of cerebral ischemia.

Acute Disease↗
PubMed1986

Three-year neuropsychological follow-up of patients with reversible ischemic attacks.

A short neuropsychological test battery designed to measure language, memory and visuospatial abilities was administered to 217 patients with reversible ischemic attacks. Patients were tested twice: the first time more than one month, but less than one year, from the last ischemic episode, and the second time three years later. A comparison between the first and the second testing session did not disclose any significant worsening. The degree of atherosclerosis and the occurrence of further ischemic episodes during the follow-up period were found to be unrelated to change in performance at the test battery. These results seems to challenge the hypothesis that multi-infarct dementia may follow apparently reversible, or even clinically silent, ischemic episodes.

Follow-Up Studies↗
PubMed1985

Prognostic significance of hyperglycemia in acute stroke.

Prognostic significance of hyperglycemia on short-term survival was evaluated in 72 patients with acute hemispheric stroke. All patients were admitted within 48 hours of onset, and the neurologic deficit was assessed by means of a standardized score. A computed tomogram was taken in all cases on admission. Mortality was higher in hyperglycemic patients with no history of diabetes mellitus (78%) than in diabetic (45%) and in normoglycemic nondiabetic (29%) patients. In nondiabetic patients, the glucose level correlated with the neurologic score and with lesion size on computed tomogram. Reactive hyperglycemia due to a major stress response accounts for the worse prognosis of these patients. This correlation was not found in diabetic patients. Preexisting hyperglycemia, as well as systemic complications, could explain the higher mortality in these patients compared with normoglycemic nondiabetic patients.

Acute Disease↗
PubMed1985

Distribution of risk factors in relation to the presence of cerebral angiographic lesions in TIA and minor stroke patients.

In a series of patients with TIA or minor stroke we have investigated the possibility of a different distribution of risk factors according to the presence or absence of angiographic lesions of the cerebral arterial circulation. The differences observed, though not statistically significant, argue for a more severe and widespread atherosclerotic process in patients with positive angiography. A significant proportion of these patients present associated insufficiency of the coronary circulation, demonstrated indirectly by exercise testing. The exercise test presents a positive predictive power of 41% for cerebral angiographic lesions.

Adult↗
PubMed1983

Italian study of cerebral reversible ischemic attacks. II. The hematocrit and hemoglobin distribution and its relationship between clinical pattern and angiographic abnormalities.

A clinical and angiographic study was conducted in 360 patients with previous reversible ischemic attacks (RIAs) in order to verify the influence of hematocrit, hemoglobin and red cell count within the normal range in the clinical picture of cerebral infarction and its relationship with angiographic atherosclerosis. No significantly different distribution of the three parameters considered has been found according to the presence and the degree of atherosclerosis. On the contrary, our data have shown a significant correlation between levels of hematocrit, hemoglobin and red cell count and some clinical aspects of the RIA when angiographic atherosclerosis is present.

Adult↗
PubMed1980

Cerebral ischemia in young adults.

56 cerebral ischemia patients up to the age of 40 were investigated using a strict clinical and instrumental protocol in order to elicit the relative importance of the various iatrogenic factors involved. In addition to atherosclerosis risk factors (smoking, hypertension, ischemic heart disease, diabetes, dyslipidemia) other possible causes of cerebral ischemia were sought (arteritis, migraine, head injury, oral contraceptives, coagulation disorders, cardiogenic embolism, etc.). 50% of the patients examined had at least two atherosclerosis risk factors and 55% had other causes singly or in association with atherosclerosis.

Adult↗
PubMed1979

Association of glycerol to dexamethasone in treatment of stroke patients.

A prospective study of 93 acute stroke patients randomly selected by type of antiedema treatment given (hypertonic glicerol infusion plus dexamethasone versus dexamethasone alone) failed to elicit any statistically significant difference between the two treatments on survival rates and quality of survival 7 and 30 days after the stroke.

Aged↗
PubMed1979

CT evaluation in patients with transient ischemic attack. Correlation between clinical and angiographic findings.

35 patients clinically diagnosed with transient ischemic attack (TIA) and 15 patients clinically diagnosed with reversible ischemic neurological deficits (RIND) were examined by computerized tomography (CT). 34% of TIA patients showed positive CT scans consisting of small hypodenase areas: 60% of RIND patients had larger lesions. In 20% of the overall group the only pathological finding consisted of unilateral focal atophy or ventricular asymmetry. Correlation between angiographically demonstrated atherosclerotic lesions and positive CT was high. On the contrary, no correlation was found between either the risk factors or the natural history of ischemic attack and positive CT findings.

Adult↗