Biomedical subjects

L García-Eroles

Publications and source records attributed to L García-Eroles.

25 records · Page 2Linked to original sources

PubMed1998

[Clinical and care implications of the 10-year application of a cerebrovascular diseases register. Descriptive analysis of the last 1000 patients and comparative with the first 1000 patients].

BACKGROUND: There are few studies which analyze clinical and patients' care implications of the continuous application of acute stroke registry. PATIENTS AND METHODS: A prospective study was carried out on 2,000 consecutive patients with acute stroke who were admitted in the neurology department over a period of 10 years (1986-1995). A descriptive clinical analysis of the last 1,000 patients (1986-1991) and a comparative clinical analysis between the last 1,000 patients and the first 1,000 patients (1991-1995) were performed. CT scan and/or MRI were performed in all patients. We used a previously validated registry and we studied clinical and assistance implications of its systematic use. RESULTS: Between the last 1,000 patients and the first 1,000 patients there were significant differences in the frequency of transient ischaemic attacks (TIA) (15% vs 9%; p < 0.0001), lacunar infarcts (20.5% vs 17%; p < 0.04), cardioembolic infarcts (22.3% vs 12.4%; p < 0.0001), infarcts of undetermined cause (7.5% vs 15%; p < 0.0005), intraparenchymatous hemorrhage (9% vs 14%; p < 0.0005), in-hospital mortality (13.8% vs 16.7%; p = 0.07, NS) and mean length of hospital stay (16.5 vs 19.5 days; p < 0.005). CONCLUSIONS: The continuous application of stroke registry brought major interest to the care of stroke patients, resulting in a higher admission rate of TIA patients, a better diagnosis of cardioembolic and lacunar stroke and fewer infarcts of undetermined cause. A decrease in the mean length of hospital stay was observed as well as a lower in-hospital mortality rate.

Aged↗

PubMed1998

[Cytogenetic study of 93 myelodysplastic syndromes].

BACKGROUND: We describe the cytogenetic results of 93 patients with myelodysplastic syndromes (MDS). The main object of this report is to analyze the prognostic value of the karyotype in patients with MDS, in relation to the evolution to acute leukemia and the survival time. PATIENTS AND METHODS: Cytogenetic studies were performed in 93 untreated cases of MDS between 1985 and 1994. Overall survival and the evolution to acute leukemia were analyzed. RESULTS: Among 93 patients who were examined at the time of diagnosis, 40 had an abnormal karyotype (43%). The highest frequency of chromosome abnormalities was observed in refractory anaemia with excess of blasts (RAEB) (65.7%) and RAEB in transformation (RAEB-t) (40%) and the lowest in refractory anaemia with ringed sideroblasts (RARS) (10%). The chromosomes most frequently involved were: 5, 7, 8, 11, 12 and 17. No relationship was found between FAB subtypes and the type of chromosomal abnormalities. In respect to the prognosis, an abnormal karyotype, and a complex karyotype were related with a higher frequency of evolution to acute leukemia. A model based on karyotype could divide patients in two groups: poor prognosis (patients with an abnormal karyotype, with involvement of chromosome 7, trisomy 8 or with a complex karyotype), and a good prognosis (patients with normal karyotype). CONCLUSIONS: The cytogenetic studies are very useful in the study of MDS for their clinical implications.

Adolescent↗

PubMed1997

Cardioembolic infarction in the Sagrat Cor-Alianza Hospital of Barcelona Stroke Registry.

OBJECTIVES: To describe the clinical features of cardioembolic infarcts. MATERIAL & METHODS: Cardioembolic infarct was diagnosed in 231 (15.4%) of 1500 consecutive stroke patients included in a prospective stroke registry over an 8-year period. RESULTS: Cardiac sources of emboli included isolated atrial dysrhythmia (57.1%), valvular heart disease (20.3%), and coronary artery disease (18.2%). Patients with cardioembolic stroke showed a significantly higher (P < 0.00001) frequency of sudden onset of neurological deficit (79.7%) and altered consciousness (31.2%) than patients with lacunar infarct (38% and 1.9%) and atherothrombotic infarction (46% and 24%). Eleven patients had a spectacular shrinking deficit and 6 a presumed cardioembolic lacunar infarct. Early recurrent embolisms occurred in 6.5% of patients mostly (60%) within 7 days of initial embolism. In-hospital mortality was 27.3% (0.8% in lacunar infarcts, 21.7% in atherothrombotic infarction, P < 0.00001). CONCLUSION: Cardioembolic infarction is a severe subtype of stroke with a high risk of early death. Clinical features at stroke onset may help clinicians to differentiate cerebral infarction subtypes and to establish prognosis more accurately.

Adult↗

PubMed1997

Predictive factors of early seizures after acute cerebrovascular disease.

BACKGROUND AND PURPOSE: Seizures within the first 48 hours of a first stroke or transient ischemic attack (TIA) are an independent prognostic factor for in-hospital mortality. The aim of this study was to determine predictive factors of early seizures in first-ever stroke patients. METHODS: Data of 1220 first-ever stroke patients admitted consecutively to an acute stroke unit of a 450-bed teaching hospital between January 1986 and December 1993 were collected from a stroke registry. Demographic, anamnestic, clinical, neurological, and neuroimaging variables in the seizure and nonseizure group were compared using the t test and the chi 2 test. The independent predictive value of each variable on the development of early seizures was assessed with a logistic regression analysis. RESULTS: Early epileptic seizures were diagnosed in 29 patients (2.4%). Seizures were significantly more frequent in patients with hemorrhagic stroke (4.3%) than in those with ischemic stroke (2%). Patients with seizures were significantly younger and significantly more likely to have acute confusional state, cortical involvement, large stroke, and involvement of the parietal, frontal, occipital, and temporal lobes than patients without seizures. The in-hospital mortality rate was 37.9% in the seizure group and 14.4% in the nonseizure group (P < .0005). After multivariate analysis, only cortical involvement (odds ratio of 6.01) and acute agitated confusional state (odds ratio of 4.44) were independent clinical factors for developing epileptic seizures. CONCLUSIONS: Cortical involvement in the neuroimaging studies and agitated acute confusional state at the onset of stroke were independent predictive factors of early seizures in first-ever stroke patients. The efficacy of anticonvulsant drugs in the prophylactic control of seizures should be assessed in prospective, randomized, double-blind clinical trials conducted in the subgroup of patients with the highest risk of developing epileptic seizures.

Acute Disease↗

PubMedDate not supplied

Predictive clinical factors of in-hospital mortality in 231 consecutive patients with cardioembolic cerebral infarction.

Cardioembolic cerebral infarction is a subtype of stroke with a high mortality. The purpose of this study was to determine predictors of in-hospital mortality in 231 consecutive patients with cardioembolic stroke by means of a multivariate analysis. Three predictive models were constructed. A first model was based on demographic, anamnestic and clinical variables collected at the bedside examination (total 8 variables). A second model was based on clinical and neuroimaging variables (total 10 variables). A third model was based on the aforementioned clinical and neuroimaging variables and the presence of early recurrent embolism (total 11 variables). Deteriorated level of consciousness, limb weakness, presence of congestive heart failure, male gender, and age appeared to be independent prognostic factors of in-hospital mortality in the predictive model based on clinical variables and in the predictive model based on clinical and neuroimaging variables. In addition to these variables, early recurrent embolization was selected in the third predictive model. In the first two models, setting a cut-off point of 0.50 for predicting vital status at hospital discharge resulted in a sensitivity of 60%, a specificity of 89% and a total correct classification of 81%. The corresponding values of the third model were 62, 89 and 81%, respectively. These data may help clinicians to establish an early prognosis of this stroke subtype more accurately as well as to allocate patients with cardioembolic stroke in clinical trials correctly.

Cerebral Infarction↗

PubMedDate not supplied

Clinical predictors of early embolic recurrence in presumed cardioembolic stroke.

BACKGROUND: We determined clinical predictive factors of in-hospital embolic recurrence in presumed cardioembolic stroke patients by means of multivariate analysis based on clinical and neuroimaging prognostic variables assessed within 48 h of stroke onset. METHODS: Data of 347 consecutive patients with presumed cardioembolic stroke included in a prospective stroke registry were collected. Demographic characteristics, clinical events, and outcome in the recurrent and nonrecurrent embolization group were compared. The independent predictive value of each variable on the development of early embolic recurrence was analyzed in two multiple liner regression models - one based on eight demographic, anamnestic, and clinical variables and another based on 10 clinical, neuroimaging, and outcome variables. RESULTS: In-hospital recurrent embolization was diagnosed in 25 (6.9%) patients. The latency period was 12.1 days. The overall in-hospital mortality was 70.8% in the recurrent embolization group and 24.4% in the nonrecurrent embolization group (p < 0.001). Alcohol abuse, the combination of hypertension, valvular heart disease, and atrial fibrillation, nausea and vomiting, and previous cerebral infarction were predictors of recurrent embolization in the model based on clinical variables. In addition to these four variables, cardiac events were selected in the model based on clinical, neuroimaging, and outcome variables. CONCLUSIONS: A small number of clinical features that can be easily obtained on the patient's initial assessment may help clinicians to identify a subgroup of patients with cardioembolic stroke at the highest risk of developing early recurrent brain or systemic embolization.

Acute Disease↗

PubMedDate not supplied

Hemorrhagic lacunar stroke.

A total of 17 patients with lacunar syndromes due to intracerebral hemorrhage or hemorrhagic lacunar stroke (pure motor hemiparesis 9, sensorimotor stroke 5, pure sensory stroke 3) are reported. Data from these patients were obtained from consecutive stroke patients included in the prospective Hospital Sagrat Cor-Aliança Stroke Registry. Hemorrhagic lacunar stroke accounted for 3.8% of all cases of lacunar syndrome (n = 439) and 7.4% of all cases of intracerebral hemorrhage (n = 229) entered in the database. Demographic, anamnestic, clinical and neuroimaging variables in patients with hemorrhagic lacunar stroke, non-lacunar intracerebral hemorrhage and non-hemorrhagic lacunar stroke were compared. Predictors of hemorrhagic lacunar stroke were assessed by logistic regression analysis. Hypertension, cigarette smoking and involvement of the internal capsule were significantly more frequent in patients with hemorrhagic lacunar stroke than in those with non-lacunar intracerebral hemorrhage, whereas nausea and vomiting, altered consciousness, speech disturbances, hemianopia, and ventricular hemorrhage were significantly less frequent. As compared with non-hemorrhagic lacunar stroke, patients with hemorrhagic lacunar stroke were more likely to have hypertension, sudden stroke onset (minutes), head injury, headache, and basal ganglia involvement and less likely to have diabetes, gradual stroke onset (hours), and dysarthria. After multivariate analysis, only headache (OR 10.14), sudden onset (OR 9.89), and dysarthria (OR 0.10) were independent predictors of hemorrhagic lacunar stroke. Accordingly, the presence of headache and sudden onset of symptoms and absence of dysarthria may be useful signs for distinguishing hemorrhagic lacunar stroke from other causes of lacunar stroke.

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