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Biomedical subjects

M von Arbin

Publications and source records attributed to M von Arbin.

At least 19 recordsLinked to original sources
PubMed2005

Long-term antidepressant treatment with moclobemide for aphasia in acute stroke patients: a randomised, double-blind, placebo-controlled study.

BACKGROUND AND PURPOSE: Pharmacotherapy aimed at stroke rehabilitation through direct central nervous effects may be assumed to work in a similar way for language recovery and sensory-motor recovery. Some data suggest that antidepressant drugs could be beneficial also for functional improvement. This prompted us to investigate whether regression from aphasia after acute stroke could be enhanced by antidepressive drug therapy. METHODS: We randomised 90 acute stroke patients with aphasia to either 600 mg moclobemide or placebo daily for 6 months, within 3 weeks of the onset of stroke. Aphasia was assessed prior to treatment and at 6 months, using Reinvang's 'Grunntest for afasi' and the Amsterdam-Nijmegen-Everyday-Language-Test (ANELT). RESULT: The degree of aphasia decreased significantly at 6 months, with no difference between the moclobemide- and the placebo-treated groups. Multivariate regression analysis including treatment group, activities of daily living, aetiology of stroke, ANELT, and Reinvang's coefficient at baseline, and neurological deficit confirmed these results. In all, 13 in the moclobemide and 10 in the placebo group stopped taking the study medication. No further change was found in the 56 aphasic patients followed up for another 6 months with no medication. CONCLUSIONS: Compared to placebo, treatment with moclobemide for 6 months did not enhance the regression of aphasia following an acute stroke.

Aged↗
PubMed2001

Acupuncture and transcutaneous nerve stimulation in stroke rehabilitation: a randomized, controlled trial.

BACKGROUND AND PURPOSE: In small trials with control groups that receive no intervention, acupuncture has been reported to improve functional outcome after stroke. We studied effects of acupuncture and transcutaneous electrical nerve stimulation on functional outcome and quality of life after stroke versus a control group that received subliminal electrostimulation. METHODS: In a multicenter randomized controlled trial involving 7 university and district hospitals in Sweden, 150 patients with moderate or severe functional impairment were included. At days 5 to 10 after acute stroke, patients were randomized to 1 of 3 intervention groups: (a) acupuncture, including electroacupuncture; (b) sensory stimulation with high-intensity, low-frequency transcutaneous electrical nerve stimulation that induces muscle contractions; and (c) low-intensity (subliminal) high-frequency electrostimulation (control group). A total of 20 treatment sessions were performed over a 10-week period. Outcome variables included motor function, activities of daily living function, walking ability, social activities, and life satisfaction at 3-month and 1-year follow-up. RESULTS: At baseline, patients in each group were closely similar in all important prognostic variables. At 3-month and 1-year follow-ups, no clinically important or statistically significant differences were observed between groups for any of the outcome variables. The 3 treatment modalities were all conducted without major adverse effects. CONCLUSIONS: When compared with a control group that received subliminal electrostimulation, treatment during the subacute phase of stroke with acupuncture or transcutaneous electrical nerve stimulation with muscle contractions had no beneficial effects on functional outcome or life satisfaction.

Activities of Daily Living↗
PubMed2000

[Commission of inquiry scrutinized complications of carotid surgery. Half of the complications could be explicable by errors or dubious indications].

As carotid endarterectomy is a prophylactic procedure, it would seem particularly important to analyze complications with an aim to avoiding them. All carotid endarterectomies in Sweden are registered, and all serious complications (death and permanent neurological deficit) are analyzed in detail, classified and discussed within the profession. During the period 1994-1996 the frequency was 4.3 percent (technical causes in 17 percent, contraindications in 8 percent and dubious indications in 21 percent, but correct indication and surgery in 54 percent). Thus, even when conditions are optimal there is a certain price to pay for the prevention of ischemic stroke.

Adult↗
PubMed2000

[Multidisciplinary cooperation behind a quality registry for carotid surgery. Good coverage during the first two years].

Carotid surgery prevents recurrent stroke in patients with symptomatic tight stenosis of the carotid artery. The Swedish Carotid Surgery Monitoring Registry seeks to promote selection of patients with significant spontaneous risk for recurrent stroke, with an eye toward expediting evaluation and minimizing surgical complications. To this end, professionals at participating hospitals are informed about their own patient selection and surgery risk in comparison with those in the country as a whole and with set targets. We report the results from the first two years, during which it is estimated that more than half of all patients eligible for carotid surgery in Sweden were included in the registry. Although almost all patients had recent onset of relevant neurological symptoms, less than 60% had a documented tight (80-99% occlusion) stenosis. While the final decision to operate a patient was made within 4 weeks of onset of symptoms for only 18% of the patients the first year, this proportion increased to 33% in the following year. The total incidence of surgery related stroke, myocardial infarct and death was 7.7%, while the incidence of severe stroke, myocardial infarct and death was 3.0%.

Amaurosis Fugax↗
PubMed1999

Plasma semicarbazide-sensitive amine oxidase in stroke.

Semicarbazide-sensitive amine oxidase (SSAO) has been suggested to be involved in the development of vascular endothelial damage. The source of the soluble form of SSAO found in the blood serum is unknown. However, it has been speculated that it is secreted from cells within the vascular wall where high activity of the enzyme is found. Altered SSAO activity has been reported in atherosclerotic plaques of the human aorta. Stroke is a manifestation of long-term atherosclerotic disease, and in this study, plasma SSAO activities were estimated in 42 patients with cerebral thrombosis and 26 patients with cerebral embolism, and compared to two control groups of 45 individuals in total. No statistically significant differences were found between the patient groups and controls regarding plasma SSAO activity, suggesting that changes in the soluble form of SSAO found in the circulation do not play a major role in this type of acute cerebrovascular event. Furthermore, it does not seem likely that the involvement of vascular tissue occurring in stroke results in release of the enzyme into the circulation. Nevertheless, further studies on tissue-bound SSAO in cerebral vessels would be of great interest.

Aged↗
PubMed1993

Screening for neuroborreliosis in patients with stroke.

BACKGROUND AND PURPOSE: Borrelia burgdorferi, the etiologic agent of Lyme disease, can cause different neurological manifestations. We studied the prevalence of Lyme neuroborreliosis in patients with stroke. METHODS: During a 1-year period, sera from patients with cerebral thrombosis or transient ischemic attack without cardioembolism were investigated for antibodies against B burgdorferi. RESULTS: One of 281 patients had a positive serum immunoglobulin M titer and 23 of 281 (8%) had positive serum immunoglobulin G titers against B burgdorferi. One of the 24 seropositive patients, with a diagnosis of transient ischemic attack due to dysphasia, had a lymphocytic pleocytosis and intrathecal antibody production against B burgdorferi. The medical history revealed a 9-month period of general and neurological symptoms compatible with Lyme neuroborreliosis before the strokelike incidents. CONCLUSIONS: We conclude that Lyme neuroborreliosis may imitate stroke, but screening for antibodies against B burgdorferi seems to be of little value and may be replaced by a careful medical history.

Adult↗
PubMed1992

Mortality and recurrences during eight years following stroke.

A total of 388 patients, of mean age 73 years, with acute cerebrovascular disease (CVD) evaluated in a non-intensive Stroke Unit, and a sample of 209 age- and sex-matched similarly acutely admitted patients with surgical diseases were followed up for 5-8 years. The CVD patients had a 21-day hospital mortality of 13%, and 66% mortality during the entire study period, compared to 2% and 48%, respectively, in controls. Old age had only a minor effect on the initial mortality. However, long-term mortality increased markedly with age. The initial mortality in 120 stroke recurrences was 50%. In CVD patients heart diseases were common causes of death, and circulatory diseases were most predominant of all (86%), with an accumulation during the first months after the occurrence of the initial CVD event. These figures clearly show that stroke patients constitute a group with high risk of stroke recurrence and death. Despite declining figures for stroke mortality, and most probably also for case fatality rate after first stroke episodes, much work remains to be done within the field of secondary prevention after stroke.

Adult↗
PubMed1991

Cerebral blood flow and indomethacin drug levels in subjects with and without central nervous side effects.

1. Central nervous system (CNS) side effects are observed during treatment with all nonsteroidal anti-inflammatory drugs (NSAIDs) but their effects are more common during treatment with indomethacin. 2. The aim of the study was to elucidate the mechanism of the CNS related side effects of indomethacin. Two groups were obtained, one with (n = 11), and one without (n = 7), CNS symptoms. Cerebral blood flow was measured in these groups with Doppler equipment, indomethacin levels with h.p.l.c. and CNS symptoms graded on a VAS scale. 3. Blood flow was reduced by 18-30% and was most marked 60 min after dose and did not differ between the two groups. The maximum CNS effect coincided with indomethacin peak levels 60-70 min after dose. These results could implicate that CNS symptoms may be related to indomethacin levels in sensitive patients.

Brain↗
PubMed1986

Mortality from and incidence of stroke in Stockholm.

To study trends in the incidence of and mortality from stroke in Stockholm during 1974-81 all cases (n = 56566) of stroke in patients aged over 40 were identified from the Swedish Cause of Death Register and the Inpatient Care Register. Information on the population at risk was obtained from the civil registration system. A multiplicative model was used to control for changes in the distribution of age during the study. Mortality from stroke decreased annually throughout the study by a mean of 2.3% for men and 3.5% for women. This favourable development was not accompanied by a similar decrease in the incidence of stroke. In men the total incidence (including recurrent strokes) and incidence of first stroke increased continuously. In women the total incidence showed virtually no change, whereas the incidence of first stroke decreased somewhat. These findings, in addition to an expected shift of age profile in the population towards more elderly people, should be considered in the planning of future health care resources.

Adult↗
PubMed1985

Circulatory manifestations and risk factors in patients with acute cerebrovascular disease and in matched controls.

The occurrence of various circulatory manifestations and risk factors was evaluated in a consecutive series of 209 patients admitted for acute cerebrovascular disease (CVD) and 209 control patients admitted for acute surgical disorders. Old and recent myocardial infarction, atrial fibrillation, congestive heart failure and reduced arterial blood pressure in the big toe were all much more frequently noted in CVD patients than in their matched controls. Hypertension, diabetes mellitus, overweight, high haemoglobin values, were also overrepresented in the CVD patients. Male CVD patients had a higher alcohol consumption than their controls. These findings implicate that CVD in old age is strongly related to both hypertension and a generalized atherosclerosis. The heavy accumulation of primary risk factors, many of which are considered to be primarily associated with atherosclerosis among elderly stroke victims, may indicate their contribution to a progressive atherosclerotic process still in operation.

Age Factors↗
PubMed1983

Prognosis in acute stroke with special reference to some cardiac factors.

Neurological assessments were done regularly during hospitalization in 283 consecutive patients (mean age 73 yr) with acute cerebrovascular disease treated at the Stroke Unit of Serafimerlasarettet. A preplanned investigation program and strict criteria for diagnosis and treatment were followed. Hospital mortality was 18%. Patients with a major cerebral infarction or haemorrhage often died very early during the hospital period and deaths due to complications increased significantly during the second week. Multivariate analysis regarding mortality showed that a low neurological score and heart failure were the most important factors for the short-term prognosis. In those patients with cerebral infarction, ambulatory capacity and ECG-diagnosed bundle branch block added significantly to the prognostic power of the neurological score. Among the 227 patients discharged alive, 1 and 2-yr mortality was 14 and 18% respectively. Here, the most important long-term prognostic factors were age and ST changes on the ECG. Again, considering only patients with cerebral infarction (N = 190), bundle branch block was found to be the single most useful predictive factor. Prognostication in acute ischemic stroke should thus be based not only on neurological findings but on careful evaluation of associated cardiac disease, especially in the long-term perspective.

Acute Disease↗
PubMed1983

Non invasive assessment of the internal carotid artery in stroke patients.

The internal carotid arteries were evaluated with Doppler ultrasound technique in patients with acute cerebrovascular disease. The results of the Doppler examination of 325 vessels were compared to presence of carotid bruits on auscultation. In 126 arteries the findings were also compared with those on aortocervical, single carotid or post-mortal angiography. The Doppler flow reaction was normal in 74% of the vessels, uncertain in 20% and pathologic in 6%. The sensitivity of the Doppler assessment in finding stenosis of more than 75% lumen diameter reduction was 85% with a specificity of 94%. The specificity increased with higher degree of vascular stenosis. Carotid bruits were heard in 34 arteries. The sensitivity of auscultation in detecting stenosis 75% was 47% with a specificity of 83%. The sensitivity fell with higher degree of stenosis. The Doppler procedure is a valuable tool in detecting haemodynamically significant stenoses in the internal carotid artery. The method could serve the following purposes in the clinical situation: 1. Screening procedure for further investigations in TIA and minor stroke patients fit enough to be candidates for vascular surgery. 2. Before blood-pressure can be safely reduced in patients with cerebrovascular disease. 3. For evaluation of the arteriosclerotic process in stroke-patients thereby improving prognostication.

Adult↗
PubMed1980

A study of stroke patients treated in a non-intensive stroke unit or in general medical wards.

To study the representativity and outcome of patients admitted to a stroke unit (SU) (n = 269), a comparison was made with all stroke patients treated in general medical wards (GMW) (n = 225) in the same hospital during two years. There was no difference between the patient groups regarding sex, age, previous cardiovascular diseases or neurological deficit on admission. As expected, more diagnostic examinations were performed in the SU than in the GMW where a diagnosis of ill-defined stroke was very frequent. A higher frequency of lumbar puncture with CSF spectrophotometry would have increased considerably the number of specific diagnoses in the GMW. Acute and, particularly, secondary prophylactic treatment was more often given in the SU. There was no difference between the patient groups regarding mortality or length of hospital stay.

Aged↗
PubMed1979

A stroke unit in a medical department. Organization and the first 100 patients.

A non-intensive stroke unit of 10 beds has been started in the Medical Department, Serafimerlasarettet, Stockholm. The aim is to make diagnostic and therapeutic studies in unselected stroke patients. Patients with suspect cerebrovascular disease in the Casualty Department are admitted to the unit non-selectively and without any age limit. Relevant physical findings and laboratory data are followed and registered by code on special charts to make evaluation by computer possible. A preplanned investigative programme is adhered to. Strict criteria for diagnosis and treatment are followed. The experience and results from the first 100 patients treated in the Stroke Unit indicate that the unit is a good basis for both education and research.

Acute Disease↗