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Biomedical subjects

Maurice Giroud

Publications and source records attributed to Maurice Giroud.

At least 19 recordsLinked to original sources
PubMed2006

Trends in the incidence of transient ischemic attacks, premorbid risk factors and the use of preventive treatments in the population of Dijon, France from 1985 to 2004.

BACKGROUND: We describe the epidemiological trends of transient ischemic attack (TIA) in a 20-year population-based pilot study. METHODS: Trends in the incidence, risk factors and pre-TIA use of preventive treatments for TIA were observed from 1985 to 2004 according to the classic definition in the population of the city of Dijon, France (150,000 inhabitants). RESULTS: The raw and standardized incidence of TIA were stable over time. We observed a significant increase in the mean age at TIA onset in women only. The prevalence of hypercholesterolemia and diastolic blood pressure > or =90 mm Hg among patients with TIA increased significantly. This contrasts with falls in smoking and in history of previous myocardial infarction. CONCLUSION: The stability of classic TIA incidence, despite the rise in the proportion of elderly people, and the increase in the mean age at onset in women may be considered as a medical progress.

Age Distribution↗
PubMed2006

Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis.

BACKGROUND: Carotid stenting is less invasive than endarterectomy, but it is unclear whether it is as safe in patients with symptomatic carotid-artery stenosis. METHODS: We conducted a multicenter, randomized, noninferiority trial to compare stenting with endarterectomy in patients with a symptomatic carotid stenosis of at least 60%. The primary end point was the incidence of any stroke or death within 30 days after treatment. RESULTS: The trial was stopped prematurely after the inclusion of 527 patients for reasons of both safety and futility. The 30-day incidence of any stroke or death was 3.9% after endarterectomy (95% confidence interval [CI], 2.0 to 7.2) and 9.6% after stenting (95% CI, 6.4 to 14.0); the relative risk of any stroke or death after stenting as compared with endarterectomy was 2.5 (95% CI, 1.2 to 5.1). The 30-day incidence of disabling stroke or death was 1.5% after endarterectomy (95% CI, 0.5 to 4.2) and 3.4% after stenting (95% CI, 1.7 to 6.7); the relative risk was 2.2 (95% CI, 0.7 to 7.2). At 6 months, the incidence of any stroke or death was 6.1% after endarterectomy and 11.7% after stenting (P=0.02). There were more major local complications after stenting and more systemic complications (mainly pulmonary) after endarterectomy, but the differences were not significant. Cranial-nerve injury was more common after endarterectomy than after stenting. CONCLUSIONS: In this study of patients with symptomatic carotid stenosis of 60% or more, the rates of death and stroke at 1 and 6 months were lower with endarterectomy than with stenting. (ClinicalTrials.gov number, NCT00190398 [ClinicalTrials.gov].).

Aged↗
PubMed2006

Stable stroke incidence rates but improved case-fatality in Dijon, France, from 1985 to 2004.

BACKGROUND AND PURPOSE: With the progress in stroke prevention, it is important to evaluate the epidemiological trends of strokes over a long period and from a nonselected population-based perspective. METHODS: We estimated changes in incidence, case-fatality rates, severity, risk factors and prestroke use of preventive treatments for first-ever strokes, from a continuous 20-year well-defined population-based registry, from 1985 to 2004. RESULTS: We recorded 3142 ischemic strokes, 341 primary cerebral hemorrhages and 74 subarachnoid hemorrhages. During the 20-year study, the age at first stroke onset increased by 5 years in men and 8 years in women. Comparing the 1985 to 1989 and the 2000 to 2004 periods, age- and sex-standardized incidences of first-ever strokes were stable except for lacunar strokes whose incidence significantly increased (P=0.01) and for cardioembolic stroke whose incidence significantly decreased (P=0.01). Twenty-eight-day case-fatality rates decreased significantly mainly for lacunar strokes (P=0.05) and for primary cerebral hemorrhages (P=0.03). The proportion of hypercholesterolemia and diabetes significantly increased (P<0.01). In contrast, the proportion of myocardial infarction significantly decreased (P=0.02). Prestroke antiplatelets and anticoagulants treatment significantly increased (P<0.01). CONCLUSIONS: The age- and sex-standardized incidences of first strokes in Dijon have been stable over the past 20 years and were associated with an increase in age at stroke onset, a decrease in case-fatality rates, and an increased use of antiplatelet treatments.

Aged↗
PubMed2006

Risk factors and outcome of subtypes of ischemic stroke. Data from a multicenter multinational hospital-based registry. The European Community Stroke Project.

BACKGROUND: Information on determinants and prognosis of ischemic stroke subtypes is scarce. We aimed at evaluating risk factors, pathogenesis, treatment and outcome of different ischemic stroke subtypes. METHODS: In a European Concerted Action involving seven countries, ischemic stroke subtypes defined according to the Oxfordshire Community Stroke Project (OCSP) were evaluated for demographics, baseline risk factors, resource use, 3-month survival, disability (Barthel Index) and handicap (Rankin Scale). RESULTS: During the 12-month study period, cerebral infarction was diagnosed in 2740 patients with first-in-a-lifetime stroke (mean age 70.5+/-12.4 years, 53.4% males). OCSP classification was achieved in 2472 (90.2%). Of these, 26.7% were total anterior circulation infarctions (TACI), 29.9% partial anterior circulation infarctions (PACI), 16.7% posterior circulation infarctions (POCI) and 26.7% lacunar infarctions (LACI). In multivariate analysis, atrial fibrillation was predictive of TACI (odds ratio [OR], 1.61; 95% CI, 1.28-2.03), hypertension (OR, 1.38; 95% CI, 1.16-1.65) and myocardial infarction (OR, 1.42; 95% CI, 1.08-1.86) predictive of PACI, hypertension (OR, 1.25; 95% CI, 1.04-1.50) predictive of LACI. A negative association was observed between TACI and hypertension (OR, 0.51; 95% CI, 0.42-0.61). Discharge home was 50% less probable in TACI and PACI than in LACI patients. As compared to LACI, TACI significantly increased the risk of 3-month death (OR, 5.73; 95% CI, 3.91-8.41), disability (OR, 3.27; 95% CI, 2.30-4.66) and handicap (OR, 2.71; 95% CI, 1.91-3.85). CONCLUSIONS: Ischemic stroke subtypes have different risk factors profile, with consequences on pathogenesis and prognosis. Information on determinants of the clinical syndromes may impact on prevention and acute-phase interventions.

Age Distribution↗
PubMed2006

[Consultation after cerebral infarction or intracerebral hematoma].

Hypertension is the principal risk factor for cerebral infarctions and intracerebral hematoma. The brain is the principal target of hypertension. The brain is the principal target of antihypertensive drugs. Controlling blood pressure and stopping smoking reduces the risk of cerebral infarction by 40%. Objectives of a consultation after cerebral infarction or intracerebral hematoma: validate diagnosis and cause, identify risk factors for recurrent cerebral infarction but also for myocardial infarction and lower limb arterial disease, begin treatment of the risk factors for recurrence, begin prevention of atherothrombotic complications and embolic heart disease, identify complications of cerebral infarction and intracerebral hematoma.

Adult↗
PubMed2006

[Air pollution and cardiovascular and cerebrovascular disease: Epidemiologic data].

Recent convergent data suggest that air pollution affects the risk of acute atherothrombotic events including both myocardial infarction and ischemic stroke. The principal epidemiologic studies begun in the 1990s first examined the respiratory effects of atmospheric pollution and then focused on how pollution peaks affected cardiovascular risk. These studies used data from large metropolitan areas in North America and Asia as well as several large European cities to demonstrate the clear existence of a relation between air pollution and cardio- and cerebrovascular mortality. They also observed an increase in hospital admissions for myocardial infarctions and cerebrovascular accidents on days with high air pollution levels. The pollutants involved have not yet been clearly designated, but it appears that fine suspended particulate matter (PM2.5) and gaseous pollutants such as ozone appear to contribute strongly to these harmful effects. A complete analysis of these data shows the need for a thorough evaluation of the cardio- and cerebrovascular risks associated with air pollution, especially in French metropolitan areas. Precise identification of those at high risk from specific pollutants is essential to improve targeting of prevention strategies.

Air Pollutants↗
PubMed2006

[Air pollution and cardiovascular and cerebrovascular disease. Pathophysiologic basis and groups at risk].

The pathophysiologic basis of the harmful action of air pollutants rests principally on their proinflammatory and prothrombotic effects. The principal pollutants currently identified as responsible for these effects are fine suspended particles (PM2.5) and ozone. Inflammatory effects, initially localized in the lungs, then become systemic. Analysis of groups at the highest risk of atherothrombotic events suggests the elderly may be most sensitive to the effects of air pollution.

Age Factors↗
PubMed2006

[Post-stroke depression, another handicap].

INTRODUCTION: Post-stroke depression is a severe complication affecting 30-50% of patients during the first year. Experienced medical and paramedical staff in stroke units, using validated scales, can now identify initial signs of depression in the first days after stroke onset. METHODS: This review of the literature is based on a Medline search for the terms stroke, depression, and epidemiology. It discusses problems of pathophysiology, diagnosis, prognosis, and therapeutics. RESULTS: Depression is an emergency in stroke patients because it impedes rehabilitation and family and social insertion. Early diagnosis is difficult, but possible with clinical somatic and cognitive symptoms. Post-stroke depression may also be a marker of pending cognitive decline. Management requires both antidepressants and psychotherapy. CONCLUSION: There is a pressing need for further research to improve clinical practice in this area of stroke care.

Activities of Daily Living↗
PubMed2005

Soluble platelet glycoprotein V is a marker of thrombosis in patients with ischemic stroke.

BACKGROUND AND PURPOSE: The diagnosis and management of patients with acute ischemic stroke still lack an informative biochemical test. Soluble glycoprotein V (sGPV) is a new plasmatic marker of thrombosis released from the platelet surface by thrombin. The objective of this prospective study was to compare the levels of sGPV in stroke and control patients. METHODS: Consecutive patients with acute ischemic stroke (n=159) and controls (n=70) were recruited for sGPV measurement. RESULTS: Plasmatic levels of sGPV were significantly increased in ischemic stroke compared with control patients (median [interquartile range] 39.4 [31.8 to 52.9] versus 28.1 [24.0 to 37.9] ng/mL; P<0.0001). In multivariate analysis, ischemic stroke was the major determinant of the sGPV increase (odds ratio [95% CI], 5.87 [2.62 to 13.12]; P<0.0001). CONCLUSIONS: sGPV is a new marker of arterial thrombosis and represents a tool to study the mechanisms involved in ischemic stroke. The increase in plasmatic sGPV observed in stroke patients supports a role of platelets and thrombin in the events leading to ischemic stroke.

Age Factors↗
PubMed2005

[Specificity of stroke in the elderly: clinical characteristics and impact on care].

Stroke in the elderly differs from stroke in younger adults in several points. It represents the most frequent consequence of atherothrombotic disease associated with hypertension, diabetes and hypercholesterolemia. It is also the main complication of cardiac arrhythmia. From a clinical point of view, epileptic seizure is frequently observed at the onset, and prognosis is darkened by a high risk of dementia occurrence (20%). Management of stroke in acute phase requires intensive care, which has been shown to decrease mortality and handicap by 20% in Stroke Units. Fibrinolysis with rt-PA can be carried out till 80 years. Primary and secondary prevention are still very efficacious in old patients and decrease not only the risk of stroke, but also the risk of dementia. Moreover, influenzae vaccination has been shown to decrease the risk of stroke in the following year in subjects over 65 years.

Acute Disease↗
PubMed2004

Time course of NAA T2 and ADC(w) in ischaemic stroke patients: 1H MRS imaging and diffusion-weighted MRI.

BACKGROUND AND PURPOSE: Proton spectroscopy and quantitative diffusion-weighted imaging (DWI) were used to investigate the pertinence of N-acetyl aspartate (NAA) as a reliable marker of neuronal density in human stroke. METHODS: The time courses of tissue water apparent diffusion coefficient (ADC(w)) and metabolite T2 were investigated on a plane corresponding to the largest area of cerebral infarction, within and outside the site of infarction in 71 patients with a large cortical middle cerebral artery territory infarction. RESULTS: Significant reductions are seen in NAA T2 deep within the infarction during the period comprised between 5 and 20 days postinfarction; the relaxation times appearing to normalise several months after stroke. After an acute reduction in ADC(w), the pseudonormalisation of ADC(w) occurs at 8-12 days after the ischaemic insult. The minimum in N-acetyl aspartate T2 relaxation times and the pseudonormalisation of ADC(w) appear to coincide. CONCLUSIONS: The data suggest that modifications in the behaviour of the observed proton metabolites occur during the period when the vasogenic oedema is formed and cell membrane integrity is lost. For this reason, NAA may not be a reliable marker of neuronal density during this period.

Aged↗
PubMed2004

Trends in utilization of antithrombotic therapy in patients with atrial fibrillation before stroke onset in a community-based study, from 1985 through 1997. From scientific evidence to practice.

BACKGROUND: Despite the significant beneficial effects of antithrombotic therapy in primary prevention of stroke in patients with chronic nonvalvular atrial arrhythmia, this prevention therapy is underutilized. We conducted this population-based study to determine the rates and the trends of utilization of antithrombotic therapy for stroke patients with atrial fibrillation before stroke onset, and to evaluate indirectly the impact of medical recommendations on physician practice. Our aim was not to evaluate the efficacy of such prevention therapy. METHODS: From 2,330 men and women of any age registered for a first-ever stroke from 1985 to 1997 in a community-based study, we selected 599 patients admitted for ischemic stroke or TIA, associated with prior atrial fibrillation. Previous antithrombotic treatment before stroke onset was recorded and we evaluated the ratio of stroke patients who had received antithrombotic treatment for atrial fibrillation, from 1985 through 1997. RESULTS: Our study was performed to evaluate the practice of physicians in the prevention of stroke, and not to evaluate the efficacy of the anticoagulants in the prevention of stroke. Atrial fibrillation before stroke onset was identified in 599 patients. Of these, 222 (37%) received no antithrombotic therapy, 65 (10.8%) received an anticoagulant alone, 147 (24.5%) received an antiplatelet agent alone and 10 (1.7%) received both anticoagulation and antiplatelet treatment. From 1985 to 1988, the proportion of treated atrial fibrillation before stroke was small (14.6%). This increased to 21.5% within the period 1989-1991, to 40.3% within the period 1992-1994 and then to 47.6% within the period 1995-1997. It appears that the most significant change occurred within the period 1992-1994 (14.6% of treated atrial fibrillation within the period 1985-1987 constituted to 40.3% within the period 1992-1994) (P < 0.05), with a current rate of utilization of antithrombotic therapy close to 50%. The logistic regression analysis concerning anticoagulant therapy before stroke onset as a dependent variable, found that the factors independently associated with the use of anticoagulants before stroke were the lack of arterial hypertension and a history of smoking. The factors independently associated with the use of aspirin before stroke were arterial hypertension and lower limb peripheral vascular disease. CONCLUSION: For primary prevention of stroke onset in patients with atrial fibrillation, therapeutic trials have changed medical practices although not to ideal levels because close to 50% of patients with atrial fibrillation experiencing an acute stroke or TIA received antithrombotic treatment. Therefore, clinical practice is inconsistent with the guidelines resulting from therapeutic trials. It is necessary to know the reasons for this inconsistency and to improve medical information about the cerebrovascular risk of atrial fibrillation and the efficacy of anticoagulants in stroke prevention in this condition.

Aged↗
PubMed2004

N-acetylaspartate: a literature review of animal research on brain ischaemia.

The present review examines and discusses the changes in N-acetylaspartate (NAA) concentration in the ischaemic brain from the existing literature of animal research. By summarizing the current knowledge on NAA metabolic pathways and reviewing the data obtained in animal models of global and focal ischaemia, the following conclusions emerge from this compilation: (i) both magnetic resonance spectroscopy (MRS) and the absolute HPLC method of NAA quantification give converging information; (ii) decreases in brain NAA concentration in acute stroke can be considered as an index of neuronal loss or dysfunction, although NAA redistribution by glial cells and NAA trapping in cell debris restrict its use as a quantitative neuronal marker; (iii) further studies on NAA metabolism in pathologic brain are required before using NAA measurement in the chronic stage of ischaemia for evaluating neuroprotective strategies.

Animals↗
PubMed2003

[Indications for anticoagulant use in secondary prevention of strokes].

THE CONTEXT: The demonstration of the efficacy of oral anticoagulants in the secondary prevention of ischemic stroke represents a major progress in medicine in the last twenty years. Efficacy in fact depends on the causes and this determines the indications. ADMITTED AND DEMONSTRATED INDICATIONS: Cardiac arrhythmia due to atrial fibrillation and the existence of mechanical prosthetic valves are the only two indications that have been demonstrated with sufficient proof. ADMITTED NON-DEMONSTRATED INDICATIONS: These are basically the dissection of cervical arteries, aortal cross atheroma, vascular cerebral accidents within the context of antiphospholipid antibody syndromes. POSSIBLE INDICATIONS: There are three: stenosis of the intra-cranial arteries, patent foramen ovale with atrial septum aneurysm and the basilar dolichoectasia trunks. NON-DEMONSTRATED SUPERIORITY: In atherosclerosis-induced cerebral ischemic accidents.

Anticoagulants↗
PubMed2003

Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry.

BACKGROUND AND PURPOSE: The information on the existence of sex differences in management of stroke patients is scarce. We evaluated whether sex differences may influence clinical presentation, resource use, and outcome of stroke in a European multicenter study. METHODS: In a European Concerted Action involving 7 countries, 4499 patients hospitalized for first-in-a-lifetime stroke were evaluated for demographics, risk factors, clinical presentation, resource use, and 3-month survival, disability (Barthel Index), and handicap (Rankin Scale). RESULTS: Overall, 2239 patients were males and 2260 females. Compared with males, female patients were significantly older (mean age 74.5+/-12.5 versus 69.2+/-12.1 years), more frequently institutionalized before stroke, and with a worse prestroke Rankin score (all values P<0.001). History of hypertension (P=0.007) and atrial fibrillation (P<0.001) were significantly more frequent in female stroke patients, as were coma (P<0.001), paralysis (P<0.001), aphasia (P=0.001), swallowing problems (P=0.005), and urinary incontinence (P<0.001) in the acute phase. Brain imaging, Doppler examination, echocardiogram, and angiography were significantly less frequently performed in female than male patients (all values P<0.001). The frequency of carotid surgery was also significantly lower in female patients (P<0.001). At the 3-month follow-up, after controlling for all baseline and clinical variables, female sex was a significant predictor of disability (odds ratio [OR], 1.41; 95% CI 1.10 to 1.81) and handicap (OR, 1.46; 95% CI 1.14 to 1.86). No significant gender effect was observed on 3-month survival. CONCLUSIONS: Sex-specific differences existed in a large European study of hospital admissions for acute stroke. Both medical and sociodemographic factors may significantly influence stroke outcome. Knowledge of these determinants may positively impact quality of care.

Adolescent↗
PubMed2003

Association between diabetes and stroke subtype on survival and functional outcome 3 months after stroke: data from the European BIOMED Stroke Project.

BACKGROUND AND PURPOSE: Although diabetes is a strong risk factor for stroke, it is still unclear whether stroke subtype, severity, and prognosis are different in diabetic and nondiabetic patients. We sought to evaluate stroke features, prognosis, and functional outcome in patients with diabetes compared with patients without diabetes. METHODS: In a European Union Concerted Action involving 7 countries and 4537 patients hospitalized for a first-in-a-lifetime stroke, defined according to the Oxfordshire Community Stroke Project criteria, we collected data on demographics, risk factors, clinical presentation, and outcome. We used logistic regression to examine the relationship between diabetes and outcome at 3 months (disability, handicap, and death), controlling for risk factors, clinical presentation, and demographics. RESULTS: Overall, diabetes was present in 937 patients (21%). Diabetic patients, compared with those without diabetes, were more likely to have limb weakness (P<0.02), dysarthria (P<0.001), ischemic stroke (P<0.001), and lacunar cerebral infarction (P=0.03). At 3 months, the case fatality rates were not higher in the diabetic groups (P=0.33). Handicap (Rankin Scale) and disability (Barthel Index) were significantly higher in diabetic patients (P=0.005 and P=0.016, respectively). CONCLUSIONS: Stroke in diabetic patients has a specific clinical pattern and a poor prognosis in terms of motor function, which emphasizes the need for early diagnosis and treatment of every case of diabetes.

Adolescent↗