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Biomedical subjects

T Strand

Publications and source records attributed to T Strand.

At least 55 records · Page 3Linked to original sources
PubMed1984

Pulmonary-artery cineangiocardiography to demonstrate cardiac thrombi in patients with cerebral infarction.

The usefulness of pulmonary-artery cineangiocardiography (PACAC) to demonstrate intracardiac thrombi in patients with cerebral infarctions of possible embolic origin has been explored. PACAC was performed in 60 patients (mean age 74 years) with sudden onset of permanent neurological deficits in whom CT scan and CSF analyses had excluded intracerebral hemorrhage. Opacification of the left atrium was excellent in 52 (87%) investigations, acceptable in 7 and poor in 1. Among 33 patients with chronic atrial fibrillation, an atrial thrombus was demonstrated in 8 (24%) and a suspected thrombus in 3. Atrial clot was also demonstrated in a patient with intermittent atrial fibrillation. In 4 out of 14 patients with previous myocardial infarction, a ventricular thrombus was demonstrated. Ventricular clots were detected in 2 of 46 patients without known previous myocardial infarction. No major complications occurred during the investigation. PACAC can be to used in the search for atrial or ventricular thrombi when cardiac source of a cerebral embolus is suspected. About 1 out of 3 patients with atrial fibrillation has remaining intracardiac thrombus after stroke.

Aged↗
PubMed1984

Knee function following suture of fresh tear of the anterior cruciate ligament.

A retrospective consecutive series of 60 patients treated with primary suture of knee ligament injuries is presented. All patients had an anterior ligament (ACL) tear. In 54 patients this injury was combined with a medial compartment tear. Four patients had isolated tears of the ACL. At follow-up after 4 years, 11 patients complained of instability, and in eight of these an anterolateral rotatory instability was demonstrated by the Slocum test. In contrast, only five of 49 patients with subjectively stable knees had positive Slocum tests. Thirty of 47 patients with negative Slocum tests had excellent function, compared with four of 13 patients with positive tests.

Adolescent↗
PubMed1984

Extra-articular stabilization of the knee a.m. Losee.

During 1979-81, 34 patients were operated according to Losee for chronic disabling anterior cruciate insufficiency. Twenty-nine patients were available for follow-up after 2 (1-4) years. At follow-up, 20 patients had a negative Slocum test. Twenty-one patients had a Lysholm knee score greater than 77 points, and were classified as good or excellent, with a significant relation to anterolateral stability.

Adolescent↗
PubMed1984

Primary repair in posterior cruciate ligament injuries.

A retrospective study of 32 consecutive patients with acute injury of the posterior cruciate ligament (PCL) treated by primary repair is presented. Only six patients had isolated injuries of the PCL, five of these as avulsion of a bone fragment from the tibia. The remaining 26 patients sustained combined ligament injuries, including 18 total ACL tears. All ruptured ligaments were repaired. At follow-up after 4 (1-7) years, function in 26 patients was excellent-good and in six fair-poor. Moderate or severe posterior instability was found in seven patients by clinical examination but their function was as good as in those with stable knees. Inferior functional results, however, were more often related to rotatory instability. Primary repair of PCL-injuries, including all associated ligament injuries, is recommended.

Adolescent↗
PubMed1983

Patellofemoral disorders treated by operations.

Thirty-six patients with patellofemoral disorders treated with various operative procedures were evaluated after an average follow-up period of 29 (6 to 72) months. Instability of the patella, either recurrent dislocation or subluxation, was present preoperatively in 27 knees (Group A). Twelve patients (Group B) were operated on for chondromalacia, which was not combined with a history of instability. Good results were obtained in 15 cases in Group A and in only three cases in Group B. Simple procedures, lateral release alone and medial duplication alone appeared to be ineffective methods.

Femur↗
PubMed1983

Respiratory alkalosis early after stroke: its relation to loco-motor function.

In 27 acute stroke patients with hemi-motor deficit blood gases (paO2, paCO2 and blood pH) were determined within 72 hours and related to level of consciousness, site of brain lesion, findings of haemorrhage into the cerebral spinal fluid, extent of motor impairment and concomitant medical disorders. Sixteen subjects were followed for three weeks with repeated blood-gas sampling and assessment of motor control. Respiratory alkalosis occurred in 37%, hypoxia in 7% but acidosis in none. Blood gas abnormalities were significantly and positively associated only with the extent of motor impairment. Only small changes in blood gases were found during the three weeks follow-up. Initial findings of respiratory alkalosis predicted poor motor recovery during the follow-up period.

Aged↗
PubMed1982

Hyperosmolar non-ketotic coma in diabetic stroke patients.

Hyperosmolar non-ketotic coma in diabetes is a life-threatening condition. We describe three patients, aged 59-67 years, who developed hyperosmolar coma during the first ten days after admission for stroke. Common to all three were normal plasma osmolality and slightly elevated plasma creatinine levels on admission, treatment with diuretics, parenteral dextrose administration before and low urinary glucose output during the coma. In the five days preceding the coma, total fluid deficits were 3.8, 6.5 and 9.4 1, respectively. In one patient the rate of glucose delivery had clearly exceeded utilization during adequate insulinization, in another a marked reduction in urinary glucose output preceded extreme hyperglycaemia and coma. Two of the three patients died, both from extensive thrombus formation in cerebral arteries and multiple emboli to the lungs. We conclude that enhanced endogenous glucose production and reduced renal clearance of glucose may contribute to precipitate hyperosmolar non-ketotic coma. A close monitoring of fluid and dextrose administration seems mandatory in diabetic stroke patients, in particular if renal function is impaired or if diuretics are given. Insulin treatment should be considered in all diabetic patients during the first days after a stroke.

Aged↗
PubMed1980

The natural history of stroke in diabetic patients.

A five-year follow-up of 53 diabetic patients admitted for their first stroke in 1972--73 has been performed. They were compared with two groups of 53 non-diabetic patients each with cerebrovascular disease (CVD), one randomly selected and one matched with the diabetics for age, sex and diagnosis of CVD at discharge. All patients could be traced at follow-up. The mean age at the time of first stroke was 66.5 years in male and 73.2 years in female diabetics. Manifest diabetes was diagnosed in 19% during hospitalization for stroke; of the remainder, 74% had had diabetes since less than ten years. In 85% of the diabetics there were no signs of severe angiopathy affecting eyes, kidneys or lower extremities. The majority of diabetic as well as non-diabetic CVD patients had a history of hypertension and/or heart disease. Few were overweight. Case fatality rate was significantly higher in diabetics than in non-diabetics throughout the follow-up (p less than 0.01 for diabetics vs. matched non-diabetics, p less than 0.001 for diabetics vs. randomly selected non-diabetics). The presence of heart disorder predicted mortality in the diabetic subjects. Surprisingly, hypertension diagnosed before stroke involved a more favourable long-term prognosis in all three groups (p less than 0.05). The major causes of death in diabetic CVD patients were cardiac disorders (50%) and stroke (47%). Previous investigations have identified diabetes as a risk factor for stroke. This study shows that diabetes also adversely affects the short-term as well as the long-term outcome in stroke.

Age Factors↗
PubMedDate not supplied

Radon: a possible risk factor in multiple sclerosis.

Ecological studies in Norway, using a method for spatially moving bivariate correlation analysis, show that south of 65 degrees N, there are significant positive correlations (p < 0.01) for rates of multiple sclerosis (MS) versus contents of radon (Rn) in indoor air, and significant negative correlations for MS rates versus fallout of magnesium (Mg) and amounts of precipitation. Based on these data, we propose the hypothesis that the content of Rn in inhaled air is a risk factor in MS. The release of harmful Rn levels to the air may be influenced by (1) the levels of exchangeable Mg in soil, which may affect the soil content of the Rn precursor radium (Ra), and (2) the amounts of precipitation through its effects on soil moisture, which is one of the factors controlling Rn emanation from the soil. This hypothesis agrees with several of the known epidemiological characteristics of MS.

Air Pollutants, Radioactive↗
PubMedDate not supplied

Brain and plasma proteins in spinal fluid as markers for brain damage and severity of stroke.

Forty well-defined acute stroke patients were investigated for some cerebro-spinal fluid (CSF) markers of cerebral damage. Myelin-basic protein (MBP), tau-fraction, albumin, IgG and transferrin were analyzed on two early occasions after onset of clinical symptoms. Patients with transitory ischaemic attack (TIA) had normal values for MBP both at first and second lumbar puncture. Patients with cerebral infarction and haemorrhage had mean MBP concentrations higher than normal at both lumbar punctures. In cerebral infarction there was a significant increase in MBP from the first to the second lumbar puncture. Patients with intracerebral haemorrhage showed the highest mean MBP values and MBP was markedly elevated already at the first lumbar puncture, suggesting different mechanisms of destruction of nervous tissue in cerebral infarction and bleeding. The amount of MBP was also significantly correlated to the visibility of the cerebral lesion at CT-scan and to the short-term outcome of the patients. The tau-fraction, indicating damage to grey matter, was higher than normal in the majority of patients with cerebral infarction and TIA. The concentration of MBP increases with the extent of brain lesion and a high value indicates a poor short-term prognosis for the patient. This study shows that the brain specific MBP in CSF is a useful marker of cerebral damage in acute cerebrovascular disease.

Acute Disease↗
PubMedDate not supplied

A randomized controlled trial of hemodilution therapy in acute ischemic stroke.

Rapid hemodilution in the early phase of ischemic stroke by the combination of venesection (250-650 ml during the first 2 days) and administration of low-molecular weight dextran was evaluated in a prospective controlled trial. Fifty-two patients were randomized to hemodilution therapy and 50 to a control group; the two groups were comparable in important prognostic variables. Mean hemoglobin was reduced from 147 to 127 g/l, hematocrit from 43 to 37% and, in a subsample of patients, whole-blood viscosity at a shear rate of 23 sec-1 from 7.0 to 4.3 cps over the first 2 days. Hemodilution was then maintained by repeated dextran infusions. Of the hemodiluted patients, 85% improved in neurological scoring over the first 10 days as compared to 64% of the control patients (p less than 0.025). The case fatality rate during the first 3 months was little affected by hemodilution. Among the survivors, 8% of the hemodiluted and 31% of the non-hemodiluted patients were unable to walk at 3 months. The proportion of surviving patients still hospitalized at the 3-month follow-up was 13% in the hemodilution group and 39% in the control group (p less than 0.01). The combination of venesection and dextran 40 administration is thus an unsophisticated but effective way to achieve rapid hemodilution in patients with acute cerebral infarction, and it improves the overall clinical outcome over the first 3 months.

Aged↗
PubMedDate not supplied

A non-intensive stroke unit reduces functional disability and the need for long-term hospitalization.

In a prospective controlled trial we compared the clinical outcome for unselected acute stroke patients in a non-intensive stroke unit (n = 110) and in general medical wards (n = 183). The patients were comparable in age, marital state and functional impairment on admission. Case fatality rates over the first year after the stroke were similar in the two groups. By three months after the stroke, 15% of the survivors initially admitted to the stroke unit and 39% of those admitted to general medical wards remained hospitalized (p less than 0.001). The corresponding figures by one year after the cerebrovascular accident were 12% and 28%, respectively (p less than 0.05). A greater proportion of surviving stroke unit patients was independent in walking (0.10 greater than p greater than 0.05), personal hygiene (p less than 0.05) and dressing (p less than 0.001). Essential features of the stroke unit are team work headed by a stroke nurse, staff, patient and family education and very early onset of rehabilitation. We conclude that this strategy improves functional outcome and reduces the need for long-term hospital care.

Aged↗