Evaluation of treatment outcome after nicergoline and pentoxifylline in patients with ischemic stroke

In this 4-year follow-up in vivo controlled study, 112 human permanent first molars from children between 6 and 11 years old were used to investigate the viability of the carbon dioxide (CO2) laser in promoting caries-free occlusal surfaces in permanent molars as an isolated form of treatment or associated with conventional fissure sealants. The findings suggest that occlusal caries prevention only by means of CO2 laser irradiation is not effective; that the utilization of photoactivated sealants, as well as its association with CO2 laser, applied over the occlusal fissures, are effective means of preventing occlusal caries, and that the application of CO2 laser over occlusal fissures prior to the application of a photoactivated fissure sealant improves the retention of the sealant.     

The protective effect of moderate alcohol consumption on ischemic stroke

Experiments were designed to investigate the influence of estrous cycle and gender of the rat on the effects of a gamma-aminobutyric acid type A (GABA(A)) receptor active neurosteroid, 3alpha-hydroxy-5alpha-pregnan-20-one (allopregnanolone), the benzodiazepine, triazolam, and a GABA(A) receptor antagonistic neurosteroid, delta5-androsten-3beta-ol-17-one sulfate (dehydroepiandrosterone sulfate), on food intake and elevated plus-maze learning behaviors. Allopregnanolone (0.25 mg/kg, s.c.) and triazolam (0.25 mg/kg, i.p.) produced a hyperphagic effect, while dehydroepiandrosterone sulfate (5 mg/kg, s.c.) elicited an anorectic effect. However, allopregnanolone was more potent in diestrous females, whereas triazolam exhibited significantly higher hyperphagic potency in estrus females. The extent of anorexia following dehydroepiandrosterone sulfate was alike in male and female rats. The triazolam- and allopregnanolone-induced hyperphagic effect was blocked by bicuculline (1 mg/kg, i.p.), a selective GABA(A) receptor antagonist. In contrast to triazolam, the hyperphagic effect of allopregnanolone was insensitive to flumazenil (5 mg/kg, i.p.), a benzodiazepine antagonist. Vehicle-treated diestrous rats displayed moderately higher latencies in the elevated plus-maze learning task than estrus or proestrus females. Although allopregnanolone and triazolam elicited equipotent learning deficits in plus-maze learning in male and female rats, the magnitude of impairment-induced by triazolam was significantly higher in diestrous females than proestrus females. Dehydroepiandrosterone sulfate enhanced memory performance only in male rats. Although the use of the elevated plus-maze as a learning paradigm with benzodiazepines and neurosteroids may be sensitive to changes in anxiety, the differential data suggest that neurosteroid-induced effects are at least partly specific to learning behavior. These results confirm the role of estrous cycle and sex of rats in modifying the potency of neurosteroids and benzodiazepines on food consumption and learning and memory processes.     

Methods for evaluating treatment and rehabilitation progress in patients with stroke]

Based on the contemporary literature review, we have been introduced generally used neurological scales estimating the influence of new method of treatment on stroke progress. They are used to evaluate to treatment and rehabilitation progress. We also paid attention on the necessary elements, which every scale should contain and have been characterized generally used scales in neurological practice.     

Atrial fibrillation in older stroke patients: association with recurrence and mortality after first ischemic stroke

Oxidation of dichlorofluorescin and dihydrofluorescin and transport of their oxidation products were studied in Saccharomyces cerevisiae cells given diacetates of these compounds. It was found that addition of peroxidase significantly accelerates the formation of dichlorofluorescein and fluorescein, indicating that peroxidase activity may be a limiting factor in studies of cellular oxidation using these probes. A significant leakage of dichlorofluorescin and dihydrofluorescin, and of their oxidized forms from the yeast cells, was found, without any apparent lag period. This phenomenon complicates interpretation of data obtained with the fluorescent precursors used but, on the other hand, points to the possibility of using measurements of dichlorofluorescein or fluorescein in the extracellular medium for studies of cellular oxidation processes.     

Emergency identification and treatment of acute ischemic stroke

In this review we describe the pathophysiology of cerebral ischemia and its implications for potential therapy. We summarize the results of recently completed trials of acute stroke intervention and explore some of the controversy surrounding thrombolysis for acute stroke. We also introduce the key concepts of neuroprotection and its therapeutic possibilities. Finally, we discuss the delays that may occur in the emergency evaluation and management of acute ischemic stroke and suggest some methods to expedite the process.     

Psychosocial rehabilitation of cranial trauma and stroke patients

This paper presents the results of a longitudinal psychosocial study of 22 cranial trauma patients and 14 stroke patients from the time preceding injury (using retrospective data), through a 4-5 month intensive rehabilitation programme, to a follow-up 1 year after completion of the programme. Although the two groups of patients differed on several demographic and medical characteristics, essentially similar patterns for psychosocial decline following injury and improvement following rehabilitation could be observed. For both groups, the proportion in marital or cohabitational relationships returned to pre-injury levels, and for both groups the proportion requiring assistance in their living situation declined following rehabilitation, as did use of the health services. Virtually all patients in both groups had been in employment or undergoing education at the time of the injury, and although this percentage declined in practice to a small minority of both groups post-injury, there was a significant increase in the proportions working or in education following the rehabilitation programme. Similarly, the pattern of leisure-time activities in both groups declined post-injury and was restored following rehabilitation. Since both groups entered the programme at over 2.5 years post-injury, these generally encouraging results seem less likely to reflect spontaneous recovery than a beneficial effect of the programme itself.     

Characteristics of epileptic seizures after ischemic stroke

BACKGROUND: Anesthesia gas delivery equipment is a potentially important source of patient injury. To better define the contribution of gas delivery equipment to professional liability in anesthesia, the authors conducted an in-depth analysis of cases from the database of the American Society of Anesthesiologists Closed Claims Project. METHODS: The database of the Closed Claims Project is composed of closed US malpractice claims that have been collected in a standardized manner. All claims resulting from the use of gas delivery equipment were reviewed for recurrent patterns of injury. RESULTS: Gas delivery equipment was associated with 72 (2%) of 3,791 claims in the database. Death and permanent brain damage accounted for almost all adverse outcomes (n = 55, 76%). Equipment misuse was defined as fault or human error associated with the preparation, maintenance, or deployment of a medical device. Equipment failure was defined as unexpected malfunction of a medical device, despite routine maintenance and previous uneventful use. Misuse of equipment (n = 54, 75%) was three times more common than equipment failure (n = 17, 24%). Misconnects and disconnects of the breathing circuit made the largest contribution to injury (n = 25, 35%). Reviewers judged that 38 of 72 claims (53%) could have been prevented by pulse oximetry, capnography, or a combination of these two monitors. Overall, 56 of 72 gas delivery claims (78%) were deemed preventable with the use or better use of monitors. The year of occurrence for claims involving gas delivery equipment ranged from 1962 to 1991 and did not differ significantly from claims involving other adverse respiratory events. CONCLUSIONS: Claims associated with gas delivery equipment are infrequent but severe and continue to occur in the 1990s. Educational and preventive strategies that focus on equipment misuse and breathing circuit configuration may have the greatest potential for enhancing the safety of anesthesia gas delivery equipment.     

Duration of neuroprotective treatment for ischemic stroke

BACKGROUND: The therapeutic time window for thrombolysis appears to be extremely short, probably because of the hemorrhagic complications associated with late reperfusion of ischemic brain tissue. Other neuroprotective forms of treatment continue to be developed, although their efficacy has yet to be conclusively proved in patients. The duration of treatment in recent phase 3 trials ranges from a single bolus injection to 12 weeks of oral therapy. SUMMARY OF REVIEW: In this article we discuss the factors that should influence the choice of route and duration of treatment. Excitotoxic injury following stroke evolves over at least 4 hours in rodents and possibly beyond 48 hours in humans. In addition, autoregulation and local cerebral perfusion are deranged for approximately 72 hours in patients with stroke. Neuroprotection should provide cover during this critical time. CONCLUSIONS: Important considerations influencing drug administration should include the pharmacology of the compound (pharmacokinetics, mechanism of action, preclinical toxicity, and pharmaceutical properties), its safety and tolerability in patients, and the likelihood of continuing or recurrent cerebral ischemia, along with practical issues such as ease of administration and interactions with early rehabilitation and other therapies. Optimization of treatment will be possible only when neuroprotection is confirmed to be effective.     

New and investigational treatment options for ischemic stroke

The last part of the review of the neurological syndromes observed among people who are HIV-infected deals with AIDS Dementia Complex, viral (CMV, HSV, VZV) encephalitides and cryptococcal meningitis and other less frequent diseases. Clinical presentation, neuropathology, diagnostic procedures and treatments are described. Diagnostic algorithm for central nervous system diseases in people with HIV is included. The main purpose of the present reviews is to pursue the common ground regarding treatment and diagnostic procedures with consulting neurologists and neurosurgeons for future cooperation in a growing area of HIV related neurology.     

The dissected aorta: percutaneous treatment of ischemic complications--principles and results

PURPOSE: Describe the principles and results of percutaneous treatment of ischemic complications of aortic dissection. MATERIALS AND METHODS: Twenty-four patients with aortic dissection complicated by ischemic compromise of the liver or bowel (n = 15), kidney (n = 18), or lower extremity (n = 13) were evaluated by means of aortography, intravascular ultrasound, and manometry, and were treated percutaneously. Visceral arteries were classified as obstructed or nonobstructed. Obstruction was classified as static, in which the dissecting hematoma extended into and narrowed the lumen of a branch artery, or dynamic, in which the dissection flap prolapsed into the vessel origin or narrowed the true lumen (TL) above it. Treatment consisted of vascular stents alone (n = 4), or balloon fenestration (n = 20) without (n = 8) or with (n = 12) vascular stents. RESULTS: Obstruction was present in 77 arteries and was static in 12 arteries, dynamic in 45 arteries, static and dynamic in 17 arteries, and indeterminate in three arteries. Percutaneous treatment did not alter false lumen (FL) pressure, but reduced the peak systolic interluminal pressure gradient from 28 mm Hg to 2 mm Hg and restored flow in 71 of 77 arteries (92%). Six patients died within 30 days (25% operative mortality), none as a result of the procedure. Two additional patients died in follow-up from complications of an expanding FL. Technical complications in two patients due to altered hemodynamics after initial intervention were recognized and corrected percutaneously during the same procedure. CONCLUSIONS: Percutaneous fenestration and endovascular stent deployment are indicated to restore blood flow to arteries compromised by aortic dissection. The prognosis of patients is related to the ischemic injury sustained prior to the percutaneous interventional procedure and, in patients with acute type I dissection who have not undergone surgery, to the preoperative stability of the FL.     

The influence of stroke unit rehabilitation on functional recovery from stroke

BACKGROUND AND PURPOSE: Shorter lengths of hospital stay in stroke units could be due to quicker functional recovery or mechanisms of expediting hospital discharge. METHODS: Stroke survivors with an intermediate prognosis at 2 weeks after stroke (n = 146) were randomized for management in a stroke rehabilitation unit or in general wards. Barthel scores were monitored at weekly intervals until hospital discharge. The duration and type of physiotherapy and occupational therapy received by patients in either setting were also recorded. The rate of change of Barthel scores, therapy input, and the duration of hospital stay were compared between the two settings. RESULTS: Neurological deficits and median initial Barthel scores were comparable between patients in the stroke unit (n = 73) and general wards (n = 68). Median discharge Barthel score of patients managed in the stroke unit was significantly higher than that of patients managed in general wards (15 versus 12). Median Barthel scores in the stroke unit group rose rapidly after 2 weeks, reaching a plateau at 6 weeks. The change in median Barthel score in patients in general wards was significantly slower, reaching a plateau at 12 weeks despite similar therapy input. There was a significant delay in discharging stroke patients in general wards (20 weeks) compared with those in the stroke unit (6 weeks). CONCLUSIONS: Functional recovery is significantly greater and more rapid in a stroke rehabilitation unit compared with general wards despite similar therapy input. These units also shorten hospital lengths of stay by expediting appropriate discharges.     

Duration of glutamate release after acute ischemic stroke

BACKGROUND AND PURPOSE: High levels of glutamate in plasma and cerebrospinal fluid (CSF) have been demonstrated in patients with acute ischemic stroke. The duration of this excitatory amino acid release has not been studied, and therefore the window of opportunity of treatment with glutamate antagonists is unknown. The aim of this investigation was to study the duration of the glutamate increase in patients with stable and progressing ischemic stroke. METHODS: Glutamate in CSF was measured by high-performance liquid chromatography in 184 patients with an acute cerebral infarction of less than 24 hours' duration and in 43 control subjects. RESULTS: Among the 120 patients with stable ischemic stroke, median glutamate levels were significantly lower- and within the reference range of control subjects-in those patients studied 6 to 24 hours from onset of symptoms than in patients studied in the first 6 hours (3 [range, 2 to 10] versus 5 mumol/L [range, 2 to 17]; P < .0001). In 64 patients with progressing ischemic stroke, glutamate concentrations measured at any time interval during the first 24 hours from onset were significantly higher than in the stable stroke and control groups. CONCLUSIONS: The presence of glutamate increase in the CSF cannot be documented for greater than 6 hours in stable ischemic stroke. The sustained elevation of glutamate observed in progressing stroke suggests that the window to prevent neurological deterioration may be wider.     

The results of autogenic training in patients with ischemic heart disease after an aortocoronary bypass operation

Were studied psychovegetative and somatic correlations in 115 patients with ischemic heart disease, having aortocoronary shunting operation and being at the sanatorium stage of the medical rehabilitation. To 70 patients was been carried out treatment with application of autogenous training (AT), to 45--without use of AT. The research has confirmed the presence in the patients psychological disadaptation, expressed essentially in asthenoneurotic and hypochondriac reactions. Is established, that estimation of expressiveness of emotional tension, investigated with the aid of Spilberger's psychometric scale, can be confirmed by parameters of peroxide oxidation of lipids and mathematical analysis of heart rythm. The use of variant of training modified by the authors has revealed improvement of clinical parameters, reflecting health state of the patients, which correlate with the data of the psychological test and the results of bicycle ergometry [correction of veloergometry].     

Home rehabilitation after stroke. Review of the literature

To find an answer to the question whether domiciliary rehabilitation after stroke is better or cheaper than alternative forms of rehabilitation, a systematic literature review of controlled trials was performed. Three large and two smaller, more preliminary studies of all together a thousand patients were found and regarded methodologically acceptable. Efficacy as regards functional, emotional and qualitative outcome of patients was equivalent for various modes of care. So was the degree of stress, social function and quality of life for the main carers. Home treatment costed less than regular day care but more than routine care including a mixture of outpatient and day care, as considered required. Domiciliary rehabilitation seems to be a good and cost effective alternative for stroke patients who need and cannot manage frequent out-patients visits without ambulance or other exhausting and expensive transports.     

The effect of co-existing diseases with cholelithiasis on the course and results of laparoscopic cholecystectomy

Six hundred laparoscopic cholecystectomies have been performed in patients with cholelithiasis. Co-existing chronic diseases have been noted in 28% of the operated patients. All these diseases have been known to increase operative risk in classic (open) cholecystectomy (hypertension, coronary disease, cardiac arrhythmias, diabetes mellitus, bronchial asthma). Statistical analysis of the body temperature following laparoscopic cholecystectomy, morbidity and duration of the postoperative hospitalization has revealed that there has been no significant increase in operative risk for laparoscopic cholecystectomy in these patients.     

急性脑梗塞后出血性转换的影响因素

目的 探讨急性脑梗塞患者发生出血性转换(hemorrhagic transformation,HT)的相关因素.方法 回顾分析108例急性脑梗塞的患者.患者入院时行头颅MRI,入院时及梗塞后7天内行头颅CT平扫.将108例患者性别、高血压、高血脂、糖尿病、冠心病、吸烟分别行x2检验,将年龄、梗塞灶数目、最大梗塞灶面积分别行成组t检验.结果 108例患者中,12例发生HT.12例术后发生HT者的最大梗塞灶面积为952.2±456.3mm2,而96例未发生HT患者的最大梗塞灶面积为317.2±197.5mm2,差异有统计学意义(P=0.001),而其他因素的差异无统计学意义(P＞0.05).结论 对于急性脑梗塞的患者,最大梗塞灶面积为梗塞后发生HT的危险因素,对梗塞后发生HT有一定的预测意义.     

社区康复护理干预对脑卒中患者生活质量的影响

目的 探讨社区康复护理干预对脑卒中患者生活质量的影响.方法 选择120例曾在本院门诊就诊或住过院的脑卒中患者,随机分成康复组和对照组,对康复组通过评估、制定康复计划,予以心理护理、肢体功能锻炼、日常生活能力训练配合理疗,对照组不予任何康复护理干预,实施前后及2组间的Barthel指数进行比较.结果 康复组和对照组分组时、2个月末和6个月时进行Barthel指数评定比较差异具有统计学意义(P<0.001).结论 针对性的社区康复护理干预,能降低脑卒中患者致残率和复发率,减少后遗症,提高生活质量,减轻家庭和社会负担.