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Kosowsky, J.M., Han, J.H., Collins, S.P., Mcafee, A.T. and Storrow, A.B. (2002), Assessment of stroke index using impedance cardiography: Comparison with traditional vital signs for detection of moderate acute blood loss in healthy volunteers. Academic Emergency Medicine, 9 (8), 775-780.

Abstract: Objectives: Impedance cardiography has been used to detect early hemorrhagic shock, but, to the best of the authors' knowledge, no previous study has looked at the test characteristics of bioimpedance-derived hemodynamic parameters for the detection of a measured loss of blood volume. The authors set out to investigate the effect of controlled hemorrhage on stroke index (SI) using impedance cardiography, and to evaluate the performance of this test for moderate blood loss in comparison with the performance of traditional vital signs. Methods: Supine and standing measurements of SI were made using a thoracic electrical bioimpedance monitor in 197 healthy, adult volunteers before and after donation of a standard unit (500 mL) of whole blood. Pre- and post-donation means for supine SI, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP), and for the postural changes in each of these measurements (ASI, DeltaHR, DeltaSBP, DeltaDBP), were compared using a paired-sample, two-tailed t- test. For each term, receiver operating characteristic (ROC) curves were generated, treating pre- and post-donation populations as independent. Areas under the ROC curves were compared using a method for correlated test result data. Results: Mean +/- SD pre- and post-donation values for SI were 47.0 +/- 6.9 mL/m(2) and 43.9 +/- 7.3 mL/m(2), respectively (p < 0.0001). Mean pre- and post-donation values for ASI were -7.7 +/- 5.8 mL/m(2) and -9.0 +/- 8.2 mL/m(2), respectively (p = 0.02). For discriminating between pre- and post-donation status, the areas under the ROC curves for SI and DeltaSI were 0.62 and 0.58, respectively. In comparison, the areas under the ROC curves for HR, SBP, DBP, DeltaHR, DeltaSBP, and DeltaDBP were 0.49, 0.61, 0.56, 0.82, 0.53, and 0.50, respectively. The area under the ROC curve for DeltaHR was significantly greater than the area under any of the other curves (p < 0.0001). Conclusions: Moderate blood loss was associated with a decline in mean SI that was clearly detectable with impedance cardiography. However, as a test for moderate blood loss in this controlled setting, neither SI nor ASI performed better than traditional vital signs

Keywords: acute/acute blood loss/adult/bioimpedance/blood/blood loss/blood pressure/blood volume/CARDIAC-OUTPUT/cardiography/changes/comparison/decline/detection/diastolic/diastolic blood pressure/effect/EMERGENCY/healthy volunteers/heart/heart rate/hemodynamic/hemodynamic parameters/hemorrhage/hemorrhagic/hemorrhagic shock/impedance/impedance cardiography/index/knowledge/loss/METAANALYSIS/monitor/noninvasive monitoring/PA/performance/postural/PRESSURE/receiver operating characteristic/shock/SHOCK/SI/standard/status/stroke/stroke index/supine/systolic/systolic blood/systolic blood pressure/thoracic/THORACIC ELECTRICAL BIOIMPEDANCE/TILT TEST/TRAUMA/USA/VOLUME

Yamaguchi, K., Hori, S., Nogawa, S., Tanahashi, N., Fukuuchi, Y. and Aikawa, N. (2002), Thrombolysis candidates for the treatment of stroke at an emergency department in Japan. Academic Emergency Medicine , 9 (7), 754-758.

Abstract: Objectives: To study the proportion and characteristics of potential candidates for the intravenous administration of tissue plasminogen activator (IV-tPA) among patients with cerebral infarction in a Japanese emergency department (ED). Methods: A retrospective observational study was performed using patients who had been transported by ambulance between August 1988 and April 2000 to an urban ED of a university hospital located in the Tokyo metropolitan area. Potential candidates for IV-tPA were identified using the criteria of the National Institute of Neurological Disorders and Stroke (NINDS) study. Results: Of all 30,064 patients transported by ambulance, 526 were diagnosed as having cerebral infarction. Among them, 190 patients arrived at the ED within two hours of symptom onset (early ED arrivers). In comparison of their demographics with late ED arrivers (n = 319), atrial fibrillation, male gender, and consciousness disturbance were related with early ED arrivers, while aging and diabetes were related with late ED arrivers. As to the stroke subtype, patients with an embolic infarction accounted for 76.8%, among early ED arrivers. Application of exclusion criteria identified 114 patients, who were suitable for the thrombolysis treatment, indicating that the proportion of potential IV-tPA candidates was 217% among all cerebral infarction patients and 0.38%, among all ED patients. Conclusions: The number of potential IV- tPA candidates among patients transported to the ED by ambulance in Japan was substantial, where the proportion of embolic infarction cases was extremely high

Keywords: ACUTE ISCHEMIC STROKE/aging/ambulance/atrial/atrial fibrillation/cerebral/cerebral infarction/comparison/consciousness/criteria/diabetes/embolic/embolism/emergency/emergency department/emergency medical services/fibrillation/gender/hospital/infarction/intravenous/Japan/Japanese/male/observational study/PA/patients/plasminogen/plasminogen activator/stroke/stroke subtype/thrombolysis/thrombolytic therapy/tissue plasminogen activator/TISSUE-PLASMINOGEN ACTIVATOR/tPA/treatment/USA

Lafleur, J. and Stokes-Buzzelli, S. (2002), Clinicopathological conference: A 73-year-old man with shock, stroke, and cyanotic extremities. Academic Emergency Medicine, 9 (2), 161-168

Keywords: ACUTE MYOCARDIAL-INFARCTION/CARDIAC RUPTURE/cyanosis/DIAGNOSIS/diagnosis/extremities/HEART/myocardial infarction/PA/pericardial tamponade/PERICARDITIS/RELEVANCE/shock/stroke/USA/VENTRICULAR FREE-WALL

Aronen, H.J., Perkio, J., Karonen, J.O., Vanninen, R.L., Ostergaard, L., Liu, Y.W., Kononen, M., Vanninen, E.J., Soimakallio, S. and Kuikka, J.T. (2002), Perfusion-weighted MRI in human acute ischemic stroke: A comparison with the progression of the infarct on diffusion- weighted images. Academic Radiology, 9 S160-S164

Keywords: acute/acute ischemic/acute ischemic stroke/CEREBRAL BLOOD-FLOW/comparison/CONTRAST/diffusion/diffusion weighted/diffusion- weighted/ECASS/EXPERIENCE/Finland/GROWTH/HIGH-RESOLUTION MEASUREMENT/human/HYPERACUTE STROKE/infarct/ischemic/ischemic stroke/MRI/progression/stroke/TIME/TRACER BOLUS PASSAGES/USA/VOLUME

Yoshiura, T., Mihara, F., Kuwabara, Y., Ogomori, K., Kaneko, K., Tanaka, A., Sasaki, M., Nakagawa, M., Koga, H., Yamanaka, T. and Masuda, K. (2002), MR relative cerebral blood flow mapping of Alzheimer disease: Correlation with Tc-99m HMPAO SPECT. Academic Radiology, 9 (12), 1383-1387.

Abstract: Rationale and Objectives. To evaluate the value of magnetic resonance (MR) perfusion imaging for diagnosis of Alzheimer disease (AD), the authors compared relative cerebral blood flow (CBF) maps obtained with MR perfusion imaging and technetium- 99m hexamethyl-propyleneamine oxime (HMPAO) single photon emission computed tomography (SPECT) in patients with AD. Materials and Methods. Eight patients with AD were studied with MR perfusion imaging and HMPAO SPECT. The relative CBF maps from the two techniques were spatially coregistered, and relative CBF values in 13 cerebral gray matter regions (total, 26 regions of interest) were compared with regression analysis. To evaluate the degree of deviation of each brain region from the regression line, a P value for the residual was calculated for each region. Results. A significant overall correlation was seen between the relative CBF values produced by the two techniques (r.68, P<.0001). Smaller P values for the residuals were obtained in the anterior cingulate cortex (P=.05) and posterior cingulate cortex (P<.001), indicating larger deviations in these regions. When data from these two regions were eliminated, the correlation coefficient rose to 0.80 (P<.0001). Conclusion. Despite fairly large discrepancies in the anterior and posterior cingulate cortices, the relative CBF map obtained with MR imaging is generally in close agreement with the HMPAO SPECT map, suggesting that MR perfusion imaging can provide clinically useful information regarding CBF abnormalities in patients with AD

Keywords: abnormalities/AD/agreement/Alzheimer/Alzheimer disease/analysis/anterior cingulate cortex/blood/blood flow/brain/CBF/cerebral/cerebral blood flow/cerebral blood vessels/computed tomography/CONTRAST/correlation/cortex/dementia/diagnosis/disease/emission/emission computed/emission-computed/flow/flow dynamics/gray matter/HIGH-RESOLUTION MEASUREMENT/HMPAO/HMPAO SPECT/HMPAO-SPECT/HYPERACUTE STROKE/imaging/information/Japan/magnetic/magnetic resonance/mapping/MR/MR imaging/MR perfusion/MR perfusion imaging/patients/perfusion/PERFUSION/perfusion imaging/POSITRON-EMISSION-TOMOGRAPHY/radionuclide studies/regions of interest/regression/regression analysis/residual/single photon emission computed tomography/SPECT/techniques/tomography/TRACER BOLUS PASSAGES/USA/VOLUME

Hofer, C.K., Zalunardo, M.P., Klaghofer, R., Spahr, T., Pasch, T. and Zollinger, A. (2002), Changes in intrathoracic blood volume associated with pneumoperitoneum and positioning. Acta Anaesthesiologica Scandinavica, 46 (3), 303-308.

Abstract: Background: It is still controversial whether elevated cardiac filling pressures after the onset of pneumoperitoneum are the consequence of increased intrathoracic pressure or of increased venous return. The aim of this study was to assess the effects of pneumoperitoneum and body positioning on intrathoracic blood volume (ITBV). Methods: Thirty anesthetized patients were randomly assigned to have CO2-pneumoperitoneum (13 mmHg) either in a supine, in a 15degrees head-up tilt or in a 15degrees head-down tilt position. Measurements of ITBV and hemodynamics by the double indicator method were recorded after induction of anesthesia and application of a fluid bolus (Lactated Ringer's solution 10 ml/kg), after positioning and after induction of pneumoperitoneum. Results: Intrathoracic blood volume index (ITBVI) increased significantly after induction of pneumoperitoneum in all body positions (supine: from 18.5 +/- 3.3-20.2 +/- 5.2 ml/kg (+6%) head-up from 16.7 +/- 3.8-17.4 +/- 3.7 ml/kg (+16%) and head-down: from 19.8 +/- 5.6-20.5 +/- 5.9 ml/kg (+14%)). Heart rate did not change significantly in any of the groups. Cardiac index showed a statistically significant change in the head-down position with pneumoperitoneum (-11%). A good correlation was found for stroke volume (SV) with ITBV (r = 0.79), but not with central venous pressure (r = 0.26). Systemic vascular resistance index increased significantly in all three groups (supine +6%, head-up +16%, head-down position +14%). Conclusion: The present study indicates that the onset of pneumoperitoneum, even with moderate intra-abdominal pressures, is associated with an increased intrathoracic blood volume in ASA I/II patients

Keywords: anesthesia/ASA/blood/blood volume/bolus/CARBON-DIOXIDE/cardiac/cardiac filling pressures/cardiac index/CARDIAC-OUTPUT/central venous pressure/COPENHAGEN/correlation/DENMARK/effects/fluid/head down tilt/head up tilt/head-up tilt/HEMODYNAMIC- CHANGES/hemodynamics/HUMANS/index/indicator-dilution technique/INSUFFLATION/INTRAPERITONEAL/intrathoracic/intrathoracic blood volume/LAPAROSCOPIC CHOLECYSTECTOMY/laparoscopy/LUNG WATER/patients/pneumoperitoneum/position/positioning/PRESSURE/pressures/resistance/stroke/stroke volume/supine/Switzerland/tilt/vascular/vascular resistance/venous pressure/VENOUS RETURN/volume

Linstedt, U., Meyer, O., Kropp, P., Berkau, A., Tapp, E. and Zenz, M. (2002), Serum concentration of S-100 protein in assessment of cognitive dysfunction after general anesthesia in different types of surgery. Acta Anaesthesiologica Scandinavica, 46 (4), 384-389.

Abstract: Background: S-100 protein serum concentration (S-100) serves as a marker of cerebral ischemia in cardiac surgery head injury and stroke. In these circumstances S-100 corresponds well with the results of neuropsychological tests. The aim of the present study was to investigate the value of S-100 and neuron specific enolase (NSE) in reflecting postoperative cognitive deficit (POCD) after general surgical procedures. Methods: One hundred and twenty patients undergoing vascular, trauma, urological or abdominal surgery were investigated. Serum values of S-100 and NSE were determined preoperatively and 0.5, 4, 18 and 36 h postoperatively. Neuropsychological tests for detecting POCD were performed preoperatively and on day 1, 3, and 6 after the operation. A decline of more than 10% in neuropsychological test results was regarded as POCD. Furthermore, we retrospectively compared the S-100 in patients with and without POCD in different types of surgery. Results: According to our definition, forty-eight patients had POCD (95% confidence interval: 37.5-58.5). These patients showed higher serum concentrations of S-100 (median 024ng/ml; range 0.01-3.3ng/ml) compared with those without POCD (n=69; median 0.14ng/ml; range 0-1.34ng/ml) 30 min post-operatively (P=0.01). Neuron specific enolase was unchanged during the course of the study. Differences of S-100 in patients with and without POCD were found in abdominal and vascular surgery but not in urological surgery. Conclusion: When all patients are pooled, S-100 appears to be suitable in the assessment of incidence, course and outcome of cognitive deficits. We suspect that in some surgical procedures, such as urological surgery, S-100 appears to be of limited value in detecting POCD. Neuron specific enolase did not reflect neuropsychological dysfunction after noncardiac surgery. (C) Acta Anaesthesiologica Scandinavica 46 (2002)

Keywords: abdominal/anesthesia/assessment/BLOOD/cardiac/cardiac surgery/CARDIAC-SURGERY/cerebral/cerebral ischemia/CEREBRAL-ISCHEMIA/cognitive/cognitive deficit/cognitive deficits/cognitive dysfunction/COPENHAGEN/CORONARY-ARTERY BYPASS/DAMAGE/decline/deficits/definition/DENMARK/dysfunction/ELDERLY PATIENTS/FEMORAL-NECK FRACTURES/general/general anesthesia/Germany/head injury/incidence/injury/ischemia/marker/NEUROBIOCHEMICAL MARKERS/neuron/neuron specific enolase/NEURON-SPECIFIC ENOLASE/neuropsychological/neuropsychological test/neuropsychological tests/NSE/outcome/patients/postoperative/postoperative cognitive deficit/protein/range/results/S-100/S-100 protein/serum/serum markers/stroke/surgery/surgical/surgical procedures/tests/trauma/TRAUMATIC BRAIN INJURY/vascular/vascular surgery

Soderstrom, S., Sellgren, J., Aneman, A. and Ponten, J. (2002), Interpretation of radial pulse contour during fentanyl/nitrous oxide anesthesia and mechanical ventilation. Acta Anaesthesiologica Scandinavica, 46 (7), 866-874.

Abstract: Background: Peripheral arterial blood pressure is not a reliable substitute for proximal aortic pressure. Recognition of this phenomenon is important for correct appreciation of cardiac afterload. Our aim was to evaluate the utility of the radial pulse wave to better understand ventriculo-vascular coupling during anesthesia. Methods: We observed the differences between aortic systolic pressure (AoSAP, tipmanometry) and radial systolic pressure in 15 patients, (including two women) aged 53-78 years, before coronary artery bypass surgery. We studied the induction of anesthesia with fentanyl (20 mug kg(-1) ), moderate volume loading, and thereafter the addition of 70% nitrous oxide. The circulatory effects of mechanical ventilation were studied by doubling the tidal volumes. Pulse wave contours were assessed by calculation of radical and aortic augmentation indices (AI), which measure the second systolic pressure peak. Results: Radial systolic pressure was higher than AoSAP in the control situation (8+/-2 mmHg), and this SAP gradient increased further with fentanyl (12+/-2 mmHg). The gradient persisted throughout the study, but was partially reduced by volume loading and nitrous oxide, respectively. Radial augmentation index was the only parameter remaining in a stepwise multivariate model to explain the variance in the SAP gradient (r (2) =0.48). Radial augmentation index also correlated with aortic pulse pressure (r (2) =0.71). Mechanical ventilation had significant and similar effects on pulse wave augmentation both in the aorta and in the radial artery, and did not affect the radial to aortic SAP gradient. Conclusion: These elderly coronary patients had stiff vasculature (high aortic AI) and considerable pulse wave reflection, which was beneficially delayed by fentanyl. Changes in the radial pulse wave augmentation during mechanical ventilation were mainly a result of cyclic changes in the stroke volume, and were seldom associated with an increased systolic pressure gradient from the aorta to the radial artery

Keywords: addition/affect/afterload/AGE/aged/AI/anesthesia/aorta/aortic/aortic pressure/arterial/arterial blood pressure/artery/artificial respiration/AUGMENTATION INDEX/blood/blood pressure/blood pressure monitors/BLOOD-PRESSURE/bypass/bypass surgery/cardiac/CARDIAC-OUTPUT/CENTRAL ARTERIAL-PRESSURE/changes/circulatory/control/COPENHAGEN/coronary/coronary artery/coronary artery bypass/coronary artery bypass surgery/coronary disease/coupling/DENMARK/effects/elderly/fentanyl/HUMANS/index/loading/measure/mechanical/mechanical ventilation/model/NITROGLYCERIN/nitrous oxide/patients/pressure/pulse/pulse pressure/pulse wave/radial/radial artery/stroke/stroke volume/surgery/Sweden/systolic/thermodilution/UPPER-LIMB/utility/vasculature/ventilation/volume/volume loading/wave reflection/women

Zorbas, Y.G., Kakurin, V.J., Afonin, V.B. and Yarullin, V.L. (2002), Biochemical and hemodynamic changes in normal subjects during acute and rigorous bed rest and ambulation. Acta Astronautica, 50 (11), 713-720.

Abstract: Rigorous bed rest (RBR) induces significant biochemical and circulatory changes. However, little is known about acute rigorous bed rest (ARBR). Measuring biochemical and circulatory variables during ARBR and RBR the aim of this study was to establish the significance of ARBR effect. Studies were done during 3 days of a pre-bed rest (BR) period and during 7 days of ARBR and RBR period. Thirty normal male individuals aged, 24.1 +/- 6.3 years were chosen as subjects. They were divided equally into three groups: 10 subjects placed under active control conditions served as unrestricted ambulatory control subjects (UACS), 10 subjects submitted to an acute rigorous bed rest served as acute rigorous bed rested subjects (ARBRS) and 10 subjects submitted to a rigorous bed rest served as rigorous bed rested subjects (RBRS). The UACS were maintained under an average running distance of 9.7 km day(-1). For the ARBR effect simulation, ARBRS were submitted abruptly to BR for 7 days. They did not have any prior knowledge of the exact date and time when they would be asked to confine to RBR. For the RBR effect simulation, RBRS were subjected to BR for 7 days on a predetermined date and time known to them right away from the start of the study. Plasma renin activity (PRA), plasma cortisol (PC). plasma aldosterone (PA), plasma and urinary sodium (Na) and potassium (K) levels, heart rate (HR), cardiac output (CO), and arterial blood pressure (ABP) increased significantly, and urinary aldosterone (UA), stroke volume (SV) and plasma volume (PV) decreased significantly (p < 0.05) in ARBRS and RBRS as compared with their pre-BR values and the values in UACS. Electrolyte, hormonal and hemodynamic responses were significantly (p < 0.05) greater and occurred significantly faster (p < 0.05) during ARBR than RBR. Parameters change insignificantly (p > 0.05) in UACS compared with pre-BR control values. It was concluded that, the more abruptly muscular activity is restricted in experimental subjects while they are very active, the greater hemodynamic and biochemical change there is and probably in individuals whose muscular activity is abruptly terminated after an accident or sudden illness. (C) 2002 Published by Elsevier Science Ltd

Keywords: activity/acute/acute rigorous bed rest/aged/aldosterone/ambulation/ambulatory/arterial/arterial blood pressure/bed rest/blood/blood pressure/cardiac/cardiac output/changes/circulatory/CO/control/cortisol/effect/electrolytes/ENGLAND/experimental/Greece/heart/heart rate/hemodynamic/hemodynamics/hormones/illness/knowledge/male/normal/normal subjects/PA/period/plasma/plasma volume/potassium/pressure/renin/right/rigorous bed rest/running/simulation/sodium/stroke/stroke volume/sudden/urinary/urine/volume/when

Erol, M.K., Yilmaz, M., Acikel, M. and Karakelleoglu, S. (2002), Left atrial mechanical function in patients with essential hypertension. Acta Cardiologica, 57 (5), 323-327.

Abstract: Objective - This study was carried out to assess the left atrial (LA) mechanical function in patients with essential hypertension with two-dimensional echocardiography by means of left atrial volume measurements. Methods - LA volumes were measured echocardiographically in 36 untreated hypertensive patients and 20 age-sex-matched healthy controls according to biplane area-length method. LA volume measurements were done at the time of mitral valve opening (V-max), at the onset of atrial systole (p wave at the electrocardiography = V-p) and at closure (V-min). All volumes were indexed for body surface area, and the following left atrial emptying functions were calculated: LA passive emptying volume = V-max - V-p, LA passive emptying fraction = LA passive emptying volume / V-max, conduit volume = left ventricular stroke volume-(V-max - Vmin), LA active emptying volume = V-p - V-min, LA active emptying fraction = LA active emptying volume / V-p, LA total emptying volume = (V-max - V-min), LA total emptying fraction = LA total emptying volume / V-max. Results - V-max (p < 0.01), V-min (P < 0.005) and V-p (p < 0.001) were significantly greater in hypertensives than in controls. Although LA passive emptying volume (p < 0.001), LA, passive emptying fraction (p < 0.001), conduit volume (p < 0.005) and LA total emptying fraction (p < 0.05) were found to be significantly lower in hypertensives than in controls, LA active emptying volume (p < 0.001) and LA active emptying fraction (p < 0.01) were found to be significantly greater in hypertensives than in controls. LA total emptying volume (p > 0.05) was similar in both groups. Conclusion - The results of the present study indicate that chronic hypertension is associated with an increased in left atrial volumes, a decrease in left atrial passive emptying function, and an increase systolic pump function. Increased left atrial pump function represents a compensatory mechanism in hypertensive patients with left ventricular hypertrophy

Keywords: atrial/atrial mechanical function/chronic/controls/DOPPLER-ECHOCARDIOGRAPHY/echocardiography/electrocardiography/essential/essential hypertension/function/HUMANS/hypertension/hypertensive/hypertrophy/IMPAIRMENT/left/left atrial function/left ventricular/left ventricular hypertrophy/lower/mechanical/mechanism/mitral valve/patients/PATTERN/results/stroke/systole/systolic/two-dimensional/VALIDATION/ventricular/ventricular hypertrophy/volume

Yilmaz, M., Erol, M.K., Cetinkaya, R. and Alp, N. (2002), Effect of haemodialysis on left atrial mechanical function in patients with chronic renal failure. Acta Cardiologica, 57 (4), 257-260.

Abstract: Objective - The aim of this study was to investigate the potential effects of haemodialysis on left atrial (LA) mechanical functions in patients with chronic renal failure. Methods - Thirty-two patients with chronic renal failure (mean age 42.8 +/- 19.6 years) were included in this study. LA volumes were determined echocardiographically at the time of mitral valve opening (maximal, Vmax), at the onset of atrial systole (p wave at the electrocardiography = V-p) and at the mitral valve closure (minimal, V-min) according to the biplane area-length method in apical 4-chamber and 2-chamber view. All volumes were corrected to the body surface area, and the following left atrial emptying functions were calculated. LA passive emptying volume = V-max - V-p, LA passive emptying fraction = LA passive emptying volume/V-max. Conduit volume = LV stroke volume-(V-max - V-min), LA active emptying volume = V-p - V-min. LA active emptying fraction = LA active emptying volume / V-p, LA total emptying volume = (V-max - V-min), LA total emptying fraction = LA total emptying volume / V-max. Results - Mean fluid removal was 1875 +/- 812 milliliter. There was no difference between in the LA passive emptying volume before and after dialysis (10.83 +/- 7.44 vs. 11.47 +/- 7.73 cm(3)/m(2), p > 0.05). Conduit volume (from 15.30 +/- 10.68 to 10.31 +/- 6.83 cm(3)/m(2) p < 0.05), LA active emptying volume (from 12.61 +/- 6.39 to 9.25 +/- 4.40 cm(3)/m(2), p < 0.005), LA total emptying volume (from 23.44 +/- 8.52 to 20.72 +/- 8.58 cm(3)/m(2), p < 0.05), LA maximal volume (from 39.44 +/- 14.07 to 28.89 +/- 11.80 cm(3)/m(2), p < 0.001), LA minimal volume (from 15.99 +/- 9.70 to 8.17 +/- 4.52 cm(3)/m(2), p < 0.001), and the volume at the onset of atrial systole (from 28.61 +/- 10.36 to 17.42 +/- 7.20 cm(3)/m(2), p < 0.001) decreased significantly after the haemodialysis session, whereas LA passive emptying fraction (from 0.27 +/- 0.14 to 0.38 +/- 0.14%, p < 0.001), LA active emptying fraction (from 0.46 +/- 0.18 to 0.53 +/- 0.17%, p < 0.05), LA total emptying fraction (from 0.61 +/- 0.14 to 0.72 +/- 0.09%, p < 0.001) increased significantly after haemodialysis. Conclusion - The results of this study suggest that left atrial mechanical functions improve after haemodialysis in patients with chronic renal failure

Keywords: age/atrial/atrial mechanical function/chronic/chronic renal failure/CHRONIC UREMIA/dialysis/effects/electrocardiography/failure/fluid/function/haemodialysis/HEMODIALYSIS-PATIENTS/left/left atrial function/LEFT-VENTRICULAR HYPERTROPHY/mechanical/mitral valve/patients/PERFORMANCE/renal/renal failure/results/STATE/stroke/systole/VOLUME

Chelala, E., Paraskevas, N., Chahidi, N., Poortmans, M., Andre, R. and Alle, J.L. (2002), Primary mechanical stapled anastomosis in surgery for colorectal emergencies. Acta Chirurgica Belgica, 102 (1), 30-32.

Abstract: From May 91 to March 99 a consecutive series of 100 acute obstructions or perforations of the left colon or rectum were treated by primary resection with mechanical anastomosis using a double or triple stapling technique without proximal colostomy. There were 8 postoperative deaths (8%) due to sepsis, acute respiratory distress syndrome, pulmonary embolism, stroke, and cachexy. Complications occurred in 29% of surviving patients. Clinical anastomotic leaks were observed in 7%, respiratory infection in 8%, wound infection in 8% and major cardiovascular problems in 4% of patients. The median hospital stay was 19 days. The morbidity and mortality of this series did not exceed the cumulative morbidity and mortality that can be expected after staged surgery. Compared with staged surgery, immediate resection and anastomosis using an entirely mechanical suture, thereby avoiding the problems of colostomy and reducing the length of hospital stay, has significant advantages for patients

Keywords: acute/acute respiratory distress syndrome/anastomosis/CANCER/CARCINOMA/cardiovascular/colic anastomosis/COLON/DISEASE/distress/DIVERTICULITIS/embolism/hospital/infection/large bowel emergencies/LARGE-BOWEL/left/length of hospital stay/MANAGEMENT/mechanical/morbidity/morbidity and mortality/mortality/OBSTRUCTION/one stage colectomy/patients/postoperative/primary colorectal anastomosis/pulmonary/pulmonary embolism/RESECTION/respiratory infection/sepsis/stroke/surgery/syndrome/technique/wound

Hingorani, A., Ascher, E., Tsemekhim, B., Markevich, N., Kallakuri, S., Schutzer, R. and Jacob, T. (2002), Causes of early post carotid endartectomy stroke in a recent series: The increasing importance of hyperperfusion syndrome. Acta Chirurgica Belgica, 102 (6), 435-438.

Abstract: Objective : Early stroke occurs in 0.9% to 7% of patients undergoing carotid endarterectomy (CEA). These have been thought to be mostly due to embolization. However, in our recent clinical experience, we noted hyperperfusion syndrome to be a significant cause of postoperative strokes. Therefore, we reviewed our experience and investigated the distribution of causes of early postoperative strokes. Materials and methods : A retrospective chart review of 444 consecutive patients who underwent CEA at our institution between June 1997 and October 1999 (500 operations) was performed to evaluate the incidence and etiology of early postoperative strokes. Indications for operation included history of stroke correlating with the side of ICA stenosis (50 patients or 10%), symptoms of transient ischemic attacks (84 patients or 16.8%), amaurosis fugax (18 patients or 3.6%), or asymptomatic stenosis (348 patients or 69.6%). All patients were evaluated with duplex scan preoperatively and postoperatively. Diagnosis of early postoperative strokes within one month after CEA was made based on clinical examination. Postoperative CT scan of the brain was available in 100% of patients with suspected diagnosis of CVA. Results : Five patients (3 male and 2 female) were diagnosed with strokes postoperatively (1%). These five were symptomatic patients with ICA stenosis greater than or equal to80% and moderate contralateral ICA stenosis. In two of those patients (40%), the reason for the stroke was considered embolization to the cerebral arteries; one patient suffered a shunt injury as a cause of stroke; two patients (40%) were diagnosed with hyperperfusion syndrome. In both patients diagnosis was made clinically, and in only one of those patients the clinical picture correlated with CT scan. Two patients (0.4%) had asymptomatic ICA occlusion at 2 weeks and 18 days postoperatively. Conclusion : Embolization to the cerebral arteries remains the leading cause of early postoperative strokes. However, hyperperfusion syndrome also accounts for a significant portion of these postoperative strokes. The percentage of patients with this syndrome might be even higher, once clinical picture is clearly defined. These data warrant further investigation of hyperperfusion syndrome

Keywords: amaurosis fugax/arteries/ARTERY/asymptomatic/asymptomatic stenosis/brain/carotid/carotid endartectomy/carotid endarterectomy/cause/causes/CEA/cerebral/cerebral arteries/CEREBRAL HYPERPERFUSION/clinical/clinical examination/clinical experience/clinical picture/CRITERIA/CT/CT scan/CT-scan/CVA/diagnosis/distribution/duplex/duplex scan/embolization/ENDARTERECTOMY/etiology/examination/experience/female/HEADACHE/history/hyperperfusion/hyperperfusion syndrome/ICA occlusion/incidence/increased frequency/injury/investigation/ischemic/ischemic attacks/male/methods/occlusion/patient/patients/PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY/postoperative/review/shunt/STENOSIS/stroke/strokes/symptoms/syndrome/transient/transient ischemic attacks/USA

Arditti, J., Bourdon, J.H., Spadari, M., de Haro, L., Richard, N. and Valli, M. (2002), Ma- Huang, from dietary supplement to abuse. Acta Clinica Belgica, 57 34-36.

Abstract: Dietary supplements containing Ma Huang (chinease ephedra) are available on the web sites and dietary shops in USA. They are widely promoted and used as a mean of weight reduction and energy enhancement. They contain Ma Huang alone or combined with Guarana (caffeine), creatine, St Jonh's wort, carnitine and are proposed with different labels. Numerous reports of adverse reactions and acute intoxication related to these products use were described in the medical literature. In the light of the severity of these cases, some of which resulted in permanent injury and death, the Food and Drug Administration has proposed limits on the dose and duration of use of such supplements. A review of 140 reports submitted to the FDA between June 1997 and March 1999, 47 % involved cardiovascular symptoms, 18 % neurological symptoms. Severe hypertension was the single most frequent adverse effect followed by tachycardia, myocardial infarction, stroke, seizure. Ten events resulted in death and 13 produced permanent impairment. In France, ampleness of the use of dietary supplements containing ephedra alkaloids is unknown. Two French recent severe poisonings (one with "ripped Fuel" for losing weight and the other with "Energy pills" in a body builder) show that there is serious health risks for the chronic users. Dietary supplements are not subject to control under "la Direction Generale de la Sante". Informations for general public, medical community and health-care authorities are necessary to be aware of potential health hazards of these products use

Keywords: abuse/acute/caffeine/cardiovascular/chronic/combined/community/control/creatine/death/dietary/duration/effect/energy/EPHEDRINE/France/general/health/health care/healthcare/hypertension/impairment/infarction/injury/intoxication/medical/myocardial/myocardial infarction/neurological/neurological symptoms/review/risks/seizure/severe/stroke/symptoms/USA/use/weight

Pontiroli, A.E. and Camisasca, R. (2002), Additive effect of overweight and type 2 diabetes in the appearance of coronary heart disease but not of stroke: a cross-sectional study. Acta Diabetologica, 39 (2), 83-90.

Abstract: We evaluated the possible additive effect of overweight and diabetes in the occurrence of coronary heart disease (CHD) and stroke, and their interaction with other established risk factors. In a cross-sectional study, we evaluated the frequency of CHD and stroke in four groups of subjects: (1) lean non- diabetic subjects (n=250); (2) lean diabetic subjects (n=269); (3) overweight non-diabetic subjects (n=203); and (4) overweight diabetic subjects (n=446). CHD was more frequent among diabetic subjects, and even more among overweight diabetic subjects; stroke was more frequent among diabetic subjects, but equally frequent in overweight and in lean diabetic subjects. At multiple logistic regression analysis, age, arterial hypertension, diabetes were independent risk factors for CHD and for stroke; BMI and hyperlipidemia were risk factors only for CHD. CHD was an independent risk factor for stroke, and stroke was a risk factor for CHID. We conclude that obesity and diabetes are additional risk factors for CHD but not for stroke. The value of established risk factors such as arterial hypertension and hyperlipidemia in determining the appearance of CHD and stroke is maintained in the presence overweight and diabetes. Finally, CHD is frequently associated with stroke, suggesting a common process of atherosclerosis underlying both diseases

Keywords: age/analysis/arterial/arterial hypertension/atherosclerosis/BMI/BODY-MASS INDEX/CARDIOVASCULAR-DISEASE/CHD/common/coronary/coronary heart/coronary heart disease/cross-sectional study/diabetes/disease/diseases/effect/established risk factors/FOLLOW-UP/frequency/heart/heart disease/hyperlipidemia/hypertension/IMPAIRED GLUCOSE-TOLERANCE/INDEPENDENT RISK FACTOR/interaction/ISCHEMIC STROKE/Italy/kidney function/logistic regression/MELLITUS/MIDDLE-AGED MEN/MORTALITY/multiple/multiple logistic regression/NEW-YORK/OBESITY/occurrence/overweight/proteinuria/regression/regression analysis/risk/risk factor/risk factors/risk-factors/stroke/type 2/type 2 diabetes/type 2 diabetes mellitus/USA

Fasching, P. (2002), The influence of age on glucose tolerance and on cardiovascular risk factors - Results of the diabetes-infobustours 1998/99. Acta Medica Austriaca, 29 17-22.

Abstract: In 19219 individuals (45,4% male, 54,6% female) with an age range from 10 to 95 years average body weight, body mass index (BMI), serum cholesterol and arterial blood pressure showed typical age-dependent changes. In the middle-aged between 45 and 65 years the high percentage of total cholesterol levels over 200 mg/dl (male: 58,3 %; female 70,7 %) seems alarming. In very old persons over 80 years the predictive value of those cardiovascular risk factors for increased mortality might be reversed, since in several epidemiological observations higher total cholesterol values and a high systolic blood pressure were associated with a longer survival. Average random blood glucose concentration is steadily rising with age. In good comparison with results from US American and European studies the age-matched relative risk for known myocardial infarction and stroke is twice to four times higher in individuals with known diabetes mellitus than in those without. These findings underline the urgent need for broadly based screening programs looking for metabolic and cardiovascular risk factors and for early disturbances of carbohydrate metabolism particularly in middle-aged groups, and for manifest diabetes mellitus in persons over 65 years of age

Keywords: age/age dependency/arterial/arterial blood pressure/Austria/blood/blood glucose/blood pressure/BLOOD-PRESSURE/body mass index/body weight/carbohydrate/cardiovascular/cardiovascular disease/cardiovascular risk/cardiovascular risk factors/changes/cholesterol/CHOLESTEROL/comparison/diabetes/diabetes mellitus/female/German/GERMANY/glucose/glucose tolerance/hypertension/index/infarction/male/metabolism/MORTALITY/myocardial/myocardial infarction/OLD/PEOPLE/predictive/predictive value/pressure/programs/range/relative risk/results/risk/risk factors/risk-factors/screening/serum/serum cholesterol/stroke/survival/systolic/systolic blood/systolic blood pressure/tolerance/total cholesterol/US/very old/weight

Pechlaner, C., Kaneider, N.C., Djanani, A., Sandhofer, A., Schratzberger, P. and Patsch, J.R. (2002), Antithrombin and near-fatal exertional heat stroke. Acta Medica Austriaca, 29 (3), 107-111.

Abstract: Heat waves result in excess deaths, excess emergency department visits, and intensive care unit admissions for heat stroke. We describe the clinical features and 3-month outcome of a patient with near-fatal heat stroke, admitted to our intensive care unit in July, 2001, After heavily working for hours at a construction site during a heat wave, the 28-year-old male presented with 41.4 degreesC body temperature and multiorgan failure, consisting of neurological impairment, rhabdomyolysis, acute renal failure, disseminated intravascular coagulation, and acute respiratory distress syndrome (ARDS). In the first week there was no evidence of infection. Treatment included cooling, aggressive volume resuscitation, administration of antithrombin-Ill concentrates and steroids. The patient survived and recovered normal neurological, renal, respiratory and haematological function, and no disability persisted. This case illustrates survival and complete recovery after multiorgan failure in heat stroke with vigorous intensive care. Treatment with antithrombin and steroids and may well have contributed to the favourable outcome. Correction of reduced antithrombin III levels to supranormal by therapeutic administration of antithrombin III concentrate in disseminated intravascular coagulation of heat stroke was not associated with any bleeding complications

Keywords: acute/acute renal failure/acute respiratory distress syndrome/antithrombin/antithrombin III/Austria/bleeding/bleeding complications/body temperature/clinical/clinical features/COAGULATION/complications/DANTROLENE SODIUM/disability/disseminated intravascular coagulation/distress/EFFICACY/emergency/emergency department/FAILURE/FIBRINOLYSIS/function/GERMANY/heat/heat stroke/heat wave/HEATSTROKE/HYPERTHERMIA/ILLNESSES/impairment/infection/intensive care/intensive care unit/male/neurological/normal/outcome/patient/recovery/renal/renal failure/resuscitation/rhabdomyolysis/SEVERE SEPSIS/steroids/stroke/survival/syndrome/temperature/therapeutic/TRIAL/vigorous/volume/week

Chang, C.Z., Winardi, D., Loh, J.K., Kung, S.S., Howng, S.L., Jeng, A.Y. and Kwan, A.L. (2002), Alteration of ischemic reperfusion injury in the rat neocortex by a potent antioxidant mexiletine. Acta Neurochirurgica, 144 (2), 189-193.

Abstract: The mechanisms by which mexiletine exerts its effects in increasing myocardial circulation, and smooth muscle perfusion and alleviating diabetic neuropathic pain have been widely discussed. The purpose of this study was to examine the protective effect of this compound in ischemia/reperfusion- induced cerebral injury following middle, cerebral artery occlusion in Spraque-Dawley rats. Blood flow to the left cerebral hemisphere of the animals was interrupted by occluding the left cerebral artery and both carotid arteries simultaneously for 3 hrs. These animals were assigned to one of ten groups and devided into treatment group and pretreatment group; I) control treatment group (n = 8); 2) vehicle treatment group (n = 8) 3) lower dose mexiletine (400 pg/kg) treatment group (n = 8); 4) medium dose mexiletine (800 mug/kg) treatment group (n = 8); 5) high dose mexiletine (2 mg/kg) treatment group (n = 8): 6) control pretreatment group (n = 8) 7) vehicle pretreatment group (n = 8): 8) lower dose mexiletine (400 pg/kg) pretreatment group (n = 8): 9) medium dose mexiletine (800 pg/kg) pretreatment group (n = 8): and 10) high dose mexiletine (2 mg/kg) pretreatment group (n = 8). The volume, of cerebral infarction was measured in serial brain sections stained with triphenyltetrazolium chloride (TTC). Tissue infarction volume and tissue edema were estimated for each animal. The volume of cerebral infarction was significantly decreased in rats pretreated with mexiletine, and the ratio of tissue edema was also decreased as the dose of mexiletine increased. These results demonstrate that mexiletine, an anti- arrhythmic and use-dependent Na+ channel blocker, has protective effects in stroke at concentrations sufficient to confer significant protection, as measured by the volume of infarction and brain edema index in a model of focal, neocortical ischemia in Spraque-Dawley rats

Keywords: animal/animals/antioxidant/arteries/artery/blocker/brain/brain edema/BRAIN INJURY/carotid/carotid arteries/cerebral/cerebral artery/cerebral artery occlusion/cerebral infarction/cerebral injury/CEREBRAL-ISCHEMIA/chloride/circulation/control/EDEMA/effect/effects/EXCITABILITY/flow/focal/FREE-RADICALS/hemisphere/HYDROXYMEXILETINE/index/induced/infarction/injury/ischemia/ischemia/reperfusion/ischemic/left/lower/mechanisms/mexiletine/model/muscle/MUSCLE-FIBERS/myocardial/neocortex/neocortical ischemia/neuropathic pain/NITRIC-OXIDE/occlusion/pain/PAINFUL DIABETIC NEUROPATHY/perfusion/protection/rat/rats/reperfusion/reperfusion injury/results/smooth/stroke/Taiwan/treatment/triphenyltetrazolium chloride/vehicle/volume/WHITE-MATTER

Ekelund, A., Reinstrup, P., Ryding, E., Andersson, A.M., Molund, T., Kristiansson, K.A., Romner, B., Brandt, L. and Saveland, H. (2002), Effects of iso- and hypervolemic hemodilution on regional cerebral blood flow and oxygen delivery for patients with vasospasm after aneurysmal subarachnoid hemorrhage. Acta Neurochirurgica, 144 (7), 703-713.

Abstract: Background Arterial vasospasm after subarachnoid hemorrhage may cause cerebral ischemia. Treatment with hemodilution, reducing blood viscosity, and hypervolemia, increasing cardiac performance and distending the vasospastic artery, are clinically established methods to improve blood flow through the vasospastic arterial bed. Method Eight patients with transcranial Doppler verified vasospasm after subarachnoid hemorrhage were investigated with global (two-dimensional (133)Xenon) and regional (three-dimensional Tc-99m-HMPAO) cerebral blood flow (CBF) measurements, before and after 1/iso- and 2/hypervolemic hemodilution. Hematocrit was reduced to 0.28 from 0.36. Hypervolemia was achieved by increasing blood volume by 1100 ml. Findings. Isovolemic hemodilution increased global cerebral blood flow from 52.25 +/- 10.12 to 58.56 +/- 11.73 ml (*) 100 g(-1) (*) min(-1) (p < 0.05), but after hypervolemic hemodilution CBF returned to 51.38 +/- 11.34 ml (*) 100 g(-1) (*) min(-1). Global cerebral delivery rate of oxygen (CDRO2) decreased from 7.94 +/- 1.92 to 6.98 +/- 1.66 ml (*) 100 g(-1) (*) min(-1) (p < 0.001) during isovolemic hemodilution and remained reduced, 6.77 +/- 1.60 ml * 100 g(-1) 1 min(-1) (p < 0.001), after the hypervolemic hemodilution. As a test of the hemodilution effect on regional CDRO2 an ischemic threshold was defined as the maximal amount of oxygen transported by a CBF of 10 ml (*) 100 g(-1) (*) min(-1) at a Hb 140 g/l which corresponds to a CDRO2 of 1.83 ml (*) 100 g(-1) * min(-1). The brain volume with a CDRO2 exceeding the ichemic threshold was 1300 +/- 236 ml before intervention. After isovolemic hemodilution the non-ischemic brain volume was reduced to 1206 +/- 341 (p < 0,003). After hypervolemic hemodilution the non- ischemic brain volume remained reduced at 1228 +/- 347 ml (p < 0.05). Interpretation. The present study of controlled isovolemic hemodilution demonstrated increased global CBF, but there was a pronounced reduction in oxygen delivery capacity. Both CBF and CDRO2 remained decreased during further hypervolemic hemodilution. We conclude that hemodilution to hematocrit 0.28 is not beneficial for patients with cerebral vasospasm after SAH

Keywords: ACUTE ISCHEMIC STROKE/aneurysmal subarachnoid hemorrhage/arterial/ARTERIAL- HYPERTENSION/artery/blood/blood flow/blood viscosity/blood volume/brain/cardiac/cardiac performance/cause/CBF/cerebral/cerebral blood flow/cerebral ischemia/cerebral oxygen delivery/cerebral vasospasm/delivery/Doppler/effect/flow/global/hematocrit/hemodilution/HEMODYNAMICS/hemorrhage/hypervolemia/hypervolemic hemodilution/intervention/INTRACRANIAL ANEURYSMS/INTRAVASCULAR VOLUME EXPANSION/ischemia/ischemic/ISOVOLEMIC HEMODILUTION/methods/oxygen/oxygen delivery/patients/performance/RANDOMIZED CONTROLLED TRIAL/regional cerebral blood flow/SAH/subarachnoid/subarachnoid hemorrhage/SURGERY/Sweden/THERAPY/three-dimensional/threshold/transcranial/transcranial Doppler/TRANSCRANIAL DOPPLER ULTRASOUND/two-dimensional/vasospasm/viscosity/volume

Kaminogo, M. and Yonekura, M. (2002), Trends in subarachnoid haemorrhage in elderly persons from Nagasaki, Japan: Analysis of the Nagasaki SAH Data Bank for cerebral aneurysm, 1989-1998. Acta Neurochirurgica, 144 (11), 1133-1139.

Abstract: Background. Many industrialized countries are facing a volumetric growth of the senior population. We studied the trends in the incidence and outcome of subarachnoid haemorrhage (SAH) in patients aged greater than or equal to70 years. Method. We retrospectively reviewed the cases of 1030 patients registered in the Nagasaki SAH Data Bank from 1989 to 1993 and 1274 patients registered from 1994 to 1998. Findings. The annual age-adjusted incidence of SAH per 100,000 increased only in women, from 15.4 in the 1989-1993 period to 19.7 in the 1994-1998 period. The average annual incidence of SAH per 100,000 women in the elderly aged greater than or equal to70 years increased significantly from 44.3 in the first period to 58.2 in the second period. In patients aged :70 years, the proportion of high-grade SAH (Hunt & Kosnik Grade IV and V) significantly increased from 27.2% in the first 5 years to 38.2% in the second 5 years. In patients aged <70 years, it increased slightly from 23.4% to 26.7%. The rate of favorable outcomes significantly fell from 43.9% (first period) to 30.9% (second period) in patients aged greater than or equal to70 years but was stable in patients aged <70 years. Interpretation. Although the incidence of elderly patients with SAH in our study is compatible with or higher than that of other reports, we believe that elderly patients (especially women) with highgrade SAH may not have all been identified. When we discuss the management of ruptured and unruptured aneurysms in the elderly, we should bear these trends of SAH in mind

Keywords: aged/aneurysm/aneurysms/CASE- FATALITY/cerebral/cerebral aneurysm/COMMUNITY/elderly/elderly patients/growth/haemorrhage/incidence/incidence rate/INTRACEREBRAL HEMORRHAGE/INTRACRANIAL ANEURYSMS/Japan/MANAGEMENT/MORTALITY/NEW-ZEALAND/outcome/outcomes/patients/period/population/PREVALENCE/RISK-FACTORS/SAH/STROKE/subarachnoid/subarachnoid haemorrhage/subarachnoid hemorrhage/the elderly/trends/women

[Anon]. (2002), Proceedings Belgian Stroke Council Meeting - Liege, 28th September 2002 - Abstracts. Acta Neurologica Belgica, 102 (4), 200-203

de Borchgrave, V., Saussu, F., Depre, A. and de Barsy, T. (2002), Moyamoya disease and Down syndrome: Case report and review of the literature. Acta Neurologica Belgica, 102 (2), 63-66.

Abstract: We present the case of a 29-year-old woman with Down syndrome who developed bilateral frontal ischemic stroke. Cerebral angiography demonstrated an occlusion of the both supraclinoid internal carotid arteries associated with dilated collateral vessels, consistent with moyamoya disease. We review the clinical and radiological features of moyamoya disease associated with Down syndrome and discuss a few major physiopathologic hypotheses to explain this association



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