Distribution and number of ischemic cerebrovascular events were studied in 57 patients who suffered from heart disorders with proven or highly probable source of cardiac embolism and compared to 39 ...patients with ulcerations of the craniocervical vessels. Patients with coexisting lesions were excluded from the present study. Out of the 57 patients with cardiac disorders, a single episode of cerebral embolism occurred in 33 patients. Of the 24 patients with recurrent ischemic episodes, different vascular territories were involved in only six cases. There was no evidence of a distinct distribution of vascular territories involved in cerebral embolism. The left middle cerebral artery was affected in 42.9%, the right middle cerebral artery in 23.8%, the vertebrobasilar territory in 19%, and the ophthalmic arteries in 14.2%. Statistical analysis revealed no significant differences in lesion localization between the group with a cardiac source of embolism and the group with ulcerations of the craniocervical vessels. There was a high frequency of patients with recurrent cardiogenic emboli in the ophthalmic (6 of 9 patients) as well as in the vertebrobasilar (6 of 12 patients) circulation who experienced a delayed initiation of cardiac assessment. The possibility of cardiac embolism should be considered in any patient with cerebral ischemia, independently of the vascular territory affected.
In the first of three articles, the producer of Energyline, Energynet, and Tele/Scope recalls the development of the databases and database business strategies. The second describes the development ...of biomedical online databases, and the third discusses future developments, including full text databases, database producers as online host, and optical data disks. (CLB)
The Inverted File Kollegger, James G
Online,
11/1988, Letnik:
12, Številka:
6
Trade Publication Article
An editorial notes that cooperation seems to be expanding between content providers and telecommunication companies due to specific policy developments in Washington: the Open Network Architecture ...(ONA) promoted by the FCC and the relaxation of the Modified Final Judgement by Judge Harold Greene.
The course of leukemic disease in a male adolescent with meningeal leukemia is described. The bone marrow aspirates showed a conversion from an acute lymphatic leukemia to an eosinophilic leukemia. ...Four weeks after the peripheral shift of phenotype two different cell clones were detected in one CSF smear. While under ultrahigh dose araC therapy the patient died 3 months after conversion. Possible explanation for the shift of phenotype and the peculiar leptomeningeal infiltration are discussed.
Use of nicotine--a risk factor for stroke? Dal Bianco, P; Zeiler, K; Baumgartner, C ...
Wiener Klinische Wochenschrift,
1989-Oct-27, Letnik:
101, Številka:
20
Journal Article
Recenzirano
The results of studies on cigarette smoking as a risk factor for stroke are more controversial than for cardiovascular disease. The CO-induced increase in the corpuscular elements of blood ...(erythrocytes), the influence on other parameters (such as RBC volume, haemoglobin, haematocrit, blood and plasma viscosity, tendency of erythrocytes and platelets to aggregate, fibrinogen level etc.), as well as the increase in catecholamine level are taken to be reversible. On the other hand, the association between cigarette smoking and probably irreversible morphological changes in the craniocervical vessels--possibly via lipid metabolism--is well documented. The following possible explanations for discrepant results in the literature are discussed: different extent of daily cigarette smoking, inhomogeneous populations, difficulties in diagnosing stroke, especially before the introduction of computed tomography and the common failure to consider other risk factors.
Hemodilution therapy in patients with ischemic cerebrovascular disease has recently become increasingly controversial, since controlled prospective trials failed to prove unequivocal clinical ...effects. A general rejection of hemodilution, however, does not seem to be justified. Undoubtedly, there is a beneficial influence on some hemorheologically relevant parameters as well as on cerebral blood flow (CBF). In addition, there is no proof that subgroups of patients profiting from this kind of treatment do not exist. Hemodilution is not recommended for patients with cerebral hemorrhages or hemorrhagic infarctions. In cases with transient ischemic attacks or ischemic strokes, however, this treatment should be taken into consideration further on. The application of hemodilution therapy in patients with progressive strokes depends on clinical signs, the course, the CT scan result, and sonographical findings. Recently, hydroxyethyl-starch (HES) has increasingly been used as an hemodiluting agent. The application of Dextran 40 should be limited to young normotensive patients without cardiac or renal disease.
Inhibitors of thrombocyte aggregation are generally accepted in the therapy and prophylaxis of ischemic cerebrovascular disease. The frequency of re-infarction, morbidity and mortality after TIA, ...PRIND and minor stroke is influenced favourably. There are controversial opinions, however, about the usefulness for patients suffering from completed strokes. In patients with progressive stroke, cerebral embolism of cardiac source, or non-infective thrombosis of sinuses or cerebral veins, inhibitors of thrombocyte aggregation are used if anticoagulation therapy is not possible. Additionally, they are applied in cases of infective thrombosis of sinuses or cerebral veins, after termination of anticoagulation therapy, after cardiac valve replacement, and after surgical reconstructions of craniocervical vessels. Acetylsalicylic acid is the clinically best examined substance; its effect--especially in males--was proven by numerous prospective trials. A combined treatment with dipyridamole, sulfinpyrazone or other drugs seems to be unnecessary. A daily dose of not more than 300 to 325 mg acetylsalicylic acid is recommended for prophylaxis after ischemic cerebral events; in connection with that dose severe gastrointestinal side effects are hardly to be expected. Whether even lower doses would yield the same prophylactic effects will have to be clarified by further studies.
Transient ischemic attacks (TIAs) are reversible neurological deficits due to cerebral ischemia in a vascular territory lasting less than 24 hours, usually less than one hour. The natural course of ...TIAs is variable. One third of the patients suffer from a subsequent completed stroke with lasting disability, one third of the patients continues to experience TIAs and in one third no further symptoms are encountered. TIAs are a warning symptom of a generalized vascular process, myocardial infarction being the most common cause of mortality and ischemic brain infarction being the most common cause of morbidity. Clinical parameters--besides age--seem to be of minor prognostic relevance. Vascular risk factors should be evaluated in all TIA patients; especially, a cardiac work up including 2D-echocardiography and an exercise stress test should be performed. Duplex sonography of craniocervical vessels shows atherosclerotic lesions in a considerable proportion of patients with TIA; however, localization of these lesions does not always correspond to clinical symptomatology. Some angiographic features are of prognostic relevance. Computed tomography (CT) and magnetic resonance imaging (MRI) show ischemic lesions in a considerable proportion of patients, which connects TIAs directly to ischemic brain infarcts. The extent and localization of these lesions are of some prognostic relevance. Blow flow studies on single photon emission computed tomography (SPECT) and studies of brain metabolism on positron emission tomography (PET) are abnormal in many TIA patients for prolonged periods and also have some prognostic impact. TIA patients probably are a heterogeneous group with a common symptom. A detailed diagnostic work-up may have implications on a more specific and efficient therapy.
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