Stroke 20 p1996 by CuiBcw3

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Rinnert, S., Scalea, T. and Sinert, R. (1996), Management of nontraumatic subarachnoid
  hemorrhage in a patient with sickle-cell disease: A case report. Academic Emergency
  Medicine, 3 (9), 859-863.
Abstract: Subarachnoid hemorrhage (SAH) due to sickle-cell anemia is rare, but
  potentially devastating. However, with early recognition of SAH, aggressive support
  with exchange transfusion, cerebral angiography, and neurosurgical intervention, a
  positive outcome may be achieved. A case report of SAH managed in this fashion is
  reported. Based on similar cases in the literature, a suggested treatment protocol is
  provided for the management of nontraumatic SAH in sickle-cell patients presenting
  to the ED
Keywords:               ABNORMALITIES/ANEMIA/ANEURYSMS/angiography/case
  report/cerebral/cerebral                                             aneurysm/cerebral
  angiography/COMPLICATIONS/CULTURED                                         VASCULAR
  hemorrhage/management/MASSIVE                                        INTRACRANIAL
  EP/sickle           cell          anemia/sickle        cell           disease/sickle-cell
  disease/stroke/STROKE/subarachnoid/subarachnoid hemorrhage/TRANSFUSION
Walleck, P., Becquemin, J.P., Desgranges, P. and Bonnet, F. (1996), Are neurologic
  events occurring during carotid artery surgery predictive of postoperative neurologic
  complications? Acta Anaesthesiologica Scandinavica, 40 (2), 167-170.
Abstract: Background. Per- and postoperative neurologic complications occurring
  during carotid artery surgery may be related to different mechanisms. Nevertheless,
  recent studies suggest that they are related and that patients who develop reversible
  neurologic events peroperatively are at risk of postoperative neurologic
  complications. We, therefore, studied 265 patients operated under regional
  anaesthesia to assess the incidence and the pathogenesis of per- and postoperative
  neurologic disorders and their relationship. Method. Neurologic function was
  adequately assessed in 261 patients during surgery. The operation was uneventful in
  234 patients, while 27 suffered from transient ischaemic neurologic deficit occurring
  mainly during carotid artery clamping. Results. Postoperative neurologic
  complications occurred in 6 (2.5%) of the patients who were symptom-free during
  surgery and in 1 (3.7%) of the patients who experienced neurologic deficit during
  surgery (NS). In this group, two additional patients had peroperative neurologic
  deficit which lasted a few hours postoperatively so that the total incidence of
  postoperative neurologic deficit (11.1%) was significantly higher than in the other
  group (P<0.05). Emboli (N=3) and carotid artery thrombosis (N=3) were the main
  causes of postoperative neurologic deficit. Conclusion. We conclude that patients
  who have suffered from a peroperative neurologic complication were more
  frequently in an unstable neurologic condition postoperatively However, the
  incidence of ''new'' neurologic deficit, separated by a free interval from the one
  occurring peroperatively, was not significantly different in this group
Keywords: anaesthesia/ANESTHESIA/artery/carotid/carotid artery/carotid artery
  surgery/carotid artery thrombosis/causes/cervical epidural anesthesia/cervical plexus
  MY/function/incidence/neurologic/neurologic                    complication/neurologic
Nordstrom, O., Potemkowski, A., Johansson, R., deRidder, B., Sternlo, J.E., Larsson, L.
   and Sandin, R. (1996), Local anaesthesia and propofol-fentanyl sedation for carotid
   artery surgery. Acta Anaesthesiologica Scandinavica, 40 (6), 724-728.
Abstract: Background: In patients undergoing carotid artery surgery with local
   anaesthesia (LA), a sedative/analgesic pharmacological supplement is appropriate in
   most cases in order to provide comfort. This adjunct should not preclude continuous
   clinical neurological monitoring. The aim was to investigate if a combination of
   fentanyl and propofol to supplement LA would provide comfort for the patient, allow
   continuous clinical neurological monitoring and absence of difficulties for the
   anaesthetist, and good conditions for surgery, including insertion of a shunt if this
   should become necessary. Methods: During a 1-year period low doses of propofol
   and fentanyl were used to supplement LA in 36 cases of carotid artery surgery in 34
   consecutive patients. A shunt tvas only used if neurological dysfunction occurred.
   Data on haemodynamics, pulmonary gas exchange, clinical neurological monitoring
   and subjective opinions from patients, surgeons and anaesthetists were obtained.
   Morbidity within 30 days was documented. Results: Conversion to general
   anaesthesia was undertaken in one patient;previously operated on the same artery,
   who became unconscious due to a stroke during manipulation of the artery before
   arteriotomy. No other adverse outcome was found within 30 days. In the remaining
   35 cases the procedures were carried out under LA. Stump pressures below 50
   mmHg were found in 17/35 cases. Intraoperative neurological dysfunction was
   detected in 10/35 cases (stump pressures between 23 and 60 mmHg). Shunting was
   easily performed, and rapidly relieved the neurologic symptoms in all these patients.
   Intraoperative respiratory and haemodynamic control was satisfactory. Ease of
   performance, including clinical neurological monitoring, was acknowledged by both
   anaesthetists and surgeons, and all 33 patients (35 operations) who were accessible
   for a postoperative interview stated that they would prefer the same regimen in the
   case of further surgery. Conclusion: The number of cases in this open uncontrolled
   study does not permit an evaluation of this anaesthetic and sedative technique in
   terms of neurological and cardiac outcome. Thus, we simply want to inform about
   our positive experiences regarding patient acceptance and ease of performance in all
   relevant respects when fentanyl and propofol are used to supplement LA for carotid
   artery surgery
Keywords:                                          anaesthesia/ANESTHESIA/anesthetic
   techniques/anesthetics/artery/cardiac/carotid/carotid                  artery/carotid
Eriksson, M., Lundkvist, K., Drott, P., Saldeen, T. and Eriksson, O. (1996), Beneficial
   effects of pre-treatment with vitamin A on cardiac and pulmonary functions in
   endotoxaemic pigs. Acta Anaesthesiologica Scandinavica, 40 (5), 538-548.
Abstract: Background: Septic shock is associated with high mortality despite the
   development of new antibiotics. Since Vitamin A has an immunomodulating ability
   and is able to lower the concentrations of endotoxin and some cytokines, we decided
   to study whether supplementation with vitamin A may have a beneficial effect in
   experimental endotoxaemia. Methods: A porcine model was used, in which normally
   bred (i.e., not vitamin A depleted) animals were anaesthetised, monitored and
  injected intramuscularly with a non-toxic dose of vitamin A (230IU . kg(-1)) (n=9) or
  the corresponding volume of vehicle (n=9) I hour before an infusion of purified E.
  coli endotoxin was given in a dose of 10 mu g . kg(-1). h(-1) over 6 hours. Another 3
  pigs also injected with vitamin A, but not endotoxin, served as controls. Results:
  Vitamin A- and endotoxin-injected pigs were significantly less affected in several
  circulatory and respiratory variables as compared to vehicle- and endotoxin-injected
  animals (e.g., blood pressure; heart rate; cardiac index; pulmonary capillary wedge
  pressure; left and right ventricular stroke work indices; pH; base excess; oxygen
  delivery; and oxygen extraction). Vitamin A did not per se significantly affect these
  variables. Hb increased significantly in the vehicle group, indicating a more
  pronounced capillary permeability. Urinary output or fluid supply did not differ
  between the groups. Myocardial production of metabolites of prostacyclin or
  thromboxane A, did not differ between the groups. Conclusion: Pre-treatment with
  vitamin A had a beneficial effect on several variables, such as oxygen delivery and
  metabolic acidosis in the endotoxaemic pig. Improvement of these variables is
  associated with increased survival in septic shock and may indicate reduced tissue
  hypoxia. Thus, vitamin A may turn out to be useful as a prophylactic agent in
  conditions where septic shock is apt to occur
Keywords:       acidosis/ANESTHESIA/animal            model/animals/ARDS/blood/blood
  SACCHARIDE/metabolic                          acidosis/model/mortality/oxygen/oxygen
  nary/rate/SECRETION/septic                 shock/stroke/survival/thromboxane/vitamin
Gunnarsson, L., Tokics, L., Brismar, B. and Hedenstierna, G. (1996), Influence of age
  on circulation and arterial blood gases in man. Acta Anaesthesiologica Scandinavica,
  40 (2), 237-243.
Abstract: Background. Modem data on the influence of age on hemodynamic and blood
  gas data in healthy subjects are sparse, especially in middle aged or older subjects.
  Most measurements have been done in patients during major surgery or in intensive
  care when the patients have one or more failing organ systems. This study reports on
  hemodynamics, blood gases and blood volume in healthy patients prior to anesthesia
  and elective Surgery. Methods. A total of 116 subjects (92 males, 24 females) were
  investigated prior to anesthesia and elective surgery No one had received any
  premedication or was taking regular medication. All subjects were in good physical
  condition, except for their surgical disease, and clinical examination and history did
  not reveal any sign of cardiopulmonary disease. Measurements were made of
  systemic and pulmonary vascular pressures, cardiac output, arterial blood gases and
  blood volume by I-131-Albumin min distribution. Results. Cardiac output, stroke
  volume, and blood volume correlated to body surface. Relating these variables to
  body size eliminated almost all differences between the male and female groups.
  These variables, as well as both systemic and pulmonary artery systolic vascular
  pressures, were affected by increasing age. Pulmonary capillary wedge and right
  atrial pressures were not influenced by age. PaO2 decreased with age from 14.0 kPa
  at 20 years to 11.3 kPa at 80, whereas PaCO2 was unaltered. No effect of light
  smoking was found on pulmonary circulation or arterial blood gases. Significant
  correlations were found between blood volume on the one hand and body size and
  age on the other hand, but not in regard to sex
Keywords:                  age/aged/ANESTHESIA/arterial/arterial                    blood
  gases/artery/atrial/blood/blood      gases/blood       pressure/blood      volume/body
  size/cardiac/cardiac                        output/cardiopulmonary/circulation/clinical
  nary artery/sex/smoking/stroke/stroke volume/surgery/systolic/total/vascular/volume
Obrez, A. (1996), Mandibular molar teeth and the development of mastication in the
  miniature pig (Sus scrofa). Acta Anatomica, 156 (2), 99-111.
Abstract: The only components of the orofacial complex that are fully developed as
  soon as they establish function are the occlusal surfaces of teeth. It is usually
  assumed that the occlusal surface of the molar teeth influences the orientation of the
  power stroke in spite of the fact that the data supporting this claim are lacking. The
  purpose of this longitudinal study was therefore to determine whether or not this
  hypothetical form- function relationship existed during development and whether or
  not it was related to growth. Serial dorsoventral and lateral radiography, and
  dorsoventral cineradiography were performed during natural feeding of 5 Hanford
  miniature pigs (Sus scrofa) of both genders between their 8th and 18th weeks.
  Sequences of power strokes were analyzed frame by frame and compared between
  sessions, and related to the position of the fourth primary mandibular molar (dm,).
  The changes in direction of the power stroke and in position of the dm, relative to the
  midline were subsequently related to growth. The results of this study indicate that
  changes in orientation of the power stroke, though significant only on the balancing
  side, occur independently of the repositioning working and balancing side
  mandibular molars, as well as of skeletal growth. The null hypothesis that the
  mandibular primary molars influence the transverse orientation of the power stroke
  during growth is therefore refuted
Keywords:                                                                       DENTAL
  dinal                study/MASSETER/mastication/miniature                     pig/molar
  STNATAL-DEVELOPMENT/power/power                                         stroke/RABBIT
VanDamme, H., Gillain, D., Desiron, Q., Detry, O., Albert, A. and Limet, R. (1996),
  Kinking of the internal carotid artery: Clinical significance and surgical management.
  Acta Chirurgica Belgica, 96 (1), 15-22.
Abstract: The authors report on 62 surgical corrections for kinking of the internal
  carotid artery during a 13-year period (1980- 1993). This represents 2.8% of all
  carotid operative procedures (n = 2188) in the same period. It always concerned a
  significant (< 60 degrees) angulation of a redundant internal carotid artery, that in all
  but 3 cases was associated with atherosclerotic involvement of the carotid bifurcation.
  The indication to surgery included transient hemispheric or ocular ischaemia in
  25.5% of cases, a regressive neurologic deficit in 8%, a minor stroke in 3%, a stroke
  in evolution in 11%, and non-lateralized cerebral ischaemia in 21%. In 19 patients
  (31%) it concerned an asymptomatic high degree stenosis. The surgical technique
  consisted in carotid transposition-reimplantation after eversion endarterectomy in 37
  cases, in posterior transverse plication with patch angioplasty in 20 cases, and in
  segmental excision with venous interposition graft in 5 cases. There was one
  postoperative death. The morbidity include one ipsilateral non-fatal stroke and 3
  transient ischaemic attacks. A complete long-term follow-up (mean duration 3.4
  years) is available for 57 patients. The late incidence of stroke is 1.5% per year. The
  5-year survival attains 67%. These long-term results are comparable to the outcome
  of standard endarterectomy in the same institution. The authors discuss the indication,
  techniques, and outcome of surgical correction of kinked internal carotid artery. They
  recommend a shortening procedure, often associated with endarterectomy for
  severely kinked vessels (angulation 60 degrees or less), symptomatic or not
Keywords: angioplasty/artery/atherosclerosis/BELGIUM/carotid/carotid artery/carotid
  artery                                                        diseases/cerebral/cerebral
  up/follow-up/graft/incidence/internal/internal          carotid/internal         carotid
  perative                      complications/prognosis/stenosis/stroke/surgery/surgical
  technique/survival/techniques/transient/transient ischaemic attacks/vascular surgery
VanDamme, H., Lacroix, H., Desiron, Q., Nevelsteen, A., Limet, R. and Suy, R. (1996),
  Carotid surgery in octogenarians: Is it worthwhile? Acta Chirurgica Belgica, 96 (2),
Abstract: Controversy surrounds the role of carotid endarterectomy in octogenarians.
  Although the prognosis of severe degree carotid stenosis is more ominous in the
  elderly, operative risk seems more important in the aged. To evaluate the presumed
  detrimental effect of advanced age on the mortality-morbidity of carotid
  endarterectomy, the authors reviewed their common experience with carotid surgery
  in patients aged 80 years or more. From 1980 to 1994, 129 octogenarians were
  operated on for occlusive carotid artery disease in two university hospitals. The data
  for these patients, 80 years of age and older (group 1) are compared to these for a
  large middle age group (less than 80 years) (group 2) operated by the same surgeons
  during that period. The baseline characteristics of both groups were similar, except
  for smoking, diabetes and previous myocardial revascularization, more prevalent in
  the younger age group. In the elderly group prophylactic surgery for asymptomatic
  stenosis was done in 36%, versus 40% of the middle aged patients, and for stroke in
  evolution in 8% versus 4% (p < 0.05). The perioperative stroke rate was 0.8% in the
  group older than 80 years, compared to 1.2% for non octogenarians (NS). The
  operative mortality was similar for both age groups (2.3 and 1.5 respectively). The
  long-term results gave a similar outlook for both age groups. The 5-year stroke-free
  rate reached 89% for group 1 versus 91% for group 2. The 5-year survival rate,
  however, was less for the elderly patients (47% versus 77%, mean follow-up periods
  of 30 and 49 months). These results suggest that carotid endarterectomy can be
  safely done in elderly patients, with a similar risk/benefit ratio as for the younger
  patients. Advanced age, by itself, is not to be considered as contraindication to
  carotid surgery
Keywords:      80      and   over/advanced/AGE/aged/artery/BELGIUM/carotid/carotid
  artery/carotid artery disease/carotid artery diseases/carotid endarterectomy/carotid
  /survival/survival rate/vascular surgery
Lacroix, H., VanGertruyden, G., VanHemelrijck, J., Nevelsteen, A. and Suy, R. (1996),
   The value of carotid stump pressure and EEG monitoring in predicting carotid
   cross-clamping intolerance. Acta Chirurgica Belgica, 96 (6), 269-272.
Abstract: The authors analyse their experience with carotid stump pressure (CSP) and
   electro-encephalogram (EEG) monitoring in relation to the incidence of peroperative
   stroke during internal carotid artery reconstruction. A series of 215 patients is
   presented, among whom six (2.8%) developed a peroperative stroke. The stroke rate
   in patients with a CSP below 50 mm Hg (n=92) was 7% (2/27) without a shunt and
   3% (2/62) with the use of a shunt. The respective numbers for patients with a CSP
   equal to or above 50 mmHg were 1.7% (2/123) and 0% (0/10). The EEG remained
   normal after cross clamping in 180 cases (84%):the incidence of stroke was 1.5%
   (2/138) without and 5% (2/42) with a shunt. A shunt was used in 33 of the 35
   patients with EEG changes after cross clamping. None of them sustained a stroke in
   contrast to both patients where despite EEG changes no shunt was used (respective
   stroke rates 0% and 100%). It is concluded that regarding cerebral function, EEG
   monitoring provides more accurate information than CSP
Keywords:           artery/BELGIUM/carotid/carotid              artery/carotid          stump
   pressure/cerebral/EEG/EEG                                              monitoring/electro-
   carotid/internal                                                                    carotid
Frippiat, F., Donckier, J., Vandenbossche, P., Stoffel, M., Boland, B. and Lambert, M.
   (1996), Splenic infarction report of three cases of atherosclerotic embolization
   originating in the aorta and retrospective study of 64 cases. Acta Clinica Belgica, 51
   (6), 395-402.
Abstract: The authors report 3 cases of thromboembolic splenic infarction due to
   atherosclerosis of the thoracic aorta and the splenic artery. On this occasion, a
   retrospective analysis of 64 splenic infarcts showed that, in contrast to the literature,
   the leading aetiology in our series consisted of haematologic disorders (50%),
   followed by cardiovascular diseases (29%) and by digestive disorders (20%). Mean
   age was 58 +/- 17 years and 50% of the patients were aged below 60 years. Hospital
   mortality rate was high (34%) but not directly related to splenic infarction,
   suggesting that splenic infarction often occurs in the setting of severe underlying
   diseases. Splenic infarct is part of the differential diagnosis of the left upper quadrant
   pain and can also mimic renal disorders. Laboratory values may show an
   inflammatory syndrome and an increase, in serum lactate deshydrogenase. Diagnosis
   is often made by CT scan and can be confirmed by a selective spleen scintigraphy.
   Transoesophageal echocardiography is essential in the detection of cardiac and
   thoracic aorta embolic material
Keywords:                                          aetiology/age/aged/analysis/aorta/ARCH
   ar/cardiovascular                                                          diseases/CT/CT
   bolization/essential/FOLLOW-                   UP/infarct/infarction/infarcts/ISCHEMIC
Sorteberg, A., Sorteberg, W., Lindegaard, K.F., Bakke, J.S. and Nornes, H. (1996),
   Haemodynamic classification of symptomatic obstructive carotid artery disease. Acta
   Neurochirurgica, 138 (9), 1079-1087.
Abstract: 63 subjects with symptomatic obstructive carotid artery disease were
  investigated with transcranial Doppler ultrasonography. Their blood velocities at rest
  (V) in the middle and posterior cerebral artery (MCA and PCA) and in the
  extracranial internal carotid artery were measured and the pulsatility index (PI) and
  U-hem index (V-MCA. PIMCA/V-PCA. PIPCA) calculated. The vasomotor
  responses in both MCAs were also tested. The subjects were divided into groups
  based on the findings on physical examination and cerebral computed tomography.
  In the patient group with lacunar/territorial infarction we found in the stroke
  hemisphere: V-MCA > V-PCA, PIMCA = PIPCA and normal values for the U-hem
  index and total vasomotor reactivity. In the patient group with watershed infarction
  this hemisphere was characterized by: V-MCA < V-PCA, PIMCA < PIPCA and
  subnormal scores for the U-hem index and total vasomotor reactivity. Displaying
  features from both stroke groups, we obtained in the hemisphere of interest in
  patients with transient ischaemic attacks: V-MCA = V-PCA, PIMCA < PIPCA and
  normal values for the U-hem index and total vasomotor reactivity. Five patients with
  clinical evidence of stroke but with negative cerebral computed tomography findings
  had scores similar to those of the watershed group of patients. For the stroke patients,
  individual measurements of V, PI and total vasomotor reactivity failed to clearly
  identify to which stroke group a subject might belong. However, such an
  identification was achieved in all subjects when using the U-hem index. The U-hem
  index data in patients with transient ischaemic attacks suggest two subgroups with
  different pathogenesis underlying the ischaemic events
Keywords: artery/blood/carotid/carotid artery/carotid artery disease/cerebral/cerebral
  artery/CEREBRAL              BLOOD-FLOW/cerebral             haemodynamics/cerebral
  tomography/COMPUTED-TOMOGRAPHY/disease/Doppler/DOPPLER                             CO2
  TEST/INFARCTION/internal/internal                  carotid/internal              carotid
  artery/MCA/measurements/middle/obstructive/obstructive             carotid        artery
  patients/subgroups/tomography/total/transcranial/transcranial Doppler/transcranial
  Doppler        ultrasonography/transient/ultrasonography/ULTRASOUND/vasomotor
Schick, U., Zimmermann, M. and Stolke, D. (1996), Long-term evaluation of EG-IC
  bypass patency. Acta Neurochirurgica, 138 (8), 938-942.
Abstract: The EC-IC Bypass Study Group could not detect any benefit from surgery
  compared to medical management in the prevention of strokes in 1985 [15]. During
  the past years surgical revascularization was re-evaluated and considered as an
  appropriate treatment for a small subgroup of patients with recurrent focal cerebral
  ischaemia and impaired haemodynamics. This retrospective study examines the
  long-term benefit and patency rats of bypass. We present a follow-up of 5.6 years of
  47 patients, all of whom underwent bypass surgery after 1985. Forty patients
  suffered recurring transient ischaemic attacks due to uni- or bilateral internal carotid
  artery occlusion. Examination included neurologic status, TCD with CO2 or Diamox
  challenge, angiography, CT and SPECT scans. Neurological improvement was seen
  in 23% of patients with better results after early surgery, a worsening in 22%
  suffering further ischaemic events on a postoperative average of 2.8 years. Patency
  rate for vein graft material was 50%, for the STA-MCA procedure 91%. Occlusion
  of the vein graft occurred on an average after 1.4 years, other anastomosis after 2.7
  years. We conclude that only few patients derived long-term benefit from EC-IC
  bypasses. Functioning of the bypass worsens over time, suggesting a role for surgery
  predominantly in the first year of ischaemic events due to insufficient collateral
  supply. Actual indications for bypass surgery may be patients with failure of
  maximal medical therapy and progressive ischaemia and haemodynamic compromise
Keywords:               ACETAZOLAMIDE/angiography/artery/bilateral/bypass/bypass
  function/bypass grafting/bypass surgery/carotid/carotid artery/carotid artery
  occlusion/cerebral/CEREBRAL BLOOD-FLOW/cerebral ischaemia/cerebrovascular
  reserve                  capacity/CEREBROVASCULAR                             RESERVE
  CAPACITY/CO2/CT/DISEASE/EC-IC                      bypass/evaluation/failure/focal/focal
  cerebral                                                                ischaemia/follow
  up/follow-up/graft/haemodynamic/haemodynamics/internal/internal carotid/internal
  carotid        artery/internal         carotid      artery       occlusion/INTERNAL
Ohno, K., Matsushima, Y., Toriyama, H., Hokari, M., Nariai, T., Suzuki, R. and
  Hirakawa, K. (1996), Surgical approaches for treatment of ischaemic cerebral stroke
  other than moyamoya disease in children. Acta Neurochirurgica, 138 (10),
Abstract: Ischaemic cerebral strokes in children are relatively uncommon. With the
  exception of patients with moyamoya disease, there is no effective treatment for
  these lesions. One potential approach is encephalo-duro-arterio-synangiosis (EDAS).
  This is a safe neu rosurgical procedure that promotes spontaneous transdural
  anastomosis that may provide additional blued now to ischaemic regions. We present
  eight children with ischaemic strokes other than moyamoya disease, and discuss
  surgical attempts to treat this entity. The mean age of the eight children was 3.6 years
  (range: 13 months to 9 years). All children presented with acute childhood
  hemiplegia. Ischaemic stroke had occurred in association with a head injury in three
  children. but without on apparent cause in five. Five children underwent stable
  xenon-enhanced computed tomography to evaluate cerebral blood flow and all but
  one patient under went EDAS. One child with no angiographic abnormalities
  recovered to a normal neurological state without surgery. Following surgery, another
  child also fully recovered, and the remaining six children recovered with only a
  slight hemiparesis. Revascularization was observed on a follow-up angiogram in
  three children. Our surgical experiences suggest that revascularization is influenced
  by haemodynamic demand and recanalization of the occluded artery, We favour the
  use of indirect anastomosis (EDAS) for selected patients and suggest that chronic
  ischaemia probably contributes to surgical success
Keywords:         abnormalities/acute/age/artery/BASAL            GANGLIA/blood/blood
  flow/cerebral/cerebral           blood         flow/cerebral          ischaemia/cerebral
  a             disease/neurological/recanalization/revascularization/spontaneous/stable
  xenon-enhanced               CT/stroke/surgery/tomography/treatment/xenon-enhanced
  computed tomography
DiPasquale, G., Labanti, G., Urbinati, S., Lusa, A.M., Borgatti, M.L. and Pinelli, G.
  (1996), The role of echocardiography in the evaluation of patients with ischemic
  stroke. Acta Neurologica Belgica, 96 (4), 322-328
Keywords:          ATRIAL           SEPTAL           ANEURYSM/BELGIUM/CARDIAC
   SOURCE/echocardiography/evaluation/IDIOPATHIC                                DILATED
   CARDIOMYOPATHY/ischemic/ischemic                              stroke/MITRAL-VALVE
   FORAMEN                          OVALE/SPONTANEOUS                               ECHO
Gille, M., VandenBergh, P., Ghariani, S., Guettat, L., Delbecq, J. and Depre, A. (1996),
   Delayed-onset hemidystonia and chorea following contralateral infarction of the
   posterolateral thalamus - A case report. Acta Neurologica Belgica, 96 (4), 307-311.
Abstract: A 68 year-old man developed progressive hemidystonia and chorea 8 months
   after a contralateral thalamic stroke. The neurological examination also showed a
   right pyramidal syndrome without hemiparesis, a right horizontal sectoranopia, and a
   right hemihypesthesia for all sensory modalities. The MRI revealed infarctions in the
   left medial temporo-occipital lobes and left posterolateral thalamus, corresponding to
   the vascular territories of both the thalamogeniculate and posterolateral choroidal
   arterial pedicles. The thalamic lesion involved the pulvinar, the lateral geniculate
   body, and the ventro-postero- lateral, dorso-lateral, posterolateral,and dorso-medial
   nuclei, but apparently did not extent to the ventrolateral thalamic nucleus, and the
   subthalamic and midbrain regions. Thalamic and striatopallidal dystonia have not a
   common pathophysiological mechanism. The involvement of the pulvinar nucleus
   and of the strategic crossing of proprioceptive, cerebellar pyramidal, and subthalamic
   pathways may play a role in the genesis of the posterolateral thalamic dystonia
Keywords:                                  2-DEOXYGLUCOSE/arterial/BELGIUM/case
   MENT/MRI/NEURAL                             MECHANISMS/neurological/neurological
   examination/nucleus/posterior                                                 choroidal
   infarction/thalamus/vascular/vascular territories
Hennerici, M. (1996), The role of cerebrovascular ultrasonography in acute stroke. Acta
   Neurologica Belgica, 96 (4), 318-321
Keywords: acute/acute stroke/BELGIUM/cerebrovascular/stroke/ultrasonography
Gobert, M., MounierVehier, F., Lucas, C., Leclerc, X. and Leys, D. (1996), Cranial
   nerve palsies due to internal carotid artery dissection: Seven cases. Acta Neurologica
   Belgica, 96 (1), 55-61.
Abstract: Cranial nerve palsies are rare complications of internal carotid artery (ICA)
   dissections. The aim of this study is to evaluate the incidence of cranial nerve palsies
   in consecutive patients with ICA dissection and to describe clinical and radiological
   characteristics and their evolution over time. This study was conducted in 52
   consecutive patients with dissection of the ICA. We have analyzed clinical data of
   patients with cranial nerve palsy as complication of ICA dissection. We defined ICA
   dissection as angiographic evidence of a string sign, double lumen, or internal flaps
   or visualization on magnetic resonance imaging (MRI) or computed tomographic
   scans of an enlarged arterial wall due to the hematoma. Of 52 consecutive patients
   with ICA dissection 7 had cranial nerve palsies : 2 had an involvement of the Vth
   cranial nerve and 5 had lower cranial nerve palsies. Five patients totally recovered
   while 2 did not after a 2 to 10-month period. The frequency of cranial nerve palsies
   associated with ICA dissection is higher in our study than in those of the literature.
   Many patients presenting with cranial nerve palsies due to ICA dissection without
  any ischemic event are probably not referred to stroke units. Angiography is less
  sensitive than cervical MRI to detect such patients. Cranial nerve palsies could either
  be due to compression by the enlarged ICA wall or an ischemia of the nerve
Keywords:                         ANEURYSM/arterial/artery/BELGIUM/carotid/carotid
  artery/complication/complications/compression/cranial        nerve     diseases/cranial
  nerves/dissection/dissections/ICA/incidence/internal/internal carotid/internal carotid
  artery/ischemia/ischemic/magnetic             resonance/magnetic             resonance
  imaging/MR/MRI/PARALYSIS/stroke/stroke units/wall
Schonen, J., DeLeval, L. and Reznik, M. (1996), Gliomatosis cerebri: Clinical,
  radiological and pathological report of a case with a stroke-like onset. Acta
  Neurologica Belgica, 96 (4), 294-300.
Abstract: A 62 year-old man was admitted with a right hemiparesis, sensory aphasia and
  right hemianopia which appeared on awakening. Ne was initially thought to have a
  stroke, but EEG showed diffuse slowing and both CT scan and MRI irregular white
  matter lesion suggesting a leucoencephalopathy. His neurological deficit regressed,
  and he was discharged after 2 weeks. He was readmitted 6 months later because of
  mental confusion. MRI revealed diffuse white matter lesions extending up to the
  frontal lobes, these were hyperintense on T2 weighted images and suggested the
  diagnosis of gliomatosis cerebri (GC). The patient became progressively comatous
  and died 6 weeks later. At autopsy the brain looked diffusely swollen with irregular
  greyish areas of the white matter of both centrum ovale and brain stem. On
  microscopic examination the cerebrum and brain stem were diffusely and
  asymmetrically infiltrated by numerous neoplastic glial cells without angiogenesis or
  disruption of architectonic boundaries. There were no mitoses nor necrosis. Many
  tumour cells were GFAP- and S100- positive. A high proportion of cells contained
  the leucocyte antigen Leu- 7. This case of gliomatosis cerebri is compared to the 9
  published cases of GC with an initial focal neurological deficit and to the 19
  publications reporting MRI results. The controversial nosological boundaries and
  etiopathogenetic hypotheses of this peculiar neoplastic disease are discussed
Keywords: angiogenesis/aphasia/autopsy/BELGIUM/brain/brain stem/cells/CT/CT
  scan/diagnosis/disease/EEG/FEATURES/focal/frontal                    lobes/GFAP/glial
  ogical deficit/neuropathology/stroke/T2/white matter/white matter lesions
Korpelainen, J.T., Huikuri, H.V., Sotaniemi, K.A. and Myllyla, V.V. (1996), Abnormal
  heart rate variability reflecting autonomic dysfunction in brainstem infarction. Acta
  Neurologica Scandinavica, 94 (5), 337-342.
Abstract: Objectives - Brainstem infarctions frequently cause disturbances of
  cardiovascular and other autonomic functions, but the pathophysiologic mechanisms
  of these prognostically unfavourable complications are not well-known. Material &
  methods - In order to evaluate the effects of ischemic brainstem infarction on
  autonomic cardiac regulation, we analyzed the power spectrum of heart rate
  variability in 15 consecutive patients with brainstem infarction and in 15 age- and
  sex-matched healthy control subjects. The components of the power spectrum which
  reflect quantitatively both sympathetic and parasympathetic cardiovascular
  regulatory functions were measured from 24-hour electrocardiogram in the acute
  phase and at 1 month and 6 months after the infarction. Results - All the measured
  components of heart rate variability, i.e. total power (p<0.01), very-low-frequency
  power (p<0.001), low-frequency power (p<0.01), and high-frequency power
  (p<0.05), were significantly lower in the patients with medullary brainstem infarction
   than in the control subjects in the acute phase of the infarction. By 6 months, these
   abnormalities had been reversed. On the contrary, heart rate variability in pontine
   brainstem infarct patients did not differ significantly from that in the control subjects.
   Conclusions - These results suggest that brainstem infarction located in the medulla
   oblongata causes cardiovascular autonomic dysregulation manifesting as impaired
   heart rate variability. Medullary brainstem infarction seems to cause both
   sympathetic and parasympathetic dysfunction, which may contribute to the
   occurrence of cardiac complications in stroke
Keywords:                                                      abnormalities/acute/ACUTE
   EN/CORONARY-                                                                    ARTERY
   DISEASE/DENMARK/effects/electrocardiogram/heart/heart                  rate/heart      rate
   SPECTRAL-ANALYSIS/rate/spectral analysis/stroke/total/variability
Braune, H.J. and Fritz, C. (1996), Asymmetry of silent period evoked by transcranial
   magnetic stimulation in stroke patients. Acta Neurologica Scandinavica, 93 (2-3),
Abstract: Introduction-A transcranial magnetic stimulus delivered during voluntary
   activity produces a prolonged postexcitatory inhibition (silent period) of this activity.
   Besides more conventional measurements of central motor conduction time and
   amplitude of evoked potentials, we investigated silent period changes in patients with
   ischaemic brain lesions. We aimed at finding a more reliable method of data
   processing to differentiate healthy subjects from patients with motor disturbances
   due to stroke. Methods-Standardized transcranial magnetic stimulation during
   sustained muscle contraction was performed on the vertex. Electromyographic
   activity was recorded via surface electrodes placed over the mm. abductor digiti
   minimi on both sides. 25 patients with different degrees of impairment due to stroke
   as well as 75 healthy control subjects were examined. Results-In the control group
   there was no statistically relevant interside difference with respect to silent period
   duration, whereas a marked interindividual variation was found. In the group of
   patients, we found mostly a significant prolongation and sometimes a shortening of
   the postexcitatory inhibition recorded from the affected side compared with the
   healthy side. This interside difference of silent periods is significantly greater than in
   the control group. Even greater group differences were found if ratios of silent
   periods (longer/shorter) were calculated. Conventional parameters were clearly less
   sensitive. Conclusion-Our findings show that the measurement of the silent period
   elicited by transcranial magnetic stimulation is a very sensitive neurophysiologic
   parameter for the assessment of central motor system disturbances, even more so if
   ratios are considered. (C) Munksgaard 1996
   COPENHAGEN/CORTICAL                               STIMULATION/DENMARK/evoked
   potentials/impairment/INHIBITION/interside                           asymmetry/ischemic
   stroke/lesions/magnetic                   cortical                  stimulation/magnetic
   stimulation/measurement/motor/muscle/postexcitatory                       inhibition/silent
   period/stroke/stroke patients/transcranial/transcranial magnetic stimulation
Li, J.Y., Kong, K.W., Chang, M.H., Cheung, S.C., Lee, H.C., Pang, C.Y. and Wei, Y.H.
  (1996), MELAS syndrome associated with a tandem duplication in the D- loop of
  mitochondrial DNA. Acta Neurologica Scandinavica, 93 (6), 450-455.
Abstract: We describe a family with two cases of adult-onset mitochondrial myopathy,
  encephalopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome.
  Interestingly, the proband also had non-insulin dependent diabetes mellitus and
  hyperthyroidism. Endocrinological studies demonstrated a high titer of TSH receptor
  antibody in the proband and elevated levels in her maternal relatives. Analysis of
  mitochondrial DNA (mtDNA) showed an A-to-G transition at nucleotide position
  3243 in the tRNA (Leu(UCR)) gene (A3243G) in the three generations of the family.
  Furthermore, a previously describe similar to 260 pb tandem duplication and
  A3243G point mutation were 12.5% and 82% in the muscle, respectively, and 1.6%
  and 35% in the blood cells, respectively, of the proband. We conclude that the
  hyperthyroidism in this MELAS patient may be related to the tandem duplication in
  the D-loop of mtDNA. This study further substantiates the importance of searching
  for additional genetic mutations in mitochondrial encephalomyopathic patients with
  new clinical phenotypes
Keywords:          acidosis/and         stroke-like         episodes/antibody/blood/blood
  HY/genetic/hyperthyroidism/JUN/KEARNS-SAYRE                           SYNDROME/lactic
  syndrome/mitochondrial/mitochondrial                                  DNA/mitochondrial
  mutation/relatives/STROKE-LIKE                         EPISODES/SUBGROUP/tandem
Muller, M., Merkelbach, S. and Schimrigk, K. (1996), Cerebral hemodynamics in the
  posterior circulation of patients with bacterial meningitis. Acta Neurologica
  Scandinavica, 93 (6), 443-449.
Abstract: Objectives - stenoses of the middle and anterior cerebral artery (MCA,ACA)
  are a clinical relevant complication of bacterial meningitis. We examined the
  involvement of the posterior cerebral (PCA) and of the basilar artery (BA) into the
  inflammatory process. Material & methods 39 unselected patients (26 men, 13
  women; mean +/- SD age, 49 +/- 17 years) with bacterial (n=37) and fungal (n=2)
  meningitis underwent serial transcranial Doppler sonography recordings of the mean
  blood velocity (MBV) and the pulsatility index (PI) in the MCA, ACA and PCA, in
  the BA and in the submandibular internal carotid artery on Days 1, 3, 5, 8, 14 and 21
  after admission. The results of the PCA and of the BA were compared to normal
  reference values and con-elated to corresponding neurological signs. The criterion to
  assume a stenosis was: for the BA an MBV greater than or equal to 95 cm/s, for the
  PCA an MBV greater than or equal to 85 cm/s. Results - compared with the controls
  MBV in both arteries was normal on Days 1 and 8-21, but significantly increased on
  Days 3 and 5. The PI was significantly increased in the BA on all days and in the
  PCA on Days 1 and 8-21. Stenoses of the PCA (4 of 43) and of the BA (4 of 32)
  remained without corresponding neurological signs, and occurred only in patients
  with two or more narrowed arteries of the anterior circulation (p<0.05). Conclusion -
  in bacterial meningitis, hemodynamic disturbances in the posterior circulation are
  less severe than in the anterior circulation and are clinically well tolerated
Keywords:              ADULTS/age/ANGIOGRAPHY/arteries/artery/bacterial/bacterial
  meningitis/basilar/basilar artery/blood/BLOOD-FLOW VELOCITY/carotid/carotid
   OSIS/Doppler/Doppler sonography/hemodynamic/hemodynamics/internal/internal
   carotid/internal                        carotid                       artery/intracranial
   circulation/pulsatility          index/sonography/stenosis/stroke/SUBARACHNOID
   HEMORRHAGE/transcranial/transcranial Doppler/TRANSCRANIAL DOPPLER
   SONOGRAPHY/transcranial                                                          Doppler
Awada, A. and Omojola, M.F. (1996), Leuko-araiosis and stroke: A case-control study.
   Acta Neurologica Scandinavica, 94 (6), 415-418.
Abstract: Objective - Association of leuko-araiosis (LA) with certain risk factors has
   been reported in Western patients. This is a case-control study to determine the risk
   factors and the type of stroke associated with LA in Saudi patients. Design and
   setting - 398 consecutive Saudi patients with the diagnosis of stroke admitted over a
   6-year period were evaluated for presence or absence of LA on cranial computed
   tomography. LA and non-LA groups were compared with regards to the presence of
   certain risk factors such as type of stroke, age, brain atrophy, systemic hypertension
   and history of cardiac disease or diabetes mellitus. The odds ratio and its 95%
   confidence interval (CI) were used to estimate the strength of association between
   the different parameters. Results - The mean age in the LA group was 67.8+/-8.5
   years as compared to 61.2+/-13.2 years in the non-LA group. No patient younger
   than 40 years had LA on CT. Incidence of LA increased with age. Forty-seven
   percent of the LA group were over 70 years of age compared to 31% of the non-LA
   group (OR=2, CI 1.26-3.15). Generalized atrophy was detected in 40% of patients
   with LA compared to 20% of non-LA group (OR 2.7, CI 1.65-4.39). Sixty-nine
   percent of patients in the LA group had lacunar infarct compare to 39% in the
   non-LA group (OR 3.4, CI 2.15-5.59). The difference was not significant between
   the two groups in relation to the frequency of cerebral hemorrhage or larger infarcts.
   Systemic hypertension was also significantly associated with the presence of LA (OR
   2.15, CI 1.34-3.43). Conclusion - LA is associated mainly with lacunar infarcts,
   cerebral atrophy, systemic hypertension and advanced age in Saudi patients
Keywords: advanced/age/ARABIA/atrophy/BLOOD-FLOW/brain/cardiac/case-control
   study/cerebral/cerebral          atrophy/cerebral          hemorrhage/cerebrovascular
   disease/computed        tomography/confidence/COPENHAGEN/cranial               computed
   N/infarcts/lacunar                                                        infarct/lacunar
   infarcts/lacune/LESIONS/leuko-araiosis/LEUKOARAIOSIS/odds                  ratio/risk/risk
   factors/SENILE DEMENTIA/stroke/tomography/WHITE-MATTER
Vorstrup, S., Haase, J., Waldemar, G., Andersen, A., Schmidt, J. and Paulson, O.B.
   (1996), EC-IC bypass in patients with chronic hemodynamic insufficiency. Acta
   Neurologica Scandinavica, 93 79-81
Keywords:           ACETAZOLAMIDE                  TEST/bypass/CAPACITY/CEREBRAL
Bitsch, A., Nau, R., Hilgers, R.A., Verheggen, R., Werner, G. and Prange, H.W. (1996),
   Focal neurologic deficits in infective endocarditis and other septic diseases. Acta
  Neurologica Scandinavica, 94 (4), 279-286.
Abstract: Introduction - Focal neurologic deficits in sepsis frequently result from
  parenchymal lesions due to cerebral embolism. The aim of this study was to
  characterize clinical, laboratory and radiologic patterns of those patients. Patients and
  methods - Medical records of 30 patients with focal neurologic symptoms during
  sepsis were analyzed retrospectively. Results - 24 patients (22 with infective
  endocarditis) had ischemic stroke. Cerebrospinal fluid (CSF) analyses revealed
  inflammation in 11 of 12 patients. Patients who died (11/24) suffered more
  frequently from secondary intracerebral hemorrhage (p=0.0031), which was
  significantly associated with intravenous high-dose anticoagulation (p=0.0059). Six
  patients had slowly progressive focal neurologic deficits without evidence for stroke.
  All showed CSF inflammation and three developed multiple cerebral abscesses.
  Conclusions - There are two distinctive groups of patients with focal neurologic
  deficits during sepsis. One presents with stroke and CNS inflammation (septic
  embolic focal encephalitis). The other group develops slowly progressive focal
  neurologic deficits and sometimes multiple cerebral abscesses (septic metastatic
  focal encephalitis)
Keywords: abscess/anticoagulation/BACTERIAL-ENDOCARDITIS/cerebral/cerebral
  hemorrhage/INTRACRANIAL               HEMORRHAGE/intravenous/ischemic/ischemic
  COMPLICATIONS/neurologic/PROSTHETIC                                              VALVE
Henon, H., Godefroy, O., Lucas, C., Pruvo, J.P. and Leys, D. (1996), Risk factors and
  leukoaraiosis in stroke patients. Acta Neurologica Scandinavica, 94 (2), 137-144.
Abstract: Objectives - Although leukoaraosis (LA) is a common CT finding, its
  pathogenesis remains debated: if small-artery pathology may explain in some cases
  white matter changes, many other factors, such as hemodynamic perturbations, might
  also lead to LA. To test these hypothesis, we determined the types of cerebrovascular
  risk factors associated with leukoaraosis in consecutive patients with acute
  cerebrovascular event. Patients and methods - Using CT-scans, we prospectively
  studied in 610 patients consecutively admitted for an acute cerebral event, the
  relation between LA and the following cerebrovascular risk factors: age, sex, arterial
  hypertension, diabetes mellitus, hyperlipemia, alcohol consumption, birth
  contraceptive pills, previous transient ischemic attack or stroke, migraine, atrial
  fibrillation, valvulopathy, coronaropathy, left ventricular hypertrophy, stenosis of the
  internal carotid artery, by means of a multiple linear regression. Relation with
  cerebral atrophy was also evaluated. Results - We found LA scores to depend on
  increasing age (p=0.0001), female sex (p=0.0146), history of stroke or TIA
  (p=0.0051), history or current atrial fibrillation (p=0.0083), increasing cerebral
  atrophy score (p=0.0001), absence of hyperlipemia (p=0.0003) and absence of
  alcohol consumption higher than 300 g/week (p=0.0398). Conclusion - Our findings
  do not support the hypothesis that, in stroke patients, LA share similar risk factors
  than small- vessel disease; other cerebrovascular risk. factors may also contribute to
  LA, perhaps because of decreased cerebral blood flow
Keywords:                   acute/age/alcohol/ALZHEIMERS-DISEASE/arterial/arterial
  hypertension/artery/atrial/atrial    fibrillation/atrophy/blood/blood       flow/BRAIN
  LUCENCIES/carotid/carotid artery/cerebral/cerebral             atrophy/cerebral    blood
  flow/CEREBRAL                        BLOOD-FLOW/cerebrovascular/cerebrovascular
  disease/cerebrovascular                                                              risk
  FARCTS/internal/internal carotid/internal carotid artery/ischemic/ISCHEMIC
  STROKE/lead/left                          ventricular/left                    ventricular
  patients/test/TIA/transient/transient ischemic attack/white matter/WHITE-MATTER
Hornig, C.R., Haberbosch, W., Lammers, C., Waldecker, B. and Dorndorf, W. (1996),
  Specific cardiological evaluation after focal cerebral ischemia. Acta Neurologica
  Scandinavica, 93 (4), 297-302.
Abstract: Purpose of this study was to define a subgroup of TIA/stroke patients who
  should be examined by transthoracal and transesophageal echocardiography or
  Holter-electrocardiography to identify those with cardiogenic brain embolism
  reliably; 300 consecutive patients with acute focal brain ischemia underwent a
  standardized diagnostic protocol for the evaluation of the etiology including, clinical
  examination        by     a     cardiologist    and      routine    electrocardiography,
  Holter-electrocardiography, transthoracal and transesophageal echocardiography.
  188 patients had a potential cardiac source of embolism. In particular
  echocardiography was diagnostic in 163 patients, and Holter-electrocardiography 10;
  159 of these 188 patients (84.6%) had competitive etiologies, predominantly large
  vessel atherosclerosis. In 136 patients cardiogenic brain embolism was assumed as
  quite definite or possible. To identify these patients reliably, transthoracal and
  transesophageal echocardiography would have been necessary in 89% of the entire
  group of patients (all with clinically cardiological abnormalities, pathological routine
  EGG, without vascular risk factors, or no atherosclerosis in duplex sonography), and
  Holter-electrocardiography in 54%
Keywords: abnormalities/acute/atherosclerosis/brain/brain ischemia/cardiac/CARDIAC
  SOURCE/cardioembolic                                             stroke/cerebral/cerebral
  tiology/evaluation/FEATURES/focal/focal                                          cerebral
  ECHOCARDIOGRAPHY/ultrasound/vascular/vascular risk/vascular risk factors
Huang, C.C., Chen, R.S., Chu, N.S., Pang, C.Y. and Wei, Y.H. (1996), Random mitotic
  segregation of mitochondrial DNA in MELAS syndrome. Acta Neurologica
  Scandinavica, 93 (2-3), 198-202.
Abstract: We describe the heterogeneity of clinical features and molecular genetic
  characteristics of the probands and other members in two families with mitochondrial
  myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS)
  syndrome. A point mutation at the 3243rd nucleotide position of mtDNA was found
  only in some of the maternal lineage members of the two families. Furthermore, the
  proportions of mutant mtDNA were varied and found only in some tissues of the
  individuals. Intriguingly, in some subjects, the mutant mtDNA was found in blood
  cells or hair follicles but was absent in muscles. The data do not support the notion of
   a selective advantage of wild-type mtDNA to rapidly replicating cells. We suggest
   that a rapid replicative segregation may occur in early embryogenesis. (C)
   Munksgaard 1996
Keywords:       acidosis/and     stroke-like    episodes/blood/blood       cells/cells/clinical
   OPATHY/genetic/heterogeneity/human               genetics/lactic       acidosis/LACTIC-
   ACIDOSIS/MELAS/MELAS                             syndrome/mitochondrial/mitochondrial
   DNA/mitochondrial                                                       myopathy/mitotic
Gjedde, A. (1996), PET criteria of cerebral tissue viability in ischemia. Acta
   Neurologica Scandinavica, 93 3-&
Harer, C. and Gusev, E.I. (1996), Asymptomatic cervical artery stenoses in Moscow.
   Acta Neurologica Scandinavica, 93 (4), 286-290.
Abstract: The risk of stroke related to asymptomatic carotid artery stenosis is known to
   be increased in high-grade or rapidly progressive stenosis. Information of the
   prevalence in the general population is required for the recommendation of screening
   methods to detect patients needing prophylactic treatment, We studied the prevalence
   and the grade of severity of extracranial carotid and vertebral artery obstructions by
   means of Doppler sonography in 529 asymptomatic Russians (m: 343, f: 186; 36-84
   years, mean: 58.4 years) living in Moscow city. Internal carotid artery obstructions of
   more than 50% stenosis were present in 22 (=4.2%) subjects, 8 of them (1.5%) had
   bilateral lesions. Appropriate abnormal findings in vertebral arteries were found in
   11 (=2.1%) subjects, in 1 of them bilaterally. Affection of both the carotid and the
   vertebral arteries was noted in 4 (=0.8%) individuals. There were no sexual
   differences. The risk factor which correlated most significantly with cervical arterial
   lesions was hypertension. Carotid lesions were also significantly associated with age
   and smoking, but not with diabetes or hyperlipoproteinemia. The prevalence of
   cervical artery stenoses was found to be lower than in western reports, which may be
   due to different technical equipment and different study design
Keywords:                                         age/arterial/arteries/artery/asymptomatic
   patients/bilateral/BRUITS/carotid/carotid artery/carotid artery stenosis/cervical
   Russia/prevalence/risk/risk                          factor/risk                          of
   ebral arteries/vertebral artery
Franke, C.L., Palm, R., Dalby, M., Schoonderwaldt, H.C., Hantson, L., Eriksson, B.,
   LangJenssen, L. and Smakman, J. (1996), Flunarizine in stroke treatment (FIST): A
   double-blind, placebo-controlled trial in Scandinavia and the Netherlands. Acta
   Neurologica Scandinavica, 93 (1), 56-60.
Abstract: Introduction - An international, multicenter trial was conducted in 331
   patients to determine the effect of a large dose of flunarizine (a calcium entry blocker)
   in the treatment of acute ischemic stroke in the territory of the Middle cerebral artery.
   Methods - The administration of the trial medication should start within 24 h after
   the initial symptoms of stroke. According to a random schedule, the patients were
   assigned to a 4-weeks double-blind treatment with either flunarizine (n = 166) or
  placebo (n = 165): one week intravenous administration (50 mg daily), followed by 3
  weeks oral treatment (week 2, 21 mg daily; week 3-4, 7 mg daily). All patients had to
  be investigated by computerized tomography (CT) within 7 days after stroke onset;
  36 patients were secundarily excluded because the CT showed another pathology.
  During the treatment period, other ''stroke therapies'' were not allowed. Patients were
  followed up for 24 weeks, Results - After the 24 weeks trial period, the percentage of
  patients who were dead or pendent (modified Rankin score 3-5) was similar in both
  treatment groups (flunarizine 67%, placebo 65%). During the trial, the scores for
  handicap severity (modified Rankin scale), neurological status (Orgogozo) and
  activities of daily living (modified Barthel index) strongly improved in both
  treatment groups, but no differences were found between the treatment groups. In
  this trial, the administration of trial treatment started relatively late after stroke onset
  (flunarizine group: mean time interval 13.5 h; placebo 12.3 h), A subgroup of
  patients received trial medication within 6 h after stroke onset (flunarizine n = 31;
  placebo n = 29). Also in this subgroup, no differences were found between the
  flunarizine and placebo group. Conclusion - Flunarizine did not improve neurologic
  and functional outcome in patients with acute ischemic stroke
Keywords:        activities    of      daily      living/acute/administration/artery/Barthel
  index/CALCIUM/calcium             entry       blocker/cerebral/cerebral       artery/clinical
  trial/computerized               tomography/COPENHAGEN/CT/DENMARK/double-
  trial/score/scores/severity/stroke/stroke                                       onset/stroke
Christopher, R., Kailasanatha, K.M., Nagaraja, D. and Tripathi, M. (1996), Case-control
  study of serum lipoprotein(a) and apolipoproteins A-I and B in stroke in the young.
  Acta Neurologica Scandinavica, 94 (2), 127-130.
Abstract: Objectives - Abnormalities of lipoprotein(a) and apolipoproteins A-I and B
  are being recognised as independent risk factors in ischaemic heart disease and
  atherosclerosis. There are no studies from India where stroke in the young constitutes
  nearly 20-30% of all strokes. Subjects and methods - Fasting serum lipids,
  lipoproteins, apolipoproteins A-I and B and lipoprotein(a) were measured in 50
  patients aged less than 40 years presenting with completed stroke and 50 normal, age
  and sex-matched control subjects. Apolipoproteins A-I and B were measured by
  immunoturbidimetry and lipoprotein(a) by enzyme-linked immunosorbent assay.
  Results - The serum total cholesterol, HDL-cholesterol, LDL-cholesterol, VLDL-
  cholesterol, triglycerides and apolipoproteins A-I and B were not significantly
  different in the test group as compared to the controls. However, serum lipoprotein(a)
  was significantly higher in the young stroke patients. Conclusion - These findings
  confirm the hypothesis that an elevated serum lipoprotein(a) level is an important
  risk factor in the development of cerebral ischaemia in patients aged less than 40
  years It may be worthwhile to study whether it is useful in identifying patients most
  at risk for stroke
Keywords:                   A-I/age/aged/apolipoprotein                   A-I/apolipoprotein
  disease/INFARCTION/ischaemia/ischaemic                   heart         disease/ISCHEMIC
   MA/risk/RISK FACTOR/risk factors/serum/stroke/stroke in the young/stroke
Christensen, T., Bruhn, T., Frank, L. and Diemer, N.H. (1996), Differential effect of
   NMDA and AMPA receptor blockade on protein synthesis in the rat infarct
   borderzone. Acta Neurologica Scandinavica, 93 (2-3), 160-167.
Abstract: We investigated whether the known neuroprotective effects of two selective
   glutamate receptor antagonists, the NMDA antagonist MK-801 and the AMPA
   antagonist NBQX, are reflected in the regional cerebral protein synthesis rates
   (CPSR) in rats with middle cerebral artery occlusion (MCAO). Rats treated with
   either saline, MK-801 (5 mg/kg i.p.) or NBQX (30 mg/kg i.p. x 3) were subjected to
   permanent MCAO. Regional CPSR and volumes of gray matter structures displaying
   normal CPSR were measured in coronal cryosections of the brain by quantitative
   autoradiography following an i.v. bolus injection of S-35- labelled L-methionine 2 h
   after occlusion. MCAO completely inhibited protein synthesis in the lateral part of
   striatum and part of the adjacent frontoparietal cortex corresponding to the ischemic
   focus. Surrounding this, a metabolic penumbra with approximately 50% reductions
   in CPSR was present. Treatment with MK-801 significantly increased the volume of
   tissue with normal CPSR in the ischemic hemisphere compared to controls, whereas
   this was not seen with NBQX treatment. The results suggest that MK-801 and
   NBQX have different effects on peri- infarct protein synthesis after MCAO. Since
   both compounds reduce infarct size, it is questionable that acute inhibition of protein
   synthesis in focal ischemia is of significant importance to the final outcome of a
   stroke lesion. (C) Munksgaard 1996
Keywords:                                                    acute/AMPA/ANTAGONIST
   SPREADING                                  DEPRESSION/DENMARK/DIZOCILPINE
   MK-801/effect/effects/ENERGY-STATE/focal/focal cerebral ischemia/FOCAL
   ISCHEMIA/glutamate/GLUTAMATE                             ANTAGONIST/infarct/infarct
   size/ISCHEMIA/ischemic/lesion/middle/middle cerebral artery/middle cerebral
   artery                                       occlusion/MK-801/NBQX/NMDA/NMDA
Tintore, M., Fernandez, A.L., Rovira, A., Martinez, X., Direskeneli, H., Khamashta, M.,
   Schwartz, S., Codina, A. and Montalban, X. (1996), Antibodies against endothelial
   cells in patients with multiple sclerosis. Acta Neurologica Scandinavica, 93 (6),
Abstract: Objectives - The humoral immune response seems to play a role in the
   pathogenesis of multiple sclerosis (MS). The blood- brain-barrier (BBB) and
   particularly the endothelial cell may be a possible target for this immune response.
   Material & methods - using an ELISA technique, we have investigated the
   prevalence of antibodies directed against human vein endothelial cells in the sera of
   84 patients with MS, 35 stroke patients, 50 systemic lupus erythematosus (SLE) and
   76 normal controls. The measurements in MS patients were tested a second time
   after cytokine stimulation with gamma and beta-interferon at different doses. Seven
   MS patients (two positive and five negative) had three or more clinical assessments
   including the Expanded Disability Status Scale (EDSS) over a three-month period,
   and at least three AECA determinations were carried out. Gadolinium MRI
   examinations were performed monthly during these three months. Results -
   anti-endothelial cell antibodies (AECA) have been identified in 9 of 84 patients
  suffering from MS (10.71%), in 3 of 35 stroke patients (8.57%) and in 20 of 50 SLE
  patients (40%). None of 76 normal controls had a positive titre of AECA. Cytokine
  stimulations did not modify the detection of these antibodies. No correlation between
  AECA and different clinical parameters such as onset age, clinical symptoms at onset
  and at sampling, clinical course and score measured by the EDSS was found in MS
  patients. No relationship was found between MRI activity and the presence of AECA.
  Conclusion - AECA do not seem to be a marker for a specific subset of MS patients
  /DENMARK/detection/endothelial/endothelial                             cell/endothelial
  erythematosus/measurements/methods/MRI/multiple                       sclerosis/normal
  patients/symptoms/systemic lupus/systemic lupus erythematosus
Passero, S. and Nuti, D. (1996), Auditory and vestibular system findings in patients
  with vertebrobasilar dolichoectasia. Acta Neurologica Scandinavica, 93 (1), 50-55.
Abstract: Impairment of the auditory-vestibular system has been reported in patients
  with vertebrobasilar dolichoectasia (VBD), but little is known about the underlying
  cause of the symptoms. Auditory testing (pure tone audiometry, auditory brain stem
  response and stapedius reflex) and vestibular tests (assessment of nystagmus, eye
  tracking tests, caloric test and rotational test) were performed in 23 patients with
  auditory-vestibular symptoms and/or cranial nerve impairment associated with VBD.
  Specific evidence of auditory and/or vestibular system impairment was observed in
  19 cases (83%). Among patients with abnormal test findings, 47% had evidence
  suggesting peripheral impairment, 16%, evidence suggesting central dysfunction, and
  37% evidence suggesting both peripheral and central dysfunction. Although
  compression of the vestibulocochlear nerve plays an important role in the genesis of
  the auditory- vestibular dysfunction in patients with VBD, mechanism such as brain
  stem-cerebellar ischemia and impaired blood supply to the vestibular labyrinth may
  be just as important
Keywords:              ANEURYSMS/assessment/auditory                  testing/BASILAR
  asilar dolichoectasia/vestibular test/vestibulocochlear nerve
Kaps, M., Seidel, G., Gerriets, T. and Traupe, H. (1996), Transcranial duplex
  monitoring discloses hemorrhagic complication following rt-PA thrombolysis. Acta
  Neurologica Scandinavica, 93 (1), 61-63.
Abstract: Introduction - Transcranial color-coded sonography (TCCS) allows imaging
  of basal cerebral arteries as well as brain parenchyma. It may therefore serve to
  monitor thrombolysis in acute stroke. Case description - rt-PA thrombolysis was
  performed in a patient, suffering from paradoxical embolism causing MCA occlusion.
  Hemorrhage immediately after completion of rt-PA infusion as well as delayed MCA
  recanalization could be monitored by TCCS. Conclusion - TCCS is useful to improve
  monitoring and safety of systemic thrombolytic treatment
Keywords: acute/acute stroke/arteries/brain/cerebral/cerebral arteries/cerebrovascular
  disease/color                                                                    coded
  CA/monitoring/occlusion/paradoxical embolism/plasminogen activator (tissue
Takasago, T., Tsuha, M., Nagatsugu, Y., Wakuta, Y. and Yamashita, T. (1996), Effects
  of acute percutaneous transluminal recanalization on cerebral embolism. Acta
  Neurologica Scandinavica, 93 99-103.
Abstract: The effects of percutaneous transluminal recanalization (PTR) on critical
  hemodynamics of cerebral embolism were studied using stable xenon-enhanced
  computed tomography in patients within 6 hours after onset. PTR was conducted in
  10 cases (PTR group) and not conducted 8 cases (non-PTR group). The development
  of infarction was followed by CT scan. In the cortical arterial regions, the lowest
  cerebral blood flow (CBF) value in regions of interests (ROIs) without development
  of infarction was 12.9 ml/100 g/min in the PTR group and 17.0 ml/100 g/min in the
  non-PTR group. In ROIs with a cerebrovascular reserve capacity (CRC) less than 0
  ml/100 g/min, even with a CBF greater than 12.9 ml/100 g/min, 3 of 4 ROIs
  underwent cerebral infarction. PTR conducted within 6 hours after onset of cerebral
  embolism would prevent the cortical regions with a CBF greater than 12.9 ml/100
  g/min and with a CRC greater than 0 ml/100 g/min from undergoing cerebral
Keywords:                    acetazolamide/acute/ACUTE                     ISCHEMIC
  STROKE/arterial/ARTERY/blood/blood                  flow/BLOOD-FLOW/CAROTID
  TERRITORY/CBF/cerebral/cerebral blood flow/cerebral embolism/cerebral
  infarction/cerebrovascular/cerebrovascular       reserve/cerebrovascular       reserve
  capacity/CLINICAL-EXPERIENCE/computed tomography/COPENHAGEN/CT/CT
  transluminal/recanalization/thrombolysis/THROMBOLYTIC THERAPY/TISSUE
  PLASMINOGEN-ACTIVATOR/tomography/URGENT                            THERAPY/xenon
  CT/xenon-enhanced computed tomography
Melberg, A., Akerlund, P., Raininko, R., Silander, H.C., Wibom, R., Khaled, A.,
  Nennesmo, I., Lundberg, P.O. and Olsson, Y. (1996), Monozygotic twins with
  MELAS-like syndrome lacking ragged red fibers and lactacidaemia. Acta
  Neurologica Scandinavica, 94 (4), 233-241.
Abstract: Typical cases of MELAS present a combination of clinical and
  neuroradiological features, lactacidaemia, and ragged red fibers (RRFs) in striated
  muscle. We have observed a MELAS-like syndrome in monozygotic twins. They
  developed seizures typically in conjunction with physical exertion, sleep deprivation
  or febrile episodes. Stroke-like episodes occurred usually during seizures. In twin 2
  the course was fatal at age 20 years. Neuroradiological findings were typical of
  MELAS. Plasma lactate was normal in both. CSF lactate was normal in twin 1 and
  normal/elevated in twin 2. RRFs were not seen in muscle biopsies of the twins.
  Complex I activity was reduced in muscle in twin 1. Brain tissue removed at epilepsy
  surgery in twin 2 showed the presence of mitochondrial angiopathy. The commonest
  mitochondrial DNA mutation in MELAS, at base pair 3243, was absent.
  Lactacidaemia and mitochondrial myopathy with RRFs constitute part of the
  diagnostic criteria of MELAS. However, the absence of these features does not
  exclude mitochondrial disorder with the serious manifestations of MELAS (seizures
  and stroke-like episodes) as seen in these twins
Keywords:                           activity/age/and                         stroke-like
  I/COPENHAGEN/criteria/CSF/DENMARK/DIABETES-                     MELLITUS/diagnostic
  criteria/DNA/ENCEPHALOPATHY/epilepsia                                          partialis
  continua/epilepsy/exertion/focal               status           epilepticus/generalised
  angiopathy/mitochondrial                                    DNA/MITOCHONDRIAL
  MYOPATHY/muscle/mutation/POINT                    MUTATION/Q             REDUCTASE
  DEFICIENCY/seizures/sleep/stroke-like                        episodes/STROKE-LIKE
Nordborg, C. and Johansson, B.B. (1996), Secondary thalamic lesions after ligation of
  the middle cerebral artery: An ultrastructural study. Acta Neuropathologica, 91 (1),
Abstract: Earlier light microscopic, immunocytochemical and morphometric
  investigations indicate that noxious substances transported with the vasogenic edema
  from hemispheric infarcts influence the character, timing and extent of the secondary
  thalamic lesions. The object of the present study was to analyze the ultrastructure of
  the secondary damage and the cytolytic nerve cell change which ensues in the
  thalamus within a week after the infarction. Adult spontaneously hypertensive rats
  (SHR) were stud; led either 7 days after permanent ligation of the right middle
  cerebral artery (MCA) (n = 4) or 7 days after a 2- h temporary occlusion of the MCA
  (n = 4). Light microscopy revealed damage in the ipsilateral thalamic nuclei and the
  electron microscopic analysis showed that the cytolytic nerve cell degeneration was
  somatodendritic. Central chromatolysis was not observed. Somatodendritic nerve cell
  degeneration, as found in the secondary thalamic lesions in the present study, has
  been described in excitotoxic brain damage as well as in chronic, edematous lesions
  in stroke-prone spontaneously hypertensive rats. The possibility that the cytolytic
  thalamic nerve cell lesion is influenced by excitatory, noxious substances spreading
  with the edema fluid from the infarct has, thus, to be considered
Keywords:       analysis/artery/BLOOD-BRAIN-BARRIER/brain/brain             damage/brain
  e/middle        cerebral      artery/NEW-YORK/OCCLUSION/permanent               arterial
  HYPERTENSIVE RATS/stroke-prone/stroke-prone spontaneously hypertensive
  rats/temporary arterial occlusion/thalamic/thalamus/timing/vasogenic edema
Kaido, M., Fujimura, H., Soga, F., Toyooka, K., Yoshikawa, H., Nishimura, T., Higashi,
  T., Inui, K., Imanishi, H., Yorifuji, S. and Yanagihara, T. (1996), Alzheimer-type
  pathology in a patient with mitochondrial myopathy, encephalopathy, lactic acidosis
  and stroke-like episodes (MELAS). Acta Neuropathologica, 92 (3), 312-318.
Abstract: A 53-year-old Japanese woman with a point mutation in mitochondrial DNA
  (tRNA(Leu(UUR)),          nt3243)     consistent    with   mitochondrial     myopathy,
  encephalopathy, lactic acidosis and stroke-like episodes (MELAS) and
  Alzheimer-type brain pathology is reported. This woman had suffered myopathy and
  psychosis without any clinical evidence of, stroke-like episodes during the last 10
  years of her life, and had died after an accident. At autopsy 30 h post mortem, a part
  of the brain was snap frozen for biochemical and histochemical studies, and the
  remaining part was processed for a routine examination and electron microscopy. In
  the brain there were no ischemic lesions. Instead, primitive/diffuse senile plaques
  were found throughout the brain, predominantly in the frontal and temporal lobes,
  while Alzheimer neurofibrillary tangles were found only in the parahippocampal
  gyrus. These plaques were positive for beta-protein and mostly negative for tau
  protein, ubiquitin, neurofilaments, alpha-choline acetyltransferase, and
  acetylcholinesterase. Mutations in codon 331 of the ND2 gene as well as codons 693,
  713 and 717 of the beta-amyloid precursor protein gene, known to be responsible for
  some cases of familial Alzheimer disease, were not found. Furthermore, coincidental
  Down syndrome was ruled out by chromosome analysis. The results suggest a
  possible correlation between this mitochondrial DNA abnormality and
  Alzheimer-type pathology
Keywords:       acidosis/Alzheimer/Alzheimer        disease/analysis/and      stroke-like
  /Down                                                               syndrome/electron
  hemic/Japanese/lactic     acidosis/lactic acidosis      and stroke-like episodes
  (MELAS)/lesions/MELAS/mitochondrial/mitochondrial                  DNA/mitochondrial
  myopathy/MUTATION/NEW-YORK/pathology/plaques/point                     mutation/senile
  plaque/SEP/stroke-like episodes/tau/TRANSFER RNALEU(UUR) GENE
Bergmann, M., Ebke, M., Yuan, Y., Bruck, W., Mugler, M. and Schwendemann, G.
  (1996), Cerebral autosomal dominant arteriopathy with subcortical infarcts and
  leukoencephalopathy (CADASIL): A morphological study of a German family. Acta
  Neuropathologica, 92 (4), 341-350.
Abstract: Cerebral autosomal dominant arteriopathy with subcortical infarcts and
  leukoencephalopathy (CADASIL) is characterized clinically by recurrent cerebral
  infarcts, subcortical dementia and pseudobulbar palsy, and morphologically by a
  granular degeneration of cerebral and, to a lesser degree, extracerebral blood vessels.
  We present morphological findings in a further German family affected by
  CADASIL. The index case showed the typical periodic acid-Schiff-positive granular
  degeneration of vascular smooth muscle cells (VSMC) in cerebral vessels, which did
  not react with antibodies against various immunoglobulins or complement factors.
  Ultrastructurally, granular osmiophilic material (GOM) covered the VSMC in
  different cerebral regions as well as in extracerebral organs (muscle, nerve, skin,
  small and large intestine, liver, kidney and heart). Skin biopsy samples from other
  family members of the last two generations also revealed GOM irrespective of the
  clinical symptomatology (CADASIL, migraine only or asymptomatic). Patients in
  the third generation had higher amounts of GOM in skin vessels than did
  asymptomatic or migraine patients in the fourth generation. We conclude that skin
  biopsy is a useful and less-invasive screening method for the differential diagnosis of
Keywords:                 ALZHEIMERS-DISEASE/antibodies/ARTERIOSCLEROTIC
  vessels/CADASIL/cells/cerebral/cerebral autosomal dominant arteriopathy with
  subcortical      infarcts     and      leukoencephalopathy       (CADASIL)/cerebral
  multi-       infarct       dementia/infarcts/kidney/MIGRAINE/MITOCHONDRIAL
  biopsy/small/smooth/smooth           muscle/STROKE/vascular/vascular            smooth
Coimbra, C., BorisMoller, F., Drake, M. and Wieloch, T. (1996), Diminished neuronal
  damage in the rat brain by late treatment with the antipyretic drug dipyrone or
  cooling following cerebral ischemia. Acta Neuropathologica, 92 (5), 447-453.
Abstract: It has been shown that changes in body core temperature several hours after a
  transient ischemic insult affect neuronal survival. We report that body core
  temperature in normal rats fluctuates over a 24-h period, while in rats subjected to 10
  min transient ischemia induced by occlusion of the common carotid arteries in
  combination with hypotension, body temperature persistently increases to above 38.5
  degrees C from 21 to 63 h following recirculation. The antipyretic drug dipyrone
  administered from 12 to 72 h recovery depresses body temperature to normothermic
  values and markedly diminishes neuronal damage in the neocortex and hippocampus
  when evaluated at 7 days of survival. Cooling the animals down to normothermic
  levels provided similar protection to that obtained with dipyrone treatment. These
  results suggest that hyperthermia occurring late during reperfusion aggravates
  delayed neuronal damage and can be effectively prevented by antipyretic drugs. The
  data imply that: (1) temperature-dependent processes occurring late during recovery
  are involved in delayed neuronal death, (2) inflammation may be an important factor
  in delayed neuronal death, (3) prostanoids and interleukins may contribute to this
  process (4) postischemic prolonged (days) temperature control is required for proper
  evaluation of drug therapy in brain ischemia models, and (5) fever in patients
  suffering brain ischemia should be impeded
Keywords:         ACUTE          STROKE/animals/antipyretic           drugs/arteries/body
  temperature/brain/brain        ischemia/carotid/carotid       arteries/cerebral/cerebral
  ischemia/control/cooling/death/delayed hyperthermia/delayed neuronal death/drug
  c insult/LEUKOTRIENES/MICROGLIAL REACTION/neuronal damage/neuronal
  death/NEW-YORK/occlusion/POSTISCHEMIC                       HYPERTHERMIA/rat/rat
Gotoh, K., Kikuchi, H., Kataoka, H., Nagata, I., Nozaki, K., Takahashi, J.C. and
  Hazama, F. (1996), Altered nitric oxide synthase immunoreactivity in the brain of
  stroke-prone spontaneously hypertensive rats. Acta Neuropathologica, 92 (2),
Abstract: To obtain information about the role of nitric oxide (NO) in the development
  of hypertensive cerebral lesions, we used immunohistochemical methods to study the
  distribution and level of nitric oxide synthase (NOS) in the brain of stroke-prone
  spontaneously hypertensive rats (SHRSPs). The early changes in the brain of
  SHRSPs were petechiae, edema and massive glial accumulation around fibrin
  deposits, which contained necrotized microvessels, whereas advanced cerebral
  lesions comprised massive bleeding, cavity formation and diffuse degeneration of the
  white matter. In the normotensive control rats, immunoreactivity for NOS was
  demonstrated in scattered neuronal cells, as has been reported previously, but there
  was no reactivity in glial cells. In the present study in SHRSPs, however,
  considerable NOS immunoreactivity was observed in most reactive astrocytes and in
  a proportion of the microglial cells and macrophages in the vicinity of the cortical
  lesions and in the subcortical white matter both ipsi- and contralateral to the cortical
  lesion, The nerve cells in the edematous region also showed weak immunoreactivity
  for NOS. The distribution of increased NOS in SHRSP brains corresponded well
  with the sites of extravasated plasma fluid as demonstrated by anti-fibrinogen
  antibody. Based on these findings, we postulate that edema and the simultaneously
  generated free radicals or some extravasated plasma components may induce
  expression of NOS in the reactive cells and nerve cells, and that the NO thus
  generated may be involved in the development of hypertensive cerebral lesions
  ISCHEMIA/formation/free                            radicals/GENE-EXPRESSION/glial
  DPH-DIAPHORASE/nerve cells/NEURONS/NEW-YORK/nitric oxide/nitric oxide
  synthase/NO/plasma/rats/reactive            astrocytes/reactivity/SHRSP/spontaneously
  hypertensive rats/stroke-prone/stroke-prone spontaneously hypertensive rats/white
Malandrini, A., Carrera, P., Palmeri, S., Cavallaro, T., Fabrizi, G.M., Villanova, M.,
  Fattapposta, M., Vismara, L., Brancolini, V., Tanganelli, P., Cali, A., Morocutti, C.,
  Zeviani, M., Ferrari, M. and Guazzi, G.C. (1996), Clinicopathological and genetic
  studies of two further Italian families with cerebral autosomal dominant arteriopathy.
  Acta Neuropathologica , 92 (2), 115-122.
Abstract: We report on two Italian families with an early-adult onset autosomal
  dominant disorder, characterized by leukoencephalopathy, migraine, psychiatric
  disturbances, stroke and dementia. These findings fulfill the diagnostic criteria for
  cerebral autosomal dominant arteriopathy with subcortical infarcts and
  leukoencephalopathy (CADASIL) syndrome. Moreover, to confirm the CADASIL,
  gene location to 19p12, we performed a linkage analysis with four microsatellite
  markers. The results of the genetic study gave positive but not significant lod scores,
  indicating only weak evidence of a linkage with 19p12. In one autopsy case, we
  found extensive ischemic changes due to the selective involvement of the small
  muscular arteries of the cerebral white matter. The lesions consisted of a thickening
  of the media with deposition of granular eosinophilic material. Ultrastructural
  examination of the arterial walls showed graded damage to smooth muscle cells,
  mostly of the longitudinal layer, and an abnormal proliferation of basal lamina
  components. Immunocytochemical analysis showed strong reactivity using
  antibodies to collagen IV and smooth myosin proteins. The results suggest a primary
  involvement of the smooth muscle cells of small cerebral arteries, with a secondary
  alteration of basal lamina components and elastic tissue
Keywords:                               analysis/antibodies/arterial/arteries/autopsy/basal
  lamina/CADASIL/cells/cerebral/cerebral                                   arteries/cerebral
  mooth muscle/smooth muscle cell/stroke/STROKES/subcortical infarcts/white
Tomimoto, H., Akiguchi, I., Wakita, H., Kinoshita, A., Ikemoto, A., Nakamura, S. and
  Kimura, J. (1996), Glial expression of cytokines in the brains of cerebrovascular
  disease patients. Acta Neuropathologica, 92 (3), 281-287.
Abstract: We examined the immunohistochemical localization of the proinflammatory
  cytokines tumor necrosis factor-alpha, lymphotoxin and interferon-gamma in 22
  autopsy brains of patients with either cerebrovascular disease (CVD) or other
  neurological diseases as well as 2 non-neurological control brains. These cytokines
  were coexpressed mostly in the microglia/macrophages and in a few astroglia in the
   brains with acute cerebral infarction and cerebral hemorrhage. In cases with cerebral
   infarction, they were observed as early as 33 h after the onset of the illness and
   persisted for up to 40 days after the onset. In one patient with cerebral hemorrhage
   who survived for 4 h, the cytokine-immunoreactive glial cells were confined to the
   margins of the hematoma. In contrast, the cytokine-immunoreactive glia were
   distributed diffusely in one patient with cerebral hemorrhage who died 12 days after
   the onset of the illness. Labeling for these cytokines was weak in the glial cells of
   control brains and those with neurodegenerative diseases, including Alzheimer's dis
   ease, Parkinson's disease and multiple system atrophy, in so far as there were no
   concomitant acute CVD foci. The present results indicate that proinflammatory
   cytokines are up-regulated in the brains of patients with acute stroke, and suggest an
   early inflammatory response in human CVD
Keywords:             acute/acute           stroke/atrophy/autopsy/cells/cerebral/cerebral
   FOREBRAIN                         ISCHEMIA/tumor/tumor                         necrosis
Riikonen, R.S., Vahtera, E.M. and Kekomaki, R.M. (1996), Physiological
   anticoagulants and activated protein C resistance in childhood stroke. Acta
   Paediatrica, 85 (2), 242-244.
Abstract: Immunological and functional protein S, protein C and antithrombin III levels
   and anticoagulant responses to activated protein C were measured in 24 patients with
   stroke in childhood. No hereditary deficiencies were found. The protein S levels in
   healthy controls of younger age did not differ from the adult levels. For optimal
   screening of protein S deficiency, measurements using functional as well as
   immunological assays are recommended. Appropriate criteria for the diagnosis of the
   deficiencies must be carefully applied if unnecessary anxiety and inappropriate
   treatment of children are to be avoided
Keywords: activated protein C resistance/adult/age/anticoagulants/antithrombin
   III/anxiety/childhood     stroke/children/criteria/diagnosis/functional/FUNCTIONAL
   ASSAY/hereditary/measurements/NORWAY/OSLO/PLASMA/protein                      C/protein
   S/protein                           S                           deficiency/resistance/S
Sonesson, S.E., Winberg, P., Lidegran, M. and Westgren, M. (1996), Foetal
   supraventricular tachycardia and cerebral complications. Acta Paediatrica, 85 (10),
Abstract: We report on two newborn infants with foetal tachycardia and cerebral lesions.
   Using foetal echocardiography, the diagnosis of supraventricular tachycardia in a
   structurally normal heart was made at 28 and 37 weeks of gestation, respectively.
   One infant had a 3 week period of foetal tachycardia and hydrops before successful
   pharmacological cardioversion. Even several weeks after a term birth he remained
   hypotonic and needed gavage feeding. A computed tomography (CT) scan
   demonstrated cerebral lesions indicating a vascular origin. A possible thrombus was
   found in the heart. The other infant converted to sinus rhythm during birth by
   Caesarean section on the day after diagnosis. He had convulsions at the second day
   of life. On CT scan an infarction was found. The observations of this report suggest
   that cerebrovascular complications to foetal arrhythmias are more common than
   previously observed and should be considered when managing cases of foetal
Keywords:                         arrhythmia/arrhythmias/cardioversion/cerebral/cerebral
   stroke/cerebrovascular/CHILDREN/complications/computed            tomography/CT/CT
Leth, H., Toft, P.B., Peitersen, B., Lou, H.C. and Henriksen, O. (1996), Use of brain
   lactate levels to predict outcome after perinatal asphyxia. Acta Paediatrica, 85 (7),
Abstract: Perinatal asphyxia is an important cause of neurological disability, but early
   prediction of outcome can be difficult. We performed proton magnetic resonance
   spectroscopy (MRS) and global cerebral blood flow measurements by xenon-133
   clearance in 16 infants with evidence of perinatal asphyxia. Cerebral blood flow was
   determined daily in the first 3 days after birth in seven cases. Proton MRS was
   performed in 11 infants within the first week (mean 3.7 days), the rest within the first
   month (mean 22.2 days), and all had a scan around 3 months of age. Four infants
   died neonatally, three showed neurological deficits and the rest seemed to be
   progressing normally at neurodevelopmental followup at 1 year of age. A significant
   correlation was found between initial brain lactate levels and severe outcome (p =
   0.0003) lust as between cerebral hyperperfusion (mean cerebral blood Row (CRF) 86
   ml (100 g)(-1) min(-1)), (p = 0.02) and outcome. The diagnostic and prognostic
   implications of early MRS and CBF are predictive of poor outcome in severely
   asphyxiated infants
Keywords:                    ACUTE                   STROKE/age/asphyxia/blood/blood
   flow/brain/CBF/cerebral/cerebral                blood               flow/CEREBRAL
   TS/lactate/lactates/magnetic               resonance/magnetic               resonance
   AY/nuclear magnetic resonance/OSLO/outcome/prediction/proton/proton magnetic
   resonance                          spectroscopy/PROTON                             MR
Ogita, F., Hara, M. and Tabata, I. (1996), Anaerobic capacity and maximal oxygen
   uptake during arm stroke, leg kicking and whole body swimming. Acta Physiologica
   Scandinavica, 157 (4), 435-441.
Abstract: In the present study, we determined both anaerobic capacity (the maximal
   accumulated oxygen deficit) and maximal oxygen uptake (Vover dotO(2max))
   during arm stroke (A), leg kicking (K), and whole body swimming (S), and
   compared them. The subjects were six trained college swimmers (two male and four
   female), aged 20+/-1 years. To determine Vover dotO(2max) for A, K and S, Vover
   dotO(2max) was measured during a 6-min swim at constant water flow rates. Vover
   dotO(2) was measured by the Douglas bag method. Anaerobic capacity was
  determined by accumulated oxygen deficit during exercise lasting 2-3 min according
  to the methods of MEdbo et al. Mean values of Vover dotO(2max) during A, K and
  S were 2.53+/-0.37 L min(-1). 2.93+/-0.37 L min(-1). and 3.23+/-0.43 L min(-1).
  respectively. Those in A and K corresponded to 78.2% and 91.0% of that in S. Mean
  values of anaerobic capacity during A. K and S were 2.15+/-0.31 L, 2.52+/-1.08 L
  and 2.99+/-0.52 L, respectively, Those in A and K corresponded to 73.3% and 81.7%
  of that in S. Both Vover dotO(2max) and anaerobic capacity in S were much lower
  than the sum of A and K, corresponding to only 59.3% and 65.9%, respectively.
  These results suggest that the total energy production during S is lower than simply
  the sum of A and K because the potentials of both the anaerobic and aerobic energy
  releasing processes in the muscle groups involved in A and K cannot be fully
  reached during S
Keywords:                        aged/anaerobic                        capacity/BUFFER
  muscle       groups/male/maximal        oxygen        uptake/MEN/methods/muscle/O-2
  SKELETAL-MUSCLE/stroke/supramaximal exercise/swimming/total/WORK
Andersen, G., Vestergaard, K., Riis, J.O. and IngemanNielsen, M. (1996), Dementia of
  depression or depression of dementia in stroke? Acta Psychiatrica Scandinavica, 94
  (4), 272-278.
Abstract: This study describes the correlation between changes in mood symptoms
  assessed by the Hamilton Depression Rating Scale (HDRS) and intellectual
  impairment assessed by the Brief Cognitive Rating Scale (BCRS) and Mattis
  Dementia Rating Scale (MDRS) in 166 unselected 1-year survivors after stroke, in
  whom post-stroke depression (PSD) has previously been described and validated,
  The course of intellectual impairment associated with PSD tvas compared with the
  course of intellectual impairment in non-PSD patients. In general, improvement in
  mood symptoms was correlated with an improvement in intellectual function.
  However, in 53 PSD patients improvement in intellectual performance was absent,
  despite the fact that the patients reported being significantly less distressed by
  dementia symptoms. Antidepressive medication did not lead to any improvement in
  MDRS score. No evidence tvas found to support the hypothesis of 'dementia of
  depression'. To the contrary, the findings indicate 'depression of dementia'
Keywords:                                                                  COGNITIVE
  EASE/FREQUENCY/function/impairment/intellectual function/INTELLECTUAL
  Rating Scale/POSTSTROKE DEPRESSION/pseudodementia/score/stroke
Landtblom, A.M., Sjoqvist, L., Soderfeldt, B., Nyland, H. and Thuomas, K.A. (1996),
  Proton MR spectroscopy and MR imaging in acute and chronic multiple sclerosis -
  Ringlike appearances in acute plaques. Acta Radiologica, 37 (3), 278-287.
Abstract: Purpose: We wanted to compare the metabolite status of brain lesions in
  different clinical subtypes of multiple sclerosis (MS). Two acute MS lesions with
  ringlike appearances were also investigated. Material and Methods: Twenty-three
  clinically stable MS patients, 2 patients with acute relapses, and 15 healthy
  individuals were examined by MR imaging and localized proton MRS. Results: No
  metabolite differences were seen in plaques of different subtypes. Decreased
  NAA/Cr and NAA/choline ratios as well as increased inositol/Cr ratios were
  observed in the plaques of the clinically stable or chronic active MS patients as
  compared with controls. The ring plaques had hyperintense cores with surrounding
  halos, separated from the cores by rings with low signal intensity in T2-weighted
  images. The core exhibited a prolonged T2 relaxation time. Proton spectra initially
  contained lactate. Conclusion: No differences between the metabolite status of
  nonacute plaques in different clinical subtypes could be detected. The ring plaques
  contained lactate signals indicating oedema, inflammation, and macrophage invasion,
  and may be transition forms between acute oedematous lesions and chronic
  demyelinated plaques
  spectroscopy/MRS/multiple                sclerosis/MYELIN               BREAKDOWN
Bakke, S.J., Smith, H.J., Kerty, E. and Dahl, A. (1996), Cervicocranial artery dissection
  - Detection by Doppler ultrasound and MR angiography. Acta Radiologica, 37 (4),
Abstract: Purpose: To evaluate pulsed Doppler ultrasound and MR angiography (MRA)
  in the diagnosis of cervicocranial dissection. Material and Methods: Fourteen
  patients with cervicocranial artery dissection were examined over a 3-year period.
  Twelve patients had dissection of the extracranial part of the internal carotid artery,
  and 2 had vertebral artery dissection. All patients were examined with pulsed
  Doppler ultrasound. In addition, all patients had conventional angiography (n=9)
  and/or MR imaging including MRA (n=9). Results: Doppler ultrasound disclosed
  unspecific abnormalities in 11 of 14 dissected vessels; 3 patients had false-negative
  Doppler findings. MRA showed vessel abnormalities in 9 of 9 patients; 2 vessels
  were occluded, and 7 vessels had changes typical of dissection (double lumen and/or
  string sign). Twelve patients had follow-up examinations with pulsed Doppler
  ultrasound (n=12), conventional angiography (n=3), and MRA/MR (n=11).
  Follow-up Doppler showed complete or partial normalization in 6 of 9 patients, all
  confirmed by either angiography or MRA. Conclusion: Our findings suggest that
  Doppler ultrasound may be used in follow-up of pathologic Doppler findings in
  known dissections, and that MRA may replace angiography in the confirmative
  diagnosis of cervicocranial dissection
Keywords:        abnormalities/angiography/arterial       dissection/artery/carotid/carotid
  tions/Doppler/Doppler ultrasound/EXPERIENCE/internal/internal carotid/internal
  carotid                                                              artery/INTERNAL
  ed Doppler ultrasound/STROKE/ultrasound/vertebral/VERTEBRAL ARTERY
OConnell, J.E. and Gray, C.S. (1996), Atrial fibrillation and stroke prevention in the
  community. Age and Ageing, 25 (4), 307-309.
Abstract: Atrial fibrillation (AF) is an important and independent risk factor for stroke,
  particularly in elderly people. The efficacy of treatment with warfarin and aspirin in
  primary and secondary stroke prevention in AF has been demonstrated in
  randomized clinical trials. In a demographic study, we examined the prevalence of
  AF in patients registered with a general practice in the North East of England; 91
  patients with known AF were identified, 69 with chronic AF and 22 with paroxysmal
  AF. The mean duration of the arrhythmia was 6.43 years and the prevalence of AF
  increased with age. There was a high prevalence of cerebrovascular disease in AF
  patients. The majority of AF patients were not receiving therapy with aspirin or
  warfarin as primary or secondary stroke prevention. If strategies for stroke
  prevention in AF are to be applied to the community, general practitioners will need
  to play a more active part
Keywords:            AF/AGE/arrhythmia/aspirin/CARE/cerebrovascular/cerebrovascular
  disease/chronic/clinical trials/disease/efficacy/elderly/ELDERLY PATIENTS/elderly
  people/ENGLAND/fibrillation/general/general                              practice/general
  factor/secondary                                          stroke/strategies/stroke/stroke
Amar, K., Wilcock, G.K. and Scott, M. (1996), The diagnosis of vascular dementia in
  the light of the new criteria. Age and Ageing, 25 (1), 51-55.
Abstract: Recently new criteria for diagnosing vascular dementia (VaD) have been
  suggested by (a) the State of California Alzheimer's Disease Diagnostic and
  Treatment Centres (ADDTC), and (b) the NINDS-AIREN group after an
  international workshop convened by the National Institute for Neurological
  Disorders and Stroke (NINDS), with support from the Association Internationale
  pour la Recherche et l'Enseignement en Neurosciences (AIREN). We have
  retrospectively applied the new criteria to two groups of patients who are thought by
  us to be suffering from VaD. The first group (20 patients) had a raised Hachinski
  Ischaemic Score, i.e. 7 or more (mean HIS = 9.5), and a second group (20 patients)
  with an HIS between 4 and 6 points (mean HIS = 4.9). In group 1, 19 patients
  fulfilled the ADDTC criteria for probable or possible VaD, compared with 16
  patients who fulfilled the NINDS-AIREN criteria. In group 2, 11 patients fulfilled
  the ADDTC criteria for probable or possible VaD, compared with only five patients
  who fulfilled the NINDS-AIREN criteria. This suggests that the ADDTC criteria
  may be more sensitive than the NINDS-AIREN criteria and the HIS. However,
  postmortem validation studies of the new criteria are needed to determine if the
  improved sensitivity of the ADDTC criteria is at the expense of their specificity
  DEMENTIA/RISK-FACTORS/STATE/vascular/vascular dementia
Baskett, J.J., Marshall, H.J., Broad, J.B., Owen, P.H. and Green, G. (1996), The good
  side after stroke: Ipsilateral sensory-motor function needs careful assessment. Age
  and Ageing, 25 (3), 239-244.
Abstract: Twenty subjects were examined 4-6 weeks after stroke to establish whether a
  sensory-motor ipsilateral deficit occurs early after stroke. Each underwent a timed
  test of repetitive side-to-side movement of both the upper and lower limbs ipsilateral
  to the cerebral infarct, and an assessment of motor disability using the Motor
  Assessment Scale. Results were compared with a group studied almost a year after
  their stroke, and with 41 age-matched healthy volunteers. There was a significantly
  worse performance (p < 0.005) on the right ipsilateral side, but not the left ipsilateral
  side, compared with normal volunteers, a finding similar to that of a group
  previously studied about a year after the stroke. There was no relationship between
  the severity of the motor deficit and performance of the 'good' side. This study
  suggests that ipsilateral sensory-motor deficit occurs after stroke but only on the right
  side, possibly owing to reduction in cerebral activation as a result of a right
   hemispheric lesion. These observations have importance in rehabilitation and
   education as well as practical skills, including driving a car and maintaining balance
Keywords:                                         AGE/ARM/assessment/cerebral/cerebral
Hiltunen, L., KeinanenKiukaanniemi, S., Laara, E. and Kivela, S.L. (1996),
   Self-perceived health and symptoms of elderly persons with diabetes and impaired
   glucose tolerance. Age and Ageing, 25 (1), 59-66.
Abstract: The aim of this study was to describe self-perceived health and symptoms of
   elderly persons with diabetes mellitus (DM) or impaired glucose tolerance (IGT) and
   to explore whether there are special symptoms associated with undiagnosed DM or
   IGT. The study population consisted of community-living northern Finnish persons
   aged 70 years or over (n=379). Poor self-perceived health and high number of
   symptoms were most common among previously diagnosed diabetic persons.
   Undiagnosed diabetes and especially IGT did not predict poorer self-perceived health
   or higher number of symptoms compared with non-diabetic status. We conclude that
   in older subjects neither undiagnosed diabetes nor IGT can be traced by worsened
   health perceptions or on the basis of symptoms
Keywords:             ADULTS/AGE/aged/BEDFORD                      SURVEY/CORONARY
Yeo, D., Lincoln, N.B., Burgess, I. and Pearce, M. (1996), SORT: A validation study
   with stroke patients. Age and Ageing, 25 (2), 121-124.
Abstract: The Salford Objective Recognition Test (SORT) was developed as a measure
   of recognition memory suitable for use with elderly people as it requires a shorter
   administration time than Warrington's Recognition Memory Test. Normative data for
   the SORT were collected from 50 normal elderly people living in the community.
   Fifty stroke patients were assessed on the SORT and other tests of psychological
   functioning. The words and faces subtests were found to correlate well with other
   measures of memory. The SORT was found to be uninfluenced by the effects of sex
   and time since onset of stroke, but was affected by language difficulties and
   perception problems. The split-half reliability of the test was found to be good as
   alternative versions of the subtests correlated well with each other
Keywords:                                 administration/AGE/CITY/effects/elderly/elderly
   al/recognition/reliability/sex/stroke/stroke patients/test
Steiner, A. (1996), Does it matter how you slice it? The relationship between population
   ageing and use of hospital and posthospital care in the United States. Ageing and
   Society, 16 205-232.
Abstract: In the context of demographic transition, one would expect public health
   planners to allocate resources according to changing needs. This paper explores the
   effects that definitions of population ageing have on the images of, and subsequent
   responses to, demographic transition in the United States. Data are drawn from the
   1988 U.S. Census and from a 20- per cent national random sample of Medicare
   patients during the same period (n = 1.9 million). Main findings are that supply and
   use of acute services do differ according to definitions and the way in which
   population ageing has occurred; that, regardless of definition, older people in
   high-ageing states make far greater use of posthospital home health care than in
   low-ageing states; and that, although individual-level clinical factors appear central
   to rehabilitative decisions, all states seem to use very old age (85-plus) as a proxy to
   determine who goes where, with low-ageing states also affected by structural
   constraints at the hospital and market levels
Keywords:              1988/ACCESS/acute/age/ageing/demography/effects/health/health
   care/health                                                                         services
   NEW-YORK/POLICIES/POLICY/public                     health/social         burden          of
   ageing/stroke/United States
Zito, M., Muscari, A., Marini, E., DiIorio, A., Puddu, G.M. and Abate, G. (1996), Silent
   lacunar infarcts in elderly patients with chronic non valvular atrial fibrillation.
   Aging-Clinical and Experimental Research, 8 (5), 341-346.
Abstract: It is still debated whether non valvular atrial fibrillation (NVAF) may be
   responsible for ''silent'' lacunar lesions. The aims of our study were to compare the
   prevalence of subcortical lacunar infarctions in highly selected elderly subjects with
   or without NVAF, and to investigate the possible relationship of such lesions to the
   impairment in cognitive and physical functions. Thirty-eight patients with NVAF
   (mean age 80.6 years) were compared with 40 patients in sinus rhythm (mean age
   80.4 years). Exclusion criteria were previous stroke or transient ischemic attacks,
   significant lesions of extracranial arteries, and any previous disease leading to
   cognitive impairment or potentially interfering with cognitive functions. A cranial
   computed tomogram was performed in every case, and the number of lacunae was
   recorded. Cognitive status and mood were assessed by means of Mini Mental Status
   Examination and the Geriatric Depression Scale, respectively. The number of
   impaired basic and instrumental activities of daily living (BADL e IADL) was also
   recorded. A significantly higher percentage of patients with lacunar lesions was
   detected in the NVAF group. The MMS score was lower in these patients, but did not
   reach significant levels. In univariate analysis, the presence of lacunae was found to
   be significantly associated with age, systolic blood pressure and atrial fibrillation, but,
   in a multiple logistic regression model, only age and atrial fibrillation retained a
   significant association. Similarly, in univariate analysis, a low, MMS score was
   found to be related to age, systolic blood pressure, leukoaraiosis and both the
   presence and the number of lacunar lesions. In multivariate analysis, only age and the
   number of lacunae were significantly associated with a low MMS. It is concluded
   that in elderly patients NVAF is associated with subcortical ischemic lesions which
   may contribute to the impairment of cognitive function. (C) 1996, Editrice Kurtis
Keywords: activities of daily living/age/analysis/arteries/ASYMPTOMATIC
   CEREBRAL                   INFARCTION/atrial/atrial               fibrillation/blood/blood
   pressure/BRAIN/CEREBROVASCULAR                      RISK-FACTORS/chronic/cognitive
   function/cognitive                            impairment/criteria/disease/elderly/elderly
   HYPERTENSION/impairment/infarcts/ischemic/ITALY/lacunar                      infarct/lacunar
   analysis/pressure/prevalence/score/sinus rhythm/STROKE/systolic/systolic blood
   pressure/transient/transient ischemic attacks/VALIDATION
Aronow, W.S., Ahn, C., Mercando, A.D., Epstein, S. and Gutstein, H. (1996),
   Correlation of paroxysmal supraventricular tachycardia, atrial fibrillation, and sinus
   rhythm with incidences of new thromboembolic stroke in 1476 old-old patients.
   Aging-Clinical and Experimental Research, 8 (1), 32-34.
Abstract: The relationship between supraventricular tachycardia and the incidence of
  thromboembolic stroke has not been previously reported. We investigated in a
  prospective study the incidence of new thromboembolic stroke in 1476 patients,
  mean age 81 years, with atrial fibrillation, paroxysmal supraventricular tachycardia,
  or sinus rhythm detected by 24-hour ambulatory electrocardiograms. New
  thromboembolic stroke developed at 31- month follow-up in 87 of 201 patients (43%)
  with atrial fibrillation, at 43-month follow-up in 84 of 493 patients (17%) with
  paroxysmal supraventricular tachycardia, and at 45-month follow-up in 143 of 782
  patients (18%) with sinus rhythm (p<0.0001 comparing atrial fibrillation with
  paroxysmal supraventricular tachycardia or sinus rhythm). Kaplan-Meier survival
  curves showed a higher significance of thromboembolic stroke in patients with atrial
  fibrillation, compared to patients with paroxysmal supraventricular tachycardia or
  sinus rhythm (log-rank: p<0.0001). Multivariate Cox regression model showed that
  independent significant predictors of thromboembolic stroke were: a) atrial
  fibrillation (relative risk = 3.31); b) prior thromboembolic stroke (relative risk =
  2.85); c) sex (relative risk for women = 0.75); and d) age (relative risk = 1.02). These
  data show that atria] fibrillation is an independent predictor of thromboembolic
  stroke in elderly patients, and that paroxysmal supraventricular tachycardia is not
  associated with thromboembolic stroke
Keywords: age/ambulatory electrocardiograms/atrial/atrial fibrillation/CARDIAC
  study/relative                risk/risk/sinus              rhythm/stroke/supraventricular
  tachycardia/survival/tachycardia/thromboembolic stroke/women
Swan, G.E., Carmelli, D. and Larue, A. (1996), Relationship between blood pressure
  during middle age and cognitive impairment in old age: The Western Collaborative
  Group Study. Aging Neuropsychology and Cognition, 3 (4), 241-250.
Abstract: We examined the relationship between blood pressure levels measured during
  middle age when few, if any, study participants were taking antihypertensive
  medication and incidence of global cognitive impairment 25 to 30 years later.
  Beginning in 1960- 1961, blood pressure was assessed biannually through 1969-1970
  when subjects were, on average, 45 years of age. Also assessed were educational
  attainment, central obesity and a variety of cardiovascular risk factors. During
  1986-1988 and again at 1992-1994, 1,173 surviving male subjects (mean age = 75
  years) were reexamined and assessed for cognitive performance using standard
  neuropsychological measures. Cognitive impairment was defined on the basis of test
  performance, self-report of dementia, or death or disease due to dementia. This
  definition resulted in 91 cases of impairment from 1986 to 1994 (an average per year
  incidence of 1.4%). Separate multiple logistic regression analyses, using either
  systolic or diastolic blood pressure measured during middle age as predictors of
  cognitive impairment, identified a significant relationship for both systolic blood
  pressure, relative risk (RR) = 1.35, 95% confidence interval (CI) = 1.08, 1.69, and
  diastolic blood pressure, RR = 1.31, 95% CI = 1.01, 1.70, after adjustment for age,
  education, and central obesity and exclusion of participants with stroke. These results
  suggest that higher levels of blood pressure measured during middle age are
  predictive of the incidence of cognitive impairment in old age
Keywords:         age/AGING/blood/blood              pressure/cardiovascular/cardiovascular
  risk/cardiovascular        risk      factors/central     obesity/CEREBROVASCULAR
  RISK-FACTORS/cognitive                                              impairment/cognitive
   HEART-DISEASE/death/DECLINE/DEMENTIA/diastolic                                      blood
   INDIVIDUALS/obesity/PERFORMANCE/predictors/pressure/relative risk/risk/risk
   factors/stroke/systolic/systolic blood pressure/test/WHITE-MATTER LESIONS
Hyde, T.T. and Anderson, E.H. (1996), Actuator with built-in viscous damping for
   isolation and structural control. Aiaa Journal, 34 (1), 129-135.
Abstract: The development and experimental application of an actuator with built-in
   viscous damping are described. A passive damper was modified to create a novel
   actuation device for two applications: isolation and structural control. The device
   uses the same fluid for damping and as: a hydraulic lever for a voice coil actuator.
   For vibration suppression, active enhancement of the inherent passive damping can
   optimize broadband damping or target certain frequencies. For vibration isolation
   applications, the passive stiffness can be chosen for small gravity sag and the active
   control designed to provide reduced mount transmissibility over a broad- or narrow-
   frequency range. Lumped parameter models capturing structural and fluid effects are
   presented. Component tests of free stroke, blocked force, and passive complex
   stiffness are used to update assumed model parameters. The structural damping
   effectiveness of the new actuator is shown to be that of a typical passive viscous
   damper and that of an actively damped piezoelectric strut with load cell feedback in a
   complex truss structure. Open- and closed-loop results are presented for a force
   isolation application showing an 8-dB passive and a 20-dB active improvement over
   an undamped mount
Agrawal, A. and Burns, M.A. (1996), Recuperative parametric pumping in adsorptive
   membranes. Aiche Journal, 42 (1), 131-146.
Abstract: Recuperative parametric pumping in adsorptive membranes, a cyclical
   adsorptive separation process, can lead to two distinct mechanisms of separation:
   rejection and preferential transport. During rejection, the adsorptive membrane
   rejects an adsorbing solute while permitting the transport of nonadsorbing solutes.
   During preferential transport the reverse occurs; the adsorptive membrane selectively
   transports an adsorbing solute while preventing the transport of nonadsorbing solutes.
   Switching fr om rejection to preferential transport can be accomplished by merely
   decreasing the ratio of the stroke volume (cyclical volume of solution pumped into
   and out of the membrane) to the membrane void volume. Preferential transport,
   earlier called an ''inverse separation, ''results from the adsorbing solute crossing over
   from an adsorbing to a desorbing region in the interior of the membrane and is
   governed by the shape of the equilibrium isotherms and by process variables In
   experiments with lysozyme and a membrane chromatography cartridge, selectivities
   obtained by preferential transport were on the order of 5 and agreed With theoretical
   predictions. Theoretical predictions suggest that to further improve separation by
   preferential transport, experiments need to be conducted on low dispersion
   membranes (Pe > 10(4)) and that both rejection and preferential transport can lead to
   continuous concentrated streams of the adsorbing solutes
Keywords:         CHROMATOGRAPHY/ION-EXCHANGE/NEW-YORK/stroke/stroke
Friedland, J., Renwick, R. and Mccoll, M.M. (1996), Coping and social support as
  determinants of quality of life in HIV/AIDS. Aids Care-Psychological and
  Socio-Medical Aspects of Aids/Hiv, 8 (1), 15-31.
Abstract: Coping, social support and quality of life (QOL) were examined in 120 HIV+
  people (mean age = 37). The sample came from ambulatory clinics and drop-in
  centres in Toronto: 29% had AIDS, 35% were HIV symptomatic, and 35% were
  asymptomatic. Information was gathered from self-administered questionnaires.
  Respondents had good levels of social support and used a variety of coping strategies.
  Their scores on the behavioural and subjective measures of QOL were somewhat
  below average. The illness-related measure indicated that their diagnosis had an
  almost neutral effect on QOL and showed several areas where QOL had been
  positively affected Data from male subjects only (n = 107) were analysed using a
  hierarchical block regression for each QOL measure. Income, emotional social
  support, and problern-oriented and perception-oriented coping were positively
  related to QOL. Tangible social support and emotion- oriented coping were
  negatively related and symptom severity was not related at all. Close friends
  provided most types of support. Although respondents indicated high levels of
  satisfaction with support generally, they expressed a need for more emotional
  support. Unemployment was high despite participants being relatively healthy and
  NCY-VIRUS-INFECTION/male/measure/OF-LIFE/OXFORDSHIRE/quality                         of
  life/scores/severity/social support/strategies/STRESS/STROKE
Weidauer, S., Nichtweiss, M. and Firnhaber, W. (1996), Prognosis of cerebral infarction
  in young adults. Aktuelle Neurologie , 23 (5), 202-206.
Abstract: To characterise the prognosis of cerebral infarction in young adults (aged:
  17-45 years), 106 consecutive patients were followed up as out patients. The
  diagnoses were based on extensive investigations during admission. In out patients
  additional diseases, recurrences of stroke and the development of ischemic deficits
  were questioned. The findings on admission and during follow-up were compared
  and evaluated by the Barthel Index. 5.7% of these patients died within 30 days after
  cerebral infarction, 3.8% during the follow-up period (mean 5.8 years) and
  recurrence of stroke occurred in 8.5%. The largest group comprised 29 patients with
  ''unclarified infarctions''. In these patients no further strokes and no other diseases
  were seen. In contrast, 3 out of 10 patients in the group with cerebral angiitis died
  during the follow-up and 4 patients suffered further strokes
Keywords:              10-YEAR                EXPERIENCE/adults/aged/cerebral/cerebral
  up/follow-up/infarction/ischemic/ISCHEMIC                      STROKE/LONG-TERM
  PROGNOSIS/prognosis/stroke/young adults
Druschky, A., Erbguth, F., Claus, D., Huk, W. and Neundorfer, B. (1996), Borrelia -
  Meningoencephalitis and Borrelia-induced cerebral vasculitis - Two case reports.
  Aktuelle Neurologie, 23 (3), 116-119.
Abstract: Two patients without vascular risk factors presented a lymphocytic
  meningoencephalitis, which was complicated by cerebral infarction. CSF analysis
  revealed intrathecal synthesis of antibodies against Borrelia burgdorferi. In the first
  case of a 50-year-old male patient, cerebral angiography and MRI showed signs of a
  vasculitis. In the second case neuroimaging could not demonstrate equivocal
  vasculitic changes. After an i.v. antibiotic therapy, there was a significant
  improvement in both patients. In the first patient, the addition of cortisone in high
  dosage plus i.v. heparinisation resulted in a distinct improvement of the clinical
Keywords:                              analysis/angiography/antibodies/BURGDORFERI
  INFECTION/cerebral/cerebral                                      angiography/cerebral
  isk     factors/STROKE/symptoms/therapy/vascular/vascular         risk/vascular     risk
Schuchardt, V., Schwab, S. and Hacke, W. (1996), What's new in neurological
  intensive-care medicine? Aktuelle Neurologie, 23 (3), 91-96.
Abstract: Neurocritical care has begun with artificial ventilation during poliomyelitis
  epidemics during the late 40s and the early 50s, and was established as a defined
  subdisciplin in the 80s. Presently, the most important developments seem to be
  improved diagnosis of inflammatory diseases by PCR, use of evoked potentials,
  improved doppler ultrasound techniques, and improved ICP monitoring. New
  therapeutic tools are thrombolysis in stroke, surgical decompression in malignant
  brain edema, and immunosuppression by high-dose intravenous immunogloblin
Keywords: brain/brain edema/BRAIN PROTECTION/diagnosis/diseases/edema/evoked
  potentials/EVOKED-                                 POTENTIALS/HERPES-SIMPLEX
Delcker, A., Rossler, S., Wilhelm, H. and Diener, H.C. (1996), Transcranial Doppler
  sonography as a prognostic parameter in unilateral occlusion of the internal carotid
  artery - A prospective follow-up study. Aktuelle Neurologie, 23 (6), 251-255.
Abstract: Transcranial Doppler-Sonography (TCD) is a reliable tool for the evaluation
  of the haemodynamic situation distal of an occlusion of the internal carotid artery
  (ICA). Our aim was to perform a prospective follow-up study over several years with
  a preexisting record of TCD parameters. Thirty-four patients were included. All
  patients fulfilled the following criteria: 1. Angiographically confirmed occlusion of
  the ICA, 2. No evidence of intracranial stenosis or occlusion. 3. Transtemporal bone
  window for transcranial Doppler signals. 4. Regular participation in follow-up
  examinations in 6 months intervalls. Mean duration of follow-up was 41 months
  (Standard deviation: 6.5 months). At the beginning of our study a TCD was
  performed on the ipsilateral and contralateral side of the ICA occlusion to examine
  the following parameters: Systolic and diastolic flow velocities, pulsatility index and
  difference of TCD parameters in the ipsilateral and contralateral middle cerebral
  artery (MCA). Occurrence of TIA or stroke was recorded. Eleven patients became
  symptomatic. Asymptomatic patients had a significantly higher pulsatility in the
  ipsilateral MCA (p < 0.02) indicating that this parameter is sensitive to
  haemodynamic effects of ICA obstructions. In addition the number of cerebral
  collaterals was significantly higher in patients with a higher pulsatility in the
  ipsilateral MCA (p < 0.05). A high pulsatility index of the ipsilateral MCA distal to
  an occlusion of the ICA and a higher number of cerebral collaterals in TCD indicate
  a better prognosis
Keywords:                 artery/bone/carotid/carotid                artery/cerebral/cerebral
  artery/criteria/DISEASE/Doppler/Doppler sonography/effects/evaluation/flow/follow
  up/follow-up/follow-up                             study/haemodynamic/haemodynamic
  effects/ICA/internal/internal                   carotid/internal                    carotid
  artery/intracranial/INTRACRANIAL                        HEMODYNAMICS/intracranial
  stenosis/ipsilateral/LONG-TERM          PROGNOSIS/MCA/middle/middle                cerebral
  artery/MIDDLE                       CEREBRAL-ARTERY/occlusion/OPHTHALMIC
  ranial/transcranial Doppler/ULTRASONOGRAPHY/unilateral
Reul, J. and Thron, A. (1996), New developments in neuroradiology. Aktuelle
  Neurologie, 23 (5), 181-188.
Abstract: New developments can be observed in CT and MRI as well as in the
  interventional therapy of cerebral and spinal diseases. The spiral-CT technique offers
  wide opportunities for the non- invasive diagnostic management of cerebral
  aneurysms and extracranial brain-supplying arteries. Magnetic Resonance
  Angiography (MRA) can be used routinely for special indications (e.g. cerebral sinus
  thrombosis). The progress of functional MRI (fMRI) has increased the value of this
  method for several clinical and scientific questions. The actual results of perfusion
  and diffusion imaging suggest that these techniques will be important in future for
  early diagnosis and therapy of ischaemic strokes. In the interventional field,
  endovascular occlusion with detachable coils is supposed to be an alternative to
  surgical clipping; however, the long-term results have to be studied. The results of
  preliminary trials of percutaneous treatment of carotid artery stenoses with dilatation
  and stents should encourage a randomised trial comparing endovascular to surgical
Keywords:                                            arteries/artery/BRAIN/carotid/carotid
Willig, V., Steiner, T. and Hacke, W. (1996), Thrombolysis in acute cerebral infarction.
  Aktuelle Neurologie, 23 (5), 220-223.
Abstract: During the last decade different fibrinolytic substances including urokinase,
  streptokinase and recombinant tissue plasminogen activator (rt-PA) have been tested
  regarding safety, efficacy, dosage and economic parameters in patients suffering
  from carotid and basilar artery territory strokes. The treatment is safe and effective if
  certain conditions are considered. Recently, two large results show that thrombolysis
  of acute carotid territory strokes improves clinical, functional and economic outcome
  parameters in a defined subgroup of patients who were treated within 6 hours from
  the onset of symptoms and had no extended early infarction sig ns on the initial
  CT-scan. Particularly beyond this inclusion criteria thrombolysis with urokinase or
  streptokinase seems to be superior to intravenous rt-PA treatment. Thrombolytic
  treatment within twelve hours after symptom onset was associated with significantly
  better results concerning both survival and neurological recovery. However,
  identification of the appropriate patients is difficult and depends on the level of
  clinical and diagnostic experience
Keywords: acute/ACUTE ISCHEMIC STROKE/artery/basilar/basilar artery/BASILAR
  infarction/criteria/CT                                       scan/efficacy/EMBOLIC
  STROKE/functional/infarction/intravenous/LOCAL                    INTRAARTERIAL
  activator/recombinant                         tissue                      plasminogen
  rombolysis/tissue                    plasminogen/tissue                   plasminogen
Kloss, T.M. and Haupt, W.F. (1996), Immunoglobulins in the treatment of
  Guillain-Barre Syndrome. Aktuelle Neurologie, 23 (1), 36-41.
Abstract: Treatment of acute Guillain-Barre syndrome (GBS) comprises the best
  standard of intensive care on one hand and immunomodulatory treatments on the
  other. Two multicenter trials have established the value of plasma exchange therapy
  to shorten the clinical course of acute GBS. A further study revealed equal results
  with plasma exchange and intravenous immunoglobulin (IvIG) treatment. The mode
  of action of IvIG is unknown, the effect may be in part due to HLA-and CD-4-
  molecules contained in variable concentrations in the various preparations. Since the
  preparation procedures vary considerably, one cannot a priori assume equal efficacy
  of all products. Treatment by IvIG offers numerous logistic and technical advantages,
  however, a number of adverse effects in the form of myocardial infarction, stroke,
  renal failure, and hepatitis C infections have been reported. The current multicenter
  trials on the treatment of acute GBS will provide more detailed information on the
  value of IvIG treatment
  us/INTRAVENOUS                 IMMUNE              GLOBULIN/myocardial/myocardial
  ROPATHY/RELAPSE/renal/renal                                    failure/stroke/T-CELL
Schwab, S., Spranger, M., vonKummer, R. and Hacke, W. (1996), The ''malignant
  MCA infarction'': Syndrome or artifact? Aktuelle Neurologie, 23 (4), 155-162.
Abstract: The clinical course of patients with complete middle cerebral artery (MCA)
  area infarction defined by CT was evaluated utilising the Scandinavian Stroke Scale
  (SSS), the Glasgow Coma Score (GCS), serial computed tomography (CT) with
  measurement of midline and septum pellucidum shift, and either angiography or
  Doppler ultrasound for determining the vascular occlusion type. Fifty-five patients
  had complete MCA area infarction caused by occlusion of the distal intracranial
  carotid artery with presumed embolic origin. Mean SSS on admission was 20. Time
  course of deterioration varied between 2-5 days. Forty- nine patients required
  artificial ventilation during the acute stage of disease. Only 12 patients survived
  (21%). Death was caused by transtentorial herniation with subsequent brain death in
  43 patients. All survivors were rated partly independent in Barthel index with a mean
  of 60 and a range of 45 to 70. Prognosis of complete MCA area stroke is poor and
  can be estimated early based on clinical and neuroradiological data within the first
  few hours after onset of symptoms
Keywords:       acute/ACUTE        ISCHEMIC         STROKE/angiography/artery/Barthel
  index/brain/brain death/BRAIN EDEMA/carotid/carotid artery/cerebral/cerebral
  artery/CEREBRAL-ARTERY                                       OCCLUSION/computed
Hummelsheim, H. (1996), Motor rehabilitation - Current principles and strategies.
  Aktuelle Neurologie, 23 (1), 7-14.
Abstract: In recent years, rehabilitation strategies have been influenced by
  neurobiological research on brain plasticity as well as on the mechanisms of motor
  learning. Emerging insights into the relationship between the recovery of motor
  function after brain lesion, symptom-related physiotherapeutic approaches and the
  impact of centrally acting drugs form the basis of modern rehabilitation medicine.
  Traditional physiotherapeutic concepts do not differ in respect of their efficacy in
  motor rehabilitation of patients with upper motor neuron lesions, given that efficacy
  is assessed on the disability or handicap level (according to the WHO definition).
  Recent electrophysiological studies emphasize the importance of direct activation of
  functionally relevant muscle groups, particularly of arm and hand, instead of indirect
  strategies working with proximal and trunk muscles. Furthermore, repeated
  execution of the very same movement that is often neglected in conventional
  physiotherapeutic approaches forms a further essential prerequisite in motor learning
  and rehabilitation. Treatment with centrally acting drugs may promote or impair
  motor recovery after brain lesion. Benzodiazepines, phenobarbital, phenytoin as well
  dopamine receptor antagonists alpha(1)- adrenergic receptor antagonists and
  alpha(2)-receptor agonists are supposed to be detrimental with respect to functional
  improvement and should be avoided during rehabilitation
Keywords:       activation/adrenergic/brain/BRAIN        INJURY/conventional/CORTEX
  NCTIONAL              RECOVERY/handicap/learning/lesion/lesions/LONG-LASTING
  POTENTIATION/medicine/MONKEY/motor/motor function/motor learning/motor
  neuron/motor         recovery/motor       rehabilitation/movement/muscle/PHYSICAL
  medicine/research/STIMULATION/strategies/STROKE REHABILITATION/upper
Diener, H.C. (1996), Guidelines for the implementation of stroke units from the
  committee on stroke units of the Deutsche Gesellschaft fur Neurologie. Aktuelle
  Neurologie, 23 (4), 171-175.
Abstract: Stroke units are hospital-based special units aiming at optimal care by a
  specialised team within an integrated concept for patients with acute strokes.
  Following the initial neurological and neuroradiological evaluation, early therapy is
  initiated based on the assumed pathophysiology of the stroke. Early treatment also
  includes monitoring of physiological parameters, care by specialized nurses, and
  early implementation of physical, speech and occupational therapy. Despite the
  increased initial costs, long-term burden for the health system is decreased by shorter
  hospital stay and decreased morbidity
  therapy/stroke/stroke units/therapy/treatment
Urbach, H., Klotz, S. and Solymosi, L. (1996), Detectability of acute supratentorial
  brain infarctions by computed tomography. Aktuelle Neurologie, 23 (4), 146-150.
Abstract: In this study the detectability of supratentorial brain infarctions by CT with
  regard to the time interval after symptom onset and to the infarction type and size
  was evaluated. 206 patients with supratentorial brain infarctions of whom a CT scan
  was performed within 24 hours after symptom onset were selected for this study.
  Signs of early ischaemia, infarction type and size were determined by two examiners,
  the diagnosis was confirmed by follow-up CT's. Eighty-seven percent of the
  territorial infarctions were recognised, the rate of defection did not increase after the
  first hour. The hyperdense middle cerebral artery sign (HMCAS) was found in 40%
  of all MCA infarctions. It was however present in 83% within the first 90 minutes
  and in only 18% from hour 12 to 24. All lentiform nucleus-MCA infarcts and 95% of
  the larger MCA infarcts but only 77 (i.e. 68%) of the infarctions covering less than
  33% of the MCA territory, were detected. Among the haemodynamic infarctions all
  watershed infarctions, but only 30 (i.e. 53%) of the terminal supply area infarctions
  were recognised. The detectability of supratentorial brain infarctions therefore
  mainly depends on infarction type and size. The detection rate of territorial
  infarctions after the first hour corresponds with the infarction size, but not with the
  time interval. The HMCAS is the earliest sign of ischaemia; however, it is
  sufficiently sensitive only within the first 90 minutes
Keywords: acute/ACUTE STROKE/artery/brain/cerebral/cerebral artery/computed
  tomography/CT/CT                    scan/detection/diagnosis/EARLY                   CT-
GromnicaIhle, E. (1996), The antiphospholipid-syndrome. Aktuelle Rheumatologie,
  21 (2), 106-113.
Abstract: The antiphospholipid-syndrome (APS) is defined as a combination of venous
  or arterial thromboses, spontaneous abortions or thrombocytopenia and repeated
  identifications of antiphospholipid-antibodies (APA). It can be associated with other
  autoimmune diseases, especially with systemic lupus erythematosus (secondary
  APS), or it can occur isolated as primary APS (PAPS). It is necessary to distinguish
  between patients with APS and those who have merely identification of APA. APA
  aim at complexes consisting of negatively charged phospholipids and plasmaproteins
  including beta-2-glycoprotein I, prothrombin, protein C, and protein S. The
  diagnostic procedure includes also necessarily haemostasiological (lupus
  anticoagulant) and immunological investigations. In patients with APS the event of
  thrombosis makes lifelong anticoagulation obligatory. The therapy of obstetrical
  complications is yet controversial. We suggest to give 75 mg of acetylsalicylic acid
  per day in case of repeated high levels of APA without clinical manifestations
Keywords:                                                           ANTICARDIOLIPIN
  al                      manifestations/COAGULATION/complications/diseases/lupus
  anticoagulant/PHOSPHOLIPIDS/protein                                            C/protein
  S/spontaneous/STROKE/systemic                 lupus          erythematosus/SYSTEMIC
Vorreuther, R., Klotz, T., Heidenreich, A., Zumbe, J. and Engelmann, U. (1996),
  Pneumatic versus electrokinetic lithotripsy during ureteroscopy. Aktuelle Urologie,
   27 (5), 306-310.
Abstract: Besides the well-known technique of pneumatic lithotripsy (lithoclast), a new,
   similar device for electrokinetic lithotripsy (EKL) has recently become available.
   The lithoclast works by air pressure pushing a projectile within the handpiece against
   the end of a metal probe, which is thereby accelerated and thrown like a
   jack-hammer against the stone. In principle, the same stroking movement of a small
   metal probe is provided by EKL, the difference being that, instead of a projectile, a
   magnetic core within the handpiece is accelerated by the electromagnetic principle.
   Testing the devices on a stone model taking into account the undesirable stone
   propulsion, both systems proved to be equally effective regarding stone
   disintegration. Stone displacement, however, was more pronounced with the
   lithoclast applied to soft stones. In a second setup a so-called opto-electronic
   movement-measuring apparatus (Zimmer camera) was employed to measure the
   range and velocity of the movement of the probe tip without any contact. After linear
   acceleration, velocity ranged between 5 and a maximum of 12.5 m/s with both
   systems. But the maximum height of the stroke was 2.5 mm with the lithoclast and
   only 1.5 mm with EKL. After initial break-up of soft stones, further impact of the
   probe tip against the stone may just result in propulsion. By modifying the EKL we
   achieved a stroke height similar to that provided by the lithoclast, which, as expected,
   also resulted in more pronounced stone propulsion. In a clinical trial, 22 ureteric
   stones were treated with the lithoclast and 35 with EKL. Both devices were equally
   effective in terms of stone disintegration and safety margin. Fixation using a Dormia
   basket was necessary in 12 cases (8 lithoclast, 4 EKL)
Keywords:            CALCULI/clinical            trial/DEVICE/ELECTROHYDRAULIC
Altura, B.M., Zou, L.Y., Altura, B.T., Jelicks, L., Wittenberg, B.A. and Gupta, R.K.
   (1996), Beneficial vs. detrimental actions of ethanol on heart and coronary vascular
   muscle: Roles of Mg2+ and Ca2+. Alcohol, 13 (5), 499-513.
Abstract: Epidemiologic studies suggest that daily ingestion of small amounts of alcohol
   may protect the heart, whereas higher intake may be detrimental. We studied: 1)
   cardiac performance, bioenergetics, and [Mg2+](i) of isolated working rat hearts
   during perfusion with Krebs-Henseleit medium containing different concentrations
   of ethanol (EtOH), 2) mechanical responses, Ca2+ metabolism, and Mg content of
   isolated coronary arteries obtained from dogs, sheep, and piglets subjected to varying
   concentrations of EtOH and [Mg2+](o), and 3) intracellular free Ca2+ of isolated rat
   cardiac myocytes. Ln intact hearts, EtOH produced a biphasic hemodynamic change,
   depending upon concentration; 15 mM EtOH (0.07 g/dl) and 45 mM EtOH (0.21 g/dl)
   were stimulatory; 90 (0.42 g/dl), 135 (0.63 g/dl), and 170 mM (0.79 g/dl) EtOH were
   depressive. EtOH 15 and 45 mM increased coronary flow up to 150%, cardiac output
   up to 130%, stroke volume up to 135%, and oxygen consumption (V-O2) up to
   130%. However, 90 mM and higher EtOH depressed most hemodynamic parameters
   (except for heart rate) dose dependently. Lactic acid, lactic acid dehydrogenase, and
   creatine phosphokinase levels in the perfusate tended to be elevated progressively
   with increasing duration of EtOH perfusion, and pH tended to be reduced (p < 0.05).
   [P-31]NMR spectroscopy on hearts revealed that EtOH greater than or equal to 90
   mM resulted in rises in P-i/ATP concentration ratio with no significant change in
   PCr/ATP ratio: [Mg2+](i) levels fell and cytosolic pH tended to become slightly
  acidotic. [F-19]NMR spectroscopy of isolated myocytes revealed that [Ca2+](i) rises
  at high concentrations of EtOH. With respect to coronary vascular muscle (CVM),
  low concentrations of EtOH resulted in a concentration-dependent reduction in
  contractions induced by K+, angiotensin II, and 5-HT; concentration-effect curves
  were shifted rightward to higher concentrations. Low [Mg2+](o) potentiated
  contractions of CVM induced by EtOH. Low EtOH also resulted in reductions in
  exchangeable and membrane-bound Ca-45 in CVM: medium to high concentrations
  of EtOH reduced Me content in CVM and increased Ca-45. In the absence of
  [Ca2+]o, caffeine and EtOH induced similar, transient contractions followed by
  relaxation in K+-depolarized coronary arterial tissues. EtOH-induced contractions
  were completely abolished by pretreatment of tissues with caffeine. These results on
  isolated coronary vessels suggest that in addition to a need for [Ca2+](o), an
  intracellular release of Ca2+ is needed for EtOH to induce contractions. Overall, the
  data indicate that low concentrations of EtOH (15, 45 mM) are beneficial on cardiac
  performance, at least in the intact rat heart and coronary arteries: higher
  concentrations of EtOH (90, 135 mM) are detrimental. High concentrations of EtOH
  decrease coronary flow, lead to loss of cellular Mg2+, hypoxia, metabolic acidosis of
  the myocardium, cell membrane damage, and Ca2+ overload, which could result in
  cardiac failure. Celluar loss of Mg2+ appears to be causative in the detrimental
  actions of EtOH on the heart
  SMOOTH-MUSCLE/arteries/cardiac/cardiac bioenergetics/cardiac output/cardiac
  performance/cardiac          phosphometabolites/cardioprotective       actions       of
  ethanol/coronary/coronary                               vasospasm/DRUG-INDUCED
  rate/hemodynamic/HIGH-DENSITY-LIPOPROTEIN/hypoxia/intracellular                    free
  calcium/INTRACELLULAR                                                            FREE
  MG/ISCHEMIC-HEART/K+/metabolism/MODERATE                                   ALCOHOL
  INTAKE/muscle/myocardium/nuclear                      magnetic               resonance
  spectroscopy/oxygen/oxygen         consumption/P-31       NMR/perfusion/pH/RABBIT
  volume/transient/VARIANT ANGINA/vascular/VO2/volume
King, A.C., Bernardy, N.C., Parsons, O.C. and Lovallo, W.R. (1996), Hemodynamic
  alterations in alcohol-related transitory hypertension. Alcohol, 13 (4), 387-393.
Abstract: Alcoholic patients are often transiently hypertensive (tHT) during days 1-3 of
  withdrawal but become normotensive thereafter. However, at 3-4 weeks
  postwithdrawal these tHT patients may still show exaggerated blood pressure rises to
  isometric handgrip exercise. We examined the hemodynamic mechanisms associated
  with persistent altered pressure response. Forty-two alcoholic inpatients were equally
  divided into three subgroups based on admission BPs: transitory hypertensive (tHT;
  BP greater than or equal to 160/95 mmHg), transitory borderline hypertensive (tBH;
  140/90 less than or equal to BP < 160/95), and normotensive (NT; BP < 140/90).
  After 3-4 weeks of sobriety, the alcoholics and a normotensive nonalcoholic group
  (CONTs; n = 14) were tested during rest and an isometric handgrip task. Impedance
  cardiographic evaluation at both times showed elevated peripheral resistance,
  elevated heart rate, and reduced stroke volume in tHTs. Liquor consumption was
  found to be highly predictive of the altered hemodynamic and BP activity. Alcoholic
  patients with acute withdrawal hypertension (1-3 days) may show a persistent
  alteration of BP regulation even when resting pressures are normal
Keywords:           activity/acute/ALCOHOL/alcohol             dependence/blood/blood
  pressure/BLOOD-PRESSURE                                   DYSREGULATION/cardiac
  /EXERCISE/heart/heart                          rate/hemodynamic/hypertension/liquor
Bornebroek, M., VanBuchem, M.A., Haan, J., Brand, R., Lanser, J.B.K., deBruine, F.T.
  and Roos, R.A.C. (1996), Hereditary cerebral hemorrhage with amyloidosis-Dutch
  type: Better correlation of cognitive deterioration with advancing age than with
  number of focal lesions or white matter hyperintensities. Alzheimer Disease &
  Associated Disorders, 10 (4), 224-231.
Abstract: The relationship between cognitive deterioration and abnormalities detected
  by magnetic resonance imaging (MRI) was investigated to determine the radiological
  correlates of cognitive deterioration in hereditary cerebral hemorrhage with
  amyloidosis-Dutch type (HCHWA-D). Twenty HCHWA-D subjects (12 patients
  who had suffered one or more strokes and eight who had not suffered a stroke) were
  studied with MRI and underwent extensive neuropsychological examination. On
  MRI the number of focal lesions was counted, and white matter hyperintensities
  (WMHs) were scored semiquantitatively. A significant correlation between cognitive
  deterioration and WMH score and number of focal lesions was found. However,
  cognitive deterioration, WMH score, and the number of focal lesions all increase
  with age, and therefore their mutual correlation can be explained as an age effect.
  This study shows that cognitive deterioration in HCHWA-D is not correlated with
  abnormalities detected by MRI (number of focal lesions and subcortical WMHs)
  independently of age. Although a contribution of white matter changes and/or focal
  lesions, possibly in combination with age, to cognitive deterioration cannot be
  excluded. Cognitive deterioration in these HCHWA-D patients is probably primarily
  the result of chronic damage of amyloid angiopathy to the brain, to which may be
  superimposed cognitive impairment from focal cerebral hemorrhage or infarction
  amyloid/brain/cerebral/cerebral              amyloid               angiopathy/cerebral
  ORDER/EAST/effect/focal/GENE/hemorrhage/hereditary cerebral hemorrhage with
  amyloidosis-Dutch                type/impairment/infarction/LEIDEN/lesions/magnetic
  resonance/magnetic                                                          resonance
  ore/stroke/WASHINGTON/white matter/white matter hyperintensities
Rasmusson, D.X., Brandt, J., Steele, C., Hedreen, J.C., Troncoso, J.C. and Folstein, M.F.
  (1996), Accuracy of clinical diagnosis of Alzheimer disease and clinical features of
  patients with non-Alzheimer disease neuropathology. Alzheimer Disease &
  Associated Disorders, 10 (4), 180-188.
Abstract: Neuropathological examination confirmed the clinical diagnosis of possible or
  probable Alzheimer disease (AD) in 90 of the first 100 patients who came to autopsy
  at the Johns Hopkins Alzheimer's Disease Research Center. In 10 cases, postmortem
  brain examination did not confirm AD but revealed variable patterns of neuronal loss
  in neocortex and limbic structures without amyloid deposits. The most common
  pattern of degeneration was relatively isolated hippocampal sclerosis CHS). Despite
  the finding that the 10 patients with non-AD neuropathology were ill for less time
  and were less cognitively impaired at study entry than those patients with definite
  AD, they had shorter survival times and showed equal behavioral disturbance at
  study entry (on a standardized measure). The clinical case reports included here
  suggest early and progressive prominent behavioral disturbance and other indexes of
  rapid illness progression in three of the four HS patients and two other non-AD
  patients. We conclude that the criteria of the National Institute of Neurological
  Disorders and Stroke/Alzheimer Disease and Related Disorders Association for
  possible or probable AD are highly accurate and that misdiagnosis is most likely to
  occur early in the course of illness and in patients with prominent behavioral
  disturbance or other atypical features
Keywords:                                                          Alzheimer/Alzheimer
  TANGLES/neuropathology/PRESENILE-                            DEMENTIA/PRIMARY
  DEGENERATIVE                                            DEMENTIA/PROGRESSIVE
Derouesne, C., Guigot, J., Chermat, V., Winchester, N. and Lacomblez, L. (1996),
  Sexual behavioral changes in Alzheimer disease. Alzheimer Disease & Associated
  Disorders, 10 (2), 86-92.
Abstract: The frequency and correlates of sexual behavioral changes in Alzheimer
  disease (AD) were assessed in two studies. In the first study, we reviewed the
  medical records of 135 consecutive community-living patients who fit the criteria of
  the National Institute of Neurological and Communicative Disorders and
  Stroke/Alzheimer Disease and Related Disorders Association for probable or
  possible AD, and we asked spouses to complete a questionnaire that included two
  questions about sexual activity. Indifference to sexual activity was reported by 70%
  of the spouses, and sexual behavioral modifications were reported by 50%. No
  correlation was found between sexual changes and the general characteristics of the
  patients, the severity of the disease, or depressive symptomatology. Sexual changes
  were correlated to the severity of behavioral and mood disorders, mainly to a
  reduction of activity and emotional deficit. Seventy-seven of the patients had a
  second examination after an interval of 18.9 +/- 9.9 months. The links between
  sexual changes and the other variables were similar to those found by the first
  examination. In the second study, a questionnaire was sent by mail to the spouses of
  100 patients. No relationship was found between sexual changes and the severity of
  cognitive deficits, previous sexual agreement, age, or gender. Sexual changes were
  considered a factor of maladjustment for the couple by 46% of the spouses
Keywords:               activity/age/Alzheimer/Alzheimer              disease/behavioral
  MPACT/severity/sexual behavior/symptomatology/WASHINGTON
Kuller, L.H. (1996), Potential prevention of Alzheimer disease and dementia. Alzheimer
  Disease & Associated Disorders, 10 13-16.
Abstract: The prevention of dementia is of critical importance. The increasing
  population of high-risk older individuals will result in an increasing prevalence of
  dementia. Primary prevention of dementia and Alzheimer disease can take either a
  public health or high-risk preventive medicine approach. At the present time, there is
  little evidence to support a specific primary public health approach such as a specific
  nutrient. The possible association of vascular disease with dementia may offer the
  best preventive high-risk approach. The identification of individuals with clinical and
  subclinical vascular disease is possible. There is a very high prevalence of subclinical
  cerebral infarction in older individuals. Specific treatments can prevent clinical
  disease such as stroke and coronary heart disease. Whether therapies will prevent
  some dementia can be determined
Keywords: ALLELE/Alzheimer/Alzheimer disease/ASSOCIATION/cerebral/cerebral
  infarction/clinical      trials/COGNITIVE      FUNCTION/coronary/coronary           heart
  PEOPLE/health/heart/heart                                                   disease/high
  ntive          medicine/public        health/RISK/specific/STROKE/vascular/vascular
Santilli, J.D., Santilli, S.M. and Rodnick, J.E. (1996), Prevention of stroke caused by
  carotid bifurcation stenosis. American Family Physician, 53 (2), 549-556.
Abstract: Prevention of stroke caused by carotid bifurcation stenosis can be achieved by
  accurate identification and evaluation of patients at risk. A consensus report from the
  National Institute of Neurologic Disorders and Stroke has standardized diagnostic
  criteria and symptoms related to this disease. Recent prospective, randomized trials
  have identified effective treatment for both asymptomatic and symptomatic carotid
  stenosis. The risk factors for carotid stenosis are similar to those for
  atherosclerosis-hypertension, diabetes, cigarette smoking and hyperlipidemia. A
  carotid bruit is the most common clinical finding, although its positive predictive
  value is only about 60 to 70 percent. Recent clinical trials have identified patient
  groups that benefit from surgical and medical therapy, depending on the degree of
  carotid stenosis and the presence or absence of symptoms. Symptomatic patients
  with carotid stenosis greater than 70 percent benefit from surgical therapy.
  Asymptomatic patients who have carotid stenosis greater than 60 percent and are
  good surgical candidates should be referred for surgical consultation
Keywords:           carotid/carotid       stenosis/cigarette       smoking/CITY/clinical
  domized                                                           trials/Recent/risk/risk
Kerle, K.K. and Nishimura, K.D. (1996), Exertional collapse and sudden death
  associated with sickle cell trait. American Family Physician, 54 (1), 237-240.
Abstract: Although rare, exertional collapse and sudden death are the most serious
  potential complications of sickle cell trait. Studies suggest that this condition may
  occur in susceptible persons when poor physical conditioning, dehydration, heat
  stress or hypoxic states precipitate sickling of the abnormal erythrocytes. Sickling
  leads to endothelial damage, which can cause vasoconstriction, disseminated
  intravascular coagulation and local tissue damage. Cardiac effects include acute
  ischemia and arrhythmias. Muscle damage results in acute compartment syndromes
  and release of myoglobin into the circulation. Acute renal failure is possible.
  Diagnosis is based on a high index of suspicion, and characteristic presentation and
  laboratory findings, including myoglobinuria, hyperkalemia, hypocalcemia,
  hyperphosphatemia and elevated creatine kinase levels. The differential diagnosis
   includes pulmonary embolism, acute cardiac events, anaphylaxis and heat stroke.
   Management is based on stabilization, rehydration, and the treatment and prevention
   of complications
   FAMILY                                                        PHYSICIAN/heat/heat
   y/pulmonary          embolism/renal/renal         failure/RHABDOMYOLYSIS/RISK
   FACTOR/stress/stroke/sudden death/treatment/vasoconstriction/WARD
Fawzy, M.E., Choi, W.B., Mimish, L., Sivanandam, V., Lingamanaicker, J., Khan, A.,
   Patel, A. and Khan, B. (1996), Immediate and long-term effect of mitral balloon
   valvotomy on left ventricular volume and systolic function in severe mitral stenosis.
   American Heart Journal, 132 (2), 356-360.
Abstract: To determine the immediate and long-term effect of mitral balloon valvotomy
   (MBV) on left ventricular (LV) volume acid function, we studied 17 patients (mean
   age 27 +/- 9 years) with severe mitral stenosis undergoing MBV by cardiac
   catheterization and angiography before and immediately after MBV and at mean 12
   months later. At baseline, LV end-diastolic volume index (EDVI) was reduced. Ten
   patients had EDVI less than or equal to 55 ml/m(2), and four patients (23.5%) had
   LV ejection fraction <50%. EDVI increased from 60 +/- 17 ml/m(2) to 66 +/- 17
   ml/m(2) (p < 0.05) immediately after MBV and increased further to 72 +/- 16 ml/m(2)
   (p < 0.05) later. Stroke volume index increased from 34 +/- 10 ml/m(2) to 41 +/- 12
   ml/m(2) (p < 0.05) immediately after MBV and increased further to 50 +/- 11 ml/m(2)
   (p < 0.001) later. LV end diastolic pressure increased from 12 +/- 5 mm Hg to 16 +/-
   4 mm Hg (p < 0.05) immediately after MBV and fell to 13 +/- 3 mm Hg at follow-up.
   LV ejection fraction increased from 57 +/- 7% to 62 +/- 6% (P < 0.05) immediately
   after MBV and 71 +/- 8% later (p < 0.001). Mean systolic ejection rate increased
   from 82 +/- 35 ml/sec to 101 +/- 48 ml/sec (p < 0.05) immediately after and 165 +/-
   81 ml/sec later (p < 0.05). Systemic vascular resistance fell from 1887 +/- 525
   dyne/sec/cm(-5) to 1280 +/- 231 dyne/sec/cm(-5) (p < 0.001) at follow-up. We
   conclude that the LV end-diastolic volume and systolic function are reduced in
   patients with mitral stenosis, and the LV end-diastolic volume is increased
   immediately after MBV and continues to increase at follow-up 12 months later; the
   LV ejection performance improves after successful MBV because of an increase in
   end-diastolic LV volume (preload) and reduction of SVR (afterload)
   ON FRACTION/end-diastolic volume/follow up/follow-up/function/HEART/left
   ventricular/left                      ventricular                       volume/mitral
   olic     function/VALVE        DISEASE/vascular/vascular        resistance/ventricular
Lip, G.Y.H., Lowe, G.D.O., Rumley, A. and Dunn, F.G. (1996), Fibrinogen and fibrin
   D-dimer levels in paroxysmal atrial fibrillation: Evidence for intermediate elevated
   levels of intravascular thrombogenesis. American Heart Journal, 131 (4), 724-730.
Abstract: Because abnormalities in hemostatic factors may in part account for the risk of
   stroke and thromboembolism in atrial fibrillation, we measured plasma fibrinogen
   and fibrin D-dimer levels in 33 patients (18 men and 15 women, mean age 60.8 +/-
   1.4 years [mean +/- SEM]) with paroxysmal atrial fibrillation (PAF) and 12 patients
   (3 men and 9 women, mean age 51.0 +/- 4.2 years) with paroxysmal supraventricular
   tachycardia (PSVT) Levels of these markers were compared to levels in (1) patients
   with chronic atrial fibrillation; (2) hospital controls (age- matched [age +/- 5 years]
   and sex-matched patients in sinus rhythm with coronary artery disease and normal
   left ventricular function); and (3) healthy population controls in sinus rhythm.
   Patients with PAF had intermediate levels of median plasma fibrinogen and fibrin
   D-dimer when compared to patients with chronic atrial fibrillation and controls in
   sinus rhythm (both p < 0.001), There was no relation with atrial size or ventricular
   function on echocardiography, Patients with PSVT had plasma fibrinogen and fibrin
   D-dimer levels that were similar to the median levels of the population controls,
   suggesting that there was no excess in thrombogenesis, These findings are consistent
   with the hypothesis that atrial fibrillation is related to the increases in plasma
   fibrinogen and fibrin D-dimer levels, Patients with PAF have intermediate levels of
   these markers, a finding that is consistent with the intermediate risk of
   thromboembolism in such patients
Keywords: abnormalities/age/artery/atrial/atrial fibrillation/chronic/chronic atrial
   fibrillation/coronary/coronary       artery/coronary    artery    disease/CORONARY
   ventricular/left           ventricular          function/men/paroxysmal            atrial
   fibrillation/plasma/RISK/risk of stroke/sinus rhythm/SPONTANEOUS ECHO
   CONTRAST/stroke/supraventricular                               tachycardia/SYSTEMIC
   EMBOLISM/tachycardia/thromboembolism/ventricular function/women
Sun, J.P., Stewart, W.J., Hanna, J. and Thomas, J.D. (1996), Diagnosis of patent
   foramen ovale by contrast versus color Doppler by transesophageal
   echocardiography: Relation to atrial size. American Heart Journal, 131 (2), 239-244.
Abstract: To ascertain the factors related to the transesophageal echocardiographic
   diagnosis of patent foramen ovale, the primary echocardiographic data were
   reviewed from 74 patients with that diagnosis. Similar detection rates were observed
   with contrast echocardiography (82%) and color flow mapping (78%), but contrast
   was more sensitive in patients with normal-sized atria (94%) and isolated right atrial
   enlargement (100%) than in those with enlarged left atria, all but three of whom had
   biatrial enlargement (52%) (p < 0.001 by chi-square test). Doppler flow mapping was
   less sensitive for normal-sized atria (66%) than for isolated enlarged right atria (81%)
   and left (bi-) atrial enlargement (96%) (p = 0.024). Patent foramen ovale was directly
   visualized by two-dimensional echocardiography in 80%, with close agreement to
   the size of the color Row jet (r = 0.90, Delta = 0.1 +/- 0.4 mm); foramen ovale size
   was related to right atrial area (r = 0.31, p = 0.015). Thus both saline contrast and
   color flow imaging are necessary to exclude the diagnosis of patent foramen ovale
   ramen              ovale/HEART/IMAGING/IMPENDING                      PARADOXICAL
   EMBOLISM/mapping/patent/patent                                                  foramen
   ovale/STROKE/test/transesophageal/transesophageal echocardiography
Jiang, L., Morrissey, R., Handschumacher, M.D., dePrada, J.A.V., Picard, M.H.,
   Weyman, A.E. and Levine, R.A. (1996), Quantitative three-dimensional
   reconstruction of left ventricular volume with complete borders detected by acoustic
   quantification underestimates volume. American Heart Journal, 131 (3), 553-559.
Abstract: Recently a new acoustic-quantification (AQ) technique has been developed to
  provide on-line automated border detection with an integrated backscatter analysis.
  Prior studies have largely correlated AQ areas with volumes without direct
  comparison of volumes for agreement. By using complete AQ-detected borders as
  the input to a validated method for three-dimensional echocardiographic (3DE)
  reconstruction, we can compare an entire cavity volume measured with the aid of AQ
  against a directly measured volume. This would also explore the possibility of
  applying AQ to 3DE reconstruction to reduce tracing time and enhance routine
  applicability. To compare reconstructed volumes with actual values in a stable
  standard allowing direct volume measurement, the left ventricles of 13 excised
  animal hearts were studied with a 3DE system that automatically combines
  two-dimensional (2D) images and their locations. Intersecting 2D views were
  obtained with conventional scanning and AQ imaging, with gains optimized to
  permit 3D reconstruction by detecting the most continuous AQ borders for each view,
  with maximal cavity size. Reconstruction was performed with manually traced
  central endocardial reflections and AQ-detected borders. 3DE reconstructions of both
  manually and AQ-detected borders visually reproduced the left ventricular shapes;
  the AQ reconstructions, however, were consistently smaller. The reconstructed left
  Ventricular (LV) volumes correlated well with actual values by both manual and AQ
  techniques (r = 0.93 and 0.88, with standard errors of 2.3 cc and 2.0 cc, p = not
  significant [NS]). Agreement with actual values was relatively close for the manually
  traced borders (y = 0.93x + 0.68, mean difference = -0.8 +/- 2.2 cc). AQ-derived
  reconstructions consistently underestimated LV volume by 39 +/- 10% (y = 0.62x -
  0.09, mean difference = -7.8 +/- 3.0 cc, different from manually traced and actual
  volumes by analysis of variance [ANOVA], F = 69, p < 0.00001). The AQ-detected
  threshold signal was displaced into the cavity, and volume between walls and false
  tendons was excluded, leading to underestimation, which increased with increasing
  cavity volume (r = 0.76). The AQ technique can therefore be applied to 3DE
  reconstruction, providing volumes that correlate well with directly measured values
  in a stable in vitro standard, minimizing observer decisions regarding manual border
  placement after image acquisition. However, when the complete borders needed for
  3D reconstruction are used, absolute volumes are underestimated with current
  algorithms that integrate backscatter and displace the detected threshold into the
  ventricular cavity
Keywords:                  3-DIMENSIONAL                    ECHOCARDIOGRAPHIC
  quantification/algorithms/analysis/animal/AUTOMATIC                    BOUNDARY
  DETECTION/CANINE                   LEFT-VENTRICLE/conventional/detection/GAIN
  COMPENSATION/HEART/image/INTEGRATED                             BACKSCATTER/left
  ventricular/left ventricular volume/measurement/MYOCARDIUM/online/ONLINE
Willenbrock, R., Ozcelik, C., Osterziel, K.J. and Dietz, R. (1996),
  Angiotensin-converting enzyme inhibition, autonomic activity, and hemodynamics in
  patients with heart failure who perform isometric exercise. American Heart Journal,
  131 (5), 999-1006.
Abstract: Effects of angiotensin-converting enzyme inhibition (ACEI) on autonomic
  responses and hemodynamics in patients with congestive heart failure (CHF)
  subjected to isometric exercise have not been studied. We tested whether acute ACEI
  might influence the effects of isometric exercise in patients with CHF. In the first
  part of the study we showed that isometric exercise increased blood pressure in the
  control group and in the CHF group, whereas cardiac output increased only in the
  control group. Stroke volume remained unchanged in the control group, whereas it
  decreased significantly in the CHF group. We next analyzed the effect of acute ACEI
  (5 mg ramipril) on the decrease in cardiac output during isometric stress in patients
  with CHF. During isometric exercise mean blood pressure and heart rate increased
  similarly in both groups. However, cardiac output decreased during placebo by -0.48
  +/- 0.12 L/min (p < 0.01) but not during ACEI. Spectral analysis of blood pressure
  showed an increase (p < 0.01) in the high-frequency parasympathetic component
  from 7.3% +/- 3.6% to 18.1% +/- 9.5% after ACEI. Norepinephrine plasma levels
  increased after isometric stress in the placebo group, whereas other hormones did not
  change. ACEI prevented the norepinephrine increase after isometric stress. Thus the
  decrease in cardiac output during isometric exercise in patients with CHF was
  prevented by acute ACEI. The effect of ACE inhibition may be related to reduced
  sympathetic activity
Keywords: ACE/ACE inhibition/ACE-inhibition/activity/acute/analysis/angiotensin
  converting         enzyme/angiotensin-converting        enzyme/autonomic/blood/blood
  pressure/BLOOD-PRESSURE/cardiac/cardiac                        output/COMPARATIVE
  ACCURACY/congestive/congestive                                                     heart
  ailure/FLOW                      VELOCITY/heart/heart                      failure/heart
  DOPPLER/ramipril/rate/SPECTRAL-                            ANALYSIS/stress/STROKE
Wolf, P.A., Benjamin, E.J., Belanger, A.J., Kannel, W.B., Levy, D. and DAgostino, R.B.
  (1996), Secular trends in the prevalence of atrial fibrillation: The framingham study.
  American Heart Journal, 131 (4), 790-795
Keywords:                                                                     atrial/atrial
Karalis, D.G., Quinn, V., Victor, M.F., Ross, J.J., Polansky, M., Spratt, K.A. and
  Chandrasekaran, K. (1996), Risk of catheter-related emboli in patients with
  atherosclerotic debris in the thoracic aorta. American Heart Journal, 131 (6),
Abstract: The aim of this study was to evaluate the risk of performing cardiac
  catheterization or intraaortic balloon pump placement in patients with
  transesophageal echocardiographically detected atherosclerotic aortic debris. cardiac
  catheterization was performed in 70 patients with atherosclerotic aortic debris (in 11
  via the brachial approach and in 59 via the femoral approach) and in 71 control
  patients. An embolic event occurred in 10 (17%) of 59 patients with atherosclerotic
  aortic debris after femoral catheterization compared to 2 (3%) of 71 control patients
  without atherosclerotic aortic debris (p = 0.01). None of the 11 patients with
  atherosclerotic aortic debris who underwent brachial catheterization had an embolic
  event. An intraaortic balloon pump was placed in 10 patients with atherosclerotic
  aortic debris and in 12 control patients. An embolic event related to placement of the
  intraaortic balloon pump occurred in 5 (50%) of 10 patients with atherosclerotic
  aortic debris; no control patient had an embolic event (p = 0.02). Patients with
  mobile atherosclerotic aortic debris were at the highest risk for catheter-related
  embolism. The strongest clinical predictors of atherosclerotic aortic debris were
   advanced age and peripheral vascular disease.Transesophageal echocardiographic
   recognition of atherosclerotic aortic debris identifies patients at high risk of stroke or
   peripheral embolism after cardiac catheterization or intraaortic balloon pump
   placement. If the aortic debris is mobile, the risk is particularly high. When
   atherosclerotic aortic debris is detected, especially if the debris is mobile, substituting
   brachial for femoral catheterization and avoiding placement of an intraaortic balloon
   pump may reduce the risk of embolism
   of          stroke/SOCIETY/stroke/thoracic/transesophageal/TRANSESOPHAGEAL
Stone, D.A., Godard, J., Corretti, M.C., Kittner, S.J., Sample, C., Price, T.R. and
   Plotnick, G.D. (1996), Patent foramen ovale: Association between the degree of
   shunt by contrast transesophageal echocardiography and the risk of future ischemic
   neurologic events. American Heart Journal, 131 (1), 158-161.
Abstract: This study investigated whether there is an association between the degree of
   interatrial shunting across a patent foramen ovate, as determined by saline contrast
   transesophageal echocardiography, and the risk of subsequent systemic embolic
   events, including stroke. Thirty-four patients found to have patent foramen ovate
   during transesophageal echocardiography were divided into two groups on the basis
   of the maximum number of microbubbles in the left heart in any single frame after
   intravenous saline contrast injection: group 1 (n=16) with a ''large'' degree of shunt
   (greater than or equal to 20 microbubbles) and group 2 (n=18) with a ''small'' degree
   of shunt (greater than or equal to 3 but <20 microbubbles). Patients were followed up
   over a mean period of 21 months for subsequent systemic embolic events, including
   transient ischemic attack and stroke. Five (31%) of the patients with large shunts had
   subsequent ischemic neurologic events, whereas none of the patients with small
   shunts had embolic events (p=0.03). These events occurred in spite of antiplatelet or
   anticoagulant therapy. We conclude that patients with a large degree of shunt across
   a patent foramen ovale, as determined by contrast transesophageal echocardiography,
   are at a significantly higher risk for subsequent adverse neurologic events compared
   with patients with a small degree of shunt
Keywords:            anticoagulant          therapy/antiplatelet/ATRIAL             SEPTAL
   PROLAPSE/neurologic/PARADOXICAL                  EMBOLISM/patent/patent           foramen
   echocardiography/transient/transient ischemic attack
Oski, J.A., Canter, C.E., Spray, T.L., Kan, J.S., Cameron, D.E. and Murphy, A.M.
   (1996), Embolic stroke after ligation of the pulmonary artery in patients with
   functional single ventricle. American Heart Journal, 132 (4), 836-840.
Abstract: In the setting of functional single ventricle with pulmonary overcirculation,
   pulmonary artery banding is frequently used to alleviate symptoms and to prepare for
   staged repair. At subsequent cavopulmonary anastomosis or Fontan procedure, the
   pulmonary artery may be ligated at the site of the pulmonary band. This article
   describes the association of embolic stroke and thrombus in a ligated or divided
   pulmonary artery stump in three patients with functional single ventricle. These
   events occurred from 1990 through 1992 among the 1700 inpatient pediatric
   cardiology admissions at two institutions. The patients, ranging in age from 15
   months to 9 years, had cerebral infarctions documented by computed axial
   tomography scan or magnetic resonance imaging associated with the
   echocardiographic finding of thrombus in the proximal pulmonary artery stump after
   the embolic strokes. The strokes occurred 5 days to 5 years after surgery. Two
   patients had a second infarction within 2 to 5 weeks of the initial stroke. It is
   concluded that the presence of the ligated pulmonary artery stump may place patients
   at risk for embolic stroke. Surgical approaches to reduce the risk of thrombus
   formation should be considered prospectively in this patient group
Keywords:                                    age/artery/cardiology/CAVOPULMONARY
   CONNECTION/cerebral/embolic                                             stroke/FONTAN
   OPERATION/formation/functional/HEART/infarction/magnetic resonance/magnetic
   resonance                                     imaging/pediatric/pulmonary/pulmonary
Ishii, M., Jones, M., Shiota, T., Heinrich, R., Yamada, I., Sinclair, B., Yoganathan, A.P.
   and Sahn, D.J. (1996), Evaluation of eccentric aortic regurgitation by color Doppler
   jet and color Doppler-imaged vena contracta measurements: An animal study of
   quantified aortic regurgitation. American Heart Journal, 132 (4), 796-804.
Abstract: To evaluate the utility of measurements of the color Doppler jet area, jet
   length, and width of the color Doppler-imaged vena contracta (the smallest flow
   diameter in any part of the flow acceleration field) as methods for quantifying aortic
   regurgitation (AR), eight sheep with surgically induced AR were studied. AR was
   quantified as peak and mean regurgitant flow rates, regurgitant stroke volumes, and
   regurgitant fractions as determined with pulmonary acid aortic electromagnetic flow
   probes and flowmeters balanced against each other. Simple linear regression analysis
   between the maximal color jet areas, jet length, and flowmeter data showed only
   moderately good correlation (jet area: 0.42 less than or equal to r less than or equal to
   0.57, SEE = 2.85 cm(2); jet length: 0.42 less than or equal to r less than or equal to
   0.59, SEE = 1.23 cm). In contrast, the width of color Doppler-imaged vena contracta
   was a better indicator of the severity of AR on the basis of the electromagnetic
   flowmeter methods (0.73 less than or equal to r less than or equal to 0.90, SEE =
   0.15 cm). Therefore the color Doppler jet length and jet area methods have limited
   use for determining AR, whereas the width of the color Doppler-imaged vena
   contracta can be used for quantifying the severity of AR
Yarzebski, J., Col, N., Pagley, P., Savageau, J., Gore, J. and Goldberg, R. (1996),
   Gender differences and factors associated with the receipt of thrombolytic therapy in
   patients with acute myocardial infarction: A community-wide perspective. American
   Heart Journal, 131 (1), 43-50.
Abstract: In spite of national interest in gender differences in the presentation and
   management of chronic disease, limited information is available about possible
   gender differences in the receipt of thrombolytic therapy after acute myocardial
  infarction (AMI). As part of an ongoing community-based study of AMI, we
  examined gender differences in the receipt of thrombolytic therapy among 2885
  patients with confirmed AMI. The study sample consisted of 1680 males and 1205
  females with validated AMI who were admitted to 16 hospitals in the Worcester,
  Massachusetts, metropolitan area in four study periods between 1986 and 1991.
  During the years under study, 24.4% of men and 14.4% of women received
  thrombolytic therapy. Increases over time in the use of thrombolytic therapy were
  seen in both men (13.9% in 1986; 31.6% in 1991) and women (3.2% in 1986; 19.0%
  in 1991). After controlling for a variety of factors that might affect use of
  thrombolytic agents, younger age, absence of a history of either congestive heart
  failure or stroke, and experiencing a Q-wave AMI were associated with receipt of
  thrombolytic therapy in both men and women; having an anterior AMI also was
  associated with use of thrombolytic agents in men. Women without as compared
  with those with a history of angina pectoris were significantly more likely to receive
  thrombolytics. Men who had Medicare insurance were significantly less likely to
  receive thrombolytics than were men with other types of health insurance. When this
  analysis was restricted to patients who were seen in area-wide hospitals within 6
  hours of the onset of symptoms suggestive of AMI, similar factors were associated
  with the receipt of thrombolytic agents in men and women. The results of this
  community-wide study suggest a marked increase over the 5-year study period in the
  use of thrombolytic therapy in both men and women, with a greater relative increase
  observed in women. A relatively similar profile of patients likely to receive
  thrombolytic therapy was seen in both men and women
Keywords:         acute/acute      myocardial        infarction/age/analysis/angina/angina
  pectoris/BIAS/BYPASS-SURGERY/chronic/chronic disease/congestive/congestive
  heart                                   failure/DISEASE/failure/females/gender/gender
  al/myocardial        infarction/SELECTION/SEX-DIFFERENCES/stroke/SURVIVAL
  RATES/symptoms/TEMPORAL                                  TRENDS/therapy/thrombolytic
  agents/thrombolytic therapy/WOMEN/WORCESTER HEART-ATTACK
Schecter, S.O., Fyfe, B., Pou, R. and Goldman, M.E. (1996), Intramural left atrial
  hematoma complicating mitral annular calcification. American Heart Journal, 132
  (2), 455-457
Keywords: atrial/HEART/STROKE
Marmor, A., Raphael, T., Marmor, M. and Blondheim, D. (1996), Evaluation of
  contractile reserve by dobutamine echocardiography: Noninvasive estimation of the
  severity of heart failure. American Heart Journal, 132 (6), 1195-1201.
Abstract: Functional status in chronic heart failure is evaluated in general by subjective
  means, such as the New York Heart Association class, or by invasive techniques
  difficult to use routinely. The aim of this study was to evaluate noninvasively the
  contractile reserve in cases of heart failure as a means to define the functional status
  of the patients. Cardiac peak power, a new noninvasively obtained
  afterload-independent index of contractility, was calculated from online Doppler and
  central arterial blood pressure estimated noninvasively in 35 patients with heart
  failure and 10 healthy subjects during dobutamine infusion. Cardiac output increased
  in all patients to the same extent, without differentiation among the functional classes.
  Contractile reserve, as assessed by peak power, was found to be a good marker of
  functional class: it was significantly higher in functional class 1 than in functional
  classes 2 through 4. A correlation of r=0.99 and probability of p<0.001 was found
   with the functional status. This new, noninvasive contractility index, peak power,
   allows an objective evaluation of the severity of heart failure
Keywords:       arterial/arterial    blood     pressure/blood/blood      pressure/CANINE
   n/EXERCISE/failure/functional/functional                       status/general/heart/heart
Krum, H., Gu, A.G., WilshireClement, M., SacknerBernstein, J., Goldsmith, R., Medina,
   N., Yushak, M., Miller, M. and Packer, M. (1996), Changes in plasma endothelin-1
   levels reflect clinical response to beta-blockade in chronic heart failure. American
   Heart Journal, 131 (2), 337-341.
Abstract: Plasma levels of endothelin-1 are elevated in patients with chronic heart
   failure; however, it is unknown whether changes in plasma endothelin-1 levels
   accurately reflect clinical response to therapy in these patients. To determine this, we
   measured plasma endothelin-1 in addition to functional, hemodynamic, and other
   neurohormonal parameters as part of a double-blind, placebo-controlled study of the
   p-blocker vasodilator carvedilol in patients with moderate to severe chronic heart
   failure. Patients were assigned (2:1 randomization) to receive carvedilol (25 mg
   twice daily, n = 10) or placebo (n = 5) for 14 weeks, with evaluations made before
   and after therapy. Compared to patients receiving placebo, patients receiving
   carvedilol improved significantly as assessed by the parameters described. These
   changes were paralleled by significant falls in endothelin-1 with carvedilol (-2.1 +
   3.8 pg/ml) in comparison to placebo (2.2 + 3.9 pg/ml; p < 0.05 for between-group
   differences). Changes in endothelin-1 after treatment in both groups correlated
   significantly with changes in symptom ; severity, New York Heart Association class,
   6-minute walk distance (r = 0.64 to 0.80; p < 0.05), hemodynamic parameters
   (ejection fraction, right atrial pressure, pulmonary artery diastolic pressure,
   pulmonary wedge pressure, right atrial pressure, and stroke volume index; r = 0.54 to
   0.86; p < 0.05), and neurohormonal parameters (serum aldosterone and plasma
   norepinephrine (r = 0.74 to 0.76; p < 0.05). By stepwise regression analysis, change
   in endothelin-1 was an independent, noninvasive predictor of functional and
   hemodynamic responses to therapy in these patients. These findings suggest that
   endothelin-l accurately reflects functional, hemodynamic, and neurohormonal
   responses to beta- blocker therapy in patients with congestive heart failure.
   Measurement of endothelin-1 may therefore be a useful, noninvasive approach to the
   evaluation of clinical response to drug therapy in these patients
Keywords:                                       aldosterone/analysis/artery/atrial/beta/beta
   blocker/beta-blockade/chronic/congestive/congestive             heart        failure/drug
   therapy/ejection          fraction/endothelin-1/evaluation/failure/functional/heart/heart
   ary artery/pulmonary wedge pressure/response/SERUM/severity/stroke/stroke
Frishman, W.H., Heiman, M., Karpenos, A., Ooi, W.L., Mitzner, A., Goldkorn, R. and
   Greenberg, S. (1996), Twenty-four-hour ambulatory electrocardiography in elderly
   subjects: Prevalence of various arrhythmias and prognostic implications (report from
   the Bronx longitudinal aging study). American Heart Journal, 132 (2), 297-302.
Abstract: Functional, ambulatory, community-dwelling subjects (n = 423, aged 75 to 85
  years) underwent baseline 24-hour ambulatory electrocardiography (EGG)
  examinations as part of the Bronx Aging Study, a 10-year prospective cohort study
  designed to identify risk factors and disease markers for cardiovascular,
  cerebrovascular, and dementia illnesses in old people. Premature ventricular
  contractions were the most commonly observed arrhythmia noted( 93% of subjects),
  with a low prevalence of nonsustained ventricular tachycardia (5%), paroxysmal
  atrial tachycardia (13%), atrial fibrillation (4%), and atrioventricular blocks (4%). A
  24-hour sinus rate of <60 beats/min was noted in 13% of subjects, and 11% of
  subjects were noted to have transient episodes of severe bradycardia (<40 beats/min).
  In a multivariate analysis, nonsustained ventricular tachycardia was an independent
  predictor of death (p = 0.015; relative risk [RR] 2.8; 95% confidence interval (CI] 1.4
  to 5.8) and myocardial infarction (p = 0.031; RR 3.2; CI 1.2 to 9.4). Transient
  atrioventricular block was an independent predictor of stroke (p = 0.0006; RR 9.7; CI
  3.3 to 28.9), as was sinus bradycardia over a 24-hour period (p = 0.033; RR 2.7; CI
  1.2 to 6.4). Ventricular tachycardia approached significance as an independent
  predictor of multiinfarct dementia (p = 0.052; PR 6.3; CI 1.4 to 28.7). Episodes of
  paroxysmal atrial fibrillation, atrial tachycardia, and severe bradycardia were not
  associated with adverse outcomes. Some arrhythmias found on the ambulatory ECG
  in very old subjects can predict an increased risk for subsequent death, myocardial
  infarction, stroke, and multiinfarct dementia
Keywords:       AGE/aged/aging/ambulatory/analysis/arrhythmia/arrhythmias/atrial/atrial
  HEALTH/cerebrovascular/cohort                   study/community-dwelling/COMPLEX
  VENTRICULAR                                 ARRHYTHMIAS/confidence/CORONARY
  ISEASE/infarction/longitudinal/low/multivariate         analysis/myocardial/myocardial
  infarction/OLDER/outcomes/paroxysmal                                                atrial
  fibrillation/prevalence/prospective/rate/relative                           risk/risk/risk
  factors/stroke/TACHYCARDIA/transient/ventricular tachycardia
Globits, S., Blake, L., Bourne, M., Fujita, N., Duerinckx, A., Szolar, D., Cheitlin, M.
  and Higgins, C.B. (1996), Assessment of hemodynamic effects of
  angiotensin-converting enzyme inhibitor therapy in chronic aortic regurgitation by
  using velocity-encoded cine magnetic resonance imaging. American Heart Journal,
  131 (2), 289-293.
Abstract: Long-term treatment with angiotensin-converting enzyme (ACE) inhibitors
  has beneficial effects in patients with chronic aortic regurgitation by reducing left
  ventricular volumes and regurgitant fraction. Velocity-encoded cine magnetic
  resonance imaging can directly measure antegrade (forward stroke volume) and
  retrograde blood flow (regurgitant volume)in the ascending aorta. Velocity-encoded
  cine magnetic resonance imaging was used in 9 patients with moderate to severe
  aortic regurgitation (regurgitant fraction 49% +/- 17%) to measure regurgitant
  fraction, regurgitant volume, and forward stroke volume at baseline and 3 months
  after therapy with enalapril (mean dose 29 +/- 13 mg). Ten additional patients with
  aortic regurgitation without any drug therapy served as a control group. In the
  treatment group, systolic blood pressure slightly decreased from 132 +/- 20 mm Hg
  to 121 +/- 14 mm Hg (p = not significant), whereas diastolic blood pressure and heart
  rate (beats per minute) remained unchanged. Regurgitant fraction decreased In 6
  patients (responders) from 49% +/- 19% to 39% +/- 20% (percentage change 24%
  +/- 14%, p = 0.002) and was unchanged In 3 patients (nonresponder, 49% +/- 19% vs
  51% +/- 16%; p = not significant). In the responder group, forward stroke volume
  increased from 128 +/- 32 ml to 148 +/- 57 ml, whereas regurgitant volume remained
  unchanged (67 +/- 40 ml vs 65 +/- 51 ml). At baseline, the responder group had a
  significant higher total vascular resistance than the nonresponder group (998 +/- 538
  dyne . sec . cm(-5) vs 625 +/- 214 dyne . sec . cm(-5);p < 0.05). With enalapril
  treatment, total vascular resistance In the responder group tended to decrease (891
  +/- 576 dyne . sec . cm(-5)), but slightly increased in the nonresponder group (679
  +/- 276 dyne . sec . cm(-5)). The control group showed no changes in regurgitant
  fraction, regurgitant volume, forward stroke volume, and total vascular resistance at
Keywords: ACE/angiotensin converting enzyme/angiotensin converting enzyme
  inhibitor/angiotensin-converting                     enzyme/aorta/ascending/ascending
  aorta/ASYMPTOMATIC                      PATIENTS/blood/blood                flow/blood
  pressure/BLOOD-FLOW/chronic/control/diastolic               blood        pressure/drug
  therapy/effects/enalapril/END-SYSTOLIC                      DIMENSION/EXERCISE
  HEMODYNAMICS/flow/follow                                   up/follow-up/HEART/heart
  rate/hemodynamic/inhibitors/INSUFFICIENCY/left                    ventricular/magnetic
  resonance/magnetic                resonance              imaging/measure/NATURAL-
  volume/systolic/systolic         blood         pressure/TERM         VASODILATOR
  resistance/ventricular volumes/VOLUME
Gorcsan, J., Denault, A., Mandarino, W.A. and Pinsky, M.R. (1996), Left ventricular
  pressure-volume relations with transesophageal echocardiographic automated border
  detection: Comparison with conductance-catheter technique. American Heart
  Journal, 131 (3), 544-552.
Abstract: Pressure-volume relations are important means used to assess left ventricular
  (LV) contractility; however, on-line volume acquisition has been limited to the
  invasive conductance catheter. The objective was to compare simultaneous measures
  of LV volume by transesophageal echocardiographic automated border detection
  (ABD) and conductance catheter and their respective pressure-volume relations
  during steady state and alterations in preload and contractility. Seven dogs had
  placement of high- fidelity pressure and conductance catheters, a vena caval balloon
  occluder, and a transesophageal probe. An automated Simpson's rule volume
  algorithm was used from the transverse four-chamber view. Inotropic modulation
  was induced with dobutamine in four dogs and propranolol in three. Relative changes
  in ABD volume were linearly related to conductance volume at steady state with
  group mean r = 0.93 +/- 0.03, standard error of estimate (SEE) = 10 +/- 2%. Changes
  in end- diastolic volume, end-systolic volume, and stroke work with caval occlusion
  were also significantly correlated: r = 0.93 +/- 0.04, SEE = 3.6 mi; r = 0.89 +/- 0.04,
  SEE = 3.8 +/- 1.9 mi; and r = 0.86 +/- 0.05, SEE = 40 +/- 21 mJ, respectively. The
  overall bias was for absolute ABD volume to be less. End- systolic and maximal
  elastance values by ABD were significantly higher than by the conductance method;
  baseline group average 4.97 +/- 0.92 mm Hg/ml versus 2.70 +/- 1.15 mm Hg/ml and
  6.63 +/- 1.66 mm Hg/ml versus 3.20 +/- 1.37 mm Hg/ml (p < 0.05), respectively.
  However, the direction and relative magnitude of changes in elastance with inotropic
  modulation were similar
Keywords:                                                       AREA/balloon/CANINE
Meredith, P.A. (1996), Implications of the links between hypertension and myocardial
  infarction for choice of drug therapy in patients with hypertension. American Heart
  Journal, 132 (1), 222-228.
Abstract: Meta-analyses of major outcome trials have demonstrated that the benefits of
  antihypertensive treatment for reduction of the incidence of stroke are entirely
  consistent with the benefits predicted from epidemiologic data; however, there
  remains a shortfall in the expected reduction of the incidence of coronary heart
  disease, Several explanations have been proffered to account for this shortfall,
  including the potential deleterious metabolic effects of long-term antihypertensive
  treatment; this has led to the speculation that antihypertensive agents with beneficial
  ancillary properties might confer additional significant advantage, However, with the
  exception of the angiotensin-converting enzyme inhibitors, few of these agents have
  translated into clinical benefit for humans. In addition, sound reasons exist to justify
  a focus on maintaining and improving the ''quality'' of blood pressure control,
  Current evidence suggests that optimal benefit is likely to result from the use of
  pharmacologic strategies that lower blood pressure consistently over a 24-hour
  period while at the same time maintaining the ''normal'' circadian pattern of blood
  pressure, This result will only be achieved with drugs and drug regimens that
  genuinely offer long duration of action with the additional potential benefit of
  maintaining a significant blood pressure lowering effect beyond the end of the
  dosage interval, This factor is particularly important because many patients with
  hypertension demonstrate poor adherence to prescribed dosage regimens
Keywords: adherence/angiotensin converting enzyme/angiotensin converting enzyme
  inhibitors/angiotensin-converting          enzyme/angiotensin-converting         enzyme
  inhibitors/antihypertensive agents/antihypertensive treatment/benefits/blood/blood
  coronary heart disease/disease/drug therapy/drugs/effect/effects/HEART/heart
Shimoyama, H., Sabbah, H.N., Rosman, H., Alam, M. and Goldstein, S. (1996), Effect
  of beta-blockade on left atrial contribution to ventricular filling in dogs with
  moderate heart failure. American Heart Journal, 131 (4), 772-777.
Abstract: Abnormal left ventricular (LV) filling has been observed in patients with heart
  failure, One feature of this abnormality is a reduction in the left atrial (LA)
  contribution to filling, a feature that can adversely affect overall LV stroke output, In
  this study we examined the effects of early, long-term monotherapy with the
  beta-blocker, metoprolol, on LA contribution to ventricular filling in dogs with
  moderate heart failure, LV dysfunction (ejection fraction 30% to 40%) was produced
  in 14 dogs by multiple, sequential intracoronary microembolizations, Dogs were
  randomized to 3 months' therapy with metoprolol (25 mg twice daily; n = 7) or to no
  therapy at all (control; n = 7). Mitral inflow velocity was measured before
  randomization and after completion of therapy by using pulsed Doppler
  echocardiography, The percentage of LA contribution to LV filling was calculated as
  the ratio of the time-velocity integral of the LA component of mitral inflow velocity
  (Al) to the time-velocity integral of total diastolic inflow velocity (Ti) times 100, In
  control dogs, the percentage of LA contribution to filling decreased after 3 months of
  follow-up compared with that before randomization (14% +/- 3% vs 23% +/- 5%; p =
  0.02), In contrast, in dogs treated with metoprolol, the percentage of LA contribution
  to filling increased after 3 months of therapy compared with that before
  randomization (26% +/- 3% vs 21% +/- 2%; p = 0.001), Therapy with metoprolol
  produced a decrease in LV end-diastolic pressure, end-diastolic wall stress and
  stiffness, and an increase in LA fractional shortening compared with no therapy at all,
  We conclude that early, long-term therapy with metoprolol improves LA
  contribution to LV filling, This beneficial effect is likely caused by the ability of
  beta- blockers to reduce LA workload and consequently improve LA performance
Keywords: atrial/beta/beta blocker/beta blockers/beta-blockade/beta-blocker/CANINE
  MODEL/completion/control/DIASTOLIC                              FUNCTION/DILATED
  fraction/failure/FLOW VELOCITY PATTERNS/follow up/follow-up/heart/heart
  failure/left            ventricular/performance/PRESSURE/pulsed                Doppler
  cular filling/wall
Yamanouchi, Y., Jaalouk, S., Shehadeh, A.A., Jaeger, F., Goren, H. and FouadTarazi,
  F.M. (1996), Changes in left ventricular volume during head-up tilt in patients with
  vasovagal syncope: An echocardiographic study. American Heart Journal, 131 (1),
Abstract: We tested the hypothesis that patients who have vasovagal syncope during
  head-up tilt have a greater decrease in their left ventricular volume in response to tilt
  than do normal subjects. Measurements were done in the supine position and during
  graded tilt by using two-dimensional echocardiography. We compared seven patients
  with vasovagal syncope with nine normal volunteers. The rate of reduction of
  end-diastolic volume index during tilt was faster in the vasovagal group than in
  normal subjects. A more significant reduction of stroke index and ejection fraction
  during tilt was found in the vasovagal group than in normal subjects, possibly
  because of more peripheral translocation of blood volume in the venous system
  during tilt and an early vagal effect on ventricular contraction
Keywords:        blood/blood         volume/contraction/echocardiography/effect/ejection
  fraction/end-diastolic volume/head-up tilt/HEART/left ventricular/left ventricular
  volume/peripheral/rate/RECEPTORS/response/stroke/stroke                    index/supine
  position/syncope/translocation/ventricular volume/volume/volunteers
Chae, J., Zorowitz, R.D. and Johnston, M.V. (1996), Functional outcome of
  hemorrhagic and nonhemorrhagic stroke patients after in-patient rehabilitation.
  American Journal of Physical Medicine & Rehabilitation, 75 (3), 177-182.
Abstract: Differences in functional prognosis for patients with hemorrhagic and
  nonhemorrhagic strokes are unclear. The purpose of this study is to compare the
  functional outcome of hemorrhagic and nonhemorrhagic stroke patients after
  inpatient stroke rehabilitation. By retrospective review, 25 hemorrhagic stroke
  patients were matched with 25 nonhemorrhagic stroke patients on the basis of age
  and onset to admission interval. Discharge Functional Independence Measure (FIM),
  FIM gain, FIM efficiency, length of stay (LOS), and discharge disposition were
  compared. Admission FIM, gender, and comorbidities were similar between the two
  groups. There were no differences in discharge FIM, FIM gain, and discharge to
  home rates between groups. However, the hemorrhagic group had a significantly
  shorter LOS (31.7 v 37.6 days; P = 0.05) with higher FIM-total efficiency (0.84 v
  0.60; P = 0.02). The FIM-motor scale accounted for most of the gains in efficiency
  (0.71 v 0.53; P = 0.05) with no significant difference in FIM-cognition efficiency
  between groups. Post hoc analysis revealed that onset to admission interval was a
  strong predictor of LOS (r = 0.62; P < 0.0001). Hemorrhagic stroke patients appear
  to exhibit functional gains somewhat faster than nonhemorrhagic counterparts.
  Confirmation of these preliminary findings must await future studies
Keywords:                                                            age/analysis/cerebral
  functional/Functional                   Independence                 Measure/functional
  outcome/gender/hemorrhagic                            stroke/home/INTRACEREBRAL
  HEMORRHAGE/length of stay/outcome/PREDICTION/prognosis/PROGNOSTIC
  VALUE/RECOVERY/rehabilitation/review/stroke/stroke                        patients/stroke
Chatellier, G., DutreyDupagne, C., Vaur, L., Zannad, F., Genes, N., Elkik, F. and
  Menard, J. (1996), Home self blood pressure measurement in general practice - The
  SMART study. American Journal of Hypertension, 9 (7), 644-652.
Abstract: The SMART study (Self-Measurement for the Assessment of the Response to
  Trandolapril) was performed in general practice and enrolled 1710 patients in order
  to assess on a large scale the feasibility and informative value of self-measurement of
  blood pressure at home (SMBP), define home blood pressure (BP) levels in
  comparison to office readings, and determine the number of home measurements
  necessary to provide an accurate and precise BP value. After a 2-week washout
  period, patients with office diastolic blood pressure within the range 95 to 119 mm
  Hg received 2 mg trandolapril once daily in the morning for 4 weeks. Four days of
  SMBP were performed both at the end of the washout period and the end of the
  treatment period, with an automatic printer-equipped oscillometric device (A&D
  UA751). The first day values were not analyzed. Thus, the maximum number of BP
  measurements obtained per patient and per period was 18. Four hundred and
  twenty-four patients (25%) did not perform any measurements. One thousand one
  hundred and nine patients (65%) performed at least 4 measurements. Among them,
  619 (36%) correctly performed all 18 measurements. A preference for digits 0 and 5
  was detected in physicians' measurements (three consecutive values, during a single
  office visit). This digit preference was not found with the semiautomatic device.
  When the number of measurements selected for analysis was increased from 1 to 18,
  in the 604 patients who provided all recordings and fullfilled all protocol criteria, the
  standard deviation of the mean BP of the cohort was reduced by 17% for SEP and by
  23% for DBP. Eighty-five percent of this reduction was already achieved by six
  home measurements taken at random. BP was significantly lower at home than at the
  office by 13 +/- 15 mm Hg for systolic BP (SEP), and 8 +/- 10 mm Hg for diastolic
  BP (DBP). This difference was independent of age, more marked in women (P <.001
  for SEP and P <.05 for DBP), and had a Gaussian distribution. Under treatment,
  office SBP/DBP decreased from 166.4 +/- 14.8/101.4 +/- 5.7 mm Hg to 144.7 +/-
  14.2/86.1 +/- 8.3 mm Hg, while SMBP decreased from 153.2 +/- 17.8/93.8 +/- 10.1
  mm Hg to 139.4 +/- 16.4/85.1 +/- 9.5 mm Hg (all P < .0001). A major aim in
  research studies and individual care is to reduce BP measurements variability. This
  study demonstrates the ability to evaluate baseline SMBP level in two-thirds of
  patients previously unfamiliar with the method, the ability to evaluate treatment
  effect in about one-half of the patients, the improvement in the measurement
  precision obtained with the repetition of measures (at least six home measurements),
  and the absence of bias of SMBP as compared to office measurements
Keywords:      ACCURACY/age/analysis/BIAS/blood/blood              pressure/CORONARY
  HEART-DISEASE/criteria/DEVICES/diastolic                                          blood
  pressure/distribution/effect/general/general          practice/home/home         blood
  office                                                                            blood
  ent                                        of                                     blood
Laster, S.B., Rutherford, B.D., Giorgi, L.V., Shimshak, T.M., McConahay, D.R.,
  Johnson, W.L., Huber, K.C., Ligon, R.W. and Hartzler, G.O. (1996), Results of
  direct percutaneous transluminal coronary angioplasty in octogenarians. American
  Journal of Cardiology, 77 (1), 10-13.
Abstract: Direct percutaneous transluminal coronary angioplasty (PTCA) has emerged
  as effective reperfusion therapy for acute myocardial infarction; however, few data
  exist on its use in octogenarians, Thrombolytic therapy in this age group has reduced
  early mortality from approximately 30% to 20%, but is associated with an increased
  risk of stroke and major hemorrhage. We analyzed the acute and long-term results of
  direct PTCA performed on patients aged greater than or equal to 80 years at our
  institution between 1980 and 1993, The study group consisted of 55 patients (mean
  patient age 83.3 +/- 2.3 years), Infarcts were anterior in 27 patients (49%),
  Cardiogenic shock was present in 6 patients (11%), The mean time to reperfusion
  was 4.3 +/- 2.8 hours, Direct PTCA was successful in 53 patients (96%). There were
  no emergent bypass operations. In-hospital death occurred in 9 patients (16%),
  including 4 of 6 (67%) presenting in cardiogenic shock and 5 of 49 (10%) who were
  hemodynamically stable on presentation, Repeat PTCA for recurrent ischemia was
  performed in 6 patients (11%), There were no strokes during hospitalization,
  Bleeding complications requiring blood transfusion were present in 4 patients (7%).
  Thirty-day mortality was 16% and 1-year actuarial survival was 67%. Direct PTCA
  in patients aged greater than or equal to 80 years can be performed safely with a high
  procedural success rate. The clinical outcome with PTCA in this high risk subset of
  patients compares favorably with that reported previously for both thrombolytic and
  medical therapy
Keywords:               acute/acute              myocardial            infarction/ACUTE
  infarction/NEW-YORK/OLDER/outcome/percutaneous transluminal/percutaneous
  transluminal        coronary       angioplasty/PTCA/rate/reperfusion/risk/risk       of
  stroke/shock/stroke/survival/therapy/THROMBOLYTIC THERAPY
Page, E., Perrault, H., Flore, P., Rossignol, A.M., Pironneau, S., Rocca, C. and
  Aguilaniu, B. (1996), Cardiac output response to dynamic exercise after atrial switch
  repair for transposition of the great arteries. American Journal of Cardiology, 77 (10),
Abstract: Results from this study showed that patients who underwent successful
  operation for transposition of the great arteries had no appropriate increase in stroke
  volume in response to exercise of a nature similar to common recreational activities.
  The impairment, most likely due to disturbances in both venous return and
  ventricular systolic function, is compensated for by an increase in peripheral oxygen
  extraction; however, this increase may not be adequate with maturation or during
  prolonged exercise when cardiovascular constraints are more important
Keywords:                        ARRHYTHMIAS/arteries/atrial/cardiovascular/dynamic
  oke volume/systolic/systolic function/venous return/volume
Chambless, L.E., Shahar, E., Sharrett, A.R., Heiss, G., Wijnberg, L., Paton, C.C., Sorlie,
  P. and Toole, J.F. (1996), Association of transient ischemic attack stroke symptoms
  assessed by standardized questionnaire and algorithm with cerebrovascular risk
  factors and carotid artery wall thickness - The ARIC study, 1987-1989. American
  Journal of Epidemiology, 144 (9), 857-866.
Abstract: The baseline examination (1987-1989) for the Atherosclerosis Risk in
  Communities (ARIC) Study was conducted in 15,792 free- living residents aged
  45-64 years in four geographically dispersed US communities. A questionnaire on
  symptoms of transient ischemic attack (TIA) and stroke was evaluated by computer
  algorithm for 12,205 of these participants. Data were also collected on lipoprotein
  levels, hemostasis, hematology, anthropometry, blood pressure, medical history,
  lifestyle, socioeconomic status, and medication use. Noninvasive high resolution
  B-mode ultrasonographic imaging was used to determine carotid arterial
  intimal-medial wall thickness (IMT). The cross-sectional relation between the
  prevalence of TIA/stroke symptoms and putative risk factors was assessed by logistic
  regression, controlling for age and community. Odds ratios for TIA/stroke symptoms
  were significantly elevated (p less than or equal to 0.01) for diabetes mellitus, current
  smoking, hypertension, lower levels of education, income, and work activity, and
  higher levels of lipoprotein(a), IMT, hemostasis factor VIII, and von Willebrand
  factor. However, the relations with education and carotid IMT were not present for
  black Americans. In whites, the relations of TIA/stroke symptoms to IMT were
  nonlinear. Only at extreme levels of IMT were symptoms substantially more frequent:
  For example, men with an IMT greater than 1.17 mm or women with an IMT greater
  than 0.85 mm had approximately twice the odds of having positive TIA/stroke
  symptoms as those with lower IMTs. The authors plan in future analyses to address
  the issue prospectively, as well as to examine the relation with magnetic resonance
  imaging-defined outcomes and clinically defined incident stroke
Keywords:                     activity/age/aged/arterial/artery/atherosclerosis/blood/blood
  pressure/CARDIOVASCULAR-                  DISEASE/carotid/carotid          artery/cerebral
  ischemia/cerebrovascular/cerebrovascular            disorders/cerebrovascular         risk
  factors/COHORT/COPENHAGEN/coronary                                  disease/CORONARY
  HEART-DISEASE/diabetes/diabetes mellitus/education/EPIDEMIOLOGY/ethnic
  ischemic        attack/ultrasonography/US/von           Willebrand        factor/wall/wall
Bovendeerd, P.H.M., Arts, T., Delhaas, T., Huyghe, J.M., Vancampen, D.H. and
  Reneman, R.S. (1996), Regional wall mechanics in the ischemic left ventricle:
  Numerical modeling and dog experiments. American Journal of Physiology-Heart
  and Circulatory Physiology, 39 (1), H398-H410.
Abstract: The mechanics of the ischemic Left ventricle during a complete cardiac cycle
  were simulated using a finite-element model accounting for the thick-walled
  ventricular geometry, the fibrous nature of the myocardial tissue, and the dependency
  of active muscle fiber stress on time, strain, and strain rate. Ischemia was modeled by
  disabling the generation of active stress in a region comprising similar to 12% of
  total wall volume. In the model simulations, the similar to 12% reduction in the
  amount of normally contracting tissue resulted in an similar to 25% reduction in
  stroke work compared with the normal situation. The more-than-proportional loss of
  stroke work may partly be attributed to storage of elastic energy in the bulging
  ischemic region. Furthermore the mechanical performance in the nonischemic border
  zone deteriorated because of reduced systolic fiber stress (if fibers were in series with
  those in the ischemic region) or reduced fiber shortening (if fibers were parallel). The
  deformation pattern of the ventricle was asymmetric with respect to the ischemic
  region because of the anisotropy of the myocardial tissue. Epicardial fiber shortening
  in and around the ischemic region, as predicted from the model simulations, was in
  qualitative agreement with shortening, as measured in four dogs in which ischemia
  was induced by occlusion of the distal part of the left anterior interventricular
  coronary artery
Keywords:                   ACTIVATION/anisotropy/artery/BLOOD-FLOW/CANINE
  LEFT-VENTRICLE/cardiac/contractile                                work/coronary/coronary
  artery/dog/dogs/EPICARDIAL          DEFORMATION/finite             element/finite-element
  model/INFARCTION/ischemia/ischemic/ischemic border zone/left ventricle/left
  ARDIAL FIBER STRAIN/systolic/total/ventricle/volume/wall
Ouzounian, J.G., Masaki, D.I., Abboud, T.K. and Greenspoon, J.S. (1996), Systemic
  vascular resistance index determined by thoracic electrical bioimpedance predicts the
  risk for maternal hypotension during regional anesthesia for cesarean delivery.
  American Journal of Obstetrics and Gynecology, 174 (3), 1019-1025.
Abstract: OBJECTIVE: Our purpose was to evaluate the predictive value of the baseline
  systemic vascular resistance index for the development of maternal hypotension
  during regional anesthesia for cesarean delivery. STUDY DESIGN: Patients
  receiving a standardized spinal or epidural anesthetic for nonemergency cesarean
  delivery were studied prospectively. Hemodynamic data were obtained
  noninvasively with an NCCOM-3 cardiac output monitor (Borned Medical
  Manufacturing, Irvine, Calif.), which uses thoracic electrical bioimpedance to
  estimate stroke volume and cardiac output. Measurements obtained were indexed to
  body surface area. The systemic vascular resistance index was calculated from mean
  arterial pressure and thoracic electrical bioimpedance-derived cardiac index.
  Hemodynamic data obtained were analyzed to identify statistically significant
  predictors of maternal hypotension. RESULTS: Maternal hypotension occurred in 24
  of 42 (57%) patients studied. The incidence of hypotension did not differ between
  the types of anesthesia: spinal 17 of 27 (62%) versus epidural 7 of 15 (47%, p = 0.48).
  The mean interval to the onset of hypotension was 12.2 minutes (SD 2.2 minutes,
  range 2 to 24 minutes). Mean (SD) baseline maternal systolic blood pressure was
  higher in patients who had hypotension (145 torr [4]) than those who did not (129
  torr [4], p = 0.01). The mean (SD) baseline systemic vascular resistance index was
  higher in patients who had hypotension (633 [SD 36] dyne . cm . sec(-5)/m(2)) than
  those who did not (454 [SD 29] dyne . cm . sec(-5)/m(2); p = 0.001). With
  receiver-operator characteristic curves, a baseline systemic vascular resistance index
  of 500 had a sensitivity of 83%, a specificity of 78%, a positive predictive value of
  83%, and a negative predictive value of 78% for maternal hypotension (odds ratio
  17.5, 95% confidence interval 3.1 to 109.4). A baseline systolic blood pressure of
  140 torr had a sensitivity and specificity of 42% and 72%, respectively (odds ratio
  1.9, 95% confidence interval 0.4 to 8.8). CONCLUSIONS: Baseline systemic
  vascular resistance index obtained by noninvasive cardiac output monitoring with
  thoracic electrical bioimpedance and systolic blood pressure are useful to predict the
  risk for maternal hypotension with regional anesthesia. Patients with increased
  baseline systemic vascular resistance index or systolic blood pressure are at increased
  risk for hypotension
Keywords: anesthesia/anesthetic/arterial/arterial pressure/bioimpedance/blood/blood
  pressure/cardiac/cardiac          index/cardiac        output/CARDIAC            STROKE
  CARDIOGRAPHY/incidence/MATERNAL/maternal                                hypotension/mean
  k/SECTION/sensitivity/spinal/stroke/stroke              volume/systemic           vascular
  resistance/systemic        vascular      resistance     index/systolic/systolic     blood
  pressure/THERMODILUTION/thoracic/vascular/vascular resistance/volume
Bovill, E.G., Bild, D.E., Heiss, G., Kuller, L.H., Lee, M.H., Rock, R. and Wahl, P.W.
  (1996), White blood cell counts in persons aged 65 years or more from the
  cardiovascular health study - Correlations with baseline clinical and demographic
  characteristics. American Journal of Epidemiology, 143 (11), 1107-1115.
Abstract: A higher white blood cell (WBC) count has been shown to be a risk factor for
  myocardial infarction and stroke in middle-aged populations. This study evaluated
  the relation between baseline WBC count and other risk factors, as well as
  subclinical and prevalent disease, in the Cardiovascular Health Study, an
  epidemiologic study of coronary heart disease and stroke in 5,201 persons aged 65
  years or older, Baseline data were collected over a 12-month period in 1989-1990.
  WBC counts were statistically significantly higher in people with prevalent and
  subclinical atherosclerotic cardiovascular disease than in those who were free of
  disease. WBC counts correlated (p < 0.01) positively with coagulation factors,
  measures of glucose metabolism, creatinine, smoking, and triglycerides. In contrast,
  WBC counts correlated negatively with high density lipoprotein cholesterol, forced
  expiratory volume, forced vital capacity, and height. The correlations between WBC
  counts and risk factors were similar in both the entire cohort and the subgroup of
  persons who had never smoked. The authors conclude that WBC counts in the
  elderly are associated with prevalent and subclinical atherosclerotic cardiovascular
  disease, as well as its risk factors
Keywords:                                         aged/ATHEROSCLEROSIS/blood/blood
  cells/cardiovascular/cardiovascular                                 disease/cardiovascular
  diseases/CHOLESTEROL/COAGULATION/coronary/coronary                                   heart
  metabolism/health/heart/heart                      disease/infarction/JUN/LEUKOCYTE
  COUNT/leukocyte                                 count/metabolism/myocardial/myocardial
  factor/risk factors/RISK-FACTORS/SMOKING/stroke/volume
Boult, C., Altmann, M., Gilbertson, D., Yu, C. and Kane, R.L. (1996), Decreasing
   disability in the 21st century: The future effects of controlling six fatal and nonfatal
   conditions. American Journal of Public Health, 86 (10), 1388-1393.
Abstract: Objectives. This study assessed the effects of reducing fatal and nonfatal
   health conditions on the number of functionally limited older Americans in the
   coming decades. Methods. Data from the 1990 census and the Longitudinal Study of
   Aging were used to project the number of functionally limited older Americans from
   2001 to 2049, assuming 1% biennial reductions in five conditions that shorten life
   expectancy (coronary artery disease, stroke, cancer, diabetes, and confusion) and one
   condition that decreases functional ability (arthritis). Results. Decreasing the
   prevalence of arthritis by 1% every 2 years would lead to a much greater reduction in
   functional limitation between 2001 and 2049 (4 million person-years) than would
   decreasing any of the other conditions by the same amount. Decreases in two fatal
   conditions (cancer and coronary artery disease) would lead to increases in functional
   limitation (0.9 and 0.1 million person-years, respectively). Conclusions. Advances
   against common nonfatal disabling conditions would be more effective than
   advances against fatal conditions in blunting the large increase in the functionally
   limited older population anticipated in the 21st century
Keywords: artery/cancer/COMMUNITY/coronary/coronary artery/coronary artery
   LY         PRACTICE/functional/functional           ability/HEALTH/HEALTH-CARE
Blitz, L.R. and Herrmann, H.C. (1996), Hemodynamic assessment of patients with
   low-flow, low-gradient valvular aortic stenosis. American Journal of Cardiology, 78
   (6), 657-661.
Abstract: In aortic stenosis (AS), conventional indexes of severity vary with changes in
   transvalvular flow. it is important to determine the true severity of obstruction
   because AS in the presence of low cardiac output and low gradient is associated with
   high mortality during aortic valve replacement. This study compares 3 indexes of
   stenosis severity at different transvalvular flow rates in patients with low-flow, low-
   gradient critical AS. Eight patients with critical AS (valve area less than or equal to
   0.7 cm(2)), low cardiac output (<4.0 L/min), and low mean transvalvular gradient
   (less than or equal to 40 mm Hg) underwent hemodynamic assessment at baseline,
   after transvalvular flow was augmented with dobutamine, and after the valve opening
   was increased with percutaneous balloon aortic valvuloplasty. Severity of obstruction
   was assessed using 3 different measures: Gorlin formula calculated valve area,
   valvular resistance, and percentage left ventricular stroke work loss. Dobutamine
   infusion increased cardiac output by 35% and mean transvalvular gradient by 27%.
   The mean Gorlin formula calculated aortic valve area increased from 0.5 to 0.6 cm(2)
   (p = 0.002). Percentage left ventricular stroke work loss increased from 23% to 28%
   (p = 0.03). Valve resistance was unchanged by dobutamine (350 to 310 dynes x sec x
   cm(-5); NS). Balloon valvuloplasty increased cardiac output 13% and decreased the
   gradient 31%; this resulted in an increase in the calculated valve area from 0.6 to 0.9
   cm(2) (p = 0.001). Percentage left ventricular stroke work loss decreased from 28%
   to 20% (p = 0.002), and valve resistance decreased from 310 to 181 dynes x sec x
   cm(-5) (p = 0.001) after valvuloplasty. We conclude that in patients with low-flow,
   low-gradient critical AS, valve resistance is the most flow-independent measure of
   severity of stenosis. All measures improve with percutaneous balloon aortic
Keywords:                   aortic                valve/AREA/assessment/cardiac/cardiac
  output/conventional/DOBUTAMINE/ELDERLY                            PATIENTS/GORLIN
  FORMULA/hemodynamic/left                           ventricular                     stroke
  P/SEVERITY/stenosis/stroke/STROKE                    WORK                LOSS/VALVE
Bode, C., Nordt, T.K., Peter, K., Smalling, R.W., Runge, M.S. and Kubler, W. (1996),
  Patency trials with reteplase (r-PA): What do they tell us? American Journal of
  Cardiology, 78 16-19.
Abstract: Thrombolytic therapy has been shown to reduce mortality and morbidity after
  acute myocardial infarction. Therapeutic benefit seems to be directly correlated with
  completeness of reperfusion (Thrombolysis in Myocardial Infarction [TIMI] grade 3
  flow) of the infarct-related coronary artery, as well as the timeliness of reperfusion.
  To determine which regimen of: reteplase (r-PA), a deletion mutant of wild-type
  tissue plasminogen activator (t-PA), is most effective for clinical thrombolysis,
  several reteplase regimens were compared with the most successful standard
  regimens of recombinant t-PA (alteplase) in 2 large-scale, randomized studies, AII
  patients received aspirin and intravenous heparin, In the Reteplase Angiographic
  Phase II International Dose finding Trial (RAPID- 1), results in 606 randomized
  patients showed that a 10 + 10 U double bolus of reteplase was more effective than a
  15 U single bolus, a 10 + 5 double bolus, or conventional alteplase (100 mg over 3
  hours). in the Reteplase versus Alteplase Potency Investigation During Acute
  Myocardial Infarction (RAPID-2) trial, results in 324 patients showed that
  significantly more patients achieved potency of the infarct-related artery (TIMI grade
  2 or 3 flow) at 90 minutes with reteplase (10 + 10 U double bolus) than with
  accelerated alteplase (100 mg over 90 minutes): 83.4% versus 73.3%, respectively (p
  = 0.03). The incidence of complete patency (TIMI grade 3 flow) at 90 minutes was
  likewise greater with reteplase than with accelerated alteplase (59.9% vs 45.2%,
  respectively; p = 0.01). At 60 minutes, the incidence of TIMI grade 2 or 3 flow was
  also significantly higher with reteplase than with alteplase (81.8% vs 66.1%,
  respectively; p = 0.01), as was the incidence of TIMI grade 3 flow (51.2% vs 37.4%,
  respectively; p <0.031). The 35- day mortality rate was 4.1% for reteplase and 8.4%
  for alteplase (p = not significant). Reteplase and alteplase did not differ significantly
  with regard to the occurrence of severe bleeding (12.4% vs 9.7%, respectively) or
  hemorrhagic stroke (1.2% vs 1.9%, respectively), The results of these trials show that
  reteplase, given as a 10 + 10 U double bolus, achieves significantly higher rates of
  early reperfusion of the infarct-related coronary artery and is associated with
  significantly fewer acute coronary interventions when compared with front-loaded
  alteplase. The benefits of reteplase are achieved without any apparent increased risk
  of complications. (C) 1996 by Excerpta Medica, Inc
Keywords:              acute/acute              myocardial             infarction/ACUTE
  artery/CORONARY-ARTERY                                       THROMBOSIS/DOUBLE
  rate/myocardial/myocardial           infarction/NEW-YORK/plasminogen/plasminogen
  OMBOLYSIS/TIMI/tissue                      plasminogen/tissue               plasminogen
Tang, Y.Y. and Rovainen, C.M. (1996), Cardiac output in Xenopus laevis tadpoles
  during development and in response to an adenosine agonist. American Journal of
  Physiology-Regulatory Integrative and Comparative Physiology, 39 (5),
Abstract: We test the hypothesis that the heart and arteries enlarge with increased
  cardiac output (CO) during development and volume overload. Transparent albino
  tadpoles of Xenopus laevis at stages 43-50 were anesthetized in 0.3-0.5 mM
  benzocaine. Areas and radii [maximum and minimum radius (R(max) and R(min),
  respectively)] of the ventricle were measured in digitized video frames during the
  cardiac cycle. Stroke volume (SV) and CO were calculated from R(max) and R(min).
  Maximal velocities of 3.4-mu m fluorescent beads were measured in the aortic arches.
  Arterial pressure was estimated by the Landis method. During normal development,
  the radii of the ventricle and aortic arch diameters increased with lengths of tadpoles,
  and SV (0.7 mu l/g) and CO (70 mu l . g(-1). min(-1)) with wet weights. Volume
  overload       was     induced      by      a    vasodilatory     adenosine      agonist
  5'-N-ethylcarboxamidoadenosine (NECA) in the aquarium water. Acute (0.5-4 h)
  NECA significantly increased R(max) and heart rate. Chronic (>1 wk) NECA
  significantly increased both R(max) and R(min). SV and CO increased more than
  two times, blood pressures decreased, and specific vascular conductances increased
  more than five times. It is concluded that NECA increases CO in Xenopus tadpoles
  through a combination of increased filling and accelerated growth
Keywords:               adenosine/amphibian/anesthetized/aortic              arch/arterial
  diameter/arteries/blood/cardiac/cardiac                           output/cardiovascular
  scaling/CELL/CO/development/growth/heart/heart rate/morphometry/peak flow
  conductance/ventricle/videomicroscopy/volume/volume overload/WASHINGTON
Walker, S.P., Rimm, E.B., Ascherio, A., Kawachi, I., Stampfer, M.J. and Willett, W.C.
  (1996), Body size and fat distribution as predictors of stroke among US men.
  American Journal of Epidemiology, 144 (12), 1143-1150.
Abstract: Evidence for an association between general obesity and risk of stroke is weak.
  However, abdominal obesity may be more closely related to stroke risk. The
  association of body mass index and abdominal obesity (waist/hip ratio) with stroke
  incidence was examined in 28,643 US male health professionals, aged 40-75 years in
  1986, who had no history of cardiovascular disease or stroke. In 5 years of follow-up,
  there were 118 cases of stroke, of which 80 were ischemic. Compared with men in
  the lowest quintile of body mass index, men in the highest quintile had an
  age-adjusted relative risk of stroke of 1.29 (95% confidence interval 0.73-2.27). In
  contrast, the age-adjusted relative risk for extreme quintiles of waist/hip ratio was
  2.33 (95% confidence interval 1.25-4.37). This relative risk was not substantially
  altered in a multivariate model including body mass index, height, and other
  potential risk factors. There was a weaker relation with waist circumference alone,
  with men in the highest quintile (>40.2 inches) having a relative risk of 1.52 (95%
  confidence interval 0.82-2.82) compared with men in the lowest quintile (less than or
  equal to 34.5 inches) (1 inch = 2.54 cm). The results suggest that abdominal obesity,
  but not elevated body mass index, predicts risk of stroke in men
  mass/body                    mass                  index/cardiovascular/cardiovascular
  disorders/confidence/CORONARY                        HEART-DISEASE/DEPENDENT
  /predictors/PROSPECTIVE COHORT/relative risk/risk/risk factors/risk of
  stroke/RISK-FACTORS/stroke/stroke incidence/stroke risk/US/WEIGHT/WOMEN
Katz, R.J., Hsia, J., Walker, P., Jacobs, H. and Kessler, C. (1996), Effects of hormone
  replacement therapy on the circadian pattern of atherothrombotic risk factors.
  American Journal of Cardiology, 78 (8), 876-880.
Abstract: Onset of acute atherothrombotic events (acute myocardial infarction, unstable
  angina, Ischemic stroke) exhibit a circadian pattern that parallels the diurnal pattern
  of endogenous fibrinolytic activity. Hormone replacement therapy in postmenopausal
  women has been shown to enhance fibrinolytic capacity by lowering plasminogen
  activator inhibitor-1 (PAI-I) and tissue plasminogen activator inhibitor (tPA) antigen
  values. We evaluated the impact of 4 weeks of estrogen alone (Premarin 0.625
  mg/day) and 2 weeks of estrogen plus progesterone (Provera 2.5 mg/day) on PAI-1
  and tPA in 17 post; menopausal women at multiple time points to assess hormone
  impact on the diurnal pattern of fibrinolytic potential, At baseline, both PAI-1 and
  tPA exhibited circadian variability, Estrogen alone selectively towered 8 A.M. PAI-I
  (35.8 +/- 7.1 ng/ml at baseline, 19.8 +/- ng/ml on estrogen; p = 0.0002 vs baseline).
  There was no significant change in the noon or 4 P.M. values, and the diurnal pattern
  was attenuated. The 8 A.M. PAI-1 remained low at 17.1 +/- 3.6 ng/ml (p = 0.0001 vs
  baseline) with total loss of the circadian rhythm. Estrogen supplementation reduced
  tPA antigen at all time points, and the diurnal pattern, although blunted, persisted,
  Addition of progesterone to estrogen did not reverse effects of the estrogen-alone
  phase of either PAI-1 or tPA values, This hormone-associated reduction of PAI-1
  was observed despite increased triglycerides, a known inducer of PAI-1 levels. These
  observations suggest that hormone replacement therapy may protect postmenopausal
  women from excess early morning acute ischemic events
Keywords:             activity/acute/acute         myocardial          infarction/ACUTE
  DISEASE/DIURNAL-VARIATION/effects/HEART-                            DISEASE/hormone
  replacement                                             therapy/infarction/INHIBITOR
  activator/progesterone/RAPID INHIBITOR/risk/risk factors/stroke/therapy/tissue
  plasminogen/tissue                       plasminogen                  activator/TISSUE
Chyou, P.H., White, L.R., Yano, K., Sharp, D.S., Burchfiel, C.M., Chen, R., Rodriguez,
  B.L. and Curb, J.D. (1996), Pulmonary function measures as predictors and
  correlates of cognitive functioning in later life. American Journal of Epidemiology,
  143 (8), 750-756.
Abstract: The relation between pulmonary function and cognitive functioning was
  investigated in a cohort of 3,036 Japanese- American men living in Hawaii.
  Pulmonary function, as indicated by forced expiratory volume in 1 second (FEV(1)),
  was measured at the baseline examination from 1965 to 1968. Cognitive function
  was assessed by the Cognitive Abilities Screening Instrument (CASI) test at least 23
  years later (1991-1993). Baseline FEV(1) was significantly correlated with follow-up
  CASI score (r = 0.22, p = 0.0001). Although the strength of the association was
  reduced by controlling for the effects of other factors, stepwise multiple linear
  regression showed that FEV(1) during middle age was a significant predictor of
  CASI in later life, after taking into account the effects of age, education, stroke,
  sedentary job activity, nonmanual occupation, height, generation, and Japanese
  speaking ability. The mean CASI value was significantly greater for men whose
  FEV(1) exceeded 2.8 liter compared with those whose FEV(1) levels were in the
  lowest (<2.5 liters) quartile. Furthermore, the test on the effect of interaction between
  FEV(1) and age was statistically significant (p = 0.0024), with subjects less than 55
  years of age at the baseline examination showing a stronger direct association of
  FEV(1) with CASI than the men aged 55 or older. These findings suggest that
  pulmonary function impairment may be associated with cognitive function
  impairment in later life
Keywords:                                     activity/age/aged/aging/cognition/cognitive
  up/follow-up/forced                                                             expiratory
Vidal, R., Garzuly, F., Budka, H., Lalowski, M., Linke, R.P., Brittig, F., Frangione, B.
  and Wisniewski, T. (1996), Meningocerebrovascular amyloidosis associated with a
  novel transthyretin mis-sense mutation at codon 18 (TTRD18G). American Journal
  of Pathology, 148 (2), 361-366.
Abstract: We describe a novel transthyretin mutation at codon 18 where Asp is replaced
  by Gly (D18G) in a Hungarian kindred, This mutation is associated with
  meningocerebrovascular amyloidosis, producing dementia, ataxia, and spasticity,
  Fifty different transthyretin muttatoo2s are related to amyloid deposition, typically
  producing a peripheral neuropathy or cardiac dysfunction, These symptoms are
  absent in this family. Up to now, amyloid-beta (A beta), cystatin C, and prion
  proteins have been known to be deposited as amyloid in the brain, leading to stroke
  or dementia. With this report we establish that transthyretin amyloid deposition can
  also produce central nervous system dysfunction as the major clinical symptom
  l              nervous               system/dementia/EAST/FIBRIL/mutation/nervous
Childers, M.K., Stacy, M., Cooke, D.L. and Stonnington, H.H. (1996), Comparison of
  two injection techniques using botulinum toxin in spastic hemiplegia. American
  Journal of Physical Medicine & Rehabilitation, 75 (6), 462-469.
Abstract: This study sought to test the hypothesis that injections of botulinum toxin type
  A (BTX-A) at the mid belly of the gastrocnemius muscle in spastic hemiplegic adults
  produce superior clinical results to proximal injections directed toward the muscular
  origin. We designed a randomized, double- blind, placebo-controlled intervention
  study at a university tertiary care setting. Seventeen subjects with chronic spastic
  hemiplegic gait were enrolled from a volunteer community sample; time range from
  acute neurologic insult was 0.75 to 31 yr; age range was 19 to 71 yr; gender
  consisted of 11 men and 4 women; diagnoses were 12 patients with stroke, 2 with
  traumatic brain injuries, and 1 with a brain tumor, Two subjects were withdrawn
  from the study because of (1) acute vascular occlusion before intervention and (2)
  noncompliance with follow-up visits. After baseline measurements, subjects were
  injected with 50 units of BTX-A (volume, 0.5 cc) into the medial or lateral
  gastrocnemius: (1) proximally at one site near the muscular origin; (2) distally at
  three sites along the mid belly. We measured outcome using the Fugl-Meyer score,
  Ashworth scale, ankle range of motion, and a timed 50-ft fastest walk. No outcome
  measures showed a significant effect attributable to site of injections. Confounding
  variables included physical therapy and varying duration of illness in the study
  cohort. We conclude that the results failed to support the hypothesis that BTX-A
  injections at the mid belly of the gastrocnemius produced superior functional
  improvements to injections located near the muscular origin using localization
  techniques described. Additional research comparing more precise localization
  methods for BTX-A injections might Further establish the importance of
  electromyographic guidance using BTX-A in management of spasticity
Keywords: A TOXIN/acute/adults/age/ankle/botulinum toxin/brain/brain injuries/brain
  tumor/CEREBRAL-PALSY/chronic/diagnoses/double-                        blind/effect/follow
  me                      measures/physical                 therapy/research/score/spastic
Chemla, D., Hebert, J.L., Coirault, C., Salmeron, S., Zamani, K. and Lecarpentier, Y.
  (1996), Matching dicrotic notch and mean pulmonary artery pressures: Implications
  for effective arterial elastance. American Journal of Physiology-Heart and
  Circulatory Physiology, 40 (4), H1287-H1295.
Abstract: It has been suggested that pulmonary artery pressure at the end of ejection is
  close to mean pulmonary artery pressure, thus contributing to the optimization of
  external power from the right ventricle. We tested the hypothesis that dicrotic notch
  and mean pulmonary artery pressures could be of similar magnitude in 15 men (50
  +/- 12 yr) referred to our laboratory for diagnostic right and left heart catheterization.
  Beat-to- beat relationships between dicrotic notch and mean pulmonary artery
  pressures were studied 1) at rest over 10 consecutive beats and 2) in 5 patients during
  the Valsalva maneuver (178 beats studied). At rest, there was no difference between
  dicrotic notch and mean pulmonary artery pressures (21.8 +/- 12.0 vs. 21.9 +/- 11.1
  mmHg. There was a strong linear relationship between dicrotic notch and mean
  pressures 1) over the 10 consecutive beats studied in each patient (mean r = 0.93), 2)
  over the 150 resting beats (r = 0.99), and 3) during the Valsalva maneuver in each
  patient (r = 0.98-0.99) and in the overall beats (r = 0.99). The difference between
  dicrotic notch and mean pressures was -0.1 +/- 1.7 mmHg at rest and -1.5 +/- 2.3
  mmHg during the Valsalva maneuver. Substitution of the mean pulmonary artery
  pressure by the dicrotic notch pressure in the standard formula of the pulmonary
  vascular resistance (PVR) resulted in an equation relating linearly end-systolic
  pressure and stroke volume. The slope of this relation had the dimension of a volume
  elastance (in mmHg/ml), a simple estimate of volume elastance being obtained as
  1.06(PVR/T), where T is duration of the cardiac cycle. In conclusion, dicrotic notch
  pressure was of similar magnitude as mean pulmonary artery pressure. These results
  confirmed our primary hypothesis and indicated that human pulmonary artery can be
  treated as if it is an elastic chamber with a volume elastance of 1.06(PVR/T)
Keywords:                            arterial/artery/CANINE                          LEFT-
  artery/pulmonary vascular resistance/relationships/resistance/RESPIRATION/right
  ventricle/stroke/stroke          volume/STROKE              WORK/TIME-VARYING
  ELASTANCE/Valsalva                                         maneuver/vascular/vascular
  resistance/ventricle/ventricular-arterial coupling/volume/VOLUME RELATION
Chin, K., Ohi, M., Kita, H., Noguchi, T., Otsuka, N., Tsuboi, T., Mishima, M. and Kuno,
  K. (1996), Effects of NCPAP therapy on fibrinogen levels in obstructive sleep apnea
  syndrome. American Journal of Respiratory and Critical Care Medicine, 153 (6),
Abstract: In patients with obstructive sleep apnea syndrome (OSAS), the blood
  coagulation system may contribute to an increased risk of cardiovascular events,
  which occur most frequently in the morning. Nasal continuous positive airway
  pressure (NCPAP) treatment can improve the mortality of patients with OSAS. We
  measured the plasma fibrinogen concentration, which is an independent risk factor
  for cardiovascular events, in the afternoon (3:30 P.M.) and the next morning upon
  awakening (8:30 A.M.) in 11 patients with OSAS (apnea and hypopnea index > 20)
  before and after NCPAP therapy. We also measured the hematocrit, the C-reactive
  protein, and the total plasma protein at the same time. The plasma fibrinogen and
  hematocrit levels in the morning (298 +/- 16 mg/dl and 48.5 +/- 1.5%, mean +/- SEM)
  were significantly higher than on the previous afternoon (275 +/- 14 mg/dl and 46.6
  +/- 1.3%) (fibrinogen, p < 0.02; hematocrit, p < 0.005). The whole blood viscosity
  (WBV) at a shear rate of 208 inverse seconds, which can be predicted based on the
  hematocrit and total plasma protein, was also significantly higher in the morning
  (4.98 +/- 0.20/s) than in the afternoon (4.73 +/- 0.17/s) (p < 0.005). These increases
  in the plasma fibrinogen concentration and the WBV in the morning disappeared
  after NCPAP treatment. The attenuation of morning increases in the plasma
  fibrinogen concentration and WBV induced by NCPAP treatment may contribute to
  an overall improvement in the mortality from cardiovascular events in patients with
Keywords:              ACUTE                 MYOCARDIAL-INFARCTION/blood/blood
  INCREASE/MORTALITY/NEW-YORK/obstructive/obstructive                              sleep
  apnea/ONSET/plasma/POSITIVE AIRWAY PRESSURE/pressure/rate/risk/RISK
  FACTOR/sleep/sleep apnea/STROKE/therapy/total/treatment
Nelson, D.L., Konosky, K., Fleharty, K., Webb, R., Newer, K., Hazboun, V.P., Fontane,
  C. and Licht, B.C. (1996), The effects of an occupationally embedded exercise on
  bilaterally assisted supination in persons with hemiplegia. American Journal of
  Occupational Therapy, 50 (8), 639-646.
Abstract: Objectives. Occupationally embedded exercise is a central idea in the
  profession of occupational therapy. This experiment compared the effect of an
  occupationally embedded exercise involving a simple dice game with a rote exercise
  in persons with stroke with pronator spasticity Both exercise conditions involved
  bilaterally assisted supination, consistent with the neurodevelopmental model of
  practice. Methods. The sample consisted of 14 men and 1Z women
  post-cerebrovascular accident with a mean age of 68.4 years (SD = 11.2) at six
  clinical sites in California, Texas, and Michigan. Subjects had pronator spasticity,
  full passive range for supination after a brief warm-up, and no functional supination.
  After random assignment for experimental condition, the subjects engaged in two
  sets of 10 repetitions of bilaterally assisted supination in either the occupationally
  embedded condition (dice game) or the rote condition (no game). A pen recorder
  electronically documented degrees of rotation of the handle that was grasped during
  the exercise. Results. The occupationally embedded exercise resulted in significantly
  more handle rotation (requiring more supination) than the vote exercise, t (24) = 2.28,
  p (one tailed) < .05. The effect size was large. Conclusion. This study advances the
  experimental analysis of therapeutic occupation in the area of occupationally
  embedded exercise. Clinicians are urged to consider the multidimensional nature of
  occupationally embedded exercise
Keywords:                             ADDED-PURPOSE/age/analysis/cerebrovascular
  hemiplegia/IMAGERY-BASED             OCCUPATION/men/model/neurodevelopmental
  therapy/NURSING-HOME                       RESIDENTS/OCCUPATION/occupational
  therapy/PERFORMANCE/PURPOSEFUL                                     ACTIVITY/ROTE
  EXERCISE/SEP/spasticity/stroke/TASK/therapeutic exercise/THERAPY/women
Launer, L.J., Feskens, E.J.M., Kalmijn, S. and Kromhout, D. (1996), Smoking, drinking,
  and thinking - The Zutphen Elderly Study. American Journal of Epidemiology, 143
  (3), 219-227.
Abstract: The authors examine the cross-sectional and longitudinal relation of smoking
  habits and current alcohol intake to cognitive status and decline over a 3-year period
  as well as the extent to which these relations are modified by the presence of clinical
  conditions indicating atherosclerosis (cardiovascular disease(CVD)/diabetes). Data
  are from the cohort of men followed in the longitudinal Zutphen Elderly Study in
  1990 (n = 489) and 1993 (n = 333). Cognitive function was measured in 1990 and
  1993 with the 30-point Mini-Mental State Examination (MMSE). After adjustment
  for age, education, and alcohol intake, current smokers made 20% more errors on the
  MMSE than never smokers in the cross-sectional analyses, Cognitive decline was
  greatest in those with CVD/diabetes who currently smoked and never smoked (-1.9
  and -1.3 points, respectively). After adjustment for age, education, and smoking
  status, men with CVD/diabetes and low-to-moderate alcohol intake had a
  significantly lower risk for poor cognitive function (MMSE less than or equal to 25)
  than abstainers (odds ratios of 0.3 for less than one drink and 0.2 for one to two
  drinks per day). Alcohol intake was not associated with cognitive decline, These
  findings do not support the hypothesis of a protective effect of smoking on cognitive
  function; they suggest that smoking may be harmful among those with CVD/diabetes.
  Alcohol may result in an acute beneficial effect on cognitive function among those
  with CVD/diabetes. However, selection bias and unmeasured confounding should be
  of concern when evaluating these results
Keywords:                 acute/age/aged/alcohol/alcohol                drinking/alcohol
Kurabayashi, H., Kubota, K., Machida, I., Tamura, K. and Shirakura, T. (1996),
  Assessment of upper limb function in hemiplegia by measuring transcutaneous
  oxygen tension. American Journal of Physical Medicine & Rehabilitation, 75 (5),
Abstract: To investigate whether the noninvasive determination of transcutaneous
  oxygen tension (TcO2) can be used to evaluate the degree of hemiplegia, we
  measured TcO2 before and after a 2-mo rehabilitation course in 12 patients with
  hemiplegia caused by cerebrovascular diseases. All patients with no evidence of
  heart failure (ejection fraction evaluated by echocardiogram: 68.7 +/- 6.4%) began to
  receive conventional physical therapy a few days after the onset of stroke. The
  measurement of TcO2 was performed at 9:00 a.m. with an electrode placed on the
  skin surface of the flexion side of the forearm 5 cm distal to the elbow. Before
  rehabilitation, the difference in TcO2 between the paralyzed and healthy upper limbs
  (Delta TcO2) in patients at Brunnstrom's stage V was significantly lower than that in
  patients at stages II, III, and IV (P < 0.05, P < 0.01, and P < 0.01, respectively). After
  rehabilitation, Delta TcO2 in patients at Brunnstrom's stage V was significantly
  lower than that in patients at stage III (P < 0.05). The Delta TcO2 in the patients with
  severe hemiplegia was larger than that in patients with slight hemiplegia. In addition,
  TcO2 at the paralyzed upper limb increased significantly after rehabilitation (before
  62.7 +/- 10.5 mm Hg; after 71.9 +/- 9.0 mm Hg; P < 0.05), although arterial blood
  oxygen tension (PaO2) did not. Therefore, the TcO2 determination may be useful in
  assessing the degree of hemiplegia in upper limbs
Keywords:                        arterial/blood/BRANCH/cerebrovascular/cerebrovascular
  diseases/conventional/diseases/ejection        fraction/elbow/failure/function/heart/heart
  therapy/rehabilitation/STROKE/therapy/transcutaneous oxygen tension/upper
Tomsick, T., Brott, T., Barsan, W., Broderick, J., Haley, E.C., Spilker, J. and Khoury, J.
  (1996), Prognostic value of the hyperdense middle cerebral artery sign and stroke
  scale score before ultraearly thrombolytic therapy. American Journal of
  Neuroradiology, 17 (1), 79-85.
Abstract: PURPOSE: To determine the relationship between the hyperdense middle
  cerebral artery sign (HMCAS) and neurologic deficit, as evidenced by the National
  Institutes of Health (NIH) stroke scale score, and to determine the relationship of the
  HMCAS and the NIH stroke scale score to arteriographic findings after thrombolytic
  therapy. METHODS: Fifty-five patients with acute ischemic stroke were rated on the
  NIH stroke scale, were examined with CT, and were treated with intravenous
  alteplase within 90 minutes of symptom onset. Presence of the HMCAS was
  determined on the baseline CT scan by a neuroradiologist blinded to the patient's
  neurologic deficit. Patients with the HMCAS were compared with those without the
  HMCAS with regard to baseline NIH stroke scale score, 2-hour NIH stroke scale
  score, findings at posttreatment arteriography, 3-month residual neurologic deficit,
  and 3-month ischemia volumes as evidenced on CT scans. RESULTS: Eighteen
  patients (33%) had the HMCAS. These patients had a median baseline NIH stroke
  scale score of 19.5 compared with a median score of 10 for the patients lacking the
  HMCAS sign. At 3 months, one (6%) of the HMCAS- positive patients was
  completely improved neurologically compared with 17 (47%) of the
  HMCAS-negative patients. Restricting analysis to those patients with a stroke scale
  score of 10 or greater (n = 37), 18 HMCAS-positive patients showed less early
  neurologic improvement, were less likely to be completely improved at 3 months,
  and had larger infarcts compared with the 19 HMCAS-negative patients. Compared
  with the HMCAS-positive and HMCAS-negative patients with a stroke scale score of
  10 or greater, patients with a stroke scale score of less than 10 had fewer occlusive
  changes of the internal carotid and middle cerebral arteries on posttreatment
  arteriograms and had a better neurologic recovery at 3 months. CONCLUSION: The
  presence of the HMCAS on CT scans obtained within 90 minutes of stroke onset is
  associated with a major neurologic deficit, and in this study it predicted a poor
  clinical and radiologic outcome after intravenous thrombolytic therapy. However, a
  major neurologic deficit, defined as a stroke scale score of 10 or more, was better
  than a positive HMCAS as a predictor of poor neurologic outcome after thrombolytic
  therapy. Patients with a low stroke scale score (<10) may benefit from ultraearly
  intravenous alteplase therapy
Keywords:                             acute/ACUTE                            ISCHEMIC
  otid/cerebral/cerebral arteries/cerebral artery/COMPUTED-TOMOGRAPHY/CT/CT
  scan/CT scans/EARLY CT- SIGN/INFARCTION/infarction/infarcts/internal/internal
  stroke/low/METHOD/METHODS/middle/middle cerebral arteries/middle cerebral
  stroke             onset/therapy/THROMBOEMBOLISM/thrombolysis/thrombolytic
Tomura, S., Nakamura, Y., Doi, M.Y., Ando, R., Ida, T., Chida, Y., Ootsuka, S.,
  Shinoda, T., Yanagi, H., Tsuchiya, S. and Marumo, F. (1996), Fibrinogen,
  coagulation factor VII, tissue plasminogen activator, plasminogen activator
  inhibitor-1, and lipid as cardiovascular risk factors in chronic hemodialysis and
  continuous ambulatory peritoneal dialysis patients. American Journal of Kidney
  Diseases, 27 (6), 848-854.
Abstract: Mortality rates associated with cardiovascular disease (CVD) are high in
  long-term dialysis patients. Increased levels of plasma fibrinogen (FBG), coagulation
  factor VII (FVII), tissue plasminogen activator (t-PA), and plasminogen activator
  inhibitor-1 (PAI-1) as well as hyperlipidemia are regarded as important risk factors
  for CVD. To investigate whether there are differences in the risk of CVD between
  chronic hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD)
  patients, serum lipid levels and plasma FBG, FVII, t-PA, and PAI-1 levels were
  measured in 17 patients on HD and 17 patients on CAPD. FBG was measured by the
  thrombin time method, FVII activity (FVIIc) by the chromogenic prothrombin time
  method, and t-PA and PAI-1 activity by the chromogenic substrate assay, No
  difference was found in body mass index (BMI) between HD and CAPD patients.
  Total cholesterol (TC), TC/high-density lipoprotein (HDL)-C ratio, low-density
  lipoprotein (LDL)-C, and triglycerides (TG) were significantly increased, and
  HDL-C was significantly decreased in CAPD patients compared with HD patients.
  FBG and FVIIc were significantly elevated in CAPD patients compared with
  controls or HD patients. T-PA activities were significantly higher in HD and CAPD
  patients than in controls. CAPD patients showed significantly higher PAI-1 activities
  than controls or HD patients. Significant positive correlations were found between
  FBG or FVIIc and TC, between FBG and LDL-C or TG, and between FVIIc and
  LDL-C in these patients. T-PA showed significant negative correlations with FBG,
  PAI-1, TC, LDL-C, and TG. There was a significant positive correlation between
  PAI-1 and TG and a significant negative correlation between PAI-1 and HDL-C. We
  conclude that CAPD patients may have a greater risk of CVD than do HD patients,
  and that coagulation and fibrinolytic activity are correlated with lipid disorders in
  these patients. (C) 1996 by the National Kidney Foundation, Inc
Keywords:       ABNORMALITIES/activity/ambulatory/body              mass/body       mass
  index/CAPD/cardiovascular/cardiovascular                        disease/cardiovascular
  risk/cardiovascular                risk             factors/cholesterol/chronic/chronic
  /plasminogen                      activator/prothrombin                    time/risk/risk
  plasminogen/tissue plasminogen activator/triglycerides
Unsworth, C. (1996), Clients' perceptions of discharge housing decisions after stroke
  rehabilitation. American Journal of Occupational Therapy, 50 (3), 207-216.
Abstract: Objective. the purpose of this research was to examine the perceptions of
  older persons with stroke concerning the discharge housing decisions made during
  their rehabilitation program. The research explored clients' locus of control, their
  perceptions of the role of the rehabilitation team and their family in the decision, and
  their perceptions of their activities of daily living skills. Method. Sixty-two subjects
  with stroke completed four measures: (a) the Functional Independence Measure
  (FIM), (b) a housing information questionnaire, (c) a semistructured interview, and
  (d) the Bialer Locus of Control Scale. Rehabilitation team members also completed
  the FIM and housing information questionnaire for each subject. These instruments
  were used to collect data relating to clients' perceptions of their functional status,
  discharge from the hospital, housing options available, and locus of control. Results.
  Despite the team or family opinions on discharge housing, subjects saw housing
  decisions as primarily their own. The majority of subjects were reluctant to consider
  alternatives to returning home, even thought they have self-care deficits and
  frequently reported that the presence of a spouse and family members were important
  to support their return home. Subjects generally seemed unaware of the influence of
  team and family opinions and the impact of their functional status on their discharge
  housing. Subjects' locus of control seemed unrelated to satisfaction with the
  discharge decision process. Conclusion. clients who have had a stroke could use
  assistance to determine housing that is appropriate for their living skills. Discussions
  with clinicians concerning accommodation options may lad to a smoother transition
  from the hospital to longer term housing for clients after stroke
Keywords:            activities          of           daily         living/control/decision
  making/DRIVE/FIM/functional/Functional             Independence       Measure/functional
  esearch/self-care/stroke/stroke rehabilitation/THERAPY
Kronmal, R.A., Smith, V.E., Oleary, D.H., Polak, J.F., Gardin, J.M. and Manolio, T.A.
  (1996), Carotid artery measures are strongly associated with left ventricular mass in
  older adults (A report from the Cardiovascular Health study). American Journal of
  Cardiology, 77 (8), 628-633.
Abstract: Associations of carotid artery diameter and intimal-medial thickness by
  ultrasound with echocardiographic left ventricular (LV) structure were examined in
  3,409 participants in the Cardiovascular Health Study, a population-based study of
  risk factors for coronary heart disease and stroke in men and women aged greater
  than or equal to 65 years, At baseline, sector- guided M-mode echocardiography and
  B-mode ultrasound were used to evaluate the left ventricle and carotid arteries,
  respectively. Common carotid artery diameter and intimal-medial thickness were
  significantly related to LV mass in correlational analysis (r = 0.40 and 0.20,
  respectively, p < 0.01), and each was independently associated with LV mass after
  adjustment for age, gender, weight, systolic and diastolic blood pressure,
  antihypertensive medication use, prior coronary heart disease, electrocardiographic
  abnormalities, high-density lipoprotein, and factor VH. We speculate that changes in
  the arterial wall affect impedance to LV ejection leading to increases in LV mass.
  further follow-up of this cohort is in progress and will help to determine whether
  such carotid artery measures could, by exacerbating LV hypertrophy, constitute
  another important risk factor for adverse cardiovascular outcomes
  /blood/blood           pressure/cardiovascular/carotid/carotid           arteries/carotid
  artery/coronary/coronary             heart            disease/diastolic            blood
  pressure/disease/echocardiography/follow               up/follow-up/gender/heart/heart
  disease/high                                                                      density
  lipoprotein/HYPERTENSION/HYPERTROPHY/impedance/left                        ventricle/left
  ventricular/left                                                              ventricular
  study/POPULATIONS/pressure/PREVALENCE/risk/risk                               factor/risk
Krishnan, K.R.R. and Gadde, K.M. (1996), The pathophysiologic basis for late-life
  depression - Imaging studies of the aging brain. American Journal of Geriatric
  Psychiatry, 4 (4), S22-S33.
Abstract: Available evidence on late-life depression does not support the concept that
  psychological or social factors are the sole contributors. Several studies suggest that
  there is a lower genetic lending to late-onset depression; thus, late-life depression
  may be attributable to other factors, such as cerebrovascular changes. With magnetic
  resonance imaging (MRI), researchers can note, examine subtle cerebrovascular
  changes in the brain. The aging process and related medical illnesses are associated
  with leukoencephalopathy, which includes periventricular hyperintensities and deep
  white-matter hyperintensities (DWMH), also associated with carotid atherosclerosis;
  both characteristics are detectable on MRI scans. Brain MRI studies of older
  depressed patients suggest that cerebrovascular pathology plays a major role in
  etiology, and imaging studies of stroke patients can clarify neuroanatomic substrates
  for the emergence of depression. There is also a correlation between the severity, of
  DWMH and the severity, of myocardial infarction. Other possible etiologies for
  late-life depression include endocrine disorders and the phenotypic apolipoprotein E
  alleles E4/4 and E4/3
Keywords: aging/ALZHEIMERS-DISEASE/apolipoprotein E/APOLIPOPROTEIN-E
  resonance/magnetic                      resonance                      imaging/MAJOR
  infarction/pathology/POSTSTROKE                                                  MOOD
  DISORDERS/psychological/severity/SILENT                                    CEREBRAL
  SIZE/WASHINGTON/white matter/white matter hyperintensities
Kiyosawa, M., Ishii, K., Inoue, C., Kawasaki, T. and Senda, M. (1996), Positron
  emission tomography in diagnosing brainstem vascular lesions that cause abnormal
  eye movements. American Journal of Ophthalmology, 122 (4), 557-567.
Abstract: PURPOSE: To evaluate the efficacy of positron emission tomography (PET)
  in aiding in the diagnosis of brainstem infarctions that cause abnormal eye
  movements. METHOD: Cerebral glucose metabolism was examined by PET with
  F-18- fluorodeoxyglucose as a tracer in five normal control subjects and six patients
  with abnormal eye movements, The PET images were registered to and
  superimposed on magnetic resonance images (MRIs). RESULTS: All control
  subjects showed little asymmetry of glucose metabolism in the brainstem, whereas
  all six patients demonstrated areas of low glucose metabolism in the brainstem,
  Areas of low metabolism seen by PET were wider than they appeared to be by MRI;
  MRIs even appeared normal in some patients, Asymmetry index measurements at the
  level of the ischemic lesion ranged between 19% and 45%. CONCLUSIONS:
  Positron emission tomography detected metabolic abnormality in patients with
  brainstem lesions that caused abnormal eye movements, Superimposing PET images
  on MRIs accurately localized abnormally low metabolism in the brainstem.
  Combined imaging with PET and MRI can be used to diagnose ischemic lesions in
  the brainstem from functional (PET) and morphologic (MRI) viewpoints
Keywords:                 brainstem/Cerebral/CO/control/diagnosis/efficacy/emission/eye
  movements/functional/glucose/glucose                      metabolism/HORIZONTAL
  emission                                       tomography/RESONANCE-IMAGING
Toole, J.F., Lefkowitz, D.S., Chambless, L.E., Wijnberg, L., Paton, C.C. and Heiss, G.
  (1996), Self-reported transient ischemic attack and stroke symptoms: Methods and
  baseline prevalence - The ARIC study, 1987-1989. American Journal of
  Epidemiology, 144 (9), 849-856.
Abstract: As part of the Atherosclerosis Risk in Communities (ARIC) Study assessment
  of the etiology and sequelae of atherosclerosis, a standardized questionnaire on
  transient ischemic attack (TIA) and nonfatal stroke and a computerized diagnostic
  algorithm simulating clinical reasoning were developed and tested at the four ARIC
  field centers: Forsyth County, North Carolina; Minneapolis, Minnesota; Jackson,
  Mississippi; and Washington County, Maryland. The diagnostic algorithm used
  participant responses to a series of questions about six neurologic trigger symptoms
  to identify symptoms of TIA or stroke and their vascular distribution, Among 12,205
  ARIC participants reporting their lifetime occurrence of one or more symptoms
  probably due to cerebrovascular causes, nearly half (47%) reported the sudden onset
  of at least one symptom sometime prior to their ARIC examination, Of those with at
  least one symptom, only 12.9% were classified by the computer algorithm as having
  symptoms of TIA or stroke. Dizziness/loss of balance was the most frequently
  reported symptom (36%); 1.2% of these persons were classified by the algorithm as
  having a TIA/stroke event. Positive symptoms of speech dysfunction were classified
  most often (77%) as being symptoms of TIA or stroke. Symptoms suggesting TIA
  were reported more frequently than symptoms suggesting stroke by both sexes. TIA
  or stroke-like phenomena were more frequent (p < 0.001) in females (7%) than in
  males (5%) and increased with age in both sexes (p = 0.13 for females; p = 0.02 for
  males). In Forsyth County, TIA and stroke symptoms were greater in African
  Americans than in Caucasians (p = 0.05, controlling for sex). The association of
  algorithmically defined symptoms of TIA or stroke with traditional cerebrovascular
  risk factors is the subject of a companion paper
Keywords:                                                                       African
  bral ischemia/cerebrovascular/cerebrovascular disorders/cerebrovascular risk
  factors/sex/stroke/symptoms/TIA/transient/transient                          ischemic
ODonnell, C., Schwartz, A.R., Smith, P.L., Robotham, J.L., Fitzgerald, R.S. and
  Shirahata, M. (1996), Reflex stimulation of renal sympathetic nerve activity and
  blood pressure in response to apnea. American Journal of Respiratory and Critical
  Care Medicine, 154 (6), 1763-1770.
Abstract: The purpose of this study was to examine the role of afferent input in the
  reflex modulation of renal sympathetic nerve activity (SNA) in response to apnea.
  Apneas of 20-, 40-, and 60-s duration were induced in the anesthetized, paralyzed cat
  (n = 7) ventilated with either room air or 100% oxygen. While receiving room air,
  there were increases (p < 0.005) in renal SNA of 34.5 +/- 4.2%, 53.3 +/- 6.4%, and
  59.9 +/- 7.2% of maximum during the 20-, 40-, and 60-s apneas, respectively. There
  were corresponding increases (p < 0.025) in mean arterial pressure (Pal of 9 +/- 3, 30
  +/- 9, and 45 +/- 12 man Hg during the 20-, 40-, and 60-s apneas while receiving
  room air, respectively. The effect of 100% oxygen was to reduce (p < 0.0001) the
  renal SNA response to apnea, at a matched level of Pa-co2, by at least 80%, and to
  eliminate any increase in Pa. During the first breath of the postapneic period, there
  was a partial inhibition of renal SNA. During the second and third breaths of the
  postapneic period, there was a marked fall in renal SNA that was associated with a
  precipitous decline in directly recorded carotid chemoreceptor activity (n = 2). The
  magnitude of the fall in renal SNA after apnea was related to the degree of
  postapneic hypertension. We conclude that hypoxic chemoreceptor stimulation is the
  predominant factor generating the renal SNA response to apnea, with modulating
  inputs from thoracic afferents and arterial baroreceptors likely contributing to the
  marked inhibition of renal SNA immediately after the apnea
Keywords:        activity/afferent    input/ANESTHESIA/anesthetized/arterial/arterial
  VOLUME/sympathetic nerve activity/TERMINATION/thoracic/VOLUNTARY
Kohl, J. (1996), Heat stroke. American Journal of Nursing, 96 (7), 51
Keywords: EAST/stroke/WASHINGTON
Offenbacher, H., Fazekas, F., Schmidt, R., Koch, M., Fazekas, G. and Kapeller, P.
  (1996), MR of cerebral abnormalities concomitant with primary intracerebral
  hematomas. American Journal of Neuroradiology, 17 (3), 573-578.
Abstract: PURPOSE: To determine whether arteriolar vessel wall degeneration in
  primary intracerebral hematomas might be associated with ischemic brain lesions
  and clinically silent (apparently intracerebral) previous hemorrhages. METHODS:
  The MR images of 120 consecutive patients (mean age, 60 years; age range, 22 to 84
  years) with their first stroke caused by a primary intracerebral hematoma were
  reviewed retrospectively for coexisting ischemic damage and previous bleeds.
  RESULTS: Early confluent to confluent white matter hyperintensities, lacunes, or
  infarction were present in 83 (69%) of the patients, and 39 (33%) had had previous
  hemorrhages consisting of microbleeds or old hematomas. Extensive white matter
  hyperintensities and lacunes were most frequent in patients with thalamic primary
  intracerebral hematomas. There was no relationship between the frequency of old
  hemorrhages and the location of subsequent primary intracerebral hematomas,
  CONCLUSION: Clinically silent ischemic lesions and previous hemorrhages are a
  common finding on MR images of patients with primary intracerebral hematoma,
  They may therefore serve as evidence of diffuse microangiopathy with a possible
  increased risk for cerebral hemorrhage
Keywords:      abnormalities/age/AMYLOID           ANGIOPATHY/brain/cerebral/cerebral
  HYPERINTENSITIES/silent/stroke/thalamic/wall/white              matter/white      matter
Cabrera, C.L., Bealer, S.L. and Bohr, D.F. (1996), Central depressor action of nitric
  oxide is deficient in genetic hypertension. American Journal of Hypertension, 9 (3),
Abstract: Inhibition of NO synthase (NOS) in the central nervous system (CNS) causes
  a presser response. This observation indicates that NO is normally produced at a
  CNS site(s) where it has a tonic blood pressure lowering effect. The current study
  tests the hypothesis that a deficient NOS activity in the CNS may contribute to the
  pressure elevation in genetically hypertensive rats. NO administered
  intracerebroventricularly (ICV) caused a greater fall in mean arterial pressure (MAP;
  femoral artery) in hypertensive (SHRSP) than in nor(motensive (WKY) rats, -66.1
  +/- 3.4 mm Hg v -23.7 +/- 3.9 mm Hg, respectively. Yet when endogenous NO was
  increased by stimulating NOS with ICV calcium, the depressor response was less in
  SHRSP than in WKY, 13.7 +/- 1.1 mm Hg v 26.7 +/- 1.9 mm Hg. Likewise, when
  NOS was blocked with N-omega-nitro-L- arginine methyl ester (L-NAME), the
  resultant presser response was less in SHRSP than in WKY,13.8 +/- 1.1 mm Hg v
  22.2 rt 1.1 mm Hg. Blockade of the action of cGMP, a mediator of the action of NO,
  caused a presser response of 6.0 +/- 2.8 mm Hg and 22.6 +/- 8.7 mm Hg (P <.01) in
  the hypertensive and normotensive rats, respectively.,Electrolytic ablation of the
  anteroventral third cerebral ventricle (AV3V) did not alter blood pressure responses
  to NO or to agents that alter NOS activity. We conclude that a deficit in NOS activity
  in some other central cardiovascular regulatory area may contribute to the elevated
  arterial pressure of these genetically hypertensive rats
Keywords: activity/anteroventral third cerebral ventricle (AV3V)/arterial/arterial
  pressure/BLOOD-PRESSURE/calcium/cardiovascular/causes/central                    nervous
  system/cerebral/CNS/cyclic                    guanosine                 monophosphate
  (cGMP)/effect/genetic/genetic                   hypertension/hypertension/hypertensive
  rats/INHIBITION/L-            GLUTAMATE/L-NAME/mean                   arterial/N-omega-
  nitro-L-arginine methyl ester (L-NAME)/nervous system/NEW-YORK/Nitric
  ke-prone        spontaneously      hypertensive      rat/ventricle/VENTROLATERAL
Matthys, D., DeWolf, D. and Verhaaren, H. (1996), Lack of increase in stroke volume
  during exercise in asymptomatic adolescents in sinus rhythm after intraatrial repair
  for simple transposition of the great arteries. American Journal of Cardiology, 78 (5),
Abstract: We studied stroke volume during exercise in 12 male asymptomatic patients
   in sinus rhythm after intraatrial repair for d-transposition of the great arteries. Data
   indicate that during exercise, stroke volume did not increase in the patient group,
   while in control subjects stroke volume increased
Keywords:                                                adolescents/arteries/asymptomatic
   rhythm/STATE/stroke/stroke volume/volume
Trappler, B. and Cohen, C.I. (1996), Using fluoxetine ''very old'' depressed nursing
   home residents. American Journal of Geriatric Psychiatry, 4 (3), 258-262.
Abstract: Data are scarce concerning the utility, of antidepressants among persons age
   75 and over. The authors conducted an open clinical trial of fluoxetine among 29
   patients (mean age = 89 years) with major depressive disorder ([MDD] 62%), major
   depression accompanying Alzheimer's disease (17%), vascular dementia (14%), and
   stroke (7%). At 12 weeks, of the 26 patients who had completed the study, 81% no
   longer had MDD and showed significant declines on the Ham-D and Zung
   depression scales. Nonresponders were more likely to have depression associated
   with a central nervous system disorder (P = 0.002). Side effects were rated as mild
Keywords: age/Alzheimer's disease/ANTIDEPRESSANT/ASSOCIATION/central
   nervous             system/clinical            trial/DEMENTIA/depression/depressive
   TRIAL/effects/EFFICACY/fluoxetine/home/MAJOR                    DEPRESSION/nervous
Oren, S., Gossman, E. and Frohlich, E.D. (1996), Effects of calcium entry blockers on
   distribution of blood volume. American Journal of Hypertension, 9 (7), 628-632.
Abstract: To evaluate the effects on hemodynamics and the distribution of blood
   volume of various calcium entry blocker (CEB) agents, we invasively studied 24
   hypertensive patients before and after treatment with isradipine, diltiazem, and
   verapamil. All three agents reduced arterial pressure through a significant fall in total
   peripheral resistance without causing reflex tachycardia, while preserving stroke
   volume and cardiac output. Verapamil reduced the central blood volume (CBV) and
   the ratio of CBV to total blood volume (TBV) in the supine position (P < .05),
   suggesting peripheral venodilatation. Isradipine and verapamil modified the
   responses to head-up tilt. The orthostatic decrease in stroke volume was accentuated
   following treatment, and it was associated with a greater fall in the ratio of CBV to
   TBV, suggesting that these two agents attenuate the reflex venoconstriction induced
   by postural change. In contrast to verapamil and isradipine, diltiazem did not affect
   volume distribution in the supine or head-up positions. These results suggest that the
   effect of CEBs varies in order of venodilatory effect from verapamil to isradipine to
   diltiazem, with verapamil having the greatest effect
Keywords: ANTAGONISTS/arterial/arterial hypertension/arterial pressure/blood/blood
   volume/calcium/calcium entry blocker/calcium entry blockers/cardiac/cardiac
   output/CARDIAC-                                                OUTPUT/CONGESTIVE
   HYPERTENSION/head-up                                    tilt/hemodynamics/hypertensive
   l/peripheral resistance/pressure/resistance/SCIENCE/stroke/stroke volume/supine
   position/SYSTEM/tachycardia/total/total                                       peripheral
vonKummer, R., Holle, R., Grzyska, U., Hofmann, E., Jansen, O., Petersen, D.,
   Schumacher, M. and Sartor, K. (1996), Interobserver agreement in assessing early
   CT signs of middle cerebral artery infarction. American Journal of Neuroradiology,
   17 (9), 1743-1748.
Abstract: PURPOSE: To assess the reliability of detecting signs of hemispheric
   infarction on CT scans obtained within 6 hours of the onset of symptoms.
   METHODS: A neuroradiologist selected 12 normal and 33 abnormal CT studies
   showing the hyperdense middle cerebral artery sign (HMCAS) (n = 10), brain
   swelling (n = 22), and parenchymal hypodensity (n = 33) from two series of 750
   patients with recent onset of middle cerebral artery stroke, These selections served as
   the reference source for a nonblinded analysis of the initial and follow-up CT scans.
   Six neuroradiologists then reviewed the CT scans twice, first blinded then not
   blinded to clinical symptoms. They assessed the signs of infarction for each
   hemisphere separately and estimated the volume of abnormal parenchymal
   hypodensity in increments of 20% within the territory of the middle cerebral artery.
   RESULTS: Unblinding the reviewers did not change interobserver agreement
   significantly, The chance adjusted agreement was moderate to substantial: kappa
   = .62 (95% confidence interval [Cl],.46 to .78) and kappa = .57 (95% CI, .33 to .81)
   for the HMCAS of the right and left hemisphere, respectively; kappa = .59 (95%
   Cl, .47 to .71) and kappa = .56 (95% Cl, .38 to .74) for focal brain swelling of the
   right and left hemisphere, respectively; and kappa = .58 (95% Cl, .50 to .66) and
   kappa = .55 (95% Cl, .32 to .67) for parenchymal hypodensity of the right and left
   hemisphere, respectively. Weighted kappa was .65 and .57 for the estimation of the
   hypodense tissue volume in the right and left hemisphere, respectively. Agreement
   with the reference source ranged from 73% to 93% for all variables and both
   hemispheres. CONCLUSION: Even with no clinical information, neuroradiologists
   can assess subtle CT signs of cerebral infarction within the first 6 hours of symptom
   onset with to substantial interobserver agreement
Keywords:                                ACUTE                                ISCHEMIC
   STROKE/analysis/arteries/artery/brain/cerebral/cerebral                 artery/cerebral
   infarction/computed tomography/COMPUTED-TOMOGRAPHY/confidence/CT/CT
   scans/focal/follow                                         up/follow-up/INCREASED
   DENSITY/infarction/METHOD/METHODS/middle/middle                                cerebral
Tischler, M.D., Battle, R.W., Ashikaga, T., Niggel, J., Rowen, M. and LeWinter, M.M.
   (1996), Effects of exercise on left ventricular performance determined by
   echocardiography in chronic, severe mitral regurgitation secondary to mitral valve
   prolapse. American Journal of Cardiology, 77 (5), 397-402.
Abstract: Data on the effects of exercise on left ventricular (LV) volumes and ejection
   performance in patients with severe mitral regurgitation (MR) are limited. With use
   of a matched-pairs design, 10 asymptomatic patients with chronic, severe MR and
   normal LV systolic function who were not receiving vasodilator therapy (group 1)
   and 10 matched normal control subjects no structural heart disease (group 2)
   performed symptom-limited upright bicycle ergometry with quantitative
   echocardiographic analysis. An additional 8 patients with severe, chronic MR and
   normal LY systolic function who were receiving vasodilator therapy at the time of
   testing (group 3) were studied for comparison. The 3 cohorts exercised for similar
   periods of time. Group 1 and 3 patients had similar end-diastolic volumes at rest,
   both of which were significantly greater than those of normal controls. Although
  resting LV end-systolic volume was greater in groups 1 and 3 than in normal controls,
  the 3 groups had similar relative percent reductions in end-systolic volume during
  exercise (30 +/- 12%, 32 +/- 13%, and 30 +/- 24%; p = NS). A similar percent
  increase in LV ejection fraction was also observed in all 3 cohorts (18 +/- 9%, 15 +/-
  9%, and 14 +/- 6%; p = NS). Forward stroke volume increased significantly in group
  1 (59 +/- 21 and 71 +/- 18 ml; p < 0.001) and in group 3 (59 +/- 17 and 68 +/- 13 ml;
  p < 0.05). Thus, in asymptomatic patients with chronic, severe MR and normal LV
  ejection fraction at rest, there is an improvement in LV ejection fraction and an
  increase in forward stroke volume during exercise. These effects are comparable to
  those observed in normal controls. Directional differences in the cohort receiving no
  active therapy were indistinguishable from either patients receiving vasodilator
  therapy or normal control subjects
Keywords: AFTERLOAD/analysis/asymptomatic patients/chronic/CONTRACTILE
  fraction/exercise/FRACTION/function/heart/heart        disease/left     ventricular/left
  ventricular performance/mitral regurgitation/mitral valve/MR/NEW-YORK/normal
  volume/systolic/systolic function/testing/therapy/ULTRASOUND/VOLUME
Thompson, J.E., Smith, M., Castillo, M., Barrow, M. and Mukherji, S.K. (1996), MR in
  children with L-carnitine deficiency. American Journal of Neuroradiology, 17 (8),
Abstract: PURPOSE: To describe the MR imaging findings in five children with proved
  L-carnitine deficiency. METHODS: MR imaging studies (five without contrast, two
  with contrast) were obtained in five children (mean age, 9 years) who presented with
  stroke symptoms and who proved to have L-carnitine deficiency as established by
  serum levels. RESULTS: In three of five patients, infarctions were confined to
  arterial distributions; one patient had a hemorrhagic infarction in one frontoparietal
  region; and one patient had only nonspecific periventricular white matter T2
  hyperintensities. Serum L-carnitine levels normalized after correction; sequelae
  included seizures in two patients, hemiparesis in one patient, normal outcome in one
  patient, and death in one patient. CONCLUSION: L-Carnitine deficiency is a rare
  metabolic disorder leading to cerebral infarctions, as seen in our five patients, and
  should be considered in the differential diagnosis of children who have had a stroke,
  particularly when associated with hypoglycemia and myopathy
  osis/diseases/hemiparesis/hemorrhagic infarction/hypoglycemia/infarction/magnetic
  resonance/metabolic        disorders/METABOLISM/METHOD/METHODS/MR/MR
  um/stroke/symptoms/T2/white matter
Kim, S.J., Kline, G. and Gwirtz, P.A. (1996), Limitation of cardiac output by a coronary
  alpha(1)-constrictor tone during exercise in dogs. American Journal of
  Physiology-Heart and Circulatory Physiology, 40 (3), H1125-H1131.
Abstract: This study was performed to examine whether an alpha(1)- constrictor tone,
  which limits coronary functional hyperemia during exercise, imposes a significant
  limitation on global cardiac performance as determined by cardiac output (CO).
  Seven dogs were chronically instrumented to measure left ventricular pressure (LVP),
  maximum rate of rise of LVP (dP/dt(max)), heart rate (HR), mean aortic pressure
  (AoP), circumflex blood flow velocity (CFV), and CO at rest and during submaximal
  exercise. Either the selective alpha(1)-adrenergic antagonist prazosin (0.5 mg) or the
  vasodilator adenosine was administered into the circumflex artery during exercise at
  6.4 kilometers per hour (kph)/16% treadmill incline. Exercise caused significant
  increase in mean AoP, HR, LVP, dP/dt(max,) CFV, stroke volume (SV), and CO,
  whereas systemic vascular resistance (SVR) was significantly reduced. After
  intracoronary alpha(1)-blockade with prazosin, CFV, dP/dt(max), SV, and CO
  increased further (17 +/- 2, 19 +/- 3, 16 +/- 2, and 17 +/- 2%, respectively) without
  changing mean AoP, HR, or SVR. Comparable increases were observed when CFV
  was increased by a similar degree using the direct vasodilator adenosine. These
  results indicate that increasing coronary flow by removing a coronary alpha(1)-
  constrictor tone with prazosin or by direct vasodilation with adenosine during
  submaximal exercise leads to an increase in myocardial oxygen supply and, as a
  result, cardiac pump performance (SV and CO)
Keywords: adenosine/ADRENERGIC-BLOCKADE/alpha-adrenergic receptor/aortic
  pressure/artery/blood/blood                         flow/blood                       flow
  velocity/BLOOD-FLOW/cardiac/cardiac                                        output/cardiac
  performance/CATECHOLAMINES/chronically instrumented dog/CO/CONSCIOUS
  DOG/coronary/coronary         blood     flow/coronary      flow/dogs/exercise/flow/flow
  velocity/functional/heart/heart rate/left ventricular/left ventricular function/left
  oke/stroke        volume/SUBMAXIMAL                 EXERCISE/systemic           vascular
  resistance/vascular/vascular                                    resistance/VASCULAR-
Kuo, T.B.J., Yang, C.C.H. and Chan, S.H.H. (1996), Transfer function analysis of
  ventilatory influence on systemic arterial pressure in the rat. American Journal of
  Physiology-Heart and Circulatory Physiology, 40 (5), H2108-H2115.
Abstract: We evaluated the hypothesis that fluctuations in systemic arterial pressure
  (SAP) are under the influence of the respiratory pumping mechanism subjected to a
  modulatory action by the autonomic nervous system that is exerted primarily on the
  heart. Computer-generated broad-band mechanical ventilation (0-3 Hz) was applied
  to Sprague-Dawley rats that wore anesthetized with ketamine and paralyzed with
  pancuronium. We observed excellent coherence between lung volume and SAP
  signals at ventilatory rates between 0.5 and 2.5 Hz; this coherence was unaffected by
  phentolamine, propranolol, atropine, bilateral vagotomy, or ventilatory stroke
  volume at 2-4 ml. Whereas bilateral vagotomy exerted no discernible effect,
  propranolol elicited a significant frequency-dependent (0.5-1.5 Hz) reduction in the
  magnitude of lung volume-SAP and lung volume-pulse pressure transfer functions.
  There was also a shift toward 0 degrees for the phase of the lung volume-SAP
  transfer function over the same frequency range. We conclude that the
  high-frequency component (0.8-2.4 Hz) of the SAP spectrum may be generated by
  the respiratory pumping mechanism. However, the lower-frequency end of this
  mechanical influence is subjected to additional amplification by the autonomic
  nervous system, in which the beta-adrenergic system played a major role via its
  influence on the heart
Keywords:          analysis/anesthetized/arterial/arterial       pressure/auto-         and
  cross-spectra/autonomic/autonomic               nervous           system/beta-adrenergic
  modulation/bilateral/BLOOD-PRESSURE/broad-band                                mechanical
  E/ketamine/lung/lung volume/LUNG- INFLATION/magnitude and phase of transfer
  function/mechanical                                     ventilation/mechanism/nervous
Brosseau, L., Philippe, P., Potvin, L. and Boulanger, Y.L. (1996), Post-stroke inpatient
  rehabilitation .1. Predicting length of stay. American Journal of Physical Medicine &
  Rehabilitation, 75 (6), 422-430.
Abstract: This study was undertaken to identify Factors predicting stroke inpatient
  rehabilitation length of stay in an acute inpatient rehabilitation program, including
  occupational therapy, physical therapy and speech therapy. A cohort of 152 patients
  suffering from stroke (76 women and 76 men) voluntarily participated in this study.
  They were recruited from a general hospital in which they had received physical
  rehabilitation. The functional status of patients was observed by a physiotherapist,
  using the Functional Independence Measures(SM). The functional status was
  observed on patient admission to rehabilitation and at 1 wk from admission. Past-
  stroke biologic characteristics, including physical, neuropsychological, and clinical
  characteristics, as well as sociodemographic characteristics were also collected. A
  path analysis, using successive multiple linear regressions, was adopted to predict
  length of stay in rehabilitation. Significant predictors of length of stay were age,
  functional status at 1 wk past-rehabilitation admission, perceptual status, and balance
  status. These predictors accounted for 43.6% of the total variance in the
  rehabilitation length of stay. Indirect predictors of length of stay were identified as
  the following: functional status at admission, rehabilitation program, motor status,
  communication problems, and medical complications, Functional, biologic, and
  sociodemographic characteristics should be considered simultaneously in the
  prediction of length of stay as well as for the better understanding of the stroke
  rehabilitation process
Keywords:        acute/ADL/age/analysis/balance/CARE/complications/CONTROLLED
  TRIAL/disability/functional/functional                     assessment/FUNCTIONAL
  STATUS/general/handicap/hospital/independence/INTENSITY/length                       of
  stay/medical                complications/men/motor/neuropsychological/occupational
  therapy/OUTCOMES/PERFORMANCE/physical                     therapy/prediction/predictive
Cardillo, C., DeFelice, F., Campia, U., Musumeci, V. and Folli, G. (1996), Relation of
  stress testing and ambulatory blood pressure to hypertensive cardiac damage.
  American Journal of Hypertension, 9 (2), 162-170.
Abstract: In essential hypertension, the severity of cardiovascular damage is only
  weakly related to clinic blood pressure (BP), whereas a better relationship seems to
  exist with BP recorded during stressful situations. The present study compared BP
  levels measured during laboratory stress testing and 24-h ambulatory monitoring
  with regard to their relationship with cardiac end-organ involvement. BP recorded
  during a mental and a physical challenge and during 24-h ambulatory monitoring
  was related to Doppler echocardiography characteristics of left ventricular structure
  and filling in 63 untreated essential hypertensives and in 32 healthy subjects. In the
  hypertensive group, only a weak relationship was observed between left ventricular
  mass and clinic BP; the strength of this association was not improved by BP
  measured during mental task and cycle ergometry, and was slightly but not
  significantly higher for BP recorded during ambulatory monitoring. In multivariate
  analysis, left ventricular mass was independently predicted by stroke index and 24-h
  systolic BP. Among the different pressure measures, 24-h, daytime, and nighttime
  BPs bore the only significant relation to relative wall thickness. In the normotensive
  group, no significant relationship was observed between left ventricular mass and
  different measures of BP. Doppler indexes of left ventricular diastolic filling did not
  significantly relate to any BP measurement in the hypertensive group, and generally
  bore a significant inverse relationship to various BP recordings in the normotensive
  group. To summarize, stress testing BP does not help in identifying hypertensive
  patients with increased left ventricular mass
Keywords: ambulatory blood pressure/ambulatory monitoring/analysis/arterial
  hypertension/EXERCISE/exercise test/HEART- RATE/hypertension/hypertensive
  patients/left                                       ventricular/LEFT-VENTRICULAR
  ricular mass/wall
Brundin, T., Branstrom, R. and Wahren, J. (1996), Effects of oral vs iv glucose
  administration on splanchnic and extrasplanchnic O-2 uptake and blood flow.
  American Journal of Physiology-Endocrinology and Metabolism, 34 (3), E496-E504.
Abstract: Effects of oral vs. iv glucose administration on splanchnic and extrasplanchnic
  O-2 uptake and blood flow. Am. J. Physiol. 271 (Endocrinol. Metab. 34): E496-E504,
  1996.-The metabolic and circulatory responses to intravenous or oral administration
  of glucose (75 g) were studied in healthy subjects. Pulmonary oxygen uptake
  increased promptly after oral but not during intravenous glucose infusion. The
  average 2-h rise above basal in whole body oxygen uptake was 8 +/- 1% (P < 0.001)
  after oral glucose and 3 +/- 1% (P < 0.05) during intravenous glucose infusion. After
  oral glucose, splanchnic oxygen uptake rose initially by similar to 15% (P < 0.01)
  and then declined; its average 2-h postprandial level was not significantly higher than
  that in the basal state. During intravenous glucose, splanchnic oxygen uptake
  decreased gradually during the first 75 min, reaching a level similar to 25% below
  basal (P < 0.05). Oxygen consumption by extrasplanchnic tissues rose significantly
  and to a similar extent (8%, 2 h average) with both intravenous and oral glucose.
  Splanchnic blood flow increased significantly after oral but not during intravenous
  glucose. It is concluded that 1) intravenous infusion and oral glucose administration
  elicit extrasplanchnic thermogenic effects of similar magnitude, 2) during
  intravenous glucose infusion, the extrasplanchnic thermogenic effect is
  counterbalanced by a simultaneous reduction in splanchnic oxygen uptake, resulting
  in a minimal (3%) net rise in whole body oxygen uptake, and 3) oral glucose
  ingestion but not intravenous glucose infusion increases the splanchnic blood flow
Keywords:        administration/blood/blood       flow/body       heat    content/BODY
  TOSE/gluconeogenesis/glucose/hepatic glucose uptake/HUMAN-LIVER/indirect
  en/oxygen                uptake/PHYSIOLOGICAL/SEP/splanchnic                     insulin
Cappell, M.S. and Iacovone, F.M. (1996), The safety and efficacy of percutaneous
  endoscopic gastrostomy after recent myocardial infarction: A study of 28 patients
  and 40 controls at four university teaching hospitals. American Journal of
  Gastroenterology, 91 (8), 1599-1603.
Abstract: Objectives: To analyze the risks versus benefits of percutaneous endoscopic
  gastrostomy (PEG) performed soon after myocardial infarction. Methods:
  Retrospective review of 28 patients undergoing PEG within 30 days after myocardial
  infarction at four university teaching hospitals for study periods of up to 10 yr. Forty
  controls undergoing PEG were matched for age and sex and had no myocardial
  infarction during the prior 6 months. Results: Indications for PEG were inability to
  eat because of stroke in 13, chronic dependency on mechanically assisted ventilation
  in seven, anoxic encephalopathy in five, dementia in two, and other in one. The mean
  patient age was 72.5 +/- 9.2 (SD) yr. PEG was performed on average 22.3 +/- 6.2
  days after myocardial infarction, Seventeen patients were intubated and were
  receiving mechanically assisted ventilation at the time of PEG, PEG was successfully
  performed in all patients. Study patients suffered two insignificant complications,
  and one significant complication from PEG of bleeding at the gastrostomy site that
  required transfusion of 4 U of packed erythrocytes. Of note, no study patient suffered
  a cardiovascular complication due to PEG. The control complication rate was not
  significantly different (three insignificant and one significant complications, NS,
  Fisher's exact test). PEG feedings in study patients resulted in stabilization of body
  weight and significant improvement of the serum albumin level (from 2.2+/- 0.3
  gm/dl to 2.5+/-0.5 gm/dl, p <0.03, Student's t test). Also the absolute lymphocyte
  count, hematocrit, and serum total protein level tended to improve after PEG. PEG
  contributed to transfer to a rehabilitation center, skilled nursing facility, or home in
  19 study patients (70%; control rate=78%, NS, chi(2)). Conclusions: Recent
  myocardial infarction is not an absolute contraindication to PEG. In this study, the
  benefits exceeded the risks of PEG in medically stable patients. PEG should be
  performed with monitoring by electrocardiography and pulse oximetry in medically
  stable patients. PEG is an elective procedure that should not be performed in highly
  unstable patients
Keywords:                                              6-YEAR/age/albumin/ARTERIAL
Brosseau, L., Potvin, L., Philippe, P. and Boulanger, Y.L. (1996), Post-stroke inpatient
  rehabilitation .2. Predicting discharge disposition. American Journal of Physical
  Medicine & Rehabilitation, 75 (6), 431-436.
Abstract: This study was undertaken to identify indicators that predict discharge
  disposition after an acute stroke rehabilitation program. A cohort of 152 incident
  cases suffering from stroke (76 women and 76 men) voluntarily participated in this
  study. They were recruited from a general hospital in which they were participating
  in a rehabilitation program. Post-stroke biologic, sociodemographic, and
  psychosocial characteristics were considered in our analyses. A polychotomous
  nominal logistic regression analysis was used to predict inpatient rehabilitation
  discharge disposition. The three discharge disposition categories were (1) private
  home, (2) rehabilitation center, and (3) long-term care facility. Significant predictors
  related to the discharge toward a rehabilitation center were functional status at
  admission, presence of social support, and gait status. Significant predictors for
  discharge to a long-term care facility were functional status at admission, presence of
  social support, gait status, and presence of medical complications. Functional status
  measured on rehabilitation admission should be considered, in conjunction with the
  patient's social support, gait status, and presence of medical complications, to be
  predictive of post-stroke rehabilitation discharge disposition
Keywords:             activities           of            daily            living/acute/acute
  status/gait/general/hemiplegia/HOME/hospital/long-term                        care/medical
  complications/men/NEEDS/outcome              and      process       assessment/predictive
  validity/predictors/rehabilitation/self-care/social                  support/stroke/stroke
Kukin, M.L., Kalman, J., Mannino, M., Freudenberger, R., Buchholz, C. and Ocampo,
  O. (1996), Combined alpha-beta blockade (doxazosin plus metoprolol) compared
  with beta blockade alone in chronic congestive heart failure. American Journal of
  Cardiology, 77 (7), 486-491.
Abstract: There has been growing evidence for the benefits of beta blockers, but alpha
  blockers have not shown sustained benefits in chronic congestive heart failure (CHF).
  Thirty patients with moderate to severe CHF (New York Heart Association class II to
  IV) were sequentially assigned to receive metoprolol 6.25 mg with the alpha-1
  antagonist doxazosin 4 mg/day or metoprolol alone. The dose of metoprolol was
  gradually increased to a target dose of 50 mg orally twice daily, Hemodynamic
  measurements were obtained before drug therapy, 2 hours after the first dose of
  combined alpha-beta therapy or metoprolol alone, and after 3 months of continuous
  treatment. Nuclear ejection fraction, plasma norepinephrine, and submaximal and
  maximal exercise capacity were also measured before and after chronic therapy.
  With initial combined drug administration, mean arterial pressure, left ventricular
  filling pressure, and systemic vascular resistance decreased significantly compared
  with results after metoprolol alone. However, after 3 months of continuous therapy,
  both treatment groups showed similar and significant reductions in systemic vascular
  resistance and heart rate, with significant increases in cardiac index, stroke volume
  index, stroke work index, ejection fraction, and exercise capacity. Furthermore, the
  next dose of chronic combined medication no longer showed vasodilating effects.
  Chronic therapy with fixed-dose doxazosin and increasing doses of metoprolol
  produced identical effects as those seen in patients receiving metoprolol alone
Keywords:                   administration/ADRENERGIC-BLOCKADE/arterial/arterial
  pressure/benefits/beta/beta       blockers/beta-blockade/beta-blockers/cardiac/cardiac
  index/chronic/congestive/congestive                 heart               failure/DILATED
  CARDIOMYOPATHY/DOUBLE-BLIND/doxazosin/drug therapy/effects/ejection
  fraction/exercise/exercise            capacity/failure/heart/heart            failure/heart
  rate/HEMODYNAMICS/HYPERTENSION/IV/left                                ventricular/maximal
  exercise/mean                                                 arterial/measurements/New
  BLOCKADE/resistance/stroke/stroke volume/stroke work/systemic vascular
  resistance/therapy/treatment/vascular/vascular               resistance/VASODILATOR
  THERAPY/ventricular filling/volume/work
Carlson, M., Fanchiang, S.P., Zenke, R. and Clark, F. (1996), A meta-analysis of the
  effectiveness of occupational therapy for older persons. American Journal of
  Occupational Therapy, 50 (2), 89-98.
Abstract: Given the current health care debate, it is imperative to document the
  usefulness of various health services for older persons, a rapidly growing population
  at increased risk for a wide variety of physical and functional impairments. A meta-
  analysis was conducted to examine the degree of effectiveness of occupational
  therapy for older persons. For a sample of 15 distinct tests of occupational therapy, a
  positive unweighted mean effect size of .51 (.54 when corrected for instrument
  unreliability) was obtained along with a highly significant cumulative result for
  treatment success (p < .001). Beneficial treatment effects extended to activities of
  daily living- functional and psychosocial outcomes. The results for physical
  outcomes suggested a beneficial effect, although not every meta-analytic test yielded
  significant results. It was concluded that factors such as publication bids or poor
  study design are incapable of accounting for the positive meta- analytic result and
  that occupational therapy represents a worthwhile treatment option for older persons
Keywords:         activities      of          daily     living/ACUTE            STROKE
  /health       care/meta-analysis/OCCUPATION/occupational               therapy/outcome
Kato, H., Nakanishi, M., Maekawa, N., Ohnishi, T. and Yamamoto, M. (1996),
  Evaluation of left atrial appendage stasis in patients with atrial fibrillation using
  transesophageal echocardiography with an intravenous albumin-contrast agent.
  American Journal of Cardiology, 78 (3), 365-369
Keywords:                       atrial/atrial                     fibrillation/CLINICAL
  enous/left                    atrial                    appendage/MITRAL-VALVE
  DISEASE/NEW-YORK/SPONTANEOUS                                                    ECHO
  RISK/THROMBUS/transesophageal/transesophageal echocardiography
Schneider, L.B., Libman, R.B. and Kanner, R. (1996), Utility of repeat brain imaging in
  stroke. American Journal of Neuroradiology, 17 (7), 1259-1263.
Abstract: PURPOSE: To determine the utility of repeat brain imaging in patients with
  stroke. METHODS: We reviewed the medical records of 98 consecutive patients in
  whom stroke was diagnosed between January 1 and December 31, 1991. We noted
  the number of brain scans performed, the indications cited, and whether repeat
  imaging changed the therapeutic decisions or final diagnosis. RESULTS:
  Ninety-eight patients underwent 221 procedures, with 123 repeat imaging studies (98
  CT scans and 25 MR images), Sixteen patients had only one scan; 51 had two, and
  31 had three or more. Indications for repeat imaging were explicitly documented in
  62 (50%) of 123 repeated scans and inferred in another 41 (33%). In 20 (16%), no
  definite indication could be determined. Indications included lack of acute abnormal
  imaging findings on the initial scan (n = 48, 39%); compliance with stroke research
  protocol (n = 24, 20%); lack of correlation between clinical examination and initial
  radiologic findings or concern that tumor was mimicking infarction (n = 20, 16%);
  and neurologic deterioration (n = 11, 9%), In none of the 82 patients did the repeated
  scan change the diagnosis; therapy was changed in only two (2%) of 82 patients
  (aspirin was discontinued). CONCLUSIONS: Repeat imaging in patients rarely
  results in changes in the initial diagnosis or the therapeutic plan; indications for
  repeat imaging are frequently not clearly stated; in certain groups of patients with
  stroke, repeat imaging may not be useful
Keywords:         acute/aspirin/brain/CEREBROVASCULAR-                 DISEASE/clinical
  scans/diagnosis/efficacy                 studies/infarction/INFARCTION/ISCHEMIC
  STROKE/LONG/magnetic resonance/MAGNETIC-RESONANCE/medical/medical
Schneider, B., Zienkiewicz, T., Jansen, V., Hofmann, T., Noltenius, H. and Meinertz, T.
  (1996), Diagnosis of patent foramen ovale by transesophageal echocardiography and
  correlation with autopsy findings. American Journal of Cardiology, 77 (14),
Abstract: Transesophageal echocardiography (TEE) is accepted as the method of choice
  for the diagnosis of a patent foramen ovale (PFO). However, direct anatomic
  confirmation regarding the presence or absence of a PFO on transesophageal imaging
  has been obtained in only a limited number of patients. Consequently, this study was
  performed to assess the diagnostic accuracy of contrast and color Doppler TEE for
  detection of a PFO by comparing the results of TEE with autopsy. The study
  population comprised 35 consecutive patients (mean age 64 +/- 14 years) who
  underwent autopsy and prior TEE with examination of the atrial septum. For
  diagnosis of a PFO, the following criteria were used: (1) no defect in the continuity
  of the atrial septum on 2-dimensional imaging; (2) greater than or equal to 1 bright
  microbubble appearing in the left atrium within 3 heart cycles after opacification of
  tile right atrium during contrast TEE; and (3) turbulent color jet within the atrial
  septum by color Doppler TEE. For estimating the PFO size, positive contrast studies
  were graded semiquantitatively (from 1 to 3), and the maximal color Doppler jet
  width was measured within the atrial septum at the area of maximal turbulence. At
  autopsy, a PFO was present in 9 of 35 patients (26%). All were correctly diagnosed
  by color Doppler TEE. The color Doppler jet width correlated well with the PFO
  diameter determined at autopsy (r = 0.99, SEE = 0.51 mm, p < 0.0001). By contrast
  TEE, 8 of the 9 patients with autopsy-proven PFO were correctly identified. In 1 case
  with left heart disease and a long interatrial channel, a PFO was missed by contrast
  TEE but clearly demonstrated by color Doppler TEE. All patients with a PFO
  diameter >10 mm showed intense left atrial opacification of grade 3. With both
  methods, there were no false-positive results. Sensitivity and specificity for diagnosis
  of a PFO were 89% and 100%, respectively, for contrast TEE, and both 100% for
  color Doppler TEE. Thus, contrast and color Doppler TEE are complementary and
  represent a highly sensitive and specific method for diagnosis of a PFO and for
  estimation of the PFO size
Keywords:                     accuracy/AGE/atrial/ATRIAL                         SEPTAL
  ovale/HEART/heart               disease/JUN/methods/NEW-YORK/PARADOXICAL
  EMBOLISM/patent/patent                                                          foramen
  ovale/RISK/SHUNTS/specific/transesophageal/transesophageal echocardiography
Hata, T., Ryukoh, K., Fujiwaki, R., Hata, K., Kitao, M. and Matsumura, S. (1996),
  Effect of dehydroepiandrosterone sulfate on maternal cardiac function in term
  pregnancy. American Journal of Perinatology, 13 (1), 11-13.
Abstract: To search for possible effect of dehydroepiandrosterone sulfate (DHAS) on
  maternal cardiac function in term pregnancy, impedance cardiographic assessments
   were made on 15 normal full-term pregnant women before acid 5, 10, 15, 20, 25, and
   30 minutes after the administration of a 200 mg intravenous dose of DHAS in 20 mL
   of 5% dextrose. The cardiac output, stroke volume, heart rate, and mean arterial
   pressure were recorded. Maternal cardiac output increased from baseline by 20% (p
   < 0.05) after 15 minutes and the mean increase in stroke volume was 25% (p < 0.05)
   after 15 minutes. No change was found in heart rate or mean arterial blood pressure.
   DHAS induces a significant increase in both maternal stroke volume and cardiac
   output without change in heart rate or mean arterial pressure, which suggests a
   possible increase in cardiac contractility in term pregnancy
Keywords: administration/arterial/arterial blood pressure/arterial pressure/blood/blood
   pressure/cardiac/cardiac               contractility/cardiac              function/cardiac
   output/contractility/dehydroepiandrosterone             sulfate/effect/function/heart/heart
   rate/impedance/impedance                                  cardiography/intravenous/mean
   volume/term pregnancy/volume/women
Fraser, G.E., Singh, P.N. and Bennett, H. (1996), Variables associated with cognitive
   function in elderly California Seventh-day Adventists. American Journal of
   Epidemiology, 143 (12), 1181-1190.
Abstract: From a cohort of white, non-Hispanic California Seventh-day Adventists, 99
   subjects over age 75 years in 1991 were randomly selected. Dietary habits and
   educational status had been measured in 1976. Subjects completed the Mini-Mental
   State Examination (MMSE) in 1991, and at that time, they or caregivers also gave
   information on current medical problems and drug therapy. Those who ate more
   calories in 1976 had lower MMSE scores in 1991 (p = 0.03), an association
   strengthened by excluding those with previous stroke or Parkinson's disease by 1991.
   This raises the possibility that higher consumption of calories in middle age may
   accelerate the decline in cognitive function seen with aging, as apparently occurs in
   some animals. Less-educated subjects had lower MMSE scores, especially among
   the very elderly. The statistical model predicts that the negative association between
   use of psychotropic drugs and MMSE score (p = 0.004) is particularly potent in those
   cognitively impaired for other reasons. If causal, this suggests that physicians should
   use these agents very cautiously in such subjects
Keywords:                                                                         ADVERSE
   intake/cognitive                           function/DEMENTIA/dementia/disease/drug
   disease/psychotropic                                                          drugs/RISK-
   FACTORS/score/scores/SCREENING-TEST/Seventh-day                     Adventists/SPATIAL
Rockman, C.B., Riles, T.S., Fisher, F.S., Adelman, M.A. and Lamparello, P.J. (1996),
   The surgical management of carotid artery stenosis in patients with previous neck
   irradiation. American Journal of Surgery, 172 (2), 191-195.
Abstract: BACKGROUND: A history of therapeutic irradiation to the neck complicates
   the management of carotid artery occlusive disease, Serious surgical concerns are
   raised regarding alternative incisions, difficult dissections, and adequate wound
   closure. Pathology may be typical atherosclerotic occlusive disease or
   radiation-induced arteritis, In order to establish guidelines for the treatment of these
   patients, we have reviewed our operative experience. PATIENTS AND METHODS:
  A review of our operative experience over the past 15 years revealed 10 patients with
  a history of prior irradiation to the neck who underwent 14 carotid operations.
  RESULTS: The indications for radiation included laryngeal carcinoma and
  lymphoma, Five patients had undergone previous radical neck dissections, and four
  patients had permanent tracheostomies. The surgical indications were asymptomatic
  high-grade stenosis in 7 cases, transient ischemic attack in 4 cases, stroke in 2 cases,
  and a pseudoaneurysm in 1 case, Conventional carotid endarterectomy with patch
  angioplasty was used in 10 of the 14 operations, In the remaining four operations,
  saphenous vein interposition grafting was utilized to replace the diseased segment of
  carotid artery secondary to a panarteritis, Wound closure required dermal grafting in
  two of five cases where surgery was performed ipsilateral to a prior radical neck
  dissection, One perioperative cerebral infarction occurred; there were no other
  neurologic or non-neurologic complications, All patients are doing well in one- to
  five-year follow-up, with serial postoperative duplex scans demonstrating no signs of
  recurrent stenosis. CONCLUSIONS: Patients with a history of irradiation to the neck
  should be screened for the presence of carotid disease. Carotid occlusive disease
  should be treated surgically in these patients with the usual indications.
  Intraoperative surgical management is similar to that of non-irradiated patients.
  Concerns about difficulty in achieving an adequate endarterectomy plane and about
  problems with wound closure have generally been unfounded
Keywords:              angioplasty/arteritis/artery/ATHEROSCLEROSIS/carotid/carotid
  artery/carotid      artery      stenosis/carotid      endarterectomy/cerebral/cerebral
  infarction/CO/complications/DELAYED                            CEREBROVASCULAR
  AL                         CERVICAL                              IRRADIATION/follow
  ke/surgery/THERAPEUTIC               RADIATION/transient/transient             ischemic
Hames, C.G., Greenlund, K.J. and Berenson, G.S. (1996), Ethnicity and cardiovascular
  disease: The Evans County heart study. American Journal of the Medical Sciences,
  311 (3), 130-134.
Abstract: A long-term study of diversity between two ethnic groups was developed in
  Evans County, Georgia. The findings are predicated on the genotypic-phenotypic
  interactions, with the multitude of environmental factors. The genetic environmental
  interaction ultimately determines the individual's state of health or disease. For
  example, coronary heart disease prevalence and incidence rates were extremely low
  for blacks in Africa and four times lower than whites in rural South Georgia in the
  1960s, Excessive hypertension and diabetes mellitus, and greater cerebrovascular
  disease mortality in black men, is now well known. Blood pressure levels studied in
  rural Africa were normal and did not rise with age, whereas blacks, conversely,
  demonstrated twice as much hypertension in South Georgia as whites and
  demonstrated an inverse relation between education and blood pressure (ie, the lower
  the education the higher the blood pressure). Cultural adaptation has accelerated
  hypertensive disease and strokes in blacks, while there remains an excess of
  atherosclerotic coronary heart disease in white men. Secular trends suggest that
  coronary heart disease is decreasing among white men but may be increasing in
  black men. Studies of ethnicity and biracial populations provide important
  cardiovascular disease associations with clinical risk factor studies
Keywords:         Africa/age/BLACK-WHITE                DIFFERENCES/blacks/blood/blood
   disease/CHOLESTEROL/CIGARETTE-SMOKING/coronary/coronary                              heart
   disease/diabetes/diabetes                        mellitus/disease/EAST/education/ethnic
   TALITY/pressure/prevalence/RACIAL-                              DIFFERENCES/risk/risk
Fritsche, R. and Burggren, W. (1996), Development of cardiovascular responses to
   hypoxia in larvae of the frog Xenopus laevis. American Journal of
   Physiology-Regulatory Integrative and Comparative Physiology, 40 (4), R912-R917.
Abstract: Cardiovascular responses (blood pressure, heart rate, stroke volume, cardiac
   output, and peripheral vascular resistance) to acute hypoxia (PO2 = 70 mmHg) in
   developing larvae of Xenopus laevis from Nieuwkoop-Faber (NF) stage 45 and up to
   newly metamorphosed froglets were investigated. The results revealed two distinct
   response patterns to acute hypoxia in ''early'' (NF stages 45-48 and 49-51) and ''late''
   (NF stages 52-53, 54- 57, and 58-62) larval Xenopus. The early larvae responded to
   acute hypoxia with a significantly decreased strobe volume, cardiac output; and
   blood pressure. Peripheral resistance increased, whereas no change in heart rate
   occurred. In late larvae, stroke volume and blood pressure increased during acute
   hypoxia, but an offsetting bradycardia prevented major changes in cardiac output.
   We conclude that, up to stage 51 of development, hypoxia exerts a direct inhibitory
   effect on the heart and smooth muscle of the blood vessels, with no Frank- Starling
   relationship apparent. Older larvae show evidence of both intrinsic and extrinsic
   regulation of the cardiovascular system in response to acute hypoxia, suggesting that
   there is a specific point in larval development when cardiovascular regulation during
   hypoxia is expressed
Keywords:           ACETYLCHOLINE/acute/AQUATIC                      HYPOXIA/blood/blood
   pressure/blood                        vessels/bradycardia/BULLFROGS/cardiac/cardiac
   output/cardiovascular/cardiovascular                            regulation/cardiovascular
   PHYSIOLOGY/response/SCI/smooth/smooth                       muscle/specific/stroke/stroke
   volume/vascular/vascular resistance/VERTEBRATES/volume
Zorowitz, R.D., Hughes, M.B., Idank, D., Ikai, T. and Johnston, M.V. (1996), Shoulder
   pain and subluxation after stroke: Correlation or coincidence? American Journal of
   Occupational Therapy, 50 (3), 194-201.
Abstract: Objective. Few studies have concomitantly examined shoulder subluxation
   and other potential causes of shoulder pain in persons who have had a stroke. This
   study explores whether shoulder pain after stroke is related to shoulder subluxation,
   age, limitations in shoulder range of motion, and upper extremity motor impairment.
   Method. Shoulder pain was measured with a visual analog scale in 20 subjects
   admitted to a rehabilitation hospital within 6 weeks of onset of their first stroke.
   Degree of shoulder pain was correlated with vertical, horizontal, and total
   asymmetries of glenohumeral subluxation; age; shoulder flexion, abduction, and
   external rotation; and the upper extremity subscore of the Fugl-Meyer Motor
   Assessment. Results. Shoulder pain after stroke was not correlated with age (r(k)
   = .019, p = .916); vertical (r(k) = .081, p = .324), horizontal (r(k) = .126, p = .241), or
   total asymmetry (r(k) = -.098, p = .288); shoulder flexion (r(k) = .049, p = .390) or
   abduction (r(k) = -.074, p = .337); or Fugl- Meyer scores (r(k) = -.123, p = .257). In
   contrast, shoulder pain was strongly correlated with degree of shoulder external
   rotation (r(k) = -.457, p = .006). Conclusion. These results do not support a strong
   relationship between shoulder subluxation and pain after stroke. Appropriate
   precautions should be taken to prevent range of motion limitations that may result in
   shoulder pain
Keywords:                                            age/asymmetry/causes/cerebrovascular
   dislocation/stroke/THERAPY/total/upper/upper extremity/visual
Ricotta, J.J. and DeWeese, J.A. (1996), Is routine carotid ultrasound surveillance after
   carotid endarterectomy worthwhile? American Journal of Surgery, 172 (2), 140-142.
Abstract: BACKGROUND: Periodic ultrasound studies are routinely performed after
   carotid endarterectomy with the aim of detecting recurrent stenosis or progression of
   contralateral disease, The frequency with which these studies should be performed
   and their clinical utility is at present unclear. Our experience with ultrasound
   surveillance after carotid endarterectomy was reviewed. METHODS: We performed
   a retrospective analysis of our carotid registry as a follow-up on patients who had
   undergone primary endarterectomy between 1982 and 1995. The database was
   searched for events referable to the contralateral carotid artery including incidence of
   contralateral endarterectomy, progression of contralateral stenosis, and development
   of new neurologic symptoms, Data was analyzed by life-table methodology.
   RESULTS: A total of 562 patients underwent 660 endarterectomies during the study
   interval with a postoperative stroke rate of 3.6% and a mortality of 1.1%, Of these,
   496 patients had data available on the contralateral artery. There were 384 patent,
   nonoperated contralateral arteries available for long-term clinical follow-up, of
   which 276 had serial Doppler examinations, At the time of initial presentation, 30%
   of patients (141 cases) had greater than 50% diameter stenosis in the contralateral
   artery including 45 occlusions. There were 67 contralateral endarterectomies
   performed within 6 months of the original surgery, An additional 15
   endarterectomies were performed within 24 months of the original surgery and only
   16 subsequent endarterectomies were performed up to the 8-year follow-up.
   Progression of contralateral stenosis from less than to greater than 50% occurred in
   10.1% of the patient population, The rate of disease progression was 5.1% at 3 years,
   17.8% at 5 years, and 30% at 7 years, Stroke-free survival in patients without
   progression was 94.7% at 3 years and 93.3% at 5 years. CONCLUSIONS:
   Significant contralateral disease occurs in about one third of patients, most of whom
   are candidates for early contralateral endarterectomy. In patients who present with
   minimal contralateral disease, the incidence of progression is low over time,
   Follow-up duplex examinations on a biennial schedule is sufficient to detect
   clinically significant disease progression in these patients
Keywords:                 analysis/arteries/artery/carotid/carotid            artery/carotid
   rvival/symptoms/TERM FOLLOW-UP/total/ultrasound
Figueiredo, M.S., Kerbauy, J., Goncalves, M.S., Arruda, V.R., Saad, S.T.O., Sonati,
  M.F., Stoming, T. and Costa, F.F. (1996), Effect of alpha-thalassemia and
  beta-globin gene cluster haplotypes on the hematological and clinical features of
  sickle-cell anemia in Brazil. American Journal of Hematology, 53 (2), 72-76.
Abstract: To compare the features of sickle-cell anemia in Brazil with those in other
  locales, we studied the effects of the beta- globin-like gene cluster haplotype and
  alpha-thalassemia upon the clinical and hematological features in 85 patients, The
  distribution of haplotypes differed from that in the United States and Jamaica, The
  Central African Republic (CAR) haplotype predominated; 34% of patients were
  CAR haplotype homozygotes, 45% CAR/Benin homozygotes, and 71% Benin
  homozygotes. No Senegal haplotype chromosomes were observed, alpha-thalassemia
  was present in 17.5% of patients, HbF levels were higher in Benin homozygotes,
  compared with the other two groups (P < 0.05). Nearly half the patients with a CAR
  haplotype had leg ulcers, compared to 12.5% of the Benin homozygote group; stroke
  did not occur in alpha-thalassemia carriers, but neither result was statistically
  significant. As in other studies, our results indicate that the CAR haplotype may be
  associated with more severe disease. (C) 1996 Wiley- Liss, Inc
  S/NEW-YORK/POPULATIONS/PREVALENCE/S-HAPLOTYPES/sickle                              cell
  anemia/sickle-cell disease/STATE/stroke/United States
McMurphy, R.M. and Hodgson, D.S. (1996), Cardiopulmonary effects of desflurane in
  cats. American Journal of Veterinary Research, 57 (3), 367-370.
Abstract: Objective-To evaluate the cardiopulmonary effects of 2 anesthetic planes of
  desflurane (DES) during spontaneous ventilation (SV) and controlled ventilation (CV)
  in cats. Design-Repeated Latin square. Animals-Eight healthy adult cats.
  Procedure-Each cat received 1.3 times the minimum alveolar concentration (MAC)
  of DES and 1.7 MAC of DES in oxygen during CV and SV. The data were analyzed
  as a repeated measures design. Heart rate, cardiac output, arterial blood pressure,
  pulmonary artery pressure, respiratory rate, Pa-O2, Pa-CO2, pHa, PCV, and serum
  total protein concentration were measured during each treatment. Stroke volume,
  cardiac index, total peripheral resistance, and oxygen consumption were calculated.
  Results-Cardiac index and stroke volume were ndt different between 1.3 and 1.7
  MAC of DES, but CV decreased cardiac index and stroke volume (P < 0.05).
  Systolic arterial pressure was decreased during 1.7 MAC of DES and during CV.
  Mean arterial blood pressure was decreased at 1.7 MAC during CV, but not SV. The
  Pa-co2 was higher at 1.7 MAC than at 1.3 MAC during SV. Spontaneously
  ventilating cats at 1.7 MAC had higher pulmonary artery pressures than other
  treatments. The PCV was decreased during CV. Conclusion-1.7 MAC of DES causes
  decreased systolic and mean arterial pressures and marked hypercapnia, but cardiac
  index is not affected. The hypercapnia is probably responsible for the increased
  pulmonary artery pressures in the spontaneously ventilating cats during 1.7 MAC.
  Hypercapnia can be corrected by CV but this reduces cardiac output
Keywords:          adult/anesthetic/arterial/arterial       blood       pressure/arterial
  pressure/artery/blood/blood             pressure/cardiac/cardiac         index/cardiac
  ACTIONS/cat/causes/CHRONICALLY                                     INSTRUMENTED
  NE/MAC/mean                                         arterial/MEDICAL/oxygen/oxygen
  consumption/peripheral/peripheral              resistance/pressure/pulmonary/pulmonary
  artery/rate/resistance/respiratory        rate/serum/spontaneous/STATE/stroke/stroke
  volume/systolic/total/total peripheral resistance/treatment/VENTILATION/volume
ShannahoffKhalsa, D.S., Kennedy, B., Yates, F.E. and Ziegler, M.G. (1996), Ultradian
  rhythms of autonomic, cardiovascular, and neuroendocrine systems are related in
  humans. American Journal of Physiology-Regulatory Integrative and Comparative
  Physiology, 39 (4), R873-R887.
Abstract: Autonomic, cardiovascular, and neuroendocrine activities were monitored for
  5-6 h in 10 normal adult resting humans (8 males, 2 females). The nasal cycle, a
  measure of lateralized autonomic tone, was measured at 4 Hz. Impedance
  cardiography (BoMed NCCOM3) was used to measure cardiac output, thoracic fluid
  index, heart rate, ejection velocity index, stroke volume, and ventricular ejection time
  (averages of 12 heart beats). Systolic, diastolic, and mean arterial pressures were
  measured with an automated cuff at 7.5-min intervals. Separate blood samples were
  taken every 7.5 min simultaneously from both arms with the use of indwelling
  venous catheters. Assays for adrenocorticotropic hormone, luteinizing hormone,
  norepinephrine, epinephrine, and dopamine were performed on samples from each
  arm. Time-series analysis, using the fast orthogonal search method of Korenberg,
  was used to detect variance structure. Significant spectral periods were observed in
  five windows at 220-340, 170-215, 115-145, 70-100, and 40-65 min. The greatest
  spectral power was observed in the lower frequencies, but periods at 115-145,
  70-100, and 40-65 min were common across variables. Significant correlation
  coefficients for linear regressions of all paired variables in each subject were
  observed in 38.87% of the comparisons (subject range, 18.05-49.70%) with r > 0.30.
  These results suggest that either a common oscillator (the hypothalamus) or mutually
  entrained oscillators regulate these systems
Keywords: adult/analysis/arterial/autonomic/basic rest-activity cycle/blood/blood
  DOGS/correlation/dopamine/females/FLUCTUATIONS/heart/heart rate/HEART-
  ESIONS/LUTEINIZING-HORMONE/males/mean                              arterial/measure/nasal
  volume/structure/thoracic/velocity/ventricular ejection time/volume
Hernandez, R.H., AngeliGreaves, M., Carvajal, A.R., Pajuelo, J.G., Padilla, M.C.A. and
  ArmasHernandez, M.J. (1996), Terazosin: Ex vivo and in vitro platelet aggregation
  effects in patients with arterial hypertension. American Journal of Hypertension, 9
  (5), 437-444.
Abstract: Antihypertensive effect, platelet aggregation, and plasma lipid profile were
  studied in a group of 14 hypertensive patients with diastolic blood pressure between
  96 and 116 mm Hg during placebo and terazosin phases. Terazosin, an
  alpha(1)-adrenergic blocking agent, was given initially at the dosage of 1 mg daily.
  Then it was continued at a dosage of 2 mg daily and 5 mg daily respectively, each
  dosage for 4 weeks. Blood pressure was taken every 2 weeks. Ex vivo platelet
  aggregation induced by epinephrine, collagen, and adenosine diphosphate (ADP)
  were carried out twice during the first placebo phase, once at the end of each
  terazosin dosage, and once in the second placebo phase. Total cholesterol, HDL
  cholesterol, and triglycerides were measured at the end of first placebo and terazosin
  phases. Blood from eight patients was taken during the second placebo phase to carry
  out in vitro response of platelet aggregation induced by ADP, collagen, and
  epinephrine before and after incubation with terazosin (1, 2 and 5 mu g/L or
  doxazosin (100, 200, and 500 mu g/L) for 5 min. Terazosin induced a statistically
  significant decrease in 14.2/8.0 mm Hg, 26.1/13.4 mm Hg, and 33.9/16.5 mm Hg in
  the supine position for 1, 2, and 5 mg/daily, respectively. No changes in heart rate
  were observed. Terazosin inhibited significant ex vivo platelet aggregation induced
  by epinephrine, collagen, and ADP in a range from 20% to 45% for different
  concentrations of inducers. Reductions in platelet aggregation seemed not to be dose
  dependent, as reductions were statistically equivalent for dosages of 1, 2, and 5 mg
  daily. Terazosin significantly reduced the level of total cholesterol (8.71%) and
  triglycerides (14.31%), and increased (although not significantly) levels of HDL
  cholesterol (3,91%). In vitro platelet aggregation was inhibited by doxazosin to a
  significant extent but not by terazosin
Keywords: adenosine/ADP/aggregation/alpha(1)-adrenergic blockers/arterial/arterial
  hypertension/blood/blood                            pressure/cholesterol/CORONARY
  HEART-DISEASE/diastolic                                                           blood
  cholesterol/HDL-cholesterol/heart/heart                 rate/hypertension/hypertensive
  SUBJECTS/placebo/plasma/plasma                                           lipids/platelet
Segal, M.E., Gillard, M. and Schall, R.R. (1996), Telephone and in-person proxy
  agreement between stroke patients and caregivers for the functional independence
  measure. American Journal of Physical Medicine & Rehabilitation, 75 (3), 208-212.
Abstract: This study examined patient/proxy agreement for telephone administration of
  the Functional Independence Measure (FIM) to a sample of 25 community-living
  stroke patients 18 mo post- stroke and their caregivers. Patients had all received in-
  patient rehabilitation for stroke. Because use of the FIM is increasing for follow-up
  purposes, it is important to document whether it is appropriate to administer a
  telephone version to proxy caregivers in situations in which patients cannot answer
  for themselves. Proxy agreement results were then compared with those obtained for
  in-person administration of the FIM to the same sample 1 yr earlier. Overall, proxy
  agreement for telephone administration was excellent for total scores (intraclass
  correlation was 0.91) and the physical dimension (0.94) and lower for the cognitive
  dimension (0.52), closely paralleling results obtained for the earlier in-person
  administration. Reasons for lower agreement on the cognitive dimension are
Keywords:             administration/CARE/caregivers/correlation/disability/FIM/follow
  up/follow-up/functional/functional        independence/functional        independence
  agreement/QUALITY/rehabilitation/scores/stroke/stroke patients/total
Heard, D.J., Nichols, W.W., Buss, D. and Kollias, G.V. (1996), Comparative
  cardiopulmonary effects of intramuscularly administered etorphine and carfentanil in
  goats. American Journal of Veterinary Research, 57 (1), 87-96.
Abstract: Objective-To determine comparative cardiopulmonary effects of IM
  administered etorphine and carfentanil in goats. Animals- Seven clinically normal
  adult female goats. Design-Each goat received at least 9 drug treatments (etorphine
  HCl, 5 [twice], 10, 20, and 40 and carfentanil citrate, 5, 10, 20, and 40 mu g/kg of
  body weight), with a minimal 2-day interval between trials. Although drug dosages
  were randomized, etorphine and carfentanil treatments were alternated. To assess for
  drug tolerance, the first and last treatments always were etorphine (5 mu g/kg).
  Procedure-All goats were instrumented for long- term cardiopulmonary variable data
  collection. Results-Both drugs induced rapid catatonic immobilization, characterized
  by limb and neck hyperextension, with occasional vocalization and bruxation.
  Etorphine elicited transient violent struggling and vocalization immediately. Time to
  immobilization appeared dose- dependent, and was more rapid with carfentanil (less
  than or equal to 5 minutes) than etorphine (5 to 10 minutes) at all dosages. Recovery
  to standing occurred earlier for etorphine (1 to 2 hours) than carfentanil (> 2 hours) at
  ail dosages. Both drugs at all dosages significantly (P less than or equal to 0.05)
  increased systemic and left ventricular (LV) end- diastolic pressures, LV peak
  negative dP/dt, total peripheral resistance (TPR), hemoglobin concentration, and left
  atrial (LA) and pulmonary O-2 contents. They also significantly decreased heart and
  respiration rates, and TPR. A significant increase was observed at some dosages for
  LV stroke volume and index, LV peak positive dP/dt, mean pulmonary artery
  pressure, Pa-o2, pulmonary artery oxygen partial pressure, Pac(o2), pulmonary
  mixed venous carbon dioxide partial pressure, LA hemoglobin saturation, LA
  transport index, and body temperature. Pulmonary and systemic mixed venous
  carbon dioxide and oxygen contents were significantly decreased at some dosages.
  Conclusions-lntramuscularly administered etorphine and carfentanil induce
  hypertension, bradycardia, and bradypnea in goats. The hypertension appears
  attributable to an increase in TPR. Clinical Relevance-Although the cardiopulmonary
  effects of carfentanil occurred more rapidly, these effects were similar in magnitude
  for etorphine and carfentanil over the evaluated dosage range
Keywords: ACEPROMAZINE/adult/AGENTS/artery/atrial/body temperature/body
  volume/SYSTEM/temperature/total/total                                         peripheral
Seki, K., Katayama, K., Sakai, H., Yonezawa, T., Kunichika, H., Saeki, Y., Hiro, T. and
  Matsuzaki, M. (1996), Effect of dobutamine on ventriculoarterial coupling in acute
  regional myocardial ischemia in dogs. American Journal of Physiology-Heart and
  Circulatory Physiology, 39 (4), H1279-H1286.
Abstract: We assessed the effect of dobutamine on left ventriculoarterial coupling
  during acute regional ischemia. Using a conductance catheter, we analyzed the
  end-systolic pressure-volume relation (ESPVR) in anesthetized dogs. We calculated
  the slope of ESPVR (E(es)), the slope of the end-systolic pressure-stroke volume
  relation (E(a)), (E(a)/E(es)) and the ratio (work. efficiency) of external work to
  pressure-volume area at baseline during ischemia induced by occlusion of the left
  anterior descending coronary artery and during low-dose (1-3 mu g . min(-1) . kg(- 1))
  and high-dose (4-10 mu g . min(-1) . kg(-1)) dobutamine infusions with ischemia.
  ESPVR shifted to the right without a change in E(es) during ischemia. Dobutamine
  caused dose- dependent increases in E(es) but did not affect the intercept of ESPVR.
  During ischemia, E(a)/E(es) increased and work efficiency decreased. Low-dose
  dobutamine was associated with a return to control for E(a)/E(es) and work
   efficiency. High-dose dobutamine increased E(es) and E(a) but produced no further
   increase in E(a)/E(es) or work efficiency. Low-dose dobutamine would appear to be
   the preferable regimen to achieve the optimal ventriculoarterial coupling in acute
   regional ischemia associated with mismatched ventriculoarterial coupling and
   depressed left ventricular work efficiency
Keywords: acute/anesthetized/artery/CANINE LEFT-VENTRICLE/CONDUCTANCE
   artery/coupling/DETERMINANTS/dobutamine/dogs/effect/effective                  arterial
   elastance/EFFICIENCY/end-systolic          pressure-volume       relationship/external
   work/HEART/INTERNAL/ischemia/left                  ventricular/myocardial/myocardial
   VOLUME/ventriculoarterial coupling/volume/work/work efficiency
Flam, E., Berry, S., Coyle, A., Dardik, H. and Raab, L. (1996), Blood flow
   augmentation of intermittent pneumatic compression systems used for the prevention
   of deep vein thrombosis prior to surgery. American Journal of Surgery, 171 (3),
Abstract: PURPOSE: TO compare, using Duplex ultrasonography, different intermittent
   pneumatic compression (IPC) systems to augment venous blood flow for deep
   venous thrombosis (DVT) prevention during and after surgery and during periods of
   immobility. METHODS: This cross-over study randomly assigned 26 young, healthy,
   adult subjects, without history of DVT, hypertension, diabetes, stroke, vascular or
   cardiac pathologies, to an order of knee-high, foam, single-pulse IPC device and
   thigh-high, vinyl, sequential-pulse pneumatic compression systems. Prior to making
   the flow measurement, the girth of the calf and thigh and length of the leg of each
   subject were determined. The right leg was used in this evaluation. RESULTS: The
   average flow augmentation, which is a direct measure of the amount of femoral vein
   blood flow velocity increase over the base, was 107% +/- 49% with the knee-high
   system, and 77% +/- 35% with the thigh-high IPC system (P <0.002). Augmentation
   was higher for 62% of the subjects with knee-high IPC, and for 23% of the subjects
   with the thigh-high system. Overall, the blood was actively moving through the vein
   during the decompression phase. On occasion, the velocity during the decompression
   phase would fall to zero for short intervals with both systems, indicating complete
   emptying of the vessel. Variation in limb anatomy did not significantly affect
   blood-flow augmentation with the knee-high IPC, but augmentation decreased with
   increase in girth with the thigh-high IPC. CONCLUSIONS: The study indicates that
   the knee-high, foam, single-pulse IPC device produces a significantly higher venous
   blood-flow augmentation than the thigh-high, vinyl, sequential-pulse system
Keywords:         adult/blood/blood       flow/blood      flow       velocity/calf/CALF
   COMPRESSION/cardiac/CO/compression/deep                                        venous
   w                           velocity/GRADUATED                               STATIC
   ry/thrombosis/ultrasonography/vascular/velocity/VENOUS THROMBOSIS
Gola, A., Pozzoli, M., Capomolla, S., Traversi, E., Sanarico, M., Cobelli, F. and
   Tavazzi, L. (1996), Comparison of Doppler echocardiography with thermodilution
   for assessing cardiac output in advanced congestive heart failure. American Journal
   of Cardiology, 78 (6), 708-712
Keywords:         advanced/cardiac/cardiac       output/congestive/congestive       heart
   failure/Doppler/Doppler         echocardiography/echocardiography/failure/heart/heart
Gold, M.R., Ogara, P.T., Buckley, M.J. and DeSanctis, R.W. (1996), Efficacy and
   safely of Procainamide in preventing arrhythmias after coronary artery bypass
   surgery. American Journal of Cardiology, 78 (9), 975-979.
Abstract: Arrhythmias are common after cardiac surgery and are associated with
   hemodynamic compromise, stroke, and prolonged hospitalization. Beta blockers
   prevent atrial fibrillation postoperatively, but there are few data regarding the
   prophylactic use of type I antiarrhythmic agents or the prevention of ventricular
   arrhythmias, Accordingly, we performed a randomized, double-blind,
   placebo-controlled study of the effects of oral procainamide on 100 patients
   undergoing elective coronary artery bypass surgery, Procainamide was received for 4
   days; the dosage was adjusted for body weight Patients receiving procainamide had a
   significant reduction in atrial fibrillation (16 vs 29 patient-days, p < 0,05) and
   ventricular tachycardia (2% vs 20%, p < 0.01). However, the incidence of atrial
   fibrillation was not significantly reduced (38% vs 26%), In the group achieving
   therapeutic serum procainamide levels, there was a reduction in all measured
   postoperative arrhythmias. No serious cardiac or noncardiac adverse events were
   noted during procainamide therapy, although there was a significant increase in the
   incidence of nausea, We conclude that procainamide reduces arrhythmias in the early
   postoperative period after coronary artery bypass surgery, most prominently in
   patients who achieve therapeutic serum levels. This was associated with no serious
   cardiac adverse reactions. (C) 1996 by Excerpta Medica, Inc
Keywords:                    adverse                 events/arrhythmias/artery/atrial/atrial
   fibrillation/ATRIAL-FIBRILLATION/body                             weight/bypass/bypass
   surgery/cardiac/cardiac      surgery/coronary/coronary       artery/coronary      artery
   bypass/coronary                               artery                             bypass
   TACHYARRHYTHMIAS/surgery/tachycardia/therapy/ventricular tachycardia
Gillum, R.F. and Ingram, D.D. (1996), Relation between residence in the southeast
   region of the United States and stroke incidence - The NHANES I Epidemiologic
   Followup Study. American Journal of Epidemiology, 144 (7), 665-673.
Abstract: For at least 50 years, stroke death rates have been higher in the southeast
   region of the United States than in other US regions. To test the hypotheses that
   stroke incidence is higher in the Southeast than in other regions and that higher levels
   of known stroke risk factors in the Southeast explain the difference in incidence, data
   were analyzed from a nationally representative, longitudinal cohort study of a sample
   drawn from the US population, the First National Health and Nutrition Examination
   Survey (NHANES I) Epidemiologic Followup Study (1971-1987), In white men and
   women aged 45-74 years, the risk of stroke was significantly higher in the Southeast
   than the Northeast or the West in men and the Midwest in women, In white men, this
   excess risk could not be explained by regional differences in multiple stroke risk
   factors (Northeast vs. Southeast risk-adjusted relative risk = 0.71, 95% confidence
   interval 0.52-0.98). In white women, some of the excess risk associated with
   residence in the Southeast compared with the Midwest could be explained by the
   regional differences in risk factors measured in NHANES I (Midwest vs. Southeast
  risk- adjusted relative risk = 0.73, 95% confidence interval 0.53- 1.00). In blacks,
  regional differences that were statistically significant could not be demonstrated.
  However, a strong association of increased stroke risk with nonmetropolitan
  residence in blacks was demonstrated that was independent of region or other stroke
  risk factors. Higher stroke incidence rates in the Southeast contribute to the higher
  stroke mortality rates in that US region
Keywords:             AGE/aged/BELT/blacks/cerebrovascular                 disorders/cohort
  lity rates/NHANES-I/regional/relative risk/RISK/risk factors/risk of stroke/rural
  population/SMOKING/stroke/stroke incidence/stroke risk/test/United States/urban
Rose, W.C. and Schwaber, J.S. (1996), Analysis of heart rate-based control of arterial
  blood pressure. American Journal of Physiology-Heart and Circulatory Physiology,
  40 (2), H812-H822.
Abstract: Vagal control of the heart is the most rapidly responding limb of the arterial
  baroreflex. We created a mathematical model of the left heart and vascular system to
  evaluate the ability of heart rate to influence blood pressure. The results show that
  arterial pressure depends nonlinearly on rate and that changes in rate are of limited
  effectiveness, particularly when rate is increased above the basal level. A 10%
  change in heart rate from rest causes a change of only 2.4% in arterial pressure due to
  the reciprocal relation between heart rate and stroke volume; at higher rates,
  insufficient filling time causes stroke volume to fall. These findings agree well with
  published experimental data and challenge the idea that changes in heart rate alone
  can strongly and rapidly affect arterial pressure. Possible implications are that
  vagally mediated alterations in inotropic and dromotropic state, which are not
  included in this model, play important roles in the fast reflex control of blood
  pressure or that the vagal limb of the baroreflex is of rather limited effectiveness
Keywords: AORTIC BARORECEPTORS/arterial/arterial blood pressure/arterial
  pressure/BARORECEPTOR REFLEX/baroreflex/blood/blood pressure/CANINE
  tal/heart/heart rate/inotropic/mathematical/MODEL/neural control of blood
  volume/vagus nerve/vascular/volume
Graafmans, W.C., Ooms, M.E., Hofstee, H.M.W., Bezemer, P.D., Bouter, L.M. and
  Lips, P. (1996), Falls in the elderly: A prospective study of risk factors and risk
  profiles. American Journal of Epidemiology , 143 (11), 1129-1136.
Abstract: xIn this prospective study, the authors determined intrinsic risk factors for
  falls and recurrent falls and constructed a risk profile that indicated the relative
  contribution of each risk factor and also estimated the probabilities of falls and
  recurrent falls, In 1992, over a 28-week period, falls were recorded among 354
  elderly subjects aged 70 years or over who were living in homes or apartments for
  the elderly in Amsterdam and the vicinity, During the study period, 251 falls were
  reported by 126 subjects (36%), and recurrent falls (greater than or equal to 2 falls)
  were reported by 57 subjects (16%). Associations of falls and recurrent falls with
  potential risk factors were identified in logistic regression models. Mobility
  impairment regarding one or more of the tested items (i.e., impairment of balance,
  leg-extension strength, and gait) was associated with falls (adjusted odds ratio (OR)
  = 2.6) and was strongly associated with recurrent falls (OR = 5.0). Dizziness upon
  standing was associated with falls (OR = 2.1) and recurrent falls (OR = 2.1).
  However, several risk factors were associated with recurrent falls only: history of
  stroke (OR = 3.4), poor mental state (OR = 2.4), and postural hypotension (OR = 2.0).
  The authors constructed a risk profile for recurrent falls that included the five risk
  factors mentioned above. Inclusion of all risk factors in the profile implied an 84%
  probability of recurrent falls over a period of 28 weeks, compared with 3% when no
  risk factor was present. The probability of recurrent falls ranged only from 11% to
  29% when predicted by number of falls occurring in the previous year. Physical
  activity, use of high-risk medication, and the use of vitamin D-3, which was
  randomly allocated to the participants, were not strongly related to either falls or
  recurrent falls. In conclusion, a large range of probabilities of falls, especially of
  recurrent falls, was estimated by the risk profiles, in which mobility impairment was
  the major risk factor. Recurrent fallers may therefore be especially amenable to
  prevention based on mobility improvement
Keywords:                                                                      accidental
  FALLS/JUN/mobility/models/MUSCLE                                      STRENGTH/odds
  ratio/prevention/prospective/prospective             study/risk/risk         factor/risk
Rybarczyk, B., Winemiller, D.R., Lazarus, L.W., Haut, A. and Hartman, C. (1996),
  Validation of a depression screening measure for stroke inpatients. American Journal
  of Geriatric Psychiatry, 4 (2), 131-139.
Abstract: The Stroke Inpatient Depression Inventory (SIDI) was developed and tested
  on 50 stroke inpatients on a rehabilitation unit. The format and content of the SIDI
  questions were intended to improve on the limited validity of the Center for
  Epidemiological Studies-Depression Scale (CES-D) and other measures of
  depression with stroke inpatients. The validity of the SIDI was supported by higher
  correlations with a psychiatrist's rating of depression level (r = 0.70), SADS-C score
  (r = 0.68), and Hamilton Rating Scale for Depression score (r = 0.78) compared with
  the CES-D. Also, the SIDI was more accurate than the CES-D in correct
  classification of patients with regard to diagnosis of depression (86% vs. 76%
Roubin, G.S., Yadav, S., Iyer, S.S. and Vitek, J. (1996), Carotid stent-supported
  angioplasty: A neurovascular intervention to prevent stroke. American Journal of
  Cardiology, 78 8-12.
Abstract: Obstructive carotid artery disease is responsible for 60% of strokes in the
  United States and is the third major cause of death. Stent-supported carotid artery
  angioplasty has the potential to prevent stroke in thousands of patients and offers a
  number of potential advantages over surgical revascularization (carotid
  endarterectomy). Results of the prospective observational study at the University of
  Alabama at Birmingham indicate that carotid stent-supported angioplasty is safe and
  probably effective in reducing stroke in patients with high-risk cerebrovascular
  disease. Technical success was achieved in 99% of 146 procedures; 210 stents were
  placed in 152 vessels, with only 1 instance of stent thrombosis. The rate of major
  in-hospital complications was unexpectedly low-only 1 death and 2 major strokes.
  Seven patients suffered minor strokes, but only 2 were left with minor weakness.
  When compared with a projected complication rate of 6% had these patients
   undergone carotid endarterectomy, stenting resulted in fewer major events. At
   6-month follow-up, 69 of 74 patients were evaluated by angiography or ultrasound,
   which detected 8 cases of stent deformation and a restenosis rate of <5%. Because of
   these instances of stent deformation, use of the Palmaz (biliary) stent was
   discontinued. Although 1 patient had a transient ischemic attack, no strokes occurred
   during follow- vp. To date, carotid stenting is an investigational procedure.
   Cardiovascular interventionalists, industry, and the FDA are encouraged to validate
   this approach through clinical testing. However, Improvements in technique, devices,
   and adjunctive therapies are needed before the method can be tested in randomized
Keywords:        angiography/angioplasty/artery/carotid/carotid       artery/carotid   artery
   disease/carotid endarterectomy/cause of death/cerebrovascular/cerebrovascular
   transient ischemic attack/trials/ultrasound/United States/weakness
Saito, H., Togashi, H. and Yoshioka, M. (1996), A comparative study of the effects of
   alpha(1)-adrenoceptor antagonists on sympathetic function in rats. American Journal
   of Hypertension, 9 (11), S160-S169.
Abstract: alpha(1)-Adrenoceptor antagonists were comparatively evaluated in terms of
   their acute and long-term effects on sympathetic function in rats. In the first study,
   the effects of alpha(1)- adrenoceptor antagonists on cardiovascular sympathetic nerve
   activity were electrophysiologically determined in anesthetized normotensive rats.
   Intravenous administration of four alpha(1)- antagonists-prazosin, bunazosin,
   SM-2470, and YM-617-produced no changes or decreases in heart rate, in spite of
   the expected reflex tachycardia resulting from their marked hypotensive effect.
   Among the alpha(1)-antagonists examined, some also produced a significant
   decrease in inferior cardiac nerve activity. All except prazosin decreased renal nerve
   activity, while prazosin showed an opposite tendency to increase the renal nerve
   activity. On the other hand, preganglionic adrenal nerve activity, an index of central
   sympathoinhibitory activity, underwent a significant decrease after SM-2470 and
   YM-617 administration, and a dose-dependent increase was observed in response to
   prazosin and bunazosin. In the second study, the long-term (4 weeks) effects of
   alpha(1)-antagonists on plasma and urinary catecholamine levels and urinary
   electrolyte excretions were evaluated in stroke-prone spontaneously hypertensive rats
   (SHRSP). Prazosin and bunazosin did not exert any consistent changes on plasma
   and urinary catecholamine concentrations. SM-2470, however, significantly
   decreased both plasma and urinary epinephrine concentrations. In addition,
   bunazosin and SM-2470 produced increases in urinary sodium and potassium
   excretions. Urine volume tended to increase after bunazosin administration. Prazosin,
   on the other hand, produced decreases in urinary sodium and potassium excretions as
   well as in urine volume. These findings demonstrate that alpha(1)-antagonists
   differentially affected cardiovascular sympathetic tone in anesthetized rats. These
   varied sympathoinhibitory profiles might be in part explainable as different effects
   on urinary electrolyte metabolism after long-term administration of
   alpha(1)-antagonists in SHRSP
Keywords:                        activity/acute/administration/ADRENAL-MEDULLARY
   FUNCTION/alpha(2)-adrenoceptor             antagonist/ALPHA-1          ADRENOCEPTOR
   SYMPATHOINHIBITORY                          ACTION/effect/effects/function/heart/heart
   rate/hypertensive                    rats/hypotensive                     effect/LOWER
   al nerve activity/response/SCIENCE/SHRSP/SM-2470/sodium/SPONTANEOUSLY
   HYPERTENSIVE RATS/stroke-prone/stroke-prone spontaneously hypertensive
   rats/sympathetic            nerve          activity/tachycardia/urinary           sodium
Gillum, R.F., Sempos, C.T., Makuc, D.M., Looker, A.C., Chien, C.Y. and Ingram, D.D.
   (1996), Serum transferrin saturation, stroke incidence, and mortality in women and
   men - The NHANES I Epidemiologic Followup Study. American Journal of
   Epidemiology, 144 (1), 59-68.
Abstract: Several studies have examined relatively large body iron stores and the risk of
   coronary heart disease with conflicting results. No reports of studies that associated
   body iron stores with stroke were found. To test the hypothesis that relatively high
   transferrin saturation is associated with increased stroke incidence and mortality in
   women and men, data from a follow-up study of a national cohort were examined. A
   total of 5,033 women and men aged 45-74 years from the First National Health and
   Nutrition Examination Survey Epidemiologic Followup Study who were free of
   stroke at baseline were followed an average of 12 years. Transferrin saturation
   (serum iron concentration divided by total iron binding capacity) was used as a
   measure of the amount of circulating iron available to tissues. in white women aged
   45-74, after adjusting for age or for age and other risk variables, the authors observed
   a significant U- shaped association of transferrin saturation with risk of incident
   stroke (>44% vs. 30-36%, relative risk = 1.96, 95% confidence interval 1.15-3.36;
   <20% vs. 30-36%, relative risk = 1.80, 95% confidence interval 1.20-2.71). However,
   no significant associations were found in white men aged 45-74 after adjusting for
   other risk variables. Similar findings were observed for stroke mortality in whites,
   but no significant associations were seen in blacks. The significantly increased risk
   of stroke that was seen at both high and low levels of transferrin saturation in white
   women should be confirmed in other cohorts of women and men
Keywords:            age/aged/ALBUMIN/blacks/cerebral                embolism           and
   thrombosis/cerebrovascular                                               disorders/cohort
   studies/confidence/CONTROL/coronary/coronary                                        heart
   disease/disease/EPIDEMIOLOGY/ferritin/follow up/follow-up/follow-up study/free
   y/NHANES-I/relative risk/RISK/risk of stroke/serum/SMOKING/stroke/stroke
Scardo, J.A., Vermillion, S.T., Hogg, B.B. and Newman, R.B. (1996), Hemodynamic
   effects of oral nifedipine in preeclamptic hypertensive emergencies. American
   Journal of Obstetrics and Gynecology, 175 (2), 336-339.
Abstract: OBJECTIVE: Our purpose was to evaluate the hemodynamic effects of oral
   nifedipine in preeclamptic hypertensive emergencies, STUDY DESIGN: A
   prospective observational study of the hemodynamic effects of oral nifedipine was
   conducted with severely preeclamptic patients receiving magnesium sulfate infusion
   during a hypertensive emergency. Patients were eligible for;he study ii systolic blood
   pressure was greater than or equal to 170 m Hg or the diastolic blood pressure was
   greater than or equal to 105 mm Hg on repeat measurements 15 minutes apart at
  greater than or equal to 24 weeks' gestation, Nifedipine was given with an initial
  dose of 10 mg orally followed by 20 mg orally every 20 minutes until systolic blood
  pressure was < 160 mm Hg and the diastolic blood pressure was < 100 mm Hg, or
  for a total of five doses. Patients were hemodynamically monitored in the lateral
  recumbent position by thoracic electrical bioimpedance before during, and after oral
  nifedipine dosing. Cardiac index, systemic vascular resistance index, mean arterial
  pressure, heart rate, and stroke index were all recorded at baseline and during
  treatment, Data were analyzed by analysis of Variance for repeated measures
  (proportional to 0.05) and by paired t tests, baseline Versus 15 minutes (proportional
  to 0.01). RESULTS: Ten severely preeclamptic patients at 33.2 +/- 3.0 (mean +/- SD)
  weeks' gestation were enrolled in the study. Mean arterial pressure measurements
  taken at baseline, 0.25, 0.5, 1, and 4 hours were 133 +/- 10, 119 +/- 8, 109 +/- 889 +/-
  12, and 100 +/- 13 mm Hg (mean +/- SD, p < 0.0001, analysis of variance repeated
  measures). Cardiac index increased over time (p = 0.0011, analysis of variance
  repeated measures). There was no significant effect on maternal heart rate or stroke
  index. No periodic fetal heart rate changes were noted, One patient had nausea.
  CONCLUSION: Oral nifedipine appears to be an effective antihypertensive agent in
  preeclamptic hypertensive emergencies. A steady decrease in mean arterial pressure,
  systemic vascular resistance, and a mirrored increase in cardiac index are noted
Keywords:           analysis/arterial/arterial         pressure/bioimpedance/blood/blood
  pressure/cardiac/cardiac      index/CARDIAC-OUTPUT/DESIGN/diastolic                blood
  pressure/effect/effects/heart/heart rate/hemodynamic/hypertension/magnesium/mean
  ssure/prospective/rate/resistance/RESULTS/stroke/stroke           index/SUBLINGUAL
  NIFEDIPINE/systemic          vascular      resistance/systemic    vascular    resistance
  index/systolic/systolic blood pressure/THERMODILUTION/thoracic/THORACIC
  ELECTRICAL BIOIMPEDANCE/total/treatment/vascular/vascular resistance
Hacklander, T., Reichenbach, J.R., Hofer, M. and Modder, U. (1996), Measurement of
  cerebral blood volume via the relaxing effect of low-dose gadopentetate
  dimeglumine during bolus transit. American Journal of Neuroradiology, 17 (5),
Abstract: PURPOSE: To quantify regional cerebral blood volume (rCBV) on the basis
  of the enhancement of blood proton relaxation rates after intravenous administration
  of gadopentetate dimeglumine. METHODS: A series of sequential MR images of
  one section was recorded during bolus transit with a standard fast low-angle shot
  sequence. The signal-intensity curves were converted into corresponding
  concentration-time curves from which rCBV images were calculated. RESULTS:
  The functional parameter images of rCBV were calculated pixel-by-pixel for two
  patients who had received a I-second bolus injection of 1 mmol of gadopentetate
  dimeglumine. In a larger series of 62 patients, a mean blood volume of 4.6 +/- 1.6
  vol% was determined for normal brain tissue. CONCLUSIONS: The relaxing effect
  of a contrast agent can be used to determine blood volume quantitatively. The results
  are in agreement with those obtained by nuclear medicine techniques. The proposed
  method requires no special hardware, and can thus be implemented on clinical MR
Keywords: administration/blood/blood volume/brain/BRAIN/cerebral/cerebral blood
  volume/CONTRAST                                            AGENTS/effect/FLOW/flow
Hamberg, L.M., Hunter, G.J., Kierstead, D., Lo, E.H., Gonzalez, R.G. and Wolf, G.L.
  (1996), Measurement of cerebral blood volume with subtraction three- dimensional
  functional CT. American Journal of Neuroradiology, 17 (10), 1861-1869.
Abstract: PURPOSE: To implement a three-dimensional subtraction functional CT
  technique to permit rapid quantitative mapping of regional cerebral blood volume
  (CBV). METHODS: The 3-D functional CT technique was implemented in a rabbit
  model using normal and ischemic animals, Two spiral data acquisitions were
  performed, one before and one during biphasic administration of contrast material.
  CBV maps were then produced on a voxel-by- voxel basis through the whole brain.
  RESULTS: The average normal CBV was 3.3+/-0.4 mL/100 g (n=7), and the
  regional values were 4.5+/-0.6 mL/100 g for cortical gray matter, 2.5+/- 0.6 mL/100
  g for white matter, and 3.7+/-0.4 mL/100 g for the basal ganglia. The CBVs in
  ischemic regions were 1.5+/-0.4 mL/100 g, 0.7+/-0.7 mL/100 g, and 1.8+/-0.9
  mL/100 g, respectively. CONCLUSION: Subtraction 3-D functional CT is a fast,
  potentially cost-effective method with which to assess whole-brain CBV. Because
  the data collected in 3-D functional CT imaging also can be used to produce
  large-vessel angiograms, its use in a clinical setting can provide a multiparametric
  study of cerebrovascular abnormalities that encompasses both large and small vessel
  circulations for patients being examined for stroke
Keywords: abnormalities/ACUTE STROKE/administration/ANGIOGRAPHY/animal
  studies/animals/basal ganglia/blood/blood volume/brain/CATS/cerebral/cerebral
  blood volume/cerebrovascular/computed tomography/CT/DIAGNOSIS/EMISSION
  mall/SPIRAL CT/stroke/three- dimensional/TISSUE/volume/white matter/X-
Gardner, P., Dalsing, M., Weisberger, E., Sawchuk, A. and Miyamoto, R. (1996),
  Carotid body tumors, inheritance, and a high incidence of associated cervical
  paragangliomas. American Journal of Surgery, 172 (2), 196-199.
Abstract: BACKGROUND: Current experience with carotid body tumors suggesting a
  high prevalence of associated cervical paragangliomas prompted this review.
  PATIENTS AND METHODS: An 8-year retrospective study of patients with carotid
  body tumors was undertaken, detailing presentation, diagnosis, and treatment.
  RESULTS: Eleven patients harboring 17 carotid body tumors were discovered, Ail
  patients had a neck mass, Seven patients (64%) had bilateral carotid body tumors,
  Six (55%) reported a positive family history-4 were first-generation relatives, 5 had
  bilateral tumors, and 3 had other head and neck paragangliomas, Angiography
  documented 4 associated vagal and 2 glomus jugulare paragangliomas in addition to
  the carotid body tumors, Precise surgical care limited blood loss to an average of 590
  cc, The carotid artery was repaired during 5 resections (29%), Cranial nerve injury
  occurred in 3 cases, all following vagal body or glomus jugulare resection, Every
  patient is currently alive, stroke free, and functioning without major disability.
  CONCLUSIONS: Patients with carotid body tumors have a propensity for multiple
  head and neck paragangliomas. Angiography is diagnostic, The need for associated
  paraganglioma resection dramatically increases the risk of cranial nerve injury
Keywords:                                           artery/bilateral/blood/carotid/carotid
Gilligan, D.M., Ellenbogen, K.A. and Epstein, A.E. (1996), The management of atrial
   fibrillation. American Journal of Medicine, 101 (4), 413-421.
Abstract: Atrial fibrillation affects approximately one million persons in the United
   States, making it the most,common cardiac arrhythmia seen in clinical practice. Its
   prevalence increases with age, and occurs in up to 10% of the population in the
   eighth decade of life. Unlike coronary heart disease, atrial fibrillation affects men
   and women approximately equally and, in an increasingly elderly population, will
   become an increasing burden to the health care system. The management of atrial
   fibrillation has undergone significant change in recent years. Large randomized
   controlled trials have shown that anticoagulation markedly reduces the risk of stroke,
   and a number of new antiarrhythmic agents are available for the restoration and
   maintenance of sinus rhythm. Furthermore, physicians have become more aware of
   the potential proarrhythmic side effects of all antiarrythmic drugs. Finally, new
   procedures such as radiofrequency ablation of the atrioventricular junction and
   permanent pacing are playing increasing roles in the management of this arrhythmia.
   In this review, the identification of underlying causes and/or precipitating factors of
   atrial fibrillation, methods to control the ventricular response with atrioventricular
   nodal blocking drugs, the questions of whether restoration of sinus rhythm is a
   possible or desirable goal and how best to maintain sinus rhythm, should sinus
   rhythm be restored, and the importance of long-term anticoagulation with warfarin or
   antiplatelet therapy with aspirin are discussed
Keywords:            age/AMIODARONE/ANTICOAGULATION/antiplatelet/antiplatelet
   heart                                      disease/disease/drugs/effects/elderly/elderly
   population/fibrillation/FLUTTER/health/health                           care/heart/heart
   VENTION/QUINIDINE/randomized controlled trials/response/review/risk/risk of
   stroke/side         effects/SINUS        RHYTHM/stroke/therapy/TRIAL/trials/United
Gillum, R.F., Mussolino, M.E. and Ingram, D.D. (1996), Physical activity and stroke
   incidence in women and men - The NHANES I Epidemiologic Follow-up Study.
   American Journal of Epidemiology, 143 (9), 860-869.
Abstract: To test the hypothesis that physical inactivity is associated with increased
   stroke risk in women and men, the authors analyzed data from a longitudinal cohort
   study with three follow-up data collection waves. In the National Health and
   Nutrition Examination Survey I (NHANES I) Epidemiologic Follow- up Study,
   7,895 white persons and black persons aged 45-74 years were examined in
   1971-1975 as part of NHANES I. Included in this analysis were 5,852 persons
   without a history of stroke or missing data. The average follow-up was 11.6 years
   (maximum, 16.4 years). Incident stroke (fatal and nonfatal) was the main outcome
   measure. Events were ascertained from cause of death information coded from death
   certificates and from discharge diagnoses coded from hospital and nursing home
   records during the follow-up period (1971 through 1987). Participants were asked to
   characterize their level of habitual physical activity as low, moderate, or high. The
   relative risk for stroke was estimated by Cox proportional hazards regression analysis,
   comparing persons reporting low with those reporting high physical activity at
   baseline and persons in the upper with those in the lower tertile of resting pulse rate.
  There were 249 incident cases of stroke identified in white women, 270 in white men,
  and 104 in blacks. In white women aged 65-74 years, low nonrecreational activity
  was associated with an increased risk of stroke (relative risk = 1.82, 95% confidence
  interval 1.10-3.02) after adjusting for the baseline risk factors of age, smoking,
  history of diabetes, history of heart disease, education, systolic blood pressure, serum
  total cholesterol, body mass index, and hemoglobin concentration. Similar
  associations were seen for men and for blacks and for low recreational activity in
  women. A higher resting pulse rate was associated with an increased risk of stroke in
  blacks but not in whites. A consistent association of reported low physical activity
  with an increased risk of stroke was observed in white women. Regular physical
  activity may be of benefit in preventing stroke in women as well as men
Keywords: activity/age/aged/analysis/blacks/blood/blood pressure/body mass/body
  mass        index/cerebral        hemorrhage/cerebral           infarction/cerebrovascular
  disorders/cholesterol/CIGARETTE-SMOKING/cohort                               studies/cohort
  DEMIOLOGY/exercise/follow up/follow-up/HEALTH/heart/heart disease/heart
  measure/men/MORTALITY/NHANES-I/outcome/physical                           activity/physical
  fitness/pressure/PULSE-RATE/rate/relative           risk/risk/risk      factors/risk     of
  stroke/RISK-FACTORS/serum/smoking/stroke/stroke                           incidence/stroke
  risk/systolic/systolic blood pressure/test/total/upper/women
Sasaki, O., Takeuchi, S., Koizumi, T., Koike, T. and Tanaka, R. (1996), Complete
  recanalization via fibrinolytic therapy can reduce the number of ischemic territories
  that progress to infarction. American Journal of Neuroradiology, 17 (9), 1661-1668.
Abstract: PURPOSE: To clarify the clinical significance of fibrinolytic therapy for acute
  ischemic stroke. METHODS: We analyzed findings in 18 patients with occlusion of
  a major artery in respect to cerebral blood flow thresholds for infarction. Nine of
  these patients had shown complete recanalization just after the treatment, between
  3.5 and 7.25 hours after symptom onset, and the other nine had shown no change,
  Cerebral blood flow was measured by single-photon emission CT using
  (TC)-T-99m-labeled         hemamethylpropyleneamine           oxime       and      assessed
  semiquantitatively: multiple regions of interest were placed on the section images
  and two parameters, the R/CL ratio and the R/CE ratio, were calculated (where R
  represents a mean count of the region of interest in the affected hemisphere, CL on
  the opposite side, and CE in the cerebellar hemisphere on the affected ischemic side).
  RESULTS: Reperfusion significantly reduced the development of infarction in the
  regions of interest with an R/CL ratio between 0.65 and 0.85 or an R/CE ratio
  between 0.55 and 0.75. No correlation was observed between the development of
  infarction and the duration of ischemia, The cerebral blood flow threshold in patients
  without recanalization was higher than that in patients with recanalization.
  CONCLUSION: Reperfusion achieved by fibrinolytic therapy in the acute stage can
  save ischemic brain within a limited cerebral blood flow value
Keywords: acute/artery/blood/blood flow/BLOOD-FLOW/brain/cerebral/cerebral blood
Gillard, J.H., Barker, P.B., vanZijl, P.C.M., Bryan, R.N. and Oppenheimer, S.M. (1996),
   Proton MR spectroscopy in acute middle cerebral artery stroke. American Journal of
   Neuroradiology, 17 (5), 873-886.
Abstract: PURPOSE: To investigate the feasibility of performing multisection proton
   MR spectroscopy in patients with acute stroke, and to determine whether this
   imaging technique can depict ischemic or infarcted brain regions. METHODS:
   Multisection proton MR spectroscopy, MR imaging, and MR angiography were
   performed within 24 hours of stroke onset (mean, 12 hours) in 12 patients who had
   had a stroke of the middle cerebral artery. Spectra were analyzed from brain regions
   containing T2 hyperintensity abnormalities on MR images, from regions
   immediately adjacent to these abnormalities, and from anatomically similar
   contralateral regions. Areas of brain containing lactate were compared with areas of
   T2 hyperintensities on MR images. RESULTS: One data set was discarded because
   of excessive artifacts from patient motion. Regions of T2 hyperintensities on MR
   images were found to contain elevated lactate (all 11 cases) and reduced N-
   acetyl-aspartate (10 of 11 cases) relative to contralateral measurements. Lactate
   levels in regions adjacent to T2 hyperintensities were not significantly different from
   those of infarcted brain. On the other hand, N-acetyl-aspartate was significantly
   lower in regions of infarction compared with periinfarct tissue. Areas of brain
   containing elevated lactate significantly exceeded those of T2 abnormality.
   CONCLUSIONS: Proton MR spectroscopy is feasible for imaging patients with
   acute stroke. In the early stages of stroke, tissue containing elevated lactate but no
   other spectroscopic or MR imaging abnormality can be identified. Such regions may
   represent an ischemic zone at risk of infarction
Keywords:       abnormalities/acute/acute       stroke/angiography/arteries/artery/BLOOD-
   FLOW/brain/cerebral/cerebral                    artery/H-1/HUMAN                 BRAIN
   middle                cerebral                 artery/MR/MR                  imaging/MR
   e onset
Feldmann, T., Geva, E., Kosloff, R. and Salamon, P. (1996), Heat engines in finite time
   governed by master equations. American Journal of Physics, 64 (4), 485-492.
Abstract: A simple example of a four-stroke engine operated in finite- time is analyzed.
   The working medium consists of noninteracting two-level systems or harmonic
   oscillators. The cycle of operation is analogous to a four-stroke Otto cycle. The only
   source of irreversibility is due to the finite rate of heat transfer between the working
   medium and the cold and hot baths. The dynamics of the working medium is
   governed by a master equation. The engine is shown to settle to a stable limit cycle
   for given contact periods with the hot and cold baths. The operation of the engine is
   analyzed subject to a fixed cycle time. The time allocation between the hot and cold
   branches that maximizes the work output is considered. Analytical results are
   obtained when the relaxation is very slow, very fast, or when the relaxation rates
   along the hot and cold branches are equal. Numerical results are presented for the
   general case. A maximization of the power with respect to the cycle time leads to
   finite optimal cycling frequency provided the adiabatic branches are allotted finite
   durations. (C) 1996 American Association of Physics Teachers
Davis, L.E., Hohimer, A.R., Giraud, G.D., Reller, M.D. and Morton, M.J. (1996), Right
   ventricular function in chronically anemic fetal lambs. American Journal of
   Obstetrics and Gynecology, 174 (4), 1289-1294.
Abstract: OBJECTIVE: Our purpose was to determine whether the increase in
   extravascular fluid in chronic fetal anemia occurs either because of heart failure or
   despite successful cardiac adaptation. STUDY DESIGN: Right ventricular function
   curves were obtained in Rye ovine fetuses at the start, midpoint, and end of 5 to 8
   days of anemia induced by isovolemic daily hemorrhage. Least-squares fit of the
   ascending and plateau lines of stroke volume versus right atrial pressure were used to
   establish breakpoints (intersection of the ascending and plateau lines), which were
   compared by analysis of variance for repeated measures. Myocardial blood flow was
   measured by microspheres. RESULTS: Carotid arterial oxygen content was reduced
   from 7.0 +/- 0.3 to 2.1 +/- 0.1 ml/dl and the hematocrit from 29% +/- 1.8% to 13%
   +/- 0.6%. Breakpoint analysis of function curves showed that although right atrial
   pressure remained unchanged (3.4 +/- 0.7 and 3.6 +/- 0.6 mm Hg) stroke volume
   increased from 1.03 +/- 0.14 to 1.62 +/- 0.25 ml/kg. Both right and left ventricular
   coronary blood flow were increased, 1351 +/- 313 and 1166 +/- 264 ml/min per 100
   gm. Excess fluid was present in the abdomen and chest of most animals at autopsy.
   CONCLUSION: Tissue edema during severe anemia occurs despite normal right
   atrial pressure, increased stroke volume, and markedly increased coronary blood
   flow, markers of successful cardiac adaptation
Keywords:                                   analysis/anemia/animals/arterial/ARTERIAL
   PRESSURES/atrial/autopsy/blood/blood flow/BLOOD-FLOW/CARBOHYDRATE
   function/CARDIAC-OUTPUT/chest/chronic/coronary/coronary                blood/coronary
   VOLUME/ventricular function/volume
Pianosi, P. and Pelech, A. (1996), Stroke volume during exercise in cystic fibrosis.
   American Journal of Respiratory and Critical Care Medicine, 153 (3), 1105-1109.
Abstract: Previous studies comparing cardiac output (Q over dot) and stroke volume
   (SV) between cystic fibrosis (CF) patients and control subjects have shown
   conflicting results: some found lower SV in CF patients with severe airflow
   limitation, and others showed no difference between CF and control subjects.
   Methodologic problems could explain these discrepant findings. The aim of this
   study was to better characterize Q over dot and SV with exercise in CF patients with
   mild as well as severe airflow obstruction. Subjects included 18 CF patients with
   FEV(1) ranging from 28 to 80% of predicted without pulmonary hypertension, and
   16 matched control subjects. Cardiac output was measured at three levels of upright
   cycle exercise using the indirect Fick (CO2) method with blood gas sampling. Q over
   dot on exercise was similar among control and CF subjects. SV was lower in CF
   patients, particularly those with FEV(1) less than or equal to 55% predicted, than in
   control subjects. Stepwise regression of SV on height, percent ideal body weight, and
   FEV(1) showed a significant effect of relative underweight on SV. Despite this,
   well-nourished patients with FEV(1) 56 to 80% of predicted also had lower SV. As
   these findings were consistent across the range of severity of lung disease and age,
   even in the absence of malnutrition, they imply that another mechanism accounts for
   SV limitation during exercise in CF
Keywords:             ADULTS/age/AIR-FLOW                  LIMITATION/BLOOD/body
   weight/CAPACITY/cardiac/cardiac                          output/CARDIAC-OUTPUT
   RK/PERFORMANCE/pulmonary/pulmonary                      hypertension/PULMONARY-
   DISEASE/severity/stroke/stroke volume/UPRIGHT/volume
Stone, G.W., Grines, C.L., Browne, K.F., Marco, J., Rothbaum, D., OKeefe, J., Hartzler,
   G.O., Overlie, P., Donohue, B., Chelliah, N., Vlietstra, R., PuchrowiczOchocki, S.
   and Oneill, W.W. (1996), Influence of acute myocardial infarction location on in-
   hospital and late outcome after primary percutaneous transluminal coronary
   angioplasty versus tissue plasminogen activator therapy. American Journal of
   Cardiology, 78 (1), 19-25.
Abstract: In the Primary Angioplasty in Myocardial Infarction trial, 395 patients with
   acute myocardial infarction (AMI) were prospectively randomized to tissue
   plasminogen activator (tPA) or primary percutaneous transluminal coronary
   angioplasty (PTCA). In 138 patients with anterior wall AMI, in-hospital mortality
   was significantly reduced by treatment with PTCA compared with tPA (1.4% vs
   11.9%, p = 0.01). PTCA also resulted in lower rates of death or reinfarction (1.4% vs
   18.0%, p = 0.0009), recurrent myocardial ischemia (11.3% vs 28.4%; p = 0.01),and
   stroke (0.0% vs 6.0%, p = 0.037) in anterior wall AMI. The independent beneficial
   effect of treatment with primary PTCA rather than tPA in anterior wall AMI was
   confirmed by multivariate analysis and interaction testing. The in- hospital mortality
   of 257 patients with nonanterior wail AMI was similar after PTCA and tPA (3.2% vs
   3.8%, p = 0.82). Compared with tPA, however, primary PTCA resulted in a
   markedly lower rate of recurrent myocardial ischemia (9.7% vs 27.8%, p = 0.0002),
   fewer unscheduled catheterization and revascularization procedures, and a shorter
   hospital stay (7.0 vs 8.6 days, p = 0.01) in nonanterior wall AMI. Thus, compared
   with tPA, primary PTCA in patients with anterior wall AMI results in significantly
   improved survival, with lower rates of stroke, reinfarction, and recurrent myocardial
   ischemia. In nonanterior wall AMI, treatment with PTCA and tPA results in similar
   early mortality, although PTCA-treated patients have a more stable hospital course
   characterized by reduced recurrent ischemia, fewer subsequent invasive procedures,
   and earlier discharge
Keywords:                              acute/acute                            myocardial
   OGRAPHY/effect/hospital/hospital                  mortality/IMMEDIATE/in-hospital
   STREPTOKINASE/ischemia/mortality/multivariate analysis/myocardial/myocardial
   infarction/myocardial                   ischemia/NEW-YORK/outcome/percutaneous
   transluminal/percutaneous                    transluminal                    coronary
   THERAPY/tissue plasminogen/tissue plasminogen activator/treatment/wall
Stergiopulos, N., Meister, J.J. and Westerhof, N. (1996), Determinants of stroke volume
   and systolic and diastolic aortic. American Journal of Physiology-Heart and
   Circulatory Physiology, 39 (6), H2050-H2059.
Abstract: We investigated how parameters describing the heart and the arterial system
   contribute to the systolic and diastolic pressures (P-s and P-d, respectively) and
   stroke volume (SV). We have described the heart by the varying-elastance model
   with six parameters and the systemic arterial tree by the three- element windkessel
   model, leading to a total of nine parameters. Application of dimensional analysis led
   to a total of six dimensionless parameters describing dimensionless P-s and P-d, i.e.,
   pressures with respect to venous pressure (P- s/P-v and P-d/P-v). SV was normalized
   with respect to unloaded ventricular volume (V-d). Sensitivity analysis showed that
   P- s/P-v, P-d/P-v, and SV/V-d could be accurately described by four, three, and three
   dimensionless parameters, respectively. With this limited number of parameters, it
   was then possible to obtain empirical analytical expressions for P-s/P-v, P-d/P-v, and
   SV/V-d. The analytic predictions were tested against the model values and found to
   be as follows: P-s predicted = (1.0007 +/- 0.0062) P-s, r = 0.987; P-d predicted =
   (1.016 +/- 0.0085) P-d, r = 0.992; and SV predicted = (0.9987 +/- 0.0028) SV, r =
   0.996. We conclude that aortic P-s, P-d, and SV can be accurately described by a
   Limited number of parameters and that, for any condition of the heart and the arterial
   system, P-s, P-d, and SV can be presented in analytical form
Keywords: analysis/arterial/arterial system/coupling of heart and arterial
   volume/SWITZERLAND/systolic/three-element                                   windkessel
   model/total/varying-elastance model/ventricular volume/volume
Pianosi, P. and Garros, D. (1996), Comparison of impedance cardiography with indirect
   fick (CO2) method of measuring cardiac output in healthy children during exercise.
   American Journal of Cardiology, 77 (9), 745-749.
Abstract: Electric bioimpedance has been used to measure cardiac output for decades,
   Improvements in modeling and microprocessor technology have spawned newer
   generations of such devices. This method would be especially useful in children, in
   whom the use of invasive methods is limited. We tested a device (ICG-M401, ASK
   Ltd.) in 30 healthy children at 2 levels of exercise (0.5 and 1.5 W/kg), and compared
   impedance measurements of cardiac output (Q(ICG)) With carbon dioxide (CO2)
   rebreathing measurements of cardiac output (Q(RB)). The Q(lCG)-oxygen uptake
   (VO2) relation was expressed by Q(ICG) = 3.8 + 4.6 VO2; r(2) = 0.68, Mean +/- SD
   bias (Q(ICG)-Q(RB)) was 0.14 +/- 1.05 L/min, not significantly different from zero
   (95% confidence interval -0.12 to + 0.44 L/min). All Q(ICG) results were within
   +/-15% of the hypothetical mean value (Bland and Altman analysis). The largest
   deviation of Q(ICG) from Q(RB) was +30%, found in 1 of 57 paired determinations.
   Eighty percent of Q(ICG) values were within +/-20% of the Q(RB) result. We
   conclude that impedance cardiography with the ICG-M401 provided realistic and
   reliable estimates of cardiac output in healthy children during exercise, This, along
   with its ease of operation and utility at rest and during exercise, make it both useful
   and attractive for clinic and research purposes
Keywords:        ACCURACY/analysis/bioimpedance/carbon             dioxide/cardiac/cardiac
   T/STROKE                VOLUME/technology/THORACIC                       ELECTRICAL
Jackson, M.R., Daddio, V.J., Gillespie, D.L. and ODonnell, S.D. (1996), The fate of
   residual defects following carotid endarterectomy detected by early postoperative
   duplex ultrasound. American Journal of Surgery, 172 (2), 184-187.
Abstract: BACKGROUND: The purpose of this study is to evaluate the results of
   color-flow duplex ultrasound (CFB) soon after carotid endarterectomy (CEA) to
   determine the incidence of residual abnormalities and their effect on subsequent
   outcome and management. METHODS: We reviewed 318 consecutive CEAs
   performed over a 48 month-period, Of these, 206 were followed up with CFD, 195
   prior to discharge and 11 at first follow-up (within 9 weeks). Patients (43) followed
   up with only oculoplethysmography (OPG) car those with no OPG or CFD (69) were
   excluded from the study, All CEAs were performed under general anesthesia with
   routine shunting and patch angioplasty. RESULTS: Twelve of the 206 studies (5.8%)
   were abnormal, Two patients with an abnormal CFD sustained perioperative stroke,
   both of whom had distal intimal lesions of >60% diameter stenosis by velocity
   criteria, Four patients had >60% stenosis and were reoperated upon to correct
   technical errors, The remaining 6 patients are asymptomatic, Four had residual
   lesions of <60% stenosis, three of which have returned to normal on subsequent CFD,
   Two residual lesions had >60% stenosis; one returned to normal by CFD and the
   other remains abnormal at 10 months, In the group of 192 normal postoperative CFD
   studies, there were no strokes, deaths, or redo procedures (0%, 95% confidence
   interval 0% to 1.54%) compared with a combined 50% rate (6 of 12) of either stroke
   (2 of 12) or redo procedure (4 of 12) when the postoperative CFD was abnormal
   (95% confidence interval 22.3% to 77.7%, P < 0.0001), During the study period the
   CEA stroke rate was 0.9% (3 of 318), with a combined stroke-mortality rate of 1.3%
   (4 of 318). CONCLUSIONS: Early postoperative CFD identified residual
   abnormalities in 5.8% of carotid endarterectomies despite a low overall stroke
   mortality rate, One half of these abnormalities resulted in stroke or required operative
   correction, Color-flow duplex ultrasound is useful in identifying residual
   abnormalities following CEA and should be considered for intraoperative use
Keywords:          abnormalities/anesthesia/ANGIOGRAPHY/angioplasty/carotid/carotid
Jamerson, K. (1996), The effect of blood pressure reduction on end stage renal disease.
   American Journal of Hypertension, 9 (8), S60-S64.
Abstract: In the past 20 years, clinicians have clearly demonstrated that antihypertensive
   therapy is very effective in reducing the incidence of myocardial infarction and
   stroke. However, little is known about the effects of blood pressure reduction on end
   stage renal disease (ESRD). Data from major clinical studies has clearly shown that
   patients with hypertension have an increased risk of developing ESRD. Black men
   and women with hypertension are at the greatest risk; however, the incidence of
   ESRD is increasing in all racial groups. Because patients with hypertensive ESRD
   often require dialysis, the cost of treating this increasing common disorder has the
   potential to deplete the Medicare system. The primary effect of blood pressure
   reduction in patients with ESRD has not been adequately addressed in any trial that
  has been completed to date. Results from some studies suggest that blood pressure
  reduction may improve renal function and that angiotensin converting enzyme
  inhibitors and calcium channel blockers may have renoprotective effects. Currently
  in progress are two large scale clinical trials that may provide more information on
  the effects of antihypertensive therapy on preventing ESRD in hypertensive patients.
  These are the African American Study of Kidney Disease and Hypertension (AASK),
  and a substudy of the Hypertension Optimal Treatment (HOT) Study. Data from the
  HOT study is expected to be available 5 years prior to that of the ASK Study, which
  is expected to be completed by the year 2002
Keywords: angiotensin/angiotensin converting enzyme/angiotensin converting enzyme
  inhibitors/antihypertensive       therapy/blood/blood         pressure/calcium/calcium
  channel/calcium channel blockers/clinical studies/clinical trials/CONVERTING
  stage                                                                              renal
  infarction/NEW-YORK/pressure/PROGRESSION/renal/renal                       disease/renal
Jama, J.W., Launer, L.J., Witteman, J.C.M., denBreeijen, J.H., Breteler, M.M.B.,
  Grobbee, D.E. and Hofman, A. (1996), Dietary antioxidants and cognitive function
  in a population- based sample of older persons - The Rotterdam study. American
  Journal of Epidemiology, 144 (3), 275-280.
Abstract: Antioxidants have been implicated in processes related to atherosclerosis,
  aging, and selective neuronal damage, all of which may ultimately affect cognitive
  function. In a sample of older persons, the authors examined the cross-sectional
  relation between cognitive function and dietary intake of beta- carotene and vitamins
  C and E. The data were derived from 5,182 community participants aged 55-95 years
  in the population-based Rotterdam Study in the period 1990 to 1993. Dietary intake
  was estimated from a semi-quantitative food frequency questionnaire and categorized
  into five levels of intake. Cognitive function was measured with the 30-point
  Mini-Mental State Examination (MMSE) and characterized as unimpaired (>25
  points) or impaired (less than or equal to 25 points). Logistic regression analysis was
  used to estimate the odds ratio (OR) and 95% confidence interval (CI) for cognitive
  impairment. After adjustment for age, education, sex, smoking, total caloric intake,
  and intake of other antioxidants, a lower intake of beta-carotene was associated with
  impaired cognitive function (<0.9 mg vs, greater than or equal to 2.1 mg intake, OR
  = 1.9, 95% CI 1.2- 3.1; p for trend < 0.04). There was no association between
  cognitive function and intake of vitamins C and E. These cross- sectional
  observations are compatible with the view that beta- carotene-rich foods may protect
  against cognitive impairment in older people. The finding could also reflect
  unmeasured confounding, measurement error, or a change in food habits that resulted
  from rather than preceded the onset of cognitive impairment
  erosclerosis/beta/beta         carotene/caloric         intake/CAROTENE/cognition
  disorders/cognitive                                                  function/cognitive
  ent/measurement/MMSE/neuronal                                             damage/odds
DanilenkoDixon, D.R., Tefft, L., Cohen, R.A., Haydon, B. and Carpenter, M.W. (1996),
  Positional effects on maternal cardiac output during labor with epidural analgesia.
  American Journal of Obstetrics and Gynecology, 175 (4), 867-872.
Abstract: OBJECTIVE: Our purpose was to test the hypothesis that the supine versus
  the lateral position is associated with a greater decrement in cardiac output after
  epidural analgesia in labor. STUDY DESIGN: Twenty-one normal term subjects
  were randomized to the left lateral or supine position in early labor. Cardiac output
  measured by the acetylene rebreathing method, stroke volume, heart rate, mean
  arterial pressure, and systemic vascular resistance were obtained at 5-minute
  intervals, beginning before a 500 ml intravenous fluid bolus (baseline) and ending 45
  minutes after epidural injection. RESULTS: Mean baseline supine versus lateral
  group differences were significant for 21% lower cardiac output, 21% lower stroke
  volume, 19% higher mean arterial pressure, 50% higher systemic vascular resistance,
  and equivalent heart rate. In the supine group fluid bolus resulted in significantly
  increased cardiac output and stroke volume, decreased mean arterial pressure and
  systemic vascular resistance, and unchanged heart rate. In the supine group cardiac
  output and stroke volume decreased significantly after epidural injection. The lateral
  position group exhibited no hemodynamic alterations after fluid bolus or epidural.
  CONCLUSIONS: In contrast to the lateral position, the supine position is associated
  with a significant postepidural decrement in cardiac output, not identified by a
  change in heart rate. This likely reflects an inability to maintain stable preload
  volume in the supine position
Keywords:             ANESTHESIA/arterial/arterial               pressure/cardiac/cardiac
  volume/systemic vascular resistance/test/vascular/vascular resistance/volume
Kannel, W.B., DAgostino, R.B., Belanger, A.J., Silbershatz, H. and Tofler, G.T. (1996),
  Long-term influence of fibrinogen on initial and recurrent cardiovascular events in
  men and women. American Journal of Cardiology, 78 (1), 90-&.
Abstract: Examination of the long-term relation of a single fibrinogen determination to
  initial and recurrent atherosclerotic cardiovascular events over 20 years of follow-up
  revealed a powerful and comparably independent impact on initial events in both
  sexes, but an influence on recurrent events only in men
Keywords:                cardiovascular/cardiovascular              events/CORONARY
Copeland, J.R., Willoughby, K.A., Police, R.J. and Ellis, E.F. (1996), Repeated cocaine
  administration reduces bradykinin-induced dilation of pial arterioles. American
  Journal of Physiology-Heart and Circulatory Physiology, 40 (4), H1576-H1583.
Abstract: Using the acute cranial window technique in rabbits under surgical anesthesia,
  we tested the vasoactivity of acetylcholine (ACh, 10(-8)-10(-5) M), bradykinin (BK,
  10(-8)- 10(-5) M), and asphyxia (10% O-2, 9% CO2, balance N-2) after subchronic
  pretreatment with cocaine. After repeated administration of cocaine (20 mg . kg(-1).
  day(-1) sc x 7 days), the BK-induced dilation of pial arterioles was reduced by 51%.
  Previous work showed that BK produces dilation of pial arterioles by a
  cyclooxygenase-dependent oxygen radical- mediated mechanism and that in rabbits
  the BK-induced dilation is dependent on both vascular and nonvascular
  cyclooxygenase. Selective blockade of vascular cyclooxygenase, in addition to
  cocaine treatment, did not produce any greater inhibition of the BK-induced dilation.
  The dilation in response to ACh and asphyxia was unaltered by cocaine. Levels of
  cerebrospinal fluid prostaglandins suggest cocaine pretreatment may inhibit cerebral
  vascular prostaglandin production. Together, cerebrospinal fluid prostaglandin and
  vasoreactivity data indicate cocaine pretreatment selectively inhibits the vascular
  cyclooxygenase-dependent mechanism mediating the BK-induced dilation. This
  decreased response to BK in cocaine-treated rabbits may result from decreased
  oxygen radical production concomitant with decreased vascular prostaglandin
  production. Alternatively, oxygen radical scavenging may be increased after cocaine
  treatment. We speculate that cocaine-induced alterations in cerebrovascular function
  and metabolism map be related to the increased incidence of stroke reported to occur
  in human cocaine users
  balance/brain blood flow/cerebral/CEREBRAL ARTERIOLES/cerebrospinal
  clooxygenase/drug                            abuse/ENDOTHELIUM-DEPENDENT
  response/SECRETION/stroke/SYSTEMICALLY                              ADMINISTERED
Mazer, C.D., Naser, B. and Kamel, K.S. (1996), Effect of alkali therapy with NaHCO3
  or THAM on cardiac contractility. American Journal of Physiology-Regulatory
  Integrative and Comparative Physiology, 39 (5), R955-R962.
Abstract: We examined the impact of alkali therapy on myocardial contractility in a
  model of myocardial ischemia in dogs using direct measurements of myocardial
  contractile function. Myocardial ischemia in the left anterior descending (LAD)
  artery territory was induced using a perfusion circuit from the internal carotid artery
  to the LAD artery. Myocardial contractile function was assessed using
  sonomicrometry for measurement of percent systolic shortening (%SS), preload
  recruitable stroke work (PRSW) slope, and end-systolic pressure-length relationship
  (ESPLR) area. Because the blood flow in LAD artery was diminished by similar to
  70%, there was a significant decrease in O-2 delivery and uptake by the ischemic
  myocardium. Ischemia led to a significant fall in LAD regional contractile function
  with %SS decreasing from 15 +/- 2 to 7 +/- 2%, PRSW slope from 82 +/- 10 to 37
  +/- 5 mmHg, and ESPLR area from 121 +/- 2 to 48 +/- 14 mmHg . mm (P < 0.05). In
  six dogs, the intracoronary administration of NaHCO3 resulted in a significant
  increase in pH in LAD arterial and venous blood. There was, however, no significant
  increase in %SS (6 +/- 2), PRSW slope (43 +/- 10 mmHg), or ESPLR area (60 +/- 13
  mmHg . mm). Since administration of NaHCO3 resulted in a significant increase in
  P-co2 in LAD arterial and venous blood, similar experiments were carried out in five
  dogs, but with the intracoronary infusion of the amine buffer THAM
  [tris(hydroxymethyl)aminomethane            (Tris)         buffer;         2-amino-2-
  hydroxyl-1,3-propandiol] instead of NaHCO3. Although administration of THAM
  resulted in a significant increase in pH and a significant decrease in P-co2, in both
  LAD arterial and venous blood, there was no significant improvement in any of the
  parameters used to assess myocardial contractile function. In conclusion,
  administration of alkali (NaHCO3 or THAM) does not enhance the contractile
  function of the ischemic myocardium
Keywords: administration/arterial/artery/BICARBONATE THERAPY/blood/blood
  flow/BLOOD-FLOW/CANADA/cardiac/cardiac                      contractility/carotid/carotid
  artery/contractility/dogs/end-systolic                                   pressure-length
  relationship/flow/function/internal/internal           carotid/internal           carotid
  contractility/myocardial                                    ischemia/MYOCARDIAL-
  recruitable      stroke      work/RAT        HEARTS/RECRUITABLE                STROKE
  WORK/regional/stroke/stroke work/systolic/systolic shortening/therapy/work
Kannel, W.B. (1996), Cardioprotection and antihypertensive therapy: The key
  importance of addressing the associated coronary risk factors - (The Framingham
  Experience). American Journal of Cardiology, 77 (6), B6-B11.
Abstract: Hypertension directly predisposes to all of the major atherosclerotic
  cardiovascular disease outcomes, including coronary artery disease, stroke, cardiac
  failure, and peripheral artery disease. Coronary artery disease deserves a high priority
  in treatment of hypertension because it is the most common and lethal sequela.
  However, reduction of blood pressure as the sole therapeutic goal of antihypertensive
  therapy is no longer appropriate. Hypertension tends to cluster with other atherogenic
  risk factors, including dyslipidemia, glucose intolerance, insulin resistance, obesity,
  and elevated uric acid. Hypertension is only one of the many risk factors for
  atherosclerotic cardiovascular disease and is variably hazardous, depending on the
  number and severity of these coexistent metabolically linked risk factors. The
  presence of coexistent, already overt cardiovascular disease and left ventricular
  hypertrophy also greatly influence the hazard and choice of therapy. The urgency for,
  and choice of, therapy should be based on the multivariate cardiovascular risk profile
  rather than relying solely on the character and severity of the blood pressure
  elevation. In this way at-risk hypertensive persons can be more appropriately
  targeted for treatment designed to improve their multivariate risk profile and to
  provide maximum benefit and cost effectiveness
Keywords:                    antihypertensive                  therapy/artery/blood/blood
  pressure/cardiac/cardiovascular/cardiovascular                    disease/cardiovascular
  risk/coronary/coronary artery/coronary artery disease/coronary risk/cost/cost
  se/HEART/HYPERTENSION/hypertrophy/insulin/left ventricular/left ventricular
  tance/risk/risk factors/severity/stroke/therapy/treatment/uric acid
deSimone, G., Devereux, R.B., Ganau, A., Hahn, R.T., Saba, P.S., Mureddu, G.F.,
  Roman, M.J. and Howard, B.V. (1996), Estimation of left ventricular chamber and
  stroke volume by limited M-mode echocardiography and validation by two-
  dimensional and Doppler echocardiography. American Journal of Cardiology, 78 (7),
Abstract: This study has been designed to improve estimation of stroke volume from
  linear left ventricular (LV) dimensions measured by M-mode echocardiography, in
  symmetrically contracting ventricles. In experimental studies, the ratio of LV
  epicardial long/short axes ''Z'' is about 1.3. We measured systolic and diastolic
  epicardial long and short axes by 2-dimensional echocardiography in 115 adults with
   widely varying LV short- axis dimensions (LV end-diastolic dimension = 3.95 to 8.3
   cm). In a learning series of 23 normotensive and 27 hypertensive subjects, Z(diastole)
   was 1.3 +/- 0.1 and Z(systole) = 1.2 +/- 0.1, similar to findings in experimental
   animals. Regression equations were developed by comparing LV volumes by
   M-mode and 2-dimensional echocardiography. In a test series (65 subjects), LV
   volumes were calculated using separate regression equations for end-diastolic
   volume ([LV end-diastolic dimension](2) 4.765 - 0.288 x posterior wall thickness])
   and for end-systolic volume ([LV end-systolic dimension](2)[4.136 - 0.288 x
   posterior wall thickness]). Because the term 0.288 x wall thickness was only about
   8% of the first term between brackets, the average wall thickness in the learning
   series was substituted in the Z-volume formulas applied to the test series:
   end-diastolic volume = (4.5 x [LV end-diastolic dimensions](2)) and end-systolic
   volume = (3.72 x [LV end- diastolic dimension](2)). The mean relative error
   produced with this simplified method was 0.9% in diastole and 1.4% in systole.
   Compared with Teichholz' M-mode volume method, Z- derived end-diastolic volume
   in the test series was equally well related to 2-dimensional volumes (both r =
   0.88),with a better intercept (1.5 vs -23 ml, p < 0.001) and a slope closer to the
   identity line (1.1 vs 1.4). Similar results were found for systolic volumes. In a second
   test series of 1,721 American Indian participants in the Strong Heart Study without
   mitral regurgitation or segmental LV wall motion abnormalities, Doppler-derived LV
   stroke volume (70 +/- 14 ml/beat) was similarly predicted by the Z-derived method (r
   = 0.65, 70 +/- 11 ml/beat) and Teichholz formulas (r = 0.64, 72 +/- 13 ml/beat), but
   Z-derived volumes had a regression line significantly closer to the identity line (p <
   0.005). Thus, LV chamber and stroke volumes can be determined from M-mode LV
   diameters over a wide range of LV sizes and in epidemiologic as well as clinical
   populations. The performance of this new method appears better than that obtained
   using the Teichholz formula, with a formula that is easy to handle and makes
   calculation of LV volumes by pocket calculator possible, even from limited
   echocardiographic studies
   pler                                  echocardiography/echocardiography/end-diastolic
   volume/experimental/HYPERTENSION/learning/left                         ventricular/mitral
   volume/systolic/test/ventricles/volume/wall/wall thickness
Johnstone, M.T., Mittleman, M., Tofler, G. and Muller, J.E. (1996), The
   pathophysiology of the onset of morning cardiovascular events. American Journal of
   Hypertension, 9 (4), S22-S28.
Abstract: Evidence obtained over the past decade indicates that myocardial infarction
   (MI) and sudden death are not random events but rather, in many cases, may be
   triggered by the daily activities of the subject, The importance of physical or mental
   stresses as triggers is suggested by the parallel morning increased onsets of MI,
   sudden cardiac death, and stroke. Unstable angina and MI are usually precipitated by
   thrombus formation over a disrupted plaque that causes partial or complete
   obstruction of coronary artery blood now. This process may be caused by
   physiologic factors that lead to rupture of a vulnerable plaque and subsequent
   thrombosis. beta-Blockers and aspirin, which can diminish these physiologic
   processes, have been shown to blunt or abolish the morning peak of onset of acute
   MI. It is hypothesized that occlusive coronary thrombosis occurs when an
   atherosclerotic plaque becomes vulnerable to rupture, and mental or physical stress
   causes the plaque to rupture. Increases in coagulability or vasoconstriction triggered
   by daily activities may also contribute to complete occlusion of the coronary artery
   lumen. Recognition of the circadian variation of the onset of acute cardiovascular
   disease suggests the need for pharmacologic protection of patients during the
   vulnerable periods and provides clues to the mechanism of disease onset, the
   investigation of which may lead to improved methods of prevention
Keywords: acute/acute cardiovascular disease/acute myocardial infarction/ACUTE
   disease/cardiovascular         events/CASE-CROSSOVER/causes/circadian/circadian
   rhythm/CIRCADIAN                                       VARIATION/coronary/coronary
   ethods/myocardial/myocardial          infarction/NEW-YORK/occlusion/pharmacologic
   protection/physical               stress/plaque/plaque           rupture/PLATELET
   oke/SUDDEN                             CARDIAC                        DEATH/sudden
   ANGINA-PECTORIS/variation/vasoconstriction/vulnerable plaque
Paty, P.S.K., Darling, R.C., Cordero, J.A., Shah, D.M., Chang, B.B. and Leather, R.P.
   (1996), Carotid artery bypass in acute postendarterectomy thrombosis. American
   Journal of Surgery, 172 (2), 181-183.
Abstract: BACKGROUND: Carotid endarterectomy has demonstrated excellent results
   over the past 2 decades with combined stroke mortality of <4% in most active
   centers, However, the optimal technique for surgical reconstruction for patients with
   acute postoperative deficits is more controversial. PATIENTS AND METHODS: In
   the last 10 years (1985 to 1995), we performed 1,267 carotid endarterectomies, with
   17 strokes (1.3%) and 16 deaths (1.2%), Twenty-four patients developed acute
   (within 72 hours) postoperative neurologic deficits, In 10 patients, the carotid artery
   was confirmed patent by duplex scan or angiography, and the neurologic deficit
   resolved without further therapy, Early reexploration was performed in 14 cases for
   suspected thrombosis associated with a new neurologic deficit, In each case,
   resection of the endarterectomy site and an interposition bypass was performed with
   greater saphenous vein (11), jugular vein (2), or polytetrafluoroethylene (2) grafts,
   (One patient required a new bypass for acute occlusion of the initial vein bypass.)
   Postoperatively, 8 patients had complete resolution of their deficit, 3 had minimal
   residual deficits, and 3 suffered permanent stroke, However, 2 of these patients died.
   RESULTS: Carotid artery bypass with exclusion of the endarterectomy site resulted
   in improvement in symptoms in 79% (11 of 14) of the patients and complete
   resolution in 57% (8 of 14), In long-term follow up (1 to 41 months), there have been
   no occlusions and one restenosis requiring revision at 11 months. CONCLUSIONS:
   Carotid artery bypass can be performed safely with acceptable results, The use of
   autogenous venous conduits allows reconstruction with an endothelial lined conduit
   that may improve results in patients with acute postoperative neurologic deficit
   secondary to thrombosis of the endarterectomized carotid artery
Keywords:                         acute/ACUTE                        POSTOPERATIVE
   URGERY/surgical reconstruction/symptoms/therapy/thrombosis
Jones, E.F., Calafiore, P., Mcneil, J.J., Tonkin, A.M. and Donnan, G.A. (1996), Atrial
   fibrillation with left atrial spontaneous contrast detected by transesophageal
   echocardiography is a potent risk factor for stroke. American Journal of Cardiology,
   78 (4), 425-429.
Abstract: Nonrheumatic atrial fibrillation (AF) frequently coexists with other risk
   factors for cerebral ischemia. This study was originally designed to determine which
   combinations of clinical and echocardiographic abnormalities were most closely
   associated with the risk of cerebral ischemic events. Patients with cerebral ischemic
   events (n = 214) and community-based control subjects (n = 201) underwent
   transesophageal echocardiography and carotid artery imaging. Adjusted odds ratios
   (ORs) were determined using multiple logistic regression analysis. Independent risk
   factors for cerebral ischemia included diabetes, carotid stenosis, aortic sclerosis, left
   ventricular dysfunction, left ventricular hypertrophy, left atrial (LA) spontaneous
   contrast, and proximal aortic atheroma. Nonrheumatic AF in combination with LA
   spontaneous contrast and LA enlargement showed a strong association with cerebral
   ischemic events (OR 33.7 [95% confidence interval 4.53 to 251]). In subjects with
   sinus rhythm or nonrheumatic AF, LA enlargement was not associated with an
   increased risk of cerebral ischemic events in the absence of LA spontaneous contrast.
   However, only 2 patients and 1 control subject had nonrheumatic AF without LA
   spontaneous contrast or LA enlargement. Therefore, study of a larger number of
   subjects is required to address the issue of whether nonrheumatic AF itself carries
   increased risk. The combination of nonrheumatic AF with LA spontaneous contrast
   is a potent risk factor for cerebral ischemia. Ascertaining the risk factor in
   nonrheumatic AF requires adequate examination for underlying cardiac, aortic, and
   carotid vascular disease. Transesophageal echocardiography may contribute to this
Keywords:               abnormalities/AF/analysis/artery/assessment/atheroma/atrial/atrial
   fibrillation/cardiac/carotid/carotid       artery/carotid      stenosis/cerebral/cerebral
   mic/left        ventricular/left      ventricular       dysfunction/left      ventricular
   hypertrophy/NEW-YORK/nonrheumatic/PROGNOSTIC IMPLICATIONS/risk/risk
   factor/risk      factors/sinus       rhythm/spontaneous/SPONTANEOUS               ECHO
   echocardiography/vascular/vascular disease
Huang, B.J., Rodriguez, B.L., Burchfiel, C.M., Chyou, P.H., Curb, J.D. and Yano, K.
   (1996), Acculturation and prevalence of diabetes among Japanese- American men in
   Hawaii. American Journal of Epidemiology, 144 (7), 674-681.
Abstract: The association between acculturation to a Western lifestyle and prevalence of
   diabetes was examined among 8,006 Japanese- American men in Hawaii with
   varying degrees of exposure to traditional Japanese social and cultural lifestyles in
   1965- 1968. A reduced prevalence of diabetes was observed among the men who had
   retained a more Japanese lifestyle. These men also reported higher levels of physical
   activity and consumed more carbohydrates and less fat and animal protein in their
   diet. An inverse association between diabetes and being born in Japan was observed
   independent of age, body mass index, physical activity, and percentages of calories
   from fat or carbohydrates (odds ratios = 0.67 and 0.66, 95% confidence intervals
   0.49- 0.93 and 0.48-0.91, respectively). The number of total years lived in Japan was
   inversely associated with prevalent diabetes after controlling for age, body mass
   index, and physical activity (odds ratio = 0.81, 95% confidence interval 0.68- 0.96).
   Current Oriental diet (compared with Western diet) was inversely associated with
   prevalent diabetes after controlling for age, body mass index, and physical activity
   (odds ratio = 0.71, 95% confidence interval 0.50-0.98). These findings suggest that
   living a Japanese lifestyle is associated with a reduced prevalence of diabetes
Keywords: acculturation/activity/age/animal/BIRTH-WEIGHT/body mass/body mass
   index/confidence/CORONARY                            HEART-DISEASE/diabetes/diabetes
   Japanese/life                          style/lifestyle/MELLITUS/men/MIDDLE-AGED
   MEN/MORTALITY/odds                                                          ratio/physical
   activity/PHYSICAL-ACTIVITY/prevalence/PROGRAM/risk factors/STROKE/total
Ende, D.J., Chopra, P.S. and Rao, P.S. (1996), Transcatheter closure of atrial septal
   defect or patent foramen ovale with the buttoned device for prevention of recurrence
   of paradoxic embolism. American Journal of Cardiology, 78 (2), 233-236
Keywords:       atrial/embolism/foramen ovale/NEW-YORK/patent/patent                 foramen
Slangen, B.F.M., Out, I.C.M., Verkeste, C.M. and Peeters, L.L.H. (1996),
   Hemodynamic changes in early pregnancy in chronically instrumented, conscious
   rats. American Journal of Physiology-Heart and Circulatory Physiology, 39 (5),
Abstract: To explore the onset of and the interrelationship between maternal
   hemodynamic changes in pregnancy, serial hemodynamic measurements were
   performed in chronically instrumented, conscious rats using electromagnetic flow
   probes around the ascending aorta and arterial catheters. The rats were studied daily
   from day 4 to day 12 and on days 14, 18, and 20 of pregnancy. Nonpregnant (NP)
   rats matched for age and days postsurgery served as controls. In the pregnant (P)
   group, the hematocrit started to decrease by postconceptional day 6 (day of
   implantation) to reach a value of 9 +/- 3% below the initial level by day 8. In these 2
   days, cardiac output (CO) increased by 9 +/- 4%, as a result of a rise in stroke
   volume (SV). No changes in mean arterial pressure were observed. In both groups,
   heart rate (HR) had decreased by day 7. Aortic flow acceleration and peak aortic
   flow, indicators of myocardial contractility, increased from day 10 on only in the P
   group. In this context, it should be emphasized that the results of this study do not
   allow differentiation between the contractile properties of the cardiac muscle and the
   contractile changes as a result of the altered preload and afterload. By days 12 and 18,
   CO had increased by 20 +/- 5 and 29 +/- 9%, respectively, above the initial value and
   by 25 and 40%, respectively, above the value observed in the NP group. The rise in
   CO after day 14 was accomplished by a concomitant increase in HR and SV and was
   accompanied by a further increase in myocardial performance. We conclude that
   hemodynamic changes can already be identified by day 8 of rat pregnancy, 2 days
   after implantation. The rise in CO in early pregnancy results from a selective
   increase in SV and is accompanied by a rise in myocardial performance
Keywords:           afterload/age/aorta/arterial/arterial    pressure/ascending/ascending
   pregnancy/electromagnetic                      flow               probe/flow/heart/heart
   rate/hematocrit/hemodynamic/hemodynamic                                    changes/mean
   arterial/measurements/muscle/myocardial/myocardial              contractility/myocardial
  HYPERTENSIVE                RATS/stroke/stroke           volume/UTEROPLACENTAL
Skarda, R.T. and Muir, W.W. (1996), Analgesic, hemodynamic, and respiratory effects
  of caudal epidurally administered xylazine hydrochloride solution in mares.
  American Journal of Veterinary Research, 57 (2), 193-200.
Abstract: Objective-To examine effects of 0.25 mg of xylazine/kg of body weight
  diluted to a total volume of 6 ml/450 kg with sterile 0.9% NaCl, administered into
  the epidural space of the sacrococcygeal joint on perineal analgesia, sedation, ataxia,
  and respiratory and cardiovascular function in standing mares. Design-Randomized,
  blinded study, using xylazine (treatment) and 0.9% NaCl (controls). At least 2 weeks
  elapsed between the treatments. Animals-Eight healthy mares. Procedure-Blood
  samples were drawn. Systemic hemodynamics were determined, including cardiac
  output and pulmonary arterial, systemic arterial, and right atrial pressures. Two-way
  ANOVA with repeated measures was used to detect significant (P < 0.05) differences
  between mean scores of analgesia, sedation, ataxia, and cardiorespiratory variables
  before and during a 3-hour testing period. Analgesia was determined by lack of
  sensory perception to electrical stimulation at the perineal dermatome and no
  response to needle prick stimulation extending from coccyx to S3 dermatomes.
  Sedation was determined by head ptosis. Results-Epidurally administered xylazine
  induced variable bilateral caudal analgesia extending from coccyx to S3, with
  minimal sedation, ataxia, and cardiovascular and respiratory depression in standing
  mares. Analgesia was attained at 15 +/- 6 minutes and lasted for 165 to over 180
  minutes. Heart and respiratory rates, systolic, diastolic, and mean arterial blood
  pressure, PCV, hemoglobin concentration, arterial oxygen content, and oxygen
  transport were decreased after xylazine, but not 0.9% NaCl, treatment. Cardiac
  output, stroke volume, mean right atrial pressure, mean pulmonary artery pressure,
  systemic vascular resistance, pulmonary vascular resis tance, arterial and mixed
  venous pH and gas tensions (Po-2, and Pco(2)), oxygen consumption, blood
  temperature, and rectal temperature did not change significantly (P < 0.05) after
  epidural administration of xylazine or 0.9% NaCl. Conclusions-Caudal epidurally
  administered xylazine (0.25 mg/kg in 6 ml of 0.9% NaCl) can be given safely to
  induce prolonged (> 2 hours) caudal analgesia with minimal sedation, ataxia, and
  circulatory and respiratory disturbances in conscious, standing mares
Keywords:                  administration/analgesia/arterial/arterial               blood
  pressure/artery/ataxia/atrial/bilateral/blood/blood                       pressure/body
  weight/cardiac/cardiac                             output/cardiovascular/cardiovascular
  IDOCAINE/mean            arterial/MEDICAL/oxygen/oxygen             consumption/oxygen
  artery/resistance/response/scores/sedation/STATE/stroke/stroke         volume/systemic
  vascular       resistance/systolic/temperature/testing/total/treatment/vascular/vascular
Essig, M., vonKummer, R., Egelhof, T., Winter, R. and Sartor, K. (1996), Vascular MR
  contrast enhancement in cerebrovascular disease. American Journal of
  Neuroradiology, 17 (5), 887-894.
Abstract: PURPOSE: To determine the significance of vascular enhancement in stroke
  patients with and without permanent neurologic deficit. METHODS: We
  prospectively studied two groups of patients with spin-echo MR imaging before and
  after injection of gadopentetate dimeglumine. In the patients in group 1 (12 women,
  22 men; age range, 32 to 76 years), who had permanent neurologic deficit caused by
  recent ischemic brain infarction, we obtained 3 to 13 serial MR images during
  follow-up examination. Group 2 consisted of 26 patients (14 women, 12 men; age
  range, 54 to 81 years) with transient neurologic deficit caused by angiographically
  proved high-grade stenosis or occlusion of the internal carotid artery. RESULTS:
  Vascular enhancement was present in 59% of patients in group 1 and in 65% of
  patients of group 2. In group 1, the frequency of vascular enhancement declined
  steadily over several weeks, but it was still present in single cases even after 3
  months. Vascular enhancement correlated positively with the extent of brain
  infarction in group 1 and with the degree of carotid stenosis in group 2.
  CONCLUSION: Vascular enhancement as shown by MR imaging may herald
  ischemic brain infarction and could persist over several weeks in areas that show
  collateral flow after infarction has occurred
Keywords: age/APPEARANCE/artery/BLOOD/brain/brain infarction/carotid/carotid
  artery/carotid stenosis/CEREBRAL INFARCTION/cerebrovascular/cerebrovascular
  disease/contrast                                   enhancement/CT/disease/flow/follow
  up/follow-up/GD-DTPA/infarction/internal/internal           carotid/internal       carotid
  stroke patients/transient/vascular/women
Hobbs, R.E., Miller, L.W., BottSilverman, C., James, K.B., Rincon, G. and Grossbard,
  E.B. (1996), Hemodynamic effects of a single intravenous injection of synthetic
  human brain natriuretic peptide in patients with heart failure secondary to ischemic
  or idiopathic dilated cardiomyopathy. American Journal of Cardiology, 78 (8),
Abstract: Synthetic human brain natriuretic peptide (sBNP) is a polypeptide with the
  same amino acid sequence, as the naturally occurring hormone, Preclinical studies
  have demonstrated that BNP has potent hemodynamic, diuretic, and natriuretic
  effects that might be beneficial in treating patients with heart- failure. This study was
  a randomized, double-blind, placebo- controlled, ascending-dose trial of sBNP
  administered as a single intravenous bolus in 27 heart failure patients, Six groups of
  patients received sequentially increasing doses of sBNP (0.3, 1, 3, 10, 15, and 20 mu
  g/kg, respectively) as a single intravenous injection, and hemodynamics were
  assessed by pulmonary artery monitoring catheter, the 10 and 15 mu g/kg doses of
  sBNP resulted in significant reductions in pulmonary capillary wedge pressure (-73%,
  p < 0.001), mean pulmonary artery pressure (-41%, p < 0.001), mean arterial blood
  pressure (-28%, p = 0.001), and systemic: vascular resistance (-53%, p = 0.004),
  Significant increases occurred in cardiac index (68%, p < 0.001) and stroke volume
  index (72%, p < 0.001), The magnitude and duration of hemodynamic changes were
  dose dependent, There were no adverse effects, sBNP injected as a single
  intravenous bolus in heart failure patients improves hemodynamics in a dose-related
  fashion, Further clinical investigations to determine the use of sBNP in
  decompensated heart failure are clearly warranted
Keywords:            arterial/arterial         blood          pressure/artery/blood/blood
  pressure/BNP/brain/cardiac/cardiac                        index/cardiomyopathy/dilated
  artery/resistance/stroke/stroke volume/vascular/vascular resistance/volume
EquiluzBruck, S., Schnack, C., Kopp, H.P. and Schernthaner, G. (1996), Nondipping of
  nocturnal blood pressure is related to urinary albumin excretion rate in patients with
  type 2 diabetes mellitus. American Journal of Hypertension, 9 (11), 1139-1143.
Abstract: Although cardiovascular and cerebrovascular morbidity and mortality in type
  2 diabetic patients is closely related to urinary albumin excretion rate (UAER), the
  causative mechanisms are not yet identified. The aim of our study was to define the
  circadian variation of blood pressure (BP) in 72 type 2 diabetic patients (mean age 60
  years, mean diabetes mellitus duration: 12 years) in comparison with 41 nondiabetic
  controls with essential hypertension (mean age 58 years) by using ambulatory blood
  pressure measurement. Thirty diabetic patients had normal UAER (< 30 mg/24 h), 27
  had microalbuminuria (30 to 300 mg/24 h), and 15 had persistent proteinuria (> 300
  mg/24 h). Systolic blood pressure during both nighttime and daytime was
  significantly elevated in type 2 diabetic patients with macroalbuminuria compared to
  controls and patients with normal UAER. During nighttime even type 2 diabetic
  patients with microalbuminuria had significantly elevated systolic blood pressure
  compared to controls with essential hypertension. We also observed a correlation of
  nocturnal blood pressure to UAER (systolic: r = 0.32, P < .007 and diastolic: r = 0.24,
  P < .04). Nondipping (defined as a reduction of nocturnal BP < 10%) was observed
  in 80% of the macroalbuminuric, 74% of the microalbuminuric, but only in 43% of
  the normoalbuminuric type 2 diabetic patients and in 37% of the controls (P < .04).
  Since a loss of circadian variation of BP is closely related to vascular complications
  in nondiabetics, our findings may indicate an important relationship between
  nondipping of BP and the high morbidity and mortality rate in diabetic patients with
  increased UAER
Keywords:       age/albumin/ambulatory/ambulatory         blood      pressure/blood/blood
  ROALBUMINURIA/morbidity/morbidity                 and      mortality/mortality/mortality
  rate/NEPHROPATHY/NEW-YORK/NIDDM/nocturnal                         blood        pressure
  drop/pressure/proteinuria/rate/SCIENCE/STROKE/systolic/systolic                   blood
  pressure/urinary albumin excretion/vascular/WHITE COAT
Similowski, T., Catala, M., Rancurel, G. and Derenne, J.P. (1996), Impairment of
  central motor conduction to the diaphragm in stroke. American Journal of
  Respiratory and Critical Care Medicine, 154 (2), 436-441.
Abstract: Respiratory complications are common in patients with stroke, but the
  involvement of the diaphragm in this setting is not completely understood. The
  purpose of this study was to assess corticodiaphragmatic pathways in patients with
  vascular hemiplegia. Fifteen patients were studied, nine with a capsular type of
  hemiplegia. Seven age-matched subjects served as the control group, and eight
  healthy young volunteers were studied to validate the methods by comparison with
  the literature. Diaphragm electromyogram was recorded bilaterally, using surface
  electrodes. Abductor pollicis brevis electromyogram was also recorded. After having
  checked the integrity of peripheral conduction, corticofugal pathways were studied
  using cortical magnetic stimulation, a reproducible and patient-independent stimulus.
   Left and right conduction times to the diaphragm were symmetrical in the control
   subjects, the young volunteers, and the six patients with hemiplegia but without
   capsular lesion (16.5 to 20.1 ms). Conversely, they were markedly asymmetrical in
   patients with capsular hemiplegia, diaphragm response on the plegic side being
   abolished or markedly delayed. Although the clinical impact of these findings
   remains to be determined, this study confirms that ''central diaphragm paralysis'' can
   be present in stroke. It also indicates that there is no bilateral motor representation of
   each hemidiaphragm
Pypendop, B., Serteyn, D. and Verstegen, J. (1996), Hemodynamic effects of
   medetomidine-midazolam-butorphanol                                                    and
   medetomidine-midazolam-buprenorphine combinations and reversibility by
   atipamezole in dogs. American Journal of Veterinary Research, 57 (5), 724-730.
Abstract: Objective-To characterize the hemodynamic effects of medetomidine (1
   mg/m(2) of body surface area; dosage, 39 to 46 mu g/kg of body weight, IM] and
   midazolam (1 mg/kg of body weight, IV) combined with butorphanol (0.1 mg/kg,
   IV), buprenorphine (10 mu g/kg, IV), or saline solution. Reversibility of these effects
   by atipamezole (2.5 mg/m(2); dosage, 97.5 to 115 mu g/kg, IM) was evaluated.
   Design-2 treated groups and 1 control group, without repetition. Animals-15
   clinically normal dogs (3 groups of 5). Procedure- Medetomidine was administered
   at time 0; midazolam and butorphanol, buprenorphine, or saline solution at time 20;
   and atipamezole at time 60. Heart rate, systemic and pulmonary arterial pressures,
   central venous pressure, body temperature, cardiac output, and arterial and mixed
   venous blood gas tensions and pH were measured. Cardiac index, stroke index,
   systemic and pulmonary vascular resistances, and left and right stroke work indexes
   were calculated. Results-Body temperature, heart rate, cardiac index, and stroke
   index were significantly decreased below baseline values in some groups. Central
   venous pressure, pulmonary capillary wedge pressure, and systemic vascular
   resistance were significantly increased above baseline in all groups, Arterial and
   venous P-o2 and pH decreased in all groups and P-co2 increased, but these changes
   were more pronounced when buprenorphine was administered. Arterial pressure
   decreased after atipamezole administration. Conclusions-The combinations seemed
   to result in cardiorespiratory depressant effects of similar importance and most of
   these effects, which are related to medetomidine, were reversed by atipamezole
Keywords:                             administration/AGENTS/ALPHA-2-ADRENERGIC
   AGONIST/ANESTHESIA/arterial/atipamezole/blood/body                      temperature/body
   weight/cardiac/cardiac            index/cardiac            output/central          venous
   MERS/stroke/stroke              index/stroke            work/systemic            vascular
   resistance/temperature/vascular/vascular resistance/work/XYLAZINE
Iafrati, M.D., Salamipour, H., Young, C., Mackey, W.C. and ODonnell, T.F. (1996),
   Who needs surveillance of the contralateral carotid artery? American Journal of
   Surgery, 172 (2), 136-139.
Abstract: BACKGROUND: Although the value of carotid endarterectomy has been
  proven, postoperative surveillance remains controversial. The purpose of this study
  was to determine the natural history of disease progression in the contralateral
  carotid artery by duplex surveillance, and to assess the cost of stroke prevention on
  this contralateral side. METHODS: Vascular laboratory records were reviewed to
  identify carotid endarterectomy patients who had two or more duplex studies
  between 1984 and 1995. Critical stenosis was defined as greater than or equal to 75%
  area reduction. RESULTS: In all, 324 patients were followed up with duplex scans
  for 1 month to 11 years (mean 30.3 months). The only factors that correlated with
  progression to critical stenosis were age and initial stenosis. Overall, 19.5% of
  patients progressed to critical stenosis within 5 years while the high-risk groups with
  age >65 years or initial stenosis greater than or equal to 50% progressed to critical
  disease in 27% and 39%, respectively (P less than or equal to 0.05). The cost per
  stroke prevented ranged from $143,500 to $418,200 when stratified by initial
  stenosis. CONCLUSION: Patients who have undergone a carotid endarterectomy
  demonstrate a propensity for progression of carotid stenosis in the unoperated
  (contralateral) artery, The cost/benefit ratio may be improved by varying the
  intensity of duplex surveillance of the contralateral carotid based on the patient's age
  and initial degree of stenosis
Keywords:       age/artery/carotid/carotid      artery/carotid    endarterectomy/carotid
  stenosis/CO/cost/COST-EFFECTIVENESS/degree                                            of
  troke prevention/WASHINGTON
Soma, J., Aakhus, S., Dahl, K., Slordahl, S., Wiseth, R., Wideroe, T.E. and Skjaerpe, T.
  (1996), Hemodynamics in white coat hypertension compared to ambulatory
  hypertension and normotension. American Journal of Hypertension, 9 (11),
Abstract: Hemodynamic alterations associated with the blood pressure response in
  subjects with white coat hypertension may provide insight into the pathophysiologic
  mechanisms of this condition. Systemic arterial hemodynamics were investigated
  with a recently validated method based on noninvasive estimates of aortic root
  pressure and now in 28 subjects with white coat hypertension (diastolic pressure
  greater than or equal to 90 mm Hg measured by the general practitioner [GP arterial
  pressure] and ambulatory daytime pressures < 140/90 mm Hg), in 23 subjects with
  previously untreated, ambulatory hypertension (GP diastolic pressure greater than or
  equal to 90 and < 115 mm Hg and ambulatory daytime diastolic pressure greater than
  or equal to 90 mm Hg), and in 32 normotensive subjects. The groups did not differ
  significantly concerning age, gender, body surface area, heart rate, stroke index and
  cardiac index, but total peripheral resistance index was increased and total arterial
  compliance reduced in the white coat group and the hypertensive group compared to
  the normotensive group. The subjects in the white coat group with a systolic arterial
  pressure during echocardiography that was > 5 mm Hg higher than the ambulatory
  daytime systolic pressure (n = 19) had increased cardiac index, increased total
  peripheral resistance, and decreased total arterial compliance compared to the
  normotensive group. The subjects in this group with a hemodynamic pattern
  characterized by a high ratio of cardiac index/peripheral vascular resistance were
  significantly younger than the subjects with the opposite pattern. Thus, the blood
  pressure increase in subjects with white coat hypertension is associated with
  increased cardiac output, increased peripheral vascular resistance, and reduced total
   arterial compliance, but the hemodynamic pattern may be influenced by age
Keywords:       AGE/ambulatory/ambulatory          blood     pressure/ARTERIAL/arterial
   compliance/arterial pressure/blood/blood pressure/BLOOD-PRESSURE/calibrated
   subclavian         artery       pulse        trace/cardiac/cardiac       index/cardiac
   resistance/peripheral                                                       resistance
   index/systolic/total/total peripheral resistance/VALIDATION/vascular/vascular
   resistance/white coat hypertension
Ito, H., Takaki, M., Yamaguchi, H., Tachibana, H. and Suga, H. (1996), Left ventricular
   volumetric conductance catheter for rats. American Journal of Physiology-Heart and
   Circulatory Physiology, 39 (4), H1509-H1514.
Abstract: Left ventricular (LV) volume (V) is an essential parameter for assessment of
   the cardiac pump function. Measurement of LVV in situ by a conductance catheter
   method has been widely used in dogs and humans but not yet in small experimental
   animals such as rats. We instituted a miniaturized six-electrode conductance catheter
   (3-F) for rat LVV measurement and its signal processing apparatus. We compared
   stroke volumes (SVs) simultaneously measured with this conductance catheter
   introduced into the LV through the apex and an electromagnetic flow probe placed
   on the ascending aorta during gradual decreases in LVV by an inferior vena caval
   occlusion. A high and linear correlation (r = 0.982) was obtained between these
   differently measured SVs pooled from six rats. In another group of three rats, LV
   pressure was simultaneously measured with a 3-F catheter-tip micromanometer
   introduced into the LV through the apex. We obtained the slope of the end-systolic
   pressure- volume (P-V) relationship (E(max)) by a gradual ascending aortic
   occlusion. After administration of propranolol, E(max) obviously decreased with no
   change in volume intercept of the P-V relationship. The conductance volumetry
   proved to be useful in rats
Keywords:                               administration/animals/aorta/ascending/ascending
   aorta/assessment/cardiac/cardiac pump function/CARDIAC-OUTPUT/conductance
   catheter/correlation/DIMENSIONS/dogs/electromagnetic flow probe/end-systolic
   processing/small/stroke/ventricular volume/volume/volumetry
Pratt, J.W., Schertel, E.R., Schaefer, S.L., Esham, K.E., McClure, D.E., Heck, C.F. and
   Myerowitz, P.D. (1996), Acute transient coronary sinus hypertension impairs left
   ventricular function and induces myocardial edema. American Journal of
   Physiology-Heart and Circulatory Physiology, 40 (3), H834-H841.
Abstract: This study was performed to evaluate the direct and indirect effects of acute
   coronary sinus hypertension (CSH) on systolic and diastolic left ventricular (LV)
   function. Coronary sinus pressure was elevated to 25 mmHg for 3 h in eight
   pentobarbital-anesthetized dogs and then relieved. LV contractility was assessed by
   preload recruitable stroke work (PRSW) and end-systolic elastance (E(es)). Diastolic
   function was assessed by the time constant of isovolumic relaxation (tau) and the
   end-diastolic pressure volume relationship (EDPVR). PRSW and E(es) decreased
   progressively, and tau and the slope of the EDPVR increased progressively with
   CSH. These changes persisted after relief of CSH. beta-Adrenergic and cholinergic
   receptor blockade, performed in six dogs, did not alter the effects of CSH on systolic
   or diastolic function. The LV wet-to-dry weight ratios of the groups with CSH were
   significantly greater than those of a control group without CSH. We conclude that
   CSH results in changes in the left ventricle that depress contractility, prolong active
   relaxation, and increase diastolic stiffness. The dysfunction was not the direct effect
   of CSH or autonomic reflex activation, but may have been induced by fluid
   accumulation within the interstitium
   activation/acute/autonomic/compliance/contractility/control/coronary/coronary sinus
   mic         relaxation/left      ventricle/left        ventricular/left        ventricular
   function/LYMPH-FLOW/myocardial/myocardial                                           water
   content/PERFUSION/PHYSIOLOGICAL/preload/preload                    recruitable     stroke
   work/systolic/tau/transient/ventricle/ventricular function/VOLUME/work
Psaty, B.M., Siscovick, D.S., Weiss, N.S., Koepsell, T.D., Rosendaal, F.R., Lin, D.Y.,
   Heckbert, S.R., Wagner, E.H. and Furberg, C.D. (1996), Hypertension and outcomes
   research - From clinical trials to clinical epidemiology. American Journal of
   Hypertension, 9 (2), 178-183.
Abstract: Outcomes research seeks to identify effective evidence-based methods of
   providing the best medical care. While randomized clinical trials (RCT) usually
   provide the dearest answers, they are often not done or not practicable. More than a
   decade after the introduction of calcium channel blockers and angiotensin converting
   enzyme (ACE) inhibitors, clinical trial data about their effect on major disease
   endpoints in patients with hypertension are still not available. The primary
   alternatives are the use of randomized trials that include surrogate endpoints, such as
   level of blood pressure or extent of carotid atherosclerosis, and the use of
   observational studies that include major disease endpoints. Both approaches, their
   strengths and limitations, are discussed in detail. The possibility of residual
   confounding limits the strength of inferences that can be drawn from observational
   studies. Similarly, the possibility of important drug effects, other than those
   involving the surrogate endpoint, limits the inferences that can be drawn from
   randomized trials that rely solely on surrogate outcomes as guides to therapy. In the
   absence of evidence from large clinical trials that include major disease endpoints,
   treatment decisions and guidelines need to synthesize the best available information
   from a variety of sources. Consistency of findings across various study designs,
   outcomes, and populations is critical to the practice of evidence-based medicine and
   the effort to maximize the health benefits of antihypertensive therapies
Keywords:                      ACE/angiotensin/angiotensin                        converting
   pressure/BLOOD-PRESSURE/calcium/calcium                  channel/calcium          channel
   blockers/carotid/clinical         trial/clinical        trials/confounding/confounding
   variables/CORONARY                                     HEART-DISEASE/disease/drug
   EW-YORK/observational/observational                                        studies/ORAL
   MILRINONE/outcomes/pressure/PRIMARY                         PREVENTION/randomized
Purdy, P.D., Horowitz, M.B., Mathews, D., Walker, B.S., Carstens, G.J., Devous, M.D.,
   White, C.L., Kulkarni, P., Constantinescu, A. and Batjer, H.H. (1996), Calcium 45
   autoradiography and dual-isotope single-photon emission CT in a canine model of
   cerebral ischemia and middle cerebral artery occlusion. American Journal of
   Neuroradiology, 17 (6), 1161-1170.
Abstract: PURPOSE: To determine whether transient ischemia can be separated from
   permanent ischemia via calcium 45 autoradiography and to assess the applicability of
   dual isotope single-photon emission CT (SPECT) in the evaluation of cerebral blood
   flow. METHODS: We examined calcium influx in 12 dogs (group A) by using
   whole-brain calcium 45 autoradiography: Animals received 250 mu Ci/kg 24 hours
   after 30-minute (n = 6) or permanent (n = 6) middle cerebral artery (MCA) occlusion.
   Forty-eight hours after MCA occlusion, 5-mm coronal brain sections were fixed for
   either autoradiography or pathologic examination. In a separate study, 9 mongrel
   dogs (group B) were given 250 mu Ci/kg calcium 45 and a mean dose of 700 mu
   Ci/kg technetium Tc 99m hexamethyl-propyleneamine oxime intravenously. A
   silicone plug was then injected into the internal carotid artery and angiography was
   performed to verify MCA occlusion. A 10th (control) animal did not undergo
   occlusion. In an 11th animal, placement of the plug could not be achieved and a
   slurry of microfibrillar collagen was injected into the carotid artery. No angiography
   was performed in animals 10 and 11. After occlusion, each animal was injected with
   a mean dose of 126 mu Ci/kg I-123-iodoamphetamine. The control animal was also
   injected, SPECT was performed using a simultaneous acquisition for technetium
   99m and I-123- iodoamphetamine. RESULTS: In group A, all animals who had
   permanent MCA occlusion showed infarction and increased calcium 45 uptake in
   infarcted territories. None of the animals who had 30-minute occlusion had either
   increased calcium 45 uptake or infarction at 48 hours. In group B, 7 of 10 dogs had
   SPECT findings that were consistent with the calcium autoradiographic marker for
   ischemia. One animal died during the procedure and 1 dog served as a control.
   CONCLUSION: Calcium 45 autoradiography allowed distinction between areas of
   temporary and permanent occlusion. Iodoamphetamine imaging was not consistently
   sensitive to that level of ischemia. Timing of calcium influx may lead to insight that
   could impact timing of pharmacologic or endovascular intervention
Keywords:                                  ACCUMULATION/angiography/animal/animal
   artery/cerebral/cerebral           artery/cerebral          blood         flow/cerebral
   on/INJURY/internal/internal                     carotid/internal                carotid
   cerebral                   artery/middle                 cerebral                artery
   adioautography/RAT/RESULTS/single-photon                    emission         computed
   tomography/SPECT/stenosis and occlusion/STROKE/THERAPY/timing/transient
Provenzale, J.M., Barboriak, D.P., Allen, N.B. and Ortel, T.L. (1996), Patients with
   antiphospholipid antibodies: CT and MR findings of the brain. American Journal of
   Roentgenology, 167 (6), 1573-1578.
Abstract: OBJECTIVE. The purpose of this study was to determine the spectrum of
   neuroradiologic findings in patients with antiphospholipid antibodies (APA) and to
   compare findings in systemic lupus erythematosus (SLE) and non-SLE patients.
   MATERIALS AND METHODS. We identified 110 patients with APA who
  underwent CT or MR imaging, of whom 59 (54%) had abnormal studies. Of these 59
  patients, abnormalities were categorized as large infarcts, cortical infarcts, lacunar
  infarcts, hyperintense white matter foci on T2-weighted images, or dural sinus
  thrombosis. White matter foci were designated as small (< 5 mm) or large (> 5 mm).
  RESULTS. Large infarcts were the most common abnormality, seen in 24 of 110
  (22%) patients, followed in frequency by hyperintense white matter foci, seen in 19
  of 110 (17%) patients. Ninety-five percent of patients with hyperintense white matter
  foci had at least one large lesion, and 76% had five or more small foci, three or more
  large foci, or both. Small cortical infarcts and lacunar infarcts were seen in 11 of 110
  (10%) and 10 of 110 (9%) patients, respectively. Dural sinus thrombosis was seen in
  five patients. The frequency of abnormalities was high in both the SLE (57%) and
  the non-SLE (41%) groups. Large infarcts were more common in the non-SLE group
  (26%) than in the SLE group (5%). Although hyperintense white matter foci and
  cortical infarcts were more common in SLE patients, the differences were not
  statistically significant. CONCLUSION. Infarcts of various sizes and hyperintense
  white matter foci are the most common abnormalities seen on CT and MR imaging
  in patients with APA. We found no significant differences in frequencies of
  abnormalities seen between non- SLE and SLE patients
Keywords:                                  abnormalities/antibodies/ANTICARDIOLIPIN
  antibodies/brain/CEREBRAL- ISCHEMIA/cortical infarcts/CT/infarcts/lacunar
  imaging/PREVALENCE/RESULTS/sinus thrombosis/SLE/small/STROKE/systemic
  lupus                                                        erythematosus/SYSTEMIC
Hundley, W.G., Meshack, B.M., Willett, D.L., Sayad, D.E., Lange, R.A., Willard, J.E.,
  Landau, C., Hillis, L.D. and Peshock, R.M. (1996), Comparison of quantitation of
  left ventricular volume, election fraction, and cardiac output in patients with atrial
  fibrillation by cine magnetic resonance imaging versus invasive measurements.
  American Journal of Cardiology, 78 (10), 1119-1123.
Abstract: Currently available invasive and noninvasive techniques for the determination
  of left ventricular end-diastolic and end- systolic volumes, ejection fraction, and
  cardiac output are more time-consuming and potentially less accurate in patients with
  atrial fibrillation (AF) than in those with sinus rhythm. Although magnetic resonance
  imaging (MRI) can rapidly and accurately measure these variables in patients with
  sinus rhythm, its ability to do so in subjects with AF is not known. To determine if
  left ventricular volumes, ejection fraction, and cardiac output can be measured
  accurately in patients with AF using MRI, 26 subjects (13 women and 13 men, aged
  15 to 76 years) in sinus rhythm (n = 13) or AF (n = 13) underwent MRI followed
  immediately by invasive measurements of these indexes. For those in AF, MRI
  measurements of left ventricular end- diastolic volume, end-systolic volume, stroke
  volume, ejection fraction, and cardiac output correlated well with catheterization
  measurements (r = 0.90, 0.90, 0.95, 0.85, and 0.90, respectively). In addition, the
  mean difference between MRI and catheterization measurements was similar in
  subjects with AF and in those with sinus rhythm. Compared with standard invasive
  measurements, MRI provides an accurate noninvasive determination of left
  ventricular volumes, ejection fraction, and cardiac output inpatients with AF. (C)
  1996 by Excerpta Medica, Inc
Keywords:          AF/aged/ANGIOGRAPHY/atrial/atrial            fibrillation/cardiac/cardiac
  output/catheterization/EJECTION               FRACTION/fibrillation/INTERNAL/left
  ventricular/left       ventricular    volume/MAGNET           RESONANCE/magnetic
  resonance/magnetic                                                            resonance
  NANCE/SINGLE/sinus                                                rhythm/stroke/stroke
  volume/ventricular volumes/volume/women
Agewall, S., Wikstrand, J., Dahlof, C. and Fagerberg, B. (1996), Negative feelings
  (discontent) predict progress of intima-media thickness of the common carotid artery
  in treated hypertensive men at high cardiovascular risk. American Journal of
  Hypertension, 9 (6), 545-550.
Abstract: A number of psychosocial factors have been identified as cardiovascular risk
  factors. The purpose of the present study was to examine, in a prospective study,
  whether quality of life, as measured by the minor symptoms evaluation profile, was
  associated with progression of the intima-media thickness in the common carotid
  artery in a group of treated hypertensive men at high risk of cardiovascular disease (n
  = 97). Patients with any cardiovascular disease (myocardial infarction, angina
  pectoris, intermittent claudication, or stroke) at entry felt significantly more
  discontent, compared with patients without signs or symptoms of cardiovascular
  disease. The change in maximum intima-media thickness during the follow-up period
  was associated with discontent at entry (r = 0.23, P =.03). The relationship between
  the change in maximum intima-media thickness and discontent at entry remained
  significant (P =.02) after adjusting for serum-cholesterol and concomitant
  cardiovascular disease. In conclusion, discontent in treated hypertensive men at high
  cardiovascular risk was significantly and independently associated with an increase
  in maximum intima-media thickness in the common carotid artery. This finding
  suggests that the experience of well-being may influence the atherosclerotic process
Keywords:                                                                   angina/angina
  ascular/cardiovascular             disease/cardiovascular           risk/carotid/carotid
  rction/intima-media                          thickness/JUN/MORTALITY/myocardial
  infarction/NEW-YORK/prospective study/psychosocial symptoms/quality of
  life/risk/risk factors/SCIENCE/stroke/SYMPTOMS
Luber, S.D., Brady, W.J., Brand, A., Young, J., Guertler, A.T. and Kefer, M. (1996),
  Acute hypoglycemia masquerading as head trauma: A report of four cases. American
  Journal of Emergency Medicine, 14 (6), 543-547.
Abstract: Hypoglycemia, a commonly encountered metabolic emergency, is most often
  easily diagnosed and rapidly treated with satisfactory patient outcome, If not
  recognized and treated promptly, hypoglycemia may cause irreversible central
  nervous system injury; it rarely results in death, The classic presentation of
  hypoglycemia, a patient with diabetes mellitus on medical therapy (insulin or oral
  hypoglycemic agents) who presents with an altered sensorium, is frequently seen in
  the emergency department (ED), Less often, patients with this metabolic emergency
  present to the ED in a manner suggestive of a situation other than hypoglycemia,
  Patients may present with seizure activity or focal neuro logical deficits, leading the
  physician to treat a primary neurological syndrome and not immediately recognize
  the primary cause of the problem, Alternatively, patients with hypoglycemia will
  present to the ED with an altered mental status after a traumatic event, The physician
  may again assume that the alteration in consciousness has resulted from a head injury
  and not a metabolic disorder, Four cases are presented in which the medical history
  of the event (ie, trauma) suggested head injury as an explanation of the presentation
  when, in fact, hypoglycemia was responsible for the altered sensorium, The
  diagnosis of hypoglycemia is easily made with the performance of a bedside
  screening test which can be subsequently confirmed by laboratory blood analysis, It
  is imperative that emergency physicians consider hypoglycemia in all patients with
  any mental status abnormality, focal neurological deficit, or seizure activity, even
  when the findings seem to be explained initially by other etiologies. Copyright (C)
  1996 by W.B. Saunders Company
Keywords:                 ACCIDENT/activity/ADMISSION/altered                        mental
  status/analysis/blood/central             nervous          system/closed             head
  mellitus/diagnosis/EMERGENCY/emergency department/focal/GLUCAGON/head
  CE/injury/insulin/masquerade/medical/nervous           system/neurological/neurological
Luepker, R.V., Rastam, L., Hannan, P.J., Murray, D.M., Gray, C., Baker, W.L., Crow,
  R., Jacobs, D.R., Pirie, P.L., Mascioli, S.R., Mittelmark, M.B. and Blackburn, H.
  (1996), Community education for cardiovascular disease prevention - Morbidity and
  mortality results from the Minnesota Heart Health Program. American Journal of
  Epidemiology, 144 (4), 351-362.
Abstract: The Minnesota Heart Health Program was a community trial of cardiovascular
  disease prevention methods that was conducted from 1980 to 1990 in three Upper
  Midwestern communities with three matched comparison communities. A 5- to
  6-year intervention program used community-wide and individual health education
  in an attempt to decrease population risk. A major hypothesis was that the incidence
  of validated fatal and nonfatal coronary heart disease and stroke in 30- to 74-year-
  old men and women would decline differentially in the education communities after
  the health promotion program was introduced. This hypothesis was investigated
  using mixed-model regression. The intervention effect was modeled as a series of
  annual departures from a linear secular trend after a 2-year lag from the start of the
  intervention program. In the education communities, 2,394 cases of coronary heart
  disease and 818 cases of stroke occurred, with 2,526 and 739 cases, respectively,
  being seen in the comparison communities, The overall decline in coronary heart
  disease incidence was 1.8 percent per year in men (p=0.03) and 3.6 percent per year
  in women (p=0.007). For stroke, there were no significant secular trends, The authors
  recently published findings showing minimal effects of sustained intervention on risk
  factor levels, In the current report, there was no evidence of a significant intervention
  effect on morbidity or mortality, either for coronary heart disease or for stroke
Keywords:                cardiovascular/cardiovascular              disease/cardiovascular
  diseases/CHOLESTEROL/coronary/coronary                                              heart
  th/health                     education/health                     promotion/heart/heart
  PROJECT/prevention/primary                                           prevention/risk/risk
  factor/RISK-FACTORS/STANFORD                                                      5-CITY
Yao, Y.M., Bahrami, S., Lichtfried, G., Redl, H. and Schlag, G. (1996), Significance of
  NO in hemorrhage-induced hemodynamic alterations, organ injury, and mortality in
  rats. American Journal of Physiology-Heart and Circulatory Physiology, 39 (5),
Abstract: In an attempt to evaluate the role of nitric oxide (NO) in pathophysiological
  alterations and multiple organ damage caused by hemorrhagic shock, we employed
  N-G-monomethyl-L-arginine (L- NMMA), an inhibitor of NO synthase, in
  anesthetized rats subjected to a prolonged hypovolemic insult (30-35 mmHg for 180
  min). Infusion of 2.0 mg/kg L-NMMA at the end of resuscitation diminished the fall
  in mean arterial pressure (MAP) and significantly increased the cardiac index and
  stroke volume, together with remarkable protection from multiple organ damage
  compared with the controls. The 48-h survival, rate was significantly improved from
  26.7% in the control group to 68.8% in the treatment group (P < 0.05). In contrast,
  the high dose of 20.0 mg/kg L-NMMA resulted in a strong blood pressure response,
  but a marked reduction in cardiac index and stroke volume concomitant with an
  increased total peripheral resistance index within the observation period, and tended
  to increase damage to various organs at 2 h after treatment. In addition, marked
  elevation in both endotoxin and tumor necrosis factor levels were observed in
  animals subjected to shock insult. The results suggest that NO induced by
  hemorrhagic shock in rats is an important mediator for pathophysiological alterations
  associated with cardiovascular abnormalities, multiple organ dysfunction, and even
  lethality. Regulation of NO generation and use of NO inhibitors might provide new
  aspects in the treatment of hemorrhage-related disorders, whereas the administration
  of L-NMMA would be either deleterious or salutary in a dose-dependent manner
Keywords:               abnormalities/administration/anesthetized/animals/arterial/arterial
  pressure/blood/blood                       pressure/BLOOD-PRESSURE/cardiac/cardiac
  oxide/NITRIC-OXIDE            PRODUCTION/NO/organ            injury/peripheral/peripheral
  resistance/peripheral                                                          resistance
  EPTIC       SHOCK/shock/stroke/stroke            volume/survival/total/total   peripheral
  resistance/treatment/tumor/tumor                                                 necrosis
Wilcox, R.G. (1996), Clinical trials in thrombolytic therapy: What do they tell us?
  INJECT 6-month outcomes data. American Journal of Cardiology, 78 20-23.
Abstract: Numerous controlled clinical trials have documented the efficacy of
  thrombolytic agents in reducing the risk of mortality after myocardial infarction (MI),
  As a result, it is no longer ethical to test a new thrombolytic regimen against placebo,
  Rather, promising new therapies must be compared with proven treatments, This has
  been the direction taken in trials of reteplase, a new recombinant plasminogen
  activator. Initial studies of double-bolus reteplase demonstrated its superior ability to
  produce TIMI grade 2 or 3 flow at 90 minutes when compared with accelerated
  alteplase, A subsequent randomized, double-blind, 9-country study, the international
  Joint Efficacy Comparison of Thrombolytics (INJECT) trial was designed to
  determine whether the efficacy of reteplase is at least equivalent to that of
  streptokinase, The 2 treatments were associated with similar frequencies of
  in-hospital cardiac events, bleeding, and strokes, Likewise, no significant difference
  was apparent between the reteplase and streptokinase groups with regard to 35-day
  mortality (the primary endpoint), the combined endpoint of 35-day mortality plus
  continuing disability from in-hospital stroke, or 6-month mortality, Unadjusted data
  from the 3 countries that contributed the majority of patients seemed to indicate a
  survival benefit, irrespective of treatment allocation, among patients who underwent
  interventional procedures. However, no such benefit was apparent when the data
  were adjusted far differences in the baseline characteristics of the patients enrolled in
  the different countries. Rather, intervention within the first 3 days post-MI was found
  to place patients at a substantially higher risk of 35-day mortality, Further insights
  into the relative efficacy of reteplase should emerge from the ongoing third Global
  Utilization of Strategies to Open Occluded Coronary Arteries (GUSTO-III) trial. (C)
  1996 by Excerpta Medica, Inc
Keywords:                  alteplase/bleeding/cardiac/cardiac                   events/clinical
  agents/thrombolytic therapy/TIMI/treatment/trials
Morley, J., Marinchak, R., Rials, S.J. and Kowey, P. (1996), Atrial fibrillation,
  anticoagulation, and stroke. American Journal of Cardiology, 77 (3), A38-A44.
Abstract: There is a demonstrated statistical association between atrial fibrillation,
  rheumatic valvular disease, and embolic stroke. This article assesses the results of 6
  major clinical trials (AFASAK, BAATAF, SPINAF, SPAF [parts I and II], CAFA
  and EAFTA- see text for trial names). Multivariate analysis revealed 4 independent
  clinical features that identified patients with atrial fibrillation at an increased risk for
  stroke: hypertension, increasing age, previous transient ischemic attack, and diabetes
  mellitus. Without anticoagulation therapy, patients with any of these risk factors had
  a 4% annual risk of stroke. Patients with cardiac disorders such as congestive heart
  failure and coronary artery disease have a stroke rate 3 times higher than patients
  without any risk factors; patients with atrial fibrillation but no concomitant risk
  factors or structural heart disease seemed to have little concomitant risk for stroke.
  Meta-analysis revealed a 64% reduction of risk for stroke in patients treated with
  warfarin, as compared with placebo. The value of warfarin therapy in patients >75
  years old is less clear because of a high risk of hemorrhagic complications
Keywords:                                   age/analysis/anticoagulation/artery/atrial/atrial
  fibrillation/CAFA/cardiac/clinical                                          features/clinical
  trials/COMPLICATIONS/concomitant/congestive/congestive                                  heart
  failure/coronary/coronary        artery/coronary       artery     disease/diabetes/diabetes
  mellitus/disease/embolic         stroke/failure/fibrillation/heart/heart       disease/heart
  rate/risk/risk factors/risk of stroke/statistical/stroke/THERAPY/transient/transient
  ischemic attack/trials/WARFARIN
Lonn, E.M., Yusuf, S., Doris, C.I., Sabine, M.J., Dzavik, V., Hutchison, K., Riley, W.A.,
  Tucker, J., Pogue, J. and Taylor, W. (1996), Study design and baseline characteristics
  of the study to evaluate carotid ultrasound changes in patients treated with Ramipril
  and vitamin E: SECURE. American Journal of Cardiology, 78 (8), 914-919.
Abstract: Atherosclerotic cardiovascular disease remains a major cause of mortality and
  morbidity in most developed countries. Experimental and clinical evidence suggests
  that angiotensin- converting enzyme inhibitors and vitamin E therapy may retard the
  atherosclerotic process; however, definitive proof in humans is lacking. The Study to
  Evaluate Carotid Ultrasound Changes in Patients Treated with Ramipril and Vitamin
  E (SECURE) is designed to assess the effects of ramipril-an angiotensin-converting
  enzyme inhibitor, at 2 doses: 2.5 mg daily (which has little effect on lowering blood
  pressure) and 10 mg daily-and the antioxidant vitamin E, 400 IU daily, on
  atherosclerosis progression in 732 patients using ct factorial 3 x 2 study design.
  High-risk patients with a documented history of significant cardiovascular disease or
  with diabetes and additional risk factors were enrolled and will be followed for 4
  years. The extent and progression of atherosclerosis are assessed noninvasively by
  B-mode carotid ultrasonography. The SECURE trial is a substudy of the larger Heart
  Outcomes Prevention Evaluation (HOPE) study of 9,541 high-risk patients
  evaluating the effects of ramipril and vitamin E on major cardiovascular events
  (cardiovascular death, myocardial infarction, and stroke), The 2 studies are
  complementary. Whereas HOPE is expected to provide information on major clinical
  outcomes, SECURE will shed light on the mechanisms by which these effects may
  be mediated
Keywords: angiotensin/angiotensin converting enzyme/angiotensin converting enzyme
  inhibitor/angiotensin     converting     enzyme       inhibitors/angiotensin-converting
  pressure/cardiovascular/cardiovascular                            disease/cardiovascular
  sease/E       CONSUMPTION/effect/effects/EVENTS/HEART-                   DISEASE/high
  factors/stroke/therapy/ultrasonography/ultrasound/vitamin E
Yaretzky, A., Levinson, M. and Kimchi, O.L. (1996), Clay as a therapeutic tool in
  group processing with the elderly. American Journal of Art Therapy, 34 (3), 75-82.
Abstract: Geriatric rehabilitation includes medical treatment, physical therapy, and
  therapy in both the psyche-social field and the activities of daily living (ADL). Its
  objective is to return the individual to independent functioning. This may be
  achieved through;art therapy, which enables verbal and non-verbal communication;
  the expression of personal feelings; and physical, sensorimotor, and cognitive
  therapy. Group work with hospitalized elderly people is generally limited, and art
  therapy using clay is particularly so. Yet it can stimulate feelings of fellowship and
  evoke a sense of cooperation and support. This article reviews group work with clay
  as an additional form of therapy with a group of 8 patients with Cerebrovascular
  Accident (CVA), or stroke, and femur neck fractures. The objective of the therapy
  was to combine bilateral sensorimotor activities of the upper limbs with social
  interaction directed towards future leisure-time activity. The subject of the clay work
  was ''the home,'' which is central in the life of the elderly person. The article
  describes initial group activity with two groups of patients. Analysis of the activity
  was through retrospective -observation examining videotapes, photographs, and
  questionnaires at the end of each session
Keywords: activities of daily living/activity/ADL/ART/bilateral/CVA/elderly/elderly
  people/interaction/medical/medical                                    treatment/physical
Worley, J.S., Harmon, N., Miller, G.J., Hollis, S.B., Harlow, S. and Briggs, V. (1996),
  Reliability of potential clinical measures of muscle tone in the elbows of patients
  after stroke. American Journal of Occupational Therapy, 50 (7), 554-560.
Abstract: Objectives. This study investigated the reliability of joint resting position
  (EJP), resistance to passive movement (ERM), and the angle of appearance of the
  resistance (EAR) as measures of muscle hypertonus of elbow flexors in patients after
  stroke. Previously, similar measures had been found reliable when applied to
  measuring shoulder and wrist hypertonus in patients after stroke. Method. Forty-five
  subjects with stroke were randomly selected fr om occupational therapy admissions
  at two rehabilitation centers. Tone of elbow flexors was measured twice at the same
  sitting by two examiners. EJP and EAR were measured with a goniometer, and ERM
  was measured with a resistance rating scale. Correlations were calculated between
  first and second measurements by center and by high tone and poor upper extremity
  function subgroups (with correction for multiple correlations) to determine reliability.
  Results, Each of the three measures was highly reliable as demonstrated try a high
  correlation in at least one of the subgroups (Center 1: EJP r = .964 for high tone
  subgroup; ERM, r = .789, EAR, r = .902, both in poor upper extremity function
  subgroup; and Center 2: EJP r = .892, ERM, r = .938, both in poor upper extremity
  function subgroup; EAR, r = .666 for all subjects; all p values < .05). Correlations
  were especially high when data for subjects with high upper extremity function were
  eliminated Conclusion. Reliability of these three methods of measuring upper
  extremity muscle tone enhances their usefulness as well as therapists' confidence in
  their judicial application
Keywords:                                                                cerebrovascular
  ONIA/joint                  mobility/measurements/methods/movement/muscle/muscle
  spasticity/muscle                                    tonus/OCCUPATION/occupational
Mahaffey, K.W., Granger, C.B., Collins, R., OConnor, C.M., Ohman, E.M., Bleich,
  S.D., Col, J.J. and Califf, R.M. (1996), Overview of randomized trials of intravenous
  heparin in patients with acute acute myocardial infarction treated with thrombolytic
  therapy. American Journal of Cardiology, 77 (8), 551-556.
Abstract: Intravenous heparin is routinely given after thrombolytic therapy for patients
  with acute myocardial infarction in the United States and in some, but by no means
  all, other countries. Several trials have documented improved infarct- artery patency
  in patients treated with heparin; however, none was forge enough individually to
  assess the effect of heparin on clinical outcomes. We performed ct systematic
  overview of the 6 randomized controlled trials (1,735 patients) to summarize the
  available data concerning the risks and benefits of intravenous heparin versus no
  heparin after thrombolytic therapy. Mortality before hospital discharge was 5.1% for
  patients allocated to intravenous heparin compared with 5.6% for controls (relative
  risk reduction of 9%, odds ratio 0.91, 95% confidence interval 0.59 to 1.39). Similar
  rates of recurrent ischemia and reinfarction were observed among those allocated to
  heparin therapy or control. The rates of total stroke, intracranial hemorrhage, and
  severe bleeding were similar in patients allocated to heparin; however, the risk of any
  severity of bleeding was significantly higher (22.7% vs 16.2%; odds ratio 1.55, 95%
  confidence interval 1.21 to 1.98), There was no significant difference in the observed
  effects of heparin between patients receiving tissue-type plasminogen activator and
  those receiving streptokinase or anisoylated plasminogen streptokinase activator
  complex, or between patients who did and did not receive aspirin. The findings of
  this overview demonstrate that insufficient clinical outcome data are available to
  support or to refute the routine use of intravenous heparin therapy after thrombolysis.
  It is not known if these findings are due to lack of statistical power, inappropriate
  levels of anticoagulation, or lack of benefit of intravenous heparin. Large randomized
  studies of heparin (and of newer antithrombotic regimens) are needed to establish the
  role of such therapy
Keywords:                               acute/acute                              myocardial
  infarction/NEW-YORK/odds             ratio/outcome/outcomes/plasminogen/plasminogen
  activator/power/randomized          controlled       trials/randomized      trials/relative
  bolysis/thrombolytic       therapy/TISSUE         PLASMINOGEN-ACTIVATOR/tissue
  type/tissue-type/total/trials/United States
Antman, E.M. (1996), Maintaining sinus rhythm with antifibrillatory drugs in atrial
  fibrillation. American Journal of Cardiology, 78 67-72.
Abstract: Management of atrial fibrillation is a common and complex clinical problem,
  Two major treatment strategies have emerged: suppression of recurrences versus
  control of ventricular rate and anticoagulation to reduce the risk of stroke.
  Maintaining sinus rhythm offers the hemodynamic benefits of improving ventricular
  performance and exercise capacity but may expose the patient to the risk of
  proarrhythmia/sudden death and drug- related morbidity, Controlling ventricular rate
  helps decrease symptomatic palpitations and improve exercise capacity but
  necessitates long-term anticoagulation (which may also be needed despite the use of
  antiarrhythmics to suppress recurrences of atrial fibrillation) with some risk of
  bleeding, Randomized trials are now needed to define the relative benefits of these 2
  treatment strategies, Such trials should be designed to provide information on the
  impact of the 2 approaches on symptoms, exercise capacity, quality of life, and
  mortality rate in patients with atrial fibrillation
Keywords:                                      AMIODARONE/anticoagulation/atrial/atrial
  rate/NEW-YORK/performance/PREVENTION/quality                     of    life/QUINIDINE
  THERAPY/rate/risk/risk                              of                        stroke/sinus
Armstrong, L.E., Crago, A.E., Adams, R., Roberts, W.O. and Maresh, C.M. (1996),
  Whole-body cooling of hyperthermic runners: Comparison of two field therapies.
  American Journal of Emergency Medicine, 14 (4), 355-358.
Abstract: Severe exercise induced hyperthermia requires rapid cooling. Of the many
  cooling modalities available, there is disagreement over which is the most effective.
  The purpose of this field study was to compare two cooling therapies for
  hyperthermic distance runners who had completed an 11.5-km summer foot race.
  Twenty-one distance runners (mean [+/- SE] initial rectal temperature 41.2 +/- 0.2
  degrees C) were treated either by ice water immersion (1 to 3 degrees C, n = 14) or
  by air exposure while wrapped in wet towels (24.4 degrees C ambient, n = 7). Ice
  water immersion versus air exposure resulted in significantly different (P <.005)
  pretherapy to posttherapy changes in rectal temperature (-3.0 +/- 0.3 v -1.4 +/- 0.3
  degrees C) and mean cooling rate(0.20 +/- 0.02 v 0.11 +/- 0.02 degrees C/min). Ice
  water immersion cooled approximately twice as fast as air exposure. These data
  refute the theory that ice water immersion is an inefficient cooling modality.
  Copyright (C) 1996 by W.B. Saunders Company
Keywords: blood pressure/body temperature/CANINE MODEL/CO/COMPARATIVE
  rate/heat exhaustion/heat injuries/HEAT-STROKE/hyperthermia/ICED GASTRIC
Aull, S., Lalouschek, W., Schnider, P., Sinzinger, H., Uhl, F. and Zeiler, K. (1996),
  Dynamic changes of plasma lipids and lipoproteins in patients after transient
  ischemic attack or minor stroke. American Journal of Medicine, 101 (3), 291-298.
Abstract: PURPOSE: Only few data are available concerning variations of lipids and
  lipoproteins in the acute stage after ischemic cerebrovascular events. It was the aim
  of this study to investigate whether the lipid and lipoprotein levels obtained in the
  first few days after a transient ischemic attack (TIA) or a minor stroke (MS) actually
  reflect 'correct' values or 'changed' (ie, false low) values, as in patients after acute
  myocardial infarction. PATIENTS AND METHODS: Total cholesterol (TC),
  HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), and triglyceride (TG) levels
  of 37 unselected patients with TIA or MS were determined within 12-48 hours
  (Group A) or within 49- 168 hours (Group B) after the acute event. After a mean
  observation period of 15.3 months, all patients were re- examined; the results were
  compared with those of the baseline evaluation. RESULTS: At the time of the
  baseline evaluation, TC and LDL-C levels of Group B patients were significantly
  lower than Group A levels. At the end of the observation period, however, Group A
  and Group B patients did not differ with regard to all four parameters. In comparison
  with the baseline examination, the values of Group A patients had not changed. In
  Group B patients, however, TC, HDL-C, LDL-C, and TG levels had significantly
  increased. CONCLUSION: Our results strongly suggest that lipid and lipoprotein
  levels of patients with TIA or MS should be assessed within a maximum of 48 hours
  after the acute event. If the examination cannot be performed within that period, the
  determination of reliable values is possible only after several weeks or months
Keywords: ACTIVATING-FACTOR DEGRADATION/acute/acute myocardial
  infarction/ACUTE                     MYOCARDIAL-INFARCTION/ACUTE-PHASE
  PROTEINS/C-REACTIVE                         PROTEIN/cerebrovascular/evaluation/HDL
  infarction/NEW-YORK/PATIENT/plasma/RESULTS/SEP/SERUM                            TOTAL
  CHOLESTEROL/stroke/TIA/transient/transient ischemic attack
Waravdekar, N.V., Sinoway, L.I., Zwillich, C.W. and Leuenberger, U.A. (1996),
  Influence of treatment on muscle sympathetic nerve activity in sleep apnea.
  American Journal of Respiratory and Critical Care Medicine, 153 (4), 1333-1338.
Abstract: Obstructive sleep apnea (OSA) is a common disorder associated with systemic
  hypertension, myocardial infarction, stroke, and premature death. Elevated
  sympathetic tone has been documented previously in OSA and may contribute to the
  cardiovascular risk. As OSA therapy appears to reduce mortality, we wondered if
  decreased apnea activity would attenuate the sympathetic hyperactivity of untreated
  patients. Muscle sympathetic nerve activity (MSNA) was measured during
  wakefulness via peroneal microneurography in seven patients with documented OSA
  before and at least 1 mo after compliance monitored nasal continuous positive airway
  pressure (CPAP) therapy. Before institution of CPAP therapy, MSNA was high in all
  patients and decreased after CPAP therapy (baseline versus CPAP: 69.4 +/- 15.3
  versus 53.9 +/- 10.5 bursts/min, mean +/- SD; p < 0.01). However, the decrease in
  MSNA was limited to the four patients with the greatest nightly use of CPAP
  (greater than or equal to 4.5 h/night), whereas it remained unchanged in the three
  patients who were less compliant. There was a direct linear correlation between the
  decrease in MSNA (bursts/min) and the average hours of CPAP use per night (r =
  0.87, p = 0.01). We conclude that in patients with OSA effective reduction in apnea
  activity with CPAP therapy diminishes the high sympathetic tone present during
  resting wakefulness
Keywords:                    activity/BLOOD-PRESSURE/cardiovascular/cardiovascular
  VARIATION/compliance/continuous                        positive                airway
  apnea/STATE/STROKE/SUDDEN                CARDIAC       DEATH/sympathetic        nerve
Aronow, W.S., Ahn, C. and Gutstein, H. (1996), Risk factors for new atherothrombotic
  brain infarction in 664 older men and 1,488 older women. American Journal of
  Cardiology, 77 (15), 1381-&.
Abstract: Older men had a significantly higher incidence of new atherothrombotic brain
  infarction than did older women, Risk factors for new atherothrombotic brain
  infarction were prior atherothrombotic brain infarction, systemic hypertension, and
  diabetes mellitus in older men and women, and cigarette smoking, serum total
  cholesterol, and serum high-density lipoprotein cholesterol (inverse association) in
  older women
Keywords:                   brain/brain               infarction/CITY/diabetes/diabetes
Mark, S.D., Wang, W., Fraumeni, J.F., Li, J.Y., Taylor, P.R., Wang, G.Q., Guo, W.,
  Dawsey, S.M., Li, B. and Blot, W.J. (1996), Lowered risks of hypertension and
  cerebrovascular disease after vitamin mineral supplementation - The Linxian
  nutrition intervention trial. American Journal of Epidemiology, 143 (7), 658-664.
Abstract: A total of 3,318 men and women from a region in rural China were
  randomized to receive daily either a multiple vitamin/mineral supplement or a
  placebo. Deaths that occurred in the participants were ascertained and classified
  according to cause over the 6-year period from 1985 to 1991, At the end of
  supplementation, blood pressure readings were taken, and the prevalence of
  hypertension was determined, There was a slight reduction in overall mortality in the
  supplement group (relative risk (RR) = 0.93, 95% confidence interval (CI) 0.75-
  1.16), with the decreased relative risk most pronounced for cerebrovascular disease
  deaths (RR = 0.63, 95% CI 0.37-1.07). This benefit was greater for men (RR = 0.42,
  95% CI 0.19-0.93) than for women (RR = 0.93, 95% CI 0.44-1.98). Among the
  survivors, the presence of elevations in both systolic and diastolic blood pressures
  was less common in those who received the supplement (RR for men = 0.43, 95% CI
  0.28-0.65; RR for women = 0.92, 95% CI 0.68-1.24). This study indicates that
  supplementation with a multivitamin/mineral combination may have reduced
  mortality from cerebrovascular disease and the prevalence of hypertension in this
  rural population with a micronutrient-poor diet
Keywords:        antioxidants/blood/blood      pressure/BLOOD-PRESSURE/CANCER
  INCIDENCE/cerebrovascular/cerebrovascular                       disease/cerebrovascular
  ion/placebo/pressure/prevalence/randomized             controlled         trials/relative
  risk/risk/risks/rural/rural                                         population/SERUM
Weber, M.A. (1996), Role of hypertension in coronary artery disease. American Journal
  of Nephrology, 16 (3), 210-216.
Abstract: Historically, stroke, heart failure and renal insufficiency were seen as the
  major complications of untreated hypertension. More recently, it has become evident
  that coronary heart disease is probably the most common outcome of this condition.
  Unlike the other complications of hypertension, coronary events have not been
  reduced in a meaningful fashion by traditional antihypertensive drug therapy. A
  partial explanation may lie in the fact that hypertension typically consists of a
  syndrome of inherited metabolic and cardiovascular abnormalities, and treatment that
  focuses primarily on blood pressure without taking into account the other factors that
  contribute to atherosclerotic disease can have only limited protective effects. The
  coronary hypothesis in hypertension extends this reasoning into 3 separate
  components. First is an intrinsic tendency to excessive proliferative and hypertrophic
  activity in vascular tissue, presumably reflecting growth-promoting activity
  stimulated by increased endocrine and local paracrine effects; second is the impact of
  the commonly encountered concomitant risk factors, including high blood pressure,
  that exaggerate and accelerate development of the underlying atherosclerotic lesions;
  third are hemodynamic factors, including increased variability and sustained
  elevations of blood pressure, that can destabilize vascular lesions and precipitate
  acute events. Treatment of these hemodynamic factors in elderly patients, whose
  underlying vascular changes are already well advanced, is likely to effectively reduce
  the incidence of vascular endpoints. In younger patients, ongoing vascular
  proliferative changes and the impact of concomitant risk factors are equally as
  important as hemodynamic forces in producing coronary disease, and effective
  treatment must take all these issues into account
Keywords:       abnormalities/activity/acute/advanced/ANGIOTENSIN-CONVERTING
  ant/coronary/coronary artery/coronary artery disease/coronary disease/coronary
  events/coronary heart disease/coronary hypothesis/development/disease/drug
  therapy/effects/elderly/elderly                    patients/endocrine/failure/FAMILY
  HISTORY/heart/heart disease/heart failure/hemodynamic/hemodynamics/high blood
  N/outcome/pressure/PROGRESSION/proliferative                        changes/renal/renal
Weber, B.E. and Kapoor, W.N. (1996), Evaluation and outcomes of patients with
  palpitations. American Journal of Medicine, 100 (2), 138-148.
Abstract: PURPOSE: To determine: (1) the etiologies of palpitations, (2) the usefulness
  of diagnostic tests in determining the etiologies of palpitations, and (3) the outcomes
  of patients with palpitations. PATIENTS AND METHODS: One hundred and ninety
  consecutive patients presenting with a complaint of palpitations at a university
  medical center were enrolled in this prospective cohort study. Patients underwent a
  structured clinical interview and psychiatric screening. The charts were abstracted for
  results of the physical exam and tests ordered by the primary physician. Assignment
  of an etiology of palpitations was based on strict adherence to predetermined criteria
  and achieved by consensus of the two physician investigators. One-year followup
  was obtained in 96% of the patients. RESULTS: An etiology of palpitations was
  determined in 84% of the patients. The etiology of palpitations was cardiac in 43%,
  psychiatric in 31%, miscellaneous in 10%, and unknown in 16%. Forty percent of the
  etiologies could be determined with the history and physical examination, an
  electrocardiogram, and/or laboratory data. The 1-year mortality rate was 1.6% (95%
  confidence interval [CI] 0% to 3.4%) and the 1-year stroke rate was 1.1% (95% CI
  0% to 2.6%). Within the first year, 75% of the patients experienced recurrent
  palpitations. At 1-year follow-up, 89% reported that their health was the same or
  improved compared to that at enrollment, 19% reported that their work performance
  was impaired, 12% reported that workdays were missed, and 33% reported
  accomplishing less than usual work at home. CONCLUSIONS: The etiology of
  palpitations can often be diagnosed with a simple initial evaluation. Psychiatric
  illness accounts for the etiology in nearly one third of all patients. The short-term
  prognosis of patients with palpitations is excellent with low rates of death and stroke
  at 1 year, but there is a high rate of recurrence of symptoms and a moderate impact
  on productivity
Keywords:           adherence/AMBULATORY                 PATIENTS/cardiac/CARDIAC-
  ARRHYTHMIAS/cohort                study/confidence/consensus/criteria/death/diagnostic
  tests/electrocardiogram/etiology/evaluation/follow             up/follow-up/GENERAL
  METHODS/MITRAL-VALVE                                   PROLAPSE/mortality/mortality
Becker, K.J., Monsein, L.H., Ulatowski, J., Mirski, M., Williams, M. and Hanley, D.F.
  (1996), Intraarterial thrombolysis in vertebrobasilar occlusion. American Journal of
  Neuroradiology, 17 (2), 255-262.
Abstract: PURPOSE: To report our experience using intraarterial thrombolysis in the
  treatment of vertebrobasilar occlusion. METHODS: Twelve patients with 13
  angiographically proved thromboses of the vertebrobasilar system underwent local
  intraarterial thrombolysis with urokinase, Angiographic and clinical outcomes were
  analyzed with respect to clinical examination al presentation, arterial occlusion
  patterns, and time to recanalization, RESULTS: The overall mortality was 75%.
  Recanalization could not be achieved in 3 of 13 treatments; all patients in whom
  recanalization failed died. The mortality rate was 60% in those patients in whom
  recanalization was successful, Coma or quadriparesis at the time of therapy
  uniformly predicted death. There were two cases each of bilateral proximal vertebral
  occlusions and midbasilar occlusions and nine cases of bilateral distal vertebral
  occlusions. There were three cases of fatal rethrombosis after initial successful
  thrombolysis. The mortality rate in the recanalized group before rethrombosis was
  30%. There were two fatal hemorrhages of the central nervous system,
  CONCLUSION: Recanalization of the vertebrobasilar system is necessary but not
  sufficient for effective treatment of vertebrobasilar occlusive disease. The site of
  occlusion may help predict angiographic and clinical outcome, Time to initiation of
  thrombolysis is not an invariable correlate of survival, although clinical condition at
  presentation may be. Rethrombosis and hemorrhage are significant problems
  affecting mortality after successful thrombolysis
Keywords: ACUTE MYOCARDIAL-INFARCTION/arterial/arteries/basilar/BASILAR
  studies/hemorrhage/local/METHOD/METHODS/mortality/mortality                rate/nervous
  LEAR                                         LEUKOCYTES/RAT/rate/RECURRENT
  ISCHEMIA/REPERFUSION/RESULTS/stenosis                                               and
Yokoyama, S. and Benoit, J.N. (1996), Effects of bradykinin on lymphatic pumping in
  rat mesentery. American Journal of Physiology-Gastrointestinal and Liver
  Physiology, 33 (5), G752-G756.
Abstract: The effects of bradykinin on lymphatic pump activity of rat mesenteric
  collecting duct were studied, and the receptor subtype responsible for the bradykinin
  response was evaluated. Rats were anesthetized with intraperitoneal alpha-chloralose
  and urethan, and exteriorized mesenteries were studied using intravital microscopic
  techniques. The diameter of the collecting lymph vessels (similar to 100 mu m) was
  continuously monitored and lymphatic pump parameters (end diastolic diameter, end
  systolic diameter, stroke volume index, ejection fraction, contraction frequency, and
  pump flow index) were calculated. Bradykinin (0.1-1.0 nM) did not affect end
  diastolic diameter end systolic diameter, stroke volume index, and ejection fraction.
  Bradykinin increased lymphatic contraction frequency and pump flow index in a
  dose-dependent manner. Des-Arg(9)-[Leu(8)]bradykinin (B-1 antagonist, 0.1 mu M)
  had no effect on baseline lymphatic pumping but completely inhibited the
  bradykinin-induced           increase         in          contraction        frequency.
  N-acetyl-D-Arg-[Hyp(3),Thi(5,8),D-phe(7)]bradykinin (B-2 antagonist, 0.1 mu M)
  significantly depressed lymphatic contraction frequency in baseline conditions but
  had no effect on bradykinin-induced increases in contraction frequency. These results
  indicate that bradykinin induces positive chronotropic but not inotropic effects on
  lymphatic pump activity through the stimulation of B-1 receptors
Keywords:                    activity/AL/anesthetized/B-1                   receptor/B-2
  flow/lymphatic               pump                activity/lymphatic             smooth
  /stroke volume/systolic/techniques/VESSELS/volume
Belardinelli, R., Ciampani, N., Costantini, C., Blandini, A. and Purcaro, A. (1996),
  Comparison of impedance cardiography with thermodilution and direct fick methods
  for noninvasive measurement of stroke volume and cardiac output during
  incremental exercise in patients with ischemic cardiomyopathy. American Journal of
  Cardiology, 77 (15), 1293-1301.
Abstract: In the last decade, an inexpensive and simple noninvasive method (i.e.,
  transthoracic electrical bioimpedance cardiography, has been tested in healthy
  subjects and patients with various heart diseases for measuring stroke volume and
  cardiac output at rest and/or during exercise. However, the results are still
  controversial, especially when measurements are obtained during exercise and data
  on reproducibility during exercise are lacking. Twenty-five consecutive patients (20
  men and 5 women, mean age 48 +/- 9 years) in sinus rhythm with documented
  coronary artery disease and a previous myocardial infarct were studied. Patients were
  divided into 2 groups. Group A had ischemic cardiomyopathy, characterized by left
  ventricular (LV) enlargement and LV ejection fraction depression (35 +/- 8%).
  Group B had normal LV dimensions and ejection fraction (62 +/- 9%). After a
  familiarization study, all patients underwent an exercise test with gas exchange
  analysis and hemodynamic measurements. Stroke volume and cardiac output were
  simultaneously obtained at rest and at the end of each work rate stage with 3 methods:
  impedance, thermodilution, and direct Fick. Group A reached a lower peak oxygen
  uptake (56%), peak work load (60%), and peak systolic blood pressure (69%) than
  group B. Cardiac output and stroke volume were significantly greater at submaximal
  and peak exercise in group B than in group A (p<0.0001). There were no significant
  differences in stroke volume and cardiac output in the 3 techniques at any matched
  work rate. There was no significant difference between measurements obtained by 2
  experienced observers or between those obtained on 2 exercise tests performed on 2
  different days. These results demonstrate that impedance cardiography is a
  noninvasive, simple, accurate, and reproducible method of measurement of cardiac
  output and stroke volume over a wide range of workloads
Keywords: ACCURACY/age/analysis/artery/blood/blood pressure/cardiac/cardiac
  output/cardiomyopathy/coronary/coronary                                         artery
  disease/depression/disease/diseases/ejection                fraction/exercise/exercise
  rate/REPRODUCIBILITY/sinus rhythm/stroke/stroke volume/systolic blood
  pressure/techniques/test/THORACIC                                      ELECTRICAL
Young, A.A., Orr, R., Smaill, B.H. and Dell'Italia, L.J. (1996), Three-dimensional
  changes in left and right ventricular geometry in chronic mitral regurgitation.
  American Journal of Physiology-Heart and Circulatory Physiology, 40 (6),
Abstract: Regional three-dimensional (3-D) right (RV) and left ventricular (LV)
  geometry was studied in eight dogs before and 5-6 mo after induction of mitral
  regurgitation (MR). Ventricular shape changes were quantified with a 3-D finite-
  element model fitted to chamber contours traced on cardiac magnetic resonance
  images. MR increased LV end-diastolic volume (LVEDV; 99 vs. 57 ml; P < 0.001)
  and LV stroke volume (LVSV; 55 vs. 26 ml; P < 0.001). In contrast, RVEDV
  decreased (45 vs. 55 ml; P < 0.01), whereas SV was maintained. LV mass (free wall
  plus septum) increased (115 vs. 94 g; P < 0.05), whereas RV free-wall mass was
  relatively unchanged. Shape changes due to MR were characterized by a marked
  (7.4-mm) rightward shift of the septum relative to the lateral LV free wall at end
  diastole. In contrast, the distance from the RV free wall to the lateral LV free wall
  was relatively unchanged (2.7 mm). The distance between the LV lateral free wall
  and septum increased more than the distance between the anterior and posterior LV
  walls (22 vs. 15%; P = 0.04). During systole, the displacement of the septum into the
  LV increased significantly (7.3 vs. 2.9 mm; P < 0.01). Consistent with the
  end-diastolic dimension changes, LV endocardial circumferential curvature was
  decreased at end diastole to a greater extent in the anterior and posterior walls than in
  the septal and lateral walls (P < 0.01). Thus chronic MR produced an asymmetric LV
  dilatation with regional variation in geometry. The septum increased its contribution
  to the LVSV at the expense of RVEDV. RVSV was maintained, possibly by
  ventricular interaction
Keywords:         cardiac/chronic/contours/diastole/dogs/DYSFUNCTION/end-diastolic
  volume/finite      element/heart     function/heart     magnetic     resonance/HEART
  WALL/interaction/left                                              ventricular/magnetic
  resonance/MAGNETIZATION/mathematical model/mitral regurgitation/mitral valve
  FUNCTION/regional/SPATIAL                                MODULATION/stroke/stroke
  volume/systole/SYSTOLIC            FUNCTION/three-dimensional/variation/ventricular
Yoshida, H., Satoh, K., Koyama, N., Hiramoto, N. and Takamatsu, S. (1996),
  Deficiency of plasma platelet-activating factor acetylhydrolase: Roles of blood cells.
  American Journal of Hematology, 53 (3), 158-164.
Abstract: Platelet-activating factor (PAF), a potent mediator of inflammation and
  circulatory shock, is inactivated by the enzyme PAF acetylhydrolase. Plasma PAF
  acetylhydrolase deficiency occurs even in healthy subjects. We hypothesized that
  erythrocyte PAF acetylhydrolase could play a supplementary role in this plasma
  acetylhydrolase deficiency. We examined 1,030 subjects who participated in mass
  checkups, and assayed plasma and erythrocyte PAF acetylhydrolase. We also
  investigated the degradation of exogenous PAF by erythrocytes or other blood cells
  obtained from subjects who exhibited the plasma enzyme deficiency. The incidence
  of the plasma enzyme deficiency in this general Japanese population was 4.7%
  (48/1,030). None of the subjects with the deficiency had a history of allergy,
  circulatory shock, or chronic inflammatory diseases. The mean values for erythrocyte
  cytosolic PAF acetylhydrolase activity in the normal and deficient subjects were
  0.51+/-0.15 (SD) and 0.71+/-0.28 nkat (nmol/s)/g protein, respectively and the
  difference was significant (P <0.001, Mann-Whitney U-test). The half-life of 10
  nmol/l [H-3]PAF in plasma from normal subjects was about 5 min, and the half-life
  in whole blood or erythrocyte suspension in autologous plasma was almost the same
  as that in plasma. In plasma from deficient subjects, unchanged PAF virtually
  remained and the degradation in whole blood or erythrocyte suspension was a little
  faster than in plasma. We conclude that erythrocytes contribute only little to PAF
  metabolism in normal blood but they account for almost all of the slow PAF
  degradation in blood from subjects deficient in plasma PAF acetylhydrolase. (C)
  1995 Wiley-Liss, Inc
Keywords:                                    acetylhydrolase/activity/allergy/blood/blood
  ERYTHROCYTES/human                    erythrocytes/incidence/inflammation/ISCHEMIC
  checkup/MEMBRANE/metabolism/NEW-YORK/plasma/plasma                               enzyme
  deficiency/platelet-activating factor/PURIFICATION/RELEASE/SECRETE/shock
Betocchi, S., Piscione, F., Losi, M.A., Pace, L., Boccalatte, M., PerroneFilardi, P.,
  CappelliBigazzi, M., Briguori, C., Manganelli, F., Ciampi, Q., Salvatore, M. and
  Chiariello, M. (1996), Effects of diltiazem on left ventricular systolic and diastolic
  function in hypertrophic cardiomyopathy. American Journal of Cardiology, 78 (4),
Abstract: Hypertrophic cardiomyopathy (HC) is characterized by impaired diastolic
  function, and left ventricular (LV) outflow tract obstruction in about one-fourth of
  patients. Verapamil improves diastolic properties, but may have dangerous adverse
  effects. This study investigates the effects of diltiazem on hemodynamics and LV
  function in 16 patients with HC who were studied with cardiac catheterization and
  simultaneous radionuclide angiography. Studies were performed during atrial pacing
  (15 beats above spontaneous rhythm) at baseline and during intravenous diltiazem
  administration (0.25 mg . kg(-1) over 2 minutes, and 0.014 mg . kg(-1). min(-1)).
  Diltiazem induced a systemic vasodilation (cardiac index: 3.4 +/- 1.0 to 4.0 +/- 1.0 L .
  min(-1). m(-2), p = 0.003; aortic systolic pressure: 116 +/- 16 to 107 +/- 19 mm Hg,
  p = 0.007; systemic resistance index: 676 +/- 235 to 532 +/- 193 dynes . s . cm(- 5).
  m(-2), p = 0.006), not associated with changes in the LV outflow tract gradient. The
  end-systolic pressure/volume ratio decreased (30 +/- 42 to 21 +/- 29 mm Hg . ml(-1).
  m(-2); 0.044). Pulmonary artery wedge pressure (11 +/- 5 to 15 +/- 6 mm Hg, p =
  0.006), and peak filling rate increased (4.1 +/- 1.3 to 6.0 +/- 2.4 stroke counts . s(-1),
  p = 0.004). The time constant of isovolumetric relaxation tau decreased (74 +/- 40 to
  59 +/- 38 ms, p = 0.045). The constant of LV chamber stiffness did not change. Thus,
  active diastolic function is improved by the acute administration of diltiazem by both
  direct action and changes in hemodynamics and loading conditions. LV outflow tract
  gradient does not increase despite systemic vasodilation. In some patients, however,
  a marked increase in obstruction and a potentially harmful elevation in pulmonary
  artery wedge pressure do occur. Passive diastolic function is not affected
  c                                                       index/cardiomyopathy/diastolic
Alderman, M.H. (1996), Absolute cardiovascular risk: The basis for deciding to treat.
  American Journal of Nephrology, 16 (3), 182-189.
Abstract: It has been convincingly demonstrated that raised blood pressure is a risk
  factor for cardiovascular disease and that its reduction saves lives. It seems logical to
  suggest that the whole population's blood pressure distribution should be displaced
  downwards, since the reduction of blood pressure by only a few millimeters of
  mercury, if easily and safely achieved, would produce more disease prevention than
  could be attained by any other conceivable clinical strategy. Physicians already have
  powerful tools to lower blood pressure in individual patients, but must make
  challenging decisions as to when and how to use them. Blood pressure level is a
  reflection of relative risk and one of many risk factors that determine absolute risk.
  Reduction of blood pressure therefore does not cure cardiovascular disease, but
  reduces the risk of developing disease. The need for hypotensive therapy should be
  determined by absolute risk and the opportunity for successful prevention, rather
  than by a threshold level of blood pressure. The task of the physician is to assist the
  patient in assessing the balance between the potential for benefit and the burden of
  intervention, and to provide the best possible care to implement the therapeutic
  choice that is made
Keywords:         absolute         risk/blood/blood        pressure/BLOOD-PRESSURE
  REDUCTION/cardiovascular/cardiovascular                          disease/cardiovascular
  INFARCTION/pressure/prevention/PROFILE/relative                             risk/risk/risk
Watson, W.J., Freeman, J., OBrien, C. and Benson, M. (1996), Embolic stroke in a
  pregnant patient with a mechanical heart valve on optimal heparin therapy. American
  Journal of Perinatology, 13 (6), 371-372.
Abstract: A 28-year-old woman with a mechanical aortic heart valve experienced an
  embolic stroke in early pregnancy after her anticoagulation therapy was changed
  from warfarin to heparin. This occurred despite use of a subcutaneous heparin
  infusion pump and optimal anticoagulation. Thromboembolism can occur in
  pregnant patients with mechanical heart valves despite optimal heparin therapy
Keywords:         ANTICOAGULANTS/anticoagulation/early                 pregnancy/embolic
  stroke/heart/heparin/heparin                   therapy/mechanical                    heart
Werner, R.A. and Kessler, S. (1996), Effectiveness of an intensive outpatient
  rehabilitation program for postacute stroke patients. American Journal of Physical
  Medicine & Rehabilitation, 75 (2), 114-120.
Abstract: The effectiveness of ongoing rehabilitation services for postacute strike
  survivors is poorly documented. We designed a randomized control, single-blinded
  study to demonstrate the effectiveness of intensive outpatient therapy. The treatment
  intervention consisted of 1 hr each of physical and occupational therapy, four times
  per week, for 12 wk; therapy focused on neuromuscular facilitation and functional
  tasks. All subjects were screened before the therapies and after 3 mo and 9 mo.
  Forty-nine stroke survivors, who were at least 1 yr (mean, 2.9 yr) poststroke, were
  randomized with two treated patients to each control (no treatment supplied). All
  patients had received inpatient rehabilitation at the time of their acute stroke, but no
  patient had any ongoing therapy within the last 6 mo. The outcome measures
  included the Functional Independence Measure (FIM), Brunnstrom stages of motor
  recovery, timed mobility tasks, and the Jebson hand evaluation. We also evaluated
  the level of depression, self-esteem, and socialization. The treated patients
  demonstrated an improvement of 6.6 points over the 3 mo of therapy compared with
  only 1.5 points in the control group in the FIM motor score transformed using Rasch
  analysis. The change from time 0 to 3 mo was significant in the treated group but not
  in the controls. Treated patients maintained their gains at the 9-mo follow-up, and
  controls lost ground. The treated group improved in terms of socialization and
  self-esteem as evidenced by a lower Sickness Impact Profile, whereas the controls
  tended to get worse. There was a trend toward less depression, but this did not reach
  a P = 0.05 level of significance. This study demonstrates that significant functional
  gains can still be attained in the postacute stroke survivor, despite prior inpatient
  rehabilitation services
Keywords:              acute/acute            stroke/analysis/cerebral             vascular
   llow      up/follow-up/functional/Functional      Independence       Measure/functional
   status/FUNCTIONAL                          STATUS/intervention/mobility/motor/motor
   recovery/occupational        therapy/outcome/outcome        measures/outcomes/physical
   therapy/Rasch                   analysis/RECOVERY/rehabilitation/score/stroke/stroke
Liu, Y., Liu, T.N., McCarron, R.M., Spatz, M., Feuerstein, G., Hallenbeck, J.M. and
   Siren, A.L. (1996), Evidence for activation of endothelium and monocytes in
   hypertensive rats. American Journal of Physiology-Heart and Circulatory
   Physiology, 39 (6), H2125-H2131.
Abstract: We have proposed that an interaction between perivascular macrophages and
   endothelium via cytokines could underlie the increased risk of stroke in hypertension.
   Therefore, the activation of monocytes, the endothelial expression of intercellular
   adhesion molecule-1 (ICAM-1), and the numbers of monocytes/macrophages in
   carotid arteries, as well as the cytokine production in carotid tissue, of spontaneously
   hypertensive rats (SHR) and normotensive Wistar-Kyoto and Sprague-Dawley rats
   were studied. The total number of blood monocytes (890 +/- 153 cells/mm(3), n = 10)
   and the number of activated (nitro blue tetrazolium-positive monocytes (220 +/- 51
   cells/mm(3), n = 10) were significantly greater (P < 0.05) in SHR than in WKY rats
   (440 +/- 81 and 40 +/- 16 cells/mm(3), respectively, n = 10). Patchy endothelial
   expression of ICAM-1 was found in 77 +/- 9% of carotid sections from stroke-prone
   SHR (SHR-SP, n = 5) and in 75 +/- 7% of the sections from SHR (n = 7) but in none
   of the sections from the two normotensive rat strains (n = 7). The number of
   endothelium-attached monocytes/macrophages per millimeter of internal elastic
   lamina was significantly greater in SHR-SP than in SHR [5.1 +/- 0.7 (n = 4) and 3.3
   +/- 0.3 (n = 6), P < 0.05], whereas no monocytes were found around the endothelium
   in either of the normotensive rat strains (n = 7 in each group). Incubation of the
   carotid arteries with lipopolysaccharide (30-300 ng/ml) induced a
   concentration-dependent expression of mRNAs for interleukin-1 beta and release of
   tumor necrosis factor-alpha to a significantly greater degree in the SHR than in the
   Wistar- Kyoto rats. The results demonstrate that hypertension is associated with
   activation of monocytes and endothelium and an increased endothelial adhesion and
   subendothelial accumulation of monocytes/macrophages and with an increased
   vascular capacity to produce cytokines
Keywords:                                                 activation/ADHESION/adhesion
   ophages/mRNA expression/necrosis/PHYSIOLOGICAL/production/rat/rats/risk/risk
   of     stroke/RISK-FACTORS/SHR/SHR-SP/SHRSP/spontaneously                   hypertensive
   rats/stroke/stroke risk/stroke-prone/stroke-prone SHR/total/tumor/tumor necrosis
Moser, F.G., Miller, S.T., Bello, J.A., Pegelow, C.H., Zimmerman, R.A., Wang, W.C.,
   OheneFrempong, K., Schwartz, A., Vichinsky, E.P., Gallagher, D. and Kinney, T.R.
   (1996), The spectrum of brain MR abnormalities in sickle-cell disease: A report from
   the Cooperative Study of Sickle Cell Disease. American Journal of Neuroradiology,
   17 (5), 965-972.
Abstract: PURPOSE: To define the spectrum of abnormalities in sickle-cell disease,
   including infarction, atrophy, and hemorrhage, that are identified by brain MR
  imaging. METHODS: All MR studies included T1, T2, and intermediate pulse
  sequences. Images were interpreted without knowledge of the clinical history or
  neurologic examination findings. Brain MR imaging was performed in 312 children
  with sickle-cell disease. RESULTS: Seventy patients (22%) had infarction/ischemia
  and/or atrophy. Infarction/ischemia was noted in 39 children (13%) who had no
  history of a stroke (the ''silent'' group). The prevalence rates for silent lesions were
  17% for sickle-cell anemia and 3% for hemoglobin sickle-cell disease. For patients
  with sickle- cell anemia and a history of cerebrovascular accident,
  infarction/ischemia lesions typically involved both cortex and deep white matter,
  while silent lesions usually were confined to deep white matter. Within the age range
  studied, the prevalence of infarction/ischemia did not increase significantly with age,
  although older patients with lesions had more lesions than did younger patients with
  lesions. CONCLUSIONS: Brain MR imaging showed infarction/ischemia in the
  absence of a recognized cerebrovascular accident in 13% of patients. The prevalence
  of these lesions did not increase significantly between the ages of 6 and 14 years,
  suggesting that lesions are present by age 6. However, the increase in the average
  number of lesions per patient with age may indicate progressive brain injury
Keywords:                                 abnormalities/age/ANEMIA/atrophy/brain/brain
  resonance/METHOD/METHODS/MR/MR                           imaging/neurologic/neurologic
  examination/NEURORADIOLOGY/prevalence/RESULTS/sickle cell anemia/sickle
  cell disease/sickle-cell disease/silent/STROKE/T1/T2/white matter
Arnell, T.D., DeVirgilio, C., Donayre, C., Grant, E., Baker, J.D. and White, R. (1996),
  Abdominal aortic aneurysm screening in elderly males with atherosclerosis: The
  value of physical exam. American Surgeon, 62 (10), 861-864.
Abstract: The purpose was 1) To assess the prevalence of abdominal aortic aneurysms
  (AAA) in elderly males with atherosclerosis and 2) to evaluate the value of physical
  exam (PE) by a vascular surgeon in detecting AAA. A total of ninety-six males older
  than 55 years referred to vascular surgery clinic with atherosclerotic disease were
  screened prospectively with PE by a vascular surgeon, followed by ultrasonography
  (US). Atherosclerosis was documented by ankle brachial index and duplex US.
  Patients who had recently undergone a vascular procedure, aortography, laparotomy,
  abdominal computed tomography, or US were excluded. Mean age was 67 years.
  Patients were 67 per cent Caucasian, 32 per cent black, and 1 per cent Hispanic.
  Presenting complaints were related to claudication (83%), carotid disease (19%),
  both (3%), and subclavian stenosis (1%). Patient characteristics included cigarette
  smoking (85%), hypertension (67%), cardiac disease (51%), diabetes (45%), stroke
  (18%), and chronic obstructive pulmonary disease (8%). One (1%) 3.7 cm AAA was
  detected by US. Sensitivity of PE was 100 per cent and specificity 92 per cent.
  Twenty-two (23%) patients were too obese for us to feel the aortic pulse. Screening
  cost was $14,250. The prevalence of AAA in this population is very low. AAA
  screening should be reserved for patients with a positive PE or who are too obese for
  the examiner to feel the aortic pulse
Keywords: AAA/age/aneurysm/ankle/atherosclerosis/cardiac/carotid/chronic/computed
Arnell, T.D., DeVirgilio, C., Chang, L., Bongard, F. and Stabile, B.E. (1996),
   Admission factors can predict the need for ICU monitoring in gallstone pancreatitis.
   American Surgeon, 62 (10), 815-819.
Abstract: The purpose was 1) to prospectively determine the prevalence of adverse
   events necessitating intensive care unit (ICU) monitoring in gallstone pancreatitis
   (GP) and 2) To identify admission prognostic indicators that predict the need for ICU
   unit monitoring. Prospective laboratory data, physiologic parameters, and APACHE
   II scores were gathered on 102 patients with GP over 14 months. Adverse events
   were defined as cardiac, respiratory, or renal failure, gastrointestinal bleeding, stroke,
   sepsis, and necrotizing pancreatitis. Patients were divided into Group 1 (no adverse
   events, n = 95) and Group 2 (adverse events, n = 7). There were no deaths and 7 (7%)
   adverse events, including necrotizing pancreatitis (3), cholangitis (2), and cardiac (2).
   APACHE II greater than or equal to 5 (P < 0.005), blood urea nitrogen (BUN)
   greater than or equal to 12 mmol/L (P < 0.005), white blood cell count (WBC)
   greater than or equal to 14.5 x 10(9)/L, (P < 0.001), heart rate greater than or equal to
   100 bpm (P < 0.001), and glucose greater than or equal to 150 mg/dL (P < 0.005)
   were each independent predictors of adverse events. The sensitivity and specificity of
   these criteria for predicting severe complications requiring ICU care varied from 71
   to 86 per cent and 78 to 87 per cent, respectively. The prevalence of adverse events
   necessitating ICU care in GP patients is low. Glucose, BUN, WBC, heart rate, and
   APACHE II scores are independent predictors of adverse events necessitating ICU
   care. Single criteria predicting the need for ICU care on admission are readily
   available on admission
   CT/failure/glucose/heart/heart rate/monitoring/predictors/prevalence/PROGNOSTIC
Jones, C.E., Jescovitch, A.J., Kahn, A., Walters, G.K. and Johnson, C.J. (1996),
   Technical results from the eversion technique of carotid endarterectomy. American
   Surgeon, 62 (5), 361-365.
Abstract: A total of 167 carotid endarterectomies by the eversion technique were
   completed in 158 patients at a teaching hospital during the 6-year period ending July
   1995. The average patient age was 66 years with a range of 39 to 89 years, and 99
   (63%) were male. General anesthesia was employed routinely, and temporary
   indwelling shunts were not used. Indications for endarterectomy included
   hemispheric transient ischemic attack (43), amaurosis fugax (20), stroke (41), and
   asymptomatic stenosis (63). Associated patient risk factors were not significantly
   different for men and women, and included diabetes mellitus (22%), tobacco abuse
   (72%), hypertension (69%), hypercholesterolemia (76%), cardiac disease (54%), and
   renal disease (21%). One (0.6%) permanent operative stroke and two (1%) 30-day
   hospital deaths occurred. Vascular laboratory follow-up was accomplished by duplex
   scanning with a documented sensitivity of 98 per cent in detecting a greater than or
   equal to 40 per cent stenosis. Eighty-nine per cent (148) of the 167 endarterectomies
   were tested at least once postoperatively. Overall laboratory follow-up averaged 17
   months and ranged from one to 69 months. Residual stenosis, including perioperative
   thrombosis, occurred in 8 (5%) arteries. Recurrent stenosis was detected in four (2%)
   cases at 9, 24, 54, and 66 months after endarterectomy. Statistical analyses failed to
   implicate any specific patient risk factor, age, sex, or operative indication relevant to
  recurrent stenosis. Residual stenosis was correlated with younger patient age (P =
  0.002), female gender (P = 0.012), and endarterectomy on the right side (P = 0.008).
  Carotid eversion endarterectomy appears to be a universally applicable, safe, and
  durable operative technique
  endarterectomy/diabetes/diabetes                      mellitus/DISEASE/duplex/duplex
  ATCH ANGIOPLASTY/RECURRENT/renal/renal disease/RESTENOSIS/risk/risk
  ombosis/tobacco/total/transient/transient ischemic attack/VEIN PATCH/women
Mitchell, R.O., Richardson, J.D. and Lambert, G.E. (1996), Characteristics, surgical
  management, and outcome in 17 carotid body tumors. American Surgeon, 62 (12),
Abstract: Tumors of the carotid body are relatively rare and may pose a difficult
  surgical problem because of their vascularity and compression of cranial nerves in
  the neck. This article reviews the physiology of the carotid body, its surgical history,
  and retrospectively reviews the management and outcome of 17 carotid body tumors
  occurring in 14 patients over an 18-year period at the University of Louisville
  Hospitals. The average age at presentation was 54.4 years, Three patients had
  bilateral tumors. Two patients (12%) had postoperative cranial nerve paralysis lasting
  greater than 6 months. One patient had a postoperative stroke after discharge from
  the hospital and subsequently died 2 months later from a pulmonary embolus, One
  patient had a malignant carotid body tumor and pulmonary metastasis and died 11
  years after her original operation during an attempted embolization of recurrent
  carotid lesion. Early operation for the tumor is indicated to prevent nerve dysfunction
  due to compression and stretch injury as the lesion increases in size
Keywords:                 age/bilateral/carotid/CHEMODECTOMA/compression/cranial
Westneat, M.W. (1996), Functional morphology of aquatic flight in fishes: Kinematics,
  electromyography, and mechanical modeling of labriform locomotion. American
  Zoologist, 36 (6), 582-598.
Abstract: Labriform locomotion is the primary swimming mode for many fishes that use
  the pectoral fins to generate thrust across a broad range of speeds. A review of the
  literature on hydrodynamics, kinematics, and morphology of pectoral fin
  mechanisms in fishes reveals that we lack several kinds of morphological and
  kinematic data that are critical for understanding thrust generation in this mode,
  particularly at higher velocities. Several needs include detailed three- dimensional
  kinematic data on species that are pectoral fin swimmers across a broad range of
  speeds, data on the motor patterns of pectoral fin muscles, and the development of a
  mechanical model of pectoral fin functional morphology. New data are presented
  here on pectoral fin locomotion in Gomphosus varius, a labrid fish that uses the
  pectoral fins at speeds of 1-6 total body lengths per second. Three-dimensional
  kinematic data for the pectoral fins of G. varius show that a typical ''drag-based''
  mechanism is not used in this species. Instead, the thrust mechanics of this fish are
  dominated by lift forces and acceleration reaction forces. The fin is twisted like a
  propeller during the fin stroke, so that angles of attack are variable along the fin
  length. Electromyographic data on six fin muscles indicate the sequence of muscle
  activity that produces antagonistic fin abduction and adduction and controls the
  leading edge of the fin. EMG activity in abductors and adductors is synchronous with
  the start of abduction and adduction, respectively, so that muscle mechanics actuate
  the fin with positive work. A mechanical model of the pectoral fin is proposed in
  which fin morphometrics and computer simulations allow predictions of fin
  kinematics in three dimensions. The transmission of force and motion to the leading
  edge of the fin depends on the mechanical advantage of fin ray levers. An integrative
  program of research is suggested that will synthesize data on morphology,
  physiology, kinematics, and hydrodynamics to understand the mechanics of pectoral
  fin swimming
  G/FIELD/fish/flight/force/functional/functional                 morphology/Gomphosus
  varius/hydrodynamics/kinematics/labriform            locomotion/locomotion/mechanical
  activity/needs/PECTORAL                            FIN/pectoral                       fin
Lauder, G.V. and Jayne, B.C. (1996), Pectoral fin locomotion in fishes: Testing
  drag-based models using three-dimensional kinematics. American Zoologist, 36 (6),
Abstract: Paired fin propulsion in fishes has classically been divided into two categories
  which represent biomechanical extremes in the use of appendages for propulsion:
  lift-based and drag-based mechanisms of thrust production. Theoretical models
  predict that fishes using drag-based propulsion should have wedge- shaped fins with
  relatively blunt distal edges, a fm beat cycle that is oriented along the anteroposterior
  (x) axis, feathering of the fin to reduce drag during the protraction phase, and
  maximal fin area during the retraction phase as the fin sweeps posteriorly
  perpendicular to the body. In this paper we use a three-dimensional analysis of
  pectoral fin propulsion in the largemouth bass, Micropterus salmoides, to (1)
  evaluate the extent to which bass pectoral fin kinematics fit predictions of drag-based
  propulsion, and (2) demonstrate the complexity of fin movement when the traditional
  two-dimensional analysis is extended into three dimensions. We attached small
  markers to visualize the diaphanous distal fin edge, and we videotaped lateral and
  ventral views from which we could measure x, y, and z coordinates from the fin and
  body. We divided the fm into two triangular elements for which we calculated planar
  (three- dimensional) angles relative to each of three reference planes (XY, YZ, and
  XZ) during the fin beat cycle. We show how angles of attack based only on
  two-dimensional data may result in gross errors that severely compromise
  understanding of the mechanics and hydrodynamics of pectoral propulsion.
  Furthermore, three-dimensional analysis revealed that bass fin kinematics are much
  more complex than expected on a rowing model of drag-based propulsion, and that
  the pectoral fins may produce drag-based thrust even during protraction. Three-
  dimensional kinematic data are critical to understanding the hydrodynamics of
  aquatic animal propulsion. Such data are a necessary foundation for reconstructing
  patterns of movement, modeling (both theoretical and empirical), and for assessing
  the extent to which motion is under active control or a passive consequence of fluid
Keywords:             active            control/analysis/ANGELFISH/animal/AQUATIC
  ment/pectoral                                fin/pectoral                            fin
Habre, W., Beghetti, M., Roduit, C., Girardin, E., Vallotton, M., Friedli, B. and Berner,
  M. (1996), Haemodynamic and renal effects of dopexamine after cardiac surgery in
  children. Anaesthesia and Intensive Care, 24 (4), 435-439.
Abstract: Dopexamine hydrochloride, a synthetic dopamine analog with predominantly
  beta and delta agonist properties, has been shown to improve cardiac performance
  and renal function in adults with heart failure. This study was designed to investigate
  the haemodynamic and renal effects of dopexamine in children after cardiac surgery.
  Seven children were selected in whom a need for postoperative vasodilation after
  cardiac surgery was anticipated Haemodynamics and renal function were determined
  under baseline conditions and during a continuous infusion of dopexamine at 2 and 6
  mu for 90 minutes, the sequence being randomized for the initial
  dose. Cardiac output was measured by thermodilution and glomerular filtration rate
  (GFR) and renal plasma flow (RPF) by the clearances of inulin and
  para-aminohippurate respectively. Dopexamine induced a dose-related increase in
  cardiac index (CI) expressed as mean (SD) from 3.5 (0.7) to 3.9 (0.76) and 4.5 (0.8)
  l.min.(-1)m(-2) (both P<0.05), and in heart rate (HR) from 107 (17) to 122 (17) and
  136 (17) beats.min(-1) (P<0.05). Stroke volume index (SVI) and mean systemic
  pressure were unchanged but pulmonary wedge pressure decreased from 14 (3) to 11
  (4) and 12 (3) mmHg (both P<0.05). Systemic vascular resistances (SVR) decreased
  from 24 (7) to 20 (5) mmHg.l(-1).min(-1).m(-2) (P<0.05), with dopexamine 6 mu Renal blood flow (RBF) increased from 319 (113) to 441 (230) and
  410 (138) ml.min(- 1).m(-2) (both P<0.05), GFR from 115 (32) to 142 (34) and 146
  (29) ml.min(-1).1.73m(-2) (both P<0.05), urine output and fractional excretion of
  sodium respectively from 3.12 (2) to 7.16 (8) and 7.21 (6) (both P<0.05)
  and from 2.24 (1) to 4.25 (3.4) (P<0.05) and 3.15 (3.1)% (n.s.). The fraction of CI
  delivered to the kidneys, the fraction of RBF filtered in the kidneys, plasma renin
  activity and aldosterone levels remained unchanged. In children after cardiac surgery
  dopexamine increases CI at the expense of a concomitant increase in heart rate and
  demonstrates few selective vascular systemic or intrinsic renal actions
Keywords:                     activity/adults/aldosterone/AUSTRALIA/beta/blood/blood
  flow/cardiac/cardiac       index/cardiac        output/cardiac    performance/cardiac
  /failure/flow/function/haemodynamic/heart/heart                            failure/heart
Denborough, M., Hopkinson, K.C., Obrien, R.O. and Foster, P.S. (1996), Overheating
  alone can trigger malignant hyperthermia in piglets. Anaesthesia and Intensive
  Care, 24 (3), 348-354.
Abstract: Seven out of eight piglets which were susceptible to malignant hyperthermia
  (MHS) died when subjected to a heat challenge which was well tolerated by controls.
  The piglets which succumbed developed the classical clinical and biochemical
  changes of malignant hyperthermia before they died. These results show that
  overheating alone can trigger malignant hyperthermia in susceptible animals.
  Because the biochemical basis of malignant hyperthermia is similar in both humans
  and pigs, these observations suggest that overheating can also trigger malignant
  hyperthermia in humans. The susceptibility to overheating in malignant hyperthermia
  susceptible humans and animals probably explains why the myopathy which
  predisposes to this condition has also been reported to predispose to heat- stroke and
  the sudden infant death syndrome. In view of this, particular care to prevent
  overheating should be taken in infants of parents who are susceptible to malignant
Keywords:           animals/AUSTRALIA/CARE/COT                  DEATH/death/heat/heat
  POSITION/stroke/sudden infant death syndrome/SUDDEN-INFANT-DEATH
Spies, C., Giese, C., MeierHellmann, A., Specht, M., Hannemann, L., Schaffartzik, W.
  and Reinhart, K. (1996), Influence of prophylactic administration of N-acetylcysteine
  on the clinical indicators of tissue oxygenation during hyperoxic ventilation in
  cardiac risk patients. Anaesthesist, 45 (4), 343-350.
Abstract: Hyperoxic ventilation, used to prevent hypoxia during potential periods of
  hypoventilation, has been reported to paradoxically decrease whole-body oxygen
  consumption (VO2). Reduction in nutritive blood flow due to oxygen radical
  production is one possible mechanism. We investigated whether pretreatment with
  the sulfhydryl group donor and O-2 radical scavenger N- acetylcysteine (NAC)
  would preserve VO2 and other clinical indicators of tissue oxygenation in cardiac
  risk patients. Methods. Thirty patients, requiring hemodynamic monitoring (radial
  and pulmonary artery catheters) because of cardiac risk factors, were included in this
  randomized investigation. All patients exhibited stable clinical conditions
  (hemodynamics, body temperature, hemoglobin, F(1)0(2)<0.5). Cardiac output was
  determined by thermodilution and VO2 by cardiovascular Fick. After baseline
  measurements, patients randomly received either 150 mg kg(-1) NAC (n=15) or
  placebo (n=15) in 250 ml 5% dextrose i.v. over a period of 30 min. Measurements
  were repeated 30 min after starting NAC or placebo infusion, 30 min after starting
  hyperoxia (F1O2=1.0), and 30 min after resetting the original F1O2. Results. There
  were no significant differences between groups in any of the measurements before
  treatment and after the return to baseline F1O2 at the end of the study, respectively.
  NAC, but not placebo infusion, caused a slight but not significant increase in cardiac
  index (CI), left ventricular stroke work index (LVSWI) and a decrease in systemic
  vascular resistance. Significant differences between groups during hyperoxia were:
  VO2 (NAC: 108 +/- 38 ml min(- 1)m(-2) vs placebo: 79 +/- 22 ml min(-1)m(-2), P
  less than or equal to 0.05, CI (NAC: 4.6 +/- 1.0 vs placebo: 3.7 +/- 1/11 min(-1)m(-2),
  P less than or equal to 0.05) and LVSWI (NAC: 47 +/- 12 vs placebo: 38 +/- 9 P less
  than or equal to 0.05). The mean decrease of VO2 was 22% in the NAC group vs
  47% in the placebo group (P less than or equal to 0.05) and the mean difference
  between groups in venoarterial carbon dioxide gradient (PvaCO(2)) was 14% (P less
  than or equal to 0.05). ST segment depression (>0.2 mV) was significantly less
  marked in the NAC group (NAC: -0.02 +/- 0.17 vs placebo: -0.23 +/- 0.15; P less
  than or equal to 0.05). Conclusions. NAC helped preserve VO2 oxygen delivery, CT,
  LVSWI and PvaCO(2) during brief hyperoxia in cardiac risk patients. Clinical signs
  of myocardial ischemia did not occur such as ST-depression if patients were
  prophylactically treated with NAC. This suggests that pretreatment with NAC could
  be considered to attenuate impaired tissue oxygenation and to preserve myocardial
  performance better in cardiac risk patients during hyperoxia
Keywords:             administration/ARTERIAL/artery/blood/blood               flow/body
  temperature/carbon           dioxide/cardiac/cardiac        index/cardiac          risk
  FAILURE/CONSUMPTION/CRITICALLY                                                     ILL
  /hemoglobin/hyperoxia/hypoxia/ischemia/left ventricular/left ventricular stroke
  artery/radical/RELAXING            FACTOR/resistance/risk/risk         factors/SEPTIC
  PATIENTS/stroke/stroke               work/SUPEROXIDE/systemic                  vascular
  resistance/ventilation/VO2/whole-body oxygen uptake/work
[Anon]. (1996), The 1st 6 hours are critical - Stroke - No longer a taboo topic -
  Preliminary successes in combating the 3rd most frequent cause of death.
  Anaesthesist, 45 (8), 763-765
Keywords: NEW-YORK
Hartman, G.S., Peterson, J., Konstadt, S.N., Hahn, R., Szatrowski, T.P., Charlson, M.E.
  and Bruefach, M. (1996), High reproducibility in the interpretation of intraoperative
  transesophageal echocardiographic evaluation of aortic atheromatous disease.
  Anesthesia and Analgesia, 82 (3), 539-543.
Abstract: Intraoperative decisions are often based on interpretation of results from
  transesophageal echocardiography (TEE). One such area is the intraoperative
  evaluation of atheromatous disease of the thoracic aorta and subsequent classification
  or grading. These grading schemes are predictive of stroke after cardiac surgery.
  Since intraoperative strategies may be modified based on this TEE aortic atheroma
  grading, assessment of the interobserver variability of TEE findings between
  observers is essential. Forty TEE videotape segments imaging three portions of the
  thoracic aorta (ascending, arch, descending) were selected from 189 reports of a
  larger cohort. Three independent, blinded observers, experienced in TEE, evaluated
  these examinations for atheroma severity. If a TEE segment had insufficient data,
  ''uninterpretable'' was recorded. Weighted kappa coefficients of agreement were
  calculated on the three data sets. Mean weighted kappa coefficients for the three
  observers A, B, and C were 0.69, 0.74, and 0.72, for the ascending, arch, and
  descending aorta segments, respectively, representing excellent agreement. We have
  demonstrated uniformly high agreement for interpretation of TEE, which indicates
  the excellent reproducibility of TEE grading and stratification of aortic atheroma.
  Reproducibility within and across specialties and institutions is essential for
  widespread application of TEE for evaluation of the thoracic aorta
Keywords:          aorta/ARCH/ascending/assessment/atheroma/ATHEROSCLEROTIC
  ASCENDING                                           AORTA/BYPASS/cardiac/cardiac
  cic/transesophageal/transesophageal echocardiography/variability
Swenson, J.D., Harkin, C., Pace, N.L., Astle, K. and Bailey, P. (1996), Transesophageal
  echocardiography: An objective tool in defining maximum ventricular response to
  intravenous fluid therapy. Anesthesia and Analgesia, 83 (6), 1149-1153.
Abstract: Ventricular preload is an important determinant of cardiac function, which is
  indirectly measured in the clinical setting by the pulmonary capillary wedge pressure
  (PCWP). Transesophageal echocardiography (TEE) is rapidly gaining acceptance as
  a monitor of cardiac func tion. Although it provides high-resolution images of
  cardiac structures, clinical assessment of ventricular preload using TEE has been
  subjective, since quantitative measurements have been difficult to perform in a
  timely fashion. Automated border detection (ABD) is a new technology used in
  conjunction with TEE that allows quantitative real-time, two-dimensional
  measurement of cavity areas. To determine whether end-diastolic area (EDA)
  measured by ABD can be used to determine an appropriate end point for intravenous
  fluid administration, nine mongrel dogs were studied. Anesthetized animals were
  hemorrhaged to achieve a central venous pressure of 0-5 mm Hg. Each animal was
  then given intravenous fluid(autologous blood followed by hetastarch) until a peak in
  thermodilution cardiac output (GO) was achieved. Measures of PCWP, EDA, CO,
  and left ventricular stroke work (LVSW) were obtained after each fluid bolus.
  Bivariate plots displaying administered volume versus CO, LVSW, and EDA
  revealed parallel curves for each of these variables with peaks evident at cumulative
  volumes of 50-55 mL/kg. Multiple regression with mixed model anal ysis of
  covariance was performed to determine the significance of EDA in relation to
  changes in CO and LVSW. Analysis was likewise performed comparing the
  relationship between PCWP and changes in CO or LVSW. A significant relationship
  was demonstrated when comparing EDA to changes in CO and LVSW (P = 0.03 and
  P < 0.0001, respectively). Similar analysis comparing PCWP to changes in CO and
  LVSW failed to demonstrate a significant relationship (P = 0.54 and P = 0.36,
  respectively). These data suggest that changes in EDA measured using TEE with
  ABD are related to trends in cardiac function and can suggest an appropriate end
  point for intravenous fluid administration as defined by maximum CO and LVSW.
  PCWP did not demonstrate a significant relationship to changes in CO and LVSW
Keywords:      administration/analysis/animal/animals/assessment/blood/cardiac/cardiac
  function/cardiac            output/central            venous           pressure/clinical
  INDEXES/intravenous/left             ventricular/left        ventricular         stroke
Heerdt, P.M. and Pleimann, B.E. (1996), The dose-dependent effects of halothane on
  right ventricular contraction pattern and regional inotropy in swine. Anesthesia and
  Analgesia, 82 (6), 1152-1158.
Abstract: The right ventricle (RV) is comprised of two embryo-logically distinct units,
  the inflow and outflow tracts, which normally contract sequentially and differ in the
  magnitude of increased inotropy during sympathetic nervous stimulation. The
  present study examined the dose-response effects of halothane on the RV contraction
  pattern and regional contractility in seven open- chest pigs instrumented for
  measurement of inflow and outflow tract pressures and segment lengths. The RV
  contraction pattern was evaluated by comparing the phase of inflow and outflow tract
  shortening and regional contractility was determined by calculation of preload
  recruitable stroke work (PRSW) slope. Using this methodology, an inflow-outflow
  tract contraction phase difference of -27 degrees (inflow tract shortened earlier) was
  evident at baseline, but was abolished by 1.0 and 1.5 minimum alveolar anesthetic
  concentration (MAC) halothane; PRSW slope of both the inflow and outflow tracts,
  however, demonstrated similar dose-related change. To determine whether
  alterations in cardiac sympathovagal balance Flayed a role in the RV response to
  halothane, an additional four animals were studied after pretreatment with
  hexamethonium, propranolol, and atropine. In these animals, there was no difference
  in the regional contraction phase either at baseline or during halothane administration,
  and dose-related depression of PRSW by halothane was again similar in both regions.
  However, when halothane effects on regional PRSW in animals with autonomic
  blockade were compared to those of neurally intact animals, a 20% greater
  depression of outflow tract PRSW by 0.5 MAC halothane was evident. This study
  demonstrates that halothane abolishes the normal sequential pattern of RV
  contraction without exerting markedly variant negative inotropic effects within
  different regions of the RV, and provides evidence to suggest that alterations in
  cardiac sympathovagal balance may contribute to the effect of halothane on RV
  contraction dynamics
Keywords: administration/anesthetic/animals/autonomic/balance/CANINE RIGHT
  halothane/inotropic/JUN/MAC/measurement/preload/preload recruitable stroke
Giebler, R.M., Walz, M.K., Peitgen, K. and Scherer, R.U. (1996), Hemodynamic
  changes after retroperitoneal CO2 insufflation for posterior retroperitoneoscopic
  adrenalectomy. Anesthesia and Analgesia, 82 (4), 827-831.
Abstract: Intraoperative complications and hemodynamic alterations during posterior
  capnoretroperitoneoscopic adrenalectomy in the prone position were investigated in
  16 consecutive patients using invasive hemodynamic monitoring. Under general
  anesthesia with propofol and fentanyl, hemodynamic changes were made before
  (M(1)) and during retroperitoneal CO2 insufflation (15 mm Hg) [M(2)]; 20 mm Hg
  [M(3)]. Retroperitoneal insufflation resulted in a significant increase of cardiac
  output (+72%), stroke volume (+42%), mean arterial pressure (+39%), and mean
  pulmonary arterial pressure (+36%). Although retroperitoneal inflation was pressure
  (+37%), an increase of preload may have led to higher filling pressures. Heart rate,
  systemic vascular resistance, and pulmonary vascular resistance did not show
  significant changes. One pneumothorax and two cutaneous emphysemas occurred.
  We have demonstrated, in a small number of patients, that retroperitoneal CO2
  insufflation for posterior capnoretroperitoneoscopic adrenalectomy in the prone
  position results in hemodynamic changes without apparent adverse effects
Keywords:                anesthesia/arterial/arterial             pressure/cardiac/cardiac
  modynamic            changes/LAPAROSCOPIC               CHOLECYSTECTOMY/mean
  ulmonary vascular resistance/rate/resistance/small/stroke/stroke volume/systemic
  vascular resistance/vascular/vascular resistance/volume
Hartman, G.S., Yao, F.S.F., Bruefach, M., Barbut, D., Peterson, J.C., Purcell, M.H.,
  Charlson, M.E., Gold, J.P., Thomas, S.J. and Szatrowski, T.P. (1996), Severity of
  aortic atheromatous disease diagnosed by transesophageal echocardiography predicts
  stroke and other outcomes associated with coronary artery surgery: A prospective
  study. Anesthesia and Analgesia, 83 (4), 701-708.
Abstract: Advanced atheromatous disease of the thoracic aorta identified by
  transesophageal echocardiography (TEE) is a major risk factor for perioperative
  stroke. This study investigated whether varying degrees of atherosclerosis of the
  descending aorta, as assessed by TEE, are an independent predictor of cardiac and
  neurologic outcome in patients undergoing coronary artery bypass grafting (CABG).
  Intraoperative TEE of the descending aorta was performed on 189 of 248 patients
  participating in a randomized controlled trial of low (50-60 mm Hg) or high (80-100
  mm Hg) mean arterial pressure during cardiopulmonary bypass for elective CABG.
  Aortic atheromatous disease was graded from I to V in order of increasing severity
  by observers blinded to outcome. Measured outcomes were death, stroke, and major
  cardiac events assessed at 1 wk and 6 mo. Nine of the 189 patients with TEE
  examinations had perioperative strokes by 1 wk. At 1 wk, no strokes had occurred in
  the 123 patients with atheroma Grades I or II, while the l- wk stroke rate was 5.5%
  (2/36), 10.5% (2/19), and 45.5% (5/11) for Grades III, IV, and V, respectively
  (Fisher's exact test, P = 0.00001). For 6-mo outcome, advancing aortic atheroma
  grade was a univariate predictor of stroke (P = 0.00001) and death (P = 0.03). By 6
  mo there were one additional stroke, three additional deaths, and one additional
  major cardiac event. Atheromatous disease of the descending aorta was a strong
  predictor of stroke and death after CABG. TEE determination of atheroma grade is a
  critical element in the management of patients undergoing CABG surgery
Keywords:                                                      aorta/ARCH/arterial/arterial
  pressure/artery/atheroma/atherosclerosis/ATHEROSCLEROTIC                   ASCENDING
  BYPASS/coronary/coronary artery/coronary artery bypass/coronary artery bypass
  grafting/coronary                                                                 artery
  nt/mean                                               arterial/neurologic/OPEN-HEART
Sorensen, G.K., Ramamoorthy, C., Lynn, A.M., French, J. and Stevenson, J.G. (1996),
  Hemodynamic effects of amrinone in children after Fontan surgery. Anesthesia and
  Analgesia, 82 (2), 241-246.
Abstract: After Fontan repair in children, we performed a prospective, open-label study
  to evaluate the effect of amrinone on pulmonary vascular resistance (PVRI). Eight
  patients who underwent the Fontan repair had baseline arterial pressure, left atrial
  pressure, central venous pressure, and cardiac output measured postoperatively.
  Hemodynamic measurements were repeated after amrinone 4.5 mg/kg. The PVRI
  tended to decrease, but the change was not statistically significant. Although the
  systemic vascular resistance decreased to 802 +/- 222 from 941 +/- 191 dynes . s .
  cm(-5). m(-2) (P < 0.05), mean arterial blood pressure was unchanged. Cardiac index
  (3.8 +/- 1.2 to 4.7 +/- 1.6 L . min(-1). m(-2)) and stroke volume index (23.6 +/- 6.7 to
  30.5 +/- 8.1 mL . beat(-1). m(-2)) increased, and heart rate decreased (160 +/- 21 to
  151 +/- 24 bpm) (P < 0.05). Colloid transfusion during amrinone bolus
  administration was 13.9 mL/kg. The mean serum amrinone concentration was 4.2 mu
  g/mL at the end of bolus and clearance was 2.24 mL . kg(-1). min(-1). Arrhythmias
  and thrombocytopenia were not noted. We conclude that amrinone administration is
  effective in increasing cardiac output in children who have undergone a Fontan
Keywords:           administration/arterial/arterial       blood        pressure/arterial
  pressure/atrial/blood/blood      pressure/cardiac/cardiac    output/central    venous
  pressure/children/effect/effects/heart/heart                                rate/mean
  arterial/measurements/pressure/prospective/pulmonary/pulmonary                vascular
  resistance/rate/resistance/serum/stroke/stroke volume/surgery/systemic vascular
  resistance/thrombocytopenia/vascular/vascular resistance/volume
Habler, O.P., Kleen, M.S., Podtschaske, A.H., Hutter, J.W., Tiede, M., Kemming, G.I.,
  Welte, M.V., Corso, C.O. and Messmer, K.F. (1996), The effect of acute
  normovolemic hemodilution (ANH) on myocardial contractility in anesthetized dogs.
  Anesthesia and Analgesia, 83 (3), 451-458.
Abstract: The influence of severe acute normovolemic hemodilution (ANH) on
  myocardial contractility (MC) was investigated in 14 splenectomized, anesthetized
  dogs. MC was assessed by the maximum rate of left ventricular pressure increase
  (LVdp/dt(max)), end-systolic elastance (Ees), and preload recruitable stroke work
  (PRSW) (conductance catheter, left ventricular pressure-volume relationship).
  Measurements of myocardial perfusion and oxygenation (radioactive microsphere
  technique) assured comparability of the model to previously performed studies.
  Global and regional myocardial blood flow increased significantly upon
  hemodilution with preference to midmyocardium and subendocardium. This resulted
  in preservation of both myocardial oxygen delivery and consumption after ANH.
  Myocardial oxygen extraction as well as coronary venous PO2 were unaffected by
  ANH, while coronary venous lactate concentration decreased, indicating that
  myocardial oxygen need was met. LVdp/dt(max) decreased significantly after
  hemodilution (2278 +/- 577 vs 1884 +/- 381 mm Hg/s, P < 0.01), whereas Ees and
  PRSW increased significantly (1.76 +/- 0.54 vs 2.15 +/- 0.75 mm Hg/mL, P < 0.05,
  for Ees and 33 +/- 14 vs 45 +/- 14 mm Hg . mL, P < 0.05, for PRSW). While the
  decrease of LVdp/dt(max) most likely reflects ANH-induced changes of ventricular
  pre- and afterload, the increase of Ees and PRSW indicates a true increase of
  myocardial contractility during ANH in anesthetized dogs
Keywords:       acute/afterload/anesthetized/AUTOLOGOUS            BLOOD/blood/blood
  ICS/ISOVOLEMIC HEMODILUTION/lactate/left ventricular/left ventricular
  pressure/model/myocardial/myocardial                 blood            flow/myocardial
  contractility/oxygen/oxygen       delivery/oxygenation/perfusion/PO2/preload/preload
  recruitable stroke work/pressure/rate/regional/SEP/stroke/VOLUME/work
Reasoner, D.K., Ryu, K.H., Hindman, B.J., Cutkomp, J. and Smith, T. (1996), Marked
  hemodilution increases neurologic injury after focal cerebral ischemia in rabbits.
  Anesthesia and Analgesia, 82 (1), 61-67.
Abstract: Moderate hemodilution (hematocrit similar to 30%) reduces neurologic injury
  after focal cerebral ischemia. In contrast, both clinical and experimental studies
  suggest that marked hemodilution (hematocrit <30%) may exacerbate neurologic
  injury. We compared the effect of marked versus minimal hemodilution on cerebral
  infarct volume after focal cerebral ischemia in rabbits. Anesthetized New Zealand
  White rabbits underwent hemodilution by exchange of arterial blood with 6% high
  molecular weight hydroxyethyl starch. In the marked hemodilution group (n = 15)
  the target hemoglobin concentration was 6 g/100 mL. In the minimal hemodilution
  group (n = 15) the target hemoglobin concentration was 11 g/100 mL. After
  hemodilution, middle cerebral artery occlusion was achieved by embolizing an
  autologous blood clot via the internal carotid artery. Four hours after embolization,
  the animals were killed and their brains removed. Brains were sectioned, stained with
   2,3,5-triphenyltetrazolium chloride, and infarct volumes determined via quantitative
   image analysis. Systemic physiologic variables were similar between groups, except
   for arterial hemoglobin concentration. The percentage of hemispheric infarct was
   significantly larger in the marked hemodilution group as compared to the minimal
   hemodilution group, 70% +/- 19% vs 51% +/- 23%, respectively (mean +/- SD); P =
   0.02. Similarly, the percentage of infarct was greater in the hemodilution group as
   compared to the minimal hemodilution group in both cortex (73% +/- 18% vs 54%
   +/- 23%, respectively; P = 0.02) and subcortex (62% +/- 25% vs 44% +/- 23%,
   respectively; P = 0.04). These findings indicate that marked hemodilution
   exacerbates neurologic injury resulting from permanent focal ischemia. Although
   some degree of hemodilution may improve neurologic outcome, the advantage is lost
   at an extreme level of therapy
Keywords:                       analysis/ANESTHESIA/animals/arterial/artery/ARTERY
   OCCLUSION/blood/BLOOD-FLOW/BRAIN                              INJURY/carotid/carotid
   artery/cerebral/cerebral artery/cerebral infarct/cerebral ischemia/CHLORIDE
   TTC/cortex/effect/embolization/experimental/focal/focal cerebral ischemia/focal
   STARCH/HYPERVOLEMIC                           HEMODILUTION/image/infarct/infarct
   volume/injury/internal/internal                carotid/internal               carotid
   artery/ischemia/ISOVOLEMIC            HEMODILUTION/middle/middle             cerebral
   artery/middle         cerebral       artery       occlusion/MODEL/neurologic/New
Park, G.E., Hauch, M.A., Curlin, F., Datta, S. and Bader, A.M. (1996), The effects of
   varying volumes of crystalloid administration before cesarean delivery on maternal
   hemodynamics and colloid osmotic pressure. Anesthesia and Analgesia, 83 (2),
Abstract: The value of intravenous crystalloid administration in preventing
   spinal-induced hypotension in the parturient has recently been questioned. Also, the
   association between increasing crystalloid volume and decreasing postpartum colloid
   osmotic pressure (COP) raises concern regarding the risk of maternal and fetal
   pulmonary edema. To study the dose-response effect of varying amounts of
   crystalloid volume prior to spinal anesthesia, we measured maternal hemodynamic
   variables and maternal and fetal COP in three groups of healthy parturients receiving
   spinal anesthesia for elective cesarean delivery. Fifty-five parturients were
   randomized in a double-blind fashion to receive one of 10, 20, or 30 mL/kg of
   crystalloid volumes prior to induction of spinal anesthesia. Measurements included
   mean arterial blood pressure (MAP), cardiac index (CI), and systemic vascular
   resistance index (SVRI) recorded using noninvasive thoracic impedance monitoring
   until delivery. Maternal and neonatal COP were measured. All groups showed
   declines in MAP and SVRI from baseline at 5 min after spinal anesthesia, but the
   amount of decline did not differ among groups. Total ephedrine and additional
   intravenous (IV) fluid administered did not differ among groups. The 20- and
   30-mL/kg groups showed a larger decline in maternal COP than the 10- mL/kg group;
   no differences in neonatal COP were seen with varying preload. We conclude that
   increasing the amount of IV crystalloid administered to 30 mL/kg in the healthy
   parturient does not significantly alter maternal hemodynamics or ephedrine
   requirements after spinal anesthesia and has no apparent benefit
Keywords: administration/anesthesia/arterial/arterial blood pressure/blood/blood
   pressure/cardiac/cardiac                  index/CARDIAC                    STROKE
   ce/IMPEDANCE                                             CARDIOGRAPHY/INDUCED
   edema/resistance/risk/SECTION/spinal/SPINAL-ANESTHESIA/systemic vascular
   resistance/systemic        vascular      resistance     index/thoracic/vascular/vascular
Dehert, S.G., Rodrigus, I.E., Haenen, L.R., DeMulder, P.A. and Gillebert, T.C. (1996),
   Recovery of systolic and diastolic left ventricular function early after
   cardiopulmonary bypass. Anesthesiology, 85 (5), 1063-1075.
Abstract: Background: Impairment of left ventricular function after cardiopulmonary
   bypass (CPB) is well recognized, but little is known about the time course of
   recovery of cardiac function early after separation from CPB. Therefore, recovery of
   left ventricular function was evaluated early after separation from CPB in patients
   undergoing coronary artery surgery. The authors tried to determine whether this
   recovery might be attributed to autoregulation of function by preload. Methods: Left
   ventricular pressure was measured with fluid-filled catheters. Data were digitally
   recorded during increased pressure induced by elevating the legs. Transgastric
   short-axis echocardiographic views of the left ventricle were simultaneously
   recorded on videotape. Systolic function was evaluated with the slope (Ees,
   mmHg/ml) of the systolic pressure-volume relation. Diastolic function was evaluated
   with the chamber stiffness constant (Kc, ml(-1)) of the diastolic pressure-volume
   relation. Cardiac function was assessed before CPB, after termination of CPB, and 5,
   10, and 15 min later. Two different separation procedures from CPB were compared:
   in protocol 1, left ventricular function was documented during the standard
   procedure (n = 24); in protocol 2, the heart was optimally filled 10 min before
   separation from CPB (n = 12). Results: In protocol 1, Ees was 2.88 +/- 0.21
   mmHg/ml (mean +/- SEM) and Kc was 0.012 +/- 0.001 ml(-1) before CPB. Within
   10 min after separation from CPB, Ees increased from 1.10 +/- 0.32 to 2.92 +/- 0.34
   (P = 0.001) and Kc decreased from 0.022 +/- 0.002 to 0.011 +/- 0.001 (P = 0.001).
   The parameters remained stable thereafter. In protocol 2, Ees was 2.92 +/- 0.51
   mmHg/ml and Kc was 0.011 +/- 0.002 ml(-1) before CPB. Depression of systolic
   and diastolic function was not observed in these patients. At time 0, Ees was 2.46 +/-
   0.16 and Kc was 0.012 +/- 0.002. These values remained stable throughout the entire
   observation period. Conclusions: Significant functional recovery was observed early
   after separation from CPB, which was suggestive of time-dependent changes in both
   systolic and diastolic left ventricular function induced by preload restoration
Keywords:                           artery/AUTOMATED                              BORDER
   DETECTION/autoregulation/bypass/CANINE LEFT-VENTRICLE/cardiac/cardiac
   function/cardiopulmonary/cardiopulmonary                       bypass/CONTRACTILE
   STATE/coronary/coronary artery/coronary artery surgery/coronary surgery/diastolic
   recovery/heart/ISCHEMIA/left           ventricle/left    ventricular/left     ventricular
   function/myocardial                                                   function/ONLINE
   ESTIMATION/PERFORMANCE/preload/pressure/PRESSURE-                             VOLUME
   VOLUME/surgery/systolic/ventricle/ventricular function/WASHINGTON
Stone, J.G., Young, W.L., Marans, Z.S., Solomon, R.A., Smith, C.R., Jamdar, S.C.,
   Ostapkovich,       N.       and      Diaz,      J.    (1996),      Consequences        of
  electroencephalographic-suppressive doses of propofol in conjunction with deep
  hypothermic circulatory arrest. Anesthesiology, 85 (3), 497-501.
Abstract: Background: Some patients who undergo cerebral aneurysm surgery require
  cardiopulmonary bypass and deep hypothermic circulatory arrest. During bypass,
  these patients often are given large doses of a supplemental anesthetic agent in the
  hope that additional cerebral protection will be provided. Pharmacologic brain
  protection, however, has been associated with undesirable side effects. These side
  effects were evaluated in patients who received large doses of propofol. Methods:
  Thirteen neurosurgical patients underwent cardiopulmonary bypass and deep
  hypothermic circulatory arrest to facilitate clip application to a giant or otherwise
  high-risk cerebral aneurysm. Electroencephalographic burst suppression was
  established before bypass with an infusion of propofol and the infusion was
  continued until the end of surgery. Hemodynamic and echocardiographic
  measurements were made before and during the prebypass propofol infusion and
  again after bypass. Emergence time also was determined. Results: Prebypass
  propofol at 243 +/- 57 mu g . kg(-1) . min(-1) decreased vascular resistance from 34
  +/- 8 to 27 +/- 8 units without changing heart rate, arterial or filling pressures,
  cardiac index, stroke volume, or ejection fraction. Propofol blood concentration was
  8 +/- 2 mu g/ml. Myocardial wall motion appeared hyperdynamic at the end of
  cardiopulmonary bypass, and all patients were weaned therefrom without inotropic
  support. After bypass, vascular resistance decreased further, and cardiovascular
  performance was improved compared to baseline values. Nine of the 13 patients
  emerged from anesthesia and were able to follow commands at 3.1 +/- 1.4 h. Three
  others had strokes and a fourth had cerebral swelling. Conclusions: Propofol infused
  at a rate sufficient to suppress the electroencephalogram does not depress the heart or
  excessively prolong emergence from anesthesia after cardiopulmonary bypass and
  deep hypothermic circulatory arrest
Keywords:                        anesthesia/anesthetic/aneurysm/arterial/blood/brain/brain
  protection/bypass/cardiac/cardiac                                          index/cardiac
  performance/cardiopulmonary/cardiopulmonary            bypass/CARDIOPULMONARY
  BYPASS/cardiovascular/cerebral/cerebral                           aneurysm/circulatory
  arrest/DAMAGE/deep hypothermic circulatory arrest/EAST/effects/ejection
  fraction/EJECTION FRACTION/emergence/heart/heart rate/high risk/hypothermic
  effects/stroke/stroke                       volume/surgery/thiopental/vascular/vascular
Wass, C.T., Scheithauer, B.W., Bronk, J.T., Wilson, R.M. and Lanier, W.L. (1996),
  Insulin treatment of corticosteroid-associated hyperglycemia and its effect on
  outcome after forebrain ischemia in rats. Anesthesiology, 84 (3), 644-651.
Abstract: Background Recent studies have reported that dexamethasone worsens
  neuronal injury after brain ischemia. This effect is assumed to be secondary to
  drug-induced hyperglycemia. The current study used a rat model to test the
  hypotheses that insulin treatment of dexamethasone-induced hyperglycemia would
  result in a postischemic neurologic outcome that is: (1) better than that of
  hyperglycemic, dexamethasone-treated subjects; and (2) better than, of equal to, that
  of saline-treated control subjects. Methods: Twenty-four halothane-anesthetized
  (1.0% inspired) rats were randomly assigned to one of three treatment groups (N = 8
  in each group): (1) normoglycemic, placebo- treated rats (group P) received an
  intravenous saline infusion; (2) hyperglycemic, dexamethasone-treated rats (group D)
  received 2 mg/kg. intraperitoneal dexamethasone at 2 days, 1 day, and 3 h before
  ischemia plus an intravenous saline infusion: and (3) normoglycemic,
  dexamethasone- and insulin- treated rats (group DI) received the same treatment as
  group D, plus an intravenous insulin infusion shortly before ischemia. Blood gases
  and acid-base status were maintained within normal physiologic ranges. Pericranial
  and rectal temperatures were maintained at normothermia. Forebrain ischemia of 10
  min duration was produced using an established model. Neurologic function was
  assessed by a blinded observer at 24 and 48 h postischemia. Brain histopathology
  was assessed at the time of ischemia-related death or after the examination at 48 h.
  All 24 rats were included in the analysis of neurologic function; however, only 21
  rats that survived for greater than or equal to 24 h postischemia were included in the
  histologic analysis. Results: Rats were web matched for systemic physiologic
  variables, with the exception of glucose concentrations. Plasma glucose
  concentration immediately before ischemia was as follows: group P = 129 +/- 8
  mg/dl (mean +/- SD), group D = 344 +/- 29 mg/dl, and group DI = 123 +/- 17 mg/dl.
  At 48 h postischemia, groups P and DI were minimally Injured and had similar
  functional scores. In contrast, all group D rats died of cerebral ischemia, Histologic
  injury was significantly worse in group D than in either group P or DI, but did not
  differ significantly between groups P and DI. When all groups were combined, there
  was a significant correlation between neurologic function and total histopathology
  score ranks. Conclusions in the current study, dexamethasone administration before
  brain ischemia resulted in a worsening of postichemic outcome that was related to
  drug-induced hyperglycemia. Restoration of normoglycemia, using insulin, resulted
  in a functional outcome similar to that in group P, and an attenuation of
  dexamethasone-associated histologic injury
Keywords:          administration/analysis/blood/brain/BRAIN            GLUCOSE/brain
  RATS/EAST/effect/function/functional/functional                outcome/glucose/glucose
  cebo/rat/rat                    model/rats/Recent/RECOVERY/score/scores/SEVERE
Weiss, S.J., Cheung, A.T., Stecker, M.M., Garino, J.P., Hughes, J.E. and Murphy, F.L.
  (1996), Fatal paradoxical cerebral embolization during bilateral knee arthroplasty.
  Anesthesiology, 84 (3), 721-723
Keywords:                      bilateral/brain/cerebral/complications/EAST/EMBOLISM
  SYNDROME/embolization/fat                        embolism               syndrome/knee
  arthroplasty/orthopedics/paradoxical          embolization/PATENT          FORAMEN
Pagel, P.S., Lowe, D., Hettrick, D.A., Jamali, I.N., Kersten, J.R., Tessmer, J.P. and
  Warltier, D.C. (1996), Isoflurane, but not halothane, improves indices of diastolic
  performance in dogs with rapid ventricular, pacing-induced cardiomyopathy.
  Anesthesiology, 85 (3), 644-654.
Abstract: Background: The left ventricular (LV) mechanical effects of isoflurane and
  halothane were examined in dogs with rapid LV pacing-induced cardiomyopathy,
  These experiments tested the hypothesis that isoflurane and halothane differentially
  enhance indices of diastolic performance in dogs with moderate LV dysfunction.
  Methods: Eight dogs were chronically instrumented for measurement of LV and
  aortic pressures, subendocardial segment length, and cardiac output, Contractility
  was quantified by preload recruitable stroke work (M(W)). Diastolic function was
  evaluated with a time constant of isovolumic relaxation (tau), segment lengthening
  velocities and time- velocity integrals during early filling (dL/dt(E) and TVI-E) and
  atrial systole (dL/dt(A) and TVI-A), and a regional chamber stiffness constant (K-p).
  Hemodynamics and LV function were recorded in the conscious state before pacing.
  The left ventricles of the dogs were then continuously paced at ventricular rates
  between 220 and 240 beats . min(-1) for 10 +/- 1 days and monitored on a daily basis,
  After the development of moderate LV dysfunction, pacing was temporarily
  discontinued, and dogs were studied in sinus rhythm in the conscious state and after
  20 min equilibration at 1.1, 1.4, and 1.7 minimum alveolar concentration isoflurane
  and halothane on separate days, Results: Chronic rapid pacing increased baseline
  (sinus rhythm) heart rate, LV end-diastolic pressure, and end- diastolic segment
  length and decreased mean arterial pressure, LV systolic pressure, and cardiac output,
  M(W) decreased and tau and K-p increased, consistent with LV systolic and diastolic
  dysfunction, Reductions in dL/dt(E)/dL/dt(A) and TVI- E/A occurred, which
  indicated that LV filling was more dependent on atrial systole, Zn dogs with
  cardiomyopathy, isoflurane and halothane increased heart rate and decreased mean
  arterial pressure, LV systolic pressure, LV end-diastolic pressure, cardiac output,
  M(W), and K-p. Decreases in LV end- diastolic pressure were more pronounced in
  dogs anesthetized with 1.1 minimum alveolar concentration Isoflurane compared
  with halothane. Halothane-induced decreases M(W) were greater than those
  observed with equi-minimum alveolar concentration isoflurane. A reduction in tau
  and increases in TVI-E/TVI-A and the ratio of early to total LV filling were observed
  with isoflurane, In contrast, halothane caused dose-related reductions in dL/dt(E),
  dL/dt(A), TVI-E, and TVI-A, and did not improve the ratios of these variables.
  Conclusions: Isoflurane, but not halothane, improved several indices of diastolic
  performance in dogs with pacing-induced LV dysfunction, despite producing
  simultaneous negative inotropic effects, These findings can probably be attributed to
  favorable reductions in LV preload and not to direct lusitropic effects, Improvement
  of filling dynamics may partially offset the decrement in LV systolic function by
  isoflurane in the setting of LV dysfunction
Keywords:                        ANESTHESIA/anesthetics/anesthetized/arterial/arterial
  pressure/atrial/cardiac/cardiac               output/cardiomyopathy/CHRONICALLY
  DOGS/CORONARY-ARTERY/development/diastole/diastolic dysfunction/diastolic
  rate/inotropic/INTRACELLULAR CALCIUM/isoflurane/isovolumic relaxation/left
  ventricular/lusitropic/MAMMALIAN                                         HEART/mean
  arterial/measurement/myocardial                                contractility/myocardial
  oad recruitable stroke work/pressure/rapid pacing/rate/RECRUITABLE STROKE
  WORK/regional/relaxation/SEP/sinus                        rhythm/stiffness/stroke/stroke
  work/STUNNED                                         MYOCARDIUM/systolic/systolic
  function/tau/total/velocity/ventricles/ventricular              compliance/ventricular
Lowe, D., Hettrick, D.A., Pagel, P.S. and Warltier, D.C. (1996), Propofol alters left
  ventricular afterload as evaluated by aortic input impedance in dogs. Anesthesiology,
  84 (2), 368-376.
Abstract: Background: Systemic vascular resistance incompletely describes left
  ventricular afterload because of the phasic nature of arterial pressure and blood flow.
  Aortic input impedance is an experimental description of left ventricular afterload
  that incorporates the frequency-dependent characteristics and viscoelastic properties
  of the arterial system. The effects of propofol on aortic input impedance were
  examined using three variables derived from the three-element Windkessel model:
  characteristic aortic impedance, total arterial compliance, and total arterial resistance.
  Methods: Eight dogs were chronically instrumented for measurement of aortic
  pressure, left ventricular pressure, +dP/dt, subendocardial segment length, and aortic
  blood flow. Systemic hemodynamics and aortic blood pressure and flow waveforms
  were recorded in the conscious state and after a bolus of 5 mg . kg(-1) propofol and
  infusion for 15 min at 25, 50, and 100 mg . kg(-1) . h(-1). Aortic input impedance
  spectra were generated using power spectral analysis of aortic pressure and flow
  waveforms corrected for the phase responses of the pressure and flow transducers.
  Characteristic aortic impedance, total arterial resistance, and total arterial compliance
  were calculated from the aortic input impedance spectrum and the aortic pressure
  waveform. Parameters describing the net site and magnitude or arterial wave
  reflection were determined from aortic impedance. Results: Propofol decreased total
  arterial resistance (3.05 +/- 0.20 during control to 2.29 +/- 0.18 dynes . s . cm(-5) .
  10(3) at the high dose) and increased total arterial compliance (0.53 +/- 0.04 during
  control to 1.15 +/- 0.17 ml . mmHg(-1) at the high dose) in a dose-related manner.
  Propofol increased characteristic aortic impedance (1.49 +/- 0.15 during control to
  2.20 +/- 0.20 dynes . s . cm(-5) . 10(2) at the high dose). The net site and the
  magnitude of arterial wave reflection were unchanged by propofol. Conclusions: In
  chronically instrumented dogs, propofol decreased total arterial resistance, a property
  of arteriolar resistance vessels, consistent with the known actions of this drug on
  systemic vascular resistance. Propofol also increased total arterial compliance and
  characteristic aortic impedance. Indicating that this anesthetic affects the mechanical
  properties of the aorta. Propofol had no effect on arterial wave reflection patterns.
  The results indicate that propofol reduces left ventricular afterload via decreases in
  peripheral resistance and increases in arterial compliance
Keywords:                                                afterload/analysis/ANESTHESIA
  INDUCTION/anesthetic/anesthetics/aorta/aortic                 blood             flow/aortic
  pressure/arterial/arterial compliance/arterial pressure/arterial system/blood/blood
  flow/blood                                                            pressure/coherence
  heart/hemodynamics/HUMANS/impedance/intravenous/left                       ventricular/left
  ventricular afterload/left ventricular pressure/measurement/model/MYOCARDIAL-
  CONTRACTILITY/peripheral/peripheral               resistance/power/power           spectral
  analysis/power spectrum analysis/PRESSURE/propofol/RECRUITABLE STROKE
  WORK/resistance/signal          processing/spectral       analysis/systemic        vascular
Lowe, D., Hettrick, D.A., Pagel, P.S. and Warltier, D.C. (1996), Influence of volatile
  anesthetics on left ventricular afterload in vivo: Differences between desflurane and
  sevoflurane. Anesthesiology, 85 (1), 112-120.
Abstract: Background: This Investigation examined the effects of desflurane and
  sevoflurane on quantitative indices of left ventricular afterload derived from aortic
  input impedance (Z(in)) interpreted using a three-element Windkessel model.
  Methods: After Animal Care Committee approval, dogs (n = 8) were chronically
  instrumented for measurement of systemic hemodynamics including aortic blood
  pressure and flow. On separate days, aortic pressure and flow waveforms were
  recorded under steady-state conditions in the conscious state and after equilibration
  for 30 min at 1.1, 1.3, 1.5, and 1.7 minimum alveolar concentration of desflurane or
  sevoflurane. Aortic input impedance spectra were obtained via power spectral
  analysis of aortic pressure and flow waveforms. Characteristic aortic impedance
  (Z(c)) and total arterial resistance were calculated as the mean of the magnitude of
  Z(in) between 2 and 15 Hz and the difference between Z(in) at zero frequency and
  Z(in) respectively. Total arterial compliance (C) was calculated from aortic pressure
  and flow waveforms using the Windkessel model. Results: Desflurane and
  sevoflurane increased heart rate and decreased systolic, diastolic, and mean arterial
  pressure, left ventricular systolic pressure, left ventricular peak positive rate of
  increase in left ventricular pressure, percent segment shortening, and stroke volume.
  Sevoflurane, but not desflurane, decreased cardiac output. Desflurane, but not
  sevoflurane, decreased systemic vascular resistance. Desflurane decreased R (3,170
  +/- 188 during control to 2441 +/- 220 dynes . second . centimeter(-5) at 1.7
  minimum alveolar concentration) and did not alter C and Z(c). In contrast,
  sevoflurane increased C (0.57 +/- 0.05 during control to 0.73 +/- 0.05 ml/ mmHg at
  1.7 minimum alveolar concentration) and Z(c) (139 +/- 10 during control to 194 +/-
  14 dynes . second . centimeter(-5) at 1.7 minimum alveolar concentration) but did
  not change R. Conclusions: The results indicate that desflurane and sevoflurane
  produce substantially different effects on left ventricular afterload in chronically
  instrumented dogs. Desflurane-induced decreases in systemic vascular resistance
  occur primarily because of effects on arteriolar resistance vessels. In contrast,
  sevoflurane increased C and Z(c) concomitant with pressure-dependent reductions in
  aortic diameter, suggesting that this anesthetic may alter left ventricular afterload by
  affecting the mechanical properties of the aorta
Keywords: afterload/analysis/anesthetic/anesthetics/aorta/aortic blood flow/AORTIC
  INPUT IMPEDANCE/aortic pressure/ARTERIAL/arterial compliance/arterial
  pressure/blood/blood         pressure/cardiac/cardiac     output/CARDIOVASCULAR
  ACTIONS/CHRONICALLY                       INSTRUMENTED                 DOG/coherence
  ow/heart/heart rate/hemodynamics/impedance/ISOFLURANE/left ventricular/left
  ventricular              afterload/left            ventricular           pressure/mean
  E/ORGAN BLOOD-FLOW/power/power spectral analysis/power spectrum
  processing/spectral       analysis/SPONTANEOUS            VENTILATION/stroke/stroke
  volume/systemic                       hemodynamics/systemic                     vascular
Hogue, C.W., DavilaRoman, V.G., Pond, C., Hauptmann, E., Braby, D. and Lappas,
  D.G. (1996), Transesophageal atrial pacing in anesthetized patients with coronary
  artery disease: Hemodynamic benefits versus risk of myocardial ischemia.
  Anesthesiology, 85 (1), 69-76.
Abstract: Background: Transesophageal atrial pacing (TEAP) provides prompt and
  precise control of heart rate and improves hemodynamics in anesthetized patients
  with bradycardia and hypotension, The authors' purpose in this study was to examine
  the hemodynamic benefits of TEAP versus the risk of myocardial ischemia in
  patients about to undergo coronary artery bypass surgery. Methods: Hemodynamics,
  ventricular filling pressures, mixed venous oxygen saturation, and end-diastolic, end-
  systolic, and fractional area change of the left ventricle, determined by
  transesophageal echocardiography (TEE), were measured after anesthesia induction
  with 30 mu g/kg fentanyl and at incremental TEAP rates of 65, 70, 80, and 90
  beats/min (bpm) in 40 adult patients. Monitoring for myocardial ischemia was
  accomplished with 12-lead electrocardiograms and biplane TEE assessment of left
  ventricular regional wall motion, Hemodynamics, electrocardiograms, and TEE
  measurements at each TEAP rate were compared with baseline awake measurements
  (except TEE) and with measurements obtained after anesthesia induction before
  TEAP. Results: Sinus bradycardia occurred in 15 patients after anesthesia induction
  and was associated with a hypotensive response and a decrease in cardiac output in
  10 patients, In these patients, TEAP restored diastolic blood pressure and cardiac
  output to baseline values at TEAP rates of 65 and 80 bpm, respectively, Stroke
  volume was similar to baseline measurements after anesthesia induction and at TEAP
  rates of 65, 70, and 80 bpm, but was significantly reduced from baseline at TEAP 90
  bpm, Myocardial ischemia was detected in 7 and 5 patients at a TEAP rate of 80 and
  90 bpm, respectively. Conclusions: Control of heart rate with TEAP restores
  intraoperative hemodynamics to baseline in patients in whom bradycardia and a
  hypotensive response develop before coronary artery bypass surgery. When using
  TEAP for patients with severe coronary artery disease, these results support using the
  lowest TEAP rate titrated to achieve optimal hemodynamics, while closely
  monitoring for myocardial ischemia, especially at TEAP rates > 80 bpm
Keywords: adult/anesthesia/anesthetized/artery/assessment/atrial/benefits/blood/blood
  pressure/BRADYCARDIA/bypass/bypass surgery/cardiac/cardiac output/cardiac
  pacing/control/coronary/coronary artery/coronary artery bypass/coronary artery
  bypass           surgery/coronary          artery        disease/diastolic         blood
  SIZE/ischemia/left                                                          ventricle/left
  ischemia/oxygen/oxygen         saturation/pacing/pressure/rate/regional/regional     wall
  echocardiography/ventricle/ventricular filling/volume/wall/WASHINGTON
Hettrick, D.A., Pagel, P.S. and Warltier, D.C. (1996), Desflurane, sevoflurane, and
  isoflurane impair canine left ventricular-arterial coupling and mechanical efficiency.
  Anesthesiology, 85 (2), 403-413.
Abstract: Background: The effects of desflurane, sevoflurane, and isoflurane on left
  ventricular-arterial coupling and mechanical efficiency were examined and compared
  in     acutely     instrumented      dogs.    Methods:      Twenty-four      open-chest,
  barbiturate-anesthetized dogs were instrumented for measurement of aortic and left
  ventricular (LV) pressure (micromanometer-tipped catheter), dP/dt(max), and LV
  volume (conductance catheter). Myocardial contractility was assessed with the
  end-systolic pressure- volume relation (E(es)) and preload recruitable stroke work
  (M(sw)) generated from a series of LV pressure-volume diagrams. Left
  ventricular-arterial coupling and mechanical efficiency were determined by the ratio
  of E(es) to effective arterial elastance (E(a); the ratio of end-systolic arterial pressure
  to stroke volume) and the ratio of stroke work (SW) to pressure- volume area (PVA),
  respectively. Results: Desflurane, sevoflurane, and isoflurane reduced heart rate,
  mean arterial pressure, and left ventricular systolic pressure. All three anesthetics
  caused similar decreases in myocardial contractility and left ventricular afterload, as
  indicated by reductions in E(es), M(sw), and dP/dt(max) and E(a), respectively.
  Despite causing simultaneous declines in E(es) and E(a), desflurane decreased
  E(es)/E(a) (1.02 +/- 0.16 during control to 0.62 +/- 0.14 at 1.2 minimum alveolar
  concentration) and SW/PVA (0.51 +/- 0.04 during control to 0.43 +/- 0.05 at 1.2
  minimum alveolar concentration). Similar results were observed with sevoflurane
  and isoflurane. Conclusions: The present findings indicate that volatile anesthetics
  preserve optimum left ventricular-arterial coupling and efficiency at low anesthetic
  concentrations (<0.9 minimum alveolar concentration); however, mechanical
  matching of energy transfer from the left ventricle to the arterial circulation
  degenerates at higher end-tidal concentrations. These detrimental alterations in left
  ventricular-arterial coupling produced by desflurane, sevoflurane, and isoflurane
  contribute to reductions in overall cardiac performance observed with these agents in
Keywords:                                   afterload/anesthetic/anesthetics/arterial/arterial
  pressure/canine/cardiac/cardiac performance/CHRONICALLY INSTRUMENTED
  DOG/circulation/CONDUCTANCE                                     CATHETER/CONSCIOUS
  STATE/contractility/control/coupling/desflurane/dogs/EAST/effective                   arterial
  elastance/effects/efficiency/elastance/end-              systolic           pressure-volume
  relation/HALOTHANE/heart/heart                   rate/isoflurane/left           ventricle/left
  ventricular/low/mean                                      arterial/measurement/mechanical
  CONDUCTANCE/performance/preload/preload                          recruitable           stroke
  work/pressure/pressure- volume area/pressure-volume area/PRESSURE-VOLUME
  RELATION/rate/RECRUITABLE STROKE WORK/sevoflurane/stroke/stroke
  volume/stroke                                  work/systolic/ventricle/ventricular-arterial
Wilt, T.J., Davis, B.R., Meyers, D.G., Rouleau, J.L. and Sacks, F.M. (1996), Prevalence
  and correlates of symptomatic peripheral atherosclerosis in individuals with coronary
  heart disease and cholesterol levels less than 240mg/dL: Baseline results from the
  Cholesterol and Recurrent Events (CARE) Study. Angiology, 47 (6), 533-541.
Abstract: Purpose: To determine the prevalence and correlates of symptomatic
  peripheral atherosclerosis in individuals with a history of myocardial infarction (MI)
  and cholesterol levels lower than 240 mg/dL. Materials and Methods: A
  cross-sectional analysis was conducted at baseline of 4159 participants in the
  Cholesterol and Recurrent Events (CARE) Study. Symptomatic diffuse
  atherosclerosis was defined as a history of MI plus lower extremity or
  cerebrovascular atherosclerosis or claudication by Rose questionnaire. Results: The
  prevalence of symptomatic diffuse atherosclerosis was 12.9%; 353 participants
  (8.5%) had lower extremity disease and 219 (5.3%) had cerebrovascular disease.
  After controlling for other variables, diffuse atherosclerosis was associated with age
  (Odds Ratio [OR]=1.44 per ten-year increase), systolic blood pressure (OR=1.13 per
  10 mm Hg increase), a history of multiple myocardial infarctions (OR=1.76),
  diabetes (OR=1.76), hypertension (OR=1.38), reduced exercise performance
  (OR=1.55), current smelting status (OR=2.87), and lower alcohol intake (OR=0.97
  per drink per week). There was no association with race, gender, or Lipid levels.
  Conclusions: The presence of clinically evident diffuse atherosclerosis is common
  and is associated with several modifiable risk factors. Early identification of these
  individuals could affect treatment and clinical outcomes
Keywords:         age/alcohol/alcohol          intake/analysis/atherosclerosis/blood/blood
  pressure/BLOOD-PRESSURE                            INDEX/CARE/CAROTID-ARTERY
  disease/cholesterol/CIGARETTE-SMOKING/coronary/coronary                             heart
  atherosclerosis/pressure/prevalence/race/RISK/risk                          factors/Rose
  questionnaire/STROKE/systolic/systolic blood pressure/treatment
Mortel, K.F. and Meyer, J.S. (1996), Prospective study of vascular events and cerebral
  perfusional changes following transient ischemic attacks. Angiology, 47 (3), 215-224.
Abstract: A prospective case-control study was carried out to clarify associations of
  cerebral transient ischemic attacks (TIAs) and other stroke risk factors with
  progression and exacerbation of cardiovascular and cerebrovascular disorders; 243
  neurologically normal controls and 123 TIA patients without prior history of stroke
  were followed up for a mean interval of 4.4 years. Of TIA patients, 26 (21%)
  developed other events (excluding recurrent TIAs); 10 died of vascular causes
  (8.1%). Of controls, 44 (18%) developed events; 13 died of vascular causes (5.4%)
  and 3 from cancer. TIA patients were at 2.3 times greater risk than normal controls
  for stroke or death from vascular causes. They were predominantly male with
  significantly higher associations of risk factors for stroke, including hypertension,
  heart disease, diabetes mellitus, smoking, hyperlipidemia, alcohol consumption, and
  limited education. Controls developing vascular events compared with controls who
  did not were older, more frequently male, and with greater incidences of heart
  disease. TIA patients had lower rates of cerebral perfusion compared with controls
  that persisted throughout the study, with similar rates of decline related to aging
  among both groups. Among TIA patients, stroke risk factors were more prevalent
  than among controls. The longer their duration, the greater the incidence and the
  more rapid the rate of severe, often fatal cardiovascular complications
Keywords:          708          ELDERLY              PATIENTS/ADRDA                WORK
  study/causes/cerebral/cerebral                perfusion/cerebrovascular/cerebrovascular
  disorders/CLINICAL-                DIAGNOSIS/complications/death/diabetes/diabetes
  RCT                                                                 DEMENTIA/normal
  risk/STROKE-DATA-BANK/TIA/transient/transient ischemic attacks/vascular
Boon, D.M.S., Michiels, J.J., Tanghe, H.L.J. and KappersKlunne, M.C. (1996),
  Heparin-induced thrombocytopenia with multiple cerebral infarctions simulating
   thrombotic thrombocytopenic purpura - A case report. Angiology, 47 (4), 407-411.
Abstract: The authors describe a patient with stroke, treated with heparin for unstable
   angina, whose clinical features mimicked those of thrombotic thrombocytopenic
   purpura (TTP). His condition eventually proved to be caused by heparin-induced
   thrombocytopenia (HIT), complicated by thrombosis (HITT). The absence of
   microangiopathic hemolytic anemia should question the diagnosis in a presumed
   TTP patient. Early diagnosis of HITT is possible since recently two highly sensitive
   and specific tests have become available. Heparin treatment has to be stopped
   immediately if HITT is diagnosed. First-choice antithrombotic treatment in HITT
   patients is danaparoid
Keywords:                     anemia/angina/case                   report/cerebral/clinical
Petersen, J.R., Drabaek, H., Gleerup, G., Mehlsen, J., Petersen, L.J. and Winther, K.
   (1996), ACE inhibition with spirapril improves diastolic function at rest independent
   of vasodilation during treatment with spirapril in mild to moderate hypertension.
   Angiology, 47 (3), 233-240.
Abstract: The effects of the ACE inhibitor spirapril and of hydrochlorothiazide on left
   ventricular diastolic function were studied. Thirteen patients with mild to moderate
   essential     hypertension      completed      this     randomized,    double-blinded,
   placebo-controlled, crossover study. After a three-week run-in period the patients
   entered three periods lasting four weeks each, wherein they were treated with
   placebo, spirapril, or hydrochlorothiazide. Blood pressure, hemodynamic variables
   (stroke volume, heart rate, cardiac output, index of contractility, and systemic
   vascular resistance), echocardiography (left ventricular mass), and Doppler-derived
   atrial to early (A/E)-ratio velocity time integrals (VTI) were measured at the end of
   each of the four periods. Spirapril lowered the A/E-ratio VTIs (0.57, 0.12-1.00)
   (P<0.02) as compared with both placebo (0.80, 0.50-2.67) and hydrochlorothiazide
   (0.83, 0.44-1.25), and the drug normalized the A/E-ratio VTI in those patients with
   elevated values. The hemodynamic variables, left ventricular mass, and end-systolic
   wall stress were unchanged during all three treatments. There were no significant
   changes in mean blood pressure during the treatment periods. These results indicate
   that spirapril lowers A/E ratio within four weeks in patients with mild to moderate
   essential hypertension. It thereby seems able to improve left ventricular diastolic
   function. The effect is not dependent upon changes in hemodynamic variables, blood
   pressure, left ventricular mass, or end-systolic wall stress
Keywords:               ACE/ACE               inhibition/ACE-inhibition/atrial/blood/blood
   pressure/cardiac/cardiac             output/CARDIAC-OUTPUT/contractility/diastolic
   CARDIOMYOPATHY/inhibition/left               ventricular/left  ventricular     diastolic
   function/left       ventricular       mass/placebo/pressure/PULSED           DOPPLER
   ROKE                              VOLUME/systemic                              vascular
   resistance/vasodilation/velocity/ventricular mass/volume/wall
Misra, U.K., Jha, S., Kalita, J. and Sharma, K. (1996), Stroke - A rare presentation of
   Eales' disease - A case report. Angiology, 47 (1), 73-76.
Abstract: Eales' disease is common in India and the Middle East, but its neurologic
   manifestations are rare. The authors report a young man with recurrent vitreous
  hemorrhage and acute amnestic confusional state who subsequently developed
  myelopathy. Eales' disease should be considered in the differential diagnosis of
  stroke in a young patient
Keywords:                                                                       acute/case
Malkoff, M.D., Gomez, C.R., Myles, G. and CruzFlores, S. (1996), Cerebrovascular
  hemodynamic inefficiency of premature ventricular contractions. Angiology, 47 (1),
Abstract: Transcranial Doppler (TCD) measurements of middle cerebral artery IMCA)
  blood flow velocities were recorded and synchronized with electrocardiographic
  (EKG) recordings in 52 EKG/TCD complexes in 4 patients. Thirty-seven normal
  sinus beats and 13 conductive and 2 nonconductive premature ventricular
  contractions (PVCs) were examined. Mean velocities averaged 45 +/- 4 cm/sec for
  normal sinus rhythm (NSR) vs 26 +/- 4 cm/sec in the PVC group (P = 0.007). Peak
  systolic velocities averaged 74 +/- 6 cm/sec for the NSR and 45 +/- 7 cm/sec in the
  PVC group (P = 0.016). The latency between the QRS complexes and corresponding
  TCD wave forms (QRS-SU) averaged 0.12 +/- 0.03 sec in NSR and 0.17 +/- 0.04 sec
  for the PVC group (P < 0.001). In addition, QRS-SU was inversely related to all
  velocities. PVCs appeared to be less hemodynamically efficient than NSR. The lower
  blood flow velocities and increased QRS-SU may result from lower stroke volume
  and delayed ventricular contraction associated with the aberrant QRS complex
Keywords:                     artery/blood/blood                    flow/cerebral/cerebral
  cerebral artery/SCI/sinus rhythm/STROKE/stroke volume/systolic/TCD/volume
Turgut, M., Ozcan, O.E., Erturk, O., Saribas, O. and Erbengi, A. (1996), Spontaneous
  cerebellar strokes clinical observations in 60 patients. Angiology, 47 (9), 841-848.
Abstract: This is a retrospective study carried out by clinical analysis of the authors'
  experience in 60 patients with cerebellar strokes-of which 39 were spontaneous
  cerebellar hemorrhage and 21 were cerebellar infarction-to compare the clinical
  presentation, course, and prognosis. Hypertension was found to be the most
  important etiologic factor. Clinical differentiation of cerebellar hemorrhage from
  infarction was not possible, but the management was similar in both entities.
  Computerized tomography was necessary to make diagnosis of the stroke mechanism,
  In evaluating outcome, the authors conclude that the most important single factor
  affecting the prognosis was the early correct diagnosis
Keywords:                                                    analysis/ARTERY/cerebellar
Fujishima, S., Abe, I., Okada, Y., Saku, Y., Sadoshima, S. and Fujishima, M. (1996),
  Serial changes in blood pressure and neurohormone levels after the onset of lacunar
  stroke. Angiology, 47 (6), 579-587.
Abstract: To assess serial changes in blood pressure and its circadian variation
  following a lacunar stroke, the authors studied 7 patients who developed a single
  lacunar infarction in either the internal capsule or the corona radiata. Blood pressure
  and pulse rate were monitored noninvasively for twenty-four hours by an ambulatory
  blood pressure monitoring device in the acute, subacute, and chronic phases of the
  strokes. In the acute and chronic phases, the authors also measured urinary excretion
  of catecholamines every 6 hr, and serum cortisol concentration at 9:00, 17:00, and
  21:00 hr. The patients were free from antihypertensive agents during the study. The
   twenty-four-hour averages of both systolic and diastolic blood pressure in the chronic
   phase were lower than those in the acute phase (P < 0.05). A nighttime fall in blood
   pressure was observed in the subacute and chronic phases (P < 0.05), but not in the
   acute phase. Urinary excretion of epinephrine at night in the acute phase was
   significantly higher than that in the chronic phase (P < 0.05). Serum levels of cortisol
   at 17:00 and 21:00 hr in the acute phase also exceeded those in the chronic phase (P
   < 0.05 and P < 0.01, respectively). The authors conclude that an increased secretion
   of epinephrine and cortisol might, at least in part, contribute to a high blood pressure
   and a lack of circadian variation in blood pressure in the acute phase of lacunar
Keywords: acute/ACUTE ISCHEMIC STROKES/ambulatory/ambulatory blood
   pressure/ambulatory blood pressure monitoring/antihypertensive agents/blood/blood
   pressure/blood             pressure            monitoring/catecholamines/CEREBRAL
   INFARCTION/chronic/circadian/circadian           variation/corona/CORTISOL/diastolic
   blood         pressure/ESSENTIAL-          HYPERTENSION/HEAD/high                  blood
   pressure/HOSPITALIZATION/infarction/INTERNAL/internal capsule/JUN/lacunar
   infarction/lacunar                                         stroke/monitoring/PLASMA
Lip, G.Y.H., Rumley, A., Dunn, F.G. and Lowe, G.D.O. (1996), Thrombogenesis in
   mitral regurgitation and aortic stenosis. Angiology, 47 (12), 1117-1125.
Abstract: not been clearly defined. Abnormalities in plasma coagulation factors
   indicative of a prothrombotic state may in part account for the risk of stroke and
   thromboembolism in such patients. The aim of this study was, therefore, to determine
   the effects of mitral regurgitation (MR) and aortic stenosis (AS) on plasma
   fibrinogen or fibrin D-dimer levels as indices of a thrombogenic (or prothrombotic)
   state. A total of 25 patients with valve disease in sinus rhythm were studied: 12
   patients (all women; mean age fifty-five years, sem 3.3) with MR; and 13 patients (7
   men, 6 women; mean age fifty-seven years, sem 3.5) with AS were studied. Patients
   with MR had a median plasma fibrinogen that was significantly elevated when
   compared with female population values (median difference 0.62 g/L; 95%
   confidence intervals (CI) 0.27 to 1.05, P = 0.0016). However, these patients had a
   median plasma fibrin D-dimer that was lower than that for population controls
   (median difference 21 ng/mL; 95% CI 0 to 38, P = 0.05). Patients with aortic valve
   disease had a median plasma fibrinogen that was significantly increased when
   compared with population controls (median difference 0.82 g/L; 95% CI 0.34 to 1.24,
   P = 0.001). These patients had a plasma fibrin D-dimer level that was similar to
   population values (median difference 3 ng/mL; 95% CI -25 to 22, P = 0.80). Patients
   with MR or AS have higher plasma fibrinogen levels when compared with ''normal''
   population values, suggesting possible hemorheologic abnormalities in these patients.
   Subjects with MR had lower plasma fibrin D-dimer levels, suggesting lesser
   intravascular clotting, consistent with clinical echocardiographic studies. Subjects
   with AS had plasma fibrin D-dimer levels similar to the ''normal'' population values,
   suggestive of a different pathophysiological mechanism for thromboembolism. These
   findings add to an improved understanding of the relationship between clinical
   observations and the significance of plasma fibrinogen and fibrin D-dimer levels in
Keywords:                       abnormalities/age/aortic                     stenosis/aortic
   BRIN                              D-DIMER/fibrinogen/HEAD/mechanism/men/mitral
  FACTOR/risk           of      stroke/sinus      rhythm/SPONTANEOUS             ECHO
Mizokami, T., Okamura, K., Sato, K., Kuroda, T., Sadoshima, S. and Fujishima, M.
  (1996), Risk factors for brain infarction in patients with Cushing's disease - Case
  reports. Angiology, 47 (10), 1011-1017.
Abstract: Two women aged 51 and 52 years old, respectively, developed a brain
  infarction before and after undergoing treatment for Cushing's disease. A
  biochemical remission was obtained more than ten years after the onset of signs or
  symptoms of Cushing's disease. The arteriosclerotic changes of the cerebral vessels
  progressed even during replacement therapy for posttreatment hypopituitarism after
  they underwent either ablative surgery or radiotherapy. One patient, who showed the
  signs of Nelson's syndrome, demonstrated severe progressive cerebrovascular
  sclerotic changes, especially around the irradiated site. Lt is thus suggested that
  hypercortisolemia, external pituitary irradiation, and posttreatment hypopituitarism
  may be risk factors for brain infarction. The early diagnosis and adequate treatment
  are therefore important to prevent cerebrovascular complications in patients with
  Cushing's disease
Keywords:                      aged/brain/brain                   infarction/CAROTID
  sk                                         factors/STROKE/surgery/symptoms/TERM
Lepojarvi, M., Peltola, T., Ylonen, K., Juvonen, T., Pokela, R. and Karkola, P. (1996),
  Cerebral haemorrhage after carotid endarterectomy. Annales Chirurgiae et
  Gynaecologiae, 85 (1), 23-26.
Abstract: Cerebral stroke is a serious complication related to carotid endarterectomy
  (CEA), being most frequently caused by thromboembolic events and less frequently
  on account of cerebral haemorrhage. The present series comprised five out of 857
  (0.6 %) patients who had undergone CEA at Oulu University Hospital between the
  years 1974 and 1993 and suffered a postoperative stroke four to 13 days after surgery
  due to intracerebral haemorrhage (IH). Preoperatively, all these patients were
  neurologically intact, with transient ischaemic attacks (TIA) as the main indication
  for CEA. All five patients had a history of arterial hypertension treated adequately
  preoperatively, and one patient had high blood pressure levels after surgery. Critical
  ipsilateral stenosis of the internal carotid artery (> 90 %) was detected in the
  preoperative angiogram in all five cases. The primary outcome after CEA was
  uneventful in every case, without any signs of neurological deficiency. The
  symptoms, comprising severe headache, convulsions and/or hemiparesis occurred
  suddenly four to 13 days (mean seven days) after CEA. The diagnosis of IH was
  based on computed tomography (CT) findings. All five patients were treated
  conservatively. Three of them died. We conclude that even normotensive,
  neurologically intact patients without demonstrable cerebral infarction or
  postoperative hypertension may suffer cerebral haemorrhage after the relief of
  high-grade carotid stenosis. The role of possible insufficiency of the autoregulatory
  mechanisms of the cerebral vasculature on account of long-standing critical stenosis
  of the internal carotid artery and subsequent uncontrolled hyperperfusion following
  CEA are discussed
Keywords:                  arterial/arterial             hypertension/artery/blood/blood
  pressure/BLOOD-FLOW/carotid/carotid           artery/carotid    endarterectomy/carotid
  stenosis/cerebral/cerebral haemorrhage/cerebral infarction/complication/computed
  aresis/high                 blood               pressure/history/HYPERPERFUSION
  SYNDROME/hypertension/infarction/internal/internal           carotid/internal    carotid
  artery/intracerebral/intracerebral                   haemorrhage/INTRACEREBRAL
Babatasi, G., Theron, J., Massetti, M., Payelle, G., Rossi, A. and Khayat, A. (1996),
  Value of the percutaneous carotid angioplasty before cardiac surgery. Annales de
  Cardiologie et D Angeiologie, 45 (1), 24-29.
Abstract: Transluminal angioplasty (TLA) of asymptomatic carotid stenoses (> 85%) in
  patients candidates for coronary artery bypass graft for stable angina appears to be an
  interesting technique to evaluate in a population whose management is controversial.
  Between January 1993 and January 1995, 10 patients underwent Carotid TLA
  (CTLA) prior to coronary artery bypass grafts (mean: 17.4 days). The mean age was
  71 +/- 4.3 years. Eight patients were classified as NYHA class II and two were
  classified as class III. The mean number of bypass grafts per patient was 2.7. Four
  patients presented contralateral thrombosis of the internal carotid artery. CTLA was
  performed under cerebral protection by means of a triple coaxial catheter. Six CTLA
  required a Strecker stent. The mean follow- up was 11.4 months, with no mortality.
  One patient presented with transient hemianopsia. All patients were reviewed at 4
  months by follow-up angiography, followed by Doppler. Only one of the 10 patients
  reviewed required redilatation with complementary stenting and another patient
  required dilatation of the stent. Although the follow-up of this short series is brief,
  the results of CTLA are encouraging in this population with a high risk of morbidity
  and mortality (elderly patients, frequently bilateral carotid lesions, coronary bypass
  grafts with multiple arterial grafts)
Keywords:                   age/angina/angiography/angioplasty/arterial/artery/ARTERY
  BYPASS-SURGERY/bilateral/bypass/cardiac/cardiac                  surgery/carotid/carotid
  artery/cerebral/cerebral                                                       vascular
  accident/CEREBROVASCULAR-DISEASE/CORONARY/coronary                                artery
  bypass/coronary                                         surgery/Doppler/elderly/elderly
  risk/internal/internal                     carotid/internal                      carotid
  artery/lesions/management/morbidity/morbidity                                       and
  rombosis/transient/transluminal carotid angioplasty
Mas, J.L. (1996), Patent foramen ovale, aneurysm of the interatrial septum and cerebral
  ischaemic accident. Annales de Cardiologie et D Angeiologie, 45 (9), 531-537.
Abstract: Persistence of a patent foramen ovale (PFO) and the presence of an aneurysm
  of the interatrial septum (AIAS) are significantly more frequent in patients examined
  for cerebral ischaemic accident of unknown cause than in control subjects. The
  mechanism of ischaemic accidents associated with these cardiac abnormalities
  (frequently associated with each other), particularly the frequency of paradoxical
  embolism, remains unclear. In young patients, the risk of recurrent cerebral
  ischaemic accident appears to be generally-low (1 to 2% per year). Secondary
  prevention remains empirical and controversial. No comparative studies are available
   to demonstrate the superiority of platelet antiaggregants, oral anticoagulants or
   invasive treatments, such as endovascular or surgical closure of the foramen ovale. A
   rational treatment can only be proposed on the basis of a better understanding of the
   natural history of ischaemic recurrences (identification of subgroups of patients at
   high or low risk of recurrence) and the therapeutic benefit risk ratio
Keywords:          abnormalities/aneurysm/aneurysm           of        the        interatrial
   ischaemic accident/CEREBROVASCULAR EVENTS/control/CRYPTOGENIC
   STROKE/embolism/EXPANSION/foramen                    ovale/FRANCE/history/interatrial
   septum/ISCHEMIC         STROKE/low/mechanism/natural            history/oral/paradoxical
   embolism/PARADOXICAL                     EMBOLISM/patent/patent                  foramen
Khatouri, A., Kendoussi, M., Elyounassi, B., Nazzi, M., Zbir, E. and Hamani, A. (1996),
   Predictive factors of thromboembolic complications in mitral stenosis with sinus
   rhythm. Annales de Cardiologie et D Angeiologie, 45 (10), 573-576.
Abstract: The authors analyse the predisposing factors to the development of
   thromboembolic complications in mitral stenosis in sinus rhythm and propose
   preventive therapeutic measures. Eighty five consecutive patients with pure or very
   predominant mitral stenosis in sinus rhythm were included in this study and divided
   into two groups according to the presence (Group I: n = 27, age: 34.2 +/- 8.31 years)
   or absence (Group II: n = 58, age. 32.6 +/-9.7 years) of thromboembolic
   complications. No significant difference was observed between the two groups for
   age, sex and functional class. Patients of group I had a more dilated left auricle (57.3
   +/- 4.5 vs 48.4 +/- 4.7 mm; p < 0.001) and a smaller mitral surface area (0.8 +/- 0.15
   vs 1.1 +/- 0.21 cm(2), p < 0.05). The spontaneous left intra-atrial contrast
   phenomenon was more frequently observed in patients with thromboembolic
   complications (23 out of 27) than in those not presenting this complication (17 out of
   58), (p < 0.001). This phenomenon was the only independent predictive factor on
   multivariate analysis. In conclusion; left atrial dilatation, the severity of mitral
   stenosis and especially the presence of spontaneous contrast are the main predictive
   factors of the development of thromboembolic complication's in mitral stenosis in
   sinus rhythm. Patients presenting one or several of these factors may benefit from
   prophylactic anticoagulant treatment
Keywords:               age/analysis/atrial/CARDIAC                 ORIGIN/CEREBRAL
   ON/FRANCE/functional/LEFT ATRIAL THROMBUS/mitral stenosis/multivariate
   analysis/predictive factors/RHEUMATIC HEART-DISEASE/SCI/severity/sex/sinus
   rhythm/spontaneous/spontaneous                               contrast/SPONTANEOUS
Finazzi, G. and Barbui, T. (1996), Feasibility of a randomized clinical trial for the
   prevention of recurrent thrombosis in the antiphospholipid syndrome: The WAPS
   project. Annales de Medecine Interne, 147 38-41
Keywords:                 ACTIVATED                   PROTEIN-C/ANTICARDIOLIPIN
  OMBIN/randomized                clinical       trial/SEP/STROKE/thrombosis/VENOUS
Malaterre, H.R. and Daver, L.E. (1996), Cerebral vascular events in patients with aortic
  atheroma. Annales de Medecine Interne, 147 (5), 347-351.
Abstract: The aorta is the most frequent site for atherosclerosis, and is more frequent
  than the internal carotids or cerebral arteries. Transesophageal echocardiography has
  made it possible to identify atheromatous lesions of the aortic arch which are situated
  before the branches to the neck vessels and are capable of causing embolic cerebral
  events. These atheromatous plaques can be irregular, may protrude into the aortic
  lumen and sometimes have loose thrombus attached to them. The risk of strokes and
  transient ischemic attacks appears to be higher when plaques are more than 4 mm in
  thickness and when mobile components are present. Atheroma in the ascending aorta
  and aortic arch is a significant risk factor for cerebral ischemia, independent of
  high-grade carotid stenosis. Aortic atherosclerotic lesions should particulary be
  looked for in patients with a history of repeated peripheral and cerebral embolism, in
  whom no obvious embolic cause is found. A standard protocol for treatment of these
  potentially embolic aortic lesions has not get been agreed upon, but the use of
  antiplatelet drugs or vitamin-K antagonists treatment should be considered
Keywords:        antiplatelet/antiplatelet     drugs/aorta/aortic      arch/aortic     arch
  atheroma/ARCH/arteries/ARTERY                         DISEASE/ascending/ASCENDING
  AORTA/atheroma/atherosclerosis/ATHEROSCLEROTIC LESIONS/carotid/carotid
  stenosis/cerebral/cerebral               arteries/cerebral              embolism/cerebral
  ATHEROMAS/risk/risk                                    factor/stenosis/stroke/SYSTEMIC
  ECHOCARDIOGRAPHIC                                          DETECTION/transesophageal
  echocardiography/transient/transient ischemic attacks/treatment/vascular
Melon, E. and Rimaniol, J.M. (1996), Vasospasm in subarachnoid haemorrhage:
  Pharmacological treatment. Annales Francaises D Anesthesie et de Reanimation, 15
  (3), 366-373.
Abstract: Pharmacological treatment of vasospasm in subarachnoid haemorrhage (SAH)
  is founded on prevention and treatment of arterial narrowing and delayed ischaemic
  deficits. Safety and efficacy of different agents have been studied and trials classified
  according to the level of evidence proposed by the ''Stroke Council'' of the American
  Heart Association. Early intracisternal fibrinolysis can prevent vasospasm (level III
  to V of evidence, grade C). Pharmacological treatment is based on few drugs.
  Nimodipine reduces poor outcome related to vasospasm, but does not affect
  angiographic vessel caliber (level of evidence I and II, grade A). Its use is strongly
  recommended. Nicardipine decreases symptomatic and angiographic vasospasm, but
  does not affect outcome (level of evidence I to V, grade B). Tirilazad associated with
  nimodipine prevents delayed ischaemic deficits due to vasospasm and improves
  outcome in male patients. Intra-arterial infusion of papaverine associated with
  transluminal angioplasty can improve symptomatic vasospasm, resistant to
  conventional therapy (level of evidence IV to V, grade C), Pharmacological
  treatment of vasospasm associated with specific management founded on
  pathophysiology of SAH has improved patients outcome
Keywords:        amino         steroids/angioplasty/arterial/calcium-channel       blocking
  agents/CEREBRAL                          VASOSPASM/conventional/COOPERATIVE
  ANEURYSM/delayed                      ischaemic               deficits/DOUBLE-BLIND
Heinrich, R.S., Fontaine, A.A., Grimes, R.Y., Sidhaye, A., Yang, S., Moore, K.E.,
  Levine, R.A. and Yoganathan, A.P. (1996), Experimental analysis of fluid
  mechanical energy losses in aortic valve stenosis: Importance of pressure recovery.
  Annals of Biomedical Engineering, 24 (6), 685-694.
Abstract: Current methods for assessing the severity of aortic stenosis depend primarily
  on measures of maximum systolic pressure drop at the aortic valve orifice and related
  calculations such as valve area. It is becoming increasingly obvious, however, that
  the impact of the obstruction on the left ventricle is equally important in assessing its
  severity and could potentially be influenced by geometric factors of the valve,
  causing variable degrees of downstream pressure recovery. The goal of this study
  was to develop a method for measuring fluid mechanical energy losses in aortic
  stenosis that could then be directly related to the hemodynamic load placed on the
  left ventricle. A control volume form of conservation of energy was theoretically
  analyzed and modified for application to aortic valve stenosis measurements. In vitro
  physiological pulsatile flow experiments were conducted with different types of
  aortic stenosis models, including a venturi meter, a nozzle, and 21-mm
  Medtronic-Hall tilting disc and St. Jude bileaflet mechanical valves. The energy loss
  created by each model was measured for a wide range of experimental conditions,
  simulating physiological variation. In all cases, there was more energy lost for the
  nozzle (mean = 0.27 J) than for any other model for a given stroke volume. The two
  prosthetic valves generated approximately the same energy losses (mean = 0.18 J),
  which were not statistically different, whereas the venturi meter had the lowest
  energy loss for all conditions (mean = 0.037 J). Energy loss correlated poorly with
  orifice pressure drop (r(2) = 0.34) but correlated well with recovered pressure drop
  (r(2) = 0.94). However, when the valves were considered separately, orifice and
  recovered pressure drop were both strongly correlated with energy loss (r(2) = 0.99,
  0.96). The results show that recovered pressure drop, not orifice pressure drop, is
  directly related to the energy loss that determines pump work and therefore is a more
  accurate measure of the hemodynamic significance of aortic stenosis
Keywords:       analysis/aortic    valve/aortic    valve      stenosis/conservation     of
  energy/control/control                                          volume/disc/DOPPLER
  ROSTHETIC                                              HEART-VALVES/PULSATILE
  FLOW/recovery/SCIENCE/SEVERITY/St                            Jude/stenosis/stroke/stroke
Love, J.N., Hanfling, D. and Howell, J.M. (1996), Hemodynamic effects of calcium
  chloride in a canine model of acute propranolol intoxication. Annals of Emergency
  Medicine, 28 (1), 1-6.
Abstract: Study objective: To evaluate the hemodynamic effects of calcium chloride in
   a canine model of acute propranolol toxicity. Methods: Two minutes after the
   completion of a propranolol infusion (10 mg/kg), a bolus of .125 mL/kg 10% CaCl
   solution followed by an infusion of .375 mL/kg over the next 30 minutes or a bolus
   and subsequent infusion of an equivalent volume of normal saline solution was
   administered to each dog. Results: CaCl yielded significant improvements in
   propranolol-induced decreases in cardiac index and stroke volume compared with
   saline solution-treated control animals (overall alpha=.05). Furthermore, CaCl
   administration resulted in earlier improvement in propranolol-induced alterations in
   mean arterial pressure, maximal left ventricular pressure change over time, and
   peripheral vascular resistance compared with saline solution (overall alpha=.05). We
   observed no difference between treatment groups In response to propranolol-induced
   bradycardia or QRS-interval prolongation. Conclusion: In this model of acute
   propranolol toxicity, CaCl therapy improved depressed hemodynamic status, mainly
   by a positive inotropic action
Keywords:                   ACEBUTOLOL/acute/administration/animals/arterial/arterial
   otropic/intoxication/left ventricular/left ventricular pressure/MANAGEMENT/mean
Idris, A.H., Becker, L.B., Ornato, J.P., Hedges, J.R., Bircher, N.G., Chandra, N.C.,
   Cummins, R.O., Dick, W., Ebmeyer, U., Halperin, H.R., Hazinski, M.F., Kerber,
   R.E., Kern, K.B., Safar, P., Steen, P.A., Swindle, M.M., Tsitlik, J.E., vonPlanta, I.,
   vonPlanta, M., Wears, R.L. and Weil, M.H. (1996), Utstein-style guidelines for
   uniform reporting of laboratory CPR research: A statement for health care
   professionals from a task force of the American Heart Association, the American
   College of Emergency Physicians, the American College of Cardiology, the
   European Resuscitation Council, the Heart and Stroke Foundation of Canada, the
   Institute of Critical Care Medicine, the Safar Center for Resuscitation Research, and
   the Society for Academic Emergency Medicine. Annals of Emergency Medicine, 28
   (5), 527-541
Keywords:                                                   BLOOD-FLOW/CORONARY
   CARDIOPULMONARY                      RESUSCITATION/force/guidelines/health/health
   care/HIGH-DOSE                                             EPINEPHRINE/HOSPITAL
Pollack, C.V., Torres, M.T. and Alexander, L. (1996), Feasibility study of the use of
   bilevel positive airway pressure for respiratory support in the emergency department.
   Annals of Emergency Medicine, 27 (2), 189-192.
Abstract: Study objective: To determine the feasibility of bilevel positive airway
   pressure (BiPAP) support for acute respiratory distress (ARD) in the emergency
   department. Methods: A convenience sample of patients in ARD as a result of any
   nontraumatic cause was recruited for a prospective, noncontrolled clinical trial in the
   ED of an urban tertiary care teaching hospital. Hemodynamically unstable patients
   and those requiring immediate endotracheal intubation were excluded. After an
   initial arterial blood gas (AGB) analysis was obtained, the patient was placed on
   BiPAP (Bi-PAP S/T noninvasive ventilator; Respironics, Incorporated) by nose mask
  or face mask to provide noninvasive pressure support at 5 cm H2O. Settings were
  titrated to patient tolerance and satisfactory pulse oximetry. After at least 30 minutes
  on a stable setting, arterial blood gases were remeasured. The cause of respiratory
  distress, vital signs, assessment of need for intubation, arterial blood gas results, and
  patient disposition were recorded. Success of noninvasive support was defined as the
  presence of (1) improvement in ABG parameters, (2) clinical improvement and
  decrease in evident dyspnea, and (3) avoidance of endotracheal intubation and
  mechanical ventilation. Results: Fifty patients were studied. Causes of ARD included
  acute congestive heart failure (CHF; n=16), exacerbation of chronic obstructive
  pulmonary disease (COPD; n=9), mixed COPD/CHF (n=3), pneumonia (n=10),
  status asthmaticus (n=6), and other causes of acute respiratory failure leg, stroke,
  overdose; n=6). Noninvasive management was successful in 43 patients (86%), with
  patients in all etiologic categories being equally likely to respond favorably to
  therapy. All patients were admitted to the hospital, but 52.5% of those who ordinarily
  would have required ICU beds were admitted to lower land less costly) levels of care.
  Three patients were eventually intubated, ail after admission to the ICU on BiPAP.
  Two patients did not tolerate BiPAP, and two others were considered ED treatment
  failures but were not intubated because of advance directives. Conclusion: As has
  been reported from other critical care set tings, use of BiPAP is feasible and has
  potential utility in the management of ARD in the ED
Keywords:       acute/ACUTE       EXACERBATIONS/analysis/arterial/arterial           blood
  gases/assessment/blood/blood gases/causes/chronic/chronic obstructive pulmonary
  disease/clinical                     trial/congestive/congestive                    heart
  failure/COPD/DISEASE/dyspnea/EMERGENCY/emergency                      department/FACE
  MASK/FAILURE/heart/heart                    failure/hospital/ICU/management/mechanical
  oximetry/respiratory failure/stroke/therapy/treatment/urban/VENTILATION
Aufderheide, T.P., Rowlandson, I., Lawrence, S.W., Kuhn, E.M. and Selker, H.P.
  (1996), Test of the acute cardiac ischemia time-insensitive predictive instrument
  (ACI-TIPI) for prehospital use. Annals of Emergency Medicine, 27 (2), 193-198.
Abstract: Study objectives: To test diagnostic performance for acute cardiac ischemia
  (ACI) in a manually calculated and in a computerized, ECG-calculated ACI
  time-insensitive predictive instrument (ACI-TIPI) in prehospital chest pain patients.
  Methods: We carried out prospective inclusion and data acquisition with
  retrospective analysis. Over a 6-month period, 439 adult emergency medical services
  patients with chest pain underwent prehospital electrocardiography. Because of
  incomplete data, 77 cases were excluded, leaving a study sample of 362 patients.
  Excluded patients did not differ significantly with respect to age, sex, final diagnosis,
  or history of myocardial infarction, heart surgery, diabetes, or stroke. ACI- TIPI
  probabilities of ACI were computed on the basis of the prehospital ECGs as
  interpreted retrospectively and independently by two study investigators blinded to
  patient outcome, with a specially programmed electrocardiograph, and with a
  computer algorithm further modified by logistic- regression analysis. Results:
  Diagnostic performance on the basis of receiver operating characteristic (ROC) curve
  areas of the ACI-TIPI was scored, by the two physician readers,.73 and .74; and by
  EGG, .75. Patients with low ACI-TIPI probability (0% to 9%) had no acute
  myocardial infarctions, a 2.3% incidence of angina, and no prehospital
  life-threatening events. Conclusion: ACI-TIPI probabilities of ACI as generated by a
  specially programmed electrocardiograph are comparable to those based on
  physician ECG interpretations and may be useful in the prehospital evaluation of
  chest pain
Keywords:                                                   ACCURACY/acute/ACUTE
Pao, B.S. and Hayden, S.R. (1996), Cerebral gas embolism resulting from inhalation of
  pressurized helium. Annals of Emergency Medicine, 28 (3), 363-366.
Abstract: Loss of consciousness, a generalized tonic-clonic seizure, right-side weakness,
  and pneumomediastinum developed suddenly in a 13-year-old boy who had inhaled
  helium directly from a pressurized helium tank. His condition improved dramatically
  with hyperbaric oxygen treatment, and he had apparently regained complete
  neurologic function by the time of follow-up 2 weeks later. On the basis of the boy's
  clinical presentation and his response to hyperbaric oxygen therapy, we diagnosed a
  cerebral gas embolism
  VENTILATION/neurologic/OXYGEN/PATENT                                        FORAMEN
Markides, K.S., StroupBenham, C.A., Goodwin, J.S., Perkowski, L.C., Lichtenstein, M.
  and Ray, L.A. (1996), The effect of medical conditions on the functional limitations
  of Mexican-American elderly. Annals of Epidemiology, 6 (5), 386-391.
Abstract: We examined the relationship of self-reported functional status to common
  medical conditions using a probability sample of 3050 noninstitutionalized
  Mexican-American men and women aged 65 or older and residing in the
  Southwestern United States (Arizona, California, Colorado, New Mexico, and Texas).
  All subjects were interviewed in person (n = 2,873) or by proxy (n = 177) in their
  homes during late 1993 and early 1994. The questionnaire obtained information on
  self-reported Junctional status and prevalence of arthritis, cancer, diabetes, stroke,
  heart attack, and hip fracture. The prevalence of medical conditions ranged from
  4.1% for hip fracture to 40.8% for arthritis. Prevalence of impairments in seven
  activities of daily living ranged from 5.4% for earing to 11.7% for bathing, while
  25.1% could not walk up and down stairs, and 28.9% could not walk a half mile
  without help. In multiple logistic regression analyses, previous diagnoses of stroke
  and hip fracture were most predictive of functional limitations, though all conditions
  examined (arthritis, cancer, diabetes, stroke, heart attack, and hip fracture) were
  independently associated with increased odds of impairment in some activities of
  daily living. In general, the odds for functional impairment associated with specific
  medical conditions were higher than those previously published for non-Hispanic
  white populations. The fact that Mexican-American elderly who live in the
  community and who have medical conditions, especially stroke and hip fracture, are
  at high risk for functional impairment probably reflects the low rate of
  institutionalization in this population and has implications for the provision of
  community- based long-term care services for Mexican-American elderly. (C) 1996
  by Elsevier Science Inc
Keywords: activities of daily living/ADULTS/aged/aging/ARTHRITIS/cancer/chronic
  nctional/functional             status/general/HEALTH/heart/high                risk/hip
   fracture/Hispanics/impairment/LONG/long-term            care/low/medical/men/Mexican
   Americans/Mexico/NEW-YORK/physical                                        functioning
   RS/SCIENCE/SEP/specific/stroke/United States/UNITED-STATES/WOMEN
Haan, M.N. and Weldon, M. (1996), The influence of diabetes, hypertension, and stroke
   on ethnic differences in physical and cognitive functioning in an ethnically diverse
   older population. Annals of Epidemiology, 6 (5), 392-398.
Abstract: Prevention of decline in cognitive and physical functioning In the elderly has
   become an important focus in geriatric medicine. Hispanics are among the
   fastest-growing group of elderly in the United States, yet few data are available on
   functional impairments in this group. We examined the association between ethnicity
   (non-Hispanic whites [NHW], English-speaking Hispanics [EH], and
   Spanish-speaking Hispanics [SH]) and cognitive status, self-assessed functional
   status, and physical performance in a community-dwelling sample of 589 people
   aged greater than or equal to 60 years. The purpose of this study was to examine the
   association between ethnicity and these measures of functional status and to evaluate
   the influence of comorbid stroke, diabetes, and hypertension on this association. We
   found that EH and SH had significantly lower scores on the MiniMental State Exam
   than NHW, but that this difference was almost entirely due to educational level.
   When SH whose educational attainment was grade 8 or higher were compared to
   NHWs, there were no differences in cognitive functioning. Those with diabetes and
   stroke had poorer cognitive functioning. Among those with stroke, EH and SH
   women had more self-assessed functional limitations (IADLs and ADLs) than NHW.
   Male SH and EH with diabetes also had more self- assessed functional limitations
   than NHW. SH with two or three of these conditions had more IADL limitations.
   Our results suggest that elderly community-dwelling Hispanics experience greater
   levels of disability and that this is due, in part, to lower socioeconomic status and
   higher prevalence of disabling conditions. (C) 1996 Elsevier Science Inc
Keywords: aged/cognitive function/community-dwelling/comorbidity/cross-sectional
   mic status/stroke/United States/women
Gillum, R.F. (1996), Coronary heart disease, stroke, and hypertension in a US national
   cohort: The NHANES I Epidemiologic Follow-up Study. Annals of Epidemiology, 6
   (4), 259-262
Keywords:                                                                 BLOOD-CELL
Mcgee, D., Cooper, R., Liao, Y.L. and DurazoArvizu, R. (1996), Patterns of
   comorbidity and mortality risk in blacks and whites. Annals of Epidemiology, 6 (5),
Abstract: Comorbidity, the co-existence of multiple chronic conditions in a single
   individual, has been shown to modify the prognosis of disease states. To estimate
   disease burdens within and among racial subpopulations of the United States, we
   examined cross- sectional patterns of comorbidity and their impact on survival using
   data from the NHANES-I Epidemiologic Follow-up Study (NHEFS). We considered
   the occurrence of four cardiovascular conditions: stroke, coronary heart disease,
   hypertension and diabetes. We summarize the joint occurrence of these four
   conditions using these different methodologies: the number of conditions occurring
   in each individual and two summaries that weight the conditions according to their
   prognostic significance. Using all three methodologies, we found an excess burden of
   chronic disease in black women as compared with white women. Black men had an
   excess burden compared to white men for the first two methodologies. However,
   when we model the relationship of the joint occurrence of the conditions to
   subsequent mortality, black men and white men are seen to have a similar burden.
   This similarity of black and white men is due to an interaction between race and
   prevalent stroke in men; that we hypothesize may be due to the small number of
   black men available for study. Given the apparent conditioning effect of co-existing
   diseases, it is evident that estimation of disease burdens among groups that differ in
   terms of health status, in particular among U.S. blacks and whites, requires
   accounting for the occurrence of multiple chronic diseases. Using either the number
   of conditions or the prognosis weighted summary, we demonstrated a higher burden
   of the conditions considered in blacks that in whites in a sample of the U.S.
   population. (C) 1996 by Elsevier Science Inc
Keywords: 1ST/black:white differentials/blacks/burden/cardiovascular/chronic/chronic
   disease/chronic diseases/CO-MORBIDITY/comorbidity/coronary/coronary heart
   United States/VALIDATION/women
Iribarren, C., Folsom, A.R., Eckfeldt, J.H., McGovern, P.G. and Nieto, F.J. (1996),
   Correlates of uric acid and its association with asymptomatic carotid atherosclerosis:
   The ARIC Study. Annals of Epidemiology, 6 (4), 331-340.
Abstract: The correlates of serum uric acid and the association of uric acid with carotid
   intimal-medial thickness (an early measure of atherosclerosis) were investigated in
   participants of the baseline examination of the Atherosclerosis Risk in Communities
   (ARIC) Study. The study sample included 6522 women (74% white) and 4966 men
   (79% white) who were aged 45 to 64 years at baseline (1986-1989). Those with
   prevalent coronary heart disease or previous stroke and those taking uricosuric
   medication were excluded. The mean (SD) uric acid concentration was 5.9 (1.5)
   mg/dL. It was highest among black men 45-54 years old (6.9 [1.5] mg/dL), and
   lowest in white women aged 45-54 years old (5.0 [1.2] mg/dL). The uric acid level
   was positively correlated in both sexes with a variety of health-related factors, most
   notably body mass index, creatinine, triglycerides, diuretic use, alcohol intake,
   hypertension, diabetes, and insulin levels. In a linear regression model adjusting for
   age and ARIC center, the level of uric acid was directly and significantly associated
   with B-mode ultrasound carotid intimal-medial thickness in women and white men
   (but not in black men). However, when known risk factors for atherosclerotic disease
   and relevant behavioral and biological correlates of uric acid were controlled for in
   multivariate analysis, the association of uric acid with this early measure of
   atherosclerosis became negligible in white women and much weaker and not
   statistically significant in black women and white men. Thus, uric acid itself may not
   be a risk factor for atherosclerosis. Future analysis of cardiovascular events in the
   ARIC Study will further elucidate the role of uric acid in atherosclerotic disease. Ann
   Epidemiol 1996; 6:331-340
Keywords: age/aged/alcohol/alcohol intake/analysis/atherosclerosis/body mass/body
   mass         index/cardiovascular/cardiovascular         events/CARDIOVASCULAR
   RISK-FACTORS/carotid/carotid                      wall                thickness/cohort
   study/confounding/coronary/coronary              heart           disease/CORONARY
   analysis/NEW-YORK/PHYSICAL-                  ACTIVITY/risk/risk              factor/risk
   factors/SCIENCE/serum/serum                                                         uric
   acid/stroke/THICKNESS/triglycerides/ULTRASOUND/uric acid/women
Haan, M.N., Selby, J.V., Rice, D.P., Quesenberry, C.P., Schofield, K.A., Liu, J. and
   Fireman, B.H. (1996), Trends in cardiovascular disease incidence and survival in the
   elderly. Annals of Epidemiology, 6 (4), 348-356.
Abstract: This study compared the age-specific incidence, postdiagnostic survival, and
   mortality for cardiovascular disease (CVD) in two cohorts of people aged 65 years
   and older. All subjects were members of a large prepaid health maintenance
   organisation. The influence of changes in CVD risk factors on these rates also was
   evaluated. Trends in prevalence, incidence, postdiagnostic survival, and mortality for
   CVD were examined in both cohorts in 1971 and 1980. Myocardial infarction (MI),
   angina pectoris, stroke, and congestive heart failure (CHF) were included as CVD
   outcomes in this analysis. Nine-year prospective data on these diagnoses were
   abstracted from medical records and computerized hospitalization records for both
   cohorts. Age-sex-adjusted cardiovascular mortality was lower for both sexes by
   similar to 20% in the 1980 cohort. Overall survival did not change, whereas cancer
   mortality increased by 76% in women and 36% in men. With the exception of stroke,
   there was no increase in age-adjusted or age-specific prevalence. In men, the age-
   adjusted prevalence of stroke in men was 24% higher in the 1980 cohort.
   Age-adjusted 9-year incidence of MI, angina pectoris, stroke, and CHF did not
   change between cohorts in either sex. Postdiagnostic, age-adjusted mortality for men
   with incident stroke was 24% lower in the 1980 cohort, and Postdiagnostic,
   age-adjusted mortality for men with incident angina was 35% lower in the 1980
   cohort. Adjustment for risk factors measured at or before baseline had little influence
   on cohort differences in CVD incidence or duration of surgical after CVD diagnosis.
   This study confirms other research showing a decline in CVD mortality over the past
   20 years. These findings suggest that prevalent angina pectoris is increasing in men,
   and that survival with stroke and with angina is improving in men. Later diagnosis of
   incident CHF in men suggests that prevention and early detection may be postponing
   the development of more serious disease. Ann Epidemiol 1996; 6:348-356
Keywords:                                                 age/aged/analysis/angina/angina
   pectoris/cancer/cardiovascular/cardiovascular                   disease/cardiovascular
   diseases/cardiovascular mortality/cohort study/COMMUNITY/congestive/congestive
   th                                                               promotion/heart/heart
   e/prevention/preventive                        medicine/prospective/research/risk/risk
Jonas, H.A., Kronmal, R.A., Psaty, B.M., Manolio, T.A., Meilahn, E.N., Tell, G.S.,
   Tracy, R.P., Robbins, J.A. and AntonCulver, H. (1996), Current estrogen-progestin
   and estrogen replacement therapy in elderly women: Association with carotid
   atherosclerosis. Annals of Epidemiology, 6 (4), 314-323.
Abstract: The cardioprotective effects of combined estrogen/progestin replacement
   therapy have been questioned. Therefore, we have compared carotid arterial wall
   thickening and the prevalence of carotid stenosis in elderly women (greater than or
   equal to 65 years old) currently using replacement estrogen/progestins (E+P) with
   arterial pathology and its prevalence in women using unopposed estrogens (E). This
   cross-sectional study used baseline data from all 2962 women participating in the
   Cardiovascular Health Study, a population-based study of coronary heart disease and
   stroke in elderly adults. Users of hormone replacement therapy (HRT) were
   categorized as never (n = 1726), past (n = 787), current E (n = 280), or current E+P
   (n = 73). Maximal intimal-medial thicknesses of the internal and common carotid
   arteries and stenosis of the internal carotid arteries were measured by
   ultrasonography. Current E+P users resembled current E users in most respects,
   although some lifestyle factors were more favorable among E+P users. Current ESP
   use and current E use (as compared with no use) were associated with smaller
   internal carotid wall thicknesses (- 0.22 mm; P = 0.003; and -0.09 mm; P = 0.05,
   respectively) and smaller common carotid wall thicknesses (-0.05 mm; P = 0.03; and
   -0.02 mm; P = 0.1, respectively) and lower odds ratios (OR) for carotid stenosis
   (greater than or equal to 1% vs. 0%); OR = 0.61; 95% confidence interval [CI]: 0.36
   to 1.01; and OR = 0.91, 95% CI: 0.67 to 1.24, respectively, after adjustment for
   current lifestyle and risk factors. When both groups of current HRT users were
   compared, there were no significant differences in carotid wall thicknesses or
   prevalence of carotid stenosis. For this sample of elderly women, both current E+P
   therapy and current E therapy were associated with decreased measures of carotid
   atherosclerosis. These measures did not differ significantly between the two groups
   of HRT users. Ann Epidemiol 1996; 6:314-323
Keywords:                   adults/arterial/arteries/atherosclerosis/CARDIOVASCULAR
   HEALTH/carotid/carotid        arterial     wall     thickness/carotid     arteries/carotid
   stenosis/CHILDREN/combined                    extrogen/progestin             replacement
   therapy/confidence/coronary/coronary         heart      disease/CORONARY-ARTERY
   DISEASE/cross-sectional                              study/disease/effects/elderly/elderly
   women/ENDOMETRIAL                 CANCER/ESTRADIOL/estrogen                  replacement
   therapy/heart/heart         disease/HEART-DISEASE/hormone                    replacement
   -YORK/pathology/population-based                            study/POSTMENOPAUSAL
Gironell, A., Altes, A., Arboix, A., Fontcuberta, J., Munoz, C. and MartiVilalta, J.L.
   (1996), Pentosan polysulfate-induced thrombocytopenia: A case diagnosed with an
   ELISA test used for heparin-induced thrombocytopenia. Annals of Hematology, 73
   (1), 51-52.
Abstract: We report a patient who developed severe thrombocytopenia and ischemic
   stroke following pentosan polysulfate treatment. An ELISA test employed in type-II
   heparin-induced thrombocytopenia was highly positive. To our knowledge, this is the
   first case in which this test has been performed in a pentosan polysulfate-induced
   thrombocytopenia (PIT). Our data suggest that the antibody against pentosan
   polysulfate-platelet complex also cross-reacts with heparin-platelet factor 4 complex.
   Due to its greater sensitivity and wider availability, this ELISA test should be used in
   cases where PIT is suspected
Keywords:       ANTIBODY/cerebrovascular           disease/COMPLEX/ischemic/ischemic
Gulba, D.C., Bode, C., Runge, M.S. and Huber, K. (1996), Thrombolytic agents - An
   overview. Annals of Hematology, 73 S9-S27.
Abstract: Thrombolysis today has become a routine option not only in the treatment of
   acute myocardial infarction but also in many other manifestations of thromboembolic
   disease. Until one decade ago, only two plasminogen activators, streptokinase and
   urokinase, were available for clinical use. They were characterized by limited
   thrombolytic potencies and major side effects including systemic fibrinogen
   breakdown, bleeds and stroke. This has promped the searche for new plasminogen
   activators with better pharmacological and clinical profils, The first such new
   plasminogen activators were Anistreplase, a chemically modified version of the
   streptokinase-plasminogen-activator-complex and tissue-type plasminogen-activator
   produced by recombinant technology. Both new substances have fuelled the
   development in modern thrombolytic treatment. While the clinical progress with
   t-PA was confirmed in large, double-blind, randomized, multicenter trials, no real
   superiority of anistreplase over the traditional plasminogen activators urokinase and
   streptokinase has been substantiated. While the clinical use of t-PA today has been
   been established for acute myocardial infarction, pulmonary embolism and deep vein
   thrombosis, current researche is focused on further plasminogen activators with
   further improved thrombolytic properties. This review summerizes the current
   knowledge on the biochemical and pharmacological properties of the first, second
   and futur generation of plasminogen activators
Keywords:               acute/acute             myocardial               infarction/ACUTE
   VEIN             THROMBOSIS/development/DIFFERENT                        MOLECULAR
   infarction/NEW-YORK/plasminogen/plasminogen                       activator/plasminogen
   activators/pulmonary/pulmonary                              embolism/RECOMBINANT
   type/tissue-type/treatment/trials/urokinase/UROKINASE                             PRO-
Peter, I., Otremski, I. and Livshits, G. (1996), Geographic variation in vascular
   mortality in Eurasia: Spatial autocorrelation analysis of mortality variables and risk
   factors. Annals of Human Biology, 23 (6), 471-490.
Abstract: The geographic variation patterns of vascular mortality and their major risk
   factors from 68 samples in Eurasia are described in this work. The goodness-of-fit
   tests and analysis of variance indicate significant differences in incidence of
   mortality from the studied diseases, as well as in risk factors among the various
   geographic regions in four age groups. Correlation analysis points out the two
   general tendencies for the majority of studied traits: (a) significant positive
   association with latitude and (b) significant negative correlation with longitude. In
   turn, one-dimensional correlograms showed no specific geographic pattern at least up
  to 3000 km for all studied variables. However, at the large geographic scale a
  long-distance differentiation pattern was indicated for total serum cholesterol and
  body mass index; regional patches - for total death rate, mortality rate from
  cardiovascular and ischaemic heart diseases, systolic and diastolic blood pressure;
  and a local patches pattern was detected for mortality rate from stroke.
  Two-dimensional correlograms uncovered three distinct and significant patterns of
  variation: (a) a north-south trend for total mortality rate, for death rate from
  cardiovascular and ischaemic heart diseases, for diastolic and systolic blood pressure
  and for body mass index; (b) a northwest-southeast pattern for mortality rate from
  cerebrovascular disease; and (c) local parches for total serum cholesterol
Keywords:     age/analysis/ANDHRA-PRADESH/ARTERY                  DISEASE/blood/blood
  pressure/BLOOD-PRESSURE/body                           mass/body                  mass
  HEART-DISEASE/correlation/COUNTRIES/death/diastolic                              blood
  /mortality                                            rate/NONCONSANGUINEOUS
  FAMILIES/POPULATION/pressure/rate/regional/risk/risk factors/SEGREGATION
  ANALYSIS/serum/specific/stroke/systolic/systolic                                 blood
vanderBom, J.G., Bots, M.L., Haverkate, F., Slagboom, P.E., Meijer, P., Dejong,
  P.T.V.M., Hofman, A., Grobbee, D.E. and Kluft, C. (1996), Reduced response to
  activated protein C is associated with increased risk for cerebrovascular disease.
  Annals of Internal Medicine, 125 (4), 265-&.
Abstract: Background: Resistance to activated protein C (APC), which results from
  various factors, including a mutation in the gene for coagulant factor V, has been
  associated with increased risk for venous thrombosis. However, its relation to arterial
  disease is sti II not well defined. Objective: To investigate the association of both
  response to APC and the factor V Leiden mutation with arterial disease. Design:
  Population-based case- control study. Setting: A district of Rotterdam, the
  Netherlands. Participants: 115 patients with a history of myocardial infarction; 112
  patients with a history of stroke, transient ischemic attack, or both; and 222
  age-matched controls without arterial disease chosen from among 7983 persons in
  the Rotterdam Study cohort. Patients using anticoagulant drugs were excluded.
  Measurements: Response to APC was determined in double-centrifuged platelet-poor
  plasma. Patients were genotyped for the Arg 506 to Gln mutation in the gene for
  coagulant factor V. Results: The prevalence of cerebrovascular disease increased
  gradually and corresponded to a decreasing response to APC (odds ratio per 1-unit
  decrease of response to APC 1.43 [95% CI, 1.12 to 1.81], adjusted for age and sex).
  Adjustment for the factor V mutation did not change the findings. We found no
  association between response to APC and myocardial infarction or between factor V
  mutation and cerebrovascular disease or myocardial infarction. Conclusions: Low
  response to APC is associated with an increased risk for cerebrovascular disease but
  not with an increased risk for myocardial infarction, independent of the factor V
  Leiden mutation. The association between the factor V Leiden mutation and
  cerebrovascular disease or myocardial infarction remains to be determined
Keywords: age/arterial/blood coagulation disorders/case control/case control
  study/cerebrovascular/cerebrovascular                          disease/cerebrovascular
  disorders/COAGULATION-FACTOR-V/control/disease/drugs/factor V/factor V
   rdial/myocardial         infarction/MYOCARDIAL-INFARCTION/Netherlands/odds
   ratio/PHYSICIAN/PHYSICIANS/plasma/POOR                             ANTICOAGULANT
   is/thrombosis/transient/transient     ischemic     attack/TRANSIENT        ISCHEMIC
Salerno, S.M., Landry, F.J., Schick, J.D. and Schoomaker, E.B. (1996), The effect of
   multiple neuroimaging studies on classification, treatment, and outcome of acute
   ischemic stroke. Annals of Internal Medicine, 124 (1), 21-26.
Abstract: Objective: To examine the effect of serial neuroimaging studies on the
   diagnosis, therapy, and outcome of patients with acute stroke. Design: Retrospective
   case series. Setting: Tertiary care teaching hospital. Patients: 206 adult patients
   (mean age +/- SD, 66.0 +/- 10.8 years) hospitalized with a diagnosis of acute stroke
   between 1990 and 1993. Measurements: Strokes were retrospectively assigned to
   five categories (large-vessel, small-vessel, cardioembolic, other, or unknown) using
   standardized criteria based on the history, physical examination, ancillary test results,
   and first computed tomographic (CT) or magnetic resonance imaging (MRI) study of
   the head. Strokes were reclassified after the results of further neuroimaging studies,
   if any, were reviewed. The type and timing of therapy and the patient outcome at
   hospital discharge were documented. Results: The additional studies changed stroke
   classification in only 20.0% of the 140 patients who had two or more neuroimaging
   studies. All classification changes were from the unknown cause category to a
   category with a specific cause. In most patients receiving treatment (93.2%), therapy
   began before an additional CT or MRI study was obtained. In patients who had one
   neuroimaging study, 70.1% went home, 24.0% went to a skilled nursing facility, and
   5.9% died; the corresponding percentages in persons who had multiple studies were
   73.3%, 24.4%, and 2.2% (P > 0.1). Conclusions: Serial neuroimaging studies did not
   alter the classification of strokes for which an initial diagnosis had already been
   made. However, they were useful in determining the cause of strokes initially
   classified as having an unknown cause. Therapy was almost always begun
   immediately after the first CT or MRI study was obtained. Outcome at hospital
   discharge was not significantly related to the number of neuroimaging studies
Keywords:                                                                      acute/acute
   DEPENDENCE/INFARCTION/ischemic/ischemic                                stroke/magnetic
   resonance/magnetic                                                           resonance
   NCE/specific/stroke/stroke classification/test/therapy/timing/treatment
Aylward, P.E., Wilcox, R.G., Horgan, J.H., White, H.D., Granger, C.B., Califf, R.M.
   and Topol, E.J. (1996), Relation of increased arterial blood pressure to mortality and
   stroke in the context of contemporary thrombolytic therapy for acute myocardial
   infarction - A randomized trial. Annals of Internal Medicine, 125 (11), 891-&.
Abstract: Background: Despite concern that hypertension increases the risk for
   intracranial hemorrhage during thrombolysis for acute myocardial infarction, the
   exact nature of the risk remains unclear. Objective: To assess the effects of previous
   hypertension and blood pressure at study entry on the outcomes of patients who had
   acute myocardial infarction and received thrombolysis. Design: Randomized trial.
   Setting: 1081 hospitals in 15 countries. Patients: 41 021 patients who had myocardial
   infarction accompanied by ST-segment elevation and who presented to hospitals
   within 6 hours of symptom onset. Intervention: One of four thrombolytic regimens.
   Main Outcome Measures: Mortality, stroke subtypes, and death plus disabling stroke
   in patients with previous hypertension and as functions of blood pressure at entry.
   Logistic regression analysis of relations among blood pressure at entry, baseline
   characteristics, and treatment effects. Results: The incidence of total stroke and
   intracranial hemorrhage increased as systolic blood pressure at entry increased and
   was particularly high for systolic pressures of about 175 mm Hg or more (incidence
   of total stroke, 3.4% compared with 1.17% for pressures between 100 and 124 mm
   Hg). Patients who had systolic blood pressure of 175 mm Hg or more at entry and
   who received accelerated alteplase therapy had a lower rate of death within 30 days
   (4.3% compared with 7.8%; P = 0.044) and a lower rate of death plus disabling
   stroke (4.9% compared with 8.9%; P = 0.031) than patients treated with streptokinase,
   despite having higher rates of total and hemorrhagic stroke (incidence of
   hemorrhagic stroke, 2.3% compared with 1.5%). Assumptions based on previous
   trials and rates of stroke from the GUSTO-I (Global Utilization of Streptokinase and
   t-PA for Occluded Coronary Arteries) trial suggest that in hypertensive patients with
   low risk for death from cardiac causes (no previous infarction, Killip class I), the
   risk-to-benefit ratio with thrombolysis is about unity, with about 13 lives saved per
   1000 persons treated at the risk of about 13 intracranial hemorrhages. Conclusions:
   Patients with myocardial infarction and very elevated blood pressure who have
   thrombolysis and patients with myocardial infarction who do not have elevated blood
   pressure have a similar risk for death, but the risk for stroke is higher in the former
   group. Future studies should assess 1) the risk-to- benefit ratio of thrombolysis in
   these patients, especially those at low risk for death from cardiac causes, and 2)
   whether decreasing elevated blood pressure before thrombolysis reduces the
   incidence of stroke without increasing mortality rates
Keywords:       acute/acute     myocardial     infarction/analysis/arterial/arterial    blood
   pressure/blood/blood                            pressure/cardiac/causes/cerebrovascular
   blood            pressure/therapy/thrombolysis/thrombolytic              therapy/TISSUE
Fihn, S.D., Callahan, C.M., Martin, D.C., McDonell, M.B., Henikoff, J.G. and White,
   R.H. (1996), The risk for and severity of bleeding complications in elderly patients
   treated with warfarin. Annals of Internal Medicine, 124 (11), 970-&.
Abstract: Objective: To determine whether increasing age is associated with an
   increased risk for bleeding during warfarin treatment. Design: Combined
   retrospective and prospective cohort studies. Setting: 6 anticoagulation clinics.
   Patients: 2376 patients receiving warfarin for various indications. Measurements:
   Bleeding events categorized as minor (resulting in no costs or consequences), serious
   (requiring testing or treatment), life- threatening, or fatal. Results: 812 first bleeding
   events (4 fatal, 33 life-threatening, 222 serious, and 553 minor) occurred during 3702
   patient-years. Age was inversely related to the mean warfarin dose and dose-adjusted
   prothrombin time ratio. The unadjusted incidence of minor bleeding complications
   did not vary according to age group: 18.0 per 100 patient-years for patients younger
   than 50 years of age, 21.5 for patients 50 to 59 years of age, 24.0 for patients 60 to 69
  years of age; 23.5 for patients 70 to 79 years of age, and 16.3 for patients 80 years of
  age and older. The unadjusted incidence of serious bleeding complications also did
  not vary according to age group: 9.3 per 100 patient-years for patients younger than
  50 years of age, 7.1 for patients 50 to 59 years of age, 6.6 for patients 60 to 69 years
  of age, 5.1 for patients 70 to 79 years of age, and 4.4 for patients 80 years of age and
  older. The unadjusted incidence of life-threatening or fatal complications combined
  was significantly higher among the oldest patients: 0.75 per 100 patient-years for
  patients younger than 50 years of age, 0.97 for patients 50 to 59 years of age, 1.10 for
  patients 60 to 69 years of age, 0.68 for patients 70 to 79 years of age, and 3.38 for
  patients 80 years of age and older. Patients 80 years of age and older had a relative
  risk of 4.5 (95% CI, 1.3 to 15.6) compared with patients younger than 50 years of
  age. After adjustment for the intensity of anticoagulation therapy and the deviation in
  the prothrombin time ratio using Cox and Poisson regression, age was not generally
  associated with the occurrence of bleeding; relative risk estimates ranged from 0.99
  to 1.03 per year of age (lower- bound 95% CI, 0.97 to 1.01; upper-bound 95% CI,
  1.00 to 1.09). The single exception was life-threatening and fatal complications in
  patients 80 years of age or older (relative risk, 4.6 [CI, 1.2 to 18.1]). Conclusions:
  Age did not appear to be an important determinant of risk for bleeding in patients
  receiving warfarin, with the possible exception of age 80 years or older. The intensity
  of anticoagulation therapy and the deviation in the prothrombin time ratio were much
  stronger predictors of risk for bleeding
Keywords:                       age/age                      factors/anticoagulation/atrial
  dictors/PREVENTION/prospective/prothrombin                           time/RACE/relative
Laakso, M. and Kuusisto, J. (1996), Epidemiological evidence for the association of
  hyperglycaemia and atherosclerotic vascular disease in non-insulin-dependent
  diabetes mellitus. Annals of Medicine, 28 (5), 415-418.
Abstract: Non-insulin-dependent diabetes mellitus (NIDDM) increases substantially the
  risk for all manifestations of atherosclerotic vascular disease, coronary heart disease
  (CHD), cerebrovascular disease and peripheral vascular disease. Only a small
  proportion of this excess risk can be explained by the effects of conventional
  cardiovascular risk factors, which implies that the diabetic state or factors related to
  it have to play a significant role in the pathogenesis of macrovascular disease in
  NIDDM. Six recent prospective population-based studies including a large number
  of NIDDM patients have indicated that poor glycaemic control evaluated by fasting
  hyperglycaemia or glycosylated haemoglobin levels increases the risk for CHD,
  stroke and amputation independently of other risk factors. A dose-response
  relationship between markers of glycaemic control and the incidence of
  cardiovascular mortality and morbidity has been demonstrated in all these studies.
  However, there is so far no direct proof that strict glycaemic control would delay or
  prevent atherosclerotic complications
Keywords:         amputation/cardiovascular/cardiovascular          disease/cardiovascular
  mortality/cardiovascular                     risk/cardiovascular                     risk
  disease/COHORT/complications/control/conventional/coronary/coronary                 heart
  disease/delay/diabetes/diabetes                      mellitus/disease/effects/ELDERLY
  SUBJECTS/ENGLAND/FASTING                                GLUCOSE/glucose/glycosylated
  haemoglobin/heart/heart                         disease/incidence/MACROVASCULAR
  DISEASE/METABOLIC                  CONTROL/morbidity/MORTALITY/NIDDM/non-
  insulin-dependent                 diabetes                mellitus/non-insulin-dependent
  diabetes/non-insulin-dependent diabetes mellitus/pathogenesis/peripheral/peripheral
  vascular                                   disease/PREVALENCE/prospective/risk/risk
  factors/RISK-FACTORS/SCIENCE/small/stroke/vascular/vascular disease
Azar, A.J., Koudstaal, P.J., Wintzen, A.R., vanBergen, P.F., Jonker, J.J. and Deckers,
  J.W. (1996), Risk of stroke during long-term anticoagulant therapy in patients after
  myocardial infarction. Annals of Neurology, 39 (3), 301-307.
Abstract: Myocardial infarction survivors have an increased risk of stroke, which is
  reduced with long-term anticoagulant therapy. However, an estimated 10-times
  increase in risk of bleeding during such treatment has been reported. We evaluated
  the risk of stroke in patients after a myocardial infarction and examined the
  relationship of the risk of intracranial hemorrhage or cerebral infarction and the
  intensity of anticoagulant therapy. The study population consisted of 3,404
  post-myocardial infarction patients who took part in a randomized, double-blind,
  placebo-controlled trial. Patients were randomized to treatment with anticoagulants
  (international normalized ratio range, 2.8-4.8) or matching placebo. Mean follow-up
  was more than 3 years. The incidence of stroke analyzed on ''intention-to-treat'' was
  0.7 per 100 patient- years in the anticoagulant patients against 1.2 in placebo, a
  hazard ratio of 0.60, with 95% confidence interval of 0.40 to 0.90. In the
  anticoagulation group, 15 patients had cerebral infarction and 17 an intracranial
  bleeding, 3 of which occurred after withdrawal of treatment. In the placebo group,
  the numbers were 43 and 2. Of the 14 intracranial bleeds during anticoagulation, 6
  occurred at an international normalized ratio between 3.0 and 4.0 and 8 at greater
  than 4.0. These results confirm that long-term anticoagulant therapy substantially
  reduces the risk of stroke in postmyocardial infarction patients. The increased risk of
  bleeding complications associated with anticoagulant therapy is offset by a marked
  reduction in ischemic events. The risk of intracranial bleeding is directly related to
  the intensity of anticoagulant treatment
Keywords:           anticoagulant          therapy/anticoagulation/bleeding/BLEEDING
  Y/INTRACEREBRAL                                HEMORRHAGE/intracranial/intracranial
  hemorrhage/ischemic/myocardial/myocardial                               infarction/ORAL
  ANTICOAGULATION/OUTPATIENTS/placebo/risk/risk                                          of
Takano, K., Latour, L.L., Formato, J.E., Carano, R.A.D., Helmer, K.G., Hasegawa, Y.,
  Sotak, C.H. and Fisher, M. (1996), The role of spreading depression in focal
  ischemia evaluated by diffusion mapping. Annals of Neurology, 39 (3), 308-318.
Abstract: This study investigated the role of spontaneous and induced spreading
  depression (SD) on the evolution of focal ischemia in vivo. We induced focal
  ischemia in 12 rats using the middle cerebral artery suture occlusion (MCAO)
  method. Chemical stimulation of nonischemic ipsilateral cortex by potassium
  chloride application (KCI group; n = 7) and saline (NaCl group; n = 5) was
  performed at 15, 30, 45, and 60 minutes following MCAO, and SD was detected
  electrophysiologically. Ischemic lesion volumes assessed over 15-minute intervals,
  evaluated by continuous apparent diffusion coefficient (ADC) of water mapping,
  demonstrated that the ischemic region increased significantly during 15-minute time
  epochs with a single SD episode (36.5 +/- 12.9 mm(3), mean +/- SD) or multiple SD
  episodes (39.8 +/- 22.3) compared with those without SD (13.9 +/- 11.5) (p =
  0.0009). Infarct volume at postmortem 24 hours after MCAO was significantly larger
  in the KCI group, with more total SDs (237.8 +/- 13.8) than the NaCl group (190.5
  +/- 12.6) (p = 0.0001). This study demonstrates that ischemia-related and induced
  SDs increase significantly ischemic lesion volume in vivo, supporting the hypothesis
  for a causative role of SD in extending focal ischemic injury
Keywords:           ADC/apparent              diffusion          coefficient/artery/BRAIN
  dle/middle                                                                        cerebral
  depression/STROKE/T2-WEIGHTED MRI/total/volume
Bassetti, C., Mathis, J., Gugger, M., Lovblad, K.O. and Hess, C.W. (1996),
  Hypersomnia following paramedian thalamic stroke: A report of 12 patients. Annals
  of Neurology, 39 (4), 471-480.
Abstract: Paramedian thalamic stroke (PTS) is a cause of organic hypersomnia, which
  in the absence of systematic deep-wake studies has been attributed to disruption of
  ascending activating impulses and considered a ''dearoused'' state. However, an
  increasing amount of data suggests a role of the thalamus in sleep regulation and
  raises the possibility that a sleep disturbance contributes to hypersomnia in PTS. We
  evaluated 12 patients with magnetic resonance imaging-proven isolated PTS and
  hypersomnia with 10 to >20 hours of sleep behavior per day. Nocturnal
  polysomnographic findings paralleled the severity of hypersomnia. All subjects had
  increased stage 1 NREM sleep, reduced stage 2 NREM sleep, and reduced numbers
  of sleep spindles. In patients with severe hypersomnia, slow-wave (stages 3-4)
  NREM sleep was often reduced, but there were no major REM sleep alterations.
  Daytime sleep behavior was associated mostly with stage I sleep try
  electroencephalogram; there was no correlation between hypersomnia and results of
  nap tests. We conclude that hypersomnia following PTS is accompanied by deficient
  arousal during the day and insufficient spindling and slow-wave sleep production at
  night. These observations support the hypothesis of a dual role of the paramedian
  thalamus as ''final common pathway'' for both maintenance of wakefulness and
  promotion of NREM sleep
  agnetic                           resonance/NUCLEI/severity/sleep/SLEEP-WAKING
Kaufmann, P., Koga, Y., Shanske, S., Hirano, M., DiMauro, S., King, M.P. and Schon,
  E.A. (1996), Mitochondrial DNA and RNA processing in MELAS. Annals of
  Neurology, 40 (2), 172-180.
Abstract: Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like
  episodes (MELAS), a maternally inherited disorder, is usually associated with a point
  mutation in mitochondrial DNA (mtDNA) at position 3,243 in the tRNA(Leu(UUR))
  gene. To further study the pathogenesis of MELAS, we analyzed tissues from 8
  MELAS-3,243 patients. Southern blot analysis showed an increase in the ratio of
   mtDNA to nuclear DNA in almost all tissues examined, implying that mitochondrial
   proliferation is ubiquitous and is not confined to ragged-red fibers in muscle. By
   northern blot analysis, we demonstrated increased steady- state levels of RNA 19, a
   polycistronic transcript corresponding to the 16S rRNA + tRNA(Leu(UUR)) + ND1
   genes (which are contiguous in the mtDNA) in heart, kidney, and muscle. These
   results provide further evidence that altered mitochondrial nucleic acid metabolism
   may have pathogenic significance in MELAS
Keywords:                          acidosis/analysis/and                       stroke-like
Mitsias, P. and Levine, S.R. (1996), Cerebrovascular complications of Fabry's disease.
   Annals of Neurology, 40 (1), 8-17.
Abstract: Fabry's disease (FD) is a rare, sex-linked disorder resulting from
   alpha-galactosidase deficiency. Cerebrovascular complications have been reported in
   the literature but have not been systematically analyzed, We report 2 patients and
   review 51 previously reported cases (descriptive meta-analysis) to clarify the clinical,
   radiologic, and pathologic features, The average age at onset of cerebrovascular
   symptoms was 33.8 years for hemizygous individuals (n = 43) and 40.3 years of
   heterozygotes (n = 10). The most frequent symptoms and signs were as follows (in
   descending order of frequency): hemiparesis, vertigo/dizziness, diplopia, dysarthria,
   nystagmus, nausea/vomiting, head pain, hemiataxia, and ataxia of gait, in the
   hemizygote group; and memory loss, dizziness, ataxia, hemiparesis, loss of
   consciousness and hemisensory symptoms, in the heterozygote group, The
   vertebrobasilar circulation was symptomatic in 67% of the hemizygotes and 60% of
   the heterozygotes. Intracerebral hemorrhage was found in 4 patients (3 hemizygotes
   and 1 heterozygote). Elongated, ectatic, tortuous vertebral and basilar arteries were
   the most common angiographic and pathologic features. For the hemizygotes, the
   recurrence rate for cerebrovascular disease was 76% and the death rate was 55%;
   86% of the heterozygotes had recurrent cerebrovascular event(s) and 40% died. The
   cerebrovascular manifestations of FD, in both hemizygotes and heterozygotes, are
   predominantly due to dilative arteriopathy of the vertebrobasilar circulation,
   frequently recur, and portend a poor prognosis
Keywords: ABNORMALITIES/age/ANEURYSMS/arteries/ataxia/basilar/BASILAR
   basilar circulation
Lindsberg, P.J., Ohman, J., Lehto, T., KarjalainenLindsberg, M.L., Paetau, A.,
   Wuorimaa, T., Carpen, O., Kaste, M. and Meri, S. (1996), Complement activation in
   the central nervous system following blood-brain barrier damage in man. Annals of
   Neurology, 40 (4), 587-596.
Abstract: The central nervous system (CNS) is virtually isolated from circulating
   immunological factors such as complement (C), an important mediator of humoral
  immunity and inflammation. In circulation, C is constantly inhibited to prevent attack
  on host cells. Since a host of diseases produce an abnormal blood-
  brain/cerebrospinal fluid (blood-brain/CSF) permeability allowing C protein
  extravasation, we investigated if C activation occurs in CSF in vitro and in CNS in
  vivo during subarachnoid hemorrhage (SAH) or brain infarction. After SAH (n = 15),
  the terminal complement complex (TCC) concentration on days 0 to 2 was higher in
  the CSF, 210 +/- 61 ng/ml, than in the plasma, 63 +/- 17 ng/ml, but null in the CSF
  of controls (n = 8) or patients with an ischemic stroke (n = 7). TCC was eliminated
  from the CSF after SAH (24 +/- 10 ng/ml on days 7 to 10). Incubation of normal
  human CSF with serum in vitro also activated the terminal C pathway. In 10 fatal
  ischemic brain infarctions, immunohistochemical techniques demonstrated neuronal
  fragment-associated deposition of C9 accompanied by neutrophil infiltration. We
  conclude that the C system becomes activated intrathecally in SAH and focally in the
  brain parenchyma in ischemic stroke. By promoting chemotaxis and vascular
  perturbation, C activation may instigate nonimmune inflammation and aggravate
  CNS damage in diseases associated with plasma extravasation
Keywords:            ABSENCE/activation/blood/blood-brain             barrier/brain/brain
  infarction/cells/central                nervous                   system/CEREBRAL
  stroke/MEMBRANE                     ATTACK                   COMPLEX/MULTIPLE-
Neau, J.P. and Bogousslavsky, J. (1996), The syndrome of posterior choroidal artery
  territory infarction. Annals of Neurology, 39 (6), 779-788.
Abstract: Posterior choroidal artery (PChA) territory infarcts remain the least
  well-known type of thalamic infarcts. Our study of 10 personal cases, selected from
  2,925 stroke patients admitted consecutively to a community-based primary care
  center, and 10 published cases of unilateral PChA territory infarct suggests that they
  can often be differentiated clinically from other thalamic infarcts. Patients with
  PChA territory infarct associated with superficial posterior cerebral artery territory
  infarct or with another infarct were excluded. Damage was characteristically limited
  to the lateral geniculate body, pulvinar, posterior thalamus, hippocampus, and
  parahippocampal gyrus, without involvement of the upper midbrain and the anterior
  nucleus of thalamus. In lateral PChA territory infarct, the most common clinical
  manifestations included homonymous quadrantanopsia, with or without hemisensory
  loss and neuropsychological dysfunction (transcortical aphasia, memory
  disturbances). A homonymous horizontal sectoranopsia is exceptional but
  particularly suggestive of the involvement of the lateral geniculate body in this
  territory. Medial PChA territory infarct was less frequent. Its neurologic picture was
  dominated by eye movement disorders not particularly suggestive of thalamic
  involvement. Late disability was usually absent or slight, being related to pain and
  delayed abnormal movements. The most common stroke etiology was presumed
  small-vessel occlusive disease
Keywords:             AMNESIA/aphasia/artery/cerebral/cerebral             artery/clinical
  DEFECTS/HEMIANOPIA/hippocampus/HOMONYMOUS                              HORIZONTAL
   RGICAL                                    ANATOMY/midbrain/movement/movement
   care/PROGNOSIS/SECTORIAL                  OPTIC           ATROPHY/STROKE/stroke
   patients/thalamic/THALAMIC INFARCTS/thalamus/unilateral/upper
Frey, J.L. (1996), Asymptomatic carotid stenosis: Surgery's the answer, but that's not
   the question. Annals of Neurology, 39 (3), 405-406
Keywords:                                                        ASPIRIN/carotid/carotid
Binkofski, F., Seitz, R.J., Arnold, S., Classen, J., Benecke, R. and Freund, H.J. (1996),
   Thalamic metabolism and corticospinal tract integrity determine motor recovery in
   stroke. Annals of Neurology, 39 (4), 460-470.
Abstract: We studied the role of remote metabolic depressions and pyramidal tract
   involvement regarding motor recovery following a first hemiparetic ischemic stroke.
   In 23 patients the regional cerebral glucose metabolism (rCMRGlu) was measured
   with positron emission tomography and the location and spatial extent of the stroke
   lesions were assessed by magnetic resonance imaging. Motor impairment during the
   acute and chronic stages (4 weeks after stroke) was determined by a motor score and
   recordings of magnetic evoked motor potentials. Twelve patients recovered
   significantly, whereas 11 patients retained a disabling hemiparesis. In contrast to
   patients with good motor recovery, rCMRGlu was severely depressed in the
   thalamus on the lesion side in patients with poor motor recovery. This patient group
   also showed more severe damage to the pyramidal tract on magnetic resonance
   images and a more pronounced reduction of the magnetic evoked motor potential
   amplitude. Neither the size of the stroke lesions nor the spatial extent of the lesional
   and remote rCMRGlu depressions outside the thalamus correlated with the thalamic
   hypometabolism and the improvement of the motor score. We conclude that
   preservation both of parts of the pyramidal tract and of the thalamic circuitry is a
   major determinant for the quality of hand motor recovery following acute brain
   ischemia in the adult
Keywords:                                                          acute/adult/brain/brain
   ATION/EVOKED-POTENTIALS/FRONTAL-                                LOBE/glucose/glucose
   stroke/lesion/LESIONS/MAGNETIC                      BRAIN-STIMULATION/magnetic
   resonance/magnetic resonance imaging/metabolism/motor/motor recovery/positron
   APSULAR INFARCTION/stroke/thalamic/thalamic circuitry/thalamus/tomography
Furlan, M., Marchal, G., Viader, F., Derlon, J.M. and Baron, J.C. (1996), Spontaneous
   neurological recovery after stroke and the fate of the ischemic penumbra. Annals of
   Neurology, 40 (2), 216-226.
Abstract: We prospectively tested the hypothesis that early recovery after ischemic
   stroke depends on the ultimate survival of functionally impaired, critically ischemic
   (i.e., ''penumbral'') tissue. From a series of 26 consecutive patients studied with
   positron emission tomography within 18 hours of first-ever stroke in the middle
   cerebral artery territory, all 11 survivors to the 2-month end point who exhibited
   increased oxygen extraction fraction were declared eligible. The positron emission
   tomographic images were compared to ultimate infarction defined by computed
   tomography performed during the chronic stage. The penumbra (operationally
   defined by increased oxygen extraction fraction and divided outcome despite
  uniformly reduced cerebral blood flow) was individually detected in 10 of the 11
  patients; cerebral blood flow ranged from 7 to 17 ml/100 gm . min, consistent with
  that found in monkey studies. The volume of the penumbra that escaped infarction
  was highly correlated with neurological recovery (p < 0.04 to P < 0.0001, depending
  on the scale used). This longitudinal study is the first to characterize the penumbra in
  humans and to document one mechanism strongly influencing recovery; the
  surviving penumbra may offer opportunities for secondary perifocal neuronal
  reorganization. Therapeutic measures to prevent infarction of the penumbra (up to 16
  hours in this series) may have reduced residual neurological impairment. Mapping
  the extent of the penumbra, according to prospective criteria, may allow one to
  predict each patient's potential for recovery, and to select the most appropriate
  candidates for therapeutic trials
Keywords:               artery/blood/blood                flow/BLOOD-FLOW/BORDER
  ZONE/CELL-DENSITY/cerebral/cerebral                      artery/cerebral           blood
  flow/CEREBRAL-ARTERY                              OCCLUSION/chronic/CO/computed
  c/ischemic                            stroke/LOCAL                               BRAIN
  HEMODYNAMICS/longitudinal/mechanism/middle/middle                                cerebral
  artery/outcome/oxygen/oxygen                                                   extraction
  fraction/OXYGEN-METABOLISM/PET/POSITRON                                       EMISSION
Tourani, J.M., Lucas, V., Mayeur, D., Dufour, B., DiPalma, M., Boaziz, C., Grise, P.,
  Varette, C., Pavlovitch, J.M., PujadeLauraine, E., Larregain, D., Ecstein, E.,
  Untereiner, M., Vuillemin, E., Merran, S. and Andrieu, J.M. (1996), Subcutaneous
  recombinant interleukin-2 (rIL-2) in out-patients with metastatic renal cell carcinoma
  - Results of a multicenter SCAPP1 trial. Annals of Oncology, 7 (5), 525-528.
Abstract: Background: This multicenter phase II trial was conducted in order to evaluate
  the efficacy and toxicity of the subcutaneous route of administration of rIL-2 in the
  treatment of patients with metastatic renal cell carcinoma and to check whether an
  increased cumulative dose of rIL-2 increases efficacy Patients and methods:
  Thirty-nine patients with metastatic renal cell carcinoma were included in this study.
  During the induction period, rIL-2 was administered subcutaneously 5 days a week
  for 8 weeks. The weekly dosages were 90 MIU during weeks 1 and 6; 63 MIU
  during weeks 2 to 4 and 7 to 9. After evaluation, responders and patients with stable
  disease received maintenance treatment which was discontinued upon the appearance
  of disease progression or unacceptable toxicity. During the maintenance period,
  rIL-2 was administered 5 days a week for 4 weeks followed by a 2-week rest period.
  The weekly dosages were 90 MIU in week 1 and 63 MIU in weeks 2 to 4. Results:
  After completion of induction treatment, 7 of 39 evaluable patients (18%) had
  objective responses (95% CI: 9% to 37%) with one complete response. Treatment
  was interrupted or reduced due to toxicity for seven patients: Neuropsychiatric
  symptoms (3 patients), joint pain (1 patient), major asthenia and anorexia (1 patient),
  stroke (1 patient), and septicemia (1 patient). Other systemic side effects in the
  remaining patients were acceptable. Seventeen patients received maintenance
  treatment. In none of the patients did the response status improve during this
  maintenance period. The median follow-up of all of the patients included was 19
  months. The one- and two- year survivals were 65% and 33%, respectively, ad the
  median duration of response was 11 months (5 to 16+). Conclusions: This
  multicentric study confirms the efficacy of subcutaneously-administered rIL-2 in
  patients with metastatic renal cell carcinoma in terms of both response rate and
  survival. The role of a maintenance therapy needs further evaluation
Keywords:                                                   administration/ADVANCED
  NDS/out-patient/pain/PROGNOSTIC                                FACTORS/PROGRESS
  REPORT/rate/renal/renal               cell         carcinoma/response/septicemia/side
Pototschnig, C.A., Schneider, I., Eckel, H.E. and Thumfart, W.F. (1996), Repeatedly
  successful closure of the larynx for the treatment of chronic aspiration with the use of
  botulinum toxin A. Annals of Otology Rhinology and Laryngology, 105 (7), 521-524.
Abstract: Botulinum toxin A was used preoperatively to temporarily paralyze the
  intrinsic laryngeal muscles to hinder movements during the healing period after
  operation. In addition, toxin was injected into the cricopharyngeal muscle to allow a
  better passive drainage of the saliva into the esophagus. We treated six patients.
  Three suffered from chronic aspiration problems after multiple lower cranial nerve
  lesions, and three patients were apallic (after stroke and major brain injury). Two
  weeks before scheduled operation, we injected the toxin into the posterior
  cricoarytenoid muscles, the aryepiglottic muscles, and the vocalis muscle on both
  sides, as well as the cricopharyngeal muscle. The amount of injected toxin varied
  between 1.0 and 1.4 mt, equal to 200 to 280 units of botulinum toxin A (Dysport).
  After a complete palsy of these muscles (controlled by direct electromyography), a
  closure of the larynx was performed. After laminotomy and exposure of the
  intralaryngeal structures, the false vocal cords were mobilized and adapted with
  sutures. Because involuntary movements of the intralaryngeal musculature were
  absent, primary healing without complications occurred in all cases. Aspiration and
  related complications disappeared in all patients. In addition, the intensity of patient
  care could be considerably reduced. Preoperative use of botulinum toxin A allows
  sufficient laryngeal closure. This procedure is especially useful in the treatment of
  children and young adults, preserving the ability of Inter speech rehabilitation
  because of the return of voluntary movements of the intrinsic laryngeal muscles 6
  months after the injection. Furthermore, this technique, as minimal surgical
  intervention, can be performed in high-risk patients
Keywords:      adults/aspiration/botulinum     toxin/botulinum     toxin    A/brain/brain
  treatment/rehabilitation/stroke/SURGICAL-TREATMENT/treatment/young adults
Aviv, J.E., Martin, J.H., Sacco, R.L., Zagar, D., Diamond, B., Keen, M.S. and Blitzer, A.
  (1996), Supraglottic and pharyngeal sensory abnormalities in stroke patients with
  dysphagia. Annals of Otology Rhinology and Laryngology, 105 (2), 92-97.
Abstract: Dysphagia and aspiration are two devastating sequelae of stroke, accounting
  for nearly 40,000 deaths from aspiration pneumonia each year in the United States.
  While motor deficits in the larynx and pharynx are thought responsible for dysphagia
  and aspiration in stroke patients, no prior study has evaluated whether these patients
  also have sensory deficits. The aim of this study was to evaluate the sensory capacity
  of the laryngopharynx (LP) in supratentorial or brain stem stroke patients who
  presented with dysphagia. Fifteen stroke patients (mean age, 66.7 +/- 13.8 [SD] years)
  were prospectively evaluated by means of our previously described method whereby
  air pulse stimuli were delivered via a flexible fiberoptic telescope to the mucosa
  innervated by the superior laryngeal nerve. There were 15 age-matched controls. No
  LP sensory deficits were found in any of the age-matched controls. In all stroke
  patients studied, either unilateral (n = 9) or bilateral (n = 6) sensory deficits were
  identified. Deficits were defined as either a moderate impairment in sensory
  discrimination thresholds (3.5 to 6.0 mm Hg) or a severe sensory impairment (>6.0
  mm Hg). These sensory discrimination thresholds were significantly greater than in
  age-matched controls (7.05 +/- 0.17 mm Hg for the supratentorial group and 6.05 +/-
  1.22 mm Hg for the infratentorial group versus 2.61 +/- 0.69 mm Hg for the controls).
  Among patients with unilateral deficits, sensory thresholds were moderately to
  severely elevated in all 9 cases on the affected side compared with the unaffected
  side (p < .01, Fisher's exact test). Moreover, the sensory thresholds of the unaffected
  side were not significantly different from those of age-matched controls (2.51 +/-
  0.25 mm Hg versus 2.61 +/- 0.69 mm Hg, respectively). All 6 patients with bilateral
  deficits had severe impairments. The results of an outcome assessment in 13 of 15
  patients revealed that 2 out of 5 patients with moderate LP sensory impairment and 5
  out of 8 with severe impairment developed aspiration. Our results show for the first
  time that stroke patients with dysphagia have significant sensory deficits in the LP
  and that these impairments are likely to contribute to the development of aspiration
  sensory        testing/sensory        impairment/sensory       thresholds/stroke/stroke
Geletko, S.M., Melbourne, K.M. and Mikolich, D.J. (1996), Pseudomonas bacteremia
  precipitated by ticlopidine-induced neutropenia. Annals of Pharmacotherapy, 30 (3),
Abstract: OBJECTIVE: To report a case of ticlopidine-induced neutropenia resulting in
  Pseudomonas bacteremia. CASE SUMMARY: An 83-year- old white man
  developed febrile neutropenia 5 days after initiation of ticlopidine therapy. At
  presentation, the patient's white blood cell count was 1.1 x 10(9)/L with an absolute
  neutrophil count (ANC) of 0. Ticlopidine was discontinued and the patient was
  treated empirically with ceftazidime, gentamicin, and filgrastim. The patient's blood
  cultures were positive for Pseudomonas aeruginosa. By day 6 of antibiotic and
  filgrastim therapy, he was clinically improved and the ANC was 17 040 x 10(6)
  cells/L. The filgrastim and intravenous antibiotics were discontinued and oral
  ciprofloxacin was started. CONCLUSIONS: Ticlopidine-induced neutropenia can
  occur suddenly and may result in a serious infection, such as bacteremia
Zuckerman, G.B., Ruiz, D.C., Keller, I.A. and Brooks, J. (1996), Neurologic
  complications following intranasal administration of heroin in an adolescent. Annals
  of Pharmacotherapy, 30 (7-8), 778-781.
Abstract: OBJECTIVE: To describe an adolescent patient who developed a stroke
  following intranasal, administration of heroin, CASE SUMMARY: A 17-year-old
  adolescent with no prior medical problems ''snorted'' an unknown quantity of heroin.
  The patient developed respiratory failure, shock and seizures. When he regained
  consciousness, the patient had evidence of hypoxic- toxic encephalopathy on
  neuropsychologic examination. Magnetic resonance imaging revealed an infarct in
  the globus pallidus region of the brain. DISCUSSION: Serious neurologic
  complications following intranasal administration of heroin have been reported rarely
  in children. Correlations between findings on neuropsychologic examination and
  magnetic resonance imaging following drug overdoses have likewise been rarely
  described. We reviewed literature pertaining to the etiology, pharmacology, and
  pathophysiology of neurologic complications resulting from heroin intoxication.
  CONCLUSIONS: As the use of intranasal heroin is increasing in the pediatric
  population, healthcare professionals should be aware of the various potentially
  serious complications that may occur
  resonance/magnetic          resonance          imaging/medical/neurologic/neurologic
  complications/pediatric/pharmacology/respiratory failure/seizures/shock/STROKE
Adubofour, K.O., Kajiwara, G.T., Goldberg, C.M. and KingAngell, J.L. (1996),
  Oxybutynin-induced heatstroke in an elderly patient. Annals of Pharmacotherapy, 30
  (2), 144-147.
Abstract: OBJECTIVE: TO report an elderly patient with oxybutynin-induced
  heatstroke and to remind clinicians of the possibility of drugs as an etiology of
  hyperthermia. CASE SUMMARY: An elderly man was admitted to the emergency
  department in a confused state. The day of admission was the hottest of the summer
  months in the San Francisco area. Because his rectal temperature was 40 degrees C
  and his skin was hot and dry, he was immediately packed in ice, given intravenous
  NaCl 0.9%, and a cooling fan was used to aid in external cooling. The patient was
  taking oxybutynin chloride, a drug with anticholinergic properties. The previous
  summer he had been admitted with a rectal temperature of 41.1 degrees C. No
  infectious etiology could be found. He was discharged in an improved state after a
  48-hour observation period. The drug was discontinued. DISCUSSION: It is
  important to recognize heatstroke and institute prompt management because of the
  high mortality associated with this thermoregulatory disorder. Prompt treatment
  should consist of rapid cooling and vigorous cardiopulmonary support.
  CONCLUSIONS: The possibility of drug-induced heatstroke should be investigated
  in all patients admitted during the summer months with unexplained hyperthermia,
  especially the elderly. To our knowledge this is the first reported case of heatstroke
  associated with the use of oxybutynin
Keywords:                     cardiopulmonary/CO/DANTROLENE/elderly/emergency
  anagement/mortality/NEUROLEPTIC                                        MALIGNANT
AlShammari, S.A., Khoja, T.A. and AlMaatouq, M.A. (1996), The prevalence of
  obesity among Saudi males in the Riyadh region. Annals of Saudi Medicine, 16 (3),
Abstract: Attendees of 15 health centers in urban and rural areas in the Riyadh region
  were screened for obesity during May and June 1994. Systemic selection yielded
  1580 Saudi males for analysis. The mean age was 33.6 +/- 13.5 years and body mass
  index (BMI) was 26.9 +/- 5.7 kg/m(2). Only 36.6% of subjects were their ideal
  weight (BMI < 25 kg/m(2)), while 34.5% were overweight (BMI 25-29.9 kg/m(2)),
  26.9% were moderately obese (BMI 30-40 kg/m(2) and 1.7% were morbidly obese
  (BMI > 40 kg/m(2)). Middle age, lower education and joblessness predicted a higher
  risk for obesity. Patients living in rural areas had greater BMIs than those living in
  urban areas (P < 0.01). Forty percent of overweight participants did not think they
  were so. The high prevalence of obesity and the lack of awareness among those
  afflicted emphasizes the need for community-based programs for preventing and
  reducing obesity, since weight control is effective in ameliorating most of the
  disorders associated with obesity, such as Type II non-insulin-dependent diabetes
  mellitus, hypertension, stroke, heart disease, sleep apnea syndrome and osteoarthritis
  of the knees. Young parents who are at risk of developing obesity and who play a
  central role in perpetuating it in their offspring should be the target of
  obesity-prevention programs
Keywords:          ADULTS/age/analysis/ARABIA/body                   mass/body        mass
Awada, A., Amene, P., AlRajeh, S. and Obeid, T. (1996), Carotid bruits and ischemic
  cerebrovascular disease. Annals of Saudi Medicine, 16 (2), 218-220
Keywords:                                                               ARABIA/ARTERY
Khan, S.A.S., Yaqub, B.A. and Aldeeb, S.M. (1996), Neurological complications of
  infective endocarditis. Annals of Saudi Medicine, 16 (3), 254-256.
Abstract: We reviewed the files of 80 successive patients with native and prosthetic
  valve endocarditis admitted to Riyadh Armed Forces Hospital. Neurological
  complications (NC) occurred in 28 (35%) patients. The valves involved were mitral
  in 12 (43%), aortic in eight (29%), combined mitral and aortic lesions in six (21%),
  and others in two (7%). The common causative organisms were Streptococci in 12
  (43%), Staphylococcus aureus and Staphylococcus epidermides, both occurring in
  four (14%). Compared to the 52 infective endocarditis patients with no neurological
  complications (NNC), the NC occurred more frequently in male patients, those with
  aortic valve lesion, those with atrial fibrillation, those with delayed therapy and those
  with causative organisms being Streptococci or Staphylococci. Eleven patients died
  (39%), 12 (43%) recovered with motor sequelae, six (21%) had seizure disorder, and
  five (18%) had full recovery. The frequency of neurological complications and
  mortality is comparable to those reported in the literature; however, the frequency of
  strokes was higher in our patients
Keywords:                         aortic                         valve/ARABIA/atrial/atrial
McCarthy, W.J., Park, A.E., Koushanpour, E., Pearce, W.H. and Yao, J.S.T. (1996),
  Carotid endarterectomy - Lessons from intraoperative monitoring - A decade of
  experience. Annals of Surgery, 224 (3), 297-305.
Abstract: Objective The authors analyzed a single institution's 10-year experience with
  intraoperative monitoring during 709 primary carotid endarterectomies and
  investigated the impact of contralateral internal carotid artery stenosis on carotid
  artery stump pressure (SP). Summary Background Data Stump pressure reflects the
  combination of contralateral carotid artery anatomy, collateral intracranial
  vasculature, and systemic blood pressure. By controlling for blood pressure with a
  stump index (SI) (SI = [SP/mean arterial pressure] X 100), a correlation between
  pressure and contralateral carotid artery anatomy can be demonstrated. Although the
  use of SP has long been advocated as an indicator of adequate cerebral perfusion, its
  correlation with perioperative complications while using an intraluminal shunt has
  not been evaluated completely. Methods From a series of 886 primary carotid
  endarterectomy cases, SP and mean arterial pressure were measured prospectively in
  709 procedures. Temporary intraluminal shunts were used in cases with
  demonstrated contralateral carotid occlusion, prior cerebrovascular accident (CVA),
  or SPs less than 35 mmHg. Ipsilateral and contralateral angiographic degree of
  carotid stenosis was recorded at the time of the operation. Neurologic status was
  recorded prospectively for ail 709 procedures. Operative electroencephalogram (EEG)
  changes and SP then were compared with the neurologic status of the patient in the
  perioperative period. Results The mean SP for the group (n = 709) was 46.2 +/- 15.3
  mmHg (mean +/- standard deviation [SD]) with a mean SI of 54.9 +/- 22.6. The
  distribution for the SI is a more gaussian curve than that for SP. There were 19
  ipsilateral CVAs (2.7%). The mean SP in the nonstroke group was 47.1 +/- 15.2
  mmHg (mean SI = 54.7 +/- 16.5) compared with 31.9 +/- 13.2 mmHg (mean SI =
  38.8 +/- 18.2) in the stroke group (p < 0.0001). Stroke rate for SP less than or equal
  to 35 mmHg was 7% (13/185) versus 1.1% (6/524) for SP > 35 (p < 0.0001). Stump
  index and SP are related to contralateral carotid artery stenosis. The pattern of SI dr
  SP versus contralateral stenosis is biphasic, with an increase at 75%. If SI is less than
  or equal to 40, the mean contralateral stenosis is 55.1%; if SI is > 40, the mean
  contralateral stenosis is 35.1% (p < 0.05). Continuous EEG monitoring was
  completed for the 549 most recent operations. Patients who had a perioperative
  stroke had EEG changes observed during the procedure in only 6 of 12 cases (50%
  sensitivity), with 76% specificity. Using SP less than or equal to 35 mmHg,
  sensitivity was 68% and specificity was 75%. Conclusion Low SPs are associated
  with perioperative stroke despite the use of shunts. This trend accelerates when SP
  less than or equal to 35 mmHg. There is an inverse correlation between contralateral
  carotid stenosis and SI or SP. A slight increase in pressure with contralateral stenosis
  greater than 50% may reflect increased collateral development secondary to chronic
  hypoperfusion. Stump pressure sensitivity is a better indicator of perioperative stroke
  than EEG monitoring, with a similar specificity
Keywords:            ANESTHESIA/arterial/arterial               pressure/artery/ARTERY
  OCCLUSION/BACK                 PRESSURE/blood/blood              pressure/carotid/carotid
  artery/carotid          artery         stenosis/carotid          endarterectomy/carotid
  stenosis/cerebral/cerebral                  perfusion/cerebrovascular/cerebrovascular
  monitoring/endarterectomy/hypoperfusion/internal/internal carotid/internal carotid
  artery/internal    carotid     artery    stenosis/intracranial/intraluminal/intraluminal
  shunt/intraoperative             monitoring/intraoperative-monitoring/ipsilateral/mean
Tan, L.C., Perry, M., Sutton, G.L., Fail, T. and Taffinder, N.J. (1996), Audit of 149
  consecutive carotid endarterectomies performed by a single surgeon in a district
  general hospital over a 12-year period. Annals of the Royal College of Surgeons of
  England, 78 (4), 340-344.
Abstract: Carotid endarterectomy has been established by two large randomised
  controlled trials (European, Carotid Surgery Trial (ECST) and North American
  Symptomatic Carotid Endarterectomy Trial (NASCET)) as an important surgical
  procedure for the prevention of ischaemic strokes in patients presenting with
  transient cerebral ischaemia or nan-disabling strokes attributable to severe ipsilateral
  carotid artery stenosis. care The operation carries significant risk of death and stroke
  and it has been advocated by some that carotid endarterectomy should only be
  performed in a small number of designated regional centres in order to achieve good
  surgical results, It is doubtful that the regional centres alone can cope with the
  increasing numbers of patients requiring carotid endarterectomy and there is
  therefore a requirement for the procedure to be carried out by vascular surgeons in
  district general hospitals. It is important that surgical results are audited to ensure
  that comparable outcomes are achieved. We present an audit of our experience of
  carotid endarterectomy since 1981. A total of 149 consecutive carotid
  endarterectomies were performed by a single surgeon with a special interest in
  carotid surgery. The results are comparable to ECST with a 30-day mortality of 0%
  and an overall 30-day stroke rate of 5.7% (major strokes) for patients with severe, ie
  70-99%, ipsilateral carotid artery stenoses, We have shown that carotid
  endarterectomy is an operation that can be performed safely and with good results by
  suitably trained surgeons in district general hospitals
Keywords:       artery/audit/carotid/carotid    artery/carotid   artery    stenosis/carotid
  endarterectomy/cerebral/cerebral               ischaemia/death/district          general
  haemia/mortality/outcomes/prevention/randomised                               controlled
Nicolosi, A.C., Hettrick, D.A. and Warltier, D.C. (1996), Assessment of right
  ventricular function in swine using sonomicrometry and conductance. Annals of
  Thoracic Surgery, 61 (5), 1381-1387.
Abstract: Background. Assessment of right ventricular (RV) pressure- volume relations
  has been hampered by difficulty measuring instantaneous, absolute RV volume.
  Accordingly, several methods were tested for their ability to reflect relative RV
  volume and to determine changes in RV contractile state. Methods. Swine (46 to 54
  kg; n = 7) were anesthetized and instrumented to measure instantaneous RV pressure,
  septal-to-RV free wall diameter (SFWD), RV free wall segment length (FWSL), RV
  volume via conductance (CV), and pulmonary artery flow, the integral of which was
  used as the standard for stroke volume. Flow- derived stroke volume was correlated
  with the systolic change in CV, FWSL, and SFWD in the steady state after
  incremental volume loading and on a beat-to-beat basis during transient inferior vena
  caval occlusion. Contractility was altered by calcium and pentobarbital and assessed
  by preload recruitable stroke work (PRSW). Results. Mean (+/- standard error of the
  mean) correlations (r) versus stroke volume during steady state conditions were 0.85
  +/- 0.04 for FWSL, 0.83 +/- 0.04 for CV, and -0.04 +/- 0.24 for SFWD. Mean r
  values versus stroke volume during caval occlusions were 0.83 a 0.03 for FWSL,
  0.85 a 0.04 for CVI and -0.03 +/- 0.31 for SFWD. Calcium increased mean PRSW
  slope compared with control using CV (20.3 +/- 2.6 versus 16.1 +/- 1.9 mm Hg; p <
  0.05), and pentobarbital decreased mean PRSW slope compared with control using
  both CV and FWSL (11.3 +/- 1.0 versus 16.1 +/- 1.9 mm Hg, p < 0.05; and 11.9 +/-
  2.1 versus 26.1 a 4.0 mm Hg, p < 0.05, respectively). There were no changes in
  PRSW slope with either calcium or pentobarbital using SFWD. The PRSW function
  was linear with both FWSL and CV but not with SFWD. Conclusions. In the normal
  heart, both FWSL and CV, but not SFWD, accurately reflect relative instantaneous
  RV volume and are thus useful for determining RV contractility by pressure-volume
  (pressure- dimension) indices
  YORK/occlusion/PERFORMANCE/preload/preload                   recruitable        stroke
  work/pressure/pulmonary/pulmonary artery/RECRUITABLE STROKE WORK/right
  ventricular              function/SCIENCE/stroke/stroke                 volume/stroke
  work/systolic/SYSTOLIC                    PRESSURE-VOLUME/transient/ventricular
Amirhamzeh, M.M.R., Dean, D.A., Jia, C.X., Cabreriza, S.E., Yano, O.J., Burkhoff, D.
  and Spotnitz, H.M. (1996), Validation of right and left ventricular conductance and
  echocardiography for cardiac function studies. Annals of Thoracic Surgery, 62 (4),
Abstract: Background. Continuous estimation of left ventricular volume from
  instantaneous conductance has compared favorably with ''gold standards,'' is less
  labor intensive, and provides real- time data. Little information exists, however,
  correlating right ventricular conductance with such gold standards or examining the
  effects of an electrical field generated in the opposite ventricle. Methods. In
  open-chested sheep, right and left ventricular conductance, two-dimensional
  echocardiography, and thermodilution cardiac outputs were measured at steady- state
  conditions. After these measurements, postmortem pressure-volume relations,
  ventricular mass, and ventricular casting were performed. Results. The corrected
  end-diastolic volume measured by conductance correlated well with volumes
  measured by echocardiography (r = 0.89), postmortem pressure- volume relations (r
  = 0.84), and casts (r = 0.85). Left ventricular end-diastolic volume measured by
  conductance did not differ significantly from other standards by analysis of variance.
  The presence of an electrical field in the opposite ventricle did not affect measured
  conductance in the studied ventricle. Conclusions. Conductance is useful for the
  measurement of right and left ventricular end-diastolic volumes in the beating heart
  and is not affected by the presence of an electrical field in the opposite ventricle.
  Hence, conductance is a useful tool in studies involving interventricular dependence
  and function
Keywords: analysis/cardiac/cardiac function/echocardiography/effects/EJECTION
DAgostino, R.S., Svensson, L.G., Neumann, D.J., Balkhy, H.H., Williamson, W.A. and
  Shahian, D.M. (1996), Screening carotid ultrasonography and risk factors for stroke
  in coronary artery surgery patients. Annals of Thoracic Surgery, 62 (6), 1714-1723.
Abstract: Background. The role of noninvasive carotid artery screening in relation to
  other clinical variables in identifying patients at increased risk of stroke after
  coronary artery bypass grafting was examined. Methods. Preoperative, intraoperative,
  and postoperative clinical data were prospectively collected for 1,835 consecutive
  patients undergoing first-time isolated coronary artery bypass grafting between
  March 1990 and July 1995, 1,279 of whom had screening carotid ultrasonography.
  All patients with postoperative neurologic events were identified and reviewed in
  detail. Average patient age was 65.3 years (range, 33 to 92 years), and 9.3% (171
  patients) had a prior permanent stroke or transient ischemic attack. Hospital and 30-
  day mortality was 2.2% (41 patients). Forty-five patients (2.5%) had a transient or
  permanent postoperative neurologic event. The data were analyzed by stepwise
  logistic regression to determine the independent predictors of both significant carotid
  stenosis and stroke. Results. On multivariate analysis, the clinical predictors of
  significant carotid stenosis were age (p < 0.0001), diabetes ((p = 0.0123), female sex
  (p = 0.0026), left main coronary stenosis greater than 60% (p < 0.0001), prior stroke
  or transient ischemic attack (p = 0.0008), peripheral vascular disease (p = 0.0001),
  prior vascular operation (p = 0.0068), and smoking (p < 0.0001). When all variables
  were evaluated for those patients who underwent noninvasive carotid artery
  screening, the independent predictors of postoperative neurologic event were prior
  stroke or transient ischemic attack (p < 0.0001), peripheral vascular disease (p =
  0.0037), postinfarction angina pectoris (p = 0.0319), postoperative atrial fibrillation
  (p = 0.0014), carotid stenosis greater than 50% (p = 0.0029), cardiopulmonary
  bypass time (p = 0.0006), significant aortic atherosclerosis (p = 0.0054),
  postoperative amrinone or epinephrine use (p = 0.0054), and left ventricular ejection
  fraction less than 0.30 (p = 0.0744). Conclusions. The etiology of postoperative
  stroke is multifactorial. Selective use of carotid ultrasonography is of value in
  identifying patients who are at greater risk of postoperative stroke independent of
  other variables and should be considered before coronary artery bypass grafting,
  particularly in patients with a history of neurologic event or peripheral vascular
Keywords:         age/analysis/angina/angina        pectoris/ARCH/artery/ASCENDING
  AORTA/atherosclerosis/atrial/atrial                           fibrillation/bypass/bypass
  onary       bypass/carotid/carotid      artery/carotid      stenosis/coronary/coronary
  artery/coronary artery bypass/coronary artery bypass grafting/coronary artery
  c/left                                                ventricular/mortality/multivariate
  vascular         disease/postoperative/predictors/risk/risk         factors/risk      of
  ischemic attack/ultrasonography/vascular/vascular disease
Kurlansky, P.A., Dorman, M.J., Galbut, D.L., Moreno, N.L., Traad, E.A., Carrillo, R.G.,
  Zucker, M., Sanchez, L. and Ebra, G. (1996), Bilateral internal mammary artery
  grafting in women: A 21-year experience. Annals of Thoracic Surgery, 62 (1), 63-69.
Abstract: Background. Coronary artery bypass grafting traditionally has carried a higher
  mortality rate in women than in men. It remains the leading cause of death in women
  despite major advances in diagnosis and treatment over the past 2 decades. Methods.
  A retrospective analysis was conducted to identify risk factors that adversely
  influence hospital mortality, morbidity, and long-term clinical results in women
  undergoing bilateral internal mammary artery grafting. From January 1972 through
  October 1994, 327 consecutive women received bilateral internal mammary artery
  grafts and supplemental vein grafts. Patient age ranged from 32 to 84 years (mean,
  65.7 years). There were 262 patients (80.1%) with three-vessel disease; 71 (21.7%)
  had substantial (>50%) stenosis of the left main coronary artery, 65 (19.9%) had a
  moderately reduced (0.30 to 0.50) ejection fraction, and 11 (3.4%) had a severely
  reduced (<0.30) ejection fraction. Preoperatively, 316 patients (96.6%) were in New
   York Heart Association class III or IV. Results. There were 1,016 coronary artery
   grafts (mean, 3.1 per patient). The overall hospital mortality rate was 3.4% (11 of
   327). Postoperative complications included myocardial infarction in 18 patients
   (5.5%), stroke in 5 (1.5%), pulmonary insufficiency in 11 (3.4%), reoperation for
   bleeding in 7 (2.1%), and sternal infection in 8 (2.4%). Independent predictors of
   operative death were postoperative cardiac arrest (p < 0.001), use of intraaortic
   balloon pump (p < 0.001), and reoperation for bleeding (p < 0.050). Follow-up was
   completed on 316 hospital survivors (100%) and ranged from 6 months to 21 years
   (mean, 5.1 years). Actuarial survival (mean +/- standard error of the mean) was
   90.5% +/- 1.9% at 5 years and 65.6% +/- 6.1% at 10 years. At follow-up, 252
   patients (94.0%) were asymptomatic in New York Heart Association class I, and 12
   (4.5%) were in class II. Conclusions. This longitudinal study demonstrates that
   bilateral internal mammary artery grafting, though technically demanding, can be
   achieved in women with low hospital mortality and morbidity rates. Patients
   experienced reduced late cardiac events, excellent functional improvement, and
   enhanced long-term survival
Keywords:                    age/analysis/artery/balloon/bilateral/bleeding/bypass/bypass
   artery/death/diagnosis/DISEASE/ejection                                   fraction/follow
   mortality           rate/myocardial/myocardial              infarction/MYOCARDIAL
   REVASCULARIZATION/New                      York/NEW-YORK/operative/OPERATIVE
Biswas, S.S., Chen, E.P., Bittner, H.B., Davis, R.D. and VanTrigt, P. (1996), Brain
   death further promotes ischemic reperfusion injury of the rabbit myocardium. Annals
   of Thoracic Surgery, 62 (6), 1808-1815.
Abstract: Background. Little is known about preload-dependent cardiac function after
   brain death (ED) and subsequent graft preservation. Methods. A validated model of
   ED in rabbits was developed and myocardial performance was studied after ED
   induction and I hour of subsequent global hypothermic ischemia using a validated
   rabbit model and an isolated work-performing heart preparation. Results. Significant
   decreases in stroke work, left ventricular contractility, and left ventricular relaxation
   were observed 2 hours after ED. After global hypothermic ischemia, significant
   decreases in stroke work, left ventricular contractility, and left ventricular relaxation
   were observed in the ED group compared with controls. Cardiac output and coronary
   flow were also significantly decreased in ED hearts compared with controls. Creatine
   kinase release was increased by 32.5% in BD hearts compared with controls.
   Conclusions. In a rabbit model, ED combined with global hypothermic ischemia
   causes a significant decrease in left ventricular function compared with global
   hypothermic ischemia. This dysfunction may be attributed to a significant decrease
   in coronary flows in ED hearts
Keywords:                                                              brain/cardiac/cardiac
   left                                                                          ventricular
   injury/SCIENCE/stroke/TRANSPLANTATION/ventricular function
Flum, D.R., Cernaianu, A.C., Meada, R., Lee, L.A., Salartash, K., Grosso, M.A., Weiss,
   R.L., Cilley, J.H. and DelRossi, A.J. (1996), Descending thoracic aortomyoplasty: A
   technique for clinical application. Annals of Thoracic Surgery, 61 (1), 93-98.
Abstract: Background. Descending thoracic aortomyoplasty is a form of skeletal
   muscle-powered cardiac assistance. Its use in clinical settings has been limited by the
   ligation of intercostal arteries necessary to complete a circumferential wrap of the
   aorta with the latissimus dorsi. Methods. This study assessed the feasibility and the
   efficacy of aortomyoplasty constructed with a modified latissimus dorsi. A
   pericardial patch was attached to the latissimus dorsi and divided around the
   preserved intercostal arteries. Nine alpine goats (37 +/- 2 kg) underwent descending
   aortomyoplasty using this technique. All intercostal arteries were preserved. After a
   6-week recovery period, the animals underwent a 6-week, incremental electrical
   conditioning program. After 90 postoperative days, animals were examined under
   anesthesia with the myostimulator on and off. Results. Aortomyoplasty activation
   resulted in augmentation of mean diastolic aortic pressure by 16.0 +/- 0.9 mm Hg
   (23%). Significant improvements in cardiac index (40%), stroke volume index (37%),
   left ventricular stroke work index (49%), and mean arterial pressure (19%) were
   noted. An intravascular sonographic probe placed in the descending aorta revealed
   circumferential compression of the aorta during counterpulsation. Mean
   cross-sectional aortic area was reduced by 51.8%, from 210.1 +/- 7.1 to 108.9 +/- 6.7
   mm(2) during aortomyoplasty activation (p < 0.05). Histologic analysis confirmed
   the long-term patency of intercostal arteries. Conclusions. Descending
   aortomyoplasty, modified with an interposing patch of pericardium, effectively
   transfers skeletal muscle force across the aortic wall and assists cardiac function.
   This technique allows preservation of all aortic branches, and with this novel
   approach, the clinical utility of aortomyoplasty can now be explored
Keywords:                            activation/analysis/anesthesia/animals/aorta/AORTIC
   COUNTERPULSATION/aortic                                         pressure/arterial/arterial
   pressure/arteries/cardiac/cardiac                                      function/cardiac
   ventricular/left               ventricular              stroke               work/mean
   muscle/stroke/stroke volume/volume/wall/work
Aksnes, J., Lindberg, H.L. and Ihlen, H. (1996), Surgical elimination of an atrial septal
   aneurysm causing cerebral embolism. Annals of Thoracic Surgery, 62 (4),
Abstract: Atrial septal aneurysms have been recognized as sources of arterial embolism.
   An intraatrial aneurysm was demonstrated in the fossa ovalis of a 45-year-old
   woman who suffered an episode of cerebral embolism. The disorder is rarely treated
   surgically. Most patients with this condition are given life- long anticoagulation, a
   treatment that may have serious complications. As an alternative treatment with
   possible lower risk, we removed the aneurysm surgically
Keywords:             aneurysm/atrial           septal          aneurysm/cerebral/cerebral
Laske, A., Jenni, R., Maloigne, M., Vassalli, G., Bertel, O. and Turina, M.I. (1996),
   Pressure gradients across bileaflet aortic valves by direct measurement and
   echocardiography. Annals of Thoracic Surgery, 61 (1), 48-57.
Abstract: Background. Pressure gradients calculated from echocardiography after aortic
  valve replacement are commonly much higher than would be expected from in vitro
  measurements. Methods. The mean, peak-to-peak, and maximal gradients across
  bileaflet aortic prostheses (St. Jude Medical) were measured invasively in 52 patients
  at high and low heart rate, cardiac index, and stroke volume. One week after
  operation the gradients were calculated from a standard transthoracic
  echocardiogram (Delta p = 4v(2)(2)). In a second study 3 to 12 months later,
  gradients were calculated using the standard, simplified Bernoulli equation, and with
  the equation considering subvalvular flow velocities (Delta p = 4(v(2)(2-)v(1)(2))).
  Invasive and echocardiographic measurements were matched and compared. Results.
  Invasively measured mean gradients for 21 to 29-mm valves ranged from 7.4 +/- 4.9
  to 4.3 +/- 1.6 mm Hg at systolic flow rates from 11.3 +/- 0.7 to 16.2 +/- 1.8 L . min(-
  1). m(-2). Mean echocardiographic gradients were 15.1 +/- 4.5 to 7.5 +/- 2.2 mm Hg
  (p < 0.001) with the standard method, and 10.5 +/- 1.9 to 5.6 +/- 1.5 mm Hg when
  considering the subvalvular flow velocity (p < 0.001). Conclusions. Mean gradients
  across bileaflet prostheses are generally low, even in small valves and with high
  systolic now. The correlation of the invasive in vivo with in vitro gradients is good.
  Standard echocardiography overestimates gradients across bileaflet heart valves and
  high gradients are not due to valve dysfunction. Gradients obtained by
  echocardiography considering the subvalvular now velocity correlate better to
  invasively measured and in vitro gradients
Keywords: aortic valve/aortic valve replacement/CARBOMEDICS/cardiac/cardiac
  DS-DUROMEDICS/EXPERIENCE/flow/flow                                 velocity/heart/heart
  roke/stroke volume/systolic/valves/velocity/volume
Redmond, J.M., Greene, P.S., Goldsborough, M.A., Cameron, D.E., Stuart, R.S.,
  Sussman, M.S., Watkins, L., Laschinger, J.C., McKhann, G.M., Johnston, M.V. and
  Baumgartner, W.A. (1996), Neurologic injury in cardiac surgical patients with a
  history of stroke. Annals of Thoracic Surgery, 61 (1), 42-47.
Abstract: Background. Controversy still exists as to whether patients with previous
  stroke are at increased risk for neurologic complications after heart operations.
  Methods. We performed a prospective analysis of 1,000 consecutive patients
  undergoing cardiac operations requiring cardiopulmonary bypass, without
  hypothermic circulatory arrest. Of the 1,000 patients, 71 had previously documented
  stroke (study group); 2 control patients with no history of stroke were selected for
  each of these patients (control group, n = 142). There were no significant differences
  between the study and control patients with respect to established risk factors for
  neurologic complications. Results. Compared with controls, study patients took
  longer to awaken (12.6 +/- 10.9 versus 3.5 +/- 2.1 hours; p < 0.001) and longer to
  extubate (29.5 +/- 29.3 versus 9.1 +/- 5.2 hours; p < 0.001), and had a greater
  incidence of reintubation (7 of 71, 9.9% versus 2 of 142, 1.4%; p < 0.01) and
  postoperative confusion (26 of 71, 36.6% versus 7 of 142, 4.9%; p < 0.001). There
  was a higher incidence of focal neurologic deficit among study patients (31 of 71,
  43.7% versus 2 of 142, 1.4%; p < 0.001). These deficits included new stroke (6 of 71,
  8.5%)) as well as the reappearance of previous deficits (19 of 71, 26.8%) or
  worsening of previous deficits (6 of 71, 8.5%), without new abnormalities on head
  computed tomography or magnetic resonance imaging. Study patients with
  neurologic deficit had longer cardiopulmonary bypass times than did study patients
  without deficit (146 +/- 48.5 versus 110 +/- 43.3 minutes; p < 0.001). The 30-day
  mortality rate was greater in study patients than in controls (5 of 71, 7% versus 1 of
  142, 0.7%; p < 0.02), with four deaths among the 6 study patients with a new stroke
  (66.7%). Conclusion. This analysis identifies a group of patients at high risk for
  neurologic sequelae and confirms the vulnerability of the previously injured brain to
  cardiopulmonary bypass, as evidenced by reappearance or exacerbation of focal
  deficits in such patients
  ry               bypass/circulatory               arrest/COMPLICATIONS/computed
  BYPASS/focal/GRAFT-SURGERY/heart/high risk/history/hypothermic circulatory
  arrest/incidence/injury/magnetic             resonance/magnetic                resonance
  imaging/mortality/mortality                                   rate/neurologic/neurologic
Mehlhorn, U., Allen, S.J., Adams, D.L., Davis, K.L., Gogola, G.R. and Warters, R.D.
  (1996), Cardiac surgical conditions induced by beta-blockade: Effect on myocardial
  fluid balance. Annals of Thoracic Surgery, 62 (1), 143-150.
Abstract: Background. Both crystalloid and blood cardioplegia result in cardiac
  dysfunction associated with myocardial edema. This edema is partially due to the
  lack of myocardial contraction during cardioplegia, which stops myocardial lymph
  flow. As an alternative, acceptable surgical conditions have been created in patients
  undergoing coronary artery bypass operations with esmolol-induced minimal
  myocardial contraction. We hypothesized that minimal myocardial contraction
  during circulatory support using either standard cardiopulmonary bypass (CPB) or a
  biventricular assist device would prevent myocardial edema by maintaining cardiac
  lymphatic function and thus prevent cardiac dysfunction. Methods. We placed 6 dogs
  on CPB and 6 dogs on a biventricular assist device and serially measured myocardial
  lymph flow rate and myocardial water content in both groups and preload recruitable
  stroke work only in the CPB dogs. In all dogs we minimized heart rate with esmolol
  for 1 hour during total circulatory support. Results. Although myocardial lymph now
  remained at baseline level during CPB and increased during biventricular assistance,
  myocardial water accumulation still occurred during circulatory support. However,
  as edema resolved rapidly after separation from circulatory support, myocardial
  water content was only slightly increased after CPB and biventricular assistance, and
  preload recruitable stroke work was normal. Conclusions. Our data suggest that
  minimal myocardial contraction during both CPB and biventricular assistance
  supports myocardial lymphatic function, resulting in minimal myocardial edema
  formation associated with normal left ventricular performance after circulatory
  support. The concept of minimal myocardial contraction may be a useful alternative
  for myocardial protection, especially in high-risk patients with compromised left
  ventricular function
Keywords:                   ANTEGRADE/artery/balance/beta-blockade/blood/BLOOD
  bypass/COLD/contraction/coronary/coronary                artery/coronary           artery
  bypass/dogs/EDEMA/flow/formation/function/HEART/heart               rate/high    risk/left
  ventricular/left            ventricular             function/left             ventricular
  performance/myocardial/myocardial               contraction/myocardial              water
  content/NEW-YORK/performance/preload/preload                   recruitable         stroke
  work/rate/SCIENCE/stroke/stroke work/total/ventricular function/WARM/work
DiPierro, F.V., Bavaria, J.E., Lankford, E.B., Polidori, D.J., Acker, M.A., Striecher, J.T.
  and Gardner, T.J. (1996), Triiodothyronine optimizes sheep ventriculoarterial
  coupling for work efficiency. Annals of Thoracic Surgery, 62 (3), 662-669.
Abstract: Background. Triiodothyronine (T-3) administration after cardiopulmonary
  bypass has been shown to significantly improve cardiac performance. The present
  study was undertaken to elucidate the effects of T-3, when administered as an
  intravenous bolus, on both cardiac energetics and stroke work- oxygen utilization
  (EW/LWO(2)) efficiency. Methods. In both unstressed and stressed hearts,
  energetics were evaluated at baseline and 2 hours after intervention in an in vivo
  sheep preparation. In the first group (n = 5) sheep received saline vehicle. In the
  second group (n = 9) sheep received an intravenous bolus of 1.2 mu g/kg of T-3. In
  the third group (n = 7) sheep received a 2-hour intravenous infusion of dobutamine at
  a rate of 5 mu g/kg/min. Results. In the unstressed heart, T-3 improved cardiac
  function at no cost in oxygen consumption by decreasing afterload and hence
  improved EW/LVVO(2) efficiency. In contrast, dobutamine improved unstressed
  cardiac function by increasing contractility at the cost of increased oxygen
  consumption and thus decreased EW/LVVO(2) efficiency. Triiodothyronine
  optimized ventriculoarterial coupling for efficiency, but dobutamine optimized
  coupling for maximal work. In the stressed heart, T-3 again improved EW/LVVO(2)
  efficiency, but dobutamine had the opposite effect. Conclusions. The bolus
  administration of T, improves unstressed cardiac performance through optimization
  of ventriculoarterial coupling for EW/LVVO(2) efficiency, primarily through
  vasodilation. Triiodothyronine also increases efficiency in the stressed heart. This
  study supports the use of T, in cardiac operations to improve cardiac performance
  with no cost in oxygen consumption characteristic of inotropic agents
Keywords:         administration/afterload/bypass/cardiac/cardiac        function/cardiac
  coupling/VOLUME/work/work efficiency
Reed, C.E., Dorman, B.H. and Spinale, F.G. (1996), Mechanisms of right ventricular
  dysfunction after pulmonary resection. Annals of Thoracic Surgery, 62 (1), 225-231.
Abstract: Background. Significant right ventricular (RV) dysfunction as measured by
  increased end-diastolic volume and reduced ejection fraction has been documented in
  the postoperative period after pulmonary resection. We hypothesized that changes in
  RV contractile state or afterload may contribute to this RV pump dysfunction.
  Methods. In part one of the study, RV preload was altered on postoperative day 2 (n
  = 6) by rapid infusion of Hespan to a total of 250, 500, and 1,000 mL. The
  relationship between RV stroke work and end-diastolic volume was plotted using
  linear regression. This preload recruitable stroke work relation had been previously
  validated as a load-insensitive index of RV contractility. The slopes of the
  preoperative relation (n = 35) and postoperative relation were compared. In part two
  of the study, RV afterload was reduced by continuous infusion of prostaglandin E(1)
  (n = 6) through postoperative day 2 and RV pump function was assessed. Results.
  Comparison of the slopes of the preload recruitable stroke work relation plotted
  preoperatively and on postoperative day 2 revealed no significant difference,
  indicating no change in RV contractile state. Infusion of prostaglandin E(1) in the
  postoperative period (n = 6) significantly reduced pulmonary vascular resistance
  (3.67 +/- 0.19 versus baseline 5.72 +/- 0.19 dyne . s . cm(-5)/m(2); p < 0.05).
  However, RV ejection fraction remained significantly reduced (0.34 +/- 0.01 versus
  baseline 0.42 +/- 0.01; p < 0.05) and end-diastolic volume significantly increased
  (105 +/- 5 versus baseline 93 +/- 2 mL/m(2): 0.05). Heart rate was increased
  compared with baseline throughout the postoperative period. Conclusions. The
  present study suggests that RV dysfunction after pulmonary resection is not caused
  by primary alterations in contractility or immediate changes in afterload. Better
  control of heart rate with minimal effect on inotropy may enhance RV pump function
Keywords:                                                     afterload/CONTRACTILE
  PERFORMANCE/contractility/control/effect/ejection                 fraction/end-diastolic
  rate/HYPERTENSION/NEW-YORK/postoperative/preload/preload                     recruitable
  stroke          work/PROSTAGLANDIN-E1/pulmonary/pulmonary                      vascular
  resistance/rate/RECRUITABLE               STROKE            WORK/resistance/RIGHT
  work/total/TRANSPLANTATION/vascular/vascular resistance/volume/work
Kim, S.Y., Euler, D.E., Jacobs, W.R., Montoya, A., Sullivan, H.J., Lonchyna, V.A. and
  Pifarre, R. (1996), Arterial impedance in patients during intraaortic balloon
  counterpulsation. Annals of Thoracic Surgery, 61 (3), 888-893.
Abstract: Background. Symptomatic improvement of a patient's hemodynamic
  condition during intraaortic balloon counterpulsation (IABC) is considered to result
  largely from a reduction in afterload. Afterload can be accurately quantified by
  arterial input impedance measurements. Here we report the effect of IABC on arterial
  impedance in humans. Methods. To characterize the effects of IABC on arterial input
  impedance, impedance measurements were obtained using aortic annulus Doppler
  flow and pressure from the aortic balloon catheter. Impedance spectra were
  compared between the cardiac cycles preceding and following the cycle with IABC
  in 25 patients. Results. Intraaortic balloon counterpulsation increased stroke volume
  (23%; p = 0.001), reduced myocardial oxygen demand (11%; p = 0.02), and
  decreased the aortic pressure at the onset of systole (16%; p = 0.001). There was also
  a decrease in systemic vascular resistance (24%; p = 0.001), characteristic arterial
  impedance (21%; p 0.002), and pulse wave reflection (20%; p = 0.006). Linear
  regression analysis showed that an increase in stroke volume was predicted only by
  the decrease in systemic vascular resistance (r = -0.81; p = 0.001). Conclusions. The
  reduction in systemic vascular resistance appeared to be the major mechanism by
  which IABC improved cardiac pumping efficiency. This effect may result from the
  passive distention of the peripheral vascular bed due to the propagation of the
  balloon-augmented diastolic pressure through the arterial system
Keywords:                 afterload/analysis/aortic              pressure/arterial/arterial
  myocardial            oxygen          demand/NEW-YORK/OUTPUT/oxygen/oxygen
  wave/REFLECTIONS/resistance/SCIENCE/stroke/stroke volume/systemic vascular
  resistance/VALIDATION/vascular/vascular resistance/volume
Tasdemir, O., Vural, K.M., Kucukaksu, S.D., Tarcan, O.K., Ozdemir, M., Kutuk, E. and
  Bayazit, K. (1996), Comparative study on cardiomyoplasty patients with the
  cardiomyostimulator on versus off. Annals of Thoracic Surgery, 62 (6), 1708-1713.
Abstract: Background. A major concern in evaluating dynamic cardiomyoplasty has
  been whether the synchronous stimulation of latissimus dorsi muscle is essential for
  benefit or not. Fire studied 10 patients to determine the efficacy of the systolic
  augmentation generated by the synchronous electrical stimulation of the latissimus
  dorsi muscle. Methods. Left ventricular ejection fraction, end-systolic and
  end-diastolic volume indexes, and stroke volume index obtained during resting, peak
  exercise, and recovery periods (''on'' values) were compared with those obtained 1
  week after cessation of electrical stimulus (''off'' values). Double product and
  estimated total body oxygen consumption at peak exercise were also calculated and
  compared. Results. Higher ejection fractions (0.36 +/- 0.07 versus 0.33 +/- 0.06 at
  rest, 0.40 +/- 0.07 versus 0.33 +/- 0.07 at peak exercise, and 0.37 +/- 0.06 versus 0.31
  +/- 0.06 at recovery) and lower end-systolic volume indexes with relatively constant
  end-diastolic volume indexes were observed with the cardiomyostimulator on.
  Further, exercise response was better with the cardiomyostimulator on. Double
  product indirectly reflected better myocardial oxygen supply/demand ratio when on
  at peak exercise (17 +/- 2.2 mm Hg x beats/min x 10(-3) for on versus 19 +/- 2.6 mm
  Hg x beats/min x 10(-3) for off). Estimated total body oxygen consumption was
  improved at peak exercise when the cardiomyostimulator was functional (12 +/- 2.7
  mL . kg(-1). min(-1) versus 11 +/- 2.6 mL . kg(-1) min(-1)). Conclusions. Current
  data suggest a hue systolic assist during synchronous contractions of the latissimus
  dorsi muscle. It is thought, therefore, that synchronous electrical stimulation is
  essential for maximum benefit and all the beneficial effect of cardiomyoplasty
  certainly cannot be attributed to simple wrapping itself
Keywords:                                       CAPACITY/cardiomyoplasty/DILATED
  fraction/electrical                                             stimulation/end-diastolic
Cochrane, A.D., Pathik, S., Smolich, J.J., Conyers, R.A.J. and Rosenfeldt, F.L. (1996),
  Depressed function in remote myocardium after myocardial infarction: Influence of
  orotic acid. Annals of Thoracic Surgery, 62 (6), 1765-1772.
Abstract: Background. We have previously shown that infarction impairs recovery of
  global function after subsequent cardioplegic arrest and that therapy with erotic acid
  improves recovery. The aim of this study was to measure the effect of infarction on
  regional and global left ventricular function and to determine whether erotic acid
  exerts a beneficial effect exclusive of the effects of cardioplegia. Methods. Acute
  myocardial infarction was produced in dogs. They then received either erotic acid or
  placebo (control) orally (n = 12 per group). Fractional radial shortening and systolic
  wall thickening were measured by two- dimensional echocardiography before and 1
  and 3 days after infarction with and without beta-adrenergic blockade, and in 6 dogs
  up to 9 days after infarction. Global function was measured under anesthesia 4 days
  after infarction. Results. In control animals, fractional radial shortening in the infarct
  decreased from 20.6% +/- 5.1% before infarction to 3.0% +/- 2.2% at day 1 and to
  1.9% +/- 1.9% at day 3 (p < 0.01). In the border zone radial shortening declined from
  21.9% +/- 3.7% to 11.0% +/- 2.3% at day I and 9.3% +/- 2.8% at day 3 (p < 0.05). In
  the noninfarcted myocardium radial shortening also declined from 27.1% +/- 1.9%
  before infarction to 18.3% +/- 2.3% on day 1 (p < 0.05) and to 16.0% +/- 2.8% on
  day 3 after infarction (p < 0.05) with recovery to preinfarct levels by 9 days after
  infarction. These findings were confirmed by measurements of systolic thickening.
   Before infarction beta-receptor blockade decreased fractional shortening in all
   regions of the left ventricle, but this effect was absent on day 3 after infarction,
   implying that the myocardium had become less responsive to beta-adrenergic
   stimulation. Measurements of global function 4 days after infarction showed marked
   depression of stroke work. There was no effect of erotic acid treatment on regional or
   global function. Conclusions. Myocardial infarction causes reversible depression of
   resting function and beta-adrenergic responsiveness in the remote and border zone
   areas, which is not prevented by metabolic therapy with erotic acid. This finding may
   explain the adverse response of the infarcted heart to cardioplegic arrest
Keywords:                   anesthesia/animals/BORDER/cardioplegia/CARDIOPLEGIC
   rdiography/effect/effects/function/heart/infarct/infarction/left           ventricle/left
   ventricular/left ventricular function/measure/measurements/myocardial/myocardial
   ONAL                                                                             WALL
Gillinov, A.M., Shah, R.V., Curtis, W.E., Stuart, R.S., Cameron, D.E., Baungartner,
   W.A. and Greene, P.S. (1996), Valve replacement in patients with endocarditis and
   acute neurologic deficit. Annals of Thoracic Surgery, 61 (4), 1125-1129.
Abstract: Background. Acute neurologic deficits occur in up to 40% of patients with left
   heart endocarditis. Appropriate evaluation and management of patients with acute
   neurologic dysfunction who require valve operations for endocarditis remain
   controversial. This retrospective review was undertaken to develop recommendations
   for the evaluation and treatment of these challenging patients. Methods. From 1983
   to 1995, 247 patients underwent operations for left heart native valve endocarditis at
   the Johns Hopkins Hospital. From a review of medical and pathology records, 34
   patients (14%) with preoperative neurologic deficits were identified. Data on these
   34 patients were recorded and analyzed. Results. Causes of neurologic dysfunction
   included embolic cerebrovascular accident (n = 23, 68%), embolic cerebrovascular
   accident with hemorrhage (n = 4, 12%), ruptured mycotic aneurysm (n = 3, 9%),
   transient ischemic attack (n = 2, 6%), and meningitis (n = 2, 6%). Preoperative
   diagnostic studies included computed tomography (32 patients), magnetic resonance
   imaging (11 patients), cerebral angiogram (14 patients), and lumbar puncture (2
   patients). Computed tomography demonstrated structural lesions in 29 of 32 patients;
   in only 1 patient did magnetic resonance imaging reveal a lesion not already seen on
   computed tomography. Of 14 patients having cerebral angiograms, 7 had a mycotic
   aneurysm. Three mycotic aneurysms had ruptured, and these were clipped before
   cardiac operations. The mean interval from onset of neurologic deficit to cardiac
   operation was 22.2 +/- 2.8 days for all patients and 22.1 +/- 3.0 days for those with
   embolic cerebrovascular accident. The hospital mortality rate was 6%. New or worse
   neurologic deficits occurred in 2 patients (6%). Conclusions. Neurologic deficits are
   common in patients with endocarditis referred for cardiac operations. Despite
   substantial preoperative morbidity, most of these patients do well if the operation can
   be delayed for 2 to 3 weeks. Computed tomography scan is the preoperative imaging
   technique of choice, as routine magnetic resonance imaging and cerebral angiogram
   are unrewarding. Cerebral angiogram is indicated only if computed tomography
   reveals hemorrhage
Keywords:                               ACTIVE                                INFECTIVE
  mortality/ischemic/lesion/lesions/magnetic         resonance/magnetic        resonance
  nt ischemic attack/treatment
Christakis, G.T., Buth, K.J., Weisel, R.D., Rao, V., Joy, L., Fremes, S.E. and Goldman,
  B.S. (1996), Randomized study of right ventricular function with intermittent warm
  or cold cardioplegia. Annals of Thoracic Surgery, 61 (1), 128-134.
Abstract: Background. Transient right ventricular dysfunction has been previously
  documented after bypass operations despite adequate myocardial protection with
  intermittent antegrade cold blood cardioplegia. Recently warm blood cardioplegia
  has been interrupted during construction of distal anastomoses to improve
  visualization. The effects of intermittent antegrade warm blood cardioplegia, and the
  resultant periods of right ventricular normothermic ischemia, on postoperative right
  ventricular function are unknown. Methods. To assess the effects of cardioplegia on
  right ventricular protection, 52 patients undergoing isolated bypass grafting were
  randomized to intermittent warm or cold blood cardioplegia. The two groups were
  similar with respect to age, sex, ventricular function, and right coronary stenoses.
  Cross-clamp times were similar (warm, 64 +/- 22 minutes; cold, 63 +/- 15 minutes;
  not significant). The cumulative time of cardioplegia interruption was longer in the
  cold group (42 +/- 8 minutes) than in the warm group (31 +/- 14 minutes; p < 0.002).
  A rapid-response thermodilution catheter was employed to assess postoperative right
  ventricular ejection fraction and end-diastolic and end- systolic volume indices.
  Results. The right ventricular ejection fraction was greater in the warm group at 6
  hours (warm, 0.46 +/- 0.06; cold, 0.37 +/- 0.08; p < 0.05) and 8 hours (warm, 0.43
  +/- 0.08; cold, 0.37 +/- 0.08; p < 0.05) postoperatively. The right ventricular
  end-diastolic volume index was less in the warm group 8 hours postoperatively
  (warm, 83 +/- 11 mL/m(2); cold, 94 +/- 16 mL/m(2); p < 0.05). There were no
  differences in pulmonary arterial pressures or right ventricular stroke work index.
  Conclusions. Despite intermittent normothermic ischemia of half the cross-clamp
  time, patients receiving warm cardioplegia maintained right ventricular
  hemodynamics after bypass grafting
Keywords:          age/arterial/blood/BLOOD          CARDIOPLEGIA/BYPASS/bypass
  lmonary/right       ventricular      function/SCI/SCIENCE/stroke/systolic/ventricular
Mussivand, T.V., Masters, R.G., Hendry, P.J. and Keon, W.J. (1996), Totally
  implantable intrathoracic ventricular assist device. Annals of Thoracic Surgery, 61
  (1), 444-447.
Abstract: Background. A totally implantable, intrathoracic electrohydraulic ventricular
  assist device (EVAD) is being developed for permanent use or as a bridge to
  transplantation. Methods. The blood pump with 70-mL nominal stroke volume,
  volume displacement chamber, reversible turbine, internal electronics and infrared
  diaphragm position sensor are combined in one compact unit (unified system). The
   size and geometry are based on human anatomic measurements and fluid dynamic
   studies. A transcutaneous energy transfer powers the system and recharges the
   implantable nickel-cadmium battery pack. Autotuning circuitry optimizes energy
   transfer efficiency over a range of transcutaneous energy transfer coil spacings and
   misalignments. An infrared diaphragm position sensor detects end-systole and
   diastole points. Results. In vitro and acute in vivo tests have demonstrated flow rates
   greater than 6 L/min. The transcutaneous energy transfer system demonstrated power
   transfer efficiencies of 60% to 80% for power demands from 5 to 60 W. Thirteen
   systems are currently undergoing durability testing; one has run for more than 750
   days failure-free. The system recently sustained circulation in an acute calf
   implantation for 96 hours. Conclusions. Results of the in vitro and in vivo testing to
   date have demonstrated that the developed system can function effectively as a
   totally implantable ventricular assist device. Chronic in vivo evaluation is planned
Keywords:         acute/blood/calf/circulation/DEVICE/DEVICES/diastole/efficiency/end
   ORK/power/SCIENCE/stroke/stroke volume/testing/transplantation/volume
Clark, R.E., Goldstein, A.H., Pacella, J.J., Walters, R.A., Moeller, F.W., Cattivera, G.R.,
   Davis, S. and Magovern, G.J. (1996), Small, low-cost implantable centrifugal pump
   for short-term circulatory assistance. Annals of Thoracic Surgery, 61 (1), 452-456.
Abstract: Background. In 1991, Allegheny General Hospital and Allegheny- Singer
   Research Institute purchased a centrifugal pump, then a 2-year-old technology, from
   Medtronic Bio-Medicus, as part of its research program for novel treatments of acute
   and chronic heart failure. During a 4-year development program, we then established
   and met goals of durability, performance, thromboresistance, and low cost. Methods.
   In vitro testing involved extensive hydraulic characterizations using Penn State mock
   loops. Calorimetry was used to determine efficiency. Durability studies used heated
   (37 degrees C) seawater for 28 to 45 days. In vivo studies used 46 sheep to test
   performance and engineering changes and to determine myocardial oxygen
   consumption, thromboresistance, and long-term durability. A left atrium-to-aorta
   circuit was used in all. Results. Hydraulic testing showed no preload sensitivity but
   moderate afterload sensitivity at all impeller speeds (2,000 to 6,000 rpm). The heat
   load was low, and overall efficiency was 13% to 15%. Bench durability studies
   showed no electrical malfunction of the stator or console without degradation of the
   biomaterials used. Acute in vitro studies showed a near-linear relationship of
   myocardial oxygen consumption and left ventricular stroke work, pump now, and
   pump speed. At speeds of 2 to 3 L/min (50% bypass), left ventricular stroke work
   and myocardial oxygen consumption were decreased approximately 50%.
   Additionally, 5 animals have had implants for 28 to 154 days with no macroemboli
   or microemboli detected in any animal. Hematologic and biochemical studies
   became normal 3 to 7 days after implantation. Hemolysis was low at less than 10
   mg/dL. Clinical costs of the device are estimated to be 80% less than those of
   currently available devices. Conclusions. We conclude that an old technology has
   been made into new technology by application of sound engineering design
   principles, microchips, and new biomaterials. Qualifying trials for a Food and Drug
   Agency investigational device exemption application are in progress
   /efficiency/failure/heart/heart failure/heat/left ventricular/left ventricular stroke
Harpole, D.H., Gall, S.A., Wolfe, W.G., Rankin, J.S. and Jones, R.H. (1996), Effects of
  valve replacement on ventricular mechanics in mitral regurgitation and aortic
  stenosis. Annals of Thoracic Surgery, 62 (3), 756-761.
Abstract: Background. This study in humans assessed changes in left ventricular
  function early and late after correction of mitral regurgitation (MR) (n = 9) or aortic
  stenosis (AS) (n = 10). Methods. Ventricular function was measured with
  radionuclide and micromanometer-derived pressure-volume loops during preload
  manipulation, thermodilution cardiac outputs, and echocardiograms. Late
  radionuclide and echocardiographic data were acquired at 24 hours and 20 months.
  Results. Perioperative left ventricular performance (stroke work-end-diastolic
  volume relationship) did not change for patients with MR or AS. Significant changes
  in afterload occurred: ejection fraction (MR, 0.49 to 0.37; AS, 0.54 to 0.60; both, p =
  0.013), mean left ventricular ejection pressure (MR, 73 to 91 mm Hg; AS, 138 to 93
  mm Hg; both, p < 0.01), and end-systolic wall stress (MR, 26 to 42 x 10(3)
  dynes/cm(2); AS, 37 to 22 x 10(3) dynes/cm(2); both, p < 0.01). Ejection efficiency
  improved for MR patients (0.69 +/- 0.26 to 1.0 +/- 0.15; p < 0.05). The 20-month
  data showed improved New York Heart Association functional class, normal resting
  ejection fraction, and normal exercise response for both groups. Conclusions. Early
  after operation, a significant change in left ventricular load was seen with correction
  of MR and AS. Data obtained late after operation showed improvement consistent
  with ventricular remodeling
Keywords:                                             afterload/cardiac/efficiency/ejection
  fraction/exercise/function/functional/humans/left         ventricular/left    ventricular
  function/left ventricular performance/mechanics/mitral regurgitation/MR/New
  function/VOLUME/wall/WALL STRESS
Bojar, R.M., Payne, D.D., Murphy, R.E., Schwartz, S.L., Belden, J.R., Caplan, L.R. and
  Rastegar, H. (1996), Surgical treatment of systemic atheroembolism from the
  thoracic aorta. Annals of Thoracic Surgery, 61 (5), 1389-1393.
Abstract: Background. Surgical procedures performed exclusively for atheroembolic
  events arising from the thoracic aorta rarely have been reported. Presented here are 2
  patients who underwent successful operation for these problems. Methods. The
  clinical presentation, diagnostic evaluation, and surgical approach to 2 patients with
  different embolic sources in the thoracic aorta are presented. One patient had
  experienced three strokes and was noted by multiplane transesophageal
  echocardiography to have protruding atheromas with ulcerations in the transverse
  arch and origin of the brachiocephalic vessels. The transverse arch was replaced
  using hypothermic circulatory arrest with individual reimplantation of the
  brachiocephalic vessels. The second patient presented with ''blue toe'' syndrome from
  mobile atheromas in the mid-descending thoracic aorta defined by transesophageal
  echocardiography. A localized debridement was performed using simple aortic
  cross-clamping. Results. Both patients had uneventful postoperative courses and had
  no further atheroembolic events. Conclusions. When standard diagnostic modalities
  do not delineate an embolic source for either stroke or peripheral embolization,
  transesophageal echocardiography is recommended as an excellent means of
  identifying atheromas in the thoracic aorta that could be the source for emboli. Once
  these lesions are identified, a surgical procedure should be performed to prevent
  further embolization
Keywords:              aorta/ARCH/ASCENDING                  AORTA/CIRCULATORY
  sources/embolization/ENGLAND/evaluation/hypothermic                         circulatory
Westaby, S., Johnsson, P., Parry, A.J., Blomqvist, S., Solem, J.O., Alling, C., Pillai, R.,
  Taggart, D.P., Grebenik, C. and Stahl, E. (1996), Serum S100 protein: A potential
  marker for cerebral events during cardiopulmonary bypass. Annals of Thoracic
  Surgery, 61 (1), 88-92.
Abstract: Background. There is no simple method to determine the incidence or severity
  of brain injury after a cardiac operation. A serum marker equivalent to cardiac
  enzymes is required. S100 protein leaks from the cerebrospinal fluid to blood after
  cerebral injury. We sought to determine the pattern of release after extracorporeal
  circulation (ECC). Methods. Thirty-four patients without neurologic problems
  underwent coronary bypass using ECC. Four had carotid stenoses. Nine others
  underwent coronary bypass without ECC. Serum S100 levels were measured before,
  during, and after the operation. Results. S100 was not detected before sternotomy.
  Postoperative levels of S100 were related to duration of perfusion (r = 0.89, p <
  0.001). Patients who did not have ECC had undetectable or fractionally raised levels
  except in 1 who suffered a stroke. No patient in whom ECC was used suffered an
  event, but those with carotid stenoses had greater S100 levels. Conclusions. S100
  protein leaks into blood during ECC and may reflect both cerebral injury and
  increased permeability of the blood brain barrier. S100 is a promising marker for
  cerebral injury in cardiac surgery if elevated levels can be linked with clinical
Keywords:                                             blood/BLOOD-FLOW/brain/brain
Cohn, L.H., Rizzo, R.J., Adams, D.H., Aranki, S.F., Couper, G.S., Beckel, N. and
  Collins, J.J. (1996), Reduced mortality and morbidity for ascending aortic aneurysm
  resection regardless of cause. Annals of Thoracic Surgery, 62 (2), 463-468.
Abstract: Background. This study was done to answer the question, ''What is the current
  risk of resection of ascending aortic aneurysms regardless of acuity or cause?''
  Methods. One hundred fifteen consecutive patients who underwent ascending aortic
  aneurysm repair from January 1, 1990, to July 1, 1995, were retrospectively
  reviewed, excluding those with acute ascending aortic dissection. The mean age was
  59 years; 55% were male. Concomitant procedures included coronary artery bypass
  in 23 (20%) and arch repair in 12 (10%). In group 1, 54 patients had replacement of
  the aortic valve, root, and ascending aorta with a valve-graft conduit using the
  ''Bentall'' technique, and of these 19 (35%) had Marfan's syndrome. In group II, 44
  patients had separate aortic valve repair or replacement and supracoronary ascending
  aortic replacement. In group III, 17 patients had supracoronary ascending aortic
  replacement, without aortic valve operation. Operative techniques included frequent
  use of (1) intraoperative transesophageal echocardiography or epiaortic ultrasound
  scanning of the ascending and descending thoracic aorta to help guide arterial
  cannulation, avoid atherosclerotic embolization, and assess the repair; (2) antegrade
  and retrograde multidose cold blood cardioplegia for myocardial protection; (3)
  exclusion and button anastomotic techniques to ensure secure suture lines; (4)
  antifibrinolytic agents and collagen-impregnated aortic grafts to reduce bleeding; and
  (5) deep hypothermic circulatory arrest and the open distal anastomotic technique in
  patients with distal ascending and arch aortic disease. Results. Operative mortality
  overall was 2/115 (1.7%). Mortality was 1/54 (1.8) in group I and 1/44 (2%) in group
  II, and there was no mortality in group III. The overall postoperative morbidity was
  3% due to bleeding, 2% due to stroke, and 1% due to myocardial infarction. The
  length of stay in the past year has decreased to less than 7 days. Conclusions. The
  current risk for ascending aortic aneurysm repair is low (<2%) whether or not the
  aortic root or valve also needs repair, regardless of the cause of the aneurysm
Keywords:                                                  acute/age/aneurysm/aorta/aortic
  onary/coronary artery/coronary artery bypass/deep hypothermic circulatory
  ermic                 circulatory               arrest/infarction/length              of
Svensson, L.G., Sun, J.P., Cruz, H.A. and Shahian, D.M. (1996), Endarterectomy for
  calcified porcelain aorta associated with aortic valve stenosis. Annals of Thoracic
  Surgery, 61 (1), 149-152.
Abstract: Background. A calcified porcelain aorta may complicate aortic valve insertion
  and require an alternative, more complex method for valve replacement. The reason
  for this is that sutures cannot be inserted through the calcific plates in the annulus
  and ascending aorta. Methods. In 6 patients with an average age of 73.8 years (range,
  65 to 81 years), we performed the simpler procedure of aortic endarterectomy of the
  calcific plates with the aortic valve replacement. We realized that there may be an
  increased risk of postoperative complications, particularly stroke. The calcific plates
  were fractured to allow debridement of the calcium. In addition, an endarterectomy
  was performed of the left main coronary ostium in 2 patients, and 5 patients also had
  coronary artery bypass grafting performed. Results. All 6 patients underwent
  successful operations without major complications. On follow-up, echocardiography
  or computed tomographic scans in 3 patients have not shown dilation of the
  ascending aorta. Conclusion. Endarterectomy of the aorta may be an option in the
  management of patients with calcification of the aorta
Keywords:      age/aorta/aortic     valve/aortic    valve      replacement/aortic   valve
  stenosis/artery/ascending/ascending aorta/ATHEROSCLEROTIC ASCENDING
  AORTA/bypass/bypass                  grafting/calcium/complications/coronary/coronary
  artery/coronary           artery         bypass/coronary            artery       bypass
Craver, J.M., Hodakowski, G.T., Shen, Y., Weintraub, W.S., Accola, K.D., Guyton,
  R.A. and Jones, E.L. (1996), Third-time coronary artery bypass operations: Surgical
  strategy and results. Annals of Thoracic Surgery, 62 (6), 1801-1807.
Abstract: Background. Increasingly, patients are returning for a second, third, and even
  fourth coronary artery bypass graft (CABG) procedure. Methods. This report reviews
  the in-hospital and long-term outcomes for 102 patients undergoing a third or fourth
  CABG at Emery University from December 1977 to April 1994. Results. The mean
  interval from the first to second CABG was 5.2 +/- 3.5 years and from the second to
  the third CABG 6.8 +/- 4.1 years. The mean age was 60 +/- 9 years, 91% were male,
  33% had hypertension, 16% diabetes, 86% class III or IV angina (Canadian
  Cardiovascular Society), 4.4% congestive failure (New York Heart Association), and
  73% three-vessel disease. The in- hospital mortality rate was 9.8%, with a
  perioperative myocardial infarction rate of 8.8% and a stroke rate of 1.9%.
  Conclusions. These perioperative mortality and myocardial infarction rates are
  several times higher than those reported for initial revascularizations or first-time
  redo CABG operations. However, the 5- and 10-year survival rates of 79% and 59%,
  respectively, and a myocardial infarction-free survival of 62% at 5 years, the benefits
  of a third-time CABG procedure are apparent for this high-risk group of patients
  y/coronary       artery/coronary       artery      bypass/diabetes/disease/failure/high
  risk/hospital/hospital mortality/hypertension/infarction/IV/male/mortality/mortality
  rate/myocardial/myocardial                                 infarction/MYOCARDIAL
Magovern, G.J. and Simpson, K.A. (1996), Clinical cardiomyoplasty: Review of the ten
  year United States experience. Annals of Thoracic Surgery, 61 (1), 413-419.
Abstract: Background. Clinical trials of dynamic cardiomyoplasty were pioneered at
  Allegheny General Hospital beginning in September 1985. Data from 9 years of
  experience with the procedure at this institution and more recent data from newer
  cardiomyoplasty centers have been analyzed for outcome analysis and future trends.
  Methods. Each patient underwent a cardiomyoplasty procedure using the left or right
  latissimus dorsi muscle. Thirty-four patients were studied at Allegheny: 5 patients
  implanted with dual chamber pacemakers as single stimulus myostimulators, 11
  patients composing the phase I Food and Drug Administration trial of the Medtronic
  burst myostimulator, and 18 patients entered in the phase II Medtronic trial. Patients
  from seven additional centers entered the phase II trial in 1991. Fifty-seven patients
  completed follow-up studies to 1 year after operation in this trial. Results. Operative
  mortality was 5/57 (11%) in the American phase II group and 5/34 (15%) in the
  Allegheny group (1/18, 6% for Allegheny phase II). Nineteen patients (19/57, 33%)
  from the combined phase II population died in the first year, and 10/34 (29%) in the
  Allegheny study. The predominant cause of postdischarge death was arrhythmia
  (12/19, 63% American; 7/10, 70% Allegheny). In all groups significant improvement
  was seen in quality of life and functional class. Phase II patients demonstrated
  significant increases in ejection fraction and stroke work. Conclusions. Failure to
  sustain improvement and arrhythmia-related death are complex challenges for this
  procedure; however, realistic solutions have been proposed and are under
Keywords:                            analysis/arrhythmia/cardiomyoplasty/death/ejection
  fraction/FAILURE/follow                                        up/follow-up/follow-up
   uality of life/SCIENCE/SKELETAL-MUSCLE/stroke/stroke work/trials/United
Odell, J.A., Blackshear, J.L., Davies, E., Byrne, W.J., Kollmorgen, C.F., Edwards, W.D.
   and Orszulak, T.A. (1996), Thoracoscopic obliteration of the left atrial appendage:
   Potential for stroke reduction? Annals of Thoracic Surgery, 61 (2), 565-569.
Abstract: Background. In a review of all relevant articles describing the site of left atrial
   thrombus in patients with atrial fibrillation, the thrombus was localized to the left
   atrial appendage in 43% of patients with rheumatic heart disease and in 91% of
   patients with nonrheumatic atrial fibrillation. This study was designed to test the
   feasibility of thoracoscopic obliteration of the left atrial appendage as a means of
   reducing thromboembolic stroke. Methods. Thoracoscopic obliteration of the left
   atrial appendage was undertaken in 10 dogs, 5 with staples and 5 with an endoloop.
   Obliteration also was attempted in 8 fresh human cadavers. Results. In all dogs, the
   appendage was rapidly obliterated (21.3 +/- 7.6 minutes) and confirmed at euthanasia
   at 11 weeks. In 3 cadavers, anatomic and disease factors prevented visualization of
   the left atrial appendage; in 1 the appendage tore, and in the remainder the appendage
   was obliterated. Conclusions. Obliteration of the left atrial appendage is feasible and
   may be considered as an additional surgical procedure to reduce stroke. The group of
   patients in whom it offers the greatest potential are those with atrial fibrillation
   deemed ineligible for warfarin, those without atrial thrombus and with a free
   pericardial and pleural space
Keywords:        1ST/atrial/atrial    fibrillation/disease/dogs/FIBRILLATION/heart/heart
   disease/human/left                  atrial              appendage/left              atrial
Hill, R.C., Jones, D.R., Vance, R.A. and Kalantarian, B. (1996), Selective lung
   ventilation during thoracoscopy: Effects of insufflation on hemodynamics. Annals of
   Thoracic Surgery, 61 (3), 945-948.
Abstract: Background. Positive-pressure insufflation during thoracoscopy has been
   advocated by some authors to facilitate exposure of the intrathoracic structures by
   expediting collapse of the lung. We hypothesized that insufflation during
   thoracoscopy may result in hemodynamic compromise despite selective lung
   ventilation. Methods. After placement of invasive monitoring lines, six adult swine
   underwent selective lung ventilation and thoracoscopy. Baseline measurements of
   hemodynamic indices were taken before selective lung ventilation. The right lung
   then was collapsed; data were obtained at insufflation pressures up to 10 mm Hg and
   were compared with baseline values using Student's t test. Results. Cardiac index,
   mean arterial pressure, and left ventricular stroke work index decreased, whereas
   pulmonary artery and central venous pressures increased (p < 0.05) at insufflation
   pressures of 5 mm Hg and greater. Conclusions. Positive-pressure insufflation during
   thoracoscopy resulted in significant hemodynamic compromise despite the use of
   selective lung ventilation. Conversion to thoracotomy may be an alternative if
   positive-pressure insufflation is necessary to perform the thoracoscopic procedure
Keywords:                   adult/arterial/arterial              pressure/artery/ASSISTED
   ventricular/left              ventricular              stroke            work/lung/mean
   artery/PULMONARY-DISEASE/SCIENCE/stroke/stroke work/test/ventilation/work
Rao, V., Todd, T.R.J., Weisel, R.D., Komeda, M., Cohen, G., Ikonomidis, J.S. and
  Christakis, G.T. (1996), Results of combined pulmonary resection and cardiac
  operation. Annals of Thoracic Surgery, 62 (2), 342-346.
Abstract: Background. Concomitant lesions of the heart and lung are uncommon, but
  when present they pose a therapeutic challenge for thoracic surgeons. A combined
  procedure avoids the need for a second major thoracic procedure and may improve
  outcomes and provide economic benefit. However, cardiopulmonary bypass may
  adversely affect the natural history of pulmonary malignancies. Methods. The
  clinical records of 30 patients were reviewed who underwent simultaneous lung
  resection and cardiac operations between January 1982 and July 1995. Follow-up
  was obtained on all 30 patients (mean follow-up, 22 months; range, 1 to 100 months).
  Results. Twenty-four patients underwent coronary artery bypass grafting in
  conjunction with pulmonary resection. Six patients underwent aortic (n = 4) or mitral
  (n = 2) valve replacement, The pulmonary resections consisted of pneumonectomy (n
  = 3), lobectomy (n = 14), wedge excision (n = 12), and tracheal resection (n = 1).
  Twenty-one patients had pathologic findings that confirmed adenocarcinoma (n =
  10), squamous cell carcinoma (n = 5), small cell carcinoma (n = 2), or other
  malignancy (n = 4). Tumor stage of primary lung cancers was stage I, n = 12; stage II,
  n = 3; and stage IIIa, n = 2. Pathologic examination revealed benign disease in 9
  patients. There were two operative deaths, one due to aspiration and one due to
  stroke, There were three late deaths, two cardiac and one of metastatic disease.
  Overall late survival was 85% +/- 7% and 73% +/- 16% at 1 and 5 years, respectively.
  Actuarial survival for patients with malignant disease was 64% at 5 years.
  Conclusions. Simultaneous cardiac operation and lung resection was not associated
  with increased early or late morbidity or mortality. Cardiopulmonary bypass does not
  adversely affect survival in patients with malignant disease. Cardiac valve
  replacement can be performed safely in conjunction with pulmonary resection
Keywords:                                                artery/aspiration/bypass/bypass
  BYPASS/COMPLEMENT ACTIVATION/coronary/coronary artery/coronary artery
  bypass/coronary              artery            bypass           grafting/disease/follow
  gnant/MEDIAN                              STERNOTOMY/morbidity/mortality/natural
Holman, W.L., Murrah, C.P., Ferguson, E.R., Bourge, R.C., McGiffin, D.C. and Kirklin,
  J.K. (1996), Infections during extended circulatory support: University of Alabama at
  Birmingham experience 1989 to 1994. Annals of Thoracic Surgery, 61 (1), 366-371.
Abstract: Background. The University of Alabama at Birmingham experience with
  investigational ventricular assist devices (VADs) used as a bridge to transplantation
  has increased over the past several years; it now includes 27 VAD implantations with
  13 VAD runs lasting for extended periods tie, >30 days). A review of complications
  experienced by patients during extended VAD runs is warranted before the further
  development and testing of chronically implanted mechanical circulatory support
  devices. Methods. This study focuses on the infectious complications of extended
  VAD support; it includes 13 patients who were supported by either a Thoratec or
  HeartMate VAD for longer than 30 days pending cardiac transplantation. Infection
  was defined as any positive culture. The infections were classed according to site and
  severity as follows: class I were patient-related non-blood-borne infections, class II
  were blood-borne infections, class III were VAD percutaneous site infections, and
  class IV were infections of the blood-contacting surfaces or intracorporeal
  components of the VAD. Results. The 8 Thoratec and 5 HeartMate patients were
  supported for a total of 1,648 days with a range of 33 to 279 days per patient. Every
  patient had at least one infection; however, there were 6 patients who had no class II
  or IV infections during the period of support. One of these 6 patients died of a stroke,
  whereas the other 5 patients survived VAD support. No trends were identified for a
  change in the incidence of bacterial compared with fungal infections during the
  course of VAD support. There was no trend for a greater number of infections in
  patients who died during VAD support compared with those who survived. Neither
  class II nor IV infections precluded transplantation. Three patients died during VAD
  support; 1 died as a direct consequence of fungal infection. Eight patients received
  transplants. One patient had an unanticipated recovery of cardiac function and the
  VAD was removed. Support in 1 patient is ongoing. Conclusions. Infection during
  VAD support pending cardiac transplantation is an important cause of morbidity and
  mortality in patients maintained for longer than 30 days by circulatory assist.
  Infectious complications will probably be a prominent component of the risk
  associated with the use of chronically implanted mechanical circulatory assist
  devices and will likely have an important effect on the quality of life experienced by
  these patients
Keywords:              bacterial/BRIDGE/cardiac/cardiac              function/CARDIAC
  on/intracorporeal/IV/MICROBIAL             ADHESION/morbidity/morbidity              and
  mortality/mortality/NEW-YORK/quality                                                   of
  INTEGRATION/total/transplantation/VENTRICULAR                                   ASSIST
  DEVICE/ventricular assist devices
Griffith, B.P., Kormos, R.L., Nastala, C.J., Winowich, S. and Pristas, J.M. (1996),
  Results of extended bridge to transplantation: Window into the future of permanent
  ventricular assist devices. Annals of Thoracic Surgery, 61 (1), 396-398.
Abstract: Background. There is interest in expanding ventricular assist device use from
  short-term bridging to transplantation to long- term and permanent support. Methods.
  We have reviewed the outcome of 162 patients who had a mechanical bridge to
  transplantation that lasted at least 60 days. Eighty-five patients received the
  HeartMate, 40 the Novacor, and 37 the Thoratec device. Results. Of the 162 patients,
  125 received transplants, and 115 survived after transplantation (93%). Within the
  group there were 174 complications including 54 infections of the driveline, 73 other
  infections, and thromboembolic strokes in 47. Infections of the driveline were
  considered major in 24 of 54 cases, and other infections were major in 36 of 73 cases.
  Twenty-seven of those who sustained thromboembolic events had residual effects.
  Of 11 patients with a major stroke and infection, only 1 survived transplantation.
  Eighty-two patients were supported between 60 and 100 days, 63 patients between
  101 and 200 days, 12 patients between 201 and 300 days, and only 5 patients in
  excess of 300 days. A greater percentage of candidates died waiting between 101 and
  200 days than between 60 and 100 days (25% versus 10%). The incidence of
  complications also rose in those patients bridged more than 100 days. Conclusions.
  The data reinforce the excellent results obtained in the bridge to transplantation trials
  that reported a shorter duration of support. For those interested in extended bridge to
  transplantation or permanent use of the currently available devices, the results
  suggest reasonable success can be anticipated, but the serious infections and strokes
  tend to be more common with longer duration of support
  ansplantation/trials/ventricular assist devices
Shahian, D.M., Williamson, W.A., Svensson, L.G., Restuccia, J.D. and DAgostino, R.S.
  (1996), Applications of statistical quality control to cardiac surgery. Annals of
  Thoracic Surgery, 62 (5), 1351-1358.
Abstract: Background. Although originally developed for use in manufacturing,
  statistical quality control techniques may be applicable to other frequently performed,
  standardized processes. Methods. We employed statistical quality control charts ((X)
  over bar - s, p, and u) to analyze perioperative morbidity and mortality and length of
  stay in 1,131 nonemergent, isolated, primary coronary bypass operations conducted
  within a 17-quarter time period. Results. The incidence of the most common adverse
  outcomes, including death, myocardial infarction, stroke, and atrial fibrillation,
  appeared to follow the laws of statistical fluctuation and were in statistical control.
  Postoperative bleeding, leg-wound infection, and the summation of total and major
  complications were out of statistical control in the early quarters of the study period
  but showed progressive improvement, as did postoperative length of stay.
  Conclusions. The incidence of morbidity and mortality after primary, isolated,
  nonemergent coronary bypass operations may be described by standard models of
  statistical fluctuation. Statistical quality control may be a valuable method to analyze
  the variability of these adverse postoperative events over time, with the ultimate goal
  of reducing that variability and producing better outcomes
Keywords:               atrial/atrial            fibrillation/bleeding/bypass/cardiac/cardiac
  on/length                of             stay/models/morbidity/morbidity                  and
Shibata, Y., Abe, T., Kuribayashi, R., Sekine, S., Seki, K., Yamagishi, I. and Chanda, J.
  (1996), Surgical treatment of isolated secundum atrial septal defect in patients more
  than 50 years old. Annals of Thoracic Surgery, 62 (4), 1096-1099.
Abstract: Background. Arrhythmia-related thromboembolic accidents continue to occur
  in patients even after closure of secundum atrial septal defect. Older age is usually
  not a contraindication to the repair of an atrial septal defect. To assess the importance
  of the type of management in elderly patients with atrial septal defect our clinical
  experience is reviewed. Methods. Between 1974 and 1994, 49 patients 50 years of
  age or older (average, 57.4 years) underwent surgical closure of secundum atrial
  septal defect. All patients have been followed up for 2 to 21 years (mean, 9.7 years).
  Results. There were no operative deaths. Functional classes in most of the patients
  were improved after operation. There were two cerebrovascular thromboembolic
  accidents with one permanent neurologic dysfunction, hemiparesis, and one septal
  dehiscence in the early postoperative period. One patient (2%) died of renal failure 6
  years after operation, late arrhythmias developed in 3 patients (6%), 3 patients had a
  late stroke (6%), and 1 patient was not available for follow-up. Conclusions.
  Long-term operative results are satisfactory and beneficial to the quality of life in
  elderly patients. Because there is no safe and effective nonsurgical alternative to
  surgical closure, atrial septal defect repair in elderly patients without severe
  pulmonary vascular disease should not be delayed once the diagnosis had been made
Keywords:                    ADULTS/AGE/arrhythmias/atrial/atrial                        septal
  defect/cerebrovascular/diagnosis/disease/elderly/elderly             patients/failure/follow
   perative/pulmonary/quality                        of                     life/renal/renal
   failure/REPAIR/SCIENCE/stroke/treatment/vascular/vascular disease
Hilgenberg, A.D., Akins, C.W., Logan, D.L., Vlahakes, G.J., Buckley, M.J., Madsen,
   J.C. and Torchiana, D.F. (1996), Composite aortic root replacement with direct
   coronary artery implantation. Annals of Thoracic Surgery, 62 (4), 1090-1095.
Abstract: Background. Composite aortic root replacement is accepted treatment for
   aneurysms of the ascending aorta involving the root with aortic valve regurgitation,
   but controversy continues regarding the best technique of operation. We excise the
   aneurysm, implant a composite valve graft, directly attach the coronary arteries to the
   aortic graft, and make the distal anastomosis to the divided aorta. Methods. We
   reviewed the records and collected complete follow-up data on 110 consecutive
   patients having composite aortic root replacement with this technique from 1979 to
   1995. Results. Average age was 54 years. Marfan's syndrome was present in 22
   patients, acute dissections in 26, chronic dissections in 11, and active endocarditis in
   13. Operative characteristics were: 25 emergency procedures, 33 urgent procedures,
   52 elective procedures, 24 reoperations, and 19 with coronary artery bypass grafting.
   Hospital death occurred in 8 patients (7.3%). Multivariate predictors of hospital
   death were postoperative renal failure and acute dissection. Actuarial survival was
   70% at 10 years (standard error, 5%). Multivariate predictors of total mortality were
   porcine valve, Bork-Shiley valve, preoperative stroke, reoperation on a composite
   valve graft, and coronary artery bypass grafting. Only 3 patients required late
   reoperation, all for valve dysfunction. Actuarial freedom from reoperation on the
   aortic root was 97.3% (standard error, 1.9%) at 10 years. Late echocardiograms in 47
   patients showed no anastomotic aneurysms. Conclusions. Composite aortic root
   replacement with direct coronary implantation is effective and durable treatment for
   a variety of aortic pathologic conditions in elective and emergency situations
Keywords:                  acute/acute                dissection/age/aneurysm/aorta/aortic
   valve/APROTININ/arteries/artery/ascending/ASCENDING AORTA/bypass/bypass
   grafting/chronic/coronary/coronary artery/coronary artery bypass/coronary artery
Chaillou, P., Bizouarn, P., Patra, P., Noel, S.F., Sellier, E. and Chabbert, C. (1996),
   Arterial pressure and neurologic morbidity during carotid surgery under peridural
   anesthesia. Annals of Vascular Surgery, 10 (3), 228-232.
Abstract: In 163 carotid reconstructions under peridural anesthesia performed from
   1988 to 1991, we routinely measured residual systemic and carotid artery pressure
   during clamping. Seventy- nine patients (48.5%) were asymptomatic and 84 (51.5%)
   had a history of neurologic manifestations in the form of transient ischemic attacks
   (28%) or stroke (13.5%). None of the patients died perioperatively. Eight patients
   (4.9%) had strokes, with complete recovery in five. A shunt was placed in 22 patients
   (13.5%) because of neurologic evidence that carotid clamping was poorly tolerated.
   This study showed a distinct association between residual pressure in the internal
   carotid artery and systemic arterial pressure and intraoperative neurologic morbidity.
   Using a cutoff value of 35 mm Hg for residual pressure, the sensitivity was 77% and
   specificity 81%. Using a cutoff of 80 mm Hg, the sensitivity was 60% and specificity
  86%. There was no correlation between mean systemic arterial pressure and residual
  carotid artery pressure. The use of a shunt was the only factor with predictive value
  for postoperative neurologic complications. These findings suggest that measurement
  of systemic arterial pressure and residual carotid artery pressure is useful during
  carotid surgery, but further study is needed before this information can be
  extrapolated to carotid surgery under general anesthesia
Keywords:                                                  1988/anesthesia/arterial/arterial
  eneral/history/internal/internal                 carotid/internal                  carotid
Sullivan, T.M. (1996), Subclavian-carotid bypass to an ''isolated'' carotid bifurcation: A
  retrospective analysis. Annals of Vascular Surgery, 10 (3), 283-289.
Abstract: Most patients with occlusion of the common carotid artery will have
  concomitant occlusion of the internal and external carotid arteries. A few, however,
  will maintain antegrade internal carotid flow via retrograde flow from the ipsilateral
  external carotid artery. These patients remain at risk for hemispheric transient
  ischemic attacks (TIAs), ischemic stroke, or vertebrobasilar insufficiency/global
  cerebral ischemia. Historically, diagnosis of this condition has relied on cerebral
  arteriography and/or blind exploration of the carotid bifurcation. More recently,
  color-enhanced duplex ultrasonography has been used to facilitate the diagnosis and
  has allowed focused, delayed arteriographic views of the appropriate carotid
  bifurcation, making blind exploration unnecessary. From 1985 to 1994, nine patients
  with TIAs (n = 5), completed stroke with minimal residual deficit (n = 2), or
  vertebrobasilar insufficiency (n = 2) were found to have occlusion of the common
  carotid artery with a patent carotid bifurcation on duplex ultrasound images. All nine
  had this particular anatomic condition confirmed by arteriography and were
  subsequently treated by subclavian-carotid bypass using autologous reversed
  saphenous vein (n = 5) or synthetic (n = 4) grafts. Five of nine patients required
  concomitant bifurcation endarterectomy. There were no perioperative strokes or
  TIAs and no operative deaths. Six of eight survivors remain asymptomatic at 1 to 92
  months' follow-up (mean 37.1 months). Symptomatic patients with occluded
  common carotid arteries and patent bifurcations can be treated surgically with low
  operative morbidity and good long-term results
Keywords:              analysis/AORTIC-ARCH/arteries/arteriography/artery/ARTERY
  OCCLUSION/bypass/carotid/carotid            arteries/carotid      artery/cerebral/cerebral
  ischemia/common                                                                    carotid
  up/follow-up/internal/internal           carotid/ipsilateral/ischemia/ischemic/ischemic
  RUCTION/risk/stroke/SURGICAL-MANAGEMENT/transient/transient ischemic
  attacks/ultrasonography/ultrasound/VASCULAR/vertebrobasilar insufficiency
Cacoub, P., Koskas, F., Timsit, S., Maistre, G., Gatel, A., Piette, J.C., Godeau, P.,
  Carayon, A. and Kieffer, E. (1996), Decrease in internal jugular endothelin levels
  after carotid cross-clamping during human carotid revascularization procedures.
  Annals of Vascular Surgery, 10 (3), 239-243.
Abstract: Endothelin-1 (ETL-1), a peptide recently isolated from vascular endothelial
  cells, acts in cerebral arteries in vitro as a potent and long-lasting vasoconstrictor and
  has been implicated in the development of cerebral vasospasm. To ascertain whether
  this new vasoconstrictor has any effect on regulation of the cerebral circulation, we
  measured plasma ETL-1 concentrations in patients undergoing carotid
  revascularization and attempted to correlate the variations of venous and arterial
  plasma ETL-1 with the characteristics of the procedure, including cerebral
  vasospasm. We prospectively studied 11 patients undergoing a total of 14 carotid
  surgical revascularization procedures (12 endarterectomies, 2 polytetrafluoroethylene
  bypass grafts from the common to the internal carotid arteries). Before carotid
  cross-clamping, blood samples were drawn from the internal jugular vein and the
  healthy common carotid artery proximal to the occlusive lesion to be treated. After
  endarterectomy, blood samples were withdrawn from the internal, external, and
  common carotid arteries. After the release of the last clamp, a final aliquot of blood
  was withdrawn from the internal jugular vein. After plasma extraction on a C2-ethyl
  microcolumn, plasma endothelin-like immunoreactivity was measured by means of
  radioimmunoassay with a polyclonal antibody. In 9 of the 11 patients, internal
  jugular vein ETL-1 concentration decreased statistically significantly after carotid
  artery crossclamping (4.2 +/- 1.4 pg/ml vs. 3.9 +/- 1.1 pg/ml; p < 0.05). In the 2
  patients in whom ETL-1 levels failed to drop, a shunt was used during the procedure
  in 1, and the other was the only patient who had an ipsilateral ischemic postoperative
  stroke. The decrease in internal jugular vein ETL-1 concentration failed to correlate
  with any of the cross-clamping times. The level of arterial blood ETL-1 remained
  steady in the common carotid artery before and after crossclamping (4.5 +/- 1.5
  pg/ml vs. 4.6 +/- 0.9 pg/ml). A small, nonsignificant decrease in ETL-1 level was
  noted in the external and internal carotid arteries after cross-clamping. The decrease
  in internal jugular vein ETL-1 levels may in part reflect a compensatory response to
  carotid artery cross-clamping, which could limit the reduction of local cerebral blood
Keywords: antibody/arterial/arteries/artery/blood/blood flow/bypass/carotid/carotid
  arteries/carotid      artery/CELLS/cerebral/cerebral          arteries/cerebral     blood
  flow/CEREBRAL                     VASOSPASM/circulation/common                     carotid
  ion/small/stroke/total/vascular/VASOCONSTRICTOR PEPTIDE/vasospasm
Granke, K., Abraham, F.M. and McDowell, D.E. (1996), Vena cava filter-disruption
  and central migration due to accidental guidewire manipulation: A case report.
  Annals of Vascular Surgery, 10 (1), 49-53.
Abstract: Vena cava filters are now widely used as a safe and effective means of
  reducing the risk of pulmonary embolus in patients hospitalized with acute stroke or
  trauma. We report a case of traumatic disruption of a vena cava filter resulting from
  guidewire manipulation with migration of the main structure to the heart after
  successful initial placement of the filter
Keywords: acute/acute stroke/case report/embolus/heart/KIMRAY-GREENFIELD
Ruby, S.T., Robinson, D., Lynch, J.T. and Mark, H. (1996), Outcome analysis of
  carotid endarterectomy in Connecticut: The impact of volume and specialty. Annals
  of Vascular Surgery, 10 (1), 22-26.
Abstract: The purpose of this study was to define the relationship between the surgeon's
  operative experience and specialty and the postoperative morbidity and mortality of
  carotid endarterectomy. All patients undergoing carotid endarterectomy (code
  ICD-9CM 38.12) in Connecticut between October 1985 and September 1991 were
  retrospectively identified. A total of 3997 carotid endarterectomies were performed
  by 226 surgeons in four specialties: general, cardiac, vascular, and neurosurgery.
  Individual surgeon volume ranged from fewer than one per year to 27.5 per year
  (mean 2.9 carotid endarterectomies per year). Outcome was measured as a combined
  stroke and/or death percentage. The average combined stroke and/or death rate for
  the entire group was 4.9%. The combined stroke and/or death percentage was
  influenced significantly by the surgeon's annual volume. Surgeons who performed
  one or fewer carotid endarterectomies (43% of total surgeons) were 2.5 times more
  likely (p < 0.002) to have a poor postoperative outcome than those wile performed 10
  or more per year (9.3% of total surgeons). Overall there was a statistically significant
  correlation between a surgeon's annual volume and outcome, particularly for general
Keywords:                                                   analysis/cardiac/carotid/carotid
  neral/MEDICAL/morbidity/morbidity                                                     and
Giangola, G., Migaly, J., Riles, T.S., Lamparello, P.J., Adelman, M.A., Grossi, E.,
  Colvin, S.B., Pasternak, P.F., Galloway, A., Culliford, A.T., Esposito, R., Ribacove,
  G., Crawford, B.K., Glassman, L., Baumann, G. and Spencer, F.C. (1996),
  Perioperative morbidity and mortality in combined vs. staged approaches to carotid
  and coronary revascularization. Annals of Vascular Surgery, 10 (2), 138-142.
Abstract: Between 1986 and 1994 we identified 57 patients who underwent carotid
  endarterectomy (CEA) and coronary artery bypass grafting (CABG) during the same
  hospitalization. Simultaneous CABG and CEA was performed in 28 patients (mean
  age 70.5 years, 58% male). Indications for CABG in these patients were myocardial
  infarction in two, crescendo angina in 19, congestive heart failure in two and left
  main or triple-vessel coronary artery disease noted during carotid preoperative
  evaluation in five, Indications for CEA were transient ischemic attack (TIA) in 12,
  crescendo TIA in six, cerebrovascular accident (CVA) in five, and asymptomatic
  stenosis in five. There were no postoperative myocardial infarctions or perioperative
  deaths. Two patients developed atrial fibrillation, and four patients had CVAs (two
  were ipsilateral to the side of CEA). Twenty-nine patients underwent staged
  procedures (i.e., not performed concomitantly but during the same hospitalization),
  Indications for CABG and CEA were comparable to those in the group undergoing
  simultaneous procedures. In 17 patients CEA was performed before CABG. There
  was a single CVA, the result of an intracerebral hemorrhage. Five of the 17 patients
  had a myocardial infarction and two died; one patient had first-degree heart block
  requiring a pacemaker. Four additional patients developed atrial fibrillation, one of
  whom required cardioversion. The remaining 12 patients had CABG followed by
  CEA. There were no CVAs, myocardial infarctions, arrhythmias, or deaths in this
  subgroup. These data demonstrate that the performance of simultaneous CABG and
  CEA procedures is associated with increased neurologic morbidity (14.3%), both
  ipsilateral and contralateral to the side of carotid surgery in contrast to staged CABG
  and CEA (3.4%), In addition, when staged carotid surgery preceded coronary
  revascularization in those with severe coronary artery disease, the combined cardiac
   complication and mortality rate was significantly higher than when coronary
   revascularization preceded CEA. This evidence suggests that when CABG and CEA
   must be performed during the same hospitalization, the procedures should be staged
   with CABG preceding CEA
Keywords:        1ST/age/angina/arrhythmias/artery/ARTERY              DISEASE/atrial/atrial
   accident/complication/COMPLICATIONS/congestive/congestive                           heart
   failure/coronary/coronary artery/coronary artery bypass/coronary artery bypass
   grafting/coronary                          artery                       disease/coronary
   /heart/heart failure/hemorrhage/hospitalization/infarction/intracerebral/intracerebral
   hemorrhage/ipsilateral/ischemic/male/MEDICAL/morbidity/morbidity                     and
   mortality/mortality/mortality                                 rate/myocardial/myocardial
   ascularization/RISK/STENOSIS/STROKE/surgery/TIA/transient/transient ischemic
Liau, C.T., Yang, T.S., Wang, C.H. and Hsueh, S. (1996), Intra-abdominal desmoplastic
   small cell tumors: Report of two cases. Anti-Cancer Drugs, 7 (2), 228-232.
Abstract: Two young adults that presented with intra-abdominal desmoplastic small cell
   tumors (DSCT) without any evidence of a primary site are described. Both cases
   share the clinical characteristic features of this rare tumor which include predominant
   intra-abdominal location as initial presentation, nesting pattern of growth, intense
   desmoplastic reaction, immunohistochemical reactivity for epithelial, neural and
   muscle markers, and highly aggressive behavior, Aggressive chemotherapy with a
   cisplatin-containing regimen was the main therapy to our patients, Up to the present,
   both cases are alive with disease, The survival is 18 and 15 months from the initial
   diagnosis, respectively, Interestingly, one of the cases encountered an episode of
   cerebral infarction at the territory of the left middle cerebral artery 12 days after the
   first cycle of chemotherapy, This is a previously unrecognized manifestation for this
   tumor type, This causal relationship between chemotherapy and an acute vascular
   event is the most likely explanation for our patient's stroke
   relationship/cerebral/cerebral                                            artery/cerebral
   minal          desmoplastic         small         cell       tumor/INTRAVASCULAR
   COAGULATION/middle/middle                                                        cerebral
   LAR-CANCER/therapy/tumor/vascular/VINBLASTINE/young adults
Dantendorfer, K., Amering, M., Prayer, D., Maierhofer, D., Schnider, P. and Katschnig,
   H. (1996), Treatment of Koro and panic attacks after stroke. Anxiety, 2 (1), 53-55
Keywords:               anticonvulsant/ANXIETY/DISORDER/Koro/NEW-YORK/panic
Denes, G., Perazzolo, C., Piani, A. and Piccione, F. (1996), Intensive versus regular
   speech therapy in global aphasia: A controlled study. Aphasiology, 10 (4), 385-394.
Abstract: A controlled study of the comparative efficacy of intensive (daily) versus
   regular (three treatments weekly) speech therapy treatment in a group of global
   aphasics of vascular origin is reported. Application of psychometric single-case
   analysis showed that the number of patients reaching a significant improvement in all
   language modalities was greater in the intensive therapy group
Keywords: analysis/aphasia/CT SCAN/efficacy/ENGLAND/EVOLUTION/global
Petheram, B. (1996), Exploring the home-based use of microcomputers in aphasia
   therapy. Aphasiology, 10 (3), 267-282.
Abstract: The results of an investigation involving the installation of a
   microcomputer-based aphasia treatment system in the homes of 10 dysphasic stroke
   victims are reported. This study is a follow- up to a previous investigation and aims
   to explore issues raised by those outcomes. The design of the computer system was
   changed to address concerns about poor matching of material to the abilities of the
   subjects. This was done by monitoring each subject's performance while using the
   system, and by automatically varying the level of difficulty of the material
   accordingly. In addition, the treatment material was especially written for this system,
   whereas the computer system in the earlier study used exercises adapted from
   aphasia textbooks. The results offer further evidence of the feasibility of this mode of
   treatment and of patients' willingness to engage in it. The distribution of patient
   effort across the material in this system was much more even than in the earlier trials,
   suggesting that the strategy of dynamic matching of difficulty is effective. There was
   wide variation in performance change among subjects on system-administered tasks
   which was not reflected in standardized language measures
Keywords:                                   aphasia/design/distribution/ENGLAND/follow
Fujii, T. and Watanabe, S. (1996), Feedback positioning cantilever using lead zirconate
   titanate thin film for force microscopy observation of micropattern. Applied Physics
   Letters, 68 (4), 467-468.
Abstract: An atomic force microscope cantilever with PZT thin film with pyramidal
   stylus was used for actuation of feedback motion. The maximum stroke of the
   cantilever was more than 1 mu m within a frequency range from direct current up to
   natural resonant frequency, e.g., 28.48 kHz. An image of a pit of a compact disk with
   a depth of 100 nm was successfully obtained using only cantilever actuation in a
   vertical direction. (C) 1996 American Institute of Physics
Keywords: CIRCULATION/direct current/feedback/force/image/lead/PHYSICS/stroke
Qirko, S., Tase, M., Lushnjari, V. and Sinjari, T. (1996), Left atrial contractility
   function in arterial hypertension. Archives des Maladies du Coeur et des Vaisseaux,
   89 (8), 1003-1007.
Abstract: The purpose of this study was the assessment of the left systolic atrial function
   (LSAF) in 43 hypertensive subjects (HS) with left Ventricular hypertrophy (LVH).
   (LV mass index) (LVMI) (> 134 g/m(2) for men, 110 g/m(2) for women) and in 32
   normal subjects (NS). The both groups were matched for age, body surface, heart
   rate and LV fractional shortening. Left atrial volume (LAV) was calculated by the
   formula : LAV = 8 A(1) x A(2)/3 pi 1 in which A(1) is the area of the four- chamber
   view, A(2) is the area of the two-chamber view and L is common length in the two
   views. The atrial function contractility was evaluated by the following parameters: 1.
   LA stroke volume (LASV) = LAV - LAMV where LAV is the volume before atrial
   systole and LAMV is the LA minimal volume. 2, LA ejection fraction (LAEF) =
   LASV/LAV. 3. Atrial ejection force (AEF) = peak A/MOA in which peak A wave is
   the maximal late diastolic velocity and MOA is the mitral orifice area. 4. Atrial
   transport (AT) = A/M in which M area is under the mitral velocity curve and A-area
   under the late diastolic velocity curved assessed by Doppler echo. [GRAPHICS]
   Thus ail above parameters are significantly increased in HS. In HS, LASV is
   correlated to LAV (r = 0.84 :p < 0.001) and to LVMI (r = 0.32;p < 0.05). LAEF is
   correlated to peak A (r = 0.90;p < 0.001) and LVMI (r = 0.34; p < 0.05). Conclusions,
   In HS with LVH in comparison with N, the increase of the LA contractility is
   considered to be urged by the increase of LAV (Frank-Starling's law). These data
   could be explained by the less distensibility of LV chamber in relation to LVH
Keywords:            age/ARCH/arterial/arterial        hypertension/assessment/atrial/atrial
   function/contractility/Doppler/ejection fraction/force/FRANCE/function/heart/heart
Chalon, S. and Lechat, P. (1996), Antithrombotic treatment in atrial fibrillation.
   Archives des Maladies du Coeur et des Vaisseaux, 89 (11), 1533-1542.
Abstract: In comparison with the incidence of a cerebrovascular accident in the general
   population, atrial fibrillation increases the risk by a factor of five. Although age is
   without doubt the main risk factor for cerebrovascular accidents in patients with
   permanent or paroxysmal non-valvular atrial fibrillation, other independent risk
   factors have been identified : a previous history of hypertension, cerebrovascular
   accident, heart failure or diabetes. These factors enable identification of a population
   at risk in which oral anticoagulation may be recommended with an excellent
   efficacy/risk ratio. Six large scale randomised controlled multicenter trials of primary
   prevention have been published with a total of over 2 800 patients with non-valvular
   atrial fibrillation. The combined results of these trials show that treatment with a
   vitamin K antagonist (INR 2-3) leads to a significant reduction in the risk of an
   ischaemic cerebrovascular accident of 64 % (95 % CI [51-74]; p < 0.001) and in the
   risk of death from all causes of 28 % (95 % CI [12-47]; p = 0.038) with a slight
   increase in the risk of cerebral haemorrhage (+ 2.7 % NS). Although the benefits of
   aspirin therapy are not as impressive (reduction of the risk of an ischaemic
   cerebrovascular accident of 22 %; 95 % CI [0-39]; p = 0.053), this alternative may be
   proposed in patients under 75 years of age without the previously mentioned risk
   factors. The value of combined aspirin-oral anticoagulant therapy, especially in high
   risk patients, has not yet been established and is under evaluation
Keywords:                                                                 age/anticoagulant
   haemorrhage/cerebrovascular/cerebrovascular                    accident/cerebrovascular
   e/heart/heart                                                                failure/high
   prevention/risk/risk factor/risk factors/RISK- FACTORS/SILENT CEREBRAL
   INFARCTION/SPONTANEOUS                                                            ECHO
Sal, R., Cormier, J.M., Chapoutot, L., Alame, A., AlKhedr, A., Raynaud, J.C., Apparuit,
   J.P. and Bailly, L. (1996), Acute upper limb ischaemia in a young adult without
   cardiac disease: Diagnostic value of transoesophageal echocardiography. Archives
   des Maladies du Coeur et des Vaisseaux, 89 (10), 1317-1321.
Abstract: The authors report the case of a 34-year old woman with no previous
   cardiovascular disease who was admitted to hospital for acute ischaemia of the right
  arm due to embolism, preceded by two episodes of pain and tingling of the left arm
  related to subacute ischaemia. After right embolectomy, with no possibility of
  controlateral disobliteration an effective anticoagulation, no cardiac source of
  embolism could be found. However, transoesophageal echography showed a large
  mobile thrombus in the aortic arch implanted just before the origin of the left
  subclavian artery. The only explanation for embolism to the right arm was a
  retro-oesophageal subclavian artery which was confirmed by scanner, Doppler and
  arteriography. These investigations, however, did not allow visualisation of the aortic
  thrombus. In view of the risk of recurrent embolism, a thrombectomy was performed
  without cardiopulmonary bypass, associated with correction of the vascular
  abnormality with no complications. This case shows that oesophageal echography is
  a useful investigation in the work up of acute arterial obstruction in young patients
  with no cardiac disease
Keywords:                                              acute/adult/anticoagulation/aortic
  monary/cardiopulmonary                            bypass/cardiovascular/cardiovascular
  al/ischaemia/pain/risk/STROKE/subclavian                            artery/SYSTEMIC
  echocardiography/upper/vascular/work/young adult
Marazanof, M. and Roudaut, R. (1996), Atrial septal aneurysm. Archives des Maladies
  du Coeur et des Vaisseaux, 89 (9), 1189-1195.
Abstract: Aneurysms of the atrial septum (ASA) frequently diagnosed since the
  introduction of transoesophageal echocardiography are implicated in the aetiology of
  cerebral and systemic embolic events. This update was undertaken to resume recent
  data on this pathology and its relationship with embolic events. The diagnostic
  criteria are described together with the morphological features (size, movements,
  thickness) and associated abnormalities (interatrial shunts, valvular prolapse). The
  authors summarise the data concerning possible complications of ASA, especially
  the different mechanisms invoked to explain embolism (paradoxical embolism,
  thrombosis in situ, supraventricular arrhythmias). Therapeutic options are discussed
  with respect to the clinical contexts (therapeutic abstention, platelet antiaggregant
  drugs, oral anticoagulants, interventional cardiology or surgery
  embolism/PATENT                                                            FORAMEN
  AGEAL ECHOCARDIOGRAPHY/transoesophageal echocardiography
Somody, E., Albucher, J.F., Delay, M., Chollet, F., Bonnet, J.P., Fourcade, J.,
  GuiraudChaumeil, B. and Puel, J. (1996), Latent atrial vulnerability in unexplained
  ischaemic cerebrovascular accidents of the young. Archives des Maladies du Coeur
  et des Vaisseaux, 89 (11), 1365-1373.
Abstract: This study searched for abnormalities of the atrial electrophysiological
  substrate in young subjects with unexplained ischaemic cerebrovascular accidents.
  Thirty-seven patients (18 to 45 years) underwent programmed atrial stimulation at 2
  sites in the right atrium after an unexplained ischaemic cerebrovascular accident.
  Seventeen of them underwent repeat study at 6 months. The following parameters
  were analysed : indices of atrioventricular conduction and sinus node automaticity;
  indices related to atrial hyperexcitability : effective refractory period; adaptation of
  the refractory periods to heart rate, intraatrial conduction and the index of latent
  vulnerability ; the inducibility test by the extrastimulus technique. The following
  results were obtained : 54 % of patients had an inducible atrial arrythmia; the
  effective refractory periods and index of latent vulnerability were lower (204 +/- 21
  ms and 2.25 +/- 0.7) in the inducible patients than in the non-inducible patients (232
  +/- 28 ms and 3.4 +/- 1.1) (p < 0.001 and p < 0.002 respectively); 76 % of patients
  had latent atrial vulnerability indicating and underlying arrhythmogenic substrate;
  this substrate was still present 6 months later in 80 % of these cases; in patients with
  an abnormality of the interatrial septum. there was an abnormality of the
  electrophysiological investigation in 85 % of cases compared with 65 % in those
  with normal transoesophageal echocardiography. These results confirm the presence
  of an arrhytmogenic substrate similar to that of patients with paroxysmal atrial
  fibrillation in over two thirds of cases. Programmed atrial stimulation is a
  reproducible technique. The relationship between latent atrial vulnerability and
  abnormalities of the interatrial septum requires confirmation in a series with a larger
  numbers of patients
Keywords:                                     abnormalities/ADULTS/ARCH/atrial/atrial
  rate/interatrial       septum/paroxysmal          atrial        fibrillation/rate/SEPTAL
  ANEURYSM/SINUS RHYTHM/STROKE/test/transoesophageal echocardiography
Ambrosi, P., Rolland, P. and Garcon, D. (1996), Homocysteine, a risk factor for
  atherosclerosis. Archives des Maladies du Coeur et des Vaisseaux, 89 (12),
Abstract: Homocysteine is a sulphurated amino acid which, at high plasma
  concentrations, predisposes to thrombosis and induces focal arteriosclerosis. These
  characteristics have been established both in patients with homocystinuria, a genetic
  disease in which homocysteine accumulates in the blood, and in animals submitted to
  intravenous infusions of this amino acid. Many recent publications have addressed
  the problem of whether mild increases in plasma homocysteine predisposed to the
  development of the usual forms of atherosclerosis. Transverse epidemiological
  studies have established a correlation between homocysteine levels and
  atherosclerosis at all its vascular localisations, coronary, carotid and lower limb.
  Multivariate analysis in several prospective studies have shown plasma
  homocysteine to be an independant risk factor for cerebrovascular accidents and
  myocardial infarction. Causes of mild increases in plasma homocysteine are usually
  dietetic deficiencies in folic acid, vitam in B6 or B12, or genetic by mutation of the
  methylene-tetrahydrofolate reductase. Renal failure is also associated with a high risk
  in plasma homocysteine levels. However, the toxicity of homocysteine to the arterial
  wall at slightly elevated concentration remains speculative
  blood/CARDIOVASCULAR                      RISK/carotid/cerebrovascular/cerebrovascular
  INJURY/failure/focal/folic                                   acid/FRANCE/genetic/high
  limb/MINIPIG/mutation/myocardial/myocardial                infarction/plasma/PLASMA
  HOMOCYST(E)INE/prospective/prospective                                  studies/risk/risk
Rosa, A. and Canaple, S. (1996), Prevention of ischaemic cerebrovascular accidents by
  platelet inhibitors. Archives des Maladies du Coeur et des Vaisseaux, 89 (11),
Abstract: Cohort studies currently available suggest that the most effective platelet
  inhibitors for the secondary prevention of ischaemic cerebrovascular accidents are
  acetylsalicylic acid and ticlopidine. Aspirin reduces the risk by 20 %. It seems that
  moderate doses (100-300 mg/day) are sufficient and better tolerated. Ticlopidine
  would seem to be more effective than aspirin as it reduces the risk by more than 20
  % with respect to aspirin therapy. Only aspirin has been evaluated in the setting of
  primary prevention and it seems to be ineffective in preventing cerebral infarction.
  Nowadays, other anti-platelet molecules are under evaluation, one of which is
Keywords:        acetylsalicylic      acid/antiplatelet/ARCH/ASPIRIN/cerebral/cerebral
  prevention/RANDOMIZED                                            TRIAL/risk/secondary
Page, E., Perrault, H., Flore, P., Rossignol, A.M., Pironneau, S., Rocca, C. and
  Aguilaniu, B. (1996), Cardiac output during exercise in children having undergone
  atrial surgery for transposition of the great vessels. Archives des Maladies du Coeur
  et des Vaisseaux, 89 (5), 593-598.
Abstract: The long-term physiopathological consequences of atrial surgery (Senning or
  Mustard procedures) for transposition of the great vessels with respect to exercise
  capacity are not well known. We measured the cardiac index by the technique of
  CO2 rebreathing at two submaximal levels of exercise corresponding to a stable
  oxygen consumption of 20 (E20) and 30 (E30) ml/min/kg in 7 patients successfully
  operatefdfor transposition of the great vessels and in 7 control children paired for age,
  gender and body surface area. Despite an identical chronotropic response to exercise
  in the two groups, the increase in cardiac index was not as great in the children
  operated for transposition (from 6.86 +/- 0.51 to 7.71 +/- 0.78 l/min/m(2)) as in the
  control population (from 7.71 +/- 0.78 to 10.2 +/- 0.51 l/min/m(2); p < 0.02). The
  stroke volume index was therefore significantly lower in the transposition group at
  both levels of exercise (52 +/- 3.2 vs 63 +/- 4.1 ml/m(2); p < 0.04 at E20; and 46.4
  +/- 4.3 vs 66 +/- 5.1 ml/m(2) at E30). The main cause of this reduction of the stroke
  volume index is probably a lack of adaptation of right ventricular systolic function on
  exercise but it is not possible to exclude diastolic dysfunction due to reduce
  compliance secondary to the intraatrial patch. The conditions of preload are in fact
  instrumental in increasing stroke volume index at submaximal exercise levels
Keywords:                age/ARCH/ARRHYTHMIAS/ARTERIES/atrial/cardiac/cardiac
  FUNCTION/MUSTARD                                         OPERATION/oxygen/oxygen
  volume/surgery/systolic/systolic function/volume
Goldstein, G., Shemansky, W.J., Beers, S.R., George, T. and Roberts, K. (1996), A
  clarification of the Russell, Neuringer, and Goldstein process key: Implications for
   outcome. Archives of Clinical Neuropsychology, 11 (7), 581-587.
Abstract: The purpose of this study was that of attempting to clarify discrepant results
   regarding classificatory accuracy of the Russell, Neuringer, and Goldstein (1970)
   Process Key. The Process Key is the component of the neuropsychological keys that
   classifies cases as having recently or remotely acquired brain damage on the basis of
   level of performance and severity of lateralizing signs. A correct classification of
   acute brain damage occurs when onset of illness began within 3 months of time of
   testing. A study of stroke patients indicated that time since onset is an inadequate
   criterion for producing a satisfactory classificatory level, but lime of onset in
   combination with type of stroke was associated with a high degree of classificatory
   accuracy. In particular; patients with recent thrombotic/hemorrhagic type strokes
   were classified as acute with a very high accuracy level, but the classification was
   substantially less accurate for recent stroke patients with other types of stroke, and
   for cares that were not of recent onset. Copyright (C) 1996 National Academy of
Keywords:                                               accuracy/acute/ARCH/brain/brain
   CE/severity/stroke/stroke patients/testing
Nadler, J.D., Grace, J., White, D.A., Butters, M.A. and Malloy, P.F. (1996), Laterality
   differences in quantitative and qualitative Hooper performance. Archives of Clinical
   Neuropsychology, 11 (3), 223-229.
Abstract: The Hooper Visual Organization Test (HVOT) is a measure of visuospatial
   processing commonly employed in neuropsychological assessment. Despite the
   well-documented relationship between visuospatial abilities and right hemisphere
   function, the literature has not supported a right hemisphere association with HVOT
   performance. The current study was conducted to examine laterality differences in
   HVOT performance. Sixty-seven geriatric stroke patients (44 right CVAs, 23 left
   CVAs) were administered the HVOT and the Mini-Mental State Exam (MMS).
   Results revealed significant differences between CVA groups for total score, with
   right CVA patients performing more poorly. Qualitative error analyses revealed
   highest frequencies for part responses and don't know/no response errors.
   Between-group differences were seen for part and unformed/unassociated errors
   (higher right CVA rates), and language-based errors (higher left CVA rates).
   Findings are consistent with theories of brain lateralization and suggest that whereas
   HVOT performance predominantly involves right hemisphere functions, left
   hemisphere dysfunction may also lead to impaired performance, and the two can be
   discriminated by qualitative analysis of the errors
   hemisphere/SCIENCE/score/stroke/stroke patients/total
Ris, M.D., Kalinyak, K.A., Ball, W.S., Noll, R.B., Wells, R.J. and Rucknagel, D. (1996),
   Pre- and post-stroke MRI and neuropsychological studies in sickle cell disease: A
   case study. Archives of Clinical Neuropsychology, 11 (6), 481-490.
Abstract: The case of a patient with sickle cell disease is presented in which
   neuropsychological and magnetic resonance imaging studies were completed prior to
   and after a right hemispheric stroke. The contribution of a new MR perfusion
   technique in understanding the neurological complications in this patient is discussed.
   This case illustrates the complex pathophysiology of neuropsychological deficits in
   SCD and underscores the need to develop models that better reflect this complexity
Keywords:                                                ANEMIA/ARCH/CEREBRAL
  /disease/ENGLAND/INFARCTION/LESIONS/magnetic                     resonance/magnetic
  deficits/perfusion/SCIENCE/sickle cell disease/stroke
Skinner, J.R., Hunter, S. and Hey, E.N. (1996), Haemodynamic features at presentation
  in persistent pulmonary hypertension of the newborn and outcome. Archives of
  Disease in Childhood, 74 (1), F26-F32.
Abstract: Thirty four newborns presenting with persistent hypoxaemia in the first three
  days of life underwent detailed haemodynamic assessment using Doppler
  echocardiography, including measurements of pulmonary arterial pressure (PAP),
  left ventricular (LV) function, and left ventricular output (LVO). Results were
  compared with values from 51 healthy babies, and those of survivors were compared
  with non-survivors. Four of the 34 babies were excluded from this analysis because
  one was found to have transposed great arteries, one had a large left- to-right shunt
  with no evidence of persistent pulmonary hypertension, and two had diffuse skeletal
  myopathy. Tricuspid regurgitation was present in 70%, permitting systolic PAP
  estimation. The pulmonary:systemic arterial pressure ratio range was 0.7:1 to 1.83:1
  (mean 1.02:1). A patent duct was present in 83%, and flow patterns indicated PAP
  approaching, or above, systemic pressure in all. Systolic time interval ratio
  TPV/RVET (time to peak velocity at the pulmonary valve/right ventricular ejection
  time) was mostly (65%) in the normal range, and did not correlate with other PAP
  measurements. LV function was below the 10th centile in only 11%, but values for
  LVO lay below the 10th centile in 41%, and for left ventricular stroke volume index
  (LSVI) in 66%. Results of 18 survivors were compared with 10 non-survivors
  (excluding two premature babies who died early with pulmonary interstitial
  emphysema). There were no significant differences for any parameter of PAP or LV
  function, but LVO and LSVI were significantly lower in non- survivors: LVO
  survivors (mean (SD)), 205 (57), non-survivors 138 (63) ml/kg/minute (P<0.01);
  LSVI survivors, 1.29 (0.51), non-survivors 0.86 (0.31) ml/kg (P<0.05). All four
  babies with LVO <100 ml/kg/minute died, and 6/7 babies with LSVI <1 ml/kg died.
  Detailed echocardiographic evaluation shows that the haemodynamic features of
  persistent pulmonary hypertension are diverse and that clinical diagnosis can be
  incorrect. Low LV output and stroke volume, usually with normal LV function, were
  the only Doppler echocardiographic parameters to predict subsequent death. This
  correlation with outcome requires further prospective evaluation
Keywords:           analysis/ARCH/arterial/arterial         pressure/arteries/ARTERY
  /Doppler/DOPPLER                                        DETERMINATION/Doppler
  ventricular/measurements/newborn/outcome/patent/peak               velocity/persistent
  pulmonary                    hypertension/pressure/prospective/pulmonary/pulmonary
  hypertension/RESPIRATORY-DISTRESS                   SYNDROME/shunt/stroke/stroke
  volume/systolic/velocity/ventricular ejection time/volume
Teig, N. and Nuesslein, T.G. (1996), Haemorrhagic shock encephalopathy syndrome
  presenting with myoglobinuria. Archives of Disease in Childhood, 74 (2), 168-169.
Abstract: An infant with haemorrhagic shock encephalopathy syndrome (HSES) who in
   addition presented with hyperpyrexia and myoglobinuria is reported. As
   rhabdomyolysis is a feature of heat stroke and malignant hyperthermia, the
   association of HSES with myoglobinuria supports the hypothesis that HSES may be
   a form of hypermetabolic state triggered by hyperthermia
   shock                         encephalopathy                        syndrome/heat/heat
Mercuri, E., Atkinson, J., Braddick, O., Anker, S., Nokes, L., Cowan, F., Rutherford, M.,
   Pennock, J. and Dubowitz, L. (1996), Visual function and perinatal focal cerebral
   infarction. Archives of Disease in Childhood, 75 (2), F76-F81.
Abstract: Aims-To evaluate the visual function of infants with perinatal cerebral
   infarction in whom the site and size of the lesion has been determined using
   magnetic resonance imaging (MRI). Methods-Twelve infants with cerebral infarction
   on MRI were studied with a battery of tests specifically designed to evaluate visual
   function in infancy. This included tests: for visual attention (fixation shifts); of
   cerebral asymmetry (optokinetic nystagmus, visual fields); for assessment of acuity
   (forced choice preferential looking); and neurophysiological measures of vision
   (phase reversal and orientation reversal visual evoked potential). Results-A
   considerable incidence of abnormalities on at least one of the tests for visual function
   used was observed. The presence or severity of visual abnormalities could not always
   be predicted by the site and extent of the lesion seen on imaging. Conclusions-Early
   focal lesions affecting the visual pathway can, to some extent, be compensated for by
   the immature developing brain. These data suggest that all the infants presenting with
   focal lesions need to be investigated with a detailed assessment of various aspects of
   al/cerebral                                     infarction/CHILD/ENGLAND/evoked
   resonance/magnetic                                                            resonance
Liss, G.M. and Finkelstein, M.M. (1996), Mortality among workers exposed to carbon
   disulfide. Archives of Environmental Health, 51 (3), 193-200.
Abstract: Mortality experience was investigated at a plant in Ontario that produced
   viscose rayon, with carbon disulfide as a main raw material. Work-history records
   for 279 deceased workers at the plant (plant A) were obtained and compared with
   those for 511 deceased workers at a pulp and paper plant in the same city (plant B).
   In a proportional mortality analysis, using as a reference the general population of
   Ontario, at both plants there were fewer deaths from ischemic heart disease than
   expected (the proportional mortality ratios [PMRs] were 83 at plant A and 95 at plant
   B) but more deaths than expected from cerebrovascular disease (PMRs were 115 at
   plant A and 149 at plant B). In a subgroup of plant A workers who had been
   employed in high-carbon-disulfide exposure areas, deaths from ischemic heart
   disease were less than expected (PMR = 82), particularly among those who worked
   in these areas for more than 5 y. Most deaths occurred among those aged 65 y or
   more. Mortality from strokes, however, was greater than expected (PMR = 207, p
   < .05); the excess was confined to workers who died at age 65 y or older (PMR =
   229, p .01). Proportional mortality from strokes was also increased in the pulp
   workers among those who died at age 65 y or older (PMR = 153). In a case-control
   analysis, the risk of ischemic heart disease at plant A was slightly less than at plant B
   (odds ratio [OR] = 0.92, 95% confidence interval [Cl] = 0.60-1.42), with no
   association between risk and years worked in high-carbon-disulfide areas (OR/y =
   0.99, 95% Cl = 0.94-1.03). Among those who died at age 65 y or older, the risk of
   stroke in the high-exposure subgroup was (a) increased significantly, compared with
   other plant A workers (OR = 4.92, 95% Cl 1.66-14.65); and (b) increased slightly,
   compared with plant B workers (OR = 1.37, 95% Cl = 0.83-2.26). These results
   suggested an unusually low risk of strokes among other plant A workers. The risk of
   stroke was associated with years in high-carbon-disulfide areas (OR/y = 1.03, 95%
   Cl = 0.96-1.10). The observed increase in proportional mortality from strokes may
   represent a chance finding, but a causal role for exposure cannot be excluded
Keywords:                       age/aged/analysis/ARCH/cerebrovascular/cerebrovascular
   disease/confidence/disease/general/HEALTH/heart/heart disease/ischemic/ischemic
   heart              disease/low/mortality/odds              ratio/risk/risk             of
Peterson, J.R. (1996), Acupuncture in the 1990s - A review for the primary care
   physician. Archives of Family Medicine, 5 (4), 237-240.
Abstract: The purpose of this article is to educate primary care providers regarding the
   theory and basic principles of acupuncture. Various indications for acupuncture are
   discussed. It is hoped that this article will allow the primary care practitioner to
   correctly identify patients in his or her practice who might benefit from acupuncture
Keywords:                    ARCH/BACTERIAL-ENDOCARDITIS/MEDICAL/primary
Cozzolino, D., Salvatore, T. and Torella, R. (1996), Diabetic non ketotic hyperosmolar
   state: A special care in aged patients. Archives of Gerontology and Geriatrics,
Abstract: The hyperosmolar hyperglycemic nonketotic state (HHNS) is an acute
   metabolic complication occurring characteristically in elderly type-2 diabetic patients.
   It may account for 10 up to 47 % of cases of severe hyperglycemia with or without
   ketoacidosis. Many factors associated with advanced age may explain the
   predilection of both elderly subjects in general and older diabetics in particular to
   develop hyperosmolar coma, including reduced glomerular filtration rate and
   elevated renal threshold for glucose [which fall to correct hyperglycemia by osmotic
   diuresis), lack of thirst appropriate to the state of hydratation and some iatrogenic
   factors. In HHNS the age of the patients is the best known prognostic indicator. The
   increased mortality rate in the elderly diabetics depends on the severity of
   precipitating acute diseases (gastrointestinal hemorrhage. cardiovascular accident,
   pneumonia, pancreatitis, etc.], but the frequent compromises of the hemodynamic
   state and renal function of aged subjects substantially contributes. However, the role
   of erroneous management is not negligible and difficulties may be encountered in
   conciliating correction of metabolic disorder with treatment of precipitating illness.
   Insulin. water and electrolytes are the most important therapeutical tools for the
   treatment of hyperglycemic emergencies. In HHNS, the aggressive fluid replacement
   with isotonic or hypotonic NaCl solutions have first priority. Such a type of strategy
   is difficult to perform in patients suffering from cerebral stroke (which needs of
   anti-edema therapy) or congestive heart failure (necessitating to avoid fluid excess).
   According to the literary data, in our experience these two precipitating factors are
   frequent causes of death. We outline the validity of prefixed protocols of
   management; on the other hand, we think that the pathophysiological understanding
   of HHNS in the single patient is essential to decide the proper corrections and to
   permit a successful outcome. The primary way aiming at diminishing mortality by
   HHNS is its prevention; it is fundamental to warrant an appropriate fluid intake and
   to utilize with caution some drugs (thiazides. steroids, phenytoin, etc.) in aged
   diabetics, especially when nephropathic or unable, or living in nursing homes
Keywords:                                                                   acute/ACUTE
   AL EDEMA/cerebral stroke/CO/COMA/complication/congestive/congestive heart
   art             failure/hemodynamic/hemorrhage/HYPERGLYCEMIA/hyperosmolar
   hyperglycemic                                                               nonketotic
Raffaele, R., Rampello, L., Vecchio, I., Tornali, C. and Malaguarnera, M. (1996),
   Trazodone therapy of the post-stroke depression. Archives of Gerontology and
   Geriatrics, 217-220.
Abstract: The incidence of depression following a hemispheric stroke ranges from 25 to
   60 %. The benefit of antidepressant therapy on the outcome of rehabilitation in the
   subacute post-stroke phase is well known. We studied subjects both with and without
   evidence of depression, as indicated by any one of three criteria: (i) Clinical
   diagnosis of depression. (ii) Abnormal Zung-depression score. (iii) Abnormal
   dexamethasone suppression test (DST). Patients in a stroke rehabilitation program
   (22) were randomized to receive either placebo or 300 mg/day trazodone-HCl,
   beginning 30 days after the stroke. Patients with either a clinical diagnosis of
   depression or abnormal Zung depression scores showed a consistent trend towards
   greater improvement in Barthel activities of daily living (ADL) scores, with
   antidepressant therapy, as compared to patients receiving placebo. An abnormal DST
   was associated with significant improvement in the ADL scores in subjects receiving
   trazodone, i.e., in post-stroke depression such a treatment seems to be beneficial
Keywords:        activities      of      daily     living/ADL/ARCH/BAY/CEREBRAL
   ome/placebo/post-stroke                                          depression/poststroke
Alletto, M., Burgio, A., Fulco, G., Paradiso, R., Piangiamore, M. and Vancheri, F.
   (1996), A marked increase of ischemic stroke incidence between 1980 and 1994 in S
   Caterina, Sicily. Archives of Gerontology and Geriatrics, 167-172.
Abstract: Stroke death rates have been declining for some decades in most of the
   industrialized countries. It is not clear, whether this has been associated with a
   decrease in stroke incidence. We studied temporal trends in stroke incidence in a
   rural community in Sicily, during two periods 1980-84 and 1990-94. There was a
   total of 231 patients (120 of them women). The diagnosis of stroke was based on the
   clinical evaluation and CT scan since 1982 and onward. There were 109 ischemic
   strokes (51 women) mean age 72.7 years, in 1980-84 period; 122 ischemic strokes
   (69 women) mean age 75.1, in 1990-94 period. Cardiovascular risk factor rates did
  not change in the two periods considered. The relative annual stroke incidence rate
  increased 37.0 %; (2.7 in 1980-84 to 3.7/1000 inhabitants in 1990-94, p = 0.016). In
  the population older than 65 years, the same parameter increased by 21.1 % between
  the two periods; (16.1 in 1980-84 to 19.5/1000 inhabitants in 1990-94, not
  significant). This increase was due mainly to a 45.3 % significant relative increase in
  women, from 7.5 to 11.0/1000 inhabitants (p = 0.039). These findings suggest a need
  of the reconsideration of effective strategics for the prevention of stroke
Keywords:          absolute         stroke         incidence/age/ARCH/BAY/CO/CT/CT
  stroke/MEN/MORTALITY/prevention/rate/relative              stroke      incidence/risk/risk
Marchionni, N., DiBari, M., Fumagalli, S., Ferrucci, L., Baldereschi, G., Timpanelli, M.
  and Masotti, G. (1996), Variable effect of comorbidity on the association of chronic
  cardiac failure with disability in community-dwelling older persons. Archives of
  Gerontology and Geriatrics, 23 (3), 283-292.
Abstract: The effect of cardiac failure (CF) and comorbidity on disability in older
  persons was studied in a cross-sectional survey. The whole population aged 65 +
  years (n = 652; 528 eligible) living in a small town near Florence (Italy) was enrolled.
  Finally, 459 individuals (73.0% of eligible) underwent a multidimensional evaluation.
  CF was defined as a NYHA II-IV class in the presence of an obviously abnormal
  EGG. Disability was assessed by the 14-item WHO scale. Comorbid conditions that
  had a prevalence > 5% and might be considered pathophysiologically unrelated to
  CF were also identified. The univariate association of CF with disability was
  analyzed. Multivariate associations were estimated as well, by taking simultaneously
  into account the effect of comorbid conditions that had an independent effect on
  disability and were considered as either confounders or effect modifiers of that
  association. Prevalence of CF [6.1% in the whole study population) was higher with
  advancing age (greater than or equal to 75 years: 8.3 versus 65-74 years: 4.5%, odds
  ratio, OR: 1.93, 95% confidence interval, CI: 1.02 4.18), in the presence of
  hypertension (OR: 2.87, 95% CI: 1.32-6.23), and among individuals who were living
  alone (OR: 2.44, 95% CI: 1.10-5.56). CF was associated with a higher prevalence of
  disability (35.5 versus 19.5%; OR 2.67. 95%, CI: 1.21-5.42). Comorbidity modified
  the association of CF with disability following two patterns: while the independent
  effect of CF on the prevalence of disability was similar in the absence or in the
  presence of chronic obstructive pulmonary disease. healing impairment,
  gastrointestinal tract disease, or osteoarthritis, such effect was much larger in the
  presence than in the absence of: visual impairment, previous stroke. or urinary
  incontinence. The composite pathophysiological pathways of such different
  interactions are still to be elucidated. Copyright (C) 1996 Elsevier Science Ireland
Keywords:       age/aged/ARCH/BAY/cardiac/cardiac           failure/CARDIOVASCULAR
  HEALTH/chronic/chronic             diseases/chronic        obstructive        pulmonary
  TED-STATES/urinary incontinence/visual
Acanfora, D., Trojano, L., Iannuzzi, G.L., Furgi, G., Picone, C., Rengo, C., Abete, P.
  and Rengo, F. (1996), The brain in congestive heart failure. Archives of Gerontology
  and Geriatrics, 23 (3), 247-256.
Abstract: In the present paper we discuss two issues about relationships between
  congestive heart failure and the brain. First, major acute cerebrovascular events are
  very frequent among elderly people, but stroke does not appear io be frequently
  associated with congestive heart failure. Second, some cardiovascular conditions
  may determine progressive damage of cerebral tissue, with consequent impairment of
  cognitive functions. The association of cognitive impairment and cardiovascular
  diseases may dramatically increase morbility and mortality risks in the elderly.
  Recent studies seem to show that hypotension and congestive heart failure are risk
  factors for dementia in elderly people. In view of this data, an Italian multicentric
  study on congestive heart failure in hospitalized elderly patients (CHF Italian Study I)
  included a brief screening of cognitive abilities (MMSE)I The presence of congestive
  heart failure induced a significant decrease of MMSE scores: mean MMSE score
  after statistical adjustment for the other variables was about one point lower in
  patients with congestive heart failure respect to elderly patients affected by heart
  disease but without congestive heart failure. A novel multicentric study (CHF Italian
  Study II) has been performed to identify cognitive functions more specifically
  impaired during congestive heart failure in the elderly. Preliminary data relative to
  385 patients, confined that congestive heart failure may induce a generalized
  impairment of cognitive functions. These data have relevant implications because
  they demonstrate that a multidisciplinary approach is necessary in these patients,
  both for prevention and rehabilitation therapy. Copyright (C) 1996 Elsevier Science
  Ireland Ltd
  BLOOD-FLOW/cerebrovascular/CO/cognitive                               function/cognitive
  impairment/COGNITIVE               PERFORMANCE/congestive/congestive                heart
  failure/dementia/disease/diseases/elderly/elderly                        patients/elderly
  people/failure/heart/heart            disease/heart           failure/HYPERTENSIVE
  k/risk                                                factors/SCI/score/scores/SENILE
Elmstahl, S., Sommer, M. and Hagberg, B. (1996), A 3-year follow-up of stroke
  patients: Relationships between activities of daily living and personality
  characteristics. Archives of Gerontology and Geriatrics, 22 (3), 233-244.
Abstract: The importance of some personality characteristics for improvement of
  activities of daily life (ADL) was studied in sixty-six stroke patients, initially
  admitted to geriatric rehabilitation (n = 37) or the department of medicine (n = 29), 3
  years after stroke. Outcome measurements were activities of daily life and motor and
  mental functions assessed using the Activity Index (AI) by Hamrin and Wohlin
  (1982). Neuroticism and extroversion were measured with the Eysenck Personality
  Inventory Scale. Preferred coping strategies were assessed from interviews on how
  the patients handle difficult events. Major improvements of ADL and motor
  functions were seen the first year after stroke. There was no major differences
  between patients admitted, either to geriatric rehabilitation or traditional medical
  wards regarding the outcome measurements except for better eating ability in the
  former group 3 years later. Subjects living alone showed deteriorated ADL functions
   after 3 years. Extrovert personality and active coping strategy predicted improved
   ADL functions. Multiple regression analyses with AI as the dependent variable
   proved active coping to predict functional outcome. In conclusion; increased
   knowledge about personality characteristics can improve possibilities for a more
   individual rehabilitation program
Keywords:                       activities                     of                     daily
   LITY/quality of life/rehabilitation/REHABILITATION/SCI/strategies/stroke/stroke
Elia, G., Carra, R., Santangelo, N., Rosso, D., Culmone, N. and Siciliano, R. (1996),
   Prevalence of risk factors in acute ischemic cerebro-vascular disease (CVD) in
   elderly patients from eastern Sicily. Archives of Gerontology and Geriatrics,
Abstract: Hundred and forty elderly patients (76 males and 64 females, over 65 years of
   age) were consecutively admitted to the Institute between November 1989 and April
   1993, in order to (i) verify if the risk factors, reported in other Italian areas and
   regions of the world, are prevalent also in our region, and (ii) outline a secondary
   prevention strategy against the statistically most important risk factors. There were
   111 cases of ischemic stroke (58 males and 53 females) and 29 cases of reversible
   ischemic attack (RIA) (18 males and 11 females). The percental occurrence of the
   following risk factors were determined: total cholesterol > 240 mg/dl, HDL
   cholesterol < 35 mg/dl, triglycerides > 180 mg/dl, fibrinogen > 450 mg/dl,
   hematocrit > 45 %, hypertension, diabetes mellitus, cigarette smoking, familial
   ischemic events, previous ischemic CVD, ischemic cardiac disease, embolic
   cardiopathy. In males with ischemic stroke the most frequent risk factors were:
   hypertension (43 %), fibrinogen > 450 mg/dl (37.9 %), diabetes mellitus. cigarette
   smoking and previous ischemic CVD (25.8 %). in females with ischemic stroke a
   clear prevalence of hypertension (69.8 %), ischemic cardiopathy and previous
   ischemic CVD (47 %) and diabetes mellitus (41.5 %) were observed. In males with
   RIA hypertension (50 %) and cigarette smoking (38 %). Females with RIA presented
   a high prevalence of reduced HDL cholesterol, lower than 35 mg/dl (77.7 %),
   hypertension (63.6 %) and ischemic cardiopathy (54.5 %). The results indicate that
   there are no highly significant differences between the data reported by other authors
   on the most important acute ischemic CVD risk factors in Italy and elsewhere.
   Arterial hypertension and diabetes mellitus are the most important risk factors of
   cerebral ischemic events in both sexes. The diffusion of cigarette smoking among
   women in the last thirty years must be taken into consideration. Although it does not
   represent a risk factor for elderly women today, it may do in the future. Therefore,
   antismoking campaigns must be more decisive and targeted at both sexes
Keywords:       acute/age/ARCH/BAY/cardiac/cerebral/cerebrovascular/cerebrovascular
   disease/cholesterol/CO/diabetes/diabetes      mellitus/diffusion/disease/elderly/elderly
   stroke/males/prevalence/prevention/reversible ischemic attack/risk/risk factor/risk
Molaschi, M., Ponzetto, M., Magnano, A., Castronuovo, F. and Gangemi, D. (1996),
   Risk profile in women with stroke: Role of plasma fibrinogen. Archives of
   Gerontology and Geriatrics, 201-205.
Abstract: In 96 women with ischemic stroke, (mean age 77.9 +/- 7.4, S.D., years, body
   mass index, BMI = 23.7 +/- 3.91), we assessed the presence of risk factors for
   atherosclerosis, particularly of hyperfibrinogenemia. A control group of 96 women
   without relevant diseases, namely neoplasms, cardiovascular and inflammatory
   diseases, well matched for age and BMI was also studied. Subjects with stroke show
   higher values of systolic and diastolic blood pressure, total serum cholesterol,
   fibrinogen, hematocrit and more frequent habit of cigarette smoking. Levels of
   HDL-cholesterol, triglyceridemia and glycemia do not differ between the 2 groups.
   In stroke group fibrinogen is positively correlated with systolic and diastolic blood
   pressure and triglyceridemia. These findings confirm the presence of a risk profile
   for stroke, in which hypertension plays the most relevant role. The weight of
   fibrinogen in pathogenesis of stroke is likely to be related to the presence of other
   risk factors
Keywords: age/ARCH/atherosclerosis/BAY/blood/blood pressure/body mass/body
   mass index/cardiovascular/cholesterol/cigarette smoking/CO/control/diastolic blood
   mic stroke/neoplasms/pathogenesis/plasma/pressure/risk/risk factors/risk factors for
Blackshear, J.L., Baker, V.S., Holland, A., Litin, S.C., Ahlquist, D.A., Hart, R.G.,
   Ellefson, R. and Koehler, J. (1996), Fecal hemoglobin excretion in elderly patients
   with atrial fibrillation - Combined aspirin and low-dose warfarin vs conventional
   warfarin therapy. Archives of Internal Medicine, 156 (6), 658-660.
Abstract: Background: Antithrombotic prophylaxis using combined aspirin and
   low-dose warfarin is under evaluation in several clinical trials. However,
   combination therapy may result in increased gastrointestinal blood loss and clinical
   bleeding vs conventional single-agent antithrombotic therapy. Methods: To assess
   differences in gastrointestinal blood loss, we measured quantitative fecal hemoglobin
   equivalents (HemoQuant, Mayo Medical Laboratory, Rochester, Minn) in 117
   patients, mean age 71 years, 1 month after initiation of assigned therapy in the Stroke
   Prevention in Atrial Fibrillation III Study. Sixty-three of these patients who had
   characteristics for high risk of stroke were randomly assigned to conventional
   adjusted-dose warfarin therapy (international normalized ratio, 2.0 to 3.0) or
   low-dose combined therapy (warfarin [international normalized ratio, <1.5] plus 325
   mg/d of enteric-coated aspirin). The remaining 54 patients with low risk of stroke
   received 325 mg/d of enteric-coated aspirin. Results: hmong the 63 patients at high
   risk of stroke, abnormal values (>2 mg of hemoglobin per gram of stool) were
   detected in 11% and values greater than 4 mg of hemoglobin per gram of stool were
   found in 8%, Mean (+/-SD) values were more for those randomly assigned to receive
   combined therapy (1.7+/-3.3 mg of hemoglobin per gram of stool vs adjusted-dose
   warfarin therapy, 1.0+/-1.9 mg/g; P=.003), The 54 nonrandomized patients with low
   risk of stroke receiving aspirin alone had a mean (+/-SD) HemoQuant value of
   0.8+/-0.7 mg of hemoglobin per gram of stool 1 month after entry in the study.
   Conclusions: Abnormal levels of fecal hemoglobin excretion were common in
   elderly patients with high risk of atrial fibrillation 1 month after randomization to
   prophylactic antithrombotic therapy. Combined warfarin and aspirin therapy was
   associated with greater fecal hemoglobin excretion than standard warfarin therapy,
   suggesting the potential for increased gastrointestinal hemorrhage
Keywords:          age/ARCH/aspirin/atrial/atrial          fibrillation/bleeding/blood/clinical
  risk/low/MEDICAL/PREDICTION/prophylaxis/quantitative/risk/risk                             of
Schlicht, J.R., Davis, R.C., Naqi, K., Cooper, W. and Rao, B.V. (1996), Physician
  practices regarding anticoagulation and cardioversion of atrial fibrillation. Archives
  of Internal Medicine, 156 (3), 290-294.
Abstract: Background: Stroke is one of the most significant potential complications in
  patients who are undergoing cardioversion for atrial fibrillation. To minimize the risk
  of stroke, the American College of Chest Physicians' (ACCP's) Third Consensus
  Conference on Antithrombotic Therapy developed specific recommendations
  regarding anticoagulation before and following elective cardioversion of patients
  with atrial fibrillation. Objective: To determine if patients undergoing cardioversion
  for atrial fibrillation are administered anticoagulants according to the ACCP's Third
  Consensus Conference on Antithrombotic Therapy recommendations. Design: A
  retrospective review of cases of atrial fibrillation a