Predicting spontaneous early neurological recovery after acute ischemic stroke

We assessed predictors of spontaneous early neurological recovery after acute ischemic stroke by means of multivariate analysis in a cohort of 1,473 consecutive patients treated at one academic center. At hospital discharge, spontaneous neurological improvement or good outcome was defined as grades 0-2 of the Rankin scale, and poor outcome (no improvement or in-hospital death) as grades 3-5. Spontaneous recovery of neurological deficit at the time of discharge from the hospital was observed in 16% of patients with cerebral infarction (n = 238). Dysarthria-clumsy hand syndrome improved in 44% of patients and was the only variable significantly associated with in-hospital functional recovery in three logistic regression models that in addition to lacunar syndromes, included demographic variables, cardiovascular risk factors, and clinical variables [odds ratio (OR) 2.56], neuroimaging findings (OR 2.48), and outcome data (OR 2.39), respectively. Clinical factors related to severity of infarction available at stroke onset have a predominant influence upon in-hospital outcome and may help clinicians to assess prognosis more accurately. Our work gives a contribution into prognostic factors after acute ischemic stroke. With regard to patterns of stroke, dysarthria-clumsy hand syndrome was a significant predictor of spontaneous in-hospital recovery in ischemic stroke patients.     

老年非瓣膜性房颤脑卒中危险分层及抗凝现状分析

目的　对非瓣膜性房颤 (NVAF)脑卒中危险分层及基层医院抗凝现状分析。方法　选择NVAF住院患者 1 2 0例并分成ABC三组 ,分别统计脑卒中发生率 (五年 )。将治疗分a组 (未抗凝 ) ,b、c组 (阿司匹林抗血小板聚集 ) ,d组 (华法林抗凝 )。结果　 1 2 0例中A组脑卒中人数 1 3人 (59.1 % )。B组脑卒中人数 2 2人 (2 9.3 % )。C组 1人 (4.3 % )。A组与B组 ,B组与C组比较有明显差异 (P <0 .0 5)。d组脑卒中发生率为 0 ,明显优于a组。阿斯匹林≥ 1 50mg d(c组 ) ,脑卒中发生人数 3人 (1 2 .5 % ) ,与a组比有明显差异 (P <0 .0 5)。结论　A、B组脑卒中发生率明显高于C组 ,口服华法令及阿斯匹林可降低脑卒中发生率。基层医院对NVAF患者抗凝治疗不充分 ,脑卒中发生率高。     

Following Catastrophic Epilepsy Patients from Childhood to Adulthood

Summary:  As patients with catastrophic epilepsies move from childhood to adulthood, evolving and innovative therapeutic regimens are often required. However, the goal of providing the best quality of life while minimizing both seizures and side effects remains the same. Clinicians can develop appropriate care plans by being aware of patients' changing needs. Clinical symptoms of the catastrophic epilepsies may change over time; by understanding the natural history of a patient's condition, clinicians can help ease the transition from childhood to adulthood. Additionally, as children with catastrophic epilepsies become adults, medical issues (e.g., medication side effects, tolerance, and dependence) and nonmedical issues (e.g., guardian/caretaker issue, group home applications, and respite care options) must be considered when developing strategies for patient care. Regular assessment of patients, the development of emergency plans, and maintenance of consistency in the delivery of care are also important issues to consider. Finally, a multidisciplinary care plan that incorporates resources from health-care practitioners, social service professionals, and community agencies can be valuable in optimizing treatment for patients with catastrophic epilepsies.     

基层医院组建卒中小组的初步探讨

目的总结探索在基层医院组建卒中小组，治疗急性脑卒中的模式。方法组建包括社区网络在内的院内卒中小组，对脑卒中患者进行动态的全面评估和系统的个体化治疗。结果规范了急性脑卒中的临床治疗行为，改善了患者预后。结论在基层医院建立卒中小组是一种可行的治疗模式。     

Changes in cardiovascular function induced by verapamil in healthy subjects and in patients with ischemic heart disease

Alterations in cardiovascular function induced by the acute intravenous administration of verapamil (5 or 10 mg) in 52 patients (29 with ischemic heart disease and 23 without heart disease) were evaluated with use of invasive techniques (right and left heart catheterization, left ventricular cineangiography, and coronary arteriography). The most significant changes were represented by a decrease in systemic vascular resistance and systemic arterial pressure, and an increase in heart rate and cardiac output. Contractility indexes were not depressed in either group, and altered ventricular wall motion tended to improve to a slightly smaller degree than in patients treated with nitroglycerin. The use of verapamil in patients with ischemic heart disease appears to be safe, and concern about the negative inotropic influences in humans no longer seems justified.     

Impact of Retrograde Cerebral Perfusion on Ascending Aortic and Arch Aneurysm Repair

Purpose. The effect of retrograde cerebral perfusion on the incidence of stroke and death among patients undergoing repair of aneurysms of the ascending aorta and transverse arch was determined.

Material and Methods. Between January 1991 and March 1995, 161 patients were operated on for aneurysms of the ascending aorta and transverse arch. Thirty-three of the patients (20%) had an aneurysm of the ascending aorta only and 128 (80%) had aneurysms of both the ascending aorta and the transverse arch. All the patients underwent cardiopulmonary bypass, profound hypothermia, and circulatory arrest, and 120 (74%) also underwent retrograde cerebral perfusion. Median pump time was 143 minutes (range, 21 to 461 minutes). Median circulatory arrest time was 42 minutes (range, 8 to 111 minutes), and median myocardial ischemic time was 71 minutes (range, 14 to 306 minutes).

Results. The overall 30-day mortality rate was 6% (9 patients) and the incidence of stroke was 4% (7 patients). The use of retrograde cerebral perfusion demonstrated a protective effect against stroke (3 of 120 patients, or 3%) compared with no retrograde cerebral perfusion (4 of 41 patients, or 9%; odds ratio, 0.24; confidence interval, 0.06 to 0.99; p < 0.049). This was most significant in patients more than 70 years of age; none of the 36 elderly patients who received retrograde cerebral perfusion had a stroke, compared with 3 of the 13 (23%) who did not (p < 0.003). Only pump time was associated with an increased risk of stroke (odds ratio, 1.01; 95% confidence interval, 1.00 to 1.02; p < 0.005). Pump time also was associated with increased mortality (odds ratio, 1.01; 95% confidence interval, 1.00 to 1.02; p < 0.008).

Conclusion. Retrograde cerebral perfusion decreased the incidence of stroke in patients undergoing repair of aneurysms of the ascending aorta and transverse arch.     

尼莫地平复方丹参注射液治疗新生儿缺氧缺血性脑病疗效观察

目的观察尼莫地平联合复方丹参注射液治疗新生儿缺氧缺血性脑病(HIE)的疗效.方法 128例HIE患儿随机分为复方丹参注射液组32例,尼莫地平组,尼莫地平加复方丹参注射液,与对照组.结果复方丹参注射液组、尼莫地平组、尼莫地平加复方丹参注射液治疗组总有效率分别为81.3%(26/32)、80.0%(24/30)、97.1%(34/35),对照组总有效率为51.6%(16/31),P＜0.05.结论尼莫地平与复方丹参注射液在治疗HIE时有协同作用,疗效显著,未见副作用发生.