The influence of baseline prognostic variables on outcome after thrombolysis

Thrombolysis increases case fatality but reduces the proportion of disabled survivors in recent trials in acute ischaemic stroke, although some trials show much higher mortality rates than others. One possible explanation for the different outcomes between trials is that the treatment effect with thrombolysis varies with baseline prognostic factors such as stroke severity. We examined the interaction between baseline risk and thrombolysis on outcome using individual patient data from the Multicentre Acute Stroke Trial–Italy (MAST-I). A multiple logistic regression of the MAST-I data was performed to identify which factors, identifiable at randomisation, most strongly predict a poor functional outcome. We then stratified the patients into those with severe strokes and those with mild strokes and examined the effect of thrombolysis on (a) case fatality and (b) dependency at 6 months after the stroke in the 157 patients who received streptokinase alone and the 156 controls. Streptokinase was found to cause an absolute increase of about 3% in case fatality in both “severe” and “mild” strokes; however, there was a 12% reduction in the number of dead or dependent “mild” strokes but a 6% increase in “severe” strokes. The number of patients was small, and therefore neither finding was statistically significant. In this exploratory analysis, the hazard with streptokinase appears similar in “severe” and “mild” strokes, but the benefit may be greater in “mild” strokes. Thrombolysis may be more effective in patients with “mild” strokes, but more information is required to confirm this hypothesis. Received: 29 January 1999 Received in revised form: 13 April 1999 Accepted: 5 May 1999     

Ultrasound Densitometry of the Os Calcis in Patients with Hemiparesis Following a Cerebrovascular Accident

Ultrasound densitometry has been measured in the os calcis of 31 stroke patients (14 women, 17 men), ages 46–87 years, to determine whether bone density is lower than expected for normal subjects at this site, and to investigate whether or not the stroke side has lower values than the nonstroke side. We have also measured a large control group of 268(39 men, 228 women) subjects who showed similar values to other published data. Immobility is a known precursor to bone loss and so we also compared ultrasound Stiffness Index with an index of mobility in 22 of the stroke patients. In healthy subjects, ultrasound densitometry (measured as Stiffness) fell by 25% in females from 48–52 to 68–72 years. Stiffness (expressed as z-score) in patients with stroke was low in females (P < 0.02) but not in males, but both stroke side and nonstroke side were equally low. Stiffness did not decline with time since stroke, but did correlate with mobility after stroke, on the stroke (r = 0.73) and nonstroke (r = 0.62) side. The data suggest that stroke patients, particularly females, have low bone density before the stroke event. The greater ultrasound Stiffness with increasing mobility after stroke may suggest that active rehabilitation after stroke may produce denser bone. Received: 30 July 1997 / Accepted: 10 June 1999     

Quality of life of stroke survivors

Adaptation to stroke requires complex, long-term change in stroke survivors' lives. This study aimed at identifying those factors that influence quality of life (QOL) of geriatric stroke survivors 1–3 years post-discharge. The objectives were: to describe the overall quality of life of stroke survivors; to examine the relationships between sociodemographic variables, neurological variables, functional status, social support, perceived health status, depression, and overall QOL; and to determine the best predictors of QOL. Data were collected on 50 stroke survivors using a cross-sectional design and standardized questionnaires, including the Quality of Life Index, the Functional Independence Measure, the Social Support Inventory for Stroke Survivors and the Centre for Epidemiologic Studies Depression Scale. The overall quality of life of the study participants was low. The most important predictors of QOL were depression, marital status, quality of social support, and functional status. Depression was the strongest predictor of QOL. By employing a multi-dimensional perspective, this study confirmed that adaptation to stroke involves much more than physical function. Thus, rehabilitation programs for this group would be more effective if they are based upon a holistic approach.     

Utilization of cardiovascular drugs (blood pressure lowering drugs, lipid lowering drugs and nitrates) and mortality from ischaemic heart disease and stroke An ecological analysis based on Sweden's municipalities

Objective: To perform an ecological study in an effort to generate questions concerning the preventive impact of various cardiovascular drugs on mortality from stroke and ischaemic heart disease (IHD) in the community, and to explore the association between sales of nitrates and mortality from stroke and IHD. Methods: Out-patient drug utilization (sales) of blood pressure lowering drugs, lipid lowering drugs and nitrates were categorized in four groups of equal size by quartiles and compared with mortality from IHD and stroke, using the group of municipalities with the lowest utilization as reference, from 1989 to 1993 in 283 of Sweden's 288 municipalities, by Poisson regression. Adjustments were made for population size, age and gender proportions, the utilization rate of cardiovascular drugs other than the tested drug group and location of the municipality. Results: Compared with the group of municipalities with the lowest sales and adjusting only for population size, mortality from IHD and stroke increased with the extent of utilization of blood pressure lowering drugs and nitrates. In contrast, mortality decreased with increased utilization of lipid lowering drugs. After further adjustments by percentage of men, age structure, geographical location (mid-points) of the municipalities, and, as a proxy for cardiovascular disease, the sales of cardiovascular drugs other than the tested drug group, the increased risk associated with blood pressure lowering drugs disappeared, and there was a dose-response association between sales of diuretics and old antihypertensives and decreasing mortality, sales of nitrates continued to be associated with an increased risk, and the low mortality risk associated with sales of lipid lowering drugs persisted. Conclusion: Lipid lowering drugs may have a preventive impact in the general population, but the preventive impact of blood pressure lowering drugs, with the exception of diuretics and old antihypertensives, may be low in many municipalities. The safety of nitrates needs more investigation at the individual level. Received: 16 April 1998 / Accepted in revised form: 10 November 1998     

Long-term lowering of blood pressure after carotid and vertebrobasilar ischemic stroke

We followed up 107 patients experiencing a first-ever ischemic stroke after having been affected by essential hypertension for at least one year, in order to analyze the phenomenon of post-stroke blood pressure lowering. Of the 82 patients still surviving after three months of follow-up, 44 (54%) had normal arterial blood pressure values. There were no significant differences between these normotensive patients and the 38 with high blood pressure in terms of cerebrovascular risk factors or disability, but blood pressure normalized in 34 of the 54 patients experiencing a carotid stroke (63%) and in only 10 of the 28 experiencing vertebrobasilar stroke (36%) (p=0.035). These data may offer a starting point for further studies of the neurogenesis of arterial hypertension.

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Sommario Al fine di analizzare il fenomeno della normalizzazione della pressione arteriosa dopo ictus cerebrale in pazienti prima ipertesi, abbiamo osservato 107 soggetti con primo ictus ischemico, che erano già precedentemente affetti da ipertensione arteriosa da almeno un anno. Degli 82 (77%) sopravvissuti a tre mesi di follow-up, 44 (54%) hanno mostrato una normalizzazione della pressione arteriosa. L'incidenza di fattori di rischio per malattia cerebrovascolare e disabilità grave non è risultata significativamente diversa nel gruppo degli ipertesi rispetto ai normotesi. Tuttavia la normalizzazione della pressione arteriosa è stata osservata in 34 dei 54 pazienti con ictus carotideo (63%) e solo in 10 dei 28 con ictus vertebrobasilare (36%) (p=0.035). Riteniamo che tali dati offrano uno spunto per ulteriori ricerche sulla genesi neurogena dell'ipertensione arteriosa essenziale.

     

舌针治疗假性延髓麻痹45例疗效观察

目的观察舌针治疗中风假性延髓麻痹的疗效.方法将90例患者随机分为治疗组和对照组各45例,治疗组取舌针的心穴、脾穴、肾穴治疗,对照组单纯体针治疗,均12次为一疗程,治疗2个疗程观察疗效.结果治疗组总有效率91.1%,对照组64.4%,两组比较,差异有非常显著性意义(P<0.01).结论舌针治疗中风假性延髓麻痹优于单纯体针治疗,是一种较理想的治疗方法.     

头针治疗中风病实验研究的思路和方法

本文查阅头针治疗中风病的有关文献并结合课题组的研究成果 ,阐述了头针治疗中风实验研究中的一些新思路和方法 ,主要有 :①建立标准化的中风动物模型 ;②中医头穴线在动物模型上的模拟 ;③头针在动物模型上的针刺手法及刺激量 ;④头针治疗中风病的时机选择 ;⑤头针治疗中风的即刻效应 ;⑥头针治疗中风的机制及检测指标的选择。为头针治疗中风病的实验研究提供参考     

益肾养心通督针法对中风患者载脂蛋白的影响:附27例临床疗效观察

目的　观察益肾养心通督针法对中风患者载脂蛋白及临床疗效的影响。方法与结果　将 5 0例中风患者的载脂蛋白A(Apo A1 )、载脂蛋白 B(Apo B1 0 0 )与正常人比较 ,再将 5 0例中风患者随机分为益肾养心通督组 2 7例 (观察组 )和阳明经穴组(对照组 ) 2 3例 ,均治疗 30 d,观察治疗前后 Apo A、B变化 ,神经功能缺损积分及总体疗效。针刺后 Apo A1 升高 Apo B1 0 0 降低 ,神经缺损评分较治疗前大幅度降低。两组比较存在显著性差异 (P<0 .0 1)。结论　在改善载脂蛋白水平和临床疗效方面 ,观察组都优于对照组 (P<0 .0 5 )     

通关利窍针法治疗中风致假性延髓麻痹临床观察

目的　观察通关利窍针法治疗中风致假性延髓麻痹的疗效。方法　将 10 0例患者随机分为治疗组和对照组各 5 0例 ,治疗组采用通关利窍针法 ,对照组采用康复训练法 ,均 14次为 1个疗程 ,疗程间休息 3日 ,2个疗程后评定疗效。结果　治疗组总有效率 96 .4 % ,对照组 2 4 % ,两组差异有显著性意义 (P<0 .0 5 ) ,治疗组疗效和年龄、病程、病情轻重有关。结论　通关利窍针法治疗中风后假性延髓麻痹优于康复训练法