bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence and prognosis of secondary ventricular fibrillation in acute myocardial infarction. Evidence for a protective effect of thrombolytic therapy. GISSI Investigators.
Authors: Volpi A , Cavalli A , Santoro E , Tognoni G
Published: June 2011

The multicenter randomized study of the Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico has provided the opportunity to analyze the impact of thrombolytic treatment on secondary ventricular fibrillation incidence in a large population of patients (11,712) with acute myocardial infarction. A reduction of about 20% in the frequency of secondary ventricular fibrillation was observed among patients allocated to thrombolytic treatment (streptokinase, 2.4% versus control, 2.9%; relative risk, 0.80; 95% confidence interval, 0.64-1.00). Streptokinase appeared to exert its protective effect specifically in patients treated within 3 hours of onset of symptoms (streptokinase, 2.6% versus control, 3.7%; relative risk, 0.71; 95% confidence interval, 0.53-0.95). This protection was essentially due to a reduced incidence of late ventricular fibrillation occurring after the first day of hospitalization. The 311 patients with secondary ventricular fibrillation represented an overall incidence of 2.7%. Such incidence was not related to infarct location or sex but was significantly more common in patients older than 65 years (3.3% versus 2.3% in younger patients). A significant excess of in-hospital deaths was found in patients with secondary ventricular fibrillation compared with those in the reference group (38% versus 24%; relative risk, 1.98; 95% confidence interval, 1.56-2.52). Conversely, secondary ventricular fibrillation was not a predictor of 1-year mortality for hospital survivors. Thrombolytic treatment with intravenous streptokinase affords protection against secondary ventricular fibrillation most probably by a limitation of infarct size. When the arrhythmia complicates the course of infarction, it is associated with an adverse short-term outcome, whereas the long-term prognosis is not influenced.
Onset of altered interventricular septal motion during cardiac surgery. Assessment by continuous intraoperative transesophageal echocardiography.
Authors: Lehmann K G , Lee F A , McKenzie W B , Barash P G , Prokop E K , Durkin M A , Ezekowitz M D
Published: June 2011

Abnormal motion of the interventricular septum is frequently observed after uncomplicated cardiac surgery. We sought to elucidate the mechanism underlying this phenomenon by using continuous echocardiographic imaging of the heart from a constant transesophageal location in 21 patients undergoing their first cardiac operation. Quantitative global and regional functional analyses were performed in each patient at baseline (stage 1), after median sternotomy (stage 2), after sternal retraction (stage 3), after pericardiotomy (stage 4), after completion of cardiopulmonary bypass (stage 5), and after chest closure (stage 6). During the first four surgical stages, mean left ventricular fractional shortening varied little among regions with a fixed reference system (maximum range, 31.6-39.2%; p = NS) but changed dramatically after the discontinuation of cardiopulmonary bypass (stage 5). The apparent medial hypokinesis that was observed (4.9 +/- 4.7% [SD]) was accompanied by lateral hyperkinesis (65.2 +/- 4.1%, p less than 0.0001). These regional differences were completely eliminated with a floating reference system (33.6 +/- 2.7% for medial, and 34.8 +/- 1.7% for lateral; p = NS), suggesting cardiac translation. Quantitative curvature analysis supported this conclusion, with preservation of baseline regional curvature seen throughout the procedure. The mean length of individual translational vectors (reflecting systolic movement of the endocardial centroid) remained minimal (less than or equal to 1.0 mm) through stage 4 but increased more than fourfold at stage 5, continuing in a medial direction after chest closure (5.2 +/- 3.0 mm and 271 +/- 6 degrees from anterior). Thus, abnormal postoperative septal motion is not caused by removal of restraining forces of the pericardium or anterior mediastinum but rather appears to be directly related to events occurring during cardiopulmonary bypass.
Myocardial stiffness derived from end-systolic wall stress and logarithm of reciprocal of wall thickness. Contractility index independent of ventricular size.
Authors: Nakano K , Sugawara M , Ishihara K , Kanazawa S , Corin W J , Denslow S , Biederman R W , Carabello B A
Published: June 2011

The slope of the end-systolic pressure-volume relation (ESPVR) is useful in assessing acute changes in contractile state. However, a limitation of ESPVR is that its slope decreases progressively as ventricular size increases without this change necessarily indicating a change in contractile state. In this respect, an index of contractile function that is independent of ventricular size would have an obvious advantage. The exponential constant (k) of the end-systolic relation between wall stress (sigma) and the natural logarithm of the reciprocal of wall thickness [ln(1/H)], sigma = Cekln(1/H), corresponds to the stiffness constant of the myocardium (kSM), a contractile index that should be independent of ventricular size and geometry. To examine the size independence of kSM, we studied left ventricular kSM during beta-blockade (to stabilize inotropic state) in 25 normal dogs with greatly differing ventricular sizes whose end-diastolic volumes ranged from 14 to 82 ml. The kSM was nearly constant (3.6 +/- 0.4) over this wide range of end-diastolic volumes and thus was independent of end-diastolic volume. Conversely, ESPVR, also obtained during beta-blockade, was closely and negatively correlated to end-diastolic volume (r = 0.92). To test the ability of kSM to measure changes in contractile state, we altered contractile state pharmacologically. The kSM increased from 3.7 +/- 0.5 to 4.8 +/- 0.8 (p less than 0.01) with infusion of dobutamine (after reversal of beta-blockade) and decreased to 3.1 +/- 0.3 (p less than 0.05) with inhalation of isoflurane, a negative inotrope, during beta-blockade (p less than 0.05). We conclude that kSM is independent of ventricular size and is sensitive to changes in inotropic state. As such, it should be useful as an index of contractile function.
Long QT interval syndrome. A new look at an old electrocardiographic measurement--the power of the computer.
Authors: Laks M M
Published: June 2011

Because clinical studies frequently include only a marginal number of patients, these relatively new, robust statistical techniques will have increased use. The utilization of ROC curves will be more commonplace because they permit the comprehension of the data in a more dynamic mode than merely the reporting of sensitivities and specificities.
Effects of tissue-type plasminogen activator and anisoylated plasminogen streptokinase activator complex on mortality in acute myocardial infarction.
Authors: Held P H , Teo K K , Yusuf S
Published: June 2011

An overview of eight randomized controlled trials of tissue-type plasminogen activator (Alteplase or Duteplase) and 10 of anisoylated plasminogen streptokinase activator complex (Anistreplase) showed that the odds of early death were reduced by 29% by tissue-type plasminogen activator and 46% by anisoylated plasminogen streptokinase activator complex, with overlapping 95% confidence intervals. Although the beneficial effects of both agents are consistent and are strengthened when all the trials are considered together, the available data do not permit comparisons of the relative efficacy of these two agents with each other or with streptokinase.
Late potentials and inducible ventricular tachycardia in surgically repaired congenital heart disease.
Authors: Stelling J A , Danford D A , Kugler J D , Windle J R , Cheatham J P , Gumbiner C H , Latson L A , Hofschire P J
Published: June 2011

We compared signal-averaged electrocardiography with invasive electrophysiological study in patients after surgical repair of congenital heart disease to determine if potentially useful correlations exist between the two methods for assessment of risk for ventricular tachycardia. Thirty-one patients (age, 1-49 years; mean, 10.6 years) with congenital heart disease repaired with right ventriculotomy or postrepair right bundle branch block (77% postoperative tetralogy of Fallot) who had electrophysiological study were studied with signal-averaged electrocardiography. Patients were classified by electrophysiological study results as having no inducible ventricular tachycardia, nonsustained ventricular tachycardia, or sustained ventricular tachycardia. Signal-averaged electrocardiograms were examined for the duration of low-amplitude (less than or equal to 40 microV) QRS signal, duration of total QRS, and root-mean-square voltage of the terminal 40 msec of the QRS. Low-amplitude terminal root-mean-square voltage of 100 microV or less had 91% sensitivity and 70% specificity for ventricular tachycardia inducible by electrophysiological study. Similar sensitivity but less specificity were seen using the criterion of 20 msec or more total low-amplitude QRS signal (initial plus terminal) or using total QRS duration of 128 msec or more. There was a weaker association between terminal low-amplitude QRS signal of 15 msec or more and inducible ventricular tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)
Neutralization of low molecular weight heparin by polybrene prevents thromboxane release and severe pulmonary hypertension in awake sheep.
Authors: Montalescot G , Zapol W M , Carvalho A , Robinson D R , Torres A , Lowenstein E
Published: June 2011

Protamine reversal of heparin anticoagulation in patients is occasionally associated with life-threatening acute pulmonary hypertension. In a sheep model, we evaluated the effect on this adverse cardiopulmonary reaction of modifying the type of heparin (low molecular weight heparin compared with unfractionated heparin) and the type of heparin antagonist (polybrene compared with protamine). Protamine reversal of low molecular weight heparin (LMWH) and polybrene reversal of unfractionated heparin induced more than a 10-fold increase of plasma thromboxane B2 levels, a threefold increase of pulmonary vascular resistance and pulmonary artery pressure, and a 25% decrease of PaO2. A similar adverse reaction followed protamine reversal of conventional unfractionated heparin. However, with polybrene (1 mg/kg) reversal of LMWH (1 mg/kg), we measured neither pulmonary hypertension (pulmonary artery pressure was 22.6 +/- 3.6 mm Hg at 1 minute after polybrene reversal of LMWH compared with 47.9 +/- 4.2 mm Hg after protamine reversal of unfractionated heparin, p less than 0.005 groups differ), hypoxemia (PaO2 was unchanged 2 minutes after polybrene compared with a decrease of 26 mm Hg 2 minutes after protamine, p less than 0.05), nor acute release of thromboxane into arterial plasma (thromboxane B2 was 0.2 +/- 0.1 at 1 minute after polybrene compared with 3.7 +/- 1.7 ng/ml at 1 minute after protamine, p less than 0.005). The hemodynamic effects and mediator release were also benign after neutralization of larger doses of LMWH (3 mg/kg) by polybrene (3 mg/kg). The increases of activated clotting time and activated partial thromboplastin time due to both types of heparin were completely reversed with polybrene. Anti-Xa activity increased to more than 3 IU/ml 4 minutes after LMWH anticoagulation (p less than 0.01) but was only partially neutralized by polybrene. Various polyanion-polycation complexes that are formed when heparin anticoagulation is reversed induce thromboxane release and acute pulmonary vasoconstriction in awake sheep. Reversal of LMWH anticoagulation with polybrene does not elicit this adverse reaction.
Thromboxane receptor blockade prevents pulmonary hypertension induced by heparin-protamine reactions in awake sheep.
Authors: Montalescot G , Lowenstein E , Ogletree M L , Greene E M , Robinson D R , Hartl K , Zapol W M
Published: June 2011

We used competitive thromboxane A2-prostaglandin endoperoxide receptor blockade (SQ 30,741) as a probe to evaluate the role of thromboxane in ovine pulmonary vasoconstriction associated with protamine reversal of heparin anticoagulation. Control heparin-protamine reactions induced rapid release of thromboxane into arterial plasma (more than 1 ng/ml plasma), a 2.5-fold increase of pulmonary artery pressure, a 20% decrease of PaO2, and a 30% reduction in arterial white blood cell concentration. After giving SQ 30,741 despite similar thromboxane release into arterial plasma after heparin-protamine challenge, acute pulmonary hypertension was significantly reduced when 94% of pulmonary vascular smooth muscle thromboxane receptors were occupied with SQ 30,741 (p less than 0.01 at 1 minute after protamine versus control heparin-protamine reaction) and was completely abolished by a 10 mg/kg i.v. bolus (p less than 0.0001 at 1 minute after protamine versus control). Peripheral leukopenia was not affected by SQ 30,741 prophylaxis, but hypoxemia was prevented. We conclude that thromboxane causes pulmonary vasoconstriction in ovine heparin-protamine-induced pulmonary hypertension. Pulmonary vasoconstriction and hypoxemia can be completely prevented by thromboxane receptor blockade.
Current status of antitachycardia devices.
Authors: Rosenthal M E , Josephson M E
Published: June 2011

With the limitations of currently available modalities for treating clinically important tachycardias, the role of implanted antitachycardia devices will continue to expand. The challenge of the future will not only involve continued technological advances but the socioeconomic impact of this efficacious but expensive mode of therapy in an era of increasing financial restraints. Further studies to definitively prove the efficacy of more widespread use of antitachycardia device therapy will be needed.
Catheterization laboratory events and hospital outcome with direct angioplasty for acute myocardial infarction.
Authors: Kahn J K , Rutherford B D , McConahay D R , Johnson W L , Giorgi L V , Shimshak T M , Ligon R W , Hartzler G O
Published: June 2011

To assess the safety of direct infarct angioplasty without antecedent thrombolytic therapy, catheterization laboratory and hospital events were assessed in consecutively treated patients with infarctions involving the left anterior descending (n = 100 patients), right (n = 100), and circumflex (n = 50) coronary arteries. The groups of patients were similar for age (left anterior descending coronary artery, 59 years; right coronary artery, 58 years; circumflex coronary artery, 62 years), patients with multivessel disease (left anterior descending coronary artery, 55%; right coronary artery, 55%; circumflex coronary artery, 64%), and patients with initial grade 0/1 antegrade flow (left anterior descending coronary artery, 79%; right coronary artery, 84%; circumflex coronary artery, 90%). Cardiogenic shock was present in eight patients with infarction of the left anterior descending coronary artery, four with infarction of the right coronary artery, and four with infarction of the circumflex coronary artery. Major catheterization laboratory events (cardioversion, cardiopulmonary resuscitation, dopamine or intra-aortic balloon pump support for hypotension, and urgent surgery) occurred in 10 patients with infarction of the left anterior descending coronary artery, eight with infarction of the right coronary artery, and four with infarction of the circumflex coronary artery (16 of 16 shock and six of 234 nonshock patients, p less than 0.001). There was one in-laboratory death (shock patient with infarction of the left anterior descending coronary artery).(ABSTRACT TRUNCATED AT 250 WORDS)
Coronary atherosclerosis is associated with left ventricular dysfunction and dilatation in aortic stenosis.
Authors: Vekshtein V I , Alexander R W , Yeung A C , Plappert T , Sutton M G , Ganz P , Selwyn A P , Bittl J A
Published: June 2011

Patients with aortic stenosis develop widely variable patterns of left ventricular hypertrophy and dysfunction. We postulated that coronary atherosclerosis (CAD) may be associated with impaired left ventricular function and chamber dilatation in patients with aortic stenosis. Left ventricular mass and volumes were quantified from two-dimensional echocardiography and correlated with coronary angiography in 78 patients with severe aortic stenosis and no previous myocardial infarction or regional wall motion abnormalities. Eighteen patients (group 1) had smooth coronary arteries, 25 patients had irregular coronary arteries with 50% or less stenosis (group 2), and 35 patients had obstructive CAD (group 3). Even though the calculated valve area was similar in all three study groups, group 1 patients had higher values for ejection fraction (65 +/- 9%, 51 +/- 17%, and 48 +/- 13%; p = 0.0002), systolic mass-to-volume ratio (9.2 +/- 3.9, 5.6 +/- 2.8, and 5.2 +/- 2.2; p = 0.0001), and cardiac index (2.9 +/- 0.7, 2.5 +/- 0.7, and 2.3 +/- 0.6 l/min.min2; p = 0.015) than patients in groups 2 and 3, respectively (mean +/- SD). Mean circumferential wall stress was inversely related to severity of CAD. Multivariate analysis showed that CAD is an independent predictor of ejection fraction and mass-to-volume ratio in this group of patients. Thus, in an elderly population with severe aortic stenosis, patients with both obstructive and nonobstructive CAD have an increased incidence of left ventricular enlargement and systolic dysfunction.
Determinants of smooth muscle injury during balloon angioplasty.
Authors: Fischell T A , Grant G , Johnson D E
Published: June 2011

To study the determinants of smooth muscle injury during balloon angioplasty, we conducted a series of experiments to examine the effects of degree of arterial stretching, duration of balloon inflation, and arterial precontraction on smooth muscle injury after balloon angioplasty in isolated, perfused whole-vessel segments of rabbit aortas and dog carotid arteries. Freshly dissected rabbit thoracic aortas and dog carotid arteries were mounted in a muscle bath-perfusion chamber and perfused at 80 mm Hg. The proximal half of each aorta was dilated with a 5-mm (41 +/- 6% stretch), 6-mm (64 +/- 6% stretch), or 8-mm (97 +/- 9% stretch) balloon angioplasty catheter, and the uninjured half of each vessel served as the control. The vasoconstrictor behavior of the dilated segment was then assessed by dose-response testing; long-axis, ultrasonic imaging combined with computerized edge-detection image processing was used to measure changes in segmental internal vessel diameters that were induced by phenylephrine. A similar series of experiments was performed in dog carotid arteries with 5-mm balloon catheters (42 +/- 2% stretch) to compare the susceptibility to smooth muscle injury between elastic (aortic) and muscular (carotid) arteries. Additional experiments were performed to determine the roles of prolonged (30 minutes) balloon inflation and arterial precontraction on smooth muscle injury after balloon angioplasty. In rabbit aortas, the dilated arterial segments demonstrated normal reactivity to phenylephrine after dilatation with 5- and 6-mm balloons (p = NS versus control). Severe smooth muscle injury (histopathologically) with "arterial paralysis" was observed after severe stretch (8-mm balloon) and after 5-mm balloon dilatation (46 +/- 5% stretch) in precontracted vessels. Prolonged balloon inflations did not impair aortic vasoconstrictor behavior. Dog carotid (muscular) arteries demonstrated angioplasty-induced smooth muscle injury with less severe degrees of stretch (47-52% stretch). Geometric modeling suggests that medial stretching during balloon angioplasty of diseased vessels in vivo is in the range of 15-41%.(ABSTRACT TRUNCATED AT 400 WORDS)
The Stroke Team Concept as Implemented in the Area VIII Regional Medical Program
Authors: TESMAN BERTRAM L. , MICHELA BERNARD J.
Published: June 2011

A training program for hospital "stroke teams," consisting of physician, nurse-coordinator and physical therapist, is a unique feature of the Area VIII Regional Medical Program. Training in team concept of stroke management based on the experience of Memorial Hospital of Long Beach will be offered Area-wide. Thirty acute hospitals and 73 extended-care facilities located within Area VIII will participate.

It is stipulated that each team completing such training at Long Beach return to its own hospital to put the new approach and methods into effect, and also to train backup teams where personnel is available. Professional faculty will make follow-up visits to gauge the effectiveness of the training program both in application of the technique by the team and in influencing total approach to the care of stroke patients.

Extended-care facilities also are urged to participate, in line with their own staffing patterns. The Easter Seal Rehabilitation Center of Orange County will cooperate by providing other disciplines for the stroke team when and where needed.

While quantitative evaluation of results may be unfeasible, it is anticipated that the qualitative effects of this new program will be reflected in better care for the stroke patient, enhanced opportunities for return to self-sufficient living, and (hopefully) eventual improvement in the morbidity, mortality and residual-disability statistics for stroke.
Cranial Arterial Circulation and Ocular Pulsations in the Dog
Authors: PATTERSON RUSSEL H. , HELMKAMP FREDERICK B.
Published: June 2011

The form of the ocular pulse in anesthetized dogs resembled an arterial pressure tracing. Obstructing the carotid artery reduced the amplitude of the pulse in the ipsilateral eye, but if collateral circulation through the basilar artery remained intact, the pulse soon returned to normal. Division of the basilar artery by itself temporarily increased the pulse amplitude in both eyes, probably reflecting increased collateral circulation through the carotid arteries. A 14% reduction in carotid blood flow or a 4% reduction in carotid blood pressure reduced the amplitude of the ocular pulse by 10% in dogs.
Cerebral Circulation Studies Using Inhaled 133-Xenon and the Gamma Camera
Authors: KLASSEN ARTHUR C. , RESCH JOSEPH A. , LOKEN MERLE K. , JOHNSON EUGENE A.
Published: June 2011

Inhaled 133-xenon was utilized in conjunction with the Anger gamma scintillation camera to evaluate cerebral circulation in 20 asymptomatic control subjects and in 41 patients with clinical cerebrovascular disease. Sequental cerebral scintiphotos thus obtained revealed focal areas of decreased activity in 2 of 19 control subjects and in 15 of 38 patients. A computerized curve-fitting technique was used to calculate an index of cerebral blood flow ("K") by means of the 133-xenon clearance curves obtained from each half of the head. Shorter periods of 133-xenon inhalation resulted in more rapid rates of clearance. In patients with clinical cerebrovascular disease, cerebral clearance rates tended to be lower and to show more variation between the two sides of the head than in asymptomatic subjects.
Internal Carotid Artery Occlusion Diagnosed by Doppler Ultrasound
Authors: MAROON JOSEPH C. , CAMPBELL ROBERT L. , DYKEN MARK L.
Published: June 2011

Using a transcutaneous Doppler ultrasonic blood velocity detector, retrograde ophthalmic artery blood flow was demonstrated in four patients, all of whom had angiographically confirmed occluded internal carotid arteries. In three, compression of the facial artery obliterated the ophthalmic artery signal. In a fourth patient compression of the superficial temporal artery produced the same result.

The technique presently used to monitor ophthalmic artery blood flow and to detect retrograde ophthalmic flow is described. This simple method appears to be at least as useful as ophthalmodynamometry in the routine evaluation of patients for extracranial occlusive disease, is easier to perform, and has a wider range of application.
Localization of Radioisotope (Chlormerodrin Hg-203) in Experimental Cerebral Infarction
Authors: DUDLEY ALDEN W. , LUNZER STEVEN , HEYMAN ALBERT
Published: June 2011

A combined histological and radioautographical study was made to determine the mechanism for the selective localization of Hg-203-labelled Chlormerodrin in the brain of 13 cats with experimentally induced cerebral infarction.

The presence of the radioactive tracer in the infarcted areas was noted within a few days after the onset of the lesions and was increased by hemorrhage into the tissues. The radioautograms revealed the radioactive material to be localized mostly within macrophages and in areas surrounding capillary proliferation. These two pathoanatomic processes associated with necrosis of the cerebral tissues most likely account for the abnormal accumulation of radionuclide tracer in brain scans of patients with cerebral infarction.
Direct Thermometry, Ophthalmodynamometry, Auscultation and Palpation in Extracranial Cerebrovascular Disease: An Evaluation of Rapid Diagnostic Methods
Authors: SHAPIRO HARVEY M. , NG LAWRENCE , MISHKIN MARK , REIVICH MARTIN
Published: June 2011

The ability of four rapid diagnostic tests—direct thermometry, ophthalmodynamometry, and bruit and pulse assessment—to discriminate for the presence or absence of significant extracranial cerebrovascular disease is examined. Utilized separately thermometry, ophthalmodynamometry and the examination for a bruit will find over 75% to 85% of cases. Pulse assessment alone reveals only 40% of significant lesions. The combination of neck examination for the presence of a bruit or pulse deficit alone will discover 93% of the vascular lesions. In the present series 100% of cases were found by including either direct thermometry or ophthalmodynamometry in combination with the aforementioned two tests.

Ophthalmodynamometry accurately located the side of the major lesion in more than 90% of the cases. The direct thermometry technique scored below 40% in lesion localization. It is suggested that the thermometry technique, because of the ease of its performance, should be utilized in combination with the neck examination as the preliminary step in assessing patients with suspected extracranial cerebrovascular disease. Ophthalmodynamometry should then be used for more accurate localization of the lesion prior to angiography.
Bruits of the Head and Neck
Authors: WELCH LAUREN K. , CROWLEY WILLIAM J.
Published: June 2011

Three hundred twenty male ambulatory outpatients were studied for the presence of bruits of the head and neck as well as for other clinical and laboratory characteristics pertinent to the vascular system. One hundred sixteen were referred for evaluation without medical or neurological complaint. Neck bruits were heard in only three of the 320 men.
Precipitating Factors, Prognosis, and Demography of Cerebrovascular Disease in an Indiana Community: A Review of All Patients Hospitalized from 1963 to 1965 With Neurologica Examination of Survivors
Authors: DYKEN MARK L.
Published: June 2011

As an initial step in studying the characteristics of cerebrovascular disease in a geographically limited segment of population, the hospital records of 285 patients coded as "CNS vascular" in the Elkhart General Hospital (Indiana) were reviewed for the years 1963, 1964 and 1965 by a team of neurology residents, under the supervision of the author. Information from examination of almost half the group by a team of neurologists and data from relatives, family physicians, hospital records and death certificates concerning the remainder led to the conclusion that the original diagnosis of "CNS vascular" could not be substantiated in 25 patients (9%), was cerebral infarction in 125 (53%), cerebral hemorrhage in 40 patients (14%), subarachnoid hemorrhage in 21 patients (7%), generalized atherosclerosis in 24 patients (8%), and transient focal cerebral ischemic attacks in 25 patients (9%).

Disorders such as diabetes, hypertension, heart disease, myocardial infarction, auricular fibrillation and genitourinary disease were significantly more frequent in patients with cerebral infarction than in a group of similar age and sex patients collected from the same hospital in an attempt to form a "contrast group." However, hypertension was the only disorder significantly more often associated with cerebral hemorrhage.

Cigarette consumption was increased at a highly significant level in the males who had infarction and the prognosis was, in general, unfavorably affected by older age, further cerebrovascular events, and abnormal electrocardiograms. Eighty-three percent of the patients with cerebral hemorrhage died during initial hospitalization.
The Fate of Hypertensive Patients with Clinically Proven Spontaneous Intracerebral Hematomas Treated Without Intracranial Surgery
Authors: SCOTT MICHAEL , WERTHAN MERYLEE
Published: June 2011

Twenty-five hypertensive patients who had clinically proven intracerebral hematomas, mainly in the internal capsule, were not treated surgically because of stabilization or improvement of their condition or because of extreme brain damage. All of these patients were treated medically, although therapy was not standardized. Ten of the 25 patients were discharged from the hospital and 15 died during their acute illness. Long-term follow-up was ultimately accomplished and the results are recorded. Profound disturbance in sensorium and abnormal pupillary or corneal reflexes were present in those who died, whereas in the group that survived only two patients had coma or stupor and none had bilateral involvement of pupillary or corneal reflexes. Analysis of a group of patients receiving surgery for intracerebral hemorrhage revealed that the mortality was 65%; thus, the results of conservative or surgical therapy were essentially the same.
Effects of Inhalation of Oxygen on Blood Flow and Microvasculature of Ischemic and Nonischemic Cerebral Cortex
Authors: REGLI FRANCO , YAMAGUCHI TAKENORI , WALTZ ARTHUR G.
Published: June 2011

The right middle cerebral artery was occluded in cats, and Pa

o
o2

was increased by increasing the amount of oxygen inhaled by the animals at atmospheric pressure. Cortical blood flow (CBF) was measured with Krypton-85, and observations and photographs of the superficial cortical microvasculature were made bilaterally. In two of five animals, increasing the Pa

o
o2

caused constriction of surface arterioles of the nonischemic hemispheres, with an associated decrease of CBF; in the three other animals, there were no circulatory responses to the increased Pa

o
o2

. In seven animals, increasing the Pa

o
o2

had no apparent effect on CBF or arteriolar caliber of the ischemic cerebral hemispheres. In four animals, at Pa

o
o2

greater than 400 torr, reactivity to increases of Pa

CO
CO2

was preserved in nonischemic cortex but impaired in ischemic cortex. Reddening of venous blood of the microvasculature of ischemic cerebral cortex occurred when Pa

o
o2

was increased, indicating that more oxygen was made available to the ischemic cerebral tissue. However, no beneficial effects could be demonstrated on the changes in the microvasculature produced by ischemia.
Spontaneous Ischemic Infarction of the Spinal Cord with Traumatic Sequela
Authors: BURTON CHARLES
Published: June 2011

What is believed to have been spontaneous infarction of the spinal cord is reported in two individuals with known chronic cardiovascular disease apparently causing paraparesis while driving motor vehicles. Although blunt trauma to the spinal cord cannot be ruled out, there was no objective evidence of such. The history of spontaneous onset of paraplegia prior to trauma is clear in the first case but could only be inferred in the second case.
Opacity Pulse Propagation in Internal and External Carotid Vascular Beds of Experimental Animals
Authors: HECK ALBERT F.
Published: June 2011

Opacity pulses and opacity pulse propagation times were recorded from the external carotid arterial bed (ear) and from the ipsilateral internal carotid arterial bed of the pial-cortical surface within the closed skull of conscious monkeys and anesthetized cats during the resting state and during carotid compression. Propagation of opacity pulses to the ear precedes those to the ipsilateral brain by 10 to 100 msec. Mean values of all pulse propagation time measurements to both brain and ear during successive cardiac cycles are stable from one minute to the next in the resting state. With compression of the common carotid artery, pulse propagation time to both beds is prolonged for the duration of compression, returning promptly to precompression levels with release of the artery, but the degree of prolongation is more marked in the external carotid bed. It is suggested that the consistent differences observed in both species between opacity pulses and pulse propagation times in the two beds, as well as the difference in responses to carotid compression, may result from inherent differences in properties of the vascular wall in the beds concerned, and/or from differences in collateral circulatory pathways subserving these beds during carotid artery obstruction.
Cerebrovascular Disease: Frequency and Population Selectivity in an Upper Midwestern Community
Authors: ALTER MILTON , CHRISTOFERSON LEE , RESCH JOSEPH , MYERS GARY , FORD JANET
Published: June 2011

The number of new strokes diagnosed in the communities of Fargo, North Dakota, and Moorhead, Minnesota, was determined by intensive review of medical records in all hospitals, clinics and nursing homes in the area for the period 1965 to 1966. These two adjacent communities have unusual advantages for such a study because their neurological diagnostic facilities are of excellent quality, the population served is stable, and the communities are isolated from other medical facilities by many miles.

Out of a population of 94,000 about one-third of which was over 35 years of age and almost all of which was white, a total of 408 patients were diagnosed as having suffered a new cerebral thrombosis (154 cases), hemorrhage (66 cases), embolus (15 cases), subarachnoid hemorrhage (30 cases) or unspecified CVA (143 cases). The average annual incidence of these strokes was respectively 83, 35, 8, 16 and 76 per 100,000 population. These rates are similar to the rates reported elsewhere in a United States, a Japanese and an English community in which similar case-finding methods were used. The similarity in incidence of various types of stroke suggested by these data is in contrast to the appreciable differences in frequency suggested by mortality data. The possibility exists, therefore, that geographical differences in stroke rates based on mortality may represent an artifact. More valid measures of frequency and population selectivity of cerebrovascular disease may show that this disease, unlike coronary vascular disease, is actually similar in populations differing widely in environmental and racial characteristics.

Besides the average annual frequency of strokes, the age-specific frequencies were calculated and revealed a marked increase of all types with age over 40 years except for subarachnoid hemorrhage. The latter showed a bimodal age distribution with peaks in the fifth and after the seventh decade. Seasonal incidence and mortality showed a spring and late fall peak. The sex differences in frequency were very small over a wide age range.

Data were also collected on brain stem vascular accidents, ischemic attacks and cerebral arteriosclerosis. An additional 245 patients were listed under these rubrics. These vascular events tend to be underreported and accuracy of diagnosis may be less. Moreover, comparable data from other communities using similar case-ascertainment techniques are lacking. However, if they were included, the average annual incidence of "strokes" would be 347 per 100,000 population.

Additional community-wide studies with special attention to ischemic attacks, brain stem vascular accidents and patients labeled vaguely as cerebral arteriosclerosis would probably yield a more accurate estimate of the true frequency of cerebrovascular accidents. Ideally, all such patients should be examined neurologically and classified according to standardized criteria if data are desired which can be compared among different communities.
Cerebrovascular Disease of Young Adults in a Mississippi Teaching Hospital
Authors: HAERER ARMIN F. , SMITH ROBERT R.
Published: June 2011

Two hundred and seven consecutive inpatients aged 15 to 50 with cerebrovascular disease at the University of Mississippi Medical Center were studied and followed up for an average of two and one-half years. Most of the patients arrived in the hospital in the acute stage of their disease. There was a rising trend for the onset of strokes with age in general, but this varied for different types of cerebrovascular disease. The diagnoses are detailed by age, race, and sex, and the prognosis is given for each subgroup. Patients with cerebral thrombosis or transient ischemic attacks had the best prognosis in this age group and thus are ideal candidates for rehabilitation and detailed study. The incidence of hypertension, concomitant major illnesses and laboratory abnormalities is given for each subgroup. The prognosis of patients in each subgroup is related to their initial motor deficit and level of consciousness.
Effect of experimental ischemia on neurotransmitter amines in the gerbil brain.
Authors: Harrison M J , Marsden C D , Jenner P
Published: June 2011

In the gerbil cerebral infarction was produced by unilateral carotid ligation. 3.5 hours later, when the neurological deficit was fully developed, hemisphere dopamine (DA) showed little change from normal. It seems unlikely that changes in DA are the direct cause of the turning behavior shown by these animals. Slight changes in norepinephrine (NE) occurred on the operated side but 4 hydroxy-3-methoxy phenyl-ethyleneglycol sulphate (MOPEG-SO4) levels were not affected. Significant falls in 5-hydroxytryptamine (5-HT) and 5-hydroxyindole acetic acid (5-HIAA) were found on the operated side but there was also a trend for both 5HT and 5-HIAA to fall on the unoperated side. These changes occurred in clincally affected and unaffected animals and their clinical significance is unproven.
Serum dopamine-beta-hydroxylase activity in acute stroke.
Authors: Kanda T , Gotoh F , Yamamoto M , Sakai F , Takeoka T , Takagi Y
Published: June 2011

Serum dopamine-beta-hydroxylase (DBH) activity was measured in 34 patients with acute cerebrovascular disease. The serum level of DBH activity showed its highest value soon after the onset of stroke and then gradually decreased over the next few days. After reaching its lowest level, the DBH activity again showed a slight increase. There was no direct relationship between serum DBH activity and total serum protein, or blood pressure. In 8 of 12 patients, DBH activity in the cerebral venous blood was higher than that in the arterial blood. These results suggest that rapid release of DBH into the circulating blood occurred after stroke, presumably from sympathetic nerve endings in the vessels or organs, including the brain.
Stroke-associated deaths in Washington county, Maryland, with special reference to water hardness.
Authors: Comstock G W , Cauthen G M , Helsing K J , Goldberg E L
Published: June 2011

Deaths associated with strokes from 1963 to 1975 among 36,860 adult residents of Washington County, Maryland, were studied in relation to the hardness of drinking water at home, assessed on the basis of 1,569 water samples taken during this period. There was no satisfactory evidence that water hardness was related to stroke mortality. Age was a strongly related factor. There was little or no association with sex, marital status, socio-economic status as reflected by education or housing, smoking history, or frequency of church attendance.
A new model of bilateral hemispheric ischemia in the unanesthetized rat.
Authors: Pulsinelli W A , Brierley J B
Published: June 2011

A new model of transient, bilateral hemispheric ischemia in the unanesthetized rat is described. During ether anesthesia the rat's vertebral arteries were electrocauterized through the alar foramina of the first cervical vertebra and reversible clasps placed loosely around the common carotid arteries. Twenty-four hr later, the awake rats were restrained and the carotid clasps tightened to produce 4-vessel occlusion. The carotid clasps were removed after 10, 20 or 30 min of 4-vessel occlusion and the animals killed by perfusion fixation 72 hr later. Rats which convulsed during the ischemic or post-ischemic period were excluded from further study. All rats subjected to 20 or 30 min of 4-vessel occlusion demonstrated ischemic neuronal damage. The H1 and paramedian hippocampus, striatum and layers 3, 5 and 6 of the posterior neocortex were the regions most frequently damaged. The advantages of this model are the ease of preparation of large numbers of animals, a high rate of predictable ischemic neuronal damage, a low incidence of seizures and the absence of anesthesia.
Brain stem dysfunction in transient global amnesia.
Authors: Longridge N S , Hachinski V , Barber H O
Published: June 2011

A patient with transient global amnesia also had transient bilateral gaze nystagmus which was detected both by conventional bedside examination and upon electronystagmographic recording. The nystagmus was absent one week later indicating recovery of the temporary brain stem deficit. The recording of objective evidence of brain stem dysfunction in the form of gaze nystagmus in a patient who had transient global amnesia, suggests that both were due to a transient ischemic attack involving the cerebral blood supply in the vertebrobasilar distribution.
Attenuation of ischemic brain edema by pentobarbital after carotid ligation in the gerbil.
Authors: Lawner P , Laurent J , Simeone F , Fink E , Rubin E
Published: June 2011

The efficacy of pentobarbital in the treatment of ischemic cerebral edema was evaluated in 160 gerbils. Animals underwent carotid ligation under ether or pentobarbital (50 mg/kg) anesthesia. The pentobarbital anesthetized group received an additional dose of 30 mg/kg 4 h after ligation. Animals were evaluated for neurologic deficit at 4 and 8 h post-ligation, then sacrificed. Water content of each hemisphere and swelling percentage were calculated from the wet and dry weights of the hemispheres. Swelling percentage in animals anesthetized with ether was 6.374 +/- 0.89 SE, whereas gerbils who underwent sham carotid ligation showed a negligible (0.491 +/- 0.15) swelling percentage (p less than 0.01). Pentobarbital animals had a swelling percentage of 3.359 +/- 0.68. This represents a significant edema reduction compared to ether-anesthetized animals (p less than 0.01). Neurologic deficit was decreased by 56.7% (17/60 vs 30/60) in pentobarbital animals compared with ether animals (p less than 0.025). Mortality at 8 hours was reduced by 75% (2/60 vs 8/60) in pentobarbital animals (p less than 0.05).
Massive doses of steroids in cryogenic cerebral injury and edema.
Authors: Clasen R A , Pandolfi S , Clasen J R
Published: June 2011

Cryogenic lesions were produced in the brains of rhesus monkeys and the accompanying edema measured by quantitative chemical methods. No effect on this type of edema could be demonstrated in animals treated with massive doses of steroids.
Correlation between glucose utilization and metabolite levels during focal ischemia in cat brain.
Authors: Welsh F A , Greenberg J H , Jones S C , Ginsberg M D , Reivich M
Published: June 2011

Focal ischemia was produced in cat brain by occluding the middle cerebral artery. After 60 min of ischemia the rate of glucose utilization, as measured by the uptake of [14C] deoxyglucose ([14C]DG), was correlated with tissue levels of ATP, phosphocreatine, and lactate measured in the same regional samples. Ischemia caused local increases of [14C]DG uptake which were associated with mild to moderate anaerobic perturbations of metabolite levels. Altered metabolite levels also occurred in regions in which the rate of glucose consumption was not markedly different from that of the non-ischemic hemipshere. In addition, there were regions with decreased [14C] DG uptake which invariably were depleted of ATP and phosphocreatine. Thus, suppression of glucose metabolism was restricted to the most severely ischemic areas, where the delivery of glucose may be rate-limiting.
Primary pontine hemorrhage: clinicopathological correlations.
Authors: Goto N , Kaneko M , Hosaka Y , Koga H
Published: June 2011

In 18 autopsies from patients with primary pontine hemorrhage we studied the sites of bleeding, the volumes and development of hematomas and clinicopathological correlations. A modular optical electronic planimeter was introduced to measure the size of hematomas. The series of patients can be divided into 2 groups from the viewpoint of bleeding sites, their development and clinical symptomatology. These are 1) the tegmentobasilar type and 2) the tegmental type. The precise location of the origin of hemorrhage, and the approximate volume of hematomas can now be determined with the help of computerized tomography. This information will be of help in understanding clinical symptoms. Two different typical patient reports, selected from the collection, are presented.
Retinal fluorescein angiographic evidence for atheromatous microembolism. Demonstration of ophthalmoscopically occult emboli and post-embolic endothelial damage after attacks of amaurosis fugax.
Authors: Muci-Mendoza R , Arruga J , Edward W O , Hoyt W F
Published: June 2011

There is evidence that microemboli responsible for amaurosis fugax may be atheromatous but it can elude ophthalmoscopic confirmation, because such emboli quickly fragment and disappear from view in the retinal vessels. This report documents 2 patients in whom fluorescein angiography of the retina provided evidence of microembolization after an attack of amaurosis although the fundus appeared normal. In one patient the angiogram revealed intraluminal material; in the other it showed fluorescein leakage from patent arteriolar bifurcations.
Epidemiology of stroke in Tilburg, The Netherlands. The population-based stroke incidence register: 1. Introduction and preliminary results.
Authors: Herman B , Schulte B P , van Luijk J H , Leyten A C , Frenken C W
Published: June 2011

We present the methodology and some preliminary findings of a population-based stroke incidence register operating in Tilburg (about 150,000 persons), The Netherlands. From October 1, 1978 to March 31, 1979, 152 new strokes occurred giving an estimated overall incidence (per 100,000 population) for total and first attacks of 202 and 162, respectively. No major sex difference in stroke risk (all ages) was noted, although males did have a significantly higher incidence at 55--64 years of age. Stroke incidence increased strikingly with age. Thromboembolic infarcts comprised 83% and intracranial hemorrhage 13% of attacks. Males and females differed little in distribution of stroke types. The proportion of cerebral infarction was higher among older than younger cases. The opposite was true regarding intracranial hemorrhage. Embolic infarcts constituted a significantly higher proportion of cases at 65--74 years of age than at other ages. Hemiplegia and speech deficits dominated the clinical picture at onset. The 3-week case fatality for all strokes was 26%. Both a lowering of consciousness (found among 38% of cases during the first 24 hours) and a history of prior stroke were found related to a reduction in survival. Of patients surviving 3 weeks 25% were completely dependent and 25% partially dependent upon others for personal care.