bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.
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.
The Effect of Body Position and Forelimb Exercise on Cephalic Blood Flow
Authors: ANAZAWA WAKOU , SHIGENO KOJI , TOOLE JAMES F. , JANEWAY RICHARD 
Published: June 2011

Flow through both common carotid, vertebral, and subclavian arteries was measured with "C-core" probes and square wave electromagnetic flowmeters in mongrel dogs. Exercise of the neurally isolated forelimb was simulated by electrical stimulation to obtain first clonic and then tetanic muscle contraction. Exercise was performed in the horizontal supine, 30° head-up, and 30° head-down positions. Bilateral forelimb exercise induced abrupt increase in subclavian artery flow and conductance. Cephalic arterial flow and conductance decreased at the onset of exercise and showed gradual recovery. Left subclavian artery flow and conductance decreased during right forelimb exercise. Right subclavian and brachiocephalic artery flow decreased during left forelimb exercise. Head-up position induced general decreases in cephalic blood flow in spite of increased mean arterial blood pressure. Response patterns of flow and conductance during bilateral exercise did not differ significantly from those in the horizontal supine position. Administration of gallamine triethiodide before stimulation eliminated all hemodynamic responses. Femoral artery flow and conductance decreased on the side contralateral to the side of the exercising limb.
The clinical implications of redistribution of blood are discussed.
Systemic vascular changes in spontaneous occlusion of the circle of Willis.
Authors: Ikeda E 
Published: June 2011

We examined the presence of systemic etiologic factors causing vascular changes in so-called "spontaneous occlusion of the circle of Willis" (cerebrovascular moyamoya disease) to determine whether extracranial, as well as intracranial, vessels are involved in this disease.
Histopathologic examination and morphometric analysis of the extracranial vessels were performed in 13 patients with this disease.
The histopathologic findings of the extracranial vessels were as follows: 1) advanced intimal fibrous thickening similar to that of the intracranial vessels; and 2) characteristic intimal fibrous nodular thickening, which may indicate organization of mural thrombi, at the proximal portions of the pulmonary arteries in three of 13 patients. Morphometric analysis revealed significant intimal thickening of the pulmonary arteries (p less than 0.05), renal arteries (p less than 0.05), and pancreatic arteries (p less than 0.01) in patients with this disease as compared with age- and sex-matched control patients.
On the basis of these findings, it is highly likely that this disease has systemic etiologic factors, as well as focal etiologic factors, that work to create vascular change in both the intracranial and extracranial vessels.
Clinical significance of new coagulation and fibrinolytic markers in ischemic stroke patients.
Authors: Ono N , Koyama T , Suehiro A , Oku K , Fujikake K , Kakishita E 
Published: June 2011

We investigated plasma levels of D-dimer products of crosslinked fibrin degradation products, thrombin-antithrombin III complex, and plasmin-alpha 2-antiplasmin complex for detecting coagulation system activation in ischemic stroke patients to determine the possible effect of age on these marker levels.
We measured plasma levels of these three markers in 54 acute ischemic stroke patients within 5 days of stroke onset, in 44 chronic ischemic stroke patients over 3 months from onset, and in 50 age-matched healthy subjects. We divided the stroke patients into two subgroups, those with visible occlusion and those with nonvisible occlusion having obstruction of the major cerebral artery.
The plasma levels of these three markers were significantly (p less than 0.01) higher in the stroke patients than in controls. Significant differences did not exist at any level between the patients and controls in the younger-aged subjects (less than or equal to 64 years of age), but did exist in the older-aged subjects (greater than or equal to 75 years of age). An age-related increase of the marker levels was noted between stroke patients and controls. No significant difference in the three markers was found among any of the stroke patients.
Increased levels of these markers in stroke patients seem to be related mostly to age.
14,15-Epoxyeicosatrienoic acid inhibits platelet aggregation in mouse cerebral arterioles.
Authors: Heizer M L , McKinney J S , Ellis E F 
Published: June 2011

Epoxygenase metabolites of arachidonic acid are produced by several tissues and have been shown to inhibit in vitro platelet aggregation. The purpose of the present investigation was to determine whether 14,15- or 8,9-epoxyeicosatrienoic acid, epoxygenase derivatives of arachidonic acid, affect the speed of platelet aggregation in in vivo mouse cerebral arterioles.
We performed a craniectomy in 116 anesthetized male mice and observed the pial arterioles by microscopy. We induced in situ platelet aggregation using a mercury light and intravascularly injected fluorescein dye.
Indomethacin (0.5 mg/kg i.p.), a known cyclooxygenase inhibitor, and 14,15-epoxyeicosatrienoic acid (0.3 mg/kg i.v.) increased the time necessary for the light plus dye to induce the first arterial platelet aggregate by 35% and 26%, respectively, whereas 8,9-epoxyeicosatrienoic acid (0.3 mg/kg i.v.) had no effect. Analysis of mouse serum by radioimmunoassay showed that the degree of inhibition of platelet aggregation by indomethacin and epoxyeicosatrienoic acids correlated with the degree of inhibition of thromboxane production.
We conclude that 14,15-epoxyeicosatrienoic acid is a potent inhibitor of in vivo platelet aggregation but cannot conclusively confirm that its effect on aggregation occurs via its reduction of platelet thromboxane A2. Because epoxyeicosatrienoic acids are produced by several tissues, including brain and vascular tissue, they may be important in vivo modulators of platelet aggregation and hemostasis.
Endothelium-independent contractions to NG-monomethyl-L-arginine in canine basilar artery.
Authors: Katusić Z S 
Published: June 2011

NG-substituted analogues of L-arginine are potent and selective inhibitors of nitric oxide synthase(s). The present study was designed to determine the effects of these analogues on the vascular smooth muscle of isolated canine basilar arteries.
Basilar artery rings without endothelium were suspended for isometric tension recording in Krebs-Ringer bicarbonate solution bubbled with 94% O2-6% CO2 (temperature = 37 degrees C, pH = 7.4). A radioimmunoassay technique was used to determine the levels of guanosine 3',5'-cyclic monophosphate (cyclic GMP).
NG-Monomethyl-L-arginine (L-NMMA) caused concentration-dependent contractions, whereas the D-enantiomer and NG-nitro-L-arginine did not. Contractions to L-NMMA were reduced in the presence of L-arginine but not in the presence of D-arginine. Superoxide anions generated by xanthine plus xanthine oxidase in the presence of catalase abolished contractions to L-NMMA but did not affect contractions to the prostaglandin H2/thromboxane A2 agonist U46619. Zaprinast, a selective cyclic GMP phosphodiesterase inhibitor, caused concentration-dependent relaxations. L-NMMA selectively inhibited these relaxations. The inhibitory effect of L-NMMA was reversed in the presence of L-arginine. L-NMMA selectively reduced the basal production of cyclic GMP.
These studies suggest that in cerebral arteries, contractions of smooth muscle cells to L-NMMA are mediated by inhibition of nitric oxide synthase with a resultant decrease in the basal production of nitric oxide.
Platelet secretory products may contribute to neuronal injury.
Authors: Joseph R , Tsering C , Grunfeld S , Welch K M 
Published: June 2011

We do not fully understand the mechanisms for neuronal damage following cerebral arterial occlusion by a thrombus that consists mainly of platelets. The view that certain endogenous substances, such as glutamate, may also contribute to neuronal injury is now reasonably well established. Blood platelets are known to contain and secrete a number of substances that have been associated with neuronal dysfunction. Therefore, we hypothesize that a high concentration (approximately several thousand-fold higher than in plasma, in our estimation) of locally released platelet secretory products derived from the causative thrombus may contribute to neuronal injury and promote reactive gliosis.
We have recently been able to report some direct support for this concept. When organotypic spinal cord cultures were exposed to platelet and platelet products, a significant reduction in the number and the size of the surviving neurons occurred in comparison with those in controls. We further observed that serotonin, a major platelet product, has neurotoxic properties. There may be other platelet components with similar effect.
The hypothesis of platelet-mediated neurotoxicity gains some support from these recent in vitro findings. The concept could provide a new area of research in stroke, both at the clinical and basic levels.
Hospitalized stroke in blacks and Hispanics in northern Manhattan.
Authors: Sacco R L , Hauser W A , Mohr J P 
Published: June 2011

The growing black and Hispanic populations in the United States call for studies of the rates and prognosis for cerebral infarction to help plan more focused prevention programs.
Using the Statewide Planning and Research Cooperative System, we obtained discharge data for 1,034 patients over age 39, who were hospitalized for stroke from 1983 to 1986, using four zip code areas of the ethnically mixed community of Northern Manhattan.
Stroke incidence increased with age in both men and women in all three race/ethnic groups. The age-adjusted stroke incidence per 100,000 per year for men greater than or equal to 40 years of age was 567 for blacks, 306 for Hispanics, and 351 for whites. Incidence in women greater than or equal to 40 years was 716 in blacks, 361 in Hispanics, and 326 in whites. Hypertension and diabetes were more prevalent in blacks and Hispanics with stroke, whereas whites had more ischemic cardiac disease. Crude in-hospital mortality was greater in younger blacks and Hispanics compared with whites, whereas 2-year readmission rates, overall and for stroke, were similar in the three groups.
These estimates of hospitalized stroke incidence and mortality substantiate the greater incidence of stroke in blacks and provide new data concerning Hispanics for public health planning.
Utility of late N-isopropyl-p-(iodine-123)-iodoamphetamine brain distribution in predicting outcome following cerebral infarction.
Authors: Gupta S , Bushnell D L , Mlcoch A , Eastman G , Barnes W E , Fisher S G 
Published: June 2011

The purpose of this study was to determine utility of late N-isopropyl-p-(iodine-123)-iodoamphetamine distribution in predicting neurological and language outcome.
We prospectively studied 29 patients with unilateral hemispheric ischemic cerebral infarction using the neuroimaging method of single-photon emission computed tomography and the above tracer. Four different imaging measures reflecting late tracer distribution or redistribution and three measures indicative of the patients' overall neurological or language outcome at 3 months were used in the data analysis. All patients had neuroimaging within 30 days of infarction, and 14 patients were imaged within 10 days of infarction. Data analysis was performed for all patients combined and then separately on the groups imaged within 10 days of and more than 10 days after infarction.
The volume of the late image defect significantly correlated with one measure of neurological outcome in the whole group and in those imaged more than 10 days after cerebral infarction. However, these results are difficult to explain based on the present understanding of the physiology of late N-isopropyl-p-(iodine-123)-iodoamphetamine distribution.
We feel that the pattern of late N-isopropyl-p-(iodine-123)-iodoamphetamine distribution is probably not useful as an independent predictor of neurological and language outcome.
Effect of adrenergic drugs on cerebral blood flow, metabolism, and evoked potentials after delayed cardiopulmonary resuscitation in dogs.
Authors: Gervais H W , Schleien C L , Koehler R C , Berkowitz I D , Shaffner D H , Traystman R J 
Published: June 2011

Epinephrine administration during cardiopulmonary resuscitation increases cerebral blood flow by increasing arterial pressure. We tested whether potential beta-adrenergic effects of epinephrine directly influence cerebral blood flow and oxygen consumption independently of raising perfusion pressure.
Four groups of seven anesthetized dogs were subjected to 8 minutes of fibrillatory arrest followed by 6 minutes of chest compression, ventricular defibrillation, and 4 hours of spontaneous circulation. Cerebral perfusion pressure was increased to approximately equivalent ranges during resuscitation by either 1) epinephrine infusion, 2) epinephrine infusion after pretreatment with the lipophilic beta-adrenergic antagonist pindolol, 3) infusion of the alpha-adrenergic agonist phenylephrine, or 4) descending aortic balloon inflation without pressor agents.
We found no difference in cerebral blood flow, oxygen extraction, or oxygen consumption during chest compression among groups. After ventricular defibrillation, depressed levels of cerebral blood flow, cerebral oxygen consumption, and somatosensory evoked potential amplitude were not different among groups.
We detected no evidence that after 8 minutes of complete ischemia, epinephrine administration during resuscitation substantially influences cerebral blood flow or cerebral oxygen consumption independent of its action of raising arterial pressure or or that epinephrine has a negative impact on immediate metabolic or electrophysiological recovery attributable to its beta-adrenergic activity.