bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnostic Impact of Early Transcranial Doppler Ultrasonography on the TOAST Classification Subtype in Acute Cerebral Ischemia
Authors: Wijman Christine A.C. , McBee Nichol A. , Keyl Penelope M. , Varelas Panayiotis N. , Williams Michael A. , Ulatowski John A. , Hanley Daniel F. , Wityk Robert J. , Razumovsky Alexander Y. 
Published: April 2003

<i>Objective:</i> The impact of early transcranial Doppler ultrasonography (TCD) upon stroke subtype diagnosis is unknown and may affect therapeutic strategies. In this study, the diagnostic usefulness of TCD in stroke subtype diagnosis according to the criteria of the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) study was investigated in patients with acute cerebral ischemia. <i>Methods:</i> TCD examination within 24 h of symptom onset was performed in 50 consecutive patients with acute cerebral ischemia. Of these 54% were female. Sixty percent of patients were black, 36% white, and 4% Asian. Initial TOAST stroke subtype diagnosis (ITSSD) was based upon clinical presentation and initial brain imaging studies. Modified TOAST stroke subtype diagnosis was determined subsequently after additional review of the TCD examination. Final TOAST stroke subtype diagnosis was determined at hospital discharge, incorporating all diagnostic studies. Using final TOAST stroke subtype diagnosis as the ‘gold standard’ ITSSD and modified TOAST stroke subtype diagnosis were compared in order to determine additional benefit from the information obtained by TCD. Data were collected retrospectively by a single investigator. <i>Results:</i> ITSSD classified 23 of 50 (46%) patients correctly. After TCD, 30 of 50 (60%) patients were classified correctly, for an absolute benefit of 14% and a relative benefit of 30% (p = 0.018). Most benefit from TCD was observed in the TOAST stroke subtype category large-artery atherosclerosis, in particular in patients with intracranial vascular disease. In this category, ITSSD had a sensitivity of 27% which increased to 64% after TCD (p = 0.002). <i>Conclusion:</i> TCD within 24 h of symptom onset improves the accuracy of early stroke subtype diagnosis in patients with acute cerebral ischemia due to large-artery atherosclerosis. This may have clinical implications for early therapeutic interventions.
Transcranial Doppler Detection of Cerebral Microemboli during Left Heart Catheterization
Authors: Leclercq Florence , Kassnasrallah Saad , Cesari Jean-Baptiste , Blard Jean-Marie , Macia Jean-Christophe , Messner-Pellenc Patrick , Mariottini Claude-Jean , Grolleau-Raoux Robert 
Published: April 2003

The role of transcranial Doppler ultrasonography (TCD) in individual risk assessment of embolic complications and the development of prevention strategies during coronary angiography remains to be determined. The purpose of this study was to assess the prevalence, time of occurrence and potential significance of microembolic signals (MES) detected with TCD during femoral left heart catheterization. TCD monitoring of the right and left middle cerebral artery was performed in 51 consecutive patients (36 men, 15 women) who were referred for coronary angiography. Percutaneous coronary angioplasty was performed during the same procedure in 16 patients. MES were counted manually during and after (off-line analysis) the procedure. Two patients were excluded from analysis because of the absence of an adequate acoustic temporal window. No neurological event occurred within 24 h in the 49 included patients. MES were detected in all except 2 patients (mean number 17.1 ± 12.8 per patient), mainly during left ventriculography (38%) and contrast media injection into the coronary arteries (55%), suggesting their gaseous origin. There was no statistically significant association between the number of MES and patient age, cardiovascular history and risk factors, or catheterization results. The presence of coronary artery disease was inversely related to the number of MES (15.8 ± 0.3 compared to 21.8 ± 0.2 per patient when a normal angiogram was present; p < 0.05). In conclusion, although asymptomatic microemboli commonly occur during left heart catheterization, the majority of them are probably of gaseous origin, since they occurred predominantly during contrast media injection in this study, and were not related to cardiovascular history or to atheroma risk factors. Because air embolism has been reported to be harmful, attempts to reduce its occurrence during catheter-based procedures could be pertinent.
Lack of Evidence for a Poor Haemodynamic or Metabolic State of the Brain in Patients with Haemodynamic Clinical Features Associated with Carotid Artery Occlusion
Authors: Klijn C.J.M. , Kappelle L.J. , van der Grond J. , Visser G.H. , Algra A. , Tulleken C.A.F. , van Gijn J. 
Published: April 2003

<i>Objective:</i> To assess whether patients with carotid artery occlusion (CAO) who have clinical features suggesting a haemodynamic origin have a poor haemodynamic or metabolic state of the brain. <i>Methods:</i> In 117 patients with ischaemic symptoms of the eye or brain that were transient or at most moderately disabling and associated with a CAO, we compared CO<sub>2</sub> reactivity, quantitative flow measurement by magnetic resonance (MR) angiography, metabolic ratios measured by <sup>1</sup>H-MR spectroscopy, collateral blood flow patterns and the presence of infarcts of the borderzone type between patients grouped by the following clinical features: (1) presence or absence of at least one of the ‘classical’ haemodynamic symptoms: limb shaking, retinal claudication, precipitation of symptoms by exercise, by rising from a sitting or lying position, by transition from a cold to a warm environment, or by documented hypotension, and (2) symptoms having occurred after demonstration of the CAO or only before the occlusion was documented. <i>Results:</i> Patients with (n = 16) and without (n = 101) one of the ‘classical’ haemodynamic symptoms did not differ in any of the measured indices. Patients with recurrent symptoms after documentation of the CAO (n = 56) had lower CO<sub>2</sub> reactivity (difference 8.3%, 95% confidence interval 0.1–16.5) than those with symptoms only before documentation of the occlusion (n = 61), whereas no significant differences were found in any of the other measured indices. The difference in CO<sub>2</sub> reactivity was no longer significant after adjustment for the interval between the patients’ last symptoms and the CO<sub>2</sub> reactivity measurement. <i>Conclusion:</i> In patients with CAO we could not find an association between symptoms that have been associated with hypoperfusion and a poor haemodynamic or metabolic state of the brain.
Transcranial Doppler Monitoring in Hypertensive Patients during Physical Exercise
Authors: Magyar Mária Tünde , Valikovics Attila , Bereczki Dániel , Ficzere Andrea , Czuriga István , Csiba László 
Published: April 2003

<i>Purpose:</i> To evaluate the diagnostic value of a combined method, i.e. ergometer cycling with continuous bilateral transcranial Doppler monitoring (TCD) to detect cerebral hemodynamic abnormalities in recently diagnosed hypertensive patients. <i>Methods:</i> 30 neurologically symptom-free, nontreated patients with essential hypertension and 30 age- and sex-matched controls were studied. Carotid ultrasound, resting ECG and blood parameters were investigated. Cycling ergometry was performed according to the WHO protocol. Blood pressure, heart rate, end-tidal CO<sub>2</sub> (etCO<sub>2</sub>) and bilateral middle cerebral artery (MCA) blood flow velocity (MV) were monitored. <i>Results:</i> At rest, MV in the MCA did not differ significantly between controls and hypertensive subjects. MV continuously increased in controls until the end of loading whereas a plateau was reached at 4 min in hypertensive subjects. During 6 min of cycling, the time course of absolute values of MV in the MCA and that of the changes in the ratio of mean velocity/end-tidal CO<sub>2</sub> (ΔMV/ΔetCO<sub>2</sub>) differed significantly between hypertensive subjects and controls (p = 0.03 and p = 0.02, respectively). <i>Conclusion:</i> Ergometer cycling combined with TCD revealed altered vasoreactivity, therefore this may be a sensitive method for the detection of early hemodynamic impairment in nontreated hypertensive subjects.
Perinatal Maternal Food Restriction Induces Alterations in Hypothalamo-Pituitary-Adrenal Axis Activity and in Plasma Corticosterone-Binding Globulin Capacity of Weaning Rat Pups
Authors: Léonhardt Marion , Lesage Jean , Dufourny Laurence , Dickès-Coopman Anne , Montel Valérie , Dupouy Jean-Paul 
Published: April 2003

We investigated the effects of perinatal maternal malnutrition on the hypothalamo-pituitary-adrenal (HPA) axis activity in both basal and stressful conditions in newborn rats at weaning. Mothers from the control group were fed ad libitum. Mothers exposed to food restriction received 50% (FR50) of the daily intake of pregnant dams during the last week of gestation (Pre group), lactation (Post group) or both periods (PP group) in order to compare the long-term effects of gestational and/or lactational restriction. FR50 reduced the body growth of pups from the Post and PP groups as soon as day 11 until day 21 after birth. At weaning, pups of the Post and PP groups showed reduced adrenal, thymus and liver weights. Although the plasma adrenocorticotropic hormone (ACTH) level was reduced in pups, FR50 affected neither corticotropin-releasing hormone expression and peptide synthesis in the hypothalamus nor proopiomelanocortin expression in the adenohypophysis. Basal circulating levels of corticosterone were not markedly affected by FR50, but free corticosterone concentration was increased in the PP group. Plasma corticosterone-binding globulin (CBG) was decreased in newborns from both the Post and PP groups. Mineralocorticoid receptor gene expression was significantly increased in both CA1 and CA3 hippocampal areas in the PP group. Glucocorticoid receptor gene expression was increased in CA1, CA2 and dentate gyrus hippocampal areas in the Pre group, as well as in CA1, CA3 and DG areas in the Post group. The ether inhalation-induced plasma ACTH increase was weaker in pups from the Post and PP groups. Similarly, the ether inhalation-induced plasma corticosterone increase returned to basal levels in the Post group, or to weaker values than baseline in the PP group 90 min after this stressful procedure. The present work suggests that maternal food restriction during the perinatal period (gestation and lactation) or during lactation only reduces the postnatal somatic growth of pups and disturbs the activity of the HPA axis at weaning under both resting and stress conditions. A reduction in the plasma CBG-binding capacity, associated with a probable increase in hippocampal corticosteroid receptors, could reinforce glucocorticoid-mediated negative feedback and shorten stress-induced activation of the HPA axis in pups at weaning.
Re-Worsening Factor after Successful Vitrectomy for Diabetic Retinopathy: Optic Disc Fibrovascular Proliferation and Macular Disease
Authors: Sakamoto Taiji , Fujisawa Kimihiko , Kinukawa Naoko , Ishibashi Tatsuro , Inomata Hajime 
Published: April 2003

<i>Purpose:</i> To investigate the factors that influence the visual-changing pattern in proliferative diabetic retinopathy even after successful vitrectomy. <i>Methods:</i> One hundred and forty-seven consecutive eyes were retrospectively reviewed for 6–48 (average 20) months, and were divided into the following 4 groups based on their changing pattern of vision: group A, the visual acuity improved postoperatively and maintained the maximal corrected vision throughout the observation period (n = 49); group B, the visual acuity improved postoperatively but deteriorated thereafter (n = 68); group C, the visual acuity remained the same as before operation (n = 17), and group D, the visual acuity deteriorated immediately after vitrectomy (n = 13). Various issues including systemic conditions, blood tests, preoperative ocular findings, the operative procedures and postoperative complications were reviewed based on the patient records. These issues were analyzed by Spearman’s rank correlation, χ<sup>2</sup> test, an analysis of variance (ANOVA) and the Kruskal-Wallis test. Finally, the discriminate factors between groups A and B were examined by a stepwise logistic regression analysis. <i>Results:</i> The following tendencies were observed in all 4 groups: younger patients tended to show a better visual-changing pattern (p = 0.02); patients with younger age at diabetes onset had a better visual-changing pattern after vitrectomy (p = 0.001), and a lower hemoglobin (Hb) A1c level is associated with a better visual changing pattern (p = 0.017). Preoperative rubeosis and macular detachment were frequently found in groups C and D, as well as postoperative rubeosis, vitreous bleeding and retinal detachment. Finally, a stepwise logistic regression analysis showed both fibrovascular proliferation (p = 0.016) from the optic disc and postoperative macular disease (p = 0.0009) to be significant factors for differentiating group A from group B. <i>Conclusions:</i> In addition to the factors which have already been indicated to affect the visual outcome of a vitrectomy, preoperative findings such as optic disc fibrovascular proliferation and postoperative macular disease were found to affect the visual-changing pattern after a successful vitrectomy. The optimal timing of surgery is very important not only in order to obtain good visual acuity but also to maintain good vision even after a successful vitrectomy.
Clinical Efficacy of Amphotericin B Colloidal Dispersion against Infections Caused by <i>Candida</i> spp
Authors: Dupont B. 
Published: April 2003

Five clinical trials of the efficacy of amphotericin B colloidal dispersion (ABCD) primarily in patients unable to tolerate or failing treatment with conventional amphotericin B (CAB) were reviewed. A total of 572 patients were treated. Systemic candidal infections were identified in 107 evaluable patients and 239 in the intent-to-treat population. Seventy percent of the evaluable patients and 50% of the intent-to-treat patients achieved a complete or partial response. There were no significant differences either in response rates for different underlying causes or in response rates according to enrolment reason. The efficacy of ABCD at doses of 3–4 mg/kg/ day in disseminated candidiasis appears to be similar to that in studies using CAB. Renal and hepatic toxicity of ABCD is low.
Patterns of Antibiotic Resistance, Serotype Distribution, and Patient Demographics of <i>Streptococcus pneumoniae</i> in Hong Kong
Authors: Ip M. , Lyon D.J. , Cheng A.F.B. 
Published: April 2003

<i>Streptococcus pneumoniae</i> isolates from clinical specimens during the period 1993–1997 at the Prince of Wales Hospital, Hong Kong, were analysed by the antibiotic resistance profiles, the distribution of serotypes, specimen types, and patient demographics. 1,229 non-duplicate <i>S. pneumoniae</i> isolates were evaluated; 84% from the respiratory tract, 11% from blood and cerebrospinal fluid and the remainder from body fluids and pus swabs. The percentage of <i>S. pneumoniae</i> of reduced penicillin susceptibility was 38.6%, and the percentage resistance to erythromycin, chloramphenicol, co-trimoxazole and tetracycline were 40.4, 43.2, 54.9 and 77.8%, respectively. The organism was isolated from patients of all age groups, 14.6% from children aged below 10 years, half of whom were from children aged 2 years or below. 57.0% were from elderly patients aged above 60. The male to female ratio was 2.5:1. Isolates with reduced penicillin susceptibility were seen significantly more so in children under 10 than in those aged 11 or above (52 versus 36%, p < 0.0001). A diverse range of serotypes was obtained in the penicillin-susceptible isolates whilst those of reduced susceptibility were confined to serotypes 23F, 19F, 6B, 14 and 9V.
Evaluation of Spontaneous Contamination of Ocular Medications
Authors: Marchese A. , Bozzolasco M. , Gualco L. , Schito G.C. , Debbia E.A. 
Published: April 2003

<i>Background:</i> In order to evaluate whether single-dose ophthalmic preparations in 0.5-ml containers can safely be used within 24 h after the first opening, eigth different sterile ocular medications containing timolol, jaluronic acid, diclofenac, ketotifen, pilocarpine, formocortal, formocortal-gentamycin, and tetryzoline-feniramine (Farmigea, Italy) were opened and tested for spontaneous bacterial contamination after exposure to air. <i>Methods:</i> Samples (10 µl) were collected from exposed ophthalmic preparations after 0, 2, 4, 8 and 24 h. <i>Results:</i> No viable microorganisms were detected during and at the end of the evaluation period. In order to assess whether the resident or pathogenic ocular bacterial population due to repeated handling might contaminate the medications, about 10<sup>5</sup> cells of different species <i>(Staphylococcus aureus,</i> coagulase-negative staphylococci, <i>Streptococcus pneumoniae, Streptococcus</i> spp., <i>Corynebacterium</i> spp., <i>Pseudomonas aeruginosa, Neisseria</i> spp., <i>Acinetobacter</i> spp., <i>Haemophilus influenzae, Escherichia coli</i> and <i>Candida albicans)</i> were added to the containers and incubated at 37°C or at room temperature. Samples were collected and the number of viable bacteria was estimated. The antibacterial effect of the ophthalmic compounds varied depending on the species considered. Tetryzoline-feniramine, pilocarpine, ketotifen and formocortal-gentamycin exhibited a frank bactericidal activity (<100 survivors after 18–24 h of exposure) against the great majority of the species tested. <i>Conclusion:</i> These results indicate that the risk of spontaneous contamination of ophthalmic preparations after their first opening is low, and that all preparations tested exhibit an aspecific antibacterial activity. As a consequence, the safe usage of these ocular medications could be extended from the recommended 3 h to at least 24 h after the first usage.
Effects of Antibiotics on Adherence of <i>Pseudomonas aeruginosa</i> and <i>Pseudomonas fluorescens</i> to Human Fibronectin
Authors: Di Martino Patrick 
Published: April 2003

The effect of subminimal inhibitory concentration (½ MIC) of antimicrobial agents on the adherence of fluorescent <i>Pseudomonas</i> to human fibronectin (FN) was investigated by examining two <i>Pseudomonas fluorescens</i> and four <i>Pseudomonas aeruginosa</i> strains. The <i>Escherichia coli</i> (MC1061 and JM109) strains, used as negative controls, adhered poorly to FN immobilized on microtiter wells (adherence indices of 0.04 ± 0.02 and 0.03 ± 0.01 10<sup>5</sup> CFU/well, respectively). Two <i>P. aeruginosa</i> strains (NK125502 and ER82483) were highly adherent to FN (adherence indices of 3.22 ± 0.75 10<sup>5</sup> and 3.08 ± 1.42 10<sup>5</sup> CFU/well, respectively), the two others (ER98513 and ER92581) adhered less efficiently (adherence indices of 0.91 ± 0.05 10<sup>5</sup> and 0.45 ± 0.23 10<sup>5</sup> CFU/well, respectively). The two <i>P. fluorescens</i> strains (MF0 and ER74508) were highly adherent to fibronectin (adherence indices of 7.06 ± 1.00 10<sup>5</sup> and 2.08 ± 0.67 10<sup>5</sup> CFU/well, respectively). Cefsulodin was the only antimicrobial agent tested that decreased the FN adherence of the majority of the strains: decrease in adherence highly significant (p < 0.01) for the <i>P. fluorescens</i> MF0 strain, significant (p < 0.05) for the <i>P. aeruginosa</i> NK125502, ER98513 and the <i>P. fluorescens</i> ER74508 strains, and not significant for the <i>P. aeruginosa</i> ER92581 strain. The effects of chloramphenicol and polymyxin B on the adherence of <i>Pseudomonas</i> were strain dependent. Gentamicin had no statistically significant effect on bacterial adherence. We conclude that, in addition to its antibacterial activity, cefsulodin could be effective in preventing the adherence of fluorescent <i>Pseudomonas</i> to FN, an important property in the presence of injured epithelium and coated biomaterials.
Stroke Case Fatality in Denmark from 1977 to 1992: The Copenhagen City Heart Study
Authors: Truelsen Thomas , Grønbæk Morten , Schnohr Peter , Boysen Gudrun 
Published: April 2003

<i>Background and Purpose:</i> Stroke mortality rates have decreased in Denmark but little is known about the reasons for these changes. One possible explanation is decreased case-fatality, and the aim of the present investigation was to study trends in case-fatality for first-ever stroke in a large population-based cohort study in Copenhagen, Denmark. <i>Subjects and Methods:</i> The Copenhagen City Heart Study comprised 19,698 inhabitants in Copenhagen, Denmark. Linkage to two national registers enabled identification of all subjects irrespective of participation in the study examinations. Follow-up in the present study was from January 1, 1977 to December 31, 1992. Case fatality after 7 days, 28 days, 1 year and 1 year in 28-day survivors was assessed for first-ever stroke. Uniform identification and validation methods made it possible to estimate trends in case-fatality. The World Health Organization’s definition of stroke was used, and stroke was categorized into either unspecified stroke, ischemic infarction, intracerebral hemorrhage, or subarachnoid hemorrhage. The effect of time was estimated by means of multiple logistic regression analyses adjusting for gender, age at onset and type of stroke. <i>Results:</i> A total of 1,213 strokes occurred during the study period from 1977 to 1992 in the study population. The case-fatality was highest during the first 28 days, and especially the initial 7 days; thereafter a steady state was reached. From the period 1977–1980 to the period 1989–1992 case-fatality did not change in analyses of 7-day case-fatality odds ratio (OR) = 1.14 (95% confidence interval, CI: 0.98–1.33), or of 28-day case-fatality OR = 1.06 (95% CI: 0.92–1.20), or of 1-year case-fatality OR = 0.95 (95% CI: 0.84–1.07). In the 1-year case-fatality, including only 28-day survivors, a significant decrease was found OR = 0.81 (95% CI: 0.67–0.97). Men had a significantly lower 7-day case-fatality than women; OR = 0.73 (95% CI: 0.52–0.99), but the difference attenuated in subsequent analyses and did not remain statistically significant. <i>Conclusion:</i> During the period 1977–1992, the 1-year case-fatality decreased in stroke patients who survived the initial 28 days, whereas no changes were observed in 7-day, 28-day and 1-year case-fatality.