bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strokes in the Elderly – Higher Acute and 3-Month Mortality – An Explanation
Authors: Sharma Jagdish C. , Fletcher Sally , Vassallo Michael 
Published: April 2003

<i>Aim:</i> Stroke is common in older people. The objective of the study was to determine if older stroke patients have a higher mortality and disability compared with younger patients for comparable stroke severity and pathology and whether there is an explanation for the difference. <i>Methods:</i> A prospective study was undertaken in 296 consecutive patients admitted with acute stroke. Patients were studied for neurological features, pre-stroke functional disability, severity of stroke defined by stroke syndromes and pathology of stroke on CT scans (202 patients). Post-stroke disability was defined according to the functional status within 72 h of admission. A record was made of the intercurrent illness while the patients were in acute wards and of the risk factors. Patients were dichotomised into two age groups: younger group – up to 75 years (163 patients) and older group – over 75 years (133 patients). Outcome was measured according to (1) discharge status from acute wards, i.e., dead or alive, and (2) mortality at 3 months. <i>Results:</i> Although there was no significant difference in severe clinical stroke syndromes (p = 0.72), CT scan features (p = 0.68) and pyrexia (0.38) between the two age groups, the older patients had significantly more disabling strokes as defined on Barthel Index (p = 0.015) and a higher mortality in the acute phase (p < 0.01) and at 3 months (p = 0.001). The older stroke patients had more severe pre-stroke disability (p < 0.001) and more severe neurological impairment for similar stroke severity and pathology. Early mortality was more influenced by pre-stroke global health than age whereas 3-month mortality was influenced by age to the exclusion of all other known prognostic factors. <i>Conclusion:</i> The older stroke patients have more disabling stroke and an increased mortality for a similar spectrum of stroke severity and pathology. The explanation for higher mortality of the older patients is the poor pre-stroke health and higher immediate post-stroke disability.
Aggravation of Acute Ischemic Stroke by Hyperthermia Is Related to an Excitotoxic Mechanism
Authors: Castillo José , Dávalos Antoni , Noya Manuel 
Published: April 2003

<i>Objective:</i> To examine whether hyperthermia aggravates cerebral injury in acute ischemia by an excitotoxic mechanism, we studied the relationship between body temperature on admission and CSF concentrations of neuroexcitatory amino acids in 128 patients with acute ischemic stroke of less than 24 h duration. <i>Methods:</i> Stroke worsening was defined as the percent change between the Canadian Stroke Scale (CSS) at 48 h and the CSS on admission. Infarct volume was measured on days 4–7 on cranial computed tomography. Excitatory amino acids were analyzed using HPLC. <i>Results:</i> Glutamate concentration [median (min.-max.)] was 11 (2–19) µmol/l in hyperthermic patients (body temperature >37.5°C) and 5 (2–22) µmol/l in normothermic patients (p < 0.0001). Glycine concentration in hyperthermic and normothermic patients was 16 (3–21) µmol/l and 9 (3–50) µmol/l, respectively (p < 0.0001). Glutamate was significantly higher in patients with hyperthermia only during the first 12 h after the onset of symptoms. The CSF concentrations of glutamate (r = 0.52; p < 0.0001) and glycine (r = 0.62; p < 0.0001) correlated with body temperature. Body temperature was significantly related to stroke worsening and infarct size, but this effect was dependent on the glutamate effect. <i>Conclusion:</i> Glutamate and glycine release during the acute phase of cerebral ischemia could be responsible for the increased brain damage in hyperthermia.
Cerebral Microembolus Detection in an Unselected Acute Ischemic Stroke Population
Authors: Lund Christian , Rygh Jørgen , Stensrød Brynhild , Sandset Per Morten , Brucher Rainer , Russell David 
Published: April 2003

<i>Objective:</i> The aims of this study were firstly to determine prevalence, frequency, and clinical significance of cerebral microemboli in an unselected acute ischemic stroke population and secondly to examine how this information may improve ischemic stroke subtype classification. <i>Methods:</i> We intended to perform transcranial Doppler (TCD) microembolus monitorings of the middle cerebral artery (MCA) in the symptomatic hemisphere for 45 min in 120 consecutive patients with internal carotid artery territory ischemia. The first examination was performed within 72 h from start of symptoms and the second 5 ± 1 days later. Platelet and coagulation system activation were measured following TCD monitoring in 38 patients. The strokes were subtyped using the TOAST classification criteria, and the patients’ clinical status was assessed at discharge using the Scandinavian Stroke Scale and the Barthel Index. <i>Results:</i> Microembolus monitoring was technically possible in 83 (69.2%) of the 120 patients. Thirty-two (26.6%) patients had an inadequate temporal bone acoustic window or were too restless to allow long-time monitoring. In 5 (4.2%) patients the relevant MCA was occluded. Twenty-two (26.5%) of the 83 patients had microemboli despite the fact that over 90% were receiving an antiplatelet or an anticoagulant treatment. The mean frequency of microemboli was 6.7 ± 13.6 per 45 min. Microemboli were more prevalent in assumed cardioembolic stroke than in other subtypes of ischemic stroke (p = 0.047). We found no association between the presence of cerebral microemboli and the clinical outcome or the parameters for platelet or coagulation system activation. The presence of microemboli was not associated with in-hospital deaths (p = 0.17), whereas MCA occlusion was (p = 0.01). <i>Conclusions:</i> Cerebral microemboli are frequent in unselected acute ischemic stroke patients despite antiplatelet or anticoagulant treatment. TCD detection of microemboli provides valuable pathophysiological information and may, therefore, improve current ischemic stroke subtype classification.
What Constitutes a True Hyperdense Middle Cerebral Artery Sign?
Authors: Koo C.K. , Teasdale Evelyn , Muir Keith W. 
Published: April 2003

<i>Objectives:</i> The ‘hyperdense MCA sign’ refers to an appearance of increased attenuation of the proximal middle cerebral artery (MCA) that is often associated with thrombosis of the M1 MCA segment and may be the only diagnostic feature on computed tomography early after ischaemic stroke. False positives are recognized, and correct recognition of this sign has, therefore, assumed greater importance with the advent of thrombolytic therapy for stroke. We sought to define objective criteria for hyperdensity of the MCA. <i>Methods:</i> Brain computed tomographs obtained by a standard protocol in a neuroradiology department were analyzed by a single observer. All consecutive scans reported as exhibiting a hyperdense MCA were compared to controls reported as having normal scans. Ovoid regions of interest were placed over the vessels and cerebral cortices, and the attenuation in Hounsfield units (HU) measured. Absolute attenuation and ratios of one side to the other were compared. <i>Results:</i> MCA attenuation was unrelated to age in cases (n = 18) and controls (n = 80). The mean MCA attenuation was greater in the affected MCA of cases as compared with controls [54.0 HU (99% confidence interval CI 46.7–61.2) vs. 41.3 HU (99% CI 39.7–43.0); p < 0.00001]. Cases were subdivided into true and false positives by the ratio of denser:less dense MCA (within or without the 95% prediction interval for controls). In all true positives, the MCA ratio was > 1.2. 9 of 10 true positives had acute ischaemic stroke; 1 patient had herpes simplex encephalitis, but had MCA attenuation within the 95% CI for controls. False positives had mature cerebral infarction or non-ischaemic pathologies. The ratio of MCA attenuation to adjacent cerebral cortex was significantly higher in both true and false positives than in controls. <i>Conclusions:</i> Hyperdense MCAs associated with acute ischaemic stroke can be distinguished from normal vessels and false positives by measurement of absolute attenuation of affected and normal vessels: an absolute density of >43 HU and a MCA ratio of >1.2 defined hyperdensity and excluded all other pathologies. Confirmation in other centres is required.
Inflammation and Intestinal Metaplasia of the Gastric Cardia: <i>Helicobacter pylori,</i> Gastroesophageal Reflux Disease, or Both
Authors: Goldblum John R. 
Published: April 2003

The gastric cardia is a microscopic zone that is normally found in the most proximal portion of the stomach, although cardiac-type mucosa may arise in the distal esophagus as a metaplastic phenomenon secondary to gastroesophageal reflux disease (GERD). Inflammation of the native gastric cardia is strongly associated with <i>Helicobacter pylori</i> infection, although there may be a second form of ‘carditis’ in which metaplastic cardiac-type mucosa becomes inflamed secondary to GERD. Intestinal metaplasia of the cardia may be difficult to recognize because of the difficulty in accurately identifying the esophagogastric junction by endoscopy and the histologic similarities of intestinal metaplasia in the proximal stomach and distal esophagus. However, cytokeratin 7 and 20 immunoreactivity patterns appear to be useful in distinguishing between these forms of intestinal metaplasia. The preponderance of data suggests that intestinal metaplasia of the cardia is associated with <i>H. pylori</i> infection as opposed to GERD, and preliminary data suggest a lower risk of progression to dysplasia and adenocarcinoma when compared to intestinal metaplasia of the distal esophagus.
Psychiatric Complications of Dementia: Impact on Caregivers
Authors: Victoroff Jeff , Mack Wendy J. , Nielson Kristy A. 
Published: April 2003

This study was designed to determine the relationship between psychiatric features of dementia and their impact on caregivers. 35 patient-caregiver pairs were evaluated at two university-affiliated dementia clinics, using standard instruments to rate patient psychiatric features and caregiver burden and depression. There were highly significant correlations between patient agitation and both caregiver burden (r = 0.59, p = 0.0002) and depression (r = 61, p = 0.0001). These associations remained significant after adjusting for multiple demographic and dementia variables. There was no significant association between patient delusions, hallucinations, or depression and caregiver burden or depression. Agitation, particularly physical aggression, may impact caregivers even more than does the cognitive status of the demented patient.
Platelet Monoamine Oxidase B Activity in Dementia
Authors: Götz M.E. , Fischer P. , Gsell W. , Riederer P. , Streifler M. , Simanyi M. , Müller F. , Danielczyk W. 
Published: April 2003

Platelet monoamine oxidase B (MAO-B) activity has been found to increase significantly in demented patients. For the first time, a 4-year follow-up of platelet MAO-B activity and Mini-Mental State (MMS) was performed in patients with probable dementia of the Alzheimer type (DAT) and age-matched controls. MAO-B activity of DAT patients increased significantly 2 years after the beginning of the study as compared with controls and remained significantly higher for the entire period of the examinations (p < 0.0001). The decrease of the MMS scores did not correlate with the time course of the increase of platelet MAO-B activity (Spearman rank correlation test). The decline of the MMS scores of DAT patients preceded the elevation of MAO-B activity. Since degenerative processes in brain areas which are responsible for cognitive function and are reflected by the MMS scores rather affect cerebral cholinergic than monoaminergic neurotransmitter systems, degeneration of the latter at late stages of DAT might be reflected by increased platelet MAO-B activity.
Acetylcholinesterase Inhibition in Dementia with Lewy Bodies: Results of a Prospective Pilot Trial
Authors: Querfurth H.W. , Allam G.J. , Geffroy M.A. , Schiff H.B. , Kaplan R.F. 
Published: April 2003

<i>Objective:</i> Dementia with Lewy bodies (DLB) is the second commonest form of dementia. The response to acetylcholinesterase inhibition (AChEI) could be greater in DLB than in Alzheimer’s disease (AD) because cholineacetyl-transferase levels are more reduced in the former. This preliminary trial seeks to compare performances in cognitive tasks before and after tacrine administration in DLB and AD subjects. <i>Methods:</i> Six DLB and 6 AD patients were enrolled in an open, nonrandomized, intervention trial using 80 mg/day tacrine. Patients met ADRDA or DLB consortium criteria for probable diseases. Subjects were matched for Mini Mental State Examination (MMSE) score, age and sex. Mattis Dementia Rating Scale (DRS), Controlled Oral Word Association Test (FAS) and Boston Naming tests were administered at baseline and at 6 months into treatment. <i>Results:</i> AD and DLB groups did not differ in initial mean total DRS scores. In the primary analysis, both groups declined during the course of treatment (–7.3 ± 4.2 and –16.8 ± 39.2 DRS points, respectively). Due to the large variability in DLB posttreatment scores, this group was divided post hoc into responders (DLBr) and nonresponders (DLBnr). The DLBr group outperformed the DLBnr group at baseline (p < 0.05) and, notably, in follow-up DRS test scores (p < 0.001). Two-way MANOVA comparing both DLB subgroups with either the entire AD cohort or similarly stratified AD subgroups showed a significant interaction (F = 7.6; p < 0.015), attributed mostly to declines in DLBnr group scores (p < 0.01). Surprisingly, on DRS memory subscale and FAS tests, there were significant improvements in DLBr scores (p < 0.02). A baseline MMSE (or DRS memory) score ≥15 predicted a positive response to tacrine in DLB. Acceleration of parkinsonism occurred in all DLB subjects. <i>Conclusion:</i> Results from a primary analysis of the therapeutic effect of 80 mg/day tacrine in DLB and AD were negative. However, post hoc analysis showed that mild to moderate DLB responds favorably to AChEI relative to AD through stabilization of global cognitive decline and improvements in specific cognitive areas. These results could be useful in the planning of a more definitive study.
An X-Linked Gene Involved in Androgenetic Alopecia: A Lesson to Be Learned from Adrenoleukodystrophy
Authors: König A. , Happle R. , Tchitcherina E. , Schaefer J.R. , Sokolowski P. , Köhler W. , Hoffmann R. 
Published: April 2003

<i>Background:</i> Adrenoleukodystrophy (ALD), including its adult variant adrenomyeloneuropathy (AMN), is an X-linked recessive trait characterized by progressive demyelinization of the nervous system. The gene defect involves a peroxisomal transporter protein, resulting in accumulation of very-long-chain fatty acids in the brain and other organs such as the adrenal glands. Affected men show various endocrine disorders. Moreover, disturbances of hair growth are frequently mentioned in reports on ALD/AMN. <i>Objective:</i> This study was performed to delineate further the hair status and type of hair loss in men with AMN. <i>Methods:</i> We examined and documented the status of hair growth in 16 men suffering from AMN. A meticulous history with particular regard to hair changes was taken from all patients and their family members. <i>Results:</i> The age of the patients varied between 27 and 62 years, their mean age was 39.8 years. Twelve men showed male-pattern androgenetic alopecia (AGA), Hamilton grades IV–VIII, 3 men had a female-pattern AGA (Ludwig grade I or II). Ten of the patients with male-pattern AGA had reached Hamilton stage VII or VIII. The remaining scalp hair was unusually scarce and thin in 11 cases, regardless of the grade of AGA. Moreover, in 10 of 16 patients the eyelids showed pronounced madarosis. The remaining body hair was found to be normal. If present, endocrine manifestations had started prior to the onset of alopecia, and in 11 of 12 patients hair loss was apparent before neurological symptoms were noted. <i>Conclusion:</i> ALD/AMN gives rise to two different types of hair loss. Firstly, affected men show diffuse hair loss involving the entire scalp and the eyelashes. Secondly, they tend to develop AGA more frequently and earlier and in a severer form. Paradoxically, pronounced AGA is present although the patients may simultaneously show some degree of hypogonadism. Hence, the X-linked ALD mutation can be taken as a well-defined gene within the polygenic spectrum of genes responsible for AGA. This may be of theoretical importance for the elucidation of the pathogenetic pathways of AGA.
Changes in Gastric Intramucosal pH following Mesenteric Traction in Patients Undergoing Pancreas Surgery
Authors: Brinkmann Alexander , Seeling Wulf , Rockemann Michael , Junge JörgHelge , Radermacher Peter , Wiedeck Heidemarie , Büchler MarkusW. , Georgieff Michael 
Published: April 2003

<i>Background/Aim:</i> During major abdominal surgery, mesenteric traction (MT) may result in hemodynamic instability mainly due to endogenous prostacyclin release. Gastric intramucosal pH (pHi) and PiCO<sub>2</sub> are indicators of splanchnic tissue perfusion with a predictive value for the postoperative outcome. We investigated the influence of MT on gastric pHi and on postoperative outcome in patients undergoing pancreas surgery. <i>Methods:</i> Forty-six consecutive patients scheduled for pancreas surgery were investigated. We registered hemodynamics and pHi by gastric tonometry and documented postoperative outcome (complications, hospital stay). Baseline data (T0) were recorded after skin incision. Further assessments followed 30, 60 and 120 min after intentional MT (T1–3) and at the end of surgery (T4). <i>Results:</i> Thirty-three patients demonstrated a decrease in mean arterial pressure (MAP) following MT, whereas 13 patients showed entirely stable hemodynamics. The significant reduction in MAP in patients with an MT response was not associated with changes in pHi as compared to patients with no response (stable MAP) (T0 7.34 ± 0.08 vs. 7.35 ± 0.06; T1 7.34 ± 0.05 vs. 7.32 ± 0.07; T2 7.32 ± 0.05 vs. 7.31 ± 0.08; T3 7.32 ± 0.05 vs. 7.32 ± 0.07; T4 7.26 ± 0.1 vs. 7.27 ± 0.08; mean ± SD, MT response vs. no response). Neither MT response nor gastric intramucosal acidosis as evidenced by a pHi <7.32 at the end of surgery predicted postoperative complications or longer hospital stay. <i>Conclusion:</i> No deterioration of gastric pHi was found, which could reflect acceptable splanchnic perfusion and oxygenation despite systemic blood pressure reactions in patients experiencing an MT response.
Distal Pancreatectomy in Chronic Pancreatitis
Authors: Schoenberg M.H. , Schlosser W. , Rück W. , Beger H.G. 
Published: April 2003

<i>Background:</i> The indications for a resective procedure in chronic pancreatitis are severe pain and local complications. The aim of this study, based on prospectively assessed data, was to evaluate distal pancreatectomy in patients suffering from chronic pancreatitis localized in the corpus and cauda of the pancreatic gland. <i>Methods:</i> Seventy-four patients undergoing distal pancreatectomy were evaluated pre- and postoperatively (after a median observation period of 58 months) for pain, professional status, alcohol consumption, and endocrine function as measured by the glucose tolerance test preoperatively. <i>Results:</i> The indication for operation was severe therapy-resistant pain in nearly all patients and an inflammatory tumor or pancreatic pseudocysts in over 50% of the patients. One fourth of the patients were operated in order to exclude malignancy. Ninety-five percent of the patients underwent distal pancreatectomy, only in 4 cases (5%) was a subtotal (Child) resective procedure performed. In 34% of patients undergoing distal pancreatectomy a splenectomy could be avoided. The early postoperative complications were few and mostly due to the severe comorbidity of the patients. During the median observation period of 58 months 14.7% of the patients died due to diseases not related to distal pancreatectomy. Six percent of the patients could not be reevaluated and were lost to follow-up. In the remaining 59 patients 88% had significantly less pain and 66% had an increase in median body weight of 8 kg. Fifty percent of the patients had full or partial professional rehabilitation, one fourth was unemployed and 24% had retired due to age. 51.7% had a normal endocrine function as assessed by the glucose tolerance test, 16.2 and 21.6% had a latent or manifest diabetes mellitus, respectively. In 74.5% of all patients the endocrine function did not worsen during the observation period. <i>Conclusion:</i> In comparison to conservative treatment distal pancreatectomy is a suitable therapeutic measure in patients with severe pain and local complications. It significantly improves the quality of life of patients without compromising endocrine function. Postoperative lethality is lower than in conservatively treated patients and is not related to distal pancreatectomy.
The Telostei Immunoglobulin Light IGL1 and IGL2 V, J and C Genes
Authors: Artéro Sylvaine , Lefranc Marie-Paule 
Published: April 2003

‘Teleostei Immunoglobulin Light IGL1 and IGL2 V, J and C Genes’, the 12th report of the ‘IMGT Locus in Focus’ section, comprises 8 tables: (1) ‘Teleostei IGL1V genes’; (2) ‘Teleostei germline IGL1J genes’; (3) ‘Teleostei IGL1C genes and alleles’; (4) ‘Teleostei IGL2V genes’; (5) ‘Teleostei germline IGL2J genes’; (6) ‘Teleostei IGL2C genes and alleles’; (7) ‘FR-IMGT and CDR-IMGT length of the Teleostei IGL1V genes’, and (8) ‘FR-IMGT and CDR-IMGT length of the Teleostei IGL2V genes’. These tables are available on the IMGT Marie-Paule page from IMGT, the international ImMunoGeneTics database (http://imgt.cines.fr: 8104) created in 1989 by Marie-Paule Lefranc, Université Montpellier II, CNRS, France.