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Biomedical subjects

B Norrving

Publications and source records attributed to B Norrving.

At least 55 records · Page 3Linked to original sources
PubMed1992

Emergency reversal of anticoagulation after intracerebral hemorrhage.

BACKGROUND AND PURPOSE: Although intracerebral hemorrhage is one of the most serious complications during oral anticoagulant therapy, there are no guidelines on emergency treatment with respect to reversal of anticoagulation effect in these patients. METHODS: We retrospectively compared laboratory data and clinical features in 17 cases of anticoagulant-related intracerebral hemorrhage treated with prothrombin complex concentrate (n = 10) or fresh-frozen plasma (n = 7). RESULTS: In the group of patients treated with prothrombin complex concentrate, the mean prothrombin time decreased from 2.83 to 1.22 International Normalized Ratio within 4.8 hours, compared with a decrease from 2.97 to 1.74 within 7.3 hours in those given fresh-frozen plasma (i.e., four to five times more rapidly after treatment with prothrombin complex concentrate) (p less than 0.001). Symptoms and signs of intracerebral hemorrhage, measured on an eight-graded Reaction Level Scale, progressed on average 0.2 grades in patients given prothrombin complex concentrate compared with 1.9 grades in those given fresh-frozen plasma (p less than 0.05). In patients with prothrombin values above 1.46, clinical progression within 12 hours occurred in five of six cases. CONCLUSIONS: Treatment with prothrombin complex concentrate reverses anticoagulation more rapidly than fresh-frozen plasma, which might be of importance for the prevention of further bleeding.

Aged↗
PubMed1992

Cancer incidence and mortality among Swedish Baltic Sea fishermen.

A 25% lower cancer mortality was found for 1360 Swedish fishermen who fished on the Baltic Sea than for the general population. The fishermen consumed twice as much fish as the population in the same county. In spite of the low overall cancer mortality, increased mortality from myeloma, as well as increased incidences of gastric carcinoma and squamous cell cancer of the skin and lips, was observed in the cohort. The decrease in risk for ischemic heart disease was not significant. Whether the dietary intake of fatty acids and selenium from fish contributed to the decreased risk was difficult to evaluate. Moreover, whether the consumption of fish from the Baltic Sea, contaminated with, for example, polychlorinated dioxins and dibenzofurans and other persistent organochlorine substances, contributed to the observed increased specific cancer risks is not known. However, the net health effect of high fish consumption from the Baltic Sea seems to be positive.

Adult↗
PubMed1992

Evaluation of long-term functional status in first-ever stroke patients in a defined population.

Medical, social and ADL variables were registered within 48 hours of stroke onset and 6 and 12 months later in 346 first-ever stroke patients. One year after stroke onset 27% of the patients were dead. 78% of the surviving patients were living in their own homes, 10.6% in old people's homes with no medical facilities and 9.5% in nursing homes. A health index was used for ADL evaluation and the quality of life was estimated according to Nottingham Health Profile (NHP). 16% of the patients had domestic social service assistance before stroke onset. The help given by relatives and friends far exceeded that given by the society before as well as after stroke onset. Right hemispheric stroke patients had a worse outcome than left-sided with respect to ADL and life satisfaction.

Activities of Daily Living↗
PubMed1991

Lateral medullary infarction: prognosis in an unselected series.

We describe the acute and long-term prognosis in 43 patients with lateral medullary infarction (LMI) collected from a population-based stroke registry from 1982 to July 1988. Mean age was 63.9 years and median time of follow-up was 33 months. In the acute phase, 5 patients (11.6%) died from respiratory and cardiovascular complications and 2 new strokes occurred, both in the posterior circulation. During follow-up, recurrent vertebrobasilar territory strokes occurred in only 2 patients (a rate of 1.9% per year). The mechanisms of stroke were vertebral artery (VA) branch occlusion, causing a medial medullary syndrome, and basilar artery thrombosis propagating from a contralateral, distal VA stenosis. In the acute phase of LMI, respiratory and cardiovascular events, presumably caused by autonomic dysfunction related to the lateral medullary lesion, are the major hazards. Recurrent posterior circulation strokes were uncommon during follow-up.

Adult↗
PubMed1990

Impaired homocysteine metabolism in early-onset cerebral and peripheral occlusive arterial disease. Effects of pyridoxine and folic acid treatment.

Severe homocysteinemia due to genetic defects either of pyridoxal 5-phosphate (PLP)-dependent cystathionine beta-synthase (CBS) or of enzymes in vitamin B12 and folate metabolism is associated with very early-onset vascular disease. Therefore, we studied homocysteine metabolism in 72 patients presenting before the age of 55 years with occlusive arterial disease of cerebral, carotid, or aorto-iliac vessels. Twenty patients (28%) had basal homocysteinemia; and 26 patients (36%) had abnormal increases of plasma homocysteine after peroral methionine loading, which exceeded the highest value for 46 comparable controls and was within the range for 20 obligate heterozygotes for homocystinuria due to CBS deficiency. Basal plasma homocysteine content was strongly and negatively correlated to vitamin B12 and folate concentrations. Plasma PLP was depressed in most patients but there was no correlation between PLP and homocysteine values. In 20 patients, treatment with pyridoxine hydrochloride (240 mg/day) and folic acid (10 mg/day) reduced fasting homocysteine after 4 weeks by a mean of 53%, and methionine response by a mean of 39%. These data show that a substantial proportion of patients with early-onset vascular disease have impaired homocysteine metabolism, which may contribute to vascular disease, and that the impaired metabolism can be improved easily and without side effects.

Adult↗
PubMed1990

Direct costs of stroke for a Swedish population.

Direct costs were estimated for the treatment, rehabilitation, and nursing of 125 patients with first stroke in the Lund and Orup health districts (population of 200,191). Patients were followed from the onset of stroke in 1983 until October 31, 1985. The data were used to calculate the present value of the expected lifetime direct costs for an individual contracting his or her first stroke at various ages. For example, at the age of 72, these costs were estimated at SEK 283,000 for a man and SEK 561,000 for a woman. Hospital care was the major cost component (75% for males and 89% for females) at this age of onset. The results could be used to estimate the economic benefits of preventing new strokes, hence, forming part of a cost-effectiveness or cost-utility analysis. Together with prognoses of the expected developments in the incidence of stroke, they could also serve as the basis of forecasts of future costs of the health care and social service sectors.

Adult↗
PubMed1990

Survival following stroke. A prospective population-based study of 438 hospitalized cases with prediction according to subtype, severity and age.

In a prospective population-based study analyses were performed to estimate the survival prognosis following stroke, in relation to age of the patient as well as to subtype, severity and occurrence of the stroke diagnosis. The statistical technique of stepwise regression analysis was used to discriminate the isolated importance of these factors on survival outcome. A total of 438 patients, consecutively admitted to the Department of Neurology during the period Feb. 1st 1986-September 30th 1987 were followed 15 days, 3, 6, and 12 months after the acute stroke. The one-year survival rate was 75% compared with 93% for a control group matched for age, sex, residence and calendar year. Mortality after stroke occurred predominantly within the first 3 months, after 3 months survival prognosis was no different from that of the general population. Statistical analysis identified 2 factors that gave significant isolated prediction on survival outcome. These factors were in order of importance age and severity of stroke diagnosis, whereas sex, subtype and occurrence of stroke were of no discriminative value.

Age Factors↗
PubMed1990

Outcome after stroke in patients discharged to independent living.

In a prospective, population-based study, we evaluated rehabilitation outcome, place of residence, and functional ability 3, 6, and 12 months after stroke onset in 129 consecutive patients discharged from the hospital to independent living, either in their own homes or in an old people's home. The study group comprised 50% of all patients admitted for acute stroke between February 1, 1986, and January 31, 1987. Of the 129 patients, 125 returned to their own homes and four moved into an old people's home. Once they returned home, only minor changes occurred in the patients' place of residence or functional capacity. The majority of the patients (90%) were still living in their own homes after 12 months; 99% could walk independently indoors, 92-95% could climb a staircase, and 90% could manage their daily hygiene. Eight patients (6%) died during follow-up, and one fourth of the patients were hospitalized again. The average number of days of rehospitalization during the 12 months was 23. Our study may serve as a guide to the planning of stroke programs and to a more effective and efficient use of available health resources.

Activities of Daily Living↗
PubMed1989

Clinical and radiologic features of lacunar versus nonlacunar minor stroke.

We determined the angiographic presence of extracerebral and intracerebral arterial disease in 122 patients with minor stroke within the carotid territory; we excluded patients with a recognized cardiac source of emboli. Based on clinical features and computed tomographic findings, patients were classified as having lacunar infarcts (n = 61), nonlacunar infarcts (n = 53), and infarcts of indeterminate type (n = 8). Severe carotid bifurcation disease (greater than or equal to 50% stenosis or occlusion) was significantly more common in nonlacunar than in lacunar infarcts, on both the ipsilateral (p less than 0.001) and the contralateral (p less than 0.01) sides; 79% of the patients with nonlacunar infarcts had severe carotid bifurcation and/or middle cerebral artery disease on the ipsilateral side compared with 3.3% of the patients with lacunar infarcts. Our data underscore the need for classification of patients by the underlying mechanisms in future studies of treatment of ischemic stroke.

Cerebral Angiography↗
PubMed1989

Intracerebral hemorrhage in stroke patients anticoagulated with heparin.

To characterize the clinical features of patients with acute cerebral infarction who sustained intracerebral hemorrhage related to heparin anticoagulation, we describe 10 patients and review reports of 16 cases. Cardiac-source embolism was identified in seven (70%) of the 10 patients and consisted of atrial fibrillation in six of the seven. The middle cerebral artery territory was affected in nine patients (90%), with moderate-sized or large infarcts by clinical and computed tomographic criteria. The interval between stroke onset and intracerebral hemorrhage was less than 72 hours in 80% of the patients. Intracerebral hemorrhage occurred less than or equal to 24 hours after the time heparin was started in 80% of the patients. The activated partial thromboplastin time closest to the time of intracerebral hemorrhage was greater than 2 x control in seven patients. Our findings in the 10 patients are similar to those of the 16 cases previously reported and suggest that heparin-related intracerebral hemorrhage occurs early after stroke onset, usually with moderate-sized or large infarcts, and with excessive anticoagulation in some patients.

Adult↗
PubMed1988

Epidemiology of stroke in Lund-Orup, Sweden, 1983-85. Incidence of first stroke and age-related changes in subtypes.

The incidence of stroke in the hospital district of Lund-Orup (total population 200,191), the local uptake area of the University Hospital, Lund, was studied. Between January 1, 1983 and December 31, 1985, there were 1054 cases of first stroke. Age adjusted (to Swedish Dec 1983 population) incidence rates were 221.2 for males, 195.8 for females, and 208.3 for total population (per 100,000 and year). Case-fatality ratio by 30 days was 17.5%. Atherothrombotic infarction was the most common subtype (58.4%), followed in frequency by cardiac embolism (30.6%), intracerebral hemorrhage (8.3%) and subarachnoid hemorrhage (2.7%). The most important change in the distribution of subtypes with age was an increase in the proportion of cardiac embolism from 13% in the youngest to 44% in the oldest age groups. The present study underscores the importance of careful determination of subtypes of stroke in future epidemiological studies.

Adolescent↗
PubMed1986

Spectral analysis with digital presentation of C-W Doppler signals in the evaluation of carotid stenosis.

Using a continuous-wave ultrasound Doppler system with spectral analysis (FFT) and digital processing and presentation, the Doppler shift characteristics of the carotid arteries were studied in 40 healthy subjects (20 men and 20 women; average age 69 years). The reference values, thus obtained, were applied to the analysis of sonograms from 46 carotid arteries, which were also studied angiographically. Stenoses which reduced the diameter of the internal carotid artery by more than 30% could be identified with a sensitivity of 97% and a specificity of 100%. The results extend previous experience that spectral analysis improves the usefulness of the ultrasound Doppler system in the evaluation of carotid artery disease. The addition of digital processing and presentation of the Doppler shift characteristics increases the diagnostic precision and provides a permanent record. The importance of well-trained sonographers and adequate reference values is emphasized.

Aged↗
PubMed1986

Young stroke patients. An angiographic study.

In 59 young stroke patients without predisposing conditions (thromboembolic mechanisms, diabetes, cardiac disease, coagulation disturbances), the angiographic findings and the clinical observations in combination make arterial dissection the most probable diagnosis in 45 patients. In an additional 7, this diagnosis remains as a possible diagnosis. It is suggest that in patients under 40 years of age with no predisposing disease and with sudden onset of neurologic deficits, preceded or accompanied by headache and/or neck pain and often associated with physical strain, arterial dissection should be regarded as the most likely diagnosis.

Adolescent↗
PubMed1985

Non-invasive detection of carotid bifurcation disease by continuous-wave Doppler with spectral analysis.

The diagnostic accuracy of 5 MHz continuous-wave (C-W) Doppler with spectral analysis for detecting carotid bifurcation disease was evaluated. In a first phase of the study, normal confidence intervals for peak frequency data and spectrum width were established and Doppler spectrum abnormalities were separated into three types (spectral broadening with preserved window, spectral broadening without window, sequence of abnormalities including inverted Doppler spectrum). In a second phase the diagnostic accuracy of these variables was tested on 86 carotid arteries as independently compared with angiography. Whereas both peak frequency data and spectrum distribution findings were invariably abnormal in stenoses greater than or equal to 60%, spectrum distribution findings were more accurate in 30-59% stenosis. Using spectrum distribution criteria, sensitivity and specificity for stenosis greater than or equal to 30% were 94.6% and 90.7% respectively. All variables were insensitive for stenoses less than 30% lumen diameter reduction.

Adult↗