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Biomedical subjects

J D Easton

Publications and source records attributed to J D Easton.

17 recordsLinked to original sources
PubMed1992

Vascular event rates in patients with atherosclerotic cerebrovascular disease.

The purpose of this study was to review data from published cerebrovascular studies to determine if it is possible to predict, based on clinical manifestations (eg, cervical bruit, transient ischemic attack, or stroke) of cerebrovascular atherosclerosis, the annual probability of having a stroke, as well as to determine and discuss the methods used in calculating and reporting vascular event rates. This overview analysis reveals that the annual stroke rates are as follows: for asymptomatic carotid stenosis, 1.3% (95% confidence interval [CI], 1.0 to 1.6); for transient monocular blindness, 2.2% (95% CI, 1.3 to 3.0); for transient ischemic attack, 3.7% (95% CI, 3.1 to 4.3); for minor stroke, 6.1% (95% CI, 5.7 to 6.6); and for major stroke, 9.0% (95% CI, 8.0 to 9.9). The data analyzed here suggest that a hierarchical profile of worsening clinical characteristics mirrors a hierarchical progression of increasing risk of stroke. These data support the idea that there is a clinical risk profile, in addition to the conventional atherosclerosis risk factor profile, for predicting subsequent stroke.

Age Factors↗
PubMed1992

Design and baseline results of the monosialoganglioside early stroke trial. The EST Study Group.

BACKGROUND AND PURPOSE: The Early Stroke Trial is a randomized, placebo-controlled, double-masked, multicenter study to assess the safety and efficacy of monosialoganglioside in patients who have suffered an ischemic stroke of the cerebral hemispheres. METHODS: Only patients who could be evaluated and treated within 5 hours after the onset of stroke were considered; within each center, subjects were stratified by age, sex, and clinical severity. Patients were randomly allocated to receive a specified sequence of intravenous and intramuscular doses of either monosialoganglioside or identical-appearing placebo for 21 days. Patients were followed up for 4 months after randomization. Neurological status was measured primarily by using the Canadian Neurological Scale. After assessing the effect of treatment on survival, the principal measure of efficacy will be the change in neurological status between baseline and the 4-month follow-up among survivors. RESULTS: Sixteen clinical centers, 15 in Europe and one in North America, entered a total of 792 eligible patients during a 36-month recruitment period (from May 1987 to April 1990). In our series there were more men than women, and the relative frequency of patients increased with advancing age. The most frequently associated cardiovascular conditions were hypertension, atrial fibrillation, and peripheral vascular disease. Approximately 46% of the patients were admitted to a hospital within 1 hour and 81%, within 2 hours after the onset of stroke. About 22% first received the study treatment within 3 hours and 57%, within 4 hours. CONCLUSIONS: This study demonstrates the feasibility of large-scale trials with the onset of treatment within 5 hours after an ischemic stroke.

Adult↗
PubMed1991

"Frontal lobe" utilization behavior associated with paramedian thalamic infarction.

Disinhibited, exaggerated responses to objects and environmental cues (utilization behavior) occur predominantly with frontal lobe damage. We report a striking example associated with paramedian thalamic infarction suggesting a thalamofrontal component to environmental interactions that require inhibition, self-monitoring, and cognitive flexibility.

Behavior↗
PubMed1991

Antiplatelet therapy in the prevention of stroke.

Aspirin (acetylsalicylic acid) is effective in reducing vascular outcome events in patients with atherosclerosis: a relative risk reduction of about 30% for stroke, 22% for stroke and death, and 15% for vascular mortality. It is probable that low and high dose aspirin are similar in efficacy. Complications are more frequent with high dose aspirin than with low doses. Four randomised trials evaluating sulfinpyrazone vs placebo, and 3 trials evaluating sulfinpyrazone vs aspirin, showed more cerebrovascular events in the sulfinpyrazone group than in the aspirin and placebo groups. One small trial comparing dipyridamole with placebo in patients with cerebrovascular disease found no difference between the 2 groups in outcome. No other studies have compared dipyridamole alone with placebo or aspirin. The European Stroke Prevention Study II is currently in progress and is comparing dipyridamole + aspirin, dipyridamole, aspirin, and placebo. In the first year, the Ticlopidine Aspirin Stroke Study (TASS) showed a 42% risk reduction for stroke and death using the efficacy analysis and a 47% risk reduction for stroke and stroke death. Ticlopidine was more effective than aspirin in reducing stroke in both males and females. Apart from a reversible severe neutropenia in 0.86% of patients, ticlopidine-related adverse effects were relatively benign and reversible. The Canadian-American Ticlopidine Study (CATS) compared ticlopidine with placebo in patients with completed major strokes. The cumulative event rates for the primary outcome events of stroke, myocardial infarction and vascular death, using the efficacy approach, show clear evidence of separation almost immediately after randomisation, consistent with a constant risk reduction of about 30% in the ticlopidine group. These data provide strong evidence that ticlopidine conveys a clinically important reduction in the risk of thromboembolic events in patients with a history of completed thromboembolic stroke. In conclusion, aspirin is effective in preventing atherothrombotic morbidity and mortality. It reduces the overall vascular event rate by about 25%. Sulfinpyrazone and dipyridamole appear to add nothing important over aspirin alone. Ticlopidine is more effective than aspirin in preventing stroke. The modest, reversible risk of neutropenia, affecting less than 1% of patients, makes the benefit: risk ratio a reasonable one.

Aspirin↗
PubMed1989

A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients. Ticlopidine Aspirin Stroke Study Group.

We report the results of the Ticlopidine Aspirin Stroke Study, a blinded trial at 56 North American centers that compared the effects of ticlopidine hydrochloride (500 mg daily) with those of aspirin (1300 mg daily) on the risk of stroke or death. The medications were randomly assigned to 3069 patients with recent transient or mild persistent focal cerebral or retinal ischemia. Follow-up lasted for two to six years. The three-year event rate for nonfatal stroke or death from any cause was 17 percent for ticlopidine and 19 percent for aspirin--a 12 percent risk reduction (95 percent confidence interval, -2 to 26 percent) with ticlopidine (P = 0.048 for cumulative Kaplan-Meier estimates). The rates of fatal and nonfatal stroke at three years were 10 percent for ticlopidine and 13 percent for aspirin--a 21 percent risk reduction (95 percent confidence interval, 4 to 38 percent) with ticlopidine (P = 0.024 for cumulative Kaplan-Meier estimates). Ticlopidine was more effective than aspirin in both sexes. The adverse effects of aspirin included diarrhea (10 percent), rash (5.5 percent), peptic ulceration (3 percent), gastritis (2 percent), and gastrointestinal bleeding (1 percent). With ticlopidine, diarrhea (20 percent), skin rash (14 percent), and severe but reversible neutropenia (less than 1 percent) were noted. The mean increase in total cholesterol level was 9 percent with ticlopidine and 2 percent with aspirin (P less than 0.01). The ratios of high-density lipoprotein and low-density lipoprotein to total cholesterol were similar in both treatment groups. We conclude that ticlopidine was somewhat more effective than aspirin in preventing strokes in this population, although the risks of side effects were greater.

Aspirin↗
PubMed1989

The Canadian American Ticlopidine Study (CATS) in thromboembolic stroke.

The Canadian American Ticlopidine Study (CATS) is a randomised, double-blind, placebo-controlled trial to assess the effect of ticlopidine (250 mg twice daily) in reducing the rate of subsequent occurrence of stroke, myocardial infarction, or vascular death in patients who have had a recent thromboembolic stroke. Twenty-five centres entered 1072 patients into the study between 1 week and 4 months after their qualifying stroke. The patients were treated and followed for up to 3 years (mean 24 months). In the efficacy analysis, the event rate per year for stroke, myocardial infarction or vascular death, considered together, was 15.3% in the placebo group and 10.8% in the ticlopidine group, representing a relative risk reduction with ticlopidine of 30.2% (95% confidence interval 7.5-48.3%; p = 0.006). Ticlopidine was beneficial for both men and women (relative risk reductions 28.1%, p = 0.037, and 34.2%, p = 0.045, respectively). Analysis by intention-to-treat gave a smaller estimate of risk reduction (23.3%, p = 0.020) for stroke, myocardial infarction, or vascular death. Adverse experiences associated with ticlopidine included neutropenia (severe in about 1% of cases) and skin rash and diarrhoea (severe in 2% of cases each); all were reversible. This study provides evidence of a beneficial effect of ticlopidine in both men and women with a recent thromboembolic stroke.

Aged↗
PubMed1977

Dieting and peroneal nerve palsy.

In seven patients, peroneal nerve palsies developed while they were on weight-reduction diets. Five palsies were unilateral; two, bilateral. All patients recovered following diet modification. Therapeutic weight loss, of itself, can cause foot-drop. The prognosis is uniformly good.

Adult↗
PubMed1976

Somatic anxiety attacks and propranolol.

Patients with acute anxiety-like attacks are often evaluated for various medical conditions, and, when nothing is found, their symptoms are attributed to psychogenic causes. "beta-Adrenergic hyperactivity" should be considered in these patients. Six patients are described who, we believe, are suffering from this condition. Low rates of isoproterenol hydrochloride infusion-precipitated symptoms that mimicked their spontaneous somatic anxiety attacks. Treatment with propranolol hydrochloride produced longterm symptomatic relief.

Adult↗
PubMed1976

Syncope.

Syncope is usually easily diagnosed, but sometimes it is confused with hypoglycemia, epilepsy, cerebral vascular disease, "drop attacks", hyperventilation attacks, and hysterical faints. Syncope is usually a benign disorder, but sometimes it is a manifestation of a serious neurologic or cardiac disease. This paper provides an approach to the evaluation and management of patients with this disorder.

Adolescent↗
PubMedDate not supplied

Stroke and mortality rate in carotid endarterectomy: 228 consecutive operations.

A retrospective study of 228 consecutive carotid endarterectomies was conducted to determine the operative stroke and mortality rate in two 600-bed community hospitals. The combined stroke-mortality rate for the series was 21.1% (48 of 228). Eleven endarterectomies were performed for asymptomatic bruits and the combined stroke-mortality rate was 18.2% (2 of 11). Fifty-seven endarterectomies were performed for transient ischemic attach(s) in the symptomatic carotid artery distribution and the combined stroke-mortality rate was 21.1% (12 of 57). Seventy-one endarterectomies were performed following a mild-moderate stroke in the symptomatic carotid artery distribution and the combined stroke-mortality rate was 21.1% (15 of 71). Twelve endarterectomies were performed following a severe stroke in the symptomatic carotid artery distribution and the combined stroke-mortality rate was 41.7% (5 of 12). There was no trend toward more or less operation strokes or deaths from 1970 to 1976. The similarity of results among the eleven board-certified neurological and vascular surgeons who performed the 228 endarterectomies suggests that the operative stroke and mortality rates for carotid endarterectomy reported here are likely to be representative of those in many other community hospitals in this country in the 1970s.

Aged↗
PubMedDate not supplied

Cervical manipulation and stroke.

Three patients are described who experienced vertebro-basilar distribution infarctions associated with neck manipulation. Two of the manipulations were chiropractic. Twenty-two previously reported cases are reviewed. Evidence favoring the use of anticoagulation in these patients is discussed along with the relative risk of such therapy.

Adult↗