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Biomedical subjects

J H Feibel

Publications and source records attributed to J H Feibel.

14 recordsLinked to original sources
PubMed1985

Predicting the likelihood of hemorrhage in patients with stroke.

To identify those clinical findings that independently help differentiate intracranial hemorrhage from cerebral infarction, we studied patients who were admitted to a hospital with acute focal neurologic deficits after strokes during a 17-month period. The predictive strength of a decision-making aid incorporating these findings was then assessed by studying patients who were admitted to a different hospital after experiencing strokes. The decision-making aid stratified the patients into groups having probabilities of intracranial hemorrhage ranging from 5% to 67%. The results of this study may facilitate more discriminating test selection during the early evaluation of patients who have had strokes.

Adult↗
PubMed1983

Community surveillance of stroke in persons under 70 years old: contribution of uncontrolled hypertension.

In 1979, a community-wide hospital surveillance system was established in Monroe County, New York (population 702,000), to investigate the continuing contribution of uncontrolled high blood pressure (HBP) to the occurrence of stroke. This paper reports findings among 200 consecutive strokes in persons under 71 years of age. Average age was 58. There was a prestroke history of HBP in 129 (65 per cent) cases. Two-thirds of the 129 had other predisposing conditions (heart disease, diabetes, previous cerebrovascular accident) and 95 per cent had one or more other cardiovascular risk factors (smoking, elevated cholesterol, obesity). Over 90 per cent had visited a physician during the year prior to stroke (average of four visits). Elevated pressures (DBP greater than or equal to 95 or SBP greater than or equal to 160) were recorded at half or more of the visits for 45 per cent of the patients; these cases were classified as uncontrolled. Reduction of "unnecessary" strokes in persons under age 71 should be achievable by giving increased attention to those already under medical care for hypertension who have co-existing stroke risk conditions and cardiovascular risk factors.

Aged↗
PubMed1982

Depression and failure to resume social activities after stroke.

In 91 stroke patients, the incidence of depression was 26% (24 patients) 6 months after stroke. Depression was significantly correlated with failure to resume premorbid social activities; depressed patients lost a mean of 67% previous activities while nondepressed patients lost a mean of 43% (p less than 0.01). Depression status was not significantly related to age, sex, marital or cognitive status, or side of brain involvement. Independence in ADL and ambulation or change in residence after stroke also were not significantly related to depression status. Since depression is common after stroke, is associated with failure to return to previous activities, and cannot be predicted by commonly used patient characteristics, the health care team must carefully identify, monitor, and manage depression in the patient recovering from stroke.

Activities of Daily Living↗
PubMed1981

Antidiuretic hormone levels in stroke patients.

Serum osmolality and antidiuretic hormone (ADH) levels were determined for 17 patients with cerebral infarction, 4 with subarachnoid hemorrhage, and 12 controls. The ADH levels were elevated significantly in the stroke patients. Hyponatremia was not observed. Stroke patients are at risk for developing electrolyte disturbances; thus, fluid intake and electrolyte levels should be closely observed.

Cerebral Infarction↗
PubMed1981

Catecholamine-associated refractory hypertension following acute intracranial hemorrhage: control with propranolol.

Seven patients (4 with subarachnoid hemorrhage, 2 with intracerebral hemorrhage, and 1 with massive cerebral infarction) had acute arterial hypertension refractory to control by several antihypertensive drugs (hydralazine, sodium nitroprusside, alpha-methyldopa, and trimethaphan camsylate) used singly or in combination. In each case, catecholamine excretion--measured by urinary norepinephrine plus epinephrine--was markedly elevated, averaging 218 microgram/day. Patients without the acute refractory hypertension had normal or only slightly elevated urinary catecholamine levels (mean, 72 microgram/day). The beta-adrenergic blocking agent propranolol, in doses between 20 and 40 mg every 6 hours, successfully controlled blood pressure, while other agents failed. The intense sympathetic nervous system discharge resulting in acute refractory hypertension may be due to injury to the diencephalon or brainstem (or both) or to diffuse brain dysfunction from increased intracranial pressure or intracranial blood.

Adult↗
PubMed1977

Prognostic value of the stress response following stroke.

The systemic metabolic response following intracranial vascular damage was measured in 65 consecutively seen patients (56 with cerebral infarction and nine with subarachnoid hemorrhage). Significantly (P less than .01) greater mortality and eventual disability occurred in patients excreting more than 200 microgram of urinary norepinephrine and epinephrine daily early in their acute illness. These patients also had significantly (P less than .001) elevated plasma cortisol levels; this measurement may prove useful in predicting prognosis after stroke. Cardiac abnormalities resulting from the elevated catecholamine levels may contribute to the excess mortality in those patients with an intense stress response.

Catecholamines↗
PubMed1976

Thyrotoxic neuropathy (Basedow's paraplegia).

Polyneuropathy is a rare but possible manifestation of severe hyperthyroidism. The patient reported here developed a polyneuropathy affecting mostly leg muscles (Basedow's paraplegia) during the course of severe thyrotoxicosis. The polyneuropathy was confirmed with sequential electrophysiological studies of nerves and muscles and by muscle biopsy. The involvement of the proximal leg muscle is also interpreted as a neuropathic or nerve-mediated process rather than a concomitant thyrotoxic myopathy.

Adolescent↗