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Biomedical subjects

M Britton

Publications and source records attributed to M Britton.

At least 73 records · Page 4Linked to original sources
PubMed1983

The diagnostic accuracy of CSF analyses in stroke.

The ability of routine analyses of cerebrospinal fluid (CSF) to differentiate between haemorrhage and infarction was evaluated in 231 stroke patients, whose diagnoses were based on computed tomography or autopsy. In all diagnostic groups the mean protein level was above normal, the highest values being associated with haemorrhage. Taking a protein level greater than 1 g/l to be characteristic of bleeding, sensitivity was 89% and specificity 92%. Spectrophotometric CSF absorbance was measured at wave lengths of 410, 415, 455 and 630 nm. Validity was equal for the first three. Taking absorbance greater than or equal to 0.040 at 415 nm to be diagnostic for haemorrhage, sensitivity was 72% and specificity 94%. The human eye was almost as sensitive as spectrophotometry in this context. Thus, among 100 patients with stroke, 7-9 out of 10 plausible cases of haemorrhage would be identified by means of routine CSF analyses. At the same time, 5-9 patients with ischaemic lesions would be diagnosed incorrectly as bleedings.

Blood Cell Count↗
PubMed1983

Non invasive assessment of the internal carotid artery in stroke patients.

The internal carotid arteries were evaluated with Doppler ultrasound technique in patients with acute cerebrovascular disease. The results of the Doppler examination of 325 vessels were compared to presence of carotid bruits on auscultation. In 126 arteries the findings were also compared with those on aortocervical, single carotid or post-mortal angiography. The Doppler flow reaction was normal in 74% of the vessels, uncertain in 20% and pathologic in 6%. The sensitivity of the Doppler assessment in finding stenosis of more than 75% lumen diameter reduction was 85% with a specificity of 94%. The specificity increased with higher degree of vascular stenosis. Carotid bruits were heard in 34 arteries. The sensitivity of auscultation in detecting stenosis 75% was 47% with a specificity of 83%. The sensitivity fell with higher degree of stenosis. The Doppler procedure is a valuable tool in detecting haemodynamically significant stenoses in the internal carotid artery. The method could serve the following purposes in the clinical situation: 1. Screening procedure for further investigations in TIA and minor stroke patients fit enough to be candidates for vascular surgery. 2. Before blood-pressure can be safely reduced in patients with cerebrovascular disease. 3. For evaluation of the arteriosclerotic process in stroke-patients thereby improving prognostication.

Adult↗
PubMed1980

A study of stroke patients treated in a non-intensive stroke unit or in general medical wards.

To study the representativity and outcome of patients admitted to a stroke unit (SU) (n = 269), a comparison was made with all stroke patients treated in general medical wards (GMW) (n = 225) in the same hospital during two years. There was no difference between the patient groups regarding sex, age, previous cardiovascular diseases or neurological deficit on admission. As expected, more diagnostic examinations were performed in the SU than in the GMW where a diagnosis of ill-defined stroke was very frequent. A higher frequency of lumbar puncture with CSF spectrophotometry would have increased considerably the number of specific diagnoses in the GMW. Acute and, particularly, secondary prophylactic treatment was more often given in the SU. There was no difference between the patient groups regarding mortality or length of hospital stay.

Aged↗
PubMed1980

Hazards of therapy for excessive hypertension in acute stroke.

Six cases with acute onset of neurological symptoms and extremely high blood pressure (BP) are reviewed. Hypertensive crisis or stroke were the main differential diagnoses. According to what is advocated for both situations, prompt antihypertensive therapy was instituted. Although recommended doses of hydralazine, reserpine or furosemide were given, the systolic BPs fell to less than 100 mmHg. Intracerebral hemorrhage or infarction was subsequently established in all patients and only one survived. Convincing evidence for a beneficial effect of BP reduction in acute stroke is lacking. Our data indicate excessive response to therapy in some patients. Also, moderate lowering of BP might reduce cerebral blood flow in these patients, often chronically hypertensive and with raised intracranial pressure. Extreme caution with antihypertensive therapy seems therefore warranted if the diagnosis of hypertensive crisis is not certain and a stroke is suspected.

Aged↗
PubMed1980

Lack of effect of theophylline on the outcome of acute cerebral infarction.

In patients with acute ischemic stroke, dramatic but often transient improvements have been noticed after theophylline injections. Whether better results could be obtained by continuous infusion of the drug was evaluated in a double-blind study. Out of 46 patients with a mean age of 75 years, 22 got theophylline as aminophylline (bolus dose of 230 mg followed by 0.5 mg/kg/h) and 24 placebo during 3 days. The groups were comparable in all aspects at the outset of the trial. Serum theophylline concentrations were kept within the therapeutic range recommended for patients with asthma. No significant difference in outcome was noticed between the groups during the hospital period when repeated neurological assessments by two different scores and mortality were compared.

Aged↗
PubMed1980

Prognostication in acute cerebrovascular disease. Subjective assessment and test of a prognostic score.

Subjective assessment of the short-term outcome and functional state at discharge was made shortly after admission in 200 consecutive patients with acute cerebrovascular disease (CVD) treated in a stroke unit. The assessments proved correct in 59% of the patients. The accuracy of the predictions was not significantly better in patients with a correct preliminary disanosis than in those with a false. When a known prognostic score for prediction of hospital mortality was tested on 179 of the patients with cerebral haemorrhage or infarction, a correct trend was noted. The score was best applicable in patients with serious symptoms and those with only minor deficit on admission. A high sensitivity of the score was combined with a relatively low specificity. A true comparison between the predictive value of the score and the quality of the subjective assessments was difficult as the latter, in addition to prediction of mortality, also included predicton of the patient's functional state at discharge. The degree of neurological deficit rather than the type of cerebrovascular lesion seemed associated with the short-term outcome. Improvement of the quality of prognostic assessments in CVD is warranted.

Age Factors↗
PubMed1979

Sulindac in ankylosing spondylitis. Double-blind evaluation of sulindac and indomethacin.

Ankylosing spondylitis affects about 1% of the population. In the past, evaluation of therapy in the management of this disease has been hampered by the lack of availability of objective criteria for following the condition. By using recently developed measurements of spinal mobility and other variables we have compared sulindac, a recently introduced nonsteroidal antiinflammatory drug, and indomethacin in a double-blind six-month parallel study of 30 patients. Sulindac and indomethacin have comparable efficacy and tolerance. Advantages of sulindac include a twice-a-day dose regimen.

Double-Blind Method↗
PubMed1979

Arrhythmias in patients with acute cerebrovascular disease.

Cardiac disease is common in patients with cerebrovascular disease (CVD) and cerebral lesions as such may influence cardiac activity and rhythm. To study the indication for continuous ECG surveillance of patients with CVD, 100 consecutive patients admitted to a medical stroke unit were investigated with 24-hour Holter recordings. The patients' mean age was 73 years and 70% of them had a history of heart disease. Twenty-three patients had chronic atrial fibrillation and 55% of the remainder showed ventricular ectopic activity. Serious ventricular arrhythmias were comparatively rare and mainly seen in association with signs of congestive heart failure and acute myocardial infarction. A prolonged Q-T interval was registered in two-thirds of the patients but there was no significant association between this finding and ventricular ectopic activity. Close observation for cardiac complications is important in patients with CVD and continuous ECG surveillance is indicated in selected high-risk patients.

Aged↗
PubMed1979

A stroke unit in a medical department. Organization and the first 100 patients.

A non-intensive stroke unit of 10 beds has been started in the Medical Department, Serafimerlasarettet, Stockholm. The aim is to make diagnostic and therapeutic studies in unselected stroke patients. Patients with suspect cerebrovascular disease in the Casualty Department are admitted to the unit non-selectively and without any age limit. Relevant physical findings and laboratory data are followed and registered by code on special charts to make evaluation by computer possible. A preplanned investigative programme is adhered to. Strict criteria for diagnosis and treatment are followed. The experience and results from the first 100 patients treated in the Stroke Unit indicate that the unit is a good basis for both education and research.

Acute Disease↗