Intracerebral hematomas during anticoagulant treatment.
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Anticoagulants↗
Biomedical subjects
P Petersen
Publications and source records attributed to P Petersen.
Thromboembolic complications of atrial fibrillation and their prevention: a review.
Atrial fibrillation (AF) is found in 0.4% of adults younger than age 60 years and in 2 to 4% older than age 60 years, and is associated with a high risk of thromboembolic complications. AF--paroxysmal and chronic--has many etiologies, including rheumatic and nonrheumatic heart disease and thyrotoxicosis. Knowing how strokes occur and what precipitates them--e.g., differentiating between cardioembolic and cerebrovascular causes--is important when deciding on appropriate treatment. Risk factors involved in the development of thromboembolic complications associated with AF are reviewed, focusing on the contributions of thyrotoxic AF, paroxysmal AF (and its transition to chronic AF), enlargement of the left atrium, silent cerebral infarction and decreased cerebral blood flow. Data from several studies are briefly presented, highlighting major outcomes. On the basis of current information about prevention of thromboembolic complications, it seems reasonable to recommend anticoagulant treatment for patients with nonrheumatic chronic AF.
Atrial Fibrillation↗
[Admission of patients with dementia to a psychiatric hospital. Social circumstances, circumstances of admission, treatment and further referral].
This investigation is a retrospective registration on the basis of the case histories of 290 patients with the main diagnosis dementia who were admitted to a psychiatric hospital in the years 1982 and 1983. The average age was 77 years. Patients with their own homes comprized 61% but only 28% were admitted from their own homes. More than 70% of the patients admitted were described as suffering from moderate or severe dementia on admission. 93% were admitted voluntarily and 91% during the daytime. The reason for admission most frequently registered was the patient's suffering. In 66% of the cases, the general practitioner had attempted treatment prior to admission. During hospitalization the majority of the patients received medicinal treatment. At the conclusion of treatment, 52% were found to be improved and 34% unchanged. 46% of the patients were assessed as requiring maximum nursing-home treatment and 29% were considered to need psychiatric nursing-home treatment. 8% could be discharged to their own homes. The average durations of hospitalization, duration of treatment and waiting-time were reviewed. It is noteworthy that the waiting-time, 311 days, was found to be nearly as long as the duration of treatment, 316 days. In addition, the waiting-times for nursing-homes with maximum care were calculated to be 229 days on an average and for psychiatric nursing homes 596 days.
Aged↗
Intravenous lidocaine and cerebral blood flow: impaired microvascular reactivity in diabetic patients.
Lidocaine infusions are used for treatment of ventricular arrhythmias and painful diabetic neuropathy. In animals high doses of lidocaine reduces cerebral blood flow (CBF). The effect of lidocaine on CBF in humans is unknown. Cerebrovascular reactivity may be impaired in long-term diabetic patients. The effect of intravenous lidocaine (5 mg/kg body weight) on CBF was investigated in eight healthy subjects and eight long-term diabetic patients with painful neuropathy. Cerebral blood flow was measured with the intravenous 133-Xenon method immediately before and after lidocaine infusion and 60 minutes later. In healthy subjects, CBF decreased 12% (P less than .02) during lidocaine infusion and normalized within 60 minutes. Diabetic patients had identical CBF level before and after lidocaine suggesting decreased cerebrovascular reactivity.
Adult↗
Thromboembolic complications in atrial fibrillation.
I review the present understanding of thromboembolic complications and their prevention in patients with nonrheumatic atrial fibrillation. Chronic atrial fibrillation carries an annual 3-6% risk of thromboembolic complications, which is 5-7 times greater than that of controls with sinus rhythm. Paroxysmal atrial fibrillation is associated with a lower risk of thromboembolic complications than chronic atrial fibrillation. Heart failure and systemic hypertension seem to be significant clinical risk factors for stroke in patients with atrial fibrillation, but disagreement persists, and, with few exceptions, subgroups at particular risk have not been convincingly identified. The risk of stroke in persons with thyrotoxic atrial fibrillation seems to be lower than believed previously. Clinical studies have shown that left atrial dilatation is a consequence of the duration of atrial fibrillation rather than a cause, but the relation of left atrial enlargement to stroke is uncertain. Cerebral blood flow may be reduced during atrial fibrillation but seems to increase after cardioversion to sinus rhythm. A high prevalence of silent cerebral infarction has been detected in patients with chronic atrial fibrillation, but there seems to be a low risk of silent cerebral infarction in persons with paroxysmal atrial fibrillation. The one prospective study published to date on stroke prevention in patients with nonrheumatic chronic atrial fibrillation showed that anticoagulation with warfarin significantly reduced the incidence of thromboembolic complications.
Aged↗
[Abortion and the experience for the physician who performs it].
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Abortion, Induced↗
Risk factors for thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study.
As previously reported, 1007 patients with chronic atrial fibrillation participated in the Copenhagen AFASAK study. Before inclusion to trial, they all had a physical examination, chest roentgenogram, and echocardiogram with determination of left atrial size. This study evaluated the importance of cardiovascular risk factors for development of thromboembolic complications. To exclude any treatment effects on occurrence of thromboembolic complications, we included only the 336 patients from the placebo group. Using Cox's regression model, previous myocardial infarction was a significant risk factor for development of thromboembolic complications. Age, gender, heart failure, chest pain, hypertensive heart disease, diabetes, systolic and diastolic blood pressure, smoking, relative heart volume, and left atrial size were all without statistical importance.
Aged↗
[Sex differences in alcoholics at a psychiatric emergency clinic].
All patients attending the psychiatric emergency clinic at Odense University Hospital in the period 2.9-6.10.1985 were interviewed by a psychiatric nurse and physician in order to determine disease pattern and social circumstances. The present investigation deals with sex distribution of alcoholics in the data collected. In the period, 141 patients with alcoholic problems were registered; of these 97 were men and 44 women. It was found that more female alcoholics than male were married/cohabiting. Unemployment was very high for both groups; almost 80 per cent being unemployed. A great number of the women had interpersonal conflicts, but apart from that the sex difference for amount of psychosocial strain was not significant. Drug abuse and affective reactions were significantly more frequent in women. More women than men were found to suffer from character neuroses, and more men than women were deviants, but this may be a reflection of a diagnostic tradition. It must be concluded that more similarities than differences were found between male and female alcoholics attending the psychiatric emergency department.
Adult↗
[Psychosocial strain among patients at a psychiatric emergency unit].
The frequency of psychosocial strain was systematically registered concerning 330 consecutive patients in the psychiatric emergency unit in Odense. Psychosocial strain was found in 211 patients (63.9%). In all, 551 stressful events were reported, which corresponds 2.5 per patient. Distribution of psychosocial strain by age, sex and civil status revealed no statistically significant correlation at the level of p less than 0.05, but there was a tendency towards greater strain among young persons, women and married/cohabiant patients. All those seeking education had psychosocial strain, while there were significantly fewer patients with psychosocial strain among early retirees and old age pensioners. The investigation showed that there were significantly fewer schizophrenic patients with psychosocial strain, and significantly more patients with strain were found among those with affective reactions and attempted suicides compared with the other patient categories. The most frequently occurring form of strain in all diagnosis groups was interpersonal conflict with a close person. In most cases the strain was not the result of an external catastrophe, and often the patient may himself have contributed in causing the psychosocial strain. This opens the possibility for socialpsychiatric intervention.
Adult↗
[Intravenous lidocaine in the treatment of chronic pain caused by bone metastases].
A controlled double-blind investigation was undertaken in which ten patients with painful bone metastases were treated with intravenous lignocaine in a dosage of 5 mg/kg body-weight infused over a period of 30 minutes or the same volume of isotonic saline. None of the patients experienced prolonged pain relief but five patients experienced considerable pain relief immediately and/or one hour after the infusion of lignocaine.
Adult↗
[Anticoagulants in treating patients with atrial fibrillation].
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Anticoagulants↗
Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study.
From November, 1985, to June, 1988, 1007 outpatients with chronic non-rheumatic atrial fibrillation (AF) entered a randomised trial; 335 received anticoagulation with warfarin openly, and in a double-blind study 336 received aspirin 75 mg once daily and 336 placebo. Each patient was followed up for 2 years or until termination of the trial. The primary endpoint was a thromboembolic complication (stroke, transient cerebral ischaemic attack, or embolic complications to the viscera and extremities). The secondary endpoint was death. The incidence of thromboembolic complications and vascular mortality were significantly lower in the warfarin group than in the aspirin and placebo groups, which did not differ significantly. 5 patients on warfarin had thromboembolic complications compared with 20 patients on aspirin and 21 on placebo. 21 patients on warfarin were withdrawn because of non-fatal bleeding complications compared with 2 on aspirin and none on placebo. Thus, anticoagulation therapy with warfarin can be recommended to prevent thromboembolic complications in patients with chronic non-rheumatic AF.
Adult↗
Cerebral blood flow before and after cardioversion of atrial fibrillation.
In nine patients with atrial fibrillation (AF) of less than 3 months' duration, CBF was measured the day before and after and again 30 days after electrical cardioversion therapy to sinus rhythm. The day before cardioversion therapy, median CBF (expressed as initial slope index 1, ml/100 g.min-1) was 35.8 and the day after it was 37.1. After 30 days in sinus rhythm, CBF was 39.4 (NS), although the end-tidal PCO2 values were lower than the pretreatment values. After correction for changes in end-tidal PCO2, the median CBF had increased significantly from 35.8 to 40.3 on day 1 and to 46.7 on day 30. The reduced CBF during AF could be a contributing factor in the development of cerebrovascular complications in patients with AF.
Adult↗
Echocardiography and cerebral computed tomography in chronic atrial fibrillation.
Chronic atrial fibrillation (CAF) may be complicated by asymptomatic small silent cerebral infarctions as well as by stroke. The echocardiographic findings in 29 patients with CAF and 29 controls in sinus rhythm are presented. The cerebral computed tomography (CT) findings in these patients were previously published and significantly more small low-density lesions, probably reflecting previous infarctions, were found in patients with CAF than in controls. The aim of the present study was to evaluate if patients with such cerebral lesions had characteristic echocardiographic abnormalities with special reference to patients with CAF. No significant differences could be detected between the groups with and without cerebral lesions regarding the occurrence of valvular heart disease, left ventricular dysfunction, end-diastolic diameter of the left ventricle, left atrial dimension and left ventricular fractional shortening. Only seven patients with CAF (24%) compared with 21 in sinus rhythm (72%) had normal echocardiograms (P less than 0.001). In conclusion, echocardiography gave no guidance to why some patients developed cerebral low-density areas on CT.
Aged↗
Lidocaine treatment of painful diabetic neuropathy and endogenous opioid peptides in plasma.
Intravenous infusion of lidocaine has a pain-relieving effect in patients with painful diabetic neuropathy. We measured plasma beta-endorphin (beta-EP), dynorphin immunoreactivity (DYN), and met-enkephalin (MET) before and after lidocaine infusion in 8 patients with painful diabetic neuropathy and in 10 controls. The pretreatment level of beta-EP and DYN was identical in the two groups. After lidocaine, beta-EP increased in diabetic patients from 3.4 to 5.5 pmol/L (median) (p less than 0.02) and in controls from 3.4 to 5.0 pmol/L (p less than 0.02). The concentration of DYN was stable, and MET was undetectable before and after lidocaine. Lidocaine reduced symptoms and pain score in diabetic patients was uncorrelated with the changes in beta-EP. Intravenous lidocaine increased plasma beta-EP and diminished complaints in patients with painful diabetic neuropathy.
Adult↗
Cerebral computed tomography in paroxysmal atrial fibrillation.
Atrial fibrillation (AF) is associated with an increased risk of stroke. In patients with chronic AF, without clinically known cerebrovascular disease, computed tomography (CT) has revealed a high frequency of abnormal low-density areas suggesting old asymptomatic infarcts. To investigate the frequency of such lesions in paroxysmal AF, 30 patients with paroxysmal AF and 30 controls matched in sinus rhythm, without history of cerebrovascular disease, were CT scanned. Four patients with paroxysmal AF (13%) and 3 controls (10%) had abnormal CT scans with areas of low density with sharp demarcation from surrounding tissue. The abnormal areas probably reflected small, clinically silent infarcts. There were no differences between paroxysmal AF and controls in number and size of abnormal areas with apparent tissue loss. In contrast to chronic AF, the risk of such lesions in paroxysmal AF does not seem to be increased compared with matched sinus rhythm controls. This is in agreement with the clinical experience of a low risk of stroke in paroxysmal AF.
Adult↗
Grip strength and hand dominance: challenging the 10% rule.
The purpose of this study was to test the utility of the 10% rule in hand rehabilitation. The 10% rule states that the dominant hand possesses a 10% greater grip strength than the nondominant hand. This rule has been used for many years to assist therapists in setting strength goals for patients with injured hands. The sample for this study consisted of 310 male and female students, faculty, and staff from a small, private liberal arts college located in Pennsylvania. Grip strength was measured with a factory-calibrated Jamar dynamometer. Results showed an overall 10.74% grip strength difference between dominant and nondominant hands. This finding verified the 10% rule. However, when the data were separated into left-handed and right-handed subjects, a 12.72% difference for right-handed subjects and a -0.08% difference for left-handed subjects was found. In conclusion, this study showed that the 10% rule is valid for right-handed persons only; for left-handed persons, grip strength should be considered equivalent in both hands.
Adolescent↗
Inhibition of platelet function by low-dose plain and micro-encapsulated acetylsalicylic acid.
The effect of two acetylsalicylic acid (ASA) formulations, plain (Magnyl) and micro-encapsulated (Globentyl), on platelet aggregation, thromboxane formation, and bleeding time was studied in 12 healthy volunteers in a randomized double-blind cross-over study. All subjects were treated with Magnyl and Globentyl (75 mg daily) in periods of 2 weeks, separated by a wash-out period of 2 weeks. Both drugs significantly depressed platelet aggregation and thromboxane formation and prolonged bleeding time without difference in mode of action of the drugs. It is concluded that significant inhibition of platelet activity may be achieved by low-dose ASA treatment with micro-encapsulated as well as with plain formulations.
Adult↗