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Biomedical subjects

R Fogelholm

Publications and source records attributed to R Fogelholm.

At least 37 records · Page 2Linked to original sources
PubMed1994

A randomized, double-blind, placebo-controlled trial of nimodipine in acute ischemic hemispheric stroke.

BACKGROUND AND PURPOSE: A randomized, double-blind, placebo-controlled multicenter trial was conducted to test the hypothesis that nimodipine would improve the functional outcome in acute ischemic hemispheric stroke. METHODS: A total of 350 patients were randomized to nimodipine 120 mg/d PO or matching placebo for 21 days. Randomization was stratified by onset of therapy, age, and stroke severity. Treatment was begun within 48 hours of onset. The patients had neurological evaluation on admission, on days 1, 7, and 21, and at 3 and 12 months. The primary end points were Rankin grade, neurological score, and mobility at 12 months. RESULTS: We did not find any differences in the functional outcome between the treatment groups or between the stratified subgroups. We were also unable in post hoc analyses to find any groups of patients who benefited from nimodipine. During the first month and at 3 months the case-fatality rate was higher in the nimodipine-treated patients than in those on placebo (P = .004 and P = .030, respectively), but at the 1-year follow-up this difference had lost statistical significance. During the first week nimodipine had a statistically significant lowering effect on both systolic (P = .005) and diastolic (P = .013) blood pressure. CONCLUSIONS: Nimodipine did not improve the functional outcome of acute ischemic hemispheric stroke. The early case-fatality rate was higher in the nimodipine group, possibly due to the blood pressure-lowering effect of nimodipine.

Aged↗
PubMed1993

Serum cortisol and outcome of ischemic brain infarction.

The predictive value of serum cortisol level on the prognosis in acute brain infarction of the carotid circulation territory was studied in 101 patients younger than 70 years. The levels of 7 a.m. and 7 p.m. serum cortisol were measured initially and at 1 week. All patients underwent a computed cerebral tomography (CT) within 2 days of the onset of symptoms, and a second CT 3 weeks or 3 month later. Serum cortisol values predicted the stroke outcome. Both the 7 a.m. and the 7 p.m. values in the initial and 1-week samples correlated positively with the severity of hemiparesis on the corresponding days. The 7 p.m. values predicted better than the 7 a.m. values the functional outcome and case fatality during the 3 month follow-up. Initially and at 1 week, the median 7 p.m. serum cortisol values were statistically significantly higher in those with frontally extending infarcts than in those with non-frontal infarcts. Both 7 a.m. fasting blood glucose and glycosylated hemoglobin (HbA1c) measurements were taken within 3 days of the onset in 95 cases. The patients were diagnosed to have prestroke normoglycemia (n = 73) and hyperglycemia (n = 22) on the basis of the HbA1c level. A highly significant (P = 0.0001) correlation was demonstrated between the initial 7 p.m. cortisol and 7 a.m. fasting blood glucose values in those with prestroke normoglycemia, suggesting that hyperglycemia during the acute phase of stroke is a stress response.

Adult↗
PubMed1993

Cigarette smoking and risk of primary intracerebral haemorrhage. A population-based case-control study.

From September 1985 to December 1989 a total of 158 patients had primary intracerebral haemorrhage in the population of 116,000 in the Jyväskylä Region, Central Finland. All had the diagnosis confirmed by either computerised tomography or necropsy, and information on cigarette smoking habits was available in 155 patients, 20% of whom were current cigarette smokers. One control was selected for each of the 155 patients matched on sex, age, and residence from the census of Central Finland. The odds ratio of primary intracerebral haemorrhage of current cigarette smokers compared with current non-smokers was estimated on basis of the number of discordant pairs as 1.4 (95% confidence interval 0.7 to 2.8). Adjustment for hypertension or diabetes did not change this estimate. Our data did not show evidence of an positive association of cigarette smoking and risk of primary intracerebral haemorrhage. This assumption was strengthened when the results of previous studies and the present study were pooled giving an odds ratio of 1.0 (95% confidence interval 0.8 to 1.3).

Aged↗
PubMed1993

Impact of early surgery on outcome after aneurysmal subarachnoid hemorrhage. A population-based study.

BACKGROUND AND PURPOSE: Population-based patient materials have not been used earlier in assessing the effects of neurosurgical treatment on survival and functional outcome of subarachnoid hemorrhage. Moreover, the proportion of all subarachnoid hemorrhage patients who might be candidates for neurosurgical treatment has not been estimated. METHODS: We compared the survival and functional outcome of two population-based patient materials from Central Finland in 1976 through 1978 (n = 146) and 1980 through 1987 (n = 351). The most important basic characteristics of both materials were similar. In the 1970s, only patients aged < 60 years with carotid territory aneurysms were operated on after an interval of 2 weeks from the bleeding. In the 1980s, early surgery was attempted, and the other exclusion criteria were abandoned. Allocation to medical or surgical treatment was not randomized. RESULTS: During the 1970s, only 14% of the patients had surgical treatment, with a median delay of 15 days after the bleeding; in the 1980s, the corresponding figures were 46% and 4 days. Despite these fundamental changes in the treatment policy, the survival up to 3 years in the 1980s was only marginally improved compared with the 1970s. Conversely, the functional outcome at 4 years after the bleeding was significantly better in the 1980s than the 1970s, with 82% and 64% of the survivors, respectively, being independent in the activities of daily living (P = .002). We estimated that 60% of all patients with subarachnoid hemorrhage might be candidates for neurosurgical treatment, provided that there are no delays in admission or evaluation. CONCLUSIONS: An active treatment policy of subarachnoid hemorrhage including early surgery only marginally improves survival, but the quality of life of the survivors is significantly better. Only 60% of all patients in the population with subarachnoid hemorrhage can, at least theoretically, benefit from surgical treatment.

Adult↗
PubMed1992

Blood glucose, glycosylated haemoglobin, and outcome of ischemic brain infarction.

From August 1987 through December 1989 all consecutive conscious patients younger than 70 years with a recent (less than 48 h) brain infarction of the carotid territory were prospectively included in the study. Blood samples for fasting blood glucose and glycosylated haemoglobin (HbA1c) were taken after a median delay of 23 h of the onset of symptoms. The severity of hemiparesis was assessed on admission, at 1 week, 3 weeks, and 3 months. The functional outcome was assessed at 3 months. Computed cerebral tomography was performed on admission, and later on at 3 weeks or 3 months. The brain infarct volume was measured from the CTs. The patients were diagnosed to have prestroke normoglycemia (n = 76) and prestroke hyperglycemia (n = 23) on basis of the HbA1c level. The case fatality rate, severity of hemiparesis, functional outcome, and infarct size did not differ between these 2 groups. On the other hand, fasting blood glucose level of the non-diabetics correlated strongly with the severity of hemiparesis and predicted stroke outcome. A statistically significant correlation was observed between blood glucose values and the volumes of cortical infarcts in non-diabetics. Because prestroke blood glucose level, in contrast to post-stroke blood glucose level, did not have any predictive value concerning stroke outcome it is concluded that high fasting blood glucose values after stroke reflect a stress response to a more severe ischemic brain lesion.

Adult↗
PubMed1992

Tizanidine in chronic tension-type headache: a placebo controlled double-blind cross-over study.

The efficacy of tizanidine in chronic tension-type headache was compared with placebo in a randomized, double-blind and cross-over study in 37 women aged 20 to 59 years with a history of headache for 7 months to 30 years (median 5 years). The treatment periods were 6 weeks with an intervening 2 week wash-out period. The treatment was started with 6 mg/day divided into three doses, and the daily dose could be increased to 18 mg/day depending on the treatment response. The effect of the treatment was measured by visual analogue scale, verbal rating scale, number of days free of headache, number of analgesics needed, and the dose of trial medication needed. In all these measurements, tizanidine was statistically significantly more effective than placebo. The pre-trial Beck Depression Inventory score did not predict the response to treatment, neither did the level of electromyographic activity of the trapezius muscle. Side-effects, drowsiness and dry mouth were significantly more common during tizanidine treatment but they were usually mild. The results of the present trial suggest that tizanidine is effective in the treatment of chronic tension-type headache in women.

Adult↗
PubMed1992

Anticoagulant treatment as a risk factor for primary intracerebral haemorrhage.

Forty one (14.2%) of 288 patients with primary intracerebral haemorrhage occurring between September 1985 and December 1989 in Central Finland were on anticoagulant treatment at the onset of symptoms. In a sample of 29,000 subjects from the same population the prevalence of anticoagulant treatment was 1.6% in those aged 40 years or older. The estimated age adjusted odds ratio of being on anticoagulant treatment at the time of primary intracerebral haemorrhage was 6.7 (95% CI from 4.5 to 9.9). The risk was highest during the first year of anticoagulation. Overtreatment (thrombotest value < 5%) was slightly more common among the patients. The haematoma volumes measured from the CT scans were similar in patients on anticoagulant treatment and those not anticoagulated. The case fatality rate during the first week and the mortality during follow up of 32 months were slightly higher, and the functional outcome slightly worse in the anticoagulated group.

Adult↗
PubMed1992

Primary intracerebral haemorrhage in the Jyväskylä region, central Finland, 1985-89: incidence, case fatality rate, and functional outcome.

The age and sex specific incidence rates, the case fatality rates, and the functional outcome of patients with primary intracerebral haemorrhage occurring in a population of 116,000 during a period of four years four months are presented. A total of 158 patients were identified, the diagnosis was confirmed in 78% by CT, and in 22% by necropsy. The crude annual incidence rate was 31/100,000 population, the age specific rates increased from two to 222/100,000 from the age of 30-39 to over 80 years. Men had higher incidence rates between the ages of 40 and 79 years. The short term case fatality rate was high, 27% of patients dying during the first day after onset of symptoms, and 50% were dead at 30 days. After the first month the probability of survival did not differ from an age- and sex-matched average population. Large haematoma volume had an adverse effect on the short term, old age (greater than 70 years) on the long term survival. Ventricular extension, especially when combined with hydrocephalus was a bad omen for short term survival. Infratentorial and large basal ganglionic haematomas, and primary intraventricular haemorrhage carried a worse prognosis than haematomas of other locations. At the end of a median 32 month follow up 55 (35%) of the patients were alive, 51% of these were independent in activities of daily living, 45% were dependent on outside help, and 4% needed constant nursing care. Old age (greater than 70 years), but not the haematoma volume or location, was associated with a poor functional recovery.

Adult↗