[Low molecular weight heparin in acute ischemic cerebrovascular disease].
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Brain Ischemia↗
Biomedical subjects
T Dahl
Publications and source records attributed to T Dahl.
[Lymphatic complications after lower limb vascular surgery].
A series of five patients with lymph fistula and two with lymphocele is described. Lymphatic complications in the groin and thigh following infrainguinal arterial surgery may increase the risk of wound infection and prolong the stay in hospital. During operation for lymph fistula and lymphocele, precise identification of the site of lymph leakage during exploration of the wound is mandatory. This can be obtained by intradermal injection of Patent blue 2.5% medially and laterally on the dorsum of the foot approximately one hour before operation. Operation for lymph fistula should be performed as soon as the diagnosis has been verified, especially if a prosthetic graft has been used. A lymphocele should be treated conservatively unless the patient is suffering from localized pain or ischemia of the skin caused by pressure of the underlying swelling.
Aged↗
[Antithrombotic therapy in cerebrovascular disorders].
Warfarin is recommended as primary prophylactic therapy for patients older than 60 years with non-valvular atrial fibrillation and for patients with additional risk factors for thromboembolism. Warfarin should also be given as secondary prophylaxis. Patients with contraindications to warfarin should be given aspirin. Anticoagulant therapy is recommended against progressive ischemic stroke and in cardiogenic cerebral embolism, although conclusive evidence of the benefit is lacking. In the case of transient ischemic attacks and minor stroke, antiplatelet therapy reduces the risk of subsequent stroke by approximately 25 percent. Antiplatelet therapy is probably indicated in cases of acute, stable ischemic stroke.
Aged↗
Long-term anticoagulant therapy in cerebrovascular disease: does bleeding outweigh the benefit?
OBJECTIVE: The aim of the present study was to determine the risk of major haemorrhagic complications, stroke and other cardiovascular events, and mortality during long-term anticoagulant therapy (ACT) in patients with cerebrovascular disease not included in any prospective trials. DESIGN: The data were collected retrospectively. SETTING: All patients with symptomatic cerebrovascular disease discharged from the Stroke Unit, Aker University Hospital, Oslo, with ACT (warfarin) during 1983 through to 1986 were included. SUBJECTS: The material consists of 161 patients with a mean age of 67.8 (range 40-90) years. The reason for initiating ACT was frequent transient ischaemic attacks (TIAs) in 52 patients, stroke in progression (SIP) in 33 patients, and probable embolic stroke in 76 patients. International normalized ratio (INR) of 4.2-2.8 was aimed at. MAIN OUTCOME MEASURES: Major haemorrhagic complications, recurrent stroke and survival was determined for the total material, and in the subgroups non-valvular atrial fibrillation (NVAF, n = 49), TIAs, and SIP. RESULTS: The mean duration of ACT was 21.1 (range 0.5-60.2) months with a total of 282.9 patient-years. The rate of major (including fatal) haemorrhagic complications was 4.6% per year, and the rate of fatal haemorrhagic complications was 1.4% per year. The complication rates in the subgroups of patients did not differ significantly from that in the total material. Only two out of the 13 major haemorrhagic complications occurred during the initial 6 months of ACT. No strokes occurred in the TIA subgroup. The rate of recurrent stroke (excluding intracranial haemorrhage) was 3.9% per year for all patients, 4.7% per year for the patients with NVAF, and 4.2% per year for the patients with SIP. CONCLUSIONS: The total results suggest a positive net effect of ACT in patients with NVAF and TIAs. Without comparable data, no definite conclusions concerning the effect of ACT on patients with SIP can be drawn. The rate of bleeding complications was similar to that in other studied materials and is not negligible. In patients with SIP and TIAs, ACT beyond 6 months should probably only be continued if aspirin is not tolerated or has proven ineffective in the particular patient.
Adult↗
[Closed functional treatment of fractures of the ulnar shaft].
Various treatments of isolated fractures of the ulnar shaft have been attempted. The rates of non-union have varied widely, and impaired movement of the elbow and wrist is common at the end of the treatment. We present a series of eight patients who were treated initially with an above-elbow plaster, followed by a brace on the lower arm. All fractures healed with good functional results.
Adolescent↗
[Duplication of the small intestine. Unusual cause of abdominal pain].
Duplications of the alimentary tract are rare. Since 1982 only three patients with such anomalies have been treated in the Department of Paediatric Surgery at the University Hospital in Trondheim, Norway. We describe the last patient treated, where duplication of the ileum was found upon laparotomy, performed because of exaggerated recurrent abdominal pain. Duplications may be found anywhere along the alimentary tract and diagnosis can be difficult. The duplications can be found upon laparotomy for suspected appendicitis or bowel obstruction. The condition may also be suspected upon antenatal ultrasonography and in the event of abdominal symptoms after birth.
Abdomen, Acute↗
[A cerebrovascular unit. Experiences after 8-years of activity].
The authors review experience gained from developing and running a non-intensive stroke unit during the years 1983-91. The number of patients treated per year has increased from 65 to 149. The average length of stay in hospital has dropped from 21 to 15 days. About 87% of the patients had verified stroke, 7% had transient ischemic attacks (TIAs). Other intracranial diseases were found in 3.3%. The mortality rate was low (5%) 48% of the patients were transferred to a rehabilitation centre, 37% were discharged to their homes, with or without out-patient care, and 10% were discharged to nursing homes. Early and systematic investigations and multi-disciplinary rehabilitation in a specialized stroke unit increases the quality of care for patients suffering from stroke. A shorter stay in hospital gives a bonus in the form of reduced health expenditures.
Cerebral Hemorrhage↗
Influence of CT on tumor classification of laryngeal carcinomas.
The routine use of CT in 51 consecutive patients with squamous cell carcinoma of the larynx revealed cartilage involvement or extralaryngeal tumor growth consistent with a T4 tumor which made 14 patients candidates for laryngectomy. Only 5 of these had a T4 classification by clinical examination while 8 cases were upstaged from T3. Except for one supraglottic tumor upstaged from T2 to T4, CT did not change the classification for T1 and T2 tumors, whose localization was mainly glottic, and there were 2 false-negative examinations. It is concluded that CT is mandatory only in advanced tumors of the glottic region or when the anterior commissure is involved. However, in suspected malignancies of the sub- or supraglottic regions CT should always be carried out because these patients are at an increased risk of unexpected deep tumor growth.
Adult↗
[Foreign bodies in the oesophagus].
We have evaluated 229 endoscopic examinations of the oesophagus performed during the period 1983 to 1989 in patients suspected of having foreign bodies in the oesophagus. The majority of our patients were aged 60 or more. Meat was the most frequent foreign body found in all the patients and particularly so in the elderly, while coins were most common in children. Bones from meat or fish were more frequent in the proximal part of the oesophagus, while meat was distributed more evenly between the proximal and distal parts. Five oesophageal perforations occurred, only one of them caused by the endoscopic examination. 18% of the patients were found to have pathologic conditions in the oesophagus, the majority being non-malignant strictures. No new cases of cancer were found.
Age Factors↗
Effects of various granulating systems on the bioavailability of naproxen sodium from polymeric matrix tablets.
Naproxen sodium and a cellulose ether derivative were granulated with either water or a poly(meth)acrylic acid ester copolymer aqueous dispersion to make three controlled-release matrix dosage forms. The different polymeric matrix systems contained hydroxypropyl methylcellulose (formulation A), hydroxypropyl cellulose:poly(meth)acrylic acid ester copolymer (formulation B), and hydroxypropyl methylcellulose:poly(meth)acrylic acid ester copolymer (formulation C). All three hydrophilic matrix tablets demonstrated identical in vitro dissolution rates. The three controlled-release formulations were compared with a marketed immediate-release naproxen sodium dosage form (formulation D) in a single-dose crossover study in six healthy volunteers. The AUC values for controlled-release dosage forms A and C were larger than those for formulations B and D. However, the reasons why the AUC for formulations A and C is larger than that for formulations B versus D can be explained differently. Formulations A and C more effectively maintain naproxen plasma levels than formulation D by reducing the amount of naproxen unbound to plasma proteins, therefore reducing naproxen available for urinary excretion. Naproxen sodium delivered from formulations A and C is also probably much better absorbed than from that from formulation B, possibly due to less drug entrapment. More importantly, although all three CR formulations had identical in vitro dissolution profiles, naproxen sodium plasma levels were better maintained (based on AUC) in subjects taking formulations A and C, which contained a lower polymer content and did not use hydroxypropyl cellulose. The tmax values were larger for the three controlled-release dosage forms. Also, the Cmax value for the conventional dosage form was nearly twofold higher than that observed for the controlled-release dosage forms.
Adult↗
A double-blind and randomized placebo-controlled trial of low molecular weight heparin once daily to prevent deep-vein thrombosis in acute ischemic stroke.
The effect of LMW heparin (Kabi 2165, Fragmin) was compared with placebo for the prevention of DVT in 103 patients with acute ischemic stroke using a prospective, double-blind, randomized trial design. Treatment was started within 72 hours, and LMW heparin was administered subcutaneously once daily according to body weight classes, which corresponded to about 55 to 65 Factor-Xa inhibitory U/kg, for 14 days, or until discharge from the hospital, if earlier. All patients underwent thrombosis surveillance with unilateral venography of the paretic limb. Evaluation of venography could be performed in 42 of 52 patients randomized to LMW heparin and in 50 of 51 patients randomized to placebo. The frequency of DVT was 15 of 42 patients or 36% (95% confidence interval 22 to 52%) in the LMW heparin group and 17 of 50 patients or 34% (21 to 49%) in the placebo group. The frequency of proximal thrombi was 5 of 42 (12%) and 8 of 50 (16%), respectively. There was one fatal pulmonary embolism in the placebo group. The mortality rate (28 days follow-up) was 5 of 52 in the LMW heparin group and 1 of 51 in the placebo group (p = 0.24). None of the deaths was related to treatment. No major hemorrhagic complications were observed. The mean Factor Xa inhibitory activity levels at peak concentration were 0.34 U/ml on day 2 and 0.42 U/ml on day 12 (p = 0.02). We conclude that LMW heparin in the dose range studied did not provide efficient prophylaxis against DVT in patients with acute ischemic stroke.
Acute Disease↗
[Atrial fibrillation: an indication to prevent stroke].
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Aspirin↗
[Parotid gland tumors. What not to do].
Patients with a tumour located anterior or inferior to the ear probably have a parotid gland tumour. These patients should be referred without further investigation to an ear, nose and throat specialist. Diagnostic measures that may be performed are fine needle aspiration cytology and ultrasonography. Biopsy or enucleation of the tumour should not be carried out. Correct treatment is parotidectomy with preservation of the facial nerve. Inadequate primary treatment may lead to a very unpleasant situation for the patient and for the physician. This is illustrated by three case histories.
Adenoma↗
Fatal stroke in migraine: a case report with autopsy findings.
A 50-year-old woman with migraine was admitted to hospital shortly after having abruptly developed hemiparesis. CT scan revealed infarction in the territory of the right middle cerebral artery. Death ensued after three days due to cerebral edema with herniation. Autopsy revealed no pathologic findings in the heart or in the extra- or intracranial arteries. It is suggested that the fatal stroke may have resulted from arterial spasm caused by ergotamine overdosage and possibly complicated by thrombosis.
Brain↗
Fatalities in a stroke unit.
During the first 4 years of the CV unit the mortality rate among 464 patients was 5.2 per cent. The records of the 24 fatalities were reviewed. In the 10 patients submitted to autopsy the clinician's opinion of the cause of death was confirmed in 6 cases. In 4 cases autopsy revealed brain abscess, pulmonary embolism, acute myocardial infarction and pneumonia, respectively. Other significant findings not registered clinically were made in 4 cases. Twenty-three patients underwent a cerebral CT scan which showed positive findings in 19 cases. In one patient a brain abscess was misinterpreted as a brain infarction and in 2 other patients with a negative CT scan, autopsy revealed a small pontine and hemispheric infarction, respectively. Apart from the misdiagnosis of the brain abscess the accuracy of the CT scan was acceptable. Extracranial complications as a cause of or contributing to death in stroke patients are common. Prevention, early detection and treatment of these complications are important. The findings underscore the importance of autopsy in the evaluation of stroke patients.
Aged↗
[Pleomorphic adenoma in the epipharynx].
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Adenoma, Pleomorphic↗
Speech rehabilitation in laryngectomees with tracheo-oesophageal fistulas and prostheses.
The Staffieri technique was used in 24 patients, but abandoned due to aspiration. The Blom-Singer or other prostheses were used in 40 cases, 50% achieved fluent speech, 15% spoke partially and 35% were not able to use the prostheses at all. Some complications are always met with in these cases: Dysphagia, leakage around the prostheses and difficulties with the function of the prostheses. The selection of suitable cases is important. Their cooperation and motivation must be ensured preoperatively, and in many cases like those living under poor social conditions or in older patients, this procedure should not be tried.
Humans↗