Impaired glucose metabolism in patients with acute stroke and no previous diagnosis of diabetes mellitus.

BACKGROUND: About a third of patients with acute stroke and no prior diagnosis of diabetes have hyperglycaemia during the acute phase of stroke. Whether this is an acute stress response or a reflection of underlying diabetes is controversial. AIM: To assess whether impaired glucose metabolism in patients with acute ischaemic stroke and no previous diagnosis of diabetes persists after 3 months, and whether such persistence can be predicted. DESIGN: Prospective observational study. METHODS: We enrolled 106 patients with acute ischaemic stroke and no history of diabetes. Fasting blood glucose, serum insulin and the insulin resistance index HOMA were recorded during hospital stay. A standard oral glucose tolerance test was performed at discharge and 3 months later. RESULTS: Ten patients did not complete the study. Eighty-one patients (84.4%) had abnormal glucose metabolism at discharge and 62 (64.6%) after 3 months. Thirty-seven (38.5%) had impaired glucose tolerance at discharge and 26 (27.1%) after 3 months. Forty-four (45.8%) had diabetes at discharge, and 36 (37.5%) at 3 months. Post-load hyperglycaemia at discharge was a predictor of diabetes after 3 months. A plasma glucose cut-off of 11.7 mmol/l (210 mg/dl) had a specificity of 90.0% and a positive predictive value of 81.3%. HOMA increased progressively from patients with normal glucose metabolism to those with newly diagnosed diabetes. DISCUSSION: Impaired glucose tolerance and previously unrecognized diabetes could be detected early in the stroke course, and persisted after 3 months in more than two-thirds of our patients. Post-load hyperglycaemia during the acute phase of stroke may be useful in identifying patients with abnormal glucose metabolism, which places them at risk for adverse outcomes, including cardiovascular disease.

A marked increase of ischemic stroke incidence between 1980 and 1994 in S. Caterina, Sicily.

Stroke death rates have been declining for some decades in most of the industrialized countries. It is not clear, whether this has been associated with a decrease in stroke incidence. We studied temporal trends in stroke incidence in a rural community in Sicily, during two periods 1980-84 and 1990-94. There was a total of 231 patients (120 of them women). The diagnosis of stroke was based on the clinical evaluation and CT scan since 1982 and onward. There were 109 ischemic strokes (51 women) mean age 72.7 years, in 1980-84 period; 122 ischemic strokes (69 women) mean age 75.1, in 1990-94 period. Cardiovascular risk factor rates did not change in the two periods considered. The relative annual stroke incidence rate increased 37.0%; (2.7 in 1980-84 to 3.7/1000 inhabitants in 1990-94, p = 0.0161. In the population older than 65 years, the same parameter increased by 21.1% between the two periods; (16.1 in 1980-84 to 19.5/1000 inhabitants in 1990-94, not significant). This increase was due mainly to a 45.3% significant relative increase in women, from 7.5 to 11.0/1000 inhabitants (p = 0.039). These findings suggest a need of the reconsideration of effective strategies for the prevention of stroke.

[Inverse relationship between fetal growth and arterial pressure in children and adults]. / Relazione inversa tra crescita fetale e pressione arteriosa in età infantile e adulta.

BACKGROUND: Increased prevalence of hypertension, ischaemic heart disease and stroke has been reported in subjects with impaired growth during fetal life and infancy. Blood pressure could mediate this relation. Indeed, reduced growth in fetal life and infancy has been associated with a raised blood pressure in children and adults. However, there is controversy about the relative importance of intrauterine environment and extrauterine adverse environment which can act throughout the life course. We therefore studied the relation between birth weight, which is known to be an indicator of fetal growth, and blood pressure in children and their parents. This association could thus be assessed in childhood before the external environmental influences became important, and in adulthood. METHODS: Seven hundred and fifteen healthy schoolchildren (379 boys) aged 3-12 years from primary schools, and 448 parents (252 women) aged 20-44 years, born at term, without hypertension or diabetes, were studied. Blood pressure and birth weight were measured. Birth weight was taken from the hospital records. Data were analysed by tabulation of means and linear regression and correlation techniques. Mean systolic and diastolic blood pressure were calculated according to birth weight and current weight as fourths of their distributions. RESULTS: There was a significant inverse relation between birth weight and systolic blood pressure both in children and adults. Current weight standardised regression coefficient showed a change of -2.68 mm Hg (95% Cl - 2.0 to 3.26, p = 0.027) for each Kg increase in birth weight in children, and -3.82 mmHg (95% Cl -3.21 to -4.39, p = 0.011) in adults. Within each current body weight group the reduction in mean systolic blood pressure from the lowest to the highest birth weight group was larger in adults (10.4 mmHg) than in children (4.1 mmHg). Adults but not children showed also an inverse relation between birth weight and diastolic blood pressure. Weight standardised regression coefficient was -3.0 mm Hg (95% Cl -2.45 to -3.62, p = 0.036). CONCLUSIONS: Blood pressure in inversely related to birth weight in childhood. This relation becomes stronger in adulthood. Therefore, reduced growth during fetal life may be linked with an increased risk of developing hypertension and cardiovascular disease.

[Sublingual captopril in hypertensive crises]. / Captopril sublinguale nelle crisi ipertensive.

Captopril is widely used in severe hypertension. Oral administration takes one-two hours to achieve a maximum effect and is not useful in hypertensive crisis. Few reports describe a more rapid effect on blood pressure following sublingual administration. We evaluated the effect of sublingual captopril 50 mg, in 26 patients with hypertensive crisis. Blood pressure levels started to decrease within 10 minutes and the maximum effect was observed 30 minutes after administration of the tablet. In all patients mean (CI 95%) systolic blood pressure dropped from 202.5 (199-206) mmHg to 160.6 (156-165) mmHg and diastolic blood pressure from 105.6 (102-109) mmHg to 86.9 (83-7-90.1) mmHg. This effect was maintained over two hours. There were no side effects. Sublingual captopril is highly effective in hypertensive crisis and its gradual hypotensive action avoid dangerous abrupt fall in blood pressure.

[A case of Martorell's ulcer: considerations on the use of hyperbaric oxygenotherapy]. / Sobre un caso de ulcera de Martorell: consideraciones sobre el empleo de la oxigenoterapia hiperbárica.

A case of hypertensive ulcer of martorell in a diabetic patient is described standing out the fast cure by means of Hyperbaric oxygenotherapy.