ABSTRACT
BACKGROUND AND PURPOSE: The data of patients with an MRI-confirmed diagnosis of thalamic stroke were analyzed to identify risk factors and to describe the clinical syndromes according to the thalamic arterial territory involved. METHODS: We examined the records of all patients with a diagnosis of thalamic stroke confirmed by MRI who attended the National Institute of Neurology and Neurosurgery "Manuel Velasco Suárez" from 1987 through 1995. A database containing demographic features, risk factors, clinical course, type and mechanism of stroke, and vascular territory was analyzed. RESULTS: Twenty-eight patients (19 men and 9 women; mean age, 48.2 years) had MRI-confirmed thalamic stroke. Infarct was present in 22 patients and hemorrhage in 6. Eleven (39.3%) patients were younger than 45 years. In these young patients, cigarette smoking was the main risk factor associated with the development of stroke. In young patients, isolated and multiple thalamic lesions were present in almost equal proportions. The remaining 17 patients were older adults (45 to 84 years of age). In such patients, most lesions were multiple and were associated with atherosclerosis-predisposing factors. The main distinguishing clinical feature for hemorrhages and paramedian infarcts in comparison with infarcts in the other thalamic territories was the presence of an altered level of consciousness. No patient died as a direct result of the stroke. CONCLUSIONS: Thalamic stroke commonly occurs in young adults. and its mechanism is often undetermined. Increased awareness of this type of stroke in young adults should lead to better delineation of its clinical features, course, and management.
Subject(s)
Cerebral Hemorrhage , Cerebral Infarction , Cerebrovascular Disorders , Thalamus/blood supply , Adolescent , Adult , Aged , Aging/physiology , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/physiopathology , Cerebral Infarction/diagnosis , Cerebral Infarction/physiopathology , Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/physiopathology , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , Risk Factors , Smoking/adverse effectsABSTRACT
GeneTox Manager (GTM) is a data capture, data management, and statistical analysis program used for microbial mutagenicity data. Its main purpose is to provide a homogeneous environment for the collection, organization, and analysis of data generated in the laboratory while also supporting a quality assurance program. The complete system consists of both a personal computer (PC) system and a minicomputer (VAX) system. The joint PC/VAX version of the system is designed to function with both the PC and VAX FOCUS databases so that the VAX can be used for long-term storage, archiving of files, and the analysis of large groups of data. Because of the highly specialized use and nature of the PC/VAX version, this discussion is focused upon the PC stand-alone version. The user-friendly system uses a structured menu system, screen entry helps, and other help screens. GTM provides tabular and graphical summaries of the data and performs specialized statistical analyses. This public domain software was written primarily using Clipper. The manuals and programs are now available through the government's National Technical Information Service.
Subject(s)
Information Systems , Mutagenicity Tests , Software , Microcomputers , Minicomputers , Mutagens/toxicity , Salmonella typhimurium/geneticsABSTRACT
OBJECTIVE: To describe the clinical outcomes and cost for high-risk critical care patients with peripherally inserted central venous catheters (PICCs). DESIGN: A prospective descriptive study. SETTING: A private acute care facility. SUBJECTS: Ninety-seven consecutive PICC insertions in four critical care units per physician order. Five subjects were excluded due to five abortive attempts. Data were analyzed on 92 PICC insertions. Age range was 23 to 92 years. OUTCOME MEASURES: Frequency of insertion complications, postinsertion complications, and cost factors were measured. RESULTS: When subjects were in critical care areas, catheters remained in place a mean of 10 days with a range of one to 50 days. After patient transfer with catheters in place to acute care areas (medical-surgical units), convalescent units, and home care, catheters were maintained a mean of 13 days with a range of 1 to 116 days. Catheter days totaled 2069. The total number of catheter days while in critical care were 878, with 1191 catheter days after transfer to other areas. Seventy-one of the original 92 PICC catheters remained in place until treatment was completed or the patient expired. Twenty-one were removed for nonelective reasons. Of these patients, only one had significant morbidity related to sepsis. This septic episode occurred in a convalescent unit. Percentage of catheter-related sepsis was 0.48% per 1000 catheter days. Because PICCs are not used to any degree in critical care patients throughout the United States, this study should increase awareness among practitioners that this approach is a safe alternative method to chest or neck insertion for central venous access in high-risk critical care patients.
Subject(s)
Catheterization, Central Venous/economics , Critical Care/economics , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/statistics & numerical data , Costs and Cost Analysis , Embolism/epidemiology , Female , Humans , Incidence , Male , Middle Aged , Phlebitis/epidemiology , Risk Factors , Staphylococcal Infections/epidemiology , Thrombosis/epidemiology , Time FactorsABSTRACT
There are very few observations on the occurrence of stroke after general surgery; the incidence lies between 0.2 and 0.7%. On the other hand, cerebrovascular accidents are mainly seen after cardiac and carotid surgery, where the incidence is high (5%). Strokes are also an important cause of morbidity and mortality following orthotopic transplantations, particularly heart, heart/lung and liver transplantations.
