Prevalence and evolution of spasticity in patients suffering from first-ever stroke with carotid origin: a prospective, longitudinal study.

BACKGROUND AND PURPOSE: The main aim of the study was to document the occurrence and evolution of post-stroke spasticity (PSS). The secondary goal was to identify predictors for increases and decreases in PSS rates during 12 months of subsequent follow-up. METHODS: In a longitudinal, multicenter, prospective cohort study, assessments were done at 7 days (V1), 6 months (V2), and 12 months (V3) after stroke onset. A total of 307 consecutive patients from four comprehensive stroke centers with the first-ever stroke of carotid origin and the presence of motor deficit at day 7 were included. The demographic data, baseline characteristics, Barthel index, degree and pattern of paresis and muscle tone were evaluated and recorded. Spasticity was assessed using the modified Ashworth scale. RESULTS: Spasticity was present in 45.0% of patients at V1, in 49.5% at V2, and in 43.2% at V3. A significant number of patients experienced changes in spasticity between visits: increased/new occurrence of spasticity in 32.5% (V1 and V2) and in 13.6% (V2 and V3) of patients; decreased occurrence/disappearance of spasticity in 18.5% (V1 and V2) and in 18.3% (V2 and V3) of patients. The number of patients with severe spasticity increased throughout the year, from 2.6% to 13.0% (V2) and 12.5% (V3). CONCLUSIONS: Spasticity developed in almost half of the included patients. The degree of spasticity often changed over time, in both directions. The rate of severe spasticity increased during the first year, with the maximum at 6 months following stroke onset.

Assessment of burbot Lota lota (L. 1758) population sustainability in central European reservoirs.

A novel sampling scheme, using a combination of electrofishing, visual exploration by scuba divers, two types of fyke nets and longlines, was tested in four reservoirs (including their inlets and outlets) to monitor a population of burbot Lota lota. This was supplemented by fry trawling and vertical hydro-acoustics, to detect L. lota larvae in two deep reservoirs that have had a long-term stocking programme. The majority of the L. lota detected were juveniles, captured by electrofishing in the littoral zones of the reservoirs and in running waters. Older individuals were rarely captured with longlines or fyke nets in deeper zones or structured habitats within the reservoirs. A combination of multiple sampling methods provided an assessment of the whole population. Population establishment could not be demonstrated as the age structure of the sampled fish corresponded with that of the stocked fish. Low post-stocking survival, migratory behaviour, interactions with other species and warmer water temperatures are considered the potential drivers for unsuccessful establishment of L. lota populations in these reservoirs.

The occurrence of non-native tubenose goby Proterorhinus semilunaris in the pelagic 0+ year fish assemblage of a central European reservoir.

In July 2008, early juvenile tubenose goby Proterorhinus semilunaris were found in nocturnal pelagic waters of the Vranov Reservoir, Czech Republic. Presence of benthic-living prey in the guts of these fish suggested migration between benthic and pelagic habitats.

Myocardial tissue engineering and regeneration as a therapeutic alternative to transplantation.

Ischemic cardiomyopathy leading to congestive heart failure remains the leading source of morbidity and mortality in Western society and medical management of this condition offers only palliative treatment. While allogeneic heart transplantation can both extend and improve the quality of life for patients with end-stage heart failure, this therapeutic option is limited by donor organ shortage. Even after successful transplantation, chronic cardiac rejection in the form of cardiac allograft vasculopathy can severely limit the lifespan of the transplanted organ. Current experimental efforts focus on cellular cardiomyoplasty, myocardial tissue engineering, and myocardial regeneration as alternative approaches to whole organ transplantation. Such strategies may offer novel forms of therapy to patients with end-stage heart failure within the near future.

Off pump coronary artery bypass grafting in EuroSCORE high and low risk patients.

OBJECTIVE: Off pump coronary artery bypass grafting (OPCAB) is claimed to reduce the operative morbidity and mortality in high risk patients. It was the aim of the study to compare the outcome of OPCAB patients classified as high- and low risk according to the EuroSCORE. METHODS: Medical records of patients undergoing off pump coronary artery bypass grafting (n=126) at our institution between 1998 and 2001 were retrospectively reviewed. We classified them into two subgroups: low risk (EuroSCORE < or = 5, n=72, male 58 (81%), female 14 (19%), age 61 (37-78) years) and high risk (EuroSCORE >5, n=54, male 32 (59%), female 22 (41%), age 73 (42-83) years). RESULTS: EuroSCORE high risk patients showed significantly higher rates of blood transfusion (70 vs 31%; P<0.0001), intraaortic balloon pump insertion (16 vs 3%; P=0.013), atrial fibrillation (43 vs 22%; P=0.014), and renal failure (13 vs 3%; P=0.028). ICU length of stay was significantly longer in the high risk group (25 vs 22 h; P=0.002). There was also a higher perioperative mortality in the high risk group (9 vs 0%; P=0.008). CONCLUSION: From these data we conclude that using off pump coronary artery bypass grafting results as predicted by the EuroSCORE can be achieved. OPCAB is safe for low risk patients. Major complications seem to occur preferentially in the high risk group.

Declining hospital mortality in acute myocardial infarction.

Beta-blockers, nitrates, aspirin and thrombolytic drugs have each separately been shown to reduce mortality in acute myocardial infarction, but the effect of these treatments combined during routine coronary care has not been assessed. The coronary care unit at Ostra Hospital services a stable community of 250,000 inhabitants. Since 1984 all patients have been entered into a computerized database. In addition, information on age, sex, discharge diagnosis and hospital outcome is also available for patients admitted between 1979 and 1983. In 1984, routine treatment with intravenous beta-blockers was introduced, to be followed in 1986 by intravenous nitroglycerin and in 1988 by aspirin in all patients without contraindications. Since 1988, intravenous thrombolytic treatment has been also given routinely to all patients with ST-elevation and chest pain < 6 h. Despite a similar number of patients and an increasing median age, the in-hospital mortality has declined from 18.5% in 1979 to 11.8% in 1990 (P < 0.01). It is concluded that mortality from acute myocardial infarction has declined by almost 40% since 1979. This reduction cannot be explained by a single major therapeutic intervention but may be attributed to the combined use of multi-lead monitoring, early use of beta-blockers, nitroglycerin, aspirin and thrombolytic agents.

Changes in the QRS segment during exercise: effects of acute beta-blockade with propranolol.

Changes in the QRS complex during exercise may provide information with respect to ischaemic heart disease. The intention with present investigation was to shed light on mechanisms behind QRS changes and to study the possibly confounding effects of beta-blockade on such alterations with exercise. Placebo or propranolol respectively was infused in randomized and double-blinded order in seven young healthy men before a maximum exercise test. Advanced computerized vectorcardiography and impedance cardiography was recorded continuously together with blood pressures and blood samples. The Y-lead magnitude increased significantly with propranolol infusion (P < 0.05), but it tended to decrease in the Z-lead (P < 0.07). While the serum potassium concentrations increased (P < 0.0005), the spatial QRS magnitude tended to decrease irrespective of treatment (P < 0.07). These changes correlated with changes in QR-duration (adj r2 > 0.58). With exercise, the mean spatial QRS magnitude decreased with similar amounts irrespective of treatment. However, propranolol made the magnitude decrease earlier (P < 0.01). No effect of treatment was detected on the decrease in QRS-duration. Immediately after exercise, the QRS complex continued to change as during exercise in the placebo investigations, but did not with propranolol (P < 0.05). These different patterns were most obvious in the first half of the QRS complex in the Y-lead. It is concluded that acute beta-blockade modifies QRS alterations both during and after exercise in healthy subjects. This indicates that such drugs may have confounding effects in evaluations of the diagnostic value of QRS alterations.

Changes in QRS segments during exercise in relation to scintigraphic myocardial perfusion defects: a multivariate analysis.

BACKGROUND: The relation between QRS changes during exercise and ischemic heart disease is controversial. The present investigation addressed whether exercise QRS changes are related 1) to myocardial ischemia or necrosis, 2) to possibly confounding factors such as baseline QRS size and changes in heart rate and ST magnitude during exercise, and 3) to the location of scintigraphic defects. METHODS: Advanced computerized vectorcardiography (MIDA1000, Ortivus Medical AB, Sweden) was recorded in 71 consecutive patients referred for 201TI exercise myocardial scintigraphy. Maximal exercise tests were performed in the sitting position on a bicycle ergometer. Planar scintigraphic images were obtained immediately after exercise and 4 hours later in three projections, and were evaluated blindly. RESULTS: Exercise QRS changes correlated to baseline QRS size (X, Y, and Z leads; P < 0.005), change in heart rate (X and Y leads; P < 0.01), and ST change at J + 20 ms (X, Y, and Z leads; P < 0.0001). Increased QRS magnitudes in the Y and Z leads correlated to late perfusion defects (P < 0.0001). These correlations remained after correction for baseline QRS size and changes in heart rate and ST magnitude at J+20 ms during exercise (P < 0.0001). No consistent relationships were observed between the location of myocardial perfusion defects and the stress-induced alterations in QRS. CONCLUSIONS: Baseline QRS size and changes in heart rate and ST magnitude may have important confounding effects on the QRS response to exercise. However, even after consideration of these factors, the QRS response to exercise was related to late (4 h) scintigraphic myocardial perfusion defects. The findings suggest that the presence of myocardial infarctions or long-lasting ischemia after exercise is associated with increased QRS magnitudes during exercise.

Exercise-induced QRS changes in healthy men and women: a multivariate analysis on their relation to background data and exercise performance.

Changes in the QRS segment during exercise have repeatedly been suggested to provide diagnostic information with respect to ischaemic heart disease, but the subject is controversial. In order to study the possibly confounding effects of gender, age, resting ECG and exercise performance, 50 healthy subjects were investigated with computerized vectorcardiography during a maximal ergometer exercise test. The overall change in the QRS complex decreased significantly with age and female gender (P < 0.001). However, these responses were better explained by baseline QRS size, change in heart rate and systolic blood pressure (adjusted r2 > 0.70, vs adjusted r2 > 0.41). Effects of age were seen in the Y-lead, and gender effects in the X- and Z-leads (P < 0.0001). In multivariate analyses, X- and Y-lead alterations correlated negatively to change in heart rate and resting QRS size (X-lead; adjusted r2 > 0.50, Y-lead; r2 > 0.44). Z-lead alterations correlated negatively with female gender and resting Z-lead QRS size (adjusted r2 > 0.31). ST changes correlated with QRS changes in the X- and Y-leads (P < 0.05). QRS changes immediately after exercise correlated with alterations during exercise (P < 0.004), maximal load (P < 0.01) and time to hypotension post-exercise (X- and Z-lead; P < 0.02). In conclusion, QRS changes appear to be related to baseline QRS size, change in heart rate and ST change, factors which may have important confounding effects. Consideration of these factors may help in resolving the controversy surrounding QRS changes.

Dynamic changes of the QRS complex in unstable angina pectoris.

Despite intensive medical treatment to control chest pain, about one-third of patients with unstable angina have an unfavourable outcome within a period of 1 to 2 months. Holter monitoring can identify patients with silent myocardial ischaemia that are at a high risk of sustaining a major cardiovascular event. The present paper describes the use of dynamic, continuous, computerized on-line vectorcardiography for real-time monitoring of QRS-complex and ST-segment changes in patients with unstable coronary disease. In many patients a pattern of frequent repetitive episodes of QRS change was observed, with or without concomitant ST change. Whereas no patient had episodes of ST-vector change without also having episodes of significant QRS change, 15 patients had several episodes of QRS changes without any episode of significant ST change. The number of episodes of significant increase of the QRS vector difference correlated weakly but significantly with the number of episodes of significant ST-vector magnitude change (r = 0.34, p less than 0.05). The present study suggests that myocardial ischaemia will influence the QRS complex as well as the ST segment. The mechanism behind the QRS changes observed is not clear but episodes of QRS change without ST change or chest pain, may reflect sudden depressions of left ventricular function, as has been reported by others to occur in patients with coronary artery disease. Dynamic vectorcardiography offers the opportunity to monitor all parts of the QRST complex in real time.

Ischaemic heart disease and the changes in the QRS and ST segments during exercise: a pilot study with a novel vectorcardiographic system.

In order to find new ischaemic parameters, the spatial changes of the Frank vectorcardiogram were continuously analysed with a new, highly precise vectorcardiographic method during, and immediately after a maximal exercise test. This was done in 18 young healthy males, and 18 patients with scintigraphic reversible ischaemia. During exercise, different patterns between the groups were noted for the changes in the mean QRS magnitude in the Y-lead (P less than 0.005), the QRS-integral (P less than 0.05), and the QRS-duration (P less than 0.05). Immediately after exercise, several QRS parameters in the normal group continued to change according to the same pattern as during exercise (P less than 0.05), which was in contrast with the patterns of the ischaemic group (P less than 0.01). The spatial ST difference at J+20 ms discriminated well between the groups, especially when corrected for QRS-magnitudes at rest and heart rate (P less than 0.0005). In short, this pilot study supports previous findings in that changes in amplitude and duration of the QRS complex during exercise discriminated between healthy young males and patients with ischaemic heart disease. Moreover, rapid discriminating changes were seen in the QRS segment during cessation of exercise. These changes deserve attention since they may be of importance for the conflicting results on the diagnostic value of QRS changes during exercise.

Dynamic QRS-complex and ST-segment monitoring in acute myocardial infarction during recombinant tissue-type plasminogen activator therapy. The TEAHAT Study Group.

Changes of the QRS complex are the electrocardiographic expression of irreversible injury of the myocardium. In humans, the process of infarction occurs over several hours. A more rapid development of QRS changes has been reported in patients treated with thrombolytic agents. Patients with strongly suspected acute myocardial infarction (AMI) included in a placebo-controlled trial of 100 mg of recombinant tissue-type plasminogen activator (rt-PA) were monitored for 24 hours with continuous, on-line vectorcardiography. The magnitude of the QRS vector changes correlated with infarct size estimated by the maximal value of lactate dehydrogenase-1 (r = 0.69, p less than 0.001) as well as with left ventricular ejection fraction 30 days after randomization (r = 0.49, p less than 0.001). Treatment with intravenous rt-PA limited total QRS vector change but the QRS vector changes observed occurred more rapidly and reached a plateau 131 minutes earlier in patients treated with rt-PA than in those receiving placebo (p less than 0.01). A certain pattern of highly variable ST vector magnitude was identified and was associated with higher maximal lactate dehydrogenase-1 values (23 +/- 13 vs 14 +/- 10 mu kat/liter, p less than 0.001) and a tendency to higher 1-year mortality (24 vs 9%, p = 0.08) than in patients without this pattern. In patients with this pattern, rt-PA did not affect maximal lactate dehydrogenase-1, time to maximal creatine kinase and final magnitude of QRS vector change.

Effects of maternal glucose infusion on fetal acid-base status in human pregnancy.

The maternal and fetal metabolic effects of three commonly used intravenous fluids administered before regional anesthesia were studied in 32 gravid women undergoing elective cesarean section at term. Patients were randomized into one of three groups to receive 1 L of either 5% dextrose (50 gm of glucose) or Ringer's lactate or isotonic saline solution before epidural anesthesia. Acute glucose infusion resulted in maternal hyperglycemia, hyperinsulinemia, and an increase in the blood lactate level. Cord blood glucose, insulin, and lactate levels were also increased in this group. The key finding of this study was the significant lowering of pH in the umbilical cord vein (7.31 +/- 0.04) and artery (7.21 +/- 0.06) in the glucose-infused group when compared with the non-glucose infusion groups (p less than 0.05). Confounding perinatal factors such as maternal position, maternal hypotension, and prolonged time of surgery did not influence the fetal acid-base status. Thus acute maternal glucose infusion in normal patients can cause fetal hyperglycemia, metabolic acidosis, and neonatal hypoglycemia. These findings may be of particular clinical importance when fetal distress or fetal hypoxemia is due to other perinatal events. Under these circumstances, acute maternal glucose infusion may further contribute to fetal metabolic acidosis.

A computerized system for handling renal size measurements from urograms.

The size of a kidney, as measured on a urogram, is a sensitive indicator of renal damage in a child with urinary tract infection and renal surface area correlates well with glomerular filtration rate. Sequential measurements can be invaluable in evaluating the efficacy of a regimen of treatment. A system utilizing a personal microcomputer has been developed to facilitate the measuring procedure and the handling and analysis of data.

Gestational diabetes mellitus. Is further improvement necessary?

The maternal antepartum, intrapartum, and neonatal characteristics of 158 patients with gestational diabetes mellitus (GDM) attending a large teaching hospital between 1979 and 1983 were described and compared with a matched nondiabetic control group. The primary cesarean section rate in patients with GDM (18%) was significantly greater than in the control group (11%, P less than 0.04). Neonatal macrosomia, as reflected in mean birthweight (P less than 0.04), the number of neonates weighing greater than 4 kg (P less than 0.05) and large-for-gestational-age infants (P less than 0.05), and the birthweight adjusted for gestational age (K-score, P less than 0.01) was significantly increased in the diabetic group. The characteristics of patients with GDM treated with diet alone and diet and insulin together were examined. The insulin-therapy group was characterized by more patients older than 25 yr (P less than 0.01) and a higher mean birthweight (3743 +/- 677 g) (P less than 0.02) than the diet-alone group. This may reflect an increased magnitude of glucose intolerance in the insulin-treated group. Obese patients with GDM delivered heavier neonates than the nonobese patients with GDM (P less than 0.01). Although there was no difference between the groups, perinatal mortality was present in this study. These data indicate that the major perinatal morbidity in GDM included increased cesarean section for fetal macrosomia. Early diagnosis with strict diagnostic criteria and rigid antenatal surveillance may result in further improvements in outcome.

Morbidity and immunological test in miners working in mines with low ionizing radiation level.

Total count of morbidity as well as prevalence of upper respiratory tract diseases (RTD) were followed in 210 miners working in shale mines with a low level of ionizing radiation regarding their smoking habits. After one and half year of observation were performed some tests of humoral immunity in the blood serum and saliva (immunoglobulins G, A, M and sIgA) as well as some tests of non-specific indices (alpha 2 macroglobulin -A 2M, transferrin -TRF, lysozyme -- LYS). The number of healthy non--smokers reached 41.3%, whereas the number of healthy smokers was only 26.5% (P less than 0.05). The greater was the number of diseases in single subjects, the greater was the difference between smokers and non-smokers (P less than 0.005). The difference between RTD morbidity of smokers and non-smokers was not significant in the subgroup of miners employed less than 10 years, but the length of employment it rose significantly (P less than 0.002) in disfavour of the smokers. The difference between smokers and non-smokers is emphasized by ageing. The mean levels of immunoglobulins (IgG, IgA, IgM) are significantly higher in healthy non-smokers in comparison with other miners; that is stressed also by distribution analysis. The distribution analysis. The distribution of A 2M values is also significantly different in the subgroup of healthy non-smokers compared with other miners. Highly significant differences were found between healthy non-smokers and other miners by discrimination analysis of coupled tests. The differences among the paired comperformed some tests of humoral immunity in the blood serum and saliva (immunoglobulins are apparently cooperative in the prevention of RTD. In contrast to that the level of A 2M are in reverse relationship to the levels of Ig; in the subgroup of healthy non-smokers low levels of A 2M are in connection with high levels of Ig of all three classes. The results are discussed from the point of view of the smoker's habits, the length of employment in mine's environment, the age of the miners and the supposed genetical factors.