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Nogova L, Mattonet C, Scheffler M, Taubert M, Gardizi M, Sos ML, Michels S, Fischer RN, Limburg M, Abdulla DSY, Persigehl T, Kobe C, Merkelbach-Bruse S, Franklin J, Backes H, Schnell R, Behringer D, Kaminsky B, Eichstaedt M, Stelzer C, Kinzig M, Sörgel F, Tian Y, Junge L, Suleiman AA, Frechen S, Rokitta D, Ouyang D, Fuhr U, Buettner R, Wolf J. Sorafenib and everolimus in patients with advanced solid tumors and KRAS-mutated NSCLC: A phase I trial with early pharmacodynamic FDG-PET assessment. Cancer Med 2020; 9:4991-5007. [PMID: 32436621 PMCID: PMC7367645 DOI: 10.1002/cam4.3131] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/14/2020] [Accepted: 04/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Treatment of patients with solid tumors and KRAS mutations remains disappointing. One option is the combined inhibition of pathways involved in RAF-MEK-ERK and PI3K-AKT-mTOR. METHODS Patients with relapsed solid tumors were treated with escalating doses of everolimus (E) 2.5-10.0 mg/d in a 14-day run-in phase followed by combination therapy with sorafenib (S) 800 mg/d from day 15. KRAS mutational status was assessed retrospectively in the escalation phase. Extension phase included KRAS-mutated non-small-cell lung cancer (NSCLC) only. Pharmacokinetic analyses were accompanied by pharmacodynamics assessment of E by FDG-PET. Efficacy was assessed by CT scans every 6 weeks of combination. RESULTS Of 31 evaluable patients, 15 had KRAS mutation, 4 patients were negative for KRAS mutation, and the KRAS status remained unknown in 12 patients. Dose-limiting toxicity (DLT) was not reached. The maximum tolerated dose (MTD) was defined as 7.5 mg/d E + 800 mg/d S due to toxicities at previous dose level (10 mg/d E + 800 mg/d S) including leucopenia/thrombopenia III° and pneumonia III° occurring after the DLT interval. The metabolic response rate in FDG-PET was 17% on day 5 and 20% on day 14. No patient reached partial response in CT scan. Median progression free survival (PFS) and overall survival (OS) were 3.25 and 5.85 months, respectively. CONCLUSIONS Treatment of patients with relapsed solid tumors with 7.5 mg/d E and 800 mg/d S is safe and feasible. Early metabolic response in FDG-PET was not confirmed in CT scan several weeks later. The combination of S and E is obviously not sufficient to induce durable responses in patients with KRAS-mutant solid tumors.
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Affiliation(s)
- Lucia Nogova
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Lung Cancer Group, University of Cologne, Cologne, Germany
| | - Christian Mattonet
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Lung Cancer Group, University of Cologne, Cologne, Germany.,Onkologische Praxis Moers, Moers, Germany
| | - Matthias Scheffler
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Lung Cancer Group, University of Cologne, Cologne, Germany
| | - Max Taubert
- Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, University of Cologne, Cologne, Germany
| | - Masyar Gardizi
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Lung Cancer Group, University of Cologne, Cologne, Germany
| | - Martin L Sos
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Lung Cancer Group, University of Cologne, Cologne, Germany
| | - Sebastian Michels
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Lung Cancer Group, University of Cologne, Cologne, Germany
| | - Rieke N Fischer
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Lung Cancer Group, University of Cologne, Cologne, Germany
| | - Meike Limburg
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Lung Cancer Group, University of Cologne, Cologne, Germany
| | - Diana S Y Abdulla
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Lung Cancer Group, University of Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Faculty of Medicine and University Hospital Cologne, Institute for Diagnostics und Intervention Radiology, University of Cologne, Cologne, Germany
| | - Carsten Kobe
- Faculty of Medicine and University Hospital Cologne, Department for Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Sabine Merkelbach-Bruse
- Faculty of Medicine and University Hospital Cologne, Institute for Pathology, University of Cologne, Cologne, Germany
| | - Jeremy Franklin
- Faculty of Medicine, Institute for Medical Statistics and Bioinformatics, University of Cologne, Cologne, Germany
| | - Heiko Backes
- Max Planck Institute for Metabolism Research, Cologne, Germany
| | - Roland Schnell
- Praxis for Medical Oncology and Haematology (PIOH), Frechen, Germany
| | - Dirk Behringer
- Heamatology and Oncology, Augusta Hospital, Bochum, Germany
| | | | | | - Christoph Stelzer
- Institute for Biomedical and Pharmaceutical Research (IBMP), Nürnberg, Germany
| | - Martina Kinzig
- Institute for Biomedical and Pharmaceutical Research (IBMP), Nürnberg, Germany
| | - Fritz Sörgel
- Institute for Biomedical and Pharmaceutical Research (IBMP), Nürnberg, Germany
| | - Yingying Tian
- Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, University of Cologne, Cologne, Germany.,Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
| | - Lisa Junge
- Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, University of Cologne, Cologne, Germany
| | - Ahmed A Suleiman
- Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, University of Cologne, Cologne, Germany
| | - Sebastian Frechen
- Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, University of Cologne, Cologne, Germany
| | - Dennis Rokitta
- Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, University of Cologne, Cologne, Germany
| | - Dongsheng Ouyang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory for Bioanalysis of Complex Matrix Samples, Changsha, China
| | - Uwe Fuhr
- Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, University of Cologne, Cologne, Germany
| | - Reinhard Buettner
- Faculty of Medicine and University Hospital Cologne, Institute for Pathology, University of Cologne, Cologne, Germany
| | - Jürgen Wolf
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Lung Cancer Group, University of Cologne, Cologne, Germany
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Michels S, Massutí B, Schildhaus HU, Franklin J, Sebastian M, Felip E, Grohé C, Rodriguez-Abreu D, Abdulla DS, Bischoff H, Brandts C, Carcereny E, Corral J, Dingemans AMC, Pereira E, Fassunke J, Fischer RN, Gardizi M, Heukamp L, Insa A, Kron A, Menon R, Persigehl T, Reck M, Riedel R, Rothschild SI, Scheel AH, Scheffler M, Schmalz P, Smit EF, Limburg M, Provencio M, Karachaliou N, Merkelbach-Bruse S, Hellmich M, Nogova L, Büttner R, Rosell R, Wolf J. Safety and Efficacy of Crizotinib in Patients With Advanced or Metastatic ROS1-Rearranged Lung Cancer (EUCROSS): A European Phase II Clinical Trial. J Thorac Oncol 2019; 14:1266-1276. [DOI: 10.1016/j.jtho.2019.03.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 12/21/2022]
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Limburg SD, Pols J, Limburg M. [Is there quality of life with locked-in syndrome?]. Ned Tijdschr Geneeskd 2018; 161:D2048. [PMID: 29328011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 57-year-old man developed a locked-in state due to a brain stem stroke. He communicated through eye movements. The team suggested treatment should be discontinued, as there was no perspective of improvement. The family was very upset because they experienced sufficient quality of life. We investigated what 'quality of life' means. The literature shows that severely ill and completely care-dependent patients may experience high quality of life; this is called the disability paradox. Patients and families evaluate quality of life by looking for positive things to live for. Some quality-of-life tests, however, understand quality of life as 'functionality'. Healthy people evaluate the situation of people living with handicaps more negatively than the handicapped themselves do. Practitioners may overlook the instability of patients' evaluations: responses and situations may shift. Quality of life as an outcome in clinical trials may be different for individual patients. These insights may improve communication.
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Affiliation(s)
- S D Limburg
- Academisch Medisch Centrum-Universiteit van Amsterdam, afd. Huisartsgeneeskunde, sectie Medische Ethiek, Amsterdam
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Scherf S, Limburg M, Wimmers R, Middelkoop I, Lingsma H. Increase in national intravenous thrombolysis rates for ischaemic stroke between 2005 and 2012: is bigger better? BMC Neurol 2016; 16:53. [PMID: 27103535 PMCID: PMC4839134 DOI: 10.1186/s12883-016-0574-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/14/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Intravenous thrombolytic therapy after ischaemic stroke significantly reduces mortality and morbidity. Actual thrombolysis rates are disappointingly low in many western countries. It has been suggested that higher patient volume is related to shorter door-to-needle-time (DNT) and increased thrombolysis rates. We address a twofold research question: a) What are trends in national thrombolysis rates and door-to-needle times in the Netherlands between 2005-2012? and b) Is there a relationship between stroke patient volume per hospital, thrombolysis rates and DNT? METHODS We used data from the Stroke Knowledge Network Netherlands dataset. Information on volume, intravenous thrombolysis rates, and admission characteristics per hospital is acquired through yearly surveys, in up to 65 hospitals between January 2005 and December 2012. We used linear regression to determine a possible relationship between hospital stroke admission volume, hospital thrombolysis rates and mean hospital DNT, adjusted for patient characteristics. RESULTS Information on 121.887 stroke admissions was available, ranging from 7.393 admissions in 2005 to 24.067 admissions in 2012. Mean national thrombolysis rate increased from 6.4% in 2005 to 14.6% in 2012. Patient characteristics (mean age, gender, type of stroke) remained stable. Mean DNT decreased from 72.7 min in 2005 to 41.4 min in 2012. Volume of stroke admissions was not an independent predictor for mean thrombolysis rate nor for mean DNT. CONCLUSION Intravenous thrombolysis rates in the Netherlands more than doubled between 2005 and 2012, in parallel with a large decline in mean DNT. We found no convincing evidence for a relationship between stroke patient volume per hospital and thrombolysis rate or DNT.
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Affiliation(s)
- S Scherf
- Department of Neurology, Canisius Wilhelmina ziekenhuis, Nijmegen, Netherlands.
| | - M Limburg
- Department of Neurology, Flevoziekenhuis, Almere, Netherlands.,Stroke Knowledge Network Netherlands, Maastricht, Netherlands
| | - R Wimmers
- Stroke Knowledge Network Netherlands, Maastricht, Netherlands.,Dutch Heart Foundation, The Hague, Netherlands
| | - I Middelkoop
- Department of Neurology, Flevoziekenhuis, Almere, Netherlands.,Stroke Knowledge Network Netherlands, Maastricht, Netherlands
| | - H Lingsma
- Department of Public Health, Erasmus MC, Rotterdam, Netherlands
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Liem MI, Schreuder FH, van Dijk AC, de Rotte AA, Truijman MT, Daemen MJ, van der Steen AF, Hendrikse J, Nederveen AJ, van der Lugt A, Kooi ME, Nederkoorn PJ, Schreuder A, Koudstaal P, Limburg M, Weisfelt M, Korten A, Saxena R, van Oostenbrugge R, Mess W, van Orshoven N, Tromp S, Bakker S, Kruyt N, de Kruijk J, de Borst G, Meems B, Verhey J, Wijnhoud A. Use of Antiplatelet Agents Is Associated With Intraplaque Hemorrhage on Carotid Magnetic Resonance Imaging. Stroke 2015; 46:3411-5. [DOI: 10.1161/strokeaha.115.008906] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 10/01/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Madieke I. Liem
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Floris H.B.M. Schreuder
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Anouk C. van Dijk
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Alexandra A.J. de Rotte
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Martine T.B. Truijman
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Mat J.A.P. Daemen
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Anton F.W. van der Steen
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Jeroen Hendrikse
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Aart J. Nederveen
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Aad van der Lugt
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - M. Eline Kooi
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | - Paul J. Nederkoorn
- From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (M.I.L., P.J.N.); Department of Radiology, CARIM School for Cardiovascular Diseases (F.H.B.M.S., M.T.B.T., M.E.K.) and Department of Clinical Neurophysiology (F.H.B.M.S., M.T.B.T.), Maastricht University Medical Center, Maastricht, The Netherlands; Departments of Radiology (A.C.v.D., A.v.d.L.), Neurology (A.C.v.D.), and Cardiology (A.F.W.v.d.S.), Erasmus Medical Center, Rotterdam, The Netherlands; Department of
| | | | | | | | | | | | | | | | - W.H. Mess
- Maastricht University Medical Center
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de Rotte AA, Truijman MT, van Dijk AC, Liem MI, Schreuder FH, van der Kolk AG, de Kruijk JR, Daemen MJ, van der Steen AF, de Borst GJ, Luijten PR, Nederkoorn PJ, Kooi ME, van der Lugt A, Hendrikse J, Schreuder A, Koudstaal P, Limburg M, Weisfelt M, Korten A, Saxena R, van Oostenbrugge R, Mess W, van Orshoven N, Tromp S, Bakker S, Kruyt N, Meems B, Verhey J, Wijnhoud A. Plaque Components in Symptomatic Moderately Stenosed Carotid Arteries Related to Cerebral Infarcts. Stroke 2015; 46:568-71. [DOI: 10.1161/strokeaha.114.008121] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alexandra A.J. de Rotte
- From the Departments of Radiology (A.A.J.d.R., A.G.v.d.K., P.R.L., J.H.) and Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Radiology (M.T.B.T., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S.), and Neurology (F.H.B.M.S.), Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (M.T.B.T., M.E.K.); Department of Radiology, Erasmus Medical Center, Rotterdam
| | - Martine T.B. Truijman
- From the Departments of Radiology (A.A.J.d.R., A.G.v.d.K., P.R.L., J.H.) and Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Radiology (M.T.B.T., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S.), and Neurology (F.H.B.M.S.), Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (M.T.B.T., M.E.K.); Department of Radiology, Erasmus Medical Center, Rotterdam
| | - Anouk C. van Dijk
- From the Departments of Radiology (A.A.J.d.R., A.G.v.d.K., P.R.L., J.H.) and Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Radiology (M.T.B.T., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S.), and Neurology (F.H.B.M.S.), Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (M.T.B.T., M.E.K.); Department of Radiology, Erasmus Medical Center, Rotterdam
| | - Madieke I. Liem
- From the Departments of Radiology (A.A.J.d.R., A.G.v.d.K., P.R.L., J.H.) and Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Radiology (M.T.B.T., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S.), and Neurology (F.H.B.M.S.), Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (M.T.B.T., M.E.K.); Department of Radiology, Erasmus Medical Center, Rotterdam
| | - Floris H.B.M. Schreuder
- From the Departments of Radiology (A.A.J.d.R., A.G.v.d.K., P.R.L., J.H.) and Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Radiology (M.T.B.T., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S.), and Neurology (F.H.B.M.S.), Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (M.T.B.T., M.E.K.); Department of Radiology, Erasmus Medical Center, Rotterdam
| | - Anja G. van der Kolk
- From the Departments of Radiology (A.A.J.d.R., A.G.v.d.K., P.R.L., J.H.) and Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Radiology (M.T.B.T., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S.), and Neurology (F.H.B.M.S.), Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (M.T.B.T., M.E.K.); Department of Radiology, Erasmus Medical Center, Rotterdam
| | - Jelle R. de Kruijk
- From the Departments of Radiology (A.A.J.d.R., A.G.v.d.K., P.R.L., J.H.) and Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Radiology (M.T.B.T., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S.), and Neurology (F.H.B.M.S.), Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (M.T.B.T., M.E.K.); Department of Radiology, Erasmus Medical Center, Rotterdam
| | - Matt J.A.P. Daemen
- From the Departments of Radiology (A.A.J.d.R., A.G.v.d.K., P.R.L., J.H.) and Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Radiology (M.T.B.T., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S.), and Neurology (F.H.B.M.S.), Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (M.T.B.T., M.E.K.); Department of Radiology, Erasmus Medical Center, Rotterdam
| | - Anton F.W. van der Steen
- From the Departments of Radiology (A.A.J.d.R., A.G.v.d.K., P.R.L., J.H.) and Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Radiology (M.T.B.T., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S.), and Neurology (F.H.B.M.S.), Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (M.T.B.T., M.E.K.); Department of Radiology, Erasmus Medical Center, Rotterdam
| | - Gert Jan de Borst
- From the Departments of Radiology (A.A.J.d.R., A.G.v.d.K., P.R.L., J.H.) and Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Radiology (M.T.B.T., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S.), and Neurology (F.H.B.M.S.), Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (M.T.B.T., M.E.K.); Department of Radiology, Erasmus Medical Center, Rotterdam
| | - Peter R. Luijten
- From the Departments of Radiology (A.A.J.d.R., A.G.v.d.K., P.R.L., J.H.) and Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Radiology (M.T.B.T., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S.), and Neurology (F.H.B.M.S.), Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (M.T.B.T., M.E.K.); Department of Radiology, Erasmus Medical Center, Rotterdam
| | - Paul J. Nederkoorn
- From the Departments of Radiology (A.A.J.d.R., A.G.v.d.K., P.R.L., J.H.) and Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Radiology (M.T.B.T., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S.), and Neurology (F.H.B.M.S.), Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (M.T.B.T., M.E.K.); Department of Radiology, Erasmus Medical Center, Rotterdam
| | - Marianne Eline Kooi
- From the Departments of Radiology (A.A.J.d.R., A.G.v.d.K., P.R.L., J.H.) and Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Radiology (M.T.B.T., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S.), and Neurology (F.H.B.M.S.), Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (M.T.B.T., M.E.K.); Department of Radiology, Erasmus Medical Center, Rotterdam
| | - Aad van der Lugt
- From the Departments of Radiology (A.A.J.d.R., A.G.v.d.K., P.R.L., J.H.) and Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Radiology (M.T.B.T., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S.), and Neurology (F.H.B.M.S.), Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (M.T.B.T., M.E.K.); Department of Radiology, Erasmus Medical Center, Rotterdam
| | - Jeroen Hendrikse
- From the Departments of Radiology (A.A.J.d.R., A.G.v.d.K., P.R.L., J.H.) and Vascular Surgery (G.J.d.B.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Radiology (M.T.B.T., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S.), and Neurology (F.H.B.M.S.), Maastricht University Medical Center, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, The Netherlands (M.T.B.T., M.E.K.); Department of Radiology, Erasmus Medical Center, Rotterdam
| | | | | | | | | | | | | | | | - W.H. Mess
- Maastricht University Medical Center
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Truijman MT, de Rotte AA, Aaslid R, van Dijk AC, Steinbuch J, Liem MI, Schreuder FH, van der Steen AF, Daemen MJ, van Oostenbrugge RJ, Wildberger JE, Nederkoorn PJ, Hendrikse J, van der Lugt A, Kooi ME, Mess WH, Schreuder A, Koudstaal P, Limburg M, Weisfelt M, Korten A, Saxena R, van Orshoven N, Tromp S, Bakker S, Kruyt N, de Kruijk J, de Borst G, Meems B, Verhey J, Wijnhoud A. Intraplaque Hemorrhage, Fibrous Cap Status, and Microembolic Signals in Symptomatic Patients With Mild to Moderate Carotid Artery Stenosis. Stroke 2014; 45:3423-6. [DOI: 10.1161/strokeaha.114.006800] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Martine T.B. Truijman
- From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of
| | - Alexandra A.J. de Rotte
- From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of
| | - Rune Aaslid
- From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of
| | - Anouk C. van Dijk
- From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of
| | - Jeire Steinbuch
- From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of
| | - Madieke I. Liem
- From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of
| | - Floris H.B.M. Schreuder
- From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of
| | - Anton F.W. van der Steen
- From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of
| | - Mat J.A.P. Daemen
- From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of
| | - Robert J. van Oostenbrugge
- From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of
| | - Joachim E. Wildberger
- From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of
| | - Paul J. Nederkoorn
- From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of
| | - Jeroen Hendrikse
- From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of
| | - Aad van der Lugt
- From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of
| | - Marianne Eline Kooi
- From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of
| | - Werner H. Mess
- From the Cardiovascular Research Institute Maastricht (CARIM) (M.T.B.T., J.S., F.H.B.M.S., R.J.v.O., J.E.W., M.E.K.); Departments of Radiology (M.T.B.T., J.E.W., M.E.K.), Clinical Neurophysiology (M.T.B.T., F.H.B.M.S., W.H.M.), and Neurology (F.H.B.M.S., R.J.v.O.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.J.d.R., J.H.); Hemodynamics AG, Bern, Switzerland (R.A.); Departments of
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Bour A, Rasquin S, Limburg M, Verhey F. Depressive symptoms and executive functioning in stroke patients: a follow-up study. Int J Geriatr Psychiatry 2011; 26:679-86. [PMID: 20945362 DOI: 10.1002/gps.2581] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 06/03/2010] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cognitive and emotional sequellae are commonly observed in stroke patients and these symptoms often co-occur. Diagnosis can be difficult since symptoms of depression and executive dysfunction overlap. OBJECTIVE To study the longitudinal relationship between depressive symptoms and executive dysfunction in stroke patients. METHODS The study comprises of 116 first-ever stroke patients who were followed-up for 2 years and who were assessed for emotional and cognitive sequellae after 1, 6, 12, and 24 months. Emotional disturbances were evaluated using the SCL-90 depression subscale. Executive functions were assessed using compound scores of a combination of the interference scores of the Stroop Colour Word Test and the Concept Shifting Test. RESULTS Twenty-five patients suffered from both depressive symptoms and executive dysfunction, 28 patients were depressed with no signs of executive dysfunction, and 13 patients showed executive dysfunction with no depressive symptoms. Patients with executive dysfunction had higher mean SCL-90-D scores compared to patients with no executive dysfunction (30.9 (SD 11.7) versus 26.2 (SD 11.1, p = 0.037). Depressive symptoms were predictive for executive dysfunction in a regression analysis corrected for age, sex, and diabetes mellitus but not after additional correction for pre-existent brain damage and other vascular risk factors. After 2 years 66.6 and 53.3% of patients with both depressive symptoms and executive dysfunction at baseline still had depressive symptoms and executive dysfunctions respectively and had worse prognostic outcome than patients with depressive symptoms or executive dysfunction alone. CONCLUSIONS Symptoms of depression and executive dysfunction are highly prevalent in stroke patients and often co-occur. These patients are more at risk for poor stroke outcome, chronic depression, and cognitive deterioration.
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Affiliation(s)
- A Bour
- Department of Neurology, Maastricht University Medical Centre, The Netherlands.
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Bour AMJJ, Rasquin SMC, Baars L, van Boxtel MPJ, Visser PJ, Limburg M, Verhey FRJ. The effect of the APOE-epsilon4 allele and ACE-I/D polymorphism on cognition during a two-year follow-up in first-ever stroke patients. Dement Geriatr Cogn Disord 2010; 29:534-42. [PMID: 20606435 DOI: 10.1159/000314678] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cognitive impairment is commonly observed after stroke and has a negative impact on survival and rehabilitation. Some stroke patients deteriorate in cognitive functioning whereas others do not. Environmental and demographic risk factors cannot fully explain this. There is growing evidence that a genetic predisposition plays a role in the pathogenesis of post-stroke cognitive decline. OBJECTIVE To study the influence of the APOE-epsilon4 allele and the ACE-I/D polymorphism on cognitive functioning after stroke. METHODS We included 194 first-ever stroke patients of whom information about APOE genotyping and ACE-I/D polymorphism was available in 92 and 129 patients, respectively. Patients were cognitively assessed at 1, 6, 12 and 24 months after the event. Linear mixed models with slope estimates were used to study the influence of the APOE-epsilon4 allele and the ACE-I/D polymorphism on the MMSE score, CAMCOG, executive functioning, psychomotor speed, and verbal memory function during follow-up. RESULTS Patients carrying the APOE-epsilon4 allele more often suffered a lacunar infarction than non-carriers. The APOE-epsilon4 allele had no effect on cognitive functioning during the follow-up. ACE-DD homozygosity was associated with a worse performance in executive functioning compared to patients with neither an APOE-epsilon4 allele nor the ACE-DD genotype. There was no interaction between the APOE-epsilon4 allele and the ACE-DD phenotype in the prediction of cognitive decline. CONCLUSION The ACE-DD genotype may be associated with post-stroke cognitive decline while the APOE-epsilon4 allele is not. Further research is needed to examine the role of genetic risk factors for post-stroke cognitive decline and to determine why some patients deteriorate cognitively after stroke but others do not.
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Affiliation(s)
- A M J J Bour
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands.
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Abstract
BACKGROUND Stroke patients commonly suffer from neuropsychiatric disorders, such as depression, that negatively influence stroke outcome. Diagnosis, treatment and prevention of post-stroke psychiatric disorders including depression are under debate. OBJECTIVE To study the course of depression after stroke. METHODS One hundred and ninety first-ever stroke patients were screened for depressive symptoms at 1, 3, 6, 9, and 12 months after stroke. Diagnosis of depression was made according to the DSM-IV criteria of major and minor depression. RESULTS Follow-up was completed in 138 patients. The cumulative incidence of post-stroke depression (PSD) in 1 year was 36.2%. One month after stroke the prevalence of PSD was 18.8%. Thirty percent of patients who were depressed in the first three months did not reach cut-off levels on depression screening instruments at the following assessments. In 44% of these patients symptoms recurred. Recurrent cases were older than patients with limited disease. In 40% of PSD patients depression persisted for at least two consecutive following follow-up visits. Persistent cases were more disabled and suffered more often from major depression. CONCLUSION Half of PSD patients become depressed within the first month after stroke. Although most patients recover, a clinician has to be aware that symptoms can recur especially in older patients and that in patients with major depression symptoms may be persistent. In these patients treatment should be considered, whereas in patients with limited disease an observational approach may suffice.
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Affiliation(s)
- A Bour
- Dpt. Neurology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
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Bour A, Rasquin S, Aben I, Strik J, Boreas A, Crijns H, Limburg M, Verhey F. The symptomatology of post-stroke depression: comparison of stroke and myocardial infarction patients. Int J Geriatr Psychiatry 2009; 24:1134-42. [PMID: 19418490 DOI: 10.1002/gps.2236] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Depression is a frequent problem in stroke patients but, all too often, the problem goes unrecognized. How depression-like symptoms in post-stroke depression (PSD) should be interpreted is still subject to debate. If PSD has a distinct symptom profile of depression accompanying other chronic vascular somatic conditions then this could imply that PSD is a specific disease entity. OBJECTIVE To study whether depressed stroke patients exhibit other signs and symptoms than patients suffering from depression after myocardial infarction (MI). METHODS Depressive signs and symptoms were measured using the Hospital Anxiety and Depression Scale and the 17-item Hamilton Depression Rating Scale. The results of 190 stroke patients were compared with the results of 198 MI patients every 3 months during the first year after the event. RESULTS Depressed stroke patients exhibited more loss of interest, psychomotor retardation, and gastro-intestinal complaints as compared to depressed MI patients. However, in multivariate analyses including both depressed and non-depressed stroke and MI patients, no specific symptom profile was found to differentiate between the two depressive syndromes by looking at the modifying effect of stroke vs MI on the occurrence of specific symptoms in depression. CONCLUSION Although in their clinical presentation, depressed stroke patients exhibit a symptom profile different from depressed MI patients, this is not due to differences in the depressive syndrome in these two patient groups but it reflects differences between stroke and MI patients in general.
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Affiliation(s)
- A Bour
- Department of Neurology, Maastricht University Hospital, Maastricht, The Netherlands
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Monté CPJA, Arends JBAM, Tan IY, Aldenkamp AP, Limburg M, de Krom MCTFM. Sudden unexpected death in epilepsy patients: Risk factors. A systematic review. Seizure 2006; 16:1-7. [PMID: 17134918 DOI: 10.1016/j.seizure.2006.10.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Revised: 10/09/2006] [Accepted: 10/23/2006] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Several risk factors for sudden unexplained death in epilepsy patients (SUDEP) have been proposed, but subsequent work has yielded conflicting data. The relative importance of various risk factors for SUDEP was never explored. The aim of this study is to review systematically risk factors for SUDEP and also to determine their relevance for SUDEP by calculating relative risk factor ratios. METHODS AND MATERIALS Authors performed a literature-search on "SUDEP" in Medline, the Cochrane Library and EMBASE. Studies with unknown number of SUDEP cases or with less than five SUDEP cases and reviews were excluded from further analysis. The value of each paper was assessed, based on the quality of the study and the reliability of the diagnosis of SUDEP. This value ranged from 1 (low quality) to 10 (high quality). Papers with a value below 7 were eliminated for further analysis. For each analysed factor, a risk factor ratio was determined, with a higher ratio for a stronger risk factor. RESULTS A number of strong risk factors for SUDEP: young age, early onset of seizures, the presence of generalized tonic clonic seizures, male sex and being in bed. Weak risk factors for SUDEP: prone position, one or more subtherapeutic bloodlevels, being in the bedroom, a strucural brain lesion and sleeping. CONCLUSIONS In this study, authors have designed a quality scale to select papers. The relative importance of risk factors for SUDEP is demonstrated.
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Affiliation(s)
- C P J A Monté
- University Hospital Maastricht, Department of Neurology, Maastricht, The Netherlands.
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Lodder J, van Oostenbrugge R, Boreas A, Limburg M. [Secondary prevention of recurrent stroke by lowering cholesterol levels and blood pressure]. Ned Tijdschr Geneeskd 2006; 150:2622; author reply 2622-3. [PMID: 17203705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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Abstract
PURPOSE Business process redesign (BPR) is used to implement organizational transformations towards more customer-focused and cost-effective care. Ideally, these innovations should be carefully described and evaluated so that "best practices" can be re-applied. To investigate this, available evidence was collected on patient care redesign projects. DESIGN/METHODOLOGY/APPROACH The Ebsco Business Source Premier, Embase and Medline databases were searched. Studies on innovations related to re-engineering patient care that used before-after design as minimum prerequisites were selected. General characteristics, logistic parameters and other outcome measures to determine the objectives and results and interventions used were looked at. FINDINGS A total of 86 studies that conformed to the criteria were found: a minority mentioned measurable parameters in their objectives. In the majority of studies, multiple interventions were combined within single studies, making it impossible to compare the effects of individual interventions. Only three randomized controlled trials were found. Furthermore, inconsistencies were noted between the study objectives and the reported results. Many more issues were reported in the results than were mentioned in the study aims. It would appear that publications were hard to find owing to a lack of specific MeSH headings. Nearly 7,500 abstracts were scanned and from these it was concluded that clear and univocal research methods, terms and reporting guidelines are advisable and must be developed in order to learn and benefit from BPR innovations in health care organizations. ORIGINALITY/VALUE This appears to be the first time available evidence about redesign projects in hospitals has been systematically collected and assessed.
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Affiliation(s)
- S G Elkhuizen
- Academic Medical Center, University of Amsterdam, Department of Innovation and Process Management, Amsterdam, The Netherlands.
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16
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Abstract
Master Classes arose within the performing arts and are now being offered in system sciences. The IPhiE group of faculty from six universities in Europe and the United States has offered Master Classes in health informatics to provide an integrative forum for honors students. Featured are international views of health systems, varied opportunities for student interaction and promotion of informatics professionalism. Five years of experience indicate the success of this concept and suggest changes that will be considered for the future.
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Affiliation(s)
- L Gatewood
- Health Informatics, University of Minnesota Medical School, 420 Delaware At. SE/MMC 511, Minneapolis, MN 55455, USA.
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Roos YBWEM, Pals G, Struycken PM, Rinkel GJE, Limburg M, Pronk JC, van den Berg JSP, Luijten JAFM, Pearson PL, Vermeulen M, Westerveld A. Genome-wide linkage in a large Dutch consanguineous family maps a locus for intracranial aneurysms to chromosome 2p13. Stroke 2004; 35:2276-81. [PMID: 15331791 DOI: 10.1161/01.str.0000141415.28155.46] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Familial occurrence of intracranial aneurysms suggests a genetic factor in the development of these aneurysms. In this study, we present the identification of a susceptibility locus for the development of intracranial aneurysms detected by a genome-wide linkage approach in a large consanguineous pedigree. METHODS Patients with clinical signs and symptoms of intracranial aneurysms, confirmed by radiological, surgical, or postmortem investigations, were included in the study. Magnetic resonance angiography was used to detect asymptomatic aneurysms in relatives. RESULTS Seven out of 20 siblings had an intracranial aneurysm. Genome-wide multipoint linkage analysis showed a significant logarithm of the odds score of 3.55. CONCLUSIONS In a large consanguineous pedigree intracranial aneurysms are linked to chromosome 2p13 in a region between markers D2S2206 and D2S2977.
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Affiliation(s)
- Y B W E M Roos
- Department of Neurology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
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18
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Struycken PM, Pals G, Limburg M, Pronk JC, Wijmenga C, Pearson PL, Luijten JAFM, van den Berg JSP, Vermeulen M, Rinkel GJE, Westerveld A. Anticipation in familial intracranial aneurysms in consecutive generations. Eur J Hum Genet 2003; 11:737-43. [PMID: 14512962 DOI: 10.1038/sj.ejhg.5201039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Intracranial aneurysms (IA) are the major cause of subarachnoid haemorrhages (SAH). A positive family history for SAH is reported in 5-10% of the patients. The mode of inheritance is not unambiguously established; both autosomal dominant and recessive modes have been reported. In sporadic as well as in familial SAH, approximately 60% of the SAH patients are female. Recently, anticipation has been described in familial SAH. Since up to 15% of the SAHs are not caused by an IA, we have analysed anticipation, sex ratio and mode of inheritance only in families with patients with a proven IA in two consecutive generations. A total of 10 families were studied in which at least two persons in consecutive generations were affected by SAH, a symptomatic IA (SIA) or a presymptomatic IA (PIA). We also analysed published data from families with a proven IA in two consecutive generations on age of SIA onset and sex ratios among affected family members (both SIA and PIA). The age of SIA onset in the parental generation (mean 55.5 years) differed significantly from the age of onset in their children (mean 32.4 years). In the parental generation 11 men and 37 women were affected (both SIA and PIA), in the consecutive generation these numbers were 28 men and 32 women. There is a significant difference in sex ratio of affected family members when the generations are compared (P<0.02). No family could be found in which three consecutive generations were affected by an IA (SIA or PIA).
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Affiliation(s)
- P M Struycken
- Department of Human Genetics, Academic Medical Center, Universiteit van Amsterdam, The Netherlands.
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Huijskes RV, Koch KT, van Herwerden LA, Berreklouw E, Limburg M, Tijssen JG. [The waiting time for heart interventions: trends for percutaneous coronary interventions and cardiothoracic interventions]. Ned Tijdschr Geneeskd 2003; 147:1860-5. [PMID: 14533500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVE (a) To describe trends in the number of heart interventions performed over time, (b) to determine the length of waiting lists for elective heart interventions in the Netherlands according to the monthly survey of the Supervisory Committee for Heart Interventions in the Netherlands [Begeleidingscommissie Hartinterventies Nederland (BHN)], (c) to compare the length of the waiting lists with existing standards, and (d) to determine the reliability of the waiting list survey. DESIGN Prospective. METHOD Data were obtained from the monthly waiting list survey of the 13 heart centres in the Netherlands (1 January 1999-30 November 2002) and from the intervention registry (1 January 1999-30 June 2001), which was complete for 10 centres. Both the survey and the maintenance of the registry are carried out by the Supervisory Committee for Heart Interventions in the Netherlands. RESULTS (a) The number of percutaneous coronary interventions performed in the Netherlands has increased. The number of cardiothoracic interventions remained stable. (b) The number of patients waiting for a percutaneous coronary intervention is increasing by 16% per annum. In November 2002 there were 751 patients on the waiting list. The number of patients waiting for a cardiothoracic intervention increased by 20% per annum until August 2001 and since then there has been a decrease of 21% per annum. In November 2002, 1557 patients were on the waiting list. (c) The percentage of patients treated within existing standards has fallen to 78% for percutaneous coronary interventions and to 53% for cardiothoracic interventions. (d) The length of the waiting list and the waiting times obtained in the survey concurred with the data taken from the intervention registry. CONCLUSIONS The length of the waiting list for heart interventions has increased and complies increasingly less with existing standards. The monthly waiting-list survey was a reliable method of determining the length of waiting lists for elective heart interventions.
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Affiliation(s)
- R V Huijskes
- Afd. Klinische Informatiekunde, Academisch Medisch Centrum/Universiteit van Amsterdam, Amsterdam.
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20
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Jaspers MWM, Fockens P, Ravesloot JH, Limburg M. The medical information sciences program of Amsterdam. AMIA Annu Symp Proc 2003; 2003:877. [PMID: 14728382 PMCID: PMC1480187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
The medical information sciences program of Amsterdam has been in existence for 15 years now. Starting in 1987, the program has been modified several times. Now a full-fledged 4 years master program exists. Students are taught skills to adequately and systematically apply information and communication technologies in order to optimize health care information processing. The program is offered within the Faculty of Medicine of the University of Amsterdam. The structure and contents of the current program will be described.
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Affiliation(s)
- M W M Jaspers
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, The Netherlands
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21
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Zatik J, Aranyosi J, Settakis G, Páll D, Tóth Z, Limburg M, Fülesdi B. Breath holding test in preeclampsia: lack of evidence for altered cerebral vascular reactivity. Int J Obstet Anesth 2002; 11:160-3. [PMID: 15321541 DOI: 10.1054/ijoa.2002.0950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Twenty-five healthy and thirty-one preeclamptic pregnant women were assessed by means of transcranial Doppler sonography. Resting cerebral blood flow velocities in the middle cerebral arteries were measured followed by a repeat measurement 30 s after breath holding. Absolute blood flow velocities and per cent changes after breath holding procedure were compared between the groups. Absolute blood flow velocities were higher in preeclamptic pregnant women both at rest and after breath holding. The percent increase in cerebral blood flow velocity after breath holding (cerebral vascular reactivity) was similar in the two groups. Our data suggest that cerebral vascular reactivity is preserved in pregnant women with preeclampsia.
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Affiliation(s)
- J Zatik
- Department of Gynecology and Obstetrics, University of Debrecen, Hungary
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22
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Abstract
BACKGROUND AND PURPOSE Based on the results of animal experiments, clinical trials were performed with nimodipine, which did not demonstrate a beneficial effect on outcome after stroke. The aim of this study was to determine whether the evidence from animal experiments with nimodipine supported the use of nimodipine in clinical trials. METHODS - We performed a systematic review of animal experiments with nimodipine in focal cerebral ischemia. Studies were identified by searching Medline and Embase. We assessed whether these studies showed a beneficial effect of active treatment. In-depth analyses were performed on infarct size and amount of edema, and subgroup analyses were performed on the length of the time window to the initiation of treatment and the methodological quality of the studies. RESULTS - Of 225 identified articles, 20 studies were included. The methodological quality of the studies was poor. Of the included studies, 50% were in favor of nimodipine. In-depth analyses showed statistically significant effects in favor of treatment (10 studies). No influence of the length of time to the initiation of treatment or of the methodological quality on the results was found. CONCLUSIONS - We conclude that the results of this review did not show convincing evidence to substantiate the decision to perform trials with nimodipine in large numbers of patients. There were no differences between the results of the animal experiments and clinical studies. Surprisingly, we found that animal experiments and clinical studies ran simultaneously.
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Affiliation(s)
- J Horn
- Department of Neurology, Academical Medical Center, University of Amsterdam, the Netherlands.
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23
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Abstract
In a cohort 760 consecutive stroke patients (23 hospitals in the Netherlands), we studied prognosis in relation to stroke type and focused on (a) short-term and long-term mortality, and (b) long-term functional health. Based on clinical and CT data, we distinguished infratentorial strokes from supratentorial strokes (lacunar infarctions, (sub)cortical infarctions and intracerebral hemorrhages). Cumulative mortality for all stroke patients was 34% at 6 months, 51% at 3 years, and 62% at 5 years. Short-term mortality could be explained by stroke type, whereas long-term mortality could not. Of all survivors, 55% were in poor functional health at 6 months, 49% at 3 years and 42% at 5 years. Long-term functional health outcomes were associated with stroke type. We conclude that the impact of stroke type on mortality is limited to the first 6 months, whereas the type of stroke influences the long-term functional health.
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Affiliation(s)
- A van Straten
- Department of Social Medicine, Academic Medical Center, University of Amsterdam, The Netherlands.
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24
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Abstract
We present a family with 2 female cousins with intracranial aneurysms and type III collagen deficiency. DNA analysis revealed no mutations in the COL3A1 gene, encoding type III collagen, and including the segment encoding the C-propeptide of type III collagen. The 2 patients with low type III collagen production and intracranial aneurysms had inherited different type III collagen alleles. The type III collagen deficiency in this family may results from defects during posttranslational modification or from an altered collagen metabolism.
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Affiliation(s)
- J S van den Berg
- Department of Neurology, Isala Kliniek, Locatie Sophia, PO Box 10400, NL-8000 GK Zwolle, The Netherlands
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25
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Zatik J, Major T, Aranyosi J, Molnár C, Limburg M, Fülesdi B. Assessment of cerebral hemodynamics during roll over test in healthy pregnant women and those with pre-eclampsia. BJOG 2001; 108:353-8. [PMID: 11305540 DOI: 10.1111/j.1471-0528.2001.00095.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare cerebral autoregulatory responses obtained during roll over tests in healthy pregnant women and those with pre-eclampsia in order to assess the middle cerebral artery velocity changes in relation to the roll over test in normotensive and pre-eclamptic women. PARTICIPANTS Twenty-two healthy pregnant women and 26 with pre-eclampsia underwent transcranial Doppler measurements of the middle cerebral artery. METHODS Systolic, mean and diastolic blood flow velocities and mean arterial blood pressures were recorded in the left lateral position and five minutes after turning to the supine position. Absolute values of mean blood flow velocities, mean arterial blood pressure values and calculated cerebral blood flow indices as well as cerebrovascular resistance area products were compared at different positions among the groups. RESULTS Mean arterial blood pressure increased in both groups while turning from the left lateral to the supine position. In women with pre-eclampsia both mean arterial blood pressure and absolute values of mean blood flow velocity values were higher in both positions, compared with healthy pregnant women. In both groups, changing the position resulted in a decrease of absolute values of mean blood flow velocities. Calculated cerebral blood flow indices did not change, while cerebrovascular resistance area products increased significantly in the groups during roll over testing. In women with pre-eclampsia, the increase of cerebrovascular resistance area products was more pronounced as compared with healthy pregnant women. CONCLUSIONS In women with pre-eclampsia roll over test results in an increase of the mean arterial blood pressure, which is accompanied by a decreased mean blood flow velocity in the middle cerebral artery. Further studies are needed to clarify the pathophysiological background of cerebral haemodynamic changes in pre-eclampsia.
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Affiliation(s)
- J Zatik
- Department of Obstetrics and Gynaecology, University of Debrecen Medical Centre, Hungary
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26
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Jaspers MW, Gardner RM, Gatewood LC, Haux R, Leven FJ, Limburg M, Ravesloot JH, Schmidt D, Wetter T. IPHIE: an International Partnership in Health Informatics Education. Stud Health Technol Inform 2001; 77:549-53. [PMID: 11187613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Medical informatics contributes significantly to high quality and efficient health care and medical research. The need for well educated professionals in the field of medical informatics therefore is now worldwide recognized. Students of medicine, computer science/informatics are educated in the field of medical informatics and dedicated curricula on medical informatics have emerged. To advance and further develop the beneficial role of medical informatics in the medical field, an international orientation of health and medical informatics students seems an indispensable part of their training. An international orientation and education of medical informatics students may help to accelerate the dissemination of acquired knowledge and skills in the field and the promotion of medical informatics research results on a more global level. Some years ago, the departments of medical informatics of the university of Heidelberg/university of applied sciences Heilbronn and the university of Amsterdam decided to co-operate in the field of medical informatics. Now, this co-operation has grown out to an International Partnership of Health Informatics Education (IPHIE) of 5 universities, i.e. the university of Heidelberg, the university of Heilbronn, the university of Minnesota, the university of Utah and the university of Amsterdam. This paper presents the rationale behind this international partnership, the state of the art of the co-operation and our future plans for expanding this international co-operation.
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Affiliation(s)
- M W Jaspers
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam
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27
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Heinrichs M, Beekman R, Limburg M. Simulation to estimate the capacity of a stroke unit. Stud Health Technol Inform 2001; 77:47-50. [PMID: 11187595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Preceding the implementation of a Stroke Unit (SU), data have been collected and used for building a simulation model of patient flow. This model was subsequently used to estimate the optimal capacity of the SU to be implemented. Because stroke patients require acute hospital care, this implies a highly variable number of immediate admissions. This variability complicates optimizing the capacity. In order to support decisions with regard to staffing (i.e. capacity) of the SU, different scenarios are simulated and compared to provide insight in the trade-off between regular understaffing and a low bed occupancy rate. In 1996 the Department of Neurology of the Academic Medical Center in the Netherlands implemented its SU to improve the quality of care for stroke patients. Data collected in the years 1997 and 1998 that the SU has been operational were evaluated and confirm the predictions made from simulating different scenarios. We conclude that simulation models provide a powerful tool for supporting decision making with regard to resource planning at the departmental level in our hospital.
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Affiliation(s)
- M Heinrichs
- Dept. Clinical Informatics, Academic Medical Center, Amsterdam, The Netherlands
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28
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Abstract
BACKGROUND AND PURPOSE The Very Early Nimodipine Use in Stroke (VENUS) trial was designed to test the hypothesis that early treatment with nimodipine has a positive effect on survival and functional outcome after stroke. This was suggested in a previous meta-analysis on the use of nimodipine in stroke. However, in a recent Cochrane review we were unable to reproduce these positive results. This led to the early termination of VENUS after an interim analysis. METHODS In this randomized, double-blind, placebo-controlled trial, treatment was started by general practitioners or neurologists within 6 hours after stroke onset (oral nimodipine 30 mg QID or identical placebo, for 10 days). Main analyses included comparisons of the primary end point (poor outcome, defined as death or dependency after 3 months) and secondary end points (neurological status and blood pressure 24 hours after inclusion, mortality after 10 days, and adverse events) between treatment groups. Subgroup analyses (on final diagnosis and based on the per-protocol data set) were performed. RESULTS At trial termination, after inclusion of 454 patients (225 nimodipine, 229 placebo), no effect of nimodipine was found. After 3 months of follow-up, 32% (n=71) of patients in the nimodipine group had a poor outcome compared with 27% (n=62) in the placebo group (relative risk, 1.2; 95% CI, 0.9 to 1.6). A treatment effect was not found for secondary outcomes and in the subgroup analyses. CONCLUSIONS The results of VENUS do not support the hypothesis of a beneficial effect of early nimodipine in stroke patients.
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Affiliation(s)
- J Horn
- Department of Neurology, Academic Medical Center, University of Amsterdam (Netherlands)
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29
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Abstract
BACKGROUND AND PURPOSE Stroke is a common disease, and many trials with calcium antagonists as possible neuroprotective agents have been conducted. The aim of this review is to determine whether calcium antagonists reduce the risk of death or dependency after acute ischemic stroke. METHODS Acute stroke trials were identified with help of the Cochrane Collaboration Stroke Group and personal contacts. All randomized trials (published and unpublished) investigating a calcium antagonist (acting on voltage-sensitive calcium channels) were included. Poor outcome, defined as death or dependency in activities of daily living, was used as main outcome. Analyses were, if possible, "intention-to-treat"; pooled relative risks with 95% CIs were calculated. RESULTS Forty-seven trials were identified, of which 29 were included (7665 patients). No effect of calcium antagonists on poor outcome at the end of follow-up (relative risk, 1.04; 95% CI, 0.98 to 1.09) or on death at end of follow-up (relative risk, 1.07; 95% CI, 0.98 to 1.17) was found. Sensitivity analyses on route of administration and time interval between stroke and start of treatment showed no effect on outcome. In subgroups of unpublished and methodologically sound trials, a statistically significant negative effect for calcium antagonists was found. This contrasts with results of published trials and trials of moderate or poor methodological quality. CONCLUSIONS The presented evidence rules out a clinically important effect of calcium antagonists after ischemic stroke. The large amount of data leads to narrow CIs with no significant heterogeneity, and the overall results are therefore likely to be statistically robust.
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Affiliation(s)
- J Horn
- Department of Neurology, Academic Medical Center, University of Amsterdam (Netherlands).
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30
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Jaspers MWM, Limburg M, Ravesloot JJ. Medical informatics in Amsterdam: Research and Education. Yearb Med Inform 2001:117-123. [PMID: 27701607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Affiliation(s)
- M W M Jaspers
- Monique W.M. Jaspers, Department of Medical Informatics and Educational Institute for Medical, Information Sciences, Academic Medical Center, University of Amsterdam, AMC-Meibergdreef 15, NL-1105 AZ Amsterdam Zuidoost, The Netherlands
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Fülesdi B, Limburg M, Oláh L, Bereczki D, Csiba L, Kollár J. Lack of gender difference in acetazolamide-induced cerebral vasomotor reactivity in patients suffering from type-1 diabetes mellitus. Acta Diabetol 2001; 38:107-12. [PMID: 11827430 DOI: 10.1007/s005920170006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of the present work was to investigate the impact of gender on resting cerebral blood flow velocity and cerebrovascular reserve capacity among diabetic patients. Middle cerebral artery mean blood flow velocity (MCAV) was measured in 72 patients suffering from type 1 diabetes mellitus at rest and 5, 10, 15 and 20 min after intravenous administration of 1 g acetazolamide. Cerebrovascular reserve was calculated as the maximal percent increase in MCAV after acetazolamide. Resting MCAV and cerebrovascular reserve capacity were compared between males and females. Resting cerebral blood flow velocity was higher in diabetic females than in males (men, 55.0+/-17.0 cm/s; women, 64.4+/-12.6 cm/s, p=0.0094). Cerebrovascular reserve capacity was similar in diabetic women and men (men, 44.0%+/-18.6%; women, 52.6%+/-32.9%, p=0.17). Comparing MCAV and cerebrovascular reserve capacity among the diabetic subgroups with disease duration < or = 10 years and >10 years, we did not detect any differences between women and men. Duration of diabetes was an important factor in determining cerebrovascular reserve capacity in both sexes: long-term diabetic women and men showed lower CRC values than diabetics with < or = 10 years disease duration. Cerebrovascular reserve capacity is similar in diabetic women and men. Taking into consideration that cerebrovascular reserve is normally higher among women, our finding indicates a relatively more serious worsening of cerebral vasodilatory responses in women suffering from type 1 diabetes.
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Affiliation(s)
- B Fülesdi
- Department Anesthesiology and Intensive Care, Neurointensive Care Unit, University of Debrecen, Hungary
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32
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van Straten A, de Haan RJ, Limburg M, van den Bos GA. Clinical meaning of the Stroke-Adapted Sickness Impact Profile-30 and the Sickness Impact Profile-136. Stroke 2000; 31:2610-5. [PMID: 11062283 DOI: 10.1161/01.str.31.11.2610] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Handicap or health-related quality of life (HRQL) measures are seldom used in stroke trials, although the importance of these measures has been stressed frequently. We studied the clinical meaning of the Stroke-Adapted Sickness Impact Profile-30 (SA-SIP30) and the original SIP136 for use in stroke research. METHODS We included 418 patients who had had a stroke 6 months earlier. We studied the associations between the SA-SIP30 and SIP136 scores versus other frequently used outcome measures from the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) (Barthel Index, Rankin Scale) and the HRQL model (health perception items, Euroqol). To interpret the continuous SA-SIP30 and SIP136 scores, we used receiver operating characteristic curve analysis with the aforementioned measures as external criteria. RESULTS The psychosocial dimension scores of both SIP versions remained largely unexplained. The physical dimension and total scores of both SIP versions were mainly associated with the disability measures derived from the ICIDH model, as well as with the physical HRQL domains. Most patients with an SA-SIP30 total score >33 or an SIP136 total score >22 had poor health profiles. There were no major differences between the SA-SIP30 and the SIP136, although the SA-SIP30 scores were less skewed toward the healthier outcomes than the SIP136. CONCLUSIONS Our study showed that (1) both SIP total scores primarily represent aspects of physical functioning and not HRQL; (2) both SIP versions provide more clinical information than the frequently used disability measures; and (3) the SA-SIP30 should be preferred over the SIP136.
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Affiliation(s)
- A van Straten
- Department of Social Medicine, Academic Medical Center, University of Amsterdam, Netherlands.
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33
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Niessen LW, Dippel DW, Limburg M. [Calculation of costs of stroke, cost effectiveness of stroke units and secondary prevention in patients after a stroke, as recommended by revised CBO practice guideline 'Stroke']. Ned Tijdschr Geneeskd 2000; 144:1959-64. [PMID: 11048560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Economic analyses have been part of the revision of the Dutch multi-disciplinary stroke guidelines. We evaluated the recommendations on stroke units and prevention of stroke recurrencies in terms of medical costs and health effects among stroke patients. DESIGN Cost calculation. METHOD Mathematical modelling of medical costs per patient and costs per life year gained without severe stroke (Rankin score (> 3)), by age and sex for each guideline. RESULTS Lifetime costs of stroke depended on age and sex and vary between 84,000 and 292,000 Dutch guilders (HFL). The cost-effectiveness of stroke units decreases with age and varies between HFL 37,000 and HFL 60,200 with a large uncertainty range. Four of seven options in secondary prevention were cost-effective by previously established criteria (< HFL 40,000 per year gained without severe disease). Acetylsalicylic acid remained the drug of choice for monotherapy with dipyridamol as a second choice in patients without atrial fibrillation. Clopidogrel was not cost-effective at the current cost level. Anticoagulation after stroke in case of atrial fibrillation was cost-effective. CONCLUSIONS Given a short hospital stay stroke units can be as affective as other hospital interventions. Acetylsalicylic acid is the most cost effective monotherapy for secondary prevention.
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Affiliation(s)
- L W Niessen
- Instituut voor Medical Technology Assessment, Erasmus Universitair Medisch Centrum/Erasmus Universiteit, Rotterdam.
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34
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Reitsma JB, Limburg M, Kleijnen J, Bonsel GJ, Tijssen JG. Epidemiology of stroke in The Netherlands from 1972 to 1994: the end of the decline in stroke mortality. Neuroepidemiology 2000; 17:121-31. [PMID: 9648117 DOI: 10.1159/000026163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 1994, stroke was responsible for the death of 4,994 men and 7,601 women in the Netherlands, corresponding to 7.5% of all deaths in men and 11.4% in women. Age-adjusted stroke mortality declined by 39% for men and by 45% for women between 1972 and 1994. However, the decline in mortality levelled off after 1987. In contrast to mortality, age-adjusted discharge rates increased by 47% for men and by 28% for women during the study period. The decline in mortality was equally distributed over the age groups, while the increase in the number of hospital admissions was more pronounced in the older age groups. The analyses by diagnostic subgroups of stroke showed the importance of increasing diagnostic capabilities in the hospital setting. The use of diagnostic subgroups in national mortality data was of limited value, illustrated by the fact that 70% of all stroke deaths in 1994 belonged to the ill-defined type of stroke.
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Affiliation(s)
- J B Reitsma
- Department of Clinical Epidemiology, University of Amsterdam, The Netherlands.
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Loor HI, Groenier KH, Limburg M, Schuling J, Meyboom-de Jong B. Risks and causes of death in a community-based stroke population: 1 month and 3 years after stroke. Neuroepidemiology 2000; 18:75-84. [PMID: 10023130 DOI: 10.1159/000069410] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We performed a community-based study on a cohort of 221 stroke patients followed for 3 years. In this paper, we tried to answer the following questions: Is the risk of dying increased throughout the first 3 years after stroke? What are the causes of death after the 1st month? What factors at stroke onset are independent predictors of early and late mortality? The relative risk of death was estimated using age- and sex-specific mortality rates for the Netherlands. Causes of death were registered by the attending physicians, mostly general practitioners. During the 1st month 26% of the patients died. At 1, 2 and 3 years, the cumulative mortality rates were 37, 46 and 54%, respectively. Stroke patients had an increased risk of dying, approximately twice that of the general population, during the 3 years of follow-up. In women, this increased risk was more pronounced than in men. After 1 month, cardiovascular pathology, stroke and diseases resulting from stroke were the causes of death in 70% of the patients, i.e. substantially higher than in the general population, matched for age and sex. Factors predicting mortality after stroke varied over time. Severity of the stroke, preexisting atrial fibrillation and congestive heart failure were associated with early mortality (within 30 days). For 1-month survivors, incontinence and preexisting atrial fibrillation were associated with mortality in the 1st year after stroke. After 1 year, only age was associated with mortality.
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Affiliation(s)
- H I Loor
- Department of General Practice, University of Groningen, Amsterdam, The Netherlands.
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van den Berg JS, Hennekam RC, Cruysberg JR, Steijlen PM, Swart J, Tijmes N, Limburg M. Prevalence of symptomatic intracranial aneurysm and ischaemic stroke in pseudoxanthoma elasticum. Cerebrovasc Dis 2000; 10:315-9. [PMID: 10878438 DOI: 10.1159/000016076] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pseudoxanthoma elasticum (PXE) is an heritable connective tissue disorder with clinical manifestations of the ocular, dermal, and cardiovascular system. The purpose of this study was to investigate the prevalence of symptomatic intracranial aneurysms (IAs) and ischaemic stroke (IS) in PXE. METHODS The records of 100 patients with PXE were retrieved. All patients were contacted and data on complications were collected. The literature was reviewed regarding PXE, ISs, and IAs. RESULTS No patient with PXE had a symptomatic IA as presenting symptom. One patient presented with an IS. During follow-up of 94 of the 100 patients (mean follow-up 17.1 years, range 1-49 years), none presented a symptomatic IA (3,168 retrospective patient observation years and 1, 602 prospective patient observation years). Upper gastrointestinal haemorrhage during follow-up occurred in 17 patients, in 1 patient during aspirin use. One patient has IS as presenting symptom and a recurrence during follow-up, and 7 patients had IS during follow-up. All were caused by small-vessel disease. The relative risk of IS in PXE under 65 years compared with the general population was 3.6 (95% confidence interval 3.3-4.0). CONCLUSIONS On the basis of the currently available data, an association between symptomatic IAs and PXE is unlikely. However, the incidence of IS, due to small-vessel disease, was increased. Antiplatelet therapy in patients with PXE may lead to a high incidence of upper gastrointestinal haemorrhages.
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Limburg M, Tuut MK. [CBO guideline 'Stroke' (revision) Dutch Institute for Healthcare Improvement]. Ned Tijdschr Geneeskd 2000; 144:1058-62. [PMID: 10850108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The stroke consensus dating from 1991 had to be revised, because of the introduction of new developments in the treatment of patients with stroke. More than 50 representatives from 25 professions and institutions participated. Under methodological assistance of the Dutch Institute for Healthcare Improvement CBO separate working groups (diagnosis, treatment, organization of care, rehabilitation/education, implementation and cost-effectiveness) studied the literature and translated the results into recommendations with explanatory text. The strength of scientific evidence was classified. During a national public meeting the results were discussed. In the field of guideline development cost-effectiveness analyses and specific attention for implementation are new. Care on a stroke unit decreases the risk of mortality, life-long disabilities, and dependence on permanent care with about 20%. Regional stroke services should be instituted, in which continuity and efficient care can be guaranteed. Very early thrombolysis with recombinant tissue plasminogen activator strongly decreases the number of patients dying, or remaining care-dependent in a selected group of appropriate patients. Secondary prevention (lifestyle measures, acetylsalicyclic acid, treatment of hypertension and hypercholesterolaemia, and surgery of the carotids) may decrease the number of residual strokes and myocardial infarctions. In the occurrence of cerebral ischaemia and atrial fibrillation oral anticoagulants are indicated. Early intensive rehabilitation increases the chance of recovery. Silent cognitive defects may hinder rehabilitation. The extensive guideline summarises the scientific literature about treatment of patients with stroke and should serve as a basis for local protocols and appointments.
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Affiliation(s)
- M Limburg
- Academisch Medisch Centrum/Universiteit van Amsterdam
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Abstract
BACKGROUND The sudden loss of blood supply in ischemic stroke is associated with increased levels of calcium ions within neurones. Inhibiting this increase could protect neurones and is thought to reduce neurological impairment, disability and handicap after stroke. OBJECTIVES The aim of this review is to determine whether calcium antagonists reduce the risk of death or dependency after acute ischemic stroke. The influence of different drugs, dosages, routes of administration, time intervals after stroke and trial design on the risk of poor outcome was investigated. SEARCH STRATEGY Relevant trials were identified in the Specialised Register of Controlled Trials (last searched: March 1999). SELECTION CRITERIA All truly randomised trials comparing a calcium antagonist with control in patients with acute ischaemic stroke were included. DATA COLLECTION AND ANALYSIS Two authors assessed all trials and extracted the data. Poor outcome, defined as death or dependency in activities of daily living, was used as the main outcome. Analyses were, if possible, "intention-to-treat". MAIN RESULTS 46 trials were identified of which 28 were included (7521 patients). No effect of calcium antagonists on poor outcome at the end of follow-up (OR 1.07, 95% CI 0.97/1.18), or on death at end of follow-up (OR 1.10, 95% CI 0.98/1.24) was found. Intravenous administration (i.v.) of calcium antagonists was associated with an increase in the number of patients with poor outcome compared to oral administration (indirect comparisons). Comparisons of different doses of nimodipine suggested that the highest doses were associated with poorer outcome. Administration within 12 hours of onset was associated with an increase in the proportion of patients with poor outcome, but this effect was largely due to the poor results associated with i.v. administration. A subgroup analysis on nimodipine (oral, 120 mg/day) started within 12 hours of stroke onset, did not show a beneficial effect. REVIEWER'S CONCLUSIONS No evidence is available to justify the use of calcium antagonists in patients with acute ischaemic stroke.
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Affiliation(s)
- J Horn
- Dept of Neurology, Academical Medical Center, Meibergdreef 9, Amsterdam, Netherlands, 1105 AZ.
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Raaymakers TW, Buys PC, Verbeeten B, Ramos LM, Witkamp TD, Hulsmans FJ, Mali WP, Algra A, Bonsel GJ, Bossuyt PM, Vonk CM, Buskens E, Limburg M, van Gijn J, Gorissen A, Greebe P, Albrecht KW, Tulleken CA, Rinkel GJ. MR angiography as a screening tool for intracranial aneurysms: feasibility, test characteristics, and interobserver agreement. AJR Am J Roentgenol 1999; 173:1469-75. [PMID: 10584784 DOI: 10.2214/ajr.173.6.10584784] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE MR angiography may be an appropriate tool to screen for unruptured intracranial aneurysms. Feasibility, test characteristics, and interobserver agreement in evaluation of MR angiograms were assessed by members of the MARS (Magnetic resonance Angiography in Relatives of patients with Subarachnoid hemorrhage) Study Group. SUBJECTS AND METHODS We screened 626 first-degree relatives of a consecutive series of 193 patients with subarachnoid hemorrhage examined at two institutions. We used MR imaging and MR angiography (three-dimensional time-of-flight imaging at both institutions and additional three-dimensional phase-contrast imaging at one institution). Three observers independently assessed the MR angiograms. Conventional angiography was performed in relatives with possible or definite aneurysms on MR angiography and was considered the standard of reference. RESULTS Thirty-three aneurysms were found in 25 (4%; 95% confidence interval [CI], 3-6%) of 626 relatives. Thirteen (8%) of 169 relatives who refused screening had MR-related reasons; an additional six persons could not be screened because of contraindications for MR imaging (pregnancy, n = 1; claustrophobia, n = 5). The positive predictive value of MR angiography was 100% (95% CI, 79-100%) for "definite" aneurysms and 58% (95% CI, 28-85%) for "possible" aneurysms. Sensitivity of MR angiography was estimated at 83% (95% CI, 65-94%) and specificity at 97% (95% CI, 94-98%). Interobserver agreement in the evaluation of MR angiograms was poor (kappa < .30), probably because different diagnostic strategies used by individual observers resulted in different use of the assessment category "possible aneurysm." CONCLUSION MR angiography is a feasible screening tool for detection of intracranial aneurysms. Positive predictive value, sensitivity, and specificity are acceptable when at least two neuroradiologists independently assess MR angiograms.
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Affiliation(s)
- T W Raaymakers
- Department of Neurology, University Hospital Utrecht, The Netherlands
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Fülesdi B, Limburg M, Bereczki D, Molnár C, Michels RP, Leányvári Z, Csiba L. No relationship between cerebral blood flow velocity and cerebrovascular reserve capacity and contemporaneously measured glucose and insulin concentrations in diabetes mellitus. Acta Diabetol 1999; 36:191-5. [PMID: 10664327 DOI: 10.1007/s005920050166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Blood glucose and insulin concentrations have been reported to influence cerebral hemodynamics. We studied the relationship between actual blood glucose and insulin concentrations and resting cerebral blood flow velocity in the middle cerebral artery and cerebrovascular reserve capacity after acetazolamide stimulation. Thirty-six insulin-dependent diabetic patients in a state of good glycemic control were studied. Blood samples were taken for determination of glucose and insulin concentrations. Subsequently we measured resting cerebral blood flow velocities in supine position using transcranial Doppler, administered 1 g acetazolamide intravenously, and repeated the measurements after 5, 10, 15 and 20 minutes. Cerebrovascular reserve was calculated as the maximal percent increase after acetazolamide stimulation. Multiple regression was used for statistical analysis. Blood glucose levels were not correlated with resting blood flow velocity (R = 0.21, p = 0.22) nor cerebrovascular reserve capacity (R = 0.17, p = 0.32). Similarly, no correlation was found between insulin concentrations, resting cerebral blood flow velocity (R = 0.24, p = 0.22) and cerebrovascular reserve (R = 0.26, p = 0.24). Studying patients with long-term (> 10 years) and short-term (</= 10 years) disease duration yielded the same lack of correlation. We conclude that there is no significant correlation between contemporaneously measured glucose and insulin concentrations and either cerebral blood flow velocity or cerebrovascular reserve capacity in the middle cerebral artery in type 1 diabetic patients with good control.
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Affiliation(s)
- B Fülesdi
- Department of Neurology, University Medical School of Debrecen, H-4012 Debrecen Nagyerdei krt. 98, Hungary
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van den Berg JS, Pals G, Arwert F, Hennekam RC, Albrecht KW, Westerveld A, Limburg M. Type III collagen deficiency in saccular intracranial aneurysms. Defect in gene regulation? Stroke 1999; 30:1628-31. [PMID: 10436112 DOI: 10.1161/01.str.30.8.1628] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We sought to determine whether there are mutations in the COL3A1 gene in patients with saccular intracranial aneurysms with a type III collagen deficiency and whether there is an association between a marker in the COL3A1 gene and saccular intracranial aneurysms. One of the heritable factors possibly involved in the pathogenesis of saccular intracranial aneurysms is a reduced production of type III collagen, demonstrated earlier by protein studies. METHODS We analyzed the type III collagen gene in a group of 41 consecutive patients with an intracranial aneurysm, of whom 6 patients had shown a reduced production of type III collagen in cultured diploid fibroblasts from a skin biopsy. RESULTS No mutations could be demonstrated in the COL3A1 gene, especially not in the globular N- and C-terminal regions. A null allele was excluded in 25 patients, including 1 patient with a decreased type III collagen production. No differences were found between 41 patients and 41 controls in allele frequencies of a DNA tandem repeat polymorphism located in the COL3A1 gene. CONCLUSIONS It is concluded that the COL3A1 gene is not directly involved in the pathogenesis of most of intracranial aneurysms. The reduced type III collagen production in cultured fibroblasts found in some patients with an intracranial aneurysm is not explained by the present study and needs further exploration.
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Affiliation(s)
- J S van den Berg
- Department of Neurology, Institute for Human Genetics University of Amsterdam, The Netherlands.
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Fülesdi B, Limburg M, Bereczki D, Káplár M, Molnár C, Kappelmayer J, Neuwirth G, Csiba L. Cerebrovascular reactivity and reserve capacity in type II diabetes mellitus. J Diabetes Complications 1999; 13:191-9. [PMID: 10616858 DOI: 10.1016/s1056-8727(99)00044-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The aim of the study was to test the hypothesis that cerebrovascular reserve capacity and cerebrovascular reactivity are impaired in patients suffering from non insulin-dependent diabetes mellitus. We also intended to investigate factors which may influence resting cerebral blood flow velocity and cerebrovascular reserve capacity. A total of 28 patients suffering from type II diabetes mellitus and 20 healthy control subjects were studied. Based on diabetes duration patients were divided into two groups: subjects with > 10 years and those with < or = 10 years disease duration. Middle cerebral artery mean blood flow velocities were measured at rest and after intravenous administration of 1g acetazolamide. Cerebrovascular reactivity and reserve capacity were calculated. Blood glucose, insulin, glycosylated hemoglobin, hemostatic factors (fibrinogen, alpha-2 macroglobulin and von Willebrand factor antigen) were determined. Cerebrovascular reactivity and reserve capacity values were compared between the two diabetic subgroups and controls. Correlations between laboratory parameters and cerebrovascular reserve were investigated by linear regression analysis. Resting cerebral blood flow velocity was similar in controls and in the two diabetic subgroups. Cerebrovascular reactivity was elevated for a shorter time in patients with > 10 years disease duration than in controls and short-term diabetic patients. Cerebrovascular reserve capacity was lower in the long-term diabetes group (means +/- SD: 39.6 +/- 20.7%) than in patients with < or = 10 years disease duration (63.3 +/- 17.4%, p < 0.02 after Bonferroni correction). Cerebrovascular reserve capacity was inversely related to the duration of the disease (R = 0.53, p < 0.003). None of the determined laboratory factors had any relation with resting cerebral blood flow and cerebrovascular reserve capacity. The vasodilatory ability of cerebral arterioles is diminished in long-standing type II diabetes mellitus.
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Affiliation(s)
- B Fülesdi
- Department of Neurology, University Medical School of Debrecen, Hungary
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op Reimer WJ, Scholte de Haan RJ, Rijnders PT, Limburg M, van den Bos GA. Unmet care demands as perceived by stroke patients: deficits in health care? Qual Health Care 1999; 8:30-5. [PMID: 10557667 PMCID: PMC2483631 DOI: 10.1136/qshc.8.1.30] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe unmet care demands as perceived by stroke patients and to identify sociodemographic and health characteristics associated with these unmet demands to investigate the appropriateness of health care. SETTING Sample of patients who participated in a multicentre study (23 hospitals) on quality of care in The Netherlands. PATIENTS Non-institutionalised patients who had been admitted to hospital because of stroke. Patients were interviewed six months (n = 382) and five years (n = 224) after stroke. DESIGN Six months after stroke data were collected on: (a) sociodemographic characteristics in terms of age, sex, living arrangement, educational level, and regional level of urbanisation; (b) health characteristics in terms of cognitive function, disability, emotional distress, and general health perception; (c) utilisation of professional care; and (d) unmet care demands as perceived by patients. Data on utilisation of care and unmet demands were also collected five years after stroke. Data were collected from June 1991 until December 1996. RESULTS The percentage of unmet care demands was highest at six months after stroke (n = 120, 31%). Multiple logistic regression analyses showed that disabled patients were more likely to be unmet demanders for therapy, (I)ADL care and aids (range odds ratio (OR) = 3.5 to 7.9) than to be no demanders, whereas emotionally distressed patients were more likely to be unmet demanders for psychosocial support (OR = 3.8). When comparing unmet demanders with care users only for (instrumental) activities of daily living (I)ADL care differences were found: men (OR = 3.8), disabled patients (OR = 3.0), and emotionally distressed patients (OR = 6.5) were more likely to be users. CONCLUSIONS Patients who perceived an unmet care demand do appear genuinely to have an unmet care need as supported by assessment of their health status: (a) types of unmet care demands correspond with types of health problems and (b) unmet demanders were in general unhealthier than no demanders and more comparable with care users for health characteristics. IMPLICATIONS To improve an equitable distribution of healthcare services, guidelines for indicating and allocating health care have to be developed and should be based on scientific evidence and consensus meetings including professionals' and patients' perspectives.
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Affiliation(s)
- W J op Reimer
- Department of Social Medicine (J3-309), Academic Medical Centre, University of Amsterdam, The Netherlands
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Limburg M. Assessment of quality rehabilitation. Ital J Neurol Sci 1998; 19 Suppl 1:S41-S42. [PMID: 19130019 DOI: 10.1007/bf00713885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- M Limburg
- Division of Clinical Methods and Information, Academic Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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Abstract
BACKGROUND AND PURPOSE Greater availability and improvement of neuroradiological techniques have resulted in more frequent detection of unruptured aneurysms. Because prognosis of subarachnoid hemorrhage is still poor, preventive surgery is increasingly considered as a therapeutic option. Elective surgery requires reliable data on its risks. Therefore, we performed a meta-analysis on the mortality and morbidity of surgery for unruptured intracranial aneurysms. METHODS Through Medline and additional searches by hand, we retrieved studies on clipping of unruptured (additional, symptomatic, or incidental) aneurysms published from 1966 through June 1996. Two authors independently extracted data. We used weighted linear regression for data analysis. RESULTS We included 61 studies that involved 2460 patients (57% female; mean age, 50 years) and at least 2568 unruptured aneurysms (27% >25 mm, 30% located in the posterior circulation). Mortality was 2.6% (95% confidence interval [CI], 2.0% to 3.3%). Permanent morbidity occurred in 10.9% (95% CI, 9.6% to 12.2%) of patients. Postoperative mortality was significantly lower in more recent years for nongiant aneurysms and aneurysms with an anterior location; the last 2 characteristics were also associated with a significantly lower morbidity. CONCLUSIONS In studies published between 1966 and 1996 on clipping of unruptured aneurysms, mortality was 2.6% and morbidity was 10.9%. In calculating the pros and cons of preventive surgery, these proportions should be taken into account.
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Affiliation(s)
- T W Raaymakers
- Department of Neurology, Academic Hospital Utrecht, The Netherlands.
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Abstract
BACKGROUND AND PURPOSE Few data are available on the specific caregiving-related problems of stroke patients' caregivers and factors that influence the burden of these caregivers. The aim of this study was to describe the level and specific nature of the burden of caregiving as experienced by stroke patients' partners and to estimate the relative contribution of patient and partner characteristics to the presence of partners' burden. METHODS As part of a multicenter study on quality of care, burden of caregiving was assessed in 115 partners at 3 years after stroke. Explanatory factors of burden were studied in terms of (1) characteristics of patients (sociodemographic status, severity, type, and localization of stroke, disability, handicap, and unmet care demands) and (2) characteristics of partners (age, sex, disability, quality of life, loneliness, amount of care provided, and unmet care demands). RESULTS Partners of stroke patients perceived most caregiving burden in terms of feelings of heavy responsibility, uncertainty about patients' care needs, constant worries, restraints in social life, and feelings that patients rely on only their care. Multiple regression analysis revealed that a higher level of burden could partly be explained by patients' disability (R2 = 14%), but primarily by partners' characteristics in terms of emotional distress (R2 = 16%), loneliness (R2 = 6%), disability (R2 = 3%), amount of informal care provided (R2 = 2%), unmet demands for psychosocial care (R2 = 4%), and unmet demands for assistance in activities of daily living (R2 = 2%). CONCLUSIONS Higher levels of burden are primarily related to partners' emotional distress and less to the amount of care they provided, or to patients' characteristics. Sharing responsibilities, helping to clarify the patients' needs, and getting occasional relief of caregiving may be important in the support of caregivers.
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Affiliation(s)
- W J Scholte op Reimer
- Department of Social Medicine, Academic Medical Center, University of Amsterdam, The Netherlands.
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Fülesdi B, Limburg M, Molnár C, Káplár M, Bereczki D, Neuwirth G, Csiba L. [Cerebrovascular reactivity in non-insulin dependent diabetes mellitus (preliminary results)]. Orv Hetil 1998; 139:1789-92. [PMID: 9718946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIMS Previously numerous investigators reported about impairment of cerebrovascular reserve capacity in Type I, diabetes mellitus. However, no similar data are available about patients suffering from Type II diabetes. The goal of the study was to assess cerebrovascular reserve in Type II diabetic patients. PATIENTS AND METHODS 14 NIDDM patients and 20 healthy controls were studied. Middle cerebral artery mean blood flow velocity was measured at rest and during 20 minutes after i.v. administration of 1 g. acetazolamide. Velocities measured after acetazolamide were compared to resting values and were expressed as the percent increase of the mean velocity. Data obtained in diabetics and healthy persons were compared using Student's t-test. The correlation between age of the patients, diabetes duration, actual blood glucose-, insulin-, glycosylated hemoglobin-, urine microalbumin concentrations and resting blood flow velocity and cerebrovascular reserve capacity was assessed using linear regression analysis. RESULTS Resting cerebral blood flow velocities, cerebrovascular reactivity and reserve capacity did not differ from that of healthy controls. No correlation has been found between obtained laboratory parameters and resting cerebral blood flow velocities and cerebrovascular reserve capacity. CONCLUSIONS Vasodilatory ability of the cerebral arterioles in NIDDM-patients did not differ from that of healthy control persons. Further studies are needed to find out an accurate screening method for detection of cerebral microangiopathic changes in Type II diabetes mellitus.
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Affiliation(s)
- B Fülesdi
- Neurológiai Klinika, Debreceni Orvostudományi Egyetem
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van den Berg JS, Limburg M, Kappelle LJ, Pals G, Arwert F, Westerveld A. The role of type III collagen in spontaneous cervical arterial dissections. Ann Neurol 1998; 43:494-8. [PMID: 9546331 DOI: 10.1002/ana.410430413] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A case-control study was carried out to investigate whether type III collagen deficiency plays a role in the pathogenesis of spontaneous cervical arterial dissections. In 16 patients with spontaneous cervical arterial dissections and in 41 healthy controls, protein analysis of type III collagen (ratio of type III/type I collagen) was performed. Furthermore, single-stranded conformation polymorphism/heteroduplex analysis was used to investigate the type III collagen gene in the 16 patients with spontaneous cervical dissections to detect mutations. The ratios of type III/type I collagen in the controls ranged from 5.5 to 19.8% (median, 10%). The ratios of type III/type I collagen in the patients with spontaneous cervical arterial dissections ranged from 3.2 to 17.9% (median, 9.3%). Two patients had a low ratio of type III/type I collagen (<5.5%). No abnormalities suggesting a mutation in the gene of type III collagen were demonstrated in any of the 16 patients. Our findings are in keeping with the hypothesis that a reduced production of type III collagen may contribute to the formation of spontaneous cervical arterial dissections in some patients. The absence of a responsible mutation indicates that the coding sequence of the type III collagen gene is not involved.
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Affiliation(s)
- J S van den Berg
- Department of Neurology, University of Amsterdam, Academic Medical Center, The Netherlands
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Abstract
OBJECTIVE To describe risk factors and explore mechanisms of ischemic strokes after general surgery. BACKGROUND Strokes follow general surgery in about 0.08% to 2.9% of cases. Patients with previous cerebrovascular disease, atrial fibrillation, hypertension, advanced age, or atherosclerosis were found to have an increased risk. Knowledge of factors involved may guide physicians in determining the overall risk of surgery. METHODS This case-control study was performed in a referral center. A total of 61 patients identified through a computerized database with ischemic strokes after surgical procedures-excluding heart, brain, vessels, or neck-between July 1986 and July 1996 were studied. Procedures included 11 urogenital, 16 gastrointestinal, 17 orthopedic, 12 pulmonary, and 5 other. A total of 122 randomly selected controls were matched for age, sex, procedure, and year of procedure. Main outcome measures included arterial territory, timing, risk factors, and perioperative events. Differences were expressed as adjusted odds ratios (AOR) with 95% confidence limits (CL), using multivariate conditional logistic analyses for matched case-control design. RESULTS Arterial territory included 37 middle cerebral artery, 11 posterior circulation, 7 borderzone, and 6 multiple. Median procedure to stroke interval was 2 days (range, 0 to 16); 10 patients had intraoperative strokes. Three major risk factors emerged: previous cerebrovascular disease (AOR 12.57, 95% CL 2.14/73.70), chronic obstructive pulmonary disease (COPD) (7.51, 1.87/30.12), and peripheral vascular disease (PVD) (5.35, 1.25/22.94). After adding stroke-related factors, PVD (14.70, 2.01/107.71) and COPD (10.04, 1.90/53.14) remained the strongest variables; blood pressure (1.05, 1.01/1.10) and urea (1.04, 1.01/1.07) contributed slightly. Hypotension did not contribute. Four patients (6.6%) and no controls had diffuse intravascular coagulation (p = 0.01). Four stroke patients had myocardial infarction (6.6% versus 0%; p = 0.01). CONCLUSIONS Ischemic strokes after general surgery most commonly occur after an asymptomatic interval. Previous cerebrovascular disease, COPD, and PVD greatly increase the risk. Hypotension rarely accounts for postoperative strokes. Major comorbidity of the patient at risk seems more important than complicating events during surgery.
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Affiliation(s)
- M Limburg
- Department of Neurology, Mayo Clinic and Foundation, Rochester, MN, USA
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Fülesdi B, Valikovics A, Orosz L, Oláh L, Limburg M, Dink L, Káposzta Z, Csiba L. [Assessment of cerebrovascular reactivity in patients with symptomatic and asymptomatic atherosclerotic carotid artery lesions]. Orv Hetil 1998; 139:623-8. [PMID: 9545795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS Strokes caused by hemodynamically significant internal carotid artery stenoses and occlusions are believed to be embolic or hemodynamic of origin. The aim of the study was to assess cerebral hemodynamic compromises of significant carotid artery stenosis of occlusion using vasodilatory testing (acetazolamide test) in asymptomatic and symptomatic patients. PATIENTS AND METHODS 36 patients with unilateral, hemodynamically significant carotid stenosis were investigated using transcranial Doppler acetazolamide-test. There were 12 asymptomatic and 24 symptomatic patients. The middle cerebral artery mean blood flow velocity was measured at rest and after intravenous injection of 1 g acetazolamide. The absolute mean blood flow velocities and the cerebrovascular reactivity was compared at the stenotic and non-stenotic side. In a further analysis the mean velocities and the cerebrovascular reactivity values of the stenotic side were compared. Results of acetazolamide test performed on 28 healthy volunteers were used as control values. RESULTS There were no side-differences between the middle cerebral artery mean blood flow velocity and cerebrovascular reactivity values in the asymptomatic group. In the symptomatic group, however middle cerebral artery mean velocity and cerebrovascular reactivity after acetazolamide was significantly lower on the stenotic side, than on the non-stenotic one. Comparing the different groups non-stenotic sides did not differ to each other in their cerebral blood flow velocity and cerebrovascular reactivity. In the symptomatic patients, however, cerebral blood flow velocity and cerebrovascular reserve capacity after acetazolamide was lower, than that of the stenotic side of asymptomatic patients and controls. CONCLUSIONS The transcranial Doppler is a suitable method for detecting altered cerebral hemodynamics in significant carotid stenosis. Impaired cerebrovascular reactivity may refer to the impairment of cerebral autoregulatory mechanisms.
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Affiliation(s)
- B Fülesdi
- Debreceni Orvostudományi Egyetem Ideg-és Elmegyászati Klinika.
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