Are clinical differences between black and white stroke patients caused by variations in the atherosclerotic involvement of the arterial tree?

The differences in site and degree of atherosclerotic involvement of various vascular beds and their clinical significance are emphasised in a study of 304 black stroke patients. Detailed clinical examinations, computed tomography (CT), gated blood pool studies, echocardiography and ECG were performed and autopsy studies carried out. CT of the brain showed that non-haemorrhage, i.e. ischaemic lesions, accounted for 71.2% of strokes, a similar figure to that found in white stroke patients. However, carotid bruits (0.62%) and peripheral vascular disease (0.9%) followed by transient ischaemic attacks (1.9%) were found to be uncommon. Similarly, ischaemic heart disease (6.9%) appeared to be less common than the incidence in reported white stroke patients. In 30 patients who came to autopsy, the maximum degree of atherosclerotic stenosis of the extracranial carotid arteries was 21.7% of the lumen diameter. The differences in the site and degree of atherosclerosis in blacks not only give rise to differences in the clinical features of stroke patients but may have an important bearing on their investigation, management and prognosis.

The cardiovascular status of the black stroke patient.

The cardiac status of 102 consecutive black stroke patients entered to the Medunsa Stroke Databank was determined. Cardiological examination, echocardiography and a gated blood pool scan revealed structural and/or functional cardiac abnormalities in 73.6% of patients. Rheumatic heart disease was diagnosed in 15.6%, mitral valve prolapse in 5.8% and mitral annulus calcification in 4.9% of cases. 'Possible' cardiac sources of cerebral embolism were detected in 22.5% and 'definite' sources in 23.5% of patients. Hypertensive heart disease was diagnosed in 35.2% and cardiomyopathy in 13.7% of the study population. Ischaemic heart disease was present in 6.86%. Ultrasonography revealed ventricular bands in 29.4% of patients. The high incidence of structural cardiac abnormalities detected by non-invasive means is in keeping with recent studies in white stroke patients.

Sonographic demonstration of atypical congenital anomalies in the fetus of a diabetic mother. A case report.

Uncontrolled diabetes, particularly in early pregnancy during the stage of organogenesis, increases the risk of teratogenesis. A case of mixed congenital abnormalities in a fetus demonstrated ultrasonographically during the second trimester of pregnancy in an uncontrolled insulin-dependent diabetic mother is presented. Necropsy of the abortus confirmed the findings.

The relevance of left ventricular bands.

Left ventricular bands (LVBs) were first described almost a century ago but were largely ignored until their 'rediscovery' by echocardiography. Renewed interest in LVBs and the demonstration of their association with clinical abnormalities have resulted in attempts to establish their causal relationship with various phenomena, especially the vibratory systolic murmur and premature ventricular contractions. Published articles on LVBs are reviewed with specific reference to nomenclature, embryological development, histological features, prevalence, demonstration in vivo and at autopsy, and alleged clinical importance. Current views on LVBs are evaluated and future research directions are suggested.

The possible etiology of the vibratory systolic murmur.

Between January and September 1985, 476 patients underwent two-dimensional and M-mode echocardiography. Left ventricular bands were noted in 104 of these individuals. Of these patients, 89 (85.6%) were referred for evaluation of a systolic murmur. In view of this high incidence of association between left ventricular bands and systolic murmurs, we decided to perform a prospective analysis on patients with the classical vibratory systolic murmur (Still's murmur) which is commonly found in children and young adults. The incidence of left ventricular bands would be compared with a group of individuals in whom no cardiac murmurs could be detected. It was hoped in this way to possibly determine whether there was a definite relationship between the vibratory systolic murmur and left ventricular bands. Echocardiographs were performed using an Advanced Technical Laboratories machine and gain settings were adjusted such that all artefacts and normal structures could easily be distinguished from the ventricular bands. The ventricular bands were divided into two types. Of significance, we felt, were those which crossed the left ventricular outflow tract and which could therefore have been responsible for the production of turbulence and thus a murmur reminiscent of the Still's murmur. This type of left ventricular band was noted in 76% of our patients with Still's murmurs as opposed to only 14% of the individuals without any murmur (p less than 0.001). This statistically significant difference led us to conclude that left ventricular bands might be the cause of the Still's murmur. Further investigation, particularly with Doppler studies would be required to confirm this interesting association.

An echographic evaluation during the early puerperium of the uterine wound after caesarean section.

Serial echographic evaluation of the uterine wound after lower uterine segment caesarean section was performed on 48 puerperal patients. Similar examinations after vaginal delivery were carried out on 14 puerperal patients. The aim of this study was to determine whether evidence of abnormal healing could be detected by this method. Although three distinctive patterns were noted, no correlation with clinical findings could be made and no conclusions could be drawn.