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1.
Thromb Res ; 207: 75-84, 2021 Sep 21.
Artículo en Inglés | MEDLINE | ID: mdl-34563981

RESUMEN

INTRODUCTION: Human body functions exhibit a circadian rhythm generated in peripheral cells and synchronized by the suprachiasmatic nucleus (SCN), which mostly is entrained by the daily light/dark cycles. Activity, meals and posture are capable of interfering with the endogenous circadian rhythm of coagulation parameters. An increasing number of human disorders show a circadian component, and epidemiological studies find cardiovascular events to peak in the morning hours. The aim was to review the circadian rhythms impact on fibrinolysis and coagulation in healthy individuals and cardiovascular patients. MATERIALS AND METHODS: A total number of 25 studies were identified where 8 enrolled cardiovascular patients with or without healthy individuals. Using a MeSH-search in MEDLINE PubMed. Only original peer-reviewed papers were included. RESULTS: Results showed substantial variance with respect to exhibition of circadian rhythms and/or peak/trough times. Circadian rhythms of fibrinolysis were less pronounced in cardiovascular patients than in healthy individuals with decreased levels in the morning hours compared to healthy inducing higher risk of blood clotting. CONCLUSIONS: Because of small studied group sizes and failure to control for entraining factors, larger studies are needed to fully establish the effects of the circadian rhythm on especially coagulation. The findings of chronobiologic rhythms in coagulation and fibrinolysis could suggest a need for a chrono-pharmacological approach when treating/preventing cardiovascular diseases.

2.
Neurology ; 2021 Jan 20.
Artículo en Inglés | MEDLINE | ID: mdl-33472916

RESUMEN

Objective: To evaluate the effects of an outpatient clinic set-up for minor stroke/TIA using subsequent admission of patients at 'high risk' of re-stroke.Methods: A cohort study of all patients with suspected minor stroke/TIA seen in an outpatient clinic at Aarhus University Hospital, Denmark, between September 2013 and August 2014. Stroke patients were compared to historic (same hospital) and contemporary (another comparable hospital) matched, hospitalized controls on the non-prioritized outcomes: Length-of-stay, re-admissions, care quality (10 process-performance measures) and mortality. TIA patients were compared to contemporary matched, hospitalized controls.Following complete diagnostic work-up, patients with stroke/TIA were classified into 'low'/high risk' of re-stroke ≤7 days. RESULTS: We analyzed 1,076 consecutive patients of whom 253 (23.5%) were subsequently admitted to the stroke ward. Stroke/TIA was diagnosed in 215/171 patients, respectively. Fifty-six percent (121/215) of the stroke patients were subsequently admitted to the stroke ward. Comparison with the historic stroke cohort (n=191) showed a shorter acute hospital stay for the strokes (median 1 vs 3 days); adjusted length-of-stay ratio 0.49 (95% CI 0.33-0.71). Furthermore, 30-day readmission rate was 3.2% vs 11.6%; adjusted hazard ratio 0.23 (0.09-0.59); and care quality was higher with a risk ratio of 1.30 (1.15-1.47). The comparison of stroke and TIAs to contemporary controls showed similar results. Only one patient in the 'low risk' category and not admitted experienced stroke within 7 days (0.6%). CONCLUSIONS: An outpatient clinic set-up for patients with minor stroke/TIA yields shorter acute hospital stay, lower re-admissions rates, and better quality than hospitalization in stroke units. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that a neurovascular specialist driven outpatient clinic for minor stroke/TIA patients with the ability of subsequent admission is safe and yields shorter acute hospital stay, lower re-admissions rates, and better quality than hospitalization in stroke units.

3.
Eur J Neurol ; 26(8): 1044-1050, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-30748047

RESUMEN

BACKGROUND AND PURPOSE: Acute endovascular reperfusion treatment (aERT) of stroke patients with large-vessel occlusions is efficacious and safe according to several clinical trials. Data on outcome and safety of aERT in daily clinical routine are warranted and, in this study, we present national data from Denmark during 2011-2017. METHODS: National data for Denmark from 2011 to 2017 on all aERT procedures in patients with acute ischaemic stroke and computed tomography angiography/magnetic resonance angiography-verified large-vessel occlusion were derived from the Danish Stroke Registry, a national clinical quality registry to which reporting is mandatory for all hospitals treating stroke patients. Outcome (modified Rankin Scale score) after 3 months, including time of death, was assessed prospectively based on clinical examination or the Danish Civil Registration System. RESULTS: During the 7 years of observation, a total of 1720 patients were treated with aERT. The annual number of procedures increased from 128 in 2011 to 409 in 2017. The median age was 70 years, 58% were males and median National Institutes of Health Stroke Scale score at baseline was 16. Median time from symptom onset to groin puncture was 238 min with a decreasing trend during the years. Successful recanalization was reported in 1306 (76%) patients. At 3-month follow-up, an modified Rankin Scale score of 0-2 was reported in 46% of patients, whereas 14% of patients had died. CONCLUSION: Routine data on aERT in acute ischaemic stroke in Denmark from 2011 to 2017 suggest that the procedure is safe and efficacious.


Asunto(s)
Isquemia Encefálica/terapia , Procedimientos Endovasculares/métodos , Accidente Cerebrovascular/terapia , Anciano , Isquemia Encefálica/diagnóstico por imagen , Dinamarca , Femenino , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Reperfusión , Accidente Cerebrovascular/diagnóstico por imagen , Resultado del Tratamiento
4.
BMC Nurs ; 17: 17, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29719491

RESUMEN

BACKGROUND: During the past two decades, attempts have been made to describe nurses' contributions to the rehabilitation of inpatients following stroke. There is currently a lack of interventions that integrate the diversity of nurses' role and functions in stroke rehabilitation and explore their effect on patient outcomes. Using a systematic evidence- and theory-based design, we developed an educational programme, Rehabilitation 24/7, for nursing staff working in stroke rehabilitation aiming at two target behaviours; working systematically with a rehabilitative approach in all aspects of patient care and working deliberately and systematically with patients' goals. The aim of this study was to assess nursing staff members' self-perceived outcome related to their capability, opportunity and motivation to work with a rehabilitative approach after participating in the stroke Rehabilitation 24/7 educational programme. METHODS: A convergent mixed-method design was applied consisting of a survey and semi-structured interviews. Data collection was undertaken between February and June 2016. Data from the questionnaires (N = 33) distributed before and after the intervention were analysed using descriptive statistics and Wilcoxon sign rank test. The interviews (N = 10) were analysed using deductive content analysis. After analysing questionnaires and interviews separately, the results were merged in a side by side comparison presented in the discussion. RESULTS: The results from both the quantitative and qualitative analyses indicate that the educational programme shaped the target behaviours that we aimed to change by addressing the nursing staff's capability, opportunity and motivation and hence could strengthen the nursing staff's contribution to inpatient stroke rehabilitation. A number of behaviours changed significantly, and the qualitative results indicated that the staff experienced increased focus on their role and functions in rehabilitation practice. CONCLUSION: Our study provides an understanding of the outcome of the Rehabilitation 24/7 educational programme on nursing staff's behaviours. A mixed-methods approach provided extended knowledge of the changes in the nursing staff members' self-percived behaviours after the intervention. These changes suggest that educating the nursing staff on rehabilitation using the Rehabilitation 24/7 programme strengthened their knowledge and beliefs about rehabilitation, goal-setting as well as their role and functions.

5.
Colorectal Dis ; 20(5): 399-406, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29161761

RESUMEN

AIM: Although the rate of local recurrence (LR) after colorectal cancer surgery has decreased, it still poses major surgical and oncological challenges. The aims of this study, based on an audit from a tertiary referral centre, was to evaluate determinants associated with outcomes after surgery for pelvic LR and how these have changed over time. METHOD: Retrospective analysis of all resections for pelvic LR of colorectal cancer performed at the Karolinska University Hospital from January 2003 until August 2009 (period 1) and from September 2009 until November 2013 (period 2) . RESULTS: Ninety-five patients with pelvic LR were operated on with a curative intent. An R0 resection was achieved in 77% and an R1 resection in 23%. Lateral compartments were invaded in 48% and this proportion increased in resections performed in period 2 (37% vs 60%, P = 0.05). R1 resections were associated with a higher risk of local re-recurrence than R0 resections (64% vs 16%; OR = 8.90, 95% CI: 2.71-29.78). Lateral recurrences were associated with a lower R0-resection rate than nonlateral recurrences (63% vs 90%; OR = 0.20, 95% CI: 0.05-0.64) and a higher risk of treatment failure in terms of local re-recurrence or distant metastases, or death, as first event (hazard ratio [HR] = 1.75, 95% CI: 1.06-2.75). However, in a multivariate analysis only R1 resections remained a significant prognostic factor for treatment failure (HR = 2.37, 95% CI: 1.32-4.27). CONCLUSION: The proportion of lateral pelvic recurrences has increased over time. In comparison with non-lateral LRs, lateral LRs are more difficult to resect radically and are associated with worse overall and disease-free survival. However, with radical surgery many patients with pelvic locally recurrent colorectal cancer may be offered curative treatment.


Asunto(s)
Neoplasias Colorrectales/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/mortalidad , Recurrencia Local de Neoplasia/cirugía , Exenteración Pélvica/mortalidad , Neoplasias Pélvicas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Femenino , Humanos , Masculino , Auditoría Médica , Persona de Mediana Edad , Análisis Multivariante , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Exenteración Pélvica/métodos , Neoplasias Pélvicas/mortalidad , Neoplasias Pélvicas/patología , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Centros de Atención Terciaria , Insuficiencia del Tratamiento
6.
AJNR Am J Neuroradiol ; 38(7): 1356-1361, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28495947

RESUMEN

BACKGROUND AND PURPOSE: The Embolus Retriever with Interlinked Cages (ERIC) device is a novel stent retriever for mechanical thrombectomy. It consists of interlinked cages and could improve procedural benchmarks and clinical outcome compared with classic stent retrievers. This study compares the rates of recanalization, favorable clinical outcome, procedural adverse events, and benchmarks between the ERIC device and classic stent retrievers. MATERIALS AND METHODS: From 545 patients treated with thrombectomy between 2012 and 2015, 316 patients were included. The mean age was 69 ±13 years, the mean baseline NIHSS score was 17 ± 5, and 174 (55%) were men. The ERIC was used as the primary thrombectomy device in 59 (19%) patients. In a propensity score matched analysis including the NIHSS score, clot location, delay to groin puncture, neurointerventionalist, and anesthetic management, 57 matched pairs were identified. RESULTS: Patients treated with the ERIC device compared with classic stent retrievers showed equal rates of recanalization (86% versus 81%, P = .61), equal favorable 3-month clinical outcome (mRS 0-2: 46% versus 40%, P = .71), and procedural adverse events (28% versus 30%, P = 1.00). However, in patients treated with the ERIC device, thrombectomy procedures were less time-consuming (67 versus 98 minutes, P = .009) and a rescue device was needed less often (18% versus 39%, P = .02) compared with classic stent retrievers. CONCLUSIONS: Mechanical thrombectomy with the ERIC device is effective and safe. Rates of favorable procedural and clinical outcomes are at least as good as those with classic stent retrievers. Of note, the ERIC device might be time-saving and decrease the need for rescue devices. These promising results call for replication in larger prospective clinical trials.


Asunto(s)
Isquemia Encefálica/cirugía , Embolia Intracraneal/cirugía , Accidente Cerebrovascular/cirugía , Instrumentos Quirúrgicos , Trombectomía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Anestesia , Estudios de Casos y Controles , Remoción de Dispositivos , Femenino , Ingle , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Puntaje de Propensión , Punciones , Estudios Retrospectivos , Stents , Instrumentos Quirúrgicos/efectos adversos , Trombectomía/efectos adversos , Resultado del Tratamiento
7.
Neuropsychologia ; 92: 79-89, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26970141

RESUMEN

Impaired visual attention is common following strokes in the territory of the middle cerebral artery, particularly in the right hemisphere, while attentional effects of more posterior lesions are less clear. Commonly, such deficits are investigated in relation to specific syndromes like visual agnosia or pure alexia. The aim of this study was to characterize visual processing speed and apprehension span following posterior cerebral artery (PCA) stroke. In addition, the relationship between these attentional parameters and single word reading is investigated, as previous studies have suggested that reduced visual speed and span may explain pure alexia. Eight patients with unilateral PCA strokes (four left hemisphere, four right hemisphere) were selected on the basis of lesion location, rather than the presence of any visual symptoms. Visual attention was characterized by a whole report paradigm allowing for hemifield-specific measurements of processing speed and apprehension span. All patients showed reductions in visual span contralateral to the lesion site, and four patients showed bilateral reductions in visual span despite unilateral lesions (2L; 2R). Six patients showed selective deficits in visual span, though processing speed was unaffected in the same field (ipsi- or contralesionally). Only patients with right hemifield reductions in visual span were impaired in reading, and this could follow either right or left lateralized stroke and was irrespective of visual field impairments. In conclusion, visual span may be affected bilaterally by unilateral PCA-lesions. Reductions in visual span may also be confined to one hemifield, and may be affected in spite of preserved visual processing speed. Furthermore, reduced span in the right visual field seems to be related to reading impairment in this group, regardless of lesion lateralization.


Asunto(s)
Alexia Pura/etiología , Atención , Infarto de la Arteria Cerebral Posterior/complicaciones , Infarto de la Arteria Cerebral Posterior/psicología , Percepción Visual , Anciano , Alexia Pura/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Femenino , Lateralidad Funcional , Humanos , Infarto de la Arteria Cerebral Posterior/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Tiempo de Reacción , Lectura , Pruebas del Campo Visual
8.
Br J Surg ; 102(8): 972-8; discussion 978, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-26095256

RESUMEN

BACKGROUND: The Stockholm III Trial randomized patients with primary operable rectal cancers to either short-course radiotherapy (RT) with immediate surgery (SRT), short-course RT with surgery delayed 4-8 weeks (SRT-delay) or long-course RT with surgery delayed 4-8 weeks. This preplanned interim analysis examined the pathological outcome of delaying surgery. METHODS: Patients randomized to the SRT and SRT-delay arms in the Stockholm III Trial between October 1998 and November 2010 were included, and data were collected in a prospective register. Additional data regarding tumour regression grade, according to Dworak, and circumferential margin were obtained by reassessment of histopathological slides. RESULTS: A total of 462 of 545 randomized patients had specimens available for reassessment. Patients randomized to SRT-delay had earlier ypT categories, and a higher rate of pathological complete responses (11·8 versus 1·7 per cent; P = 0·001) and Dworak grade 4 tumour regression (10·1 versus 1·7 per cent; P < 0·001) than patients randomized to SRT without delay. Positive circumferential resection margins were uncommon (6·3 per cent) and rates did not differ between the two treatment arms. CONCLUSION: Short-course RT induces tumour downstaging if surgery is performed after an interval of 4-8 weeks.


Asunto(s)
Adenocarcinoma/radioterapia , Adenocarcinoma/cirugía , Cuidados Preoperatorios , Neoplasias del Recto/radioterapia , Neoplasias del Recto/cirugía , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Prospectivos , Radioterapia Adyuvante , Neoplasias del Recto/patología , Factores de Tiempo
9.
Top Stroke Rehabil ; 22(3): 185-93, 2015 06.
Artículo en Inglés | MEDLINE | ID: mdl-25779892

RESUMEN

BACKGROUND: Erectile dysfunction and lower urinary tract symptoms (LUTS) are common sequelae in men after stroke. OBJECTIVE: The objective of this study was to evaluate the effect of pelvic floor muscle training (PFMT) on measured erectile function as an indicator of sexuality in men with LUTS after stroke. METHOD: A sample of 516 men with stroke was invited to participate in this single-blinded, randomized controlled trial according to in- and exclusion criteria. This resulted in 31 participants who were randomized to either a Treatment Group (n = 16) or a Control Group (n = 15). The intervention included 12♣weeks of PFMT. The effect was measured on the International Index of Erectile Function (IIEF-5) questionnaire. RESULTS: Thirty participants (median age: 68 years; interquartile range: 60-74 years) completed the study, 15 in each group. The results of the IIEF-5 sum score showed a significant improvement (P < 0.04) from pre-test to post-test in the Treatment Group, but not in the Control Group. Within pre-test and 6-month follow-up, the median sum score decreased in both groups, worsened in the Control Group [Treatment Group, 3 (17%) versus Control Group, 5 (31%)]. There were differences between the groups at post-test and at follow-up, but they were not statistically significant. CONCLUSION: The results showed that, as measured by erectile function in men with LUTS after stroke, PFMT may have short-term and long-term effect, although no statistically significant effect was demonstrated between the groups.


Asunto(s)
Disfunción Eréctil/terapia , Terapia por Ejercicio/métodos , Contracción Muscular/fisiología , Evaluación de Resultado en la Atención de Salud , Diafragma Pélvico/fisiopatología , Accidente Cerebrovascular/terapia , Anciano , Disfunción Eréctil/etiología , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Método Simple Ciego , Accidente Cerebrovascular/complicaciones
10.
Acta Neurol Scand ; 131(2): 132-9, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25214428

RESUMEN

OBJECTIVES: Angiotensin II type 1 receptor blockade has neuroprotective effects in animal stroke models, but no effects in clinical stroke trials. We evaluated cerebral and peripheral changes in the renin angiotensin aldosterone system (RAAS) and stress responses in acute ischemic stroke patients. MATERIALS AND METHODS: Blood from a jugular and cubital vein was collected within 48 h of stroke onset, after 24 and 48 h, and renin, angiotensin I, angiotensin II, aldosterone, norepinephrine, epinephrine, and cortisol were measured. Post-stroke cubital vein samples were collected after 8 (4.7-10) months. RESULTS: The acute systolic blood pressure was significantly increased, 148 (141-168) vs 140 (130-147) mmHg post-stroke. Angiotensin I, renin and aldosterone levels were significantly lower, angiotensin II was unchanged, and ACE activity was higher in the acute phase compared to post-stroke. No differences in RAAS were detected between jugular and cubital plasma levels. Jugular venous plasma levels of epinephrine and cortisol were elevated in the acute phase compared to cubital levels (P < 0.05). CONCLUSION: Increased epinephrine and cortisol levels in the jugular vein blood may reflect a higher peripheral turnover. The observed changes in RAAS in the acute stroke phase are consistent with responses to increased blood pressure.


Asunto(s)
Sistema Renina-Angiotensina/fisiología , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/fisiopatología , Anciano , Anciano de 80 o más Años , Aldosterona/sangre , Angiotensina II/sangre , Animales , Biomarcadores/sangre , Presión Sanguínea , Femenino , Humanos , Hipertensión , Masculino , Persona de Mediana Edad , Renina/sangre
11.
Eur J Cancer Care (Engl) ; 22(6): 726-37, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23855405

RESUMEN

The aim of this article is to present findings about self-reported spirituality of a group of Danish cancer survivors. The findings derive from a qualitative study that was carried out during rehabilitation week courses at a Danish rehabilitation centre. Methods comprised participant observation, semi-structured interviews and focus group interviews. Employing interpretative phenomenological analysis as analytical strategy, a prominent part of the informants' self-reported spirituality was found to centre around a perceived sense of relatedness to a transpersonal entity that transcends the self and extends beyond spatial-temporal boundaries. Three transpersonal entities were identified: 'God', a 'guardian angel' and a 'deceased family member'. The key findings of the study demonstrate that the transpersonal entities were experienced as empowering and supportive resources during cancer treatment and rehabilitation and that they were furthermore perceived as responsible for the informants' healing and survival. These findings are interpreted through the lenses of two interrelated theoretical frameworks: Hay and Nye's approach to spirituality as 'relational consciousness' and Kirkpatrick and colleagues' understanding of religion and/or spirituality as attachment relationships. These two theoretical understandings are suggested as useful frameworks for capturing spiritual dimensions of cancer survivors' meaning making and coping in a secular society.


Asunto(s)
Neoplasias/psicología , Espiritualidad , Sobrevivientes/psicología , Adulto , Anciano , Dinamarca , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Autoinforme , Encuestas y Cuestionarios
12.
Br J Surg ; 100(7): 969-75, 2013 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23553796

RESUMEN

BACKGROUND: Radiotherapy (RT) in rectal cancer increases postoperative morbidity. A suggested reason is RT-induced bone marrow depression resulting in impaired leucocyte counts. The ongoing Stockholm III Trial randomizes patients with operable rectal cancers to short-course RT with immediate surgery (SRT), short-course RT with surgery delayed for 4-8 weeks (SRT-delay) and long-course RT with surgery delayed for 4-8 weeks (LRT-delay). This study examined differences between the randomization arms regarding leucocyte response and postoperative complications. METHODS: Patients randomized in the Stockholm III Trial between October 1998 and November 2010 were included. Data were collected in a prospective register. Additional data were obtained by retrospective review of clinical records. RESULTS: Of 657 randomized patients, 585 had data on leucocytes. The SRT arm had the highest proportion of postoperative complications (SRT, 52·5 per cent; SRT-delay, 39·4 per cent; LRT-delay, 41 per cent; P = 0·010). There was no association between low preoperative leucocyte count and postoperative complications (P = 0·238). Irrespective of randomization arm, patients with an impaired postoperative to preoperative leucocyte ratio had the highest rate of complications (low ratio, 56·6 per cent; intermediate ratio, 46·9 per cent; high ratio, 36·3 per cent; P = 0·010). The SRT arm had the highest proportion of low ratios (SRT, 48·9 per cent; SRT-delay, 22·8 per cent; LRT-delay, 22 per cent; P < 0·001). CONCLUSION: An impaired postoperative leucocyte response is associated with postoperative complications. The highest risk is with immediate surgery following short-course radiotherapy. REGISTRATION NUMBER: NCT 00904813 (http://www.clinicaltrials.gov).


Asunto(s)
Adenocarcinoma/radioterapia , Leucocitos/efectos de la radiación , Neoplasias del Recto/radioterapia , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Femenino , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Cuidados Preoperatorios/efectos adversos , Radioterapia/efectos adversos , Neoplasias del Recto/cirugía
13.
Ultrasound Obstet Gynecol ; 40(4): 445-51, 2012 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22378629

RESUMEN

OBJECTIVE: To evaluate the feasibility of ultrasound-guided radiofrequency ablation (USgRFA) for the treatment of women with symptomatic uterine fibroids in relation to volume of fibroid. METHODS: Forty-three women with symptomatic fibroids underwent USgRFA for treatment of uterine fibroids. Improvements in fibroid symptoms and quality of life were measured by the Uterine Fibroid Symptom and Quality of Life questionnaire scores at baseline and 3, 6 and 9 months after the intervention, and analyzed in relation to baseline fibroid volume. Volume reduction of fibroids was measured and the frequency of adverse events and re-interventions was recorded. RESULTS: Following USgRFA, mean Symptom Severity Scores (SSS) decreased from 60.7 ± 17.8 to 31.2 ± 19.5, corresponding to an improvement of 48.6%. The total Health-Related Quality of Life (HRQOL) score improved by 46.4% from 55.6 ± 20.9 to 81.4 ± 16.6. There was no correlation between fibroid volume at baseline and improvement in SSS and HRQOL scores. Fibroid volume was reduced in all patients, by a mean of 69.7 ± 19.4%. Two (4.7%) patients underwent hysterectomy. No adverse events occurred. CONCLUSION: USgRFA reduces fibroid symptom and size even in patients with larger fibroids. USgRFA is a promising new treatment for fibroids in gynecological settings and should be further investigated.


Asunto(s)
Aborto Espontáneo/prevención & control , Ablación por Catéter , Leiomioma/cirugía , Calidad de Vida , Neoplasias Uterinas/cirugía , Aborto Espontáneo/epidemiología , Adulto , Ablación por Catéter/efectos adversos , Dinamarca/epidemiología , Femenino , Humanos , Leiomioma/epidemiología , Persona de Mediana Edad , Factores de Riesgo , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Resultado del Tratamiento , Neoplasias Uterinas/epidemiología
14.
Br J Surg ; 99(4): 577-83, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22241246

RESUMEN

BACKGROUND: Short-course radiotherapy (SRT) with immediate surgery and long-course chemoradiotherapy (CRT) are currently the standard preoperative treatment options for rectal cancer. SRT with surgery delayed for 4-8 weeks (SRT-delay) is an option described for patients with locally advanced tumours who are not fit for CRT. This study examined early toxicity, response to radiotherapy (RT) and short-term outcomes of SRT-delay. METHODS: Patients in the Stockholm region diagnosed with rectal cancer between January 2002 and December 2008, who received SRT (25 Gy over 5-7 days) and had surgery with resection of the primary tumour more than 4 weeks after the start of RT, were identified from a prospective register. Additional data were obtained by retrospective review of clinical records. RESULTS: A total of 112 patients had SRT and delayed surgery. The reasons given for SRT included primary unresectable disease and co-morbidities. Severe RT-induced toxicity was noted in six patients (5·4 per cent). Signs of tumour regression were seen on magnetic resonance imaging in 74 per cent of patients reassessed after RT. Pathological stage (44·9 versus 60·7 per cent stage 0-II; P < 0·001), tumour category (11·9 versus 29·4 per cent T0-T2; P < 0·001) and node category (45·8 versus 63·6 per cent N0; P = 0·014) were significantly lower than those at initial assessment. Nine patients (8·0 per cent) had a complete pathological response. CONCLUSION: The SRT-delay schedule was a feasible alternative with low toxicity. The study indicated a downstaging effect of SRT if surgery was delayed.


Asunto(s)
Adenocarcinoma/radioterapia , Adenocarcinoma/cirugía , Neoplasias del Recto/radioterapia , Neoplasias del Recto/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/prevención & control , Complicaciones Posoperatorias/etiología , Cuidados Preoperatorios/métodos , Radioterapia/efectos adversos , Factores de Tiempo , Resultado del Tratamiento
15.
Neurology ; 77(21): 1866-72, 2011 Nov 22.
Artículo en Inglés | MEDLINE | ID: mdl-22094479

RESUMEN

BACKGROUND: Patients with concomitant diabetes mellitus (DM) and prior stroke (PS) were excluded from European approval of alteplase in stroke. We examined the influence of DM and PS on the outcomes of patients who received thrombolytic therapy (T; data from Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register) compared to nonthrombolyzed controls (C; data from Virtual International Stroke Trials Archive). METHODS: We selected ischemic stroke patients on whom we held data on age, baseline NIH Stroke Scale score (NIHSS), and 90-day modified Rankin Scale score (mRS). We compared the distribution of mRS between T and C by Cochran-Mantel-Haenszel (CMH) test and proportional odds logistic regression, after adjustment for age and baseline NIHSS, in patients with and without DM, PS, or the combination. We report odds ratios (OR) for improved distribution of mRS with 95% confidence interval (CI) and CMH p value. RESULTS: Data were available for 29,500 patients: 5,411 (18.5%) had DM, 5,019 had PS (17.1%), and 1,141 (5.5%) had both. Adjusted mRS outcomes were better for T vs C among patients with DM (OR 1.45 [1.30-1.62], n = 5,354), PS (OR 1.55 [1.40-1.72], n = 4,986), or concomitant DM and PS (OR 1.23 [0.996-1.52], p = 0.05, n = 1,136), all CMH p < 0.0001. These are comparable to outcomes between T and C among patients with neither DM nor PS: OR = 1.53 (1.42-1.63), p < 0.0001, n = 19,339. There was no interaction on outcome between DM and PS with alteplase treatment (tissue plasminogen activator × DM × PS, p = 0.5). Age ≤80 years or >80 years did not influence our findings. CONCLUSIONS: Outcomes from thrombolysis are better than the controls among patients with DM, PS, or both. We find no statistical justification for the exclusion of these patients from receiving thrombolytic therapy.


Asunto(s)
Isquemia Encefálica/complicaciones , Complicaciones de la Diabetes/fisiopatología , Accidente Cerebrovascular , Terapia Trombolítica/métodos , Activador de Tejido Plasminógeno/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Masculino , Estudios Retrospectivos , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/etiología , Resultado del Tratamiento
16.
Cephalalgia ; 30(8): 928-32, 2010 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-19740120

RESUMEN

Provoking delayed migraine with nitroglycerin in migraine sufferers is a cumbersome model. Patients are difficult to recruit, migraine comes on late and variably and only 50-80% of patients develop an attack. A model using normal volunteers would be much more useful, but it should be validated by testing the response to drugs of known efficacy in acute migraine. Furthermore, treatment during headache rather than pretreatment is the most naturalist method. To fulfil these requirements we used continuous long-lasting infusion of glyceryl trinitrate (GTN) 0.2 microg kg-1 min-1 for 140 min and gave aspirin 1000 mg, zolmitriptan 5 mg or placebo to normal healthy volunteers. The design was double-blind, placebo-controlled three-way crossover. Our hypothesis was that these drugs would be effective in the treatment of the mild constant headache induced by long-lasting GTN infusion. The headaches did not fulfil the International Headache Society diagnostic criteria for migraine without aura. Moreover, there was no effect on headache of either zolmitriptan or aspirin. Thus our hypothesis was disproved and we conclude that our model is not valid for the testing of new acute antimigraine drugs. Our experiment suggests that headache caused by direct nitric oxide (NO) action in the continued presence of NO is very resistance to analgesics and to specific acute migraine treatments. This suggests that NO works very deep in the cascade of events associated with vascular headache, whereas tested drugs work higher in the cascade. The model suggested here should therefore be tested with other headache/migraine-provoking agents that supposedly work higher in the cascade of events. The need for human models persists, but the solution to this problem is still pending.


Asunto(s)
Trastornos Migrañosos/inducido químicamente , Modelos Biológicos , Nitroglicerina/efectos adversos , Vasodilatadores/efectos adversos , Adulto , Analgésicos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Aspirina , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Infusiones Intravenosas , Masculino , Trastornos Migrañosos/tratamiento farmacológico , Nitroglicerina/administración & dosificación , Oxazolidinonas/uso terapéutico , Agonistas de Receptores de Serotonina/uso terapéutico , Triptaminas/uso terapéutico , Vasodilatadores/administración & dosificación , Adulto Joven
17.
Cephalalgia ; 30(4): 467-74, 2010 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19673898

RESUMEN

The role of nitric oxide (NO) in migraine has been studied in the experimental glyceryl trinitrate (GTN)-infusion headache model. We hypothesized that GTN-induced headache may activate the trigeminovascular system and be associated with increased levels of sensory neuropeptides, including calcitonin gene-related peptide (CGRP). CGRP, vasoactive intestinal peptide (VIP), neuropeptide Y (NPY) and somatostatin plasma levels were measured before and after placebo/sumatriptan injection and during GTN-induced headache. Following a double-blind randomized cross-over design, 10 healthy volunteers received subcutaneous sumatriptan 6 mg or placebo. This was succeeded by 20 min of GTN (0.12 µg kg(-1) min(-1)) infusion. At baseline no subject reported headache (using verbal rating scale from 0 to 10) and the jugular CGRP-like immunoreactivity (-LI) level was 18.6 ± 2.5 pmol/l. After a 20-min intravenous infusion of GTN 0.12 µg kg(-1) min(-1), median peak headache intensity was 4 (range 2-6) (P < 0.05), while jugular CGRP-LI levels were unchanged (19.0 ± 2.8 pmol/l; P > 0.05). There were no changes in VIP-, NPY- or somatostatin-LI. In conclusion, the NO donor GTN appears not to induce headache via immediate CGRP release.


Asunto(s)
Péptido Relacionado con Gen de Calcitonina/sangre , Cefalea/inducido químicamente , Cefalea/metabolismo , Donantes de Óxido Nítrico/efectos adversos , Nitroglicerina/efectos adversos , Adulto , Estudios Cruzados , Femenino , Cefalea/tratamiento farmacológico , Humanos , Masculino , Neuropéptido Y/sangre , Óxido Nítrico/sangre , Valores de Referencia , Somatostatina/sangre , Sumatriptán/administración & dosificación , Péptido Intestinal Vasoactivo/sangre , Vasoconstrictores/administración & dosificación
18.
Eur J Neurol ; 16(10): 1106-11, 2009 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-19614965

RESUMEN

BACKGROUND AND PURPOSE: Glyceryl trinitrate (GTN) induces delayed migraine attacks in migraine patients. The purpose of this study was to investigate whether pre-treatment with prednisolon could decrease this effect of GTN. METHODS: In this double-blind, randomized and placebo-controlled, crossover study 15 migraineurs with migraine without aura were pre-treated with 150 mg of prednisolone or placebo followed by a 20-min infusion of GTN (0.5 ug/kg/min). One hour after the GTN-infusion, the participants were sent home, but continued to rate headache and possible associated symptoms by filling out a headache diary every hour for 12 h. There were two equal primary efficacy end-points: frequency of delayed migraine and intensity of delayed headache. RESULTS: Nine patients experienced a GTN headache fulfilling the diagnostic criteria for migraine without aura on the placebo day compared with four patients on the prednisolone day (P = 0.14). Prednisolone pre-treatment did not alter the summed or peak immediate headache responses to GTN significantly (P = 0.08, P = 0.07), whereas the peak headache scores during the following 12 h were significantly lower after prednisolone pre-treatment (median peak score = 1, range 0-8) compared with placebo (median = 4, range 0-8) (P < 0.01). There was no difference between the two treatment days in the effect of GTN on blood flow velocity of the middle cerebral artery (a decrease) or on the dilation of the superficial temporal artery or the radial artery. CONCLUSION: Pre-treatment with prednisolone did not reduce the immediate GTN-induced headache, did not inhibit the frequency of delayed headache but significantly decreased the intensity of delayed GTN-induced headache. These findings suggest that GTN causes induction of inflammatory mediators, and that this is the mechanism of delayed GTN-induced migraine. They also support a role of inflammatory mediators in spontaneous migraine attacks.


Asunto(s)
Migraña sin Aura/inducido químicamente , Migraña sin Aura/tratamiento farmacológico , Nitroglicerina/efectos adversos , Prednisolona/uso terapéutico , Adulto , Análisis de Varianza , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Circulación Cerebrovascular/efectos de los fármacos , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Índice de Severidad de la Enfermedad
19.
Cephalalgia ; 29(12): 1294-300, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19438913

RESUMEN

Glyceryl trinitrate (GTN) is a pro-drug dissociating nitric oxide throughout the body. It dilates cephalic arteries without increasing cerebral blood flow (CBF). GTN induces headache in healthy volunteers and migraine attacks in migraineurs. Acetazolamide (Az) increases CBF but does not dilate cerebral arteries. The hypothesis tested here was that Az, by dilating cerebral arterioles but not arteries and thereby decreasing pulsatile stretching of the wall of the large arteries and their perivascular sensory nerves, would reduce or prevent the GTN-induced headache We tested this hypothesis in 14 healthy volunteers. In a randomized, double-blind, cross-over study, they were pretreated with Az or placebo followed on both study days by a GTN infusion of 0.5 microg kg(-1) min(-1) for 20 min. Headache was scored on a verbal rating scale and a headache diary was kept for 12 h. Mean blood velocity of the middle cerebral artery was measured (transcranial Doppler). Our hypothesis was disproved, as Az did not decrease GTN-induced headache. Unexpectedly but interestingly, GTN combined with Az induced more delayed headache than GTN alone. Furthermore, a migraine-like headache was observed in three volunteers, who did not develop migraine after GTN alone. The fact that a suitable pharmacological intervention may trigger migraine in individuals with no prior migraine may suggest that the ability to develop migraine without aura is a quantitative genetic trait.


Asunto(s)
Acetazolamida/efectos adversos , Anticonvulsivantes/efectos adversos , Migraña sin Aura/inducido químicamente , Nitroglicerina/efectos adversos , Vasodilatadores/efectos adversos , Acetazolamida/administración & dosificación , Adulto , Anticonvulsivantes/administración & dosificación , Arteriolas/efectos de los fármacos , Arteriolas/fisiología , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Presión Sanguínea/efectos de los fármacos , Dióxido de Carbono/metabolismo , Estudios Cruzados , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino , Arteria Cerebral Media/diagnóstico por imagen , Arteria Cerebral Media/efectos de los fármacos , Arteria Cerebral Media/fisiología , Migraña sin Aura/genética , Nitroglicerina/administración & dosificación , Placebos , Ultrasonografía Doppler Transcraneal , Vasodilatadores/administración & dosificación , Adulto Joven
20.
Cephalalgia ; 29(3): 384-7, 2009 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-19220317

RESUMEN

Stress is a provoking factor for both tension-type headache and migraine attacks. In the present single-blind study, we investigated if stress induced by norepinephrine (NE) could elicit delayed headache in 10 healthy subjects and recorded the cranial arterial responses. NE at a dose of 0.025 microg kg(-1) min(-1) or placebo was infused for 90 min and the headache was followed for 14 h. Blood flow velocity in the middle cerebral artery (measured with transcranial Doppler) and diameters of the temporal artery and the radial artery (measured with ultrasound) were followed for 2 h. There were no changes in these arterial parameters after NE. In both treatment groups three subjects developed delayed headaches. Thus, stress by NE infusion did not result in delayed headache.


Asunto(s)
Circulación Cerebrovascular/efectos de los fármacos , Epinefrina/farmacología , Cefalea/etiología , Hemodinámica/efectos de los fármacos , Estrés Fisiológico , Adulto , Encéfalo/irrigación sanguínea , Encéfalo/efectos de los fármacos , Estudios Cruzados , Femenino , Humanos , Masculino , Arteria Cerebral Media/efectos de los fármacos , Arteria Radial/efectos de los fármacos , Método Simple Ciego , Arterias Temporales/efectos de los fármacos
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