Intravenous thrombolysis and three-year ischemic stroke mortality.

BACKGROUND AND PURPOSE: Intravenous thrombolysis (IVT) in ischemic stroke (IS) does not reduce three-month mortality; however, longer-term survival after IVT has not been clearly established. Thus, we aimed to compare three-year mortality after IS in IVT-treated vs non-treated patients and to indicate predictors of long-term mortality after IVT. METHODS: We have evaluated data of 366 subjects with IS (196 treated with IVT and 170 non-treated with IVT, whose age, sex, and calendar time of IS occurrence matched the control group) collected via the Pomeranian Stroke Register. We estimated the three-year survival and its determinants in both groups. RESULTS: In univariate analysis, IVT was not associated with three-year mortality (OR 0.68; 95% CI 0.44-1.05). Independent predictors for unfavorable long-term outcome in a Cox regression model were older age, parenchymal hemorrhage type 2 (ph2), and modified Rankin scale >2 points at discharge from the hospital. IVT was strongly associated with a lower risk of death in the period 0-36 months from IS (HR 0.44, 95% CI 0.28-0.69, P<.001). CONCLUSIONS: Treatment of IS with intravenous recombinant tissue plasminogen activator was associated with increased survival during the three-year follow-up.

Long-term mortality after stroke is higher than after myocardial infarction.

Mortality caused by coronary heart disease and ischemic stroke (IS) in Poland is still among the highest in Europe. Because acute myocardial infarction (AMI) and IS share major common risk factors, it would be expected that trends in long-term mortality (LTM) and incidence of these two diseases would be similar. Nevertheless, better AMI acute phase therapy and older age of IS patients make post-IS and post-AMI prognosis difficult to compare. The aim of the study was to verify the thesis that, regardless of age and sex, the long-term prognosis is worse for post-IS than for post-AMI subjects. The study was conducted in Polish city-Gdynia (250,000 of inhabitants) among 997 subjects (464 post-IS, 533 post-AMI) randomly selected from all post-IS and post-AMI patients, witch survived hospitalization period in years 2000-2005. The observation period varied from 1 month to 11 years. LTM was shown as standardized mortality ratios. Kaplan-Meyer survival curves and Cox proportional hazard regression model were used to compare LTM in post-IS and post-AMI subjects. Post-IS and post-AMI groups did not differ by sex or age of event. Fewer deaths were recorded in post-AMI group (38.8 vs. 51.5 %, OR 0.60, 95 % CI 0.46-0.77). This difference was most evident in males (39.7 vs. 57.8 %, OR 0.48, 95 % CI 0.34-0.66). Kaplan-Meyer estimates showed faster reduction of survival probability in the post-IS males. In Cox regression model presence of IS increased long-term mortality in males. Long-term prognosis was worse for post-IS males in comparison with post-AMI population from Gdynia.

Intravenous rt-PA in patients with ischaemic stroke and renal dysfunction.

OBJECTIVE: Renal dysfunction (RD) increases risk for ischaemic stroke (IS). The impact of RD on the effects of iv-thrombolysis in the Caucasian population has not been fully determined. AIMS: To evaluate the associations between RD and the outcome of iv-thrombolysis in Caucasian patients with IS. METHODS: The observational, multicentre study included 404 patients with IS who were treated with iv-thrombolysis. RD was defined as estimated glomerular filtration rate ≤ 60 ml/min/1.73 m(2). Outcome was assessed with modified Rankin Score at 3 months after the stroke onset. RESULTS: Medians baseline NIHSS score did not differ between groups of patients with and without RD (12.0 vs. 11.0 pts, p=0.33). Unfavourable outcome was found in 52.1% of patients with and in 41.2% of patients without RD (p=0.05), mortality was higher in patients with RD (29.9% vs. 14.3%, p<0.001), and the presence of haemorrhagic transformation (HT) did not differ between the groups (17.1% vs. 17.1% respectively, p=0.996). A multivariate analysis showed no impact of RD on the unfavourable outcome (OR 0.98; 95%CI 0.88-1.10), mortality (OR 0.92; 95%CI 0.81-1.05) or presence of HT (OR 1.03; 95%CI 0.90-1.18). CONCLUSIONS: We found no impact of RD on the safety and efficacy of iv-thrombolysis in Caucasian patients with IS.

Pre-hospital delays and intravenous thrombolysis in urban and rural areas.

INTRODUCTION: It is crucial to understand the reasons behind pre- and in-hospital delays to improve nationwide access to effective treatment for acute stroke. AIMS: To evaluate the pre- and in-hospital delays and to compare the intravenous (IV) thrombolysis rates in the urban and rural areas of the Province of Pomerania, Poland. MATERIALS & METHODS: We evaluated the medical records of 2134 patients treated in the stroke units (SUs) and consecutively reported to the Pomeranian Stroke Register from June 2006-December 2007. RESULTS: The time of ischaemic stroke onset was known in 488 (59%) of the 834 urban patients and in 744 (70%) of the 1063 rural patients (P < 0.001). The proportion of patients who called the emergency medical services with a delay of >45 min was similar in both locations: urban, 314/488 (64.3%) vs rural, 490/744 (65.8%). Although the proportion of patients who reached the emergency room within 3 h was higher in the rural areas (29.0% vs 24.3%; P = 0.02), only 4.2% of these patients received IV thrombolysis compared with 23.1% in the urban areas (P < 0.001). The proportion of patients who did not seek any kind of professional medical help prior to admission was lower in the rural areas (29/744 (3.9%) vs urban 50/488 (10.2%)) (P < 0.001). CONCLUSIONS: Pre-hospital delays reduced the number of patients eligible for IV thrombolysis in both rural and urban areas. The low proportion of patients treated with IV thrombolysis in rural SUs may be attributed to ineffective in-hospital procedures.

Assessment of the quality of secondary ischemic stroke prevention in selected urban areas of Poland and Ukraine: the ASCEP study results.

UNLABELLED: The aim of this study was to assess the quality of secondary ischemic stroke (IS) prevention among subjects after IS from selected urban areas of Poland (Gdynia, G) and Ukraine (Lutsk, L). METHODS: The study was conducted on representative samples of post-IS patients from G and L who suffered from IS in the years 2000-2005. A questionnaire, anthropometric and blood pressure (BP) measurements and laboratory tests were performed. RESULTS: The data of 440 patients were collected. Only 47% in G and 58% in L (p < 0.05) had visited a neurologist within 6 months before the interview. Results of the prevalence and control of consecutive IS risk factors were estimated: (1) arterial hypertension (prevalence: 88% G, 92% L, p = 0.1; BP <140/90 mm Hg: 23% G, 16% L, p = 0.02); (2) hypercholesterolemia (prevalence: 90% G, 76% L, p < 0.05; total cholesterol <175 mg/dl: 11% G, 6% L, p = 0.05); (3) self-reported diabetes or glycemia >125 mg/dl: 22% G, 17% L, p = 0.08; (4) smoking: 26% men versus 16% women in G, 33% men versus 2% women in L, p < 0.05, and (5) self-reported atrial fibrillation: 28% G, 7% L, p < 0.05. Antiplatelet drugs or oral anticoagulants were taken by 51% G versus 45.5% L (not significant). CONCLUSIONS: The quality of secondary IS prevention is insufficient, and there is a need for complex educational interventions in patients, their families and medical staff. Our data also call for organizational changes in the health service both in Poland and Ukraine.

Intravenous recombinant tissue plasminogen activator for acute stroke in Poland: an analysis based on the Safe Implementation of Thrombolysis in Stroke (SITS) Registry.

OBJECTIVES: Intravenous thrombolysis was conditionally approved in the European Union (EU) in 2002, under the requirement of entering all patients into Safe Implementation of Thrombolysis in Stroke - Monitoring Study (SITS-MOST). Countries not belonging to the EU by 2002, i.e. Poland were invited to enter data into the SITS International Stroke Thrombolysis Registry (SITS-ISTR). The aim of this study is to compare the safety and efficacy of thrombolysis in the Polish SITS-ISTR stroke patient population with patients registered in SITS-MOST. METHODS: 481 patients in Poland were reported between 2003 and 2007. Baseline and outcome data of Polish patients were compared with SITS-MOST. RESULTS: Most of the baseline characteristics did not differ between the groups. The most important was the onset-to-needle and door-to-needle times were significantly longer in Polish patients, 150 vs 136 min and 82 vs 68 min, respectively (P < 0.001). The symptomatic intracranial haemorrhage and independence rates at 3 months were similar in both populations. Polish patients had a significantly higher 3-month mortality rate, 18.6% vs 11.3% (P < 0.001). CONCLUSIONS: Because of higher mortality the study implies the need to improve the organization of thrombolysis services and provides the rationale to continue the monitoring of treatment in Poland.

Cerebral blood flow changes in Parkinson?s disease associated with dementia.

Dementia is one of the main non-motor symptoms of Parkinson's disease (PD) and it is diagnosed in about 30% of cases. Its aetiology remains unclear and contributing factors are controversial. Dementia may be more common in old patients with severe motor symptoms and mild cognitive impairment. Clinico-pathological studies show the association between dementia in PD and the age-related group of dementias, such as AD and VaD. A valuable aid in the assessment of dementia in PD is cerebral blood flow (CBF) brain SPECT scanning. It shows three different patterns of rCBF reduction, including frontal lobe hypoperfusion, Alzheimer-like type of hypoperfusion and multiple, vascular defects. The heterogeneity of rCBF reduction may reflect the multifactorial pathophysiology of dementia in PD. It may result from concomitant AD pathology, cerebrovascular disease, destruction of nigro-striato-frontal projection or may be a distinct disease of different aetiology.

[Evaluation of long term results of surgery for myasthenia gravis (with regard to electrophysiological studies)]. / Ocena odleglych wyników leczenia operacyjnego miastenii (z uwzglednieniem badan elektrofizjologicznych).

The study aimed to quantify clinical and electrophysiological results of thymectomy. The study included 43 patients (14 men and 29 female) with the peak age of onset of symptoms between 20 to 40 years. The mean duration time after the thymectomy was 36 months. In all the patients the supramaximal repetitive nerve stimulation was performed. In 31 patients the clinical results of thymectomy were good (remission or reduced post operative dosage of drugs). The abnormal decrement in repetitive nerve stimulation was detected in 38 patients. The study demonstrates that clinical improvement after thymectomy is not equal to normalization of neuromuscular junction and clinical remission did not predict the final course of myasthenia.

[Neurological examinations of workers with chronic exposure to manganese dioxide during the production of piles and batteries]. / Badania neurologiczne pracowników przewlekle narazonych na dzialanie dwutlenku manganu w produkcji ogniw i baterii.

The authors examined 118 workers making piles and batteries under conditions of exposure to toxic action of manganese dioxide dust. Neurological and EEG investigations showed presence of pyramidal tract lesion signs in 16.9% of workers, extrapyramidal syndromes in 6.8%, peripheral nervous system involvement in 13.5% and neurotic complaints in 42.4%. The frequency of neurological manifestations was directly proportional to the duration of work in exposure. The difference in the frequency of neurotic complaints and signs of peripheral and central nervous system damage was statistically significant between the group exposed to manganese dioxide and the control group. EEG investigations were performed in 51 workers and abnormalities were found in 21 cases.

[Case of Hakim's syndrome]. / Przypadek zespolu Hakima

The authors report a case of Hakim's syndrome developing in a 53-year-old man. Manifestations of parkinsonian syndrome prevailed. After implantation of a Pudenz-type valve significant improvement was obtained which confirms the clinical diagnosis.

[Diagnostic difficulties in a case of leukemia with radicular symptoms]. / Trudnosci rozpoznawcze w przypadku bialaczki z objawami korzeniowymi

The author describes a 20-year-old patient with leukaemia and with meningoradicular symptoms. The first neurological symptoms developed 2 years after disclosure of haematological changes. Despite treatment with steroids, intrathecal Methotrexate and radiotherapy the patient died 3 years after the diagnosis of leukaemia had been established. Myeloblastic leukaemia was confirmed on autopsy. The importance of early intrathecal Methotrexate treatment is stressed.

Cerebral lesions of mature newborn due to perinatal hypoxia. I. Placental and umbilical cord pathology.

The structure and topography of the damages in the central nervous system of mature (35th week of pregnancy and more) human newborns, who died in the perinatal period due to hypoxia, have been investigated. Two homogenous groups were separated: In the first group hypoxia was due to placental pathology, in the second group it was the result of umbilical cord pathology. The greatest damages of the cells in paleocortex were found in the region of Ammon's horn, in neocortex the most seriously injured were parietal and occipital lobes.

Cerebral lesions of mature newborn due to perinatal hypoxia. II. Mother's diseases.

The influence of chronic intrapregnancy hypoxia caused by mother's diseases (toxemia, gravidarum, hypochromic anemia, diabetes) on the brain of a mature newborn has been investigated. Besides the vast damages of the parieto-occipital cortex, Ammon's horn (entorhinal) motor and insula cortex there were also some damages of the cerebellum and the brain stem cells. The damages of the cells in the brain stem seem to be one of the causes of the abnormal perinatal adaption.