Early supported discharge of patients with acute stroke: a randomized controlled trial.

PURPOSE: To evaluate the feasibility and effectiveness of early supported discharge (ESD) following acute stroke. METHOD: An ESD scheme was compared to conventional rehabilitation in a randomized controlled trial. All patients admitted with acute stroke were considered for inclusion. Eighty-eight (20.2%) were found to be eligible and 82 were randomized either to early supported discharge (n = 42) or conventional rehabilitation (n = 40). The primary outcome measure was the Nottingham Extended Activities of Daily Living Scale. The General Health Questionnaire, the Montgomery Aasberg Depression Rating Scale, mortality, placement and patient and career satisfaction served as secondary outcome measures. RESULTS: Median length of stay was reduced from 31 days in the conventional hospital rehabilitation group to 22 days in the early supported discharge group (p = 0.09). No differences were found regarding primary outcome. The General Health Questionnaire score showed a significant difference in favour of the early supported discharge group at three months (19.5/24, p = 0.02), but not at six. At six months, the proportion of patients being dead or in institution showed a trend of being higher in the conventional rehabilitation group (OR 3.8, 95% CI 0.8-23). CONCLUSIONS: Early supported discharge after stroke is feasible and it is possible that it has benefits compared with conventional rehabilitation.

Cerebral microembolus detection in an unselected acute ischemic stroke population.

OBJECTIVE: The aims of this study were firstly to determine prevalence, frequency, and clinical significance of cerebral microemboli in an unselected acute ischemic stroke population and secondly to examine how this information may improve ischemic stroke subtype classification. METHODS: We intended to perform transcranial Doppler (TCD) microembolus monitorings of the middle cerebral artery (MCA) in the symptomatic hemisphere for 45 min in 120 consecutive patients with internal carotid artery territory ischemia. The first examination was performed within 72 h from start of symptoms and the second 5 +/- 1 days later. Platelet and coagulation system activation were measured following TCD monitoring in 38 patients. The strokes were subtyped using the TOAST classification criteria, and the patients' clinical status was assessed at discharge using the Scandinavian Stroke Scale and the Barthel Index. RESULTS: Microembolus monitoring was technically possible in 83 (69.2%) of the 120 patients. Thirty-two (26.6%) patients had an inadequate temporal bone acoustic window or were too restless to allow long-time monitoring. In 5 (4.2%) patients the relevant MCA was occluded. Twenty-two (26.5%) of the 83 patients had microemboli despite the fact that over 90% were receiving an antiplatelet or an anticoagulant treatment. The mean frequency of microemboli was 6.7 +/- 13.6 per 45 min. Microemboli were more prevalent in assumed cardioembolic stroke than in other subtypes of ischemic stroke (p = 0.047). We found no association between the presence of cerebral microemboli and the clinical outcome or the parameters for platelet or coagulation system activation. The presence of microemboli was not associated with in-hospital deaths (p = 0.17), whereas MCA occlusion was (p = 0.01). CONCLUSIONS: Cerebral microemboli are frequent in unselected acute ischemic stroke patients despite antiplatelet or anticoagulant treatment. TCD detection of microemboli provides valuable pathophysiological information and may, therefore, improve current ischemic stroke subtype classification.

[Poisoning with long-acting anticoagulants]. / Forgiftninger med langtidsvirkende antikoagulanter.

Until last year, all rodenticides that could be marketed freely in Norway contained anticoagulants. In recent years rodenticide manufacturers have replaced warfarin by so-called "superwarfarins" as the active substances in their products. The latter are more toxic, also in a human context. One single intake can produce an anticoagulatory effect which may last for 50 to 60 days, and the intake of larger quantities over a period of time can induce the same effect for close to seven months. We describe two patients who were poisoned with bromadiolone. One of them had to be treated with vitamin K1 for six months. Reference is further made to similar casuistics described in the literature. Finally, the authors outline a recommended method of treatment.

[Ischemic colitis. Clinical, coloscopic and biopsy findings illustrated by 10 cases]. / Ischemisk kolitt. Klinikk, koloskopiske og bioptiske funn illustrert med to tilfeller.

Transient ischemia of the colon may be so severe as to cause segmental strictures, but in other cases it may be so slight that the damage heals up without any demonstrable morphological changes. The patients are often older than 60 years. Characteristic clinical features are acute abdominal pain and simultaneous bloody diarrhea. The diagnosis is normally made on the basis of clinical and colonoscopic findings and typical histological changes in biopsies. It is important to make a correct diagnosis at an early stage because close observation is necessary for some days. No specific treatment is needed.