摘要:

Assessment of the results of medical intervention in acute stroke presents particular difficulties. Firstly the condition is extremely variable both in its clinical presentation and in its underlying pathology. Secondly, extreme care must be taken over the methods used to assess outcome. A reduction in mortality is no indication of success if there is a consequent increase in the number of survivors with extreme disability. Nor is it valid to compare functional or neurological outcome in survivors, since differences in mortality between treatment groups may upset the balancing effect of initial randomisation. Furthermore, overall ‘neurological scores’ are of dubious validity when the progress of patients with different patterns of disability has to be compared. Despite these difficulties a pragmatic approach can be used in which the design and conduct of a stroke trial closely resemble the normal clinical situation. This requires a knowledge of the range and natural history of stroke cases seen, best obtained from a stroke register. A pilot trial is then needed to assess the extent of variation in outcome and thus to estimate the numbers needed for the main study. The latter should then be conducted in two stages. Initially ‘neurological benefit’ should be assessed by counting the number of individual neurological signs which show improvement or deterioration in patients in each treatment group. Finally, a simple functional end-point should be compared in large numbers of patients with death being treated as equivalent to the worst possible non-fatal outcome. These principles are now being applied in a large, double-blind, placebo-controlled trial of low-dose β-blockers in conscious stroke

ISSN:0251-5350    

DOI:10.1159/000110130

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Injuries are the leading cause of death in the United States for those between 1 and 44 years of age and brain injuries are a major component of trauma. This report examines survival in a cohort of San Diego County, California, residents who incurred a brain injury in 1981. Cumulative risk of death over time, using the Cox Proportional Hazards Model, and predictors of death (determined by logistic regression) are used to evaluate survival. The results showed that about half of all brain-injured people who died, died in less than 2 h. Severe overall body damage and severe brain injury are the greatest causes of prehospital death. Even if they survived to the hospital, most people who die have brain injury as their underlying cause of death. Age as well as nature and severity of brain injury are the important predictors of in-hospital death. People who are discharged alive from the hospital have survival comparable to that of the population they came from. However, more die from trauma-related causes than would be expected.

ISSN:0251-5350    

DOI:10.1159/000110131

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

An epidemiological survey has been conducted during a 3-month period in the Regional Hospital of S. Giovanni Rotondo, a small city in Southern Italy. A total of 1,878 patients aged 12 years and over admitted to the hospital were randomized during the study period. Each patient was asked 7 specific questions focusing on symptoms most likely due to polyneuropathy. The sensitivity and specificity of the screening procedure were tested separately and found to be high. All cases who gave affirmative answers to at least 2 questions were carefully investigated in search of a polyneuropathy. Of the 20 cases which gave an affirmative answer to 2 or more questions, 19 (1 % or 10 cases per 1,000 hospital population) had a neurological examination fitting with the diagnosis of polyneuropathy. There were 3 males and 16 females with a median age of 61 years. Diabetes was the commonest associated disorder. The disease ran a mild course in 12 cases and was severe in only 1. The screening model used in the current study seems a valuable and simple approach for case ascertainment in epidemiological investigations of polyneuropathy.

ISSN:0251-5350    

DOI:10.1159/000110132

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

This work was set up to investigate the possible presence of peripheral nervous system involvement as a long-term effect of the exposure to dioxin in 152 subjects with chloracne from the Seveso area; 123 age- and sex-matched subjects living in nearby towns with similar environmental pollution formed the control group. The accident in Seveso took place in July, 1976, and this study was carried out from October, 1982, to May, 1983. Although a peripheral neuropathy was not found in any of the subjects, a significant increase of the number of individuals presenting at least two bilateral clinical signs (p < 0.05) or one abnormal electrophysiological parameter (p < 0.02) was found in the Seveso group. Principal component analysis did not show any subdivision between these two groups. The Fisher approach to discriminant analysis reveals a clear subdivision between the group of the most exposed subjects and randomly selected subgroups of control subjects. In conclusion, clinical and electrophysiological signs of peripheral nervous system involvement occur with a statistically increased frequency in the Seveso population 6 years after the accident, although a peripheral neuropathy was not evident in any of the chloracne patients using the World Health Organization diagnostic criteria.

ISSN:0251-5350    

DOI:10.1159/000110133

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

We studied the three most commonly used rating scales in Parkinson’s Disease (Hoehn and Yahr Clinical Staging, Webster Rating Scale, Columbia University Rating Scale) in order to examine the agreement between observers. Six neurologists, experts at using such scales, evaluated 48 patients suffering from the idiopathic form of Parkinson’s Disease. Reliability using the K index was moderate, although a slight superiority was found with the Columbia University Rating Scale. Analysis of the various items used has suggested that scales of disability could be a valid alternative to those exami

ISSN:0251-5350    

DOI:10.1159/000110159

出版商:S. Karger AG    

年代:1988

数据来源: Karger

ISSN:0251-5350    

DOI:10.1159/000110134

出版商:S. Karger AG    

年代:1988

数据来源: Karger

ISSN:0251-5350    

DOI:10.1159/000110135

出版商:S. Karger AG    

年代:1988

数据来源: Karger