Stroke; a journal of cerebral circulation
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While it is well known that longer duration of cardiac arrest (CA) is often associated with poorer long-term outcome, the influence of resuscitation efficacy on postischemia recovery is less clear. The objective of the present study is to investigate whether an inadequate and prolonged resuscitation after a shorter CA can lead to worse long-term outcomes than an effective resuscitation after a longer CA, provided that the total time from the onset of CA to the return of spontaneous circulation is comparable. ⋯ Effective resuscitation increased early reperfusion and improved survival after CA. The clinical implication is that inadequate and prolonged resuscitation may have detrimental effects on the recovery of CA patients.
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Randomized Controlled Trial Clinical Trial
Effect of controlled release/extended release metoprolol on carotid intima-media thickness in patients with hypercholesterolemia: a 3-year randomized study.
Beta-adrenergic blockade has in several studies been shown to improve survival after myocardial infarction. In animal experiments beta-blockers have also shown an antiatherosclerotic effect. The aim of this study was to test the hypothesis that the beta-blocker metoprolol succinate controlled release/extended release (CR/XL), when given to patients with hypercholesterolemia on concomitant lipid-lowering therapy, provides an additional antiatherosclerotic effect to that provided by the statins, measured as carotid intima-media thickness (IMT). ⋯ The results from the present study in patients with hypercholesterolemia under concomitant lipid-lowering therapy are the first clinical data to show an antiatherosclerotic effect of beta-blockade as additional therapy to statins. The data indicate that statin treatment and treatment with beta-blockers affect different mechanisms in the atherosclerotic process and have additive beneficial effects.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomized controlled study of stroke unit care versus stroke team care in different stroke subtypes.
The benefits of stroke unit management may vary according to stroke subtype. A post hoc analysis of the influence of stroke subtype on stroke unit effectiveness was undertaken by using prospective data collected in a randomized controlled trial. ⋯ Stroke units improve the outcome in patients with large-vessel infarcts but not in those with lacunar syndromes. For lacunar strokes, stroke unit management may be associated with higher initial health costs for equivalent benefit.
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Temperature is a well-known modulator of experimental cerebral injury. We hypothesized that hyperthermia would be associated with a worsened cognitive outcome after coronary artery bypass graft surgery (CABG). ⋯ This is the first report relating postoperative hyperthermia to cognitive dysfunction after cardiac surgery. Whether the hyperthermia caused the worsened outcome or whether processes that resulted in the worsened cognitive outcome also produced hyperthermia requires further investigation. In addition, interventions to avoid postoperative hyperthermia may be warranted to improve cerebral outcome after cardiac surgery.
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Clinical Trial
Effects of body position on intracranial pressure and cerebral perfusion in patients with large hemispheric stroke.
The purpose of this study was to prospectively evaluate the effects of body position in patients with large supratentorial stroke. ⋯ In patients with large hemispheric stroke without an acute ICP crisis, cerebral perfusion pressure was maximal in the horizontal position although ICP was usually at its highest point. If adequate cerebral perfusion pressure is considered more desirable than the absolute level of ICP, the horizontal position is optimal for these patients.