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  • 1
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Stroke Unit ; Schlaganfallspezialstation ; Hirninfarkt ; Zerebrale Ischämie ; Monitoring ; Transkraniale Dopplersonographie ; Key words Stroke unit ; Cerebral ischemia ; Monitoring ; Stroke treatment ; Transcranial Doppler sonography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary We studied the effects of stroke unit care in an acute Neurology department on the outcome and the length of hospital stay in acute stroke patients. After an emergency evaluation on admission including CCT, ultrasound studies and ECG the patients were treated on a specialist stroke unit for an average 3.9 days. For 48 ± 24 h monitoring of blood pressure, ECG, pO2 and transcranial Doppler sonography was instituted. Stroke unit treatment reduced the length of hospital stay from an average 15.8 days in the time period before institution of the stroke unit to 12.9 days. This effect was especially marked in patients with acute occlusion of major intracranial arteries (before stroke unit treatment: n = 33; hospital stay 22.5 days; after stroke unit treatment: n = 54; hospital stay 13.9 days). Clinical deterioration in acute ischemic stroke was related to reduction of cerebral blood flow velocities due to blood pressure changes or space occupying effects. Monitoring on the stroke unit allowed immediate treatment of systemic hypotension, cerebral edema or cardiac arrhytmias. Transcranial Doppler sonography revealed HITS in 6/55 acute stroke patients without new clinical symptoms. Monitoring on the stroke unit improved the specific care for acute stroke patients. The length of hospital stay was reduced after stroke unit care.
    Notes: Zusammenfassung Wir untersuchten die Effekte einer Stroke Unit in einem neurologischen Akutkrankenhaus auf das Outcome und die Länge des Krankenhausaufenthalts nach akutem Schlaganfall. Nach einer notfallmäßigen Diagnostik bei der Aufnahme einschließlich CCT, Ultraschalldiagnostik und EKG wurden die Patienten auf einer spezialisierten Stroke Unit für durchschnittlich 3,9 Tage behandelt. Für 48 ± 24 h erfolgte ein Monitoring von Blutdruck, EKG, pO2 und transkranialer Dopplersonographie. Durch die Behandlung auf der Stroke Unit ließ sich die Länge des Krankenhausaufenthalts von durchschnittlich 15,8 Tagen in dem Zeitraum vor Einrichtung der Stroke Unit auf 12,9 Tage verkürzen. Dieser Effekt war besonders ausgeprägt bei Patienten mit akutem Verschluß intrakranialer Gefäße (vor der Behandlung auf der Stroke Unit: n = 33; Krankenhausaufenthalt für 22,5 Tage; nach Einrichtung der Stroke Unit: n = 54; Länge des Krankenhausaufenthalts 13,9 Tage). Eine klinische Verschlechterung bei Patienten mit akuter zerebraler Ischämie zeigte sich bei einer Reduktion der Blutflußgeschwindigkeiten durch Blutdruckschwankungen oder zerebrale Raumforderung. Das Monitoring auf der Stroke Unit machte die sofortige gezielte Behandlung einer systemischen Hypotension, eines zerebralen Ödems bzw. kardialer Arrhythmien möglich. Das Monitoring mittels transkranialer Dopplersonographie zeigte HITS bei 6 von 55 akuten Hirninfarktpatienten, ohne daß neue neurologische Symptome oder eine Befundverschlechterung auftraten. Das Monitoring auf der Stroke Unit verbessert die spezifische Behandlung akuter Hirninfarktpatienten. Die Länge des Krankenhausaufenthalts läßt sich durch die Behandlung auf einer Stroke Unit verkürzen.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Clinical autonomic research 7 (1997), S. 131-135 
    ISSN: 1619-1560
    Keywords: heart rate variability ; blood pressure waves ; deep breathing ; spectral analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The measurement of heart rate variation during forced breathing (HRDB) is a well-known clinical test of parasympathetic function. It is known that normal values of HRDB are strongly dependent on age. However, little is known about other physiological factors that may lead to reduced HRDB values that may mimic parasympathetic failure. Thirty-two normal subjects (age 56.7±12.4 years) and 32 neurological patients with pathological autonomic test findings (age 57.9±10.2) were studied. Oscillations in heart rate and in mean arterial blood pressure were recorded in the supine position during forced breathing (6 cycles/min) using the Finapres monitor. Amplitudes of heart rate and blood pressure waves at 6 cycles/min (HR6 and ABP6) as well as gain values (Gain6=HR6/ABP6) and phase differences ({ie131-1}) between HR and ABP waves were calculated by means of spectral analysis. The mean (±SD) HR6 in normal subjects was 6.34±3.36 cycles/min with a mean ABP6 of 5.11±2.49 mmHg. HR6 correlated significantly with age (r=−0.426) and with ABP6 (r=0.602). No significant correlation was found between HR6 and mean blood pressure, mean heart rate or sex. From 24 patients with pathological findings in the classical HRDB value, only nine could be classified as pathological when the effect of ABP6 was considered. In conclusion, ABP variations significantly influence the amplitude of heart rate variations during forced breathing. We interpret these findings in terms of a baroreflex mechanism of HRDB including both vagal and sympathetic efferents. Normal reference value tables for clinical HRDB studies should not only consider age but also the amplitude of blood pressure variations.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Clinical autonomic research 7 (1997), S. 311-314 
    ISSN: 1619-1560
    Keywords: idiopathic Parkinson's disease ; sympathetic dysfunction ; autonomic evaluation ; spectral analysis ; baroreflex
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Standard autonomic tests (heart rate response to deep breathing-HR db , heart rate and systolic blood pressure response to tilt-ΔHR and ΔSBP) and spectral analysis of heart rate and arterial blood pressure and their transfer function (for the mid-frequency band a measure of baroreflex sensitivity) were performed in 20 patients with idiopathic Parkinson's disease (IPD) and 20 age-matched controls. Patients showed significantly diminished ΔSBP, and reduced sympathetic vasomotor and cardiomotor outflow (diminished Mayer waves), consistent with an alteration of the efferent arc of the baroreflex. These results were only significant in long-standing IPD (IPD-1, 〉5 years), whereas patients with short disease duration (IPD-s, 〈5 years) showed values comparable to controls. Respiratory-related heart rate variability was slightly reduced in IPD-1 but this was mainly due to diminished respiratory effort, indicated by low respiratoryrelated blood pressure variability. We conclude that autonomic abnormalities are only present in long-standing IPD and consist in reduced sympathetic vasomotor and cardiomotor outflow.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Clinical autonomic research 6 (1996), S. 157-161 
    ISSN: 1619-1560
    Keywords: baroreflex sensitivity ; power spectral analysis ; transfer function analysis ; autonomic nervous system ; heart rate ; blood pressure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Human baroreflex sensitivity is traditionally derived from changes in heart rate due to alterations of the baroreceptor input (pharmacologically or physically induced blood pressure changes). Transfer function analysis (TFA) of changes in heart rate (output function) and physiological blood pressure oscillations (input function) at approximately 0.1 Hz (Mayer waves) has already been accepted as a measure of baroreflex sensitivity (BRS). Transfer function analysis provides gain and phase shift values for each frequency band and body position. We performed TFA in 50 normal subjects in the supine and tilted positions, at mid-frequency (0.05–0.15 Hz) and high-frequency (0.15–0.33 Hz) bands, recording heart rate and blood pressure continuously with a Finapres device. Gain values were in accordance with previous studies. Phase shifts lay within a narrow range for all frequency bands and positions. High correlations were found between phase shifts of the same frequency band, but not for those of the same position. This supports the idea that the transfer mechanisms for the two frequency bands may, in part, be different. There was a poor correlation between gain and phase values on the one hand and, on the other hand, further spectral measures and the results of standard autonomic tests. This suggests that TFA may not only be a measure of BRS, but also a complementary tool for evaluation of autonomic function.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Clinical autonomic research 6 (1996), S. 71-74 
    ISSN: 1619-1560
    Keywords: syncope ; head-up tilt ; transcranial Doppler
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The purpose of the present study was to investigate changes in cerebral circulation during neurocardiogenic syncope (NCS). Twenty patients with a history of unexplained syncopes were studied over a 45 min period in a tilted position. Heart rate and arterial blood pressure were recorded non-invasively using Finapres. Cerebral blood flow velocity of both middle cerebral arteries was measured with transcranial Doppler (TCD). Ten patients (50%) developed a NCS during the tilt test, with a strong reduction in blood pressure (mean, 48/34 mmHg) and heart rate (mean, 54 beats/min). Simultaneously, diastolic blood flow velocities dropped to values close to zero. However, systolic blood flow velocities did not decrease. In consequence, the pulsatility index (PI) increased considerably from 0.93 to 2.01. The increase in PI suggests that there is a constriction of cerebral resistance vessels during NCS. Despite the drop in blood pressure and the putative increase in cerebrovascular resistance, systolic blood flow velocities remained unchanged in the TCD records. This fact can be explained by a lumen narrowing of the middle cerebral artery at the site of insonation. In conclusion, the typical changes in cerebral blood flow velocity during NCS are probably due to a strong constriction of both the proximal and the peripheral segments of cerebral arteries. It is clear that, in addition to vasodepression and cardiac inhibition, cerebral vasoconstriction is a further mechanism in the pathogenesis of a NCS.
    Type of Medium: Electronic Resource
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