Is hyperglycaemia an independent predictor of poor outcome after
acute stroke? Results of a long term follow up study
Christopher J Weir, Gordon D Murray,
Alexander G Dyker, Kennedy R
Lees
Abstract
Objective: To determine whether raised plasma glucose
concentration independently influences outcome after acute stroke or is
a stress response reflecting increased stroke severity.
Design: Long term follow up study of patients
admitted to an acute stroke unit.
Setting: Western Infirmary, Glasgow.
Subjects: 811 patients with acute stroke confirmed by
computed tomography. Analysis was restricted to the 750 non-diabetic
patients.
Main outcome measures: Survival time and placement
three months after stroke.
Results: 645 patients (86%) had ischaemic stroke and
105 patients (14%) haemorrhagic stroke. Cox's proportional hazards
modelling with stratification according to Oxfordshire Community Stroke
Project categories identified increased age (relative hazard 1.36 per
decade; 95% confidence interval 1.21 to 1.53), haemorrhagic stroke
(relative hazard 1.67; 1.22 to 2.28), time to resolution of symptoms
g72 hours (relative hazard 2.15; 1.15 to 4.05), and hyperglycaemia
(relative hazard 1.87; 1.43 to 2.45) as predictors of mortality. The
effect of glucose concentration on survival was greatest in the first
month.
Conclusions: Plasma glucose concentration above 8
mmol/l after acute stroke predicts a poor prognosis after correcting
for age, stroke severity, and stroke subtype. Raised plasma glucose
concentration is therefore unlikely to be solely a stress response and
should arguably be treated actively. A randomised trial is
warranted.
Acute Stroke Unit,
University Department of
Medicine and Therapeutics,
Western Infirmary,
Glasgow G11
6NT
Christopher J Weir, MRC training
fellow
Alexander G Dyker, lecturer in
stroke medicine
Kennedy R Lees, clinical
director, acute stroke unit
Robertson Centre for Biostatistics,
University of Glasgow,
Glasgow G12 8QQ
Gordon D
Murray, reader in medical
statistics
Correspondence to: Mr
Weir.
Full text on BioMedNet
Randomised comparison between adrenaline injection alone and
adrenaline injection plus heat probe treatment for actively bleeding
ulcers
Sydney S C Chung, James Y W Lau,
Joseph J Y Sung, Angus C W Chan, C W Lai,
Enders K W Ng, Francis K L Chan, M Y
Yung, Arthur K C Li
Abstract
Objective: To compare endoscopic adrenaline injection
alone and adrenaline injection plus heat probe for the treatment of
actively bleeding peptic ulcers.
Design: Randomised prospective study of patients
admitted with actively bleeding peptic ulcers.
Setting: One university hospital.
Subjects: 276 patients with actively bleeding ulcers
detected by endoscopy within 24 hours of admission: 136 patients were
randomised to endoscopic adrenaline injection alone and 140 to
adrenaline injection plus heat probe treatment.
Main outcome measures: Initial endoscopic
haemostasis; clinical rebleeding; requirement for operation;
requirement for blood transfusion; hospital stay, ulcer healing at four
weeks; and mortality in hospital.
Results: Initial haemostasis was achieved in 131/134
patients (98%) who received adrenaline injection alone and 135/136
patients (99%) who received additional heat probe treatment (P=0.33).
Outcome as measured by clinical rebleeding (12 v 5),
requirement for emergency operation (14 v 8), blood
transfusion (2 v 3 units), hospital stay (4
v 4 days), ulcer healing at four weeks (79.1%
v 74%), and in hospital mortality (7 v
8) were not significantly different in the two groups. In the subgroup
of patients with spurting haemorrhage 8/27 (29.6%; 14.5% to 50.3%)
patients from the adrenaline injection alone group and 2/31 (6.5%;
1.1% to 22.9%) patients from the dual treatment group required
operative intervention. The relative risk of this was lower in the dual
treatment group (0.17; 0.03 to 0.87). Hospital stay was significantly
shorter in the dual treatment group than the adrenaline injection alone
group (4 v 6 days, P=0.01).
Conclusion: The addition of heat probe treatment
after endoscopic adrenaline injection confers an advantage in ulcers
with spurting haemorrhage.
Department of Surgery,
Prince of Wales Hospital,
Chinese University of Hong Kong,
Shatin, New
Territories,
Hong Kong
Sydney S C
Chung, professor
James Y W
Lau, senior medical officer
Angus C W
Chan, lecturer
Enders K W
Ng, senior medical officer
M Y
Yung, research assistant
Arthur K C
Li, chairman and
professor
Department of Medicine,
Prince of Wales
Hospital,
Chinese University of Hong Kong,
Shatin,
New Territories,
Hong Kong
Joseph J Y
Sung, reader
C W
Lai, senior medical officer
Francis K L
Chan, senior medical
officer
Correspondence to: Dr
Li.
Full text on BioMedNet
Body weight: implications for the prevention of coronary heart
disease, stroke, and diabetes mellitus in a cohort study of middle aged
men
A Gerald Shaper, S Goya Wannamethee,
Mary Walker
See editorial by
Tunstall-Pedoe
Abstract
Objective: To determine the body mass index
associated with the lowest morbidity and mortality.
Design: Prospective study of a male cohort.
Setting: One general practice in each of 24 British
towns.
Subjects: 7735 men aged 40-59 years at screening.
Main outcome measures: All cause death rate, heart
attacks, and stroke (fatal and non-fatal) and development of diabetes,
or any of these outcomes (combined end point) over an average follow up
of 14.8 years.
Results: There were 1271 deaths from all causes, 974
heart attacks, 290 strokes, and 245 new cases of diabetes mellitus. All
cause mortality was increased only in men with a body mass index
(kg/m2) <20 and in men with an index 30.
However, risk of cardiovascular death, heart attack, and diabetes
increased progressively from an index of <20 even after age, smoking,
social class, alcohol consumption, and physical activity were adjusted
for. For the combined end point the lowest risks were seen for an index
of 20.0-23.9. In never smokers and former smokers, deaths from any
cause rose progressively from an index of 20.0-21.9 and for the
combined end point, from 20.0-23.9. Age adjusted levels of a wide range
of cardiovascular risk factors rose or fell progressively from an index
<20.
Conclusion: A healthy body mass index in these middle
aged British men seems to be about 22.
Department of Primary Care and Population
Sciences,
Royal Free Hospital School of Medicine,
London NW3
2PF
A Gerald Shaper, emeritus professor of
clinical epidemiology
S Goya Wannamethee,
British Heart Foundation research
fellow
Mary Walker, research
administrator
Correspondence to: Professor Shaper.
Full text on BioMedNet
Comparison of physiotherapy, manipulation, and corticosteroid
injection for treating shoulder complaints in general practice:
randomised, single blind study
Jan C Winters, Jan S Sobel, Klaas H
Groenier, Hans J Arendzen, Betty Meyboom-de
Jong
Abstract
Objective: To compare the efficacy of physiotherapy,
manipulation, and corticosteroid injection for treating patients with
shoulder complaints in general practice.
Design: Randomised, single blind study.
Setting: Seven general practices in the Netherlands.
Subjects: 198 patients with shoulder complaints, of
whom 172 were divided, on the basis of physical examination, into two
diagnostic groups: a shoulder girdle group (n=58) and a synovial group
(n=114).
Interventions: Patients in the shoulder girdle group
were randomised to manipulation or physiotherapy, and patients in the
synovial group were randomised to corticosteroid injection,
manipulation, or physiotherapy.
Main outcome measures: Duration of shoulder
complaints analysed by survival analysis.
Results: In the shoulder girdle group duration of
complaints was significantly shorter after manipulation compared with
physiotherapy (P<0.001). Also the number of patients reporting
treatment failure was less with manipulation. In the synovial group
duration of complaints was shortest after corticosteroid injection
compared with manipulation and physiotherapy (P<0.001). Drop out due
to treatment failure was low in the injection group (17%) and high in
the manipulation group (59%) and physiotherapy group (51%).
Conclusions: For treating shoulder girdle disorders,
manipulation seems to be the preferred treatment. For the synovial
disorders, corticosteroid injection seems the best treatment.
Department of General Practice,
University of
Groningen,
Ant Deusinglaan 4,
9713 AW Groningen,
Netherlands
Jan
C Winters, general practitioner
Jan S
Sobel, general practitioner
Klaas H
Groenier, statistician
Betty Meyboom-de
Jong, professor of general practice
Department
of Rehabilitation Medicine,
University Hospital Groningen,
9700 RB,
Groningen,
Netherlands
Hans J Arendzen, medical
director of clinic for rehabilitation medicine,
"Beatrixoord"
Correspondence to: Dr J C Winters,
Nieuwe Schoolweg 2A,
9756 BB Glimmen,
Netherlands.
Full text on BioMedNet
The social origins of infantile colic: questionnaire study
covering 76,747 infants
N S Crowcroft, D P
Strachan
Abstract
Objective: To describe risk factors for infantile
colic.
Design: Questionnaire administered by health
visitors.
Setting: Sheffield.
Subjects: Mothers of 76,747 infants born between 1
August 1975 and 31 May 1988, interviewed when the infant was 1 month
old.
Main outcome measures: Reporting of infantile colic
and its duration; weight of infant, feeding, state of the home,
socioeconomic characteristics of the parents, parents' age, and
mother's parity.
Results: The odds of reporting infantile colic were
increased with breast feeding (odds ratio of breast v
bottle feeding 1.35 (95% confidence interval 1.28 to 1.43)),
increasing parental age, lower parity, increasing parental age at
leaving full time education, and more affluent homes and districts of
residence. In a logistic regression analysis, mother's age and parity
and socioeconomic factors remained the most important risk factors for
the reporting of infantile colic (each P<0.005), and the effect of
breast feeding was attenuated (odds ratio of breast v
bottle feeding 1.09 (1.02 to1.15)).
Conclusion: At a population level, dietary factors
contribute little to mothers' reporting of infantile colic, and
dietary change should not be the primary intervention.
Department of Public Health Sciences, St
George's Hospital Medical School, London SW17 0RE
N S
Crowcroft, senior registrar in public health
medicine
D P Strachan, reader in
epidemiology
Correspondence to: Dr N S Crowcroft,
Epidemiology Department,
Scientific Institute of Public Health - Louis
Pasteur,
14 Juliette Wytsmanstreet,
Brussels B-1050,
Belgium.
Full text on BioMedNet
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