Background and PurposeTo assess the prevalence of asymptomatic abnormalities on magnetic resonance imaging of the brain and their possible relation to hypertension, heart disease, and carotid artery disease, we studied 77 randomly selected subjects (mean age, 65.1 years; range, 36 to 95 years) with no history of focal brain lesions.Methods The study protocol included magnetic resonance imaging of the brain, transthoracic and transesophageal echocardiography, ultrasonography of the carotid arteries, and electrocardiographic recording. Deep and periventricular white matter hyperintensities on magnetic resonance imaging were assessed both separately and together.Results On magnetic resonance imaging of the brain 62.3% (95% confidence interval [CI], 51.5% to 73.2%) of the subjects had white matter hyperintensities. These abnormalities increased significantly with age (x 2 test; P=.OO01), from 13.6% (95% CI, 0% to 28.0%) of subjects aged younger than 55 years to 85.2% (95% Q , 71.8% to 98.6%) of subjects aged 75 years or older. Six subjects had deep gray matter hyperintensities localized in the basal ganglia, and one had a cerebellar infarction. Stepwise logistic regression analysis identified age and a history of heart disease (but not echocardiographic

Fluorescein angiography (FA) was performed on 83 patients (68 diabetics) with foot ulcer or gangrene. Densitometric measurements were made on the FA images, and different FA parameters were defined. These parameters, as well as systolic ankle and toe blood pressures, were evaluated for predicting the future course, i.e., whether healing would occur or whether major amputation below or above the knee had to be performed. The toe slope (i.e., the rate of increase of fluorescence on the big toe during the first 10 seconds after its appearance on the toe) predicted healing correctly in 0.83 and major amputation in 0.88. The ankle and toe pressures had only slightly lower predictive value. The combination of ankle pressure and toe slope predicted healing correctly in 0.91 and major amputation in 0.88. When ankle pressure cannot be measured, FA is the method of choice. Further, FA provides information on regional blood flow unobtainable by any other method.

The aim of the study was to determine the prevalences of carotid artery disease and major and minor potential cardioembolic sources (1) in patients with cerebral infarction and age-matched control subjects and (2) in different clinical subtypes of cerebral infarction. A series of 166 consecutive patients with cerebral infarction and 59 control subjects was examined. The study protocol included clinical subtyping of the cerebral infarctions, ultrasonography of the carotid arteries, transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), ECG, and examination of the brain with computed tomography, magnetic resonance imaging, or autopsy. Carotid artery stenosis > or = 80% or occlusion was present in 35 (21%) patients but in no control subjects (P < .001; chi 2 test). A major potential cardioembolic source was detected in 65 (39%) patients and 3 (5%) control subjects. Atrial fibrillation was present in 35 (21%) patients and 3 (5%) control subjects at initial ECG (P < .01) and in 47 (28%) patients at repeat examination; 17 patients had paroxysmal atrial fibrillation. Sinus rhythm and a major potential cardioembolic source were detected in 18 (11%) patients but in no control subjects (P < .01) at TTE (all patients and control subjects examined) or TEE (118 patients and 52 control subjects examined). The frequency of a minor potential cardioembolic source detectable at TTE or TEE was similar in the patient and control groups (51% and 53%, respectively [NS]) and increased significantly with age. A finding of carotid artery stenosis > or = 80% or occlusion, atrial fibrillation, or a major cardioembolic source detected at TTE or TEE was more frequent among patients with cortical symptoms from anterior or middle cerebral artery territories than among those with lacunar syndromes (66% versus 22%, respectively). The probable source of cerebral infarction was identified in most of the 166 patients: cardiac embolism in 28% of cases (n = 46), carotid artery disease in 8% (n = 14), both cardiac embolism and carotid artery disease in 7% (n = 11), and lacunar infarction in 23% (n = 38). In 57 (34%) of the patients no unequivocal cause of the cerebral infarction was found. The prevalences of carotid artery and heart disease differ significantly between clinical subtypes of cerebral infarction. The cause of cerebral infarction remains uncertain in one third of patients. Because a minor potential cardioembolic source occurs in about 50% of both patients and control subjects, this finding is of questionable value as a risk factor for stroke in the elderly.

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Objective To evaluate the glomerular filtration rate IGFR and incidence of anastomotic stenosis in patients with urinary diversion by ileal or colonic conduit (refluxing or anti-reflux uretero-intestinal anastomosis) or with a continent caecal reservoir. Patients and methods All conduit urinary diversions performed from 1 9 i 7 to 1984 were randomized by type (ileal or colonic) and by the method of ureteric implantation (with or without anti-reflux technique).In continent caecal reservoirs anti-reflux implantation was used for both ureters. Total and separate GFR were measured pre-operatively and after a mean follow-up of 123 months (range 36-198) with 51Cr-EDTA and scintillation renography. Results Of the 56 evaluable patients. 18 had an ileal and 20 a colonic conduit, and 18 had a continent reservoir. The total mean GFR fell from 88 to 71 mllmin in the ileal group. from 84 to 65 mI,/min in the colonic group and from 1 0 0 to 85 mL/min in the reservoir group. Separate GFR did not differ significantly between kidneys with and without reflux protection in the patients with a conduit diversion. Strictures occurred in 1 5 uretero-intestinal anastomoses and were unrelated to the mode of ureteric implantation (in the conduit groups). Renal function improved after ureteric reimplantation in six of Seven kidneys. but after balloon dilatation in only one of fire. Conclusion GFR fell moderately in all three groups. with no significant intergroup difference. and the continent caecal reservoir compared favourably with conduit diversion. The fall in separate GFR did not differ significantly between kidneys with and without reflux protection. Surgical exploration of uretero-intestinal stenosis is recommended if renal function is threatened. Keywords Glomerular filtration rate. ileal conduit. colonic conduit. continent caecal reservoir, refluxing ureteric anastomosis. anti-retlux ureteric anastomosis introduction 'The number of proposed techniques for continent cutaneous urinary diversion and bladder substitution as alternatives to conduits has increased dramatically during the past decade. To achieve acceptability. these nrw methods must be shown to protect renal function at least as well as conduit diversion. which should serve as the 'gold standard'. However, there are some controversial aspects of conduit diversion. These include the choice of intestinal segment for the conduit and. in particular, whether nonrefluxing or refluxing uretero-intestinal anastomosis is optimal for the preservation of renal function. The generally held belief that anti-reflux ureteric implantation is beneficial for preservation has been proven only experimentally [ 11. The results from long-term follow-up after anti-reflux implantation into colonic conduits havr tended to be unsatisfactory. possibly due to failure of the anastomosis to prevent reflux. and not superior to those achieved with ileal conduit [ 2.31.To explore the choice of optimal intestinal segment for urinary conduit and methods of ureteric implantation, a prospective study was b...

Anti-reflux ureteric anastomosis seems to be important for preventing scarring and bacteriuria in the upper urinary tract of patients with a conduit urinary diversion. Despite the anti-reflux technique of ureteric implantation, most patients with a continent reservoir had renal scarring, though it was generally less severe than in patients with a conduit urinary diversion.

Forty-three pairs and 10 triplets of bicycle exercise tests were performed. Seven different workload incremental procedures were used. Triplets and nine pairs of tests were performed by healthy subjects (n = 19) and 34 pairs of tests by patients (n = 19) 3 and 15 months after coronary by-pass operation. From each test result a hypothetical maximal workload sustainable for 6 min (Wmax6') was calculated. The two and three Wmax6' values obtained for each pair and each triplet of tests, respectively, were compared. The ratios between the corresponding Wmax6' values were 1.00 +/- 0.01 (mean +/- SE) for healthy subjects and 0.96 +/- 0.03 for patients. It is concluded that working capacities determined by bicycle exercise tests with different workload incremental procedures can be compared via the Wmax6'.

Transoesophageal echocardiography renders a better image than transthoracic echocardiography of cardiac changes especially at the atrial level, and of atherosclerotic changes in the aorta. Although several studies on stroke patients have included transthoracic and transoesophageal echocardiography, the relevance of the reported findings remains unclear because of limited information on the prevalence of cardiac changes related to cardioembolism in a control population without stroke. In order to define a non-hospitalized group of volunteers without previous stroke or transient ischaemic attack, we randomly selected a group of 68 volunteers (mean age 65.4 years). These volunteers were divided into two groups: the elderly group, 65 years or older (n = 38) and the younger group, younger than 65 years (n = 30). The subjects underwent transthoracic and transoesophageal echocardiography, sonography of the carotid arteries, and magnetic resonance imaging of the brain. The prevalences of atrial septal aneurysm, patent foramen ovale, mitral annulus calcification, and protruding plaque in the aorta were investigated. We found atrial septal aneurysm in 13%, patent foramen ovale in 22%, protruding plaque in the aorta in 7%, and mitral annular calcification in 22% of the 68 subjects. No significant differences were found between the two age groups with the exception of mitral annular calcification, which was seen more often in the older group (P < 0.001). Total cardiac changes related to thromboembolism (including three cases with atrial fibrillation in the older group and other less common cardiac embolic sources) were more common in the older than in the younger group (23/38 vs 9/30; P < 0.05). If mitral annular calcification was excluded, no difference was found between the elderly and the younger group, 14/38 vs 8/30; ns. Even when subjects with a history of heart disease or a pathological ECG were omitted, no differences between the two age groups were found. The causal relationship between a possible embolic source and a clinical embolic event remains unsettled. The high prevalence of cardiac changes in a control population has to be considered when evaluating the significance of similar findings in patients with stroke.