No abstract

Asymptomatic cervical atherosclerosis carries a variable risk of vascular events. We sought to identify patients with asymptomatic cervical bruits who may be at increased risk of developing ischemic events. We conducted a prospective multicenter cohort study of neurologically asymptomatic patients presenting a cervical bruit. Patients had biannual neurologic and carotid duplex evaluation. Association between ultrasonographic findings and vascular events, adjusting for common risk factors, was evaluated. Seven hundred fifteen patients were followed on average for 3.6 years. Mean age was 65 years. At initial visit, 357 subjects had a > or = 50% stenosis. Overall, 237 events occurred in 177 patients. Annual rate of all primary vascular events in patients with > or = 50% stenosis was 11.0% versus 4.2% in those with < 50% stenosis (p < 0.001). Annual rate of stroke and vascular death was 5.5% in the > or = 50% group compared with 1.9% in the < 50% group (p < 0.001). Yearly rate of unheralded ischemic stroke was 4.2% in subjects with > or = 80% stenosis and 1.4% in those with stenosis < 80% (p < 0.001). A stroke or TIA was ipsilateral to a > or = 80% stenosis in 66% of patients. Progression of carotid stenosis particularly to more than 80% was associated both with a higher rate of ipsilateral neurologic events and overall combined vascular events. Our data suggest that severity of carotid stenosis is the main risk factor predicting occurrence of neurologic and other vascular events. Yearly rate of ipsilateral stroke with > or = 50% carotid stenosis is low (1.4%) and most are nondisabling. Progression to > or = 80% or occlusion is associated with worse outcome.

No abstract

Regional cerebral blood flow (rCBF) was studied using the Xe 133 intra-arterial injection method during a long-lasting preheadache phase of a migraine attack. The patient was hyperventilating moderately, rCBF was markedly reduced, and the reduction was uniform throughout the hemisphere. Increase of arterial carbon dioxide pressure by the inhalation of a carbon dioxide mixture did not change rCBF. At the end of the study, papaverine was injected into the internal carotid artery; flow increase was observed, but the patient's preheadache phase now seemed to end gradually. Whether papaverine had a vasodilator effect in the preheadache phase remains unknown. The patient was restudied when asymptomatic, and rCBF and its regulation were normal. Am J Obstet Gynecol 114:950-953 (Dec 1) 1972Women who complained of premenstrual distress showed a significant change in capillary filtration coefficient (CFC) during the month; the lowest CFC values were found immediately after the onset of the menses and the highest values occurred just before the beginning of menstruation. Arch Pathol 96:227-234 (Oct) 1973Intimal hyperplasia has been found in women receiving oral contraceptives, in pregnant and in postpartum women, in males with severe liver disease and has been noted by others in pregnant and postpartum guinea pigs and in animals receiving steroids. Endogenous and exogenous female reproductive steroids may be the common hormonal factor acting on the vascular system as a target organ. These steroids should be included in the list of agents and diseases with which intimal proliferation may be associated.

ABSTRACT:This study was designed to compare flunarizine, a cerebro-specific calcium channel antagonist, and propranolol in the prophylaxis of migraine with or without aura. Following a 1 month single-blind placebo baseline period, 94 patients were equitably randomised under double-blind conditions to take flunarizine 10 mg daily or propranolol 80 mg twice daily for 4 months. Both treatments led to a significant reduction in the frequency of migraines and use of rescue analgesics with a significantly greater decrease in number of attacks for flunarizine after 1 and 4 months. Neither treatment affected the severity nor duration of migraines. Overall, 67% of flunarizine patients and 51 % of propranolol patients responded positively. Propranolol significantly reduced blood pressure and heart rate; flunarizine had no effect on cardiovascular function. Weight gain was noted with both treatments. Flunarizine is at least as effective as propranolol in the prophylactic treatment of migraine and may have a better safety profile.