Glycerol and Rheomacrodex in the Treatment of the Acute Ischemic Insult: A Placebo-Controlled Double-Blind Trial

  • A. Frei
  • C. Cottier
  • P. Wunderlich
Conference paper

Abstract

Stroke is still a major cause of morbidity and death in western societies [9, 30]. Early mortality is reported to be 30% and one out of two survivors suffers permanent disability [23]. The majority of strokes are due to atherothrombotic brain infarction or cerebral embolism [23]. Our understanding of the pathophysiology of acute cerebral ischemia has improved considerably in recent years [8, 29, 34]. Based on this knowledge various therapeutic strategies have been developed. Substances such as glycerol or steroids have been shown to decrease edema formation [1, 4, 5, 22, 25, 27, 38]. Anticoagulants and platelet antiaggregation drugs impede thrombosis [17]. In other experiments the hemorheological effects of dextran have improved regional cerebral blood flow [14, 15, 37]. Drugs that influence cell metabolism, such as prostacyclin or calcium channel blockers [11, 19], have been evaluated.

Keywords

Placebo Sugar Glycerol Ischemia Creatinine 

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References

  1. 1.
    Bauer RB, Teller H (1973) Dexamethasone as treatment in cerebrovascular disease. II. A controlled study in acute cerebral infarction. Stroke 4: 541PubMedCrossRefGoogle Scholar
  2. 2.
    Benard A, van Elteren (1953) A generalization of the method of rankings. Indigationes Mathematicae 15: 258–269Google Scholar
  3. 3.
    Buonanno F, Toole JF (1981) Management of patients with established (“completed”) cerebral infarction. Stroke 12: 7–16PubMedCrossRefGoogle Scholar
  4. 4.
    Cantore G, Guidetti B, Virno M (1961) Oral glycerol for the reduction of intracranial pressure. J Neurosurg 21: 278Google Scholar
  5. 5.
    Dodson RF, Tagashira Y, Way Feng Chu I (1975) The effect of glycerol on cerebral ultrastructure following experimentally induced cerebral ischemia. J Neurol Sci 26: 235–244PubMedCrossRefGoogle Scholar
  6. 6.
    Friedli W, Imbach P, Ghisleni-Steinegger S, Schwarz C, Maire Ph (1979) Infusionsbehandlung des akuten ischämischen Hirninfarktes mit Glycerin 10%. Schweiz med Wschr 109: 737–742PubMedGoogle Scholar
  7. 7.
    Frithz G, Werner I (1975) The effect of glycerol infusion in acute cerebral infarction. Acta med scand 198: 287–289PubMedCrossRefGoogle Scholar
  8. 8.
    Garcia JH (1984) Experimental ischemic stroke: a review. Stroke 15: 5–14PubMedCrossRefGoogle Scholar
  9. 9.
    Garraway WM, Whisnant JP, Furlan AJ, Phillips LH, Kurland LT, O’Fallon WM (1979) The declining incidence of stroke. New Engl J Med 300: 449–452PubMedCrossRefGoogle Scholar
  10. 10.
    Gelmers HJ (1975) Effect of glycerol treatment on the natural history of acute cerebral infarction. Clin Neurol Neurosurg 4: 277–282CrossRefGoogle Scholar
  11. 11.
    Gelmers HJ (1984) The effects of nimodipine on the clinical course of patients with acute ischemic stroke. Acta N eurol Scand 69: 232–239CrossRefGoogle Scholar
  12. 12.
    Gilroy J, Barnhart MI, Meyer JS (1969) Treatment of acute stroke with dextran 40. JAMA 210: 293–297PubMedCrossRefGoogle Scholar
  13. 13.
    Gilsantz V, Rebollar JL, Buencuerpo J, Chantres MJ (1975) Controlled trial of glycerol versus dexamethasone in the treatment of cerebral edema in acute cerebral infarction. Lancet I: 1049CrossRefGoogle Scholar
  14. 14.
    Gottstein U, Held K (1969) Effekt der Hämodilution nach intravenöser Infusion von niedermolekularen Dextranen auf die Himzirkulation des Menschen. Dtsch med Wschr 94: 522–526PubMedCrossRefGoogle Scholar
  15. 15.
    Grotta J, Ostrow P, Fraifeld E, Hartman D, Gary H (1985) Fibrinogen, blood viscosity, and cerebral ischemia. Stroke 16: 192–198PubMedCrossRefGoogle Scholar
  16. 16.
    Larsson O, Marinovich N, Barber K (1976) Double-blind trial of glycerol therapy in early stroke. Lancet I: 832–834CrossRefGoogle Scholar
  17. 17.
    Lodder J, van der Lugt PJM (1983) Evaluation of the risk of immediate anticoagulant treatment in patients with embolic stroke of cardiac origin. Stroke 14: 42–45PubMedCrossRefGoogle Scholar
  18. 18.
    Lüdin E (1985) Die Anwendung des Monte-Carlo-Verfahrens von Wall für diskrete Zufallsgrößen. Biometrie in der chemisch-pharmazeutischen Industrie. 3: 141–148Google Scholar
  19. 19.
    Martin JF, Hamdy N, Nicholl J et al (1985) Double-blind controlled trial of prostacyclin in cerebral infarction. Stroke 16: 386–389PubMedCrossRefGoogle Scholar
  20. 20.
    Matthew NT; Meyer JS, Rivera VM, Charney JZ, Hartmann A (1972) Double-blind evaluation of glycerol therapy in acute cerebral infarction. Lancet II: 1327–1329CrossRefGoogle Scholar
  21. 21.
    Matthews WB, Oxbury JM, Grainger KMR, Greenhall RCD (1976) A blind controlled trial of dextran 40 in the treatment of ischaemic stroke. Brain 99: 193–206PubMedCrossRefGoogle Scholar
  22. 22.
    Garcia JH (1984) Experimental ischemic stroke: a review. Stroke 15: 5–14PubMedCrossRefGoogle Scholar
  23. 23.
    Buonanno F, Toole JF (1981) Management of patients with established (“completed”) cerebral infarction. Stroke 12: 7–16PubMedCrossRefGoogle Scholar
  24. 24.
    Mohr JP, Rubinstein LV, Tatemichi TK, Nichols FT, Caplan LR, Hier DB, Kase CS (1985) Blood sugar and acute stroke. Stroke 16: 143Google Scholar
  25. 25.
    Mulley G, Wilcox RG, Mitchell JRA (1978) Dexamethasone in acute stroke. Brit med J II: 994–996CrossRefGoogle Scholar
  26. 26.
    Norris JW (1976) Steroid therapy in acute cerebral infarction. Arch Neurol 33: 69–71PubMedGoogle Scholar
  27. 27.
    Patten BM, Mendell J, Brunn B, Curtin W, Carter S (1972) Double blind study of the effect of dexamethasone on acute stroke. Neurology (Minneap.) 22: 377Google Scholar
  28. 28.
    Pocock ST (1977) Group sequential methods in the design and analysis of clinical trials. Biometrika 64: 191–199CrossRefGoogle Scholar
  29. 29.
    Friedli W, Imbach P, Ghisleni-Steinegger S, Schwarz C, Maire Ph (1979) Infusionsbehandlung des akuten ischämischen Hirninfarktes mit Glycerin 10%. Schweiz med Wschr 109: 737–742PubMedGoogle Scholar
  30. 30.
    Benard A, van Elteren (1953) A generalization of the method of rankings. Indigationes Mathematicae 15: 258–269Google Scholar
  31. 31.
    SPSS Inc. SPSS-X user’s guide. McGraw Hill, New YorkGoogle Scholar
  32. 32.
    Spudis EV, de la Torre E, Pikula L (1973) Management of completed strokes with dextran 40. A community hospital failure. Stroke 4: 895–897PubMedCrossRefGoogle Scholar
  33. 33.
    Strand T, Asplund K, Eriksson S, Hägg E, Lithner F, Wester PO (1984) A randomized controlled trial of hemodilution therapy in acute ischemic stroke. Stroke 15: 980–989PubMedCrossRefGoogle Scholar
  34. 34.
    Dodson RF, Tagashira Y, Way Feng Chu I (1975) The effect of glycerol on cerebral ultrastructure following experimentally induced cerebral ischemia. J Neural Sci 26: 235–244CrossRefGoogle Scholar
  35. 35.
    Tope C, Reyes TM, Skversky NJ (1973) Phlebographic analysis of the incidence of thrombosis in hemiplegia. Radiology 109: 581–584Google Scholar
  36. 36.
    Warlow C, Ogston D, Douglas AS (1976) Deep venous thrombosis of the legs after strokes. Part I. Incidence and predisposing factors. Brit med J 1: 1178–1181PubMedCrossRefGoogle Scholar
  37. 37.
    Wood JH, Kee DB (1985) Hemorheology of the cerebral circulation in stroke. Stroke 16: 765–772PubMedCrossRefGoogle Scholar
  38. 38.
    Wright WB (1974) High-dosage dexamethasone in treatment of strokes in the elderly. Gerontclin 16: 88–91Google Scholar
  39. 39.
    Gould AL (1976) A new approach to the analysis of clinical drug trial with withdrawals. Biometrics 36: 721–727CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1987

Authors and Affiliations

  • A. Frei
    • 1
  • C. Cottier
    • 2
  • P. Wunderlich
    • 2
  1. 1.Kreisspital RütiRütiSwitzerland
  2. 2.Department of Internal MedicineUniversity HospitalBaselSwitzerland

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