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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Brain insult in neurosurgical patients is highly dependent on hydroelectrolytic and haemodynamic disturbances. The magnitude of their effect is related to blood-brain barrier integrity and characteristics of cerebral perfusion pressure. Moderate disturbances in ionic balance or CPP may lead to interstitial oedema or worsening of cerebral ischaemia. As a consequence, intracranial pressure (ICP) may rise and neurological status worsen. This study discusses the cerebral effects of intercompartimentary water and electrolyte movements, which themselves are either secondary to early neurological dysfunction, as insipid diabetes, the syndrome of inappropriate ADH secretion, and/or to renal losses of sodium, or iatrogenic, after administration of mannitol or furosemide. Understanding the early mechanism underlying these disorders is essential for treatment. Early interstitial oedema is mainly a consequence of low plasma osmolality, whereas low oncotic pressure plays a minor role. Worsening of cerebral ischemia by hyperglycaemia should contra-indicate glucose for perioperative infusion. Keeping CPP at normal levels is essential, especially in case of disturbances of the autoregulation of the cerebral circulation. Normovolaemia and the choice of an appropriate agent for plasma volume expansion are essential. Correction of hypovolaemia is best obtained with (except for packed red cells when necessary) normal saline, 4% human albumin or hydroxyethylstarch. The benefit of utilizing hypertonic electolytic or HES solutions in neurosurgical patients has still to be assessed.
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PMID:[The injured brain. Basis for hydroelectrolytic and hemodynamic resuscitation]. 809 86

We have reviewed 15 cases of carotid artery stenosis in the neck, consisting of 11 patients with cerebral ischemia and 4 asymptomatic patients, in relation to associated coronary heart disease. The 15 patients had systemic complications, including hypertension in 87%, diabetes mellitus in 40% and hyperlipidemia in 57%. Systemic vascular complications other than coronary heart disease were present in 27% of the patients. Three of the 15 patients had a history of ischemic heart disease and had been treated by cardiologists. One patient developed angina pectoris on the second day of a cerebral ischemic attack. Coronary angiography (CAG) and simultaneous cerebral angiography following carotid endartectomy (CEA) were performed 4 of the remaining 12 patients, who had symptoms or history of ischemic heart attacks. Three of these four patients had stenotic lesions in their coronary arteries. Another one patient among the remaining 8 developed angina pectoris one year after undergoing CEA. This patient had 3-vessel coronary artery disease. These findings suggest that a strong correlation between stenotic lesions of the carotid arteries in the neck and coronary heart disease, with or without episodes of ischemic heart disease. CAG should be strongly recommended in such patients to assess the severity of complicating ischemic heart disease and to improve the prognosis following CEA.
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PMID:[Severe carotid artery stenosis in the neck is frequently associated with coronary heart disease]. 812 3

The pathogenesis, clinical manifestations, and management of orthostatic hypotension (OH) are reviewed. OH is a decline in blood pressure that occurs when one moves from a lying to a standing position that results in symptoms of cerebral hypoperfusion, most commonly lightheadedness and syncope. The disorder may result from primary autonomic disorders, such as Shy-Drager syndrome; reversible nonautonomic causes, such as reduced blood volume; underlying diseases, such as diabetes mellitus; and drugs. Elderly people are predisposed to OH. The diagnosis of OH is based on the documentation of postural hypotension accompanied by symptoms of cerebral ischemia. The goal of therapy is to relieve symptoms. Nonpharmacologic approaches are preferred and include increasing sodium intake, avoiding rapid postural changes, and wearing elastic garments. OH is difficult to treat pharmacologically because of varying responses and adverse effects. The drug of choice for all types of OH is fludrocortisone acetate, although caution must be used in patients with congestive heart failure. Prostaglandin synthetase inhibitors can also be used for all types of OH but have had more limited success. Sympathomimetics with or without monoamine oxidase inhibitors, beta-adrenergic antagonists, and ergot alkaloids should be administered only to patients with certain types of OH, and patients must be monitored closely. Clonidine, midodrine, yohimbine, octreotide, dopamine antagonists, desmopressin, and epoetin alfa have not been well studied and should be limited to patients with severe, refractory disease. Although no uniformly effective treatment regimen exists, OH can often be adequately managed with a combination of nondrug and drug therapies.
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PMID:Management of orthostatic hypotension. 820 84

From January 1985 to October 1992 ten patients were submitted to reconstruction of the external carotid artery (ECA). Nine were males and one female with age that ranged from 64 to 74 years, mean 68. All were symptomatic due to TIAs in seven and amaurosis fugax in four of this group, previous completed stroke plus TIAs in two and chronic low perfusion in one. Associated risk factors were smoking (8 pts: 80%), coronary disease (5 pts: 50%), hypertension (4 pts: 40%), diabetes (4 pts: 40%) and peripheral arterial obstructive disease (2 pts: 20%). All patients were submitted to non invasive (Doppler C. W., Echo-color Doppler) studies as well as angiography. All the patients had an occlusion of the internal carotid artery (ICA) unilateral and homolateral to external carotid stenosis in 8 and bilateral in 2; in addition three patients had a non haemodynamic stenosis of the contralateral ICA. One patient had an occlusion of the common carotid artery with collateral supply to the ECA; nine had severe stenosis of the ECA at the origin. In one case a homolateral vertebral stenosis was detected as well as a prevertebral contralateral subclavian stenosis in another one. Surgery was advised to correct amaurosis fugax, to increase external-internal collateral supply in order to avoid cerebral ischaemia and prior to contralateral ICA endarterectomy. All patients were operated upon under general anesthesia; an endarterectomy with a PTFE patch was performed in 9 cases, while in one a subclavian-ECA bypass was carried out using an autologous vein segment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:External carotid artery repair in cerebrovascular insufficiency. 825 54

During the last decade, a multitude of experimental arguments have led to the concept that EDRF is nitric oxide (NO), a messenger not only involved in the control of vasomotor tone but also in vascular homeostasis, neuronal and immunological functions. Regardless of its origin, endogenous NO is produced through the conversion of L-arginine to L-citrulline by NO-synthase (NOS) from which several isoforms have recently been isolated, purified and cloned. NOS-type I (isolated from brain) and type III (isolated from endothelial cells) are termed "constitutive-NOS" and produce picomolar levels of NO from which only a small fraction elicits physiological responses. These isoforms are regulated by Ca(2+)-calmodulin with NADPH, FAD/FMN and tetrahydrobiopterin as co-factors and reveal a high degree of homology with the amino-acid sequence of cytochrome P450 reductase within the C-terminal domain. Functionally, neuronal-NOS type I is important in neurotransmission (modulation of NMDA receptor), the central control of vascular homeostasis and possibly learning and memory. In the peripheral nervous system, NOS appears to be linked to nonadrenergic noncholinergic (NANC) neuronal pathways. Endothelial-NOS type III is essential for the control of vascular tone in response to the release of endogenous mediators, although shear stress is the major trigger of endothelial-NOS activity under physiological conditions. NOS-type III also contributes to the prevention of abnormal platelet aggregation. NOS-types II and IV (isolated from macrophages) are Ca(2+)-calmodulin independent and are termed "inducible-NOS" since their activation is only promoted under pathophysiological situations where macrophages exert cytotoxic effects in response to cytokines. In contrast with NOS-types I and III, activation of NOS-type II in these cells induces the formation of nanomolar levels of NO which act as a defense mechanism of the immune system. Dysfunctions of the L-arginine-NO pathway have been characterized in multiple diseases (atherosclerosis, hypertension, diabetes, sepsis, cerebral ischemia, etc) and the design of more selective activators/inhibitors of NOS isoforms is a new challenge for the understanding of their pathophysiology and treatment.
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PMID:Nitric oxide: an ubiquitous messenger. 829 80

Selective control of cell function by applying specifically configured, weak, time-varying magnetic fields has added a new, exciting dimension to biology and medicine. Field parameters for therapeutic, pulsed electromagnetic field (PEMFs) were designed to induce voltages similar to those produced, normally, during dynamic mechanical deformation of connective tissues. As a result, a wide variety of challenging musculoskeletal disorders have been treated successfully over the past two decades. More than a quarter million patients with chronically ununited fractures have benefitted, worldwide, from this surgically non-invasive method, without risk, discomfort, or the high costs of operative repair. Many of the athermal bioresponses, at the cellular and subcellular levels, have been identified and found appropriate to correct or modify the pathologic processes for which PEMFs have been used. Not only is efficacy supported by these basic studies but by a number of double-blind trials. As understanding of mechanisms expands, specific requirements for field energetics are being defined and the range of treatable ills broadened. These include nerve regeneration, wound healing, graft behavior, diabetes, and myocardial and cerebral ischemia (heart attack and stroke), among other conditions. Preliminary data even suggest possible benefits in controlling malignancy.
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PMID:Beneficial effects of electromagnetic fields. 849 42

Nonrheumatic atrial fibrillation (AF) frequently coexists with other risk factors for cerebral ischemia. This study was originally designed to determine which combinations of clinical and echocardiographic abnormalities were most closely associated with the risk of cerebral ischemic events. Patients with cerebral ischemic events (n = 214) and community-based control subjects (n = 201) underwent transesophageal echocardiography and carotid artery imaging. Adjusted odds ratios (ORs) were determined using multiple logistic regression analysis. Independent risk factors for cerebral ischemia included diabetes, carotid stenosis, aortic sclerosis, left ventricular dysfunction, left ventricular hypertrophy, left atrial (LA) spontaneous contrast, and proximal aortic atheroma. Nonrheumatic AF in combination with LA spontaneous contrast and LA enlargement showed a strong association with cerebral ischemic events (OR 33.7 [95% confidence interval 4.53 to 251]). In subjects with sinus rhythm or nonrheumatic AF, LA enlargement was not associated with an increased risk of cerebral ischemic events in the absence of LA spontaneous contrast. However, only 2 patients and 1 control subject had nonrheumatic AF without LA spontaneous contrast or LA enlargement. Therefore, study of a larger number of subjects is required to address the issue of whether nonrheumatic AF itself carries increased risk. The combination of nonrheumatic AF with LA spontaneous contrast is a potent risk factor for cerebral ischemia. Ascertaining the risk factor in nonrheumatic AF requires adequate examination for underlying cardiac, aortic, and carotid vascular disease. Transesophageal echocardiography may contribute to this assessment.
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PMID:Atrial fibrillation with left atrial spontaneous contrast detected by transesophageal echocardiography is a potent risk factor for stroke. 875 87

With the aid of a protracted passive postural test, the rate of occurrence and the variants of orthostatic hypotensive reactions in hypertensive patients were studied. Three hundred and eighty-two consecutive tilt tests in 161 hypertensive patients, 89.4% of whom were taking antihypertensive medications, were reviewed. Orthostatic hypotensive reactions were recognized in 33.8% of examinations. Thirty-one hypotensive episodes (8.1%) were associated with symptoms of cerebral ischemia, resulting in termination of the tilt test at a median of 5 min from onset (range 1-30 min). A survey of possible risk markers of symptomatic hypotensive reactions during tilt showed that increasing age was associated with significantly increased risk (P < 0.001), while gender, office blood pressure (BP), diabetes mellitus, ischemic heart disease, anxiety, history of syncope, and treatment with antihypertensive drugs were not. Asymptomatic orthostatic hypotension early in the course of the tilt test was a weak predictor of symptomatic hypotensive reactions later during the test (positive predictive value 17.4-33.3%). Among the 31 symptomatic hypotensive reactions, 10 were typical cases of orthostatic hypotension, four were typical vasovagal reactions, and 17 episodes were difficult to classify. The implications of symptomatic hypotensive reactions triggered by protracted head-up tilt in hypertensive patients are unknown and can only be elucidated in longitudinal studies.
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PMID:Hypotensive reactions on passive head-up tilt testing of hypertensive patients. 887 99

The pathogenic role of aortic arch atherosclerosis (AAA) in embolic stroke is not well understood. We investigated, prospectively, the prevalence and severity of AAA in patients with embolic stroke to ascertain its role as a risk factor for cerebral ischemia. We examined 100 consecutive patients who had experienced acute symptoms due to cerebral ischemia. Clinical examination, electrocardiogram, x-ray, ultrasound examination of craniocervical arteries, transesophageal echocardiography (TEE), cranial computerized tomography, and magnetic resonance imaging were undertaken. Seventy-five patients showed evidence of AAA; 34 patients had moderate to severe (> 5 mm thickening) AAA. Age was positively related to the severity of AAA, as were smoking, coronary heart disease, diabetes mellitus, internal carotid artery (ICA) occlusive disease, and embologenic heart disease. Hypertension, which was evident in 52 patients, did not distinguish those cases showing AAA. Twelve patients showed evidence of high-degree ICA stenosis on the symptomatic side, although the extent of ICA stenosis and AAA were unrelated. A cardiac source of emboli was found in 28 patients. AAA was found to be the probable source for embolic stroke in 14 patients. These data indicate that aortic arch atherosclerosis is an important source of cerebral emboli which may increase the risk for ischemic stroke. Furthermore, we suggest that TEE examination of the aortic arch may be important for the diagnosis of AAA and ultimately for the prophylactic treatment of severe cerebral ischemia.
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PMID:Embolism from the aortic arch in patients with cerebral ischemia. 891 14

Electromagnetic fields are now being used in many diseases such as osseous, ligamental, cartilaginous, or nervous reparation, diabetes, and myocardial or cerebral ischemia. Although many publications show the usefulness of magneto-therapy, discrepancies exist about the utility of electromagnetic fields in skin wound healing. The objective of this work was to study the effect of pulsed electromagnetic fields on wound healing in rats. Twenty-two male Wistar rats were used; a circular lesion was made in the back of each animal. They were divided into three groups: group C (control) with sham treatment (n = 8), group NF, treated with topical nitrofurazone solution (n = 7), and group PEMF, treated with pulsed electromagnetic fields of 20 mT (n = 7). The treatments were 35 minutes twice a day. The absolute and relative values of the area and perimeter of the wounds showed significantly lower values in the PEMF group at days 7, 14, and 21 compared with those in group C (p < 0.01, analysis of variance), whereas the PEMF group showed significantly lower values at day 21 only compared with the NF group (p < 0.01, analysis of variance). The results suggest a significant beneficial stimulation in the wound healing process in rats treated with PEMF, which could lead to the development of a practical tool for research and clinical use.
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PMID:Pulsed electromagnetic fields in experimental cutaneous wound healing in rats. 895 40


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