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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We have made a prospective study of 23 patients diagnosed of subclinical hypothyroidism and 45 of overt hypothyroidism, aged 68.3-70.3 years and with a mean illness of 4.5 and 6.5 years respectively. It has been proved a higher prevalence of females in both groups. The most frequent clinical symptoms, similar in both groups, were fatigue, constipation and dyspnea. The most repeated initial diagnosis at the entry were prymary hypothyroidism, heart failure, hypertensive urgencies and stroke. We have found differences of statistical significance between the Free Thyroxine (fT4), triiodothyronine (T3), total serum cholesterol (CT), triglycerides (TG), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C) and thyrotropin (TSH) initial and ending serum levels in patients with overt hypothyroidism (p < 0.05). We only have found significant differences in TSH serum levels in patients with subclinical hypothyroidism. The antithyroglobulin and antimicrobial antibodies, have been both positive in two and one patient respectively. Both are more useful as a predictor than their diagnostic value. The levothyroxine (L-T4) daily dose needed to normalize the TSH serum concentration, was lesser in subclinical hypothyroidism (71.8 micrograms opposite 107 micrograms-p < 0.001). We didn't find significant differences between the different groups in the time necessary for normalizing TSH. It seems that the L-T4 therapy should be started in all patients with subclinical hypothyroidism and TSH > or = 10 microU/ml or with TSH > 5 and goiter or with thyroid antibodies. The aim to reach is to normalize the TSH serum levels. The mean daily necessary L-T4 dose is 50-100 micrograms.
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PMID:[Clinical and subclinical hyperthyroidism: two faces of the coin?]. 892 46

To understand central nervous damage after long-term exposure to carbon disulfide (CS2), 10 patients who had polyneuropathy with various neuropsychiatric symptoms in a viscose rayon plant were studied. Clinical and laboratory examinations including electroencephalography (EEG), brain computed tomography (CT), brain magnetic resonance images (MRI), and carotid duplex sonography were carried out. Clinically, headache, unpleasant dreams, memory impairment, fatigue, anorexia and emotional lability were common in these patients while 2 patients had stroke episodes. EEGs were all normal. Brain CT scan showed mild cortical atrophy in 3 and low density lesions in the basal ganglia in 3. Brain MRI studies also disclosed mild cortical atrophy in 4 and multiple lesions involving the basal ganglia and corona radiata in 4. Carotid duplex sonography revealed mild atherosclerosis with plaques (< 20% stenosis) of extracranial vessels in 6. However there was no significant difference in flow velocities and flow volumes in the extracranial carotid arteries between patients and the normal controls. Interestingly, 2 patients had multiple brain lesions in the subcortical white matter but without strokes. In conclusion, encephalopathy with possible strokes may occur after chronic exposure to CS2, as well as polyneuropathy. The lesions usually involve the basal ganglia and subcortical white matter. Furthermore, MRI study may detect brain lesions particularly in the subcortical white matter areas before the occurrence of stroke.
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PMID:Chronic carbon disulfide encephalopathy. 895 4

Reduction of exercise capacity with confinement to bed rest is well recognized. Underlying physiological mechanisms include dramatic reductions in maximal stroke volume, cardiac output, and oxygen uptake. However, bed rest by itself does not appear to contribute to cardiac dysfunction. Increased muscle fatigue is associated with reduced muscle blood flow, red cell volume, capillarization and oxidative enzymes. Loss of muscle mass and bone density may be reflected by reduced muscle strength and higher risk for injury to bones and joints. The resultant deconditioning caused by bed rest can be independent of the primary disease and physically debilitating in patients who attempt to reambulate to normal active living and working. A challenge to clinicians and health care specialists has been the identification of appropriate and effective methods to restore physical capacity of patients during or after restricted physical activity associated with prolonged bed rest. The examination of physiological responses to bed rest deconditioning and exercise training in healthy subjects has provided significant information to develop effective rehabilitation treatments. The successful application of acute exercise to enhance orthostatic stability, daily endurance exercise to maintain aerobic capacity, or specific resistance exercises to maintain musculoskeletal integrity rather than the use of surgical, pharmacological, and other medical treatments for clinical conditions has been enhanced by investigation and understanding of underlying mechanisms that distinguish physical deconditioning from the disease. This symposium presents an overview of cardiovascular and musculoskeletal deconditioning associated with reduced physical work capacity following prolonged bed rest and exercise training regimens that have proven successful in ameliorating or reversing these adverse effects.
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PMID:An overview of the issues: physiological effects of bed rest and restricted physical activity. 904 21

Impaired functional capacity is common in patients with mitral regurgitation (MR), but the determinants of functional capacity in patients with normal left ventricular (LV) function are unclear. Forty patients with chronic, isolated, nonrheumatic MR with no coronary artery disease underwent exercise echocardiography with continuous expired gas analysis. Cardiac output and regurgitant stroke volume were measured at rest and immediately after exercise by pulsed-wave Doppler echocardiography. For controls, 17 healthy volunteers without MR were also studied. Patients achieved a significantly lower VO2max compared with controls (25.6 +/- 7.7 vs 31.7 +/- 7.7 ml/kg/min, p = 0.008). VO2max showed better correlations with exercise cardiac output than with cardiac output at rest in both patients and controls. Multiple linear regression identified exercise cardiac output (partial r = 0.65), patient age (partial r = -0.56), and gender as independent determinants of VO2max (multiple R = 0.85, p <0.001). Cardiac output at rest, LV ejection fraction, regurgitant stroke volume, and fraction were not significant determinants. With exercise, the regurgitant stroke volume increased in 13 patients and decreased in 27 patients. The former 13 patients had a significantly lower exercise cardiac output (7.4 +/- 2.5 vs 9.4 +/- 2.6 L/min, p = 0.026). Patients who stopped exercise due to dyspnea (n = 7) had a significantly lower exercise cardiac output and VO2max compared with those who stopped due to fatigue (n = 33), with no differences in resting or exercise regurgitant volume. Patients with an increase in LV end-systolic volume with exercise (n = 8) also had a significantly lower exercise cardiac output (6.9 +/- 1.9 vs 9.2 +/- 2.7 L/min, p = 0.037) and showed a trend toward a lower VO2max (21 +/- 7.5 vs 26 +/- 6.4 ml/kg/min, p = 0.07). In patients with chronic MR, exercise cardiac output is the major determinant of VO2max. Regurgitant volume and fraction are not related to functional capacity. Limitations in functional capacity in these patients may be more related to a diminished cardiac reserve than to a large regurgitant volume.
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PMID:Determinants of functional capacity in chronic mitral regurgitation unassociated with coronary artery disease or left ventricular dysfunction. 910 6

Three patients, two women and one man, aged 56-70 year (mean 59 years) with modest neurological deficits and bilateral occlusion of the common carotid arteries initially identified by duplex scanning and angiography were followed by repeated clinical and transcranial Doppler examination (TCD) over 6.5 years. Vasomotor reactivity (VMR) was tested by combined examination of TCD and xenon-133 cerebral blood flow (CBF) before and after intravenous administration of 1 g acetazolamide. At follow-up CBF was measured using single photon emission computerised tomography (SPECT). In two patients mean velocities in the middle cerebral artery (MCA) were within the normal range at repetitive examinations with good VMR ranging 30-111%, whereas CBF was reduced in MCA territories ranging 29-36 ml 100 g(-1) min(-1), but increasing 44-69% after acetazolamide, indicating good VMR. These 2 cases had anterograde flow in the ophthalmic artery and siphon. The third patient had very low MCA mean velocities of 21-27 cm sec(-1), increasing 26-33% after acetazolamide. This patient had retrograde flow in the ophthalmic artery and siphon connected with bilateral prolonged episodes of amaurosis fugax and transient ischemic attacks. In all three patients the posterior cerebral arteries were major supplying collaterals having high mean velocities of about 100 cm sec(-1) and high velocities in the basilar arteries of 85 cm sec(-1) as well. During follow up no patient had a new stroke, but all experienced orthostatic dizziness and chronic fatigue.
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PMID:Bilateral common carotid artery occlusion with minimal neurological deficit: long term follow up in 3 patients. 916 64

The side-effects and complications of posteroventral pallidotomy are analysed in 138 consecutive patients who underwent 152 pallidotomies. Transient side-effects, lasting less than three months, appeared in 18% of the patients, that is, 16.5% of the surgical procedures. Long term complications, lasting more than 6 months, were noted in 10% of the patients, that is, 9.2% of the surgical procedures. Sixteen complications occurred alone or in various combinations in 14 patients and included fatigue and sleepiness (2), worsening of memory (4), depression (1), aphonia (1), dysarthria (3), scotoma (1), slight facial and leg paresis (2) and delayed stroke (2). Complications such as dysarthria and paresis could be attributed to MR- or CT-verified pallidal lesions lying too medially and encroaching on the internal capsule. Two of the patients with deterioration in memory had some memory impairment before surgery, and the aphonic patient had dysphonia preoperatively. The study suggests that stereotactic MRI and careful impedance monitoring and macro-stimulation of the posteroventral pallidum area should be sufficient for minimizing the risk of complications; the stereotactic lesion should be centered within the posterior ventral pallidum without involvement of internal capsule. It is concluded that pallidotomy is a safe procedure if performed on cognitively alert patients, and it seems that both the incidence and especially the severity of complications are lower for posteroventral pallidotomy than for thalamotomy.
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PMID:The side-effects and complications of posteroventral pallidotomy. 923 12

Sleep-related breathing disorders (SRBD) include several disorders gradually developing from simple and loud snoring through upper airway resistance syndrome and sleep apnoea up to the Pickwickian syndrome. They are manifestant as a respiratory distress and apnoeic episodes, desaturation of oxygen in the blood and interruption of sleep. These symptoms are demonstrated in a case of a patient with the Pickwickian syndrome. SRBD may result in severe secondary life-threatening cardiovascular complications (nocturnal arrhythmias, sudden cardiac death, stroke and pulmonary oedema). They may contribute also to the development of important disorders of public health such as hypertension, obesity, and traffic accidents resulting from hypersomnolence and fatigue. (Tab. 1, Fig. 3, Ref. 46.)
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PMID:[Sleep-related breathing disorders--an interdisciplinary topic in undergraduate and postgraduate medical education]. 926 12

Latissimus dorsi (LD) muscles of six canines were studied to assess changes induced by electrical conditioning and to quantify the capacity of these muscles to perform hemodynamic work. Muscles were conditioned using burst stimuli delivered over an 8-wk period. Contralateral LD were used as control. Muscles were tested in situ to simulate anticipated linear-pull cardiac assist conditions. This training process reduced muscle mass and cross-sectional area by 16 and 17%, respectively. Muscle phenotype shifted to a predominantly "slow" form by coordinate reduction of myosin heavy chain (MHC) 2A expression and increased expression of the MHC beta/slow form. Force generation was reduced by 54%, and contractile duration increased 13%. Fatigue resistance was markedly enhanced, and chronic stroke work increased from 0.19 to 0.72 mJ/g. The highest steady-state power output (2.06 mW/g) was obtained from one muscle fully converted to a slow phenotype. These data suggest that single LD trained via conventional techniques can provide energy sufficient for partial cardiac assistance but cannot sustain work levels needed to achieve total circulatory support.
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PMID:Functional properties of conditioned skeletal muscle: implications for muscle-powered cardiac assist. 927 56

For original ovoid shaped artificial ventricles, a biomechanical double sac consisting of a biological sac (porcine pericardium) as the blood contact interface and a synthetic sac (Pebax 3533) as the mechanical support to assume systolic-diastolic dynamic constraints was conceived. The volumetric and mechanical properties were assessed with a three-dimensional modeling of Pebax sacs and computerized simulations of their systolic distortions for both right and left ventricular configurations. The stresses and strains of these sacs were represented as quantitative mappings for a maximum end-systolic state and were below the respective threshold values above which the Pebax material is jeopardized for permanent structure impairment. After fatigue tests applied on Pebax strips under the alleged working conditions of Pebax sacs, the material structure was unchanged and maintained its intrinsic mechanical properties. The theoretical maximum stroke volumes were 74.4 cm3 and 62.4 cm3 for the left and right ventricular configurations, respectively. With these mechanical and volumetric features, the biomechanical double sac concept was considered valid and could be provided for a consequent specific total artificial heart.
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PMID:A biomechanical double sac (pericardium-Pebax) for specially shaped artificial ventricles: a computerized study to evaluate its mechanical and volumetric properties. 933 68

Patients with right hemisphere injury frequently neglect to cancel targets primarily in the left part of the page nearest the body. Since this region is diagonally opposite the area from where such patients usually begin cancelling, near left ('diagonal') neglect may be consequent to stimulus order effects ('fatigue'). We evaluated the persistence of near left neglect in nine stroke patients when they had to cancel either the near or the far half of the page before proceeding to the other half. Our results showed that near left neglect on the page was largely unaffected by cancellation order. Furthermore, a near left gradient of omissions was established within both radial (near and far) halves of the page, as well as for the entire page. Our findings suggest that diagonal cancellation neglect is unrelated to fatigue and reflects a consistent, two-dimensional disorder of spatial attention. Such neglect may be related to the extent of the visible stimulus array, as well as to the array's location in egocentric space.
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PMID:Diagonal neglect on cancellation. 935 20


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