Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020639 (hypoproteinemia)
 1,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A survival case of central pontine myelinolysis (CPM) is reported herein with a review of 22 MRI-analyzed CPM survivors in the literature. A 65-year-old male was struck on the forehead while in a traffic accident. He was almost fully conscious and neurologically free on admission. Laboratory data were normal except hyponatremia [122 mEq/l] and hypoproteinemia [5.8 g/dl]. 2 hours later he became drowsy and left hemiparesis. The CT scan showed right frontal cerebral hematoma leading to a remarkable midline shift. Immediately, aspiration of the hematoma was performed. On the next day, he returned to the initial neurological level. On the third day, however, he again became comatose followed by tetraparesis and ataxic respiration. While the CT scan at that time did not display any abnormality in the pons, the severe dysfunction of the brain stem occurred after the correction of hyponatremia strongly suggesting CPM. The serum Na levels were kept between 110 and 125 [mEq/l]. In addition, 375 mg of methylprednisolone had been daily administrated during and after a gradual correction of the hyponatremia, because glucocorticoid proved to be effective in the models of CPM. The neurological condition began to improve on the 14th day after admission. Eventually, he became conscious and independent in his daily activities, the time span being 8 months after the trauma. The trident MRI lesion in the basis pontis was 5 mm in diameter and much smaller than clinically expected. The 23 MRI-analyzed CPM survivors were reviewed in the literature including the present case. There were 7 males and 16 females, with a mean age of 48.5 years.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of central pontine myelinolysis with neurological recovery after administration of glucocorticoid]. 191 Sep 33

The authors experienced 55 cases of anesthetic management in 52 elderly surgical patients, 14 men and 38 women, aged 90 to 101 years with an average of 92.1 +/- 2.1 years for the past ten years. Surgical procedures included 38 cases of orthopedic, 14 cases of general surgical and 3 cases of ophthalmic operations. Thirteen cases out of them were emergency. General, epidural, spinal, and local anesthesia were applied in 34 cases, 18 cases, 2 cases, and one case out of these elderly patients, respectively. These general anesthesia consisted of total intravenous anesthesia with propopol, fentanyl and ketamine in 27 cases, sevoflurane with nitrous oxide in 4 cases, isoflurane with nitrous oxide or air in 2 cases, and thiopental anesthesia in one case. The elderly patients had past history of heart disease, dementia, hypertension, cerebral infarction/hemorrhage, diabetes mellitus and others. Their preoperative examinations revealed anemia, hypoproteinemia, renal hypofunction, serum electrolytes imbalance, and others. Vasopessors were given to 42% of the patients during anesthesia and surgery. Their postoperative complications included myocardial infarction, paroxysmal atrial fibrillation, hypotension following anemia, transient hemiparesis, delirium and so on. Two patients developed myocardial infarction postoperatively and died thereafter. The authors suggest that appropriate anesthetic management for elderly patients aged 90 years or older requires proper preoperative evaluation, sufficient vigilance of hemodynamics with direct arterial pressure measurement, reliable preparation of medical agents, and awareness of impairment of circulatory function and others by aging.
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PMID:[Anesthetic management of elderly patients aged 90 years or older]. 1501 25

A 65-year-old man with left hemiparesis was referred to our hospital by ambulance. Diffusion-weighted magnetic resonance imaging (DWI-MRI) showed a slight hyperintensity area in the right basal ganglion and deep white matter, and brain magnetic resonance angiography (MRA) revealed right middle cerebral artery (MCA) occlusion in the M1 proximal segment. Receiving intravenous rt-PA therapy, the patient showed no neurological improvement. Therefore emergency neuroendovascular revasculization was decided. After the first evacuation of the clot, the occlusion site was partly recanalyzed. However it was re-occluded after a few minutes. Then, mechanical disruption using balloon catheters were added for the occlusion site allowing it to be recanalyzed. After the acute ischemic stroke therapy, the patient was diagnosed as nephrotic syndrome, because his blood chemistry test indicated hypoproteinemia and urine examination showed proteinuria. Renal biopsy confirmed nephrotic syndrome due to AL amyloidosis. Nephrotic syndrome causes hypercoagulability and increases platelet aggregation. Thus we speculated that nephrotic syndrome inhibited the early recanalization in this patient.
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PMID:[Nephrotic syndrome might be an inhibitor of the endovascular recanalization in a patient with acute ischemic stroke]. 2567 60