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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It is clear that all mucosal defensive mechanisms acting against aggressive ulcerogenic factors depend on adequate blood flow. When defence is active, ulcers tend to heal and do so faster when luminal aggression is prevented by reduction of acidity or eradication of H. pylori. Such successful treatment is so profitable that pharmaceutical companies invest vast fortunes on research into every aspect of therapy. This may explain why research on basic aetiology has been slower. Nevertheless there have been recent advances which increasingly point towards an ischaemic pathogenesis of both acute and chronic ulcers. We have been studying those ischaemic mechanisms that may be triggered by alteration of normal physiological processes, and we now have a body of evidence supporting an infarction-like mechanism induced by abnormal motility which might explain the initiation of both acute and chronic human ulceration. In this article we review the evidence for this and show that such a pathogenesis is compatible with the features and current concepts of gastro-duodenal ulceration. Perhaps the most striking feature of chronic ulcers is their singularity, and localisation to the lesser curvature and first part of the duodenum. Within the lesser curvature there is an increasing incidence from the oesophageal end towards pylorus, with maximal incidence in the incisural area (1). Duodenal ulcers occur on the anterior or posterior walls of the first 4 cm. uncommonly on the superior "cap" and rarely on the inferior wall. Such localisation points to a primary cause which, by analogy with other localised necroses eg coronary or stroke, is usually an infarction of an end-artery system.
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PMID:Evidence for an infarctive pathogenesis of acute and chronic gastroduodenal ulceration. 139 15

Despite some evidence that neuroleptic medication is overused or misused in long-term care facilities for the elderly, there has been virtually no attention paid to the pattern of use of antidepressants in these facilities. All patients in long-term care in a geriatric hospital and a home for the aged who were receiving antidepressants were identified; 10.5% of the patients in the hospital and 12.7% in the home for the aged were receiving an antidepressant. The rate of use of antidepressants on the different units ranged from 0% to 26.8%. The most commonly prescribed antidepressant was doxepin followed by nortriptyline. The mean dose of antidepressant was 34.8 mg. Although depression was the most common reason for the prescription of an antidepressant (69% of patients receiving one), other reasons included pain, agitation, aggression, and insomnia. Patients had been receiving antidepressants for up to 10 years, with a mean duration of 32 months. The majority of patients (60%) had a history of depression predating their institutional admission. Patients receiving antidepressants were compared to a group not receiving antidepressants, who were matched for age, sex, unit, and attending physician. Patients receiving antidepressants were more likely to have a history of stroke (33.8% versus 16.9%). There was no significant difference between the two groups regarding the prevalence of dementia, Parkinson's disease, thyroid disease, malignant tumor, congestive heart failure, or diabetes mellitus. Prospective studies are required to determine the efficacy of antidepressants in this population and to identify factors that can predict a positive response to treatment.
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PMID:Pattern of use of antidepressants in long-term care facilities for the elderly. 141 68

We retrospectively reviewed the records of 88 patients who underwent a total of 95 in-situ bypass operations. Seventy-eight percent were diabetics, 56% hypertensives, 23% had a history of a myocardial infarction, 18% a previous stroke or transient ischemic attack, and 19% a renal transplant. Eighty-eight percent had general anesthesia. Eighty-four percent of the operations extended distal to the popliteal trifurcation, with an average operating time of 5.12 +/- 1.25 hours and blood loss of 354 +/- 239 ml. The overall mortality was 4.2%, with two deaths due to wound sepsis and two deaths due to congestive heart failure. The perioperative myocardial infarction rate was 6.3%. The average age of the patients who died was significantly greater than the age of those who survived (78.2 +/- 17.7 years vs. 59.9 +/- 14.8 years, p less than 0.05). The Goldman risk index was not helpful in predicting cardiac complications. The results show that patients undergoing in-situ bypass operations are at high risk for cardiovascular complications. Aggressive perioperative evaluation and management similar to that shown to reduce such complications in abdominal aortic aneurysm surgery should be helpful.
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PMID:Complications and mortality of the in-situ saphenous vein bypass for lower extremity ischemia. 153 65

By increasing local cerebral blood flow to ischemic brain tissue in a timely fashion, impending cerebral infarction can be reversed. Aggressive, early intervention is the key to overall neurological improvement of stroke patients. Ancrod, a purified protein fraction of venom from the Malayan pit viper, has been shown to produce rapid and effective defibrinogenation in humans. A current clinical trial with ancrod in patients with acute or progressing nonhemorrhagic ischemic stroke requires an onset to treatment time of no more than 6 hours. Ancillary hospital personnel, physicians and nurses all play important roles in expediting study treatment. Nurses must assess ancrod study patients for potential bleeding problems. Community awareness and education about the warning signs of impending stroke are factors important to insuring early intervention and improving neurological outcome of stroke victims.
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PMID:Experimental ancrod (Arvin) for acute ischemic stroke: nursing implications. 183 48

Heat stroke is the most serious entity amongst the heat disorders. Whilst potentially fatal, it is preventable and salvageable. A retrospective study involving 27 patients admitted for exertional heat stroke to the Medical Unit, Toa Payoh Hospital, Singapore from January, 1984 to January, 1987 was carried out. These patients presented with a rectal temperature of greater than 40 degrees C and central nervous system disturbances. All were males and, except for three, were local born. All except two were below thirty years old. The patients were treated with a standard regime of IV fluids and sponging in the ICU. 19 patients (70.4%) presented in coma whilst abnormal behaviour, e.g. aggression and mental confusion was seen in the remainder. Fits were seen in only 5 patients (18.5%). Metabolic acidosis was seen in 93.3%. Hypokalaemia was present in 3 patients (11.1%). Of the enzymes, creatinine phosphokinase was elevated in all except 1 patient (mean: 4868.8, range: 146-28850). There were no deaths recorded in this series. Complications include reversible DIVC (3 instances), oliguric renal failure (4 instances) and residual neurological deficit (2 instances). 9 patients (39.1%) took more than 4 hours for the rectal temperature to attain 37.5 degrees C. All the above complications except for 1 instance of DIVC occurred in this group with delayed cooling. Heat stroke is a serious condition with serious complications and require prompt treatment.
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PMID:Heat stroke: a clinical review of 27 cases. 260 67

In rats with chronically implanted intrathecal catheters, high concentrations of morphine (3 microliters of 50 mg/ml: 150 micrograms) yielded a reliable and striking syndrome of pain behavior that involved intermittent bouts of biting and scratching at the dermatomes innervated by levels of the spinal cord proximal to the catheter tip. In addition, during intervals between bouts of agitation, the animals displayed a clear, marked hyperesthesia where an otherwise innocuous stimuli (brush stroke) evoked significant signs of discomfort and consequent aggressive behavior. These effects were exaggerated rather than reversed by high doses of naltrexone. The effect, perfectly mimicked by a considerably lower dose of morphine-3-glucuronide (15 micrograms) or the glycine antagonist strychnine (30 micrograms), was not produced by equimolar concentrations of sodium sulfate, glucuronide, methadone, or sufentanil. In halothane-anesthetized cats, light brushing of the hindpaw and tail or low-intensity stimulation of the sciatic nerves resulted in prominent elevations in blood pressure and pupil diameter following the intrathecal administration of high concentrations (50 mg/ml; 0.1 ml) of morphine sulfate. This effect, exaggerated by naloxone, was produced by a lower concentration of intrathecal morphine-3-glucuronide (5 mg/ml; 0.1 ml) but not by intrathecal saline. These results suggest the possibility that the effects of high doses of morphine may be characterized by a nonopiate receptor-mediated effect that alters the coding of sensory information in the spinal cord. The authors speculate that high concentrations of spinal opiates, as may be employed in tolerant terminal-cancer patients, could exert an action that physiologically antagonizes the analgesic effects otherwise mediated by the action of morphine on the spinal opiate receptor.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:High dose of spinal morphine produce a nonopiate receptor-mediated hyperesthesia: clinical and theoretic implications. 293 24

This review of the effects of sex steroids and oral contraceptives (OCs) on neurologic function in health and disease covers the following: sex steroids and their interaction with neural tissues; the human menstrual cycle and OCs; and sex hormones and OCs in human neurologic disease, i.e., stroke (thromboembolic cerebral infarction, subarachnoid hemorrhage, vascular malformations, and cerebral venous thrombosis), migraine, movement disorders, nervous system neoplasm, and the peripheral nerve. The various sex hormones may exert their effects on the nervous system directly or undergo conversion to more active metabolites. Interactions of sex hormones with neural substrates subserve numerous activities essential to both the well-being and perpetuation of the individual and the species. These interactions are key to the sexual differentiation of the brain, control of the brain-pituitary-gonad axis, and to the establishment of normal patterns of sexual and aggressive behavior in both sexes. Additionally, they play a role in temperature regulation (progesterone), caloric homeostasis (estrogen), and possibly sensory discrimination. The potent influences exerted by sex steroids on catecholamine and indoleamine turnover and the colocalization of labeled E2 within catecholamine and luteinizing hormone-releasing hormone (LHRH) positive perikarya suggest that many of the physiologic effects of sex steroids are mediated by modulation of specific monoaminergic and peptidergic pathways. Estrogens and aromatizable androgens also induce irreversible structural alterations in the rodent hypothalamus during the neonatal and peripubertal periods that are predominantly synaptogenic. In adult mammals, estrogens induce pathologic changes in the hypophysiotropic hypothalamus that may contribute to reproductive senescence in some species. Data from a series of retrospective and prospective studies have implicated OC use as an independent risk factor for the development of hemorrhagic and nonhemorrhagic stroke. Hormonal changes accompanying the pregnant state and the estrogen (and possibly progestogen) content of OCs may be predisposing factors in thromboembolic cerebral infarction, subarachnoid hemorrhage, cerebral venous thrombosis, and bleeding from intracranial and spinal vascular malformations. There are well-documented temporal associations of migrainous headache with specific phases of the menstrual cycle and the modifying influences of pregnancy, the menopause, and OC use. Also well established are relationships between endogenous and exogenous sex hormones and chorea. Fluctuating sex steroids also influence neuropsychiatric states, such depression and neuroendocrine disorders.
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PMID:Neurology of sex steroids and oral contraceptives. 302 81

Homocystinuria commonly affects the central nervous system (CNS), primarily as mental retardation, seizures, and stroke. Case reports have long suggested a predisposition to schizophrenia, but no careful study of predisposition to psychiatric illness has been performed. Accordingly, we evaluated 63 persons with homocystinuria due to cystathionine beta-synthase deficiency for psychiatric disturbance, intelligence, evidence of other CNS problems, and responsiveness to vitamin B6. The overall rate of clinically significant psychiatric disorders was 51%, predominated by four diagnostic categories: episodic depression (10%), chronic disorders of behavior (17%), chronic obsessive-compulsive disorder (5%), and personality disorders (19%). The average IQ was 80 +/- 27 (1 SD); and an IQ of less than or equal to 79 was two-thirds more common among vitamin B6-nonresponsive patients compared to vitamin B6-responsive patients. Aggressive behavior and other disorders of conduct were particularly common among patients with mental retardation and among vitamin B6-nonresponsive patients.
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PMID:Psychiatric manifestations of homocystinuria due to cystathionine beta-synthase deficiency: prevalence, natural history, and relationship to neurologic impairment and vitamin B6-responsiveness. 359 41

We investigated the relation of psychosocial risk factors to mortality in a prospective study of 1353 inhabitants of Crvenka, 619 of whom died between 1966 and 1976. All 38 lung cancer deaths occurred in those with high scores for rationality and antiemotionality (R/A), a factor related to suppression of aggression. Compared with lower R/A, high R/A was also associated with a relative risk of mortality of 29 for other cancer, 4.3 for ischaemic heart disease and 6.5 for stroke. Standardising for R/A reduced the smoking/lung cancer association, virtually eliminated the smoking/other cancer and smoking/heart disease relationships and reduced the association of heart disease with blood cholesterol, blood sugar and hypertension. Long lasting hopelessness was also independently associated with cancer as was anger with heart disease, though not so strongly as for R/A. Psychosocial variables are important predictors of mortality and decisively modify the effect of physical risk factors such as smoking.
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PMID:Psychosocial factors as strong predictors of mortality from cancer, ischaemic heart disease and stroke: the Yugoslav prospective study. 400 17

The diagnosis of intracerebral hemorrhage (ICH) has become precise with the advent of computerized tomography (CT). Little, however, is known concerning the long-term prognosis. Seventy consecutive patients with primary intracerebral hemorrhage (all known etiologies except hypertension excluded) proven by CT scan were studied. Follow up, averaging 2 1/2 years, was successful in all cases. The status of alertness, EKG, and clinical impression on admission were significant prognostic factors. As expected, mortality increased with size of the hematoma and ventricular rupture. Acute in hospital mortality was 40%. Another 17% died during the long-term follow up, but none of them from cerebrovascular disease. Ninety-two percent of the survivors were ambulatory at follow up. Hypertensive intracerebral hemorrhages, unlike aneurysms, rarely, if ever, rebleed. Patients are not likely to have a second bleed in another location. Hypertensive intracerebral hemorrhage is more common in blacks, especially young adult males with severe hypertension, but overall mortality is lower than thought prior to the CT scan. Most survivors can achieve independence and deserve aggression rehabilitation efforts.
Stroke
PMID:Long-term prognosis of hypertensive intracerebral hemorrhage. 710 49


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