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

Cardiac output, using dye-dilution technique, and intra-arterial blood pressure at rest and during exercise on a bicycle ergometer were determined in six boys with bronchial asthma, mean age 11.9 years. Intra-arterial blood pressure was also measured in another group of eight boys with bronchial asthma. Cardiac output, stroke volume, arteriovenous oxygen difference, blood pressure and total peripheral vascular resistance at rest and during exercise up to maximal level were within the normal limits of healthy boys of the same age. At maximal exercise, cardiac output averaged 12.4 l/min, stroke volume 66 ml, systolic, diastolic and mean blood pressures 128, 81 and 107 mmHg, respectively, and total peripheral vascular resistance 10.9 mmHg/l/min. The maximal arteriovenous oxygen difference amounted to 14.1 ml/100 ml blood which is similar to that in healthy adults.
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PMID:Cardiac output and blood pressure at rest and during exercise in boys with bronchial asthma. 44 97

The laryngeal mask airway (LMA) provides a patent airway when placed 'blindly' into the hypopharynx. At the laryngeal side it is supposed to form a seal surrounding the laryngeal inlet with the epiglottis lying outside the mask aperture. This study is designed to assess the prelaryngeal position of the mask by the fibreoptic technique. METHODS. After approval by the local ethical committee and informed consent, 100 adult patients (ASA groups I and II) undergoing general anaesthesia for extracorporal stroke wave lithotripsy (ESWL, Lithotripter HM 3, Dornier) of the kidney were studied. Anaesthesia was induced with propofol (1.5-2.5 mg.kg-1) and fentanyl (1-1.5 micrograms.kg-1) and maintained with isoflurane and N2O (65% in O2) as clinically indicated. The LMA was left in situ until the patients opened their mouth on command. Monitoring consisted of an ECG (SMV 104-D, Dornier), a pulse oximeter (Nellcor 200, Draeger), and a non-invasive blood pressure monitor (BP 103 N, Hoyer). Clinical assessment of airway patency and fibreoptic laryngoscopy (BF Typ 10, Olympus)--immediately and 20 min following the insertion of the LMA--were performed by two observers. RESULTS. The insertion of the LMA was successful on the first attempt in 89 patients while 5% required two, 4% three and 2% four attempts. 'Blindly' inserted without neuromuscular blockade the LMA provided a clinically sufficient airway in all patients. A central position of the LMA was assessed in only 59% of the cases. In 4 patients the mask was riding on the vocal folds. Positioned at the posterior larynx the cuff produced a compression of the laryngeal orifice when insufflated. Oblique insertion of the LMA or oblique head position during insertion produced a misplacement of the LMA. In 5 cases the LMA followed lateral movements of the head without losing its central position. In 87% the epiglottis was within the lumen of the LMA. Secretions inside the mask lumen or at the anatomic structures were seen in 36%. During manual ventilation with high inspiratory pressure (> 25 cm H2O) the oesophagus opened in 10 cases. CONCLUSIONS. Previous studies have suggested that the LMA takes a 'perfect' position at the laryngeal side when a clinically patent airway is recognized. In contrast, our results demonstrated that a central position of the LMA is achieved in only 59% of the cases. Our results indicate that epiglottic downfolding or left/right side or anterior/posterior misplacement are common but generally provide a satisfactory patent airway. This is consistent with fibreoptic findings in children and radiological observations in adults. The LMA is an essential enrichment to conventional airway management. It provides a better seal than the face mask, especially in bearded or in old patients where the facial contours are often not suited to the mask. Ideal indications seem to be elective operations of intermediate duration (1-2 h). The LMA does not protect against aspiration. For patients who are at risk of regurgitation of gastric contents, use of the LMA is absolutely contraindicated. Relative contraindications are local pathology of the pharynx and situations with low pulmonary compliance and/or high airway resistance (massive obesity, asthma, etc.), especially during controlled ventilation. Further studies are necessary to establish definite indications for the application of the LMA.
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PMID:[Fiberoptic determination of the position of the laryngeal mask]. 148 77

This study measured the prevalence of chronic medical conditions in 4,549 middle aged persons attending three large general practices in Dublin over the course of a calender year. The prevalence of the following conditions were measured: coronary heart disease, hypertension, stroke, diabetes, asthma, chronic bronchitis, rheumatic disorders, dyspepsia, depression, anxiety disorders, psychoses, and cancer. In order to obtain a valid denominator for the study a second community based study was carried out in the same areas to determine what proportion of persons visit their general practitioner over the course of a year. Overall 40.5% of males and 44% of females suffered from a least one of the twelve conditions, with rheumatic disorders having the highest prevalence (14.5%) and psychotic disorders the lowest (0.75%).
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PMID:General practice estimates of the prevalence of common chronic conditions. 147 57

Thromboxane A2 is a very unstable arachidonate metabolite, yet a potent stimulator of platelet aggregation and a constrictor of vascular and respiratory smooth muscles. It has been implicated as a mediator in diseases such as myocardial infarction, stroke and bronchial asthma. Using a stable analogue of this compound we recently purified the human platelet thromboxane A2 receptor to apparent homogeneity. Using an oligonucleotide probe corresponding to its partial amino-acid sequence, we have obtained a complementary DNA clone encoding this receptor from human placenta and a partial clone from cultured human megakaryocytic leukaemia cells. The placenta cDNA encodes a protein of 343 amino acids with seven putative transmembrane domains. The protein expressed in COS-7 cells binds drugs with affinities identical to those of the platelet receptor, and that in Xenopus oocytes opens Ca2(+)-activated Cl- channel on agonist stimulation. Northern blot analysis and nucleotide sequences of the two clones suggest that an identical species of the thromboxane A2 receptor is present in platelets and vascular tissues. This first report on the molecular structure of an eicosanoid receptor will promote the molecular pharmacology and pathophysiology of these bioactive compounds.
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PMID:Cloning and expression of cDNA for a human thromboxane A2 receptor. 182 98

To study past histories of patients who died suddenly, we selected cases from all the summary death certificates in which death occurred within 24 hours from the onset of symptoms spanning 1984 to 1986 in Niigata prefecture with a population of 2.5 million. We then re-examined all information on the death certificates to determine the underlying causes. Sudden deaths due to cardiovascular diseases other than acute myocardial infarction and cerebrovascular accident (OCD) accounted for the largest proportion (51.4%). The proportion of death of unknown etiology increased with the decrease in age in both sexes aged 15 to 54 years, accounting for 67.8% in males and 51.1% in females. The number of cases with histories of diseases related to atherosclerosis (e.g. hypertension, old cerebrovascular accident, etc) increased with age in both sexes, accounting for 38.5% in males and 36.4% in females, both aged 75 years old and over. Except diseases related to atherosclerosis, the past histories accounted for 2.5% or greater were as follows: alcoholism (4.1%), psychiatric disorder (PSY, 2.9%) and valvular heart diseases (VD, 2.6%) in 15-54-year-old males; ischemic heart diseases (IHD, 9.4%), arrhythmia without organic heart diseases (ARR, 2.5%) and VD (2.5%) in 55-74-year-old male; IHD (11.4%), bronchial asthma (3.7%), common cold within one month (CC, 3.6%), cor pulmonale or its related diseases (3.0%) and ARR (2.6%) in male of 75 years old and over; PSY (8.7%), IHD (5.8%), VD (5.1%), pregnancy, delivery or related diseases (4.4%), chronic renal failure (3.6%) and CC (2.9%) in 15-54-year-old females; IHD (10.2%), VD (3.2%) and ARR (2.6%) in 55-74-year-old females; and IHD (11.8%) in females of 75 years old and over. When diseases related to atherosclerosis were included, half of the sudden death cases due to OCD had past histories of underlying cause. As descriptions of past histories are often incomplete, there were probably more cases with past histories. The results of this study indicate that investigation of past histories may aid in elucidating and preventing sudden death.
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PMID:[Past histories of sudden death without specific underlying disease]. 184 23

Two young children, 5 and 30 months of age, developed acute transient dyskinesias. The novel features of these patients were classic orobuccal-lingual dyskinesias, their young ages, and the association with asthma and theophylline. The movements resembled tardive dyskinesias of older patients on neuroleptics, but neither patient had any exposure to neuroleptic drugs. Choreiform movements were moderately severe and remitted several hours after discontinuation of theophylline or over days in the patient who remained on the drug. No symptomatic treatment of dyskinesia was required. Both infants otherwise had normal neurologic examinations with no clinical evidence of meningoencephalitis, seizures, or stroke. Both infants required hospitalization for respiratory distress, but not intensive care. The highest theophylline levels measured in these patients were 22 and 25 micrograms/ml and levels determined closest to the appearance of dyskinesias were lower. Urine toxicology screen for other drugs and routine blood work were normal. The infants, examined subsequently for 1 1/2-2 years for asthma, have demonstrated no reappearance of dyskinesias or other neurologic abnormalities. We propose an interaction of theophylline, hypoxemia, or other factors related to asthma in the pathophysiology of reversible dyskinesia in our patients.
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PMID:Acute dyskinesias in young asthmatics treated with theophylline. 158 Sep 64

Airways obstruction is usually associated with substantial decreases in inspiratory and mean intrathoracic pressure (ITP). The change in ITP is correlated with the degree of inspiratory fall in arterial pressure, pulsus paradoxus. The factors influencing the degree of pulsus include venous return, afterload effects on the left ventricle (LV), diastolic ventricular interdependence, lung volume, and circulatory reflexes. I have reviewed these factors and attempted to demonstrate that their relative importance changes under different circumstances. I have discussed the importance of measuring transmural pressures to assess ventricular performance, and pointed out some possible pitfalls in the use of esophageal or pleural pressure to estimate LV surface pressure. During normal and loaded inspiration, decreased LV preload, probably related to right ventricle (RV)-LV diastolic interdependence, appears to be the primary mechanism responsible for decreased stroke volume during inspiration. During Mueller maneuvers, and possibly with severe decreases in ITP. LV afterload may be more important. When lung volume increases, as with asthma, venous return from the lower body may be a more important determinant of pulsus paradoxus. Although previous predictions that decreased ITP would lead to increased myocardial O2 consumption were not borne out, coronary blood flow did increase with inspiratory loading. This appears to be due to a nonvagally mediated change in autonomic tone with loaded breathing. This and other reflex-mediated effects deserve more attention in future studies of stressed or abnormal inspiration. As a final point, pericardial tamponade probably leads to pulsus paradoxus by exaggerating normal diastolic right-left interactions.
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PMID:Cardiovascular effects of airways obstruction. 201 Oct 41

The greater and lesser circulation hemodynamics was examined in 59 patients with bronchial asthma and 23 controls by tetrapolar rheography, kinetocardiography, and ultrasonic Doppler cardiography. Simultaneously measurements of intrathoracic pressure (ITP) were carried out with an esophageal controller. Reduced stroke index, increased total peripheral resistance of the vessels, and elevated systolic pressure in the pulmonary artery were revealed in the patients as against the controls. ITP values in asthmatics surpassed twofold those in the reference group. To reveal elevated ITP effects on the hemodynamics, the authors have examined the hemodynamic parameters during Valsalva's test (with elevation of oral pressure up to 25-35 mm Hg) in 16 reference subjects. The results evidence the leading role of elevated ITP on the greater and lesser circulation hemodynamics in asthma. Elevated ITP lowers the venous blood flow to the heart and reduces the preload thus decreasing the blood flow to the lesser circulation and not increasing the pulmonary artery systolic pressure.
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PMID:[Role of intrathoracic pressure in changes in the greater and lesser circulation hemodynamics in patients with bronchial asthma]. 207 7

Cluster analysis was used to examine the nature and magnitude of changes in left ventricular pump function in relation to the severity of primary bronchial obstruction in patients with non-atopic bronchial asthma (n = 45) and chronic obstructive bronchitis (n = 45). In the patients with obstructive lung disease, central hemodynamic changes were found to be determined by the bronchial patency and independent of the pathogenesis of the obstruction. During a remission there was a significant reduction in total peripheral resistance as compared to the values seen in healthy subjects, whereas in moderate or severe obstruction there was a marked increase in total peripheral resistance and a decrease in stroke volume and cardiac output. A drastic bronchial obstruction was followed not only by central hemodynamic changes, but a fall in ejection fraction and a rise in left ventricular end-systolic and end-diastolic volumes.
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PMID:[Pump function of the left ventricle during the stages of cor pulmonale development]. 227 42

Factors influencing the prognosis were studied in 165 patients with polyarteritis nodosa (PAN) and Churg-Strauss angiitis. One hundred and forty-seven of the patients fulfilled histological and/or arteriographic diagnostic criteria, and in 18 patients the diagnosis was based on clinical criteria. The patients' mean age on diagnosis was 48.4 +/- 16.4 years. The main symptoms were fever (69%), weight loss (66%), arthritis (44%), mononeuritis multiplex (67%), cutaneous signs (46%), renal involvement (26%), gastrointestinal symptoms (31%), asthma (29%), hypertension (31%) and cardiac failure (18%). Ninety-two per cent of the patients survived for at least 1 year after diagnosis of the disease, 79% for 2 years, and 63% for 5 years. The immediate causes of death were gastrointestinal bleeding or peritonitis in 11 cases, pancreatitis in two, renal insufficiency in six, cardiac failure in five, infectious complications in four, stroke in three and other causes in 11. We studied the prognosis of necrotizing angiitis in relation to clinical symptoms and laboratory findings. The association of four conditions were associated with a poor prognosis: age over 50, gastrointestinal problems, cardiomyopathy and renal signs. The survival rates in patients with these conditions were: for gastrointestinal problems, 55% 5-year survival (versus 67%); and for age over 50, 68% 3-year survival (versus 78%; p less than 0.09). One hundred and fifty-nine patients were treated with steroids for at least 18 months. Forty-eight also received cytotoxic agents (27%) and 46 plasma exchange. Patients who were treated with plasma exchange and prednisone were randomly assigned to additional treatment with cyclophosphamide. Survival rates were comparable in both groups.
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PMID:Clinical findings and prognosis of polyarteritis nodosa and Churg-Strauss angiitis: a study in 165 patients. 290 Jun 59


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