Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sixty-three patients with internal carotid artery occlusion manifesting as transient ischemic attack or minor stroke received superficial temporal artery-middle cerebral artery bypass surgery and medical treatment (n = 27) or medical treatment only (n = 36). Long-term follow-up showed that there was no significant difference in the outcomes. However, positron emission tomography studies suggested that patients with misery perfusion in the chronic stage benefited from extracranial-intracranial bypass surgery.
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PMID:STA-MCA bypass surgery for internal carotid artery occlusion--comparative follow-up study. 137 87

Indobufen is an inhibitor of platelet aggregation which acts by reversibly inhibiting the platelet cyclo-oxygenase enzyme. Improvements in walking distances and microcirculatory parameters have been achieved during therapy with indobufen in patients with peripheral vascular disease and intermittent claudication. Indobufen has been shown to be as effective as aspirin plus dipyridamole in preventing the reocclusion of coronary and femoro-popliteal artery bypass grafts and has been shown to significantly reduce platelet deposition on haemodialysis membranes. Initial studies have also indicated that indobufen may have a prophylactic effect on the incidence of secondary thrombotic events following transient ischaemic attack or mild stroke and may be effective in the prophylaxis of migraine. Indobufen is well tolerated following oral administration and has been associated with a low incidence of adverse effects rarely requiring withdrawal of treatment. Thus, available evidence indicates that indobufen may be an effective alternative to aspirin for the treatment of cerebral, peripheral and coronary vascular diseases with the advantage of a lower incidence of gastrointestinal effects compared to high dose aspirin, rendering indobufen more suitable for longer term therapy.
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PMID:Indobufen. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in cerebral, peripheral and coronary vascular disease. 138 38

A total of 2435 patients with transient ischaemic attack or minor ischaemic stroke were entered into the UK-TIA aspirin trial and randomised to treatment with aspirin 1200 mg/day, aspirin 300 mg/day, or placebo. At a single point in time during the trial patients were examined ophthalmoscopically for evidence of cataracts. The length of time that each patient had been participating in the trial at the time of ophthalmic examination varied from 1 to 5 years. The prevalence of cataracts was similar in patients allocated aspirin and patients allocated placebo irrespective of the length of time that they had been in the trial. These findings suggest that aspirin taken in a dose of 300 to 1200 mg daily for a few years does not prevent cataracts.
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PMID:Does aspirin affect the rate of cataract formation? Cross-sectional results during a randomised double-blind placebo controlled trial to prevent serious vascular events. UK-TIA Study Group. 139 May 4

The aim of this study was the development of a simple bedside test to assess cerebrovascular reserve capacity using transcranial Doppler sonography. We tried to validate the increase in blood flow velocity as cerebrovascular reserve capacity in 20 (3 normal, 7 TIA, 10 completed stroke) patients. They were studied using transcranial Doppler sonography and rCBF SPECT before and after injection of 1 g acetazolamide. Their increases in blood flow velocity and changes in cerebral blood flow correlated significantly in the symptomatic hemispheres (p less than 0.001). Blood flow velocity between the two hemispheres (symptomatic and asymptomatic) was not significantly different at rest. We offer these simple and reliable methods in clinical studies to clarify the frequency of ischemic stroke of hemodynamic origin.
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PMID:[Determination of the cerebrovascular reserve capacity by using acetazolamide as well as transcranial Doppler and SPECT tests]. 140 69

In 28 (3 normal, 11 TIA, 14 completed stroke) patients 99mTc-HMPAO rCBF SPECT studies were performed at rest and after acetazolamide administration. For the investigations, a one-day protocol (the stress study directly followed the rest investigation) was used. The reconstructed and normalized slices were evaluated visually and semiquantitatively with a side difference analysis method. In the group of TIA patients, the abnormal results of the rCBF investigations increased from 55% to 82% after acetazolamide provocation. The corresponding results in the completed stroke group were 80% and 87%. After acetazolamide stimulation, hypoperfusion appeared or become more pronounced in the majority of the TIA group patients in contrast with the completed stroke patients with an unchanged or decreased perfusion abnormality. The semiquantitative evaluation method was mostly effective in the TIA group, where predominantly a one-sided cerebrovascular disorder was suspected. It was concluded that the 99mTc-HMPAO studies allow demonstration of the acetazolamide-induced cerebral perfusion alterations, and this method can be useful in the diagnosis and management of cerebrovascular disorders.
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PMID:[The value of acetazolamide provocation combined with blood flow tests in the diagnosis of ischemic cerebrovascular diseases]. 140 85

The prevalence of anticardiolipin antibodies (ACLA) in sera of 49 patients having had their first TIA or ischemic stroke before 50 years of age was studied using a solid phase enzyme immunosorbent assay (ELISA). Five patients had IgM antibodies, eight had IgG, and three had antibodies belonging to both classes. Although ACLA were detected in 32% of patients (95% confidence interval [CI] 19-45%), the ACLA positive group did not differ with respect to clinical characteristics and distribution of major stroke risk factor frequency from the ACLA negative group. Further investigations are needed to establish the role of ACLA in the pathogenesis of ischemic cerebrovascular diseases.
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PMID:Anticardiolipin antibodies, a disease marker for ischemic cerebrovascular events in a younger patient population? 141 51

Echocardiographic predictors of clinical outcome were examined in subjects from the Framingham Heart Study with overt coronary artery disease. The study population consisted of 185 men and 147 women with coronary artery disease who underwent M-mode echocardiography and were followed for a mean of 3.90 years. At baseline, 37 men (18.4%) and 16 women (10.9%) had reduced fractional shortening, 43 men (23.2%) and 28 women (19%) had left ventricular (LV) dilatation, and 76 men (41%) and 76 women (51.7%) had LV hypertrophy. During the follow-up period new cardiovascular disease events (coronary disease, stroke, transient ischemic attack, claudication, heart failure and deaths from cardiovascular disease) occurred in 60 men (32%) and 58 women (39%). With use of age-adjusted proportional hazards analyses, LV mass/height in men (relative risk [RR] = 1.25/50 g/m increment, 95% confidence interval [CI] 1.01 to 1.55) and LV end-diastolic diameter in women (RR = 1.36/5 mm increment, 95% CI 1.05 to 1.76) were predictors of new cardiovascular disease events. Cardiovascular risk was also associated with LV end-systolic diameter in both sexes (in men RR = 1.28/1 SD increment, 95% CI 1.02 to 1.63; in women RR = 1.40/1 standard deviation increment, 95% CI 1.09 to 1.82). Reduced fractional shortening alone (RR = 1.91, 95% CI 1.11 to 3.31) and in combination with LV dilatation (RR = 2.13, 95% CI 1.13 to 4.02) was associated with the incidence of new cardiovascular disease outcomes in men.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Echocardiographic determinants of clinical outcome in subjects with coronary artery disease (the Framingham Heart Study). 141 14

A retrospective analysis of the medical charts of 117 patients (50 men and 67 women) with multi-infarct dementia took place. All patients admitted to the psychogeriatric nursing home 'Joachim en Anna' in Nijmegen between 1980 and 1989 were studied. The aim of the study was to obtain epidemiological information and to investigate the prevalence of comorbid conditions, prognosis and mortality. The results were compared with patients with Alzheimer's disease. The patients remained in the institute for 1.4 years and the mean total duration of the disease was 5.3 years. About twenty-five percent died in the first three months of admission. Life expectation, counted from time of admission, was 6 years shorter in comparison with Dutch mortality tables. Morbidity frequently seen at admission included circulatory system diseases and cerebrovascular accidents. The risk factor hypertension was seen in a smaller percentage of patients than expected. During the stay the diseases most frequently diagnosed were respiratory and urinary tract infections, adverse effects of drugs, constipation and chronic ulcers of the skin. About twenty percent of the patients were struck by a (recurrent) cerebrovascular accident or a transient ischaemic attack. Most patients died of dehydration or bronchopneumonia. There was, apart from the diagnosis of multi-infarct dementia, no single patient aspect that could predict a poor prognosis. Nursing home patients with multi-infarct dementia are clearly different from patients with Alzheimer's disease. Time spent in the nursing home and duration of disease are shorter. They have more comorbid conditions, especially of a cardiovascular nature, and they have a poor life expectation.
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PMID:[Multi-infarct dementia in nursing home patients; more comorbidity and shorter life expectancy than in Alzheimer's disease]. 143 2

Recent studies concerning secular trends in stroke incidence and mortality and identification of independent risk factors for stroke are reviewed. Stroke mortality has declined in many industrialized countries in recent decades. In France, it has been declining by more than 30% between 1968 and 1982 in all age groups and in both sexes except for women under 40 years. The decline in stroke mortality seems to be partly real and partly apparent. In the community-based study of Rochester, Minnesota, stroke incidence decreased by 54% between 1945-49 and 1975-79. Recent data from Rochester, however, suggest that the incidence of stroke may no longer be declining. Survival after stroke has also apparently been improving but several sources of potential bias may also have influenced the decrease in reported survival rates. Hypertension is a major risk factor for stroke. Prolonged differences in "usual" diastolic blood pressure of 5 to 10 mmHg are associated with about 40% difference in stroke incidence. Recent analysis suggests that stroke incidence reduction could arise rapidly after hypertension control and that a lower blood pressure should confer a lower risk of vascular disease, even in individuals conventionally considered as "normotensive". There is evidence that cigarette smoking is an important risk factor for stroke with an overall relative risk of 1.5 and that the risk of stroke declines rapidly after the cessation of smoking. A cardiac condition may be a marker for another risk factor or the primary substrate for cerebral embolism. In patients with atrial fibrillation, the risk of stroke is increased through both of these mechanisms. Diabetes mellitus, chronic alcohol consumption (> 3 drinks/day), and high fibrinogen levels are other independent risk factors for stroke. While high levels of cholesterol may be associated with ischemic stroke, an inverse association of the serum cholesterol with the occurrence of intracerebral hemorrhage in men has been reported. In patients with asymptomatic internal carotid stenosis, higher degrees of stenosis convey a higher risk of stroke. However, far from all these strokes are due to thromboembolism from an atheromatous plaque in the ipsilateral internal carotid artery. The relative risk of stroke during the first 5 years following a transient ischemic attack is 7 times that in persons without transient ischemic attack. More than a third of the subsequent strokes occur in a vascular territory different from that of the incident TIA. While the use of oral contraceptives may increase the relative risk of stroke, postmenopausal estrogen treatment may have a protective effect on the risk of vascular diseases.
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PMID:[Epidemiology of cerebrovascular accidents]. 143 51

Extracardial carotid artery disease is a frequent cause of transient ischemic attack and of cerebral infarction. The records of 485 patients who underwent carotid endarterectomy between 1978 and 1991 were reviewed, with special attention to both cardiac and neurological complications. 432 patients had symptomatic carotid disease whereas 53 were asymptomatic but presented with significant carotid stenosis or a large ulceration at doppler-duplex examination and/or angiography. These examinations showed the following lesions in symptomatic patients: unilateral stenosis > 75% (331; 68.5%), ulceration (41; 8.5%), bilateral stenosis (61; 12.5%) and unilateral stenosis with contralateral occlusion (51; 10.5%). Intraluminal shunt was used in nearly all patients whereas special management of cerebral metabolism (intraoperative electroencephalogram, somatosensory evoked potentials) were used in high-risk patients only. Overall early mortality was 1.8%. Three patients died from the sequelae of a neurologic injury, whereas six patients died from myocardial infarction or intractable arrhythmia. Mortality decreased from 2.4% between 1978 and 1984 to 0.8% between 1985 and 1991. At 6 and 8 years, actuarial survival rates of 88.1% and 76.1% and stroke-free survival rates of 86% and 81.5% were observed. Late mortality was essentially due to ischemic cardiac complications (38.5% of the actuarial late mortality at 8 years). Review of the literature shows that carotid endarterectomy is the treatment of choice for symptomatic high-grade extracranial carotid stenosis in patients who are not high-risk candidates.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Immediate and long-term results of carotid endarterectomy: the Zurich experience]. 143 89


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