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

In the total population, cerebrovascular ischemic diseases account for 0.2-0.3% cases per year, and in the 20-40% of them it is possible to recognize a cardioembolic mechanism. The cardiological examination in patients with stroke is, therefore, aimed at detecting cardiac sources of emboli (left atrial, valvular, and ventricular thrombosis, atherosclerotic plaques of ascending aorta), and at identifying the cardiovascular disease directly or indirectly associated with ischemic stroke. Transesophageal echocardiography (TEE) is particularly suitable for this purpose, due to the proximity of the transducer to the posterior cardiac structures and to its better resolution. Many recent reports have demonstrated that TEE not only improves the recognition of known cardioembolic diseases (intracardiac thrombi, mitral stenosis, valvular prosthesis thrombosis, endocardial infectious diseases), but is also the most reliable non invasive technique suitable to detect atherosclerotic lesions of the ascending aorta. Furthermore, TEE allowed to recognize new anatomic and functional abnormalities, such as left atrial spontaneous echo contrast, atrial septal aneurysm, patent foramen ovale, frequently associated with stroke. Noteworthy, TEE is the only technique suitable for functional and anatomic evaluation of the left atrial appendage. The Authors studied by TEE the functional properties of left atrial appendage in patients with severe mitral stenosis with or without atrial fibrillation, as compared to patients with left atrial thrombosis. Results showed that fractional shortening of left appendage was greatly reduced, at the same extent in the 3 groups, demonstrating that abnormalities in left atrial appendage emptying could be a risk factor for atrial thrombosis. In order to compare TEE with the transthoracic 2D-echo for the detection of cardioembolic sources, the Authors studied 63 patients with ischemic stroke. TEE revealed a possible cardioembolic source in 70% of younger patients and in 50% of patients older than 45 years. These abnormalities were detected by TEE respectively in 10% and in 1.8% of cases. These data are in agreement with many other reports in literature, and suggest the usefulness of TEE in the evaluation of patients with ischemic stroke and no evidence of severe atherosclerotic cerebrovascular disease, in contrast to the poor role of TEE. Another important field is the prevention of stroke in patients at high risk of cardioembolic events. The role of TEE before and immediately after cardioversion in patients with atrial fibrillation has been recently studied by several papers. Cardioversion was proved at low risk of stroke when TEE did not show left atrial or left appendage thrombosis. Therefore, the transesophageal approach identifies patients needing prolonged anticoagulation (roughly 20%), avoiding an undue, potentially dangerous therapy.
 ...
PMID:[Role of transesophageal echography in the study of embolism of cardiac origin]. 802 30

We observed 40 patients aged from 15 to 40 years who suffered either a transient ischemic attack or an arterial ischemic stroke. All patients were clinically and physically examined, i.e. chest-X rays, electrocardiograms, biological tests and C.T. scan or magnetic resonance imaging that confirmed the diagnosis of ischemic cerebral infarction. Most patients underwent echocardiography and angiography. The time span between the onset of the ischemic event and angiography was recorded. A few of them had CSF analysis and determinations of antithrombin III, protein C and protein S. The etiology was confirmed in 15 patients (5 cardioembolic diseases, 7 vasculopathies, 3 coagulopathies). Twenty three had well-known vascular risk factors, but also an increase in serum fibrinogen concentration, which might have been associated with specific predisposing factors: oral contraceptives, patent foramen ovale, migraine, craniocervical trauma, acute alcohol intoxication and infectious diseases. No cause was found in 2 patients. We suggest a practical approach and highlight the value of angiography when performed early in the course of the illness to enhance the percentage of positive diagnosis. About 45 p. 100 of the patients followed-up (mean duration: 3 years) were unable to resume normal professional activity.
 ...
PMID:[Cerebral ischemic arterial accidents in young adults. 40 cases]. 802 69

One hundred and twenty cases of stroke occurring in Saudi Arabian subjects aged 15 to 45 years are reviewed. These constituted 12.7% of a group of 946 stroke patients. Males outnumbered females (76/44). The frequency of intracranial hemorrhage, including subarachnoid hemorrhage, was slightly lower than cerebral infarction (41.5 vs 58.5%). The causes of large cerebral infarction were as follows: atherosclerosis 17 (28%), cardiac embolism 12 (19.5%), uncommon and uncertain causes 21 (34.5%). Some unusual causes were encountered such as dissecting arterial aneurysm due to popular healing manoeuvres or to traditional dance, retrograde embolism from a thoracic outlet syndrome or embolism from a fibroelastoma of the mitral valve chorda. Lacunar cerebral infarction was diagnosed in nine cases. Hypertension (25.5%) and arteriovenous malformations (20.5%) were the main causes of cerebral hemorrhage; all subarachnoid hemorrhages except one were due to berry aneurysms. The cause was undetermined in 16% of cerebral infarction and 26% of intracranial hemorrhage. The high frequency of stroke in young Saudi Arabian adults is probably a reflection of the demographic structure of the predominantly young Saudi society. The observed causes were relatively similar to those in industrial societies. Contrary to other developing countries infectious disease no longer seems to be an important cause of stroke. Drug abuse, which is becoming an important cause in Western societies, was encountered in only two of our cases.
 ...
PMID:Stroke in Saudi Arabian young adults: a study of 120 cases. 808 29

A case is presented of recent anterior myocardial infarction in 40-year-old man, treated in acute stage with streptokinase and heparin, complicated by spleen rupture and splenectomy on the 6th day of infarction and by ischemic cerebral stroke on the 15th day. After 10-weeks of therapy patient left the hospital in good clinical condition, which continued 6 months of out-patient follow-up. Results of our examinations excluded haematologic proliferative diseases as a cause of spleen rupture. Fever and recurring pains in the left hypochondrium occurring before infarction suggested possibility of infectious diseases with spleen involvement. In histopathological examination the spleen swelling (as a reaction on an infection) was found. The influence of fibrinolytic and anticoagulant therapy on spleen rupture was discussed. In pathogenesis of ischemic stroke, the thrombocythemia observed after splenectomy and platelet hyperactivity following thrombolytic therapy were taken into consideration.
 ...
PMID:[Spleen rupture and ischemic cerebral stroke in a patient with recent myocardial infarction]. 819 Jun 58

The central nervous system is especially vulnerable to hyperthermia-induced dysfunction, yet the mechanism for this susceptibility is poorly understood. High levels of adenosine triphosphate are necessary to maintain normal re-uptake of glutamate and aspartate, the major excitatory amino acids, by excitatory amino acid co-transporters. We hypothesized that excitotoxic neurotransmitters accumulate extracellularly when hyperthermia depletes adenosine triphosphate, leading to decreased uptake or release of excitatory amino acids by these co-transporters. Incubation of hippocampal slices at 42 degrees C, a temperature that results in coma in vivo, reduced adenosine triphosphate to 70% of control values and decreased uptake of the transportable excitatory amino acid analogue, D,L threo-beta-hydroxyaspartate, to 50% of control values. The degree of adenosine triphosphate depletion induced by hyperthermia was highly correlated with decreases in excitatory amino acid uptake. Severe adenosine triphosphate depletion (< or = 20% of control) induced by hyperthermia in combination with metabolic insults was highly correlated with the release of endogenous glutamate and aspartate. Preloading slices with excitatory amino acid analogues potentiated hyperthermia-induced alterations of excitatory amino acid transport, strongly suggesting that the hyperthermia-induced changes were largely due to altered excitatory amino acid co-transporter activity. Immunocytochemical studies suggested glutamate-like immunoreactivity was lost from axonal terminals during hyperthermia in a similar manner to losses induced by metabolic toxins. Hyperthermia due to infectious diseases or heat stroke my induce disorientation and coma. These dysfunctions may be due, in part, to altered excitatory amino acid transport induced by adenosine triphosphate depletion.
 ...
PMID:Hyperthermia depletes adenosine triphosphate and decreases glutamate uptake in rat hippocampal slices. 855 37

In the United States, sickle cell disease primarily affects people of African descent, and the multisystemic complications caused by the resultant vaso-occlusive state create a multitude of diagnostic considerations. In the musculoskeletal system, likelihood is high for avascular necrosis of the femoral humeral head, as a consequence of skeletal infarcts, and also for leg ulceration and osteomyelitis; in the eyes, the incidence of proliferative retinopathy is high; in the urinary tract, dehydration is common, and causes for renal failure are many; in the pulmonary system, pneumonia is of prime concern, as are sickle cell chest syndrome (from occlusion within the microvasculature of the lung) and the deadly sickle cell chronic lung disease, for which pulmonary function tests are important in early asymptomatic stages. Cholelithiasis occurs in 40% of young adult patients with sickle cell disease and can be confused with sickle cell hepatopathy, and rheumatologic and immunologic diseases can occur concomitantly with sickle cell disease, with similar symptoms. The chance for stroke in patients with sickle cell disease is 25%, and early recurrence is common, although the pathogenesis has been more clearly elucidated through computed tomography and magnetic resonance imaging. Infection with Streptococcus pneumoniae has high mortality because of the asplenia associated with sickle cell disease.
 ...
PMID:Sickle cell disease: the clinical manifestations. 855 48

A national survey was performed in France from May to June, 1993. The aim of this study was to evaluate general practitioners' attitudes and behaviors when diagnosing and managing patients with lower extremity arterial disease (LEAD). One thousand general practitioners, randomly drawn from an exhaustive list, were contacted to participate in a telephone interview concerning the last patient with intermittent claudication seen in their practice. Four hundred seventy-six general practitioners participated. Risk factors noted for these 476 patients with intermittent claudication were in agreement with the literature: 86% were men aged 64 +/- 10 years (mean +/- SD) and 14% were women aged 73 +/- 8 years. Sixty-two percent had a pain-free walking distance of between 100 and 500 meters at diagnosis. Forty-five percent were former smokers and 37% currently smoked; 55% had hypertension, 14% diabetes, and 56% disturbances of lipid metabolism. A majority of them were hypercholesterolemic. The diagnosis of the disease was based primarily on a clinical assessment, confirmed for 33% by Doppler or echo Doppler. The mean duration of diagnosis was 4.4 +/- 4.1 years. Management of the disease was mainly by prescription of vasodilators (91%), antiplatelet agents (59%), and anticoagulants (8%). Use of Doppler or echo Doppler was recommended once a year. Infection was observed in 27% of patients. Thirty-eight percent had had a cardiac incident (angina pectoris or myocardial infarction) and 10% a cerebrovascular accident. They differed significantly from those with LEAD alone for the following parameters: age (68.5 +/- 9.2 vs. 63.2 +/- 10.3 years; p < 0.001); duration of LEAD (5.6 +/- 4.6 vs. 3.6 +/- 3.5 years; p < 0.001); hypertension (65% vs. 50%; p < 0.01); and current smoking (29% vs. 43%; p < 0.01). This survey confirmed the feasibility of telephone interviewing, on a large sample of general practitioners in France. The high level of association with other cardiac incidents was, for these patients, a much higher risk of mortality and morbidity than LEAD alone. It would be interesting to validate the associations observed with a prospective study of comorbidity.
 ...
PMID:National study of obliterative arterial disease of the lower limbs involving general practitioners in France: Artemio study. 869 62

Accurate usage of the term 'epidemic' is important scientifically and it should ideally be used to mean only contagious diseases, not used loosely or emotively to mean non-infectious diseases, particularly coronary heart disease, which is a non-specific complication of many diseases. It should not be used as a surrogate term for atherosclerosis of indefinite severity. An epidemic of atherosclerosis is impossible, there being no variation in prevalence because the disease is ubiquitous. Moreover, vital statistics are too unreliable to determine the existence of an increase or decline in coronary heart disease. A coronary heart disease epidemic could be due to an increase in non-atherosclerotic coronary heart disease or increased severity of atherosclerosis. The former has not been studied and the latter would cause a shift to the left in age distribution and is inconsistent with the fall in 'all cause' and stroke mortality rates whilst coronary heart disease mortality allegedly increased alarmingly. A coronary heart disease epidemic, having no scientific basis, negates any reason for the sustained search for a speculative causative environmental factor.
 ...
PMID:The hypothetical epidemic of coronary heart disease and atherosclerosis. 874 84

Rapid economic growth in Taiwan is accompanied by changing lifestyles, and the mortality pattern has switched from predominantly infectious diseases to chronic diseases. Age-adjusted mortality from heart disease has increased slowly but steadily. However, mortality from heart disease in Taiwan remains low compared with many other countries. Mortality from the cerebrovascular diseases has decreased gradually. Current age- and sex-specific values of blood cholesterol low density lipoprotein cholesterol (LDL-C) and triglyceride (TG) are, in general, higher than values in mainland China, but lower than those in the NHANES III and PROCAM studies. From 1950 to 1987, percent dietary fat increased from 16% to 36% in Taiwan. However, a high polyunsaturated fat/saturated fat (P/S) ratio (1.3) maintained during this period may in part explain the favorable blood lipid status and low mortality from heart disease. Data from prospective studies are scarce. In case-control studies carried out in Chinese, significantly higher values of TG, CHOL LDL-C, but lower high density lipoprotein cholesterol (HDL-C) levels have often been found in coronary artery disease (CAD) patients than in controls. The percent differences in TG and HDL-C values (20%) were much greater than those of CHOL and LDL-C (3%). A few studies have identified the TG level as an independent risk factor for stroke and CAD in Taiwan, where a moderate to high fat diet with an advantageous P/S ratio is consumed.
 ...
PMID:Plasma lipid profiles and epidemiology of atherosclerotic diseases in Taiwan--a unique experience. 877 Mar 22

The present article provides an overview of epidemiological studies in Japan. The origin of modern epidemiology of Japan can be traced back into the late 19th century. Baron K. Takaki at that time made brilliant epidemiological studies on beriberi and was thus able to eradicate the disease long before vitamin B1 deficiency was identified as the cause of the disease. Epidemiological studies really began to flourish in Japan after the end of World War II. Since the most of infectious diseases have been controlled, epidemiological studies on cancer, heart disease, stroke, and other chronic diseases have become the main target of investigations. It may be cautioned that, among infectious diseases, tuberculosis is still a serious health problem today and HIV infection has become a threatening health issue although the number of AIDS patients reported was still about 1,000 for the whole country in 1995. In contrast to other industrialized countries, heart disease is far less common in Japan, probably reflecting still not-too-rich diet among Japanese. There are a number of unique or unusual epidemiological studies in Japan, including a long-term surveillance of those who were exposed to A-bomb irradiation in 1945. Readers are encouraged to refer to detailed description of each, specific topic presented in this volume. Essential vital statistics are also presented as background information of epidemiological studies in Japan.
 ...
PMID:Epidemiological studies in Japan. 880 Feb 69


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>