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

The myocardial contractility function was studied with the aid of echocardiography in 42 male patients during dosaged physical exercises. The patients were selected so that at the peak of the exercises they developed an angina pectoris attack documented by ischaemic ECG changes. In some of the patients the changes were also observed during attacks of angina decubitus. Anginal attacks are accompanied by a reduction of the myocardial function. Haemodynamic reactions of two types were noted with myocardial ischaemia: type I reaction was observed in patients with ischaemic heart disease and practically normal values of the initial heart volume, and consisted in an increasing end-systolic and end-diastolic volumes, with the stroke volume remaining unchanged, and the ejection fraction somewhat decreasing; type 2 reaction was observed in patients with initially increased heart volumes, and consisted in a decreasing end-diastolic and stroke volumes, with an insignificant alteration of the end-systolic volume. The ejection fraction, being initially insignificantly decreased, tends to decrease further during the attack.
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PMID:[Myocardial contractility during angina pectoris attack in ischemic heart disease]. 85 2

Two hundred eighty patients were admitted to an intensive care stroke unit over a one-year period. Subsequent investigation indicated that only 199 of these patients actually had cerebral ischemic or hemorrhagic lesions, 10 had other cerebrovascular lesions, and the remaining 71 patients had unrelated diseases, predominantly seizures. Detailed analysis of 103 stroke patients revealed an overall incidence of 59% hypertension, and 72% had hypertensive, ischemic or valvular heart disease. Fifty percent of the patients had various cardiac arrhythmias, some of which were responsible for the acute cerebrovascular lesion. Fourteen patients died during the acute phase, 11 from apparently irreversible cerebral selling, mainly due to cerebral hemorrhage. Secondary complications such as pneumonia, pulmonary embolism, pressure sores and urinary infection were almost nonexistent, but beneficial effects on the primary cerebral lesions were more difficult to demonstrate.
Stroke
PMID:Intensive care management of stroke patients. 100 32

The mortality rate and causes of death after a hip fracture were studied in 493 consecutive patients with a hip fracture. All patients were treated in three hospitals in Utrecht, The Netherlands. The mortality rate following hip fractures is high and age dependent. Forty-five patients, 38 women and 7 men, died during the period of hospitalization (9.1%). One year after the date of hip fracture 23.6% of the women had died and 33.0% of the men. Four years after the date of hip fracture the mortality rates in women and men were 44.4% and 55.3%, respectively. Male sex, concomitant illnesses and in-hospital complications are negative determinants of survival. The in-hospital mortality was due to: cerebrovascular accident (n = 7), cardiac decompensation (n = 12), myocardial infarction (n = 4), pulmonary infection (n = 6), intestinal bleeding (n = 1) and sepsis (n = 5). From the registration of death causes we learned that 54 deaths were directly due to the hip fracture, 4 due to bed sores, 34 due to infectious diseases, 62 due to cardiovascular disease, 22 due to cerebrovascular accidents, 14 due to diabetes mellitus, and 33 due to neoplasm. The high mortality rate within the first 8 weeks after the date of hip fracture was mainly attributed to the hip fracture.
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PMID:Mortality and causes of death after hip fractures in The Netherlands. 140 39

Fifty-nine elderly patients who had been hospitalized more than six months in five hospitals in the city of Mino in Osaka Prefecture, were studied to clarify the factors influencing prolonged hospital stays by the elderly. Their mean age was 82.2 years, and women accounted for 86% of the patients. One-third had suffered a stroke. As for ADL, 44% were completely dependent when walking, eating, bathing and dressing. Moreover, 36% had severe dementia, 19% suffered from decubitus ulcers, 66% were undergoing rehabilitation, 58% were receiving venous infusion therapy, 36% used a urethral catheter, and 10% were receiving tube feeding. The subjects were divided into two groups according to the likelihood of discharge assessed by the doctors in charge: one group consisted of 27 patients who might be discharged and the other of 32 patients with an ongoing need for inpatient care. Multivariate analyses using Hayashi's quantification method II indicated that use of a urethral catheter and not undergoing rehabilitation were the main factors associated with the need for inpatient care, while being a woman, being of advanced age and not having one's own room at home were the non-medical factors which made it difficult for the patients to be discharged from the hospital. As use of a urethral catheter was the factor most strongly related to prolonged hospital stay, multivariate analyses were applied to the 45 patients with urinary incontinence, who were divided into one group of 21 patients with, and one of 24 without a urethral catheter. The factors associated with use of a urethral catheter were then investigated.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Factors influencing prolonged hospital stays by elderly patients: problems in medical management including use of urethral catheters]. 146 52

The effects of quiet respiration and body position on right ventricular (RV) size and function were assessed by two-dimensional (2DE) and M-mode echocardiography in 15 healthy children. All end-diastolic echocardiographic dimensions, areas, and volumes increased slightly but significantly with inspiration. At end-systole similar changes were found. RV ejection fractions were significantly higher during inspiration, as were stroke volume indices. RV dimensions also increased from supine to left lateral decubitus position. Thus, our results indicate a need for standardization of 2DE and M-mode measurements not only for body position, but also for respiratory phase when used to assess RV size and function.
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PMID:Effects of respiration on right ventricular size and function: an echocardiographic study. 160 12

A consensus conference on stroke was held on March 22, 1991. Subjects on which consensus was reached were: There are different kinds of cerebral haemorrhage and infarction, which can be differentiated by computerized tomography, and this can have practical consequences. At clinical examination special attention should be paid to cognitive impairment. Angiography is indicated only if carotid surgery or unusual causes are considered. CSF examination and EEG are performed only on special indications. Cardiological consultation is necessary in young patients, or if clinical signs of cardiogenic embolism are present. Coumarin derivatives are prescribed in some of these cardiac causes of stroke, to prevent recurrence. There is as yet no effective medical treatment for cerebral infarction. In lobar and cerebellar haemorrhage surgical treatment may be indicated. In the acute phase of stroke it is always important to prevent aspiration pneumonia, pulmonary embolism and decubitus, and to care for muscles and joints. Advantages and disadvantages of gastric tube and indwelling catheter should be weighed. Treatment of hypertension after the acute phase is indicated to prevent recurrent stroke. After TIA and minor stroke, aspirin is prescribed, which reduces the risk of cerebral and myocardial infarction by 30%. Carotid endarterectomy in symptomatic patients with carotid stenosis of 70% or more, reduces the number of fatal or disabling strokes by 50%, if perioperative complications are less than 4%. Rehabilitation after stroke reduces disability and improves the adaptation of both the patient and his environment. The patient should be stimulated and supported; good information, including the family, is essential. Supplying aids and taking special measures should be done on individual basis, after a period of training.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Consensus cerebrovascular accident]. 174 34

Medical complications may account for 30% or more of the deaths resulting from acute ischemic stroke in the elderly. In descending order of frequency, the most deadly complications are bacterial pneumonia, pulmonary embolism, myocardial infarction, and sepsis without pneumonia (often in the setting of a urinary tract infection or a necrotic decubitus). Normal aging is associated with declining pulmonary and cardiovascular functions as well as declining immunocompetence and physical barriers to infection. The neurological effects of acute ischemic brain injury compound these susceptibilities. Accordingly, a high degree of vigilance is emphasized in the diagnostic and therapeutic guidelines provided for care of the lungs, the heart, the urinary tract, and the skin. Guidelines are also provided for management of blood pressure during the first hours and days following stroke onset. Treatment should be withheld unless specific medical indications are identified. When antihypertensive agents are administered, the appropriate dose may be lower than usually recommended (e.g. labetalol) in order to minimize abrupt drops in blood pressure that may result in further injury to potentially viable ischemic brain tissue.
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PMID:Prevention and management of medical complications of the hospitalized elderly stroke patient. 186 5

Nine patients (4 women and 5 men; mean age 31 [20-48] years) with severe posttraumatic adult respiratory distress syndrome (ARDS) were treated with continuous postural change (kinetic bed) and pressure-limited ventilation. Seven patients survived; only one patient died as a result of pulmonary insufficiency. As compliance was markedly reduced (less than 20 ml/cm H2O), low stroke volumes (up to 380 ml) and high respiratory rate (up to 45/min) were employed to keep airway peak pressure below 40 mmHg. Kinetic treatment lasted for a mean of 14 (2-28) days; artificial ventilation was maintained for 31 (9-49) days. Practical problems of the method are the intensive nursing care required for the kinetic bed and the risk of decubitus ulcers, as well as disconnection of infusion tubing. The results indicate that kinetic treatment with pressure-limited ventilation constitutes a low-risk and, in many cases, effective treatment of severe ARDS.
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PMID:[Acute posttraumatic lung failure. Its treatment through pressure-limited respiration and continuous postural change]. 187 28

Pressure ulcers are a common and serious problem predominately among elderly persons who are confined to bed or chair. Additional factors associated with pressure ulcer development include cerebrovascular accident, impaired nutritional intake, urinary or fecal incontinence, hypoalbuminemia, and previous fracture. Implementation of preventive measures, such as an in-depth assessment for mobility, a pressure-relieving device combined with adequate repositioning, and thorough evaluation for nutritional status and urinary incontinence, significantly reduce pressure ulcer incidence. If the pressure ulcer is a partial thickness (stage II) wound, the causative factors are probably friction or moisture. If the ulcer is full thickness (stage III and IV), it is secondary to pressure or shearing forces. The development of wound infection is the most common complication in the management approach. Osteomyelitis is not an uncommon occurrence and must be initially ruled out in all full thickness pressure ulcers. Surgical debridement of necrotic tissue is necessary prior to further treatment and assessments. Antibiotic therapy is indicated only upon evidence of infection (cellulitis, osteomyelitis, leukocytosis, bandemia, or fever). Topical pharmacologic agents may be used to prevent or treat infection but must be carefully controlled to avoid such adverse effects as toxicity to the wound, allergic reaction, and development of resistant pathogens. Proper use of occlusive dressings increase patient comfort, enhance healing, decrease the possibility of infection, save time, and reduce costs. A patient presenting an ulcer that fails to improve or, because of its size, will take a great deal of time to heal should be evaluated for surgical closure.
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PMID:Pressure ulcers. Physical, supportive, and local aspects of management. 193 37

Researchers in physical medicine and rehabilitation require access to information regarding possible interventions and programs, available services and technology, research (published, unpublished and in progress), statistics on incidence, prevalence and expected recovery, and funding sources. This paper provides an overview to the most readily available sources of information, including 16 abstracts and indexes, 6 sources of review articles, 9 population statistical databases and 84 journals specifically devoted to rehabilitation. Of these journals, 29 may be accessed through Medline and 32 through other sources. An additional 58 journals indexed in Medline publish more than 16 rehabilitation articles per year. The journals within Medline that publish the most rehabilitation articles are listed by topic area: geriatric rehabilitation, cardiac rehabilitation, pediatric rehabilitation, rehabilitation research, self-help devices, sports medicine and rheumatologic rehabilitation. Specific search strategies that may be used for any computer assisted search of Medline are given to locate articles in these topic areas and also the following areas: amputee rehabilitation, spinal cord injury rehabilitation, traumatic brain injury rehabilitation, cerebral palsy rehabilitation, stroke rehabilitation, decubitus care, electrodiagnosis, rehabilitation engineering, pain rehabilitation, pulmonary rehabilitation, sexual rehabilitation and urologic rehabilitation. The user friendly Grateful Med software is introduced for simplified online Medline searching. Exercises are provided for starting a journal club with the retrieved articles.
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PMID:Research in physical medicine and rehabilitation X. Information resources. 222 88


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