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

The clinical characteristics of seven healthy subjects who required hospital care for an exhaustion syndrome due to extenuated physical exercise during participation in a public marathon are presented. All the patients were used to practising sports activities and in all the cases the symptoms of exhaustion appeared in the last few kilometers of the race. The most frequent symptom found in all the patients was lipothymia with falling to the ground followed by gastrointestinal manifestations, muscle cramping and fever. Upon analysis the signs of rhabdomyolysis and others suggestive of dehydration were observed in all the cases. Leukocytosis was observed in four and hypopotassemia in two. Evolution was good in all the cases with rest and hydroelectrolytic reposition. Finally, the preventive measures to avoid heat stroke and exhaustion syndromes in public marathons are reported.
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PMID:[Exhaustion syndromes in a popular marathon]. 845 12

Current evidence indicates that adequate fluid ingestion during exercise enhances athletic performance, prevents a fall in plasma volume, stroke volume, cardiac output and skin blood flow, maintains serum sodium concentrations and serum osmolality, lowers rectal temperature and the perception of effort, and prevents a progressive rise in heart rate. Rates of sweating and urine flow are not influenced by fluid ingestion. The evidence suggests that the maintenance of serum osmolality and serum sodium concentrations at pre-exercise levels is the important determinant of these beneficial effects of fluid ingestion on cardiovascular function and thermoregulation. The provision of glucose in the ingested solution may be necessary to optimize performance; glucose ingestion that enhances fluid and sodium absorption in the small bowel may also present a progressive rise in oxygen consumption during exercise. Sweetened carbohydrate-containing drinks may also increase fluid intake during exercise, thereby minimizing voluntary dehydration. Hence, the optimum solution for ingestion during exercise should provide carbohydrate, probably at rates of about 1 g/min and electrolytes in concentrations that, when drunk at the optimum rate, maintain serum osmolality and plasma volume at pre-exercise levels by replacing exactly that water and electrolyte losses from the extracellular space. At present, the composition of the fluid that will optimize electrolyte and fluid replacement of the extracellular space is not established. Neither are the optimum rates of fluid ingestion during exercise known. At low sweat rates (< 1 liter/hr), it is probable that all of the lost fluid can and should be replaced; rates of fluid ingestion needed to offset higher sweat rates may exceed the maximum intestinal absorptive capacity for water. Furthermore, high rates of fluid intake (> 1 liter/hr) are achieved with difficulty during exercise, especially when running, and are likely to lead to feelings of abdominal discomfort, possibly due to the accumulation of unabsorbed fluid in the small bowel or colon. Practicing to drink regularly during training might reduce the severity and frequency of these symptoms, possibly by increasing intestinal absorptive capacity. Most athletes are "reluctant" drinkers during exercise and do not ingest fluid at rates equal to their rates of fluid loss; hence, they develop progressive (voluntary) dehydration during prolonged exercise. Surprisingly, the level of voluntary dehydration that develops during exercise is relatively independent of the duration or intensity of the activity. The factors that explain these phenomena remain elusive. Fluid consumption during exercise is enhanced by the ingestion of cold, sweet fluids. Simultaneous food consumption also stimulates fluid ingestion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Fluid replacement during exercise. 850 45

Status epileptics (SE) due to a cerebral vascular accident can cause a change for the worse in the quality of life of patients. We have performed single photon emission computed tomography (SPECT) with 99mTc-hexamethylpropylene amineoxim (HM-PAO) to evaluate regional cerebral blood flow (rCBF) in SE caused by a cerebral vascular accident. In addition, we have discussed the neurophysiology of SE based on the SPECT findings. A total of sixteen patients (5 males and 11 females, average age; 78.2 years old) with SE who were suffering from prolonged consciousness disturbance were investigated. When SPECT was performed in the ictal state, there was a remarkable increase in Radio Isotope (RI) uptake at the focus which correlated well with EEG findings. However, in other cortical regions, basal ganglia and thalamus, there was a relatively demonstrated decrease in RI uptake compared with that of the focus. Additionally in the interictal state, we found a decrease in RI uptake in the epileptic foci and normal recovery of the RI uptake level in other cerebral regions. We speculate that these characteristic patterns of cerebral blood flow distribution shown by SPECT scans in the ictal state reflect the state of consciousness disturbance due to SE. In general, in the elderly, it is difficult to make a differential diagnosis between prolonged consciousness disturbance due to nonconvulsive SE and other diseases such as cardiovascular, dehydration, metabolic disorder, etc. Nevertheless, nonconvulsive SE causes diffuse cell loss and irreversible brain damage. Therefore the elderly who have suffered from prolonged consciousness disturbance due to SE need an exact diagnosis and immediate medical treatment. When we diagnose a nonconvulsive SE, the characteristic findings of SPECT scans in the ictal state are very clear and useful. In conclusion, SPECT is a very simple and non-invasive method that demonstrates abnormalities of brain function exactly. Therefore, we should perform not only EEG but also SPECT scans when making a diagnosis of SE.
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PMID:[Regional cerebral blood flow in status epileptics measured by single photon emission computed tomography (SPECT)]. 855 Aug 6

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.
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PMID:Sickle cell disease: the clinical manifestations. 855 48

A number of Brazilian studies have been done on elderly in-patients in a General Hospital but only one studied them in a Internal Medicine Ward. PURPOSE--To analyse morbidity and mortality comparing age and sex in the elderly in-patients in a General Hospital Internal Medicine Infirmary. METHODS--We analysed 163 elderly patients (101 females, 62 males) who represent 42.3% of the total number of in-patients for 100 consecutive days; 84.1% whites and an average age of 71.4 +/- 8.3 years. RESULTS--(p < 0.05): (1) Among elderly females--there was a high rate of heart failure as cause of hospitalization. (2) Among elderly males--stroke was the main cause of hospitalization. (3) Among 60-69 year old patients--diabetes mellitus was the main cause of hospitalization. (4) > or = 70--stroke was found to be the most frequent cause of hospitalization and high frequency of level F and G on the Katz Scale. Circulatory diseases were the cause for 42.3% of hospitalization. Dehydration was the main complication during hospitalization (46.0%). There were 38 deaths (23.3% of the patients), 50.1% were caused by respiratory diseases. CONCLUSION--The elderly are an important group of in-patients in a General Hospital Internal Medicine Ward.
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PMID:[Analysis of clinical parameters of elderly inpatients in an internal medicine ward]. 857 34

Although rare, exertional collapse and sudden death are the most serious potential complications of sickle cell trait. Studies suggest that this condition may occur in susceptible persons when poor physical conditioning, dehydration, heat stress or hypoxic states precipitate sickling of the abnormal erythrocytes. Sickling leads to endothelial damage, which can cause vasoconstriction, disseminated intravascular coagulation and local tissue damage. Cardiac effects include acute ischemia and arrhythmias. Muscle damage results in acute compartment syndromes and release of myoglobin into the circulation. Acute renal failure is possible. Diagnosis is based on a high index of suspicion, and characteristic presentation and laboratory findings, including myoglobinuria, hyperkalemia, hypocalcemia, hyperphosphatemia and elevated creatine kinase levels. The differential diagnosis includes pulmonary embolism, acute cardiac events, anaphylaxis and heat stroke. Management is based on stabilization, rehydration, and the treatment and prevention of complications.
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PMID:Exertional collapse and sudden death associated with sickle cell trait. 904 99

Prevention is of importance when the patient is already suffering from a serious disease, e.g., from arterial obstructive disease causing a stroke or an amputation, from a hip fracture or other diseases that might threaten his independence. Prevention covers a wide field of topics. Most importantly, the patient must recover from his acute disease. It is important to avoid complications which are not specific for the disease but are typical for a bedridden old person (decubital ulcer, dehydration etc.). Prevention also means to avoid recurrence of the same disease as well as complications that frequently occur during the clinical course and may influence the outcome (spasticity in stroke patients, muscular calcification following hip replacement).
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PMID:[Current aspects of secondary and tertiary prevention from the viewpoint of the clinical gerontologist]. 885 Jan 12

Guidelines for preventing heat injury (HI) among military personnel are not directly applicable to civilian personnel. Military guidelines call for relatively large volumes of prophylactic water consumption and physical activity limitations depending on the wet bulb globe temperature. However, in civilian populations, there is an increased prevalence of HI risk factors: older age, medication use, especially anticholinergic and psychotropic medications, obesity, previous HI, and skin disorders. Although dehydration is a major contributor to HI in military situations, it is unlikely in classical heat stroke among civilians. Civilian guidelines are based on the heat index. Activity levels must be restricted more for civilians, and prophylactic water consumption (beyond replacing loss from sweat) is not necessary. This review discusses the pathophysiology of heat injury, contrasts the military and civilian approach to prevention of HI, and describes appropriate field intervention for HI.
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PMID:Preventing heat injury: military versus civilian perspective. 900 5

We identified the cardiovascular stress encountered by superimposing dehydration on hyperthermia during exercise in the heat and the mechanisms contributing to the dehydration-mediated stroke volume (SV) reduction. Fifteen endurance-trained cyclists [maximal O2 consumption (VO2max) = 4.5 l/min] exercised in the heat for 100-120 min and either became dehydrated by 4% body weight or remained euhydrated by drinking fluids. Measurements were made after they continued exercise at 71% VO2max for 30 min while 1) euhydrated with an esophageal temperature (T(es)) of 38.1-38.3 degrees C (control); 2) euhydrated and hyperthermic (39.3 degrees C); 3) dehydrated and hyperthermic with skin temperature (T(sk)) of 34 degrees C; 4) dehydrated with T(es) of 38.1 degrees C and T(sk) of 21 degrees C; and 5) condition 4 followed by restored blood volume. Compared with control, hyperthermia (1 degrees C T(es) increase) and dehydration (4% body weight loss) each separately lowered SV 7-8% (11 +/- 3 ml/beat; P < 0.05) and increased heart rate sufficiently to prevent significant declines in cardiac output. However, when dehydration was superimposed on hyperthermia, the reductions in SV were significantly (P < 0.05) greater (26 +/- 3 ml/beat), and cardiac output declined 13% (2.8 +/- 0.3 l/min). Furthermore, mean arterial pressure declined 5 +/- 2%, and systemic vascular resistance increased 10 +/- 3% (both P < 0.05). When hyperthermia was prevented, all of the decline in SV with dehydration was due to reduced blood volume (approximately 200 ml). These results demonstrate that the superimposition of dehydration on hyperthermia during exercise in the heat causes an inability to maintain cardiac output and blood pressure that makes the dehydrated athlete less able to cope with hyperthermia.
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PMID:Dehydration markedly impairs cardiovascular function in hyperthermic endurance athletes during exercise. 910 60

Cerebral venous thrombosis is an infrequent cause of childhood stroke. It is reported most frequently in the setting of acute dehydration, cyanotic congenital heart disease, or the nephrotic syndrome and it is commonly found in patients with hereditary coagulation or immunologic disorders. Thrombotic tendencies may also occur in children with iron deficiency anemia. We describe a 11-months old boy with cerebral venous thrombosis likely attributable to dehydration and iron deficiency anemia by intestinal chronic blood loss, caused by food allergy.
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PMID:[Cerebral venous thrombosis in a child with iron deficiency anemia caused by food allergy]. 931 49


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