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

Case 1. A 65 year old male had left hemiparesis with sudden onset since 8 years ago, which gradually aggravated for these 2 years. On Sept. 27, 1973, he was admitted to the Department of Neurosurgery, Kitano Hospital. There was left spastic hemiparesis with hemisensory disturbance and he could not walk without help for the maked spasticity. Left carotid angiogram revealed the complete occlusion of the internal carotid artery and marked stenosis of the external carotid artery at the common carotid bifurcation. External carotid endarterectomy was performed on Nov. 19, 1973, which was followed by STA-MCA anastomosis 2 months later. The spasticity of extremities and left hemisparesis were gradually improved and he was able to walk without help. Case 2. On Apr. 14, 1974, a 63 year old female developed complete stroke with right hemiparesis and speech disturbance after transient ischemic attacks of 5 days duration. On Aug. 9, he was admitted and had emotional incontinence, right hemiparesis, Gerstmann's syndrome and motor aphasia. Left carotid angiogram revealed a saccular aneurysm of the middle cerebral artery and the occlusion of the distal middle cerebral arterys. These findings suggested that the occlusion was caused by embolus from the middle cerebral aneurysm, and the combined surgery with STA-MCA anastomosis and operation for the aneurysm was planned. On Aug. 30, 1974, under left frontotemporal craniotomy, aneurysmal neck clipping and aneurysmectomy were performed and thereafter, STA-MCA double anastomosis was done. One week after operation, the gradual improvement of pre-operative symptomes was noted. Recently, STA-MCA anatomosis is well known to be one of the effective operative methods for the occlusive methods for the occlusive cerebrovascular diseases and in addition, we found that the combination of STA-MCA anastomosis with other operations was effective for unusual cases presenting in this report. Furthermore, except for the occlusive cerebrovascular diseases, we usually plan STA-MCA anastomosis for the cases of 1) carotid ligation or trapping for carotid-cavernous sinus fistula and some internal carotid aneurysms, 2) some intracranial tumors with the danger involving the main cerebral arteries by operation to protect the cerebrovascular insufficiency.
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PMID:[The combination of STA-MCA anastomosis with another operation for the occlusive cerebrovascular disease (author's transl)]. 55 37

The clinical results of treatment of infravesical prostatic obstruction with an intraurethral coil in 150 consecutive patients are reported. A total of 80 patients had urinary retention and 70 had severe prostatism. Median observation time was 8.2 months, with a range of 0 to 40 months. In 75 patients the spiral was removed after a median of 4 months (range 0 to 30 months) because of planned prostatectomy in 17, urinary retention in 16, incontinence in 10, local discomfort in 7, no symptomatic improvement in 13 and causes not related to the spiral (stroke and so forth) in 7. Migration occurred 55 times in 42 patients but this only led to coil removal in 5. A total of 23 patients died with the coil in situ. Voiding symptoms improved considerably in the majority of the patients. Approximately two-thirds of the patients had no or few symptoms, while a fourth had moderate symptoms, leaving only approximately 10% with severe prostatism. Chronic bacteriuria was noted in 52 patients but was not a clinical problem. Calcification on the top and inside of the coil was noted mainly after long-term treatment, and probably necessitated exchange of the coil after 2 to 3 years. We conclude that the prostatic spiral is a useful alternative to an indwelling catheter. However, life-long followup is necessary in most patients.
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PMID:The intraprostatic spiral: clinical results in 150 consecutive patients. 137 51

Urinary managements of 332 stroke patients in the chronic phase were performed at Bobath hospital. Cerebrovascular accidents (CVA) were caused by cerebral infarction in 178 (53.6%), intracerebral hemorrhage in 123 (37.1%) and subarachnoid hemorrhage in 31 (9.3%). Voluntary urination appeared in 124 patients before treatment, however in 29 of them occasional incontinence were observed. One hundred forty-three patients used diapers and 64 were controlled by indwelling catheters. The remaining one patient was treated by intermittent catheterization. Sixty-two patients who seemed to have communicative abilities in daily living were assessed with regard to their cerebrovascular dementia by Hasegawa's Dementia Rating Scale. After treatment 235 patients (70.8%) were able to urinate voluntarily, and only 15 of them remained incontinent and could use small pads successfully. TURP was effective for the stroke patients with benign prostatic hypertrophy (BPH) or bladder neck sclerosis (BNS). Fifty-three patients (16.0%) with persistent urinary incontinence were managed by diapers or a system of condom drainage. Thirty-nine patients (11.7%) were kept dry with intermittent catheterization at home, and long-standing use of indwelling catheters were required in the remaining 5 patients (1.5%). These results indicate that the lower level of activity, mobility and mental state tended to prevent the stroke patients from improvement of urinary disorders.
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PMID:[Urinary managements of 332 stroke patients in the chronic phase]. 147 11

The effects of stroke are complex and diverse. Deficits experienced depend on the location of damage and vary in severity. Voiding problems resulting from a stroke include uninhibited neurogenic bladder, urgency and frequency, retention, urge incontinence, and overflow incontinence. Because a variety of causative and contributing factors are involved, comprehensive and ongoing evaluation is necessary. Although bladder dysfunction is common initially after stroke, evidence has shown that improvements in voiding occur after the first few weeks. Intermittent sterile catheterization, scheduled voiding, pelvic floor exercises, and relaxation techniques can be effective, especially if other stroke deficit considerations are incorporated into the management plan.
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PMID:Bladder dysfunction after stroke. 160 11

Type III stress urinary incontinence due to severe intrinsic urethral weakness without significant urethrovesical descensus may be treated by periurethral injection, sling cystourethropexy, bladder neck reconstruction, or artificial urinary sphincter implantation. The rationale for procedure selection depends on a number of patient factors and the surgeon's experience. We herein report on 25 women who were identified as having such incontinence by evaluation which included videourodynamic study and lateral voiding cystography and who were managed by the implantation of an artificial urinary sphincter. The etiology of the severe intrinsic urethral weakness in most patients was multiple prior failed cystourethropexies. Postoperatively, 1 patient died of a cerebral vascular accident. The remaining 24 women had significantly improved continence and were completely satisfied at latest follow-up. No revisions have been required for patients receiving an artificial sphincter after 1983. No sphincter erosions or infections have occurred. Our experience and review of the literature shows that the artificial sphincter provides an excellent first option for women with type III urinary stress incontinence due to intrinsic urethral weakness of various etiologies.
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PMID:Management of type III stress urinary incontinence using artificial urinary sphincter. 161 94

Antibodies to cardiolipin were measured in 100 consecutive patients with first ever stroke, on admission and at three and six months after the acute event. One hundred healthy, age- and sex-matched, British elderly individuals were also screened for antibodies to cardiolipin as a control group. Elevated levels of anticardiolipin antibody (i.e. 5 SD above the laboratory control mean) were present in none of the control group, but in 21 per cent of the patients with stroke. Thirteen of these 21 patients (62 per cent) died within three months, compared to 17 (21.5 per cent) of the seventy-nine patients without elevated levels of anticardiolipin antibodies (p less than 0.001). Six of the eight survivors with persistently elevated anticardiolipin antibodies had significant residual disability following stroke (Barthel score 0-9) compared to 11 of the 62 without (p less than 0.001). Two patients with initially raised anticardiolipin antibodies who became independent at six months showed a progressive decline in the level of these antibodies to normal. The presence of high levels of anticardiolipin antibody did not correlate with other recognized prognostic indices of stroke, except for incontinence. No correlation was noted between levels of antibody to cardiolipin, antinuclear factor, antibody to double-stranded DNA and C-reactive protein, either in the stroke patients or in the elderly control population. Hypertension was significantly more common in the patients with high anticardiolipin antibodies than in the rest of the patients in the stroke population (p = 0.33). There was no correlation between levels of anticardiolipin antibody and age. Anticardiolipin antibody may be considered as an independent prognostic marker for both mortality and clinical outcome after acute stroke.
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PMID:Antibodies to cardiolipin in stroke: association with mortality and functional recovery in patients without systemic lupus erythematosus. 192 75

The article, based on a survey and a study of the literature, focuses on the problems of urinary disorders in patients who have suffered a stroke. The incidence of incontinence and other urination disorders was studied upon admission and six weeks later in ten stroke patients admitted consecutively to a hospital for rehabilitation. The results of the present study agreed with those of other studies, indicating that urination disorders, especially motoric urge incontinence, are common among stroke patients. The literature indicates that urinary incontinence has a negative influence on the rehabilitation process. Therefore the rehabilitation team should be particularly aware of such problems, and carry out both diagnostic and therapeutic procedures.
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PMID:[Urinary problems among patients with stroke. Are these problems underestimated?]. 194 55

The ileal neobladder produces a completely detubularized, low pressure, high capacity reservoir constructed from ileum without any valves. Since April 1986, 161 patients underwent this type of surgery at our institution. Of these patients 141 underwent simultaneous radical cystectomy for bladder cancer, and 20 received a bladder augmentation. The mean postoperative follow-up is 23.8 months with a range of 3-52 months. Perioperative mortality was 0.5 percent, 9.5 percent of the patients died later than 2 months postoperatively, 7.5 percent due to tumor progression, 2 percent because of pneumonia, severe metabolic acidosis, myocardial infarction and apoplexy. Day and night continence was preserved in 78% of all patients; severe stress incontinence was found in 4.2 percent of the patients and night time incontinence needing some external device in 7.7%. 10 percent with mild stress incontinence do not require further treatment. Our experience with this relatively simple procedure is excellent: the need for reoperation is low and the high reservoir capacity results in early continence in most cases. This concept offers a genuine alternative to any form of cutaneous urinary diversion with an incidence of complications not higher than after standard supravesical urinary diversion.
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PMID:The ileal neobladder. 205 41

A cerebral metabolic activator was administered to patients with cerebrovascular dementia to treat urinary incontinence or pollakisuria. The results are of interest as discussed in this paper. This study was carried out on 35 patients (15 males and 20 females) with cerebrovascular dementia with the chief complaint of incontinence or pollakisuria averaging in age 78.1 years with a range of 65 to 92. The underlying disease was cerebral hemorrhage in 4 cases, cerebral embolism in 21 cases and sequelae of cerebral apoplexy in 10 cases. ADL was assessed in all cases by cerebral CT or MRI and Hasegawa's test, a simple test for dementia. Bladder function was evaluated by determining urodynamic tests (CMG, UFM, UPP) before and after medical treatment. Test drug was bifemelane hydrochloride, a cerebrovascular metabolic activator. It was administered at a dose of 150 mg/day for periods of 2 months or more. As a result, bladder symptoms improved in 16/35 patients (45.7%), and mental symptoms in 21/35 (60%). Urine voiding and holding as bladder functions determined by urodynamics tests were not affected at all. The effect of this drug on bladder symptoms is secondary to improvement of mental symptoms, and its most pronounced clinical effect was on dementia.
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PMID:[Effect of the cerebro-metabolism activator (bifemelane hydrochloride) on urinary incontinence and pollakisuria associated with cerebrovascular dementia]. 206 5

We studied 27 patients with acute stroke and a corresponding infarct in the anterior cerebral artery territory, as disclosed using computed tomography. Patients were selected from 1490 patients (1.8%) admitted consecutively to a community-based primary care center who underwent standard investigations. An embolic phenomenon from the internal carotid artery or from the heart explained the infarct in 17 patients (63%). Anterior cerebral artery occlusion without a potential source of embolism was found only in one Vietnamese patient. Neurologic features correlated well with the topography and size of infarct, including hemiparesis, hemihypesthesia, mutism at onset, transcortical motor aphasia, conflictual tasks impairment, mood disturbances, and, more uncommonly, incontinence, grasp reflex, hemineglect, acute confusional state, and unilateral left apraxia. These findings suggest that the etiologic spectrum of anterior cerebral artery infarcts is the same as that of middle cerebral artery infarcts.
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PMID:Anterior cerebral artery territory infarction in the Lausanne Stroke Registry. Clinical and etiologic patterns. 230 85


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