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

The case histories of the 49 patients who died in a series of 165 patients admitted to the Medical Unit between 1958 and 1984 with polyarteritis nodosa (PAN) were reviewed. The causes of death of the 29 men and 20 women, mean age 51.44 +/- 7.4 years, were classified into 6 groups. Infection accounted for 26.5% (13/49) of deaths, the initial site of infection being pulmonary, complicated by septicaemia in 6 cases. Cardiovascular events were responsible for death in 24.4% (11/49): terminal cardiac failure (4 cases), myocardial infarction (1 case), ventricular tachycardia (1 case), stroke (1 case), pulmonary embolism (2 cases), fulminant hemoptysis (1 case). Gastrointestinal complications were the cause of death in 16.3% (8/49): ischemic necrosis (5 cases), acute pancreatitis (2 cases), oesophageal ulceration (1 case). Renal failure was observed in 10.2% (5/49), all occurring before 1972: acute renal failure (3 cases), chronic renal failure (2 cases). Cancer was the cause of death in 10.2% (5/49): primary bronchial carcinoma (2 cases), laryngeal carcinoma (1 case), carcinoma of the vulva (1 case), bone metastases (1 case). Finally, 14.2% (7/49) could not be classified in the preceding groups. Sudden death occurred in 3 patients, shock in 1 patient, multivisceral PAN in 2 patients and anaphylactic shock in 1 patient. Three of the 12 patients who had post-mortem studies had signs of progressive vasculitis. The results are compared with other reports in the literature and the pathogenic mechanisms are discussed. The infections and cardiovascular deaths occurred early or late and were not related to the state of the activity of the vasculitis. Immunosuppressive treatment seems to play an important role in their pathogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Causes of death in systemic vasculitis of polyarteritis nodosa. Analysis of a series of 165 patients]. 290 28

The role of preceding infection as a risk factor for ischaemic stroke was investigated in a case-control study of 54 consecutive patients under 50 years of age with brain infarction and 54 randomly selected controls from the community matched for sex and age. Information about previous illnesses, smoking, consumption of alcohol, and use of drugs was taken. A blood sample was analysed for standard biochemical variables and serum cholesterol, high density lipoprotein cholesterol, triglyceride, and fasting blood glucose concentrations determined. Titres of antimicrobial antibodies against various bacteria, including Staphylococcus, Streptococcus, Yersinia, and Salmonella and several viruses were determined. Febrile infection was found in patients during the month before the brain infarction significantly more often than in controls one month before their examination (19 patients v three controls; estimated relative risk 9.0 (95% confidence interval 2.2 to 80.0)). The most common preceding febrile infection was respiratory infection (80%). Infections preceding brain infarction were mostly of bacterial origin based on cultural, serological, and clinical data. In conditional logistic regression analysis for matched pairs the effect of preceding febrile infection remained significant (estimated relative risk 14.5 (95% confidence interval 1.9 to 112.3)) when tested with triglyceride concentration, hypertension, smoking, and preceding intoxication with alcohol. Although causality cannot be inferred from these data and plausible underlying mechanisms remain undetermined, preceding febrile infection may play an important part in the development of brain infarction in young and middle aged patients.
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PMID:Preceding infection as an important risk factor for ischaemic brain infarction in young and middle aged patients. 313 45

Two hundred fifty pediatric (less than 18 years of age) patients underwent orthotopic liver transplantation because of end-stage liver disease and were given combination therapy with cyclosporine and prednisone. The most common indications for transplantation in decreasing order of frequency were biliary atresia, inborn errors of metabolism, and postnecrotic cirrhosis. The 5-year actuarial survival for the entire group was 69.2%. Age and diagnosis did not influence survival. Infections were the most common cause of death, followed by liver failure and cerebrovascular accident. The impact of retransplantation on survival depends on the indication. The survival is better when retransplantation is carried out after rejection than because of technical complications, and the latter has a better survival than does primary graft nonfunction. The difference in survival among these groups is statistically significant. The quality of life for 164 of 173 survivors is good to excellent; only nine children are currently experiencing medical problems. A persistent problem in pediatric transplantation is the scarcity of small donors.
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PMID:Indications for pediatric liver transplantation. 331 78

The authors report two cases of endocarditis secondary to Streptobacillus moniliformis. A 41 year-old man, bitten by a rat, is hospitalized 5 weeks later for an endocarditis demonstrated by echocardiography, with massive aortic escape and hemodynamic failure requiring emergency valve replacement: after a favorable course, the patient dies suddenly 4 months later. A 63 year-old woman is admitted for a septicemic syndrome with sterno-clavicular arthritis which occurred 10 days after a rat bite; followed by a transient ischemic cerebral vascular accident; echocardiogram shows a clubshaped bulge of the distal end of the large mitral valve; the course is uneventful under antibiotherapy. In both cases, blood cultures isolate a Streptobacillus moniliformis. Infections secondary to Streptobacillus moniliformis are rare; this Gram negative bacillus, saprophyte of the rat's rhinopharynx, is transmitted to man, most of the time, by bite, and this causes a septicemia, the evolution of which is usually favorable. Complications, especially endocarditis, are exceptionally rare: only 12 cases are found in the world's literature. The evolution is always fatal in the absence of treatment which must include the association penicillin-aminoside. Prophylaxis of this disease is provided by penicillin antibiotherapy which should be systematic after a rodent's bite.
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PMID:[Streptobacillus moniliformis endocarditis. Apropos of 2 cases]. 361 83

Over a period of 6 years, only twelve cases of dilated cardiomyopathy were clinically diagnosed in Nigerians between the ages of 11-30 years at the University College Hospital, Ibadan, Nigeria. Eleven presented with heart failure, while the twelfth patient presented with a cerebrovascular accident. Two other patients also had a cerebrovascular accident. A history of febrile illness was obtained in seven, but in only three was fever unresponsive to antimalarials, documented on admission. Antistreptolysin-O titre was normal and erythrocyte sedimentation rates elevated in each of the patients. Leucocytosis was present in six, three had a four-fold rise or fall in antibody titres against Coxsackie-B viruses and one, a four-fold rise or fall against Toxoplasma gondii. Histological evidences of myopericarditis were found in three of the six patients who died. It is concluded that dilated cardiomyopathy is rare in young adult Nigerians, and that constitutional upset is common, as in children, but prognosis is poorer. Infections by Coxsackie-B viruses, T. gondii and possibly other viruses appear to be of major aetiological factors
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PMID:Dilated cardiomyopathy in young adult Africans: a sequel to infections? 629 52

Maternal mortality was examined in a semi-urban Nigerian community over a 10-year period. Maternal mortality was defined as death occurring as the direct result of childbearing and measured per 1000 births. Abortions at below 20 weeks gestation were excluded. From 1966 to 1975, there were 90 maternal deaths out of 13,182, a rate of 6.8/1000. The hospital records of the Baptist Medical Center, located in the western part of Nigeria, were carefully reviewed and cross-checked with obstetric statistical records. Only 13 of the deaths occurred in hospitalized patients. 78 (80%) were due to direct obstetric causes; 12% were from nonobstetric causes. Anemia due to blood loss was the leading casue of death, accounting for 30, or 33%, of the deaths. Anemia, with or without congestive heart failure accounted for 7 deaths. Infection was responsible for 5 deaths. Ruptured uterus, preeclampsia, and eclampsia occurred in equal percentages, 10-11%. Indirect obstetric deaths, such as sudden death, accounted for 10 deaths. 50% of these were anesthetic deaths; the remainder were due to pulmonary embolism. Sickle cell intrapartum crisis was the cause of 1 death. Associated causes included featured pneumonia, nephritis, hepatitis, meningitis, enteritis, and cerebrovascular accident. Parity ranged from 0-11. 25 babies were salvaged in this series. Prevention continues to be the cornerstone in improving maternal mortality figures in developing countries. The Baptist Medical Center's model for providing maternal care is described briefly and is identified as responsible for the encouraging decline in the maternal mortality rate.
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PMID:Maternal mortality in a semi-urban Nigerian community. 720 76

Catheterism of the urinary bladder in the primary therapy after stroke is often the initial condition for the development of an infected contracted bladder. The patient is bearing his catheter for life because there is a disproportion of production of urine (greater than 1500 ml) and capacity of the urinary bladder (less than 100 ml). Infection and restriction of movement hinder his discharge from hospital. There are five conditions for a treatment of contracted bladder using a closed drainage of the bladder: 1. functional training of the capacity, 2. reduction of reinfection and antibiotic therapy, 3. training of sensibility, 4. use of day-and-night-rhythm, 5. gymnastics for pelvic floor. The therapeutic result--200 ml capacity of urinary bladder, control of infection and voluntary miction--can be reached after 4-6 weeks, if patient, nursing staff and physician are cooperative. The experiences of 8 cases demonstrate that a contracted bladder needs not be a final state, but can be rehabilitated.
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PMID:[Closed drainage of the urinary bladder. Method and results in the rehabilitation of the infected, contracted bladder in stroke patients]. 725 Aug 81

To determine the causes of death in autosomal dominant polycystic kidney disease (ADPKD) patients and to examine whether the extrarenal manifestations of ADPKD influence the causes of death, the medical records of 129 patients who died between 1956 and 1993 were reviewed; 58% of the 129 patients had an autopsy performed. Seventy-seven percent died after reaching ESRD. The mean age at death increased from 51 yr for those who died before 1975 to 59 yr for those who died after 1975, reflecting the introduction of renal replacement therapies. The most common cause of death before 1975 was infection (30%), followed by uremia (28%) and cardiac disease (21%); after 1975, these were cardiac disease (36%) and infection (24%). Infection was equally prevalent before and after 1975, presenting as sepsis in 94% and directly relating to ADPKD in 47% of these patients. Underlying factors for cardiac death were cardiac hypertrophy, seen in 89% of all autopsied patients, and coronary artery disease, seen in 81%. A neurologic event was the cause of death in 12% of patients; these were ruptured intracranial aneurysm in 6%, hypertensive intracranial hemorrhage in 5%, and ischemic stroke in 1%. The mean age of those who died of ruptured intracranial aneurysm was 37 yr. No patient died of renal cancer. Liver cysts were the most common extrarenal manifestation, seen in 70% of the autopsied cases; cysts in other organs were very rare. Colonic diverticula were found in 21%. Thus, the renal and extrarenal manifestations of ADPKD are important contributors to morbidity and mortality.
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PMID:Causes of death in autosomal dominant polycystic kidney disease. 757 53

Within the Cooperative Study of Sickle Cell Disease, 694 infants with confirmed sickle cell disease were enrolled at less than 6 months of age. Information about the nature and frequency of complications was collected prospectively over a 10-year period. Painful crises and acute chest syndrome were the most common sickle cell-related events in homozygous sickle cell anemia (SS), hemoglobin SC disease (SC), and S beta thalassemia patients (overall incidence in SS patients of 32.4 and 24.5 cases per 100 person-years, respectively). Bacteremia occurred most frequently in SS children under 4 years of age and in SC patients less than 2 years of age. The mortality rate was low in this cohort compared with that found in previous reports. Twenty children, all with Hb SS, died (1.1 deaths per 100 person-years among SS patients). Infection, most commonly with Streptococcus pneumoniae and Hemophilus influenzae, caused 11 deaths. Two children died of splenic sequestration, 1 of cerebrovascular accident, and 6 of unclear causes. Two patients underwent cholecystectomies, and 17 underwent splenectomies after one or more splenic sequestration crises. The experience of this cohort should reflect closely the true clinical course of those children with Hb SS and Hb SC disease who are observed in sickle cell centers in the United States.
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PMID:Clinical events in the first decade in a cohort of infants with sickle cell disease. Cooperative Study of Sickle Cell Disease. 749

Bacteriological and systematic investigation has been carried on 135 confined to bed patients at the Neurological Department of the Policlinico of the University of Catania from January 1993 to June 1993, in order to estimate the frequency of the I.V.U. and the probable correlations with the basic nerve disease. Infections have been found with greater frequency between women and patients with catheter. The microorganisms most frequently isolated were: E. coli (36%) and Streptococcus faecalis (36%). Patients with positive urine culture have been treated in accordance with the indications of the bacterial identification. Particularly, surveys carried out in a group of patients suffering from cerebral stroke (81 cases), showed a frequent association between the I.V.U. and the beforesaid pathology. Similar results have been obtained in the two groups of patients submitted to 2 and to 3 drawings of urine respectively, practised at a distance of 5 of 5 days the one form the other.
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PMID:[Monitoring of low urinary tract infections in patients hospitalized with neurological diseases]. 781 6


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