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

Adrenomedullin (ADM) is a 52 amino-acid peptide which is a potent vasodilator in rats, and suppresses basal and CRF-induced ACTH release from cultured pituitary cells. The present study examines the hemodynamic and hormonal actions of human ADM (1-52) infusion in conscious, chronically instrumented sheep. Five sheep were infused intravenously (IV) or intracerebroventricularly (ICV) with ADM at 100 micrograms/h for 60 min, and mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), stroke volume (SV), total peripheral conductance (TPC), coronary blood flow (CF), coronary conductance (CC), peak aortic flow (Fmax), and left ventricular dF/dt were monitored by a computer-based data collection system every 2 min. Plasma concentrations of adrenocorticotropin (ACTH), arginine vasopressin (AVP) and renin were measured after 60 min of infusion. IV ADM produced a small fall in MAP of 3 +/- 1 mmHg, associated with a reflex increase in HR of 14 +/- 3 b/min. CO increased by 1.3 +/- 0.3 l/min, whereas SV remained unchanged. TPC was markedly increased by 20 +/- 3 ml/min/mmHg. Changes in CF were also seen with an increase of 10 +/- 2 ml/min, and CC increased in parallel by 0.15 +/- 0.02 ml/min/mmHg. Fmax and dF/dt showed small increases of 2.1 +/- 0.5 l/min and 85 +/- 20 l/min/sec respectively. Plasma concentrations of ACTH and cortisol were reduced by 58% and 55% respectively, whereas plasma renin concentration increased by 106%. There was no change in plasma levels of AVP. ICV infusion of ADM had no effect on any parameter measured. These data suggest that systemic ADM produces a sustained vasodilator action to lower blood pressure in sheep, and this is the first study to report the ACTH-suppressor action of ADM in conscious animals. ADM may therefore be an important hormone involved in the regulation of pituitary/adrenal function, in addition to its cardiovascular and fluid regulatory actions in mammals.
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PMID:ACTH-suppressive and vasodilator actions of adrenomedullin in conscious sheep. 874 70

Epidemiological study on autosomal dominant polycystic kidney disease (ADPKD) was undertaken in a French region from 1988 to 1993. This survey was led in a population of 410,000 inhabitants and 84 kindreds with ADPKD and 296 affected members were studied. Prevalence of ADPKD in the studied region was calculated to 1/1111 inh. Renal prognosis was evaluated according to the Kaplan-Meier method in 296 affected subjects of whom 212 were members of propositus kindreds. In our region 17% of patients had ESRD by the age of 50 years, 47% by the age of 60 years and 70% by the age of 70. No significance difference was found between males and females. The influence of the sex of the parent from whom ADPKD was received on the renal prognosis of the disease in affected descendants was evaluated. Anticipation of ESRD for at least one offspring inheriting ADPKD from parent was found in 15 (38%) out of 39 families, without genetic imprinting linked to gender. Mean survival to ESRD for fathers transmitting ADPKD to offspring (52 +/- 10 years) was significantly earlier compared to that for mothers transmitting ADPKD (61 +/- 10 years, p < 0.001), therefore that for siblings inheriting the disease from their fathers (sons: 49 +/- 7 years, daughters: 51 +/- 9 years) and for those inheriting ADPKD from their mothers (sons: 57 +/- 10 yrs, p < 0.01, daughters: 55 +/- 6 yrs, p < 0.02). Prevalence of de novo mutations was evaluated to 1/135,000 inh. Adult polycystic disease of the liver (APLD) was studied in 82 kindreds with 158 ADPKD affected members by ultrasonography and/or CT. In patients with APLD, 49/84 (58.3%) were females compared to 46/74 (62.2%) in those without APLD. Familial APLD (at least 2 affected members and all with APLD) was demonstrated in 22/27 APLD kindreds (81.5%). Familial ADPKD without APLD (at least 2 affected members and all without APLD) was demonstrated in 12/12 kindreds (100%). Renal prognosis of ADPKD in 84 APLD pts was compared to that in 71 non-APLD pts, in whom mean age was not different at the time of the study. In APLD pts 28/84 (33.3%) had reached ESRD compared to 23/71 (32.3%) non-APLD pts (ns). The occurrence of stroke in ADPKD patients was documented in 24/231 pts (10.4%) from 11/82 kindreds (13.4%). Family history of cerebro-vascular event was found in 4/11 kindreds (36%).
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PMID:[Epidemiologic data, clinical and prognostic features of autosomal dominant polycystic kidney disease in a French region]. 883 59

In the past 20 years, clinicians have clearly demonstrated that antihypertensive therapy is very effective in reducing the incidence of myocardial infarction and stroke. However, little is known about the effects of blood pressure reduction on end stage renal disease (ESRD). Data from major clinical studies has clearly shown that patients with hypertension have an increased risk of developing ESRD. Black men and women with hypertension are at the greatest risk; however, the incidence of ESRD is increasing in all racial groups. Because patients with hypertensive ESRD often require dialysis, the cost of treating this increasing common disorder has the potential to deplete the Medicare system. The primary effect of blood pressure reduction in patients with ESRD has not been adequately addressed in any trial that has been completed to date. Results from some studies suggest that blood pressure reduction may improve renal function and that angiotensin converting enzyme inhibitors and calcium channel blockers may have renoprotective effects. Currently in progress are two large scale clinical trials that may provide more information on the effects on antihypertensive therapy on preventing ESRD in hypertensive patients. These are the African American Study of Kidney Disease and Hypertension (AASK), and a substudy of the Hypertension Optimal Treatment (HOT) Study. Data from the HOT study is expected to be available 5 years prior to that of the ASK Study, which is expected to be completed by the Year 2002.
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PMID:The effect of blood pressure reduction on end stage renal disease. 886 39

Clinical data and outcomes of 18 patients, aged 80 or older, on continuous ambulatory peritoneal dialysis (CAPD) during the last five years were reviewed. There were 12 males and 6 females, with a mean age of 85 (range 82-91 years) and median duration on CAPD of 31.5 months (range 2-58 months). End-stage renal disease was caused by nephrosclerosis in 9, diabetes mellitus and light chain disease in 2 each, and chronic glomerulonephritis, membranous nephropathy, and IgA nephropathy in 1 each, with the cause unknown in yet another 2 patients. Hypertension and angina were the commonest comorbid conditions observed. Peritonitis episodes occurred one per 10.8 patient-months, and necessitated catheter removal in 7 patients and reinsertion in 6 of them. Fourteen episodes of exit-site infections were seen in 8 patients, 2 developed pericatheter leak, and 1 had tunnel infection. Nine patients are continuing CAPD successfully, with a median duration of 29 months (range 11-57 months). One patient was transferred to hemodialysis, and 8 died. The causes of death were peritonitis (3/8), cerebrovascular accident (2/8), pneumonia (1/8), and septicemia (1/8), with the cause not known in 1 patient. Our survival rate of 80% at three years is encouraging, and we advocate CAPD as a successful alternative treatment modality in octogenarians.
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PMID:Successful use of continuous ambulatory peritoneal dialysis in octogenarians. 886 86

Little is known about hypertension in Haitians. We performed a pilot survey of ambulatory Haitian patients in a multispecialty clinic at a large public teaching hospital. Approximately 10% of the clinic population was of Haitian origin. Clinical data were collected on 88 consecutive Haitian patients. Of these 88, 77 (87.5%) were hypertensive (SBP > or = 140 or DBP > or = 90 mm Hg or taking antihypertensive medication). The characteristics of the hypertensive patients were: age 54.1 +/- 13.0 (s.d.) years; 27 men, 50 women; 12/64 (19%) smoked; 7/63 (11%) used alcohol. Diabetes was present in 21/77 (27%). In patients for whom height and weight were available, obesity was present in 52%. Using JNC V criteria, 18 (23%) had Stage 1, 16 (21%) Stage 2, 18 (23%) Stage 3, and 25 (33%) Stage 4 hypertension. Despite 63/77 (82%) being treated for hypertension, only 20 (26%) were controlled (< 140/< 90 mm Hg). Of those under treatment, 29 were taking one drug; 18 (two drugs); 12 (three drugs); and four (four drugs). Target organ damage was evident in 37 (48%), including coronary artery disease (8), CHF (6), chronic renal failure (15), stroke (9), and LVH by ECG (19). There was evidence of severe noncompliance in 32 (42%). We conclude that in this clinic sample, hypertension was highly prevalent and unusually severe in terms of blood pressure (BP) level, refractoriness to treatment, and target organ consequences. Further studies are indicated.
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PMID:Hypertension in Haitians: results of a pilot survey of a public teaching hospital multispecialty clinic. 900 4

The common practice of admitting all patients to an intensive care unit (ICU) following carotid endarterectomy (CEA) is based upon concern for adverse events that may be properly cared for only in the ICU. We developed restrictive criteria for postoperative nursing unit admission based on analysis of adverse outcomes and risk factors. 365 CEAs over 15 years were reviewed. In the first 24 hours after CEA, 38 patients experienced 46 events that may have been best managed in an ICU. Preoperative factors associated with significant risk for complications were indications of cardiac disease within 6 months (n = 62, p < 0.05), emergent CEA (n = 2, p = 0.01), and need for postoperative anticoagulation (n = 2, p = 0.01). Only 56 (15%) of patients had indications for ICU admission, 57 (16%) would have been admitted to an EKG-monitored nursing unit, and 252 (69%) would have been admitted to a standard nursing unit. Immediate admission to the ICU after CEA is indicated for patients undergoing emergent CEA, those requiring anticoagulation postoperatively, those with intraoperative stroke or major cardiac complication, and possibly those with chronic renal failure. All other patients should be admitted to the RR. Patients experiencing stroke, major cardiac events, significant wound hemorrhage, or reintubation in the RR, and those requiring vasoactive medication more than 3 hours after surgery should be transferred to the ICU. Patients with indications of cardiac disease within 6 months prior to CEA but no indications for ICU admission may be discharged from the RR to an EKG monitored unit. All others may be discharged to a standard nursing unit.
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PMID:Criteria for selective utilization of the intensive care unit following carotid endarterectomy. 906 Nov 35

The actions of CRF in the brain and in the periphery are mediated through multiple binding sites. There are three receptors, CRF1, CRF2 alpha and CRF2 beta, which encode 411, 415 and 431 amino acid proteins and transduce signals via the stimulation of intracellular cAMP production. The recent identification of high-affinity non-peptide CRF receptor antagonists should allow for rapid progress in drug development of CRF receptor antagonists. In addition to the receptors, the actions of CRF in brain and in the periphery can also be modulated by a binding protein of 322 amino acids. Ligands of CRF-BP, such as CRF (6-33) can elevate brain levels of 'free' CRF and improve learning and memory without stress-like side effects of CRF receptor agonists. Urocortin, a mammalian CRF-related peptide with close sequence homology to fish urotensin, interacts with CRF1, CRF2 receptors and with CRF-BP. These data indicate that CRF receptor antagonists may be useful for the treatment of the disease states where CRF is elevated such as anxiety and depression, anorexia nervosa and stroke and that ligand inhibitors of CRF-BP may be used to elevate brain levels of 'free' urocortin and other CRF-related peptides.
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PMID:Neurobiology of corticotropin releasing factor (CRF) receptors and CRF-binding protein: implications for the treatment of CNS disorders. 911 53

Left ventricular functions were evaluated in 25 adult patients of chronic renal failure by 2-D echocardiography before and after four hours of standard hemodialysis session. Eighteen patients showed clinical evidence of fluid overload. Predialysis left ventricular end-diastolic diameter, left ventricular end-diastolic volume, left ventricular end-systolic diameter and left ventricular end-systolic volume were comparable in patients with or without fluid overload. Similarly, predialysis stroke volume and left ventricular ejection fraction were not significantly different in the two subsets. However, following hemodialysis there was a significant decrease in the left ventricular systolic and diastolic volumes and diameters in patients with fluid overload. The improvement in the left ventricular ejection fraction was of the same magnitude in the two subsets. The significant improvement in the left ventricular functions both in patients with and without fluid overload indicates that fluid overload may not be the only determinant of left ventricular functions in patients of chronic renal failure, but other factors, such as various uraemia toxins and metabolic changes might also be inhibiting the myocardial functions.
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PMID:Evaluation of left ventricular functions in chronic renal failure before and after acute hemodialysis. 935 65

Sleep apnea is a surprisingly common disorder in end-stage renal disease (ESRD) and chronic renal failure. The symptoms of sleep apnea frequently go unreported or may be misdiagnosed as uremia, depression, chronic illness, or insomnia. A review of the literature was performed to define the prevalence, morbidity, and treatment of sleep apnea syndrome in the ESRD patient. Sleep apnea occurs in at least 60% of ESRD patients. The known complications of sleep apnea include arrhythmias, pulmonary hypertension, and systemic hypertension. In addition, sleep apnea has been implicated in coronary artery disease and strokes. The contribution of sleep apnea to the high mortality from cardiac disease and stroke in peritoneal dialysis and hemodialysis patients is unknown. The causes of the increased prevalence of sleep apnea in ESRD patients are unknown and likely differ from the general population, but the treatment is similar. The literature suggests that modality of renal replacement therapy does not matter; however, large nocturnal volume peritoneal dialysis may worsen sleep apnea. Renal transplantation may be curative. In conclusion, sleep apnea may be an under-diagnosed disease in patients on dialysis. There are significant reasons to suspect that sleep apnea may worsen the morbidity and mortality of ESRD, and there are potential successful therapies.
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PMID:Sleep apnea in renal failure. 936 Jun 57

The objective of this study was to assess the cost effectiveness of eight strategies to diagnose renovascular hypertension (RVHT) followed by treatment with percutaneous transluminal angioplasty (PTRA) with or without stent placement. The eight diagnostic strategies were compared with a reference strategy, i.e. antihypertensive medication. The diagnostic imaging techniques under consideration were captopril renography, spiral computed tomography angiography (CTA), magnetic resonance angiography (MRA) and conventional angiography. Cost-effectiveness analysis was carried out from the perspective of the health care system, based on data from the literature. A model was developed to predict the reduction in 10-year morbidity and 10-year mortality owing to myocardial infarction, stroke and chronic renal failure achieved after PTRA compared with the reference strategy. Life-years gained over a 10-year follow-up period and the incremental cost-effectiveness ratio per life-year saved were the outcome measures. The strategy CTA followed by angiography was more effective, but more costly, than captopril renography followed by angiography, with an incremental cost-effectiveness ratio per life-year gained of Dfl 64700. Combining captopril renography with CTA was even more effective, but the incremental cost-effectiveness ratio per life-year gained was Dfl 236400. Strategies including MRA were not cost-effective. The results suggest that diagnostic strategies that include CTA are more effective than captopril renography in detecting renal artery stenosis (> 50%) and cost saving due to prevented myocardial infarction, stroke or chronic renal failure. MRA is even more effective, but in order to achieve an acceptable cost-effectiveness ratio, the costs would need to be reduced. The cost-effectiveness of the diagnostic strategies is sensitive to the pre-test probability of RVHT. So, careful clinical evaluation, in order to achieve a pre-test probability of at least 20%, is an essential component of the complete workup strategy in patients suspected to have RVHT.
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PMID:The cost-effectiveness of the diagnosis of renal artery stenosis. 963 34


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