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

Calciphylaxis represents a rare complication of end-stage renal disease with hyperparathyroidism. We report the case of a 26-year-old woman with systemic calciphylaxis secondary to chronic renal failure who developed mitral annular calcification and a right middle cerebral artery stroke. The high-density lesion seen on CT scan of the brain probably represents a calcified cerebral embolus originating from the mitral valve.
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PMID:Calcific cerebral embolism in systemic calciphylaxis. 967 27

Heightened hypothalamic-pituitary-adrenal (HPA) axis responses have been implicated in hypertension in the spontaneously hypertensive rat (SHR), but the exact mechanisms involved are poorly understood. To determine changes in gene expression in SHR in the paraventricular nucleus (PVN), stress-induced accumulation of CRF, CRF type 1 receptor (CRFR-1) genes, and immediate-early genes were examined using in situ hybridization in young (5 weeks old) and adult (12 weeks old) stroke-prone SHR (SHRSP), compared with normotensive Wistar Kyoto (WKY) rats. Restraint stress-induced accumulation of c-fos, jun B, and NGFI-B mRNA, and CRF hnRNA in the PVN was significantly higher in young and adult SHRSP than in WKY rats at 30 min, except for c-fos in young rats. CRFR-1 mRNA expression in the PVN was also significantly higher in adult SHRSP than in WKY rats at 120 min after stress onset. CRF mRNA was increased in response to stress in young SHRSP. The basal CRF mRNA level in the PVN was significantly lower in adult SHRSP than in WKY rats. Young SHRSP exhibit greater ACTH responses to stress without significant changes in plasma corticosterone concentrations. The adult SHRSP exhibited lower baseline concentrations of corticosterone and similar corticosterone response to stress with enhanced secretion of ACTH. Overall, these results demonstrated that stress-induced activation of immediate early genes and CRF gene transcription in the PVN, and ACTH secretion is enhanced in early hypertensive, young, and adult SHRSP, suggesting that they are probably not the result of chronic alterations in blood pressure. The abnormal hypothalamic-pituitary response to stress thus appears to be related to the development of hypertension.
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PMID:Stress-induced changes of gene expression in the paraventricular nucleus are enhanced in spontaneously hypertensive rats. 972 16

A strain of a previously undescribed non-lipophilic coryneform bacterium was isolated from pleural fluids of a patient with chronic renal failure, stroke and pneumonia. Slow fermentative acid production from glucose, maltose and sucrose, and strong N-acetyl-beta-glucosaminidase activity were the most characteristic features of the bacterium. Chemotaxonomic characterization unambiguously indicated that the organism belonged to the genus Corynebacterium. The results of comparative 16S rRNA gene sequence analysis revealed that the isolate represented a new species within the genus, for which the name Corynebacterium thomssenii sp. nov. is proposed. The type strain is DSM 44276.
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PMID:Corynebacterium thomssenii sp. nov., a Corynebacterium with N-acetyl-beta-glucosaminidase activity from human clinical specimens. 973 Dec 89

We have treated 7 myocardial revascularization cases with operative risk factors, using the beating heart technique without cardiopulmonary bypass. Operative risk factors included left ventricular dysfunction, calcified aorta, chronic renal failure, cerebrovascular accident, immunosupressive state and old age. The 6 males and 1 female ranged in age from 54 to 84 years (mean age 70 years). The mean number of grafts was 1.3 per patient. All were extubated within 3 hours of arrival at the intensive care unit. Inotropic catecholamin support was not necessary on postoperative days. None of our patients had perioperative myocardial infarction. Postoperative angiography showed that all grafts were patent. We have found, based on our experiences, that selected patients can safely undergo CABG without cardiopulmonary support.
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PMID:Myocardial revascularization without cardiopulmonary bypass in patients with operative risk factors. 1007 66

We report a 13-year-old girl with nephropathic cystinosis on chronic peritoneal dialysis who presented with two episodes of stroke. Laboratory evaluation showed severe hyperhomocysteinemia (108 mumol/l). Further testing revealed that she was homozygous for the thermolabile variant of the methylenetetrahydrofolate reductase (MTHFR) gene. Treatment with folic acid and vitamin B12 lowered plasma homocysteine to less than 20 mumol/l. No further episodes of stroke occurred over a follow-up of 12 months. Homocysteine levels should be measured in patients with chronic renal failure, since simple and safe treatment with folic acid and vitamin B12 is effective in lowering the plasma homocysteine level in patients with the thermolabile MTHFR allele.
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PMID:Cerebral vascular complication and hyperhomocysteinemia in a cystinotic uremic child. 1010 Feb 95

Most large observational studies available today establish that moderate hyperhomocysteinemia, either genetically or nutritionally determined, is an independent risk factor for myocardial infarction, stroke, and thromboembolic disease. This is also true for chronic renal failure patients, who exhibit a high prevalence of hyperhomocysteinemia (85-100%), which reaches high plasma concentrations (20-40 microM, while control values range between 8 and 12 microM). After a renal transplant, homocysteine levels decrease, but tend to be higher than normal. The cause of hyperhomocysteinemia in renal failure is still obscure, since recent data have questioned the previous notion that a net homocysteine renal extraction and/or excretion take place in man. No matter the cause of its increase, the sulfur amino acid homocysteine is thought to induce an increment in cardiovascular risk through three basic biochemical mechanisms: (1) homocysteine oxidation, with H2O2 generation; (2) hypomethylation through S-adenosylhomocysteine accumulation, and (3) protein acylation by homocysteine thiolactone. The final result is membrane protein damage, endothelial damage, and endothelial cell growth inhibition, among other effects. Hyperhomocysteinemia, in general, is susceptible of therapeutic intervention with the vitamins involved in its metabolism. Depending on the cause, vitamin B6, vitamin B12, betaine, and/or folic acid can be effectively utilized. Chronic renal failure patients benefit from folic acid in high dosage: 1-2 mg are usually not effective ('relative folate resistance'), while 5-15 mg reduce homocysteine levels to a 'normative' range (<15 microM) in a substantial group of patients. Good results are also obtained in transplant patients, best with a combination of folic and vitamin B6. The results of the interventional trials focusing on the possible reduction in cardiovascular risk after homocysteine-lowering therapy, both in the general population and in end-stage renal disease, are expected soon, as well as the genetic and biochemical studies in suitable models, with the aim to clarify the cause-effect link suggested by the numerous observational and basic science studies.
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PMID:Homocysteine, a new crucial element in the pathogenesis of uremic cardiovascular complications. 1020 68

Most dialysis patients experience prolonged periods of physical inactivity and often bedrest. The physiological consequences of bed rest and inactivity are many and detrimentally affect the functioning of many bodily systems, several of which affect physical functioning. Reductions in plasma volume reduce cardiac filling, stroke volume, and cardiac output. Skeletal muscle fiber size, diameter, and capillarity are reduced, as is bone density. These changes result in profound reductions in physical work capacity. The effects of bed rest and inactivity in patients with chronic renal failure may have more serious consequences, in that they may exacerbate the pathophysiology of renal failure such as cardiac dysfunction, anemia, muscle wasting, muscle weakness, neuropathy, glucose intolerance, and reduced bone density.
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PMID:The physiological consequences of bed rest and inactivity. 1023 Aug 79

Sialic acid (SA), N-acetylated derivatives of neuraminic acid, play a central role in the biomedical functioning of humans. The normal range of total sialic acid (TSA) level in serum/plasma is 1.58-2.22 mmol L-1, the free form of SA only constituting 0.5-3 mumol L-1 and the lipid-associated (LSA) forms 10-50 mumol L-1. Notably, considerably higher amounts of free SA are found in urine than in serum/plasma (approximately 50% of the total SA). In inherited SA storage diseases such as Salla's disease, SA levels are elevated many times over, and their determination during clinical investigation is well established. Furthermore, a number of reports describe elevated SA levels in various other diseases, tentatively suggesting broader clinical utility for SA markers. Increased SA concentrations have been reported during inflammatory processes, probably resulting from increased levels of richly sialylated acute-phase glycoproteins. A connection between increased SA levels and elevated stroke and cardiovascular mortality risk has also been reported. In addition, SA levels are slightly increased in cancer, positively correlating with the degree of metastasis, as well as in alcohol abuse, diabetes, chronic renal failure and chronic glomerulonephritis. Several different mechanisms are assumed to underlie the elevated SA concentrations in these disorders. The apparent non-specificity of SA to a given disease limits the potential clinical usefulness of SA determination. In addition, some non-pathological factors, such as aging, pregnancy and smoking, may cause changes in SA concentrations. The absolute increases in SA levels are also rather small (save those in inherited SA storage disorders); this further limits the clinical potential of SA as a marker. Tentatively, SA markers might serve as adjuncts, when combined with other markers, in disease screening, disease progression follow-up, and in the monitoring of treatment response. To become clinically useful, however, the existing SA determination assays need to be considerably refined to reduce interferences, to be specific for certain SA forms, and to be more easy to use.
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PMID:Occurrence of sialic acids in healthy humans and different disorders. 1035 98

Many cardiac functional disorders are developed in chronic renal failure. The aim of our work was the echocardiographic assessment of left ventricular functional parameters in patients on haemodialysis. We observed that left ventricular end-diastolic volume, left ventricular end-systolic volume and stroke volume significantly decreased after haemodialysis. Left ventricular ejection fraction increased after haemodialysis, but not significantly. Systolic and diastolic blood pressure decreased significantly after haemodialysis while heart rate increased significantly. During the haemodialysis, many haemodynamic changes are observed. Analysis of cardiac functional status is essential before the haemodialysis starts.
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PMID:[Effect of hemodialysis on functional parameters of the left ventricle]. 1035 25

The purpose of this study was to evaluate the risk factor of emergency coronary artery bypass grafting (CABG) in the elderly. From January 1986 to December 1998, there were 37 patients of emergency CABG in 75 years old and over. They were divided into two groups (alive: 27 patients and dead: 10 patients). The risk factors that influenced the mortality were preoperative chronic renal failure and cardiogenic shock, prolonged cardiopulmonary bypass time and aortic cross clamp time, postoperative mediasinitis and perioperative cerebrovascular accident. In conclusion, the predictors of operative mortality of emergency CABG in elderly were preoperative cardiogenic shock and renal dysfunction.
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PMID:[The risk factors of emergency coronary artery bypass grafting in the elderly]. 1044 61


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