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

Pituitary function was studied in nine patients who had recovered from pituitary apoplexy. All the patients recovered spontaneously; none required immediate surgery. Four of the patients had acromegaly, two had pituitary-dependent Cushing's syndrome, and a "functionless" pituitary adenoma was found in three. Low serum growth hormone concentrations were observed in three patients with acromegaly whereas the concentration remained increased in the fourth one. Of the two patients with Cushing's syndrome, a selective ACTH-deficiency developed in one and Nelson's syndrome appeared with excessive secretion of ACTH in the other. Transient or persistent hypofunction of the anterior pituitary occurred in al patients. Three patients underwent hypophysectomy after respective intervals of three, eight and 12 months after pituitary apoplex. The operation revealed a hemorrhage in one functionless adenoma and a large cyst in another one. In the third patient who had acromegaly, no signs of the pituitary apoplexy were observed at operation.
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PMID:Pituitary function after pituitary apoplexy. 70 35

An unusually therapy-resistant form of Nelson's syndrome developed in a 23-year-old woman two years after treatment of a pituitary-dependent Cushing's syndrome by bilateral adrenalectomy (1977). Removal of a corticotrophic adenoma by a first transsphenoidal pituitary operation (1979) brought only temporary relief. Two years later, regrowth and apoplexy of the pituitary adenoma led to oculomotor paralysis and had to be treated by a second transsphenoidal operation (1981). A second relapse became manifest two years later. Treatment with bromocriptine relieved the headaches but did not diminish the tumor size. A third pituitary operation (1984) became necessary when neurological signs revealed penetration of the cavernous sinus. The tumor was only partly removed by transsphenoidal surgery. Postoperative deterioration of the patient required emergency craniotomy to check a subarachnoidal hemorrhage and for removal of the remaining tumor. The patient died three days later of pneumococcal meningitis which had developed after the third pituitary operation.
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PMID:[A fatal course of Nelson syndrome]. 323 90

Ten patients with pituitary apoplexy were treated at the Institute of Endocrinology, Gerontology and Geriatrics in Sofia over the last 5 years. They represented 5.06% of the total number of patients with pituitary adenomas treated at the Institute during the same period. The highest frequency of pituitary apoplexy was noted among patients with Nelson's syndrome. In 5 patients of this group pituitary apoplexy was the first sign of a tumor. Headaches combined with nausea and vomiting were the earliest symptoms of pituitary apoplexy, and ptosis and ophthalmoplegy were the most common symptoms in the patients. The disease was not correctly diagnosed in 7 patients who immediately after apoplexy were treated in neurological and ophthalmological departments.
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PMID:[Pituitary apoplexy]. 365 48

We have recently demonstrated that changes in the work of breathing during maximal exercise affect leg blood flow and leg vascular conductance (C. A. Harms, M. A. Babcock, S. R. McClaran, D. F. Pegelow, G. A. Nickele, W. B. Nelson, and J. A. Dempsey. J. Appl. Physiol. 82: 1573-1583, 1997). Our present study examined the effects of changes in the work of breathing on cardiac output (CO) during maximal exercise. Eight male cyclists [maximal O2 consumption (VO2 max): 62 +/- 5 ml . kg-1 . min-1] performed repeated 2.5-min bouts of cycle exercise at VO2 max. Inspiratory muscle work was either 1) at control levels [inspiratory esophageal pressure (Pes): -27.8 +/- 0.6 cmH2O], 2) reduced via a proportional-assist ventilator (Pes: -16.3 +/- 0.5 cmH2O), or 3) increased via resistive loads (Pes: -35.6 +/- 0.8 cmH2O). O2 contents measured in arterial and mixed venous blood were used to calculate CO via the direct Fick method. Stroke volume, CO, and pulmonary O2 consumption (VO2) were not different (P > 0.05) between control and loaded trials at VO2 max but were lower (-8, -9, and -7%, respectively) than control with inspiratory muscle unloading at VO2 max. The arterial-mixed venous O2 difference was unchanged with unloading or loading. We combined these findings with our recent study to show that the respiratory muscle work normally expended during maximal exercise has two significant effects on the cardiovascular system: 1) up to 14-16% of the CO is directed to the respiratory muscles; and 2) local reflex vasoconstriction significantly compromises blood flow to leg locomotor muscles.
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PMID:Effects of respiratory muscle work on cardiac output and its distribution during maximal exercise. 968 39

A thirty-eight year-old lady with a history of bilateral adrenalectomy for Cushing's disease seven years previously, presented with sudden onset of severe headache, nausea, vomiting and loss of consciousness. She was somnolent and confused. She had neck stiffness, sixth nerve palsy and mydriasis on the left side. Computerized tomography (CT) and magnetic resonance imaging (MRI) studies revealed a non-homogeneous, grade IV D pituitary mass lesion associated with hemorrhage in the chiasmatic, interhemispheric, cerebellopontine, perimesencephalic cisterns and a hematoma within the frontal lobe. Angiography showed only bilateral elevation of horizontal segments of the anterior cerebral arteries. According to this angiographic evidence, it was presumed that the subarachnoid hemorrhage and the intracerebral hematoma were linked to pituitary adenoma apoplexy. ACTH level was 450 pg/ml. The hemorrhagic lesion with suprasellar extension was totally removed by left pterional craniotomy. Histological examination revealed a necrotic, ACTH-secreting pituitary adenoma. Even though apoplexy is a well known complication of pituitary adenomas, to our knowledge subarachnoid hemorrhage and intracerebral hematoma as a result of pituitary apoplexy in the context of Nelson's syndrome has not previously been reported.
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PMID:An unusual presentation of Nelson's syndrome with apoplexy and subarachnoid hemorrhage. 1455 76

The clinical efficacy of intravenous tissue plasminogen activator (tPA) in acute ischemic stroke is proven, and the cost-efficacy of tPA is realized through reduction in disability and associated long-term care. Only a modest proportion of eligible stroke patients receive tPA. Potential barriers include distance from treatment centers and lack of local expertise and infrastructure. Nelson and colleagues describe a telecommunications strategy to facilitate increased delivery of thrombolysis. The analysis used a model based on an expert stroke-center 'hub' offering video-based liaison with several peripheral hospital 'spokes'. Economic modeling suggested cost efficacy of this approach, albeit with all the caveats that come with long-term economic analyses of an acute stroke intervention. There is a clinical, ethical and economical imperative to increase uptake of evidence-based acute stroke therapies. These encouraging data suggest that use of audiovisual technologies may facilitate greater access to thrombolysis.
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PMID:Making the call: is telestroke cost effective? 2191 81

A person's self-evaluation influences purposeful activity undertaken in the situation of illness. It is observed in neurological patients that limited self-awareness disturbs rehabilitation. The goal of the study was to investigate select dimensions of emotional state, the relationship between anxiety and emotional state, and the level of insight into emotional state in patients at different time periods after cerebral vascular accidents (CVAs). Sixty-five patients with short (n = 36) or long (n = 29) time periods following a stroke participated in this study. The patients' relatives (n = 65) evaluated their emotional functioning. The modified Neuropsychology Behavior and Affect Profile (NBAP; Nelson, Satz, & D'Elia, 1994 ) and State and Trait Anxiety Inventory were administered. Compared groups differed significantly in self-reporting and in relatives' reports on the NBAP scales. Patients with short and long time periods after stroke did not differ in terms of mania, indifference, depression, or inappropriateness. Significant positive moderate correlations between anxiety and depression were found in both groups. In the group with a long time period after CVA, ratings of depression, mania, indifference, and inappropriateness among patients with right-hemisphere damage were significantly correlated with their relatives' ratings. Biological and psychological factors determining emotional state and adequacy of patients' self-evaluations have also been discussed.
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PMID:Assessment of select dimensions of patients' emotional functioning at different time periods after stroke. 2482 1

Based on the convincing case control study of Nelson and Grether which suggested that the administration of magnesium sulfate to mothers prior to early preterm birth might protect their offspring from cerebral palsy, and a pilot study by John Hauth et al. at the University of Alabama at Birmingham, the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, with co-funding from the National Institute of Neurologic Disorders and Stroke embarked on the Beneficial Effects of Antenatal Magnesium (BEAM) Trial in 1997.
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PMID:What we learned about the role of antenatal magnesium sulfate for the prevention of cerebral palsy. 2711 79

Several studies have investigated early outcomes with a surgical short-term ventricular assist device (VAD), but little is known about adverse event profile during prolonged support with a surgical short-term VAD. This is a retrospective analysis of 161 patients who received a CentriMag ventricular assist system (Abbott Laboratories, Abbott Park, IL) at our institution between January 2007 and June 2014. Device-related adverse events include major bleeding, infection, and stroke incidents occurring during CentriMag support. Cumulative frequency of adverse events was estimated by Nelson's nonparametric method. One hundred and forty-three (88.8%) patients had biventricular VAD and 18 (11.2%) had isolated left VAD. Median duration of support was 16 days (interquartile range [IQR]: 10-29). Mortality was 24.8% and 1 year overall survival is 51.8% (95% CI: 43.3-59.5%). The most common adverse event during support was major bleeding (n = 121, 75.1%). Ninety-five (59.0%) developed major infections such as pneumonia and urinary tract infection. Sixteen patients (10%) experienced stroke. Cumulative data analysis showed that stroke and reoperation caused by bleeding were rare beyond 30 days, whereas infection and nonsurgical bleeding events were directly related to support time. In conclusion, temporary VAD with CentriMag support is an effective treatment for patients in refractory cardiogenic shock. Despite its side effect, profile including a high rate of blood transfusion early in the immediate postoperative period of CentriMag support, aggressive use of the CentriMag support device has acceptable survival to discharge and 1 year survival.
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PMID:Adverse Event Profile Associated with Prolonged Use of CentriMag Ventricular Assist Device for Refractory Cardiogenic Shock. 3080 79

A high-pressure pneumatic catapult works under extreme boundaries such as high-pressure and rapid change of pressure and temperature, with the features of nonlinearity and gas-solid convection. In the thermodynamics processes, the pressure is much larger than the critical pressure, and the compressibility factor can deviate from the Zeno line significantly. Therefore, the pneumatic performance and thermo-physical properties need to be described with the real gas hypothesis instead of the ideal gas one. It is found that the analytical results based on the ideal gas model overestimate the performance of the catapult, in comparison to the test data. To obtain a theoretical model with dynamic leakage compensation, leakage tests are carried out, and the relationship among the leakage rate, pressure and stroke is fitted. The compressibility factor library of the equation of state for compressed air is established and evaluated by referring it to the Nelson-Obert generalized compressibility charts. Based on the Peng-Robinson equation, a theoretical model of the high-pressure pneumatic catapult is developed, in which the effects of dynamic leakage and the forced convective heat transfer between the gas and the metal wall are taken into account. The results from the theoretical model are consistent with the data from ejection tests. This research presents an approach to study the performance of a high-pressure pneumatic catapult with high precision.
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PMID:Experimental Investigation and Theoretical Modelling of a High-Pressure Pneumatic Catapult Considering Dynamic Leakage and Convection. 3328 79


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