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

We have studied 97 patients with dementia who have been discharged from our hospital and 106 inpatients with dementia who have been admitted during last two years in our hospital. The diagnosis of dementia was done according to the criteria of DSM-III. Based on their clinical course, neurological signs, Hachinski's ischemic score and neuroradiological findings, we divided patients into 4 groups, [senile dementia of the Alzheimer type (SDAT), vascular dementia (VD), unclassified dementia and other dementias which includes dementia with Parkinson's disease or motor neuron disease, etc.]. Concerning 70 demented patients who died during hospitalization, the average age of onset and the duration of illness of SDAT were 80.5 years old and 4.6 years respectively and those of VD were 77.6 years old and 2.7 years respectively. The common causes of death were pneumonia (50%) and cardiac failure (24%). Recurrence of cerebral vascular accident (CVA) was also another frequent cause of death in VD. The most common behavioral problems causing admission in patients of SDAT were aimless wandering, nocturnal delirium, illusion and hallucination. In VD, nocturnal delirium, aimless wandering, violence and abnormal monologue were most common causes of admission. The important causes degrading ADL of inpatients were fracture, especially fracture of the hip joint, pneumonia, intestinal bleeding and CVA. Concerning the increase of the population of over 75 years old, it will be suggested that the care and treatment of demented patients in this age group will become a major social problem.
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PMID:[Clinical and epidemiological studies on inpatients with dementia]. 238 92

The aim of this study was to compare the hemodynamic and oxygen transport responses to sudden, acute progressive hypoxia in normal control conditions (six healthy dogs) and in subacute respiratory failure (six dogs with naturally occurring distemper). The latter were used to simulate respiratory failure from viral pneumonitis in man. Acute progressive hypoxia was induced by rebreathing through a respirometer while hemodynamic and oxygen transport variables were rapidly and repeatedly measured. The immediate effects of hypoxia were decreased PaO2 and oxygen delivery. In the middle period of hypoxia, defined as periods 4, 5, and 6 of eight equally spaced time periods, cardiac index, stroke volume, and oxygen extraction increased; these occurred as compensatory responses. Oxygen consumption (VO2) remained relatively stable until late in both control and distemper dogs. Initially, physiologic compensations in distemper dogs were found to be partially exhausted and overall to be shorter in duration and of lesser magnitude when compared with the healthy control animals. Failure to maintain near normal VO2 toward the end of the hypoxic episode indicated the progression of decompensation, imminent circulatory deterioration, and death.
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PMID:Comparison of cardiorespiratory responses to sudden progressive hypoxia in an animal model with and without respiratory failure. 239 23

Percutaneous endoscopic gastrostomy (PEG) is currently a popular method of administering enteral feeding. Most of these patients are elderly, debilitated, and chronically ill. They are on a number of medications and have multiple diseases. With impaired consciousness and swallowing disability, these patients are prone to develop pneumonia. In order to identify possible risk factors, we followed 24 men who underwent PEG for the occurrence of pneumonia or until they died. We then analyzed the medical records of these patients for potential risk factors for pneumonia. The presence of esophagitis during PEG placement endoscopy and history of pneumonia prior to PEG were significant risk factors. Advanced age and cerebrovascular accident (CVA) tended to indicate a higher risk of pneumonia. Taking these risk factors into consideration may be beneficial in the management of such patients.
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PMID:Risk factors for pneumonia after percutaneous endoscopic gastrostomy. 239 46

The well-known coagulation inhibitors antithrombin and protein C, and the more recently described inhibitors, heparin cofactor II and extrinsic pathway inhibitor, were measured in plasma during a 7-day observation period, from patients with pneumonia (n = 13), and in stroke patients with infarction (n = 9) and haemorrhage (n = 9). In patients with pneumonia, elevated fibrinopeptide A levels and subnormal antithrombin and protein C levels suggested some degree of consumption of the inhibitors. Later, an increase was observed for all the inhibitors, but was most conspicuous for heparin cofactor II which reached high normal values. C-reactive protein, initially markedly elevated, decreased rapidly. This finding suggests that heparin cofactor II might act as a delayed acute phase reactant. In stroke patients only small, not statistically significant, changes occurred during the observation period, except for heparin cofactor II which increased in patients with haemorrhagic stroke.
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PMID:Coagulation inhibitor levels in pneumonia and stroke: changes due to consumption and acute phase reaction. 247 68

Mortality and hospitalization rates for pneumonia have increased among older Americans during recent years (1979-86), despite a national commitment to the reduction of premature deaths from pneumonia. A prospective study of deaths and hospitalizations attributable to pneumonia was conducted among 5,474 subjects ages 55 and older who participated in the NHANES I Epidemiologic Followup Study. Prevalent chronic conditions, health behaviors, and nutritional status indicators, measured at baseline, were examined in relation to pneumonia hospitalization and death during 12 years of followup. Mortality and hospitalization rates for pneumonia were higher among men than women, and higher among those ages 65 and older than among those 55-64 of both sexes. Risk of pneumonia death was higher among subjects with a history of congestive heart failure, stroke, cancer, or diabetes. Risk of pneumonia hospitalization was higher among subjects with a history of chronic obstructive pulmonary disease and among men who were current smokers. Daily alcohol consumption did not increase risk of pneumonia in this study population. Four measures of nutritional status were examined taking age, prevalent chronic conditions, and cigarette smoking into account: body mass index, arm muscle area, and serum albumin and hemoglobin levels. Risk of pneumonia death was 2.6 times higher in men in the lowest quartile, compared with men in the highest quartile, of body mass index. Similarly, the risk was 4.5 times higher among men in the lowest quartile of arm muscle area. Risk of death from pneumonia was 3.6 times higher among women in the lowest quartile of serum albumin levels compared with women in the highest quartile. Relative risks for these nutritional status indicators remained elevated after adjusting for age and the medical history risk factors. These risk factors should be taken into account when designing and evaluating pneumonia vaccination trials and community prevention programs.
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PMID:Prospective study of pneumonia hospitalizations and mortality of U.S. older people: the role of chronic conditions, health behaviors, and nutritional status. 250 6

Fifty-six patients with elevated intracranial pressure caused by cerebrovascular accident, head injury, etc., were the subjects of this study. They were divided into three groups: low dose barbiturate therapy (15 patients), high dose barbiturate therapy (24 patients), and control group (17 patients). Barbiturate therapy was instituted using thiamylal, and the complications caused by barbiturate therapy were recorded. In the control group, complications occurred in the liver of two patients, but there were no renal or pulmonary complications. Pulmonary, renal, and hepatic complications were common in the barbiturate groups. Complications in the high dose therapy group were significantly more common than in the control group. Opportunistic infections occurred in ten patients, with seven patients having pneumonia. Only one patient, with pneumonia, was seen in the control group. The deaths of three patients were influenced by complications associated with barbiturate therapy, while the single death in the control group was not associated with the complication of barbiturate therapy.
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PMID:Complications associated with barbiturate therapy. 254 69

A young woman presented with a 4-month history of retinal and vertebrobasilar ischemia. Angiography demonstrated narrowing of major branches of the aortic arch. Intractable, severe retroorbital pain of the right eye developed after a middle cerebral artery stroke. During 4 weeks of aggressive immunosuppressive therapy including IV high dose bolus corticosteroids and pulse cyclophosphamide, her neurologic deficit improved transiently, but her retroorbital pain persisted. She died of staphylococcal sepsis and pneumonia. An autopsy demonstrated thrombotic or fibrous occlusion, with minimal inflammation, of extracranial arteries.
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PMID:Takayasu arteritis presenting as retinal and vertebrobasilar ischemia. 257 Jan 49

During the first 4 years of the CV unit the mortality rate among 464 patients was 5.2 per cent. The records of the 24 fatalities were reviewed. In the 10 patients submitted to autopsy the clinician's opinion of the cause of death was confirmed in 6 cases. In 4 cases autopsy revealed brain abscess, pulmonary embolism, acute myocardial infarction and pneumonia, respectively. Other significant findings not registered clinically were made in 4 cases. Twenty-three patients underwent a cerebral CT scan which showed positive findings in 19 cases. In one patient a brain abscess was misinterpreted as a brain infarction and in 2 other patients with a negative CT scan, autopsy revealed a small pontine and hemispheric infarction, respectively. Apart from the misdiagnosis of the brain abscess the accuracy of the CT scan was acceptable. Extracranial complications as a cause of or contributing to death in stroke patients are common. Prevention, early detection and treatment of these complications are important. The findings underscore the importance of autopsy in the evaluation of stroke patients.
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PMID:Fatalities in a stroke unit. 272 77

Patients with acute pneumonia demonstrate disturbance of myocardial contractility manifesting itself in an increase of end diastolic and systolic volumes, a decrease in the ejection fraction and circular myocardial contractility rate. In a raised level of mean arterial pressure i.v. administration of strophanthin in acute pneumonia can produce a negative effect in the form of a decrease in the stroke volume and cardiac output. Myofedrin promotes an increase in cardiac ejection and can be used for therapy of patients with acute pneumonia to correct hemodynamics.
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PMID:[Correction of hemodynamics in patients with acute pneumonia]. 288 34

The Swedish trial in old patients with hypertension (STOP-Hypertension) is a multicentre, randomized, double-blind study of beta-blockers/diuretics versus placebo in old hypertensives. Primary end-points are stroke and myocardial infarction (fatal and non-fatal) as well as other cardiovascular mortality. To evaluate the logistics of STOP-Hypertension, a pilot study was carried out. All patients aged 70-84 years in 31 centres were consecutively registered in a log-book. Altogether 4668 patients were screened: 41.5% had previously been treated for hypertension and 13.5% had blood pressures greater than or equal to 180/105 mmHg. Thus, 55% were 'hypertensive'. In all, 465 patients (18% of the 'hypertensive' patients) started a 3-month washout period (previously treated, n = 396) or a 4-week run-in period (previously untreated, n = 69) period. The most frequent reasons for not starting the run-in/washout were other indications for treatment with beta-blockers/diuretics (13%), unwillingness to participate (8%) or isolated systolic hypertension (4%). The pilot study was evaluated after 1 year: 89 patients (1.9%) had been randomized, 66 patients (1.4%) were still in the run-in/washout period and the majority of the remaining patients were not randomized because they had not reached the inclusion blood pressure (greater than or equal to 180 mmHg systolic and/or greater than or equal to 105 mmHg diastolic) following withdrawal of their antihypertensive medication. During the run-in/washout period there were few serious clinical events: one case of myocardial infarction, three patients had strokes (two fatal), 10 developed congestive heart failure, three tachyarrhythmia and two pneumonia (one fatal).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:STOP-Hypertension--preliminary communication from the pilot study of the Swedish Trial in Old Patients with Hypertension. 289 71


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