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

During the past five years 75 patients aged 90 years or more had 85 major surgical procedures at the Metropolitan Nashville General and Vanderbilt University hospitals. The most common operation was exploratory laparotomy. The second was lower extremity amputation for peripheral vascular disease and/or gangrene. Fifty-seven percent had general endotracheal anesthesia. Associated medical problems were common, and included congestive heart failure (24%), hypertension (21%), diabetes mellitus (13%), chronic arrhythmias (9%), history of myocardial infarction (8%), and history of cerebrovascular accident (5%). Eleven patients (13.4%), six of whom had general anesthesia, died after operation. Of these, two had postoperative pneumonia, two did not recover from bowel perforation and peritonitis, one had a postoperative myocardial infarction, another had a cerebrovascular accident, and one had sepsis. One patient's sudden death was likely due to myocardial infarction or pulmonary embolus. The other three deaths occurred in patients with extensive carcinomas (gallbladder carcinoma in one and widely metastatic carcinoma of unknown origin in two). These three patients died of the disease for which they were operated upon when the operation failed to alter its course. When surgical procedures are necessary to prolong and/or improve the quality of life in elderly patients, these procedures may be done in most cases with acceptable results.
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PMID:Surgical procedures in patients aged 90 years and older. 649 54

Hyperbaric oxygenation (HBO) was included in the therapeutic complex for 124 patients in the acute stage of ischemic stroke. The effect of HBO on the clinical course was appraised by comparing the dynamics of changes in the clinical symptoms and the frequency of complications in patients exposed to HBO with those in the control group (patients not exposed to HBO). It was established that the depth of unconsciousness and the motor and aphasic disorders decreased during a HBO session, but the effect was usually short-lived. Aggravation of the patients' condition in the first week of the disease, evidently caused by increase of cerebral edema, occurred much less frequently when HBO was included in the complex of therapeutic measures. The number of patients with regression of the neurological symptoms was practically the same with and without the use of HBO, but the regression of the neurological defects was most evident in patients exposed to HBO. HBO prevents the development of recurrent cerebral circulatory disorders in the acute stage of ischemic stroke and reduces the incidence of some complications in this period (pneumonia, pulmonary edema, thromboembolism of the pulmonary artery, etc.).
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PMID:[Effect of hyperbaric oxygenation on the clinical course and complications of the acute period of ischemic strokes]. 661 31

Twenty-seven calves were operated on in our institute for total artificial heart replacement. Thomasu hearts (made by the Thomasu Technical Company, Japan) were used in 21 calves from February 1980 to May 1983. Utah Jarvik 7 hearts were used for the first five calves and the 17th calf. The air-driven Thomasu heart, made of segmented polyurethane, has 95 ml and 85 ml of stroke volume in its left and right sides respectively and showed recognizable function curves in mock circulation systems. There were no satisfactory results in the first 19 cases but the 20th calf survived for 28 days. In 1982, we adopted a new surgical method in which, instead of suturing, a sutureless artificial graft with a stainless steel ring was inserted into the aorta and pulmonary truncus. Since then two out of six calves have survived for more than one month; one of these survived for 66 days. The causes of death after the Thomasu heart replacements were varied. Ten (48%) out of 21 cases had heart trouble and four calves (19%) died through thrombus formation at the inflow and outflow valves. Three calves (14%) died because of mechanical failure of the driving system, two (10%) due to surgical failure, one because of pneumonia, and one due to an abnormal reaction after donor blood transfusion. Our longest surviving calf died after 66 days, because of a broken left blood diaphram though, it remained in excellent condition until its death. There was no thrombus formation in either ventricle, no fibrin net formation and no calcium deposit on the surface of the diaphragm.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Experimental studies in total artificial heart replacement. 670

Analysis of early deaths after stroke is important, since some deaths may be preventable. Previous studies have relied on retrospective and often incomplete clinical data, for comparison with pathological findings. The present study is based on 1073 consecutive stroke patients admitted to an intensive care stroke unit from a well-defined population. There were 212 deaths within the first 30 days, yielding a mortality rate of 20%. Clinical, radiological, and laboratory data were collected prospectively according to a standardized protocol. Autopsies were performed on 90 of the 212 patients, and CT scanning on a further 27. Early mortality after stroke exhibits a bimodal distribution. One peak occurs during the first week, and a second during the second and third weeks. The majority of deaths in the first week are due to transtentorial herniation. Of these, deaths due to hemorrhage usually occur within the first three days, whilst deaths due to infarction peak between the third and sixth day post ictus. After the first week, deaths due to relative immobility (pneumonia, pulmonary embolism and sepsis) predominate, peaking towards the end of the second week. Cardiac deaths occur throughout the first month, and unfortunately account for many deaths in patients with small functional deficits.
Stroke
PMID:Early mortality following stroke: a prospective review. 672 78

Twenty-four-hour ambulatory electrocardiography was performed in 25 young and 29 active elderly subjects. Sinus bradycardia and sinus arrhythmia were common in the young but uncommon in the elderly. Ventricular and supraventricular premature beats and brief runs of supraventricular tachycardia were common in the elderly but uncommon in the young. Complex ventricular arrhythmias only occurred in the elderly but brief episodes of nocturnal Wenckebach AV block were quite common in young and old alike. No significant difference in arrhythmia frequency was found between elderly subjects with heart disease and those without heart disease or between elderly subjects without symptoms and those with non-episodic symptoms such as dizziness. None of the arrhythmias in the young or elderly subjects was associated with symptoms. In follow-up at 30 months, only one elderly subject was deceased (from pneumonia) and none had suffered a stroke or heart attack. It is concluded that transient cardiac arrhythmias are commoner in the elderly than in the young. However, their long-term significance remains unknown, but it is likely that they are relatively benign.
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PMID:The significance of cardiac arrhythmias in the aged. 684 89

A mortality study of workers employed for at least one year between 1 January 1950 and 31 December 1975 at oil distribution centres from three oil companies in Britain has been carried out. Ninety nine per cent of the population were successfully traced to determine their vital status at 31 December 1975. The mortality observed in the study population was compared with that which would be expected from the mortality rates for all the male population of England and Wales. The overall mortality observed was considerably lower than expected on this basis as was the mortality from stroke, hypertensive disease, bronchitis, and pneumonia. The observed number of deaths from all neoplasms was also much less than expected as were the observed deaths from lung cancer. The observed deaths from ischaemic heart disease approximately equalled those expected overall and in each of the companies, however, and there was no evidence of a "healthy worker effect" for this disease group. The ratio of observed over expected deaths from ischaemic heart disease tended to decrease with increasing age at death, and for most of the job groups overall, the observed and expected deaths were about the same. Raised mortality patterns from ischaemic heart disease were found in several subgroups of the population of one company. Mortality from myelofibrosis and diseases of the lymphatic and haematopoietic tissue was slightly raised overall. Only myelofibrosis showed an overall excess but raised mortality was found in subgroups of the population defined by company, job, and length of service in several of the other neoplasms making up this disease group. The numbers of deaths from these causes were all small, making it difficult to exclude chance effects. Further work would be required to ascertain whether these results are due to an occupational factor and if so to identify the physical or chemical nature of the risk.
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PMID:Epidemiological survey of oil distribution centres in Britain. 687 Nov 23

In 103 patients with strokes without associated infections the prophylactic usefulness of antibiotics was assessed clinically. In 30 patients (group I) and 27 patients (group II) ampicillin was used in daily doses of 2-4 g or penicillin (Polfa) was given 2.4-4.8 million i.u. during 10 days. In the remaining 46 cases (group III) no antibiotics were given and these patients served as controls. During the first 10 days after stroke onset infectious complications developed significantly less frequently in controls (in 15 cases, i.e. 33%) than in those receiving antibiotic phophylaxis (40 cases i.e. 70%). The difference between the groups was statistically significant (p less than 0.001). In the second ten-day period no clinical evidence of new infection was observed in any group. It may be supposed in the light of these diseases that administration of penicillin G or ampicillin to patients with strokes without carrying out antibiotic sensitivity tests is unnecessary. Nearly exclusively pneumonia and urinary tract infection appear in the first ten days after stroke onset which may suggest acute and gradually levelling-off of the neuroregulation of immunological defense mechanisms.
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PMID:[Prophylactic use of penicillin G and ampicillin in stroke. I. Clinical observations]. 714 13

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

Twelve patients with severe chronic congestive heart failure (CHF) (NYHA class III and IV) resistant to digitalis and diuretics were treated with the postsynaptic alpha-blocking agent prazosin (PZ) (3 to 20 mg/day). In 11 patients oral PZ treatment was well tolerated; the agent was discontinued in the remaining patient because of orthostatic dizziness. After 4 weeks of PZ, total systemic vascular resistance decreased from 2245 +/- 792 to 1603 +/- 355 dyn sec cm-5, mean blood pressure declined from 100 +/- 15 to 90 +/- 14 mm Hg, and pulmonary capillary wedge pressure decreased from 29 +/- 8 to 25 +/- 9 mm Hg. Cardiac index increased from 1.92 +/- 0.63 to 2.30 +/- 0.41 l/min/m2. The increase of stroke volume index correlated with the fall in peripheral vascular resistance (r = --0.79, p less than 0.01) and the decline in pulmonary capillary wedge pressure (r = --0.75, p less than 0.05). In parallel, exercise tolerance increased significantly. Four patients improved from functional class IV to II, four from class IV to III, and one from class III to II, while two patients were unchanged. In the eight patients followed for 6 months, the beneficial effects of ambulatory PZ were maintained throughout the expansive observation period. Three patients died as their disease process progressed during the study (sudden death, pneumonia, and post-PZ withdrawal pump failure). Prazosin is a valuable vasodilator for long-term treatment of otherwise refractory congestive heart failure with the agent given in sufficient individualized dosage.
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PMID:Sustained effectiveness of chronic prazosin therapy in severe chronic congestive heart failure. 722 92

A mortality study of workers employed for at least one year between 1 January 1950 and 31 December 1975 at eight oil refineries in Britain has been carried out. Over 99% of the population were successfully traced to determine their vital status at 31 December 1975. The mortality observed in the study population was compared with that which would be expected from the mortality rates for the all male population of England and Wales, and Scotland, with adjustment for regional variation in mortality for the English and Welsh refineries. The overall mortality observed was considerably lower than that expected on this basis, as was the mortality from heart disease, stroke, bronchitis, and pneumonia. The observed number of deaths from all neoplasms was also very much less than expected, a result almost entirely due to a large deficit of observed deaths from lung cancer. Raised mortality patterns were found in several refineries for cancers of the oesophagus, stomach, intestines, and rectum, although no location was consistently high for all these causes of death. Different year-of-entry cohorts and job groups were also affected. In general, mortality from these causes increased as length of service and interval from starting work increased. There were also significantly more observed deaths than expected from cancer of the nasal cavities and sinus, and melanoma. Further work is required to ascertain whether these are due to an occupational factor and, if so, to identify the physical or chemical nature of the risk.
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PMID:An epidemiological survey of eight oil refineries in Britain. 727 34


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