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

296 patients who were operated between 1965 and 1993 with mitral commissurotomy, were included in this retrospective study of rheumatic heart disease in North-West Russia. There were 117 (39.5%) reported cases of acute rheumatic fever, with either polyarthritis (n = 88), carditis (n = 23), or Sydenham's chorea (n = 6). There were no reported cases of erythema marginatum and subcutaneous nodules. The first case of acute rheumatic fever in our patients was in 1924. More than 50% of the patients (164) did not get the diagnosis acute rheumatic fever, and became aware of their rheumatic heart disease only when symptoms of mitral stenosis appeared. 15 patients had a subclinical attack of rheumatic fever, i.e. not all of Jones' criteria were fulfilled. At onset of acute rheumatic fever, the mean age was 15 years, when valvular disease was confirmed 24 years, and 33 years at mitral surgery. Dyspnea (n = 293) was the most common symptom of mitral stenosis, followed by atrial fibrillation (n = 105). 15 patients developed cerebral stroke. The Archangel Health Region has one of the highest prevalences of rheumatic heart disease in Europe (3.7/1,000 in those above 16 years of age, 1993). There is high mortality and the disease develops rapidly.
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PMID:[Rheumatic fever and rheumatic heart disease in Northwest Russia]. 1035 55

Atrial arrhythmias are the most common complication of cardiac surgical procedures today. Because of the additional hospital costs associated with these arrhythmias, owing to increased use of antiarrhythmic medications, diagnostic studies, and prolonged hospitalization, this subject continues to draw the interest of cardiac surgeons, cardiologists, insurance companies, and hospital administrators, among others. Despite many clinical studies, there is still no consensus regarding the best prevention strategy for these arrhythmias. We recently reviewed our experience with these arrhythmias, with the intent of identifying risk factors for the development of these arrhythmias and identifying any associated, potentially adverse, outcomes. We found that the incidence of postoperative atrial arrhythmias has increased to more than 35% in recent years. Risk factors for the development of postoperative atrial arrhythmias include increasing patient age, preoperative use of digoxin, history of rheumatic heart disease, chronic obstructive pulmonary disease, and increasing aortic cross-clamp (ischemic) time. Among patients with postoperative atrial arrhythmias, there was an increased rate of perioperative stroke, increased frequency of ventricular arrhythmias, increased need for the placement of a permanent pacemaker, and prolongation of the intensive care unit and total hospital length of stay.
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PMID:Postoperative atrial arrhythmias: risk factors and associated adverse outcomes. 1053 69

Atrial fibrillation, the most common chronic arrhythmia, results in an increased risk of stroke. Anticoagulation therapy can reduce this risk, but appears to be underused. The objective of this study was to examine the use of warfarin and prevalence of stroke in patients with rheumatic, nonrheumatic valvular and nonvalvular atrial fibrillation. Between January 1993 and December 1998, 457 chronic atrial fibrillation patients with continuous follow-up in our hospital were identified as having rheumatic heart disease (n = 114): nonrheumatic valvular disease (n = 65); or nonvalvular disease (n = 278). Warfarin was used less often in patients with nonrheumatic valvular (16.7%) and nonvalvular diseases (20.1%) than in those with rheumatic heart disease (81.6%, p < 0.001). In contrast, the prevalence of stroke among patients with nonvalvular disease was 40.3% which was similar to the 33.3% found in patients with rheumatic heart disease but significantly higher than the 24.6% found in patients with nonrheumatic valvular disease (p < 0.05). A history of stroke did not alter the trend of use of warfarin among the three groups of patients. Only 20.6% of patients on warfarin received monthly monitoring of prothrombin time. In conclusion, the anticoagulation therapy in our patients with chronic atrial fibrillation, regardless of their associated valvular diseases, is significantly underutilized. This underuse could account for a high prevalence of stroke. This risk of stroke, however, is less in patients with nonrheumatic valvular discase than in those with nonvalvular atrial fibrillation.
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PMID:Underutilization of anticoagulation therapy in chronic atrial fibrillation. 1132 7

The production of transitive limb gestures is optimized when the appropriate tool can be physically manipulated. Little research has addressed the independent contributions of visual and nonvisual sources of sensory information to this phenomenon. In this study, 12 control, 37 LHD, and 50 RHD stroke patients performed transitive limb gestures to pantomime (to verbal command with the object visible) and object manipulation. Performance was more accurate in the object manipulation condition, suggesting that haptic and kinesthetic cues are important for transitive gesture production. Various patterns of performance were observed in the stroke groups, indicating that selective damage to the haptic/kinesthetic processing system is possible and common following unilateral stroke.
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PMID:Transitive gesture production in apraxia: visual and nonvisual sensory contributions. 1152 54

While language facility was once considered to be the sole province of the "dominant" left hemisphere, clinical and experimental findings suggest the right hemisphere plays an equally important role in many language tasks. To elucidate differential hemispheric language processes, Right Hemisphere Language Battery and Western Aphasia Battery data from left (LHD) and right (RHD) hemisphere cerebral vascular accident (CVA) patients and controls were subjected to multivariate discriminant analysis. The highly significant group differences and overall 95% classification rate obtained confirms the utility of the dependent measures in differential diagnosis. Results suggest CVA patients experience disparate language deficits, with the LHD group experiencing concordant-convergent language deficits and the RHD group displaying discordant-divergent deficits that interfere with the receptive and expressive language skills necessary for successful social discourse.
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PMID:Differential effects of left and right cerebral vascular accidents on language competency. 1157 87

Apraxia is the loss of the ability to perform learned, skilled movements correctly, and is frequently attributed to left hemisphere damage (Heilman & Rothi, 1985). Recent work (Dumont, Ska, & Schiavetto, 1999) has shown a dissociation between transitive (tool based; e.g., hammering a nail) and intransitive (expressive/ communicative; e.g., waving goodbye) actions; however, few group studies have specifically addressed apraxia for intransitive gestures. The present investigation examined the frequency and severity of praxis errors related to the production of intransitive gestures in left (LHD) or right hemisphere stroke (RHD) patients in the context of Roy's (1996) model of limb praxis. A total of 119 consecutive stroke patients (LHD = 57, RHD = 62) and 20 healthy age-matched controls performed eight intransitive gestures to pantomime and imitation. Performance was quantified via a multi-dimensional error notation system, providing detail about specific elements of performance (e.g., location), and a composite score reflecting overall gestural accuracy. Analyses of pantomime and imitation performance revealed an equal percentage of apraxic patients in each stroke group, and the severity of apraxia in these groups was also equivalent. Further, analyses of the patterns of apraxia specified by Roy (1996) revealed that patients in each stroke group demonstrated selective impairments in pantomime (LHD = 38%, RHD = 42%), or imitation (LHD = 9%, RHD = 5%) conditions, whereas others demonstrated concurrent impairments (LHD = 30%, RHD = 22%) indicating that stroke to either hemisphere can selectively impair each stage in the production of an intransitive action.
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PMID:Intransitive limb gestures and apraxia following unilateral stroke. 1177 40

The effects of sodium nitroprusside on the systemic and pulmonary circulation were assessed in 17 patients with severe mitral regurgitation (MR) during mitral valve replacement. In nine patients, MR was related to rheumatic heart disease, in six resulted from acute myocardial infarction, and in two was due to subacute bacterial endocarditis. Nitroprusside was administered intraoperatively at an infusion rate of 10 to 65 mcg/min. During vasodilation therapy, forward stroke volume increased from 34 +/- 2.8 to 46 +/- 4.8 ml, while left ventricular filling pressure decreased from 28.7 +/- 1.9 to 20.6 < or = 1.8 mm Hg. There was a significant decrease in systemic vascular resistance (from 2379 +/- 204 to 1646 +/- 161 dynes.sec.cm-5) and mean arterial pressure (from 89.8 +/- 4 to 78.1 +/- 5 mm Hg). Similarly, a significant decrease was observed in both pulmonary vascular resistance (from 414 +/- 45 to 208 +/- 31 dynes.sec.cm-5) and mean pulmonary arterial pressure (from 42.5 +/- 2.5 to 29.7 +/- 2.5 mm Hg) with nitroprusside. In all patients there was a decrease in the magnitude of the peak V wave of the pulmonary capillary wedge pressure (from 45.2 +/- 3.9 to 26.1 +/- 3.1 mm Hg). These findings suggest that judicious intraoperative administration of nitroprusside improves right and left ventricular function in patients with MR undergoing mitral valve replacement, by increasing forward stroke volume while decreasing ventricular filling pressures and vascular resistance (preload and afterload).
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PMID:Systemic and pulmonary effects of nitroprusside during mitral valve replacement in patients with mitral regurgitation. 1474 Jun 71

Kinematic analyses of reaching have suggested that the left hemisphere is dominant for controlling the open loop component of the movement, which is more dependent on motor programmes; and the right hemisphere is dominant for controlling the closed loop component, which is more dependent on sensory feedback. This open and closed loop hypothesis of hemispheric asymmetry would also predict that advance planning should be dependent on the left hemisphere, and on-line response modification, which defines closed loop processes, should be dependent on the right hemisphere. Using kinematic analyses of reaching in patients with left or right hemisphere damage (LHD or RHD), we examined the ability: (i) to plan reaching movements in advance by examining changes in reaction time (RT) when response amplitude and visual feedback were cued prior to the response; and (ii) to modify the response during implementation when target location changed at the RT. Performance was compared between the stroke groups, using the ipsilesional arm, and age-matched control groups using their right (RNC) or left (LNC) arm. Aiming movements to a target that moved once or twice, with the second step occurring at the RT, were performed with or without visual feedback of hand position. There were no deficits in advance planning in either stroke group, as evidenced by comparable group changes in RT with changes in amplitude and visual feedback. Response modification deficits were seen for the LHD group in secondary velocity only. In addition, LHD produced slower initial peak velocity with prolongation of the deceleration phase and faster secondary peak velocities, and the RHD group produced deficits in final error only. These differences are more consistent with the dynamic dominance hypothesis, which links left hemisphere specialization to movement trajectory control and right hemisphere specialization to position control, rather than to global deficits in open and closed loop processing.
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PMID:Hemispheric asymmetries for kinematic and positional aspects of reaching. 1503 98

Some potassium channel openers (KCOs) are potent vasodilators that mainly target the ATP-sensitive potassium channels in vascular smooth muscle cells. Their lack of tissue selectivity limits their clinical use in hypertension therapy. Iptakalim [2,3-dimethyl-n-(1-methylethyl)-2-butylamine], which belongs to a novel chemical type of KCO, possesses unique pharmacological characteristics. In vitro experiments have shown that iptakalim could limit its vasorelaxing actions to resistance vessels. In this study, we investigate the antihypertensive effects of iptakalim on two different experimental hypertensive models: stroke-prone, spontaneously hypertensive rats (SHRsps) and two-kidney with one-clip renal hypertensive dogs (2K1C RHD). In acute hypotensive tests, iptakalim showed stable, long-lasting antihypertensive effects in SHRsps and 2K1C RHDs. Mean-while, it had little effect on heart rate when compared with pinacidil, nifedipine, captopril, or bisoprolol. In experimental therapeutic tests, repeated doses in SHRsps for 30 days or in 2K1C RHDs for 14 days produced consistent antihypertensive effects without causing tolerance. In separate experiments, chronic administration of iptakalim resulted in reversing hypertensive vascular remodeling in spontaneously hypertensive rats and hypertensive cardiac remodeling in SHRsps. These results suggest that iptakalim is a promising antihypertensive drug.
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PMID:A new ATP-sensitive potassium channel opener reduces blood pressure and reverses cardiovascular remodeling in experimental hypertension. 1552 92

To assess long-term survival and anticoagulant-related complications after mechanical valve replacement in adolescents with rheumatic heart disease, 88 patients aged <or= 18 years were prospectively followed up for 10 years (404.2 patient-years). There were 58 (65.9%) boys and 30 (34.1%) girls, with a mean age of 15.4 +/- 2.1 years. Mitral regurgitation was detected in 39 (44.3%) patients, and both mitral and aortic regurgitation in 15 (17%). Ball valves were inserted in 52 (59.1%) patients, bileaflet valves in 31 (35.2%), and single-disc valves in 5 (5.7%). There were 4 (4.5%) hospital deaths and 11 late deaths. Patient survival at 30 days, 3 months, 1, 5, and 10 years was 95.5%, 93.2%, 87.5%, 82.9%, and 82.9%, respectively. Mechanical valve thrombosis occurred in 4 patients; it was fatal in 3 of them. Three patients died from stroke. Severe hemorrhage required hospital admission in 4 (4.5%) patients. Mechanical valve replacement in adolescents, with careful follow-up and anticoagulation, has acceptable long-term results.
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PMID:Prosthetic valve replacement in adolescents with rheumatic heart disease. 1804 71


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