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

To explore possible risk factors for progressive supranuclear palsy (PSP), we conducted a case-control study of 50 cases in New Jersey. Two neurologists confirmed the diagnosis in the 41 living patients. Two hospital controls were matched by age, sex, race, date of death, and relationship of next-to-kin to each case. A structured interview was administered in person to the next-of-kin of cases and controls. Genetic, viral, toxic, medical, surgical, and personality factors were investigated. Cases lived in areas with low population as adults significantly more frequently than controls. The study identified no other factors associated with PSP including a history of stroke, hypertension, or smoking.
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PMID:Risk factors for progressive supranuclear palsy. 221 68

In 58 patients with progressive supranuclear palsy (PSP), 19 (32.8%) had CT, MRI, or autopsy evidence of a multi-infarct (MI) state. The clinical findings in the infarct syndrome were similar to idiopathic PSP. Five MI-PSP patients had had a stroke, four had focal dystonia, two had hemiparesis, and one had an intention tremor of recent onset. In contrast, only 5.9% (12.9% of those with CT or MRI) of 426 Parkinson's disease patients had evidence of strokes. One case of PSP studied pathologically was attributed to cerebral amyloid angiopathy.
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PMID:Progressive supranuclear palsy and a multi-infarct state. 356 71

Forty-four consecutive patients with acute myocardial infarction were studied with equilibrium radionuclide angiography (RNA) within 24 hours from the onset of symptoms, three days after admission and three days before hospital discharge (14 +/- 3 days). To assess the prognostic value of RNA derived parameters we assessed: the ejection fraction (EF), the left ventricular end-systolic volume index (ESVI), the left ventricular end-diastolic volume index (EDVI), the cardiac index (CI), the stroke volume index (SVI) and the peak systolic pressure/end-systolic volume index ratio (PSP/ESVI); we also determined Peel's prognostic index (PI) on admission and measured systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and cardiac frequency (CF) as the same time as the radioisotopic parameters were taken. Thirty-nine patients were discharged without signs of ventricular failure with and without medical treatment (group A), 5 died during hospitalization (group B). Using EF alone, we obtained a very clear distinction between the two groups (Group A 43 +/- 12%; Group B 22 +/- 3%; p less than 0.005). Stepwise, multivariate analysis showed that, by linking PSP/ESVI to EF, we can even obtain a function that correlate better with hospital survival (F = 0.09832 X EF - 0.32035 X PSP/ESVI - 3.12981; p less than 0.002). There was good exponential correlation between EF and PSP/ESVI (r = 0.781) and this would seem to confirm that PSP/ESVI is a more sensitive contractility index for patients with a not very depressed EF.
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PMID:[Prognostic setting and bloodless hemodynamic evaluation of acute myocardial infarct with equilibrium radioisotopic ventriculography]. 373 24

In order to determine the relationship of the peak systolic pressure/end-systolic volume (PSP/ESV) ratio to standard ejection phase indices [ejection fraction (EF), mean normalized systolic ejection rate (MNSER), mean velocity of circumferential fiber shortening (Vcf)], and ventricular function curves (VFC), hemodynamic and angiographic studies were carried out in 38 subjects: 11 normal controls (Group I) and 27 with coronary artery disease (CAD). The CAD patients were subdivided into those without (Group II) and those with (Group III) regional asynergy. EF, MNSER and Vcf were calculated from the ventriculogram using standard formulae. The slope of the left ventricular function curve was constructed by determining left ventricular stroke work index and left ventricular end-diastolic pressure before and after ventriculography, and dividing the change in the left ventricular stroke work index by the change in the left ventricular end-diastolic pressure. Peak systolic left ventricular pressure was determined before left ventriculography; minimal systolic volume was measured from the left ventriculogram. PSP/ESV ratio in the control group (Group I) was 6.4 +/- 2.8. This differed significantly from the ratio in patients (Group II) with CAD but without asynergy (4.7 +/- 2.2 p less than 0.025) and from that in patients (Group III) with CAD and asynergy (2.4 +/- 1.4, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Relationship of peak systolic pressure/end systolic volume ratio to standard ejection phase indices and ventricular function curves in coronary disease. 649 62

In order to identify the hemodynamics of borderline essential hypertension, radionuclide angiography was performed before and after bolus injection of furosemide (40 mg i.v.) both at 3 min (i.e. before diuretic effect) and at 30 min (i.e. after diuretic effect) in 16 borderline (B) patients and in 14 age-matched WHO classification I-II essential hypertensives (H) patients. 14 age-matched normotensive (N) subjects were used as controls. B patients were further subdivided into two subgroups according to a cardiac index under or above 3 liter/min/m2 in basal conditions. Baseline hemodynamic characteristics showed higher values of mean arterial pressure (MAP) and systemic vascular resistance index (SVRI) in both H and B patients when compared with N subjects (p less than 0.001). Furthermore, B and H patients exhibited lower values of left ventricular peak filling rate (PFR) than seen in N subjects (p less than 0.01 and p less than 0.05, respectively). H patients demonstrated higher peak systolic blood pressure/endsystolic volume ratio (PSP/ESV) than seen in N subjects (p less than 0.05). PFR positively correlated with peak emptying rate (PER) only in N and B patients (p less than 0.05). After furosemide administration, even though differences were observed in the absolute values, B and H patients showed similar hemodynamic patterns. Only the B subgroup with cardiac index (CI) greater than 3 liter ('volume-dependent' patients) showed a decrease in left ventricular end-diastolic volume index (LVEDVI) at 30 min associated with a lowering of stroke index (SI; p less than 0.005 for both), when compared with pre-drug values. In B patients with CI less than 3 liter ('afterload-dependent' patients) no differences were observed either at 3 min or at 30 min in comparison with values obtained prior to drug administration. Moreover, in this subgroup, like in H patients, there was a negative correlation (p less than 0.01) between 3-min percent change of SVRI and 3-min percent change of SI. Our data suggest that in 'borderline' hypertension: (a) there may be an increase in peripheral resistance, as in established hypertension, especially when age-matched groups are considered; (b) the earliest sign of compromised left ventricular function is the reduction in diastolic PFR but, unlike established hypertension, this index is still correlated with systolic function; (c) cardiac output might be even somewhat reduced and also negatively correlated with vascular resistance ('afterload-dependent' hearts); (d) furosemide (acute administration) might contribute to a better definition of hemodynamic behavior.
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PMID:Hemodynamics in borderline hypertension: acute effect of furosemide. 652 11

We investigated left ventricular (LV) function in 40 patients (pts) with hypertension (HT), 16 pts with hypertrophic cardiomyopathy (HCM), 3 pts with ASH and HT and in 27 control subjects by M-mode echocardiography using supine exercise (50 watts, 3 minutes). The hypertensive subjects were echocardiographically divided into three subsets; the normal LV (17 cases), the hypertrophied LV (17 cases) and the dilated LV (6 cases). Similarly, pts with HCM were echocardiographically and cineangiographically divided into three subsets; ASH (asymmetric septal hypertrophy, 6 cases), APH (predominant apical hypertrophy, 6 cases) and DFH (diffuse left ventricular hypertrophy, 4 cases). Changes of left ventricular dimension Controls and HT: Stroke volume was increased during exercise in the controls, normal LV and hypertrophied LV groups by decreasing LV end-systolic dimension ( LVDs ), but it was increased in dilated LV group by increasing LV end-diastolic dimension ( LVDd ) (Frank-Starling mechanism). LVDd was increased transiently in the controls and normal LV group during recovery, but its grade and duration were more pronounced in the latter. LVDd did not change significantly in hypertrophied and the dilated LV groups. HCM: LVDd and LVDs did not change significantly during exercise in all 3 groups. LVDd was increased transiently during recovery in ASH group, but not in the other groups. Changes of peak velocity of circumferential fiber shortening (VCF) and the ratio of peak systolic blood pressure to LV end-systolic volume (PSP/ LVVs ). Controls and HT: Peak VCF was increased during exercise most markedly in the normal LV group, but it was not increased in the dilated LV group. PSP/ LVVs was increased significantly during exercise in the controls, the normal and hypertrophied LV groups, but not in the dilated LV group. HCM: Peak VCF showed a significant increase during exercise in ASH group, but not in the other two groups. Changes of the D/S ratio. The ratio of systolic to diastolic velocity of the LV posterior wall was expressed as a D/S. This ratio did not change significantly in the controls, HT and APH groups, but it was decreased significantly in ASH and DFH groups. LV end-systolic wall stress and LVDs relationship ( ESWst - LVDs ).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Exercise echocardiography in different types of hypertension classified by left ventricular geometry; comparison with hypertrophic cardiomyopathy]. 668 25

The relation of left ventricular regional wall motion to global ventricular function was evaluated by radionuclide ventriculography in 127 patients within 18 hours of acute myocardial infarction. No patient had evidence of previous myocardial infarction. The following parameters were measured: (1) wall motion index; (2) percent of abnormally contracting segment; (3) ejection fraction (EF); (4) end-diastolic volume (EDV) and end-systolic volume (ESV); and (5) peak systolic cuff pressure/end-systolic volume ratio (PSP/ESV). The measurements of global function correlated well with wall motion index (r = 0.83, p less than 0.001 for EF; r = -0.69, p less than 0.001 for ESV; and r = 0.061, p less than 0.001 for PSP/ESV), but EDV correlated less well (r = -0.35, p less than 0.001). Multiple linear regression analysis revealed that EF correlated best with wall motion index, and no other parameters of global left ventricular function added significantly to the regression. The correlation of motion in each segment with EF was determined by multiple linear regression analysis. Ejection fraction correlated best with motion in the anterobasal, then in order of correlation, in the apical-septal, inferoapical, anterolateral, and superlateral walls. The relation of EDV, ESV, and degree of percent abnormally contracting segments was as follows: EDV did not increase with a mild regional wall motion abnormality; however, ESV did increase and reduced stroke volume. As percent abnormally contracting segments worsened, enlargement of both EDV and ESV was seen and was associated with further reduction in systolic volume. These data suggest that EF is the best global left ventricular function correlate of the severity of the regional wall motion abnormality, and that abnormal motion in the territory of the left anterior descending coronary best predicts reduction in global left ventricular function. Radionuclide ventriculography is useful in characterizing global and regional left ventricular function in the early hours of acute myocardial infarction.
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PMID:Relation of segmental wall motion to global left ventricular function in acute myocardial infarction. 684 55

The echocardiographic tracings of 40 subjects with pure or prevalent mitral stenosis are obtained. The modification of the isovolumetric relaxation time of the right (Pc-To) and the left (Ac-Mo) ventricle, measured from echocardiographic tracings, versus the values of systolic (PSP cat.) and wedge (PVCP cat.) pulmonary pressure are studied in 15 sinusal rhythm patients who underwent cardiac catheterization. The variations of Pc-To versus Ac-Mo and of Pc-To/Ac-Mo ratio versus the most important indices of mitral stenosis and right ventricular performance evaluation are studied in all the patients. Good correlation has been found between Pc-To and Ac-Mo ratio and PSP, PVCP, E-F, Wells index, Yigitbasi index, RICT/RVET, RPEP/RVET, mitral surface; poor correlation has been found between Pc-To/Ac-Mo ratio and left atrial dimension and stroke volume, while no-significant correlation has been found between this ratio and the ejection fraction, V cf, delta S%. For values of Pc-To/Ac-Mo ratio less than 1.20, 1.20 greater than and less than 1,50, greater than 1.50 the stenosis has been considered, respectively, mild, moderate and severe. The Pc-To/Ac-Mo ratio, obtained from echocardiographic tracings, is considered a useful index in the evaluation of the severity of the stenosis and of the pulmonary pressure variations in the presence of mitral stenosis.
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PMID:[Echocardiographic evaluation of mitral stenosis: significance of Pc-To/Ac-Mo ratio (author's transl)]. 737 34

Gelatinase A is an enzyme capable of cleaving soluble beta-amyloid protein (beta AP), and may function as an alpha-secretase to produce secretory forms of amyloid precursor protein. We examined gelatinase A immunoreactivity in the brains and posterior roots of neurologically normal, lacunar stroke, Alzheimer disease (AD), amyotrophic lateral sclerosis, progressive supranuclear palsy and myasthenia gravis cases. The gelatinase A antibody stained only microglial cells in the white matter in all the brain tissues. In AD brain, the reactive microglia located in the center of classical senile plaques, as well as in other microglial cells in the gray matter, showed no immunoreactivity. Gelatinase A in white matter microglial cells may play a role in preventing local deposition of beta AP. In the posterior root, Schwann cells had positive immunoreactivity. As with other metalloproteases, gelatinase A in Schwann cells may play an antiproliferative role.
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PMID:Selective localization of gelatinase A, an enzyme degrading beta-amyloid protein, in white matter microglia and in Schwann cells. 753 20

To improve the specificity and sensitivity of the clinical diagnosis of progressive supranuclear palsy (PSP, Steele-Richardson-Olszewski syndrome), the National Institute of Neurological Disorders and Stroke (NINDS) and the Society for PSP, Inc. (SPSP) sponsored an international workshop to develop an accurate and universally accepted set of criteria for this disorder. The NINDS-SPSP criteria, which were formulated from an extensive review of the literature, comparison with other previously published sets of criteria, and the consensus of experts, were validated on a clinical data set from autopsy-confirmed cases of PSP. The criteria specify three degrees of diagnostic certainty: possible PSP, probable PSP, and definite PSP. Possible PSP requires the presence of a gradually progressive disorder with onset at age 40 or later, either vertical supranuclear gaze palsy or both slowing of vertical saccades and prominent postural instability with falls in the first year of onset, as well as no evidence of other diseases that could explain these features. Probable PSP requires vertical supranuclear gaze palsy, prominent postural instability, and falls in the first year of onset, as well as the other features of possible PSP. Definite PSP requires a history of probable or possible PSP and histopathologic evidence of typical PSP. Criteria that support the diagnosis of PSP, and that exclude diseases often confused with PSP, are presented. The criteria for probable PSP are highly specific, making them suitable for therapeutic, analytic epidemiologic, and biologic studies, but not very sensitive. The criteria for possible PSP are substantially sensitive, making them suitable for descriptive epidemiologic studies, but less specific. An appendix provides guidelines for diagnosing and monitoring clinical disability in PSP.
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PMID:Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): report of the NINDS-SPSP international workshop. 871 59


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