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

An analysis was carried out of the mortality rate on the medical wards of the University College Hospital, Ibadan, over a 14-year period (1960-73). A total of 4,568 cases were reviewed with an annual death rate of between 300 and 400. Most of the deaths resulted from cardiovascular diseases, especially hypertension, the mortality rate from which has shown no appreciable decline over the years. Death from cerebrovascular accident is steadily increasing. Infections contribute considerably to mortality from chest and alimentary tract disease, although there has been a progressive decline in mortality rates from infectious diseases such as tetanus and typhoid fever. The standard of death certification needs to be improved upon, especially with respect to the clarification of the primary and the contributory causes of death and whether post-mortem examination was carrie dout or not. It is suggested that more effort should be made to ensure that post-mortem examination is carried out in cases where there is doubt about the ante-mortem diagnosis unless such a request is specifically refused by the relatives of the deceased after explaining to them the value of such an examination to medical knowledge.
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PMID:Analysis of the causes of death on the medical wards of the University College Hospital, Ibadan over a 14-year period (1960-1973). 84 50

Detailed invasive haemodynamic studies were performed in 27 of 32 patients with severe tetanus. Nineteen had severe uncomplicated tetanus and eight had associated major complications, chiefly infection and pulmonary complications. The results were compared with those obtained from 15 healthy male volunteers who served as controls. There were two deaths in 32 patients (mortality 6.25 per cent). Severe tetanus without major complications was characterized by a high output hyperkinetic circulatory state with tachycardia (heart rate 131 (19.2) beats/minute), increased stroke volume index (43.1 (10.7) ml/m2), increased cardiac index (5.48 (0.94) l/min/m2) and a normal left ventricular stroke work index (60.5 (15.9) g/m/m2). Volume loading demonstrated a significant haemodynamic response and increased vascular capacitance. Even so the maximum percent rise from baseline values of these indices after volume load was significantly higher in controls (p < 0.001). Autonomic cardiovascular disturbances affected both sympathetic and parasympathetic activity. Hypertension and tachycardia alternating with hypotension and bradycardia were related to sudden fluctuations in systemic vascular resistance. Our studies suggested some degree of myocardial dysfunction in patients with severe uncomplicated tetanus. The haemodynamics of severe tetanus were masked and altered by complicating infection, pneumonia, and atelectasis.
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PMID:Haemodynamic studies during the management of severe tetanus. 144 46

The use of magnesium sulphate infusions as an adjunct to the management of patients with very severe tetanus was studied in 10 subjects with persistent autonomic dysfunction despite heavy sedation. Satisfactory cardiovascular control was established in nine of these cases, and there were two deaths in the series, neither directly attributable to the tetanus itself. Haemodynamic measurements performed in six patients, showed that cardiac output was well preserved during magnesium infusions. There was a significant reduction in pulse rate (p less than 0.05) and systemic vascular resistance (p less than 0.01), with an increase in stroke volume (p less than 0.05). It is suggested that magnesium may be a useful adjunct to standard forms of management of such cases.
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PMID:The use of magnesium sulphate infusions in the management of very severe tetanus. 396 3

Over the January 1, 1979 to March 31, 1980 period sterilization-attributable deaths were identified in Dacca and Rajshahi Divisions, Bangladesh. These deaths were identified primarily through government records of compensation to families of deceased sterilization patients. This list was augmented by deaths reported from clinics of the Bangladesh Association for Voluntary Sterilization, detected through a prospective study of sterilization in Bangladesh, and identified by interviews with government family planning officials. A sterilization-associated death was defined as the death of a patient from any cause occurring within 42 days of tubal ligation or vasectomy. Death-to-case rates for vasectomy and tubal ligation were calculated for each month with 95% confidence intervals based on the Poisson distribution. 31 sterilization-associated deaths were identified over the study period. 28 of these were sterilization attributable and 3 were not. The mean age of the 21 women was 30.6 years, and their mean parity was 4.8. The mean age of the 7 vasectomy patients was 37.0 years. Abdominal Pomeroy method of tubal ligation was the only female sterilization technique used. 2 temporal clusters of sterilization attributable deaths occurred during the study. The 1st was a cluster of 5 deaths from tubal ligation performed in June 1979. 3 of these operations took place on June 5, 1979 but in different facilities. 1 factor common to each of these operations was the unseasonably hot weather. The 2nd temporal cluster consisted of 3 deaths after vasectomy in July 1979. 2 men from the same village died from scrotal infections after vasectomy on July 19, 1979 by the same surgeon at a single clinic. A similar death occurred earlier the same month. Another patient of the same surgeon and clinic associated with the deaths after operation on July 19 died from scrotal infection in January 1980. 3 vasectomy deaths related to 1 surgeon in a single remote facility suggests a breach of sterile technique. This could not be confirmed as this clinic physician could not be interviewed. The death-to-case rate for all procedures combined was 21.3 deaths/100,000 procedures, with the rate for vasectomy 1.6 times higher than that for tubal ligation. Anesthesia overdosage was the leading cause of death attributed to tubal ligation with tetanus (24%), intraperitoneal hemorrhage (14%), and infection other than tetanus (5%) as other leading causes. 2 patients (10%) died from pulmonary embolism after tubal ligation; 1 (5%) died from each of the following: anaphylaxis from anti-tetanus serum, heat stroke, small bowel obstruction, and aspiration of vomitus. All 7 men died from scrotal infections after vasectomy. Improvement in anesthesia management and sterile technique can lower the death-to-case rate for contraceptive sterilization in 2 Divisions of Bangladesh.
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PMID:Sterilization-attributable deaths in bangladesh. 612 37

We report a case of tetanus associated with the syndrome of sympathetic overactivity. BP changes were associated with changes in systemic vascular resistance index (SVRI). Cardiac index (CI) varied independently from changes in SVRI and was correlated with the stroke volume. Oxygen consumption during the hypotensive periods was normal. Among several pharmacologic agents, only curare was effective in decreasing the severity and number of the hypertensive episodes. Physical stimulation of the patient rapidly reversed the hypotension. The potential mechanisms involved in producing these cardiovascular abnormalities are discussed.
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PMID:Cardiovascular findings in a patient with severe tetanus. 613 21

Increased levels of CuZn superoxide dismutase (SOD-1) are cytoprotective in experimental models of neurological disorders associated with free radical toxicity (e.g. stroke, trauma). Targeted delivery of SOD-1 to central nervous system neurons may therefore be therapeutic in such diseases. The nontoxic C-fragment of tetanus toxin (TTC) possesses the nerve cell binding/transport properties of tetanus holotoxin and has been used as a vector to enhance the neuronal uptake of proteins including enzymes. We have now produced a recombinant, hybrid protein in Escherichia coli tandemly joining human SOD-1 to TTC. The expressed hybrid protein (SOD:Tet450) has a subunit molecular mass of 68 kDa and is recognized by both anti-SOD-1 and anti-TTC antibodies. Calculated per mol, SOD:Tet450 has approximately 60% of the expected SOD-1 enzymatic activity. Analysis of the hybrid protein's interaction with the neuron-like cell line, N18-RE-105, and cultured hippocampal neurons by enzyme immunoassay for human SOD-1 revealed that SOD:Tet451 association with cells was neuron-specific and dose-dependent. The hybrid protein was also internalized, but there was substantial loss of internalized hybrid protein over the first 24 h. Hybrid protein associated with cells remained enzymatically active. These results suggest that human SOD-1 and TTC retain their respective functional properties when expressed together as a single peptide. SOD:Tet451 may prove to be a useful agent for the targeted delivery of SOD-1 to neurons.
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PMID:CuZn superoxide dismutase (SOD-1):tetanus toxin fragment C hybrid protein for targeted delivery of SOD-1 to neuronal cells. 779 32

Length steps (complete in 0.2 ms; amplitude < 2% of the fibre length) were applied during the tetanus plateau of intact frog muscle fibres (1.7-3.2 degrees C). The effects of varied tonicity on the early changes in tension in response to the length steps were studied. The solutions were made hypotonic by reduction of the NaCl concentration from 115.5 mM to 92.4 mM and hypertonic by addition of 98 mmol sucrose per litre of the normal Ringer fluid. In all solutions tested, the length step first caused tension to change simultaneously with the step reaching an extreme value T1. After completion of the length change, tension recovered quickly to an intermediate level T2 and, after a period with slowing or reversal of the recovery, it returned slowly to the steady-state value. The maximum isometric tension was significantly reduced by increases in tonicity. In contrast, there were only small effects of varied tonicity on the peak tension-change in response to a length step (the stiffness) and on the amplitude of the fast force recovery (T2-T1) after releases. The slope of the T2-curve (a plotting of T2 versus amplitude of the length step) was reduced for releases and increased for stretches when tonicity was raised. Furthermore, the T2-curve intersected the length axis for smaller releases at high tonicity levels. The reduced isometric tension to stiffness ratio at raised tonicity could be interpreted as a reduced average force per crossbridge. Simulations using the crossbridge model of Huxley and Simmons (1971) showed that the lack of change of the recovery amplitude (T2-T1) after releases and the changes in the T2-slope are in accordance with this interpretation. The shift of the T2 length intercept is consistent with the idea that the distance traversed by the crossbridges during the power-stroke is reduced by raised tonicity.
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PMID:Tension transients in skeletal muscle fibres of the frog at varied tonicity of the extracellular medium. 847 24

When Lombardi and colleagues reported the phenomenon of rapid regeneration of the power stroke after a quick release of muscle fibre during a tetanus, they gave an explanation in terms of detachment of cross-bridges and re-attachment further along the thin filament. We show here that the phenomenon can also be explained on assumptions that lead to a majority of myosin molecules being attached by only one head during steady isometric contraction; the other head may then become attached after a quick release and can add its contribution to the early tension recovery after a second release.
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PMID:Rapid regeneration of power stroke in contracting muscle by attachment of second myosin head. 914 87

The nontoxic C fragment of tetanus toxin (TC) can transport other proteins from the circulation to central nervous system (CNS) motor neurons. Increased levels of CuZn superoxide dismutase (SOD) are protective in experimental models of stroke and Parkinson's disease, whereas mutations in SOD can cause motor neuron disease. We have linked TC to SOD and purified the active recombinant proteins in both the TC-SOD and SOD-TC orientations. Light microscopic immunohistochemistry and quantitative enzyme-linked immunosorbant assays (ELISA) of mouse brainstem, after intramuscular injection, demonstrate that the fusion proteins undergo retrograde axonal transport and transsynaptic transfer as efficiently as TC alone.
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PMID:Delivery of recombinant tetanus-superoxide dismutase proteins to central nervous system neurons by retrograde axonal transport. 921 90

Although multiple sclerosis (MS) patients and healthy individuals have similar frequencies of myelin basic protein (MBP)-specific T cells, the activation state of these cells has not been well characterized. Therefore, we investigated the dependence of MBP-reactive T cells on CD28-mediated costimulation in MS patients, healthy controls, and stroke patients. MBP-reactive T cells from healthy controls and stroke patients failed to proliferate efficiently when costimulation was blocked using anti-CD28, consistent with a naive T cell response. In contrast, MBP-specific T cell proliferation was not inhibited, or was only partially inhibited when CD28-mediated costimulation was blocked in MS patients. Blockade of CD28 failed to inhibit tetanus toxoid-specific T cell proliferation in both the controls and MS patients, demonstrating that memory cells are not dependent on CD28-mediated costimulation. Limiting dilution analysis indicated that the frequency of MBP-reactive T cells was significantly decreased in healthy controls compared with MS patients when CD28-mediated costimulation was blocked. These data suggest that MBP-reactive T cells are more likely to have been activated in vivo and/or differentiated into memory T cells in MS patients compared with controls, indicating that these cells may be participating in the pathogenesis of MS.
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PMID:Decreased dependence of myelin basic protein-reactive T cells on CD28-mediated costimulation in multiple sclerosis patients. A marker of activated/memory T cells. 946 65


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