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

Anti-phospholipid syndrome, originally called anticardiolipin syndrome, is characterized by the presence of anti-phospholipid antibodies and a marked tendency to both arterial and venous thrombosis. The little information available on the implications of this syndrome for anesthesia derive from the recent description of the disease. We describe 2 patients, each with 1 of the 2 forms of antiphospholipid syndrome that have been described to date, and each needing surgery for a different reason. The first was a 24-year-old woman who was admitted to the hospital with diarrhea, fever and metrorrhagia in her fifth month of pregnancy. Blood tests revealed a weakly positive title of anti-cardiolipin antibodies. Steroid and antiplatelet therapy was begun. Delivery was at 35 weeks by elective cesarean with epidural anesthesia due to oligoamnios. The second patient was 52-year-old woman with a history of 13 miscarriages, cerebrovascular accident and deep venous thrombosis. She had been diagnosed as having systemic lupus erythematosus with anti-phospholipid syndrome and was receiving corticoid and antiplatelet therapy. She had been admitted on 2 occasions for epistaxis, purpura in the lower extremities and severe thrombocytopenia. The last condition did not respond well to immunosuppressant therapy and a splenectomy was therefore performed with the patient under general anesthesia. In both cases recovery was good in spite of the serious complications of anesthetic management.
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PMID:[Anesthetic implications in antiphospholipid syndrome. 2 clinical cases]. 779 18

Type II of heparin-associated thrombocytopenia (HAT) is well known, but the cardinal symptom, thrombocytopenia, is rarely adequately considered. Serious and potential lethal complications such as pulmonary embolism, cerebral stroke, or limb gangrene are often falsely regarded as insufficient anticoagulation. Guided diagnosis and therapy are of vital importance for the patient's outcome. Based on the experience of patients with HAT Type II treated in the intensive care unit, a diagnostic and therapeutic approach to the cardinal symptom thrombocytopenia is presented. A recently developed heparin-induced platelet activation assay (HIPAA) seems to be a highly sensitive laboratory test. The first therapeutic principle in case of presumed and diagnosed HAT is the cessation of unfractioned or low-molecular-weight heparins. ORG 10172 (Orgaran), a low-sulfated heparinoid with a low cross-reactivity (10%) to heparins, can be regarded as the most effective anticoagulant in patients with HAT Type II.
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PMID:Heparin-associated thrombocytopenia (HAT)--still a diagnostic and therapeutical problem in clinical practice. 781 55

Physical electro- and echocardiographic methods were used to study myocardial function in 70 patients with acute leukemia (AL). 40% of them in the primary active phase had hypokinetic, while 60% hyperkinetic circulation. Leucocytosis and thrombocytopenia proved prognostically unfavorable for myocardium condition. Cardiotoxic rubomycin doses have been established. Pathogenic mechanisms underlying deterioration of myocardial contractility, reduction of stroke volume and rearrangement of central hemodynamics are considered. Administration of riboxin with finoptine promoted normalization of clinical and improvement of echo-CG sings of myocardiopathy in patients given total rubomycin doses 200-450 mg/m2.
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PMID:[Changes in myocardial function in patients with acute leukemias under the influence of rubomycin]. 790 29

A periodic fall of platelet number characterizes an acquired pathological condition named cyclic thrombocytopenia. We observed a patient in whom the episodes of thrombocytopenia (platelet number less than 50 x 10(9)/l) were followed regularly by thrombocytosis (700-2300 x 10(9) platelets/l). The period of platelet count fluctuation was about 40 d. Morphological examination of bone marrow showed the cyclic disappearance of mature and immature megakaryocytes; bone marrow cultures revealed a periodic severe defect of both multilineage and single-lineage progenitor cell growth. When platelet count was falling, a mild defect of platelet aggregation and ATP release was observed, while platelet function was normal when platelet count was rising. Prednisone, thymopentin, high-dose intravenous gamma-globulin and splenectomy were without effect. After 4 years of cyclic platelet and megakaryocyte fluctuations, stable amegakaryocytic thrombocytopenia developed and the patient died of haemorrhagic stroke.
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PMID:Acquired cyclic thrombocytopenia-thrombocytosis with periodic defect of platelet function. 791 35

The objective of this study was to determine the prevalence and clinical significance of elevated antiphospholipid antibodies (APA) in a large series of patients admitted to a department of Internal Medicine. At the end of entry phase, 1014 patients were tested (488 males-526 females, mean age: 66.7 years, range 18-97). Seventy-two (7.1%) patients were found APA positive at least once: 44 males and 28 females, mean age 69 years, range 23 to 94. Twenty fulfilled the criteria of Primary Antiphospholipid Antibody Syndrome: 10 patients were referred for deep vein thrombosis, 3 had history of deep vein thrombosis, 1 had both arterial thrombosis and a history of venous thrombosis; 2 had thrombocytopenia; 3 had stroke, 1 had a history of a stroke. One patient had SLE according to ARA classification. The most frequent associated disease was cancer: 14 patients, 9 had evolutive malignant disease, 5 were in clinical remission of neoplasia. Other clinical conditions included chronic and/or acute alcoholic intoxication (n = 8), severe atherosclerosis (n = 4), leg ulcer (n = 4). Insufficient data are available about the evolution, but 7 patients died in the year following diagnosis. Eight patients had fluctuations in APA detection: 2 initially APA positive became negative, 5 initially negative became positive and 1 patient was alternatively positive, negative and positive without steroid treatment. Thus, as expected, APA occur in a variety of clinical disorders. The association with cancer or alcoholic intoxication deserves further investigations.
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PMID:A prospective epidemiological study on the occurrence of antiphospholipid antibody: the Montpellier Antiphospholipid (MAP) Study. 798 47

Symptomatic immune thrombocytopenia in adults is potentially lethal, and, when conventionally treated with oral corticosteroid agents, approximately two thirds of patients will have some response in platelet count, but this is seldom durable. Since cytotoxic drugs are of limited benefit at this stage, splenectomy becomes necessary in 70% of patients. Intravenous gammaglobulin has been advocated as an alternative to prednisone as the primary form of treatment. A prospective, randomized comparison was carried out between oral prednisone (1 mg/kg/day; group 1; n = 17), high-dose intravenous gammaglobulin (400 mg/kg on days 1 through 5; group 2; n = 13), or a combination of both agents given on the same schedule (group 3; n = 13). The groups were well matched clinically and hematologically. No mortality occurred after initiating therapy, but one patient experienced a cerebrovascular accident. Response, defined as a platelet count greater than 50 x 10(9)/L, was achieved in 82%, 54%, and 92% of patients in groups 1, 2, and 3, respectively, but was only significant between groups 2 and 3 (P = 0.0365). The median times to peak platelet counts were 8.5 days (range 7 to 21 days), 7 (range 5 to 10 days), and 7 (range 3 to 23 days), respectively. Although there was a trend in favor of the steroid-administered groups, relapse was not significantly different, which occurred at a median of 184, 32, and 76 days, respectively, nor was the average time to splenectomy different at 339, 59, and 98 days, respectively. At a minimum of 2 years of follow-up, 5 of 17 in group 1, 2 of 13 in group 2, and 1 of 13 in group 3 had achieved platelet counts of greater than 100 x 10(9)/L and, therefore, did not require splenectomy. In contrast, where this indication was present for failure to respond, 8 of 12 (67%) in group 1, 4 of 8 (50%) in group 2, and 9 of 12 (75%) in group 3 remain in complete remission. Significantly more patients in group 2 than group 3 experienced a relapse (P = 0.0365). It is concluded that in previously untreated adults with symptomatic immune thrombocytopenia, gammaglobulin offers no advantage over conventional corticosteroid administration as the primary form of therapy. Additionally, more intense immunosuppression, resulting from the use of both agents combined, is no better than single agent corticosteroid agents and appears to be an unnecessary and unwarranted expense.
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PMID:Intravenous gammaglobulin has no advantages over oral corticosteroids as primary therapy for adults with immune thrombocytopenia: a prospective randomized clinical trial. 803 Jun 57

A 40-year-old woman presented with profound muscle weakness resulting in failure to wean from a ventilator and persistent lactic acidosis after having recovered from a pneumonia complicated by adult respiratory distress syndrome, myocardial infarction, renal failure and shock. She had a 28 year history of chronic anemia and exercise intolerance. Anemia and thrombocytopenia persisted after admission. Nonobstructive hypertrophic cardiomyopathy was present. A stroke-like episode occurred. A mitochondrial myopathy with deficiencies in complexes IV and II was demonstrated, but no DNA defect has yet been found. This patient represents a distinct clinical presentation of a mitochondrial disorder characterized by late onset mitochondrial myopathy, chronic anemia, cardiomyopathy, and lactic acidosis.
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PMID:Mitochondrial myopathy with anemia, cardiomyopathy, and lactic acidosis: a distinct late onset mitochondrial disorder. 809 86

Fenoldopam, a selective DA1-receptor agonist, infused intravenously for 24 hours (0.6 +/- 0.3 microgram/kg/min, range 0.1-1.5) in 25 patients with NYHA functional class III or IV heart failure, produced a prompt and sustained hemodynamic response. Cardiac index rose from an average preinfusion baseline value of 1.8 to 2.6/l min. Stroke volume index increased from 19 to 26 ml/m2 and stroke work index increased from 18 to 25 g M/m2. These changes were accompanied by a reduction in systemic vascular resistance from an average of 2400 to 1500 dynes sec/cm5. There was no change in the heart rate or right atrial pressure. There was a transient reduction in the left ventricular filling pressure from 25 to 20 mmHg. Urinary sodium excretion did not change significantly. Transient asymptomatic thrombocytopenia developed in four patients. The drug was well tolerated by all patients. These results suggest that continuous intravenous infusion of fenoldopam is safe and produces favorable hemodynamic responses in severe heart failure. However, unlike its effects in patients with hypertension, it failed to produce sustained natriuresis in these patients.
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PMID:Intravenous fenoldopam infusion in severe heart failure. 809 27

The global and regional effects of left ventricular circulatory assistance were examined in dogs during acute myocardial infarction using a new coaxial flow device (Hemopump). In 12 dogs the left anterior descending coronary artery was occluded for 4 h and subsequently reperfused for 12 h. In six dogs, left ventricular assistance was started 90 min after coronary artery occlusion and maintained for several hours; six control animals received no circulatory support. Survival rate in the animals receiving mechanical support was 100% vs 0% in the control group. The Hemopump reduced left ventricular stroke work up to 80% and maintained blood flows to the brain, kidneys, liver and intestine throughout the experiment. Infarct size, expressed as a percentage of the left ventricle, however, was not modified (12% in supported animals vs 13% in control dogs). Side effects of the coaxial flow pump were thrombocytopaenia, occurring in all six dogs, and haemolysis, which was demonstrated in one animal. It was concluded that the Hemopump provides effective global and regional circulatory support in a canine model of severe cardiogenic shock. However, the value of left ventricular support to modify infarct size could not be demonstrated in this experimental model.
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PMID:Left ventricular assistance using a catheter-mounted coaxial flow pump (Hemopump) in a canine model of regional myocardial ischaemia. 847 23

Although patients with AIDS frequently develop high titers of anticardiolipin antibodies, the clinical significance of this laboratory abnormality in AIDS patients is unknown. A 33-year-old female with AIDS, a prior small cerebrovascular accident, thrombocytopenia, and a coagulopathy suddenly developed left upper quadrant pain and tenderness due to splenic infarction associated with a high titer of anticardiolipin antibodies. Possible clinical manifestations of anticardiolipin antibodies in this patient include recurrent thromboembolism, coagulopathy, and thrombocytopenia. This case report suggests that anticardiolipin antibodies are associated with splenic infarction and that anticardiolipin antibodies associated with AIDS may sometimes be clinically significant.
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PMID:Splenic infarction associated with anticardiolipin antibodies in a patient with acquired immunodeficiency syndrome. 850 12


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