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

Ehlers-Danlos syndrome (EDS) type IV is an autosomal dominant disorder that results from mutations in the COL3A1 gene, which encodes chains of type III procollagen. Individuals with this disorder are predisposed to rupture of arteries, the bowel, and the gravid uterus. To assess the frequency of central nervous system complications, we reviewed clinical data concerning 202 individuals with EDS type IV from 121 families in which the diagnosis was confirmed by biochemical or molecular studies. We identified 19 individuals with cerebrovascular complications, which included intracranial aneurysms with secondary hemorrhage, spontaneous carotid-cavernous sinus fistula, and cercical artery dissection. The mean age at presentation with these events was 28.3 years (range, 17-48 years). Although uncommon, EDS type IV is an important potential cause of stroke in young people. The disorder is readily identifiable clinically and the diagnosis has important implications for acute and long-term management and, potentially, for other family members. Because conventional angiography may exacerbate severe complications, noninvasive procedures such as Doppler and magnetic resonance angiography are the investigations of choice. Anticoagulation therapy may result in increased bruising or bleeding and should be used with caution.
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PMID:Cerebrovascular complications in Ehlers-Danlos syndrome type IV. 852 72

Japan was defeated in World War II and almost all of the nation was demoralized by the destruction and damage to much of the nation. The medical and health care system during and before World War II needed to be reformed radically and fundamentally since almost all medical and health institutes were destroyed. On the other hand, many health personnel came back from overseas after the war. Japanese modern medicine had developed on the basis of German medicine; however, many aspects of American medicine, including public health and democracy, were rapidly introduced following the end of World War II. The American type of health center was established and many laws concerning medical and health care were enacted in 1947-1948. One of them was "The Health Center Law." The National Health Insurance Act was enacted in 1958 and the total population has been covered by health insurance plans since 1961. Many physicians quit the health centers and they have worked as clinicians under the National Health Insurance scheme, because health centers were introduced before adequate education and research existed in the field of public health. On the other hand, the health insurance scheme was in its golden age during the high economic growth period of the 1960s. Japan has succeeded in all forms of modern technology and economy for the past 30 years and is now one of the top nations in the field of medical and health care, such as the numbers of clinics and hospitals and beds, the frequency of consulting with a doctor, length of hospital stay, examinee rates in mass health examinations in the community and workplace and so on. Health conditions have changed drastically from the 1950s to the present. Therefore, health centers do not fit current health needs. For example, mortality from tuberculosis, acute infections diseases and also stomach and uterus cancers and apoplexy have decreased rapidly while mortality from chronic diseases, especially lung, breast and rectal cancers, and myocardial infarction have increased gradually. Changes of life style resulting from rapid economic growth are suspected to be important causes of the change in the prevalence of these diseases. Mass health examination was important and effective as a preventive measure against tuberculosis, especially as a means of early detection and early treatment. However, it is not now effective against chronic diseases. The screening examination has resulted in identifying many patients suspected of being ill. Every examiner must be able to distinguish pathologic findings from physiologic changes of aging. Every patient must, therefore, understand his/her individuality and evaluate the result of his/her efforts to improve life style by receiving a health examination. Accordingly, the aim of health examination has changed from early detection to health support for the examinee. During the decades when life expectancy was less than 50 years of age, it was not necessary for people to plan for retirement. Moreover, there was little burden on younger generations to provide care for the aged people because there were few old people more than 70 years of age and the birth rate was high. Nowadays, elderly people face many years of life after retirement and there are too many aged people in relation to the number of younger persons. As for medical care services, many new medical needs have emerged in recent years, including "quality of life," "palliative medicine in terminal care," "establishment of a primary care system" and "comprehensive care connecting health and medical care with welfare" etc. Improved living standards resulting from economic growth, called the "economic miracle" internationally, have helped to bring about a rapid and wide range of change in daily lifestyle, such as eating habits, working conditions and environment. The Ministry of Health and Welfare has made every effort to revise the laws in relation to health and medical care systems, in order to adjust to recent
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PMID:[Background and prospects of the Community Health Act]. 872 Sep 29

Uteroplacental apoplexy is a rare but nonfatal complication of severe forms of placental abruption. It occurs when vascular damage within the placenta causes hemorrhaging that progresses to and infiltrates the wall of the uterus. It is a syndrome that can only be diagnosed by direct visualization or biopsy (or both). For this reason, its occurrence is perhaps underreported and underestimated in the literature. The subject of this report is a 24-year-old pregnant woman who had a placental abruption an in whom classic uteroplacental apoplexy was diagnosed at the time of her cesarean section.
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PMID:Couvelaire uterus. 931 51

The basic mechanisms that underlie alterations in the physiology of pregnancy are virtually unknown. Basal oxygen consumption increases by some 50 mL/min in pregnant women at term. Blood volume increases gradually over gestation as does red cell mass. Cardiac output increases by some 50% by mid-third trimester. Stroke volume and heart rate increase over the course of pregnancy with heart rate increasing gradually until term. The heart of the pregnant woman remodels dramatically in the first few weeks of pregnancy; end diastolic volume increases. Stroke volume is augmented by the increase in end diastolic volume and maintenance of ejection fraction through a possible increase in contractile force. Systolic and diastolic blood pressures drop during normal pregnancy. There is evidence of blood vessel remodeling in all vessels. Venous compliance and venous blood volume are increased. Renal plasma flow increases by some 70% in pregnancy with glomerular filtration rate increasing by 50% by unknown mechanisms. The complex hormonal environment is changing throughout pregnancy. In summary, under the influence of circulating chemical mediators blood flow is redistributed to the uterus, breast, and kidney.
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PMID:Hemodynamic changes in pregnancy. 1070 51

Stroke volume and heart rate rise at the very beginning of a pregnancy and decline after birth, over the course of months. Arterial blood pressure is lowered, plasma volume is increased while central venous pressure stays constant during pregnancy. The rise in cardiac output in early pregnancy can be induced quantitatively by oestrogen. The pregnancy-induced rise in cardiac output is based on the fairly general remodelling of the cardiovascular system. In a process of development, many portions of the cardiovascular system undergo programmed dilation (expansion): There is a programmed dilation of the heart, of the aorta, of the resistance vessels of the kidney and the resistance vessels of the placenta, and a programmed dilation of the venous system. All the changes favour the perfusion of the pregnant body. Cardiac dilation increases directly stroke volume, aortic dilation increases the susceptance (Windkessel function) of the aorta, the peripheral dilation increases the vascular conductance, and the venous dilation raises blood volume. Since the vascular conductance increase by peripheral dilation is higher than the increase in stroke volume, arterial pressure drops and evokes, via the baroreceptor reflex, an increase in heart rate; the increase in cardiac output occurs to an equal extent by an increase in stroke volume and an increase in heart rate. Compression of the caval vein by the pregnant uterus increases peripheral venous pressure and possibly slows down blood flow in the limbs. Increase in cardiac output means a burden for the heart, especially when associated with increase in heart rate. In this condition, cardiac energy expenditure is increased while oxygen supply is decreased. The rise in energy expenditure by an increase in flow rate is especially high for turbulent flow conditions at stenotic valves. In addition, there is an increased risk of arterial rupture by arterial remodelling and an increased risk of thrombosis by deceleration of venous blood flow velocity. Thus, the cardiovascular adaptation to pregnancy means an increased cardiovascular risk which may, on the basis of a basic cardiac disease, lead to cardiac failure.
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PMID:[Physiological cardiovascular adaptation in pregnancy--its significance for cardiac diseases]. 1137 40

Hemodynamic changes in early-pregnant and pseudopregnant rats are comparable, indicating that the trophoblast does not contribute to these changes. It is unclear whether the presence of the uterus is needed for the normal early-pregnancy hemodynamic adaptation. In this study we tested the hypothesis that uterine factors do not contribute to the systemic hemodynamic changes in early pseudopregnancy. To this end, we studied systemic hemodynamics in conscious pseudopregnant rats subjected to a hysterectomy, and compared these results with those obtained in a control group of pseudopregnant rats. The animals were studied on days 4, 8, 12 and 19 postmating. On day 8 of pseudopregnancy, cardiac output has increased by 23+/-7% in the hysterectomized group and 15+/-5% in the control group. In both groups this rise in cardiac output was entirely accomplished by a rise in stroke volume, by 28+/-8% and 19+/-5%, respectively. Mean arterial pressure did not change appreciably. Therefore, total peripheral resistance also decreased in both groups (17+/-6%) by day 8. After day 12 the hemodynamic parameters returned to baseline. We conclude that systemic hemodynamic changes in hysterectomized pseudopregnant rats closely resemble those in intact pseudopregnant rats. Therefore, the uterus does not seem to play a role in these changes. This supports the hypothesis that only hormones from ovarian origin trigger the initial hemodynamic adaptation to early pregnancy.
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PMID:Hemodynamic changes in pseudopregnancy in chronically instrumented, conscious rats are preserved after hysterectomy. 1181 Feb 13

1. The effects of ovariectomy (Ovx), menopause and oestrogen replacement on the haemodynamics remain controversial. The present study employed the technique of arterial impedance analysis to measure and calculate the steady and pulsatile haemodynamics. The purpose was to determine the haemodynamic consequence of ovariectomy and oestrogen replacement. 2. Ovariectomy was carried out under anaesthesia on female Sprague Dawley rats aged 9 weeks. Oestrogen (17 beta-estradiol or E(2)) replacement started 1 week after ovariectomy for 4 weeks. Ovx increased the body weight (BW), while it greatly reduced the uterus weight. Left ventricular weight (LVW) was slightly increased, but LVW/BW ratio was slightly reduced. These changes were reversed after E(2) replacement. 3. Compared to sham group, Ovx with or without E(2) replacement did not significantly affect the systolic, mean and diastolic pressure. In Ovx, pulse pressure (PP) and heart rate were significantly increased, while stroke volume and cardiac output were slightly decreased. Total peripheral resistance (TPR) was largely elevated, indicating Ovx induced systemic vasoconstriction. These changes all returned to close normal values (sham group) after E(2) replacement, except PP. 4. Ovx increased the characteristic input impedance (Zc) and pulse wave reflection, while it decreased arterial compliance. E(2) treatment reversed these changes, except Zc. 5. These results demonstrate that Ovx influences both the resistance and Windkessel functions of the artery. E(2) treatment effectively reverses most the effects of Ovx both on the steady and pulsatile haemodynamics.
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PMID:Effects of oestrogen replacement on steady and pulsatile haemodynamics in ovariectomized rats. 1211 Jun 5

The pill is discussed. Discovery of the pill was carried out by Dr. G. Pincus. He developed a substance called norethynodrel. Through Professor Marker's work progesterone was made available. Dr. Pincus and Dr. J. Rock started clinical trials with progesterone in Puerto Rico. The chief effect of progesterone in the 20 day pill is to prevent the release of the ripe egg. It also disrupts the normal sequence of hormones that make the lining of the womb receptive to a fertilized egg. Small amounts of a substance resembling estrogen are added to the progesterone to reduce the unpleasant side effects produced by progesterone. Oral contraceptives should not be used by women with thrombophlebitis, thromboembolic disorders, cerebral apoplexy or past history of these conditions, markedly impaired liver function, known and suspected carcinoma of the breast, uterus, and cervix, estrogen dependent neoplasms, jaundice, diabetes, congestive cardiac failure, epilepsy, or severe allergic conditions. It is also advised that oral contraceptives not be used by nursing mothers in the first 6 months and by those with vaginal bleeding. There are side effects to the contraceptives, and certain precautions should be taken before oral contraceptives are prescribed. Physical examinations should be carried out. The patient with history of psychic depression should be carefully observed on orals, and if severe depression occurs, use of the pills should be discontinued. British studies have shown higher mortality and hospitalization rates due to thromboembolic disease in oral contraceptive users than in nonusers.
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PMID:The pill. 1225 8

Progestin only birth control pills appeared on the US market in 1973. As there is no estrogen in these mini pills, they may have fewer dangerous side effects than the combined pills. Some clinics suggest mini pills for women who suffer from estrogen excess side effects. The 3 mini pills available in the U.S. are called Micronor, NOR-QD, and Ovrette. Instructions are presented for patients who are interested in using mini pills. The mini pills most likely work by affecting a women's fertility in several ways: act as a messenger to the woman's ovaries and uterus to prevent the release of an egg; thicken the mucous on the cervix, making it difficult for the sperm to "get through" the cervix and reach the egg; and change the lining of the uterus so that it may not develop properly for the fertilized egg to grow. The mini pills can be 97% effective is used perfectly. The mini pills are only effective for as long as a woman takes them. A woman must take a pill every day to prevent pregnancy. A woman should not use the mini pill if she has or ever has had any of these problems: blood clotting problems in veins; stroke; cancer of the breast or reproductive parts of the body; suspected pregnancy, current pregnancy; and undiagnosed, abnormal genital bleeding. Possible benefits for a woman using mini pills include: an effective method of birth control; a method for nursing mothers since it does not seem to affect the amount of their breast milk; and a possible reduction in premenstrual cramps. Possible risks for a woman using mini pills include: irregular periods; and a less effective method if the patient does not take a pill every day. The danger signals to look for are abdominal pain, chest pain, headaches, eye problems, and severe leg pain. A patient should revisit a clinic in the following situations: has not had a period within 45 days of the last period; severe abdominal pains while taking mini pills; experiences a warning signal; any time one thinks the pills are causing trouble; and once a year for a pap smear, breast examination, and laboratory tests.
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PMID:How to use mini-pills: helpful patient instructions. 1226 79

The bulk of the experimental data suggest beneficial effects of estrogen (both premenopausal use of OCs and postmenopausal use of ERT-HRT). An intriguing finding from the monkey studies is that social subordination, which induces estrogen deficiency in female monkeys, accelerates atherosclerosis premenopausally and predicts extent of postmenopausal atherosclerosis. This effect can be inhibited by exogenous estrogen, premenopausally. The results suggest that more effort on detecting and regulating premenopausal ovarian dysfunction may be justified. A complication in understanding estrogen action may be the result of varying extents of arterial damage. For example, primary prevention studies in both postmenopausal animals and women have provided strong evidence of atheroprotection with a variety of estrogens. In contrast, the results of secondary prevention studies [10,12] have in general suggested little cardioprotection with either ERT or HRT. Studies in rabbits suggest the antiatherogenic effect of estrogen may not be present when the endothelium is damaged [64]. The state of the endothelium may be critical for some estrogen actions. For those effects of estrogen that require the ER, be it ERalpha or ERbeta, the presence of the receptor may vary with age, disease state, or type of hormone therapy. If continuous combined HRT therapy decreases ER in the artery as it does in the uterus, this may eliminate those estrogen actions requiring the ER, but not others. Older women who have not been exposed to estrogens for many years may be more sensitive to some estrogen effects, and may need lower doses of ERT-HRT. Recent reports suggest that lower doses of estrogens maintain beneficial effects on lipoproteins and coagulation factors [95], while also requiring lower doses of progestogens to protect the uterus [96]. These beneficial findings are very promising in light of the improvements in CHD risk and decreased stroke risk reported with low-dose estrogens [5]. It ill be interesting to see if CRP is increased with lower doses of estrogens and whether these changes are associated with increased early risk of CHD. Perhaps older women with CHD are also more obese, may have diabetes, and may be more susceptible to inflammatory and thrombotic effects of higher doses of estrogens. There are many questions left unanswered. It is hoped that some of the answers may come from the WHI, which is a large prospective trial assessing ERT and HRT. The age range is also relatively large and may be able to determine if older women respond differently than younger women. Some initial data from the WHI have been made available suggesting a small increased risk in the first 2 years and a trend for decreasing risk in the last months of the first 2 years [34]. Just recently, the CEE + MPA arm of the study was stopped early by the data and-safety monitoring board as the overall health risks exceeded benefits with increases in both breast cancer and CVD [97]. The remainder of the study groups including an estrogen-only arm, are expected to continue until 2005.
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PMID:Reproductive hormones and cardiovascular disease mechanism of action and clinical implications. 1235 69


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