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

The cases of 52 consecutive persons with ocular ischemic syndrome (ocular symptoms and signs attributable to severe carotid artery obstruction) were studied. Followup disclosed a five year mortality of 40%. In comparison, an age and sex matched control group from the Framingham study had a five year mortality of 11%. The leading cause of death was cardiac disease (63%), while stroke was second (19%). Other associated diseases included systemic arterial hypertension (73%), diabetes mellitus (56%) and peripheral vascular disease (19%).
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PMID:The ocular ischemic syndrome. II. Mortality and systemic morbidity. 279 12

This third paper from the Persantine Aspirin Trial examines the data to identify risk factors for stroke in persons with a history of carotid territory transient ischemic attacks (TIAs) Fifteen centers in the United States and Canada participated, and 890 subjects were admitted and randomly allocated to either aspirin plus placebo or aspirin plus dipyridamole (Persantine). Persons with the following characteristics were in greater jeopardy for stroke, retinal infarction, or death: older age, history of heart disease, history of peripheral vascular disease, and persisting neurologic deficit from a recent event. Elevated diastolic blood pressure, diabetes, use of estrogen, and smoking were not found to be risk factors. Elevated systolic blood pressure was a risk factor primarily in subjects with a history of heart disease. Estrogen use may actually have had a protective effect for women. This cannot be considered as a report of the natural history of TIA patients; it does identify risk factors in a specific cohort of subjects under treatment.
Stroke
PMID:Persantine aspirin trial in cerebral ischemia--Part III: Risk factors for stroke. The American-Canadian Co-Operative Study Group. 286 49

Potential risk factors for various types of stroke were studied using a case-control study design. All 1978 US death certificates for which the registered underlying cause of death was subarachnoid hemorrhage (SAH), cerebral hemorrhage (CH), or cerebral infarction (CI) were identified. The frequency with which other conditions appeared on the death certificates of cases with and without hypertension was compared with controls. These data provide new information, such as the occurrence of peripheral vascular disease in association with SAH, the risk of CH in epileptic and cirrhotic patients, and the association of benign neoplasms of the nervous system, motor neuron disease, and 'paralysis agitans' with CI.
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PMID:Conditions associated at death with specific types of completed stroke in patients with and without hypertension: a case-control study. 291 91

Epidemiologists studying the risk factors of coronary heart disease, as indicated by a heart attack, often presume that these risk factors combine in a susceptible host to increase the risk of the heart attack. The "biological" basis for the interaction of the key risk factors is often not considered in the analysis. A more rational model for the study of clinical heart disease, stroke, and peripheral vascular disease would be to separate the epidemiology of atherosclerosis from that of the clinical event. In the past, this has been extremely difficult because of the absence of techniques for the measurement of atherosclerosis in vivo, especially in well-defined populations. However, in recent years, greater emphasis on the quantification of atherosclerosis and its relationship to specific risk factors has improved our ability to study the underlying pathology that is atherosclerosis. Atherosclerosis is an example of a common-source epidemic. The environmental agent is the intake of cholesterol and saturated fat. The interaction of specific dietary factors and genetic determinants is the key to the evolution of atherosclerosis. There are marked variations in the evolution of the disease in different vascular beds as well as among individuals exposed to similar environmental factors. In the future, we will probably be able to study atherosclerosis as a continuous variable in populations and to relate the rate of progression, the extent of disease at any point in time, and topical distribution of atherosclerosis within individual vascular beds to specific genetic and environmental determinants.
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PMID:The epidemiology of atherosclerosis in 1987: unraveling a common-source epidemic. 304 99

Ancrod has been used in Europe for over 15 years for peripheral vascular disease, deep vein thrombosis, and central retinal venous thrombosis, and in patients at risk for thromboembolism. In a double-blind, randomized, placebo-controlled study at University Hospitals in Cincinnati, 20 acute cerebral infarction patients received a series of IV infusions of ancrod (ten) or placebo (ten) for seven days. Early fibrinolysis with a small decrease in fibrinogen was observed, and d-dimers were elevated at four hours, indicating early clot lysis. At three months, patients with moderate to severe strokes (less than 40 on the Scandinavian Stroke Scale) in the ancrod group showed average improvement by a factor of 3 over the placebo group. No bleeding, abnormal laboratory results, or deaths occurred, but ancrod was discontinued in one patient who had seizures. As a result of this study, a double-blind multicenter international clinical trial to further assess the safety and effectiveness of ancrod is being planned.
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PMID:Use of ancrod in acute or progressing ischemic cerebral infarction. 305 31

Endothelial cells release a potent vasodilator which activates guanylate cyclase and thereby induces relaxation of vascular smooth muscle cells. The so-called endothelium-derived relaxing factor (EDRF) is released by acetylcholine, local and circulating hormones, and substances released from aggregating platelets or formed during activation of the coagulation cascade. Nitric oxide (NO) probably accounts for the factor's activity. Thus, endothelial cells produce endogenous nitrates causing vasodilatation and inhibition of platelet adhesion and aggregation. Under physiological conditions, EDRF may play a role in the prevention of vasospasm and thrombosis. On the other hand, the impairment of endothelial regulatory mechanisms in atherosclerosis and hypertension may be involved in the pathogenesis of vascular occlusion and thereby of myocardial infarction, stroke and peripheral vascular disease.
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PMID:[Endothelium-derived relaxing factor(s): endogenous nitrates in the circulation?]. 306 71

The treatment of end stage renal diabetic nephropathy remains a challenge. A large experience allows us to clearly outline the advantages and the drawbacks of continuous ambulatory peritoneal dialysis (CAPD). 81 patients, mean age 51.3 years, were treated over the past nine years by CAPD-CCPD. Extrarenal complications, mainly vascular lesions, account for qualifying these patients as a high risk population. The technique was modified in order to inject insulin intraperitoneally, four times per day, to control blood glucose level. Peripheral vascular disease was prospectively studied in 19 patients. Actuarial survival was 92% at one year, 50% at four years mainly influenced by age: 85% survival at two years in 35 patients aged less than 50 years and 62% at two years in 46 patients aged more than 50 years. The main causes of death were of cardiovascular origin: arteritis, myocardial infarction, stroke. The main causes for transfer to an alternative method of treatment were technical complications. Peritonitis rate was one episode ever 14 months. Satisfactory control of blood pressure, blood glucose levels, main biological parameters, visual status were the clear advantages of the method. Peripheral vascular disease is not influenced by the technique. CAPD can be the technique of first choice in young diabetics awaiting a kidney transplant and the reference technique for home dialysis.
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PMID:[Clinical aspects of continuous ambulatory peritoneal dialysis in diabetics]. 306 89

Results are presented of a retrospective analysis of 651 carotid endarterectomies in 605 patients with carotid territorial transient ischemic attacks (TIAs). All operations were performed by the same surgeon in a community hospital from 1963 to 1986. Arteriographic findings consisted of carotid stenosis of 50% or greater in 88.5% of patients and stenosis less than 50% and/or an ulcerated plaque in the remaining 11.5%. Medical risk factors were detected in 92% of patients; hypertension, peripheral vascular disease, and coronary atherosclerosis were most prevalent. All operative procedures were conducted with the patients under general anesthesia, routine shunting, and arterial closure without a patch. The perioperative stroke rate was 1.5% (10 patients); the morality rate was 0.8% (three deaths from myocardial infarction and two from stroke) for a combined stroke and mortality rate of 2.0% (13 of 605 patients). Follow-up (mean 61.8 months) was possible in 570 (96%) of the patients surviving operation without a perioperative stroke. The cumulative probability of late stroke (i.e., cerebral infarct ipsilateral to the operated artery) was 2.5% at 5 years and 8.1% at 10 years. When the perioperative stroke-mortality rate (2.0%) is combined with the data for late ipsilateral stroke, the 5- and 10-year probabilities of ipsilateral stroke were 4.5% and 9.9%, respectively (mean 1% per year for 10-year period). Coronary atherosclerosis accounted for 43% of late deaths and 16% of strokes. The perioperative stroke-mortality rate of 2.0% in this group of patients falls within the acceptable range for carotid endarterectomy in patients with TIA.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Carotid endarterectomy in patients with territorial transient ischemic attacks. 317 81

Thirty adults (17 male and 13 female patients) with spastic disorders were treated by hamstring releases of 46 extremities. The diagnoses were stroke, traumatic brain injury, spinal cord injury, multiple sclerosis, and anoxia. The mean age at surgery was 38.6 years. Three extremities had partial release of the hamstring tendons behind the knee; the remaining 43 extremities had a complete release. The average position of the knee was 61.4 degrees of flexion preoperatively and 6 degrees postoperatively. The follow-up period averaged 21.3 months. Preoperatively, 87% of patients were nonambulatory. Following hamstring release 43% became ambulatory and 17% had gained the ability to transfer. Complications included two stroke patients with severe peripheral vascular disease; one developed a large nonhealing sore of the ankle and the other developed gangrene of the foot. Both patients required amputation. Three other patients developed recurrent flexion contractures that have since been rereleased with good results.
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PMID:Hamstring release for knee flexion contracture in spastic adults. 318 May 74

In a prospective study of postoperative complications, strokes occurred in 6 out of 2463 patients (0.2%) who underwent non-cardiac, non-carotid artery surgery. The patients who experienced cerebrovascular accidents, including three cases of transient ischemic attack, were significantly older than the rest of the group (mean age 79 years versus 65 years) and had manifestations of atherosclerosis in at least one organ preoperatively. Significant predictors of risk for postoperative cerebrovascular accidents were previous cerebrovascular disease, heart disease, peripheral vascular disease, and hypertension. Cerebrovascular accidents occurred late in the postoperative period, 5-26 days after surgery, and were not directly related to surgery and anesthesia. They were more frequent after acute than after elective operations. Precipitating factors for some of the stroke incidents were rapid atrial fibrillation and postoperative dehydration.
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PMID:Postoperative cerebrovascular accidents in general surgery. 321 96


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