Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The centrally active, alpha-2 adrenergic receptor agonist clonidine was given to 12 spinal cord injury patients with problematic spasticity not adequately controlled by recognized spasmolytic drug therapy. Five patients had an excellent reduction and 2 patients had some reduction in clinical spasticity (average dose 0.39 mg daily). Four of the 7 responders discontinued clonidine because of adverse reactions after an average of ten weeks of therapy. Three responders have continued to tolerate the drug well with excellent control of spasticity for 18 to 34 months. Five patients had no change in clinical spasticity (average dose of 0.24 mg daily). Three of the non-responders discontinued clonidine because of adverse reactions after an average of three weeks of therapy. Significant associated adverse reactions included syncopal seizures (3), cerebrovascular accident (1), deep vein thrombosis (1), autonomic hyperreflexia (3), lethargy/drowsiness (3), and nausea/vomiting (1). Possible mechanisms of action for clonidine to affect spasticity and the unstable cardiovascular system of quadriplegics is discussed. While spinal cord injured patients with severe spasticity may benefit from clonidine, great caution is recommended during its use until further study establishes safe parameters of administration and efficacy is confirmed on controlled studies.
 ...
PMID:Early clinical experience with clonidine in spinal spasticity. 374 98

The combined estrogen/progestogen oral contraceptive (OC) is the most common form of contraception that is used by sexually active women who are between the ages of 15-35 years. Serious side-effects are infrequent, and the failure rate is exceedingly low. The major side-effects of OC administration are seen in 4 distinct areas: subsequent fertility; the cardiovascular system; metabolic effects; and malignancy. Approximately 1% of women experience persistent amenorrhea after they cease to take OCs, but considerable doubt exists as to whether this is purely an effect of OC or is due to other factors such as weight change, excessive exercise, or psychological disturbances. The major cardiovascular problems are those of hormone-induced hypertension, deep vein thrombosis, coronary artery disease, and stroke. It is not possible to predict which patients will develop hypertension while taking OCs, and all patients should have their blood pressure checked within 6 months of starting OC use and then approximately once a year. There is little doubt that the increased risk of deep vein thrombosis that was observed in women using OCs in the 1960s was related to the high estrogen content of the early OCs. As the dose of estrogen has been reduced progressively, the incidence of deep vein thrombosis has decliined. It is now a rare occurrence in clinical practice. The association between coronary artery disease and cerebrovascular disease and OCs has been known for the last 5-6 years. It is evident that the risk is increased in women who smoke, especially when they are over age 35. The main predictor of the risk of coronary artery disease and stroke appears to be a reduction of high-density lipoprotein (HDL) cholesterol levels. In the combined OC preparations, the action of 1 steroid is variably balanced by the other, and the overall effect on HDL cholesterol levels is often minimal. The major metabolic side-effects concern the changes in gluclose tolerance and an apparently increased risk of gall bladder disease. Low-dose OCS have virtually no effect on glucose status and, providing that diabetic patients are supervised adequately and have no evidence of vascular disease, low-dose OC preparations can be used safely. The question of whether the steroidal components of OCs may have initiating or promoting effects in relation to the development of cancer continues to be debated. The major concern recently is in relation to breast and cervical malignancies.
 ...
PMID:Beneficial and adverse side-effects of hormonal contraception. 394 15

The scientific basis for the statement that cigarette smoking increases the risk of serious cardiovascular side effects from oral contraceptive (OC) use is reviewed. The published literature and the new statistical analyses of the data are examined. Attention is directed to 3 broad categories of relevant vascular disease--deep vein thrombosis and pulmonary embolism, stroke--both occlusive and hemorrhagic, and ischemic heart disease. Within each category, the epidemiologic relationship of cigarette smoking alone, of OC use, and of a combination of the 2 is addressed. This review of smoking and OC use as risk factors for major classes of cardiovascular disease reveals little convincing evidence for an interaction of the smoking and OC use. Essentially all of the data have been interpreted to indicate that OC use is a risk factor for cardiovascular disorders derive from retrospective case-control studies, which continue to be a subject of controversy. The role of smoking as a risk factor appears to be little questioned in the case of myocardial infarction, and the evidence suggests that it may also be a factor in hemorrhagic stroke. There is little evidence to implicate smoking in the pathogenesis of thrombotic stroke in young women, and several publications suggest that it has a protective effect for deep vein thrombosis. In sum, evidence for an interaction of smoking and OC use has been reported but is deemed to be weak. A major existing difficulty is the methodological problems that are inherent in epidemiologic investigations, both retrospective and prospective. While conservatism could thus withhold needed and effective contraception, the recommendation is for the OC user to forego smoking.
 ...
PMID:Smoking, oral contraceptives, and thromboembolic disease. 612 53

In spite of good correlations between cardiac output measurements by impedance and established invasive procedures (dye- and thermo-dilution) reported by numerous authors it is doubtful uptil now whether calculations of stroke volume according to the formula of Kubicek et al. (1974) can provide absolutely reliable results. The origin of the dz/dt curve and influencing factors of impedance wave have to be cleared up prior to the total acception of impedance cardiography as a reliable method for determining non-invasive stroke volume. This is true in spite of the agreement of all authors we know, that the reproducibility of the impedance cardiography values is as good as in dye or thermo-dilution measurements. However, for patient monitoring it is sometimes more important to assess the relative changes in stroke volume than to measure its absolute value. For long-term non-invasive monitoring of myocardial contractility in critically ill patients or after pharmacological interventions impedance cardiography may be recommended. Besides systolic time intervals, such as pre-ejection time and ventricular ejection time, three more reliable parameters can be derived from the first derivate of impedance wave. Impedance plethysmography has been shown as a reliable method to diagnose deep vein thrombosis and good correlations between impedance and strain-gauge plethysmography and phlebographic findings are reported. In addition fluid volume changes in the leg, venous capacity, venous outflow and arterial inflow may be determined by impedance plethysmography in a simple way. There is no doubt that alterations in the fluid content of biological tissue may measured by impedance technique. However, correlations between changes in the transthoracic impedance and fluid content of the thorax can be quantified only in a single subject which serves as its own control. Overall standardization is not possible. The reason for interindividual differences in the thoracic impedance at a given reduction of body water are due to anatomical differences, intrapulmonary air volume and pressure, location of the electrodes, electrical conductivity of the tissue and, above all, due to the position of the body. Therefore if transthoracic impedance is determined sequentially measurements must be performed with special attention to the position of the body to get reproducible results. Rapid infusion of colloids or blood transfusion may decrease transthoracic impedance due to intravascular volume expansion even at a net fluid lost during forced furosemide-induced diuresis or extracorporal hemodialysis.(ABSTRACT TRUNCATED AT 400 WORDS)
 ...
PMID:Application of impedance cardiography in critical care medicine. 632 26

The frequency of venous disease probably surpasses that of heart disease and stroke. The fallibility of the clinical diagnosis of pulmonary embolism and deep vein thrombosis (DVT) approaches 50% error in both conditions. Because of the serious errors in omission and commission of the clinical diagnosis of venous thrombosis, a variety of noninvasive diagnostic techniques have been developed within the past decade. The purpose of this paper is to analyze these noninvasive venous modalities with more emphasis on what is available in our vascular lab at Charleston Area Medical Center-Charleston Division, West Virginia University Medical Center.
 ...
PMID:Current status of the vascular laboratory in the diagnosis of deep vein thrombosis. 649 49

The risk of thromboembolism in oral contraceptive (OC) users is evaluated based on findings of major cohort studies conducted in England, the US, and Denmark. Since approximately 25% of Danish Women aged 15-45 use OCs, such an assessment is timely and critical. A study by the Royal College of General Practitioners (RCGP) found a slightly higher risk of venous thrombosis and pulmonary embolism, especially postoperatively (deep venous thrombosis). Major risk was found only with the use of high estrogen-content pills. No connection between OC use and subarachnoidal bleeding could be established according to the latest studies. In a US study examining 182 cases of apoplexy cerebri of thrombotic origin in comparison with 98 controls, the risk was 9.5 times higher on OC users. However, 74% of the patients with cerebral thrombosis were smokers vs. 43% of controls. The high gestagen component of pills was implicated in the increased risk. In a case control study, the risk of myocardial infarct was found 4 times higher in OC users and 20 times higher in smokers who used OCs. Another study of the RCGP supported these findings: myocardial infarct was .3/1000 women per year in pill users vs. .15 in nonusers, and the risk of death from ischemic heart disease was 6.4 times higher among users. These risk factors were also borne out by Danish data: the number of women aged 35-39 and 40-45 dying of ischemic heart disease between 1951-1981 rose slightly, but there was no significant increase after 1967, when low-dose OCs were introduced; in recent years there has been a decline. To establish a firm link between the use of the estrogen and gestagen components of OCs and thromboembolic disease, further investigations must be conducted in view of recently introduced low-dose pills.
 ...
PMID:[The pill and thrombosis]. 651 90

The production of 6-keto-PGF1 alpha and thromboxane B2 (TxB2) was determined in vitro in hand veins from 35 patients with deep venous thrombosis (DVT), 13 patients with stroke and 14 controls. The TxB2 production was significantly increased, approximately doubled, in patients with DVT and unchanged in patients with stroke. The production of 6-keto-PGF1 alpha was significantly increased in both groups. It is suggested that the increased production of TxB2 might be contributory to thrombosis.
 ...
PMID:Increased synthesis of thromboxane B2 and 6-keto-PGF1 alpha in hand veins from patients with deep venous thrombosis. 665 23

The effectiveness of low-dose subcutaneous heparin in the prophylaxis of deep vein thrombosis in patients with ischemic stroke was investigated in an unblinded controlled study. The frequency of deep vein thrombosis and pulmonary embolism in the control group was 23% versus 2% in the patients receiving heparin. There were no bleeding complications in the test group and there were no differences in the occurrence of hemorrhage changes in the cerebral ischemic infarction in both groups.
 ...
PMID:Effects of low-dose subcutaneous heparin on the occurrence of deep vein thrombosis in patients with ischemic stroke. 738 75

During an 8-month study of stroke patients, a 9% incidence of pulmonary embolism and a 1.5% incidence of thrombophlebitis was found among hemiparetic patients undergoing intensive rehabilitation after being medically stabilized. Patients were usually studied 10 days to 2 weeks after the onset of stroke. During the next 18 months, 141 subsequent patients were studied with 125I-fibrinogen uptake leg scans, disclosing a 29% incidence of deep venous thrombosis. Venograms were obtained in 28 patients; clots in 25 patients were confirmed in normal locations on the fibrinogen scan, and there was 1 false negative and 2 false positives. The subsequent 14 patients with clot were anticoagulated on the basis of the fibrinogen scan alone. Early anticoagulation of clinically silent leg thrombi prevented any pulmonary emboli.
 ...
PMID:Pulmonary embolism in stroke: prevention by early heparinization of venous thrombosis detected by iodine-125 fibrinogen leg scans. 745 23

Thrombolytic therapy mimics and enhances physiological fibrinolysis. The following substances are presently available for clinical use: the nonphysiological thrombolytics streptokinase, the APSAC (acylated plasminogen-streptokinase activator complex), the physiological plasminogen activators urokinase and tissue plasminogen activator (t-PA). Whereas the first three systematically activate the fibrinolytic system, t-PA possesses relative fibrin selectivity. The fibrin-selective active pro-urokinase has not yet been officially approved for the treatment of thromboembolic diseases, but it is being clinically tested. Fibrinolytic therapy has an established place in the management of acute myocardial infarction and of massive pulmonary embolism. When an acute deep venous thrombosis is diagnosed with a proximal extension into the popliteal vein, thrombolytic therapy is clearly superior to heparin. The lysis has proven to be an effective form of treatment of peripheral occlusive arterial disease. Local thrombolytic therapy is an option for acute and chronic femoro-popliteal occlusions involving the trifurcation into the calf arteries and for embolic occlusions of the same segment in patients with contraindications to surgical therapy. First study results of thrombolytic therapy of stroke are promising.
 ...
PMID:[Fibrinolytic agents--who benefits when?]. 748 76


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>