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

Over the period 1 April 1990 to 31 December 1992, a total of 179 PEG procedures were performed on 161 elderly patients, mean age 79 years (range 53-99). In most (141) patients, the indication was neurological dysphagia (usually stroke), but in 20 the tube was inserted to attain adequate nutritional support. Thirty-day fatality was 20% overall, but in those who underwent PEG only for nutritional support, survival was poor--only 20% at 30 days. Almost all deaths were a result of progression of the original illness. Only one procedure-related death occurred. Fifty-six complicating episodes occurred in 20 (12%) patients, the majority being minor. The commonest adverse event was PEG site infection. PEG is a useful and in general well tolerated procedure in geriatric practice, but careful patient selection is essential; in particular its use as a nutritional adjunct in frail patients needs careful evaluation.
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PMID:The use of percutaneous endoscopic gastrostomy (PEG) in 161 consecutive elderly patients. 802 28

The correlation between the circulating immune complexes (CIC) and dyslipidemia was studied in a group of 150 patients with acute ischemic stroke and 50 normal controls. The object of the study was also to find out whether these two components represent a macromolecular complex with increased atherogenic capacity or only two risk factors acting separately but achieving a summation of their atherogenic power. It can be considered that in acute ischemic stroke the presence of the two risk factors constitutes a condition of acceleration of the atherogenic process, i.e., the appearance of the vascular accident. The decrease of HDL-cholesterol detected in all the subgroups studied is probably due to the decrease of the cholesterol "reverse transport" process which favours the atherogenic process. It was found that CIC and low density lipoproteins (LDL) are risk factors which act separately determining by the effects they generate a summation of their atherogenic capacity. Cholesterol and triglycerides apparently contained in the CIC structure, can be considered as a methodologic artefact due to the use of a common reagent (PEG-6000).
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PMID:Circulating immune complexes and low density lipoproteins--a molecular complex or the summation of the atherogenic risk of two separate entities? 813 Jul 57

In order to develop a versatile model for blood-compatible materials, we studied morphology and platelet adhesion of a dipalmitoyl-phosphatidylcholine (DPPC)/dipalmitoyl-phosphatidylethanolamine-polyethylene glycol (PEG lipid) mixed monolayer. This monolayer, which mimics the cell membrane structure, consists of two heterogeneous layers, that is, a PEG layer lying on top of a phospholipid monolayer. The DPPC/PEG lipid mixed monolayer was prepared using the Langmuir-Blodgett (LB) Technique. The monolayer was transferred onto a silanized glass substrate by the down-stroke mode, at a surface pressure of 25 mN/m. The transfer efficiency achieved unity at all times. The morphologies of PEG chains on the phospholipid monolayer in water, in a dried state, and in a hydrated state were evaluated using Pi-A isotherm, ellipsometry, and atomic force microscopy (AFM), respectively. When the concentration of PEG lipid was below 1 mol %, the PEG chains could cover the DPPC surface completely in water, but not in the dried state. On the other hand, the PEG chains could cover the phospholipid surface completely in a dried state, as well as in water, when the PEG lipid concentration was above 3 mol %. These PEG chains, showing a brush-type conformation in water, were highly packed and had a bulky structure at the surface in the dried state as well as in the hydrated state. A bulky and extended PEG layer, above 3 mol % concentration, was greatly effective in the prevention of platelet adhesion.
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PMID:Preparation of a PEG-grafted phospholipid Langmuir-Blodgett monolayer for blood-compatible material. 1103 68

One of the commonest indications for PEG is nutritional support in dysphagia. We investigated the current practice of PEG insertion in South Wales (UK). A postal questionnaire was sent to hospital consultants with responsibility for acute medical/geriatric intake in the South Wales area. Eighty-eight of 114 (78.5%) responded. In 69 of 107 (65%) responses (Radiologists and Geriatricians also performed PEG in some hospitals) Gastroenterologists performed the insertion of PEG. Seventy-one (87%) always involved speech therapists before PEG insertion. Forty-five (55%) and 47 (57%) always involved dieticians and nurses, respectively. Eighty (92%) involved carers before PEG. Sixty-three (76%) used nasogastric feed for nutritional support before PEG. Thirty-six of 80 (45%) responses would wait more than 2 weeks before inserting PEG (range less than 7 days to more than 6 weeks). Five (6.5%) preferred long-term nasogastric feed to PEG. Twenty-five (30%) had definite knowledge of a PEG clinic in their hospital and 38 of 77 (49%) who responded to this question said there was no routine follow-up or were not aware about follow up of PEG patients. There is wide variation in the timing of PEG insertion and involvement of paramedical staff. More research needs to be undertaken to provide evidence so guidelines can be developed in this area. Follow up of patients with PEG is poor but current evidence suggests follow up of these patients may be worth while as some patients with dysphagic stroke can regain their swallow late.
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PMID:Audit of percutaneous endoscopic gastrostomy (PEG): a questionnaire survey of hospital consultants. 1131 2

Risk factors for long-stays (more than 30 days) in Winnipeg hospitals were identified, including sociodemographic, illness, and system characteristics. The largest determinant of length of stay was discharge destination; discharge to a nursing home increased length of stay by 173% and 89% for medical and surgical patients, respectively. Hospital of stay also made a big difference for patients discharged to nursing homes. Only 13% of long-stay patients were discharged to a nursing home; 52% were discharged home. Other factors which were associated with an extended length of stay included, hospitalization for stroke, cognitive impairment, rehabilitation therapy, PEG tube insertion, and inhospital fall.
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PMID:Long stay patients in Winnipeg acute care hospitals. 1263 77

A 44-year-old woman was almost completely paralysed after a severe brainstem haemorrhage. Even after several years of efforts at rehabilitation, she remained completely dependent on the help of others. However, a special device enabled her to administer (after careful preparation) liquids through the PEG catheter despite her poorly coordinated movements. Four years after the stroke, the woman joined a right-to-die society with the wish to bring her life to an end. A doctor working with this organisation prescribed her a lethal dose of pentobarbital. In the presence of her husband and her companion from the organisation, the woman administered herself the lethal substance by means of the device. On the basis of the fact that she herself had switched the device on this death was classed as (assisted) suicide.
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PMID:Assisted suicide bordering on active euthanasia. 1269 May 8

Dysphagia is a common complication after stroke, being reported in 30-50% in acute stage patients. It is also critical that dysphagia may occur 3 to 5 days after onset because of brain edema, so clinicians must be careful to treat stroke patients with close observation. Especially elderly patients with dysphagia have a high risk of aspiration pneumonia, which might be life threatening condition for them. Dysphagia generally recovers spontaneously and frequency of the chronic stage cases is thought to be less 6%. The 30 ml water swallow test is used to screen dysphagia. If cough or some symptom of aspiration such as wet voice or breathing difficulties are seen, dysphagia is strongly suspected. Oral care is essential and diet modification and rehabilitation techniques are applied. Fiberoptic evaluation or fluoroscopic examination is recommended for severe dysphagia. The treatment plan should be established according to the pathological conditions. The goal of dysphagia management is to prevent aspiration pneumonia, dehydration and malnutrition. If swallowing difficulties continue, alternative nutrition. PEG or intermittent tube feeding, could be helpfull. Multidisciplinary team approach should be adopted for dysphagia management.
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PMID:[Evaluation and management of dysphagia after stroke]. 1270 45

To achieve an efficient delivery targeting to post-ischemic cerebral vascular endothelium, PEG-liposome conjugated with transferrin (Tf) (Tf-PEG-liposome) was intravenously administered to the rats after 90 min of transient middle cerebral occlusion. The expression of Tf receptor (TfR) in the cerebral endothelium increased with a peak at 1 day after the reperfusion and returned to the control level by 6 days. The Tf-PEG fluorescence was marginally detectable in sham control brain, but remarkably increased with a peak at 2 days, showing about 70% of TfR positive vascular endothelium double-labeled with Tf-PEG. These results indicate that the Tf-PEG-liposome could be utilized as an efficient drug delivery tool to the brain after stroke.
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PMID:Targeting of post-ischemic cerebral endothelium in rat by liposomes bearing polyethylene glycol-coupled transferrin. 1273 37

Dysphagia is a common problem with individuals who have experienced a stroke. The interdisciplinary stroke team noted delays in clinical decision-making, or in implementing plans for patients with severe dysphagia requiring an alternative method to oral feeding, such as enteral feeding via Dobhoff (naso-jejunum) or PEG (percutaneous endoscopic gastrostomy) tubes, occurred because protocols had not been established. This resulted in undernourishment, which in turn contributed to clinical problems, such as infections and confusion, which delayed rehabilitation and contributed to excess disability. The goal of the project was to improve quality of care and quality of life for stroke patients experiencing swallowing problems by creating a dysphagia management decision-making process. The project began with a retrospective chart review of 91 cases over a period of six months to describe the population characteristics, dysphagia frequency, stroke and dysphagia severity, and delays encountered with decision-making regarding dysphagia management. A literature search was conducted, and experts in the field were consulted to provide current knowledge prior to beginning the project. Using descriptive statistics, dysphagia was present in 44% of the stroke population and 69% had mild to moderate stroke severity deficit. Delays were found in the decision to insert a PEG (mean 10 days) and the time between decision and PEG insertion (mean 12 days). Critical periods were examined in order to speed up the process of decision-making and intervention. This resulted in the creation of a decision-making algorithm based on stroke and dysphagia severity that will be tested during winter 2002.
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PMID:Meeting the nutritional needs of patients with severe dysphagia following a stroke: an interdisciplinary approach. 1462 95

Female CFY rats (21 months old) and male spontaneously hypertensive, stroke-prone (SHRsp) rats (3 months old), in conventional housing conditions, received placebo (5% gum arabic solution) or 50 mg/kg bw/day idebenone suspended in 5% gum arabic, through a gastric tube for 5 weeks; then their brains were elaborated as follows: (1) Total proteins as well as water-soluble and water-insoluble proteins (WSP and WIP, respectively) were separated from the brain homogenate by centrifugation at 500 X g. The WIP fractions were tested also in vitro by heat denaturation at 64 degrees C (10 min) and by 3 M urea treatment. In the placebo group of CFY rats the total protein content was 113.9 mg per g fresh weight. WIP amounted to 27.2% of the total proteins. Idebenone-treatment did not alter the protein composition in these old rats. In the SHRsp rats the total protein content of the brain cortex was almost identical with that of the normal, Wistar-derived CFY rats of much more advanced age (about 2 years). The idebenone-treatment did not alter the protein content of the brain cortex, although the WIP content and the heat-resistant fraction of it increased significantly in this strain. (2) The osmotic potential of brain tissue was determined by measuring swelling or shrinkage velocities in Ringer solution, the osmotic concentration of which was rendered hypo- or hyperosmotic by dilution or addition of polythylene glycol (PEG 6000), respectively. Idebenone treatment exerted no effect on the osmometric properties of the brain tissue in either the normal old or the SHRsp rats.
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PMID:The effect of idebenone on the total content and solubility characteristics of proteins and osmometric behavior of the intracellular mass in brain of CFY and SHRsp rats. 1537 76


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