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

In a retrospective study of 632 patients with pituitary disease we diagnosed pituitary insufficiency without hypersecretion of any pituitary hormone in 122 patients. Patients were substituted with sex hormones (76%), hydrocortisone (74%) and/or L-thyroxine (77%). 76% had additional growth hormone deficiency, as shown by an increase of growth hormone of less than 5 ng/ml after i.v. administration of L-arginine. In 17% of all patients the diagnosis of osteoporosis was proven or suspected radiologically. 57% had low bone mass of lumbar spine (dualphotonabsorptiometry) and 73% had low bone mass of the proximal forearm (singlephotonabsorptiometry). BMD values of pituitary insufficient patients were in the same range as those of patients with established osteoporosis. More than half of all patients (53%) complained of tiredness, exhaustion and muscle weakness. 40% suffered from adipositas. 77% had hyperlipidemia (68% hypertriglyceridemia and 42% hypercholesterinemia), 18% had hypertension. 14% of the patients had arteriosclerotic events in their history (myocardial infarction or stroke). These figures are higher than incidences shown in the German PROCAM-study. These data show an increased prevalence of osteoporosis and vascular diseases. This is in contrast to the general opinion, that patients with pituitary insufficiency are adequately treated by substitution with adrenal, thyroid and sex hormones. Whether other factors such as the additional growth hormone deficiency are responsible for these diseases has to be examined in prospective studies.
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PMID:[Increased prevalence of osteoporosis and arteriosclerosis in conventionally substituted anterior pituitary insufficiency: need for additional growth hormone substitution?]. 176 81

Moderate hypothermia (30 degrees C) induced before circulatory arrest is known to improve neurologic outcome. We explored, for the first time in a reproducible dog outcome model, moderate hypothermia induced during reperfusion after cardiac arrest (resuscitation). In three groups of six dogs each (N = 18), normothermic ventricular fibrillation cardiac arrest (no blood flow) of 17 minutes was reversed by cardiopulmonary bypass--normothermic in control group I (37.5 degrees C) and hypothermic to 3 hours in groups II (32 degrees C) and III (28 degrees C). Defibrillation was achieved in less than or equal to 5 minutes and partial bypass was continued to 4 hours, controlled ventilation to 20 hours, and intensive care to 96 hours. All 18 dogs survived. Electroencephalographic activity returned significantly earlier in groups II and III. Mean +/- SD best neurologic deficit between 48 and 96 hours was 44 +/- 8% in group I, 38 +/- 12% in group II, and 35 +/- 7% in group III (differences not significant). Best overall performance category 2 (good outcome) between 48 and 96 hours was achieved in none of the six dogs in group I and in four of the 12 dogs in the combined hypothermic groups II and III (difference not significant). Mean +/- SD brain total histologic damage score was 130 +/- 22 in group I, 93 +/- 28 in group II (p = 0.05), and 80 +/- 26 in group III (p = 0.03). Gross myocardial damage was greater in groups II and III than in group I--numerically higher overall and significantly higher in group III for the right ventricle alone (p = 0.02). Moderate hypothermia after prolonged cardiac arrest may or may not improve cerebral outcome slightly and can worsen myocardial damage.
Stroke 1990 Nov
PMID:Moderate hypothermia after cardiac arrest of 17 minutes in dogs. Effect on cerebral and cardiac outcome. 223 54

I used leg and arm paresis to predict outcome measured as extremity function in a prospective study of 75 consecutive hemiplegic patients admitted to an inpatient stroke rehabilitation unit. In each patient, extremity paresis was quantified according to the five-point scoring system advised by the Medical Research Council, upper extremity function was quantified using the Barthel Index subscore for feeding and dressing the upper body, and lower extremity function was quantified according to a five-point scoring of the ability to walk. Improvement was recorded for upper extremity function in 52% of the patients and for lower extremity function in 89%. Best extremity function was reached a mean +/- SEM of 9 +/- 3 and 10 +/- 4 weeks after stroke for the upper and lower extremities, respectively. In patients experiencing complete recovery, this occurred a mean +/- SEM of 7 +/- 2 weeks (for both upper and lower extremities) after the stroke. Only 8-11% of the patients with paresis scores of less than or equal to 2 regained independent extremity function after rehabilitation. Half of the patients with paresis scores of greater than or equal to 3 regained independent extremity function after rehabilitation, while the other half were able to perform extremity function with only minimal assistance. As predictors of extremity function, the Barthel Index subscore was slightly better (r = 0.64) than paresis score (r = 0.58). However, because evaluation of extremity paresis is easy, it appears to be useful as a preliminary predictor of outcome following stroke.
Stroke 1990 Feb
PMID:Arm and leg paresis as outcome predictors in stroke rehabilitation. 230

Minoxidil in combination with propranolol and diuretics was used in the treatment of 41 patients with severe refractory hypertension due to a spectrum of causes. These etiologies included essential hypertension, advanced renal failure, renovascular hypertension, and kidney transplant rejection. All patients had evidence of renal and cardiac damage prior to therapy and had failed to respond to all standard medications. The study included patients treated for periods of 3--42 months. Forty of the 41 patients responded most impressively to this therapy. Minoxidil was given in a dose of 7.5--40 mg daily. No tolerance to minoxidil was observed. Side effects were minimal. Three myocardial infarcts were observed. Two of these patients had had previous infarcts. One patient suffered a fatal cerebrovascular accident after he had deliberately stopped all medications. Nine patients showed sodium retention, which was easily controlled in 8 cases. Mild hirsutism was occasionally seen. Mean serum creatinine levels showed a slight decrease in the essential hypertension group after treatment. Best long-term results were seen in the essential hypertension and renovascular groups, although several cases with advanced renal disease and with kidney transplant rejection hypertension showed very impressive and encouraging outcomes.
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PMID:Minoxidil in the treatment of refractory hypertension due to a spectrum of causes. 615 48

Bone mineral loss after stroke in affected extremities can increase the prevalence of fractures that interrupt the rehabilitation programme and lower the level of activity. In stroke rehabilitation, precise bone mineral measurement is needed in order to assess the risk of fractures. We defined five regions-of-interest of the upper extremity (proximal humerus, distal forearm, distal radius, distal ulna and hand) consistently, so that the position was comfortable for hemiplegic patients to maintain during the measurement. The aim of this study was to determine whether our method using dual-energy X-ray absorptiometry is useful in hemiplegic patients. Ten normal subjects and 15 hemiplegic patients were studied. In normal subjects the reproducibility of our method was evaluated by repeated measurements of both the right and left sides. In hemiplegic patients the reproducibility was evaluated by repeated measurements of the affected side. The coefficient of variation (CV) values were obtained for BMD (0.7-1.7%) and BMC (0.7-2.3%) in normal subjects, and BMD (1.3-2.1%) and BMC (1.7-5.4%) in hemiplegic patients. The CV for the side-to-side BMD and BMC ratios in the normal subjects ranged from 1.1% to 2.2% and from 1.8% to 3.1%, respectively. Our study shows that the reproducibility of our method is sufficient for application to hemiplegic patients.
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PMID:Reproducibility of dual-energy X-ray absorptiometry in the upper extremities in stroke patients. 944 90

In May 1994 the Physiotherapy Department at John Hunter Hospital received a Commonwealth Best Practice in the Health Sector grant to design a critical pathway for the treatment of stroke. The implementation of the pathway at John Hunter Hospital and the introduction of the methodology to secondary sites (The Alfred Healthcare Group, Melbourne, and Royal Hobart & Repatriation General Hospitals, Hobart) resulted in the development of a Benchmarking Consortium. This paper will discuss the importance of benchmarking in understanding clinical processes, and the methodology employed to ensure that meaningful benchmarks were achieved.
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PMID:Using partner hospitals in collaborative benchmarking.. 1016 40

The mainstay of the management of severe pre-eclampsia is early referral, stabilization of the mother with antihypertensive therapy and anticonvulsants if required, full assessment of the mother and the baby, and delivery on the best day in the best way. It is to be remembered that delivery is the long-term cure, but most women get worse after delivery and most maternal deaths occur postpartum. It is important that doctors have the training to be aware of the dangers of this condition, guidelines to follow and senior support. Lowering blood pressure has been associated with a reduction in the mortality from cerebrovascular accident and early use of antihypertensive agents is beneficial to both mother and baby. The main cause of death is now pulmonary oedema, with renal failure a rare complication. It is important that, after delivery, vigilance is maintained and fluid replacement is given with care. It is better to 'run them dry' than to give fluid replacement that may encourage pulmonary oedema. Followup is required with counselling about what has happened and the prospects of recurrence.
Baillieres Best Pract Res Clin Obstet Gynaecol 2000 Feb
PMID:Severe pre-eclampsia and eclampsia. 1078 60

This review has shown that osteoporosis is a major public health problem because of its association with fracture. It is now possible to predict future risk of fracture by measuring BMD with noninvasive techniques. The relation between BMD and fracture is comparable to that between blood pressure and stroke such that fracture risk can be assessed from a definition of osteoporosis using bone mass and past history of fracture. Because some of the risk factors for peak bone mass, involutional bone loss, and fracture are now characterized, coupled with innovative agents capable of retarding bone loss, it is becoming possible to generate preventive strategies, for the entire population as well as for those at highest risk.
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PMID:Epidemiology of osteoporosis. 1128 89

Coordinated efforts to identify susceptibility genes for unipolar major depressive disorder (MDD) and related disorders are now underway. These studies have focused on recurrent, early-onset MDD (RE-MDD), the most heritable form of this disorder. The goal of this study was to characterize the burden of MDD and other mood disorders, comorbid mental disorders, and excess mortality in RE-MDD families. A total of 81 families were identified through probands over the age of 18, who met criteria for recurrent (> or = 2 episodes), early-onset (< or = 25 years), nonpsychotic, unipolar MDD (RE-MDD), and included 407 first-degree relatives and 835 extended relatives. Psychiatric diagnoses for probands and their family members who provided blood samples were formulated from structured personal interviews, structured family history assessments, and available medical records. The remaining family members who participated and those who were deceased were evaluated through the family history method augmented by available medical records. Best estimate diagnoses were made during a consensus conference according to established diagnostic criteria. Approximately half of the first-degree relatives and a quarter of extended relatives of RE-MDD probands suffered from at least one mood disorder, typically MDD. As commonly observed for other oligogenic, multifactorial disorders, the severity of MDD reflected by age at onset and number of episodes attenuated with increasing familial/genetic distance from the proband. A substantial fraction of RE-MDD probands and their first-degree relatives met diagnostic criteria for additional psychiatric disorders that include prominent disturbances of mood. The deceased relatives of RE-MDD probands died at a median age that was 8 years earlier than for the local population; over 40% died before reaching age 65. These differences in mortality statistics resulted from a shift toward younger ages at death across the lifespan, including a fivefold increase in the proportion of individuals who died in the first year of life. Several-fold increases in the proportion of deaths by suicide, homicide, and liver disease were observed among the relatives of RE-MDD probands. However, the rank order of the three most common causes of death-heart disease, cancer, and stroke-remained unchanged and differences in the proportions of deaths from the remaining causes were small. RE-MDD is a strongly familial condition with a high rate of psychiatric comorbidity, whose malignant effects have a significant negative impact on the health and longevity of patients and their family members.
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PMID:Malignancy of recurrent, early-onset major depression: a family study. 1180 16

Arterial occlusion resulting from primary thrombus formation in an artery or due to embolization from a site elsewhere in the circulation is uncommon in women of childbearing age. Myocardial infarction, stroke and peripheral arterial occlusion are rare in pregnant or puerperal women. Although atherosclerosis is the most common cause of arterial thromboembolism in the general population, other mechanisms--for example, prosthetic heart valves and drugs which cause vasospasm--are also important in young and pregnant patients. The clinical sequelae of arterial thromboembolism include sudden death and significant long-term morbidity. The best management must be the recognition of women at risk and, where possible, risk reduction and the introduction of measures to prevent acute events.
Best Pract Res Clin Haematol 2003 Jun
PMID:Arterial thromboembolism in pregnancy. 1276 93


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