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)

Thirty-three cases of infective endocarditis presenting during a 6.5 year period to a district general hospital were analysed retrospectively. The annual incidence was 22 cases per million population. Twenty-two cases had pre-existing cardiac disease, mainly valvular disease-usually rheumatic (nine cases) and prosthetic valves (10 cases). Recognizable precipitants such as recent surgery were uncommon. Two cases presented after deliberate drug overdose possibly due to depression exacerbated by systemic disease. Symptoms were usually non-specific. All but two cases had murmurs and most were pyrexial. Splinter haemorrhages and clubbing were seen in about 20% of cases. Viridans-type streptococci were the commonest infecting organisms (14 cases). Staphylococcal infection (six cases) was confined to intravenous drug abusers and patients with prosthetic valves. Five cases were culture negative. Cardiac failure was present in 13 cases at presentation and developed in seven others during treatment. Acute valve replacement was necessary in eight cases, and late replacement in three. Renal impairment (plasma urea > 8 mmol/l and/or plasma creatinine > 120 mumol/l) occurred in 19 cases during the course of their illness. Embolic phenomena occurred in 12 patients and mostly involved the central nervous system. In the 8 fatal cases, the cause of death was cardiac failure in six, cerebrovascular accident in one, and myocardial infarction in one. Four of the six patients who subsequently died of cardiac failure had been referred for surgery. Both those who were not referred had coexisting medical problems. Factors associated with increased mortality were age, male sex, cardiac failure (P < 0.01), renal impairment (P < 0.05), and embolic phenomena (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Infective endocarditis in a district general hospital. 143 86

Aspirin (acetylsalicylic acid) and its salicylate derivatives are effective antipyretic, analgesic, and anti-inflammatory agents that are still very widely used by the elderly despite the advent of newer, potentially safer nonsteroidal anti-inflammatory drugs (NSAIDs). However, none of the new NSAIDs have been proven to be more effective than aspirin or salicylic acid. Chronic salicylate intoxication which is most common in the elderly, may occur with therapeutic doses. Increased toxicity in older patients often appears due to inadvertent overdosage. Dual prescribing or additional use of nonprescription salicylates are some causes of unwitting long term toxicity. According to some studies, systemic clearance of salicylate (mainly by hepatic metabolism) is reduced with age, as is renal elimination. These changes are of increased importance in the elderly using high therapeutic doses of salicylates when metabolism is saturated and more unchanged drug is available for renal excretion. In the face of renal impairment, the risk of toxicity is increased. The diagnosis of acute salicylate intoxication generally does not pose diagnostic problems. Patients often present with a history of intentional overdose, with hyperventilation, fever, and nausea. The diagnosis can be confirmed by measuring serum salicylate concentrations. Chronic intoxication often poses a diagnostic dilemma with atypical presentations mimicking other disease states such as diabetic ketoacidosis, delirium, cerebrovascular accident, myocardial infarction or cardiac failure. The diagnosis of salicylate intoxication should be borne in mind when an older patient presents with recent deterioration in activities of daily living with no known cause. Plasma salicylate concentrations should be measured if salicylate intoxication is suspected, even if there is no documented history of salicylate ingestion. The risk of salicylate nephrotoxicity is also increased with age, and upper gastrointestinal haemorrhage is associated with increased mortality in older age groups. Treatment of acute toxicity consists of prompt recognition of salicylate intoxication, use of activated charcoal, correction of acid-base abnormalities, general supportive measures, and if concentrations are extremely high, dialysis can be effectively used. Chronic toxicity, which can occur even with marginally high salicylate concentrations, is treated with drug withdrawal and supportive therapy. Chronic salicylate toxicity can be averted by prescription of conservative doses of drug, avoidance of concomitant use of different salicylate preparations, and therapeutic monitoring to guide dosage. Renal function should be monitored to detect nephrotoxicity from chronic salicylate therapy. Patients should be regularly screened for evidence of gastrointestinal bleeding.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Salicylate intoxication in the elderly. Recognition and recommendations on how to prevent it. 155 71

Enalapril is an effective agent in the treatment of mild to severe hypertension. It is equally effective in elderly and young adult patients but appears to be more effective in white than in black hypertensive patients. Following treatment with enalapril, an assessment of maximum exercise performance found a decrease in total peripheral resistance without significant changes in cardiac output, heart rate, or stroke volume compared with pretreatment values. In addition, there have been reports of reversal of left ventricular hypertrophy in enalapril-treated hypertensive patients. Enalapril is also effective and well tolerated in hypertensive patients with renal impairment of varying etiology. The most common adverse experiences reported in controlled clinical trials were headache (5.2%), dizziness (4.3%), and fatigue (3.0%). In high-risk hypertensive patients, no enalapril-treated neutropenia, proteinuria, dysgeusia, or ageusia were reported. It may be concluded that the benefit-to-risk ratio of enalapril is among the best of the antihypertensive therapies currently available.
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PMID:Enalapril: benefit-to-risk ratio in hypertensive patients. 169 15

While treatment of hypertension has been effective in preventing stroke, the malignant phase, cardiac failure, and renal impairment, it has been less useful in limiting coronary artery disease and its consequences. Hopes that the increasing use of beta-blockers in the prophylactic treatment of hypertension might have an impact on hypertension-related coronary events have been only in part realised. Some of the possible reasons and prospects for the future are considered.
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PMID:Factors influencing treatment of hypertension. 248 Nov 75

In any therapeutic situation, the choice of drug therapy depends on an estimation of relative risk and benefit. With respect to moderate hypertension, and with less certainty, mild hypertension, the use of drug therapy has resulted in a decrease in overall mortality, a decrease in the incidence of stroke and renal impairment, but little or no change in the incidence of ischemic heart disease. For several years, the choice of first drug in these situations has rested between thiazide diuretics and beta-adrenoceptor blocking agents. There is probably little to choose between these two groups in terms of efficacy, and equally there is little evidence that patient response to one or other agents can be predicted either on demographic or biochemical evidence. There are, however, several studies both in Africa and America suggesting that black patients have a relatively greater hypotensive response to thiazides than to beta-blockers. The adverse reaction profile of these two groups is quite different. There is currently much debate whether the administration of large doses of thiazide diuretics (for example, 10 mg bendrofluazide per day) may cause a constellation of metabolic side effects (hyperlipemia, hypokalemia, abnormal glucose tolerance, and hyperuricemia) which may result in an increase of the risk of developing coronary artery disease in spite of lowering blood pressure. Further, there is no good evidence that the hypotensive effect of diuretics is dose dependent. On the other hand, the evidence that beta-blockers when used as antihypertensive agents have a primary preventive effect for ischemic heart disease is currently very small.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Angiotensin converting enzyme inhibition in clinical practice. Re-examination of step care: choice of first drug. 258 Jan 63

Reduction of elevated blood pressure is effective in reducing morbidity and mortality from cardiovascular disease in general. Striking decreases in stroke, congestive heart failure, and renal impairment have been observed when blood pressure is reduced. However, the ability of traditional, diuretic-first, stepped-care therapeutic algorithms to reduce the occurrence of myocardial infarction or angina has been exceedingly difficult to demonstrate. An increased frequency of sudden death among hypertensive men with electrocardiographic abnormalities has been observed in some diuretic-based treatment trials. The failure of conventional therapy to reduce coronary artery disease and death has forced a re-appraisal of antihypertensive treatment. The risk factors for coronary disease are reviewed in detail with an emphasis on the impact of various classes of antihypertensive drugs on these factors. The emergence of effective antihypertensive agents that lower blood pressure without adversely affecting cardiovascular risk factors provides a new opportunity to further extend the benefit of treatment by reducing such risk.
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PMID:Cardiovascular risk factors and antihypertensive therapy. 290 69

To evaluate the influence of renal function on the efficacy of converting-enzyme inhibition in patients with severe chronic heart failure, we measured the long-term hemodynamic and clinical responses to captopril in 101 consecutive patients with heart failure grouped according to pretreatment serum creatinine concentration (group I, less than 1.4 mg/dL; group II, 1.4 to 2.8 mg/dL; and group III, greater than 2.8 mg/dL). After 1 to 3 months of treatment, patients with preserved renal function (group I) had greater increases in stroke volume index and greater decreases in left ventricular filling pressure and systemic vascular resistance than did patients with renal impairment (groups II and III) (p less than 0.05). Clinical improvement paralleled these hemodynamic benefits; only 2 of 12 patients with severe renal insufficiency (group III) improved clinically compared with 29 of 40 patients with preserved renal function (group I) and 29 of 49 patients with mild-to-moderate renal impairment (group II), (p less than 0.005). Therapy-limiting rash and dysgeusia occurred most frequently in patients with renal impairment. Our findings support an important role for the kidneys in mediating the beneficial actions of captopril in patients with severe congestive heart failure.
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PMID:Influence of renal function on the hemodynamic and clinical responses to long-term captopril therapy in severe chronic heart failure. 293 91

From August 1974 to January 1985, 53 patients (26 men; seven Maoris) mean age 45 (SD 15) years, with diabetes mellitus for a mean of 12 (SD nine) years had a renal biopsy and were followed. Indications for biopsy were nephrotic syndrome, proteinuria, renal impairment (five) and hematuria (one). Mean plasma creatinine concentration was 0.22 (SD 0.18) mmol/L and protein excretion 3.4 (SD 2.5) g/24 h. Diabetic nephropathy was demonstrated in 39 patients and significantly associated with retinopathy and insulin dependent diabetes mellitus (IDDM). Of the 39 patients followed for 25.7 (SD 22.8) months, 18 had died (nine myocardial infarction, six uremia, two sepsis, one stroke) and nine had begun dialysis. The five-year cumulative renal survival was 28%. The presence of the nephrotic syndrome and the plasma creatinine concentration at presentation were the best predictors of survival. Diabetics with IDDM of 20 years duration, retinopathy and heavy proteinuria, who survive the other complications of their disease, are likely to have diabetic nephropathy requiring renal replacement therapy.
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PMID:Renal disease in diabetics--which patients have diabetic nephropathy and what is their outcome? 324 62

The present study was undertaken to elucidate the effects of ketanserin and trichlormethiazide on blood pressure in stroke-prone spontaneously hypertensive rats (SHRSP). Oral ketanserin and trichlormethiazide were administered to separate groups for 4 weeks. Combined ketanserin and trichlormethiazide was also administered and the effects observed. 1) In both ketanserin and trichlormethiazide administered groups, significant antihypertensive actions were observed as compared with the non-treated SHRSP. 2) In the ketanserin administered group, a significant increase in water drinking activity was observed, accompanied with an increased urinary volume. 3) In the trichlormethiazide administered group, urinary sodium excretion decreased significantly, accompanied with an increased urinary norepinephrine excretion. 4) Combined administration of ketanserin and trichlormethiazide enhanced the decreases in blood pressure which were produced by single administration of either ketanserin or trichlormethiazide. Moreover, both the increasing tendency in the urinary sodium excretion and the decreasing tendency in the urinary norepinephrine excretion occurred after the combined administration in SHRSP. These findings suggest that ketanserin produces an antihypertensive effect and may act prophylactically for thiazide-induced renal impairment in SHRSP.
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PMID:[Effects of chronic oral administration of ketanserin and trichlormethiazide on blood pressure in stroke-prone spontaneously hypertensive rats]. 338 94

Sixteen patients with progressive systemic sclerosis (PSS), including 3 with the "CREST" (calcinosis, Raynaud's, esophageal dysfunction, sclerodactyly, and/or telangiectasias) variant, were evaluated with resting M-mode echocardiography and noninvasive measurements of cardiac output at rest and during submaximal exercise to determine the nature and extent of any cardiovascular impairment. No patient had arterial hypertension, significant renal impairment, clinical evidence of large vessel coronary artery disease, or severe pulmonary dysfunction. The duration of disease was 1 to 12 years (9 to 30 for patients with the CREST variant). Echocardiographic abnormalities included increased right ventricular dimension (3 patients), reduced left ventricular ejection fraction (3 patients), and pericardial effusion (3 patients). Cardiac index (CI) and stroke volume index (SVI) at rest were similar for patients and controls. Patients and controls were exercised to similar heart rates (130 +/- 3 vs 124 +/- 4; p, NS). Total peripheral resistance (TPR) was higher for patients (1123 +/- 81 vs 810 +/- 44 dyn X s X cm-5) and their mean SVI failed to increase significantly compared with sitting rest values (30 +/- 2 vs 35 +/- 3 ml/m2). The control subjects had the expected increase in SVI (36 +/- 2 vs 51 +/- 5; p less than 0.01). Ten patients with an abnormal hemodynamic response to exercise had a normal echocardiographic circumferential fiber shortening (VCF) or ejection fraction (EF) at rest. The data indicate that PSS patients have a greater degree of cardiovascular dysfunction than would be predicted from clinical data and laboratory evaluation of cardiovascular and pulmonary function at rest. Multiple mechanisms, including right and left ventricular dysfunction and abnormal vasoconstrictor activity, are likely to contribute to the reduction in exercise capacity seen in patients with PSS.
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PMID:Cardiovascular function in patients with progressive systemic sclerosis (scleroderma). 621 13


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