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

Fifty-two patients with a mean age of 67.6 years underwent coronary artery bypass plus mitral valve replacement from 2 April 1984, through 6 February 1989. All but four of these 25 males and 27 females were in the New York Heart Association Functional Classes III and IV, with presenting symptoms of angina and/or dyspnea. Twenty-four patients (44.2%) presented with acute myocardial infarctions, and eleven patients (21.2%) had a past history of rheumatic fever or rheumatic heart disease. Forty-five patients (86.5%) had a diagnosis of coronary artery disease plus mitral regurgitation. Treatment included a mean of 2.3 bypass grafts per patient plus mitral valve replacement with Carpentier-Edwards (41), St. Jude (10), and Bjork-Shiley (1) prostheses. The four operative deaths (7.7%) were attributed to congestive heart failure (1), mediastinal bleeding (1), mediastinitis (1), and stroke (1). There were eight late cardiac deaths (16.7%) and six late noncardiac deaths (12.5%), a mean of 16.6 and 18.9 months postoperatively, respectively. Thirty-four patients have survived from 10 to 65 (mean 33.7) months postoperatively with a mean New York Heart Association Functional Class 1.6. Follow-up determination of patients' attitudes toward their surgery was ascertained in 28 of the 34 survivors, and 26 (92.8%) patients indicated that they were pleased with their surgery. These results compare favorably with data reported in the recent literature. In addition, the study shows that patients requiring supportive treatment in a critical care unit preoperatively had the same operative mortality but more postoperative complications and a longer mean hospital stay than the equal number of patients who were not in a critical care unit preoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
Conn Med 1990 Dec
PMID:Coronary artery bypass plus mitral valve replacement. A five-year study. 228 98

The prevalence, reversibility, and mortality of secondary hypertension among 3783 patients with moderately severe nonmalignant hypertension attending the Glasgow (Scotland) Blood Pressure Clinic were assessed. Underlying causes of hypertension were found in 297 patients (7.9%). Eighty-seven patients (2.3%) were considered to have a potentially reversible cause for their hypertension, including the oral contraceptive pill (38 patients), renovascular disease (27 patients), and primary hyperaldosteronism (ten patients), but of these only 33 patients (0.9% of total clinic population) were cured by specific intervention. Two hundred ten patients (5.6%) had irreversible renal parenchymal disease and significantly higher mortality than men and women with other causes of hypertension. Excess deaths in the renal group were attributed to renal failure (International Classification of Diseases [ICD] 580 to 589) and vascular causes (ICD 390 to 458) but not to cancer (ICD 140 to 208; 235 to 239) or other nonvascular disease. These results suggest that investigation of hypertension for an underlying cause will reveal a small number of patients with treatable disorders, of whom only a few will be cured by specific intervention, and a moderate number with irreversible disease who are at high risk of myocardial infarction and stroke.
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PMID:Secondary hypertension in a blood pressure clinic. 360 86

We report two patients with arterial hypertension (AHT) secondary to Conn's disease and cerebral vascular accident (CVA). Both had histories of long-standing AHT that had been poorly controlled with drugs, though no complications had developed up to the time of presentation. One CVA was a hemorrhage in the right capsular-lenticular region and the other was a cerebral ischemic infarction. Blood tests done upon admission found low potassium levels. The final clinical-pathological diagnosis was primary hyperaldosteronism secondary to suprarenal adenoma. After laparoscopic surgery AHT reverted to normal in one patient. Although Conn's disease is a rare cause of AHT, early diagnosis and treatment can provide a cure and prevent the development of severe complications.
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PMID:[Cerebral vascular complications in Conn's disease: report of two cases]. 761 40

One hundred and thirty-five patients with malignant hypertension seen over a period of 11 years (1979 to 1989) at a referral hospital were analyzed to characterize the clinical features and etiology of this disease. Ninety male and 45 female patients with an average age of 38.2 +/- 1.4 years were studied. Malignant hypertension was the presenting feature in 68 patients. The etiology included essential hypertension in 88 patients and a secondary cause in 47 patients. Secondary causes included a renovascular etiology in 20 patients, renal parenchymal disease in 19, pheochromocytoma in 6 and Conn's syndrome and adrenal carcinoma in one patient each. Among the 20 patients with renovascular hypertension, Takayasu's arteritis was seen in 15 (75%). The mean age of patients with essential hypertension was 41.7 + 1.14 years while the mean age in patients with secondary hypertension was 33.2 + 1.96 years. Duration of preexisting hypertension was longer in essential hypertensives (2.42 + 0.45 years) than in patients with secondary hypertension (1.27 + 0.41 years, p < 0.05). Raised serum creatinine was seen in 93 patients. Seventy-seven patients had left ventricular hypertrophy on ECG. Ninety-six patients were followed for a period ranging from 18 months to 10 years (mean 32 months). Sixteen patients died during hospital stay while 6 patients died during the follow-up period. The deaths were related to the effects of uncontrolled hypertension including, renal failure (11), stroke (6), congestive cardiac failure (3) and myocardial infarction (1).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Malignant hypertension in north west India. A hospital based study. 783 Mar 25

Stroke is a common, devastating and frightening event among older persons, often resulting in death or major loss of independence. Professional and lay attitudes of the past have assumed an inevitable and immutable course of stroke risk progression with age. Although stroke is strongly age-associated, recent data have accumulated demonstrating reduction in stroke rate by preventive interventions in older patients with risk factors. Statistically significant stroke reduction has been achieved by 1) antihypertensive treatment of patients with elevated systolic blood pressure, even beyond age 80; 2) anticoagulation with warfarin for patients with chronic or intermittent non-valvular atrial fibrillation; 3) use of low-dose aspirin in patients with TIA or nondisabling stroke; and 4) carotid endarterectomy for patients with symptoms and ipsilateral serve stenosis. Clinical strategies to prevent stroke in older adults are now tested and proven useful; they should be used as indicated in older persons at risk.
Conn Med 1993 May
PMID:Stroke prevention in the elderly. 831 44

Renovascular hypertension and high renin hypertension were found to be associated with an excess prevalence of carotid artery atherosclerotic lesions and to a higher risk of stroke, respectively, as compared to low-to-normal renin hypertension. Primary aldosteronism, being characterized by hypertension and a chronically suppressed plasma renin activity, should be accompanied by a low prevalence of carotid artery lesions. To verify this hypothesis we investigated prospectively, by a high resolution duplex ultrasound technique, the prevalence of extracranial carotid artery lesions in a case-controlled study of 34 (22 women and 12 men, aged 22 to 76 years) patients with no history or symptoms of cerebrovascular disease. Primary aldosteronism was diagnosed in 17 patients; 12 had a surgically confirmed unilateral aldosterone-secreting adenoma; and 5 had idiopathic hyperaldosteronism. Each primary aldosteronism patient was individually matched with a control with primary hypertension for sex, race, age, body mass index, casual blood pressure levels, duration of hypertension, smoking, diabetes mellitus, total serum cholesterol, and triglycerides. After the matching, the two groups were similar in terms of demographic features and overall cardiovascular risk profile (all P = NS). However, plasma renin activity and aldosterone levels were significantly lower and higher, respectively, in primary aldosteronism than in primary hypertensive patients. In primary aldosteronism the overall prevalence of carotid artery lesions at duplex was 59%, not significantly different from that (53%) found in primary hypertensives. Thus, at variance with renovascular hypertension, primary aldosteronism is not associated with an excess prevalence of carotid artery lesions.
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PMID:Prevalence of extracranial carotid artery lesions at duplex in primary aldosteronism. 842 67

To define the causal relationship of ischemic cerebral infarction to automobile accidents in hospitalized patients a computerized hospital record search with ICD-9 diagnostic codes 433 and 434 for occlusive cerebrovascular disease, and E810 and E819 for motor vehicle traffic accidents was conducted over a three-year period. Inclusion criteria required patients be identified as the driver of the vehicle and demonstrate computed tomographic (CT) evidence of an evolving cerebral infarction on serial scans. Of 2,844 ischemic cerebral infarctions admitted to the hospital during the study period, four met the selection criteria. In three, stroke was the cause and in one, the result of the accident. When stroke preceded the accident, visual field defect impaired consciousness, and/or loss of motor control were major contributing factors. Head CT, detailed accident scene history, and vascular disease risk factors were most important in determining a cause-and-effect relationship of stroke to the accident.
Conn Med 1996 Mar
PMID:Stroke and automobile accidents. 877 36

The basic clinical pathophysiology of primary aldosteronism (PAL) was described by Conn in terms of autonomous production of aldosterone, secondary suppression of renin and development of hypertension with hypokalaemic alkalosis. Conn recognised a normokalaemic form of the syndrome and suggested that it might masquerade as essential hypertension and be not uncommon. This was hotly disputed at the time, and normokalaemic PAL considered rare until recently, and, as a consequence, overlooked. The advent of a simple screening test, the aldosterone-renin ratio, led to recognition that normokalaemic forms are not uncommon. In fact, PAL may be the commonest specifically treatable and potentially curable form of hypertension so far identified. In all patients with PAL confirmed by lack of suppressibility ("autonomy") of aldosterone production, Familial Hyperaldosteronism Type I (FH-I, glucocorticoid-remediable hyperaldosteronism, reviewed elsewhere in this issue) should first be excluded by dexamethasone suppression or genetic testing. Capable of causing fatal stroke in young people affected by this dominantly inherited disorder, it can be reversed by doses of glucocorticoids such as dexamethasone which partially suppress endogenous ACTH without producing "steroid" side-effects. The remaining varieties of PAL may eventually also be shown to have a genetic basis, but are currently treated either by excision of a solitary aldosterone-secreting tumour or by antagonism of aldosterone's action in the renal tubule. It is possible that both adrenal cortices are genetically predisposed to overproduction of aldosterone in all varieties of PAL, whether because of anomalous regulation of aldosterone secretion or because of a tendency towards hyperplasia and neoplasia. Aldosterone-producing adenomas (APA's) can be divided into two main subtypes based on morphology and biochemical behaviour. The first subtype to be morphologically and biochemically characterised is composed predominantly of fasciculata-like cells and is unresponsive to angiotensin II (ALL-U-APA). The more recently characterised subtype is composed predominantly of glomerulosa-like cells, is responsive to angiotensin II (AII-R-APA) and could previously have been misdiagnosed as bilateral hyperplasia. The renin gene is often overexpressed in the second variety of adenoma, and in surrounding non-tumorous cortex, and the two subgroups show different allelic frequencies for RFLP's of the constitutive renin gene and the constitutive ANP gene locus. Unilateral, solitary, benign adrenal cortical adenomas producing aldosterone (APA's) represent a potentially surgically curable form of hypertension. Adrenal venous sampling (AVS) should always be performed because APA's are biochemically recognisable by adrenal venous steroid measurement before they are identifiable by computerised tomography or scintigraphy, and adrenal masses seen on CT may not be responsible for PAL. The secretory activity of adrenal masses must therefore be established by AVS before surgical removal. Discovery of an adrenal mass on CT requires formulation of a plan, whether or not it is found to be secreting hormones in excess. Independently of the treatment of the patient's hypertension, an apparently nonfunctioning adrenal mass ("incidentaloma") should be removed if 2.5 cm or more in diameter, because of the risk of cancer. Smaller masses require long-term follow-up. Primary aldosteronism not lateralising on AVS should be treated with low dose spironolactone, or with amiloride. For any such patients intolerant of medical treatment, laparoscopic removal of the adrenal showing higher production of aldosterone on AVS is an option worthy of consideration.The resultant reduction in mass of tissue autonomously secreting aldosterone should improve hypertension, as aldosterone productions falls below a critical level, and may even be curative in the short, medium or long term, depending on the rate of growth and activity of au
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PMID:Primary aldosteronism. 922 Dec 68

Primary aldosteronism (PA) is widely believed to be a relatively benign form of hypertension associated with a low incidence of vascular complications. However, several recent studies showed that cardiovascular complications were not rare in PA. PA is known as one of the most typical forms of sodium-sensitive hypertension. Recently, we found that the sodium sensitivity of blood pressure was a marker for greater risk for cardiovascular complications, especially stroke, in patients with essential hypertension. Therefore, we investigated cardiovascular complications in 58 patients with PA confirmed to be Conn's adenoma. Cardiovascular complications were found in 34% of 58 patients. Coronary artery disease was found in only one patient (1.7%), as angina pectoris. Stroke was found in nine patients (15.5%), four patients (6.9%) with cerebral infarctions and five patients (8.6%) with cerebral hemorrhages. Proteinuria and renal insufficiency were found in 14 (24.1%) and 4 (6.9%) patients, respectively. The incidence of cerebral infarction and renal insufficiency was greater in men than women. The prevalence of proteinuria was greater in patients with than without stroke (P = 0.03) among those aged older than 40 years. These results indicated that cardiovascular complications, especially stroke and proteinuria, were common in patients with PA, and proteinuria might be an indicator for stroke as target-organ damage.
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PMID:Cardiovascular complications in patients with primary aldosteronism. 1002 36

A 63-year-old man with multiple left atrial myxomas presenting with right hand weakness is described. Two-dimensional echocardiography obtained during the evaluation for his stroke showed a large left atrial mass. At surgery, two separate left atrial myxomas were excised. Pathology confirmed the diagnosis. Although left atrial myxomas are uncommon, they should be included in the differential diagnosis of stroke, especially in patients who present without cardiovascular or cerebrovascular risk factors. The absence of cardiac symptoms and signs does not rule out a cardiac myxoma.
Conn Med 1999 May
PMID:Left atrial myxomas presenting with right hand weakness. 1036 3


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