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

Though major differences exist in subcategory mortality levels, cardiovascular disease remains a leading cause of death among both Asian Chinese and Westerners. This paper examines the possible relationship between cardiovascular mortality and biochemical, diet and lifestyle factors based on two surveys in China. Statistically significant associations indicate five variables negatively correlated: molybdenum, oleic acid, liquor consumption (males), legumes, and age at first pregnancy with ischemic heart disease; molybdenum, oleic acid (females) and age at first pregnancy with hypertensive heart disease; and legumes and age at first pregnancy with stroke. Five variables were positively correlated: triglycerides and herpes antibodies with ischemic heart disease; salt and phosphorus (females) with hypertensive heart disease; and only albumin (males) with stroke. Some findings confirm those observed in the West (salt, triglycerides, herpes, legumes, oleic acid, and liquor), but molybdenum and age at first pregnancy have not been emphasized previously. Still others significant in the West have not been observed here, such as cholesterol and smoking.
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PMID:Diet and blood nutrient correlations with ischemic heart, hypertensive heart, and stroke mortality in China. 134 47

Overall cardiovascular function at rest in most healthy elderly individuals is adequate to meet the body's need for pressure and flow. The resting heart rate is unchanged. Heart size is essentially not different in younger vs older adults, but heart wall thickness increases modestly, due largely to an increase in myocyte size. While the early diastolic filling rate is reduced, an enhanced atrial contribution to ventricular filling in elderly individuals maintains filling volume at a normal level. Although systolic pressure at rest increases with age, the resting end-systolic volume and election fraction are not altered, due partly to the increase in left ventricular thickness. Physical work capacity declines with advancing age, but the extent to which this can be attributed to a decrement in cardiac reserve is not certain. Part of the age-related decline in maximum oxygen consumption appears to be due to peripheral rather than central circulatory factors, e.g. to a decrease in muscle mass with age during exercise, the ability to direct blood flow to muscles, and the ability of muscle to utilize oxygen. Some elderly individuals exhibit cardiac dilatation which produces an increased stroke volume sufficient to counter the well-known age-related decrease in exercise heart rate, such that high levels of cardiac output can be maintained during exercise. Still, in these individuals, the exercise-induced reduction in end-systolic volume and increase in ejection fraction is less than in younger individuals. A similar haemodynamic profile occurs in individuals of any age who exercise in the presence of beta-adrenergic blockade.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Changes in cardiovascular function with aging. 218 39

In order to initiate early activation and counteract the negative effects of bed rest, 71 patients acutely admitted to hospital with a confirmed stroke were randomized to either training or control wards. Sixty-three persons participated in a first orthostatic tolerance test on days 5-7 after admission, which was replicated on days 10-12. A third test was performed three months later. Regular stand-ups were initiated on days 1-2 after admission to hospital and were continued for 1-2 weeks. The trained group had a lower increase in heart rate during tilting and a lower proportion of severely disabled patients on days 5-7 compared with the control group. This difference was statistically significant but cannot be proved to be a result from the regular stand-ups. Still, this minimum type of early activation can be recommended for acute stroke patients, mainly those with a cerebral infarction, who are able to cooperate with the nursing staff.
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PMID:Orthostatic tolerance training of stroke patients in general medical wards. An experimental study. 269 5

Heart rate (HR), central venous pressure (CVP), mean arterial pressure (MAP), and cardiac index (CI) were measured in anesthetized rats subjected to a 40% body surface area full-thickness scald burn. Postburn intravenous fluid therapy with lactated Ringer's (5 ml/hr), plasma (2.5 ml/hr), or very hypertonic saline (2,400 mosmol/l) (0.75 ml/hr) was compared to unburned or burned, untreated controls. HR and CVP were not influenced significantly by thermal injury. MAP decreased steadily in the untreated group from 110 mmHg to 80 mmHg at 3 hr postburn. In the fluid-treated groups MAP did not change significantly. During the first 15 min postburn, CI was reduced to 58-71% of control values (P less than 0.01). CI increased during Ringer's and plasma infusion to 74-80% of control values (P less than 0.02 vs. unburned). Despite infusion therapy, hematocrit increased from 48 to 52%, clearly less than in the unresuscitated group (increase from 48 to 58%). Theoretically, the 2,400 mosmol/l saline would expand extracellular volume by five to six times the infused volume. Still, CI was reduced by 55% at 3 hr postburn in the hypertonic saline as well as in the burned, untreated group (P less than 0.001 vs. unburned). The low CI was mainly due to a reduced stroke volume.
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PMID:Thermal skin injury: I. Acute hemodynamic effects of fluid resuscitation with lactated Ringer's, plasma, and hypertonic saline (2,400 mosmol/l) in the rat. 291 70

Changes in potassium levels clearly have hemodynamic significance. In mechanistic terms, they affect the transmembrane potential of vascular smooth muscle cells. They also influence the levels and activity of pressor hormones and of intracellular messengers involved in vasoconstriction. Furthermore, they alter the body's handling of sodium. As the net result, perhaps, of these phenomena, chronic supplementation of dietary potassium is associated with a small but appreciable decline in blood pressure. In humans, the effect, which could be predicted epidemiologically, has been demonstrated in studies of potassium administration in hypertensive patients. In experimental animals, the effect is most pronounced in salt-sensitive models of hypertension. The studies done to date do not permit firm recommendations about modification of dietary potassium content for hypertensive patients. However, in certain clinical settings, potassium repletion even for mildly depressed levels is vitally important, and in other circumstances, excess potassium clearly is dangerous. Still, indications are emerging that potassium may be valuable in preventing renal damage and stroke, quite apart from any effect on hypertension itself. Continued investigation will be of great value in the effort to arrive at a firm understanding of the precise roles that potassium may play in the treatment of hypertension or the prevention of its sequelae.
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PMID:Potassium: weighing the evidence for supplementation. 314 7

Continuous-wave Doppler ultrasonography and clinical examination were used over a 2-year period to monitor the natural history of subclavian stenoses and occlusions in 67 patients. Thirty-nine presented with subclavian steal and 28 without. We also studied an additional group of 29 patients who had undergone surgery for subclavian steal syndrome and vertebrobasilar transient ischemic attacks. The results, in terms of both ultrasonographic and clinical criteria, demonstrate the benign nature of the subclavian steal syndrome: all neurologic signs and symptoms were of a transient character. Spontaneous remission of vertebrobasilar transient ischemic attacks occurred in approximately 50% of the initially symptomatic patients, and only 15% of the initially asymptomatic patients experienced vertebrobasilar transient ischemic attacks during follow-up. Doppler ultrasonography revealed progression during follow-up in only 17% of the subclavian stenoses, and in 13% a stenosis was no longer detectable. Still-ongoing brainstem transient ischemic attacks were reported in 24% of the operated patients. The most important factor for the lack of improvement was the occlusion of the bypass. Continuation of transient neurologic symptoms could be observed in only 14% of the patients with intact carotid-subclavian bypass. In conclusion, indications for surgical treatment of the subclavian steal syndrome should be restricted to cases in whom vertebrobasilar transient ischemic attacks occur frequently and are either debilitating or greatly frighten the patient.
Stroke 1988 Apr
PMID:Ultrasonographic follow-up of subclavian stenosis and occlusion: natural history and surgical treatment. 328 16

1. Using deafferented preparations of the stomatogastric nervous system of spiny lobsters (Panulirus interruptus), we stimulated the central soma of the Anterior Gastric Receptor neuron (AGR) and analyzed sensorimotor integration in the gastric central pattern generator during rhythm production. 2. Driving AGR to spike tonically at lower frequencies (10-20/s) accelerated the gastric rhythm, while higher frequencies (> or = 30/s) suppressed it. 3. Shorter spike trains in AGR evoked phase-dependent resetting of the gastric rhythm. Repetitive trains could entrain rhythms to both longer and shorter cycle periods. Some pattern-generating effects are consistent with effects upon the lateral gastric neuron, an influential member of the gastric mill network. 4. AGR affected the burst intensity of many of the gastric neurons in specific, complex ways. Some power-stroke motor neurons were excited because AGR activated excitatory, premotor interneurons (E cells). However, AGR also activated parallel, seemingly inhibitory inputs, whose mechanism remains unclear. Still other effects on motor neurons may be mediated partly by synaptic interactions within the network.
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PMID:Multiple effects of an identified proprioceptor upon gastric pattern generation in spiny lobsters. 815 22

Competitive swimming is one of the most demanding and time-consuming sports. Swimmers at elite level practice 20-30 h per week. During 1 year's practice, the average top level swimmer performs more than 500,000 stroke revolutions per arm. These innumerable repetitions over many years of hard training together with an increasing muscular imbalance around the shoulder girdle seem to be the main etiological factors in the development of the over-use syndrome swimmer's shoulder. Shoulder pain in swimmers has in general been regarded as synonymous with coracoacromial impingement, i.e. anterior shoulder pain due to rotator cuff tendinitis, but new knowledge suggests that a concomitant glenohumeral instability plays an additional role. The diagnostic complexity of the problem is as challenging as the search for the gold standard of treatment. The condition should ideally be diagnosed as early as possible, and intensive functional rehabilitation of the shoulder girdle including the scapular muscles should be started in order to restore muscle balance. The surgical possibilities include subacromial decompression in cases of purely mechanical impingement. If a painful glenohumeral instability persists after intensive functional rehabilitation, anterior capsulolabral reconstruction can be performed. Still, however, short- and long-term results show that surgery is less successful in elite athletes involved in overhead sports. Prevention protocols include education of coaches in primary injury prophylaxis and the institution of resistance strength training in prepubescent swimmers. Emphasis should be made to improve muscular balance around the glenohumeral and scapulothoracic joints.
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PMID:Nontraumatic glenohumeral instability and coracoacromial impingement in swimmers. 882 42

Still an experimental approach, the direct intra-arterial infusion of plasminogen activators in the setting of acute thrombotic stroke has received impetus from successful clinical trials of intravenous infusion therapy. Direct therapy, employing catheter delivery, has successfully produced evidence of recanalization in carotid artery territory and vertebrobasilar artery territory thrombotic occlusions. One very recent prospective randomized study has demonstrated the success and limitations of this approach. Attention to safety concerns will be important to the future success of direct intra-arterial delivery of plasminogen activators in acute thrombotic stroke.
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PMID:Interventional use of plasminogen activators in central nervous system diseases. 964 79

This review analyses the benefit-risk ratio of antiplatelet drugs in secondary stroke prevention and is based on the published data from eight large stroke prevention trials. In patients with prior transient ischaemic attack (TIA) or stroke, aspirin prevented one to two vascular events (stroke, AMI, or vascular death) per 100 treatment-years with an excess risk of fatal and severe bleeds of 0. 4-0.6 per 100 treatment-years. The gastrointestinal bleeding risk was significantly lower with ticlopidine and clopidogrel, which were both somewhat more effective than aspirin in the prevention of vascular events. The combination of dipyridamole and aspirin prevented 2.82 strokes at the expense of an excess risk of 0.61 (95% CI = 0.27-0.95) fatal or severe bleeds per 100 treatment-years. In the acute phase of stroke, the aspirin-associated risk of haemorrhagic complications was much increased compared with that in the stable phase after stroke, with 0.48 (95% CI = 0.13-0.83) fatal or severe bleeds per 100 treated patients for the first 4 weeks after stroke in the Chinese Acute Stroke Trial and 0.41 (95% CI = 0. 05-0.77) in the International Stroke Trial. Still, there was a net benefit with the prevention of about one death or non-fatal ischaemic stroke per 100 treated patients.
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PMID:Bleeding complications in secondary stroke prevention by antiplatelet therapy: a benefit-risk analysis. 1047 91


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