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

To evaluate the influence of antiplatelet drugs on patency in femoropopliteal vein bypasses, 48 vascular surgeons recruited 549 patients to a randomized double-blind trial of aspirin (300 mg) + dipyridamole (150 mg) or placebo twice daily starting 2 days before surgery and continuing indefinitely. Graft occlusion measured objectively by independent coordinators and cardiovascular events (myocardial infarction or stroke) were studied, expressed by life table, and analyzed statistically by log rank and confidence intervals (95% CI). Randomization achieved comparable groups with 60% of grafts inserted for rest pain or gangrene. Operative complications on aspirin plus dipyridamole included 18 reoperations for bleeding and 12 hematomas compared with 9 and 14, respectively, on placebo (NS). Most of the 172 graft failures occurred early with failure rates of 43/1000 patient-months in the first 3 months, reducing to 17/1000 at 6 to 12 months, and under 10/1000 in subsequent years. Cumulative graft patency on placebo was 72%, 62%, and 60% at 1, 2, and 3 years, respectively, compared with 78%, 70%, and 61% on aspirin plus dipyridamole. The difference in patency of 6.1% (95% CI, -3% to 15.5%) at 1 year and 8.0% (95% CI, -5% to 21%) at 2 years failed to achieve significance (p = 0.43). On mean follow-up of 34 months, 53 (132/1000 patient-years) cardiovascular events (myocardial infarction or cerebrovascular accident) occurred in patients on placebo compared with only 35 (73/1000) on aspirin plus dipyridamole, a significant difference of 59/1000 (p = 0.004). Antiplatelet therapy had little influence on femoropopliteal vein patency, but subsequent myocardial infarction and stroke was reduced in these patients with peripheral vascular disease.
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PMID:Antiplatelet drugs in femoropopliteal vein bypasses: a multicenter trial. 198 87

Perioral and distal upper limb sensory dysfunction (cheiro-oral syndrome) has classically been attributed to cortical involvement. In previously reported cases of the syndrome, caused by stroke, however, the thalamus or brain stem has been the actual site of the lesion. We have studied two patients with infarct in the superficial middle cerebral artery territory involving the parietal operculum. Sensory involvement was purely subjective in the face, but severe hypoesthesia was present in the distal upper limb, involving mainly position sense, stereognosis, and graphesthesia. Temperature and pain sensation were involved in one patient. These findings correlated with involvement of the lower part of the postcentral gyrus, more caudal parts of the parietal operculum, and underlying white matter. This opercular cheiro-oral syndrome seems more uncommon than faciobrachiocrural hemihypesthesia associated with anterior parietal artery territory infarct. A double supply to the parietal opercular region through branches of the temporal arteries and anterior parietal artery may explain the rarity of cheiro-oral syndrome resulting from hemisphere stroke, because simultaneous and partial compromise to two different pial artery networks is uncommon.
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PMID:Opercular cheiro-oral syndrome. 203 91

A hypertensive man had a long standing history of contumacious hyperpathia in the right upper extremity, resistant to medical therapy, secondary to a lacunar infarct in the left thalamus. A second cerebrovascular accident caused a small lesion in the left corona radiata, interrupting the thalamoparietal interconnections, and terminated the pain instantly. Interruption of the subcortical parietal white matter may more effectively control pain than cortical lesions. A few surgeons have successfully treated rebellious chronic pain with stereotaxic operations in the corona radiata, resulting in lesions very similar to our patient's. This overlooked and nearly forgotten technique may still have value in treating selected cases.
Pain 1991 Mar
PMID:Disappearance of thalamic pain after parietal subcortical stroke. 205 98

The material, definition, delimitation, and classification of facial pain, general data, hereditary conditions, and previous diseases have been discussed in a preceding study. According to the character of the attacks the material has been classified into TTN = Typical Trigeminal Neuralgia (1/4), ATN = Atypical Trigeminal Neuralgia (1/4), and NNFP = Non-neuralgiform Facial Pain (1/2). The typical Trigeminal Neuralgia is a transitory, shooting pain, well defined. The other two groups are less well defined. The patients come to be treated by specialists 1-5 years after the onset of pain. The oral cavity is often perceived as the origin of the pain. A systematic examination shows that demonstrable pathological diseases in the masticatory organs are rarely connected with the pain condition. Dental treatment has provided poor results. Facial pain is a very constant phenomenon which does not- or only to a negligible degree--change over an agelong course. In the present material 8 characters of pain are used: Shooting-cutting, boring, squeezing-pressing, throbbing-hammering, dull, burning-smarting, prickling-sticking, paraesthetic. With the exception of a few cases of apoplexy and herpes zoster there is no pain reaction which can be referred to on an aethilogical basis.
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PMID:Facial pain. II. A prospective survey of 1052 patients with a view of: character of the attacks, onset, course, and character of pain. 207 48

All thrombolytic agents convert plasminogen to plasmin, either directly as urokinase, saruplase and alteplase or indirectly as streptokinase. In the majority of recent clinical trials with streptokinase, a high-dose (0.7 to 1.5 mega-units), brief-duration (30 to 90 minutes) drug regimen has been used. After a mean time interval of 4.2 hours from onset of pain to intravenous infusion of streptokinase, a repeat angiography performed 60 to 90 min after start of thrombolytic treatment gives a reperfusion rate of 43%, the corresponding figures for anistreplase, saruplase and alteplase are 56%, 67% and 69%. The patency rates of similar studies with the same endpoint are for streptokinase 56%, for anistreplase 77%, for urokinase 62%, for saruplase 71% and for alteplase 75%. The reduction in hospital mortality in randomized trials with intravenous streptokinase (high-dose) is in 6 large studies in a total of 23,267 randomized patients from 10.7% in the control group to 7.0% in the streptokinase group. In a mortality study involving 1,004 patients randomized to intravenous anistreplase or placebo the 30-day mortality was reduced by 47%, from 12.2% to 6.4%. A large trial in which 5,011 patients were randomized to alteplase or placebo, the 30-day mortality was 7.2% compared to 9.8% in controls, a reduction of 27% by alteplase. In another trial 721 patients were randomized to placebo or alteplase; all patients were on aspirin. The 14-day mortality was only 2.8%, 51% less than that in the control group. It is most important that the favourable impact on hospital survival is maintained at 1 year with any thrombolytic drug. Large scale trials directly comparing mortality after alteplase, streptokinase or anistreplase are being performed or in the planning phase. The risk of bleeding exists with any thrombolytic agent but intracranial bleeding is the most serious one. In a large trial on 5,011 patients with acute myocardial infarction, stroke occurred in 1.1% of alteplase treated patients compared with 1.0% in placebo treated controls. Crucial problems are residual stenosis of the coronary artery and reocclusion. Urgent angioplasty does not seem to be the right answer; more effective antithrombotic strategies still have to be developed.
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PMID:[Thrombolytic therapy in acute myocardial infarct]. 219 44

Researchers in physical medicine and rehabilitation require access to information regarding possible interventions and programs, available services and technology, research (published, unpublished and in progress), statistics on incidence, prevalence and expected recovery, and funding sources. This paper provides an overview to the most readily available sources of information, including 16 abstracts and indexes, 6 sources of review articles, 9 population statistical databases and 84 journals specifically devoted to rehabilitation. Of these journals, 29 may be accessed through Medline and 32 through other sources. An additional 58 journals indexed in Medline publish more than 16 rehabilitation articles per year. The journals within Medline that publish the most rehabilitation articles are listed by topic area: geriatric rehabilitation, cardiac rehabilitation, pediatric rehabilitation, rehabilitation research, self-help devices, sports medicine and rheumatologic rehabilitation. Specific search strategies that may be used for any computer assisted search of Medline are given to locate articles in these topic areas and also the following areas: amputee rehabilitation, spinal cord injury rehabilitation, traumatic brain injury rehabilitation, cerebral palsy rehabilitation, stroke rehabilitation, decubitus care, electrodiagnosis, rehabilitation engineering, pain rehabilitation, pulmonary rehabilitation, sexual rehabilitation and urologic rehabilitation. The user friendly Grateful Med software is introduced for simplified online Medline searching. Exercises are provided for starting a journal club with the retrieved articles.
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PMID:Research in physical medicine and rehabilitation X. Information resources. 222 88

One hundred and three consecutive out-patients with ischaemic rest pain were studied. There were 77 men and 26 women with a mean (s.d.) age of 71 (10) years. Thirty-six (35.0%) patients had rest pain alone, 41 (39.8%) in association with an ischaemic ulcer and 26 (25.2%) with digital gangrene. A significantly increased risk of amputation was seen in those patients with an elevated serum cholesterol (greater than 5.2 mmol/l; P = 0.01), white blood cell count of greater than 10 x 10(9)/l (P = 0.05), fibrinogen greater than 4g/l (P = 0.04), and in women with elevated triglyceride levels (greater than 1.8 mmol/l; P less than 0.03). An increased risk of death for all patients was also associated with elevated triglyceride levels (P = 0.03). Few of the women smoked (P less than 0.0004), but they were more likely to have suffered a stroke (P = 0.01). They also had a significantly increased cholesterol level (P = 0.03) and tended to have a higher mortality rate than the men (P = 0.08). Surprisingly, smokers did not have a significantly higher amputation or death rate than non-smokers. Elevated plasma viscosity, packed cell volume, platelet count, haemoglobin and creatinine levels were not independent risk factors for any group. At 30 days after presentation the limb salvage rate was 73% (75/103), amputation was required in 15 (14.6%) cases and 13 (12.6%) patients died. Patients with ischaemic rest pain constitute a heterogeneous group with multiple diseases and risk factors. Early identification and treatment of risk factors may help to improve limb salvage and the mortality rate in this condition.
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PMID:Risk factors in patients with ischaemic rest pain of the lower limbs. 223 94

While reflex sympathetic dystrophy syndrome (RSDS) research is lacking and the pathophysiology remains obscure, it is known that it affects all age groups with the common overriding complaint of severe, unrelenting, burning pain. It seems to be triggered by trauma (major or minor), including more central events such as myocardial infarction, cerebrovascular accident and tumours. Diagnostic characteristics of RSDS are: spontaneous burning pain, hyperalgesia, vasomotor disturbances, exacerbations by emotional upset, occurrence either spontaneously or after minor injury, occasional spontaneous resolution, extension to other body parts, and relief by sympathetic denervation. The problem may recur after earlier resolution. The problem for this author, and others, is the discrepancy between what appears in the literature and what is evidenced in clinical practice. What is being observed is a large number of individuals with RSDS who are not easily treated or cured. The problem for some clients becomes one of total body involvement, with severe incapacitation related to the constant and intense nature of the pain and the accompanying alterations in mobility. This author and two colleagues designed and conducted a study of clients registered with the RSDS Association to delineate the magnitude and long-term effects of RSDS in this sample.
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PMID:Reflex sympathetic dystrophy syndrome: a retrospective pain study. 228 58

The lateral medullary syndrome is a rare syndrome resulting from a cerebrovascular accident involving part of the medulla oblongata with consequent loss of pain and temperature sensation in the orofacial region, loss of taste, and palatal palsy and loss of gag reflex, together with Horner's syndrome and ataxia. A case is presented and the literature reviewed.
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PMID:The lateral medullary syndrome. 231 57

We initially surveyed the practice patterns of 24 private sector neurologists in Colorado between June and September, 1985, having chosen representative practices from each of 4 practice types (solo [6], nonsolo single discipline [11], nonsolo multispecialty [4], and nonsolo HMO [3]) and from both urban (14) and rural (10) practice locations. Among 2,373 consecutive new patient visits initially surveyed, we reexamined 2,359 (99%) charts 1 year later to investigate patterns of principal care. We defined principal care as 2 or more follow-up visits in the year following the initial office visit. One-fifth of initial visits received principal care, and the mean number of follow-up visits per year among those receiving principal care was 4 (range, 2 to 32 visits). The best indicators of principal care were Medicare coverage, a classic neurologic diagnosis (seizure, stroke), rural practice location, and solo neurology practice. The best indicators of consultative care were self-pay coverage, a diagnosis of musculoskeletal, psychiatric, or pain disorder, urban practice location, and HMO neurology practice. Age, sex, race, and type of referring physician were unimportant in determining subsequent principal care. Projections of future manpower needs must reflect both consultative as well as principal care services provided by neurologists, as well as the cost-effectiveness of such care.
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PMID:A prospective study of principal care among Colorado neurologists. 232 Feb 47


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