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)

Fifteen women with claudication and increased serum thyrotrophin (TSH) were treated with L-thyroxine (25-75 micrograms). These women were selected from a group of 80 consecutive women presenting with claudication, rest pain or gangrene. One year after their TSH was normal, their progress, serum lipids and lipoproteins were compared with the 58 women with normal levels of serum TSH; the remainder were already receiving thyroxine. Non-invasive assessment showed that three of the 15 (20%) women treated with thyroxine had progression of arterial disease, two in the legs and one in the legs and coronary arteries; two women showed improvement of ankle/brachial pressure indices. There was no accelerated angina, myocardial infarction, stroke or death in this group. Fifty-six of the 58 patients with normal levels of TSH were alive at follow-up and there was progression of distal disease in 24 (43%), coronary artery disease in 6 (11%), increasing carotid stenosis in four and two complained of transient ischaemic attacks. In this group, disease progression affected 32/56 (57%) of the women and this is significantly greater than in the thyroxine treated group chi 2 (P less than 0.05). Treatment with L-thyroxine caused a significant increase in HDL-cholesterol from 1.29 +/- 0.34 to 1.45 +/- 0.49 mmol/L (P less than 0.05) and a significant decrease in cholesterol from 8.0 +/- 1.3 to 7.2 +/- 1.1 mmol/L (P less than 0.01) and apolipoprotein B from 1.23 +/- 0.20 to 1.04 +/- 0.16 g/l (P less than 0.001). Significant changes in apolipoprotein B were observed after 3 months of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Can thyroxine halt the progression of peripheral arterial disease? 271 58

Two patients with acute aortic thrombosis presented with painless paraplegia secondary to spinal cord infarction. In one case, the initial symptom was unilateral leg weakness, leading to the misdiagnosis of stroke. In the other case, a patient with a large, painful vulvar abscess, experienced spontaneous relief of pain. In the complete absence of pain, both patients slept undisturbed and awoke with complete paraplegia, incontinence, and cadaveric extremities. Aortic reconstruction was advised to obviate thigh or hindquarter amputation, not to restore limb function. One patient died on the second postoperative day; the second remains well but paraplegic two years later.
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PMID:Acute aortic thrombosis presenting as painless paraplegia. 274 42

The somatosensory abnormalities in 20 men and 7 women (mean age 67 years, range 53-81) with central post-stroke pain (CPSP) have been analysed in detail with traditional neurological tests and quantitative methods. The cerebrovascular lesions were located in the lower brain-stem in 8 patients, involved the thalamus in 9 and in 6 were suprathalamic. In 4 patients the location of the CVL could not be determined. All patients had abnormal temperature and pain sensibility, with a severe deficit in most cases. All except 2 had raised thresholds to thermal pain and all except 1 had abnormal sensibility to pin-prick. Eighty-eight percent exhibited hyperpathia with combined loss and suprathreshold exaggeration of somatic sensibility. In 85% somatic stimuli evoked dysaesthesia and about half of these patients also experienced spontaneous dysaesthesia. Paraesthesias were reported by 41%, radiation of stimuli by 50%, after-sensations by 45% and allodynia by 23%. Vibration sensibility was abnormal in 41%; raised thresholds to the perception of touch were found in 52%, to 2-PD in 35%, to dermolexia in 45% and to joint movements in 37%. The results indicate that all patients with CPSP have lesions that affect the major pathways for temperature and pain sensibility, i.e., the spino-thalamo-cortical pathways. Furthermore it appears that neither the level of the lesion along the neuraxis nor concomitant injury to the medial lemniscal pathways is crucial for the development of CPSP. The results confirm the notion that CPSP is a deafferentation syndrome, but they also provide evidence against the hypothesis that CPSP is a release phenomenon caused by a lesion that removes inhibitory influences of the lemniscal pathways on neurones that evoke pain.
Pain 1989 May
PMID:Central post-stroke pain--a study of the mechanisms through analyses of the sensory abnormalities. 274 90

Sixty-three patients with acute thrombotic stroke were compared with 47 age and sex-matched patients admitted concurrently with acute ischaemic cardiac pain and a further 44 with acute noncardiovascular illnesses. Overall the stroke patients scored highest on a questionnaire designed to estimate mean daily intake of vitamin C before hospital admission. There were problems with this retrospective dietary assessment, however, and the diet scores of the 27 stroke patients able to answer the questionnaire themselves fell between those of the other two groups. There were no significant differences between the three patient groups in plasma ascorbic acid or uric acid levels, but plasma magnesium and albumin levels were higher in the stroke patients. These findings were similar for patients aged over and under 70 but intergroup differences in magnesium and albumin levels were more marked in the elderly. These results do not support the postulated inverse relationship between vitamin C status and the risk of stroke.
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PMID:Vitamin C status and other nutritional indices in patients with stroke and other acute illnesses: a case-control study. 276 Jun 55

The purposes of this investigation of patients with stroke were to 1) determine and compare shoulder lateral rotation range of motion (SLRROM) measured at the threshold of pain on the paretic and nonparetic sides; 2) establish the intrarater and interrater reliability of the measurements; and 3) determine the relationship between SLRROM measurements and the independent variables of age, sex, and time since onset of stroke. Subjects were 25 rehabilitation inpatients. The two investigators each measured the patients' SLRROM twice on both the paretic and nonparetic sides using a gravity goniometer. An analysis of variance (ANOVA) demonstrated that SLRROM was significantly less on the paretic side than on the nonparetic side (F = 28.98, p less than .001). The ANOVA demonstrated no difference in the two raters' measurements of SLRROM. The intraclass correlation coefficients (ICC[3,1]) and interrater reliability coefficients were all good to high (.874-.989). The SLRROM on the paretic side correlated significantly with time since onset of stroke (r = -.538, p less than .01). As a consequence of this study, we concluded that 1) patients with stroke tend to lose SLRROM on the paretic side, 2) SLRROM tends to decrease with time, and 3) measurements of SLRROM obtained with a gravity goniometer are reliable and sensitive.
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PMID:Decreased shoulder range of motion on paretic side after stroke. 277 40

Because the cause and natural history of amaurosis fugax and ocular infarction are unknown in most younger patients, we reviewed the records of 83 patients who had become symptomatic before the age of 45. Cerebral transient ischemic attacks had occurred in 9 of these patients but no case of stroke was found. A striking feature of these patients was that 41% had headache or orbital pain accompanying their amaurotic spells and an additional 25.3% had severe headaches independent of the visual loss. Results of laboratory studies were rarely abnormal and echocardiography disclosed that only 1 patient had previously unknown heart disease. Mitral valve prolapse was detected in 6.5%, a figure similar to that expected for the general population. Of the original 83 patients, 42 were reexamined after a mean period of 5.8 years. None of the patients in this group had had a stroke, and the clinical status at follow-up was not found to correlate with the duration of the visual loss (amaurosis fugax versus ocular infarction), frequency (single versus recurrent episodes), sex, presence of headache or heart disease, cigarette smoking, use of oral contraceptives, or abnormal findings on echocardiograms or laboratory studies. We conclude that amaurosis fugax and ocular infarction occurring in the younger patient are probably associated with a more benign clinical course than that seen in older persons and that migraine is a likely cause for the episodes of visual loss in a majority of this group. Because of this, we believe that a conservative approach to the evaluation of such patients seems warranted.
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PMID:Amaurosis fugax and ocular infarction in adolescents and young adults. 277 3

This paper documents an unusual case of a stress fracture of the ninth rib in an elite oarsman. A 25-year-old male presented with a 3-day history of right-sided chest pain aggravated by deep inspiration and movements simulating rowing. The athlete was treated initially as having a soft tissue injury; however, a technetium-99 bone scan confirmed the diagnosis. Routine radiographs of the ribs were negative. The pain and symptoms were confined to the anatomical area of the fracture along the anterolateral portion of the rib where the serratus anterior muscle originates. An analysis of the stroke mechanics involved in rowing implicated the serratus anterior muscle as being a major contributor to the repetitive stress that resulted in the injury. The primary etiological factor was errors in the training program. The athlete responded to simple conservative measures and was able to return to competitive rowing in 1 month's time.
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PMID:Stress fracture of the rib in an elite oarsman. 277 39

Financial and other constraints, such as operative risk, may prevent older patients being considered for coronary arterial bypass grafting. Grafting was performed in 315 elderly patients (244 males, 71 females, age 65-79, mean 69 years) between 1981-1986. All patients had limiting angina, 38% had rest pain, 90% were housebound and 80% had triple-vessel disease. Impairment of left ventricular function was absent in 46%, mild in 20%, moderate in 23% and severe in 10% of patients. Grafts (saphenous vein or internal mammary artery) were inserted into 3 vessels (52%), 4 vessels (42%), 5 vessels (6%), 6 vessels (0.5%). Death during surgery occurred in 1.6% and a further 3.5% of patients died later during the same admission (70% of deaths were among the 33% with preoperative moderate or severe left ventricular impairment). Surgical complications included myocardial infarction (8%), cerebrovascular accident (1%), transient cerebral vascular ischaemia (5%), chest infection (10%) and wound infection (4%). Median stay on the intensive care unit was 1 day and median total hospital stay 12 days. 299 patients therefore survived to leave hospital and follow-up data are available for 217 (72%) of these. 96% were subjectively improved by surgery, 88% being free of angina on no antianginal drugs a median of 72 weeks (range 8-307) and a further 8% not limited by angina on medical therapy a median of 85 weeks (range 9-302) after surgery. We conclude that coronary arterial surgery is an effective treatment for angina in the elderly. This will have consequences for future resource allocation if the elderly are not to be denied effective therapy because of financial rather than clinical restraints.
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PMID:Coronary arterial surgery in the elderly: its effect in the relief of angina. 278 54

The effect of high (conventional) and low frequency (acupuncture-like) transcutaneous electrical nerve stimulation (Hi-, Lo-TENS) was tested in 15 patients with central post-stroke pain. During the initial 16 day trial of stimulation ipsilateral and contralateral to the pain, 4 patients obtained pain relief. Three of them benefitted from ipsilateral Hi- and Lo-TENS. Two patients also obtained pain relief with contralateral stimulation. Three patients continued to use TENS ipsilaterally with good effect at follow-up 23-30 months after the initial trial. In one-third of the patients, TENS temporarily increased the pain.
Pain 1989 Aug
PMID:Central post-stroke pain--the effect of high and low frequency TENS. 278 61

The effects of high thoracic epidural anesthesia (TEA) on central hemodynamics as measured by pulmonary arterial catheterization were studied in nine patients with severe coronary artery disease and unstable angina pectoris. The patients were also treated with a combination of beta-blockers, calcium antagonists, and nitrates, as well as salicylates, low-dose heparin, and nitroglycerin infusion for greater than 24 hr. Management of pain with high TEA was started with the bolus epidural injection of 4.3 +/- 0.2 mL bupivacaine (5 mg/mL), which induced a sympathetic blockade from Th. During ischemic chest pain, pulmonary artery and pulmonary capillary wedge pressures were significantly increased. TEA, while relieving the chest pain, significantly decreased systolic arterial blood pressure, heart rate, and pulmonary artery and pulmonary capillary wedge pressures, without any significant changes in coronary perfusion pressure, cardiac output, stroke volume, and systemic or pulmonary vascular resistances. In some patients, ST-segment depression was less pronounced during TEA. Thus, during ischemic chest pain, TEA has beneficial effects on the major determinants of myocardial oxygen consumption, without jeopardizing coronary perfusion pressure. TEA may therefore favorably alter the oxygen supply/demand ratio within ischemic myocardial areas.
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PMID:Thoracic epidural anesthesia and central hemodynamics in patients with unstable angina pectoris. 280 91


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