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

Pharmacologic doses of glucocorticoids are administered to patients with adrenal insufficiency during operative procedures to prevent hemodynamic instability, cardiovascular collapse, and death. Since these supraphysiologic doses might not be necessary and might have adverse effects, we examined the effects of different doses of glucocorticoids on hemodynamic adaptation during surgical stress in adrenalectomized primates. Sham-adrenalectomized placebo-treated animals served as controls. Adrenalectomized monkeys were maintained for 4 mo on physiologic glucocorticoid and mineralocorticoid replacement. The adrenalectomized monkeys were then stratified into three groups receiving, respectively, subphysiological (one-tenth the normal cortisol production rate), physiological, or supraphysiological (10 times the normal cortisol production rate) cortisol (hydrocortisone) treatment. 4 d later a cholecystectomy was performed. The intraoperative hemodynamic and metabolic parameters, perioperative survival rates, and postoperative wound healing were compared. The subphysiologically treated group was hemodynamically unstable before, during, and after surgery and had a significantly higher mortality rate than control. In this group, arterial blood pressure was low, and the cardiac index, systemic vascular resistance index, and left ventricular stroke work index were all reduced, suggesting decreased cardiac contractility and blood vessel tone. In contrast, the physiologically replaced group was indistinguishable from either supraphysiologically treated animals or sham-operated controls. All groups had similar metabolic profiles and normal wound healing. These findings suggest that the permissive actions of physiologic glucocorticoid replacement are both necessary and sufficient for primates to tolerate surgical stress. Supraphysiological glucocorticoid treatment has no apparent advantage during this form of stress in the primate.
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PMID:Adaptation during surgical stress. A reevaluation of the role of glucocorticoids. 395 89

Gastrocnemius-soleus dysfunction is a frequent result of cauda equina lesions and peripheral neurophathies and of stroke and brain injury. Temporary tibial nerve paralysis constitutes a comparable laboratory condition which allows the controlled examination of aspects of these disabilities. The biomechanical effects of temporary tibial nerve paralysis in six normal young adult volunteers were examined to quantitatively define the gait abnormalities resulting from gastrocnemius-soleus paralysis and to provide a basis for the assessment of the effectiveness of different orthotic designs in restoring a normal gait pattern. The motion of the right lower extremity, ground reactive forces acting on the right lower extremity, timing of gait events and step length were recorded, first during normal ambulation and then during ambulation after a right tibial nerve block. Step length was reduced bilaterally after the nerve block (p less than 0.005); the reduction was greater for the left (unblocked) step than for the right (blocked) step (p less than 0.005). Right heeloff was delayed until the time of left heelstrike in all subjects after the right tibial block. Right heeloff occurred later (p less than 0.005) while left heelstrike occurred earlier than normal (p less than 0.005). The shorter left step length and earlier left heelstrike resulted from a reduction in the forward progression of the right hip (p less than 0.001). When subjects were deprived of the plantarflexion activity necessary to counteract dorsiflexion moments at the ankle, they delayed the forward progression of the center of pressure (p less than 0.001) to avoid the unstable collapse of the foot into dorsiflexion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Gait abnormalities in tibial nerve paralysis: a biomechanical study. 397 Jun 62

An inspiratory decline in systolic arterial blood pressure exceeding 10 mm Hg has been used clinically to identify hemodynamically significant pericardial effusions. Recently, the echocardiographic sign of right ventricular diastolic collapse (RVDC) has been shown to occur early in the course of cardiac tamponade in association with a hemodynamically important decline in cardiac output. This study was undertaken to compare the relative merits of pulsus paradoxus and the onset of RVDC in the early detection of cardiac tamponade in an unanesthetized canine preparation. We studied six chronically instrumented, conscious dogs with two-dimensional echocardiography during cardiac tamponade induced by continuous infusion of saline into the pericardial space. We recorded intrapericardial pressure, cardiac output (electromagnetic flowmeter), aortic (catheter-tip transducer) and right atrial blood pressures, heart rate, and respiration. None of the dogs had RVDC when the pericardial space was empty, but all dogs showed RVDC during cardiac tamponade. We found that RVDC was strongly related to all of the cardiac parameters evaluated (intrapericardial pressure, cardiac output, aortic blood pressure, heart rate, and stroke volume) and provided information on each that was independent of that provided by pulsus paradoxus. Furthermore, RVDC appeared to be more strongly related to most cardiac parameters than was pulsus paradoxus and to be more sensitive and specific than pulsus paradoxus in detecting changes in intrapericardial pressure early in cardiac tamponade.
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PMID:The relative merits of pulsus paradoxus and right ventricular diastolic collapse in the early detection of cardiac tamponade: an experimental echocardiographic study. 397 48

Leukotriene D4, a constituent of slow-reacting substance of anaphylaxis, elicits a pressor response followed by hypotensive shock in spontaneously hypertensive rats but not in other rats. Hemodynamic mechanisms underlying this pattern in spontaneously hypertensive rats, pithed and vagotomized to eliminate circulatory reflexes, were studied using radiolabeled microspheres. One minute after leukotriene D4 administration (20 micrograms/kg i.v.), mean arterial pressure increased by 54 mm Hg, total peripheral resistance index increased by 68%, heart rate decreased by 34 beats/minute, and cardiac index was unchanged. Profound reductions of blood flow and increases of vascular resistance in the hepatosplanchnic area, skeletal muscles, and skin also occurred. Five minutes later, mean arterial pressure remained elevated (+35%), hematocrit rose (+17%), and total peripheral resistance index increased, which offset 40% decreases in cardiac and stroke volume indices. Ten minutes after leukotriene D4 administration, during hypotension, cardiac and stroke volume indices and blood flow to all vascular beds declined further while total peripheral resistance index and hematocrit (+28%) continued to rise. In Wistar-Kyoto rats, administration of leukotriene D4 caused less of a pressor response (+34 mm Hg) because vascular resistance was increased only in skeletal muscles, which was followed by a slight hypotension without any significant changes in cardiac and stroke volume indices, total or regional vascular resistance, and hematocrit. Thus, in spontaneously hypertensive rats the leukotriene D4-induced pressor response appears to be caused by generalized vasoconstriction, and the subsequent hypotension appears to result not from vascular collapse but from reduced cardiac output.
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PMID:Overall and regional hemodynamic effects of leukotriene D4 in spontaneously hypertensive rats. 400 88

Glucose-insulin-potassium (GIK) has beneficial effects during endotoxin shock, possibly through improvement of myocardial function, but the mechanism is not clear. We have studied the effects of GIK on left ventricular function, coronary flow, and oxygen consumption in controls and dogs treated with endotoxin (1.5 mg/kg-1). The animals were anaesthetized (etomidate 4 mg/kg-1/hr-1) and ventilated (N2O:O2 = 2:1). We have measured left ventricular pressure, left ventricular end-diastolic pressure (LVEDP) and LVdP/dt, systemic blood pressure, cardiac output (CO; thermodilution), coronary blood flow (CBF; radioactive microspheres), and oxygen content and lactate in arterial and coronary sinus blood. Endotoxin caused a rapid fall of CO and blood pressure with a temporary recovery followed by gradual circulatory collapse. GIK infusion (50% glucose, 2 g/kg-1 bw, 8 mmol KCl, and 3 U insulin/kg-1 bw) increased CO (56%), CBF (61%), blood pressure (21%), LVEDP (77%), and LVdP/dt (28%), and systemic vascular resistance decreased (23%). Stroke work (80%) and tension time index (42%) decreased during shock, but GIK temporarily improved these variables. The ratio of stroke work, respectively tension time index to oxygen consumption, suggests that myocardial efficiency decreased during shock and improved after GIK. Endotoxin decreased the ratio of endo- to epicardial flow. GIK did not change this ratio. However, for the same endo to epi ratio, increased CBF implies increased flow to endocardium.
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PMID:Effects of glucose-insulin-potassium (GIK) on myocardial blood flow and metabolism in canine endotoxin shock. 638 52

Detection and evaluation of functionally significant carotid occlusive disease are effectively achieved by noninvasive pressure and/or volume measurements from the eye. Ocular arterial blood pressure is measured by applying either direct compression or suction to evaluate intraocular pressure to the point of arterial collapse. Carotid blood flow is evaluated as it affects ocular volume waveforms, which result from the difference between pulsatile arterial flow and relatively constant venous flow. The relationship between noninvasive measurements from the eyes and carotid blood flow can be predicted using simple models of the cervical-cerebral circulatory system. Proper models verify clinically observed correlations between pressure and volume measurements from the eye and the underlying carotid occlusive disease. Electrical analog circuits provide a method for varying model parameters to simulate abnormalities, producing waveforms with good similarity to waveforms recorded from patients with known vascular or ophthalmic pathology. Further model refinements can be contributed by interested investigators. By using the improved models the strengths and weaknesses of current tests and techniques can then be better defined. Techniques that have been widely used for screening and evaluating potential stroke patients can thereby be modified to give improved functional analysis of these patients.
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PMID:Pressure and volume measurements from the eye for detecting possible arterial obstruction. 639 3

When exposed to hypoxia, intact mice, with elevated blood ketones, live longer than mice with normal blood ketones. To evaluate a possible mechanism responsible for this phenomenon a rat brain slice preparation was used to determine if brain tissue would utilize glucose or ketones preferentially during exposure to reduced oxygen. Reducing available oxygen in the incubation medium from 95%, in steps, to 5% produced the expected gradual reduction in the carbon dioxide formation from glucose. In contrast, reducing the oxygen level to 40 and 20% resulted in a statistically significant stimulation of the production of carbon dioxide from the ketone beta-hydroxybutyrate. At very low oxygen levels carbon dioxide production from either substrate was reduced. These results are consistent with the hypothesis that ketones can be used in addition to glucose as a substrate for brain energy production even during reduced oxygen availability. If the increase in carbon dioxide production from ketones can be equated with an increase in energy production from this supplemental substrate then ketones may be therapeutically useful in avoiding the collapse of brain function during moderate hypoxia.
Stroke
PMID:Hypoxia induced preferential ketone utilization by rat brain slices. 642 88

We studied canine left ventricular contractile performance following splanchnic artery occlusion (SAO) shock. We evaluated contractile performance by analyzing the left ventricular end systolic pressure-diameter relationship (sigma ES) because we have previously shown that sigma ES is independent of large changes in preload, afterload, and heart rate but sensitive to changes in ventricular contractility. Following release from 2 hours of SAO, seven dogs survived, five expired immediately, and ten expired between 0.5 and 3.5 hours (termed nonsurvivors, [NS]). The NS dogs exhibited slight tachycardia, slight increase in total peripheral resistance, marked decreases in +dP/dt, cardiac output, arterial blood pressure, stroke volume, and stroke work. Ventricular performance (sigma ES) declined with time following SAO release in the nonsurviving dogs; in contrast, surviving animals exhibited an augmentation of sigma ES during SAO and following SAO release. Sham dogs exhibited no time-dependent changes in sigma ES. The dogs that expired immediately following SAO release exhibited a precipitous decline in sigma ES from 43.0 +/- 9.0 to 23.0 +/- 4.8 mm Hg/mm within minutes of SAO release. We analyzed these data by Cox multiple regression analysis to determine the major covariates of survivability. The analysis revealed that sigma ES at the midpoint in time between SAO release and death was best correlated with the survival function. These results suggest that cardiovascular collapse of SAO shock is associated with an early and sustained loss of ventricular contractility.
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PMID:Depression of left ventricular performance during canine splanchnic artery occlusion shock. 650 27

To determine if 1,3-Butanediol (BD), which protects mice from hypoxia, would extend the tolerance of rats to ischemic-hypoxia, the Levine rat (unilateral carotid ligation and conscious hypoxic exposure) was modified to record mean arterial pressure (BP), heart rate (HR), central venous pressure (CVP), spontaneous respiration and EEG. Age and weight matched, male, Sprague-Dawley rats were anesthetized under halothane (1-2%), ligated, instrumented, and recovered 2 hrs before hypoxia (4.5% oxygen). Thirty minutes prior to hypoxia, groups of rats received, BD (47 mmoles/kg i.v.; n = 7), equal volumes of saline (S) (n = 6) or no-infusion (NI) (n = 7). Since no significant difference was observed between S and NI they were combined into a single control group (C). In a parallel group administered BD, resultant beta- hydroxybutarate ( BHB ) levels increased from 0.13 +/- 0.02 to 0.84 +/- 0.03 mM and temperature declined only 1.5 degrees C. The EEG of all ischemic-hypoxic rats invariably became isoelectric before cessation of spontaneous respiration and eventual loss of BP. BD significantly (p less than 0.01, Student's t) increased ischemic-hypoxic tolerance (time to isoelectric EEG) from 875 +/- 56 for the control group to 1338 +/- 67 seconds for the BD group, without changing the interval from isoelectric EEG to loss of BP. Further, EEG activity persisted at a lower mean BP (p less than 0.01) in the BD group (44 +/- 5 mm Hg) than in the control group (66 +/- 4 mm Hg). In summary, isoelectric EEG invariably precedes ventilatory failure and cardiovascular collapse. BD increases ischemic-hypoxic tolerance in the conscious rat by extending, at a lower mean BP, the time to isoelectric EEG.
Stroke
PMID:Butanediol induced cerebral protection from ischemic-hypoxia in the instrumented Levine rat. 672 86

There is an unusual vascular network at the base of the brain in patients with moyamoya disease. We detected various histologic lesions in the perforating arteries of 22 patients. Vessels showing rupture ranged from 50 to 530 microns in diameter; they were dilated, some had fibrin deposits in the wall, fragmented elastic laminae and attenuated media. Non-ruptured perforating arteries (diameter 200 to 550 microns) revealed microaneurysm formation, focal fibrin deposits and marked attenuation of the wall thickness with diminution of the elastic lamina. These changes seem to predispose to rupture of perforating arteries. Stenotic changes such as fibrous intimal thickening, collapse of the lumen and thrombosis were detected in 14 out of 22 cases. Morphometric analysis of perforating arteries indicated that arteries showing extreme degrees of stenosis or dilatation were more frequent in the patients with moyamoya disease than in the control cases. Dilative arteries were more frequent in the young patients and stenotic vessels were, in contrast, less frequent in the young patients.
Stroke
PMID:Histopathology of the brain vascular network in moyamoya disease. 682 86


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