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

Five prepubertal females and five college women, matched for aerobic power, walked on a treadmill at approximately 30% VO2 max for two 50-min periods in three environments: 1) 28 degrees C, 45% rh, 2) 35 degrees C, 65% rh, and 3) 48 degrees C, 10% rh. In the mild heat (28 degrees C) both groups were able to work 100 min with no discomfort. At 35 and 48 degrees C tolerance time for the prepubertal subjects averaged 84.4 and 37.0 min, respectively; for adults, 100 and 75.0 min. At all temperatures the girls had higher heart rates and a lower stroke index, and finished the walks with a higher rectal temperature. There were no differences between groups in cardiac index, mean skin temperature, forearm blood flow, or percent loss in body weight. The proportion of the thermal load dissipated by the two groups was similar but the route for heat transfer was related to the BSA/wt ratio and environmental conditions. Marked circulatory instability was a primary factor in the lower tolerance of the prepubertal girls to work in the heat probably due to a shift in blood volume from the central to the peripheral circulation.
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PMID:Response of prepubertal girls and college women to work in the heat. 60 89

The treatment of choice in idiopathic spontaneous pneumothorax is continuous suction drainage by chest tube for 8--10 days. If this method is not successful, i.e., in patients with a persistent or recurrent pneumothorax, an attempt can be made to produce local pleural adhesions by means of a special fibrin glue, especially in patients with poor general condition. This fibrin glue pleurodesis was performed successfully in seven patients, four of them having a persistent, two a recurrent, and one an iatrogenic pneumothorax. Six of them are now, 3--10 months after therapy, without a recurrence and free of discomfort. One patient died 6 days after treatment from a cerebral stroke. Autopsy showed fibrinous adhesions in the area of the upper lobe. Good tissue compatibility was confirmed histologically.
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PMID:[Fibrin glue. A new treatment technic in persistent recurrent spontaneous pneumothorax]. 63 18

Disorders of the peripheral vascular system often are associated with heart disease which may increase operative risk. The purpose of this study was to investigate the clinical usefulness of radionuclide angiocardiography for evaluation of cardiac function in patients with vascular disorders. This simple procedure provides measurements of cardiac output, pulmonary blood volume, and left ventricular end-diastolic volume, stroke volume, and ejection fraction with no significant risk or discomfort to the patient. A total of 22 patients with vascular disorders were studied by this technique. Five patients had systemic arteriovenous malformations. The cardiac output, end-diastolic volume, and stroke volume were documented to be greater than normal in these patients before operation. In three patients studied following closure of the arteriovenous fistula, the cardiac output, left ventricular end-diastolic volume, and stroke volume decreased. Postoperative changes in left ventricular ejection fraction were variable. A group of 17 patients with atherosclerotic vascular disease underwent cardiac evaluation. In nine patients with no history of cardiac disease, the lowest ejection fraction of 0.45 occurred in a patient with a saccular thoracic aneurysm, the only patient of the 22 who died after operation. A wide variation in ejection fraction was observed in patients with a history of cardiac disease which ranged from 0.32 to 0.86. Objective documentation of cardiac function by radionuclide angiocardiography would appear to enhance the management of patients with peripheral vascular disorders.
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PMID:Noninvasive radionuclide assessment of cardiac function in patients with peripheral vascular disease. 75 15

The clinical results of treatment of infravesical prostatic obstruction with an intraurethral coil in 150 consecutive patients are reported. A total of 80 patients had urinary retention and 70 had severe prostatism. Median observation time was 8.2 months, with a range of 0 to 40 months. In 75 patients the spiral was removed after a median of 4 months (range 0 to 30 months) because of planned prostatectomy in 17, urinary retention in 16, incontinence in 10, local discomfort in 7, no symptomatic improvement in 13 and causes not related to the spiral (stroke and so forth) in 7. Migration occurred 55 times in 42 patients but this only led to coil removal in 5. A total of 23 patients died with the coil in situ. Voiding symptoms improved considerably in the majority of the patients. Approximately two-thirds of the patients had no or few symptoms, while a fourth had moderate symptoms, leaving only approximately 10% with severe prostatism. Chronic bacteriuria was noted in 52 patients but was not a clinical problem. Calcification on the top and inside of the coil was noted mainly after long-term treatment, and probably necessitated exchange of the coil after 2 to 3 years. We conclude that the prostatic spiral is a useful alternative to an indwelling catheter. However, life-long followup is necessary in most patients.
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PMID:The intraprostatic spiral: clinical results in 150 consecutive patients. 137 51

The presentation of an AMI in the older person is often atypical, with a lower incidence of classic chest discomfort but increasing incidence of dyspnea, syncope, stroke, and acute confusion. Atypical presentation is especially common in those 85 years and older. The altered pattern of symptoms predisposes the elderly to a delayed or missed diagnosis. Delay in diagnosis may also occur when the ECG is nondiagnostic. In addition, enzyme elevations may be lower and fail to reflect the extent of myocardial damage. Thus, among the greatest challenges confronting critical care nurses is that of caring for elderly patients presenting with atypical AMI and concomitant polypathology. Nurses who are well informed about the normal age-related changes in the cardiovascular system contribute to more accurate and timely diagnosis and treatment of AMI in the elderly.
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PMID:Geriatric acute myocardial infarction: a challenge to recognition, prompt diagnosis, and appropriate care. 159 52

A total of 503 consecutive cases of suspected stroke were examined for potential eligibility based on recent development of a paralyzed limb. Of 123 otherwise eligible subjects, 22 were found by ultrasound to have deep vein thrombosis (DVT) on admission. Therefore, 101 patients were assigned randomly to one of the treatment groups or to the control group. The three treatments were adjusted-dose heparin, external pneumatic compression and functional electrical muscle stimulation. An ultrasound examination of the lower extremities was conducted twice a week on each patient until completion of the study (28 days or discharge, whichever came first). Electrical muscle stimulation was discontinued after 4 mo of the study because of discomfort, blister formation and high drop-out rate. Ten patients developed DVT during the study period. In 17 of the 32 cases of DVT, venography was performed, which confirmed the ultrasound findings in every case. The 32 cases of DVT differed from those without DVT by having a higher prevalence of hypertension (P = 0.02), cholesterol (P = 0.08) and a longer time interval between stroke and admission (P less than 0.05). We conclude that ultrasound is effective for DVT detection in the rehabilitation setting, and two-thirds of such cases are detectable on admission.
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PMID:Deep vein thrombosis in rehabilitating stroke patients. Incidence, risk factors and prophylaxis. 174 2

A drug-use evaluation (DUE) of i.v. alteplase for the treatment of acute myocardial infarction (AMI) in two community hospitals is described. From November 1987 to June 1989, all 118 patients who were treated with i.v. alteplase for suspected AMI at two large community hospitals were monitored daily to determine patterns of use of alteplase, clinical outcomes, the hospital time needed to diagnose AMI and begin therapy, and the pharmacy time needed to prepare and deliver alteplase. Patient inclusion criteria were (1) chest discomfort of less than six hours' duration and unrelieved by nitroglycerin or nifedepine, (2) age less than 75 years, and (3) electrocardiographic evidence of transmural AMI. Each patient received alteplase 100 mg i.v. and i.v. heparin therapy; 58% of the patients were also given aspirin 81-325 mg/day. The data for the two institutions were combined; there was no control group. The mean +/- S.D. age of patients was 58 +/- 10 years; 75% were men. Treatment began at a mean of 181 +/- 111 min after symptom onset, including the time it took for the 96 patients whose symptoms began outside the hospital to reach the hospital. The mean hospital time required to initiate treatment was 89 +/- 65 min. The mean pharmacy time required to prepare and deliver alteplase was 12 +/- 6 min. The in-hospital mortality rate was 6.4%, the rate of patency of the infarct-related artery was 85% at a mean of seven days in the 95 patients who underwent coronary angiography, and the nonfatal reinfarction rate was 1.8%. Severe bleeding complications occurred in only two patients, and no patient suffered a stroke.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Use of alteplase for myocardial infarction in two community hospitals. 211 88

This study reports the results of a retrospective review of the case records of 28 seriously ill patients who received intravenous cimetidine (generally 300 mg q8h) for the treatment of gastric discomfort and/or hemorrhage or for prophylaxis against stress-induced ulcers. Most of these patients presented with complex symptoms arising from a variety of pathological conditions including ischemic heart disease, myocardial infarction, cerebrovascular accident, pneumonia, and trauma. A number of patients also had acute gastrointestinal hemorrhage. Over two-thirds of the patients treated with intravenous cimetidine demonstrated a reduction in gastrointestinal symptom severity, and a statistically significant reduction in the mean severity rating for all patients was observed. Adverse reactions reported during cimetidine therapy were generally mild to moderate in severity and required discontinuance of therapy in only one patient. The most common complaint was headache. Intravenous cimetidine administered q8h offers a safe and cost-effective approach to H2-receptor blockade and reduction of gastric acid secretion in patients who are temporarily unable to take oral medication.
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PMID:Intensive care experience with intravenous cimetidine. 228 32

The acute haemodynamic effects of intravenous infusion of adenosine, a dilator of most vascular beds, were studied in 16 patients (seven with coronary artery disease, nine with normal coronary arteries) undergoing cardiac catheterization for investigation of chest pain. At the lowest dose used (4.3 mg min-1) adenosine increased minute ventilation by 44% (P less than 0.01, n = 11) and reduced pulmonary vascular resistance by 20% (P less than 0.05) without causing other significant haemodynamic changes. Symptoms, including chest discomfort in 14 patients and dyspnoea in 11, limited the maximum dose to 8.5 +/- 2.3 mg min-1 (mean +/- SD, 108 +/- 24 micrograms kg-1 min-1). At this dose, adenosine reduced pulmonary and systemic vascular resistance (by 38% and 34%, respectively) and increased heart rate (by 34%), stroke index (by 12%) and cardiac index (by 52%). Systemic blood pressure and right atrial pressure did not change. Unexpectedly, adenosine increased left ventricular end-diastolic pressure (LVEDP) (from 5 +/- 6 to 14 +/- 10 mmHg, n = 8), pulmonary capillary wedge pressure (from 3 +/- 2 to 10 +/- 5 mmHg, n = 16) and consequently mean pulmonary artery pressure (from 10 +/- 2 to 16 +/- 5 mmHg). Minute ventilation increased by 84% (n = 11), resulting in hypocapnia (PCO2: 31 +/- 3 mmHg, n = 8) and alkalosis (pH: 7.46 +/- 0.02, n = 8). Oxygen consumption was unchanged during the infusion, but increased by 21% 5 min post infusion. All effects were similar in patients with and without coronary artery disease. Adenosine therefore causes pulmonary and systemic vasodilation and respiratory stimulation. Symptoms and an increase in LVEDP of uncertain cause, which occur with high doses, may limit the use of adenosine as a systemic vasodilator in conscious subjects. However at lower doses adenosine causes selective pulmonary vasodilation which merits further study.
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PMID:Acute haemodynamic effects of intravenous infusion of adenosine in conscious man. 228 21

LOCAs offer significant advantages in certain situations, but in others their advantages are either absent or unproved. On the basis of current knowledge and practice, there is no legal mandate to use these agents. Clear advantages to the use of LOCAs are (a) decreased pain and discomfort in painful examinations (in this regard, however, they are equivalent to dilute HOCAs in intraarterial digital subtraction angiography), (b) decreased myocardial and generalized hemodynamic effects, and (c) decreased osmotic load, perhaps important in infants or severely dehydrated patients. LOCAs may be helpful in examinations of patients with alteration of the blood-brain barrier (major trauma, tumor, or stroke), prior contrast media reactions, and marked anxiety. However, in the following areas, there are, as yet, no clear answers about the use of LOCAs: (a) reduction of overall mortality, (b) reduction of morbidity in elderly patients, and (c) reduction of the risk of nephrotoxicity in patients either with or without specific risk factors such as diabetes mellitus or renal failure.
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PMID:Guidelines for use of low-osmolality contrast agents. 267 4


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