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

We report three patients with anticholinergic poisoning caused by the substitution of hyoscine hydrobromide for hyoscine butylbromide in preparations compounded by two different pharmacists. The patients took the preparations for gastrointes tinal discomfort and presented with altered mental status tachycardia, facial flushing, dilated pupils, and dry skin shortly after the ingestion. In one patient the intoxication was initially not recognized and he was treated as suffering from an acute cerebrovascular accident. Two patients experienced long-lasting effects such as decreased ability to concentrate, memory dis turbances, tremor, and photo- and phonophobia. It was obviously impossible to elucidate the exact nature of the relationship between the intoxication and these long-lasting complaints. Information from the Belgian poison control center revealed that cases of substitution error with hyoscine hydrobromide are not unique The Belgian authorities issued a warning to all pharmacists.
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PMID:Three cases of substitution errors leading to hyoscine hydrobromide overdose. 1644 May 14

Stroke patients present a high prevalence of obstructive sleep apnea (OSA) and those with OSA have a higher mortality after 1 year and poorer functional outcome compared with others. The aim of this study was to prospectively evaluate the acceptance of nasal continuous positive airway pressure (CPAP) by recent stroke patients with OSA. Recruitment of non-comatose stroke patients with sufficient consciousness for diagnostic evaluation of OSA was performed and they were treated at home with nasal CPAP after hospital calibration and training on the usage of CPAP. Initial evaluation and regular follow-up of the home trial of auto-CPAP was carried out for a duration of 8 weeks. Of 50 initially recruited patients, 32 (100%) responded to the minimum cognitive criteria but seven patients (22%) only used nasal CPAP for 8 weeks. Subject dropout was related to difficulties with CPAP usage as perceived by patient and family members, facial weakness, motor impairment and increase difficulties and discomfort with usage of full-face mask. The majority of OSA stroke patients rejected CPAP treatment. Better education and support of patients and families, and special training sessions in rehabilitation services, will be needed to improve compliance.
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PMID:Stroke and treatment with nasal CPAP. 1649 54

The medical records of 54 dogs presented to the Hebrew University Veterinary Teaching Hospital and diagnosed with heat stroke were retrospectively reviewed. Data abstracted included history, clinical and clinicopathological signs at admission, treatment, disease progression, and outcome. Exertional and environmental heat stroke were present in 63% (34 of 54) and 37% (20 of 54) of the dogs, respectively, and 78% (42 of 54) were examined between June and August. The mean temperature and heat discomfort index in the particular days of heat stroke were significantly increased (P < .001, P < .001, respectively) compared with their corresponding average daily values. In 27 dogs the body temperature was > or = 41 degrees C (105.8 degrees F). Belgian Malinois (15%, odds ratio [OR] = 24, 95% confidence interval [CI95%] 8.2-64.5), Golden and Labrador Retrievers (21%, OR = 2.08, CI95% 0.95-4.2), and brachycephalic breeds (25%, OR = 1.7, CI95%], 0.81-3.21) were overrepresented, whereas small breeds (<8 kg) were underrepresented (2%, OR = 0.08, CI95%, 0.002-0.48). Thrombocytopenia (45 of 54 dogs) and prolongation of the prothrombin (PT) and activated thromboplastin (aPTT) times (27 of 47 dogs) were recorded during hospitalization. Disseminated intravascular coagulation (P = .013) and acute renal failure (P = .008), diagnosed in 28 of 54 and 18 of 54 of the cases, respectively, were risk factors for death. The overall mortality rate was 50%. Hypoglycemia (<47 mg/dL, P = .003), prolonged PT (>18 seconds, P = .05), and aPTT (>30 sec, P < .001) at admission were associated with death. Serum creatinine >1.5 mg/dL (P = .003) after 24 hours, delayed admission (>90 minutes, P = .032), seizures (P = .02), and obesity (P = .04) were also risk factors for death. Heat stroke in dogs results in serious complications and high fatality rate despite appropriate treatment.
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PMID:Heat stroke in dogs: A retrospective study of 54 cases (1999-2004) and analysis of risk factors for death. 1649 21

Hormonal contraception is available in oral contraceptive pills and in newer formulations, including the transdermal patch, the vaginal ring, subcutaneous implants, and IM injections. Prevention of pregnancy is achieved by inhibiting ovulation, fertilization, and/or implantation of an egg. Hormonal contraception provides effective, tolerable, and reversible prevention of pregnancy. Efficacy and safety profiles are similar for different formulations and administration routes. Lowest expected failure (i.e., method failure) rates for hormonal contraceptives, regardless of formulation, are <2%. Typical failure rates for oral formulations range from <3% to 5% due to failures in compliance. The most commonly reported adverse effects are weight gain, nausea, variations in menstrual flow, breast changes such as tenderness, discomfort, or swelling, depression or mood disturbances, decreased sexual desire or response, and acne. Rare but serious potential effects include cardiovascular diseases, such as stroke, and an increased risk for breast cancer, liver tumors, and gallbladder disease. Hormonal contraceptive use should be avoided in women at risk for blood clots, by heavy smokers, and in women with breast or other cancers. Use of hormonal contraception in adolescents requires special consideration, in part because of decreased compliance.
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PMID:An overview of oral contraceptives: mechanism of action and clinical use. 1656 39

Rehabilitation specialists often are uncomfortable with dying clients and patients. This article explores the reasons why and offers suggestions to reduce the discomfort, improve service, and grow as a professional and human being.
Top Stroke Rehabil 2006
PMID:Shedding your fears: bedside etiquette for dying patients. 1658 31

The electrocardiogram, when applied in the prehospital setting, has a significant effect on a patient with chest pain. The potential effect includes both diagnostic and therapeutic issues, including the diagnosis of acute myocardial infarction and the indication for thrombolysis or invasive procedures. We report the case of a man who suffered from a syncope, with a prehospital electrocardiogram showing prominent ST-segment elevation. Out-of-hospital thrombolytic therapy was planned by the emergency department. Fortunately, thrombolysis did not start because the patient fared worse. He was taken to the emergency department and, because of mental status impairment, it was decided to perform a cranial computed tomographic scan. The diagnosis shifted to a haemorrhagic stroke. According to the guidelines, prehospital thrombolysis would have been inappropriate in this case because the patient did not have any chest discomfort. The pathophysiological mechanisms of electrocardiographic abnormalities in the setting of intracranial haemorrhage are reviewed, as well as the issue of thrombolysis administered or planned only on the basis of an electrocardiogram.
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PMID:Electrocardiographic abnormalities mimicking myocardial infarction in a patient with intracranial haemorrhage: a possible pitfall for prehospital thrombolysis. 1672 Dec 8

This study compared physiological responses associated with exercise tolerance in girls (G) and women (W) of similar fitness and heat acclimatization level during exercise in a hot and humid outdoor environment (33.4 degrees C and 55.1 % RH; WBGT = 29.9 +/- 0.2 degrees C). Nine pre-menarcheal G (age = 11.3 yr) and nine W (age = 26.8 yr), matched for aerobic capacity and heat acclimatization level, performed a cycling session at 60 % VO2max until fatigue. A sports drink was provided periodically to prevent dehydration. Tolerance time was not different between the groups (G = 56.9 +/- 6.3, W = 76.5 +/- 9.9 min, p > 0.05). During exercise, sweat rate (G = 9.1 +/- 1.1, W = 12.0 +/- 1.1 ml.m(-2).min(-1)), the increase in rectal temperature [T(re)] (G = 0.9 +/- 0.1, W = 1.1 +/- 0.1 degrees C), and heat storage (G = 10.6 +/- 5.3, W = 20.5 +/- 4.5 W.m(-2)) did not differ between the groups. At fatigue, T(re) (G = 38.2 +/- 0.1, W = 38.4 +/- 0.1 degrees C), heart rate (G = 167.3 +/- 7.3, W = 171 +/- 3.3 beats.min(-1)), stroke index (G = 48.3 +/- 1.5, W = 52.4 +/- 1.8 ml.m(-2)), and forearm skin blood flow (G = 9.5 +/- 1.3, W = 11.7 +/- 1.5 ml.100 ml(- 1).min(-1)) did not differ between the groups. Similar to women, the main reasons reported by girls to stop exercising in the heat were localized leg fatigue and gluteus muscle discomfort. We conclude that heat-acclimatized girls exhibit an adequate cardiovascular and thermoregulatory adjustment while exercising in a hot and humid outdoor environment when hypohydration is prevented.
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PMID:Exercise tolerance in a hot and humid climate in heat-acclimatized girls and women. 1673 90

Pain in the paretic upper limb is a common complaint in the post-stroke patients. It usually affects shoulder joint and, less frequently, wrist and hand. Pain is usually accompanied by limited mobility of the shoulder and sometimes by swelling of the hand and wrist. The aetiology of these complaints remains unclear. The objective of the study was to evaluate the incidence of pain, limited mobility, swelling and other signs that appear in the paretic limb within the first year after stroke. Forty-five stroke patients treated in the Department of Neurology in 2000 who answered the questionnaire concerning type, localization and intensity of the complaints from paretic upper limb were included. Twenty-six patients (58%) had a painful shoulder, wrist or hand. These complaints concerned women more frequently than men (71% vs. 46%, consecutively), younger patients aged below 55, and those who initially had more severe paresis. Symptoms and signs appeared within first month after stroke in majority of patients, and 70% of patients considered these symptoms very disturbing, significantly deteriorating the dexterity of the paretic limb. Thirty five percent of patients complained of limited mobility in the shoulder joint, 18% had incomplete mobility of fingers in the paretic limb. Twenty two percent of patients had swollen wrist and hand, and 24% had a discoloration and trophic changes of the skin in the paretic hand. Cold intolerance by means of freezing sensation in the affected limb was experienced by 58% of patients. Three patients had complaints both in shoulder and hand, with accompanied swelling, trophic changes and vasomotor disturbances in the hand, what fulfilled criteria for the diagnosis of shoulder-hand syndrome. The results of the study show that upper limb pain and limited mobility are common complications of the stroke. Usually underestimated by family doctors these symptoms and signs cause a significant discomfort for the patients and delay the recovery of the paretic limb.
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PMID:[Upper limb pain and limited mobility in the patients after stroke]. 1681 69

Biomaterials are regularly used in various types of artificial tissues and organs, such as oxygenators, plasmapheresis equipment, hemodialysers, catheters, prostheses, stents, vascular grafts, miniature pumps, sensors and heart aids. Although progress has been made regarding bioincompatibility, many materials and procedures are associated with side effects, in particular bioincompatibility-induced inflammation, infections and subsequent loss of function. After cardiopulmonary bypass, coagulopathies can occur and lead to cognitive disturbances, stroke and extended hospitalization. Hemodialysis is associated with anaphylatoid reactions that cause whole-body inflammation and may contribute to accelerated arteriosclerosis. Stents cause restenosis and, in severe cases, thrombotic reactions. This situation indicates that there is still a need to try to understand the mechanisms involved in these incompatibility reactions in order to be able to improve the biomaterials and to develop treatments that attenuate the reactions and thereby reduce patients' discomfort, treatment time and cost. This overview deals with the role of complement in the incompatibility reactions that occur when biomaterials come in contact with blood and other body fluids.
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PMID:The role of complement in biomaterial-induced inflammation. 1690 92

Intrathecal baclofen (ITB) therapy has been increasingly employed for the management of poststroke spastic hypertonia, a complication that can lead to deformity, discomfort, and exacerbation of motor impairments. Because its use in stroke is not as established as other indications, ITB therapy has not been subjected to rigorous investigation. There is limited evidence to guide clinicians regarding application of this therapy in this patient population. This article aims to review the available scientific literature and the opinion of several experts on the topic. It will also describe the recommendations of these experts with regard to addressing common clinical situations that may influence treatment decisions in the stroke population.
Top Stroke Rehabil 2006
PMID:Consensus panel guidelines for the use of intrathecal baclofen therapy in poststroke spastic hypertonia. 1708 72


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