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

Preoperative and postoperative left ventricular cineangiograms of 26 patients with mitral stenosis (MS) were analyzed to calculate left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF) and systolic regional wall motion. Nine patients underwent commissurotomy (OMC group) and 17 patients underwent mitral valve replacement (MVR group). In both groups, postoperative EDV, SV and EF tended to increase, while ESV remained unchanged. In the OMC group, systolic wall motion of the left ventricle was found to be improved postoperatively, whereas systolic wall motion in the MVR group was found to be impaired postoperatively. The latter finding was assumed to be due to excision of the papillary muscles and chordae tendineae. Preservation of these structures is likely to be important for better postoperative functional recovery of the left ventricle.
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PMID:Postoperative left ventricular function in patients with mitral stenosis. The effect of commissurotomy and valve replacement on left ventricular systolic function. 372 90

The continuous measurement of intramyocardial pH was used to follow the progression of ischemia and was correlated to the recovery of left ventricular function following normothermic (38 degrees C) and hypothermic (25 degrees C) global ischemia. New miniature myocardial transducers, which incorporate fiberoptic technology and dual pH- and temperature-sensing capability, were placed into the left ventricular free wall and septum of 52 sheep undergoing cardiopulmonary bypass. Left ventricular stroke work as a function of mean left atrial pressure curves were generated before and after cardiopulmonary bypass by volume loading with whole blood. Functional recovery was determined by the ratio of the integrals of the preischemic and postischemic function curves. Control sheep (N = 11) did not undergo ischemia. Three groups (N = 41) underwent aortic cross-clamping until pH reached 7.0, 6.8, or 6.6. The preischemic myocardial pH averaged 7.42 +/- 0.01. Following both normothermic and hypothermic global ischemia, no significant difference was demonstrated in recovery of function between control (pH 7.4) and pH 7.0 groups at either temperature. However, recovery of function of the pH 6.8 and pH 6.6 groups was significantly decreased (p less than 0.01) versus control and pH 7.0 groups at both temperatures. No significant difference in recovery of function was demonstrated at any pH level when normothermic versus hypothermic groups were compared. However, hypothermia provided increased time (p less than 0.001) before each level of function was reached with a slower rate of change of pH (p less than 0.01) compared with the corresponding same pH group in sheep undergoing normothermic (38 degrees C) cardiopulmonary bypass.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Continuous measurement of intramyocardial pH: correlation to functional recovery following normothermic and hypothermic global ischemia. 372 14

Knowledge of the natural course of stroke patients has become increasingly important since new therapeutic methods have been proposed for patients with cerebral infarction in the acute stage. In order to clarify the acute stage of this disease, 188 patients admitted within 24 hours after onset of middle cerebral artery (MCA) occlusion were followed for 2 months, and data relating to mortality and changes in disturbances of consciousness and motor function were investigated. It was shown that the prognosis for MCA occlusion cases is poor, and about 80% of these patients are unable to return to their previous lifestyle. The level of consciousness in the acute stage is a good index for estimating the patients' quality and time of survival, and motor function in the acute stage is a good indicator of functional recovery. Thus, when evaluating the effectiveness of a new therapy for cerebral infarction, rapid improvement in the acute stage before and after treatment should be carefully noted.
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PMID:Clinical course of acute middle cerebral artery occlusion. 373 83

This study tests the hypotheses that postischemic adenosine triphosphate levels are unreliable predictors of functional recovery, myocardial adenosine triphosphate concentration of less than 2 mumol/gm does not indicate irreversible damage, mitochondrial adenosine triphosphate generating capacity can be nearly normal despite low levels of tissue adenosine triphosphate and the failure to replenish adenosine triphosphate after ischemia is due to depletion of the adenosine nucleotide pool, which can be replenished partially by exogenous precursors (e.g., 5-amino-4-imidazolecarboxamide ribotide [AICAR]). Myocardial adenosine triphosphate was depleted to less than 2 mumol/gm by either global ischemia (37 degrees C aortic clamping) or regional ischemia (acute coronary occlusion). Reperfusion was either with normal blood or with substrate-enriched blood cardioplegic solution during total vented bypass. Tissue adenosine triphosphate content and mitochondrial adenosine triphosphate generating capacity were measured, and functional recovery was determined by right heart bypass function curves or regional segmental shortening (ultrasonic crystals). Hearts undergoing 15 minutes of global ischemia and normal blood reperfusion had impaired functional recovery (stroke work index = 58 +/- 5%; p less than 0.05 of control) despite adenosine triphosphate concentration greater than 2 mumol/gm. Transmural mitochondrial State 3 respiration averaged 83% of control values despite adenosine triphosphate levels of 1 mumol/gm in hearts undergoing 45 minutes of 37 degrees C global ischemia and 2 additional hours of aortic clamping with multidose glutamate-enriched blood cardioplegia. AICAR increased adenosine triphosphate to 2 mumol/gm (p less than 0.05), but functional recovery was nearly complete (stroke work index = 94 +/- 2% of control) and was comparable with and without AICAR. Hearts undergoing 4 hours of regional ischemia recovered 31 +/- 5% systolic shortening after controlled reperfusion despite tissue adenosine triphosphate less than 0.5 mmol/gm (15% of control), and they retained 63% adenosine triphosphate generating capacity. Postischemic adenosine triphosphate levels correlate poorly with functional recovery, and adenosine triphosphate levels less than 2 mumol/gm do not indicate irreversible ischemic injury. Low postischemic levels may be repleted partially by adenine nucleotide precursor supplementation (AICAR).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Biochemical studies: failure of tissue adenosine triphosphate levels to predict recovery of contractile function after controlled reperfusion. 374 77

Previous experimental studies found that acute intoxication may alter the long-term outcome of standardized spinal cord injury resulting in increased spinal cord necrosis and impaired functional recovery. We examined the effects of acute intoxication (blood alcohol concentration of 100 mg/dl) on hemorrhage and axonal conduction three hours after moderate severity spinal cord contusion induced by a constrained stroke pneumatic impactor. The hemorrhagic spinal cord lesion resulting from standardized injury was significantly increased by acute intoxication. Both local hemorrhage at the injury site and rostro-caudal and total extent of hemorrhage were increased. Also, the ability of nerve axons to recover function during the first three hours post-contusion was impaired by intoxication. These findings confirm that increased post-contusion hemorrhage results when spinal cord contusion injury occurs in the presence of acute intoxication, and suggest that increased intramedullary hemorrhage may contribute to previously observed increases in anatomic damage and impaired functional recovery with alcohol intoxication.
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PMID:Effects of acute alcohol intoxication on spinal cord vascular injury. 380 21

The presence of a bruit after carotid endarterectomy may indicate a persistent or recurrent lesion. The authors noninvasively evaluated, by Duplex scanning, 18 asymptomatic postoperative patients who underwent a total of 23 carotid endarterectomies and who developed a postoperative bruit to determine the significance of the bruit. Eleven men and seven women were studied from 6 weeks to 2 years postsurgery. Ages ranged from 49 to 75 years (63.6 +/- 8.0 years). Indications for endarterectomy were: transient ischemic attacks (including amaurosis fugax), 17 vessels; completed stroke with significant functional recovery and residual carotid disease, 3 vessels; and asymptomatic bruit with hemodynamically significant carotid stenosis, 3 vessels. Each patient had a Duplex scan performed to noninvasively evaluate the carotid artery. All scans were independently reviewed by two observers. Real-time B images were interpreted as normal in 14 vessels, mild thickening in eight vessels, and moderate thickening in only one vessel. Doppler recordings demonstrated a spectral range of 15-40 cm/sec (26 +/- 8 cm/sec). Ratio of velocity in the internal carotid artery to common carotid artery (VIC/VCC) ranged from 0.389 to 1.281 (0.779 +/- 0.250). This study demonstrates that the presence of a postoperative carotid bruit does not necessarily signify the presence of residual carotid disease or a hemodynamically significant lesion.
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PMID:The post endarterectomy carotid bruit. Evaluation by Duplex scan. 390 47

Of the 373 stroke patients 95 were admitted to the feasibility study of stroke rehabilitation. The patients were divided into two groups, an intensive and a normal treatment group. In this study, the functional recovery of stroke, measured by ADL and motor function was significantly better in the intensive treatment group. There was no difference in institutionalization or incidence of death between the groups. The gain of ADL and motor function was greatest during the first three months after stroke in the intensive treatment group. The conclusion is that intensified physiotherapy seems to improve the functional recovery of stroke patients.
Stroke
PMID:The significance of intensity of rehabilitation of stroke--a controlled trial. 391 6

The immature myocardium has a greater tolerance for ischemia than does the mature heart. The effect of ischemia when combined with hypothermia on the newborn heart is poorly understood but has important clinical applications. This study examined the metabolic and functional recovery after 90 minutes of global ischemia at 20 degrees C in neonatal (1 week), immature (1 month), and mature (4 month) isolated working rabbit hearts. Following ischemia, aortic flow, cardiac output, heart rate, and stroke work remained at baseline values for neonatal hearts. Only coronary flow was significantly reduced from a control level of 4.5 +/- 1.4 (standard error of the mean) to 3.3 +/- 1.1 ml/min, p less than 0.05. In the immature group, hemodynamic parameters were below baseline, although no statistical differences were noted. Among mature hearts, however, all hemodynamic values were significantly below preischemic control. Water content was significantly higher in immature (73.2% +/- 1.4%) and mature (75.3% +/- 2.5%) hearts when compared with the neonatal group (46.8% +/- 4.6%), p less than 0.001. Coronary sinus creatine kinase was unchanged from baseline at 10 and 30 minutes following ischemia in the neonatal group. Although demonstrating substantial increases from baseline, statistical significance was not seen in the immature group because of the wide variation about the mean. In the mature group, creatine kinase rose significantly from preischemic levels of 15.4 +/- 4.3 IU/L/gm to 184.2 +/- 51.6 IU/L/gm at 10 minutes (p less than 0.01) and 123.7 +/- 31.9 IU/L/gm at 30 minutes (p less than 0.05). This study demonstrated improved tolerance to prolonged hypothermic ischemia in neonatal rabbit hearts when compared with older hearts subjected to the same conditions. The role of cardioplegic solutions in protecting the neonatal heart during cardiac operations when deep hypothermia is used may be of lesser importance than in the older patient.
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PMID:Recovery of left ventricular function after hypothermic global ischemia. Age-related differences in the isolated working rabbit heart. 394 54

A novel model of hemiplegia in young and aged rats is described. Osmotic minipumps were used to deliver a chronic (7 days), localized application of gamma-aminobutyric acid (GABA) (100 micrograms/microliter/h), to the somatomotor cortex of unrestrained rats. This resulted in an easily quantifiable, contralateral and reversible motor syndrome in both young and aged animals. In the young group, the motor deficit cleared over 5-day period, while in the aged animals it persisted for at least a 2-week period. Control animals treated with saline-filled minipumps did not develop a long-lasting motor deficit. The GABA-induced facilitation of hemiplegia due to small motor cortex lesions and the age effects on behavioral recovery of function are discussed. Cortical inhibitory mechanisms may play a role in debilitating syndromes such as stroke or post-epileptic paralysis.
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PMID:gamma-Aminobutyric acid-induced potentiation of cortical hemiplegia. 394 81

This study tests the hypothesis that aspartate enrichment of glutamate-blood cardioplegia improves metabolic and functional recovery after ischemic and reperfusion damage. Ischemic and reperfusion damage were produced in 15 dogs by 45 minutes of aortic clamping at 37 degrees C and 5 minutes of blood reperfusion, before 2 more hours of aortic clamping (simulated operation). Six received multidose blood cardioplegia at 4 degrees C. In nine others, the cardioplegic solution was infused at 37 degrees C for the first 5 minutes, followed by multidose infusions at 4 degrees C. Four received 26 mmol glutamate-enriched cardioplegic solution. In five, the glutamate (13 mmol) cardioplegic solution was enriched with aspartate (13 mmol). Oxygen uptake and ventricular function (stroke work index, left atrial pressure) were measured. These data suggest aspartate enrichment produced the highest oxygen uptake (32 +/- 4 versus 17 +/- 2 ml/100 gm for glutamate and 7 +/- 1 ml/100 gm for 4 degrees C blood cardioplegia). Complete functional recovery occurred in aspartate/glutamate-treated hearts (stroke work index 90% +/- 4%, left atrial pressure 12 +/- 2 mm Hg), whereas recovery was incomplete with both glutamate alone (stroke work index 66% +/- 14%, left atrial pressure 20 +/- 3 mm Hg) and 4 degrees C blood cardioplegia at low cardiac outputs. Eight of 10 hearts not receiving aspartate failed at high cardiac outputs. Aspartate enrichment of glutamate-blood cardioplegia improves recovery after severe ischemic/reperfusion damage by improving oxidative metabolism during cardioplegic infusion and during postischemic work.
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PMID:Safety of prolonged aortic clamping with blood cardioplegia. III. Aspartate enrichment of glutamate-blood cardioplegia in energy-depleted hearts after ischemic and reperfusion injury. 395 Dec 46


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