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

Up to 90% of patients (those with occlusive stroke) may be candidates for clot lysis. Fears that lysis might cause hemorrhage appear to be unwarranted. The most important clinical lesson learned to date is that the earlier the intervention, the better the outcome. Issues such as the most efficient diagnosis, most amenable sites, and IV versus intra-arterial administration are under study.
Hosp Pract (Off Ed) 1993 Nov 15
PMID:Thrombolysis and stroke management. 822 48

Off-pump CABG was utilized on patients who had multivessel coronary artery disease and other organ diseases. A total of 79 patients who underwent off-pump CABG were evaluated. Of these, 66 suffered from OMI and AP, 4 form AP, 6 from u-AP, and 3 from AMI. LITA was used in 75 cases, RA in 48, GEA in 45, RITA in 13, IEA in 3, and SVG in 38. Revascularization was performed at # 2 in 3 cases, # 3 in 11, 4 PD in 37, 4 PL in # 7 or # 8 in 79, # 9 in 27, # 12 in 51, and # 14 in 17. A time of 10.3 min was spent on LAD revascularization, 9.8 min on D 1, 10.2 min on Cx, anf 11.5 on RCA. Seven patients were transferred to on-pump beating CABG because of hemodynamic instability. One patients suffered postoperative CVA, and 2 had wound infection. Complete revasculization was accomplished in 78 patients, and hospital death was not reported.
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PMID:[Evaluation of cases of off-pump CABG with mid-sternotomy]. 1129 16

The adult rodent brain is capable of generating neuronal progenitor cells in the subventricular zone, and in the dentate gyrus of the hippocampus, throughout the life of the animal. Signals that regulate progenitor cell proliferation, differentiation, and migration are not well known. We report that administration of a nitric oxide donor, (Z)-1-[N-(2-aminoethyl)-N-(2-ammonioethyl) aminio]diazen-1-ium-1,2-diolate (DETA/NONOate), to young adult rats significantly increases cell proliferation and migration in the subventricular zone and the dentate gyrus. Treatment with DETA/ NONOate also increases neurogenesis in the dentate gyrus. Furthermore, administration of DETA/NONOate to rats subjected to embolic middle cerebral artery occlusion significantly increases cell proliferation and migration in the subventricular zone and the dentate gyrus, and these rats exhibit significant improvements of neurological outcome during recovery from ischemic stroke. Administration of DETA/NONOate significantly increases cortical levels of guanosine monophosphate both in ischemic and nonischemic rats, supporting the role of nitric oxide in promoting cell proliferation and neurogenesis. Thus, our data indicate that nitric oxide is involved in the regulation of progenitor cells and neurogenesis in the adult brain. This suggests that nitric oxide delivered to the brain well after stroke may have therapeutic benefits.
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PMID:A nitric oxide donor induces neurogenesis and reduces functional deficits after stroke in rats. 1170 66

Off-pump coronary artery bypass grafting (OPCAB) is clearly preferable for patients with extracardiac complications. The aim of this study was to evaluate the initial outcome of OPCAB, and its validity for patients with extracardiac complications. One hundred and fifty-seven consecutive coronary artery bypass graft (CABG) patients were divided into two groups: 30 OPCAB patients and 127 on-pump CABG patients. The early outcomes of the two groups were compared. Preoperatively, OPCAB patients had more extracardiac risk factors than on-pump CABG patients. There were no differences in age or cardiac function between the groups, but the off-pump group had a higher incidence of previous surgery, cerebrovascular disease, and renal failure. There were no differences in graft patency, stroke, or mortality between the two groups, even though the OPCAB patients had more risk factors than the on-pump patients. Our initial experience with OPCAB showed that it is acceptable for high-risk patients in view of the serious nature of their extracardiac condition.
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PMID:Initial experience with off-pump coronary artery bypass grafting. 1182 19

Pyrroloquinoline quinone (PQQ) is a redox active essential nutrient that can generate or scavenge superoxide depending on its microenvironment. PQQ has been shown previously to be neuroprotective in a rodent stroke model. Here we test whether PQQ interacts with reactive nitrogen species, known to be involved in the pathogenesis of stroke. Using rat forebrain neurons in culture, we determined that the toxicity of SIN-1 was mediated by peroxynitrite and that PQQ could block this toxic action. However, PQQ could not block the toxicity of peroxynitrite itself. Both SIN-1 and peroxynitrite caused ATP depletion, but only SIN-1 evoked ATP depletion was blocked by PQQ. In a cell-free system, PQQ blocked nitration of bovine serum albumin produced by SIN-1, but potentiated peroxynitrite-induced nitration. PQQ was unable to block ATP depletion and cell death induced by NO. donors (DEA/NO, DPT/NO and DETA/NO), indicating that it does not directly interact with nitric oxide, and suggesting that it acts as a superoxide scavenger. PQQ significantly potentiated cGMP accumulation evoked by SIN-1, similar to the effect of superoxide dismutase (SOD). However, unlike SOD, which potentiated neurotoxicity induced by SIN-1, PQQ blocked its toxicity, arguing against the possibility that PQQ functions simply as a SOD mimetic. Indeed, substantially less H2O2 was produced by the incubation of SIN-1 with PQQ, when compared to SOD. These results suggest that PQQ scavenges superoxide without forming toxic levels of H2O2. Therefore, the protective effect of PQQ on stroke might be due, at least in part, to the suppression of peroxynitrite formation.
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PMID:The essential nutrient pyrroloquinoline quinone may act as a neuroprotectant by suppressing peroxynitrite formation. 1238 30

Patients with porcelain aorta and severe calcification of the great vessels are a challenging dilemma for the cardiovascular surgeon regarding bypass technique, choice of conduit, and selection of proximal anastomotic sites due to the high incidence of devastating thromboembolization and aortic injury. No currently proposed surgical approach avoids manipulation of the heavily calcified ascending aorta. Three patients presented with unstable angina and decreased ventricular function secondary to significant left main coronary artery stenosis and 3-vessel coronary artery disease. In addition to the coronary artery disease, severely calcified ascending aorta and great vessels were discovered. One patient presented with near total distal abdominal aortic occlusion, severe peripheral vascular disease, history of stroke, and carotid endarterectomy. Surgical coronary revascularization was indicated. Coronary artery bypass grafting using internal thoracic artery and greater saphenous vein composite arterial inflow grafts in combination with off-pump beating heart surgery was successfully used. Cardiopulmonary bypass and clamping of the aorta was avoided. No new neurologic deficit was observed. Coronary revascularization with internal thoracic artery composite grafts and avoiding cardiopulmonary bypass and clamping the calcified aorta is an effective method to prevent clamp injury and thromboembolization. Off-pump coronary artery bypass grafting seems to be an ideal indication in patients with porcelain aorta because the surgical techniques of "no-touch" and "no-cannulation" can be applied.
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PMID:Off-pump coronary artery revascularization: ideal indication for patients with porcelain aorta and calcification of great vessels. 1281 87

Off-pump coronary artery bypass technique or bypass graft surgery without the use of a heart-lung machine has been introduced in the last six years, and now comprises approximately 25 per cent of all coronary artery bypass surgery being done in the world. One of the goals of beating heart surgery is to eliminate the complications associated with the use of cardiopulmonary bypass. The use of all arterial conduits for coronary artery bypass graft has become more acceptable after experiences gained and reports of better long-term results. From January 2001 to December 21 2002 the authors performed 251 off-pump procedures. One hundred and nine of these cases were done utilizing all arterial conduits. The data was stratified using the US National Society of Thoracic Surgeons Cardiac Surgery Database pre-operative risk module and divided into 3 groups as suggested: Low risk group with a predicted mortality of 0-1 per cent (2 patients); Medium risk group with a predicted mortality of 2-9 per cent (87 patients), and High risk group with a predicted mortality of 10+ per cent (10 patients). The predicted mortality of the entire group was 4.5 per cent. There were 90 males and 19 females with a mean age of 60.2 +/- 10.7 years, with 15.6 per cent of them older than 70 years. Pre-operative co-morbidities included 1/4 of the patients who had ejection fraction (EF) of equal to or less than 0.4, 4.5 per cent had unstable angina, 1.6 per cent had urgent/emergent status, 26.6 per cent underwent re-operative procedure, 1 per cent had pre-operative serum creatinine more than 2 mg per cent, 4.8 per cent had a history of stroke, 20.2 per cent had a history of congestive heart failure, 45.2 per cent had a history of previous myocardial infarction, 10.7 per cent had a history of chronic obstructive pulmonary disease, 46.9 per cent had a history of diabetes, 62 per cent had hypertension, and 20 patients (18.3%) required intra aortic balloon pump. Intra-operative parameters revealed 3.7 +/- 1.3 grafts/patient. The left internal mammary artery (LIMA) was used to the left anterior descending (LAD) in 6.4 per cent, or sequential with the diagonals 93.6 per cent. The 30 days mortality was 3.6 per cent (4 cases). Further analysis revealed that pre-operatively, none of these 4 cases was in the low predicted (predicted mortality of 0-1%) risk group, 2 of them were in the medium (predicted mortality of 2-9%) and the other 2 were in the high predicted risk (predicted mortality of 10+%) group. The skin-to-skin time was 4.1 hours and there were two conversions to on-pump in this group. Post-operatively, the intubation time was 4.7 hours. There was no peri-operative myocardial infarction, one patient required dialysis, and no patient experienced stroke. There was no sternal wound or arm wound infection, 9.5 per cent experienced temporal sensation impairment at the site of the radial artery harvesting at one month. Re-operation for bleeding occurred in 3 cases, and thirteen patients (14.3%) developed new atrial fibrillation. The authors are no longer making a one-foot long incision and spread ten inches wide like in the old days'. With the less invasive approach lessened in the recent past, the authors have found the less invasive the incision the less the pain after surgery. Totally eliminating the leg incision has allowed the patient to get up and mobilize on the same afternoon, if the procedure was done in the morning. All of these approaches combined with the off-pump technique, as far as the authors are concerned, will provide those who need coronary arterial bypass graft the best operative procedure.
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PMID:Off-pump coronary bypass surgery and all arterial conduits: learning experience at Bangkok Heart Institute. 1286 64

Off-pump coronary artery bypass (OPCAB) using in-situ grafts does not require aortic manipulation, and it is theoretically free from the risk of stroke. Because of the limited availability of in-situ grafts, aortocoronary bypass has been conducted in addition to in-situ grafting. In this paper, the authors prospectively investigated whether or not on aortocoronary bypass increases the incidence of stroke after off-pump bypass. Perioperative data were collected prospectively from patients who underwent isolated off-pump bypass at their hospital group between March 1997 and February 2002. The patients were divided into 2 groups; group AC (patients with at least 1 aortocoronary bypass, n = 280) and group IS (patients with all in-situ grafts, n = 234). Patients with 3-vessel disease more frequently underwent aortocoronary bypass and patients with a history of stroke, calcified ascending aorta, or renal failure more often underwent in-situ graft. The number of distal anastomoses was greater in group AC (3.5 +/- 1.0) than in group IS (2.7 +/- 1.1), p < 0.0001. Patient recovery and complication rates were similar, including the occurrence of postoperative stroke: 3.0% (7/234) in group IS vs 0.7% (2/280) in group AC, p = 0.051, NS. The graft patency and remote results were not significantly different between the 2 groups. Side clamping of the aorta used in off-pump aortocoronary bypass does not increase the risk of postoperative strokes compared to in-situ bypass. Postoperative stroke after OPCAB may depend on the patient's preoperative comorbidities.
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PMID:Stroke rate of off-pump coronary artery bypass; aortocoronary bypass versus in-situ bypass. 1466 52

Abstract Background: Cardiac surgery has expanded the available approaches to aortocoronary artery bypass grafting to include approaches from minimally invasive surgery to full sternotomy. The heart can be arrested, left beating, or assisted with a right ventricular assist device or cardiopulmonary bypass pump. We have examined the 4 surgical modes that we use routinely in our large multisurgeon practice to determine our selection biases and the outcomes of the different techniques. Methods: Of the 4733 coronary artery bypass grafting (CABG) patients we studied from January 2000 through December 2002, 2332 (49.3%) operations were done on-pump on the arrested heart, 1908 (40.3%) were performed off-pump, 364 (7.7%) were performed on-pump on the beating heart, and 129 (2.7%) were performed with right heart assist. The preoperative risk factors, operative variables, and postoperative outcomes of the groups were analyzed. Results: Patients selected for on-pump beating heart procedures tended to be sicker with the highest predicted risk of death. We also selected patients who were in cardiogenic shock, in resuscitation, in emergent or salvage status, on dialysis, and with preoperative intra-aortic balloon pump (IABP) use for on-pump beating heart procedures at higher than expected rates. Patients with renal failure with or without dialysis, and those having a history of cerebrovascular accident tended not to be chosen for on-pump arrested heart procedures. Off-pump beating heart procedures were avoided for patients with cardiogenic shock or resuscitation, in emergent or salvage status, and with preoperative IABP use. The mortality rate in these patients was slightly worse in the on-pump beating heart group (4.4%) than in the on-pump arrested heart (3.5%) and off-pump (2.3%) groups (analysis of variance [ANOVA], P =.04). Atrial fibrillation occurred more frequently in both the on-pump beating heart (20.1%) and on-pump arrested heart (23.8%) groups (ANOVA, P <.001). The on-pump groups had higher rates of blood product use and reoperation for bleeding and a prolonged ventilation rate, compared with the other procedures. On-pump patients had a statistically longer length of stay than either off-pump or right heart-assisted patients ( P <.05) and required longer times on the ventilator and in the intensive care unit. Conclusions: Normothermic cardiopulmonary bypass with a beating heart is safe and efficacious and may be the method of choice for patients in cardiogenic shock, requiring resuscitation, or with previous CABG surgery, recent myocardial infarction, a low ejection fraction, or unstable arrhythmias.
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PMID:On-Pump Beating Heart Surgery Offers an Alternative for Unstable Patients Undergoing Coronary Artery Bypass Grafting. 1498 Aug 39

Different methods of inducing experimental brain lesions can result in distinct neuropathological sequelae. This could be of consequence in attempts to establish animal models of recovery of function following stroke, as differences in the progression of experimental lesion pathology may have an impact on the magnitude and rate of recovery of function observable with any particular lesioning method. In the present study, a novel method of producing a focal ischaemic lesion by intracortical microinjection of endothelin-1 (ET-1) was compared with excitotoxic (microinjection of quinolinic acid) and mechanical (aspiration) lesioning procedures. Lesions were unilateral and were targeted at the forelimb representation zone in sensorimotor cortex. It was found that all three types of lesion had an essentially identical effect with regard to reaching accuracy in a paw-reaching task. All lesioned animals displayed a similar, significant long-term deficit in reaching accuracy and limited degree of recovery relative to sham animals. Off-line analysis of the performance of animals during post-lesion week 9 indicated that animals in each lesion group also displayed a similar deficit. The current results suggest that the spontaneous behavioural consequences of a unilateral lesion of FL in the rat appear to be independent of the nature of lesion production. However, the increased face validity of an ET-1-induced lesion, coupled with the ease of control of lesion placement and extent offered by this technique make for a potentially important animal model for research into drug effects on recovery of function following stroke.
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PMID:The effects of intracortical endothelin-1 injections on skilled forelimb use: implications for modelling recovery of function after stroke. 1503 90


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