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

Acetylsalicylic acid (ASA) inhibits thromboxane production and hence platelet aggregation. However, individual variations in platelet aggregability and serum thromboxane B2 (TxB2) concentration after a low dose of ASA (40 mg/day) have been reported. To clarify this issue, we studied plasma thromboxane levels and platelet aggregation in 43 ischemic stroke patients. Of the 22 patients who received 100 mg of ASA daily, dissociation between inhibitory effects of ASA on the plasma TxB2 level and threshold concentrations of adenosine diphosphate was found in three cases after one month of drug administration, and in three cases after six, 12 and 18 months of ASA therapy. This dissociation also developed in two patients after one month and six months, respectively, of treatment in the 21 patients who received 300 mg of ASA daily. The dissociation between the inhibitory effects on plasma TxB2 and the circulating platelet aggregate ratio was found in two cases after taking medication for one month, and in four cases after six, 12, 18 and 24 months of therapy in the 100 mg ASA group. In the 300 mg ASA group, dissociation was noted in two cases after one month of medication, and in two cases after six and 12 months of medication. In these patients, although their TxB2 levels were inhibited to almost unmeasurable levels, platelet aggregation was still not inhibited. This ASA inhibitory dissociation phenomenon on platelet function may be due to the low dose of ASA, individual differences in platelet function in response to ASA therapy, or factors other than those involved in the cyclooxygenase system.
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PMID:Dissociation of inhibitory effects of low-dose ASA on thromboxane production and platelet aggregation in ischemic stroke patients. 136 90

Marked advances in the treatment of neurological disorders which affect the elderly have been established in recent years. Cerebrovascular disorders including stroke and vascular dementia are still among the most frequent diseases in the Japanese elderly. For treatment of hypertensive patients with or without a history of stroke, slight decrease of blood pressure (BP) is recommended since recent PET studies have revealed that an excessive drop of BP markedly decreases cerebral blood flow. Furthermore, 24-hour-monitoring of BP revealed that physiological fluctuation of BP consisting of high daytime BP and low nocturnal BP disappears in hypertensive patients with vascular dementia and those with non-symptomatic vascular lesions on MRI. Recommendable BP levels for the hypertensive elderly must be established. The efficacy of both aspirin and ticlopidine for prevention of stroke has been established. Recent multi-centric trials have revealed that ticlopidine is more effective in preventing stroke but has more dangerous adverse effects than aspirin. Aspirin is reported to improve both the intellectual scale and cerebral blood flow in vascular dementia. In Parkinson's disease (PD), L-DOPA therapy, usually in combination with a dopa decarboxylase inhibitor, is common. Other dopaminergic drugs including bromocriptine, lisuride and pergolide are used clinically or are being studied. Recently selective monoamine oxidase (MAO) B inhibitors have been used in order to slow clinical progression of the disease, in addition to an attempt to increase the potential of dopamine through inhibition of MAO. Neural transplants to the striatum of PD were first applied using autografts of the adrenal medulla in 1985, but resulted in transient or only slight improvements.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Recent therapeutic advances in geriatric neurology]. 143 48

The laryngeal mask airway (LMA) provides a patent airway when placed 'blindly' into the hypopharynx. At the laryngeal side it is supposed to form a seal surrounding the laryngeal inlet with the epiglottis lying outside the mask aperture. This study is designed to assess the prelaryngeal position of the mask by the fibreoptic technique. METHODS. After approval by the local ethical committee and informed consent, 100 adult patients (ASA groups I and II) undergoing general anaesthesia for extracorporal stroke wave lithotripsy (ESWL, Lithotripter HM 3, Dornier) of the kidney were studied. Anaesthesia was induced with propofol (1.5-2.5 mg.kg-1) and fentanyl (1-1.5 micrograms.kg-1) and maintained with isoflurane and N2O (65% in O2) as clinically indicated. The LMA was left in situ until the patients opened their mouth on command. Monitoring consisted of an ECG (SMV 104-D, Dornier), a pulse oximeter (Nellcor 200, Draeger), and a non-invasive blood pressure monitor (BP 103 N, Hoyer). Clinical assessment of airway patency and fibreoptic laryngoscopy (BF Typ 10, Olympus)--immediately and 20 min following the insertion of the LMA--were performed by two observers. RESULTS. The insertion of the LMA was successful on the first attempt in 89 patients while 5% required two, 4% three and 2% four attempts. 'Blindly' inserted without neuromuscular blockade the LMA provided a clinically sufficient airway in all patients. A central position of the LMA was assessed in only 59% of the cases. In 4 patients the mask was riding on the vocal folds. Positioned at the posterior larynx the cuff produced a compression of the laryngeal orifice when insufflated. Oblique insertion of the LMA or oblique head position during insertion produced a misplacement of the LMA. In 5 cases the LMA followed lateral movements of the head without losing its central position. In 87% the epiglottis was within the lumen of the LMA. Secretions inside the mask lumen or at the anatomic structures were seen in 36%. During manual ventilation with high inspiratory pressure (> 25 cm H2O) the oesophagus opened in 10 cases. CONCLUSIONS. Previous studies have suggested that the LMA takes a 'perfect' position at the laryngeal side when a clinically patent airway is recognized. In contrast, our results demonstrated that a central position of the LMA is achieved in only 59% of the cases. Our results indicate that epiglottic downfolding or left/right side or anterior/posterior misplacement are common but generally provide a satisfactory patent airway. This is consistent with fibreoptic findings in children and radiological observations in adults. The LMA is an essential enrichment to conventional airway management. It provides a better seal than the face mask, especially in bearded or in old patients where the facial contours are often not suited to the mask. Ideal indications seem to be elective operations of intermediate duration (1-2 h). The LMA does not protect against aspiration. For patients who are at risk of regurgitation of gastric contents, use of the LMA is absolutely contraindicated. Relative contraindications are local pathology of the pharynx and situations with low pulmonary compliance and/or high airway resistance (massive obesity, asthma, etc.), especially during controlled ventilation. Further studies are necessary to establish definite indications for the application of the LMA.
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PMID:[Fiberoptic determination of the position of the laryngeal mask]. 148 77

Aspirin (acetylsalicylic acid) and its salicylate derivatives are effective antipyretic, analgesic, and anti-inflammatory agents that are still very widely used by the elderly despite the advent of newer, potentially safer nonsteroidal anti-inflammatory drugs (NSAIDs). However, none of the new NSAIDs have been proven to be more effective than aspirin or salicylic acid. Chronic salicylate intoxication which is most common in the elderly, may occur with therapeutic doses. Increased toxicity in older patients often appears due to inadvertent overdosage. Dual prescribing or additional use of nonprescription salicylates are some causes of unwitting long term toxicity. According to some studies, systemic clearance of salicylate (mainly by hepatic metabolism) is reduced with age, as is renal elimination. These changes are of increased importance in the elderly using high therapeutic doses of salicylates when metabolism is saturated and more unchanged drug is available for renal excretion. In the face of renal impairment, the risk of toxicity is increased. The diagnosis of acute salicylate intoxication generally does not pose diagnostic problems. Patients often present with a history of intentional overdose, with hyperventilation, fever, and nausea. The diagnosis can be confirmed by measuring serum salicylate concentrations. Chronic intoxication often poses a diagnostic dilemma with atypical presentations mimicking other disease states such as diabetic ketoacidosis, delirium, cerebrovascular accident, myocardial infarction or cardiac failure. The diagnosis of salicylate intoxication should be borne in mind when an older patient presents with recent deterioration in activities of daily living with no known cause. Plasma salicylate concentrations should be measured if salicylate intoxication is suspected, even if there is no documented history of salicylate ingestion. The risk of salicylate nephrotoxicity is also increased with age, and upper gastrointestinal haemorrhage is associated with increased mortality in older age groups. Treatment of acute toxicity consists of prompt recognition of salicylate intoxication, use of activated charcoal, correction of acid-base abnormalities, general supportive measures, and if concentrations are extremely high, dialysis can be effectively used. Chronic toxicity, which can occur even with marginally high salicylate concentrations, is treated with drug withdrawal and supportive therapy. Chronic salicylate toxicity can be averted by prescription of conservative doses of drug, avoidance of concomitant use of different salicylate preparations, and therapeutic monitoring to guide dosage. Renal function should be monitored to detect nephrotoxicity from chronic salicylate therapy. Patients should be regularly screened for evidence of gastrointestinal bleeding.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Salicylate intoxication in the elderly. Recognition and recommendations on how to prevent it. 155 71

The purpose of this study was to gain information about the hemodynamic effects following the induction of anesthesia with fentanyl and either 1 mg/kg of propofol (P) or 0.25 mg/kg of etomidate (E) in ASA III-IV patients with aortic insufficiency (AI) or coronary artery disease (CAD). Four patient groups resulted: (1) AI and P, n = 10; (2) AI and E, n = 10; (3) CAD and P, n = 6; and (4) CAD and E, n = 8. Hemodynamics were recorded in the awake state, following induction, intubation, and 10 minutes after intubation. No complications occurred in groups 1, 2, and 4. In 2 patients of group 3, who suffered from three-vessel CAD, induction resulted in severe hypotension associated with an increase in pulmonary capillary wedge pressure. Because of this, the investigation of group 3 was prematurely terminated after the sixth patient. The following changes were observed under general anesthesia: in all four groups, arterial pressure (AP), cardiac index (CI), and left ventricular stroke work index decreased. Significantly different values between group 1 (AI and P) and 2 (AI and E) were observed for heart rate (HR) (P less than E), stroke volume (SV) (P greater than E), arterial elastance (Ea), and systemic vascular resistance (SVR) (P less than E); differences between group 3 (CAD and P) and 4 (CAD and E) were seen for AP, Ea, and SVR (P less than E each). After tracheal intubation, baseline values of AP and HR were not surpassed in any group. Signs of systolic myocardial dysfunction were present in all groups (P greater than E).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Propofol/fentanyl versus etomidate/fentanyl for the induction of anesthesia in patients with aortic insufficiency and coronary artery disease. 156 3

Skeletal muscle ventricles (SMVs) were constructed from the left latissimus dorsi in 22 mongrel dogs. The configuration of these SMVs was different from those previously reported. The animals were divided into two groups: group A (n = 11) SMVs rested for 10 weeks after construction; group B (n = 11) SMVs rested for 18 weeks. At the end of the delay period, SMVs were tested in vivo with a mock circulation device. The SMVs in group B developed stroke work greater than those in group A. After acute testing, SMVs (n = 12) were connected to the descending thoracic aorta and stimulated to contract during diastole. Aortic diastolic counterpulsation was achieved in all dogs, with 9 animals surviving from 1 to beyond 28 weeks. In all of the dogs surviving 1 week or more, the SMVs remained free of thrombus. Aspirin was used as the only antithrombotic agent. Skeletal muscle ventricles in this study were able to develop stroke work similar to that previously reported, intermediate between that of the right and left ventricular stroke work, with a significantly decreased incidence of thromboembolism.
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PMID:Skeletal muscle ventricles with improved thromboresistance: 28 weeks in circulation. 159 23

Fibromuscular dysplasia (FMD) is a non-atheromatous, non-inflammatory, segmental arteriopathy of unknown etiology. Fibroplasia of the tunica media is most common. After the renal arteries, the carotid arteries are most frequently affected. Angiographically beaded and tubular stenoses are seen. Complete occlusions and spontaneous dissection of the carotid arteries occur. The angiopathy causes general symptoms such as headache and vertigo, but also recurrent TIA and ischemic cerebral infarction. We examined 15 patients (12 female) suffering from FMD and stroke. The diagnosis of FMD was based on angiographic findings in all cases. 13 patients made a good recovery and seven of them could be discharged from hospital without any neurological deficit. Apart from conservative treatment, primary percutaneous or operative angioplasty may be necessary in some cases in spite of the mostly benign outcome of the disease. Acetylsalicylic acid should be given in all cases.
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PMID:[Fibromuscular dysplasia as a cause of cerebral infarct]. 163 15

The efficacy of aspirin in daily doses of 300 mg and more as secondary prophylaxis after cerebrovascular events is well established. Since much lower doses of aspirin can inhibit platelet function, and carry a lower risk of adverse effects, the Swedish Aspirin Low-dose Trial (SALT) was set up to study the efficacy of 75 mg aspirin daily in prevention of stroke and death after transient ischaemic attack (TIA) or minor stroke. 1360 patients entered the study 1-4 months after the qualifying event: 676 were randomly assigned to aspirin treatment and 684 to placebo treatment. The median duration of follow-up was 32 months. Compared with the placebo group, the aspirin group showed a reduction of 18% in the risk of primary outcome events (stroke or death; relative risk 0.82, 95% confidence interval 0.67-0.99; log-rank analysis p = 0.02), and reductions of 16-20% in the risks of secondary outcome events (stroke; stroke or two or more TIAs within a week of each other necessitating a change of treatment; or myocardial infarction). Adverse drug effects were reported by 147 aspirin-treated and 123 placebo-treated patients Gastrointestinal side-effects were only slightly more common in the aspirin-treated patients, but that group had a significant excess of bleeding episodes (p = 0.04). Thus, we have found that a low dose (75 mg/day) of aspirin significantly reduces the risk of stroke or death in patients with cerebrovascular ischaemic events.
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PMID:Swedish Aspirin Low-Dose Trial (SALT) of 75 mg aspirin as secondary prophylaxis after cerebrovascular ischaemic events. The SALT Collaborative Group. 134 62

Aspirin (acetylsalicylic acid) is effective in reducing vascular outcome events in patients with atherosclerosis: a relative risk reduction of about 30% for stroke, 22% for stroke and death, and 15% for vascular mortality. It is probable that low and high dose aspirin are similar in efficacy. Complications are more frequent with high dose aspirin than with low doses. Four randomised trials evaluating sulfinpyrazone vs placebo, and 3 trials evaluating sulfinpyrazone vs aspirin, showed more cerebrovascular events in the sulfinpyrazone group than in the aspirin and placebo groups. One small trial comparing dipyridamole with placebo in patients with cerebrovascular disease found no difference between the 2 groups in outcome. No other studies have compared dipyridamole alone with placebo or aspirin. The European Stroke Prevention Study II is currently in progress and is comparing dipyridamole + aspirin, dipyridamole, aspirin, and placebo. In the first year, the Ticlopidine Aspirin Stroke Study (TASS) showed a 42% risk reduction for stroke and death using the efficacy analysis and a 47% risk reduction for stroke and stroke death. Ticlopidine was more effective than aspirin in reducing stroke in both males and females. Apart from a reversible severe neutropenia in 0.86% of patients, ticlopidine-related adverse effects were relatively benign and reversible. The Canadian-American Ticlopidine Study (CATS) compared ticlopidine with placebo in patients with completed major strokes. The cumulative event rates for the primary outcome events of stroke, myocardial infarction and vascular death, using the efficacy approach, show clear evidence of separation almost immediately after randomisation, consistent with a constant risk reduction of about 30% in the ticlopidine group. These data provide strong evidence that ticlopidine conveys a clinically important reduction in the risk of thromboembolic events in patients with a history of completed thromboembolic stroke. In conclusion, aspirin is effective in preventing atherothrombotic morbidity and mortality. It reduces the overall vascular event rate by about 25%. Sulfinpyrazone and dipyridamole appear to add nothing important over aspirin alone. Ticlopidine is more effective than aspirin in preventing stroke. The modest, reversible risk of neutropenia, affecting less than 1% of patients, makes the benefit: risk ratio a reasonable one.
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PMID:Antiplatelet therapy in the prevention of stroke. 172 15

We examined the baseline characteristics of patients in the Ticlopidine Aspirin Stroke Study (TASS) to determine if the effects of the two treatments in preventing stroke differed in various subgroups. Patients with the following characteristics did less well on aspirin: elevated creatinine, hypertension or diabetes requiring treatment, or treatment with anticoagulant or antiplatelet drugs prior to their qualifying TIA or stroke. Women and patients with vertebrobasilar symptoms did particularly well on ticlopidine. We performed arteriography in 1,188 patients with carotid qualifying events. The frequency of stroke in patients with abnormal arteriograms ipsilateral to their symptoms was slightly higher than in those with normal carotid arteries. Ticlopidine was more effective in patients without carotid stenosis. Ticlopidine is more effective than aspirin in preventing strokes in patients having warning TIAs. The patients who benefit most from ticlopidine may be women, those who have vertebrobasilar symptoms, those with cerebral ischemic symptoms while on aspirin or anticoagulant therapy, and patients with diffuse atherosclerotic disease rather than high-grade carotid stenosis.
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PMID:Prevention of stroke with ticlopidine: who benefits most? TASS Baseline and Angiographic Data Subgroup. 173 90


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