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

Intriguing questions have recently been raised regarding the applicability of direct observations of the pial microcirculation to the behavior of the total cerebral microcirculation. Operating under the assumption that arteriolar tone and, thus, cerebrovascular resistance is, to some extent, directly related to the intrinsic energy metabolism of the arteriolar wall, a comparative histochemical analysis of cerebral microvessels, both pial and parenchymal, was undertaken. Reactions were chosen on the bases of representation of substrate and of enzymes of glycolysis, the hexose monophosphate shunt, beta-oxidation of fat, Krebs cycle, cytochrome system and ATP hydrolysis. Three metabolically distinct segments of the cerebral microvasculature were delineated with the pial vessels showing strong capacities for glycolysis, beta-oxidation of fats and utilization of glucose through the hexose monophosphate shunt. Microvessels of the gray matter have a qualitatively similar metabolic profile but the capacities of each pathway are lower when compared to pial arterioles. Arterioles of the white matter demonstrate the weakest energy-yielding capacities.
Stroke
PMID:Metabolic profiles of canine cerebrovascular tree: a histochemical study. 14 24

Stupor in patients with nonketotic hyperglycemia has been ascribed to hyperosmolarity, but the cause of depressed consciousness in patients with ketoacidosis has been puzzling. In this study, blood pH, serum glucose and sodium concentrations, and serum osmolality were measured in eighty-five consecutive episodes of diabetic ketoacidosis and forty-seven of nonketotic hyperglycemia. In the acidotic patients, as in those with nonketotic hyperglycemia, stupor closely paralleled hyperosmolarity and not the severity of acidemia. Indeed, the mean elevations of serum osmolarity were almost the same in the ketotic and in the nonketotic patients who were deeply obtunded. It seems likely that depression of consciousness in patients with severely uncontrolled diabetes mellitus, if not due to a nonmetabolic disorder, such as acute stroke, is attributable to hyperosmolarity, whether or not ketoacidosis is present.
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PMID:Hyperosmolar nature of diabetic coma. 23 99

Cardiovascular complications of oral contraceptives (OCs) are discussed. OCs are safe for most young women for temporary birth control, however, they should not be used by women over age 35 who want no more children. Problems such as hypertension, increased tendency to clot, a rise in triglycerides, and a decrease in glucose tolerance occur in 5-10% of women of any age who take OCs for 5 years. These factors in turn are responsible for complications such as thromboembolism, heart attack, and stroke which occur with increased frequency among OC users. Most who take OCs suffer more subtle disturbances in blood pressure, and biochemical and hormonal levels which may pose additional risks for cardiovascular disease. It is concluded that the risks of OC use often outweigh the benefits, however, prudent use of OCs will improve the balance between risk and benefit.
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PMID:Cardiovascular complications of oral contraceptives. 34 38

A double-blind, randomized trial was performed with 51 patients suffering from focal ischemic lesions in the territory of the middle cerebral artery. Intravenous infusions of 10% glycerol in 0.9% NaCl--5% glucose solutions were administered twice daily for 6 days to 26 patients, and the same amount of NaCl--glucose solutions to 25 controls. Glycerol did not reduce mortality (9 deaths in each group). The functional recovery was assessed by repeated neurological examinations during the 4 month trial. Glycerol significantly improved global performances and motor and sensory functions in patients with moderate disability, but its effect on global performances was transient. The patients with severe disability were not improved at all.
Stroke
PMID:Intravenous glycerol in cerebral infarction: a controlled 4-month trial. 36 Apr 95

The treatment of the acute phase of stroke creates a difficult problem to the clinician. The presently used drugs lead to controversial results. The progress in knowledge of the pathogenesis of cerebral damage underlines the determinant role of the metabolic deficits in the ischemic areas. The effect on the clinical symptomatology of patients in the acute phase of stroke was studied during a double-blind comparative clinical trial with an alcaloid of Vinca minor (Pervincamine) which acts favorably against disturbances of oxydative glucose metabolism and of cerebral microcirculation. 20 patients divided into two homogeneous groups received during 5 days either Pervincamine (4 ampoules of 3 ml = 60 mg vincamine p.d.) + glycerol, or glycerol + placebo administered by i.v. infusion. Clinically the results indicate a greater improvement of the neurological status (objectivated by a neurological scale) with vincamine treatment than with placebo. Statistically the analysis confirms the highly significant effect of vincamine on motility of lower and upper limbs (p less than 0.02) and the significant effect on cranial nerves (homonymous hemianopsia and conjugated deviation of eyes) (p less than 0.05) and on the sphincter control level (p less than 0.05).
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PMID:Comparative study of the clinical effects of vincamine + glycerol versus glycerol + placebo in the acute phase of stroke. 38 7

During the last 3 years we have performed a detailed study in 50 patients using the Swan-Ganz catheter to provide prognostic haemodynamic and metabolic values at an early stage. There was a total of 320 severe injuries in these 50 patients with a statistical mean of six to seven. The severity of injuries is documented by the volume replacement necessary within the first 24 hr. On average more than 8 litres of whole blood, albumin and dextran were given intravenously. Out of 50 patients, 28 survived. During the first 2h there was a significant difference between survivor and non-survivor in systolic blood pressure and shock index. From the very beginning the surviving patients demonstrated a higher cardiac index than non-survivors. Pulmonary artery pressure and total pulmonary resistance were also elevated from the very beginning. The right ventricular stroke work index was increased; the left ventricular stroke work index was decreased in the group of non-survivors. The arteriovenous oxygen content difference as well as oxygen extraction ratio was elevated, and the oxygen availability was decreased in the group of the non-surviving patients. Of the metabolic parameters, an increase in the lactate/pyruvate ratio as well as in serum glucose and a decrease in base excess values permit an early prediction of a favourable outcome. There were significant differences in the enzymes SGOT, SGPT, LDH, CHE, as well as bilirubin concentrations between survivors and non-survivors from sixth day on.
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PMID:Cardiorespiratory and metabolic patterns in multiple trauma patients. 39 52

Present methods of management of juvenile-onset diabetes mellitus do not prevent serious and debilitating complications affecting multiple organ systems. In an effort to reverse advanced forms of these complications, segmental transplantation of the pancreas has been performed on 10 patients, seven of whom simultaneously or subsequently received renal transplants. Long periods of normoglycemia (two to four and one-half years) were achieved in two patients who also maintained transplant kidney function. The course of these two patients is described to illustrate the possible value and limitations of the procedure. These patients had normal blood glucose levels, exhibited repeated normal intravenous glucose tolerance curves, and had repeated normal endogenous insulin levels. Their courses were characterized by (1) absence of problems related to pancreatic exocrine secretions into the bladder; (2) stable eye changes despite some episodes of hemorrhage from preexisting retinopathy; (3) vascular complications, including stroke and gangrene of extremities necessitating amputation despite successful femoropopliteal bypass grafting; (4) peripheral neuropathy; and (5) repeated infections. Both patients succumbed to vascular complications. Thus, pancreatic transplantation can maintain blood glucose and insulin at normal levels for extended periods of time. However, it does not reverse such complications as advanced retinopathy or atherosclerosis. Since the procedure may have value in preventing progression of these complications, it should be evaluated in patients with less advanced complications of diabetes.
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PMID:Long-term effects of pancreatic transplant function in patients with advanced juvenile-onset diabetes. 40 Jan 24

A comparison was made between the effects of two different anesthetics, alpha-D-gluco-chloralose and 1-1-phenylcyclohexyl piperidine hydrochloride (Sernylan), on cerebral blood flow (CBF), brain metabolism and cerebrovascular CO2 responsiveness in primates. The experiments were carried out on immobilized and artificially ventilated baboons. Anesthesia was induced either with 100/mg/kg chloralose (i.p.) or with 1 mg/kg Sernylan (i.m.). CBF in 8 different brain regions was measured by the intra-arterial 133Xe clearance technique. The CO2 responsiveness of the cerebrovascular bed was tested by a gas mixture containing 5% CO2. Chloralose depressed total as well as regional CBF compared to the effect of Sernylan. A significant shift occurred toward lower CBF values in the grey matter while white matter flow was identical in the two groups. Brain O2 consumption was significantly higher during Sernylan analgesia (3.35 +/- 0.34 ml/100 g/min) than during chloralose anesthesia (2.42 +/- 0.22 ml/100 g/min). There were no differences in glucose uptake, lactate and pyruvate production, or in arterial and cerebral venous blood gases in the two types of anesthesia. The cerebrovascular CO2 sensitivity of the Sernylan-treated baboons was higher than that of the chloralose-anesthetized animals, in both the grey and white matter.
Stroke
PMID:Comparative effects of chloralose anesthesia and Sernylan analgesia on cerebral blood flow, CO2 responsiveness, and brain metabolism in the baboon. 40 48

We prospectively studied the clinical, biochemical (including creatine phosphokinase (CPK) isoenzymes) and electrocardiographic features of exertional heat stroke in 13 patients (group 1) and severe heat exhaustion in 14 patients (group 2). Despite initial presentations with severe hyperthermia, tachycardia and hypotension, only one patient with heat stroke had myocardial ischemia. The CPK isoenzymes were not indicative of myocardial damage in any patient. The patients with heat stroke were somewhat more dehydrated than those with heat exhaustion as measured by differences in serum creatinine, sodium and osmolality, and the former (group 1) had a significantly lower initial glucose level (P less than 0.05). Although significant differences in potassium were not observed in the pretreatment samples, at 12 hours the serum potassium was significantly lower in group 1 (P less than 0.05). This suggests that this group may have been more potassium-depleted at the time of heat stroke. Prompt recognition and vigorous therapy were successful in rapidly lowering high temperatures and in preventing serious complications.
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PMID:Cardiovascular and metabolic manifestations of heat stroke and severe heat exhaustion. 42 71

Chemical characteristics of vascular collagen were studied in stroke-prone spontaneously hypertensive rats (SHRSP) which developed cerebrovascular lesions spontaneously in over 90% of the population. Aminoacid analysis of arterial collagen among SHRSP showed no remarkable difference from stroke-resistant SHR (SHRSR) and normotensive Wistar-Kyoto rats (WK). The uronic acid content of the aorta, which elevated with aging, was increased in SHRSR and especially in SHRSP. The hexose content of collagen was also increased in SHRSP characteristically with a concomitant increase in the ratio of the disaccharide unit (glucosyl-galactosyl-hydroxylysine) to the monosaccharide (galactosyl-hydroxylysine). The relative increase in beta and gamma components was also noted in SHRSP. These structural changes of vascular collagen especially noted in SHRSP may be related to the fragility of arterial wall or to the stroke-proneness.
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PMID:Chemical analysis of vascular collagen in stroke-prone spontaneously hypertensive rats. 51 69


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