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

A 47-year-old patient with severe decompensated alcoholic liver disease developed a progressive deterioration of her renal function (serum creatinine 4.0 mg/dL) with a renal failure index (RFI: UNa/U/PCr) consistently less than 1.0. In the absence of other causes of renal failure, these values supported the diagnosis of hepatorenal syndrome (HRS). A five-hour head-out water immersion (HWI) in a sitting position was carried out to increase the patient's "effective" blood volume (EBV) in an attempt to reverse the HRS. Hemodynamic monitoring (Swan-Ganz) was performed during the entire HWI procedure. Cardiac index increased by 64% during HWI (2.57 to 4.22 L/min/m2). Stroke volume index doubled (32.9 to 65.0 mL/m2) and systemic vascular resistance decreased by 48% (1426 to 754 dyne sec/cm). Increases in right atrium (RA) pressure (7.5 to 17.5 mm Hg) and pulmonary wedge (PW) capillary pressure (7.5 to 16.3 mm Hg) also occurred. Hemoglobin, hematocrit, and plasma protein concentrations decreased by 18% during HWI. Only a modest improvement in creatinine, urea, inulin, and para-aminohippurate (PAH) clearances was observed during HWI, and the RFI remained below 1.0. Plasma levels of antidiuretic hormone (ADH), aldosterone, and renin activity decreased during HWI. The patient's renal function progressively deteriorated over the next 15 days, but tubular function, as assessed by an RFI less than 1.0, was still intact seven days after our study. Our results indicate that a considerable increase in effective blood volume does not restore renal function in HRS.
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PMID:Effect of head-out water immersion on hepatorenal syndrome. 669 41

The technique for estimating cerebral blood flow (CBF) in anesthetized rats by injecting 133Xe into the internal carotid artery represents a potentially useful and inexpensive model for screening cerebral vascular responses to pathophysiological and pharmacological stimuli. We have examined associated neuropathology, the validity and the reproducibility of the method, and made comparisons of initial slope estimates of CBF with those obtained by stochastic analysis. Initial slope estimates (CBF = 1.62 +/- 0.04 ml min-1g-1, X +/- SE, N = 38) were linearly related to stochastic measurements (CBF = 1.42 +/- 0.09 ml min-1g-1, N = 6), and overestimated mean CBF by about 15%. A reactivity to CO2 of 0.05 ml min-1g-1 per mm Hg, and an auto-regulation range of 70 to 180 mm Hg were found. CBF responses to the intra-arterial infusion of aminergic drugs were determined before and after opening of the blood-brain barrier with hypertonic urea. Serotonin reduced CBF after, but not before, the administration of urea. Acetylcholine increased CBF when the barrier was intact, the effect being augmented when the barrier was disrupted; these responses were reduced by atropine. Histamine increased CBF only after barrier opening, and this response was attenuated by the H2-receptor antagonist, metiamide. These studies indicate that initial slope estimates of CBF derived in rats from intracarotid 133Xe injection, which represents an inexpensive and simplified approach for screening cerebral circulatory adjustments, may facilitate the characterization of stimuli affecting CBF.
Stroke
PMID:Cerebral blood flow in rats during physiological and humoral stimuli. 678 49

Unilateral uareteral obstruction (UUO) in 6-week old male spontaneously hypertensive rats (6-w-SHR) accelerated the elevation of blood pressure and developed stroke with high frequency from 3 weeks after operation, whereas UUO had no effect in either 20-week old SHR or 6-week old normotensive Wistar Kyoto rats. Urinary protein excretion and plasma urea and renin concentrations in 6-w-SHR began to increase 2 weeks after UUO. Removal of the obstructed kidney in 6-w-SHR one week after UUO prevented the acceleration of hypertension, while the same treatment 2 weeks after operation did not. In the ureter-obstructed kidneys of 6-w-SHR, hydronephrotic atrophy was markedly observed already one week after operation, while in the opposite kidneys, hypertensive vascular lesions were manifested from the second week. These results indicate that with regard to reversibility of the hypertensive process, the obstructed kidney is more important in the early postoperative stages and the contralateral kidney more important later.
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PMID:Acceleration of hypotension and development of stroke in the spontaneously hypertensive rat by unilateral ureteral obstruction. 699 78

In canine veterinary medicine, both acute and chronic renal failure occur relatively frequently, from a variety of causes similar to those in man. However, the normal dog has a very high protein catabolic rate and high endogenous kidney function, and, therefore, requires frequent and highly efficient dialysis, for maintenance during renal failure. We have developed techniques to support the uremic dog with hemodialysis. An experimentally anephric dog, and two dogs with clinically occurring acute renal failure (caused by ethylene glycol intoxication and heat stroke) have been supported with frequent use of hollow fiber dialyzers, using a carotid artery to jugular vein shunt. Patency of shunts was maintained by administration of oral aspirin. A very high urea and creatinine generation rate necessitated daily dialysis during much of the clinical course of renal failure. The experimentally anuric animal was supported for 35 days. The ethylene glycol-induced renal failure animal was euthanized on the 21st day, and the heat stress-induced renal failure animal recovered sufficient intrinsic renal function after 16 days of dialysis for maintenance of life without dialysis.
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PMID:Dialytic support of dogs with clinically occurring renal failure: a realistic model of acute renal failure in man. 709 13

General medical examinations were performed in two rural areas of Shimane Prefecture in Japan, one was a farming village and the other a fishing village where incidences of death due to stroke differed, higher in the former and lower in the latter. Comparisons were made on salt and protein intake by analyzing the fasting single spot urine collected in the morning and by blood tests. Urine samples were analyzed for sodium (Na), potassium (K), urea nitrogen (UN), inorganic sulfate (SO4) and creatinine (Cr) and blood samples for cholesterol (Chl), triglyceride (TG), hematocrit (Ht) and hemoglobin (Hb). Blood pressure, Na/Cr, Na/K and Ht were higher in the farming village and K/Cr, UN/Cr, SO4/Cr, SO4/UN, Chl and TG were higher in the fishing village. These findings indicate the higher salt intake and lower intake of K, animal protein and fat in the farming village. This typical dietary pattern of the Japanese may explain the higher incidence of hypertension and stroke in the farming village.
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PMID:Dietary risk factors of stroke and hypertension in Japan -- Part 3: Comparative study on risk factors between farming and fishing villages in japan. 710 11

A survival analysis was applied to 1,453 patients treated between 1972 and 1978 in 33 French dialysis centers and prospectively followed up in the computerized Diaphane Dialysis Registry. 198 deaths (overall mortality = OM) were registered, of which 87 (43%) were secondary to cardiovascular complications (cardiovascular mortality = CVM). Risk factors for OM and CVM (p values less than 0.05) were age, male sex, nephroangiosclerosis or diabetic nephropathy as the primary renal disease, elevated systolic and diastolic blood pressure and two weekly dialysis rather then three. In contrast with the results observed for the general population, a high body mass index and elevated cholesterol, triglycerides and uric acid were not found to be associated with significantly increased CVM or OM. On the contrary, low body mass index (less than 20 kg/m2), low cholesterol (less than 4.5 mmol/l) and low mean predialysis blood urea (less than 4.6 mmol/l) were associated with increased OM and CVM, and more especially with high stroke mortality. Results for urea but not for cholesterol remain significant after adjustment for age, sex, weekly dialysis schedule and body mass index. They suggest that, in addition to elevated blood pressure, a poor nutritional state and/or low protein intake may be important factors for explaining the high cardiovascular mortality, particularly for strokes, observed in dialyzed patients.
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PMID:Mortality risk factors in patients treated by chronic hemodialysis. Report of the Diaphane collaborative study. 712 51

The contractile activity of various fresh, or incubated blood fractions was studied in vitro using the isolated canine basilar artery. Significantly greater contraction was induced by fresh platelet rich plasma (PRP) and serum compared to red blood cells (RBC). Following incubation, the contractile activity of RBC increased, reaching a plateau at day-3 and it was maintained for at least 14 days, while both PRP and serum lost most of their activity after 24 h of incubation. The contractions induced by fresh blood fractions were only partially blocked by desensitization of 5-hydroxytryptamine (5-HT) receptors or by the 5-HT antagonist methysergide. D-600 effectively antagonized the response to all blood fractions. Biochemical analysis of the incubated RBC by means of Sephacryl S-200 column chromatography and SDS-urea polyacrylamide gel electrophoresis revealed that the contractile substance possessed a molecular weight of about 60,000 daltons. Vasoactivity was only present in one peak of the chromatographically eluted fractions which was shown to possess a similar absorption spectrum to that of hemoglobin. Hemoglobin concentration was highest in day 3, 7, and 14 fractions and may be correlated with the contractile activity of incubated samples.
Stroke
PMID:Changes in vasoactive properties of blood products with time and attempted identification of the spasmogens. 730 68

To examine the importance of left ventricular chamber size in determing the response to vasodilator therapy, we performed echocardiography in 40 patients with chronic refractory heart failure before they were treated with oral hydralazine. The left ventricular end-diastolic dimension (LVEDD) correlated significantly with the per cent change in stroke volume (r = 0.77), left ventricular filling pressure (r = -0.68), and stroke work index (r = 0.87) during short-term drug administration. After 14 to 21 days of maintenance therapy, 15 of 24 patients with an LVEDD greater than or equal to 60 mm were improved, and one was worse; mean blood urea nitrogen decreased from 45.6 to 30.6 mg per deciliter in the 21 patients in this group who completed the study (16.3 to 10.9 mmol per liter) (P less than 0.001). In contrast, only two of 16 patients with an LVEDD less than 60 mm improved, whereas 10 showed clinical deterioration; blood urea nitrogen increased from 49.3 to 64.2 mg per deciliter in the 13 patients in this group who completed the study (17.6 to 22.9 mmol per liter) (P less than 0.01). These findings indicate that left ventricular chamber size is an important factor in the response to hydralazine in patients with severe chronic heart failure.
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PMID:Importance of left ventricular chamber size in determining the response to hydralazine in severe chronic heart failure. 738 9

Rhabdomyolysis caused 28 out of 903 (3.1%) of cases of severe acute renal failure (ARF) treated at Leeds General Infirmary over a 14-year period (1980-1993). The commonest cause of rhabdomyolysis was muscle compression, usually due to drug- or alcohol-induced coma. Other causes included fits, infection, acute limb ischemia, trauma, and heat stroke. Prognosis was relatively good, with a 78.6% survival rate and recovery of renal function to normal in all survivors who were followed up. The creatinine/urea ratio was higher in ARF due to rhabdomyolysis than in an unselected group of patients with other causes of ARF but not when the comparison was with sex- and age-matched controls with ARF. This suggests that this previously described feature of rhabdomyolysis simply reflects the increased muscle mass of a younger group of patients, rather than a specific effect of muscle damage. Clinical features of muscle damage were often absent and so the possibility of rhabdomyolysis should be considered in appropriate settings if the diagnosis is to be made early enough to administer treatment that may prevent ARF and the consequences of the compartment syndrome.
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PMID:The clinical and biochemical features of acute renal failure due to rhabdomyolysis. 756 17

Two hundred and ten patients who were normotensive during pregnancy and labour but developed hypertension during puerperium have been studied. Two groups were identified with this unexpected postpartum hypertension. Although the patients in group A who had earlier onset hypertension were younger and mainly nulliparas, there was no significant difference between both groups with respect to age, serum creatinine, blood urea, blood pressures and presence of abnormal urine sediment at the onset of illness. The incidence of postpartum hypertension was 3.5. per cent; there was remission of hypertension in 8 patients (3.8%) without treatment, recurrence in 17 (8%) while cardiac failure occurred in (5.4%), cerebrovascular accident in 3 (1.4%) and acute oliguric renal failure in 3 (1.4%). Overall mortality was 0.9 per cent while persistent or chronic hypertension was observed in 52 (23.8%) Postpartum hypertension is a definite clinical entity with significant morbidity and mortality. Frequent monitoring of blood pressure in the puerperium is advocated to avoid or reduce cardiovascular, cerebrovascular and renal complications of postpartum hypertension in susceptible women.
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PMID:Morbidity and mortality from postpartum hypertension in Nigerian women. 783 76


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