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

Metabolic diseases are a rare cause of strokes. However, prevention and treatment are available for some of them. This work describes some metabolic diseases generating strokes by disturbing directly vascular function (homocysteine disorders, Fabry disease, congenital defects of glycosylation) and those for which clinical presentation is similar to a stroke (urea cycle disorders, branched-chain organic acidurias, mitochondrial diseases).
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PMID:[Hereditary metabolic causes of stroke and pseudo-stroke in adulthood]. 1179 78

Serum uric acid (UA) and creatinine (Cr) mainly derive from skeletal muscle tissues. Although, remarkable postmortem stability of the serum levels has been reported, there appears to be very poor knowledge of the diagnostic value in investigation of death, except for uremia. The aim of the present study was to evaluate postmortem serum UA and Cr levels using 395 forensic autopsy cases, in comparison with blood urea nitrogen (BUN), for investigation of the pathophysiology of death with special regard to the causes of death involving possible skeletal muscle damage, e.g. due to hypoxia, heat or agonal convulsions. Cr and BUN showed relatively good topographic stability in the cadaveric blood, whereas, UA was often much higher in the right heart blood than in the left heart and peripheral blood, independent of postmortem intervals. Moderate to marked elevation of Cr and BUN accompanied with hyperuricemia was observed in delayed death. In the acute death cases (survival time <30 min), UA, especially in the right heart blood, showed a considerable elevation in mechanical asphyxiation and drowning. The Cr level in fire victims with a lower carboxyhemoglobin (COHb) level (<60%) was significantly higher than in those with the possible fatal level (>60%). A similar elevation of Cr was observed in fatalities from heat stroke and methamphetamine (MA) poisoning. The observations suggested that hyperuricemia in acute death may be indicative of advanced hypoxia and that elevated Cr level may reflect the skeletal muscle damage, especially due to thermal influence.
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PMID:Postmortem serum uric acid and creatinine levels in relation to the causes of death. 1185 3

The blood flow rate delivered by the dialysis machine (d-BFR) may not be accurately reflected by the blood flow rate set on the machine (sm-BFR). High negative arterial pressure may lead to deformity of the blood pump-segment tubing, resulting in a lower stroke volume and d-BFR. The Hagen-Poiseuille law predicts that the use of larger gauge needles should make arterial pressure less negative. Twenty-two patients on chronic hemodialysis therapy with a percentage of reduction in urea (PRU) levels less than 65% and/or a greater than 10% difference between sm-BFR and d-BFR underwent dialysis using one-gauge larger arterial and venous needles. d-BFR increased by 23 +/- 5 mL/min. Arterial pressure became less negative by 58 +/- 5 mmHg, and venous pressure decreased by 31 +/- 7 mm Hg. Changes in arterial and venous pressures allowed sm-BFR to be increased to 500 mL/min in all 22 patients, resulting in an increase in d-BFR of 83 +/- 7 mL/min. This translated into an increase in PRU of 5% +/- 0.01%. All results were significant at P < 0.001. A survey showed that less than 5% of needles used in our region were 14 G. This study shows that the use of larger gauge needles can significantly increase d-BFR and PRU as a result of changes in arterial and venous pressures, resulting in a significantly increased dialysis dose at no additional cost.
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PMID:Correction of discrepancy between prescribed and actual blood flow rates in chronic hemodialysis patients with use of larger gauge needles. 1204 36

In the present study, the determinants of fasting plasma homocysteine in diabetic subjects were examined; whether plasma homocysteine and vascular disease are related and the influence of the C677T polymorphism in the methylenetetrahydrofolate reductase (MTHFR) gene on serum and erythrocyte folate, plasma homocysteine and vascular disease. Diabetic clinic subjects (Type I, n=354; Type II, n=392) were recalled for a cross-sectional survey. Standard methods were used to measure biochemical variables and to characterize vascular disease and MTHFR genotype. Plasma homocysteine was significantly and directly related to age, male sex and serum urea, and inversely related to serum folate and vitamin B12, independently in stepwise regression. When corrected for age and sex, homocysteine was significantly related to hard end points of coronary artery disease and stroke (each P<0.01), remaining significant when additionally adjusted for serum folate (P=0.043 and P=0.019 respectively). Serum folate was not clearly related to these events, although there was a trend to associate with the lower quintile of serum folate. The MTHFR genotype was not a determinant of plasma homocysteine, even in those in the lowest quintile of serum folate, nor of vascular disease. TT homozygosity at residue 677 was associated with elevation of total erythrocyte folate compared with both other genotypes (P<0.0001), almost certainly due to the diversion of 5,10-methylenetetrahydrofolate into derivates subsequent to the partial metabolic block that results from the MTHFR enzyme defect. In conclusion, in this clinic cohort of people with diabetes, vascular disease is related to plasma homocysteine, which is correlated with serum folate. The MTHFR genotype does not significantly influence either plasma homocysteine or vascular disease, despite it being a determinant of erythrocyte folate, which reflects its effect on folate metabolism.
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PMID:Homocysteine, folate, methylene tetrahydrofolate reductase genotype and vascular morbidity in diabetic subjects. 1204 16

The antihypertensive effect of Brand's Essence of Chicken (BEC), a popular chicken extract used as a traditional health food, was examined with stroke-prone spontaneously hypertensive rats (SHRSPs). The animals were maintained from 6 to 25 weeks of age on drinking water with or without BEC. The BEC-fed group showed a significant reduction in the development of hypertension when compared with the control animals. The levels of blood urea nitrogen and plasma creatinine in the BEC-fed group were significantly lower than those in the control group, suggesting that the renal glomerular function had been improved by the daily administration of BEC. It thus seems likely that BEC would be useful as a prophylactic treatment against the development of hypertension and renal injury.
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PMID:Preventive effect of a chicken extract on the development of hypertension in stroke-prone spontaneously hypertensive rats. 1209 23

Malnutrition affects up to half of all chronic dialysis patients and is an important predictor of mortality, but the efficacy of interventions designed to improve the nutritional status of dialysis patients has been poorly studied. Specifically, although enteral tube feeding is often cited as an important option in the treatment of malnourished dialysis patients, there are few studies examining the effectiveness and complications of enteral tube feedings in adults on dialysis. We performed a retrospective analysis of a small cohort (n = 10) of chronic hemodialysis patients who received enteral tube feeding as all or part of their nutrition between January 1 and May 1, 1999, with follow-up through May 1, 2000, to assess the efficacy and complications of enteral tube feeding. Six patients received feeding via a peritoneoscopically placed (PEG) tube, 3 via nasogastric (NG) tube, and 1 patient was switched from PEG to NG feeding after an exit site infection developed at her PEG site. Seven patients received enteral feeding because of swallowing difficulties occurring after a cerebrovascular accident. Four patients were fed via enteral tube temporarily (</=4 months); the range of time on enteral feeding was 0.5 to 36 months. Five patients died by study end; only 1 recovered and no longer required enteral feeding. Patients were well dialyzed (median urea reduction rate, 73%). A significant improvement in serum albumin was seen (initial median albumin, 2.8, versus final median albumin, 3.4 g/dL, P =.04). Hypophosphatemia occurred in 8 of the 10 patients, and the nadir median phosphorus level was 1.95 mg/dL. One patient died as a result of an infected PEG. We conclude that enteral tube feeding is an important tool in the treatment of malnourished chronic hemodialysis patients and deserves formal study. Hypophosphatemia commonly occurs, and phosphorus levels should therefore be followed closely when initiating tube feedings in hemodialysis patients. In some cases, a nonrenal enteral formula may be useful for avoiding hypophosphatemia in these patients.
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PMID:Enteral tube feeding in a cohort of chronic hemodialysis patients. 1210 15

The prevalence of diabetes increase in the elderly. Ageing is one of the most important factors contributing to development of glucose intolerance (insuline resistance). NHANES II data showed that in the poppulation over 65 years 18.7% has got overt diabetes and 22.8% glucose intolerance. Similar data were obtained among ageing inhabitants of the city of Bialystok (downtown). The criteria of diagnosis of diabetes in the elderly are the same like in the younger population. However, in the elderly the clinical symptoms are not characteristic and scanty (limited). The period without symptoms is long. Very often, the diabetes is diagnosed for the first time in patient with the heart infarct, brain stroke, diabetic foot or even hyperosmolar coma. There may occur two critical situations in the elderly diabetic persons, namely non-ketotic hyperosmolar coma and hypoglycameia. The non-ketotic hyperosmolar coma is a result of a considerable elevation in the blood concentration of glucose, sodium and urea. This, in turn, is a consequence of osmotic diuresis which is non balanced by elevation in the volume of water intake. Factors facilitating development of the coma include: nontreated diabetes, infirmity, inadequate care, diuretics, stroke, hyperthermia. Hypoglycaemia in the elderly is a very serious problem. It can cause arrhythmia, a rise in the blood pressure, unconsciousness, falls and injuries. The most often reason of hypoglycaemia in the elderly are: long-acting derivatives of sulphonylurea, treatment with insulin and irregular meals. The major aims of treatment of diabetes in the elderly are: reduction of hyperglycaemia, reduction in the development of complications and minimizing of the risk of hypoglycaemia. An elderly patient with diabetes should have each year a check-up which would include examination of the eyes, kidneys, feet. The elderly patient with diabetes is often crippled, indolent and lives often alone. Therefore, such a patient should be taken care of by a team of people. The most important role in the team should be played by a family physician and a social nurse.
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PMID:[Diabetes mellitus in the elderly]. 1218 66

An 18-year-old male patient with MELAS phenotype and 2 previous episodes of cerebral stroke, recurrent seizures and nephropathy, was treated with creatine monohydrate after the acute onset of psychomental regression and changing states of somnolence and aggressive and agitated behaviour. These symptoms disappeared completely after 4 weeks of treatment with creatine after which the patient regained all his previous mental abilites. Brain (white matter) proton magnetic resonance spectroscopy (chemical shift imaging) performed at 6 and 12 months of treatment showed lactic acid (Lac) accumulation and high creatine (Cr) levels in relation to choline-containing compounds (Cho). Urinary creatinine excretion as an indicator of the muscle and brain creatine pool increased upon short-term (12 days) high-dosage creatine supplementation (20 g per day) while plasma creatinine concentrations as possible indicators both of increasing creatine pool and of renal insufficiency increased during the course (28 months) of low-dosage creatine supplementation (5 g per day). Deterioration of renal function was finally indicated by urea retention and by impairment of renal creatinine clearance. These observations suggest that creatine supplementation may have a neuroprotective effect in patients with MELAS and episodes of acute mental deterioration. Adverse effects of creatine supplementation on renal function must be considered especially in patients with preexisting nephropathy.
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PMID:Effects of oral creatine supplementation in a patient with MELAS phenotype and associated nephropathy. 1220 Jul 46

For the first time in Japan, off-pump coronary artery bypass grafting (OPCAB) was compared with the conventional on-pump technique, retrospectively examining the morbidity associated with coronary artery bypass grafting (CABG) and assessing the efficacy of OPCAB. In 2000, 158 patients underwent CABG: 95 patients (60%) had OPCAB (Group I) and 63 patients (40%) had conventional CABG (Group II). The operating time, length of intensive care unit (ICU) stay, ventilation time, postoperative bleeding, transfusion, postoperative renal function, occurrence of stroke, and early graft patency were examined in both groups. There were no hospital deaths in either group. The operating time, ICU stay, and ventilation time were significantly (p < 0.0001, p = 0.013, and p < 0.0001, respectively) shorter in Group I (351 +/- 85 min, 3.0 +/- 1.4 days, and 5.1 +/- 2.8h) than in Group II (449 +/- 112 min, 3.6 +/- 1.8 days, and 13.7 +/- 18.0 h). The postoperative blood loss within 12h and the transfusion volume were significantly (p = 0.0004 and p < 0.0001, respectively) smaller in Group I (480 +/- 210 ml and 300 +/- 490ml) than in Group II (720 +/- 430ml and 1,230 +/- 1,180 ml). Peak serum blood urea nitrogen and creatinine concentrations (excluding patients with preoperative chronic renal failure, ie a preoperative serum creatinine > 1.5 mg/dl) were significantly (p < 0.0001 and p < 0.0001, respectively) lower in Group I (16.2 +/- 15.2mg/dl and 0.81 +/- 0.72 mg/dl) than in Group II (19.2 +/- 7.6 mg/dl and 0.92 +/- 0.28 mg/dl). There were no perioperative strokes in Group I, but 6.4% of Group II patients suffered a stroke. There was no significant difference in graft patency between the groups (95.6% vs 94.9%). OPCAB reduced the mortality and morbidity of coronary revascularization, with a shorter operating time and more rapid recovery from surgery.
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PMID:Perioperative advantages of off-pump coronary artery bypass grafting. 1222 14

This discussion focuses on the presently available technology of abortion induction techniques, which, though recent scientific interest has been in abortifacient agents, still primarily consists of some variation on the ancient technique of forcible cervical dilatation and pregnancy extraction in the first trimester. With the advent of legal abortions in the United States, technology and expertise that will lower the already low rate of abortion-associated complications are of paramount importance. That abortion may be preferable to contraception as a fertility control measure is argued from the following 3 drawbacks of present means of contraception: 1) they are preventitive and must be used in advance of need; 2) they fail more frequently than is usually thought (e.g., 4% for birth control pills, 5% for IUDs, and from 17-21% for more conventional methods); and 3) they are associated, though rarely, with potentially fatal side effects such as heart attack, stroke, or infection (some also raise the incidence of pathological pregnancies). The article devotes itself to an overview of complications of induced abortions (the mortality for legal abortions is 1/100,000 vs. maternal mortality of 10/100,000 in the United States), and to discussions of appropriate evacuation procedures per gestational age. Instruments and techniques for menstrual regulation (uterine aspiration during first trimester), are discussed. Procedures and instrumentation required for standard vacuum aspiration are covered. Use of analgesics and anesthetics during abortion procedures comprises one topic, with especial focus on the use of curettage for midtrimester terminations. Midtrimester terminations by amnioinfusions of abortifacients (saline, urea, and prostaglandins, e.g.) are analyzed. And, in addition to discussing sequelae for each particular abortion type, a section is devoted to the sequelae of induced abortion for subsequent pregnancy. Though 100% effectiveness has not been achieved yet, today a procedure which is 98% effective, menstrual regulation with Karman cannula and 50-ml syringe, already exists and focus should be placed on training developing-nation practitioners to master this relatively simple, safe, effective, and inexpensive procedure.
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PMID:Current technology for abortion. 1231 Apr 19


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