Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ramipril is safe and effective in the treatment of hypertension and heart failure, but this is not reviewed here. Ramipril is a lipophilic angiotensin-converting enzyme inhibitor suitable for once-daily administration. In addition to decreasing angiotensin II and increasing bradykinin levels, ramipril increases the levels of vasodilatory renal medullary neutral lipids and inhibits platelet-derived growth factor-induced proliferation of glomerulus cells. Ramipril also decreases transforming growth factor-beta in the kidney. Changes in kidney structure and proteinuria are characteristics of the streptozotocin (STZ) rat model of diabetes, and these are prevented by ramipril. In STZ diabetes, doses of ramipril that have no effect on blood pressure reverse vascular hypertrophy. In animal models of kidney failure (subtotal nephrectomy, stroke-prone spontaneously hypertensive rats), ramipril is renoprotective and some of this renoprotective effect is independent of blood pressure lowering. In humans, clinical doses of ramipril probably do not modify glucose metabolism but do reduce the levels of LDL- and HDL-cholesterol. In clinical trials of renal effects, ramipril has been shown to increase cortical nephron flow in hypertension and to reduce proteinuria in patients with and without diabetes and/or hypertension. Some of the smaller clinical trials showed beneficial effects on kidney function with low doses of ramipril that do not lower blood pressure. A large clinical trial in nondiabetic proteinuria, the Ramipril Efficacy in Nephropathy (REIN) trial, has shown that ramipril 1.25 mg/day, which does not lower blood pressure, arrested the decline in glomerular filtration rate and prolonged the time to end-stage renal failure. In diabetic patients who have had a previous cardiovascular event or having one other cardiovascular risk factor, the MICRO-HOPE clinical trial showed that ramipril lowers the combined risk of myocardial infarction, stroke and cardiovascular death by 25%. In conclusion, ramipril has proven beneficial effects in kidney disease alone or in association with diabetes and in diabetes without kidney disease, and is the pril for diabetes and kidney disease. (c) 2001 Prous Science. All rights reserved.
 ...
PMID:Is Ramipril the pril for diabetes and kidney disease? 1276 20

Growing evidence has suggested an important role of n-3 polyunsaturated fatty acids in reducing risk of cardiovascular disease in the general population and patients with preexisting heart disease. In particular, several long-term epidemiologic studies have found an inverse association between fish consumption and risk of coronary heart disease or stroke. Two secondary prevention trials have found that increasing fish consumption or fish oil supplementation significantly reduced coronary death among patients with existing myocardial infarction. In addition, epidemiologic and clinical studies have suggested that alpha-linolenic acid (ALA), a short-chain n3-3 fatty acid from plant sources, may have similar cardiac benefits as long-chain n-3 fatty acids from fish. Potential mechanisms through which n-3 polyunsaturated fatty acids protect against CVD include their antiarrhythmic and antithrombotic effects, and improving insulin sensitivity and endothelial function. (c) 2001 Prous Science. All rights reserved.
 ...
PMID:The role of n-3 polyunsaturated fatty acids in the prevention and treatment of cardiovascular disease. 1278 97

Stroke is the third leading cause of death in the adult population. Numerous neuroprotective agents and procedures have been developed and a new wave of therapies is now on the horizon with the potential to minimize ischemic brain damage. On the other hand, surgical treatment has also played an important role in the treatment of stroke. This article highlights recent advances in stroke treatment, including surgical and neurointerventional radiological procedures, as well as potential new therapies. (c) 2001 Prous Science. All rights reserved.
 ...
PMID:Current and future therapies for ischemic cerebrovascular disease. II. Surgery and new treatments on the horizon. 1278

Atrial fibrillation (AF) is the most common sustained arrhythmia in adults, and its incidence and prevalence increase progressively with age. As a result, AF-associated morbidity and mortality increase with age. Therefore, because even asymptomatic AF markedly increases the risk of stroke and other embolic events, aggressive treatment is warranted in order to avoid the potentially devastating sequelae of this condition. Goals for the treatment of AF in the elderly population should primarily focus on alleviation of symptoms and prevention of strokes, while minimizing potential toxic effects of polypharmacy. Rate control should be optimized with atrioventricular (AV) nodal- blocking agents. The decision of anticoagulation should be individualized for each patient, balancing the risk of stroke against the risk for major bleeding complications. In elderly patients without symptoms, rate control and anticoagulation is the preferred method of treatment. Antiarrhythmic therapy to maintain sinus rhythm is generally reserved for patients with significant symptoms attributable to AF. However, simply maintaining sinus rhythm has not been proven to decrease stroke risk; therefore, long-term anticoagulation is recommended even in patients who are in sinus rhythm on antiarrhythmic drugs. AV nodal ablation with implantation of a pacemaker is a safe and excellent method of rate control for elderly patients who do not respond adequately to pharmacotherapy. Other invasive procedures, such as pulmonary vein isolation and Cox-Maze operations, are associated with high risks of complications in the elderly and are generally not recommended. Postoperative AF is common in the elderly population, and its development in high-risk patients should be anticipated and promptly treated to avoid potential hemodynamic compromise and prolonged hospitalization.
 ...
PMID:Atrial Fibrillation in the Elderly. 1294 Dec 4

Allogeneic haematopoietic cell transplantation (HCT) is presently the only treatment which offers the possibility of a cure for patients with sickle cell disease (SCD). While approximately 84% of patients survive disease-free after human leukocyte antigen (HLA)-identical sibling donor HCT, this therapy has traditionally been reserved for patients who have suffered serious complications due to the risk of transplant-related morbidity and mortality. Typically, these sickle-related complications have included recurrent episodes of acute chest syndrome, recurrent vaso-occlusive episodes and stroke. The future of HCT for haemoglobinopathies undoubtedly will evolve as transplant-related complications are reduced and as the process of selecting patients for HCT is refined.
 ...
PMID:Haematopoietic cell transplantation in the treatment of sickle cell disease. 1464 Sep 47

Prosthetic valve thrombosis (PVT) is a life-threatening disease, the treatment strategies for which remain controversial. Transesophageal echocardiography (TEE) is the diagnostic technique of choice. Prosthetic valve obstruction is defined as limited leaflet motion; obstructive and non-obstructive PVT are separated by abnormal or normal leaflet motion. TEE is limited in differentiating thrombus from pannus ('tissue ingrowth'), and sterile thrombi from infected vegetations. Clinical aspects are helpful. The estimated incidence of PVT is 2-4% per year based on autopsy and surgical findings. The true incidence should be higher, as TEE reveals almost as many obstructive as non-obstructive PVT, of which 50% are asymptomatic. The prevalence of asymptomatic non-obstructive PVT in the early postoperative period may reach 10%. Three therapeutic approaches are available for PVT. Surgical mortality may reach 69%, depending on NYHA class and need for emergency surgery. Thrombolysis represents an alternative to surgery, with 84% success and low complication rates (stroke 9%, mortality 5%). In non-obstructive PVT patients in NYHA class I or II, thrombolysis success was higher (92%), without severe complications. No other clinical predictor of success could be confirmed. Besides classical contraindications there are no absolute contraindications (large thrombi, pregnancy, early postoperative period) for thrombolysis. Long-term streptokinase protocols have been used with regular TEE monitoring. Heparin may be an initial treatment for non-obstructive PVT, but thrombolysis is superior in this subset. If thrombi are > 5 mm in size, heparin therapy is unsuccessful and unsafe. TEE monitoring is mandatory during heparin treatment, as thrombi may increase in size and become obstructive. Thrombolysis is recommended as first-line treatment if there are no contraindications. Heparin may be used initially for small non-obstructive thrombi, particularly if thrombolysis is contraindicated. Surgery should be reserved for patients in whom thrombolysis is either contraindicated or has been ineffective, independent of NYHA class.
 ...
PMID:Management of prosthetic valve thrombosis. 1522 76

Postmenopausal women in Western societies are conscious of breast cancer as a potential cause of death and ill health, which they wish to avoid with the advice of their doctors. Yet many factors that predispose women to the development of cancer will have been laid down before the menopause, in their genetic makeup or during their adolescent years. Even in middle age it is important to take account of the intrinsic level of risk, and to give women advice tailored to their own individual risk level. This results from their family history, previous diseases such as benign breast disease, and previous treatment for breast cancer or Hodgkin's disease. For those at the highest level of risk, strategies will include regular screening, prophylactic mastectomy, and the use of chemoprevention agents, such as tamoxifen. These women should avoid hormone replacement therapy (HRT) and control their menopausal symptoms and osteoporosis through the use of other agents now available - venlafaxine for menopausal symptoms and bisphosphonates for osteoporosis. Raloxifene is an agent under trial that may be valuable for breast cancer control as well as for osteoporosis. Women at standard population risk will require less robust preventive strategies, which will include screening and lifestyle modification. Their decisions regarding HRT should now be modified by recent evidence of associated risks. Recent studies show that tibolone causes less mammographic density and has a lower relative risk of breast cancer than combined estrogen/progestogen preparations. There is limited evidence that controlling obesity, participating in exercise and adopting a diet low in fats and high in fruit and vegetables will alter risk at this age. These precautions will, however, reduce the risk of other diseases common in this age group, such as hypertension, heart disease, stroke, and type 2 diabetes mellitus. Alcohol, even in small amounts, is a risk factor for breast cancer. Given the cardioprotective effect of moderate alcohol intake, advice on alcohol must reflect the individual relative risk of cardiovascular disease and breast cancer. Personal risk assessment is relevant for all women. Screening and a healthy lifestyle are worthwhile approaches for all, with the more aggressive approaches such as chemoprevention and prophylactic surgery reserved for those who have substantially elevated levels of risk. Once the menopause has passed, screening is probably the most effective evidence-based tool for breast cancer control by early diagnosis.
 ...
PMID:Strategies for managing breast cancer risk after the menopause. 1533 Jun 77

Venous thromboembolism (VTE) is a common complication after acute ischemic stroke. When screened by 125I fibrinogen scanning or venography, the incidence of deep-vein thrombosis (DVT) in stroke patients is comparable with that seen in patients undergoing hip or knee replacement. Most stroke patients have multiple risk factors for VTE, like advanced age, low Barthel Index severity score or hemiplegia. As pulmonary embolism is a major cause of death after acute stroke, the prevention of this complication is of crucial importance. Prospective trials have shown that both unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are effective in reducing DVT and pulmonary embolism in stroke patients. Current guidelines recommend the use of these agents in stroke patients with risk factors for VTE. Some clinicians are concerned that the rate of intracranial bleeding associated with thromboprophylaxis may outweigh the benefit of prevention of VTE. Low-dose LMWH and UFH seem, however, safe in stroke patients. Higher doses clearly increase the risk of cerebral bleeding and should be avoided for prophylactic use. Both aspirin and mechanical prophylaxis are suboptimal to prevent VTE. Graduated compression stockings should be reserved to patients with a clear contraindication to antithrombotic agents.
 ...
PMID:Prevention of venous thromboembolism after acute ischemic stroke. 1594 9

Controversies about the safety of different postmenopausal hormone therapies (HTs) started 30 years ago and reached a peak in 2003 after the publication of the results from the Women Health Initiative (WHI) trial and the Million Women Study (MWS) [Writing group for the women's health initiative investigations. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA 2002;288:321-33; Million women study collaborators. Breast cancer and hormone-replacement therapy in the million women study. Lancet 2003;362:419-27]. The single HT formulation used in the WHI trial for non hysterectomized women-an association of oral conjugated equine estrogens (CEE-0.625 mg/day) and a synthetic progestin, medroxyprogesterone acetate (MPA-2.5 mg/day)-increases the risks of venous thromboembolism, cardiovascular disease, stroke and breast cancer. The MWS, an observational study, showed an increased breast cancer risk in users of estrogens combined with either medroxyprogesterone acetate (MPA), norethisterone, or norgestrel. It is unclear and questionable to what extent these results might be extrapolated to other HRT regimens, that differ in their doses, compositions and administration routes, and that were not assessed in the WHI trial and the MWS. Significant results were achieved with the publication of the WHI estrogen-only arm study [Anderson GL, Limacher M, Assaf AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA 2004;291:1701-1712] in which hormone therapy was reserved to women who had carried out hysterectomy. What emerged from this study will allow us to have some important argument to develop.
 ...
PMID:New evidence regarding hormone replacement therapies is urgently required transdermal postmenopausal hormone therapy differs from oral hormone therapy in risks and benefits. 1596 66

When psychological and behavioral disorders of Alzheimer's disease appear suddenly, somatic, iatrogenic and reactive or relational psychological causes must be ruled out or treated before concluding that the cause is lesional. Non-pharmacological interventions should be privileged for the prevention and management of behavioral manifestations of mild to moderate intensity: psychological support of the patient (short therapies), training the caregiver, work on daily habits, reorganization of the home, behavioral measures against apathy and especially agitation, rehabilitation strategies, and therapy involving music, light, aromas, etc. Pharmacological therapies are only moderately effective in these disorders. They must be targeted and follow a sequence of prescription that maximizes tolerance and distinguishes treatment of acute and chronic states. Anticholinesterase agents may be useful in this domain to prevent or ease some symptoms (especially apathy). The efficacy of memantine must be confirmed by additional data. Some selective serotonin reuptake inhibitors agents may be useful not only in depression but also anxiety, emotional disturbances, irritability and compulsiveness. Atypical neuroleptics are better tolerated than the classic ones. They are most effective in this context but must be reserved for specific indications and limited in time because of the increased risk of stroke. Other psychotropics (benzodiazepines, carbamates, antiepileptics) should be used cautiously in this context.
 ...
PMID:[Treatment of the psychological and behavioural disorders of Alzheimer's disease]. 1598 46


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>