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

Isolated left ventricular noncompaction (ILVNC) is a rare congenital cardiomyopathy characterized by prominent trabeculae, deep intertrabecular recesses, and thickened myocardium with 2 distinct layers (compacted and noncompacted). Clinical characteristics, outcomes, and appropriate therapies remain poorly defined. Data were collected on patients diagnosed with ILVNC by echocardiographic criteria at the Mayo Clinic from 2001 through 2006. These data were entered prospectively into a clinical database and retrospectively analyzed. All-cause mortality, stroke, and development of atrial fibrillation (AF) were compared to community and nonischemic dilated cardiomyopathic (DC) controls. Implantable cardioverter-defibrillator (ICD) therapies were examined. Thirty patients with confirmed ILVNC were included in analyses (mean age at diagnosis 39 +/- 19.5 years, 60% men). Three patients with ILVNC died during follow-up (mean 2.5 +/- 1.2 years) compared to 5 DC and 1 community controls. No mortality difference was observed among these groups (p = 0.42 and 0.054, respectively). No ILVNC deaths were observed in patients with normal LV ejection fraction. New-onset AF was diagnosed in 2 patients with ILVNC, and none was observed in DC controls. Stroke occurred in 2 DC controls and none was observed in patients with ILVNC. ICDs were implanted in 11 patients with ILVNC. No appropriate therapies were identified during follow-up, but 2 patients underwent inappropriate therapies related to AF. In conclusion, mortality in patients with ILVNC is similar to that in DC patients. Deaths were observed only in patients with decreased LV ejection fraction, suggesting that ICD therapy may be reserved for this subgroup. New-onset AF may lead to inappropriate ICD discharges.
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PMID:Isolated left ventricular noncompaction syndrome. 2038 82

At present approximately 70% of carotid endarterectomy and stenting in the United States is being performed for asymptomatic carotid stenosis (ACS). This is based on historical risks of ACS that no longer pertain in the era of intensive medical therapy with statins and other therapies. In the past, the surgical risk of 3% in clinical trials was marginally better than medical therapy for male patients with ACS; however, this is no longer the case. Even in the past, women with ACS did not benefit from endarterectomy. Except for patients with microemboli on transcranial Doppler (who have a 2-year risk of stroke of approximately 14%), the 2-year risk of stroke in ACS is now 1% or less. Endarterectomy or stenting should be reserved for the < 5% of patients with microemboli on transcranial Doppler ultrasonography. In future, 3 dimensional ultrasound detection of ulceration, and magnetic resonance imaging of vulnerable plaque may provide additional approaches to identifying those patients with ACS who may benefit from endarterectomy or stenting. Routine endarterectomy or stenting for patients with ACS should now be regarded as inappropriate.
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PMID:Asymptomatic carotid stenosis: mainly a medical condition. 2047 Jun 80

Two new oral anticoagulants are licensed in France for prevention for venous thromboembolism in patients undergoing hip or knee arthroplasty. Dabigatran (Pradaxa) inhibits the active site of thrombin. The 220-mg dose is recommended for the majority of patients whereas the 150-mg dose is reserved for patients also taking amiodarone and for those at higher risk for bleeding (patients with moderate renal insufficiency). Rivaroxan (Xarelto) inhibits reversibly the active site of fXa, the 10 mg-dose once daily is recommended started 6 to 12 hours after wound closure. The two drugs are given once daily in fixed doses without coagulation monitoring. However the aim of the new anticoagulants is to replaced VKAs particularly for prevention of stroke in patients with auricular fibrillation and for the treatment of venous thrombo-embolism. Recently published results in these two indications with dabigatran are very promising.
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PMID:[New oral anticoagulants: prospects]. 2056 41

Stroke in young adults is not a rare entity, and often provides difficult management decisions for neurologists. The knowledge gained from stroke in older adults does not transfer easily to this younger group given the different causes of stroke observed. Cardiac causes of stroke are common in this group, but often consist of low risk cardiac lesions such as a patent foramen ovale. Appropriate investigation should follow a stepwise approach to initially exclude higher risk pathology for recurrent stroke such as arterial dissection. Similarly, stepwise application of cardiac investigations will allow early identification of significant pathology, with investigation for abnormalities of the inter-atrial septum reserved for those with no other identified cause of stroke. Bubble contrast echo is now widely available, and with improved image quality may be performed with either transthoracic or transoesophageal echo, as well as with transcranial Doppler. Following this approach, patients can be best categorised by the expected rate of recurrent stroke, as informed by observational studies. Appropriate secondary prevention can then be tailored to the recurrence rate, with anticoagulation and possibly device closure reserved for those at highest risk of recurrence.
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PMID:Stroke in younger patients: the heart of the matter. 2062

Recombinant thrombolytic peptides are mainly represented by recombinant forms of tissue plasminogen activator (t-PA), a proteolytic enzyme that catalyzes the conversion of plasminogen into active plasmin, which then functions to dissolve clots. The three clinically relevant recombinant thrombolytic peptides are alteplase (t-PA), reteplase (r-PA), and tenecteplase (TNK). r-PA and TNK have been structurally modified from native t-PA to increase their half-life and fibrin specificity. Thrombolytics play an important role in several diseases, including ST-segment elevation myocardial infarction (STEMI), deep vein thrombosis (DVT) and pulmonary embolism (PE), ischemic stroke, and peripheral arterial disease. Thrombolytic therapy has evolved into an alternative treatment for STEMI, reserved predominantly for patients who do not have access to timely percutaneous coronary intervention. In patients with DVT/PE or arterial related critical limb ischemia, the use of thrombolytic therapy is limited to specific patient populations. Thrombolytic therapy is the treatment of choice for ischemic stroke in patients who present <or=3 hours following the onset of symptoms. Moreover, thrombolytic therapy is used to restore function to stenotized central venous access devices as well as occluded hemodialysis access grafts.
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PMID:Recombinant peptides in thrombolysis. 2063 50

Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis, and Stroke-like syndrome (MELAS) is a rare, fetal disease caused by a mutation in mitochondrial DNA that leads to impaired oxidative metabolism in skeletal muscle, the central nervous system, and liver function. This report presents the case of a 50-year-old woman with biliary cystadenocarcinoma complicated by MELAS who underwent a successful left hemihepatectomy. In this case, the diagnostic key for the malignant tumor was an (18)F-fluorodeoxyglucose positron emission tomography study, which was useful even in a patient with MELAS, which causes abnormal glucose metabolism. The perioperative management of such patients includes special precautions to prevent lactic acidosis and deterioration of the reserved liver function after a hepatectomy, since the mitochondrial function in MELAS patients is abnormal. The patient in this report has remained free of liver dysfunctions and cancer recurrence for 2 years following the hepatectomy. This is the first report of a successful major hepatectomy for a patient with MELAS.
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PMID:Successful left hemihepatectomy and perioperative management of a patient with biliary cystadenocarcinoma, complicated with MELAS syndrome: report of a case. 2074 Mar 54

Obesity is endemic in many regions of the world and a forerunner of several serious and sometimes fatal diseases such as ischemic heart disease, stroke, kidney failure and neoplasia. Although we know its origin--it results when energy intake exceeds energy expenditure--at present, the only proven therapy is bariatric surgery. This is a major abdominal procedure that, for reasons that are largely unknown (it cannot be explained solely by a reduction in ventricular volume), significantly reduces energy intake, but because of cost and limited availability, it will most likely be reserved for only a small fraction of those who stand to gain from effective antiobesity treatment. Clearly, alternative ways to treat obesity are needed. Another way to combat excessive accumulation of white adipose tissue would be to increase energy expenditure. Rodents, hibernators and human infants all have a specialized tissue--brown adipose tissue (BAT)--with the unique capacity to regulate energy expenditure by a process called adaptive thermogenesis. This process depends on the expression of uncoupling protein-1 (UCP1), which is a unique marker for BAT. UCP1 is an inner mitochondrial membrane protein that short circuits the mitochondrial proton gradient, so that oxygen consumption is no longer coupled to adenosine triphosphate synthesis. As a consequence, heat is generated. Mice lacking ucp-1 are severely compromised in their ability to maintain normal body temperature when acutely exposed to cold and they are also prone to become obese. We have shown that, in mice, BAT protects against diet-induced obesity, insulin resistance and type 2 diabetes. This is based on prevention of excessive accumulation of triglyceride in non-adipose tissues such as muscle and liver. Ectopic triglyceride storage at these locations is associated with initiation of insulin resistance and, ultimately, development of type 2 diabetes.
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PMID:Brown adipose tissue in humans. 2093 66

Warfarin is commonly used to prevent stroke in patients with atrial fibrillation; however, patients on haemodialysis may not derive the same benefit from warfarin as the general population. There are no randomized controlled studies in dialysis patients which demonstrate the efficacy of warfarin in preventing stroke. In fact, warfarin places the dialysis patient at increased risk for haemorrhagic stroke and possibly ischaemic stroke. Additionally, warfarin increases the risk of major bleeding and has been associated with vascular calcification. Routine use of warfarin in dialysis for stroke prevention should be discouraged, and therapy should only be reserved for dialysis patients at high risk for thrombo-embolic stroke and carefully monitored if implemented.
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PMID:Warfarin in haemodialysis patients with atrial fibrillation: what benefit? 2113 29

Cerebral vein thrombosis has been well recognized for nearly two centuries. However, therapeutic options for the condition are limited due to lack of large randomized trials. The various modalities reportedly used include antiplatelets, anticoagulation, fibrinolysis, and mechanical thrombectomy. Of these, antiplatelets are the least studied, and there are only anecdotal reports of aspirin use. Anticoagulation is the most widely used and accepted modality with favorable outcomes documented in two randomized controlled trials. Various fibrinolytic agents have also been tried. Local infusions have shown more promise compared to systemic agents. Similarly, mechanical thrombectomy has been used to augment the effects of chemical thrombolysis. However, in the absence of randomized controlled trials; there is no concrete evidence of the safety and efficacy of either of these modalities. Limited study series disclosed that decompression surgery in malignant CVT can be life saving and provides good neurological outcome in some cases. Conclusion. Overall therapeutics for CVT need larger randomized controlled trials. Anticoagulaion with heparin is the only modality with a reasonable evidence to support its use in CVT. Endovascular thrombolysis and mechanical thrombectomy are reserved for selected cases who fail anticoagulation and decompression surgery for malignant CVT with impending herniation.
Stroke Res Treat 2010 Dec 19
PMID:Controversies of treatment modalities for cerebral venous thrombosis. 2119 52

Revascularisation is indicated in patients with left main stenosis (LMS) because of its known positive effect on long-term survival. Coronary artery bypass graft (CABG) surgery has been the traditional procedure of choice for LMS patients, with percutaneous coronary intervention (PCI) being reserved for high-risk surgical patients or for those who have one or more functioning distal bypass grafts (i.e. "protected" left main PCI). Recent studies have re-examined the role of PCI in LMS, however, leading to a recent Class II recommendation for its use in selected patients. The SYNTAX Trial demonstrated that PCI can be performed with good results in the following patient subgroups: patients with isolated LMS, particularly if confined to the ostium; patients with concomitant LMS and isolated single vessel disease; patients with a SYNTAX score of <33; and patients who are at high risk for conventional CABG surgery. Patients with complex coronary anatomy (SYNTAX score >33) or those with concomitant double- or triple-vessel disease are more suited to CABG surgery. Patients who undergo PCI for LMS should be treated in specialized centers with surgical back-up, preferably with patient management decisions being made by a "heart team" consisting of at least one cardiologist and one cardiac surgeon. Ongoing studies are being performed using the hard clinical endpoints of death, myocardial infarction, and stroke in order to further compare the results of PCI vs CABG in LMS patients.
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PMID:[Left main intervention: options and limitations in interventional cardiology]. 2156 23


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