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

Experience with 192 operations of vascular reconstruction for atherosclerosis in the proximal brachiocephalic and vertebral arteries is reported. These procedures constitute only 10 per cent of operations for extracranial arterial occlusive cerebrovascular disease at the University of California, San Francisco, in the past 20 years. All patients were asymptomatic. Except for six patients with cerebral embolization from ulcerating lesions, symptoms resulted from cerebral hypoperfusion. Prevention of ultimate stroke was the primary objective of operation in patients with embolization and in patients with stenosis or occlusion of the common carotid arteries. Purely obstructive lesions in the subclavian and vertebral arteries were symptomatic only when there was bilateral involvement and the objective of operation was the relief of disabling symptoms of hypoperfusion for these otherwise essentially benign lesions. Prior correction of associated stenosis of the carotid artery often removed the need for a proximal operation. The majority of the operations were endarterectomy or transposition, or combinations of the two. Cervical bypass grafts, because of their less certain durability, were used only when a more direct operation was neither feasible nor safe.
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PMID:Surgery of the aortic arch branches and vertebral arteries. 38 6

In a 22-year followup of 3686 San Francisco longshoremen, the roles of physical activity, cigarette smoking habit, and systolic blood pressure level were evaluated independently in relation to risk of death from a broad range of diseases. Smoking pattern and blood pressure status were established in 1951 and job activity was assessed annually during the followup period. Lower levels of energy expenditure predicted increased risk of fatal heart attack and perhaps of stroke. Heavy cigarette smoking predicted increased risk of death from heart attack, cancer, chronic obstructive respiratory disease, and pneumonia. Higher levels of systolic blood pressure were associated with death from all cardiovascular diseases, diabetes mellitus, and cirrhosis. Tacit to these findings: sedentary living takes its toll largely through heart disease and stroke; the toxicity of cigarette smoking is associated with a broader range of diseases, including heart attack, cancer, and respiratory disease; and higher level of blood pressure related to an even broader range of cardiovascular disease than either of the other characteristics studied.
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PMID:Energy expenditure, cigarette smoking, and blood pressure level as related to death from specific diseases. 68 71

Acupuncture, needling with electrostimulation, at Tsu San Li (St-36) produced (1) significant decrease in cardiac output, (2) decrease in stroke volume, (3) increase in total peripheral resistance, and (4) minimal changes in heart rate, mean arterial pressure, pulse pressure, and central venous pressure in dogs under halothane anesthesia. Atropine given alone and given before acupuncture at Tsu San Li (St-36) produced (1) early significant increase in cardiac output, (2) early significant increase in heart rate, (3) increase in mean arterial pressure, (4) decrease in total peripheral resistance, and (5) minimal changes in stroke volume, pulse pressure, and central venous pressure in anesthetized dogs. It was concluded that the effects of acupuncture at Tsu San Li (St-36) were parasympathomimetic-like and that these effects could be blocked by atropine, a parasympatholytic drug.
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PMID:Cardiovascular effects of atropine on acupuncture, needling with electrostimulation, at Tsu San Li (St-36) in dogs. 87 81

Stroke, coronary heart disease (CHD) and total mortality are evaluated from death certificates in enumerated cohorts of 45-64-year old Japanese men in Hiroshima and Nagasaki (1965-1970), in Homolulu (1966-1970), and in the San Francisco area (1968-1972). Total mortality is highest in Japan with no consistent differences between Japanese Americans in Homolulu and San Francisco. Age-specific CHD death rates are markedly lower in all three Japanese groups than in American whites. The CHD rates are consistently and significantly lower in Japan that in American Japanese. Stroke death rates for American Japanese men appear equivalent to figures for US white men of the same age, but are significantly lower than in the Japan cohort for the 60-64-year-old group. The number of stroke deaths below that age are too few as yet for analysis. Validation of mortality ascertainment and of the accuracy of death certification has been carried out in Japan and in Hawaii. The international differences in mortaltiy do not appear to be due to certification or other methodologic artifact.
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PMID:Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: mortality. 120 50

The Honolulu Heart Program (HHP) is a long-term prospective epidemiologic study of cardiovascular disease (CVD) in male descendants of Japanese migrants to Hawaii. The article is a review of data from recent and past HHP studies relevant to the Seventeenth Pacific Science Congress symposium "Changes in Disease Patterns in the Western Pacific and Southeast Asia." The Ni-Hon-San Study, which compared CVD rates and risk factors in Japanese men living in Japan, Hawaii (HHP), and California, showed that coronary heart disease (CHD) and stroke mortality rates in Hawaii were intermediate between rates in Japan and California. Gradients in CVD risk factors were similar to the gradients in disease rates. From 1966 to 1984 trends in incidence rates for CHD, stroke, and cause-specific mortality were compared for the 8006 participants and 3130 non-participants in the HHP. CHD and stroke rates declined by about 40% for the total HHP cohort. There was a larger decline for CHD mortality (over 60%) in the nonparticipants. There was also a much greater decline in total mortality and cancer mortality rates in the nonparticipants. The results of the reviewed studies show that the subjects, although sharing a common ethnic background, experience different rates of disease when living in diverse geographic and cultural locales. This finding supports evidence that environmental and behavioral factors influence chronic disease rates and provides a basis for intervention and prevention. The finding that nonparticipants in epidemiologic studies can show different incidence trends suggests that caution should be used in interpreting trends limited only to participants.
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PMID:Studies of cardiovascular disease and cause-specific mortality trends in Japanese-American men living in Hawaii and risk factor comparisons with other Japanese populations in the Pacific region: a review. 142 39

Stroke in Asian and Pacific-Islander populations remains the principal cause of death among adults, but its incidence in the United States approximates that of Caucasians. Although controversial, uncontrolled hypertension in certain population groups (e.g., northern Japanese) and high dietary saturated fat in others (e.g, Pacific-Islanders) are believed to be responsible for the high stroke incidence rates. The recent reduction in stroke frequency rates in these areas is thought to be the result of better hypertension control. In the Ni-Hon-San Study, the level of hypertension and its frequency were similar in Hawaii and Japan, but ischemic infarction and intracerebral hemorrhage were less frequent in Hawaii. Reduced meat and fat intake may contribute to small vessel disease in Japan. Stroke is the third major cause of death among Hispanic-Americans and Native Americans, yet there is a paucity of information, especially about stroke, in subgroups of these populations. There is also considerable ignorance and controversy about risk factors for stroke in these populations. The need for additional research is urgent.
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PMID:Strokes in Asians and Pacific-Islanders, Hispanics, and Native Americans. 201 69

Amaurosis fugax is considered an ocular transient ischemic attack with an ominous prognosis. One hundred twenty-eight patients with amaurosis fugax as the presenting symptom underwent carotid endarterectomy at the University of California, San Diego (UCSD) and Scripps Clinic between 1970 and 1985 with one death (0.8%) and one postoperative permanent stroke (0.8%). Subsequently, these patients were followed up for 6 to 160 months (mean 45.3 months). Only two subsequent late strokes were documented (at 2 and 5 years after operation). These results were significantly better (p less than 0.01) by life-table analysis than the late stroke rate after carotid endarterectomy performed to treat anterior motor transient ischemic attacks at both UCSD and Scripps Clinic, as well as the reported late follow-up for all transient ischemic attacks after carotid endarterectomy in the literature (1.8% per year, 17 publications, 1980 operations). Thus amaurosis fugax appears to be a particularly favorable indication for carotid endarterectomy. Left untreated, this event carries a high risk of stroke; after carotid endarterectomy, which has a low operative risk, there is a very low postoperative stroke rate (two strokes in 448 patient-years of follow-up).
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PMID:Late results after carotid endarterectomy for amaurosis fugax. 365 82

A retrospective case-control study was carried out to examine the relationship between cigarette smoking and cerebrovascular disease occurrence. Cases were obtained from the University of California-American Heart Association, San Diego Stroke Data Bank, and controls from selected Veterans Administration and University of California, San Diego, outpatient departments. When cigarette smoking was dichotomously coded into categories of low and high lifetime exposure, consistent significant positive associations were found with cerebrovascular disease occurrence in both bivariate and multivariate analysis when controlling for blood pressure. These associations, however, were not found when smoking was categorized as smoker, ex-smoker, and non-smoker. No association was found between passive smoking and cerebrovascular disease. The results indicate that a cumulative lifetime exposure to active cigarette smoking is directly associated with cerebrovascular disease.
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PMID:The association between cerebrovascular disease and smoking: a case-control study. 378 27

Three hundred patients with cerebrovascular occlusive disease have had cerebral angiographic examination at the Veterans Administration Hospital, San Francisco, in the last five years. The present technique consists of preliminary visualization of the aortic arch and the major extracranial branches, followed by selective study of the subclavian and carotid arteries as necessary for evaluation of the intracranial circulation.Nine major complications occurred (an over-all incidence of 3 per cent). Two patients died after angiography and seven had major neurologic deficits persisting for more than 24 hours. Three of these patients had permanent damage, but four recovered completely.One-third of the patients had extracranial disease and one-third had intracranial disease. No significant lesion was found in the remainder. In the 212 patients with lesions, multiple lesions were common, the average number being three. Six patients had brain tumors and five had aneurysms. The mechanism of the stroke could be ascertained readily in most of the patients, but the extent of the disease and the resulting symptoms varied considerably. Several patients with occlusion of most of the cerebral vessels had minimal symptoms, while others had catastrophic symptoms but only minimal findings at arteriography.
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PMID:Cerebrovascular occlusive disease. Experience with panarteriography in 300 consecutive cases. 583 84

As part of the Ni-Hon-San Study, stroke incidence was compared in the Japan and Hawaii cohorts. Stroke cases were classified in two types, intracranial hemorrhage (ICH) and thrombo-embolic stroke (T-E). For each type the incidence in Japan was about three times as great as in Hawaii. The ratio ICH/T-E was 1/2.2 and 1/1.6 in Japan and Hawaii, respectively. Blood pressure was the most important risk factor, followed by age for total stroke in both Japan and Hawaii. Proteinuria was also a risk factor in Hawaii. Conversely, an index of animal food intake was inversely related to total stroke, significantly in Hawaii, and at a suggestive level for total and hemorrhagic stroke in Japan. Since the levels of blood pressure do not differ between Japan and Hawaii, one possible explanation for the large difference in stroke incidence between the two cohorts may be the fact that animal protein and saturated fat intake, which is inversely associated with stroke incidence, is much greater in Hawaii than in Japan. This explanation would support epidemiologic and experimental studies in Japan which suggest that dietary animal protein and fat exert an inhibitory effect on the incidence of stroke.
Stroke
PMID:Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: incidence of stroke in Japan and Hawaii. 669 20


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