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1.
J Stroke Cerebrovasc Dis ; 29(10): 105164, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912544

RESUMO

INTRODUCTION: The incidence of lung cancer and acute ischemic stroke remains high in recent years, both of which occur mostly in people over 60 years old. In the present study, we aimed to further clarify the pathogenesis of lung cancer-associated acute ischemic stroke (LCA-AIS) by comparing and analyzing clinical characteristics of stroke patients with or without lung cancer. METHODS: A total of 51 patients with lung cancer were selected as the case group (LCSG), and 78 patients without cancer history were adopted as the control group (SG). The data collected in this study included sex, age, traditional cerebrovascular disease risk factors (TCDRFs), blood test index, imaging findings, etiological typing, and prognosis evaluation. SPSS21.0 software was used for statistical analysis. Normally distributed data were analyzed by t-test, and count data were analyzed by chi-square test or exact probability method. P < 0.05 was considered statistically significant. RESULTS: In the case group, the levels of plasma D-dimer, fibrinogen degradation products (FDPs) and NIHSS, as well as the mRS score and mortality of patients, were higher, while the levels of RBC, Hb and Hcy were lower compared with the control group. Imaging findings showed that multivessel involvement was more common in the case group, and the infarcts were more likely to be multiple and involved in both the anterior and posterior circulations. The TOAST classification of LCSG was dominated by stroke of undetermined etiology (SUE) and stroke of other determined etiology (SOE). Statistical analysis showed that the patients were more likely to suffer from acute ischemic stroke within 1 year after the diagnosis of lung cancer (41 cases, 80.39%). CONCLUSIONS: Hypercoagulability and acute multiple brain infarcts were more common in patients with LCA-AIS, and hypoproteinemia and hyponatremia were more likely to occur in these patients, leading to worse prognosis. Patients were most likely to have a stroke within 1 year after the diagnosis of lung cancer.


Assuntos
Infarto Encefálico/etiologia , Neoplasias Pulmonares/complicações , Tromboembolia/etiologia , Trombofilia/etiologia , Idoso , Biomarcadores/sangue , Infarto Encefálico/diagnóstico , Infarto Encefálico/mortalidade , Estudos de Casos e Controles , Avaliação da Deficiência , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Hiponatremia/diagnóstico , Hiponatremia/etiologia , Hipoproteinemia/diagnóstico , Hipoproteinemia/etiologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Fatores de Risco , Tromboembolia/diagnóstico , Tromboembolia/mortalidade , Trombofilia/diagnóstico , Trombofilia/mortalidade , Fatores de Tempo
3.
Z Gerontol Geriatr ; 53(5): 463-472, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32691149

RESUMO

The aim of this continuing medical education (CME) article (part II) is to describe the particular challenge of the treatment of hyponatremia, which occurs in older patients. This part II follows on from part I concerning the diagnosis in the previous volume. A staged approach is necessary. The best treatment is always when the underlying cause can be eliminated. Hyponatremia in older patients is mainly induced by the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. The authors use a concept for the first, second and third line strategy: (1) changing or discontinuation of drugs, (2) fluid restriction and (3) tolvaptan medication. The algorithm for treatment should be simple. It also contains recommendations for the correction rate. Caution is also needed in order to avoid the occurrence of an osmotic demyelination syndrome (ODS).


Assuntos
Antagonistas dos Receptores de Hormônios Antidiuréticos/uso terapêutico , Hidratação/métodos , Hiponatremia/terapia , Síndrome de Secreção Inadequada de HAD/complicações , Solução Salina Hipertônica/uso terapêutico , Tolvaptan/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Terapia Combinada , Humanos , Hiponatremia/diagnóstico , Hiponatremia/etiologia , Síndrome de Secreção Inadequada de HAD/diagnóstico , Infusões Intravenosas , Resultado do Tratamento
5.
Z Gerontol Geriatr ; 53(4): 347-356, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32488305

RESUMO

Old age is a strong independent risk factor for hyponatremia. Dizziness, fatigue, reduced vigilance, cognitive impairment, gait deficits, nausea, vomiting, headache, falls, osteoporosis and fractures, coma and seizures are more frequent and severe than in middle-aged patients. Hyponatremia is mainly caused by the syndrome of inappropriate antidiuretic hormone (SIADH) secretion and also including drugs. Hyponatremia is multifactorial in a significant proportion of older patients. Hyponatremia requires a staged diagnostic approach to identify the underlying cause. The aim of this continuing medical education (CME) report (part I) is to emphasize the special challenges in the diagnostics of hyponatremia, which occur in older patients. Diagnostics should be kept simple. A special algorithm is presented. Part II concerning treatment will follow.


Assuntos
Hiponatremia/diagnóstico , Hiponatremia/etiologia , Síndrome de Secreção Inadequada de HAD/complicações , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Humanos , Hiponatremia/metabolismo , Síndrome de Secreção Inadequada de HAD/diagnóstico , Síndrome de Secreção Inadequada de HAD/metabolismo , Pessoa de Meia-Idade , Fatores de Risco
10.
12.
J Clin Neurosci ; 78: 409-410, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32354647

RESUMO

Acute water intoxication (AWI) is a disorder of excess water intake that can manifest in neurological injury and death. We describe a case of a 54-year-old man that presents to the emergency department with a generalized toxic-clonic seizure due to AWI. Initial computed tomography of the brain demonstrated diffuse cerebral edema. However, with correction of serum sodium over the one hospital day, the patient's neurological symptoms and imaging completely resolved. Clinicians should recognize of reversibility of this entity with management of hyponatremia.


Assuntos
Edema Encefálico/etiologia , Sódio/sangue , Intoxicação por Água/sangue , Encéfalo/diagnóstico por imagem , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/prevenção & controle , Intervenção Médica Precoce , Humanos , Hiponatremia/diagnóstico , Hiponatremia/terapia , Masculino , Pessoa de Meia-Idade , Convulsões , Tomografia Computadorizada por Raios X/métodos , Intoxicação por Água/diagnóstico
14.
J Stroke Cerebrovasc Dis ; 29(6): 104789, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32205028

RESUMO

BACKGROUND: Hyponatremia is a common complication after aneurysmal subarachnoid hemorrhage (aSAH). Previous studies have reported an association between hyponatremia and vasospasm, however whether hyponatremia directly contributes to the pathogenesis of cerebral vasospasm (CVS), or is a by-product is still unclear. The aim of this study was to explore an association between hyponatremia and CVS after aSAH, and evaluating the temporality of these 2 events. METHODS: A retrospective study of consecutive patients with aSAH admitted to the Baylor St. Luke's Medical center between January 2008 and December 2012 was conducted. Demographics, baseline characteristics, serum sodium levels, and evidence of vasospasm detected by transcranial Doppler, CT Angiogram, MR angiogram, and digital subtracted angiography were collected. Patients were dichotomized into a hyponatremic and a normonatremic group. CVS incidence and clinical outcome was compared between groups. Timing of CVS after initial hyponatremia episodes was recorded Results: One hundred and sixty 4 patients with aSAH were included. Hyponatremia was identified in 66 patients (40.2%) and CVS occurred in 71 subjects (43.2%). The incidence of CVS was higher in the hyponatremic group compared to the normonatremic group, 65.1 % versus 28.5%, respectively (P < .001). Hyponatremia preceded CVS by median 1.5 days suggesting a temporal trend. CONCLUSIONS: Our study shows a significant association between hyponatremia and CVS, with hyponatremia preceding CVS events. This retrospective finding denotes the need for larger prospective studies, aiming to clarify the temporal relationship of serum sodium levels and CVS.


Assuntos
Hiponatremia/epidemiologia , Sódio/sangue , Hemorragia Subaracnóidea/epidemiologia , Vasoconstrição , Vasoespasmo Intracraniano/epidemiologia , Adulto , Idoso , Biomarcadores/sangue , Feminino , Humanos , Hiponatremia/sangue , Hiponatremia/diagnóstico , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Hemorragia Subaracnóidea/diagnóstico , Texas/epidemiologia , Fatores de Tempo , Vasoespasmo Intracraniano/diagnóstico , Vasoespasmo Intracraniano/fisiopatologia
15.
J Surg Res ; 250: 45-52, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32018142

RESUMO

BACKGROUND: The Model for End-Stage Liver Disease Sodium (MELD-Na) incorporates hyponatremia into the MELD score and has been shown to correlate with surgical outcomes. The pathophysiology of hyponatremia parallels that of ascites, which purports greater surgical risk. This study investigates whether MELD-Na accurately predicts morbidity and mortality in patients with ascites undergoing general surgery procedures. MATERIALS AND METHODS: We used the National Surgical Quality Improvement Program database (2005-2014) to examine the adjusted risk of morbidity and mortality of cirrhotic patients with and without ascites undergoing inguinal or ventral hernia repair, cholecystectomy, and lysis of adhesions for bowel obstruction. Patients were stratified by the MELD-Na score and ascites. Outcomes were compared between patients with and without ascites for each stratum using low MELD-Na and no ascites group as a reference. RESULTS: A total of 30,391 patients were analyzed. Within each MELD-Na stratum, patients with ascites had an increased risk of complications compared with the reference group (low MELD-Na and no ascites): low MELD-Na with ascites odds ratio (OR) 4.33 (95% confidence interval [CI] 1.96-9.59), moderate MELD-Na no ascites OR 1.70 (95% CI 1.52-1.9), moderate MELD-Na with ascites OR 3.69 (95% CI 2.49-5.46), high MELD-Na no ascites OR 3.51 (95% CI 3.07-4.01), and high MELD-Na ascites OR 7.18 (95% CI 5.33-9.67). Similarly, mortality risk was increased in patients with ascites compared with the reference: moderate MELD-Na no ascites OR 3.55 (95% CI 2.22-5.67), moderate MELD-Na ascites OR 13.80 (95% CI 5.65-33.71), high MELD-Na no ascites OR 8.34 (95% CI 5.15-13.51), and high MELD-Na ascites OR 43.97 (95% CI 23.76-81.39). CONCLUSIONS: MELD-Na underestimates morbidity and mortality risk for general surgery patients with ascites.


Assuntos
Ascite/cirurgia , Doença Hepática Terminal/diagnóstico , Hiponatremia/diagnóstico , Cirrose Hepática/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Índice de Gravidade de Doença , Adulto , Idoso , Ascite/sangue , Ascite/etiologia , Doença Hepática Terminal/sangue , Doença Hepática Terminal/complicações , Feminino , Mortalidade Hospitalar , Humanos , Hiponatremia/sangue , Hiponatremia/etiologia , Cirrose Hepática/sangue , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Sódio/sangue , Resultado do Tratamento
16.
BMJ Case Rep ; 13(1)2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31911412

RESUMO

Hyponatremia is the most commonly observed electrolyte disturbance in clinical medicine. Occasionally the initial presentation of a patient with a symptomatic hyponatremia is a seizure or coma. This life-threatening complication needs early diagnosis and immediate treatment. Here, we report a case of a 27-year-old man who presented with an epileptic seizure, lactate acidosis and sulcal effacement on CT in which a transient sodium increase masked a clinically relevant hyponatremia thereby delaying diagnosis. This phenomenon is caused by an extracellular water shift and can occur when blood analysis is performed shortly after vigorous exercise or a seizure. This case provides awareness for a less well-known cause of plasma sodium increase and offers recommendations to prevent misinterpretation and help clinicians in decision making.


Assuntos
Hiponatremia/diagnóstico , Convulsões/etiologia , Sódio/sangue , Sódio/urina , Adulto , Diagnóstico Diferencial , Humanos , Hiponatremia/complicações , Masculino
18.
Med Klin Intensivmed Notfmed ; 115(1): 29-36, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31792559

RESUMO

Hyponatremia (sodium <135 mmol/l) is the most common electrolyte disorder. Despite identical serum concentrations, clinical symptomatology can vary greatly from mild to life-threatening. Accordingly, individual patients require immediate active treatment, while the majority of (mostly oligosymptomatic) patients should first undergo differentiated diagnosis. The most important element is the assessment of the clinical situation of the patient and never isolated laboratory chemical constellations: "Treat the patient, not the numbers".


Assuntos
Cuidados Críticos , Hiponatremia , Fluxo de Trabalho , Humanos , Hiponatremia/diagnóstico , Hiponatremia/terapia , Sódio
19.
Am J Kidney Dis ; 75(2): 272-286, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31606238

RESUMO

Overall body fluid concentration is regulated within a narrow range by the concerted action of the hypothalamic-pituitary axis to influence water intake through thirst and water excretion via the effect of vasopressin, or antidiuretic hormone, on renal collecting duct water permeability. Sodium is the principal extracellular cation; abnormalities in overall effective body fluid concentration, or tonicity, manifest as disturbances in serum sodium concentration. Depending on its severity and chronicity, hyponatremia can lead to significant symptoms, primarily related to central nervous system function. Failure to correct hyponatremia can lead to permanent neurologic damage, as can over rapid correction. It is thus essential to stay within specific limits for correction, particularly for chronic hyponatremia. Hypernatremia also leads to central nervous system dysfunction, although goals for its correction rate are less well established. This Core Curriculum article discusses the normal regulation of tonicity and serum sodium concentration and the diagnosis and management of hypo- and hypernatremia.


Assuntos
Currículo , Gerenciamento Clínico , Hipernatremia/diagnóstico , Hiponatremia/diagnóstico , Sódio/sangue , Humanos , Hipernatremia/sangue , Hipernatremia/terapia , Hiponatremia/sangue , Hiponatremia/terapia , Desequilíbrio Hidroeletrolítico
20.
Am J Kidney Dis ; 75(2): 256-264, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31606239

RESUMO

Hyponatremia can complicate thiazide use in a minority of susceptible individuals and can result in significant morbidity and even mortality. Risk factors for thiazide-associated hyponatremia include age, female sex, and possibly low body mass. A genetic susceptibility has recently been uncovered. Although frequently developing early after thiazide treatment initiation, many cases of hyponatremia present after months or years of use. Many cases are asymptomatic or have mild symptoms, but seizures and/or coma may develop, especially in those with acute onset. The pathophysiology is incompletely understood and includes some combination of excessive fluid intake, cation (sodium and potassium) depletion, osmotic inactivation of sodium, and reduced ability to excrete free water. Reduced distal delivery of filtrate, reduced solute load (urea), direct inhibition of the sodium-chloride cotransporter, and increased collecting duct permeability to water mediated by some combination of antidiuretic hormone, prostaglandins, and thiazides themselves may contribute to this diluting defect. The predominant pathophysiologic mechanism(s) varies from patient to patient. The cornerstone of therapy is cessation of thiazide use, cation repletion, and oral fluid restriction. If severely symptomatic, 3% saline solution may be indicated. Overly rapid correction of chronic hyponatremia must be avoided in all cases.


Assuntos
Hiponatremia/induzido quimicamente , Sódio/sangue , Tiazidas/efeitos adversos , Biomarcadores/sangue , Humanos , Hipertensão/tratamento farmacológico , Hiponatremia/sangue , Hiponatremia/diagnóstico
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