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  • 1
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Schlaganfall ; Paraneoplastische Hämostasestörung ; Trousseau-Syndrom ; Ovarialtumor ; Atypische Endosalpingiose ; Key words Stroke ; Paraneoplastic hemostasis ; Trousseau’s syndrom ; Ovarian tumor ; Atypical endosalpingiosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Thrombembolic events as paraneoplastic complications in malignant disease account for severe morbidity and mortality in these patients. In some cases disturbance in hemostasis is the first manifestation of a neoplastic process. We report the cases of two patients with cerebral and extracerebral vessel occlusions, in whom epithelial tumors of low malignant potential (borderline-tumors) of ovar and peritoneum were diagnosed later on. In one case the removal of the tumor stopped the coagulation problems. The second patient died a few days after the first symptoms with devastating multiple vessel occlusion. In stroke of unknown aetiology a paraneoplastic process should be kept in mind. The diagnosis is more probable with recurrent thrombembolism in different body regions and when warfarin therapie was ineffective. Thoughtful coagulation studies and a tumor search program is recommended in these cases.
    Notes: Zusammenfassung Thrombembolische Komplikationen treten paraneoplastisch bei malignen Erkrankungen auf und tragen zu Morbidität und Mortalität bei. In einigen Fällen sind Hämostasestörungen die erste Manifestation eines neoplastischen Prozesses. Wir beschreiben die Fälle von zwei Patientinnen mit zerebralen und extrazerebralen Gefäßverschlüssen, bei denen nach der Gefäßmanifestation epitheliale Tumoren mit niedrigem Malignitätspotential (Borderline-Tumoren) an Ovar und Peritoneum diagnostiziert wurden. Paraneoplastische Hämostasestörungen sind bei diesen Tumoren mit per se guter Prognose bisher nicht beschrieben worden. In einem Fall führte die Tumorentfernung zum Sistieren der Gerinnungsstörung. Die zweite Patientin starb wenige Tage nach den ersten Symptomen an den Folgen multipler Gefäßverschlüsse. Bei Schlaganfällen unklarer Ätiologie sollte auch an eine paraneoplastische Genese gedacht werden. Besonders wahrscheinlich ist die Diagnose bei rezidivierenden venösen und arteriellen Gefäßverschlüssen in verschiedenen Körperregionen und bei der Resistenz auf die Therapie mit Vitamin-K-Antagonisten. Eine sorgfältige Gerinnungsdiagnostik und ein Tumorsuchprogramm sind in diesen Fällen zu empfehlen.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 0942-0940
    Keywords: Subarachnoid haemorrhage ; plasma renin activity ; sympathetic nervous system ; brainstem dysfunction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The possible relationship between plasma renin activity and neurological deficits was examined in ten patients with spontaneous subarachnoid haemorrhage in a prospective clinical study. The patients were examined daily, particular attention being given to signs of brain stem dysfunction. The degree of impaired consciousness was assessed using the Glasgow Coma Score. Plasma renin activity was determined on days 1–5, 7, 9, 11, 13, 15 and 21 after the initial bleeding episode using an Angiotensin-I-radioimmunoassay. Six of seven patients with signs of brain stem dysfunction displayed a marked increase in plasma renin activity. Thus a significant negative correlation between the degree of consciousness and the plasma renin activity resulted. An explanation for this correlation may be found in the localization of the autonomous centres and the high concentrations of renin in the hypothalamus and brain stem. The individual changes in plasma renin activity have prognostic significance, whereas single estimated plasma renin activities show great interindividual differences and have only limited prognostic value.
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 121 (1993), S. 119-122 
    ISSN: 0942-0940
    Keywords: Subarachnoid haemorrhage ; autonomic deregulation ; beta-blockade ; metoprolol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The effects of beta-blockade to prevent autonomic disorders after acute aneurysmal subarachnoid haemorrhage were prospectively investigated. 11 patients were treated with the beta-1-selective beta-blocker metoprolol (up to 200 mg/die intravenously). 14 patients received standard therapy as controls. Pulse rate, blood pressure and dosage of the additional antihypertensive medication as signs of sympathetic disturbance were registered. The main result was the normalizing of the pulse rate especially during the first two weeks in contrast to the control group. The patients in the beta-blocker group did not need further antihypertensive medication. This was mainly a result of the reduction in sympathetic activation. No severe side-effects were documented and the survival was better in the treated group. Thus, beta-blockade is able to prevent and reduce autonomic disorders, especially activation of the sympathetic tone, in subarachnoid haemorrhage. Metoprolol as a so called cardioselective beta-blocker seems to be one of the suitable agents and is considered superior to the non-selective agents.
    Type of Medium: Electronic Resource
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