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Biomedical subjects

P N Karanjia

Publications and source records attributed to P N Karanjia.

8 recordsLinked to original sources
PubMed1999

Initial clinical experience with IV tissue plasminogen activator for acute ischemic stroke: a multicenter survey. The t-PA Stroke Survey Group.

We assessed initial clinical experience with IV tissue plasminogen activator (t-PA) treatment of acute ischemic stroke in a standardized retrospective survey of hospitals with experienced acute stroke treatment systems. The incidence of symptomatic intracerebral hemorrhage (ICH) was 6% (11 of 189 patients; 95% CI 3 to 11%), similar to that in the National Institute of Neurological Disorders and Stroke (NINDS) t-PA Stroke Study. Deviations from the NINDS protocol guidelines were identified in 30% of patients (56 of 189). The incidence of symptomatic ICH was 11% among patients with protocol deviations as compared with 4% in patients who were treated according to the NINDS protocol guidelines, suggesting that strict adherence to protocol guidelines is prudent.

Aged↗
PubMed1997

Validation of the ACAS TIA/stroke algorithm.

BACKGROUND AND PURPOSE: An easily administered questionnaire and algorithm classifying transient ischemic attacks (TIAs) or strokes, and also their distribution, could be invaluable for identifying endpoints in epidemiologic studies or clinical trials of prevention and therapy of cerebral ischemia. The Asymptomatic Carotid Atherosclerosis Study (ACAS) devised a symptom-based questionnaire and algorithm for detecting events in the trial. The purpose of this study was to determine sensitivity, specificity, and agreement rates of the questionnaire and algorithm against diagnoses of a panel of cerebrovascular disease authorities. METHODS: Three hundred eighty-one men and women at eight medical centers reported symptoms of stroke, TIA, or other neurologic illness. The questionnaire was administered by trained interviewers and the responses were analyzed using the algorithm. A standardized neurologic examination was performed by a neurologist. Data were submitted to two or more external reviewers. Sensitivity, specificity, and the kappa statistic (kappa) were used to evaluate the relationship between the algorithm and the external reviewers' diagnosis. RESULTS: Of the 381 reviews, 196 were diagnosed as TIA or stroke by the external panel. The algorithm's agreement with the diagnosis of TIA or stroke was 80.1%, and kappa was 0.60. Sensitivity was 87.8%, and specificity was 71.9%. CONCLUSION: While statistical agreement rates depend on the method of sample selection, the algorithm has a high agreement with an external panel of experts and is a sensitive tool for event detection. The lower specificity indicates that careful neurologic evaluation may be required to confirm or refute events identified by the screening algorithm.

Adult↗
PubMed1995

Accuracy of initial stroke subtype diagnosis in the TOAST study. Trial of ORG 10172 in Acute Stroke Treatment.

Rapid identification of stroke subtype is valuable for both practicing clinicians and the optimal design of clinical stroke trials. Mechanisms of ischemic injury might differ among different stroke subtypes. Certain subtypes might be clinically identified as suboptimal for future therapeutic or prophylactic stroke trials. Some subtypes might be so clinically distinct that extensive laboratory investigation is unwarranted. Investigators in the ongoing Trial of ORG 10172 in Acute Stroke Treatment are using criteria to categorize stroke etiology among enrolled patients into one of five subtypes: large-artery atherothromboembolic, cardioembolic, small-vessel thrombotic, other etiology, or undetermined etiology. As part of the study, physicians initially predict the most likely subtype of stroke based on clinical features and baseline CT. Three months after stroke, investigators use the criteria, which also incorporate results of diagnostic testing, to reclassify stroke subtype. Initial clinical impression of subtype agreed with final determination in 62% of patients, and the rate was similar for all stroke subtypes. No stroke subtype was more accurately diagnosed than others by initial assessment. No subtype was more commonly identified by diagnostic studies. Fifteen percent of patients remained without a clear etiologic subtype diagnosis at 3 months. We conclude that clinical trials in stroke should not attempt to restrict entry into trials based on presumed stroke subtype. A careful evaluation for etiology is justified in all patients presenting with stroke, regardless of presumed subtype.

Cerebrovascular Disorders↗
PubMed1994

Coexistence of abdominal aortic aneurysm in patients with carotid stenosis.

BACKGROUND AND PURPOSE: The study was designed to assess the incidence of coexistent abdominal aortic disease in patients with known carotid artery stenosis. METHODS: Abdominal ultrasound and physical examination of the abdomen were performed in 89 consecutive patients referred to this tertiary medical center for evaluation of both symptomatic and asymptomatic carotid artery disease. The frequency of abdominal aortic aneurysm detected in this population was compared with that incidentally found in age- and sex-matched patients undergoing abdominal ultrasound for nonvascular reasons. RESULTS: Eighteen aortic aneurysms were detected by ultrasound in 89 patients with carotid stenosis, compared with three aneurysms in 89 matched patients (P < .01, corrected chi 2). Twelve of the 18 patients with aneurysm had an abnormal abdominal physical examination. CONCLUSIONS: Aortic aneurysm occurs with high frequency in patients with carotid stenosis. Physicians should perform careful abdominal examination on these patients and consider routine abdominal ultrasonic screening.

Aged↗
PubMed1990

Computed tomography ventricular size has no predictive value in diagnosing pseudotumor cerebri.

We compared linear indices of computed tomography ventricular size in patients with pseudotumor cerebri and in age-matched controls, and found no difference between these populations. Two physicians showed poor agreement and sensitivity when blindly judging whether patients and controls had "slit-like" ventricles. We conclude that ventricular size on routine CT has no predictive value when evaluating patients with suspected pseudotumor cerebri.

Adult↗
PubMed1985

EEG changes during carotid endarterectomy: drug effect and embolism.

Clinical neurological status and the electroencephalogram (EEG) were monitored during right carotid endarterectomy under regional anaesthesia in a patient who had suffered two prior cerebral infarctions. No change in EEG or clinical status was seen with occlusion of the carotid artery, but generalized encephalopathic changes were seen after a small dose of narcotic given before carotid occlusion. Bihemispheric changes in EEG and neurological status occurred upon release of carotid occlusion. This case demonstrates three important points. First, EEG changes can be seen with sedative or anaesthetic agents in patients who have previously suffered brain injury. Second, temporary neural dysfunction may be seen remote from the site of a localized injury to the brain--a phenomenon known as diaschisis. Finally, this report reiterates the observation that the risk of injury to the brain during carotid endarterectomy is not limited to the period of possible ischaemia during occlusion of the carotid artery.

Aged↗
PubMed1983

Passive joint position sense after total hip replacement surgery.

Passive joint position sense was tested in 10 subjects after unilateral total hip replacement surgery (which included capsulectomy). Varied initial limb position, amplitude, and velocity of movement were used. The unoperated side was used as a control. Statistically barely significant errors (p less than 0.025) on the operated side were detected at 0.6 degrees per second but not at 2 degrees per second. No significant differences were noted among the different hip positions. The results indicate that the ability to detect passive hip joint position sense remains largely, but not completely, intact after hip joint replacement. The joint capsule, ligaments, and joint surfaces, although not essential for kinesthesia, may provide some limb movement and position information, the absence of which is not now clinically apparent.

Follow-Up Studies↗