Responses of small myelinated "warm" fibers to noxious heat stimuli applied to the monkey's face.
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Action Potentials↗
Biomedical subjects
S Starkman
Publications and source records attributed to S Starkman.
The professional model: Paradox in school psychology.
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Humans↗
Cranial computed tomography interpretation in acute stroke: physician accuracy in determining eligibility for thrombolytic therapy.
CONTEXT: Intracranial hemorrhage must be excluded prior to administration of thrombolytic agents in acute stroke. OBJECTIVE: To evaluate physician accuracy in cranial computed tomography scan interpretation for determining eligibility for thrombolytic therapy in acute stroke. DESIGN: Administration of randomly selected, randomly ordered series of 15 computed tomography scans from a pool of 54 scans that demonstrated intracerebral hemorrhage, acute infarction, intracerebral calcifications (impostor for hemorrhage), old cerebral infarction (impostor for acute infarction), and normal findings. PARTICIPANTS: A convenience sample of 38 emergency physicians, 29 neurologists, and 36 general radiologists. MAIN OUTCOME MEASURES: Physician determination of eligibility for thrombolytic therapy based on computed tomography scan interpretation. RESULTS: Average correct score by all physicians on all computed tomography scans was 77% (95% confidence interval, 74%-80%). Of 569 computed tomography readings by emergency physicians, 67% were correct; of 435 readings by neurologists, 83% were correct; and of 540 readings by radiologists, 83% were correct. Overall sensitivity for detecting hemorrhage was 82% (95% confidence interval, 78%-85%); 17% of emergency physicians, 40% of neurologists, and 52% of radiologists achieved 100% sensitivity for identification of hemorrhage. CONCLUSION: Physicians in this study did not uniformly achieve a level of sensitivity for identification of intracerebral hemorrhage sufficient to permit safe selection of candidates for thrombolytic therapy.
Brain↗
Design and retrospective analysis of the Los Angeles Prehospital Stroke Screen (LAPSS).
OBJECTIVES: The therapeutic window for intervention in acute cerebral ischemia is brief. Prehospital identification of acute stroke patients and paramedic administration of neuroprotective agents may soon become critical components of successful acute stroke treatment. This preliminary study sought to demonstrate that a new prehospital screening instrument, the Los Angeles Prehospital Stroke Screen (LAPSS), sensitively identifies acute stroke patients. Further, the study evaluated the potential time savings that could be achieved by paramedic administration of neuroprotective agents in the field. METHODS: The authors designed a simple stroke screening tool for use by prehospital personnel, emphasizing motor deficits. They then tested instrument performance and time savings retrospectively, employing data from patients enrolled within six hours of symptom onset in randomized stroke trials at three university-associated paramedic receiving hospitals. RESULTS: Fifty of 83 patients enrolled in hyperacute stroke trials arrived by ambulance, including 41 with ischemic infarcts and seven with hemorrhages. Of the 41 with acute ischemic stroke, 38 (93%) would have been accurately identified by the LAPSS. For these 38 patients, 1 hour and 50 minutes would have been saved had neuroprotective drug been administered by paramedics at the time of transport vs the actual time of study agent administration in the emergency department. CONCLUSIONS: The LAPSS sensitively identifies ambulance-arriving acute stroke patients, and a substantial time savings will potentially occur if neuroprotective agents are administered by paramedics in the field. The LAPSS is a promising tool that may enable paramedic recognition of stroke with a high degree of sensitivity and simplicity in a short period of time.
Acute Disease↗
Endovascular mechanical clot retrieval in a broad ischemic stroke cohort.
BACKGROUND AND PURPOSE: Our aim was to describe an expanded experience with endovascular mechanical embolectomy in a broad group of patients, including those not meeting entry criteria for the MERCI multicenter trials. METHODS: We performed an analysis of all patients with ischemic stroke treated with the Merci Clot Retrieval Device at a single academic center outside of the Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trials. RESULTS: Twenty-four patients were treated with the device. Nine were MERCI trial ineligible: 4 received intravenous (IV) tissue plasminogen activator (tPA), 1 received IV tPA and was younger than 18 years of age, and 4 had time-to-treatment of longer than 8 hours. Mean age was 64 years (range, 14-89 years; 42% women). Median National Institutes of Health Stroke Scale (NIHSS) score was 21 (range, 11-30). Median symptoms-to-procedure-start time was 303 minutes (range, 85-2385 minutes). Recanalization (Thrombolysis in Myocardial Infarction, 2-3) was achieved in 15/24 (63%). In device-only patients, recanalization occurred in 10/16. In patients who failed IV tPA undergoing rescue embolectomy, recanalization was achieved in 4/5. Three patients unresponsive to device therapy received rescue intra-arterial tPA/abciximab; recanalization was achieved in 2/3. Recanalization was achieved in 3/4 patients in whom treatment was started longer than 8 hours after symptom onset. Asymptomatic hemorrhage occurred in 38%; symptomatic hemorrhage, in 8%. Three device fractures occurred; none worsened clinical outcome. In-hospital mortality was 17%; 90-day mortality, 29%. Good 90-day functional outcome (modified Rankin Scale, <or=2) was achieved by 25% (6/24). CONCLUSIONS: Endovascular mechanical embolectomy is an effective means of achieving revascularization in patients with acute ischemic stroke, including patients with late treatment start and intravenous tPA failure. Device-based therapy achieved recanalization in nearly two thirds of patients and good clinical outcomes in one fourth, with symptomatic hemorrhage in less than one tenth.
Adolescent↗
[Stenosis of the left coronary artery: a report on 50 cases (author's transl)].
Stenosis of the left coronary artery differs from other atheromatous lesions by the severity of the affection. It is not a rare condition as it occured in 50 out of 750 patients. Clinical and electrocardiographic signs are not truly specific and coronarography is essential for diagnosis even though this procedure carries a certain risk of accidents (2%). At a time when medical and surgical treatment of coronary insufficiency is being compared, stenosis of the left coronary insufficiency is being compared, stenosis of the left coronary artery definitely required operative intervention which improves both functional prognosis and mortality.
Adult↗