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Sherman C Stein

Publications and source records attributed to Sherman C Stein.

13 recordsLinked to original sources
PubMed2005

Apo E genotype not associated with intravascular coagulation in traumatic brain injury.

There is considerable evidence linking both genotype and coagulopathy to vascular complications of traumatic brain injury (TBI) and other cerebral insults. The authors explored a possible connection between the apolipoprotein E (Apo E) genotype, coagulopathy and intravascular microthombosis (IMT) in TBI. The predicted association was not confirmed.

Apolipoproteins E↗
PubMed2005

Prophylaxis for deep venous thrombosis in craniotomy patients: a decision analysis.

OBJECTIVE: We sought to determine the most efficient perioperative prophylactic strategy for deep venous thrombosis (DVT) in craniotomy patients by use of a decision analysis model. METHODS: We conducted a structured review of the relevant literature and compiled the reported incidences of DVT, pulmonary embolism, and postoperative intracranial hemorrhage (ICH) in craniotomy patients. We also obtained from the literature estimates of the likelihood and the impact of various outcomes of these complications. Data from 810 craniotomies performed at our own institution were also examined. The decision analytic model was then used to compare the effectiveness of pneumatic compression boots with pneumatic compression boots combined with either unfractionated or low-molecular-weight heparin. The model dealt with variability by using both sensitivity analysis and Monte Carlo simulation. RESULTS: As expected, the addition of heparin lowered the incidence of both DVT and pulmonary embolism, but at the cost of increasing ICH. Because the deleterious effects of ICH were so much greater than the benefits from heparinization, overall outcomes were best with mechanical prophylaxis alone. This was especially true for low-molecular-weight heparin, which is associated with a relatively high risk of ICH. Our own institutional data support the findings in the literature. Although the differences are modest, they reach statistical significance in the case of low-molecular-weight heparin. CONCLUSION: Using decision analytic modeling, we have shown that mechanical prophylaxis yields outcomes in craniotomy patients superior to those of either unfractionated or low-molecular-weight heparin.

Anticoagulants↗
PubMed2005

Cost-effectiveness of intraoperative imaging in carotid endarterectomy.

OBJECTIVE: There has never been a large, randomized controlled trial to assess the impact of intraoperative imaging on the success of carotid endarterectomy (CEA). This comparison involves cost-effectiveness analysis. METHODS: We constructed a decision-analytic model to compare effectiveness and costs of intraoperative ultrasound (IUS) and completion angiography as adjuncts to CEA. Data on procedural mortality, morbidity, and costs were obtained from the English-language literature. The review included a total of 52 reports, encompassing more than 22,000 patients. The main components of costs were those of the monitoring interventions and the care of perioperative stroke. RESULTS: Mean perioperative outcome without completion imaging is approximately 96.7% of what it would be in the absence of perioperative stroke or death. IUS and completion angiography each result in approximately 2% improvement in expected outcome. Mean perioperative costs are 396.50 dollars for IUS, 721.30 dollars for no monitoring, and 840.90 dollars for completion angiography. Because IUS is significantly more effective at detecting technical errors that would likely result in perioperative stroke than no imaging and is significantly less costly than angiography, this strategy dominates the other two (i.e., it provides greater effectiveness at lower cost). CONCLUSION: Although surgical complications are uncommon, IUS substantially lowers the rate of perioperative stroke and mortality and thus is significantly more cost-effective than either completion angiography or no operative imaging.

Angiography↗
PubMed2005

Mild head injury.

Explore the source record for details and available documents.

Craniocerebral Trauma↗
PubMed2004

Prophylaxis for deep venous thrombosis in patients with craniotomies: a review.

Deep venous thrombosis (DVT) remains a source of significant morbidity and mortality in patients who undergo craniotomy procedures. Despite several studies in which the safety and efficacy of various prophylactic strategies were examined, there is still no consensus among clinicians. In this paper the authors review the literature with regard to epidemiological and pathophysiological features, screening methods, and prophylactic measures for DVT.

Craniotomy↗
PubMed2004

Association between intravascular microthrombosis and cerebral ischemia in traumatic brain injury.

OBJECTIVE: To determine the association between traumatic cerebral ischemia and intravascular thrombosis, a common finding after traumatic brain injury (TBI). METHODS: We reviewed samples of the frontal cortex and hippocampus from individuals who had sustained a fatal TBI. Sections stained with hematoxylin and eosin were reviewed and rated for severity of selective neuronal necrosis (SNN). Because intravascular fibrin microthrombi may lyse within a few days of TBI, we restricted our analysis to patients who had died within 48 hours of injury. Medical records in all cases were reviewed to rule out severe or prolonged hypotension or hypoxemia. Eleven patients with severe or global SNN were compared with 11 patients in whom SNN was mild or absent. Slides adjacent to the hematoxylin and eosin sections were stained with an immunofluorescent antibody to antithrombin III and were reviewed for intravascular microthrombosis. The number of microthrombi on each slide was counted by an investigator blinded to the hematoxylin and eosin findings, and density of intravascular microthrombi was calculated. RESULTS: Intravascular microthrombi were noted in every section, excluding control (non-TBI) brain tissue. However, the density of microthrombi varied with the degree of SNN. We found a highly significant difference in the mean density of microthrombi between patients with severe SNN (7.74 +/- 3.7/cm(2)) and those with little or no SNN (2.58 +/- 1.0/cm(2)). Furthermore, a good correlation was noted between the location of intravascular microthrombi and that of SNN. CONCLUSION: These data support a strong link between intravascular microthrombosis and neuronal death after brain trauma in humans and may have important implications for new therapeutic approaches.

Brain Injuries↗
PubMed2004

Coagulopathy in traumatic brain injury.

Abnormalities in blood coagulation, although quite common after traumatic brain injury (TBI), are of unknown significance. The authors review the clinical and pathophysiological features of this phenomenon and emphasize its origin in disseminated intravascular coagulation. This connection provides a possible explanation for much of the cerebral ischemia that accompanies TBI, namely intravascular microthrombosis. The authors' own research findings support this contention and suggest possible therapeutic avenues. A number of compelling studies demonstrate that DIC is a common and important consequence of TBI. In particular, posttraumatic coagulopathy appears to be linked to secondary cerebral injury. Although the extent of this process has yet to be elucidated fully, coagulation abnormalities are evident soon after trauma. This allows early identification of patients likely to suffer secondary complications and provides an opportunity to evaluate promising agents that may mitigate posttraumatic DIC and related pathologies in these patients. This is an area deserving of more intensive research.

Blood Coagulation Disorders↗
PubMed2004

What we research: survey of American Association of Neurological Surgeons and Congress of Neurological Surgeons member publications.

OBJECT: The goal of this study was to create a searchable database of research manuscripts authored by members of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons (AANS/CNS) to describe the nature and character of the research currently being undertaken by neurosurgeons. METHODS: Manuscripts published by all physician members listed in the 2001 AANS/CNS Membership Directory (6921 physicians) were gathered into a database through individual literature searches of the author name for the calendar year 2001. Duplicate publications were purged and the database was reviewed for accuracy. An internal verification of the database revealed a 4% underreporting rate. Statistics from the database were compiled and displayed with information about AANS/CNS members and their clinical activities. The AANS/CNS members published a total of 2748 research the manuscripts in 479 different journals during 2001. Thirty-eight percent of the manuscripts (1042 of 2748) were authored by US members and 62% (1706 of 2748) by non-US members. The focus of the majority of manuscripts included the areas of brain tumor (26%; 707 of 2748), vascular disease (20%; 558 of 2748), spine (10%; 282 of 2748), and trauma (8%; 233 of 2748). Sixty-nine percent of manuscripts (1897 of 2748) were retrospective and technical clinical studies, and of these 39% (744 of 1897) were case reports. Laboratory investigations made up 15% (414 of 2748) of all manuscripts, whereas prospective randomized clinical trials represented 1% (34 of 2748). CONCLUSIONS: The majority of AANS/CNS member manuscripts are authored by non-US members despite their small AANS/CNS representation. Most research is clinical, based on retrospective data, and includes a large number of case reports. A disparity exists between what neurosurgeons do clinically and both the quantity and subject of their research.

Authorship↗
PubMed2002

Decision analysis to estimate cost effectiveness in neurosurgery.

Medical decisions often depend, in part, on cost-effectiveness concerns. Decision analysis is frequently used to help resolve these questions. Unfortunately, this technique has received little attention in neurosurgery. Using an example of moderate head injury, the authors illustrate the utility of this powerful tool in estimating the cost effectiveness of neurosurgical management options.

Cost-Benefit Analysis↗
PubMed2002

Intravascular coagulation: a major secondary insult in nonfatal traumatic brain injury.

OBJECT: The goal of this study was to determine the frequency with which cerebral intravascular coagulation (IC) complicates traumatic brain injury (TBI). The authors also investigated the incidence of IC in relation to varying mechanisms, time courses, and severities of TBI and in different species. METHODS: Tissue was sampled from surgical specimens of human cerebral contusions, from rats with lateral fluid-percussion injuries, and from pigs with head rotational acceleration injuries. Immunohistochemical fluorescent staining for antithrombin III was performed to detect cerebral intravascular microthrombi. Abundant IC was found in all specimens, and microthrombi had formed in arterioles and venules of all sizes, ranging from 10 to 600 microm. Although it was more pronounced in focal lesions and more severe injuries, considerable IC was also observed in mild and diffuse injuries. The authors found a strong association between the severity of coagulopathy and the density of IC. CONCLUSIONS: These results strongly support the contention that IC is a universal response to TBI and an important secondary cerebral insult.

Animals↗