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Biomedical subjects

B Romner

Publications and source records attributed to B Romner.

At least 55 records · Page 3Linked to original sources
PubMed1998

Aneurysm clip MR artifacts. Titanium versus stainless steel and influence of imaging parameters.

PURPOSE: The aim of this study was to evaluate the extent to which titanium aneurysm clips could improve the quality of MR imaging compared with stainless steel clips, and to determine whether the clip artifacts could be reduced by controlling certain MR imaging parameters in frequently used pulse sequences. MATERIAL AND METHODS: The metal artifacts induced by 3 aneurysm clips were compared in 3 pulse sequences. The clips were: a Yasargil titanium aneurysm clip FT 752 T; a Yasargil standard aneurysm clip FE 752 K; and, for comparison, a ferromagnetic Scoville aneurysm clip En-58J. The pulse sequences were: spin echo (SE); gradient echo (GE); and fast SE. An evaluation was made of 3 imaging parameters with regard to their influence on the size of the metal artifacts. The parameters were: bandwidth; echo time (TE); and echo-train length. RESULTS: The titanium clip showed artifacts that were about 60% smaller than those from the stainless steel clip. The only parameter that influenced artifact size to any major degree was bandwidth in the SE sequences but not in the GE sequences. GE sequences induced larger artifacts than SE sequences and showed larger artifacts with longer TE. CONCLUSION: Titanium aneurysm clips reduced MR artifacts by approximately 60% compared to stainless steel clips. Artifacts were further reduced by using SE-based sequences with a high bandwidth or, if necessary, GE sequences with a low TE.

Artifacts↗
PubMed1998

The epidemiology of hospital-referred head injury in northern Norway.

This retrospective population-based survey describes the epidemiology of head injury in a defined population in Northern Norway. It includes all 247 patients with head injury referred to the University Hospital of Tromsø, Norway, during 1993. Head injury was defined as physical damage to the brain or skull caused by external force. The annual incidence rate of hospital-referred head injury was 229/100,000 population with a male preponderance of 1.7:1.0. The cause was a fall in 62%, road traffic accident in 21% and assault in 7% of the cases. The observed incidence rate is low despite the use of wide inclusion criteria, probably due to a decrease in road traffic accidents. A further decrease in the number of head injuries in our region may be achieved by preventing falls.

Accidental Falls↗
PubMed1997

Neuropsychological function in patients with increased serum levels of protein S-100 after minor head injury.

Protein S-100 is a calcium binding protein, synthetized in astroglial cells in all parts of the central nervous system (CNS). We have previously reported high serum levels of protein S-100 in patients after minor head injury (MHI). A battery of conventional and computerized neuropsychological measures was administered to two groups of MHI patients. Neuropsychological outcome at 12 months postinjury was examined in a group of 7 patients with increased serum levels of protein S-100 after MHI and 7 age- and sex-matched controls without detectable S-100 in serum after MHI. Our results demonstrate no overall cognitive dysfunction in either of the two groups. Our findings indicate specific dysfunction on measures of reaction time, attention and speed of information processing for the S-100 group. Posttraumatic depression does not explain the neuropsychological differences between the groups. These findings support that increased serum levels of protein S-100 may be of predictive and prognostic value for longlasting neurocognitive abnormalities after minor head injury. Presence of S-100 in serum may indicate the presence of diffuse brain damage. Our results suggest that information processing measures in computerized neuropsychological assessment are more sensitive for detecting small signs of neurocognitive abnormalities after MHI than conventional test batteries.

Adolescent↗
PubMed1997

Management of minor head injuries in hospitals in Norway.

Management protocols for minor head injury (MHI) should include strategies for early detection of intracranial hematomas and prevention of persistent sequelae. This study focuses on today's management of MHI in Norwegian hospitals. We report considerable inter-hospital variation in the management of MHI. In most hospitals (81%), MHI patients are treated by general surgeons. The management is focused on the risk of complications in the acute stage. Emergency room evaluation includes assessment according to the Glasgow Coma Scale in 27 (43%) hospitals and routine radiological examination in 18 (29%). Thirty-three (52%) hospitals discharge MHI patients without in-hospital observation. Most hospitals (83%) offer no follow-up. We conclude that the acute care as well as the follow-up of MHI patients can be improved in Norwegian hospitals. Neurosurgeons and neurologists should initiate this process.

Aftercare↗
PubMed1996

[Minor head injuries in sport. Occurrence, management, sequelae and prevention].

Approximately 10% of all head injuries are caused during sport and about 10% of all sport-related injuries are head injuries. Most of these are minor head injuries. Many sports involve risk of repeated head injury. The classic punch-drunk syndrome in boxers reflects severe chronic traumatic encephalopathy. Recent research shows that repeated head injury can entail encephalopathy also in other types of athletes. They may experience symptoms such as headache, dizziness, irritability, memory deficit and concentration deficit. Neuropsychological testing reveals such cognitive deficits as impaired memory and attention, and reduced speed of information processing. Persistent sequelae can be prevented by correct management in the acute stage, appropriate follow-up, and prevention of repeated head injuries.

Athletic Injuries↗
PubMed1996

Is transcranial Doppler sonography useful in detecting late cerebral ischaemia after aneurysmal subarachnoid haemorrhage?

Transcranial Doppler (TCD) examination was performed in 109 patients with aneurysmal subarachnoid haemorrhage. Fifty-seven demonstrated flow velocities exceeding 120 cm/s in the middle cerebral artery. Of these, 23 developed delayed ischaemic deficit (DID). Mean flow velocity in this group was 170, SD 12.8 cm/s, in comparison with 155, SD 11.2 cm/s in the 34 patients without late signs of cerebral ischaemia. This difference is significant (p = 0.0269). In the 34 patients without DID, but TCD > 120 cm/s, 17 received anti-ischaemic therapy based on TCD values only, while 17 were given no additional treatment. The mean TCD values and the neurological outcome in the two groups were similar. A rapid increase in flow velocities of 50 cm/s or more during a 24-h period seemed to be a strong predictor of symptomatic vasospasm as seven out of 12 patients developed DID, five with permanent neurological sequelae. The study confirms results from other centres, that a strict correlation between high TCD flow velocities and occurrence of DID does not exist.

Adult↗
PubMed1996

Elevated transcranial Doppler flow velocities after severe head injury: cerebral vasospasm or hyperemia?

Sixty-seven patients (45 males and 22 females) aged 2 to 70 years (mean 36 years) who had suffered closed head injury were investigated with daily transcranial Doppler (TCD) recordings. A total of 470 TCD recordings (mean 7) were made during Days 1 to 14 after admission. Blood flow velocities were determined in the middle cerebral artery (MCA) and the extracranial internal carotid artery (ICA). Twenty-seven (40%) of the 67 patients demonstrated traumatic subarachnoid hemorrhage (tSAH) on the first computerized tomography (CT) scan after the injury. Flow velocities exceeded 100 cm/second in 22 patients. Eleven (41%) of the 27 patients who showed tSAH on the first CT scan developed velocities greater than 100 cm/second, as compared to 11 (28%) of 40 patients without tSAH on CT. Two patients in whom a thick layer of tSAH was revealed on the first CT scan had MCA flow velocities exceeding 200 cm/second for several days. Measurements of cerebral blood flow (CBF) with single-photon emission CT (SPECT) were performed in six tSAH patients who showed TCD flow velocities exceeding 120 cm/second (uni- or bilaterally) to determine whether the increase in velocity reflected vasospasm or hyperemia. The SPECT studies verified ischemia in five patients but revealed general hyperemia in one. The bilateral increase in MCA flow velocities in the latter case was due to high-volume flow through the MCA secondary to elevated CBF rather than arterial narrowing. In one patient with a thick layer of subarachnoid blood on a CT scan obtained at admission, MCA flow velocities exceeded 220 cm/second bilaterally on Day 8 after the head injury. A SPECT measurement obtained on the same day reflected bilateral ischemia. In this patient flow velocities decreased, with a corresponding normalization of CBF, after 5 days of intravenous nimodipine administration. The MCA/ICA ratio correlated well with the distribution of CBF in the six patients studied using SPECT. This report suggests that vasospasm is an important secondary posttraumatic insult in patients suffering severe head injury and, in some cases, is probably treatable by administration of intravenous calcium channel blockers.

Adolescent↗
PubMed1996

Serial S-100 protein serum measurements related to early magnetic resonance imaging after minor head injury. Case report.

The authors studied 24 patients with a Glasgow Coma Scale score of 14 or 15 and normal computerized tomography scans after minor head injury. The study protocol included obtaining serial measurements of S-100 protein in serum during the first 12 hours after injury and early magnetic resonance (MR) imaging. Four patients (17%) had detectable levels of S-100 protein in serum. The S-100 protein levels were highest immediately after trauma, declining hour by hour. In two patients, MR imaging revealed intracranial contusion. Levels of S-100 protein were not detectable in serum in one patient with MR-verified cerebral contusion, but the first measurements were made late, 6 hours after trauma. The highest serum level of S-100 protein (0.9 microgram/L) was seen in a 73-year-old man 2 hours after injury. Magnetic resonance imaging revealed a contusion of the left cerebellar hemisphere, and the patient suffered permanent sequelae of impaired posture and dizziness.

Adolescent↗
PubMed1995

Transcranial Doppler ultrasound in hypertensive versus normotensive patients after aneurysmal subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: Arterial hypertension is a negative prognostic risk factor after aneurysmal subarachnoid hemorrhage (SAH). Transcranial Doppler ultrasound is commonly used for measuring blood flow velocities to predict cerebral ischemia due to vasospasm after SAH. Our purpose was to evaluate the influence of arterial hypertension on blood flow velocities in the cerebral circulation after aneurysmal SAH. METHODS: With transcranial Doppler ultrasound we compared the blood flow velocities in matched groups of hypertensive and normotensive patients with aneurysmal SAH. Twenty-four patients with arterial hypertension were examined daily during a 2-week period. As controls, 24 normotensive patients, also with SAH, were matched by age, sex, neurological status, and clinical outcome. RESULTS: Minimum, mean, and maximum flow velocities in the middle cerebral artery in the hypertensive patients were significantly lower than in the normotensive individuals, with P = .02 for minimum, P = .02 for mean, and P = .02 for maximum. There was no statistical significance for pulsatility index differences in these groups (P = .45). Diastolic notch was noted in two of the hypertensive and in six of the normotensive patients. CONCLUSIONS: The results indicate that even moderately increased flow velocities in hypertensive patients may represent significant vasospasm.

Adult↗
PubMed1994

Duration of symptoms as a predictor of outcome after lumbar disc surgery.

Retrospectively 93 consecutive patients operated on for lumbar disc herniation were studied in order to evaluate the prognostic value of symptoms (lumbar pain and sciatica) and sick-leave. Surgical results were evaluated 1-3 years postoperatively by a questionaire. The duration of the present attack of sciatica and sick-leave prior to surgery was significantly longer in the group with unsatisfactory outcome compared to the group with satisfactory outcome. Patients with duration of the present attack of sciatica of less than 6 months had a significantly better result concerning outcome compared to patients with duration of 6-12 months and more than 12 months. Patients who returned to the same type of work had a preoperatively statistically significant shorter duration of present sick-leave, compared to the patients who had changed the type of work and the patients who did not return to work. The patients with duration of their present sick-leave of less than 6 months had a significantly higher percentage of returning to the same type of work compared to patients with duration of their present sick-leave of 6-12 months and more than 12 months. We conclude that the duration of sciatica and sick-leave before the operation has value as predictive factors concerning the over-all result after surgery for lumbar disc herniation.

Adult↗
PubMed1994

Transcranial Doppler sonography, angiography and SPECT measurements in traumatic carotid artery dissection.

In two young patients with traumatic internal carotid artery dissection, early transcranial Doppler sonography (TCD) primarily indicated the lesion. A subsequent carotid angiogram confirmed the diagnosis. The course of the disease was followed by daily TCD recordings and repeated SPECT measurements. Beside CT and angiography, TCD and SPECT are helpful guidelines for different therapeutic approaches aiming to reduce cerebral ischaemia and infarction.

Adult↗
PubMed1994

Hypothalamic hamartoma causing precocious puberty treated by surgery: case report.

A 6-year-old girl was treated for precocious puberty secondary to a hypothalamic hamartoma by resection of the tumor. When she was six months old, her parents noticed incipient pubic hair and menses accompanied by breast development. Computed tomography was judged as normal. The girl was treated with monthly gonadotropin-releasing hormone analogue injections until 6 years of age, when magnetic resonance imaging (MRI) demonstrated a pedunculated isodense mass below the tuber cinereum. The hamartoma was totally removed using microsurgery. The symptoms and signs of precocious puberty disappeared after surgery. Follow-up MRI 1 year later showed no remaining tumor.

Child↗
PubMed1994

Symptomatic, expansive middle cranial fossa arachnoid cyst treated by a cysto-peritoneal shunt. Case report and evaluation of treatment options.

We report a symptomatic space-occupying arachnoid cyst in a 16-year-old boy. During the last two years, he was frequently absent from school because of headaches. Due to symptoms of nausea, fever and headache the patient was primarily referred to a surgical unit, where appendectomy was performed, revealing a normal appendix. Postoperatively, the patient complained of severe headache. Computed tomography (CT) of the head demonstrated a large left-sided middle cranial fossa arachnoid cyst. The patient was operated with insertion of a cysto-peritoneal shunt. A total regress of the clinical symptoms was seen at follow-up examination 3 months after shunting.

Adolescent↗
PubMed1994

Modified Robinson-Smith procedure for the treatment of cervical radiculopathy.

In the present study, a modified Robinson-Smith procedure was used surgery for cervical radiculopathy in 52 patients. Thirty-one one-level and 21 two-level operations were performed. All patients were followed up between 1 and 3 years (mean 23 months) after surgery with a clinical evaluation by an independent investigator including a radiological examination. In 26 patients the postoperative result was classified as excellent, in 23 the result was good, in 2 satisfactory, while one patient was unchanged compared to the preoperative examination. No patient developed worsening of symptoms after surgery. Of 18 patients with duration of symptoms of more than 4 years, 16 demonstrated markedly improvement. No permanent postoperative complications were seen. A modified Robinson-Smith procedure appears to be safe and reliable and can be recommended in surgery for cervical radiculopathy.

Adult↗
PubMed1994

Large peripheral cystic schwannomas. Two case reports and a review.

Two patients presented with benign cystic schwannomas, which originated from the brachial plexus and the sciatic nerve, respectively. The tumours were single, egg-shaped growths that were excised completely without damage to the nerve. Histopathological examination confirmed the diagnosis of encapsulated, cystic, benign schwannomas. Preoperative magnetic resonance imaging provided useful information and is recommended in the evaluation of peripheral nerve tumours.

Adult↗