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Biomedical subjects

B Romner

Publications and source records attributed to B Romner.

70 records · Page 4Linked to original sources
PubMed1993

Blood flow velocity in the middle cerebral artery and carotid artery stump pressure during carotid endarterectomy.

Twenty-one patients undergoing carotid endarterectomy were investigated by simultaneous intra-operative measurements of carotid stump pressure (CSP) and transcranial Doppler (TCD) flow velocity in the middle cerebral artery. The relationship between the two methods was evaluated as well as the potential benefits of the intraoperative transcranial Doppler monitoring technique. Clamping of the carotid artery resulted in a significant decrease in TCD flow velocity in the ipsilateral middle cerebral artery as well as in CSP. There was no correlation between relative change in CSP and the simultaneously obtained relative change in TCD flow velocity during carotid clamping (r = 0.31, p = 0.26). The insertion of an intra-operative shunt was followed by an increase in flow velocity compared to the clamping value. One patient with clear TCD signs of a re-occlusion (a sudden decrease in flow velocity) during closure of the wound, demonstrated a thrombosis at re-exploration. TCD gives information of the collateral cerebral circulation during carotid clamping and is an alternative monitoring technique during carotid endarterectomy. The method is useful intraoperatively for detecting embolic events as well as thrombosis during wound closure. Further studies are necessary to clarify the critical change in flow velocity during clamping when the use of a peroperative shunt is indicated.

Aged↗
PubMed1993

Left ventricular performance and cerebral haemodynamics during xenon anaesthesia. A transoesophageal echocardiography and transcranial Doppler sonography study.

The effects of xenon anaesthesia on myocardial function and cerebral blood flow velocities were investigated with transoesophageal echocardiography and transcranial Doppler sonography. Seventeen ASA 1 patients undergoing open cholecystectomy (n = 16) or abdominal hysterectomy (n = 1) were studied. Anaesthesia with 65% xenon in oxygen was induced by ventilating the lungs through a circle system with minimal fresh gas flow. The echocardiographically obtained mean (SD) fractional area change in a short axis view of the left ventricle at the level of the papillary muscles was 65 (10)% (n = 14) before xenon. There was no significant change after 5, 10 and 15 min of xenon anaesthesia. Cerebral blood flow velocities were unchanged during the first 5 min of xenon anaesthesia, but were significantly increased in the left and right middle, and the right anterior, cerebral arteries after 15 and 30 min (n = 16) (p < 0.05). In conclusion, xenon anaesthesia had no adverse effect on myocardial function, but probably increased cerebral flood flow.

Adult↗
PubMed1991

Simultaneous transcranial Doppler sonography and cerebral blood flow measurements of cerebrovascular CO2-reactivity in patients with aneurysmal subarachnoid haemorrhage.

Transcranial Doppler sonography (TCD) flow velocities and cerebral blood flow (CBF) measurements were evaluated in 14 patients who had suffered a major aneurysmal subarachnoid hemorrhage (SAH). Cerebrovascular reactivity to hypocapnia was evaluated simultaneously by the two methods. The measurements were performed under general anaesthesia preoperatively, within 72 hours after the bleed, during normocapnia and hypocapnia. There was poor correlation between absolute values of hemispheric CBF and corresponding TCD mean flow velocity. Controlled hyperventilation was associated with a significant decrease in CBF as well as TCD flow velocity (p less than 0.001). In terms of reactivity indices the correlation between the two methods was poor and not significant (r = 0.33, p = 0.09). The principal differences between the methods are discussed as well as the application of TCD in the evaluation of cerebrovascular reactivity.

Adult↗
PubMed1991

Does nimodipine eliminate arterial hypertension as a prognostic risk factor in subarachnoid haemorrhage?

Several studies have demonstrated an association between arterial hypertension (AH) and an increased morbidity and mortality from both cardiovascular diseases and stroke (including subarachnoid haemorrhage, SAH). Among the functional disturbances implicated in hypertension much interest has been focused on the calcium handling in the vascular smooth muscle cells, and it has been proposed that a defect in the calcium gating mechanisms in the cell membrane is of major importance. Clinical trials have confirmed that calcium antagonists of the dihydropyridine type (nimodipine) are useful in preventing secondary ischaemia after SAH. The purpose of this retrospective study was to determine if the protective effect of nimodipine differs between normotensive and hypertensive patients focused on delayed ischaemia, total morbidity and mortality. In the group (137 patients) without nimodipine treatment 17 out of 31 individuals (55%) with AH had an unfavourable outcome. In the nimodipine group (also 137 patients) four out of 25 individuals (16%) with AH had an unfavourable outcome. In terms of vasospasm and delayed ischaemia only, the difference was even more evident. These results indicate that nimodipine seems to significantly reduce the prognostic difference between normo- and hypertensive individuals with an aneurysmal SAH.

Adolescent↗
PubMed1990

Advances in the management of victims struck by ruptured intracranial aneurysms.

The advances in management of victims struck by the rupture of an intracranial aneurysm is reviewed. In the 1970s the management outcome was still far from acceptable; many victims who had 'recovered' following a major aneurysmal subarachnoid haemorrhage (SAH) succumbed or became crippled as the result of repeat bleeds and/or delayed SAH-induced ischaemic deterioration ('cerebral vasospasm'). The era of prosperity for microneurosurgery, the introduction of the calcium channel blocker nimodipine and the accumulation of cases in centres with a team of dedicated aneurysm surgeons form the basis of a recent breakthrough in the previously gloomy management outcome. With microsurgical techniques elective surgery can now be performed in the acute stage thereby preventing disastrous reruptures which occur frequently in the early phase after the first bleed. The concomitant use of nimodipine minimizes delayed SAH-induced ischaemic deterioration. Today a management regime including early operation combined with nimodipine has led to grossly improved results. Nevertheless cognitive disturbances and psychosocial maladjustment are frequent sequelae following a major aneurysmal bleed. Hope for further improvements could depend on the development of techniques which may allow identification of intracranial aneurysms before they rupture and increased knowledge of the aetiology of such cerebral arterial wall lesions.

Aged↗
PubMed1990

Correlation of transcranial Doppler sonography findings with timing of aneurysm surgery.

Thirty-six patients with a proven first subarachnoid hemorrhage (SAH) from a ruptured supratentorial aneurysm were subjected to repeated transcranial Doppler sonography assessments. Eighteen individuals (Group A) were operated on within 48 hours, while the other 18 (Group B) had surgery between 49 and 96 hours after SAH. The patients represented two clinically comparable groups. In the first 72 hours post-SAH, no increased flow velocities suggestive of arterial narrowing or vasospasm were recorded. There was no significant difference in preoperative flow velocities between the groups. Postoperative flow velocities were significantly lower in patients operated on within 48 hours (p less than 0.001). Two patients, who had surgery on Day 4 post-SAH and who showed the highest recorded postoperative flow velocities, died from cerebral vasospasm and infarction. The results favor a referral system which enables early surgical intervention not only to prevent rebleeds but also aimed at reducing delayed ischemic dysfunction.

Adult↗
PubMed1989

Late magnetic resonance imaging related to neurobehavioral functioning after aneurysmal subarachnoid hemorrhage.

Twenty patients who underwent early aneurysm surgery--that is, surgery within 72 hours after rupture--underwent further follow-up examination including magnetic resonance imaging (MRI) of the brain and a comprehensive neuropsychological assessment. Significant statistical correlation between tissue loss as seen on a late MRI scan and neurobehavioral deficits could not be established. Among 9 patients with no tissue loss seen on MRI, 3 exhibited substantial cognitive dysfunction and 6 had mild impairment. Three patients showed minor but corresponding tissue loss and deficits. In 3 patients with pronounced pathological indications on MRI, evidence of cognitive dysfunction was absent in 2, and 1 patient showed substantial impairment. The remaining 5 individuals displayed moderate pathological indications on MRI, with no obvious correspondence to cognitive functioning. In 7 patients, small white matter lesions, probably silent infarcts not seen on computed tomographic scan, were discovered on MRI. There was a clear relationship between arterial hypertension prior to aneurysm rupture and the extent of tissue loss seen on MRI. Absence of pathological findings on MRI scan did not exclude cognitive malfunctioning, and vice-versa.

Adult↗
PubMed1989

Magnetic resonance imaging and aneurysm clips. Magnetic properties and image artifacts.

The magnetic properties of 12 different types of aneurysm clip were investigated in order to identify which clips allow postoperative magnetic resonance (MR) imaging without risk. Clip-induced MR artifacts were also quantitatively studied using a geometrical phantom. Nonferromagnetic aneurysm clips like the Yaşargil Phynox, Sugita Elgiloy, and Vari-Angle McFadden clips do not appear to contraindicate MR studies performed with a FONAR beta-3000M imager. There is no clip movement upon introduction of the phantom into the MR imager, and the image artifacts caused by the clips are so limited that patients harboring such clips may well be considered for MR imaging. This examination may reveal information not obtainable by any other radiological modality.

Aneurysm↗
PubMed1989

Transcranial Doppler sonography within 12 hours after subarachnoid hemorrhage.

Twenty-one patients were subjected to repeated assessment of cerebral blood flow velocities by means of transcranial Doppler sonography (TCDS) during the first 12 hours after subarachnoid hemorrhage (SAH). In 19 patients the study was performed following the first SAH, and in two after early rebleeds. Flow velocities did not indicate an early phase of arterial narrowing in any case. Following the first TCDS assessment, flows were evaluated repeatedly in the 19 survivors. Increased flow velocities suggesting arterial narrowing or vasospasm occurred only after a delay of at least 4 days. The results of this study favor the restoration of normal velocity patterns in surviving patients and do not indicate that an acute phase of vasospasm exists either immediately after or in the first 12 hours after SAH.

Blood Flow Velocity↗
PubMed1988

Aneurysmal subarachnoid haemorrhage: overall outcome and incidence of early recurrent haemorrhage despite a policy of acute stage operation.

A series of 480 patients who were alive upon admission following an aneurysmal subarachnoid haemorrhage (SAH) is reported. These patients represented 40% of the total Swedish incidence during a 3-year period. The three neurosurgical referral centres covering this population had a similar policy of early diagnosis and acute state surgery in all patients considered of having a potential to survive without permanent disabling cerebral malfunction. At 2-year follow up 45% showed a good neurological recovery, the morbidity was 25% and the mortality was 30%. Some more lives might have been saved with an improved ultra-early referral system since there were 21 initially good-to-fair risk patients (4% of the total SAH population) who rebled fatally before surgery and within 48 h. For comparison, in the Kingdom of Denmark, with a general policy of delayed operation, out of 1076 patients who were alive upon admission, 27.5% made a good recovery, while the morbidity was 27%, and the mortality was 45.5%.

Humans↗
PubMed1988

Comparison of MR imaging and CT in patients with intracranial aneurysm clips.

CT and MR imaging of the brain were performed without complications in 16 patients who had undergone surgery for a ruptured aneurysm with the use of nonferromagnetic Yasargil 316 or Sugita Elgiloy clips. MR was performed on a 0.3-T Fonar beta-3000M imaging system. The artifacts caused by the clips were smaller on MR than on CT, and, therefore, anatomic structures such as the brainstem and temporal lobes were better visualized on MR. Brain-tissue lesions corresponding to the frontotemporal surgical approach were seen with MR in seven patients and with CT in six. In three patients temporal-lobe lesions seen on MR were not seen on CT because of beam-hardening artifacts. Lesions unrelated to the region of surgery were seen with MR in nine patients and with CT in five. In conclusion, MR was safe and superior to CT both in demonstrating anatomic details and in detecting tissue lesions in patients with aneurysm clips.

Alloys↗
PubMed1987

Prediction and prevention of delayed ischemic dysfunction after aneurysmal subarachnoid hemorrhage and early operation.

Mean hemispheric cerebral blood flow (CBF) was studied after the intravenous administration of xenon-133 in 20 anesthetized patients with aneurysmal subarachnoid hemorrhage. Before early aneurysm operation, repeated CBF measurements were made to evaluate the cerebral vascular reactivity to controlled hyperventilation. Thirteen individuals received intravenous treatment with the calcium channel blocker nimodipine, whereas the other seven patients did not receive such specific antiischemic treatment. Five of the latter patients had an impaired CO2 response, and three showed delayed ischemic deterioration (DID), whereas none of the seven nimodipine-treated patients with impaired CO2 response showed DID. One nimodipine-treated patient with a preserved CO2 response, in whom operation was complicated, developed DID. The observed findings indicate that DID after uncomplicated early aneurysm operation may be associated with an early disturbance of cerebral vasoreactivity. Treatment with nimodipine may counteract the development of DID in patients with an impaired CBF CO2 response.

Adult↗
PubMed1987

Management of ruptured intracranial aneurysm: a review.

The discouraging history associated with management of aneurysmal subarachnoid haemorrhage (SAH) is reviewed along with improvements in outlook attributable to progress made within the past decade. Among the new developments is the introduction of microsurgical techniques that allow elective surgery in the acute stage thereby preventing repeat haemorrhages. Early operation also offers the possibility of a more aggressive pharmacological anti-ischaemic treatment. Notwithstanding the improved results of acute elective surgery and the fact that delayed ischaemic deterioration (symptomatic cerebral vasospasm) now may be almost eliminated, the overall outcome remains gloomy. Despite recent advances not more than one out of three individuals, who are struck by the rupture of an intracranial aneurysm, may be expected to make a good neurological and functional recovery. Hope for further improvements may depend on the development of techniques that can identify intracranial aneurysms before they rupture and increased knowledge of the aetiology of such arterial wall lesions.

History, 18th Century↗
PubMedDate not supplied

Routine early CT-scan is cost saving after minor head injury.

Significant hospital resources are invested in early detection of intracranial complications after minor head injuries (MHI). This study focuses on economic aspects of MHI management. 88 MHI patients underwent routine early CT-scan and at least 24 h in-hospital observation. The cost of this management was calculated, and compared to estimated costs of three alternative management protocols. CT-scans demonstrated intracranial lesions in eight (9%) patients, but none required neurosurgical intervention. The expense of our management was Norwegian Kroner (NOK) 576,136. An alternative management protocol including routing early CT-scan and discharge of patients with normal CT-findings, Glasgow coma score > or = 14 and no neurological deficits, was found to be safe, and estimated to reduce costs with 43% to NOK 326,669. It is concluded that routine early CT-scan is the most reliable and cost saving management procedure after MHI.

Adolescent↗