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Bertil Romner

Publications and source records attributed to Bertil Romner.

27 records · Page 2Linked to original sources
PubMed2003

Mild head injuries: impact of a national strategy for implementation of management guidelines.

BACKGROUND: A national survey in 1996 showed insufficient routines for management of patients with mild head injuries in Norwegian hospitals. Since then, the Scandinavian Guidelines for Management of Mild Head Injuries have been published. METHODS: A cross-sectional questionnaire survey of management practice was performed in all 59 hospitals in 2002. We compared the results with figures from 1996 and evaluated guideline compliance. RESULTS: The proportion of noncompliant hospitals was reduced (p = 0.02) from 52% to 31%. The proportion assessing the patient's level of consciousness according to the Glasgow Coma Scale increased (p = 0.001) from 49% to 80%. The proportion requiring a normal computed tomographic scan if a patient with a history of loss of consciousness was to be sent home from the accident and emergency department increased (p < 0.001) from 1 (2%) to 13 (19%). CONCLUSION: The Scandinavian Guidelines for Management of Mild Head Injuries have had a significant impact on management practice in Norwegian hospitals.

Algorithms↗
PubMed2003

Neurosurgery at the University Hospital of North Norway: the history of the northernmost neurosurgical department in the world.

The university hospital of North Norway hosts the northernmost neurosurgical department in the world. The hospital is located in the city of Tromsø, often dubbed "the Gateway to the Arctic." We describe the role of this city in polar exploration, the history preceding the establishment of the world's northernmost university, the history of neurosurgery at this institution, and the present state of the Department of Neurosurgery. The experience from Tromsø shows that it is possible to establish a complete neurosurgical service at remote locations. Training of physicians native to the region, close integration between clinical activities and research, and a wide definition of the specialty has been essential for the success of the department.

History, 19th Century↗
PubMed2003

Clinical experience with the use of a shunt with an adjustable valve in children with hydrocephalus.

OBJECT: The goal of this study was to assess the value of making adjustments in the opening pressure of a shunt valve and to determine shunt survival in children and young adults in whom an adjustable valve was used to manage cerebrospinal fluid drainage. METHODS: The authors conducted a single-center retrospective study of 158 children and young adults who had received 199 Codman Hakim programmable valves (noninvasively adjustable to settings in the range of 30-200 mm H2O). The mean age at which the patients underwent shunt implantation was 4.4 years (median 0.4 years, maximum 18 years); 94 patients were younger than 2 years of age, including 14 patients with a gestational age younger than 38 weeks at the time of implantation. In 84 (53.2%) of the 158 patients, valve pressure adjustment was required at least once (mean 1.3 times, maximum 16 times). Among the 202 adjustments made in patients the reason for adjustment was underdrainage in 74 adjustments (36.6%) and overdrainage in 119 (58.9%). The clinical status of the patient improved after 121 (69.1%) of 175 adjustments and after 58 (73.4%) of 79 minor adjustments (less than or equal to +/- 20 mm H2O). The shunt infection rate was 13 (10.9%) of 119 patients. Shunt survival was 60.5% at 1 year, 47.1% at 2 years, and 43.9% at 3 years of follow-up review. CONCLUSIONS: Adjustment of the valve's opening pressure further improves outcome in pediatric patients.

Adolescent↗
PubMed2003

Biochemical serum markers for brain damage: a short review with emphasis on clinical utility in mild head injury.

PURPOSE: To provide an overview of clinical research on the use of biochemical serum markers for traumatic brain injury (TBI) in the evaluation of patients with mild head injuries (MHI). METHODS: The MEDLINE database was searched for publications on biochemical serum markers of TBI until August 2002. Clinical studies addressing their use in MHI were reviewed. RESULTS: Desirable characteristics for biochemical serum markers of TBI were identified. Creatine kinase isoenzyme BB (CK-BB), neuron specific enolase (NSE) and S-100B protein have been most extensively studied. The sensitivity and specificity of CK-BB is inadequate for use as an indicator of traumatic brain injury. Serum levels of NSE do not correspond to the amount of TBI, probably because of its long (20 h) half-life. S-100B serum levels are correlated to both clinical measures of injury severity, neuroradiological findings and outcomes in several studies from different authors. CONCLUSION: Currently, S-100B protein is the most promising marker for evaluation of TBI in patients with MHI.

Biomarkers↗
PubMed2002

Adjustable valves in normal-pressure hydrocephalus: a retrospective study of 218 patients.

OBJECTIVE: We sought to assess the value of adjusting shunt valve opening pressure, complications, and outcomes with the use of an adjustable shunt valve in the treatment of patients with normal-pressure hydrocephalus (NPH). METHODS: In a single-center retrospective study, 231 adjustable valves (range, 30-200 mm H(2)O) were the first shunt implantations in 147 patients with idiopathic NPH (INPH) and 71 patients with secondary NPH (SNPH). The effect of adjustment on gait disturbance, cognitive impairment, urinary incontinence and other symptoms were evaluated, and an improvement index was created. RESULTS: In the INPH group, 138 adjustments were performed in 49.0% of the patients (average, 0.94 adjustments/patient). For the SNPH group, 49 adjustments were performed in 32.4% of the patients (average, 0.69 adjustments/patient). The reasons for adjustment were overdrainage in 48 patients (25.7%), underdrainage in 98 patients (52.4%), subdural hematoma in 37 patients (19.8%), and other reasons in 2 patients (2.1%). Clinical status improved after 56 (49.1%) of all 114 adjustments, whereas 23 (42.6%) of 54 minor (< or =20 mm H2O) and 33 (66.0%) of 50 larger adjustments improved the patient's clinical status. The correlation of the improvement index with the size of the individual adjustments was not significant. Complications occurred in 43 (19.7%) of 218 patients, valve malfunction occurred in 3 patients (1.3%), infection occurred in 14 patients (6.4%), and nontraumatic subdural effusion occurred in 15 patients (6.9%; 8 were treated by adjustment alone). The 5-year shunt survival rate was 80.2%. Outcomes were excellent or good in 71 (78.9%) of 90 patients with INPH and in 30 (69.8%) of 43 patients with SNPH. CONCLUSION: Noninvasive, particularly consecutive, minor or single larger adjustments to the valve opening pressure can further improve outcome in patients with NPH who undergo shunting.

Adolescent↗