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Biomedical subjects

C Wikkelsö

Publications and source records attributed to C Wikkelsö.

48 records · Page 3Linked to original sources
PubMed1989

Computed tomography of the brain in the diagnosis of and prognosis in normal pressure hydrocephalus.

Thirty-eight patients with normal pressure hydrocephalus were examined by CT before and after a ventriculo-peritoneal shunt operation. Evans ratio, periventricular hypodensity and width of hemispheric sulci, sylvian fissures, cella media, temporal horns and third and fourth ventricle were examined. Twenty-eight patients improved after the operation while 10 were unchanged (non responders). Those patients who improved had more often enlarged third ventricle, enlarged temporal horns and normal sylvian fissures than those who did not improve. No single CT parameter or combination of CT parameters alone could identify responders and non-responders. The ventriculo-peritoneal shunt operation reduced ventricular size (Evans ratio, cella media width), abolished periventricular hypodensity and reduced width of the temporal horns and third ventricle in both responders and non-responders. Reduction of the width of the third ventricle correlated to clinical improvement.

Aged↗
PubMed1989

Liquid chromatographic separation of cerebrospinal fluid amino acids after precolumn fluorescence derivatization.

Sampling and HPLC analysis procedures for CSF amino acid determination were evaluated. It is recommended to analyse native CSF. The sample should be taken from the first 12 ml obtained by lumbar puncture. Amino acid concentrations are stable for short periods over a wide range of temperature however, storage at -70 degrees to -80 degrees C is recommended. With the precolumn derivatization and a 30 cm reverse-phase column, the separation and reproducibility are reliable for analyses in the daily hospital routine.

Adult↗
PubMed1988

A double-blind cross-over 12-month study of L-thyroxine treatment of women with 'subclinical' hypothyroidism.

Twenty women, who had been randomly selected from women with subclinical hypothyroidism identified in a population study were treated with L-thyroxine and placebo in a double-blind cross-over design during 2 x 6 months. Three women did not complete the study, one because she moved to another part of the country, and two because of nervousness and sense of tachycardia. None of these 'drop-outs' had any objective signs of overtreatment; they had normal pulse rate and a serum T3 concentration within the reference interval. During L-thyroxine treatment serum procollagen-III-peptide concentration increased in 13 women out of the 17 women completing the study and at the end of treatment the mean concentration was significantly raised (P less than 0.001). Serum concentrations of procollagen-III-peptide then correlated with those of free thyroxine (P less than 0.01), total thyroxine (P less than 0.05), and reverse triiodothyronine (P less than 0.05). The same comparison revealed little or no effect on the concentrations of serum creatine kinase activity, transcortin or sex-hormone binding globulin. Heart rate-corrected preejection period and symptom score decreased (P less than 0.05). Four women starting with L-thyroxine showed a marked and prolonged (4-6 months) rise in thyrotrophin concentration during the subsequent placebo period, but remained clinically euthyroid. Four women (of 17) improved during therapy as judged by psychometric testing and their own rating. We could not by pretreatment observations identify these four women apart from serum free and total 3,5,3'-triiodothyronine concentrations in the lower part of the health-associated reference interval. Subclinical hypothyroidism is common among middle-aged and old women, and our findings indicate that approximately one woman in four with this 'subclinical' condition will benefit from L-thyroxine treatment.

Aged↗
PubMed1988

Outcome of shunt operation on urinary incontinence in normal pressure hydrocephalus predicted by lumbar puncture.

Bladder function in four patients with normal pressure hydrocephalus, one with dementia of Alzheimer type and five patients with multi-infarct dementia was studied by history and urodynamic tests (cystometry and Bor's ice water test). The bladder hyperactivity could be temporarily improved by a lumbar puncture and removal of 50 ml CSF and later abolished by a shunt operation in patients with normal pressure hydrocephalus while no changes occurred in the other patients. Urodynamic testing in connection with a lumbar puncture may be a reliable way to predict the outcome of a shunt operation in cases of normal pressure hydrocephalus.

Aged↗
PubMed1987

Sarcoidosis with hydrocephalus: report of a case successfully treated with a ventriculo-peritoneal shunt and methylprednisolone pulse therapy.

We describe a female patient with systemic sarcoidosis and hydrocephalus. She was initially satisfyingly treated with peroral steroids. When she later deteriorated, the treatment had to be changed due to side-effects. High dose intravenous methylprednisolone pulse therapy was tried with some, but insufficient, improvement. Therefore, a ventriculoperitoneal shunt operation was performed with immediate improvement. After that she was treated with intravenous methylprednisolone and her condition has remained proper and stable for 5 years. The possibility that pulse therapy might have contributed to the favourable course in our patient is discussed.

Brain Diseases↗
PubMed1986

Normal pressure hydrocephalus. Predictive value of the cerebrospinal fluid tap-test.

Twenty-seven patients with normal pressure hydrocephalus were operated upon by a ventriculo-peritoneal shunt. Selection for shunt surgery was based on typical symptoms (gait disturbancy, mental deterioration and urgency incontinence) and characteristic changes at cranial computed tomography and/or radionuclide cisternography. Prior to operation a cerebrospinal fluid tap-test (CSF-TT) was performed with measurements of psychometric functions and gait pattern before and after a lumbar puncture of 50 cc CSF. Nineteen patients improved and 5 were unchanged after shunt operation. Three patients could not be evaluated. Improvement in the psychometric functions and gait pattern after lumbar puncture correlated to improvement after the shunt operation (r = 0.64, p less than 0.01: r = 0.96, p less than 0.001, respectively). Improvement in 2 or more of the 4 tests used (3 psychometric and 1 gait test) at CSF-TT implied in all cases successful result of the shunt operation. It was concluded that CSF-TT could predict which NPH patient will improve by a shunt operation, and albeit to envisage the degree of improvement.

Adult↗
PubMed1985

Dementia--and adenylate kinase activity in cerebrospinal fluid.

Adenylate kinase (AK) was determined in a lumbo-cisternal cerebrospinal fluid (CSF) gradient and in CSF from patients with mental deterioration. AK activity was unchanged in the gradient and different from albumin and albumin ratio (alb CSF/albumin serum), a blood-brain barrier marker in the same gradient. No differences between normal pressure hydrocephalus, multiinfarct dementia and dementia of the Alzheimer type could be found with regard to adenylate kinase activity in CSF.

Adenylyl Cyclases↗
PubMed1984

Isoelectric focusing followed by silver staining. A suitable method for routine investigation of cerebrospinal fluid proteins.

Cerebrospinal fluid (CSF) and serum samples from 361 consecutive patients were investigated. The protein pattern of each sample was examined by isoelectric focusing (IEF) of unconcentrated CSF followed by silver staining and by agar gel electrophoresis of concentrated CSF stained with amido black. 347 paired samples were compared. The results were the same in 83% of the samples. Discordant results were found in 10% of the samples. and in 7% additional information was achieved by one of the methods. IEF was superior to agar gel electrophoresis for the identification of oligoclonal immune reactions of the central nervous system. Tau globulin increase was seen in a few CSF samples, more often with IEF and then associated with other changes of the pattern. IEF of unconcentrated CSF followed by silver staining only requires 20 microliters CSF, while 3-4 ml CSF is needed for the agar gel electrophoretic method. It was concluded that IEF has several advantages compared to agar gel electrophoresis and is suitable as a routine method in clinical laboratories.

Adolescent↗
PubMed1984

Hypotension induced by prostacyclin treatment during cardiopulmonary bypass does not increase the risk of cerebral complications.

High-dose prostacyclin treatment during cardiopulmonary bypass reduces platelet activation and possibly postoperative blood loss. A side-effect is arterial hypotension. We studied the incidence of cerebral complications in 79 patients requiring coronary bypass. Only patients without known cerebrovascular disease were studied. Thirty-nine patients received prostacyclin 50 ng/kg/min during cardiopulmonary bypass and 40 patients served as controls. Mean arterial blood pressure in the group given prostacyclin was below 30 mm Hg during the first 30 minutes of bypass but remained above 60 mm Hg in the control group. Postoperative neurological examination revealed transient cerebral dysfunction in six control patients and two prostacyclin-treated patients. Investigation of cerebrospinal fluid showed signs of blood-brain barrier damage in 12 control and seven prostacyclin-treated patients. Cytologic changes in cerebrospinal fluid consistent with brain tissue damage occurred in two control patients but in no patient given prostacyclin. Myelin basic protein and adenylate kinase in cerebrospinal fluid were assayed as being markers of brain damage. Myelin basic protein was within the normal range in all patients. Adenylate kinase was moderately increased (greater than 0.035 U/L) in five of 15 control patients and six of 13 prostacyclin-treated patients. We conclude that treatment with prostacyclin 50 ng/kg/min during cardiopulmonary bypass does not increase the risk of postoperative cerebral damage.

Adenylate Kinase↗
PubMedDate not supplied

Frontotemporal dementia can be distinguished from Alzheimer's disease and subcortical white matter dementia by an anterior-to-posterior rCBF-SPET ratio.

Sixteen patients with frontotemporal dementia (FTD), 27 with early-onset Alzheimer's disease, 25 with late-onset Alzheimer's disease, 19 with subcortical white matter dementia (SWD) and 28 normal controls underwent semiquantitative regional cerebral blood flow measurement (rCBF) using single-photon emission tomography (SPET; (99m)Tc-HMPAO) and either computerized tomography (CT) or magnetic resonance imaging (MRI) of the brain. An anterior-to-posterior rCBF-SPET ratio (mesial superior frontal gyrus/medial temporal lobes) was calculated, which significantly separated the FTD group from the other dementia groups and controls with a sensitivity of 87.5% and a specificity of at least 78.6%. CT/MRI was found to be helpful in the differential diagnosis between FTD and SWD. In FTD patients, the mesial superior frontal gyrus, near the polus frontalis, was found to be the region with the most reduced rCBF values.

Aged↗
PubMedDate not supplied

Intracerebroventricular administration of GM1 ganglioside to presenile Alzheimer patients.

We have conducted a preliminary study of the optimum conditions for a therapeutic effect of ganglioside GM1 in Alzheimer's disease. Five patients with the early onset form of Alzheimer's disease (AD type I) received the ganglioside by intracerebroventricular administration for 12 months. Bilateral stereotactic punction of the frontal horns of the ventricular system was performed, and shunt catheters were implanted and connected to a programmable pump. The optimum GM1 dose varied between 20 and 30 mg/24 h. Neurological neuropsychological, psychiatric and neurochemical examinations were performed 7 days before surgery and on days 30, 90, 180 and 360. No patient found the surgery difficult and no patient or relative regretted that they participated in the study. The patients became more active and safer in relation to others and to performance of various activities from day 90. The cerebrospinal fluid level of the monoamine metabolites homovanillic acid and 5-hydroxyindoleacetic acid and the neuropeptide somatostatin increased.

Aged↗