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Biomedical subjects

G Sundbärg

Publications and source records attributed to G Sundbärg.

29 records · Page 2Linked to original sources
PubMed1981

Results of early operations for ruptured aneurysms.

In a consecutive series of 219 patients with a ruptured aneurysm of the anterior part of the circle of Willis, 119 patients (54%) made a good recovery and 67 (31%) died. Of 53 patients who did not have surgery, six (11%) made a good recovery and 37 (70%) died. Urgent surgery with evacuation of an associated significant intracerebral hematoma was performed in 30 patients; nine (30%) made a good recovery and 15 (50%) died. Delayed surgery was performed in 55 patients of whom 42 (76%) made a good recovery and two (4%) died. Early intracranial operation (within 48 to 60 hours after subarachnoid hemorrhage (SAH)) was performed in 81 patients who were in Grades I to III prior to surgery. Sixty patients (74%) made a good recovery, and eight died within a month. Five patients were severely disabled and died 2 to 8 months after SAH and surgery. In 17 patients, although the immediate postoperative course was uneventful, evidence of cerebral ischemia developed 4 to 13 days after the bleed and resulted in death in eight patients. A poor outcome was correlated with a history of elevated blood pressure before SAH. Seven patients, of whom six were women of child-bearing age, demonstrated pronounced vasospasm on postoperative angiography; nevertheless, they remained well and free from ischemic symptoms after surgery. Early operation combined with removal of subarachnoid clots and rinsing the basal cisterns does not eliminate the risk of delayed ischemic dysfunction. Such early surgery, however, improves overall outcome by preventing recurrent bleeding, and may also reduce the frequency of hydrocephalus.

Adolescent↗
PubMed1980

Improvements in the radiotherapy of medulloblastoma, 1946-1975.

The prognosis in medulloblastoma has often been reported to be gloomy, and five-year survival rates of approximately 25% are often reported. In recent years, however, some centers have published results that indicate a possible cure rate of 60% or even more. During the years 1946-1975, 50 children received radiotherapy for medulloblastoma at the University Hospital, Lund, Sweden. During this period the target volume had been defined in three different ways, whereas the target-absorbed dose had not differed. When only the demonstrated tumor was treated, the ten-year survival rate was 5%. If the spinal subdural space also was included, it rose to 25%, and when the whole subdural space was treated in addition to the demonstrated tumor, the projected ten-year survival rate was 53%. It is apparent that the target volume in the radiotherapy of medulloblastoma should include not only the demonstrated tumor but also the whole subdural space from the tip of the frontal lobes down to and including the second sacral segment. The size of the target-absorbed dose to be aimed at is not settled, but should consider not only the cure rate but also the performance status of the survivors. It seems from the present series that an absorbed dose of 45 Gy in not more than 30 fractions over six weeks to the demonstrated tumor and 30 Gy in 20 fractions over four weeks to the subdural space resulted in a fair frequency of tumor healing and minimal side effects. The delivery of this complicated treatment demands a high degree of precision in the technique. In this material the performance status of the children was not affected by the radiation treatment.

Adolescent↗
PubMed1977

Pattern of radioactivity in the CSF after intravenous injection of 99mTc.

It has been shown that intravenously injected pertechnetate enters to CSF space and also that a transport of pertechnetate ions to the blood occurs when injected into the ventricles. Activity curves obtained by repeated samplings of CSF after intravenous injection of pertechnetate appears to differ at different levels of the intraventricular pressure but also in patients with different types of intracranial pathology, i.e. in patients with ventricular dilatation due to hydrocephalus and due to cerebral atrophy.

Brain Diseases↗
PubMedDate not supplied

Severe traumatic brain lesions in Sweden. Part I: Aspects of management in non-neurosurgical clinics.

This paper reports a study of 587 consecutive patients treated for severe traumatic brain lesions (coma greater than 6 hours) during 1977-1984. Epidemiology, management and outcome were documented in 425 patients during the first part of the study (1977-1982) as a basis for future efforts at improvements. A total of 70-80 patients with severe head injuries were admitted annually to the Department of Neurosurgery in Lund and 88.6% of these patients were referred from 14 local hospitals, most of which are situated more than 50 km from Lund. Half of the patients were older than 40 years and 25% older than 60. Focal intracranial mass lesions were diagnosed in 64% of the patients. In the total study 41% of the patients were described as 'talk and deteriorate' and 13% as 'talk and die'. In 1983 a protocol for primary management was introduced in all local hospitals in the region. The management protocol caused a significant decrease (p less than or equal to 0.05) in the number of explorative craniotomies in local hospitals and a virtual disappearance of late surgical procedures (greater than 6 hours after injury). A fall was observed in the number of patients arriving at the Department of Neurosurgery with respiratory insufficiency. The study illustrates the epidemiology of severe head injuries in Sweden and the present state of management of these patients in non-neurosurgical departments. It is concluded that an overall outcome comparable to other reported series is also feasible in regions with a relatively sparse population and large geographical distances provided that strict recommendations for initial management are given to the local hospitals.

Adult↗
PubMedDate not supplied

Severe traumatic brain lesions in Sweden. Part 2: Impact of aggressive neurosurgical intensive care.

During a 6 year period (1977-1982), 425 patients were treated in the Department of Neurosurgery, University Hospital of Lund, for severe traumatic brain lesions (coma greater than 6 hours). From 1983 a more aggressive management protocol was introduced including early recording of intracranial pressure (ICP) and 162 patients were included in the study 1983-1984. A dangerous increase in ICP in spite of adequate surgical treatment and moderately controlled hyperventilation was the incentive for barbiturate coma therapy in selected patients. In the first part of the study overall mortality was 48% whereas 39% of the patients reached good recovery/moderate disability 6 months after injury. During the second part of the study the corresponding figures were 35% and 54%, respectively (in both cases p less than or equal to 0.01). In the group of patients with focal intracranial mass lesions mortality decreased from 59% to 46% (p less than or equal to 0.05) and good recovery/moderate disability increased from 30% to 42% (p less than or equal to 0.05). Improvement in outcome was even more pronounced in patients with no-mass lesions, mortality decreased from 30% to 12% and good recovery/moderate disability increased from 56% to 80% (p less than or equal to 0.05 and p less than or equal to 0.01, respectively). No change occurred in age distribution or in the types of intracranial lesions that could explain these improvements. It is concluded that aggressive neurosurgical intensive care significantly improves outcome in patients with severe traumatic brain lesions.

Accidents, Traffic↗
PubMedDate not supplied

Severe traumatic brain lesions in Sweden. Part 3: Economic aspects of aggressive neurosurgical intensive care.

The present study had two main objectives: Firstly, to document the economic differences between 'ordinary' and 'aggressive' neurosurgical intensive care and secondly, to evaluate the medical benefits in relation to costs for different subgroups of head-injured patients. The study compares patients injured in traffic accidents and treated in the Department of Neurosurgery, University Hospital of Lund, during 1977-1978 (n = 67) with similar patients treated during 1983-1984 (n = 87) after introduction of more vigorous neurosurgical intensive care. The economic analysis was performed by means of the CRISE-method (Cost Related Index Score Evaluation) and all costs were related to the monetary value in 1984. Adoption of a program for 'aggressive' neurosurgical intensive care increased the costs per treated patient by about 46% (from 70.887 Swedish Crowns (SEK) to 103.452 SEK). Mortality decreased significantly after the change in intensive care and the cost per surviving patient remained virtually unaffected (131.928 SEK vs. 132.357 SEK). Further, after introduction of the 'aggressive' programme a larger proportion of the economic expenditures were spent on patients who ultimately recovered well. It is concluded that the increase in costs following introduction of a more vigorous intensive care programme in patients with severe traumatic brain lesions is very reasonable in relation to the documented medical benefits.

Accidents, Traffic↗