Biomedical subjects

G Toolanen

Publications and source records attributed to G Toolanen.

At least 19 recordsLinked to original sources

PubMed2001

Prospective study of trigeminal sensibility after whiplash trauma.

Trigeminal sensory impairment is frequent in whiplash cases. The pathophysiology is unknown. The purpose of the present investigation was to prospectively study the trigeminal sensibility for temperature and vibration and to evaluate their relationship with the clinical symptoms. Thirty-four of 43 patients with whiplash injury were investigated through quantitative sensory tests with a mean of 6 weeks and 71 months after injury. Sensory disturbances over the trigeminal skin area persisted over the years ( r = 0.764. p < 0.000). At follow-up, a significant correlation ( r = 0.614, p < 0.000) was found between the sensory disturbances and the symptoms related to the central nervous system, whereas no significant relationship was found with the musculoskeletal symptoms. Trigeminal sensory impairment can either be explained by dysfunction in the central nervous system or by inhibitory mechanisms secondary to pain.

Adult↗

PubMed1998

High-dose methylprednisolone prevents extensive sick leave after whiplash injury. A prospective, randomized, double-blind study.

STUDY DESIGN: A prospective, randomized, double-blind study comparing high-dose methylprednisolone with placebo. OBJECTIVES: To evaluate the efficacy of high-dose methylprednisolone when administered within 8 hours after whiplash injury. SUMMARY OF BACKGROUND DATA: Whiplash injury often results in chronic symptoms. The management of whiplash injuries is controversial, and pharmacologic therapy has received little evaluation. In recent reports, dysfunction of the central nervous system has been indicated in several cases. Methylprednisolone administered within 8 hours after the injury to patients with acute spinal cord injury has been demonstrated to improve the outcome. This procedure was also adopted in a randomized study of cases of whiplash injury in car accidents. METHODS: Forty patients, 22 men and 18 women with a mean age of 35 years (range, 19-65), were included in the study, 20 in each of two groups. They were treated for whiplash injury, which they had sustained in car accidents. The patients were enrolled if their diagnoses were complete and treatment had begun within 8 hours after injury. Disabling symptoms severe enough to prevent the patient from returning to work, number of sick days before and after injury, and sick-leave profile after injury were used as parameters for the evaluation of the effects of the treatment. Baseline demographic data were controlled for when statistical analysis had been performed. RESULTS: At the follow-up examination 6 months after initial treatment, there was a significant difference in disabling symptoms between the actively treated patients and the placebo group (P = 0.047), total number of sick days (P = 0.01), and sick-leave profile (P = 0.003). CONCLUSIONS: The results of this study indicate that acute treatment with high-dose methylprednisolone may be beneficial in preventing extensive sick leave after whiplash injury. However, the number of patients studied was small, and therefore further prospective, controlled studies are needed.

Accidents, Traffic↗

PubMed1998

Oculomotor dysfunction in rheumatoid patients with upper cervical dislocation.

Several studies of patients with chronic cervical pain and chronic whiplash syndrome report a high frequency of oculomotor function derangements pointing towards brainstem involvement and/or default sensory input from neck afferents. In light of these reports, it seems important to investigate other patient groups with similar upper cervical spine disorders. In this study, voluntary eye motor performance was evaluated in 11 rheumatoid patients (RA) with upper cervical dislocation and a clearly noticed joint affection of the cervical spine. The results were compared with 6 RA patients without cervical engagement and normal individuals. Nine of the 11 patients with atlanto-axial dislocation showed pronounced oculomotor disturbances of smooth pursuits compared with only minor changes in the control group. The pattern of oculomotor dysfunction in patients with rheumatoid cervical dislocation indicates brainstem involvement, which may be an early sign of brainstem affection/myelopathy.

Aged↗

PubMed1997

Disc pathology after whiplash injury. A prospective magnetic resonance imaging and clinical investigation.

STUDY DESIGN: This study was used to evaluate the relationship between magnetic resonance imaging findings and clinical findings after whiplash injury. OBJECTIVES: To identify initial soft-tissue damage after whiplash injury, the development of disc pathology, and the relationship of disc pathology to clinical findings. SUMMARY OF BACKGROUND DATA: Although a few studies have reported pathological magnetic resonance imaging findings after whiplash injuries, there is no prospective study published to our knowledge. METHODS: Thirty-nine patients, 20 women and 19 men with a mean age of 32 years, were treated for whiplash injury. Magnetic resonance imaging and clinical examination were performed in a blinded manner at a mean of 11 days after trauma. The procedure was repeated at a 2-year follow-up visit. Two patients could not be examined with the second magnetic resonance imaging because of claustrophobia and pregnancy, respectively. RESULTS: The authors found 13 patients (33%) with disc herniations with medullary (six cases) or dura (seven cases) impingement over the 2-year follow-up period. At the follow-up examination all patients with medullary impingement had persistent or increased symptoms, and three of 27 patients (11%) with no or slight changes on magnetic resonance imaging had persistent symptoms. No ligament injuries were diagnosed. CONCLUSION: Although disc pathology seems to be one contributing factor in the development of chronic symptoms after whiplash injury, it may be unnecessary to examine these patients in the acute phase with magnetic resonance imaging; correlating initial symptoms and signs to magnetic resonance imaging findings is difficult because of the relatively high proportion of false-positive results. Magnetic resonance imaging is indicated later in the course of treatment in patients with persistent arm pain, neurologic deficits or clinical signs of nerve root compression to diagnose disc herniations requiring surgery.

Adolescent↗

PubMed1996

Late vascular complication after fracture of the proximal humerus.

A case of late vascular complication after a fracture of the proximal humerus is presented. The main clinical feature was neurological loss of the brachial plexus, while angiography showed no rupture or false aneurysm. The long delay before surgical intervention caused irreversible damage to the nerves. Early diagnosis and surgical intervention are emphasized.

Angiography, Digital Subtraction↗

PubMed1995

Decreased width of the spinal canal in patients with chronic symptoms after whiplash injury.

STUDY DESIGN: The sagittal diameter of the cervical spinal canal was measured on standard lateral radiographs of 48 consecutive patients with acute whiplash injury. A follow-up was done 12 months after injury. OBJECTIVES: The purpose of this study was to evaluate the relationship between spinal canal width and chronic symptoms after whiplash injury. SUMMARY OF BACKGROUND DATA: A narrow sagittal diameter of the cervical spinal canal has been correlated with neurologic deficits in degenerative conditions and after fractures. The authors are not aware of previous studies on whiplash patients related to this area. METHODS: Forty-eight consecutive patients were evaluated for whiplash trauma after car accidents. Twenty-four patients (12 men and 12 women; mean age, 37 years) had persistent symptoms after 12 months, while 24 patients (12 men and 12 women; mean age, 34 years) were asymptomatic. All measurements were done from standard lateral radiographs with a graphic digitizer connected to a microcomputer. Three anteroposterior and one oblique measurement of the canal were reconstructed for each vertebrae from C2-C6. Multivariate analysis of variance was used to evaluate any association between gender, remaining symptoms at follow-up, and the recorded values of the spinal canal width. RESULTS: The spinal canal was significantly smaller in the patients with persistent symptoms than in the asymptomatic group. A significant difference also was found between men and women. CONCLUSION: Narrow diameter of the cervical spinal canal is unfavorable in patients with whiplash.

Adult↗

PubMed1994

MRI and neurology in acute whiplash trauma. No correlation in prospective examination of 39 cases.

39 consecutive cases of whiplash injury of the neck were examined clinically and with MRI at a mean of 11 days after trauma. 26 of these showed changes on MRI with disc lesions in 25, 10 of which were classified as disc herniations, and a muscle lesion in 1 case. All had neck pain or headache. 29 cases had neurological deficits, mostly sensibility disturbances. 22 of the 26 cases with pathologic MRI findings had neurological signs, as had 7 of the 10 cases with disc herniation. The relationship between the MRI findings and the clinical symptoms and signs was poor.

Adolescent↗

PubMed1993

Negative scintigraphy despite spinal fractures in the multiply injured.

Skeletal injuries may be overlooked in multiply-injured patients. Skeletal scintigraphy, a very sensitive indicator of skeletal injuries, may give complementary information. We therefore performed scintigraphic screening in 20 patients with multiple injuries. In all, 38 fractures were diagnosed by plain skeletal radiography, and were also visualized scintigraphically. Furthermore, scintigraphy revealed a fracture of the pelvis in one patient and a tibial plateau fracture in another. Scintigraphy was, however, negative in three patients; two with fractures of the transverse processes in the lumbar spine and one with a cervical spine fracture of the articular processes with dislocation. The use of scintigraphy as a screening method in patients with multiple injuries may be helpful in the diagnosis of skeletal injuries. However, fractures of the vertebral column were not always visualized, possibly because of technically inadequate examinations in injured patients unable to co-operate.

Accidental Falls↗

PubMed1993

Early complications after anterior dislocation of the shoulder in patients over 40 years. An ultrasonographic and electromyographic study.

The rate of complications after anterior dislocation of the shoulder was evaluated in 65 patients aged over 40 years. 36 of 55 cases had electromyographically verified axillary nerve or brachial plexus injury. Rotator-cuff lesion was seen in 24 of the 63 sonographically examined cases. At follow-up in a telephone interview on average 3 years after the injury, 27 of the 57 cases had complaints from their shoulder. The incidence of initial nerve and/or cuff lesions was higher in those with persisting symptoms at follow-up.

Adult↗

PubMed1993

Eye motility dysfunction after soft-tissue injury of the cervical spine. A controlled, prospective study of 38 patients.

We investigated eye motility prospectively in 40 patients with a soft-tissue injury of the cervical spine. The initial oculomotor test, performed within 3 months, was pathologic in 8 patients. The follow-up test in 38 patients, on average 15 months after the accident, remained pathologic in the 8 patients and 5 additional patients had changed from normal to pathologic test results. At follow-up, all the 13 patients with oculomotor dysfunction had persisting symptoms, while 5 of the 25 cases with normal test results still were symptomatic.

Adolescent↗

PubMed1993

Surgery for chronic symptoms after whiplash injury. Follow-up of 20 cases.

20 patients operated on with discectomy and anterior cervical fusion because of chronic symptoms after whiplash injury were examined 4 years after surgery. The commonest indications for surgery were disabling headache and neck pain and radiographically verified disc protrusion. At follow-up, 11 patients had reduced headache and neck pain, while paresthesia and radicular pain were diminished in 9 patients. Based on Robinsson's criteria for the evaluation of surgical results, 2 patients had good, 9 had fair and 9 had poor results.

Adult↗

PubMed1992

Ultra low field MR imaging of cervical spine involvement in rheumatoid arthritis.

In a study of 30 patients with longstanding rheumatoid arthritis the diagnostic usefulness of ultra low field MR equipment was analyzed in assessing lesions of the craniocervical junction. It was found that at 0.04 T all the examinations were diagnostic and that in combination with plain radiography the diagnostic information obtained was valuable in further planning of the treatment strategies. The neurologic findings were related to the degree and severity of atlantoaxial luxation, either horizontal or vertical, and to the periodontoid pannus formation. The correlation between the degree of cord compression shown with MR imaging and the clinical symptoms, especially long tract symptoms, was poor. The only correlating factor was the duration of the disease.

Adult↗

PubMed1990

Chronic achilles paratenonitis with tendinosis: an experimental model in the rabbit.

An experimental model for inducing chronic Achilles paratenonitis with tendinosis in the rabbit is presented. Thirteen rabbits were exercised in a kicking machine producing passive flexions and extensions of the ankle joint. Active contractions of the triceps surae muscles were induced by electric stimulation via surface electrodes. The animals were exercised for 5 to 6 weeks, with a rate of 150 flexions and extensions per minute for 2 h, three times a week. Light microscopic examination showed degenerative changes of the tendon, and increased number of capillaries, infiltrates of inflammatory cells, edema, and fibrosis in the paratenon. We conclude that chronic Achilles paratenonitis with tendinosis can be experimentally induced in a standardized manner in rabbits.

Achilles Tendon↗

PubMed1990

Trigeminal sensory impairment after soft-tissue injury of the cervical spine. A quantitative evaluation of cutaneous thresholds for vibration and temperature.

The cutaneous sensibility for vibration and temperature in the trigeminal skin area was examined with quantitative methods in 30 patients with a previous soft-tissue injury of the cervical spine. Sixteen patients with chronic and disabling symptoms had significantly increased thresholds for vibration over the ophthalmic (p less than 0.001) and mandibular (p less than 0.01) divisions of the trigeminal nerve compared with 14 without symptoms. Temperature thresholds were measured in all three divisions of the trigeminal nerve, and were significantly increased in all three compared with controls (p less than 0.001 in ophthalmic division, p less than 0.01 in maxillary and p less than 0.05 in mandibular divisions). The impairment of vibration and temperature sensibility in the trigeminal skin area in patients with chronic symptoms after soft-tissue injury of the cervical spine indicates damage to the central trigeminal system in upper spinal cord segments and ponto-medullary levels of the brainstem.

Accidents, Traffic↗

PubMed1990

Soft-tissue injury of the neck in a hospital based material.

In a study from northern Sweden, 139 patients with a history of a soft-tissue injury of the neck were studied. The incidence was 1 per 1000 inhabitants. Male patients in the age group 20-29 years were most commonly injured. Traffic accidents constituted the major group with 96 (69%) and falls with 24 (17%). Forty-one cases received sickness benefit for a median time of 16 days for males and 25 days for females. Five persons were on sick-leave for over a year. The calculated total cost of treatment and sickness insurance benefit was about 0.9 million SEK/year.

Adolescent↗

PubMed1990

Tumour DNA content and skeletal metastases in renal cell carcinoma. A preliminary report.

The DNA content of the tumour cells in 10 patients with primary renal cell carcinomas was analysed; from six of the patients skeletal metastases were also studied. Four patients had homogenously diploid primary tumours, with solitary metastases. Six patients had aneuploid primary tumours, three with solitary and three with multiple metastases. In two patients radical excision of diploid metastases resulted in long disease-free intervals. Patients with diploid tumours survived significantly longer than patients with aneuploid tumours. These results indicate that tumour DNA content might be a useful prognostic indicator. The measurement of DNA content may be a suitable method of identifying those patients likely to survive long enough to benefit from major surgical resection and reconstruction.

Adult↗

PubMed1990

Outcome after soft-tissue injury of the cervical spine. A prospective study of 93 car-accident victims.

Ninety-three cases with a car-accident soft-tissue injury of the cervical spine were studied prospectively. Neck pain and stiffness were the main initial symptoms, while 4 cases had abnormal neurologic signs. At follow-up, on an average 2 years after the accident, 42 percent had recovered completely, 15 percent had minor discomfort, and 43 percent had discomfort sufficient to interfere with their capacity for work. The statistical analysis of 17 factors, including acute symptoms and physical findings, as well as the forces and directions of impact, head rests, radiographs, length, and sex, did not reveal any factor of prognostic importance.

Adolescent↗

PubMed1990

The Alvik glenoplasty for the unstable shoulder. Modification of the Eden-Hybbinette operation in 66 cases.

66 shoulders treated with the Alvik modification of the Eden-Hybbinette operation for recurrent anterior dislocation or subluxation were examined with an average follow-up of 6 years. Two shoulders had redislocated and one had subluxations. Forty-five of the 57 cases radiographically examined showed bony healing of the transplant; nonunion of the transplant occurred in 6 cases and resorption in another 6. The objective results were excellent in 35 cases, good in 18, fair in 3, and poor in 3 cases. The patients' subjective rating was excellent or good in 61 of the 66 cases. The Alvik operation can be recommended.

Adult↗