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Biomedical subjects

H J Nordal

Publications and source records attributed to H J Nordal.

At least 19 recordsLinked to original sources
PubMed2000

Lumbar spinal stenosis: conservative or surgical management?: A prospective 10-year study.

STUDY DESIGN: A cohort of 100 patients with symptomatic lumbar spinal stenosis, characterized in a previous article, were given surgical or conservative treatment and followed for 10 years. OBJECTIVES: To identify the short- and long-term results after surgical and conservative treatment, and to determine whether clinical or radiologic predictors for the treatment result can be defined. SUMMARY OF BACKGROUND DATA: Surgical decompression has been considered the rational treatment. However, clinical experience indicates that many patients do well with conservative treatment. METHODS: In this study, 19 patients with severe symptoms were selected for surgical treatment and 50 patients with moderate symptoms for conservative treatment, whereas 31 patients were randomized between the conservative (n = 18) and surgical (n = 13) treatment groups. Pain was decisive for the choice of treatment group. All patients were observed for 10 years by clinical evaluation and questionnaires. The results, evaluated by patient and physician, were rated as excellent, fair, unchanged, or worse. RESULTS: After a period of 3 months, relief of pain had occurred in most patients. Some had relief earlier, whereas for others it took 1 year. After a period of 4 years, excellent or fair results were found in half of the patients selected for conservative treatment, and in four fifths of the patients selected for surgery. Patients with an unsatisfactory result from conservative treatment were offered delayed surgery after 3 to 27 months (median, 3.5 months). The treatment result of delayed surgery was essentially similar to that of the initial group. The treatment result for the patients randomized for surgical treatment was considerably better than for the patients randomized for conservative treatment. Clinically significant deterioration of symptoms during the final 6 years of the follow-up period was not observed. Patients with multilevel afflictions, surgically treated or not, did not have a poorer outcome than those with single-level afflictions. Clinical or radiologic predictors for the final outcome were not found. There were no dropouts, except for 14 deaths. CONCLUSIONS: The outcome was most favorable for surgical treatment. However, an initial conservative approach seems advisable for many patients because those with an unsatisfactory result can be treated surgically later with a good outcome.

Activities of Daily Living↗
PubMed1995

Lumbar spinal stenosis. Clinical and radiologic features.

STUDY DESIGN: A prospective, randomized study of patients with symptomatic lumbar spinal stenosis. OBJECTIVES: Evaluation of clinical and radiologic characteristics and relationship. SUMMARY OF BACKGROUND DATA: The diagnosis of lumbar spinal stenosis is frequently used and represents a wide variety of patients with more or less well-defined spinal disorders. METHODS: One hundred patients who met inclusion criteria were consecutively selected from a neurology department and examined clinically and radiologically with plain radiography, myelography, and computed tomographic imaging. RESULTS: Duration of complaints was long, and multilevel, bilateral afflictions were common. The dominanting symptoms were sciatica, neurogenic claudication, and low back pain. The clinical findings were modest. Narrowness in the spinal canal was demonstrated radiologically with signs of compression on nerve roots, centrally and/or laterally. The radiologic findings were more extensive than expected from the clinical symptoms and signs. In most patients the sagittal diameter of the spinal canal increased on flexion and decreased on extension of the spine. An exception was demonstrated in 33 patients where extension increased the diameter, usually at one level. Radiologic subgroups of stenosis were found, but their clinical relationship could hardly be identified. No definite association between the degree of narrowing and clinical symptoms was found. CONCLUSIONS: A clinical picture is demonstrated in 100 patients with symptomatic lumbar spinal stenosis. Different types of stenosis are found radiologically, but their clinical relationships are not identified. The radiologic changes were more extensive than expected from the clinical picture, and the degree of narrowing did not correspond to the degree of clinical affliction.

Adolescent↗
PubMed1993

Grading stenoses of the internal carotid artery by estimation of blood velocity with pulsed Doppler ultrasound.

The relationship between blood velocity and residual lumen diameter at the origin of 100 internal carotid arteries was studied. The diameter was measured by angiography and blood velocity by relatively simple Doppler ultrasound equipment. A scatter diagram between maximal velocity and diameter was used to construct a table on the sensitivity and specificity of various cutoff values for maximal velocity to diagnose stenoses of different degrees. A maximal velocity > or = 0.8 m/s had a sensitivity of 87% and a specificity of 93% to diagnose stenoses with a diameter < or = 3 mm (i.e. more than 50% diameter reduction). Thus, simple recording of maximal velocity can be used as a reliable screening method to detect patients with high- and medium-grade stenosis. Analysis of the spectral spreading of velocities across the lumen of a stenosis, or estimation of percent stenosis from the velocity in a stenosis and that in a poststenotic segment, were in our hands less useful for this purpose. None of the methods were good to detect or exclude the presence of low-grade stenosis.

Adult↗
PubMed1992

[Stenosis of the internal carotid artery at the bifurcation. Radiologic definition and Doppler diagnosis].

One hundred internal carotid arteries with varying degrees of stenosis were studied by angiography and doppler ultrasound. We found the minimal diameter of a stenosis, measured in mm, more suitable as reference for the doppler-based method than verbal assessment of a stenosis as slight, moderate or pronounced. The sensitivity and specificity of maximal blood velocity to diagnose high-grade stenosis is satisfactory for screening patients who might benefit from endarterectomy. Spectral velocity spread, or comparison of the velocity in the stenosis with that of a cranial reference segment of the artery did not increase the sensitivity to detect low-grade stenoses.

Adult↗
PubMed1992

Radiological assessment of stenosis of the internal carotid artery at the junction with the common.

Stenoses at the origin of 100 internal carotid arteries from patients with ischemic cerebrovascular disease were studied by intra-arterial angiography. Three principles were employed to evaluate the degree of stenosis: 1) verbal description, grading stenoses as mild, moderate of severe, 2) estimation of the true residual diameter, and 3) calculation of percent stenosis, defined here as the diameter of the artery at the origin relative to that at the level of the angle of the mandible. The true diameter, estimated to the nearest whole mm, corresponded well with the verbal description, and correlated significantly with percent stenosis. Since the true diameter is precisely defined, easy to estimate, and directly related to its hemodynamic effect, we suggest that this simple parameter, rather than the more commonly used, but more vaguely defined term "percent lumen reduction", is used to grade stenoses of the internal carotid artery.

Adult↗
PubMed1990

[Death assistance and terminal care--at the hospital].

Euthanasia, i.e. active termination of life in a seriously ill patient, is not performed in Norway at present. Between active and so-called passive euthanasia there is a "grey zone", and it is discussed where the border should be drawn, how and by whom. The decision to treat or not is becoming increasingly difficult, due to technical advances in the development of life-supporting devices. There is increasing sympathy for the view that it is not the duty of the medical profession to prolong the life of patients under all circumstances. The present paper discusses such problems in relation to hospitalized patients in an acute life-threatening situation, and in patients with, known, chronic disabling, or malignant disease.

Euthanasia↗
PubMed1988

Fat infiltration, atrophy and hypertrophy of skeletal muscles demonstrated by X-ray computed tomography in neurological patients.

Since 1982, we have used X-ray computed tomography (CT) to study the skeletal muscles of neurological patients. We present here the findings in 23 patients with myogenic and 29 patients with neurogenic diseases. The method is convenient to demonstrate fat infiltration, atrophy and hypertrophy of skeletal muscles, but is of little help in differentiating between the 2 disease categories or individual diagnoses. The maximal isometric voluntary force of m. quadriceps femoris was measured in 13 of the patients with neurogenic, and in 10 of the patients with myogenic diseases. The power was compared with the cross-sectional area and the structural changes observed in the parenchyme of the muscles in the CT scans. A positive correlation was found between the size and the force of the muscle in both patient groups. The appearance of the muscular parenchyme was of little help to predict its function.

Adipose Tissue↗
PubMed1987

The treatment of spasticity in multiple sclerosis: a double-blind clinical trial of a new anti-spastic drug tizanidine compared with baclofen.

The anti-spastic effect of a new drug, tizanidine, was compared with that of baclofen in a double-blind clinical trial; 40 seriously handicapped patients with multiple sclerosis (MS) were randomly allocated treatment with one or the other drug for a 6-week period. The antispastic effect was evaluated by clinical criteria. The optimal daily dose of both drugs varied considerably from patient to patient, and was on the average 23 mg for Tizanidin and 59 mg for baclofen. To the extent an antispastic effect was observed, the 2 drugs appeared to be equally effective when given at a 1:2 ratio (mg tizanidine: mg baclofen). Side effects of both drugs were sleepiness, muscular weakness and dry mouth. Tizanidine had a mild depressive effect on blood pressure. Sudden withdrawal of both drugs was accompanied by a transient relative increase of spasticity in approximately half the patients. There were no other changes suggesting physical or psychological dependence. The present study underscores that neither baclofen nor tizanidine are ideal antispastic drugs, and emphasize the need for further research.

Adult↗
PubMed1982

Lymphocyte capping: a diagnostic method in progressive muscular dystrophy?

Recent observations indicate that antibody-induced redistribution ("capping") of membrane antigens of B-lymphocytes is subnormal in patients with progressive muscular dystrophy. The present study was primarily designed to verify or refute claims that such an abnormally low capping capacity can be used to diagnose this disease group. In eight dystrophy patients we found the median capping to be reduced to 40%, while it was 52% in 27 neurological control patients, and 62% in 20 healthy blood donors. However, there was considerable overlap between the capping percentages of the three groups. Thus, our data indicate that the demonstration of reduced lymphocyte capping in the individual patient is of little, if any, diagnostic value.

Female↗
PubMed1979

Optic neuritis: local synthesis in the central nervous system of oligoclonal antibodies to measles, mumps, rubella, and herpes simplex viruses.

Antibodies to measles, mumps, rubella and herpes simplex type 1 viruses in serum and CSF of 10 patients with acute monosymptomatic optic neuritis were characterized by imprint electro-immunofixation (IEIF). Comparisons of the IEIF antibody patterns in serum and CSF indicated that a local synthesis in the central nervous system of oligoclonal virus antibodies took place in five of the 10 patients. Three of the five patients had a local synthesis of antibody to more than one type of virus. Oligoclonal IgG was detected by agarose electrophoresis of the CSF in four of the five patients with a local synthesis of virus antibodies. There was, however, no association between the locally synthesized antibodies and the oligoclonal CSF IgG, indicating that they account for only a minor fraction of the locally synthesized IgG in these patients. In the fifth patient, distinct fractions of locally synthesized virus-specific oligoclonal Ig were detected by the IEIF method, although the agarose electrophoresis showed a normal pattern of CSF IgG.

Adult↗
PubMed1978

Demonstration of electrophoretically restricted virus-specific antibodies in serum and cerebrospinal fluid by imprint electroimmunofixation.

A sensitive technique for the electrophoretic characterization of virus-specific antibodies is described. Electrophoretically separated Ig is allowed to diffuse into a virus-antigen containing gel. The antibodies bound to viral antigen are then demonstrated by 125I-labelled rabbit antihuman Ig and autoradiography. Electrophoretically restricted antibodies against measles, rubella, mumps or herpes simplex viruses were demonstrated in some normal sera. The antibody patterns of normal cerebrospinal fluids (CSF) closely resembled those of the matching sera. A selective increase of oligoclonal antibodies was demonstrated in CSF from patients with infection of the central nervous system (CNS) caused by any of the four viruses. We propose that the method may be used to demonstrate local synthesis in the CNS of antibodies against viral or other antigens.

Antibodies, Viral↗
PubMed1978

Multiple sclerosis: local synthesis of electrophoretically restricted measles, rubella, mumps and herpes simplex virus antibodies in the central nervous system.

An imprint electroimmunofixation (IEIF) technique was used to study measles, rubella, mumps and herpes simplex virus antibodies in serum and concentrated cerebrospinal fluid (CSF) from ten patients with multiple sclerosis (MS). Electrophoretically restricted virus-specific antibodies were detected in sera or CSF from nine of the ten patients. Comparison of the antibody patterns in matching serum and CSF samples indicated that electrophoretically restricted populations of antibody against one or more of the four viruses were produced locally in the central nervous system of nine patients. No association between the locally produced antibody populations the oligoclonal IgG of the CSF could be demonstrated. The virus-specific antibodies studied thus seem to constitute only a minor fraction of the total IgG of the CSF from MS patients.

Antibodies, Viral↗
PubMed1976

Measles virus-induced migration inhibition in vitro of leukocytes from patients with multiple sclerosis.

The migration inhibition in vitro induced by measles virus material on leukocytes from 17 patients with multiple sclerosis (MS) was compared with that of 8 patients with various other central nervous system diseases and that of 12 healthy blood donors. Significant differences could not be demonstrated. The results do not indicate that MS patients' leukocytes show an altered behaviour to measles virus material in the migration inhibition test.

Adult↗
PubMed1976

Measles virus-induced migration inhibition of human leukocytes in vitro: an expression of cell-mediated immunity?

Attempts were made to establish measles virus-induced migration inhibition of human leukocytes as an in vitro test of cell-mediated immunity to the virus. Crude material from cell cultures infected with two different strains of measles virus was used as antigen in the capillary modification of the test. Both virus preparations induced migration inhibition. Incubation with puromycin indicated that the inhibition was dependent on protein synthesis, which has been regarded as a characteristic feature of an immunologically specific inhibition. However, no difference was found when the migration inhibition of leukocytes from donors without clinical and serological evidence of previous measles infection was compared with that of leukocytes from donors with such evidence. It is concluded that the migration inhibition induced by crude measles virus material does not necessarily measure cell-mediated immunity to the virus.

Adult↗
PubMed1976

Oligoclonal measles virus-specific IgG antibodies isolated from cerebrospinal fluids, brain extracts, and sera from patients with subacute sclerosing panencephalitis and multiple sclerosis.

Measles virus-specific antibodies were isolated from sera, cerebrospinal fluids (CSF), and brain extracts of patients with subacute sclerosing panencephalitis (SSPE) and multiple sclerosis (MS) by absorption with measles antigens and subsequent acid elution of the antigen-antibody precipitates. Electrophoretically homogeneous measles antibodies were isolated from CSF or brain extracts in five patients with SSPE and in five out of seven patients with MS. Homogeneous IgG antibodies were also demonstrated in the sera from all SSPE patients and from three of the MS patients. The antibodies isolated from various control sera and from pooled CSF were electrophoretically heterogeneous. The results support the concept of a local synthesis in the nervous system of oligoclonal IgG antibodies to measles virus in all patients with SSPE and in some patients with MS. In SSPE, most or all oligoclonal IgG proteins of the CSF or brain carry measles antibody activities. In MS, only part of the oligoclonal IgG appears to be associated with measles antibody activity.

Antibodies, Viral↗