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Biomedical subjects

K J van Dongen

Publications and source records attributed to K J van Dongen.

14 recordsLinked to original sources
PubMed1990

Non-familial degenerative disease and atrophy of brainstem and cerebellum. Clinical and CT data in 47 patients.

We studied the clinical features of 47 patients with a non-hereditary degenerative disease and with atrophy of brainstem or cerebellum or both in CT scanning. There was no relation between the CT findings and duration or severity of the disease, nor with the kind of the neurological signs which comprised ataxia, a hypokinetic rigid syndrome, oculomotor abnormalities, upper and lower motor neuron signs, orthostatic hypotension and dementia. The 2 main diagnoses were olivopontocerebellar atrophy (OPCA), or a combination of OPCA and striatonigral degeneration (SND). The differential diagnosis with Parkinson's disease and progressive supranuclear palsy was discussed. We concluded, that a CT scan is warranted in all cases of suspected Parkinson's disease, especially in those without tremor, and in cases of motoneuron disease with broad-based gait. In our patients with mainly hypokinesia and rigidity, levodopa treatment had no or brief beneficial effects. If ataxia predominated, OPCA appeared the most sensible diagnosis; if a hypokinetic-rigid syndrome predominated, the diagnoses SND plus OPCA appeared the most suitable. We assessed the degree of atrophy on CT subjectively, because an interobserver study of 60 normal CT scans, did not produce reliable measurements.

Adult↗
PubMed1988

Non-corresponding radiological and surgical diagnoses in patients operated for sciatica.

One hundred and nine patients with radicular leg-pain underwent both computer-tomography and myelography and were subsequently operated upon. The diagnoses on computer-tomogram, myelogram and surgery failed to correspond in 41 cases. Stenosis of the bony spinal canal, scar formation, and an intra- or extraforaminal herniation were the most frequent causes of discrepancy in the diagnoses. In cases of spinal stenosis and previous disc surgery both computer-tomography and myelography have to be performed. Certain precautions taken during computer-tomography and myelography may reduce the number of discrepant findings.

Adolescent↗
PubMed1987

Lumbar disk herniation: diagnosis with CT or myelography.

The value of computed tomography (CT) and myelography as single investigations in the diagnostic evaluation of patients with radiating leg pain probably due to lumbar disk herniation (LDH) has been adequately demonstrated. However, the extent to which CT can replace myelography and the conditions in which the examinations should be combined and in which order are still uncertain. Results of CT scans and myelograms from 461 patients with symptoms of lumbar root compression, probably due to LDH, were evaluated and compared with surgical results, if available. The sensitivity of myelography exceeded that of CT (82% vs. 73%), but its specificity was lower (67% vs. 77%). The positive predictive value of myelography only slightly differed from that of CT (93% vs. 94%). These results were used to establish a sequential diagnostic workup for patients with radiating leg pain. If, in this population with a high prior probability for surgery, CT had been the investigation of first choice in patients suspected of having LDH, the number of myelographic procedures performed could have been reduced by two-thirds.

Adult↗
PubMed1985

Long-term treatment of acromegaly with the somatostatin analogue SMS 201-995.

We treated four patients with acromegaly for 8 to 24 weeks with SMS 201-995, the long-acting somatostatin analogue, in dosages of 100 to 300 micrograms a day given subcutaneously. A rapid amelioration of the clinical signs and symptoms and near normalization of laboratory test results occurred in all patients. Mean plasma growth hormone concentrations (+/- S.E.M.), as measured over 24 hours, fell from an initial value of 57 +/- 18 micrograms per liter to 7.5 +/- 2 micrograms per liter at the end of the investigational period. Likewise, levels of plasma somatomedin-C, which were originally elevated in all patients, dropped to the normal or nearly normal range. The suppression of insulin secretion and the resulting hyperglycemia that were observed at the beginning of treatment became less marked as therapy progressed. There was evidence of slight tumor shrinkage in three of the subjects. No side effects were recorded throughout the treatment period. These preliminary results suggest that SMS 201-995 represents an additional option for the management of acromegaly, especially in patients who do not benefit sufficiently from surgery or radiotherapy and do not respond well to treatment with dopaminergic drugs.

Acromegaly↗
PubMed1985

Perimesencephalic hemorrhage: a nonaneurysmal and benign form of subarachnoid hemorrhage.

We studied 28 patients with subarachnoid hemorrhage and normal angiograms. On early CT (within 5 days) in 13 cases, blood was seen mainly or only in the cisterns around the midbrain. This pattern of hemorrhage was found in only 1 of 92 patients with a ruptured aneurysm. None of the unexplained perimesencephalic hemorrhages was associated with intracerebral hematoma or intraventricular hemorrhage. The clinical features also differed from those of aneurysmal hemorrhage; loss of consciousness was rare, and after 3 months, all 13 patients had returned to normal life. The cause of this benign disorder remains elusive, but a venous or capillary source seems likely.

Humans↗
PubMed1983

The prognostic value of computerized tomography in comatose head-injured patients.

In a series of 121 comatose head-injured patients, computerized tomography (CT) scans were obtained at various intervals after onset of coma. The scans were classified without knowledge of previous scans or of the patient's clinical state, and predictions as to outcome at 1 year were made based on clinical features and CT findings. The state of the basal cisterns as seen on CT scans proved to be a very powerful prognosticator. Subsets of features with the greatest prognostic weight were selected systematically for CT features, clinical features, and for a combination of CT and clinical features. With these features, probability statements were made about death or survival at 1 year. The quality of the predictions was established by comparing them with actual outcome. The percentage of accurate predictions was markedly higher with a combination of clinical and CT features than with clinical or CT features alone.

Adolescent↗
PubMed1982

The time course of aneurysmal haemorrhage on computed tomograms.

We performed serial CT scans in a prospective series of 100 patients with a ruptured aneurysm who were first scanned within 2 days of the haemorrhage. In all patients the early CT scan showed evidence of extravasated blood. In 96 patients the source of bleeding was clearly at the base of the brain, and 32 of these had a haematoma. We estimated from the results of 139 repeat scans that the probability of recognizing an aneurysmal haemorrhage on CT is 85% after 5 days, 50% after 1 week, 30% after 2 weeks (mostly patients with haematomas), and almost nil after 3 weeks.

Hematoma↗
PubMed1980

Computed tomography in the diagnosis of subarachnoid haemorrhage and ruptured aneurysm.

One hundred consecutive patients with subarachnoid haemorrhage were investigated by computed tomography (CT) within five days of the bleeding. In 19 cases CT indicated other sources than a ruptured aneurysm, most often a cerebellar haematoma. The other 81 patients did not all undergo angiography. It could be estimated by extrapolation that an aneurysm would be demonstrated in 66 of the 68 patients in whom CST showed extravasated blood in the basal cisterns, and in only five of the remaining 13 patients. In a consecutive series of 50 patients with bleeding from a verified aneurysm, CT showed some extravasated blood in all cases and a haematoma in half of these. In 74% the site of the haemorrhage correctly predicted the site of the ruptured aneurysm. Intravenous contrast medium visualized the aneurysm on CT in 15 of 25 cases; this can improve the identification of the bleeding aneurysm to 88%. Rebleeding occurred in 21 patients, and was obvious in Ct in 19. If available, CT should be the first investigation in patients with first and recurrent subarachnoid haemorrhage.

Hematoma↗
PubMed1980

Computerized tomography in subarachnoid hemorrhage: difference between patients with and without an aneurysm on angiography.

Fifty patients with spontaneous subarachnoid hemorrhage were investigated by both computerized tomography (CT), within 5 days of onset, and complete cerebral angiography. CT showed blood in the basal cisterns in 38 of the 42 patients with a demonstrable aneurysm, but in only 1 of 8 patients with a negative angiogram (p less than 0.001). This means that: (1) blood in the basal cisterns on CT almost certainly indicates a ruptured aneurysm, and (2) unexplained subarachnoid hemorrhages are unlikely to be caused by occult basal aneurysms.

Cerebral Angiography↗
PubMed1980

Late computed tomography in survivors of severe head injury.

Ninety-seven of a consecutive series of 225 head-injured patients who were in coma for at least 6 hours survived for 12 months or more. Seventy-nine underwent computed tomography (CT) 1 to 4 years after the injury. Ct findings such as infratentorial and focal and diffuse supratentorial atrophy were correlated with overall social outcome, persistent neurological deficit, operations, and prognostic features. Coma lasting longer than 24 hours, ataxia, and severe disability show a high correlation with infratentorial atrophy, alone or in combination with supratentorial atrophy. Patients who came out of coma within 24 hours after injury and those who ultimately recovered well usually had a normal CT scan or focal supratentorial atrophy only. Most patients who had undergone operation for space-occupying extra- or intradural hematomas or contusions had focal atrophy on the operated side.

Adolescent↗