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Biomedical subjects

L G Strömblad

Publications and source records attributed to L G Strömblad.

At least 19 recordsLinked to original sources
PubMed2001

Morphine with or without a local anaesthetic for postoperative intrathecal pain treatment after selective dorsal rhizotomy in children.

Selective dorsal rhizotomy is a surgical procedure with a selective division of posterior spinal nerve rootlets to treat spasticity in children. The extensive surgical procedure with multilevel laminectomies and the nerve root manipulation result in intense pain postoperatively. Two intrathecal (IT) regimes of pain treatment were compared in these children, concerning their pain relief and possible side-effects. In a prospective study, 12 children (3-6 years of age) with six in each group, received either intermittent IT morphine (5 microg x kg(-1) four times a day) or continuous infusion of a mixture of bupivacaine (40 microg x kg(-1) x h(-1)) and morphine (0.6 microg x kg(-1) x h(-1)). Pain score was lower in the bupivacaine/morphine group (0.2 +/- 1.1) compared to intermittent morphine (2 +/- 2.4) on a scale from 0 to 6 (P less than or = 0.0001). Bupivacaine/morphine resulted in a lower, but not significant, difference in pruritus and lower muscle spasm. Haemodynamic and ventilatory parameters did not differ between the groups. Intrathecal continuous infusion of bupivacaine and morphine was superior to intermittent morphine in the treatment of pain after selective dorsal rhizotomy operations.

Analgesia, Epidural↗
PubMed2000

A ring-enhancing metastasis with central high signal on diffusion-weighted imaging and low apparent diffusion coefficients.

Diffusion-weighted imaging (DWI) has been reported to be useful in the differential diagnosis between abscesses and cystic or necrotic tumours. However, experience is still limited and the true sensitivity and specificity remain to be determined. Our purpose is to describe a ring-enhancing metastasis of adenocarcinoma with a DWI pattern similar to that reported for abscesses. The tumour had a diameter of 1.5 cm and give signal from its centre similar to that of normal brain on T1-weighted images, whereas it was increased on T2-weighted images, and surrounded by a low signal ring, suggesting a capsule. The signal was high on DWI and the apparent diffusion coefficient (ADC) was low (0.55 x 10(-3) mm2/s). The findings were misinterpreted as representing an abscess in the early capsule-formation stage, but the signal pattern probably represented early tumour necrosis with intracellular oedema, but without liquefaction. Findings on DWI during the early capsule formation stage in abscesses and early tumour necrosis are probably similar and must be interpreted with caution.

Adenocarcinoma↗
PubMed1999

Paragangliomas of the spinal canal.

We report the clinical MRI and histopathological features of five consecutive cases of spinal paraganglioma. Three intradural tumours were found in the typical location (two at the L4, one at the S2 level); one intradural extramedullary tumour arose at an unusual level, from the ventral C2 root, and one extradural tumour growing along the L5 nerve root sheath had an aggressive growth pattern with early, local paraspinal recurrence and, eventually, intradural metastatic spread. This type of growth pattern has not been described previously. Paragangliomas of the spinal canal are more common than previously thought and can be located anywhere along the spine, although the lumbosacral level is the most common. Their appearance on MRI can not distinguish them from other tumours in the spinal canal. Even though paragangliomas in general are benign and slowly growing their growth pattern can vary and be more aggressive, to the point of metastatic spread.

Adult↗
PubMed1998

Vagus nerve stimulation in 16 children with refractory epilepsy.

PURPOSE: Vagus nerve stimulation (VNS) has been reported to produce >90% reduction in the number of seizures in children with intractable epilepsy. These encouraging results need confirmation. METHODS: Sixteen children, 10 boys and 6 girls aged 4-19 years, were treated with VNS (Cyberonics, Webster, TX, U.S.A.) for 12-24 months. Seizure frequency, seizure severity, changes in quality of life (QOL: visual analogue scale), and side effects were recorded. Eight children had partial and 8 had generalized seizures; 4 of the latter had Lennox-Gastaut syndrome (LGS). RESULTS: During the tenth to twelfth month of VNS, 6 of 16 children experienced > or =50% reduction in seizure frequency. One girl became seizure-free. Seizure severity showed an average decrease in the score from 15 to 11. After 10 months of treatment, QOL was estimated to have improved > or =50% in 6 of 16 children. Reduction in seizure frequency, decreased seizure severity, and reported improvement in QOL did not entirely coincide. Six children experienced hoarseness, 1 had neck pain, 2 had hypersalivation, 2 experienced tiredness, 2 had aspiration episodes during liquid intake, and 6 had electrical transmission problems; in 4 the problem has been surgically corrected. Five stimulators were turned off due to lack of efficacy. CONCLUSIONS: Six of 16 children with refractory epilepsy treated with VNS improved, with a reduction not only in seizure frequency but also in seizure severity and in QOL.

Adolescent↗
PubMed1997

Spontaneous regression of intraspinal neuroblastoma.

In two infants aged 5 days and 2 months paresis of the legs due to spinal cord compression by a dumbbell neuroblastoma suddenly appeared. Immediate surgical resection of only the paraspinal tumor mass was performed. Without any further treatment, prompt spontaneous regression of the intraspinal component occurred, and the paresis disappeared within 2 weeks in both infants. We advocate surgical excision of the paraspinal tumor mass as the sole treatment in infants with symptomatic dumbbell neuroblastoma.

Female↗
PubMed1993

Reoperation for malignant astrocytomas: personal experience and a review of the literature.

All patients in a randomized study comparing chemotherapy with chemotherapy plus radiotherapy for patients with astrocytomas grade 3 and 4, were considered for reoperation when tumour progression was established. Fifty-eight patients were reoperated and 85 were not. Different prognostic factors, such as age, sex, Karnofsky performance status and reoperation were evaluated univariately and simultaneously in a multivariate model. The Karnofsky index and age were found to be independent prognostic factors, while re-operation could not be demonstrated to prolong life when controlled for age and the Karnofsky index. We review the literature on re-operation of malignant astrocytomas.

Analysis of Variance↗
PubMed1992

Emergency reversal of anticoagulation after intracerebral hemorrhage.

BACKGROUND AND PURPOSE: Although intracerebral hemorrhage is one of the most serious complications during oral anticoagulant therapy, there are no guidelines on emergency treatment with respect to reversal of anticoagulation effect in these patients. METHODS: We retrospectively compared laboratory data and clinical features in 17 cases of anticoagulant-related intracerebral hemorrhage treated with prothrombin complex concentrate (n = 10) or fresh-frozen plasma (n = 7). RESULTS: In the group of patients treated with prothrombin complex concentrate, the mean prothrombin time decreased from 2.83 to 1.22 International Normalized Ratio within 4.8 hours, compared with a decrease from 2.97 to 1.74 within 7.3 hours in those given fresh-frozen plasma (i.e., four to five times more rapidly after treatment with prothrombin complex concentrate) (p less than 0.001). Symptoms and signs of intracerebral hemorrhage, measured on an eight-graded Reaction Level Scale, progressed on average 0.2 grades in patients given prothrombin complex concentrate compared with 1.9 grades in those given fresh-frozen plasma (p less than 0.05). In patients with prothrombin values above 1.46, clinical progression within 12 hours occurred in five of six cases. CONCLUSIONS: Treatment with prothrombin complex concentrate reverses anticoagulation more rapidly than fresh-frozen plasma, which might be of importance for the prevention of further bleeding.

Aged↗
PubMed1992

Mononuclear leukocyte ADP-ribosylation as an indicator of immune function in malignant-glioma patients treated with betamethasone for cerebral edema.

Glioma patients receiving corticosteroids (16 mg/day betamethasone) were examined for evidence of immune cell dysfunction by using quantitative estimates of adenosine diphosphate (ADP)-ribosylation in peripheral mononuclear leukocytes as the physiological indicator. The duration of daily treatment with corticosteroids varied from 0 to 35 days at the time of collection of the blood samples. Even after adjustment for covariate factors such as age, sex, smoking habits, alcohol use, antiepileptic medications, and tumor grade, there still remained a highly significant dose-dependent inverse relationship between constitutive and hydrogen peroxide-induced mononuclear leukocyte ADP-ribosylation levels and the duration of corticosteroid treatment (beta coefficients -0.40 and -0.29, respectively; p less than 0.03). No other variable under consideration significantly influenced ADP-ribosylation levels after statistical adjustment. These data support a mutual interdependence of mononuclear leukocyte ADP-ribosylation and corticosteroid-induced immune cell dysfunction in vivo.

Betamethasone↗
PubMed1991

A randomized study of chemotherapy with procarbazine, vincristine, and lomustine with and without radiation therapy for astrocytoma grades 3 and/or 4.

The authors undertook a controlled, prospective, randomized study of 171 patients with supratentorial astrocytoma grades 3 and/or 4 (classified according to Kernohan). All patients were given chemotherapy consisting of procarbazine, vincristine, and lomustine (CCNU) (PVC). Half of the patients received whole-brain irradiation (RT) to a dose of 5800 cGy in the tumor-bearing hemisphere and 5000 cGy in the contralateral hemisphere. After diagnosis of progressive tumor growth, patients received individual treatment. The endpoint of the study was time to progression, but cases were followed until the patients died. Median time to progression (MTP) for the whole randomized population was 21 weeks. Median survival time (MST) was 53 weeks; 18% of patients survived for 2 years or longer. Survival analysis showed that patients less than 50 years of age treated with PVC plus RT had significantly longer MTP (81 weeks) and MST (124 weeks) than all other patients. For patients less than 50 years of age treated with PVC alone, MTP was 21 weeks and MST was 66 weeks. For patients more than 50 years of age treated with PVC plus RT, MTP was 23 weeks and MST was 51 weeks; in the PVC group, MTP was 17 weeks and MST was 39 weeks. Age, Karnofsky index, areas of Grade 2, and absence of extensive necrosis in the tumor were significant prognostic factors in the univariate analyses. Patients less than 50 years of age treated with PVC plus RT had significantly longer survival (P = 0.037) when correcting for these factors in a multi-variate analysis.

Adult↗
PubMed1991

Early postoperative basal serum GH level and the GH response to TRH in relation to the long-term outcome of surgical treatment for acromegaly: a report on 39 patients.

During a 10-year period 39 patients with acromegaly, aged 23-73 years, underwent selective adenomectomy via a trans-sphenoidal or transfrontal (one case) approach. Six to 12 months after the operation, the serum level of growth hormone (GH) was reduced to less than 5 micrograms l-1 in 28 patients (74%) in at least two of three random samples and/or suppressed to less than 3 micrograms l-1 during an oral glucose load, thus fulfilling the commonly used criteria for a successful operation. In 10 patients these criteria for adequate GH reduction were not fulfilled, but their median S-GH level was reduced from 38 to 11 micrograms l-1 (P less than 0.01) after the operation. Surgery was successful in 11 of 13 (85%) patients with a microadenoma (less than 10 mm in diameter), in 10 of 14 (71%) patients with an adenoma of diameter greater than 10 mm but still enclosed in the sella, and in seven of 11 (64%) patients with locally invasive tumours. Impaired pituitary function was observed in 23% of the patients after surgery, independent of tumour size. In one patient the postoperative period was complicated by a lethal intracranial infection. During follow-up for 1-10 years, four patients relapsed, after 1, 1.5, 6 and 9 years, respectively. Patients for whom surgery appeared to have been ineffective at the evaluation 6-12 months postoperatively, or who later relapsed were identified by early (within 7 d) postoperative serum GH with a sensitivity of 90%. The accuracy for identification of a satisfactory outcome of surgery was 85%, and the predictive value was 90%. The corresponding values for the GH response to TRH measured 6-12 months postoperatively were 47, 40 and 54%, respectively. It is concluded that the basal level of serum GH measured 1-7 d postoperatively has higher sensitivity and specificity than the GH response to TRH 6-12 months postoperatively for evaluation of the effect of surgery on GH overproduction, and that it has a higher predictive power with regard to the long-term outcome of surgery for acromegaly.

Acromegaly↗
PubMed1990

Palliative surgery for brain metastases of malignant melanoma.

Forty patients with melanoma brain metastases were treated by surgery. Single brain metastases were found in 32 cases and multiple in eight. The most frequent tumor location was the frontal and frontoparietal lobes. Neurological improvement was observed in 25 patients and surgical mortality rate was less than 5%. The median survival time for all patients was 8 months. When patients with multiple cerebral metastases were excluded the median survival time was 13 months. The 3- and 5-year survival was 25% and 15%, respectively. Seventeen patients with extracerebral metastases received treatment and were without known extracerebral tumor at the time of brain metastases diagnosis. These patients had a median survival time that did not significantly differ from those without occurrence of extracerebral metastases. Quality of life as judged by Karnofsky index was improved after surgery and maintained on an acceptable level for the remaining time of survival.

Adult↗
PubMed1987

Bacterial contamination in cerebrospinal fluid shunt surgery.

Infection is a major complication of cerebrospinal fluid (CSF) shunt treatment with a reported incidence of 8-27%. In the present study, comprising 64 patients operated under strictly defined preoperative and peroperative hygienic measures and without use of prophylactic antibiotics, the infection rate was 3.1%. Out of the 2 cases of shunt infection recorded, 1 was probably caused by peroperative contamination and 1 by postoperative, hematogenous spread. Bacterial cultures from the operation area before incision and during operation were negative in 95% and 78%, respectively, and when positive yielded low numbers of organisms. Specimens taken after skin closure revealed growth in 59% and high bacterial numbers in 20%, mostly of Staphylococcus epidermidis and other resident skin bacteria. In addition, cultures of irrigation solutions, kept in open bowls during operation, yielded bacterial growth in 65% with a predominance of S. epidermidis. Thus, the strict hygienic measures did not prevent bacterial recolonization of the wound during operation. It is conceivable that endogenous as well as exogenous spread may be of importance in this context. The contamination of irrigation solutions indicates that closed irrigation systems should be used in this type of surgery.

Adolescent↗
PubMed1984

Ganglioneuroma with an uncommon location in a six-year-old girl.

A 6-year-old girl with a neurogenic bladder disease is described. Additional gait disturbances and mild but progressive foot deformities led to the diagnosis and surgical treatment of a ganglioneuroma located exclusively intraspinally. It is suggested that the tumor originated from remnant neural crest cells, probably early in life or even prenatally.

Child↗
PubMed1984

gamma-trace in human pituitary adenomas.

gamma-Trace, a small protein occurring in body fluids and in secretory and neuroendocrine cells, was demonstrated by immunohistochemical techniques in the cytoplasm of the tumor cells of 13 pituitary adenomas obtained at surgery and autopsy. Seven of the adenomas also contained LH immunoreactivity. FSH, TSH, and ACTH were each found in one gamma-trace-containing adenoma. gamma-Trace was also demonstrated in extracts of 1 pituitary adenoma and of 5 nontumorous adenohypophyses. The immunoreactive protein found in the extracts had a molecular weight and electrophoretic mobility characteristic of gamma-trace. Computerized amino acid sequence comparisons between the primary structure of gamma-trace and those of known hormonal peptides showed no significant similarities.

Adenoma↗