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Biomedical subjects

M Kosteljanetz

Publications and source records attributed to M Kosteljanetz.

At least 19 recordsLinked to original sources
PubMed1995

[Do Danish surgeons have problems of conscience and responsibility? Results of a preliminary questionnaire survey].

A survey among Danish surgeons was conducted in order to elucidate whether Danish surgeons have problems of conscience related to their operative activity, especially when the results of the latter are unsatisfactory or lead to the death of the patient. Forty-three surgeons returned a questionnaire. All surgeons agreed that the problem that was raised was a significant one. The majority of the surgeons were aware of a patient, whom they had operated on and where the result of surgery was unsatisfactory or even caused the death of the patient. These problems are only to a limited extent discussed at work, whereas they are more frequently dealt with at home.

Denmark↗
PubMed1995

[Craniopharyngiomas. Neurosurgical treatment and therapeutic results].

From 1984 to 1993, 24 patients were operated for craniopharyngeoma at the University Clinic of Neurosurgery, Rigshospitalet, Copenhagen. We undertook a retrospective study based on the patients' records in order to elucidate the course of the illness from the time of diagnosis until the end of treatment. The median age of the patients was 35 years (range 1.5-75 years). The follow-up period was one month-9.5 years. Preoperatively most patients had symptoms or clinical signs of compression of the optic pathways. Eighteen patients were operated by the transcranial route and six patients by the transsphenoidal route. Radical excision was achieved in 10 cases. Nine patients had recurrence of tumor. Postoperative endocrine disturbances were diagnosed in 19 cases. By the end of the follow-up eight patients were dead, of whom seven had had relapse of tumor. We recommend radical excision at the primary operation whenever possible, but the issue is controversial.

Adolescent↗
PubMed1990

Cerebrospinal fluid outflow resistance measurements in the selection of patients for shunt surgery in the normal pressure hydrocephalus syndrome. A controlled trial.

In an attempt to determine to what extent the measurement of cerebrospinal fluid (CSF) outflow resistance (R(out)) can distinguish patients with normal-pressure hydrocephalus (NPH) who respond to shunt surgery from patients who fail to do so, the authors undertook a controlled trial. Eighteen patients with the diagnosis of NPH entered the study. In connection with the shunt operation all patients who entered the study underwent R(out) measurement by means of the pressure-volume index (PVI) method of bolus manipulation (Marmarou et al.). As a safety measure patients above 70 of age and patients with dementia as the only clinical symptom underwent continuous intraventricular pressure measurement before they entered the final study. As a result a total of fourteen patients underwent PVI test and shunt surgery during the same procedure. Patients with normal R(out) thus served as controls, since all patients underwent shunt surgery irrespective of the result of the R(out) measurement. Eight patients improved following surgery and the outcome did not correlate with result of PVI nor R(out) determinations.

Aged↗
PubMed1990

Post-operative infections of osteoplastic compared with free bone flaps.

A retrospective study was performed to evaluate the rate of infection in free and osteoplastic bone flaps after craniotomy. Two hundred and two craniotomies were performed in 98 cases of tumour, 35 cases of trauma and 69 cases of vascular disease. The overall incidence of infection was 6.4% (13 cases). The infectious agents were Staphylococcus aureus in four cases; Pneumococcus and gram-positive rods each in one case. In seven cases no infectious agent was identified. In 127 cases with free bone flaps eight (6.3%) were infected, and in 75 cases with osteoplastic bone flaps five (6.7%) were infected. One of five (20%) osteoplastic and four of eight (50%) free bone flaps had to be removed in order to accomplish healing, suggesting that an osteoplastic bone flap may be preserved more often in cases of infection.

Adolescent↗
PubMed1989

[Donors of cadaver kidneys. Reactions of relatives illustrated by a questionnaire study].

Fifteen relatives of 11 patients from whom kidneys were removed after death with the object of transplantation were interviewed, three or more years after the death of the patient. The object of the investigation was to illustrate whether the procedure hitherto employed in Denmark, in which the relatives are asked for their permission for removal of the organs, is satisfactory. The authors were particularly interested to know how the surviving relatives experienced the decision to give permission for removal of the kidneys from their relative. The most important conclusion of this investigation is that the majority of the relatives were satisfied afterwards with the permission they had given and found that this decision had made an otherwise tragic situation meaningful.

Attitude to Death↗
PubMed1989

Infected ventriculostomy: bacteriology and treatment.

During a period of 6 years 256 patients underwent ventriculostomy as their first operative procedure. Twenty-seven patients (11%) developed CSF-infections, in almost 90% caused by Gram-positive cocci compatible with normal skin flora. The incidence of infection was distributed evenly in the postoperative period. All patients received intravenous and intrathecal antibiotic treatment simultaneously according to the sensitivity test. The treatment was highly effective, and without serious adverse effects.

Acinetobacter Infections↗
PubMed1988

The clinical significance of straight-leg raising (Lasègue's sign) in the diagnosis of prolapsed lumbar disc. Interobserver variation and correlation with surgical finding.

Limitation of straight-leg raising (SLR) (Lasègue's sign) is considered an important test in the diagnosis of herniated lumbar disc disease. In a prospective study of 55 patients suffering from unilateral sciatica this sign was evaluated. Two aspects were investigated: 1) the interobserver variation, and 2) the correlation between the result of the test and the surgical finding. There was considerable interobserver variation among three observers concerning the measured angle at which pain was elicited. However, in 2/3 to 3/4 of the cases the variation amounted to 10 degrees or less. There was also some discordance in the classification of the type of pain that was elicited. Fifty-two patients underwent surgery; 45 had a prolapsed disc. SLR was "positive" in 49 cases, 43 of whom harbored a prolapsed disc. Crossed SLR was noted in 20, 19 of whom had a prolapsed disc at surgery. Absence of SLR limitation does not preclude the presence of a herniated lumbar disc.

Humans↗
PubMed1988

Clinical brain death with preserved cerebral arterial circulation.

We present a case of a 44-year old male suffering from severe subarachnoid haemorrhage secondary to a ruptured basilar artery aneurysm. Clinical examination on 3 consecutive days fulfilled the criteria for the diagnosis of clinical brain death. Nevertheless, cerebral angiograms showed intracranial filling until the third day after the bleeding. Autopsy showed acute infarction of the brain stem and the cerebellum.

Adult↗
PubMed1988

Cerebrospinal fluid production in subarachnoid haemorrhage.

Eight patients with subarachnoid and/or intraventricular haemorrhage underwent continuous extraventricular drainage and cerebrospinal fluid production was estimated by modified open drainage. The patients were in Hunt & Hess grades 2-5 on admission. Drainage was instituted within 24 h after the last bleeding episode in seven patients and the duration of drainage was 3-37 days. The median amount of CSF that was drained in 24 h was 210 ml. CSF production rate was 0.10-0.55 ml/min (median 0.28 ml/min) and there was a great variation within as well as between patients. Thus there was a trend towards a reduction in CSF production compared to reported normal values for CSF production. Three of six surviving patients required a shunt. The possible role of reduction in CSF production rate in the modification of intracranial hypertension and hydrocephalus after subarachnoid haemorrhage is discussed.

Adult↗
PubMed1987

Intracranial pressure: cerebrospinal fluid dynamics and pressure-volume relations.

Continuous measurement of the intracranial pressure (ICP) is routine in todays evaluation of various intracranial diseases and increased ICP is a common therapeutical problem in neurosurgical patients. Still, very little is known about the patho-physiological and biomechanic events that lead to increased ICP. ICP is governed by 1) the resistance to absorption of cerebrospinal fluid (Rout), 2) the production rate of CSF (If) (taken together Rout and If are referred to as the "CSF dynamics"), and 3) the pressure in the Sagittal Sinus (Pss) in accordance with the equation: ICP = If X Rout + Pss. When an intracranial mass grows the cranio-spinal volume buffering capacity is exhausted and the ICP subsequently rises. This event has been imitated in experiments and is described by the classical exponential pressure-volume curve. In a semilogarithmic coordinate system the curve will be linear and if one exchanges the abscissa and ordinate (x = log ICP, y = volume) the slope is the pressure-volume index (PVI). In normal adults PVI = 25 ml and defines the volume that theoretically will increase the ICP tenfold when injected into the CSF space. The main goal of the present study was to analyse the ICP in accordance with the above mentioned principles by measurements of Rout and the PVI. Furthermore, to evaluate the PVI method (synonymous with the "bolus injection" method) described by Marmarou and coworkers. By this method a bolus of a few milliliters of fluid is injected into the ventricles via an intraventricular cannula. PVI is computed based on the immidate ICP rise. The following slowlier ICP decrement defines the Rout. Another goal was to analyse whether measurements of the ICP pulse amplitude, which cancels the need of manipulations of the CSF space, could replace PVI measurements. Finally, to evaluate whether or not CT of the brain depicts pressure-volume relations and Rout in adult patients with hydrocephalus. The study comprised 63 patients with subarachnoid haemorrhage, cranio-cerebral injury or so-called normal-pressure hydrocephalus. The following variables were measured: 1) ICP, 2) pulseamplitude, 3) PVI and 4) Rout. The latter was measured by means of the PVI method and in some instances for reasons of comparison with the constant rate infusion technique and "controlled withdrawal". The main conclusions of the studies were: 1) For estimates of PVI the bolus injection technique was applicable. For Rout measurements the method was only safe at relatively low ICP levels.(ABSTRACT TRUNCATED AT 400 WORDS)

Brain↗
PubMed1986

Clinical evaluation of a simple epidural pressure sensor.

The Plastimed epidural pressure sensor was evaluated in 35 patients, twenty-eight of whom were suffering from head injury. In seven patients simultaneous intraventricular pressure measurements were obtained. The epidural pressure sensor was only functioning satisfactorily in approximately 2/3 of the patients, while it was malfunctioning or not functioning in the remainder. In seven comparable IVP/EDP studies significant differences up to 25 mm Hg were noted. In three patients IVP was greater than EDP. In two patients the opposite was true. No significant complications were observed. These unsatisfactory results have made us abandon the technique and resort to intraventricular or subarachnoidal pressure measurements.

Adolescent↗
PubMed1986

Acute head injury: pressure-volume relations and cerebrospinal fluid dynamics.

The main purposes of this study were to evaluate pressure-volume relations and cerebrospinal fluid (CSF) dynamics in patients with head injury and to evaluate the pressure-volume index (PVI) in that context. Sixteen head-injured patients underwent continuous intracranial (intraventricular) pressure (ICP) monitoring, studies of the PVI and the width of the pulse amplitude, and studies of CSF dynamics determined by the PVI technique or controlled withdrawal and expressed as resistance to the outflow of CSF (Rout). In this study, the PVI technique proved safe and relatively simple. The PVI based on bolus injections was significantly greater than the PVI based on CSF withdrawal. The PVI varied independently of clinical course, outcome, and ICP. The ICP pulse amplitude increased linearly with the ICP. It was not possible to establish any clinically useful correlation between pulsatile ICP changes and intracranial compliance (PVI). There was a linear correlation between ICP and Rout.

Adolescent↗
PubMed1986

CSF dynamics and pressure-volume relationships in communicating hydrocephalus.

Twenty-nine patients consecutively admitted with a diagnosis of communicating hydrocephalus underwent continuous intracranial pressure (ICP) monitoring; pressure-volume studies; and measurement of resistance to outflow of cerebrospinal fluid (Rout). The two latter calculations were made by the bolus injection and pressure-volume index (PVI) techniques. In 19 patients mean ICP never exceeded 15 mm Hg. In the other 10 patients varying degrees of mildly raised ICP was noted. The frequency of waves at 1/2 to 2/min varied from 3% to 58%. The ICP pulse amplitude ranged from 0.5 to 10 mm Hg, and PVI from 4.6 to 18.2 ml. The Rout ranged from 2.5 to 31.4 mm Hg/ml/min, and was linearly correlated to the ICP. Thus, patients with a higher Rout also had a higher ICP as compared with patients with lower Rout, yet ICP could still be within limits considered normal. The cerebrospinal fluid dynamics (formation rate X resistance) contributed much more to the ICP than in normal individuals. It is postulated that communicating hydrocephalus represents one endpoint of a continuum, where the preceding phase is high-pressure and high-resistance hydrocephalus as, for instance, is seen after subarachnoid hemorrhage. In some patients, there is a possibility of cerebral atrophy accompanied by otherwise insignificant increased Rout. In this study, the PVI technique proved to be a fast and safe method of measuring Rout.

Adult↗