PubMed Health⌕ Search

Biomedical subjects

Tor Ingebrigtsen

Publications and source records attributed to Tor Ingebrigtsen.

At least 19 recordsLinked to original sources
PubMed2006

[Diffuse axonal injury in traumatic brain injury].

BACKGROUND: Head trauma of varying severity may induce diffuse axonal injury. More attention is now given to this important type of injury, as examinations of head-injured patients with MRI have given us more knowledge. MATERIAL AND METHODS: We present a review of diffuse axonal injury with the main focus on clinical presentation and radiology, based on a Pubmed search and own experience. RESULTS AND INTERPRETATION: Axons seldom rupture at the moment of injury. It is more common that it takes hours or a few days until the axons are detached. Areas most commonly affected are white matter in the hemispheres, corpus callosum and the brain stem. Half of the patients with severe head injury have diffuse axonal injury, but this type of injury also occurs in patients with moderate and mild head injury. The clinical presentation and prognosis will therefore vary. Diffuse axonal injury can present with typical signs revealed by CT, but the CT scan may also be normal, especially when there is no bleeding. New MRI techniques are more sensitive and show that diffuse axonal injury occurs more often than previously assumed. MRI is therefore necessary to give the patients correct diagnoses and adequate rehabilitation and follow-up.

Brain Injuries↗
PubMed2006

Head injury outcome prediction: a role for protein S-100B?

INTRODUCTION: Prediction of the likely outcome of head injury from the outset would allow early rehabilitation to be targeted at those with most to gain. Clinical evaluation of a head injured patient may be confounded by intoxicants such as alcohol. Imaging modalities are insensitive (CT) or impractical (MR) for screening populations of such patients. A peripheral marker that reflected the extent of brain injury might offer an objective indication of likely adverse sequelae. This review evaluates the evidence for Protein S-100B as such a marker. METHODS: A search of published literature revealed 18 studies designed to evaluate the relation between serum S-100B and measures of outcome after head injury. RESULTS: A cut-off point of 2.5microg/L is related to dependent disability in those presenting with low conscious level, and may be a specific test for this. There appears to be a relation between initial serum S-100B concentration and measures of disability as well as post-concussion symptoms for those with seemingly mild injuries. There does not appear to be a relation between S-100B and measures of neuropsychological performance. CONCLUSION: Patients with high levels of S-100B at initial assessment (>2.5microg/L) may represent a high risk group for disability after head trauma.

Biomarkers↗
PubMed2006

[Impact of Scandinavian guidelines on management of mild head injuries].

BACKGROUND: A national survey in 1996 showed insufficient routines for management of patients with mild head injuries in Norwegian hospitals. Since then, the Scandinavian guidelines for management of mild head injuries have been published. METHODS: A cross-sectional questionnaire survey of management practice was performed in all 59 hospitals in 2002. We compared the results with figures from 1996 and evaluated guideline compliance. RESULTS: The proportion of noncompliant hospitals was reduced (p = 0.02) from 52% to 31%. The proportion assessing patient consciousness according to the Glasgow Coma Scale increased (p = 0.001) from 49% to 80%. The proportion requiring a normal computed tomographic scan if a patient with a history of loss of consciousness was to be discharged from the emergency department increased (p < 0.001) from 2% to 19%. CONCLUSION: The Scandinavian guidelines have had a significant impact on management practice in Norwegian hospitals.

Craniocerebral Trauma↗
PubMed2006

Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study.

The effectiveness of lumbar fusion for chronic low back pain after surgery for disc herniation has not been evaluated in a randomized controlled trial. The aim of the present study was to compare the effectiveness of lumbar fusion with posterior transpedicular screws and cognitive intervention and exercises. Sixty patients aged 25-60 years with low back pain lasting longer than 1 year after previous surgery for disc herniation were randomly allocated to the two treatment groups. Experienced back surgeons performed transpedicular fusion. Cognitive intervention consisted of a lecture intended to give the patient an understanding that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks. The primary outcome measure was the Oswestry Disability Index (ODI). Outcome data were analyzed on an intention-to-treat basis. Ninety-seven percent of the patients, including seven of eight patients who had either not attended treatment (n=5) or changed groups (n=2), completed 1-year follow-up. ODI was significantly improved from 47 to 38 after fusion and from 45 to 32 after cognitive intervention and exercises. The mean difference between treatments after adjustment for gender was -7.3 (95% CI -17.3 to 2.7, p=0.15). The success rate was 50% in the fusion group and 48% in the cognitive intervention/exercise group. For patients with chronic low back pain after previous surgery for disc herniation, lumbar fusion failed to show any benefit over cognitive intervention and exercises.

Adult↗
PubMed2006

Analysis of protein S-100B in serum: a methodological study.

BACKGROUND: Dysfunction and damage of the human central nervous system can be detected with biochemical markers, and protein S-100B is the best-established such marker. The aim of this study was to evaluate whether the protein is stable during long-term storage, to establish reference values for the new Elecsys S100 test and to compare this new method with the Liaison Sangtec 100 test. METHODS: We analysed blood samples from 118 blood donors and 196 patients with subarachnoid haemorrhage or head injury. The long-term stability of S-100B in frozen serum samples was evaluated with repeated analysis in 1997 and 2003 using an immunoradiometric assay. Method comparison between the Liaison Sangtec 100 and Elecsys S100 tests was performed using Bland-Altman difference plots. RESULTS: Serum concentrations increased significantly during long-term storage (mean difference 0.15 microg/L; +/-2 SD, 0.55 microg/L). Serum measurements using the Elecsys S100 method in 118 healthy blood donors showed S-100B levels between 0.02 and 0.08 microg/L (mean 0.05). The 95th percentile was 0.07 microg/L. The Liaison Sangtec 100 test usually measured higher concentrations than the Elecsys S100 method, and the difference between the two methods increased with increasing concentrations. The mean difference between the methods was 0.14 microg/L (+/-2 SD, 0.39 microg/L). CONCLUSIONS: Protein S-100B is not stable during long-term storage and the two analytical methods are not interchangeable.

Biomarkers↗
PubMed2005

[Treatment of intracranial aneurysms].

BACKGROUND: The department of neurosurgery at the University Hospital of North Norway has treated intracranial aneurysms since 1986. This study was conducted in order to evaluate outcomes after the introduction of endovascular therapy in 2000. MATERIAL AND METHODS: We included all patients treated for intracranial aneurysms during the years 1999 through 2002 in a retrospective, cross-sectional study. Data were collected from patient files. RESULTS: We treated 113 aneurysms in 104 patients in 108 procedures. 81 (78 %) patients were treated after a subarachnoid haemorrhage, while 23 (22 %) underwent treatment of an unruptured aneurysm. 75 (66 %) aneurysms were operated with craniotomy and clipping of the aneurysm neck, 38 (34 %) were treated with coiling. The choice of modality was dependent on the location and shape of the lesion. Complications related to the treatment were more common after surgical treatment than after coiling (41 versus 16 %, p=0.009), but the method of treatment did not influence long-term outcome evaluated according to the Glasgow Outcome Scale (GOS). All patients who underwent treatment for an unruptured aneurysm achieved a good outcome (GOS score 4 or 5), while patients treated after subarachnoid haemorrhage experienced significantly (p = 0.003) less favourable outcomes. Regression analysis revealed poor clinical condition (high Hunt & Hess grades) after the haemorrhage as the only independent predictor of outcome. INTERPRETATION: The university hospital has treated an increasing proportion of patients with intracranial aneurysms with endovascular coiling after introduction of this method in 2000. The outcomes presented in this study equal those published from international multicentre trials.

Aged↗
PubMed2005

Health-related quality of life assessment by the EuroQol-5D can provide cost-utility data in the field of low-back surgery.

There is limited data on the cost-utility of low-back surgical procedures. The EuroQol-5D (EQ-5D) is a generic health-related quality of life (HRQL) instrument, which was designed for cost-utility analyses and for comparisons of therapeutic effects across different diseases. Disease-specific (HRQL) instruments cannot be used for such purposes. However, there is little evidence of the usefulness of the EQ-5D in the field of low-back surgery, and it might be too general to assess specific conditions. We therefore tested its validity and responsiveness against a widely used disease-specific HRQL instrument [the Oswestry disability index (ODI)], in a prospective study on 326 patients operated for degenerative disorders in the lumbar spine. The reliability of the EQ-5D was also evaluated. Follow-up time was 12 months. Cross-sectional construct validity of the EQ-5D and ODI in the assessments of pain, functional status, health state and employment status were equal. The ODI performed better only in the assessment of walking capability. Only small differences in responsiveness were found. The reliability of the EQ-5D was solid. Our results indicate that the EQ-5D is useful for estimating health state values and for monitoring outcome of patients undergoing low-back surgery. Hence, this instrument would provide valid data for cost-utility analyses.

Cost-Benefit Analysis↗
PubMed2005

Raised serum S100B levels after acute bone fractures without cerebral injury.

BACKGROUND: S100B, a protein abundant in astroglial cells within the central nervous system, has been shown to increase in cerebrospinal fluid and serum after various neurologic diseases. However, the cerebral specificity of S100B has been questioned. This study aims to show serum S100B levels after uncomplicated bone fractures in patients without current or prior neurologic diseases. METHODS: Blood for sampling was drawn from patients seeking care at the emergency department presenting with various uncomplicated orthopedic fractures no older than 24 hours and having no previous or suspected neurologic disorder or head injury. RESULTS: Fifty-five consecutive patients with acute fractures were included in the study. Serum S100B levels were raised above 0.15 microg/L in 16 of 55 (29%) patients (range, 0.02-0.51 microg/L; mean, 0.13 +/- 0.11 microg/L). CONCLUSION: S100B levels were raised in 29% of patients with acute fractures without apparent cerebral injury, which suggests an extracerebral source of S100B. This information should be taken into account when interpreting S100B levels when dealing with brain damage.

Adult↗
PubMed2005

Serial single-photon emission computed tomographic and transcranial doppler measurements for evaluation of vasospasm after aneurysmal subarachnoid hemorrhage.

OBJECTIVE: To assess the clinical value of serial single photon-emission computed tomographic (SPECT) measurements after aneurysmal subarachnoid hemorrhage (SAH). METHODS: Thirty-two patients were studied prospectively during the first 26 days after SAH with repeated SPECT measurements, clinical examinations, and transcranial Doppler recordings. Time trends were analyzed with a general linear model. A final SPECT measurement was performed after 1 year. RESULTS: A mean of 2.6 (range, 1-5) SPECT measurements revealed a significant (P = 0.001) quadratic curve consistent with initial hypoperfusion and then with hyperperfusion during the acute stage. SPECT findings were significantly associated with transcranial Doppler recordings (P = 0.016) and clinical assessments (P = 0.008). Patients fulfilling clinical and transcranial Doppler criteria for vasospasm demonstrated a more pronounced relative hypoperfusion-hyperperfusion time course. A multivariate logistic regression analysis identified SPECT measurements obtained during Days 7 to 14 after the SAH as the only independent predictor (beta = 0.042, P = 0.02) for impaired perfusion after 1 year. CONCLUSION: Serial SPECT measurements after aneurysmal SAH demonstrate that regional changes in cerebral perfusion follow a nonlinear time trend, and repeated measurements are necessary. This observation, as well as the low feasibility of SPECT, restricts the clinical value of such measurements.

Adult↗
PubMed2004

The risk of "getting worse" after lumbar microdiscectomy.

A frequent concern among patients operated for lumbar disc herniation is the risk of "getting worse". To give an evidence-based estimate of the risk for worsening has been difficult, since previous studies have been more focused on unfavourable outcome in general, rather than on deterioration in particular. In this prospective study of 180 patients, we report the frequency of and the risk factors for getting worse after first time lumbar microdiscectomy. Follow-up time was 12 months. Primary outcome measure was the Oswestry disability index, assessing functional status and health-related quality of life. Of the patients 4% got worse. Independent risk factors of deterioration were a long duration of sick leave and a better functional status and quality of life prior to operation. We conclude that the risk of deterioration is small, but larger if the patient has been unable to work despite relatively small health problems. This study also demonstrates that changes in instrument scores should be reported, so that an accurate failure rate can be assessed.

Adult↗
PubMed2004

Neurosurgical teleconsultations in northern Norway.

We carried out a prospective study of the effect of neurosurgical teleconsultations on patient management in northern Norway. The total number of teleradiology image transfers during an eight-month study period was 723. We recorded data on 99 (14%) of these teleconsultations, which concerned 92 patients; the remainder were transfers to other departments at our hospital and transfers of routine examinations from a small community hospital that did not have a radiologist. The neurosurgeon on call noted the clinical condition and response time for each consultation. The consequences of the teleconsultation and the eventual benefits of the image transfer were evaluated. All 10 referring hospitals in the region used the service. The median response time was 3 hours (range 1-21 hours) in emergency cases and 1 day (range 1-7 days) in ordinary consultations. The response time was significantly shorter for patients with head injuries (median 3 hours) than for those with intracranial tumours (median 24 hours). Image transfer was considered beneficial for the patient in 93% of the cases. Avoidance of unnecessary patient transfer, changes of treatment at the referring hospital on the advice of the neurosurgeon and initiation of emergency transfer occurred in 34%, 42% and 13% of cases, respectively. The results confirm that teleconsultations between referring hospitals and a regional neurosurgical service influence patient management and reduce the frequency of patient transfer.

Aged↗
PubMed2004

Bifurcation geometry and the presence of cerebral artery aneurysms.

OBJECT: The angles of arterial bifurcations are governed by principles of work minimization (optimality principle). This determines the relationship between the angle of a bifurcation and the radii of the vessels. Nevertheless, the model is predicated on an absence of significant communication between these branches. The circle of Willis changes this relationship because the vessels proximal to the ring of vessels have additional factors that determine work minimization compared with more distal branches. This must have an impact on understanding of the relationship between shear stress and aneurysm formation. The authors hypothesized that normal bifurcations of cerebral arteries beyond the circle of Willis would follow optimality principles of minimum work and that the presence of aneurysms would be associated with deviations from optimum bifurcation geometry. Nevertheless, the vessels participating in (or immediately proximal to) the circle of Willis may not follow the geometric model as it is generally applied and this must also be investigated. METHODS: One hundred seven bifurcations of the middle cerebral artery (MCA), distal internal carotid artery (ICA), and basilar artery (BA) were studied in 55 patients. The authors analyzed three-dimensional reconstructions of digital subtraction angiography images with respect to vessel radii and bifurcation angles. The junction exponent (that is, a calculated measure of the division of flow at the bifurcation) and the difference between the predicted optimal and observed branch angles were used as measures of deviation from the geometry thought best to minimize work. The mean junction exponent for MCA bifurcations was 2.9 +/- 1.2 (mean +/- standard deviation [SD]), which is close to the theoretical optimum of 3, but it was significantly smaller (p < 0.001; 1.7 +/- 0.8, mean +/- SD) for distal ICA bifurcations. In a multilevel multivariate logistic regression analysis, only the observed branch angles were significant independent predictors for the presence of an aneurysm. The odds ratio (OR) (95% confidence interval) for the presence of an aneurysm was 3.46 (1.02-11.74) between the lowest and highest tertile of the observed angle between the parent vessel and the largest branch. The corresponding OR for the smallest branch was 48.06 (9.7-238.2). CONCLUSIONS: The bifurcation beyond the circle of Willis (that is, the MCA) closely approximated optimality principles, whereas the bifurcations within the circle of Willis (that is, the distal ICA and BA) did not. This indicates that the confluence of hemodynamic forces plays an important role in the distribution of work at bifurcations within the circle of Willis. In addition, the observed branch angles were predictors for the presence of aneurysms.

Angiography, Digital Subtraction↗
PubMed2003

[Bipolar head injury with global amnesia].

We report the first case of bipolar head injury, that is, subsequent head injuries sustained near both poles of the Earth. The injury caused a true global amnesia with loss of memory for the journey around the globe. This case history illustrates how modern emergency services have reduced the hazards of polar exploration, and how a second impact after a primary head injury may cause life-threatening complications.

Adult↗
PubMed2003

Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration.

STUDY DESIGN: Single blind randomized study. OBJECTIVES: To compare the effectiveness of lumbar instrumented fusion with cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. SUMMARY OF BACKGROUND DATA: To the authors' best knowledge, only one randomized study has evaluated the effectiveness of lumbar fusion. The Swedish Lumbar Spine Study reported that lumbar fusion was better than continuing physiotherapy and care by the family physician. PATIENTS AND METHODS: Sixty-four patients aged 25-60 years with low back pain lasting longer than 1 year and evidence of disc degeneration at L4-L5 and/or L5-S1 at radiographic examination were randomized to either lumbar fusion with posterior transpedicular screws and postoperative physiotherapy, or cognitive intervention and exercises. The cognitive intervention consisted of a lecture to give the patient an understanding that ordinary physical activity would not harm the disc and a recommendation to use the back and bend it. This was reinforced by three daily physical exercise sessions for 3 weeks. The main outcome measure was the Oswestry Disability Index. RESULTS: At the 1-year follow-up visit, 97% of the patients, including 6 patients who had either not attended treatment or changed groups, were examined. The Oswestry Disability Index was significantly reduced from 41 to 26 after surgery, compared with 42 to 30 after cognitive intervention and exercises. The mean difference between groups was 2.3 (-6.7 to 11.4) (P = 0.33). Improvements inback pain, use of analgesics, emotional distress, life satisfaction, and return to work were not different. Fear-avoidance beliefs and fingertip-floor distance were reduced more after nonoperative treatment, and lower limb pain was reduced more after surgery. The success rate according to an independent observer was 70% after surgery and 76% after cognitive intervention and exercises. The early complication rate in the surgical group was 18%. CONCLUSION: The main outcome measure showed equal improvement in patients with chronic low back pain and disc degeneration randomized to cognitive intervention and exercises, or lumbar fusion.

Adult↗