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Biomedical subjects

A Karle

Publications and source records attributed to A Karle.

At least 37 records · Page 2Linked to original sources
PubMed1993

Severe low-back pain. II: Changes in CT scans in the acute phase and after long-term observation.

No significant changes were noted in the CT-scan before and after 14 days of conservative therapy for low-back pain. Twenty of 33 patients had a disc herniation diagnosed on CT, and of these 18 patients were re-scanned after two weeks. Twelve patients were subsequently treated surgically, and of the remaining 8 patients 6 were re-scanned after 18 months. At this time the disc herniation had diminished significantly and was located in a more median position. In the 8 conservatively treated patients, the pain score at follow-up was related to the original size of the herniation (r = 0.72, p < 0.05).

Adult↗
PubMed1992

Adenocarcinoma of the prostate and metastatic medullary compression. A retrospective study of 22 patients.

A retrospective study of 709 patients with prostatic cancer was carried out. Twenty-two developed medullary cord compression (an incidence of 3%). All but two of the 22 patients were treated by radiation and 10 had additional hormonal treatment. Ten had some benefit from the treatment, but only 2 of 19 regained their ability to walk. The need for immediate diagnosis and treatment is stressed.

Adenocarcinoma↗
PubMed1992

Percutaneous transluminal angioplasty in 226 iliac artery stenoses: role of the superficial femoral artery for clinical success.

We reviewed the results of 174 consecutive percutaneous transluminal angioplasties (PTA) for 226 iliac artery stenoses (mean length 1.6 cm, range 0.2-9.6 cm) in 150 patients with lower limb ischaemia. Vascular intervention was indicated by intermittent claudication in 123 and critical ischaemia in 51 (29%) limbs. There were 12 (7%) failed guide-wire recanalizations. Four (2%) serious complications from puncture site haemorrhages or peripheral embolizations were handed surgically and caused one major amputation. Five-year patency in 162 successful dilatations was 68% primarily and 81% secondary to vascular surgical reconstructions during an average 28 (range 1-60) months of observation. One hundred and thirteen (70%) limbs improved clinically. In 95 limbs treated exclusively by iliac PTA, clinical improvement was achieved in 38/47 (81%) limbs with patency and 24/48 (50%) limbs with occlusion of the superficial femoral artery (SFA) (p < 0.003), whereas vascular patency of iliac PTA was unaffected by status of the SFA. Five-year limb salvage rate was 50% in limbs with critical ischaemia. We conclude that PTA for iliac artery stenoses is a low-risk procedure offering acceptable clinical results provided the SFA is patent. As an adjunct to distal bypass surgery, iliac PTA improves inflow without the requirement for major aorto-iliac surgery and may extend indications for vascular intervention in patients with lower limb ischaemia.

Adult↗
PubMed1990

Timing and topography of cerebral blood flow, aura, and headache during migraine attacks.

Ten years of study has resulted in considerable but fragmented knowledge about regional cerebral blood flow in migraine with aura (classic migraine). In the present study, the number of repeatedly studied patients (n = 63) was large enough to determine statistically significant sequences of events and statistically significant spatial relations. The first observable event was a decrease of regional cerebral blood flow posteriorly in one cerebral hemisphere. Further development of this pathological process was accompanied by the aura symptoms. Thereafter headache occurred while regional cerebral blood flow remained decreased. During the headache phase, regional cerebral blood flow gradually changed from abnormally low to abnormally high without apparent change in headache. In some patients headache disappeared while regional cerebral blood flow remained increased. Although regional cerebral blood flow reduction and aura symptoms in the great majority of patients were unilateral, one-third had bilateral headache. Unilateral headache usually localized to the side on which regional cerebral blood flow was reduced and from which the aura symptoms originated (i.e., aura symptoms were perceived to occur contralaterally but presumably originated in the hypoperfused hemisphere). Our results suggest a simple model for migraine attacks: A pathological disturbance in one cerebral hemisphere causes the aura symptoms and after a time delay, it also causes the headache by stimulating local vascular nociceptors. Bilateral headache caused by a unilateral cerebral disturbance may be explained by recent neuroanatomical and neurophysiological findings.

Adolescent↗
PubMed1988

Percutaneous transluminal angioplasty of the superficial femoral artery by retrograde catheterization via the popliteal artery.

We report the results of 50 angioplasty procedures via the popliteal artery. A 3-year follow-up including control of blood pressures at ankle and toe levels show results comparable to reports in the literature. This new approach for angioplasty of the superficial femoral artery and eventually of coexisting iliac lesions enables treatment of previously inaccessible lesions. The technique is especially suited for lesions close to the takeoff of the superficial femoral artery.

Aged↗
PubMed1988

Percutaneous transluminal angioplasty of infrarenal arteries in intermittent claudication.

Percutaneous transluminal angioplasty was performed on 55 iliac and 31 femoropopliteal arteries in 71 patients with intermittent claudication (23 women, 48 men). The two-year patency rate was 80% after iliac and 41% after femoropopliteal angioplasty. In 17 femoropopliteal cases with lesions greater than or equal to 5 cm the 2-year patency rate was only 32%, but the corresponding figure for shorter lesions was 53%. Complicating haematoma appeared in 10% of the cases and the arterial state deteriorated in one patient. There was no distal embolization. Percutaneous transluminal angioplasty in intermittent claudication is indicated for all cases of occlusion or stenosis of the iliac artery and for occlusion or stenosis shorter than 5 cm of the superficial femoral or the popliteal artery.

Adult↗
PubMed1987

Observer variability in assessment of angiographic vasospasm after aneurysmal subarachnoid haemorrhage.

In clinical practice and in many reported studies about incidences and time courses of vasospasm the angiographic spasms are judged by eye without clear definition of vessel narrowings. To evaluate the reliability of this diagnostic method two experienced neuroradiologists and two experienced neurosurgeons independently in two sessions, examined 30 carotid angiograms performed after an aneurysmal subarachnoid haemorrhage. The intra- and inter-observer agreements for the absent/present and localization diagnosis of vasospasm were calculated by means of Kappa statistics. Kappa values for both intra- and inter-observer agreement showed great variability and in general most of the agreements were not much better than chance expected agreement. The diagnostic method of judging angiographic vasospasm by eye without clear-cut definitions of vessels narrowings is unreliable and should not be used in the future, neither in clinical practice nor in research.

Cerebral Angiography↗
PubMed1986

Intravenous digital subtraction angiography with iohexol (Omnipaque) and sodium meglumin diatrizoate (Urografin).

A randomized, double-blind crossover trial in intravenous digital subtraction angiography (DSA) (aorto-femoral or aorto-cervical) was performed in 38 patients with Omnipaque, 350 mg I/ml versus Urografin, 370 mg I/ml. The aim of the study was to compare subjective reactions, ECG, heart rate, blood pressure, image quality and disturbing artefacts. The median volume of contrast media given per patient was 165 ml, ranging from 85 to 250 ml. No serious complications occurred. Fewer and significantly (p less than 0.05) less intense reactions as sensations of heat and taste were experienced after Omnipaque. Significantly more patients preferred Omnipaque. The heart rate changed significantly more after Urografin than after Omnipaque. Urografin also caused a significantly greater but transient decrease in systolic and diastolic blood pressure. There was a tendency to better overall quality and less artefacts when using Omnipaque, but the difference between the two media was not statistically significant.

Aged↗
PubMed1983

Brain CT-scanning and neurological examination in small cell bronchogenic carcinoma.

A brain CT-scan and a neurological examination were performed on forty-nine consecutive patients with small cell bronchogenic carcinoma before the start of chemotherapy and every three months thereafter. Contrast-enhancement was used in 90% of the CT-scans. Ninety percent of the neurologic examinations were performed by the same neurologist. No prophylactic cranial irradiation was given, and cranial irradiation was withheld if a CT-scan indicated metastases, unless the patient was symptomatic. Thirty-five patients are evaluable including 34 with a brain autopsy. CNS-metastases were found in 18 patients. Two of them had not been examined within three months of autopsy and are excluded from the calculations of diagnostic accuracy. Of the remaining 16 patients 10 had a correct diagnosis of cerebral metastases made by CT-scan, while the neurologist made 11 correct diagnoses of CNS-metastases. Seventeen patients did not have CNS-metastases including one patient alive and free of disease. Fifteen and 11 were judged to be free of metastases by the CT-scan and the neurologist, respectively. Two patients with negative autopsies had positive CT-scans turning negative at subsequent examinations. Two had positive CT-scans which became negative and at autopsy CNS-metastases were located at different sites from those initially indicated by CT. The positive predictive value of CT-scan was 71%, while the negative predictive value was 71%. In conclusion, routine CT-scan and neurological examination are equally sensitive but have low yields when there is no clinical suspicion of CNS-metastases. The predictive value of CT-scanning could possibly be higher with the newer generations of equipment.

Aged↗
PubMed1982

Size reduction of extrasellar pituitary tumors during bromocriptine treatment.

The well-known size-reducing effect of bromocriptine on prolactinomas was tested on five types of large, extrasellar pituitary tumors. Twenty patients were treated prospectively for up to 4.5 years with bromocriptine, 30 or 60 mg/d (two patients received 15 mg and 160 mg, respectively). The effect on the size of the pituitary tumors was quantitated by planimetry of computed tomographic scans before and during treatment. The immediate success rate was 16 of 20 tumors. Eleven nonsecreting tumors were reduced by a median of 32% (range of reduction for 50% of cases, 18%-41%) with an immediate success rate of nine of 11. Nine secreting tumors (four that secreted prolactin; three, growth hormone; one, adrenocorticotropic hormone; and one, thyroid stimulating hormone) were reduced by a median of 51% (range of reduction for 50% of cases, 25%-72%). The reduction in tumor size was significantly associated with pretreatment size (r=0.6360, p less than 0.005), but not with the serum concentration of any hormones assayed or previous radiation treatment. Bromocriptine causes a clinically significant reduction in size of nonsecreting as well as secreting pituitary tumors with the same success rate as that of conventional treatments.U

Acromegaly↗