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Biomedical subjects

A Twijnstra

Publications and source records attributed to A Twijnstra.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Lack of uniformity and low compliance concerning wake-up advice following head trauma].

OBJECTIVE: To asses the use, content and patient compliance concerning the waking advice (WA) given to non-professional care-givers of mild head injury patients (MHI). DESIGN: Retrospective study. SETTING: University Hospital Maastricht. METHOD: Data were collected from 26 First Aid departments (FAD) of 8 university and 18 other hospitals to asses the use and content of WA. Indications for WA were investigated in 326 trauma capitis patients (TC). The compliance of non-professional care-givers of MHI were investigated by an inquiry among 61 TCs. RESULTS: All 26 FADs responded. The waking interval was 1-4 hours. Of 326 TCs, 180 had commotio cerebri. Seventy-four per cent of those patients were given a WA. Total compliance was 7% and partial compliance 55%. In patients who were instructed both orally and in writing compliance was best. CONCLUSION: There was no consensus on use and content of WA. Double instruction (oral and written) gives the best compliance.

Adult↗
PubMed1994

[Value of treatment of low-grade glioma still controversial].

There is debate in the literature on the treatment of low-grade glioma, especially regarding the role of radiotherapy. Several retrospective analyses have demonstrated longer survival and delayed tumour recurrence in patients treated with radiotherapy. However, radiotherapy may bring about adverse events, especially in long-term survivors. In four patients, a women of 54 and three men of 51, 31 and 16 years old, a low-grade glioma was diagnosed. In three, expectative therapy, combined with antiepileptic drugs, or with radiotherapy and partial tumour resection (n = 1) led to a period of many years without symptoms. In the fourth, total tumour resection followed by radiotherapy did not prevent recurrence of the tumour and death of the patient.

Adolescent↗
PubMed1994

Neuron-specific enolase as a marker of brain metastasis in patients with small-cell lung carcinoma.

Neuron-specific enolase (NSE) is one of the iso-forms of enolase, a glycolytic enzyme found in the neuroendocrine system. NSE is one of the most widely used tumor markers in small-cell lung carcinoma (SCLC). To assess the value of NSE in discriminating between the sites of metastases in SCLC-patients with and without cerebral involvement, serial NSE determinations were performed. Serum NSE was elevated in 76% of the patients at initial diagnosis. The value did not discriminate between the extent of disease nor between the sites of extrathoracic disease. NSE levels declined significantly at restaging. A persistent, significant rise occurred in patients with relapse of their disease, regardless of the site of relapse. In patients with brain metastases with and without extracranial disease at relapse, the NSE increase was significantly smaller than in patients without intracranial involvement. These findings indicate that serial determination of serum NSE in SCLC-patients may be useful in monitoring tumor activity but not in predicting the site of metastatic disease.

Adult↗
PubMed1993

Neuron-specific enolase in cerebrospinal fluid of patients with metastatic and non-metastatic neurological disease.

Neuron-specific enolase (NSE) activities were measured in cerebrospinal fluid (CSF) in 361 patients with various neurological diseases. CSF was collected as part of the diagnostic procedure both in the control group, which consisted of 189 subjects with low back pain, and in the patient group (172 patients). The mean CSF NSE level in 189 control subjects was 7.14 +/- 1.94 micrograms/l. Slight elevations of CSF NSE (> or = 11.0 micrograms/l) were observed in 9 patients with non-malignant diseases and in 2 patients with malignant diseases. The findings of this study indicate that measurement of NSE in CSF cannot be used as an adjunctive diagnostic test for CNS metastases.

Adult↗
PubMed1993

Water metabolism and postconcussional symptoms 5 weeks after mild head injury.

Posttraumatic diabetes insipidus has been reported as a sequela to head injury. It is unknown whether subclinical types of diabetes insipidus, or other types of water metabolism disorders, occur after mild head injury (MHI) and, if so, whether they are related to the persistence of postconcussional symptoms. MHI patients (n = 38) were screened for disturbances of water metabolism by comparing plasma and urine osmolalities at about 5 weeks after the trauma. Eight patients had evidence of an increased plasma osmolality together with a relatively decreased urine osmolality after an overnight fast. The presence of this disturbance was significantly related to the persistence of postconcussional symptoms. The results suggest that subclinical disturbances of water metabolism may, among other factors, be related to the persistence of symptoms after MHI.

Adolescent↗
PubMed1993

A controlled trial with vasopressin analogue (DGAVP) on cognitive recovery immediately after head trauma.

Recent evidence suggests that the vasopressin analogue desglycinamide-arginine8-vasopressin (DGAVP) might specifically benefit mild brain trauma patients. We investigated the effect of intranasal DGAVP treatment in 32 patients who had sustained a mild head injury for 3 months in a double-blind, placebo-controlled, matched-pairs study. DGAVP did not have a positive effect on cognitive recovery in this group of mildly affected patients.

Adolescent↗
PubMed1992

[Is skull radiography indicated in patients with head injuries?].

The value of the radiographic finding of a skull fracture in predicting intracranial haematoma is assessed in this study. Patients with a skull injury can be divided into three risk groups, based on the history and examination findings. The low-risk group includes patients who are asymptomatic or have scalp haematoma, lacerations, headache or dizziness. The moderate-risk group includes patients who have posttraumatic amnesia and/or alcohol intoxication and those who are suspected of having a skull fracture. The patients in the high-risk group have clear symptoms and signs such as depressed level of consciousness or focal neurological signs. The records of 1218 patients were studied. The risk group, the existence of a skull fracture and development of intracranial haematoma were determined. Not a single haematoma was found in the low-risk group. Therefore skull radiography had no significance in this group. In the moderate-risk group two patients had an intracranial haematoma, of whom one patient had a skull fracture. Negative skull radiography therefore did not fully exclude intracranial complications. There were many patients with an intracranial haematoma in the high-risk group, both in the presence and the absence of a skull fracture. CT scanning is the best method of detecting an intracranial haematoma in this group.

Adolescent↗
PubMed1992

Performance in the Stroop color word test in relationship to the persistence of symptoms following mild head injury.

There is much controversy about whether the persistence of postconcussive symptoms (PCS) in mild head injured patients (MHI) is related to the presence of cognitive deficits. Most studies performed so far have relied on normal non-concussed control subjects rather than directly comparing patients with and without PCS following MHI. In addition, subtle cognitive deficits may be present in MHI patients that are demonstrable only with more demanding cognitive tasks. In the present study the Stroop Color Word Interference Test together with a more demanding modified interference subtask was administered to two groups of patients with uncomplicated MHI 10 days, 5 weeks and 3 months after the injury. Ten patients with persistent symptoms at 3 months were selected and individually matched with MHI patients who had initially reported symptoms but who had recovered by 3 months. The scores of the two retrospectively defined groups were compared at the different time points. Between-subjects analysis revealed overall differences for both the original and modified color word interference subtask. Within-subject analysis indicated that only the recovery rate in the modified interference subtask was significantly different between the two groups. The observation that there was a parallel trend between recovery and persistence of PCS and performance on the cognitive interference measures supports the notion that there is a functional relationship between these two phenomena.

Adult↗
PubMed1992

Recovery from visual and acoustic hyperaesthesia after mild head injury in relation to patterns of behavioural dysfunction.

Patients with head injuries frequently complain of a decreased ability to endure intense light and sound stimuli. The few psychophysical studies that have objectively studied this type of hyperaesthesia have not assessed to what extent patients recover from this hyperaesthesia after mild head injury (MHI). A computerised rating technique was used to assess tolerance to intense sound (95 dB) and light (1500 lux) stimuli in patients with an uncomplicated MHI. Patients were tested 10 days and five weeks after the injury. Although most patients substantially recovered from both visual and acoustic hyperaesthesia, 25% of the patients were still not able to endure intense stimuli by five weeks. Analysis of data obtained with two behavioural rating scales (one with post-concussive/cognitive complaints and a second with emotional/vegetative complaints) indicated that visual hyperaesthesia was specifically related to the post-concussive/cognitive complaints scale.

Adult↗
PubMed1992

The Neuro-Oncology Register.

In this report we describe the establishment of a Neuro-Oncology Register (NOR) at the University Hospital of Maastricht, The Netherlands. The register includes data on numbers and types of primary central nervous system (CNS) tumours and neurological complications of systemic cancer. One of the objectives of the register is to determine the incidence rate of neuro-oncological complications in systemic tumours and the incidence and prevalence rates of primary CNS tumours in a well-defined population. The catchment area of the NOR was defined with the help of the Dutch Regional Cancer Register. It involves 140,819 inhabitants and will be considered as our catchment population. At present, 1,168 cases have been recorded since the NOR became operational. All neuro-oncological reports in 1988 were chosen for further analysis (n = 276). We diagnosed 79 metastatic complications from systemic cancer. Metastasis of the brain is the most frequent metastatic complication in our population, followed by epidural metastasis. As in other series, the lung and breast are the most frequently encountered tumour sites. The NOR is a clinically based register which, in co-operation with the Dutch Regional Cancer Register, will generate important epidemiological data on CNS complications.

Adult↗
PubMed1992

Diagnostic value of CT in the detection of brain metastasis in small cell lung cancer patients.

Fifty-seven patients with histologically proven small cell lung carcinoma were prospectively evaluated for signs of brain metastasis by neurological examination and computerized tomographic (CT) brain scanning. The reliability of demonstrating brain metastases by means of neurological examination was compared with that of CT. Three (5%) patients, two with cerebrovascular infarcts and one with leptomeningeal metastases, were excluded from the study. Four (7%) patients, all with extensive disease, showed neurological symptoms and signs of brain metastases, which were confirmed in three cases by brain CT. The fourth patient had neurological symptoms and signs pointing to cerebral metastasis, but no sign of this was detected on CT at the time of diagnosis. However, six months later, after completion of chemotherapy, CT revealed signs of brain metastasis. The other fifty neurologically asymptomatic patients had no brain metastases on CT. This clinical study suggests that routine CT of the brain is not useful in neurologically asymptomatic patients with small cell lung carcinoma.

Aged↗
PubMed1992

Neuropsychological deficits in patients with persistent symptoms six months after mild head injury.

There is much debate on the nature and duration of cognitive deficits and postconcussive symptoms (PCS) after mild head injury. Most studies performed so far have compared head-injured patients with subjects who had not suffered a concussion, instead of directly comparing patients with and without persistent PCS. The present study examined whether patients with PCS (n = 9) about 6 months after an uncomplicated mild head injury performed less well on selected neuropsychological tests than patients with mild head injuries who did not have PCS (n = 9) and healthy controls (n = 9). Patients with PCS were individually matched with controls for the time elapsed after the injury, age, sex, and education. We found that patients with PCS performed less well on tests of divided and selective attention than both patients without PCS and healthy controls. It is concluded that cognitive deficits may be present up to 6 months after mild head injury when symptoms persist. The findings indicate that patients with mild head injury and subjective symptoms may manifest demonstrable cognitive deficits.

Adult↗
PubMed1991

Tolerance for light and sound of patients with persistent post-concussional symptoms 6 months after mild head injury.

Patients with post-concussional symptoms (PCS) about 6 months after a mild head injury (MHI) were examined for tolerance of light and sound in comparison with concussed patients without PCS and non-concussed healthy controls. MHI patients with PCS were individually matched with subjects from the two control groups for the time elapsed from the injury, and for age and sex. Using a computerized rating technique, we assessed both the maximal and submaximal levels of lowered tolerance for light and sound over a wide range of stimuli. We found that the MHI patients with PCS 6 months after the trauma (n = 11) tolerated significantly less well stimuli of intensities of 71 dB and 500 lx than MHI patients without PCS (n = 11) and non-concussed controls (n = 11). There were no significant differences in tolerance for light and sound between MHI patients without PCS and the non-injured controls. Decreased tolerance for light and sound may contribute to the persistence of symptoms up to 6 months after a mild head injury. The psychophysical method provides an objective measure for the evaluation of the late persistent post-concussional syndrome.

Acoustic Stimulation↗
PubMed1991

An unusual cause of diplopia in a cancer patient.

A 47-year-old woman with metastatic infiltrating lobular carcinoma of the breast developed diplopia. Computed tomography of the orbits showed enlargement and irregularity of the right inferior rectus and inferior obliques muscles. Biopsies of these muscles contained breast carcinoma cells. This case report discusses the causes of diplopia in cancer patients, with special attention to the diagnostic problems of metastasis in extraocular muscles. The possible combined occurrence of metastasis in the leptomeninges and extraocular muscles is also to be borne in mind if the latter diagnosis is not to be missed.

Breast Neoplasms↗
PubMed1991

Cerebrospinal fluid tumour markers in patients treated for meningeal malignancy.

The results of cerebrospinal fluid (CSF) biochemical markers were compared with conventional CSF cytology in patients treated for leptomeningeal metastases from extra cranial malignancies. For lumbar CSF, before treatment, no statistically significant difference of the probabilities of being positive was found between CSF cytology and a classification by linear discriminant analysis, based on patient's age, of beta-glucuronidase and beta 2-microglobulin. During treatment, classification by linear discriminant analysis was found more often positive than cytology. Possible mechanisms for this difference are discussed. For ventricular CSF a correlation was found between CSF cytology and beta-glucuronidase for solid tumours, and between CSF cytology and beta 2-microglobulin for haematological malignancies. Reference values for ventricular protein, CEA beta-glucuronidase and beta 2-microglobulin were obtained for cytological negative samples.

Adult↗