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Biomedical subjects

B Magnaes

Publications and source records attributed to B Magnaes.

At least 19 recordsLinked to original sources
PubMed2001

Post-traumatic cerebral infarction. Neuroimaging findings, etiology and outcome.

PURPOSE: To assess the radiological characteristics of post-traumatic cerebral infarctions (PTCIs), the etiology and site of infarction, and to provide neuroimaging indicators of a poor clinical outcome. MATERIAL AND METHODS: A retrospective study of 16 patients with the neuroimaging-based diagnosis of PTCI was carried out. All CT, MR examinations, cerebral angiograms and medical records of the patients were reviewed. RESULTS: Infarcts were diagnosed in the territory of the posterior cerebral artery in 9 patients, in the middle cerebral artery in 5, in the anterior cerebral artery in 3, lenticulostriate-thalamoperforating in 2, vertebrobasilar in 3, and cortical infarcts in 2 patients. Neuroimaging studies suggested focal mass effect and/or acquired intracranial herniations as the cause of infarction in 13/16 patients (81.2%). In 3/16 patients (18.8%), PTCI was due to vascular injury of which 2 were angiographically documented (carotid artery dissection). Eight of the 16 patients in this study died or were left in a persistent vegetative state. Patients with associated subdural hematoma, brain swelling/edema and traumatic subarachnoid hemorrhage (tSAH) exhibited the worst outcome. CONCLUSION: Gross mechanical shift of the brain and herniation across the falx and/or tentorium accounted for infarction in a majority of cases in our study. The overall death rate was 43.8% and this result suggests that PTCI is an indication of a poor clinical outcome, especially among patients with associated subdural hematoma, brain swelling/edema and tSAH.

Adolescent↗
PubMed2000

Lumbar spinal stenosis: conservative or surgical management?: A prospective 10-year study.

STUDY DESIGN: A cohort of 100 patients with symptomatic lumbar spinal stenosis, characterized in a previous article, were given surgical or conservative treatment and followed for 10 years. OBJECTIVES: To identify the short- and long-term results after surgical and conservative treatment, and to determine whether clinical or radiologic predictors for the treatment result can be defined. SUMMARY OF BACKGROUND DATA: Surgical decompression has been considered the rational treatment. However, clinical experience indicates that many patients do well with conservative treatment. METHODS: In this study, 19 patients with severe symptoms were selected for surgical treatment and 50 patients with moderate symptoms for conservative treatment, whereas 31 patients were randomized between the conservative (n = 18) and surgical (n = 13) treatment groups. Pain was decisive for the choice of treatment group. All patients were observed for 10 years by clinical evaluation and questionnaires. The results, evaluated by patient and physician, were rated as excellent, fair, unchanged, or worse. RESULTS: After a period of 3 months, relief of pain had occurred in most patients. Some had relief earlier, whereas for others it took 1 year. After a period of 4 years, excellent or fair results were found in half of the patients selected for conservative treatment, and in four fifths of the patients selected for surgery. Patients with an unsatisfactory result from conservative treatment were offered delayed surgery after 3 to 27 months (median, 3.5 months). The treatment result of delayed surgery was essentially similar to that of the initial group. The treatment result for the patients randomized for surgical treatment was considerably better than for the patients randomized for conservative treatment. Clinically significant deterioration of symptoms during the final 6 years of the follow-up period was not observed. Patients with multilevel afflictions, surgically treated or not, did not have a poorer outcome than those with single-level afflictions. Clinical or radiologic predictors for the final outcome were not found. There were no dropouts, except for 14 deaths. CONCLUSIONS: The outcome was most favorable for surgical treatment. However, an initial conservative approach seems advisable for many patients because those with an unsatisfactory result can be treated surgically later with a good outcome.

Activities of Daily Living↗
PubMed2000

Open reduction and internal fixation in flexion-distraction injuries to the lower spine in children and adolescents involved in traffic accidents as car occupants. A report and literature review.

Flexion-distraction injuries of the spine are reported after traffic accidents in individuals wearing only lap seatbelts. We examine here this type of injury in one child and two adolescents who all were seated in the rear seat of cars involved in traffic accidents. All of the children were wearing regular three-point safety belts not adjusted to children. They were all treated surgically. Two of the patients had no neurological impairment, while one patient suffered persistent complete paraplegia. In two patients intra-abdominal lesions required surgery. Flexion-distraction injuries in individuals with an immature skeleton, wearing standard three-point safety belts, have not been reported in the literature. The pathomechanism of the lesion in the lower spine may well involve damage to the intestines, particularly at the junction between the mobile intra-abdominal and the fixed retroperitoneal part of the gut. Reduction and stable fixation preserve the anatomy of the lower spine, while unstable fixation methods do not secure reduction sufficiently to allow early mobilisation.

Accidents, Traffic↗
PubMed1999

[Surgical treatment of low back pain].

Sciatica in low back pain is usually caused by lumbar disc herniation, degenerative spinal disease or lumbar spinal stenosis. Important pathogenetic factors are mechanical compression of and inflammatory changes in nerve roots caused by nucleus pulposus tissue. Decompression of nerve roots and removal of nucleus pulposus tissue are the main surgical goals. Emphasis should be placed on clinical identification of the symptomatic nerve roots. Computerized tomography (CT) and magnetic resonance (MR) imaging are the most important diagnostic tools today. Plain X-ray may be required for correct identification of the lowest mobile segment. Functional myelography combined with CT may be required to diagnose lumbar spinal stenosis. A proper selection of patients for surgery seems to be more important for a successful outcome than whether macro- or microsurgery is used, or wether the operation comprises one or several nerve roots. The combination of clear nerve root affection, mechanically provoced pain, and corresponding pathological findings at imaging are the best predictors of successful outcome. Psychosocial stability is an additional positive predictive factor. Impaired fibrinolysis occurring in smokers and in sedentary and obese patients, may be a negative predictive factor.

Decompression, Surgical↗
PubMed1999

[Early postoperative complications in carotid surgery].

Carotid endarterectomy has a documented stroke preventing effect in symptomatic high-grade carotid stenosis when the rate of serious complications is below 6%. In the period 1986-96, 160 procedures were performed on 150 patients at the Department of Neurosurgery, Ullevål Hospital. Oslo. The indication for surgery was hemispheric transient ischemic attack and/or amaurosis fugax in 137 patients and/or minor stroke in 49 in addition to a high-grade stenosis. Mean age was 61 years (42-74 years). One patient (0.6%) died four hours after surgery. Three patients (1.9%) suffered disabling postoperative stroke. The rate of serious complications was thus 2.5%. In addition, nine patients experienced minor and temporary paresis. Three patients were reoperated for haematoma and one for wound infection. Our surgical morbidity and mortality rate is comparable to larger series.

Aged↗
PubMed1999

A Norwegian nosocomial outbreak of methicillin-resistant Staphylococcus aureus resistant to fusidic acid and susceptible to other antistaphylococcal agents.

In Norway, infections caused by methicillin resistant Staphylococcus aureus (MRSA) are still uncommon. From December 1993 to January 1997, MRSA was isolated from 22 people in Oslo county; 17 patients and five carriers (healthcare workers). A cluster of ten people (five patients and five healthcare workers) were associated with an outbreak at two hospitals in Oslo. The five patients were all admitted to the same intensive care unit (ICU) at Ullevål University Hospital between May-July 1995 (they were not transferred from abroad) and treated for acute neurological lesions. After surgery, four of them (one died) were transferred to another hospital for rehabilitation and training. The presence of MRSA was discovered in the patients and the five healthcare workers during the 10 months June 1995-March 1996. All cluster strains showed an unusual antibiotic resistance pattern in vitro, with a relatively low degree of methicillin resistance, resistance to fusidic acid, but sensitivity to all other anti-staphylococcal agents. A clonal spread of this fusidic acid resistant MRSA was supported by strain typing using pulsed-field gel electrophoresis (PFGE), which showed that all ten cluster strains belonged to one type or its subtype.

Adolescent↗
PubMed1999

Seven-year clinical follow-up after lumbar disc surgery: results and predictors of outcome.

This study evaluates the 7-year outcome of lumbar disc surgery and the predictive value of pre- and perioperative risk factors. The 7-year follow-up rate of a sample of 122 patients was 93% (n = 114). Six per cent of the patients had undergone repeat surgery. Approximately 90% reported that they were satisfied with having undergone surgery. The clinical outcome was evaluated in 96 patients (54 men and 42 women) by means of patient-scores (VAS) of low back and leg pain, and a Clinical Overall Score (COS). In multivariate regression analyses, women were shown to have poorer outcome than men. Preoperative psychological distress and impaired fibrinolytic activity were predictors of poor 7-year outcome. Age, weight, smoking habits and physical fitness had no statistically significant prognostic value. Whether the patients were operated for one or two herniated discs, or whether surgery involved a full or partial laminectomy, did not influence the outcome significantly.

Adaptation, Psychological↗
PubMed1998

Influence of fibrinolytic factors on scar formation after lumbar discectomy. A magnetic resonance imaging follow-up study with clinical correlation performed 7 years after surgery.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To assess the amount of scar tissue by viewing magnetic resonance images, and to evaluate the correlation between the amount of scar tissue and clinical outcome, surgical technique, and fibrinolytic factors. SUMMARY OF BACKGROUND DATA: The influence of fibrinolytic factors on magnetic resonance images has not been investigated previously. The relation between clinical outcome and findings on magnetic resonance imaging remains uncertain. METHODS: Magnetic resonance imaging at 0.5 Tesla was performed to produce sagittal and axial spin-echo T1-weighted images before and after contrast enhancement on 78 patients 7 years after traditional lumbar discectomy with partial or full laminectomy. Before surgery all patients had been tested for fibrinolytic factors. RESULTS: The overall clinical success rate of the surgery was 73%. No evidence of scar formation was seen in 19 patients, a small amount was seen in 36 patients, a moderate amount in 17 patients, and a large amount was observed in 6 patients. Ten patients who had undergone surgery at two disc levels and 18 who had been treated with full laminectomy exhibited more scar tissue than those patients who had undergone surgery on a single level (P = 0.033) and those who had undergone a partial laminectomy, respectively (P = 0.017). The amount of scar formation also was associated with a poor outcome (P = 0.017) and with low preoperative values of tissue plasminogen activator antigen (P = 0.003) and tissue plasminogen activity (P = 0.048) in samples collected after venous occlusion. The intensity of contrast enhancement, however, was not influenced by these or any other parameters. CONCLUSION: The amount of scar formation after lumbar discectomy seems to be related to the clinical outcome, the size of the surgical exposure, and some fibrinolytic factors.

Adolescent↗
PubMed1998

[Methicillin resistant yellow staphylococci].

The incidence of methicillin-resistant Staphylococcus aureus in Norway is extremely low. Isolation of such strains is nearly always associated with import. From December 1993 to January 1997 at the Ullevål University Hospital Department of Medical Microbiology, methicillin-resistant Staphylococcus aureus was isolated from 22 persons in Oslo (17 patients and five healthy carriers). A cluster of ten infected persons was detected (five patients and five carriers (nurses)) who were infected with strains showing an unusual antibiotic resistance pattern. All of the cluster strains except for beta-lactams were resistant to fucidic acid and sensitive to other antistaphylococcal agents. The cluster was associated with two hospitals. The five patients were all admitted to the same intensive care unit during the period May to July 1995. Four of the five patients (one died) were referred to the same department in a long-term care hospital for rehabilitation and training. Problems concerning epidemiological investigation and control are discussed.

Adolescent↗
PubMed1998

Background variables (medical history, anthropometric and biological factors) in relation to the outcome of lumbar disc surgery.

In a prospective cohort study 122 patients with herniated intervertebral lumbar disc and no previous low back surgery preoperatively were assessed regarding medical history, anthropometric and biological background variables. The outcome of surgery (traditional methods) was evaluated one year postoperatively, mainly using a composite Clinical Overall Score (COS), including pain intensity, physical signs, functional capacity and analgesics. Return to work was also assessed. In regression analyses, low body height, high values of weight and body mass index, as well as long duration of sickness absence were shown to be significantly related to a poor outcome, as evaluated by the COS. However, after controlling for modifying effects of previously determined predictive fibrinolytic and psychological variables, the background variables lost their significance. Female sex, low stature, long duration of sickness absence and physically strenuous work activities were statistically significantly related to lower frequencies of return to work.

Body Height↗
PubMed1998

[Sciatica--diagnosis and surgical management].

Sciatica (a term used synonymously with lumbar radiculopathy) is usually caused by lumbar disc herniation or lumbar spinal stenosis. Mechanical compression of nerve roots is a predominant factor, and decompression the surgical goal. Emphasis should be placed on clinical identification of the nerve roots causing the complaint. Although computed tomography (CT) and magnetic resonance imaging (MRI) are the most important diagnostic tools used today, plain x-ray may be required for correct identification of the lowest mobile segment, and the functional myelography combined with CT may be required if lumbar spinal stenosis is suspected, or if the clinical findings are unclear--especially if the patient has already undergone surgery for sciatica. The proper selection for candidates for surgery seems to be a more important determinant of successful outcome than whether macro- or micro-surgery is used, or whether one or more segments are operated upon (12, 13). Clear clinical identification of the roots affected and corresponding pathological findings at imaging are the best predictors of successful surgical outcome, an additional factor of positive predictive value being psychosocial stability. Impaired fibrinolysis, occurring in smokers and in the sedentary and obese, may be a negative predictive factor (10, 11). Published findings suggest that, unlike the case with disc surgery (9), neither long duration of symptoms nor long preoperative sick leave is associated with poor outcome of surgery for spinal stenosis (14).

Female↗
PubMed1997

Combined endovascular and surgical treatment in vertebral arteriovenous fistula. A case report.

A 7-year-old girl with a right-sided congenital arteriovenous fistula in the neck was admitted with signs of cardial incompensation. Her fistula was fed from the right vertebral artery in antegrade as well as retrograde directions. A steal from the intracranial arteries was established. In addition, smaller feeding arteries from the neck were found. She was operated on with ligation of the right vertebral artery proximal to the fistula but the attempted ligation of the artery cranially to the fistula was unsuccessful. She was therefore embolized by the formation of a plug of platinum fiber coils in the upper right vertebral artery. Catheterization was performed from the left vertebral artery via the basilar artery. Persisting minor feeders to the fistula from cervical arteries were embolized in a second session. Finally, surgical extirpation of the fistula was performed together with the operative ligation of a crossover feeding artery from the left vertebral artery. Her heart size, heart rate and blood pressure were successively normalized.

Arteriovenous Fistula↗
PubMed1997

Neuropsychological course after surgery for intracranial aneurysms. A prospective study and a critical review.

Previously, only three studies with representative samples of patients with ruptured intracranial aneurysms have provided detailed results of prospective, repeated, neuropsychological assessments after surgery. These studies apparently disagree with regard to occurrence of cognitive deficits and to degree of improvement between early and delayed follow-ups. The present paper attempts to analyze the conditions underlying these differences in results. As a first step in this analysis we present a comprehensive, prospective, neuropsychological investigation of a consecutive sample of 41 patients with rupture of a supratentorial aneurysm, assessed 4 and 12 months after surgery. It is concluded that a prorated course of improvement of a wide specter of psychological functions may be revealed, but that sensitive tests and large samples are needed to establish the range of deficits and improvements with time. Differences in patient selection with respect to severity of the acute clinical state and delayed deterioration apparently contribute importantly to the discrepance in previously reported outcome.

Adolescent↗