Biomedical subjects
Publications and source records attributed to C Gyldensted.
The recent refinement of super-selective angiography and subsequent embolisation offer new promising possibilities in the treatment of central haemangiomas in the maxillo-facial area, either as a pre-operative measure allowing safer surgical removal, or as definitive therapy. Two cases of central haemangiomas of the maxilla are presented, both treated successfully by embolisation.
Twenty patients suspected of meningeal carcinomatosis (MC) secondary to small cell carcinoma of the lung were evaluated by myelography and by cytologic examination of cerebrospinal fluid (CSF). In 4 patients both investigations demonstrated MC. Four had positive cytology but a negative myelogram. Five patients had a positive myelogram but negative cytology. Thus 13 of the 20 patients had MC diagnosed by one or both of these investigations. Two additional patients suspected of MC were studied; both had positive myelography, but cytologic examination of CSF was not performed in either case. Six patients underwent autopsy with microscopic examination of the spinal cord; in all cases post-mortem findings supported myelographic findings. In conclusion, myelography is useful in the evaluation of patients suspected of MC secondary to small carcinoma of the lung and complements the diagnostic role of CSF examination.
Explore the source record for details and available documents.
Forty-four untreated patients with an enlarged sella were studied (excluding patients with acromegaly, Cushing's disease, and those with radiological evidence of suprasellar extension). In 20 patients CT revealed a completely or partially empty sella. Based on recent studies we take this finding to signify the previous presence of a pituitary adenoma which has undergone complete or partial necrosis. Ten of the 20 patients had in fact experienced symptoms typical of a pituitary apoplexy compared with only one out of the other 24 patients. Adrenal, thyroid, and growth-hormone insufficiency occurred as often in patients with an empty sella as in those with a solid pituitary tumour. In contrast, plasma prolactin levels were much lower in patients with an empty sella than in patients with a solid tumour (11 vs 166 ng/ml). It is assumed that this discrepancy reflects previous necrosis occurring in an adenoma hypersecreting prolactin. These results emphasize the importance of taking the spontaneous course of pituitary adenomas into account when assessing the effect of various treatment protocols.
During the period 1935-1976, 200 cases of brain abscess were treated in the University Clinic of Neurosurgery, Rigshospitalet, Copenhagen. 119 patients survived. Out of 40 deaths during the follow-up period, 37 were unrelated to the previous brain abscess. 12 patients emigrated and were lost to follow-up. History and neurologic examination of the remaining 67 surviving patients with follow-up periods of between 3 and 40 years (mean 18 years) showed no sequelae in 23, unrestricted working capacity in 46, epilepsy in 37, neurologic deficit in 18, and intellectual impairment in 13 patients. The most serious sequelae, incapacitating epilepsy and severe mental reduction, were seen in patients with brain abscess during childhood.
In 5 patients with definite or highly probable MS, unusually large hypodense plaques are seen by computerized tomography (CT scan). The active plaques all show enhancement after i.v. contrast medium injection, suggestive of blood-brain-barrier-damage, and differ from the well-known CT findings in chronic MS patients, causing diagnostic difficulties between glioma and infarction.
From 1935-1976 a total of 200 patients with cerebral abscesses were referred to the University Clinic of Neurosurgery, Rigshospitalet, Copenhagen. The primary source of infection could be established in 169 cases (85%). Bacteria could be cultured in 58% of the cases. From 1935-1957 nearly all patients were subjected to ventriculography (107/129). Cerebral angiography was the dominating diagnostic method from 1958-1974. Since then, 30 patients with a suspected intracranial abscess have been examined by computed tomography. The overall mortality has been 40%, but for the period 1958-1976 17%.
Cerebral blood flow (CBF) was studied in 11 controls and 9 house painters occupationally exposed to organic solvents for a mean of 22 years. They had mild to moderate intellectual impairment, and no or only minor cerebral atrophy was seen in a CT-scan of the brain. The 133Xe inhalation technique was used and the flow was calculated from the initial slope of the 133Xe wash out curve (ISI). ISI averaged 36.8 ml/100 g/min in the painters and 45.4 ml/100 g/min in the controls, representing a significant difference (P less than 0.05). The reduced CBF in these painters with slight to moderate intellectual impairment might be due to limited neuronal loss or to permanently decreased metabolism of the neurones.
In 44 consecutive patients with sellar volume larger than 1100 mm3, computer tomography showed that 20 had an empty or partly empty sella. None had radiological evidence of a suprasellar tumor. 10 of the 20 patients had experienced episodes with acute neurological symptoms presumably reflecting a pituitary apoplexy. It is suggested that an unknown proportion of intrasellar adenomas may disappear as a result of an infarction, which may comprise the entire adenoma or part of it--leaving an empty or partly empty sella as diagnosed by computer tomography. Air encephalography will demonstrate the empty sella only if the diaphragmatic aperture is large enough to allow cisternal herniation. The infarction may present clinically with no, slight or severe acute neurological symptoms. Late consequences of a pituitary adenoma infarction may be rhinorrhea or hydrocephalus.
15 consecutive patients with non-traumatic cerebrospinal fluid rhinorrhea were studied. 13 operations were performed on 10 patients. In 8 transcranial operations, an assumed defect in the anterior fossa was plugged with muscle, but only 3 operations were successful. In 4 operations, either transcranial or transsphenoidal, the sella was packed with muscle and rhinorrhea ceased immediately. Based on radiological and operative findings, 3 groups of patients appeared (1) 9 patients had pathology related to the pituitary gland or the sella turcica: enlarged sella, empty sella, pituitary tumour, intrasellar cyst or erosion of the sellar osseous border. (2) 2 patients had rhinorrhea from extrasellar origin. (3) In 4 patients no abnormality could be found. Prior to the rhinorrhea, 6 patients (5 from group 1 and 1 from group 3) had experienced episodes of neurological symptoms, compatible with a pituitary apoplexy. It is suggested that non-traumatic cerebrospinal fluid rhinorrhea in most cases is the result of a spontaneous necrosis in a pituitary adenoma, which has caused sellar bony erosion.
Ten patients with pseudotumor cerebri were studied. The diagnosis was based on bilateral papilledema and absence of intracranial masses and hydrocephalus. Based on the radiological findings, three groups of patients emerged: (A) Five patients with an empty sella. Four had an enlarged sella; (B) Two patients with a pituitary adenoma; and (C) Three patients without sellar or pituitary pathology. The onset of symptoms was acute in four patients, two from group A and one each from groups B and C. One patient from group A had a lesion of the chiasma. Two patients from group B and two from group C had symptoms and signs suggesting engagement of structures in the cavernous sinus. It is suggested that pseudotumor cerebri may be caused by bilateral compression of the cavernous sinuses because of acute necrotic swelling of a preexisting pituitary adenoma.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The prognosis of chronic toxic encephalopathy in former house painters was examined in a prospective study with a two-year observation period. Twenty-six patients, who at the initial examination had cerebral atrophy and/or intellectual impairment, were selected for the follow-up study. No competitive etiological factors (including alcohol) to the encephalopathy were suspected. During the two-year follow-up interval these patients were not professionally exposed to organic solvents. At the follow-up examination neurological, biochemical, neuropsychological, and neuroradiological parameters were reassessed and compared to the original findings. Generally the condition was unchanged. Slight improvements with regard to headache and dizziness were reported by some. However, the neurological status, the neuropsychological impairment, and the cerebral atrophy, did not change significantly. In three patients further deterioration was observed. It is argued that our patients suffered from a brain disorder different from presenile dementia of the Pick-Alzheimer type. Other alternative etiological entities were also excluded. Our findings indicate that long-term exposure to organic solvents may lead to a chronic brain syndrome. Once intellectual impairment and/or cerebral atrophy had developed, reversibility is not observed. Nor is further progression to be expected if exposure is stopped. Occupational exposure to organic solvents should be maximally restricted as it represents a risk of inducing invalidating brain syndromes.
The conductance to outflow of CSF (Cout) was measured in 66 patients with normal pressure hydrocephalus (NPH). All patients were investigated with computed tomography (CT); 34 of the patients also had pneumoencephalography (PEG). Periventricular hypodensity on CT indicates a low Cout. Cortical sulci smaller than 1.9 mm on CT indicate a low Cout, while wide cortical sulci do not exclude a low Cout. There was a good correlation between ventricular size on CT and PEG, but the ventricular size is unrelated to Cout. No findings on PEG indicate a low Cout.
The normal ventricular system and subarachnoid space were evaluated on the CT scans of 155 children chosen from 1,400 pediatric CT examinations, and linear measurements were made. The left septum-caudate distance was greater than the right, and the width of the left anterior horn and size of the skull were larger in boys. The interhemispheric and sylvian fissures, the third ventricle and Evans' ratio were larger in the younger group (less than 3 years) than in the older (greater than or equal to 3 years), while the opposite was found for the cella media index and size of the skull. The size of the lateral ventricles (expressed by anterior horn width, septum-caudate distance and width of cella media) was not different in the two age groups of children. Normal limits for the linear measurements and indices are given in Table 2.
Seventy house painters were examined after being referred because organic solvent intoxication of dementia was suspected. In 50 cases no competitive etiological factors to the cerebral symptoms other than exposure to organic solvents could be disclosed. In these, neuropsychological examination showed signs of intellectual impairment in 39 patients and neuroradiological examination by PEG or CT demonstrated the presence of cerebral atrophy in 31 patients; 38 patients studied with CT were compaired to an age-matched control group regarding maximum sulcus width, and a highly significant difference was found. It is argued that long-term exposure to turpentine substitute-often through a period with acute intoxication symptoms--gradually may lead to the development of a chronic brain syndrome, which we have called the "chronic painters' syndrome".