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J Thomsen

Publications and source records attributed to J Thomsen.

At least 37 records · Page 2Linked to original sources
PubMed2000

Intracanalicular vestibular schwannoma--therapeutic options.

The growth of purely intrameatal vestibular schwannoma (VS) was investigated in a series of 40 patients with 40 unilateral VS in the period 1973 to 1996 (mean 3.6 years). Twenty-seven tumours (67.5%) revealed growth and 13 tumours (32%) had no measurable growth. Four growth patterns were observed: (i) 15 tumours (37.5%) exhibited constant growth; (ii) 13 tumours (32.5%) had no measurable growth; (iii) 8 tumours (20%) revealed growth subsequent to a no-growth period; and (iv) 4 tumours (10%) manifested different growth patterns during the observation period. The mean diameter growth per year was 3.2 mm. The findings of the present study, especially those achieved in groups B (the non-growing tumours) and C (tumour growth subsequent to a silent period), question the reliability of the results achieved by radiosurgery, as no tumour growth may occur with no intervention.

Adolescent↗
PubMed2000

Round window gentamicin mu-catheter--a new therapeutic tool in Ménière's disease.

The vestibulotoxic effect of gentamicin is well documented; however, there is no general agreement on the gentamicin dose needed to control vertigo attacks without affecting the hearing. In the current study, 14 patients with Ménière's disease refractory to medical treatment were treated by small doses of gentamicin delivered via a mu-catheter, placed into the round window niche. An electronic micropump delivered 10 microliters (100 micrograms)/h. The patients received a total dose of 4-14 mg. The effects on the vestibular symptoms were most encouraging, with cessation of vertigo in 13 of the 14 patients, control of Tumarkin attacks in 4 out of 6 cases and release of aural pressure and fullness in 2 out of 4 cases. According to the recommendations of the Committee on Hearing and Equilibrium, the patients in this material belonged to functional levels 5 and 6. At the last clinical follow-up, five patients were classified as level 1, eight patients as level 2 and one patient as level 3. A significant hearing loss was seen in one patient; however, this was most likely due to the natural development of the disease in this particular case. The results look promising, but must be investigated further in a placebo-controlled study.

Adult↗
PubMed2000

Surgical outcome in malignant parotid tumours.

Of 494 parotid gland tumours treated in Copenhagen county (population 600,000 inhabitants) in the period 1986-95, 50 patients (34 males, 16 females) had tumours that were proven to be malignant, making an incidence of 0.62/100,000/year. The patients age ranged from 14 to 87 years, mean 64 years. According to the UICC classification system, 6 tumours (12%) were classified as stage I, 23 (46%) as stage II, 14 (28%) as stage III, and 7 (14%) as stage IV. The material included 41 primary parotid gland tumours, histologically the tumours were verified as mucoepidermoid carcinoma (n = 13), adenocarcinoma (n = 9), squamous cell carcinoma (n = 6), carcinoma ex pleomorph adenoma (n = 3), acinic cell carcinoma (n = 3), adenoid cystic carcinoma (n = 3) and other histological diagnoses (n = 4). Primary malignant lymphoma of the parotid gland was diagnosed in six tumours and the last three tumours were metastatic carcinoma. Four therapeutic modalities were applied: surgery only, surgery + radiation, surgery + chemotherapy, and surgery + chemotherapy + radiation. Surgical radicality was achieved in 76% and radicality was unrelated to tumour histology. Normal or nearly normal facial nerve function (HB1&2) was noted at last follow-up in 60%. Five-year crude survival for all patients was 68%. Survival was not dependent on N-classification. Patients in stage I had a better survival than did patients in stages II, III and IV. No significant difference was observed in 5-year crude survival or in the post-operative facial nerve function between the radically operated patients (n = 38) and patients with residual tumour (p = 0.27, Log-rank test), (p = 0.48, chi 2 test).

Adolescent↗
PubMed2000

Middle fossa approach in vestibular schwannoma surgery. Postoperative hearing preservation and EEG changes.

When the middle fossa (MF) approach was introduced in Denmark, we were concerned about the possible risk to the temporal lobe caused by the retraction of the lobe when exposing the internal acoustic meatus. EEG recordings were therefore obtained prospectively before (21 patients) and after MF tumor removal (all 23 patients operated from 1989 to 1997). Only three patients had normal EEG recordings before and after surgery, while 86% had induction, or worsening, of focal and paroxystic activity, even at the last follow-up (median 3.5 years). Sixteen patients operated prospectively via the translabyrinthine (TL) also had pre- and postoperative EEG and served as a control group. Only minor EEG changes were found in this group. In neither group did the patients display any clinical neurological signs (seizures). At the latest evaluation the facial function was reduced in 8 patients (35%) with 6 patients going 1 step up the scale, 1 patient 2 steps up and 1 patient 3 steps up (from HB-1 to HB-4). The integrity of the facial nerve was maintained in all patients. Postoperatively, 10 patients (44%) had useful hearing (hearing class A and B) on the operated side. Four patients had anacusis and an additional 4 patients were reduced to hearing class D with very low PTA and SDS. In total, 9 patients (39%) retained their preoperative hearing class, while 14 patients (61%) had impairment in their hearing class. In conclusion, EEG changes (low frequency activity and IEA) may be provoked or worsened as part of the middle cranial fossa procedure. The mechanism is not fully known, but may reflect peroperative pressure on the temporal lobe. EEG changes are fewer and lighter in translabyrinthine-operated patients. The practical clinical implications of the possibility of developing EEG changes, even without clinical signs, are potentially serious, and must be included in the information given to the patients before surgery.

Adult↗
PubMed2000

Vestibular schwannoma growth: the continuing controversy.

OBJECTIVE: To investigate the growth of vestibular schwannoma (VS) in a series of 123 patients with 127 tumors allocated to the "wait and scan" group in the period 1973-1999. STUDY DESIGN: Retrospective review of prospectively registered data on all patients with VSIE from the entire country who were allocated to the wait and scan group. METHOD: Clinical charts, audiometric data, and neuroradiological images were reviewed and tabulated for age, hearing level expressed as speech reception threshold (SRT) and speech discrimination score (SDS), maximum extra-canalicular tumor extension, and possible changes in tumor diameter. The material was updated three times (in June 1993, June 1996, and June 1999). Via the Danish national register, data on whether the included patients were alive or dead were collected in 1999. RESULTS: The tumor growth, growth rate, and growth patterns were calculated in three periods 1973 to 1993 (mean observation period, 3.4 y), 1973 to 1996 (mean observation period, 3.8 y), and from 1973 to 1999 (mean observation period, 4.2 y). By termination of the first period, 94 tumors (74%) exhibited measurable growth, 23 tumors (18%) no measurable growth, and 10 tumors (8%) revealed negative growth. By the end of the extended observation period, tumor growth was observed in 104 tumors (82%), no tumor growth in 15 tumors (12%), and negative growth in 8 tumors (6%). Subsequent to the third observation period, growth was observed in 108 tumors (85%), no growth in 11 tumors (9%) and negative growth in 8 tumors (6%). However, the results may also be interpreted in another way: 52 patients (42%) were alive at the time of writing, tumor growth did not demand any intervention, 23 patients (19%) died as a result of non-tumor-related causes, and 35 patients (28%) were previously treated and alive by the termination of the third observation period. CONCLUSION: Depending on the observation period, three sets of growth results were obtained. The long observation period, updating and re-updating the results, gave us the opportunity for a de novo interpretation of the results and the long-term consequences of the wait and scan policy. Combined with other factors, the achieved results should be considered when timing of surgery is to be decided.

Adolescent↗
PubMed2000

Meningitis following stapedotomy: a rare and early complication.

Controversy exists concerning stapedotomy for patients with small unilateral air-bone gaps. Surgical treatment of otosclerosis involves an opening to the labyrinth and accordingly, a risk of complications, usually vertigo and sensorineural hearing loss and infrequently anacusis. In this paper we present a 33-year-old woman with a small unilateral air-bone gap, who developed bacterial labyrinthitis with meningitis and anacusis three days after stapes surgery. The patient had a stapedotomy with the small fenestra piston prosthesis technique. Due to the potential for serious complications, patients with unilateral otosclerosis and mild hearing loss should be given the possibility to choose between a hearing aid and surgery. Although stapedotomy in the vast majority of interventions is a highly successful procedure and the best method of treatment for otosclerosis if successful, there is a high price to pay in the event of failure.

Adult↗
PubMed2000

Cystic vestibular schwannoma: surgical outcome.

We investigated the proportion of the cystic form of vestibular schwannoma and assessed the results of surgery in this subtype of the condition. The definition of cystic vestibular schwannomas was based on the following criteria: per-operative identification of cystic components; occurrence of the hypodense/hypointense areas on computed tomography (CT) and/or magnetic resonance (MR); and histological verification of S-100 protein membrane-like structures. In a study of 773 Danish patients with vestibular schwannomas, 44 (5.7 per cent) displayed cystic components. The outcome of surgery on 44 cystic vestibular schwannoma (mean tumour size 39 mm) was evaluated and compared with that for 151 solid grant vestibular schwannoma (mean tumour size 49.8 mm). Per-operatively, we found a substantially higher adherence to different intracranial structures in the solid giant vestibular schwannoma compared with the cystic vestibular (95 per cent vs 70 per cent for brainstem, 91 per cent vs 59 per cent for trigeminal nerve, 85 per cent vs 45 per cent for cranial nerves X and XI, 67 per cent vs 32 per cent for dura). Nevertheless, the preservation of the facial nerve function was much better in patients with solid giant vestibular schwannoma compared with those with cystic vestibular schwannoma (House-Brackmann facial nerve dysfunction grade 6 (one year post-operative): 27 per cent vs 41 per cent, respectively p < 0.04). We conclude that the cystic components in vestibular schwannoma are associated with a less favourable surgical outcome, probably due to the rapid tumour growth and symptoms caused by compression of the posterior fossa structures.

Adult↗
PubMed1999

Alternatives to tracheostomy in infants and children with obstructive sleep apnea.

PURPOSE: Since 1989, 70 children have been treated surgically with varying degrees of obstructive sleep apnea (OSA). Of these, 29 patients had completely failed conventional medical and surgical treatment and were considered tracheostomy (T) candidates, whereas five had previously undergone T for severe OSA as infants and did not respond to standard decannulation protocols. The preoperative diagnoses were cerebral palsy (n = 5), Down's syndrome (n = 5), hemifacial microsomia (n = 4), Pierre Robin sequence (n = 6), and a mixed group of craniofacial disorders (n = 14). The patients ranged in age from 2.5 weeks to > or =18 months (mean, 7.32 years). Preoperatively, four patients were on ventilators and one suffered a cardiac arrest, attesting to the severity of OSA. METHODS: To enlarge the caliber of the airway, each patient underwent an aggressive surgical treatment protocol. All sites of upper airway obstruction were treated simultaneously by a combination of craniofacial skeletal expansion and soft-tissue reduction. RESULTS: Tracheostomy was avoided in 90.4% of patients. Temporary or "permanent T" were required in three patients (9.6%). One patient with cerebral palsy had recurrent OSA and died. A second patient with severe laryngotracheomalacia and retrognathia who did not respond to apnea surgery underwent a tracheostomy and ultimately died of pulmonary causes. Four patients (7.8%) required supplemental home oxygen or continuous positive airway pressure. The average preoperative respiratory disturbance index, defined as the average number of apneic and hypopneic events per hour of sleep, dropped from 25.9 to 4.4 after surgery. The average lowest recorded oxygen saturation during overnight polysomnography rose from 61% to 92% after surgery. Of the five patients with permanent T, four had thus far been decannulated. Complications occurred in 10 patients, 50% of which were related to minor problems with mandibular distraction devices. CONCLUSION: Our results confirm the efficacy of an aggressive surgical approach to the treatment of OSA in children, avoiding the necessity for tracheostomy or permitting decannulation of permanent T in the majority of cases.

Child↗
PubMed1999

Management of intrameatal vestibular schwannoma.

The growth of purely intrameatal vestibular schwannoma (VS) was investigated, in the period 1973-96 in a series of 40 patients with 40 unilateral VS. In the present study, the material was analysed and updated. By the end of the observation period (mean 3.6 years), 27 tumours (67.5%) revealed growth and 13 tumours (32%) had no measurable growth. Four growth patterns were observed: (A) 15 tumours (37.5%) exhibited constant growth; (B) 13 tumours (32.5%) had no measurable growth; (C) 8 tumours (20%) revealed growth subsequent to a no-growth period; and (D) 4 tumours (10%) showed different growth patterns during the observation period. The annual diameter growth rate ranged between 00 mm/year and 6.5 mm/year and the mean diameter growth per year was 3.2 mm. The findings of the present study, especially those for group B (the non-growing tumours) and C (tumour growth subsequent to a silent period) bring into question the reliability of the results achieved by radiosurgery, as without any intervention it may be that no tumour growth occurs.

Adolescent↗
PubMed1999

Incidence of vestibular schwannomas.

OBJECTIVE: To determine the incidence of vestibular schwannoma (VS) in Denmark in a period of 191/2 years. STUDY DESIGN: Retrospective review of prospective registered data on all patients with VS operated on by the translabyrinthine, lateral suboccipital, or middle cranial fossa approach, as well as patients who were allocated to the "wait-and-scan" group. METHODS: Charts were reviewed and tabulated for age, extrameatal tumor extension, and date of diagnosis. The available data were divided into three periods: June 1976 to June 1983, July 1983 to June 1990, and July 1990 to December 1995. RESULTS: The number of newly diagnosed tumors in the first period was 278, corresponding to an incidence of 7.8 tumors/million population per year; in the second period 337, corresponding to an incidence of 9.4 tumors/million population per year; and in the third period 355, corresponding to an incidence of 12.4 tumors/million population per year. A significant increase in incidence of the newly diagnosed intracanalicular tumors in the second and third periods was observed. CONCLUSION: The increase in incidence of VS can probably be explained by the awareness among otolaryngologists of the diagnosis of VS and better access to computed tomography and magnetic resonance imaging scans. The observed increase in the diagnosis of the small and intrameatal tumor creates a clinical dilemma, whether to operate on tumors in this early stage or to allocate patients to the wait-and-scan group. This problem will still be relevant in the upcoming years, since the incidence of intrameatal and small VS is expected to increase.

Denmark↗
PubMed1999

Dietary calcium and bone density in adolescent girls and young women in Europe.

The objective of this study was to investigate the association between dietary calcium intake and radial bone density among young women, over the whole range of intake and at different levels of calcium intake. The study design was a cross-sectional, observational multicenter investigation in six European countries. One thousand one hundred and sixteen healthy Caucasian girls aged 11-15 years and 526 women aged 20-23 years participated, after having been selected from larger population samples to represent a large range in calcium intake. Bone mineral density (BMD) was measured with dual-energy X-ray absorptiometry at the ultradistal and middistal radius. Calcium intake was assessed with 3-day food records. Other potential determinants of BMD were measured by anthropometry or questionnaires. Mean calcium intake among the girls varied between 609 mg/day in Italy and 1267 mg/day in Finland; intakes for women were in a similar range. After adjustment for height, weight, and age at menarche for the women, and adjustment for age, height, weight, Tanner stage, and bone area for the girls, radial BMD at both sites did not significantly vary among quartiles of calcium intakes for both age groups. In multivariate linear regression, calcium was weakly positively associated with BMD at both sites in the girls (per 100 mg of calcium: beta = 0.57 mg/cm2, p = 0.03 for middistal BMD and beta = 0.56 mg/cm2, p = 0.01 for ultradistal BMD). For middistal BMD, the association was observed predominantly in pre-menarcheal girls. The associations were no longer statistically significant after full adjustment for all determinants of BMD, except again in pre-menarcheal girls. Radial BMD in the women was not associated with calcium intake, except after full adjustment for determinants of BMD, when ultradistal BMD became inversely associated with calcium intake (per 100 mg beta = -1.02, p = 0.03); this finding was due to results in one of the countries and not found in other countries. There was no evidence for a different relation between calcium and BMD at different levels of intake; although there was a positive association at calcium intake levels < 600 mg/day, the interaction was not significant and there was no consistent trend over intake categories. These results do not support the hypothesis that dietary calcium is a determinant of peak BMD in European women, for a wide range of intake. This study does not provide evidence that Recommended Dietary Allowances for calcium should be increased.

Adolescent↗
PubMed1999

The hemispherical Harris-Galante acetabular cup, inserted without cement. The results of an eight to eleven-year follow-up of one hundred and sixty-eight hips.

We studied the results for 168 available hips from a series of 324 consecutive primary total hip arthroplasties that had been performed with insertion of a Harris-Galante-I acetabular component without cement. The acetabulum had been reamed in a so-called line-to-line manner, and the cup had been fixed with one to four screws. A femoral component with a modular alumina-ceramic head had been inserted with cement in all hips. The median duration of follow-up was 112 months (range, 101 to 131 months). Of the original 324 hips, 109 could not be included in the clinical and radiographic follow-up because the patients had died and thirty could not be included because the patients were not available for examination. Seventeen hips had had a revision of the acetabular cup: five, because of infection; five, because of dislocation; three, because of aseptic loosening; and four, because of technical failure. This left 168 hips for clinical and radiographic follow-up; of these, fifteen had had a revision of the femoral component only. Of the remaining 153 hips, which had not had a revision, 147 (96 percent) were considered by the patient to have a satisfactory, good, or excellent result. One hip was found to have a loose cup on radiographic evaluation and was therefore considered to have failed, but the clinical function was good. We concluded that, with an overall rate of aseptic loosening of 1 percent (four of 324) after an intermediate (ten-year) duration of follow-up, use of this cup has good results.

Acetabulum↗
PubMed1998

Treatment of children with secretory otitis media (SOM) with amoxicillin and clavulanic acid (Spektramox) or penicillin-V (Primcillin). Bacteriological findings in the nasopharynx before and after treatment.

A total of 386 children, aged 1-10, with secretory otitis media for at least 3 months were randomly allocated to 2 or 4 weeks' treatment with penicillin-V (Primcillin) or amoxicillin + clavulanic acid (Spektramox). Spektramox was superior (p < 0.01) to Primcillin in eradicating Haemophilus influenzae and Branhamella catarrhalis from the nasopharynx. No difference was noted for Streptococcus pneumoniae and haemolytic streptococci, gr. A, B, C, G. No increase in the number of beta-lactamase-producing bacteria was noted after treatment. The nasopharynx was recolonized with the same bacteria within 4 weeks from cessation of treatment.

Amoxicillin-Potassium Clavulanate Combination↗
PubMed1998

Problems in recruiting patients to controlled trials on children with secretory otitis media: a demographic comparison of excluded versus included patients.

One thousand one hundred and sixty-four patients formed the pool of patients from which we intended to recruit children to a controlled trial evaluating the efficacy of amoxicillin-clavulanate and penicillin-V in the treatment of secretory otitis media (SOM). Only 360 patients ended up to be evaluated, consisting only 30% of the primarily involved patients. The spontaneous improvement of the tympanometric condition was the major course of pre-trial dropouts. The demographic composition of included and excluded patients did not differ, as one might have expected. Very little has previously been published about this great number of excluded patients even though other authors must have had the same experience. It is concluded that a 3-month duration of SOM, evaluated by tympanometry by the investigators, is required as a minimum to qualify for entering a trial evaluating SOM.

Acoustic Impedance Tests↗
PubMed1998

Clinical experience with vestibular schwannomas: epidemiology, symptomatology, diagnosis, and surgical results.

The Danish model for vestibular schwannoma (VS) surgery has been influenced by some historical otological events, taking its origin in the fact that the first attempt to remove CPA tumors was performed by an otologist in 1916. In approximately 50 years VS surgery was performed by neurosurgeons in a decentralized model. Highly specialized neuro- and otosurgeons have been included in our team since the early beginning of the centralized Danish model of VS surgery in 1976. Our surgical practice has always been performed on the basis of known and proven knowledge, but we spared no effort to search for innovative procedures. The present paper reflects the experience we have gained in two decades of VS surgery. Our studies on the incidence, symptomatology, diagnosis, expectancy and surgical results are presented.

Craniotomy↗
PubMed1998

Microsurgical technique in thyroid surgery--a 10-year experience.

OBJECTIVE: To report the results of thyroid surgery in a University department of ENT--head and neck surgery, and to evaluate the benefits of the use of the surgical microscope in thyroid surgery. DESIGN: A retrospective evaluation of the records of all patients who underwent thyroid surgery in the 10-year period 1987-1996. METHODS: In addition to standard surgical principles the Zeiss multi-discipline universal surgical microscope with a 250 mm ocular lens was used in all cases. Total thyroidectomy was performed in all malignant cases, while unilateral lobectomy plus isthmus resection was the standard procedure in benign cases. PATIENTS: There were 573 patients, aged 11-87 years, 444 females and 129 males. Four hundred and fifty-one had benign lesions, 122 malignant. Four hundred and eighty-nine had primary surgery, 84 underwent completion surgery or surgery for recurrent disease. RESULTS: Primary thyroid gland surgery in benign/malignant disease resulted in permanent recurrent laryngeal nerve palsy in 0.6 per cent/3.5 per cent of the patients respectively, when calculated as nerves at risk (NAR). In benign recurrent or malignant completion surgery this complication rate was 4.5 per cent/2.9 per cent respectively. CONCLUSION: Thyroid surgery in our University ENT--Head and Neck Department with the use of the surgical microscope provides pleasing results, especially considering the diversity of surgeons, due to the departments' teaching responsibilities.

Adolescent↗
PubMed1998

The non-specific effect of endolymphatic sac surgery in treatment of Meniere's disease: a prospective, randomized controlled study comparing "classic" endolymphatic sac surgery with the insertion of a ventilating tube in the tympanic membrane.

A prospective, randomized study was carried out comparing the effect of two surgical modalities in the treatment of patients with Meniere's disease: insertion of an endolymphatic sac shunt and insertion of a ventilating tube in the tympanic membrane. A total of 29 patients, 12 males and 17 females, age 27-71 years, were operated on in two ear, nose and throat (ENT) departments. Of these patients, 15 had an endolymphatic shunt inserted and 14 had a ventilating tube inserted in the tympanic membrane. Postoperative follow-up was carried out in the department in which the patients had not been operated. The severity of the disease was scored pre- and postoperatively, and the results evaluated under the guidelines of the Committee on Hearing and Equilibrium (1995) for the diagnosis and evaluation of therapy in Meniere's disease. The patients in both groups had a statistically significant reduction in dizzy spells, measured 6 and 12 months postoperatively, and there was no difference between the groups. The pathophysiological explanation for the reduction in dizzy spells in each of the treatment modalities is debatable and the effect is non-specific. The patients' hearing and tinnitus were statistically unaffected by the treatment in both groups, though 2 patients in the shunt group developed severe hearing loss (anacusis/70 dB).

Adult↗