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Biomedical subjects

K Ericson

Publications and source records attributed to K Ericson.

At least 37 records · Page 2Linked to original sources
PubMed1998

Radiosurgery for cavernous malformations.

OBJECT: The authors examined 22 patients with cavernous malformations (CMs) who had undergone gamma knife radiosurgery (GKRS) to assess the value of this procedure in treating these lesions. METHODS: At the Karolinska Hospital, GKRS was used to treat 23 patients with CMs during the period of 1985 through 1996. One of the patients was lost to follow up and the treatment results of the 22 remaining patients were analyzed. In the first half of the series, the CMs were treated with high doses of radiation (> 15-Gy dose to the periphery); in the second half of the series, lower doses were used. Nine of the 22 patients suffered a post-GKRS hemorrhage and six developed a radiation-induced complication (two of these patients experienced both). Some time after GKRS was performed, surgical removal of the CM had to be undertaken in four patients because of hemorrhage and in two patients because of radiation-induced complications. Four of the nine patients who experienced no post-GKRS hemorrhage or radiation-induced complication were treated before 1990; recent magnetic resonance imaging revealed a decrease in the size of the CM in three of these individuals and no size change in the other. The annual post-GKRS hemorrhage rate was 8% in this group. There was a trend in the hemorrhage rate to decrease 4 years postsurgery. There was also a trend for higher radiation doses administered to the periphery of the lesion to result in a lower risk of posttreatment hemorrhage. However, it could not be concluded whether GKRS affects the natural course of a CM. The incidence of radiation-induced complications was approximately seven times higher than that expected if the same number of patients had been treated by GKRS with the same radiation dose distributions for arteriovenous malformations instead of CMs. CONCLUSIONS: The high incidence of radiation-induced complications does not seem to justify the limited protection the treatment may afford in only exceptional cases. A prospective randomized study is needed before the role of radiosurgery in the management of these lesions can be defined. Until such a study has proved differently, a caveat must be raised for the treatment of CM with GKRS.

Cavernous Sinus↗
PubMed1997

Construction of a standard reference for PET studies of methionine accumulation using a computerised brain atlas.

Positron emission tomography (PET) is valuable for assessing the biochemistry and physiology of the human brain. A computerised brain atlas has been developed which allows demonstration of anatomical regions of PET images and manipulation of these images into a standardised anatomical space. Once the images are in this standardised three-dimensional space it is possible to make comparisons between individuals and groups of individuals. We describe the use of this atlas in the generation of a set of mean reference images using methionine PET images of normal volunteers.

Adult↗
PubMed1997

Changes in motor performance in persons with Parkinson's disease after exercise in a mountain area.

For one week in autumn, over a period of three consecutive years, a total of 12 persons with Parkinson's disease (PD) participated in daily walks of about 4 kilometers in a mountain area in Sweden in order to train rhythm, balance and coordination on the soft heaths. These persons were 60-78 years of age and had been found to be between stage 1 and stage 3 on the Hoehn and Yahr Staging Scale. The aim of the study was to find out whether a week of daily walks in the Swedish mountains would affect the motor performance of persons with PD, objectively and quantitatively assessed by a computer-assisted, opto-electronic movement analysis program, the Posturo-Locomotor-Manual (PLM) test. As compared with those before the journey, the results showed improved motor performance both immediately after the walking week and also at 3 but not 6 months later. The first year of participation showed the most pronounced improvements. The results demonstrate a long-lasting improvement in decreased movement time, indicating enhanced general motor performance and also an improved simultaneous index (SI), indicating a possible effect on the central nervous system. These findings, along with participants' narratives about what they did after returning home, may be indicative of strengthened self-confidence.

Aged↗
PubMed1997

X-ray angiography in stereotactic conditions: techniques and interest for interventional neuroradiology.

This paper reports work in progress on X-ray angiography acquired under stereotactic conditions. The objective is to be able to match multimodality images (typically MRI and X-ray) without a stereotactic frame but with stereotactic precision. We have identified potential problems and have studied them in detail. We conclude that, although the overall application is feasible, much work remains to be done on the estimation of the X-ray system conic projection and on automatic matching based on vascular structures.

Angiography, Digital Subtraction↗
PubMed1997

Tumor seeding following stereotactic biopsy of brain metastases. Report of two cases.

In a series of 22 patients treated with gamma knife surgery for brain metastasis in whom biopsy specimens were obtained via stereotactically guided procedures before the radiosurgical treatment was administered, two cases with evidence of tumor seeding were observed on subsequent follow-up examination. These findings contradict the opinion that the risk for tumor spread after a biopsy is negligible. This evidence may be explained by the fact that radiosurgery leaves the surrounding tissue unaffected by the treatment, which results in preserved anatomy around the tumor. This allows the surgeon to define the previous biopsy channel and, consequently, whether a distant tumor recurrence may have resulted from tumor seeding related to the biopsy procedure. Additionally, radiosurgical treatment leaves tumor cells that may have been spread as a result of the biopsy unaffected, giving them the potential to divide and develop into a new tumor. In contrast to this, microsurgical removal of the tumor will affect the surrounding tissue, making it impossible to detect whether new metastases are resulting from seeding. Furthermore, conventional fractionated radiation therapy will sterilize tumor cells that may have spread, thus making it impossible for these cells to regrow. The authors conclude that the risk for tumor seeding following a stereotactically guided biopsy may be higher than previously assumed.

Adult↗
PubMed1996

Tumor suppressor p16INK4A: structural characterization of wild-type and mutant proteins by NMR and circular dichroism.

The tumor suppressor p16INK4A with eight N-terminal amino acids deleted (p16/delta 1-8) was expressed in Escherichia coli without any fusion artifacts and purified. The integrity of p16/delta 1-8 was confirmed by mass spectrometry, and its activity was demonstrated by in vitro cdk4 inhibition assay. Various physical methods were used to characterize the molecular and structural properties of p16/delta 1-8. The protein was found to oligomerize in vitro, as demonstrated by gel electrophoresis, mass spectrometry, and NMR. Various approaches, including changes of concentration and pH, additions of salts, detergents, and various organic solvents, and construction of a C-terminal deletion mutant and a cysteine mutant were used to try to reduce the extent of oligomerization. Only decreasing the protein concentration was found to reduce oligomerization. The affinity between p16 molecules in vivo was demonstrated by the yeast two-hybrid system. The protein was found to be very unstable on the basis of urea- and guanidinium chloride-induced denaturation studies monitored by NMR and CD, respectively. Despite these unfavorable properties, total NMR assignments were accomplished with uniform 13C and 15N isotope labeling. All multidimensional NMR experiments were performed at a very low concentration of 0.2 mM. The secondary structure was then determined from the NMR data. The results of NMR and CD studies indicate that the protein is highly alpha-helical, and the ankyrin repeat sequences show helix-turn-helix structures. This is the first structural information obtained for the important motif of ankyrin repeats. Overall, p16/delta 1-8 appears to be conformationally flexible. In order to understand the structural basis of the functional changes for some mutants existing in tumor cells, several missense mutants of p16/delta 1-8 were constructed. Four of them were expressed at high levels and purified. The molecular and structural properties of these mutants were analyzed by CD and NMR and compared with the corresponding properties of wild-type p16/delta 1-8. The results suggest that the functional changes in P114L and G101W are likely to be related to global conformational changes. In addition, we have demonstrated that the tendency of aggregation increases significantly by a single D84H mutation.

Amino Acid Sequence↗
PubMed1996

Sustained attention and awareness of disability in chronic neglect.

The possible causative role of defective sustained attention and awareness of disability on the persistence of neglect was explored. The study included stroke patients who had had moderate or severe neglect 1-5 years before the start of the present examination. Questionnaire responses showed that the patients were aware of their disability. Impaired sustained attention was associated with poor performance in two out of three tests most sensitive in detecting neglect. This, together with indications of compensation on neglect tests, is interpreted as providing support for the hypothesis that chronic neglect is related to an impaired sustained attention.

Aged↗
PubMed1996

Clinical experience with stereotactic digital subtraction angiography with distortion correction software.

Recently developed software for correction of the geometric distortion in digital subtraction angiography was tested clinically. Localization and subsequent radiosurgical treatment of intracranial arteriovenous malformations was undertaken in 60 patients. During each angiographic series, a series of grid images was also acquired. All images were transferred to a workstation where the grid images were compared to a previously stored ideal image of the grid. A distortion correction was then performed on the grid images. The same pixel-by-pixel correction was applied to the respective angiographic images. The target was outlined on corrected subtracted images on the monitor. The outlined regions of interest and reference points were transferred to another workstation for dose planning, and the treatment was subsequently executed in the Gamma Knife unit. The clinical applicability of the distortion correction program was tested and possible sources of error examined. The experience gained is being used for further development of the software and for smoother data management and reduction of the processing time.

Adolescent↗
PubMed1996

Positron emission tomography using 18F-fluorodeoxyglucose in patients with stereotactically irradiated brain metastases.

Thirty-one patients with intracranial metastases were examined with positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) as a tracer. The PET study was prompted by growth of the tumor in spite of therapy, or regrowth after an initially favorable response. Increased accumulation of FDG was seen in 14 patients (group 1) and decreased in 17 (group 2). Patients in group 1 had verified tumor growth in 9 of 14 cases. The median survival after radiosurgery was 12.3 months. One patient in this group is still alive after open surgery of a recurrent metastasis. Six patients in group 2 are still alive. The median survival after radiosurgery was 19.9 months. Verified radiation reaction/necrosis was found in 5/17 and viable tumor tissue in 2. The survival time in group 2 was significantly longer than in group 1. PET is superior to computed tomography and magnetic resonance imaging in the differentiation between recurrence and radiation reaction/necrosis. However, temporary radiation effects may mask remaining tumor tissue, and repeat PET studies may sometimes be necessary.

Adult↗
PubMed1995

Functional neuroanatomy of visually elicited simple phobic fear: additional data and theoretical analysis.

We investigated central nervous system correlates of simple phobic fear. Regional cerebral blood flow (rCBF) was measured using positron emission tomography (PET) in eight volunteers with symptomatic spider phobia that were exposed to visual phobogenic and neutral stimuli. Diazepam (0.1 mg/kg body weight i.v.) or placebo was administered under double-blind conditions after initial PET scans. The PET scans were then repeated. The presence of fear was confirmed by rating procedures and increased number of nonspecific electrodermal fluctuations and by higher heart rate during phobic than during neutral stimulation. Phobic as compared to neutral stimulation elevated the regional to whole brain (relative) CBF in the secondary visual cortex but reduced relative rCBF in the hippocampus, prefrontal, orbitofrontal, temporopolar, and posterior cingulate cortex. Diazepam treatment did not affect the relative rCBF or the subjective or physiological fear indices. The observed rCBF pattern replicates our previous findings in snake phobics (M. Fredrikson et al. [1993] Psychophysiology, 30, 127-131; G. Wik et al. [1993] Psychiatry Research (Neuroimaging), 50, 15-24) and indicates that fear and anxiety affect cortical areas outside the classic limbic system areas.

Adult↗
PubMed1995

Early [18F]FDG positron emission tomography in infants with hypoxic-ischaemic encephalopathy shows hypermetabolism during the postasphyctic period.

Six full-term infants suffering from perinatal asphyxia and with moderate or severe hypoxic-ischaemic encephalopathy were investigated by positron emission tomography (PET). Regional cerebral metabolic rates of glucose (rCMRgl) were determined using [2-18F]2-fluoro-2-deoxy-D-glucose ([18F]FDG) PET scans at a median age of 2.5 days (range 2-5 days). Localized increases in rCMRgl were visually observed in five infants. In a subgroup of three infants, absolute values of rCMRgl in different brain regions were calculated. In all cases the results of the PET studies were in good agreement with those of the neuroradiological, neurophysiological and clinical investigations. Information indicating pathophysiological events could be extracted earlier with PET than with conventional morphological imaging techniques. We conclude that [18F]FDG-PET scans performed in critically ill, asphyxiated infants very soon after birth provide valuable information for the prediction about neurological outcome.

Asphyxia Neonatorum↗
PubMed1995

Is there a relationship between obesity and intracranial hypertension?

BACKGROUND: Intracranial hypertension and obesity have been reported in recent studies of patients with periorbital venous vasculitis. These findings indicate that obese patients should be investigated for signs of inflammation in serum and lumbar cerebrospinal fluid (CSF) pressure. PATIENTS AND METHODS: Twenty obese females, aged 27-68 years participated in the study of associated symptoms, signs of inflammation in serum, intracranial hypertension and magnetic resonance imaging of the brain (MR). Twenty randomly selected age- and sex-matched females were also investigated for associated symptoms and MR as controls. RESULTS: There were no statistically significant differences in associated symptoms and diseases except for infertility (P < 0.05) between the two groups. The values for orosomucoid, haptoglobin, IgG, IgM and tests for rheumatic and antinuclear factors were significantly increased in the obese group compared with normal values at the hospital. The lumbar CSF pressure was increased above 20 cm water in 79% and above 25 cm water in 42% in the obese patients. MR showed that the subarachnoidal space in the obese patients were significantly smaller than in the controls. CONCLUSIONS: Signs of inflammation in serum, intracranial hypertension and decreased subarachnoidal space were statistically significantly more common in patients with obesity, than in controls.

Adult↗
PubMed1994

Haemorrhagic pituitary tumours.

In a group of 69 patients with pituitary tumours, 12 were found to have evidence of intratumoral haemorrhage on MRI, characterized by high signal intensity on short TR/TE sequences. This was verified in all but 1 patient. The majority of the bleedings occurred in macroadenomas. Five (42%) were prolactinomas and 4 (33%) were non-functioning adenomas. There were 2 GH- and 1 ACTH-secreting tumours. All 5 patients with prolactinomas were on bromocriptine medication. Two of the patients had a clinical picture of pituitary apoplexy. The haemorrhage was not large enough to prompt surgery in any of the patients. However, surgical verification of the diagnosis was obtained in 5 cases, while 6 patients were examined with follow-up MRI.

Adenoma↗
PubMed1994

Multiple intracranial arteriovenous malformations: a case report.

Multiple intracranial arteriovenous malformations are rare. There are a few cases in the literature with up to three malformations in one patient. A child with seven separate cerebral malformations is now described. There was no history of haemorrhage, but only of febrile seizures. The malformations were discovered at CT and verified at angiography. Six were selected for stereotaxic irradiation with the multi-cobalt unit. The seventh was considered too big for irradiation and suitable for surgery.

Cerebral Angiography↗
PubMed1994

Periorbital venous vasculitis, intracranial hypertension and empty sella.

Sixteen patients with chronic periorbital venous vasculitis without nerve involvement and 9 patients with active episodic cluster headache were studied as to cerebrospinal fluid (CSF) pressure. Eighty-one percent of the patients with chronic and 33% with episodic symptoms had pathologically increased CSF pressure. Magnetic resonance imaging of the brains in the chronic group showed empty sella in 60%, cerebral atrophy in 21% and white matter lesions with high signal intensity on T2 weighted sequences in 29%. Abnormal obesity was found in 31% of the patients with chronic periorbital venous vasculitis under 60 years of age. Venous vasculitis is suggested as a cause of intracranial hypertension, empty sella, and endocrinologic dysfunctions.

Adult↗
PubMed1994

Urge to scratch represented in the human cerebral cortex during itch.

1. We used functional positron emission tomography (PET), measuring regional cerebral blood flow (rCBF) as an index of neuronal activity, to investigate the central processing of itch in 10 healthy volunteers subjected to intracutaneous injections of histamine. 2. The study has unraveled a central representation that depicts a motor intention of the urge to scratch contingent on the perception of unpleasant itch. The coactivation of the anterior cingulate cortex (ACC), supplementary motor area (SMA), premotor area (PM), and inferior parietal lobule (IPL) substantiates that the posterior sector of the ACC (Brodmann 24) is related to the sensorial/affectional aspect of the event. The premotor cortical areas (SMA, PM) and the IPL may participate in the preparation of an intended action.

Adult↗
PubMed1993

Even the smallest remnant of an AVM constitutes a risk of further bleeding. Case report.

A case with an ill-defined arteriovenous malformation in the parieto-occipital region is presented. Open surgery was unsuccessful in removing the AVM totally, and treatment with gamma knife radiosurgery was then attempted. At 14 months after this treatment the AVM was believed to be obliterated. The patient had a new intracranial haemorrhage 59 months after radiosurgery. Renewed angiography showed an obvious AVM outside the previously irradiated area. Retrospective analysis of the angiogram at 14 months after radiosurgery revealed early filling of a draining vein as a sign of residual AVM at this time. Renewed radiosurgical treatment was performed. It is believed that an ill-defined margin, laminar flow, and effects of previous surgery might add to difficulties in a proper visualisation and delineation of an AVM. Further, a small remaining shunt may be overlooked if the angiogram is not carefully analysed or if the angiogram is of inferior quality. It should be stressed that partial or almost total obliteration of an AVM is no protection against rebleeding.

Cerebral Angiography↗