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Biomedical subjects

R Salvesen

Publications and source records attributed to R Salvesen.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Raeder's syndrome].

Raeder's syndrome was first described by the Norwegian ophthalmologist J.G. Raeder in 1918 and again in 1924 by the same author. The seminal report was a description of a young male patient with unilateral periocular pain combined with ipsilateral miosis and ptosis, and with slight objective signs of trigeminal nerve involvement. Autopsy demonstrated a tumour at the base of the skull in the middle cranial fossa. Raeder coined the term "paratrigeminal" for the reported clinical picture. Later case reports by Raeder and other authors have included patients experiencing a more benign clinical course, some with spontaneous remissions, with unilateral periocular pain and ipsilateral signs of oculosympathetic paresis as the common denominator. This article is a chronological survey of the main contributions to the medical literature. Various definitions of the syndrome are outlined, including the more recent classification, as well as some pathophysiological and prognostic considerations.

Aortic Dissection↗
PubMed1999

[Current viewpoints on etiology and physiopathology of migraine].

Migraine is an inheritable disease, and the mutation causing a rare variant of migraine (familial hemiplegic migraine) has now been demonstrated. The mutated gene encodes a subunit of a brain-specific calcium channel in cell membranes. Brains of patients with recurrent migraine attacks seem to behave differently from other brains, also when examined outside attacks, in that they commonly demonstrate lack of habituation when exposed to serial stimuli. The patho-physiological process of the attack might well consist of a spreading cortical depression starting in the occipital region and gradually involving other parts of the cortex. It is primarily a cerebral process secondarily accompanied by reduced cerebral blood flow, later converting into increased flow. The pain of migraine probably is mediated by way of the trigeminal nerve which releases vasoactive peptides leading to dilatation of the greater blood vessels. During an attack there is increased metabolism in cranial parts of the brain stem, demonstrated as areas of increased blood flow in PET studies. This increased metabolism persists even when the symptoms of migraine have disappeared after drug treatment, perhaps because the migraine attacks may be generated in this region. The primary dysfunction in migraine probably is located in the brain rather than in blood vessels.

Adolescent↗
PubMed1999

Do human lumbar discs reconstitute after chemonucleolysis? A 7-year follow-up study.

STUDY DESIGN: A retrospective, longitudinal study of 51 patients, covering a mean follow-up period of 81 months. OBJECTIVE: To observe the long-term temporal course of the height of human lumbar discs after chemonucleolysis. To document whether human lumbar discs reconstitute, thus characterizing the healing potential of central disc tissue. SUMMARY OF BACKGROUND DATA: Although reconstitution of disc height within some months of chemonucleolysis has been observed in animal experiments, human lumbar discs have shown no tendency to regain their initial height within 1 year of treatment. To date, there has been no report on longer follow-up periods. The different reactions of animal and human discs may be dose-related or related to differences in tissue properties, physiologic environment or in vivo loading conditions. METHODS: Using a new protocol, the heights of lumbar discs were measured from sets of lateral radiographic views of 51 patients subject to chemonucleolysis by treatment with chymopapain (doses of 4000 or 3000 picokatals [pkat]). The sets comprised a view taken before treatment, a view taken (on average) 4 months after treatment, and a view taken (on average) 81 months after treatment. In the majority of patients, untreated discs adjacent to discs treated with chemonucleolysis served as control discs. RESULTS: Shortly after injection of chymopapain, all treated discs decreased in height. The height decrease of treated discs amounted to 15.8% on average. In the subcohort treated with 4000 pkat, the loss did not reverse during the entire follow-up period; in the subcohort treated with 3000 pkat a small fraction of the lost height was regained. Untreated neighboring control discs showed a minor (3.4%) decrease in height. CONCLUSIONS: Human lumbar discs do not reconstitute after chemonucleolysis. Because the long-term temporal course of disc height in patients is in disagreement with observations from animal experiments, caution is suggested when generalizing results from animal studies to humans.

Chymopapain↗
PubMed1999

Cluster Headache.

The care of patients with cluster headache has at least two goals: 1) immediately abolishing an ongoing attack and 2) stopping or shortening a bout (a cluster period). The fierceness and the relative brevity of the attacks dictate the use of a fast-acting agent. There are probably three agents fulfilling these criteria: sumatriptan (by subcutaneous injection), oxygen (inhaled through a face mask), and ergotamines (by injection or, perhaps, sublingual tablets). An abundance of data from controlled studies as well as recent clinical experience probably favors sumatriptan as the most effective alternative, the most significant drawback being its high cost. Oxygen inhalation is free of side effects and may be effective but is inconvenient to use. Ergotamines in tablet form act less rapidly, and there are more contraindications to their use. In short-term prophylaxis, however, ergotamine may still be a drug of choice if the timing of the attacks allows planned use of the drug shortly before the attack. If the timing is more irregular, steroids may at least temporarily break a cycle (eg, prednisolone, 60 or 80 mg/d, gradually tapered to zero in 3 to 4 weeks). If more long-lasting prophylaxis is needed or expected, lithium carbonate, 900 mg/d, or verapamil, 360 mg/d, both have reasonable response rates. As for chronic cluster headache, lithium probably will still be the drug of choice. For a very limited group of patients with chronic cluster headache, surgery may be a last resort. The best surgical options are probably radiofrequency rhizotomy or microvascular decompression of the trigeminal nerve.

Journal Article↗
PubMed1999

Cervicogenic headache: long-term postoperative follow-up.

The patient, a 50-year old female had been suffering from right-sided head- and neck pain since she was 31 years of age. It started in connection with an indirect neck trauma. Analgesics were of little or no avail and operative procedures, including liberation of the greater occipital nerve (GON) (n = 2) and decompression of the C2 ganglion/root, had only a transitory effect. At 42, a magnetic resonance scan of the cervical spine demonstrated a degenerated disk C5-C6, with encroachment on the foramina and the cord. At 42 years of age, a stabilization operation at C5-C6 (Robinson-Smith) alleviated her discomfort--only some motor complaints in the ipsilateral upper extremity remaining and only in the first 12-18 months.

Cervical Vertebrae↗
PubMed1999

Raeder's syndrome.

Raeder's syndrome was first described by the Norwegian ophthalmologist J. G. Raeder in 1918, and the description extended in 1924 by the same author. The seminal report was a description of a young, male patient with unilateral periocular pain combined with ipsilateral miosis and ptosis, and with slight objective signs of trigeminal nerve involvement. Autopsy demonstrated a tumor at the base of the skull in the middle cranial fossa. The term "paratrigeminal" was coined for the picture reported. Later case reports by the same and other authors have included patients with a more benign clinical course, including spontaneous remissions, with unilateral periocular pain and ipsilateral signs of oculosympathetic paresis as the common denominator. This review is a chronological survey of the main contributions that have appeared in the literature and an outline of the various definitions of the syndrome, including a recent classification as well as some pathophysiological and prognostic considerations.

Eponyms↗
PubMed1998

[Reflexes in brain-dead patients].

We report on a patient who suffered an acute, extensive intracerebral haemorrhage, leading to symptoms of cerebral herniation within a few hours. The clinical diagnosis of brain death was made based on a neurological examination, and an apnoea test eight hours after the haemorrhage. A few hours later the diagnosis was changed, as several reflexes reappeared. After six days mechanical ventilation was withdrawn, as the brain damage was considered so serious as to render further therapy futile. It was considered unethical to sustain therapy for a possible organ donation at a later date. A review of relevant the literature, however, shows that brain-dead patients may exhibit such varying degrees of autonomic and spinal reflexes as to cause confusion, thus delaying the physician in making a diagnosis. Often, an opportunity for organ donation is lost. Based on this review, we believe that our patient was indeed brain dead when the first diagnosis was made, and that a cerebral angiography should have been performed. Because organ donation is an important issue, the diagnosis of brain death must be definitive.

Brain Damage, Chronic↗
PubMed1998

[Migraine and stroke].

When young patients suffer a stroke the etiology often differs from that found in the elderly. One of the risk factors for stroke in young people could possibly be migraine. The first author to describe what was probably a migrainous cerebral infarction was Wepfer, in 1727. In recent years, cases of stroke in migraineurs have been frequently reported. Extensive cohort studies and smaller, well-conducted case-control studies seem to confirm that migraine is a risk factor for stroke. However, the risk is only moderately increased, perhaps doubled. Among women under the age of 45, the correlation is greater with a threefold increased risk of stroke in a migraineur; it is even greater in patients suffering attacks of migraine with aura. Pure migrainous infarctions are probably rare and reports are perhaps exaggerated in the literature. Cerebral ischaemia may lead to symptomatic migraine attacks. Overall, the absolute risk of stroke is small enough to validate the opinion that migraine is a benign condition.

Adult↗
PubMed1998

Extrapontine myelinolysis after surgical removal of a pituitary tumour.

Extrapontine myelinolysis is a rare and serious disorder characterized by patches of demyelination in certain areas of the brain. Common sites of involvement are the basal ganglia and the thalamus. The patient most often presents with behavioural abnormalities, including mutism, and extrapyramidal symptoms and signs. The diagnosis is established by magnetic resonance imaging. It usually carries a grave prognosis. The pathogenesis seems to be related to profound hyponatremia that is corrected with infusions of saline. We report a case that underwent surgical removal of a pituitary tumour and subsequently was treated with desmopressin. Probably due to an overdose of this antidiuretic hormone, she became obtunded and was found to have profound hyponatremia. This was corrected with infusions of saline, mostly isotonic. She later developed mental disorientation and mutism, and magnetic resonance imaging demonstrated myelinolysis in the basal ganglia. In the course of several months, she has made some recovery, though still demonstrating some memory deficit.

Adenoma↗
PubMed1997

[Terson's syndrome. Subarachnoid hemorrhage combined with vitreous body hemorrhage].

Terson's syndrome consists of the combination of acute intracranial haemorrhage (most often an aneurysmal subarachnoidal haemorrhage) and profuse bleeding in the vitreous body of one or both eyes. The incidence is from 2% to 16% of patients with subarachnoidal haemorrhage. These patients are often confused in the early phase of their disease, and their decreased visual acuity is often not recognized. We describe findings in a patient recently seen in our department, with subarachnoidal haemorrhage and gross bleeding in the vitreous body of both eyes. We emphasize the importance of being aware of the syndrome, both in order to provide adequate nursing care, and to be able to perform early vitrectomy to restore visual function.

Female↗
PubMed1997

[Chemonucleolysis of lumbar disk prolapse. Choice and complications].

Chemonucleolysis with chymopapain is a well-documented method of treating lumbar disc herniation. In spite of this, only few patients are treated in this way in Norway. We have offered selected patients chemonucleolysis at our hospital since 1985. This article reports the long-term outcomes as regards employment status, back pain and leg pain. We have treated 277 patients. 269 were still alive in October 1995 and were sent a follow-up questionnaire. 257 patients responded, of whom 36 (14%) had undergone surgery later, due to an unsatisfactory outcome of chemonucleolysis. 72% of the patients were fully employed at the time of follow-up. 61% had little or no back pain, while 69% never or only rarely suffered pain in the leg.

Adult↗
PubMed1996

[Drug treatment of migraine attacks. Pharmacological considerations].

In the 1990s, the Decade of the Brain, significant progress has been made in our understanding of the pathophysiological events that take place during a migraine attack. Simultaneously, a big step forward has been made as regards drug therapy. The development of the 5-Hydroxy Tryptamine ID (5HT1D)-agonist sumatriptan has changed the lives of many migraine sufferers. This review describes attack management with analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), ergotamines and sumatriptan. Adverse events associated with ergotamines and use of sumatriptan are focused upon, with special attention to the pharmacokinetic and pharmacodynamic aspects of both these drugs. Sumatriptan has both vascular and neurogenic effects, both of which may be necessary for a good clinical outcome.

Analgesics↗
PubMed1996

Oculopharyngeal muscular dystrophy in Norway. Survey of a large Norwegian family.

OBJECTIVES: Oculopharyngeal muscular dystrophy was first described by Taylor in 1915. A substantial number of cases have been reported from North America, the disorder being most frequent in Quebec, Canada. MATERIAL: The onset of disease is in middle life, most often presenting with ptosis and a slight degree of ophthalmoplegia, followed some years later by dysphagia and often by proximal limb weakness. The course is slowly progressive, but the dysphagia may become severe and has caused death by starvation in several cases. The disorder is transmitted autosomally dominant in families. RESULTS: The present report describes a large Norwegian family with 13 affected members of whom we have examined eight. Transmission is autosomally dominant, mode of presentation may be either by ptosis or by dysphagia. In rare cases gait difficulties may be the presenting symptom. CONCLUSION: Electromyographic and muscle biopsy examinations demonstrate a primary myogenic disorder.

Aged↗
PubMed1993

A controlled study of peripheral neuropathy in systemic lupus erythematosus.

In 34 patients with systemic lupus erythematosus (SLE) and 34 age- and sex-matched healthy controls we performed standardized quantifiable neurological testing for neuropathic symptoms (Neuropathic Symptom Score) and deficits (Neurological Disability Score), as well as nerve conduction velocity studies (NCV) and determination of vibration thresholds (VT). SLE patients had more neuropathic symptoms and deficits than controls. Most quantitative and qualitative NCV attributes showed no difference between patients and controls. However, if categorized as NCV abnormalities of 2 or more nerves in each individual, a frequency of polyneuropathy of 21% was seen in SLE patients compared to 6% in controls. VT indicated a slight, but widespread, diffuse polyneuropathy in patients compared to controls.

Adolescent↗
PubMed1991

[Horner's syndrome. With special reference to topographical diagnosis].

The triad miosis, ptosis and hemifacial anhidrosis make up the well-known Horner's syndrome. This is caused by a lesion or a dysfunction in the "oculosympathetic pathway" running from the hypothalamus to the eye. Various disease entities may manifest themselves in this way, and it is important to be able to determine whether the dysfunction is localized to the central, preganglionic or postganglionic neurone. This review presents the various tests used for this purpose, describes our recent contributions in the field, and finally proposes a simple scheme that is suitable for topographical diagnosis.

History, 19th Century↗