185 results on '"Bertil Romner"'
Search Results
152. Modified Robinson-Smith procedure for the treatment of cervical radiculopathy
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Bertil Romner, Anke Im, B. J. Due-Tønnessen, Arild Egge, and Trumpy Jh
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Adult ,Male ,medicine.medical_specialty ,Brachialgia ,Preoperative examination ,Spinal Osteophytosis ,Cervical radiculopathy ,Postoperative Complications ,Postoperative results ,Medicine ,Humans ,Neurologic Examination ,business.industry ,Nerve Compression Syndromes ,General Medicine ,Radiological examination ,Middle Aged ,Surgery ,Spinal Fusion ,Neurology ,Cervical Vertebrae ,Female ,Neurology (clinical) ,business ,Spinal Nerve Roots ,Clinical evaluation ,Intervertebral Disc Displacement ,Follow-Up Studies - Abstract
In the present study, a modified Robinson-Smith procedure was used surgery for cervical radiculopathy in 52 patients. Thirty-one one-level and 21 two-level operations were performed. All patients were followed up between 1 and 3 years (mean 23 months) after surgery with a clinical evaluation by an independent investigator including a radiological examination. In 26 patients the postoperative result was classified as excellent, in 23 the result was good, in 2 satisfactory, while one patient was unchanged compared to the preoperative examination. No patient developed worsening of symptoms after surgery. Of 18 patients with duration of symptoms of more than 4 years, 16 demonstrated markedly improvement. No permanent postoperative complications were seen. A modified Robinson-Smith procedure appears to be safe and reliable and can be recommended in surgery for cervical radiculopathy.
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- 1994
153. Hypothalamic hamartoma causing precocious puberty treated by surgery: case report
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Trumpy Jh, Gudmund Marhaug, Bertil Romner, Inge M. Anke, and Helgi J. Isaksson
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medicine.medical_specialty ,Breast development ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Hamartoma ,Puberty, Precocious ,Magnetic resonance imaging ,Microsurgery ,medicine.disease ,Pubic hair ,Surgery ,medicine.anatomical_structure ,Hypothalamic hamartoma ,Tuber cinereum ,Medicine ,Precocious puberty ,Humans ,Female ,Neurology (clinical) ,business ,Child ,Hypothalamic Diseases - Abstract
A 6-year-old girl was treated for precocious puberty secondary to a hypothalamic hamartoma by resection of the tumor. When she was six months old, her parents noticed incipient pubic hair and menses accompanied by breast development. Computed tomography was judged as normal. The girl was treated with monthly gonadotropin-releasing hormone analogue injections until 6 years of age, when magnetic resonance imaging (MRI) demonstrated a pedunculated isodense mass below the tuber cinereum. The hamartoma was totally removed using microsurgery. The symptoms and signs of precocious puberty disappeared after surgery. Follow-up MRI 1 year later showed no remaining tumor.
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- 1994
154. Transcranial Doppler sonography, angiography and SPECT measurements in traumatic carotid artery dissection
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Bertil Romner, H Sjöholm, and Lennart Brandt
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Adult ,Carotid Artery Diseases ,Male ,medicine.medical_specialty ,Ultrasonography, Doppler, Transcranial ,Infarction ,Carotid artery dissection ,Medicine ,Humans ,cardiovascular diseases ,Wrestling ,Neuroradiology ,Tomography, Emission-Computed, Single-Photon ,Internal carotid artery dissection ,medicine.diagnostic_test ,business.industry ,Vascular disease ,Interventional radiology ,Intracranial Aneurysm ,Cerebral Infarction ,medicine.disease ,Cerebral Angiography ,Aortic Dissection ,Positron emission tomography ,Angiography ,Athletic Injuries ,cardiovascular system ,Surgery ,Female ,Neurology (clinical) ,Radiology ,business ,Carotid Artery Injuries ,Blood Flow Velocity ,Follow-Up Studies - Abstract
In two young patients with traumatic internal carotid artery dissection, early transcranial Doppler sonography (TCD) primarily indicated the lesion. A subsequent carotid angiogram confirmed the diagnosis. The course of the disease was followed by daily TCD recordings and repeated SPECT measurements. Beside CT and angiography, TCD and SPECT are helpful guidelines for different therapeutic approaches aiming to reduce cerebral ischaemia and infarction.
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- 1994
155. Transcranial Doppler Evaluation of Cerebral Perfusion After SAH
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Bertil Romner
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medicine.medical_specialty ,Subarachnoid hemorrhage ,business.industry ,Vasospasm ,medicine.disease ,Transcranial Doppler ,Cerebral blood flow ,Hypocapnia ,Internal medicine ,Hyperventilation ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,Normocapnia ,medicine.symptom ,Cerebral perfusion pressure ,business - Abstract
Transcranial Doppler sonography (TCD) flow velocities and cerebral blood flow (CBF) measurements were evaluated in 14 patients who has suffered a major aneurysmal subarachnoid hemorrhage (SAH). Cerebrovascular reactivity to hypocapnia was evaluated simultaneously by the two methods. Measurements were performed under general anesthesia preoperatively, within 72 hours after the bleed, during normocapnia and hypocapnia. There was poor correlation between absolute values of hemispheric CBF and corresponding TCD mean flow velocity. Controlled hyperventilation was associated with a significant decrease in CBF as well as TCD flow velocity (p < 0.001). In terms of reactivity indices the correlation was poor and not significant (r = 0.33, p = 0.09). Further 21 patients were subjected to repeated assessment of TCD flow velocities during the first 12 hours after SAH. In 19 patients, recordings were performed following the first SAH, and in two after early rebleeds. Flow velocities did not indicate an early phase of arterial narrowing in any case. Following the first TCD recording, flow velocities were evaluated repeatedly in the 19 survivors. Increased flow velocities suggesting arterial vasospasm occured only after a delay of at least 4 days. Additional 36 patients with a proven first SAH from a ruptured supratentorial aneurysm were subjected to repeated TCD assessments. 18 individuals were operated within 48 hours, while the other 18 had surgery between 49 and 96 hours after SAH. Postoperative flow velocities were significantly lower in patients operated within 48 hours (p < 0.001).
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- 1994
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156. Prophylactic Hyperdynamic Postoperative Fluid Therapy after Aneurysmal Subarachnoid Hemorrhage: A Clinical, Prospective, Randomized, Controlled Study
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Arild Egge and Bertil Romner
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Surgery ,Neurology (clinical) - Published
- 2002
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157. Alcohol consumption, blood alcohol concentration level and guideline compliance in hospital referred patients with minimal, mild and moderate head injuries
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Pål Rønning, Bertil Romner, Ben Heskestad, Eirik Helseth, Tor Ingebrigtsen, and Marianne Efskind Harr
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Alcohol Drinking ,Population ,Alcohol ,Critical Care and Intensive Care Medicine ,Hospitals, University ,Young Adult ,chemistry.chemical_compound ,Craniocerebral Trauma ,Humans ,Medicine ,Young adult ,education ,Aged ,Retrospective Studies ,Original Research ,Aged, 80 and over ,education.field_of_study ,Ethanol ,VDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801 ,business.industry ,Head injury ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Guideline compliance ,VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Traumatology: 783 ,Blood alcohol concentration level ,Retrospective cohort study ,lcsh:RC86-88.9 ,Middle Aged ,medicine.disease ,Triage ,chemistry ,VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Traumatologi: 783 ,Emergency medicine ,Emergency Medicine ,Patient Compliance ,Female ,Guideline Adherence ,business ,Follow-Up Studies - Abstract
Background In 2000 the Scandinavian Neurotrauma Committee published guidelines for safe and cost-effective management of minimal, mild and moderate head injured patients. The aims of this study were to investigate to what extent the head injury population is under the influence of alcohol, and to evaluate whether the physicians' compliance to the guidelines is affected when patients are influenced by alcohol. Methods This study included adult patients (≥15 years) referred to a Norwegian University Hospital with minimal, mild and moderate head injuries classified according to the Head Injury Severity Scale (HISS). Information on alcohol consumption was recorded, and in most of these patients blood alcohol concentration (BAC) was measured. Compliance with the abovementioned guidelines was registered. Results The study includes 860 patients. 35.8% of the patients had consumed alcohol, and 92.1% of these patients had a BAC ≥ 1.00‰. Young age, male gender, trauma occurring during the weekends, mild and moderate head injuries were independent factors significantly associated with being under the influence of alcohol. Guideline compliance was 60.5%, and over-triage was the main violation. The guideline compliance showed no significant correlation to alcohol consumption or to BAC-level. Conclusions This study confirms that alcohol consumption is common among patients with head injuries. The physicians' guideline compliance was not affected by the patients' alcohol consumption, and alcohol influence could therefore not explain the low guideline compliance.
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- 2011
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158. Should central venous catheters, with the tip accidentally placed retrograde in the internal jugular vein, be corrected
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Bertil Romner, Birgitta Ramgren, Martin Engström, and Peter Reinstrup
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medicine.medical_specialty ,Anesthesiology and Pain Medicine ,business.industry ,Medicine ,General Medicine ,business ,Internal jugular vein ,Surgery - Published
- 2001
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159. Simultaneous transcranial Doppler sonography and cerebral blood flow measurements of cerebrovascular CO2-reactivity in patients with aneurysmal subarachnoid haemorrhage
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Leif Berntman, Kenneth Messeter, Lars Algotsson, Bertil Romner, Lennart Brandt, and Bengt Ljunggren
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Adult ,Subarachnoid hemorrhage ,Hemodynamics ,Aneurysm ,Hypocapnia ,Hyperventilation ,medicine ,Humans ,Normocapnia ,Ultrasonography ,Rupture, Spontaneous ,business.industry ,Intracranial Aneurysm ,General Medicine ,Bleed ,Carbon Dioxide ,Middle Aged ,Subarachnoid Hemorrhage ,medicine.disease ,Respiration, Artificial ,Cerebral blood flow ,Anesthesia ,Cerebrovascular Circulation ,cardiovascular system ,Surgery ,Neurology (clinical) ,medicine.symptom ,Blood Gas Analysis ,business - Abstract
Transcranial Doppler sonography (TCD) flow velocities and cerebral blood flow (CBF) measurements were evaluated in 14 patients who had suffered a major aneurysmal subarachnoid hemorrhage (SAH). Cerebrovascular reactivity to hypocapnia was evaluated simultaneously by the two methods. The measurements were performed under general anaesthesia preoperatively, within 72 hours after the bleed, during normocapnia and hypocapnia. There was poor correlation between absolute values of hemispheric CBF and corresponding TCD mean flow velocity. Controlled hyperventilation was associated with a significant decrease in CBF as well as TCD flow velocity (p less than 0.001). In terms of reactivity indices the correlation between the two methods was poor and not significant (r = 0.33, p = 0.09). The principal differences between the methods are discussed as well as the application of TCD in the evaluation of cerebrovascular reactivity.
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- 1991
160. Correlation of transcranial Doppler sonography findings with timing of aneurysm surgery
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Hans Säveland, Bertil Romner, Lennart Brandt, and Bengt Ljunggren
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Adult ,Male ,medicine.medical_specialty ,Subarachnoid hemorrhage ,Time Factors ,Ischemia ,Infarction ,Hemodynamics ,Cerebral vasospasm ,Aneurysm ,medicine ,Humans ,cardiovascular diseases ,Aged ,Ultrasonography ,business.industry ,Vasospasm ,Intracranial Aneurysm ,Middle Aged ,Subarachnoid Hemorrhage ,medicine.disease ,nervous system diseases ,Surgery ,Ischemic Attack, Transient ,Anesthesia ,Female ,medicine.symptom ,business ,Vasoconstriction ,Blood Flow Velocity - Abstract
✓ Thirty-six patients with a proven first subarachnoid hemorrhage (SAH) from a ruptured supratentorial aneurysm were subjected to repeated transcranial Doppler sonography assessments. Eighteen individuals (Group A) were operated on within 48 hours, while the other 18 (Group B) had surgery between 49 and 96 hours after SAH. The patients represented two clinically comparable groups. In the first 72 hours post-SAH, no increased flow velocities suggestive of arterial narrowing or vasospasm were recorded. There was no significant difference in preoperative flow velocities between the groups. Postoperative flow velocities were significantly lower in patients operated on within 48 hours (p < 0.001). Two patients, who had surgery on Day 4 post-SAH and who showed the highest recorded postoperative flow velocities, died from cerebral vasospasm and infarction. The results favor a referral system which enables early surgical intervention not only to prevent rebleeds but also aimed at reducing delayed ischemic dysfunction.
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- 1990
161. Spontaneous Intracranial Hypotension Resulting in Coma: Case Report
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Faisal T Sayer, Elna-Marie Larsson, Bertil Romner, and Mikael Bodelsson
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Male ,Intracranial Hypotension ,Unnecessary Procedures ,Neurosurgical Procedures ,Hematoma ,Humans ,Medicine ,Coma ,Diagnostic Errors ,Subdural space ,Epidural blood patch ,Cerebrospinal fluid leak ,business.industry ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Subdural Effusion ,Hematoma, Subdural ,medicine.anatomical_structure ,Anesthesia ,Chronic Disease ,Intracranial pressure monitoring ,Surgery ,Neurology (clinical) ,Cerebrospinal fluid pressure ,medicine.symptom ,Tomography, X-Ray Computed ,business ,Blood Patch, Epidural - Abstract
Objective Spontaneous intracranial hypotension is a potentially severe condition characterized by a distinct clinical picture caused by low cerebrospinal fluid pressure. Although coma has been reported previously as a presentation of this condition, this is the first report in which misdiagnosis of this condition and unwarranted surgery led to coma. Clinical presentation A 62-year-old man presented with a history of headache, and cranial magnetic resonance imaging showed bilateral chronic subdural hematomas. After evacuation of the hematoma, the patient's condition deteriorated into a state of profound depression of consciousness. Repeated cranial computed tomographic scans showed intracranial air, and intracranial pressure monitoring showed negative recording. Spinal magnetic resonance imaging demonstrated epidural cerebrospinal fluid leaks at the middle and lower thoracic levels. Intervention Epidural blood patch resulted in almost immediate improvement in the patient's condition, and he was fully awake 24 hours later. Conclusion This case report expands the presently known clinical spectrum of this uncommon and generally benign illness.
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- 2006
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162. The value of serum protein S-100 measurements after mild head injury
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Trumpy Jh, Tor Ingebrigtsen, and Bertil Romner
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medicine.medical_specialty ,business.industry ,Internal medicine ,Head injury ,Serum protein ,Medicine ,Surgery ,Neurology (clinical) ,General Medicine ,business ,medicine.disease ,Gastroenterology ,Value (mathematics) - Published
- 1997
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163. THROMBOCYTOPENIA PREDICTS CONTUSION DEVELOPMENT AFTER HEAD TRAUMA
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Martin Engström, Peter Reinstrup, Bertil Romner, and Wilhelm Schalén
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medicine.medical_specialty ,business.industry ,medicine ,Critical Care and Intensive Care Medicine ,business ,Head trauma ,Surgery - Published
- 2004
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164. [Untitled]
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Johan Bellner, Bertil Romner, Johan Undén, Peter Reinstrup, and Christer Alling
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medicine.medical_specialty ,Microdialysis ,medicine.diagnostic_test ,business.industry ,Central nervous system ,Physical examination ,Critical Care and Intensive Care Medicine ,Surgery ,Transplantation ,Cerebrospinal fluid ,medicine.anatomical_structure ,Neuroimaging ,Anesthesia ,medicine ,business ,Intracranial pressure ,Cerebral angiography - Abstract
S-100B is a small dimeric calcium-binding protein that is abundant in astroglial cells within the central nervous system (CNS). It has been shown to increase in cerebrospinal fluid (CSF) and serum after various neurological diseases, including minor head injury, severe head injury, subarachnoid haemorrhage and cerebral infarcts as well as after cardiopulmonary bypass surgery. We report on a patient with severe head injury after a traffic accident who was followed with routine neuromonitoring techniques (intracranial pressure [ICP], microdialysis, clinical examination and neuroimaging) with the addition of serial serum S-100B measurements (a total of 41 S-100B measurements during admission of almost 3 days). Results of S-100B analysis were available within 2 hours of sampling allowing us to increase the sampling rate at physician discretion. Cerebral herniation, confirmed by cerebral angiography, occurred 1 day after admission. After brain death was established we continued to monitor S-100B levels in conjunction with an organ harvesting procedure for transplantation. We found that S-100B levels seemed to peak immediately prior to cerebral herniation and then decreased shortly thereafter. In conjunction with the organ harvesting procedure S-100B levels increased, indicating a clear extracerebral source of the protein.
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- 2003
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165. High Serum S100B Levels for Trauma Patients without Head Injuries
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Tor Ingebrigtsen and Bertil Romner
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medicine.medical_specialty ,Text mining ,business.industry ,Head (linguistics) ,Predictive value of tests ,Internal medicine ,High serum ,MEDLINE ,Medicine ,Surgery ,Neurology (clinical) ,business - Published
- 2001
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166. 708 Prophylactic Triple H Therapy after Aneurysmal Subarachnoid Hemorrhage: A Clinical, Prospective, Randomized, Controlled Study
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Arild Egge, Tore Solberg, Bertil Romner, Tor Ingebrigtsen, Knut Waterloo, and Hans Sjøholm
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medicine.medical_specialty ,Subarachnoid hemorrhage ,Randomized controlled trial ,law ,business.industry ,medicine ,Surgery ,Neurology (clinical) ,medicine.disease ,business ,law.invention - Published
- 2001
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167. Traumatic Brain Injury--Biochemical Markers
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Bertil Romner
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Pathology ,medicine.medical_specialty ,Arts and Humanities (miscellaneous) ,Traumatic brain injury ,business.industry ,medicine ,Neurology (clinical) ,medicine.disease ,business ,Biochemical markers - Published
- 2000
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168. Seven-year clinical experience with the Codman Hakim programmable valve: a retrospective study of 583 patients
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Bertil Romner and Göran Zemack
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medicine.medical_specialty ,business.industry ,Pseudotumor cerebri ,Retrospective cohort study ,General Medicine ,medicine.disease ,Infection rate ,Surgery ,Hydrocephalus ,medicine.anatomical_structure ,Medicine ,Cyst ,Neurology (clinical) ,Atrium (heart) ,business ,Shunt (electrical) - Abstract
A retrospective study was undertaken to assess the value of the Codman Hakim programmable valve in the treatment of 583 patients (421 adults and 162 children) with hydrocephalus of various causes (379), normal-pressure hydrocephalus (NPH) (174), an arachnoidal cyst (14), and pseudotumor cerebri (16). In all patients the programmable valve was implanted (the valve can be noninvasively adjusted to settings in the range of 30-200 mm H2O). In 73% of the cases this was their first shunt implantation. Ninety-two percent of the shunts drained to the peritoneal cavity and 8% to the atrium. In 42% of the cases valve pressure adjustment was required at least once (mean number of adjustments 1.2, maximum 23). The authors present reprogramming statistics, and strategies for reprogramming are discussed. In 65% of the cases in which pressure adjustments were required, reprogrammings improved the patients' clinical status. The overall infection rate was 8.5% (56 of 660 valve implantations). Valve malfunction, blockage, or reprogramming difficulty occurred in 17 cases, and nontraumatic subdural fluid collections were demonstrated in 30 cases (13 of which were treated by valve pressure reprogramming alone). Of the patients undergoing first-time shunt placement, 21.5% eventually underwent shunt revision at least once, and a total of 318 revisions were performed during the 7-year follow-up period. At follow up, 97% of children and 90% of adults had improved. In conclusion, catheter-related complications and shunt-related infections were the main reasons for revision and the major cause of shunt failure. Few incidents of valve malfunction were observed. The Hakim Codman programmable valve is of value in the treatment of hydrocephalus of all causes, especially in the treatment of patients with NPH, pseudotumor cerebri, arachnoidal cyst, aqueductal stenosis, traumatic hydrocephalus, and intraventricular hemorrhage.
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- 1999
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169. EFFECTS OF HYPERVOLEMIC HEMODILUTION ON rCBF IN PATIENTS WITH VASOSPASM AFTER SAH
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H. Saveland, Erik Ryding, K.-A. Kristiansson, Bertil Romner, L. Brandt, A. Ekelund, and Peter Reinstrup
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medicine.medical_specialty ,Anesthesiology and Pain Medicine ,business.industry ,Internal medicine ,Cardiology ,medicine ,In patient ,Vasospasm ,medicine.disease ,business - Published
- 1998
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170. 5 Years of Clinical Experience with the Programmable Medos Valve, 428 Implanted Valves in 388 Patients
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Gvran Zemack and Bertil Romner
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medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Pseudotumor cerebri ,Aqueductal stenosis ,medicine ,Surgery ,Neurology (clinical) ,Atrium (heart) ,business ,medicine.disease ,Hydrocephalus - Published
- 1997
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171. Cognitive function in patients with increased serum levels of protein S-100 after minor head injury
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Bertil Romner, Knut Waterloo, and Tor Ingebrigtsen
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medicine.medical_specialty ,Minor Head Injury ,biology ,business.industry ,Cognition ,General Medicine ,Gastroenterology ,Protein S ,Psychiatry and Mental health ,Clinical Psychology ,Neuropsychology and Physiological Psychology ,Internal medicine ,medicine ,biology.protein ,Surgery ,In patient ,Neurology (clinical) ,business - Published
- 1997
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172. Clinical significance of serum S100B levels in neurointensive care.
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Johan Undén, Ramona Astrand, Knut Waterloo, Tor Ingebrigtsen, Johan Bellner, Peter Reinstrup, Gunnar Andsberg, and Bertil Romner
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BRAIN damage ,BIOMARKERS ,NEUROLOGICAL intensive care ,BRAIN injuries ,MEDICAL imaging systems ,CRITICAL care medicine - Abstract
Objective S100B is viewed as the most promising biomarkerfor brain damage. It has been proposed that thismarker is useful in a Neurointensive Care Unit (NICU) as amonitoring parameter. This study aims to examine theclinical usefulness of daily serum S100B measurements inthis setting.Design Prospective consecutive inclusion of patients.Patients A total of 79 patients with confirmed or suspectedhead injury or cerebrovascular insults (CVIs) (basedupon patient history, computed tomography (CT) and/ormagnetic resonance imaging (MRI) and neurologicalexamination including coma scoring) who required neurointensivecare were included in the study.Interventions Sampling for S100B was performed atadmission and daily until patients were discharged from theNICU. S100B measurements were statistically compared tooccurrence of secondary complications and outcomeaccording to Glasgow Outcome Scale (GOS), with focuson clinical prediction.Measurements and main results 17 of 79 patients (22%)had secondary neurological complications. Mean S100Blevels were found to be an independent parameterassociated with these complications (P = 0.03). MeanS100B levels were higher in patients with complicationscompared to those without on both the complication day(P = 0.033) and the day after (P = 0.015), but not the dayprior to the complication (P = 0.62). S100B did not predictsecondary neurological complication. Neither mean(P = 0.182) nor peak (P = 0.370) S100B levels wereassociated with or predicted outcome according to dichotomisedGOS.Conclusion Daily S100B measurements are associatedwith secondary complications but not to outcome. However,daily S100B levels do not predict secondary complications,which limit the usefulness of this brainbiomarker in this setting. [ABSTRACT FROM AUTHOR]
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- 2007
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173. Thrombocytopenia Predicts Progressive Hemorrhage after Head Trauma.
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Martin Engstrm, Bertil Romner, Wilhelm Schaln, and Peter Reinstrup
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- 2005
174. Mild Head Injuries: Impact of a National Strategy for Implementation of Management Guidelines.
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Kay Müller, Knut Waterloo, Bertil Romner, Knut Wester, and Tor Ingebrigtsen
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- 2003
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175. Management of Ruptured Intracranial Aneurysm: A review
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Bengt Ljunggren, Karl-Erik Andersson, Bengt Sonesson, Lennart Brandt, Bertil Romner, Hans Säveland, Stefan Zygmunt, Torsten Ryman, and Pekka Mellergård
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Sweden ,medicine.medical_specialty ,Rupture, Spontaneous ,business.industry ,History, 19th Century ,Intracranial Aneurysm ,General Medicine ,History, 20th Century ,Subarachnoid Hemorrhage ,History, 18th Century ,Functional recovery ,medicine.disease ,Acute stage ,Surgery ,Cerebral vasospasm ,Aneurysm ,medicine ,Humans ,Subarachnoid haemorrhage ,cardiovascular diseases ,Neurology (clinical) ,Elective surgery ,business - Abstract
The discouraging history associated with management of aneurysmal subarachnoid haemorrhage (SAH) is reviewed along with improvements in outlook attributable to progress made within the past decade. Among the new developments is the introduction of microsurgical techniques that allow elective surgery in the acute stage thereby preventing repeat haemorrhages. Early operation also offers the possibility of a more aggressive pharmacological anti-ischaemic treatment. Notwithstanding the improved results of acute elective surgery and the fact that delayed ischaemic deterioration (symptomatic cerebral vasospasm) now may be almost eliminated, the overall outcome remains gloomy. Despite recent advances not more than one out of three individuals, who are struck by the rupture of an intracranial aneurysm, may be expected to make a good neurological and functional recovery. Hope for further improvements may depend on the development of techniques that can identify intracranial aneurysms before they rupture and increased knowledge of the aetiology of such arterial wall lesions.
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- 1987
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176. S100B proteins in febrile seizures
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Niina Pekkala, Heikki Rantala, Bertil Romner, Tytti Pokka, Matti Uhari, and Kirsi Mikkonen
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Male ,medicine.medical_specialty ,Clinical Neurology ,S100 Calcium Binding Protein beta Subunit ,Brain damage ,Gastroenterology ,S100B ,Seizures, Febrile ,Epilepsy ,Cerebrospinal fluid ,Recurrence ,Febrile seizure ,Internal medicine ,Humans ,Medicine ,Clinical severity ,Nerve Growth Factors ,Pathological ,Children ,business.industry ,S100 Proteins ,Age Factors ,Infant ,General Medicine ,medicine.disease ,Serum samples ,Confidence interval ,Neurology ,Blood-Brain Barrier ,Child, Preschool ,Anesthesia ,Female ,Neurology (clinical) ,medicine.symptom ,business ,Biomarkers - Abstract
S100B protein concentrations correlate with the severity and outcome of brain damage after brain injuries, and have been shown to be markers of blood–brain barrier damage. In children elevated S100B values are seen as a marker of damage to astrocytes even after mild head injuries. S100B proteins may also give an indication of an ongoing pathological process in the brain with respect to febrile seizures (FS) and the likelihood of their recurrence. To evaluate this, we measured S100B protein concentrations in serum and cerebrospinal fluid from 103 children after their first FS. 33 children with acute infection without FS served as controls for the serum concentrations. In the FS patients the mean S100B concentration in the cerebrospinal fluid samples was 0.21μg/L and that in the serum samples 0.12μg/L. The mean serum concentration in the controls was 0.11μg/L (difference 0.01μg/L, 95% confidence interval −0.02 to 0.04μg/L, P =0.46). There was a correlation between age and serum S100B concentration ( r =−0.28, P =0.008) in children under four years, but S100B concentrations did not predict the clinical severity of the FS nor their recurrence. There was no correlation between time of arrival at the hospital after FS and S100B concentration in serum ( r =−0.130, P =0.28) or in cerebrospinal fluid samples ( r =−0.091, P =0.52). Our findings indicate that FS does not cause significant blood–brain barrier openings, and increase the evidence that these seizures are relatively harmless for the developing brain.
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177. Comparison of MR and CT in Patients with Intracranial Aneurysm Clips
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Bertil Romner, S. Holtås, E.-M. Larsson, and M. Olsson
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Surgical approach ,Aneurysm clips ,Ruptured aneurysms ,business.industry ,Soft tissue ,Temporal lobe ,Beam hardening ,Medicine ,In patient ,CLIPS ,business ,Nuclear medicine ,computer ,computer.programming_language - Abstract
CT and MR images of the brain were obtained without complications in 16 patients operated upon for ruptured aneurysms using nonferromagnetic Yasargil Phynox or Sugita Elgiloy clips. These clips were not magnetized and did not move when introduced into our scanner (0.3 T Fonar β-3000 M) in a previous study. The artifacts caused by the clips were smaller on MR than on CT and anatomical structures such as brain stem and temporal lobe were therefore better visualized on MR. Brain tissue lesions corresponding to the frontotemporal surgical approach were seen in seven patients with MR and in six with CT. In three patients temporal lobe lesions seen on MR were not visualized on CT because of beam hardening artifacts. Lesions unrelated to the region of surgery were seen in nine patients with MR and in five with CT. In conclusion, our study shows that patients with nonferromagnetic Yasargil and Sugita clips can safely be examined in a 0.3 T Fonar MR scanner. MR provides more information than CT because of less disturbance of the image by metal artifacts and superior soft tissue discrimination.
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- 1989
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178. Aneurysmal subarachnoid hemorrhage: prevention of delayed ischemic dysfunction with intravenous nimodipine
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Karl-Erik Andersson, Lennart Brandt, Bertil Romner, Bengt Ljunggren, Torsten Ryman, and Hans Säveland
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medicine.medical_specialty ,Subarachnoid hemorrhage ,medicine.medical_treatment ,MEDLINE ,Brain Ischemia ,Aneurysm ,Postoperative Complications ,medicine ,Humans ,Nimodipine ,Chemotherapy ,Clinical Trials as Topic ,Rupture, Spontaneous ,business.industry ,Vasospasm ,Intracranial Aneurysm ,General Medicine ,Subarachnoid Hemorrhage ,medicine.disease ,Surgery ,Clinical trial ,Ischemic Attack, Transient ,Anesthesia ,Neurology (clinical) ,Neurosurgery ,business ,medicine.drug - Published
- 1987
179. Calcium Channel Blockade in Cerebral Vasospasm
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Bertil Romner, H. Säveland, L. Brandt, and B. Ljunggren
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medicine.medical_specialty ,Subarachnoid hemorrhage ,business.industry ,Calcium channel blockade ,Bleed ,medicine.disease ,Pathophysiology ,nervous system diseases ,Cerebral vasospasm ,Cerebrospinal fluid ,Aneurysm ,Internal medicine ,medicine.artery ,medicine ,Anterior cerebral artery ,Cardiology ,cardiovascular diseases ,business - Abstract
In aneurysmal subarachnoid hemorrhage (SAH), aside from the direct effect of the initial bleed, most of the death and disability can be traced to rebleeding and/ or ischemic deterioration (“cerebral vasospasm”) [13]. Consequently, early aneurysm operation has been increasingly proposed to eliminate rebleeds and possibly to decrease ischemic deterioration of delayed onset by intraoperative evacuation of blood-contaminated cerebrospinal fluid (CSF) and clots [16, 21]. During recent decades a large number of studies have been undertaken in attempts to elucidate the pathophysiology of cerebral vasospasm and delayed ischemic dysfunction (DID) after SAH. Such studies have, however, “produced more questions than answers” [26].
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- 1989
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180. Transcranial Doppler sonography within 12 hours after subarachnoid hemorrhage
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Bengt Ljunggren, Hans Säveland, Lennart Brandt, and Bertil Romner
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Subarachnoid hemorrhage ,business.industry ,Transcranial doppler sonography ,Vasospasm ,Subarachnoid Hemorrhage ,medicine.disease ,nervous system diseases ,Transcranial Doppler ,Cerebral Angiography ,Cerebral blood flow ,Ischemic Attack, Transient ,Anesthesia ,Cerebrovascular Circulation ,Medicine ,Humans ,cardiovascular diseases ,Early phase ,Normal velocity ,business ,Blood Flow Velocity ,Ultrasonography - Abstract
✓ Twenty-one patients were subjected to repeated assessment of cerebral blood flow velocities by means of transcranial Doppler sonography (TCDS) during the first 12 hours after subarachnoid hemorrhage (SAH). In 19 patients the study was performed following the first SAH, and in two after early rebleeds. Flow velocities did not indicate an early phase of arterial narrowing in any case. Following the first TCDS assessment, flows were evaluated repeatedly in the 19 survivors. Increased flow velocities suggesting arterial narrowing or vasospasm occurred only after a delay of at least 4 days. The results of this study favor the restoration of normal velocity patterns in surviving patients and do not indicate that an acute phase of vasospasm exists either immediately after or in the first 12 hours after SAH.
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- 1989
181. Aneurysmal subarachnoid haemorrhage: overall outcome and incidence of early recurrent haemorrhage despite a policy of acute stage operation
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Jan Hillman, Bertil Romner, Bengt Ljunggren, Harald Fodstad, von Essen C, Algers G, Lennart Brandt, and Hans Säveland
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medicine.medical_specialty ,Neurosurgical referral ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,Population ,Intracranial Aneurysm ,General Medicine ,Subarachnoid Hemorrhage ,Acute stage ,Surgery ,Recurrent haemorrhage ,medicine ,Referral system ,Humans ,Subarachnoid haemorrhage ,Neurology (clinical) ,education ,business - Abstract
A series of 480 patients who were alive upon admission following an aneurysmal subarachnoid haemorrhage (SAH) is reported. These patients represented 40% of the total Swedish incidence during a 3-year period. The three neurosurgical referral centres covering this population had a similar policy of early diagnosis and acute stage surgery in all patients considered of having a potential to survive without permanent disabling cerebral malfunction. At 2-year follow up 45% showed a good neurological recovery, the morbidity was 25% and the mortality was 30%. Some more lives might have been saved with an improved ultra-early referral system since there were 21 initially good-to-fair risk patients (4% of the total SAH population) who rebled fatally before surgery and within 48 h. For comparison, in the Kingdom of Denmark, with a general policy of delayed operation, out of 1076 patients who were alive upon admission, 27.5% made a good recovery, while the morbidity was 27%, and the mortality was 45.5%.
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- 1988
182. Late magnetic resonance imaging related to neurobehavioral functioning after aneurysmal subarachnoid hemorrhage
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Bengt Ljunggren, Bertil Romner, Lennart Brandt, Stig Holtås, Hans Säveland, and Bengt Sonesson
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Adult ,Male ,medicine.medical_specialty ,Neurology ,Subarachnoid hemorrhage ,Neurocognitive Disorders ,Neuropsychological Tests ,Aneurysm ,Postoperative Complications ,medicine ,Humans ,Neuropsychological assessment ,Pathological ,Aged ,medicine.diagnostic_test ,Rupture, Spontaneous ,business.industry ,Cognitive disorder ,Brain ,Magnetic resonance imaging ,Intracranial Aneurysm ,Middle Aged ,Subarachnoid Hemorrhage ,medicine.disease ,Magnetic Resonance Imaging ,Hyperintensity ,Surgery ,Brain Damage, Chronic ,Female ,Radiology ,Neurology (clinical) ,business ,Follow-Up Studies - Abstract
Twenty patients who underwent early aneurysm surgery—that is, surgery within 72 hours after rupture—underwent further follow-up examination including magnetic resonance imaging (MRI) of the brain and a comprehensive neuropsychological assessment. Significant statistical correlation between tissue loss as seen on a late MRI scan and neurobehavioral deficits could not be established. Among 9 patients with no tissue loss seen on MRI, 3 exhibited substantial cognitive dysfunction and 6 had mild impairment. Three patients showed minor but corresponding tissue loss and deficits. In 3 patients with pronounced pathological indications on MRI, evidence of cognitive dysfunction was absent in 2, and 1 patient showed substantial impairment. The remaining 5 individuals displayed moderate pathological indications on MRI, with no obvious correspondence to cognitive functioning. In 7 patients, small white matter lesions, probably silent infarcts not seen on computed tomographic scan, were discovered on MRI. There was a clear relationship between arterial hypertension prior to aneurysm rupture and the extent of tissue loss seen on MRI. Absence of pathological findings on MRI scan did not exclude cognitive malfunctioning, and vice-versa.
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- 1989
183. Prediction and prevention of delayed ischemic dysfunction after aneurysmal subarachnoid hemorrhage and early operation
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Bertil Romner, Lars Algotsson, Niels Aage Svendgaard, Lennart Brandt, Bengt Ljunggren, Erik Ryding, and Kenneth Messeter
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Adult ,Male ,medicine.medical_specialty ,Subarachnoid hemorrhage ,Time Factors ,medicine.drug_class ,Ischemia ,Calcium channel blocker ,Brain Ischemia ,Aneurysm ,Internal medicine ,Hyperventilation ,Medicine ,Humans ,In patient ,Nimodipine ,Rupture, Spontaneous ,business.industry ,Intracranial Aneurysm ,Middle Aged ,Subarachnoid Hemorrhage ,medicine.disease ,Prognosis ,Cerebral blood flow ,Cerebrovascular Circulation ,Cardiology ,Surgery ,Female ,Neurology (clinical) ,medicine.symptom ,business ,medicine.drug - Abstract
Mean hemispheric cerebral blood flow (CBF) was studied after the intravenous administration of xenon-133 in 20 anesthetized patients with aneurysmal subarachnoid hemorrhage. Before early aneurysm operation, repeated CBF measurements were made to evaluate the cerebral vascular reactivity to controlled hyperventilation. Thirteen individuals received intravenous treatment with the calcium channel blocker nimodipine, whereas the other seven patients did not receive such specific antiischemic treatment. Five of the latter patients had an impaired CO2 response, and three showed delayed ischemic deterioration (DID), whereas none of the seven nimodipine-treated patients with impaired CO2 response showed DID. One nimodipine-treated patient with a preserved CO2 response, in whom operation was complicated, developed DID. The observed findings indicate that DID after uncomplicated early aneurysm operation may be associated with an early disturbance of cerebral vasoreactivity. Treatment with nimodipine may counteract the development of DID in patients with an impaired CBF CO2 response.
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- 1987
184. Magnetic resonance imaging and aneurysm clips. Magnetic properties and image artifacts
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Lennart Brandt, Bengt Ljunggren, Stig Holtås, Bertil Romner, Magnus Olsson, Hans Säveland, and Bertil Persson
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medicine.medical_specialty ,medicine.diagnostic_test ,Aneurysm clips ,business.industry ,Magnetic resonance imaging ,Mr imaging ,Aneurysm ,Constriction ,Magnetic Resonance Imaging ,Imaging phantom ,Magnetics ,Medicine ,Humans ,Mr studies ,Radiology ,CLIPS ,business ,Nuclear medicine ,computer ,Vascular Surgical Procedures ,computer.programming_language - Abstract
✓ The magnetic properties of 12 different types of aneurysm clip were investigated in order to identify which clips allow postoperative magnetic resonance (MR) imaging without risk. Clip-induced MR artifacts were also quantitatively studied using a geometrical phantom. Nonferromagnetic aneurysm clips like the Yaşargil Phynox, Sugita Elgiloy, and Vari-Angle McFadden clips do not appear to contraindicate MR studies performed with a FONAR β-3000M imager. There is no clip movement upon introduction of the phantom into the MR imager, and the image artifacts caused by the clips are so limited that patients harboring such clips may well be considered for MR imaging. This examination may reveal information not obtainable by any other radiological modality.
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- 1989
185. No impact of early intervention on late outcome after minimal, mild and moderate head injury
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Roald Baardsen, Eirik Helseth, Tor Ingebrigtsen, Bertil Romner, Knut Waterloo, and Ben Heskestad
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Male ,medicine.medical_specialty ,Time Factors ,Critical Care and Intensive Care Medicine ,Outcome (game theory) ,Cognition ,Intervention (counseling) ,medicine ,Craniocerebral Trauma ,Humans ,Glasgow Coma Scale ,Prospective Studies ,Referral and Consultation ,Original Research ,Cognitive Behavioral Therapy ,Norway ,business.industry ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Late outcome ,VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Traumatology: 783 ,lcsh:RC86-88.9 ,Outcome and Process Assessment, Health Care ,VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Traumatologi: 783 ,Emergency medicine ,Physical therapy ,Emergency Medicine ,Female ,business ,Moderate head injury - Abstract
Objectives To evaluate the effect of an educational intervention on outcome after minimal, mild and moderate head injury. Methods Three hundred and twenty six patients underwent stratified randomization to an intervention group (n = 163) or a control group (n = 163). Every second patient was allocated to the intervention group. Participants in this group were offered a cognitive oriented consultation two weeks after the injury, while subjects allocated to the control group were not. Both groups were invited to follow up 3 and 12 months after injury. Results A total of 50 (15%) patients completed the study (intervention group n = 22 (13%), control group n = 28 (17%), not significant). There were no statistically significant differences between the intervention group and the control group. Conclusions There was no effect on outcomes from an early educational intervention two weeks after head injury.
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