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Galteland P, Døving M, Næss I, Sehic A, Utheim TP, Eken T, Skaga NO, Helseth E, Ramm-Pettersen J. The association between head injury and facial fracture treatment: an observational study of hospitalized bicyclists from a level 1 trauma centre. Acta Neurochir (Wien) 2024; 166:132. [PMID: 38472419 PMCID: PMC10933183 DOI: 10.1007/s00701-024-06019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE To compare the types of facial fractures and their treatment in bicyclists admitted to a level 1 trauma centre with major and minor-moderate head injury. METHODS Retrospective analysis of data from bicycle-related injuries in the period 2005-2016 extracted from the Oslo University Hospital trauma registry. RESULTS A total of 967 bicyclists with head injuries classified according to the Abbreviated Injury Scale (AIS) were included. The group suffering minor-moderate head injury (AIS Head 1-2) included 518 bicyclists, while 449 bicyclists had major head injury (AIS Head 3-6). The mean patient age was 40.2 years (range 3-91 years) and 701 patients (72%) were men. A total of 521 facial fractures were registered in 262 patients (on average 2 facial fractures per bicyclist). Bicyclists with major head injury exhibited increased odds for facial fractures compared to bicyclists with minor-moderate head injury (sex and age adjusted odds ratio (OR) 2.75, 95% confidence interval (CI) 2.03-3.72, p < 0.001. More specifically, there was increased odds for all midface fractures, but no difference for mandible fractures. There was also increased odds for orbital reconstruction in cyclist with major head injury compared to bicyclist with minor-moderate head injury (adjusted OR 3.34, 95% CI 1.30-8.60, p = 0.012). CONCLUSION Bicyclists with more severe head injuries had increased odds for midface fractures and surgical correction of orbital fractures. During trauma triage, the head and the face should be considered as one unit.
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Affiliation(s)
- Pål Galteland
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Nydalen, PO Box 4956, NO-0424, Oslo, Norway.
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Mats Døving
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Nydalen, PO Box 4956, NO-0424, Oslo, Norway
- Faculty of Dentistry, Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Ingar Næss
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Amer Sehic
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Nydalen, PO Box 4956, NO-0424, Oslo, Norway
- Faculty of Dentistry, Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Tor Paaske Utheim
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Nydalen, PO Box 4956, NO-0424, Oslo, Norway
- Faculty of Dentistry, Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Torsten Eken
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Anaesthesia and Intensive Care Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Nils Oddvar Skaga
- Department of Anaesthesia and Intensive Care Medicine, Oslo University Hospital Ullevål, Oslo, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Eirik Helseth
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Jon Ramm-Pettersen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway
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Frič R, König M, Due-Tønnessen BJ, Ramm-Pettersen J, Berg-Johnsen J. Long-term outcome of patients treated for craniopharyngioma: a single center experience. Br J Neurosurg 2023:1-9. [PMID: 36799140 DOI: 10.1080/02688697.2023.2179600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
PURPOSE Treatment of craniopharyngiomas (CP) is challenging due to their proximity to critical neural structures, risk of serious complications and impaired quality of life after treatment. Recurrences may occur many years after surgical resection. However, long-term outcome data are still scarce. The purpose of this retrospective study was therefore to assess the long-term results after treatment of patients with CP. MATERIAL AND METHOD Patients surgically treated for a histologically verified CP at Oslo University Hospital between 1992 and 2015 and with at least a 5-year follow-up were included. Patients' medical records and radiological studies were reviewed. RESULTS Sixty-one patients (mean age 35.8 ± 22.2 years) were included; 18 patients (30%) were children <18 years of age. The incidence for the study period and the referral population was 1.1 cases/million/year, with trimodal peak incidence at 6, 32 and 59 years of age. The commonest presenting symptoms were visual disturbances (62%), headache (43%) and endocrine dysfunction (34%). The transcranial approach was utilized in 79% of patients. Gross total resection (GTR) was achieved in 59%. The surgical complication rate was 20%. Three patients (5%) received radiotherapy or radiosurgery after primary resection. The mean follow-up was 139 ± 76 months, with no patients lost to follow-up. Postoperatively, 59% of patients had panhypopituitarism and 56% diabetes insipidus. Eighteen patients (30%) developed tumour recurrence after a mean follow-up of 26 ± 25 months. The 10-year overall survival (OS) rate was 75%, whereas the disease-specific survival (DSS) rate was 84%, and recurrence-free survival (RFS) 61%. Subtotal resection (STR) (p = .01) and systemic comorbidity (p = .002) were associated with worse DSS. CONCLUSION Surgical treatment of CP, even though combined with adjuvant radiotherapy in only selected cases, provides good long-time OS and DSS, and relatively good functional outcome in long-term survivors despite postoperative morbidity, particularly endocrine dysfunction. Systemic comorbidity and STR are individual negative prognostic factors.
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Affiliation(s)
- Radek Frič
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Marton König
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | - Jon Berg-Johnsen
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Stray AV, Siverts H, Melhuus K, Enger M, Galteland P, Næss I, Helseth E, Ramm-Pettersen J. Characteristics of Electric Scooter and Bicycle Injuries After Introduction of Electric Scooter Rentals in Oslo, Norway. JAMA Netw Open 2022; 5:e2226701. [PMID: 35969397 PMCID: PMC9379742 DOI: 10.1001/jamanetworkopen.2022.26701] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE When society introduces and accepts new transportation modes, it is important to map risks and benefits. OBJECTIVE To compare electric scooter (e-scooter) and bicycle injuries. DESIGN, SETTING, AND PARTICIPANTS This cohort study is based on prospectively collected data on Norwegian patients who sustained e-scooter or bicycle injuries and presented to an emergency department affiliated with Oslo University Hospital between January 1, 2019, and March 31, 2020. MAIN OUTCOMES AND MEASURES e-Scooter and bicycle injuries were evaluated for associations with sex, age, time of injury, helmet use, intoxication, body region, and injury severity. Descriptive statistics are presented as mean (SD) or number with percentage, with significance set at P < .05 (2-tailed). RESULTS During the study period, 3191 patients were included (850 e-scooter riders, 2341 bicyclists) with 3839 injuries recorded (997 e-scooter, 2842 bicycle). The mean (SD) age of those injured was 34 (17) years, 2026 riders (63.5%) were male, 1474 (46.2%) were helmeted at the time of injury, and 516 (16.2%) were intoxicated by alcohol or other drugs. The annual incidence of injuries was 120 per 100 000 inhabitants for e-scooters and 340 per 100 000 inhabitants for bicycles. Men were overrepresented in both groups (529 e-scooter riders [62.2%] and 1497 bicyclists [63.9%]). e-Scooter riders were younger than bicyclists (mean [SD] age, 31 [12] vs 35 [18] years). Most injured e-scooter riders were aged 20 to 40 years, whereas injured bicyclists had a broader age distribution. e-Scooter injuries commonly occurred on weekends (378 [46.6%]) and during evening (230 [32.3%]) or nighttime (242 [34.1%]) hours. Most bicycle injuries occurred during weekdays (1586 [69.7%]) and daytime (1762 [61.3%]). e-Scooter riders were more often intoxicated (336 [39.5%] vs 180 [7.7%]) and had a lower rate of helmet use (18 [2.1%] vs 1456 [62.2%]). During nighttime, 230 injured e-scooter riders (91.3%) and 86 bicyclists (69.4%) were intoxicated. e-Scooter riders had more head and neck (317 [31.7%] vs 636 [22.4%]) and lower-limb (285 [28.6%] vs 632 [22.2%]) injuries and fewer upper-limb (341 [34.2%] vs 1276 [44.9%]), thoracic (41 [4.1%] vs 195 [6.9%]), and abdominal, pelvic, and lumbar (13 [1.3%] vs 103 [3.6%]) injuries. CONCLUSIONS AND RELEVANCE In this cohort study, e-scooter riders were younger than bicyclists, did not use helmets, were more often intoxicated, and were more often injured during nighttime. The rate of intoxication among e-scooter riders injured at night was high. Preventive measures, including awareness campaigns, regulating e-scooter availability, improving infrastructure, and implementing stricter helmet and alcohol policies, may prove effective for reducing injuries.
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Affiliation(s)
| | - Henrik Siverts
- Division of Orthopaedic Surgery, Oslo University Hospital, Norway
| | - Knut Melhuus
- Division of Orthopaedic Surgery, Oslo University Hospital, Norway
| | - Martine Enger
- Division of Orthopaedic Surgery, Oslo University Hospital, Norway
| | - Pål Galteland
- Department of Maxillofacial Surgery, Oslo University Hospital, Norway
| | - Ingar Næss
- Institute of Clinical Medicine, Faculty of Medicine, Oslo University Hospital, Norway
| | - Eirik Helseth
- Institute of Clinical Medicine, Faculty of Medicine, Oslo University Hospital, Norway
- Department of Neurosurgery, Oslo University Hospital, Norway
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Døving M, Naess I, Galteland P, Ramm-Pettersen J, Dalby M, Utheim TP, Skaga NO, Helseth E, Sehic A. Anatomical distribution of mandibular fractures from severe bicycling accidents: A 12-year experience from a Norwegian level 1 trauma center. Dent Traumatol 2022; 38:424-430. [PMID: 35481880 PMCID: PMC9544727 DOI: 10.1111/edt.12756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Abstract
Background/Aim The mandible makes up a substantial part of the lower face, and is susceptible to injury. Even in helmeted cyclists, accidents may lead to fractures of the mandible because conventional helmets provide little protection to the lower part of the face. In addition, some studies indicate that helmets may lead to an increased risk of mandibular fractures. Thus, the aim of this study was to examine the anatomic distribution of mandibular fractures in injured cyclists and to assess if helmet use influenced the fracture locations. Material and Methods Data from a Norwegian Level 1 trauma center were collected in the Oslo University Hospital Trauma Registry over a 12‐year period. Of 1543 injured cyclists, the electronic patient charts of 62 cyclists with fractures of the mandible were retrospectively evaluated in detail. Demographic data, helmet use, and fracture type were assessed. Results Sixty‐two patients (4%) had fractures of the mandible, and women had an increased risk (OR 2.49, 95% CI 1.49–4.16, p < .001). The most common fracture site was the mandibular body, followed by the condyle. Isolated mandibular fractures occurred in 45% of the patients and 55% had other concomitant facial fractures. There were 42% of the patients with fractures in multiple sites of the mandible, and 42% had a concomitant dentoalveolar injury. Half of the cyclists were wearing a helmet at the time of the accident and 39% were not. There was no significant difference in fracture distribution between the helmeted and non‐helmeted groups. Conclusions Fracture of the mandibular body was the most prevalent mandibular fracture type following bicycle accidents. Women had an increased risk of mandibular fractures compared with men, whereas helmet wearing did not affect the anatomical fracture site.
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Affiliation(s)
- Mats Døving
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Ingar Naess
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Pål Galteland
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jon Ramm-Pettersen
- Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Marius Dalby
- Department of Ophtalmology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Tor Paaske Utheim
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Nils Oddvar Skaga
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital Ullevål, Oslo, Norway
| | - Eirik Helseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Amer Sehic
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
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Munkvold BKR, Solheim O, Bartek J, Corell A, de Dios E, Gulati S, Helseth E, Holmgren K, Jensdottir M, Lundborg M, Mireles EEM, Mahesparan R, Tveiten ØV, Milos P, Redebrandt HN, Pedersen LK, Ramm-Pettersen J, Sjöberg RL, Sjögren B, Sjåvik K, Smits A, Tomasevic G, Vecchio TG, Vik-Mo EO, Zetterling M, Salvesen Ø, Jakola AS. Variations in the management of diffuse low-grade gliomas-A Scandinavian multicenter study. Neurooncol Pract 2021; 8:706-717. [PMID: 34777840 PMCID: PMC8579093 DOI: 10.1093/nop/npab054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Early extensive surgery is a cornerstone in treatment of diffuse low-grade gliomas (DLGGs), and an additional survival benefit has been demonstrated from early radiochemotherapy in selected “high-risk” patients. Still, there are a number of controversies related to DLGG management. The objective of this multicenter population-based cohort study was to explore potential variations in diagnostic work-up and treatment between treating centers in 2 Scandinavian countries with similar public health care systems. Methods Patients screened for inclusion underwent primary surgery of a histopathologically verified diffuse WHO grade II glioma in the time period 2012 through 2017. Clinical and radiological data were collected from medical records and locally conducted research projects, whereupon differences between countries and inter-hospital variations were explored. Results A total of 642 patients were included (male:female ratio 1:4), and annual age-standardized incidence rates were 0.9 and 0.8 per 100 000 in Norway and Sweden, respectively. Considerable inter-hospital variations were observed in preoperative work-up, tumor diagnostics, surgical strategies, techniques for intraoperative guidance, as well as choice and timing of adjuvant therapy. Conclusions Despite geographical population-based case selection, similar health care organizations, and existing guidelines, there were considerable variations in DLGG management. While some can be attributed to differences in clinical implementation of current scientific knowledge, some of the observed inter-hospital variations reflect controversies related to diagnostics and treatment. Quantification of these disparities renders possible identification of treatment patterns associated with better or worse outcomes and may thus represent a step toward more uniform evidence-based care.
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Affiliation(s)
- Bodil Karoline Ravn Munkvold
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Ole Solheim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Alba Corell
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eddie de Dios
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Sasha Gulati
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Eirik Helseth
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Klas Holmgren
- Department of Clinical Sciences, Neuroscience, Umeå University, Umeå, Sweden.,Department of Neurosurgery, University Hospital of Northern Sweden, Umeå, Sweden
| | - Margret Jensdottir
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Mina Lundborg
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | | | - Ruby Mahesparan
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Øystein Vesterli Tveiten
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Peter Milos
- Department of Neurosurgery, Linköping University Hospital, Sweden
| | - Henrietta Nittby Redebrandt
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Neurosurgery, Skåne University Hospital, Lund, Sweden
| | | | | | - Rickard L Sjöberg
- Department of Clinical Sciences, Neuroscience, Umeå University, Umeå, Sweden.,Department of Neurosurgery, University Hospital of Northern Sweden, Umeå, Sweden
| | - Björn Sjögren
- Department of Neurosurgery, Linköping University Hospital, Sweden
| | - Kristin Sjåvik
- Department of Neurosurgery, University Hospital of North Norway, Tromsø, Norway
| | - Anja Smits
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Gregor Tomasevic
- Department of Neurosurgery, Skåne University Hospital, Lund, Sweden
| | - Tomás Gómez Vecchio
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Einar O Vik-Mo
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Maria Zetterling
- Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Asgeir S Jakola
- Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Døving M, Galteland P, Eken T, Sehic A, Utheim TP, Skaga NO, Helseth E, Ramm-Pettersen J. Dentoalveolar injuries, bicycling accidents and helmet use in patients referred to a Norwegian Trauma Centre: A 12-year prospective study. Dent Traumatol 2020; 37:240-246. [PMID: 33220164 DOI: 10.1111/edt.12627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM Despite its many benefits, bicycling carries the risk of accidents. Although numerous studies have reported the effect of helmet use on traumatic brain injury, it remains unclear if, and to what extent, helmet use reduces the risk of facial injuries. This is particularly true in regard to injuries of the lower face. In addition, there is limited evidence of the effect of helmet use on dentoalveolar injuries. Thus, the aim of this study was to determine the frequency and distribution of dentoalveolar injuries in bicycling accidents and to explore the influence of helmet use. MATERIAL AND METHODS A total of 1543 bicyclists were included from the trauma registry of a Norwegian tertiary trauma center over a 12-year period. Data were collected prospectively, including patient characteristics, type of injury, and helmet use. The prevalence of dentoalveolar injuries was assessed in conjunction with helmet use and facial fractures. RESULTS Twenty-five percent of the patients had maxillofacial injuries, and 18% of those with facial fractures exhibited concomitant dentoalveolar injuries. The most common type of dentoalveolar injury was tooth fracture (39%). The most frequent location of facial fractures with combined dentoalveolar injuries was the maxilla, which had fractured in 32 patients. Women had a higher risk of sustaining dentoalveolar injuries compared to men (odds ratio 1.50, 95% confidence interval 1.02-2.22). There were 1257 patients (81%) who had reliable registration of helmet use; 54% of these wore a helmet, while 46% did not. Helmet users had an increased risk of dentoalveolar injuries compared to non-helmeted bicyclists (adjusted odds ratio 1.54, 95% confidence interval 1.02-2.31). CONCLUSIONS Dentoalveolar injuries are fairly common in trauma patients admitted to a trauma center following bicycling accidents. Bicycling helmets are associated with an increased risk of dentoalveolar injuries.
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Affiliation(s)
- Mats Døving
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Pål Galteland
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Torsten Eken
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Amer Sehic
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tor Paaske Utheim
- Department of Maxillofacial Surgery, Oslo University Hospital Ullevål, Oslo, Norway.,Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Nils Oddvar Skaga
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital Ullevål, Oslo, Norway
| | - Eirik Helseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway
| | - Jon Ramm-Pettersen
- Department of Neurosurgery, Oslo University Hospital Ullevål, Oslo, Norway
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7
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Næss I, Galteland P, Skaga NO, Eken T, Helseth E, Ramm-Pettersen J. The number of patients hospitalized with bicycle injuries is increasing - A cry for better road safety. Accid Anal Prev 2020; 148:105836. [PMID: 33171415 DOI: 10.1016/j.aap.2020.105836] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 05/27/2020] [Accepted: 10/08/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Norwegian authorities encourage people to commute by bicycle to improve public health, decrease rush-hour traffic jams and reduce pollution. However, increasing the number of bicyclists, especially in the rush-hour traffic, may increase the number of serious bicycle injuries. OBJECTIVE To explore trends in hospitalized bicycle injuries at a Norwegian level I trauma centre during the last decade. METHODS Data was extracted from the prospectively registered institutional trauma registry. We identified patients admitted after bicycle injuries between 2005 and 2016. RESULTS A total of 1543 patients were identified. Median age was 40 years (range 3-91) and 73 % were males. The majority of weekday injuries occurred in the morning and during the afternoon rush-hour, peaking at 8 am. and 4 pm. The annual number of admitted bicycle injuries increased from 79 to 184 during the study period. Also, an increase in the share of bicyclists using helmets was observed. The median Injury Severity Score (ISS) of 10 remained unchanged. 63 % had serious trauma (ISS ≥ 9), while 34 % suffered severe trauma (ISS ≥ 16). The absolute number of both serious and severe trauma increased annually. 36 % had head and neck injuries, while 16 % had chest injuries graded with Abbreviated Injury Scale ≥3. Loss of consciousness with Glasgow Coma Scale score <9 was seen in 7%. Median length of hospitalization was 3 days, and 39 % had surgery in one or more body regions. The 30-day mortality was 2.3 %. CONCLUSIONS The number of admitted bicycle injuries to our trauma centre is increasing. Rush-hour injuries dominate during weekdays. Bicycle injuries can be devastating and deserve more public attention to promote road safety.
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Affiliation(s)
- Ingar Næss
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Pål Galteland
- Department of Maxillofacial Surgery, Oslo University Hospital, Oslo, Norway.
| | - Nils Oddvar Skaga
- Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.
| | - Torsten Eken
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.
| | - Eirik Helseth
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
| | - Jon Ramm-Pettersen
- Department of Maxillofacial Surgery, Oslo University Hospital, Oslo, Norway.
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8
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Nome T, Herrman H, Lehtimäki K, Egge A, Konglund A, Ramm-Pettersen J, Taubøll E, Dietrichs E. Direct visual targeting versus preset coordinates for ANT-DBS in epilepsy. Acta Neurol Scand 2020; 142:23-29. [PMID: 32078161 DOI: 10.1111/ane.13233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/04/2020] [Accepted: 02/18/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Deep brain stimulation (DBS) of the anterior thalamic nucleus (ANT) may be used against refractory focal epilepsy, but only two randomized double-blinded trials have been performed. The Oslo study was discontinued prematurely since reduction in seizure frequency was less than expected. The aim of the present study was to review the targeting used in the Oslo study and to identify the actual positions of the contacts used for stimulation. MATERIAL AND METHODS BrainLab MRI data were available from 12 Oslo study patients. Based on MRI the coordinates of the center of the ANT were identified. The coordinates were considered as the visually identified preferred target and were compared with the target originally used for ANT electrode implantation and with the actual electrode positions estimated from post-operative CT scans. RESULTS We found considerable differences between the visually identified preferred target, the originally planned target, and the actual electrode position. The total distance between the active electrode position and the visually identified preferred target was on average 3.3 mm on the right and 2.9 mm on the left side. CONCLUSION Indirect targeting based on preset coordinates may contribute to explain the modest effect of ANT-DBS on seizure frequency seen in the Oslo study. Observed differences between the center of the ANT and the actual electrode position may at least in part be explained by variations in position and size of the ANT. Direct identification of the target using better MRI imaging protocols is recommended for future ANT-DBS surgery.
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Affiliation(s)
- Terje Nome
- Department of Radiology and Nuclear Medicine Oslo University Hospital Oslo Norway
| | - Helle Herrman
- Department of Neurology Oslo University Hospital Oslo Norway
- National Centre for Epilepsy Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | - Kai Lehtimäki
- Department of Neurosciences and Rehabilitation Tampere University Hospital Tampere Norway
| | - Arild Egge
- Department of Neurosurgery Oslo University Hospital Oslo Norway
| | - Ane Konglund
- Department of Neurosurgery Oslo University Hospital Oslo Norway
| | | | - Erik Taubøll
- Department of Neurology Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | - Espen Dietrichs
- Department of Neurology Oslo University Hospital Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
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Berg-Johnsen J, Ramm-Pettersen J, Langmoen IA, Kolstad F. Geir Ketil Røste. Tidsskriftet 2019. [DOI: 10.4045/tidsskr.18.0886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Lundborg M, Helseth E, Josefsen R, Braathen M, Skogen K, Ramm-Pettersen J. Hyperbaric oxygen therapy of air embolus in the cerebral venous sinuses after intracranial surgery: a case report. Acta Neurochir (Wien) 2018; 160:1401-1405. [PMID: 29696503 DOI: 10.1007/s00701-018-3537-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/04/2018] [Indexed: 01/28/2023]
Abstract
A case with cerebral venous air embolism (CVAE) after neurosurgery and treated with hyperbaric oxygen therapy (HBOT) is presented. This is a rare and potentially fatal complication that neurosurgeons should be aware of. A 52-year-old male was diagnosed with an intracerebral hematoma. An emergency evacuation of the hematoma was performed with a craniotomy and the postoperative CT scan showed a complete evacuation of the hematoma, but it also revealed a CVAE. The patient was immediately referred to HBOT and received three sessions within 48 h. The CT scan after the first HBOT showed no CVAE, venous thrombosis, or new hematoma.
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Ramm-Pettersen J, Halvorsen H, Evang JA, Rønning P, Hol PK, Bollerslev J, Berg-Johnsen J, Helseth E. Low immediate postoperative serum-cortisol nadir predicts the short-term, but not long-term, remission after pituitary surgery for Cushing's disease. BMC Endocr Disord 2015; 15:62. [PMID: 26499317 PMCID: PMC4620605 DOI: 10.1186/s12902-015-0055-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 10/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cushing's disease is an ACTH-producing pituitary adenoma, and the primary treatment is microscopic or endoscopic transsphenoidal selective adenectomy. The aims of the present study were to evaluate whether the early postoperative S-cortisol level can serve as a prognostic marker for short- and long-term remission, and retrospectively review our own short and long term results after surgery for Cushing's disease. METHODS This single centre, retrospective study consists of 19 consecutive patients with Cushing's disease who underwent transsphenoidal surgery. S-cortisol was measured every 6 h after the operation without any glucocorticoid replacement. We have follow-up on all patients, with a mean follow-up of 68 months. RESULTS At the three-month follow-up, 16 patients (84 %) were in remission; at 12 months, 18 (95 %) were in remission and at the final follow-up (mean 68 months), 13 (68 %) were in remission. Five-years recurrence rate was 26 %. The mean postoperative S-cortisol nadir was significantly lower in the group of patients in remission than in the non-remission group at 3 months, but there was no difference between those in long-term remission compared to those in long-term non-remission. The optimal cut-off value for classifying 3-month remission was 74 nmol/l. CONCLUSION We achieved a 95 % 1-year remission rate with transsphenoidal surgery for Cushing's disease in this series of consecutive patients. However, the 5-year recurrence rate was 26 %, showing the need for regular clinical and biochemical controls in this patient group. The mean postoperative serum-cortisol nadir was significantly lower in patients in remission at 3 months compared to patients not in remission at 3 months, but a low postoperative S-cortisol did not predict long-term remission.
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Affiliation(s)
- Jon Ramm-Pettersen
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Helene Halvorsen
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
| | - Johan Arild Evang
- Faculty of Medicine, University of Oslo, Oslo, Norway.
- Section of Specialized Endocrinology, Medical Clinic B, Oslo University Hospital, Oslo, Norway.
| | - Pål Rønning
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
| | - Per Kristian Hol
- Faculty of Medicine, University of Oslo, Oslo, Norway.
- The Intervention Centre, Oslo University Hospital, Oslo, Norway.
| | - Jens Bollerslev
- Faculty of Medicine, University of Oslo, Oslo, Norway.
- Section of Specialized Endocrinology, Medical Clinic B, Oslo University Hospital, Oslo, Norway.
| | - Jon Berg-Johnsen
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Eirik Helseth
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
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Halvorsen H, Ramm-Pettersen J, Josefsen R, Rønning P, Reinlie S, Meling T, Berg-Johnsen J, Bollerslev J, Helseth E. Surgical complications after transsphenoidal microscopic and endoscopic surgery for pituitary adenoma: a consecutive series of 506 procedures. Acta Neurochir (Wien) 2014; 156:441-9. [PMID: 24343227 DOI: 10.1007/s00701-013-1959-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 11/20/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND This single-institution, consecutive series of transsphenoidal procedures included all patients in a defined population of 2.6 million inhabitants who underwent surgery during a specific time period. OBJECTIVE We sought to determine the surgical complication rate and overall survival rate after transsphenoidal surgery for pituitary adenoma. METHODS All transsphenoidal procedures for histologically verified pituitary adenomas performed between September 2002 and February 2011 at our institution were included in this study. The data were obtained from a prospectively collected database and from reviewing medical records. No patients were lost to follow-up, and the median follow-up time was 28 months. RESULTS A total of 506 transsphenoidal procedures were performed on 446 patients. There were 268 microscopic and 238 endoscopic procedures involving 352 non-functioning and 154 hormone-secreting adenomas. A total of 73% of the procedures were primary surgeries, and 27% were repeat surgeries for tumor recurrence. The overall complication rate was 9.1%. The three most frequent complications were cerebrospinal fluid (CSF) leakage (4.7%), meningitis (2%), and visual deterioration (2%). Multivariate analyses showed that the overall risk for complications increased with older age, surgery for recurrent tumors, and surgery performed by a low-volume surgeon. There was no significant difference in the overall complication rate between the microsurgical and endoscopic techniques. The rate of surgical mortality was 0.6%, and the overall survival rates at 1 and 5 years were 95% and 90%, respectively. The only negative predictor of survival was older age. CONCLUSIONS Transsphenoidal surgery for pituitary adenomas has a low complication rate and a low rate of mortality. We did not find a significant difference in the complication rate between endoscopic and microscopic techniques.
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Casar-Borota O, Heck A, Schulz S, Nesland JM, Ramm-Pettersen J, Lekva T, Alafuzoff I, Bollerslev J. Expression of SSTR2a, but not of SSTRs 1, 3, or 5 in somatotroph adenomas assessed by monoclonal antibodies was reduced by octreotide and correlated with the acute and long-term effects of octreotide. J Clin Endocrinol Metab 2013; 98:E1730-9. [PMID: 24092823 DOI: 10.1210/jc.2013-2145] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Reduced expression of somatostatin receptors (SSTRs) in somatotroph adenomas and their potential down-regulation after medical treatment may explain the unsatisfactory response to octreotide in particular acromegalic patients. The expression of SSTRs other than SSTR2a has not been studied in large, unselected cohorts using novel rabbit monoclonal antibodies. OBJECTIVE We aimed to determine the expression of SSTRs 1, 2a, 3, and 5 in somatotroph adenomas, to correlate expression with clinical characteristics and the response to octreotide, and to ascertain whether preoperative octreotide treatment affected SSTR expression. DESIGN, SETTING, PATIENTS The study included 78 adenomas from patients operated on consecutively during 2000 to 2010. After exclusion of 13 patients, immunohistochemical analysis with rabbit monoclonal antibodies against SSTRs 1, 2a, 3, and 5 (clones UMB-7, -1, -5, and -4) was performed on 65 adenomas. INTERVENTION Twenty-eight patients received preoperative octreotide, and 37 patients were operated on without pretreatment. Twenty-six patients were randomized to direct surgery (n = 13) or to octreotide pretreatment (n = 13). MAIN OUTCOME MEASURE SSTR expression was evaluated using a 12-grade scoring system. The responses to the octreotide test dose (GH reduction) and to 6 months of octreotide (IGF-I reduction) were measured. RESULTS The majority of adenomas showed membranous expression of SSTRs 2a and 5. SSTR2a expression was reduced in the pretreated group and correlated with the acute octreotide test results and the effect of octreotide treatment. In a linear regression model with SSTR2a expression as the determinant, the correlation with the acute test response improved after adjustment for medical pretreatment. CONCLUSION Rabbit monoclonal antibodies are reliable markers of SSTRs in somatotroph adenomas. SSTR2a expression correlated with the response to octreotide and was reduced after octreotide treatment, indicating the need for adjustment when SSTR2a expression is correlated with baseline characteristics. Evaluation of SSTR subtypes may be an important aspect of improving the medical treatment for acromegaly.
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Affiliation(s)
- Olivera Casar-Borota
- Section of Specialized Endocrinology, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway.
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Evang JA, Bollerslev J, Casar-Borota O, Lekva T, Ramm-Pettersen J, Berg JP. Different levels of various glucocorticoid-regulated genes in corticotroph adenomas. Endocrine 2013; 44:220-7. [PMID: 23315031 DOI: 10.1007/s12020-012-9871-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 12/29/2012] [Indexed: 10/27/2022]
Abstract
Recently, correlations between corticotroph tumor dedifferentiation and both E-cadherin immunostaining and reduced mRNA expression of the E-cadherin gene (CDH1) have been demonstrated. The purpose of this study was to explore whether tumor dedifferentiation correlated with glucocorticoid resistance and whether the resistance was associated with both positively and negatively regulated genes. Tumor material from 20 patients with verified Cushing's disease or Nelson's syndrome operated on at Rikshospitalet, Oslo. Reverse transcription polymerase chain reaction analysis of genes such as E-cadherin (CDH1), proopiomelanocortin (POMC), glucocorticoid-induced leucine zipper (GILZ), and thioredoxin-interacting protein (TXNIP) was performed. The correlations between the expression of the GILZ, TXNIP, and POMC genes in different stages of corticotroph adenomas, the E-cadherin mRNA expression and staining pattern, and the preoperative 24-h cortisol excretion were examined. The GILZ and TXNIP expression levels were positively correlated to the CDH1 expression and were highest in microadenomas and in tumors with a high membranous E-cadherin reactivity. In contrast, the POMC expression was not significantly different between the groups. This divergence between the genes that were positively and negatively regulated by glucocorticoids could not be supported by other gene expression analyses. No correlations to urinary cortisol were found. The expression of the glucocorticoid-responsive genes POMC, GILZ, and TXNIP in corticotroph adenomas showed a remarkable variation. The pattern and variability of glucocorticoid resistance in corticotroph adenomas seem to correlate with a loss of the epithelial phenotype associated with corticotroph tumor dedifferentiation.
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Affiliation(s)
- Johan Arild Evang
- Section of Specialized Endocrinology, Oslo University Hospital Rikshospitalet, P.O. Box 4950, Nydalen, 0424, Oslo, Norway.
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Abstract
AIM The aim of this study was to evaluate the long-term results of resective surgery on children with difficult-to-treat epilepsy in Norway. METHODS In the period 1995-2004, 64 surgical procedures (54 resections and 10 functional hemispherotomies) were performed in 54 children. The children's medical records were retrospectively reviewed at a minimum of 2 years after surgery. We sent a questionnaire regarding their epilepsy (seizures, usage of antiepileptic drugs) and general functioning (social situation, motor, language, cognition, behavioural or emotional problems, any remedial action) to the children/parents after a mean follow-up period of 7 years. RESULTS 55.5% of the children were seizure-free. The success rate varied according to the type of surgery. Best results were found after functional hemispherotomies and temporal lobe resections, as nine of 10 (90%) and 10 of 19 (53%) of these patients, respectively, became seizure-free. In addition to a better seizure control, 71% of the children/parents reported of a better cognitive and psychosocial functioning. CONCLUSION The results of epilepsy surgery in this paediatric cohort are very edifying, and it is our impression that this treatment option is underused in Norway.
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Affiliation(s)
- K M Aaberg
- National Center for Epilepsy, Division of Surgery and Neuroscience, Oslo University Hospital, Oslo, Norway.
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Heck A, Ringstad G, Fougner SL, Casar-Borota O, Nome T, Ramm-Pettersen J, Bollerslev J. Intensity of pituitary adenoma on T2-weighted magnetic resonance imaging predicts the response to octreotide treatment in newly diagnosed acromegaly. Clin Endocrinol (Oxf) 2012; 77:72-8. [PMID: 22066905 DOI: 10.1111/j.1365-2265.2011.04286.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary, preoperative medical treatment is an option in selected patients with acromegaly, but a subset of patients respond poorly. Valid prediction of response to somatostatin analogues (SA) might thus alter treatment stratification. The aims of this study were to assess whether T2 signal intensity could determine long-term response to first-line SA treatment and to assess clinical and biochemical baseline characteristics, as well as histological subtype in relation to the magnetic resonance imaging (MRI) appearances. METHODS In 45 newly diagnosed patients, T2-weighted signal intensity of the tumour was classified into hypo-, iso- or hyperintense. Biochemical and clinical baseline variables for the three groups were compared. In 25 patients primarily treated with long-acting SA for a median of 6 months [interquartile range (IQR):155-180 days], GH and IGF-1 reduction was assessed, and in 34 cases, immunohistochemical granulation pattern was evaluated. RESULTS The results showed that 12 (27%) adenomas were hypointense, 15 (33%) isointense and 18 (40%) hyperintense. Median IGF-1 [ratio IGF-1/ULN; (upper limit of normal)] was 3·5 (2·3-4·9), 2·9 (2·6-3·8) and 1·9 (1·3-2·6), respectively (P = 0·006 for difference between groups). Median GH values (μg/l) of a 3- to 5-point profile were 17·5 (6·1-35), 9·3 (6·0-32·5) and 4·1 (1·5-8·3), (P = 0·025). Median IGF-1 reduction (% of baseline) after first-line SA treatment was 51 (49-70), 36 (19-74) and 13 (5-42) (P = 0·03); median reduction in GH (% of baseline) was 86 (72-94), 78 (62-85) and 46 (1-70) (P = 0·02). T2 hyperintensity was associated with sparse granulation pattern on immunohistochemistry. CONCLUSION In patients with acromegaly, T2 signal intensity at diagnosis correlates with histological features and predicts biochemical outcome of first-line SA treatment.
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Affiliation(s)
- Ansgar Heck
- Section of Specialized Endocrinology, Oslo University Hospital, Rikshospitalet, Norway.
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Fric R, Ramm-Pettersen J, Berg-Johnsen J. Minimally Invasive Endoscopic Transsphenoidal Surgery or Just “Wait and Scan” in Selected Cases of Clivus Chordomas. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1314095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Stanisic M, Aasen AO, Pripp AH, Lindegaard KF, Ramm-Pettersen J, Lyngstadaas SP, Ivanovic J, Konglund A, Ilstad E, Sandell T, Ellingsen O, Sæhle T. Local and systemic pro-inflammatory and anti-inflammatory cytokine patterns in patients with chronic subdural hematoma: a prospective study. Inflamm Res 2012; 61:845-52. [DOI: 10.1007/s00011-012-0476-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 03/18/2012] [Accepted: 04/02/2012] [Indexed: 01/05/2023] Open
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Evang JA, Berg JP, Casar-Borota O, Lekva T, Kringen MK, Ramm-Pettersen J, Bollerslev J. Reduced levels of E-cadherin correlate with progression of corticotroph pituitary tumours. Clin Endocrinol (Oxf) 2011; 75:811-8. [PMID: 21595730 DOI: 10.1111/j.1365-2265.2011.04109.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Loss of E-cadherin is an important marker of epithelial tumour progression. The aims of this study were to explore whether E-cadherin expression and localization correlate to corticotroph tumour progression, relate the expression of the E-cadherin gene (CDH1) to immunohistochemical E-cadherin staining pattern, and study whether the E-cadherin levels were correlated to methylation status of the CDH1 promoter region. DESIGN Immunohistochemical analyses of E-cadherin protein were performed, as was RT-qPCR of the CDH1 and the POMC genes. Methylation pattern of the promoter region of CDH1 was measured using pyrosequencing of bisulfite-treated DNA. PATIENTS Forty-five patients operated at a tertiary referral centre in Oslo, Norway. Adenoma tissue sections and RNA samples from patients with verified Cushing's disease or Nelson's syndrome were collected. MEASUREMENTS Expression of E-cadherin mRNA and protein in pituitary corticotroph adenomas and average percentage of methylated cytosines in a cytosine-phosphate-guanosine island of the CDH1 promoter. RESULTS Correlations were observed between tumour progression and both nuclear expression of E-cadherin and reduced CDH1 mRNA. The E-cadherin expression was not determined by the methylation pattern of the CDH1 promoter. CONCLUSIONS Corticotroph tumour progression was associated with reduced expression of the epithelial marker E-cadherin.
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Affiliation(s)
- Johan Arild Evang
- Section of Specialised Endocrinology, Department of Endocrinology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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Skogseid IM, Ramm-Pettersen J, Volkmann J, Kerty E, Dietrichs E, Røste GK. Good long-term efficacy of pallidal stimulation in cervical dystonia: a prospective, observer-blinded study. Eur J Neurol 2011; 19:610-5. [PMID: 22117556 DOI: 10.1111/j.1468-1331.2011.03591.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Deep brain stimulation of the internal globus pallidus (GPi-DBS) is established as an effective treatment of primary generalised dystonia in controlled studies. In cervical dystonia (CD), only one previous study has reported observer-blinded outcome assessment of long-term GPi-DBS, with 1-year follow-up. METHODS In this prospective, single-centre study, eight patients with CD (7 women:1 man, 4 focal:4 segmental) treated with bilateral GPi-DBS for median (range) 30 (12-48) months, were evaluated by the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS; Severity, Disability and Pain scores), the Short-Form Health Survey-36 (SF-36), and the Becks Depression Index in an open design. In addition, a blinded rater assessed the TWSTRS Severity score from videos obtained preoperatively and at the last follow-up. RESULTS In the blinded evaluation, median (range) TWSTRS Severity score improved from 25 (19-30) to 8 (4-23) (P = 0.028), thus a 70% (23-82) score reduction. In the open evaluation, median Severity score improvement at the last follow-up was 73%, representing a significant further improvement from 50% at 6 months. The Disability and Pain scores improved by median 91% and 92%, respectively, and the SF-36 subdomain scores improved significantly. A reversible right hemiparesis and aphasia occured in one patient 4 days postoperatively, because of reversible oedema around the left electrode. No other serious adverse effects and no permanent morbidity were observed. CONCLUSIONS This single-blinded study shows good long-term efficacy of GPi-DBS in CD patients and supports using this treatment in those who have insufficient response to medical treatment.
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Affiliation(s)
- I M Skogseid
- Department of Neurology Neurosurgery, Oslo University Hospital, Oslo, Norway.
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Ramm-Pettersen J, Berg-Johnsen J, Hol PK, Roy S, Bollerslev J, Schreiner T, Helseth E. Intra-operative MRI facilitates tumour resection during trans-sphenoidal surgery for pituitary adenomas. Acta Neurochir (Wien) 2011; 153:1367-73. [PMID: 21523361 PMCID: PMC3111601 DOI: 10.1007/s00701-011-1004-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 03/23/2011] [Indexed: 12/04/2022]
Abstract
Background During trans-sphenoidal microsurgical resection of pituitary adenomas, the extent of resection may be difficult to assess, especially when extensive suprasellar and parasellar growth has occurred. In this prospective study, we investigated whether intra-operative magnetic resonance imaging (iMRI) can facilitate tumour resection. Methods Twenty patients with macroadenomas, (16 non-functioning, three growth-hormone secreting and one pharmaco-resistant prolactinoma) were selected for surgery in the iMRI. The mean tumour diameter was 27 mm (range 11–41). The mean parasellar grade, according to the Knosp classification, was 2.3. Pre-operative coronal and sagittal T1-weighted and T2-weighted images were obtained. The trans-sphenoidal tumour resection was performed at the edge of the tunnel of a Signa SP 0.5-Tesla MRI. The surgeon aimed at a radical tumour resection that was followed by a peri-operative MRI scan. When a residual tumour was visualised and deemed resectable, an extended resection was performed, followed by another MRI scan. This procedure was repeated until the imaging results were satisfactory. In all patients, we were able to obtain images to assess the extent of resection and to classify the resection as either total or subtotal. Results After primary resection, eight out of 20 cases were classified as total resections. A second resection was performed in 11 of 12 cases classified as subtotal resections, and in four of these, total resection was achieved. A third resection was performed in three of the remaining seven cases with subtotal resections, but we did not achieve total resection in any of these cases. Therefore, the use of iMRI increased the number of patients with total resection from 8/20 (40%) to 12/20 (60%). The only observed complication was a transient spinal fluid leakage. Conclusion Intra-operative MRI during trans-sphenoidal microsurgery is useful in selected patients for a safe and more complete resection.
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Toft M, Lilleeng B, Ramm-Pettersen J, Skogseid IM, Gundersen V, Gerdts R, Pedersen L, Skjelland M, Røste GK, Dietrichs E. Long-term efficacy and mortality in Parkinson's disease patients treated with subthalamic stimulation. Mov Disord 2011; 26:1931-4. [PMID: 21656853 DOI: 10.1002/mds.23817] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Revised: 05/04/2011] [Accepted: 05/09/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The objective of this study was to examine the clinical outcome and mortality of long-term deep brain stimulation of the subthalamic nucleus in advanced Parkinson's disease. METHODS We included all 144 patients (mean age, 60.3 years; mean disease duration, 11.0 years) treated in our center from 2001 to 2007. RESULTS Twelve months after surgery, the off-medication Unified Parkinson's Disease Rating Scale motor score was reduced by a mean of 53%, and the annual increase after surgery was 3.2 points. The daily dose of dopaminergic medication was reduced by a mean of 49% and increased only marginally during follow-up. Twelve of the 144 patients died in the study period, including 2 suicides (1.4%). Survival was 97% after 3 years and 90% after 5 years. CONCLUSIONS The study confirms the stable efficacy of long-term subthalamic stimulation in selected patients with advanced Parkinson's disease. Throughout the study the patient characteristics at time of surgery changed, with less severe disease and shorter disease duration toward the end of the study period.
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Affiliation(s)
- Mathias Toft
- Department of Neurology, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
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Vik-Mo EO, Sandberg C, Olstorn H, Varghese M, Brandal P, Ramm-Pettersen J, Murrell W, Langmoen IA. Brain tumor stem cells maintain overall phenotype and tumorigenicity after in vitro culturing in serum-free conditions. Neuro Oncol 2010; 12:1220-30. [PMID: 20843775 DOI: 10.1093/neuonc/noq102] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Traditional in vitro culturing of tumor cells has been shown to induce changes so that cultures no longer represent the tumor of origin. Serum-free culturing conditions are used in a variety of cancers to propagate stem-like cells in vitro. Limited reports, however, exist on the effects of such propagation. We have compared cells from brain tumor biopsies cultivated under serum-free conditions at passages 2 and 10 to describe the effects of in vitro culturing. We were able to establish cell lines from 7 of 10 biopsies from patients with glioblastoma. The cell lines adapted to conditions and had 2.2 times increased population doubling rate at later passages. Karyotyping and comparative genomic hybridization analysis revealed that all examined cell lines had cytogenetic aberrations commonly found in glioblastomas, and there were only minor differences between tumor and early and late passages in the same culture. Whole-transcriptome analysis shows that tumors had interindividual differences. Changes in the overall expression patterns through passaging were modest, with a significant change in only 14 genes; the variation among cultures was, however, reduced through passages. The ability to differentiate differed among tumors but was maintained throughout passaging. The cells initiated tumors upon transplantation to immunodeficient mice with differing phenotypes, but a given cell culture maintained tumor phenotype after serial cultivation. The cultures established maintained individual characteristics specific to culture identity. Thus, each cell culture reflects an image of the tumor--or a personalized model--from which it was derived and remains representative after moderate expansion.
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Evang JA, Borota OC, Melum E, Holm R, Ramm-Pettersen J, Bollerslev J, Berg JP. HDAC2 expression and variable number of repeats in exon 1 of the HDAC2 gene in corticotroph adenomas. Clin Endocrinol (Oxf) 2010; 73:229-35. [PMID: 20346000 DOI: 10.1111/j.1365-2265.2010.03805.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Alterations in protein expression of histone deacetylase 2 (HDAC2) have been demonstrated in various neoplasms, and lack of nuclear expression of HDAC2 has previously been shown in some human and canine corticotroph adenomas. This study aimed to examine HDAC2 expression in a Norwegian cohort of corticotroph adenomas, screen for exonic HDAC2 gene variants in the adenomas and correlate the results with clinical data. PATIENTS AND DESIGN Forty-four patients with verified Cushing's disease or Nelson's syndrome, positive ACTH staining and tissue available for immunohistochemistry and/or DNA sequencing were included. Ninety-four controls were chosen from the Norwegian Bone Marrow Registry. RESULTS Histone deacetylase 2 expression examined by immunohistochemistry was strongly reduced in 3/30 adenomas. There were no association between HDAC2 expression and clinical variables. A previously unidentified insertion of three bases in a region coding for a polyserine cluster in exon 1 of the HDAC2 gene was identified in 6/32 adenomas. No other mutations in HDAC2 exons were found. Examination of DNA extracted from peripheral blood confirmed germ-line origin of the exon 1 insertion. The same insertion was also found in 28/94 of the controls (i.e., not significantly different from the patients). CONCLUSIONS Strongly reduced HDAC2 protein expression was confirmed in a small portion of corticotroph tumours. Mutations in HDAC2 exons are unlikely to play an important role in the development of corticotroph adenomas.
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Affiliation(s)
- J Arild Evang
- Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital and University of Oslo, Oslo, Norway.
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Ramm-Pettersen J, Bachmann-Harildstad G, Meling T, Hol P, Berg-Johnsen J. Endoscopic Endonasal Skull Base Surgery in a 3-T Intraoperative MRI Suite: Complications and Postoperative Hospitalization. Skull Base 2009. [DOI: 10.1055/s-2009-1222187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Toft M, Lilleeng B, Ramm-Pettersen J, Røste GK, Pedersen L, Skogseid IM, Dietrichs E. [Treatment of movement disorders with deep brain stimulation]. Tidsskr Nor Laegeforen 2008; 128:1972-1976. [PMID: 18787575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Deep brain stimulation is an established symptomatic treatment of movement disorders such as Parkinson's disease, tremor conditions and dystonia when medical treatment fails. We here present a review of indications and results for this treatment. We also present data om the activity related to patients with Parkinson's disease in a representative year and data on implantations performed Rikshospitalet University Hospital in the period 1999-2007. MATERIAL AND METHODS The manuscript is based on non-systematic searches in PubMed, clinical experience, and internal statistics on implantations and clinical visits carried out at our centre. RESULTS AND INTERPRETATION 243 procedures were performed in our clinic in the period; 187 for Parkinson's disease, 37 for tremor and 19 for dystonia. The vast majority of patients have been implanted with bilateral electrodes, and the targets were the subthalamic nucleus, the thalamus and the internal segment of globus pallidus. Studies have demonstrated that deep brain stimulation is an effective treatment of selected patients with Parkinson's disease, tremors and primary dystonia. Many of these patients have no other efficient treatment options. Patients should be referred for preoperative assessment when symptoms of their movement disorder can no longer be treated sufficiently with medical therapies and when their quality of life is impaired. A broad and careful evaluation of patients' symptoms and findings is important for correct patient selection for this treatment.
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Affiliation(s)
- Mathias Toft
- Nevrologisk avdeling, Nevroklinikken, Rikshospitalet, 0027 Oslo.
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Fougner SL, Bollerslev J, Latif F, Hald JK, Lund T, Ramm-Pettersen J, Berg JP. Low levels of raf kinase inhibitory protein in growth hormone-secreting pituitary adenomas correlate with poor response to octreotide treatment. J Clin Endocrinol Metab 2008; 93:1211-6. [PMID: 18230656 DOI: 10.1210/jc.2007-2272] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Excessive GH production by pituitary tumors causes acromegaly. Medical treatment of acromegaly with somatostatin analogs (SMSs), like octreotide, is well established, but the clinical effect is variable. One mechanism for octreotide effect is inhibition of the MAPK signaling pathway after binding to the G protein-coupled somatostatin receptor. Nonphosphorylated Raf kinase inhibitory protein (RKIP) binds to and inhibits Raf1 kinase, and thereby attenuates MAPK signaling, whereas phosphorylated RKIP inhibits G protein receptor internalization and degradation due to inhibition of G protein receptor kinase 2. OBJECTIVE Our objective was to study RKIP levels in pituitary somatotroph adenomas, and relate them to clinical characteristics and response to octreotide treatment in patients with acromegaly. PATIENTS AND METHODS RKIP level was analyzed by Western blot of proteins extracted from somatotroph tumors frozen a short time after surgery in 51 patients with active acromegaly. An acute somatostatin test was performed in 46 of the patients, and in 21 the IGF-I level before and 6 months after SMS treatment was available. RESULTS The adenoma RKIP level correlated significantly to both the acute and the long-term octreotide responses on serum levels of GH and IGF-I, respectively. In multiple regression analyses, the RKIP level was a significant determinant for both the GH reduction in the acute test and the IGF-I reduction after approximately 6 months. CONCLUSION The RKIP level in somatotroph adenomas seems to be important for the clinical effect of SMS treatment, in which low levels of RKIP correlate to poor clinical response to SMSs.
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Affiliation(s)
- Stine Lyngvi Fougner
- Research Institute for Internal Medicine, Section of Endocrinology, University of Oslo, Oslo N-0027, Norway.
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Fougner SL, Borota OC, Berg JP, Hald JK, Ramm-Pettersen J, Bollerslev J. The clinical response to somatostatin analogues in acromegaly correlates to the somatostatin receptor subtype 2a protein expression of the adenoma. Clin Endocrinol (Oxf) 2008; 68:458-65. [PMID: 17941904 DOI: 10.1111/j.1365-2265.2007.03065.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Reduced expression of the somatostatin receptor subtype 2 (SSTR2) has been suggested as an explanation for the poor response to octreotide in acromegaly, but studies correlating levels of SSTR2 mRNA to octreotide efficacy have been contradictory. Some studies have found better responses to somatostatin analogues in G-protein alpha subunit (Gsalpha) mutation (gsp oncogene)-positive adenomas. The aim of this study was to determine adenoma SSTR2a protein expression and gsp status in a large group of patients with acromegaly, and relate this to the clinical effect of octreotide. PATIENTS Seventy-one patients were included. All underwent transsphenoidal surgery, 23 patients after preoperative octreotide treatment. MEASUREMENTS The adenoma SSTR2a expression was examined by immunohistochemistry and Western blot analysis, and gsp status determined. An acute octreotide test was performed, and the change in IGF-1 level after 6 months preoperative octreotide treatment was recorded. RESULTS The acute octreotide response in non-pretreated patients and the preoperative long-term octreotide response were significantly better in patients with adenomas containing a large proportion of cells that stained positively for SSTR2a by immunohistochemistry. However, the SSTR2a protein level assessed by Western blot did not correlate with the octreotide response. The preoperatively treated group had lower SSTR2a protein levels and fewer adenomas with a large percentage of positively stained cells. The gsp oncogene was detected in 43% of the adenomas but did not correlate to the octreotide response. CONCLUSION The clinical effect of octreotide correlates with the proportion of cells positive for SSTR2a in immunohistochemical staining, rather than the adenoma SSTR2a protein level. There may be a down-regulation of SSTR2a during octreotide treatment.
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Affiliation(s)
- Stine L Fougner
- Research Institute for Internal Medicine, University of Oslo, Oslo, Norway.
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Evang JA, Carlsen SM, Svartberg J, Aanderud S, Johannesen Ø, Schreiner T, Ramm-Pettersen J, Bakke SJ, Lund-Johansen M, Bollerslev J. [Endogenous Cushing's syndrome]. Tidsskr Nor Laegeforen 2006; 126:599-602. [PMID: 16505869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Untreated endogenous Cushing's syndrome is a serious condition with high morbidity and mortality. New diagnostic procedures make today's assessment more accurate. We describe which tests should be done when there is suspicion of the syndrome. Treatment options are mentioned. MATERIAL AND METHODS The paper is based on current international literature and reflects the experience of the authors. RESULTS AND INTERPRETATION Endogenous Cushing's syndrome is caused by elevated cortisol levels. The reason can be overproduction of ACTH or an adrenocortical pathology. It should be considered when combinations of symptoms like central obesity, proximal muscle weakness, striae and menstrual irregularities are seen. Osteoporosis and impotence are other important symptoms. Diagnosis of Cushing's syndrome is often challenging. Measurement of urinary free cortisol or overnight dexamethasone suppression test has usually been performed initially. Midnight salivary cortisol seems promising as an alternative. The final diagnosis is often made after a combined evaluation of dynamic tests. The first-line treatment of endogenous Cushing's syndrome is surgery.
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Affiliation(s)
- Johan Arild Evang
- Endokrinologisk seksjon, Medisinsk avdeling, Rikshospitalet, 0027 Oslo.
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Moe MC, Varghese M, Danilov AI, Westerlund U, Ramm-Pettersen J, Brundin L, Svensson M, Berg-Johnsen J, Langmoen IA. Multipotent progenitor cells from the adult human brain: neurophysiological differentiation to mature neurons. ACTA ACUST UNITED AC 2005; 128:2189-99. [PMID: 15958504 DOI: 10.1093/brain/awh574] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
It was long held as an axiom that new neurons are not produced in the adult human brain. More recent studies have identified multipotent cells whose progeny express glial or neuronal markers. This discovery may lead to new therapeutic strategies for CNS disorders, either by stimulating neurogenesis in vivo or by transplanting multipotent progenitor cells (MPCs) that have been propagated and differentiated in vitro. The clinical application of such approaches will be limited by the ability of these cells to develop into functional neurons. To facilitate an understanding of mechanisms regulating neurogenesis in the adult human brain, we characterized the developmental processes MPCs go through when progressing to a neuron. Human tissue was harvested during temporal lobe resections because of epilepsy, and cells were cultured as neurospheres. Our findings demonstrate that at an early stage, these cells often stain with neuronal markers without possessing any functional neuronal properties. Over a period of 4 weeks in culture, cells go through characteristic steps of morphological and electrophysiological development towards functional neurons; they develop a polarized appearance with multiple dendrites, whereas the membrane potential becomes more negative and the input resistance decreases [from -48 +/- 10 mV/557 +/- 85 MOmega (n = 15) between days 7 and 11 to -59 +/- 9 mV/380 +/- 79 MOmega (n = 9) between days 25 and 38, respectively]. Active membrane properties were first observed on day 7 and consisted of a voltage-gated K+-current. Later in the second week the cells developed voltage-gated Ca2+-channels and fired small Ca2+-driven action potentials. Immature Na+-driven action potentials developed from the beginning of the third week, and by the end of the fourth week the cells fired repetitive action potentials with a completely mature waveform generated by the combined action of the voltage-gated ionic channels INa, IA and IK. After 4 weeks, the newly formed neurons also communicated by the use of GABAergic and glutamatergic synapses. The adult human brain thus harbours MPCs, which have the ability to develop into neurons and in doing this follow characteristic steps of neurogenesis as seen in the developing brain.
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Affiliation(s)
- Morten C Moe
- Department of Clinical Neuroscience, Karolinska Institutet, 171 76 Stockholm, Sweden.
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Stabell KE, Bakke SJ, Andresen S, Bjørnaes H, Borchgrevink HM, Due-Tønnessen P, Heminghyt E, Nome T, Pedersen HK, Ramm-Pettersen J, Røste GK, Tennøe B. Selective Posterior Cerebral Artery Amobarbital Test: Its Role in Presurgical Memory Assessment in Temporal Lobe Epilepsy. Epilepsia 2004; 45:817-25. [PMID: 15230707 DOI: 10.1111/j.0013-9580.2004.59903.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the efficacy and risk of complications of selective posterior cerebral artery (PCA) amobarbital anesthesia in memory assessment of patients with epilepsy under consideration for temporal lobe resection. METHODS Thirty-two candidates for temporal lobectomy in whom conclusive memory assessment could not be obtained by the standard intracarotid amobarbital procedure were submitted to a selective PCA amobarbital test. A mean dose of 75 mg amobarbital was injected via microcatheter into the P2 segment of the PCA. Ten common objects were presented for naming and remembering while the anesthesia was judged efficient. After return to neurologic baseline, recall and recognition memory were assessed. RESULTS In all of the 32 patients, angiography and PCA anesthesia were successfully accomplished without serious adverse events. All but one of the patients remained alert and cooperative for memory testing under the anesthesia, and 28 of these patients showed adequate memory capacity of the hemisphere contralateral to the side targeted for surgery. So far, 19 patients have proceeded to surgery, and no case of global amnesia or serious, material-specific memory impairment has resulted. Three patients failed the PCA test (fewer than 67% items correctly recognized) and were excluded from surgery, partly on the basis of the PCA test results, but also supported by an overall evaluation of all the diagnostic procedures used. CONCLUSIONS The selective PCA amobarbital test appears justifiable when performed by interventional neuroradiologists and may significantly reduce the risk of erroneously excluding patients with epilepsy from temporal resection. Further corroboration of the safety of the procedure seems warranted.
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