• 20 years follow-up after the first microsurgical lumbar discectomies in Iceland

      Jensdottir, M; Gudmundsson, K; Hannesson, B; Gudmundsson, G (Springer Verlag, 2007-01-01)
      Background. Microsurgical discectomies are an established procedure in spinal surgery. This operating technique was first used in the Department of Neurosurgery in Iceland in 1981 and has become standard operative treatment for herniated lumbar discs. There is a great variability in outcome reports regarding recurrence rate and re-operation rate. Few articles are based on follow-up of more than 10 years. This article presents the results of a 20 years follow-up study. Methods. A retrospective study of all patients undergoing microsurgical discectomy for herniated lumbar disc, from June 1, 1981 to December 31, 1984. Outcome, based on recurrence rate, return to work and patient satisfaction was determined by a self-evaluation questionnaire, phone interviews and patient medical records. Findings. Of the 170 patients, 134 (78.8%) were included in the study (M:F, 58:42%). Preoperative symptoms: back pain with sciatica 108 (80.6%), sciatica 20 (14.9%), back pain 2 (1.5%). Mean follow-up time was 20.7 years (19.5-22.8). Recurrence rate was 12.7%. 19 patients (14.2%) underwent a subsequent lumbar operation at a different level or side. A majority of patients 108 (80.6%) returned to previous level of work, 26 (19.4%) lost some or all working capabilities. Patient satisfaction was high, 91.1% reporting excellent (68.7%) or good (22.4%) results. 5.2% of patients rated the outcome fair and 3.7% poor. Women reported worse outcome than men, excellent M:F 74.7:60.7%, and poor 7.1:1.3%. There was no significant difference in patient satisfaction in patients undergoing additional operations or those with recurrence of the herniated disc. Conclusions. Outcome was very good with 92.0% return to work and 91.1% patient satisfaction. The recurrence rate was 12.7% with a substantial number of cases occuring 10-20 years after operation. To conclude, microsurgical discectomies maintain a high success rate in the long-term.
    • Association of ApoE genotype with clinical features and outcome in idiopathic normal pressure hydrocephalus (iNPH): a preliminary report

      Gudmundsson, Gardar; Kristjansdottir, Gudlaug; Cook, Elizabeth; Olafsson, Isleifur; Landspitali University Hospital, Reykjavik, Iceland. gardar@mac.com (Springer Verlag, 2009-11)
      Fifteen patients suspected of having iNPH were clinically evaluated and their ApoE genotype determined prior to a possible ventriculoperitoneal shunt insertion. All patients fulfilling our criteria for intervention and who had a shunt implanted with good results were homozygous for the ApoE3/3 genotype.
    • Secondary insults following traumatic brain injury enhance complement activation in the human brain and release of the tissue damage marker S100B.

      Bellander, Bo-Michael; Olafsson, Ingvar Hakon; Ghatan, Per Hamid; Bro Skejo, Hanne Pernille; Hansson, Lars-Olof; Wanecek, Mikael; Svensson, Mikael A; Landspitali The National University Hospital, Reykjavík, Iceland. Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska University Hospital Solna, S-171 76 Stockholm, Sweden. bo-michael.bellander@karolinska.se (Springer Verlag, 2011-01)
      OBJECT: Complement activation has been suggested to play a role in the development of secondary injuries following traumatic brain injury (TBI). The present study was initiated in order to analyze complement activation in relation to the primary brain injury and to secondary insults, frequently occurring following TBI. METHODS: Twenty patients suffering from severe TBI (Glasgow coma score ≤ 8) were included in the study. The "membrane attack complex," C5b9, which is the cytolytic end product of the complement system was analyzed in cerebrospinal fluid (CSF). The degree of brain tissue damage was assessed using the release of S100B and neuron-specific enolase (NSE) to the CSF and blood. The blood-brain barrier was assessed using the CSF/serum quotient of albumin (Q (A)). RESULTS: Following impact, initial peaks (0-48 h) of C5b9, S100B, and NSE with a concomitant loss of integrity of the blood-brain barrier were observed. Secondary insults at the intensive care unit were monitored. Severe secondary insults were paralleled by a more pronounced complement activation (C5b9 in CSF) as well as increased levels of S100B (measured in CSF), but not with NSE. CONCLUSION: This human study indicates that complement activation in the brain is triggered not only by the impact of trauma per se but also by the amount of secondary insults that frequently occur at the scene of accident as well as during treatment in the neurointensive care unit. Complement activation and in particular the end product C5b9 may in turn contribute to additional secondary brain injuries by its membrane destructive properties.