المؤلفون: Pirkko Räsänen, Arja Mainio, Asko Niemelä, John Koivukangas, Helinä Hakko

المصدر: Journal of Psychosocial Oncology. 31:507-516

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Pediatrics, Time Factors, Population, Brain tumor, Comorbidity, Sleep Initiation and Maintenance Disorders, mental disorders, Humans, Medicine, Prospective Studies, education, Prospective cohort study, Finland, Applied Psychology, Depression (differential diagnoses), Aged, Psychiatric Status Rating Scales, education.field_of_study, Brain Neoplasms, Depression, business.industry, Beck Depression Inventory, Middle Aged, medicine.disease, Surgery, Psychiatry and Mental health, Treatment Outcome, Nottingham Health Profile, Oncology, Population study, Female, Neurosurgery, business, Follow-Up Studies

الوصف: Patients with neurological diseases often suffer from sleep disturbances. Insomnia among adult brain tumor patients has usually been studied as part of quality-of-life studies, or some case reports on insomnia in these patients have been described. The authors aimed to study insomnia in a prospective study setting among patients with primary brain tumors and evaluate whether insomnia is related to tumor laterality. Entire study population consisted of 70 patients with a solitary primary supratentorial brain tumor treated surgically at the Clinic for Neurosurgery, Oulu University Hospital. The overall functional state of the patients was assessed by the Karnofsky Performance Scale, depression was measured by Beck Depression Inventory, and insomnia by Nottingham Health Profile. Repeated measurements were assessed before tumor operation as well as 3 months and one year after surgery. Prevalence of insomnia among patients with a primary brain tumor waiting for surgery was higher compared to general population, but level of insomnia significantly decreased as soon as 3 months after tumor operation. Patients with a bilateral primary brain tumor had significantly more often insomnia without comorbid depression compared to patients with a left or right tumor for up to one year after operation. The authors suggest that insomnia among patients with a bilateral brain tumor may not be associated with depression but have other biological background.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::bcb1ccec1e5bd0939801174875cff332Test
https://doi.org/10.1080/07347332.2013.822048Test

المؤلفون: Pirkko Räsänen, Asko Niemelä, John Koivukangas, Arja Mainio, Helinä Hakko

المصدر: Clinical Neurology and Neurosurgery. 113:649-653

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Brain tumor, 1 year follow up, Comorbidity, Anxiety, Neuropsychological Tests, Functional Laterality, Neurosurgical Procedures, Postoperative Complications, Internal medicine, mental disorders, medicine, Humans, Prospective Studies, Prospective cohort study, Psychiatry, Depression (differential diagnoses), Aged, Psychiatric Status Rating Scales, Depressive Disorder, Brain Neoplasms, business.industry, Beck Depression Inventory, General Medicine, Middle Aged, medicine.disease, Combined Modality Therapy, Magnetic Resonance Imaging, Phobic Disorders, Preoperative Period, Phobic anxiety, Female, Surgery, Neurology (clinical), Obsessive Behavior, medicine.symptom, Tomography, X-Ray Computed, business, Follow-Up Studies

الوصف: Depression is found to be present in up to 44% of brain tumor patients during their illness process. Anxiety as a comorbid psychiatric disorder with depression has formerly been studied, but phobia or obsessive-compulsive symptoms among brain tumor patients have not yet been noticed. By using a clinical prospective database of primary brain tumor patients (n=77) we studied the level of depression, anxiety, obsessionality (traits and symptoms) and phobic anxiety symptoms. Psychiatric symptoms were assessed before tumor operation as well as at three months and at one year after operation. The presence of comorbid anxiety, obsessionality and phobic anxiety symptoms was assessed before operation and at follow-ups in depressed and non-depressed patients, separately. Before tumor operation 16% of the patients had depression according to Beck Depression Inventory (BDI), while 10% had depression at three months and 15% at one year after operation. The depressed patients had statistically significantly higher anxiety scores and phobic scores at all three measurement points compared to corresponding scores among non-depressed brain tumor patients. The mean obsessionality scores among depressed brain tumor patients were significantly higher when measured before operation and at one year after the operation compared to non-depressed patients. To our knowledge, this is the first study so far in which comorbidity of psychiatric symptoms has been shown among depressive brain tumor patients. Concurrent comorbid conditions have been shown to be associated with increased severity, morbidity and chronicity of depression. It is recommended that treatment of depressive patients complicated with comorbid psychiatric disorders be planned by psychiatric units.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9868d1d17c770580109f70b8bec4a615Test
https://doi.org/10.1016/j.clineuro.2011.05.006Test

المؤلفون: Antti Raappana, John Koivukangas, Tapani Ebeling, Tapio Pirilä

المصدر: The Journal of Clinical Endocrinology & Metabolism. 95:4268-4275

مصطلحات موضوعية: Adenoma, Adult, Male, medicine.medical_specialty, Pediatrics, Time Factors, Adolescent, Endocrinology, Diabetes and Metabolism, Clinical Biochemistry, Population, Context (language use), Biochemistry, Young Adult, Sex Factors, Endocrinology, Pituitary adenoma, Internal medicine, Epidemiology, medicine, Humans, Pituitary Neoplasms, Prolactinoma, education, Finland, Aged, Retrospective Studies, education.field_of_study, business.industry, Incidence, Incidence (epidemiology), Biochemistry (medical), Retrospective cohort study, Middle Aged, medicine.disease, Cohort, Female, business, Pituitary Apoplexy

الوصف: Data on the incidence of pituitary adenomas (PAs) are scant and outdated. A population-based regional cohort with thorough case identification was used to evaluate the incidence of clinically detected PAs in the era of magnetic resonance imaging.The objective of the study was to describe the age- and sex-specific incidence of all PA subgroups, with data on incidentally found PAs, pituitary apoplexies, and time trends.This was a retrospective descriptive analysis of PA patients diagnosed during 1992-2007 in Northern Finland (NFi).World Health Organization 2000-standardized incidence rates (SIRs) of PAs per 100,000 were measured.The final cohort consisted of 355 PAs. The incidence rates of the Oulu University Hospital regional district were used as a reference to assess the applicability of our case finding over the rest of NFi. Incidence rates of all PA subgroups except microprolactinomas were statistically equal between these areas; thus, all presented SIRs are based on the NFi's cohort except Oulu University Hospital regional district-based prolactinomas and PAs overall. Overall SIR of PAs was higher (4.0 per 100,000) than in previous reports. Prolactinomas had the highest SIR: 2.2 per 100,000, followed by clinically nonfunctioning PAs (1.0) and GH-secreting (0.34), ACTH-secreting (0.17), and TSH-secreting (0.03) PAs. The gender-specific SIR was 2.2 per 100,000 in males and 5.9 per 100,000 in females. Pituitary apoplexy occurred as a presenting symptom in 11% of clinically nonfunctioning PA patients. The SIR of incidentally discovered PAs increased significantly from 1992-1999 to 2000-2007 (0.59 to 1.6, respectively; P0.01), which accounted for the perceived increasing trend in the overall SIR of PAs (3.8 to 4.2; P0.05).

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::87275669f02c7e0ab7d4c8a5b6b73ef4Test
https://doi.org/10.1210/jc.2010-0537Test

المؤلفون: Arja Mainio, Satu Tuunanen, Asko Niemelä, John Koivukangas, Helinä Hakko, Pirkko Räsänen

المصدر: European Archives of Psychiatry and Clinical Neuroscience. 256:516-521

مصطلحات موضوعية: Adult, Male, Gerontology, Oncology, medicine.medical_specialty, Poor prognosis, Statistics as Topic, Brain tumor, Malignancy, Postoperative Complications, Quality of life, Internal medicine, Glioma, medicine, Humans, Pharmacology (medical), Dominance, Cerebral, Biological Psychiatry, Depression (differential diagnoses), Aged, Depressive Disorder, Brain Neoplasms, business.industry, Beck Depression Inventory, General Medicine, Middle Aged, Prognosis, medicine.disease, Postoperative survival, Survival Analysis, Psychiatry and Mental health, Disease Progression, Quality of Life, Female, business, Follow-Up Studies

الوصف: To assess the long-term survival of brain tumor patients, and in particular to evaluate the relation of quality of life (QOL) to survival among low-grade glioma patients. The postoperative survival of 101 brain tumor patients was followed from surgery (1990–1992) until the end of the year 2003. Depression was evaluated by the Beck Depression Inventory (BDI) and QOL with Sintonen’s 15D scale before operation and at one year as well as at five years after operation. The mean survival times in years (SD) were significantly related to tumor malignancy, being the shortest, 1.9 (0.6), for patients with high-grade gliomas, while patients with low-grade gliomas or a benign brain tumor had mean survival times of 9.1 (1.0) and 11.6 (0.5), respectively. At all follow-ups, depressed low-grade glioma patients had a significantly shorter survival time, 3.3–5.8 years, compared to non-depressed low-grade glioma patients, 10.0–11.7 years. A decreased level of QOL in low-grade glioma patients was significantly related to the shorter survival. The results suggest that depression and decreased QOL among low-grade glioma patients is related to shorter survival at long-term follow-up. Decreased QOL may serve as an indicator for poor prognosis in low-grade glioma patients.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::25f1c3f4cbcd4386a151bc37e5a697f4Test
https://doi.org/10.1007/s00406-006-0674-2Test

المؤلفون: Jani Katisko, Salla-Maarit Kokkonen, Hagen Shiffbauer, Juho Tuominen, Jari Erkkilä, Eero Ilkko, Sanna Yrjänä, John Koivukangas

المصدر: Academic Radiology. 13:219-228

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Neuronavigation, Adolescent, medicine.medical_treatment, Brain tumor, Brain Edema, Astrocytoma, Neurosurgical Procedures, Cerebral edema, Diagnosis, Differential, Edema, medicine, Humans, Neuroectodermal Tumors, Primitive, Radiology, Nuclear Medicine and imaging, Child, Craniotomy, Aged, Postoperative Care, Intraoperative Care, medicine.diagnostic_test, Brain Neoplasms, business.industry, Brain, Signal Processing, Computer-Assisted, Magnetic resonance imaging, Middle Aged, Image Enhancement, medicine.disease, Magnetic Resonance Imaging, Surgery, Image-guided surgery, Feasibility Studies, Female, Radiology, medicine.symptom, business

الوصف: Rationale and Objectives Minimally invasive neurosurgery requires methods to specify surgical boundaries of target tissue, such as brain tumors. This study investigated technical possibilities and clinical usefulness of adapting edema attenuated inversion recovery (EDAIR) pulse sequences to suppress magnetic resonance signal from cerebral edema in brain tumor patients. Materials and Methods A resistive 0.23-T magnetic resonance scanner with magnitude-encoded inversion recovery sequences was used. Twenty-eight separate scanning tests in 25 neurosurgical brain tumor patients were performed on the day before surgery. An inversion recovery sequence with several inversion times between 150 and 2,200 ms was tested. The same sequences were also used intraoperatively and postoperatively. Results T1 relaxation time of brain edema varied from case to case. An inversion recovery sequence with an inversion time of 400–800 milliseconds attenuated brain edema and seemed to help in demarcating gross brain tumor for surgical resection. These features were helpful for the evaluation of resectable tumor tissue particularly using neuronavigation techniques. Conclusions According to these preliminary findings, inversion recovery sequences supplement other imaging modalities and assist neurosurgeons in evaluating different surgical trajectories and in estimating brain tumor volume before craniotomy.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::25353687d332e5fee293f2b2d25c2e5cTest
https://doi.org/10.1016/j.acra.2005.10.004Test

المؤلفون: Pirkko Räsänen, Helinä Hakko, John Koivukangas, Asko Niemelä, Arja Mainio

المصدر: Journal of Neurosurgery. 103:841-847

مصطلحات موضوعية: Adenoma, Adult, Male, medicine.medical_specialty, Population, Pituitary neoplasm, Disability Evaluation, Internal medicine, Meningeal Neoplasms, medicine, History of depression, Humans, Pituitary Neoplasms, Sex Distribution, education, Depression (differential diagnoses), Depressive Disorder, education.field_of_study, Brain Neoplasms, business.industry, Incidence, Incidence (epidemiology), Beck Depression Inventory, Glioma, Neuroma, Acoustic, Recovery of Function, Middle Aged, Surgery, Treatment Outcome, Population study, Female, Neurosurgery, Meningioma, business, Follow-Up Studies

الوصف: Object. The authors analyzed changes in depression and contemporary functional states by using valid tools in a population-based study sample during a 1-year follow-up period. Methods. The study population consisted of 77 patients with a solitary primary brain tumor treated surgically at the Oulu Clinic for Neurosurgery. Each patient's depressive status, according to the Beck Depression Inventory (BDI), and functional outcome, based on the Karnofsky Performance Scale (KPS), were evaluated before the tumor was surgically treated as well as 3 months and 1 year after surgery. Before surgery 27 patients (35%) had BDI scores indicating the presence of depression. These scores were significantly higher in patients with a history of depression (p = 0.017) and in those with a lower functional outcome (p = 0.015). In the entire study sample the severity of depression decreased statistically significantly (p = 0.031) at 3 months postsurgery. A lower functional status (KPS score ≤ 70) in patients was significantly associated with high depression scores at the 3-month (p = 0.000) and 1-year (p = 0.005) assessments. The decrease in the level of depression was significant in patients with an anterior tumor (p = 0.049) and those with a pituitary adenoma (p = 0.019). Conclusions. Affective disorders among patients with brain tumors must be considered immediately after surgery, especially in persons with a depression history and in those with a coincident physical disability.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::246abacf7703909ae5b701bd639204e7Test
https://doi.org/10.3171/jns.2005.103.5.0841Test

المؤلفون: John Koivukangas, Jarmo Salo, Arja Mainio, Helinä Hakko, Asko Niemelä, Pirkko Räsänen

المصدر: The Journal of Neuropsychiatry and Clinical Neurosciences. 17:399-404

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Intracranial tumor, Brain tumor, Neurosurgical Procedures, Anterior region, Lesion, Central nervous system disease, Sex Factors, medicine, Humans, Prospective Studies, Analysis of Variance, Brain Neoplasms, business.industry, Middle Aged, medicine.disease, Primary tumor, Surgery, Psychiatry and Mental health, Population study, Female, Neurology (clinical), Obsessive Behavior, medicine.symptom, business

الوصف: Obsessive-compulsive symptoms have been associated with different types of damages or dysfunctions in the brain. However, the accumulated evidence on obsessive-compulsive symptoms among patients with a primary brain tumor is so far based on case reports only. The study population consisted of 59 neurosurgical patients with a primary brain tumor. One preoperative and two postoperative assessments for the level of obsessionality were done with the Crown-Crisp Experiential Index (CCEI)-instrument. Mean obsessionality scores increased significantly among the patients with a tumor in the left anterior region of the brain measured at 3 months after operation, especially in women, compared to the patients with a tumor in other regions of the brain. The level of obsessionality seemed to increase immediately after operation among patients with a primary tumor left anteriorly in the brain. This increase may be linked with the lesion caused by the tumor itself or the neurosurgical operation.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::15d265fb26bb748cb24c1ad60c383212Test
https://doi.org/10.1176/jnp.17.3.399Test

المؤلفون: Tarja H. Haapaniemi, Juho Tuominen, Petri Karinen, Esa Heikkinen, T. Erola, Vilho V. Myllylä, John Koivukangas

المصدر: Parkinsonism & Related Disorders. 11:89-94

مصطلحات موضوعية: Male, medicine.medical_specialty, Deep brain stimulation, Parkinson's disease, Deep Brain Stimulation, Health Status, medicine.medical_treatment, Disease, Neurological disorder, Functional Laterality, Physical medicine and rehabilitation, Quality of life, Subthalamic Nucleus, Surveys and Questionnaires, medicine, Humans, Aged, Health related quality of life, business.industry, Parkinson Disease, Middle Aged, medicine.disease, humanities, nervous system diseases, Subthalamic nucleus, Nottingham Health Profile, nervous system, Neurology, Quality of Life, Physical therapy, Female, Neurology (clinical), Geriatrics and Gerontology, business, Follow-Up Studies

الوصف: Parkinson's disease (PD) is a common neurological disorder. Recently, bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become an option in the treatment of severe PD. We measured the health-related quality of life (HRQoL) of 27 parkinsonian patients, who underwent a bilateral STN-operation. The instruments used for the evaluation of the HRQoL were the Parkinson's Disease Questionnaire (PDQ-39) and the Finnish version of the Nottingham Health Profile (NHP). We found that the quality of life significantly improved when measured with both HRQoL scales. Clinical improvement and improvement in HRQoL were positively correlated.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0bb871fdc9edd4a5fcc89a7b53a9618fTest
https://doi.org/10.1016/j.parkreldis.2004.08.006Test

المؤلفون: John Koivukangas, Sanna Yrjänä, H. Schiffbauer, Osmo Tervonen, R. O. Ojala, Jani Katisko

المصدر: Acta Neurochirurgica. 144:271-278

مصطلحات موضوعية: medicine.medical_specialty, Neuronavigation, medicine.diagnostic_test, Interventional magnetic resonance imaging, business.industry, Context (language use), Magnetic resonance imaging, Interventional radiology, Intraoperative MRI, Image-guided surgery, medicine, Surgery, Neurology (clinical), Radiology, business, Neuroradiology

الوصف: Several models for the application of intra-operative magnetic resonance imaging (IMRI) have recently been reported, most of them unique. Two fundamental issues need to be addressed: optimal use of the scanner to ensure a wide base for research, development and clinical application, and an organisational model that facilitates such use. While in our setting the IMRI project was initiated by the neurosurgeons, the need for wider use of the facilities was recognised since the beginning of the planning phase in 1996. An organisational model was developed that allowed for development of neurosurgical applications, radiological imaging, and radiological interventions and for the research and development work of the vendor. A resistive 0.23 T MR scanner was installed in a dedicated operating room environment. Unique to this scanner is the ability to turn off the magnet, allowing for normal OR activities and devices, and to turn on the magnet as needed with a relatively short six-minute ramp up time. A staged surgical technique was perfected, allowing for transfer of data to the neuronavigator outside the scanner during surgery. In neurosurgery, IMRI was used as one part of a neuronavigational system that included ultrasound imaging, intra-operative cortical stimulation during awake procedures, electrocorticography and two neuronavigators. 34 neurosurgical cases included 27 brain tumour resections, 5 brain tumour biopsies, 1 extirpation of an arterio-venous malformation, and 1 haematoma evacuation. The scanner could also be used for normal clinical imaging where obese patients, children, claustophobic patients and postoperative control examinations were the major groups. The radiologists performed 110 interventions, including bone and abdominal biopsies, nerve root infiltrations and local pain therapies, with the optical needle tracking system under continuous MRI guidance. The organisational model allowed frequent use of the facilities for both neurosurgery and radiology and continuous development of the facilities. Intra-operative ultrasound was used in 20 tumour resections and in two open brain biopsies. This resulted in reduction of the number of MR imaging sessions during surgery. Five of the 27 resections were performed as awake craniotomies with cortical stimulation. For two of the resections, electrocorticography and depth electrode registrations were used. Furthermore, various non-MRI-compatible instruments and devices were used. Intra-operative MRI is an imaging tool that can be useful especially in the context of neuronavigation. A scanner that can be turned off during surgery is particularly appropriate for neurosurgery. The concept of joint use of such facilities with other clinicians is mutually worthwhile.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::d9161fcc8f88de0ea8887a903c30e760Test
https://doi.org/10.1007/s007010200035Test

المؤلفون: Juha Ohman, Pirjo Koivukangas, Arto Ohinmaa, Petri Karinen, John Koivukangas

المصدر: Scopus-Elsevier

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Subarachnoid hemorrhage, Adolescent, Cost-Benefit Analysis, Vasodilator Agents, Aneurysm, Ruptured, Placebo, law.invention, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Double-Blind Method, Randomized controlled trial, law, medicine, Humans, Vasospasm, Intracranial, 030212 general & internal medicine, Hospital Costs, Nimodipine, Aged, Retrospective Studies, business.industry, Intracranial Aneurysm, Vasospasm, Retrospective cohort study, Cost-effectiveness analysis, Middle Aged, Subarachnoid Hemorrhage, medicine.disease, Combined Modality Therapy, 3. Good health, Surgery, Clinical trial, Treatment Outcome, Anesthesia, Female, Neurology (clinical), business, 030217 neurology & neurosurgery, medicine.drug

الوصف: Objective To assess the cost-effectiveness ratio of nimodipine administration after aneurysmal subarachnoid hemorrhage (SAH) and surgery. Methods One hundred twenty-seven patients of both sexes who had a ruptured aneurysm (verified using angiography), who presented with Hunt and Hess Grades I to III on admission, who underwent an operation within the first week after SAH, and who had participated in a randomized prospective clinical trial of nimodipine medication were enrolled in the study. The efficiency (cost-effectiveness) of nimodipine treatment was evaluated by incremental cost-effectiveness analysis. The cost-effectiveness ratio was evaluated for two groups: patients treated with nimodipine and patients given placebo. The cost was estimated as direct hospitalization costs, and the patient outcome was measured as life years gained. Results The incremental cost-effectiveness ratio for nimodipine treatment was $223 per life year gained on the basis of 1996 monetary values and contemporary management of SAH. Patients in the nimodipine group had an average of 3.46 years longer life expectancy (incremental effectiveness) than those in the placebo group. There was a significant difference in 3-month follow-up mortality and a slight difference in sickness pensions during the 10 years after SAH. Nimodipine treatment was associated with a significant decrease in mortality. There were no statistically significant differences between the treatment groups in the length of hospital stay. There were no statistically significant differences between the treatment groups in sickness pensions. Conclusion Nimodipine is cost-effective. Therefore, its use in the management of patients with SAH seems economically justified because it increases patient life years at very low incremental cost.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::dc7f4bf2913f35f2cb20b436db8b488eTest
https://doi.org/10.1097/00006123-199910000-00009Test