Biomedical subjects

A Brawanski

Publications and source records attributed to A Brawanski.

At least 37 records · Page 2Linked to original sources

PubMed1999

Comparison of clinical, radiologic, and serum marker as prognostic factors after severe head injury.

BACKGROUND: S-1OOB, a protein of astroglial cells, is described as a marker for neuronal damage. Reliable outcome prediction from severe head injury is still unresolved. Clinical scores such as the Glasgow Coma Scale score (GCS) and diagnostic scores such as the Marshall Computed Tomographic Classification are well established and investigated, but there are still some concerns about these tools. The aim of this study was to investigate the predictive value of the initial serum level of S-100B compared with the predictive value of the GCS score and the Marshall Computed Tomographic Classification to outcome after severe head injury. METHODS: Forty-four patients with severe head injury (GCS score < 9) were included. Blood samples were drawn within 1 to 6 hours of injury. After a period of 11 months, their outcome was correlated by using the Glasgow Outcome Scale. Patients with an S-100B serum level above 2 microg/L, a GCS score between 3 and 5, and a computed tomographic scan in the categories 4 to 6 are predicted to have an unfavorable outcome. The predictive values of these tools were calculated according to these definitions. RESULTS: The protein S-100B had with 17% the lowest total misclassification rate. When compared with the GCS score and Marshall Computed Tomographic Classification the S-100B serum level calculated on admission had the highest positive predictive value (87%) and negative predictive value (77%). CONCLUSION: The serum level of S-100B calculated within 1 to 6 hours of a severe head injury is a useful additional outcome predictor.

Adolescent↗

PubMed1999

Functional MR imaging of the motor cortex in healthy volunteers and patients with brain tumours: qualitative and quantitative results.

The purpose of this study was to compare functional magnetic resonance (MR) imaging of the motor cortex in healthy volunteers and patients with brain tumours. Functional MR imaging was performed in 14 healthy volunteers and 14 patients with tumours in or near the primary motor cortex with groups being matched for age, sex, and handedness. Functional images were acquired during motion of the right and left hand. Time courses of signal intensity within the contralateral, ipsilateral, and supplementary motor cortex as well as z-maps were calculated, their quality being assessed visually. Mean signal increase between activation and rest were evaluated within the contralateral, ipsilateral, and supplementary motor cortex, the activated area in those regions of interest was measured using z-maps. The quality of functional MR experiments was generally lower in patients than in volunteers. The quantitative results showed a trend towards increased ipsilateral activation in volunteers during left hand compared to right hand motion and in patients during motion of the affected compared to the non-affected hand. Considering quantitative and qualitative results, significantly increased ipsilateral activation was found in patients compared to healthy volunteers. In conclusion, functional MR imaging quality was significantly reduced in patient studies compared to healthy volunteers, even if influences of age, sex, and handedness were excluded. Increased ipsilateral activation was found in patients with brain tumours which can be interpreted by an improved connectivity between both hemispheres.

Adult↗

PubMed1999

Telemedicine in neurosurgical daily practice.

Telemedicine has been in daily practice at our neurosurgical department for five years. In our experience the standard personal computer-based telemedicine systems Medicom and especially RADO Look are reliable, easy to use, and of high quality performance. Telemedicine makes possible better patient management at regional hospitals and the avoidance of patient transports. Therefore treatment costs in neurosurgical patients can be highly reduced.

Cost Savings↗

PubMed1998

Is there a clinical correlate to the histologic evidence of inflammation in herniated lumbar disc tissue?

STUDY DESIGN: The presence of inflammatory cells was examined immunohistochemically in routinely processed resection specimens of the lumbar disc. The histologic results were compared with prospectively obtained clinical data. OBJECTIVES: To assess the clinical relevance of inflammatory cells in herniated lumbar disc specimens. SUMMARY OF BACKGROUND DATA: It is postulated that in addition to nerve root compression, an inflammatory stimulus of the herniated lumbar disc is responsible for sciatic pain and radiculopathy. However, the clinical relevance of the histologically described inflammatory infiltrates is not defined clearly. METHODS: Disc specimens from 44 patients who underwent surgery for lumbar disc herniation were studied immunohistologically. Before surgery, severity of pain was classified in each patient according to a visual analog scale, and general clinical data were recorded prospectively. RESULTS: Varying amounts of inflammatory cells could be demonstrated in the resected disc tissue. In the statistical analysis, no statistically significant correlation between the histologic evidence of macrophage infiltrates and the pain grading scale or the clinical data was noted. CONCLUSIONS: There is no statistically significant correlation between macrophage infiltrates in herniated lumbar disc specimens and the obtained clinical data.

Adult↗

PubMed1998

Brain ischemia detected by tissue-PO2 measurement and the lactate-oxygen index in head injury.

The aim of the study was to find out whether there is a correlation between the tissue-pO2 (ti-pO2) measurement and the lactate-oxygen index (mLOI). Both methods are to be considered as methods to detect brain ischemia. We studied 7 patients after severe head injury (GCS < 8) with a jugular bulb catheter and a tissue pO2 probe. Possible ischemia was defined with ti-pO2 below 10 mm Hg and mLOI above 0.08. 67 pairs of ti-pO2 and corresponding mLOI were found. In 5 cases out of the 7 cases with a ti-pO2 below 10 we found a pathological mLOI above 0.08. In 11 cases with pathological mLOI values, however, we found only 6 cases of decreased ti-pO2. The absolute values did not correlate. The sensitivity to predict normal values is above 85% with both methods. The specifity to predict ischemia is low (< 72%). The reason is the fact, that ti-pO2 is a local method in contrast to the mLOI values. In cases of diffuse brain injury without major contusions there should be a correlation between ti-pO2 and the mLOI.

Brain↗

PubMed1998

Macrophage tissue infiltration, clinical symptoms, and signs in patients with lumbar disc herniation. A clinicopathological study on 179 patients.

It is postulated that in addition to nerve-root compression, an inflammatory stimulus of the herniated lumbar disc is responsible for sciatic pain and radiculopathy. The clinical relevance of the histologically described inflammatory infiltrates is, however, not clearly defined [8, 22]. It was the aim of this study to assess the clinical relevance of inflammatory cells in herniated lumbar disc specimens. The presence of inflammatory cells was examined immunohistochemically in routinely processed resection specimens of the lumbar disc. The histological results were compared to prospectively obtained clinical data. Disc specimens of 179 patients who underwent surgery for lumbar disc herniation were studied immunohistologically. Preoperatively each patient received a visual analogue scale for classification of the pain level and general clinical data were recorded prospectively. Varying amounts of inflammatory cells could be demonstrated in the resected disc tissue. In the statistical workup no statistically significant correlation between the histological evidence of macrophage infiltrates and the pain grading scale or the clinical data could be found. In our study there is no statistically significant correlation between macrophage infiltrates in herniated lumbar disc specimen and the obtained clinical data.

Adult↗

PubMed1998

Clinical signs in patients with brachialgia and sciatica: a comparative study.

BACKGROUND: The aim of the study was to compare the clinical signs of patients with cervical and lumbar root affections. METHODS: From January 1994 to January 1995, we performed a prospective study on 395 patients. The study comprised 93 patients with a cervical and 302 patients with a lumbar root affection. 338 patients underwent surgery. General data, case histories, and neurological findings were analyzed. RESULTS: The patients with brachialgia had a nonradicular pain radiation in 67%, the patients with sciatica only in 35%. All other data showed no significant differences. The investigation also shows that a radicular pain radiation is significantly correlated with an unequivocal radicular deficit. In particular, the patients with a cervical radicular pain radiation had a highly significant incidence of a radicular neurological deficit. CONCLUSIONS: We could demonstrate in this prospective study that only about one third of the patients with a cervical root affection showed an unequivocal radicular pain radiation. This contradicts the traditional medical textbook concept of a cervical root compression syndrome. This difference in respect of the clinical signs of lumbar and cervical root compressions might be explained by the anatomical variations of cervical root anastomoses. To determine the affected cervical root level, further investigation of the myotomes is recommended.

Brachial Plexus Neuritis↗

PubMed1998

Deep hypothermia and circulatory arrest for surgery of complex intracranial aneurysms.

OBJECTIVE: Some intracranial aneurysms may not be operable by conventional neurosurgery due to their location or morphology. Cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest renders surgery of these complex aneurysms possible. Brain temperatures can be measured directly in this setting. METHODS: Eight patients with complex intracranial aneurysms were operated on with the aid of CPB. Femoro-femoral bypass with heparin-coated circuit components was used in all cases. Venous drainage was augmented by a centrifugal pump in six patients and by a newly developed vacuum technique in two patients. Temperatures were monitored by probes in brain, tympanum, nasopharynx, bladder, rectum, arterial and venous blood. These measurements were recorded on-line together with those of cerebral oxygen saturation, AP, CVP and PAP. Blood gas analyses and an EEG were also performed continuously. RESULTS: Outcome was excellent in seven patients, in one patient moderate neurological disability occurred. Mean time on cardiopulmonary bypass was 160 (117-215) min, for cooling to a brain temperature of 18 degrees C 33 (20-47) min, and for total circulatory arrest 27 (15-45) min. Additionally, terminal brain arteries were clamped for up to 68 min in four patients. No cardiac complications were observed. Actual brain temperatures were best reflected by the tympanum probes (max. deviation 2 degrees C), whereas temperatures measured in bladder or rectum exhibited deviations of up to 10 degrees C. EEG activities were arrested between brain temperatures of 19 and 26 degrees C. CONCLUSIONS: Complex intracranial aneurysms can be treated successfully using deep hypothermic circulatory arrest. Extensive monitoring adds to the speed and safety of the procedure. The resulting comparative measurements of temperatures at different body sites including brain, EEG, and other variables may be of general relevance for operations employing deep hypothermia and circulatory arrest.

Adult↗

PubMed1998

Clinical evaluation of the InnerSpace fibreoptic intracranial pressure monitoring device.

OBJECTIVE: The aim of this study is the clinical evaluation of the intraparenchymal ICP monitor InnerSpace OPX 100. METHODS: Sixty-four Inner Space OPX 100 transducers in 51 patients with severe head injury (42), intracranial spontaneous bleeding (6) or hypoxia (3) were studied. The transducer was placed in the frontal white matter. Thirty-nine patients received one catheter, eleven patients two catheters and one patient three catheters. The study period ranged from 10 hours-25 days; total study time was 421.5 days (mean duration 6.6 days). RESULTS: In nine cases (14.1%) an inadequate location of the ICP transducer was found, but the accuracy of the measurement was not influenced. Dislocation of the transducer occurred in eight cases (12.5%) due to inadequate handling. A failed transducer was observed in four cases (6.3%) because of a damaged optical fibre (1) or inadequate handling (3). In one patient (1.9%) a minor local infection developed. In eleven cases (17%) a haematoma around the ICP sensor was observed. Six haematomas were small; five haematomas were larger than 1 cm in diameter. In two patients a large frontal haematoma developed after exchange of the transducer. Operative evacuation was necessary in both cases. Zero shift was below 2 mmHg in all catheters. CONCLUSION: It is concluded that the InnerSpace intraparenchymal ICP monitor is a reliable device: the rate of catheter related intracerebral haematomas, however, is not acceptable. This could be improved by a better fixation of the catheter in the burr hole in order to avoid micromovements of the transducer.

Adult↗

PubMed1998

Monitoring of cerebral oxygen metabolism in the jugular bulb: reliability of unilateral measurements in severe head injury.

To investigate the reliability of unilateral jugular venous monitoring and to determine the appropriate side, we performed bilateral jugular venous monitoring in 22 head-injured patients. Fiberoptic catheters were placed in both jugular bulbs. Arterial and bilateral jugular venous blood samples were obtained simultaneously for in vitro determination of jugular venous oxygen saturation (SJO2), arterial minus jugular venous lactate content difference (AJDL), and modified lactate-oxygen index (mLOI). Ischemia was assumed if one of the following pathologic values occurred at least unilaterally: SJO2 <54%, AJDL <-0.37 mmol/L, mLOI >0.08. The sensitivity of calculated unilateral monitoring in detecting ischemia was evaluated by comparing the incidence detected unilaterally with that disclosed bilaterally. The mean and maximum bilateral SJO2 differences varied between 1.4% and 21.0%, and 8.1% and 44.3%, respectively. The bias and limits of agreement (mean differences +/- 2 SD) between paired samples were 0.4% +/- 12.8%. There was no significant variation in bilateral SJO2 differences with time. Decreasing cerebral perfusion pressure (r = -0.559, P < 0.001) and arterial PCO2 (r = -0.342, P < 0.001) were associated with increasing bilateral SJO2 differences. Regarding AJDL, the maximum bilateral differences varied between 0.04 mmol/L and 1.52 mmol/L. The bias and limits of agreement were -0.01 +/- 0.18 mmol/L. At best, 87% of ischemic events were disclosed by monitoring on the side of predominant lesion or, in diffuse injuries, on the side of the larger jugular foramen (computed tomographic [CT] approach). We conclude that in severe head injury, even calculated unilateral jugular venous monitoring has an unpredictable risk for misleading or missing data. Therefore, the reliability of unilateral jugular venous monitoring appears suspicious. For diagnosing ischemia the CT approach is recommended.

Adult↗

PubMed1998

S-100 serum levels after minor and major head injury.

BACKGROUND: S-100, a protein of astroglial cells, is described as a marker for central nervous system damage. The aim of this study was to evaluate whether the marker could give information about the severity and possibility of functional recovery after minor and severe head injury. METHODS: Thirty patients after severe head injury (Glasgow Coma Scale score < 9) and 11 patients after minor head injury (Glasgow Coma Scale score > 12) were included. In each case, blood samples were drawn within 6 hours after injury. Outcome was estimated at hospital discharge using the Glasgow Outcome Scale. RESULTS: All patients who sustained minor head injury had reached a favorable outcome by the time they were discharged from the hospital. Their mean S-100 serum level was 0.35 microg/L. Patients who sustained severe head injury and were classified as having an unfavorable outcome (31%) showed a mean serum concentration of 4.9 microg/L, whereas patients classified as having a favorable outcome (69%) had a mean S-100 level of 1.2 microg/L. All groups differed significantly (p < 0.05). CONCLUSION: S-100 appears to be a promising marker for the severity of head injury and neuronal damage.

Adolescent↗

PubMed1998

Short-term prognostic factors in lumbar disc surgery: the low back prognostic score is of predictive value.

In order to determine prognostic factors of lumbar disc surgery, we examined 107 patients who were conventionally operated on in a prospective, consecutive study. We analysed general data, the case history, the neurological examination at admission and all data from imaging examinations and therapy. In addition, all patients received a questionnaire based on the Low Back Outcome Score [9, 10]. The patients were re-examined after 2-8 months (103 days mean). According to their ratings on a pain grading scale, the patients were divided into a group with favorable and another with unfavorable results. These groups were analysed in relation to the patients' initial condition. At follow up, 88% of the patients had either completely recovered or their complaints had been relieved. According to the Low Back Outcome Score (LBOS), 64.5% went well. Used to evaluate the initial condition of the patients on admission the LBOS was able to predict favorable outcome in 68% and unfavorable outcome in 50%. To improve the prognostic value, we combined significant questions of the LBOS with the pain grading scale and significant prognostic factors to form a new prognostic score (Low Back Prognostic Score). With this new score we were able to predict a favorable outcome in 84% of our patients, and an unfavorable outcome in 71%. The Low Back Prognostic score seems to provide a sensitive method for predicting a favorable or unfavorable outcome for patients scheduled to undergo lumbar disc surgery.

Adolescent↗

PubMed1998

Are prognostic factors still what they are expected to be after long-term follow-up?

The aim of this prospective study of 121 patients was to investigate whether or not the predicting factors of lumbar disc surgery become lost over an increased follow-up time. Preoperatively, the patients classified their pain on the visual analogue scale, and general data, case histories, and neurologic findings were recorded. Follow-up examinations were carried out at 3, 12, and 28 months. At the 3-month follow-up examination, six predictive factors were calculated, after 1 year there were only four, and after 28 months only two predictive factors were found. After reviewing these results, it was apparent that the number of prognostic factors diminished over time. To obtain reliable surgery-related results for the prognostic factors in lumbar disc surgery, we believe that the follow-up period should not exceed 1 year.

Adolescent↗

PubMed1997

Does the choice of outcome scale influence prognostic factors for lumbar disc surgery? A prospective, consecutive study of 121 patients.

From January to June 1994, we operated conventionally on 121 consecutive hemiated lumbar disc patients as part of a prospective study. We analysed general data, case histories, neurological findings on admission and all data from imaging investigations and therapy. In addition, all patients received a questionnaire based on the Low Back Outcome Score. Most of the patients (93%) were followed-up for 1 year postoperatively in the same manner. On the Prolo Scale, we obtained a good result in 70%; 76% had a good Low Back Outcome Score. Predictive factors are different for different outcome scales. The preoperative duration of pain, the preoperative duration of paresis and smoking seem to be general predictive factors.

Adult↗

PubMed1997

Comparison of serial S-100 and NSE serum measurements after severe head injury.

We investigated the time course of neuron specific enolase (NSE) and S-100 protein after severe head injury in correlation to outcome. We included 30 patients (GCS < 9), who had been admitted within 5 hours after injury, in a prospective study. Blood samples were taken on admission, 6, 12, and 24 hours and every 24 hours up to the fifth day after injury. The outcome was estimated on discharge using the Glasgow Outcome Scale. 70% reached a good outcome. All concentrations of NSE and 83% of the S-100 samples were elevated concerning the first probe (30.2 micrograms/l NSE mean and 2.6 micrograms/l S-100 mean). Patients with bad outcome had an NSE concentration of 38 micrograms/l (mean) compared with 26.9 micrograms/l (mean) in patients with good outcome. Patients with bad outcome had an S-100 concentration of 4.9 micrograms/l (mean) compared with 1.7 micrograms/l (mean) in patients with good outcome (p < 0.05). The mean values of NSE and S-100 decreased during the first 5 days. Four patients with increasing intracranial pressure showed a quick increasing concentration of NSE, in two patients the S-100 level showed a slower rise. The NSE serum levels did not correlate with intracranial pressure values. Our results show that the first serum concentration of S-100 seems to be predictive for outcome after severe head injury.

Adolescent↗

PubMed1997

Comparison of changes in cerebral blood flow and cerebral oxygen saturation measured by near infrared spectroscopy (NIRS) after acetazolamide.

The present study compares the change of cerebral blood flow and HbO2 measured by near-infrared spectroscopy (NIRS) after administration of 1000 mg acetazolamide intravenously. CBF studies in 21 patients with ischaemic cerebrovascular disease were performed routinely with the 133Xenon technique. Additionally the local HbO2 was recorded by NIRS. A rest study was followed by a second study after the administration of 1000 mg acetazolamide. In 18 patients we observed an increase of 30.8% of CBF and 4.7% of HbO2, 3 patients showed a decrease of CBF and 2 patients a simultaneous decrease of HbO2. We did not find a correlation between the absolute values of CBF and HbO2 at rest or after stimulation. However, a positive correlation (r = 0.71, p < 0.05) between the change of CBF and HbO2 could be detected. Assuming a threshold value of normal CBF reactivity of 30% and 4% HbO2 reactivity we found for NIRS a sensitivity of 0.88 and a specificity of 0.75. The results demonstrate that changes of CBF can be detected with NIRS and the algorithm of the used monitor is able to calculate the intracranial part of the signal. So, NIRS can be used as non-invasive screening method to test the cerebrovascular reserve capacity.

Acetazolamide↗

PubMed1997

Dynamic changes of cerebral oxygenation measured by brain tissue oxygen pressure and near infrared spectroscopy.

The aim of this study was to find out whether a correlation exists between changes in brain tissue oxygen pressure (ti-pO2) and hemoglobin oxygenation (HbO2) measured by near-infrared spectroscopy. We studied 10 patients with severe head injury. A ti-pO2 monitoring device was introduced in the frontal white matter as soon as possible after administration. Additionally a NIRS sensor was placed at the forehead. All data were recorded simultaneously. Changes of the ti-pO2 curve were defined as events with the following criteria: > 10% change from the baseline value, > 3 min duration, clearly not an artifact. 137 events were found with a mean change of ti-pO2 of 8.3 +/- 10.2 mmHg. In 77.4% we observed a corresponding change of the HbO2. In 7 patients we found a good correlation (r > 0.7) between change ti-pO2 and change HbO2. In 3 patients the correlation was poor. The reason for poor correlation might be poor signal quality of the NIRS sensor or inhomogenous distribution of ischemic areas in the whole brain. We conclude that under the condition of a stable NIRS signal and a diffuse brain lesion, changes of ti-pO2 are well reflected by NIRS.

Adult↗

PubMed1997

Prognostic factors of posterior cervical disc surgery: a prospective, consecutive study of 54 patients.

OBJECTIVE: To our knowledge, there is no prospective study to date about the prognostic factors of dorsal foraminotomy. The aim of this prospective study was to provide further information in this field. METHODS: From January 1994 to January 1995, we performed a prospective, consecutive study of 54 patients, each of whose lateral herniated cervical disc was operated on via a dorsal foraminotomy. We analyzed the general data, the case history, the neurological examination at admission, and all data from imaging examinations and therapy. Most of the patients (93%) were followed up at 1 year, postoperatively. The patients were divided into one group with good results and another group with bad results, according to their ratings on a pain scale. The groups were analyzed in relation to the patients' initial condition. RESULTS: At follow-up, 94% of the patients had completely recovered or their condition had improved. CONCLUSION: A long duration of preoperative complaints and a long-standing neurological deficit seem to be important prognostic factors for a bad outcome after dorsal foraminotomy.

Adult↗