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Biomedical subjects

A Brawanski

Publications and source records attributed to A Brawanski.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1996

Transcranial Doppler sonography in a patient with Ehlers-Danlos syndrome: case report.

OBJECTIVE AND IMPORTANCE: Ehlers-Danlos syndrome is of special interest because of the risk of formation of intracranial aneurysms. The reason is increased elasticity of the vessel wall, which can influence the waveform of the transcranial doppler signal. CLINICAL PRESENTATION: A patient with Ehlers-Danlos syndrome Type IV and an aneurysm of the left middle cerebral artery was studied with transcranial doppler sonography. Compared with a reference group of 29 volunteers, there was no difference in blood flow velocity in the middle cerebral and anterior cerebral arteries on both sides. The pulsatility index, however, was lower compared to the pulsatility index of the reference group (right middle cerebral artery, 0.69 versus 0.89; left middle cerebral artery, 0.58 versus 0.87; right anterior cerebral artery, 0.66 versus 0.94; left anterior cerebral artery, 0.68 versus 0.88). There was no difference in blood pressure during examination between the described patient and the reference group. CONCLUSION: Under the concept of an increased elasticity of the vessel wall, a decreased flow resistance can be expected, which is represented by a decreased pulsatility of the blood flow waveform. It might be possible that in patients with Ehlers-Danlos syndrome, intracranial arteries that show a very low pulsatility index run a high risk to develop an aneurysm.

Adult↗
PubMed1996

Moderate hypothermia in patients with severe head injury: cerebral and extracerebral effects.

Cerebral and extracerebral effects of moderate hypothermia (core temperature 32.5 degrees C-33.0 degrees C) were prospectively studied in 10 patients with severe closed head injury (Glasgow Coma Scale score < 7) in the intensive care unit of a university hospital. Hypothermia was induced by cooling the patient's body surface with water-circulating blankets. Before cooling, a conventional intracranial pressure (ICP) reduction therapy was applied, which remained unchanged throughout the study. Cerebral blood flow (CBF), cerebral metabolic rates for oxygen (CMRO2) and lactate (CMRL), and ICP were simultaneously measured prior to inducing hypothermia, after obtaining hypothermia, after 24 hours of hypothermia, and after rewarming. With respect to extracerebral effects, supplemental investigations were conducted 24 and 72 hours after rewarming. The median delay between injury and induction of hypothermia was 16 hours. Hypothermia reduced CMRO2 by 45% (p < 0.01), whereas CBF did not change significantly. Before cooling, six patients had elevated CMRL indicating cerebral ischemia. Cooling normalized CMRL in all patients (p < 0.01). The intracranial hypertension present prior to cooling declined markedly during hypothermia (p < 0.01) without significant rebound effects after rewarming. Cardiac index decreased by 18% after hypothermia was reached (p < 0.05), recovered at 24 hours of hypothermia, and surpassed baseline values after rewarming. Platelet counts dropped continuously up to 24 hours after rewarming (p < 0.01). Plasma coagulation tests did not show significant worsening. Creatinine clearance decreased during cooling (p < 0.01) and recovered by 24 hours after rewarming. Twenty-four hours after cooling had begun, eight patients had elevated serum lipase activity (p < 0.01) and four of them acquired pancreatitis. Rewarming normalized both pancreatic alterations. Seven patients made a good recovery; one survived severely disabled; and two patients died. Moderate hypothermia is effective in preventing secondary brain damage while reducing cerebral ischemia. However, there are potentially hazardous side effects that require additional monitoring.

Adolescent↗
PubMed1994

Surgical intervention and heparin-anticoagulation improve prognosis of rhinogenic/otogenic and posttraumatic meningitis.

It is still controversial, whether early surgical removal of infectious material and heparin-anticoagulation to reduce vascular complications will improve outcome in acute meningitis. In the present pilot-study 40 patients with acute or delayed post-traumatic or oto-/rhinogenic purulent bacterial meningitis were analysed for neurological outcome by using the Glasgow outcome score (GOS) and the Tuthill functional score; patients were treated either by early surgical revision of the septic focus (Group 1, within 6 days, n = 15), late surgery (Group 2, later than 6 days, n = 19), or no surgery at all (Group 3, n = 6). All patients, independent of surgical approach, received therapeutic heparin-anticoagulation. Patient groups were otherwise comparable for antibiotic treatment, osmotherapy, microbiology, CSF-findings, CT-scans and prognostic factors. Outcome according to GOS was superior in Group 1 compared with Groups 2/3 (non-significant). Although there was no significant difference on admission in the Tuthill functional score, Group 1 achieved a superior final outcome of 96 points compared with Groups 2 and 3, who gained 72 points (p < 0.01). In addition, Group 1 patients had significantly less intracranial complications (8/15 patients versus 21/25 patients in Groups 2/3, p < 0.01) and were dependent upon respirator treatment for fewer days (10.2 days) than Groups 2/3 (12.5 days, non-significant). In 31 patients CSF-leakage was identified: among these, 17 patients had CSF-leakage, which had not been anticipated by clinical/neuroradiological examinations and revealed only by surgery. The overall mortality in this study population was very low (2.5%), therefore, therapeutic heparin seems to represent an additional favorable treatment measure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Transcranial Doppler sonography with evaluation of CO2 reactivity in craniocerebral trauma].

17 patients with severe head injury were examined by transcranial Doppler sonography. Resting values and CO2 reactivity were determined. The resting measurements had no prognostic value. There was no significant side difference in patients with unilateral intracranial lesions. CO2 reactivity was 2.8 +/- 2.3%/mmHg pCO2 in patients with good outcome, whereas in patients with bad outcome CO2 reactivity was 0.6 +/- 5.1%/mmHg pCO2. However, in the acute situation after the trauma there was no difference between the two. In patients with a unilateral lesion we found a significantly lower CO2 reactivity on the side of the lesion of 1.8 +/- 0.4%/mmHg pCO2, on the non-affected side CO2 reactivity was 4.5 +/- 2.1%/mmHg pCO2. The conclusion is that the CO2 reactivity yields information on the actual haemodynamic situation in brain-injured patients. Repeated measurements are necessary to improve the prognostic value of CO2 reactivity, because this parameter may improve during treatment.

Adult↗
PubMed1992

Continuous-pressure controlled, external ventricular drainage for treatment of acute hydrocephalus--evaluation of risk factors.

Experience with a continuous-pressure controlled, external ventricular drainage system (EVD) in 100 patients (n = 49 female, n = 51 male; mean age, 56.3 yr) with acute hydrocephalus is reported. Cerebrospinal fluid circulation disturbances resulted from hemorrhages caused by subarachnoid hemorrhage (n = 45), parenchymal hemorrhages from angioma (n = 4), anticoagulants (n = 7), or hypertension or other reasons (n = 30); in addition, hydrocephalus developed from infections (n = 3), tumors (n = 2), infratentorial infarction (n = 5), or unknown reasons (n = 4); 52 patients had ventricular hemorrhages. No patient died of system-associated morbidity. Mean time of EVD treatment was 9.5 days, with 40 patients being treated for 10 to 29 days; routine refobacin (5 mg) flushing of the system was performed three times a day. Patients without cerebrospinal fluid leakage had a 2% rate of secondary infection compared with 13% in patients with cerebrospinal fluid leakage due to ventricular catheter placement (P < 0.05; overall infection rate, 5%). A clinical mortality rate of 29% during EVD treatment was observed in subarachnoid hemorrhage patients (Hunt and Hess Grades II, III, IV, and V; n = 9, 9, 18, and 9, respectively); recurrent hemorrhages during EVD treatment occurred in 19 patients (26 hemorrhages), and of these, 10 patients died. System occlusion was seen in 19 cases (12 of 45 patients with subarachnoid hemorrhage), requiring catheter and system renewal in 1 case; system extraction was seen in 3 cases, misplacement was seen in 11 cases, and disconnection was seen in 5 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebrospinal Fluid Pressure↗
PubMed1992

CBF studies with Xenon-133 in arteriovenous malformations: a methodological study.

A new model for the two dimensional rCBF technique using the inhalation of Xenon 133 was tested in patients with arteriovenous malformations. It was hypothetized that, in contrast to the conventional CBF model, it corrects for the artifactual shunt flow through the AVM and thus yields physiological CBF data. Four regions of interest (AVM, contralateral to AVM, ipsilateral hemisphere, contralateral hemisphere) were defined in 17 patients with AVMs and analyzed for differences in grey matter flow (F1). In contrast to the conventional CBF model, the new model shows a decreased flow over the AVM area, corresponding to the results of Xenon CT and SPECT. Furthermore, the blood pool parameter P4 is very sensitive to the location of the AVM. Thus further investigations of the hemodynamics of AVMs with this model are encouraged.

Adult↗
PubMed1991

Cerebral blood flow and cerebrovascular reserve 5 years after EC-IC bypass.

CBF-studies using the Xenon-133-inhalation technique were performed in 18 patients with a unilateral carotid artery occlusion, 5.4 years after a STA-MCA procedure. For comparison we used the CBF data of 29 patients with the same diseases who had had conservative treatment for a variable period of time. CBF was measured during rest and after the intravenous administration of 1 g acetazolamide. During rest we found a significant interhemispheric difference in both groups. After activation with acetazolamide this difference disappeared in the bypass group, but not in the conservatively treated patients. Our data show that the bypass procedure obviously affects the vascular reserve capacity in a positive way over a long period of time. One criteria for success of STA-MCA procedures might be the cerebral reserve capacity tested with CBF-studies under activation.

Acetazolamide↗
PubMed1991

Diagnosis and monitoring of subarachnoid hemorrhage by transcranial color-coded real-time sonography.

Thirty-six patients with acute spontaneous subarachnoid hemorrhage (26 caused by rupture of an aneurysm) were examined by transcranial color-coded real-time sonography by using a 2.25-MHz ultrasound transducer. In 20 of these 26 patients (76%), the aneurysm could be identified by a characteristic abnormal blood flow pattern within the aneurysm in coronal and axial scanning planes by transcranial color-coded real-time sonography. Blood within the basal cisterns, on top of the tentorium, and within the ventricles and parenchyma was sonographically detected by increased echodensity in 75%. In addition, cerebrospinal fluid circulation disturbances and cerebral vasospasm were detected in two-dimensional B-mode images in 85% and 100%, respectively. In Doppler mode, intravascular blood flow velocity could be quantified. We conclude that transcranial color-coded real-time sonography, a new, noninvasive method for diagnosis and follow-up of patients with subarachnoid hemorrhage, allows detection of the primary vascular lesion and monitoring of complications.

Blood Flow Velocity↗
PubMed1990

Hemispheric CBF-alterations in the time course of focal and diffuse brain injury.

Hemispheric CBF-alterations were studied in the time course of focal and diffuse-brain injury in a series of 25 head injured patients. Repeated 133 Xe CBF measurements with a mobile 10 detector system were performed in order to evaluate hemispheric CBF and cerebral vasoreactivity after change of PaCO2. Focal brain injury influenced hemispheric CBF varying in the time course: A hyperperfusion could be found within the first seven days after injury in 55 percent, whereas a hypoperfusion could be detected during the whole examination period in 18 percent. In diffuse injury we never saw such CBF abnormalities. On the other hand hemispheric CO2-reactivity was disturbed in focal and diffuse lesions, whereas a correlation between altered CBF at rest and CO2-reactivity could be only detected in 40% in focal injury. This investigations demonstrates no significant general, however, a partial influence of morphological damage upon cerebral microcirculation.

Adolescent↗
PubMed1989

Nocardial cerebral abscess cured with imipenem/amikacin and enucleation.

A 72 year old female with cerebral abscess due to Nocardia farcinica is reported. Needle aspiration, antimicrobial therapy using a new combination of imipenem and amikacin, and, finally, surgical excision led to prompt and complete recovery. This is the oldest patient to survive cerebral nocardiosis reported in the literature. This infection, is usually regarded as opportunistic and is encountered with increasing frequency in immunocompromised conditions (organ transplantation, chemotherapy, underlying disabling disorder, acquired immunodeficiency syndrome, etc.). The literature is extensively reviewed for various aspects of this disease including prognostic factors, recent developments in antibiotic therapy (imipenem, amikacin, minocycline etc.) and the essential role of surgery in the treatment strategy.

Aged↗