Biomedical subjects
Publications and source records attributed to A Huber.
Discussion of the clinical symptomatology of optic nerve and chiasmal gliomas based on personal observations. Evaluation of plain X-ray diagnostic procedures, A-scan ultrasonography and especially computertomography for diagnosis of optic nerve and chiasmal gliomas. Discussion of modern attitude in treatment of these tumors: surgical, irradiation therapy.
Long-term observation of the use-effectiveness and safety of 745 Copper-IUD's has demonstrated: 1) The pregnancy rate decreases distinctly after 2 years; until now no pregnancy has been observed after 4 years continuous use. 2) The endometrium responds first with an inflammatory reaction, later it shows signs of deficient secretion, but after a longer period seems to become normal again. 3) Contamination of IUD's begins early, mostly with bacteria of vaginal origin, later the number of sterile IUD's increases. -- A septic abortion after pregnancy with an IUD in situ has not occurred amongst our cases. 4) The rate of copper elution continues steadily, but in spite of demonstrable corrosion there is no obse-vable decrease of contraceptive effectiveness. Copper-IUD's can remain as long as 5 years in situ, if no untoward side effects (pain, bleeding, infection) occur. It may be advisable to remove them after that period as corrosion may affect devices at present commercially available.
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It has been tried to ascertain the comparative value of the different diagnostic measures with regard to colorectal cancer. On the basis of the results achieved, the addition of the Hämoccult test (if this has not yet been done), of the rectoscopy and of endoscopic polypectomy to the programme of preventive medicine is indicated. Also measures for an early diagnosis of the post-operative recurrence of tumors are advisable.
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The survey tried to reveal the strata of population which are badly provided with dental care, in the city of Berne and surroundings of 25 km. In a house-to-house query questions were asked on 3 parameters: dental hygiene, removable dentures, and number of remaining teeth. Socioeconomic criteria such as age, residence (urban or rural), presence or absence of a dentist in the region and social status were used. The results showed that the 3 examined parameters were in close relationship to the socio-economic factors. People over 50 and people from lower social level had inferior dental treatment and a 5 times higher percentage of full dentures. This applied particularly to regions without dentist.
After the discussion of the clinical symptomatology of paralytic squint (diplopia, variable angle of squint, compensatory head posture etc.) the importance of modern electromyography for differentiation between myopathy (affection of the eye muscles), myastherias (affection of the neuromuscular transmission) and peripheral neurogenic palsies (affection of the peripheral neuron up to the nuclear region) is discussed. The clinical symptomatology of these affections of different levels is discussed as well as the differential diagnosis. The treatment of eye muscle palsies in principle consists in: 1. medical treatment (local and general), 2. optical treatment (glasses, occlusions, prisms etc.), 3. orthoptic treatment, 4. surgical treatment.
Three cases of histologically verified neurinomas of the oculomotor nerve are reported. The preoperative diagnosis in all three cases was not made; on the contrary all cases were diagnosed as sphenoid ridge meningiomas. The oculomotor neurinoma manifests itself in the beginning with a discrete progressive palsy of the oculomotor nerve leading in later stages to complete ophthalmoplegia. Proceeding the oculomotor nerve paresis or going parallel to it is a functional loss of the homolateral optic nerve sometimes progressing to amaurosis. Unilateral exophthalmos as well as frontal or orbital neuralgic pain with or without sensory disorders in the area of trigeminus-I are characteristic for the clinical picture in later stages, all symptoms characteristic for the syndrome of the apex orbitae, resp. the superior orbital fissure, resp. the anterior cavernous sinus. The differential diagnosis has to consider above all the sphenoid ridge meningioma, the trigeminal neurinoma and the numerous tumors within the cavernous sinus (aneurysmas, meningiomas, chondromas, metastases of carcinomas, pituitary adenomas etc.) or the middle cranial fossa. Plain X-ray, carotid angiogram and computer tomogram are essential diagnostic means for localization and extension of the tumor but not for histological diagnosis. Oculomotor neurinomas are very seldom. The three observed cases did not have any relation to a possible generalized neurofibromatosis.
A prospective study was carried out on a series of 1500 patients of a gastro-enterological and surgical unit in order to evaluate critically the accuracy of rectal digital examination as a single tool in the early diagnosis of colorectal tumours. The patients in this study were explored independently by two investigators, first by rectal digital palpation and afterwards by means of the proctosigmoidoscope. Endoscopy confirmed the presence of 239 tumours, 96 of these being diagnosed histologically as carcinoma. Comparative analysis of the results of physical and endoscopic examination demonstrated that digital palpation provided a correct diagnosis in 58 out of 239 tumours, equivalent to an accuracy of 24.3% for tumours within the reach of the rectoscope, and 10% for all colorectal tumours. Hence, rectal examination should not be used as single diagnostic tool in screening for large bowel cancer. A multiphasic screening system, including investigations for occult blood, proctosigmoidoscopy, endoscopic polypectomy and determination of colon-embryonic-antigen levels is discussed to obtain better results in general health screening, early diagnosis and avoidance of incurable colorectal carcinomas and the early detection of recurrence.
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Direct visualization of the inner anal orifice by means of coloscopic inversion in the ampulla recti eliminates one of the last "blind zones" in digestive endoscopy.
After discussion of the modern concepts of pathophysiology of ocular myasthenia the ocular symptoms such as ptosis and eye muscle palsies are discussed. As important diagnostic sign the Simpson lid fatigue test before and after application of Tensilon is described. For diagnosis of myasthenic eye muscle palsies electrooculography has a special significance especially in connection with the application of Edrophonium, which normalizes myasthenic hypometric saccades and transforms them even in hypermetric saccades. In doubtful cases of eye muscle palsies the electromyogram of the affected muscle in connection with the Edrophonium-test is extremely valuable. With regard to modern treatment apart from cholinesterase inhibitors (Pyridostigmine, Neostigmine) thymectomy, the application of corticosteroids, ACTH and especially also immune suppressive drugs (Imurel etc.) is discussed. Of great significance in ocular myasthenia is the local application of cholinesterase inhibitors like Eserine, Prostigmin or Phospholine Iodide.
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Chiasmal syndromes (characterized by bitemporal field defects, decrease of vision and simple optic atrophy) are not only caused by tumors within the chiasmal region, but also occur in inflammatory, toxic, demyelinizing and hereditary-atrophic processes of the chiasm, respectively the optic nerve. In the presence of classic bitemporal visual field defects the probability of a tumor within the sellar region is very great. Apart from the most frequent pituitary adenoma one has to consider the craniopharyngioma, the meningioma of the tuberculum sellae, the olfactory meningioma and the meningioma of the sphenoid wing. The specific symptomatology of these sellar, supra- or parasellar tumors is discussed. In the presence of atypical or incipient bitemporal visual field defects, as they occur also in the early stages of tumors of the chiasmal region, one has first of all to exclude all other possible causes for such field defects such as refraction scotomas, tobacco-alcohol-amblyopias, dominant hereditary optic atrophies, the uni- or bilateral optic neuritis and the intoxications of the optic nerves. In the differential diagnosis of tumors of the sellar region one has to consider infra- and supraclinoidal aneurysms, tumors of the chiasm (gliomas of the chiasm), the distant effect of a hydrocephalus of the IIIrd ventricle on the chiasm and the optochiasmatic arachnoiditis.