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Biomedical subjects

A Kohler

Publications and source records attributed to A Kohler.

At least 37 records · Page 2Linked to original sources
PubMed1998

Needle muscle biopsy in the investigation of neuromuscular disorders.

We have evaluated needle muscle biopsies in 220 patients with various neuromuscular disorders, using a method developed previously at Tuft's University. The method uses a 14-gauge needle propelled by an automatic device. An average of 3.5 samplings were taken per patient. Muscle samples were used for histological and molecular genetic analysis, and for the isolation of muscle satellite cells for in vitro cultures. The biopsy is well tolerated by the patients who never declined multiple samplings. Complications were few and minor, with no sequelae. In most cases the small size of the muscle specimen (ca. 15 mg per sampling) was sufficient to perform the various procedures and to yield a diagnosis. Specimens were considered insufficient for histological results in 9 patients (4%), due to technical artifacts or insufficient material. We now routinely use this method, which has several advantages over the surgical technique for most muscle biopsies.

Adolescent↗
PubMed1998

Diagnostic value of duplex ultrasound and liquid crystal contact thermography in preclinical detection of deep vein thrombosis after proximal femur fractures.

During a prospective clinical study the diagnostic value of the two non-invasive examinations colour-coded duplex ultrasound (Duplex) and fluid crystal contact thermography (LCCT) was investigated in relation to phlebography, the standard examination for the diagnosis of deep vein thrombosis (DVT), in 112 patients with proximal femur fractures. In 19% of the patients, DVT was diagnosed by phlebography, with the main localisation in the lower leg in 19 of 21 (90%) thromboses. With a negative prediction value of 83%, Duplex is less suitable than LCCT under such difficult examination conditions as the early postoperative period. The specificity of Duplex is 95%, but the sensitivity only 18%. The specificity of LCCT is 85% and the sensitivity 75%. Considering the frequency of postoperative DVT after surgery on the legs, especially hip surgery, a postoperative screening for DVT should become mandatory. LCCT has proved to be a suitable, cheap, non-invasive examination with a negative prediction value of 94%.

Adult↗
PubMed1998

A new HF current generator with automatically controlled system (Endocut mode) for endoscopic sphincterotomy--preliminary experience.

BACKGROUND AND STUDY AIMS: The main complications of endoscopic sphincterotomy are pancreatitis, hemorrhage, perforation and cholangitis. In a prospective randomized trial, a conventional current generator was compared to a new generator with an automatically controlled cut system (Endocut) for sphincterotomy. The purpose was to establish whether the new device reduces the complication rate of sphincterotomy. Our experiences over the last 2 years with the new HF current generator are described here. PATIENTS AND METHODS: In this study 100 patients were randomly assigned to one of the two generators. The following points were documented in a protocol form: abrupt or continuous cutting; length of papillotomy; complications. RESULTS: There were no significant differences in sex, age or indication for sphincterotomy. Nor were there any significant differences in the length of the sphincterotomy or mild pancreatitis. In contrast, an abrupt opening of the papillary roof was more frequently observed with the conventional generator (18 patients) than with the new device (one patient, P < 0.001). Mild bleeding occurred in two patients with the new unit, but in 13 with the conventional unit (P = 0.002). Moderate or severe bleeds were observed in neither of the two groups. During the subsequent application phase lasting for 2 years, the following complications occurred in a total number of 850 sphincterotomies (EST): pancreatitis 2.8% (one patient died); hemorrhages requiring transfusion 1% (n = 8); concealed perforations 0.3% (n = 3). CONCLUSIONS: According to our experience to date and based on this study, this new HF surgery unit enables performance of controlled, bloodless sphincterotomies. The danger of papillary hemorrhage appears to be reduced. All examiners found the new system to be safer and more convenient.

Electric Power Supplies↗
PubMed1998

[Brown-Vialetto-Van Laere syndrome: a case with anti-ganglioside GM1 antibodies and literature review].

We report the case of a woman suffering from progressive bulbopontine paralysis in whose the first symptom, bilateral hypoacousia, began in childhood. This clinical picture is that of the Brown-Vialetto-Van Laere (BVVL) syndrome. Anti-ganglioside GM1 antibodies were moderately elevated in this patient. Intravenous immunoglobulins produced little benefit. The main clinical characteristics of 29 BVVL patients reported in literature are reviewed, and the pathological significance of anti-GM1 antibodies is discussed in the context of this disorder.

Adult↗
PubMed1997

Long-term results and survivorship of Protasul 10 straight stem Müller femoral hip prosthesis.

In a retrospective study 88 consecutively cemented Protasul 10 straight stem total hip prostheses, implanted during a two year period, were investigated. After a nine to ten year period 8 hips had been revised. In the clinically and radiologically checked group, the patients' opinion was in 82% very good or good, in 9% moderate and in 9% bad. The X-Ray findings showed in 20% an initial or advanced loosening of the stem and/or the cup. The survivorship after a nine to ten year period is 89%.

Aged↗
PubMed1997

[Veno-lymphatic angiodysplasia as the cause of recurrent inguinal varicose veins].

Veno-lymphatic angiodysplasia may be the reason for the development of varicose leg veins. This form of angiodysplasia is illustrated by two case reports. Until now, angiodysplasia as possible cause of recurrent varicose veins after surgical treatment has not been included in the classification of the morphological types of recurrent varicose veins. The surgical approach exposing the common femoral vein in a first step and secondly performing a complete resection of the malformation with careful consideration of the adjacent femoral vessels is recommended as the treatment of choice.

Adult↗
PubMed1997

Successful treatment of an extended leg ulcer in systemic sclerosis.

We report the successful surgical treatment of a large and painful leg ulcer associated with systemic sclerosis (scleroderma). In addition, there was a long occlusion of the superficial femoral artery, and ankle systolic blood pressure was 80 mmHg (ankle-brachial-index 0.65). All conservative treatments including systemic antibiotics, nifedipine, intravenous iloprost, intravenous penicilline G and hyperbaric oxygen failed. Pain was intolerable and below-knee amputation was considered. In a first attempt to save the limb, the patient underwent femoropopliteal bypass surgery. Despite a successful outcome of the bypass operation and normalization of the ankle blood pressure, the large wound remained recalcitrant and extremely painful. A second attempt to save the limb consisted of complete debridement of all sclerotic tissue down to the fascia and split skin grafting. The graft took in over 90% of the surface and the remaining wound healed spontaneously. Large leg ulcers in systemic sclerosis can become limb threatening. Radical debridement combined with a split skin graft seems to be a promising way to avoid amputation.

Aged↗
PubMed1996

Catheter fracture: a rare complication of totally implantable subclavian venous access devices.

Catheter fracture represents a rare problem among non-infectious complications following the insertion of totally implantable long-term central venous access systems for the application of chemotherapeutic agents. A literature survey revealed a total incidence of catheter fractures of 0-2.1%. Imminent catheter fracture can be identified radiologically, using different degrees of catheter narrowing between the clavicle and the first rib, called pinch-off sign. Two cases of catheter fracture are described and potential causes are discussed. Recommendations to avoid the pinch-off sign with the subsequent risk of catheter fracture and migration include a more lateral and direct puncture of the subclavian vein. In case of catheter narrowing in the clavicular-first rib angle, patients should be followed carefully by chest X-rays every 4 weeks. Whenever possible, the system should be removed within 6 months following insertion.

Adult↗
PubMed1996

Contraction response to muscle percussion is increased in peripheral nerve conduction block.

We studied the contraction of skeletal muscle upon direct percussion in 119 patients presenting with palsies related to focal peripheral nerve disorders. We compared the response of the paralyzed muscles with the response obtained on the contralateral normal side. The cause of the palsy was subsequently assessed by electrophysiological testing which disclosed: conduction block (CB), axonal, or mixed lesions (when both CB and denervation existed in similar proportions). Most of the time, the muscle response to percussion was increased in patients with CB (37/47), decreased in axonal lesions (44/53), and symmetric in mixed lesions (12/19). We conclude that distinction between CB and denervation is often possible on the basis of this simple bedside test.

Adult↗
PubMed1996

[Percutaneous tracheostomy: a minimally invasive procedure on the intensive care unit].

INTRODUCTION: In 1985 Ciaglia [2] introduced percutaneous tracheostomy as a minimal invasive procedure. Since October 1991 percutaneous tracheostomy has been performed in 40 patients at the University Hospital in Zürich. This paper compares our complication rate using the Cook-system with the conventional open technique in the literature. MATERIALS AND METHODS: 40 patients, mean 53.6 years of age, 26 male, 14 female. Indications were: inability to perform sufficient bronchial suction, recurrent atelectasis, long term ventilation, difficult or prolonged weaning (i.e. neurotrauma). The tracheal tube is introduced following stepwise dilatation after making skin incision, according to the Seldinger technique. RESULTS: In all patients tracheostomy was carried out as an elective procedure in the Intensive Care Unit. Time between primary intubation and tracheostomy varied between O and 51 days, mean 15.9 days. Complications occurred in 5/40 cases (12.5%), with only one serious complication: the tracheostoma was misplaced, requiring intubation. Beside that we have seen 2 minor hematomas, 1 bradycardia and 1 subcutaneous emphysema. CONCLUSIONS: Percutaneous tracheostomy can be safely performed at bedside in the ICU. The method is simple and has a lower complication rate compared to the conventional open technique as reported by Hazard [7] and Griggs [8].

Adult↗
PubMed1995

Electrophysiological characteristics of lesions in facial palsies of different etiologies. A study using electrical and magnetic stimulation techniques.

Using magnetic stimulation techniques in addition to conventional electrical stimulation, the entire facial motor pathway can be assessed electrophysiologically. To study the diagnostic yield of these examinations, 174 patients with facial palsies of a variety of etiologies were examined (85 Bell's palsies, 24 Guillain-Barré syndrome (GBS), 19 Lyme borreliosis, 17 zoster oticus, 12 meningeal affections, 10 brain-stem disorders and 7 HIV-related facial palsies). The facial nerve was stimulated electrically at the stylomastoid fossa and magnetically within its canalicular portion. Additionally, the face-associated contralateral motor cortex was stimulated magnetically. Recordings were from the nasalis or mentalis muscle, or both, using surface electrodes. Bell's palsy patients showed typically a unilateral local hypoexcitability of the facial nerve to canalicular stimulation. In GBS, bilateral latency prolongations were frequent, as expected for a myelinic disorder. In contrast, in zoster, predominant axonotmesis was unilateral, and in HIV infection sometimes bilateral. The method was very sensitive to detect subclinical dysfunctions in meningo-radiculitis and malignant meningeal diseases, either prior to the onset of palsy, or on the contralateral (clinically unaffected) side. It also distinguished reliably between central and peripheral facial motor pathway lesions. In our experience, these inexpensive and non-invasive electrophysiological techniques contribute substantially to the differential diagnosis of facial palsies.

Adult↗
PubMed1995

[Isolated peripheral facial paralysis and HIV infection: 7 cases].

Human immunodeficiency virus infection frequently involves the peripheral or central nervous system. Seven cases of isolated peripheral facial palsy that occurred at various stages of the disease are reported. The palsy was the first manifestation of the disease in 5 patients, and revealed it in 3 of them. The palsy involved the right side in 6 cases (complete N = 2; incomplete N = 4); it was bilateral in one (complete on both sides). Abnormalities of the cerebrospinal fluid were present in all patients but differed depending on the stage of the retroviral infection. Electroneuromyography defined the type of the palsy, principally due to axonotmesis in 4 patients (including the bilateral one) and principally to neurapraxia in 3 patients. The outcome was good in most cases. The physiopathology remains undetermined.

Adult↗