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Biomedical subjects

A M Frank

Publications and source records attributed to A M Frank.

12 recordsLinked to original sources

[The interesting case--case no. 59].

UNLABELLED: Complications after endoscopic sinus surgery are rare and occur in about 0.5 % of all cases. However postoperative symptoms such as severe cephalgia and nasal discharge of clear fluids indicate a cerebrospinal fluid leakage. CASE: A 64 year-old-patient presented to our clinic four months after an endoscopic sinus surgery complaining of the two above mentioned symptoms for about 4 weeks. In a computed tomography study of the frontobasis there was no evidence of an osseous defect. An MRI of the head revealed a bilateral temporal fluid collection as seen in bilateral chronic subdural hematoma. Therefore the present illness was no consequence of the preceding surgery. CONCLUSION: Significant symptoms of severe postoperative complications after endoscopic sinus surgery can still be misleading. Therefore accurate diagnostic and imaging procedures are always crucial to support the initial diagnosis.

Cerebrospinal Fluid Rhinorrhea↗

Non-invasive measurement of intracranial pressure changes by otoacoustic emissions (OAEs)--a report of preliminary data.

Up to now changes of intracranial pressure can only be objectively assessed by invasive measurement tools e.g. epidural transducers or intraventricular or intraparenchymatous catheters. Changes of intracranial pressure (ICP) are known to influence the inner ear since the subarachnoid space is linked to the perilymphatic space of the inner ear via the cochlear aquaeduct. A new method for assessing cochlear disorders is based on otoacoustic emissions (OAE) which are generated by the outer hair cells (OHCs) of the inner ear. The aim of the present study was to find out whether changes of intracranial pressure can be monitored by spontaneous otoacoustic emissions (SOAEs), transient evoked otoacoustic emissions (TEOAEs) and distortionproduct otoacoustic emissions (DPOAEs). SOAEs, TEOAEs and DPOAEs were measured in 12 young normally hearing subjects (volunteer group) in different body postures (horizontal, -30 degrees and +30 degrees supine position). In 5 patients undergoing continuous intraventricular pressure monitoring for the assessment of normal pressure hydrocephalus (NPH), DPOAEs were measured simultaneously in different body postures as well (patient group). At an increase of ICP the SOAE-level of the volunteer group decreased by -3.3 dB SPL (sound pressure level) and the TEOAE-level by -2.1 dB SPL. The DPOAEs showed a frequency dependent reduction of its level with maximal changes at the lowest frequency tested (f2 = 1 kHz; -7.9 dB SPL). In the patient group the ICP amounted to 19.2 cm H(2)0 and the DPOAE-level also decreased particularly at lower frequencies (-2.0 dB SPL). In conclusion otoacoustic emissions, particularly DPOAEs, may provide a new clinical tool for non-invasive monitoring of ICP.

Environmental Monitoring↗

Dorsal extradural lipoma as cause of spinal claudication. Case report and review of the literature.

Extradural spinal lipomas are rare tumorous lesions. "True adult lipomas" have to be histologically differentiated from angiolipomas. The authors describe a case of segmental dorsal lipomas in the lower lumbar spine which led to a clinical apparent spinal claudication. Having reviewed the literature this case is the first ever described. In this case MRI was the diagnostic tool of choice. The tumor could be removed completely via interarcual laminotomy and flavectomy. The clinical outcome was excellent. In differential diagnosis of a spinal claudication this rare cause should be kept in mind when typical osseous changes are absent.

Adult↗

[Postoperative spondylodiscitis as the cause of failed-back syndrome--clinical aspects, diagnosis, therapy].

Postoperative lumbar spondylodiscitis can cause a failed back syndrome. With 0.1 to 3% according to the literature it belongs to the rarer complications following lumbar disc surgery. We present the characteristic clinical picture and typical findings (ESR, plain X-rays, MR) with suspected spondylodiscitis on 19 patients (= 0.2% of 9492 operative interventions for lumbar disc prolapse from 1980 to 1990) and show MR tomography to be the most sensitive investigation. Principles of therapy consist of lumbar immobilisation with a light cast orthesis for an average of 12 weeks and additional antibiotic therapy up to two weeks beyond normalisation of ESR. Finally results of therapy are presented with a satisfying outcome in 84.2% of cases.

Adult↗

[Are sacroiliac joint block and insertion tendinosis of the musculus erector trunici too rarely diagnosis as the etiology of failed back syndrome after intervertebral disk operation].

Dysfunction of sacroiliac joint and tendinosis of erector trunci muscle may cause severe pain after lumbar discectomy. In this paper we discuss pathophysiology, clinical appearance as well as specific diagnostic procedures and therapy. We want to point out that sacroiliac joint dysfunction must be taken into consideration if persistent pain occurs after discectomy.

Diagnosis, Differential↗

The value of spinal magnetic resonance imaging (MRI) in locating prolapses of lumbar intervertebral discs.

Between 1986 and 1988 100 patients in whom MRI had been used to diagnose prolapses of lumbar intervertebral discs were admitted to the neurosurgical department of the Munich Technical University. MRI proved to be a valuable diagnostic technique, even if one has to concede certain limitations to the usefulness of the results when compared to conventional methods, particularly in such cases where clinical symptoms are not clear. Typical findings are illustrated and compared with those seen in MRI, whose relative importance is discussed.

Humans↗

[Diagnosis of recurrent intervertebral disk prolapse with nuclear magnetic resonance tomography].

Persisting low back pain after lumbar discectomy may have many reasons. Reoperation is likely to be successful if a recurrent disc prolapse is found. The sensitivity and validity of diagnostic tools used cannot as yet be considered to be optimal. For this reason in our study 130 patients who were supposed to have a recurrent disc herniation underwent MRI with and without application of Gadolinium DTPA. In all patients we saw enhancement in the spinal canal. Sensitivity of MRI as verified by reoperation was > 90%. Hence, we can recommend this diagnostic tool for the diagnosis of recurrent disc herniation.

Adult↗

The role of magnetic resonance imaging (MRI) in the diagnosis of spondylodiscitis.

Spondylodiscitis is a well-known as well unavoidable complication of lumbar disc surgery. For diagnosis typical clinical symptoms and diagnostic procedures such as x-ray and scintigram are important but MRI proved to be the most sensitive and reliable. However, meaningful results can only be obtained with MRI if the measurement parameters are carefully considered, where by the field strength of the magnet plays a subordinate role. Therapy of spondylodiscitis using a light cast corset is described and it's advantages over other methods are shown.

Anti-Bacterial Agents↗

Prophylaxis of postoperative lumbar spondylodiscitis.

Spondylodiscitis after lumbar disc surgery is a well-known complication with a frequency of 0.1 to 3%. According to the authors, the etiological factors are: combination of operated segment instability, damage to the lower and upper plates due to disc space curettage and transmission of germs. After treatment of 100 selected cases, all with increased risk of postoperative spondylodiscitis, distinct possibilities for prevention have been discovered. Basic treatment consisted of 3 x 80 mg perioperative doses of Gentamicin i.m. In addition a collagen sponge (Sulmycin Implant) containing 50 mg Gentamycin was inserted in the cleared disc spaces of 50 patients. Complications in this procedure were not observed. The following is recommended for prevention of postoperative spondylodiscitis: a careful operating technique, perioperative antibiotics, and in particularly endangered patients, insertion of Sulmycin Implant in the disc-spaces.

Adult↗

[Spondylodiscitis following lumbar intervertebral disk surgery. Clinical aspects--diagnosis--therapy].

From 1980 to 1986 6632 operations of the lumbar spine due to disc prolapse were carried out by the Department of Neurosurgery of the hospital of the Technical University of Munich. During this period we saw 14 cases of postoperative spondylodiscitis. Patients' main symptom was increasing low back pain. Physical examination showed difficulty in forward flexion of the body. The blood sedimentation rate was always examined: an average increase to 42/66 mm was recorded. X-ray examination of the lumbar spine and magnetic resonance imaging proved to be the most sensitive methods of investigation, better than scintigram and computed tomography. Our therapeutic management consists of fixation in normal position with a "Light Cast" corset and additional antibiotic therapy with cephadroxil. In comparison to other therapy methods, i.e. restcure, the advantage for our patients is that they can stay at home and move about. Therapy must be continued until the blood sedimentation rate is normal and radiological signs of consolidation can be seen for at least over 10 weeks. Good long-term results were seen in all patients.

Adult↗

Distribution of horseradish peroxidase (HRP)-anti-HRP immune complexes in mouse spleen with special reference to follicular dendritic cells.

The distribution of immune complexes has been studied in mouse spleen stimulated to contain many germinal centers (GC's). Horseradish peroxidase (HRP)-anti-HRP complexes were used as an appropriately precise and sensitive model. We were primarily interested in the relative abilities of three cell types to interact with complexes: lymphocytes, macrophages, and follicular dendritic cells (FDC's). The latter are distinctive, nonendocytic, stellate cells located primarily at the transition of mantle and GC zones of 2 degrees lymphoid follicles (Chen, L. L., J. C. Adams, and R. M. Steinman, 1978, J. Cell Biol. 77:148). Binding of immune complexes to lymphocytes could not be visualized in situ. Macrophages avidly interiorized complexes into lysosomes, but did not retain them extracellularly. In contrast, FDC's could retain HRP-anti-HRP extracellularly under appropriate conditions, but did not endocytose them. Cytochemical reactivity accumulated progressively on FDC's 1--6 h after administration of complexes i.v., remained stable in amount and location for 1 day, and then was progressively lost over a 1- to 5-day period. Several variables in the association of complexes with macrophages and FDC's were pursued. Only 1 microgram of complexed HRP had to be administered to visualize binding to both cell types. Macrophages interiorized complexes formed in a wide range of HRP/anti-HRP ratios, while FDC's associated with complexes formed in HRP excess only. Quantitative studies with [125I]HRP-anti-HRP demonstrated that 20% of the splenic load of HRP associated with FDC's. Complexes formed with an F(ab')2 anti-HRP were distributed primarily in macrophages. When the levels of the third component of serum complement were depleted by prior treatment with cobra venom factor, uptake of complexes by macrophages was reduced some 50% whereas association with FDC's was abolished. The fact that antigen excess complexes are retained extracellularly strengthens the idea that they are immunogenic. Finally, the association of complexes with FDC's seems to retard the entry of antigen into the GC proper.

Animals↗