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Biomedical subjects

C J Lang

Publications and source records attributed to C J Lang.

At least 37 records · Page 2Linked to original sources
PubMed2000

Recall and recognition in Huntington's disease.

We assessed 19 patients with Huntington's disease (HD) at early to moderately advanced stages of their disease using memory tests that investigated verbal and visual recall and recognition. In those tests where identical material was subject to recall and recognition the standardized results (z scores) were lower for recognition. Performance was better with pictorial than with verbal material. While recognition bias and savings scores did not differ significantly from controls, all other recognition parameters did so. This is in contrast to the claim that defective retrieval in HD is greatly enhanced by multiple choice recognition. One major reason for maintaining this assumption was apparently the disregard of false-positive responses. Our results indicate that verbal and visual recognition are impaired in HD, and the notion of a salient deficit of free recall is not supported.

Journal Article↗
PubMed1999

Visually guided exploration in Huntington disease.

We compared 24 patients in various stages of Huntington disease (HD) with 26 control patients free from cerebral disorders using a simple visual saccadic tracking test. The two groups were well matched in regard to age, sex, verbal IQ and years of schooling. Test results differed widely. On a time versus error plot, sensitivity (96%) and specificity (100%) were high and the results did not depend on age, education, or disease duration, although an influence of disease stage could be observed. This study shows that a simple saccadic tracking task may be useful in detecting visuomotor disturbances in HD.

Adult↗
PubMed1999

Sesamoiditis of the index finger presenting as acute suppurative flexor tenosynovitis.

Sesamoiditis involving the hand is uncommon, usually reported in the thumb, and has not been reported in the index finger. As rare as this clinical entity remains, its presentation simulating an acute suppurative flexor tenosynovitis is even more rare. We report a patient who presented with Kanavel's 4 cardinal signs of acute suppurative tenosynovitis who was subsequently found to have an acute sesamoiditis of the index finger. This finding was supplemented by a cadaveric and radiographic study to better delineate the anatomy of the index sesamoid and further explain the clinical presentation.

Acute Disease↗
PubMed1999

[Dementia of the Alzheimer type in women].

Within the different kinds of dementia, Alzheimer's Disease (AD) obviously is the only one showing relevant gender differences, concerning epidemiology, risk factors and cognitive deficits. Women more often suffer from AD, achieve lower Mini Mental Status Test scores when demented and show lower verbal skills. The possibility of using estrogen as a therapeutic agent, either only or as an augmentation to acetylcholinesterase inhibitors, could become more important for clinical practice, as it is said to cause distinct improvements of cognitive skills. Epidemiological studies were able to show that estrogen replacement therapy in menopausal women lowers risk of AD.

Aged↗
PubMed1999

Herniated cervical intervertebral discs with radiculopathy: an outcome study of conservatively or surgically treated patients.

To study the functional outcomes of patients with cervical herniated intervertebral discs with radiculopathy but without signs of cervical myelopathy using a retrospective cohort study design. The patients were retrospectively identified by chart reviews. Inclusion criteria were (a) cervical radiculopathy with defined neurological disturbances (sensory disorder, reflex abnormalities, and motor weakness); (b) a spinal computed tomograph scan or magnetic resonance image demonstrating neuroradiologic abnormalities (soft or hard disc); and (c) completion of conservative physical and pharmacological treatment. Of 119 consecutive patients who were treated at the Departments of Neurology and Neurosurgery, University of Erlangen-Nuremberg, between January 1, 1985, and December 31, 1995, 60 patients met the inclusion criteria and were prospectively assessed, with an average follow-up time of 5.5 years. The patients were interviewed with regard to their daily activities, ability to work, and the surgical treatment they had undergone. A complete neurological examination also was performed. In 88.3%, the onset of disease was acute and in 11.7% subacute or chronic. The most common signs and symptoms were brachialgia (98.3%), neck pain (93.3%), sensory disorders (88.3%), reflex abnormalities (61.7%), and motor weakness (51.7%). The neuroimaging procedures demonstrated a disc prolapse (soft disc) in approximately 90% and spondylotic osteophytes (hard disc) in approximately 10%. During an average follow-up time of 5.5 years (range, 4.6 months-10.6 years) 39 (65%) patients had been treated using only conservative methods (COG = conservatively treated group), and 21 (35%) patients had undergone surgery (ventral discectomy) (SUG = surgically treated group). Brachialgia was completely or essentially improved in 100% of the COG and 95.1% of the SUG. Sensory disorders remitted completely or markedly in 97% of the COG and 75% of the SUG. The reflex abnormalities normalized or improved in 59.2% of the COG and in 53.3% of the SUG. Motor weakness improved in 94.1% of the COG and in 50% of the SUG. Neck pain was difficult to treat. It improved in only 36.1% of the COG and in 20% of the SUG. Occupational capacity was lost in 10% of the COG and in 38.9% of the SUG. In a self-rating scale, 89.7% of patients in the COG did not feel disabled in their everyday activities, compared with 66.7% of the patients in the SUG. Patients with a herniated cervical intervertebral disc with radiculopathy can be treated conservatively with good results, although a residual intermittent neck pain syndrome often persists. The patients in the SUG, who initially showed more severe and long-lasting neurological disturbances, were improved at the time of examination, although with more marked residual disorders. Surgery is indicated only when appropriate conservative treatment for a reasonable time has failed.

Adult↗
PubMed1998

Creutzfeldt-Jakob disease via dural and corneal transplants.

A review of all published cases of iatrogenic Creutzfeldt-Jakob disease (CJD) via dural (N=71) and corneal (N=4) transplants is given. All but three of the dural cases were obviously due to a commercial product recalled in 1996. Two of the corneal grafts were taken from patients who had died of sporadic CJD. These cases differed from CJD due to human growth hormone injections and the new variant. Instead. they were akin to sporadic cases, but memory loss, disorders of higher cerebral functions and extrapyramidal signs were fewer, while cerebellar abnormalities were more frequent. Progressive dysarthria and gait disorder/gait ataxia were prominent signs during the early stages, myocloni the most salient feature later. A nonperiodic EEG did not contradict the diagnosis. Using current diagnostic criteria the disease was underdiagnosed ante mortem. Utmost care is needed in selecting, harvesting and handling dural and corneal grafts to avoid inadvertent transmission of CJD.

Adolescent↗
PubMed1998

Apnea testing guided by continuous transcutaneous monitoring of partial pressure of carbon dioxide.

OBJECTIVE: To continuously monitor PCO2 during two different protocols for apnea testing as part of the determination of brain death. DESIGN: Prospective comparative study using continuous transcutaneous PCO2 (tcPCO2) monitoring in 54 apnea tests with or without artificial CO2 augmentation. Another 53 apnea tests were not continuously monitored. SETTING: Intensive care wards in Northern Bavaria. PATIENTS: Ninety-six consecutive patients with suspected brain death. INTERVENTIONS: Apnea tests guided by transcutaneous monitoring during a PaCO2 of > or = 60 torr (> or = 8 kPa). MEASUREMENTS AND MAIN RESULTS: The mean of the difference between tcPCO2 and PaCO2 was -0.26 +/- 1.16 (SEM) torr (-0.035 +/- 0.15 kPa). Seventy percent of all transcutaneous measurements were within +/-10% of the PaCO2 values. The individual differences ranged from -25.8 to 16.9 torr (-3.44 to 2.25 kPa). CONCLUSIONS: While not as precise as could be desired in individual cases, the overall agreement between tcPCO2 and PaCO2 was good. Transcutaneous monitoring aided in effectively reducing the CO2 target overshoot with artificial CO2 augmentation, reduced the necessary number of blood gas checks compared with a former study, using predetermined time-locked evaluations, and prolonged only tests with artificial CO2 augmentation.

Adult↗
PubMed1998

A biomechanical study of the ankle syndesmosis after fibular graft harvest.

Harvesting the fibula as corticocancellous bone graft is not without complications. Multiple clinical studies chronicled the morbidity at the donor site, both immediately after surgery and at long-term follow-up. To our knowledge, no cadaveric or biomechanical studies addressed the effect that fibular osteotomy has on the ankle syndesmosis. We carried out two experiments by using cadaveric tibias/fibulas to determine the ability of the ankle syndesmosis to resist both lateral and vertical displacement of the intact fibula, as well as lateral and vertical displacement of the distal fibular stump after serial fibular osteotomies had been made at distances of 14, 10, 6, and 4 cm from the tip of the lateral malleolus. The results of this study show that, once the fibula is cut, the syndesmosis provides significantly less resistance to lateral and vertical displacement. Further, although this resistance continues to decrease with each decrease in fibular stump length, the length of the fibular stump does not significantly affect the stability of the syndesmosis.

Aged↗
PubMed1997

Blood pressure and heart rate changes during apnoea testing with or without CO2 insufflation.

OBJECTIVE: To determine changes of blood pressure and heart rate during apnoea testing for brain death without (A) and with (B) artificial CO2 augmentation. DESIGN: Prospective, consecutive study. SETTING: 12 intensive care units in six towns in Northern Bavaria. PATIENTS AND PARTICIPANTS: A total of 55 apnoea tests were performed on 55 consecutive patients as part of the determination of brain death, 27 without and 28 with CO2 augmentation. INTERVENTIONS: Apnoea tests following oxygenation with 100% O2 either after reduction of ventilatory volume (A) or after insufflation of CO2 during normoventilation (B). In each case, an arterial partial CO2 pressure of at least 8 kPa was documented. RESULTS: All apnoea tests were without serious adverse effects (hypoxia, newly induced cardiac arrhythmia, cardiac asystole). An increased dopamine infusion rate was deemed necessary in only one case of group (A) because of marked systolic hypotension (< 8 kPa). Individual variation of systolic and diastolic blood pressure (BP) did not exceed + 62 to -46% and + 49 to -52% respectively, in group (A) and + 35 to -57% and + 40 to -48% respectively, in group (B). Variation of heart rate (HR) remained within the range + 24 to -31% in group (A) and + 37 to -22% in group (B). CONCLUSIONS: HR varied less than BP. The possibility of a marked relative rise of fall of BP in group (A) was equal; in group (B) there was a lower change of rising BP. The chances for a rise or fall in HR were equal for the two groups. There was a tendency for less variation of cardiovascular parameters in group (B).

Apnea↗
PubMed1997

Transmission of Creutzfeldt-Jakob disease via a corneal transplant.

A 45 year old woman is reported who initially presented with a cerebellar syndrome, severe ataxia, and dysarthria. She rapidly deteriorated to coma vigile with bilateral myoclonic jerks, flexion rigidity, and immobility necessitating complete nursing. Her EEG showed generalised slow activity and periodic biphasic and triphasic waves. The CSF concentration of neuron specific enolase was very high. Consequently the diagnosis of Creutzfeldt-Jakob disease was established. Eight months later she died of respiratory complications. Thirty years earlier the patient had undergone corneal transplantation for keratoconus. Review of the organ donor's hospital records showed that death was caused by intercurrent pneumonia subsequent to subacute spongiform encephalopathy confirmed by necropsy. In view of two previous case reports in the literature it is presumed that the cadaveric cornea was the source of transmission of Creutzfeldt-Jakob disease in this patient.

Corneal Transplantation↗
PubMed1997

Chemosensory event-related potentials in response to trigeminal and olfactory stimulation in idiopathic Parkinson's disease.

Decrease of olfactory function in patients with Parkinson's disease (PD) has been reported by several authors. The current study investigated olfaction in PD patients using olfactory event-related potentials (OERPs) as an electrophysiologic correlate of olfactory function in combination with psychophysical testing. A specific focus was the influence of antiparkinsonian drugs. We investigated PD patients treated with antiparkinsonian drugs (n = 13) and PD patients who received no pharmacologic treatment (n = 18). They were compared to age- and sex-matched control subjects (n = 38). To obtain OERPs, stimulants were chosen to stimulate specifically the olfactory nerve (2.1 ppm vanillin, 0.8 ppm H2S). In addition, chemosomatosensory event-related potentials were recorded after trigeminal stimulation with 52% v/v CO2. Moreover, the subjects' ability to identify and to discriminate odorants was tested by means of a "squeeze bottle" technique. The study yielded the following major results: (1) Odor identification was impaired in PD patients. It was not influenced by treatment with antiparkinsonian drugs. (2) The OERP latencies were prolonged in both PD patients taking and not taking antiparkinsonian drugs; however, this effect was more pronounced in PD patients taking antiparkinsonian drugs. (3) The intranasal chemosensory trigeminal system seemingly was neither affected by the neuronal degeneration seen in PD nor by treatment with antiparkinsonian drugs.

Adult↗
PubMed1996

[Diagnosis of brain death in the admission department of the Neurologic Clinic of Erlangen University from 1984 to 1994].

OBJECTIVE: The reliable diagnosis of brain death is a precondition of organ removal for subsequent transplantation. As demographic data, information on the underlying cause and written consent to organ removal from brain-dead patients are largely unknown; protocols relating to the determination of brain death were analysed to obtain these data. PATIENTS AND METHODS: The study was based on an examination of the protocols of 547 consecutive and unselected patients who between 1984 and 1994 had been examined for possible brain death by experienced members of the Neurological Department of Erlangen University, in consequence of the establishment of a consultation service for this purpose to hospitals in the region of North Bavaria. The criteria of brain death were those established by the Federal German Doctors' Chamber, all the data in the written protocol being analysed retrospectively. RESULTS: Brain death was confirmed in 521 patients (319 males, 202 females; mean age 40.1 [1.5 - 84] years). 473 patients (86.5%) had been examined at the Erlangen University Clinic or the Municipal Hospital in Nuremberg, the remainder in regional hospitals. The most common causes were trauma to the head/brain (43.5%), subarachnoid haemorrhage (18.6%), generalised hypoxaemia (9.5%), cerebral infarction (7.3%) or other conditions (4.5%). 33 patients (6%) had committed suicide. Organs were removed in 244 of 413 patients (59.1%) for whom there data on possible organ removal: seven patients had carried donor cards, relatives' consent was obtained in 237. No consent was given in 90 cases (21.8%), while 79 (19.2%) were excluded for medical reasons. CONCLUSION: If brain death is suspected, an experienced neurological consultant should be called in as soon as possible to assess the patients survival chances and evaluate possible organ removal for subsequent transplantation.

Admitting Department, Hospital↗
PubMed1995

Methodological problems and clinical relevance of structural neuroimaging in dementia research.

Structural neuroimaging and dementia are conceptually different being only loosely correlated. Computed tomography or magnetic resonance imaging can never "prove" a clinical syndrome such as dementia, but yield clues as to its cause and the site and extent of pathological changes. Conversely, the type and degree of intellectual deterioration can hardly predict neuroradiological findings. The value of structural neuroimaging lies in detecting or excluding possible causes of dementia and quantifying linear or volumetric parameters of tissue and fluid volume. If based on a presumed or established etiology, however, specific neuropsychological and dementia syndromes may correspond to focal pathological changes seen in well-defined cerebral areas as recent investigations have shown with hippocampal atrophy in Alzheimer's dementia.

Alzheimer Disease↗