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Biomedical subjects

D Claus

Publications and source records attributed to D Claus.

At least 109 records · Page 6Linked to original sources
PubMed1991

[Treatment of spasmodic torticollis with local injections of botulinum toxin A].

Sixty patients (30 men, 30 women, mean age 45.5 [18-71] years) with various forms of spasmodic torticollis were treated with local injections of botulinus A toxin. The results of treatment were assessed on an arbitrary scale (0-4) by the patients, by an examiner and by a neurologist who studied video recordings without knowing at what stage they had been recorded. After the first course of injections (a maximum of three injections of 10-40 ng in four weeks) 50 patients (83%) reported a better than 50% improvement; the mean score on the four point scale fell from 3.6 to 1.85 (P less than 0.001). The severity of the disorder as judged from the video recordings fell from a mean of 3.23 to 1.71 (P less than 0.001). The effect lasted for an average of 14 weeks. 6 patients developed mild dysphagia, in two further cases severe dysphagia occurred which lasted for up to four weeks. Twenty patients were followed up for more than one year: in nine of them the interval between courses of injections, the dose being unaltered, remained the same (12-14 weeks), but thereafter the abnormal movements returned with the same severity as before treatment. In eight patients the intervals between courses grew longer and the abnormal movements became less severe. Two patients have been symptom free for 20 and 13 months respectively, but one female patient failed to respond owing to the presence of antibodies against botulinus A toxin. The results indicate that local injection of botulinus toxin is a successful treatment for spasmodic torticollis.

Adolescent↗
PubMed1991

Continuous multivariable monitoring in neurological intensive care patients--preliminary reports on four cases.

Evoked potential monitoring is a standard examination method in neurological intensive therapy units. Previously, multimodality observation was only possible in follow-up examinations. First experience with a new bed-side system continuously monitoring 12 neurophysiological and clinical parameters is reported. It consists of a personal computer and various stimulation units. EEG activity, median nerve somatosensory evoked potentials (SEPs) and brainstem auditory evoked potential (BAEPs) are recorded. Additionally, EEG spectral band power, heart rate, heart rate variability, intracranial pressure, body temperature, expiratory PCO2, blood pressure and transcutaneously measured oxygenation can be monitored. This paper reports on 4 exemplary cases of the 33 patients we have monitored to date, illustrating the principles and main advantages of the system. The system was developed to support the observation of ICU patients as well as to aid therapeutic decisions. It supports the clinical determination of brain death by specifying the deterioration of various neurological systems.

Aged↗
PubMed1991

Liver transplantation in children with biliary atresia and polysplenia syndrome.

Biliary atresia is the most common indication for orthotopic liver transplantation (OLT) in children. The polysplenia syndrome anomalies, which occur in approximately 10% of children with biliary atresia, may represent special difficulties at liver transplantation. We have reviewed our experience with this syndrome in 116 children with biliary atresia who underwent liver transplantation between March 1984 and December 1989. The main features of the polysplenia syndrome, which included absence of the inferior vena cava, preduodenal portal vein, midgut malrotation, aberrant hepatic artery, and situs inversus, were encountered in 12 of the 116 children (10.3%). Severe portal vein hypoplasia (3.5 mm or smaller) was also present in 7 of these children. Eight patients received a complete and four received a reduced liver graft. The vascular anomalies increased the technical difficulty of OLT but could be surmounted, although they did contribute to the peroperative death of one child. The 1-month survival rate was 83% for the 12 children with features of the polysplenia syndrome and 88% for the other 92 children with biliary atresia alone.

Abnormalities, Multiple↗
PubMed1991

[Successful treatment of the neuroleptic malignant syndrome using i.v. dantrolene sodium in the neurologic intensive care station].

The neuroleptic malignant syndrome (NMS) is one of the most dramatic psychiatric disorders every doctor in intensive care medicine can be confronted with. Two cases of successful treatment of NMS with intravenous application of dantrolene are presented. Although we used two very different doses, the treatment results were the same. Further studies will therefore be necessary to assess the optimal doses for this therapy.

Adult↗
PubMed1991

Magnetic stimulation: technical aspects.

When the voltage induced in a measuring coil by different magnetic stimulators was assessed, the strongest stimulus was generated by Cadwell followed by Novametrix, Dantec and then Digitimer. The Cadwell produced a polyphasic pulse, while the other stimulators generated monophasic stimuli. This is the reason that reversing coil polarity does not influence the site of nerve excitation with the Cadwell equipment, but does with the other stimulators. The magnetic method has proved to be most useful for transcranial excitation of the motor cortex. Magnetic stimuli at C7 excite cervical roots submaximally. Electrical stimuli excite cervical roots supermaximally. No advantage was found in the use of small coils for cervical transcutaneous root stimulation. Electrical stimulation (60-85% output) excited lumbar motor roots supramaximally in each healthy subject. However, magnetic stimulation at T12/L1 (100% output) evoked responses in only 8 (Novametrix) and 12 (Cadwell) out of 18 trials without any difference between right and left. The most reliable method for transcutaneous non-invasive excitation of motor roots is electrical stimulation.

Action Potentials↗
PubMed1991

[Magnetic stimulation using double coils--methodology and normal findings].

Magnetic stimulation of the motor cortex and spinal nerve roots was investigated in a group of 45 normal subjects using double coils. Figure of eight coils allows for an isolated excitation of the motor cortex of one hemisphere which cannot be achieved with circular coils. To evoke compound responses in hand muscles the optimal position of the figure of eight coil is with its centre about 5 cm lateral of the vertex and contralateral to the target muscle. The coil handle is in frontal position (occipito-frontal direction of the stimulation current in the coil; physical current definition is used resembling the electron flow from - to +). For the excitation to leg muscles the double coil centre is over the vertex with the handle contralateral to the target muscle (frontal current direction). Cervical roots can easily be stimulated using figure of eight coils with the handle contralateral to the target muscle and the coil centre over the root segment.

Adult↗
PubMed1990

Hereditary motor and sensory neuropathies and hereditary spastic paraplegia: a magnetic stimulation study.

Central motor conduction to the small hand muscles was investigated in 59 patients with peroneal muscular atrophy and hereditary spastic paraplegia (HSP) by using transcranial magnetic brain stimulation. These comprised 20 patients with type I hereditary motor and sensory neuropathy (HMSN I), 15 with type II (HMSN II), 4 with HMSN I and 10 with HMSN II with associated pyramidal features, and 10 with the "pure" form of HSP. Central motor conduction was usually normal in HMSN I, HMSN II, and HSP. In HMSN I with pyramidal signs, central motor conduction time was greatly prolonged bilaterally. This result may reflect an associated involvement of the central motor pathways in these patients. In HMSN II with accompanying pyramidal features, 6 of the 10 patients had abnormal central motor conduction, although conduction times were only slightly prolonged, suggesting a different pathophysiological pattern.

Adolescent↗
PubMed1990

Central motor conduction: method and normal results.

Normal results of CMCT to upper extremities do not correlate with height, age, or sex. In cases of peripheral conduction slowing, upper limits of CMCT must be adapted. Cervical root excitation can be carried out by electrical or magnetic stimulation. The F wave technique also produces reliable results. Electrical stimulation of lumbar roots produces the most reliable results when measuring CMCT to leg muscles. CMCT to the tibialis anterior correlates with height, but not with age or sex. The same is true for intraspinal motor conduction time. Contraction of the target muscle enlarges CMAP amplitudes after cervical and transcranial stimulation. However, a latency shortening is only seen after brain stimulation. This is thought to be at least partially due to spatial summation of D and I waves. Age affects peripheral nerve conduction and central nerve conduction in different ways.

Adult↗
PubMed1990

Resistance to ischaemia of small afferent nerve fibres in diabetes mellitus.

Thermal thresholds were measured in the left forearms of 26 healthy subjects and 10 patients with diabetes mellitus during ischaemic compression block. During the period when ischaemic block of large fibres caused paraesthesia and loss of touch sensation, the cold threshold rose in normals. The cold threshold was less clearly elevated and the warm perception remained unaltered by ischaemia in diabetics. These results show that not only large afferent and efferent nerve fibres but also thinly myelinated A delta and unmyelinated C fibres are resistant to ischaemia in the diabetic nerve.

Adult↗
PubMed1990

Parotid gland abnormality found in children seropositive for the human immunodeficiency virus (HIV).

Out of our series of 24 children seropositive for the Human Immunodeficiency Virus (HIV), parotid gland enlargement was noted in 4 children with AIDS-related complex (ARC) presenting also a Lymphocytic Interstitial Pneumonitis (LIP) on their chest radiographs. The ultrasound (US) aspect of the parotid gland suggests acinar enlargement (suggesting the presence of lymphocytic infiltration). The aspect displayed in the parotid mirrors the process developing in other areas (lungs, liver, spleen, lymph-nodes), i.e. a syndrome of lymphocytic (CD8) proliferation present at the stage of ARC.

Child, Preschool↗
PubMed1990

Major malformations in a case of infantile myofibromatosis.

A case of infantile myofibromatosis associated with oesophageal atresia, annular pancreas, additional sacral vertebra and hypoplatic right kidney in a male neonate is reported. The possibility of associated malformations in this rare disease is outlined.

Abnormalities, Multiple↗
PubMed1990

The influence of stimulus type on the magnetic excitation of nerve structures.

The voltage measured was that induced in a measuring coil from 3 different commercially available magnetic stimulators. The strongest stimulus was from the Cadwell, followed by Novametrix and then Digitimer. The Digitimer and Novametrix produced a monophasic pulse, whilst the Cadwell stimulator produced a polyphasic pulse, all measured by an induction coil. This is thought to be the reason why reversed coil polarity does not influence the position of peripheral nerve excitation with a Cadwell stimulator; this is, however, the case with the two other magnetic stimulators. Nevertheless, electrical stimulation was found to be the most useful method for exciting peripheral nerves. The lack of influence of Cadwell coil polarity on the excitation of spinal roots and motor cortex is also thought to be due to the bipolar stimulus effect mentioned above. The stimuli induced by Digitimer and Novametrix are monophasic, exciting one hemisphere first, depending on the direction of the current impulse. The stimulus generated by Cadwell excites both hemispheres by reversal of current direction.

Electric Stimulation↗
PubMed1990

Unifocal stricture of the common bile duct in two children: a localized form of primary sclerosing cholangitis.

A 4-year-old boy and a 14-year-old girl referred for a cholestatic syndrome were found to have a unifocal stricture of the extrahepatic bile duct. Both radiological (endoscopic-retrograde-choledocopancreatography) and histological findings were suggestive of primary sclerosing cholangitis. There was no past history of chronic inflammatory bowel disease nor any other disorder. Serum autoimmune markers were negative. Complete remission was observed after surgical drainage, and both patients remained symptom-free after a follow-up of 12 months and 8 years, respectively. Such unifocal form of the disease may have a better prognosis than the plurifocal disease. The absence of associated disorders and autoimmunity may also be an indicator of better prognosis in these patients.

Adolescent↗
PubMed1990

Taxonomy of alkaliphilic Bacillus strains.

The DNA base compositions of 78 alkaliphilic Bacillus strains were determined. These strains were grouped as follows: DNA group A, guanine-plus-cytosine (G+C) content of 34.0 to 37.5 mol% (17 strains); DNA group B, G+C content of 38.2 to 40.8 mol% (33 strains); and DNA group C, G+C content of 42.1 to 43.9 mol% (28 strains). DNA group A includes the type strain of Bacillus alcalophilus Vedder 1934. DNA-DNA hybridization studies with DNA group A strains revealed that only one strain, strain DSM 2526, exhibited a high level of DNA homology with B. alcalophilus DSM 485T (T = type strain). Neither strain DSM 485T nor any other DNA group A strain is homologous to any of the Bacillus type strains with comparable base compositions. Six strains formed a distinct group containing three highly homologous strains and three strains exhibiting greater than 50% DNA homology.

Bacillus↗
PubMed1990

Periventricular leukomalacia: ultrasonic and neuropathological correlations.

Ultrasound scans of a preterm neonate (27 weeks gestation) at seven weeks of age showed periventricular echo-free cavities, but these were no longer visible at 15 weeks, three weeks before the infant died. At autopsy, a linear glial scar, extending from the periventricular white-matter into the white axis of the parasagittal gyrus, was found in the area occupied by the periventricular cysts. The larger cavity was reduced to a slit-like excavation in the midst of glial tissue. Unsuspected focal infarcts in the cerebral cortex were also found. This observation demonstrates that transient echo-free cavities represent foci of cystic necrosis, which are subject to secondary collapse. In the authors' experience, the linear extension of periventricular leukomalacia (PVL) into the core of parasagittal gyri is a frequent feature of PVL, and one which cannot easily be accounted for by the usual explanations of border-zone ischaemic softening.

Brain↗
PubMed1990

Neuropsychological findings in treated Wilson's disease.

Seventeen patients, treated for Wilson's disease (WD), underwent a set of neuropsychological tests and were compared with a closely matched control group. There were clear differences between the groups (chi 2-test, p less than 0.0001). Wilson patients with only hepatic involvement, however, did not at all differ from their controls. Wilson patients with neuropsychiatric signs differed from controls on a reasoning test (p = 0.0016), and the entire WD group differed on a perceptual speed task (p = 0.0025). Compared to normal test values, however, the patients' group means were all within plus or minus one standard deviation from the normal mean. Special testing procedures and construction of the test battery excluded a factor of motor deficits as a major cause for the differences. The neuropsychological findings are viewed in relation to other findings in patients with motor disorders and predominantly subcortical lesion sites. Wilson's disease may be a dementing condition, but not when treated adequately.

Adolescent↗