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Biomedical subjects

D Krieger

Publications and source records attributed to D Krieger.

At least 55 records · Page 3Linked to original sources
PubMed1992

[Lemierre's syndrome with splenic abscesses].

A week after onset of a pharyngo-tonsillitis a previously healthy 23-year-old man developed high fever (41.4 degrees C), leukocytosis (12,200/microliters) with marked shift to the left, thrombocytopenia (86,000/microliters) and increased transaminases (GOT 83 U/l, GPT 113 U/l). Chest x-ray film suggested intrapulmonary abscesses with left-sided pleural effusion. The suspected diagnosis of "post-tonsillitis" septicaemia (Lemierre's syndrome) was confirmed by demonstrating anaerobic, fusiform, gram-negative bacteria (Fusobacterium nucleatum and necrophorum) in several blood cultures. Despite antibacterial treatment (amoxicillin/clavulanic acid, imipenem/cilastatin, clindamycin) he had recurrent pain referred to the kidney region and persisting fever. Repeated ultrasound and radiological examinations revealed new foci in the spleen, which were enlarging. Laparotomy with splenectomy performed on day 17 after the begin of treatment confirmed multiple splenic abscesses, but abscess pus and splenic tissue were sterile. After altogether 6 weeks of antibiotic treatment, finally with chloramphenicol, the patient was discharged in a good general state.

Abscess↗
PubMed1992

German-Austrian Space Occupying Cerebellar Infarction Study (GASCIS): study design, methods, patient characteristics. The Steering and Protocol Commission.

An open prospective multicentric therapeutic trial to determine the timing and type of therapeutic intervention in patients presenting with secondary deterioration following cerebellar stroke is described. According to the results of retrospective studies a controlled approach comparing different therapies is ethically not feasible. Participants use the same scores and protocol for patient data collection but many choose different therapeutic procedures.

Austria↗
PubMed1992

Instantaneous characterization of time-varying nonlinear systems.

A nonlinear system may be characterized by an orthogonal functional power series (FPS) computed from cross correlations between input and output variables. "Is the response changing over the course of the experiment?" is a fundamental question encountered in the analysis of both FPS and evoked potentials (EP's). Regression on closed-form functions of time produces a time-varying FPS or EP. Evaluation of these functions at a specified time point produces a system characterization for that instant.

Evoked Potentials↗
PubMed1992

Pure motor hemiparesis with stable somatosensory evoked potential monitoring during aneurysm surgery: case report.

We report a patient who sought treatment for an acute subarachnoid hemorrhage as a result of an intracranial aneurysm. Management included early surgical repair and intraoperative monitoring of evoked potentials. Pan-angiography revealed berry aneurysms of the communicating anterior artery and right middle cerebral artery. Surgery was uneventful, and the somatosensory evoked potential monitoring did not show any abnormalities. Nevertheless, the patient showed a neurological deficit due to a clip-related infarct in the right middle cerebral artery territory characterized by a right hemiparesis with no sensory deficit. This case report supports the possibility of false-negative results in single-mode intraoperative monitoring during aneurysm surgery.

Adult↗
PubMed1992

Outcome following hindbrain decompression of symptomatic Chiari malformations in children previously treated with myelomeningocele closure and shunts.

Between 1975 and 1989, 25 children treated with myelomeningocele closure and shunting for hydrocephalus at the Children's Hospital of Pittsburgh developed progressive lower brain-stem dysfunction from their Chiari malformation. Retrospective univariate and multivariate analyses of these cases were undertaken to assess the relationship between preoperative clinical factors and postoperative outcome. Since earlier reports have suggested that neonates with symptomatic Chiari malformations show a less favorable response than older children to craniocervical decompression, particular attention was directed at examining the effect of age on preoperative symptoms and postoperative outcome. Patients were subdivided by age into two groups, namely: 13 patients who became symptomatic before 2 months of age (neonatal group) and 12 older infants and children who developed initial symptoms between 6 months and 10 years of age. Once symptoms developed, patients in both groups deteriorated progressively until brain-stem decompression was performed. The mode of presentation and the rate and extent of neurological deterioration differed substantially in the two groups. Whereas the neonates typically showed rapid neurological deterioration and often manifested profound brain-stem dysfunction within a period of several days, the older patients experienced a more insidious symptom progression and rarely demonstrated the severe degree of impairment seen in the neonates. All patients underwent suboccipital craniectomy, cervical laminectomy, and dural decompression. A shunt from the fourth ventricle and/or syrinx to the subarachnoid space was placed in those with significant syringomyelia. Following surgery, 17 patients had complete or nearly complete resolution of all signs of brain-stem compression, three had mild to moderate residual deficits, and five showed no improvement. Outcome correlated closely with the preoperative neurological status. In particular, the presence of bilateral vocal cord paralysis was associated with a poor response to surgery (p < 0.001 on both univariate and multivariate analyses). Of the six patients (all neonates) who progressed to complete bilateral vocal cord paralysis before surgery, only one improved. In contrast, all patients with less profound but nonetheless severe deficits recovered function postoperatively. Although the neonates as a group had a poorer outcome than did the older patients (p = 0.02 on univariate analysis), this in large part reflected their more severe preoperative impairments; neonates who still had some preservation of vocal cord function before surgery subsequently did as well as the older patients. Accordingly, age did not prove to be an independent prognostic factor on multivariate analysis. Taken together, these results indicate that, in most patients with symptomatic Chiari II malformations (including neonates), neurological deficits are potentially reversible if hindbrain decompression is performed expeditiously.

Age Factors↗
PubMed1992

Intraoperative somatosensory evoked potential monitoring of pelvic and acetabular fractures.

The efficacy of intraoperative somatosensory evoked potential (SSEP) monitoring was evaluated in the surgical management of 82 patients with pelvic and acetabular fractures. The injuries consisted of 45 acetabular fractures, 30 pelvic ring disruptions, and seven combined injuries. Preoperative neurological deficits were recorded in 34% of the study group (29% of those with an acetabular fracture and 47% of those with a pelvic ring injury). Three patients sustained an iatrogenic sciatic nerve injury during the study period (all of which were documented in the first 40 cases). Two patients sustained an exacerbation of an existing sciatic nerve injury. In the group of pelvic fractures, hazardous parts of the exposure, reduction, and fixation were identified by the SSEP monitoring. Removal of the provocative stimulus by the surgeon led to reversal of the SSEP abnormalities, and none of this group of patients sustained an iatrogenic injury. When the intraoperative SSEP changes were noted during an acetabular fracture fixation, immediate attempts were made to relieve the excessive tension on the sciatic nerve by replacing or removing a retractor, flexing the knee, extending the hip, or dividing the femoral insertion of the gluteus maximus. None of the SSEP changes were associated with the lacerative injury to the sciatic nerve. For the method to be clinically effective in reducing the incidence of neurological deficit, even subtle changes in the SSEP tracing must be recognized immediately by the neurophysiologist so that a corresponding corrective measure can be rapidly undertaken by the surgeon to remove the offending stimulus.

Acetabulum↗
PubMed1991

[Experience with flash-evoked visual potentials in unconscious patients in the neurologic intensive care station].

Evoked potential monitoring has become a widely used procedure in the evaluation of stuporous patients on neurological intensive care units. Currently BAEP and SEP are preferentially employed. VEP monitoring is a relatively uncommon procedure, because late evoked potentials tend to be relatively unstable, varying in amplitude to a moderate extend from changes of temperature, drugs, attention and the level of consciousness. A valuable approach of VEP monitoring on intensive care units are structures of the visual system at risk in vascular disease of the vertebrobasilar system or during evaluated intracranial pressure (EIP). This study uses the data of 20 stuporous patients presenting with either intracranial mass lesions or vascular diseases of the vertebrobasilar system and 20 control persons. Light emitting diode (LED)-VEP are compared with checkerboard stimulation in control persons using the technique of cross-correlation. The comparison of the control group with patients using LED-VEP allows definition of limits for normal variation as a base for identification of significant changes. Despite methodical restrictions of LED-VEP, our results are in favour of serial studies in patients with EIP. There are no corresponding findings in LED-VEP and vascular lesions of the retrochiasmatic visual system.

Adult↗
PubMed1990

[Dissections of the vertebral artery following cervical chiropractic manipulations].

In a 37-year-old female patient complaining of increasing pain in the neck and occiput, chiropractic manipulations at the cervical vertebral column were associated with ischaemias of the brain stem presenting as vertigo, transient "locked-in" syndrome followed by vomiting, and sensorimotor hemiparesis. Digital subtraction angiography (DSA) revealed complete obstruction of the right and slight dissection of the left vertebral artery. The symptoms receded within a few days after heparinisation with 1000 IU/h intravenously. A 39-year-old female patient developed vertigo, nystagmus, tetraparesis and dysarthria two days after chiropractic intervention because of refractory pain in the neck and occiput. DSA showed embolism of the basilar artery and extensive dissections of the vertebral arteries. The basilar artery was completely recanalized after local intraarterial fibrinolysis with 50,000 IU urokinase. During the further course of treatment the symptoms receded under heparin and phenprocoumon over a period of 8 months, except for hemiparesis on the left side especially affecting the arm. Trivial traumas can result in dissections of the vertebral arteries. Severe neck pain is a frequent, typical early symptom. Hence, patients with cervical vertebral column syndromes should receive chiropractic treatment only after careful diagnosis.

Adult↗
PubMed1990

[Guillain-Barré polyneuropathy in Wegener's granulomatosis with pulmonary-renal syndrome].

A 49-year-old female patient suffering from severe necrotising respiratory granulomatosis (Wegener's granulomatosis) had acute renal failure, nearly uncontrollable haemoptyses and severe deterioration of pulmonary function. Haemodialysis had to be performed; immuno-suppressive therapy was effected by administration of high doses of methylprednisolone (100-500 mg/d) and cyclophosphamide (initially with single doses of 500-1000 mg) and plasmaphereses. Artificial ventilation by positive-negative pressure breathing became necessary because pulmonary function became consistently poorer. Glucocorticoid therapy led to the development of several duodenal ulcers resulting in profuse gastrointestinal bleedings requiring transfusions; on the whole, 20 erythrocyte concentrates had to be substituted. These transfusions, in turn, caused a non-A, non-B hepatitis. In the further course of the illness, a Guillain-Barré polyneuropathy developed. Biopsy and electrophysiological tests excluded granulomatous involvement of the nerves as a cause of the latter. But it is likely that there was a pathogenetic connection between the hepatitis and the polyneuropathy.

Acute Kidney Injury↗
PubMed1990

Computer analyses of EEG-sleep in the neonate: methodological considerations.

Neonatal EEG interpretation can aid in the estimation of central nervous system maturation, as well as provide diagnostic and prognostic information of the high-risk infant. However, one cannot easily visualize the complex interrelationships coupling EEG and polysomnographic components of the EEG-sleep rhythm. This is particularly relevant for the preterm neonate, in whom a rudimentary sleep cycle has not yet been clearly delineated. Computer analysis can augment the information derived from the visual interpretation of scalp-generated EEG activity. Automated techniques for EEG-sleep analysis have only recently been applied to a neonatal population. Such studies have been limited to full-term rather than preterm infants and rely on conventional methods that assume stationarity of neurophysiologic signals. We describe a computer system that simultaneously compares behavioral and electrographic components of EEG-sleep in a manner that preserves the integrity of the signals over time, while investigating the time- and frequency-dependent relationships among signals. Strategies for on-line and off-line editing, data storage, and off-line signal processing are described. Computational algorithms regarding analyses of EEG power, motility, and cardiorespiratory data are being used to study the ontogeny of EEG-sleep in asymptomatic preterm and full-term neonates. Computer strategies are based on both principles of stationarity and nonstationarity of physiologic signals and are applied depending on the temporal resolution required for specific signal processing needs.

Computer Systems↗
PubMed1988

Antimicrobial prophylaxis in neutropenic patients after bone marrow transplantation.

Fourty-one patients with haematological malignancies or severe aplastic anaemia underwent allogeneic or syngeneic bone marrow transplantation and received one of two forms of infection prophylaxis while granulocytopenic: total decontamination in strict reverse isolation (ITD, 26 patients) or selective decontamination of the digestive tract with barrier nursing (SD, 15 patients). The patients were evaluated for infection acquisition, fever days, days on systemic antibiotics and granulocyte transfusions from 48 hours after the beginning of the decontamination procedure until 1,000 granulocytes/microliter have been reached. Ten of 26 patients of the ITD group remained free of febrile episodes and infections, whereas all patients of the SD group acquired infections (p less than 0.001). During granulocytopenia patients of the ITD group had fewer fever days, were less frequently on systemic antibiotics and received fewer granulocyte transfusions as compared with the SD group. Both methods were obviously very effective in preventing gram-negative infections, infections caused by Staphylococcus aureus and infections due to yeasts or fungi. No death due to infection occurred in either group. However, the data of this study provide evidence that ITD is a more effective antimicrobial prophylaxis in bone marrow transplant recipients than SD.

Adolescent↗