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Biomedical subjects

D Stolke

Publications and source records attributed to D Stolke.

At least 109 records · Page 6Linked to original sources
PubMed1988

[Acute lowering of blood pressure by infusion of hyperosmolal sorbitol solution in brain operations. Dangerous adverse effect or favorable side effect?].

Osmotherapy with sorbitol 40% during intracranial surgery using neurolept analgesia usually produced acute decreases in arterial blood pressure. Haemodynamical measurements during intraoperative infusions of sorbitol in 97 patients showed a rapid decrease of arterial mean pressure from 91 to 72 mm Hg. In 22 of these patients cardiac output measurements were performed. Increases of cardiac index from 2.5 to 4.3 l/min x m2 could be found. The hypotensive side effect can be used for treatment of reactive arterial hypertension in neurosurgical patients during surgery where this therapy is advantageous per se because of its cerebral dehydrating effects. The decrease of blood pressure is obviously caused by peripheral vasodilatation. Cardiac disturbances were not observed. Other side effects, especially the danger of hereditary fructose intolerance are discussed.

Blood Pressure↗
PubMed1987

Arachidonic acid metabolism following aneurysm rupture. Evaluation of cerebrospinal fluid and serum concentration of 6-keto-prostaglandin F1 alpha and thromboxane B2 in patients with subarachnoid hemorrhage.

Experimental investigations have suggested an important role of arachidonic acid metabolites in the genesis of cerebral vasospasm following subarachnoid hemorrhage. In this clinical study the cerebrospinal fluid (CSF) and serum levels of the two main arachidonic acid metabolites prostacyclin and thromboxane A2 are evaluated by measuring their stable degradation products 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) and thromboxane B2 (TXB2) using radioimmunoassay methods during the pre- and postoperative course in patients after aneurysm rupture. Although the serum levels of both substances do not seem to be important for the clinical course of the patients, the CSF concentrations of 6-keto-PGF1 alpha and TXB2 provide important data. A close correlation between the initial TXB2 level of the individual patient and the amount of blood in the basal cisterns as detected by computed tomography scan can be demonstrated. The predictive value of this additional information for the occurrence of cerebral angiospasm is discussed. Comparing the CSF levels of both metabolites the slight preoperative elevation of 6-keto-PGF1 alpha is significantly surmounted by an extraordinary rise in TXB2 concentration. Postoperatively, after cleavage of the basal cisterns there is a decline in the CSF levels of both substances. The pre- and postoperative clinical course in comparison to the CSF levels of 6-keto-PGF1 alpha and TXB2 is demonstrated in four patients. A nearly normal course of TXB2 and 6-keto-PGF1 alpha seems to be associated with an uneventful clinical course, whereas a high TXB2 level--whether occurring preoperatively or, even more important, as a secondary postoperative rise--seems to be associated with ischemic complications and neurological deterioration. It is suggested that pre- and postoperative monitoring of CSF levels of 6-keto-PGF1 alpha and especially TXB2 may serve as a possible indicator for the detection of patients at risk of developing cerebral vasospasm.

6-Ketoprostaglandin F1 alpha↗
PubMed1987

[Successful treatment of a brain abscess with antibiotics and drainage puncture in an 11-year-old boy with a complex cyanotic heart defect].

A Blalock-Taussig-anastomosis was performed at the age of 2 years in a boy with transposition of the great arteries, ventricular septal defect, and pulmonary atresia. Nine years later he developed a transient aphasia. Cranial computed tomography (CT-scan) revealed a structure compatible with brain abscess. The boy was conscious and no neurological deficit was found. Initial therapy consisted of Ampicillin, Tobramycin, and Metronidazole, 12 days later an acute hemiplegia developed. 30 ml of pus were aspirated from the brain abscess, and the boy's condition dramatically improved. Streptococcus milleri was found bacteriologically and antibiotic therapy was continued over six weeks. Serial CT-scans during and after therapy demonstrated disappearance of the brain abscess. The presented case shows that after a shunt procedure in cyanotic heart disease right-to-left-shunting and therefore chronic oxygen desaturation and polycythemia are still present as facilitating factors for focal encephalomalacia, cerebritis, and brain abscess. In case of short duration of neurological symptoms and a size of abscess less than 4 cm in diameter antibiotic therapy without total excision may eliminate the infection.

Anti-Bacterial Agents↗
PubMed1986

[Arachidonic acid metabolism following aneurysm rupture].

Imbalance between the two arachidonic acid metabolites, prostacyclin (PGI2) and thromboxane A2 (TXA2), is thought to be at least in part responsible for the development of cerebral vasospasm following aneurysm rupture. In 12 patients with subarachnoid hemorrhage the pre- and postoperative serum and CSF levels of PGI2 and TXA2 were measured as a function of their stable hydrolysis products, 6-Keto-PGF1 alpha (PGI2) and thromboxane B2 (TXA2), with a highly specific radioimmunoassay. Serum levels of both metabolites were elevated in half of the patients, but no correlation to the clinical course could be found. However, TXB2 concentration in the CSF was significantly increased preoperatively with close correlation to the amount of intracisternal blood, as detected by CT scan. Furthermore, it could be demonstrated that the postoperative course of the TXB2 concentrations in the CSF reflects the clinical course in such a way that a characteristic secondary rise of TXB2, concentration postoperatively is closely related to the occurrence of cerebral vasospasm and clinical deterioration. The conclusion is drawn that measurement of arachidonic acid metabolites in the CSF may provide important information concerning the pathophysiological events following subarachnoid hemorrhage, especially with regard to incipient cerebral vasospasm.

6-Ketoprostaglandin F1 alpha↗
PubMed1986

[Modification of intracranial pressure by urapidil following experimental cold lesions in the cat].

The action of the antihypertensive agent Urapidil was investigated in an experimental animal model of vasogenic brain oedema. Animals with normal or raised intracranial pressure received Urapidil as a bolus injection (0.25 mg/kg body weight) followed by a continuous infusion of Urapidil (1 mg/kg body weight). The bolus injection of the drug was followed by a sharp fall in systemic blood pressure, paralleled by a rise in intracranial pressure, resulting in a shortlasting decline of cerebral perfusion pressure. During continuous infusion of Urapidil in both groups with normal or elevated ICP there was a long-lasting significant fall in the systemic blood pressure without any significant alteration of the intracranial pressure.

Animals↗
PubMed1985

[Gunshot wounds of the skull during peacetime].

66 patients with gunshot wounds were treated at the Department of Neurosurgery of Hanover University up to May 1982. These included wounds inflicted by bolt guns of the type used in slaughter houses, and by bolt-setting or nail-setting tools used in building construction work. The total mortality was 50%. Seventeen patients died directly after admission or within the first 24 hours. Operation was not indicated in cases which appeared hopeless. In patients with mild neurological deficits, only the superficial skin wounds were treated to avoid additional damage to the brain. CT scans performed in approximately one-half of the patients yielded valuable information on the path of the bullet and on haematomas. Postoperatively, there were several complications, mainly pneumonia and cerebrospinal fluid fistulas; in fact, pneumonia was responsible for the death of some patients. The mortality is compared with the findings by other authors. No patients remained in need of care after rehabilitation.

Adolescent↗
PubMed1985

[Comparative studies on early and late operations in aneurysm surgery].

In a five years period from January 1979 to December 1983 241 patients with angiographically verified aneurysms underwent operative treatment in the Department of Neurosurgery at Hannover Medical School. The final results six months after surgery are presented with special regard to the following subjects: preoperative grading (Hunt and Hess scale) and postoperative outcome (Glasgow Outcome Score) timing of surgery: early surgery within 72 hours (88 patients) versus delayed surgery (153 patients) incidence of rebleeding outcome of patients with space occupying intracerebral hemorrhage due to ruptured aneurysms.

Adolescent↗
PubMed1985

[Experimental studies on the behavior of intracranial pressure under prostacyclin application].

In recent experimental studies the beneficial therapeutic effect of the arachidonic acid metabolite prostacyclin (PG 12) has been demonstrated for the treatment of different states of impaired brain perfusion following subarachnoid hemorrhage or focal cerebral ischemia. Prostacyclin has been recommended especially for the possible prevention and treatment of cerebral vasospasm after aneurysm rupture. Because prostacyclin is a potent vasodilator of the cerebral circulation it is an essential prerequisite for a possible therapeutic use of PG 12 that no negative side effects concerning the intracranial pressure are allowed to occur during intravenous infusion of the drug. In our study we therefore investigated the course of intracranial pressure during continuous experimental perfusion with prostacyclin in four different dosages. The results and our conclusions concerning further experimental or clinical studies with prostacyclin are presented.

Animals↗
PubMed1985

[Treatment results in severe craniocerebral trauma with and without dexamethasone therapy].

A retrospective study was performed to determine the effect of dexamethasone-therapy on the outcome of severe head injuries not combined with other serious injuries. Between 1981 and 1983 we treated 53 of 110 patients with an initial dose of 40 mg dexamethasone followed by 16 mg daily for 10 days. There was no statistically significant difference in the outcome and the lethality of the steroid and nonsteroid group. Infections or other complications did not occur more frequent in dexamethasone-therapy.

Adolescent↗
PubMed1985

[Results of volar transposition of the ulnar nerve in cubital tunnel syndrome].

66 volar transpositions of the ulnar nerve were performed in 63 patients with cubital tunnel syndrome. 53 patients were male, 10 female. The average age was 49.2 years ranging from 21-74 years. 64 patients had a neurological deficit, 2 merely suffered from pain. The nerve conduction velocity was delayed in all patients. 14 patients had had a cubital fracture in their history, 6 patients showed an arthrosis of the cubital joint. 5 patients suffered from a habitual luxation of the ulnar nerve. In 14 cases there had been recurrent distorsions of the cubital joint. 4 patients were diabetics, 2 alcoholics. In 31 cases no pathogenetic factor could be found. A deep intramuscular transposition with insertion of the intramuscular septa was performed. There were excellent and good results in 82% of all cases. 15% remained unchanged. In 3% a deterioration was observed. The shorter the preoperative history the better the prognosis. Complete recovery was less frequent in patient with severe neurological deficit than with slight. The results were better in younger patients than in elder. But long lasting severe atrophies in elder patients recovered completely in some cases. Diabetes mellitus and alcoholism could not be proved as contributing factors but seemed to cause poorer results.

Adult↗
PubMed1985

[CT findings in chordomas of the base of the skull].

Nine chordomas of the skull base and their CT appearances are described. Destruction of the clivus and of the parasellar portions of the middle fossa are characteristic, as is calcification which may be spotty, coarse or ill-defined. The tumour is characterised by marked enhancement following contrast but, on the unenhanced CT, contrary to statements in the literature, it is hypodense or isodense with respect to cerebral tissue. The tendency to recurrence and an altogether poor prognosis is confirmed.

Adolescent↗
PubMed1984

[Pseudomeningoceles--a rare complication following lumbar intervertebral disk operations].

Pseudomeningoceles arising in connexion with an intervertebral disc operation are a very rare complication in our own material, with an incidence of less than 0.1%. The patients complaints resemble very closely those of an intervertebral disc prolapse, with symptoms of lumbago and lumbo-ischial pain, with, at times, definite root irritation. The diagnosis is usually made, on average 2-3 years after the preceding operation. The myelographic findings confirm the diagnosis, but the introduction of spinal CT is promising for the future. After removal of the meningocele and closure of the dura, complete freedom from symptoms is usually achieved.

Adult↗