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Biomedical subjects

F Brandt

Publications and source records attributed to F Brandt.

At least 19 recordsLinked to original sources
PubMed2001

[Surgical treatment and rehabilitation for improving function of shoulder muscle impairment].

INTRODUCTION: The results of our integrated conservative and operative concept of therapy to compensate insufficient shoulder muscles following brachial plexus palsy or other nerve damages are presented. PATIENTS/METHODS: To improve stability and function of the shoulder in case of deltoid and supraspinatus paralysis 19 patients (3 female; 16 male; average age 37 years, range 17 to 61 years) underwent a shoulder arthrodesis. In 69 patients (12 female; 57 male; average age 31 years, range 19 to 69 years) a trapezius transfer was performed. The indication for a rotation osteotomy of the humerus to improve loss of external rotation due to paralytic infraspinatus muscle was determined in 5 male patients (average age 30 years, range 15 to 42 years). Our results are based upon an average follow-up of 21 (6-70) months after shoulder fusion, 21 (2-68) months after trapezius transfer and 28 (3-62) months after rotation osteotomy of the humerus. RESULTS: The trapezius transfer resulted in increased function of abduction of 6.6 degrees to 35.9 degrees (10 degrees-90 degrees) and forward flexion of 12.6 degrees to 30.9 degrees (5 degrees-85 degrees). A more stable condition of multidirectional shoulder instability was experienced by 64 patients (92.8%), and 65 patients (94.2%) were subjectively satisfied with the outcome of the operation. The strength and extent of functional improvement was, on average, greater following shoulder arthrodesis: abduction 10.3 degrees to 57.4 degrees (20 degrees-80 degrees), forward flexion of 12.6 degrees to 57.1 degrees (20 degrees-105 degrees). 17 patients (89.5%) were subjectively satisfied with the outcome. Patients who had undergone external rotation osteotomy showed an average deficiency of external rotation of 30 degrees before operation. After osteotomy an improvement of 29 degrees to 3 degrees external rotation was achieved. All patients were satisfied with the increase of function. CONCLUSIONS: In patients with failed shoulder muscles, particularly after brachial plexus palsy, secondary operations according to the individual pattern of muscle failure result in an improvement of shoulder function and stability, as well as patients' satisfaction. Therefore, adequate conservative treatment before and after reconstructive operations is of great importance.

Adolescent↗
PubMed1999

Outcomes after stereotactically guided pallidotomy for advanced Parkinson's disease.

OBJECT: Parkinson's disease (PD) is a prevalent neurodegenerative disorder that becomes refractory to medication as the disease progresses. Although in the past 5 years increasing numbers of patients have undergone stereotactically guided posteroventral pallidotomy for advanced PD, the safety and efficacy of surgery remains to be documented. The goal in this study was to determine the potential operative morbidity and types of functional outcomes by using validated PD rating scales and a patient survey. METHODS: In a prospective analysis of a consecutive surgical series the authors evaluated 58 patients with advanced PD who ranged in age from 40 to 79 years (mean 67 years) and who had undergone surgery between 1994 and 1997. They used a patient survey and the Unified Parkinson's Disease Rating Scale (UPDRS) to study patients during periods of medication administration ("on") and withdrawal ("off"; mean off score before surgery = 96). Temporary surgical morbidity was found in four patients (6.9%), three of whom developed transient dysarthria and one of whom exhibited transient confusion (1.7%). One patient had persistent dysarthria (1.7%). No patient developed a visual field deficit or sustained a brain hemorrhage. All patients were discharged from the hospital within 24 hours. Significant postsurgical improvements were noted in the UPDRS off-period total and motor scores, as well as in tremor, rigidity, bradykinesia, and contralateral dyskinesia (p < 0.005). Improvements persisted in dyskinesia and tremor for the 21 patients who were evaluated past 1 year. The authors found no improvement in any on-period symptoms except dyskinesia. Thirty-one (61 %) of 51 patients surveyed reported functional gains and/or dramatic improvement in symptoms, 17 (33%) reported symptomatic improvement without functional gains, and three (6%) had minimal or no change in symptoms. No change in the mini mental state examination score was noted during follow up. There were no significant postoperative changes in the use of medication. CONCLUSIONS: In advanced PD associated with either a medically refractory state with significant off periods or levodopa-induced dyskinesias, magnetic resonance imaging-guided pallidotomy with macrostimulation was associated with minimal morbidity and yet significantly reduced dyskinesia and off-period disability. These improvements were of value to the patient and persisted beyond the 1st year.

Adult↗
PubMed1998

Solar retinopathy. A study from Nepal and from Germany.

319 patients with a solar retinopathy were seen in an eye clinic in Nepal within 20 months. All patients had either a positive history of sun-gazing or typical circumscribed scars in the foveal area. In more than 80% of the patients the visual acuity was 6/12 or better and did not deteriorate over time. 126 (40%) patients had a history of gazing at the sun during an eclipse, 33 (10%) were sun worshipers and 4 (1%) were in both categories. Three years later 29 patients were re-examined in a follow-up study. Only 16 had had visual disturbances directly after they had gazed into the sun. No colour vision defects were seen in any of the 44 affected eyes, when tested with Panel D 15, while four patients (6 eyes) had some uncertainty with the tritan plates of the Ishihara test charts. Metamorphopsia were recorded in 11 eyes. Five German patients with solar retinopathy were examined in more detail. Colour contrast sensitivity (CCS) was tested for the central and the peripheral visual field. CCS for tritan axis was raised in all patients for the central visual field, while it was normal for the peripheral visual field.

Adolescent↗
PubMed1997

[After-care regimen after muscle replacement operations in brachial plexus lesions].

Following augmentation of the upper extremity muscles necessitated by damage to the brachial plexus, special post-operative care programs are required to provide the patient with the best possible results. Proper care requires cooperation between the orthopedic surgeon, physical therapists and nurses. Only then can postoperative rehabilitation and functional control of the extremity improve. We describe interdisciplinary postoperative care programs for augmentation of the deltoid muscle with trapezius transfer, arthrodesis of the glenohumeral joint, biceps augmentation with the latissimus dorsi transfer, Steindler flexorplasty and augmentation of flexors/extensors muscles in the hand.

Adult↗
PubMed1997

Communication Scale for Older Adults (CSOA).

The communication Self-Assessment Scales for Older Adults (CSOA) are comprised of a 41-item Communication Strategies scale and a 31-item Communication Attitudes scale. Three-point and 5-point response formats are available. The scales were standardized on a population of 135 independent-living adults with hearing loss, ranging in age from 60 to 88 years. Item analysis, internal consistency reliability, test-retest reliability, normative data, and 95 percent confidence intervals are presented. A sample case illustrates how the scales can be used to evaluate the communication strategies and attitudes of an individual client. In addition, data are presented to show changes in the use of communication strategies and attitudes of a group of clients 3 months and 9 months after completion of aural rehabilitation programs.

Aged↗
PubMed1995

Revised Communication Self-assessment Scale Inventory for Deaf Adults (CSDA).

The 125-item Communication Self-assessment Scale Inventory for Deaf Adults evaluates difficult communication situations, their importance to the client, communication strategies, and attitudes toward hearing loss. Each scale contains subscales, and the scales may be used independently of each other. The original 115-item scale was revised to improve internal consistency of some of the subscales and modify language in some items. Internal consistency reliability, test-retest reliability, and normative data are presented. The scales were presented to a group of prelingually deaf adults and adolescents who differed in the frequency of hearing aid use, primary mode of communication home, school, and work, and educational background. Subjects responded to some of the scales and subscales in a significantly different manner based on these parameters.

Adolescent↗
PubMed1993

Prenatal diagnosis of nonrhizomelic chondrodysplasia punctata (Conradi-Hünermann syndrome).

Chondrodysplasia punctata has been classified into two major types including the rare autosomal recessive "rhizomelic type" and a more common but genetically heterogenous nonrhizomelic type (referred to by some authors as "Conradi-Hünermann (CH) type"). The former is typically lethal, manifesting serious anomalies, and allowing several instances of confident prenatal diagnosis. The latter being milder has more subtle anomalies and prenatal diagnosis has been uncommonly reported (confined to cases diagnosed incidentally by flat-plate X-ray examination of the mother in late third trimester, and a case found by directed ultrasound performed in a Mendelian affected mother). Cases included 1) a young primigravida thought to be affected with Conradi-Hünermann syndrome presented at 16 weeks gestation for prenatal diagnosis and counseling. Ultrasound examination of the fetus detected assymetric limb shortness allowing the presumptive diagnosis of an affected fetus which was confirmed after delivery near term. 2) A normal 38-year-old multipara with unremarkable family history underwent routine fetal ultrasound evaluation at 18 weeks gestation. Disorganization of the spine, premature echogenicity of femoral epipheses, and frontal bossing with depressed nasal bridge were described. Neonatal examination confirmed suspicion of CH. Case 1 demonstrates the importance of solid clinical diagnosis in Mendelian malformation-affected parents for directing prenatal diagnostic efforts. Case 2 represents the first index case of CH diagnosed antenatally by ultrasound. Diagnostic clues which must be considered in establishing these diagnoses are discussed, as are some of the difficulties and limitations in antenatal counseling such cases.

Adult↗
PubMed1993

A histological study of the eye lesions in 12 leprosy patients with tuberculoid lesion in 4 eyes.

The histological reactions in 12 eyes of 12 leprosy patients were studied (5 BT, 1 BB, 1 BL and 5 LL). Granuloma lesions composed of epithelioid cells, Langerhans giant cells, macrophages and lymphocytes were found in various intraocular tissues, e.g. cornea, sclera, iris, ciliary body or retina in 4 patients (1 BT and 3 LL). Of the 3 LL patients, according to the records, 2 were cured and in the other patient the outcome of the treatment was not mentioned. In view of the finding of the granulomatous lesions in the clinically cured patients and tuberculoid granuloma in the intraocular tissues in the LL patients, could there be some peculiarities in the intraocular sites? Or perhaps the tuberculoid reaction is just a manifestation of an upgrading reaction? More examinations on human leprosy eye specimens will be needed to answer these questions.

Adult↗
PubMed1992

The natural interleukin-1 receptor antagonist in term and preterm parturition.

OBJECTIVE: Interleukin-1 has been implicated in the mechanisms responsible for preterm labor in the setting of infection. The interleukin-1 receptor antagonist is a new member of the interleukin-1 gene family that inhibits the biologic effects of interleukin-1 by blocking its receptors. Reduction of interleukin-1-induced prostaglandin production by intrauterine tissues may have potential value in the treatment of preterm labor associated with infection. The purpose of these studies was (1) to determine interleukin-1 receptor antagonist levels in the amniotic fluid of women with term and preterm labor (with and without infection) and (2) to study the effects of interleukin-1 receptor antagonist on interleukin-1-induced prostaglandin biosynthesis by human amnion and chorion. STUDY DESIGN: Amniotic fluid was obtained from women in the midtrimester of pregnancy (n = 20), at term pregnancy (with and without labor, n = 69), and in preterm labor (n = 47). Fluid was cultured for aerobic and anaerobic bacteria and Mycoplasmas. Interleukin-1 alpha, interleukin-1 beta, and interleukin-1 receptor antagonist concentrations were measured by immunoassays previously validated for human amniotic fluid. The effect of interleukin-1 receptor antagonist on interleukin-1-induced prostaglandin production by amnion and chorion was studied with primary cultures. Cells were incubated with interleukin-1 receptor antagonist and interleukin-1 alpha or interleukin-1 beta for 16 hours. Prostaglandin E2 released into the media was assayed by immunoassay. RESULTS: (1) Interleukin-1 receptor antagonist was present in all amniotic fluid samples; (2) amniotic fluid contains the highest interleukin-1 receptor antagonist concentrations detected in any biologic fluid to date; (3) amniotic fluid interleukin-1 receptor antagonist concentrations were not increased in women with preterm labor and intraamniotic infection in spite of dramatically elevated concentrations of interleukin-1 alpha and interleukin-1 beta in the same fluid (median 22 ng/ml and range 0.16 to 70 for preterm labor with negative amniotic fluid culture vs median 30 ng/ml and range 6 to 70 for preterm labor with positive amniotic fluid culture; p > 0.05); (4) interleukin-1 receptor antagonist reduced interleukin-1 beta-induced prostaglandin E2 production by amnion and chorion in a dose-dependent manner; (5) interleukin-1 receptor antagonist by itself did not stimulate prostaglandin E2 release by amnion and chorion when used in concentrations ranging from 0.1 to 1000 ng/ml. CONCLUSIONS: (1) Interleukin-1 receptor antagonist is a physiologic component of amniotic fluid; (2) the release of interleukin-1 alpha and interleukin-1 beta into the amniotic fluid in women with preterm labor is not associated with an increase in interleukin-1 receptor antagonist levels in amniotic fluid; (3) interleukin-1 receptor antagonist reduces interleukin-1-induced prostaglandin production by amnion and chorion; (4) exogenous anticytokine agents may be of value in the treatment of preterm labor.

Adult↗
PubMed1992

Infection and labor. VIII. Microbial invasion of the amniotic cavity in patients with suspected cervical incompetence: prevalence and clinical significance.

OBJECTIVE: The purpose of this study was to determine the prevalence and clinical significance of microbial invasion of the amniotic cavity in patients presenting with cervical dilatation in the midtrimester of pregnancy. STUDY DESIGN: Amniocentesis for microbial studies was performed in women admitted with cervical dilatation > or = 2 cm, intact membranes, and without active labor between 14 and 24 weeks of gestation. Amniotic fluid was cultured for aerobic and anaerobic bacteria, as well as for mycoplasmas. Gram stain was performed on all samples. RESULTS: The prevalence of microbial invasion of the amniotic cavity was 51.5% (17/33). The most common microbial isolates were Ureaplasma urealyticum, Gardnerella vaginalis, Candida albicans, and Fusobacterium sp. All patients with microbial invasion of the amniotic cavity had complications. Patients who underwent cervical cerclage in the presence of a positive amniotic fluid culture had rupture of membranes, clinical chorioamnionitis, or pregnancy loss. On the other hand, the prognosis of patients with a negative amniotic fluid culture was better than that of patients with a positive culture. Of 16 patients with a negative amniotic culture, nine were delivered at > 34 weeks. CONCLUSIONS: (1) Microbial invasion of the amniotic cavity occurs frequently in women presenting with cervical dilatation in the midtrimester; (2) the microbiologic state of the amniotic cavity is an important prognostic factor for pregnancy outcome; (3) amniocentesis to determine the microbiologic characteristics of the amniotic cavity should be considered before a cerclage is placed in women presenting with cervical dilatation in the midtrimester.

Abortion, Spontaneous↗
PubMed1991

Communication Self-Assessment Scale Inventory for Deaf Adults.

The Communication Self-Assessment Scale for Deaf Adults (CSDA) evaluates difficult communication situations, their importance to the respondent, communication strategies, and communication attitudes. Scale items use simple descriptive language in active declarative form. Each scale is comprised of three or more subscales. The subject responds using a three point semantic differential based on frequency of occurrence or degree of importance. Item analysis, factor analysis, internal consistency reliability studies, and collection of normative data have been performed on a population of 290 deaf adults.

Adult↗
PubMed1990

Histopathological findings in the iris of dapsone treated leprosy patients.

From 43 Nepalese leprosy patients skin smear negative, and treated with dapsone (diamino diphenyl sulphone), and without any sign of active leprosy or iritis, specimens from iridectomy during cataract surgery were studied histopathologically. Of 49 iris specimens only six (12%) were found to be without any histopathological change. Atrophy of the iris stroma was seen in 63% and neovascularisation in 6% of all cases. In 16% in which the dilator muscle could be detected, it was atrophic, and in 11% the pigmented epithelium was thinned and atrophic. Cellular inflammatory infiltrations were seen in 88% of all specimens. They were mostly slight in eyes which before operation had been without posterior synechiae of the iris. In most of the eyes in which posterior synechiae had been present moderate or heavy inflammatory cell infiltrates composed of lymphocytes and plasma cells, often associated with macrophages, neutrophils, or eosinophils, were found. In five iris specimens acid fast bacilli were present. This raises the question whether these can survive systemically despite dapsone chemotherapy in the iris, thus leading to dapsone-resistant leprosy and to recurrent iritis.

Adult↗
PubMed1990

The pathology of the eye in armadillos experimentally infected with Mycobacterium leprae.

One hundred and twenty-seven eyes from 66 Mycobacterium leprae inoculated armadillos were studied histologically and some ultrastructurally. Inflammatory reactions were found in the following extraocular tissues: the eyelid, including the orbicularis muscle and the third eyelid, extraocular muscles, tear gland and Harder's gland. The early and slight changes of the intraocular tissues, small amounts of lymphocytes, plasma cells and macrophage infiltrations were confined to the area around the anterior angle specifically within the trabeculae and the adjacent ciliary body, the root of the iris and the limbus region of the cornea. But in the cases with severe lesions the whole uvea was densely infiltrated with large, foamy macrophages intermingled with small amounts of lymphocytes, plasma cells and frequently, neutrophils. No specific necrosis of the granulomas was seen. No explanation for the neutrophil infiltrations was given. The lesions in the cornea were significantly less severe than those in the uvea. Retinal lesions comprised of macrophage infiltrations were all obvious extensions of the adjacent uvea lesions. Acid-fast bacilla (AFB) were found within all tissues. The infection of the intraocular tissues in the armadillo eyes seemed to be mainly, if not solely, haematogenous.

Animals↗