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Biomedical subjects

F Erbguth

Publications and source records attributed to F Erbguth.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Nosocomial pneumonias in a neurology intensive care unit].

BACKGROUND AND OBJECTIVE: Nosocomial pneumonia in patients in an intensive care unit (ICU) are a great problem as a cause of increased morbidity and mortality as well as the resulting high cost of treatment. This study was aimed at determining the incidence of nosocomial pneumonia and the risk factors for its occurrence in patients with severe neurological disease. PATIENTS AND METHODS: Between 1.1. and 31.12.1997, 217 patients (125 men, 92 women; average age 63.4 years) were prospectively included if they were treated for more than 48 hours in the ICU of the Neurology Department of Erlangen University. The occurrence of nosocomial pneumonia (NP) was noted, using the criteria of the Center of Disease Control and Prevention (CDC). Incidence of the diseases was related to age, sex, initial state of consciousness, type of ventilation, duration of stay in the ICU and any associated medical condition. RESULTS: NP was diagnosed in 68 patients (31.4%). Statistically significant relative risks were male sex (2.4 fold, P < 0.01), clouded consciousness with a Glasgow coma score < 8 (6.2 fold, P < 0.001), mechanical ventilation (8.4 fold, P < 0.001), time in ICU > or = 8 days (9.3 fold, P < 0.001) and associated medical condition (3.3 fold, P < 0.005). In 17.7% of cases no relevant pathogen was identified microbiologically. A mixed infection was present in 36.8% of cases. The most common Gram-positive organism was Staph, aureus (35.3%), the most common Gram-negative ones were Ps. aeruginosa (25%), Kl. pneumoniae and Kl. oxytoca (11.8%), E. Coli (10.3%) and Acinetobacter species (7.4%). There was also a high rate of infection or infestation with Candida albicans or glabrata (41.2%). NP played a clinically decisive role in the fatal course of 13 of the 47 patients who died. CONCLUSION: These data (incidence, relative risk) can, by taking into consideration various aspects of specialist and hospital hygienic practices, contribute to a continuing optimization of the prevention and treatment of disease.

Aged↗
PubMed1999

[Renal tubular acidosis with severe hypokalemic tetraparesis after ibuprofen intake].

HISTORY: A 72-year-old woman was admitted because of severe acute tetraparesis, more marked proximally. For six months she had been taking ibuprofen, up to 4800 mg daily, for a painful ulcer of the lower leg. INVESTIGATIONS: Biochemical tests revealed marked hypokalaemia (serum potassium 1.4 mmol/l) with a metabolic acidosis (pH 7.29). The ECG showed changes of hypokalaemia (ST-segment depression and U wave). TREATMENT AND COURSE: Within two days of administering potassium and bicarbonate the pareses completely regressed. Transitorily abnormal renal functions also rapidly normalized after ibuprofen had been discontinued. CONCLUSION: The biochemical findings suggest renal tubular acidosis, type 2, most likely caused by the excess intake of ibuprofen, a drug which can cause renal dysfunctions with life-threatening electrolyte abnormalities.

Acidosis, Renal Tubular↗
PubMed1999

Ondine's curse in association with diabetes insipidus following transient vertebrobasilar ischemia.

Ischemic lesions of the brainstem can lead to complex neurologic deficits. Failure of the automatic control of ventilation (Ondine's curse syndrome) is a possible but rare syndrome following localized brainstem dysfunction. We report on a 49-year-old man with intermittent bradycardia, cranial nerves' dysfunctions and a slight right-sided hemiparesis. An acute brainstem ischemia was diagnosed and treated immediately with high-dose heparin. Cerebral angiography revealed a proximal occlusion of the left vertebral artery but a normal right vertebral artery and a hyperplastic right posterior inferior cerebellar artery. Cranial Computed Tomography and MRI scan demonstrated multiple ischemic lesions in the posterior circulation. During a 4-week treatment course the patient underwent six episodes of acute severe hypoxia and hypercapnia requiring orotracheal intubation twice and manual ventilation by air mask over a few minutes for four times after a tracheostomy had been performed. Twice a short-term episode of hypothalamic Diabetes insipidus was observed following hypoventilation. We conclude that both Ondine's curse syndrome and diabetes insipidus were due to transient vertebrobasilar ischemia.

Brain Stem Infarctions↗
PubMed1999

Phenotypic variability of the DYT1 mutation in German dystonia patients.

Primary dystonia is a clinically and genetically heterogeneous movement disorder characterized by sustained involuntary muscle contractions causing repetitive movements and/or abnormal postures. Recently, the gene locus (DYT1) and mutation responsible for a substantial number of cases suffering from early-onset primary dystonia was described. Here we report 2 German families and 1 sporadic patient with early-onset dystonia due to the DYT1 mutation in order to illustrate the variability of clinical manifestation within this molecularly defined entity. We demonstrate that writer's cramp or focal cervical dystonia is a clinical presentation of DYT1 as well as generalized dystonia.

Adolescent↗
PubMed1999

[Brain syndrome and home ventilation--diagnosis, therapy and consequences].

BACKGROUND: A growing number of patients with neuromuscular diseases has been treated with mechanical ventilatory support during the last years. In some of these patients acute or chronic organic brain syndromes complicate the situation. PATIENTS AND METHODS: We present case reports of 5 patients who have been ventilated at home with neuromuscular diseases but who also suffered from brain syndromes of different etiology. CASE REPORTS: (1) Multifactorial acute organic brain syndrome after intensive care therapy. (2) Recurrent paranoid psychosis correlating with hypercapnia. (3) Oneiroids (awake dreamings). (4) Refusal of the rejection of mechanical ventilation facing dyspnea. (5) Persistent vegetative state after polyradiculomyeloencephalitis. DISCUSSION: Patients with hypoventilation or mechanical ventilation often present with various types of brain syndromes. Careful history taking and the use of laboratory and imaging techniques allow the differentiation in primary and secondary (metabolic) brain syndromes. With respect to the fact that home ventilation has marked consequences for the patient and his carer organic disorders of brain function raise two questions: (1) Is the patient able to understand and critically reflect the consequences of long-term mechanical ventilation? (2) Is the patient able to understand and manage the practical aspects and skills of home-ventilation. e.g., does he have the mental capacity for a sufficient compliance? From our point of view patients with severe brain syndromes should not be selected for home-ventilation.

Adult↗
PubMed1998

[Invasive therapeutic strategies in the acute phase of ischemic arterial cerebral infarct].

BACKGROUND: Currently to an increasing extent aggressive therapeutic approaches in ischemic stroke are discussed. These approaches include intraarterial and systemic thrombolysis to reduce infarction size and also decompressive surgical measures to prevent from fatal consequences of elevated intracranial pressure. This report gives an overview over these strategies. Their specific values are discussed. STRATEGIES: In acute vertebrobasilar artery occlusion an attempt of intraarterial thrombolysis is indicated because of the mostly poor prognosis of large brainstem infarction. Acute artery occlusion in carotid territory has a better prognosis, so that the indication of intraarterial thrombolysis has to be regarded more critically. In view of recent reports systemic rt-PA-thrombolysis seems to be justified in well defined cases independently from site of occlusion. At present there is no longer doubt about the benefit of decompressive surgery in space occupying cerebellar stroke. The value of surgery in malignant brain infarction in carotid territory is not clear due to date. Further randomised studies are necessary to learn more about benefit, risks and required proceedings in space occupying supratentorial infarction. CONCLUSIONS: A well defined group of patients suffering from ischemic stroke seems to benefit from aggressive therapeutic approaches in ischemic stroke. Concerning the selection of patients and management of those approaches a close cooperation with an experienced center is required.

Cerebral Infarction↗
PubMed1998

["Paradoxical" herniation after decompressive trephining].

The intracranial space is divided into two large compartments by the tentorium. The hydrostatic pressure of spinal fluid is responsible for buoyancy of the brain within these compartments. In patients with craniectomy this equilibrium is exposed to atmospheric pressure. We report on four cases of reversible herniation after either bilateral or unilateral decompressive craniectomy performed for increased intracranial pressure (ICP) and failure of conservative ICP treatment. All four patients had survived a severe neurological disease (encephalitis, subdural haematoma, stroke) which required craniectomy to control raised ICP. All were successfully weaned from the ventilator and awake and CT scans showed no space-occupying lesion anymore. The patients showed a typical "sunken pattern" at the trepanation site. All patients developed clinical signs of transtentorial herniation (i.e. unilateral dilated pupils, deteriorated alertness, and extensor posturing) shortly after either diagnostic or presumed therapeutic lumbar puncture. One patient developed herniation a second time while in the typical 30 degrees upright position. After craniectomy, transtentorial herniation is possible even in the absence of increased ICP. It is related to a negative gradient between atmospheric and intracranial pressure, which is enhanced by changes in the CSF compartment following lumbar puncture. Lumbar puncture should be avoided if possible and, when necessary, only be performed in the head-down position. Acute therapy in these cases is quite simple; it requires flat or even head-down positioning and early cranioplasty.

Adult↗
PubMed1998

[Protective ptosis by botulinum A toxin injection in corneal affectations].

BACKGROUND: Botulinum toxin A has been introduced as a local injection therapy of different conditions with focal muscular hypercontractions. In the ophthalmologic field the toxin has proven its efficacy in the therapy of blepharospasm and hemifacial spasm. There are only few reports on the use of a botulinum toxin A to induce a protective ptosis in patients with persistent corneal ulcers. PATIENTS AND METHODS: 21 patients who failed to respond to conservative therapy of corneal erosions or ulcers of different origin received a botulinum toxin A injection into the levator palpebrae superioris muscle. RESULTS: The ptosis began after a mean of 1.5 days (1-3 days) and was complete after a mean of 5.1 days (3-12 days) after injection. Complete recovery of the levator function could be observed after a mean of 12.4 weeks (4-24 weeks). In 13 patients (61.8%) the botulinum toxin A induced protective ptosis lead to a complete healing of indolent ulcers or erosions, in 4 patients (19%) an additional tarsorrhaphy was necessary. In 3 patients no healing could be observed during follow up, in one patient (with neuroparalytic ulcer) the injection was given prophylactically. The period of healing on average was 3.8 weeks. There was no relationship between the healing rate and the duration of the corneal disease prior to the botulinum toxin injection. The mean healing rate of younger patients was higher (75%) than that of older patients (53.8%) and higher in erosions (70%) than in ulcers (30%). No side effects were observed besides in one patient the undesirable duration of the ptosis of a half year. CONCLUSION: The induction of a protective ptosis with botulinum toxin A injection is an efficacious treatment alternative in persistent corneal erosions and ulcers before performing a tarsorrhaphy. This method is preferrable especially in patients with lagophthalmos due to facial nerve paresis with potential recovery.

Adolescent↗
PubMed1998

Central nervous system involvement in thrombotic thrombocytopenic purpura.

Thrombotic thrombocytopenic purpura (TTP) is an uncommon multisystem disease characterized by microangiopathic hemolytic anemia, thrombocytopenic purpura, fluctuating neurologic dysfunctions, renal disease, and fever. Delayed diagnosis and treatment may lead to a high mortality rate that can be as great as 90%. We describe 7 patients in whom CNS involvement was the first clinical manifestation of TTP. Despite early diagnosis and treatment, 3 patients died because of multiple system organ failure. Four patients recovered completely. In patients with focal neurologic disorders in whom infectious CNS diseases were excluded TTP should be considered in the differential diagnosis.

Adult↗
PubMed1997

[Managing life and death wishes of invasively ventilated amyotrophic lateral sclerosis patients].

BACKGROUND: Find of life decisions of patients with amyotrophic lateral sclerosis and respiratory failure are influenced by several environmental factors. PATIENTS AND METHODS: We describe the course of disease and decision making of four of these patients. RESULTS: Most decisions have been inconsistent and were seen to be depending on actual situations. Main factors were: 1. preclinically (before respiratory failure) medical information, 2. during respirator dependency in the hospital's intensive care unit the clinical setting and the individual perspective depending on the patient's private situation, 3. at home ventilation the family's situation and conflicts. Especially the patients requests for disconnection from the respirator overtaxed their carers capacities. CONCLUSION: We conclude that there is need for professional psychosocial intervention for the patients and their families.

Adult↗
PubMed1997

[Friedreich disease. A neurocardiologic syndrome with uncertain nosologic classification of heart involvement].

Friedreich's ataxia (FA) represents a degenerative, genetically determined disease of the nervous system in combination with myocardial affection and in some cases endocrinological disturbances. Manifestation of myocardial involvement usually follows symptoms of nervous system degeneration later in the course, but seems not to be secondary. These cardiac disturbances are the main cause of death in FA-patients. Therapeutic management of heart disease is possible and interdisciplinary neurologic-cardiologic cooperation should start early in the course of FA.

Adult↗
PubMed1997

[The use of alternative medicine by multiple sclerosis patients--patient characteristics and patterns of use].

UNLABELLED: The use of alternative medicine is growing in all Western countries. Little is known about the modalities and patterns of use of alternative medicine by patients suffering from multiple sclerosis. PATIENTS AND METHODS: We analysed an anonymous questionnaire that was sent to and answered by 129 former inpatients who had multiple sclerosis diagnosed by typical clinical and laboratory findings. RESULTS: 82 of 129 patients (63.6%) have been using alternative therapies. They were treated with a total of 87 different alternative healing methods or substances. Some patients used up to 9 different methods. The mean duration of the alternative treatment was 2.6 (0-20) years. Most patients used homoeopathy (n = 35), herbs (29 different substances, 32 users), different relaxation methods like yoga (n = 38) and various diets (n = 21). The most important motivation to look for alternative medicine was the aim to participate actively in the healing process. Most patients thought that there was some positive effect from the alternative treatment but did not inform their general practitioner or neurologist about it. DISCUSSION: Like in other chronic diseases many MS-patients use alternative medicine. The experiences of these treatments forms part of the patient's coping with the disease.

Adult↗
PubMed1995

[Acute meningoencephalitis--diagnosis and therapy].

Meningoencephalitis is still associated with a mortality rate of up to 30% and early selective treatment is extremely important. Whenever the disease is suspected, lumbar puncture should be performed immediately with the aim of differentiating on the basis of the cell count and cell picture between the various forms of inflammation namely bacterial, viral, and other special forms (tuberculous, leptospiral, spirochaete-associated or fungus-associated infections). Bacterial meningoencephalitis requires immediate antibiotic treatment. The present article discusses the choice of suitable medication. When herpes encephalitis is suspected, acyclovir should be administered immediately. The diagnosis and treatment of tuberculous meningoencephalitis are also briefly discussed. Infections with less common pathogens are not considered in the present article.

Acute Disease↗