Search PubMed⌕ Search

Biomedical subjects

F Loew

Publications and source records attributed to F Loew.

At least 55 records · Page 3Linked to original sources
PubMed1986

Burr hole third ventriculo-cisternostomy. An unpopular but effective procedure for treatment of certain forms of occlusive hydrocephalus.

79 cases of obstructive hydrocephalus treated between 1972 and 1983 by burr hole third ventriculo-cisternostomy have been analysed together with the published literature. There were 80% good results in non-tumoral aqueduct stenosis and in hydrocephalus caused by pineal, posterior third ventricle or basal ganglia tumours. The results in hydrocephalus caused by dysrhapic malformations or following meningitis as well as in cases which previously had been treated by shunting procedure were unsatisfactory. Such cases therefore should be excluded from third ventriculo-cisternostomy. In the first mentioned cases the patency of the basal cisterns should be verified beforehand by CSF scintigraphy. Only cases with open cisterns should be selected for third ventriculo-cisternostomy. If these selection guidelines are followed good results can be expected in approximately 90%. Judging from the literature and from our own material the mortality rate is below 1% and the rate of transient neurological deficits about 5%. These complications seem to be avoidable by improved technique. The alternative methods used in the treatment of obstructive hydrocephalus, viz: ventriculo-cardiac or ventriculo-peritoneal shunting, have an overall complication rate higher than 50%. This comparison leads us to recommend third ventriculo-cisternostomy as the treatment of choice for properly selected cases of obstructive hydrocephalus.

Basal Ganglia Diseases↗
PubMed1986

Different operative possibilities for treatment of lumbar disc herniations--how to choose the best method for the individual patient.

The indications for operative treatment of lumbar disc herniations are outlined and the advantages, short-comings and temptations of discolysis, micro-operation and large approach discussed. The following indication scheme is proposed: Discolysis: Non-displaced disc herniation without other major causative pathology; Micro-operation: Displaced disc herniation; non-displaced disc herniation with monosegmental additional causative factors; Large approach: Multiple disc herniations with suspected displacement and multisegmental additional pathologies.

Chymopapain↗
PubMed1986

Increased functional vulnerability to acute compression injury of a spinal cord segment under barbiturate anesthesia.

Posttraumatic changes in polysynaptic reflex activity and axonal long-tract conduction were measured after transient compression of the L-7 spinal cord segment of cats, either made high spinal and unanesthetized or left intact under pentobarbital anesthesia. The severity of acute post-injury changes increased significantly in the anesthetized animals. Partial recovery and stabilization of functional deficits were observed in the spinal cat, but not in the anesthetized one. These findings suggest that, at least in the acute postinjury stage, pentobarbital anesthesia may enhance functional damages after experimental spinal cord compression.

Animals↗
PubMed1986

Acute effects of dexamethasone on normal and on posttraumatic spinal cord polysynaptic reflex activity and axonal conduction.

The effects of a single intravenous injection of a high dose of dexamethasone (4 mg/kg) on polysynaptic reflex activity and axonal conduction were measured for 5 hours in the intact and in the compression-injured L-7 spinal cord segment of high spinal cats. The segment was injured by a transient compression of preset degree and duration. In the uninjured preparation, dexamethasone administration significantly reduced polysynaptic reflex size for 2 hours. Axonal conduction was unaltered. One group of injured animals was given dexamethasone 30 minutes after trauma, whereas another was not treated. The acute posttraumatic changes in both parameters did not differ significantly in treated and untreated animals. Histopathologically, differences in the amount of segmental edema and hemorrhage between untreated and treated animals were not significant.

Animals↗
PubMed1986

Acute changes in somatosensory evoked potentials following graded experimental spinal cord compression.

Amplitude and latency of cortical somatosensory potentials evoked in cats by peripheral nerve stimulation were measured before, during, and for 5 hours after injury of spinal cord segment L-7 by a predetermined degree and duration of compression. An amplitude decrease, slight and transitory, was first observed after compression reduced the segmental cross section by 60%. After an 80% compression, amplitude reduction was initially larger and lasted longer, but recovered 2.5 hours after injury to a level that did not differ statistically from control values. After total (100%) compression, evoked responses disappeared abruptly and did not recover significantly. Latency was unaltered at all degrees of compression. Structural damage increased with the degree of compression. In this model, evoked potential changes neither reflect nor predict the magnitude of acute incomplete spinal cord injury.

Animals↗
PubMed1986

Medical care and social support for the elderly in Switzerland: imbalance and mix.

Medicalization refers to the current practice of providing medical solutions to broad social problems facing the old. This approach is destined to bring about serious economic and sociocultural dilemmas in the coming decades due to the aging trends in Switzerland. On the one hand, additional bed requirements will double, really jeopardizing the present federal savings policy on health and welfare. On the other side, ignoring the specific needs of nearly 20% of the population (as the 65 and over age group are expected to reach in the year 2010), will provoke unwielding social/political tensions. Assigning medical answers to social needs is both expensive and inadequate. This proposition is illustrated by two aspects of Geneva's medical care system for the aged: At the University Geriatric Hospital a large proportion of the patients are admitted for purely social reasons ('home maintenance impossible'). The long term bed stays, medically unjustified, constrains the optimal functioning of this acute care and rehabilitation hospital. The prolonged length of institutionalization reduces the capacity of the elderly out-patients to carry on autonomously. This observation is confirmed by many Swiss medical and sociological surveys which reveal that institutionalization is rarely necessary or desirable in the 10 to 20 first years of post-retirement provided there is an adequate system of social and primary care services available. The drug prescription to those 65 and over consulting at the out-patient department of the Geneva University Medical Policlinic typically amounts to excessive prescription for women and especially of psychoactive drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

Intradiscal collagenase for treatment of lumbar disc herniations. A comparison of clinical results and computed tomography follow-up.

In a series of 34 patients with herniated lumbar discs, treated by intradiscal injection of highly purified collagenase, the post-treatment course has been followed-up clinically and by repeated computed tomographies (CT). Good or excellent results have been achieved in 17 patients. An only slight improvement of pain was noted in 2 patients. Fifteen patients had to be operated on due to not improved or worsened clinical symptoms. The most striking result of our CT follow-up was a tendency of the disc herniation to increase initially after collagenase injection. About two thirds of the patients had such an increase at the one week after injection control. After 6 weeks this rate had decreased to only about one quarter, but in the meantime 13 patients had to be operated. Only after 6 months most hernias of the up till then not operated patients were smaller and none were larger than before treatment. There was also a transient density decrease of the treated disc, most pronounced one week after collagenase injection. At controls 6 months later density had reached again pre-treatment levels. It is likely that the volume increase tendency of the disc material after collagenase injection is responsible for a worsening of the clinical symptoms, which not seldomly occurs during the initial post-treatment period, and in some patients makes an operation necessary.

Back Pain↗
PubMed1985

Reflex activity and axonal conduction in the L-7 spinal cord segment following experimental compression trauma.

In cats in which the spinal cord was transected at C-1, the exposed L-7 spinal cord segment was compressed with an electromagnetically driven rod applied to the dorsal surface of the segment. With the magnitude of compression constant at 3 mm, the cord was compressed for durations of 50 msec, 0.5 sec, or 1.0 sec. Polysynaptic reflex discharges integrated in the injured segment and action potentials conducted in dorsal column axons traversing the same region were electrophysiologically measured before, during, and for 41/2 hours after trauma. Structural changes were evaluated on frozen serial sections obtained both from compressed segments and from tissue adjacent to the injury. At a compression duration of 50 msec, the amplitude of evoked reflex activity decreased abruptly, and dorsal column axonal conduction was blocked for 1 minute following compression. This early-phase response was followed by partial recovery of both functions which persisted until the end of the experiment. Prolonging compression to 0.5 sec brought about a further decrease of polysynaptic reflex activity. Axonal conduction was also decreased, but not significantly. With compression lasting 1.0 sec, no significant changes in reflex discharges and axonal conduction occurred compared with those measured at 0.5 sec. Neither function was abolished, even after the longest compression time. Prolongation of compression significantly increased both the intensity and the spread of edema, whereas changes in hemorrhage were not significant. Thus, a plateau rather than a progressive increase in severity of functional and structural posttraumatic changes was reached by increasing the duration of compression. This injury model reduces the sources of variability found in other experimental compression trauma models and permits the quantitative assessment of basic spinal cord mechanisms and correlated histopathological changes in the same preparation following trauma.

Animals↗
PubMed1984

Traumatic, spontaneous and postoperative CSF rhinorrhea.

CSF fistulas are a major complication of head injury but also occur spontaneously or symptomatically in connection with tumours of the skull base, empty sella syndrome, ethmoidal encephalomyelocele, intracranial hypertension or postoperatively in connection with operations on skull base tumours or ENT operations. Their main risk is the possibility of meningitis. The main clinical symptom is CSF leakage from the nose, but meningitis may be the first manifestation. Isotope cisternography and metrizamide CT cisternography are the most important methods for precise localization, sometimes also for verification of a suspected fistula. Most traumatic CSF fistulas of the frontal and ethmoidal region have to be treated operatively. The method of choice is the transfrontal approach and the closure of the fistula opening using a pedicled pericranial flap or fascia lata graft. Most sphenoidal fistulas have to be treated by packing the sphenoidal sinus with muscle. The treatment methods of the rare spontaneous and symptomatic CSF fistulas are also described. The results of operative treatment are satisfactory. About 6% recurrences, which as a rule can be cured by reoperation, and a mortality rate of about 1-3% seem to be an acceptable price for prevention of an otherwise unavoidable and oftenly deadly meningitis. Future efforts are necessary to improve the operative technique in order to reduce the incidence of anosmia. Our descriptions and advice are based not only on literature reports but also on our own experiences with a combined material of 237 cases operated on for rhinorrhea.

Adult↗
PubMed1984

Treatment of detrusor instability of the urinary bladder by selective sacral blockade.

Detrusor instability and its associated incontinence frequently impair activity and the results of pharmacological and operative treatment have often been unsatisfactory. Twenty-two patients with idiopathic detrusor instability were treated by selective local anaesthesia of both sacral roots S3. The follow-up period ranged from 4 months to 2 years. In patients with neuropathic detrusor instability, local anaesthesia had no permanent effect, but in four such cases it was possible to achieve continence by permanent blockade of S3 using phenol injections. A disadvantage of the latter procedure was that bladder emptying was achieved only by manual abdominal compression or catheterisation.

Female↗
PubMed1984

[Selective sacral nerve blockade in the treatment of detrusor hyperreflexia of the bladder].

Hyperreflexive detrusor instability causes severe impairment of the patients private and professional life. Involuntary detrusor contractions lead to incontinence. The results of previous pharmacological and operative therapeutic procedures are unsatisfactory. 22 cases with idiopathic hyperreflexive detrusor instability were cured by selective local anaesthesia of both sacral roots S3. The follow-up period ranges from 4 months to 2 years. In case with neurogenic detrusor instability local anaesthesia of the sacral roots S3 has no permanent effect. But in 4 such cases it was possible to reach continence by permanent interruption of the roots S3 using phenolglycerin injections. Unavoidably this success, which enables social rehabilitation, results in voiding disturbance of the bladder which makes voiding by manual bladder compression or even catheterization necessary.

Adult↗
PubMed1982

Treatment of lumbo-ischialgias of different origins by intradiscal injection of chymopapain (discolysis). Analysis of literature and personal experiences.

An analysis is given of a series of 25 patients suffering from lumboischialgic pain of different causes, which have been treated by discolysis. Literature reports are taken into consideration. As a result of analysis, the following statements seem justified: In no kind of lumbar disc prolapse are the results of discolysis superior to those of modern operative treatment. Discolysis results are indisputably worse in cases with the usual operative indication, which consists of neurological deficit and large disc prolapse. Favourable results by discolysis can be obtained in cases with disc protrusion or small prolapse, but these cases can mostly be cured also by consequent conservative treatment. Contraindications are marked neurological deficit, demonstration of a large disc prolapse by contrast methods, Verbiest's stenosis of the lumbar spinal canal, low back pain and ischialgia without possible proof of a disc protrusion, cases with low back pain as the main or only feature, spondylolisthesis. Disc prolapse recurrences after discolysis often occur about one month afterwards. Structural instability at this stage is likely. Therefore, as with postoperative treatment, it is advisable to avoid major physical stress for the first weeks after discolysis. Major complications after discolysis are possible, and have occurred. Because discolysis offers no real advantages but some shortcomings compared to conservative treatment for disc protrusions, and to operative treatment in real disc prolapses, its justification seems more than questionable.

Adolescent↗