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Biomedical subjects

F Mundinger

Publications and source records attributed to F Mundinger.

At least 37 records · Page 2Linked to original sources
PubMed1990

Stereotactic evacuation and fibrinolysis of cerebellar hematomas.

Despite modern diagnostic and operative methods, the mortality and morbidity rates of spontaneous cerebellar hematomas remain very high, i.e., according to a review of the literature as high as 45%. By stereotactic puncture, partial evacuation and fibrinolysis of the remaining hematoma with urokinase, much more favorable results can be achieved. As we could observe in long-term follow-up, only 1 patient out of 15 died within 2 months after operation. The method is effective, easy, exact, without risk and applicable at every age, so that actually there is no comparable alternative way of treatment.

Adult↗
PubMed1989

Stereotactic interstitial irradiation of diencephalic tumors with iridium 192 and iodine 125: 10 years follow-up and comparison with other treatments.

The only possible treatment of non-removable tumors of the diencephalon or recurring tumors invading the diencephalon after partial resection or percutaneous radiotherapy is interstitial irradiation (Curie therapy). With the CT/MRI stereotactic method, biopsy for histological tumor classification can be performed and 125I or 192Ir implanted, provided the neuroimaging methods show the delimitation of the tumor, its diameter does not exceed 3 cm and, given the patient's condition, focal irradiation seems advisable. As of 31 August 1987, a total of 1883 cases had been stereotactically biopsied and interstitially irradiated. The indications and results are reported in 204 patients under 18 years of age with diencephalic and deep-seated astrocytomas, after a follow-up period of up to 10 years; the data were compared for tumor resection, percutaneous irradiation, and for interstitial irradiation. The latter proved to be the most effective treatment.

Adolescent↗
PubMed1989

[The significance of stereotaxic brain biopsy in atypical multiple sclerosis].

Multiple sclerosis (MS) is one of the most common diseases of the central nervous system. Up to now, there is no pathognomonic test to ascertain the diagnosis and in 10 to 15% of MS cases there are problems in differential diagnosis. We report 15 bioptically diagnosed MS cases with atypical clinical, C.S.F. and neuroradiological findings. In each case the diagnosis of MS was made by CT/MRI-stereotactic brain biopsy. Neoplastic and other non-tumorous lesions could be excluded. Indications for and significance of stereotactic brain biopsy in atypical cases of MS are discussed.

Adult↗
PubMed1988

Computed tomography in cases of multiple sclerosis: problems of differential diagnosis in cases with atypical findings.

The value of computed tomography in the diagnosis of multiple sclerosis is undisputed. The examination is usually carried out as a routine part of the examination program. We report on the CT results of 112 patients with confirmed or suspected MS. Seventy-three patients were examined without, 39 with intravenous administration of a contrast medium. In 41% of the patients, isolated or multiple hypodense foci were found as a manifestation of a multilocular demyelinization process. In 17.8%, only cerebro-atrophic changes were encountered. In 30.3% of the cases the CT showed normal results. In the group of patients examined with a contrast medium, a pathological contrast medium concentration was found in 30.7%. The differential diagnostic demarcation against other diseases of the CNS with similar CT findings and problems of differential diagnosis with MRI are discussed.

Adult↗
PubMed1987

Continuous intraventricular morphine- or peptide-infusion for intractable cancer pain.

The continuous intraventricular administration of small daily doses of morphine by means of an implantable pump is an effective method of obtaining considerable pain reduction for patients suffering from otherwise untractable carcinoma pain. We consider this method of treatment to be an excellent alternative to the epidural and intrathecal application. Particularly in cases with obstruction of the spinal canal or in cases suffering from untractable pain in the face, neck or upper thoracic area. During the period of treatment, none of the patients involved in the study developed tolerance to morphine or specific opiate side effects. The programmable pump allows precise dosage which is adjusted to the requirements of the individual patient. The high cost of a pump is a justifyable investment in patients in good general condition with a life expectancy longer than 3 months. In most cases the patient may be cared for at home, making further hospitalization unnecessary.

Adult↗
PubMed1987

Molecular size distribution of somatostatin-like immunoreactivity in the cerebroventricular fluid of neurosurgical patients.

The molecular size distribution of somatostatin-like immunoreactivity (SLI) in the cerebroventricular fluid of patients with Parkinson's disease, dystonic syndromes, multiple sclerosis, basal and midline tumors, epilepsy and pain syndromes was investigated by separation with a Sephadex G-50f column and subsequent radioimmunoassay of the eluate. Marked heterogeneity of SLI was observed in most of the pools investigated. The most conspicuous feature of the elution profiles was the preponderance of the peak coeluting with synthetic somatostatin-14, whereas the peaks comigrating with synthetic somatostatin-28 and attributable to precursor-like SLI represented only minor or trace amounts of total immunoreactivity. These findings are consistent with the greater biological activity of somatostatin-14 in the human central nervous system, whereas somatostatin-28 appears to represent the more active form in the pituitary and in the intestinal mucosa. Solely in the case of brain tumor patients, some differences could be seen, resulting in an approximately equal distribution of somatostatin-14 and somatostatin-28 in two pools of ventricular fluid and by the detection of a degradation product of somatostatin-14 in another one. These observations could be explained by a lowered barrier function as a consequence of increased intracranial pressure in case of brain tumors, which is well in accordance with a markedly elevated total protein content being a sign of a lowered barrier function.

Adolescent↗
PubMed1987

Somatostatin-like immunoreactivity in cerebroventricular fluid of patients with basal midline tumours.

The concentration of somatostatin-like immunoreactivity (SLI) was determined by specific radioimmunoassay in the cerebroventricular fluid of patients with tumours of the basal midline and compared to findings in patients with multiple sclerosis. Mean SLI levels of the two groups were not significantly different. In patients with basal tumours (astrocytoma, craniopharyngioma, etc.) SLI levels varied widely and tended to increase with increased intracranial pressure. Lateral ventricular SLI levels decreased in patients with blockade of foramen Monro and in patients with communicating hydrocephalus or post-radiation encephalopathy. There was no apparent correlation with dysfunction of the hypothalamohypophyseal axis.

Adolescent↗
PubMed1987

Stereotactic mesencephalotomy versus multiple thalamotomies in the treatment of chronic cancer pain syndromes.

Two neurosurgical centers, Bologna (Italy) and Freiburg (FRG), have compared results obtained with stereotactic mesencephalotomy (SM; Bologna) and multiple thalamotomies (MT; Freiburg) in the surgical treatment of chronic cancer pain syndromes. In total, 161 patients were operated, 109 in Bologna and 52 in Freiburg. In SM the lesions were single and centered on the spinothalamic tract at the mesencephalic level, while in MT the lesions were multiple in the thalamic nuclei (ventrocaudal parvocellular nucleus, nucleus limitans, lamella medialis, centromedian nuclei). The following results emerged after 2-7 months' follow-up: (1) in an antalgic sense, SM was much more beneficial, with 91 patients (83.5%) pain-free after the operation versus 27 patients (51.9%) who had only an attenuation of the pain syndrome after MT; (2) SM, compared to MT, is burdened by mortality and a higher morbidity [2 deaths (1.8%) vs. 0; 3 anesthesia dolorosa and 8 severe gaze palsies (10.1%) vs. only 1 case of permanent aphasia (1.9%)].

Chronic Disease↗
PubMed1987

CT-stereotaxic drainage of colloid cysts in the foramen of Monro and the third ventricle.

Colloid cysts in the foramen of Monro and third ventricle account for 0.5% to 1% of all intracranial space-occupying lesions. The introduction of computerized tomography (CT) and magnetic resonance imaging has represented a major advance in the early detection of these cysts. The risks associated with the management of benign space-occupying lesions by open surgical procedures have made it necessary to search for safer techniques. The CT-stereotaxic method provides a simple, precise, and safe method of puncturing deep-seated space-occupying cysts. Between January, 1979, and December, 1984, 12 patients with colloid cysts in the foramen of Monro and third ventricle were operated on by this method. The operations were successful, and there were no intraoperative or postoperative complications. The advantages of the CT-stereotaxic method are discussed and the results are presented.

Adult↗
PubMed1986

Computerized tomography-guided stereotactic dentatotomy.

The CT stereotactic technique of dentatotomy is described and illustrated with two examples. With this combined technique, ventriculography or pneumencephalography is no longer needed to determine the target point. In addition, due to the direct representation of anatomic structures in the CT, abnormal positions of the dentate nucleus may be taken into consideration in the determination of the target point and approach for the coagulation probe.

Adult↗
PubMed1986

[CT stereotactic biopsy in the differential diagnosis of deeply situated intracerebral hematomas].

The diagnosis of intracerebral haematomas, especially of those which are relatively small, occupy little space and are deeply situated, presents considerable problems. The problem is even greater when the expected acute case history and the acute beginning of the symptoms do not occur and unusual localisations are found. The consequences of this are false diagnoses and the treatment of these patients within the framework of blanket diagnosis "intracerebral tumours" or "space occupying processes" without any confirmation of the histological diagnosis. - Using a sample of 26 patients where the histological diagnosis of non-recent intracerebral hemorrhages had been confirmed (out of a series of 818 CT-stereotactically biopsied patients punctured by us from the beginning of 1983 until the end of 1984), the problem of establishing a diagnosis is exposed. - A histological diagnoses should in any case be confirmed before any thorough and deep-reaching therapy is begun, since false diagnoses and misinterpretations can cause serious consequences for the patient.

Biopsy↗
PubMed1985

CT stereotactic biopsy for optimizing the therapy of intracranial processes.

The CT stereotactic method (Mundinger/Birg) and the bioptic results of intracranial processes in 815 cases are reported. In 17% of the cases, no tumor was found, in contrast to the diagnosis established by modern imaging techniques (CT, MRI). The necessity of confirming the diagnosis of intracranial lesions to optimize the treatment plan is pointed out. Low mortality and morbidity rates (0.6 and 3%) make this method acceptable for the patient, since misdiagnoses, mistreatment or omission of treatment can thus be avoided. The accuracy (0.6 mm) of CT stereotactic localization and biopsy makes the method reliable even for small lesions.

Biopsy↗
PubMed1985

X-ray and magnetic resonance stereotaxy for functional and nonfunctional neurosurgery.

By means of new plastic stereotactic ring and head fixers, stereotactic procedures can be combined with MRI, with stereotactic coordinates obtained from the MRI images. The method was rechecked against CT stereotaxy and shows a good correspondence of the target coordinates. With MRI stereotaxy, structures near bony regions will be more accessible than with CT stereotaxy. Moreover, the MRI procedure seems to have advantages for functional therapy without the necessity of contrast ventriculography.

Brain Neoplasms↗
PubMed1984

CT-stereotaxy in the clinical routine.

Up to now more than 600 patients have been treated according to the previously described method of CT-stereotaxy. In order to use this method, a special holder for the stereotactic device is required. This device must be exactly adjustable to the centre of the CT gantry within two spatial directions. The accuracy of the method is higher than 1 mm.

Biopsy↗
PubMed1984

[Analysis of movement in extrapyramidal motor diseases using a computer].

Normals are able to move their limbs in a continuous spectrum of speeds. In contrast patients with so called extrapyramidal disorders show typical changes of movement. Short ballistic movements of the upper limb were analysed by a joystick connected with a computer in 57 patients with different extrapyramidal disorders (parkinsonsyndrome, essential tremor, torsion dystonia, chorea and intention tremor) and in 22 normals. Patients with parkinsonsyndrome and with torsion dystonia move the upper limb slower than normals and all other patients. Their movements show breaks. All patients execute aimed movements less precisely than normals. Most unprecise are the movements of patients with essential tremor. Oscillation of movements of all patients deminish, but less than in normals. Patients with parkinsonsyndrome show smallest oscillations at the beginning of each movement. Patients with intention tremor differ not from normals at the beginning, but show still the highest oscillations at the end of movement. Holding the target they correct most frequent. We discuss, that striatum generates timing and strength of ballistic movement and cerebellum apeases oscillation of movement and frequency of correcting while holding a target.

Adult↗