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Biomedical subjects

H E Clar

Publications and source records attributed to H E Clar.

At least 19 recordsLinked to original sources
PubMed1993

[Cervical intervertebral disk prolapse. Diagnosis, differential diagnosis and surgical therapy].

Among the so-called cervical spine syndromes cervical disc prolapse represents a well defined disease entity which should be kept in mind considering treatment resistant painful neck and shoulder as well as neurological dysfunctions of this region. Differential therapy consists of conservative measures and especially a variety of surgical procedures for cervical disc syndromes. Under all circumstances decision for surgery has to take into consideration the individual psychological situation (e.g. expectations of the patient) and social factors (e.g. the patient's occupation). Therefore a close cooperation of the family doctor and the surgeon is required. The aim of this article is to point out the neurosurgical aspects as well as the point of view of the general practitioner at the same time.

Cervical Vertebrae↗
PubMed1989

[Occlusion of the intracranial segment of the carotid artery by a hypophyseal tumor].

A patient of 49 years of age presented with clinical signs of acute stroke. Computed tomography revealed a suprasellar mass and cerebral infarct. Angiographically an occlusion of the intracavernous internal carotid artery was found, caused by pituitary tumour. After total removal of the tumour the internal carotid artery was recanalised, as the postoperative angiography showed. The patient's neurological deficiencies disappeared almost completely. The literature is reviewed and our diagnosis and procedures are compared with the published reports.

Adenoma, Chromophobe↗
PubMed1986

Diagnostic criteria in pituitary tumour recurrence--combined modality of surgery and radiotherapy.

The tumour recurrence rate of 210 patients with operated hypophysomas were investigated. Depending on the surgical approach, total or subtotal extirpation of the adenomas, the recurrence rates varied from 10,4 to 35%. 33 patients with pituitary tumour recurrences were followed up over a period of 20 years. Clinical symptoms CT-results at relapse are represented. Serum prolactin level (PRL) was determined before and after surgical and radiotherapy of PRL-producing adenomas. In these cases PRL can be accepted as a tumour marker. 13 patients with relapsed hypophysomas received local irradiation (5.7 MeV linear accelerator) after recurrence operation. An individual comparison in the same patient between surgical therapy alone and combined surgical and radiotherapy was possible. Based on the obtained experience with this combined treatment a therapy scheme using combined surgery and radiotherapy in pituitary tumours is suggested.

Adenoma↗
PubMed1985

Tumors of the pineal region in children and adolescents.

The treatment of tumors in the pineal area remains controversial. There are two main approaches: Conservative treatment, consisting in CSF shunting and radiotherapy, and direct surgical removal. We report on 25 children (22 boys and 3 girls) aged between 4 and 20 years who underwent conservative treatment. The follow-up period ranges from 1 to 11 years (mean, 4.8 years). 19 patients are still alive at a mean survival time of 5.8 years. 17 children are free of disease, two have severe neurological deficits. Our diagnostic and therapeutical concepts are presented.

Adolescent↗
PubMed1985

Disturbances of the hypothalamic thermoregulation.

Although compression of the hypothalamus in cases of suprasellar tumour is common, spontaneous dysregulation of body temperature is extremely rare. Bilateral localization of the hypothalamic nuclei and a high grade of compensatory value of temperature regulation may be the reason for this phenomenon. In the postoperative period temperature dysregulation is observed more often. In order to analyse the influence of diencephalic regulation in these patients classification of the degree of hypothalamic compression is necessary. The problem was studied under experimental and clinical conditions. Experimental studies in rabbits after acute hypothalamic compression and decompression showed a reversible disturbances of temperature regulation. Hypothalamic compression in dogs resulted in reversible hypothalamic endocrine dysfunction. Clinical observations of body temperature in the period after operation of suprasellar tumors showed similar results. The temperature study was extended on patients with cerebral trauma and intracranial haemorrhage to differentiate the degree of hypothalamic lesion. Morphological examinations confirmed alterations localized in the anterior and posterior region of the hypothalamus. The analysis proved the fact that temperature regulation seems to be a highly sensitive parameter of diencephalic function.

Adenoma↗
PubMed1984

[Therapy of brain stem tumors--palliative concept with a curative perspective?].

From 1969 to 1981, 23 patients with tumors in the pons region were irradiated at the Department of Radiotherapy of the West German Tumor Center in Essen. The age of the patients ranged from 18 months to 50 years. Fifteen patients (65%) were younger than 18 years, one was 25 years old, and seven were between 40 and 50 years old. In two cases the histologic diagnosis of an astrocytoma I and astrocytoma II could be confirmed by exploratory excision and cyst punction, respectively. Nineteen patients received a shunt system (ventriculoatrial shunt) prior to radiotherapy in order to achieve a pressure reduction. After a follow-up period of 1.5 to 12 years, eleven patients are alive, and twelve patients died from a local recurrence or from progressive tumor growth. The five-year survival rate is 47%. Five of the surviving patients show no or only slight adverse effects on their general condition and are able to attend school or carry out their profession (in Karnofsky: 90 to 100%). Four other patients suffering from marked remaining neurologic symptoms are able to take care of themselves (Karnofsky: 70 to 80%). Two patients need permanent nursing (Karnofsky: 50 to 60%). Because of the local propagation tendency of pons tumors, radiotherapy should be locally restricted to the brain stem and the adjacent brain structures, e.g. cerebellum and proximal neck marrow. The authors recommend target volumes of 55 to 60 Gy, which must be applied within 6 to 8 weeks, taking into account the age of patients. This palliative therapy conception should be applied routinely in the hope of bringing about a curative treatment to this group of patients.

Adolescent↗
PubMed1983

[Therapy of hormone-active hypophyseal tumors from a neurosurgical viewpoint].

Perioperative hormone determinations were performed in 16 patients with acromegaly, in 12 patients with prolactinomas and in 4 patients with tumours producing ACTH. These determinations are an essential basis for assessing the results of the operation. Surgical treatment is the method of choice in hormone-active tumours if reduction of the elevated hormone values cannot be achieved with drug treatment. An exponential lowering of the hormone level can be obtained in acromegaly and in tumours producing ACTH. Although levels above 100 ng/ml could be reduced, it was not possible to restore them to standard values. In some cases, it was possible to lower the prolactin level, but normal values could never be obtained because of the size of tumours. The consequences resulting from these findings (drug treatment and radiotherapy) are discussed.

Acromegaly↗
PubMed1982

Hypothalamic function in patients with tumors of the pineal area.

10 patients, aged 4-17 years, were investigated in order to study the influence of tumors of the pineal area on the hypothalamic endocrine function. Immunoreactive growth hormone (GH) failed to increase sufficiently in 9 patients after insulin induced hypoglycemia (IIH) and in seven patients after propranolol-glucagon (PG). Secondary adrenocortical insufficiency was present in four patients. Three of these patients showed biochemically hypothalamic hypothyroidism with elevated basal prolactin levels, hypogonadotropic hypogonadism and neurohumoral diabetes insipidus. The study shows that hypothalamic dysfunction in patients with tumors of the pineal area is at least as frequent as in patients with suprasellar tumors and that diabetes insipidus may be present before any surgical or radiological treatment.

Adolescent↗
PubMed1981

Follow-up studies in the posterior fossa in children using computerized tomography.

Tumours in the posterior fossa in children only present minor problems in diagnosis since the introduction of the computerized tomogram, but in postoperative follow-up studies it is rather difficult to distinguish between the various findings in the posterior fossa. This holds true especially for medulloblastomas and ependymomas. Operative changes in the anatomical structures, metal-clips, scar-like changes, post-radiation sclerosis and other findings are reasons why it is almost impossible to diagnose early recurrence of these tumours. In order to obtain more information after operation, CT findings were studied in 36 children with tumours in the posterior fossa. The findings are summarized and discussed.

Astrocytoma↗
PubMed1980

Experimental hypothalamic dysfunction in dogs.

The authors demonstrate an experimental model in dogs developed in order to study endocrine disorders as a result of suprasellar space occupying lesion. Fogarty balloon catheters were inserted in dogs below the optic chiasm and filled with contrast medium. The study of thyroid function shows that initially reversible hypothalamic hypothyroidism develops and that in a second stage most animals develop chronic thyroid dysfunction which is irreversible even after careful removal of the experimental tumor. The clinical symptoms correlate with these findings. Morphological examinations prove the fact that the hypothalamic disorders are due to disturbances of the blood-brain-barrier in the hypothalamus following hypothalamic compression and decompression.

Animals↗
PubMed1980

[Computertomographic and morphological findings in cerebral infarctions and intracerebral haematomas in identical sections (author's transl)].

The paper deals with computertomographic and morphological studies in patients who died suffering from brain ischaemia, haemorrhagical infarction and haemorrhages. These examinations were done in identical sections. Methodically computerized tomograms in living patients, postmortal tomograms, brain sections and macrosections were used. Not in all cases corresponding findings were observed, due to the following factors 1. Size of the lesion 2. Localisation 3. Time of examination 4. Premortal alterations. The different factors are discussed in detail.

Adult↗
PubMed1979

Clinical and morphological studies of pineal tumours.

This is a report of clinical, morphological, diagnostic, endocrinological and therapeutical experiences with 18 patients with tumours in the pineal region. The histological diagnosis was verified in four cases by autopsy, in seven cases by biopsy, and in one case by microscopical verification of tumour cells in the CSF. In all biopsy cases we are dealing with typical germinomas. In the other clinical cases diagnosis was made by neuroradiological and endocrinological methods. The localization was possible by encephalotomography or CT scan, according to Kageyama, Particular attention was given to the endocrinological dysfunctions which originate in the hypothalamus. Also the hypothalamic dysfunctions after irradiation were discussed. Since the results of primary surgical approach and biopsy have been unsatisfactory, we preferred a non-operative schedule for treatment of pineal tumours.

Biopsy↗
PubMed1979

Pre- and postoperative evaluation of hypothalamo- pituitary function in children with craniopharyngiomas.

Pre- and postoperative evaluation of hypothalamic-pituitary function was performed in six children, aged 5.5 to 13.3 years with craniopharyngiomas. Before surgery growth hormone deficiency (GHD) was documented in four, hypothalamic hypothyroidism in three, and secondary ACTH-deficiency and hyperprolactinaemia in one patient. Diabetes insipidus was absent in all patients. After neurosurgical treatment GHD was present in all, hypothyroidism in five, ACTH-deficiency in three, hyperprolactinaemia in three, and diabetes insipidus in four children. The study shows that all endocrine functions tested may be defective even before surgery, although diabetes insipidus seems to be a rare preoperative complaint. Surgical intervention, however, often leads to additional endocrine disorders. From the data presented here one may suggest that TRH stimulation tests, evaluation of serum prolactin, and lysin-vasopressin stimulation tests are the most useful investigations to distinguish between hypothalamic and primary pituitary disorders.

Adolescent↗