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Biomedical subjects

J Schramm

Publications and source records attributed to J Schramm.

262 records · Page 15Linked to original sources
PubMedDate not supplied

Factors that limit the use of flash visual evoked potentials for surgical monitoring.

A study was conducted comparing the incidence with which the N2/P2/N3 was obtained after flash VEP in 3 groups: anterior visual pathway lesions, non-tumor craniotomies and non-cranial surgery. These groups allowed evaluation of the effects of anesthesia, visual pathway lesions and craniotomy on the stability of the flash VEP. It was found that the latency was not significantly affected in the 3 groups, whereas the incidence of obtainable peaks and the amplitudes were adversely affected by anesthesia, cranial surgical manipulation and especially by the presence of a visual pathway lesion. These adverse effects were so marked that the application of flash VEP for intraoperative monitoring seems of little use.

Brain Neoplasms↗
PubMedDate not supplied

Expression of CYP19 (aromatase) mRNA in different areas of the human brain.

The conversion of androgens to estrogens by CYP19 (cytochrome P450AROM, aromatase) is an important step in the mechanism of androgen action in the brain. CYP19 expression has been demonstrated in the brain of various animal species and in the human temporal lobe. Studies on postnatal CYP19 expression in various other areas of the human brain are rare and carried out in a limited number of post mortem obtained tissue. Therefore, we investigated CYP19 mRNA expression in fresh human frontal and hippocampal tissues and compared them to the expression in temporal neocortex tissues. We studied biopsy materials removed at neurosurgery from 45 women and 54 men with epilepsy. Quantification of CYP19 mRNA was achieved by nested competitive reverse transcription-PCR. CYP19 mRNA concentrations were significantly higher in temporal (2.29+/-0.40 arbitrary units, AU, mean +/- SEM; n = 57) than in frontal neocortex specimens (0.92+/-0.17 AU; n = 18; P<0.04). In hippocampal tissue specimens CYP19 expression (1.41+/-0.18 AU; n = 24) was lower than in temporal neocortex specimens, but the difference did not reach statistical significance. Sex differences were not observed in any of the brain regions under investigation. In conclusion, CYP19 mRNA is expressed in the human temporal and frontal neocortex as well as in the hippocampus. Regardless of sex, CYP19 expression was significantly higher in the temporal than in the frontal neocortex.

Adult↗
PubMedDate not supplied

[Sonographic diagnosis of the juvenile tarsus. Clinical application possibilities demonstrated by examples].

Radiologic assessment of foot deformities in young children is limited especially by the ossification status. Ultrasonography proved to be a useful diagnostic supplement e.g. in idiopathic talipes equinovarus, vertical talus, and tarsal coalitions. Effects of treatment and three-dimensional movements of the tarsal joint complex can be delineated. Sonographic assessment of tarsal alignment is applicable already in the first months of life. This study deals with first experiences in clinical application of this new diagnostic technique.

Ankle↗
PubMedDate not supplied

[Intraoperative monitoring of the spinal cord. Personal results and an inventory of the current status].

The concept of intraoperative monitoring as continuous surveillance of sensory pathways by intraoperative sensory evoked potentials is described. The need for intraoperative monitoring is derived from the morbidity of certain spinal operations. First experiences from 25 own cases are outlined and the advantages of different methods discussed. The current status of spinal cord monitoring is briefly reviewed.

Afferent Pathways↗
PubMedDate not supplied

Prognostic significance of ictal and interictal epileptiform activity in temporal lobe epilepsy.

Long-term electrocorticograms (ECoG), recorded by chronically implanted subdural electrodes during preoperative evaluation of 59 patients with temporal lobe epilepsy (TLE) were analyzed retrospectively to assess the prognostic relevance of distribution of interictal epileptiform potentials (IEP) and seizure origin (SO) and to investigate factors affecting their lateralization. Subsequent to preoperative evaluation, a standardized two thirds anterotemporal lobectomy including subtotal hippocampectomy had been performed in all patients. The following results were obtained: (a) Only patients with 100% lateralization of SO and IEP had excellent seizure outcome (= 89% seizure-free); (b) patients with bitemporal SO were unlikely to benefit from surgical treatment (= 12.5% seizure-free); (c) 40-56% patients with unilateral temporal SO and bitemporal IEP, became seizure-free irrespective of the degree of lateralization of IEP; and (d) multidimensional analysis of variance showed that lateralization of SO, presence of a magnetic resonance imaging (MRI)-detectable lesion, presence of hippocampal sclerosis, presence of febrile seizures and seizures at age < or = 6 years are the five most important variables indicating abolition of seizures. Combined analysis of ECoG-recorded SO and IEP allows prediction of postoperative seizure control within close boundaries.

Adolescent↗
PubMedDate not supplied

Cerebral edema following experimental subarachnoid hemorrhage.

The development of cerebral edema after experimental subarachnoid hemorrhage (SAH) was studied in cats by determining regional brain tissue water content with the microgravimetric technique as well as the drying-weighing method. SAH was induced by withdrawing needles previously pierced into one or both infraclinoid internal carotid arteries through a unilateral transorbital approach. Serial determinations of regional cerebral blood flow (rCBF) by labelled microspheres, and monitorings of vital signs such as intracranial pressure (ICP), blood pressure and EEG were carried out up to 24 h after SAH. Animals could be classified into three grades according to the severity of SAH. In grade I, the increase of ICP was transient and minor. In grade II, ICP increased up to 200 mm Hg with a marked reduction of rCBF below 20% of control in cerebral hemispheres. Following subsequent reduction of ICP, rCBF increased over control, indicating reactive hyperemia. Thereafter, a great reduction of rCBF was again observed. In grade III, rCBF was sustained at essentially zero flow with the presence of continuously increased ICP above 100 mm Hg. Cerebral edema was observed particularly in the parasagittal water-shed areas of all grade II animals. It is concluded that cerebral edema complicating SAH is caused by the combination of an initially induced global cerebral ischemia and the subsequent recovery of cerebral circulation. Post SAH hypertension is another factor to exacerbate the development of cerebral edema.

Animals↗
PubMedDate not supplied

[Quality of life and mortality following major neurosurgical interventions in advanced age].

Mortality and quality of life was studied retrospectively in a group of 109 patients over 60 years old who had undergone a major neurosurgical operation because of vascular malformation, an acute or chronic intracranial hematoma or an intracranial tumor, were compared with a group of younger patients (n = 80) submitted to surgical treatment of the same kind of lesions, and also with a group of patients (n = 40) over 60 years old submitted to lumbar disk surgery. The overall mortality (within 2 years) was significantly higher in the group of older patients undergoing neurosurgery (52% vs. 22%), while in the group of patients submitted to lumbar dis surgery, the overall mortality (10%) corresponded to the natural mortality rate. The postoperative quality of life was improved in 70% of the surviving elderly patients after neurosurgery, in 67% of the group of younger patients and in 65% of the group of patients submitted to lumbar disk surgery. These differences are not significant.

Adult↗
PubMedDate not supplied

[Gerontopsychiatric management in a university clinic].

The patients of the Heidelberg Section of Gerontopsychiatry in 1990 (99 persons aged between 52 and 97 years) were studied in respect to their social data, medical history, severity of illness, and extent of their need of nursing care. Of special interest was how they coped after release from the hospital. In comparison to a study performed in 1982/83, there were many more old and (especially physically) severely impaired patients. We also found an increased percentage of transferrals to nursing homes. The results are discussed with regard to gerontopsychiatric care in the Heidelberg area.

Activities of Daily Living↗
PubMedDate not supplied

Results of early surgery in poor-grade aneurysm patients.

METHODS: During a 4-year-period (1991-1994) a total of 85 poor-grade [Hunt and Hess (H&H) IV and V] patients were treated for aneurysmal subarachnoid hemorrhage. Patients who were admitted in poor grades but improved after initial treatment were excluded from this study. RESULTS: Overall mortality was 46% (N = 39). In particular, 29% (18 out of 63) of surgically treated patients had died as opposed to 95% (21 out of 22) of conservatively treated patients. Early surgery provided favourable (Glasgow-Outcome-Scores (GOS) 4-5) results in 52% of H&H grade IV patients but only in 22% of grade V patients. In particular, approximately one fourth of grade IV patients had a good outcome and 30% were only moderately disabled. Intracranial pressure (ICP) below 20 mmHg proved to be a favourable prognostic sign. CONCLUSIONS: It is concluded that, in consideration of the management mortality encountered with delayed surgery, H&H grade IV patients benefit from early surgical treatment while the prognosis of grade V patients still remains unfavourable.

Adult↗