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Biomedical subjects

Josef G Heckmann

Publications and source records attributed to Josef G Heckmann.

25 records · Page 2Linked to original sources
PubMed2003

Multiple brain abscesses caused by Fusobacterium nucleatum treated conservatively.

BACKGROUND: Multiple brain abscesses are serious neurological problems with high mortality and disabling morbidity. The frequency is rising as a result of AIDS and the increasing number of immunocompromised patients. CASE STUDY: A 59-year-old woman developed signs and symptoms of diffuse brain dysfunction including fever and neck stiffness. A brain CT scan demonstrated nine contrast-enhancing ring-shaped lesions. Analysis of the cerebrospinal fluid using PCR-technique revealed DNA of Fusobacterium nucleatum. Conservative treatment with antibiotics was successful. The patient recovered with only mild cognitive deficits. RESULTS: The experience of our patient and the review of the literature indicate that multiple brain abscesses due to Fusobacterium nucleatum are rare. The most probable source is oral infection. CONCLUSION: Multiple brain abscesses may be caused by Fusobacterium nucleatum. Cerebrospinal fluid analysis using PCR technique is helpful with diagnosis. Conservative management can be successful.

Anti-Bacterial Agents↗
PubMed2003

Electrocerebral silence with preserved but reduced cortical brain perfusion.

Isoelectric electroencephalogram in conformance with clinical findings is strongly suggestive of brain death. In clinical practice, isoelectric electroencephalogram in not-brain-dead patients is rarely seen. We report on a 53-year-old patient who suffered ischaemic encephalopathy after cardiopulmonary arrest. He had residual brainstem function with sufficient spontaneous breathing and evidence of cerebral blood flow on single photon emission computed tomography scan, but his electroencephalogram was isoelectric. He survived this condition for more than 7 weeks. This case demonstrates that isoelectric electroencephalogram can not be equated with brain death, and that in prognostic assessment both clinical findings and supportive technical methods are mandatory.

Brain↗
PubMed2003

Delayed cerebrovascular autoregulatory response to ergometer exercise in normotensive elderly humans.

BACKGROUND: Relatively little is known about physiological cerebrovascular haemodynamics during physical stress in elderly healthy individuals. The aim of this study was to determine the effect of ergometer stress on cerebrovascular haemodynamics in elderly healthy individuals in comparison with young healthy individuals, using non-invasive methods. METHODS: Continuous middle cerebral artery blood flow velocity (CBFV; transcranial Doppler ultrasound), beat-to-beat blood pressure, heart rate and transcutaneous pCO(2) were measured in response to 3 min ergometer exercise stress in 18 elderly healthy subjects (mean age +/- SD 66.5 +/- 5.8 years) and 18 healthy young subjects (mean age +/- SD 29.4 +/- 4.7 years). Pulsatility index (PI) was used as a parameter for cerebrovascular resistance. The subjects were in a supine position with an elevated trunk and performed exercise by pedalling on an ergometer, generating 75-100 W. Statistical analysis was carried out using MANOVA, a general linear model with repeated measures. RESULTS: In both groups, blood pressure increased significantly (p < 0.001) with time during exercise, with no significant differences between the groups or regarding interaction (time sequence/group factor). Heart rate increased significantly with time during exercise (p < 0.001) and was significantly more prominent (p = 0.002) and prolonged (p < 0.001) in the young group. pCO(2) did not differ with time or between the groups and with regard to interaction. Mean CBFV (MFV) increased significantly during time (p < 0.001). Between the groups, there was no significant difference (p = 0.836), but with regard to interaction (time sequence/group factor), there was a significant delay in MFV increase in the group of young subjects (p = 0.002). The PI, a measure of cerebrovascular resistance, increased significantly with time without significant differences between the groups (p = 0.061), but was significantly delayed in the elderly regarding the interaction time sequence/group factor (p < 0.001). CONCLUSION: The cerebrovascular changes during ergometer exercise may reflect the combined activation of the cerebrovascular autoregulative mechanisms (predominantly neurogenic and myogenic). In healthy normotensive elderly subjects, cerebral autoregulatory capacity is retained but delayed in response to ergometer stress compared with young healthy subjects. We speculate that these findings may contribute to a higher risk of cerebral hypoperfusion in the elderly.

Adult↗
PubMed2002

[Ocular myasthenic syndrome and systemic lupus erythematosus].

BACKGROUND: Reports on association of systemic lupus erythematosus (SLE) and myasthenia gravis are sparse. CASE REPORT: An 40-year old woman complained of sudden onset of diplopia. A SLE was known for 6 years. Both eyes showed a deficit in upgaze, the right eye showed a deficit in abduction and a slight ptosis. Further ophthalmologic and neurologic status were normal. Magnetic resonance tomographic imaging of the brain and the results of the spinal fluid examination were unremarkable. Sonographic imaging and magnetic resonance tomographic imaging studies showed normal extraocular muscles. The edrophonium test (short acting inhibitor of acetylcholinesterase) was positive (elevation of the ptotic lid after injection of edrophonium). Acetylcholine receptor antibodies were elevated to 70 nmol/l (norm: < 0.25 nmol/l). Thoracic computed tomographic scan showed no evidence of a thymoma/thymus hyperplasia or thymus carcinoma. Systemic steroid treatment resolved the complaints within weeks. CONCLUSIONS: The patient with SLE had an ocular myasthenic syndrome. The etiology of the association of the two autoimmune diseases is not clear. SLE patients showing fatigue signs or pareses should be examined for myasthenia gravis. Patients with isolated ocular myasthenic syndromes should be examined for a generalized immunological disorder.

Adult↗