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Biomedical subjects

M Mumenthaler

Publications and source records attributed to M Mumenthaler.

At least 109 records · Page 6Linked to original sources
PubMed1976

[Pseudoparalytic myasthenia gravis. Diagnostic and therapeutic aspects in 60 separate cases].

Based on 60 of our own cases and on the medical literature the authors discuss the diagnostic, pathophysiological and therapeutic aspects of myasthenia gravis. Myasthenia is suspected in cases of motor weakness of changing intensity, diminishing by rest. The weak muscles are innervated by different peripheral nerves. At the beginning a weakness of upperlid-muscles, external eye muscles and bulbar muscles is particularly frequent. There is no sensory loss or other neurological symptoms. A transitory disappearance of motor weakness after an intravenous dose of Edrophonium (Tensilon) is a typical diagnostic sign. The effect is less evident with eye-muscle weakness. A typical appearance of potentials after repetitive stimulation of peripheral nerves as well as other characteristics in electrophysiological testing of muscles are of high diagnostic value. This allows differentiation from other types of muscle weakness. In the pathogenesis of myasthenia an autoimmune process related to a persistent thymus gland plays an important part. This leads to an ultrastructural change in the postsynaptic membrane of the muscle fibre. The postsynaptic membrane no longer reacts in a normal way to acetylcholine as a transmitter substance at the level of the motor endplate. Therefore the first step in the treatment of myasthenia consists of cholinesterase-inhibitors, specially Neostigmin (Prostigmin) and Pyridostigmin (Mestinon). Thymectomy is advised in all cases of myasthenia with the exception of the pure ocular form and of myasthenia in patients older than 60 years. The thymus gland is practically always persistent or hypertrophic in myasthenia. The suprasternal access is recommended. A thymoma should always be operated upon because of the danger of malignancy. In cases where thymectomy is not performed or not successful and if cholinesterase-inhibitors are not sufficiently efficient, treatment with corticosteroids or ACTH is recommended.

Adolescent↗
PubMed1976

Guillain-Barré syndrome in children with special reference to the natural history of 38 personal cases.

38 children which had had an episode of Guillain-Barré syndrome were studied after a period between 2 and 12 years. The age of the children at the follow-up varied between 7 years 9 months and 27 years. 11 of the children were not completely cured from the point of view of the peripheral nervous system. 9 showed slight signs of motor weakness, 2 of which also had a slight distal atrophy of some leg muscles. None of these 9 patients however had any subjective symptoms of diminished capacity in every-day life. 2 of these and 2 other patients without any muscle weakness had loss of one or more tendon reflexes. 4 other patients apart from the 9 mentioned above had a very slight intention tremor. All of these had had some cerebellar ataxia during the acute phase. A sweat test done in 19 of the 38 controls never showed any asymmetry. 36 patients were examined electrophysiologically during the follow-up: EMG was done in only 35 and in one only conduction velocities were measured. In 16 patients a pathological EMG and (or) an anomalous conduction velocity was found. The only correlations which seemed to exist between the amount of residual findings and some elements during the acute phase of the illness were a positive correlation with the importance of maximum motor deficiency and with the time between the beginning of maximum motor weakness and the beginning of recovery.

Adolescent↗
PubMed1975

[Acroparesthesias due to damage of the nerves of the upper arm and forearm (author's transl)].

Compression syndromes of the radial nerve arise, for example, through pressure in the axilla from crutches or from pressure of the arm against a hard support during sleep. The mechanism is similar in lesions of the median nerves (irritation of the supracondylar apophysis, pronator syndrome). Lesions of the ulnar nerve usually arise from damage to the olecranon groove such as can be caused in manual workers in industry through constant flexion and extension of forearm. As treatment, a change of workplace is often sufficient. Anatomical changes must be removed surgically.

Arm↗
PubMed1975

[Cerebral sclerosis. Diagnostic criteria and differential diagnostic consideration in practice].

In"cerebral arteriosclerosis" the diffuse sclerotic involvement of the cerebral vessels may produce acute softening of cerebral tissue. However this paper concentrates mainly on the clinical symptomatology which, in the absence of major vascular accidents, is characterized from the psychopathologic viewpoint by acute confusional states, aggressive behaviour, fluctuating loss of memory, disturbances of concentration and finally dementia. The chief neurologic symptoms are motor disturbance with short-stepping gait, stooped position of the body, pseudobulbar symptoms with dysarthric speech and disturbances of swallowing, and increased perioral reflexes. A complete case history and a thorough neurologic and psychopathologic examination are the most important factors in diagnosis, while ancillary methods are of value only for differential diagnosis. Prophylaxis and therapy (cardiotherapy, treatment of diabetes and hypertension, lowering of serum cholesterol and sedation) are discussed. In the differential diagnosis of dementia in the elderly patient consideration should be given to chronic vascular diseases, degenerative cerebral atrophies, brain tumors, low pressure hydrocephalus, progressive paralysis and some other rare brain conditions.

Age Factors↗
PubMed1975

Autonomic dysfunction in botulism B: a clinical report.

Nine cases of botulism B with preponderant effects upon cholinergic autonomic innervation are presented. Blurred vision and dry mouth were constant symptoms. Impairment of salivary and lacrimal secretion were detectable for months. In the absence of clinical signs, electromyographic studies did not reveal neuromuscular involvement. Administration of antitoxin in the late course of such cases is not recommended, but guanidine can be used. Doubt is cast upon a new clinical entity called "acute autonomic neuropathy."

Adult↗
PubMed1975

[Whiplash injuries of the cervical spine. A catamnestic study].

Whiplash injuries of the cervical spine are due to the rapid sequence of movements in opposite direction. They are mainly following rear-end collisions where the trunk is pushed rapidly forward. Very important forces act therefore on the different segments of the cervical spine and lead to lesions of the perispinal soft tissues, of the ligaments, of the disks and the bony structures. In 24 tables, the signs and symptoms in 104 personal cases observed for a period which lasted more than 4 years are described. Amongst the clinical signs there are cervical strain, cervico brachial pain, headaches, radicular signs as well as symptoms of concussion and cercial medullar lesion. Radiological findings are discrete; functional X-rays sometimes show local diminution of motility in a single segment. The treatments, amongst these immobilisation and local heat, are discussed. The unusually long duration of local disturbance is stressed. Signs of neurasthenia are part of the typical findings and do not at all mean a secondary neurotic development.

Accidents, Traffic↗
PubMed1975

[Neurologic aspects of cranial arteritis].

This study describes 44 cases of cranial arteritis (41 of whome had been established by arterial biopsy). Special attention has been payed to the type and the significance of initial symptoms. The majority of the patients were from 65-80 years, the youngest 55 years old. The frequency was slightly higher in the male than in the female. All the patients except for two suffered from pain in the area of the head or the face. Ocular disorders had been found in 62% of the cases, commonly represented by blindness of one eye, decreased vision, papillar edema and eventually by occlusion of the retineal artery. The sedimentation rate of red blood cells showed acceleration between 32 and 130 mm after 1 hour. In the average a laps of time of one month was noted between the appearance of the first subjective symptoms and the moment when diagnosis was made. The administration of 60-80 mg Prednisone daily was followed by a decrease in the clinical signs within a few days to 3 weeks. It is important that therapy be started with a high dosis of Prednisone and that it should be reduced to smaller doses given during several years.

Aged↗