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Biomedical subjects

M Sturzenegger

Publications and source records attributed to M Sturzenegger.

At least 91 records · Page 5Linked to original sources
PubMed1994

[Characteristics of young suicide attempters and their importance for helpers].

66 suicide attempters were interviewed with the European Parasuicide Study Interview Schedule (EPSIS) and characteristics of persons under the age of 26 were compared with those over 26.82% of the young suicide attempters gave interpersonal conflicts as reasons for their suicide attempts while most older persons gave psychiatric disorders as reasons. The younger group also had significantly lower scores on the Beck Depression Inventory and the Hopelessness Scale. While younger suicide attempters rarely had sought help from their GP within the month preceding the attempt one third of the older group had done so. It is concluded that in order to understand the reasons why people attempt suicide a differential approach combining the concept of crisis as well as the concept of illness is needed. Helpers should know that young suicide attempters rarely show signs of clear psychiatric disorder but usually attempt suicide because they are unable to cope with interpersonal conflicts.

Adolescent↗
PubMed1994

[The treatment of combined digital-palmar injuries].

Different treatment modalities for palmar combined injuries of the fingers are described. Several possibilities are mentioned for each traumatized structure which can be involved in such injuries. Early functional after-treatment is emphasized, which usually needs stable reconstruction for all injured components (skin, nerves, arteries, fractures, joints, flexor tendons and pulleys), so as to allow immediate active mobilization. The results of palmar combined injuries of 178 fingers in 150 patients, treated from September 1986 to May 1991 at the Division of Hand Surgery, University of Bern, Switzerland, offer the more recent experience for the favoured handling of such injuries. The results were collected and statistically analyzed to seek for mutual interactions in the healing of the different structural components.

Adolescent↗
PubMed1993

[Transcranial color-coded duplex ultrasonography in adults].

UNLABELLED: Transcranial color-coded duplex sonography (TCCD) represents an improvement in ultrasound technology for study of the intracranial circulation. This new method was applied in 33 healthy volunteers and 63 neurological patients in order to study the following questions: (1.) how often can non-occluded intracranial arteries be delineated; (2.) reliability of pathological TCCD findings in comparison with cerebral angiography; (3.) reference blood flow velocity data. RESULTS: 99% of vertebral (VA), 98% of basilar (BA), 96% of middle (MCA) and posterior cerebral (PCA), 95% of internal carotid (ICA; siphon and terminal segment), 93% of anterior cerebral (ACA), and 86% of posterior inferior cerebellar (PICA) arteries were delineated. In conjunction with the findings of extracranial color-coded duplex sonography (ECCD), 4 stenoses (2 MCA, 1 ICA and PCA each), 8 occlusions (4 ICA, 1 ACA, MCA, BA and VA each; differential diagnosis: subtotal stenosis), 9 collateral circulations (anterior and posterior communicating arteries in 4 cases each, occipital artery-intracranial VA in one), 4 cerebral arteriovenous malformations, and 2 giant aneurysms of the terminal ICA were suspected and confirmed by angiography. However, 2 hypoplastic VA's and ipsilateral PICA's were missed. (3.) Maximal +/- SD values were 83 +/- 27, 110 +/- 18, 67 +/- 12, 64 +/- 13, 53 +/- 13, and 51 +/- 12 cm/sec for systolic, and 36 +/- 9, 49 +/- 9, 30 +/- 7, 29 +/- 8, 24 +/- 7, and 25 +/- 7 cm/sec for end-diastolic velocity in the ACA, MCA, PCA, BA, VA, and PICA.

Adult↗
PubMed1993

Factors influencing recovery from headache after common whiplash.

OBJECTIVE: To assess the relation between pretraumatic and trauma related headache in patients suffering from whiplash. DESIGN: Follow up study of patients examined a mean (SD) of 7.4 (4.2) days after trauma and again at three and six months. SETTING: Patients referred from primary care. SUBJECTS: 117 patients (mean age 30.8 (9.5) years. MAIN OUTCOME MEASURES: Prevalence of trauma related headache and the predictive relation by multiple logistic regression between different somatic and psychological variables and trauma related headache at each examination. RESULTS: Prevalence of trauma related headache decreased from 57% to 27%. History of pretraumatic headache proved a significant risk factor for presenting with trauma related headache. A significant relation between trauma related headache and the following variables was found: at seven days the initial wellbeing score, early onset of neck pain, depression scale from the personality inventory, and the initial intensity of neck pain; at three months, intensity of neck pain, and history of pretraumatic headache; and at six months neck pain, pain intensity, and history of pretraumatic headache. CONCLUSIONS: History of pretraumatic headache significantly increases the likelihood of presenting with trauma related headache but only in combination with findings indicative of clinically important injury to the cervical spine.

Adult↗
PubMed1993

[Results of a 1-year follow-up study of whiplash injury].

Based on a strict definition of whiplash injury, a sample of 117 non-selected patients was examined 7.2 +/- 4.2 days and at 3, 6 and 12 months after trauma. Initially all patients underwent a neurological examination, cognitive and psychosocial factor assessment and cervical spine x-rays. 56%, 70% and 76% of patients had completely recovered at 3, 6 and 12 months respectively. The results indicated that impairment of patients' well-being and cognitive ability was closely associated with somatic symptoms. No major impairment of attentional functioning was found, but some change in cognitive equilibrium was observed which may be related to the type of medication utilized. Delayed recovery at 12 months could be predicted by the following initial variables: higher age, intensity of initial neck pain and headache, symptoms of radicular irritation, sleep disturbances, pretraumatic headache, history of head trauma, nervousness score and--significantly inversely proportional--initial concentration problems and neuroticism score. These results suggest that a more severe neck injury may in particular account for delayed recovery from whiplash.

Adult↗
PubMed1993

[Vertebral artery dissection following manipulation of the cervical vertebrae].

We report on two patients who developed symptoms and signs of infarction of dorsolateral medulla oblongata (Wallenberg's syndrome) and the cerebellum respectively, following cervical manipulation for slight neck pain. Subsequent vertebral artery angiography and MRI showed the typical signs of vertebral artery dissection of the atlantoaxial and intracranial segment in one patient, and of the intertransverse segment in the second. The pathogenesis of vertebral artery injury following cervical manipulation is discussed and the literature is reviewed. The practical implications of this rare complication are discussed.

Adult↗
PubMed1993

[Acute headache].

Sudden, explosive headache is rather rare. Though dramatic for the patient and the physician, it does not necessarily herald an intracranial catastrophe. Benign and dangerous thunderclap headaches cannot be distinguished from the features of headache itself, but rather on the basis of the situation, the additional symptoms and the findings. This means that every sudden headache should be considered potentially dangerous and be investigated immediately. The dangerous forms comprise intermittent hydrocephalus, acute bacterial meningitis and above all vascular complications. Subarachnoid hemorrhage frequently must be ruled out by computed tomography and lumbar puncture. Intracerebral, especially cerebellar hemorrhage, as well as hypertensive crisis require immediate treatment. Fatal cerebral embolism complicating spontaneous dissection of craniocervical arteries (carotid or vertebral arteries) can be prevented by early anticoagulant therapy. To confirm diagnosis, additional investigations such as CT, lumbar puncture or cerebrovascular ultrasound, and in rare cases MRI, should be performed early as the available time for effective therapy in many situations is short. Many of the benign forms of sudden headache can be diagnosed with a focused interview (cold or drug induced and food dependent headaches, sinusitis, glaucoma). Others, such as neuralgia, cough and coital headache, can be diagnosed as benign only when additional investigations have ruled out symptomatic forms.

Acute Disease↗
PubMed1993

Cognitive functioning after common whiplash. A controlled follow-up study.

A random sample of 98 patients with common whiplash was examined early after trauma (mean +/- SD, 7.3 +/- 3.9 days) and again 6 months later. Cognitive functioning was assessed in conjunction with complaints, pain intensity, well-being, subjective cognitive impairment, neuroticism, and medication. At 6 months, 67 patients had fully recovered (asymptomatic group), while 31 were still symptomatic (symptomatic group). Symptomatic patients who were older at baseline, had a greater variety of symptoms, higher neck pain intensity, and greater subjective cognitive impairment. At baseline, both groups scored poorly on tests requiring complex attentional processing. All neuropsychological functions improved to normal at 6 months in both groups. This improvement cannot be explained by a practice effect, as shown by the results of normal volunteers. The symptomatic group showed delayed recovery regarding complex attentional functioning, which may be related to adverse effects of medication.

Adult↗
PubMed1993

Psychosocial stress, cognitive performance and disability after common whiplash.

The relationship between psychosocial stress, cognitive performance and disability was assessed in 97 randomly selected common whiplash patients. Patients were investigated early after injury (mean 7.2 days, SD = 3.8) and again at 6 months. Assessment included different aspects of psychosocial stress, negative affectivity, personality traits and attentional functioning. At 6 months six patients (7%) showed partial or complete disability (disabled group) while 91 patients went back to work at pre-injury levels (non-disabled group). However, 26 patients from the latter group at 6 months were still symptomatic. The disabled and non-disabled groups did not differ with respect to psychosocial stress, negative affectivity and personality traits as assessed at baseline. At 6 months no significant differences were found between the disabled group and 26 symptomatic patients from the non-disabled group with respect to any of the assessed factors. The disabled group showed a combination of the following variables as assessed at baseline: greater age, initial neck pain intensity, initial back pain, blurred vision, and anxiety but less dizziness, sensitivity to noise and neurotic or behavioural problems in childhood.

Adult↗
PubMed1993

Cranial nerve palsies in spontaneous carotid artery dissection.

Two patients had isolated unilateral cranial nerve palsies due to spontaneous internal carotid artery (ICA) dissection without ischaemic cerebral involvement. One had acute glossopharyngeal and vagal, the other isolated hypoglossal nerve palsy. Reviewing all reported cases of angiographically confirmed ICA dissection in the literature, 36 additional cases with unequivocal ipsilateral cranial nerve palsies were analysed. While an isolated palsy of the IXth and Xth has not been reported previously, palsies of the XIIth nerve or the IXth to XIIth nerves were most frequently found. In these patients, lower cranial nerve palsies are probably the result of compression by an enlarging ICA due to mural haematoma. Symptoms and signs indicative of carotid dissection were concurrently present only in some reported cases. This raises the question of unrecognised carotid dissection as a cause of isolated cranial nerve palsies. When the dissection occurs in the subadventitial layer without relevant narrowing of the arterial lumen and when an aneurysm is thrombosed, angiography does not reliably yield the diagnosis. Therefore, carotid dissection might have been underestimated as a cause of isolated lower cranial nerve palsies before the advent of MRI. MRI demonstrates directly the extension of the wall haematoma in the axial and longitudinal planes. Some arteriopathies such as fibromuscular dysplasia and tortuosity make a vessel predisposed to dissection.

Adult↗
PubMed1993

Ultrasound findings in spontaneous extracranial vertebral artery dissection.

BACKGROUND AND PURPOSE: In this study we analyzed the value of ultrasound examination for diagnosis of vertebral artery dissection. METHODS: The vertebrobasilar arterial system was assessed in 14 patients using transcranial and extracranial pulsed-wave Doppler and duplex sonography. RESULTS: The dissections were verified by angiography (in 1 patient), magnetic resonance imaging (in 5), or both (in 8). The dissected segments were atlantoaxial (V-3) in 6, V-3 and intertransverse (V-2) in 3, V-3 and intracranial (V-4) in 3, and V-2 in 2 patients. Extracranial and transcranial Doppler examination of the atlas loop, involved in 12 patients, showed absent flow signal in 5, low bidirectional flow signal in 1, and poststenotic low blood flow velocities in 3 patients. Seven of these patients had high-grade stenosis or occlusion. The stenotic segment with increased flow signal could be identified directly in 2 patients. Duplex examination of the intertransverse segment confirmed absent flow in 4 patients, making technically insufficient examination unlikely. In the 2 patients with directly detected stenosis, duplex examination showed low flow velocities before the stenosis. The combined use of extracranial and transcranial Doppler and duplex sonography increases the diagnostic yield to detect vertebral artery pathology. If any abnormal sonographic finding was considered, the yield was 86%; relying only on definitively abnormal findings (absent flow signal, severely reduced vertebral artery blood flow velocities, no diastolic flow, bidirectional flow, and a stenosis signal), the yield was 64%. CONCLUSIONS: In most cases, there is no pathognomonic ultrasound finding for vertebral artery dissection. However, if a patient presents with suggestive symptoms, ultrasound may corroborate the clinical suspicion and aid in the decision regarding early anticoagulant treatment. A definite diagnosis can be made noninvasively when magnetic resonance imaging demonstrates hematoma in the vessel wall. Angiography yields additional information such as nature of underlying vascular disease, site and extent of dissection, intracranial extension, and presence of pseudoaneurysm.

Adult↗
PubMed1993

[Lumbalgia--how to proceed?].

In more than 80% of these patients no objective pathologic cause can be found and in most the disorder is self limited and benign. Nonetheless, a systematic approach to LBP should identify those patients with a serious disorder requiring special treatment. Thorough examination is the basis of treatment and management of these patients at risk for back pain disability with enormous socio-economic consequences. Psychosocial factors are at least as predictive for disability as physical.

Diagnosis, Differential↗
PubMed1993

[Mononeuritis multiplex as initial manifestation of systemic granulomatosis].

We report two young patients with a painful and rapidly progressive polyneuropathy of the mononeuritis multiplex type confiding them to bed. Extensive investigations led to the diagnosis of a granulomatosis in both: Churg-Strauss allergic granulomatosis in one and Wegener's granulomatosis in the other. The importance and frequency of peripheral nervous system manifestations in the presenting clinical pattern of a systemic granulomatosis and vasculitis are discussed. Their proper recognition with regard to available effective therapeutic measures is stressed.

Adult↗
PubMed1992

[Neurogenic pain syndrome].

Several pathophysiologic mechanisms are known which induce neuropathic pain in presence of peripheral nerve damage. They help to explain the clinical features of neuropathic pain syndromes and why causal and symptomatic treatments can be effective. However, careful analysis of every pain syndrome is necessary in order to select the type of pain management required.

Analgesia↗
PubMed1992

Tibial nerve mistakenly used as a tendon graft. Reports of three cases.

We describe three patients in whom the tibial nerve was used, in mistake for the plantaris tendon, to repair a ruptured calcaneal tendon. The tendon repair was successful in all cases, but despite attempted reconstruction of the nerve, no patient had any motor recovery although two regained some protective sensation.

Adolescent↗
PubMed1992

[Microsurgical and histological observations in schwannoma of peripheral nerves].

From 1986 to 1991, eight patients with benign schwannomas (neurilemomas) of peripheral nerves underwent tumor resection. In six of eight cases, microsurgical dissection revealed one or several nerve fascicles "disappearing" in the center of the schwannoma. Therefore, these fascicles had to be removed along with the tumor. This observation contradicts the current opinion that enucleation of benign schwannomas is usually straightforward and possible without fascicular damage. Interestingly, the resection of fascicles did not create additional neurological deficits. For functional reasons, partial nerve grafts bridging the resulting fascicular defects were considered appropriate in two cases. Tumors of peripheral nerves should be treated by surgeons familiar with microsurgical operative techniques.

Adult↗