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Biomedical subjects

O Gratzl

Publications and source records attributed to O Gratzl.

At least 91 records · Page 5Linked to original sources
PubMed1990

Cerebral blood flow and common carotid flow in neurologically asymptomatic carotid endarterectomy patients.

To define subgroups in 50 neurologically asymptomatic patients with carotid stenosis (mean diam. of stenosis 81.1 +/- 12.5%) regional cerebral blood flow (rCBF) and common carotid artery flow were measured by means of the intravenous Xenon-133 technique and a Doppler flowmeter, respectively. The rCBF studies were performed both at rest and after administration of acetazolamide (Diamox). In this asymptomatic cohort of 50 patients we found subgroups with significant hemispheric baseline asymmetry (BA) (five patients; BA = 7.2 +/- 1.8%) and/or pathological Diamox asymmetry enhancement (DAE) (five patients; DAE = 8.8 +/- 1.3%). Carotid endarterectomy in these cases resulted in a significant reduction of hemispheric differences of rCBF (postoperative BA = 0.4 +/- 3.4, postoperative DAE = 1.7 +/- 3.8). Measurements of common carotid flow revealed significantly higher flow rates in the postoperative period and compensation of intercarotid flow asymmetry. In pathophysiologically defined preclinical subgroups of cerebrovascular disease with hemispheric rCBF differences and/or impairment of the cerebral vascular reserve capacity surgical procedures might be useful.

Adult↗
PubMed1990

Aneurysm, arteriovenous malformation and arteriovenous fistula in posterior fossa compression syndrome.

To discuss the problem of neuroradiological preoperative procedures in patients with therapy-resistant facial pain, we present 3 case examples of vascular processes in the cerebellopontine angle (aneurysm, arteriovenous malformation, arteriovenous fistula). The microsurgical treatment in combination with artificial embolization is described. The vascular causes of microvascular compression at the root entry zone of the trigeminal nerve and malformations involving the nucleus caudalis are reviewed.

Aged↗
PubMed1989

[The value of myelography, computerized tomography and course of pain for the diagnosis of recurrent herniated disk].

29 patients with recurring symptoms after lumbar disk surgery have been examined with computed tomography and myelography before they underwent a reoperation. This study shows that the myelography has the higher diagnostic accuracy than the CT concerning the differentiation between recurrent disk herniation and scar. The analysis of clinical features is helpful in predicting the etiology of the recurring symptoms.

Adult↗
PubMed1989

[Acetazolamide stimulation test in the preoperative assessment of cerebrovascular reserve capacity in unilateral carotid obstruction].

Using the 16-detector 133Xe-NaCl technique (Novo Cerebrograph) quantitative measurements of regional cerebral blood flow (rCBF) were performed in 13 patients with unilateral carotid obstruction before and after stimulation with 1 g acetazolamide. In all patients resting studies showed no significant difference in hemispheric perfusion and a 47% flow increase after acetazolamide on the side with normal carotid artery. On the obstructed side in 8 patients the hemispheric flow increased equally indicating a sufficient and adequate intracerebral collateral circulation and capacity. In 5 patients a significant redistribution of brain flow occurred with diminished increase on the occluded side. This flow pattern indicates an inadequate vasodilator response and insufficient collateral capacity. The rCBF stimulation test identifies patients with a restricted collateral capacity and these patients could benefit from a surgical treatment.

Acetazolamide↗
PubMed1989

[Complications of thromboembolic prophylaxis with heparin-dihydroergotamine].

In a prospective study the complications of Heparin-Dihydroergotamine (HDHE) [2,500 units Heparin + 0.5 mg DHE] s c. twice daily as thromboembolic prophylaxis have been studied in patients undergoing a lumbar disc operation. During a two year period 616 patients were operated, 47 patients had to be excluded, 107 patients did not receive HDHE desired by the surgeon; 462 patients received HDHE as described in the protocol. Because the distribution of age, sex, duration of hospitalisation of the 107 patients without HDHE is the same as in the HDHE group, this group can be used as control group. Increased intraoperative bleeding--written down in the operation report--66 patients (14.3%) in HDHE group and 6 patients (5.6%) in the control group. There is no statistic significance between the both groups in superficial and deep wound hematomas, deep vein thromboses or pulmonary embolism. In the HDHE group two death appears. Both patients [a 37 year old, asymptomatic woman and a 65 year old man with mild ischemic symptoms 11 months prior to operation] died because of an acute myocardial infarction. The clinical course and the missing of stenosis or occlusion at autopsy let us think at the possibility of coronary arterial spasm, presumably caused by DHE, as the cause of myocardial infarction. We suggest not to apply HDHE to patients with coronary artery heart disease or with atypical thoracic pain.

Adult↗
PubMed1988

Intravenous phenytoin loading in patients after neurosurgery and in status epilepticus. A population pharmacokinetic study.

In 49 patients treated with intravenous phenytoin after a neurosurgical procedure or because of repetitive frequent seizures, the serum concentration was measured before and 2 hours after an intravenous bolus injection. Based on these data the apparent volume of distribution and intra- and interpatient variability were determined in this representative patient population, using the statistical package NONMEM. From 5 characteristics tested (age, sex, bodyweight, serum albumin, renal function) only bodyweight was found to significantly influence the apparent volume of distribution of phenytoin. The population average was estimated as 1.0 +/- 0.04 L/kg (estimate +/- SE) and interindividual variability, expressed as coefficient of variation, was 23 +/- 6%. By means of Monte Carlo simulations an optimal dosing scheme for phenytoin loading has been calculated. Based on these results, a dose of 15 mg/kg divided into 3 intravenous injections administered 2 hours apart at a maximum rate of 50 mg/min is recommended. This loading regimen should result in therapeutic concentrations (10 to 20 mg/L) in 90% of patients within 6 hours.

Adolescent↗
PubMed1986

[Acute myocardial infarct after prophylactic administration of low doses of heparin-ergotamine: coronary artery spasm the cause?].

There have been several recent publications reporting vasospastic complications under heparin-dihydroergotamine prophylaxis. We report on 2 patients without significant coronary artery stenosis who died of acute myocardial infarction. Both patients had been operated on for a lumbar disc protrusion and were treated with 2500 IU heparin + 0.5 mg dihydroergotamine s.c. twice daily. The possibility of coronary arterial spasm as the cause of the myocardial infarctions is discussed. Publications reporting cases with myocardial infarctions, presumably caused by coronary arterial spasm, and other vasospastic complications under ergotamine therapy are briefly reviewed.

Adult↗
PubMed1986

Benign intra- and extracranial meningioma.

Report of a case with nonmalignant multiple meningiomas at different levels (supratentorial and spinal) of the cerebromedullary axis. Literature is reviewed for epidemiological, clinical and pathophysiological features of such tumors. The possibility of multifocal intra-and extracranial growth of benign meningiomas should be remembered when patients with changing neurological findings are examined postoperatively.

Aged↗
PubMed1986

[Development, symptomatology and treatment of "animal" and "plant" parasites of the central nervous system].

Eight cases of today rather rare infections of the brain and spinal cord with animal and plant parasites are described. Echinococcus was identified in one patient, cysticercus cellulosis in 4 and in 3 patients various fungi (actinomycosis Meyerii, aspergillus fumigatus, nokardiose asteroides) were found. Prior to the admission to the hospital none of these patients were correctly diagnosed. Animal parasites mimicked the symptomatology of a brain tumour or of a space occupying process. If localised intraspinally they produced signs similar to prolapsed lumbar disc. Plant parasites caused formation of particular suppurative granulation tissues in the form of abscesses which were often disseminated. By contrast, animal parasites produced only mechanical damage of the brain tissue. In addition to surgical intervention aiming at complete removal of parasite cysts or abscesses, drug therapy with the broadspectrum antibiotics or Praziquantel, an isochinoline derivate, is appropriate. Although due to the better diagnostic procedures and specific drug treatment the mortality rate in the countries with widespread parasite infections (Southern Europe and South America) has dropped from 50-80% to 5-6%, the experience shows that only about half of the patients survive the operation when a longer time-span is considered.

Actinomycosis↗
PubMed1985

Topographic studies with 32P tumor marker during operations of brain tumors.

A method for the intraoperative detection of brain tumor propagation is described. Based on the well-known radiophosphorus test, a very sensitive semiconductor probe was tested in 16 brain tumor operations. With this miniaturized sensor, the beta-emission of 32P could be measured with a high topographical resolution. Especially in high-grade gliomas, in meningiomas and in metastases a good discrimination of normal and tumor-infiltrated tissue was possible. The perspectives of a technical improvement of this method and the application of more specific tumor markers are discussed.

Brain Neoplasms↗
PubMed1984

[Epidural hematoma before and following introduction of cerebral computer tomography].

An analysis of 120 extradural hematomas 7 years before and after introduction of computerized axial tomography (CT) showed that application of this new method resulted in considerable progress in diagnostic accuracy and a small saving of time. It was, however, prognostically decisive that the physician at the site of the accident or in the first-aid unit recognized the risk of imminent bleeding and immediately arranged for transport to the neurosurgical centre. The significance of the "typical" early symptoms of extradural hematomas was analysed. The importance of the exposed temporoparietal skull fracture, of careful neurological supervision and generous diagnostic use of the CT-scan is stressed.

Adolescent↗
PubMed1984

Prevention of thromboembolic complications with miniheparin-dihydroergotamine in patients undergoing lumbar disc operations.

We have evaluated the incidence of bleeding complications using miniheparin (2 X 2500 IU daily)-dihydroergotamine starting preoperatively in a randomized, controlled, prospective, double-blind study in 50 patients undergoing herniated lumbar disc operations. There was no difference in the incidence of intraoperative bleeding problems between the two groups. Preoperatively, 13 patients have been treated in another hospital with conventional low-dose heparin, and of these 13 patients, 7 developed bleeding complications. There were two deep wound hematomas in the placebo group. Early removal of stitches or operative revision of the wound was not necessary in either group. We conclude that the use of minidose heparin-dihydroergotamine is feasible for the prevention of thromboembolic complications in patients undergoing herniated lumbar disc operations, since an increased incidence of bleeding complications was not observed. This preventive method should therefore be further clinically evaluated.

Adult↗