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Biomedical subjects

R A Frowein

Publications and source records attributed to R A Frowein.

At least 37 records · Page 2Linked to original sources
PubMed1989

Early post-traumatic intracranial hematoma.

To summarise, it is apparent that operable acute hematomas are found particularly in the second and third hours after a CCI. Therefore, it is during the first hour after a CCI that the control of the vital functions of respiration and circulation are the most important. When a hematoma is suspected, the diagnostic procedure must be organized promptly, particularly in the second and third hour. Later, the chances of recovery for a patient with an epidural hematoma are greatly reduced.

Brain Injuries↗
PubMed1989

Encapsulated subdural hematoma.

In 45 out of 103 cases with chronic subdural hematoma a definite membrane was found. Membranectomy was performed in 37 cases, mostly as a secondary procedure after burr-hole evacuation and closed system drainage. The mortality rate was 6.6% and in the survivors a complete recovery was achieved in 90%. CT monitoring of the diameter of the hematoma and midline shift did not reveal any correlation of size of the hematoma with neurological findings. The indication for membranectomy can, therefore, not be based on radiological findings alone, but on the clinical course of events and with due regard to the CT findings.

Adult↗
PubMed1989

Brain death criteria: third generation.

Hence, in the third generation of brain death criteria, the disappearance of evoked potentials is, in our opinion, the best of the new tests. There are, therefore, three tests alternatively available: ECS, EP-abolition and CCA, which permit a shortening of the observation time, before the determination of brain death. This is not valid for newborns. In these tests the difference between supratentorial and infratentorial primary brain lesions has to be considered carefully. In infratentorial lesions the apnea can precede the ECS by several hours.

Brain Death↗
PubMed1989

Humoral immunodeficiency syndrome in patients with severe head injury?

Twenty patients with severe head injury were analysed as to whether they developed a humoral immunodeficiency syndrome. In spite of the fact that 75% developed pyogenic complications all patients showed a polyclonal humoral activation of their immune system with an increase in IgG, IgA, IgM and the complement factors. Four patients died from cerebral complications partly associated with infections. Because our patients did not develop a humoral immune defect and because there is no proof so far of a cellular defect, we think that the cause of respiratory infections is a pulmonary disturbance primarily caused by hypothalamic factors, whose release is stimulated by traumatically induced cerebral lesions.

Adolescent↗
PubMed1989

Fractures of the thoraco-lumbar spine with neurological deficits.

We present 78 patients with spinal cord injuries. Operation is not indicated in cord contusion, extended bleeding into the spinal canal or severe fracture dislocation. However, it would seem advisable to operate on patients with vertebral fractures, particularly at the lower thoracic and lumbar levels, if intraspinal bone fragments are detected by CT scan.

Adolescent↗
PubMed1989

Traumatic disc prolapses.

Traumatic disc lesions are uncommon not only in lumbar but also in the cervical region. They are, nevertheless, a reality. In adults they occur almost exclusively where there is previous damage to the disc. Therefore, the trauma has always the significance of only transitory, not definitive deterioration in this illness. Such a traumatic effect could be demonstrated in four patients out of 1,771 lumbar disc operations as definite (0.2%) and in 7 patients (0.4%) as possible. In 15 patients (0.9%) the effect remains doubtful. An analysis of the cause of the illness in 600 patients with cervical disc operations showed a definite influence of trauma in 12 (2%) and a possible influence in 10 (1.6%). In 4 patients the effect remains doubtful (0.6%).

Accidental Falls↗
PubMed1988

Personality after head injury.

For the discussion of post-traumatic so-called full recovery, only a very limited array of injured persons were at our disposal. Two-thirds of these patients are young and their personality needs long, patient rehabilitation. However, duration of coma in young severely injured patients does not seem to mean the same as in elderly patients. Of the last third of our patients the greatest number work as craftsmen. Among the patients with a higher level of education, there were only 7% of patients with full recovery and also 7% with partial recovery, who actually went back to their original work. For the assessment of results, we have to be aware of the important differences of age and level of education. Therefore it would be probably worth-while to continue the work of Jean Brihaye in the Glossary, to define the items of post-traumatic personality, so that for a strongly restricted assessment of results, a limited but clearly defined group of patients can be compared.

Brain Damage, Chronic↗
PubMed1987

Postoperative magnetic resonance imaging artifacts. Report of three cases.

Artifacts are occasionally encountered on magnetic resonance imaging after operation. These may be due to minute metallic particles from neurosurgical instruments. Particles not detectable on plain x-ray films or computerized tomography scans may cause local change of magnetic resonance activity, resulting in a deceptive magnetic resonance appearance. Three illustrative case reports are presented.

Adult↗
PubMed1987

[CT cisternography in the diagnosis of nasal cerebrospinal fluid fistulas].

Four out of 12 patients with CT-cisternography were operated on. The CT findings were all confirmed at operation. In three patients with positive CT findings, the fistula was located at operation. In one case with negative CT findings, operation revealed no fistula either. Advantages of CT-cisternography are reliability of positive findings and the possibility of locating the fistula in some cases. The procedure bears relatively little risk and can be repeated.

Cerebrospinal Fluid Rhinorrhea↗
PubMed1987

[Criteria of brain death: 3d generation. Interpretation of criteria established by the Federal Chamber of Physicians in determining brain death].

The criteria of brain death published by the Federal Chamber of Physicians in 1982 in their second generation have stood the test of time and remain valid. The most important amendments in issuing a third generation are the following: In primary cerebral lesions supratentorial lesions have to be distinguished from infratentorial processes. In primarily the infratentorial processes EEG activities of the cortex max outlast apneic brain stem areflexia. Therefore in infratentorial processes controls of the EEG are indispensable. The extinction of evoked potentials, certain conditions being observed, may prove the loss of brain stem function and therefore may allow to shorten observation time, and may offer an alternative to isoelectricity in the EEG or cerebral perfusion stop as a diagnostic procedure. Additional tests for brain death are commented on. Special considerations are necessary in brain death in children.

Brain Damage, Chronic↗
PubMed1985

Acute spinal epidural empyema. Observations from seven cases.

Seven cases with an acute epidural spinal empyema are presented. The best results are observed in cases with early treatment. Since this rare condition is not widely known and swift diagnosis and treatment is imperative, it is stressed that immediate referral of the patient with back pain and any signs of infection in addition to commencing neurological abnormalities to a neurological unit for myelography can be vital or can at least reduce the risk of permanent paraplegia.

Abscess↗