Search PubMed⌕ Search

Biomedical subjects

R Brunner

Publications and source records attributed to R Brunner.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Psychotherapy aspects of inpatient treatment of adolescents with acute psychiatric illnesses].

In the inpatient treatment of acute psychiatric episodes in children and adolescents, the psychiatrist must set up an initial treatment plan incorporating one or more psychotherapeutic modalities and adapt this plan to the patient's clinical course. This article summarises the clinical experience of a model unit at the University of Heidelberg, the result of a collaboration between the Department of General Psychiatry and the Department of Child and Adolescent Psychiatry at the Clinic of Psychiatry. A series of 116 adolescent admissions was reviewed for clinical diagnosis, the nature and frequency of psychotherapeutic modalities, and the role of family involvement in patient care. Differential and adaptative approaches to the selection of treatment modalities in the context of an acute care setting are emphasised.

Acute Disease↗
PubMed1997

[Vitrectomy in treatment of eyes with complicated uveitis].

BACKGROUND: Vitrectomy serves as an important treatment modality in uveitis, removing inflamed vitreous body and eliminating secondary complications. The aim of our retrospective study was to evaluate the value of vitrectomy in the treatment of complications in uveitis. PATIENTS AND METHOD: We included 50 eyes of 50 patients suffering from chronic uveitis, which underwent vitrectomy surgery during the period of 1990 to 1993. The study only included patients who had vitrectomy for uveitis for the first time. Indications leading to surgery were density of optic media, retinal detachment, cyclitic or preretinal membranes. The mean follow-up was 455 (range 48-1420) days. RESULTS: Vitrectomy was performed at a mean delay of 452 days after initial presentation. The mean visual acuity at the time of surgery was 0.05. The best visual acuity postoperatively was measured at a mean time of 118 days after vitrectomy. Overall, at the last control, eyes with preoperative retinal detachment presented a much worse final functional result (visual acuity of 0.02) than eyes without detachment (visual acuity of 0.5). Ten eyes resulted in hypotonia after surgery (7 eyes with persisting hypotonia). Most frequent complications in the postoperative course were macular pucker (11 eyes), secondary glaucoma (10 eyes), macular edema (6 eyes) and retinal detachment (6 eyes). Fifty percent of all complications occurred within the first 3 months following surgery. CONCLUSION: Vitrectomy leads to a permanent increase in visual acuity through the treatment of complications, on the condition that a stable retinal situation was present preoperatively.

Adult↗
PubMed1997

Arthrogrypotic joint contracture at the knee and the foot: correction with a circular frame.

The purpose of this study was to investigate the efficacy of an external fixator (Ilizarov apparatus) for the treatment of severe joint contractures in patients with arthrogryposis multiplex congenita. Thirteen knees and 16 feet were treated in 13 patients at an average age of 11.9 years. The knee flexion contractures were corrected from 38.9 degrees preoperatively to a mean of 6.5 degrees postoperatively and to 17.3 degrees at follow-up (34 months). In the foot deformities, the equinus position was corrected from 29.7 degrees to 7.8 degrees on average. This external fixator is an efficient tool for correction of deformities in arthrogryposis.

Adolescent↗
PubMed1997

Morphology of the acetabulum in hip dislocations caused by cerebral palsy.

Twenty-four hip joints in 20 children with spastic cerebral palsy were assessed by standardised three-dimensional reconstructions from computed tomographic scans. All the hip joints showed a channel-like ebony deformity of the acetabulum along which the femoral bead had slid out, indicating a unidirectional instability. The channel was oriented along the longitudinal axis of the body within a sector of 25 degrees anteroposteriorly. In relation to the pelvis, the dislocation was directed more dorsally by 20 degrees as a result of a flexion contracture of the hip. The size of the femoral head corresponded with the size of the acetabulum in every case, even in long-standing dislocations.

Acetabulum↗
PubMed1997

Minimum alveolar concentration for halothane in children with cerebral palsy and severe mental retardation.

Children with cerebral palsy and severe mental retardation who present for operation may require lower concentrations of inhalational anaesthetics than healthy children. The minimum alveolar concentration (MAC) for halothane was measured in 36 children and adolescents, aged 4-18 years, who underwent orthopaedic surgery. The control group consisted of 12 healthy children (group 1). Children with cerebral palsy and severe mental retardation were allocated to one of two groups: those taking chronic anticonvulsant medication (group 2) (n = 12) and those who did not take any drugs (group 3) (n = 12). The mean (SEM) MAC value for halothane (expressed in volume per cent) was 0.90 (0.02) for healthy children. Children with cerebral palsy had significantly lower MAC values whether they took anticonvulsant drugs or not (0.62 (0.03) and 0.71 (0.10), respectively).

Adolescent↗
PubMed1997

Multidrug resistance-associated protein in acute myeloid leukemia: No impact on treatment outcome.

Drug resistance remains a major problem in the treatment of patients with acute myeloid leukemia (AML). Expression of the MDR1 gene in leukemic cells was shown previously to be associated with worse clinical outcome of the patients. The multidrug resistance-associated protein (MRP) has been shown recently to be another protein causing the multidrug resistance phenotype in cell lines, but its impact on clinical outcome in patients with AML remains to be proven. To determine the clinical significance of MRP in patients with de novo AML, we have studied the MRP expression in leukemic cells and its association with both response to induction chemotherapy and survival of the patients. MRP gene expression was determined by immuno-cytochemistry (n = 80) by means of the monoclonal antibodies QCRL-1 and QCRL-3. MRP expression was low, intermediate, and high in 19, 55, and 26% of the patients, respectively. High MRP expression was independent of age and sex of the patients, WBC count, and percentage of blasts. However, high MRP expression was more frequent in the FAB M5 subtype as compared to the other subtypes. MRP expression had no impact on clinical outcome. The complete remission rates were 65, 68, and 63% for patients with low, intermediate, and high expression, respectively. Overall survival was also independent of MRP expression. In contrast, patients with P-glycoprotein-positive AML had lower complete remission rates and shorter durations of survival. These data indicate that MRP is expressed in patients with de novo AML but, in contrast to P-glycoprotein, does not predict for outcome of induction chemotherapy or survival.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1996

The triple flash electroretinogram and its significance in macular diseases. B-wave recovery as a diagnostic tool.

PURPOSE: The purpose of this study was to evaluate recovery data for the b-wave of the electroretinogram (ERG) elicited using multiple flash stimulation with increasing stimulus intervals in normal controls and in patients with macular diseases. The results will describe effects of age and macular disease and define indexes characterizing the recovery process. METHODS: Scotopic Ganzfeld flash ERGs were elicited using interstimulus intervals of 140, 280, and 560 ms. Relative b-waves were calculated as the ratio b140 ms/b560 ms and b280 ms/b560 ms, respectively. Responses obtained in 134 eyes of 134 normal controls served as reference data. Fifty-four patients with different macular diseases were also examined and their data compared to the reference data. RESULTS: Relative b-wave amplitudes correlated with interstimulus interval and with flash luminance, but not with age. All patients had a normal ERG when recorded following the standard of clinical electroretinography. A sigmoidal model was suggested, providing three indexes characterizing the b-wave recovery process. Relative b-waves and recovery indexes varied in age-related macular degeneration, central serous retinopathy, vitelliform macular degeneration, Stargardt's disease, and pattern dystrophy. CONCLUSION: The triple flash ERG reflects energy-yielding and -utilizing mechanisms. It proved to be more sensitive in detecting functional lesions in macular diseases than the standardized explorating procedure. The b-wave recovery model allows differentiation between two independent mechanisms contributing to the b-wave recovery process. One or more of the three characterizing indexes are affected in different macular diseases.

Adolescent↗
PubMed1996

[Effects of fluorescein and indocyanine green angiography on subsequent dark adaptation and the electroretinogram].

BACKGROUND: In clinical practice the electroretinogram (ERG) usually should not be recorded immediately after conventional fluorescein angiography (FLA), because of the bleaching effects of strong light exposure on the course of dark adaptation and on the ERG. Currently it is not known, if indocyaningreen (ICG) angiography using the Heidelberg Retina Angiograph (HRA) has similar effects on the outer retina and if therefore the ERG should also not be recorded after ICG angiography. METHODS: Eight patients with different retinal diseases were examined. After 5 minutes of light adaptation to 160 cd/m2, Ganzfeld ERGs were repeatedly recorded using DTL electrodes during a 30 minutes dark period with a flash luminance of 0.1 cds/.m2. After this dark adaptation period a standardized ERG was recorded according to the ISCEV recommendations. This procedure was followed either by ICG angiography using the HRA or by conventional fluorescein angiography using the Canon CF 60 fundus camera. Within an interval of 5 minutes the above mentioned ERG procedure was repeated. RESULTS: ICG angiography using the HRA did neither affect the course of dark adaptation as measured by increasing b-wave amplitudes during the 30 minutes dark adaptation period, nor the values for each response of the Ganzfeld standard ERG. FLA did neither affect b-wave responses to dim stimuli, nor to stronger stimuli in the scotopic range. However, the course of dark adaptation was significantly prolonged after FLA. The maximum b-wave was not affected. CONCLUSIONS: ICG angiography using the HRA could be performed prior to the recording of the ERG, without any effect on the ERG. In contrast conventional FLA must be performed after ERG recordings, in order not to alter the electrophysiological responses.

Adult↗
PubMed1996

Inaccuracy of the migration percentage and center-edge angle in predicting femoral head displacement in cerebral palsy.

Six patients (seven hips) with total-body-involvement cerebral palsy were assessed for a hip reconstruction. Four patients (five hips) underwent three-dimensional computerized tomographic (3D CT) scans, and in two patients, faux profile views were obtained. The femoral head was subluxed or dislocated anteriorly in all seven hips. The migration percentage (MP) and center-edge angle (CEA) underestimated the pathology. We conclude that the MP and CEA do not exclude an anterior displacement of the femoral head and calls into question the accuracy of methods relying on two-dimensional imaging in assessing hip containment in this group of patients. The faux profile view is sufficient to show an anterior hip displacement but a 3D CT gives superior detail to help in planning a surgical reconstruction.

Cerebral Palsy↗
PubMed1996

Clinical efficacy of haemorheological treatment using plasma exchange, selective adsorption and membrane differential filtration in maculopathy, retinal vein occlusion and uveal effusion syndrome.

The aim of the study was to test the clinical efficacy of haemorheological treatment with extracorporeal techniques in ocular diseases. We treated patients suffering from maculopathies of different origin: age-related (AMD, n = 17), uveitis-associated (n = 14) and myopia-associated maculopathy (n = 5). We also treated patients with uveal effusion syndrome (n = 3) and central retinal vein occlusion (n = 4) resistant to haemodilution or steroid therapy. The treatment consisted of plasma exchange, selective adsorption with a tryptophan-polyvinylalcohol adsorber and membrane differential filtration. Maculopathy patients underwent two treatments while the other patients received between 1 and 7 treatments. Pulsatile ocular blood flow was measured in 10 patients before and after therapy. The main parameter for evaluating clinical outcome was the change in visual acuity. Severe side-effects did not occur. The rheological parameters including plasma viscosity, whole blood viscosity and erythrocyte aggregation were statistically significantly lowered. Of 36 patients suffering from maculopathy, 25 showed an improvement of at least 1 line of visual acuity after therapy, 7/17 patients in AMD, 6/14 in uveitis and 0/5 in myopia improved 3 lines or more. All patients suffering from retinal vein occlusion improved at least 1 line and two showed an improvement of 3 lines or more. In uveal effusion syndrome, an improvement of 3 lines or more was reached in all patients. Plasma exchange, selective adsorption and membrane differential filtration are effective rheological treatment approaches to improving visual acuity in patients suffering from maculopathy except myopia-associated maculopathy. Efficacy in patients suffering from central retinal vein occlusion and uveal effusion syndrome was proven, even when the patients were resistant to previous haemodilution or steroid therapy. We conclude that a rheological approach should be considered before invasive methods such as laser coagulation, radiation therapy or surgery are applied.

Hemofiltration↗
PubMed1996

Changes of haemorheological parameters when using plasma exchange, selective adsorption and membrane differential separation.

At present, conventional haemorheotherapy consists of changes in life-style, drug therapy and haemodilution. Extracorporeal therapy has been considered only for the treatment of hyperviscosity syndromes. However, a wide range of viscosity-related syndromes may be amenable to rheological therapy if appropriate techniques were available. According to our data, plasma exchange, selective adsorption and membrane differential filtration may lead to an improvement of haemorheology and clinical conditions. For reasons of economy and feasability, membrane differential filtration is favoured over other techniques of differential separation therapy.

Blood Viscosity↗
PubMed1996

Pathological fractures in patients with cerebral palsy.

A retrospective study was made of 37 patients with 54 fractures that occurred without significant trauma. The morbidity and causes of these pathological fractures in patients with cerebral palsy were analyzed. The major causes for the fractures were long and fragile lever arms and stiffness in major joints, particularly the hips and knees. An additional factor was severe osteoporosis following a long period of postoperative immobilization. Seventy-four percent of the fractures occurred in the femoral shaft and supracondylar region. Stress fractures were rare (7%) and involved only the patella. Conservative treatment was sufficient in most cases but surgical fixation provided a good alternative for fractures of the femoral shaft. Intraarticular fractures with joint incongruity resulted in a decreased level of activity of the patient. Since osteoporosis is a major risk factor, patients with cerebral palsy should bear weight to prevent pathological fractures. Any stiffness of major joints and extended periods of immobilization should be avoided.

Adolescent↗
PubMed1995

Prevention of heterotopic ossification in hip arthroplasties by means of an early single-dose radiotherapy (6 Gy).

Radiotherapy has proven to be efficient in the prevention of heterotopic bone formation. Its importance is increasing in the treatment of uncemented implants in prosthetic hip surgery, where a localized irradiation field is applied to cover the bone-implant interface. In a prospective study the efficiency of two radiation concepts using two different doses to prevent heterotopic ossifications after total hip arthroplasties or revision arthroplasties was compared. In 7 patients after fractioned irradiation (5 x 2 Gy), two recurrences of periarticular ossification occurred, whilst in 17 patients after a single-shot irradiation of 6 Gy on the first postoperative day, no recurrences were seen. There were no side-effects from the radiation. Radiological signs of lucent cement-free implants or delayed wound-healing were absent. Thus, a single shot of 6 Gy applied within 24 h postoperatively reliably prevents heterotopic bone formation. It is safer than 5 x 2 Gy and facilitates the management of the patient.

Aged↗
PubMed1995

Circadian variations in antigen-specific proliferation of human T lymphocytes and correlation to cortisol production.

Cortisol is a well-known immunosuppressant when used therapeutically. The present investigation was set out to study if diurnal variations in endogenous cortisol production are reflected by changes in proliferative responses of human lymphocytes to either a mitogen (phytohemagglutinin-A, PHA) or an antigen (tetanus toxoid, TT) stimulus. The study included eight healthy volunteers. Blood was withdrawn at 0200, 0600, 1000, and 1800h for preparation of lymphocytes and determination of cortisol in plasma. Isolated cells were incubated without (baseline activity) or with inclusion of either 1 micrograms PHA or 10 micrograms TT. Proliferation was measured by labelling with 3H-thymidine for 16 h of culture. The cortisol plasma levels exhibited the well known diurnal variations with highest concentrations at 1000h and lowest levels at 0200h. Baseline activity or PHA stimulated cell proliferation did not show significant diurnal fluctuations. The response to TT, however, decreased by 38% between 0600 and 1000h (p = .01). Correlation analyses revealed that the reduction of the proliferative responses to TT correlated significantly (p < .05) with increases in cortisol plasma levels. It was concluded that diurnal fluctuations in the production of endogenous cortisol might be relevant for daytime dependent variations in immune responsiveness.

Adult↗
PubMed1995

Electrophysiologic abnormalities in two cases of familial amyloidosis.

PURPOSE/METHODS: We recorded electrophysiologic data of two patients with familial amyloidosis. RESULTS/CONCLUSIONS: Only minor abnormalities could be demonstrated clinically and by means of fluorescein angiography in one patient. Considerable alterations of electrophysiologic responses could be found in both patients. These results suggest that an early retinal or optic nerve involvement in amyloidosis could be detected by using these noninvasive techniques.

Adult↗
PubMed1995

[Changes in muscle power following tendon lengthening and tendon transfer].

Each muscle consists of a tendon, the aponeuroses and the muscle fibers. Because of the anatomical architecture a force functionally adapted to the joint motion is generated by the muscle. If the functional length changes, the muscle adapts by altering the number of sarcomeres in a series. If the tendon is elongated without changing the functional range of motion at which the muscle is active on the joint, the passive tension is decreased. As a result, the number of sarcomeres in a series is reduced. The muscle produces less force and the range of active force production is narrowed. If by elongating the tendon, however, the functional range of motion of the muscle at the joint is moved and the tension remains unchanged, the muscle force can be preserved. A tendon transfer affects the muscle in a similar way. If the length of the muscle (and the tension) remains unchanged, the muscle force will be preserved. This prerequisite is fulfilled even better the more the architecture of the replacing muscle equals what is being replaced.

Biomechanical Phenomena↗
PubMed1995

Change in hemorrheological and biochemical parameters following membrane differential filtration.

INTRODUCTION: The elimination of high molecular weight proteins may have a positive influence on disorders of the microcirculation due to an improvement in rheological parameters. We therefore attempted to evaluate the rheological efficacy of membrane differential filtration (MDF). PATIENTS AND METHODS: Ten patients suffering from macular disease underwent MDF. Rheological and biochemical parameters as well as visual acuity were determined one day before and after therapy: The study aimed at a reduction in plasma viscosity, standardized whole blood viscosity at hematocrit 0.45 and erythrocyte aggregation at hematocrit 0.3. RESULTS: Severe side-effects were not observed. The rheological parameters were significantly reduced. In detail the posttreatment values were reduced as compared to the pretreatment values as follows: plasma viscosity 85%, standardised whole blood viscosity 86% (hematocrit 0.45), erythrocyte aggregation 59% (hematocrit 0.3), total protein 81%, IgG 66%, IgA 59%, IgM 33%, alpha-2-macroglobulin 30%, triglycerides 102%, total cholesterol 47%, VLDL cholesterol 94%, LDL cholesterol 33%, HDL cholesterol 62%. Visual acuity was improved in 7/10 patients. CONCLUSIONS: MDF is a safe and highly effective method for lowering biochemical and improving rheological parameters which led to improvement in visual acuity. We have already replaced plasma exchange with MDF in our clinical practice of hemorrheological therapy.

Aged↗