Biomedical subjects

S Kellermann

Publications and source records attributed to S Kellermann.

At least 19 recordsLinked to original sources

PubMed2001

Intervertebral disc calcification in childhood--a case report and review of the literature.

The authors report the case of a 10-year-old girl with intervertebral disc calcifications from the levels C6/C7 to Th1/Th2, presenting with a herniated calcified intervertebral disc at the C7/Th1 level, causing spinal cord compression with subsequent progressive paresis and sensory loss of her left leg. After anterior cervical discectomy and fusion the neurological deficits completely resolved within 2 weeks. It can be concluded that calcification of an intervertebral disc is a rare syndrome in childhood, causing progressive neurological deficit only in a few reported cases. Although the treatment of choice is conservative, surgery is required in patients who develop progressive neurological deficit.

Calcinosis↗

PubMed2001

Case report. Mycotic arteritis due to Aspergillus fumigatus in a diabetic with retrobulbar aspergillosis and mycotic meningitis.

A 74-year-old man with diabetes mellitus type II, retinopathy and polyneuropathy suffered from exophthalmus, ptosis and diplopia. Magnetic resonance imaging and computer tomography showed a space-occupying process in the right orbital apex. An extranasal ethmoidectomy accompanied by an orbitotomia revealed the presence of septated hyphae. Aspergillus fumigatus was grown from the tissue. After surgical removal of the fungal masses, therapy with amphotericin B (1 mg kg(-1) body weight) plus itraconazole (Sempera, 200 mg per day) over 6 weeks was initiated. Five months later the patient's condition deteriorated again, with vomiting, nausea and pain behind the right eye plus increasing exophthalmus. Antifungal therapy was started again with amphotericin B and 5-fluorocytosine. Neutropenia did not occur. The patient became somnolent and deteriorated, a meningitis was suggested. Aspergillus antigen (titre 1:2, Pastorex) was detected in liquor. Anti-Aspergillus antibodies were not detectable. Both the right eye and retrobulbar fungal masses were eradicated by means of an exenteratio bulbi et orbitae. However, renal insufficiency and an apallic syndrome developed and the patient died. At autopsy, a mycotic aneurysm of the arteria carotis interna dextra was detected. The mycotic vasculitis of this aneurysm had caused a rupture of the blood vessel followed by a massive subarachnoidal haemorrhage. In addition, severe mycotic sphenoidal sinusitis and aspergillosis of the right orbit were seen, which had led to a bifrontal meningitis.

Aged↗

PubMed2001

Unusual triplet expansion associated with neurogenic changes in a family with oculopharyngeal muscular dystrophy.

The occasional observation of neurogenic features in oculopharyngeal muscular dystrophy (OPMD) is unclear both in nosological and in etiological respects. Studies are reported here of a family with autosomal-dominant OPMD involving seven members over three generations. In three of them muscle biopsies were performed. Two of the patients (a 45-year-old sister and a 57-year-old brother of the third generation) were studied in more detail and, in addition to the typical changes of OPMD, showed a neurogenic component both by electrophysiology and morphology. Molecular genetic investigations revealed a repeat unit of (GCG/GCA)13 in the first exon of the poly(A)binding-protein2 gene in both siblings. A possible association of this unusually long triplet repeat extension with the atypical phenotype is considered and has to be verified in other cases.

Biopsy↗

PubMed2001

Gross-total surgery of supratentorial low-grade gliomas under intraoperative MR guidance.

BACKGROUND AND PURPOSE: Length of survival of patients with low-grade glioma correlates with the extent of tumor resection. These tumors, however, are difficult to distinguish intraoperatively from normal brain tissue, often leading to incomplete resection. Our goal was to evaluate the effectiveness of intraoperative MR guidance in achieving gross-total resection. METHODS: We studied 12 patients with low-grade glioma who underwent surgery within a vertically open 0.5-T MR system. During surgery, localization of residual tumor tissue was guided by interactive, near real-time imaging. The amount of residual tumor tissue on MR images was evaluated at the point of the operation at which the neurosurgeon would have terminated the procedure under conventional conditions (first control) and again before closing the craniotomy. RESULTS: Significant residual tumor (more than 10% of original tumor volume) was shown in eight patients at the first control condition. The percentage of resection varied from 26% to 100% (mean, 68%) at this time. Twelve tissue samples from seven patients were obtained in areas identified as residual tumor on MR images. In 10 cases, the neuropathologic investigation confirmed the presence of residual low-grade glioma; in two cases, the borderzone of tumor was identified. In evaluating the final sets of images, we found total resection in six cases, over 90% resection in five cases, and 85% resection in one case (mean, 96%). CONCLUSION: Surgical treatment of low-grade gliomas under intraoperative MR guidance provides improved resection results with maximal patient safety.

Adult↗

PubMed1999

[Cytophotometric investigations in recurrent gliomas: correlation of DNA-parameters with WHO-grade, proliferation index and recurrence-free interval].

DNA-cytophotometry is one of the methods that may contribute to a more precise evaluation of the biological behaviour of tumours in addition to the WHO-classification. In this study 121 tumour specimens of 50 patients suffering from gliomas with one or up to three recurrencies were investigated. In all cases the histological type and WHO-grade and the Ki-67/MIB1 labeling index were determined. DNA cytophotometry was performed after single cell preparation on Feulgen-stained preparations, and the following parameters were calculated: stemline ploidy, 5c-exceeding rate, and 2c-deviation index. Statistical evaluation revealed a highly significant correlation between recurrence-free interval and WHO-grade only. The DNA parameters, however, furnished additional information about increasing genetic instability in the majority of the recurrencies independently of changes in the WHO-grade. They thus seem to be useful as additional parameters for the determination of glioma progression.

Adult↗

PubMed1999

Preliminary experience with interactive guided brain biopsies using a vertically opened 0.5-T MR system.

The purpose of our study was to evaluate the feasibility and accuracy of brain biopsies performed within a vertically opened MR system. We worked with the interventional 0.5-T MR "SIGNA SP" (General Electric Medical Systems, Milwaukee, Wis.) with an integrated tracking device "Flashpoint Position Encoder" (Image Guided Technologies, USA). As a holding device for this instrument we constructed a special frame. The whole system allows an exact adjustment of an optimum biopsy direction and guidance of the biopsy in a non-stereotactic, interactive mode in near real-time. As biopsy tools we used MR-compatible aspiration and specially made side-cut needles (Daum, Germany; E-Z-EM, USA). We performed a prospective diagnostic brain biopsy study in 18 patients. Guidance of the needle was carried out using gradient-echo single-slice technique. The sample was taken after controlling the exact position of the needle tip on spin-echo images. In 12 cases an exact neuropathological diagnosis was possible. In 6 cases of negative biopsy (4 aspiration biopsies) the samples were not representative. Our results demonstrate the feasibility of interactive MR-guided minimally invasive brain biopsies in an open MR system. The best results were achieved using cut needles for biopsies of contrast-enhancing lesions visible on T1-weighted gradient-echo guidance sequence.

Adult↗

PubMed1999

Cerebellopontine angle lipoma: case report and review of the literature.

Intracranial lipomas located in the cerebellopontine angle are extremely rare. These tumours are mal-developmental lesions which can cause slowly progressive neurological symptoms. The clinical management of these tumours differs significantly from other lesions in this region. A 27 year old woman presented with a 2-month history of vertigo and a slowly progressive deterioration of hearing in the left ear. Computed tomography (CT) revealed a large low-density mass in the left cerebellopontine angle without any contrast-enhancement. In T1-weighted magnetic resonance imaging (MRI) the lesion was hyper-intense and did not enhance after application of gadolinium. Areas of lower signal intensity inside of the lesion were suggested as incorporated cranial nerves. A left retro-sigmoidal approach in a semi-sitting position was chosen to expose the tumour. After reducing the tumour mass, the tumour was dissected from the cranial nerves which were incorporated into the tumour. The residual tumour was adherent to the brain stem and the encased lower cranial nerves, allowing only a near subtotal resection of the highly vascularized tumour in order to avoid neurological deficits. The histological examination revealed a lipoma. Attempts at complete removal of cerebellopontine angle lipomas usually result in severe neurological deficits. Conservative treatment should therefore be preferred. Limited surgery is indicated if the patients suffer from disabling neurological symptoms and signs e.g., vertigo, nausea, trigeminal neuralgia, facial weakness or facial spasm.

Adult↗

PubMed1999

Intradiploic arachnoid cyst with extensive deformation of craniofacial osseous structures: case report.

OBJECTIVE AND IMPORTANCE: A unique case of a large intradiploic arachnoid cyst involving craniofacial osseous structures is reported. CLINICAL PRESENTATION: The patient presented with a hard mass in the right frontal region, proptosis, and inferior globe displacement. Computed tomography revealed an intraosseous cyst of cerebrospinal fluid intensity with extension from the anterior cranial fossa to the infratemporal fossa. INTERVENTION: After resection of the cyst wall and closure of two small round dural defects, the involved craniofacial region was reconstructed. CONCLUSION: The medical history of the patient and the intraoperative observations support the contention that the cyst in the reported case was congenital in origin. The features concerned with diagnosis and pathogenesis of this rare entity are discussed.

Adult↗

PubMed1998

[Appearance of the resection area of brain tumors in intraoperative MRI imaging].

During MRI-controlled resection of brain tumors using an open MRI system, operation-induced alterations may occur, especially enhancement of the resection cavity wall. This may simulate tumor areas, resulting in false assessment of the resection or resection of non-tumorous areas. Based on 42 MRI- and biopsy-controlled brain tumor resections in an 0.5 T open MRI (Signa SP, GE), the appearance and origin of operation-induced reactions are analyzed. In our opinion, there is a superposition of preformed peritumoral reactions by operation-induced microcontusions. The beginning of the cavity wall enhancement needs at least 10-15 min. MRI-controlled analysis of the intraoperative steps by the neurosurgeon and neuroradiologist allows discrimination of operation-induced reactions from tumor areas and leads to safe operation.

Astrocytoma↗

PubMed1998

Rhinocerebral zygomycosis following bone marrow transplantation in chronic myelogenous leukaemia. Report of a case and review of the literature.

We report on a man suffering from chronic myelogenous leukaemia treated by allogeneic bone marrow transplantation who, in the late post-transplantation phase, developed a hyperacute fatal invasive rhinocerebral zygomycosis. The origin of the ascending infection was the sinus sphenoidalis from which fungal hyphae spread to the central nervous system via the skull and the dura mater. The first symptoms of this severe infection were cerebral convulsions and a bilateral total amaurosis. The isolation of the pathogen from post mortem tissue was not successful. The present case is compared with previous reports of zygomycoses after bone marrow transplantation.

Adult↗

PubMed1997

[Acute blindness caused by fungal infection in chronic myeloid leukemia].

PATIENT: A 35-year-old man had suffered from leukemia since September 1990. A transplantation of bone marrow was carried out in February 1994. He developed a graft-versus-host disease in November 1995. In December 1995 a keratoplasty was necessary because of a perforated corneal ulcer. 17 days later the patient noted a complete loss of vision, first in the left and one day later in the right eye. The optic nerve head was white and the retina looked ischaemic like in central retinal artery occlusion. A hypodensic area was found in the frontal brain reaching up to the optic chiasm in computer tomography. Inspite of intensive treatment the immunosuppressed patient died 4 days after he had become blind. Autopsy showed a mycotic infiltration by mucormycosis of the brain and the right optic nerve sheath. This human- pathogenic fungal infection belongs to the group of mould as well as aspergillus. CONCLUSION: Mycosis should be considered in the differential diagnosis of acute visual loss in immunosuppressed patients.

Adult↗

PubMed1997

[Atypical metastasis of stomach carcinoma].

We report a case of unusual metastases from a gastric cancer. In a 66 years old female with bone metastases a breast cancer was diagnosed. The patient was treated by ablative surgery and chemotherapy but died short time later. An autopsy was performed and showed a large signetring cell carcinoma of the stomach. Further a diffuse involvement of the spleen unknown until autopsy was diagnosed. Serial tissue sections of all metastatic localizations were made. Histopathology and immunostaining including oestroprogesterone receptors identified a gastric cancer as the primary malignancy. A review of the recent literature on breast metastases from gastrointestinal tumours, gastric metastases from breast cancer and the problem of second primary malignancies is given. Further we reviewed the occult metastatic spread of the spleen and the importance of splenectomy in case of total gastrectomy.

Aged↗

PubMed1991

[Pulsatile tinnitus. Causes, diagnostic procedures, case presentation].

The pulsatile tinnitus is a rare sign. It is characterised by a rhythmic sound that is synchronous with the patient's heart beat. The underlying causes vary widely and may be life-threatening. Pulsatile tinnitus may be due to cardiac or vascular malformation, metabolic disorders, hyperdynamic circulatory states, elevated intracranial pressure, and tumours. The diagnostic evaluation includes physical examination, audiologic assessment and often computed image processing for precise topodiagnosis. A case report illustrates our current management of patients with pulsatile tinnitus.

Arteriovenous Fistula↗

PubMed1968