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Biomedical subjects

S Schwab

Publications and source records attributed to S Schwab.

At least 127 records · Page 7Linked to original sources
PubMed1996

The value of intracranial pressure monitoring in acute hemispheric stroke.

BACKGROUND AND PURPOSE: Persistently elevated intracranial pressure (ICP) has been associated with poor clinical outcome after severe brain injury, such as neurotrauma, intracerebral hemorrhage, and subarachnoidal hemorrhage. Although ICP monitoring is increasingly being used in intensive care treatment of patients with ischemic stroke, its value has not been established. PATIENTS AND METHODS: The clinical course of 48 patients with the clinical signs of increased ICP due to large hemispheric or middle cerebral artery territory infarction defined by CT and subjected to ICP monitoring was prospectively evaluated. Epidural ICP probes were inserted ipsilaterally to the site of primary brain injury in all and also contralaterally in seven patients. Initial clinical presentation was assessed by the Scandinavian Stroke Scale (SSS) and the Glasgow Coma Score (GCS). All patients were treated according to a standardized treatment protocol for elevated ICP. ICP values were correlated with the clinical presentation at the time point of deterioration, with outcome, and with CT findings. Different treatment strategies to lower ICP were analyzed as to their effectiveness. RESULTS: Only nine of the 48 patients survived the infarct (19%). The cause of death was transtentorial herniation with subsequent brain death in all 39 patients. The patients' mean SSS on admission was 20.6 (survivors 21.5 +/- 5.6, nonsurvivors 19.8 +/- 6.5). In all patients clinical signs of herniation preceded the increase in ICP. Patients with ICP values > 35 mm Hg did not survive. CT changes did not always correspond with the measured ICP values. All medical strategies to lower ICP, including osmotherapy, hyperventilation, THAM-buffer, and barbiturates, were initially effective, but only in a minority of patients was ICP control sustained. CONCLUSIONS: ICP monitoring of large hemispheric infarction can predict clinical outcome. Pharmacologic intervention had no sustained effect. ICP monitoring was not helpful in guiding long-term treatment of increased ICP. It remains doubtful that ICP monitoring in acute ischemic stroke has a positive influence on clinical outcome.

Acute Disease↗
PubMed1996

[Intensive care in acute ischemia].

Therapy of ischemic infarction has changed enormously during the last decade. This is due to an increase of pathophysiological knowledge on cerebrovascular disease, new diagnostic and intensive-care methods and success in thrombolytic therapy strategies; new neuroprotective drugs are on the way to be used on a routine base. The old fatalistic attitude towards treatment of stroke can nowadays not be justified. The success of stroke treatment is dependent on a fast and consequent therapeutic performing: patients with ischemic stroke who reach the hospital within six hours after onset of symptoms are candidates for thrombolysis. If certain inclusion criteria are fulfilled. Increasingly intracranial pressure is one of the major problems during the acute phase. Anti-edema treatment follows a stepwise scheme. In some selected cases we perform hemicraniectomy. Besides the routine intensive-care monitoring, further monitoring is necessary by evoked potentials, brain pressure probes and Doppler ultrasound.

Acute Disease↗
PubMed1995

Decompressive surgery in space-occupying hemispheric infarction: results of an open, prospective trial.

OBJECTIVE: Space-occupying hemispheric infarctions, requiring neurocritical care treatment, demonstrate high mortality and morbidity rates. This study was performed to determine the beneficial effects of decompressive craniotomy on mortality and morbidity rates. DESIGN: Open, nonrandomized, control trial. Outcome was rated at discharge from the hospital (Glasgow Outcome Scale) and at follow-up (Barthel Index, Oxford Handicap Scale). SETTING: Patient recruitment from the Department of Neurology, University of Heidelberg (primary care center) over 65 months. PATIENTS: Thirty-two patients were prospectively selected for surgical treatment; 21 patients were treated conservatively. INTERVENTIONS: Extended craniotomy and dura patch enlargement were performed in all surgically treated patients. MEASUREMENTS AND MAIN RESULTS: At discharge, the outcome of six (18.8%) of 32 surgically treated patients was good compared with 0 (0%) of 21 conservatively treated patients. Fifteen (46.9%) of 32 surgically treated patients were moderately to severely disabled compared with five (23.8%) of 21 conservatively treated patients, and 11 (34.4%) of 32 surgically treated patients died compared with 16 (76.2%) of 21 conservatively treated patients. At follow-up in surgically treated patients, the Barthel Index (mean 62.6) showed an excellent level of daily activity in one patient, minimal assistance (Barthel Index of > or = 60) in 15 patients, and dependency in five patients. The Oxford Handicap Scale indicated no handicap in one patient, moderate handicaps in 15 patients, and moderately severe handicaps in five patients. In the control group, all five surviving patients needed assistance and all but one patient demonstrated a moderately severe handicap. CONCLUSIONS: Hemicraniotomy may improve survival in massive hemispheric stroke victims, decreasing mortality rates to < 35%. The disability rate remains high (24%), although some patients seem to benefit significantly.

Adolescent↗
PubMed1995

[Craniectomy in space-occupying middle cerebral artery infarcts].

Space occupying supratentorial ischemic stroke has a high mortality. The benefit of decompressive surgery in these patients is still matter of debate. In a prospective study we performed craniectomy in 37 patients with acute middle cerebral artery infarction and progressive deterioration under conservative antiedematous therapy. Twenty-one patients treated conservatively during the same period served as control group. All survivors were reexamined between one to two years after surgical decompression. In addition, neuropsychological tests were performed, including an Aachener Aphasie Test (AAT) in those patients with infarction of speech-dominant hemisphere. Clinical evaluation was graded using the Barthel index (BI). Mortality rate in the operated group was 37%. Twenty-three patients survived acute stroke and were reexamined. Despite complete hemispheric infarction, no patient suffered from complete hemiplegia or was permanently wheel chair bound. In speech dominant hemispheric infarction (n = 8) only mild to moderate aphasia could be detected. Mean BI was 64. Mortality rate in the conservatively treated group was 76%. The clinical outcome following craniectomy for the treatment of severe ischemic hemispheric infarction is unexpectedly good. Therefore, decompressive surgery should be considered in cases of space-occupying hemispheric infarctions and conservatively uncontrollable intracranial pressure.

Adolescent↗
PubMed1995

[Adult Leigh syndrome. A rare differential diagnosis of central respiratory insufficiency].

Subacute necrotizing encephalomyelopathy (Leigh's syndrome) is a rare neurodegenerative disease in the adult. The precise metabolic defect is unknown, but abnormalities of a mitochondrial enzyme system related to cytochrome-c oxidase or pyruvate dehydrogenase are described. The clinical picture usually consists of an altered breathing pattern, oculomotor paralysis, other signs of cranial nerve dysfunction, ataxia, myoclonic jerks, nystagmus, generalized seizures, optic atrophy and demyelinating peripheral neuropathy. Hypopnea leads to CO2-retention with consecutive loss of consciousness demanding mechanical ventilation. Respiratory failure is the most frequent cause of death. Here we describe two patients with adult onset Leigh's syndrome and we discuss the longterm treatment strategies including vitamin B1 and CPAP mask.

Adult↗
PubMed1995

[Therapy of Frey syndrome with botulinum toxin A. Experiences with a new method of treatment].

The effectiveness of botulinum toxin for the treatment of Frey's syndrome is demonstrated. Since December 1993, 14 patients with severe symptomatic gustatory sweating have been treated at the ENT Department, University of Göttingen. Botulinum toxin A (approximately 0.5 U/cm2) was injected intracutaneously into the affected skin area as determined by Minor's starch iodine test. Gustatory sweating in the treated skin area ceased completely within 2 days and did not reappear during the period of following (13 months maximum follow-up). There were no side effects. Findings show that local botulinum toxin injections are a highly effective, safe and minimally invasive treatment for Frey's syndrome. Moreover, this could be a new therapeutic tool for other forms of hyperhidrosis.

Adult↗
PubMed1994

Absence of linkage between schizophrenia and the dopamine D4 receptor gene.

The dopamine D4 receptor gene and the closely placed tyrosine hydroxylase (TH) receptor gene are important candidate genes for schizophrenia; both are located on the short arm of chromosome 11. Multipoint linkage analyses excluded linkage of schizophrenia/schizoaffective disorder to both candidate genes in a sample of 15 multiplex and systematically recruited families. This result was not dependent on the definition of the affection status and on the specification of the mode of transmission (insofar as it is monogenic) of the disease. There was no evidence for a subgroup of families being linked. This result does not preclude the possibility that the D4 receptor gene or the TH gene has only a nonmajor effect on the genetic etiology of schizophrenia or that families in other populations are linked.

Genes, Dominant↗
PubMed1994

No evidence of linkage between the dopamine D2 receptor gene and schizophrenia.

The antipsychotic effects of dopamine D2 receptor antagonists (neuroleptics) and the psychotomimetic effects of dopamine agonists suggest that a defect of the D2 receptor gene might be a factor in the etiology of schizophrenia. Fifteen families that contained several members suffering from schizophrenia were tested for linkage between the D2 receptor gene and schizophrenia. In addition, four flanking markers were tested. The mode of inheritance was assumed to be dominant. Five different models of the affection status, which ranged from a narrow to a broad definition of the affection status, were studied. Linkage analysis was carried out with dominant, recessive, and intermediate modes of transmission. Two-point and multipoint analyses between schizophrenia and the D2 receptor gene resulted in log-likelihood differences < -2 for all five models, and linkage between this candidate gene and schizophrenia was excluded. A mutation in the D2 receptor gene itself is therefore extremely unlikely to be related to a higher susceptibility to schizophrenia, at least in the present group of families.

Bipolar Disorder↗
PubMed1994

[Therapeutic hypothermia after cerebral ischemia. Theoretical principles and possible clinical applications].

In animal models of cerebral ischemia hypothermia has been shown to have a beneficial effect. Reduction of infarct size, fewer potentially neurotoxic metabolites, and a better neurological outcome were observed compared to sham-operated animals. In clinical practice hypothermia has been widely used in cardiovascular surgery and occasionally in neurosurgery. The first trials with hypothermia in patients with severe head injury have also shown beneficial results. However, studies on therapeutic hypothermia in the clinical management of acute stroke are not yet available.

Animals↗
PubMed1986

Ureteral occlusion decreases phospholipid and cholesterol of renal tubular membranes.

Unilateral ureteral obstruction of 24 h duration in the dog results in a 20% decrease in the amount of total phospholipids present in basolateral membranes of renal tubular cells obtained from the experimental kidney as compared with the amount of phospholipid in basolateral membranes prepared from the contralateral kidney of the same dogs or from the kidneys of normal sham-operated dogs. There was also a decrease in the content of cholesterol and cholesterol esters of the basolateral membranes from the experimental kidney. By contrast, no significant change in lipid content was observed in brush border membranes obtained from the experimental kidney of dogs with unilateral ureteral obstruction. The decrease in phospholipid content of basolateral membranes was accompanied by a 40% fall in the content of phosphatidylcholine and a 12% fall in sphingomyelin. There was a small (12%) but significant increase in the content of phosphatidylethanolamine in basolateral membranes. The mechanisms responsible for the selective decrease in phospholipid content of basolateral membranes remain to be established. It is postulated that changes in solute transport and altered response to hormones observed in the postobstructed kidney of animals with unilateral ureteral obstruction may be explained, at least in part, by changes in the lipid composition of basolateral membranes.

Animals↗
PubMed1983

PH-dependent accumulation of clindamycin in a polycystic kidney.

We determined the concentrations of clindamycin and gentamicin in fluid aspirated from 16 cysts of a surgically excised polycystic kidney. The patient had received both drugs intravenously for seven days before nephrectomy. The cysts were grouped into proximal (pH greater than 6.5) and distal (pH less than 6.5) types according to the pH of the fluid. In nine proximal cysts the mean concentration of gentamicin was 1.3 +/- 0.2 and that of clindamycin was 9.2 +/- 2.3 micrograms/mL. In seven distal cysts the gentamicin concentration was 0.7 +/- 0.2 micrograms/mL and the clindamycin concentration was 34.0 +/- 5.2 micrograms/mL. Plasma gentamicin was 3.8 (peak) and 1.9 (trough) micrograms/mL, and clindamycin was 3.9 micrograms/mL (random). Clindamycin cyst concentrations showed an inverse correlation with cyst fluid pH (r2 = 0.78). These studies confirm that in autosomal dominant polycystic kidney disease (ADPKD), certain cysts develop steep pH gradients between fluid and plasma and indicate that intracystic pH determines the extent to which basic lipophilic antibiotics accumulate in the fluid. Lipid-soluble antibiotics with relatively alkaline pKaS may be useful in the treatment of infected renal cysts.

Body Fluids↗
PubMed1983

Soluble luteinizing hormone/human chorionic gonadotropin receptors of the rat ovary: comparative studies of water- and detergent-soluble receptors.

The water-soluble LH-hCG receptors of the luteinized rat ovary have the properties of glycoproteins and can be separated into four fractions by chromatography on Sepharose-Concanavalin A. Polyacrylamide gel electrophoresis of these fractions demonstrates a broad similarity of molecular compositions. However, the chromatographic fractions had different quantities of the individual receptor species (mol wt, 165,000, 81,000, 24,000, 48,000, and 12,000). While all receptor species declined in the desensitized ovaries the losses of the 24.000 and 12,000 mol wt species were most prominent. Analysis of detergent extracts demonstrated that water-soluble and detergent-soluble LH/hCG receptors have comparable molecular compositions and resolved similarly during chromatography on Sepharose-Concanavalin A. These results have also indicated that lectin affinity chromatography is a powerful tool for the initial purification step of water-soluble or detergent-extracted ovarian LH/hCG receptors.

Animals↗
PubMed1981

Hypertensive crisis resulting from avocados and a MAO inhibitor.

A hypertensive episode precipitated by avocados in a patient on tranylcypromine is described. The patient complained of severe throbbing headache, chest pain, and diaphoresis upon visiting the emergency room. Intravenous phentolamine was administered repeatedly to treat elevated blood pressure. Approximately 4 1/2 hours later, the patient's blood pressure stabilized, and he was released after a short period of observation. This is the first documented case of avocado induced hypertensive crisis.

Adult↗
PubMedDate not supplied

Indomethacin for brain edema following stroke.

Conventional therapies for raised intracranial pressure (ICP) frequently are not effective. We report a patient with raised ICP following a large hemispheric stroke. After conventional therapies had failed, indomethacin was repeatedly administered. After bolus infusion (50 mg), the ICP fell by a mean of 8.1 mm Hg, and the mean arterial blood pressure increased by a mean of 7.1 mm Hg, leading to a mean increase in the cerebral perfusion pressure by 15.3 mm Hg. After 1 h, the ICP had returned to baseline values after most infusions. Continuous infusion of indomethacin was not effective. We conclude that indomethacin may reduce elevated ICP over a short time in patients with ischemic brain edema even after conventional therapy has failed.

Adult↗