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W H Jost

Publications and source records attributed to W H Jost.

89 records · Page 5Linked to original sources
PubMed1994

Magnetic stimulation of the pudendal nerve.

UNLABELLED: Electroneurography of the pudendal nerve is extremely important in the diagnosis of neurogenic fecal incontinence and a pudendal canal syndrome. PURPOSE: The aim of this study was to determine pudendal nerve motor latency of the overall distance by stimulation of nerve root S3 by discharging a magnetic coil. METHODS: This can be achieved by positioning an earth electrode between the site of stimulation and the registration electrode. We investigated 18 volunteers by this method. RESULTS: The average latency period was 2.51 milliseconds (SD = 0.32) on the right and 2.49 milliseconds (SD = 0.33) on the left side. CONCLUSION: This method enables precise diagnosis in neuropathies of the pudendal nerve more so than with conventional electric stimulation.

Adult↗
PubMed1994

Therapy of anal fissure using botulin toxin.

PURPOSE: With chronic anal fissure, sphincterotomy to relieve sphincter spasm is the recommended therapy. This breaks the vicious circle of inflammation-pain-spasm. This obvious success is weighed against the possible risk of the operation and the risk of subsequent fecal incontinence. The following report describes a therapy for anal fissure involving injection of the external anal sphincter with botulin toxin. METHODS: We have used this new method in 12 cases (7 females and 5 males; mean age, 37 years). We injected 0.1 ml of diluted toxin on both sides lateral to the fissure. RESULTS: The fissure healed thanks to a time-limited paresis of the sphincter in ten cases. In one case there was a recurrence within the first six months. Two patients could not be healed and had to undergo surgery. CONCLUSION: Injection of botulin toxin gives us a possible new mode of therapy in the treatment of chronic, uncomplicated anal fissures with increased sphincter tone. It is well tolerated, can be performed as an outpatient, does not cause any lesion of the continence organ, and subsequently does not lead to any permanent latent or apparent fecal incontinence.

Adult↗
PubMed1994

A new method to determine pudendal nerve motor latency and central motor conduction time to the external anal sphincter.

By placing the earth electrode between the site of the stimulus and the site of derivation, peripheral motor latency to the external anal sphincter can be determined and thus central motor conduction time (CMCT) can be calculated. In 18 volunteers we found a total motor conduction time of 19.4 msec (S.D. 1.71) after stimulation of the motor cortex and recording above the external anal sphincter. Latency was 5.6 msec (S.D. 0.66) when stimulated above L1 and pudendal latency (MEPuL) after stimulation above S3 was 2.5 msec (S.D. 0.32). CMCT to L1 (TMCT minus MCT to L1) was 13.8 msec (S.D. 1.13) and to S3 (TMCT minus MEPuL) it was 16.9 msec (S.D. 1.67). This method allows us to locate spinal dysfunction more precisely and also improves diagnosis of a possible neuropathy of the pudendal nerve.

Adult↗
PubMed1994

[HELLP syndrome--amaurosis in sinus thrombosis with complete recovery].

We report on a case of a 22-year old primigravida with HELLP syndrome in association with blindness and cerebral sinus thrombosis. The diagnosis of the cerebral sinus thrombosis was based on MRI 1h after delivery. Immediate caesarean section and intensive care treatment led to a complete recovery of the patient.

Adult↗
PubMed1994

Colonic transit time in nonidiopathic Parkinson's syndrome.

Constipation is well known to be a frequent symptom in idiopathic Parkinson's disease. In this study, colonic transit time was measured in 16 patients with nonidiopathic Parkinson's syndrome (non-IPS). These patients all had lacunar infarcts in the caudate, putamen, or globus pallidus, as a cause of the disease, as demonstrated by MRI. In comparison with the control group there was only a slightly longer transit time with, on the whole, a normal transit time (about 59 h). In only five cases was the transit time significantly decreased. Our results suggest that colonic transit is only prolonged in patients with idiopathic PD, whereas it is normal in non-IPS. This seems to be cause by a multi-degenerative process in the idiopathic disease.

Aged↗
PubMed1994

The effect of cisapride on delayed colonic transit time in patients with idiopathic Parkinson's disease.

Disorders of autonomic regulation are common in patients with Parkinson's disease (PD). Patients most frequently complain of dysphagia and therapy resistant constipation, as far as the gastrointestinal tract is concerned. These symptoms have to be attributed to a neuronal degeneration. In a pilot study we therefore investigated the effect of stimulation of the myenteric plexus by cisapride. 11 women and 13 men were examined, the average age was 67.3 years, the Webster rating 17 points. In 2 out of 24 patients, colonic transit was prolonged up to the limit, both with and without therapy. The other 22 patients showed an acceleration in transit on response to cisapride. On average the colonic transit of 130 hours was reduced to 79 hours. This objective improvement was associated with a subjective improvement. Central side effects or a worsening of Parkinsonian symptoms were not found. We conclude that cisapride is effective in the treatment of constipation in idiopathic PD.

Aged↗
PubMed1994

[Ergotamine-induced rectal lesions in asymptomatic patients].

Suppositories containing ergotamine can cause anorectal lesions and even fistulae. We therefore carried out prospective investigations on 20 patients (17 female, 3 male) who had been prescribed ergotamine suppositories for migraine therapy. No serious ulceration was found. There was one case of reduced local blood circulation and three patients showed signs of increased blood circulation in the anterior rectal wall. In two further cases we found local hyperemia with minor bleeding. In our opinion anorectal ergotism is a possible, although rare consequence of ergotamine suppository abuse. For longterm treatment alternative routes of ergotamine administration or other groups of substances should therefore be used.

Adult↗
PubMed1993

[Routine diagnosis of disorders of autonomic regulation. References for implementation and evaluation].

In the routine diagnosis evaluation of regulatory disorders of the autonomous nervous system, 5 non-invasive procedures have proved both easy to perform and valid: orthostatic and static blood pressure reactions, the ratio of the 30th to the 15th RR interval on changing to an erect posture, variations in the heart rate in response to the Valsalva maneuver and deep respiration. These measures need no special equipment and can be carried out at any hospital or outpatient department. They provide not only qualitative but, in part, also quantitative information about possible disorders of the autonomic nervous system, as well as permitting a certain differentiation to be made between parasympathetic and sympathetic regulation. More complex tests should be employed only for specific problems.

Arousal↗
PubMed1993

Cisapride treatment of constipation in Parkinson's disease.

Constipation, a frequent symptom in Parkinson's disease (PD), is probably caused by degeneration of the autonomic nervous system, particularly the myenteric plexus. Cisapride is a drug that causes increased release of acetylcholine in the myenteric plexus. In a pilot study, cisapride therapy was investigated in 20 PD patients, 10 women and 10 men, who suffered from delayed intestinal transit. In all cases, cisapride therapy was associated with a significant acceleration of colonic transit, as measured by radioopaque pellets viewed on radiographs. Pellet count fell from a mean of 53.8 pretreatment to 30.4 after cisapride treatment. No adverse reaction and no "overshoot affects," such as diarrhea, were seen. Our findings suggest that cisapride may alleviate the constipation associated with Parkinson's disease.

Acetylcholine↗
PubMed1993

[Functional studies of the autonomic nervous system].

There are many methods to choose from in the investigation of the autonomic nervous system. The value of the individual tests to the clinician varies according to the method of investigation used. No one test can elucidate all the information needed for all functional disturbances. As a routine, measurement of blood pressure and heart rate reaction to active orthostasis and heart rate variation with deep breathing and the Valsalva manoeuvre can be useful. Spectral analysis of the heart rate is an easily performed test, only minimally disturbing for the patient, and is a valid means of investigation which may find a way into routine clinical use in the future.

Arousal↗
PubMed1992

[Long-term treatment of Lambert-Eaton syndrome by 3, 4 diaminopyridine].

A patient with a 5 year history of slow-progressive Lambert-Eaton Myasthenic Syndrome (LEMS) was treated for a period of 12 months with 3,4-diaminopyridine (3,4-DAP). The therapy led to an objective increase in muscle power. During the treatment period, there was no increase in muscle weakness, but attempts at withdrawal of the drug confirmed a progression. The mouth dryness disappeared and autonomic regulation disturbances were improved. All of the laboratory parameters remained unchanged. A neoplasia was excluded by extensive endoscopic and radiological investigations. Side-effects included initial perioral paresthesia and, later, paresthesia down the skin and along the ulnar edge of the forearm. 3,4-DAP seems to be an effective and acceptable long-term symptomatic therapy in LEMS.

4-Aminopyridine↗
PubMed1992

[Rational neurologic diagnosis in fecal incontinence].

The effective therapy of a disturbance of anal continence requires an adequate preoperative diagnostics. In most cases this includes some kind of neurophysiological investigation. Close cooperation between the internist, the surgeon and the neurologist is advantageous. The initial history, clinical examination and electromyography of the pelvic floor will usually be enough to differentiate between aetiologies. In the first phase it is necessary to decide whether the problem is neurogenic or muscular, and then to see localising signs for a nerve defect (central or peripheral) or, respectively, signs of a defect in the skeletal musculature. It must be said that a peripheral nerve lesion (eg. a stretching injury of branches of the pudendal nerve) and a muscular defect may be combined. At the end of the diagnostic process the surgeon or internist and neurologist must decide together whether the diagnosis is appropriate, and then whether an operative or non-operative approach to treatment is fitting. In the second phase of diagnosis are further neurophysiological investigations, which are only indicated in more special circumstances. These investigations include: nerve conduction velocities, reflex latencies (anal-, bulbocavernosus-, and pudendoanal reflexes), evoked potentials, and the single fibre EMG to determine fibre density. These neurophysiological investigation in proctology allows the clinician a wider scope of diagnostic possibilities, which should lead to more sensible therapeutic options being taken.

Electromyography↗
PubMed1991

Constipation in Parkinson's disease.

Constipation is a frequent symptom in Parkinson's disease. In this study colonic transit time was measured in 20 patients and 20 sex- and age-matched controls. Colonic transit was normal in all but two of the controls. In 16 patients with Parkinson's disease the average colonic passage was 5 to 7 days. For four patients transit-time was within normal limits. The delayed transport affected all sections of the colon. There was no obvious dependence on age, sex, presentation of the disease, physical activity, or medication. In our opinion, lesions of the autonomic nervous system are responsible.

Aged↗
PubMed1991

Anorectal ergotism. Induced by migraine therapy.

The current report describes 15 patients, 14 women and one man, in whom anorectal ulceration appeared after use of ergotamine suppositories. In seven cases there was only ulceration to be seen, whereas in eight anovaginal or rectovaginal fistulae were visible. Symptoms are not specific. In the majority of situations, ulceration can usually be treated successfully by immediate withdrawal alone. In one case a stenosis of the anal canal remained. Fistulae need surgical intervention. Two fistulae could be treated sufficiently by the local flap technique. In six cases a colostomy was needed, which was transient in five and permanent in one patient. One recurrence was seen after continued ergot-abuse. Dosage is not in direct correlation to ulceration.

Adult↗
PubMed1991

Therapeutic approaches to Lambert-Eaton myasthenic syndrome in the intra-individual comparison.

A patient with Lambert-Eaton myasthenic syndrome was clinically treated several times over a period of 9 months. During at least 3 weeks each time, the patient received prednisone, then underwent 9 plasmaphereses, and was given guanidine-hydrochloride (HCl) and 3,4-diaminopyridine (3,4-DAP). The muscle-power scoring, muscle function tests and the electrophysiological parameters showed a superiority of 3,4-DAP over the other pharmacological therapies. Good results were also obtained with plasmapheresis. Corticoid medication proved to be less effective. No improvement was seen with guanidine-HCl. For comparative judgement, two months after beginning the last therapy, the patient and the attending physician were questioned with regard to subjective therapeutic success. The answers largely match the objective results. Both favour 3,4-DAP. In contrast to the patient's opinion, the physician sees a distinct effect of plasmapheresis. All in all, the administration of 3,4-DAP may be seen as an effective and acceptable therapy in Lambert-Eaton myasthenic syndrome.

4-Aminopyridine↗