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  • 1
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    German Medical Science; Düsseldorf, Köln
    In:  55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie; 20040425-20040428; Köln; DOCMI.03.06 /20040423/
    Publication Date: 2004-04-22
    Keywords: ddc: 610
    Language: English
    Type: conferenceObject
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  • 2
    ISSN: 1433-0431
    Keywords: Key words Atlantooccipital and Atlantoaxial instability • Basilar impression • Craniocervical junction • Os odontoideum • Rheumatoid arthritis • Microsurgical transoral approach • Ventrodorsal procedure • Vertebral tumor ; Schlüsselwörter Atlantookzipitale und atlantoaxiale Instabilität • Basiläre Impression • Kraniozervikaler bzw. okzipitozervikaler Übergang • Os odontoideum • Rheumatoide Arthritis • Mikrochirurgischer transoraler bzw. ventraler Zugang • Ventrodorsale Vorgehensweise • Wirbelsäulentumor
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Neben der mikrochirurgischen ventralen Dekompression, verbunden in der Regel mit der interkorporellen Fusion unter Verwendung eines autologen trikortikalen Beckenkammspans und einer Plattenosteosynthese, bei der operativen Behandlung von zervikalen Bandscheibenvorfällen, hat sich der mikrochirurgische transorale Zugang zum kraniozervikalen Übergang bei entsprechender Indikationsstellung als Standardverfahren bewährt. Dabei stehen zur operativen Behandlung von Erkrankungen und Verletzungen des kraniozervikalen Übergangs ventrale, anterolaterale, laterale und dorsale Zugänge zur Verfügung die getrennt und kombiniert angewendet werden können. Die besonderen anatomischen und funktionellen Verhältnisse dieser Region machen aber eine im Vergleich zu den übrigen Halswirbelsäulenabschnitten geänderte Indikationsstellung für die unterschiedlichen Zugangswege erforderlich. Insbesondere die Frage nach isolierten ventralen, sprich transoralen, Eingriffen und bei dorsoventral kombinierten Eingriffen die Frage nach der Notwendigkeit einer zusätzlichen ventralen Stabilisierung bedarf wegen der postoperativen Komplikationsmöglichkeiten einer kritischen Betrachtung. Wir berichten anhand von 20 Fällen über die Indikationsstellung sowie die verfahrenstypischen Probleme transoraler Maßnahmen.
    Notes: Summary Besides the microsurgical ventral decompression for treatment of cervical disc prolapses, combined with an intercorporal fusion using an autologous bone graft from the iliac crest and a plate osteosynthesis, the microsurgical, transoral approach to the craniocervical junction has proven to be an effective procedure for adequate indications. Even for surgical treatment of diseases and injuries of the craniocervical junction ventral, anterolateral, lateral and dorsal approaches are applicable alone or in combination. The special anatomic and functional conditions of this region, however, obviously require that the indicational criteria for the various approaches differ from those selected for the other cervical segments. The postoperative complication risk requires that particulary critical consideration be given to the question of isolated transoral interventions. The same holds true for the question as the necessity for additional ventral stabilisation in combined dorsoventral interventions. This report is about 20 patients who underwent transoral decompression, about the indications and the procedure typical problems.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A comparison has been made of the relative merits of air, Conray 60, and Dimer X ventriculography in 100 cases. The great virtue of positive contrast ventriculography is its superior ability to demonstrate abnormalities in the midline and in the posterior cranial fossa. Tomoventriculography using a multiple layer cassette permits exact localization of intraventricular lesions without causing additional discomfort to the patient. The subtraction technique confers additional benefits. Positive contrast ventriculography has its limitations when there are large extraventricular masses.
    Notes: Zusammenfassung Es werden hinsichtlich Beurteilbarkeit und Nebenerscheinungen die Ergebnisse von je 100 Luft-, Conray 60- und DIMER-X-Ventrikulographien verglichen. Die Stärke der positiven Ventrikulographie liegt in der ungleich besseren Verträglichkeit und erheblich besseren Beurteilbarkeit bei Prozessen der Mittellinie und der hinteren Schädelgrube. Die Tomoventrikulographie mit mehrschichtiger Simultankassette erlaubt eine exakte Lokalisation intraventrikulärer Prozesse ohne weitere Belastung des Patienten. Ebenso ergibt das Subtraktionsverfahren einen besseren Überblick über Einzelheiten, ebenfalls ohne weitere Belastung des Patienten. Ihre Grenzen findet die positive Ventrikulographie bei Mißbildungen des Ventrikelsystems infolge Überlagerungseffekten und der notwendigen großen Kontrastmittelmengen.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 0942-0940
    Keywords: Intracranial pressure ; decerebrate rigidity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The authors analyse the relationship between the muscle activity during paroxysms of decerebration and the intracranial pressure. These relationships differ, and depend upon the presence or absence of mesencephalic herniation and patency of the perimesencephalic cisterns, as well as on whether the decerebration posturing has been spontaneous or induced by external stimulus. It is suggested that the magnitude of ICP reaction during decerebration is connected with the possibility of compensating the increased intracranial volume and with the strain imposed upon the brain stem at the mesencephalic level. Close correlations between the vegetative variables occuring during spontaneous DR paroxysms suggest a common excitatory neuronal mechanism. In cases when decerebration is provoked by external stimuli the response becomes more complex and not uniform.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    ISSN: 1749-6632
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Natural Sciences in General
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 0942-0940
    Keywords: Acromegaly ; growth hormone ; pituitary adenoma ; octreotide
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Long term results after surgery for growth hormone (GH)-secreting adenomas indicate only a limited cure rate, particularly in patients with tumours invading the durai boundaries of the sella with suprasellar extension. Since octreotide had become a treatment option, it was used i.v. via an implantable pump system in five patients (age range 24–46 yr) showing symptoms of uncontrolled acromegaly, in spite of previous surgery and X-ray therapy. The octreotide doses used permanently for a cumulative treatment period of 8.8 yr ranged between 300 and 1000 uμg/24 h. Serial evaluations of clinical findings, 24-h GH and insulin profiles, insulin growth factor-1 (IGF-1), oral glucose tolerance test and pituitary function revealed sustained GH suppression, without interim escape, below 2 ng/ml in two and below 5 ng/ml in three patients, IGF-1 decrease in all with normalization in two patients and no clinically relevant disturbances of carbohydrate tolerance or thyroid-stimulating hormone secretion. In one case of previous unresponsiveness to dopamine agonists i.v. octreotide application for 29 months facilitated later disease control by bromocriptine only. In two patients octreotide was terminated after 15 and 30 months of i.v. administration, respectively, because the effects of irradiation had occurred. For a subgroup of patients with resistant acromegaly continuous i.v. octreotide can be considered as a safe and effective alternative, which increases patients' independency from the inconvenience of daily repeated s.c. injections.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Trotz der zahlreichen veröffentlichten Statistiken sind die wohl bekannten Schwierigkeiten in der Differentialdiagnose von malignen und nicht malignen supratentoriellen Gliomen und der richtigen Indikationsstellung zur operativen Behandlung nicht zurückgegangen. Wegen der Verwendung unterschiedlicher histologischer Klassifikationen, der Verschiedenartigkeit der Kriterien, nach denen die Patienten für die operative Behandlung ausgewählt werden und schließlich wegen eines Wechsels in dem derzeitigen klinischen Bild gegenüber demjenigen, das vor einigen Jahrzehnten bei solchen Fällen üblicherweise zu beobachten war, ist ein Vergleich der verschiedenen Statistiken außerordentlich erschwert. Eine Analyse des eigenen Krankenguts des Autors zeigt, daß die o. g. Veränderungen zum Teil darauf beruhen, daß der Anteil der älteren Menschen in der Gesamtbevölkerung angestiegen ist, ärztliche Hilfe in zunehmendem Maß zur Verfügung steht, oder daß technische Fortschritte eine frühere Diagnose ermöglichen. Bei malignen Gliomen wurden keine statistisch signifikanten Beziehungen zwischen dem histologischen Befund, der Lokalisation und dem Einwachsen in tiefere Strukturen einerseits und dem klinischen Bild, der Krankheitsdauer und dem Alter der Patienten andererseits gefunden. Dagegen hat die Analyse der Autoren einige andere Beziehungen erkennen lassen, die in der alltäglichen klinischen Arbeit leicht übersehen werden, zur Ursache klinischer Fehler werden können und deshalb weiterer Untersuchungen bedürfen.
    Abstract: Résumé La publication de nombreuses statistiques n'a en rien diminué les difficultés rencontrées quand il s'agit de faire le diagnostic différentiel d'un gliome supratentoriel bénin ou malin. Il en est de mëme quand il s'agit d'évaluer leur traitement chirurgical. Les difficultés d'analyse des statistiques proviennent de l'emploi de classification différente, de la très grande variété de critères acceptés dans le choix des candidats à la chirurgie. A cela il faut ajouter le mode de présentation clinique actuelle des malades porteur de telles lésions qui différe de celui rencontré il y a plusieurs décades. Après analyse de leur matériel, les auteurs sont d'avis que cette différence est due soit au pourcentage élevé du nombre de personnes âgées dans la population générale actuelle, soit à un accés plus facile aux soins médicaux ou soit encore grâce auxprogrès de la technique. Après étude comparée de l'histologie de la tumeur, sa localisation, sa présentation clinique, la durée de la maladie, et enfin l'âge du patient, les auteurs n'ont pu réussir à grouper un ensemble de faits qui auraient permis d'isoler un syndrome particulier au gliome malin ou à son extraction en profondeur. Cette analyse a cependant démontré certains faits qui sont souvent négligés en pratique courante et qui sont aussi la cause d'erreur de diagnostic clinique.
    Notes: Summary The well-kown difficulties in the differential diagnosis of malignant and nonmalignant supratentorial gliomas and in the adequate evaluation of their operative treatment have not diminished in spite of the numerous published statistics. The inadequacy of comparisons based on statistics is mainly due to the use of different histological classifications, to the variety of criteria accepted in selecting patients for operative treatment and finally to certain changes in the contemporary clinical picture as compared with that seen some decades ago. The analysis of the authors' material showed that the above mentioned change may be due either to an increased percentage of aged people in the general population, or to the growing availability of medical care, or to technical progress enabling an earlier diagnosis. No statistically significant relationships which could be regarded as pathognomic for a malignant glioma and for expansion of the tumour into deep structures were found when correlating the histology and localisation of the neoplasm with the clinical picture, the duration of the disease, and the patient's age. However, our analysis has detected some relationship which might be overlooked in everyday clinical practice and it indicates some sources of clinical errors, thereby suggesting some trends for further research.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 0942-0940
    Keywords: Decerebrate rigidity ; intracranial pressure ; vegetative signs
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Decerebrate rigidity, intracranial pressure and vegetative signs were studied in 25 patients. Advanced statistical techniques were used to analyse the interrelationships between muscle activity (IEMG), blood pressure (ABP), intracranial pressure (ICP), pulse rate (HR), respiratory rate (RR), and central venous pressure (CVP) occurring during paroxysms of decerebration. The pattern of reaction is influenced by compression or stress imposed on the brain stem at the tentorial incisure and is related to the degree of cisternal obstruction. Significant differences in reaction were disclosed between provoked and spontaneous decerebration posturing.
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  • 9
    ISSN: 0942-0940
    Keywords: Invasive prolactinoma ; dopamine agonist therapy ; nasal CSF fistula
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We report on the occurrence of CSF rhinorrhea in a group of 17 patients harbouring macroprolactinomas who were treated with a dopamine agonist (DA, bromocriptine) alone or the combination of DA and transcranial operation. In 2 out of 17 cases shrinkage of tumour remnants during therapy with the oral or injectable form of bromocriptine was responsible for delayed occurrence of rhinorrhea. Operative procedures for successfull closure of the fistulae were mandatory in both cases.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 0942-0940
    Keywords: Arterial blood pressure ; ICP monitoring ; ICP pulse amplitude analysis ; intracranial pressure ; mathematical model
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The influence of arterial blood pressure (ABP) on the intracranial pulse pressure relationship (PPR) was studied in 17 patients in 29 recordings, with a total period of registration of 71.5 hours. The relationship between ICP and ABP was analysed by sampling the data every 15 seconds during spontaneous fluctuations of both these variables, and the analysis was performed on the basis of a mathematical model which includes pulsatory components. MABP and ABP amplitude had an opposite effect on the slope of PPR. Flattening of the PPR slope was caused by a MABP increase or an ABP amplitude decrease. The slope became steeper with decreasing MABP or increasing ABP amplitude. In accordance with the theoretical assumptions the quotient MABP/ABP-AMP was found to be suitable to express these opposite effects on PPR. Qualitatively, the same pattern of reaction was found in all patients. Rapid changes in PPR occurring during monitoring can be explained by a change in MABP/ABP-AMP relationship, regardless whether ABP changes influence intracranial elastance or not. The breakpoint of the PPR was recorded only on two occasions and could be explained in one by the influence of ABP. Monitoring of PPR as a measure of intracranial elastance and correlation of PPR with the patient's condition it not permitted unless at least the influence of ABP is analysed in each individual case.
    Type of Medium: Electronic Resource
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