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Biomedical subjects

A Grepe

Publications and source records attributed to A Grepe.

At least 19 recordsLinked to original sources

Immunologic basis for adverse reactions to radiographic contrast media.

The lymphocyte transformation test (LTT) was used to elucidate whether certain side effects induced by radiographic contrast media have an immunologic etiology. Groups studied were: 8 patients who had previously experienced adverse reactions in association with urography, 6 patients who underwent urography without notable side reactions, 17 occupationally exposed nurses, and 9 unexposed controls. The lymphocytes from 2 hypersensitive patients and from 11 nurses exhibited a positive proliferative response to amidotrizoate. Five nurses who had shown a positive response, had a previous history of hypersensitivity reactions when handling contrast media, whereas the remaining 6 were free of symptoms. Amidotrizoate-specific memory cells were absent in patients who underwent urography without signs of hypersensitivity and in 7/9 of unexposed control subjects. Lymphocytes from patients sensitive to amidotrizoate cross-reacted to structurally related ionic contrast media while non-ionic contrast agents did not induce proliferation of the lymphocytes. Thus, ionic radiographic contrast agents have antigenic properties in man. Irradiated mixtures of radiographic contrast media and serum proteins were, in general, not effective in inducing an LTT response.

Adult

Bacteremic pneumococcal pneumonia in Sweden: clinical course and outcome and comparison with non-bacteremic pneumococcal and mycoplasmal pneumonias.

279 patients with 285 episodes of bacteremic pneumococcal pneumonia (Pnb), treated at the 2 departments for infectious diseases in Stockholm, Sweden, were reviewed retrospectively. Almost half of all episodes were caused by serotypes 3, 9 and 4 (in that order). The overall mortality rate was 7% and as low as 5% if patients with extrapulmonary complications were excluded. As in other studies male sex, alcoholism and absence of leukocytosis on admission to hospital were all associated with a higher mortality rate. However, the prognosis for old patients was much better than in most other studies. This was true also when the infecting strain was of serotype 3. For 89 consecutive patients out of the 279 ones with Pnb the clinical, laboratory and chest X-ray data were compared with those of 44 patients with non-bacteremic pneumococcal pneumonia (Pn) and 27 patients with Mycoplasma pneumoniae pneumonia (MP). Within the pneumococcal group almost all non-bacteremic patients had respiratory tract symptoms compared to less than half of the patients with bacteremic disease. High age, alcoholism, chills, pleuritic chest pain, a leukocyte count of greater than 15 x 10(9)l and an elevated CRP were factors significantly more common among those with pneumococcal pneumonia than among the MP patients. On chest X-ray an alveolar pattern was seen in all but 2 of the totally 133 patients with a pneumococcal pneumonia, but also in half the patients with MP.

Adolescent

The epileptogenicity of neurolept anaesthesia in patients during and after neuroradiological examinations with metrizamide.

Previous experimental studies caution against the use of neurolept anaesthesia during subarachnoid injection of metrizamide for neuroradiodiagnostic procedures because of severe epileptogenic complications. To examine whether these recommendations are relevant in the clinical situation or not, 104 patients were studied. They underwent neuroradiological investigations with metrizamide subarachnoidally and were anaesthetized with neurolept anaesthesia either during the investigation (59 patients, Group I) or within 48 h afterwards (45 patients, Group II) when a neurosurgical operation was performed. In 10 patients of Group I, EEG was recorded during the investigation. All patients were observed for occurrence of clinical epileptic manifestations during and after the anaesthesia. Apart from one patient who had a short episode of suspected epileptogenic EEG-activity shortly after the injection of metrizamide, none of the other patients showed EEG-abnormalities of epileptogenic type and none of them had any clinical signs of epileptic manifestations. On the basis of the results of this clinical study it is concluded that neurolept anaesthesia does not increase the risk of epileptic complications during neuroradiological investigations with metrizamide.

Adolescent

Atlantoaxial instability in Marfan's syndrome. Diagnosis and treatment. A case report.

A case of Marfan's syndrome is described in which progressive neurological signs and symptoms were produced by flexion of the head. Radiological examinations revealed hypermotility between the atlas and axis, as well as compression of the medulla oblongata by the odontoid process on flexion, since low positioned cerebellar tonsils prevented dorsal shift of the oblongata. The signs and symptoms disappeared after occipitocervical internal transfixation.

Adult

Stereotaxic reconstruction of the aqueduct of Sylvius.

A stereotaxic technique has been developed to cannulate the cerebral aqueduct in patients with hydrocephalus resulting from occlusion of the aqueduct of Sylvius. Precise placement of a 15- to 20-mm long radiopaque prosthesis between the third and fourth ventricles can reestablish the normal cerebrospinal fluid (CSF) pathway. Since 1974, seven patients have undergone aqueductal reconstruction. The surgical goal in this series was to manage the hydrocephalus by creating and maintaining a patent aqueductal channel. The follow-up period ranged from 1.5 to 6.5 years. In four cases, aqueductal reconstruction alone resulted in control of the hydrocephalus, although two patients underwent revisions of their prosthesis. Three patients ultimately required shunts, despite initial symptomatic improvement after reconstruction. In these seven cases (13 stereotaxic procedures), no mortality and no significant operative morbidity were encountered. Although the technique is relatively simple to perform, technical difficulties remain. At present, no clinical or radiographic test adequately discerns the ideal candidate for stereotaxic aqueductal reconstruction. Four patients required stereotaxic revision because of malposition or malfunction of the prosthesis. This approach should be reserved for patients with a short aqueductal occlusion, and normal distal CSF pathways and dynamics. The rationale, technique, problems, and results of stereotaxic reconstruction are presented.

Adolescent

Atlantoaxial arthrography. A postmortem study.

The atlantoaxial joints of nine cadavers were examined with Amipaque. A lateral percutaneous approach was elaborated. Interarticular communications and pertinent anatomical features were analyzed.

Atlanto-Occipital Joint

Pneumoencephalographic changes with intrasellar cisternal herniation (primary empty sella).

In a selected material of 47 cases of primary intrasellar cisternal herniation, analysis of pneumoencephalographic changes demonstrated the long axis of the anterior part of the third ventricle to point towards the center of the herniation. Transmitted CSF pulsations from the third ventricle probably determine the formation and location of intrasellar herniations. The distribution of air in the subarachnoid space indicated a disturbed CSF circulation in the majority of patients. Visual field defects were unrelated to the slight deformity of the optic nerves observed but rather to a high position of the third ventricle.

Adolescent

Cisternography with metrizamide of the posterior fossa following lateral C1-C2 puncture.

A report is given of a series of 23 consecutive cisternographies with metrizamide (Amipaque) of the posterior fossa using the lateral puncture at the C1-C2 level. Two to 4 ml metrizamide 300 mg I/ml were injected. The good clinical tolerance with regard to short as well as long-term effects of the contrast medium may be attributed to the low dose used and rendered possible by the selective distribution. No clinical epileptogenic seizures were observed.

Cranial Fossa, Posterior

Anatomy of the cranial nerves in the basal cisterns. A radiologic post-mortem investigation.

A post-mortem radiologic investigation of the basal cisterns has been made with special regard to the cranial nerves. The cisterns were removed in one piece together with the adjacent brain structures and the skull base. The anatomy of the cranial nerves as seen at cisternography and the frequency of their identification have been analysed. The application in clinical cisternography of the information obtained is discussed.

Abducens Nerve