Biomedical subjects
Publications and source records attributed to A Huber.
Thermal lumbar sympathectomy has been the method of choice since the 'eighties in the treatment of reflex dystrophy. We are using this method since January 1990. First results are presented and critically analysed. 15 patients who underwent thermal lumbar sympathectomy were examined and interviewed 1 year after treatment. 7 patients reported persisting pain relief, while the remaining 8 did not.
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Epidemiological data have rarely been generated during United Nations (UN) missions to Third World countries, even in situations where there is hardly any combat involvement. Continuous surveillance was therefore carried out during the 12-month stay of UN personnel in Namibia in 1989-90. In this population of 7114 persons, mostly young men, the mortality rate was 255 per 100,000; death was mainly due to traffic accidents. Hospitalization was chiefly because of fever of unknown origin or trauma. Repatriation to the country of origin was necessary in 46 patients, frequently for psychiatric reasons including alcoholism. Over this one-year period there were, on average, 2.7 new consultations per person for treatment (mostly for dental problems), and 0.8 per person for prophylactic measures. The extremely high mortality due to traffic accidents indicates a need for prevention. In the selection process for future missions, more emphasis should be given to the psychological and dental health of volunteers. All military contingents and civilian groups should learn about effective preventive measures prior to their arrival, and adhere to them.
Between 1985 and 1990 restorative proctocolectomy with ileo-anal anastomosis was performed in 19 patients (in 15 cases for ulcerative colitis, in 2 cases for familial adenomatous polyposis and in 2 cases for multiple synchronous colorectal carcinomas). Restoration of intestinal continuity was performed by ileo-anal J-pouch (j-shaped ileal reservoir) by the method of UTSUNOMIYA. Eleven patients were operated upon in a two-stage procedure and 8 patients in a three-stage procedure. There was no mortality and no pouch had to be removed. Mean bowel frequency is 5-6 times during daytime and 0-once during nighttime, a fact which speaks for the excellent quality of life in these patients.
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An unbiased place preference conditioning procedure was used to examine the secondary reinforcing effects of selective D-1 dopamine (DA) receptor antagonists and the neuroanatomical substrates mediating these effects. Systemic administration of SCH-23390 or the non-benzazepine D-1 receptor antagonist A-69024 produced dose-related conditioned aversions for the drug-associated place. In contrast, the D-2 antagonists spiperone and (-)sulpiride were without effect. SCH-23390-induced place aversions were also observed after intracerebroventricular administration. The minimum dose producing this effect was significantly lower than that after systemic injection. Aversive effects were also observed after microinjection of SCH-23390 into the n. accumbens. In contrast, microinjections of this antagonist into the ventral tegmental area, caudate putamen or medial prefrontal cortex were without effect. These data confirm that the blockade of D-1 but not D-2 DA receptors induces aversive states. Furthermore, they suggest that D-1 receptors in the n. accumbens may play an important role in the regulation of non-drug induced affective states.
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The IVUS system allows for a complete, only slightly invasive assessment of the femoral, pelvic and abdominal vessels in cross-section within the framework of intraoperative diagnostics and quality control. This method provides clear information concerning the vascular walls and internal structure. In our experience so far, it provides an ideal form of intraoperative control in cases of venous thrombectomy, embolectomy in the abdominal and pelvic vessels, following half-closed and open thromboendarterectomy and after intraoperatively performed angioplastic interventions.
Anatomical principles of the suprachiasmatic pathway. The neuro-ophthalmological examination of homonymous hemianopia: qualitative perimetry (confrontation tests), quantitative perimetry (campimetry on the Bjerrum screen, kinetic perimetry, static perimetry, automatic computer controlled perimetry, perimetry with colours, flickerfusion frequency-perimetry), oculomotor disturbances (gaze strategies, opto-kinetic nystagmus), pupillary disturbances, visual evoked potentials, anosognosia, Riddoch-phenomenom, hemiachromatopsia. Synopsis of different forms of homonymous hemianopsia: Unilateral, total or quadrant, bilateral, temporal half moon preserved or not, homonymous scotomas, horizontal hemianopsia. Pathogenetic analysis: tumors, infarcts, cerebral injuries, neuro-surgical operations, inflammatory conditions, congenital or perinatal brain damages, migraine. Additional disturbances of visual space recognition (hemineglect), of colour vision and of reading ability (alexia). In connection with the above mentioned theme appreciation of the scientific work of Prof. E. Aulhorn (Tübingen) regarding the perimeter apparatus, the perimetric examination technique and the interpretation of the perimetric results.
After a fall, a 67-year-old patient was admitted to our hospital. The unique clinical sign was an exophthalmus, which led to the diagnosis of carotid-cavernous sinus fistula. During his stay in our clinic the fistula was verified by CT and angiography. Transfemoral embolization was planned, but the fistula closed spontaneously prior to the intervention.
224 patients with liver injuries treated in 14 District and Regional Hospitals over a 10-year period were retrospectively evaluated. The results were compared to those obtained in 175 patients referred to the Central University Clinic "Inselspital", Berne/Switzerland. In all cases the degree of multiple trauma was assessed by the Injury Severity Score (ISS) and the severity of the liver injury by a Liver Injury Score (modified after MOORE). Blunt injury to the abdomen as a result of road traffic accidents, accidents at work or sporting misadventures were responsible for about 80% of all liver injuries. Peritoneal lavage was the main special investigation and was reliable in the diagnosis of haemoperitoneum. Abdominal ultrasonography proved of additional value. It allowed in experienced hands not only the diagnosis of liver injury but also some assessment of the severity of injury. Additional injuries to other abdominal organs can be assessed. By utilizing abdominal ultrasonography (or computed-tomography) liver trauma were managed conservatively in selected stable patients with minor injuries. The overall mortality was 17% in the 224 patients and compares well with the international figures. The results of treatment revealed a low mortality for liver injuries Grades I to III, whether managed in a District or Regional Hospital or in the Central University Clinic. For more severe injuries (Grades IV or V) the prognosis was worse in the District or Regional Hospitals than in the Central University Clinic. 20% of patients with liver injury Grades I to III in stable circulatory condition could be treated conservatively.(ABSTRACT TRUNCATED AT 250 WORDS)
For the assessment of the indication for surgical intervention in chronic arterial occlusive disease, the patients complaints (clinical necessity), local operability and operative risk for the patient have to be considered. In stage II disease (intermittent claudication) the patients demand for symptom-free walking distance is decisive. A young, sporting patient will not accept a distance of 500 m whereas an old patient limited by cardiopulmonary insufficiency will accept less than 50 m. Stages III and IV mean marginal perfusion and endanger the extremity acutely. Persistent severe pain or trophic lesions force to surgical intervention. If vascular reconstruction is impossible amputation will become necessary although lumbar sympathectomy might be attempted before amputation. Because of better collaterals proximal arterial occlusions endanger the extremity less than more peripheral ones, even in the case of operative failure. At the pelvic level endarterectomy or prosthetic replacement are the choice procedures. Allografts are equivalent to autografts. Bypass is best used for the cruro-femoral region. The material of choice is the autologous great saphenous vein. Below the knee it can be used as "in situ" bypass. Artificial prostheses give less favorable results. Inhibitors of platelet aggregation are used for protection of the arterial wall, anticoagulants for prevention of venous thrombosis and arterial re-embolization.
The rhodopsin and metarhodopsin states of two very distantly related fly species (Calliphora and Drosophila) are found to exhibit no species-specific differences in their absorbance spectra. Isolation and characterization of cDNAs encoding the major opsin of Calliphora reveal a high (86%) degree of amino acid identity with the corresponding Drosophila visual pigment. Completely conserved is the third cytoplasmic loop which displays the major structural differences with the vertebrate photopigments. Other conserved motifs are six potential phosphorylation sites in the C-terminal region of the molecule and two potential glycosylation sites in the extracellular domains at positions Asn18 and Asn194, respectively. Interestingly, unlike vertebrate visual pigments, only newly synthesized fly opsin is N-glycosylated, while the mature protein is not. The conserved structure of the cytoplasmic loops suggests that the molecular mechanism for the activation of the transduction cascade is precisely the same in Drosophila and in Calliphora. Thus, data obtained by investigating the biochemistry of rhodopsin-related processes in larger flies may be integrated with the results of genetic experiments in Drosophila into a common model of invertebrate phototransduction.
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Botulinum toxin A injection in essential blepharospasmus and hemifacial spasmus is an important alternative to surgical therapy. The toxin is injected into the lateral parts of the lower and upper lid in single doses of one to two nanograms under electromyographic control. The effect is visible after a few days and lasts for several months. The procedure can be repeated several times. A second important application of botulinum toxin A is strabismus. In paralytic strabismus the contracture of the antagonist of the paralyzed muscle can be weakened by local injection of botulinum toxin by means of a needle electrode under electromyographic control. Thus the contracture of the homolateral antagonist can be overcome and not seldom singular binocular vision obtained again. In cases of moderate pareses which recover spontaneously the muscle weakening effect of the toxin on the antagonist helps to restore binocular single vision. In cases of chronic paralytic strabismus the toxin injection into the antagonist facilitates the surgical intervention on the paralyzed muscle. In concomitant strabismus botulinum toxin A is above all valuable in small angle cases, in sensory strabismus, in cases of over- or undercorrection after surgery, and these especially in adults. In congenital esotropia, in commitant squints with large angles and in chronic or intermittent exotropia surgery is the preferred modality of treatment. The best results are obtained with repeated small doses. Generally a 65% reduction of the strabismus angle after two to three injections can be expected. With injections into the lids and the extraocular muscles no general systemic side effects has been observed.
We describe the case of a 31-year-old woman who underwent a section caesarean and 24 hours later a laparotomy for treatment of a ruptured subcapsular liver hematoma due to a HELLP syndrome. The HELLP syndrome (hemolysis, elevated liver enzymes, low platelets count) is a serious complication of the pregnancy with or without eclampsia. This complication has a high mortality and morbidity and can occur during the pregnancy or after delivery. The diagnosis of a subcapsular hematoma of the liver should be considered in patients with acute abdominal pain in the last trimenon or just after delivery. Laparotomy must be performed at the first signs of hemodynamic instability.
PROBLEM: Full pre- and postoperative assessment is mandatory in the management of complex cases of incomplete biliary obstruction. Investigations should not only define the level of extrahepatic bile duct obstruction but also detect intrahepatic obstruction, give some index of liver function and of the dynamics of biliary flow. Computed tomography, ultrasonography and direct cholangiography are very valuable. IODIDA-scanning provides a non-invasive method which not only complements other studies but also gives information otherwise unobtainable. CLINICAL MATERIAL: In an initial retrospective study 36 patients, 12 of whom had previously undergone operation for biliary obstruction, were fully investigated with particular reference to the use of IODIDA-scanning. PROCEDURE: 2-5 mCi of 99mTc labelled IODIDA were injected intravenously and the liver and upper abdomen scanned at 1 minute intervals and displayed at 5 minute intervals during the first hour. RESULTS: All patients were studied on admission and then postoperatively at intervals. In 31 of 36 patients IODIDA-scanning gave reliable evidence of the level of obstruction of biliary flow and of the patency of biliodigestive anastomosis. Assessment of liver function before and after biliary reconstruction was also possible. CONCLUSION: IODIDA-scanning has proved a valuable non-invasive method for the assessment of liver parenchymal function, intrahepatic abnormalities and of bile flow in cases of complex biliary obstruction. This is particularly valuable with the Roux-Y biliary reconstruction since ERCP is impossible and PTC an invasive method which, although supplying an accurate picture of major biliary obstruction, fails to characterize hepatic function and bile flow.