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Biomedical subjects

C Hamburger

Publications and source records attributed to C Hamburger.

At least 19 recordsLinked to original sources
PubMed1992

Surgical observations in extremely lateral lumbar disc herniation.

About 10% of lumbar disc herniations are localized in an extreme lateral position referred to as "extracanalicular". The clinical syndrome is a typical one with compression signs of the lateral, extra-foraminal nerve root and minimal lumbar pain. A reliable diagnosis can be made only since high resolution spinal computed tomography has become available. Surgical treatment will be rendered difficult by the "hidden" localisation of the disc fragments. A total number of 15 patients has been operated on in our department during the last year. In 10 patients, we used the lateral microsurgical approach proposed by REULEN, in five cases a combined procedure with lateral sequestrotomy and medial nucleotomy. In the first group, re-sequestration occurred in three cases and further surgery including medial nucleotomy was performed then. A good result with remission could be achieved in 13 cases, whereas in two cases with additional spondylolisthesis, lumbar back pain continued, but the radicular symptoms were reduced.

Follow-Up Studies↗
PubMed1992

Management and prognosis of intracranial giant aneurysms. A report on 58 cases.

Between 1975 and 1989, 58 patients, 32 females and 26 males, mean age 50 years, with intracranial giant aneurysms with a diameter more than 2.5 cm were treated at our clinic. 48% of the patients presented with subarachnoidal hemorrhage. The most of the other 30 patients presented with cranial nerve dysfunctions. The most common site of the aneurysm was the internal carotid artery (25 cases, 43%), followed by the anterior cerebral artery (14%), and the vertebro-basilar region (11 cases, 19%). In 14 patients direct surgery was not performed because of the poor general condition of the patient, the high risks, or non-consent. In seven patients (12%) the aneurysm had been misdiagnosed as meningeoma, pituitary-adenoma, craniopharyngeoma or glioblastoma. 47% of all patients were discharged as "independent" and 19% died. Patients without SAH had better chance of survival: 7% of patients without SAH died and 29% of patients with hemorrhage. 50% of patients without hemorrhage were discharged as "independent" but only 18% of patients with SAH. Because of the high incidence of hemorrhage and the better prognosis for patients without hemorrhage, we recommend routine surgical treatment of patients with giant aneurysms.

Adult↗
PubMed1992

[The proton MR spectroscopy of intracranial tumors. The differential diagnostic aspects for gliomas, metastases and meningiomas].

Twenty-two patients with intracranial tumours were examined by MR images and in vivo proton-MR-spectroscopy. The changes of relative concentrations of NAA, PCr/Cr, Cho, and Ins were measured spectroscopically and the amount of these metabolites were related to different tumour groups. Analysis of the results has shown that the spectra from all the tumours differed from normal spectra. All cerebral tumours showed marked reduction of the Pcr/Cho quotient and the NAA/Cho quotient was also reduced. The Ins/Cho quotient for meningiomas and metastases was also lower than in normals; in gliomas of low malignancy the quotient was slightly raised and in gliomas of greater malignancy it was significantly higher than normal. The spectra of cerebral metastases showed unusual high lipid signals of 0.9 ppm and 1.25 ppm. The only common feature for meningiomas was marked reduction of NAA concentration. In summary, localised in vivo proton-MR-spectroscopy can be used clinically to obtain valuable information for the differential diagnosis of gliomas and intracerebral metastases.

Brain Neoplasms↗
PubMed1990

Neurosurgical management of cerebellar hemorrhage.

Controversy remains concerning the management of patients with cerebellar hemorrhage. In this study the records of 42 patients were reviewed. In 60% of them the signs of brainstem compression and upward transtentorial herniation were found. The level of consciousness was found to be consistent with the radiologic finding of the ambient cistern on the CT scan. Complete compression of the ambient cistern was always associated with coma, a partially compressed ambient cistern with stupor or drowsiness, while a normally shaped ambient cistern was associated with a normal level of consciousness. Immediate surgical decompression of the posterior fossa was life-saving for patients with brainstem compression and upward transtentorial herniation. Mortality was 57% for comatose patients and 9% for drowsy or stuporous patients. Ventriculostomy alone is the treatment of choice in cases with only hydrocephalus without brainstem compression or transtentorial herniation.

Adolescent↗
PubMed1990

Methods and applications of three-dimensional imaging in orthopedics.

Computed tomography is a commonly used technique for detecting pathological alterations in soft tissues and the skeleton. Three-dimensional images of the skeleton are very useful for planning surgical treatment and monitoring therapy, but unfortunately mental reconstruction of complex three-dimensional anatomical structures from conventional tomography is very difficult. This article describes a process by which automated analysis of the regions of interest in the computed tomographic (CT) images yields the contours of the surfaces which can be presented pseudo-three-dimensionally using Phong's lighting model and Gouraud's shading methods. Three applications in the areas of orthopedics and neurosurgery demonstrate the efficacy of the method.

Bone Diseases↗
PubMed1989

[The importance of 111-indium marked leukocyte scintigraphy in inflammatory intracranial processes].

111-indium-labelled leukocyte scintigraphy used for testing inflammatory intracranial lesion delimitation in differential diagnosis, shows reliable results in 80% of the cases, whereas 10% demonstrate false-positive as well as false-negative results. Loss of time is caused by the 24 h waiting period for measurement, and because of supply problems. Due to these drawbacks, this method is of only limited help to the neurosurgeon in quickly finding safe pointers for determining the time of operation if inflammatory intracranial lesions are suspected. Hence, this method requires to be improved upon, or a new one should be developed.

Adult↗
PubMed1989

Noninvasive differentiation of tumors with use of localized H-1 MR spectroscopy in vivo: initial experience in patients with cerebral tumors.

A recently developed method for image-selected localized hydrogen-1 magnetic resonance (MR) spectroscopy was assessed in the differential diagnosis of nine primary and secondary cerebral tumors, including four gliomas, two meningiomas, one neurilemoma, one arachnoid cyst, and one metastasis of breast cancer. Well-resolved H-1 MR spectra of these tumors were obtained in vivo with a conventional 1.5-T whole-body MR imaging system. All tumor spectra were remarkably different from spectra from normal brain tissue. Spectra obtained from different tumors exhibited reproducible differences, while histologically similar tumors yielded characteristic spectra with only minor differences. The observed spectral alterations reflect variations in concentrations and relaxation times of the H-1 MR sensitive pool of free (mobile) metabolites within the tissues. In most cases, the concentrations of N-acetyl-aspartate and creatine/phosphocreatine are reduced below detectability, whereas choline-containing compounds are generally enhanced. The spectral differences between the tumors are mainly due to the differing concentrations of lipids, lactic acid, and carbohydrates. Localized H-1 MR spectroscopy may become an important clinical tool for the differentiation of tumors as well as for therapeutic control.

Adult↗
PubMed1987

[Diagnosis and surgical treatment of cervical intervertebral disk displacement and cervical myelopathy].

Despite the availability of excellent neuroradiological examination techniques, a decision to operate is usually still reached largely on the basis of a diagnosis of radical and/or medullary cervical compression syndrome made by clinical neurological examination. Computer tomography has allowed a decisive improvement in the diagnosis of these processes, since the position of parts of discs that have prolapsed or sequestrated dorsally or dorsolaterally relative to the spinal cord and the nerve roots can be visualized directly. Since core spin tomography does not yield information that is any more helpful in the diagnosis, despite the considerably higher level of technical sophistication and higher costs, we are of the opinion that there is no call to apply this procedure routinely for the diagnosis of medial and lateral cervical disc rupture. Since the neurological symptoms do not always allow localization of the radicular or medullary damage to the segment or segments affected, it is sometimes necessary to perform myelography with water-soluble contrast media for this purpose. The microsurgical procedures available are restricted foraminotomy for the relief of cervical nerve root compression and ventral diskectomy for the relief of spinal cord compression.

Adult↗
PubMed1979

Intracranial pressure in the cat during nitroglycerin-induced hypotension.

Intracranial pressure measurements were made during nitroglycerin-induced hypotension in the cat anesthetized with halothane. A total of 48 individual observations were made in eight animals. The administration of sufficient nitroglycerin to decrease mean arterial pressure from a control value of 87 +/- 7 torr by 12 +/- 4 torr resulted in an increase in mean intracranial pressure from a control value of 7 +/- 2 torr to 12 +/- 2 torr. Larger decreases in mean blood pressure were associated with larger increases in intracranial pressure. The increase in intracranial pressure was similar to that previously reported for nitroprusside, and greater as well as more reproducible than that reported for trimethaphan. Thus, nitroglycerin may produce significant increases in intracranial pressure, and this may be a limiting factor in its clinical use.

Anesthesia, Inhalation↗