Biomedical subjects

Chris Woertgen

Publications and source records attributed to Chris Woertgen.

At least 19 recordsLinked to original sources

PubMed2006

Comparison of craniotomy and craniectomy in patients with acute subdural haematoma.

Despite the increasing acceptance of craniectomy in patients with traumatic brain injury, the value of early decompressive craniectomy in patients with acute subdural haematoma is still under debate. In this retrospective study, we reviewed 180 patients with traumatic acute subdural haematoma, 111 of whom were treated with haematoma evacuation via craniotomy and 69 of whom were treated with early decompressive craniectomy. Due to the higher incidence of signs of herniation for patients in the craniectomy group, the mortality rate in this group was higher than that in the craniotomy group (53% vs. 32.3%). However, overall there was no significant difference in outcome between the two groups. Age and clinical signs of herniation were significantly associated with an unfavourable outcome, regardless of the type of surgery. Decompressive craniectomy did not seem to have a therapeutic advantage over craniotomy in traumatic acute subdural haematoma.

Craniotomy↗

PubMed2006

ICAM-1 and VCAM-1 expression following aneurysmal subarachnoid hemorrhage and their possible role in the pathophysiology of subsequent ischemic deficits.

BACKGROUND: The pathophysiology of ischemic cerebral lesions following aneurysmal subarachnoid hemorrhage (SAH) is poorly understood. There is growing evidence that inflammatory reactions could be involved in the pathogenesis of such delayed occurring ischemic lesions. The aim of this study was to evaluate adhesion molecules with regard to these lesions following SAH. METHODS: Serum and cerebrospinal fluid (CSF) samples were taken daily from 15 patients up to day 9 after SAH and evaluated for intercellular adhesion molecule-1 (ICAM-1) and vascular adhesion molecule-1 (VCAM-1). RESULTS: CSF and serum samples correlated well during nearly the whole time course (p < 0.0001). A secondary increase in ICAM-1 and VCAM-1 in the serum and CSF correlated with an increase in flow velocity in the transcranial Doppler (p > 0.0001 and p < 0.007) but not to a delayed lesion in the CT scan. CONCLUSION: We believe that inflammatory processes are involved in the pathogenesis of cerebral vasospasm but they might only be a part of a multifactorial pathogenesis.

Adolescent↗

PubMed2006

Possible role of the C-reactive protein and white blood cell count in the pathogenesis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage.

The delayed ischemic neurologic deficit (DIND) is a common and potentially devastating complication in patients who have sustained subarachnoid hemorrhage (SAH). Recent evidence suggests that various constituents of the inflammatory response may be critical in the pathogenesis of this ischemic complication. The aim of this study was to evaluate the possible relationship between the C-reactive protein (CRP)/white blood cell (WBC) count and DIND. A total of 88 patients with acute SAH were included. CRP and WBC count were estimated on a daily basis. Outcome was evaluated 1 year after the initial ictus according to the Glasgow Outcome Scale. CRP levels on days 5, 6, 7, and 8 were statistically significantly higher in the group of patients developing a DIND (P < 0.025, P < 0.016, P < 0.011, P < 0.0002). WBC counts were higher in this patient group on days 1, 4, 5, 6, and 7 (P < 0.0253, P < 0.0087, P < 0.00167, P < 0.0026, P < 0.0045). Overall CRP values were higher with increasing severity of the initial ictus according to the Hunt and Hess Scale and to the outcome according to the Glasgow Outcome Scale from day 3 on. A statistically significant relationship between WBCs and outcome could not be observed. The presented data do not prove that WBCs and CRP values have a direct contribution to the pathogenesis of ischemic complications following SAH, but it supports the assertion that inflammation may present a common pathogenic pathway in the development of such complications.

Adult↗

PubMed2006

Pyogenic spinal infections and outcome according to the 36-item short form health survey.

OBJECT: Pyogenic vertebral infections are rare. In most papers investigators have focused on risk factors, clinical characteristics, and diagnostic findings, and discussed different management strategies. The optimal strategy for dealing with spinal infections, however, remains controversial. Additionally, outcome data regarding quality of life (QOL) after pyogenic spinal infections are sparse. The aim of this study was to provide further data in this field. METHODS: The authors retrospectively investigated 62 patients suffering from pyogenic spinal infections. In 37 patients (59%), lumbar lesions were observed; thoracic and thoracolumbar infections were documented in 19 (31%) and a cervical infection was demonstrated in six patients (10%). Overall 28 patients (45%) underwent conservative treatment, and 34 (55%) underwent surgery with or without the placement of instrumentation. At follow-up examination the authors recorded each patient's satisfaction as well as QOL according to the 36-Item Short Form Health Survey. Quality of life after treatment of pyogenic spine infections did not reach the level of the normative sample. Most patients continued to suffer some sort of pain. Despite different indications, the surgically treated patients experienced a slightly better QOL and self-reported satisfaction levels, as well as a statistically significant better outcome, than patients treated conservatively. CONCLUSIONS: The results obtained in the present study suggest that surgery, especially in conjunction with the placement of instrumentation, may be more beneficial than conservative treatment in patients with a spinal infection.

Adult↗

PubMed2005

High re-bleeding rate in young adults after subarachnoid haemorrhage from giant aneurysms.

Low re-bleeding rates within the first 14 days of aneurysmal subarachnoid haemorrhage are reported in young patients. Furthermore, re-bleeding rate for giant aneurysms does not exceed 20% according to the literature. Our own clinical impression is that the re-bleeding rate seems to be much higher in giant aneurysms than reported, particularly in young patients. The aim of this study was to evaluate re-bleeding rate after subarachnoid haemorrhage following rupture of giant aneurysms in a younger population. We reviewed records of 23 patients who were treated in our institution for subarachnoid haemorrhage from giant aneurysms between 1994 and 2003. By definition, the aneurysms were larger than 25 mm in diameter. Five patients were younger than 40 years of age at the time of the aneurysmal subarachnoid haemorrhage. All younger patients (<40 years of age) showed re-bleeding after the first subarachnoid haemorrhage within the first 14 days of the initial event. In four patients (20%) older than 40 years at the time of the haemorrhage re-bleeding could be observed within the first 14 days of subarachnoid haemorrhage. We can confirm the re-bleeding rate of approximately 20% in patients suffering from subarachnoid haemorrhage (SAH) in the group of patients older than 40 years of age. However, younger patients seem to be at much higher risk of re-bleeding from giant aneurysms.

Adult↗

PubMed2005

Long-term outcome after hemicraniectomy for space occupying right hemispheric MCA infarction.

OBJECTIVE: To examine the long-term prognosis in patients with 'malignant' supratentorial ischemia of the right hemisphere treated with hemicraniectomy, especially in respect to depression, with a focus on age as a possible predictor of outcome. METHODS: We performed a prospective, long-term, follow-up examination in 23 survivors of 32 patients (mortality 28.1%) treated with hemicraniectomy for malignant middle cerebral artery (MCA) infarction of the right hemisphere, who were identified in our data bank since 1993. Long-term was defined as at least 20 months after craniectomy. Outcome data consisted of the items functionality, depression and quality of life. Tests applied included the Barthel Index (BI), the modified Rankin Scale (mRS), Beck Depression Inventory (BDI) and stroke-specific quality of life (QoL) scale. RESULTS: Of the 23 patients 15 (65.2%) had a BI>or=60, 11 (47.8%) a mRS<4 and 9 (39.1%) a SS-QOL>or=60%, each representing a favourable outcome. In retrospect, 14 (60.9%) patients approved the surgery. Depression, i.e. a BDI>9, was diagnosed in 13 (56.5%) patients and 5 (38.5%) of them were treated with antidepressants. In a multiple linear regression analysis age at craniectomy was a predictor of a low BI (beta=-0.863; p=0.031), but not of the other outcome parameters. CONCLUSIONS: Depression is a common and rarely treated long-term complication after 'malignant' right hemispheric ischemia. While high age is a strong predictor of poor functional outcome, it has no impact on depression and retrospective approval of craniectomy.

Adult↗

PubMed2005

Level of evidence in the literature concerning brain tumor resection.

Microsurgical resection is a cornerstone in the treatment of brain tumors. However, the benefit of radical resection still remains controversial. We attempted to analyze the level of scientific evidence (LOE) and methodological aspects of studies concerning the impact of the extent of resection (EOR) on outcome. The LOE classification was Ia: 0%, Ib: 0%, IIa: 0.8%, IIb: 5.8%, IIc: 0%, IIIa: 13.3%, IIIb: 52.5%, IV: 10.8%, V:16.8%. 72.5% observed a positive effect of total tumor removal. 84.2% did not report the criteria for treatment assignment, 62.5% did not define the terms gross total; radical; partial; or subtotal resection. The average age of the treatment groups was reported in 29.2%, the Karnofsky index in 75.8%. Tumor size was reported in 32.5%, location in 51.7%. Assessment of EOR was based on the surgeon's impression in 75.0%, determined by postoperative CT/MRI scans in 20.8%, quantified by CT/MRI-based volumetry in 3.4%, and assessed by histological analysis in 0.8%. To date, no studies with high LOE are available addressing the benefit of gross total brain tumor removal. Although the majority of the reports found a positive effect of radical resection, the reviewed articles contain methodological limitations which may significantly influence the results.

Brain Neoplasms↗

PubMed2005

Diagnostic and therapeutic value due to suspected diagnosis, long-term complications, and indication for sural nerve biopsy.

In order to elicit the usefulness of sural nerve biopsy we retrospectively evaluated the courses of disease of every patient, who underwent this procedure in our department between January 1995 and March 2000. Sixty seven patients with the suspected diagnosis of peripheral neuropathy could be included. From these chart reviews and patient questionings were done. Inflammatory-demyelinating neuropathies were suspected in 14 patients (20.9%), specific histological findings confirmed diagnosis in 50% of these patients and resulted in therapy. In cases of polyneuropathy of unknown etiology (46 patients, 68.6%) diagnosis was made in 11 patients (23.9%), and lead to therapy in 9 patients (19.6%), merely. In all, diagnostic consequences arouse in 32.8%, therapeutic consequences in 26.9%. The follow-up of 47 patients (mean 24.4 months) found chronic pain in the distribution of the sural nerve in 14 patients (29.8%), dysesthesia in 22 patients (46.8%), and persistent sensory loss in 34 patients (72.3%). Only 24 patients (51.1%) would submit to biopsy again. Because of high complication rates and poor results we conclude that sural nerve biopsy should be done only in carefully selected cases after thorough clinical work-up, and should be limited to cases of suspected inflammatory neuropathies, collagenoses and immunologic neuropathies, and hereditary neuropathies.

Adult↗

PubMed2005

Pumpless extracorporeal lung assist (pECLA) in patients with acute respiratory distress syndrome and severe brain injury.

BACKGROUND: A retrospective analysis was performed to estimate the practicability of a pumpless extracorporeal lung assist system (pECLA) in trauma patients suffering from severe brain injury and the acute respiratory distress syndrome (ARDS). METHODS: Five patients with acute severe brain injury and ARDS, ventilated in a lung protective mode, were connected to pECLA to avoid the detrimental effects of hypercapnia on intracranial pressure (ICP) and cerebral outcome. With pECLA hypercapnia was eliminated in all patients while the minute volume of artificial ventilation could be reduced. Subsequently, ICP was reduced, systemic hemodynamics and cerebral perfusion pressure remained stable. One patient died due to multi-organ failure as a consequence of multi-trauma. The remaining patients survived showing a good neurologic function. CONCLUSIONS: pECLA is a promising alternative compared with conventional pump-driven systems for patients with ARDS and brain injury, since the pECLA system has minor restrictions, limitations and side effects.

Adolescent↗

PubMed2005

A large, erosive intraspinal and paravertebral gout tophus. Case report.

Symptomatic gout tophi of the spine are a rare but well-characterized complication of tophaceous gout. The authors report the case of a 29-year-old previously healthy man who presented with L-5 radiculopathy. Lumbar magnetic resonance (MR) imaging revealed a 4.5 x 4.5 x 2.8-cm large gout tophus mimicking a malignant spinal tumor or abscess. The tophus completely destroyed both L-4 and L-5 facet joints and the left L-4 lamina and spread epidurally from L-3 to L-5, compressing the left L-5 nerve root. There has been no similar case reported so far with respect to the extent of bone destruction. The authors describe the case history and present intraoperative, MR imaging, and histological findings.

Abscess↗

PubMed2004

Ventricular tapping seems to have no influence on S-100B and NSE serum concentrations.

Serum markers, e.show $132#g., the protein S-100B and neuron-specific enolase (NSE), are recognized to give additional information about the extension and prognosis of brain damage. In some of these patients it is necessary to insert a ventricular drain. Whether the cannulation of the ventricle falsifies the serum concentrations of these markers is unknown. The aim of this study was to get further information in this field. In this prospective study we included 19 patients. All patients underwent ventricular tapping and insertion of a ventricular drain. Serum samples for estimation of S-100B and NSE were collected before, directly after and 6 h after insertion. In addition we investigated the cerebrospinal fluid (CSF) directly after and 6 h after insertion. All patients but one showed no significantly increased S-100B or NSE serum concentration after insertion of the drainage. The concentrations in the CSF were significantly higher. One patient showed increasing concentrations of the markers in all samples reflecting ongoing brain damage. The serum values of S-100B and NSE seem not to be falsified by insertion of a ventricular drain. Therefore the prognostic value of these serum markers seems to be preserved despite the surgical manipulation.

Adolescent↗

PubMed2004

Hyperemia following aneurysmal subarachnoid hemorrhage: incidence, diagnosis, clinical features, and outcome.

OBJECTIVE: Hyperemia is a known phenomenon after aneurysmal subarachnoid hemorrhage, but only a few reports describe and analyze hyperemia in these patients. This could be the result of diagnostic difficulties in order to identify elevated cerebral blood flow; thus, it seems that hyperemia could be an underdiagnosed clinical state. The aim of the study was to evaluate this phenomenon in comparison with clinical outcome and imaging data in order to describe the frequency of hyperemia after subarachnoid hemorrhage and maybe improve clinical diagnosis. DESIGN: Retrospective analysis of our cerebral blood flow and transcranial Doppler sonography data bank. SETTING: . Neurosurgical/Anesthesiological intensive care unit University of Regensburg, Regensburg, Germany. PATIENTS AND PARTICIPANTS: A total of 37 patients were included (24 women and 13 men). All patients suffered from aneurysmal subarachnoid hemorrhage. MEASUREMENTS AND RESULTS: Standard transcranial Doppler ultrasonography, as well as the Xenon(133) clearance technique for cerebral blood flow measurements, was employed. We observed 37 increases of flow velocities in 37 patients according to Doppler ultrasonography. In order to distinguish between ischemia and hyperemia a Xenon(133) regional cerebral blood flow examination was performed. Global hyperemia was detected in 5 patients (14%). Hyperemia correlated only to favorable outcome ( p=0.01) and fewer ischemic lesions in the computed tomography ( p<0.05). CONCLUSION: The results indicate that while global hyperemia is a frequent phenomenon that cannot be detected by standard Doppler ultrasonography or clinical examination, hyperemic cerebral blood flow values following aneurysmatic subarachnoid hemorrhage are correlated to favorable outcome.

Adult↗

PubMed2004

Intracerebral haemorrhage: surgical therapy vs. patient-adapted treatment concept.

In spontaneous intracerebral haemorrhage (SICH), the indication for surgery is still controversial. Therefore we developed clinical guidelines for therapy and compared the outcome of these patients to an exclusively surgically treated group. We retrospectively evaluated outcome in 70 patients with SICH, who were treated only surgically and compared this group with 58 prospectively collected patients, who were treated surgically (n=13) or medically (n=45). Initial level of consciousness, haematoma volume, and ventricular extension of blood were inversely correlated with mortality (p<0.0001, respectively). Use of clinical guidelines reduced the number of operations without affecting the outcome. We can formulate the following guidelines according to our data: comatose patients with and without brain herniation signs should be treated conservatively. Patients with a haematoma volume between 25 and 85 ml and a clinical deterioration are candidates for surgical therapy.

Adult↗

PubMed2003

Level of evidence and citation index in current neurosurgical publications.

Systematic clinical reviews or meta-analyses offer scientifically valid sources of clinical information. They provide information in a concise form and can contribute to clinical quality management. Such studies, however, are only able to reflect the quality of the articles reviewed. The aim of this study was to evaluate the quality of the neurosurgical literature according to evidence-based medicine (EBM) standards. We reviewed all articles published in 1999 in three major neurosurgical journals. These articles were subdivided according to the level of evidence (LOE) scale (from 0 to V), article type, and citation index. Nine hundred eighty-two articles were published in these journals in 1999. Of these, 346 (35%) were clinical studies, 287 (29%) case reports, 153 (16%) experimental studies, 122 (13%) technical reports, and 74 ( 8%) other types. Subdivision according to LOE was: Ia 0.3%, Ib 2.5%, IIa 0.2%, IIb 4.3%, IIc 9.5%, IIIa 0.1%, IIIb 3.9%, IV 22.4%, and V 1.6%. Fifty-five percent of all published studies were case reports, experimental studies, technical reports, or others and thus could not be subdivided according to the EBM standards. The number of articles published with high LOE seems to be rather low in 1999. If these data reflect overall publication practice, it seems unclear whether enough articles with high LOE are published to propose scientifically sound clinical treatment suggestions according to EBM standards.

Abstracting and Indexing↗

PubMed2003

Lack of correlation between Xenon133 and near infrared spectroscopy/indocyanine green rCBF measurements.

In recent literature there are some reports describing cerebral blood flow measurements by a near infrared spectroscopy-based technique with indocyanine-green as an absorbant. To our knowledge there is no systematical study which evaluates this technique in comparison to absolute cerebral blood flow measurements. Ten patients suffering from head injury (n = 9) or subarachnoid hemorrhage (n = 1) were included. Twenty measurements of cerebral blood flow were performed, employing a Xenon133 clearance technique. Near-infrared spectroscopy measurements were performed with the Somanetics 4100 System. Indocyanine-green was given at a total dose of 0.2 mg kg-1 bodyweight intravenously. The indocyanine-green curve was compared to cerebral blood flow measurements according to rising time and area under the curve as suggested in the literature. No correlation between the indocyanine-green clearance curve and the Xenon133 cerebral blood flow measurements could be found. Neither the area under the curve (p = 0.93) nor the rising time (p = 0.75) showed a statistically significant correlation. The near-infrared spectroscopy based indocyanine-green clearance curve measurement method of cerebral blood flow seems not to give reliable results using simple mathematical models (area under the curve and rising time). In view of our findings, we have serious reservations in the potential of this technique.

Adult↗

PubMed2002

When should conservative treatment for lumbar disc herniation be ceased and surgery considered?

Different authors recommend different time spans for conservative treatment before considering surgery in patients suffering from lumbar disc herniation. We analyzed the time of onset of symptoms such as pain, sensory deficit, and motor deficit in a surgically treated group in comparison to outcome after surgery in order to define a time threshold when surgical results deteriorate and operation should therefore be considered. General data, symptoms, signs, and neurological findings of 219 patients were preoperatively recorded. The outcome was evaluated according to the Prolo scale after a mean of 9.9 months. In the statistical workup, we calculated the duration of symptoms, sensory deficits, and motor deficit as continuous variables. Additionally, the population was divided into three groups of duration of symptoms, sensory deficit, or motor deficit for < or = 30 days, 30-60 days, and >60 days. Statistically significant predictors for unfavourable outcome were, for example, a longer duration of preoperative pain and motor and sensory deficit. Patients suffering for more than 60 days from disc herniation were found to have statistically worse outcome than patients suffering for 60 days or less. Findings were similar for the different time groups concerning the duration of sensory deficit but not for duration of motor deficit. The overall outcome seems to be better when patients are operated on for lumbar disc herniations within 2 months after onset of symptoms and sensory deficits. Due to these findings, we recommend conservative treatment up to 2 months and, if conservative management does not succeed, consideration of surgery.

Adolescent↗

PubMed2002

Does bungee jumping release S-100B protein?

The S-100B protein is a recognised indicator of traumatic brain damage, but the impact threshold at which S-100B is released into serum still remains unknown. The aim of the study was to investigate whether moderate shear forces are able to release S-100B into serum in people who did a bungee jump. Eleven healthy probands jumped from a height of 50 microm and were exposed to an acceleration of about 2.8 g. Blood samples were drawn before the jump, immediately after and 71 min (mean) after the jump. The initial serum values of S-100B of all probands were normal (mean 0.22 microg/l). Also the serum values directly after and 71-min (mean) after the jump showed no increase of S-100B (0.22 microg/l and 0.23 microg/l, mean). This finding indicates that a moderate acceleration and deceleration force to the brain does not activate the release of the protein S-100B into the serum.

Acceleration↗

PubMed2002

Pain resolution after lumbar disc surgery is influenced by macrophage tissue infiltration. A prospective consecutive study on 177 patients.

The aim of this study was to assess the influence of inflammatory reactions in herniated lumbar disc specimens on pain resolution after lumbar disc surgery. Disc specimens of 200 patients who underwent surgery for lumbar disc herniation were studied immunohistologically. Preoperatively each patient received a verbal rating scale (VRS) for classification of the pain level and general clinical data were recorded prospectively. Varying amounts of macrophages could be demonstrated. Eighty-nine percent of patients could be followed up for a mean period of 7 months. A statistically significant correlation between the histologically observed macrophage infiltration and postoperative pain grading according to the VRS was found. Patients with evidence of inflammatory reactions rated their postoperative complaints lower than patients with no evidence of inflammatory reactions on the VRS (P = 0.04). In our study, a statistically significant correlation between inflammatory changes in the herniated lumbar disc specimen and outcome after lumbar disc surgery could be demonstrated.

Adult↗