PubMed Health⌕ Search

Biomedical subjects

D Kühne

Publications and source records attributed to D Kühne.

At least 55 records · Page 3Linked to original sources
PubMed1996

Visualisation of intracranial aneurysms by transcranial duplex sonography.

We examined 72 patients with 89 angiographically confirmed intracranial aneurysms, using transcranial colour-coded duplex sonography (TCCD) to determine the location and size of the aneurysm. The patients were admitted for coil embolisation of their aneurysm following subarachnoid haemorrhage or because of a cranial nerve palsy. Using a 2/2.25 MHz transducer, 42 aneurysms (47%) were seen satisfactorily through the temporal bone window or foramen magnum. In 24 cases (27%) image quality was insufficient as a result of a poor bone window, of the aneurysm having a diameter of less than 6 mm or of its being in an unfavorable location. In 23 other cases (26%) it was not possible to detect the aneurysm. Thrombosed structures could be demonstrated using TCCD in 8 of 12 giant intracavernous or basilar artery aneurysms, and in 15 of 19 aneurysms treated by platinum coil embolisation. TCCD offers a noninvasive method for monitoring progressive intra-aneurysmal thrombosis following coil embolisation and for follow-up of patients with untreatable fusiform aneurysms, should this be required. Detection of small aneurysms is limited by spatial resolution and insonation angles.

Aneurysm, Ruptured↗
PubMed1996

Spinal MRI in progressive myeloneuropathy associated with vitamin E deficiency.

We describe a patient with a progressive neurological disorder consisting of ataxia, loss of proprioception and pyramidal tract dysfunction in his sixth decade. He had severe vitamin E deficiency due to fat malabsorption secondary to chronic inflammatory bowel disease. Sural nerve biopsy revealed a reduced number of myelinated fibres. MRI of the cervical spine showed high-signal lesions on T2-weighted images in the posterior columns, correlating well with the clinical findings.

Biopsy↗
PubMed1996

Sumatriptan: vasoactive effect on human dural vessels, demonstrated by subselective angiography.

Sumatriptan, a selective 5-hydroxytryptamine (5HT1D)-receptor agonist, has recently been introduced in the pharmacotherapy of acute migrane attacks. The potential vasoactive effect of sumatriptan on human dural vessels in vivo, however, is still a matter of controversy. We investigated the effects of sumatriptan on dural vessels after subcutaneous or intra-arterial injection. During interventional angiography, the middle meningeal artery (MMA) of nine patients was catheterized with a microcatheter using the transfemoral route. Three MMA were entirely normal, two supplied a dural arteriovenous fistula (AVF) and four were transdural feeders to a brain arteriovenous malformation (AVM). Sumatriptan was injected either into the subcutaneous tissue of the right shoulder (6 mg, two patients) or into the catheterized MMA (2 mg, six patients). The substance caused a marked vasoconstriction of the three normal MMA, visible angiographically and confirmed by intravascular Doppler ultrasonography. Vasoconstriction was still present in the last angiogram obtained 15 min post-injection. Slightly hypertrophied feeders to dural AVF and to brain AVM showed some vasoconstriction in one and four patients, respectively. In two patients with markedly hypertrophied dural feeders to a dural AVF and to a brain AVM, respectively, rapid shunting probably prevented obvious vasoactive effects of sumatriptan. The data obtained by angiography and intravascular Doppler ultrasonography provide strong evidence that sumatriptan has a vasoconstrictive effect on normal as well as hypertrophied dural vessels.

Adult↗
PubMed1996

Endovascular laser detachment of platinum alloy microcoils: principle and initial experimental experience.

The aim of the investigation was the technical realization and approval of a new method for insertion and detachment of platinum alloy microcoils and other vascular implants via standard microcatheters. Flexible lightconducting fibers, 105 microns in diameter were connected to platinum alloy microcoils. It was examined whether an insertion wire, a lightconducting fiber and a platinum alloy microcoil could be advanced through a Tracker-18 (Target) microcatheter. The detachment of the attached coil from the lightconducting fiber was investigated. Platinum alloy microcoils can be attached to available lightconducting fibers in a reliable and reproduceable manner. Together with the fiber they can be advanced via a Tracker-18 microcatheter. Only extremely tortuous vessels may increase the friction to critical values. A Ho-YAG laser source was used. This allowed the instantaneous detachment of microcoils from laser fibers. In contrast to electrolytical detachment, no foreign substances are released to the blood stream. The detachment does not require waiting time and does not activate thrombus formation. Due to specific technical features, injuries of the vessel wall are avoided. After further miniaturization and adaption of the lightconducting fibers to the required characteristics, laster detachment may have the potential to replace current methods such as electrolytical and mechanical coil detachment.

Lasers↗
PubMed1995

Transcranial color-coded duplex sonography in cerebral arteriovenous malformations.

BACKGROUND AND PURPOSE: It is well known that significant changes in cerebral hemodynamics may occur during the treatment of cerebral arteriovenous malformations with the complication of intracerebral hemorrhage and parenchymal edema. We used transcranial color-coded duplex sonography to study alterations in blood flow velocities during staged embolization. METHODS: Forty-one patients aged 40 +/- 13 years (mean +/- SD) with angiographically proven cerebral arteriovenous malformations were studied. The blood flow velocities of the anterior, middle, and posterior cerebral arteries were measured in 16 patients with supratentorial arteriovenous malformations, both before the first and then after each successive embolization (three to seven treatments). RESULTS: In 29 of 41 patients (71%), transcranial color-coded duplex sonography satisfactorily revealed the malformations and their main feeders. After the final embolization, we found a reduction in the peak flow velocity in treated feeders of 23 +/- 28% compared with the values before the first embolization. The untreated feeders showed an increase in peak flow velocities of 12 +/- 23% as an expression of increased collateral flow. After the treatment of the supplying feeders, we observed a reduction in flow velocity of 25 +/- 13% in seven patients, with cross-filling of the arteriovenous malformation through the contralateral anterior cerebral artery and the anterior communicating artery. CONCLUSIONS: The technical advantage of transcranial color-coded duplex sonography compared with transcranial Doppler sonography is that it allows the exact identification of different feeding arteries in arteriovenous malformations. Repeated measurements during stepwise embolization with corrected insonation angle are easily achieved, and noninvasive quantification of hemodynamic changes is possible. The method may be helpful in the planning of the different steps of embolization.

Adult↗
PubMed1995

[Therapy of cerebral aneurysms and arteriovenous vascular malformations in hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease)].

Little is known about the course of cerebral aneurysms in hereditary hemorrhagic teleangiectasia (Rendu-Osler-Weber's disease). Thus, therapeutic decisions are often difficult. For the first time, we report the successful embolization of an arteriovenous fistula and multiple aneurysms of the posterior inferior cerebellar artery (PICA) of a patient with Rendu-Osler-Weber's disease after subarachnoid hemorrhage. Two years later she suffered another severe intracranial hemorrhage. Angiography revealed an aneurysm in the same artery (PICA), which spontaneously disappeared within 2 months. Spontaneous regression of aneurysms in Rendu-Osler-Weber's disease has not been reported before.

Cerebellum↗
PubMed1994

Blood flow velocity and vasomotor reactivity in patients with arteriovenous malformations. A transcranial Doppler study.

BACKGROUND AND PURPOSE: A large percentage of patients with a cerebral arteriovenous malformation (AVM) show focal neurological signs or have a history of intracranial hemorrhage. The present study used transcranial Doppler sonography to assess the clinical significance of hemodynamic disturbances in the intracranial arteries of patients with an AVM. METHODS: Eighteen patients with untreated AVMs were examined clinically, angiographically, and with transcranial Doppler sonography (blood flow velocity measurement and vasomotor reactivity in all main intracranial arteries). RESULTS: A pathological increase in blood flow velocity (57.6%) and a decrease in vasomotor reactivity (72.7%) were frequently found in AVM feeding arteries. Vasomotor reactivity was also reduced in several nonfeeding arteries both ipsilateral (53.3%) and contralateral (30.8%) to the AVM. AVM size was a poor predictor of pathological transcranial Doppler results. Vasomotor reactivity of arteries ipsilateral to an AVM in patients with a history of hemorrhage was significantly higher (2.10 +/- 1.66% per mm Hg; mean +/- SD) than in patients with no history of bleeding (1.12 +/- 1.48% per mm Hg; P < .05). In patients with focal neurological signs but no history of hemorrhage, the percentage of arteries ipsilateral (100%) and contralateral (63.6%) to an AVM showing a pathological vasomotor reactivity was significantly larger than in nonhemorrhagic patients without focal signs (66.7% and 22.2%, respectively; both P < .05). CONCLUSIONS: Our results suggest two distinct relations between transcranial Doppler results and clinical findings: (1) Relatively normal vasomotor reactivity values in arteries ipsilateral to an AVM indicate a high-pressure AVM with an increased risk of hemorrhage. (2) A strongly pathological vasomotor reactivity in arteries ipsilateral and contralateral to an AVM indicates a low-pressure AVM with a higher prevalence of hemodynamically induced neurological signs.

Adolescent↗
PubMed1994

[Cerebral arteriovenous malformations. Diagnosis, clinical aspects and therapy].

An overview of cerebral arteriovenous malformations is presented. These congenital lesions are classified according to volume, number of feeding arteries, type of venous drainage, and localization. Clinical manifestations are intracerebral or subarachnoidal hemorrhages, or symptomatic epileptic seizures. Most patients with AVM exhibit their first symptoms before the age of 40. Migraine-like headaches and "steal" phenomena are rarely the main symptoms. Diagnosis is obtained by means of MRI and selective angiography; the treatment of choice is a combination of interventional neuroradiological therapy, radiosurgery and/or microsurgery which is adjusted to the individual case.

Cerebral Hemorrhage↗
PubMed1993

[Endovascular Doppler sonography of intracranial blood vessels. Technical indications and potential applications].

Intravascular Doppler ultrasonography was initially performed with specially designed catheters and was used primarily for cardiological purposes. The recent introduction of a 0.018-in. flexible, steerable guide wire with an integrated 12-MHz piezoelectric transducer (FloWire) has made it possible to use this technique in neuroangiography. This system allows recording of Doppler spectra and determination of blood flow velocities in intracranial vessels after subselective introduction of a standard 3-F microcatheter. The measurement of blood flow velocity in an AVM feeding branch of a middle cerebral artery and the haemodynamic effects of the vasoconstrictive substance sumatriptan on the middle meningeal artery are used to illustrate potential applications of intravascular Doppler ultrasonography in neuroangiography.

Adult↗
PubMed1992

Local thrombolytic therapy for thromboembolic occlusion of the middle cerebral artery.

We report on 10 patients with thromboembolic occlusion of the middle cerebral artery (MCA) who underwent local thrombolytic therapy. Six patients developed a MCA occlusion during long-standing interventional neuroradiological procedures, while four had a proven or suspected cardio-embolic stroke. Streptokinase or urokinase was applied by a microcatheter placed into the thrombus within six hours of clinical onset. Complete or partial revascularization was achieved in all patients. Recovery was complete in seven and partial in three of the patients. In two patients, minor haemorrhagic transformation of the infarct occurred, which did not lead to neurological deterioration. It is concluded that in a selected group of patients with MCA occlusion, local thrombolytic therapy represents a safe and effective therapy.

Adult↗
PubMed1989

The value of different neuro-imaging methods in the diagnosis of a congenital, spinal, epidural meningeal cyst.

Congenital, spinal, epidural cysts are rare causes of transverse or radicular spinal lesions. Usually these cysts are located in the thoracal region, are oblong-shaped, and extend over several segments dorsally to the cord. Frequently, they cause no symptoms for years. They are fairly accessible to diagnostics by modern neuro-imaging methods. We report on a 15 year old girl with paraparesis, which showed a slow progression over two years, short-term remissions, and finally impairment of bladder function. Myelogram, computer-assisted tomography and nuclear magnetic resonance tomography showed a large space-occupying mass from D8 to L1 epidural and dorsal of the myelon. Operation disclosed an epidural cyst from D10 to L2. Histologically, the removed material was classified as a meningeal cyst. Post-operatively the girl's condition improved under intensive physio-therapy. For the diagnosis of this spinal dysrhapic disorder CT scanning after intrathecal application of contrast medium and magnetic resonance imaging were most valuable.

Adolescent↗
PubMed1989

[Clinical aspects and treatment of spontaneous carotid artery-cavernous sinus fistula].

21 patients, who fulfilled the clinical and angiographic criteria of a spontaneous carotid cavernous fistula (CCF), were studied at the Alfried Krupp Hospital, Essen, Germany, between 1980 and 1988. Of these patients, 4 had direct shunts between the internal carotid artery and the cavernous sinus and 17 patients had unilateral or bilateral dural shunts between meningeal branches of the internal and/or external carotid artery and the cavernous sinus. The most common initial symptoms were eye redness, bruit and headache. 6 of 12 patients with double vision had mechanical disorders of eye movement. A rapid irreversible loss of vision occurred in 2 patients. In 9 of 21 patients either progressive visual deterioration, proptosis or severe orbital pain necessitated prompt institution of treatment. All direct fistulas could be occluded by the use of the detachable balloon technique. 5 patients with dural CCF were successfully treated with particle embolization of the external carotid artery blood supply. In dural CCF not requiring emergent treatment, combined carotid artery and jugular vein compression was preferred and resulted in complete cure or sufficient improvement in all but one patient. We recommend this method as the first stage of treatment in dural CCF with uncomplicated course.

Adult↗
PubMed1987

Coping with breast cancer--a longitudinal prospective study.

In a prospective longitudinal study over several years, 58 patients with breast cancer are compared to 52 patients with fibrocystic disease and 24 patients with mastodynia. Results of coping (as assessed with the Bernese Coping Modes) are presented for the illness course of the first 6 months: (1) There is considerable variation of coping depending on illness situation and illness state. A core group of coping modes is predominant in most situations: 'attention & care', 'problem analysis', and 'Tackling'. In average 10 different coping modes were used by patients per given illness situation. (2) The different aspects of illness (in the same organ) ask for different coping. In the initial evaluation phase, however, the possibly fatal diagnosis overrides these differences. (3) Change over time (first 6 months) is net. Besides the core group of coping modes mentioned above, there is more variability in coping; in cancer a trend from a more fighting to a more accepting attitude is obvious; in fibrocystic disease more restricted coping is observed. Interdependence of coping with emotional stability and social adaptation will be studied as well.

Adaptation, Psychological↗
PubMed1985

[Therapy of orbital and retroorbital space occupying processes with optic nerve compression].

Space occupying lesions involving the optic nerve require individual management. Graves' disease is first treated with cortisone: failures of treatment require radiation and operative decompression. Good results have been achieved with cytostatic drugs and, in acute progressive loss of vision, with plasmapheresis. Idiopathic pseudo-tumor orbitae disappears with cortisone, failures of treatment indicate malignant development of a lymphoma, which requires management with cytostatic drugs or radiation. Granulomatous infiltration of the optic nerve in sarcoidosis should be treated first of all with steroids before proceeding to operative treatment. Primary optic nerve tumors such as gliomas and meningeomas should be removed operatively if they are located in front of the chiasm and continue to grow. If the chiasm is involved, radiation is preferable. Doubtful cases of clinically almost indistinguishable pinealomas which are very radiosensitive require primary radiation therapy. Sinus cavernosus fistulas should be treated by selective angiographic occlusion of the fistula. If this is impossible, the internal carotid artery may be occluded by introducing a ballon catheter. Loss of vision after blunt head trauma should be treated with megadoses of steroids, operative treatment is only promising in cases with progressive loss of vision.

Arteriovenous Malformations↗
PubMed1983

Comprehensive monitoring and computerized tomographic follow up in patients with acute severe head injury: coma-outcome correlations.

In 88 patients with acute severe head injury the Glasgow coma scale (GCS), computerized tomography and autonomic monitoring during the first 24 hours were used to characterize different types of post-traumatic brain dysfunction. A subgroup is defined--GCS 8.1--with signs of diffuse brain swelling and autonomic instability which included two cases with dorsal midbrain lesions. These preliminary results suggest that autonomic instability is a valid criterion for identifying patients suffering from diffuse axonal injury.

Atrophy↗