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Biomedical subjects

D Steube

Publications and source records attributed to D Steube.

At least 19 recordsLinked to original sources
PubMed2004

[Treadmill therapy in patients after ischaemic stroke].

Treadmill training with body weight support was applied in 30 patients who had suffered an ischaemic stroke, with the goal of improving their independence in the activities of daily living (ADL). The following inclusion criteria were used: inability to walk (FAC-score 0 - 2); motor abilities (the ability to sit without support, a palpable muscle function of the hip extensors, abductors and the knee extensors in the affected leg); adequate cooperation, motivation and vigility; absence of muscle contractures which would affect gait; onset of therapy no later than one year after the incident. The average duration of treadmill training was 6,6 weeks. The patients' age was an average 68 years (48 - 82). 87 % of the patients were able to improve their gait within the Functional Ambulation Categories (FAC) scale. 60 % of the patients achieved the ability to walk independently without technical aid. Apart from improving their gait, the patients also attained significantly increased scores in the motor scale of the Rivermead Motor Assessment (gross function) and the motor part of the ADL scale of the Barthel Index (items 2 - 4) and the Functional Independence Measure (items 3 and 4). Treadmill training is establishing itself as an important therapeutic approach in gait rehabilitation with patients with acquired brain damage.

Activities of Daily Living↗
PubMed2001

Prognostic value of lower limb motor evoked potentials for motor impairment and disability after 8 weeks of stroke rehabilitation--a prospective investigation of 100 patients.

We investigated 100 patients with a one-sided, functionally relevant hemiparesis after stroke. Motor evoked potentials (MEPs) were obtained from the anterior tibial muscle four or more weeks after the insult as well as after an eight week period of inpatient rehabilitation. The MEP results were correlated with motor deficit, walking ability, and activities of daily living (ADLs). Patients with loss of MEP had lower scores on the Motricity Index (MI) both at the beginning and at the end of the rehabilitative treatment (p < 0.001) and also gained fewer points on the MI than patients with preserved MEP. This was the case even when analyzing the lower limb scores alone (p < 0.001 before treatment, p = 0.003 after eight week rehabilitation). When the MEP was preserved, patients were more likely to regain independence in walking (specificity 0.67, positive predictive value 0.96) and stair climbing (specificity 1.0, positive predictive value 1.0). Patients with preserved MEP also scored higher on global outcome scales such as Barthel Index (BI), Functional Independence Measure (FIM) and Glasgow Outcome Scale (GOS). However, these differences did not reach statistical significance (p > 0.05). According to our results, MEPs of the lower extremity are of predictive value for the rehabilitative treatment of patients in the postacute phase after stroke. This is especially true for the extent of the motor impairment and walking ability. The utilization of MEPs for prediction of future levels of disability and handicap is limited and only useful taking into consideration other clinical and diagnostic findings as well as the patients' cognitive, emotional and social state.

Adult↗
PubMed1998

[Terson syndrome: a frequently missed ophthalmologic complication in subarachnoid hemorrhage].

The syndrome of intra-vitreous bleeding in association with subarachnoid hemorrhage (SAH) was first described by the French ophthalmologist Albert Terson. In the last 10 years, 31 articles describing 202 cases of Terson's syndrome (TS) were published. Only 3 out of the 31 were printed in non-ophthalmological journals. The findings of our prospective study underline the fact that too little attention is paid to TS in the early treatment of patients with SAH. Between 1/95 and 8/97, 89 patients with spontaneous SAH (7% of all admissions) were transferred to our hospital for post acute phase rehabilitation. Out of these, 13 patients (19 eyes) could be diagnosed with TS. This corresponds to an incidence of 14.6% of all patients with SAH (previous studies: 2-27%). However, only one patient had been correctly diagnosed with TS in the referring clinic. Early recognition of TS is of high importance since diminuation of visual acuity even to functional blindness, complicated in the bilateral case, can hamper the rehabilitative process considerably. Moreover, complications can lead to significant and irreversible damage, i.e. proliferative vitreo-retinopathy (PVR), retinal breaks, traction amotio, and cataract. Suspicion of TS is raised in either cooperative patients complaining of compromised visual acuity or in patients where funduscopy shows vitreous opacity. According to our results, visual evoked potentials (VEP) have only a limited role in diagnosis because of their low sensitivity. Not infrequently, however, VEP may point to accompanying optic nerve atrophy, thereby suggesting conservative treatment. Absolute indications for surgical interventions are PVR and its sequelae; relative indications are subjective visual impairment, impediment of rehabilitation, or lack of spontaneous resorption of the hemorrhage. The surgical procedure of choice is the pars plana vitrectomy (PPV). Rare complications of this operation are retinal damage, endophthalmitis, and reoccurrence of hemorrhage.

Adult↗
PubMed1988

[Traumatic infraclinoid aneurysms].

Traumatic infraclinoidal aneurysms of the internal carotid artery are rare. They can occur after craniocerebral lesions and can lead to life-threatening haemorrhages from the nasopharyngeal space. Frequently it may take months after the accident before the patient experiences single or repeated rupture bleeding and is referred to acute treatment in an ENT ward. Angiography can confirm the diagnosis and is mandatory to clarify the question of collateral flow in cerebral circulation. In case of local inoperability combined with the need for a ligature of the internal carotid artery, the protective application of an extra-intracranial microvascular anastomosis is an improved safeguard against postoperative deficits. During the past five years five patients suffering from an infraclinoidal aneurysm of the carotid artery have been operated on successfully in this manner. Two of these patients suffered from a traumatic aneurysm; these two case reports are presented.

Adolescent↗
PubMed1988

Experimental studies in animals on the use of a fibrin glue from the human plasma fraction Cohn I in nerve reconstruction.

In order to compare the effects of suture and glue direct nerve connections and nerve transplantations in the sciatic nerve in rats were performed. 4, 6 and 12 weeks later, the nerve anastomosis were histologically studied. In the direct nerve connections, despite a single holding suture, dehiscences were frequently detected with the penetration of the adhesive between the nerve ends. Due to the exact adaptation with the aid of inserted nerve grafts, the anastomoses could be repaired sutureless successfully using a fibrin glue cuff. Since histologically, in comparison to suture, no foreign body granulomas were found, the findings in the literature could be confirmed. No cicatricial contractions of the anastomoses could be found. In the interfascicular nerve transplantation, comparatively good results may be obtained using the two-component adhesive on the Cohn I-fraction basis.

Anastomosis, Surgical↗
PubMed1988

Fibrin glue on the Cohn I fraction basis in repairing cerebral and dura defects--an experimental study on rats.

The rat skulls were operated upon using a trephine osteoplastically, and a defined cerebral and dura defect was induced. The repair of the cerebral defect was performed with Cohn I glue, or in combination with collageneous fleece. The dura defect was repaired by suture and/or glueing of a split skin or pedicle galeal-periostal flap. Thanks to using Cohn I glue, at all times sufficient venous hemostasis could be achieved, and in combination with collagen fleece the repair was at an optimum. The histological check-up demonstrated that neurotoxic side-effects were absent and there were no conglutinations with the dura. Suturing of the dura was highly time-consuming and impossible when the dura had been removed near the bone. The use of Cohn I adhesive permitted ready and defect repair commonly applicable. At high tension the combined suture-glueing technique proved to be superior.

Animals↗
PubMed1988

[A model for microsurgical interference of the rat cranium].

A trepanation model in the rat cranium is represented starting from the permanent enlargement of the microneurosurgical interventions with the necessity of trepanation below the microscope, the suture of the dura mater in regions with difficult access, and the dressing of cerebral tissue defects. A possibility for the microsurgical training is given for the trepanation and the dressing of dural and cerebral defects. Surgical materials and/or drugs for local application can be tested for using them in the neurosurgery too.

Animals↗
PubMed1987

[Microsurgical suture and fibrin gluing of nerve anastomoses. Animal experiment study using Cohn I human plasma fraction].

In a comparison of suture and fibrin bonding (using human plasma fraction Cohn I) direct as well as autologous and homologous nerve transplantations were performed in animal experiments. The study was carried out in a total of 66 Nn. ischiadici in Albino Wistar rats. With and without transplants the anastomoses were provided 26 times with the usual microsurgical single-button suture technique and 11 times tith a fibrin adhesive cuff with sequential application of the two components (500 I. U. thrombin/ml, 3,000 units contrycal) or simultaneous application after premixing of the components (5 I. U. thrombin/ml, 50 units contrycal). The qualitative evaluation was carried out after 4, 6, and 12 weeks according to the clinical and histological findings. With the use of sufficiently long transplants the nerve anastomoses could be fixed sutureless with the adhesive cuff more simply than with sutures. Histologically an undisturbed growing forth of the axons without foreign-body reactions and scarred constrictions could be proved. The sutured anastomoses, too, showed a good regeneration; owing to the 2-3 single button-sutures only low-degree tissue reactions occurred around the threads without any greater impairment of the proliferation of the neurites. In case of the direct uniting of the nerves adhesion was only possible in combination with a holding suture. In most cases, however, anastomose dehiscences with a bad result were nevertheless found. The direct nerve suture had to be carried out with 5-7 single-button sutures. In this case, considerably pronounced foreign-body reactions were sometimes found histologically. The nerve regeneration, however, was much better than in case of bonding by adhesion. In contrast to the application in direct nerve joining, the Cohn I adhesive could be used with good results for nerve transplantations.

Anastomosis, Surgical↗
PubMed1986

[Neurosurgical aspects of arachnoid cysts].

After an analysis of the patients treated in the last five years, a report is given on 9 cases of arachnoid cysts as a rare form of intracranial space occupation. The etiology of the arachnoid cysts has not been fully cleared up yet, but the semipermeability of the cyst membrane appears to be an important pathogenetic factor. Today, the diagnosis of the disease is verified by CT techniques. In case of the occurrence of clinical symptoms the treatment should always be carried out in the form of an operation.

Adolescent↗
PubMed1986

[Experiences with alloplasty repair of defects of the skull calotte with modern artificial materials].

There are controversial views on alloplastic repair of skull cap defects. This has prompted the authors to report their own experience from indirect cranioalloplasty, using polymethylmethacrylates (PMMA). Seventy-two implantations were performed on patients, within 13 years, most of them for traumatic defects. Immediate repair was carried out in four cases, following neurosurgical interventions. Two implants had to be removed for cosmetic reasons and four for infections. Hence, the rate of complications amounted to six per cent. The brain-dura region was improved, accompanied by positive effects on seizure problems. Cosmetic results were good to very good in 54 patients. Ten patients could move from part-time to full-time employment, following plastic repair. Benefits and setbacks of the method are discussed.

Adolescent↗
PubMed1984

[Virologico-serologic studies in patients with brain tumors].

The etiological role played by human pathogenic herpes viruses for diseases of the central nervous system has been verified (Herpes simplex virus, varicella zoster virus) or is being discussed (cytomegalo virus, Epstein-Barr virus). In this study, the significance of herpes virus infections for surgically treated cerebral tumour patients is examined. In a total of 30 patients with various cerebral tumours, infectious virus from cerebral tumour tissue could be isolated in none of the cases. The mean geometric antibody titres against herpes virus in the patients did not differ from those of comparable healthy controls. In patients with cerebral tumours, however, acute herpes virus infections were serologically identified with a significantly greater frequency than in the control group. They are mainly an expression of endogenous re-infections with these viruses which inhabit latently the human organism. Possible causes of the observed asymptomatically proceeding herpes virus reactivations are discussed.

Adult↗
PubMed1981

[Cancers of extravesical origin with secondary perforation into the bladder].

The pseudotumorous forms of cystitis, the benign diseases of the adjacent organs, the rare diseases of the urinary bladder as well as the malignomas of extravesical origin are included into the differential diagnosis of tumours of the urinary bladder. In the present report altogether 17 malignomas of extravesical origin with secondary perforation into the urinary bladder are evaluated. Culmination points of diagnostics and therapy are discussed. Apart from the consequent performance of preventive programmes the improvement of the results of treatment presumes a vast diagnostics.

Abdominal Neoplasms↗