[Louis-Bar-like syndrome in adults].
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Ataxia Telangiectasia↗
Biomedical subjects
E Németh
Publications and source records attributed to E Németh.
[Physical medicine in the diagnosis and treatment of functional disorders of the spinal column].
INTRODUCTION: Manual (Physical) Medicine is concerned with physiology, pathophysiology, diagnosis and therapy of the musculoskeletal system functional disorders. Functional disorders are caused by direct or indirect injury (muscular spasm), inflammation, sudden movements etc. Functional disorders in regard to decreased joint volume are also called segmental or peripheral joint dysfunction, somatic dysfunction and function blocking. Blocking means: reversible disorder with decreased functional joint movement; muscular spasms caused by neurophysiological changes including decreased movement; pain and functional disorder of internal organs and tissues being part of the joint. Intervertebral joints, intervertebral discs, muscles and their nerve control belong to such control circles which are integrated within an organism. The basic principles of Manual (Physical) Medicine are good knowledge of functional anatomy and three-dimensional imaging of biochemical functions of the spine. The most important functions of the spinal column are as follows: it is an organ of axis with a protective and supportive function and it enables normal walk and balance. The basic functional unit in the architecture of the vertebral column is the dynamic spinal segment. Its basic function is movement, posture maintenance and protection of spinal nerve roots. The functional disorder of one part of the dynamic segment cannot be isolated from other parts. Thus functional blocks within the fascial joints, abnormalities within intervertebral discs, changes within the ligament apparatus, and muscular disorders may be both causes and consequences at the same time. The dynamic segment is thus included into a mechanical functional circle. Its mechanical function is tightly connected with the statics of the whole body. Different leg length, severe abnormalities of great leg joints may cause blocks within the fascial joints. The vertebral dynamic segment is also a part of the nervous, functional reflex circle. Clinical symptoms associated with functional disorders within intervertebral joints are as follows: restricted joint mobility and nervous reflex disorders (local segmental and peripheral segmental injuries). MANUAL (PHYSICAL) DIAGNOSIS: In order to make physical diagnosis it is necessary to have good knowledge of anatomy, functional anatomy, kinesiology and neurology. History taking is of great importance for the physician who establishes physical therapy. It is also necessary to note various abnormalities, muscle atrophy and to analyze patient's walk. Palpation at rest reveals changes, skin disorders, subcutaneous and fatty tissues and muscles and it assesses the status of soft tissues. By physical examination of the spine it is possible to diagnose intervertebral joint blocks. Thus examination of joint mobility is performed. It is important to differ physiological, anatomic and pathologic ranges of mobility and to determine the greatest mobility and joint play. Joint play represents the property of the joint to achieve some additional mobility. This examination requires knowledge of a special technique. Palpation of local segmental irritation is performed on all spinal segments after a special technique examining bone-transversal joints as well as sacroiliac joints. Local irritation points, muscle spasms and tendomyosis are being detected. The diagnosis of blocks is also the therapeutic diagnosis at the same time. Physicians using physical medicine must apply x-ray of the spinal column, whereas the aim of physical therapy is to eliminate functional blocks, which occur in the form of reduced reversible mobility in one or more directions. Only physical examination can establish this, while apparatuses cannot objectivize it. Manipulative techniques on the spine should be performed only by specialists. MANUAL (PHYSICAL) THERAPY: Manual (Physical) therapy comprises numerous techniques and is used in various indications. (ABSTRACT TRUNCATED)
Contraindications↗
[Recovery of facial nerve function using sural nerve transplantation after its injury in acoustic nerve surgery].
INTRODUCTION: Statoacoustic n. neurinoma is a benign, slow-growing and usually unilateral tumor. During its growth the tumor exerts pressure on the surrounding anatomic forms within the pontocerebellar angle: cranial nerves, pons, cerebellum. Therefore the first clinical symptoms are ear buzzing and deafness, vision disorders, occipital headache or walking difficulties. The diagnosis of such conditions must be precise, whereas CT (computerized tomography) and MRI (magnetic resonance imaging) are the methods of choice. Surgical tumor removal is the only therapy, but during surgery facial nerve injury occurs. The objective of this paper is a case report of a facial nerve injury and sural nerve transplantation during acoustic neurinoma surgery and recovery of facial nerve function. CASE REPORT: A 23-year-old male patient suffered from ear buzzing in the right ear for a year and a half with gradual development of deafness. Due to frequent headaches and after ophthalmologic examination, the patient was urgently hospitalized at the Neurology Clinic of the Faculty of Medicine in Novi Sad where MRI of the endocranium was performed revealing a tumor of the pontocerebellar right angle, 3 x 3.5 cm in size. The patient has undergone surgery at the Neurosurgery Clinic of the Faculty of Medicine in Pees in Hungary, with suboccipital craniotomy and tumor ablation. During surgery facial nerve injury occurred in the premeatal segment and intraoperative transplantation of sural nerve grafts from the left leg to the distal parts of the facial nerve was performed. The histopathologic finding revealed an acoustic neurinoma (Schwannoma). After surgery a control CT was performed revealing a complete tumor removal. The wound healed per primam intentionem and the patient was released from hospital two weeks later. During the postoperative period physical therapy was performed in the aim of rehabilitation of the facial nerve due to peripheral paralysis. After electrodiagnostic tests using GALVOMED 20 apparatus, massage was performed in the periorbital and perioral regions. Kinesitherapy was also done in front of a mirror several times a day. 6 months after surgery an EMG (electromyography) of m. frontalis dx., m. orbicularis oculi dx. and m. orbicularis oris dx. were performed. The EMG revealed evident reinnervation possibilities. A year after surgery the control MR finding of the endocranium was regular, as well as the control MR two years after surgery (postoperative cyst without signs of recurrence of the removed neurinoma). Control EMG of the m. frontalis dx., m. orbicularis oculi dx., m. orbicularis oris dx. showed signs of reinnervation. DISCUSSION: Tumors of the pontocerebellar angle are usually acoustic nerve neurinomas. 8% of intracranial tumors are Schwannomas. They originate from neurilemmal cells, by rule they grow slowly and are benign tumors. Therefore, for years the only signs pointing to them are ear buzzing and gradual development of deafness. That is why these anamnestic data are important for diagnosis. Headaches, walking difficulties, vision disorders are the usual difficulties due to which patients seek doctor's help. Computerized tomography and magnetic resonance imaging represent the diagnostic methods of choice in establishing the diagnosis. In this case MRI was performed on time. Surgery is the only therapy, but during tumor ablation the facial nerve was injured in the premeatal region. Intraoperative transplantation of grafts taken from sural nerve to proximal and distal parts of the facial nerve provides possibilities for injured nerve regeneration. The process of regeneration of such a nerve is long-term and often permanent 40% axon loss occurs. This is the reason to perform a control EMG two years after surgery. During peripheral paralysis rehabilitation is performed in the aim of preventing contractures. It is achieved by passive exercises in front of a mirror a few times a day. (ABSTRACT TRUNCATED)
Adult↗