Biomedical subjects

Erich Schmutzhard

Publications and source records attributed to Erich Schmutzhard.

16 recordsLinked to original sources

PubMed2006

Scanning electron microscopy of the neuropathology of murine cerebral malaria.

BACKGROUND: The mechanisms leading to death and functional impairments due to cerebral malaria (CM) are yet not fully understood. Most of the knowledge about the pathomechanisms of CM originates from studies in animal models. Though extensive histopathological studies of the murine brain during CM are existing, alterations have not been visualized by scanning electron microscopy (SEM) so far. The present study investigates the neuropathological features of murine CM by applying SEM. METHODS: C57BL/6J mice were infected with Plasmodium berghei ANKA blood stages. When typical symptoms of CM developed perfused brains were processed for SEM or light microscopy, respectively. RESULTS: Ultrastructural hallmarks were disruption of vessel walls, parenchymal haemorrhage, leukocyte sequestration to the endothelium, and diapedesis of macrophages and lymphocytes into the Virchow-Robin space. Villous appearance of observed lymphocytes were indicative of activated state. Cerebral oedema was evidenced by enlargement of perivascular spaces. CONCLUSION: The results of the present study corroborate the current understanding of CM pathophysiology, further support the prominent role of the local immune system in the neuropathology of CM and might expose new perspectives for further interventional studies.

Animals↗

PubMed2006

Pharmacokinetics of intravenous linezolid in cerebrospinal fluid and plasma in neurointensive care patients with staphylococcal ventriculitis associated with external ventricular drains.

The pharmacokinetic profile of linezolid in cerebrospinal fluid (CSF) in five neurointensive care patients with staphylococcal ventriculitis was studied. The mean area under concentration-time curve (+/- standard deviation) was 63 +/- 18.9 mg x h/liter, with a CSF-to-plasma ratio of 0.8 +/- 0.3. Times above MIC in CSF were 99.8% and 57.2% for pathogens with MICs of 2 mg/liter and 4 mg/liter, respectively.

Acetamides↗

PubMed2006

Simplified multi-organ dysfunction score predicts disability in African children with Plasmodium falciparum malaria.

In this prospective study, we assessed the simplified multi-organ dysfunction score (sMODS) in 485 consecutive African children, hospitalized with Plasmodium falciparum malaria. Children were grouped according to their ability to walk unaided (Group 1, N = 414), sit unaided (Group 2, N = 63), or inability of both (Group 3, N = 8) before contracting malaria. The sMODS on admission to hospital was highly correlated with prolonged disease duration in Groups 1 and 2 (Spearman r = 0.79 and r = 0.78, respectively). A sMODS of > or = 16 was indicative for prolonged disease duration in Group 1 (> 48 hours of inability to walk, sensitivity of 87%, specificity of 82%) and Group 2 (> 24 hours of inability to sit, sensitivity of 100%, and specificity of 78%.). The simplified MODS is a simple and sensitive measure merit of severity of illness in children with P. falciparum malaria and allows early prognostic evaluation.

Child, Preschool↗

PubMed2005

Case report: severe heat stroke with multiple organ dysfunction - a novel intravascular treatment approach.

INTRODUCTION: We report the case of a patient who developed a severe post-exertional heat stroke with consecutive multiple organ dysfunction resistant to conventional antipyretic treatment, necessitating the use of a novel endovascular device to combat hyperthermia and maintain normothermia. METHODS: A 38-year-old male suffering from severe heat stroke with predominant signs and symptoms of encephalopathy requiring acute admission to an intensive care unit, was admitted to a ten-bed neurological intensive care unit of a tertiary care hospital. The patient developed consecutive multiple organ dysfunction with rhabdomyolysis, and hepatic and respiratory failure. Temperature elevation was resistant to conventional treatment measures. Aggressive intensive care treatment included forced diuresis and endovascular cooling to combat hyperthermia and maintain normothermia. RESULTS: Analyses of serum revealed elevation of proinflammatory cytokines (TNF alpha, IL-6), cytokines (IL-2R), anti-inflammatory cytokines (IL-4) and chemokines (IL-8) as well as signs of rhabdomyolysis and hepatic failure. Aggressive intensive care treatment as forced diuresis and endovascular cooling (CoolGard and CoolLine) to combat hyperthermia and maintain normothermia were used successfully to treat this severe heat stroke. CONCLUSION: In this case of severe heat stroke, presenting with multiple organ dysfunction and elevation of cytokines and chemokines, which was resistant to conventional cooling therapies, endovascular cooling may have contributed significantly to the reduction of body temperature and, possibly, avoided a fatal result.

Adult↗

PubMed2005

Prevalence of active epilepsy in a rural area in South Tanzania: a door-to-door survey.

OBJECTIVE: A door-to-door survey was carried out to assess the prevalence of active epilepsy in the rural population within the catchment area of the Mnero Diocesan Hospital in Southern Tanzania. METHODS: A total of 4,905 individuals living in 1,047 households were enrolled in a study, consisting of a screening dialogue with a representative family member followed by a face-to-face interview with the affected subject. The diagnosis of epilepsy followed clinical guidelines proposed by the International League Against Epilepsy (ILAE). RESULTS: We detected 42 cases (21 males and 21 females) of active epilepsy (8.6/1,000; 95% CI: 6.0/1,000-11.1/1,000; age-adjusted prevalence ratio: 7.4/1,000). Thirty of them met the case definitions of generalized seizures, whereas 12 patients reported partial seizures. The peak prevalence was found in both sexes in the second decade of life (f: 16.9/1,000; m: 15.8/1,000; t: 16.4/1,000), with a second peak in the group aged 30-39 years (f: 10.4/1,000; m: 8.8/1,000; t: 9.7/1,000). Eleven patients (26.2%) were classified as "strongly suspected of symptomatic" epilepsy, the remaining 31 patients (73.8%) as possibly being idiopathic, symptomatic, or cryptogenic epilepsy cases. DISCUSSION: This study provides baseline data about the active epilepsy prevalence in a rural African population. Compared to western countries, our study confirmed a pattern toward higher prevalence of epilepsy in tropical countries. As shown in previous studies, we observed a higher prevalence of epilepsy in children and adolescents, followed by a steady decline with increasing age. Reasons for this type of frequency could be ascribed to malnutrition, trauma, genetic conditions, antenatal and prenatal care, diseases resulting in febrile convulsions, cerebral infections and may even result in death in specifically diseased individuals.

Adolescent↗

PubMed2004

Concentrations of fosfomycin in the cerebrospinal fluid of neurointensive care patients with ventriculostomy-associated ventriculitis.

OBJECTIVE: The present study was performed to test the ability of fosfomycin to penetrate into the CSF of neurointensive care patients with ventriculostomy-associated ventriculitis. PATIENTS AND METHODS: Six patients requiring neurointensive care monitoring, including extraventricular drainage due to secondary obstructive hydrocephalus, were enrolled into the study. All patients received 8 g of fosfomycin intravenously three times a day over a period of at least 5 days. Concentrations of fosfomycin in the CSF and plasma were measured after single-dose administration and at steady state. RESULTS: Mean values of the fosfomycin area under the time-concentration curves for the dosing interval of 8 h (AUC(8)) were 929 +/- 280 and 225 +/- 131 mg.h/L for plasma and CSF after single-dose administration, respectively (P < 0.03). The ratios of the AUC(8) for CSF to the AUC(8) for plasma were 0.23 +/- 0.07 after a single dose and 0.27 +/- 0.08 following multiple doses (P > 0.05, not significant). Additional in vitro experiments have shown that fosfomycin exerts non-concentration-dependent microbial growth inhibition. At steady state, the time above MIC (t > MIC) values were 98%, 92% and 61% for pathogens with MIC values of 8, 16 and 32 mg/L, respectively. CONCLUSION: The present pharmacokinetic study indicates that 8 g of fosfomycin three times per day should provide sufficient antimicrobial concentrations in the CSF for the overall treatment period. Thus, the co-administration of fosfomycin could be useful for the treatment of ventriculitis caused by susceptible pathogens.

Adult↗

PubMed2004

Time course of coagulation parameters, cytokines and adhesion molecules in Plasmodium falciparum malaria.

We studied 38 patients with malaria tropica over a period of 5 days during antiparasitic therapy. Serum or plasma levels of interleukin (IL) 1beta, IL-6, IL-10, tumour necrosis factor-alpha (TNF-alpha), the soluble vascular adhesion molecule (sVCAM) and the soluble intracellular adhesion molecule (sICAM) were determined by enzyme-linked immunosorbent assay. Protein C and antithrombin III activity were analysed by chromogenic tests and protein S activity by a clotting test. Antithrombin III, protein C and protein S activity was significantly lower in patients with severe malaria and displayed a highly significant increase in activity over the time of evaluation. Levels of sVCAM and sICAM were increased for the whole study period, but no significant differences were found between severe and mild malaria cases. Serum IL-1beta, IL-6 and IL-10 levels were significantly higher in patients with severe malaria, whereas no significant differences were found for TNF-alpha. IL-6 and IL-10 decreased significantly over 5 days during schizontocidal therapy. Our data show an impairment of the coagulation system which correlates with pro-inflammatory cytokines and therefore with the severity of the disease.

Adolescent↗

PubMed2004

Imported Dengue fever presenting with febrile diarrhoea: report of two cases.

Dengue fever is a significant health problem in most tropical regions and increasingly observed among travelers returning from tropical countries. Clinical presentation might not be typical in patients from non-endemic areas. We report 2 patients returning from South-East Asia with proven Dengue-virus infection initially presenting with "febrile diarrhea" followed by hemorrhagic skin lesions during hospitalization. Blood and stool examination remained negative for bacteria, parasites and plasmodia. Dengue fever was suspected early, mainly due to the typical course of the complete blood cell count with thrombocytopenia (19 x 10(9)/L and 86 x 10(9)/L) and leucopenia (3 x 10(9)/L and 1.8 x 10(9)/L). Both patients had a benign clinical course, which still required intensive care monitoring. Platelet inhibitors and NSAIDs should be stopped when Dengue infection (Dengue fever and Dengue hemorrhagic fever) is suspected in order to minimalize the risk of bleeding. Although presentation of the disease might not always be typical, Dengue infection has to be considered early in the course of disease by taking an in-depth history and profound physical examination.

Adult↗

PubMed2003

Traumatic intracranial hemorrhages in facial fracture patients: review of 2,195 patients.

OBJECTIVE: Patients sustaining facial fractures are at risk for accompanying traumatic intracranial hematomas, which are a major cause of morbidity and mortality. Prompt recognition is crucial in improving patient survival and recovery. This study examined which simple clinical signs identify facial fracture patients at risk for intracranial hemorrhage before the performance of computed tomography. DESIGN AND METHODS: Retrospective study of 2,195 patients with facial fractures during a period of 7 years. By means of univariate and multivariate analysis clinical features potentially predictive for (a) intracranial hemorrhage and (b) surgery for intracranial hemorrhage were identified. SETTING: Critical care units of anesthesiology and neurology, general traumatology, and oral and maxillofacial surgery in a level I trauma university hospital. RESULTS: Seizures (OR 22.1) and vomiting/nausea (OR 20.2) were the strongest independent predictors of intracranial bleeding in facial fracture patients. For intracranial hemorrhages requiring surgical intervention closed head injuries (OR 9.75) and cranial vault fractures (OR 5.0) were the most significant risk factors. However, among those patients without vomiting/nausea and without seizures and without closed head injury ( n=1,628), 20 patients (1.2%) suffered intracranial hemorrhage, and six (0.37%) of them required surgical intervention. CONCLUSIONS: Simple clinical symptoms, such as seizures, vomiting/nausea, history of a closed head injury or cranial vault fractures are strong predictors for intracranial hemorrhage in facial fracture patients. The early consideration of such important indicators allows us to detect patients at elevated risk of an intracranial hematoma requiring surgical intervention.

Facial Bones↗

PubMed2003

Computed tomographic parameters predicting fatal outcome in large middle cerebral artery infarction.

BACKGROUND: Large middle cerebral artery (MCA) ischaemic stroke when associated with extensive mass effect can result in brain herniation and neurological death. As yet there are few guidelines to aid the selection of patients for aggressive interventional therapies, such as decompression hemicraniectomy and/or hypothermia. METHODS: We studied a cohort of patients from seven centres with large MCA infarction requiring neurocritical care. The purpose of this analysis was to assess the use of early radiological signs on follow-up computed tomographic (CT) signs performed within 48 h of stroke onset for predicting mortality at 30 days. The CT parameters assessed included horizontal displacement of the septum pellucidum, pineal shift, complete or partial infarction of the temporal lobe, involvement of additional vascular territories, and the presence of hydrocephalus. The primary outcome measure was in-hospital death within 30 days. RESULTS: One hundred and thirty-five patients who had follow-up CT scans within 48 h were identified from a total of 201 patients with large MCA infarction that received conventional medical therapy alone. The median age was 68 (range 29-99), 56% were female, and the median NIHSS category was 26-30 at 48 h. Among CT variables in univariable analysis, anteroseptal shift >/=5 mm, pineal shift >/=2 mm, complete temporal lobe infarction, involvement beyond the MCA territory, and moderate or severe hydrocephalus were equally predictive of death. Multivariable analysis adjusting for time to CT scan revealed the following predictors of fatal outcome: anteroseptal shift >/=5 mm (OR 10.9; 95% CI 3.2-37.6), NIHSS within 48 h >20 (OR 6.6; 95% CI 2.3-19.3), and infarction beyond the MCA territory (OR 4.9; 95% CI 1.6-15.0). CONCLUSIONS: We identified the role of early CT signs in predicting death following massive MCA infarction. The CT parameters anteroseptal shift (>5 versus </=5 mm), pineal shift >/=2 mm, hydrocephalus, temporal lobe infarction, and other vascular territory infarction if present were predictive of fatal outcome. These CT parameters require prospective validation before they should be considered reliable markers for decision-making.

Adult↗

PubMed2003

Treatment of staphylococcal ventriculitis associated with external cerebrospinal fluid drains: a prospective randomized trial of intravenous compared with intraventricular vancomycin therapy.

OBJECT: Staphylococcal ventriculitis may be a complication in temporary external ventricular drains (EVDs). The limited penetration of vancomycin into the cerebrospinal fluid (CSF) is well known; the pharmacodynamics and efficacy of systemically compared with intraventricularly administered vancomycin is examined in this prospective study. METHODS: Ten patients in whom EVDs were implanted to treat intracranial hemorrhage and who were suffering from drain-associated ventriculitis were randomized into two treatment groups. Five of these patients (median age 47 years) were treated with 2 g/day vancomycin administered intravenously (four infusions/day, Group 1), and the other five(median age 49 years) received 10 mg vancomycin intraventricularly once daily (Group 2). Vancomycin levels were measured in serum and CSF six times a day. The maximum vancomycin level in CSF was 1.73 +/- 0.4 micro/ml in Group 1 and 565.58 +/- 168.71 microg/ml 1 hour after vancomycin application in Group 2 (mean +/- standard deviation). Vancomycin levels above the recommended trough level of 5 microg/ml in CSF were never reached in Group 1, whereas in Group 2 they below the trough level (3.74 +/- 0.66 microg/ml) only at 21 hours after intraventricular vancomycin application. The vancomycin level in the serum was constant within therapeutic levels in Group 1, whereas in Group 2 in most instances vancomycin was almost below a measurable concentration. In both groups bacteriologically and laboratory-confirmed CSF clearance could be obtained. CONCLUSIONS: Intraventricular vancomycin application is a safe and efficacious treatment modality in drain-associated ventriculitis, with much higher vancomycin levels being achieved in the ventricular CSF than by intravenous administration.

Adult↗

PubMed2003

[Multibacillary leprosy in Tyrol].

Five cases of multibacillary leprosy have been diagnosed in a period of 15 years (1987-2001) at the outpatient Department of Neurology of the University Hospital Innsbruck. All patients presented with dermatological and mild to severe polyneuropathic signs and symptoms. 4/5 patients recovered fully, whereas 1 patient with an initially severe polyneuropathy showed persistent polyneuropathy as long-term sequela. The prevalence of leprosy in the catchment area of the Department of Neurology, University Hospital Innsbruck (comprising the entire province of Tyrol--650,000 inhabitants) is to be calculated as 0.5/1 million. The incidence of newly diagnosed leprosy within this province of Tyrol is 0.04/100,000/year. The aim of the presentation of these 5 patients is--beside the epidemiologic aspect--to alert all neurologists and dermatologists that this disease still exists--despite decreasing prevalence and incidence rates on a global scale; this is of particular importance since neurological long-term sequelae can only be avoided by early diagnosis.

Adult↗

PubMed2002

Multiple sclerosis and Lyme borreliosis.

In a deductive approach the two disease entities of multiple sclerosis and chronic progressive neuroborreliosis are discussed. Various clinical features, seroepidemiology, neuroimaging, CSF findings, CSF serology, specific proteins within the CSF and antibodies against neuronal structures as well as the most recent findings of different dendritic cells within the CSF are discussed as a means of differentiating these two disease entities.

Antibodies, Bacterial↗

PubMed2002

[Recommendations for prognostic assessment of cerebral hypoxia after cardiopulmonary resuscitation--Austrian Interdisciplinary Consensus Conference].

Various clinical parameters, neurological examination models, biochemical tests, electrophysiological procedures and neuro-imaging techniques have been studied with respect to the detection of cerebral hypoxia in patients after cardiopulmonary resuscitation. These parameters were critically evaluated by the members of the Austrian interdisciplinary consensus conference. Based on the results of scientific publications, the consensus meeting identified 26 parameters, which allow the prognostic evaluation of cerebral hypoxia after cardiopulmonary resuscitation. Among these parameters, however, the strength of evidence and the level of recommendation are different.

APACHE↗

PubMed2002

Safety and efficacy of a novel intravascular cooling device to control body temperature in neurologic intensive care patients: a prospective pilot study.

OBJECTIVE: To determine the safety and efficacy of a novel intravascular cooling device (Cool Line catheter with Cool Gard system) to control body temperature (temperature goal <37 degrees C) in neurologic intensive care patients. DESIGN: A prospective, uncontrolled pilot study in 51 consecutive neurologic intensive care patients. SETTING: A neurologic intensive care unit at a tertiary care university hospital. PARTICIPANTS: Patients were 51 neurologic intensive care patients with an intracranial disease requiring a central venous catheter due to the primary (intracranial) disease. We excluded patients under the age of 19 yrs and those with active cardiac arrhythmia, full sepsis syndrome, bleeding diathesis and infection, or bleeding at the site of the intended catheter insertion. Male to female ratio was 31:20, and the median age was 55 yrs (range, 24-85 yrs). Forty-four of 51 patients (86.3%) had an initial Glasgow Coma Scale score of 3, three patients had a Glasgow Coma Scale score of 9, one patient presented with an initial Glasgow Coma Scale score of 11, two patients had an initial Glasgow Coma Scale score of 13, and one patient had an initial Glasgow Coma Scale score of 15. The mean initial tissue injury severity score was 45.1 and the median initial tissue injury severity score 45.0 (range, 19-70). INTERVENTIONS: Patients were enrolled prospectively in a consecutive way. Within 12 hrs after admission, the intravascular cooling device (Cool Line catheter) was placed, the temperature probe was located within the bladder (by Foley catheter), and the Cool Gard cooling device was initiated. This Cool Gard system circulates temperature-controlled sterile saline through two small balloons mounted on the distal end of the Cool Line catheter. The patient's blood is gently cooled as it is passed over the balloons. The Cool Gard system has been set with a target temperature of 36.5 degrees C. The primary purpose and end point of this study was to evaluate the cooling capacity of this intravascular cooling device. Efficacy is expressed by the calculation formula of fever burden, which is defined as the fever time product ( degrees C hours) under the fever curve. MEASUREMENTS AND MAIN RESULTS: The cooling device was in operation for a mean of 152.4 hrs. The ease of insertion was judged as easy in 42 of 51 patients; in a single patient, the catheter was malpositioned within the jugular vein, requiring early removal. The rate of infectious and noninfectious complications (nosocomial pneumonia, bacteremia, catheter-related ventriculitis, pulmonary embolism, etc.) was comparable to the rate usually observed in our neurologic intensive care patients with such severe intracranial diseases. The total fever burden within the entire study period of (on average) 152.4 hrs was 4.0 degrees C hrs/patient, being equivalent to 0.6 degrees C hrs/patient and day. Thirty of 51 patients showed an elevation of the body temperature (>37.9 degrees C) within 24 hrs after termination of the cooling study. One awake patient (subarachnoid hemorrhage, Glasgow Coma Scale score 15) experienced mild to moderate shivering throughout the entire period of 7 days. The mortality rate was 23.5%. CONCLUSION: This novel intravascular cooling device (Cool Line catheter and Cool Gard cooling device) was highly efficacious in prophylactically controlling the body temperature of neurologic intensive care patients with very severe intracranial disease (median Glasgow Coma Scale score, 3-15). Morbidity and mortality rates were consistent with the ranges reported in the literature for such neurologic intensive patients.

Adult↗

PubMed2002

Temporal and spatial profile of Bid cleavage after experimental traumatic brain injury.

Apoptosis plays an essential role in the cascade of CNS cell degeneration after traumatic brain injury. However, the underlying mechanisms are poorly understood. The authors examined the temporal profile and cell subtype distribution of the proapoptotic protein Bid from 6 hours to 7 days after cortical impact injury in the rat. Increased protein levels of tBid were seen in the cortex ipsilateral to the injury site from 6 hours to 3 days after trauma. Immunohistologic examinations revealed expression of tBid in neurons, astrocytes, and oligodendrocytes from 6 hours to 3 days after impact injury, and concurrent assessment of DNA damage using TUNEL identified tBid-immunopositive cells with apoptoticlike morphology in the traumatized cortex. Moreover, Bid cleavage and activation of caspase-8 and caspase-9 occurred at similar time points and in similar brain regions (i.e., cortical layers 2 to 5) after impact injury. In contrast, there was no evidence of caspase-8 or caspase-9 processing or Bid cleavage in the ipsilateral hippocampus, contralateral cortex, and hippocampus up to 7 days after the injury. The results provide the first evidence of Bid cleavage in the traumatized cortex after experimental traumatic brain injury in vivo, and demonstrate that tBid is expressed in neurons and glial cells. Further, findings indicate that cleavage of Bid may be associated with the activation of the initiator caspase-8 and caspase-9. Finally, these data support the hypothesis that cleavage of Bid contributes to the apoptotic degeneration of different CNS cells in the injured cortex.

Animals↗