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Biomedical subjects

F Ahlhelm

Publications and source records attributed to F Ahlhelm.

At least 19 recordsLinked to original sources
PubMed2007

[Cubital tunnel syndrome--simple nerve decompression or decompression with subcutaneous anterior transposition?].

The purpose of this prospective, randomised and controlled study was to evaluate which kind of operative technique for treatment of cubital tunnel syndrome is favourable: subcutaneous anterior transposition or nerve decompression without transposition. This study included 66 patients suffering from pain and/either neurological deficits with clinically and electrographically proven cubital tunnel syndrome. 32 patients underwent nerve decompression without transposition, whereas 34 underwent subcutaneous transposition of the nerve. Follow-up examinations evaluating pain, motor and sensory deficits as well as motor nerve conduction velocities were performed three, nine and 24 months postoperatively. Irrespectively of operative procedures (simple decompression vs. subcutaneous anterior transposition) there were no significant differences between the outcomes of the two groups at either postoperative follow-up examination (p > 0.05).

Aged↗
PubMed2006

Disc replacement using Pro-Disc C versus fusion: a prospective randomised and controlled radiographic and clinical study.

Anterior cervical discectomy and fusion (ACDF) may be considered to be the gold standard for treatment of symptomatic degenerative disc disease within the cervical spine. However, fusion of the segment may result in progressive degeneration of the adjacent segments. Therefore, dynamic stabilization procedures have been introduced. Among these, artificial disc replacement by disc prosthesis seems to be promising. However, to be so, segmental motion must be preserved. This, again, is very difficult to judge and has not yet been proven. The aim of the current study was to first analyse the segmental motion following artificial disc replacement using a disc prosthesis. A second aim was to compare both segmental motion as well as clinical result to the current gold standard (ACDF). This is a prospective controlled study. Twenty-five patients with cervical disc herniation were enrolled and assigned to either study group (receiving a disc prosthesis) or control group (receiving ACDF, using a cage with bone graft and an anterior plate.) Radiostereometric analysis was used to quantify intervertebral motion immediately as well as 3, 6, 12 and 24 weeks postoperatively. Further, clinical results were judged using visual analogue scale and neuro-examination. Cervical spine segmental motion decreased over time in the presence of disc prosthesis or ACDF. However, the loss of segmental motion is significantly higher in the ACDF group, when looked at 3, 6, 12 and 24 weeks after surgery. We observed significant pain reduction in neck and arm postoperatively, without significant difference between both groups (P > 0.05). Cervical spine disc prosthesis preserves cervical spine segmental motion within the first 6 months after surgery. The clinical results are the same when compared to the early results following ACDF.

Adult↗
PubMed2006

[Vascular anomalies of the cerebellopontine angle].

Vascular anomalies of the cerebellopontine angle are rare compared to tumors in this area. Irritation of the trigeminal, facial, or vestibulocochlear nerve may cause trigeminal neuralgia, hemifacial spasm and vertigo, or tinnitus accordingly. Vessel loops in the cerebellopontine cisterns may cause compression at the root entry or exit zone of the cranial nerves V, VII, and VIII, a phenomenon which is called "vascular loop syndrome." Megadolichobasilar artery and aneurysms of the vertebrobasilar system can also lead to dislocation and compression of the cranial nerves and brain stem. Three-dimensional CISS MR imaging and MR angiography are useful in the detection of neurovascular compression. Microvascular decompression is an effective surgical procedure in the management of compression syndromes of the cranial nerves V, VII, and VIII.

Aged↗
PubMed2006

[Spondylitis/spondylodiscitis].

Spondylitis is an inflammation of the vertebral body. If the infection is manifested in the vertebral motor segment it is called spondylodiscitis, which can be divided into specific and nonspecific forms. It is clinically impressive that at the beginning of the disease, the patients who are quite often immunosuppressed suffer from localized, especially nocturnally exacerbated backache. The initial diagnostic work-up generally consists of clinical history, examination, laboratory tests, and (especially advanced) imaging findings. Although computed tomography still remains the most frequently used advanced imaging technique, magnetic resonance imaging is the golden standard for the diagnosis of spondylitis and spondylodiscitis.

Back Pain↗
PubMed2006

[Differential diagnosis of back pain].

Back pain is one of the most frequent clinical pictures encountered in a physician's practice. It can pose a great burden on the individual and in addition have a multifactorial origin. It can be caused by intervertebral discs, vertebral joints, nerve roots, ligaments, sacroiliac joints, or a combination of the above. Back pain, as a symptom of a systemic disease, can also be a warning signal of grave disorders such as malignancies or in the event of aortic aneurysm. The well-considered choice of appropriate diagnostic procedures and suitable treatment requires a thorough knowledge of this multifactorial clinical picture.

Back Pain↗
PubMed2006

[Postoperative syndrome after spine surgery].

Postoperative syndrome after spine surgery, i.e., symptoms or syndromes caused by complications or procedure-related consequences, is gaining more and more importance. Due to great improvements concerning imaging and operative techniques (microsurgery, instrumentation) the total number of spinal surgeries as well as their related complications are increasing. Procedure-related postoperative complications including neurological deficit syndromes can occur acutely or at a later date. Concerning imaging techniques for postoperative evaluation after spinal surgery there are several modalities available. Their indications depend on complex factors including initial pathology the surgery was performed for, kind of surgical technique (surgical approach, instrumentation), anatomy of the patient as well as the time between onset of symptoms and surgery. In cases of ambiguous findings, the combination of different imaging techniques can be instrumental.

Back Pain↗
PubMed2006

[Imaging of extradural spinal lesions].

There is a wide variety of spinal extradural tumors. In addition to real neoplasms, degenerative diseases, congenital abnormalities and inflammatory disorders can be causes of extradural masses. Due to the bony boundary of the spinal canal, both benign as well as malignant masses can cause progressive neurological deficits including paraplegia. Most of the spinal tumors are benign (hemangioma of the vertebral body, degenerative diseases). In younger patients congenital abnormalities and primary tumors of the spine have to be considered, whereas in adults the list of differential diagnoses should include secondary malignancies such as metastases and lymphomas as well as metabolic disorders such as osteoporotic vertebral compression fracture and Paget's disease. Cross-sectional imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) of the spine often help to make a specific diagnosis of extradural spinal lesions and represent important tools for tumor staging and preoperative evaluation.

Diagnosis, Differential↗
PubMed2006

[Differential diagnosis of non-neoplastic space-occupying lesions of the spinal cord].

This overview addresses the topic of non-neoplastic intraspinal space-occupying lesions. Knowledge of these entities is essential to distinguish them from tumorous processes. A selection of clinically relevant differential diagnoses is presented which pertain to inflammatory, vascular, and degenerative diseases. In addition, special clinical findings, the radiological procedure, and therapeutic possibilities are outlined.

Angiography↗
PubMed2006

[Spinal infections].

Regardless of the compartment involved, imaging of spinal infections and other spinal inflammatory diseases must be performed by magnetic resonance imaging (MRI). This allows early detection of changes in disk space or vertebral bodies. Associated paraspinal and epidural masses are depicted. However, in spinal cord inflammation MRI has a very limited specificity and cannot usually differentiate between the wide array of possible causes of intramedullary lesions. This article covers a spectrum of inflammatory lesions of the spinal cord.

Adult↗
PubMed2006

[Imaging of spinal tumors].

Spinal tumors are often categorized into extradural, intradural extramedullary, or intramedullary. Although this classification represents somewhat of an overgeneralization as a lesion may reside in two compartments, it still helps to characterize spinal tumors. In the intradural, extramedullary space, primary tumors, such as neurofibroma and meningioma, are relatively common. Secondary tumors or leptomeningeal enhancement also occur. In the intramedullary space, primary tumors are far more common than secondary tumors or metastases.

Contrast Media↗
PubMed2005

[Function of the facial nerve after operative treatment of acoustic neurinomas. Influence of intraoperative monitoring].

The aim of this study was to evaluate the influence of intraoperative monitoring on the function of the facial nerve after surgical treatment of acoustic neurinomas, classified according to the grading system of Stennert. One hundred thirty patients were divided into two groups. The first group underwent surgery without intraoperative facial monitoring; the second group included intraoperative facial monitoring. Concerning degree of paresis, preoperatively there was no statistically significant difference between the two groups (group 1: 0.77+/-1.5; group 2: 0.4+/-1.2). Despite structural preservation of the facial nerve, postoperative deterioration of its function was observed which consecutively improved postoperatively. Postoperatively, the mean degree of paresis increased to 4.4+/-3.0 in group 1 and 2.4+/-2.3 in group 2. For better understanding of the role of intraoperative monitoring, we investigated the outcome of patients with acoustic neurinomas who underwent surgery over the following 6 months postoperatively. At that time, function improved by 4.1+/-3.2 (group 1) and 2.0+/-2.3 (group 2). We could show that intraoperative monitoring of the facial nerve was a significant factor for better postoperative function in patients undergoing microsurgical excision of neurinomas (P=0.001) .

Facial Nerve↗
PubMed2005

[Spinal syndrome triggered by a lumbar spinal av malformation. A case report].

We report the case of a 64-year-old male suffering from long-term claudicatio spinalis who underwent surgery in an orthopedic outpatient ward for posterior lumbar interbody fusion and bony decompression due to spinal stenosis. Postoperatively, the clinical symptoms, consisting of difficulties with walking and stocking-like dysesthesia of both lower extremities, did not improve. Due to persistent complaints, spinal MRI was performed which revealed myelomalacia and moreover was indicative of dural arteriovenous (AV) malformation at the L2-3 spinal level, which was verified as a type Ia AV fistula (according to Spetzler) by digital subtraction angiography (DSA). After microsurgical treatment of the AV fistula, clinical symptoms improved and control DSA could demonstrate complete disconnection of the fistula without any signs of recanalization. This case demonstrates that neurological deficits of patients suffering from degenerative spinal disorders can generally be considered as caused by more common spinal disease such as lumbar stenosis. Since vascular malformations may also cause neurological deficits and even mimic symptoms of spinal stenosis, it is important to consider these entities in diagnostic evaluation.

Arteriovenous Malformations↗
PubMed2005

[Skull base tumors].

Modern imaging techniques have great importance in the diagnosis and therapy of skull-base pathologies. Many of these lesions, especially in relation to their specific location, can be evaluated using CT and MR imaging. Tumors commonly found in the anterior skull base include carcinoma, rhabdomyosarcoma, esthesioneuroblastoma and meningioma. In the central cranial fossa, nasopharyngeal carcinoma, metastases, meningioma, pituitary adenoma and neurinoma have to be considered. The most common neoplasms of the posterior skull base, including the CP angle, are neurinoma, meningioma, nasopharyngeal carcinoma, chordoma and paraganglioma. One major task of imaging is the evaluation of the exact tumor extent as well as its relationship to the neighboring neurovascular structures. The purpose of this review is to recapitulate the most important anatomical landmarks of the skull base. The typical imaging findings of the most common tumors involving the skull base are also presented.

Cerebellopontine Angle↗
PubMed2005

Simple decompression or subcutaneous anterior transposition of the ulnar nerve for cubital tunnel syndrome.

The purpose of this prospective randomised study was to evaluate which operative technique for treatment of cubital tunnel syndrome is preferable: subcutaneous anterior transposition or nerve decompression without transposition. This study included 66 patients suffering from pain and/or neurological deficits with clinically and electromyographically proven cubital tunnel syndrome. Thirty-two patients underwent nerve decompression without transposition and 34 underwent subcutaneous transposition of the nerve. Follow-up examinations evaluating pain, motor and sensory deficits as well as motor nerve conduction velocities, were performed 3 and 9 months postoperatively. There were no significant differences between the outcomes of the two groups at either postoperative follow-up examination. We recommend simple decompression of the nerve in cases without deformity of the elbow, as this is the less invasive operative procedure.

Cubital Tunnel Syndrome↗
PubMed2004

[MRSA-infections-treatment with intraoperatively produced gentamycin-vancomycin PMMA beads].

INTRODUCTION: We present gentamicin-vancomycin-impregnated beads that can be produced intraoperatively in moulds and demonstrated their successful use in ten cases of problematic Methicillin-resistant Staphylococcus aureus (MRSA) infection. METHODS: To produce the antibiotically loaded PMMA beads, a two-part mould of polyoxymethylene was used. The mixture of PMMA and antibiotic is poured into the mould halves, and during polymerisation the halves bond together. The in vivo antibiotic concentrations of wound secretion from the redon drainage were measured by fluorescence-polarisation immunoassay, and a concentration/time function was determined. The PMMA beads (2 g of vancomycin plus 0.5 g of gentamicin plus 40 g of PMMA) were implanted in ten patients aged 41-76 years. RESULTS: In all ten patients, the infection was cured (follow-up 15 months). CONCLUSION: The combination of gentamicin and vancomycin in the PMMA of standardised beads represents a good alternative in the treatment of MRSA infections. Understanding of the mechanism of antibiotic release from PMMA allows differentiated dosing during systemic application.

Adult↗
PubMed2004

Gender-specific differences in school sports injuries.

OBJECTIVE: About 5 % of the pupils suffer from an injury in school sports every year. In addition to the kind of injury, the localization and the type of sport, the corresponding reasons for the injuries should be investigated to provide insights for physical education. METHODS: In a prospective study 213 accident cases with 234 injuries during physical education classes were examined. At primary presentation in our clinic, an empirical questionnaire was used to document the grade of class, the exact time point of the injury, the question of guilt, out-of-school sports activity as well as the mechanisms of injuries and the type of sport. Clinicians who worked in our out-patient clinic completed the questionnaire after physical examination documenting diagnosis, therapy and the duration of restriction of sports practice. All patients were followed until returning to physical education at school. The data were statistically analyzed using the chi (2)-test to examine gender-specific differences. RESULTS: Gender-specific differences were seen in the type (p = 0.018) and mechanisms (p = 0.028) of injuries. The most common injuries were sprains (female pupils 36.8 % male pupils 24.5 %], contusions (female pupils 27.4 % male pupils 27.9 %) and fractures (female pupils 14.7 % male pupils 18.6 %). Frequent mechanisms of injuries were errors in basic motion training like running, jumping and catching (female pupils 35.8 % male pupils 28.8 %). No gender-specific differences could be shown for the localization of injuries or for the type of sport. The upper extremity with 55 % was more frequently involved than the lower extremity with 37 %. Playing soccer (21.2 %) and basketball (19.8 %) were the most frequent reasons for sports injuries. The highest prevalence of school sports injuries occurred at the onset of and during puberty. CONCLUSION: For the girls it is necessary to improve the basic motor skills, while the boys need to learn considerate behavior and how to read the game. Basic skill levels in ball games must be improved before practice in competition form is initiated.

Adolescent↗
PubMed2003

[Sports injuries, sports damages and diseases of world class athletes practicing modern pentathlon].

108 world class athletes (54 males, 54 females) practicing modern pentathlon had been interviewed about their individual training and competition efforts as well as their sports related injuries, damages and diseases in the last world cup season using a standardized empirical questionnaire. The mean training extent was about 25 hours per week, the mean number of national and international competitions athletes made was 9, especially concerning swimming and running. Mean number of health threatening incidents of each athlete had been 2 with 41% diseases such as otitis and pharyngitis, 23% injuries such as contusions and distortions and 33% damages such as tendinitis, periostitis and strains. Head and neck involvement were more frequent than those of pelvis and the lower extremities. Training efforts were the most frequent reasons for health threatening events (84%), especially concerning diseases and damages, whereas most of the injuries happened during competitions (p<.01). Most of the injuries happened practicing horse riding during competitions (9%). Running was the most frequent reason for damages, whereas horse riding is the leading cause for injuries, furthermore damages and injuries are typical for fencing. Swimming is often associated with diseases. In contrary shooting did not show typically affiliated health threatening events. The incidence of health threatening incidents concerning world class athletes practicing modern pentathlon is quite low. Especially running and swimming combined with a high training extent empirically predisposed to suffer from damages and diseases. Horse riding with a quite low training extent and fencing show a higher incidence of injuries. From the training-methodological point of view the training extent should not be too extended. Due to a high number of diseases it may be profitable to be in attendance of an inner medicine physician.

Adult↗