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Biomedical subjects

F Albert

Publications and source records attributed to F Albert.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Epidural cerebrospinal fluid pressure measurement and therapy of intracranial hypertension in "malignant" middle cerebral artery infarct].

BACKGROUND AND PURPOSE: A permanent elevation of ICP after severe brain injury for instance in subarachnoid or intracerebral hemorrhage or neurotrauma is associated with a poor clinical outcome. Although increasingly being used in the intensive care of patients with elevated ICP, continuous epidural ICP monitoring in ischemic stroke has not been firmly established yet. PATIENTS AND METHODS: We prospectively evaluated the clinical course and outcome of patients with raised ICP due to space occupying ischemic middle cerebral artery (MCA) infarction as seen in CT, who underwent continuous ICP monitoring. Epidural ICPprobes were inserted ipsilaterally (all patients) and contralaterally (additional in 7 patients) to the side of infarctation. Glasgow Coma and Scandinavian Stroke Scales (GCS and SSS) were obtained initially and in the further clinical course. All patients were subjected to a standardized treatment protocol for raised ICP. ICP values were correlated with clinical presentation at the time point of deterioration, with outcome and CT findings. Effectiveness of different treatment modalities to lower ICP were analyzed and discussed. RESULTS: 9 of 48 patients survived the MCA infarct (19%), with the cause of death being transtentorial herniation with subsequent brain death in all 39 patients. Mean SSS at admission was 20.6 (survivors 21.5 +/- 5.6, nonsurvivers 19.8 +/- 6.5). All patients showed clinical signs of herniation before the increase of ICP. All 39 patients who died developed ICP values higher than 35 mmHg and no patient with ICP values of more than 35 mmHg survived. CCT changes dit not necessarily reflect the absolute measured ICP values. All treatment modalities for raised ICP including osmotherapy, controlled hyperventilation, tromethamol and barbiturates were initially effective, but only in a minority of patients ICP control could be sustained. CONCLUSIONS: We conclude that ICP monitoring in large hemispheric infarction may predict clinical outcome. ICP monitoring was not helpful in guiding long term treatment of ICP. It remains doubtful, whether ICP monitoring has a positive influence on clinical outcome of acute severe ischemic stroke.

Adult↗
PubMed1996

The value of intracranial pressure monitoring in acute hemispheric stroke.

BACKGROUND AND PURPOSE: Persistently elevated intracranial pressure (ICP) has been associated with poor clinical outcome after severe brain injury, such as neurotrauma, intracerebral hemorrhage, and subarachnoidal hemorrhage. Although ICP monitoring is increasingly being used in intensive care treatment of patients with ischemic stroke, its value has not been established. PATIENTS AND METHODS: The clinical course of 48 patients with the clinical signs of increased ICP due to large hemispheric or middle cerebral artery territory infarction defined by CT and subjected to ICP monitoring was prospectively evaluated. Epidural ICP probes were inserted ipsilaterally to the site of primary brain injury in all and also contralaterally in seven patients. Initial clinical presentation was assessed by the Scandinavian Stroke Scale (SSS) and the Glasgow Coma Score (GCS). All patients were treated according to a standardized treatment protocol for elevated ICP. ICP values were correlated with the clinical presentation at the time point of deterioration, with outcome, and with CT findings. Different treatment strategies to lower ICP were analyzed as to their effectiveness. RESULTS: Only nine of the 48 patients survived the infarct (19%). The cause of death was transtentorial herniation with subsequent brain death in all 39 patients. The patients' mean SSS on admission was 20.6 (survivors 21.5 +/- 5.6, nonsurvivors 19.8 +/- 6.5). In all patients clinical signs of herniation preceded the increase in ICP. Patients with ICP values > 35 mm Hg did not survive. CT changes did not always correspond with the measured ICP values. All medical strategies to lower ICP, including osmotherapy, hyperventilation, THAM-buffer, and barbiturates, were initially effective, but only in a minority of patients was ICP control sustained. CONCLUSIONS: ICP monitoring of large hemispheric infarction can predict clinical outcome. Pharmacologic intervention had no sustained effect. ICP monitoring was not helpful in guiding long-term treatment of increased ICP. It remains doubtful that ICP monitoring in acute ischemic stroke has a positive influence on clinical outcome.

Acute Disease↗
PubMed1993

Accelerated methaemoglobin formation: potential pitfall in early postoperative MRI.

Postoperative magnetic resonance imaging (MRI) of glioblastomas to assess residual tumour should be performed within the first 4 days following surgery. Early methaemoglobin formation near the resection site may mimic residual tumour if only gadolinium-DTPA-enhanced images are obtained. In a prospective study 24 of 54 patients (44%) showed well-defined areas of increased signal intensity on unenhanced T1-weighted images performed soon after surgery. By in vitro experiments we showed that hydrogen peroxide used in neurosurgery as a styptic agent accelerates formation of methaemoglobin when added to whole blood samples.

Brain↗
PubMed1993

[Cardiac metastasis disclosed by ventricular tachycardia. Diagnosis by echocardiography and ultrafast tomodensitometry].

The authors report the case of a right ventricular metastasis presenting with ventricular tachycardia and underline the usual diagnostic problems of secondary cardiac tumours, the symptoms of which are often unspecific and late. The appearance of a cardiac arrhythmia in the absence of known cardiac disease should raise the possibility of a cardiac metastasis in patients with malignant disease. The reported case also illustrates the diagnostic value of non-invasive cardiac imaging techniques (echocardiography and ultra-fast computerised tomography) in this context.

Aged↗
PubMed1992

Postoperative spondylodiscitis: results of a prospective study about the aetiology of spondylodiscitis after operation for lumbar disc herniation.

In 412 patients undergoing surgery for herniated lumbar discs from September 1986 to September 1987 and from January 1988 to July 1989 a microbiological specimen was taken from the intervertebral disc space and from the cover of the operating microscope. Also the tips of the wound drains were examined microbiologically after removal. 17% of the patients had a positive bacteriological culture from their intervertebral disc space; 12% of the specimen from the operating microscope were positive. These results favour the hypothesis that intra-operative contamination of the disc space, in contrast to haematogenous spread, causes spondylodiscitis. On the other hand we saw during this time course only one case of clinical spondylodiscitis, which implies a possible involvement of other predisposing factors such as pre- or perioperative infections or compromised patient immunologically. It is also possible, that the routine application of local antibiotic or antiseptic solutions into the disc space at the end of the operation could decontaminate the operative site and prevent clinical infection despite positive culture findings.

Adolescent↗
PubMed1992

Autoimmune hemolytic anemia presenting in Sézary syndrome. Report of a case and review of the literature.

A 52-year-old man, who presented with Sézary syndrome with autoimmune hemolytic anemia (AIHA) and was successfully treated with corticosteroids is reported. Helper function assay determining immunoglobulin confirmed inducer capability of this clonal population. This patient brings to 4 the number of cases of T cell cutaneous lymphoma and AIHA now reported in the English literature, and is the first case of Sézary syndrome and AIHA thus far.

Anemia, Hemolytic, Autoimmune↗
PubMed1992

Pure motor hemiparesis with stable somatosensory evoked potential monitoring during aneurysm surgery: case report.

We report a patient who sought treatment for an acute subarachnoid hemorrhage as a result of an intracranial aneurysm. Management included early surgical repair and intraoperative monitoring of evoked potentials. Pan-angiography revealed berry aneurysms of the communicating anterior artery and right middle cerebral artery. Surgery was uneventful, and the somatosensory evoked potential monitoring did not show any abnormalities. Nevertheless, the patient showed a neurological deficit due to a clip-related infarct in the right middle cerebral artery territory characterized by a right hemiparesis with no sensory deficit. This case report supports the possibility of false-negative results in single-mode intraoperative monitoring during aneurysm surgery.

Adult↗
PubMed1989

[Safe placement of atrial shunt catheters using intracardiac ECG. Initial experiences with a new ECG adapter system in 33 patients].

In 1960 Robinson inaugurated the method of placing atrial shunt catheters with the help of intracardiac ECG monitoring. Vulnerability to artifacts and problems with electrical safety (which have since been solved) led to its disuse. A newly developed ECG adapter proved free from artifacts and was practicable in 33 patients. 31 shunts were correctly placed without requiring time-consuming radiography. 2 extracardiac false positions were clearly identifiable by means of true negative results, which after correction showed a typical atrial ECG. The ECG method is compared with 9 other positioning methods. It seems to be superior to the conventional chest x-ray and equal to fluoroscopy. However, the method is not on a par with sophisticated measuring techniques such as intracardiac pressure monitoring or intravasal sonography.

Adolescent↗
PubMed1989

[Report of a case of allergic granulomatous vasculitis (Churg-Strauss syndrome)].

A 35 year female with a previous history of asthma came to our observation about 10 months ago. She was dyspneic, showed small nodules (2 to 5 mm) in arms, hands and legs and had radiological evidence of pulmonary granulomatosis and pleural effusion. Diagnosis was made by means of cutaneous biopsy showing a necrotic granulomatous vasculitic lesions with eosinophilic infiltration and giant cells, consistent with allergic granulomatosis of Churg-Strauss syndrome. Steroid therapy alone (prednisone 1 mg/kg/die) led to a rapid and complete clinical and humoral remission. The patient is still doing an alternate day prednisone therapy (15 mg) and is well after a 10 months follow-up.

Adult↗
PubMed1989

[Prevalence of anti-HIV-2 antibodies in a population at risk attending the drug-dependence center of the Rho hospital].

We have evaluated the prevalence of anti HIV-2 antibodies in a population of 139 individuals at risk for AIDS, attending the center for drug addiction of the Rho hospital. 79.85% of our patients were positive for anti HIV-1 antibodies. 51 patients (36.69%) were positive for anti HIV-2 antibodies in an immunoenzymatic method, but only 16 patient (11.51%) have been confirmed in Western Blot. We stress, therefore, the necessity of confirming the positivity for anti HIV-2 antibodies with the Western Blotting method. 14.41% of our anti HIV-1 positive patients were also anti HIV-2 positive, but no one showed an isolate positivity for anti HIV-2 antibodies.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Visual evoked potentials in tumors from orbita to occipital lobe in childhood.

68 infants and children with proven tumours along the visual pathway visually evoked potentials with pattern reversal and flash were investigated. Subdivided in 5 locational groups (orbital, optic nerve, chiasmatic, retrochiasmatic and occipital lobe) best results were obtained by stimulation with pattern reversal using variable checksizes (91.2%) versus 61.8% by using flash evoked responses. Furthermore, using patterned stimuli not only latency shifts are best detected but also hints for visual function correlating to visual acuity could be given also in nonverbal or disabled children. For long term follow-up studies in known space-occupying lesions along the visual pathway, the use of pattern VEP is extraordinary because of its high sensitivity and complete harmlessness. Pattern VEP are even more sensitive than visual acuity testing in cooperative patients. The close interdisciplinary follow-up controls in these children between pediatric neurophysiologists and neurosurgeons are, therefore, strongly recommended.

Adolescent↗