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Biomedical subjects

F Martens

Publications and source records attributed to F Martens.

At least 19 recordsLinked to original sources
PubMed1992

Transventricular endoscopic investigation and treatment of suprasellar arachnoid cysts.

Three children with a suprasellar arachnoid cyst and characteristic neuropathological signs are presented. Through the use of CT scanning and NMR imaging the location, volume and attenuation factors of these cysts can be documented. Stereotactically guided endoscopic exploration of the third ventricle region with visualization and manipulation of the cyst have been performed. This technique should be considered a safe and accurate alternative to craniotomy.

Adolescent↗
PubMed1992

Clinical experience in the therapy of bites from exotic snakes in Berlin.

Since there are nearly no indigenous poisonous snakes in Germany, snake bites by poisonous snakes are rare. Most serious snake bites reported to poison information centres or treated at hospitals are caused by exotic snakes that are kept in private households. Only few types of antivenom are stored in emergency depots in Germany including polyvalent antivenoms from commercial sources. Since experience with the treatment of poisonous snake bites is limited, the records of the Intensive Care Unit and the Poison Information Centre of the Universitätsklinikum Rudolf Virchow from 1980-1991 were evaluated. During this period, 51 snake bites were reported. Eleven patients who had been bitten by exotic poisonous snakes were treated in intensive care. In eight of the cases, ethanol (blood levels on admission 1.2-4.2 g-1) had played an important role in the cause of the bite. A moderate to severe local inflammation at the site of the bite followed by oedema and necrosis was typical. One patient developed respiratory failure, probably because of the neurotoxic effects of the snake venom and a compartment syndrome necessitating fasciotomy. Haemolysis was observed in four patients and coagulopathy in six patients. All patients received polyvalent antivenom within 2-12 h of the snake bite. Despite serious coagulopathy in two of the patients and respiratory arrest in one, all survived without sequelae.

Adult↗
PubMed1991

Transesophageal echocardiography: a simple method for monitoring the patency of ventriculoatrial shunts. Technical note.

A new method for evaluating the patency of a ventriculoatrial shunt is described, and early experience with it is reported. Transesophageal echocardiography can demonstrate a cerebrospinal fluid leak in the right atrium through the atrial tip of a shunting device. This capability was an incidental discovery, and since then the accuracy of the technique in evaluating the patency of a ventriculoatrial shunt has been prospectively studied in 20 observations of 16 patients. The method proved to be accurate in 90% to 100% of cases. It is concluded that transesophageal echocardiography offers a rapid and accurate assessment of ventriculoatrial shunt function, is well tolerated, and is easy to perform.

Adolescent↗
PubMed1990

On the management of neonatal tentorial damage. Eight case reports and a review of the literature.

From the history of 15 personal patients--8 reported here in extenso--and from 63 patients in the literature with the diagnosis of posterior fossa subdural haemorrhage during life, we discuss the possibility of detecting tentorial damage on computed tomography (CT) and ultrasound (US) scan. The association of a (peri)cerebellar haemorrhage with peritentorial bleeding around the straight sinus and a subdural haemorrhage between both occipital cerebral lobes is suggestive of tentorial laceration(s). Both coronal CT scan and sagittal US scan are very helpful in locating these haemorrhages near the falco-tentorial junction. The conservative management of one of our infants with very extensive but asymmetric posterior fossa haemorrhage, leading to resorptive hydrocephalus, is compared with both surgical and conservative treatment of patients from the literature. Two reasons that warrant neurosurgical intervention are: life-threatening brain-stem compression--as in one of our own patients--and acute obstructive hydrocephalus. Craniotomy of the posterior fossa within the neonatal period does not prevent later-onset resorptive hydrocephalus. The communicating nature of this latter process is adequately demonstrated by lumbar isotope cisternography. Finally, neonatal posterior fossa subdural haemorrhage is one of the many causes of cyst-like structures behind the cerebellum.

Arteries↗
PubMed1990

Spinal cord stimulation in chronic pain therapy.

Spinal cord stimulation was undertaken in 45 patients referred to the University Hospital in Ghent. Failed back surgery was the major indication for implantation. Raynaud's phenomenon, causalgia, polyneuropathy, phantom limb pain, and diverse causes were the other indications. Before neurosurgical implantation of the system, a percutaneous epidural trial procedure was performed. The efficacy of the implanted stimulation system was estimated by considering the use of medication and the patients' personal appreciation of the obtained pain relief. Thirty-five patients experienced very good pain relief. Only two patients needed further narcotic analgesics. Eight patients stopped using the stimulation system. To ensure good results, strict selection criteria and many surgical reinterventions seemed to be necessary. Although spinal cord stimulation is a nonablative technique, many complications may occur.

Chronic Disease↗
PubMed1990

Clinical experience with the benzodiazepine antagonist flumazenil in suspected benzodiazepine or ethanol poisoning.

The clinical efficacy of different doses of the specific benzodiazepine antagonist flumazenil was studied in a total of 72 patients with benzodiazepine or ethanol overdose. In a randomized double-blind study, 18 patients (group 1) and eight patients (group 2) with suspected benzodiazepine overdose received 5 mg (group 1) or 1 mg (group 2) flumazenil or placebo, respectively. The stage of coma, heart rate, blood pressure and respiratory rate were monitored within the following 15 min. If no change in the stage of coma was observed, 5 mg (group 1) or 1 mg (group 2) flumazenil were given, and the stage of coma, heart rate and blood pressure were again monitored. In a similar way, the effect of 5 and 1 mg flumazenil was investigated in 13 patients (group 3) and four patients (group 4) with ethanol intoxication. In an open trial, the clinical efficacy of flumazenil for the diagnosis of benzodiazepine or ethanol overdose was studied in 29 patients (group 5). In all patients, a toxicological screening confirmed benzodiazepine or ethanol overdose. None of the patients receiving placebo showed effects on stage of coma, heart rate, blood pressure or respiratory rate. Patients with benzodiazepine overdose who received 5 mg flumazenil regained consciousness about 1-2 min after the end of injection. The effect of 1 mg flumazenil (group 2) on benzodiazepine-induced coma was less pronounced. In patients with ethanol overdose (group 3), ethanol-induced coma was reversed after 5 mg flumazenil more slowly than in patients of group 1. No effect of flumazenil on ethanol-induced coma was observed in group 4. In group 5, flumazenil proved to be useful for diagnosing benzodiazepine or ethanol intoxication. In one patient with coma due to carbamazepine overdose, flumazenil was also found to be effective. Additionally, a possible analytical interference of flumazenil and its metabolites with the identification of other benzodiazepines by a toxicological screening procedure was studied. Even after an oral dose of 200 mg flumazenil, no interference with immunological benzodiazepine assays (EMIT, TDX, and RIA) was found. A metabolite and an artifact of flumazenil could be identified in urine by gas chromatography/mass spectrometry.

Adolescent↗
PubMed1989

Traumatic lumbosacral nerve root meningoceles. The value of myelography, CT and MRI in the assessment of nerve root continuity.

A case of traumatic lumbar meningoceles at four levels in combination with total and partial nerve root avulsion and with preservation of a nerve root is reported. Several diagnostic imaging techniques (myelography, CT, myelo-CT and MRI) are compared and their value in demonstrating the continuity of the nerve roots is discussed. MRI could assess the continuity of a nerve root in a traumatic meningocele, not demonstrable by myelography or myelo-CT. The combination of myelography, myelo-CT and MRI is likely to provide a complete diagnostic evaluation of nerve root lesions.

Adult↗
PubMed1988

Hemoperfusion in acute camphor poisoning.

After ingestion of an unknown dose of a 10% camphor spirit (maximum dose 200 ml), a 54-year-old female was found in coma, having developed grand-mal-like seizures and respiratory failure. For detoxification, gastric lavage and hemoperfusion with amberlite XAD4 were performed. During hemoperfusion, seizures ceased, but no marked influence on the clinical course of the intoxication--especially on grade of coma--was observed. For further evaluation of the efficacy of treatment, camphor plasma elimination kinetics during hemoperfusion were compared to plasma elimination kinetics determined in a volunteer after an oral dose of 200 mg of camphor. Although the plasma compartment was almost completely (89%-95%) cleared of camphor by hemoperfusion, only a total of 35 mg of camphor was removed due to its high apparent volume of distribution (estimated 2-4 l/kg). The plasma elimination half-life was not affected by hemoperfusion, which may be explained by the saturation of metabolizing enzymes, still incomplete absorption, or metabolic interference of isopropanol. In the case presented here, neither the clinical course of the intoxication nor plasma level data gave evidence for a pronounced beneficial effect of hemoperfusion.

Acute Disease↗
PubMed1988

Priorities in the management of polytraumatised patients with head injury: partially resolved problems.

The results of a retrospective analysis of a series of 73 polytraumatised patients with severe head injuries are presented. The neurological outcome has been less favourable in cases with early osteosynthesis of peripheral fractures compared to cases in which such operations had been delayed. Therefore it seems advisable to postpone the non-vital operative treatment of osteoarticular lesions until stabilisation of the cerebral and vegetative situation.

Adolescent↗
PubMed1988

Spinal epidural hematoma without lesion of the spine. Report of 4 cases.

The authors report 4 cases of spinal epidural hematoma without a lesion of the spine. The medical literature relating to this subject is reviewed with special reference to the pathophysiology of the bleeding. There are arguments in favor of the venous origin as well the arterial origin of the bleeding. As far as recovery following surgical treatment is concerned, the history of our cases confirms the opinion that the prognosis depends on two factors: the delay between onset of symptoms and operation and the severity of the neurological deficit.

Adolescent↗
PubMed1987

A BASIC program for calculation of often needed parameters in intensive care medicine.

For rational therapeutic decision making in intensive care patients with artificial ventilation and the use of vasoactive drugs, parameters such as pulmonary shunt, cardiac index and other determinants of gas exchange and circulation are often necessary. For this purpose, a BASIC program suitable for microcomputers was established which facilitates control of therapy. The formulae needed for the calculations are described, and the program is discussed.

Critical Care↗
PubMed1987

Unusual cause of cerebellar abscess: occipital dermal sinus and dermoid cyst.

Cerebellar abscess induced by a contiguous dermal sinus is a rare event. In a large series of acute posterior fossa abscedation, otogenic suppuration is the cause in 93% of the cases, while hematogenous infection is infrequent, probably because of the relatively weak bloodflow in this part of the central nervous system. The authors present an occipital dermal sinus and dermoid cyst revealed by a cerebellar abscess. The literature is reviewed briefly, treatment and prophylactic measures are discussed.

Brain Abscess↗
PubMed1985

Tranquilizers, analgetics and antidepressants in patients treated with hemodialysis.

Tranquilizers, analgetics and antidepressants are applied in different ranges in the treatment of patients on hemodialysis. Due to many different pharmacokinetic properties, no perfect rules for dosage in acute or chronic hemodialysis exist. Adequate applicable drugs without adaptation disregarding different states of renal failure are such with predominate hepatic metabolism and elimination or with inactive metabolites. In the management of acute renal failure, usually in connection with multiple organic disorders, a nonschematic, individually adapted therapy is indicated. In some substances, therapy can be determined by control of plasma concentration levels, in other drugs dosage is possible exclusively according to clinical effects. Substances with side effects on coagulation or acid-base equilibrium should be avoided. It is recommendable to get well acquainted with one substance out of each group in order to avoid polypragmasy.

Acetaminophen↗