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Biomedical subjects

G Bachmann

Publications and source records attributed to G Bachmann.

At least 73 records · Page 4Linked to original sources
PubMed1996

[Hypoglossal nerve paralysis after endonasal paranasal sinus operation in intubation narcosis].

BACKGROUND: In the literature the possibility of a pressure trauma to the hypoglossal nerve between the root of the tongue and the ligamentum stylohyoideum is discussed. A recent in vivo study examined the effects of forced reclination of the head on the nerve. PATIENT: A left sided hypoglossal nerve paralysis occurred in a patient after an endoscopically controlled endonasal operation under general anesthesia with transoral intubation. RESULTS: Clinically and electrophysiologically the palsy seemed to be transient due to neurapraxia. An X-ray of the neck performed after the operation revealed a calcification of the left ligamentum stylohyoideum. All the other diagnostic studies (ultrasound of the neck, neurological examination, serological tests, and CT scan of the head) did not show any abnormalities. This is the first time, that a postoperative hypoglossal nerve palsy has been observed, which could not be explained by extensive stretching or pressure. CONCLUSION: We believe that the short pressure of the Mcintosh spatula produced the hypoglossal nerve palsy described.

Adult↗
PubMed1995

Urogenital ageing: an old problem newly recognized.

Urogenital symptoms associated with estrogen loss can occur episodically throughout a woman's life (e.g. during lactation, during treatment with GnRH agonists, etc.) but it is most common and chronic in duration in postmenopausal women. More than 50% of postmenopausal women experience lack of vaginal lubrication and frequent vaginal infections [1]. These urogenital complaints were associated with a diminished frequency of all forms of sexual behaviour. Complaints associated with urogenital ageing include vaginal dryness, irritation and pressure, vaginal discharge and infection, vulvo-vaginal pruritus, dyspareunia, post-coital bleeding, urinary frequency, urgency and incontinence and recurrent urinary tract infections. Although these symptoms have affected women for centuries, they are now becoming more widely recognized by health professionals and society in general because of the increased life expectancy, the acceptance of open discussion of this topic, and the advent of effective therapy. Urogenital ageing is a public health issue because of its high prevalence and because early detection and pharmacological intervention may prevent the development of serious conditions such as uterine prolapse and urinary incontinence. Although systemic hormone replacement therapy is frequently used for the treatment of urogenital atrophy, recent attention has also focused on local delivery of estrogen to the affected urogenital tissue. In this era of fiscal constraint, intervention to maintain urogenital health by the use of estrogen must be considered for all postmenopausal women.

Adult↗
PubMed1995

The estradiol vaginal ring--a study of existing clinical data.

Eleven reports on clinical trials with the estradiol vaginal ring have been completed to date. In five of these, the ring was compared with other vaginally-applied estrogen preparations while in the other six trials there were no parallel controls. Three trials with no parallel controls were carried out on patients who had participated in previously controlled studies. In the controlled studies, reference therapy included an estriol pessary in two, conjugated estrogen cream in two and an estriol vaginal cream in one. After 3 and 12 weeks of treatment in the non-controlled studies, vaginal maturation by cytologic as well as physician assessment was documented. These urogenital maturation changes were associated with improvement or elimination of patient symptoms in 67%-100% of the subjects. Average plasma levels of estradiol, with first and second ring, indicated a transient Cmax of 232 and 162 pmol/l, respectively, but with steady-state concentrations at 28 and 21 pmol/l, respectively. In the five controlled studies, patients were randomized to the agents mentioned above or to the ring, and the dependent variables were vaginal and urinary symptoms reported by subjects and physician and cytopathologic evaluation of the urogenital tissue. These variables were vaginal dryness, pruritus, dyspareunia, dysuria, urinary urgency and stress incontinence. Physician assessment of overall improvement in vaginal and urinary status and cytologic maturation value and vaginal pH were also recorded. Statistical analysis of each trial revealed no significant difference between treatments, and good patient acceptance of the ring. The longer term studies (over 1 year) indicated good to excellent patient acceptance of this low dose estradiol-releasing vaginal ring in the treatment of symptoms associated with urogenital ageing. In summary, clinical experience from 946 postmenopausal women treated with the ring for up to 96 weeks indicates a good response with respect to patient complaints and physical and cytologic examination, without serious adverse reactions.

Administration, Intravaginal↗
PubMed1995

The role of sickness funds in secondary and tertiary prevention.

Present Swiss federal legislation on health insurance provides only a very limited basis for an active engagement of sickness funds in prevention. Nevertheless, sickness funds have offered supplementary insurance coverage benefits for primary and secondary prevention. With the revision of the health insurance act the engagement of sickness funds in prevention is bound to change. With health promotion, medical prevention and rehabilitation all three levels of prevention will be considered in the revised act. In the context of the ongoing political discussion on cost containment in health care and on health insurance premium increase, an active engagement in prevention will be of high interest for sickness funds. Sickness funds have been active in patient education for many years at the institutional level. New fields of activity can be the promotion and probably also the installation of programs in patient education, ambulatory rehabilitation, and followup activities for individual patients and target populations.

Health Promotion↗
PubMed1995

[The staging of osteochondritis dissecans in the knee and ankle joints with MR tomography. A comparison with conventional radiology and arthroscopy].

PURPOSE: A prospective study was performed on 50 patients suffering from osteochondritis dissecans of the knee and ankle to define criteria for stability and fixation of osteochondral lesions. METHODS: Morphological parameters in MRI (size, fragmentation, cartilage, interface) and conventional radiology (separation, fragmentation) were registered and compared with arthroscopic staging. MRI staging based on different types of interfaces was demonstrated on T1- and T2-weighted images. RESULTS: MRI could correctly predict a Grade 1 lesion in 50%, a Grade 2 lesion in 90%, a Grade 3 lesion in 0%, and a Grade 4 lesion in 79%. Stable lesions were differentiated from unstable lesions in 90%. Radiographic findings corresponded with arthroscopic staging in only 56% of the cases because fibrotic connection may guarantee stability in cases of bony separation. CONCLUSION: MRI should be performed before therapy to select those patients who do not need surgical therapy or arthroscopy.

Adolescent↗
PubMed1995

[Temporary cava filter: effective prophylaxis of pulmonary embolism in venous thrombosis in the region of the pelvic vascular system and the inferior vena cava?].

PURPOSE: To assess the temporary Günther filter system concerning handling, complication rate and efficacy in respect to prophylaxis of pulmonary embolism. PATIENTS AND METHODS: 45 temporary Günther filters were placed in 44 patients (mean age 46 years) with deep venous thrombosis of the iliac and/or inferior vena cava. RESULTS: The mean time until filter retrieval was 6.1 +/- 4.1 days (maximum 14 days) dependent on the success of either thrombolytic therapy or thrombus consolidation. 27 patients underwent systemic thrombolytic therapy (61%), three patients (7%) received local thrombolysis. 14 patients (32%) were treated with heparin in a therapeutic dosage (PTT > 60 sec). We observed four complications (8.8%): one accidental arterial puncture (carotid artery on attempting an internal jugular vein approach), one infection located at the puncture site and one caval vein thrombosis in a patient with known heparin-associated thrombocytopenia. One patient died of pulmonary embolism despite correct filter positioning. CONCLUSION: Percutaneous placement of inferior vena cava filters is therefore an easy, safe and effective prophylaxis in respect of pulmonary embolism if combined with thrombolytic therapy or therapeutic heparinisation.

Adult↗
PubMed1995

Clinical spectrum of the MELAS mutation in a large pedigree.

INTRODUCTION: MELAS is most often due to an mentally transmitted A-G transition mutation of mitochondrial DNA (mtDNA) at position 3243. In this study we report on the clinical spectrum associated with the mutation in the largest family reported so far. PATIENTS AND METHODS: In a family with three MELAS cases we identified 47 persons at risk for the mutation; sufficient data was available on 29. Mitochondrial disease was diagnosed in two of 9 deceased numbers (posthumous molecular analysis in one); 27 surviving family members underwent examination and 25 a molecular analysis of mt DNA from lymphoblasts. Then had a muscle biopsy and two were later autopsied. RESULTS: All 26 cases investigated by molecular analysis showed the mutation at position 3243. The 18 symptomatic patients without stroke-like episodes had sensorineural hearing loss in 15 cases, diabetes in 6, nephropathy in 7, mild myopathy in 4, cardiomyopathy in 2, cerebellar disease in 4 and mental retardation in 2 cases. Eight carriers were asymptomatic. Autopsy showed > 80% mutant mt DNA in all tissues except blood (20%) examined in a MELAS patients, but < 20 mutant mt DNA in all tissues except lever (40%) and kidney (70%) in a patient with hepatopathy, renal failure and diabetes. Histologic and biochemical studies of muscle biopsy were often non-informative. CONCLUSIONS: The mutation of mt DNA at position 3243 causes a multisystem disorder with a variable phenotype due to heteroplasmy. Most carriers are oligosymptomatic with hearing loss and a variety of neurological and internal medical symptoms. Diabetes, cardiomyopathy and renal disease, which is newly reported here for this mutation, are frequent. The blood test is a reliable screening tool in affected families, but is of prognostic value only combined with examination of other tissues.

Biopsy↗
PubMed1995

[The MRI in pre- and postnatal diagnosis of congenital sacrococcygeal teratoma].

INTRODUCTION: The main tasks of imaging methods on the evaluation of relatively rare and potentially malignant connatal sacrococcygeal teratomas (SCT) are to depict the extent, structure and relationship to surrounding systems. METHODS: Two cases with SCT were studied with pre- and postnatal MRI and findings were compared with the ultrasound and clinical data. RESULTS: Before delivery, MRI permits depiction of the size and structure of teratomas and the integrity of the serum. After delivery, evaluation of the rectum, urinary tract and levator muscles is important to facilitate surgical reconstruction.

Adult↗
PubMed1995

[Myotonic dystrophy: magnetic resonance tomography and clinico-genetic correlations].

Myotonic dystrophy (DM) is an autosomal dominant multisystem disorder involving muscle, brain, heart, eyes and endocrine organs, among others. The molecular basis is an unstable trinucleotide repeat at the 3'-untranslated end of the myotonin protein kinase gene on chromosome 19 q 13.3, and the number of repeats correlates with the severity of muscle weakness. We performed a clinical, psychometric and MRI study on 43 patients with DM and correlated findings with the molecular analysis. Nineteen patients had mild distal muscle weakness, 17 moderate und 7 severe weakness. Thirteen had marked cognitive deficits with reduced speed of cognition, low IQ, and apathy. MRI showed pathological muscle signal in 35 cases with a characteristic mosaic involving distal muscle groups, often sparing the posterior tibial muscle. Cerebral MRI showed significant subcortical white matter lesions in 20 cases and brain atrophy in 15 cases. Clinical and MRI findings of CNS and muscle both correlated with CTG repeat length, but did not parallel each other. DM is a significant disease of the brain as well as muscle, and several aspects of the disease correlate with molecular findings, with a threshold effect for repeats exceeding 1000 trinucleotides. The individual predominance of specific organ involvement probably depends on variable somatic mosaicism of the molecular defect.

Adolescent↗
PubMed1995

[MRI and CT in diagnosis and follow-up of idiopathic (retroperitoneal) fibrosis].

Six cases of idiopathic fibrosis are presented to demonstrate the different manifestations of the disease and the efficiency of CT and MRI. In addition to the most common form, retroperitoneal fibrosis (Ormond's disease), fibrosis was seen in the mediastinum and pelvis. The inflammatory aortic aneurysm is a special variant. MRI was superior to CT in many diagnostic requirements. The extent of fibrosis was demonstrated more sensitively and MRI showed sclerosis in regions that appeared normal on CT. Occlusion of large vessels and collateral circulation were better depicted on MRI. The superior tissue contrast of MRI permitted differentiation of several stages of inflammation, which is of major significance for treatment and follow-up.

Adult↗
PubMed1994

Brain disease and molecular analysis in myotonic dystrophy.

Abnormal amplification of a CTG repeat on chromosome 19 is the molecular basis of myotonic dystrophy (DM). Expansion of the repeat has been correlated with severity of several clinical features of the disease. We performed extensive cognitive testing, cerebral magnetic resonance imaging (MRI) and a molecular analysis in 28 cases of DM to determine the relationship between the molecular defect and brain disease. Performance in two or more cognitive tests was pathological in 10 cases. Fourteen patients had subcortical white matter lesions on MRI, 14 had cerebral atrophy. Amplification of the CTG repeat showed a strong correlation with cognitive test deficits when exceeding a length of over 1000 trinucleotides. MRI lesions were associated with impaired psychometric performance, but MRI and molecular findings were only weakly related. Disease duration influenced the appearance and amount of white matter lesions on MRI. Quantification of CTG repeat size may allow an early estimate on the probability of brain involvement in DM; cognitive dysfunction is associated with white matter lesions and cerebral atrophy later on in the course.

Adult↗
PubMed1994

The prognostic value of magnetic resonance imaging for the management of breech delivery.

In patients with breech presentation secondary cesarean section is often caused by a failure to progress in labor due to a disproportion between fetal breech and maternal pelvis. The aim of the present study was to select such patients for primary cesarean section by prenatal use of magnetic resonance imaging. In 39 patients with breech presentation at term, maternal obstetric conjugate, transversal inlet diameter, sagittal mid-pelvis diameter, and interspinal distance, as well as fetal transversal and sagittal breech diameters, were measured by magnetic resonance imaging 1-7 days before delivery. All obstetricians that were involved in this study were blind to the measured values. For statistical evaluation the Mann-Whitney U-test was used. In 13 of these patients a secondary cesarean section was performed due to failure to progress in labor and in 9 due to other indications (intrauterine asphyxia, etc.). Seventeen women were delivered vaginally. The proportion between maternal pelvic inlet and fetal breech diameters was significantly less favourable in patients with failure to progress in labor (n = 13) than that in patients who were delivered vaginally (n = 17) (0.97 +/- 0.06 vs. 0.86 +/- 0.05, P < 0.001). Furthermore, by comparing the maternal pelvic inlet diameters with the corresponding fetal breech diameters, three groups of patients could be selected: one group (A; n = 8), in which the patients could be delivered only by cesarean section, a second group (B; n = 10), in which delivery by both cesarean section and vaginally was possible, and a third group of patients (C; n = 12), in which vaginal delivery was exclusively successful.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[MRT and dynamic CT in the diagnosis of a recurrence of rectal carcinoma].

A prospective study on 29 patients with presacral lesions after operation of rectal cancer was performed to define the accuracy of CT using a dynamic contrast study and MRI for detection of tumour recurrence (sensitivity) and differentiation from scar formation (specificity). In dynamic CT sensitivity was 88% and specificity was 100%. In MRI the respective data were 94% (sensitivity) and 92% (specificity). Additionally 14 patients with primary rectal cancer were included to define standards for dynamic CT; no differences between primary tumour and relapse were found. In MRI the assessment of signal intensities in T2w images permits differentiation between tumour relapse and scar tissue. In dynamic CT automatically calculated time-density graphs enable differentiation of presacral lesions and the initial increase of density after standardised bolus application was shown to be the most reliable parameter.

Adult↗
PubMed1994

[MRT of the knee in the follow-up of the plastic repair of the anterior cruciate ligament with autologous semitendinosus tendon].

In a prospective study, 153 MRI examinations were performed on 74 patients following reconstruction of a ruptured anterior cruciate ligament with a semitendinosus graft. MRI examinations were performed at three defined intervals (3 months, 4 to 12 months, and 1 to 2 years postoperatively), and the findings were compared to simultaneous clinical tests to define stability criteria. This permitted reliable assessment of the integrity of the ligament graft; in three cases we correctly diagnosed a ruptured graft. A well-defined tendon graft with recognizable fibrous structures correlated with a clinically stable ligament in 98% of the cases. Due to physiological transformation occurring from three months to one year postoperatively, that graft temporarily appears less distinct. Complete integration of the graft with full stability of the knee is visualized in the MRI scan as a tendon with low signal intensity. Postoperative complications and the desire to participate in sports activities are indications for MRI examination.

Adolescent↗
PubMed1994

White matter lesions and cognitive deficits: relevance of lesion pattern?

Magnetic resonance imaging (MRI) permits efficient visualization of white matter lesions (WML). A growing body of literature deals with the correlation of WML and cognitive dysfunction with conflicting results. We studied the influence of lesion pattern as well as size by analyzing MRI and psychometric test performance in 2 patient collectives with different WML patterns. 22 patients with myotonic dystrophy (MD) and mainly subcortical WML were compared with 39 patients with multiple sclerosis (MS) and mainly periventricular lesions. 73% of MD patients had WML, the extent of which correlated with cognitive deficits. Severely impaired patients had psychometric findings compatible with "subcortical" dementia. In MS the extent of WML alone did not correlate significantly with cognitive deficits. Significant cognitive dysfunction was observed with extension of WML to areas of white matter immediately underlying cortex, but not with exclusively periventricular lesions. Cerebral atrophy had less impact. Comparison of MD and MS indicates that WML immediately subjacent to cortex are likely to cause significant cognitive deficits, whereas extensive periventricular demyelination may cause no major dysfunction. This may relate to early disturbance of associative fibers by subcortical lesions. Our results emphasize the significance of pattern as well as total extent of WML. Myotonic dystrophy is a useful model to study the effect of subcortical lesions, due to a typical lesion pattern unusual in other conditions.

Adolescent↗
PubMed1994

[MELAS syndrome. Clinical aspects, MRI, biochemistry and molecular genetics].

MELAS is a mitochondrial cytopathy characterized by encephalopathy with stroke-like episodes and lactic acidosis. Most patients exhibit an A-G transition mutation at np 3243 of mitochondrial DNA (tRNA(Leu)(UUR)). We present a family of four in which the mutation was discovered in blood and in muscle mt DNA. Two patients had the classic MELAS syndrome with multiple stroke-like episodes. Some episodes were precipitated by metabolic stress. The remaining two patients had an oligosymptomatic disease with mild chronic encephalopathy, small stature and hearing loss. MRI was followed over a period of 4-8 years, during which the MELAS patients showed progression from nonspecific multifocal signal change to typical extensive cortico-subcortical parieto-occipital lesions and progressive cerebral atrophy. MRI in the oligosymptomatic cases was normal, or showed non-progressive cerebellar atrophy. Biochemical findings were non-specific, indicating increased mitochondrial volume in all cases, and a relatively complex IV defect in one case. All patients were treated with coenzyme Q with varying clinical response. The percentage of mutant mt DNA in blood and muscle did not correlate with clinical severity. Pathogenetic theories based on molecular genetics, and the therapeutic regimen in terms of the underlying biochemical concepts are discussed.

Adolescent↗
PubMed1993

Magnetic resonance imaging of muscle and brain in myotonic dystrophy.

Myotonic dystrophy (MD) is characterized by myotonia, weakness and extramuscular symptoms, including intellectual impairment. We performed magnetic resonance imaging (MRI) of brain and muscle in 25 MD patients: 81% had cerebral atrophy (severe in 36%); 68% had focal white matter lesions, which were large and multiple in 27%. Brain MRI findings correlated with mental impairment; the severity of both correlated with disease duration. Changes in brain and muscle MRI were progressive with time, but independent of each other. Muscle MRI findings were fatty degeneration and loss of bulk. In the calves, the medial gastrocnemius muscles were involved earliest and the posterior tibial muscles relatively spared. In the thighs the vastus muscles were damaged most often and the rectus femoris least. Focal muscle damage was efficiently visualized, sometimes preceding clinical detection. Muscle MRI was less sensitive than conventional methods for early diagnosis, but ideal for follow-up, owing to its non-invasiveness and examiner-independence.

Adolescent↗