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Biomedical subjects

G Hamann

Publications and source records attributed to G Hamann.

32 records · Page 2Linked to original sources
PubMed1993

Beta-blockade in acute aneurysmal subarachnoid haemorrhage.

The effects of beta-blockade to prevent autonomic disorders after acute aneurysmal subarachnoid haemorrhage were prospectively investigated. 11 patients were treated with the beta-1-selective beta-blocker metoprolol (up to 200 mg/die intravenously). 14 patients received standard therapy as controls. Pulse rate, blood pressure and dosage of the additional antihypertensive medication as signs of sympathetic disturbance were registered. The main result was the normalizing of the pulse rate especially during the first two weeks in contrast to the control group. The patients in the beta-blocker group did not need further antihypertensive medication. This was mainly a result of the reduction in sympathetic activation. No severe side-effects were documented and the survival was better in the treated group. Thus, beta-blockade is able to prevent and reduce autonomic disorders, especially activation of the sympathetic tone, in subarachnoid haemorrhage. Metoprolol as a so called cardioselective beta-blocker seems to be one of the suitable agents and is considered superior to the non-selective agents.

Adult↗
PubMed1993

[Neurologic complications of malaria infection].

Infections with malaria are increasing in Europe and Northern America and are also spreading in tropical endemic areas. A falciparum variety of malaria known as cerebral malaria is the most well-known neurological complication, caused by Plasmodium falciparum and characterised by a fulminant course with disturbances of consciousness and facultative seizures or focal neurological deficits. 50% of deaths caused by malaria are due to cerebral involvement. Pathologically a disseminated vasculomyelinopathic disorder is seen. Immunological changes, vascular-hypoxic disturbances and metabolic-toxic factors contribute to these pathological findings. Facts on diagnostic, differential diagnostic and therapeutic procedures are presented. Beside the severe and life-threatening cerebral malaria some unspecific cerebral symptoms are seen, such as cerebellar ataxia and chorea. Spinal disease and peripheral nerve involvement, polyradiculitis and especially psychiatric disorders have also been described. Every neurological and psychiatric disorder presented first in tropical areas or malaria-endemic regions requires malaria diagnostic tests. In our geographical region, any previous history of a journey to the tropics is an important pointer; in particular, neurological or psychiatric symptoms can be important pointers to malaria.

Adult↗
PubMed1993

Renin activation correlates with blood amount and distribution in subarachnoid haemorrhage.

Blood extent and localization visible in CCT predicts complications and prognosis in patients suffering from subarachnoid haemorrhage (SAH). Plasma renin activity (PRA) elevation is one of the hormonal parameters of autonomic disorders after SAH and its prognostic relevance could be confirmed by this study, too. But the correlation of PRA with blood amount and distribution was the main target of this study. Large amounts of blood are connected with higher PRA-levels and more PRA-rises. Even a linear correlation between the amount of blood defined by a CCT-score and PRA in ng ml h-2 could be established. A significant correlation was found between intraventricular, suprasellar blood, ventricular enlargement of the third/lateral ventricles and PRA-elevations. Disorders of hypothalamic and/or medullary centres of sympathetic control are thought to be the underlying cause and to depend on blood extent and distribution.

Adult↗
PubMed1993

Absence of elevation of big endothelin in subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: Endothelin peptides are potent vasoconstrictors and thus are seen as potential cause of cerebral vasospasm after subarachnoid hemorrhage (SAH). Earlier reports showed elevated or normal endothelin levels in plasma and cerebrospinal fluid in patients suffering from SAH. The present study was designed to determine whether endothelin is a causal factor in SAH. METHODS: We studied 11 patients with acute SAH. Seven of these 11 patients had a proven aneurysm and six had experienced vasospasm. Big endothelin levels were determined by a radioimmunoassay recognizing the C-terminal peptide (normal range, 1-11 fmol/ml). RESULTS: There were no elevations of big endothelin in the 59 plasma samples and the 17 simultaneously estimated cerebrospinal fluid samples. Differences between plasma and cerebrospinal fluid did not reach significant levels. Big endothelin values between patients with and without vasospasm showed no significant differences. CONCLUSIONS: Our findings suggest that plasma elevation of the endothelins is not reproducible in SAH and that big endothelin is unlikely to be a causal plasma factor in the complex multifactorial development of vasospasm after SAH.

Adult↗
PubMed1993

[Brain metastases as an initial manifestation of tumor disease].

A retrospective study compared a group of 122 patients with brain metastases from unknown primaries with a second group of 121 patients, who developed brain metastases in the course of a known malignant disease. Special attention was paid to the kind of primary cancer, therapeutic influences and prognostic differences. The results pointed to a late occurrence of brain metastases in breast cancer, no patient with this type of cancer being found in group 1. Melanoma and colorectal cancer were also found predominantly in group 2, whereas lung cancer was the most common cause of metastasis in group 1 and the most frequent cancer in both groups. Clinical course, therapy and outcome showed no significant differences between the two groups. Mean survival time was 4.6 (+/- 6) months for the patient series as a whole. Patients with breast cancer had a significantly higher survival rate than those with other forms of cancer. Localisation and degree of malignancy mainly determine the life-prognosis, the type and intensity of therapy being of secondary importance.

Adult↗
PubMed1992

[A personal computer-based system for online monitoring of neurologic intensive care patients].

In the management of neurological intensive care patients with an intracranial space-consuming process the measurement and recording of intracranial pressure together with arterial blood pressure is of special interest. These parameters can be used to monitor the treatment of brain edema and hypertension. Intracranial pressure measurement is also important in the diagnosis of the various subtypes of hydrocephalus. Not only the absolute figures, but also the recognition of specific pressure-patterns is of particular clinical and scientific interest. This new, easily installed and inexpensive system comprises a PC and a conventional monitor, which are connected by an AD-conversion card. Our software, specially developed for this system demonstrates, stores and prints the online-course and the trend of the measurements. In addition it is also possible to view the online-course of conspicuous parts of the trend curve retrospectively and to use these values for statistical analyses. Object-orientated software development techniques were used for flexible graphic output on the screen, printer or to a file. Though developed for this specific purpose, this system is also suitable for recording continuous, longer-term measurements in general.

Cerebral Hemorrhage↗
PubMed1992

[Basilar aneurysm in the cerebello-pontine angle. Case report with review of the literature].

The importance of vascular lesions in the cerebello-pontine angle is discussed with reference to a case report of a basilar artery aneurysm with typical clinical signs of cerebello-pontine angle lesion. A review of 29 cases of aneurysms with cerebello-pontine angle syndrome is given. The presented case is the twelfth reported basilar artery aneurysm in this region with the typical clinical syndrome.

Aged↗
PubMed1992

Spastic disorder in patients with hereditary multiple exostoses, but without spinal cord compression: a new syndrome?

We describe a 37 year old man with a history of a gait disorder which had been worsening over a period of three years. Clinical examination showed the typical signs of a spastic tetraparesis with increased tone of all the extremities. Sensation, autonomic and cerebellar functions were not disturbed. Multiple exostoses had been present since early childhood, but none had been found in the spine or the cranium to cause the tetraspastic disorder. MRI scan was normal. Pedigree analysis of four generations showed that other family members were affected by both disorders. Chromosomal analysis was normal. We consider this to be a previously unknown hereditary syndrome transmitted as an autosomal dominant and manifesting a combination of spastic tetraparesis and multiple exostoses.

Adult↗
PubMed1989

Has plasma renin activity a prognostic significance in subarachnoid haemorrhage?

The possible relationship between plasma renin activity and neurological deficits was examined in ten patients with spontaneous subarachnoid haemorrhage in a prospective clinical study. The patients were examined daily, particular attention being given to signs of brain stem dysfunction. The degree of impaired consciousness was assessed using the Glasgow Coma Score. Plasma renin activity was determined on days 1-5, 7, 9, 11, 13, 15 and 21 after the initial bleeding episode using an Angiotensin-I-radioimmunoassay. Six of seven patients with signs of brain stem dysfunction displayed a marked increase in plasma renin activity. Thus a significant negative correlation between the degree of consciousness and the plasma renin activity resulted. An explanation for this correlation may be found in the localization of the autonomous centres and the high concentrations of renin in the hypothalamus and brain stem. The individual changes in plasma renin activity have prognostic significance, whereas single estimated plasma renin activities show great inter-individual differences and have only limited prognostic value.

Brain Diseases↗
PubMed1989

Characterizing anticholinergic abuse in community mental health.

To identify factors associated with anticholinergic abuse in patients taking antipsychotics and anticholinergics and to document the extent of extrapyramidal side effects in anticholinergic abusers, 21 anticholinergic abusers were matched with 21 controls without a history of anticholinergic abuse for diagnosis and antipsychotic dose. Data were collected prospectively, and extrapyramidal side effects and abnormal involuntary movements were evaluated using the Modified Simpson Angus Scale and the Abnormal Involuntary Movement Scale. The abuse group reported significantly more subjective effects from anticholinergic agents than did those in the control group (mean +/- SD = 10.5 +/- 5.4 vs. 6.5 +/- 3.7, p less than 0.05). The abuse group was significantly more likely to report feeling a buzz (p less than 0.05) and difficulty learning (p less than 0.05) when taking anticholinergic medications. Abusers reported abusing significantly more drugs in the past (2.7 +/- 2.1 vs. 0.8 +/- 0.9, p less than 0.01) and had taken antipsychotics (12.7 +/- 6.3 vs. 8.7 +/- 5.4 years, p less than 0.05) and anticholinergics (10.9 +/- 3.1 vs. 6.1 +/- 4.6 years, p less than 0.01) significantly longer than controls had. Patients in the control group spent significantly more years working full-time than did abusers (6.2 +/- 7.3 vs. 0.7 +/- 1.4, p less than 0.01). There was a nonsignificant trend for abusers with a longer duration of antipsychotic use to have higher Abnormal Involuntary Movement Scale scores (r = 0.40, p less than 0.10). Although these drugs are potentially abusable, the term "anticholinergic abuse" should be reevaluated in light of accumulating evidence that many patients taking these drugs report improved functioning, with improvement in negative symptoms and minimal or no adverse anticholinergic effects.

Adult↗
PubMed1988

Clinical outcome and adverse effect profile associated with concurrent administration of alprazolam and imipramine.

Clinical outcome and adverse effects associated with concurrent alprazolam and imipramine administration were studied in 29 patients with major depressive disorder who completed a 6-week trial in which they served as their own controls. Alprazolam was added on Day 8 in gradually escalating, then gradually tapering dosages while imipramine dosages remained unchanged. Significant decreases were observed in scores on the Hamilton Rating Scales for Depression and Anxiety at all later evaluation days with Day 8 as baseline. The mean total Symptom and Side Effects score decreased significantly from Day 8 to Day 22 when alprazolam doses were 1 mg q.i.d. For most side effects, total number of reports remained constant or decreased from Day 1 to later evaluation days. Standing diastolic blood pressures were significantly lower on Day 22 than on Day 1. No significant relationship was found between any rating scale score and plasma concentration data.

Adult↗
PubMed1987

[Intracranial pressure-controlled treatment of brain edema with glycerin and sorbitol in intracerebral hemorrhage].

The continuous epidural registration of intracerebral pressure showed that the pronounced brain edema which develops during the 4th to 14th day of an intracerebral hemorrhage could lead to an increase in intracerebral pressure (ICP greater than 25 mmHg) requiring treatment. During the therapy extensive ICP crises (ICP greater than 35 mmHg), lasting for 1 to 3 days and only controllable through high doses of glycerol and sorbitol, developed. Glycerol (50 g orally) and sorbitol (50 g i.v.) lowered the pressure during this phase for approximately 3 h and 1.5 h respectively. These time intervals were in accordance with the changes in plasma osmolality through the administration of both substances. Due to its longer efficacy, glycerol provides an important supplement or alternative to sorbitol therapy, especially as the permitted maximum dosage would have to have been exceeded in a treatment consisting exclusively of sorbitol. The duration of the decrease in intracerebral pressure lasted longer during the remainder of the treatment in the case of both substances, being decisively dependent on the intracerebral pressure intensity. The relatively harmless epidural measurement of intracerebral pressure allowed an optimal control of the brain edema therapy as the dosage of the hyperosmolar substances could be given exactly in accordance with the intracerebral pressure intensity and subsequently varying efficacy.

Administration, Oral↗