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Biomedical subjects

H Bennefeld

Publications and source records attributed to H Bennefeld.

11 recordsLinked to original sources
PubMed1995

Treatment of patients with severe head injury by triamcinolone: a prospective, controlled multicenter clinical trial of 396 cases.

The present studies were conducted to test whether the outcome of severe head injury is improved by early administration of the synthetic corticosteroid triamcinolone. In a prospective, double-blind, multicenter clinical trial, 396 patients with severe head injury were randomized to a steroid group (n = 187) receiving 200 mg triamcinolone acetonide (Volon A soluble) i.v. within 4 h after trauma, followed by 3 x 40 mg/day i.v. for 4 days, and 3 x 20 mg/day i.v. for a further 4 days, and a placebo group (n = 209) receiving injections which did not contain any active drug. The placebo group was subjected to the same standard treatment procedures. Clinical features were not different between the groups upon admission to hospital. Subdural hematoma, epidural hematoma, and focal supratentorial contusion were among the most frequent diagnoses. The result of treatment with triamcinolone was assessed at discharge from the hospital and at 1 year after trauma, using the Glasgow Outcome Scale. Differences in favor of steroid treatment could be detected with regard to the patients' condition at discharge (P = 0.0634). More patients with steroids had a good recovery (49.2% vs 40.7%), and fewer died (16.0% vs 21.5%). Differences in outcome were even more pronounced (P < 0.0145) in patients with a focal lesion and a Glasgow Coma Score on admission of < 8 (n = 93). In this group, 34.8% of the patients made a good recovery, as against 21.3% of the placebo group; mortality was also lower in the verum group (19.6% vs 38.3%). The results indicate that a major subgroup of patients with severe head injury benefits from early administration of triamcinolone. Efficacy of the treatment can be expected, in particular, in patients with a focal cerebral lesion and a Glasgow Coma Score of < 8 on admission. Administration of steroids beginning at the scene of an accident would therefore be beneficial in these cases.

Adolescent↗
PubMed1992

Effect of physical stress on 5-hydroxytryptamine uptake kinetics (Km and Vmax) in human platelets.

Platelet 5-HT uptake is possibly one mechanism by which plasma level of 5-HT is physiologically controlled. This mechanism may be of importance in the vascular 5-HT mediated tone and protect against thrombolysis and cardiovascular events. Physical stress is known to affect various platelet functions. The aim of this study was to investigate whether or not physical stress has any influence on platelet 5-HT uptake kinetics. In healthy adult persons (n = 13) the maximal rate (Vmax) and Michaelis-Menten constant (Km) of platelet 5-HT uptake (in vitro) were determined before (a), immediately after (b) and 1 hour after 50 min of squash playing (c). Immediately after squash Vmax and Km were elevates significantly as compared to the values before squash [Vmax(a): 77.0 +/- 31.0 (SD) pmol 5-HT/10(8) pl./min, Vmax(b): 109.9 +/- 48.4 (SD) pmol 5-HT/10(8) pl./min, p less than 0.01; Km(a): 5.16 +/- 1.73 (SD) x 10(-7) mol/1, Km(b): 7.59 +/- 2.37 (SD) x 10(-7) mol/1, p less than 0.05]. The percent elevations of Vmax (47%) and Km (42%) were of the same range. One hour after squash the values of Vmax(c) and Km(c) were found to be normalized. It is concluded that physical stress, like squash playing, does not affect net platelet 5-HT uptake in healthy persons at physiological plasma 5-HT concentrations. The significant increases of Vmax and Km of platelet 5-HT uptake are suggested to be adaptation reactions to keep the platelet net 5-HT uptake constant.

Adult↗
PubMed1990

Bacteriological analysis of pyogenic infections of the brain.

Pyogenic infections of the brain are divided according to the anatomic structures they involve. Brain abscess and subdural empyema are the main phenomena. This retrospective study analyses case records of the Neurosurgical University Teaching Hospital at Münster from a bacteriological standpoint and compares them with other reports in the literature. Various kinds of bacteria depending on etiology and pathogenesis are described. It is found that with improved bacteriological techniques the number of anaerobic infections increases and, at the same time, the number of sterile empyema decreases. A significantly higher mortality of patients with sterile suppuration is also found. It must be assumed that insufficient bacteriological evaluation leads to faulty diagnoses and ineffective antibiotic therapy and that genuine sterile empyema is rare.

Bacteria, Anaerobic↗
PubMed1989

Classification of gliomas and medulloblastomas using the new TNM system for cerebral tumors.

In 1987 the UICC presented a proposal for TNM classification of brain tumors. This proposal is assessed in a retrospective study on 316 glioma and medulloblastoma patients treated in the Neurosurgical Clinic of the University Münster. It is evident that the T categories do not produce the correct sequence of prognostic differentiation required. The features of tumor spread used for classification are not of equal significance for the various types of tumors. In our opinion it is not possible to adequately describe the greatly varying development characteristics of all brain tumors using one system of classification.

Brain Neoplasms↗
PubMed1989

The influence of fibronectin on the fibrosing of a nerve anastomosis in the rat.

Although the fibrin adhesion enjoys increasing success in many areas of surgery, it has not, however, become fully established in nerve anastomosis. It was in this area particularly that significant advantages were expected, especially by the avoidance of suture granulomas. As the fibrin clot dissolved prematurely, however, and dehiscences ensued, antifibrinolytic substances had to be added to the adhesive. Fibroses occurred frequently as a result, which to date encumber nerve adhesive. We examined fibronectin for its fibrosis-inducing effect, comparing both presently available fibrin adhesive systems, because one contained up to 5 times more fibronectin per milliliter than the other. On the basis of a test grouping using 100 and 1000 KIU aprotinin/ml, we were able to establish that fibronectin in fibrin adhesives possesses a fibrosis-promoting effect.

Action Potentials↗
PubMed1989

[The effect of fibrin gluing and its important components on fibrosis of nerve anastomoses].

The fibrinous adhesion, although generally adopted and more and more successfully applied in many sectors of surgery, is not yet fully established in the anastomosis of separated nerves. Initially, the adhesion was expected to offer some essential advantages in this domain, especially in the prevention of suture granulomas. However, the blood clots dissolved too early, and this resulted in the formation of dehiscences. So antifibrinolytic substances had to be added to the adhesive, and this led to a frequent appearance of fibroses. The adhesion of nerves is still hampered by this fact. Now we have examined the fibrosis-inducing effect of different factors of the adhesive system. We found that aprotinin and the fibrin clot as an obstacle to supply had no additional fibrotic effect, whereas thrombin, factor XIII and fibronectin promoted the formation of fibroses.

Anastomosis, Surgical↗
PubMed1989

[Brain abscess and subdural empyema from the bacteriologic viewpoint].

The bacteriology has changed since beginning of antibiotic therapy. Reports of literature and the dates of patients treated in Neurosurgical Clinic of Münster are analyzed. The improvement of microbiological technique leads to the evidence of a greater role of anaerobics and of a smaller part of sterile cultures. The success of therapy depends on the early beginning of specific therapy. The poor prognosis of the sterile inflammations is caused by inefficiency of unspecific therapy.

Bacteria↗
PubMed1988

Surgical strategies for combined intraorbital and intracranial tumors.

Three unusual cases of combined intraorbital-intracranial tumors of various types which were chosen from cases treated in the Clinic and Polyclinic of Neurosurgery of the University of Münster, to demonstrate the problems of surgical therapy. A list of indications for the various accesses to the orbita is worked out. Close co-operation among the neurosurgeon, the ophtalmologist, the oto-rhino-laryngologist and the maxillofacial surgeon is necessary. All facets of the patient's condition and situation must be taken into consideration when planning therapy.

Adenoma↗
PubMed1988

Orbital cavernous hemangiomas.

Cavernous hemangiomas are the most frequently found primary tumors in the orbital region. They normally appear in adults. Diagnostic features in the majority of cases include protrusio bulbi and orbital enlargement. B-Scan and computed tomography/MRI are the prime diagnostic aids. We recommend surgical removal of these tumors, at least in cases with marked orbital protrusion or significant optic nerve compression. The prognosis is usually good.

Adolescent↗
PubMed1988

[Clinical aspects of hypophyseal metastases].

Metastatic tumors within the pituitary gland are rare. The incidence--reported by series of autopsies--differs from 1.8-12% of metastatic tumors. Most of the primary tumors are breast cancers, followed by cancers of the gastro-intestinal system. Only 20% of these metastases are clinically diagnosed. Diabetes insipidus is the main symptom, correlating with the greater incidence of metastatic lesions in the posterior lobe. The unusual features of a reported case are discussed. In this case the dysfunction of cranial nerves passing the sella turcica led to the diagnosis. Therapy with Flutamid initiated a remission. Survival of 18 months is remarkably long.

Aged↗