Biomedical subjects
Publications and source records attributed to H Gumprecht.
A frameless, armless neuronavigation system with microscope interconnection is described. The registration accuracy lies within 0.7 to 3.2 mm with 0.51 standard deviation. The BrainLab VectorVision is very applicable in neurosurgical procedures.
A 25 years old female person suffered from v. Hippel-Lindau disease with three manifestations within the central nervous system (cerebellum, nerve root C1 and Medulla oblongata). Pancreatic cysts, a cyst and a tumour of the kidney were diagnosed as well. In a first operation, the large cerebella's tumour and the small haemangioblastoma of the nerve root C1 were removed via a suboccipital craniectomy. A few weeks later, after the patient had made a good recovery, the tumour at the craniocervical junction was removed through a far lateral approach. The postoperative course was without complications. The MRI control seven months after surgery was free of tumour and the young person was in a good clinical condition, without neurological deficit.
BACKGROUND: The timing of surgery in patients suffering from subarachnoid hemorrhage grade IV and V according to Hunt and Hess, is still controversial. Several authors advocate early surgery for patients in poor clinical condition. Improved outcome and decreased mortality rates were reported. Others exclude patients in poor condition from early aneurysm surgery. METHODS: Forty grade IV aneurysm patients were admitted to our department. After ventriculostomy and cerebral angiography, 28 of them were operated on within 72 hours. The postoperative treatment included hypertensive, hypervolemic, hemodilutional therapy (triple-H therapy) and intensive monitoring (intracerebral pressure, blood pressure, hemodynamic parameters). The mean follow-up time was 6 months. RESULTS: Out of the 28 patients who underwent early surgery, 64% were in good health, 11% in poor health, 25% died; there were no survivors in a vegetative state. Twelve patients were treated conservatively; 50% died from infarction and rebleeding, before the operation was performed. Six underwent delayed aneurysm surgery after clinical improvement. In this group, 25% had good clinical outcome. CONCLUSIONS: Our results favor an aggressive treatment of grade IV aneurysm patients by means of ventricular drainage, early surgery and triple-H therapy.
In critical care patients requiring prolonged mechanical ventilation, tracheostomy is necessary. Alternatively to the standard surgical method, a percutaneous dilatational technique is available. From September 1993 to October 1994 38 critically ill neurosurgical patients underwent tracheostomy using the minimal invasive puncture method. The patients were aged between 20 and 92 years. The average duration of the tracheostomy was 7.5 [4-15] minutes and was performed bed sided at the ICU. The tracheostomy was controlled endoscopically through the naso- or orotracheal tube. A 8 mm cannula was inserted in each case. One patient died during the procedure of sudden fulminant pulmonary artery embolism. One procedure had to be interrupted because of cardiac failure. In this patient the tracheostomy was performed the day after under optimized conditions. There was no peri- or postoperative bleeding, no pneumothorax, no misplacement of the cannula. An infection of the stoma site was not noticed. The decannulation did not cause any complications (16 cases). The stoma was closed within a few days, only a small scar remained. The bed side procedure of percutaneous dilatational tracheostomy is a safe and quick technique. There is no need to disconnect the patient from intensive monitoring for means of transportation to the surgery room. Thus we find it the method of choice for critically ill neurosurgical patients.
The production of cytokines and their receptors in the pituitary gland as well as receptor-mediated cytokine effects on pituitary function have been demonstrated. We have investigated whether the naturally occurring interleukin-1 receptor antagonist (IL-1ra), which has been shown to block IL-1 biological actions during inflammatory processes, could be expressed in human pituitary adenomas (n = 16) cultured in vitro. By polymerase chain reaction of reverse-transcribed RNA we detected IL-1ra messenger RNA in cultures of all types of pituitary adenomas under basal conditions as well as after stimulation of the cells with endotoxin or phorbol myristate acetate. The amplified complementary DNA fragment was identical to the fragment observed when RNA from purified human monocytes was subjected to reverse transcription polymerase chain reaction. In addition, we provide evidence that the IL-1ra messenger RNA detected in human pituitary adenomas corresponds to the intracellular IL-1ra variant. By using specific primers for the monocyte/macrophage marker CD14 as a control, we could exclude a contamination by monocytes or macrophages in the cell cultures of pituitary adenomas as a source of IL-1ra expression. Immunofluorescence studies showed the presence of cellular IL-1ra protein in the pituitary adenoma cultures and the colocalization with hormone-producing cells in GH- and ACTH-secreting adenomas. Production of IL-1ra within the anterior pituitary may act as a protective mechanism, modulating the sensitivity of pituitary cells to circulating or intrinsically produced IL-1 during inflammatory or tumoral processes.