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Biomedical subjects

H Müller-Vahl

Publications and source records attributed to H Müller-Vahl.

17 recordsLinked to original sources
PubMed1991

Brachial plexus injury after cardiac surgery. The role of internal mammary artery preparation: a prospective study on 1000 consecutive patients.

Brachial plexus injury is a typical complication after median sternotomy. A prospective study was performed on 1000 consecutive patients to determine whether preventive actions, including lower position and least possible opening of the sternal retractor, help to reduce the complication rate. Twenty-seven patients were observed with postoperative brachial plexus injury. Nerve conduction measurements and electromyography were performed. Patients without preparation of the internal mammary artery had a complication rate of less than 1%, whereas the complication rate of those patients with preparation of the internal mammary artery was as high as 10.6%. The main symptoms were continuous pain and motor and sensory disturbances. Most frequent were lesions corresponding to the roots C8-T1. Six patients had Horner's syndrome; three had ptosis only with no other signs of Horner's syndrome. Symptoms persisted in eight patients more than 3 months after the operation, and one patient still had intractable pain. Increasing use of internal mammary artery grafts in coronary artery bypass demands measures to protect the brachial plexus.

Brachial Plexus↗
PubMed1990

Familial migraine coma: a case study.

A family suffering from a rare malignant type of migraine is described. The syndrome is characterized by episodes of coma with meningitic signs and fever and pareses as well as persistent cerebellar signs. Coma attacks last up to several days and can be precipitated by minor head trauma, vigorous work and angiography. From a study of this family and the literature, it is concluded that this syndrome has to be included in the differential diagnosis of coma and that angiography should be avoided in the patients.

Adult↗
PubMed1987

A three-year prospective study of systemic manifestation in rheumatoid arthritis.

Rheumatoid arthritis (RA) as a systemic disease can attack many other organs in addition to the joints. A variety of pathological lesions of the blood vessels are responsible for the extra-articular features (EAF). In the present study, we investigated firstly whether the presence of blood vessel changes in one organ--namely the skin--may indicate blood vessel pathology and, consequently, EAF in other organs. Secondly, we investigated the number of EAF in individual patients with RA, and observed whether this changed during the course of the disease. Fifty-one RA-patients (40 female, 11 male; ages had a mean of 49.5, minimum 19, maximum 73 years; mean duration of RA was 7.3, minimum 0.25, maximum 41 years) were included in the study. Punch biopsies from the posterior calf were examined immunohistologically for vessel wall immune deposits. Further, EAF were determined by means of instrumental clinical methods such as pulmonary function test, echocardiography, electromyography, and nerve conduction velocity measurement. At the first investigation 21/51 patients had skin vessel wall immune deposits (SVWID). Five patients--all showed SVWID at first investigation--died during the three-year investigation period, 10 patients could not be followed-up for unknown reasons; the skin biopsy of one patient could not be assessed. At the final investigation, we found SVWID in 11/35 patients. SVWID-positive patients had more EAF compared to SVWID-negative patients; this was true both, at the first investigation (1.85 EAF/patient vs 1.05 EAF/patient) and at the final investigation (1.91 EAF/patient vs 0.67 EAF/patient).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

The importance of skin vessel wall immune deposits in the course of the systemic and articular features of rheumatoid arthritis. A prospective study.

Fifty-one rheumatoid arthritis patients were examined prospectively during a 3-year investigation period by means of immunohistological, histological, and instrumental clinical methods. Skin vessel wall immune deposits (SVWID) were found in 21/51 patients at the first and in 11/35 patients at the concluding investigation. Patients with SVWID showed more extra-articular features, more rapid progress of joint damage, higher mortality frequency, higher inflammatory activity, and higher levels of circulating immune complexes, compared with patients without SVWID.

Arthritis, Rheumatoid↗
PubMed1984

[Aseptic tissue necrosis: a severe complication after intramuscular injections].

Aseptic necrosis after intramuscular injection (Nicolau syndrome) occurred in 38 patients. Symptoms were severe immediate pain, swelling and livid discoloration of the skin with development of gangrene of skin and muscle tissue. It was the result of an unintentional intra-arterial injection of toxic substances: to assume an allergic reaction is unwarranted. Since irreversible tissue damage occurs within a short time, treatment results are unsatisfactory. For this reason prevention is essential. Using proper precautions, intra-arterial injections can be largely avoided. Since the greater proportion of these severe complications occurs after the administration of antirheumatic drugs, there should be a fundamental reconsideration of the need for intramuscular application of such drugs, as pharmacologically it is not essential.

Aged↗
PubMed1984

[Iatrogenic lesions of peripheral nerves in surgery].

The frequency of various iatrogenic nerve injuries is reported based on an evaluation of representative material from medical liability proceedings. During operations, nerve injuries occurred most frequently in the neck (lymph node biopsy, thyroidectomy) and the extremities (operations on the hand, total hip arthroplasty). Paralysis of the sciatic nerve following intragluteal injection is still the main injury caused by injection.

Cranial Nerve Injuries↗
PubMed1984

The EMIT FreeLevel ultrafiltration technique compared with equilibrium dialysis and ultracentrifugation to determine protein binding of phenytoin.

A rapid new ultrafiltration technique (EMIT FreeLevel System I) for the routine measurement of unbound phenytoin concentrations was evaluated. The precision of this procedure was sufficient (between-days coefficient of variation, 11.7%). The results obtained by the ultrafiltration technique for the percentage of free phenytoin in samples from about 40 non-uraemic patients treated with this drug were in good agreement with those determined by ultracentrifugation and equilibrium dialysis (ultrafiltration vs ultracentrifugation, y = 0.94x + 0.60%; ultrafiltration vs equilibrium dialysis, y = 1.02x - 0.60%). The mean value of the results obtained by ultracentrifugation was significantly about 8% lower than that observed with equilibrium dialysis, apparently due to a sedimentation of free phenytoin during ultracentrifugation. With the methods used in our study, the mean values of percentage phenytoin bound to serum proteins obtained in samples from non-uraemic patients ranged from 91.8 to 92.8%. All 3 methods yielded similar binding curves for phenytoin, with spiked human pool sera containing albumin concentrations between 19 and 45 g/L. A rise of the unbound phenytoin fraction was observed with increasing total concentrations of the drug and a decrease of the albumin concentration. With samples from non-uraemic patients (n = 203), a rather good correlation was found between free and total phenytoin concentrations (r = 0.91). In a number of patients (n = 11), free phenytoin concentrations correlated better than total phenytoin concentrations with the clinical status. Patients with free phenytoin concentrations of less than or equal to 2.1 micrograms/ml and total phenytoin concentrations above the therapeutic range did not show signs of toxicity. From the results of our study it is concluded that the EMIT FreeLevel ultrafiltration technique is very well-suited for a rapid and reliable separation of unbound phenytoin. In patients with altered protein binding or an unusual clinical response, free phenytoin determinations appear to be necessary for proper interpretation of total phenytoin levels and rational dosage adjustment.

Adolescent↗
PubMed1984

An animal model for aseptic necrosis after intramuscular injections.

Ten drugs or vaccines commonly given to patients by intramuscular injection were injected into the femoral artery of normal young anaesthetized pigs, in order to establish an animal model for macroscopically identifiable aseptic tissue necrosis (Nicolau syndrome). Despite the wide range of constituents and chemical groupings in the drugs which had caused Nicolau syndrome in patients, when injected into the pigs a typical pattern of reactions could be observed for many of them, as follows: the leg contracted rapidly, the skin area supplied by this artery initially became pale and then bluish-red with an irregular reticular appearance before finally tissue necrosis developed. These reactions are comparable to the symptoms of Nicolau syndrome in man. However, no reactions were seen when drugs or vaccines which have not been known to cause aseptic necrosis in man, e.g. tetanus toxoid, influenza vaccine or triamcinolon, were injected i.a.

Animals↗
PubMed1983

[Malpractice in otorhinolaryngology. Report of experiences of the Board of Arbitration in Hannover].

In this article we report on the observations of an arbitration board for medical indemnity problems. The task of this board is to settle disputes concerning the reproach of medical malpractice privately. The producers of the arbitration board are explained. In a survey the proceedings with claims against otorhinolaryngologists are presented. Iatrogenic damages were most often seen after nasal sinus surgery. Recurrent laryngeal nerve palsy after thyroidectomy, spinal accessory palsy after posterior triangle operations and complications after intramuscular injections are frequent iatrogenic injuries of general interest.

Adenoidectomy↗