Biomedical subjects

H Mattle

Publications and source records attributed to H Mattle.

At least 37 records · Page 2Linked to original sources

PubMed1989

Projection arteriography and venography: initial clinical results with MR.

Motion currently limits the applications of magnetic resonance (MR) angiography in certain regions of the body. To overcome this problem, a series of breath-hold, two-dimensional, flow-compensated gradient-echo images were acquired. These images were then processed by means of the maximum intensity projection algorithm to produce projection angiograms. The method was evaluated in 10 healthy subjects and in 12 patients and validated by comparing conventional angiograms, contrast material-enhanced computed tomographic scans, and duplex sonograms with MR projection arteriograms and venograms of the chest, abdomen, and pelvis. The aorta and pulmonary arteries and their branches were demonstrated, as was detailed anatomy of the hepatic and portal venous systems and inferior vena cava. Renal arteries and veins could be studied in both native and transplanted kidneys. The method permits determination of flow direction and differentiation of arteries and veins and is superior to three-dimensional acquisition techniques for imaging slow blood flow. Initial results suggest that the method may have clinical applications for a variety of vascular disorders.

Arteries↗

PubMed1989

Atheromatous pseudo-occlusion of the internal carotid artery.

Between 1978 and 1988, the diagnosis of atheromatous pseudo-occlusion of the internal carotid artery was made in 34 patients by angiography. Results of noninvasive tests were abnormal in 33 of the 34 patients examined. Twenty-five patients had carotid endarterectomy, and the other nine were treated medically. Four of the 34 patients (12%) had significant complications, two related to angiography and two to surgery. Twenty-three of the 25 operated patients were seen in long-term follow-up; 19 (83%) were found to have a patent operated vessel by noninvasive testing. None of the 23 operated patients followed up suffered recurrent neurologic deficits following surgery; two had distant contralateral strokes. Three of the nine patients treated medically (33%) experienced delayed ipsilateral stroke. This study shows that the risks associated with angiography and surgery for atheromatous pseudo-occlusion are significant and are higher than previously reported.

Aged↗

PubMed1988

Transcranial Doppler sonographic findings in middle cerebral artery disease.

The transcranial Doppler sonographic findings of 61 patients with middle cerebral artery (MCA) disease were compared with those of 535 controls. According to computed tomographic, angiographic, and/or autopsy findings, the patients were classified as having MCA occlusive lesions in the central (sphenoidal) part or in peripheral branches or MCA stenosis. With MCA lesions, the MCA flow velocity (FV) was reduced. At the same time the anterior cerebral artery FV increased because of collateral flow over leptomeningeal anastomoses. Central MCA lesions showed less marked changes than did peripheral lesions. In MCA stenosis a steep rise of MCA FV appeared inside the stenotic segment. If there was a high-grade stenosis or occlusion of the internal carotid artery, a collateral circulation over the anterior part of the circle of Willis was seen in addition to the changes caused by the MCA disease. From these hemodynamic changes, transcranial Doppler sonographic diagnostic criteria for MCA occlusive and stenotic lesions were established.

Blood Flow Velocity↗

PubMed1988

Lumbosacral plexus lesions: correlation of clinical signs and computed tomography.

Neurological signs and computed tomographic morphology were compared in 60 patients. The primary neurological deficit was most commonly located in the sacral (n = 31) or lumbar plexus (n = 23) and was most commonly caused by a neoplasm (n = 40). In 78% of the patients it correlated with the lesions detected by computed tomography (CT). CT reliably demonstrates extraspinal mass lesions, but only moderately well predicts functional signs.

Fecal Incontinence↗

PubMed1987

[Buccolinguofacial apraxia--a probably psychogenic speech and deglutition disorder].

Difficulties in swallowing and speaking may in rare cases be due to buccolinguofacial apraxia, which usually results from lesions of the frontal operculum--mostly on the left side--or of connections to and from it. Two cases with this disorder, probably due to a multiple sclerosis, are presented and the differential diagnosis is discussed.

Adult↗

PubMed1987

[Dangerous snoring. Sleep-apnea syndrome].

Snoring usually is trivial and unimportant, but it can turn into a social or medical problem. Obesity, hypertension and heart disease are more frequent among snorers than among nonsnorers, and especially snorers with hypersomnia during the day are at risk. Hypersomnia in association with snoring usually signifies obstructive sleep apnea. Increased resistance in the upper airways, together with negative inspiratory pharyngeal pressure and muscular hypotonia during deep non-REM and REM sleep, lead to collapse of the pharynx, hypoxia and hypercapnia. Only after arousal from sleep does muscle tone return, pharyngeal obstruction reopen and airflow resume. Since this process can occur 300 or 400 times a night, repetitive alveolar hypoventilation leads to pulmonary-arterial hypertension and cor pulmonale, and the repetitive sympathetic activations can cause systemic hypertension or serious cardiac arrhythmias. The countless arousals deprive the sufferer of deep non-REM and REM sleep and their consequence is sleep fragmentation. The symptoms are excessive daytime sleepiness, intellectual deterioration and personality and behavioral changes. Oronasomaxillofacial, endocrine and neuromuscular anomalies and diseases predispose to sleep apnea, and alcohol or CNS-depressant drugs can favour its occurrence. Diagnosis is made by nighttime oxymetry, and if this is abnormal, by polysomnography. After polysomnography it is possible to distinguish between obstructive and nonobstructive sleep apnea, and the decisions for an adequate treatment can be made.

Airway Resistance↗

PubMed1987

Morbidity and mortality of carotid endarterectomy. A literature review of the results reported in the last 10 years.

A review of the mortality and morbidity of carotid endarterectomy reported during the last 10 years was made and compared to the risk of carotid stenosis managed by the best medical treatment. For comparison, the patients were classified in asymptomatic patients (grade I), patients with transient ischaemic attacks (grade II), patients with ischaemic neurological deficits operated on acutely (grade III) and into patients with no or incomplete recovery 4-6 weeks after the stroke (grade IV). Based on the results of this literature review, only patients in grade II seem to benefit from carotid endarterectomy.

Carotid Artery Diseases↗

PubMed1987

[Possibilities and limits of transcranial Doppler sonography].

A review of our 4-years' experience with the transcranial Doppler technique in the evaluation of cerebrovascular disease is given. The physiological variations of the measured parameters and their clinical significance are presented. The diagnosis of occlusive diseases, spasms after subarachnoid haemorrhage, arteriovenous malformations and brain death are discussed. Some technical problems and limiting factors in diagnosis are summarised.

Blood Flow Velocity↗

PubMed1987

Nontraumatic spinal epidural and subdural hematomas.

Ten patients with a nontraumatic spinal extramedullary hematoma are reported, nine of the hematomas localized in the epidural space. Seven of the patients were taking anticoagulant drugs and five showed signs of liver disease, mostly due to alcoholism. The invariable first symptom was an intense local pain in the spine, followed in all but one case by radicular irradiation and in all by bladder disturbances and sensory and motor deficits of the spinal cord or cauda equina. All the patients had myelography to verify the spinal mass and were operated on as fast as possible. The outcome depended mainly on the preoperative neurologic status. If there was only an incomplete sensory and motor lesion before the operation, the patients recovered fairly well or completely. The patients who did not become capable of walking again were completely paralytic preoperatively.

Adult↗

PubMed1986

[Diagnosis and differential diagnosis of back pain from the neurological point of view].

Affections of the vertebral body, the intervertebral disc, the epidural and subdural space, the nerve root, and the spinal cord may have back pain as the main symptom. Initially a topical diagnosis is established in the light of the neurologic symptoms and signs (segmental "beltlike" pain, radicular motor and sensory signs, central mono-, para-, and tetraparesis, as well as sensory signs and bladder dysfunction). Degenerative changes and herniated discs are the most frequent causes of cervical and lumbar spinal disease with neurologic signs, followed by extramedullary tumors. In the extradural space metastases, plasmocytoma, lymphomas and primary bone tumors are the most common, and neurinomas and meningiomas in the intradural space. In the spinal cord ependymomas and astrocytomas are found, as well as benign cavities (syringomyelia). Conditions which are rare, but very important because treatable at an early stage, are spinal epidural hematomas with anticoagulation and spinal epidural abscesses. Vertebral osteomyelitis must also be considered in differential diagnosis. Inflammatory nerve root lesions seldom cause pain, except for subacute demyelinating polyneuropathy responding to corticosteroid treatment, and radiculitis caused by borrelia and herpes zoster.

Adult↗

PubMed1986

[Acute spinal epidural abscess].

An acute spinal epidural abscess is a rare cause of paraplegia, seen in seven patients over a period of ten years. All patients had fever and severe localized back-pain. Unless treated, within hours or a few days, there will be root defects and rapidly progressive paraplegia. Staphylococcus is the most frequent causative organism and clinically manifest septicaemia is common. Rapid diagnosis and treatment are essential in deciding the patient's fate. Myelography is an important additional examination as it demonstrates the abscess in 96% of cases. Non-contrast radiology is of little value. High-dosage antibiotics and surgical spinal decompression are the cardinal treatment procedures. Antibiotics alone are justified only so long as there are no neurological deficits and neurosurgical intervention, if needed, is immediately available.

Abscess↗

PubMed1986

Stapedius reflex in multiple sclerosis.

The stapedius reflex (StR) was studied in humans by impedance audiometry. Ipsilateral and contralateral reflexes, obtained from 48 multiple sclerosis (MS) patients and 26 controls, were analysed. MS patients showed smaller reflex amplitudes, longer onset latencies and higher contralateral reflex thresholds. Using onset latencies, 33% of all MS patients had at least two abnormal ipsi- and/or contralateral StRs. If the diagnosis was MS of the definite type, this figure was 39%. The StR is therefore a useful tool for detecting a subclinical lesion in the brainstem and can contribute to the early diagnosis of MS.

Acoustic Impedance Tests↗

PubMed1985

[Neurologic manifestations of osmolality disorders].

Irrespective of the etiology, a water and electrolyte imbalance provoking a hypo- or hyperosmolar state causes metabolic encephalopathy, as may occur with any metabolic disturbance. The pathophysiology of metabolic encephalopathy relies on a diffuse neuronal dysfunction which occasionally shows a focal maximum. To the clinician it presents in the form of nonspecific symptoms or signs, such as altered level of alertness or awareness of the environment, or impaired attention, cognition or orientation. When the onset of hypo- or hyperosmolality is rapid, delirium may develop or the level of consciousness can decrease to the point of coma. Myoclonic jerks, gait disturbance and focal or generalized fits are additional nonspecific signs. When the water and electrolyte imbalance coincides with or is caused by brain disease, the signs of the two conditions are added. On the other hand, complicating hemorrhages, sinus thrombosis, or brainstem herniation or compression may be taken for a primary structural brain lesion, and the water and electrolyte imbalance may easily be overlooked. Pathophysiology, symptoms and signs, and therapy of hypo- and hyperosmolar states are discussed. Central pontine myelinolysis is considered separately.

Brain Diseases, Metabolic↗

PubMed1985

Early cortical median nerve somatosensory evoked potentials. Prognostic value in anoxic coma.

Subcortical and early cortical median nerve somatosensory evoked potentials (SEPs) were examined in 26 patients in hypoxic coma. The amplitude ratio between the negative slope of the scalp response and the following positive trough was determined. The latency difference between the major negative component recorded from the upper neck, N14, and the initial negative potential from the scalp, N20, was also measured. The mean of these parameters in both hemispheres was referred to as mean central conduction time (MCCT) and mean amplitude ratio (MAR). There was a significant difference in MAR in patients with a bilaterally recordable scalp response between those with a good and those with a bad outcome, but no difference in MCCT. Comparison of SEP findings with postmortem examinations suggests that a reduced MAR may yield an estimate of cortical damage in hypoxic coma.

Adult↗

PubMed1983

[Evaluation of coma using evoked brain potentials].

Subcortical sensory evoked potentials are of growing importance in assessing brain damage in comatose patients. First, they are not susceptible to sedative and narcotic drugs; second, the investigation can easily be performed in the intensive care unit; and third, off-line results are immediately available. Subcortical somatosensory evoked potentials (SEP) proved to be more reliable in assessing brain function than brainstem auditory evoked potentials (BAEP). Our own experience with this method is illustrated by several case reports.

Adult↗

PubMed1982

[Acute delirium in bismuth poisoning].

Typical clinical signs and symptoms of bismuth intoxication are illustrated in a cases of a 45-year-old woman. Initially psychasthenia appears followed by acute delirium with ataxia, myoclonic jerks and occasionally coma. If patients survive the acute phase they recover only gradually following discontinuation of bismuth medication. In cases of extreme intoxication, permanent memory deficits may occur. Etiology, pathogenesis, laboratory findings, differential diagnosis and therapy of this rare iatrogenic encephalopathy are discussed.

Bismuth↗

PubMed1981

[Central-core myopathy. A clinical and morphological study on the diagnostic specificity of central muscle fiber changes].

Predominance of type I fibres and loss of oxidative enzyme activity, such as DPNH-dehydrogenase, in the centre of muscle fibres, an alteration called "central core", are considered characteristic findings in central core myopathy. Similar findings in various peripheral neurogenic disorders motivated the authors to check the diagnostic specificity of central cores. Among 1200 muscular biopsies performed for various neuromuscular diseases, 13 biopsies with central cores were found. Only 2 or 3 of them were central core myopathies, while clinical and electromyographic findings served to classify the remaining 10 cases as peripheral neurogenic disorders (anterior horn cells, anterior nerve roots, plexus, peripheral nerves). The results support the observation that central cores are not a specific finding in central core myopathy; identical alterations are caused by various peripheral neurogenic disorders. Clinical, electromyographic and morphologic findings must be considered for the purpose of diagnostic classification. It is not yet known whether central core myopathy really is of myogenic origin or whether it is caused by a peripheral neurogenic disorder. The authors therefore prefer the term "central core disease" to "central core myopathy". Their findings support the neurogenic hypothesis.

Adolescent↗

PubMed1977

[Exercise-induced muscular weakness, myalgia and contractures. I. A clinical review].

In the differential diagnosis of intermittent claudication some rare myopathies have to be considered. The most frequent is phosphorylase deficiency (McArdle's disease). Exercise-induced muscular pain, weakness, contractures and occasionally myoglobinuria are the most prominent clinical signs. Serum creatine phosphokinase, aldolase and lactic dehydrogenase may be elevated after exertion. In the ischemic forearm test there is no rise of serum lactic acid. The enzyme deficiency can be demonstrated by histochemical and biochemical examination of a muscle specimen. Further, but more infrequent, enzymatic disturbances of glycolysis are phosphofructokinase deficiency and phosphohexoisomerase inhibitor, which also yield an abnormal ischemic forearm test and must be demonstrated histochemically and biochemically. Apart from muscular signs, myopathy with lactic acidosis is associated with palpitation, dyspnea and exhaustion, and a disproportionate rise in serum lactic acid level after exertion. Histochemically and electronmicroscopically demonstrable fat accumulation in the muscle can be a sign of a disturbance in lipid metabolism. This type of exercise-induced myopathy has been reported only in a few cases with carnitine-pylmityltransferase deficiency, which has to be demonstrated biochemically. Muscular contractures also exercise-induced but painless and reversible within seconds may be due to deficient uptake of sarcoplasmic calcium in the tubular system. Dyskalemic paralysis causes painless paresis within minutes of hours after exertion, which disappears within hours to a few days. Myopathy with tubular aggregates can be differentiated from other exercise-induced myopathies by morphology. Myotonia combined with painful contractures characterizes myopathia myotonica.

Acidosis↗