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Biomedical subjects

J Jörg

Publications and source records attributed to J Jörg.

At least 19 recordsLinked to original sources
PubMed2000

[Diagnostic and prognostic value of additional neurologic diagnosis in alcohol withdrawal delirium].

A severe course of alcohol withdrawal has been observed in 28% of patients in a neurological intensive care unit due to complicating central nerve system (CNS) diseases. In any atypical alcoholic delirium, especially with focal neurological signs, partial seizures, or decreased level of consciousness, CNS diseases like meningoencephalitis, intracranial hemorrhage, or central pontine myelinolysis must be diagnosed by computed tomography (CT) scan and cerebral spinal fluid (CSF) tap. The diagnostic and prognostic value of CT scan and CSF analysis was examined in 32 persons with alcohol withdrawal syndrome or delirium tremens. Neurological complications and cerebral convulsions at the beginning of delirium tremens appear to predispose the patient to a protracted clinical course and necessary mechanical ventilation. Blood-CSF barrier permeability is increased in 70% of alcohol withdrawal patients and that also seems to be a marker of a prolonged clinical course. Cerebral atrophy as shown in CT scan does not play a role in predicting clinical course. In our experience, CT examination or lumbar puncture is not necessarily recommended if clinical signs are typical for alcohol delirium.

Adult↗
PubMed1999

[Motility disorders of the esophagus in patients with apoplectic infarct during the acute illness phase].

BACKGROUND: Prolonged oropharyngeal dysphagia occurs in up to 45% of patients presenting with a unilateral hemiplegic stroke. The aim of this study was to investigate esophageal motility in patients with hemiplegic stroke and to evaluate, whether detected motility disorders improve within 10 days after the beginning of symptoms. PATIENTS AND METHODS: Fifteen patients with hemiplegic stroke and dysphagia underwent esophageal manometry within the first 2 days after admission to the hospital and 10 days later. Eighteen healthy volunteers served as controls. RESULTS: The following parameters showed no significant differences between the 2 study days (day 2: day 10: controls, p-value [comparison with controls]): resting pressure of the lower esophageal sphincter: 21 +/- 3 mm Hg: 20 +/- 3 mm Hg: 18 +/- 2 mm Hg, NS, contraction amplitude: 67 +/- 8 mm Hg: 72 +/- 11 mm Hg: 78 +/- 9 mm Hg, NS, duration of contraction: 4.2 +/- 1.0 s: 4.2 +/- 0.9 s: 2.2 +/- 0.7 s, p < 0.001, and contraction velocity: 6.3 +/- 1.1 cm/s: 5.2 +/- 0.9 cm/s: 3.2 +/- 0.8 cm/s, p < 0.001. As far as the contraction pattern was concerned, on both study days significant pathologic contraction patterns were seen compared with normal controls. Normal propulsive contractions were seen in 54 +/- 5%: 60 +/- 6%: 96 +/- 5%, p < 0.001. Patients with no dysphagia after 10 days still had demonstrable abnormal motility patterns. CONCLUSION: The findings indicate that manometrically demonstrable pathologic motility patterns of the tubular esophagus in patients without oropharyngeal dysphagia after 10 days do not induce the symptom dysphagia. The function of the esophagus seems not to be impaired by these measurable pathologic contractions.

Aged↗
PubMed1999

[Esophageal manometric studies in patients with an apoplectic stroke with/without oropharyngeal dysphagia].

BACKGROUND AND OBJECTIVE: As many as 45% of all strokes can lead to permanent dysphagia, usually considered to be due to abnormal oropharyngeal coordination of contraction. It was the aim of the study to compare oesophageal motility in stroke patients with and without dysphagia. PATIENTS AND METHODS: The study group consisted of 36 patients (13 men, 23 women, mean age 74.1 +/- 11.3 years) who had sustained a stroke (19 [mean age 70.6 +/- 10.5 years] with and 17 [mean age 77.6 +/- 10.5 years] without dysphagia). All these patients underwent oesophageal manometry within 2 days after hospital admission. RESULTS: There were significant differences in the mean proportion of regular peristaltic waves in the distal oesophagus, 93.5 +/- 1.1% in patients without but in only 53.5 +/- 4.4% of those with dysphagia (P < 0.0001). Measurement of the proximal oesophagus showed 93.2 +/- 3.4% and 62.1 +/- 7.3% respectively. There was no significant difference between these two patient cohorts with regard to the resting pressure in the upper and lower oesophageal sphincters as well as in the amplitude and duration or speed of contraction in the region of the smooth and striated oesophageal muscles. CONCLUSIONS: In patients after a stroke who have dysphagia abnormalities of oesophageal motility are also of importance for their symptoms, being due less to pressure relations than to abnormal contraction patterns.

Aged↗
PubMed1999

Outcome of central pontine and extrapontine myelinolysis (n = 44).

The findings in 44 patients (42 of whom were chronic alcoholics) with central pontine myelinolysis show that the outcome does not depend on the severity of neurological deficits during the acute phase of the condition or on concomitant internal diseases, including the degree of hyponatremia. Of the 34 patients for whom follow-up data were available, 32 survived. Of these 11 completely recovered, 11 had some deficits but were independent, and 10 were dependent (4 through disorders of memory or cognition, 3 with tetraparesis, 2 with cerebellar ataxia, 1 with polyneuropathy). The electrophysiological findings did not contribute usefully to the prediction of outcome. Additional neuroradiological diagnostic testing with magnetic resonance imaging was also of no prognostic significance. The extent of the initial pontine lesion was not correlated with the severity of clinical findings during the acute phase of disease, nor was persistence of the pontine lesion as usually seen on magnetic resonance imaging correlated with clinical improvement. We conclude that patients with cerebral myelinolysis survive if the nonspecific secondary complications of transient illnesses such as aspiration pneumonia, ascending urinary tract infection with subsequent septicemia, deep venous thrombosis, and pulmonary embolism can be avoided.

Adult↗
PubMed1998

[Day time fatigue in frontal lobe epilepsy with primarily sleep-related seizures. A case report].

We present a 43-year-old patient who has had up to 15 frontal lobe seizures nightly for 12 years. The patient had no complaints apart from excessive daytime sleepiness. Neurological and psychiatric examination as well as cerebral computed tomograph and magnetic resonance imaging were normal. After sleep deprivation an interictal electroencephalogram demonstrated a recurrent excess of theta activity over the right frontal and frontopolar area. A cerebral PET study showed diminished glucose metabolism of the right cingular and frontomesial region. The sleep structure was extremely fragmented. There was an excessive reduction of slow-wave sleep and REM sleep. Carbamazepine therapy produced complete seizure control lasting a few weeks, followed by return of up to 8 seizures per night. Vigabatrin as add on therapy diminished the noctural seizures to 1 to 3 per night.

Adult↗
PubMed1998

[Pontine and extra-pontine myelinolysis. Early diagnostic and prognostic value of cerebral CT and MRI].

Retrospective examination of 44 patients with central pontine and/or extrapontine myelinolysis leads to the conclusion that in early diagnostics cerebral NMR is superior to cCT. T2-weighted images turned out to be the most sensitive parameter. Frequent contrast-medium enhancement early in the course up to 4 weeks after clinical manifestation in 7 patients underlines the pathogenetic idea of an initial transient blood-brain barrier. According to our results, central-pontine myelinolysis (CPM) proof by NMR can be expected after 1 week. During the clinical course, cCT and NMR findings showed no regression. Also no connection was noted between the size of the pontine lesion and the favorable clinical course in 72.2% of the patients, nor was there a correlation with the extent of the neurological symptoms at the crisis of the disease. Altogether, cCT and NMR are irrelevant for the prognosis of cerebral myelinolysis.

Adult↗
PubMed1996

[Reversible exogenous psychosis in thiazide-induced hyponatremia of 97 mmol/l].

Severe hyponatraemia may be cause unconsciousness, vomiting, seizures or exogenous psychosis and is associated with a high mortality. We report on a 44-year-old woman who presented with somnolence and psychomotor unrest. After rousing stimuli she showed no verbal response and did not follow any instructions. For three days she suffered from nausea and vomiting. Laboratory values included a natrium serum level of 97 mmol/l. CT scan demonstrated no abnormal findings. Because of severe arterial hypertonia she received for 12 days intensive diuretic therapy with 50 mg hydrochlorothiazide and 100 mg triamterene. Retrospectively, we proved that as a result of saluretic therapy, chronic hyponatremia had already existed before admission. Serum sodium was corrected slowly (< 12 mmol/l) with fluid restriction and normal saline solution. This is considered to be the first case report of a complete restitution after hyponatremia less than 100 mmol/l. We suggest that the preexisting chronic hyponatremia and the slow correction of serum sodium level are responsible for the favorable outcome of this case of severe hyponatremia.

Adult↗
PubMed1996

[Memory performance of Parkinson patients with and without sleep apnea syndrome].

We investigated the effect of SAS on the long term memory in PD patients and compared them with patients with brain infarction or cataract (control group), respectively. PD patients develop SAS and cognitive impairments more often then healthy people. Since SAS leads to a fragmentation of the sleep structure it interferes with memory. Therefore SAS may be a pathogenic factor of cognitive impairment in PD. We studied 14 patients (7 with and 7 without SAS) with PD, brain infarction or cataract using the LGT-3, which measures the verbal, numeric and figural long term memory. All patients answered subtest 7 of the Wechsler-Memory-Scale at night and in the morning. The saving between the evening and morning measure was calculated. An analysis of variance was performed using the SAS-condition and the different groups as independent variable. A significant difference (p < or = 0.005) of all memory measurements between patients with and without SAS but not between the different groups has been proved with a superiority of the patients without SAS. A significant difference of the influence of the SAS for verbal memory score on patients with PD (pp < or = 0.05) and brain infarction (pp < or = 0.005) respectively and the control group could be demonstrated. Therefore we found a quantitative difference of memory consolidation in PD patients with SAS. The influence of SAS on memory in patients with neurological disease is more pronounced compared to the control group.

Cataract↗
PubMed1995

Identification of the characteristic vascular changes in a sural nerve biopsy of a case with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy' (CADASIL) has recently been identified as a hereditary disorder with characteristic fine structural changes of small intracerebral arteries and arterioles. Electron microscopically there are characteristic perivascular deposits of granular electron-dense material resembling immunoglobulin deposits. The present case from a family with four affected members in three successive generations shows that similar vascular changes as described in the central nervous system are present in blood vessels of the sural nerve, although less pronounced and, therefore, affording electron microscopy for their unequivocal detection. Nevertheless it has been shown for the first time that the diagnosis of CADASIL can be verified by a sural nerve biopsy. Occasional focal accumulation of pinocytotic vesicles opposite the granular deposits suggests exocytosis as one of the possible pathomechanisms for their production.

Biopsy↗
PubMed1994

[The Vogt-Koyanagi-Harada uveomeningoencephalitic syndrome].

VKHS is an inflammatory system disease with a subacute chronic course. It has a very variable, selective involvement of certain pigment cells of the eye, skin, inner ear, and meninges. Due in part to the fact that its symptoms are responsive to immunosuppressive therapy, pathogenesis as an autoimmune disease is considered. The clinical course of one of our patients is discussed. Early diagnosis of VKHS, although often very difficult, is mandatory for appropriate and timely treatment.

Adult↗
PubMed1993

[Etiology of Parkinson disease. An epidemiologic perspective with possible implications for prevention].

This review summarizes recent epidemiological research about the etiology of idiopathic Parkinson's disease (PD). Descriptive and analytical epidemiologic studies, supported by basic neurosciences research, suggest a role for neurotoxins in the pathogenesis of PD, but also for mediating environment influences, which include occupational exposures, urban or rural living and nutritional factors. Such epidemiologic evidence can provide a basis for the potential development of preventive measures for this disease.

Aged↗
PubMed1993

[A rare differential diagnosis of waddling gait--osteomalacia caused by vitamin D deficiency].

The so-called "waddling gait" caused by paresis or mechanical insufficiency of the hip muscles is an ambiguous clinical guiding symptom. This pelvifemorally accentuated muscular weakness coinciding with pain in the range of the locomotor system should make one consider the diagnosis of osteomalacia due to deficiency of vitamin D, especially in Asian patients. In the present case, the course of investigation is described in detail, as well as the effective therapy. The diagnosis of this clinical picture ought to be familiar to any neurologist, since its more frequent appearance must be expected as an increasing number of Asians seek asylum in the years ahead. Social integration of the affected persons may be made easier by treatment on the lines described here.

Adult↗
PubMed1992

[Current aspects in diagnosis of Parkinson disease].

The causes of symptomatic parkinsonism are enumerated and discussed including drug-induced, vascular, toxic, postencephalitic and posttraumatic parkinsonism. The environmental hypothesis and the concept of oxidative stress in the pathogenesis of Parkinson's disease are illustrated. The clinical diagnosis, the differential diagnosis and the possible diagnostic errors originating from the cardinal symptoms akinesia, rigor und tremor in the early stages of the disease are delineated. At last the contributions of EEG, CCT, evoked potentials, MRI, PET und the apomorphine test to the diagnosis especially early diagnosis are evaluated.

Humans↗
PubMed1991

Epidemiology and out-patient care in Parkinson's disease--results from a pilot-study in northern Germany (Schleswig-Holstein).

An attempt was made to estimate prevalence on Parkinsonism using consultation rates in physicians' practices in a two-step, one-phasic pilot study in a rural-urban area of Northern Germany. Though participation of physicians was low, reported rates for Parkinsonian patients (183/100,000) were in the range yielded in comparable areas, but by different methodology. Only 64% of a large subsample of patients used L-Dopa preparations for therapy. Confirming previous results the objective records of doctors and the subjective notices of patients regarding disease state showed considerable differences in several important items.

Adult↗
PubMed1990

[The prevalence of Parkinson disease in West Germany--are general practice data a suitable survey instrument?].

Investigations on prevalence rates in idiopathic Parkinson's disease (IPD) have raised fairly different results due to variations in methodology. Door-to-door studies in circumscribed geographical areas revealed lower prevalence rates in China and Japan compared to countries of the Western hemisphere. Due to the health system organization and present legislation on personal data referral such systematic door-to-door epidemiological surveys seem nearly impossible in the Federal Republic of Germany. The present pilot study therefore used doctor's practices as a means to obtain evidence rates on patients diagnosed on and treated for IPD. Standardized questionnaires with appropriate items regarding symptoms, diagnosis and treatment for the disease were distributed by mail or personally in 387 practices of general practitioners, internal specialists, neurologists, and psychiatrists and 3 hospital ambulances in the handestadt Lübeck, the Kreis Stormarn and the Kreis Herzogtum Lauenburg. Investigation time was March, 1 to June, 30, 1987. Each patient cared for IPD was to fill up a personal questionnaire with similar items as well. A second estimation of prevalence was made according to published sales of L-Dopa drugs for treatment of IPD. The third estimation used statistics about disease pattern of the Bundesverband der Allgemeinen Ortskrankenkassen (AOK). Participation of doctors was to be maintained high by varying methods of repeated requirements during the investigation period. 41 of 210 (20%) of the doctors requested by mail and 126 of the 180 visited physicians (70%) participated in the study with 1018 patients altogether. The estimate of prevalence for the Hansestadt Lübeck was 188, for the Kreis Stormarn 206 and for the Kreis Herzogtum Lauenburg 147 patients per 100,000 (183 in toto). According to latest data on L-Dopa drug sale the prevalence rate in the above areas was 144/100,000. According to the statistics of disease pattern of the AOK the prevalence estimate was 185/100,00 assured persons. These results are discussed with special emphasis on the methodological aspects.

Cross-Sectional Studies↗