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Biomedical subjects

J Schiffer

Publications and source records attributed to J Schiffer.

At least 19 recordsLinked to original sources
PubMed2004

Polysomnography in patients with intracranial tumors before and after operation.

OBJECTIVE: To evaluate the breathing and sleep patterns in patients with brain tumors before and after operation, and assess their relation to the location and size of the tumor, as well as to the post-operative outcome. METHODS: Polysomnographic studies were performed in 11 patients with intracranial tumors (nine supra- and two infratentorial) before and after surgery. RESULTS: Pre-operatively, the mean apnea-hypopnea index (AHI) was 23.3. Six patients demonstrated signs of obstructive sleep apnea (SA) and one had mixed obstructive and central type SA. After operation, the mean AHI decreased to 8.1(P < 0.05). The duration of random eye movement sleep stage increased after tumor removal (P < 0.04). No relation was found between the characteristics of the tumor, nor the post-operative outcome and SA. CONCLUSIONS: Patients with brain tumors often suffer from SA and this can further worsen their symptoms related to increased intracranial pressure. Removal of the tumor results in a substantial decrease in sleep-related disturbances and may thus play a role in clinical recovery.

Adult↗
PubMed2001

Electroencephalographic abnormalities in aseptic meningitis and noninfectious headache. A comparative study.

BACKGROUND: The finding of abnormalities on electroencephalogram (EEG) during the course of aseptic meningitis is often considered to be indicative of parenchymal brain involvement, even in absence of clinical signs of encephalitis. OBJECTIVE: To investigate if patients with aseptic nonherpetic meningitis who have abnormal EEG recordings during the acute stage of the disease differ in clinical characteristics or cerebrospinal fluid findings from patients with aseptic meningitis and normal EEG recordings. METHODS: The EEG records of 82 patients with aseptic meningitis were reviewed. A comparative group consisted of 41 age-matched patients with severe headaches without evidence of meningeal inflammation. RESULTS: Significantly more patients with aseptic meningitis (28%) demonstrated abnormalities on EEG than controls (12%) (P =.048). Patients with aseptic meningitis and abnormal EEG findings (n = 23) did not differ in age, duration of symptoms, clinical course, cerebrospinal fluid cell count, or protein level from those with normal EEG findings (n = 59). However, all patients with aseptic meningitis who were confused (n = 5) also revealed EEG abnormalities (P<.00012). Patients with headache with normal EEG recordings did not differ from those with abnormal EEGs in age, sex, or duration of symptoms. Nevertheless, patients with common migraine (n = 9) showed abnormalities on EEG (P =.06) more frequently. CONCLUSIONS: The finding of an abnormal EEG in patients with aseptic meningitis, clear mental state and absence of focal neurological signs should not be used as proof of encephalitis. Because pathological examination is usually not performed, it remains unclear if EEG abnormalities in patients with aseptic meningitis indicate a silent parenchymal inflammation, or reflect an infectious encephalopathy.

Acute Disease↗
PubMed1999

Revival of non-surgical management of neonatal depressed skull fractures.

The management of depressed skull fractures in the newborn infant can be controversial. We report on a neonate, born by Caesarean section with difficult head extraction, complicated by a parietal depressed fracture. This 'ping-pong' fracture was treated by elevation with an obstetrical vacuum extractor. No complications occurred. The possible treatment modalities for neonatal depressed fractures, being conservative or operative, will be discussed.

Adult↗
PubMed1999

Concept on health promotion about the unemployed in Switzerland.

Unemployment is a relatively new phenomena for Switzerland. Compared with other countries our unemployment rate of approximately 4% is rather low. Among the unemployed we found similar health problems as in other countries. The health situation of the unemployed forces us to take more notice of their problems. In our federalist country many national, cantonal and local institutions are treating social and health questions, but no one is responsible for the health problems of the unemployed, resulting in ineffective interventions. In order to change this situation we have developed a national concept of health promotion for the unemployed and are seeking to implement it. Three areas of health promotion for the unemployed and their families: Services within existing, and if need, newly created institutions, which can range from counselling to triage and further referral; Health modules in existing occupational programs and formation courses as an introduction to the health problems of the unemployed; Special health courses for the unemployed with in depth treatment of health questions. Realisation steps of the concept: Sensitisation of the responsible institutions and persons; Systematic documentation of existing resources and structures; Elaboration of the course concepts and documents; Carrying out of pilot projects; Set-up of an infrastructure on the national, cantonal and local level.

Health Promotion↗
PubMed1999

Hartshill spinal fixation in vertebral metastasis.

Spinal fusion by Hartshill rectangle frame was used in 10 patients with spinal cord compression secondary to vertebral metastasis in the thoracic and lumbar spine, occupying mainly the posterior elements. All patients presented with pain, bone collapse, and neurologic deficit. The procedure is built on a system of sublaminar wires passed under two to three lamina above and below the decompressed area and tightened to a prebent metal frame. This procedure was relatively simple, and the immediate stabilization achieved in our patients was good. All patients experienced immediate pain relief. While only two patients were able to walk before surgery, seven were able to do so at follow-up. During a follow-up period of at least 2 years in two patients, or until death in the other eight patients, one patient had a broken wire that did not affect the correction achieved at surgery. Partial loss of correction in the sagittal plane was found in two patients who had metastasis in the lumbar spine and in another patient who had metastasis in the ninth thoracic vertebra.

Adenocarcinoma↗
PubMed1998

Neurosurgical intervention for cervical disk disease in dystonic cerebral palsy.

We report five young patients with athetoid-spastic cerebral palsy who had deteriorated neurologically. Magnetic resonance imaging (MRI) was used to investigate suspected compressive cervical spine lesion. Cervical spondylosis with disk protrusions was found in all patients. Four patients underwent surgery by an anterior approach with insertion of a bone graft resulting in substantial clinical improvement. The other patient, diagnosed 8 years after onset of symptoms, was treated conservatively. The availability of MRI makes early recognition of cervical cord compression possible, allowing effective surgical intervention in this special group of patients.

Adult↗
PubMed1998

Indication to surgical management of cerebellar hemorrhage.

Few reports have compared patients operated for cerebellar infarcts with those operated for cerebellar hemorrhage. Considering our previous paper about patients with massive cerebellar infarcts, we report on our surgical experience with five patients with cerebellar hemorrhage. The indication for operation was decreased consciousness with signs of brainstem compression. In all patients hydrocephalus was absent or mild, as opposed to patients with cerebellar infarcts. Suboccipital craniotomy with hematoma evacuation was therefore the surgical procedure of choice. The outcome was worse than in patients with cerebellar infarcts. We conclude that depressed mental state in cerebellar hemorrhage is mainly due to pressure of the cerebellum on the activating reticular system of the brainstem. The surgical approach to patients with bleeding in the cerebellum differ somewhat from that of patients with cerebellar infarcts in timing and kind of first choice procedure.

Aged↗
PubMed1998

Effect of very high single dose of cisplatinum and of radiation on the brain of the rabbit.

The importance of chemotherapy and radiotherapy for treating brain tumors, is well established. In a previous study, a rabbit's brain was treated with doses of up to 12 mg kg-1 of cisplatinum and 4000 cGy, without any morphological or pathological changes. The purpose of this study is to establish the effect of very high single doses of cisplatinum and radiation on the rabbit's brain, applied in 12, 16 and 18 mg kg-1, and 5000, 7500 and 8000 cGy, respectively. The general clinical and neurological condition of the rabbits was unaffected, but areas of alopecia and scalp ulcers appeared. Although these are very high doses of chemotherapy and radiotherapy, the histopathological and morphological examination of the rabbit's brain remained normal.

Animals↗
PubMed1998

Quantified EEG in patients with vertigo of central or peripheral origin.

Computerized EEG frequency analysis was performed in 18 patients with peripheral vestibular dysfunction (PVD), 17 patients with central vestibular dysfunction (CVD) and 22 aged matched controls. Increase in the relative theta activity in the centrotemporal region was found in patients with PVD. The decrease of centroparietal beta activity in both groups of patients, as compared to controls, did not reach statistical significance. We conclude that quantified EEG may be a sensitive method to show changes of cortical electrical activity in patients with vertigo, reflecting the imbalance in afferent vestibular input to the cortex.

Adult↗
PubMed1997

Symptomatic patients after craniectomy.

Various surgical procedures in neurosurgery end with cranial vault defects. It is generally believed that the reason for repair of the skull defect is cosmetic or protective. There is evidence, however, that in selected cases neurologic deterioration can be reversed by cranioplasty. In the sinking scalp flap syndrome the deterioration has been thought to be related to the concavity of the skin flap and underlying brain tissue secondary to atmospheric pressure and also to the in-and-out displacement of the brain through the skull defect. Five cases of symptomatic patients after craniectomy are reported, of which all had a neurologic deterioration that was improved by cranioplasty.

Adult↗
PubMed1997

Effect of high simple dose of cisplatinum and of radiation on the brain of rabbit.

In former studies of intracarotid and intravenous administration of cisplatinum, separate and combined with brain irradiation, we found no cerebral damage. In this study, gradually increasing high doses (above the therapeutic ones) of cisplatinum were administered intravenously to one series of rabbits and increasing high amounts of irradiation (above the therapeutic amounts) were given to another series. Although the rabbits that received highest doses of irradiation developed areas of alopecia and skin ulcers on the head, the general clinical and histopathologic examination of the rabbits' brains in both series was normal. The purpose of this study was to establish the effects of high doses of intravenous cisplatinum and irradiation on the rabbits brains.

Alopecia↗
PubMed1996

Brain effect of intracarotid administration of cisplatinum.

The antitumoral effect of Cisplatinum is well known, including its effect on brain tumors. With the purpose of establishing the effect of intraarterial cis-dichlorodiammine platinum (CDDP) on the brain, Cisplatinum was injected in rabbits that were sacrificed at different intervals. The general clinical and neurological condition of the rabbits was unaffected, and histopathological examination of the rabbit's brain was normal.

Animals↗
PubMed1996

Effect of the combination of cisplatinum and radiation in the rabbit's brain.

The effect of cisplatinum as a potential radiosensitizer in brain tumors is controversial. We examined the effect of the combination of cisplatinum with radiation compared to radiation alone in rabbits' brain. All rabbits were irradiated and cisplatinum was injected intravenously into part of them. Therapeutic doses of cisplatinum and irradiation were given. The rabbits were euthanised at different intervals according to protocol. The general clinical and neurological condition of the rabbits was unaffected, and histopathological examination of the rabbit's brain was normal. The purpose of this study was to establish the effect of cisplatinum followed by cranial irradiation in therapeutic doses to the normal rabbit's brain.

Animals↗
PubMed1996

Posterior fossa lesions associated with neuropsychiatric symptomatology.

We reviewed 7 cases with posterior fossa structural abnormalities (3 tumors, 2 megacisterna magna and 2 Dandy-Walker syndrome) presenting with neuropsychiatric symptomatology. Derangement in the balance of dopamine, serotonin and noradrenergic networks has been implicated in the pathogenesis of schizophrenia, affective and even personality disorders. Disruption of the cerebellar output to mesial dopaminergic areas, locus coeruleus and raphe nuclei, or deafferentation of the thalamolimbic circuits by a cerebellar lesion may lead to behavioral changes. Seven patients (pts) (comprising 4 men and 3 women with mean age 22 years) were diagnosed as suffering from psychosis (2 pts), major depression (1 pt), personality disorders (2 pts) and somatoform disorders (2 pts) (DSM-IV criteria). Brain CT scan (7 pts) and MRI (4 pts) revealed tumors of the posterior fossa (2 pts), megacisterna magna (2 pts) and Dandy-Walker variant (2 pts). In one patient a IVth ventricle tumor was removed in childhood.

Adult↗
PubMed1995

Acute subdural hematoma following disseminated intravascular coagulation associated with an obstetric catastrophe.

The clinical, laboratory, radiological and operative recordings of a patient with disseminated intravascular coagulation (DIC) related to therapeutic abortion is reported. During a comatose state following respiratory arrest, anisocoria with right dilated unreactive pupil and decerebration signs appeared. A brain CT scan showed a right frontotemporal hemorrhage. On surgical intervention a subdural hematoma was found and removed. The patient remained in a persistent vegetative state. The rarity of subdural hematoma complicating DIC is presented and the causes of intracranial bleeding in obstetrics are reviewed.

Abortion, Therapeutic↗
PubMed1994

The management of epidural haematomas--surgical versus conservative treatment.

We treated 14 children and infants during 1990-1993 who suffered severe head trauma with consequent epidural haematomas. We tried, in accordance with several recent publications, to follow part of them conservatively. The report describes the clinical and radiological features of these patients and discusses the criteria for conservative management of epidural haematoma in paediatric patients. The relevant literature is reviewed.

Adolescent↗