PubMed Health⌕ Search

Biomedical subjects

J Trenkler

Publications and source records attributed to J Trenkler.

15 recordsLinked to original sources
PubMed2003

Treatment of chronic neuropathic pain after traumatic central cervical cord lesion with gabapentin.

Central cord syndrome may be associated with severe pain, resistant to conventional pain therapy regimens. Chronic pain may be a persistent problem in rehabilitation of spinal cord injuries. These pain syndromes are long lasting and challenging to treat. Gabapentin has been shown to be useful in treatment of different conditions which may be caused by increased neuronal excitability. This report describes a case where central cord syndrome and its chronic neuropathic pain associated with allodynia was successfully treated with gabapentin.

Acetates↗
PubMed2002

Surgical or endovascular treatment of carotid stenosis.

Carotid endarterectomy (CEA) is a proved standard treatment in stenosis of high-grade carotid artery stenosis. On the basis of new experience, percutaneous transluminal angioplasty with stent (PTAS) has gradually been established as an alternative method to carotid endarterectomy. The aim of the three-month investigation was to evaluate PTAS, CEA and conservative medicamentous therapy. A group of 75 patients (78 stenoses) with symptomatic and asymptomatic stenoses of the carotid artery of 70 and more percent were evaluated within a unicentric retrospective study. The period of investigation commenced in August 1999, and lasted 14 months. The patients were treated by PTAS (23 patients), CEA (23 patients). Two patients were treated by bilateral stenting. One patient was subdued to both operation and endovascular treatment, while the former treatment was performed on one side and the latter on the contralateral side. This patient was included into both surgical and endovascular groups. The rest of the patients were treated solely by medicamentous therapy (30 patients). During the period of 30 days after the intervention, one patient in both PTAS and CEA groups (4.3%) developed a severe ipsilateral infarction. Recurrent stenoses were recorded in two patients from the PTAS group (8.7%) (sonographically more than 50%), and in one patient from the CEA group (4.3%). Immediately after stent implantation, 12 patients (52.2%) developed pinlike ischemic lesions observed by means of diffusion-weighted MR imaging (DWI). Hyperintensive signals did not lead to any neurologic deficits. After 3 months, none of the latter lesions were found in any of the patients. In the group treated by conservative therapy, only one of the patients (3%) developed a mild infarction. After the evaluation of our experience with peri-interventional PTAS and CEA complications in our small group of investigated patients, it is possible to state that the performance of both methods can be comparably successful. However, at the moment we cannot consider PTAS as an equivalent method. (Tab. 6, Fig. 2, Ref. 33.).

Aged↗
PubMed2000

Advanced surgical approach for selective amygdalohippocampectomy through neuronavigation.

OBJECTIVE: Selective removal of the mesiobasal temporal structures through the transsylvian approach was introduced by Yasargil and Wieser in 1982. This alternative to standard temporal lobectomy provides excellent outcomes for seizure control. Basic actions in the transsylvian fissure exposure mainly serve to orient the surgeon, and they carry the risk of vasospasm and vessel damage. The aim of our study was to reduce landmark-guided surgery steps through neuronavigation. METHODS: During a 14-month period, 16 selective amygdalohippocampectomies were performed with the aid of the SMN (Carl Zeiss, Inc., Thornwood, NY) or StealthStation (Sofamor Danek, Memphis, TN) optically guided systems. We added safety procedures to the operation (including intraoperative rereferencing, obtaining additional bony reference points before craniotomy, performing a small craniotomy and making an accurate dural incision, and using contrast medium for vessel visualization) to develop a method that relies on navigational systems without further orientation by anatomic landmarks. RESULTS: Originally, performing an amygdalohippocampectomy required exposing the sylvian fissure from the carotid bifurcation to 2 cm beyond the middle cerebral artery bifurcation, which exposed one-third of the insula. By determining the entry point at the limen insulae and the target at the tip of the temporal horn, the mandatory extent of the opening to the sylvian fissure can be projected. Therefore, the exposure of the fissure can be limited to exactly the extent required for the transventricular approach through the uncinate fasciculus. CONCLUSION: Computer-assisted surgery is an effective tool in eliminating the exposure of anatomic landmarks in selective amygdalohippocampectomy. This modification combines the precision of targeting with minimal cortical and vessel traumatization.

Adult↗
PubMed1999

[Digital 3D rotational angiography for the preoperative and preinterventional clarification of cerebral arterial aneurysms].

OBJECTIVE: Does the recently introduced 3D angiography provide additional information beyond standard angiography (DSA) for the diagnosis of cerebral aneurysms? METHODS: During a 3-months period DSA and 3D-angiography were performed in 40 patients harbouring a total of 49 aneurysms. Vascular regions that presented an aneurysm diagnosed by DSA were reevaluated by 3D-angiography. RESULTS: In two patients, vessel-loops previously described as aneurysms by DSA could be identified by 3D-angiography. In one patient, an aneurysm was diagnosed that could not be detected by DSA. In another case, the definitive diagnosis of an aneurysm was obtained only with 3D-angiography. In one patient, an aneurysm was diagnosed that could not be detected by DSA. In another case, the diagnosis of an aneurysm was obtained only with 3D-angiography. In two cases, aneurysms could be definitively excluded by 3D-angiography, whereas in another aneurysm a vessel originating from this lesion was identified. The size of the aneurysms measured by both methods was identical. CONCLUSIONS: Multiple projections of 3D-angiography provide a better evaluation of the anatomic situation regarding the base of the aneurysm as well as the relationship of an aneurysm to neighbouring vessels. Further, an exact differentiation between a vessel loop and an aneurysm can be made. Therefore, 3D-angiography is a valuable tool when used in conjunction with DSA.

Adult↗
PubMed1995

Turbo gradient-spin-echo (GRASE): first clinical experiences with a fast T2-weighted sequence in MRI of the brain.

The aim of this study was to obtain first clinical experiences with Turbo gradient-spin-echo (TGSE). This fast MRI technique is based on the GRASE sequence which combines the gradient-echo and the spin-echo technique. In 60 patients suffering from different brain pathologies, a T2-weighted TGSE sequence was compared to a conventional spin-echo sequence. Anatomical and pathological structures were evaluated visually by three independent observers; signal and contrast behavior was assessed in regions of interest. TGSE showed reduced signal-to-noise-ratios of anatomical structures except for cerebrospinal fluid. The contrast of tumors, infarctions, and hematomas was similar in both sequence types. Small microangiopathic and inflammatory lesions as well as basal ganglia degeneration presented with diminished contrast in TGSE. The TGSE sequence can already now be used to acquire T2-weighted images in additional orientations requiring extremely short measurement time. However, further improvements of image quality are necessary for routine use of TGSE.

Adolescent↗
PubMed1994

True proton density and T2-weighted turbo spin-echo sequences for routine MRI of the brain.

Our aim was to evaluate the diagnostic reliability of turbo spin-echo (TSE) sequences compared to a conventional dual-echo spin-echo (SE) sequence in routine brain MRI at 1.0 T. The following demands were made on TSE sequences: acquisition time-reduction of at least 50% and true proton density (PD) contrast (low-signal cerebrospinal fluid). A conventional spin-echo and two single-echo TSE sequences were used in 150 patients, a dual-echo TSE sequence in addition in 50 patients. Demonstration of most anatomical structures and disorders was equivalent with TSE and SE sequences. Advantages of TSE were reduced flow artefacts on T2-weighted images, better lesion contrast on PD-weighted TSE images (especially in the dual-echo sequence) and acquisition time reduction to about 5 min (single-echo TSE) and 3:35 min (dual-echo TSE). Disadvantages of TSE were: reduced contrast of iron-containing substances such as haemosiderin and of areas of calcification. By virtue of the shorter acquisition time and diagnostic reliability dual-echo TSE proved the best sequence. If it is used with only one acquisition--whereby image quality but not diagnostic reliability is slightly decreased--acquisition time can be further reduced to 1:48 min. Application of a susceptibility-sensitive gradient-echo sequence, such as FLASH, compensates for the disadvantages mentioned above.

Artifacts↗
PubMed1993

[Whiplash trauma of the cervical spine from the neurosurgical, traumatologic and psychologic viewpoint].

Since the early 50's, whiplash injury has been a subject of intensive study in order to find out the genesis of this disease. Unfortunately, most of the studies were planned retrospectively and were based on inhomogeneous groups of patients. In our prospective study, we tried to keep the patient group homogeneous. 62 patients were examined neurologically and radiologically immediately after the accident. Furthermore, they underwent a psychological test, the so-called Freiburg personality profile. 6 months later the patients were checked again. On the basis on our findings, the suspected psychological influence has to be confirmed. Preexisting degenerative lesions of the cervical spine, also, are undoubtedly prognostic for longer-lasting symptoms.

Adult↗
PubMed1989

[Single-photon emission-computed tomography in the differential diagnosis of dementia].

To assess the value of single photon emission computed tomography (SPECT) in the differential diagnosis of dementia SPECT and conventional computed tomography were performed in 77 patients (50 men, 27 women, mean age 59 [28-90] years) with dementia diagnosed by a battery of psychometric tests. In 13 out of 15 patients with dementia of Alzheimer type SPECT showed a typical Alzheimer pattern (bilateral parietotemporal perfusion defects). Both patients with dementia of Pick type had definite decreases in frontal perfusion. All 21 patients with dementia due to Huntington's chorea showed a typical pattern with absent perfusion of the head of the caudate nucleus, although in three of them conventional computed tomography didn't demonstrate complete atrophy of this structure. Out of 23 patients with multi-infarct dementia there were 17 with focal uptake deficits at various sites, while six displayed an Alzheimer pattern. In Korsakoff's syndrome (n = 11), Down's syndrome (n = 1), Fahr's syndrome (n = 2), senile chorea (n = 1) and HIV encephalopathy (n = 1) no typical distribution patterns were noted. Single photon emission computed tomography can make a contribution to the diagnosis and classification of primary degenerative dementias and can be used to differentiate them from other forms of dementia.

AIDS Dementia Complex↗
PubMed1988

[Chronic subdural hematoma in aged patients. Diagnostic problems].

The history, clinical features, laboratory tests and admission circumstances were analysed retrospectively in 14 patients, aged 60 to 87 years, who were found to have a chronic subdural haematoma. Typical clinical features consisted of dominant psychiatric disorders, slow progression and frequently only traces of neurological signs. In only four patients was headache the initial symptom. Delay in diagnosis and treatment worsened the prognosis. Several factors account for the nonspecific signs and symptoms: diffuse cerebral atrophy, dementia of a degenerative or vascular nature, and cerebral decompensation. Computed tomography immediately after a trauma may be negative.

Accidental Falls↗
PubMedDate not supplied

Heparin treatment in acute cerebral sinus venous thrombosis: a retrospective clinical and MR analysis of 42 cases.

The only randomized data on heparin treatment in acute cerebral sinus venous thrombosis (CSVT) are derived from a small number of patients. The rate of intracranial hemorrhages as a complication of high-dose heparin treatment is still unknown. This retrospective study evaluates the clinical features, neuroimaging monitoring and outcome of 42 patients with proven CSVT. Diagnosis was established by DSA, CT, MR tomography and MR angiography. All patients received heparin intravenously guided by doubling the aPTT value for 3 weeks, followed by oral anticoagulation. Partial or complete recanalization was found in 36 cases. 40 patients improved clinically, in 26 of them complete recovery was observed. One patient deteriorated and developed an apallic syndrome, one further patient died of septic multiorgan failure. Only in one patient was hemorrhagic transformation of infarcted brain tissue observed but without clinical deterioration.

Acute Disease↗