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Biomedical subjects

J Zierski

Publications and source records attributed to J Zierski.

At least 19 recordsLinked to original sources
PubMed1998

[Microsurgical transoral decompression in diseases of and injuries to the cranio-cervical junction].

Besides the microsurgical ventral decompression for treatment of cervical disc prolapses, combined with an intercorporal fusion using an autologous bone graft from the iliac crest and a plate osteosynthesis, the microsurgical, transoral approach to the craniocervical junction has proven to be an effective procedure for adequate indications. Even for surgical treatment of diseases and injuries of the craniocervical junction ventral, anterolateral, lateral and dorsal approaches are applicable alone or in combination. The special anatomic and functional conditions of this region, however, obviously require that the indicational criteria for the various approaches differ from those selected for the other cervical segments. The postoperative complication risk requires that particulary critical consideration be given to the question of isolated transoral interventions. The same holds true for the question as the necessity for additional ventral stabilisation in combined dorsoventral interventions. This report is about 20 patients who underwent transoral decompression, about the indications and the procedure typical problems.

Bone Neoplasms↗
PubMed1992

Results of continuous long-term intravenous application of octreotide via an implantable pump system in acromegaly resistant to operative and X-ray therapy.

Long term results after surgery for growth hormone (GH)-secreting adenomas indicate only a limited cure rate, particularly in patients with tumours invading the dural boundaries of the sella with suprasellar extension. Since octreotide had become a treatment option, it was used i.v. via an implantable pump system in five patients (age range 24-46 yr) showing symptoms of uncontrolled acromegaly, in spite of previous surgery and X-ray therapy. The octreotide doses used permanently for a cumulative treatment period of 8.8 yr ranged between 300 and 1000 micrograms/24 h. Serial evaluations of clinical findings, 24-h GH and insulin profiles, insulin growth factor-1 (IGF-1), oral glucose tolerance test and pituitary function revealed sustained GH suppression, without interim escape, below 2 ng/ml in two and below 5 ng/ml in three patients, IGF-1 decrease in all with normalization in two patients and no clinically relevant disturbances of carbohydrate tolerance or thyroid-stimulating hormone secretion. In one case of previous unresponsiveness to dopamine agonists i.v. octreotide application for 29 months facilitated later disease control by bromocriptine only. In two patients octreotide was terminated after 15 and 30 months of i.v. administration, respectively, because the effects of irradiation had occurred. For a subgroup of patients with resistant acromegaly continuous i.v. octreotide can be considered as a safe and effective alternative, which increases patients' independency from the inconvenience of daily repeated s.c. injections.

Acromegaly↗
PubMed1989

Rhinorrhea following dopamine agonist therapy of invasive macroprolactinoma.

We report on the occurrence of CSF rhinorrhea in a group of 17 patients harbouring macroprolactinomas who were treated with a dopamine agonist (DA, bromocriptine) alone or the combination of DA and transcranial operation. In 2 out of 17 cases shrinkage of tumour remnants during therapy with the oral or injectable form of bromocriptine was responsible for delayed occurrence of rhinorrhea. Operative procedures for successful closure of the fistulae were mandatory in both cases.

Adult↗
PubMed1988

[The Huber needle as a special cannula for the puncture of implanted ports and pumps--a mistake in multiple variations].

Huber-point needles, which are thought to be noncoring, are usually recommended for puncture of implanted drug-delivery devices, such as ports and pumps. Nevertheless, we found occlusion by silicone chips deriving from the silicone inlet septum to be a major technical complication. Electron microscopic investigations demonstrated substantial loss of material from the port membrane after repeated puncture with this type of needle. During an in vitro test, multiple puncture with Huber-type cannulas led to a pressure-dependent leakage of a port after only 150 to 750 insertions of a needle. In addition, the forces necessary for puncture or for withdrawal of the needle were increased with Huber-point needles, possibly due to a coring effect. Another disadvantage of the available port needles is the formation of a hook at the tip, which may lead to additional lesion of the port or pump membrane. In our opinion, resterilization of Huber needles, recommended by the manufactures, is not advisable, because it is well known that safe sterilization of small lumina, e.g., the lumen of the needle, is impossible.

Catheterization↗
PubMed1988

Implanted pump systems for treatment of spasticity.

In about one third of patients with violent spasticity due to spinal trauma, multiple sclerosis, and diffuse brain injury adequate control with oral antispastic medication cannot be achieved and successful rehabilitation is severely handicapped. In the past these patients were subjected to destructive chemical procedures or extensive surgery. The authors present the results of management of uncontrollable spasticity by means of continuous intrathecal administration of baclofen with a totally implantable gas driven pump system (Infusaid). 30 patients were treated between June 1985 and January. 1987. The main indication was incapacitating spasticity resistant to oral treatment with baclofen and caused by spinal cord injury or lesion (11 patients), multiple sclerosis (11 patients), infantile cerebral palsy (3 patients) and cerebral injury, hypoxia or ischaemia (5 patients). Clinical assessment included spasticity scores, integrated electromyography (Iemg) and motography. Effective control for spasticity with mean reduction of Iemg by 55%, decrease of Ashworth's score from 3 to 0 and improvement of life quality was obtained in all patients with daily dose of 10-800 micrograms of Baclofen. Voluntary resting motoricity was not impaired and there were no untoward central side effects. The excellent effect of intrathecal baclofen in comparison with oral therapy is explained by local, spinal GABAergic inhibitory action of the drug which is delivered directly into spinal subarachnoid space. Dose finding and dose adjustment is performed prior to pump implantation by intermittent injections into a subcutaneous port. The complications of the procedure were minor (catheter displacement, disconnection) and easily correctable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Interactions between nimodipine and general anaesthesia--clinical investigations in 124 patients during neurosurgical operations.

Haemodynamic, respiratory, metabolic and endocrine investigations were performed in a total number of 124 patients, divided into four different groups, during opiate anaesthesia for neurosurgical operations in order to characterize general effects of nimodipine, a calcium channel blocking agent with a preferential cerebrovascular action. These studies led to the following conclusions: Nimodipine is a vasodilator drug with a hypotensive action, which is especially obvious in hypertensive patients and in combination with similarly acting agents, such as sodium nitroprusside or nitroglycerin. This vascular hypotensive effect may be also enhanced by combined cardiodepressive activity if nimodipine is applied together with inhaled anaesthetics, such as halothane or isoflurane. Nimodipine as well as other vasodilator drugs may lead to increased pulmonary shunting in patients with artificial ventilation, which, however, can be reduced by adequate positive end-exspiratory pressure. With high doses the decrease of oxygen extraction and consumption, seen with nimodipine, is accompanied by a moderate rise of lactate. Determination of stress hormones did not reveal analgesia potentiation of nimodipine, as has been assumed in other studies.

Anesthesia, General↗
PubMed1988

[Giant cell tumors, aneurysmal bone cysts and osteoid osteomas of the spine].

Experience collected by us from treating 15 patients suffering from giant cell tumours, aneurysmatic bone cysts or an osteoid osteoma prompted us to investigate which progress has been made to date in the diagnosis and treatment of these lesions that contain giant cells, basing on recent diagnostic methods such as computed tomography and magnetic resonance, as well as neurosurgical methods. It was found that the course of these rare changes cannot be influenced either by extensive diagnostic or special neurosurgical measures and that the prognosis finally depends on the growth trends inherent in the lesion concerned. Now that both diagnostic and surgical techniques are more refined than previously, there is a tendency to an improved individual approach that is better suited to the needs of the patient. Radiotherapy of benign changes involving giant cells in the region of the vertebral column is no longer of any importance.

Adolescent↗
PubMed1987

Blood flow in brain structures during increased ICP.

The effect of a supratentorial expanding mass lesion and of uniform increase of ICP on regional cerebral blood flow was examined in 31 cats. The blood flow was measured using the radioactive microsphere technique and continuous ICP increase was produced by inflating an extradural balloon or by infusion of mock CSF into subarachnoid lumbar space. Four additional animals in whom no ICP rise was produced were used as controls; several blood flow measurements were performed at different ICP levels and after sudden ICP release. The analysis of the data obtained revealed that intracranial hypertension caused inhomogenous pattern of blood flow change with compartmentalization of flow between supra- and infratentorial structures connected with cisternal herniation. The flow decrease may correspond to the craniocaudal pressure gradients in the brain stem. Irrespective of the method used to produce intracranial hypertension the blood flow in the lower brain stem was less susceptible to diminished perfusion pressure. Sparing of cerebral blood flow in the lower brain stem during progressive brain compression can be explained by compartmentalization. The ranking of regions at cerebral perfusion pressure below 60 mm Hg was similar for the lower brain stem regions independently of the method which was used to increase the ICP. This suggests that when CBF becomes reduced due to increase of ICP the perfusion favours the areas where neurons related to control of circulation are located. Diffuse increase of ICP produced no interhemispheric differences in the blood flow. These differences were detected when balloon compression was used. Asymmetry of perfusion in the brain stem structures was not observed. During continuously increasing ICP an increase of blood pressure taking place before pupillary dilatation occurred was not caused by medullary ischaemia. If the pressure continued to increase the vasopressor response occurring after pupillary dilatation took place did not improve the cerebral blood flow. Increase of cerebral perfusion followed a sudden release of ICP. In an experimental animal subjected to unilateral compressive lesion producing tentorial herniation, hyperperfusion involved especially the thalamus and the midbrain with relative flow decrease in the lower brain stem.

Animals↗
PubMed1987

The effect of intrathecal baclofen on electrical muscle activity in spasticity.

The efficacy of intrathecally administered baclofen was demonstrated in three patients with different types of muscular hypertonia (supraspinal rigidity, spasms shortly after spinal trauma, spasms for many years induced by multiple sclerosis) using integrated electromyography. Reduction of muscular electrical activity was accompanied by clinical improvement during long-term infusion via an implanted pump. The three patients have been observed for more than 1 year, during which time the antispastic activity of intrathecally infused baclofen has remained stable. Intrathecal application of baclofen may be considered as a possible alternative to surgery.

Adult↗
PubMed1987

Atlanto-axial dislocation in rheumatoid arthritis--diagnostic and therapeutic aspects.

Symptoms, signs and neuroradiological findings of 15 cases with atlanto-axial dislocation (AAD) due to rheumatoid arthritis are presented. CT of the craniocervical region revealed the exact anatomical relationships between the dens, the subarachnoid space and the brain stem, especially after intrathecal contrast medium injection and different positions of the head. From the results of operative procedures to reduce AAD it was concluded that early diagnosis and treatment of AAD leads to prompt relief of painful symptoms within 3 months and protects from neurological deterioration.

Arthritis, Rheumatoid↗
PubMed1986

[Technic of chemonucleolysis].

Chemonucleolysis is technically easy to perform and free from complications. Correct positioning of the patient is the most important factor for successful puncture of the intervertebral disc. Difficulties during puncture can arise if the intervertebral space is very narrow or if the articular processes of the vertebra are hypertrophied; likewise, if this is the case with the transverse process of the fifth lumbar vertebra, or if congenital lumbosacral anomalies are present. Puncture at the level of the 5th lumbar vertebral body/sacrum can be rendered more difficult by a high iliac crest. In such cases the double-needle technique should be employed. Discography as the last examination directly before nucleolysis serves to verify vertebral disc degeneration, to control the position of the needle, and to exclude perforation of the dura. 150 nucleolyses were performed without complications. In one case only the scheduled intervention had to be discontinued because of technical difficulties during puncture.

Humans↗