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Biomedical subjects

K F Druschky

Publications and source records attributed to K F Druschky.

At least 19 recordsLinked to original sources
PubMed2000

[Carbamazepine poisoning caused by confusing the drugs].

HISTORY AND FINDINGS: By error a pharmacist had dispensed to a 41-year-old woman Tegretal (carbamazepine; 400 mg retard tablets) instead of Trental (pentoxifylline; 400 mg retard dragées). Similarly, a 76-year-old woman had been prescribed carbamazepine-neuroxpharm (600 mg retard tablets) instead of piracetam-neuraxpharm (800 mg tablets) by her family doctor. Thirdly, a 79-year-old man was, as an in-patient, by error given by a nurse Tegretal, 400 mg retard tablets three times daily, presumably instead of 400 mg Trental retard. All 3 patients developed mild cerebellar symptoms. The two elder patients showed additionally wakefulness. After a fall the male in-patient, known to have a hemiparesis, also developed myoclonus in the limbs: computed tomography demonstrated a mild left temporal contusion. INVESTIGATIONS: Routine laboratory tests were unremarkable. All 3 patients had raised carbamazepine levels (12-13 micrograms/ml [normal range: 4-12 micrograms/ml]). DIAGNOSIS, TREATMENT AND COURSE: Because fast carbamazepine saturation had been done in those three patients by error, all of them showed symptoms of carbamazepine overdosage, but all symptoms fully regressed within a few days without specific treatment. CONCLUSION: Adverse drug events are not rare in routine medical practice and should be thought of in the differential diagnosis of both in- and out-patients with unclear symptoms. In addition to careful history-taking and consideration of the clinical symptoms, toxicological screening can be of vital importance.

Adult↗
PubMed2000

[Trans-sternal thymectomy. Surgical indications and perioperative management].

Between 1985 and 1998 42 transsternal thymectomies were performed. The median duration of symptoms in myasthenia gravis patients (n = 27, 25/27 patients in stadium I/II of the Ossermann classification) was 40.3 weeks and 70.8 days between first diagnosis and operation. In 12 patients a thymoma was found (11/12 patients with stadium I/II of Masaoka classification), which was associated with myasthenia gravis symptoms in 10 cases. In 3 patients thymic tumors of other origin were verified histologically. After surgery these patients have an increased risk of pulmonary complications. We changed 1996 the perioperative anesthesiological procedure using total intravenous anesthesia with propofol/remifentanil and systemic patient-controlled analgesia with piritramide in the first two days after transsternal thymectomy. This management allows a quick extubation after operation and improved lung function postoperatively.

Adolescent↗
PubMed1999

[Grand mal series after Ecstasy abuse].

The consumption of the jet set drug Ecstasy (3,4-methylenedioxymetamphetamine, abbreviated to MDMA) by young people is increasing markedly. Parallel to this development, there is a large number of reports on severe neurological, psychiatric and medical complications following the use of Ecstasy. Seizures are among the most common clinical complications of the CNS following the ingestion of Ecstasy. Our report presents the case of a 21-year-old patient, who had a series of grand mal seizures after taking 12 tablets of Ecstasy. 36 hours after ingestion the substance MDMA was demonstrated at a level of 300 ng/ml in the serum and CSF. Following treatment with Clonazepam and under an adequate level of carbamazepine, no further seizures occurred. The diagnosis was difficult because the patient initially denied the consumption of drugs and the routine toxicological screening does not contain the substance MDMA.

Adult↗
PubMed1999

Progression of optic neuritis to multiple sclerosis: an 8-year follow-up study.

OBJECTIVE: The relationship between acute monosymptomatic optic neuritis (AON) and subsequent multiple sclerosis (MS) is still doubtful. We investigated the risk of developing MS in patients from North Bavaria, who were suffering from AON. PATIENTS/METHODS: Twenty-nine patients with clinical evidence of AON were included in the study. Initial evaluation included brain resonance imaging (MRI) and a clinical neurological examination. Follow-up examinations were performed after 72-108 months (mean: 96 months) in 26 patients (three patients were lost to follow-up) and consisted of a second complete neurological examination. Diagnosis of MS was established according to the criteria of Poser CM, Paty DW, Scheinberg L. New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 1983:13:227-231. RESULTS: At follow-up, 14 of 26 patients (54%) had converted to clinically definite MS. Nine patients (64%) had developed MS within 2 years after the onset of AON. CONCLUSION: We observed the development of MS in 54% of the 26 investigated AON patients. The exceptional feature of the present study was the relatively long follow-up period of 8 years.

Acute Disease↗
PubMed1999

[Diagnostic value of combined conventional magnetic resonance imaging and magnetic resonance angiography in sinus venous thrombosis].

25 patients are presented, who were diagnosed with cerebral sinus venous thrombosis by a combination of Magnetic Resonance Angiography (MRA) and conventional Spin-Echo sequences. An angiography in DSA technique was carried out additionally in 12 cases. In 24 patients MR-angiographic control examinations were conducted. In seven cases MRA revealed an isolated thrombosis of the superior sagittal sinus (SSS) whereas in eleven patients there was an additional occlusion of other sinuses or cerebral veins. The transverse sinus (ST) was the second most affected. DSA essentially confirmed the MR-imaging data. Despite anticoagulation follow up MRA's showed complete recanalisation in only 7 patients, in 8 cases partial recanalisation was observed and in 9 cases a complete occlusion persisted. In contrast to these findings neurological examinations during the follow up period were unremarkable in 16 patients and the remainder revealed only mild residual symptoms. In general no further morphological alterations of the cerebral sinus system were detectable by MRA after 6 months. Follow up imaging beyond 6 months therefore appears unnecessary, unless a relapse is suspected.

Adolescent↗
PubMed1998

Prothrombin gene G20210-->A transition is a risk factor for cerebral venous thrombosis.

BACKGROUND AND PURPOSE: It has been recently reported that a G-->A transition at nucleotide position 20210 in the 3'-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increased risk of deep venous thrombosis. To date, it is unknown whether this polymorphism also represents a risk factor for cerebral venous thrombosis (CVT). METHODS: Venous blood samples were collected from 45 patients with CVT and from 354 healthy blood donors as controls. A second control group consisted of 131 subjects with acute ischemic stroke or transient ischemic attack (TIA). Genomic DNA was isolated from peripheral blood leukocytes. Amplification of DNA was performed by polymerase chain reaction (PCR). The G-->A transition at nucleotide position 20210 of the prothrombin gene was detected by allele-specific restriction digestion. RESULTS: The G20210-->A transition in the prothrombin gene was found in a heterozygous form in 4 of 45 patients with CVT (8.9%) and in 8 of 354 healthy control subjects (2.3%). This difference was statistically significant (P=0.010). The G20210-->A transition increased the relative risk for CVT approximately 5-fold (age-adjusted odds ratio 5.7; 95% CI 1.5 to 21.5). In contrast, in the group of patients with acute cerebral ischemia, only 3 of 131 subjects (2.3%) were heterozygous for the G20210-->A transition, which corresponded to the prevalence in the group of healthy blood donors. CONCLUSIONS: The recently described G20210-->A transition in the 3'-untranslated region of the prothrombin gene is an inherited risk factor for CVT but obviously not for acute ischemic stroke or TIA.

Adolescent↗
PubMed1996

[Reversible bilateral changes in cerebral proton-spin tomography in eclampsia].

HISTORY AND CLINICAL FINDINGS: Case 1: A 19-year-old primigravida was hospitalised in the 24th week of pregnancy after a series of grand-mal seizures. Investigation showed the classical eclamptic triad of oedema, hypertension and proteinuria. Case 2: 6 days post-partum a 24-year-old primipara developed hypertension and typical clinical prodromata. Subsequently she had a series of sometimes initially focal grand-mal seizures. TREATMENT AND COURSE: In both cases seizures ceased following pharmacological treatment. The pregnancy in the first case remained intact. Cerebral magnetic resonance imaging (MRI) demonstrated characteristic findings in both cases, in case 1 bilateral disseminated supratentorial foci of oedema without space-occupying features, in case 2 occipital white matter oedema and several supratentorial foci. All changes were completely reversible, in case 1 after 10 days, in case 2 after 16 days. CONCLUSIONS: Together with the clinical findings the focal changes on MRI provide a characteristic picture. MRI can thus be an important aid to the diagnosis of eclampsia and will prevent a misinterpretation as focal encephalitis or venous sinus thrombosis.

Adult↗
PubMed1996

[The aortic arch as an embolism source for cerebral infarcts].

Atherosclerotic plaques in the aortic arch are a potential source of cerebral emboli in patients with cryptogenic stroke (Amarenco et al., 1994). We report on seven patients with cerebral infarction, who had atherosclerotic plaques in the aortic arch, diagnosed by transesophageal echocardiography (TEE). Cardiovascular risk factors as hypertension, diabetes, hypercholesterolemia or cigarette smoking were found in all cases. Carotid disease was present in four patients, one patient had atrial fibrillation with left atrial spontaneous echo contrast, which might have been an additional potential embolic source. Intraluminal protrusion of the plaques ranged from five to twenty-four millimeters. In conclusion, even in patients with carotid or heart disease, the aortic arch may be an important source of cerebral emboli. In cases with mobile and pedunculated protruding atheromas anticoagulation should be considered.

Aged↗
PubMed1995

[High-grade transverse syndrome caused by echinococcus cysts].

In this report we present the case of a 16-year-old patient, born in Macedonia, who complained of abdominal and back pain and developed paraparesis. On admission to hospital, he showed a paraplegic syndrome, the level of sensation being T7, together with high-grade paraparesis of the lower extremities and spasticity and urinary incontinence. The protein content of the CSF was raised to 183 mg/dl. CT and MRI of the thoracic spine showed cystic lesions at the level of the 6th and 7th thoracic vertebrae, in the paravertebral area and in the 7th rib on both sides. The antibody titer of Echinococcus in the serum was positive. To treat this problem, corporectomy of the 6th to 8th thoracic vertebrae was performed, the area being bridged by a corticospongoid pelvic bone graft and with instrumental support of the 5th to 9th thoracic vertebrae. Histological examination revealed multilocular Echinococcus lesions. Under long-term treatment with mebendazole, the neurological deficits decreased in the postoperative phase.

Adolescent↗
PubMed1994

Characterization of a 58- and a 78-kD monocytic membrane protein with affinity to the acetylcholine receptor in myasthenia gravis patients.

The autoimmune disease myasthenia gravis (MG), caused by the effect of specific antibodies, directed towards the nicotinic acetylcholine receptor, is triggered by autoantigen-specific T cells. In order to investigate cellular parts of the immune response in MG, the authors investigated the binding of the nicotinic acetylcholine receptor (AChR) to peripheral blood mononuclear cells (PBMC) from MG patients. AChR binding cells were identified by rosetting experiments using AChR-coated fluorescein beads. Applying this technique, a significant percentage of PBMC (21.2 +/- 7.65%) from MG patients formed rosettes with AChR-coated beads. Membrane preparations of nycodenz- or percoll-separated monocytes from MG patients or T-cell depleted monocytic subpopulations were applied to SDS-PAGE under reducing conditions. Ligand-blotting studies with biotinylated AChRs revealed two cell-membrane proteins with molecular weights of 58- and 78-kD. In parallel the same results were obtained by affinity chromatography of monocytic membrane proteins using AChR-sepharose. A possible interference of anti-AChR IgG was excluded. The 58- and the 78-kD proteins are detectable under reducing conditions by ligand blotting with AChR-biotin, while under non-reducing conditions only the 58-kD protein can be detected. Furthermore, in experiments using Endoglycosidase-H, the 58-kD protein appears to be non-glycosylated, while the 78-kD protein bears carbohydrates. These findings suggest that monocytes which bind the AChR via specific membrane proteins on their surface might act as antigen-presenting cells and may lead to an induction of the T-cell response, in the early phase of the disease.

Antigen-Presenting Cells↗
PubMed1994

[Rhombencephalitis caused by Listeria monocytogenes].

We report the case of a 57-year-old man with Listeria rhombencephalitis. This had been ascertained by means of Listeria isolation from the cerebrospinal fluid. After an nonspecific prodromial period with nausea and headache, he developed fever, meningism, brain stem dysfunction and an organic psychosis. With early antibiotic therapy (ampicillin/gentamycin), it was possible to bring about a restitio ad integrum. Different brain-imaging methods (computed tomography, MRI, brain SPECT) in the acute and follow-up stages are discussed.

Ampicillin↗
PubMed1991

Diagnosis and treatment of deep cerebral vein thrombosis.

Three cases of deep cerebral vein thrombosis are reported. In all three cases focal neurological deficits and impaired consciousness occurred after a short period of non-specific clinical manifestations. Computed tomography revealed bilateral hemorrhagic infarctions of thalamus and basal ganglia. The CSF analysis which was performed in two cases showed pleocytosis, increased protein level, disturbed blood-brain barrier, and signs of necrosis and hemorrhage. In two cases the diagnosis was confirmed by transfemoral carotid angiography. MRI was performed in one case only and showed thrombosis of the internal venous system. All patients were treated with high-dose heparine in spite of hemorrhage. Good recovery was seen in all patients with almost complete improvement of neurological deficits. No complications were observed during treatment. Because of these promising therapeutic results, bilateral thalamic lesions should alert the physician to consider the possibility of deep cerebral vein thrombosis.

Cerebral Veins↗
PubMed1991

Continuous multivariable monitoring in neurological intensive care patients--preliminary reports on four cases.

Evoked potential monitoring is a standard examination method in neurological intensive therapy units. Previously, multimodality observation was only possible in follow-up examinations. First experience with a new bed-side system continuously monitoring 12 neurophysiological and clinical parameters is reported. It consists of a personal computer and various stimulation units. EEG activity, median nerve somatosensory evoked potentials (SEPs) and brainstem auditory evoked potential (BAEPs) are recorded. Additionally, EEG spectral band power, heart rate, heart rate variability, intracranial pressure, body temperature, expiratory PCO2, blood pressure and transcutaneously measured oxygenation can be monitored. This paper reports on 4 exemplary cases of the 33 patients we have monitored to date, illustrating the principles and main advantages of the system. The system was developed to support the observation of ICU patients as well as to aid therapeutic decisions. It supports the clinical determination of brain death by specifying the deterioration of various neurological systems.

Aged↗
PubMed1990

[Wilson's disease--critical deterioration under high-dose parenteral penicillamine therapy].

A 31-year-old man with Wilson's disease, not treated for the past 4 1/2 years, was admitted to hospital with brain concussion after a fall. While receiving penicillamine, 1 g i.v. four times daily, the neurological signs worsened and akinesia, mutism, tachy- and bradyarrhythmias, as well as transitory respiratory insufficiency developed. Serum copper concentration on the sixth day of treatment was markedly decreased to 28 micrograms/dl, rising to 60 micrograms/dl on the ninth day. 24-hour urinary copper excretion was at first 4500-5000 micrograms. Only after drastic reduction of the penicillamine dosage to 600 mg three times daily was there any improvement and after 11 weeks the patient was again able to walk and was discharged. Marked, mainly hepatic, copper depletion from the high penicillamine dosage was the likely cause of the patient's initial deterioration. To avoid cerebral complications penicillamine should be administered in gradually increasing doses.

Adult↗
PubMed1990

Zieve's syndrome and intracranial haemorrhage: coincidence or related disorders.

Zieve's syndrome (hyperlipidaemia, anaemia and fatty liver degeneration) may rarely occur with intracranial haemorrhage. Four patients suffering from both diseases are reported. Although it remains unclear whether there is a causal relationship between the two, it seems that hyperlipidaemia may be a major cause of intracranial bleeding. One reason for the small number of reported cases may be that hyperlipidaemic serum levels rapidly decrease after alcohol withdrawal.

Adult↗
PubMed1990

Fatal complications after myelography with meglumine diatrizoate.

A case of inadvertent intrathecal injection of diatrizoate meglumine is presented. After myelography with 10 ml i.e. 6.5 g Angiografin, a 76-year-old man rapidly developed myoclonus, drowsiness and excessive metabolic acidosis. He died only a few hours later. Postmortem showed non-specific brain edema. RP-HPL-Chromatography confirmed high concentration of the contrast medium in CSF (6 mg/ml) which must have induced refractory central nervous dysregulation. The lethal effects of the misapplication of this agent on the nervous system are discussed.

Aged↗