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Biomedical subjects

K W Sturm

Publications and source records attributed to K W Sturm.

15 recordsLinked to original sources
PubMed1986

[Atraumatic diagnosis and semi-invasive therapy of subclavian steal syndrome using percutaneous transluminal angioplasty. A current concept].

Percutaneous transluminal angioplasty (PTA) is a semiinvasive, non-operative transvascular technique for dilatation of stenosed vessel segments by help of balloon catheters. This technique was applied to 30 out of 42 patients with a subclavian steal mechanism due to highgrade proximal subclavian artery (PSA) lesions. The transfemoral, transaxillary or both approaches were used. A staging of the severity of the subclavian steal mechanism on the basis of the pre-interventional Doppler ultrasound findings (Grade I-IV) was proposed for adequate selection of patients for angioplasty. During balloon dilatation of the subclavian artery permanent CW Doppler monitoring of the ipsilateral vertebral blood flow velocity was performed at the mastoid. Balloon dilatation failed to be effective in 4 patients with complete subclavian artery occlusions (Stage IV). In 26 patients with high-grade stenoses of the proximal subclavian artery (Stage II/III), angioplasty led to recanalisation of the vessel and abolishment of the steal mechanism. However, relief or improvement of the concomitant subclavian steal syndrome could not be achieved except in one-third or two-thirds of the patients, respectively. Long term follow-up with repeat Doppler sonography indicated a complete removal of the subclavian lesions in 50% of the cases, whereas the remaining patients produced some kind of re-stenosis. However, repeat angioplasty became necessary in only 5 cases and was permanently successful in two of them. If patients with complete subclavian artery occlusions were excluded, the complication rate due to angioplasty was very low. Embolism into the finger arteries could only be observed once. In another case, accidental dissection and complete occlusion of the distal subclavia artery occurred but underwent spontaneous recanalisation. Doppler monitoring of vertebral flow velocity was very useful for both control of the effectiveness of the dilatation procedure and deeper insight into the pathophysiology of the subclavian steal mechanism. An unexpected delay phenomenon concerning the re-establishment of cephalad vertebral flow direction was observed immediately after recanalisation of the subclavian artery and was thought to protect the posterior circulation against early embolism due to mobilisation of plaque debris within the proximal subclavian segment. From an angiological point of view, the outcome of percutaneous transluminal angioplasty does not yet meet the success rates of various modern extra-thoracic surgical procedures for operative treatment of subclavian steal mechanism. However, the rate of improvement of clinical signs and symptoms is equal with both methods.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1983

[Fetal cystic tumor in the ultrasonic image].

Using ultrasonography we were able to identify prenatally an intrauterine cystic tumour next to a foetus at 22 weeks of gestation, which was later diagnosed as a cystic lymphangioma of the foetal neck.

Abortion, Therapeutic↗
PubMed1982

[Anaesthetic problems with glomus tumors of the head and neck (author's transl)].

Anaesthesia and Postanaesthetic Course of Three Cases of Glomus Jugulare Tumor Were Studied. Pathophysiology and clinical features of this very rare tumor is discussed on a brief review of literature. After all localisation and dimension of this tumor can cause serious complications during operation and postoperative period. It must be considered that a safe operative and postoperative period is implied by carefull preoperative diagnostic management, special anaesthetic technics like controlled hypotension as well as postoperative intensive care.

Adult↗
PubMed1980

Predominant white matter involvement in subcortical arteriosclerotic encephalopathy (Binswanger disease).

Fifteen of 605 examinations of patients aged 60 to 85 years showed symmetrical white matter hypodensity on computed tomography (CT). Six of these showed severe white matter hypodensity, low grade atrophy, and dilated ventricles. A diagnosis of encephalopathia subcorticalis chronica progressiva, or Binswanger disease, featuring the typical clinical course of neurological and psychiatric symptoms was reached. In one case, the diagnosis was confirmed by postmortem anatomopathological findings. The etiology is considered to be vascular and to represent a special course of arteriosclerosis. In some elderly patients, both white and gray matter involvement is seen on CT, but white matter hypodensity is not a common finding in severe vascular brain atrophy.

Aged↗
PubMed1977

[Morphological findings on the brain of rats after local freezing (author's transl)].

In continuation of our investigations of the wound healing process after cryonecrosis in the liver, kidney, spleen and stomach, the wound healing in the brain was studied under the same condition. Through a trepanation of about 3 mm diameter, the cortex of the parietal region of the cerebrum was frozen by a cryoprobe applied directly through the intact dura mater (-196degreesC/30s). The animals were killed at definite time intervals between 12 h and 21 days after freezing. Twelve hours after freezing, the necrosis of the brain cortex is complete. It extends wedgeshaped into the subcortical white matter. The central parts of the necrosis become colliquative and are demarcted by leucocytes. Two days after freezing, the necrotic area is almost totally invaded by leucocytes. Three days p.op. the brain wound is infiltrated by microglial cells, later on the mesenchymal cell proliferation extends to the meninges. There is new capillary formation and partially a wall like proliferation of the perivascular connective tissue cells. Ten days and later, an uni- or multiloculated pseudocyst develops, which can be considered as the final stage of the reparative wound healing of the cryonecrosis. Similar as in the other investigated organs (liver, kidneys, spleen) these investigations underline the rapid wound healing of the cryonecrosis in the brain. The advantages of cryosurgical manipulations with the well known good wound healing process of other organs, justifies therefore the short term tissue freezing on the cerebrum.

Animals↗
PubMed1976

Wound healing of the brain of rats after cryonecrosis. Autoradiographic investigations with 3H-thymidine.

Histologic and autoradiographic studies were performed to investigate the cellular reactions during wound healing of the brain of rats after cryonecrosis. A parietal lobe was frozen for 30 s with a cryoprobe at a temperature of -196 degrees C. The survival time ranged between 12 h and 21 days. One h before killing, tritiated thymidine was injected intraperitoneally. Stripping film autoradiograms of the brain sections were made in the usual manner. A typical cryonecrosis develops 12 h after local freezing surrounded by an edematous tissue layer with activated mesenchymal and neurologlial cells. After 10 days a pseudocyst develops surrounded by highly cellular glial tissue. The pseudocyst is still recognizable 3 weeks later but without any remarkable cellular reaction. Autoradiographically the labeling indices of the fibroblasts, leptomeningeal,and endothelial cells in the periphery of the necrosis and the labeling indices of neuroglial, perivascular connective tissue, and microglial cells in the perinecrotic zone increase after 12 h and have their maximum between the 2nd and 3rd postoperative day. In the nonfrozen contralateral cerebral hemispheres, the labeling indices of neuroglial and mesenchymal cells show small peaks in the first 3 postoperative days,also. This can be explained by accompanying edema. There are no remarkable differences between frozen and nonfrozen parts of the brain 3 weeks after local freezing. The results underline the rapid repair of cryonecrosis.

Animals↗
PubMedDate not supplied

[The problems of the decrease in periventricular density due to hypoxia in computer tomograms of new-born infants].

200 premature and mature neonates with clinical evidence of hypoxia or traumatic encephalopathy were examined by cranial computerized tomography (CT) during the first two weeks postnatally. The findings were compared with those in a "control group" consisting of 14 neonates with extraneural malformations. Cerebral hemorrhages were easily identified by their high density, in CT images. Bilateral areas of lowered density within the periventricular white matter, however, could not always be attributed to irreversible tissue damage prior to about 14 days after the hypoxic event in term newborns, and in preterm infants even later. During this early period of life an apparent decrease of periventricular density was regularly observed that must not be mistaken for a pathological change. In two cases persistent periventricular areas of decreased density were caused by neuropathologically verified foci of incomplete leucomalacia.

Cerebral Hemorrhage↗