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Biomedical subjects

K von Wild

Publications and source records attributed to K von Wild.

At least 19 recordsLinked to original sources
PubMed2002

Computer added locomotion by implanted electrical stimulation in paraplegic patients (SUAW).

Paraplegia means a live long sentence of sensory loss, paralysis and dependence with approximately 1000 new victims in every European country every year and 11.500 new traumatic SCI cases in the US. respectively. Sixty percent are injured before age 30. More than 90% of SCI victims may survive with nearly normal experience of live. Most patients will recover somewhat from SCI over time but no patient who remained plegic for one year regains voluntary motor function after that time period. Despite remarkable efforts and recent achievements in rehabilitation no treatment can be recommended so far to enhance functional recovery and restoring locomotion in paraplegic humans. FES as a technical compensation has become therefore a challenging treatment to restore muscle function and to prevent atrophy and to improve mobility and quality of life at the same time. In paraplegics FES could be the basis to restore locomotion. One of the advantages of an implanted FES version (neuroprosthesis) is that the FES system, electrodes, and cables remain permanently implanted within the body, so that the patient can stay without cables, the programmer attached to the crutches. The SUAW project, supported under BIOMED II Programme by the European Community was aimed to finalize and to put into practice the results of previous research and development. The novel implant with an ASCI-Chip has 16 channels, 8 on each side, 20 mA for monopolar and 2 mA for bipolar stimulation, only one electrode can be stimulated at a given time. Stimulation of 6 muscle groups of both legs are known to be sufficient for locomotion: M. ileopsoas (erector of the body, hip flexor), M. gluteus maximus (hip extensor), M. gluteus medius (lateral hip stabilisator, knee abductor), Mm. hamstrings (knee flexor) stimulated by epimysial electrodes, Mm. sartorius and rectus femoris (knee extensor) stimulated by neural, bipolar electrodes. Patient's selection criteria were: stable spinal cord lesion between T7 and T11, minimum 1 year after the accident without deformity of the spine, the muscle groups for locomotion responding to external FES with the EXOSTIM programmer with the same programme used later for the neuroprosthesis. Two paraplegic male patients, T8, 38 and 31 years old respectively, were operated on by an international group of surgeons according to the protocol in 09/1999, respectively 7/2000. The postop. course was uneventful. Because the threshold of the primary implant was too low regarding scare tissue around the electrodes, this implant was changed in 01/2000 and worked perfectly. Both patients are happy with the success of the novel treatment modalities.

Adult↗
PubMed2002

Requirements of team effectiveness in neurosurgical rehabilitation.

The purpose of this article is to stress the importance of working with interdisciplinary teams in neurorehabilitation and describe requirements of team effectiveness. It is not sufficient to focus only on different impairments associated with brain injury and offer individuals a variety of therapy. The essential aspect in neurorehabilitation is the integration of disciplines and consistent goal setting to regard individual patient's needs. Interdisciplinary teams benefit from a leader qualified for neuroscience, neurorehabilitation, clinical neuropsychology and psychotherapy. A good structural organization of the team, notice of basic communication rules, understanding typical group dynamics and stressors of interdisciplinary teams, conflict management and a definite decision making increase productive interdisciplinary working and enable the team to continue to mature. Further empirical research is necessary to support the effectiveness of interdisciplinary teams as an important variable in the evaluation of rehabilitation outcome and quality control.

Humans↗
PubMed2002

EFNS guideline on mild traumatic brain injury: report of an EFNS task force.

In 1999, a Task Force on Mild Traumatic Brain Injury (MTBI) was set up under the auspices of the European Federation of Neurological Societies. Its aim was to propose an acceptable uniform nomenclature for MTBI and definition of MTBI, and to develop a set of rules to guide initial management with respect to ancillary investigations, hospital admission, observation and follow-up.

Brain Injuries↗
PubMed2001

Rosetted glioneuronal tumor: a case with proliferating neuronal nodules.

Glioneuronal tumors with neuropil-like islands (rosetted glioneuronal tumors) were recently reported as a novel brain tumor entity with characteristic clinicopathological features (Am J Surg Pathol 23: 502, 1999). Here we describe the clinical, histological and genetic features of another case arising in the parietal lobe of a 43-year-old man suffering from focal motor epilepsy. Histologically, nodules of small neuronal tumor cells immunoreactive for synaptophysin and NeuN were embedded within a diffuse astrocytoma. Remarkably, highest proliferative activity was observed within the neuronal nodules. Comparative genomic hybridization revealed a gain of chromosome 7q and a loss on chromosome 9p.

Adult↗
PubMed2001

Diagnostic confusion in mild traumatic brain injury (MTBI). Lessons from clinical practice and EFNS--inquiry. European Federation of Neurological Societies.

A 1997 inquiry of 130 neurosurgeons throughout Germany, dealing with diagnosis and therapy of patients with mild traumatic brain injury showed a mainly inhomogeneous picture. The European Federation of Neurological Societies inquiry form 'Management of Patients with Mild Head Injury' was sent on behalf of the German Society of Neurological Surgeons to every leading neurosurgeon in Germany, of whom only 74 (57%) answered. The diagnosis 'mild brain injury' is used by 63%, 'commotio cerebri' by 49%, and 'brain concussion' by 4% of the institutions. GCS is used for classification by 60%, PTA 48%, retrograde amnesia by 50%, and LOC by 63% of institutions. Guidelines are used in 78%. Diagnostic x-ray of the skull is used in 77%, cervical spine in 62%, CT in 66%, MRT in 7%; and routine EEG in 35%. Fourteen per cent of the patients are not admitted; home observation is used in 45% of institutions, full bedrest in 19%, working pause in 48%, pain medication in 27%, control in 51%. Seperate guidelines for children in 54% of those departments.

Adult↗
PubMed1999

[Neuropsychological fields in early neurotrauma rehabilitation].

It meanwhile is commonly accepted that early onset of specific rehabilitation intervention in traumatic brain injured patients will enhance the recovery of brain function. The integration of neuropsychology in the early treatment of traumatic brain injury can mainly be ascribed to the increasing recognition that cognitive, personality and emotional deficits have been the most devasting longterm problems faced by patients and their families. The aim of our paper is to illustrate the role of neuropsychology in the early stage of rehabilitation. Neuropsychological therapy and the application of appropriate tests depend on the level of consciousness and the extent of behavioural problems. Observation, cognitive screening tests and the use of valid neuropsychological tests make up the main approaches. Our rehabilitation program includes measures of sensory and cognitive stimulation. Improvement of attention and stimulation of cognitive functions are one of the most important aims of early neuropsychological therapy. We choose tasks which require automatic information processing, the retrieval of well established knowledge and implicit learning. Appropriate tests and the development of neuropsychological treatment programmes represent an important means of maximising the patient's capacity to benefit from early rehabilitation.

Brain Injuries↗
PubMed1997

Secretion of brain natriuretic peptide in patients with aneurysmal subarachnoid haemorrhage.

BACKGROUND: Subarachnoid haemorrhage is commonly associated with natriuresis and hyponatraemia. One possible explanation for these features is a defect in the central regulation of renal sodium reabsorption with increased secretion of a natriuretic factor. We investigated whether excess sodium secretion in patients with subarachnoid haemorrhage is related to increased secretion of natriuretic peptides or to the presence of digoxin-like immunoreactive substances. METHODS: We measured the plasma concentrations of digoxin-like immunoreactive substances (by a fluorescence polarisation immunoassay) and natriuretic peptides, aldosterone, renin, and antidiuretic hormone (by radioimmunoassay) in ten patients with aneurysmal subarachnoid haemorrhage, ten patients undergoing elective craniotomy for cerebral tumours, and 40 healthy controls of similar age and sex distribution. Samples were collected before surgery, 1 h, 4 h, and 12 h after surgery, then daily until 7 days postoperatively in the two groups of patients. FINDINGS: All patients with subarachnoid haemorrhage, but none of the tumour patients, showed increased urine output and urinary excretion of sodium (p = 0.018 for comparison of means of curves to 7 days). The patients with subarachnoid haemorrhage had much higher plasma concentrations of brain natriuretic peptide (BNP) than controls, on admission (mean 15.1 [SE 3.8] vs 1.6 [1.0] pmol/L, p < 0.001) and throughout the study period, accompanied by lower than normal aldosterone concentrations and normal plasma concentrations of atrial and C-type natriuretic peptides (ANP, CNP). The patients with tumours had similar plasma concentrations of ANP, BNP, and CNP to the controls. We did not detect digoxin-like immunoreactive substances in either group of patients. INTERPRETATION: Salt-wasting of central origin may induce hyponatraemia in patients with aneurysmal subarachnoid haemorrhage, possibly as a result of increased secretion of BNP with subsequent suppression of aldosterone synthesis.

Brain Neoplasms↗
PubMed1997

[Reconstruction of frontal bone, periorbital and calvarial defects with autogenic bone].

The repair of bony defects in the craniomaxillo-facial region in 40 patients is reported. In 22 patients with autogenous calvarian bone grafts no changes in the grafted bone were found. However, in 4 out of 11 patients with iliac bone grafts, partial bone resorption was observed. Repair of bony defects of the face with autogenous calvarian bone is the therapy of choice. It is superior to any other transplant or implant.

Bone Transplantation↗
PubMed1996

Lumbar spinal surgery for sciatica due to intervertebral disc disease in the elderly.

This report reviews 36 patients aged 71 to 93 years who had lumbar spinal surgery for sciatica pain some with motor and or sensory disturbances and with no motor and sensory disturbances. Even though we found soft disc herniations, these patients should have a thorough circumferential decompression because of bony osteophytes and facet hypertrophy. Special attention is drawn to the removal of herniated discs associated with massive spondylotic degenerative changes.

Aged↗
PubMed1995

Microsurgical management of the lumbar intervertebral disc-disease.

One hundred consecutive patients operated on for sciatica pain using microsurgical techniques between April 1984 and February 1985 were evaluated retrospectively. This paper gives preoperative clinical data, end-result of surgery, rate of complications and true recurrent herniations. On the basis of the results, both soon after operation and at later follow-up (between three and five years) we feel encouraged to continue using this mode of operation. Complete or significant pain relief was achieved in 92% of patients; 93% were able to return to their preoperative normal physical activities. The frequency of complications was low.

Adolescent↗
PubMed1994

Percutaneous nucleus pulposus denaturation in treatment of lumbar disc protrusions--a prospective study of 50 neurosurgical patients.

In a prospective study on 50 patients, the 1064-nm Nd-YAG laser was used to denaturate protruding lumbar discs. The method of Ascher [1] was modified using a saline pressure infusion system. Early results show a very good decompressive effect with 48 out of 50 patients in the categories very good and good. At follow-up (mean 184 days postoperation) 31 out of 46 were in these categories, indicating a longer lasting retrieval of the protruded mass. A marked reduction of clinical nerve compression signs was noted. No severe complications occurred. Due to the irrigation system less low back pain was reported. The method seems promising in the standard neurosurgical setting.

Adult↗
PubMed1993

Desmoplastic ganglioglioma: report of two non-infantile cases.

Two supratentorial desmoplastic gangliogliomas arising in a 15-year-old boy and a 25-year-old man are reported. Both tumors reached the brain surface and exhibited large cysts. They showed intense desmoplasia and tumor cells of astrocytic and ganglionic differentiation. In one case the ganglionic nature was only demonstrable by immunohistochemistry. Such neoplasms can no longer be regarded as exclusively infantile brain tumors.

Adolescent↗
PubMed1993

[Primary intracerebral non-Hodgkin's lymphoma--a clinicopathologic study].

Primary cerebral lymphomas (PCL) were diagnosed with increasing frequency also in our retrospective study of 44 patients. Clinically these tumors presented with signs of a rapidly growing brain neoplasm. The analysis of CCT data showed that the tumors were of varying density before and showed mostly (60%) homogeneous enhancement after contrast medium application. MR imaging was more sensitive, but could not aid in distinguishing PCL from other brain tumors. The lesions lay mainly (82%) in the supratentorial space and involved the frontal lobe in 42% of cases. Only 16% were located in the periventricular region including corpus callosum and basal ganglia. 20% of cases showed multiple lesions. Suspected diagnoses were therefore mainly meningeoma, glioma and metastases. Morphological diagnosis was easily possible with the aid of immunohistological methods: there were 41 B-cell lymphomas (93%), two T-cell lymphomas and one large cell anaplastic lymphoma of the non-B non-T phenotype. An unequivocal correlation between morphology and radiological picture existed in the way that tumors with a dense cellular infiltrate appeared mainly as hyperdense lesions with homogeneous contrast enhancement. The clinical course was characterized by CNS-relapses frequently with multiple cerebral lesions and a spinal recurrence in one case. 7% of cases showed evidence of extracerebral disease in a bone marrow biopsy specimen or at autopsy. The average survival of the patients was 15 months, one year survival was 36%, two year survival 12% and 5% of patients lived for more than 5 years.

Adult↗
PubMed1992

Effect of pyritinol on EEG and SSEP in comatose patients in the acute phase of intensive care therapy.

The extent and duration of acute disturbances of consciousness depend on the severity and localization of the underlying cerebral dysfunction. The Glasgow Coma Scale (GCS) permits a relevant statement to be made on the course and recovery tendency of functional damage patterns in cerebral, mesencephalic, and brain stem structures. Therapy is directed at exerting a beneficial effect on the disturbed cerebral metabolism by administration of centrally active substances and at utilizing the available reserve plasticity of the brain for any possible recovery of mental performance. The bioavailability and profile of action of pyritinol have been well documented in animal experiments. We have studied the question as to the extent to which the substance influences the depth of coma in patients receiving acute intensive care therapy, and how this can be objectified electrophysiologically in the form of a specific central effect on basal brain structures. In a phase-II pilot study over five days the acute effect of intravenous 60-min. administration of 1,000 mg pyritinol on the depth of coma, the central conduction time (CCT) and the primary complex amplitude (N20/P25) of the SSEP, and on vigilance behavior (spectral edge frequencies and power) was investigated for 90 minutes in each case under intensive-medical steady-state conditions in 10 comatose patients. Because of the differences in the underlying brain damage, the primary depth of coma, age (30-89 years), sex (two female, eight male), as well as previous treatment (surgery, conservative), the significance of the results could not be evaluated by confirmatory statistical analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Convexity meningioma associated with empty sella presenting as primary amenorrhea.

A case of a 30-year-old female seen for a convexity meningioma is presented. History and investigations revealed an empty sella turcica associated with primary amenorrhea. The removal of the convexity meningioma resulted in the disappearance of the amenorrhea and in the rise of plasma gonadotropins. The importance of the consideration of intracranial causes in patients who have a delayed puberty or the absence of a menstrual history is briefly emphasized in the light of literature.

Adult↗
PubMed1992

Arachnoid cysts of the middle cranial fossa.

In 18 cases of temporal arachnoid cysts the etiology, clinical and radiographic findings, surgical treatment, and outcome are reviewed. Cysts of the middle cranial fossa are susceptible to trauma, which may cause bleeding either into the cyst or into the subdural space. CT or MRI scans are diagnostic in arachnoid cysts. In cases of intracranial mass lesion with displacement of the midline structures and increasing ICP, osteoplastic craniotomy is performed and the medial wall of the cyst is resected down to the tentorial notch, with opening into the basal cisterns. There were no operative or postoperative complications in 18 consecutive cases. However, one boy required a cystoperitoneal shunt 3 months later as a result of hydrocephalus following subdural hematoma and two other patients were also subsequently shunted. Asymptomatic arachnoid cysts are discussed with the respect to brain function and potential risks.

Arachnoid↗
PubMed1990

[Evaluating performance in lumbar intervertebral disk damage following chemonucleolysis].

In spite of the good or excellent long-term results in 60% to 80% of the cases reported in the literature, the efficacy of the less invasive percutaneous nucleolysis in the treatment of therapy-resistant lumbar compression of the nerve root in patients with lumbar disk protrusion still remains controversial. On the one hand, there is discussion about the actual effectiveness of the enzymes injected and their local activity in bringing about the desired long-lasting nerve-root decompression. On the other hand, the presumed advantage of he method is questioned. It is said that postoperative morbidity is decreased and shortened, and that job rehabilitation is faster, especially with people performing hard physical work. More recently, the same can be said for the much-vaunted method of percutaneous automated diskectomy and nucleotomy. It was only possible to use these less invasive treatment techniques with approx. 10% of the author' patients with therapy-resistant lumbar compression syndromes of the nerve root caused by disk protrusion. In 85% of all patients treated, CNL produced a good or satisfactory result as regards the relief of sciatica and neurological disturbances. These long-term results cannot be transferred to job-rehabilitation results, as a critical review of 133 cases has shown. The authors were able to examine 108 of the 133 patients approx. one year after nucleolysis. In the group of businessmen, government officials, white-collar workers, and students, there was a correlation between long-term neurological results and job rehabilitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗