Biomedical subjects
Publications and source records attributed to M Gabl.
Two cases in which the M. opponens pollicis was ruptured with a bony fragment are reported. In each case the injury, which occurred in young people (24-29 years of age), was the outcome of a fall during alpine skiing, whereby the hand hit the icy slope. Operative treatment was necessary due to the intense subjective pain which followed a significant thenar hematoma.
In this retrospective study about 101 patients, two groups of patients are compared in order to find out the most significant factors affecting survival after an acute, posttraumatic subdural hematoma (ASDH) of patients older than 60 years. Solitary ASDH in people older than 60 years showed an advantage in terms of survival. Additional traumas to the brain, chest or the blood circulatory system doubled the lethality rate of people older than 60 years. This was primarily caused by additional traumas to the brain rather than by traumas to the chest or hypovolemic shock syndrome. If the ASDH was caused by a bleeding due to a ruptured cortical artery or a venous sinus, people older than 60 years would have a poorer outcome than younger patients. A prognostic advantage on the contrary could be observed by patients older than 60 years whose ASDH was caused by a ruptured bridging vein. Most of the ASDH in older people occurred after falling down steps. Some patients fell according to an epileptic attack of an intracerebral bleeding after an anticoagulation therapy.
The imidazobenzodiazepinone derivative Ro 15-4513 has the activity profile of a partial inverse (low efficacy) agonist at the benzodiazepine receptor (BZR). It reverses central nervous depressant effects of diazepam, and, in part, of phenobarbitone and ethanol in mice, rats and cats in behavioural, electrophysiological, and neurochemical paradigms. The interaction of Ro 15-4513 with barbiturates and ethanol is due to its inverse agonistic (negative allosteric modulatory) property at the BZR, as it was reversed by the selective BZR blocker flumazenil (Ro 15-1788). In the present experiment situations, other BZR partial inverse agonists in subconvulsant or overt convulsant doses were less effective against ethanol effects than Ro 15-4513. Possible mechanisms for this differential activity of BZR inverse agonists are discussed.
With a collective of 46 patients we show the details and kinds of accidents caused by paragliding. The base for the casuistry of the accidents was a questionnaire which was answered by most of the injured persons. These were questions about the theoretical and practical training, the course of the flight during the different phases, and the subjective point of view of the course of the accident. The patterns of the injuries showed a high incidence of injuries of the spinal column and high risks for the ankles. At the end, we give some advice how to prevent these accidents.
A 55-year-old female was brought to our out-patient clinic with an initially ascending, acute hemiplegia. The following descending myelography and CT scan disclosed a mass lesion at C6-D4. The acute spinal subarachnoidal haemorrhage found at operation, its genesis, diagnosis, treatment and rehabilitation are discussed.
In this study we analyzed neurocranial fractures of 116 children up to the age of 12. The changes of the anatomical skull structure during the child's development, the pathogenesis, diagnosis and treatment of the different kinds of skull fractures and methods for a sufficient prophylaxis to avoid them are discussed in the following.
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The article deals with a rare case of granulocytopenia following a seizure prophylaxis after a severe head injury. Although fatal complications like the one described occur extremely seldom, we want to emphasize the necessity of regular controls during the critical time period between the 10th and the 67th day of diphenylhydantoin treatment. The blood level should not exceed 10-20 micrograms/ml to prevent any toxic reaction to the myelopoetic system. If this treatment cannot be provided, we suggest to administer Clonazepam or Convulex.
We treated 13 elite rock climbers for isolated disruptions of the pulleys of the long fingers. Diagnosis and treatment were based on the clinical finding of bow-stringing, which was confirmed by magnetic resonance imaging. Eight patients had bowstringing indicating incomplete disruption of the major pulley A2 and were treated nonoperatively (group A). Five patients showed bowstringing indicating complete disruption of the pulley A2. After failed nonoperative treatment, the pulleys were reconstructed (group B). The mechanism of injury and clinical and subjective results were evaluated. At a 31-month follow-up (range, 18 to 43 months), loss of extension in the proximal interphalangeal joint measured 5.6 degrees (range, 0 degree to 10 degrees) in group A and 4 degrees (range, 0 degree to 10 degrees) in group B. Circumference of the finger section was increased 4.2 mm in group A (range, 0 to 10 mm) and 4.8 mm in group B (range, 0 to 10 mm). Grip strength decreased 20 N in group A (range, 10 to 50 N) and 12 N in group B (range, 10 to 30 N). Four patients in group A and one in group B had bowstringing at clinical evaluation. On follow-up magnetic resonance images, bowstringing remained unchanged in group A but was reduced in all patients in group B. Good subjective results were seen in both groups.
Dynamic high-resolution ultrasonography findings obtained in 34 extreme rock climbers with finger injuries were compared with those in 20 healthy volunteers. Thicknesses of the flexor tendon and A-2 flexor tendon pulley system were measured at the base of the proximal phalanx. The distance between the tendon and phalanx was evaluated with the finger in extension and in forced flexion as a measure of bowstringing. Gliding ability of the flexor tendons was assessed during active and passive motion. Compared with healthy volunteers, climbers showed a significantly increased thickness of the flexor tendons and the flexor tendon pulley system but no impairment of the gliding mechanism. Only in climbers did the distance between tendon and phalanx increase from 0.14 cm (+/-0.07) during extension to 0.30 cm (+/-0.09) during forced flexion. In three climbers with complete A-2 pulley ruptures this distance was up to 0.51 cm (+/-0.15) during forced flexion. Clinically unsuspected synovial cysts, thickened joint capsules, fibrous tissue, or fluid collection were found only in climbers. We concluded that dynamic ultrasonography is a valuable tool for accurate assessment of early changes in "climber's finger." It provides useful information, especially in cases where clinical evaluation is difficult, and should be performed to select appropriate therapeutic management.