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Biomedical subjects

M Mumenthaler

Publications and source records attributed to M Mumenthaler.

At least 91 records · Page 5Linked to original sources
PubMed1978

Giant cell arteritis (cranial arteritis, polymyalgia rheumatica).

Giant cell arteritis, which is probably due to disturbed immune mechanisms, has a spectrum of clinical symptoms in elderly people. In nearly all cases such general signs as loss of appetite, loss of weight and fever are present. The sedimentation rate is almost without exception about 100 mm in the first hour. The two most frequent and typical clinical syndromes are polymyalgia rheumatica and cranial arteritis. The polymyalgia rheumatica is characterized by periarticular pain which is mostly symmetrical and accentuated in the shoulder girdle. Increasingly severe temporal headache and ocular distrubances are found with cranial arteritis in more than 50% of cases. A combination of both diseases is frequent. Other arterial branches are rarely involved. The course of the disease is over a period of 1 1/2 to 2 years. Treatment with corticosteroids is indicated mainly because of the severe ocular complications with blindness. It should begin immediately, be intensive and last over a long period. Regular followup is necessary over several years in order to avoid relapses.

Age Factors↗
PubMed1978

The syndrome of 'continuous muscle fiber activity.'.

A 7-year-old boy who suffered from increasing stiffness and contractures of the extremities had distally pronounced atrophy and absent tendon reflexes. Electromyography showed continuous electrical activity during rest, sleep, after intravenous injection of diazepam, and after peripheral nerve block. The H reflex was elicitable; the silent period after the reflex was absent. Histopathological examination of the peroneus muscle disclosed a marked preponderance of type I fibers and slight atrophy of the type II fibers. Electron microscopic examination of the endplates demonstrated a marked atrophy of the postsynaptic regions and widened synaptic clefts. After one year's treatment with phenytoin, 200 mg daily, the patient showed an almost normal muscle tone. As not all of these electrophysiological phenomena can be fully explained by disturbances of the nerve terminals or the endplates, a further anomaly proximal from the peripheral nerve block seems to have been present.

Child↗
PubMed1977

[Criteria for determining whether to offer compensation in cases of whiplash injury to the spine (neck area). A study of cases in which compensation or cash settlement has been granted (author's transl)].

We compared two groups of patients with whplash injury. The first group of 17 patients received a life annuity or a cash settlement, whereas the second group, comprised of 84 people, received no compensation at all. This comparison revealed some considerable differences. However, with regard to statistically significant factors, the 2 groups differ only in neurological symptoms, giddiness, and degenerative changes revealed by X-ray. In the first group, 11 patients who received compensation showed two of the statistically significant factors; 5 patients showed one factor; and 1 showed none. The criteria which govern the granting of compensation are being discussed in detail on the basis of our own cases and the literature. It is an exception when permanent damage due to whiplash is accepted. In individual cases, however, continuous complaints and objective findings years after the trauma are justification for a moderate compensation.

Adult↗
PubMed1977

[Criteria of brain death. Spinal reflexes in 45 personal studies].

In 45 patients without spontaneous breathing or cranial reflexes, and in whom blood pressure had to be supported, spinal reflexes were obtained in 60% and polysynaptic spinal reflexes in 33%. In all cases angiography showed cerebral circulatory arrest and/or repeated EEG recording gave an isoelectric line. The presence of spinal reflexes, appearing most frequently 6-36 h after death (which we defined as a sudden fall in blood pressure below 80 mm Hg with absence of spontaneous breathing) is not in contradiction with the assumption of brain death. 9 patients without signs of intoxication showed, in addition, a fall in body temperature below 34 degrees C. Such a fall in body temperature also in agreement with the diagnosis of brain death.

Adolescent↗
PubMed1977

The perifascicular atrophy factor. An aid in the histological diagnosis of polymyositis.

19 biopsies of polymyositis patients were compared with 19 matched controls. The presence of smaller fibres in the periphery of the fascicles has been analyzed quantitatively using a perifascicular atrophy factor. The thinner fibres are multiplied by a factor from 1-4, considering their significance for the diagnosis of fibre atrophy. The value obtained with this method from centrally located fibres as related to the value from peripherally located ones is called the perifascicular atrophy factor. If this is less than -300 a myopathy of the group of the polymyositis/dermatomyositis can be assumed. 47 per cent of dermatomyositis biopsies and none of the controls were below this range

Adult↗
PubMed1977

The Landry-Guillain-barré syndrome. Complications, prognosis and natural history in 123 cases.

One hundred and twenty-three patients, 68 males and 55 females in whom acute polyradiculitis Guillain-Barré appeared at an age of between 1,6 and 76 years were re-examined after 0.9 to 12.3 years. The initial symptoms, the signs during the acute phase, in particular the cranial nerve signs and central nervous signs, as well as findings in the cerebrospinal fluid and complications are described. Three patients died during the acute phase. At follow-up only 57% of the patients were completely cured. In 22% motor signs, mainly distal in the lower extremities were found. Only 6 of these patients however were handicapped. Twenty-two patients had loss of one or more tendon reflexes, in general the ankle jerk. Only 6 showed very slight central nervous system signs. Eleven of 55 follow-up cases had pathological findings in needle electromyography. A disturbance of conduction velocity or distal latency was also found in several adults and children without residual clinical signs. The time span between the maximum of the initial signs and the beginning of recovery seemed to be particularly long in patients who showed residual signs on follow-up. These patients also seemed frequently to have had a severe tetraparesis in the initial phase. We could not confirm the therapeutic effect of cortisone or ACTH in our patients: amongst the 30 adults treated with cortisone 6 (20%) had residual signs at follow-up, whilst 5 (25%) of the 22 untreated ones had similar findings.

Acute Disease↗
PubMed1977

Programmed texts: success or failure? An analysis of medical students' opinions.

It is shown that German medical textbooks have sold about nine times better than programmed texts, even if they were written by the same author and on the same subject. To explore some of the reasons why programmed texts are being used so little in comparison with conventional textbooks, 4th and 5th year medical students of the University of Berne were asked to work through a short programmed text in clinical neurology and to answer questions related to several aspects of using programmed texts and other materials. The analysis of the 212 questionnaires returned (58%) indicates that almost all students considered such a learning experience as highly useful and stimulating, but only about 25 per cent had no reservations. It is concluded that programmed medical texts may be used so little because they require students to learn in a highly standardized way, and because students need additional learning resources which provide them with conceptual framework of and sufficient information about a given area.

Adult↗
PubMed1977

[The Landry-Guillain-Barré-Strohl-syndrome. Prognosis in adults (author's transl)].

The clinical aspect of acute polyradiculitis (Landry-Guillain-Barré-Strohl syndrome) of 85 patients is resumed. 52 of these 85 patients were seen after an average of 5, 1 years, 8 were dead at the time of control and 25 could not be traced. Two patients died during the acute phase of polyradiculitis corresponding to a letality of 2%. 24 of the subjects (46%) had recovered completely, 28 (54%) showed some residual symptoms. Eleven patients (21%) had some residual weakness of hands and/or feet. Out of these eleven six (11% of total) were so much disabled that they received a disablement pension. 17 patients with slight sensory disturbances and/or some loss of reflexes were not handicapped in their every-day life. 20 patients were examined electrophysiologically during the follow-up. All the five patients with a pathological EMG also showed some clinical residual signs. A positive correlation between pathological conduction velocities in the median and/or deep peroneal nerve and clinical residua was only inconstantly found. Patients with severe tetraparesis during the acute phase had more often residual symptoms. The time from the maximum motor deficiency to the beginning of recovery was longer in the latter group than in patients without residual symptoms (23 respectively 8 days) while there was no difference of the time between the beginning of motor weakness and the maximum motor deficiency in the two groups. A treatment with ACTH and/or corticosteroids seemed not to influence the long term prognosis of the illness.

Acute Disease↗
PubMed1976

[Myasthenia gravis in old age. A retrospective study of 58 patients].

The course in 58 cases of myasthenia gravis in subjects over 50 years of age is reported. They total about 30% of cases in all age-groups. 36.2% of the patients died after an average period of illness of 3.4 years. 58.6% initially showed only ocular symptoms and in 58.8% of these the myasthenia was likewise located only in the eyes in the further course of the illness. The prognosis of ocular myasthenia is very good if the myasthenic process does not extend to other muscle groups in the first or second year of illness. 41.2% of primary ocular myasthenia turned into other types, in most cases a generalized type, and these had a poor prognosis. 69.2% of these patients died after an average period of illness of 1.5 years due to myasthenia-induced complications. Cases of myasthenia which initially are of the generalized type, in which the average duration is only 2.7 years until death, and to some extent the bulbar types, also have a poor prognosis. Ocular myasthenic cases generally need only small doses of cholinesterase inhibitors. Some patients had no medical treatment because there was no subjective or objective need for it. Several patients were given doses of cholinesterase inhibitors which were too large; excessive doses are to be avoided because of the proven negative influence of cholinesterase inhibitors on the myoneural system. It is recommended that types of myasthenia with a poor prognosis be treated early with corticoids, ACTH or azathioprin, if the cholinesterase inhibitors have proved ineffective or it their effect is unsatisfactory. Thymectomy is advisable only in patients under 60 years of age.

Aged↗