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Biomedical subjects

M Neuber

Publications and source records attributed to M Neuber.

12 recordsLinked to original sources
PubMed1999

[Gangrene of the fingers caused by accidental intra-arterial injection of diazepam].

HISTORY: A 51-year-old woman was accidentally given an intra-arterial injection of 10 mg diazepam to control an acute claustrophobic anxiety attack. She complained of severe knocking pain in the entire left arm during the injection. On the second day the hand and lower arm were red an swollen and she complained of increasingly feeling cold and having paraesthesias. On the fifth day the radial half of the palm as well as the first to third digits showed livid discoloration. In the further course necrotic areas developed in the palmar aspect of the distal phalanx of the thumb and of the index finger proximal to the middle phalanx. INVESTIGATION: Angiography on the tenth day after the injection revealed very poor perfusion of the radial artery as far as the wrist, occlusion of the superficial palmar arterial arch and occlusions of the digital arteries of the five fingers. TREATMENT AND COURSE: Infusion of 25,000 IU heparin over 24 h brought no improvement. On the 24th day after the diazepam injection the palmar aspect of the distal phalanx of the thumb and the index finger became necrotic, requiring amputation of the latter and, after removal of necrotic tissue, flap-plasty using subcutaneous soft tissue of the extensor surface of the index finger to cover the defect on the thumb. The patient was without symptoms on discharge and the wounds were healing well. CONCLUSION: Every doctor should be aware of the dangers of accidental intra-arterial injection. The slightest suspicion and symptoms require immediate and adequate treatment to save the limb.

Amputation, Surgical↗
PubMed1999

[Iatrogenic avulsion of the greater trochanter during prosthetic replacement of the hip].

An iatrogenic avulsion of the greater trochanter occurring during prosthetic hip replacement after a fracture of the neck of the femur is a rare complication. The need for maximum internal rotation of the limb during the operation imposes serious mechanical stress on the greater trochanter in patients who are often elderly and whose bones are osteoporotic. Two case reports illustrate that a conservative management--without internal fixation--combined with early mobilisation is successful. Our view is based on the current, international opinion that conservative management with early mobilisation is preferable for isolated traumatic avulsion of the greater trochanter, even if there is wide displacement.

Aged↗
PubMed1999

Anterior interosseous nerve compression after supracondylar fracture of the humerus: a metaanalysis.

OBJECT: The authors conducted a metaanalysis of reports of anterior interosseous nerve syndrome, a rare nerve compression neuropathy that affects only the motor branch of the median nerve. This syndrome is characterized by paralysis of the flexor pollicis longus, the flexor digitorum profundus to the index finger, and the pronator quadratus, with weakness on flexion of the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger without sensory loss. METHODS: The authors reviewed reports of 34 cases of anterior interosseous nerve syndrome combined with supracondylar fractures of the humerus in children. They have added a new case identified in a 7-year-old boy in whom a diagnosis was made from the clinical findings and whose treatment and outcome are analyzed. The ages of patients reported in the literature ranged from 4 to 10 years. Ten patients (29%) were treated with closed reduction and application of a cast, whereas 25 patients (71%) were treated with open reduction and fixation of the fracture. CONCLUSIONS: All patients regained full flexion and strength after 4 to 17 weeks. The fractures that were surgically treated showed no entrapment of the anterior interosseous nerve.

Casts, Surgical↗
PubMed1998

[Patient motivation--an essential therapeutic tool].

A deciding factor for the future functioning of a hand with a mutilating hand injury is the self-motivation that the patient brings with him to rehabilitation. This is illustrated in the case of a guitar teacher who returned to his career after subtotal and total finger amputation of his left hand (used for gripping chords). With consistent exercise on his instrument he compensated for the functional deficits of his hand and won a law suit against his employer who denied that he had the physical ability to play the classical guitar. It is more clear than ever that an injured person is jointly responsible, through self-motivation in the working process, for more-or-less complete rehabilitation. It is not uncommon in a system of job-sharing in which several members of the health service (surgeons, physiotherapists, social workers, general practitioners) must co-ordinate their work, for the patient--if he does not involve himself--to fall by the wayside. It is shown how inherent and rewarding it can be to support the patient in his desire to return to work. Apart from that, we hope that this example will be an encouragement to those similarly affected.

Adult↗
PubMed1998

[Closed rupture of the tendon of the anterior tibial muscle].

Closed rupture of the anterior tibial tendon is rare. Fewer than 50 cases have been reported in the literature, perhaps because the symptoms are often neglected by the patient as well as by the doctor. Most often the rupture occurs as a consequence of a sudden plantar flexion of the ankle and pre-existing degenerative changes of the tendon tissue due to systemic disease or iatrogenic local corticoid injections. Clinically, the tendon rupture presents as acute weakness of the ankle extensors without reddening, swelling or neurological signs. Differential diagnoses such as anterior tibial syndrome and peroneal nerve palsy can thus be excluded. During the clinical examination the distal stump and the discontinuity of the anterior tibial tendon are often palpable. The clinical diagnosis can be confirmed by an ultrasound examination. An operation may be undertaken up to 3 months after the injury. Preferred procedures are end-to-end anastomosis and transosseous refixation of the tendon, followed by a plaster cast for 6 weeks post-operatively. High-risk patients can be treated conservatively, but the functional results are less satisfactory. We describe a case of an acute closed rupture of the anterior tibial tendon. A yet unpublished method of osseous reinsertion of the tendon is presented.

Ankle Injuries↗
PubMed1998

[Osseous avulsion of the ischio-crural muscle group with concomitant sciatica].

Avulsion fractures of the ischial tuberosity are rare. They are often caused by a typical "splits"-like accident. In general the patients feel sudden severe pain in the buttock with localized tenderness in the region of the ischial tuberosity, rarely in combination with sciatic nerve irritation. According to the functional anatomy, flexion of the knee and extension of the hip may be impaired. Roentgenograms often reveal no abnormality and show no evidence of fracture. Therefore, inadequate therapy because of missed diagnosis can result in avoidable persistent pain. We report on a 42-year-old man with an avulsion fracture of the ischial tuberosity. The epidemiology, symptoms, including irritation of the sciatic nerve, differential diagnoses, diagnostic procedures and therapy are presented in detail.

Adult↗
PubMed1998

[Secondary reconstruction of flexor tendon function of the fingers].

Among the various procedures to restore flexor tendon function after failed or omitted primary suture flexor tendon grafting is the most frequently applied technique. It can be performed in a one-stage procedure using a palmaris- or plantaris graft in cases with less scarring or in a two-stage procedure for cases in unsuitable conditions. The main purpose for using silicone rods is to prepare an artificial tendon sheath to avoid adhesions of the tendon graft. The disadvantage of two operations seems to be justified by better results. We performed this technique in 168 zone-II-lesions. According to the Buck-Gramcko score we achieved excellent results in 30.9% and good results in 25.6%. In 76 fingers we applied the combination of the Paneva-Holevich technique of using a pedicled superficialis tendon with Hunters method without obtaining better results (22.4% and 32.9% respectively). The various techniques of grafting are described as well as indication and technique of tenodesis and alternatively staged procedure for isolated profunda lesions.

Cicatrix↗
PubMed1997

[Post-traumatic anterior interosseous nerve syndrome after supracondylar humerus fracture in a child].

The interosseus anterior syndrome is a rare nerve compression syndrome that concerns only the motor branch of the median nerve. It is evidenced by paralysis of the M. flexor pollicis longus and M. flexor digitorum profundus II with weakness of flexion of the terminal joint of the thumb and index finger but without sensory loss. From the surgical point of view this complication has special importance because of pediatric fractures of the distal humerus. In this paper we discuss the differential diagnosis, therapy and prognosis of this nerve injury by presenting an illustrative case of a 7-year-old boy suffering a supracondylar fracture of the humerus with a post-traumatic anterior interosseus nerve syndrome.

Child↗
PubMed1995

Expression of tenascin in tumors of the esophagus, small intestine and colorectum. An immunohistochemical study.

Tenascin, a large glycoprotein of the extracellular matrix, is involved in cell proliferation, differentiation, and migration during embryogenesis. In adult tissue, it is expressed only in certain areas. However, it gains importance again in proliferative processes such as wound healing and especially in tumor development. We examined paraffin-embedded specimens of 25 patients with a squamous cell carcinoma of the esophagus, 5 patients with an adenocarcinoma of the small intestine, 4 patients with a carcinoid tumor of the small intestine, and 49 patients with an adenocarcinoma of the colorectum. Immunohistochemical staining was performed by the use of a monoclonal antibody against human tenascin and the avidin-biotin-complex technique. Amino-Ethylcarbazol served as a chromogen. We investigated the distribution of tenascin in tumors, normal tissue, and lymph node metastases and compared it to tumor grading and TNM-classification. We found a uniform pattern of tenascin expression in all tumors and lymph node metastases examined in the gastrointestinal tract. One pattern was characterized by an immunoreaction near the basement membrane in well-differentiated areas and the other showed a diffuse, network-like expression in poorly differentiated areas with abundant stroma. There was a more intensive staining of the surrounding stroma near tumor cells invading into the submucosa or muscularis propria. It was even possible to detect small early carcinomas as well as small tumor cell populations in and around the lymph nodes by a strong immunostaining of the surrounding stroma. But we could not find any correlation of the tenascin expression patterns in comparison to the tumor grading and TNM-classification.

Adenocarcinoma↗
PubMed1994

[Evaluation of refractive values in patients working for several years at video display terminals. A long-term study].

The authors discuss whether working at a VDT (video display terminal) over a period of years causes non-reversible changes in refraction, especially if it induces a drift towards myopia. A total of 107 persons who had been working at VDT for many years were examined at 2-year intervals and the observations compared with those recorded in 69 persons who had never worked at a VDT. Changes in the correction strengths of their spectacles were evaluated. The statistical analysis was done by chi-square value determination and the Mann-Whitney U-test. The special lens values (diopters) showed no significantly different development in the two groups. It can therefore be concluded that VDT work does not cause myopia to worsen. The cylindrical lens values on the other hand differed significantly in the two groups. This is most probably because any inadequacy in the correction of visual acuity will be noted more easily by persons involved in VDT work.

Adult↗
PubMed1993

Polyploidies in abortion material decrease with maternal age.

Among 639 spontaneous abortions between the 8th and 14th week of gestation 342 (53.5%) revealed an abnormal karyotype. While the rate of trisomies distinctly increased with advancing maternal age, a decrease in the rate of 45,X conceptuses and polyploidies was observed among abortions from older women. The overall relation of XXXX:XXYY among the tetraploidies was 14:11 and that of XXX:XXY:XYY among the triploidies was 26:36:1. However, when the latter was related to maternal age, a reversal of the XXX:XXY ratio of 1:2 in the younger to 2:1 in the older age groups became evident. Furthermore a decrease in the rate of "paternally" derived partial hydatidiform moles was found among the triploid abortion specimens from older women. From these observations we conclude that digyny plays a major role in the origin of triploidy in the increased maternal age groups, while diandry related to immaturity of oocytes and impairment of oocyte cortical function is more frequent in triploid abortions from younger women.

Abortion, Spontaneous↗