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P Schramm

Publications and source records attributed to P Schramm.

At least 19 recordsLinked to original sources
PubMed2005

Behr syndrome variant with tremor treated by VIM stimulation.

Behr syndrome was first described in 1909 as a syndrome of heredofamilial optic atrophy, visual disturbances, nystagmus, and variable pyramidal tract signs. The syndrome has been reported in both sexes. So far, tremor has not been reported to be part of Behr Syndrome. We present the case of a 51-year-old man with a rare complicated dominant inherited cerebellar ataxia with accompanying visual loss and tremor (CICALVT) resembling a Behr Syndrome variant who suffered from advanced visual deterioration since childhood and progressive spastic paraparesis for 15 years. Furthermore, the patient presented increasing tremor of both hands for 5 years. The successful treatment of the tremor using deep brain stimulation (DBS) of the ventral intermediate thalamic nucleus (VIM) is reported. Our case indicates that deep brain stimulation of the ventral intermediate nucleus is an adequate operative intervention that can help to reduce tremor even in patients with complicated movement disorders.

Deep Brain Stimulation↗
PubMed2005

[CT diagnosis in acute cerebral ischemia].

The advent of new MRI techniques such as perfusion- (PWI) and diffusion- (DWI) weighted imaging has improved diagnostic imaging in stroke. However, CT scanners are more widely available and less expensive than MRI scanners and are often located in the emergency departments even of smaller community hospitals. Topic of this article is CT-based diagnosis of patients with hyperacute ischemic stroke. In hyperacute stroke, a multiparametric CT protocol allows a comprehensive diagnosis by combining non-contrast enhanced CT (NECT), perfusion CT (PCT), and CT angiography (CTA). PCT can render important information about the hypoperfused brain tissue, CTA provides further important information about the vessel status. When stroke MRI is not available, multiparametric stroke CT can give nearly equivalent information, and can help to identify patients for thrombolytic therapy.

Brain Ischemia↗
PubMed2004

Intramedullary subependymoma of the lower spinal cord.

A 22-year-old woman developed an increasing distal paraparesis, which resulted in a severe ataxic gait. MRI demonstrated a very large intramedullary tumour mass from D11 to L2, which could not be identified as one of the common neoplastic diseases of the spinal cord. The tumour was removed completely and the diagnosis of subependymoma confirmed. With respect to our patient and to the limited reports in the literature, we describe some typical features that may help in the diagnostic and preoperative assessment of this very rare spinal cord tumour.

Adult↗
PubMed2002

[The value of multi-slice computed tomography for early diagnosis of focal cerebral ischemia].

The aim of this survey is the characterization of the present value of multi-slice computed tomography (MSCT) for the assessment of hyperacute cerebral ischemia based on our experience and a review of the literature. MSCT is compared with single-slice CT (SSCT) as to the diagnostic value of standard cranial CT, CT angiography (CTA) and perfusion CT. CTA obtained with MSCT surpasses CTA obtained with SSCT. For perfusion CT, the value added by MSCT is small. With regard to standard cranial CT, MSCT and SSCT are considered equivalent. CTA and perfusion CT should be used in patients with acute stroke if the indication for thrombolysis is entertained but diffusion and perfusion weighted MRI cannot be carried out. This applies to both SSCT and MSCT. If advanced MRI and advanced CT are available, MRI continues to be the preferred imaging modality.

Acute Disease↗
PubMed2002

CT and diffusion-weighted MR imaging in randomized order: diffusion-weighted imaging results in higher accuracy and lower interrater variability in the diagnosis of hyperacute ischemic stroke.

BACKGROUND AND PURPOSE: Diffusion-weighted MRI (DWI) has become a commonly used imaging modality in stroke centers. The value of this method as a routine procedure is still being discussed. In previous studies, CT was always performed before DWI. Therefore, infarct progression could be a reason for the better result in DWI. METHODS: All hyperacute (<6 hours) stroke patients admitted to our emergency department with a National Institutes of Health Stroke Scale (NIHSS) score >3 were prospectively randomized for the order in which CT and MRI were performed. Five stroke experts and 4 residents blinded to clinical data judged stroke signs and lesion size on the images. To determine the interrater variability, we calculated kappa values for both rating groups. RESULTS: A total of 50 patients with ischemic stroke and 4 patients with transient symptoms of acute stroke (median NIHSS score, 11; range, 3 to 27) were analyzed. Of the 50 patients, 55% were examined with DWI first. The mean delay from symptom onset until CT was 180 minutes; that from symptom onset until DWI was 189 minutes. The mean delay between DWI and CT was 30 minutes. The sensitivity of infarct detection by the experts was significantly better when based on DWI (CT/DWI, 61/91%). Accuracy was 91% when based on DWI (CT, 61%). Interrater variability of lesion detection was also significantly better for DWI (CT/DWI, kappa=0.51/0.84). The assessment of lesion extent was less homogeneous on CT (CT/DWI, kappa=0.38/0.62). The differences between the 2 modalities were stronger in the residents' ratings (CT/DWI: sensitivity, 46/81%; kappa=0.38/0.76). CONCLUSIONS: CT and DWI performed with the same delay after onset of ischemic stroke resulted in significant differences in diagnostic accuracy. DWI gives good interrater homogeneity and has a substantially better sensitivity and accuracy than CT even if the raters have limited experience.

Acute Disease↗
PubMed1998

Trophic factor modulation of c-Jun expression in supraspinal neurons after chronic spinal cord injury.

Cervical, but not thoracic spinal cord injury upregulates, in certain brainstem neurons, the expression of c-Jun, an inducible transcription factor that may be involved in the regenerative program/cell body response to injury. This study was designed to evaluate changes in c-Jun expression over a long period after spinal cord injury and to determine if such expression could be influenced by trophic or growth factors. Adult rats received a cervical (C3) hemisection lesion. Four or eight weeks later the lesion site was exposed, scar tissue in the cavity was removed and gel foam saturated with ciliary neurotrophic factor (CNTF), basic fibroblast growth factor (FGF2), or phosphate-buffered saline (PBS) as a control was placed into the cavity. Animals were sacrificed 7 days after treatment. In response to axotomy, c-Jun expression remained elevated in the red nucleus (RN) and vestibular complex (VST) at 4 weeks after injury, with no changes observed following scar tissue removal and PBS treatment. In contrast, treatment with CNTF further increased expression by RN neurons, but not VST neurons. Treatment with FGF2 had no significant effect on c-Jun expression at 4 weeks after injury. After 8 weeks, c-Jun expression approached baseline levels; however, removal of scar tissue, with subsequent secondary injury, caused an upregulation of c-Jun expression in both RN and VST neurons, which could be enhanced by CNTF, but not FGF2, treatment. At long postinjury intervals, interventive therapy known to promote axonal regeneration from chronically injured neurons leads to a reinduction of c-Jun expression. This reinduction may be related to the initiation of the regenerative effort of these neurons, although the lack of c-Jun upregulation by certain types of neurons does not appear to prevent a regenerative response by these cells.

Animals↗
PubMed1998

Combination of behaviour therapy with fluvoxamine in comparison with behaviour therapy and placebo. Results of a multicentre study.

BACKGROUND: We investigated whether the combination of multi-modal behaviour therapy (BT) with fluvoxamine is superior to BT and placebo in the acute treatment of severely ill in-patients with obsessive-compulsive disorder (OCD). METHOD: In a randomised, double-blind design, 30 patients were treated for nine weeks with BT plus placebo and 30 patients with BT plus fluvoxamine (maximum dosage 300 mg, mean dose 288.1 mg). BT included exposure with response prevention, cognitive restructuring and development of alternative behaviours. RESULTS: Both groups showed a highly significant symptom reduction after treatment. There were no significant differences between the groups concerning compulsions. Obsessions were significantly more reduced in the fluvoxamine and BT group than in the placebo and BT group. Furthermore, the group BT plus fluvoxamine showed a significantly higher response rate (87.5 v. 60%) according to a previously defined response criterion. Severely depressed patients with OCD receiving BT plus placebo presented a significantly worse treatment outcome (Y-BOCS scores) than all other groups. CONCLUSIONS: The results suggest that BT should be combined with fluvoxamine when obsessions dominate the clinical picture and when a secondary depression is present.

Adult↗
PubMed1997

[Contraception for the man].

Current possibilities of contraception that can be practiced by the male continue to be based on the barrier concept. Methods that have an action on the spermatozoa, whether toxic, immunologic or hormonal have not become established in Germany, although the latter is still being researched, and even practiced (gestagen implant), in some countries. The two barrier methods--the condom and vasectomy--both have a permanent place in contraception: the condom is by far the more popular of the two, additionally providing protection against infection and free of side effects. The invasive procedure of vasectomy is not widely practiced, although, on the basis of risk-benefit considerations, it is the method of choice vis-à-vis the pill when a couple definitively want no more children.

Contraceptive Agents, Male↗
PubMed1992

Treatment of idiopathic oligozoospermia with tamoxifen--a randomized controlled study.

There is no conclusive evidence of the usefulness of tamoxifen in the treatment of idiopathic oligozoospermia (OAT-syndrome), as it has been used mostly in uncontrolled studies. We herein report on the controlled treatment of OAT-syndrome with tamoxifen versus placebo following a randomized design. Seventy-six men with sperm counts of 2-20 x 10(6) ml-1, sperm motility of 20-50%, and sperm morphology (abnormal cells) between 50 and 80% were involved in the study. Patients with varicocele, a history of testicular maldescent or genital inflammation were excluded. Thirty-nine patients received tamoxifen (30 mg daily), 37 patients placebo. There was a statistically significant increase in the mean serum testosterone level after treatment in the tamoxifen-treated group (from 4.9 +/- 1.9 to 7.9 +/- 3.6 ng ml-1) in comparison to the placebo group (5.3 +/- 2.0 and 5.6 +/- 2.0 ng ml-1). Serum FSH levels increased slightly in the tamoxifen group (from 6.8 +/- 4.1 to 7.3 +/- 4.8 mU ml-1), but this was not statistically significant in comparison to the placebo group (from 5.9 +/- 3.9 to 5.2 +/- 3.5 mU ml-1). Serum levels of LH did not show any differences between groups. The sperm count increased during treatment from 9.3 +/- 11.7 to 11.4 +/- 13.7 x 10(6) ml-1 in the tamoxifen group and from 9.1 +/- 7.1 to 9.3 +/- 8.8 x 10(6) ml-1 in the placebo group; this difference did not reach statistical significance. The percentage of motile and abnormal sperm was not different between the two treatment groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Light exposure of the lower leg as a pathogenetic factor in the occurrence of malignant melanoma.

Of the 1,198 women and men studied in Mainz from 1966 to 1987 there was an approximately fivefold increase in the incidence of melanoma. Among the men melanomas on the trunk (59.9%) predominated, whereas among the women melanomas on the extremities (40.0%) were more common, especially on the lower leg (26.3%). Comparing the decades 1966-1976 and 1977-1987 there was a significant decrease in melanomas affecting women's lower legs (1966-1976: 33%,; 1977-1987: 24.2%). Fashion-dependent sun exposure of this body area might offer an explanation. It could be demonstrated that common stocking materials do not sufficiently protect against UV radiation (average permeability for UV light about 55%), therefore an intense sun exposure of the lower leg in the fifties and sixties (nylon stockings and knee-long skirts) and a less intense sun exposure in the seventies (skirts of all lengths and trousers) can be assumed. The difference in the incidence of women's melanomas on the lower leg in our two subgroups correlates indeed with the fashion-dependent insolation 10-20 years before tumour diagnosis.

Clothing↗
PubMed1988

[After-care of melanoma. 8 years' experience using the Mainz model].

Since 1972, patients suffering from malignant melanoma have been checked up at our hospital, after primary treatment, for a period of 10 years at an average interval of 3 months. X-ray controls of the chest and ultrasonic investigations of the abdomen are carried out every 6 months. In some cases, additional ultrasonic detection of lymphatic nodules is useful. Based on our experiences with numerous patients with malignant melanoma, we distinguish malignant, prolonged, and intermediate types of metastasizing melanomas. Periodical check-ups seem to be especially helpful in patients with beginning lymphatic metastases, who fall under the prolonged type. During the control period, the mortality rate was less high than we had expected it to be, although 46% of our patients showed metastases.

Adolescent↗