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Peter J Koehler

Publications and source records attributed to Peter J Koehler.

12 recordsLinked to original sources
PubMed2005

Inclusion body myositis. Clinical features and clinical course of the disease in 64 patients.

The clinical features of inclusion body myositis (IBM) were of minor importance in the design of consensus diagnostic criteria, mainly because of controversial views on the specificity of signs and symptoms, although some authors reported "typical" signs. To re-assess the clinical spectrum of IBM, a single investigator using a standard protocol studied a cohort of 64 patients cross-sectionally. Symptom onset was before the age of 50 years in 20% of cases. Only a few patients (14 %) started with weakness other than that of quadriceps, finger flexor or pharyngeal muscles. The sequence of power loss was erratic, but onset of symptoms with quadriceps weakness predicted an earlier onset of dysphagia in older patients (> or = 56 years) compared with younger ones (< 56 years) (p = 0.02). Despite widespread weakness patients had favourable scores on three commonly used function scales and they kept their employment. Complete wheel-chair dependency was rare (3 %). A dominant characteristic was the anatomical distribution of afflicted muscles: ventral extremity muscle groups were more affected than dorsal muscle groups and girdle muscles were least affected, the latter preserving postural stability. Ankylosis, especially in extension of the fingers,was frequently present. Together with the sparing of intrinsic hand muscles it was helpful in the preservation of many skillful movements. IBM has a unique distribution of muscle weakness. Ankylotic contractures are common. We feel that their joint impact on daily functioning is characteristic for the disease.

Age of Onset↗
PubMed2004

The Monakow concept of diaschisis: origins and perspectives.

The idea that damage to one part of the nervous system can have effects at a distance was popular during the 19th century. Constantin von Monakow, MD, accepted this idea and blended it with the newly formulated neuron doctrine early in the 20th century to account for ipsilateral paralyses and recovery of function. He called his theory of neural depression caused by loss of inputs to structures tied to the damaged area diaschisis. In this article, we examine the origins of diaschisis and the goals of Monakow. Credit is given to Monakow for drawing needed attention to the dynamics of the nervous system, remote lesion effects, and recovery of function, even though the fine details or specifics of his theory have had a mixed reception.

Animals↗
PubMed2004

Babinski's clinical differentiation of organic paralysis from hysterical paralysis: effect on US neurology.

BACKGROUND: The formalized neurological examination developed near the end of the 19th century, and clinicians searched for signs to differentiate weakness due to structural lesions of the central nervous system (organic paralysis) from weakness caused by hysteria. Joseph F. F. Babinski worked in the shadow of his mentor, Jean M. Charcot, until 1893, but then developed independent studies to examine patients with both types of weakness. OBJECTIVES: To elucidate the role of Babinski in differentiating organic paralysis from hysterical paralysis and to describe his influence on 2 US neurologists, Charles Gilbert Chaddock and Charles Franklin Hoover. DESIGN: Primary and secondary sources were studied to outline the discoveries of Babinski and to determine his influence on US neurology. RESULTS: Babinski described toe extension in cases of organic paralysis and specifically stated that this sign did not occur in cases of hysterical paralysis. Chaddock and Hoover were influenced by the work of Babinski and disseminated his discoveries to US neurologists, each developing additional techniques to differentiate the 2 forms of paralysis. Each considered his technique superior to the Babinski toe sign. CONCLUSIONS: Although Babinski was only modestly appreciated by his contemporary peers of French neurology, his influence on US neurology was substantial. The Babinski, Chaddock, and Hoover signs that demonstrate whether structurally related upper motor neuron weakness exists continue to be useful maneuvers in separating these forms of paralysis from psychogenic weakness.

History, 19th Century↗
PubMed2004

Mitchell's influence on European studies of peripheral nerve injuries during World War I.

OBJECTIVE: Describe the influence of S. Weir Mitchell's (1829-1914) work, and in particular his ideas on causalgia, on European physicians who treated peripheral nerve injuries during World War I (WWI). BACKGROUND: During the American Civil War (1861-1865), Mitchell studied peripheral nerve injuries with colleagues George Read Morehouse and William Williams Keen. Three monographs resulted from this work. All were important landmarks in the evolution of knowledge of peripheral nerve injuries. A subsequent occasion to improve knowledge came in WWI. METHODS: The most important European monographs or series on peripheral nerve injuries from WWI were studied with special interest in references to causalgia and Mitchell's works on peripheral nerve injuries. We included works by Tinel, Athanassio-Benisty, Purves-Stewart & Evans and Carter, Foerster and Oppenheim. RESULTS: Tinel and Athanassio-Benisty provided the most detailed information on peripheral nerve injuries and causalgia and often referred to Mitchell. Both mentioned a possible sympathetic origin. Athanassio-Benisty described tremor and other movement disorders in relation to causalgia. Purves-Stewart and Evans mentioned Mitchell and causalgia in the second edition of their book. They advocated the term "thermalgia." Carter, who had access to data of many cases, concentrated his work on causalgia, referring to Mitchell. Foerster provided data of a great number of peripheral nerve injuries, but did not refer to Mitchell. However, he described the symptoms of causalgia cursorily, applying the term Reflexschmerz (reflexpain). Oppenheim was particularly interested in muscle innervation and referred to Mitchell with respect to hypertrichosis and glossy skin. Oppenheim did not use the term causalgia, although he described the syndrome in some of his patients. It wasn't until around 1920 that German physicians devoted significant attention to causalgia and began using the term. CONCLUSION: Knowledge of peripheral nerve injuries was greatly advanced during and after WWI. Mitchell's influence was mainly found in the French medical literature, where his findings provided the basis for further research on the origin of causalgia. In England, Mitchell and causalgia were also well-known. We found evidence to suggest that some of the English knowledge came from French physicians. German physicians described the symptoms of causalgia, but did not use the term, nor did they refer to Mitchell. This variation in Mitchell's influence by country probably reflects the fact that Mitchell's Injuries of nerves and their consequences was translated into French but not German.

Biomedical Research↗
PubMed2003

Hereditary neuropathy with liability to pressure palsies: the first publication (1947).

The first report of hereditary neuropathy with liability to pressure palsies (HNPP) was published in Dutch in 1947. The present paper makes it accessible in the English language. de Jong described two families, but only the cases from the first family may be considered to have had HNPP. Five persons from three generations had recurring peripheral neuropathies. de Jong hypothesized a hereditary disposition for the occurrence of neuropathies, but suggested a relationship with low vitamin B(1) levels.

Female↗
PubMed2003

Bernard Brouwer's lecture tours in the United States (1926 and 1933).

Bernard Brouwer (1881-1949), the first ordinary professor of neurology in the Netherlands and a man of prominent stature among continental neurologists, was invited to read lectures at several university clinics in the United States in 1926 and 1933. In this article, we describe Brouwer's impressions from these tours to obtain a view of US neurology in the 1920s and 1930s compared with the state of Dutch neurology. We studied Brouwer's reports of the lecture tours and pertinent materials obtained from several institutes in the United States where he lectured. Brouwer read the Herter Lectures at The Johns Hopkins University (Baltimore, Md) in April 1926 and subsequently visited several American cities. His second tour was by invitation from the Association for Research in Nervous and Mental Disease in New York, NY (1933), and he accepted invitations to visit New Haven, Conn; Boston, Mass; and Montreal, Quebec. According to Brouwer, neuroanatomy in the United States was studied on a wider experimental basis than in Europe. American colleagues, frequently working in teams, tended to have their theoretical-scientific work led by direct practical results. The scientific level among various universities ranged more widely than in the Netherlands, where the levels were homogeneous. In the United States, Brouwer encountered a general willingness to engage in scientific investigations, usually manifesting already in young students and residents, their inquisitive minds being stimulated early. His US colleagues had more assistants in the clinics and laboratories than those in the Netherlands. American neurologists were particularly interested in the anatomic and physiologic features of the meninges and cerebrospinal fluid circulation. American neurosurgeons were vastly advanced in neurosurgery.

History, 20th Century↗
PubMed2003

The correspondence between Bernard Brouwer and John Fulton (1930-1940).

In 1933, Bernard Brouwer (1881-1949), first professor of neurology in Amsterdam (1923), made his second lecture tour in the USA. He met John Fulton (1899-1960) who had recently assumed the position of Sterling professor of physiology (1930). Next to clinical neurology, Brouwer had become well-known by his clinical-anatomical, experimental neuroanatomical, and comparative neuroanatomical work at the Central Institute for Brain Research in Amsterdam. At the time, John Fulton, pupil of Sherrington and Cushing, was particularly interested in research of the primate central nervous system. The correspondence between Brouwer and Fulton (1930-1940), preserved at the Manuscripts and Archives Division of Yale Library, provides an opportunity to study international exchange of neuroscientific knowledge in the first half of the 20th century. Brouwer and Fulton first met during the first International Congress of Neurology at Berne in 1931, where they discussed the anatomy of optic tracts. Next to this subject, the correspondence in that year dealt with the crossed and uncrossed pyramidal tracts. Brouwer's visit at Yale (1933) was well appreciated as appears from their correspondence as well as from Fulton's diary. Fulton sent several students to Amsterdam, including Margaret Kennard (1899-1976) who visited Amsterdam in order to "receive further neuroanatomical and clinical training of the type that only you can give". On the other hand, Brouwer sent several Amsterdam pupils and Dutch colleagues to New Haven. From the correspondence, we learn that there was a vivid exchange of neuroscientific knowledge by books, letters, reprints and pupils. The correspondence demonstrates the changing dynamics of scientific exchange between Europe and America.

Correspondence as Topic↗
PubMed2002

Comparison of weakness progression in inclusion body myositis during treatment with methotrexate or placebo.

We investigated whether 5 to 20mg per week oral methotrexate could slow down disease progression in 44 patients with inclusion body myositis in a randomized double-blind placebo-controlled study over 48 weeks. Mean change of quantitative muscle strength testing sum scores was the primary study outcome measure. Quantitative muscle strength testing sum scores declined in both treatment groups, -0.2% for methotrexate and -3.4% for placebo (95% confidence interval = -2.5% to +9.1% for difference). There were also no differences in manual muscle testing sum scores, activity scale scores and patients' own assessments after 48 weeks of treatment. Serum creatine kinase activity decreased significantly in the methotrexate group. We conclude that oral methotrexate did not slow down progression of muscle weakness but decreased serum creatine kinase activity.

Administration, Oral↗
PubMed2002

The historical roots of the visual examination.

The history of the visual examination is discussed in five parts. The history of visual acuity is followed from the minimum separable of Persian scientists to the 19th-century charts. Events in the history of the examination of the pupil include the late discovery of the significance of anisocoria in trauma, the description of the pupillary light reflex, the midbrain nucleus responsible for it, and the discovery of the neuroanatomic basis of pupillary abnormalities. Attempts to look into the eyeball date from the 17th century and are followed up to the discovery of the ophthalmoscope (1851). The evolution of the visual field examination is described from the first observations of hemianopia in the Hippocratic Corpus, to the present day visual field examination. Important landmarks in the history of central disorders of visual integration include "mind blindness" and the theories on aphasia that formed the basis for the study of disorders of central integration.

Diagnostic Techniques, Ophthalmological↗
PubMedDate not supplied

Lumbar disc herniation: level increases with age.

BACKGROUND: Prompted by the clinical impression that L4 radicular syndrome and disc herniations at L3-4 occurred at older ages we studied the correlation between age and level of herniated discs. METHODS: We retrospectively correlated mean age and level of disc herniation of patients suffering from lumbar disc herniation. Data from 1431 patients were obtained from the neurologic database of the Atrium Medical Center Heerlen from 1995 through 1998. Nonparametric data were analyzed with the Mann-Whitney U test, and correlation was analyzed using linear regression. RESULTS: Mean ages of the patients with disc herniation at L5-S1, L4-5, L3-4, and L2-3 were 44.1 +/- 0.5 years, 49.5 +/- 0.6 years, 59.5 +/- 0.9 years, and 59.6 +/- 2.7 years, respectively. Mean ages were significantly higher with herniation levels at L4-5, L3-4, and L2-3 compared to L5-S1 (p < 0.0001). Analogously, the mean age of patients with disc herniation at L3-4 was significantly higher compared to those with herniation at L4-5 (p < 0.0001). No difference in mean age was seen between L3-4 and L2-3 (p = 0.815). A strong correlation was observed between the level of herniation and increasing age (R = 0.371; p < 0.0001). CONCLUSION: These results indeed prove that with increasing age, lumbar disc herniation is more cranially localized. It may help in understanding the patho-anatomic process of disc herniation, and in recognizing higher level radicular syndromes in advanced age.

Adolescent↗