Biomedical subjects

R Firsching

Publications and source records attributed to R Firsching.

At least 19 recordsLinked to original sources

PubMed1995

Gagel's granuloma (localized Langerhans cell histiocytosis) in the pituitary stalk.

A 46-year-old man with diabetes insipidus, hypothyroidism and hypocortisolism was found to have a tumor of the pituitary stalk. After transsphenoidal resection of the tumor substitution of cortisol and thyroxin was necessary. Pathological examination of the lesion revealed an extremely rare granulomatous infiltration classified as Gagel's granuloma (Langerhans' cell histiocytosis). Pre- and postoperative magnetic resonance imaging (MRI) studies, differential diagnosis and treatment of such lesions are presented.

Diabetes Insipidus↗

PubMed1995

[Dysphagia: a neurosurgical indication for an operation?].

Ventral osteophytes of the cervical spine can be the reason for dysphagia in rare cases. We present a 67-year old man with difficulties in swallowing for three years and a ventral osteophyte at the level of C 5/6. Native X-rays of the cervical spine, CT-scan and x-ray examination with barium meal and with a barium ball was performed. In our case the most useful procedure for operative indication was the dynamic examination with the barium ball which demonstrates clearly the obstructed oesophageal passage. During operation the ventral osteophyte was resected via ventral approach to the cervical spine. Postoperatively patient's symptoms completely disappeared. Differential diagnosis and therapy are discussed.

Aged↗

PubMed1992

Rehabilitation after severe head injury.

123 survivors of severely head injured patients presenting with coma grade III show a decreasing mean duration of coma with increasing age. The numbers and frequency of good recovery decrease, whereas poor recovery increases with age. Increase of the duration of coma grade III produces an increase of the mean latency and time of recovery and of the frequency of poor recovery, regardless of the age of the patients. Increasing age does not increase the mean latency and time of recovery systematically. The important conclusion of this analysis is, that the clinical feature of coma grade III, corresponding to GCS score of 4 and RLS of 6 and 7, indicates a different kind of brain damage at various age groups. It represents a lesser degree of brain damage for younger patients under 20, than for those over 20. In our opinion our observations do not demonstrate a better capacity of recovery of the young patients: but the young patients show a more severe clinical picture than the older patients do, if only the clinical syndrome of coma grade III with extensor rigidity, is considered as a yardstick for comparison.

Activities of Daily Living↗

PubMed1992

Brain death: practicability of evoked potentials.

Multimodally evoked potentials were registered in 85 patients who fulfilled the criteria for brain death. While somatosensory and visual evoked potentials have been found to be of limited value for the diagnosis of brain death, the stepwise abolition of brain stem auditory evoked potentials (BAEP) confirmed brain death in 26 out of 85 patients, i.e. 31%. Registration of the abolition of BAEP is concluded to be a safe and acceptable confirmatory test. It is, however, more feasible for institutions, in which BAEP are analysed routinely. In spite of all efforts sequential BAEP could not be used for the diagnosis of brain death in the majority of cases either because of absence of reproducible responses at the initial registration or because the patient was already apnoic at the time of the initial BAEP. Assuming that bilateral preservation of wave I has the same significance as the stepwise abolition of BAEP, since it also proves the integrity of the peripheral receptor, BAEP are relevant for the declaration of brain death in approximately 30% of patients.

Brain Death↗

PubMed1992

Cerebral reperfusion in brain death of a newborn. Case report.

A case of "sudden infant death" after 15 minutes of successful resuscitation of cardiovascular function is presented. While apnoic cranial nerve areflexia and electrocerebral silence persisted, angiography and transcranial Doppler sonography demonstrated nearly normal cerebral perfusion, which even increased day by day inspite of the persistence of other signs of brain death. The phenomenon "cerebral reperfusion" is concluded to be compatible with the diagnosis of brain death.

Blood Flow Velocity↗

PubMed1992

Lesions of the sensorimotor region: somatosensory evoked potentials and ultrasound guided surgery.

In 10 patients with lesions of the sensorimotor cortex cortical SEP were registered to identify the postcentral gyrus, and intra-operative ultrasound sonography served to locate the lesion. The combination of both techniques helped to find the optimal approach to the lesion. Postoperative results were considered favourable, as only one patient suffered transient postoperative deterioration, six were unchanged and in three patients the pre-operative motor deficits were improved. The combination of intra-operative ultrasound and neurophysiological identification of the sensorimotor cortex is concluded as being useful in surgery within this region.

Adult↗

PubMed1992

Differentiation of oxytalan fibres from elastic fibres with reagents for detection of magnesium.

Elastic fibres in various human and animal tissues revealed positive results with reagents for the detection of magnesium. By contrast, no Mg could be detected in oxytalan fibres or in zonular fibres of the ciliary body, which are composed of microfibrils not containing elastin. Mg is therefore concluded to be associated with the elastin core of elastic fibres. Its antagonism to calcium is speculated to play a protective role in maintaining the extensibility of elastin.

Animals↗

PubMed1991

Cerebellar haemorrhage: management and prognosis.

Of 26 patients with CT confirmed intracerebellar haematoma, 17 had ventricular drainage performed and 7 patients had the haematoma evacuated. Eleven patients died. Mortality was clearly related to state of consciousness. Seven out of 8 non-comatose patients survived but 10 out of 18 comatose patients died. As there was no incidence of deterioration immediately following placement of a ventricular drainage, the actual risk of upward transtentorial herniation seemed low. Absence of evoked potentials in 6 patients accurately predicted a fatal outcome but normal SEP and BAEP were of lesser value for predicting survival.

Aged↗

PubMed1991

Pyramidal tract lesions in comatose patients.

In 197 comatose patients transcranial magnetic evoked potentials were registered to investigate the integrity of the pyramidal tract. Findings were compared to somatosensory, visual and auditory evoked potentials. Preservation, abnormalities and absence of evoked potentials were related to survival and non-survival. Transcranial magnetic and somatosensory evoked potentials proved to be of high prognostic value. While the accuracy of prediction of a fatal outcome based on transcranial magnetic evoked potentials was close to 90%, the prediction of survival was less dependable. Transcranial magnetic evoked potentials are concluded to be a valuable adjunct to the neurophysiological assessment of the comatose patient.

Adolescent↗

PubMed1991

[The effects of halothane and nitrous oxide on transcranial magnetic evoked potentials].

The influence of volatile anaesthetic agents on transcranial magnetic motor evoked potentials (TMEP) is not known. The effect of halothane and nitrous oxide on TMEP as recorded from hand was studied in 10 patients undergoing lumbar spinal surgery. In no case were the TMEP documented when halothane and nitrous oxide were administered. After withdrawal of both agents it took up to 29 minutes until the TMEP reappeared. It is concluded that intraoperative monitoring of TMEP is not possible if halothane and nitrous oxide are administered.

Anesthesia, Inhalation↗

PubMed1991

Demonstration of elastic fibres with reagents for detection of magnesium.

Investigation of elastic fibres in various human and animal tissues with the reagents quinalizarin, magneson II, and titan yellow for the detection of magnesium revealed striking positive results. After pretreatment of skin and ligamentum flavum with elastase the tests were negative. The results support the supposition that the amount of magnesium in elastic fibres is sufficient for histochemical detection. It is speculated that the marked chelate-forming property of magnesium, or its antagonistic function to calcium, is associated with the elastic property of the fibres.

Animals↗

PubMed1991

Russel bodies-containing cells in the Harderian gland of the chicken in relation to different immune conditions.

The modulation of the number of Russel bodies-containing plasma cells in the Harderian gland under different experimentally induced immune conditions is reported. The findings support the conception of an immunologic function of the Harderian gland which is similar to the function of the thymus on the one hand, and to the function of the bursa of Fabricius on the other.

Animals↗

PubMed1991

Magnesium in cross bands of injured myocytes.

Magnesium was found to accumulate in cross bands of myocytes due to myofibrillar degeneration in the context of myocardial lesions and was also detected from contraction bands in injured fibres of duck feather muscles. Relevant findings were based on histochemical detection of magnesium with quinalizarin, magnesone, and titan-yellow. Amassed degenerated myofibrils and injured mitochondria were supposed to make for the substrate of magnesium. Elective staining of cross bands by Luxol Fast Blue MBS was assumed to be attributable to bondability to divalent cations.

Animals↗

PubMed1990

Significance of eosinophilic granulocytes in chronic subdural hematomas.

Despite a number of studies on infiltration of eosinophilic granulocytes into the outer membrane of chronic subdural hematomas, the significance of this phenomenon is not clear. We investigated histologically the membranes of 40 patients with chronic subdural encapsulated hematoma. Infiltrations with eosinophilic leucocytes were found in the granulation tissue of the inner layer of the outer membrane, either diffuse and sporadic (12 cases) or as massive agglomerations (28 cases). Fifty percent of the patients with marked infiltrations were between 61 and 80 years old. In 5 cases Charcot-Leyden crystals were identified. The numerous functions of the eosinophils play a more important role in repair than in maintenance of fluidity of hematomas.

Aged↗

PubMed1990

Multimodality evoked potentials and early prognosis in comatose patients.

In 112 comatose patients somatosensory, visual and auditory evoked potentials were registered within 36 hours after the onset of coma or admission. Main causes of coma were head injury, and intracerebral and subarachnoid haemorrhage. The initial bilateral loss of any evoked potential was associated with a mortality of 98%. Normal somatosensory evoked potentials were associated with a survival rate of 74%, while normal visual and normal auditory evoked potentials had a survival rate of 60% and 66%, respectively. It is concluded that SEPs can be valuable for the prognosis of coma after primary brain lesions.

Brain Injuries↗

PubMed1990

Clinical correlates of erythropoiesis in chronic subdural hematoma.

Histologic investigation was performed in 38 out of 224 chronic subdural hematomas treated at our institution from 1978 to 1988. Nucleated red blood cells were found in 33% of the chronic subdural membranes examined. Additional sections were examined in 14 of these 38 patients, revealing erythroblasts in 57%. The clinical course and radiographic findings in the patients whose membranes contained erythroblasts were compared with those whose specimens did not. Neither history, presentation, size of hematoma, nor postoperative recovery differed from one group to the other. By comparing histologic and clinical findings, we are able to conclude that the production of erythrocytes by chronic subdural membranes is of no surgical significance.

Adult↗

PubMed1989

The brain-stem and 40 Hz middle latency auditory evoked potentials in brain death.

Bilateral recordings of brain stem auditory evoked responses were compared with the 40 Hz middle latency auditory evoked responses in 38 patients either brain dead or in coma grade IV. In 4 cases the 40 Hz auditory evoked potential was partly preserved, while the brain stem auditory evoked potential was not reproducible beyond wave II. Recording of the 40 Hz auditory evoked potential is found to be more sensitive in some rare instances.

Acoustic Stimulation↗

PubMed1989

Encapsulated subdural hematoma.

In 45 out of 103 cases with chronic subdural hematoma a definite membrane was found. Membranectomy was performed in 37 cases, mostly as a secondary procedure after burr-hole evacuation and closed system drainage. The mortality rate was 6.6% and in the survivors a complete recovery was achieved in 90%. CT monitoring of the diameter of the hematoma and midline shift did not reveal any correlation of size of the hematoma with neurological findings. The indication for membranectomy can, therefore, not be based on radiological findings alone, but on the clinical course of events and with due regard to the CT findings.

Adult↗