Biomedical subjects

Ralf D Rothoerl

Publications and source records attributed to Ralf D Rothoerl.

6 recordsLinked to original sources

PubMed2005

A large, erosive intraspinal and paravertebral gout tophus. Case report.

Symptomatic gout tophi of the spine are a rare but well-characterized complication of tophaceous gout. The authors report the case of a 29-year-old previously healthy man who presented with L-5 radiculopathy. Lumbar magnetic resonance (MR) imaging revealed a 4.5 x 4.5 x 2.8-cm large gout tophus mimicking a malignant spinal tumor or abscess. The tophus completely destroyed both L-4 and L-5 facet joints and the left L-4 lamina and spread epidurally from L-3 to L-5, compressing the left L-5 nerve root. There has been no similar case reported so far with respect to the extent of bone destruction. The authors describe the case history and present intraoperative, MR imaging, and histological findings.

Abscess↗

PubMed2003

Level of evidence and citation index in current neurosurgical publications.

Systematic clinical reviews or meta-analyses offer scientifically valid sources of clinical information. They provide information in a concise form and can contribute to clinical quality management. Such studies, however, are only able to reflect the quality of the articles reviewed. The aim of this study was to evaluate the quality of the neurosurgical literature according to evidence-based medicine (EBM) standards. We reviewed all articles published in 1999 in three major neurosurgical journals. These articles were subdivided according to the level of evidence (LOE) scale (from 0 to V), article type, and citation index. Nine hundred eighty-two articles were published in these journals in 1999. Of these, 346 (35%) were clinical studies, 287 (29%) case reports, 153 (16%) experimental studies, 122 (13%) technical reports, and 74 ( 8%) other types. Subdivision according to LOE was: Ia 0.3%, Ib 2.5%, IIa 0.2%, IIb 4.3%, IIc 9.5%, IIIa 0.1%, IIIb 3.9%, IV 22.4%, and V 1.6%. Fifty-five percent of all published studies were case reports, experimental studies, technical reports, or others and thus could not be subdivided according to the EBM standards. The number of articles published with high LOE seems to be rather low in 1999. If these data reflect overall publication practice, it seems unclear whether enough articles with high LOE are published to propose scientifically sound clinical treatment suggestions according to EBM standards.

Abstracting and Indexing↗

PubMed2002

The value of routine electroencephalographic recordings in predicting postoperative seizures associated with meningioma surgery.

We analyzed the incidence of postoperative seizures in patients undergoing craniotomy for meningioma removal in order to determine whether EEG recordings are able to predict the incidence of postoperative seizures. We included 102 patients who had undergone surgery on intracranial meningiomas. Pre- and postoperative EEG images were divided into groups showing epileptiform activity including spikes or sharp waves, focal slowing, and normal activity. Follow-up was carried out using a standardized telephone questionnaire by an independent investigator after a mean of 889 days. Seizure outcome was determined by patient reports to the interviewer. Preoperatively obtained, abnormal EEGs correlated significantly to preoperative seizures (P<0.0005), but neither preoperative nor postoperative EEGs correlated to the incidence of postoperative seizures. It would seem that, while evaluation of some clinical parameters revealed a statistically significant correlation, pre- and early postoperative EEGs after meningioma surgery are not useful in determining the risk of postoperative seizures.

Adult↗

PubMed2002

When should conservative treatment for lumbar disc herniation be ceased and surgery considered?

Different authors recommend different time spans for conservative treatment before considering surgery in patients suffering from lumbar disc herniation. We analyzed the time of onset of symptoms such as pain, sensory deficit, and motor deficit in a surgically treated group in comparison to outcome after surgery in order to define a time threshold when surgical results deteriorate and operation should therefore be considered. General data, symptoms, signs, and neurological findings of 219 patients were preoperatively recorded. The outcome was evaluated according to the Prolo scale after a mean of 9.9 months. In the statistical workup, we calculated the duration of symptoms, sensory deficits, and motor deficit as continuous variables. Additionally, the population was divided into three groups of duration of symptoms, sensory deficit, or motor deficit for < or = 30 days, 30-60 days, and >60 days. Statistically significant predictors for unfavourable outcome were, for example, a longer duration of preoperative pain and motor and sensory deficit. Patients suffering for more than 60 days from disc herniation were found to have statistically worse outcome than patients suffering for 60 days or less. Findings were similar for the different time groups concerning the duration of sensory deficit but not for duration of motor deficit. The overall outcome seems to be better when patients are operated on for lumbar disc herniations within 2 months after onset of symptoms and sensory deficits. Due to these findings, we recommend conservative treatment up to 2 months and, if conservative management does not succeed, consideration of surgery.

Adolescent↗

PubMed2002

Does bungee jumping release S-100B protein?

The S-100B protein is a recognised indicator of traumatic brain damage, but the impact threshold at which S-100B is released into serum still remains unknown. The aim of the study was to investigate whether moderate shear forces are able to release S-100B into serum in people who did a bungee jump. Eleven healthy probands jumped from a height of 50 microm and were exposed to an acceleration of about 2.8 g. Blood samples were drawn before the jump, immediately after and 71 min (mean) after the jump. The initial serum values of S-100B of all probands were normal (mean 0.22 microg/l). Also the serum values directly after and 71-min (mean) after the jump showed no increase of S-100B (0.22 microg/l and 0.23 microg/l, mean). This finding indicates that a moderate acceleration and deceleration force to the brain does not activate the release of the protein S-100B into the serum.

Acceleration↗

PubMed2002

Comparison of near-infrared spectroscopy and tissue p(O2) time series in patients after severe head injury and aneurysmal subarachnoid hemorrhage.

Monitoring of local oxygen pressure in brain white matter (tip(O2)) and of local hemoglobin oxygen saturation (rS(O2)) with near-infrared spectroscopy (NIRS) are increasingly employed techniques in neurosurgical intensive care units. Using frequency-based mathematical methods, the authors sought to ascertain whether both techniques contained similar information. Twelve patients treated in the intensive care unit were included (subarachnoid hemorrhage, n = 3; traumatic brain injury, n = 9). A tip(O2) probe and an NIRS sensor were positioned over the frontal lobe with the most pathologic changes on initial computed tomography scan. The authors calculated coherence of tip(O2) and rS(O2) ts overall density distribution, its distribution per data set, and its time evolution. The authors identified a band of significantly correlated frequencies (from 0 to 1.3 x 10(3) Hz) in more than 90% of the data sets for coherence and overall density distribution. Time evolution showed slow but marked changes of significant coherence. By means of spectral analysis the authors show that tip(O2) and rS(O2)signals contain similar information, albeit using completely different registration methodologies.

Adolescent↗