Biomedical subjects
Publications and source records attributed to S G Zipper.
Posterior encephalopathy (PE) is a rare condition with different origins and unknown pathogenesis. We report on a case of a 16-year-old boy with Crohn's disease who developed PE after peridural anesthesia with ropivacain. A possible connection between PE, ropivacain and Crohn's disease is discussed on the basis of the current literature.
Nowadays spinal cord anesthesia is, when indicated, a standardized and acknowledged medical procedure with a low complication rate. This is also true of neurological after-effects, like spinal paralysis, which are greatly feared, especially by medical laymen. In the following case report we describe a charge against anesthesiologists, who were accused of causing a conus-cauda syndrome after spinal cord anesthesia. Neurological examinations led to the diagnosis of an anesthesia-independent Tethered-Cord-Syndrome (TCS). In most cases the patients' fear can be alleviated by clear explanations about the method. The indication for the method of anesthesia is also based on a thorough body examination. If the documentation of the treatment is faulty or incomplete it can be used against the physician facing a lawsuit more easily. The aim of this case report is to remind anesthesiologists of the rare TCS and to emphasise again the importance of using standardized procedures and correct documentation, which can be very helpful for the physician facing unjustified claims in case of medical litigation.
Irritation of superficial nerves is known to be a frequently ocurring and quickly healing side effect in the sclerosing of varicose veins. Persistent severe neuropathy is a rarely seen complication, although the generally used substance, aethoxysclerol (polidocanol, chemical name polyethylenglycolmonododecylether), has a neurotoxic potential. Whether a nerve lesion appears or not depends as well on the concentration and quantity of the applied medicament and on the distance between the nerve and the place of drug administration. Intravaricose, intraarterial and paravasal injection can cause nerve damage. In a single case report the pathophysiology, clinical course and neurophysiological findings of a subtotal lesion of a profound peroneal nerve at the back of the foot is described as a rarely occurring but typical complication of sclerosing varicose veins. Medicolegal aspects are especially considered.
BACKGROUND: Livedo reticularis generalisata (LR) in combination with affection of CNS is referred to as Sneddon's syndrome (SNS). Latest data suggest chronic progressive systemic disorder with occlusion of small and medium sized vessels (e.g., cutis, brain, kidneys, heart, eyes). No conclusive etiology is known, though there are correlations to the antiphospholipid syndrome, systemic secondary vasculitis and coagulopathies. Hereditary and toxic factors seem to play a role in pathogenesis in some cases. CASE REPORT: Diagnostic procedure and clinical course of a 56-year-old woman with dementia and hemiparesis proceeded by LR is reported. MRI-, SPECT- and TCD-findings were congruent with diffuse ischemic lesions of the brain due to affection of small- and medium-sized vessels. Histopathological specimens of the brain, meninges and cutis were non diagnostic. Some laboratory findings suggested vasculitis as an underlying cause. LR improved under immunosuppressive therapy with prednisolone and azathioprin. CONCLUSION: SNS does not seem to be a nosological entity. A differentiation between primary (idiopathic) and secondary SNS is useful for different therapeutical approaches.
AIM: In Germany computer-assisted hip replacement (CAHR), e. g., ROBODOC, has been carried out in several thousand cases. After a period of enthusiasm, the technique now faces growing resistance from both patients and physicians. After CAHR many patients complain about persistent pain and problems with walking. Due to these problems, patients very often ask whether they have a nerve injury. In general, it is important to know whether or not there is a specific risk of nerve injuries with CAHR. At present neurological data are inconsistent, and neurophysiological studies have not yet been reported. METHODS: We have analysed a case series of 29 patients after CAHR with ROBODOC in 30 operated joints. All patients underwent a systematic neurological and neurophysiological examination. RESULTS: In 3 out of 30 operated sites functionally relevant nerve injuries were found, which led to disability in the first year after surgery. Permanent disability due to nerve injury was not found. CONCLUSION: There is no evidence of a specific risk of nerve injury after CAHR. The incidence of partial and transient nerve damage in the first year after operation might be higher than in classical hip replacement (3.1 %).