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Biomedical subjects

W F Haupt

Publications and source records attributed to W F Haupt.

At least 55 records · Page 3Linked to original sources
PubMed1994

Intraoperative recording of parietal SEP can miss hemodynamic infarction during carotid endarterectomy: a case study.

Serial recording of median nerve somatosensory evoked potentials (SEPs) provides reliable intraoperative information on critical lowering of brain perfusion which compares favorably with other monitoring methods. However, single-channel parietal SEP recording may not detect hemodynamic cerebral infarctions affecting the pre-rolandic area. Following left carotid endarterectomy for high-grade symptomatic stenosis in a 66-year-old male, predominantly motor hemiparesis and aphasia were detected which were largely reversible. Pre- and intraoperative SEPs were normal. Postoperative SEPs showed significant interhemispheric amplitude differences. Postoperative CT examinations demonstrated hemodynamic watershed-type infarctions. This rare complication of carotid endarterectomy was not detected by intraoperative single-channel parietal SEP monitoring.

Aged↗
PubMed1994

Treatment of autoimmune disease by immunomodulation through extracorporeal elimination and intravenous immunoglobulin.

If customary drug mediated immunosuppressive therapy leads to intolerable side effects or is inefficient, extracorporeal elimination and untargeted or targeted immunoglobin therapy modulating the immune response are taken into consideration for the treatment of patients with autoimmune diseases. Both elimination and immunoglobulin therapy, are not alternatives but appear to act complementary, if sequentially applied. Selective immunoadsorption is increasingly applied for extracorporeal elimination and is able to replace plasma exchange therapy. Both, hydrophobic interaction chromatography and affinity chromatography are effective in given clinical conditions. Therapeutic affinity chromatography appears to be superior to hydrophobic interaction chromatography, if an effective, rapid elimination of the disease promoting agent is desired. Experience with therapeutic chromatography collected in the past, indicates that a rapid elimination of immunoglobulins and the subsequent intravenous infusion of 7S immunoglobulin is superior to elimination or untargeted immunomodulation alone. These experimental approaches lead to an extension of the available treatment modalities. However, controlled trials rather than anecdotal reports are needed, to provide substantial information.

Adsorption↗
PubMed1994

Visual evoked potentials in Alzheimer's disease: investigations in a PET-defined collective.

Intravital diagnosis of Alzheimer's disease (AD) based clinical and neuropsychological findings alone does not allow sufficient differentiation from other disorders such as vascular dementia. Positron emission tomography (PET) secures intravital diagnosis with high accuracy by determination of a typical metabolic pattern. Numerous publications have proposed visual evoked potentials (VEP) for the detection of AD. In a collective of 15 patients with probable AD according to NINCDS/ADRDA criteria and the typical metabolic pattern of AD, we examined pattern reversal and flash VEPs. The results were compared to those of an age-matched collective of patients without impairment of memory. Neither pattern reversal nor flash VEP were correlated to severity of dementia as determined by the mini-mental status examination (MMSE). The positive results of other investigators are probably due to different patient selection criteria which do not include findings of cerebral glucose metabolism in the definition of AD.

Aged↗
PubMed1993

Long-term results of carpal tunnel decompression. Assessment of 60 cases.

The long-term prognosis of 60 patients operated on for carpal tunnel syndrome has been assessed in a prospective study with a median follow-up period of 5.5 years (range 2-11 years). Analysis of motor, sensory, trophic, and electrodiagnostic findings and assessment of pain were performed pre- and post-operatively using a standardized grading system. The results were generally favourable with a variable degree of improvement in 86% of cases. Statistical evaluation using multiple Dunn-Rankin tests revealed pain to be the most prominent pre-operative finding. On post-operative re-examination, pain was found to be improved to a significantly greater extent than any other variable. Analysis of several potential prognostic factors showed that pain lasting for more than 5 years prior to surgery indicates a poor prognosis. Only patients with diabetes mellitus exhibited a trend toward less pain relief.

Carpal Tunnel Syndrome↗
PubMed1993

Adsorption therapy with tryptophan-conjugated polyvinyl alcohol gels in 10 patients with acute Guillain-Barré syndrome.

In 10 cases of acute Guillain-Barré syndrome selection adsorption (SEA) of immunoglobulins was performed with IM TR350 columns (Asahi Medical, Japan). During this therapy the symptoms of 8 patients were reduced. Side effects were moderate and not specific for SEA. The columns removed large amounts of immunoglobulins, but also eliminated other plasma components.

Acute Disease↗
PubMed1993

Plasma exchange and selective adsorption in Guillain-Barré syndrome--a comparison of therapies by clinical course and side effects.

Selective adsorption is a new method of treating Guillain-Barré syndrome. Its therapeutic effects and its concomitant side effects were compared between plasma exchange and symptomatic treatment only. The clinical study of three groups of 10 Guillain-Barré patients, each matched for age and maximal disability, was analyzed. Selective adsorption compared favorably with plasma exchange in shortening the time to first improvement and duration of in-hospital treatment. Side effects were similar in both groups. Symptomatic arteriosclerosis should be considered a relative contraindication for selective adsorption.

Adsorption↗
PubMed1993

[The prognostic value of AEP and SEP values in subarachnoid hemorrhage. An analysis of 64 patients].

In 64 patients with confirmed subarachnoid haemorrhage the clinical grading according to Hunt and Hess was compared to the initial findings of BAEP und SEP to elicit possible prognostic statements. Clinical and electrodiagnostic findings showed a high correlation. Patients without or with only slight alterations of amplitude and/or latency generally showed a favourable course. Recurrent haemorrhages or internal complications which can be decisive for outcome cannot be predicted by clinical or electrodiagnostic findings. The alterations of BAEP and SEP increase parallel to severity of clinical findings. Bilateral loss of BAEP or SEP indicates poor prognosis. Prognostic statements can be made with certainty only in cases with primary poor clinical condition (Hunt-Hess Grade IV-V) and marked alterations of evoked potentials.

Adult↗
PubMed1992

Follow-up studies in a case of unusual congenital myopathy, suggestive of nemaline type.

A 20-month-old boy--offspring of consanguinous parents, whose mother presumably had subclinical myopathy--presented with clinical signs of congenital non-progressive myopathy, neurogenic-myogenic electromyographic findings and normal motor conduction velocity. Biopsy of quadriceps muscle showed fiber-type disproportion with hypotrophic type 1, hypertrophic 2A and absent 2B fibers. Subsarcolemmal segmental foci of abnormally, in part regularly arranged bundles of mostly thin myofilaments were found in 13% of hypotrophic type 1 fibers. Rods were seen in only 1 fiber out of 20 tissue blocks. Reexamination 6 years later revealed slightly increased muscle force, myopathic EMG pattern and borderline motor and sensory nerve conduction velocities. Biopsy specimen from deltoid muscle consisted of untypable fibers of varying diameters with jagged Z-lines and increased variability of myofibrillar diameters. Multiple rods were present in 1% of the fibers, the formerly seen segmental foci in 0.1% only. Several intramuscular nerves were normal. The case contributes some new features to the spectrum of congenital myopathies of the nemaline type and suggests different stages of arrested maturation of type 1 fibers at least in this particular case.

Biopsy↗
PubMed1992

Evoked potential monitoring in carotid surgery: a review of 994 cases.

Intraoperative monitoring of brain function is desirable in carotid artery surgery to detect possible complications, but the monitoring methods must be simple to perform, sensitive, and reliable. Median nerve somatosensory evoked potential (SEP) monitoring fulfills these criteria. Between 1985 and 1990, we performed 994 operations of the carotid artery with SEP monitoring. In 92% of the cases, we were able to obtain viable SEP tracings. In seven cases, irreversible SEP loss was followed by a new neurologic deficit. In one case only, neurologic complications ensued without SEP loss. Although immediate intraoperative therapeutic options are limited, the monitoring enhances patient security by allowing intraoperative detection and postoperative analysis of complications. SEP monitoring appears to be at least as effective as conventional EEG monitoring. The viability, sensitivity, and reliability of newer methods, such as modified spectral EEG analysis, must be measured by this established procedure.

Carotid Arteries↗
PubMed1991

[Primary extinct evoked cerebral potentials in the diagnosis of brain death].

In a collective of 82 patients with the clinical signs of brain death and examination of evoked cerebral potentials the incidence of primary abolished evoked potentials was studied. The initial examination occurred at the same time after onset of disease in both groups. We found a marked correlation with the clinical course of the patients. Whereas the group with primary loss of evoked potentials mainly contained patients with intracerebral and subarachnoid hemorrhages and short survival times, the other group with primary preserved evoked potentials showed a high rate of ischemic infarctions and longer survival periods. The rate of primary abolished evoked potentials can be lowered only by routine examination at the earliest time possible. Outside of neurological intensive care units the early examination of evoked potentials is hardly possible. In these units, the EEG remains the technical examination of choice in the confirmation of brain death.

Brain Death↗
PubMed1991

[Acute paraparesis in chronic hepatic disease].

An acuta caude equina syndrome following portacaval shunt in a 64-year-old patient suffering from liver cirrhosis is reported. Diagnosis of a hepatic radiculopathy was confirmed by clinical and electrophysiological findings. A nearly complete remission of the neurological symptoms was achieved by treatment of the primary liver disease. Since there are only a few descriptions of severe hepatic polyneuro- and radiculopathies, the differential diagnosis of hepatic myelopathy is discussed.

Cauda Equina↗
PubMed1990

[Diagnosis and prognosis of acute cerebellar infarcts. A retrospective study].

37 patients with acute cerebellar infarction were analysed retrospectively. Diagnosis of cerebellar infarction cannot be made by clinical symptoms alone rather together with CT and MRT displaying the localisation and size of the lesion. Evoked potentials do predict clinical outcome more accurately than EEG or doppler sonography do.

Adult↗
PubMed1989

[Intraoperative positional damage to the ulnar nerve in anatomic variants].

After laparotomy (for acute abdomen) a 53-year-old woman had signs of pressure damage to the right ulnar nerve at the elbow. On open inspection at surgery 3 1/2 months later the rather deep right ulnar sulcus was markedly narrowed by connective tissue and the ulnar nerve thinned out; an epi- and perifascicular neurolysis was performed. There was no evidence of abnormal mobility of the left ulnar nerve. Nerve function gradually improved. Subsequent expert opinion concluded that adequate protective measures had been taken at the time of laparotomy to avoid positional or pressure damage to the nerve if the anatomy had been normal. - An abnormal mobility of a right ulnar nerve (it could be dislocated at the elbow) was demonstrated in a 35-year-old woman whose right ulnar nerve had been found to be damaged after laparotomy. It is recommended that, in the rare case in which such increased mobility is known preoperatively, the arm should be placed in supination with the elbow extended and carefully padded.

Adult↗
PubMed1989

[Idiopathic facial paralysis: long-term catamnestic study of prognosis and the significance of electrodiagnostic findings].

550 patients suffering from Bell's palsy and examined by electromyography (EMG) as well as electroneurography (ENG) were interviewed in respect of treatment and remission. In more than 80% of the cases it was possible to register volitional activity by EMG as well as to elicit an electroneurographic response. We found a high correlation between electrodiagnostical deficit and degree of recovery. EMG and ENG were equally suitable to assess the severity of damage. The overall prognosis of Bell's palsy was favorable in cases of incomplete lesions. The recovery was probably improved by administration of steroids in the examined group, especially in cases with temporary loss of electroneurographic response.

Electrodiagnosis↗