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Biomedical subjects

W Winkelmüller

Publications and source records attributed to W Winkelmüller.

At least 19 recordsLinked to original sources
PubMed2001

[The epifacial electric stimulation of the occipital nerve in cases of therapy-resistant neuralgia of the occipital nerve].

BACKGROUND: The term "neuralgia of the occipital nerve" in clinical work includes different kinds of pain in the occipital region. Correctly, this diagnosis should be reserved for such pain syndromes which, corresponding to the definition of neuralgia, are due to damage of the cervical roots C1-C3 or of the major occipital nerve arising from those roots. We introduce an operative method to treat chronic therapy-resistant headaches in the area of the major and minor occipital nerve. The courses of three of the first patients operated in our hospital are described. METHODS: An electrode with four poles is positioned epifacially in the area of the affected nerve in local anaesthesia. In cooperation with the patient the correct position of the electrode and the right poling have to be found. Afterwards, the electrode is externalized after subcutaneous tunneling. For several weeks, the patients stimulate while being at home. If they report about a satisfactory reduction of pain, a subcutaneous receiver for use with an external stimulator is implanted. RESULTS: Most of the patients who received an electrode had a satisfying reduction of pain of 50-100% during the testing period so that the receiver was implanted. We had no success in two patients whose occipital nerves were destroyed by previous operations so that the system was explanted. CONCLUSIONS: The epifacial stimulation of the occipital nerve is an effective method to treat neuralgia of this nerve. Patients with destruction of the nerve have to be excluded, because in their cases the stimulation does not work.

Adult↗
PubMed1997

Clinical realities and economic considerations: efficacy of intrathecal pain therapy.

Studies of analgesia in cancer patients have revealed that intrathecal administration of opioids can deliver potent analgesia with fewer systemic side effects than equivalent doses of systemic opioids. In addition, several trials have examined the safety and efficacy of this modality in patients with pain of nonmalignant origin. In one survey of 35 physicians involving 429 patients treated with intrathecal therapy, physician reports of global pain relief scores were excellent in 52.4% of patients, good in 42.9%, and poor in 4.8%. In another study of 120 patients, the mean pain intensity score had fallen from 93.6 to 30.5 six months after initiation of therapy. In both studies, patients reported significant improvement in activities of daily living, quality of life measures, and satisfaction with the therapy. Constipation, urinary retention, nausea, vomiting, and pruritus are typical early adverse effects of intrathecal morphine and are readily managed symptomatically. Other potential adverse effects include amenorrhea, loss of libido, edema, respiratory depression, and technical issues with the intrathecal system.

Analgesics, Opioid↗
PubMed1996

Long-term effects of continuous intrathecal opioid treatment in chronic pain of nonmalignant etiology.

In the present retrospective investigation, the long-term effects of continuous intrathecal opioid therapy via implantable infusion pump systems were examined in 120 patients with chronic, nonmalignant pain syndromes. The follow-up period was 6 months to 5.7 years (mean 3.4 years +/- 1.3 standard error of the mean). Deafferentation pain and neuropathic pain showed the best long-term results, with 68% and 62% pain reduction (visual analog scale), respectively. The mean morphine dosage initially administered was 2.7 mg/day (range 0.3-12 mg/day); after an average of 3.4 years, it was 4.7 mg/day (range 0.3-12 mg/day). In a long-term observation of 28 patients who received intrathecal morphine for longer than 4 years. 18 patients (64.3%) had a constant dosage history and 10 patients (35.7%) showed an increase in morphine dosage to more than 6 mg/day 1 year after dosage determination. In seven cases, a tolerance developed: in four patients the tolerance was controlled by means of "drug holidays"; but in three patients it was necessary to remove the pump systems. Explantation of the pump system occurred in 22 additional cases for other reasons. Throughout the follow-up period, 74.2% of the patients profited from the intrathecal opiate therapy: the average pain reduction after 6 months was 67.4% and, as of the last follow-up examination, it was 58.1%. Ninety-two percent of the patients were satisfied with the therapy and 81% reported an improvement in their quality of life. The authors' 6-year experience with administration of intrathecal opioid medications for nonmalignant pain should encourage the use of this method in carefully selected patients.

Dose-Response Relationship, Drug↗
PubMed1993

[Primary intracerebral non-Hodgkin's lymphoma--a clinicopathologic study].

Primary cerebral lymphomas (PCL) were diagnosed with increasing frequency also in our retrospective study of 44 patients. Clinically these tumors presented with signs of a rapidly growing brain neoplasm. The analysis of CCT data showed that the tumors were of varying density before and showed mostly (60%) homogeneous enhancement after contrast medium application. MR imaging was more sensitive, but could not aid in distinguishing PCL from other brain tumors. The lesions lay mainly (82%) in the supratentorial space and involved the frontal lobe in 42% of cases. Only 16% were located in the periventricular region including corpus callosum and basal ganglia. 20% of cases showed multiple lesions. Suspected diagnoses were therefore mainly meningeoma, glioma and metastases. Morphological diagnosis was easily possible with the aid of immunohistological methods: there were 41 B-cell lymphomas (93%), two T-cell lymphomas and one large cell anaplastic lymphoma of the non-B non-T phenotype. An unequivocal correlation between morphology and radiological picture existed in the way that tumors with a dense cellular infiltrate appeared mainly as hyperdense lesions with homogeneous contrast enhancement. The clinical course was characterized by CNS-relapses frequently with multiple cerebral lesions and a spinal recurrence in one case. 7% of cases showed evidence of extracerebral disease in a bone marrow biopsy specimen or at autopsy. The average survival of the patients was 15 months, one year survival was 36%, two year survival 12% and 5% of patients lived for more than 5 years.

Adult↗
PubMed1990

[Classification of trigeminal neuralgia and its effect on the results of surgical treatment].

The trigeminal neuralgia has to be differentiated from the trigeminal neuropathy in respect of pain character and etiology. The neuralgia is characterized by paroxysmal pain evoked by trigger stimuli. The most frequent cause of this type of pain is a parapontine vascular compression of the trigeminal root without neurological deficits. The symptoms of neuropathy are some sensory loss associated with continuous pain resulting from peripheral damage of the trigeminal nerve. This distinction alleviates the indication for specific operative procedures and is more precise than the subdivision in typical and atypical neuralgia. The results of neurovascular decompression and thermorhizotomy can be much improved if neuropathic pain syndromes are excluded from operation. Out of 180 patients suffering from trigeminal neuralgia 94% were pain-free after neurovascular decompression and 96% of 144 patients following thermorhizotomy. For the treatment of continuous neuropathic pain augmentative electrostimulation of the Gasserian Ganglion via implanted electrodes is recommended.

Adult↗
PubMed1985

[Treatment of deafferentation pain by high-frequency intervention on the dorsal root entry zone].

From August 1980 to May 1981, high-frequency lesions of the dorsal root entry zone of the spinal cord were performed on 35 patients with chronic deafferentiation pains. Among them were 15 patients with traumatic transverse cord lesions, 5 with non-traumatic transverse lesions and 7 with cervical root tears or traumatic brachial plexus lesions, 6 with stump or phantom pain after amputation, and 1 each with sciatic paralysis or spinal arachnopathy. Treatment results were best in complete transverse lesions, cervical root avulsion and brachial plexus lesion, less so for stump or phantom pain of the lower extremities. It failed in patients with sciatic-nerve lesion and arachnopathy. Thus best results are to be expected if the method is limited to genuine deafferentiation pain.

Adult↗
PubMed1985

Phantom phenomena (phantom arm) following cervical root avulsion. Effect of dorsal root entry zone thermocoagulation.

We report on nine male patients with cervical root avulsions and brachial plexus injuries following traffic accidents. These non-amputees (mean age 33.7 years) had a phantom arm beside the paralysed arm. Cervical root avulsions were demonstrated either by myelography or surgically. Mostly the roots C5-Th1 were affected. Eight of the nine patients had Horner's syndrome on the side of the root avulsion. The phantom arm appeared immediately after the accident, except in one patient who was symptom-free for 2 weeks. In two cases the phantom arm disappeared spontaneously. Four patients underwent a DREZ lesion. After surgery the phantom arm disappeared, and three of the patients became painfree, while one patient experienced pain relief of 20% to 50%. Reviewing the literature it is assumed that phantom limb following injury to the brachial plexus indicates cervical root avulsion. In such cases Horner's syndrome is a good indication for lower cervical root avulsion (C8-Th2).

Accidents, Traffic↗
PubMed1982

[On the biological behaviour of the rare malignant plexus papilloma in childhood: long-term observations in two operated cases].

Only a few verified cases of malignant papilloma of the choroid plexus have been described in the literature. The biological nature and prognosis of those tumours are not well known. Two cases of our own material are presented in whom large tumours of the lateral ventricles have been removed. One patient was 9 months and the other seven years old at the time of operation. The clinical follow-up period was seven years. Computer-tomography controls did not reveal any sign of recurrence. The published cases are reviewed until 1981. Their clinical aspects, the histological features and the nature of these rare tumours are discussed.

Cerebral Ventricle Neoplasms↗
PubMed1977

[The influence of permanent cerebellar stimulation on senso-motor disorders in cerebral palsy (author's transl)].

Based on Cooper's good results implantation of a bilateral cerebellar stimulator was performed in 2 children with cerebral palsy. The patients suffered from marked hypertonia of all limbs and involuntary movements. The follow-up study of 8 months revealed a decrease of spasticity and a progressive improvement of fine motor control. Our preliminary results justify the clinical application of cerebellar stimulation for functional treatment of sensory-motor disorders.

Adolescent↗
PubMed1975

Ventral midbrain stimulation, blood pressure responses and their relation to the dopaminergic nigro-striatal pathways.

In 40 cats systematic, electrical stimulation of ventral midbrain structures was performed. In the lightly anaesthetised animals, fixed in a stereotaxic frame, ECoG and arterial blood pressure were registrated. As a result stimulation-induced phasic blood pressure increases have been found within a distinct area including substantia nigra and ventral tegmentum. From the same region nonspecific responses in the ECoG (spindling, recruiting and desynchronisation by low and middle frequent stimulation) could be obtained. The blood pressure responses were enhanced after hemisection at the level of the posterior hypothalamus ipsilateral to the stimulation side. Drugs (Haloperidol, alpha-methyltyrosin and 6-hydroxydopamine), affecting the dopamine metabolism in different ways, abolished the stimulation-induced blood pressure responses. In agreement with previous findings it is concluded that motor and autonomic activation, elicited in ventral midbrain structures are mediated by catecholaminergic transmission.

Animals↗