0000000000117272
AUTHOR
Th. Wallenfang
Regional cerebral blood flow and regional metabolism in cold induced oedema.
24 hours following a cold induced oedema in cats rCBF was measured in the lesion area, the bluish stained cortex immediately adjacent to the lesion, a cortical area remote from the lesion, and in the contralateral uninjured hemisphere. Thereafter the brain was frozen and the respective tissue areas were removed and analyzed for water and electrolyte content as well as metabolite concentrations. It seems, that in the neighbourhood of a local lesion at least 3 different brain regions can be differentiated with regard to their characteristic pattern of data. In non-oedematous regions either hyperaemia or hypoaemia could be observed. In areas with local brain oedema rCBF was reduced inversely p…
Die ärztliche Aufklärung — Eine Gratwanderung zwischen juristischem Muß und ärztlichem Tun?
Die arztliche Aufklarung — mit den Worten Karl Jaspers — zeichnet sich aus durch die Verantwortung fur die Richtigkeit der Aussage und fur die Wirkung auf den Kranken [7]. Die Problematik dieses sowohl von Juristen als auch von Arzten anerkannten Anspruchs wird besonders deutlich, wenn die Krankheit selbst dem sog. „verstandigen Patienten“ als abstrakte juristische Konstruktion die innere Verarbeitung des Aufklarungsgesprachs versperrt.
Brain Oedema and Intracranial Pressure in Superior Sagittal Sinus Balloon Occlusion. An Experimental Study in Pigs
About 2/3 of all patients with thrombosis of the superior sagittal sinus (SSS) develop signs of increased ICP and/or brain oedema (BE). The time of onset and the spectrum of symptoms in SSS thrombosis vary extremely. This variability might be caused by differences in pathomechanism like BE and rise of ICP, parameters studied in the present contribution.
Experimental Hypertensive Intracerebral Mass Hemorrhage in Cats
About two–thirds of all patients with spontaneous intracerebral hemorrhage suffer from systemic hypertension. Additionally systemic hypertension is the main factor indicating a poor prognosis of intracerebral hemorrhage. This has been shown in our statistical evaluation of 117 cases of conservatively treated spontaneous intracerebral hemorrhage. More than 48% of the hypertensive patients died, but only 30% of the normotensive patients (Fig. 1). In an experimental study we investigated the influence of systemic hypertension and normotension on epidural pressure and on the formation of brain edema during the first 12 h after artificial intracerebral hemorrhage.
Rare sacral space-occupying lesions, their surgical management and reconstructive measures involved
Nine cases of space-occupying lesions of the sacral bone are presented. The problems of the clinical diagnosis, which in many cases comes too late, are discussed together with the indications for surgical treatment in this special group of tumours. The main clues are provided by the changes in the X-rays as well as the more modern imaging techniques (CT and MRI). The surgical technique aims at a most radical tumour removal with preservation of the sacral nerve roots, after which stabilisation of the sometimes weakened pelvic girdle may be necessary. The good prospects of complete removal of these tumours of the sacrum with satisfactory results seem to be very little known and justifies furt…
Tissue elastance and fluid conduction in normotensive and hypertensive intracerebral mass haematomas.
This is an investigation into the prognostic factors of 117 patients with spontaneous normo- and hypertensive intracerebral haematomas, supported by animal experiments. Preserved tissue elastance and fluid conduction enables the drainage of intrinsic haematoma serum into the CSF spaces in normotensive patients, who showed an increased extension of a perifocal hypodensity in the CT. Arterial hypertension decreased the possibility of fluid resolution. Our experimental studies showed that in hypertensive cases the serum remained trapped in the haematoma, which explains the small hypodense area around the haematoma in most of the hypertensive cases. If as an exception in hypertensives of perifo…
Pathomechanism of Brain Oedema in Experimental Intracerebral Mass Haemorrhage
The prognosis of intracerebral haemorrhage is extremely poor when arterial hypertension is present. We investigated elastance of the brain tissue and brain hydraulic conductivity in normotensive (MAP ~ 110 mmHg) and hypertensive (MAP ~ 170 mmHg/angiotensin infusion) cats following a stereotactically produced intracerebral haemorrhage. For 12 hours after the onset of haemorrhage we registered the course of ICP, subsequently the water content of cortex, white matter and basal ganglia as well as the interstitial concentration of serum proteins in the corresponding regions were determined (Evans-Blue, immunofluorescence). Hypertension was associated with a slight increase in ICP and tissue wate…
The Influence of Systemic Hypertension on Intracranial Pressure and Edema Formation in Experimental Intracerebral Hemorrhage
Systemic hypertension is not only the most frequent cause of intracerebral hemorrhage but also the most important complication of this disease. In our clinical investigation of 117 cases almost 70% of the patients suffered from systemic hypertension. Despite advances in diagnosis (Schiirmann, Dei Anang, 1980) mortality of hypertensive patients was 48%. Normotensive hemorrhages showed a better prognosis: only 31% of the patients died and 33% (17% in hypertensive patients) obtained good neurological recovery (Wallenfang et al., 1985).
ICP- and IOP-Effects of Deliberate Hypotension Using Urapidil
Deliberate hypotension is an accepted method to facilitate certain neurosurgical and intraocular procedures. The rationale is to reduce transmural pressure on arterial vessels and thus to facilitate preparation of cerebrovascular aneurysms and malfunctions — or in ophthalmology to reduce the risk of expulsive bleeding (Jantzen and Earnshaw 1988).
Effects of Various Therapeutic Management on Raised Intracranial Pressure and on Dynamics Brain Edema in Brain Abscess Model in Cats
In spite of the improved antibiotic treatment of brain abscess, the mortality remains high, between 30% and 40% (2,3). With the help of effective antibiotic treatment it is possible to bring the inflammatory Part of the lesion under control, but not the space-occupying element which is determined by the inflammatory brain edema. Any improvement in the results will therefore have to wait until an effective antiedematous treatment has also been developed. The aim of our previously described investigations on experimental brain abscess in cats (3) was to demonstrate that only the additional treatment with steroids as well as the antibiotics results in an improvement in the final outcome.
Immunohistochemical Investigation in Experimental Intracerebral Hemorrhage (ICH) and Its Correlation with Findings in Clinical Studies
Since McKissock et al. 1961 investigated the effects of surgical and conservative treatment of ICH on final outcome it is well known that systemic hypertension worsens the prognosis of this serious cerebrovascular disease. Our own studies on this problem have revealed differences in final outcome, as well as in level of consciousness after ICH, between normotensive and hypertensive patients. Whilst 30.6% of the normotensive patients died, 48.1% of the hypertensive patients had a lethal outcome.