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  • 1
    Electronic Resource
    Electronic Resource
    25-hydroxyvitamin D, 24, 25-dihydroxyvitamin D and 1,25-dihydroxyvitamin D in human cerebrospinal fluid (1984)
    Springer
    Journal of molecular medicine 62 (1984), S. 1086-1090 
    Details
    ISSN: 1432-1440
    Keywords: Vitamin D metabolites ; Cerebrospinal fluid
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Samples of CSF and plasma were obtained simultaneously from 46 adult patients who had no endocrine disorders and were undergoing routine diagnostic lumbar puncture because of suspected or proved prolapse of a disc. Concentrations of 25-OHD, 24,25(OH)2D and 1,25(OH)2D were measured. The samples were purified by column chromatography and fractionated by HPLC. In the appropriate fractions the vitamin D metabolites were measured by PBA, and cytoreceptor assay. The results were as follows (median, range in brackets): 25-OHD in CSF 8.3 ng/ml (2.0–24.8), in plasma 14.5 ng/ml (7.0–36.0). 24,25(OH)2D in CSF 1.8 ng/ml (0.3–4.6) and 2.5 ng/ml (0.4–4.7) in plasma. 1.25(OH)2 D in CSF 25.0 pg/ml (2.2–39.0) and 31.0 pg/ml (10.1–55.0) in plasma. The correlations between plasma and CSF concentrations were as follows: 25-OHDr=0.479 (P〈0.001); 24,25(OH)2Dr=0.815 (P〈0.001) and for 1.25(OH)2Dr=0.497 (P〈0.001). Our findings showed vitamin D metabolites to be present in human CSF.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01711378
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  • 2
    Electronic Resource
    Electronic Resource
    Radiological Investigations and Intra-operative Evoked Potentials for the Diagnosis of Nerve Root Avulsion: Evaluation of Both Modalities by Intradural Root Inspection (1998)
    Springer
    Acta neurochirurgica 140 (1998), S. 527-531 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Brachial plexus injuries; intradural inspection; CT-myelography; intra-operative electrophysiology.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  Fourteen patients with traumatic brachial plexus injuries underwent intradural inspection of cervical nerve roots to evaluate radiological and intra-operative electrophysiological findings concerning cervical nerve root avulsion from the spinal cord. Four neurosurgeons of our department assessed independently from each other both myelography and CT-myelography concerning intradural nerve root lesions. Each neurosurgeon assessed a total of 26 cervical nerve roots. Two investigators assessed 6/26 and 2 investigators 7/26 nerve roots falsely concerning ventral or/and dorsal root lesions compared with the findings on intradural inspection (23% and 27% false findings). There was a considerable variance concerning the assessibility and findings among the 4 neurosurgeons. Reconstructive surgery was performed after a mean interval of 6.5 months following trauma and 2 weeks following intradural inspection. After exposure of the brachial plexus and the cervical nerve roots in question via a ventral approach, 13 cervical nerve roots were stimulated electrically close to the neuroforamen and cortical evoked potentials (root-SEPs) were recorded from the contralateral postcentral region. All 5 roots with SEPs were intact (no root lesion) and all 8 roots without SEPs showed interrupted (ventral or/and dorsal) rootlets on intradural inspection. Our results demonstrate that false radiological findings concerning root lesions are possible. Intra-operative root-SEPs seem to be a useful aid for evaluation of cervical nerve root lesions. However, more electrophysiological data are necessary to ascertain, if this modality is able to replace intradural inspection in unclear radiological cases in the future.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050136
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  • 3
    Electronic Resource
    Electronic Resource
    Results of DREZ coagulations for pain related to plexus lesions, spinal cord injuries and postherpetic neuralgia (1996)
    Springer
    Acta neurochirurgica 138 (1996), S. 364-369 
    Details
    ISSN: 0942-0940
    Keywords: Pain ; DREZ lesion ; plexus lesions ; postherpetic neuralgia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The results of 58 dorsal root entry zone (DREZ) thermocoagulation procedures in 51 patients are reported. The postoperative analgesic effect was judged by the patients as being good (more than 75% pain reduction), fair (25–75% pain reduction) or poor (less than 25% pain reduction). Of the 14 patients who underwent surgery for pain due to cervical root avulsion, 10 (77%) had permanently good (8) or fair (2) pain relief after a mean follow up period of 76 months, another 2 (15%) experienced recurrence to the pre-operative level (initially 1 good, 1 fair) after more than 2 and 4 years, respectively. Twenty two paraplegics were operated upon, 3 of whom twice, for intractable pain. After a mean observation time of 54 months, continuing pain relief was reported by 12 (55%) patients (11 good, 1 fair), and one (initially fair) had recurrent pain after 8 months. All 3 (early) re-operations remain successful for an average period of 75 months. Poor results were seen especially in cases of associated spinal cord cysts (5 out of 7), despite combined drainage, and in patients with diffuse pain distribution (5 out of 6). Continuous marked improvement for longer periods (mean follow up: 52 months) after DREZ lesions was reported only by 2 out of 10 patients with postherpetic neuralgia (12 procedures) and by 1 out of 5 with painful states due to radiation-induced brachial plexopathy (2), previous surgery (2) and malignant tumour infiltration of the brachial plexus (1). Three patients died postoperatively due to acute cardiac failure (2) and pulmonary embolism (1). Major complications, especially permanent gait disturbances were observed in 6 patients (12%) following primary procedures and in 2 out of 7 patients after re-operations, most of them suffering from postherpetic neuralgia. Minor neurological deficits were noted in 9 cases (18%). DREZ lesions revealed to be an effective procedure in patients with pain related to root avulsion and paraplegia. In contrast, it seems to be less successful for painful states due to other plexus lesions or postherpetic neuralgia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01420297
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  • 4
    Electronic Resource
    Electronic Resource
    Intra-operative electrophysiological diagnosis of spinal root avulsion during surgical repair of brachial plexus stretch injuries (1997)
    Springer
    Acta neurochirurgica 139 (1997), S. 238-239 
    Details
    ISSN: 0942-0940
    Keywords: Brachial plexus stretch injury ; root avulsion ; intraoperative electrophysiology ; direct root SEPs ; peripheral nerve surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Intra-operative direct root-SEPs combined with evoked muscle action potentials (EMAPs) from neck muscles are presented as helpful tools for evaluation of anterior and/or posterior spinal root avulsion from the spinal cord during surgical management of brachial plexus stretch injuries.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01844758
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  • 5
    Electronic Resource
    Electronic Resource
    Laminar and Arch Fractures with Dural Tear and Nerve Root Entrapment in Patients Operated upon for Thoracic and Lumbar Spine Injuries (1998)
    Springer
    Acta neurochirurgica 140 (1998), S. 114-119 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Spine fractures; lamina fracture; dural tear; root entrapment; neurological deficit
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Objective: To determine the neurological outcome in patients with laminar fractures associated with dural tears and nerve root entrapment, operated upon for thoracic and lumbar spine injuries. Patient population: Out of 103 patients operated upon consecutively for thoracic and lumbar spine injuries during the period 1990 to 1994 inclusive, 24 (23.3%) patients had laminar fractures out of whom 3 (2.9%) had an associated dural tear and an other 17 (16.5% or 70.8% of the total patients with laminar fractures) had an associated dural tear and nerve root entrapment. Results: Twelve (70.5%) patients had injury at the thoraculumbar junction, 13 (76.5%) had Magerl's type A3 or above, 10 (58.8) had a kyphotic angle deformity greater than 5°. Seven (41.1%) had their spinal canal's sagittal diameter reduced by at least 50% and two had dislocations. Nine (52.9%) had initial neurological deficits. Four (50%) out of 8 patients with no initial neurological deficits (Frankel E) worsened to Frankel D. However, one patient among the 3 with initial Frankel A improved to Frankel C while both patients with initial Frankel C usefully improved to final Frankel grades D and E respectively. Two of the four patients with initial Frankel D improved to Frankel E, the other 2 remaining unchanged. All in all five patients' neurological status improved, 4 worsened and 8 remained unchanged after neurosurgical treatment. Conclusions: Vertical laminar fractures with dural tears and nerve root entrapment represent a special group of thoracic and lumbar spine injuries that carry a poor prognosis. However, special operative precautions lead to significant improvement in some of them although a majority remain unchanged or even worsened.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050071
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  • 6
    Electronic Resource
    Electronic Resource
    Erfahrungen mit der endoskopischen Operation zur Behandlung des Karpaltunnelsyndroms Vorläufige Ergebnisse einer prospektiven Studie (1997)
    Springer
    Der Nervenarzt 68 (1997), S. 503-508 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Karpaltunnelsyndrom ; Endoskopische Operation ; Key words Carpal tunnel syndrome ; Endoscopic technique
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Endoscopic carpal tunnel release is a new technique for treatment of carpal tunnel syndrome. The benefits of this procedure are a small skin wound with less local pain, the fact that the hand can quickly be used again, and earlier return to work or other activities. We present the preliminary results of the 3-month follow-up of 88 patients out of a prospective study of 100 patients. All patients were operated on using the one-port technique. Six additional decompressions had to be abandoned and open release was performed. Of the patients with pain, 73.6% (68/88) were completely pain-free and in 13.2% (9/68) pain improved by more than 50%. Subjective symptoms like paresthesia and numbness of the hand disappeared completely in 77.2% (64/83). Sensory deficits disappeared in 50% (33/66). Ten of 17 patients with preoperative paresis of the abductor pollicis brevis muscle and 11/14 with paresis of the opponens pollicis muscle had normal motor function 3 months after the operation. The complication rate concerning nerve lesions was 2.3%. The return to work time was 21 days (range 3–49 days). According to clinical symptoms, our preliminary results do not seem to have any benefits compared to the conventional open technique, and the costs for the endoscopic procedure are markedly higher. The complication rate after the learning curve period is approximately the same as open carpal tunnel release.
    Notes: Zusammenfassung Die endoskopische Spaltung des Lig. carpi transversum stellt heute ein neues Verfahren in der Behandlung des Karpaltunnelsyndroms dar. Vorteile dieser Methode sollten kleine unauffällige Narben mit weniger lokalen Schmerzen, schnellere Gebrauchsfähigkeit der Hand und kürzere Arbeitsunfähigkeit sein. Die vorläufigen Ergebnisse der Nachuntersuchung von 88 Patienten 3 Monate nach endoskopischer Spaltung des Retinaculum flexorum werden vorgestellt. Sie sind Teil einer prospektiven Studie von 88 Patienten. Alle Patienten wurden nach der monoportalen Technik operiert. Bei 6 zusätzlichen Patienten mußte die endoskopische Operation in eine offene umgewandelt werden. 73,6% (68/88) der Patienten mit Schmerzen waren postoperativ schmerzfrei, und in weiteren 13,2% (9/68) besserten sich die Schmerzen mehr als 50%. In 77,2% (64/83) wurden die subjektiven Parästhesien und sensiblen Störungen ganz beseitigt. Die objektiven sensiblen Störungen waren in 50% (33/69) vollständig zurückgebildet. Die Kraft normalisierte sich bei 10 von 17 Patienten mit Paresen des M. abductor pollicis brevis und bei 11/14 des M. opponens pollicis. In 2,3% kam es zu iatrogenen Nervenläsionen. Die Arbeitsunfähigkeit betrug im Durchschnitt 21 Tage (3–49 Tage). Unsere bisherigen Ergebnisse zeigen bezüglich des klinischen Bildes keine Vorteile gegenüber der konventionellen Operation, bei allerdings deutlich höheren Operationskosten. Die Komplikationsrate liegt nach der Lernkurve annähernd gleich mit der der offenen Operation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050153
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  • 7
    Electronic Resource
    Electronic Resource
    Juxtafacettenzysten als raumfordernde intraspinale Prozesse (1997)
    Springer
    Der Nervenarzt 68 (1997), S. 515-520 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Juxtafacettenzysten ; Intraspinal ; Nervenwurzelkompression ; Key words Juxta-facet cysts ; Intraspinal ; Nerve root compression
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Ganglionic and synovial cysts (juxta-facet cysts) causing nerve root compression are very rare. Magnetic resonance imaging is the best means of diagnosis. The treatment of choice is surgical removal of the cysts, though spontaneous remissions do occur. CT-guided aspiration of the cysts and corticosteroid injection can lead the symptoms to disappear, but only for a short time. In a retrospective study covering a period of 16.5 years, we discovered 24 juxta-facet cysts (10 ganglionic and 14 synovial cysts) with clinical symptoms in a total of 19,107 lumbar and thoracic operations performed to relieve nerve root compression: 16 cysts were located at the level L4–5, 3 at the level L5–S1, 2 at L3–4, and 1 each at the levels L2–3, L1–2, and T10–1. Seven patients complained of radicular pain, and the other 17 patients also had neurological deficits. Fourteen cysts were resected, and in 10 cases the lumbar disc was removed simultaneously. The average follow-up in 23 of the 24 patients was 26.6 months. Most (74%) of the patients became free of pain. Pareses disappeared in 89% and sensory deficits in 73% of cases.
    Notes: Zusammenfassung Intraspinale Ganglien- und Synovialzysten (Juxtafacettenzysten) mit Nervenwurzelkompression sind extrem selten. Ihr Nachweis gelingt am besten mit der Kernspintomographie. Die Behandlungsmethode der Wahl ist die operative Resektion der Zyste. Es gibt aber auch spontane Remissionen dieser Zysten. Durch eine CT-gestützte Kortikosteroidinjektion werden die Symptome in der Regel nur passager behoben. In einer retrospektiven Studie über einen Zeitraum von 16,5 Jahren fanden wir unter 19107 operierten lumbalen und thorakalen Wurzelkompressionssyndromen 24 Juxtafacettenzysten (10 Ganglien- und 14 Synovialzysten). 16 waren im Segment L4/5, 3 im Segment L5/S1, 2 im Segment L3/4 und je 1 in den Segmenten L2/3, L1/2 und Th10/11 lokalisiert. 7 Patienten hatten nur radikuläre Schmerzen, die restlichen 17 zusätzlich neurologische Störungen. Bei 14 Patienten wurde nur die Zyste entfernt, bei 10 Patienten zusätzlich die Bandscheibe ausgeräumt. 23/24 Patienten konnten zwischen 6 Monaten und 10 Jahren (Durchschnitt 26,6 Monate) untersucht werden. 74% der Patienten waren radikulär schmerzfrei. In 89% der Fälle bildeten sich die motorischen und in 73% die sensiblen Störungen vollständig zurück.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050155
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  • 8
    Electronic Resource
    Electronic Resource
    Die lumbale Spinalkanalstenose und ihre operative Behandlung (1998)
    Springer
    Der Nervenarzt 69 (1998), S. 306-311 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Lumbale Spinalkanalstenose ; Operative Therapie ; Key words Lumbar spinal stenosis ; Surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Today lumbar spinal stenosis can stand on its own as a clinical entity that can be radiologically and clinically divided into central and lateral stenosis. Foraminal stenosis is a special form of the latter. During the period 1990–1991 we operated on 148 patients for spinal stenosis. Using a standardized questionnaire, 109 patients were evaluated on their pain and gait status 3 years after the operation. Patients with previously known spondylolisthesis or degenerative instability were excluded from the study. Forty-four out of 109 patients were free of pain, while significant reduction of pain was noted in 35/109 patients. In 19 patients, the pain remained the same or worsened postoperatively. Seventy-four out of the 109 patients had no gait disturbances, whereas only 14/109 worsened postoperatively. Six patients could walk with support and seven patients were unable to walk because of other disturbances. Because of unclear responses, the status of the remaining patients could not be completely evaluated in either group.
    Notes: Zusammenfassung Die lumbale Spinalkanalstenose gilt heute als eigenständiges Krankheitsbild. Man unterscheidet klinisch und radiologisch 2 Formen, die zentrale und die laterale Spinalstenose. Die Foramenstenose ist eine Sonderform der lateralen Stenose. Bei 109 von 148 Patienten, die wegen einer Spinalstenose in den Jahren 1990 und 1991 operiert wurden, wurde 3 Jahre nach der Operation anhand eines standardisierten Fragebogens der aktuelle Zustand bezüglich Schmerzen und Gehfähigkeit erfaßt. Patienten mit nachgewiesener Spondylolisthese oder degenerativer Instabilität waren ausgeschlossen. 11/109 Patienten machten keine Angaben. 44/109 waren schmerzfrei, 35/109 deutlich gebessert. Bei 19 Patienten waren die Schmerzen nach der Operation nicht besser oder hatten sogar zugenommen. 74/109 Patienten waren postoperativ uneingeschränkt, 14/109 eingeschränkt und 6 weitere nur mit Gehhilfe gehfähig. 7/109 Patienten waren aufgrund anderer Leiden nicht gehfähig und 8 Patienten wurden wegen fehlender Angaben nicht berücksichtigt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050275
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  • 9
    Electronic Resource
    Electronic Resource
    Operative Behandlung von geburtstraumatischen Läsionen des Plexus brachialis (1997)
    Springer
    Monatsschrift Kinderheilkunde 145 (1997), S. 1080-1085 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Geburtstraumatische Plexusläsion ; Diagnostik ; Operation ; Key words Obstetrical brachial plexus palsy ; Diagnosis ; Surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Objektive: Obstetrical brachial plexus palsy occurs at a frequency of 0,6–2,5 per 1000 births. 80–95% of these lesions recover spontaneously. Should spontaneous recovery not occur within the first 6 months of life, electrophysiological examination CT-Myelography, and surgical exploration of the brachial plexus are recommended. Methods: Seven children who had obstetrical brachial plexus palsies were operated over a five year period among 99 operations of traumatic brachial plexus injuries. In 6/7 children we found nerve root avulsions. In two cases we performed a neurotisation, in four nerve grafting after neuroma excision and in one an external neurolysis of the brachial plexus. Results: So far, we only have a long-term follow-up in 3/7 children (26–42 months). All these children showed clinically regeneration of grafted nerves. Full recovery of the brachial plexus lesions was limited because of concomitant nerve root avulsions. Conclusion: We recommend decision for surgery at the age of 6–9 months. Physical therapy and options including muscle transfers and orthopedic procedures must be available to ensure the optimal outcome for these children.
    Notes: Zusammenfassung Fragestellung: Geburtstraumatische Läsionen des Plexus brachialis treten in 0,6–2,5‰ aller Geburten auf. 80–95% dieser Läsionen bilden sich spontan zurück. Sollte keine spontane Funktionsrückkehr innerhalb der ersten 6 Monate eintreten, müßte nach entsprechender Diagnostik, wie elektrophysiologische und myelocomputertomographische Untersuchungen eine operative Freilegung des Plexus brachialis erfolgen. Methode: In einem Zeitraum von 5 Jahren haben wir 7 Kinder mit postpartaler Plexusläsion unter 99 operativ versorgten Plexusläsionen behandelt. 6/7 Kindern zeigten präoperativ Wurzelausrisse. Bei 2 Kindern wurde eine Neurotisation, bei 4 eine autologe Transplantation und beim letzten eine äußere Neurolyse des Plexus brachialis vorgenommen. Ergebnisse: Bisher wurden nur 3/7 Kindern über einen längeren Zeitraum (26–42 Monate) nachuntersucht. Alle transplantierten Nerven zeigten klinisch eine Reinnervation. Eine Wiederherstellung der normalen Funktion war durch begleitende Wurzelausrisse limitiert. Schlußfolgerungen: Wir empfehlen als optimalen Zeitpunkt für die Operation den Zeitraum zwischen dem 6. und 9. Monat. Um optimale Ergebnisse bei diesen Kindern zu erzielen, muß sich zunächst eine intensive krankengymnastische Behandlung anschließen und später sollte die Option für Muskeltransfers und orthopädische Operationen gewährleistet sein.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050208
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