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Kofler M, Reitmeir P, Glodny B, Rass V, Lindner A, Ianosi BA, Gaasch M, Schiefecker AJ, Putnina L, Beer R, Rhomberg P, Schmutzhard E, Pfausler B, Helbok R. The Loss of Temporal Muscle Volume is Associated with Poor Outcome in Patients with Subarachnoid Hemorrhage: An Observational Cohort Study. Neurocrit Care 2023; 39:198-206. [PMID: 37308731 PMCID: PMC10499691 DOI: 10.1007/s12028-023-01751-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/05/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Intensive care unit (ICU) acquired weakness is a major contributor to poor functional outcome of ICU patients. Quantification of temporal muscle volume assessed on routine computed tomography (CT) scans may serve as a biomarker for muscle wasting in patients suffering from acute brain injury. METHODS This is a retrospective analysis of prospectively collected data. Temporal muscle volume was assessed on head CT scans of consecutive patients with spontaneous subarachnoid hemorrhage within prespecified time frames (on admission, then weekly ± 2 days). Whenever possible, temporal muscle volume was assessed bilaterally and averaged for the analysis. Poor functional outcome was defined as a 3-month modified Rankin Scale Score ≥ 3. Statistical analysis was performed using generalized estimating equations to handle repeated measurements within individuals. RESULTS The analysis comprised 110 patients with a median Hunt & Hess score of 4 (interquartile range 3-5). Median age was 61 (50-70) years, 73 patients (66%) were women. Baseline temporal muscle volume was 18.5 ± 0.78 cm3 and significantly decreased over time (p < 0.001) by a mean of 7.9% per week. Higher disease severity (p = 0.002), hydrocephalus (p = 0.020), pneumonia (p = 0.032), and bloodstream infection (p = 0.015) were associated with more pronounced muscle volume loss. Patients with poor functional outcome had smaller muscle volumes 2 and 3 weeks after subarachnoid hemorrhage compared with those with good outcome (p = 0.025). The maximum muscle volume loss during ICU stay was greater in patients with poor functional outcome (- 32.2% ± 2.5% vs. - 22.7% ± 2.5%, p = 0.008). The hazard ratio for poor functional outcome was 1.027 (95% confidence interval 1.003-1.051) per percent of maximum muscle volume loss. CONCLUSIONS Temporal muscle volume, which is easily assessable on routine head CT scans, progressively decreases during the ICU stay after spontaneous subarachnoid hemorrhage. Because of its association with disease severity and functional outcome, it may serve as a biomarker for muscle wasting and outcome prognostication.
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Affiliation(s)
- Mario Kofler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Reitmeir
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Glodny
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Verena Rass
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Lindner
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bogdan A Ianosi
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Max Gaasch
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alois J Schiefecker
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lauma Putnina
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Ronny Beer
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Paul Rhomberg
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Erich Schmutzhard
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Pfausler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Helbok
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
- Department of Neurology, Johannes Kepler University Linz, Linz, Austria.
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Pfaller MA, Carvalhaes CG, Deshpande LM, Rhomberg P, Rhomberg P, Castanheira M. 868. In Vitro Activity of Isavuconazole and Other Mould-Active Triazoles Against Aspergillus fumigatus With and Without cyp51 Alterations. Open Forum Infect Dis 2022. [PMCID: PMC9751544 DOI: 10.1093/ofid/ofac492.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Azole resistance in Aspergillus fumigatus (AFM) is mainly associated with mutations in cyp51A and its promoter region or its homologue cyp51B. We evaluated the in vitro activity of isavuconazole (ISC), itraconazole (ITC), posaconazole (PSC), and voriconazole (VRC) against 660 AFM collected during 2017–2020. Methods Isolates from Europe (EU), North America (NA), Latin America (LA), and Asia-Pacific (APAC) were identified by MALDI-TOF and/or sequencing and tested by CLSI broth microdilution. CLSI epidemiological cut-off values (ECV) were applied. A PSC ECV of 0.5 mg/L was used. Non-wildtype (NWT) isolates to azoles were screened for alterations in the cyp51 genes using whole genome sequencing. Results Azoles had similar activities against 660 AFM isolates. Overall, AFM displayed WT MIC values to ISC (92.7%), ITC (92.9%), PSC (97.3%), and VRC (96.7%). Only 66 isolates (10.0%) were NWT to 1 or more of the azoles, and 32 harbored one or more alterations in the cyp51 genes. Of these AFM, 29/32 (90.1%) were NWT to ITC, 25/32 (78.1%) NWT to ISC, 17/32 (53.1%) NWT to VRC, and 11/32 (34.4%) NWT to PSC. The most frequent alteration was CYP51A TR34/L98H, carried by 14 EU isolates, all NWT to ISC and ITC. Four isolates from NA carried the alteration I242V in CYP51A (all NWT to ITC; all WT to ISC). One NA isolate carried the CYP51A alteration G448S (NWT to ISC, VRC, and ITC) and one carried A9T (NWT to ISC). A single isolate from APAC carried a CYP51A G138C alteration and was NWT to all 4 triazoles. Multiple alterations in CYP51A were detected in 5 isolates: 4/5 NWT to ISC or ITC, 1/5 NWT to VRC, all WT to PSC. Alterations in CYP51B were noted in 7 isolates; 6/7 carried Q42L, 3 from NA (all NWT to ITC and 2 NWT to ISC), 2 from APAC (all NWT to VRC or ISC), and 1 from EU (NWT to ISC, ITC, and PSC). Among 34 NWT isolates without cyp51 alterations, 32.4% were WT to ISC, 47.1% WT to ITC, 85.3% WT to VRC, and 82.4% WT to PSC. Conclusion The majority of AFM were WT to azoles. Ten different cyp51 alterations were detected in 32/66 NWT isolates. Only EU isolates harboured the environmental alteration TR34/L98H that was associated with a NWT phenotype to ISC and ITC. Alterations in AFM cyp51 can have variable effects on the in vitro activity of the azoles that are best delineated by testing all triazoles. Disclosures Michael A. Pfaller, MD, Pfizer: Grant/Research Support Cecilia G. Carvalhaes, MD, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support Lalitagauri M. Deshpande, PhD, Melinta: Grant/Research Support|Pfizer: Grant/Research Support Paul Rhomberg, BS, MT(ASCP), Cidara: Grant/Research Support|Pfizer: Grant/Research Support Paul Rhomberg, BS, MT(ASCP), Cidara: Grant/Research Support|Pfizer: Grant/Research Support.
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Carvalhaes CG, Rhomberg P, Rhomberg P, Strand G, Klauer AL, Castanheira M. 1731. Rezafungin Activity against Candida spp. and Aspergillus spp. Isolates Causing Invasive Infections Worldwide in 2021. Open Forum Infect Dis 2022. [PMCID: PMC9752930 DOI: 10.1093/ofid/ofac492.1361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Rezafungin (RZF) is a once-weekly echinocandin (ECH) with a long half-life and front-loaded drug exposure. RZF is in development to treat candidemia and invasive candidiasis and prevent invasive fungal disease caused by Candida, Aspergillus, and Pneumocystis spp. We evaluated the in vitro activity of RZF, caspofungin (CSF), micafungin (MCF), and anidulafungin (ANF) against a worldwide collection of fungal isolates causing invasive infection.
![]() Methods 830 isolates were collected from Europe (EU; 40.2%), North America (NA; 31.6%), Asia-Pacific (APAC; 15.3%), and Latin America (LA; 12.9%), identified by MALDI-TOF and/or sequencing, and tested by CLSI broth microdilution. Isolates included C. albicans (CA; 316 isolates), C. glabrata (CG; 162), C. parapsilosis (CP; 148), C. tropicalis (CT; 83), C. dubliniensis (CD; 21), C. krusei (CK; 19), Cryptococcus neoformans (CN; 10) A. fumigatus (AF; 59), and A. section Flavi (ASF; 12). CLSI criteria was applied, including the recently approved rezafungin provisional breakpoints against Candida spp. Results RFZ inhibited 99.7% of CA, 98.1% of CG, 95.2% of CD, and all CP, CT, and CK (MIC50/90 in Table) at the susceptibility (S) breakpoint (BP). RZF had similar activity to the other ECHs against CA (99.7%S), CG (95.7-96.3%S), CT (100.0%S), CK (100.0%S), and CD (MIC50/90 range, 0.015-0.06/0.03-0.06 mg/L). Although CSF displayed lower MIC50/90 values (0.25/0.25 mg/L) than RZF (MIC50/90, 1/2 mg/L), MCF (MIC50/90, 1/1 mg/L), and ANF (MIC50/90, 2/4 mg/L) against CP, all ECHs but ANF (87.2%S) inhibited 100% of CP isolates at the respective BP. Only 1 CA (EU), 1 CD (EU), and 3 CG (NA) were non-S to RZF, while 1 CA (EU), 6 CG (5 NA, 1 APAC), and 19 CP (8 EU, 5 NA, 4 APAC, 2 LA) were ANF non-S. Limited activity was noted for all ECHs against CN (MIC50, > 4 mg/L). All AF isolates were inhibited by RZF at ≤ 0.06 mg/L, and ANF, MCF, and CSF at ≤ 0.12 mg/L. RZF (MIC range, 0.008-0.06 mg/L) and other ECHs (MIC range, 0.008-0.12 mg/L) were also active against 7 voriconazole non-S AF isolates (4 NA, 3 EU). RZF and other ECHs inhibited all ASF isolates at ≤ 0.06 mg/L. Conclusion RZF was very active against Candida spp., AF, and ASF isolates causing invasive infections worldwide, including voriconazole non-S AF isolates and CP displaying non-S to ANF. Disclosures Cecilia G. Carvalhaes, MD, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support Paul Rhomberg, BS, MT(ASCP), Cidara: Grant/Research Support|Pfizer: Grant/Research Support Paul Rhomberg, BS, MT(ASCP), Cidara: Grant/Research Support|Pfizer: Grant/Research Support Greg Strand, MLS (ASCP)CM, Cidara: Grant/Research Support Abby L. Klauer, BS, Cidara: Grant/Research Support Mariana Castanheira, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|GSK: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support.
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Pinggera D, Rhomberg P, Beer R, Thomé C, Petr O. Brain Tissue Damage Induced by Multimodal Neuromonitoring In Situ during MRI after Severe Traumatic Brain Injury: Incidence and Clinical Relevance. J Clin Med 2022; 11:jcm11113169. [PMID: 35683575 PMCID: PMC9181231 DOI: 10.3390/jcm11113169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022] Open
Abstract
Both neuromonitoring and early magnetic resonance imaging (MRI) provide crucial information for treatment management and prognosis in patients with severe traumatic brain injury (sTBI). So far, neuromonitoring in situ impedes the routine implementation of MRI due to safety concerns. We aimed to evaluate the brain tissue damage induced by inserted neuromonitoring devices and its clinical relevance. Nineteen patients with sTBI and being exposed to at least one MRI with neuromonitoring in situ and one follow-up MRI after neuromonitoring removal were analyzed. All MRIs were reviewed for specific tissue damage. Three females and sixteen males (aged 20–74 years, mean 42.8 years) with an initial median GCS of 5 (range 3–8) were analyzed. No lesion was observed in six patients (31.6%), whereas another six patients (31.6%) demonstrated a detectable probe trajectory. Probe-related tissue damage was visible in seven patients (36.8%) with the size of the lesion prone to further enlarge with increasing cumulative duration of MRI examinations. Upon interdisciplinary evaluation, the lesions were not considered clinically relevant. Neuromonitoring probes in situ during MRI examinations may cause local brain tissue damage, yet without any clinical implications if placed correctly. Therefore, indications must be strictly based on joint decision from all involved disciplines.
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Affiliation(s)
- Daniel Pinggera
- Department of Neurosurgery, Medical University Innsbruck, 6020 Innsbruck, Austria; (C.T.); (O.P.)
- Correspondence: ; Tel.: +43-512-504-27452
| | - Paul Rhomberg
- Department of Neuroradiology, Medical University Innsbruck, 6020 Innsbruck, Austria;
| | - Ronny Beer
- Department of Neurology, Medical University Innsbruck, 6020 Innsbruck, Austria;
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, 6020 Innsbruck, Austria; (C.T.); (O.P.)
| | - Ondra Petr
- Department of Neurosurgery, Medical University Innsbruck, 6020 Innsbruck, Austria; (C.T.); (O.P.)
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Auer M, Hegen H, Hotter A, Löscher W, Berek K, Zinganell A, Fava E, Rhomberg P, Deisenhammer F, Di Pauli F. Recovery of Chronic Inflammatory Demyelinating Polyneuropathy on Treatment With Ocrelizumab in a Patient With Co-Existing Multiple Sclerosis. J Cent Nerv Syst Dis 2022; 14:11795735221084837. [PMID: 35370432 PMCID: PMC8966083 DOI: 10.1177/11795735221084837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
The chimeric anti-CD20 antibody rituximab has demonstrated good efficacy as an off-label treatment in chronic inflammatory demyelinating polyneuropathy (CIDP), while the humanized anti-CD20 antibody ocrelizumab has been approved for treatment of multiple sclerosis (MS), whereas there is no evidence for its use in CIDP so far. We present a patient suffering from CIDP and MS, both refractory to standard treatment and both showing marked improvement on ocrelizumab. To the best of our knowledge, this is a unique report of CIDP with an almost full electrophysiological recovery on ocrelizumab which could be considered as a potential treatment option for refractory CIDP.
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Affiliation(s)
- Michael Auer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Hotter
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Löscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Berek
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anne Zinganell
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elena Fava
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Paul Rhomberg
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Franziska Di Pauli
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Kofler M, Beer R, Marinoni S, Schiefecker AJ, Gaasch M, Rass V, Lindner A, Lanosi BA, Rhomberg P, Pfausler B, Thomé C, Stover JF, Schmutzhard E, Helbok R. Early supplemental parenteral nutrition for the achievement of nutritional goals in subarachnoid hemorrhage patients: An observational cohort study. PLoS One 2022; 17:e0265729. [PMID: 35303046 PMCID: PMC8932621 DOI: 10.1371/journal.pone.0265729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 03/07/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Enteral nutrition (EN) often fails to achieve nutritional goals in neurocritical care patients. We sought to investigate the safety and utility of supplemental parenteral nutrition (PN) in subarachnoid hemorrhage (SAH) patients. Materials and methods Data of 70 consecutive patients with non-traumatic SAH admitted to the neurological intensive care unit of a tertiary referral center were prospectively collected and retrospectively analyzed. We targeted the provision of 20–25 kilocalories per kilogram bodyweight per day (kcal/kg/d) by enteral nutrition. Supplemental PN was given when this target could not be reached. Nutritional data were analyzed for up to 14 days of ICU stay. Hospital complications were tested for associations with impaired enteral feeding. The amounts of EN and PN were tested for associations with the level of protein delivery and functional outcome. Repeated measurements within subjects were handled utilizing generalized estimating equations. Results Forty (27 women and 13 men) of 70 screened patients were eligible for the analysis. Median age was 61 (IQR 49–71) years, 8 patients (20%) died in the hospital. Thirty-six patients (90%) received PN for a median duration of 8 (IQR 4–12) days. The provision of 20 kcal/kg by EN on at least 1 day of ICU stay was only achieved in 24 patients (60%). Hydrocephalus (p = 0.020), pneumonia (p = 0.037) and sepsis (p = 0.013) were associated with impaired enteral feeding. Neither the amount nor the duration of PN administration was associated with an increased risk of severe complications or poor outcome. Supplemental PN was associated with significantly increased protein delivery (p<0.001). In patients with sepsis or pneumonia, there was an association between higher protein delivery and good functional outcome (p<0.001 and p = 0.031), but not in the overall cohort (p = 0.08). Conclusions Enteral feeding was insufficient to achieve nutritional goals in subarachnoid hemorrhage patients. Supplemental PN was safe and associated with increased protein delivery. A higher protein supply was associated with good functional outcome in patients who developed sepsis or pneumonia.
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Affiliation(s)
- Mario Kofler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ronny Beer
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stephanie Marinoni
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alois J. Schiefecker
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Maxime Gaasch
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Verena Rass
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Lindner
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bogdan A. Lanosi
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Medical Informatics, UMIT–University for Health Sciences, Hall, Austria
| | - Paul Rhomberg
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Pfausler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - John F. Stover
- Fresenius Kabi Germany, Bad Homburg vor der Höhe, Germany
| | - Erich Schmutzhard
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Helbok
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- * E-mail:
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Di Pauli F, Morschewsky P, Berek K, Auer M, Bauer A, Berger T, Bsteh G, Rhomberg P, Schanda K, Zinganell A, Deisenhammer F, Reindl M, Hegen H. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease and Varicella Zoster Virus Infection - Frequency of an Association. Front Immunol 2021; 12:769653. [PMID: 34737756 PMCID: PMC8560958 DOI: 10.3389/fimmu.2021.769653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/05/2021] [Indexed: 11/13/2022] Open
Abstract
To determine whether there is a correlation between myelin oligodendrocyte glycoprotein (MOG) antibody-associated diseases and varicella zoster virus (VZV) infection. We provide a case report and performed a study to determine the frequency of MOG antibodies (MOG-IgG) in neurological VZV infections. Patients admitted to the Medical University of Innsbruck from 2008-2020 with a diagnosis of a neurological manifestation of VZV infection (n=59) were included in this study; patients with neuroborreliosis (n=34) served as control group. MOG-IgG was detected using live cell-based assays. In addition, we performed a literature review focusing on MOG and aquaporin-4 (AQP4) antibodies and their association with VZV infection. Our case presented with VZV-associated longitudinally extensive transverse myelitis and had MOG-IgG at a titer of 1:1280. In the study, we did not detect MOG-IgG in any other patient neither in the VZV group (including 15 with VZV encephalitis/myelitis) nor in the neuroborreliosis group. In the review of the literature, 3 cases with MOG-IgG and additional 9 cases with AQP4 IgG associated disorders in association with a VZV infection were identified. MOG-IgG are rarely detected in patients with VZV infections associated with neurological diseases.
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Affiliation(s)
- Franziska Di Pauli
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Paul Morschewsky
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Berek
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Auer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Angelika Bauer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Paul Rhomberg
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Schanda
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anne Zinganell
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Markus Reindl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Pfaller MA, Carvalhaes CG, Rhomberg P, Messer SA, Castanheira M. Correction: Antifungal susceptibilities of opportunistic filamentous fungal pathogens from the Asia and Western Pacific Region: data from the SENTRY Antifungal Surveillance Program (2011-2019). J Antibiot (Tokyo) 2021; 75:123. [PMID: 34408290 PMCID: PMC8786655 DOI: 10.1038/s41429-021-00460-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Michael A Pfaller
- JMI Laboratories, North Liberty, IA, USA.,University of Iowa, Iowa City, IA, USA
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Keser T, Kofler M, Katzmayr M, Schiefecker AJ, Rass V, Ianosi BA, Lindner A, Gaasch M, Beer R, Rhomberg P, Schmutzhard E, Pfausler B, Helbok R. Risk Factors for Dysphagia and the Impact on Outcome After Spontaneous Subarachnoid Hemorrhage. Neurocrit Care 2021; 33:132-139. [PMID: 31732847 PMCID: PMC7392368 DOI: 10.1007/s12028-019-00874-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Despite the tremendous impact of swallowing disorders on outcome following ischemic stroke, little is known about the incidence of dysphagia after subarachnoid hemorrhage (SAH) and its contribution to hospital complications, length of intensive care unit stay, and functional outcome. Methods This is a retrospective analysis of an ongoing prospective cohort study. Swallowing ability was assessed in consecutive non-traumatic SAH patients admitted to our neurological intensive care unit using the Bogenhausen Dysphagia Score (BODS). A BODS > 2 points indicated dysphagia. Functional outcome was assessed 3 months after the SAH using the modified Rankin Scale with a score > 2 defined as poor functional outcome. Results Two-hundred and fifty consecutive SAH patients comprising all clinical severity grades with a median age of 57 years (interquartile range 47–67) were eligible for analysis. Dysphagia was diagnosed in 86 patients (34.4%). Factors independently associated with the development of dysphagia were poor clinical grade on admission (Hunt & Hess grades 4–5), SAH-associated parenchymal hematoma, hydrocephalus, detection of an aneurysm, and prolonged mechanical ventilation (> 48 h). Dysphagia was independently associated with a higher rate of pneumonia (OR = 4.32, 95% CI = 2.35–7.93), blood stream infection (OR = 4.3, 95% CI = 2.0–9.4), longer ICU stay [14 (8–21) days versus 29.5 (23–45) days, p < 0.001], and poor functional outcome after 3 months (OR = 3.10, 95% CI = 1.49–6.39). Conclusions Dysphagia is a frequent complication of non-traumatic SAH and associated with poor functional outcome, infectious complications, and prolonged stay in the intensive care unit. Early identification of high-risk patients is needed to timely stratify individual patients for dysphagia treatment. Electronic supplementary material The online version of this article (10.1007/s12028-019-00874-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tobias Keser
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Mario Kofler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Mariella Katzmayr
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Alois J Schiefecker
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Verena Rass
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bogdan A Ianosi
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.,Medical Informatics, UMIT - University for Health Sciences, Hall in Tirol, Austria
| | - Anna Lindner
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Maxime Gaasch
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Ronny Beer
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Paul Rhomberg
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Erich Schmutzhard
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bettina Pfausler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Raimund Helbok
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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10
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Lindner A, Rass V, Ianosi BA, Schiefecker AJ, Kofler M, Gaasch M, Addis A, Rhomberg P, Pfausler B, Beer R, Schmutzhard E, Thomé C, Helbok R. Individualized blood pressure targets in the postoperative care of patients with intracerebral hemorrhage. J Neurosurg 2021:1-10. [PMID: 33836501 DOI: 10.3171/2020.9.jns201024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recent guidelines recommend targeting a systolic blood pressure (SBP) < 140 mm Hg in the early management of patients with spontaneous intracerebral hemorrhage (ICH). The optimal SBP targets for ICH patients after hematoma evacuation (HE) remain unclear. Here, the authors aimed to define the optimal SBP range based on multimodal neuromonitoring data. METHODS Forty poor-grade ICH patients who had undergone HE and then monitoring of intracerebral pressure, brain tissue oxygen tension (PbtO2), and cerebral metabolism (via cerebral microdialysis [CMD]) were prospectively included. Episodes of brain tissue hypoxia (BTH) (1-hour averaged PbtO2 < 20 mm Hg) and metabolic distress (CMD-lactate/pyruvate ratio [LPR] ≥ 40) were identified and linked to corresponding parameters of hemodynamic monitoring (SBP and cerebral perfusion pressure [CPP]). Multivariable regression analysis was performed using generalized estimating equations to identify associations between SBP levels, PbtO2, and brain metabolism. RESULTS The mean patient age was 60 (range 51-66) years and the median [IQR] initial ICH volume was 47 [29-60] ml. In multivariable models adjusted for Glasgow Coma Scale score, probe location, ICH volume, and age, lower SBP was independently associated with a higher risk of BTH (≤ 120 mm Hg: adjusted OR 2.9, p = 0.007; 120-130 mm Hg: adj OR 2.4, p = 0.002; 130-140 mm Hg: adj OR 1.6, p = 0.017) compared to a reference range of 140-150 mm Hg at the level of the foramen interventriculare Monroi, which corresponded to a CPP of 70-80 mm Hg and SBP levels between 150 and 160 mm Hg at the heart level. After exclusion of episodes with mitochondrial dysfunction, SBP targets < 140 mm Hg were associated with higher odds of cerebral metabolic distress (≤ 130 mm Hg: OR 2.5, p = 0.041; 130-140 mm Hg: OR 2.3, p = 0.033). Patients with a modified Rankin Scale score ≥ 5 at neurological ICU discharge more often exhibited BTH than patients with better outcomes (51% vs 10%, p = 0.003). CONCLUSIONS These data suggest that lower SPB and CPP levels are associated with a higher risk for BTH. Further studies are needed to evaluate whether a higher SPB target may prevent BTH and improve outcomes.
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Affiliation(s)
- Anna Lindner
- 1Neurological Intensive Care Unit, Department of Neurology, and
| | - Verena Rass
- 1Neurological Intensive Care Unit, Department of Neurology, and
| | - Bogdan-Andrei Ianosi
- 1Neurological Intensive Care Unit, Department of Neurology, and.,2Institute of Medical Informatics, UMIT: University for Health Sciences, Medical Informatics and Technology, Tyrol, Austria; and
| | | | - Mario Kofler
- 1Neurological Intensive Care Unit, Department of Neurology, and
| | - Max Gaasch
- 1Neurological Intensive Care Unit, Department of Neurology, and
| | - Alberto Addis
- 3School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | | | - Ronny Beer
- 1Neurological Intensive Care Unit, Department of Neurology, and
| | | | | | - Raimund Helbok
- 1Neurological Intensive Care Unit, Department of Neurology, and
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11
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Berek K, Fava E, Zinganell A, Hegen H, Auer M, Wurth S, Rhomberg P, Deisenhammer F, Di Pauli F. Transverse myelitis as a rare presentation of antiphospholipid-antibody-associated disorders. Mult Scler Relat Disord 2020; 45:102405. [PMID: 32707532 DOI: 10.1016/j.msard.2020.102405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/08/2020] [Accepted: 07/15/2020] [Indexed: 11/18/2022]
Abstract
We report the case of a 35-year-old male patient suffering from a clinical and radiological manifestation of a transverse myelitis associated with antiphospholipid antibodies. After a challenging diagnosis the patient improved substantially due to immunosuppressive treatment. The demyelinating spinal cord lesion and the impressive therapeutic outcome may support the possibility of a direct binding of antiphospholipid antibodies to CNS antigens and consequently leading to a neuroimmunological pathomechanism distinct from the well-known pro-thrombotic effect of antiphospholipid antibodies. In terms of clinical routine diagnostic this case report highlights a rare but notable differential diagnosis of Multiple Sclerosis-like syndromes.
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Affiliation(s)
- Klaus Berek
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elena Fava
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anne Zinganell
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Harald Hegen
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Auer
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sebastian Wurth
- Clinical Department of Neurology, Medical University of Graz, Graz, Austria
| | - Paul Rhomberg
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Deisenhammer
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Franziska Di Pauli
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
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12
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Rass V, Ianosi BA, Wegmann A, Gaasch M, Schiefecker AJ, Kofler M, Lindner A, Addis A, Almashad SS, Rhomberg P, Pfausler B, Beer R, Gizewski ER, Thomé C, Helbok R. Delayed Resolution of Cerebral Edema Is Associated With Poor Outcome After Nontraumatic Subarachnoid Hemorrhage. Stroke 2020; 50:828-836. [PMID: 30869561 DOI: 10.1161/strokeaha.118.024283] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background and Purpose- Global cerebral edema occurs in up to 57% of patients with subarachnoid hemorrhage (SAH) and is associated with prolonged hospital stay and poor outcome. Recently, admission brain edema was successfully graded using a simplified computed tomography-based semiquantitative score (subarachnoid hemorrhage early brain edema score [SEBES]). Longitudinal evaluation of the SEBES grade may discriminate patients with rapid and delayed edema resolution after SAH. Here, we aimed to describe the resolution of brain edema and to study the relationship between this radiographic biomarker and hospital course and outcome after SAH. Methods- For the current observational cohort study, computed tomography scans of 283 consecutive nontraumatic SAH patients admitted to the neurological intensive care unit of a tertiary hospital were graded based on the absence of visible sulci at 2 predefined brain tissue levels in each hemisphere (SEBES ranging from 0 to 4). A score of ≥3 was defined as high-grade SEBES. Multivariable regression models using generalized linear models were used to identify associated factors with delayed edema resolution based on the median time to resolution (SEBES ≤2) in SAH survivors. Results- Patients were 57 years old (interquartile range, 48-68) and presented with a median admission Hunt and Hess grade of 3 (interquartile range, 1-5). High-grade SEBES was common (106/283, 37%) and resolved within a median of 8 days (interquartile range, 4-15) in survivors (N=80). Factors associated with delayed edema resolution were early (<72 hours) hypernatremia (>150 mmol/L; adjusted odds ratio [adjOR], 4.88; 95% CI, 1.68-14.18), leukocytosis (>15 G/L; adjOR, 3.14; 95% CI, 1.24-8.77), hyperchloremia (>121 mmol/L; adjOR, 5.24; 95% CI, 1.64-16.76), and female sex (adjOR, 3.71; 95% CI, 1.01-13.64) after adjusting for admission Hunt and Hess grade and age. Delayed brain edema resolution was an independent predictor of worse functional 3-month outcome (adjOR, 2.52; 95% CI, 1.07-5.92). Conclusions- Our data suggest that repeated quantification of the SEBES can identify SAH patients with delayed edema resolution. Based on its' prognostic value as radiographic biomarker, the SEBES may be integrated in future trials aiming to improve edema resolution after SAH.
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Affiliation(s)
- Verena Rass
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria
| | - Bogdan-Andrei Ianosi
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria.,Institute of Medical Informatics, UMIT: University for Health Sciences, Medical Informatics and Technology, Hall, Austria (B.-A.I., )
| | - Andreas Wegmann
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria
| | - Max Gaasch
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria
| | - Alois J Schiefecker
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria
| | - Mario Kofler
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria
| | - Anna Lindner
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria
| | - Alberto Addis
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria.,Department of Clinical and Experimental Medicine, University of Sassari, Italy (A.A.)
| | - Salma S Almashad
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria.,Faculty of Medicine, Alexandria University, El-Khartoum Square Azarita Medical Campus, Egypt (S.S.A.)
| | - Paul Rhomberg
- Department of Neuroradiology (P.R., E.R.G.), Medical University of Innsbruck, Austria
| | - Bettina Pfausler
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria
| | - Ronny Beer
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria
| | - Elke R Gizewski
- Department of Neuroradiology (P.R., E.R.G.), Medical University of Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery (C.T.), Medical University of Innsbruck, Austria
| | - Raimund Helbok
- From the Neurological Intensive Care Unit, Department of Neurology (V.R., B.-A.I., A.W., M.G., A.J.S., M.K., A.L., A.A., S.S.A., B.P., R.B., R.H.), Medical University of Innsbruck, Austria
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13
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Lindner A, Kofler M, Rass V, Ianosi B, Gaasch M, Schiefecker AJ, Beer R, Loveys S, Rhomberg P, Pfausler B, Thomé C, Schmutzhard E, Helbok R. Early Predictors for Infectious Complications in Patients With Spontaneous Intracerebral Hemorrhage and Their Impact on Outcome. Front Neurol 2019; 10:817. [PMID: 31447758 PMCID: PMC6691092 DOI: 10.3389/fneur.2019.00817] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/15/2019] [Indexed: 01/05/2023] Open
Abstract
Background: Infectious complications (IC) commonly occur in patients with intracerebral hemorrhage (ICH) and are associated with increased length of hospitalization (LOS) and poor long-term outcome. Little is known about early ICH-related predictors for the development of IC to allow appropriate allocation of resources and timely initiation of preventive measures. Methods: We prospectively enrolled 229 consecutive patients with non-traumatic ICH admitted to the neurocritical care unit (NICU) of a tertiary care hospital. Patients were screened daily for IC. Multivariable regression models using generalized linear models were used to identify associated factors with the occurrence of IC and to study their impact on functional outcome, which was assessed using the modified Rankin Scale Score (mRS) after 3 months. Unfavorable outcome was defined as mRS ≥3. Results: The most common IC were pneumonia (n = 64, 28%) and urinary tract infection (n = 54, 24%), followed by sepsis (n = 9, 4%) and ventriculitis (n = 4, 2%). Patients with a higher admission ICH Score (>2) had higher odds to develop any IC during NICU stay (OR = 1.7, 95% CI 1.2–2.3, p = 0.02). Moreover, early-onset pneumonia (≤48 h after admission) was predictive of sepsis occurring at a later time-point (median at day 11 [IQR = 6–34 days], adjOR = 22.5, 95% CI 4.88–103.6, p < 0.001). Having at least one IC and pneumonia itself were independently associated with unfavorable 3-months outcome (adjOR = 3.0, 95% CI 1.41–6.54, p = 0.005; adjOR = 4.2, 95% CI 1.33–13.19, p = 0.015, respectively). All patients with sepsis died or had poor functional outcome. Conclusions: Infectious complications are common in ICH patients and independently associated with unfavorable outcome. An ICH Score >2 on admission and early pneumonia may help to early identify patients at high risk of IC to allocate resources and start careful surveillance.
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Affiliation(s)
- Anna Lindner
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Mario Kofler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Verena Rass
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bogdan Ianosi
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Institute of Medical Informatics, University for Health Sciences, Medical Informatics and Technology, Hall, Austria
| | - Max Gaasch
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alois J Schiefecker
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ronny Beer
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sebastian Loveys
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Paul Rhomberg
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Pfausler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Erich Schmutzhard
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Helbok
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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14
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Kofler M, Schiefecker AJ, Gaasch M, Sperner-Unterweger B, Fuchs D, Beer R, Ferger B, Rass V, Hackl W, Rhomberg P, Pfausler B, Thomé C, Schmutzhard E, Helbok R. A reduced concentration of brain interstitial amino acids is associated with depression in subarachnoid hemorrhage patients. Sci Rep 2019; 9:2811. [PMID: 30808966 PMCID: PMC6391430 DOI: 10.1038/s41598-019-39569-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 01/14/2019] [Indexed: 01/24/2023] Open
Abstract
The amino-acids tryptophan, phenylalanine and tyrosine seem to play an important role in the pathophysiology of depressive disorders. We measured daily brain extracellular levels of these amino-acids using cerebral microdialysis (CMD) and high performance liquid chromatography in 26 consecutive subarachnoid hemorrhage (SAH) patients and associated them with the presence of depressive disorders. Patients were grouped as follows: medical history of depression (prior to SAH), antidepressant intake 12 months after SAH (but not before), or neither. CMD-tryptophan, CMD-phenylalanine and CMD-tyrosine levels were significantly lower in patients with preexisting depressive disorders compared to those without depression (p < 0.01). Disease severity and SAH-related complications were not associated with amino-acid concentrations. We found a positive correlation between nutritionally administered and brain interstitial levels of tryptophan and phenylalanine in non-depressed patients (R = 0.26 and R = 0.24, p < 0.05), which was not present in patients with preexisting depression (p > 0.1). In conclusion, brain interstitial levels of tryptophan, phenylalanine and tyrosine measured in the context of the clinical management of SAH were significantly decreased in patients with a medical history of depression. This study supports the hypothesis that the availability of these neurotransmitter precursor amino-acids in the human brain may play an important role in the pathophysiology of depressive disorders.
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Affiliation(s)
- Mario Kofler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alois Josef Schiefecker
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Maxime Gaasch
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Sperner-Unterweger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter, Medical University of Innsbruck, Innsbruck, Austria
| | - Ronny Beer
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Boris Ferger
- CNS Diseases Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Verena Rass
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Hackl
- Medical Informatics and Technology, UMIT - University for Health Sciences, Hall, Austria
| | - Paul Rhomberg
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Pfausler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Erich Schmutzhard
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Helbok
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
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15
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Rass V, Kofler M, Schiefecker AJ, Gaasch M, Unterhofer C, Thomé C, Rhomberg P, Pfausler B, Beer R, Schmutzhard E, Helbok R. Perifocal metabolism in a patient with brain abscess: insights from cerebral microdialysis. J Neurol Neurosurg Psychiatry 2019; 90:239-242. [PMID: 29735515 DOI: 10.1136/jnnp-2017-317652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/21/2018] [Accepted: 04/22/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Verena Rass
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Mario Kofler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alois J Schiefecker
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Max Gaasch
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudia Unterhofer
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Paul Rhomberg
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Pfausler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ronny Beer
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Erich Schmutzhard
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Helbok
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Ianosi B, Gaasch M, Rass V, Huber L, Hackl W, Kofler M, Schiefecker AJ, Addis A, Beer R, Rhomberg P, Pfausler B, Thomé C, Ammenwerth E, Helbok R. Early thrombosis prophylaxis with enoxaparin is not associated with hematoma expansion in patients with spontaneous intracerebral hemorrhage. Eur J Neurol 2018; 26:333-341. [DOI: 10.1111/ene.13830] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/08/2018] [Indexed: 11/28/2022]
Affiliation(s)
- B. Ianosi
- Institute of Medical Informatics; UMIT - University for Health Sciences, Medical Informatics and Technology; Hall
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - M. Gaasch
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - V. Rass
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - L. Huber
- Institute of Medical Informatics; UMIT - University for Health Sciences, Medical Informatics and Technology; Hall
| | - W. Hackl
- Institute of Medical Informatics; UMIT - University for Health Sciences, Medical Informatics and Technology; Hall
| | - M. Kofler
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - A. J. Schiefecker
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - A. Addis
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
- Department of Clinical and Experimental Medicine; University of Sassari; Sassari Italy
| | - R. Beer
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - P. Rhomberg
- Department of Neuroradiology; Medical University of Innsbruck; Innsbruck
| | - B. Pfausler
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
| | - C. Thomé
- Department of Neurosurgery; Medical University of Innsbruck; Innsbruck Austria
| | - E. Ammenwerth
- Institute of Medical Informatics; UMIT - University for Health Sciences, Medical Informatics and Technology; Hall
| | - R. Helbok
- Neurological Intensive Care Unit; Department of Neurology; Medical University of Innsbruck; Innsbruck Austria
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17
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Schiefecker AJ, Kofler M, Gaasch M, Beer R, Unterberger I, Pfausler B, Broessner G, Lackner P, Rhomberg P, Gizewski E, Hackl WO, Mulino M, Ortler M, Thome C, Schmutzhard E, Helbok R. Brain temperature but not core temperature increases during spreading depolarizations in patients with spontaneous intracerebral hemorrhage. J Cereb Blood Flow Metab 2018; 38:549-558. [PMID: 28436257 PMCID: PMC5851146 DOI: 10.1177/0271678x17703940] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Spreading depolarizations (SDs) are highly active metabolic events, commonly occur in patients with intracerebral hemorrhage (ICH) and may be triggered by fever. We investigated the dynamics of brain-temperature (Tbrain) and core-temperature (Tcore) relative to the occurrence of SDs. Twenty consecutive comatose ICH patients with multimodal electrocorticograpy (ECoG) and Tbrain monitoring of the perihematomal area were prospectively enrolled. Clusters of SDs were defined as ≥2 SDs/h. Generalized estimating equations were used for statistical calculations. Data are presented as median and interquartile range. During 3097 h (173 h [81-223]/patient) of ECoG monitoring, 342 SDs were analyzed of which 51 (15%) occurred in clusters. Baseline Tcore and Tbrain was 37.3℃ (36.9-37.8) and 37.4℃ (36.7-37.9), respectively. Tbrain but not Tcore significantly increased 25 min preceding the onset of SDs by 0.2℃ (0.1-0.2; p < 0.001) and returned to baseline 35 min following SDs. During clusters, Tbrain increased to a higher level (+0.4℃ [0.1-0.4]; p = 0.006) when compared to single SDs. A higher probability (OR = 36.9; CI = 36.8-37.1; p < 0.001) of developing SDs was observed during episodes of Tbrain ≥ 38.0℃ (23% probability), than during Tbrain ≤ 36.6℃ (9% probability). Spreading depolarizations - and in particular clusters of SDs - may increase brain temperature following ICH.
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Affiliation(s)
- Alois J Schiefecker
- 1 Department of Neurology, Division of Neurocritical Care, Medical University Innsbruck, Innsbruck, Austria
| | - Mario Kofler
- 1 Department of Neurology, Division of Neurocritical Care, Medical University Innsbruck, Innsbruck, Austria
| | - Max Gaasch
- 1 Department of Neurology, Division of Neurocritical Care, Medical University Innsbruck, Innsbruck, Austria
| | - Ronny Beer
- 1 Department of Neurology, Division of Neurocritical Care, Medical University Innsbruck, Innsbruck, Austria
| | - Iris Unterberger
- 1 Department of Neurology, Division of Neurocritical Care, Medical University Innsbruck, Innsbruck, Austria
| | - Bettina Pfausler
- 1 Department of Neurology, Division of Neurocritical Care, Medical University Innsbruck, Innsbruck, Austria
| | - Gregor Broessner
- 1 Department of Neurology, Division of Neurocritical Care, Medical University Innsbruck, Innsbruck, Austria
| | - Peter Lackner
- 1 Department of Neurology, Division of Neurocritical Care, Medical University Innsbruck, Innsbruck, Austria
| | - Paul Rhomberg
- 2 Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Elke Gizewski
- 2 Department of Neuroradiology, Medical University Innsbruck, Innsbruck, Austria
| | - Werner O Hackl
- 3 Institute of Biomedical Informatics, University for Health Sciences, Medical Informatics and Technology (UMIT), Hall, Austria
| | - Miriam Mulino
- 4 Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Martin Ortler
- 4 Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Claudius Thome
- 4 Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Erich Schmutzhard
- 1 Department of Neurology, Division of Neurocritical Care, Medical University Innsbruck, Innsbruck, Austria
| | - Raimund Helbok
- 1 Department of Neurology, Division of Neurocritical Care, Medical University Innsbruck, Innsbruck, Austria
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18
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Kofler M, Schiefecker AJ, Beer R, Gaasch M, Rhomberg P, Stover J, Pfausler B, Thomé C, Schmutzhard E, Helbok R. Enteral nutrition increases interstitial brain glucose levels in poor-grade subarachnoid hemorrhage patients. J Cereb Blood Flow Metab 2018; 38:518-527. [PMID: 28322077 PMCID: PMC5851142 DOI: 10.1177/0271678x17700434] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Low brain tissue glucose levels after acute brain injury are associated with poor outcome. Whether enteral nutrition (EN) reliably increases cerebral glucose levels remains unclear. In this retrospective analysis of prospectively collected observational data, we investigate the effect of EN on brain metabolism in 17 poor-grade subarachnoid hemorrhage (SAH) patients undergoing cerebral microdialysis (CMD) monitoring. CMD-values were obtained hourly. A nutritional intervention was defined as the clinical routine administration of EN without supplemental parenteral nutrition. Sixty-three interventions were analyzed. The mean amount of EN per intervention was 472.4 ± 10.7 kcal. CMD-glucose levels significantly increased from 1.59 ± 0.13 mmol/l at baseline to a maximum of 2.03 ± 0.2 mmol/l after 5 h (p < 0.001), independently of insulin-treatment, baseline serum glucose, baseline brain metabolic distress (CMD-lactate-to-pyruvate-ratio (LPR) > 40) and the microdialysis probe location. The increase in CMD-glucose was directly dependent on the magnitude of increase of serum glucose levels (p = 0.007). No change in CMD-lactate, CMD-pyruvate, CMD-LPR, or CMD-glutamate (p > 0.4) was observed. Routine EN also increased CMD-glucose even if baseline concentrations were critically low ( < 0.7 mmol/l, neuroglucopenia; p < 0.001). These results may have treatment implications regarding glucose management of poor-grade aneurysmal SAH patients.
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Affiliation(s)
- Mario Kofler
- 1 Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alois J Schiefecker
- 1 Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ronny Beer
- 1 Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Maxime Gaasch
- 1 Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Paul Rhomberg
- 2 Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - John Stover
- 3 Fresenius Kabi, Bad Homburg vor der Höhe, Germany
| | - Bettina Pfausler
- 1 Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- 4 Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Erich Schmutzhard
- 1 Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Helbok
- 1 Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Kofler M, Schiefecker A, Beer R, Sohm F, Broessner G, Rhomberg P, Lackner P, Pfausler B, Thomé C, Schmutzhard E, Helbok R. Neuroglucopenia and Metabolic Distress in Two Patients with Viral Meningoencephalitis: A Microdialysis Study. Neurocrit Care 2017; 25:273-81. [PMID: 27112148 PMCID: PMC5043006 DOI: 10.1007/s12028-016-0272-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction Viral encephalitis is an emerging disease requiring intensive care management in severe cases. Underlying pathophysiologic mechanisms are incompletely understood and may be elucidated using invasive multimodal neuromonitoring techniques in humans. Methods Two otherwise healthy patients were admitted to our neurological intensive care unit with altered level of consciousness necessitating mechanical ventilation. Brain imaging and laboratory workup suggested viral encephalitis in both patients. Invasive neuromonitoring was initiated when head computed tomography revealed generalized brain edema, including monitoring of intracranial pressure, brain metabolism (cerebral microdialysis; CMD), brain tissue oxygen tension (in one patient), and cerebral blood flow (in one patient). Results Brain metabolism revealed episodes of severe neuroglucopenia (brain glucose <0.7 mM/l) in both patients, which were not attributable to decreased cerebral perfusion or hypoglycemia. CMD-glucose levels changed depending on variations in insulin therapy, nutrition, and systemic glucose administration. The metabolic profile, moreover, showed a pattern of non-ischemic metabolic distress suggestive for mitochondrial dysfunction. Both patients had a prolonged but favorable clinical course and improved to a modified Rankin Scale Score of 1 and 0 three months later. Conclusion Invasive multimodal neuromonitoring is feasible in poor-grade patients with viral meningoencephalitis and may help understand pathophysiologic mechanisms associated with secondary brain injury. The detection of neuroglucopenia and mitochondrial dysfunction may serve as treatment targets in the future.
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Affiliation(s)
- Mario Kofler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Alois Schiefecker
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Ronny Beer
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Florian Sohm
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gregor Broessner
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Paul Rhomberg
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Peter Lackner
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bettina Pfausler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Erich Schmutzhard
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Raimund Helbok
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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20
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Helbok R, Schiefecker AJ, Friberg C, Beer R, Kofler M, Rhomberg P, Unterberger I, Gizewski E, Hauerberg J, Möller K, Lackner P, Broessner G, Pfausler B, Ortler M, Thome C, Schmutzhard E, Fabricius M. Spreading depolarizations in patients with spontaneous intracerebral hemorrhage: Association with perihematomal edema progression. J Cereb Blood Flow Metab 2017; 37:1871-1882. [PMID: 27207168 PMCID: PMC5435285 DOI: 10.1177/0271678x16651269] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/05/2016] [Accepted: 04/26/2016] [Indexed: 11/16/2022]
Abstract
Pathophysiologic mechanisms of secondary brain injury after intracerebral hemorrhage and in particular mechanisms of perihematomal-edema progression remain incompletely understood. Recently, the role of spreading depolarizations in secondary brain injury was established in ischemic stroke, subarachnoid hemorrhage and traumatic brain injury patients. Its role in intracerebral hemorrhage patients and in particular the association with perihematomal-edema is not known. A total of 27 comatose intracerebral hemorrhage patients in whom hematoma evacuation and subdural electrocorticography was performed were studied prospectively. Hematoma evacuation and subdural strip electrode placement was performed within the first 24 h in 18 patients (67%). Electrocorticography recordings started 3 h after surgery (IQR, 3-5 h) and lasted 157 h (median) per patient and 4876 h in all 27 patients. In 18 patients (67%), a total of 650 spreading depolarizations were observed. Spreading depolarizations were more common in the initial days with a peak incidence on day 2. Median electrocorticography depression time was longer than previously reported (14.7 min, IQR, 9-22 min). Postoperative perihematomal-edema progression (85% of patients) was significantly associated with occurrence of isolated and clustered spreading depolarizations. Monitoring of spreading depolarizations may help to better understand pathophysiologic mechanisms of secondary insults after intracerebral hemorrhage. Whether they may serve as target in the treatment of intracerebral hemorrhage deserves further research.
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Affiliation(s)
- Raimund Helbok
- Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria
| | | | - Christian Friberg
- Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | - Ronny Beer
- Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria
| | - Mario Kofler
- Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria
| | - Paul Rhomberg
- Department of Neuroradiology, Medical University Innsbruck, Austria
| | - Iris Unterberger
- Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria
| | - Elke Gizewski
- Department of Neuroradiology, Medical University Innsbruck, Austria
| | - John Hauerberg
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Kirsten Möller
- Department of Neuroanesthesiology, Rigshospitalet, Copenhagen, Denmark
| | - Peter Lackner
- Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria
| | - Gregor Broessner
- Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria
| | - Bettina Pfausler
- Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria
| | - Martin Ortler
- Department of Neurosurgery, Medical University Innsbruck, Austria
| | - Claudius Thome
- Department of Neurosurgery, Medical University Innsbruck, Austria
| | - Erich Schmutzhard
- Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria
| | - Martin Fabricius
- Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
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21
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Tschugg A, Tschugg S, Hartmann S, Rhomberg P, Thomé C. Far caudally migrated extraforaminal lumbosacral disc herniation treated by a microsurgical lateral extraforaminal transmuscular approach: case report. J Neurosurg Spine 2016; 24:385-8. [DOI: 10.3171/2015.7.spine15342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 33-year-old man presented with moderate low-back pain and L-5 radiculopathy that progressed to severe paresis of L-5. On initial imaging, a corresponding spinal lesion was overlooked. Further CT and contrast-enhanced MRI demonstrated a presacral mass along the L-5 root far extraforaminally. A herniated disc was suspected, but with standard imaging a schwannoma could not be ruled out. The presacral L-5 root was explored via a microsurgical lateral extraforaminal transmuscular approach. To the best of the authors' knowledge, there have been no reports of sequestered extraforaminal lumbosacral disc herniations that herniated into the presacral region.
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Affiliation(s)
| | | | | | - Paul Rhomberg
- 3Department of Neuroradiology, Medical University of Innsbruck; and
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22
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Di Pauli F, Höftberger R, Reindl M, Beer R, Rhomberg P, Schanda K, Sato D, Fujihara K, Lassmann H, Schmutzhard E, Berger T. Fulminant demyelinating encephalomyelitis: Insights from antibody studies and neuropathology. Neurol Neuroimmunol Neuroinflamm 2015; 2:e175. [PMID: 26587556 PMCID: PMC4635550 DOI: 10.1212/nxi.0000000000000175] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/18/2015] [Indexed: 11/15/2022]
Abstract
Objectives: Antibodies to myelin oligodendrocyte glycoprotein (MOG) are detectable in inflammatory demyelinating CNS diseases, and MOG antibody–associated diseases seem to have a better prognosis despite occasionally severe presentations. Methods: We report the case of a 71-year-old patient with acute visual and gait disturbance that dramatically worsened to bilateral amaurosis, tetraplegia, and respiratory insufficiency within a few days. Results: MRI showed multiple progressive cerebral and spinal lesions with diffusion restriction (including both optic nerves) and marginal contrast enhancement. Routine blood and CSF measures including oligoclonal bands were normal. At disease onset, MOG immunoglobulin G was detected (serum titer 1:1,280, corresponding CSF titer was 1:20) and remained positive in patient serum. Aquaporin-4 antibodies were absent at disease onset but seroconverted to positive at week 9. In addition, CSF glial fibrillary acid protein and myelin basic protein levels were very high at onset but decreased during disease course. After 4 months, the patient died despite immunomodulatory treatment. Postmortem neuropathologic examination revealed an acute multiple sclerosis (MS) defined by multiple demyelinating lesions with a pronounced destructive component and loss of astrocytes. Lesion pattern of optic chiasm met MS pattern II characterized by antibody and complement-mediated demyelination. Conclusion: The case with the clinical presentation of an acute demyelinating encephalomyelitis with predominant optic and spinal involvement, absent oligoclonal bands, a histopathology of acute MS pattern II and development of aquaporin-4 antibodies extends the spectrum of MOG antibody–associated encephalomyelitis. Although, MOG antibodies are suspected to indicate a favorable prognosis, fulminant disease courses are possible and warrant an aggressive immunotherapy.
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Affiliation(s)
- Franziska Di Pauli
- Clinical Department of Neurology (F.D.P., M.R., R.B., K.S., E.S., T.B.) and Department of Neuroradiology (P.R.), Medical University of Innsbruck; Institute of Neurology (R.H.) and Center for Brain Research (H.L.), Medical University of Vienna, Austria; and Departments of Neurology and Multiple Sclerosis Therapeutics (D.S., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Romana Höftberger
- Clinical Department of Neurology (F.D.P., M.R., R.B., K.S., E.S., T.B.) and Department of Neuroradiology (P.R.), Medical University of Innsbruck; Institute of Neurology (R.H.) and Center for Brain Research (H.L.), Medical University of Vienna, Austria; and Departments of Neurology and Multiple Sclerosis Therapeutics (D.S., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Markus Reindl
- Clinical Department of Neurology (F.D.P., M.R., R.B., K.S., E.S., T.B.) and Department of Neuroradiology (P.R.), Medical University of Innsbruck; Institute of Neurology (R.H.) and Center for Brain Research (H.L.), Medical University of Vienna, Austria; and Departments of Neurology and Multiple Sclerosis Therapeutics (D.S., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ronny Beer
- Clinical Department of Neurology (F.D.P., M.R., R.B., K.S., E.S., T.B.) and Department of Neuroradiology (P.R.), Medical University of Innsbruck; Institute of Neurology (R.H.) and Center for Brain Research (H.L.), Medical University of Vienna, Austria; and Departments of Neurology and Multiple Sclerosis Therapeutics (D.S., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Paul Rhomberg
- Clinical Department of Neurology (F.D.P., M.R., R.B., K.S., E.S., T.B.) and Department of Neuroradiology (P.R.), Medical University of Innsbruck; Institute of Neurology (R.H.) and Center for Brain Research (H.L.), Medical University of Vienna, Austria; and Departments of Neurology and Multiple Sclerosis Therapeutics (D.S., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kathrin Schanda
- Clinical Department of Neurology (F.D.P., M.R., R.B., K.S., E.S., T.B.) and Department of Neuroradiology (P.R.), Medical University of Innsbruck; Institute of Neurology (R.H.) and Center for Brain Research (H.L.), Medical University of Vienna, Austria; and Departments of Neurology and Multiple Sclerosis Therapeutics (D.S., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Douglas Sato
- Clinical Department of Neurology (F.D.P., M.R., R.B., K.S., E.S., T.B.) and Department of Neuroradiology (P.R.), Medical University of Innsbruck; Institute of Neurology (R.H.) and Center for Brain Research (H.L.), Medical University of Vienna, Austria; and Departments of Neurology and Multiple Sclerosis Therapeutics (D.S., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuo Fujihara
- Clinical Department of Neurology (F.D.P., M.R., R.B., K.S., E.S., T.B.) and Department of Neuroradiology (P.R.), Medical University of Innsbruck; Institute of Neurology (R.H.) and Center for Brain Research (H.L.), Medical University of Vienna, Austria; and Departments of Neurology and Multiple Sclerosis Therapeutics (D.S., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hans Lassmann
- Clinical Department of Neurology (F.D.P., M.R., R.B., K.S., E.S., T.B.) and Department of Neuroradiology (P.R.), Medical University of Innsbruck; Institute of Neurology (R.H.) and Center for Brain Research (H.L.), Medical University of Vienna, Austria; and Departments of Neurology and Multiple Sclerosis Therapeutics (D.S., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Erich Schmutzhard
- Clinical Department of Neurology (F.D.P., M.R., R.B., K.S., E.S., T.B.) and Department of Neuroradiology (P.R.), Medical University of Innsbruck; Institute of Neurology (R.H.) and Center for Brain Research (H.L.), Medical University of Vienna, Austria; and Departments of Neurology and Multiple Sclerosis Therapeutics (D.S., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Thomas Berger
- Clinical Department of Neurology (F.D.P., M.R., R.B., K.S., E.S., T.B.) and Department of Neuroradiology (P.R.), Medical University of Innsbruck; Institute of Neurology (R.H.) and Center for Brain Research (H.L.), Medical University of Vienna, Austria; and Departments of Neurology and Multiple Sclerosis Therapeutics (D.S., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
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23
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Kofler M, Schiefecker A, Ferger B, Beer R, Sohm F, Broessner G, Hackl W, Rhomberg P, Lackner P, Pfausler B, Thomé C, Schmutzhard E, Helbok R. Cerebral Taurine Levels are Associated with Brain Edema and Delayed Cerebral Infarction in Patients with Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 2015; 23:321-9. [DOI: 10.1007/s12028-015-0140-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Helbok R, Schiefecker AJ, Beer R, Dietmann A, Antunes AP, Sohm F, Fischer M, Hackl WO, Rhomberg P, Lackner P, Pfausler B, Thomé C, Humpel C, Schmutzhard E. Early brain injury after aneurysmal subarachnoid hemorrhage: a multimodal neuromonitoring study. Crit Care 2015; 19:75. [PMID: 25887441 PMCID: PMC4384312 DOI: 10.1186/s13054-015-0809-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 02/12/2015] [Indexed: 12/01/2022]
Abstract
Introduction There is a substantial amount of evidence from animal models that early brain injury (EBI) may play an important role for secondary brain injury after aneurysmal subarachnoid hemorrhage (aSAH). Cerebral microdialysis (CMD) allows online measurement of brain metabolites, including the pro-inflammatory cytokine interleukin-6 (IL-6) and matrix metalloproteinase-9 (MMP-9), which is indicative for disruption of the blood-brain barrier. Methods Twenty-six consecutive poor-grade aSAH patients with multimodal neuromonitoring were analyzed for brain hemodynamic and metabolic changes, including CMD-IL-6 and CMD-MMP-9 levels. Statistical analysis was performed by using a generalized estimating equation with an autoregressive function. Results The baseline cerebral metabolic profile revealed brain metabolic distress and an excitatory response which improved over the following 5 days (P <0.001). Brain tissue hypoxia (brain tissue oxygen tension of less than 20 mm Hg) was common (more than 60% of patients) in the first 24 hours of neuromonitoring and improved thereafter (P <0.05). Baseline CMD-IL-6 and CMD-MMP-9 levels were elevated in all patients (median = 4,059 pg/mL, interquartile range (IQR) = 1,316 to 12,456 pg/mL and median = 851 pg/mL, IQR = 98 to 25,860 pg/mL) and significantly decreased over days (P <0.05). A higher pro-inflammatory response was associated with the development of delayed cerebral ischemia (P = 0.04), whereas admission disease severity and early brain tissue hypoxia were associated with higher CMD-MMP-9 levels (P <0.03). Brain metabolic distress and increased IL-6 levels were associated with poor functional outcome (modified Rankin Scale of more than 3, P ≤0.01). All models were adjusted for probe location, aneurysm securing procedure, and disease severity as appropriate. Conclusions Multimodal neuromonitoring techniques allow insight into pathophysiologic changes in the early phase after aSAH. The results may be used as endpoints for future interventions targeting EBI in poor-grade aSAH patients.
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Affiliation(s)
- Raimund Helbok
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria.
| | - Alois Josef Schiefecker
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria.
| | - Ronny Beer
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria.
| | - Anelia Dietmann
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria.
| | - Ana Patrícia Antunes
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria. .,Department of Neurosciences, Santa Maria Hospital, Hospital de Santa Maria, 1649-028, Lisbon, Portugal.
| | - Florian Sohm
- Department of Neurosurgery, Innsbruck Medical University, Anichstreet 35, 6020, Innsbruck, Austria.
| | - Marlene Fischer
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria.
| | - Werner Oskar Hackl
- Institute of Biomedical Informatics, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard Wallnöfer-Zentrum I, 6060, Hall in Tirol, Austria.
| | - Paul Rhomberg
- Department of Radiology, Innsbruck Medical University, Anichstreet 35, 6020, Innsbruck, Austria.
| | - Peter Lackner
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria.
| | - Bettina Pfausler
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria.
| | - Claudius Thomé
- Department of Neurosurgery, Innsbruck Medical University, Anichstreet 35, 6020, Innsbruck, Austria.
| | - Christian Humpel
- Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria.
| | - Erich Schmutzhard
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Anichstreet 35, 6020, Innsbruck, Austria.
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Schiefecker AJ, Beer R, Kofler M, Pfausler B, Unterberger I, Lackner P, Broessner G, Rhomberg P, Sohm F, Mulino M, Thome C, Fabricius M, Schmutzhard E, Helbok R. Cortical spreading depolarizations in patients with intracerebral hemorrhage: preliminary data. Crit Care 2015. [PMCID: PMC4472272 DOI: 10.1186/cc14548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Di Pauli F, Berger T, Walder A, Maier H, Rhomberg P, Uprimny C, Steurer M, Stockhammer G. Progressive multifocal leukoencephalopathy complicating untreated chronic lymphatic leukemia: case report and review of the literature. J Clin Virol 2014; 60:424-7. [PMID: 24929753 DOI: 10.1016/j.jcv.2014.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 04/28/2014] [Accepted: 05/10/2014] [Indexed: 11/27/2022]
Abstract
A 58-year old female with a four-year history of previously untreated CLL at Binet stage A complained about word finding problems, impaired vision, and gait unsteadiness. Concerning her CLL she was asymptomatic and had never required any specific treatment. Her neurological examination disclosed cognitive alterations, homonyme hemianopia to the right, aphasia, and mild right-sided hemiparesis. Cerebral MRI showed a hyperintense lesion on T2 weighted images without contrast enhancement. CSF examination revealed normal findings, including CSF protein, cell count, cytology and PCR-analysis was negative for the presence of JC virus DNA. On follow-up MRI, performed 2 weeks later, the T2 lesion was further enlarging. Subsequent stereotactic brain biopsy was diagnostic for PML revealing abnormal oligodendrocytes staining positive against antibodies specific for simian vacuolating virus 40. In addition, repeated CSF analyses for JC-Virus DNA in the course of the disease became positive. After confirmation of diagnosis treatment with mirtazapine (30 mg/d) and mefloquine (250 mg/d) was initiated. Rapid clinical progression correlated to further worsening on MRI. Therefore this treatment was terminated after 16 days and the regime was changed to a five-day courses of cytarabine (2 mg/kg/d) combined with intrathecal administration of liposomal cytarabine (50 mg). Due to further clinical progression with global aphasia, blindness and severe right-sided hemiparesia, medication was stopped. The Patient died three and a half months after onset of symptoms.
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Affiliation(s)
- Franziska Di Pauli
- Clinical Department of Neurology, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria.
| | - Thomas Berger
- Clinical Department of Neurology, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria
| | - Alois Walder
- Division of Haematology & Oncology, Regional Hospital Lienz, Emanuel-von-Hibler-Str 5, 9900 Lienz, Austria
| | - Hans Maier
- Institute of Pathology, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria
| | - Paul Rhomberg
- Department of Radiology, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria
| | - Christian Uprimny
- Department of Nuclear Medicine, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria
| | - Michael Steurer
- Division of Haematology & Oncology, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria
| | - Guenther Stockhammer
- Clinical Department of Neurology, Innsbruck Medical University, Anichstr. 35, 6020 Innsbruck, Austria
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Koppelstaetter F, Siedentopf CM, Rhomberg P, Lechner-Steinleitner S, Mottaghy FM, Eisner W, Golaszewski SM. fMRT vor Motorkortexstimulation beim Phantomschmerz. Nervenarzt 2007; 78:1435-9. [PMID: 17846735 DOI: 10.1007/s00115-007-2323-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study deals with the diagnostic value of functional magnetic resonance imaging (fMRI) in a patient with phantom limb pain following traumatic amputation of the right arm. After failure with medication, resection of stump neurinoma, and spinal cord stimulation, fMRI with evidence of cortical reorganization was performed. Tactile stimulation of the perioral region and motor imagery with cranial, tactile stimulation of the stump led to a caudal shift in fMRI activity. Subsequent motor cortex stimulation brought relief from the pain. By detecting cortical reorganization, fMRI contributes to the indication for motor cortex stimulation for phantom pain and aids in electrode positioning.
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Affiliation(s)
- F Koppelstaetter
- Univ.-Klinik für Radiologie II, Medizinische Universität, Innsbruck, Austria
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Koppelstaetter F, Poeppel TD, Siedentopf CM, Ischebeck A, Verius M, Haala I, Mottaghy FM, Rhomberg P, Golaszewski S, Gotwald T, Lorenz IH, Kolbitsch C, Felber S, Krause BJ. Does caffeine modulate verbal working memory processes? An fMRI study. Neuroimage 2007; 39:492-9. [PMID: 17936643 DOI: 10.1016/j.neuroimage.2007.08.037] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Revised: 07/24/2007] [Accepted: 08/17/2007] [Indexed: 12/11/2022] Open
Abstract
To assess the effect of caffeine on the functional MRI signal during a 2-back verbal working memory task, we examined blood oxygenation level-dependent regional brain activity in 15 healthy right-handed males. The subjects, all moderate caffeine consumers, underwent two scanning sessions on a 1.5-T MR-Scanner separated by a 24- to 48-h interval. Each participant received either placebo or 100 mg caffeine 20 min prior to the performance of the working memory task in blinded crossover fashion. The study was implemented as a blocked-design. Analysis was performed using SPM2. In both conditions, the characteristic working memory network of frontoparietal cortical activation including the precuneus and the anterior cingulate could be shown. In comparison to placebo, caffeine caused an increased response in the bilateral medial frontopolar cortex (BA 10), extending to the right anterior cingulate cortex (BA 32). These results suggest that caffeine modulates neuronal activity as evidenced by fMRI signal changes in a network of brain areas associated with executive and attentional functions during working memory processes.
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Affiliation(s)
- F Koppelstaetter
- Department of Radiology II, Medical University of Innsbruck, University Hospital of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria
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Sader H, Rhomberg P, Fritsche T, Jones R. P1828 Update on daptomycin activity and spectrum when tested against Gram-positive strains collected in European medical centres (2006). Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71667-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rhomberg P, Kirby J, Fritsche T, Sader H, Jones R. P1808 Update on potency and spectrum of activity of meropenem and selected broad-spectrum agents: testing results from the USA MYSTIC Program (2006). Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71647-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kaufmann L, Koppelstaetter F, Delazer M, Siedentopf C, Rhomberg P, Golaszewski S, Felber S, Ischebeck A. Neural correlates of distance and congruity effects in a numerical Stroop task: an event-related fMRI study. Neuroimage 2005; 25:888-98. [PMID: 15808989 DOI: 10.1016/j.neuroimage.2004.12.041] [Citation(s) in RCA: 156] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2004] [Revised: 12/16/2004] [Accepted: 12/21/2004] [Indexed: 11/19/2022] Open
Abstract
This study aimed at investigating the neural correlates of a number-size congruity task. Using an event-related fMRI design, we presented one-digit number pairs to 17 participants in a number-size interference task that required subjects to focus on one stimulus property (e.g., numerical size) and to ignore the other (physical size). In different blocks, participants were asked to decide which digit of a digit pair was numerically larger (numerical comparison task) or physically larger (physical comparison task). Stimuli were classified into three categories: (a) congruent: physical and numerical comparison leads to the same response; (b) incongruent: physical and numerical comparison leads to different responses; (c) neutral: the stimuli differ only with regard to the task-relevant stimulus property. Behavioral results reflect robust distance effects (quicker reaction times for long distances relative to short ones) and size congruity effects (longer reaction times for incongruent relative to congruent stimuli) in both tasks. Imaging results reveal that-compared to congruent trials-incongruent trials led to a stronger activation in the dorsolateral prefrontal cortex and the anterior cingulate cortex, areas associated with attentional control. The distance effect (neutral condition only) led to a stronger activation in bilateral parietal areas including the intraparietal sulcus (IPS).
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Affiliation(s)
- Liane Kaufmann
- Innsbruck Medical University, Clinical Department of Pediatrics, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Siedentopf CM, Koppelstaetter F, Haala IA, Haid V, Rhomberg P, Ischebeck A, Buchberger W, Felber S, Schlager A, Golaszewski SM. Laser acupuncture induced specific cerebral cortical and subcortical activations in humans. Lasers Med Sci 2005; 20:68-73. [PMID: 15990948 DOI: 10.1007/s10103-005-0340-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Revised: 04/14/2005] [Accepted: 04/27/2005] [Indexed: 10/25/2022]
Abstract
As recent studies demonstrated, acupuncture can elicit activity in specific brain areas. This study aims to explore further the central effect using laser acupuncture. We investigated the cerebral effects of laser acupuncture at both acupoints GB43 with functional magnetic resonance imaging (fMRI). As a control condition the laser was mounted at the same acupoints but without application of laser stimulation. The group results showed significant brain activations within the thalamus, nucleus subthalamicus, nucleus ruber, the brainstem, and the Brodmann areas 40 and 22 for the acupuncture condition. No significant brain activations were observed within the placebo condition. The activations we observed were laser acupuncture-specific and predominantly ipsilateral. This supports the assumption that acupuncture is mediated by meridians, since meridians do not cross to the other side. Furthermore, we could show that laser acupuncture allows one to design a pure placebo condition.
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Affiliation(s)
- Christian M Siedentopf
- Department of Radiology II, University Hospital of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
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Golaszewski SM, Siedentopf CM, Koppelstaetter F, Rhomberg P, Guendisch GM, Schlager A, Gallasch E, Eisner W, Felber SR, Mottaghy FM. Modulatory effects on human sensorimotor cortex by whole-hand afferent electrical stimulation. Neurology 2004; 62:2262-9. [PMID: 15210892 DOI: 10.1212/wnl.62.12.2262] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the effect of electrical stimulation of the nerve afferents of the hand on cortical activity elicited by whole-hand subthreshold stimulation for sensation in healthy human subjects. METHODS Ten healthy volunteers were studied using BOLD-fMRI with 1) a test motor-task with finger-to-thumb tapping of the left hand, 2) a whole-hand afferent electrical stimulation of the left hand below the sensory level for sensation for 30 minutes, 3) a second fMRI run with the same paradigm as in the test motor-task immediately after electrical stimulation, and 4) a final identical fMRI run 2 hours post-stimulation to test the cortical changes induced by electrical stimulation. Experiments were carried out on a 1.5 T MR scanner and for fMRI echoplanar sequences were used. Data analysis was performed with SPM99. RESULTS An increase of movement-related responses was seen within the primary motor and primary somatosensory areas of both hemispheres when comparing the test motor-task with the motor-task after electrical stimulation relative to the baseline or sham stimulation. Two hours post-stimulation the modulatory effects of mesh-glove stimulation diminished to baseline level except within the contralateral primary motor region. CONCLUSIONS The increased BOLD response spatially localized within the sensorimotor cortex reflects an increase in neuronal activity that may provide augmented neuronal excitability.
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Affiliation(s)
- S M Golaszewski
- Department of Neurology, University Hospital of Graz, Austria.
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Brueggemann AB, Coffman SL, Rhomberg P, Huynh H, Almer L, Nilius A, Flamm R, Doern GV. Fluoroquinolone resistance in Streptococcus pneumoniae in United States since 1994-1995. Antimicrob Agents Chemother 2002; 46:680-8. [PMID: 11850248 PMCID: PMC127509 DOI: 10.1128/aac.46.3.680-688.2002] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2001] [Revised: 10/30/2001] [Accepted: 11/21/2001] [Indexed: 11/20/2022] Open
Abstract
The in vitro activities of ciprofloxacin, levofloxacin, gatifloxacin, and moxifloxacin against a large collection of clinical isolates of Streptococcus pneumoniae (n = 4,650) obtained over a 5-year period, 1994-1995 through 1999-2000, were assessed as part of a longitudinal multicenter U.S. surveillance study of antimicrobial resistance. Three sampling periods were used during this investigation, the winter seasons of 1994-1995, 1997-1998, and 1999-2000; and 1,523, 1,596 and 1,531 isolates were collected during these three periods, respectively. The overall rank order of activity of the four fluoroquinolones examined in this study was moxifloxacin > gatifloxacin > levofloxacin = ciprofloxacin, in which moxifloxacin (MIC at which 90% of isolates are inhibited [MIC(90)], 0.25 microg/ml; modal MIC, 0.12 microg/ml) was twofold more active than gatifloxacin (MIC(90), 0.5 microg/ml; modal MIC, 0.25 microg/ml), which in turn was fourfold more active than either levofloxacin (MIC(90), 1 microg/ml; modal MIC, 1 microg/ml) or ciprofloxacin (MIC(90), 2 microg/ml; modal MIC, 1 microg/ml). Changes in the in vitro activities of fluoroquinolones against S. pneumoniae strains in the United States over the 5-year period of the survey were assessed by comparing the MIC frequency distributions of the study drugs against the isolates obtained during the three sampling periods encompassing this investigation. These comparisons revealed no evidence of changes in the in vitro activities of the fluoroquinolones. In addition, the percentages of isolates in the three sampling periods for which MICs were above the resistance breakpoints were compared. Low percentages of resistant strains were detected, and there was no evidence of resistance rate changes over time. For example, by use of a ciprofloxacin MIC of > or = 4 microg/ml to define resistance, the proportions of isolates from the three sampling periods for which MICs were at or above this breakpoint were 1.2, 1.6, and 1.4%, respectively. A total of 164 unique isolates (n = 58 from 1994-1995, 65 from 1997-1998, and 42 from 1999-2000) were examined for evidence of mutations in the quinolone resistance-determining regions (QRDRs) of the parC and the gyrA genes. Forty-nine isolates harbored at least one mutation in the QRDRs of one or both genes (1994-1995, n = 15; 1997-1998, n = 19; 1999-2000, n = 15). Among the 4,650 isolates of S. pneumoniae examined in the study, we estimated that 0.3% had mutations in both the parC and gyrA loci. The majority of mutations (67.3% of the mutations in 49 isolates with mutations) were amino acid substitutions in the parC locus only. Four isolates had a mutation in the gyrA locus only, and 12 isolates had mutations in both genes (8.2 and 24.5% of isolates with mutations, respectively). There was no significant difference in the number of isolates with parC and/or gyrA mutations detected during each study period. Finally, because of the magnitude of the study, we had reasonably large numbers of pneumococcal isolates with genotypically defined mechanisms of fluoroquinolone resistance and were thus able to determine the effects of specific resistance mutations on the activities of different fluoroquinolones. In general, isolates with mutations in parC only were resistant to ciprofloxacin but remained susceptible to levofloxacin, gatifloxacin, and moxifloxacin, whereas isolates with mutations in gyrA only and isolates with mutations in both parC and gyrA were resistant to all four fluoroquinolones tested.
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Weber S, Herwaldt LA, Mcnutt LA, Rhomberg P, Vaudaux P, Pfaller MA, Perl TM. An outbreak of Staphylococcus aureus in a pediatric cardiothoracic surgery unit. Infect Control Hosp Epidemiol 2002; 23:77-81. [PMID: 11893152 DOI: 10.1086/502010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate an outbreak of Staphylococcus aureus surgical-site infections. DESIGN Case-control study. SETTING Pediatric cardiothoracic surgery service of a tertiary-care university medical center. METHOD Molecular typing was used to identify healthcare workers who carried the epidemic strain. RESULTS Three children acquired surgical-site infections caused by a single strain of S. aureus. Fourteen (25%) of the staff members in the operating room and 17 (11%) on nursing units carried the epidemic strain (P = .01). A case-control study identified 4 healthcare workers who were associated statistically with the outbreak, 2 of whom (a cardiothoracic surgeon and a perfusionist) carried the epidemic strain in their nares. The surgeon also carried the epidemic strain on his hands. Each staff member who carried the epidemic strain was treated with mupirocin; those carrying the strain on their hands were required to wash their hands with chlorhexidine. The surgeon was not allowed to perform surgery until 2 of his hand cultures did not grow S. aureus. CONCLUSIONS Only three children were infected with the epidemic strain, but it was disseminated widely among staff who cared for children who underwent cardiothoracic surgery. No additional cases were identified after staff members who carried the epidemic strain were decolonized. Both classic epidemiologic methods and molecular typing techniques were necessary to identify the source and extent of this outbreak.
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Affiliation(s)
- Stefan Weber
- Department of Internal Medicine University of Iowa College of Medicine, Iowa City, USA
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Klepser ME, Ernst EJ, Petzold CR, Rhomberg P, Doern GV. Comparative bactericidal activities of ciprofloxacin, clinafloxacin, grepafloxacin, levofloxacin, moxifloxacin, and trovafloxacin against Streptococcus pneumoniae in a dynamic in vitro model. Antimicrob Agents Chemother 2001; 45:673-8. [PMID: 11181341 PMCID: PMC90354 DOI: 10.1128/aac.45.3.673-678.2001] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Several new quinolones that exhibit enhanced in vitro activity against Streptococcus pneumoniae have been developed. Using a dynamic in vitro model, we generated time-kill data for ciprofloxacin, clinafloxacin, grepafloxacin, levofloxacin, moxifloxacin, and trovafloxacin against three isolates of quinolone-susceptible S. pneumoniae. Three pharmacokinetic profiles were simulated for each of the study agents (0.1, 1, and 10 times the area under the concentration-time curve [AUC]). Target 24-h AUCs were based upon human pharmacokinetic data resulting from the maximal daily doses of each agent. Ciprofloxacin was the least active agent against all three isolates. With regimens that simulated the human 24-h AUC, ciprofloxacin resulted in an initial, modest decline in the numbers of CFU per milliliter; however, by 48 h the numbers of CFU per milliliter returned to or exceeded the starting inoculum. At the AUC, levofloxacin resulted in variable bacteriostatic and bactericidal activities against the isolates. The remaining agents yielded bactericidal (99.9% reduction) activity by 48 h with regimens that simulated the AUC. At 0.1 time the AUC ciprofloxacin and levofloxacin produced no inhibitory effect, grepafloxacin exhibited bacteriostatic activity, trovafloxacin had mixed static and cidal activities, and clinafloxacin and moxifloxacin caused significant reductions in the numbers of CFU per milliliter by 48 h. All six agents produced cidal activity at 10 times the AUC. In this dynamic in vitro model of infection, the quinolones demonstrated various degrees of activity against S. pneumoniae. The rank order of activity, with respect to bactericidal effect, was ciprofloxacin (least active) << levofloxacin < grepafloxacin, trovafloxacin < clinafloxacin and moxifloxacin (most active). The rank order of the agents with respect to the selection of resistance was ciprofloxacin (most likely) > grepafloxacin, moxifloxacin, and trovafloxacin > levofloxacin > clinafloxacin.
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Affiliation(s)
- M E Klepser
- University of Iowa College of Pharmacy, Iowa City, Iowa 52242-1112, USA.
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Rangel-Frausto MS, Rhomberg P, Hollis RJ, Pfaller MA, Wenzel RP, Helms CM, Herwaldt LA. Persistence of Legionella pneumophila in a hospital's water system: a 13-year survey. Infect Control Hosp Epidemiol 1999; 20:793-7. [PMID: 10614601 DOI: 10.1086/501586] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe the molecular epidemiology of Legionella pneumophila infections in the University of Iowa Hospitals and Clinics (UIHC). DESIGN Molecular epidemiological study using pulsed-field gel electrophoresis (PFGE). SETTING A large university teaching hospital. ISOLATES: All surviving isolates obtained from culture-proven nosocomial L. pneumophila infections and all surviving isolates obtained from the University of Iowa Hospital and Clinics' water supply between 1981 and 1993. RESULTS Thirty-three isolates from culture-proven nosocomial cases of L. pneumophila pneumonia were available for typing. PFGE of genomic DNA from the clinical isolates identified six different strains. However, only strain C (16 cases) and strain D (13 cases) caused more than 1 case. Strain C caused clusters of nosocomial infection in 1981, 1986, and 1993 and also caused 4 sporadic cases. Strain D caused a cluster in 1987 and 1988 plus 4 sporadic cases. Of the six strains causing clinical infections, only strains C and D were identified in water samples. PFGE identified three strains in the water supply, of which strains C and D caused clinical disease and also persisted in the water supply during most of the study period. CONCLUSION Specific strains of L. pneumophila can colonize hospital water supplies and cause nosocomial infections over long periods of time.
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Affiliation(s)
- M S Rangel-Frausto
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City 52242-1081, USA
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Pfaller MA, Bale MJ, Buschelman B, Rhomberg P. Antifungal activity of a new triazole, D0870, compared with four other antifungal agents tested against clinical isolates of Candida and Torulopsis glabrata. Diagn Microbiol Infect Dis 1994; 19:75-80. [PMID: 7805359 DOI: 10.1016/0732-8893(94)90116-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
D0870 is a new triazole agent with potent, broad-spectrum antifungal activity. We investigated the in vitro activity of D0870, fluconazole, itraconazole, amphotericin B, and 5-fluorocytosine (5FC) against 319 clinical isolates of Candida spp. and Torulopsis glabrata. In vitro susceptibility testing was performed using a microdilution broth method performed according to NCCLS guidelines. D0870 was very active (MIC90 of 0.12 microgram/ml and 0.5 microgram/ml at 24 and 48 h incubation, respectively) against all of the yeast isolates. D0870 was 2- to 32-fold more active than amphotericin B and 2- to 8500-fold more active than 5FC. By comparison with the other triazoles, D0870 was generally 2- to 16-fold more active than itraconazole and > or = 16-fold more active than fluconazole. More than half (53%) of C. albicans isolates with elevated fluconazole and itraconazole MICs (> or = 128 micrograms/ml and > 8.0 micrograms/ml, respectively) were inhibited by < or = 1.0 microgram/ml of D0870. Based on these studies, D0870 has promising antifungal activity and warrants further in vitro and in vivo investigation.
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Affiliation(s)
- M A Pfaller
- Department of Pathology, University of Iowa College of Medicine, Iowa City 52242
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Eberle C, Rhomberg P, Metzger U. [Long-term follow-up of surgically treated intra-articular calcaneus fractures]. Helv Chir Acta 1994; 60:629-35. [PMID: 8034545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Between 1980 and 1991 we treated 150 joint fractures of the os calcis with open reduction and internal fixation with a special AO-plate. In this report we show the results of 36 fractures in 33 patients after an average follow-up of 89 months (43-132). Patients got back their working ability between 4.6 and 5.6 months. At the time of the clinical control two third of the patients had a working ability of 100%. 4 patients changed their profession due to the poor result of the fracture. 12% of the cases ended in spontaneous or secondary arthrodesis of the lower ankle joint. One third of the patients need orthopedic supports or special shoes. 73% of the patients are satisfied with the result.
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Affiliation(s)
- C Eberle
- Chirurgische Klinik, Stadtspital Triemli Zürich
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Stamler J, Rhomberg P, Schoenberger JA, Shekelle RB, Dyer A, Shekelle S, Stamler R, Wannamaker J. Multivariate analysis of the relationship of seven variables to blood pressure: findings of the Chicago Heart Association Detection Project in Industry, 1967-1972. J Chronic Dis 1975; 28:527-48. [PMID: 1081548 DOI: 10.1016/0021-9681(75)90060-0] [Citation(s) in RCA: 155] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Stamler J, Stamler R, Rhomberg P, Dyer A, Berkson DM, Reedus W, Wannamaker J. Multivariate analysis of the relationship of six variables to blood pressure: findings from Chicago community surveys, 1965--1971. J Chronic Dis 1975; 28:499-525. [PMID: 1081547 DOI: 10.1016/0021-9681(75)90059-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Braunsteiner H, Gabl F, Lederer B, Pastner D, Propst A, Rhomberg P. [Thymus tumor with extreme lymphopenia and atrophy of the lymphatic tissue with normal plasma cell count and with occurrence of a monoclonal IGM(lambda) increase]. Schweiz Med Wochenschr 1968; 98:1188-92. [PMID: 5705670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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