Klinikum Dortmund

Dortmund, Germany

Klinikum Dortmund

Dortmund, Germany
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Muller T.,St Joseph Hospital Berlin Weissensee | Saft C.,Ruhr University Bochum | Harati A.,Klinikum Dortmund
NeuroRehabilitation | Year: 2013

BACKGROUND: Assessment of impaired motor behaviour serves as tool for diagnosis and for evaluation of progression of chronic neurodegeneration. METHODS: We measured performance of rapid alternating movements, simple and complex motion series with instruments in scored, drug naïve patients with Huntington's disease and controls. OBJECTIVES: To compare device outcomes with the ones of controls and to correlate them with each other and with the disease symptoms. RESULTS: Patients showed lower peak velocities and longer intervals for performance of rapid alternating movements than the controls. On the right dominant side, a correlation was found between intervals needed for standardised alternating movement performance and the simple motion task outcomes in the patients. No relations to the rated disease symptoms appeared. CONCLUSION: Execution of alternating movements is disturbed in Huntington's disease. Performance of the simple motion task and realisation of alternating motions shares a need for low cognitive efforts. Both ask for a more automated motion execution. Therefore they were related to each other to a certain extent. Execution of complex movement series asks for higher cognitive load, as it demands aiming and planning of movement series with visual input. This motion pattern does not resemble to the realisation of rapid alternating movements. © 2013 - IOS Press and the authors. All rights reserved.

Hametner C.,University of Heidelberg | Stanarcevic P.,University of Belgrade | Stampfl S.,University of Heidelberg | Rohde S.,Klinikum Dortmund | And 2 more authors.
Journal of Cerebral Blood Flow and Metabolism | Year: 2015

Implementing endovascular stroke care often impedes neurologic assessment in patients who need sedation or general anesthesia. Cerebral near-infrared spectroscopy (NIRS) may help physicians monitor cerebral tissue viability, but data in hyperacute stroke patients receiving endovascular treatment are sparse. In this observational study, the NIRS index regional oxygen saturation (rSO 2) was measured noninvasively before, during, and after endovascular therapy via bilateral forehead NIRS optodes. During the study period, 63 patients were monitored with NIRS; 43 qualified for analysis. Before recanalization, 10 distinct rSO 2 decreases occurred in 11 patients with respect to time to intubation. During recanalization, two kinds of unilateral rSO 2 changes occurred in the affected hemisphere: small peaks throughout the treatment (n=14, 32.6%) and sustained increases immediately after recanalization (n=2, 4.7%). Lower area under the curve 10% below baseline was associated with better reperfusion status (thrombolysis in cerebral infarction ≥ 2b, P=0.009). At the end of the intervention, lower interhemispheric rSO 2 difference predicted death within 90 days (P=0.037). After the intervention, higher rSO 2 variability predicted poor outcome (modified Rankin scale > 3, P=0.032). Our findings suggest that bi-channel rSO 2 -NIRS has potential for guiding neuroanesthesia and predicting outcome. To better monitor local revascularization, an improved stroke-specific set-up in future studies is necessary. © 2015 ISCBFM.

Muller T.,St Josef Hospital Bochum | Muller T.,St Joseph Hospital Berlin Weissensee | Peters S.,Bergmannsheil University Hospital | Harati A.,Klinikum Dortmund
Journal of Neural Transmission | Year: 2013

Disturbances of alternating movement execution are a characteristic clinical sign of patients with Parkinson's disease (PD). Objectives were to compare instrumentally measured diadochokinetic motion series carrying out before and 1 h after standardised levodopa intake and to correlate the device results with the respective rating scores of the PD patients. Maximum velocity and interval improved following levodopa application. The amplitude of motions did not differ between both assessment moments. Closer correlations between rating- and diadochokinesimeter outcomes appeared before levodopa intake. © 2012 Springer-Verlag.

Peterburs J.,Ruhr University Bochum | Bellebaum C.,Ruhr University Bochum | Koch B.,Klinikum Dortmund | Schwarz M.,Klinikum Dortmund | Daum I.,Ruhr University Bochum
Cerebellum | Year: 2010

Findings concerning cognitive impairment in patients with focal cerebellar lesions tend to be inconsistent and usually reflect a mild deficit. Patient variables such as lesion age and the age at lesion onset might affect functional reorganization and contribute to the variability of the findings. To assess this issue, 14 patients with focal vascular cerebellar lesions and 14 matched healthy control subjects performed a verbal working memory and a verbal long-term memory task as well as verbal fluency tasks. Patients showed deficits in working memory and verbal fluency, while recall of complex narrative material was intact. Verbal fluency performance correlated significantly with age in the patient group, with more severe impairments in older patients, suggesting that age at lesion onset is a critical variable for cognitive outcome. In controls, no significant correlations with age were observed. Taken together, our findings support the idea of cerebellar involvement in nonmotor functions and indicate the relevance of interindividual differences in regard to clinical parameters after focal cerebellar damage. © 2010 Springer Science+Business Media, LLC.

Peterburs J.,Ruhr University Bochum | Koch B.,Klinikum Dortmund | Schwarz M.,Klinikum Dortmund | Hoffmann K.-P.,Ruhr University Bochum | And 2 more authors.
Cerebellum | Year: 2013

Efference copies of motor commands are used to update visual space across saccades, ultimately ensuring transsaccadic constancy of space. Thalamic lesions have been shown to impair efference copy-based saccadic updating in an oculomotor context, i.e., when two successive saccades are required. Moreover, the cerebellum has also been discussed as one possible source of saccade-related efference copy signals. The present study aimed to investigate the effects of thalamic and cerebellar lesions on saccadic updating in a perceptual context. To this end, seven patients with focal cerebellar lesions, seven patients with focal thalamic lesions and 11 healthy controls completed a perceptual localisation task in which the position of a target had to be updated across a single horizontal saccade, while saccade-related event-related potentials (ERPs) were recorded. Contrary to the expectations, localisation precision in both patient groups did not differ from the respective controls. A positive ERP component with centroparietal distribution occurring from about 300 to 500 ms after saccade onset in the updating condition was observed equally pronounced in controls and thalamic lesion patients. In cerebellar lesion patients, there was evidence of a reduction of this relative positivity in the updating condition, particularly for leftward saccades. This finding suggests that cerebellar damage altered the neural processes underlying saccadic updating in a perceptual context without causing overt behavioural deficits. © 2012 Springer Science+Business Media, LLC.

Peterburs J.,Ruhr University Bochum | Pergola G.,Ruhr University Bochum | Koch B.,Klinikum Dortmund | Schwarz M.,Klinikum Dortmund | And 3 more authors.
PLoS ONE | Year: 2011

Event-related potentials (ERP) research has identified a negative deflection within about 100 to 150 ms after an erroneous response - the error-related negativity (ERN) - as a correlate of awareness-independent error processing. The short latency suggests an internal error monitoring system acting rapidly based on central information such as an efference copy signal. Studies on monkeys and humans have identified the thalamus as an important relay station for efference copy signals of ongoing saccades. The present study investigated error processing on an antisaccade task with ERPs in six patients with focal vascular damage to the thalamus and 28 control subjects. ERN amplitudes were significantly reduced in the patients, with the strongest ERN attenuation being observed in two patients with right mediodorsal and ventrolateral and bilateral ventrolateral damage, respectively. Although the number of errors was significantly higher in the thalamic lesion patients, the degree of ERN attenuation did not correlate with the error rate in the patients. The present data underline the role of the thalamus for the online monitoring of saccadic eye movements, albeit not providing unequivocal evidence in favour of an exclusive role of a particular thalamic site being involved in performance monitoring. By relaying saccade-related efference copy signals, the thalamus appears to enable fast error processing. Furthermore early error processing based on internal information may contribute to error awareness which was reduced in the patients. © 2011 Peterburs et al.

Deitmer T.,Klinikum Dortmund | Neuwirth C.,Klinikum Ludenscheid
Laryngo- Rhino- Otologie | Year: 2010

Background: There is only little systematic evidence about blood-loss and management of cases of post-tonsillectomy hemorrhage. Method: 105 cases of post-tonsillectomy hemorrhage were identified and data as gender, age, time of hemorrhage, amount of blood loss, circumstances of hemorrhage and management of hemorrhage were detailed by chart review. Results: The typical two points of hemorrhage are the day of surgery and the fifth to eighth postoperative day, the latter as the time of debridement of the fibrin layers. The distribution of gender and age were similar to the cases operated on. In Germany tonsillectomy-patients are kept as inpatients until the fifth to seventh day after sugery to care for pain-management, food-intake and possible hemorrhage. It must be noted that 77 patients experienced hemorrhage after dismission from the ward. Concerning the blood loss, estimated from the hemoglobin-concentration before tonsillectomy and at the time of hemorrhage, we found declines of up to 5g/dl. Plotted against the time of hemorrhage or against the age of the patient we must state, that blood-loss does not correlate to the time after sugery nor to the age. Conclusions: We saw severe blood-loss even two weeks after surgery, whereas the events of hemorrhage around the time of debridement of fibrinlayers showed no accumulation of severe outcomes. © Georg Thieme Verlag KG Stuttgart - New York.

Eisfeld W.,HNO Praxis | Deitmer T.,Klinikum Dortmund
Laryngo- Rhino- Otologie | Year: 2010

From Tonsil Capping to Tonsillectomy to Tonsillotomy Medicine has been dealing with palatine tonsil disorders since its beginnings. With the initial aim of eliminating chronic centres of infl ammation, over time manifold surgical processes to extract tonsils were developed and tested. Very early on it already became clear that the complete extraction of the tonsil along its connective tissue capsule can lead to serious complications: the risk of bleeding after a tonsillectomy is well-known to currently practising surgeons. In order to reduce this risk and due to not yet existing safe anaesthesia, various techniques were developed aimed at merely reducing the size of the tonsils that is partially removing them within their capsules. Since only smaller intratonsillar blood vessels were aff ected in this process and bigger peritonsillar feeding arteries and veins remained unharmed, the risk of secondary haemorrhage was reduced considerably. The subtlest instruments for this process were created primarily during the 19 th century. This intracapsular, partial tonsillectomy, also referred to as tonsillotomy or tonsil capping , became widespread during that time. Due to its fast and easy application, as well as the low complication rates, it was used especially for children. However, the development of safer anaesthetic techniques at the beginning of the 20 th century meant that the extraction of the entire tonsil, tonsillectomy in toto, eventually became more feasible even in children. Against this background as well as a result of intense discussions on possible secondary scarring of the remaining tonsil tissue accompanied by infl ammatory after-eff ects, the technique of tonsillotomy, the partial extraction of the tonsils, was gradually abandoned in favour of that of tonsillectomy and eventually almost completely forgotten during the latter half of the 20 th century. The advances in sleep research and the discovery of general developmental physiological impairment arising from disrupted sleep patterns during infancy led to a rebirth of this surgical application. Tonsillotomy is currently widely accepted as a safe and eff ective method of treatment for obstructive sleep-related breathing disorders in children. However, due to the history of this procedure, the problem of possible long-term infl ammatory complications remains. In the following chapters, fi rst, an abstract of the history of the tonsillotomy is presented. Several historic papers on infl ammatory secondary disorders in large patient collectives will be introduced based on a search of the existing literature. Despite the correct diagnostic evaluation as well as the limitation to children unfavourable clinical experiences following a tonsillotomy could not be confi rmed even then. The development of tonsillotomy to full tonsillectomy procedures in the 20 th century will be illustrated by means of these historic sources. © Georg Thieme Verlag KG Stuttgart.

Mathias K.,Klinikum Dortmund
Journal of Cardiovascular Surgery | Year: 2013

Filters are a valuable aid for safe carotid artery stenting, but require good knowledge of their function, and their shortcomings. Filters capture visible particles in 5-20% and microscopically in about 70% of the cases. Transcranial Doppler ultrasound and diffusion weighted MRI investigations have shown that particles are released during filter placement and also during the next steps of the procedure. They can pass through the filter pores when they are small enough and through unprotected areas when the filter is not completely apposed to the arterial wall. Therefore, they do not reliably prevent transient ischemic attacks and minor strokes, but major strokes. They are easier to handle than proximal balloon protection in normal anatomy and are safe in patients with moderate plaque burden and effective medication with platelet inhibitors and anticoagulation.

Eisfeld W.,HNO Praxis | Amler S.,University of Munster | Deitmer T.,Klinikum Dortmund
Laryngo- Rhino- Otologie | Year: 2010

Background: Tonsillotomy is accepted as a safe and effective method for treatment of obstructive sleep-related respiratory disturbances in children. However, the question of inflammatory complications in the remaining tonsillar tissue is still present for long-term progression. Investigations performed with multiple-year observations should contribute to a clarification of the indicative conditions. Patients and methods: A total of 181 patients were observed following a tonsillotomy performed with CO2 laser (age: 4.6 years;±1.9 years). Using a standardized questionnaire, 145 patients were evaluated over an observation period of up to 6 years (average 3.0 years) with respect to post-operative complications, as well as subsequent inflammatory illnesses. Of these, 131 patients were evaluated with regard to long-term development of obstructive symptoms. Results: Within the subsequent observation period no abscess formation occurred, a re-occurrence of tonsillitis was observed in fewer than 3% of the patients. Subsequent bleeding requiring treatment did not occur during the post-operative progress for any of the 145 patients. Obstructive symptoms in the form of snoring, respiratory interruptions, daytime symptoms, or dysphagy could also be significantly reduced (p<0.001) in the long-term. The overall success of the operation was evaluated by 95% of parents as "good" or "very good". Conclusions: A CO2 laser tonsillotomy using for treatment of obstructive tonsil hyperplasy in small children (with consideration of an inflammation-free anamnesis) represents a safe, effective, and low-complication method, also for long-term continued development. © Georg Thieme Verlag KG Stuttgart - New York.

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