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  • 1
    Online Resource
    Online Resource
    Correlation of Active Contact Positions with the Electrophysiological and Anatomical Subdivisions of the Subthalamic Nucleus in Deep Brain Stimulation
    S. Karger AG ; 2013
    In:  Stereotactic and Functional Neurosurgery Vol. 91, No. 5 ( 2013), p. 298-305
    Details
    In: Stereotactic and Functional Neurosurgery, S. Karger AG, Vol. 91, No. 5 ( 2013), p. 298-305
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 The most effective contacts in subthalamic nucleus (STN) deep brain stimulation are reported to be dorsolateral, and suppression of synchronized oscillatory activity might be a mechanism of action. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 To analyze the optimal contact position in regard to the anatomical and electrophysiological position and to determine whether oscillatory and bursty activity is more frequent around the active contact. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 In 21 patients, the clinically most effective contacts were analyzed according to their relative position to the anatomical and electrophysiological STN center, which was assessed by T2-weighted MRI and microrecording. In 12 out of 21 consecutive patients, autocorrelograms of the action potentials within the vicinity of the active contact were compared to the most ventromedial reference contact. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The isocenter of the anatomical and electrophysiological STN had a mean deviation of 0.8 mm (SD 1.45). Thirty-two out of 42 active contacts were found dorsal to the anatomical isocenter of the STN. None of the active contacts were ventral to the STN. Synchronized oscillatory or bursty activity was found in 67% of the patients within the vicinity of the active contact. In 64% of the patients, the ventromedial reference contact showed irregular activity. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Synchronized activity in the autocorrelogram correlates with the most effective contact. The optimal localization of the finally stimulated contact is dorsal to the STN isocenter.
    Type of Medium: Online Resource
    ISSN: 1011-6125 , 1423-0372
    URL: Article
    DOI: 10.1159/000345259
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
    detail.hit.zdb_id: 1483576-9
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  • 2
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    Online Resource
    Diurnal Variation of Hypothalamic Function and Chronic Subthalamic Nucleus Stimulation in Parkinson's Disease
    S. Karger AG ; 2013
    In:  Neuroendocrinology Vol. 97, No. 3 ( 2013), p. 283-290
    Details
    In: Neuroendocrinology, S. Karger AG, Vol. 97, No. 3 ( 2013), p. 283-290
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Deep brain stimulation of the subthalamic nucleus (STN-DBS) improves quality of life in patients with advanced Parkinson's disease (PD), but is associated with neuropsychiatric side effects and weight gain in some individuals. The pathomechanisms of these phenomena are still unknown. Considering anatomical and functional connections of the STN with the hypothalamic-pituitary (HP) system, we prospectively investigated whether chronic STN-DBS alters HP functioning in 11 PD patients. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Basal hormone levels of the HP-adrenal (HPA), HP-gonadal and HP-somatotropic axis were determined before surgery as well as 3 and 6 months after electrode implantation. In addition, 24-hour cortisol profiles and dexamethasone suppression tests were obtained. Postoperative hormone changes were correlated with individual neuropsychological test performance, psychiatric status and anthropometric measures. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 While PD patients experienced weight gain (p = 0.025) at follow-up, most neuropsychological data and basal HP hormone levels did not change over time. HPA regulation and diurnal rhythmicity of cortisol remained intact in all patients. The 24-hour mean cortisol levels decreased 6 months after surgery (p = 0.002) correlating with improved postoperative depression (p = 0.02). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Chronic application of high-frequency electrical stimuli in the STN was not associated with HP dysfunction in patients with advanced PD. The diurnal variability of peripheral cortisol secretion as one important element of the endogenous biological clock remained intact. Evening cortisol levels decreased after surgery reflecting a favorable regulation of the cortisol setpoint. STN-DBS can be considered safe from a neuroendocrine perspective, but the origin of unwanted side effects warrants further elucidation.
    Type of Medium: Online Resource
    ISSN: 0028-3835 , 1423-0194
    URL: Article
    DOI: 10.1159/000343808
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
    detail.hit.zdb_id: 1483028-0
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  • 3
    Online Resource
    Online Resource
    Evaluation of a Novel Endobronchial Ultrasound-Guided Lymph Node Forceps in Enlarged Mediastinal Lymph Nodes
    S. Karger AG ; 2013
    In:  Respiration Vol. 86, No. 3 ( 2013), p. 229-236
    Details
    In: Respiration, S. Karger AG, Vol. 86, No. 3 ( 2013), p. 229-236
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Endobronchial ultrasound-transbronchial nee dle aspiration (EBUS-TBNA) is a useful technique for cytological assessment of enlarged mediastinal lymph nodes with a high diagnostic yield for lung cancer. However, the small sample volume can be problematic in diagnosing benign diseases and for molecular analysis of malignant tumours. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 The aim of the study was to evaluate a novel lymph node forceps for EBUS-guided lymph node biopsy (EBUS-transbronchial forceps biopsy; EBUS-TBFB) in malignant and benign conditions concerning safety, feasibility, and diagnostic yield. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Patients with enlarged mediastinal or hilar lymph nodes were included. EBUS-TBNA was performed followed by EBUS-guided TBFB with the lymph node forceps. Three biopsy specimens were obtained. The diagnostic yields of EBUS-TBFB, EBUS-TBNA, and the combination of both sampling techniques were compared. Complications were systematically recorded. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Fifty-five patients with enlarged mediastinal nodes were enrolled into this study. Specimens adequate for histological analysis were obtained in all but one case using EBUS-TBFB. EBUS-TBFB increased the diagnostic yield of EBUS-TBNA from 64 to 93% in benign conditions. The overall diagnostic yield was higher compared to EBUS-TBNA alone. EGFR mutation analysis could be achieved in the forceps biopsy samples as needed. No complications were observed. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 EBUS-TBFB with a novel lymph node forceps is safe and provides adequate histological specimens of enlarged mediastinal lymph nodes. EBUS-TBFB increases the diagnostic yield in benign conditions and may add value in molecular analysis of non-small cell lung cancer.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000350867
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
    detail.hit.zdb_id: 1464419-8
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  • 4
    Online Resource
    Online Resource
    Functional Bronchoscopy: Development of a New Bronchoscopic Method for Real-Time Gas Exchange Assessment of Lobes and Lung Segments
    S. Karger AG ; 2014
    In:  Respiration Vol. 88, No. 6 ( 2014), p. 469-477
    Details
    In: Respiration, S. Karger AG, Vol. 88, No. 6 ( 2014), p. 469-477
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 There are various imaging methods in use designed to provide information on lung functional status, particularly gas exchange within specific lung segments. These complex imaging methods provide indirect information about volume and local lung function. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 The objective of this research was to develop a simpler and more direct method for the functional assessment of gas exchange in lung segments. 〈 b 〉 〈 i 〉 Method: 〈 /i 〉 〈 /b 〉 We have developed a new bronchoscopic method to sample gas concentrations of oxygen and carbon dioxide at the orifices of segmental bronchi in a breathing patient. Endocapnometry and oximetry curves are displayed in real time and superimposed on the endoscopic video images. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The gas exchange mapping of a lung could be achieved in 〈 5 min. We identified typical curve patterns of localized slow and fast clearance regions, and segments with higher or lower oxygen uptake. This method is simple and versatile and the data displayed can help to identify target zones for endoscopic emphysema treatments, e.g. for lowering the risk of resection surgery, or to improve ventilation strategies in ICU patients. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 This new method enables gas sampling at the lung segment level. The concomitant display of local endocapnometry and endooximetry curves allows for a better identification of target zones for endoscopic emphysema treatments or to improve ventilation strategies for patients on respiratory support.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000368087
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2014
    detail.hit.zdb_id: 1464419-8
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