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Biomedical subjects

A Bollinger

Publications and source records attributed to A Bollinger.

At least 55 records · Page 3Linked to original sources
PubMed1994

Inflammatory aneurysm of the splenic artery.

The case of a middle-aged man is described, who was admitted because of intermittent back pain and a high sedimentation rate. Abdominal sonography and arteriography showed a large aneurysm of the splenic artery, but failed to recognize the aneurysm as of inflammatory origin. However, the inflammatory nature of the aneurysm was evident on computer tomography scan. Intraoperatively the inflammatory origin of the aneurysm was confirmed. A saphenous vein graft was implanted and marsupialization of the aneurysm performed. Histology could clearly verify the diagnosis of an inflammatory aneurysm. This report indicates the possibility of inflammatory changes occurring in connection with a visceral artery rather than solely with the abdominal aorta.

Aneurysm↗
PubMed1994

Low frequency oscillations of skin blood flux in peripheral arterial occlusive disease.

Using the laser Doppler technique patterns of spontaneous oscillations of skin blood flux within the low frequency band (< 10 min-1; LF waves) were analysed in 12 healthy controls and 24 patients with different degrees of peripheral arterial occlusive disease (PAOD). Measurements were performed at 5 different sites at the dorsum of the foot in healthy controls and patients with severe claudication or rest pain and/or gangrene due to PAOD. Patterns were classified as "periodic", "aperiodic" or "no flux motion". The aperiodic pattern was characteristic for skin blood flux of controls. In severe claudication prevalence of periodic LF oscillations significantly increased (p < 0.05) whereas it decreased again in patients with severe ischemia. In the latter group, LF waves often were completely absent. Periodic LF waves mainly occurred between an ankle/arm pressure ratio of 0.4 to 0.8. We suggest that periodic LF waves most likely ar the result of a synchronized vasomotor activity of different arterioles within the sample volume, whereas the aperiodic pattern may resemble the net effect of simultaneous activities of different control mechanisms on skin blood flow. Based on animal experiments it is hypothesized that decreased postocclusive driving pressure and flow in patients with advanced PAOD may be the stimulus for synchronized arteriolar vasomotion.

Adult↗
PubMed1993

[Treatment strategies in arterial occlusive diseases].

The risk factors predominating in patients with peripheral arterial occlusive disease are cigarette smoking and diabetes. Moreover, hypertension and hyperlipidemia play an important role. Especially younger patients profit from elimination or treatment (primary or secondary prevention), whereas in elderly patients these measures are no longer crucial. In patients with intermittent claudication, the quality of life may be improved by physical training, vasoactive medicaments, optimal management of concomitant diseases and the different modalities of catheter therapy. According to the special situation in critical ischemia, surgical or catheter revascularization is preferred. If these two techniques cannot be used, intra-arterial or intravenous prostanoids are still promising. Aspirin and in second priority ticlopidine are suited for secondary prevention of arteriosclerosis not only in the extracranial, but also in the peripheral vascular region. After endarterectomy and catheter therapy, aspirin improves the long-term outcome by reducing the incidence of restenoses. Better results are obtained by oral anticoagulation in patients with emboli and after local thrombolysis.

Adult↗
PubMed1993

Lymphatic capillary pressure in patients with primary lymphedema.

Flow and pressure dynamics in minute human lymphatics are unexplored. Lymphatic capillary pressure was measured by the servo-nulling technique at the foot dorsum of 14 patients with primary lymphedema and 15 healthy controls. Glass micropipettes (7-9 microns) were inserted under microscopic control into lymphatic microvessels previously stained by fluorescence microlymphography (FITC-Dextran 150,000). Mean lymphatic capillary pressure was 7.9 +/- 3.4 mm Hg in the controls and 15.0 +/- 5.1 mm Hg in the patients. The difference was significant at the P < 0.001 level. In about half of the patients and control subjects studied pressure fluctuated by more than 3 mm Hg. The mean intralymphatic pressure of lymphedema patients was slightly below mean interstitial pressure measured by J. T. Christensen, N. J. Shaw, M. M. Hamas and H. K. Al Hassan (1985, Microcirc., Endothelium, Lymphatics 2, 267-384) (17.9 mm Hg) in lower leg lymphedema. Microlymphatic hypertension present in patients with primary lymphedema is probably an important factor for edema formation.

Adolescent↗
PubMed1993

[Three-dimensional imaging of the pelvic veins using magnetic resonance angiography].

The veins in the pelvis and lower limbs have been demonstrated by means of magnetic resonance angiography (MRA) in 11 normals and in 20 patients, using a "time-of-flight" technique (TOF). Using normals, changes in the measurement parameters were used in order to optimise the examination protocol; consequently, the internal and external iliac veins and the superior and inferior gluteal veins could be identified in all cases and the internal pudendal veins in 6 out of 11 cases. This examination protocol was then used in patients with clinical suspicion of lower limb or pelvic vein thrombosis. Comparison of the MRA findings with those of phlebography (7 cases), duplex sonography (6 cases) and colour Doppler examinations (11 cases) showed that MRA was better for diagnosing thrombosis of the internal iliac veins (10 cases) than the other methods. In two patients thromboses of the common iliac veins and the inferior vena cava were demonstrated which were missed by colour Doppler examination. On the basis of our present experiences, MRA, using a two-dimensional TOF technique, appears to be a reliable non-invasive technique for demonstrating the veins of the pelvis and thigh.

Adult↗
PubMed1993

[Magnetic resonance arteriography, duplex sonography and conventional arteriography for the evaluation of peripheral arterial occlusive disease].

A prospective controlled study of 41 peripheral arterial occlusions was carried out, comparing duplex sonography, magnetic resonance arteriography and contrast arteriography. 87.8% of duplex sonography findings and 80.5% of magnetic resonance arteriographies agreed with the appearances of contrast arteriography (gold standard). Duplex sonography tended to overestimate the length of an occluded segment by an average of 2 cm (0.5-5 cm), whereas magnetic resonance arteriography showed less deviation from contrast arteriography (+/- 2 cm). The advantage of duplex sonography lies in its ability to provide morphological and functional information concerning the obliterated segment. Its disadvantage is that it can only demonstrate one segment and that the examination must be carried out in individual segments. Magnetic resonance arteriography provides vascular demonstration in several planes similar to angiography but signal-voids due to limited resolution and flow changes may limit diagnosis of occlusions. Additional phase contrast techniques may provide quantitative information on flow velocities and flow rates. Both duplex sonography and magnetic resonance arteriography are suitable methods for the non-invasive investigation of peripheral arterial occlusive disease.

Aged↗
PubMed1993

[Chronic anterior tibial syndrome].

In two young athletic men we made the diagnosis of chronic tibialis anterior syndrome. Pain during strenuous exercise was localized in the anterolateral aspect of both calves. After stopping exercise the complaints disappeared within 15-20 minutes and not in 2-3 minutes as it would be typical for patients with atherosclerotic peripheral arterial occlusive disease. Diagnosis is based on patient history, normal clinical examination (systolic ankle pressure determined by Doppler-Sonography, electronic segmental oscillography) and increased intramuscular pressure at rest (> 10 mmHg) and after exercise (42 and 35 mmHg). Bilateral fasciotomy was performed in both patients. They are free of pain after 3 respectively 6 months postoperatively.

Adult↗
PubMed1993

[Amyloidosis cutis nodularis atrophicans (Gottron)].

We report an exceptionally severe case of amyloidosis cutis nodularis atrophicans (Gottron) of the lower limbs in a 49-year-old female patient. The diagnosis was made on clinical and histological grounds and was confirmed by immunohistochemical evidence of amyloid of the A-lambda type. For the first time, cutaneous microcirculation in the region of the nodules was investigated by means of fluorescence video microscopy. Pronounced microangiopathy characterized by avascular fields, enlarged and tortuous capillaries and increased transcapillary diffusion of sodium fluorescein, was clearly demonstrable in the area of the nodules. The pathogenetic role of these vascular changes is discussed.

Amyloid↗
PubMed1993

Variability of different patterns of skin oscillatory flux in healthy controls and patients with peripheral arterial occlusive disease.

Variability of patterns of laser Doppler flux motion was analysed at 5 different sites at the foot of 12 healthy controls and 24 patients with different degrees of ischemia due to peripheral arterial occlusive disease. Patterns were evaluated by means of the frequency histogram method. Three main flux motion components were detected at mean frequencies of 3.5 +/- 1.1 min-1 (low frequency waves, LF), 17.2 +/- 2.7 min-1 (high frequency waves, HF) and at 62.6 +/- 8.5 min-1 (pulsatile waves, PF). The characteristic pattern in normals consisted of LF and PF waves. In severe ischemia oscillatory flux was predominantly characterized by the combination of LF and HF waves and loss of pulsatile flux, or by the absence of any flux motion. Claudicants covered the entire spectrum of the flux motion patterns. In controls spatial variations were mainly due to the occasional presence of HF waves at one of the 5 sites. With increasing ischemia spatial variability of HF waves decreased due to more homogeneous presence. Loss of pulsatile flux was inhomogeneous in claudicants but almost complete in severe ischemia. Whereas LF waves were almost always observed at all sites of controls and claudicants there was considerable spatial variability in severe ischemia due to inhomogeneous loss of LF waves. Prevalence of the distinct flux motion patterns was well reproducible in controls and patients. Patterns showed a marked day to day variability when sites of measurement were compared.

Adult↗
PubMed1993

Microlymphatics of human skin.

Microlymphatics of human skin form two superposed networks. The superficial one located at the level of dermal papillae may be visualized by fluorescence microlymphography. Microlymphatics fill from a subepidermal depot of minute amounts of FITC-dextran 150,000. In primary lymphedema with late onset the depicted network with vessels of normal size is significantly larger than in healthy controls, whereas in congenital lymphedema (Milroy's disease) microlymphatics are aplastic or ectatic (diameter > 90 microns). Lymphatic microangiopathy with obliterations of microvessels develops in chronic venous insufficiency, in lipedema (preliminary results) and after recurrent erysipelata. In healthy controls microlymphatics are permeable to FITC-dextran 40,000 and impermeable to the larger molecule 150,000. Preserved fragments of the network in chronic venous insufficiency exhibit increased permeability to FITC-dextran 150,000. After visualization of the vessels by the fluorescent dye microlymphatic pressure may be measured by the servo-nulling technique. First results indicate that microlymphatic hypertension contributes to edema formation in patients with primary lymphedema.

Edema↗
PubMed1992

[Livedo racemosa, skin necrosis at the basal toe joint].

An 81 year old male patient treated by sulfonylurea and diet was known to have type II diabetes for three years. Because of pulmonary embolism phenprocoumon had been administered for four months. Painful livedo racemosa developed acutely on both lateral sides of the feet and the left knee. A necrosis of the skin over the base of the left small toe developed within a few days. On the basis of the clinical picture cholesterol-embolism was diagnosed. Since anticoagulation is known to promote cholesterol-embolism it was discontinued. Prostaglandin E1 infusions into both legs were administered. Within 3 months the cutaneous lesions healed completely.

Aged↗