Biomedical subjects
Publications and source records attributed to A Kroese.
A case with a rare arterial trauma after a femoral head replacement with a Christiansen prosthesis is presented. The common femoral artery was penetrated by the tip of a Homan speculum and a false aneurysm developed.
Postoperative hyperaemia in the calf was studied in 25 patients successfully operated for obstructing atherosclerosis of the lower limbs. The calf flow was measured by strain gauge plethysmography. No difference in the preoperative calf flow between the patients and the control group was found. The flow at rest in the operated limb increased to a maximum on the 5th postoperative day, at which time it was 2.4 times the flow in the control leg. A significant correlation was found between the postoperative hyperaemia and the preoperative ankle pressure. These findings support the theory of Husni & Manion (1966), that there is a greater postoperative hyperaemia in patients with severe atherosclerosis. No significant correlation was found between the postoperative hyperaemia on the one hand and (1) the preoperative arterial flow increase after reconstruction, (2) the maximum flow increase in the artery after intra-arterial injection of papaverin or (3) clinical symptoms and angiographic findings on the other.
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The microcirculation in the skin was assessed in 31 patients with sequelae from local cold injuries (LCI) in the extremities. All patients reported cold intolerance 3-4 years after the primary cold injury, which they sustained during military service. The used methods were laser Doppler fluxmetry, transcutaneous oxygen tension (TCpO2) and vital capillaroscopy. Neurovascular reflexes were stimulated by deep inspiration, digital cuff occlusion of venous and arterial circulation, neck cooling with an ice bag and water immersion at 5 and 15 degrees C. Unaffected lower or upper extremities were also investigated as part of a search for generalized effects of LCI. During immersion in ice water the cold-induced vasodilation (CIVD or Lewis' 'hunting' reaction) was profoundly delayed or abolished in the affected limbs. These also showed the lowest skin temperatures after 15-20 min of immersion. Additionally, a delayed CIVD was found in the unaffected feet of patients with a previous hand injury. TCpO2 resting values were decreased in the patients, but oxygen reappearance time, oxygen recovery index, postocclusive reactive hyperemia and the venoarterial reflex were normal. No capillary abnormalities were found. In conclusion, LCI induces disturbances in the CIVD, impairs cold tolerance and increases the risk of future cold injuries. These data demonstrate disturbances of reflex mechanisms mediated by the central nervous system. Neurophysiologic factors seem to be more important than ischemic mechanisms in the pathophysiology of late sequelae from LCI.
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