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B Moriggl

Publications and source records attributed to B Moriggl.

At least 19 recordsLinked to original sources
PubMed2006

Ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerve: accuracy of a selective new technique confirmed by anatomical dissection.

BACKGROUND: Ilioinguinal and iliohypogastric nerve blocks may be used in the diagnosis of chronic groin pain or for analgesia for hernia repair. This study describes a new ultrasound-guided approach to these nerves and determines its accuracy using anatomical dissection control. METHODS: After having tested the new method in a pilot cadaver, 10 additional embalmed cadavers were used to perform 37 ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerve. After injection of 0.1 ml of dye the cadavers were dissected to evaluate needle position and colouring of the nerves. RESULTS: Thirty-three of the thirty-seven needle tips were located at the exact target point, in or directly at the ilioinguinal or iliohypogastric nerve. In all these cases the targeted nerve was coloured entirely. In two of the remaining four cases parts of the nerves were coloured. This corresponds to a simulated block success rate of 95%. In contrast to the standard 'blind' techniques of inguinal nerve blocks we visualized and targeted the nerves 5 cm cranial and posterior to the anterior superior iliac spine. The median diameters of the nerves measured by ultrasound were: ilioinguinal 3.0x1.6 mm, and iliohypogastric 2.9x1.6 mm. The median distance of the ilioinguinal nerve to the iliac bone was 6.0 mm and the distance between the two nerves was 10.4 mm. CONCLUSIONS: The anatomical dissections confirmed that our new ultrasound-guided approach to the ilioinguinal and iliohypogastric nerve is accurate. Ultrasound could become an attractive alternative to the 'blind' standard techniques of ilioinguinal and iliohypogastric nerve block in pain medicine and anaesthetic practice.

Abdomen↗
PubMed2006

[Sonography of synovial and erosive inflammatory changes].

High-frequency sonography enables excellent detection of early erosions and synovial proliferations. Power Doppler sonography (PDUS) allows for an improved characterization of articular and peritendinous augmented volume, because detection of hypervascularity correlates with inflammatory activity and further is helpful in differentiation from effusion and inactive pannus. The use of contrast media improves the sensitivity of vascularity detection, because they allow for a delineation of vessels at the microvascular level. This is of increased interest, as the development of new therapeutic options targeting the microvascular level calls for earlier diagnosis and optimal assessment of disease activity. Because of good availability, cost effectiveness, and patient acceptance, sonography facilitates early diagnosis of synovial proliferations and erosions as well as therapy follow-up.

Arthritis, Rheumatoid↗
PubMed2005

Incidence of lower thoracic ligamentum flavum midline gaps.

BACKGROUND: Lower thoracic epidural anaesthesia and analgesia (EDA) has gained increasing importance in perioperative pain therapy. The loss-of-resistance technique used to identify the epidural space is thought to rely on the penetration of the ligamentum flavum. Investigations at the cervical and lumbar regions have demonstrated that the ligamentum flavum frequently exhibits incomplete fusion at different vertebral levels. Therefore, the aim of this study was to directly investigate the incidence of lower thoracic ligamentum flavum midline gaps in embalmed cadavers. METHODS: Vertebral column specimens were obtained from 47 human cadavers. Ligamentum flavum midline gaps were recorded between the vertebral levels T6 and L1. RESULTS: The incidence of midline gaps/number of viable specimens at the following levels was: T6-7: 2/45 (4.4%), T7-8: 1/47 (2.1%), T8-9: 2/45 (4.4%), T9-10: 7/39 (17.9%), T10-11: 12/34 (35.2%), T11-12: 10/35 (28.5%), T12/L1: 6/38 (15.8%). CONCLUSIONS: In the present study we have determined the frequency of lower thoracic ligamentum flavum midline gaps. Gaps are less frequent than at cervical levels, but more frequent than at lumbar levels. Peak incidence was found in the region between T10 and T12. Using a strict midline approach, one cannot therefore rely on the ligamentum flavum to impede entering the epidural space in all patients.

Adult↗
PubMed2005

Arteries in the posterior cervical triangle in man.

Due to frequent changes in the anatomical nomenclature of the arteries in the posterior cervical triangle (lateral cervical region), anatomical and surgical papers relating to these topics are sometimes difficult to understand and are hard to compare. These changes, coupled with improper knowledge of the gross anatomy and nomenclature of the arteries in the posterior cervical triangle, have presented difficulties in musculocutaneous flap planning, especially in plastic and reconstructive surgery. As an illustration of this concern, the term, transverse cervical artery (A. transversa colli [cervicis]), and its associated branches, have been used frequently over the past several decades with different meanings. In an effort to address this nomenclature challenge and to offer a rational basis for arguing specific name changes, a total of 498 neck-halves were investigated in Graz, Innsbruck, and Munich. Lateral neck dissections were carried out to expose the subclavian artery and those branches destined for the posterior cervical triangle, specifically, the superficial cervical artery, the dorsal scapular artery, and the suprascapular artery. The course of these arteries and details of their origins and branching patterns were documented. Several arose either as direct branches or from trunks. The convention used in labeling trunks was similar to that described for other trunk formations in the body (e.g., linguo-facial trunk). Four trunks were observed and named according to the branches that arose from each. A cervico-dorsal trunk gave origin to the superficial cervical and dorsal scapular arteries, and was found in 30% of cases. A cervico-scapular trunk gave rise to the superficial cervical and suprascapular arteries in 22% of cases, and a dorso-scapular trunk provided origins for the dorsal scapular and suprascapular arteries in 4% of cases. A cervico-dorso-scapular trunk gave origin to the superficial cervical artery, the dorsal scapular artery, and the suprascapular artery, and was found in 24% of cases. Each of these trunks, in turn, arose from either the subclavian artery or from the thyrocervical trunk. This labeling convention necessitated omitting the term, transverse cervical artery, because this term has become inherently imprecise and variously used over the years. This study describes a simple, uniform, and rational basis for standardizing the nomenclature of the arteries in the posterior cervical triangle.

Aged↗
PubMed2004

Unintentional arterial puncture during cephalic vein cannulation: case report and anatomical study.

BACKGROUND: The cephalic antebrachial vein is often used for venous access. However, superficial radial arteries of the forearm are known and unintentional arterial puncture can result from attempts to cannulate the lateral veins of the arm. METHODS: Accidental puncture of a superficial radial artery during peripheral venous cannulation prompted us to study the anatomy of 26 specimens and to assess the relationship between the radial artery and the cephalic vein in the forearm. RESULTS: In two cases, we found accessory branches of the radial artery close to the cephalic forearm vein. Venous cannulation at the lateral wrist carries a small risk of arterial puncture if arterial anomalies are present. CONCLUSIONS: If venous cannulation is attempted at the radial side of the wrist, palpation for pulsation should reduce the danger of arterial puncture.

Aged↗
PubMed2004

The "enthesis organ" concept: why enthesopathies may not present as focal insertional disorders.

OBJECTIVE: The Achilles tendon insertion is associated with a complex of adjacent fibrocartilages, a bursa, and a fat-pad, and is functionally much more than a focal insertion. This has important implications for a better understanding of the spondylarthropathies (SpA). However, the degree to which other insertions form comparable "enthesis organs" has not been established. The aim of this study was to demonstrate the applicability of the enthesis organ concept to other insertion sites. METHODS: Both joint-related (articular) and extraarticular entheses were removed from 28 sites in the limbs of formalin-fixed cadavers (age at death 70-101 years) that had been donated for anatomic study. The samples were prepared for paraffin histologic analysis and sectioned longitudinally. The presence and extent of enthesis organs was evaluated at each site in serial sections stained with Masson's trichrome and toluidine blue. RESULTS: Articular enthesis organs were found at 14 entheses, including the attachments of the digital extensor tendons and collateral ligaments, the cruciate ligaments, tibialis anterior, the lateral collateral ligament of the knee, and the popliteal tendon. Extraarticular enthesis organs were seen at 2 sites, the biceps brachii and patellar tendon insertions. In all enthesis organs, sesamoid and/or periosteal fibrocartilage was present in close association with synovium. CONCLUSION: The concept of an enthesis organ is of general significance in understanding attachment sites and may explain the diverse pathologic changes, including synovitis, bursitis, and extracapsular changes, seen adjacent to tendon/ligament entheses in SpA. These findings may provide insight into the reason the target tissues in SpA are apparently so diverse.

Aged↗
PubMed2004

Adipose tissue at entheses: the rheumatological implications of its distribution. A potential site of pain and stress dissipation?

OBJECTIVES: To describe the distribution of adipose tissue within and adjacent to entheses in order to assess its functional significance at attachment sites. METHODS: Entheses were removed from 29 different sites in the limbs of formalin fixed, elderly, dissecting room cadavers and the samples prepared for paraffin and/or methylmethacrylate histology. Entheses from four young volunteers with no history of significant musculoskeletal injury were examined by magnetic resonance imaging using T(1) weighted sequences. RESULTS: Adipose tissue was present at several different sites at numerous entheses. Many tendons/ligaments lay on a bed of well vascularised, highly innervated, "insertional angle fat". Endotenon fat was striking between fascicles, where entheses flared out at their attachments. It was also characteristic of the epitenon, where it occurred in conjunction with lamellated and Pacinian corpuscles. Fat filled, meniscoid folds often protruded into joint cavities, immediately adjacent to attachment sites. CONCLUSION: Adipose tissue is a common feature of normal entheses and should not be regarded as a sign of degeneration. It contributes to the increase in surface area of attachment sites, promotes movement between tendon/ligament and bone, and forms part of an enthesis organ that dissipates stress. The presence of numerous nerve endings in fat at attachment sites suggests that it has a mechanosensory role and this could account for the rich innervation of many entheses. Because damage to fat is known to lead to considerable joint pain, our findings may be important for understanding the site of pain in enthesopathies.

Adipose Tissue↗
PubMed2003

Inferior central sulcus: variations of anatomy and function on the example of the motor tongue area.

We wanted to define the position of the primary motor tongue area (MTA) by using functional magnetic resonance imaging (fMRI) to display the MTA in relation to the inferolateral segment of the central sulcus (CS). The anatomy of the inferolateral segment was analyzed in 24 healthy subjects, using the magnetization prepared rapid acquisition gradient echo sequence. The position of the MTA was defined in 11 subjects by using fMRI to identify the sites of maximal activation for each subject in relation to that subject's own CS. The MTA was then displayed in three orthogonal planes, and in lateral surface reformations. The inferolateral segment displayed two distinct curves in 33 of 48 (69%) hemispheres, three curves in 6%, and four curves in 23%. Significant paradigm correlated activations were found in every hemisphere. Thereof 89 local maxima were determined, with 84 (94%) located in the region of the CS. Sixty-seven (80%) of the 84 CS activations lay along the two lowest curves of the CS. In 86% of cases, activations situated in the middle and deep portion of the anterior bank of the CS were encompassed within the three axial sections centered on the cella media of the lateral ventricles. In conclusion, the variability of the inferior CS segment precluded the assignment of the MTA to a specific anatomic configuration. However, the position of the MTA could be approximated by the intersection between the CS and the three axial planes through, just above, and just below the cella media of the lateral ventricles.

Adult↗
PubMed2002

Relationship between the descending branch of the inferior gluteal artery and the posterior femoral cutaneous nerve applicable to flap surgery.

Flap surgery in the distal part of the gluteal region has to deal with a lack of detailed descriptions of the inferior gluteal artery and the posterior femoral cutaneous nerve. The existing papers are mainly clinical studies, based on low numbers of observations. Our study includes 118 cadaveric gluteal regions. The descending branch was present in 91% and gave rise to a cutaneous branch. When the descending branch was absent, this cutaneous branch came from the medial or lateral femoral circumflex artery or as a perforator of the deep artery of the thigh. The posterior femoral cutaneous nerve was found in a common sheath of connective tissue with the descending branch of the inferior gluteal artery in 72% of cases. Nerve loops around the vessel are present in 29%. Our results show that a cutaneous or fasciocutaneous flap, either local or free, in this region can be reliably lifted on a cutaneous branch of the descending branch of the inferior gluteal artery without loss of sensitivity. However, the close relationship of the artery and nerve limits the arc of rotation in the case of a local flap.

Aged↗
PubMed2002

Anatomical basis for a new island axial pattern flap in the perioral region.

Soft tissue defects of the perinasal and perioral regions usually result from trauma and tumor resection as well as from congenital diseases. Coverage of facial defects is frequently challenging. The goal of reconstruction is to achieve a functional and esthetically satisfactory result. The most common techniques of wound care, such as full-thickness skin grafts and primary wound closure, are not suitable in all cases and therefore transposition flaps become necessary. Despite the description of numerous flaps, the search for other reconstruction possibilities and the development of additional flaps with good color match and minimal donor site morbidity is continuing. The purpose of our study was to describe the course of the facial artery and the pattern of its branches, because clinical cases have shown that there are branches which are suitable for skin island flaps. During the anatomical dissection of 31 cadavers (62 hemifaces), we analyzed a cutaneous branch of the facial artery, which we named due to its topographical location the "cutaneous zygomatic branch". This vessel shows a highly constant origin and course, as well as a relatively wide area of supplied skin. Based on our anatomical observations, we suggest a new axial pattern skin island flap which awaits clinical application. We feel that this flap has great future potential.

Aged↗
PubMed2001

Fibrocartilage in the transverse ligament of the human atlas.

STUDY DESIGN: Immunohistochemical investigation. OBJECTIVE: To determine whether molecules typical of articular cartilage are present in the transverse ligament and whether the ligament may be a target for an autoimmune response in rheumatoid arthritis. SUMMARY OF BACKGROUND DATA: In chronic rheumatoid arthritis there is often a marked instability of the atlantoaxial complex, and the transverse ligament can show degenerative changes that compromise its mechanical function. In some rheumatoid patients there can be an autoimmune response to cartilage link protein, aggrecan, and Type II collagen. METHODS: Transverse ligaments were removed from 13 cadavers and fixed in 90% methanol. Cryosections were immunolabeled with antibodies against proteoglycans (aggrecan, link protein, and versican), glycosaminoglycans (chondroitin-4-sulfate, chondroitin-6-sulfate, dermatan sulfate, and keratan sulfate), and collagens (Types I, II, III, and VI). RESULTS: Labeling for aggrecan and link protein was characteristic of the fibrocartilages, but versican was only detected in the fibrous regions. Equally, Types I, III, and VI collagens and keratan, dermatan, and chondroitin-4-sulfates were found throughout the ligament, but labeling for Type II collagen and chondroitin-6-sulfate was restricted to the fibrocartilages. CONCLUSION: The presence of molecules typical of articular cartilage (aggrecan, link protein, and Type II collagen) in the transverse ligament explains why it can be a target for destruction in rheumatoid arthritis and also suggests that it is subject to constant compression against the dens rather than only at the extremes of movement.

Aged↗
PubMed2001

Fibrocartilage at the entheses of the suprascapular (superior transverse scapular) ligament of man--a ligament spanning two regions of a single bone.

The suprascapular ligament converts the suprascapular notch into a foramen separating the vessels and nerve of the same name. It connects 2 regions of the same bone and does not cross any joint, and no mechanical function has yet been attributed to it. Nevertheless, variations in its thickness and length, and its tendency to ossify, suggest that the ligament responds to changes in mechanical load. This should be reflected in the composition of the extracellular matrix. The primary purpose of the present study is to demonstrate that the suprascapular ligament has fibrocartilaginous entheses (i.e. insertion sites), even though there is no obvious change in insertional angle that directly results from joint movement. Such a change is more typical of tendons or ligaments that cross highly mobile joints. The complete ligament (including both entheses) was removed from 7 cadavers shortly after death and fixed in 90% methanol. Cryosections were immunolabelled with a panel of monoclonal antibodies against collagens (types I, II, III, VI), glycosaminoglycans (chondroitin 4 sulphate, chondroitin 6 sulphate, dermatan sulphate and keratan sulphates), proteoglycans (aggrecan and versican) and link protein. Both entheses were strongly fibrocartilaginous, and a moderately fibrocartilaginous matrix was also detected throughout the remainder of the ligament. The extracellular matrix of both entheses labelled strongly for type II collagen, aggrecan and link protein. The fibrocartilaginous character of the entheses suggests that the insertion sites of the ligament are subject to both compressive and tensile loading and are regions of stress concentration. This in turn probably reflects the complex shape of the scapula and the presence of a conspicuous indentation (the suprascapular notch) near the ligament. The loading patterns may reflect either the attachment of muscles and/or the forces transmitted to the suprascapular ligament from the neighbouring coracoclavicular ligament.

Adult↗
PubMed2001

Can the dimensions of artificial tendon lesions be predicted ultrasonographically? A cadaveric study.

OBJECTIVE: To prove the reliable assessment of artificial partial tendon lesions in cadavers. METHODS: The tendon of the tibialis anterior muscle was cut twice (transversely, not standardized depths) along its dorsal surface. The dimensions were measured by using a 10-MHz linear probe and a gliding caliper. The lesions were classified as type A tears (<60%; n = 15) and type B tears (>60%; n = 28). RESULTS: The depths of type A tears had high correlation (r = 0.827), and those of type B tears had low correlation (r = 0.415). This low correlation was due to subtotal lesions (50%-70%; r = 0.699). High-resolution ultrasonography allowed the correct detection of 14 type A tears and 21 type B tears (kappa = 0.63; accuracy, 81%; type B tears: sensitivity, 75%; specificity, 93%). CONCLUSIONS: High-resolution ultrasonography is able to assess the dimensions of artificial partial tendon lesions in cadavers and would be an accurate tool for determining the lesion percentages in patients with partial tendon tears.

Cadaver↗
PubMed2001

Cervical MR imaging in postural headache: MR signs and pathophysiological implications.

BACKGROUND AND PURPOSE: Postural headache most often occurs after lumbar puncture as post-lumbar puncture headache (PLPH) or, rarely, spontaneously as spontaneous intracranial hypotension headache (SIHH). In this prospective study, we used spinal MR imaging to determine the findings that would assist in the diagnosis of PLPH and SIHH and that would further our pathophysiological understanding of postural headache. METHODS: The study group consisted of 15 healthy volunteers and 20 patients with postural headache: nine with SIHH and 11 with PLPH. The craniocervical junction and the cervical spine were studied using T2-weighted fast spin-echo and T1-weighted spin-echo sequences in the axial and sagittal planes. Follow-up studies were performed in 13 patients. RESULTS: Dilatation of the anterior internal vertebral venous plexus was the most constant finding, present in 17 (85%) of 20 patients with postural headache. Spinal hygromas, whose location as subdural or epidural could not be exactly determined, were present in 14 patients (70%). A focal fluid collection was detected in the retrospinal region at the C1-C2 level in six patients with SIHH and in four patients with PLPH (50%). Tonsillar descent was detected in only one patient, and subtentorial hygroma in five patients. No abnormalities were found in the volunteers. CONCLUSION: The MR signs of dilatation of the venous plexus, presence of spinal hygromas, and presence of retrospinal fluid collections can help to establish the diagnosis of intracranial hypotension. They are probably the result of decreased CSF volume, with the retrospinal fluid collections being a transudate from the venous plexus rather than frank extravasation. Resolution of these signs parallels resolution of the headache.

Adult↗
PubMed2000

Acetabular ossicles: normal variant or disease entity?

Ossicles located in the acetabular fossa may confuse diagnostic and therapeutic work-up. An accessory ossification centre may persist unfused as an os acetabuli centrale which is surrounded by intact hyaline cartilage representing an anatomic variant. Bone islands located in the pillars of the acetabulum can project into the acetabular fossa simulating acetabular ossicles. Osteochondrosis dissecans, posttraumatic articular bodies, degenerative disease and other rare lesions may be responsible for clinical symptoms and are of similar appearance than anatomic variants. Plain film radiography, X-ray tomography, CT and MRI are used to categorize these lesions. MRI is very valuable to assess cartilage integrity in a noninvasive way, but arthro-CT or arthro-MRI have to be used in unclear cases. Therefore the purpose of this presentation is to discuss the appearance, the possible etiology and the differential diagnosis of acetabular ossicles and how they can be evaluated to avoid an unnecessary arthrotomy.

Acetabulum↗