Biomedical subjects

B Moriggl

Publications and source records attributed to B Moriggl.

34 records · Page 2Linked to original sources

PubMed1999

[The carpus in the conflict between stability and mobility].

The stability of the carpus is determined by a precise interaction of the osseous and ligamentous elements. The main load of the carpus responsible for the adaptation of concerned tissues is a longitudinal compression caused by the force of the muscles of the forearm with their insertions to the metacarpus and fingers. As a consequence, the proximal row is distracted due to the wedge-shaped form of the hamatum together with the capitatum. It is the function of the mainly oblique orientated ligaments to take these transverse tensional forces, supported by the circular arrangement of the retinacula. Here, the ligaments are described in respect of their precise course into three groups. The distribution of material which is needed for bearing the enormous static and dynamic forces is minimised by the integration in a system of oblique fibre bundles which guaranties that all elements, osseous as well as ligamentous, are involved in the force distribution. This is the prerequisition for the minimalisation of osseous material. On the other hand, damage of only one element can cause severe consequences to the stability of the whole system.

Carpal Bones↗

PubMed1999

Detailed magnetic resonance imaging anatomy of the cisternal segment of the abducent nerve: Dorello's canal and neurovascular relationships and landmarks.

OBJECT: The goal of this study was to identify reliably the cisternal segment of the abducent nerve by using the three-dimensional Fourier transform constructive interference in steady-state (3-D CISS) magnetic resonance (MR) imaging sequence to define landmarks that assist in the identification of the abducent nerve on MR imaging and to describe the nerve's relationship to the anterior inferior cerebellar artery (AICA). METHODS: A total of 26 volunteers underwent 3-D CISS MR imaging, and 10 of these volunteers also underwent MR angiography in which a time-of-flight sequence was used to identify the facial colliculus, the abducent nerve and its apparent origin, Dorello's canal, and the AICA. The authors identified the abducent nerve with certainty in 96% of 3-D CISS sequences obtained in the axial and sagittal planes and in 94% obtained in the coronal plane. The nerve emerged from the pontomedullary sulcus in 94% of cases. The facial colliculus could always be identified, and Dorello's canal was identified in 94% of cases. In 76.6% of cases, the abducent nerve was seen to contact the AICA, which passed inferior to the nerve in 63.8% of cases and superior to it in 29.8%. CONCLUSIONS: The anatomical course of the abducent nerve and its relationship to the AICA and other blood vessels can be reliably identified using a 3-D CISS MR sequence with the facial colliculus and Dorello's canal serving as landmarks.

Abducens Nerve↗

PubMed1998

[Use of the internal mammary artery in reconstructive microsurgery in the thoracic region: anatomical-radiologic study].

In this study, the topographic anatomy and the diameter of the internal mammary (thoracic) vessels was investigated in regard to their potential as a recipient vessel in reconstructive microsurgery in the ventral thoracic region. Particularly for reconstruction of large thoracic wall defects as well as for female breast reconstruction with free tissue transplantation, these vessels seem to be suitable due to their location. We performed an anatomical study on 86 cadavers and a radiological investigation on 50 female patients and volunteers. We found a mean diameter on 50 female patients and volunteers. We found a mean diameter of 1.8 mm of the artery and 2.1 mm of the commitant vein at the level of the fourth rib, one to two centimeters parasternally. We conclude that the internal mammary vessels can serve as recipient vessels in reconstructive microsurgery in the ventral thoracic region at the level of the fourth rib or cranially. Hypothetically, free muscle flaps for the treatment of sternal osteitis, free fasciocutaneous flaps to replace presternal burn scars or appropriate flaps to fill up a funnel chest cavity subcutaneously may be anastomosed to the internal mammary vessels.

Adult↗

PubMed1997

Internal mammary veins: classification and surgical use in free-tissue transfer.

The internal mammary artery has been well-investigated due to its frequent use in cardiac surgery. However, in reconstructive microsurgery in the thoracic region, the internal mammary vessels have been used rarely as recipient vessels, due to difficulties and lack of knowledge about the internal mammary veins. This study was designed to investigate the anatomy and topography of the veins. Its goal was to gain sufficient information about their availability in free-tissue transfer. Dissection of the vessels was performed in 86 cadavers bilaterally to the sternum. At the level of the fourth rib, which is the most desired access for microvascular anastomosis in reconstructive breast surgery with free flaps, the veins were found to be adequately large (range 0.64 to 4.45 mm). Results were in close agreement with 100 bilateral measurements obtained by color Doppler sonography in 16 patients preoperatively, and additionally in 34 healthy volunteers. Preoperative detection of vessels with the aid of sonography facilitated planning of surgical procedures. According to these findings, the internal mammary veins may be used as suitable recipient veins for free microvascular tissue transfer, especially for established autologous breast reconstruction with the free transverse rectus abdominis myocutaneous flap, or for reconstruction of complex thoracic-wall defects.

Adolescent↗

PubMed1997

[Fundamentals, possibilities and limitations of sonography of osteofibrous tunnels in the shoulder area. 1].

The first part of this report includes basic morphological as well as morphometric data concerning osteo-fibrous pathways within the shoulder region as determined by investigating a large number of anatomical specimens (286 macerated scapulae, 122 cadaver shoulders). Some parts of these passages, either inaccessible by means of ultrasonography or already sufficiently dealt with in the relevant literature, are not taken into consideration. This applies especially to the so called subacromial space. As to the shape of the scapular notch, five different patterns were found. The spinoglenoid notch appeared in four distinguishable types. According to the results of the measurements, type II ("shallow") and type IV ("V-shaped") scapular notches can be regarded as being predisposed to cause suprascapular nerve lesions. Contrary to what has previously been reported, nerve entrapment due to a partially ossified superior transverse scapular ligament seems to be unlikely. Cadaver dissections confirmed these observations. A comparison was made between the different types of scapular notches and the outlines of the scapular foramina (shapes one to nine) showing that a large indentation does not necessarily result in a larger nerve passage. By reason of the restricted space, foramina classified as "buttonhole-shaped" (shape 5) must be regarded as a possible threat to the suprascapular nerve. In contrast, hypertrophy of the ligament as mentioned above causing nerve problems is, to say the least, doubtful. A spinoglenoid ligament bridging the neck of the scapula was found in over half of the cases studied. A clear relationship was detected between the coracoacromial distance and the shape of the coracoacromial ligament: the greater the distance the more arched was the band. Measurements of this distance in shoulder blades were also found to be highly dependent on the sex (significantly smaller in females). Side differences relative to the aforementioned parameters did not occur. This also applies to the dimensions of the following structures: the long head of the biceps brachii muscle, the intertubercular groove and the transverse humeral ligament. The author considers the latter as having been underrated so far. Due to its constancy as well as its consistency, the ligament has to be regarded as a valuable contribution to the protection of the biceps tendon. A basic knowledge of the local anatomy is essential to sonographic analysis.

Cadaver↗

PubMed1997

[Fundamentals, possibilities and limitations of sonography of osteofibrous tunnels in the shoulder area. 2].

In the second part of this study on osteo-fibrous pathways within the shoulder region, new ultrasound (US) possibilities for showing these tunnels are described. Following two pilot studies (clarifying the choice of transducers and frequencies, relevance of US-related measurements), 97 volunteers were investigated bilaterally (57 women and 40 men, aged between 18 and 39). The normal sonoanatomy for areas which had not been explored by US for the most part is demonstrated, as are the limits and pitfalls of this method. Types of scapular notches as determined in part one have been confirmed by US. Type V (with a "partially ossified ligament") was hardly ever found in the sample, whereas a true foramen could not be observed at all. Neither of these have any influence on the development of a "scapular notch syndrome", according to the results of this study. As expected from anatomical observations, a very narrow nerve passage was usually associated with type II ("shallow") and type IV ("V-shaped") scapular notches. These types should be regarded as a potential threat to the suprascapular nerve. When identifying the parameters (16 in all), care was taken to see that they approximated to those of the basic anatomical investigation. There was a good match between measurement results in both parts of this study. In addition, there were no significant differences of data between the two sides (even in the same individual). In contrast, women showed significantly lower values for the following measurements: width and depth of the spinoglenoid notch, width and depth of the intertubercular groove, breadth and thickness of the long head of the biceps brachii, and thickness as well as length of the coracoacromial ligament. Comparable data from the sonographic literature are only available for the long head of the biceps brachii. The calculated mean thickness of this tendon is 2.5 mm, thus being far lower than the results previously reported. Overall, US can be regarded as a very precise and reliable method for evaluating the osteo-fibrous passages within the shoulder region. Normal sonoanatomy and standard values of the structures mentioned can be used as a basis for resolving diagnostic problems. The author considers that US, as a prelude to more sophisticated imaging techniques, provides a significant non-invasive contribution to the checking of pre-existing factors or alterations at an early stage of entrapment syndromes of the shoulder.

Adult↗

PubMed1996

Absence of three regular thyroid arteries replaced by an unusual lowest thyroid artery (A. thyroidea ima): a case report.

During routine dissection of an 89-year-old female donor both inferior thyroid aa. as well as the left superior thyroid a. were found to be absent, whereas the right superior thyroid a. came from the right common carotid. A large lowest thyroid a. rose from the left internal thoracic a. at the level of the first intercostal space. Up to this point the internal thoracic a. was of immense diameter, almost reaching that of the lateral part of the subclavian. The lowest thyroid a. ascended in an oblique and sigmoid course to the thyroid gland. Slightly left of the median line it bifurcated into two branches. Both had a winding course in front of the trachea before entering the base of the thyroid gland. Other arterial variations of minor significance were also observed in this unique case. The clinical impact lies in the localisation, course and size of the lowest thyroid a. reported.

Aged↗

PubMed1996

[Ultrasound diagnosis of the shoulder].

Sonography of the shoulder joint is a well-established technique in the hands of the experienced examiner, when using a standardized protocol. It has proved invaluable in assessing pathological soft tissue changes, especially after trauma. The static evaluation of anatomy and dynamic assessment of function are especially helpful in both preoperative staging and postoperative follow-up. The normal anatomy, examination techniques, including our own variations, and pathological conditions are discussed. The findings and various classifications of impingement syndrome, rotator cuff injuries, biceps tendon lesions and inflammatory changes are examined. Review of the major articles in the literature shows excellent correlation with our results, the overall sensitivity in the case of rotator cuff lesions being over 90%. A well-performed ultrasound examination in most cases obviates the need for the more invasive arthroscopy and the more cumbersome and expensive MRI examinations.

Adolescent↗

PubMed1995

Internal mammary vessels: anatomical and clinical considerations.

This study was designed to investigate the anatomy of the internal mammary (thoracic) artery (IMA) and comitant vein(s) (IMV) relevant to their use in microsurgery. We dissected the internal mammary (thoracic) vessels bilaterally in 86 cadavers from the clavicle down to the 6th rib. At the level of the 4th rib, the distance between the sternum and the IMA was large enough [range 10.0-23.6 mm] and the diameter of the IMA [range 0.99-2.55 mm] and comitant vein(s) [range 0.64-4.45 mm] wide enough for both end-to-end and/or end-to-side anastomosis. These results were in close agreement with supplementary measurements obtained by Doppler ultrasound in 34 healthy female volunteers. Based on all these findings we suggest that the internal mammary vessels are suitable recipient vessels for free tissue transfers in the thoracic region, especially for breast reconstruction with the free transverse rectus abdominis myocutaneous (TRAM) flap.

Adult↗

PubMed1995

[Visualization of the inferior mesenteric artery in the ultrasound B image].

AIM: Reports in the literautre differ widely with regard to visualisation of the inferior mesenteric artery (IMA) by B-mode ultrasonography. Hence, our study aimed at obtaining exact data on the feasibility of visualising the inferior mesenteric artery via B-mode ultrasonography in a relatively large patient population. METHOD: At the outpatient department of gastroenterology and hepatology 51 males (aged 14 to 75 years) and 53 females (aged 16 to 79 years) were examined consecutively by two experienced investigators via B-mode scan within the overall framework of a routine screening programme, in each case after overnight fasting. Knowledge of normal anatomic conditions and of the possible variations of the IMA is mandatory for correct IMA visualisation. RESULTS: We succeeded in visualising the IMA via B-mode scan in 41 of the 51 males (80.39%) and in 40 of the 53 females (75.47%), i.e. in a total of 81 of 104 patients (77.88%) in 2-3 cm length. CONCLUSION: The results show that IMA can be visualised by B-mode ultrasonography in a manner comparable to visualisation of the superior mesenteric artery (82). This is an essential finding, since duplex sonography of the IMA yields important information on disease activity in inflammatory bowel disease, and B-mode scanning of the IMA is the prerequisite for duplex scanning.

Adolescent↗

PubMed1994

Ultrasono-anatomy for evaluation of the local lymphatic groups of the mamma.

Sonography has been established as an important adjunct to current diagnostic techniques for the assessment of mammary lymph nodes. Although this method is widely used, no reproducible standard procedure which is equally applicable to the examination of all relevant lymphatic groups has been developed to date. Healthy subjects (n = 50) were examined in an attempt at defining sonographic scanning levels for optimum visualization of anatomic reference landmarks. Images were acquired with a 7.5-MHz linear-array transducer. Anatomic cross-sections of the same level as imaged by sonography were used to identify important details. Unique structures close to the lymph nodes could be identified by sonography, it was not possible, however, to differentiate normal lymph nodes. The correct assessment of lymph drainage areas is therefore possible only if the sonographic level is clearly defined and if the examiner is familiar with the topographic relationships between the depicted structures. By presenting a reproducible examination technique as well as anatomic details, this study aims at avoiding false interpretations and increasing the efficacy of sonographic exploration. The authors believe that this simple and hardly time-consuming technique can contribute to a comprehensive evaluation of the lymph drainage areas of the breast.

Adult↗

PubMed1994

[The openings of the inferior thyroid vein(s)].

Because of the importance concerning angiography and approach in neck surgery the venous drainage from the inferior border of the thyroid gland, including its variants, had been reported in numerous times in surgical and anatomic literature. Statistical information on the frequency of opening sites and number of the thyroid veins are rather poor and differ with the variant authors tremendously, due to the small number of patients or preparations investigated. To provide more accurate data are the objectives of this paper. Our issues derive from examinations on cadavers of the dissecting-courses in the years 1987-1992 (n = 168). Preparations showing signs of semiresection of the thyroid gland had been rejected for this study, obviously. In regard to the brachiocephalic veins three groups of venous drainage could be established: A) Exclusive drainage to the right or left brachiocephalic vein or their junction, respectively; B) Combinations of the possibilities shown in A); C) Special cases with supernumerary drainage to other veins of the mediastinum. Besides detailed descriptions of the frequency of the variants found, the discrepancies to the known literature are discussed. Some of the variants described by us have not been mentioned at all.

Adult↗

PubMed1993

[Determining normal ultrasound values of the supra- and infraspinatus muscles].

Sonographic investigations concerning thickness of tendons (in longitudinal sections) and muscles (in resting position and isometric contraction) were performed on 60 volunteers without shoulder complaints. Increase in muscle thickness within isometric contraction did not depend on thickness in resting position. There was no side difference in tendon thickness. Since the observed values (median 4-5 mm) were far below measurements cited in the greater part of literature, we tried to verify our data by sonographic and anatomic examination of shoulders of corpses. We conclude that, by standardising, thickness measurement of tendons and muscles might become more important in diagnosis of shoulder complaints.

Adult↗

PubMed1992

[Anatomy of the posterior urethra].

The short section of the urethra that passes through the urogenital diaphragm is termed the membranous urethra. It is accompanied by several vessels and nerve fibers. In surgery on the membranous urethra the perineal body is of crucial importance, and precise knowledge of the course of the urethra through the pelvic floor is essential. Furthermore, the relationship between the membranous urethra and its accompanying structures is of great importance. These include the branches of the internal pudendal artery, the prostatic venous plexus and the cavernous nerves coursing ventrally from the pelvic plexus. The nerves supplying the membranous urethra were studied in fetuses with the help of a magnifying lens. The results of the dissections are documented by histological sections, photographs and paintings.

Aged↗

PubMed1991

[Approach to radical cystoprostatectomy].

A new possibility of using a standardized surgical approach is demonstrated by specific topographic-anatomical paintings. The operation, in this case radical cystoprostatectomy and lymphadenectomy in the man is demonstrated in the cadaver, from the incision of the skin to the excision of prostate and bladder. The significant surgical steps are documented in paintings, which allow exact documentation of the anatomical approach.

Cystectomy↗

PubMed1991

[The topography of the maxillary artery within the infratemporal fossa].

The topographical anatomy of the maxillary artery in the infratemporal fossa is investigated. 194 preparations from 98 adult specimens are examined (53 male, 45 female). Our important findings are the following: 1. In 29 of 96 specimens (in 2 cases only one side was available) the maxillary artery is located on the outer side of the external pterygoid muscle on one side of the head whereas on the opposite side of the same head it is situated on the inner side of the external pterygoid muscle. 2. in our dissections the maxillary artery is running more frequently medial to the external pterygoid muscle (107 out of 194 preparations; 55.2%) 3. in 2 cases the relation of the maxillary artery to the branches of the mandibular nerve is considerable interesting. 4. An accessory meningeal artery is found in 9 cases (4.6%). 5. In 2 cases the maxillary artery perforates the lingual nerve.

Female↗