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Biomedical subjects

G Pierer

Publications and source records attributed to G Pierer.

At least 37 records · Page 2Linked to original sources
PubMed1996

Anatomic basis of the lower trapezius musculocutaneous flap.

Differences in the description of the blood supply of the lower trapezius m. and the fact that all former findings are based on very few cases caused us to reinvestigate the arterial supply of the lower trapezius m. Based on the anatomic investigation of 70 human cadavers, the trapezial branch of the dorsal scapular a. was found to be the constant vessel to the lower trapezius m. The origin of the dorsal scapular a., however, was found to be very variable. In 45% it was a direct branch of either the subclavian a. or the costocervical trunk. In the remaining 55% the dorsal scapular a. formed different trunks with the superficial cervical a. and/or suprascapular a. branching off either the subclavian a., the thyrocervical trunk, or the internal thoracic a. Additional segmental musculocutaneous perforators also supply the lower part of the trapezius m. and the overlying skin. Consequently, the lower or ascending part of the trapezius m. has a vascular pattern type V. Thus, the lower trapezius musculocutaneous flap merits consideration in head and neck reconstruction.

Back↗
PubMed1995

[Cutaneous calciphylaxis in chronic renal failure].

A case of a 53-year-old chronically uraemic female patient who suddenly developed widespread cutaneous necrosis on both thighs is presented. On the basis of the typical histopathological features a diagnosis of calciphylaxis was made and supported by elevated serum parathyroid hormone levels. Calciphylaxis is a rare and serious disease, mostly seen in uraemic patients subjected to chronic haemodialysis. Typical features are calcifying panniculitis and thrombosis of small to medium-sized blood vessels followed by necrosis of the skin. The poor prognosis is due to systemic calcifications of visceral organs. When acute cutaneous necrosis of the skin is encountered in patients with chronic uraemia calciphylaxis should always be considered as a possible cause in the differential diagnosis. Determination of the serum parathyroid hormone level is recommended.

Biopsy↗
PubMed1995

[Results of various reconstructive methods after subcutaneous mastectomy and objective evaluation of tissue fibrosis with a new measurement procedure].

Of 35 patients undergoing subcutaneous mastectomy performed within the last 15 years, 25 were evaluated for follow-up studies. Reconstruction had been achieved either using silicone implants or autologous tissue formed from the resulting dermal-fat pedicles. The patients were interviewed for subjective results. In addition, firmness of the breast according to the classification of Baker was investigated. The compressibility of the breast was electronically measured, employing a new compression device. In 13 patients, the breast was distorted after reconstruction with implants. The deformity did not correlate with submuscular or subcutaneous placement of the implants. The aesthetic results after dermal-fat pedicle techniques were superior to reconstruction with silicone implants. Compressibility to 32% of breast diameter was defined to be a border value between a soft and firmer breast, correlating with clinical conditions between Baker 2 and Baker 3.

Adult↗
PubMed1995

[Mammography of the reconstructed breast--a comparison of different methods of reconstruction].

The choice of a breast reconstruction technique is considerably influenced by the possibility of detecting recurrence. Mammography is the most important diagnostic aid in detecting a tumor. We have compared the mammographic evaluation of different reconstruction methods. 41 patients were investigated and divided into three subgroups: Group I (n = 10): Reconstruction with autologous tissue (TRAM-flap); group II (n = 22): Reconstruction with silicone gel-filled implants, muscle and soft tissue replacement (latissimus flap or submuscular expander technique and silicone gel prostheses); group III (n = 9): Reconstruction with silicone gel-filled implants. Evaluation was performed employing a scoring system. The mammographic appearance of autologous breast reconstructions consisting of skin, subcutaneous fat and muscle is comparable to involuted breasts. One mammography in this group was of poor, one of acceptable, and eight of good quality. Autologous reconstruction is associated with the highest chance of recurrence detection. Within group II and III, parts of the reconstructed breast are covered by the X-ray absorbing silicone gel prosthesis. In group II, seven mammographies were considered poor, 14 acceptable, and one good; in group III it was two, four und three respectively. The interpretation depended on the implant soft tissue ratio. If thin soft tissue layers cover the prosthesis, inspection and palpation become increasingly important, nevertheless it is not possible to achieve comparable data as with mammography.

Adult↗
PubMed1993

Prevalence of antibodies to Borrelia burgdorferi flagellin in Styrian blood donors.

Lyme borreliosis and tick-borne encephalitis (TBE) are the most common diseases in Austria caused by tick bites. TBE endemic areas are well defined. It seemed to be of interest to compare prevalence data of antibodies against Borrelia burgdorferi (B.b.) to TBE endemic and non endemic areas. Blood samples (n = 1162) were obtained from healthy blood donors in combination with a standardized questionnaire during 21 excursions to 7 selected regions of Styria, Austria. Serum samples were screened for IgG antibodies against B.b. by a commercial flagellum ELISA. None of the tested persons showed symptoms of active Lyme borreliosis. A higher prevalence of antibodies against B.b. could be found in TBE endemic areas (7.7%) compared to TBE nonendemic areas (3.8%). There was a significant increase in positive antibodies against B.b. with age, exposure and number of tick bites remembered by test persons. The antibody prevalence to B.b. flagellin antigen is significantly higher in TBE endemic areas than in non-endemic comparative regions.

Adolescent↗
PubMed1993

"Mammacompliance": an objective technique for measuring capsular fibrosis.

The results achieved with silicone implants are usually assessed on the basis of the clinical and therefore subjective technique of Baker's classification. Yet, for scientific studies, more objective measurements are clearly necessary. For this reason, the calliper originally developed by Burkhardt and used for measuring compressibility of the breast was adapted, adding a force transducer and a distance-measuring device, which allowed us to plot a force-distance graph for each breast. In soft breasts, the curves obtained rise very slightly, while firm breasts produce sharply rising curves. The data computed from the graphs give the degree of "mammacompliance" and are expressed in centimeters at a defined force value. Sixty-eight augmented and reconstructed breasts were examined with this device. Measurements also were taken on a series of 59 normal, untreated breasts for comparison. A strong correlation was found between the mammacompliance values and Baker's classification. At the same time, the results revealed a number of clinical misjudgments. Our technique permits the objective assessment of capsular contracture. Being highly sensitive, it is an excellent method to control and monitor postoperative development and therapeutic concept.

Breast↗
PubMed1992

The vascular blood supply of the second metacarpal bone: anatomic basis for a new vascularized bone graft in hand surgery. An anatomical study in cadavers.

After traumatic loss of the index finger the second metacarpal bone is often used as a free graft to reconstruct bony defects of the thumb. Since clinical experience has shown numerous advantages of using a blood supplied bone graft, an anatomical study was performed in 104 cadaveric hands to investigate the vascularization supply of this bone. After dye injections into the arterial system the vascular situation of the second metacarpal was studied and a classification was made. Six variations in arterial vascularization were found. The nutrient vessels to the bone originate from the radial artery or from the deep palmar arch and correspond to variable metacarpal arteries. Selective injection studies via the respective pedicles showed sufficient perfusion and complete dye distribution in the bone. Further dissections could demonstrate the feasibility of raising a pedicled bone graft only partially with preservation of the index finger. The second metacarpal as a vascularized graft may be harvested entirely in serious injuries with destruction of the index finger in emergency cases of skeletal thumb reconstruction or partially as an elective procedure. All types have a useful arc of rotation and their pedicles allow transpositions within the radial side of the hand, especially for applications in the thumb and carpus. The clinical application of these procedures could be shown in five cases. The results of this study therefore provide the anatomical basis for transposition or free microvascular transplantation of the second metacarpal as a vascularized bone graft for a variety of indications in hand surgery.

Blood Vessels↗
PubMed1992

Open-window thoracostomy in pleural empyema.

Open-window thoracostomy (OWT) was performed in 21 cases of empyema. The indications were postpneumonectomy empyema with (n = 6) or without (n = 1) fistula, early recurrent empyema after decortication (n = 6), chronical empyema in ill elderly patients with (n = 5) or without fistula (n = 2), and total unilateral lung gangrene with a large fistula of the main bronchus after radiotherapy and chemotherapy (n = 1). All cases presented with severe sepsis, eight of them with acute septic shock, and six with signs of multiorgan failure. Three to five ribs were resected, the muscles and skin were sutured to the ribs confining the window located at the lowest point of the empyema cavity, while the intercostal muscles of the resected ribs were used to close fistulae. The cavity was packed with dressings every day. In all cases, the sepsis subsided immediately after OWT. With the exception of one patient with postpneumonectomy empyema, who died of contralateral pneumonia on day 36, no surgery-related complications were seen. Four further patients died of unrelated causes 2, 4, 5, and 7 months, respectively, after OWT. In one of them, the OWT had been closed. Up to this time, obliteration and closure of the cavity has been carried out in 7 cases by using thoracoplasty (n = 2) or predicted muscle flaps (n = 5) either in the early course or after a delay of 11 to 23 months, with fair functional and cosmetic results. In one further case, operative closure has been planned. In seven of the eight remaining patients, four of whom declined further operations, the cavities closed spontaneously, despite their initial size after intervals of between 11 and 21 months.

Adult↗
PubMed1991

[Scar tissue cancer: observations and results of 23 cases].

The scar tissue carcinoma is a rare disease which arises from the floor of unstable scars, chronic fistulae, ulcera and radiation injuries. The clinical pictures of 23 cases between 1976 and September 1990 have been elucidated. Compared to earlier findings it must now be stated that the development of cancer in stasis ulcera is more frequent than in burn scars or X-ray cancer. Generally, the number of scar tissue carcinomas seems to decrease. Since surgical and adjuvant therapies are--like in any other cancers--limited, prevention and early diagnosis have become of major importance. Though the cancer grows mainly on the body surface and could, therefore, be easily recognised, we still found tumours of remarkable dimension and disturbance, which were either shown to the physician too late or remained unrecognised by the diagnostician.

Adult↗
PubMed1991

[Kinetic effects of 6% hydroxyethyl starch 200.000/0.6-0.66 in hypervolemic hemodilution].

An open study was carried out in order to examine therapeutic effectivity of repeated administration of 6% hydroxyethyl starch 200.000/0.60-0.66 (HES). 10 patients aged 63 to 77 years with peripheral arterial occlusive disease Stage II b were given 500 ml Elohaest as a hypervolemic hemodilution for 12 days. Fasting levels of hydroxyethyl starch (HES) in serum, hematocrit, and serum-alpha-amylase were measured. During the first 4 treatment days, HES levels and serum-alpha-amylase increased in a significant manner; then it fluctuated towards a plateau without significant differences. The hematocrit decreased significantly from the beginning to the end of therapy. So it was possible to show, that during repeated application with the chosen dosage of 6% HAES 200.000/0.6-0.66 there is no dangerous cumulation of HAES.

Aged↗
PubMed1991

[Hypervolemic hemodilution with medium molecular-weight hydroxyethyl starch: effect of duration of administration on viscoelasticity of blood in IIa and IIb peripheral arterial occlusive disease].

45 consecutive patients suffering from peripheral arterial occlusive disease (PAOD) stage IIa and b were integrated in a study about the effect of hemorheological parameters due to different application times. The patients were divided into 3 subgroups with different application times: group A received the infusion during 2, group B during 4, and group C during 6 hours. The used substance was 500 ml 6% HES 200,000/0.6-0.66. Except elasticity of group A all hemorheological parameters from group A to group C show a decrease after 6 hours, the trend to the same phenomenon could be observed after 24 hours in group B and C, while group A except plasma viscosity showed even a trend to increasing values compared to onset. As a conclusion of these results, long-time application should be preferred.

Adult↗
PubMed1991

[Gallopamil and changes of adenosine diphosphate- and collagen-induced thrombocyte aggregation].

In blood samples of 12 healthy volunteers (5 female, 7 male) the influence of Gallopamil (Procorum, CAS 16662-47-8) on the adenosine-diphosphate- (ADP-) and collagen-induced platelet aggregation was studied. Measurements in platelet rich plasma after induction with 1 mumol ADP and 0.5 microgramml collagen with gallopamil were performed. After incubation mit 250 mumol gallopamil a second test was carried out. The parameters were compared with the U-test. After application of 250 mumol gallopamil a significant reduction of ADP- and collagen-induced platelet aggregation could be observed. This is a sign for a protective effect of gallopamil in atherosclerotic disorders due to its calcium-channel blocking property.

Adenosine Diphosphate↗
PubMed1991

[Effect of metoprolol on microcirculation and blood viscoelasticity].

In 40 patients microcirculation of skin as well as viscoelasticity of blood and plasma were investigated. 20 of them suffered from essential hypertension (group A) and were treated with metoprolol with a dosage of 50 to 200 mg per day. The rest of 20 subjects were controls (group B). In the group treated with metoprolol the values for blood viscosity were decreased in a significant manner, while skin microcirculation, blood elasticity and plasma viscosity did not show a significant difference. The results demonstrate that metoprolol is not only possible as medication in ischemic disease, but this substance can have a benefit in this indication because of its hemorheological effect.

Blood Flow Velocity↗
PubMed1991

[Skeletal thumb reconstruction by vascularized metacarpal II transposition. Anatomic study and clinical case reports].

In complex hand injuries with destruction of the index finger, improved function is achieved by resection of the second metacarpal. We examined the possible use of the second metacarpal for reconstruction of simultaneous bony thumb defects. Its vascular anatomy was studied by dissection of 104 cadaver hands that had been injected with "Kleistermasse". Six arterial patterns were found, all of them useful for transposition of the second metacarpal into a thumb defect. The use of this new vascularized pedicle bone graft is demonstrated.

Adolescent↗
PubMed1990

Extracorporeal CO2 removal in a lung lavage induced respiratory distress syndrome.

Ten pigs with experimental respiratory distress syndrome were treated by extracorporeal CO2 removal (ECCO2-R) combined with low frequency positive pressure ventilation (LPPV). After lung damage had been induced by repeated lung lavages a PEEP trial was conducted in order to find the appropriate PEEP for the damaged lungs. This PEEP was then applied during the ECCO2-R/LPPV period. Blood gas values improved significantly on extracorporeal bypass within a short time (pre-bypass paO2: 54.2 +/- 3.7 vs 168.5 +/- 31.6 mmHg after 15 min on bypass, p less than 0.001) and were kept constant during the next 4 hours. Minute ventilation (MV) was reduced from 4.01 +/- 0.31 to 0.74 +/- 0.07 l/min (p less than 0.0001), FiO2 of the ventilator from 1.0 to 0.46 +/- 0.08 (p less than 0.0001) whereas FiO2 of the membrane lung (ML) was not changed significantly (FIO2ML 0.59 +/- 0.07 vs 0.53 +/- 0.06). During controlled mechanical ventilation (CMV), comparable adequate gas exchange was only achieved at a significantly higher mean airway pressure (Paw 14.1 +/- 0.08 vs 21.2 +/- 0.47 cmH20, p less than 0.0001). Hemodynamic variables did not change significantly during bypass time. ECCO2-R/LPPV driven by a simple renal perfusion system allows adequate gas exchange in experimental respiratory failure.

Animals↗