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Biomedical subjects

H Rieger

Publications and source records attributed to H Rieger.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Coarctation of the abdominal aorta].

HISTORY AND FINDINGS: When a 27-year-old woman went to her general practitioner with symptoms of acute gastroenteritis he noted a paraumbilical murmur on auscultation. There were no symptoms of intermittent claudication or abdominal angina. All peripheral pulses were easily palpable and bilaterally equal, and there were no vascular murmurs. Physical examination and blood pressure (140/70 mm Hg bilaterally) were normal. INVESTIGATIONS: Biochemical tests gave no indication of inflammatory disease. Oscillography showed a brief decrease in amplitude after muscular exertion, predominantly of the thigh. Posterior tibial systolic pressure was 20 mm Hg lower than radial pressure on the right, 25 mm Hg on the left. Colour Doppler sonography demonstrated elongated and looping coarctation of the abdominal aorta. TREATMENT AND COURSE: As the patient had no symptoms only regular follow-up was indicated. There have been no symptoms for 27 months and no progression of the coarctation. CONCLUSION: In young patients with the described symptoms abdominal coarctation should be included in the differential diagnosis.

Acute Disease↗
PubMed1996

Importance of the duodenal passage and pouch volume after total gastrectomy and reconstruction with the Ulm pouch: prospective randomized clinical study.

The objective of this randomized study was to examine which reconstruction method and which pouch volume offer the best preconditions for a good quality of life and extensive physiologic regulation of gastrointestinal hormones after total gastrectomy. Up to now there is no general agreement with regard to the ideal reconstruction after total gastrectomy. The importance of the duodenal passage, the need for a pouch reconstruction, and the ideal pouch volume are matters of controversy. A total of 60 patients underwent the following reconstructions: Ulm pouch (pouch reconstruction with preservation of the duodenal passage), Hunt-Lawrence-Rodino pouch, or Roux-en-Y reconstruction without pouch. The clinical course, quality of life, and regulation of gastrointestinal hormones in correlation to reconstruction type and pouch volume were documented. Quality of life was assessed by means of a standardized specific questionnaire. Blood glucose, insulin, cholecystokinin, motilin, secretin, and pancreatic polypeptide were measured after stimulation by a standardized test meal. Six months after total gastrectomy those patients with an Ulm pouch were found to have a significantly better life quality (p < 0.01), higher body weight, and better physiologic regulation of gastrointestinal hormones; moreover, they developed (in contrast to all other reconstruction types) no pathologic glucose tolerance. Our conclusion is that all patients with a postoperative life expectancy of at least 6 months (i.e., tumor stages UICC I and II) should undergo pouch reconstruction with preservation of the duodenal passage.

Aged↗
PubMed1996

Clinical and biomechanical aspects of external fixation of the pelvis.

OBJECTIVE: The aim was to evaluate the mechanical stability of several traditional and modern external fixators in unstable pelvic ring disruption. DESIGN: In a laboratory study external and internal fixation techniques were tested in seven fresh and five embalmed human pelves with a disruption of the pubic symphysis and one sacroiliac joint (type C1.2 injury according to the Tile-AO classification). BACKGROUND: Stability provided by external fixation depends upon many factors, with the residual pelvic stability being the most important. METHODS: Simulating a single-leg stance, the load was applied quasi-statically to the acetabulum of the unstable hemipelvis. Device failure was defined as displacement >10 mm either at the symphysis pubis or the sacroiliac joint. RESULTS: The frame with the highest failure load (fresh versus embalmed specimens) was the Egbers configuration with the AO fixator (analysis of variance; P < 0.05). Failure was noted at 114.9 N versus 129.5 N. Augmentation of the Mono-Tube by additional internal posterior osteosynthesis gave the following results: sacral bars 325.4 N versus 217.8 N, plate fixation 294.3 N versus 215.8 N, lag screws 338.4 N versus 215.8 N. Failure loads of hybrid fixation of the Orthofix were as follows: sacral bars 257.9 N versus 213.9 N, plate fixation 333.5 N versus 245.3 N, lag screws 397.3 N versus 280.6 N. The differences between the two fixators were not statistically significant. CONCLUSIONS: No single external frame provided sufficient stability. The addition of a posterior internal fixation significantly increased failure loads and controlled the weight-bearing pelvic elements.

Journal Article↗
PubMed1996

A severe infection following endoscopic carpal tunnel release.

A 59-year-old patient underwent endoscopic carpal tunnel release by Chow's two-portal technique. He developed a pyogenic tenosynovitis and an infection within the ulnar and radial bursae, an abscess in the middle palmar, thenar and Parona's space, and a pyogenic wrist arthritis. Surgical treatment included a wide exposure of the infected region, débridement, irrigation, application of a resorbable collagen sponge containing gentamicin, insertion of two drains and primary wound closure. The infection was brought under control and hand function restored.

Abscess↗
PubMed1996

[Abdominal trauma and pelvic injury in the growth period].

Children with pelvic fractures usually are polytraumatized. Concomitant abdominal and pelvic injuries are not uncommon. Medical records and X-rays of 54 children, in which a pelvic fracture was diagnosed at our institution from 1974-1993, were reviewed. Children ages < or = 16 years and treated as in-patients were included in this study. The fractures were classified according to the AO-Classification. 47 patients (87.0%) had concomitant injuries. The mean Polytrauma Score was 23.7 (mean Injury Severity Score 30.5). Nine Children sustained an open pelvic fracture with rectal and/or vaginal tear. 15 genitourinary lesions were found in 13 children. 18 patients underwent laparotomy. A large pelvic/retroperitoneal hematoma was found in 11 cases. There were 7 liver lacerations, 7 splenic injuries, 2 mesenteric tears, 2 kidney injuries and 1 small bowel lesion. Eight children (14.8%) died with 5 of them due to retroperitoneal or/and abdominal bleeding complications. A recent follow-up examination (81.8%) with a mean follow-up of 11.3 years showed that long-term morbidity usually was attributed to pelvic concomitant injuries.

Adolescent↗
PubMed1996

[Surgical treatment and results of healing of de Quervain stenosing tenovaginitis].

Within a period of 6 years we operated on 109 patients with De Quervain's disease. Of the patients 82% recovered completely, 18% had slight residual complaints, e.g. stress-dependent discomfort and irritations of the superficial radial nerve. The operative technique is presented in detail and the frequency of anatomical variations of the first extensor tendon compartment is emphasized.

Adolescent↗
PubMed1995

Topographical evaluation of skin perfusion patterns in peripheral arterial occlusive disease by means of computer-assisted fluorescein perfusography.

OBJECTIVE: To evaluate the clinical impact of computer-assisted fluorescein perfusography in peripheral arterial occlusive disease (PAOD). DESIGN: Foot and calf skin perfusion was visualised by intravenous fluorescein injection. Fluorescein influx was recorded photographically and converted into functional images of fluorescein appearance times (AT) by means of digital film processing. SETTING: Vascular Laboratory of Clinic for Vascular Disease. MATERIALS: 249 patients with PAOD. Among 481 limbs studied, 83 legs presented with patent arteries, 70 with asymptomatic obstructions (Stage I), 170 with claudication (Stage II) and 158 with rest pain and skin lesions (Stage III/IV). CHIEF OUTCOME MEASURES: Forefoot and calf mean ATs and standard deviations (SD) served as arbitrary measures of regional skin perfusion rates and their homogeneity, respectively. MAIN RESULTS: In the control legs, a homogeneous and fast fluorescence appearance was observed (medians at the foot: AT33.4 s, SD 3.6). In stage II disease, AT (39.9 s, SD 5.6) were slightly impaired as compared to limbs with patent arteries or stage I disease (p < 0.01). Ninety-seven out of the 158 legs in stage III/IV could be managed by conservative therapy. According to fluorescein-perfusography, they did not differ from stage II disease (AT 38.8 s, SD 6.1). Sixty-one limbs were clinically affected by critical ischaemia. They exhibited a markedly delayed and heterogenous fluorescein influx at the foot (AT 77.3 s, SD 26.5, p < 0.01 vs all other groups). Non-fluorescent areas occurred in 53% compared to only 1% of limbs with and without critical ischaemia, respectively. Retrospectively, predictive values of fluorescein perfusography in identifying a critical limb ischaemia (accuracy 93%) were superior to the ankle systolic arterial pressure determination (accuracy 80%). CONCLUSIONS: Fluorescein perfusography seems to be of diagnostic and prognostic use in PAOD in stage III/IV where inflammatory and ischaemic patterns of dye appearance can be distinguished.

Adult↗
PubMed1993

[Color-coded duplex ultrasonography in the diagnosis of renal artery stenosis].

To diagnose possible renal artery stenosis in 120 patients (36 women, 84 men; mean age 57.3 [21-84] years) colour duplex sonography (CDS) of the renal arterial tree was performed before 53 intraarterial angiographies and 67 central venous digital subtraction angiographies. The criterion of stenosis was a maximal flow velocity of > 180 cm/s in the colour duplex sonogram and a diameter reduction of > 50% in the angiogram. CDS demonstrated the renal artery bed in 209 of 247 renal arteries (85%). 84 of the 209 had regional maximal velocities of > 180 cm/s. The sensitivity and specificity of CDS when comparing it with both angiographic methods (in 185 cases that could be evaluated, in 74 of them with abnormal results) were 91 and 88.2%, respectively. Comparing CDS results with those by intraarterial angiography alone (88 cases, with 51 abnormal findings), sensitivity and specificity were 92.1 and 91.8%, respectively. These results demonstrate that CDS can reliably demonstrate flow obstructions in the renal arterial tree and can thus be recommended for the diagnosis of renovascular hypertension.

Aged↗
PubMed1993

[Determination of the length of the occlusion in extremity arteries--color duplex ultrasound versus angiography].

In the management of patients with peripheral arterial occlusive disease the length and location of an arterial occlusion has an impact on the choice of the method of arterial reconstruction, i.e. percutaneous transluminal angioplasty or vascular surgery. The aim of this study was to determine the accuracy of colour-coded Doppler sonography (CDS) compared to conventional contrast arteriography in detecting the length and localisation of an occlusion in peripheral arteries. 100 legs of 94 patients (27 women, 44 to 82 years of age [mean 60.9 years] and 67 men, 21 to 78 years of age [mean 61.3 years]) with clinically suspected artery occlusion were examined prospectively with CDS before angiography and angioplasty. The exact localisation was correctly diagnosed by CDS in 95% with a high correlation (r = 0.95) of occlusion length between both methods. The sensitivity in detecting occlusions was 98% (positive predictive value 98%). It is concluded that colour-coded Doppler sonography can diagnose the length and location of an occlusion in peripheral arteries accurately and therefore can be used as a noninvasive method to select patients for further therapy management.

Adult↗
PubMed1993

Noninvasive assessment of pressure gradients across iliac artery stenoses: duplex and catheter correlative study.

The present study investigates prospectively the validity and accuracy of the simplified Bernoulli equation in the duplex-derived determination of pressure gradients across iliac artery stenoses in patients with occlusive artery disease. In 28 patients (age range, 38 to 76 years; mean, 53 years) with short iliac artery stenoses, we obtained both duplex scan stenotic jet velocity and catheter pressure measurements. Mean and maximum pressure gradients were determined by both methods, as was the peak-to-peak catheter gradient. The correlation between the duplex-determined and nonsimultaneously measured catheter mean pressure gradients was r = 0.77 (standard error of the estimate [SEE] = 5 mm Hg), that between the duplex-derived and catheter-determined maximum pressure gradients was r = 0.80 (SEE = 10 mm Hg), and that between maximum duplex-determined and peak-to-peak catheter gradient was r = 0.76 (SEE = 12 mm Hg). The peak-to-peak catheter gradient was significantly lower than the maximum duplex-derived gradient (46 versus 53 mm Hg, P < 0.05). Duplex-determined mean pressure gradient decreased from 15 +/- 6 to 3 +/- 1 mm Hg after balloon angioplasty of the iliac stenoses. Duplex scan can be used to predict pressure gradients across short iliac artery stenoses, provided that errors caused by angle malcompensation are prevented.

Adult↗