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Biomedical subjects

H Rieger

Publications and source records attributed to H Rieger.

At least 91 records · Page 5Linked to original sources
PubMed1992

Clinical information content of transcutaneous oxymetry (tcpO2) in peripheral arterial occlusive disease (a review of the methodological and clinical literature with a special reference to critical limb ischaemia).

About 160 publications (1978-1992) dealing either directly or indirectly with transcutaneous oxygen partial pressure measurements (tcpO2) in peripheral arterial occlusive disease (PAOD) are reviewed. Thereby, various clinical applications and results are related to the theory and methodology of the tcpO2 technique. In PAOD patients, the tcpO2 reflects local hyperemic skin blood supply. The clinically relevant intersection of the tcpO2-flow hyperbola is of considerably non-linear shape and partially insensitive to flow. In view of macrocirculatory pathology, tcpO2 values depend particularly on PAOD staging, hemodynamic compensation, and calf artery patency. Pathophysiological and pharmacological microcirculatory effects, however, cannot be read unequivocally from corresponding tcpO2 responses due to the heat-induced local vasoparalysis. In daily practice, the tcpO2 does not provide substantial information in patients with asymptomatic obstructions (Fontaine stage I) or intermittent claudication (stage II) but is of clinical impact in limbs with rest pain and skin lesions (stages III and IV). In such a complicated PAOD, diagnostic and prognostic capabilities can be essentially improved by provocational manoeuvres which narrow the flow-insensitive range. A critical limb ischaemia may be assumed if supine and dependent foot tcpO2 values exceed neither 10 mmHg nor 45 mmHg, respectively.

Arterial Occlusive Diseases↗
PubMed1991

[Duplex sonographic determination of blood pressure gradient in iliac artery stenoses. Comparison with invasive measurement].

The present study investigates the validity and accuracy of the simplified Bernoulli equation in the duplex-derived determination of pressure gradients across iliac artery stenoses. 28 patients presenting with iliac artery stenoses were examined by both duplex scanning and intraarterial catheter pressure measurement. The catheter-determined and duplex-derived mean pressure gradient was 16 +/- 7 and 14 +/- 7 mmHg, respectively. There was a fairly good correlation between the mean pressure gradients assessed nonsimultaneously by both methods (r = 0.77). The catheter-determined and duplex-derived maximum instantaneous pressure gradient was 53 +/- 16 and 52 +/- 21 mmHg, respectively. The correlation coefficient (r) for the maximum instantaneous pressure drop values determined by the two methods was r = 0.79. The results show that duplex ultrasound predicts mean and maximal-instantaneous pressure gradients with acceptable approximation in patients with iliac artery stenoses.

Adult↗
PubMed1991

Traumatic dislocation of the hip in young children.

Traumatic dislocation of the hip joint is an uncommon injury in children. The present report on this traumatic emergency is based on the authors' own observations of three cases and a review of the literature. The main problem is the possible development of avascular necrosis of the femoral head. The crucial therapeutic intervention to avoid this serious complication seems to be immediate, usually closed, reduction under general anaesthesia. A management protocol is presented.

Accidental Falls↗
PubMed1991

Use of duplex scanning in the diagnosis of arteria profunda femoris stenosis.

To evaluate the accuracy of duplex scanning in diagnosing arteria profunda femoris stenoses in patients with concomitant superficial femoral artery occlusions, 123 femoral artery bifurcations were examined in 103 patients. Peak systolic and time-averaged maximal flow velocity parameters were measured in the arteria profunda femoris and compared with independently performed angiography. For detecting stenoses greater than 30% diameter reduction (50% by area) of the arteria profunda femoris, duplex scanning had a sensitivity of 91% and 96%, a specificity of 85% and 98%, a positive predictive value of 86% and 98%, and a negative predictive value of 91% and 96%, for a peak systolic velocity of 180 cm/sec and more, and for a time-averaged maximal velocity of 50 cm/sec and more in the arteria profunda femoris, respectively. The day-to-day variability for peak systolic and time-averaged maximal velocity parameters was low with correlation coefficients between velocity measurements on both days of 0.96 and 0.98 (n = 20), respectively. In 10 patients with arteria profunda femoris stenoses and superficial femoral artery occlusions, undergoing percutaneous transluminal angioplasty of arteria profunda femoris stenosis, the duplex scan revealed a reduction in stenotic peak systolic velocity from 330 +/- 84 to 163 +/- 50 cm/sec and a decrease in stenotic time-averaged maximal velocity from 156 +/- 47 to 54 +/- 17 cm/sec after the interventional procedure. These results show that peak systolic and time-averaged maximal velocities are accurate parameters to detect significant arteria profunda femoris stenosis in patients with superficial femoral artery occlusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Skin perfusion patterns (fluorescein perfusography) during reactive hyperaemia in peripheral arterial occlusive disease.

From the pathophysiological point of view the regional distribution of blood flow is of special importance in ischaemic tissues. Within this study foot sole skin perfusion was investigated by means of fluorescein perfusography at rest and during reactive hyperaemia in patients with peripheral arterial occlusive disease confined to one limb (Fontaine stage II). Ambient temperatures were maintained around 21 degrees C. Mean fluorescein appearance times on the one side and their standard deviations (SD) and coefficients of variation (CV) on the other side were taken as measures of overall blood supply and homogeneity of flow, respectively. At rest no differences in these parameters could be detected between diseased legs and controls. After a 3-min supra-systolic circulatory arrest at the thigh, a significant reduction of fluorescein appearance times was observed for both groups but was statistically more pronounced in the controls. Furthermore, during reactive hyperaemia standard deviations as well as coefficients of variation decreased significantly only in normal limbs whereas they either remained constant (SD) or even increased (CV) in those with arterial obstructions. All effects associated with reactive hyperaemia showed statistically significant correlations with systolic ankle pressure indices. From these results it is concluded that haemodynamically effective arterial obstructions are followed by not only a restriction of overall hyperaemic blood supply but also a failure to homogenize microcirculatory perfusion in the case of increased flow requirements.

Arterial Occlusive Diseases↗
PubMed1991

[Contribution of duplex sonography to prediction of pressure drop across iliac artery stenoses].

The present study investigates the validity and accuracy of the simplified Bernoulli equation in the duplex-derived determination of pressure gradients across iliac artery stenoses. Twenty eight patients presenting with iliac artery stenoses could be examined by both duplex and intraarterial catheter pressure measurements. The correlations between mean and maximal-instantaneous pressure gradients assessed by both methods were r = .77 and r = .79, respectively. Duplex scan can be used to predict pressure gradients in patients with iliac artery stenoses.

Arterial Occlusive Diseases↗
PubMed1991

[The most frequent tendon injury: the "mallet finger". Review, therapeutic concept and results].

This study covers treatment and after-treatment of 126 extensor tendon injuries of the DIP-joint in 125 patients over a period of 4 years. Tendon injuries were classified into 4 types and the final results were evaluated using a modified Riedeberger and Zeumer scale. In recent subcutaneous tendon injuries conservative therapy is indicated, depending on the primary extension deficit (less than 20 degrees modified Stack splint, greater than 20 degrees Mommsen plaster of Paris or special dressing). Chip fractures should be stabilized by pull-out suture.

Athletic Injuries↗
PubMed1991

[Use of retrograde venous perfusion in patients with advanced peripheral arterial occlusive disease].

Bier's method of regional anaesthesia has been proposed to deposit various drugs intravenously distal to an arterial block in legs with severe arterial insufficiency. From the theoretical point of view it is assumed that ischaemic acral skin areas while being cut off the arterial blood supply may still be reached on the venous route. The purpose of this study was to test this hypothesis for different injection techniques using sodium fluorescein as tracer. Measurements were carried out in ten patients with intermittend claudication. After a circulatory arrest according to v. Esmarch had been established a total volume of 100 ml was injected into a peripheral vein at either the calf or foot. In five patients a homogenous fluorescein mixture was prepared prior to the injection ("cocktail"-group) whereas the other five received an isolated fraction of 10 ml fluorescein ("fraction"-group). Subsequently, the fluorescence distribution at the calf and dorsum of the foot was photographically recorded over a period of 20 minutes and evaluated by means of digital image analysis. Fluorescence rapidly and homogeneously spread over the investigated skin areas including the toes in all five cases of the "cocktail"-group. In contrast, a rather delayed and heterogenous fluorescein distribution was observed in the "fraction"-group. Furthermore, in two cases no dye could be detected at the digits after 20 minutes. These results have confirmed the hypothesis of RVP provided that all ingredients are dissolved within an adequate amount of fluid prior to injection.

Anesthesia, Conduction↗
PubMed1991

[Traumatically-induced thrombosis of the distal ulnar artery. Case report and review of the literature].

The authors report on a patient who fell and struck his right hypothenar against a sharp edge. He had immediate pain and reduced circulation in his ring and little fingers. The neurological findings revealed paraesthesia in the two ulnar fingers and loss of abduction strength in the little finger. Treatment was at first conservative, but the symptoms persisted. Four weeks after injury, the patient was referred to our unit. Doppler ultrasound and angiography of the brachial artery were performed, showing an occlusion of the ulnar artery just distal to the space of Guyon. Operative revision was carried out and a 20 mm thrombus removed. Recovery was then uneventful, and all previous symptoms disappeared. A review of the literature is presented and typical symptoms, diagnostic and therapeutic approaches discussed. The need for an early diagnosis and operative revision is demonstrated.

Angiography↗
PubMed1991

[Injury of the pelvic ring and abdominal trauma].

Fractures and disruptions of the pelvic ring are usually found in multiply injured patients and exacerbate the life-threatening character of the concomitant injuries. The main prognostic factors are haemorrhagic complications, abdominal trauma and associated injuries of the urogenital tract. All patients admitted to the Department of Surgery of the University of Münster between July 1985 to December 1989 were analysed with particular reference to pelvic ring instability and the accompanying pelvic and abdominal lesions. Of 27 patients with unstable displaced lesions of the pelvic ring, 9 were female (33.3%) and 18 male (66.7%); the average age was 35.1 years. Multiple trauma was present in 25 patients (92.6%). Associated pelvic or abdominal injuries were found in 15 cases (55.6%) [multiple entries]. In 9 patients (33.3%) there were lesions of the urogenital tract. Injuries to pelvic blood vessels were diagnosed in 3 patients (11.1%). In 2 patients (7.4%) there were lesions of the perineum. A ruptured spleen was found in 4 patients (14.8%), lesions of the liver in 3 patients (11.1%), lacerations of the mesentery in 2 patients (7.4%). Bleeding into the mesentery, lacerations of serosa of the sigmoid colon and contusion of the pancreas were each seen in 1 case (3.7%). In 12 patients (44.4%) laparotomy was performed: The mortality in this series was 22.2% (6 patients). The authors propose a procedure for immediate diagnosis of these associated pelvic and abdominal injuries. The key factor for a favourable outcome is the differentiation between intraabdominal and retroperitoneal bleeding. A treatment algorithm is described. The value of laparotomy, interventional radiology and primary anterior stabilization of the pelvic ring with an external frame is discussed.

Abdominal Injuries↗