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Biomedical subjects

H Rieger

Publications and source records attributed to H Rieger.

At least 109 records · Page 6Linked to original sources
PubMed1991

[Heterotopic ossifications from the trauma surgery viewpoint].

A heterotopic ossification is a non-neoplastic bone formation located in the soft tissues (so-called myositis ossificans). Important aspects of this condition, which is not uncommon after trauma or surgical procedures, are discussed from the trauma surgeon's viewpoint. The results of treatment of heterotopic ossifications are frequently unsatisfactory. Therefore, the importance of preventive measures is emphasized.

Fracture Fixation, Internal↗
PubMed1990

[Acral skin circulation following intra-arterial infusion of vasodilating substances in patients with intermittent claudication].

The value of vasodilator drugs for the conservative treatment of peripheral arterial occlusive disease is widely questioned because clinical and experimental studies have shown paradoxical redistribution phenomena of blood flow in disfavour of an already ischemic peripheral circulation. This paper deals with acute effects of intraarterially infused prostaglandin E1 and buflomedil on the overall foot sole perfusion as well as its distribution patterns. Measurements were performed in patients with sufficiently compensated obstructions of the superficial femoral artery by means of dynamic fluorescein angiography. After i.a. infusion in general an increase of the total blood supply to the feet was found. However, in response to this common vasodilator effect in some patients apparently non-perfused circumscribed skin areas occurred which could never be observed under control conditions. With respect to these results the clinical value of vasodilator drugs as well as the meaning of such adverse redistribution phenomena are discussed from a pathophysiological and pharmacodynamical point of view. It is proposed that the therapeutical concept of pharmacological vasodilation should not be rejected in general. However, special attention should be paid to the development of steal effects.

Aged↗
PubMed1990

Variability of Doppler ophthalmic pressure index with occlusive carotid artery disease.

To evaluate day-to-day variability of Doppler ophthalmic pressure index by means of the ophthalmomanometry-Doppler technique, bilateral ophthalmic artery pressure and indirect systemic blood pressure determinations were repeated within 1 month in 40 patients with clinically stable occlusive carotid disease. No difference in Doppler ophthalmic pressure and calculated pressure index between both days could be demonstrated. The standard deviation of differences in ophthalmic pressure index between first and second day measurements was 0.04. Correlation between bilateral ophthalmic pressure index measurements on both days was high (r = 0.93, n = 80). It is concluded that individual Doppler ophthalmic pressure index must change at least 0.08 before it can be considered significant. In 37 patients with occlusive carotid artery disease (greater than 60% diameter reduction) undergoing 38 endarterectomies, Doppler ophthalmic pressure index was evaluated before and after surgery. Mean +/- SD ipsilateral Doppler ophthalmic pressure index increased from 0.59 +/- 0.07 to 0.71 +/- 0.05 (p less than 0.001) after endarterectomy. In 12 patients with significant bilateral occlusive carotid disease, mean +/- SD contralateral Doppler ophthalmic pressure index increased from 0.54 +/- 0.05 to 0.61 +/- 0.06 (p less than 0.02), whereas contralateral pressure index in patients with unilateral disease showed no change (0.71 vs 0.71) after ipsilateral endarterectomy. These results indicate that carotid endarterectomy not only normalizes ipsilateral Doppler ophthalmic pressure index but also improves contralateral Doppler ophthalmic pressure index provided significant bilateral occlusive carotid disease is present.

Adult↗
PubMed1990

A microcomputer system for evaluation of laser Doppler blood flux measurements.

Results of local skin perfusion measurements performed by laser-Doppler-fluxmetry (LDF) are generally expressed in terms of relative mean values of time constants of signal responses to various procedures. In addition, information is obtained from the frequency and amplitude of temporal signal variations. In this report, a microcomputer system designed for recording, storage, artifact elimination, evaluation, and documentation of LDF measurements will be described. This system consists of a desk-top computer with additional hardware necessary for digital data acquisition and acceleration of mathematical operations. A three-phase model defined by a control, a transient, and an effect interval was programmed in order to standardize calculations within the time domain. For spectral analysis of periodical signal fluctuations, an algorithm was implemented based on a Fast-Fourier-Transformation (FFT) in combination with an optional averaging of several spectra within the frequency domain. Clinical measurements performed on patients with peripheral arterial occlusive disease (PAOD) and healthy volunteers illustrate the features of the system.

Arterial Occlusive Diseases↗
PubMed1990

[Tuberculosis of the hand].

Skeletal tuberculosis of the hand has become rare. The authors report a 27-year-old female patient with tuberculous osteomyelitis of the middle phalanx of the left ring finger without occupational exposure of the hand and with positive chest roentgenogram. The case shows the diagnostic difficulties of the uncommon manifestation of skeletal tuberculosis in the short tubular bones of the hand. By means of a review of the literature the differential diagnosis, the course and necessary treatment are discussed.

Adult↗
PubMed1990

[Doppler ultrasound determination of pressure decrease in model peripheral arterial stenoses].

In a pulsatile in vitro flow model with mounted concentric peripheral arterial stenoses, we compared the mean trans-stenotic pressure difference between pre- and poststenotic segment with the Doppler-estimated mean pressure gradient calculated according to the simplified Bernoulli equation applied over an entire stroke cycle. A close linear correlation was found between Doppler-estimated and invasively measured pressure drop values: Y = 1.13X + 0.47 (r = 0.98, SEE = 1.4 mmHg, n = 16). The Doppler-derived overestimation of the invasively measured mean pressure-drop by an average of 16% (absolute values 2.2 +/- 1.7 mmHg) suggests that in this in vitro model a small part of the kinetic energy of the stenotic jet is recovered distal to the poststenotic turbulences. The difference between both methods is so little that the Doppler-estimated mean pressure drop is acceptable in concentric peripheral model arterial stenoses.

Arterial Occlusive Diseases↗
PubMed1989

[Doppler-ophthalmomanometry in patients with obstruction of the carotid arteries].

A novel noninvasive method to determine simultaneously ophthalmic artery pressure (OAP) and flow direction based on Doppler ultrasound principles is presented: ophthalmomanometry-Doppler (OMD). Studies performed on 25 angiographically proven normal subjects with direct recording of the internal carotid artery pressure (ICP) and indirect determination of the brachial artery pressure (BAP) demonstrated that OAP values assessed by the OMD device are highly correlated with simultaneous ipsilateral intraarterial systolic ICP measurements (r = 0.95, n = 10) and with simultaneous recordings of the BAP (r = 0.88, n = 15). In 50 patients presenting angiographically occlusions and 52 patients presenting angiographically stenoses (greater than 60%) of the carotid artery the measured Doppler ophthalmic pressure index (OPI = ratio of the ophthalmic to systemic blood pressure) was lower ipsilateral to an occlusion (0.46 +/- 0.08) than ipsilateral to a stenosis (0.54 +/- 0.08; p less than 0.001) of the carotid artery. In both it was clearly diminished compared to normal values (0.68 +/- 0.04; p less than 0.001). In carotid artery occlusions, the ipsilateral OPI was 0.46 +/- 0.06 for antegrade (n = 17) and 0.46 +/- 0.09 for retrograde (n = 28) ophthalmic artery flow. In carotid artery stenoses, the ipsilateral OPI was 0.55 +/- 0.07 for antegrade (n = 41) and 0.48 +/- 0.06 for retrograde (n = 9) ophthalmic artery flow (p less than 0.01). It is concluded that in carotid occlusions presenting a longer disease history extra-intracranial collateralisation via the ophthalmic artery are as efficient as a functional circle of Willis.

Blood Pressure Determination↗
PubMed1989

Doppler ophthalmic blood pressure measurement in the hemodynamic evaluation of occlusive carotid artery disease.

In 102 patients with angiographically proven occlusive carotid artery disease of 60-100% diameter reduction, Doppler ophthalmic artery pressure and blood flow direction were recorded by the recently developed ophthalmomanometry-Doppler technique. Among these 102 patients, 50 presented with complete carotid artery occlusions and 52 with carotid artery diameter stenoses of greater than or equal to 60%. Mean +/- SD Doppler ophthalmic artery pressure was 69 +/- 15 mm Hg ipsilateral to the occlusion and 86 +/- 18 mm Hg ipsilateral to a stenosis of the carotid artery (p less than 0.001). The mean +/- SD Doppler ophthalmic pressure index (ratio of the ophthalmic artery to systemic blood pressure) was lower ipsilateral to the occlusion (0.46 +/- 0.08) than ipsilateral to a carotid artery stenosis (0.54 +/- 0.08; p less than 0.001); in both, the index was clearly diminished compared with normal values (0.68 +/- 0.04; p less than 0.001). It is concluded that the intracranial hemodynamic consequences in the patients with occlusion are on average more profound than in the patients with stenosis. In carotid artery occlusions, the mean +/- SD ipsilateral ophthalmic pressure index was 0.46 +/- 0.06 for antegrade and 0.46 +/- 0.09 for retrograde ophthalmic artery blood flow. In carotid artery stenoses, the mean +/- SD ipsilateral ophthalmic pressure index was 0.55 +/- 0.07 for antegrade and 0.48 +/- 0.06 for retrograde ophthalmic artery blood flow (p less than 0.01). These results indicate that in carotid stenoses the collateral capacity of the ophthalmic artery is insufficient compared with intracranial collaterals, while in carotid occlusions the blood flow direction in the ophthalmic artery does not predict intracranial hemodynamic compensation.

Adult↗
PubMed1989

[A rare hand injury].

Simultaneous dislocations of the carpometacarpal joints are relatively rare hand injuries. This is a case report of dislocations of the carpometacarpal joints II-V, combined with Bennett's fracture. The case is discussed in this article with particular reference to the therapeutical aspects.

Adult↗
PubMed1989

[Conservative therapy of arterial occlusive disease].

Since in stage II of peripheral arterial disease (PAD), according to the definition, there is no objective evidence of danger for the involved extremity, management is dependent on the extent to which the claudication complaints are tolerated (Figure 1). If well tolerated, observation and treatment of risk factors, possibly enrollment in an out-patient training group, are sufficient. Exceptions are the cases of pending danger to viability as well as isolated stenoses in the pelvic region or larger leg arteries easily amendable to percutaneous dilatation. If the patient does not tolerate the complaints, for aortic and pelvic artery occlusions, training of the muscles of the upper thigh is indicated, for occlusions in the thigh training of the calf musculature is warranted. The pathophysiologic basis of training lies in an increase in perfusion via collaterals due to dilatation of the muscular arterioles distal to the stenosis incurred by virtue of work and ischemia. This mechanism may also involve a sheer-induced release of endothelium-derived relaxing factor. Over a moderate period of time, there is an organic increase in collateral caliber due to the perfusion-dependent growth stimulus. A further effect of training is an increase in metabolic activity. If training is unsuccessful, lumen enlarging measures ("LEM" in Figure 1) should be considered. Indications for percutaneous transluminal angioplasty (PTA) are stenoses in the pelvic region or large leg arteries as well as short occlusions of the femoropopliteal vessels (less than 10 cm). With the help of special techniques like rotational angioplasty even occlusions of the pelvic arteries are treatable in selected cases. The five-year patency rate of dilated pelvic artery stenoses is 82%, three-year patency rate for femoral artery stenoses 81% and femoral artery occlusions 78%. Among newer procedures are laser and auger angioplasty, catheter atherectomy and stents. The question of efficacy of platelet inhibiting drugs of the aspirin type, with regard to prophylaxis of early and late re-stenosis remains unsettled. In principle new medical approaches are selective inhibition of thromboxane as well as inhibition of arteriosclerosis-induced proliferation and migration of active mediamyocytes, for example, with highly negative-charged polyanions. For the prophylaxis of peripheral arterial occlusion with aspirin, a dosage of one to 1.5 gram daily would seem appropriate until studies are available to document the effects of lower dosages.(ABSTRACT TRUNCATED AT 400 WORDS)

Arterial Occlusive Diseases↗
PubMed1989

[Duplex ultrasound studies of the deep femoral artery].

In case of occlusion of the superficial femoral artery (SFA), the deep femoral artery (DFA) supplies the entire lower extremity. Not infrequently, the SFA occlusion is associated with stenosis of the origin of the DFA. The angiographic study of the origin of DFA is often unsatisfactory. The purpose of the present study was to develop objective criteria for the diagnosis of the DFA origin stenosis by duplex scanning. In 60 patients, we examined 75 femoral bifurcations by duplex scanning and compared them with the independently performed angiography. Group 1 (n = 20 DFA origins) consisted of 10 normal individuals. Group 2 (n = 30 DFA origins) consisted of 25 patients with angiographically proven SFA occlusion and normal DFA. Group 3 (n = 25 DFA origins) consisted of 25 patients with angiographically proven SFA occlusion and DFA orifice stenosis. We measured the maximal systolic and mean flow velocity in the orifice of the DFA at rest and during the maximal hyperemia following 3 min of ischemia of the lower leg. At rest, the maximal flow velocity in groups 1-3 was 60 +/- 15, 142 +/- 44, and 255 +/- 60 cm/s (p less than 0.01) and the mean flow velocity was 8 +/- 6, 32 +/- 9, and 96 +/- 42 cm/s (p less than 0.01). During hyperemia, the maximal and mean flow velocity for groups 1-3 was 59 +/- 15, 155 +/- 42, and 286 +/- 82 cm/s (p less than 0.01) and 8 +/- 5, 55 +/- 19, and 144 +/- 51 cm/s (p less than 0.01), respectively. An origin stenosis of the DFA is highly probable when at rest the mean and maximal velocity in the proximal DFA exceed 50 cm/s and 180 cm/s, respectively. These results show that duplex scanning is able to detect safely DFA origin stenosis. The increase in postischemic DFA flow velocity when SFA occlusion is present, helps to evaluate total flow resistance of the deep-outflow channels (run-off) thereby being useful in planning appropriate therapy.

Adult↗
PubMed1988

[The importance of atypical adenoma of the thyroid gland].

Histological appraisals were made of 8,741 specimens of removed thyroid glands at the Pathologico-Bacteriological Institute of Kaiserin Elisabeth Spital, between 1978 and 1987. Included, according to classification, were 234 atypical adenomas, 47 encapsulated follicular carcinomas, and 158 invasive follicular carcinomas. Atypical adenoma was found to differ histologically from encapsulated follicular carcinoma by non-detectability of vascular invasions. The age distribution of the patients involved failed to provide any conclusive clue to the effect that atypical adenoma was a precursor of encapsulated follicular carcinoma. Females were more often affected than males with atypical adenoma. No recurrence, metastasation nor complaints are recordable at present from any of the surviving patients with atypical adenoma. Patients who died did not reveal any sign indicative of a thyroid disease as cause of death. The five-year survival rate has been 95 per cent for encapsulated follicular carcinoma. Diagnosis of atypical adenoma is not merely a qualitative problem but a quantitative problem as well. Atypical adenoma of the thyroid gland should be classified as a neoplasia in its own right and as absolutely benign.

Adenocarcinoma↗
PubMed1986

[Noninvasive determination of stroke volume with impulse Doppler echocardiography: comparison with the Fick method].

Pulsed Doppler echocardiographic studies were performed in 14 patients (eleven with mitral valve disease, two with coronary artery disease, one with aortic and mitral valve replacement) for determination of cardiac output and the results compared with those obtained from simultaneous measurements carried out according to the Fick principle. Determination of cardiac output and stroke volume was achieved with a pulsed Doppler instrument specifically designed in our laboratory (repetition frequency 10 kHz, maximal penetrance 7.7 cm, ultrasonic beam diameter 3 cm at a distance of 5 cm from the transducer). Doppler measurements of the instantaneous blood flow velocity in the ascending aorta were obtained with the transducer in a suprasternal position. Through integration of the mean spatial velocity over an entire cardiac cycle, the distance traversed by the blood during one heart beat was obtained and then multiplied by the echocardiographically-determined cross-section area of the aorta and the heart rate to yield the cardiac output. There was a statistically-significant linear correlation between the cardiac output determined by Doppler (CO-D) and Fick (CO-F): CO-D = 0.92 CO-F X 0.48, r = 0.85, n = 14. The mean values for the two methods were 3.89 and 3.68 1/min, respectively. The correlation between the two methods improved if only those patients with sinus rhythm were taken into consideration (CO-D = 1.05 CO-F - 0.21, r = 0.93, n = 11). The results show that the pulsed Doppler method used enables accurate determination of cardiac output. The method can be carried out in all patients without aortic stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

The cardiac anxiety syndrome--a subtype of panic attacks.

Cardiac anxiety syndrome and the diagnosis of cardiac neurosis respectively are characterized by panic attacks. Panic attacks are the core syndrome of a validated anxiety disorder (panic disorder). The purpose of this study was to investigate if the cardiac anxiety syndrome represents a separate disorder or if it is only a subtype of panic attacks. In a sample of 122 patients with panic attacks, all patients with a cardiac anxiety syndrome were selected (n = 31). Furthermore, parallel to this group--matched in the variables age and sex--a second group of patients with no cardiac anxiety syndrome was selected. There were no significant differences in course; in clinical phenomenology, patients with a cardiac anxiety syndrome were only distinguished by a greater intensity of somatization and phobic avoidance from patients with no cardiac anxiety syndrome. These results confirm the hypothesis that the cardiac anxiety syndrome is a subtype of panic attacks and does not represent a separate disorder.

Adult↗