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Hannes Gruber

Publications and source records attributed to Hannes Gruber.

14 recordsLinked to original sources
PubMed2005

Successful treatment of a tuberculous vertebral osteomyelitis eroding the thoracoabdominal aorta: a case report.

Mycotic aortic aneurysms are rare complications of systemic tuberculosis that affect very few patients. We report a case of a false aneurysm of the visceral segment of the aorta that was associated with tuberculous vertebral osteomyelitis. Both conditions were successfully treated with antituberculous chemotherapy and a combined surgical procedure, ie, aneurysm resection and homograft implantation, followed by orthopedic stabilization of the spine.

Aneurysm, False↗
PubMed2005

Peroneal nerve palsy associated with knee luxation: evaluation by sonography--initial experiences.

OBJECTIVE: Traumatic knee dislocation needs immediate surgical repair to restore joint function. A concomitant traction injury of the peroneal nerve is reported to exist in up to 25% of cases and is often overlooked initially. In patients with major nerve lesions, immediate surgical nerve repair might be necessary to avoid irreversible loss of neural function. In the present study, we tried to evaluate whether sonography is a valuable tool for identification of nerve pathology that warrants surgical intervention. SUBJECTS AND METHODS: In this prospective study, both peroneal nerves in nine patients with one-sided peroneal nerve palsy after closed knee luxation and the peroneal nerves of 11 healthy volunteers were investigated with sonography. Using statistical analysis, we tried to define the comparability and significance of the findings. RESULTS: The mean cross-sectional area of healthy peroneal nerves in the genicular region was 0.18 cm2 (SD, 0.07 cm2). Impaired nerves were significantly discerned because of their increased cross-sectional area at the level of the injury (mean cross-sectional area, 0.7 cm2; SD, 0.46 cm2; p < 0.05). Identification of caliber changes and depiction of at least one nerve stump were found to be the most specific criteria for the definition of a major neural lesion. The ability of sonography to provide additional information about surrounding soft-tissue impairment (scar tissue and hematoma formation) proved helpful. CONCLUSION: Sonography allows radiologists to visualize neural and extraneural pathology and to define the exact level and extent of lesions. Thus, it may be a valuable adjunct in the decision of whether surgical intervention is necessary.

Adolescent↗
PubMed2004

CT virtual reality in the preoperative workup of malunited distal radius fractures: preliminary results.

Our objective was to evaluate the usefulness of CT virtual preoperative planning in the surgical repositioning of malunited distal radius fracture. Eleven patients with malunited distal radius fracture underwent multislice CT of both wrists. A preoperative workup was performed in a virtual reality environment created from the CT data sets. Virtual planning comprised three main procedures, carrying out the virtual osteotomy of the radius, prediction of the final position of the distal radius after osteotomy and computer-assisted manufacturing of a repositioning device, which was later placed at the surgical osteotomy site to reposition objectively the distal radius fragment before fixation with the osteosynthesis. All patients tolerated the surgical procedure well. During surgery, the orthopedic surgeons were not required in any of the cases to alter the position of the distal radius that was determined by the repositioning device. At postoperative follow-up, the anatomic relationship of the distal radius was restored (radial inclination, 21.4 degrees ; volar tilt, 10.3 degrees ; ulnar variance, 0.5 mm). Clinically, a significant improvement of pronation (P=0.012), supination (P=0.01), flexion (P=0.001) and extension (P=0.006) was achieved. Pain decreased from 54 to 7 points. CT virtual reality is a valuable adjunct for the preoperative workup and surgical reposition of malunited distal radius fractures.

Adult↗
PubMed2004

Why CT-guided?

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Anesthetics, Local↗
PubMed2003

Cross-sectional and functional imaging of the temporomandibular joint: radiology, pathology, and basic biomechanics of the jaw.

The temporomandibular joint (TMJ) is a common site of complaint. Clicking sounds and pain are indicators of a frequent condition called internal derangement, most often affecting females. As a general term, internal derangement describes a structural abnormality within an articulation. The internal derangement of the TMJ is a specific term defined as an abnormal positional and functional relationship between the disk and articulating surfaces. Imaging of the joint is an important element in the diagnostic work-up. Trauma and inflammatory arthritis account for most of the other TMJ problems. A thorough understanding of joint anatomy and normal function is a prerequisite for perceiving abnormalities and making the correct diagnosis. The authors elucidate joint anatomy, correlating cadaveric specimen and anatomic slices with conventional and cross-sectional imaging studies. TMJ biomechanics are illustrated with schematics and animations, and an overview of imaging strategies and techniques is presented. Common abnormalities are described and illustrated, and a brief discussion of therapeutic options is included.

Adolescent↗
PubMed2003

The ultrasonographic appearance of the femoral nerve and cases of iatrogenic impairment.

OBJECTIVE: To assess the feasibility of ultrasonography of femoral nerves in a cadaveric specimen, healthy volunteers, and patients. METHODS: In 1 unembalmed cadaveric specimen (female, 90 years) and 20 healthy volunteers (9 male and 11 female, 18-50 years; n = 40 scans), the topographic features, cross-sectional shapes (oval or triangular), and cross-sectional areas of the femoral nerves were evaluated by ultrasonography (5- to 12-MHz broadband linear array). In a subsequent study, 7 consecutive patients with postoperative findings assigned to the femoral nerve were evaluated and assessed by a neurologist. RESULTS: The mean +/- SD anteroposterior and mediolateral diameters of the femoral nerves in the volunteers were 3.1 +/- 0.8 and 9.8 +/- 2.1 mm, respectively, at an average cross-sectional area of 21.7 +/- 5.2 mm2. The cross-sectional shape was oval in 67.5% superior to the inguinal ligament and in 95% inferior to the ligament. The infrainguinal femoral nerve showed variable distances to the femoral artery. In the subsequent patient study, 5 patients had swelling of the femoral nerve in the affected side. In 1 patient, the nerve had a blurred echo structure due to a hematoma. In 1 patient, major damage of the femoral nerve was ruled out clearly. CONCLUSIONS: Ultrasonography allows the depiction and assessment of the femoral nerve from about 10 cm superior to 5 cm inferior to the inguinal ligament. In this region, ultrasonography is helpful in detection of impairments and, therefore, in decisions about planning and even acceleration of further treatment.

Adult↗
PubMed2002

Fetal development of the first metatarsophalangeal joint complex with special reference to the intersesamoidal ridge.

In most individuals, plantar to the first metatarsal head, a more or less well developed crest separates the two furrows for the medial and the lateral sesamoid bones. In some instances, the absence of this crest has been observed in a previous study. This observation may be related to a pathological and/or an ontogenetic development. For the present examination, we have assumed the ontogenetic hypothesis. Twenty-two feet were examined at different developmental stages from week 12 to 38. The feet were prepared for examination using methods of plastination-histology. Sesamoids have already developed from the joint capsule by the first stage (12th week). Attachment bundles of collagenous fibers have deeply penetrated the cartilage of the sesamoids on their capsular side. Only some inner fibers of the muscular tendons join the sesamoids on their plantar side. The intersesamoid ligament is blended into the synovial tendon sheath of the flexor hallucis longus. The plantar crest has already developed in the fetal cartilage of the first metatarsal head as a strong ridge. With further growth, the surfaces become inwardly tapered on both sides of the ridge through the sesamoid bones, so that in the end the ridge results in a more or less clear crest. If the tapering of the furrows for the sesamoid bones proceeds too briskly or too far, this can result in an absence of the plantar crest. If the absence of this crest stands in relation to the formation of a Hallux valgus, this result would be a first indication of an developmentally based cause for this wide-spread disease of the foot.

Embryonic and Fetal Development↗
PubMed2002

Ultrasonography of the accessory nerve: normal and pathologic findings in cadavers and patients with iatrogenic accessory nerve palsy.

OBJECTIVE: To determine feasibility of ultrasonography in detecting the normal accessory nerve as well as pathologic changes in cases of accessory nerve palsy. METHODS: Four patients with accessory nerve palsy were investigated by ultrasonography. Three cases of accessory nerve palsy after lymph node biopsy and neck dissection were primarily diagnosed on the basis of ultrasonography using a 5- to 12-MHz linear transducer. In addition, we performed ultrasonography in 3 cadaveric specimens to show the feasibility of detecting the accessory nerve. RESULT: Nerve transection (n = 2), scar tissue (n = 1), and atrophy of the trapezius muscle (n = 4) were confirmed by electroneurographic testing and surgical nerve inspection. In 1 case in which a patient had a whiplash injury with accessory nerve palsy, ultrasonography showed atrophy of the trapezius muscle with a normal nerve appearance. CONCLUSIONS: Ultrasonography allows visualization of the normal accessory nerve as well as changes after accessory nerve palsy.

Accessory Nerve↗
PubMed2002

Ultrasonographic appearance of supinator syndrome.

OBJECTIVE: To describe ultrasonographic findings in 4 patients with supinator syndrome (i.e., deep branch of the radial nerve). METHODS: Four patients with weakness and pain in their forearm underwent ultrasonographic examination with subsequent electroneurographic testing and surgical nerve inspection. Normal measurements of the deep branch of the radial nerve in 10 healthy volunteers served as comparison for measurements in the patients. RESULTS: An enlarged deep branch of the radial nerve was found in all 4 patients at the affected side. Electroneurographic testing and surgical inspection confirmed the ultrasonographic findings. The mean transverse diameter was 4.2 mm (range, 3.8-4.5 mm), and the anteroposterior diameter was 3.3 mm (range, 2.5-3.8 mm). In volunteers, the mean transverse diameter was 2.13 mm (range, 1.7-2.6 mm), and the mean anteroposterior diameter was 1.3 mm (range, 1.0-1.5 mm). CONCLUSIONS: The deep branch of the radial nerve appears enlarged in patients with supinator syndrome.

Adult↗
PubMedDate not supplied

The vascular nature of hemorrhoids.

The arterial blood supply of the internal hemorrhoidal plexus is commonly believed to be associated with the pathogenesis of hemorrhoids. Ultrasound-supported proctoscopic techniques with Doppler-guided ligature of submucosal rectal arteries have been introduced for the therapy of hemorrhoids. The present investigation focuses on caliber and flow changes of the terminal branches of the superior rectal artery (SRA) supplying the corpus cavernosum recti (CCR) in patients with hemorrhoids. Forty-one outpatients (17 female, 24 male; mean age 48 years) with hemorrhoids of Goligher grades I-IV were compared with 17 healthy volunteers (nine female, eight male; mean age 29 years) by means of transperineal color Doppler ultrasound. The mean caliber of the arterial branches in the study group with hemorrhoids was 1.87 +/- 0.68 mm (range, 0.6 to 3.60 mm) and 0.92 +/- 0.15 mm (range, 0.6 to 1.2 mm) in the control group (P < 0.001). The arterial blood flow was significantly higher in patients with hemorrhoids than in the control group (mean 33.9 vs. 11.9 cm/second, P < 0.01). Our findings demonstrate that increased caliber and arterial blood flow of the terminal branches of the SRA are correlated with the appearance of hemorrhoids. We suggest that the hypervascularization of the anorectum contributes to the growth of hemorrhoids rather than being a consequence of hemorrhoids. Transperineal color Doppler ultrasound (CDUS) is an appropriate method to assess these findings in patients with hemorrhoids.

Adult↗
PubMedDate not supplied

Ultrasound-guided periradicular injections in the middle to lower cervical spine: an imaging study of a new approach.

BACKGROUND AND OBJECTIVES: The objective of this study was to show the efficacy of ultrasound in facilitating the performance of a simulated cervical periradicular injection in cadavers. METHODS: A total of 40 ultrasound-guided examinations at 4 levels (C3 to C7) were performed on 4 embalmed cadavers. The cervical spinal nerves were located with ultrasound. First, the transverse process of each level was taken as a sonoanatomic landmark. The most lateral aspect of the transverse process of the seventh cervical vertebra was then established as the reference point. Ipsilateral distances (A, B, C, and D) between this point and each one of the transverse processes of the cervical spine up to the third vertebra were then computed. Subsequently, coronal computed tomography (CT) scans were taken to verify these distances. In a second part, a spinal needle was advanced under ultrasound guidance to the spinal nerves C5 to C8 on both sides of one cadaver. The exact placement of the needle tips was checked by CT. RESULTS: The transverse processes were identified in all cadavers. In 5 attempts, a depiction of the spinal nerves was not possible. Ultrasound and CT provided the same mean measurements of 1.1 cm, 2.1 cm, 3.1 cm, and 4.1 cm for distances A, B, C, and D, respectively. All 8 needle tips were placed within 5 mm dorsal to the spinal nerve and less than 5 mm away from the posterior tubercle of each level's transverse process, as also verified by CT. CONCLUSIONS: This preclinical study suggests that ultrasound is a useful guiding tool for periradicular injections in the cervical spine.

Cervical Vertebrae↗
PubMedDate not supplied

Ultrasound-guided facet joint injections in the middle to lower cervical spine: a CT-controlled sonoanatomic study.

OBJECTIVES: The aim of this study was to investigate the efficacy of ultrasound as a guiding tool for simulated cervical facet joint injections in cadavers. METHODS: A total of 40 ultrasound examinations at 5 levels (C6-7 to C2-3) were performed on 4 embalmed cadavers. The zygapophyseal joints were located with ultrasound. First, the transverse processes of C6 and C7 were established and the facet joint of C6-7 was demonstrated. The midpoint of this joint space, defined as the middle of its cranio-caudal extension on its lateral surface, was taken as a reference point. Ipsilateral distances (A, B, C, and D) between this point and each one of the 4 facet joints of the cervical spine up to the facet joints C2-3 were then computed. Subsequently, coronal computed tomography (CT) scans were taken to verify these distances. In a second experiment, a spinal needle was advanced under ultrasound guidance to the zygapophyseal joints from C2-3 to C6-7 on both sides of 1 cadaver. The exact placement of the needle tips was again verified by CT. RESULTS: In 4 attempts, a depiction of the joint space was not possible. Ultrasound and CT provided the same mean measurements of 1.2+/-0.2 cm, 2.0+/-0.3 cm, 3.0+/-0.2, and 4.0+/-0.5 cm for distances A, B, C, and D, respectively. All 10 needle tips were located in the joint space during simulated facet joint injections, as also verified by CT. DISCUSSION: This preclinical study suggests that ultrasound is a useful guiding tool for facet joint injections in the cervical spine.

Cervical Vertebrae↗