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Biomedical subjects

J Holle

Publications and source records attributed to J Holle.

98 records · Page 6Linked to original sources
PubMedDate not supplied

[Functional electrostimulation of paraplegic patients--1 year's practical application. Results in patients and experiences].

In October 1982 two patients suffering from paraplegia ware, world wide for the first time, implanted two 8-channel-stimulation-devices at the II. Surgical Clinics Vienna. Four electrodes were fixed to the nervus femoralis and the nervus gluteus inferior with the help of microsurgical techniques. The aim of the operation is to enable the paralysed patient to "stand up himself" and to "cover a short distance on crutches". They must learn to manipulate the implanted "more-channel-device" with their fingers, and to coordinate this with the supporting function and the balance function of their arms. The wheel-chair shall not and cannot be substituted with this method: Not without, but with wheel-chair and functional electrostimulation. A comprising training-programme for building up muscles, balance control and gait training was necessary. After 4 months muscle-force and endurance had increased 200%. The patients could stand up stimulatedly without help between parallel bars. At the rehabilitation center Bad Häring the first steps were done in March 1983 (= 5. month after operation). The greatest success was when a patient could get stimulatedly out of her car and do the through-swing-gait over a distance of 60 meters. After one year the muscle force was quadrupled, the endurance was increased 20-30 times, depending on the type of gait. Both patients are able to walk in the 4-P-gait or swing-through-gait on crutches over short distances without help from others. Riding a bicycle stimulatedly on even ground was demonstrated.

Adult↗
PubMedDate not supplied

[Clinical and electroneurographic results following surgical treatment of the ulnar nerve sulcus syndrome].

The sulcus of the elbow-joint represents a bottleneck which may cause compression of the ulnar nerve. We studied clinical and electroneurographical results in 26 patients after operation of the sulcus ulnaris-syndrome. The influence of the duration of compression as well as additional illnesses was evaluated on the postoperative result. The surgical treatment was an anterior transposition of the nerve in a subcutaneous layer combined with external neurolysis. Due to the symptoms and the electroneurographical results after operation the patients were divided into three groups. The best results were obtained in cases with a short period of preoperative complaints (below 1 year). Although heavy work had a positive effect on the manifestation of a sulcus ulnaris-syndrome, it had no adverse effect if started again after operation. Anterior subcutaneous transposition is the operative procedure of choice in cases of sulcus ulnaris-syndrome.

Adult↗
PubMedDate not supplied

Technology and long-term application of an epineural electrode.

An epineural electrode (ENE) was developed to achieve a controllable, progressive muscle contraction and reduce muscle fatigue during functional electrostimulation. In vitro studies of annular (torus-shaped) electrodes have been carried out to select adequate electrode materials and electrode diameters. We investigated the long-term stability of ENEs using different intensities of current (range: 0.8-1.2 mA) in sheep and rat experiments. Depending upon size and material, ENE tolerates anodic and cathodic impulses of up to 1 msec and 8 mA (peak current). ENEs were used during clinical application in four paraplegic patients (16 channel implants) for stimulation of lower extremities, and in nine quadruplegic patients (eight channel implants) for diaphragm pacing, for a total observation time of 37 patient years. The low rate of clinical complications, including no corrosion of the electrodes or significant loss of nerve fibers, seems related to the small dimensions of the electrode (less than 1 mm2).

Animals↗
PubMedDate not supplied

Multichannel stimulation of phrenic nerves by epineural electrodes. Clinical experience and future developments.

Between 1983 and 1992, 23 patients with complete ventilatory insufficiency of differing etiologies were treated with an eight channel implant (Medimplant Inc., Vienna) for fatigue free stimulation of both phrenic nerves. Data for 15 patients with high spinal cord lesions (ages: 9-51 years) are summarized: 1) level of lesion: C0, 3 patients; C1/C2, 4; C2/C3, 8; 2) time between incident and implantation: 3-14 months; 3) diaphragm training: 1-22 months; 4) chronic pacing: 5-83 months; 5) tracheostomy closed: 7 patients; 6) living permanently at home: 13 patients; 7) respiratory rate per minute: 12-17; 8) duration of inspiration: 1.0-1.3 sec; 9) tidal volume: 7-20 ml/kg body weight; 10) volume per minute: 121-198 ml/kg body weight; 11) pH: 7.39-7.42; 12) pCO2: 22.9-38.6 mmHg; 13) pO2: 81.2-104.5 mmHg; and 14) died by December 1992, 4 patients. All currently available implants for phrenic pacing need an external power supply and radio control. The authors have developed and tested the first fully implantable device. Features of this implant include an electronic circuit based on the microcontroller MC68HC705C8; surface mounted technology (SMD); eight channels; constant current source adjustable to 5 mA in 256 steps, impulse duration: 100-1000 musec, stimulation frequency: 1-33 Hz; and minimum lifetime: 3 years. The implant is programmed via bidirectional radio transmission using an IBM compatible computer. The dimensions, including battery, eight electrode connectors, and antenna, are 67 x 48 x 13 mm. The implant weights 58 g. This new device may improve patients' safety and quality of life in the near future.

Adolescent↗