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Biomedical subjects

U Brunner

Publications and source records attributed to U Brunner.

At least 19 recordsLinked to original sources
PubMed2000

Juxtaacetabular ganglion as a differential diagnosis in pulsating groin masses.

Ganglion cysts of the hip joint are uncommon synovial-lined fluid-filled juxtaarticular groin lesions. Whereas in the past the correct diagnosis was often made only at surgery there are now valuable imaging methods used for the diagnostic work-up. In experienced hands ultrasonography (US) combined with colour duplex Doppler ultrasonography (CDDS) as a real-time imaging technique easily performed at the patient's bedside is a valid alternative to more expensive or invasive investigations. We report on a patient who presented with a ganglion cyst and in whom first supported by conventional US an aneurysm of the femoral artery was suspected. The diagnosis of a juxtaarticular ganglion was subsequently correctly made at our institution by CDDS and magnetic resonance imaging, respectively, and the cyst was exstirpated successfully. The differential diagnosis of a pulsating groin mass as well as the most useful and specific imaging methods in the diagnostic work-up in this clinical setting are discussed.

Acetabulum↗
PubMed2000

Experiences with hydrofibres in the moist treatment of chronic wounds, in particular of diabetic foot.

BACKGROUND: Chronic wounds are an everyday problem in general medicine. Likewise, their persistence, painfulness and frequency of relapse are everyday problems which strain the stamina of patients and doctors to the point of desperation. Over recent years, the moist therapy concept has proven to be a major advance in wound treatment. The introduction of innovative wound dressings in the 1990's made it possible to substantially accelerate wound healing and couple it with a simultaneous alleviation of pain. PATIENTS: In the scope of our team's experience one such product is the hydrofibre. This paper offers information on the possibilities for using this material on the basis of 135 wound situations, 44% of which are within the context of diabetes mellitus. RESULTS: There was a positive influence on wound healing in 92% of the cases. This treatment result is analysed in terms of causal, topographic and iconographic aspects. CONCLUSION: Given the main focal points of our group of patients, it may be stated that hydrofibres are suitable for diabetic wounds.

Adult↗
PubMed1999

Topical treatment of venous ulcer with fibrin stabilizing factor: experimental investigation of effects on vascular permeability.

BACKGROUND: The clinical observation of distinct reduction of wound secretion tendency during treatment of venous leg ulcer with topically applied factor XIII let us speculate that this enzyme may be involved in modulation of vascular permeability. METHODS: For experimental study porcine aortic endothelial cells were cultured on filter membrane to confluent monolayer. Endothelial covered filters then were used in a two-compartment modell creating an artificial luminal and abluminal compartment. To investigate the influence of factor XIII on endothelial barrier function, we measured the flux of trypan blue-labeled albumin through endothelial monolayers by spectrophotometer. RESULTS: Monolayers that were exposed to factor XIII showed a distinct (n = 10, p < 0.05) decrease of albumin flux in contrast to control. This effect was not dependent on serum substrates. Partially, the permeability reducing effect was due to a certain amount of albumin that is a stabilizing component of Fibrogammin HS. CONCLUSION: Although the mechanism is unclear at the moment, we conclude that reduction of endothelial permeability can be achieved by factor XIII which may play an important role in wound healing of venous leg ulcer.

Administration, Topical↗
PubMed1999

[The diabetic foot from the viewpoint of infection surgery].

Pressure ulceration and bacterial superinfection are main risk factors for the diabetic foot. Surgical interventions for prophylaxis and treatment of infection are demanded. The aim of emergency surgery to treat infection is conservation of as much foot as possible. Therapeutic strategies and an algorithm are established for definite treatment of the infected diabetic foot: primary treatment of infection--arterial revascularization--amputation--orthopedic shoesupply.

Algorithms↗
PubMed1998

Quality assurance of physical parameters in radiation oncology at the University Hospital of Basel--a retrospect.

BACKGROUND AND PURPOSE: The necessity for and the benefit of a quality assurance program in radiation oncology are not questioned. Nevertheless, a retrospective analysis of the accumulated results of several years of quality assurance offers the possibility for further optimization. MATERIALS AND METHODS: The results of the physical quality control in radiation treatment planning and on radiation treatment units in the Institute for Radiation Oncology at the University Hospital of Basel for the years 1985, 1991 and 1994 are analyzed and compared mutually. The frequencies of the deviations from the nominal values for the different tests are stated. RESULTS: The relevance of the deviations for the different parameters is rated and the manifested influence of the type and age of the equipment on the results of the quality assurance is discussed. CONCLUSIONS: A condition for the maximum benefit gained from the quality assurance is the oncologist's understanding of the necessity for regular checks and the urgency for eliminating the established deficiencies. In that way the accuracy for the treatment planning, simulation and set-up process and for the realization of the radiation treatment can be increased and the methods can be improved.

Hospitals, University↗
PubMed1998

Chronic prosthetic hip infection caused by a small-colony variant of Escherichia coli.

From two different specimens of a chronic prosthetic hip infection taken at an interval of 2 months a slow-growing gram-negative bacterium was isolated in pure culture. The strain grew with the typical features of a small-colony variant (SCV). 16S rRNA sequencing identified the bacterium as Escherichia coli. Biochemical characterization demonstrated multiple phenotypic alterations of a mutant carrying a defect in the heme biosynthetic pathway (Hem-): (i) catalase and nitrate reductase reactions were both negative, (ii) a negative benzidine reaction demonstrated the lack of heme-containing cytochromes, and (iii) growth stimulation under anaerobic conditions as well as gentamicin resistance indicated defective aerobic respiration. PCR and Southern hybridization demonstrated that the mutation of the SCV of E. coli was localized in the hemB gene and was most likely due to a deletion of the hemB gene. On blood agar plates revertants were recognized growing as normal-sized colonies between the dominant small colonies of the strain. Feeding experiments indicated that the revertants but not the small colonies were permeable for hemin. A strong antibody response against the infecting SCV of E. coli was found. To our knowledge, this is the first report of a Hem- E. coli strain as the etiological agent of a chronic bacterial infection.

Escherichia coli↗
PubMed1998

Prospective evaluation of MR arthrography performed with high-volume intraarticular saline enhancement in patients with recurrent anterior dislocations of the shoulder.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of high-volume saline-enhanced MR arthrography in assessing the labrum, the ligaments, and the bony components of the glenohumeral joint. SUBJECTS AND METHODS: Forty-four patients with recurrent anterior dislocations of the shoulder underwent MR arthrography after intraarticular injection of 15-40 ml of saline solution. Two-dimensional fast low-angle shot and T1-weighted spin-echo sequences were prospectively evaluated by two observers. Anterior (Bankart) lesions, superior labral lesions extending from anterior to posterior, and Hill-Sachs lesions were diagnosed. Glenohumeral ligaments (GHLs) were identified and classified using a standard system. MR imaging results were compared with those of arthroscopy (n = 32) or open surgery (n = 12), either of which was the gold standard. RESULTS: Bankart lesions and superior labral lesions extending from anterior to posterior were revealed with a sensitivity of 93% and 89%, respectively, and a specificity of 80% and 89%, respectively. Diagnostic accuracy was 89% for both types of lesions. All six patients with bony Bankart lesions had high fat-marrow signal intensity within the fragment on T1-weighted MR images. For GHLs, MR imaging results and arthroscopy correlated in 25 of the 31 patients. In three patients all three GHLs were visible on MR imaging, but only two GHLs were detected with arthroscopy. In three patients two GHLs were detected on MR imaging but all three were visible on arthroscopy. Hill-Sachs lesions were revealed with a sensitivity of 95%, a specificity of 50%, and an accuracy of 81%. CONCLUSION: High-volume saline-enhanced MR arthrography is accurate in revealing the labrum, the ligaments, and the bony components of the glenohumeral joint Saline solution is inert and inexpensive, two advantages over gadopentetate dimeglumine.

Adult↗
PubMed1997

[Dislocated multiple fragment fractures of the head of the humerus. Does dislocation of the humeral head fragment signify a worse prognosis?].

PROBLEM: The vascularity of the articular fragment is of key importance for the final outcome in three- and four-part fractures of the humeral head. Displacement of the articular segment may compromise the arterial blood supply to the humeral head and result in avascular necrosis. There is still controversy as to whether three-and four-part fracture dislocations (articular fragment outside the glenoid) have an even worse prognosis than displaced three- and four-part fractures. PATIENTS AND METHODS: Between January 1985 and May 1993, 102 patients with three- and four-part fractures of the humeral head were treated by ORIF (mostly tension band wiring) at our institution. In a retrospective study we analysed the functional (Constant 100 point score) and radiological outcome of 67 (66%) of these patients. There were 21 patients with fracture dislocations (FD), n = 5 type B2X, n = 5 type B3X, n = 3 type C2X, n = 8 type C3X, according to the classification of Habermeyer [7]. The "X" represents the dislocation of the articular fragment, whereas the classification to each type is done after reduction of the head. The remaining 46 patients presented with displaced, but not dislocated, three- and four-part fractures (DF), n = 24 type B2, n = 7 type B3, n = 3 type C2, n = 12 type C3. Average follow-up was 25 months (7-72 months). Patients with FD were significantly younger (average age 50 years) than patients with DF (average age 63 years, P < 0.05) and showed a significantly higher incidence of traumatic nerve or plexus lesions (FD 19%, DF 2%, P < 0.05). RESULTS: Concerning the functional results, there was no statistically significant difference between the two groups. The FD patients even showed a slight tendency to better results than patients with DF. This was true for the three-part fractures (average Constant score 78 versus 67 points), as well as for the four-part fractures (average Constant score 62 versus 55 points). The significantly younger age of the FD patients may explain their better results. The entire group of patients with three-part fractures showed a significantly better functional outcome (average Constant score 68 points) than patients with four-part fractures (average Constant score 55 points, P < 0.05). The rate of partial and total avascular necrosis of the humeral head was strongly correlated to the fracture type (number of fragments, fracture of the anatomical or surgical neck, according to the classification of Habermeyer),but again there was no difference between the FD and DF group (B2X: 20%, B3X: 20%, C2X: 33%, C3X: 63%; B2: 25%, B3: 29%, C2: 33%, C3: 67%). Astonishingly, the FD were not associated with an increased rate of avascular necrosis of the humeral head. Three (axillary nerve) out of the five observed primary nerve and plexus lesions had a full neurological recovery after 6-12 months; the two patients with alterations of the brachial plexus showed a slow tendency of improvement at follow-up (12 and 18 months), but still had gross muscular atrophy and impaired sensory function. CONCLUSION: In displaced three-and four-part fractures of the humeral head the dislocation of the articular segment does not seem to increase the risk of avascular necrosis, if treated by timely and careful ORIF with respect to the vascularity. Even with the increased risk of primary nerve and plexus lesions in fracture dislocations, good functional results can be achieved by early operative nerve decompression and fracture stabilization in this middle-aged patient group. However, older patients with displaced or dislocated four-fragment fractures through the anatomical neck (type C3) have a poor chance of a favourable outcome, and therefore primary prosthetic replacement should be considered.

Adult↗
PubMed1997

[Veno-lymphatic angiodysplasia as the cause of recurrent inguinal varicose veins].

Veno-lymphatic angiodysplasia may be the reason for the development of varicose leg veins. This form of angiodysplasia is illustrated by two case reports. Until now, angiodysplasia as possible cause of recurrent varicose veins after surgical treatment has not been included in the classification of the morphological types of recurrent varicose veins. The surgical approach exposing the common femoral vein in a first step and secondly performing a complete resection of the malformation with careful consideration of the adjacent femoral vessels is recommended as the treatment of choice.

Adult↗
PubMed1997

Successful treatment of an extended leg ulcer in systemic sclerosis.

We report the successful surgical treatment of a large and painful leg ulcer associated with systemic sclerosis (scleroderma). In addition, there was a long occlusion of the superficial femoral artery, and ankle systolic blood pressure was 80 mmHg (ankle-brachial-index 0.65). All conservative treatments including systemic antibiotics, nifedipine, intravenous iloprost, intravenous penicilline G and hyperbaric oxygen failed. Pain was intolerable and below-knee amputation was considered. In a first attempt to save the limb, the patient underwent femoropopliteal bypass surgery. Despite a successful outcome of the bypass operation and normalization of the ankle blood pressure, the large wound remained recalcitrant and extremely painful. A second attempt to save the limb consisted of complete debridement of all sclerotic tissue down to the fascia and split skin grafting. The graft took in over 90% of the surface and the remaining wound healed spontaneously. Large leg ulcers in systemic sclerosis can become limb threatening. Radical debridement combined with a split skin graft seems to be a promising way to avoid amputation.

Aged↗
PubMed1997

[Hemodynamic assessment of venous aneurysm of the lower leg and therapeutic consequences].

Based on the hemodynamic findings in patients with fusiform and saccular aneurysms, one can conclude that only cases with a saccular aneurysm will subsequently form parietal thrombi in the aneurysm that will bear the danger of pulmonary embolism. In fusiform aneurysms no disturbance of flow was noted. We have been comparing two patients from our institution with the current literature. As far as the treatment plan is concerned, it can be said that aneurysms with a history of thromboembolic complications and/or mural thrombi will undoubtedly be a strict indication for operative correction. The remainder of patients can be followed by means of color Doppler and duplex sonography.

Aneurysm↗
PubMed1996

[Treatment guidelines for venous leg ulcers: causal therapy initiation and local wound treatment].

Treatment of leg ulcers should consider two aspects, i.e. the exact underlying condition (main cause and contributing factors) and local conditions. Compression therapy remains the corner-stone of the therapeutic concept. A compression of 35 mmHg at the distal calf improves insufficient venous function. A systolic ankle pressure of < or = 80% of blood pressure (ankle-arm-index < or = 0.8) requires reduction of compression therapy. At an ankle pressure below 80 mmHg compression should not be used. If superficial reflux is the major cause of chronic venous insufficiency, vein stripping should be considered. Contributing diseases like heart insufficiency, anemia or diabetes may require general medical care. Local contributing factors like reduced mobility of the ankle joint and lymphostasis may require physical therapy, and calcification of the wound bed should be excised. Local treatment considers ulcer bed and border. The ulcer bed needs debridement and moist wound care. Infection is treated with systemic antibiotics, according to the antibiogram. Tetanus immunization is required for all leg ulcer patients. Some centers report good results with endoscopic subfascial decision of perforator veins, paratibial fasciotomy and excision of fibrous tissue. Local application of recombined growth factors is currently under clinical evaluation. Adjuvant pharmacotherapy plays a minor role in the treatment of venous leg ulcers. An efficient treatment of the underlying cause combined with optimal wound care are the key to therapeutic success.

Anti-Bacterial Agents↗
PubMed1996

Management of venous leg ulcers.

In the management of leg ulcers two aspects should be considered, i.e. the exact underlying condition (main cause and contributing factors) and local conditions. Concomitant peripheral arterial occlusive disease must systematically be excluded. Effective compression therapy (35 mmHg pressure at the distal calf) is the corner-stone in treatment of venous leg ulcers. Superficial venous reflux can be the major cause of chronic venous insufficiency. Careful examination of reflux patterns helps to distinguish between indications for conservative treatment and indications suitable for surgical treatment. To what extent the stripping of varicose veins and/or endoscopic subfascial perforator vein discision really improves the outcome and prevents recurrence still remains to be shown in controlled trials. Local treatment considers ulcer wound bed and border. Modern synthetic wound dressings follow the concept of moist wound healing whilst local application of growth factors is currently under clinical evaluation. Management of eczema includes avoidance of potent or known allergens, patch tests in severe cases with suspicion of contact dermatitis and an adapted local therapy.

Humans↗
PubMed1996

[Intramedullary nailing of the humerus as an alternative to conservative therapy and to plate osteosynthesis].

For humeral shaft fractures conservative treatment, plate osteosynthesis and IM nailing are possible options according to the localization, type of fracture or additional soft tissue problems. While the majority of humeral shaft fractures is still treated conservatively, today an increasing number of fractures is felt to be suitable for ORIF. Pseudarthroses, pathological fractures, multiple fractures or polytrauma, very severe open fractures, soft tissue interposition or concomitant nerve or vascular injuries are all indications for operative treatment. We think that plate osteosynthesis is still the standard. IM interlocking nailing has been shown to be advantageous for early rehabilitation and low radial nerve damage rates. In IM nailing it is still necessary to improve the implants and implantation techniques. A retrograde extra-articular nailing technique with elastic implants is preferable. The preliminary results for a newly developed elastic nail ("Monachia Nail") in 18 patients are very promising with respect to the implantation technique, fracture healing and functional rehabilitation.

Bone Nails↗
PubMed1995

[Parvovirus B19-induced arthritis/arthropathy--an important differential diagnosis of chronic polyarthritis].

INTRODUCTION/AIMS: The differential diagnosis of rheumatoid arthritis (RA) and parvovirus-B19-induced arthritis/arthropathy (PBA) can be difficult, but is of importance because of the different therapeutic implications. The purpose is to describe characteristic features serving to differentiate between chronic PBA and RA, based on 6 personal cases and the literature. METHODS/PATIENTS: 6 patients presenting with acute (3 cases) or chronic PBA (3 cases) over the last 5 years are described. RESULTS/CONCLUSIONS: The demonstration of anti-parvovirus-B19-immunoglobulins (Ig)M in addition to anti-parvovirus-B19-IgG is the most important diagnostic finding. Measurement of IgM must be done within the first months after onset, as it disappears later on. Furthermore, history of disease (exposure, prodromi and acute onset of arthritis), clinical examination (rash) and further investigations (normal ESR and CRP, typical hematologic findings, examination of synovial tissue and fluid without inflammatory changes, demonstration of the genome of parvovirus B19 by polymerase chain reaction, no erosions on radiographs) support the diagnosis of PBA. 2 of the 3 patients with chronic PBA fulfilled the criteria for classification of RA. Therapeutic approaches in PBA are discussed. In contrast to the favourable effect in RA, immunosuppressive agents may prolong persistence of virus and disease in PBA.

Adult↗
PubMed1995

Uremic small-artery disease with medial calcification and intimal hyperplasia (so-called calciphylaxis): a complication of chronic renal failure and benefit from parathyroidectomy.

BACKGROUND: Uremic small-artery disease with medial calcification and intimal hyperplasia can lead to life-threatening skin necrosis or acral gangrene. It is a distinct complication of chronic renal failure that must be differentiated from soft-tissue calcification. An increased calcium-phosphate product and secondary hyperparathyroidism are the main underlying conditions. The benefit of parathyroidectomy is controversial. OBJECTIVE: This article is based on a literature search to determine prognostic factors and, in particular, the benefit of parathyroidectomy. METHODS: The literature on uremic small-artery disease (so-called calciphylaxis) was reviewed (full data set: 104 cases, including five of our own). The therapeutic benefit of parathyroidectomy and the relation between prognostic predictors (localization, dialysis, and transplant) and outcome were analyzed. The relation between diabetes and acral gangrene was also examined. Further epidemiologic data on the reviewed group of patients were established. RESULTS: Thirty-eight of 58 patients who underwent parathyroidectomy survived compared with 13 of 37 patients who did not undergo parathyroidectomy (p = 0.007, n = 95). Forty of 53 patients with distal localization of necrosis survived compared with 11 of 42 patients with proximal pattern (p < 0.00001; n = 95). Dialysis and kidney transplantation followed by immunosuppression showed no relation to disease outcome. No association was found between diabetes and acral gangrene (p = 0.50). CONCLUSION: Uremic small-artery disease is a distinct complication of chronic renal failure. Its recognition and early diagnosis should allow more effective treatment. In our retrospective study parathyroidectomy was significantly related to survival. Only a randomized, controlled, prospective trial (parathyroidectomy vs conservative treatment of secondary hyperparathyroidism) can establish the value of parathyroidectomy in uremic small-artery disease.

Adult↗