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Biomedical subjects

U Brunner

Publications and source records attributed to U Brunner.

At least 37 records · Page 2Linked to original sources
PubMed1995

Management of congenital angiodysplasia of the lower limb: magnetic resonance imaging and angiography versus conventional angiography.

The purpose of the study was to compare magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) with conventional angiography in distinguishing congenital angiodysplasia amenable to radical cure from that in which only palliation is feasible and to design a rational pre-operative work-up in those patients undergoing an interventional procedure. Axial T1, T2 weighted spin-echo and contrast-enhanced 3D SPGR sequences were performed in 13 patients with angiodysplasia, followed by time-of-flight MRA. The results were compared with conventional arteriography and venography. Dysplasia was arteriovenous with microshunts in nine cases and purely venous in the remaining four. MRI was the best method for assessing the extent of malformation and involvement of anatomical structures. MR arteriography and MR venography were inferior to conventional techniques. It is concluded that MRI is valuable in distinguishing patients amenable to radical cure from those in whom only palliation is feasible. Pre-operatively, conventional arteriography and venography remain mandatory.

Adolescent↗
PubMed1995

Surgical aspects of popliteal artery entrapment syndrome: 26 years of experience with 26 legs.

The authors present their experience in diagnosis, therapy and follow up of the Popliteal Artery Entrapment Syndrome (PAES) during the last 26 years. PAES appears most frequently in young athletic male patients. From 1967 to 1993, 20 patients, 17 male (85%) and 3 female (15%), with 26 entrapment legs were treated. Average age at the time of the first symptoms was 33.5 years and at the time of diagnosis 38.5 years. Six patients suffered from PAES on both legs. In 5 of the 24 operated cases a re-operation was necessary. One case required a third operation. To reduce the postoperative complication rate, surgical technique was chosen according to the anatomical situation. If there was only slight disease of the popliteal wall, the current surgical technique consisted in decompressing the artery and replacing it in the orthotopic position through a direct entrance with the patient in the prone position. If there was severe disease of the popliteal wall, an autologous venous bypass from the popliteal artery segment I to segment III should be done with the patient supine. In our opinion, a primary catheter lysis therapy, which can be indicated for stenosed arteries, should not be done for peristenotic aneurysms. Successful therapy of PAES largely depends on early diagnosis that has been confirmed by CT scan.

Adolescent↗
PubMed1994

[Differential surgical therapy of popliteal entrapment syndrome 1967 to 1992].

From 1967 to 1992 at the University Hospital of Zurich 16 patients (14 male, 2 female) with 22 popliteal artery entrapment syndromes underwent a surgical treatment. In this period several different operation procedures were used. The modern operative procedure depends on the degree of the arteries wall compression. The procedure of choice for minimal compression of arterial wall is a musculo-tendinous decompression with a medial replacement of the popliteal artery. In the cases of severe compression we used autologous venous bypass from femoropopliteal I to popliteal III.

Adult↗
PubMed1994

[Standardized follow-up after peripheral bypass operation].

We present a standard protocol of postoperative controls designed for early recognition of possible stenosis or graft failures after peripheral bypass operations. This protocol includes: a) angiography during the first week after surgery, b) clinical and Doppler-pressure measurement 1, 3, 6 and 12 months after surgery. 53 patients with 62 peripheral bypasses were followed. The cumulative patency rate was 87.5% after 12 months.

Aftercare↗
PubMed1993

[Treatment strategies in infections of the shoulder joint].

Shoulder joint infections are severe pathological conditions. Since the success of therapy is decisively dependent on early treatment, if joint infection is suspected, the patient should be hospitalized immediately. Characteristic suspicious features are extremely severe shoulder pain, adoption of a pain-relieving posture, and severe malaise. The diagnosis and differential diagnosis are discussed. In addition to selective parenteral administration of antibiotics, treatment comprises various methods of draining the shoulder joint in combination with temporary immobilization.

Anti-Bacterial Agents↗
PubMed1993

[Arterial popliteal entrapment syndrome as the cause of acute peripheral ischemia].

The popliteal artery entrapment syndrome results from an abnormal relation of artery and tendomuscular structures in the popliteal fossa, which can compromise the artery. We report our experience in 18 cases of popliteal artery entrapment syndrome in 14 patients (12 men, 2 women) operated on at the University Hospital in Zurich during the period 1967-1988. A follow-up examination was possible in 12 of the 14 patients in whom popliteal artery entrapment syndrome (both legs in 2) was treated surgically. These patients had first presented with ischaemic symptoms at an average age of 30 years. The correct diagnosis of an entrapment syndrome was made at an average age of 36 years. In all, 5 of the 14 patients were affected bilaterally. In 5 cases the first sign was an acute ischaemic syndrome. All these patients were young and had formerly taken active part in sport. The follow-up examination after an average age of 11.25 years showed a very good result in 13 cases, a good result in 2 cases and an unsatisfactory postoperative result in 1.

Adolescent↗
PubMed1993

[Misinterpretations in arteriography of the lower extremities].

Arteriography is still the most important diagnostic tool in the assessment of chronic lower limb ischemia. Unfortunately, demonstration of distal vessels is often poor. Inadequate arteriography makes decisions on the feasibility and the site of reconstruction impossible. Methods to improve the quality of arteriograms include correct positioning of the legs in internal rotation, long exposure times, additional lateral views and the capacity of digital subtraction. The importance of positioning the legs in internal rotation is illustrated by several examples.

Angiography↗
PubMed1993

[How often does an aneurysm of the popliteal artery rupture?].

Rupture of a popliteal artery aneurysm is an unusual complication and did occur six times in our series of 252 popliteal artery aneurysms that underwent operative repair from January 1965 to December 1991. Rupture while equally serious as thrombosis of the popliteal artery aneurysm of distal embolization from the aneurysm, is reported as an exceedingly unusual complication. Reported incidence of rupture is less than 2 to 4 percent in most large series and was 2.4 percent in the present series.

Aged↗
PubMed1993

[Indications, technique and interpretation of arterial Doppler ultrasound].

Doppler sonography is one of the most important diagnostic tools for angiologists and vascular surgeons, and also for general practitioners with an interest in vascular disease. It can be carried out easily and at low cost and at the same time provides reproducible, quantitative data on with further diagnostic and therapeutic decisions can be based. First, systolic arterial pressure in the anterior and posterior tibial and in the peroneal arteries are measured, with the Doppler probe placed at ankle level. A cuff is wrapped around the lower leg and inflated until the Doppler signal disappears and then deflated. The highest value measured in each leg is termed "ankle pressure". Division of the latter by systolic brachial pressure results in the so-called "ankle-brachial-index" or "ABI". Ankle pressure and ABI correlate well with clinical findings. In normal individuals, the ABI is greater than 1. In claudicators, it ranges between 0.3 and 0.9, in patients with resting pain between 0.1 and 0.5 and with ischemic tissue loss between 0.0 and 0.2. After angioplastic or surgical revascularisation procedures, a fall of the ABI by 0.15 or more is an indication of relevant hemodynamic deterioration and therefore calls for further investigation by arteriography or colour duplex sonography.

Arterial Occlusive Diseases↗
PubMed1993

[Bilateral reversed palmaris longus muscle--a rare cause of peripheral median nerve compression syndrome. Case report].

A rare case of median nerve compression syndrome outside the carpal tunnel in the distal forearm is reported. A 21-year-old man suffered while working from symptoms of temporary median nerve compression in both forearms; this was caused by hypertrophy of reversed palmaris longus muscles. Resection of the abnormal muscle bellies relieved the symptoms immediately. Only ten similar cases have been reported in the literature, and this is the first case with bilateral symptoms.

Adult↗
PubMed1993

The continuing challenge of aneurysms of the popliteal artery.

This report is an analysis of 252 popliteal artery aneurysms (PAA) in 167 patients treated surgically at the University Hospital in Zurich during a 27 year period from 1965 to 1991. The predominance of male patients (95 percent) was consistent with that of other reports. PAA were bilateral in 51 percent of the patients and were associated with aneurysms at other sites in 38 percent. Atherosclerosis was by far the most common cause (98 percent). PAA were symptomatic in 75 percent of the patients, the predominant findings being ischemia from emboli, thrombosis or rupture. Primary amputation was required in 23 extremities. Surgical reconstruction with bypass was performed for 229 PAA. A secondary amputation was necessary in 18 limbs. The risk of complications from popliteal aneurysms, and the good results from surgical treatment suggest that a revascularization procedure in the asymptomatic stage should be recommended unless specific contraindications exist. We conclude that surgical treatment should be performed in symptomatic and asymptomatic PAA larger than 2 centimeters in diameter. Long term results of surgical reconstruction are improved if an autogenous saphenous vein is used and if reconstruction is performed before the occurrence of complications. Polytetrafluoroethylene prostheses should be used when an autologous saphenous vein is not available. The use of Dacron (polyester fiber) grafts is no longer indicated.

Adult↗
PubMed1993

[New pathophysiologic and functional viewpoints about the insufficiency of the vena saphena parva. Preliminary report].

Insufficiency of the subfascial short saphenous vein is a distinct clinical entity and commonly associated with deep venous insufficiency. There is a high incidence of postoperative recurrence despite established surgical therapy. Preoperative imaging in 21 patients by means of ascending and descending venography as well as color doppler and color duplex sonography revealed a concomitant deep popliteo-femoral venous insufficiency in 86% of cases. The sensitivity of non-invasive color encoded sonography was comparable to phlebography. Pathophysiologically, the association of deep venous and short saphenous insufficiency can be explained as being the result of primary or secondary (postthrombotic) valve dysfunction of the deep venous system. This is different from the findings in patients with great saphenous vein insufficiency. Surgical consequences are ligation of the vein directly at the level of the sapheno-popliteal junction without leaving a short saphenous stump, and the obligation to inform the patient about the high risk for postoperative recurrence.

Adult↗
PubMed1993

[Proximo-distal course of the diameter of the great saphenous vein and distribution of the number of side branches as an inherent difficulty in infra-inguinal arterial in situ bypass].

The greater saphenous vein is still the best material for infrainguinal arterial bypasses, particularly if they have an infrapopliteal distal anastomosis. Although a lot of advantages have been presumed for the in-situ bypass, the reported results are not significantly better than with the reversed technique. To find some additional explanations, we studied post mortem the anatomy of 20 greater saphenous veins with regard to the diameter and the number of side branches and compared the results with 10 phlebographies. A minimal diameter (2.6 mm) and a maximum of side branches and venous valves were found at the proximal calf. Furthermore, this region was characterized by a lot of anatomic variants such as double systems (25%) or cross over variants (5%). These findings are surgically relevant and may reduce the bypass patency: 1. There is an increased hemodynamic resistance in longer bypasses, 2. The small diameter (particularly if smaller than 2 mm) means a risk for the patency of the distal anastomosis, 3. The high frequency of side branches requires a comparable exposition of the GSV as for the reversed technique, 4. The introduction of the valvulotomy from distally may overestimate the proximal diameter and underestimate the frequency of variants and may therefore cause significant endothelial damages or even perforation.

Humans↗
PubMed1993

[Current status of combined physical decompression therapy in primary and secondary lymphedema of the legs].

Clinical lymphology has become an important part of angiology. Patients suffering from lymphedema are in need of physicians and physiotherapists who guide them trough this chronic disease and who are familiar with the different complications of chronic lymphatasis. The necessary experience in the treatment of lymphedema of the lower extremities can be achieved only at lymphologic treatment centers with adequate numbers of such patients. Nihilism concerning therapy of these disorders is not justified as our experience with the enumerated combined physical drainage therapy demonstrates.

Bandages↗
PubMed1993

[Recurrent acute occlusions of the popliteal artery before age 50: popliteal entrapment syndrome?].

Compression of the popliteal artery by the medial head of the gastrocnemius muscle is termed "Popliteal Artery Entrapment". The anatomical course of the artery can be normal or abnormal. The entrapment can cause occlusion of the artery or peripheral embolism. This syndrome is an important differential diagnosis in younger patients with recurrent peripheral arterial ischemia. Diagnosis is made by history, clinical findings, arteriography and CT-scan of the knees. All cases of popliteal artery entrapment, whether the artery is occluded or not, should be operated on.

Adult↗
PubMed1992

[Indications for, technique and interpretation of arterial Doppler sonography from the vascular surgeon's viewpoint].

Doppler sonography is one of the most important diagnostic tools for angiologists and vascular surgeons and also for general practitioners with an interest in vascular disease. It can be carried out easily and at low cost and, at the same time, provides reproducible, quantitative data on which further diagnostic and therapeutic decisions can be based. First, systolic arterial pressures in the anterior and posterior tibial and in the peroneal arteries are measured, with the Doppler probe placed at ankle level. A cuff is wrapped around the lower leg and inflated until the Doppler signal disappears. The highest value measured in each leg is termed ankle pressure. Division of the latter by systolic brachial pressure results in the so-called ankle-brachial index or "ABI". Ankle pressure and ABI correlate well with clinical findings. In normal individuals it is greater than 1. In claudication it ranges between 0.3 and 0.9, in patients with resting pain between 0.1 and 0.5 and with ischemic tissue loss between 0.0 and 0.2. After angioplastic or surgical revascularization procedures, a fall of the ABI by 0.15 or more is an indication of relevant hemodynamic deterioration and, therefore, calls for further investigation by arteriography or color duplex sonography.

Arm↗