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Biomedical subjects

B Moriggl

Publications and source records attributed to B Moriggl.

At least 19 recordsLinked to original sources
PubMed2002

Anatomical basis for a new island axial pattern flap in the perioral region.

Soft tissue defects of the perinasal and perioral regions usually result from trauma and tumor resection as well as from congenital diseases. Coverage of facial defects is frequently challenging. The goal of reconstruction is to achieve a functional and esthetically satisfactory result. The most common techniques of wound care, such as full-thickness skin grafts and primary wound closure, are not suitable in all cases and therefore transposition flaps become necessary. Despite the description of numerous flaps, the search for other reconstruction possibilities and the development of additional flaps with good color match and minimal donor site morbidity is continuing. The purpose of our study was to describe the course of the facial artery and the pattern of its branches, because clinical cases have shown that there are branches which are suitable for skin island flaps. During the anatomical dissection of 31 cadavers (62 hemifaces), we analyzed a cutaneous branch of the facial artery, which we named due to its topographical location the "cutaneous zygomatic branch". This vessel shows a highly constant origin and course, as well as a relatively wide area of supplied skin. Based on our anatomical observations, we suggest a new axial pattern skin island flap which awaits clinical application. We feel that this flap has great future potential.

Aged↗
PubMed2001

Fibrocartilage in the transverse ligament of the human atlas.

STUDY DESIGN: Immunohistochemical investigation. OBJECTIVE: To determine whether molecules typical of articular cartilage are present in the transverse ligament and whether the ligament may be a target for an autoimmune response in rheumatoid arthritis. SUMMARY OF BACKGROUND DATA: In chronic rheumatoid arthritis there is often a marked instability of the atlantoaxial complex, and the transverse ligament can show degenerative changes that compromise its mechanical function. In some rheumatoid patients there can be an autoimmune response to cartilage link protein, aggrecan, and Type II collagen. METHODS: Transverse ligaments were removed from 13 cadavers and fixed in 90% methanol. Cryosections were immunolabeled with antibodies against proteoglycans (aggrecan, link protein, and versican), glycosaminoglycans (chondroitin-4-sulfate, chondroitin-6-sulfate, dermatan sulfate, and keratan sulfate), and collagens (Types I, II, III, and VI). RESULTS: Labeling for aggrecan and link protein was characteristic of the fibrocartilages, but versican was only detected in the fibrous regions. Equally, Types I, III, and VI collagens and keratan, dermatan, and chondroitin-4-sulfates were found throughout the ligament, but labeling for Type II collagen and chondroitin-6-sulfate was restricted to the fibrocartilages. CONCLUSION: The presence of molecules typical of articular cartilage (aggrecan, link protein, and Type II collagen) in the transverse ligament explains why it can be a target for destruction in rheumatoid arthritis and also suggests that it is subject to constant compression against the dens rather than only at the extremes of movement.

Aged↗
PubMed2001

Fibrocartilage at the entheses of the suprascapular (superior transverse scapular) ligament of man--a ligament spanning two regions of a single bone.

The suprascapular ligament converts the suprascapular notch into a foramen separating the vessels and nerve of the same name. It connects 2 regions of the same bone and does not cross any joint, and no mechanical function has yet been attributed to it. Nevertheless, variations in its thickness and length, and its tendency to ossify, suggest that the ligament responds to changes in mechanical load. This should be reflected in the composition of the extracellular matrix. The primary purpose of the present study is to demonstrate that the suprascapular ligament has fibrocartilaginous entheses (i.e. insertion sites), even though there is no obvious change in insertional angle that directly results from joint movement. Such a change is more typical of tendons or ligaments that cross highly mobile joints. The complete ligament (including both entheses) was removed from 7 cadavers shortly after death and fixed in 90% methanol. Cryosections were immunolabelled with a panel of monoclonal antibodies against collagens (types I, II, III, VI), glycosaminoglycans (chondroitin 4 sulphate, chondroitin 6 sulphate, dermatan sulphate and keratan sulphates), proteoglycans (aggrecan and versican) and link protein. Both entheses were strongly fibrocartilaginous, and a moderately fibrocartilaginous matrix was also detected throughout the remainder of the ligament. The extracellular matrix of both entheses labelled strongly for type II collagen, aggrecan and link protein. The fibrocartilaginous character of the entheses suggests that the insertion sites of the ligament are subject to both compressive and tensile loading and are regions of stress concentration. This in turn probably reflects the complex shape of the scapula and the presence of a conspicuous indentation (the suprascapular notch) near the ligament. The loading patterns may reflect either the attachment of muscles and/or the forces transmitted to the suprascapular ligament from the neighbouring coracoclavicular ligament.

Adult↗
PubMed2001

Can the dimensions of artificial tendon lesions be predicted ultrasonographically? A cadaveric study.

OBJECTIVE: To prove the reliable assessment of artificial partial tendon lesions in cadavers. METHODS: The tendon of the tibialis anterior muscle was cut twice (transversely, not standardized depths) along its dorsal surface. The dimensions were measured by using a 10-MHz linear probe and a gliding caliper. The lesions were classified as type A tears (<60%; n = 15) and type B tears (>60%; n = 28). RESULTS: The depths of type A tears had high correlation (r = 0.827), and those of type B tears had low correlation (r = 0.415). This low correlation was due to subtotal lesions (50%-70%; r = 0.699). High-resolution ultrasonography allowed the correct detection of 14 type A tears and 21 type B tears (kappa = 0.63; accuracy, 81%; type B tears: sensitivity, 75%; specificity, 93%). CONCLUSIONS: High-resolution ultrasonography is able to assess the dimensions of artificial partial tendon lesions in cadavers and would be an accurate tool for determining the lesion percentages in patients with partial tendon tears.

Cadaver↗
PubMed2001

Cervical MR imaging in postural headache: MR signs and pathophysiological implications.

BACKGROUND AND PURPOSE: Postural headache most often occurs after lumbar puncture as post-lumbar puncture headache (PLPH) or, rarely, spontaneously as spontaneous intracranial hypotension headache (SIHH). In this prospective study, we used spinal MR imaging to determine the findings that would assist in the diagnosis of PLPH and SIHH and that would further our pathophysiological understanding of postural headache. METHODS: The study group consisted of 15 healthy volunteers and 20 patients with postural headache: nine with SIHH and 11 with PLPH. The craniocervical junction and the cervical spine were studied using T2-weighted fast spin-echo and T1-weighted spin-echo sequences in the axial and sagittal planes. Follow-up studies were performed in 13 patients. RESULTS: Dilatation of the anterior internal vertebral venous plexus was the most constant finding, present in 17 (85%) of 20 patients with postural headache. Spinal hygromas, whose location as subdural or epidural could not be exactly determined, were present in 14 patients (70%). A focal fluid collection was detected in the retrospinal region at the C1-C2 level in six patients with SIHH and in four patients with PLPH (50%). Tonsillar descent was detected in only one patient, and subtentorial hygroma in five patients. No abnormalities were found in the volunteers. CONCLUSION: The MR signs of dilatation of the venous plexus, presence of spinal hygromas, and presence of retrospinal fluid collections can help to establish the diagnosis of intracranial hypotension. They are probably the result of decreased CSF volume, with the retrospinal fluid collections being a transudate from the venous plexus rather than frank extravasation. Resolution of these signs parallels resolution of the headache.

Adult↗
PubMed2000

Acetabular ossicles: normal variant or disease entity?

Ossicles located in the acetabular fossa may confuse diagnostic and therapeutic work-up. An accessory ossification centre may persist unfused as an os acetabuli centrale which is surrounded by intact hyaline cartilage representing an anatomic variant. Bone islands located in the pillars of the acetabulum can project into the acetabular fossa simulating acetabular ossicles. Osteochondrosis dissecans, posttraumatic articular bodies, degenerative disease and other rare lesions may be responsible for clinical symptoms and are of similar appearance than anatomic variants. Plain film radiography, X-ray tomography, CT and MRI are used to categorize these lesions. MRI is very valuable to assess cartilage integrity in a noninvasive way, but arthro-CT or arthro-MRI have to be used in unclear cases. Therefore the purpose of this presentation is to discuss the appearance, the possible etiology and the differential diagnosis of acetabular ossicles and how they can be evaluated to avoid an unnecessary arthrotomy.

Acetabulum↗
PubMed1999

[The carpus in the conflict between stability and mobility].

The stability of the carpus is determined by a precise interaction of the osseous and ligamentous elements. The main load of the carpus responsible for the adaptation of concerned tissues is a longitudinal compression caused by the force of the muscles of the forearm with their insertions to the metacarpus and fingers. As a consequence, the proximal row is distracted due to the wedge-shaped form of the hamatum together with the capitatum. It is the function of the mainly oblique orientated ligaments to take these transverse tensional forces, supported by the circular arrangement of the retinacula. Here, the ligaments are described in respect of their precise course into three groups. The distribution of material which is needed for bearing the enormous static and dynamic forces is minimised by the integration in a system of oblique fibre bundles which guaranties that all elements, osseous as well as ligamentous, are involved in the force distribution. This is the prerequisition for the minimalisation of osseous material. On the other hand, damage of only one element can cause severe consequences to the stability of the whole system.

Carpal Bones↗
PubMed1999

Detailed magnetic resonance imaging anatomy of the cisternal segment of the abducent nerve: Dorello's canal and neurovascular relationships and landmarks.

OBJECT: The goal of this study was to identify reliably the cisternal segment of the abducent nerve by using the three-dimensional Fourier transform constructive interference in steady-state (3-D CISS) magnetic resonance (MR) imaging sequence to define landmarks that assist in the identification of the abducent nerve on MR imaging and to describe the nerve's relationship to the anterior inferior cerebellar artery (AICA). METHODS: A total of 26 volunteers underwent 3-D CISS MR imaging, and 10 of these volunteers also underwent MR angiography in which a time-of-flight sequence was used to identify the facial colliculus, the abducent nerve and its apparent origin, Dorello's canal, and the AICA. The authors identified the abducent nerve with certainty in 96% of 3-D CISS sequences obtained in the axial and sagittal planes and in 94% obtained in the coronal plane. The nerve emerged from the pontomedullary sulcus in 94% of cases. The facial colliculus could always be identified, and Dorello's canal was identified in 94% of cases. In 76.6% of cases, the abducent nerve was seen to contact the AICA, which passed inferior to the nerve in 63.8% of cases and superior to it in 29.8%. CONCLUSIONS: The anatomical course of the abducent nerve and its relationship to the AICA and other blood vessels can be reliably identified using a 3-D CISS MR sequence with the facial colliculus and Dorello's canal serving as landmarks.

Abducens Nerve↗
PubMed1998

[Use of the internal mammary artery in reconstructive microsurgery in the thoracic region: anatomical-radiologic study].

In this study, the topographic anatomy and the diameter of the internal mammary (thoracic) vessels was investigated in regard to their potential as a recipient vessel in reconstructive microsurgery in the ventral thoracic region. Particularly for reconstruction of large thoracic wall defects as well as for female breast reconstruction with free tissue transplantation, these vessels seem to be suitable due to their location. We performed an anatomical study on 86 cadavers and a radiological investigation on 50 female patients and volunteers. We found a mean diameter on 50 female patients and volunteers. We found a mean diameter of 1.8 mm of the artery and 2.1 mm of the commitant vein at the level of the fourth rib, one to two centimeters parasternally. We conclude that the internal mammary vessels can serve as recipient vessels in reconstructive microsurgery in the ventral thoracic region at the level of the fourth rib or cranially. Hypothetically, free muscle flaps for the treatment of sternal osteitis, free fasciocutaneous flaps to replace presternal burn scars or appropriate flaps to fill up a funnel chest cavity subcutaneously may be anastomosed to the internal mammary vessels.

Adult↗
PubMed1997

Internal mammary veins: classification and surgical use in free-tissue transfer.

The internal mammary artery has been well-investigated due to its frequent use in cardiac surgery. However, in reconstructive microsurgery in the thoracic region, the internal mammary vessels have been used rarely as recipient vessels, due to difficulties and lack of knowledge about the internal mammary veins. This study was designed to investigate the anatomy and topography of the veins. Its goal was to gain sufficient information about their availability in free-tissue transfer. Dissection of the vessels was performed in 86 cadavers bilaterally to the sternum. At the level of the fourth rib, which is the most desired access for microvascular anastomosis in reconstructive breast surgery with free flaps, the veins were found to be adequately large (range 0.64 to 4.45 mm). Results were in close agreement with 100 bilateral measurements obtained by color Doppler sonography in 16 patients preoperatively, and additionally in 34 healthy volunteers. Preoperative detection of vessels with the aid of sonography facilitated planning of surgical procedures. According to these findings, the internal mammary veins may be used as suitable recipient veins for free microvascular tissue transfer, especially for established autologous breast reconstruction with the free transverse rectus abdominis myocutaneous flap, or for reconstruction of complex thoracic-wall defects.

Adolescent↗
PubMed1997

[Fundamentals, possibilities and limitations of sonography of osteofibrous tunnels in the shoulder area. 1].

The first part of this report includes basic morphological as well as morphometric data concerning osteo-fibrous pathways within the shoulder region as determined by investigating a large number of anatomical specimens (286 macerated scapulae, 122 cadaver shoulders). Some parts of these passages, either inaccessible by means of ultrasonography or already sufficiently dealt with in the relevant literature, are not taken into consideration. This applies especially to the so called subacromial space. As to the shape of the scapular notch, five different patterns were found. The spinoglenoid notch appeared in four distinguishable types. According to the results of the measurements, type II ("shallow") and type IV ("V-shaped") scapular notches can be regarded as being predisposed to cause suprascapular nerve lesions. Contrary to what has previously been reported, nerve entrapment due to a partially ossified superior transverse scapular ligament seems to be unlikely. Cadaver dissections confirmed these observations. A comparison was made between the different types of scapular notches and the outlines of the scapular foramina (shapes one to nine) showing that a large indentation does not necessarily result in a larger nerve passage. By reason of the restricted space, foramina classified as "buttonhole-shaped" (shape 5) must be regarded as a possible threat to the suprascapular nerve. In contrast, hypertrophy of the ligament as mentioned above causing nerve problems is, to say the least, doubtful. A spinoglenoid ligament bridging the neck of the scapula was found in over half of the cases studied. A clear relationship was detected between the coracoacromial distance and the shape of the coracoacromial ligament: the greater the distance the more arched was the band. Measurements of this distance in shoulder blades were also found to be highly dependent on the sex (significantly smaller in females). Side differences relative to the aforementioned parameters did not occur. This also applies to the dimensions of the following structures: the long head of the biceps brachii muscle, the intertubercular groove and the transverse humeral ligament. The author considers the latter as having been underrated so far. Due to its constancy as well as its consistency, the ligament has to be regarded as a valuable contribution to the protection of the biceps tendon. A basic knowledge of the local anatomy is essential to sonographic analysis.

Cadaver↗
PubMed1997

[Fundamentals, possibilities and limitations of sonography of osteofibrous tunnels in the shoulder area. 2].

In the second part of this study on osteo-fibrous pathways within the shoulder region, new ultrasound (US) possibilities for showing these tunnels are described. Following two pilot studies (clarifying the choice of transducers and frequencies, relevance of US-related measurements), 97 volunteers were investigated bilaterally (57 women and 40 men, aged between 18 and 39). The normal sonoanatomy for areas which had not been explored by US for the most part is demonstrated, as are the limits and pitfalls of this method. Types of scapular notches as determined in part one have been confirmed by US. Type V (with a "partially ossified ligament") was hardly ever found in the sample, whereas a true foramen could not be observed at all. Neither of these have any influence on the development of a "scapular notch syndrome", according to the results of this study. As expected from anatomical observations, a very narrow nerve passage was usually associated with type II ("shallow") and type IV ("V-shaped") scapular notches. These types should be regarded as a potential threat to the suprascapular nerve. When identifying the parameters (16 in all), care was taken to see that they approximated to those of the basic anatomical investigation. There was a good match between measurement results in both parts of this study. In addition, there were no significant differences of data between the two sides (even in the same individual). In contrast, women showed significantly lower values for the following measurements: width and depth of the spinoglenoid notch, width and depth of the intertubercular groove, breadth and thickness of the long head of the biceps brachii, and thickness as well as length of the coracoacromial ligament. Comparable data from the sonographic literature are only available for the long head of the biceps brachii. The calculated mean thickness of this tendon is 2.5 mm, thus being far lower than the results previously reported. Overall, US can be regarded as a very precise and reliable method for evaluating the osteo-fibrous passages within the shoulder region. Normal sonoanatomy and standard values of the structures mentioned can be used as a basis for resolving diagnostic problems. The author considers that US, as a prelude to more sophisticated imaging techniques, provides a significant non-invasive contribution to the checking of pre-existing factors or alterations at an early stage of entrapment syndromes of the shoulder.

Adult↗
PubMed1996

Absence of three regular thyroid arteries replaced by an unusual lowest thyroid artery (A. thyroidea ima): a case report.

During routine dissection of an 89-year-old female donor both inferior thyroid aa. as well as the left superior thyroid a. were found to be absent, whereas the right superior thyroid a. came from the right common carotid. A large lowest thyroid a. rose from the left internal thoracic a. at the level of the first intercostal space. Up to this point the internal thoracic a. was of immense diameter, almost reaching that of the lateral part of the subclavian. The lowest thyroid a. ascended in an oblique and sigmoid course to the thyroid gland. Slightly left of the median line it bifurcated into two branches. Both had a winding course in front of the trachea before entering the base of the thyroid gland. Other arterial variations of minor significance were also observed in this unique case. The clinical impact lies in the localisation, course and size of the lowest thyroid a. reported.

Aged↗
PubMed1996

[Ultrasound diagnosis of the shoulder].

Sonography of the shoulder joint is a well-established technique in the hands of the experienced examiner, when using a standardized protocol. It has proved invaluable in assessing pathological soft tissue changes, especially after trauma. The static evaluation of anatomy and dynamic assessment of function are especially helpful in both preoperative staging and postoperative follow-up. The normal anatomy, examination techniques, including our own variations, and pathological conditions are discussed. The findings and various classifications of impingement syndrome, rotator cuff injuries, biceps tendon lesions and inflammatory changes are examined. Review of the major articles in the literature shows excellent correlation with our results, the overall sensitivity in the case of rotator cuff lesions being over 90%. A well-performed ultrasound examination in most cases obviates the need for the more invasive arthroscopy and the more cumbersome and expensive MRI examinations.

Adolescent↗
PubMed1995

Internal mammary vessels: anatomical and clinical considerations.

This study was designed to investigate the anatomy of the internal mammary (thoracic) artery (IMA) and comitant vein(s) (IMV) relevant to their use in microsurgery. We dissected the internal mammary (thoracic) vessels bilaterally in 86 cadavers from the clavicle down to the 6th rib. At the level of the 4th rib, the distance between the sternum and the IMA was large enough [range 10.0-23.6 mm] and the diameter of the IMA [range 0.99-2.55 mm] and comitant vein(s) [range 0.64-4.45 mm] wide enough for both end-to-end and/or end-to-side anastomosis. These results were in close agreement with supplementary measurements obtained by Doppler ultrasound in 34 healthy female volunteers. Based on all these findings we suggest that the internal mammary vessels are suitable recipient vessels for free tissue transfers in the thoracic region, especially for breast reconstruction with the free transverse rectus abdominis myocutaneous (TRAM) flap.

Adult↗
PubMed1995

[Visualization of the inferior mesenteric artery in the ultrasound B image].

AIM: Reports in the literautre differ widely with regard to visualisation of the inferior mesenteric artery (IMA) by B-mode ultrasonography. Hence, our study aimed at obtaining exact data on the feasibility of visualising the inferior mesenteric artery via B-mode ultrasonography in a relatively large patient population. METHOD: At the outpatient department of gastroenterology and hepatology 51 males (aged 14 to 75 years) and 53 females (aged 16 to 79 years) were examined consecutively by two experienced investigators via B-mode scan within the overall framework of a routine screening programme, in each case after overnight fasting. Knowledge of normal anatomic conditions and of the possible variations of the IMA is mandatory for correct IMA visualisation. RESULTS: We succeeded in visualising the IMA via B-mode scan in 41 of the 51 males (80.39%) and in 40 of the 53 females (75.47%), i.e. in a total of 81 of 104 patients (77.88%) in 2-3 cm length. CONCLUSION: The results show that IMA can be visualised by B-mode ultrasonography in a manner comparable to visualisation of the superior mesenteric artery (82). This is an essential finding, since duplex sonography of the IMA yields important information on disease activity in inflammatory bowel disease, and B-mode scanning of the IMA is the prerequisite for duplex scanning.

Adolescent↗