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Biomedical subjects

C R Wyss

Publications and source records attributed to C R Wyss.

15 recordsLinked to original sources
PubMed1990

The effects of age and peripheral vascular disease on the circulatory and mechanical response of skin to loading.

The skin and subcutaneous soft tissues of amputation residual limbs are required to withstand externally applied loads of greater magnitude than similar tissues of the intact lower limb. Increased age and poor circulatory status may contribute to the increased risk of tissue injury seen in this population. This study evaluates the effects of age and circulatory status as risk factors for skin injury resulting from externally applied forces. Twelve young control (YC), six elderly control (OC) and 11 subjects with peripheral vascular disease (PVD) were studied. After base-line ankle arm index (AAI) measurements, TcPO2 electrodes were applied 10 cm below the knee over the medial surface of the tibia and the muscle belly of tibialis anterior. TcPO2 measurements and tissue displacements were obtained under the influence of incremented, normally oriented, external loads. The sensitivity of the tissues to applied loads was determined by calculating the load at which the TcPO2 reached zero. The stiffness of the tissues (displacement/load) was calculated under high (greater than 40 mm Hg) and low (less than 20 mm Hg) loading conditions. No difference was noted in tissue sensitivity to applied loads between the OC and YC populations. The TcPO2 decreased to zero in the PVD population at significantly lower applied loads than both the OC and YC populations. The tissue stiffness of the PVD and the OC populations over bone was greater than the YC population, but no significant differences were noted between the PVD and the OC populations. In summary, increased age does not result in a greater tissue sensitivity to externally applied loads, in spite of the demonstrated increased tissue stiffness.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Circulatory and mechanical response of skin to loading.

We investigated the tolerance of skin to mechanical loading over the tibia and over the tibialis anterior muscle in 12 normal volunteers. Surface load, subcutaneous tissue pressure, skin deformation under load, and transcutaneous partial pressure of oxygen (TcPO2) were simultaneously monitored. The skin over bone showed a significantly stiffer load deformation relationship than the skin over muscle (p less than 0.001). The displacement required to reduce TcPO2 to 0 over bone, 1.1 +/- 0.3 mm (mean +/- standard deviation), was significantly less than that required over tibialis anterior muscle, 5.4 +/- 1.1 mm (p less than 0.001). The applied pressure required to reduce TcPO2 to 0 was significantly greater for skin over muscle (71 +/- 16 mm Hg) than for skin over bone (42 +/- 8 mm Hg) (p less than 0.001). However, the subcutaneous pressure required to reduce TcPO2 to 0 was not significantly different for skin over muscle (36 +/- 11 mm Hg) than for skin over bone (28 +/- 10 mm Hg) (p greater than 0.05). Our results indicate that skin over muscle tolerates greater locally applied loads and deformations because the pressure is lower within the tissue than when similar loads and deformation are applied to skin over bone. Cutaneous perfusion, as indicated by TcPO2, seems to be linked more closely to the subcutaneous tissue pressure than to the surface load or deformations. These results provide some data for predicting mechanical and physiologic response to locally applied loads such as those that may be encountered in prosthetic wear.

Adult↗
PubMed1988

Transcutaneous oxygen tension as a predictor of success after an amputation.

We measured local transcutaneous oxygen tension at the foot and proximal and distal to the knee in 162 patients who then had 206 amputations. When the values for oxygen tension at the foot and distal to the knee were compared with the success or failure of healing after an amputation of the foot or distal to the knee, respectively, a clearly increasing probability of failure was correlated with decreasing transcutaneous oxygen tension. However, even at a tension of zero the probability of failure was not 100 per cent. The results were similar for diabetic and non-diabetic patients. Preoperative values for transcutaneous oxygen tension were a much more consistent predictor of success or failure of healing after an amputation of the foot or distal to the knee than were measurements of systolic blood pressure at the ankle, but neither was predictive of the outcome after an above-the-knee amputation.

Amputation, Surgical↗
PubMed1987

Reliability of transcutaneous oxygen tension (TcPO2) measurements in elderly normal subjects.

This study was conducted to evaluate the reliability of TcPO2 measurements in a well characterized group of 10 elderly normal subjects with an age distribution typical for the population with peripheral vascular disease (PVD) and amputation. The TcPO2 values were obtained on three separate occasions at 2-week intervals at seven anatomic sites commonly measured in patients with PVD. The TcPO2 values were comparable to those previously reported for similar sites in normal elderly subjects. Measurement to measurement variation averaged 1.1 kPa (8 mmHg) for a coefficient of variation (CV) of 14.4%. Confidence intervals ranging from 2.1 kPa (16 mmHg) above a single TcPO2 value to 2.1 kPa (16 mmHg) below were necessary to contain the true value 95% of the time. While TcPO2 measurement is assuming an important role in the evaluation of disease states in both paediatric and adult medicine, our observations emphasize the importance of using such measurements as an adjunct in clinical decision making and not basing such decisions on a single TcPO2 value alone. The size of the confidence intervals can be reduced substantially for a given site by taking the mean of two or more TcPO2 measurements taken at separate times.

Aged↗
PubMed1987

Does inadequate oxygen delivery trigger pressor response to muscle hypoperfusion during exercise?

In dogs running on a treadmill at 2 or 4 mph or 4 mph plus 10% incline, graded reductions in hindlimb perfusion reflexly elicited pressor responses. To test the idea that systemic arterial pressure (SAP) is raised by accumulation in muscle of a nerve-activating "pressor substance" release when O2 delivery becomes inadequate, arterial O2 content (CaO2) was reduced 29.1% by carbon monoxide (CO) inhalation before repeating exercise at 2 mph. We reasoned that the pressor substance, or related substances, should appear in femoral venous blood and be correlated to SAP. [K+] behaved inappropriately as a signal to raise SAP, i.e., when flow was reduced, SAP rose markedly with little or no change in [K+]. SAP was well correlated to pH and [lactate] over the three work loads. Compared with the same work load with normal CaO2, CO shifted the relation between SAP and terminal aortic flow rightward 0.30 l/min (34.5%) and the relation between SAP and PO2 leftward 7.7 mmHg. CO did not affect the relation of SAP to terminal aortic O2 delivery, hindlimb O2 uptake index, pH, or [lactate]. Thus pressor responses are apparently generated when O2 delivery falls below some critical level causing accumulation of a pressor substance the release of which is linked to a metabolic event that precipitates lactate accumulation.

Animals↗
PubMed1987

Total shoulder arthroplasty.

A prospective study was done of fifty total shoulder replacements in forty-four patients who were followed for an average of 3.5 years (range, 2.0 to 7.5 years). The preoperative diagnosis was osteoarthritis in thirty-three shoulders, rheumatoid arthritis in eleven, and a previous fracture of the humeral head in six shoulders. Nine of the shoulders had a tear of the rotator cuff. The Neer-II system of total shoulder replacement with a non-metal-backed component was used in all fifty shoulders. At follow-up, forty-four shoulders (88 per cent) had no significant pain. Of the six painful shoulders, four had loosening of the glenoid component and one had malposition of both components. Three of the six shoulders had no significant pain after revision. The average range of active forward elevation in all of the shoulders improved from 71 to 100 degrees, and both external and internal rotation improved as well. Five specific activities of daily living were evaluated, and the patients' ability to perform them improved from 14 to 78 per cent. Thirty-five shoulders (68 per cent) were rated by the patients as much better; thirteen shoulders (26 per cent), as better; and three (6 per cent), as no better. An incomplete lucent line was noted around five (10 per cent) of the cemented humeral stems and around thirty-seven (74 per cent) of the glenoid prostheses. Four arthroplasties (8 per cent) required revision: three for loosening of the glenoid component and one for malposition of both components.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1987

Relationship between transcutaneous oxygen tension, ankle blood pressure, and clinical outcome of vascular surgery in diabetic and nondiabetic patients.

We measured ankle systolic blood pressure (ABP) and limb transcutaneous oxygen tension (TcPO2) before and after 53 vascular procedures performed to relieve limb-threatening ischemia. We compared changes in ABP and TcPO2 and also compared these measurements of limb hemodynamics with the clinical outcome of the vascular procedures. For the procedures performed on patients without diabetes, both ABP and TcPO2 registered similar changes after surgery. Furthermore, those nondiabetic patients who had a postoperative ABP greater than 75 mm Hg or TcPO2 greater than 20 mm Hg showed resolution of the clinical symptoms within 60 days after surgery. All patients falling below these levels underwent a subsequent limb amputation. The results differed somewhat for procedures performed on patients with diabetes. First, a number of diabetic patients showed high ABP in conjunction with low TcPO2. We attribute these observations to the high incidence in diabetic patients of calcific medial stenosis leading to artificially elevated ABP measurements. Second, the clinical outcome among diabetic patients was uncorrelated with the postoperative ABP and was poorly correlated with postoperative TcPO2. Those diabetic patients with postoperative TcPO2 below 20 mm Hg showed unfavorable clinical outcomes, but many patients with postoperative TcPO2 greater than 20 mm Hg and postoperative ABP greater than 75 mm Hg also showed unfavorable clinical outcome (slow healing of ulcers, persistence of rest pain, and/or an amputation on the limb). These data suggest that among our patients with diabetes, simple relief of limb ischemia was not sufficient to result in a trouble-free clinical course. We conclude that TcPO2 is a useful replacement or adjunct to ABP measurements for evaluating the hemodynamic outcome of vascular surgery. Our results also suggest that it is extremely important to evaluate the outcome of such surgeries separately in patients with and without diabetes.

Adult↗
PubMed1986

Factors relating to the sensory acuity of limbs with peripheral vascular insufficiency.

We examined several possible causes for the high incidence of poor sensory acuity in the limbs of 176 patients with moderate to severe peripheral vascular insufficiency. We investigated the relationships of diabetes, alcoholism, and smoking, as well as the severity of peripheral vascular disease, to the integrity of basic sensory modalities such as two-point discrimination and perception of light touch. The presence or absence of diabetes exerted the strongest effect on peripheral sensation. In patients who did not have diabetes, sensation in the limbs was most strongly affected by whether the patient was an alcoholic. Smoking did not have a significant effect on limb sensation. Among nondiabetic, nonalcoholic patients, there was a weak residual effect related to the severity of the peripheral vascular insufficiency. Even among these patients, however, systemic factors predominated in determining the loss of sensation. We also examined the extent to which loss of sensation might be related to the development of ulcers. Among patients who were not diabetic, there was a highly significant relationship between loss of sensation and the presence of limb ulceration. Surprisingly, however, there was no discernable relationship between the presence of ulcers in diabetic patients and the degree of loss of peripheral sensation. This result suggests that a large percentage of ulcers seen in diabetic patients are not of neurogenic origin.

Adult↗
PubMed1986

The nature of the exercise stimulus.

The two foremost hypotheses concerning the nature of the exercise stimulus are: Central Command. Centrally generated signals activate in parallel cardiovascular and skeletal muscle motor systems; Muscle Chemoreflex. Chemosensitive nerves within the skeletal muscle detect local accumulations of metabolites which reflect disparities between muscle blood flow and metabolism. The focus is mainly on the second hypothesis. The neurophysiological basis for this reflex is well established. Accumulations of metabolites within ischemic muscle reflexly trigger pressor responses that are abolished by blockade of sensory nerves from muscle. However, such blockade does not abolish circulatory responses to static or mild dynamic exercise. To assess the importance of muscle chemoreflexes, stepwise partial occlusions of the terminal aorta were made in exercising dogs. The rise in arterial pressure was related to reductions in terminal aortic flow and arterial pressure below the occluder. In mild exercise sensitivity of the reflex was low until flow was substantially reduced to a threshold. In heavier exercise sensitivity of the reflex was high (no threshold) and could provide a tonically active exercise stimulus. The nature of the metabolic signal is unknown. The pressor response was most closely related to femoral venous lactate concentration and unrelated to femoral venous K+ or PO2.

Animals↗
PubMed1976

Lack of humanlike active vasodilation in skin of heat-stressed baboons.

To discover whether humanlike active skin vasodilation occurs in a sweating, subhuman primate, four unanesthetized male baboons (Papio anubis) were heated (blood temp = 39-39.5 degrees C) before and after arterial administration of the alpha-adrenergic blocking agent phenoxybenzamine HCl. Hcat stress alone increased common iliac vascular conductance (CIVC) from 1.2 to 3.7 ml-min-1-mmHg-1 (averages). alpha-Blockade alone increased CIVC from 1.2 to 3.3 ml-min-1-mmHg-1. Heat stress subsequent to alpha-blockade further increased CIVC by only 0.4 ml-min-1-mmHg-1. Thus, most of the rise in CIVC caused by heat stress could be mimicked by alpha-blockade. If, as in man, the dominant means of raising skin blood flow were nonadrenergic active vasodilation, the response of CIVC to heating would far exceed that due to alpha-blockade. We conclude that, in baboons, humanlike active vasodilation of skin plays no significant role in CIVC response to heat stress. Thus, the baboon is not an appropriate model for investigation of control of human skin circulation during hyperthermia.

Animals↗
PubMed1975

Altered control of skin blood flow at high skin and core temperatures.

Five subjects were studied during periods of controlled increases and decreases in skin temperature (Ts) over the Ts range of 34-40 degrees C. One protocol was designed to observe changes in forearm blood flow (FBF) and heart rate (HR) with changes in core temperature (Tc; right atrial blood temperature and esophageal temperature were measured) with Ts held constant at two levels. FBF and HR changed linearly with Tc in the Tc range of 37-38 degrees C with Ts constant at 38 degrees C. A second protocol imposed Ts changes at two levels of Ts and Tc; this protocol also included a prolonged cooling period. The influence of Ts on FBF and HR was reduced when Ts changes occurred at an elevated Ts and Tc, and FBF showed considerable hysteresis during cooling. We conclude that a linear model for the control of FBF or HR is inadequate as a tool for predicting the control of these variables.

Adult↗
PubMed1975

A high accuracy linear rate meter.

By implementing analog computer techniques using digital circuits, an instantaneous rate meter was built with approximately 100 times the accuracy of commercially available rate meters. The circuit is accurate to within +/- 0.2 events/min over a range of rates of 0.2-900 epm. Modifications can be made to provide a digital display of rate. The circuit design techniques used in developing the rate meter may be used to generate a wide variety of functions of time with very high accuracy.

Animals↗