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Biomedical subjects

M Jünger

Publications and source records attributed to M Jünger.

At least 37 records · Page 2Linked to original sources
PubMed2001

Venous leg ulcers and microcirculation.

Incompetence of venous valves do not lead per se to trophic skin changes of the lower limb. In severely concerned patients suffering from dermatoliposclerosis or venous leg ulcers retrograde pressure waves were detected in the nutritive capillaries of the skin by the "servo nulling" pressure measurement during simulated calf muscle contraction. Between the degree of trophic skin change and the capillary density and cutaneous oxygen partial pressure a close correlation was found. Healing of venous ulcers occurred only if the cutaneous microangiopathy in the ulcer area improved. Capillary density and transcutaneous oxygen partial pressure were of prognostic impact as to healing of venous ulcers.

Blood Pressure↗
PubMed2001

Dysregulated L-selectin expression on lymphocytes in patients with chronic venous insufficiency.

In this study we analysed blood samples taken from the dorsalis pedis vein and a brachial vein of 11 healthy test persons and 8 patients with venous leg ulcer under experimental venous hypertension in order to examine changes in the expression of leukocyte adhesion molecules (LFA-1 (CD11a), Mac-1 (CD11b), p150,95 (CD11c), CD18, VLA-4 (CD49d) and L-selectin (CD62L)) which are involved in the adhesion steps of leukocytes to endothelial cells for transmigration into tissues. Under orthostatic stress, lymphocytes in controls collected at the foot level showed a significant reduction in the expression of L-selectin (p=0.002), compared to those of patients. This finding suggests that venous stasis negatively influences the expression of L-selectin on leukocytes only in healthy volunteers. Patients with chronic venous insufficiency seem to suffer from a specific defect in the regulation of L-selectin shedding under orthostatic stress.

Adult↗
PubMed2000

[Compression stocking in treatment of ulcus cruris. An efficient alternative to bandages].

BACKGROUND AND OBJECTIVE: The aim of the study was to measure the pressure exerted on the skin with application of the specially designed UlcerCare compression stocking for treatment of chronic venous leg ulcers and simultaneously to objectify the improvement in venous function. PATIENTS/METHODS: Twenty patients with chronic venous insufficiency according to the CEAP Classification C1-4 EP AS, A14, AP, PR were examined. Static exerted pressure was measured while standing and the dynamic equivalent was measured during 10 repetitions of tip-toe exercise. The patients were wearing the standard stocking JOBST Medical LegWear UlcerCare (Beiersdorf AG, Hamburg, Germany). As a control for the effectiveness of the therapy on venous hemodynamics, the lower leg volume, calculated using optoelectronically-measured lower leg circumference and venous reflux, determined by strain gauge plethysmographically-measured venous refill time, were used. RESULTS: Use of the compression stocking system UlcerCare resulted in a decreased lower leg volume. This decrease was on average 5.3%, corresponding to 106 +/- 78 ml (p < 0.001). The calf and forefoot venous function parameters also improved. The venous refill time improved from 27.2 +/- 15.2 s to 45.0 +/- 27.4 s at the forefoot (p < 0.003) and from 10.5 +/- 4.5 s to 19.4 +/- 10.9 s at the calf (p < 0.002). The exerted pressure at the ankle while standing was 46.2 +/- 24.2 mmHg (resting pressure) and 48.5 +/- 27.2 mmHg during repetitive tip-toe exercises (mean exercise pressure). At the calf, the exerted pressure while standing was 40.7 +/- 26.9 mmHg (resting pressure) and during the repetitive tip-toe exercises it was 42.1 +/- 29.5 mmHg (mean exercise pressure). CONCLUSIONS: The exerted pressure of the UlcerCare compression stocking is equivalent to that of a class 3 medical compression stocking. This newly developed stocking diminishes venous reflux and reduces leg edema. These objectified effects suggest that the UlcerCare stocking is effective as compression therapy for venous ulcers.

Bandages↗
PubMed2000

[FOITS (fast optical in vivo topometry of human skin): new approaches to 3-D surface structures of human skin].

FOITS (Fast Optical In-vivo Topometry of human Skin) is a new technique for the three-dimensional analysis of the microstructures of the skin. Based on the surface roughness standards used in the metal-working industry, it uses computer-assisted strip analysis to process information gathered from high-speed, non-contact scanning. It is possible to visualise the mathematical data in 3D form. So far, surface relief parameters have had to be acquired indirectly by first making silicone casts of the skin and then digitalising them with image analysis, mechanical scanners or, more recent, laser profilometry and confocal microscopy. We selected the roughness parameters Ra, Rz and Rmax (DIN defined) and "positive" and "negative" volume to describe the skin surface. In 40 healthy volunteers we were able to define significant intra-individual differences in these roughness parameters, which were correlated with the location of the area of skin being scanned (p < 0.05). When healthy areas of skin were compared with areas of chronic eczema in 10 patients with neurodermatitis the differences in the above-mentioned roughness parameters were just as striking (p < 0.05). In patients with chronic atopic eczema there was a statistically significant correlation between changes in the parameters "positive" and "negative" volume, and the smoothing of the skin seen after 14 days of treatment with standard ointments (p < 0.02). Apart from its industrial uses, we see potential applications for FOITS in the investigation of quantitative and qualitative aspects of aging processes, physiological and pathological processes in the skin, and the effect of topical preparations applied to the skin.

Adolescent↗
PubMed2000

[A new optoelectronic measuring device for assessment of leg circumference in comparison with manual measurement].

For compression treatment to be effective in patients with chronic venous insufficiency, it is vital that leg circumference be measured accurately. If compression stockings are custom fit and appropriate for the medical indications, patient compliance will be high. Exact measurements of circumference and length are prerequisites for a good fit. The aim of the present study was to compare an opto-electronic device for the contact-free measurement of calf circumference with the conventional manual method using a tape measure. We investigated the differences between the results obtained with the two methods, and also their reproducibility. Circumferences were measured at defined heights on an anatomically shaped non-yielding leg model and on the leg of a healthy volunteer by 10 different experimenters both with the tape measure and with the opto-electronic device. The calf circumferences measured manually with the tape measure varied significantly more than those measured opto-electronically, both in the leg model and in the leg of the volunteer. A systematic error in the opto-electronic method appears unlikely, since the manual measurements on the leg model were both larger and smaller than those obtained with the opto-electronic device. Reproducibility was exceptionally high with the opto-electronic device (standard deviation 0.11-0.42 cm). The opto-electronic method yields rapid accurate measurements of circumference with excellent intra- and inter-operator reproducibility.

Anthropometry↗
PubMed2000

Microcirculatory dysfunction in chronic venous insufficiency (CVI).

The elevated ambulatory pressure in the peripheral venous system of chronic venous insufficiency (CVI) patients manifests itself not only in the form of disturbed macrocirculation but also and particularly in microangiopathic changes. For this reason, it is closely correlated with trophic disorders of the skin and can ultimately lead to ulceration. Using microcirculation research techniques, we are able to provide clear evidence of a typical microangiopathy in chronic venous insufficiency. Fifty CVI in Widmer stages I, II, and III were examined with fluorescence video microscopy, intravital video capillaroscopy, transcutaneous oxygen partial pressure measurement, TcpO2 and laser Doppler flowmetry. The effects of compression therapy with individually fitted compression stockings on capillary morphology were studied over a period of 4 weeks in 20 CVI patients in Widmer stages I and II. The capillary pressure was measured during simulated muscle contraction using a servo-null micropressure system. We periodically drew blood from the dorsalis pedis vein and a brachial vein of 11 healthy test persons and 8 patients with stage III CVI during experimental venous hypertension in order to evaluate the expression pattern of leukocyte adhesion molecules involved in inflammation: LFA-1 (CD11a), Mac-1 (CD11b), p150,95 (CD11c), CD18, VLA-4 (CD49d), and L-selectin (CD62L). In the same patients, we used immunohistochemical methods to examine clinically unaffected skin and the skin near an ulcer, focusing on the adhesion molecules ICAM-1, VCAM-1, and E-selectin. The microangiopathic changes observed with worsening clinical symptoms include a decrease in the number of capillaries, glomerulus-like changes in capillary morphology, a drop in the oxygen content (tcpO2) of the skin, increased permeability of the capillaries to low-molecular-weight substances, increased laser Doppler flux reflecting elevated subcutaneous flow, and diminished vascular reserve. These microangiopathic changes worsen in linear proportion to the clinical severity of chronic venous insufficiency. In patients with venous ulcerations, the baseline expression of LFA-1 and VLA-4 on lymphocytes, Mac-1 expression on the myeloid cell line, and L-selectin expression on all three cell lines was not significantly different form that in healthy controls. During orthostatic stress, there was a significant reduction in the expression of L-selectin in blood cells collected at foot level in the controls (p=0.002), but not in the patients. Clinical improvement by compression therapy was accompanied by an increase in the number of nutritive capillaries, while the diameter of the capillaries and the dermal papillae was reduced. When ulcers healed in a short period (<6 weeks), we observed a concomitant increase in the number of capillaries (p<0.05). Microangiopathy appears before tropic disorders of the skin develop. Even trophically normal skin areas may have dilated nutritive capillaries, an early sign of disturbed skin perfusion. These changes represent a plausible explanation for the development and to recurrency tendency of venous ulcers. The reduced expression of lymphocytic L-selectin in healthy controls during the orthostatic stress test may be an indication that the cells are activated by venous stasis. Clinically effective therapeutic measures improve the impaired microcirculation of the skin in the ankle area.

Bandages↗
PubMed1999

Local cold exposure test with a new arterial photoplethysmographic sensor in healthy controls and patients with secondary Raynaud's phenomenon.

Local cold exposure tests are used to diagnose cold-induced vasospastic disorders and to evaluate therapeutic success. We investigated the pulsatile signal detected with a newly developed arterial photoplethysmography (APPG) method and the signal change induced by local cold exposure using a temperature-controlled finger holder, comparing it with laser Doppler flux (red and green laser, rLDF and gLDF) and red blood cell velocity measured in nailfold capillaries (CBV). Ten healthy volunteers and 10 age- and sex-matched patients suffering from Raynaud's phenomenon due to systemic sclerosis were investigated using a moderate cooling temperature of 16 degrees C for 5 min. All signals were recorded simultaneously. The results show a significant reduction of CBV (P < 0.0001), rLDF (P < 0.0003), and gLDF (P = 0.0214) during cooling and characteristic changes in the APPG signal (for instance a decrease in pulse wave amplitude; P < 0.0001). Significant differences in the APPG amplitude could be detected under resting conditions; at cooling temperatures there were also significant differences in CBV and APPG. The temperature-controlled finger holder with its built-in APPG probe appears to be a useful tool for evaluating the effect of local cooling on finger skin perfusion and differentiating between healthy controls and patients with secondary Raynaud's phenomenon due to systemic sclerosis. The gLDF signal was rather weak, limiting its value in cold stress tests. The differences between controls and patients in CBV were somewhat smaller than in previous studies, suggesting the advantage of lower local cooling temperatures, e.g., 12 degrees C.

Adult↗
PubMed1999

[Microcirculation of cutaneous melanoma].

The microcirculation of human skin tumours can be visualized with noninvasive methods from clinical microcirculation research (capillaroscopy and laser Doppler fluxmetry (LDF). The latter can also be used to measure the blood flow in such tumours. This prospective study was designed to evaluate melanoma-associated cutaneous neoangiogenesis. We studied the microcirculation of 114 pigmented skin tumours in 103 patients (63 women, 40 men) averaging 38.8 +/- 21.1 years of age. On the basis of histological findings, we diagnosed melanocytic naevus in 86 cases and malignant melanoma in 28. The malignant melanoma was characterized by a chaotic arrangement of the capillaries, which were dilated and formed corkscrew-shaped or glomerular structures. In the transitional area between healthy and cancerous areas there was hypervascularization. The capillaries of the melanoma appeared to be more permeable towards the low-molecular-weight, water-soluble sodium fluorescein. Laser Doppler flux, a measure of cutaneous circulation in the upper 2 mm of the skin, is higher in the center of the melanoma than in either the middle of melanocytic naevus (p < 0.0005) or in neighbouring healthy skin areas (P < 0.005). In the future, antiangiogenetic therapy strategies could play a significant role in the treatment of malignant melanoma. These methods provide a reliable means of evaluating the specific antiangiogenetic efficacy of treatments for cutaneous melanoma.

Adolescent↗
PubMed1999

[Questionable effectiveness of autologous platelet growth factors (PDWHF) in treatment of venous ulcers of the leg].

Chronic venous insufficiency (CVI) can cause ulcers of the lower limb having the character of a full thickness wound involving the subcutaneous tissues and fat. Healing requires wound contraction, connective tissue formation and finally reepithelialization. To induce wound healing, on an underlying disturbed environment due to longterm effects of CVI, artificial stimuli may be needed. In a placebo controlled study we tried topical application of autologous PDWHF (platelet derived wound healing factors), to achieve ulcer healing and improve the microangiopathy surrounding of the ulcer area, as there are decreased number of skin capillaries and reduction in cutaneous vascular reserve. Alterations of cutaneous circulation during the course of the study were documented by capillaroscopy, transcutaneous oxygen pressure and laser Doppler flux (LDF) measurements. We were able to recruit 15 patients a I suffering from chronic nonhealing venous stasis ulcers. Eleven of the 15 patients agreed to participate in a placebo-controlled double blind study, whereas 4 patients agreed to participate only if they would be treated with PDWHF. The median age and duration of ulceration of the 6 patients (3 male/3 female) treated with placebo were 71 years and 1089 days. The median age and duration of ulceration of the 9 patients (1 male/8 females) treated with PDWHF were 66 years and 732 days. Duration of therapy for the PDWHF group was 91 days, as compared to 154 days for the placebo group. Despite 2 completely healed ulcers, the expensive treatment did not reveal any significant clinical advantage. In den PDWHF group an ulcer area of 26.9 cm2 was measured at the beginning, of 26.2 cm2 at the end; in the placebo group, 34.7 cm2 and 35.5 cm2. The nonsignificant increase of the capillary density at the ulcer border in the active group as well as the increase in the tcPO2, in contrast to little change in both parameters in the placebo group, suggests neoangiogenic abilities to PDWHF, secondarily leading to a better blood distribution with higher oxygen tension.

Aged↗
PubMed1999

The effect of compression therapy on venous haemodynamics in pregnant women.

OBJECTIVE: To study the influence of compression on the haemodynamics of the deep venous system in pregnancy. DESIGN: A prospective, observational study. SETTING: The phlebological unit of the department of dermatology at a university hospital. POPULATION: Fifteen pregnant women with no previous signs of chronic venous insufficiency. METHODS: Parameters of the venous pump function were assessed by strain-gauge plethysmography. Blood flow velocity, flow volume and vessel diameter in the superficial femoral vein were measured by duplex sonography. All examinations were performed with and without applied compression stockings (25-32 mmHg) at two different stages of gestation and after delivery. In addition, subjective symptoms were graded. RESULTS: Venous pump function improved and refilling time lengthened significantly when compression was used during gestation and postnatally. Duplex sonography showed an increase in blood flow velocity and flow volume in the superficial femoral vein with applied compression; the vessel diameter increased slightly. Subjective symptoms of the leg, graded on an arbitrary scale, were reduced by regular compression therapy. CONCLUSION: Our results indicate that compression improves the clinical symptoms of venous congestion and the venous haemodynamics of the legs during pregnancy and in the postpartum period. Thus, the regular use of compression during pregnancy and the puerperium may reduce the incidence of thromboembolic events.

Bandages↗
PubMed1999

[Value of compression therapy in treatment of deep venous thrombosis].

Therapy in the acute phase of deep vein thrombosis aims to prevent the longitudinal growth of the thrombus as well as the life-threatening complication of pulmonary embolism. Compression therapy is part of all revascularisative and conservative treatment strategies, but hardly mentioned in most of the literature. Clinical efficacy of a sufficient compression therapy in patients with acute deep vein thrombosis is marked by a quick ease of subjective complaints as well as a reduction of the edema. The long-term risk of deep vein thrombosis, the postthrombotic syndrome, is avoidable by the use of compression therapy. Clinical studies about the effectiveness in relation to the length of the thrombus and the incidence of pulmonary embolism are missing as well as studies about the selection of the best compression material. Recently compression pressures were experimentally measured between long and short stretch bandages and the skin in order to select bandage material. It can be concluded that long stretch bandages can be used in the treatment of acute phlebothrombosis in mobile out-patients. Short stretch bandages should be used in immobile patients in order to avoid high pressures between the skin and the bandages. Compression stockings (Class III) represent an equivalent alternative to compression bandages after the resolution of edema.

Acute Disease↗