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Biomedical subjects

R Fröber

Publications and source records attributed to R Fröber.

At least 19 recordsLinked to original sources
PubMed2005

ECG recording of central venous catheter misplaced in inferior thyroid artery.

A 71-year-old male patient with liver metastases secondary to rectal carcinoma was scheduled for hemi-hepatectomy. Two months earlier he had undergone subtotal resection of the thyroid gland. Prior to surgery, a triple-lumen catheter and an introducer sheath were introduced into the right internal jugular vein using a landmark technique. No problems occurred during insertion of the triple-lumen catheter, but resistance was noticed during insertion of the 8.5 FG introducer sheath. After placement of the introducer sheath, intra-arterial misplacement was confirmed using a pressure transducer. The opportunity was taken to record and compare intravascular ECG by the arterial and venous catheters before removal. No difference was noticed in the P-wave patterns; both showed a marked increase. Surgical exploration of the neck, recommended by the vascular surgeon consulted, showed that the carotid artery was not injured. The introducer sheath had completely punctured the right internal jugular vein and entered the inferior thyroid artery. A thrill was felt. The management of this case is discussed, with suggestions for best practice. Intravascular ECG was unhelpful in differentiating between venous and arterial placement of the catheter.

Aged↗
PubMed2005

[Uncorrected transposition of the great arteries and large ventricular septum defect perioperative management of a caesarean section].

Patients with congenital cyanotic heart disease are a challenge to the anaesthetist due to the individual haemodynamic characteristics. Maintaining a balance between systemic and pulmonary-vascular resistance is crucial. Here we outline the successful perioperative management of a 24-year-old female with uncorrected transposition of the great arteries (D-TGA) and large septal defect of the ventricle (functionally single ventricle). She was transferred to our perinatologic centre in the 32nd week of pregnancy with symptoms of increasing cardial insufficiency. The peripartum management was agreed upon at an interdisciplinary conference and caesarean section was performed in the 35th week of pregnancy with epidural anaesthesia and no significant problems. Due to hypercoagulability and the risk of "paradoxical" embolism, low molecular weight heparin was given for 6 weeks post partum. The infant was underweight and was admitted to the neonatal intensive care unit, where she made a satisfactory progress.

Adult↗
PubMed2005

[Modified ECG-guidance for optimal central venous catheter tip positioning. A transesophageal echocardiography controlled study].

BACKGROUND: Intraatrial electrocardiography (ECG) is a well-established method for central-venous catheter (CVC) placement and an intraatrial position is assumed, when a significantly increased P-wave is registered. However, an increase in P-wave amplitude also occurs in other positions. Therefore we evaluated CVC tip positioning by means of transesophageal echocardiography (TEE) at a maximum P-wave amplitude. PATIENTS AND METHODS: In this prospective randomized study the right or left internal jugular vein was cannulated with 100 patients in each group and catheter tip positioning was guided by means of ECG. The catheter was fixed at the position of maximum P-wave amplitude and the insertion depth was registered. The relationship of the CVC tip position to the superior edge of the crista terminalis was demonstrated with the help of TEE. RESULTS: In all patients the catheter tip was found +/- 0.5 cm from the superior edge of the crista terminalis at the transition from the superior vena cava to the right atrium. On x-ray control, all catheters ran along the length of the vessel wall of the superior vena cava. CONCLUSIONS: A maximum P-wave is derived even at the entrance to the right atrium. This explains why ECG-guided CVC placement -- based on the largest P-wave amplitude -- consistently resulted in correct positioning of the CVC tip at the transition from the superior vena cava to the right atrium.

Adult↗
PubMed2003

Persistent left superior vena cava and central venous catheter position: clinical impact illustrated by four cases.

Variations in the course of the blood vessels are often incidental findings during clinical examination. A persistent left superior vena cava (LSVC) is really not rare (healthy individuals, 0.3-0.5%; patients with congenital heart disease, 4%) and serious complications have been described during catheterization in adults with LSVC (shock, cardiac arrest, angina). Therefore variations of the superior vena cava should be considered, especially when central venous catheterization via the subclavian or internal jugular vein is difficult. We describe the embryogenesis and the anatomic variations of persistent LSVC. Subsequently we suggest a classification of superior vena cava according to the positioning of a central venous catheter on the chest radiograph: type I, normal anatomy; type II, only persistent left superior vena cava; type IIIa, right and left superior vena cava with connection; type IIIb, right and left superior vena cava without connection. This classification is illustrated by four clinical cases.

Adult↗
PubMed2001

Unusual blood supply to the pancreas by a dorsal pancreatic artery.

A variation of the blood supply to the pancreas was observed in an 89-year-old female, in which the celiac trunk gave off four arteries: the hepatic, splenic, left gastric arteries and an additional dorsal pancreatic artery. One of the branches the dorsal pancreatic artery joined with the superior mesenteric artery to form a longitudinal anastomosis. The anterior and posterior pancreaticoduodenal arcades arose from branches of the superior pancreaticoduodenal and the dorsal pancreatic arteries. The inferior pancreaticoduodenal artery, a branch of the superior mesenteric artery, was missing. The majority of the pancreas was, therefore supplied by the dorsal pancreatic artery. The clinical implications of this finding are that the size, location and course of a dorsal pancreatic artery should be established given its central role in the blood supply to the pancreas observed in the present study.

Aged↗
PubMed2001

[The extralobar sequestration of the fetal lung].

The extralobar sequestration is a rare pulmonary malformation. An accurate antenatal evaluation is required for a timely therapy and subsequently a good outcome. Here an unusual case of extralobar pulmonary sequestration in a male human fetus is reported. Antenatal ultrasound at 28th week of gestation has revealed a fetal hydrothorax in coexistence with pulmonary hypoplasia and an isolated pulmonary structure. Authors summarise their postnatal findings with special reference to the pathogenesis of an accessory lung. The aim of this report is to define the association of clinical, gross, and histological features of this rare congential malformation in order to improve the antenatal diagnosis. This case indicates that an extralobar pulmonary sequester is not connected to the tracheobronchial tree, and that the arterial as well as the venous blood supply is realised by aberrant systemic vessels. Moreover, histologically revealed dilatations of the normally differentiated terminal airways within the sequester suggest that hyperechogenity can not be a reliable diagnostic criterion. For the accurate assessment of a pulmonary sequestration a detailed antenatal evaluation of both, the arterial and the venous blood supply is essential.

Adult↗
PubMed2001

Three-dimensional reconstruction of the anal striated musculature in a human fetus.

Conflicting opinions in the recent literature indicate that the morphological organization and function of the anorectal continence organ has, up to now, not been clearly understood. But a clear imagination of the spatial arrangements of this compound muscle system is of clinical relevance for the pediatric surgeon performing reconstructive surgery. We analyzed 18-microm sections of the pelvic region of 4 human fetuses in order to describe the individual components of this muscle complex. A series of 630 Azan-stained sections was the base for the computer-assisted 3D reconstruction of the levator ani and the external sphincter complex in a male human fetus (14th week p.c.). In this context, special attention was paid to the intermediate muscle layer of the puborectalis which develops ventrally from the funnel-shaped levator ani and joins the tripartite ring system of the sphincter muscle dorsally. Our findings lead to a clear imagination of the spatial arrangement of this intermediate layer and characterize the anorectal muscle complex as an integrated ensemble in which the puborectalis holds a key position.

Anal Canal↗
PubMed1994

Anatomic bases of the forearm compartment syndrome.

One of the most common sites for the compartment syndrome (CS) is the forearm. Its compartments have been studied by injection of colored gelatin into the particular anatomical spaces. The three "pressure-measuring-points" recommended in the clinical literature to measure intracompartmental tissue pressure in equivocal diagnostic cases were used for the dye injections on the forearms of five preserved cadavers of adults. However, instead of the compartments especially affected in CS two adjacent spaces were revealed. In order to elucidate the clinical relevant spaces two additional approaches for the injection had been used. Cross-sections at 15 mm intervals of the injected forearms had been performed. Some of them are presented and schematically summarized in this article. Recent studies have suggested that there are different guidelines for description of the anatomically isolated spaces. However, especially one of these spaces seems to be responsible for the CS on the forearm. The remarkable features of this so called "deep flexor compartment" are its very restrictive envelopes, its rare fascial contacts, its impermeable seal in proximal-radial direction as well as the extremely endangered structures within the compartment. The flexor carpi ulnaris muscle is recommended to be the "primary structure" for measuring the tissue pressure as well as for surgical decompression. The article reviews the anatomical base of the CS.

Adult↗
PubMed1991

[New aspects of the ontogenetic development of the human colon].

The parts of the fetal colon--later retroperitoneally located (ascending and descending colon)--were examined in 31 human fetuses in order to determine their ontogenetic formation, position, and dorsal attachment. The present data cast doubt upon so-called "descending of the caecum" described in current textbooks of embryology. Considering the literature available a new concept of the formation of the right colon flexure and the ascending colon is presented.

Cecum↗
PubMed1982

[The altered membrane of the erythrocyte. I. Ultrahistochemical and biocellular investigations for the detection of activated acetylcholinesterase (ACHE) and demasking of IgG receptor sites (author's transl)].

Different states of the erythrocyte membrane with regard to its disintegration are characterized. The binding power of autologous and allogenic IgG, the degree of the activation of the membrane associated acetylcholinesterase (inhibited in the intact plasmalemma of red blood cells), and the membrane vesiculation served as criteria. The findings demonstrate that, obviously, the IgG binding increases in dependence on the extent of the disturbance of the membrane structure. The acetylcholinesterase is increasingly activated. The enzyme can be demonstrated by spectrophotometrical and ultrahistochemical methods. Microvesiculation is understood as expression of fundamental disturbances of the membrane structure. These disturbances express local remodelling processes in the membrane of banked red blood cells. Highly extended damage of red blood cells after mechanical stress, heat or urea incubation lead to comparatively high rates of vesiculation, partially even to cell fragmentation. Extremely spectrindeficient ghosts tend to microvesiculation, which leads to complete microvesicular decay of the ghost membrane. The membrane associated autologous IgG is demonstrated by means of immuneological and ultrahistochemical methods. Its importance as homeostatically effective immun-signal for the elimination of red blood cells aged in vivo or in vitro, ghosts and microvesicles by the reticulohistiocytic-system is evidenced by means of model experiments. Molecular mechanisms for unmasking of IgG-receptor sites and activation of acetylcholineesterase in the altered erythrocyte membrane are discussed.

Acetylcholinesterase↗
PubMed1981

[Importance of the cell membrane for the sequestration of aged erythrocytes].

The erythrocyte membrane is an important cell organelle which determines the intravital life time of the cell in a decisive way. Their mechanic properties are closely connected with the metabolism of the cells. Increasing disturbance of the cellular metabolism especially in the course of biological aging leads to enhanced cell rigidity. It is supposed that the decreased elasticity of the aged erythrocytes in critical regions of the blood circulation (capillaries with a diameter of 2.5 to 3.0 micrometers) leads to pressure induced vesiculation and spherocytosis. It is possible that also IgG-receptors are demarked by this process. After passing a threshold concentration as immunobiological signals increased irreversible binding of IgG induces the sequestration of the erythrocytes by the erythrocyte destructing system.

Animals↗
PubMed1981

Defined rearrangement of the membrane of banked erythrocytes.

Segregation of integrated proteins, detachment of actin and spectrin from cytoplasmic aspect as well as decomposition of phospholipids may cause the release of vesicles from spicula of banked erythrocytes. The findings provide evidence for a mechanism of plasmalemmal rearrangement, because a clear distinction between the protein composition of the vesicle membrane and of the erythrocyte plasmalemma could be shown. The vesiculation mechanism is discussed.

Actins↗