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Biomedical subjects

U Brunner

Publications and source records attributed to U Brunner.

At least 19 recordsLinked to original sources
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↗
PubMed1992

[Preoperative cardiovascular assessment of patients with vascular diseases].

Pathologic cardiovascular symptoms and signs were assessed preoperatively in 72 consecutive patients scheduled for vascular surgery. All postoperative cardiovascular complications were monitored and statistical relation to the preoperative pathology was tested using the X2-method. The following preoperative cardiovascular symptoms are associated with a significant incidence of postoperative complications: Angina pectoris (p < 0.05); congestive heart failure (p < 0.025); ventricular and/or supraventricular arrhythmias (p < 0.01); pathologic ECG (p < 0.01); ejection fraction < 50% in echocardiography (p < 0.05); myocardial hypokinesias in echocardiography (p < 0.025). The use of preoperative echocardiography as a reliable and accurate method is emphasized.

Aged↗
PubMed1992

[Popliteal anastomotic aneurysm as the origin of recurrent embolism].

We report on a young patient who underwent numerous arterial interventions after injury to the right groin. After several years, a popliteal anastomotic aneurysm, unidentified at that time, began to cause recurrent peripheral emboli. The importance of an intensive search for the source of the emboli is demonstrated. Bland arteriography does not rule out the presence of an aneurysm and should prompt further investigation with duplex-sonography and/or MR-imaging. Aneurysms causing recurrent peripheral emboli are an absolute indication for surgery.

Adult↗
PubMed1992

[Esthetic aspects of varicose vein surgery].

In addition to relieving variceal pain and preventing potential ulcer formation, the goal of variceal surgery is also a cosmetic one. The problems faced at surgery include scars, hematomas, and residual and recurrent varicose veins. Intraoperative interventions and surgical techniques to prevent these are presented here.

Esthetics↗
PubMed1992

[Intra-articular calcaneus fracture. Classification in CT as a prerequisite for therapeutic decision and quantitative comparison].

Whether conservative or operative management is selected for intra-articular fractures of the os calcis depends on subjective factors and on the surgeon's experience. There is no classification available that allows ranking of such fractures according to the extent of destruction and the degree of dislocation at the same time. CT scans of 44 calcaneal fractures have been used to elaborate a new classification system for calcaneal surfaces. According to the involvement of joint surfaces, especially of the posterior facet, the degree of dislocation and the number of fragments of the posterior facet, six classes are defined. Within each class of fracture, the formation of "steps" in the posterior facet, widening of the heel, loss of height and deviation of axes are quantified. The new classification provides an instrument for use in the evaluation of joint destruction and dislocation. It helps to provide an objective basis for decisions between functional treatment and open reduction with internal fixation and for prospective analysis of fracture treatment.

Adolescent↗
PubMed1992

[Calcified and ossified phlebosclerosis].

Eight cases of dystrophic calcification and/or ossification within the walls of deep and superficial leg veins were analyzed and histologically examined. Calcification of superficial veins is a frequent clinical finding. Calcification of deep veins is occasionally observed. Ossification of the venous wall, however, has been rarely described. Calcification and ossification of the venous wall always concern the intimal layer or an organized thrombus and do not involve the media. This is in contrast to the findings in arteries where calcification and ossification of the media is frequent (Mönckeberg's mediasclerosis). The clinical consequences of calcification and ossification in the venous wall are briefly discussed.

Aged↗
PubMed1992

[Special status of lateral clavicular fracture].

Fractures of the lateral clavicle have different biomechanical conditions compared with fractures of the medial and central third; they therefore demand different therapy. Some 237 patients with fractures of the clavicle were followed, of which 75 (33%) were located in the lateral third of the clavicle. At the 5-year follow-up after exclusively conservative treatment, good results were found for Neer types I and III and 3 Jäger/Breitner type IIb fractures, while 4 out of 13 Jäger/Breitner type II a fractures ended in pseudarthroses (31%). Conservative treatment is recommended for Neer types I and III, as well as for the more stable Jäger/Breitner type II b and old II a fractures. Therefore, a new bandage is presented. It prevents the posterior and upward dislocation of the proximal fragment by vertical compression and rotation of the distal fragment by fixation of the arm. Open reduction and internal fixation by preferably extraarticular implants is recommended for unstable and dislocated Jäger/Breitner type II a fractures. For fractures of the lateral clavicle, good results can be achieved when the instability is recognized and adequately treated.

Acromioclavicular Joint↗
PubMed1992

[Exercise for venous insufficiency 1992].

A program of seven body exercises which was developed at our clinic in 1969, is presented in a new and adapted version. These exercises support the natural drainage function of the venous and lymphatic reflux system. The posture (elevated position of the pelvic area) and an adequate respiration during the exercises are of paramount importance. Exercises supporting the drainage function are only part of several components of the individually adapted therapy program. Within these limits they represent one of the most valuable measures, because they are carried out entirely by the patient himself.

Exercise Therapy↗
PubMed1992

[Acute ischemia of the lower extremity in an adolescent with Crohn disease].

The authors report a case with a rare form of peripheral ischaemia. A 25-year-old man with Crohn's disease suffers from sudden ischaemia of his right leg. There is no evidence of entrapment of the popliteal artery, of arterial embolism or Buerger's disease. Thrombocytosis in combination with hypercoagulability as described previously in patients with Crohn's disease seems to be the most probable cause. - In this case percutaneous transluminal thrombectomy and thrombolysis were more successful than surgical thrombectomy using balloon catheters.

Adolescent↗
PubMed1991

[Permanent arterial approach to the lower extremity using a totally implantable reservoir system].

In 10 patients with peripheral arterial occlusive disease intraarterial infusions were performed using a totally implantable port system. The port is fixed to the gluteal fascia on the outside of the iliac wing. The inferior epigastric artery is dissected through an additional incision above the inguinal ligament. A 2 mm catheter is connected to the port and inserted through the epigastric artery into the external iliac artery. Using this new suprainguinal technique the groin remains intact permitting surgical and interventional procedures. In one case a dislocation of the catheter occurred. The reason for this complication was an unsafe surgical fixation. The totally implantable port system is an alternative to conventional intraarterial infusions. There are several advantages using the suprainguinal technique as described above.

Aged↗
PubMed1991

[A new application of plastination in bone histology].

The plastination techniques originally developed for macroscopy can be modified for the preparation of plastinated sections for microscopy. Particularly good penetration of the specimen during preparation of the histological section is obtained, when the techniques described for freeze substitution, degreasing and forced impregnation with resin are employed. The different types of polymers are compared to determine the particular advantages and disadvantages of each. The sectioning technique and the use of histological stains are described for both undecalcified and decalcified bones. The modified Spalteholz technique with decalcification of sections and second plastination procedure for the preparation of transparent decalcified bone sections is described. This makes it possible to produce plane parallel standardized sections for morphometric examination of the vascular structure of the bone. The possible uses of the plastination for the histological examination procedures currently in use, such as fluorescence microscopy, microangiography and microradiography, are shown. The relative values of different microangiographic techniques have been determined for the first time by means of further developments of the Spalteholz and plastination techniques, because they have provided the possibility of standardizing sections. Thus, the plastination technique appears to be especially useful for the examination of microscopic specimens.

Animals↗
PubMed1991

[False aneurysm in a vascular surgery patient population].

40 false aneurysms have been diagnosed at the University Hospital in Zürich during the last three years. These aneurysms are mainly (24) anastomotic aneurysms with synthetic arterial substitutes. 6 false aneurysms were found after arterial catheterization. The majority of these 40 aneurysms (60%) were localized in vicinity of joints. The time interval between the original procedure (anastomosis, arterial catheterization, trauma) and the diagnosis of false aneurysm varies from a few days to 21 years. In seven cases a endarterectomy preceded the development of a false aneurysm. Three therapeutic groups are presented.

Adult↗
PubMed1990

Gluteal necrosis after acute ischemia of the internal iliac arteries.

Ligation of the internal iliac artery mostly remains without consequences because of the well established collateral network. In patients with compromised collateral circulation however, acute interruption of both hypogastric arteries during aorto-iliac surgery or transluminal embolisation can lead to necrosis of the gluteal muscles and other adjacent organs (rectum, bladder, lumbosacral plexus). Experience with 3 similar cases after aorto-iliac surgery demonstrates two main intraoperative mechanisms: 1. Embolisation, 2. Ligature of both internal iliac arteries in patients with compromised arteriosclerotic collaterals. Despite of adequate therapy, mortality is over 70%. The most important feature during aorto-iliac operations is to preserve at least one internal iliac artery by either reimplantation of the main stem or by an additional bypass to this artery.

Aged↗
PubMed1990

[Treatment of defects of the long bones using distraction osteogenesis (Ilizarov) and intramedullary nailing. Theoretic principles, animal experiments, clinical relevance].

For large shaft defects of tibia and femur, distraction-compression osteosynthesis (Ilizarov) provides an ideal autologous bone graft. Combination of this with an intramedullary interlocking nail instead of an external fixator could improve patient comfort, because transport with a small external device takes only one-third of the total fixation period. Using 21 adult female sheep we created standardized tibia shaft defects 20 mm (medium size) and 45 mm (large size) in length. The tibiae were stabilized with non-reamed intramedullary interlocking nails. Following corticotomy by chisel, segments were transported using subcutaneous traction wires with a screw as a fulcrum to maintain stationary skin exit points without soft tissue problems. The external traction devices were removed after 12 or 16 weeks. Animals were sacrificed after 12 or 24 weeks with medium-size defects, and after 16 or 32 weeks with large defects. We evaluated the results clinically, by standardized weekly X-rays and, after sacrifice, by quantitative computed tomography (QCT). No animals had to be excluded from the study. Despite primary destruction of the intramedullary circulation all distraction gaps were spanned with bone. X-Rays showed typical signs of good quality of distraction bone regeneration (narrow radiolucent zone in the middle of the regenerate, longitudinal structure), continuous calcification, and cortex formation. QCT cross sections showed completely circular bone regeneration with small and large defects. Bone regeneration was faster on the dorsal side, where more bone was formed than ventrally. Small defects can remain ventrally in the regenerate; these close secondarily.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

[How much foot is better than none?].

The long-term analysis of ten cases of borderline amputations at midfoot level permits the following conclusions. The functional result of borderline amputation ad midfoot level depends on several parameters, including the elevator effect of the muscle antagonists; the quality of the integument; the traction between full-thickness skin and split-thickness skin grafts; local pressure over prominent bones; osteoarthropathy and osteolysis, especially in the diabetic foot; and subjective circumstances including general state of the health, age and activities.

Amputation Stumps↗
PubMed1989

[Fractures of the distal end of the radius].

Attitudes to the treatment of distal radial fracture are now more critical than previously, especially where intraarticular fracture is concerned. Inadequate primary reduction and such complications as redislocation or dystrophic problems lead to poor results. Quantification of fracture instability is becoming increasingly important in fracture classification, determination of the indications for the different treatment modalities and management. Accurate anatomical reduction also improves later function. The quality of alignment attained during the treatment depends on the quality of reduction. Closed reduction by means of traction should be achieved by pulling on fingers I, II and IV. The radial dislocation should be corrected first and then the dorsal dislocation; a cast applied to the lower arm is sufficient for immobilization. Primary surgery is indicated more urgently and the type of surgery in more detail, for example, when there are steps in the articular surface or when there is more than one factor in instability. Pin fixation should be applied sooner and more frequently with either primary or early secondary indications. Plate fixation is mostly achieved from the volar surface; it is indicated in flexion fractures and sometimes in extension fractures, but only in combination with rigid screw fixation with or without bone grafting. We are finding increasingly more indications for external fixation, not only in the case of open fractures with soft tissue damage but also with multiple fragments or comminuted fractures, sometimes in combination with bone grafting.

Bone Nails↗