Othmar Gaber

Cervical Spine Motion During Airway Management: A Cinefluoroscopic Study of the Posteriorly Destabilized Third Cervical Vertebrae in Human Cadavers

We conducted a randomized, controlled, crossover study to determine cervical spine motion for six airway management techniques in human cadavers with a posteriorly destabilized third cervical (C-3) vertebra. A destabilized C-3 segment was created in 10 cadavers (6–24 h postmortem). Cervical motion was recorded by continuous lateral fluoroscopy. The following airway management techniques were performed in random order on each cadaver with manual in-line stabilization applied: face mask ventilation (FM), laryngoscope-guided orotracheal intubation (OETT), fiberscope-guided nasal intubation (FOS-NETT), esophageal tracheal Combitube® (Kendall-Sheridan, Neustadt, Germany) insertion (ETC), intubating laryngeal mask insertion with fiberscope-guided tracheal intubation (ILM-OETT), and laryngeal mask airway insertion (LMA). Afterward, maximum head-neck flexion (FLEX-MAX) and maximum head-neck extension (EXT-MAX) without manual in-line stabilization was performed to determine maximum motion. The maximum posterior displacement of C-3 and the maximum segmental sagittal motion of C2-3 were determined. There was a significant increase in posterior displacement for the FM (1.9 ± 1.2 mm, P < 0.01), OETT (2.6 ± 1.6 mm, P < 0.0001), ETC (3.2 ± 1.6 mm, P < 0.0001), ILM-OETT (1.7 ± 1.3 mm, P < 0.01), LMA (1.7 ± 1.3 mm, P < 0.01), FLEX-MAX (3.7 ± 1.9 mm, P < 0.0001), EXT-MAX (1.8 ± 1.7, P < 0.01), however, not for FOS-NETT (0.1 ± 0.7 mm). Posterior displacement was less for the ILM-OETT and LMA than for the ETC (both P < 0.04). There were no significant increases in segmental sagittal motion with any airway manipulation other than with FLEX-MAX (−4.5 ± 4.0°, P < 0.01). Posterior displacement was similar to FLEX-MAX for the OETT and ETC; however, it was less for the FM, FOS-NETT, ILM-OETT, and LMA (all P < 0.01). Posterior displacement was similar to EXT-MAX for all airway manipulations other than for FOS-NETT (P < 0.001). For cervical motion and the techniques tested, the safest method of airway management in a patient with a posteriorly destabilized C-3 segment is FOS-NETT. LMA devices may be preferable to the ETC. Implications In the cadaver model of a destabilized third cervical vertebrae, significant displacement of the injured segment occurs during airway management with the face mask, laryngoscope-guided oral intubation, the esophageal tracheal Combitube® (Kendall-Sheridan, Neustadt, Germany), the intubating and standard laryngeal mask airway; but not with fiberscope-guided nasal intubation. For cervical motion and the techniques tested, the safest airway technique with this injury is fiberscope-guided nasotracheal intubation. Laryngeal mask devices are preferable to the esophageal tracheal Combitube®.

Importance of Arterial Blood Supply to the Femur and Tibia for Transplantation of Vascularized Femoral Diaphyses and Knee Joints

Abstract. The role of the periosteal and intraosseous blood supply to the femur and the proximal tibia was investigated to improve the operating technique for transplantation of allogenic vascularized femoral diaphyses and knee joints in humans. Altogether 48 limbs were injected with gelatin, red latex milk, or Revertex and macroscopically prepared; 41 limbs were studied for the variation and division of the truncus profundo-circumflexus. In 200 femurs and 200 tibias the location of the nutrient foramen was determined. The arteries supplying the periosteum of the distal femur and the proximal tibia have defined nutritive areas. The following technique should be followed: If the femoral artery alone is prepared as the vascular pedicle, the optimal section for resection of the femur in knee joint transplantations is 6 to 12 cm above the level of the femur condyles and 5 to 7 cm below the tibial plateau. For the transplantation of femoral diaphyses, the deep femoral artery can be used if the lateral femoral circumflex artery is protected. The proximal line of resection is defined between the greater and lesser trochanter. For shorter grafts one must consider the number and location of nutrient foramens. For longer grafts the distal branches of the femoral artery must be respected as the intraosseous blood supply reaches distally down to the level of about 8 cm above the femoral condyles. In all these operations the variation of the truncus profundo-circumflexus and the trifurcation of the popliteal artery must be considered.

Man from the Hauslabjoch

On September 19, 1991, at an altitude of 3,200 m (10,498 feet), the remains of a well-preserved, freeze-dried mummified body of a 3,000 BC, Late Stone Age man, was found on the Austrian-Italian border. Studies conducted at the University of Innsbruck have revealed that these are the remains of a 45-46-year-old male, 45 kg (99 lbs) (living weight) and 160 cm (5 feet, 2 inches) tall. Morphometric, pathophysiologic, paleobotanical, photogrammetric, anthropological, computer tomographic, and other studies have been conducted to determine the living conditions and possible causes of death of this Late Stone Age man.

Storage phosphor radiography of wrist fractures: a subjective comparison of image quality at varying exposure levels

Abstract. Image quality of storage phosphor radiographs acquired at different exposure levels was compared to define the minimal radiation dose needed to achieve images which allow for reliable detection of wrist fractures. In a study on 33 fractured anatomical wrist specimens image quality of storage phosphor radiographs was assessed on a diagnostic PACS workstation by three observers. Images were acquired at exposure levels corresponding to a speed classes 100, 200, 400 and 800. Cortical bone surface, trabecular bone, soft tissues and fracture delineation were judged on a subjective basis. Image quality was rated according to a standard protocol and statistical evaluation was performed based on an analysis of variance (ANOVA). Images at a dose reduction of 37% were rated sufficient quality without loss in diagnostic accuracy. Sufficient trabecular and cortical bone presentation was still achieved at a dose reduction of 62%. The latter images, however, were considered unacceptable for fracture detection. To achieve high-quality storage phosphor radiographs, which allow for a reliable evaluation of wrist fractures, a minimum exposure dose equivalent to a speed class of 200 is needed. For general-purpose skeletal radiography, however, a dose reduction of up to 62% can be achieved. A choice of exposure settings according to the clinical situation (ALARA principle) is recommended to achieve possible dose reductions.

Verteilung und Größe der Tätowierungen am Eismann vom Hauslabjoch

Eine der auffalligsten Besonderheiten am Karper des Eismannes sind dunkle Strichmarken und Kreuze, die als Tatowierungen bestimmt worden sind (van der Velden et al. 1995). Einige wurden teilweise schon sehr fruh entdeckt und uber die Medien bekannt gemacht. Beim ersten Bergungsversuch am 20. September 1991 wurden sie als schwarze Striche beobachtet und am 21. September von Reinhold Messner als Brandmale gedeutet (Zissernig 1992). Auf einem von Gerlinde Haid am gleichen Tag aufgenommen Foto sind sie bereits zu sehen. Dieses in LIFE (Dowling 1991) veroffentlichte Foto machte den Eismann weltbekannt (Abb. 1). An diesem Bild last sich eine Gruppe von vier dunklen Strichen in der rechten Lendengegend feststellen

Computer-Assisted Interstitial Brachytherapy

We present the current state-of-the art of computer-assisted interstitial (fractionated) brachytherapy as a “picture-book” without wanting to give an in-depth presentation of either brachytherapy itself or of otolaryngologic aspects of oncologic treatment. However, our results show that 3D-computer-assisled navigation techniques can successfully be applied in interstitial brachytherapy to exactly plan the hollow-needle’s position(s) in order to reach a prospective planning of brachytherapy which exploits the full 3D-information of the modern imagery and incorporates state-of-the-art navigational techniques.

Die Gefässversorgung der Menisken Morphologische Grundlagen für die Refixation

Degeneration of the knee joint and increase of anterior-posterior tibial displacement are resulting from total meniscectomy, especially in knees with anterior cruciate deficiency. Vascularisation of t

Die Bedeutung der arteriellen Gefäßarchitektur des Oberschenkelknochens für die gefäßgestielte Femurdiaphysen- und Kniegelenktransplantation

Zwischen November 1994 und November 1996 wurden von uns bei funf Patienten 3 Femurdiaphysen- bzw. 2 Kniegelenktransplantationen durchgefuhrt [1, 2]. Die Operationen erfolgten entsprechend den Transplantationen parenchymatoser Organe: al-logen, gefasgestielt und unter Immunsuppression [3]. Zweimal muste eine Operation im Vorfeld abgebrochen werden, da wahrend der Back-table-Praparation bei 2 Diaphysen kein venoser Ruckstrom zu verzeichnen war (nach arterieller Injektion von Methylenblau). Wir vermuteten, das u. a. eine besondere Topographie der Gefasversorgung zu diesem Phanomen fuhren kann. In eigenen anatomischen Studien wurde die sektorielle Arterienversorgung des Kniegelenkes bereits teilweise beschrieben [4]. Es interessierten uns daruber hinaus die folgenden Fragen: 1. Welche Aste der bislang bekannten Arterien am Oberschenkel versorgen den Femurschaft ? 2. In welchen Bereichen wird die arterielle Versorgung des Femurs vornehmlich uber das Periost und wo uber den Markraum gewahrleistet? 3. Lassen sich fur die Arterienaste des Femurs bestimmte Areale definieren? 4. Wenn ja, welche Konsequenzen hat eine sektorielle Arterienversorgung fur das operative Vorgehen, insbesondere fur die Lange des Kniegelenk- bzw. Femurdiaphysentransplantates ?