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Biomedical subjects

C W Hanke

Publications and source records attributed to C W Hanke.

At least 37 records · Page 2Linked to original sources
PubMed1997

The medical necessity for treatment of port-wine stains.

BACKGROUND: Port-wine stains are congenital vascular malformations that can be disfiguring and may lead to psychosocial as well as medical complications. The 585-nm pulsed dye laser is very effective in treating port-wine stains. Laser treatment is often viewed by insurance companies as a "cosmetic procedure" and not "medically necessary". Consequently many patients are denied coverage for treatment of their disfiguring birthmarks. OBJECTIVE: To determine variability of insurance coverage for laser treatment of port-wine stains from state to state. Natural history, progression, and potential complications of port-wine stains are reviewed and rationale for consistent insurance coverage for laser treatment of port-wine stains is given. METHODS: A questionnaire was mailed to 40 dermatologic surgeons in 22 states and the District of Columbia. We reviewed the literature regarding port-wine stains and their potential complications, and health care policy guidelines regarding "medical necessity" and "cosmetic procedures". RESULTS: Insurance coverage for laser treatment of port-wine stains varies from state to state. CONCLUSION: Based on current health care policy guidelines, laser treatment of port-wine stains should be regarded, and covered, as a medical necessity by all insurance providers.

Age Factors↗
PubMed1997

Infusion rates and levels of premedication in tumescent liposuction.

BACKGROUND: Tumescent liposuction has proven to be an extremely safe and effective method of liposuction. However, the infusion of tumescent anesthesia can take 1 hour or more to complete. OBJECTIVE: To document the types, dosages, and routes of administration of premedication utilized by four experienced tumescent liposuction surgeons. To determine if infusion rates for tumescent anesthesia are affected by types of premedication. METHODS: Four experienced liposuction surgeons were asked to review their most recent 100 tumescent liposuction patients with respect to types and dosages of premedication and routes of administration. Data were also provided on corresponding infusion pump settings and infusion rates. Volumes of tumescent anesthesia and corresponding volumes of fat aspirated were also collected on the same 400 patients. RESULTS: Infusion of tumescent anesthesia could be performed more rapidly in patients who were given greater amounts of premedication. Volumes of tumescent anesthesia infused were generally two or more times the volume of fat aspirated. Patients could be infused with less premedication if slow infiltration was employed. CONCLUSION: Infusion rates for tumescent anesthesia can be increased of greater amounts of premedication are given. However, this must be balanced against the safety of the premedication.

Adult↗
PubMed1996

Mohs' micrographic surgery and distal urethrectomy with immediate urethral reconstruction for glanular carcinoma in situ with significant urethral extension.

OBJECTIVES: To report the use of conservative extirpative surgical techniques to manage glanular carcinoma in situ with significant urethral extension. METHODS: Over a 5-year period, 2 patients with carcinoma in situ of the glans with significant distal urethral involvement, who refused penectomy, were managed with combined treatment modalities using Mohs' micrographic surgery and distal urethrectomy with immediate urethral reconstruction. RESULTS: At follow-up of 5 years and of 12 months, there has been no evidence of meatal or proximal urethral recurrence. CONCLUSIONS: Mohs' micrographic surgical excision and distal urethrectomy with immediate urethral reconstruction offers an acceptable alternative to partial penectomy in patients with perimeatal carcinoma in situ who fail conservative treatment or refuse penectomy.

Aged↗
PubMed1996

Risk assessment of polymyositis/dermatomyositis after treatment with injectable bovine collagen implants.

BACKGROUND: Questions have been raised about a possible relation between injectable collagen and polymyositis and dermatomyositis (PM/DM). Predictions of the prevalence of PM/DM have been based on anecdotal estimates of the duration of follow-up for the collagen-treated population. OBJECTIVE: Our purpose was to study the duration of follow-up for a large sample of collagen-treated patients. METHODS: Physicians in North America who purchased collagen implants during fiscal year 1988 were categorized according to collagen practice size; one third were randomly invited to participate in the study. RESULTS: Review of 2622 patient records yielded an average duration of follow-up of 4 years. CONCLUSION: Five-year incidence rates were used to estimate the expected number of cases of PM/DM in the collagen-treated population. Through June 1993 the expected number was 30.2. The number of confirmed cases after treatment was seven, less than one fourth of the number of cases expected for a model of the collagen-treated population, matched for age, sex, and race.

Adolescent↗
PubMed1996

Current status of tumescent liposuction in the United States. National survey results.

BACKGROUND: Tumescent liposuction is an extremely safe method of liposuction that can be performed entirely under local anesthesia. OBJECTIVE: To determine evolving trends in the current practice of tumescent liposuction in 15,336 patients treated by 66 dermatologic surgeons. METHODS: A survey questionnaire was sent to 1,778 Fellows of the American Society for Dermatologic Surgery in February 1994. The comprehensive questionnaire requested information on the number of patients treated with tumescent liposuction, complications, and various practice issues. RESULTS: Sixty-six dermatologic surgeons provided data on 15,336 patients; 44,014 body areas were treated. The complications that developed were infrequent and minor and have been reported previously. The average amount of fat removed per patient was 1,276 cc. An average of 33 cc of blood was lost per patient per procedure. Cannulas of 4.0 mm or less in diameter were commonly used. The abdomen and outer thighs were the most common areas treated in women. The flanks/love handles and abdomen were the most common areas treated in men. Intraoperative monitoring of vital signs was common. CONCLUSIONS: Tumescent liposuction is an evolving technique that has virtually eliminated blood transfusions and the major complications of liposuction under general anesthesia. Large amounts of fat can be removed using small diameter cannulas. The fat can be safely removed with a minimum risk of minor complications.

Abdomen↗
PubMed1996

Ignition potential of the 585-nm pulsed-dye laser. Review of the literature and safety recommendations.

BACKGROUND: The 585-nm pulsed-dye laser is the treatment of choice for many port-wine stains. The risk of accidental flash fires occurring with the pulsed-dye laser is considered minimal. Recently, however, there have been several reports of unwanted ignitions. These cases all share two features: 1) oxygen delivery by face mask, and 2) the ignition of a hair-bearing surface. OBJECTIVE: We report a case of a laser-induced fire that occurred on a non-hair-bearing surface in a patient who was receiving oxygen by nasal cannula. The mechanisms, risk factors, and guidelines for the prevention of pulsed-dye laser-induced fires are presented. METHODS: We reviewed the literature regarding the safety of pulsed-dye laser use. RESULTS: Pulsed-dye laser-induced fires can occur on non-hair-bearing regions and in patients receiving oxygen by nasal cannula. CONCLUSION: Precautions should be taken to prevent pulsed-dye laser fires regardless of treated region or method of oxygen delivery.

Burns↗
PubMed1996

LY191704 inhibits type I steroid 5 alpha-reductase in human scalp.

Conversion of testosterone to dihydrotestosterone (DHT) has been demonstrated to be catalyzed by two isoforms of steroid 5 alpha-reductase, designated types I and II. Although several classes of steroid-based inhibitors of the type II isoform have been identified, these agents have not demonstrated highly selective pharmacological activity against human type I 5 alpha-reductase. LY191704 is representative of a series of nonsteroidal agents that have potent [apparent inhibitory constant (Ki) = 11.3 nM] inhibitory activity in human scalp skin homogenates (pH 7.5), a source of type I 5 alpha-reductase. [3H]-DHT production in the presence and absence of LY191704 is consistent with a noncompetitive mode of inhibition. In human prostatic homogenates (pH 5.5), a source of type II 5 alpha-reductase, LY191704 is virtually inactive as an inhibitor [concentration of inhibitor producing 50% inhibition of enzymatic activity (IC50) > 1,000 nM] of [3H]-DHT formation. LY191704 does not inhibit the type I or type II isoforms of rat 5 alpha-reductase, nor does the compound compete for binding to the murine androgen receptor expressed in SF9 cells using a baculo virus expression system. The benzoquinolinones, as exemplified by LY191704, possess exquisite pharmacological selectivity and provide a tool to understand the role of human type I 5 alpha-reductase in normal and pathophysiological states. These agents may also find clinical utility in treating androgen-dependent dermatological conditions.

5-alpha Reductase Inhibitors↗
PubMed1996

Histologic evaluation of preauricular and postauricular human skin after high-energy, short-pulse carbon dioxide laser.

BACKGROUND: Despite its growing use in dermatalogic surgery, the effects of high-energy, short-pulse carbon dioxide laser on human skin have not been well documented. OBJECTIVES: To study the histologic effects of this high-energy, short-pulse CO2 laser on human skin and to compare these changes with the effects of standard chemexfoliation procedures. OBSERVATIONS: Twenty-four hours after laser administration, there was extensive epidermal necrosis and coagulative change in the superficial papillary dermis. With increasing doses of laser energy, there was a statistically significant increase in the depth of dermal wounding (P<.001 for days 1 and 3, F-test). Reepithelialization occurred in most specimens by day 3. By day 90, most specimens showed a subepidermal dermal repair zone consisting of compact new collagen fibers overlying collagen with evidence of solar elastosis. CONCLUSION: This high-energy, short-pulse CO2 laser produces morphologic changes similar to those seen with medium-depth chemical peels. This laser can ablate skin precisely and bloodlessly with little interference in the wound healing process, suggesting that it may serve as an alternative treatment for photoaged skin.

Analysis of Variance↗
PubMed1996

Dermatofibrosarcoma protuberans treated with Mohs micrographic surgery: cure rates and surgical margins.

BACKGROUND: Dermatofibrosarcoma protuberans is an uncommon malignant tumor of the skin with a frequent tendency to recur after standard surgical excision. This study assesses the degree of subclinical tumor extension and evaluates the cure rate and tissue conservation abilities of Mohs micrographic surgery. METHODS: Twenty-four patients with dermatofibrosarcoma protuberans underwent Mohs micrographic surgery. Surgical margins and clinical outcome were evaluated and compared with the results of standard surgical treatment in the medical literature. RESULTS: Twenty-six Mohs micrographic surgical procedures were performed on 24 patients. Eighty-five percent of the procedures were microscopically cleared with 2.5-cm margins, 69% with 2.0-cm margins, 50% with 1.5-cm margins, and 35% with 1.0-cm margins. Two tumors would have been inadequately excised if standard 3-cm had been used. The assessment of tissue conservation revealed a mean of 43.0 cm(2) of tissue spared in a subset of seven tumors in functionally or cosmetically critical locations. Two tumors were recurrent following MMS and are detailed as case reports. CONCLUSION: The variability of subclinical tumor extension in dermatofibrosarcoma protuberans is confirmed. The ability of Mohs micrographic surgery to minimize surgical margins, preserve cosmetically and functionally vital tissue, and yield high cure rates is confirmed.

Adult↗
PubMed1995

Safety of tumescent liposuction in 15,336 patients. National survey results.

BACKGROUND: Tumescent liposuction is a new method of liposuction under local anesthesia that has been developed by dermatologic surgeons. OBJECTIVE: To determine the safety of tumescent liposuction in a large group of patients treated by dermatologic surgeons. METHODS: A survey questionnaire was sent to 1,778 Fellows of the American Society for Dermatologic Surgery in February 1994. The comprehensive questionnaire requested information on numbers of patients treated with tumescent liposuction and complications that occurred. RESULTS: Sixty-six dermatologic surgeons provided data on 15,336 patients. The complications that were reported were infrequent and minor. There were no serious complications such as death, embolism (pulmonary or fat), hypovolemic shock, perforation of peritoneum or thorax, or thrombophlebitis. Blood transfusions were not required in any of the 15,336 patients and there were no admissions to the hospital for treatment of complications. CONCLUSIONS: Tumescent liposuction is an exceptionally safe method of liposuction under local anesthesia that eliminates the necessity of general anesthesia and blood transfusions. Tumescent liposuction is safer than liposuction under general anesthesia and results in fewer complications.

Humans↗
PubMed1991

Abscess formation and local necrosis after treatment with Zyderm or Zyplast collagen implant.

The incidence, clinical presentation, pathophysiology, and possible treatment of two rare but clinically meaningful complications of tissue augmentation with Zyderm and Zyplast Collagen Implant are described. Abscesses as a manifestation of hypersensitivity to bovine collagen occur rarely (4 in 10,000 cases) and may persist for days to weeks. Periods of remission and exacerbation may occur from 1 month to more than 24 months. Localized tissue necrosis also occurs rarely (9 in 10,000 cases) after implantation and is probably the result of local vascular interruption and not hypersensitivity. The incidence varies greatly between the anatomic sites of implantation; more than half the reported cases involve the glabella. Evidence strongly suggests that the increased vulnerability of the glabellar region is due to its unique vascular distribution.

Abscess↗
PubMed1990

Electrosurgical treatment of rhinophyma.

Thirteen patients with moderate to severe rhinophyma were treated with electrosurgery. All patients achieved cosmetic improvement with minimal postoperative complications. Six of 13 patients noted an improvement in nasal breathing after treatment. Patients with a predominantly lobular rhinophyma achieved the best overall results whereas younger patients with generalized nasal hypertrophy were at the highest risk for scarring. This low-cost treatment was associated with few complications and gave excellent cosmetic results. A new clinical classification of rhinophyma has been developed on the basis of the patients in this series.

Adult↗