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H Breuninger

Publications and source records attributed to H Breuninger.

At least 55 records · Page 3Linked to original sources
PubMed1998

Lymph node micrometastases of cutaneous melanoma: increased sensitivity of molecular diagnosis in comparison to immunohistochemistry.

The presence of regional lymph node metastases is one of the most significant prognostic factors for predicting survival in patients with clinical stage I or II cutaneous melanoma. For accurate staging of the primary tumor a sensitive technique is required to detect occult nodal micrometastases. This prospective diagnostic study was designed to evaluate the incidence of nodal micrometastases using nested reverse transcription-polymerase chain reaction (RT-PCR) for tyrosinase in comparison to immunohistochemical examination. Furthermore, the incidence of melanoma micrometastases detected by RT-PCR was analysed in correlation to major prognostic factors. A total of 466 regional lymph nodes from 79 patients with primary cutaneous melanoma (tumor thickness > 0.75 mm) were investigated. In 49 lymph nodes from 31 patients immunohistochemistry demonstrated melanoma metastases. Using tyrosinase RT-PCR, nodal micrometastases were detected in 136 lymph nodes from 52 patients including all lymph nodes positive by immunohistochemical examination. Out of the 417 lymph nodes negative by immunohistochemistry, 87 nodes (21%) were identified to express tyrosinase by the RT-PCR technique. Among the 48 patients negative by immunohistochemical assessment, 21 (44%) had nodal micrometastases (n = 40) using RT-PCR. All 68 lymph nodes from 46 non-melanoma patients serving as negative controls for tyrosinase RT-PCR were negative. The detection of melanocytic nodal micrometastases by tyrosinase RT-PCR is a highly specific method with a sensitivity significantly higher than that achieved by immunohistochemistry (p < 0.0001). Patients with nodal micrometastases identified exclusively by RT-PCR had significantly higher tumor thickness as compared to patients with negative results by RT-PCR (p < 0.01).

Biomarkers, Tumor↗
PubMed1998

[Desmoplastic squamous epithelial carcinoma of the skin and lower lip. A morphologic entity with great risk of metastasis and recurrence].

The desmoplastic type of the squamous cell carcinoma (DSCC) of the skin is an entity which is readily distinguished by light microscopy. The DSCC has fine branches surrounded by a desmoplastic stroma and shows in some cases typical perineural, perivascular and widespread intradermal invasion (maximum 6 cm!). This type accounts for 8.2% (n = 44) of our collective of 594 squamous cell carcinomas (SCC) of the skin and vermilion border. Clinically DSCC look like other malignant epithelial tumors of the skin. All tumors were followed up for at least 3 years (maximum 10 years). The local recurrence rate was high (24.3%) even though micrographic surgery was carried out. The rate of local or regional metastasis was also very high (22.7%). In comparison the recurrence rate and the rate of metastasis of the remaining common 91.8% SCC's (n = 550) was low: 2.6% and 3.8%, respectively. The DSCC seems to be identical with the so called neurotropic SCC, the fine stranded SCC or the SCC with perineural invasion which have a high rate of local recurrence and metastasis as well, but DSCC is a better generic histopathologic term for the entire group. The DSCC is best treated with micrographic surgery and wider safety margins than any other type and should be followed up very frequently.

Adult↗
PubMed1998

[Subcutaneous infusion anesthesia with prilocaine diluted with Ringer's lactate].

BACKGROUND: Dermatologic surgery is usually possible under local anesthesia, even when large amounts of highly diluted anesthetic solutions are required (tumescent anesthesia). Although special pumps now render such large injections effortless, it is usually still necessary to hold and guide the injection cannula. We have overcome this handicap by injecting anesthetic solutions slowly with an infusomat, which allows slow painless automatic infusion into the subcutaneous layer. METHOD: The speed of infusion varied between 40 ml and 1500 ml per hour depending on location, size of the operation, and needle size. Volumes usually ranged from 1 ml to 500 ml but rose as high as 1000 ml if necessary. We found it easier to inject larger amounts than with the conventional method. We used 21-gauge to 30-gauge needles with a length of 1 to 10 cm. The anesthetic solution was prilocaine (Xylonest), and the dilution liquid was original Ringer's solution in 500 ml bottles with no additives. The concentration of the solution varied between 0.4% and 0.1%. After setting up the system, the physician even can leave the room. Especially for children and very anxious patients, this feature is calming. MATERIAL: We used this type of subcutaneous infusion anesthesia (SIA) in our department to treat 502 patients ranging in age from 3 to 92 years (mean age: 51 years). We performed all kinds of tumor operations (n = 213), dermabrasions (n = 5), scar revisions (n = 21), stripping of the long and short saphenous veins (n = 82), sentinel node dissection (n = 27), complete lymph node dissection of the axilla (n = 12) and groin (n = 17), and 125 other operations as well. RESULTS: There were no severe complications. Postoperative recovery was fast. 110 (91%) of 121 patients who had previously experienced other forms of anesthesia for the same kind of operation preferred SIA. CONCLUSIONS: SIA Ringer's solution diluted prilocaine is an economical, safe and comfortable technique for nearly all skin operations, even for children and very sensitive patients.

Adolescent↗
PubMed1998

Slow infusion tumescent anesthesia.

BACKGROUND: Dermatologic surgery is usually possible under local anesthesia, even when large amounts of highly diluted anesthetic solution are required (tumescent anesthesia). Although special pumps now render such large injections effortless, it is usually still necessary to hold and guide the injection cannula. OBJECTIVE: We have found it possible to overcome this handicap by injecting anesthetic solutions slowly with a common infusomat, as in paravenous infusion, into the subcutaneous layer. METHODS: The method consists of slow, automated tumescent anesthesia by means of infusion. The speed of injection varies between 50 and 1500 mL per hour depending on the location, the size of the operation, and the needle size. Volumes usually range from 2 to 500 mL but may rise as high as 1000 mL if necessary (maximum, 12 mg/kg). We use 30- to 20-gauge needles with a length of 1.5-10 cm and butterfly infusion cannulas. We customarily use an anesthetic solution of prilocaine (Xylonest); the dilution liquid is original Ringer's solution with epinephrine (1:1,000,000) in 500-mL bottles. The concentration of the solution varies between 0.4% and 0.1%. After setting up the system during pulsoxymetry, the physician can usually leave the room. This is calming, especially for children and very anxious patients. We used the slow infusion tumescent anesthesia (SITA) in our department to treat 502 patients ranging in age from 3 to 92 years (mean age, 51 years). We performed all kinds of tumor operations (n = 213), dermabrasions (n = 5), scar revisions (n = 21), stripping of the long and short saphenous veins (n = 82), sentinel node dissection (n = 27), complete lymph node dissection of the axilla (n = 12) and groin (n = 17), and 125 minor operations as well. RESULTS: There were no severe complications. One hundred ten (91%) of 121 patients who had previously experienced general or regional anesthesia for the same kind of surgery and all who had previously had conventional syringe injection preferred SITA. CONCLUSIONS: SITA is an economical, safe, and comfortable technique for nearly all skin operations, even for children and very sensitive patients. Choosing the most suitable concentration, needle, needle position, flow ad volume requires some experience.

Adolescent↗
PubMed1997

Metastatic melanoma of unknown primary origin shows prognostic similarities to regional metastatic melanoma: recommendations for initial staging examinations.

BACKGROUND: Metastatic melanoma of unknown primary origin accounts for approximately 2-6% of all melanoma cases. The prognostic significance of this diagnosis is still controversial. METHODS: Of 3258 patients with malignant melanoma recorded during the period 1976-1996, 2.3% had metastases of unknown primary origin. Anatomic distribution, clinical stage, and survival probabilities were evaluated. RESULTS: Thirty patients were classified as having cutaneous or subcutaneous in-transit metastases, and they showed a 5-year survival rate of 83%. Thirty-seven patients were classified as having lymph node metastasis, and their 5-year survival rate was 50%. Disseminated disease was diagnosed in only 8 patients, who had a median survival of 6 months. Comparison of survival probabilities for patients with in-transit metastases and unknown primary tumors with the probabilities for those with cutaneous primary tumors revealed a significant advantage for the former group. No significant differences were found for patients with lymph node metastasis when those with unknown primary tumors were compared with those who had cutaneous melanomas with regional lymph node metastasis. CONCLUSIONS: The clinical disease course of patients with metastatic melanoma of unknown primary origin is similar to that of patients with primary cutaneous melanoma when the same clinical stages of the disease are compared. Based on the assumption that the majority of regional metastases develop from completely regressed primary cutaneous melanoma, recommendations for initial staging examinations in patients with unknown primary tumors are given in this article.

Adolescent↗
PubMed1997

Desmoplastic squamous cell carcinoma of skin and vermilion surface: a highly malignant subtype of skin cancer.

BACKGROUND: The prognosis of squamous cell carcinoma (SCC) of the skin is directly related to the development of metastases or local recurrence. This is affected by numerous factors, most of which are independent: clinical tumor size, histopathologic tumor thickness, depth of penetration, degree of cell differentiation, degree of keratinization, location, and immunosuppression. The determination of whether desmoplasia, previously described in only one case of SCC, constitutes an additional prognostic factor was the objective of this study. METHODS: The study was performed prospectively on 594 SCCs from 509 patients. All of the factors mentioned earlier were present. Forty-four SCCs were identified by light microscopy as desmoplastic due to their prominent trabecular growth patterns, narrow columns of atypical epithelial cells, and marked desmoplastic stromal reaction, in some cases with perineural and perivascular invasion. Follow-up ranged from 4 to 10 years (median, 5.3 years). RESULTS: All tumors in the study patient population were treated using the paraffin section method of micrographic surgery. The 44 desmoplastic SCCs were found to metastasize 6 times more often than the remaining 550 tumors (22.7% vs. 3.8%), with 10 times as many local recurrences (27.3% vs. 2.6%). CONCLUSIONS: Desmoplasia is a highly significant (P < 0.001) prognostic factor for SCCs and is associated with the development of metastases or recurrence.

Carcinoma, Squamous Cell↗
PubMed1997

[Teleangiectasia haemorrhagica hereditaria. Surgical therapy of malignant skin tumors (Osler-Weber-Rendu disease].

A 65 year old male patient was diagnosed with hereditary hemorrhagic telangiectasia at 30. During recent years he has suffered frequent, almost daily, nose bleeds causing anemia and making several blood transfusions necessary. In the past 2-3 years, the patient has developed multiple squamous cell carcinomas on the face. These unusually large tumours were treated by micrographic surgery using paraffin sections and the defects dosed with a variety of flaps and grafts. Several solar keratoses were also removed. If hemostasis parameters are normal, skin surgery can be performed without hesitation in hereditary hemorrhagic telangiectasia.

Aged↗
PubMed1997

[Extensive rodent ulcer (type: solid basal cell carcinoma)].

A 52 year old female had a large destructive basal cell carcinoma of the back measuring 27 cm in diameter. There was destruction of the vertebral bodies, envelopment of the medullary cone, early spinal compression and soft tissue spread into the retroperitoneum. Early neurological defects were present. The tumor was excised, covered with two large rotation flaps and post operatively irradiated. The patients quality of life has improved, the tumor has not progressed and there is no sign of paraplegia.

Basal Cell Carcinoma↗
PubMed1996

[Umbilical reconstruction after excision of melanomas in the area of the umbilicus].

Reconstruction of the navel after tumour excision with subsequent navel resection is of great aesthetic importance for the patient. Methods of navel reconstruction are found in the literature but do not provide an elegant solution to the problem. Our method permits reconstruction of the navel during wound closure, by creation of two opposing trapezoidal skin flaps at the excision margin in the midline of the body; the umbilical fossa is then restored by jointly anchoring these flaps to the linea alba. Reconstruction has been successfully carried out in this way after melanoma excision in 7 patients.

Abdominal Neoplasms↗
PubMed1996

[A histological technique for processing excised skin tumors for continuous tumor margin control].

In the treatment of basal cell carcinoma, squamous cell carcinoma and a number of other tumors of the skin, the recurrence rate is tenfold lower if they are treated with micrographic surgery in comparison with tumors, assessed by parallel histological sections. We demonstrated this in our investigations including over 5900 cases. The rate of local recurrences in under 1%. The difference can be explained by the typical growth pattern of skin tumors. In the following article two simple methods of tissue processing are described, which can be used for formalin-fixed tissues and for fresh tissues.

Basal Cell Carcinoma↗
PubMed1994

Prevalence of antimicrobial resistance of Streptococcus pneumoniae in southwest Germany as determined by the E test.

We have studied the prevalence of anti-microbial resistance of Streptococcus pneumoniae in Southwest Germany. One hundred seventy-four clinical isolates of pneumococci collected from hospitalized patients between October 1992 and April 1994 were used for MIC determinations. MICs for penicillin, ceftriaxone, erythromycin, and rifampicin were assessed by the E test. Eleven of the 174 strains (6.3%) were intermediately resistant to penicillin (MIC between 0.1 and 1.0 microgram/ml) and four of the 174 strains (2.3%) were intermediately resistant to ceftriaxone (MIC between 0.1 and 1.0 microgram/ml). All four isolates with a reduced susceptibility to ceftriaxone also demonstrated intermediate resistance to penicillin. Six of the 174 strains (3.5%) were highly resistant (MIC > or = 8 micrograms/ml) to erythromycin. Resistance to rifampicin was not observed. Our results demonstrate that pneumococcal resistance to penicillin and erythromycin has increased markedly in Germany over the last decade. Our findings underline the need for continuous surveillance of antimicrobial resistance of Streptococcus pneumoniae.

Adult↗
PubMed1994

[Is acrolentiginous melanoma (ALM) more malignant than superficially spreading melanoma (SSM) at a high-risk site? A matched-pair comparison between 113 ALM and SSM within the scope of a multicenter study].

Even today, the prognosis of acrallentiginous melanoma (ALM) remains a controversial topic. We present a large case study including all known factors relevant for prognosis. 113 ALMs in 3616 melanoma patients were paired as precisely as possible with their twins, i.e. with 113 superficial spreading melanomas (SSM) from a group of 619 SSMs with high-risk location. The ALMs and SSMs were equivalent in tumor thickness, patient gender and mode of treatment. The follow-up period was for at least 5 years. The 5-year Kaplan-Meier survival curve in both groups are identical. The poor prognosis often ascribed to ALM results from the prognostic factor location. ALM should therefore be regarded as acral localized melanoma.

Aged↗
PubMed1994

[Subclinical spread of dermatofibrosarcoma protuberans and resulting treatment modalities].

Dermatofibroma protuberans is a rare malignant tumour with a high rate of local recurrence. This is attributable to the tumour's characteristic of forming subclinical, pseudopodium-like outgrowths. Between 1981 and 1991 we treated 23 cases of dermatofibrosarcoma (9 primary tumours, 14 recurrences of tumours following initial treatment elsewhere) using the method of micrographic surgery with paraffin sectioning. Tumour size and localization were taken as parameters, along with the excision depth and the safety margin required for elimination of all tumour cells. The safety margin required for complete extirpation ranged from 5 to 60 mm. On average, recurring tumours infiltrated twice as far beyond the clinically visible tumour margin (22.4 mm) as primary tumours (10.0 mm). Up to now, no localized recurrences have been found in any patient. The therapy used here can be designated as the method of choice.

Adult↗