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H Breuninger

Publications and source records attributed to H Breuninger.

At least 73 records · Page 4Linked to original sources
PubMed1994

[Prognostic advantage for defined risk groups by lymphocyte dissection. Long-term study of 3,616 melanoma patients].

Nine medical centres with different practices in elective lymph node dissection (ELND) but comparable standards regarding diagnosis, excision of the primary tumour, classification, and follow-up, have collected their data on 3616 patients with primary melanoma of the skin (tumour category pT 2 to pT 4a, N 0, M 0 [UICC 1987] with the aim of producing an unbiased analysis of the prognostic benefit of ELND. The multivariate risk analysis (Cox's proportional hazard model) revealed tumour thickness (Breslow or alternative pT categories), sex, anatomic site of the primary tumour, and ELND therapy ("yes" or "no") as independent prognostic factors. Observed survival curves (Kaplan-Meier) show a significant difference of prognosis with regard to ELND therapy in the following risk groups: women with melanomas over 2.5 to 4 mm thick on head, neck, thorax, and in acral locations; men with melanomas over 1.5 to 4 mm thick on head, neck, thorax, and in acral locations; and finally men with melanomas over 2.5 to 4 mm thick on abdomen and extremities. Further investigations and the discovery of additional prognostic factors would help in more precisely formulation of guidelines for ELND.

Adult↗
PubMed1994

[Melanoma metastasis in the oropharynx].

Malignant melanomas of the upper respiratory tract are rare tumors but even rarer are their metastases in this region. Between 2% and 3.6% of malignant melanomas of the head and neck occur in the upper respiratory tract. We report a case history of a 48-year-old patient who underwent excision of a superficial spreading melanoma (tumor-thickness, 2 mm) from his trunk and later radical dissections of metastases in his axilla and groin. Chemotherapy with DTIC, an alpha-interferon, was performed. During follow-up, CT-scan demonstrated a 1 cm asymptomatic metastasis in the nasopharynx. Nasal endoscopy confirmed the CT finding as a dark tumor mass in the mucosa of the roof of the nasopharynx, close to Rosenmüller's fossa. Tumor was excised by a temporary split of the soft palate.

Chemotherapy, Adjuvant↗
PubMed1993

Benefit of elective lymph node dissection in subgroups of melanoma patients. Results of a multicenter study of 3616 patients.

BACKGROUND: The benefit of elective lymph node dissection (ELND) for the treatment of the nonmetastasized malignant melanoma has been assessed differently until today. METHODS: Nine medical centers with a different ELND practice but comparable standards regarding diagnosis, excision of the primary tumors, classification, and follow-up, have collected their data (primarily ascertained prospectively) of 3616 patients of the tumor categories pT2 to pT4N0M0 to produce an unbiased analysis of the prognostic benefit of ELND, and to find the indications for its application. The data are based on patients 70 years of age and younger with a primary melanoma of the skin, who have been followed for at least 4 years (median, 9.6 years). The stratification (according to pT category [alternatively, tumor thickness], sex, anatomic site) was in accordance with the results of the multivariate risk analysis (Cox hazard model). Imbalances of other criteria such as ulceration, type, and age were excluded by chi-square tests of the individual strata. The results are based on the observed survival rates according to Kaplan-Meier analysis of the different strata. RESULTS: A prognostic benefit of the ELND group (improvement of the 5-year survival rate of about 20%) can be claimed for male patients with axial and acral melanomas (excluding lentigo maligna melanoma [LMM] and ulcerated tumors) of the categories pT3a up to pT4a (tumor thickness of > 1.5-4.5 mm, respectively) (P < 0.001). As to the rest of the nonulcerated tumors of male patients, only those of the categories pT3b and 4a benefited from ELND (P < 0.01). A benefit from ELND for women was statistically verified (improvement of the 5-year survival rate of about 5%-10%) only for the subgroup with a tumor thickness > 2.5-5 mm, excluding LMM) (P = 0.016). CONCLUSIONS: This retrospective study strongly suggests the efficacy of ELND in subgroups of melanoma patients.

Adult↗
PubMed1993

Intracutaneous butterfly suture with absorbable synthetic suture material. Technique, tissue reactions, and results.

BACKGROUND: Tension on surgical wound edges is often an obstacle to proper closure and good cosmetic results in dermatologic surgery. OBJECTIVE: A buried, butterfly-shaped, interrupted suture has been developed to remedy this. The suture is anchored very broadly in the corium, the knot is below the corium. The butterfly suture can be supplemented by a temporary running suture or by close-set, superficially placed interrupted sutures. METHODS: This technique was studied in a follow-up of 876 operations, with histologic study of 60 scars resulting from the suture. In particular, the specific advantages and disadvantages of two synthetic suture materials were compared: monofilament (polydioxanon) and polyfilament (polyglactin 910). RESULTS: Polydioxanon sutures were found to be clinically superior. It was important, however, that the suture knot be deeply anchored and that the surgeon be experienced. CONCLUSION: Cosmetic results of 18,000 procedures with this suture over a period of 6 years were found to be clearly better than those of surgery with conventional sutures.

Absorption↗
PubMed1992

Demonstration of proteases in basal cell carcinomas. A histochemical study using amino acid-4-methoxy-2-naphthylamides as chromogenic substrates.

BACKGROUND: Proteases are reported to play an essential part in the proliferative, invasive, and metastasizing behavior of malignant tumors. The aim of the current study was to determine the activity and localization of proteases in basal cell carcinomas (BCC) histochemically. METHODS: Various proteases were identified histochemically in frozen sections of BCC. The following amino acid-4-methoxy-2-naphthylamides (MNA) were used as chromogenic substrates:alanine-MNA for the detection of aminopeptidase M (APM), glycyl-proline-MNA for dipeptidyl peptidase IV (DPP IV), lysyl-proline-MNA and lysyl-alanine-MNA for dipeptidyl peptidase II (DPP II), glycyl-arginine-MNA for dipeptidyl peptidase I (DPP I), and carbobenzoxy (CBZ)-arginyl-arginine-MNA for cathepsin B. RESULTS: APM activity was high in the peritumorous connective tissue, whereas the tumor epithelium and epidermis had negative results. DPP IV showed a highly positive reaction in both tumor epithelium and surrounding connective tissue. Cathepsin B and DPP I reacted strongly in the tumor epithelium but not in the peritumorous connective tissue. CONCLUSIONS: The marked activity of APM, DPP IV, DPP I, and cathepsin B may be related to the proliferation and invasive growth of BCC. The distribution of the activity of APM and DPP IV indicates dynamic interactions between the tumor epithelium and the adjacent connective tissue in the neoplastic process.

2-Naphthylamine↗
PubMed1992

[Quantitative analysis of recurrence and spontaneous regression of basalioma parts left in situ].

To some extent, parts of basalomas found remaining in situ following tumour excision tend to spontaneous regression. This is a well-known phenomenon and has significance for the recurrence of incompletely excised tumors. The present study involved a quantitative investigation of the relationship between recurrence and spontaneous regression. Following precisely defined excision of basalomas, the entire exterior of the excised material was examined by contrast microscopy in HE-stained paraffin sections (3-dimensional histology). Whenever tumour outgrowths were found, it was possible to document exactly their type, localization, extent, and depth of invasion. In 66 such cases no follow-up operation was performed, but only a follow-up examination after a minimum of 31 and a maximum of 113 months (average: 60 months). Only 50% of these undisturbed tumour outgrowths resulted in a recurrence during the follow-up period. A very high rate of spontaneous regression (71%) was found among the solid tumour outgrowths, but a significantly lower rate (19%) among the fibrosing tumours. Moreover, regression was dependent on the tumour remnant's mass and the clinical diameter of the tumour removed. It was independent of the depth of infiltration. Although the rate of spontaneous regression of tumour outgrowths persisting after therapy is relatively high, it cannot be predicted in individual cases. It is not possible to be certain that tumour removal has been achieved unless micrographic surgery has been continued until complete absence of tumour is proved. In all procedures that are not subsequently monitored, an unacceptably high rate of recurrence must be expected, especially in the case of fibrosing basaloma. This is commented on at length.

Aged↗
PubMed1991

Destruction of tumour parenchyma in basal cell carcinoma by tumour-associated neutral proteases: a histochemical study.

Proteolytic activity was demonstrated histochemically in frozen sections of basal cell carcinomas (BCCs). After incubation of tissue sections in 0.1 M phosphate buffer with 0.25 M NaCl the tumour epithelium was almost completely destroyed. The basal and squamous cell layers of the epidermis disintegrated to varying degrees, particularly where they were directly in contact with tumour epithelium. Serine and metalloprotease inhibitors diminished this tissue destruction. Iodoacetate enhanced tumour destruction, urea and potassium thiocyanate even more so. The high proteolytic activity of BCC demonstrated in this study may be an important factor in the proliferative, invasive and destructive behaviour of this tumour.

Basal Cell Carcinoma↗
PubMed1991

Prediction of subclinical tumor infiltration in basal cell carcinoma.

Two thousand-sixteen basal cell carcinomas (BCCs) were documented in terms of age, anatomic location, tumor diameter, initial excision depth, safety margin, histologic type, and the position of tumor outgrowths as determined by three-dimensional histologic study of the tumor margins in paraffin sections (micrographic surgery). The extent of each subsequent excision was recorded until tumor-free tissue was reached. The results showed that BCCs have a highly irregular infiltration pattern and a predilection for small, fingerlike outgrowths whose bases occupy 1-30 degrees of the tumor circumference. When superficial extension was expressed mathematically, the resulting exponential functions varied highly significantly (P = .001) according to histologic tumor type and diameter. The resulting curves permitted very precise prediction of the probability of tumor-positive margins (ie, subtotal excision), depending on the safety margin, histologic tumor type, and tumor diameter. For example, the probability of tumor-positive margins after excision of a BCC up to 10 mm in diameter is 30% with a safety margin of 2 mm, 16% with a safety margin of 3 mm, and 5% with a safety margin of 5 mm. The probability of tumor-positive margins for fibrosing primary BCCs 10-20 mm in diameter is 48, 34, and 18% with safety margins of 2, 3, and 5 mm, respectively. Recurrent tumors have a significantly higher probability of positive margins (P = .001) than primary ones. Anatomic location and tumor age affect subclinical extension only indirectly.

Basal Cell Carcinoma↗
PubMed1991

[Condylomata acuminata--topical and systemic interferon therapy].

An open study was carried out to test the effect of systemic administration of interferon (IFN) gamma and local application of IFN beta as monotherapy and adjuvant treatment. The topical application of IFN beta gel had no effect as monotherapy and when it was given as adjuvant therapy the rate of recurrence was not significantly reduced. IFN gamma was given for monotherapy in two different doses (100 and 200 micrograms per s.c. injection). The response rate to the cyclic treatment was 45% in the group (20 patients) receiving a dosage of 100 micrograms, and 57% in the group (26 patients) receiving a dosage of 200 micrograms. Patients with a duration of the disease longer than 18 months and patients with immune deficiency did not respond to the monotherapy. A group of 15 patients with resistant genital warts received adjuvant treatment with IFN gamma over 7 days after surgical treatment. In patients with inconspicuous immune status it was possible to reduce the recurrence rate.

Condylomata Acuminata↗
PubMed1991

[Locally infiltrative growth of squamous cell carcinoma of the skin and treatment guidelines resulting from it].

The infiltrative growth behaviour of squamous cell of the skin carcinomas is characterized by subclinical outgrowths, very frequently extending horizontally and sometimes over long distances. They are presented in the form of a negative exponential function. These outgrowths have an irregular pattern. It is much more extensive in the case of tumours with a clinical diameter of more than 20 nm. All types of "blind" therapy such as cryopexy, irradiation, laser, and surgery monitored in only two dimensions involve an inevitable risk of recurrences, which can be calculated statistically from the results available. Routine histographical surgery of skin carcinomas in the form of continuous, 3-dimensional histology can dramatically reduce the risk of local relapse, especially in the case of small and medium-sized carcinomas. The test group presented here (411 carcinomas) was treated with histographic surgery using the paraffin section method; during the follow-up period (maximum: 7 years, minimum: 3 years) the danger of recurrence was 2.2% for all carcinomas but only 0.6% for those up to 20 mm in diameter (n = 340). Carcinomas with a diameter of more than 20 mm (n = 71) involved a much higher risk of recurrence with 9.8%. This is probably because of local micrometastases, which require more generous local excision with a safety margin of about 10 mm.

Carcinoma, Squamous Cell↗
PubMed1990

Microstaging of squamous cell carcinomas.

The clinical classification of squamous cell carcinoma, which was established primarily by the International Union Against Cancer (UICC), does not permit optimal estimation of expected metastasis. The authors' results indicate that metastasis can be more accurately estimated on the basis of invasion depth, histopathologic grading, and especially tumor thickness. One essential advantage of these criteria is that they can be established by a histopathologist. It is interesting to note that in the authors' collective no carcinoma less than 2 mm thick metastasized, that is, a relatively high percentage of carcinomas (48%) can be graded as no-risk carcinomas. The risk of metastasis for undifferentiated carcinomas greater than 6 mm thick that have infiltrated the musculature, the perichondrium, or the periosteum, however, is quite high. Tumors between 2 and 6 mm thick with moderate differentiation and a depth of invasion that does not extend beyond the subcutis can be classified as low-risk carcinomas.

Carcinoma, Squamous Cell↗
PubMed1990

[The subclinical portion in the periphery of lentigo maligna and lentigo maligna melanoma].

Lentigo maligna is a precancerosis or a melanoma in situ, whose level of malignancy has not yet been definitively clarified. Recurrences are not rare after excision, even when an ample safe margin is observed. One reason for this is the existence of a subclinical ramification in the marginal area of the lentigo maligna. Such subclinical ramifications were investigated by means of excision with histological monitoring of the margins by the paraffin section technique. There was a clear relationship between the frequency of these ramifications and the clinical safe margin left in 64 excisions. With the aid of parametric evaluation methods the distribution of the subclinical portion referred to the distance from the clinical margin could be determined with a special formula. If an invasion, in the form of a lentigo maligna melanoma had already taken place, then the subclinical portion within the marginal area was significantly more extensive. For the treatment of lentigo maligna, and especially of lentigo maligna melanoma, we therefore recommend excision with histological monitoring of the margins. There were no local recurrences within an average follow-up period of about 2 1/2 years.

Adult↗
PubMed1990

[In vitro studies of the effect of a mistletoe preparation on melanoma cells].

In concentrations usually achieved in vivo, extracts of mistletoe (e.g. Iscador) exert no direct action on melanoma cells or human fibroblasts in tissue cultures. Only very high concentrations of Iscador in combination with prolonged incubation time (over several days) resulted in damaging the cells irreversibly. Therefore we are not able to confirm the suggestion that mistletoe extracts exert a deleterious action selectively on malignant cells.

Adult↗
PubMed1989

[Depth of invasion of basaliomas].

The infiltration depths of 1421 basal cell carcinomas (BCC) were determined by means of the mid and basic sections of excised tumor specimens. According to our findings, BCC shows peripheral spreading in the majority of the cases. Deep infiltration primarily occurs in large tumors, scirrhous forms, tumors with exophytic growth or ulceration, and particularly in recurrent BCC. Because of the asymmetric infiltrative growth in depth, conventional evaluation of the mid-section does not provide satisfactory information on the question of radical removal in depth. Therefore, histological control of excisional margins is absolutely essential at least in the tumors mentioned above. The proportion of the tumors with subtotal excision in depth at the first operation was 5.9% for primary BCC and 14.8% for recurrent BCC. In almost all these cases, radical removal could be achieved by re-excision into a deeper layer.

Basal Cell Carcinoma↗
PubMed1989

[The margin of safety and depth of excision in surgical treatment of basalioma. Use of 3-dimensional histologic study of 2,016 tumors].

During the treatment of 2016 basal cell carcinomas (BCC), 1757 of which were primary tumours and 259, recurrences, every operation was followed by a check on radicality by means of histological evaluation of the margins of the excised tissue (three-dimensional histology). The average safe margin at first excision was 3.8 mm, and excision normally extended to the lower subcuticular border in depth. After first excisions, tumour tissue was found in 31.6% of histological sections prepared from the marginal sections at the circumference and/or on the underside of the excised material. Tumour material was far more frequent in the marginal area (28.3%) than on the underside (7%). With a 2-mm safe margin around the primary BCC there were still 46.7% tumour-positive marginal sections; with 4 mm, 20.3%; and with 6-8 mm, 14.7%. Fibrosing BCC and tumours with diameters over 20 mm, and recurrent BCC in particular had a significantly larger share of tumour-positive marginal sections and considerably more frequently required two or more reoperations until the final radical excision than did the solid and superficial types of BCC. An average safe margin of 4.5 mm plus standard deviation to give 7 mm (standard deviation 2.5 mm) was necessary for radical excision of primary BCC, but often even larger margins, up to a maximum of 3.2 mm were necessary. Hence, when surgical treatment of BCC does not include three-dimensional histological evaluation generous safe margins are necessary. Surgery with histological monitoring is the only justifiable method of treating tumours of the fibrosing type, recurrent BCC and BCC over 10 mm in diameter.(ABSTRACT TRUNCATED AT 250 WORDS)

Basal Cell Carcinoma↗
PubMed1989

[Long-term experiences with histologic control of the incision margin (3-D histology)].

In order to make sure that malignant tumors of the skin are excised completely, excisional margin control has been performed in our department for 8 years. For this purpose, tissue is excised, fixed in formalin and embedded in paraffin. The tumor and the excisional margins are examined separately. A total of 2016 basal cell carcinomas have been followed up for up to 4 years. If histological examination of the excised margins still show evidence of the tumor, re-excision is performed until the excised margins are free of the lesion. This procedure has proven to be very successful, with a recurrence rate of only 0.35%. The tissue is processed in a routine histology laboratory according to standard procedures.

Basal Cell Carcinoma↗