Search PubMed⌕ Search

Biomedical subjects

H Millesi

Publications and source records attributed to H Millesi.

At least 37 records · Page 2Linked to original sources
PubMed1995

Resection-replantation for primary malignant tumours of the arm. An alternative to fore-quarter amputation.

We describe a method of partial limb salvage for the treatment of large primary malignant tumours of the arm. The tumour-bearing area is resected as a cylindrical segment and the distal arm is then replanted with the necessary shortening. The method is suitable for stage-IIB tumours with or without neurovascular involvement which, because of their extent, could otherwise be adequately treated only by amputation. From 1987 to 1992 we used this method in 12 patients with primary malignant bone or soft-tissue sarcomas. Wide resection margins were achieved in all, but six patients died from their disease at a mean of 21.5 months (6 to 48), none with any local recurrence. Five patients have no evidence of disease at a mean follow-up period of 52.2 months (22 to 78), and one was lost to follow-up at 48 months postoperatively when there was no evidence of disease. The results of the functional evaluation of ten patients with a follow-up of over ten months were excellent in one, good in six and fair in three, by the criteria of Enneking (1987). Recovery after nerve reconstruction was satisfactory in all cases with sensation S3 or higher and motor function M2+ or higher. Detailed evaluation of hand function on the Millesi score rated only 22% (9.6% to 33.7%) as compared with the contralateral side, but the patients were satisfied and refused further operations for the improvement of function. These oncological and functional results allow us to recommend resection-replantation as a valuable alternative to amputation for the treatment of primary malignant tumours of the arm.

Adolescent↗
PubMed1994

Intraoperative spinal root stimulation to detect most proximal site of leprous ulnar neuritis.

In 10 patients with leprous ulnar neuritis, we investigated the most proximal site of lesion in the affected nerves. Spinal roots C8 and T1 were stimulated intraoperatively to evoke efferent mixed compound nerve action potentials which were recorded from the exposed ulnar nerves. The site at which amplitudes reached a maximum was considered the most proximal site of lesion. Nerve damage was found far proximally from the thickened segments in otherwise inconspicuous sections. Epineuriotomy within these apparently unaffected segments revealed fibrosis of the interfascicular epineurium in 9 patients, which is an indication for microsurgical interfascicular neurolysis.

Action Potentials↗
PubMed1994

Prevalence of HLA-DR3 and autoantibodies to connective tissue components in Dupuytren's contracture.

Forty-six patients with Dupuytren's contracture (DC) and 55 control persons were HLA-typed for class I and HLA-DR class II antigens and were investigated for the presence of autoantibodies against elastin (ELAB) and collagen types I-IV (ACA I-IV). Using the chi 2 test, obtained from 2 x 2 contingency tables, a significant association was found between DC and HLA-DR3 and autoantibodies to types I-IV collagen. ELAB and ACA I and III were significantly correlated with HLA-DR3 in the whole group of patients plus controls. In analogy to other diseases with autoimmunologic features the presence of HLA-DR3 therefore seems to indicate a higher risk for the formation of connective tissue autoantibodies. The remodeling processes during the course of fibrosis in DC might be responsible for this autoantibody formation.

Adult↗
PubMed1994

Superficial branch of the radial nerve emerging between two slips of a split brachioradialis muscle tendon: a variation of possible clinical relevance.

One hundred and fifty upper extremities of 75 nonrandomized human cadavers were dissected to study the topographical relationship between the brachioradialis muscle tendon (BRMT) and the superficial branch of the radial nerve (SBRN). A split BRMT was found in nine arms, while in five of those nine arms the SBRN emerged from under the brachioradialis muscle between the two slips of a divided BRMT to become superficial. This topographical relationship is mentioned sparsely in very old literature, yet its frequency has not been studied before. Further clinical investigations should be undertaken to study the clinical relevance of the above-mentioned topographical relationship.

Female↗
PubMed1993

Microsurgical neurolysis: its anatomical and physiological basis and its classification.

Neurolysis is a procedure which has to be performed if the gliding apparatus of a peripheral nerve does not function, and consequently, adhesions and fibrosis develop. The gliding tissue has to provide the ability for the nerve to adapt to the different position of the extremity by longitudinal passive movement. The paraneurium provides movements between the nerve and the surrounding tissue; the interfascicular epineurium provides the possibility of the movement within the nerve. Internal neurolysis is defined as surgery within the nerve if the epifascicular epineurium is completely transected. A classification of different degrees of fibrosis is given with special reference to the procedure which has to be done in each case. Neurolysis is a step-wise procedure with the aim to decompress the fascicles and which is immediately stopped if this aim is achieved. In very severe cases, if the gliding tissue does not regenerate, a gliding tissue flap to envelope the nerve may solve the problem.

Cicatrix↗
PubMed1993

[Pain syndromes of the tibial nerve at the leg-foot transition].

The prognosis of surgical treatment of the tarsal tunnel syndrome (TTS) with regard to total pain relief is worse than following surgery of the carpal tunnel syndrome. In TTS, additional static factors play a role. The indication for surgery, therefore, is made with utmost reluctance. The surgical strategy is described extensively. In the majority of patients a considerable improvement of symptoms can be achieved. There are, however, individual patients in whom surgical intervention is followed by increased pain. Three such patients are reported. This pain syndrome is caused and increased by recurrent fibrosis of the nerve bed, eventually including the integument and inducing entrapment neuropathy by the contracted dermal covering. Surgical resolution of this problem is transplantation of soft tissues to surround the nerve and skin grafting to augment the covering dermal layer.

Adult↗
PubMed1992

Are growth alterations a consequence of surgery for prominent ears?

This study was undertaken to detect growth alterations after surgery for prominent ears. The cartilage excision technique was used in all 76 patients seen for follow-up. Two hundred students served as controls. Auricular measurements were done according to standardized guidelines of anthropometry. There was no significant difference in the retroauricular angle between the surgical group and controls. The morphologic ear length in the surgical group was significantly smaller than in controls. Maximum ear length was significantly greater in men. Our measurements in the control group were significant below the reference values reported in the literature. Comparing the ear index of both groups with published data, we found a harmony between the width and the length of the ear. We could demonstrate that prominent ears were significantly larger in all other dimensions and that auricular growth does not stop following surgery for prominent ears with the cartilage excision method. We also evaluated subjective criteria such as tolerance to cold, scar formation, and patient satisfaction.

Adult↗
PubMed1992

Are growth alterations a consequence of surgery for prominent ears?

This study was undertaken to detect growth alterations after surgery for prominent ears. The cartilage excision technique was used in all 77 patients seen for follow-up. Two hundred students served as controls. Auricular measurements were done according to standardized guidelines of anthropometry. There was no significant difference between the retroauricular angle in the surgical group and in controls. The morphologic ear length in the surgical group was significantly smaller than in controls. Maximum ear length was significantly greater in men. Our measurements in the control group were significant below the reference values reported in the literature. Comparing the ear index of both groups with published data, we found a harmony between the width and the length of the ear. We could demonstrate that prominent ears were significantly larger in all other dimensions and that auricular growth does not stop following surgery for prominent ears with the cartilage excision method. We also evaluated subjective criteria such as tolerance to cold, scar formation, and patient satisfaction.

Child↗
PubMed1991

Biomechanical properties of elastase treated palmar aponeuroses.

Human palmar aponeurosis was treated with elastase in the presence or absence of soybean trypsin inhibitor. The removal of elastic fibers was complete as proved by electron microscopy. Cyclic loading was performed at a constant strain rate. Residual strain was measured and the stiffness and the fraction of dissipated energy of strain energy was calculated and compared to that of untreated samples of palmar aponeurosis. Residual strain and dissipated energy showed a dramatic increase after enzyme treatment, both in presence and absence of soybean trypsin inhibitor. Stiffness, on the other hand was reduced. The remaining collagen fibers show a more viscous behavior. Our results support the hypothesis that the elastin fibers are responsible for the elastic recovery, observed on specimens of untreated palmar aponeurosis.

Adult↗
PubMed1990

The gliding apparatus of peripheral nerve and its clinical significance.

Every nerve must have the capacity to adapt to different positions by passive movement relative to the surrounding tissue. This capacity is provided by a gliding apparatus around the nerve trunk. There is another level of gliding provided by the interfascicular epineurium which allows the fascicles to glide against one another. The clinical significance of the gliding apparatus in the context of external and internal neurolysis and nerve repair is discussed. An explanation is offered for the occurrence of the so-called meander-like deformity of fascicles, seen in nerve entrapment syndromes.

Elasticity↗
PubMed1990

[Results of decompression of the ulnar nerve in Guyon's canal].

Between January 1980 and March 1988 twenty-two patients with compression neuropathies of the ulnar nerve in the Guyon's canal were treated. In seven patients the ulnar nerve was simultaneously decompressed at the elbow. Nine patients suffered from disorders of the sensibility and thirteen patients had sensory and motor symptoms. The ulnar nerve compressions were caused by a ganglion, a thrombosed aneurysm of the ulnar artery, or an aberrant branch of the ulnar artery; in ten cases by the fibrotic arch of the origin of the hypothenar muscles and in eight cases by the roof of the Guyon's canal. In one case no abnormality could be found. The follow-up of twenty-one patients showed, that the sensibility was improved or normalized. The motor function was normalized or improved in three patients and remained unchanged in four patients. No correlation could be found between the postoperative results, the intraoperative findings, the patients' age and the period of symptoms.

Adult↗
PubMed1990

[The gliding tissue of the median nerve in the carpal tunnel].

Passive movement of nerves is possible because the epifascicular epineurium is connected to the surrounding tissue by a loose connective tissue. In the carpal tunnel tendon sheaths have been developed to facilitate gliding of tendons produced by muscle contraction. By cadaveric dissection and by intraoperative examination of the carpal tunnel, a special gliding tissue of the median nerve could be demonstrated. Injection of fluid into the tissue revealed a sheath-like structure with a space between the layers limited both proximally and distally. Intraoperatively a parietal layer of loose connective tissue and several layers surrounding the median nerve could be demonstrated.

Connective Tissue↗
PubMed1989

[Is intraneural neurolysis in ulnar nerve sulcus syndrome justified?].

A follow-up of thirty-seven patients with ulnar nerve entrapment at the elbow is presented. External neurolysis was performed in fourteen cases, whereas internal neurolysis involving interfascicular dissection was performed in twenty-three cases. When indicated, internal neurolysis can lead to very good results. However, unnecessary interfascicular dissection may result in unwarranted impairment of hand function.

Elbow↗
PubMed1989

[Elastic behavior of the median nerve and ulnar nerve in situ and in vitro].

This study was performed to investigate the mechanical properties of the median and the ulnar nerve in ten fresh cadaver extremities in situ and in a second series in vitro in a strain controlled testing equipment. In situ the nerves were fixed in the equipment at the level of the insertion of the pectoral muscle. The extensions of the nerves were tested in the undissected bed of the nerve with loads from 2 to 25 Newtons. The extension rate of three sections was measured: A: Axilla-wrist, B: Axilla-forearm, C: Axilla-elbow. On the contralateral arm the section D: Axilla-wrist was measured after cutting the nerve's branches without destroying the nerve's bed. The values of the section A, B, and C were significantly different. The nerves were less extensible the more distal the load was fixed. The values of the two sections with equal length A, without, and D, after cutting the nerve's branches also were significantly different (p less than 0.001). The in vitro series showed that the nerves were more extensible after removal of the connective tissue of the nerve's bed.

Biomechanical Phenomena↗
PubMed1988

Sonoanatomy of the muscles of facial expression.

Primary anatomic studies served for identification and differentiation of the individual mimetic muscles. As a second step, we investigated the clinical potential of ultrasound imaging to visualize the mimetic musculature in 15 volunteers. This examination technique was used to diagnose pathological alterations, especially associated with facial palsy. The excellent sonographic visualization of the mimetic musculature indicates that this technique may be a valuable adjunct in the diagnosis and differentiation of facial palsy, as well as in planning plastic surgery and reconstructive procedures, and in follow-up care.

Adolescent↗