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Biomedical subjects

M Greulich

Publications and source records attributed to M Greulich.

At least 19 recordsLinked to original sources
PubMed2002

[Spondylodiscitis in childhood].

Spondylitis is a rare disease in childhood and atypical symptoms frequently retard the diagnosis. From 1968 to 1988, 25 children with a diagnosis of spondylitis were treated in our orthopedic hospital. Anamneses, clinical symptoms, roentgenograms, and differential diagnoses are described for these cases. Spondylodiskitis represents a mild course of the disease in childhood. Tuberculous spondylitis was not present in any of the cases. The prognosis of childhood spondylitis is favorable, and surgical interventions were not necessary in our patients. Spondylitis healed with an ankylosis of one segment of the spine without essential disturbance of spinal function.

Age Factors↗
PubMed2001

Single-stage defect repair with latissimus dorsi free flap after extensive resection of terebrant ulcer of the head: three case reports.

Three cases of advanced ulcerating basal cell carcinoma (terebrant ulcer or ulcus terebrans) of the head are reported. Neglected basaliomas had deeply destroyed larger parts of the skull in three women ages 78, 69, and 65 years when the patients were first admitted for treatment. Death due to meningitis, hemorrhage, or brain damage was imminent. Wide resection and coverage by free latissimus dorsi flaps was carried out in single-stage procedures. The latissimus dorsi, a versatile and very reliable free flap with its constant vascular anatomy and long pedicle, is the ideal flap for the coverage of large defects on the head. The donor site can usually be closed primarily, and the functional deficit is acceptable. All three patients recovered completely. Although only palliative resection could be achieved, the procedures could be justified by the increased survival time and gain in quality of life.

Aged↗
PubMed1999

[Clinical aspects and therapy of benign symmetrical lipomatosis--Madelung disease].

The clinical picture, diagnosis, therapy, and theories on the etiology of benign symmetric lipomatosis (Madelung disease) are outlined. Personal experience from 62 operations on 28 patients is compared to the literature. Up to now, there is only palliative surgical treatment for this sporadically appearing disease of unknown etiology. Liposuction--a less traumatic treatment--has considerably facilitated the treatment of the circumscribed fatty hyperplasias. The surgical characteristics of different anatomical regions are pointed out.

Adult↗
PubMed1998

[Effect of anesthesia technique on blood loss in breast reduction-plasty. A study of 56 patients operated on by one surgeon].

Since we had the impression that there was an increase in blood loss during mammaplasties after a change in the anesthesiology department responsible, we conducted a study to compare 28 cases from each anesthesiology department. All operations were carried out by the first author in succession using the same operative technique. The two groups did not differ in age, BMI, operative time, weight of resected tissue or preoperative laboratory. Blood loss was calculated from the perioperative drop in hemoglobin and patient's blood volume. Blood pressure, heart rate, medication and intravenous fluid supply were obtained from the anesthetic protocols. RESULTS (MEANS AND STANDARD DEVIATIONS): Group I (n = 28) and [Group II (n = 28)]: total resected tissue 1862 +/- 928 g [1912 +/- 791 g]; Hb-preop. 13.6 +/- 0.9 g/dl [13.8 +/- 0.8 g/dl]; Hb-postop. 10.8 +/- 1.3 g/dl [9.7 +/- 1.3 g/dl] P = 0.006; Blood loss 970 +/- 339 ml [1443 +/- 456 ml] P < 0.001. After exclusion of surgical or biological causes hemodynamic effects of the anesthetic techniques were suspected as the reason for the significant difference in blood loss. MAP was elevated only initially, while the heart rate was considerably elevated throughout the procedures in group II. During anesthesia with nitrous oxide and enflurane, the dose of enflurane in group I could be limited to 0.3-0.5% after initial i.v. administration of 60 to 100 micrograms sufentanil, while in group II without opioids doses of 0.5-2% were required. The well-known dose-dependent effect of enflurane on the peripheral vascular tone was not masked by vasoconstrictors at the operative site. CONCLUSIONS: Blood loss during mammaplasties can be affected considerably by the anaesthetic technique--even without deliberate hypotension. Sufentanil can indirectly reduce the blood loss by lowering the necessary dose of enflurane. Blood transfusions can be avoided at mammaplasties.

Adult↗
PubMed1995

Experimental and clinical study on the vitality of orthotopic cartilage transplants.

Orthotopic cartilage transplants are performed in the course of numerous rhinosurgical operations. Precondition of a permanent success of the operation is preservation of vitality of the transplanted cartilage. Although numerous study results of heterotopic cartilage transplants exist, corresponding examinations in orthotopic transplants have not been done so far. Therefore, in 33 rabbits we did a partial submucous septumresection and put the cartilage back between the mucosal wall. After 1, 2, 3, 6, and 12 weeks, the animals were killed and the cartilage histologically proved. These results were compared to analogous human biopsies. Cartilage reintegration showed a characteristic picture. In the rabbit, the replanted cartilage was healed and stable after 3 months in each case. During reintegration, appositional growth started from the inner perichondrium. With microangiographical examinations, we were able to demonstrate that the speed of reintegration increased with decreasing distance of the cartilage cell from the blood vessels. We managed to confirm the experimental results in human cartilage biopsies.

Animals↗
PubMed1995

Late results of breast reconstruction with free TRAM flaps: a prospective multicentric study.

When the free TRAM flap was introduced for breast reconstruction, it was supposed to have many advantages over the pedicled TRAM flap: good perfusion of all four zones, better mobility and easier shaping of the breast, lower incidence of abdominal-wall complications, and less restrictive selection of patients. However, we have experienced several complications after free TRAM flaps in our practice, including fat necrosis, partial and complete flap necrosis, abdominal-wall weakness, and hernias. In order to evaluate the incidence and types of complications, as well as the influence of preoperative risk factors (chemotherapy, radiotherapy, overweight, smoking habits, and abdominal scars), on complications, a multicentric prospective study including Bern (Switzerland), Leuven (Belgium), Stuttgart (Germany), and Verona (Italy) was designed. In 111 consecutive patients, operated on over a period of 18 months, 123 flaps were done; 99 flaps were unilateral and 24 bilateral, and 36 were used for primary and 87 for late reconstruction. There was no preoperative selection of patients. The follow-up period was from 8 to 24 months (average 19 months). A two-team operating approach was used. All four zones were always included in the flap, and the end-to-end anastomoses were done to the thoracodorsal, the circumflex scapular, or the internal mammary arteries. The total number of fat and flap necroses was 24 (19.5 percent), 6 (5 percent) minor and 4 (3 percent) major fat necroses, 2 (1.6 percent) minor and 6 (5 percent) major flap necroses, and 6 (5 percent) total flap necroses. Twenty-two (20 percent) patients had abdominal-wall complications. The results of this study show that the complication rate of free TRAM flaps is considerable. Preoperative risk factors did not play a major role in the development of complications and should not be considered as contraindications for free TRAM flap surgery. All total flap failures resulted from impaired arterial inflow to the flap, and the choice of recipient vessel did not influence the outcome. The incidence of total flap failures might be reduced by good postoperative flap monitoring and early revision of the anastomosis. Partial fat and flap necroses might be prevented by removing the fat under the scarpa fascia in zones 4 and 3 or by reducing zone 4. Sparingly harvesting the rectus muscle and its sheath as well as the use of mesh in the rectus sheath repair may reduce the abdominal-wall complications.

Breast Neoplasms↗
PubMed1991

[Possibilities in lower eyelid reconstruction].

Reconstruction of the lower lid is associated with aesthetic and functional problems. Different techniques are proposed. From 1985 to 1988, 17 patients have been treated by a bridge flap technique from the upper lid combined with a composite graft from the septum. In our opinion, this method is indicated in smaller through-and-through defects as well as in total lid reconstruction. The advantages of the technique are discussed and demonstrated.

Aged↗
PubMed1990

[Orbital reconstruction].

Orbital reconstruction by local flaps, distant flaps, free skin transplants or mucosal transplants, means numerous operations. Good results are often spoiled by postoperative shrinking, especially, when the patient previously had radiation. Therefore we use nowadays free flaps (forearm flap, dorsalis pedis flap) as fascio-cutaneous or fascio-mucosal flaps. By this procedure, reconstruction can be done in one or two stages and postoperative shrinking can be avoided. Our experience in 4 cases is demonstrated.

Adolescent↗
PubMed1990

[The Tsuge suture. Experimental and clinical experiences].

Microangiographic studies in the flexor profundus tendon of the rabbit show the relationship between the gaps in tendon-stumps and tendon adhesions of the suture line. Reasonably low average gaps could be achieved by the Kirchmayr/Kessler-type and by the Tsuge-type of tendon suture, which have both the same principle of fixation: solid anchorage in a set distance from the suture line and axial traction of the thread. Clinical cases show the advantages of the Tsuge suture for flat and oval tendons especially for the flexor superficialis tendon and the extensor apparatus. For distal fixation of tendon sutures to bone, pulley and tendon insertion it has also proven to be a reliable and simple technique.

Animals↗
PubMed1989

[Burn sequelae of the hand and face, when full-thickness skin transplant, when flap?].

Full-thickness skin grafts if possible and flap plasties if necessary are our common guideline for reconstruction of the face and hands after burns injuries. If the mobility of the lips, the eyelids or the fingers is limited by contracted scars, the interposition of full-thickness skin grafts is generally very helpful. This is also true for the face and the hands. Flaps are necessary for the hands if there are tendons to be covered or joints to be closed.

Adult↗
PubMed1989

[Reimplantation of a free graft of the nasal septum. Technic and indications].

Severe nasal trauma produces concomitant lesions of the pyramid and septum. These functional and cosmetic sequelae are inseparable and must be treated during the same operative procedure. Among the procedures for nasal straightening, the method of choice is ablation of the septum, intra-operative reconstruction of a continuous plate followed by reimplantation in an intact perichondro-mucosal sleeve.

Humans↗
PubMed1984

[Replantation of parts of the distal phalanx without venous anastomosis].

In six cases parts of the distal phalanx were replanted with arterial anastomosis alone without suture of a vein. With heparinisation venous haemorrhage continued for two to three days. After this time venous drainage was sufficient through new vessels and venous bleeding stops. This method is only a salvage procedure when venous congestion develops or with distal replants where venous repair is not possible.

Amputation, Traumatic↗
PubMed1980

Continent valve ileostomy.

2 years of experience with the sphincteroplasty in colostomy as well as intensive histological studies have shown that gastrointestinal smooth muscle can be autotransplanted without loosing functional or histological integrity. The following conclusions are based on experimental studies in dogs: (1) the sphincteroplasty technique can be successfully applied in ileostomy, and (2) the sphincteroplasty must, however, be combined with a pre-sphincter valve and an omega loop with Braun's anastomosis. The first clinical results confirm this concept.

Animals↗
PubMed1979

[The plasma concentration of beta 2-microglobulin in the diagnosis of malignancy of the gastrointestinal tract (author's transl)].

In patients with various stages of carcinoma of the colon-rectum (n = 42) or stomach (n = 15) the plasma concentration of beta 2-microglobulin was determined. The upper limit for normal was evaluated in a control group of healthy people (n = 36) and was found to be 2.4 mg/l. 36% of the patients with carcinoma of the colon-rectum and 27% of those with carcinoma of the stomach had higher than normal beta 2-microglobulin values. In the group of colon carcinoma patients there was a positive correlation between the extent of the tumor and the beta 2-microglobulin concentration. Thus, an appreciable frequency of increased values (greater than 50%) was found only in advanced stage carcinoma. In patients with carcinoma of the stomach only occasionally increased values were observed, independent of the stage of the tumor. In conclusion, the plasma concentration of beta 2-microglobulin is no adjunct in the early diagnosis of carcinoma of the gastrointestinal tract.

Adult↗
PubMed1979

[Continent colostomy through free transplantation of autologous colon muscles].

The study is concerned with a problem which is to a great extent still surgically unsolved, namely that of the incontinent hollow organ occlusion. We report on our own experiments on animals and on physiologicofunctional studies, which reveal the suitability of the smooth muscles as an ideal material for sphincter replacements. By histologic research it became obvious that autotransplantations of smooth muscles, carried out for the first time by the Department of Surgery of the University of Würzburg, are possible without significant tissue changes. The transplant is soon supplied by vessels which sprout ubiquitously and completely permeate it so that it can take over its function as sphincter. Meanwhile, the experience gained in experiments on animals has been transferred to surgery on humans. Incontinence and incontinence of the preternatural anus were eliminated in the first operations using autologous autotransplanted sphincteroplasties.

Animals↗
PubMed1979

[Arguments for suturing of a gap in the flexor tendons of fingers].

1. Tendon healing may originate from the vascularized epitenon of the tendon stumps. 2. This is dependent upon the gap between the tendon stumps being rather small. 3. In tendon sutures after Kessler the gap averaged only 2.5 mm, whereas the average after Bunnell suture was 6.7 mm and after Lengemann suture, 9.8 mm. 4. After isolated division of the deep flexor tendon (80% of cases) and division of both flexor tendons (65%), good results with a distance = 2.5 cm between the nail and the distal palmar crease could be obtained.

Age Factors↗
PubMed1979

[Direct flexor tendon suture in the digital sheath].

From 1976 to 1976 in 44 fingers (41 patients) flexor tendons within the digital sheath (zone I and II) were repaired by direct suture. A modification of KESSLER's "grasping" suture was employed. In 21 fingers only the deep flexor and in 23 fingers both flexor tendons were divided; in these cases a repair of both tendons was carried out whenever possible. In cases of delayed repair, however, secondary changes of the gliding apparatus often prevented a repair of the superficialis tendon. Tenolysis was proposed in one half of the cases. It was done not earlier than 3 months after tendon suture. After division of both flexor tendons we obtained in cases with good preoperative conditions (21 fingers) 66% of good and excellent results, according to BOYES' classification, and 75% according to BUCK-GRAMCKO's classification.

Adolescent↗