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Biomedical subjects

P Brenner

Publications and source records attributed to P Brenner.

At least 55 records · Page 3Linked to original sources
PubMed1996

[What is the advantage of free microvascular tissue transfer after pelvic exenteration? A argument for delayed primary management].

Locoregional pelvic recurrences are amenable to re-resection even if musculoskeletal fixation is present. This report updates our experience with pelvic composite resections and microsurgical closure of the perineal cavity by nine latissimus dorsi flaps, one as a bilobed type combined with a scapula flap. All flaps survived. There was one rupture of the vascular pedicle following repositioning of the patient. Another flap healed completely, but presented a wound rupture with secondary healing in the area of the rima ani. Three major advantages to this method have been proven: (1) Healing and hospitalization could be reduced compared to conservative treatment; (2) The latissimus dorsi transfer allows stable perineal coverage and closure of dead space, preventing any pelvic herniation; (3) Performed as a delayed procedure the free tissue transfer is well tolerated by the patient.

Adult↗
PubMed1995

Significance of prophylactic urodilatin (INN: ularitide) infusion for the prevention of acute renal failure in patients after heart transplantation.

Acute renal failure is a serious problem following heart transplantation. In first uncontrolled clinical trials, Urodilatin revealed beneficial effects in the prophylaxis and therapy of acute renal failure following heart and liver transplantation. Here, we present the first randomized, placebo-controlled, double-blind study on 24 patients following heart transplantation to investigate whether prophylactic i.v. Urodilatin infusion can prevent acute renal failure requiring renal replacement therapy. Postoperative drug management was characterized by intravenous application of high furosemide, cyclosporine, and vancomycin doses. Urodilatin infusion was started postoperatively with a dose of 40 ng / kg bw / min for 6 days. 6 of the 12 patients in the Urodilatin group and 6 of the 12 patients in the placebo group had a stable diuresis (3 - 4 l / day) during the study period of 6 days. In contrast, the remaining 6 patients of each group developed oliguria / anuria and required subsequent hemofiltration / hemodialysis. Cumulative duration of hemofiltration (88 +/- 7.39 hours in the placebo treated patients versus 44 +/- 5.35 hours in the Urodilatin treated patients, p < 0. 05) as well as frequency of hemodialysis (3.0 +/- 0.49 times in the placebo group vs 1.2 +/- 0.29 times in the Urodilatin group, p < 0. 05) were significantly reduced using Urodilatin. Mean arterial blood pressure was stable during the Urodilatin infusion period and was not different to that observed in placebo patients. We conclude that Urodilatin does not reduce the incidence of acute renal failure and the subsequent requirement for hemofiltration / hemodialysis in our patient population, but seems to reduce the duration of hemofiltration and frequency of hemodialysis compared to the placebo group.

Acute Kidney Injury↗
PubMed1995

Secondary surgery following brachial plexus injuries.

The favourable treatment of post-traumatic brachial plexus lesions based on our experience of 362 cases over a 12 year period is reported. Twenty-five percent of the patients needed secondary operations. The spectrum of the latter consisted of arthrodesis, tenodesis, and musculotendinous transfer, including free neurovascular tissue transfer partially innervated by nerve transposition. Functionally, secondary tendon transfer can help to improve the effect of nerve repair techniques. To restore shoulder function the trapezius transfer (n = 22) has been used mainly; elbow flexion has been regained by pedicled latissimus dorsi translocation (n = 22), triceps-to-biceps transfer (n = 18), bipolar latissimus muscle transfer, and free neurovascular tissue transfer (n = 8). The Steindler flexorplasty was performed in four plexopathies, and finally a pedicled serratus muscle transfer was used. A unipolar latissimus dorsi transfer results in an ability to lift 10-15 kg, whilst the bipolar latissimus transfer and the triceps-to-biceps transfer produced a maximal strength of 5-8 kg. Epitrochlear flexor-pronator mass transfer produced a strength of 2-5 kg, whereas free neurovascular latissimus dorsi transfer developed a maximal muscular strength of 2-4 kg in the unipolar variation and 1-2 kg for the bipolar LD. In 97 secondary procedures to the lower arm and hand the following secondary operations were indicated: in 29 cases of radial nerve palsy transfers according to Merle d'Aubigne, a further 21 wrist tenodeses and 8 wrist arthrodeses were performed. To restore median nerve function, coupling tendon transfer (n = 4) and free neurovascular gracilis transfer (n = 3) were selected.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthrodesis↗
PubMed1995

[Solitary glomus tumors of the hand. A clinico-pathologic evaluation study].

The incidence of recurrence following surgical treatment of solitary tumours of the hand ranges from 12% to 50%. Examination of the reports in the literature reveals that different methods of histological typing have been used and that most of the publications available are case reports or refer to studies of small numbers of patients, so that direct adequate comparison of the rates in the literature is not possible. In an attempt to find out the reasons for local recurrence of retrospective clinicopathological study was performed. All histological specimens examined within one decade were analysed. The tumours they were taken from included 46 glomus tumours (female: male ratio 28:18, age range 9-82, average 52.3 years) of different locations, 30 of them affecting the upper extremity. We had operated on 13 solitary, digitopalmar glomus tumours (8 vascular type, 3 epitheloid solit type, 1 myxoid, 1 neural) in our institution, in most cases with the aid of either a magnifying lens or an operating microscope. The mean follow-up period was 76 months, and we had no recurrences. Therefore, we conclude that regardless of the histological type, optical magnification during surgical resection of solitary glomus tumours of the hand prevents recurrences. In our opinion, early recurrences are due to incomplete excision of tumours of the types mentioned above or to misdiagnosis because of the multiple forms of glomus tumours that can occur, especially during childhood.

Adolescent↗
PubMed1995

Experience with the Novacor left ventricular assist system as a bridge to cardiac transplantation, including the new wearable system.

The three components of the Novacor left ventricular assist system, compact controller, battery, and back-up battery, have been miniaturized in the development of the wearable system. Therefore patients can be fully mobilized receiving mechanical circulatory support while awaiting heart transplantation. Between February 1992 and April 1994 a total of eight patients with decompensated heart failure (6 dilated cardiomyopathy, 1 acute myocarditis, 1 ischemic cardiomyopathy) were treated with the Novacor left ventricular assist systems. In the most recent four cases the wearable system (N100P) was used. Patients' ages ranged from 17 to 49 years. In five patients severe failure of the right side of the heart was present at the time of implantation. Hemodynamic stabilization was achieved in all patients during the 2 to 122 days (mean 30.8 +/- 42.5 days) of support. The following parameters were measured on average before and 24 hours after implantation of the left ventricular assist system: mean arterial pressure 70 +/- 11 versus 87 +/- 13 mm Hg (p < 0.05), cardiac index 1.71 +/- 0.42 versus 3.23 +/- 0.74 L/min/m2 (p < 0.05), pulmonary capillary wedge pressure 27.1 +/- 4.4 versus 9.9 +/- 5.2 mm Hg (p < 0.01), mean pulmonary pressure 41 +/- 9 versus 27 +/- 6 mm Hg (p < 0.05), and right ventricular ejection fraction 16.7% +/- 10.3% versus 22.0% +/- 11.6% (not significant). Patients who received the wearable system were capable of managing their own power supply during the bridging period and were able to walk to the hospital park and shopping area. One patient had a serious pulmonary infection, which was treated successfully, and two patients had a cerebrovascular accident, which resolved in one and resulted in a minor residual deficit in the other. All eight patients received a heart transplant. One patient died early after transplantation and seven patients are alive and well. In summary, the wearable Novacor left ventricular assist system provides major advantages regarding quality of life of patients during mechanical circulatory support. However, there is a remaining risk of thromboembolism despite anticoagulation therapy.

Adolescent↗
PubMed1995

[Updated status of replantation services in Germany, Austria and Switzerland].

The revised survey involves the years 1991 and 1992 and includes 41 university and major civil hospitals. As in the years 1989 and 1990, replantation activity in the year 1991 still declined, whereas in 1992 we registered a sharp increase in replantations, especially in Germany. In numbers, 856 were reported for 1991 (72 macro- and 784 microreplantations), and 1091 in 1992 (85 macro- and 1006 microreplantations). A considerable number of amputation cases (617) were rejected mainly due to lack of operative manpower capacity.

Austria↗
PubMed1995

[Fournier gangrene: therapy with a pedicled rectus abdominis flap].

This paper describes the technique to reconstruct the genitals after an episode of Fournier's gangrene using the rectus abdominis muscle flap. A 44-year-old diabetic man felt ill with a Fournier's gangrene following inguinal herniotomia. The infection could be treated by aggressive débridement and by muscle flap coverage. Then we reconstructed the genitalia.

Adult↗
PubMed1995

[Replantation in multiple injuries?].

While amputations of extremity parts are not uncommon in multiple trauma, replantation of these parts is not always feasible. Initial therapy will concentrate on plain survival. We suggest an aid to identify those patients with multiple trauma and extremity amputation, who should undergo replantation.

Adolescent↗
PubMed1995

[Therapy of thumb tip injuries].

Thump-tip lesions are the most common occupational and non-occupational injuries to the hand. Our fingers and especially the thumb are the integral part of any manual activity and, at the same time, are the most exposed. In this report we illustrate the possibilities of treating thumb-tip injuries. Depending on the kind of injury, the extent of tissue loss and the length of the remaining part of the thumb, the different methods of treatment are shown. Their advantages and disadvantages are discussed and the recommendations in the literature are listed. Our own results in treating 86 thumb-tip injuries during the passed 10 years are demonstrated.

Accidents, Occupational↗
PubMed1995

[Timing of free microsurgical tissue transplantation in hand injuries during the acute phase].

Due to favourable survival rates in replantation surgery and a high standard of free tissue transplantation, the interval between injury and microsurgical reconstruction has continuously decreased in the past. The acute phase can be defined as the interval ranging from emergency procedures within 24 hours to "urgence différée" procedures within 72 hours. Bearing in mind the infection rates of 1.5% and 17.5% respectively as it has been reported in the literature, we should encourage emergency reconstructions. However, in most cases of upper extremity injuries, reconstruction with conventional flaps is possible. Between 1981 and 1991, 674 free tissue transplantation have been performed in our unit, 61% of the cases of free tissue transplantations to the upper extremity were done in the acute phase, the majority within 72 hours (urgence différée). No significant differences in rates of infections were evident comparing acute phase and urgence différée procedures. Because of this, we still support the concept of urgence différée. In our opinion the following advantages have to be considered: urgence différée allows a second loop operation, the vitality of the extremity can be ascertained, and the reconstructive procedure can be planned more precisely. Last not least, a procedure performed during the day-time assures better operating conditions. This concept is demonstrated with clinical cases.

Adult↗
PubMed1994

Focus on Chile.

Explore the source record for details and available documents.

Chile↗
PubMed1993

[Genesis and treatment of hand para-articular, painful tendon and tendon sheath changes].

Many patients suffer from wrist disorders caused by tendon- and tendon-sheath-affections. Apart from this the successful treatment of these affections is an important implication concerning national economy. In Lower Saxony 2.3% of all RVO-insured patients have these disorders. Most tendon- and tendon-sheath-affections are due to chronic stress which is generally treated by a non-operative therapy. Only some need be treated by a surgical intervention. In this paper the most frequent painful tendon- and tendon-sheath-diseases are listed, their clinical appearance is shown and the different methods of treatment are discussed.

Adult↗
PubMed1993

[Treatment strategy in explosion and gunshot injuries of the upper extremity].

Explosion and gunshot injuries represent a challenging problem with regard to preserve optimal hand function. These wounds exhibit a spectrum of complexity and mostly include extensive soft tissue trauma complicated by burns, foreign bodies, fractures and concomitant trauma. To gain maximal restoration of hand function the use of microsurgical technique, grafting of nerves, vessels and soft tissue as an acute free flap to cover a large defect immediately is necessary. The experience in treatment of 38 cases of blast and gunshot injuries of the hand are reported. The results are discussed in relation to literature, complication, indication and technique.

Adolescent↗
PubMed1993

[Value of heterotopic finger replantation].

Multidigital amputations represent a challenging problem with regard in restoring optimal sensomotoric hand function. Often orthotopic finger stumps or the separated digits are unfit for conventional replantation. This condition is an imperative indication for transpositional replantation. Among 24 heterotopic replantations the survival rate was 82 percent. The favorable finger transfer was a pollizisation, followed by a substitution of the middle finger and finally creating an expanding opposite grip on the ulnar site of the hand. Secondary corrective procedures have been performed in 37.5 percent. To evaluate the global hand function score systems according to Millesi or Tamai have been applied. 65 percent presented a "good" subjective and objective hand function as to Tamai. However the regain of hand function has to be aspired much more in the single and individual case of transpositional replantations when compared to the Millesi-score system.

Adolescent↗