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Biomedical subjects

P Brenner

Publications and source records attributed to P Brenner.

At least 73 records · Page 4Linked to original sources
PubMed1992

Male reduction mammoplasty in serious gynecomastias.

This article is a report on long-term followup of a total of 44 serious gynecomastia cases in the stages I-III (according to Deutinger). The treatment consisted of either a semicircular incision and subcutaneous mastectomy or a superiorly or an inferiorly based nipple transposition while performing male reduction mammoplasty. Aesthetically pleasing results could be obtained by a periareolar approach and mastectomy. This inconspicuous procedure is feasible even in massive gynecomastia cases (stage III) or in cases of male breast asymmetry. On the other hand, all cases with breast reduction plasty and nipple transposition resulted in wing-shaped, mainly broad scars, and subjectively unfavorable results. Consequently, we favor the semicircular approach in male reduction mammoplasty in treating serious gynecomastias. With regard to possible male breast cancer etiology, the histological specimen of the mammary gland in gynecomastia is excised prior to any additional liposuction for supplementary body contouring.

Follow-Up Studies↗
PubMed1992

Changes in peripheral sympathetic outflow of pithed spontaneously hypertensive rats after bradykinin and DesArg-bradykinin infusions: influence of converting-enzyme inhibition.

Because converting enzyme and kininase II are identical enzymes and probably influence both the biosynthesis of angiotensin II and the metabolism of bradykinin, we investigated the effects of bradykinin and desArg-bradykinin on the sympathetic outflow of pithed spontaneously hypertensive rats (SHRs) before and after acute or chronic inhibition of the converting enzyme by ramipril. Sympathetic outflow was induced by preganglionic electrical stimulation of the spinal cord and measured as circulating, stimulation dependent norepinephrine and epinephrine by high-performance liquid chromatography (HPLC) and electrochemical detection. Bradykinin increased dose-dependently norepinephrine and epinephrine release, particularly when converting enzyme was inhibited. DesArg-bradykinin did not influence norepinephrine outflow but caused a dose-dependent increase in epinephrine release only after converting-enzyme inhibition. It is suggested that both bradykinin and desArg-bradykinin could compensate for the lack of effect of angiotensin II on sympathetic outflow.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1992

Modulation of presynaptic sympathetic activity by kinins and related compounds: influence of converting enzyme inhibition.

Since converting enzyme and kininase II are identical enzymes and probably influences both, the biosynthesis of Ang II and the metabolism of bradykinin we investigated the effects of bradykinin, desArg-bradykinin and some bradykinin antagonists (desArg[9]-Leu[8]-bradykinin, HOE S 890307) on the sympathetic outflow of pithed SHR or Brown-Norway-Rats before and after acute or chronic inhibition of the converting enzyme by ramipril. bradykinin increased dose dependently the noradrenaline and adrenaline release in particular when the converting enzyme was inhibited. DesArg-bradykinin caused a dose-dependent increase in adrenaline release only after converting enzyme inhibition. The bradykinin-antagonists led to an increase in adrenaline release during ramipril administration. The weak but significant stimulation of adrenaline release by the bradykinin antagonists after converting enzyme inhibition might be due to unspecific actions on the adrenal medulla possibly induced by histamine release from mast cells.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1992

[The status of replantation centers and services in the area served by the German Professional Society of Microsurgery of Peripheral Nerves and Blood Vessels (Commission for Replantation)].

This survey concerns the years 1989 and 1990. While the number of institutions performing replantations remained constant in Austria and Switzerland, there has been a noticeable trend in Germany from around-the-clock replantation centers to simple replantation services, offering emergency microsurgery by arrangement only. The total number of replantations performed decreased from 975 replanted parts (903 microreplantations and 72 macroreplantations) in 1989 to 875 in 1990, with a micro-/macroreplantation ratio of 12.8:1. Based on the results of questionaire received from 34 university and city hospitals in Austria, Switzerland and former West Germany, an analysis of clinical organization and management of replantation services is presented.

Amputation, Traumatic↗
PubMed1992

[Epitheses of the face].

Despite progress in maxillofacial cancer surgery, most patients present disfiguration of their faces. External prostheses are a pleasing alternative to camouflaging maxillofacial mutilations after tumor ablation. Established indications for external prosthesis are: 1. the patient refusing soft-tissue reconstruction, 2. patient's multimorbidity, and, 3. the impossibility of fully reconstructing a specific maxillofacial defect. Consequently, the benefits of applying external prosthesis include the simple camouflage of an unsightly tumor defect, the ease in supervising any possible local tumor growth beneath the external prosthesis as well as helping to prevent patient's isolation. Thus, external prostheses are a good option in the rehabilitation of maxillofacial surgery patients.

Adult↗
PubMed1991

Diagnosis and treatment of deep cerebral vein thrombosis.

Three cases of deep cerebral vein thrombosis are reported. In all three cases focal neurological deficits and impaired consciousness occurred after a short period of non-specific clinical manifestations. Computed tomography revealed bilateral hemorrhagic infarctions of thalamus and basal ganglia. The CSF analysis which was performed in two cases showed pleocytosis, increased protein level, disturbed blood-brain barrier, and signs of necrosis and hemorrhage. In two cases the diagnosis was confirmed by transfemoral carotid angiography. MRI was performed in one case only and showed thrombosis of the internal venous system. All patients were treated with high-dose heparine in spite of hemorrhage. Good recovery was seen in all patients with almost complete improvement of neurological deficits. No complications were observed during treatment. Because of these promising therapeutic results, bilateral thalamic lesions should alert the physician to consider the possibility of deep cerebral vein thrombosis.

Cerebral Veins↗
PubMed1991

Histochemical localization of glycoconjugates in the palmar aponeurosis of Dupuytren's patients.

Acridine orange added to the primary fixative or reduced osmium tetroxide as postfixative have been used in order to localize by thin section electron microscopy glycoconjugates in the extracellular matrix of the normal palmar aponeurosis as well as in tissues at different stages of Dupuytren's contracture. After use of acridine orange or reduced osmium tetroxide, in the nodule of the active stage an extensive network of fine filaments separated single or small bundles of collagen fibrils from each other. In the cord of the residual stage fixed in presence of acridine orange, the tightly packed collagen fibrils in the central region of the specimens were swollen and had stained material interposed between the single microfibrils. In specimens of the same cord first fixed with glutaraldehyde alone, followed by reduced osmium tetroxide, the disaggregation of collagen fibrils could be seen only occasionally and the intrafibrillar stained glycoconjugates were less evident. Comparable alterations were absent from the normal tissue. The possible reasons of these differences are discussed.

Acridine Orange↗
PubMed1991

[Functional reconstruction by neurovascular muscle and myocutaneous flaps of the lower extremity].

The management of resurfacing problems is simplified in using free, microvascular flaps in complex trauma or tumor surgery. To restore motor function neurovascular muscle or myocutaneous flaps are imperative. Therefore 29 neurovascular latissimus dorsi flaps in 28 patients among more than 570 free tissue transfers have been applied to the lower extremity. One patient had a monoblock transfer, while another had bilateral latissimus dorsi flaps to both legs. Reanimation of the neurovascular flaps was perceptible at an average of 13.5 months. Of the 29 neurovascular muscle, or myocutaneous flaps 27 developed a joint excurvation according to muscle grading scale: M3 to M5.

Adult↗
PubMed1991

[Functional rehabilitation of the upper extremity after compartment syndrome].

In established compartment syndrome discrimination between the different forms of flexion contracture, i.e., manifest Volkmann's contracture and intrinsic contracture is necessary. A combination of both is also possible. Classification is essential for determination of whether reconstruction is indicated and what procedure should be selected. Shortening osteotomies of the ulna and radius are now of historical interest only, as is carpalectomy. Lengthening of the flexor tendons is indicated only in mild and localized limited contracture of only some of the long fingers, but there is a danger of possible further adhesions limiting the range of motion. Thus, cases of stage I and II according to Tsuge with persisting partial flexor motor function are treated mainly by muscle sliding operation (Scaglietti) combined with microsurgery for internal neurolysis of the median and ulnar nerves. The latter is anteriorly transposed. In cases of solitary intrinsic contracture we prefer the Littler release procedure. The most useful repair in advanced compartment syndrome, however, consists in free microsurgical tissue transfer. The non-contractile, degenerated scarred flexor muscle remnants are excised and substituted orthotopic by transfer of free, neurovascular muscle, with salvage of flexor motor function in the forearm.

Arm Injuries↗
PubMed1990

Pancreatitis and pancreas divisum: aetiological and surgical considerations.

It has been suggested that acute pancreatitis occurs more commonly in patients with pancreas divisum and that these patients may respond to surgery aimed at improving pancreatic ductal drainage. We have studied the incidence of pancreas divisum in patients referred for endoscopic retrograde cholangio pancreatography (ERCP) and the results of surgical sphincteroplasty in a separate series of such patients. Twenty-three patients with pancreas divisum were identified among 336 successful pancreatograms (Group A), an incidence of 6.8%. The incidence of pancreas divisum in patients having ERCP for documented pancreatitis was 13% (11 of 86) compared with 4.8% (12 of 250) in those having ERCP for other indications. This difference was statistically significant (P less than 0.05). However, pancreas divisum was not the sole risk factor for pancreatitis in the majority of our patients; most also had one of the commonly recognized causes for their pancreatitis. There is dispute about the indications for surgery in patients with recurrent acute pancreatitis and pancreas divisum, but without any other risk factor. We have reviewed the results of operations on 13 patients with pancreas divisum (Group B) treated in four different hospitals. Surgical sphincteroplasty was carried out on 10 patients with documented pancreatitis and seven of these had good results. Three patients who had operations for pain without documented pancreatitis were not improved.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1990

[Function preserving surgery of skin and soft tissue tumors: head and neck].

Epithelial malignancies predominantly affect the head and the neck. Ablation requsives free margins of 1 centimeter (except in solid basal cell carcinoma). In a combined modality procedure resection of squamous cell carcinoma is completed by modified neck dissection. The majority of 397 tumor defects were treated by either primary suture and skin grafts or conventional flaps. Indications for 145 microvascular operations were the failure of the classic procedure, expanded defects, and postoperative radiotherapy. Essential for oncological patients with limited life expectancy is the rapid postsurgical recovery in case of free flaps.

Basal Cell Carcinoma↗
PubMed1990

[Clinical aspects and surgical treatment of Dupuytren contracture].

The etiology of Dupuytren's contracture is still not clear. Many theories have been proposed, but no basic data are currently available that would make it possible to treat Dupuytren's contracture by other methods than surgical intervention. The surgical technique used in our clinic is described, and a postoperative treatment is also outlined. This paper is designed to propose an acceptable technique for practicing trauma and hand surgeons.

Dupuytren Contracture↗
PubMed1988

Angiologic observations following autologous vein grafting and free radial artery flap elevation.

Fifteen cases with radial forearm flap harvesting and autologous vein-graft reconstruction of the missing radial artery portion, are reported. Post-repair follow-up examinations, using segment plethysmography, photoplethysmography, and Doppler ultrasound, demonstrated an angiologic donor site morbidity, even when radial artery reconstruction was performed. Typically diminished blood pressure occurred, in comparison with the contralateral healthy extremity. Index shifting of pulse wave peaks, as well as widening of pulse wave bases occurred, especially in the thumb and index finger. These latter findings appear to be discrete indicators of arterial insufficiency.

Adult↗
PubMed1988

The one-stage surgical treatment of multilocated pressure sores using various myocutaneous island flaps.

Report on 32 patients suffering from chronical pressure sores (n = 18 solitary, n = 14 multilocated), Campbell stages IV-VI, overlaying sacral bone, ischial tuberosity and tuber femoris, which were treated by using various combinations of myocutaneous island flaps (uni- or bilaterally glutaeus maximus and/or biceps femoris flaps). Indications, operative procedures, perioperative management and follow-up results are presented. Superficial skin lesions (n = 2) and wound dehiscence (n = 1) appeared as temporary wound complications in the 14 patients with multilocated pressure sores. In all cases stable and durable coverage was achieved without any recurrence. The value of adequate rehabilitation in avoiding relapses is pointed out.

Adult↗
PubMed1988

[Late results following conservative treatment of elbow dislocations].

Conservative treatment was applied to 56 cases of elbow dislocation in the surgical department of the Hannover School of Medicine, between 1978 and 1986. Follow-up checks were made on 30 of them. Functional results were found to be good to very good in 27 cases. Hence, conservative treatment is considered to be an appropriate therapeutic approach to simple elbow dislocations.

Adolescent↗
PubMed1986

[Knee joint exarticulation in arterial occlusive disorders of the lower extremity].

In 35 patients suffering from peripheral ischemic disease of the legs, disarticulation of the knee joint was performed instead of above-knee amputation. Operations were executed primarily or after failed bypass procedures for the salvation of the limb. 24 cases (67%) showed primary or delayed secondary stump healing. In 11 cases (31%), however, no stump healing was achieved due to either a wound infection (4 cases) or a necrosis of the anterior flap covering the weight bearing area of the stump (7 cases). Factors influencing the outcome of stump healing are discussed and different techniques of knee disarticulation are evaluated as to their benefits and disadvantages in ischemic limbs. As the method offers several advantages over above-knee amputation, a more frequent use of knee disarticulation in the surgical treatment of ischemic legs which cannot be preserved by other surgical measures and usually would be amputated at above-knee level is recommended.

Adult↗