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Biomedical subjects

V E Meyer

Publications and source records attributed to V E Meyer.

At least 19 recordsLinked to original sources
PubMed1999

[The development of malignant tumors in nevus sebaceus--therapeutic consequences].

OBJECTIVE: Nevus sebaceus has been considered a relatively infrequent and unimportant congenital hamartoma for plastic surgeons, unless the lesions are so big that they require a large closure of the defect. As such tumors are primarily of a benign nature and the malformed sebaceus glands are located abnormally high in the dermis, surgeons are tempted not to excise the tumors but to eradicate them by dermabrasion or laser beam therapy. Yet, a nevus sebaceus does not only affect sebaceus glands but includes various other malformations of the affected skin and its appendages. In addition, different malignant tumors may occur in nevus sebaceus, even in children and young adults. MATERIALS AND METHODS: We encountered 4 such malignant tumors out of 18 nevus sebaceus operated from 1989 to 1997. All nevi had been clinically inconspicuous. RESULTS: In three patients, one of them being only fifteen years old, an associated basal cell carcinoma was found. The fourth patient had a mixture of three additional tumours, a cystadenoma, a keratoacanthoma and a basal cell carcinoma besides the sebaceous malformations. CONCLUSION: These findings have two consequences. The first is to continue surgical treatment of nevus sebaceus instead of dermabrasion or dermablation and to have the specimen examined histologically. The second consequence is to excise such tumors as early as possible.

Adolescent↗
PubMed1999

Care of burns victims in Europe.

There is no detailed information about the care of burns victims, in Europe, in the case of a fire disaster. Several countries have discussed how to treat burn victims, but only a little is known of their capacity to offer space to other countries in the event of a fire disaster outside the country in question. In Europe, most countries are dependent on England, France and Germany in such cases. Since "Los Alfaques", "Ramstein" and other examples of such disasters, we know how important it is to focus more on burn victims in Europe with respect to national and international cooperation.

Adult↗
PubMed1999

Which technique for which breast? A prospective study of different techniques of reduction mammaplasty.

This study was designed to analyse the outcome of three different techniques of reduction mammaplasty with long-term follow-up. We developed a prospective protocol to record patient satisfaction and complaints as well as to objectively quantify the final result. The techniques used were the B-technique of Regnault, the Eren technique and the Frey technique. The technique was chosen according to a preoperatively applied protocol. Eighty-one women, all of whom exhibited physical symptoms of macromastia, were followed up postoperatively for 12 months to 5.4 years (mean 31.8 months). The relief of chronic back pain, improvement of mastodynia and overall satisfaction were rated by the patients subjectively and were reduced with all three techniques. Long-term stability of the postoperative result, especially of the vertical inframammary distance, was achieved in the techniques using a central pedicle and dermis suspension, namely the Eren and the Frey techniques. In smaller and medium-size reductions a medial submammary scar can be avoided using the Frey techniques. Complications, secondary scar and dog-ear revisions were significantly less frequent in the techniques with B-shaped skin incisions. For reductions with nipple transpositions up to 10 cm we prefer the Frey technique. In reduction mammaplasties with nipple transpositions more than 10 cm the Eren technique should be performed. The free nipple-areola graft is the procedure of choice in the treatment of gigantomastia.

Adult↗
PubMed1999

[Effective treatment of a large muscle hernia by local botulinum toxin administration].

A 53-year-old patient developed an impairing muscle hernia when a fascia lata graft was harvested as a substitute for a cruciate ligament of the knee and closure of the defect was not possible. The fascial defect enlarged with time, extending along the whole upper leg. The large muscle protrusion and incarceration in the distal fascial slit was extremely painful during walking and getting up from a chair. Since autologous grafts were disregarded because of the high tissue pressure and alloplastic substitutes seemed problematic, the large hernia was successfully reduced by local muscle denervation with injections of botulinum-A toxin into the protruding vastus lateralis muscle. This procedure achieved relief of pain and enabled the patient to walk without complaints. Side effects were not observed.

Botulinum Toxins, Type A↗
PubMed1998

Use of vein loops in reconstructive procedures.

The use of a temporary arteriovenous fistula prior to flap harvesting was suggested by Threlfall in 1982 (Threlfall, Aust NZ J Surg 52:182-184, 1982). The basic idea is to use long venous grafts that can be branched side-to-end to a main artery at an easily accessible level using one of the well-established exposures from general vascular surgery. In reconstructive microsurgery, AV-loops are used in limb salvage procedures and in cancer surgery. These patients have often undergone previous surgery and additional radiotherapy. AV-loops facilitate the use of normal recipient vessels out of the zone of injury, or far away from scar or irradiated tissue.

Arteriovenous Shunt, Surgical↗
PubMed1998

Long-term follow-up after finger and upper-limb replantation: clinical, angiologic, and lymphographic studies.

This 10-year follow-up study evaluates 25 patients with a total of 57 successfully replanted fingers and six successfully replanted upper limbs. The global functional loss, including loss of range of motion, sensibility, and strength of the hand, was determined using the "Millesi score." The hemodynamic parameters of replanted and control fingers under resting and stress conditions were measured using a laser Doppler flowmeter. The lymphatic system at the site of replantation was examined by fluorescence microlymphography. All patients showed a considerable functional loss, according to the Millesi score, that averaged 56 percent of the normal function of the hand. In order to overcome functional deficit, many patients had developed successful compensatory mechanisms. In general, the patients themselves subjectively rated their functional deficits lower than indicated by the Millesi score. Laser Doppler flowmetry at rest and after arterial occlusion, and capillaroscopy before, during, and after a cold provocation test, revealed subnormal resting flow conditions and significantly decreased vascular capacity in the replanted fingers. Lymphatic drainage capacity was also significantly reduced despite documented reanastomosis between the skin microlymphatic network distal and proximal to the scar (fluorescence microlymphography). The coexistence of functional loss with compensatory mechanisms, decreased reactive hyperemia, and deficit in lymphatic drainage, present in all patients, must be considered as definitive sequelae of the initial injury.

Adolescent↗
PubMed1998

The extensor digitorum brevis island flap: possible applications based on anatomy.

In the past few years, the proximally based extensor digitorum brevis island flap has been recognized as a useful method in the reconstruction of the lower extremity. The major goal of this study, which was performed in 16 cadavers, was to show the possible application of the extensor digitorum brevis island flap based on its anatomy. The vascularization and morphology of the muscle were also studied. We are able to show that, with sufficient mobilization of the vascular pedicle, the extensor digitorum brevis easily can reach both the lateral and the medial malleoli. In most cases, the island flap even reaches the Achilles tendon, the posterior aspect of the heel, and the lower to middle part of the anterior crural region. The vascular supply of the extensor digitorum brevis muscle shows a great consistency, with the lateral tarsal artery being the dominant supply of the muscle. The mean surface of 27 cm2 allows coverage of small to medium-sized defects.

Adult↗
PubMed1996

Fibromuscular proliferation in finger arteries after hand replantation: a case report.

We report on a case where a digit of a previously replanted hand was amputated 3 years after injury. Histologically, the finger arteries demonstrated a marked intimal thickening due to fibromuscular proliferation, with narrowing of the lumen. The media showed muscular hyperplasia and fibrosis, whereas the adventitia was normal. These changes are probably a consequence of ischemia and reperfusion injury and might explain the persistent vasomotor insufficiency found in replantation patients.

Adult↗
PubMed1996

Surgical treatment of the ulnar nerve entrapment neuropathy: submuscular anterior transposition or simple decompression of the ulnar nerve? Long-term results in 79 cases.

The surgical treatment of the ulnar nerve entrapment neuropathy at the elbow is controversial. None of the presently advocated procedures (simple decompression of the ulnar nerve, medial epicondylectomy, subcutaneous or submuscular anterior transposition of the ulnar nerve) has proven optimal regarding long-term results. We studied the outcome in 79 patients whose ulnar nerve had been operated on for the first time, either by simple decompression (31 cases) or by submuscular anterior transposition (48 cases). The mean follow-up was 76 months. Patients were classified according to McGowan pre- and postoperatively; we also applied a more detailed scoring system of our own. Preoperatively, the patients were distributed almost equally between the three McGowan classes. Postoperatively, about one out of three patients in both treatment groups experienced a distinct improvement, i.e. was upgraded to a better McGowan class. Using our own scoring system, the overall rate of objective improvement was 73% after transposition and 55% after simple decompression. Irrespective of the surgical method, roughly 90% of the patients considered their postoperative condition to be improved. However, one specific group of patients (people with habitual ulnar luxation or subluxation of the ulnar nerve) experienced a distinctly better result when treated by anterior transposition than by simple decompression. Our results show that simple decompression of the ulnar nerve can be recommended in all patients without cubital (sub)luxation of the nerve, whereas people with a tendency of cubital (sub)luxation of the ulnar nerve should be treated by submuscular anterior transposition.

Adolescent↗
PubMed1996

[Ulnodorsal impingement syndrome: meniscus lesions of the wrist].

In a consecutive series of 166 wrist arthroscopies, a lesion of the meniscus was found in 16 patients. All of them complained of ulnar wrist pain evoked by axial load in extension. 14 patients had previous wrist trauma. The preoperative physical examination showed marked ulnodorsal tenderness on palpation and the examiner could feel crepitation by passive motion in the radial-ulnar direction. The meniscus represents a part of the triangular fibrocartilage complex (TFCC). At this time it is not possible by magnetic resonance imaging (MRI) to differentiate between articular disc and meniscus lesion. In contrast the two structures are clearly identifiable by arthroscopy especially if there is a radial tear through the meniscus or even a complete avulsion from its insertion on the palmar aspect of the triquetrum. The avulsed part of the meniscus can prolapse into the ulnocarpal joint, causing an impingement phenomenon.

Adolescent↗
PubMed1995

Soft tissue infections of the upper extremities with special consideration of abscesses in parenteral drug abusers. A prospective study.

Despite surgical advances and new antibiotics, upper extremity infections continue to present a serious problem. Soft tissue infections of the upper extremities were prospectively examined to elucidate incidence, cause, bacterial pathogens involved, and treatment. Special attention was paid to infections associated with parenteral drug abuse. During an 18-month period all patients over 16 years of age presenting for treatment of an established infection were included in the study. Conservative treatment consisted of immobilization and antibiotics. Radical débridement with removal of all necrotic tissue was the guideline for operative care. In addition, for both regimens a penicillinase-resistant antibiotic was administered. A total of 415 patients (271 men and 144 women; mean age 36.7 +/- 14.5 years) were enrolled into the study, 55 of whom were parenteral drug abusers; 45 of these were HIV-reactive. Infections of fingers (excluding paronychia), paronychia and abscesses at injection sites were the most common diagnoses. Operative and conservative treatment were performed in 285 and 130 patients respectively. Staphylococcus and streptococcus species were the predominant organisms recovered from 212 specimens of pus. Anaerobic bacteria and yeasts were of minor importance. Therefore, a penicillinase-resistant antibiotic is a good initial choice.

Abscess↗
PubMed1995

[Nerve compression syndromes of the extremities].

Peripheral entrapment neuropathies occur in high frequency and present clinically with a wide range of variations. They need to be recognized early enough in order to initiate correct therapy and so to obviate serious nerve lesions and possible neurological sequelae. This paper overviews the essentials of the compression neuropathies as they are encountered in both upper and lower extremities. Pathomechanisms , pathogenesis, evaluation considerations as well as differential diagnosis and basic treatment algorithms are emphasized.

Carpal Tunnel Syndrome↗
PubMed1994

[Is the "classical" release of the flexor retinaculum in carpal tunnel syndrome obsolete?].

Carpal tunnel release used to be the standard treatment for carpal tunnel syndrome. However, some authors now prefer reconstruction of the transverse carpal ligament, due to suspected palmar dislocation of the median nerve in wrist flexion after simple ligament release. In this retrospective study the topographic location of the median nerve after release is investigated and an attempt made to find a correlation with the postoperative clinical outcome. In computed tomography no palmar subluxation of the nerve was found, even in a patient with a poor clinical result.

Adult↗
PubMed1993

Fiber regeneration in nerve grafts without connection to a target muscle: an experimental study in rabbits.

In 30 rabbits, both saphenous nerves were harvested as autografts and coapted to the branch for the rectus femoris muscle without connection to any distal target muscle. The graft from the right thigh was led to the contralateral extremity (crossover grafting). The graft on the left side remained on the same extremity (ipsilateral grafting). Animals were separated into four groups and were sacrificed 3, 6, 9, and 12 months after grafting. Specimens of the grafts and the donor motor branches were harvested for histomorphometric examination. The number of myelinated nerve fibers in the distal end of the nerve grafts was significantly increasing from 3 to 6 months after grafting and remained on a relatively constant level in the long-term groups. Three months after the first operation, greater numbers of myelinated nerve fibers were counted after ipsilateral grafting than after crossover grafting. In the long-term groups, this difference could not be observed.

Animals↗
PubMed1993

Silicone cuffs for peripheral nerve repair: experimental findings.

The effectiveness of silicone cuffing in peripheral nerve repairs was assessed in a comparative study in rats. The femoral nerve was dissected out and severed bilaterally. The nerve ends were brought together with four epineural sutures on one side, while only one epineural suture was used on the other side, placing a silicone cuff around the junction site. Initially, nerve regeneration appeared to be improved by the cuff, with electrophysiologic parameters and histologic studies 6 weeks after the procedure yielding better results for the tubulated nerves. Subsequently, however, conductivity was less in the tubulated nerves, and results were clearly inferior to sutured nerves at 4 months after the operation. The deterioration was due to nerve compression caused by the cuff, which prevented axons from penetrating into the distal nerve stump, and resulted in axon fragmentation in the compressed nerve segment. The risk of nerve compression makes the use of silicone cuffs of doubtful value.

Animals↗