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Biomedical subjects

G Hauer

Publications and source records attributed to G Hauer.

At least 19 recordsLinked to original sources
PubMed1999

Development of endoscopic dissection of perforating veins and fasciotomy for treatment of chronic venous insufficiency.

As the subfascial endoscopic perforator vein surgery (SEPS) has become increasingly popular, it becomes important to trace the development of this procedure first initiated in 1985. (Improvements in the technique and modifications of initial instrumentation have occurred. These changes are based on experience with greater than 1000 patients treated since 1980 at Krankenhaus der Barmherzigen Brüder in Munich, Klinikum Merheim in Cologne, and the Weilheim Hospital. Results obtained in 96 patients (140 legs) were examined retrospectively and are presented as well as the prospective evaluation of 39 patients with 56 operated legs. (Hauer G, Vasa 1985, 14:59-61; Hauer G, Barkun J, Wisser I, Deiler S, Surg Endosc 1988, 2:5-12; Schneidemann B, Inaug Diss, 1985). This report details the fact that in using our own instruments, including a specially designed videoscope, it has been possible to approach perforating veins of the medial anterior and posterior compartments. This can be done through a 2 cm incision in the proximal calf. Using these instruments, it has been possible to perform a fasciotomy under direct vision. This summary emphasizes that it is not necessary to locate perforating veins preoperatively, and that wound infection and recurrent ulcerations do not occur. This allows application of the method to patients with open ulcers. Further, this report emphasizes that patients with combined arterial and venous ulceration require arterial reconstruction rather than perforator vein interruption. The SEPS operation is relatively contraindicated if there is widespread necrosis and infection of the fascia, especially in combination with ankle ankylosis. In addition, this is the method of choice in patients with multiple incompetent perforating veins with or without open venous ulceration.

Dissection↗
PubMed1999

[Evaluation of the effect of professional dental cleaning and education in dental hygiene in type 1 diabetic patients].

In the setting of a prospective, randomized trial the impact of professional oral hygiene and of intensive patient education in oral hygiene was investigated. It was studied, whether in young to middle-aged type 1 diabetic patients the risk or the progression of periodontal disease can be influenced during one year. Primary endpoint was bleeding at probing, secondary indices, the plaque index and probing pocket depth. 83 patients were enrolled, 70 completed the study according to the protocol. Oral cleansing was dramatically improved by education in the short term, however, the effect was much weaker after 6 and 12 months, respectively, although there remained some improvement compared to the basic level. Bleeding at probing increased in both groups, without reaching the level of statistical significance. Probing pocket depth increased in the intervention group weakly but significantly and remained unchanged in the control group. The tested intervention (professional oral hygiene, patient education in oral hygiene) could not improve the periodontal status in our type 1 patients.

Adolescent↗
PubMed1996

[Chronic venous insufficiency].

In severe chronic venous insufficiency (CVI) the fascia cruris is increasingly involved in the pathological process. The resulting loss of compliance as a consequence of altered fascia texture leads to increased pressure in the compartments of the lower extremity, followed by reduced circulation. Arteries and nerves, which penetrate the fascia along with insufficient perforating veins, are damaged through the increased pressure and are therefore functionally impaired. Accordingly many pathological changes in the crural ulcer have their anatomical substrate here. The microcirculation is distributed by either primary varicosis with secondary insufficiency of the deep veins or by primary insufficiency of the deep venous system as seen in a post-thrombotic syndrome. Subsequent therapy should be based on this knowledge and therefore consists of medication and basic physical therapy along with dissection of the perforating veins-fasciotomy and fasciectomy combined with plastic surgery. All of the therapeutic measures have to take the stage of the CVI into consideration. In order to eliminate the insufficient perforating veins and to perform fasciotomy the endoscopic approach is considered the state of the art. In extreme cases, only fasciectomy combined with plastic surgery can lead to durable healing.

Combined Modality Therapy↗
PubMed1992

[Surgery of perforant veins].

The eradication of incompetent perforating veins combined with fasciotomy is a successful concept in the therapy of leg ulcers. Both can be achieved by endoscopy. Under endoscopic control, the medial, anterior, and posterior groups of perforating veins can be prepared at different levels and dissected after bipolar coagulation. Under endoscopic control the superficial fasciae of the leg are split.

Fasciotomy↗
PubMed1991

Mycobacterium bovis infection in humans exposed to elk in Alberta.

The evidence of zoonotic transmission of M. bovis infection in the 1 veterinarian is confirmed by growth of the organism from his sputum 6 months after animal contact. The high rate of initial tuberculin reactivity and the skin test conversions of 6 persons in contact with culture-positive animals strongly suggest that further human infection has taken place. However, the lack of baseline testing on 48/81 test-positive individuals and the relatively high proportion of immigrants in some occupational groups makes it impossible to determine the extent of reactivity and infection that can be attributed to handling diseased elk. The method of spread is likely by aerosolization of infected particles produced from the cough of live animals, or by the housing of infected material in the rendering plant or postmortem laboratory. Although isoniazid prophylaxis has not been demonstrated to be protective against M. bovis reactivation disease, it seems reasonable to offer the drug to those contacts who are newly infected. Follow-up of human contacts of animal tuberculosis must be carried out.

Adult↗
PubMed1989

[Effect of endoscopy on surgery of veins].

Endoscopic techniques influence the diagnosis and management of surgical problems more and more. The endoscopic subfascial dissection (ESDP) of incompetent venous perforators, which are often found in conjunction with a venous stasis ulcer, is a prime example. The two principles of surgical management, the interruption of blood flow through the perforators and the performance of a medial paratibial fasciotomy, are fulfilled with this technique. The evaluation of this new operative extraluminal endoscopic procedure using specific criteria suggests that it will become increasingly wide-spread.

Endoscopes↗
PubMed1989

[Diagnosis and surgical management of varicosities].

The diagnosis of varicose veins is based on historical details pertaining to risk factors such as familial preponderance, advanced age, overweight, multiple births, professional activities carried out mainly in the standing or sitting position, use of oral contraceptives, diuretics or drugs which lower venous tone. Swelling of the legs on prolonged recumbancy, during pregnancy, fractures or cast treatment may be associated with thrombosis (Table 1). In addition to inspection and palpation in the standing and lying positions, the status of the pulses and the joints are of importance. The diagnostic measures must clarify the stage of the chronic venous insufficiency and provide adequate information on the various forms of venous functional disturbances (Table 2). Classification of varicose veins is carried out according to etiology--primary or secondary--or according to anatomical and functional derangement: with varicosities of the great saphenous vein and the lesser saphenous vein, in addition to valve incompetence at the proximal confluence of the saphenous-femoral junction, there may be segmental or global valve incompetence frequently in combination with a perforating vein incompetence. Varicosities of the great saphenous vein are classified with respect to whether the venous valves involved are those only in the region of the proximal confluence or from the inguinal region to above or below the knee or to the ankle, respectively, in four degrees of severity (Figure 1). For varicosities of the lesser saphenous vein, three degrees of severity are differentiated, the confluence incompetence, incompetence of the venous valves from the knee to the middle of the lower leg or from the knee to the ankle.4+ as the postthrombotic syndrome. Chronic venous insufficiency is characterized by venous hypertension and subdivided into three degrees of severity: grade I in the presence of corona phlebectatica paraplantaris and stasis edema; grade II in the presence of hyperpigmentation, melanodermitis, atrophy blanche, stasis induration and hypodermitis; grade III in the presence of hyperpigmentation, melanodermitis, atrophy blanche, stasis induration and hypodermitis; grade III in the presence of healed or florid ulceration. The two most important diagnostic measures are Doppler ultrasonography and ascending pressure phlebography which complement each other (Table 3)...

Dissection↗
PubMed1988

Endoscopic subfascial discission of perforating veins.

The insufficiency of perforating veins is thought to be crucial in the pathogenesis of varicose and postphlebitic ulcers as well as postoperative varicose vein recurrence. Their eradication is a valid and effective therapeutic concept. No presently available technique has yielded satisfactory results, hence our efforts to develop a new method: the endoscopic subfascial discission of perforating veins (ESDP). It involves performing a small incision in an area remote from the point of trophic disturbance and allows the operator to accurately and atraumatically perform a subfascial discission of the perforating veins where they join the deep veins under direct endoscopic control. Our initial experience with the technique showed promising results: 78%-93% good and very good results depending on the clinical parameters applied. These are the results of a follow-up period of up to 14 months. During that time, none of our patients developed a complication or recurrence. Our technique has many advantages over traditional techniques of perforator vein eradication: (1) more accurate localization; (2) improved wound healing, (3) dependable occlusion; (4) immediate postoperative mobilization of the patient. We feel that ESDP represents a major advance in the development of better methods of subfascial perforator vein eradication. Greater experience and a longer follow-up period will, however, be required to confirm this initial observation.

Endoscopy↗
PubMed1988

[Endoscopic dissection of perforating veins].

The eradication of incompetent perforating veins in combination with fasciotomy is an effective way of treating advanced postphlebitic leg ulcers. Our newly developed endoscopic instrument can be used with both techniques. First the superficial fasciae of the leg are split, and then the perforating veins at different levels are located, injected with anticoagulant and severed. Preliminary clinical studies have reported very encouraging results: leg ulcers healed in all cases and the venous function was improved.

Endoscopes↗
PubMed1978

[Dupuytren's palmar fibromatosis (author's transl)].

The analysis of a total of 500 patients with Dupuytren's contracture is reported. In agreement with the literature it was found that 90% of the patients are men. 29.9% are in the 5th decade of life at the time of the operation. The disease usually begins on one side. But after up to 3 years the second hand is also affected in 51%. The preferred location, both in its entirety and also in relation to the initial manifestation, is the ulnar portion of the hand. Because of the progressive nature of the complaint, relapses are to be expected even after a successful operation. At the time of the follow-up, 26.2% of the patients had recurrences. A correlation between the clinical picture and the histological phase classifications is not possible with certainty.

Adult↗
PubMed1978

[Solitary cyst of the distal radius].

One case of an aneurysmal bone cyst in the distal end of the radius of a 10 year old boy is described. These bone cysts probably develop from local hemodynamic disturbance and should be treated by evacuation and cancellous bone packing. Their propensity for recurrence is confirmed in the literature.

Bone Cysts↗
PubMed1978

[2-stage flexor tendon transplantation: follow-up study results].

It is shown in 246 flexor tendon grafts in the so-called no man's land that autologous grafting in a single surgical procedure preserving the tendon sheath yields the best results, whereas good results can only be achieved by two operations after more extensive injuries of the sheath with or without accompanying injuries. For estimation of the results we developed our own scheme, because it seemed difficult to make reliable judgments when the rather divergent published criteria were applied.

Adolescent↗
PubMed1977

[Late results after homologous nerve grafting (author's transl)].

An account is given about the results of transplantation of homolouges lyophilisated nerves. 48 patients (56 nerves) could be reexamined. The critical clinical and neurological examination shows no positive results. Regarding the taken late results and the experimental findings the use of homolouges lyophilisated nerves for bridging larger defects in human must be rejected, at least at the present.

Adolescent↗