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Biomedical subjects

H Bohmert

Publications and source records attributed to H Bohmert.

At least 19 recordsLinked to original sources
PubMed1998

Immediate breast reconstruction for breast carcinoma using the periareolar approach.

Skin-sparing mastectomy with immediate breast reconstruction has shown to be oncologically safe while providing dependable aesthetic results. However, flap inset into the skin defect of the excised biopsy site and nipple-areola complex often results in a patchlike effect and transverse scars. By keeping the mastectomy incision solely around the areola, all breast skin can be preserved. Thus, in immediate breast reconstruction with replacement of the nipple and areola by a small skin island from a deepithelialized TRAM flap or latissimus dorsi muscle flap, the scar is kept at the natural border between areola and breast skin. Reconstruction of the nipple-areola complex further helps to camouflage the incision line. This may result in the best possible aesthetic outcome after mastectomy to date. The technique has been used in 17 breast cancer patients (intraductal cancer, n = 5; T1/T2 ductal cancer, n = 13) with good to excellent results. No local or distant recurrences have been seen; however, mean follow-up time is short (10 months). As the procedure of choice, a free TRAM flap was performed in nine patients for immediate reconstruction. The other eight patients were too slim for an autologous reconstruction; therefore, a latissimus dorsi muscle flap with a small skin island and a silicone implant were used. There were no major complications in either group. In contrast to traditional skin-sparing mastectomy, all breast skin is preserved with the periareolar approach. Therefore, special surgical expertise is required to ensure tumor free margins, especially with respect to the skin overlying the tumor. If these requirements are met, excellent results in breast reconstruction are amenable with adequate oncologic safety.

Abdominal Muscles↗
PubMed1996

Comparative analyses of bone marrow micrometastases in breast and gastric cancer.

This study is a comparative analysis of the prevalence, absolute number and aggregation status of bone marrow micro-metastases (BMM) between breast (n=234) and gastric (n=102) cancer patients based on a standardized number of 1 X 10(6) bone marrow-derived cells per patient. Additionally, expression of the epithelial cell adhesion molecule E-cadherin was analyzed on disseminated tumor cells. A positive BMM status was demonstrated in 88/234 breast and 45/102 gastric cancer patients. The presence of CK18+ cells positively correlated with parameters of advanced tumor progression in breast, but not in gastric cancer. Interestingly, 25.2% of the node-negative patients already had micrometastatic cells in the bone marrow at diagnosis. Regarding the absolute number of CK18+ cells and the frequency of CK18+ cell clusters, no significant difference was found between the 2 tumor types. However, clusters consisting of more than 10 CK18+ cells (type II clusters) were present exclusively in breast cancer patients. Additionally, co-expression of CK18 and E-cadherin was detectable in 15/21 micrometastases-positive breast but in only 1/9 gastric cancer patients. While prevalence of micrometastatic cells in bone marrow is discussed as an early indicator for systemic disease, aggregation status and a certain antigen profile might be indicative for site-specific differences in the manifestation pattern of solid metastases.

Bone Marrow Neoplasms↗
PubMed1996

[Dynamic MR mammography: is the course of signal intensification suitable for the differentiation of different forms of mastopathy?].

PURPOSE: The capacity of dynamic contrast-enhanced MR mammography to distinguish between different forms and grades of mastopathy according to Prechtel's classification was evaluated in a retrospective study. PATIENTS AND METHODS: MR mammograms of 51 patients with histologically proven mastopathy were retrospectively evaluated in areas subsequently biopsied. RESULTS: Mean values of regressive and hyperplastic types of mastopathy differed significantly no significant differences were found between proliferating and non-proliferating mastopathies or Prechtel grades I-III mastopathy when MRI data obtained with a FLASH 3 D sequence (TR = 8.4 ms, TE = 3 ms, flip angle = 30 degrees at 1.0 T) were compared one minute, three, 5 and 8 minutes after i.v. bolus administration of contrast media (Gd-DTPA, 0.1 mmol/kg body weight). CONCLUSION: Our data indicate that dynamic contrast-enhanced MR mammography does not allow the differentiation of proliferating and non-proliferating mastopathy according to the Prechtel classification. Dynamic MR mammography assessment of breast cancer risk does not seem to be feasible.

Breast↗
PubMed1996

[Technics for the preoperative marking of nonpalpable breast lesions in MRT].

We describe a method of localizing suspicious breast lesions only visible by MRI that does not require additional hardware and can be carried out on any MRI-scanner suited for MR-mammography. We have performed a total of 48 localizations with different techniques: 28 charcoal/Gd-DTPA, 18 with wires and two skin markings. All localizations have been successful; wire localizations provided the best results, since the position of the wire could be corrected under MR-guidance. Until suitable localization- and biopsy coils become available the methods employed by us provide a satisfactory alternative which allows radiologists who perform diagnostic MR-mammography with techniques to carry out precise pre-operative localisations of breast lesions.

Breast↗
PubMed1996

[Immediate reconstruction of the breast with the free, microvascular "TRAM" flap].

The free TRAM flap for breast reconstruction offers superior blood flow and a lower donor defect morbidity than the pedicled flap. In the immediate setting, it is much easier to dissect the recipient vessels, because the thorco-dorsal vessels are not encased in a scarred post-mastectomy bed, which adds to the advantage of the free flap. The operative technique, the results and complications of nine patients having received a free TRAM for immediate breast reconstruction between 5/95 and 3/96 are reported.

Adult↗
PubMed1991

Immediate breast reconstruction using an external oblique rectus musculofascial turnover flap.

The development of the external oblique rectus musculofascial turnover flap has recently received a great deal of attention. With this method, the upper part of the external oblique muscle is lifted off the lower thoracic wall along with a segment of the rectus muscle, pedicled in the sixth intercostal space and subsequently connected with the lower margin of the pectoralis major muscle. This approach bridges the weak regions of the thin muscle layers in the medioinferior breast area. Because this procedure avoids the need for a second operation to restore the contour and enables production of a natural ptosis and a well-accentuated lower breast fold, it has become increasingly important in immediate breast reconstruction. Compared with the complex myocutaneous flaps techniques, this procedure is characterized by relative simplicity and ease of performance. Compared with the tissue expansion technique, the oblique rectus turnover flap allows restoration of the female form in a one-stage procedure with a better, more natural ptotic breast shape and well-defined inframammary crease. Results have been encouraging. In fact, this procedure has almost completely replaced other techniques for immediate reconstruction of the female breast following mastectomy.

Adult↗
PubMed1991

[Protective microvascular anastomosis in transverse rectus abdominis myocutaneous flap for breast reconstruction].

Given favorable conditions, breast reconstruction with the TRAM-flap yields the best results. However, because of limited blood flow in the flap after dissection, partial flap necrosis occurs frequently. To avoid this, a bipedicled flap has been used. Although complications are substantially fewer, the necessity for improvement of flap perfusion still remains. We have carried out breast reconstruction using the TRAM-flap in 66 cases to date. In two of these, the vascular system of the deep inferior epigastric artery and vein were successfully anastomosed (end-to-side) with the thoracodorsal vessels. Although this technique was more time consuming and entailed cooling, it has proven to adequately protect the flap. Careful dissection and preservation of the deep inferior epigastric vessels is mandatory.

Anastomosis, Surgical↗
PubMed1989

[Surgical procedure for secondary breast reconstruction after mastectomy].

The type of reconstruction is determined by the mastectomy deformity and requirements for symmetry. There are five basic techniques. A silicone breast implant placed submuscularly beneath the available tissues is the most straight-forward procedure. Latissimus dorsi flap is used with a silicone breast implant when additional skin and/or muscular cover is needed. Transverse rectus abdominis musculocutaneous utilizes excess lower abdominal tissue for reconstruction of the breast with autogenous tissue. The tissue expander is most frequently used following modified radical mastectomy. The external oblique rectus abdominis musculofascial turn-over flap is an attractive new technique.

Breast Neoplasms↗
PubMed1988

[Immediate reconstruction of the breast following mastectomy].

Immediate reconstruction of the breast has become an integral part of treatment of breast cancer during the last years. Several studies have reported that breast cancer patients who undergo immediate reconstruction have the same survival rates as unreconstructed patients and that reconstruction does not adversely affect the natural course of breast cancer. Since 1983 immediate reconstruction has been performed in 87 patients at our institution. It has been demonstrated that the psychological trauma has been dramatically reduced and that many patients will accept mastectomy almost with a sense of relief, when immediate reconstruction can be offered.

Breast↗
PubMed1986

[Late results of McKissock breast reduction-plasty].

162 patients had a McKissock's reduction mammaplasty between 12.78 and 4.85. The areola is transposed thereby on a cranio-caudal flap. A questionnaire and a checkup was performed 3 1/2 years postop., 57% found the results very good and good, 31% satisfactory, 3% adequate, 6% imperfect and 3% bad. The sensibility of the nipple was almost unchanged in 40%. Erectibility of the nipple was in most cases present. The measures of the breast changed only little after 3 1/2 years.

Breast↗
PubMed1986

A microsurgical method for reconstruction of interrupted lymphatic pathways: autologous lymph-vessel transplantation for treatment of lymphedemas.

Refinements in microsurgery have made it possible to perform causal therapy on lymphedemas due to a local blockade of lymphatic pathways through transplantation of the patient's lymph collectors. End-to-end anastomoses with lymphatics before and after the blockade or crossing to the opposite side are performed under 40-fold magnification. Between July 1980 and February 1985 32 patients received this treatment. 23 patients had postmastectomy edema, and 9 patients had unilateral edema of the lower limb (2 primary, 7 secondary edemas). The lasting result was that the volume difference between the affected and the healthy limb decreased to about 65%. Lymphatic scintiscans showed improved lymphatic transport capacity with increasing time from surgery and long patency of the grafts.

Adult↗
PubMed1986

[Regulation of lipolysis--biochemical research on the fat cells of obese patients].

Subcutaneous adipose tissue was obtained from ten obese patients. Isolated fat cells were incubated with porcine beta-lipotropin but no stimulation of lipolysis was obtained. To avoid accumulation of lipolysis inhibiting substances, such as free fatty acids and adenosin, as well as protease activity, perifusion of isolated fat cells was carried out. Under these test conditions, which allow continuous determination of released glycerol, lipolytic activity could be shown for the peptide hormone beta-lipotropin in human adipocytes.

Adipose Tissue↗