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H Breuninger

Publications and source records attributed to H Breuninger.

At least 19 recordsLinked to original sources
PubMed1999

Ropivacaine: an important anesthetic agent for slow infusion and other forms of tumescent anesthesia.

BACKGROUND: Reliable, long-acting local anesthetics reduce postoperative pain and make it easier to plan surgery. This is especially true when slow infusion tumescent anesthesia (SITA) is used. The anesthetic agent ropivacaine appears to meet the requirements of SITA especially well. OBJECTIVE: This study examined the clinical effectiveness and tolerance of ropivacaine in healthy volunteers and in a large number of patients. METHODS: Ropivacaine's clinical action was investigated as follows: Thirty healthy volunteers received 30 ml of three solutions of lidocaine alone, lidocaine mixed with ropivacaine, and ropivacaine alone, all containing epinephrine 1:1,000,000. The local anesthetic effects were studied. Ropivacaine was used clinically both alone and with different mixtures of ropivacaine and prilocaine, containing epinephrine 1:1,000,000, in a total of 5220 surgical procedures of all kinds in 3270 patients. The maximum dose of ropivacaine was 300 mg. No patient was excluded from this kind of anesthesia. Patient ages ranged from 5 to 95 years (median 54). No suprarenin was added for nerve blocks of the fingers and penis. RESULTS: Ropivacaine acted more than twice as long as lidocaine. Clinical application was completely free of side effects and complications and involved a very low rate of postoperative bleeding. The patients remained free of pain as a rule for many hours. CONCLUSION: We regard ropivacaine as a major step forward in the use of local anesthesia.

Adolescent↗
PubMed1999

Detection of melanoma micrometastasis in sentinel nodes by reverse transcription-polymerase chain reaction correlates with tumor thickness and is predictive of micrometastatic disease in the lymph node basin.

The sentinel node has been reported to be representative for the presence or absence of metastatic melanoma in the draining lymph node basin. In this study, for the first time sentinel nodes and adjoining nonsentinel nodes were analyzed for micrometastatic disease using tyrosinase reverse transcription-polymerase chain reaction (RT-PCR) in comparison with standard immunohistochemistry. Successful identification of the sentinel nodes using a gamma probe-guided surgery was achieved in 73 (92%) of 79 patients with cutaneous stage I and II melanoma (tumor thickness > or =0.75 mm). A total of 794 regional lymph nodes, 148 sentinel nodes, and 646 adjoining nonsentinel nodes were evaluated. Tyrosinase RT-PCR was shown to increase the sensitivity for melanoma cell detection in sentinel nodes significantly (49% positivity) as compared with immunohistochemistry using antibodies against HMB-45 antigen and S-100 protein (18% positivity). Examination of sentinel nodes was highly predictive in determining the presence of regional lymph node micrometastasis by immunohistochemistry (99%) and RT-PCR (89%). Interestingly, detection of nodal micrometastasis by RT-PCR showed a strong positive correlation with tumor thickness of primary cutaneous melanoma. These results suggest the clinical significance and emphasize the importance of tyrosinase RT-PCR for detection of melanoma micrometastasis in sentinel nodes.

Adult↗
PubMed1999

Patterns of local horizontal spread of melanomas: consequences for surgery and histopathologic investigation.

Understanding local spreading patterns of melanomas is a precondition for the localized surgical treatment and histopathologic investigation. We used hematoxylin and eosin-stained paraffin sections for a two-phase, cellular and microscopic study of patterns of lateral spread in superficial spreading melanomas (SSMs), nodular melanomas (NMs), lentigo maligna melanomas (LMMs), and acral lentiginous melanomas (ALMs). Complete histologic examination of vertical excisional margins was carried out with paraffin sections 5 mm beyond the clinical tumor border of 1395 SSMs, 376 NMs, 179 LMMs, 46 ALMs, and 37 acrally located SSMs or NMs. Further sections of embedded material were analyzed when tumor-positive margins were found. In case of continuous tumor spread, reoperations were continued until the tissue was free of tumor cells. In case of noncontinuity, a final excision was made to a minimum safety margin of 10 to 20 mm. Concentrically consecutive, 5-microm thick hematoxylin and eosin-stained sections were taken from the outside of a 10-mm safety margin inward to the clinical borders of 34 SSMs, five NMs, 10 LMMs, and five ALMs. Noncontinuous subclinical spread was found in all SSMs and NMs in the form of few isolated cell nests at the epidermis-dermis junction. Ninety-two percent of these were located within 6 mm of the central tumor. All LMMs and ALMs showed a clearly demonstrable, uninterrupted spread into the periphery at the epidermis-dermis junction, too, usually in groups of outgrowths. The probability of finding these outgrowths 5 mm beyond the clinical tumor border was 54% in LMM and ALM. Complete histologic examination of vertical excisional margins (micrographic surgery) is therefore the therapy of choice only for LMM and ALM and is inefficient for SSM and NM.

Humans↗
PubMed1998

Lymph node micrometastases of cutaneous melanoma: increased sensitivity of molecular diagnosis in comparison to immunohistochemistry.

The presence of regional lymph node metastases is one of the most significant prognostic factors for predicting survival in patients with clinical stage I or II cutaneous melanoma. For accurate staging of the primary tumor a sensitive technique is required to detect occult nodal micrometastases. This prospective diagnostic study was designed to evaluate the incidence of nodal micrometastases using nested reverse transcription-polymerase chain reaction (RT-PCR) for tyrosinase in comparison to immunohistochemical examination. Furthermore, the incidence of melanoma micrometastases detected by RT-PCR was analysed in correlation to major prognostic factors. A total of 466 regional lymph nodes from 79 patients with primary cutaneous melanoma (tumor thickness > 0.75 mm) were investigated. In 49 lymph nodes from 31 patients immunohistochemistry demonstrated melanoma metastases. Using tyrosinase RT-PCR, nodal micrometastases were detected in 136 lymph nodes from 52 patients including all lymph nodes positive by immunohistochemical examination. Out of the 417 lymph nodes negative by immunohistochemistry, 87 nodes (21%) were identified to express tyrosinase by the RT-PCR technique. Among the 48 patients negative by immunohistochemical assessment, 21 (44%) had nodal micrometastases (n = 40) using RT-PCR. All 68 lymph nodes from 46 non-melanoma patients serving as negative controls for tyrosinase RT-PCR were negative. The detection of melanocytic nodal micrometastases by tyrosinase RT-PCR is a highly specific method with a sensitivity significantly higher than that achieved by immunohistochemistry (p < 0.0001). Patients with nodal micrometastases identified exclusively by RT-PCR had significantly higher tumor thickness as compared to patients with negative results by RT-PCR (p < 0.01).

Biomarkers, Tumor↗
PubMed1998

[Desmoplastic squamous epithelial carcinoma of the skin and lower lip. A morphologic entity with great risk of metastasis and recurrence].

The desmoplastic type of the squamous cell carcinoma (DSCC) of the skin is an entity which is readily distinguished by light microscopy. The DSCC has fine branches surrounded by a desmoplastic stroma and shows in some cases typical perineural, perivascular and widespread intradermal invasion (maximum 6 cm!). This type accounts for 8.2% (n = 44) of our collective of 594 squamous cell carcinomas (SCC) of the skin and vermilion border. Clinically DSCC look like other malignant epithelial tumors of the skin. All tumors were followed up for at least 3 years (maximum 10 years). The local recurrence rate was high (24.3%) even though micrographic surgery was carried out. The rate of local or regional metastasis was also very high (22.7%). In comparison the recurrence rate and the rate of metastasis of the remaining common 91.8% SCC's (n = 550) was low: 2.6% and 3.8%, respectively. The DSCC seems to be identical with the so called neurotropic SCC, the fine stranded SCC or the SCC with perineural invasion which have a high rate of local recurrence and metastasis as well, but DSCC is a better generic histopathologic term for the entire group. The DSCC is best treated with micrographic surgery and wider safety margins than any other type and should be followed up very frequently.

Adult↗
PubMed1998

[Subcutaneous infusion anesthesia with prilocaine diluted with Ringer's lactate].

BACKGROUND: Dermatologic surgery is usually possible under local anesthesia, even when large amounts of highly diluted anesthetic solutions are required (tumescent anesthesia). Although special pumps now render such large injections effortless, it is usually still necessary to hold and guide the injection cannula. We have overcome this handicap by injecting anesthetic solutions slowly with an infusomat, which allows slow painless automatic infusion into the subcutaneous layer. METHOD: The speed of infusion varied between 40 ml and 1500 ml per hour depending on location, size of the operation, and needle size. Volumes usually ranged from 1 ml to 500 ml but rose as high as 1000 ml if necessary. We found it easier to inject larger amounts than with the conventional method. We used 21-gauge to 30-gauge needles with a length of 1 to 10 cm. The anesthetic solution was prilocaine (Xylonest), and the dilution liquid was original Ringer's solution in 500 ml bottles with no additives. The concentration of the solution varied between 0.4% and 0.1%. After setting up the system, the physician even can leave the room. Especially for children and very anxious patients, this feature is calming. MATERIAL: We used this type of subcutaneous infusion anesthesia (SIA) in our department to treat 502 patients ranging in age from 3 to 92 years (mean age: 51 years). We performed all kinds of tumor operations (n = 213), dermabrasions (n = 5), scar revisions (n = 21), stripping of the long and short saphenous veins (n = 82), sentinel node dissection (n = 27), complete lymph node dissection of the axilla (n = 12) and groin (n = 17), and 125 other operations as well. RESULTS: There were no severe complications. Postoperative recovery was fast. 110 (91%) of 121 patients who had previously experienced other forms of anesthesia for the same kind of operation preferred SIA. CONCLUSIONS: SIA Ringer's solution diluted prilocaine is an economical, safe and comfortable technique for nearly all skin operations, even for children and very sensitive patients.

Adolescent↗
PubMed1998

Slow infusion tumescent anesthesia.

BACKGROUND: Dermatologic surgery is usually possible under local anesthesia, even when large amounts of highly diluted anesthetic solution are required (tumescent anesthesia). Although special pumps now render such large injections effortless, it is usually still necessary to hold and guide the injection cannula. OBJECTIVE: We have found it possible to overcome this handicap by injecting anesthetic solutions slowly with a common infusomat, as in paravenous infusion, into the subcutaneous layer. METHODS: The method consists of slow, automated tumescent anesthesia by means of infusion. The speed of injection varies between 50 and 1500 mL per hour depending on the location, the size of the operation, and the needle size. Volumes usually range from 2 to 500 mL but may rise as high as 1000 mL if necessary (maximum, 12 mg/kg). We use 30- to 20-gauge needles with a length of 1.5-10 cm and butterfly infusion cannulas. We customarily use an anesthetic solution of prilocaine (Xylonest); the dilution liquid is original Ringer's solution with epinephrine (1:1,000,000) in 500-mL bottles. The concentration of the solution varies between 0.4% and 0.1%. After setting up the system during pulsoxymetry, the physician can usually leave the room. This is calming, especially for children and very anxious patients. We used the slow infusion tumescent anesthesia (SITA) in our department to treat 502 patients ranging in age from 3 to 92 years (mean age, 51 years). We performed all kinds of tumor operations (n = 213), dermabrasions (n = 5), scar revisions (n = 21), stripping of the long and short saphenous veins (n = 82), sentinel node dissection (n = 27), complete lymph node dissection of the axilla (n = 12) and groin (n = 17), and 125 minor operations as well. RESULTS: There were no severe complications. One hundred ten (91%) of 121 patients who had previously experienced general or regional anesthesia for the same kind of surgery and all who had previously had conventional syringe injection preferred SITA. CONCLUSIONS: SITA is an economical, safe, and comfortable technique for nearly all skin operations, even for children and very sensitive patients. Choosing the most suitable concentration, needle, needle position, flow ad volume requires some experience.

Adolescent↗
PubMed1997

Metastatic melanoma of unknown primary origin shows prognostic similarities to regional metastatic melanoma: recommendations for initial staging examinations.

BACKGROUND: Metastatic melanoma of unknown primary origin accounts for approximately 2-6% of all melanoma cases. The prognostic significance of this diagnosis is still controversial. METHODS: Of 3258 patients with malignant melanoma recorded during the period 1976-1996, 2.3% had metastases of unknown primary origin. Anatomic distribution, clinical stage, and survival probabilities were evaluated. RESULTS: Thirty patients were classified as having cutaneous or subcutaneous in-transit metastases, and they showed a 5-year survival rate of 83%. Thirty-seven patients were classified as having lymph node metastasis, and their 5-year survival rate was 50%. Disseminated disease was diagnosed in only 8 patients, who had a median survival of 6 months. Comparison of survival probabilities for patients with in-transit metastases and unknown primary tumors with the probabilities for those with cutaneous primary tumors revealed a significant advantage for the former group. No significant differences were found for patients with lymph node metastasis when those with unknown primary tumors were compared with those who had cutaneous melanomas with regional lymph node metastasis. CONCLUSIONS: The clinical disease course of patients with metastatic melanoma of unknown primary origin is similar to that of patients with primary cutaneous melanoma when the same clinical stages of the disease are compared. Based on the assumption that the majority of regional metastases develop from completely regressed primary cutaneous melanoma, recommendations for initial staging examinations in patients with unknown primary tumors are given in this article.

Adolescent↗
PubMed1997

Desmoplastic squamous cell carcinoma of skin and vermilion surface: a highly malignant subtype of skin cancer.

BACKGROUND: The prognosis of squamous cell carcinoma (SCC) of the skin is directly related to the development of metastases or local recurrence. This is affected by numerous factors, most of which are independent: clinical tumor size, histopathologic tumor thickness, depth of penetration, degree of cell differentiation, degree of keratinization, location, and immunosuppression. The determination of whether desmoplasia, previously described in only one case of SCC, constitutes an additional prognostic factor was the objective of this study. METHODS: The study was performed prospectively on 594 SCCs from 509 patients. All of the factors mentioned earlier were present. Forty-four SCCs were identified by light microscopy as desmoplastic due to their prominent trabecular growth patterns, narrow columns of atypical epithelial cells, and marked desmoplastic stromal reaction, in some cases with perineural and perivascular invasion. Follow-up ranged from 4 to 10 years (median, 5.3 years). RESULTS: All tumors in the study patient population were treated using the paraffin section method of micrographic surgery. The 44 desmoplastic SCCs were found to metastasize 6 times more often than the remaining 550 tumors (22.7% vs. 3.8%), with 10 times as many local recurrences (27.3% vs. 2.6%). CONCLUSIONS: Desmoplasia is a highly significant (P < 0.001) prognostic factor for SCCs and is associated with the development of metastases or recurrence.

Carcinoma, Squamous Cell↗
PubMed1997

[Teleangiectasia haemorrhagica hereditaria. Surgical therapy of malignant skin tumors (Osler-Weber-Rendu disease].

A 65 year old male patient was diagnosed with hereditary hemorrhagic telangiectasia at 30. During recent years he has suffered frequent, almost daily, nose bleeds causing anemia and making several blood transfusions necessary. In the past 2-3 years, the patient has developed multiple squamous cell carcinomas on the face. These unusually large tumours were treated by micrographic surgery using paraffin sections and the defects dosed with a variety of flaps and grafts. Several solar keratoses were also removed. If hemostasis parameters are normal, skin surgery can be performed without hesitation in hereditary hemorrhagic telangiectasia.

Aged↗
PubMed1997

[Extensive rodent ulcer (type: solid basal cell carcinoma)].

A 52 year old female had a large destructive basal cell carcinoma of the back measuring 27 cm in diameter. There was destruction of the vertebral bodies, envelopment of the medullary cone, early spinal compression and soft tissue spread into the retroperitoneum. Early neurological defects were present. The tumor was excised, covered with two large rotation flaps and post operatively irradiated. The patients quality of life has improved, the tumor has not progressed and there is no sign of paraplegia.

Basal Cell Carcinoma↗