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Biomedical subjects

H Mandelkow

Publications and source records attributed to H Mandelkow.

11 recordsLinked to original sources

Giant cell granuloma of the lung.

In a 50-year-old man without bronchopulmonary symptoms a round mass lesion close to the hilum of the right lung was detected in a routine chest x-ray and confirmed by computed tomography. Histological examination of two biopsy specimens did not result in a definitive diagnosis. Therefore thoracotomy with enucleation of the focus was performed. The histological picture of the lesion is characterized by connective tissue proliferation, multinucleated giant cells, ossification, localised hemorrhage, deposits of hemosiderin and foci of foam cells. The findings are interpreted as a giant cell granuloma of the lung.

Granuloma, Giant Cell

Is aggressive surgical palliation of proximal bile duct cancer with involvement of both main hepatic ducts worthwhile?

The only curative treatment for proximal bile duct cancer with involvement of both main hepatic ducts is liver transplantation. Most patients do not fulfill the requirements for liver transplantation. Our treatment strategy in appropriate cases is palliative tumor resection and reconstruction of the biliary passage by sutureless bilioenteric anastomosis. We have treated 12 patients, 5 in combination with intraluminal and percutaneous radiotherapy. Our results indicate that this strategy leads to effective palliation in some cases provided that only microscopic residual tumor is left in-situ. Our survival times compare favourably with survival after liver transplantation.

Aged

[The effect of various sterilization procedures on the osteoinductive properties of demineralized bone matrix].

To minimize potential infection following the transplantation of allogeneic bone, extremely rigorous selection of donors and careful processing and storage of samples are required. Other major problems related to allogeneic transplants, such as reduced osteogenic properties and immunological reactions, led to the development of demineralized bone matrix (DBM). This osteoinductive bone extract is largely free of antigens and is easy to produce. However, to eliminate the potential risk of infection, DBM should be sterilized prior to implantation. The purpose of this study was to investigate the influence of different sterilization techniques on the osteoinductive properties of DBM. A series of 76 cortical defects (drill holes) 0.6 cm in diameter in the tibiae of 11 Merino sheep were filled with DBM in addition to autogeneic and allogeneic cancellous bone. Prior to implantation DBM was sterilized by autoclaving, gamma irradiation, or application of ethylene oxide or ethyl alcohol. A further 12 drill holes were left empty as controls. The formation of new bone was examined 3 and 6 weeks postoperatively, using histological, fluorescent-optical and microradiographical techniques. The amount of newly formed bone was also quantified. Apart from autoclaved DBM all matrix grafts showed excellent new bone formation following sterilization, by far exceeding the formation with allogeneic cancellous bone.

Animals

[Organization of a bone bank].

The transmission of infectious diseases by allografts from bone banks has led to considerable restrictions on bone transplantations. HIV and hepatitis are considered to be the most dangerous diseases transmitted in this way. To prevent the transmission of any infections, extensive precautions have to be applied when allografts are taken and during their storage. Donors have been checked for infectious diseases at the time of collection and 3 months later. In addition, the donated grafts must be cultured for aerobic and anaerobic bacteria. This elaborate series of tests can only be mastered if the bone bank is tightly organised. The number of available grafts also be increased by sterilisation and the use of demineralised bone matrix.

Acquired Immunodeficiency Syndrome

[Perioperative preventive use of antibiotics in thoracic surgery--results of a controlled randomized study with optocillin].

There seems to be general agreement that antibiotic prophylaxis should be provided for patients undergoing resections of the lung. In order to obtain further information about the extent of resection beyond which this is necessary, and also to establish the type of prophylaxis that is meaningful over the long term, we carried out a controlled study involving two groups of 100 patients each. In the first group, who received minor resections, ultrashort-term prophylaxis was compared with an 0 group. We were able to show that in high-risk patients with prior pulmonary diseases, prophylaxis is indeed meaningful. In the second group of patients undergoing major resections, antibiotic prophylaxis must be provided; a one-day administration suffices, and long-term administration fails to offer any further advantages.

Drug Administration Schedule

[Expanded trans-pedicular spongiosa grafting--dorsal approach to filling of the intervertebral spaces with cancellous bone].

Internal fixation of dorsolumbar spinal fractures can be accomplished by dorsal plating or internal fixator. So far, the technique of transpedicular grafting has been applied to fill the vertebral body with cancellous bone. In this paper, we present a new technique of extended transpedicular bone grafting to fill the intervertebral space also. By this means, the disadvantage of secondary loss of height after removal of the metal implants can be prevented.

Bone Plates

The iliohypogastric and ilioinguinal nerves. Distribution in the abdominal wall, danger areas in surgical incisions in the inguinal and pubic regions and reflected visceral pain in their dermatomes.

The courses of the iliohypogastric and ilioinguinal nerves were studied in 44 adult human cadavers, in order to clarify their relations to incisions in the abdominal wall in appendectomy, inguinal hernial repair, caesarean section and lumbar nephrectomy. If either of these nerves is trapped during suturing of the abdominal layers, especially after inguinal hernia repair and appendectomy typical nerve irritation in the inguinal region is observed. To avoid cutting the anterior branches of the iliohypogastric and ilioinguinal nerves in appendectomy, incisions should be placed at a distance of not less than 3 cm from the anterior superior iliac spine. In inguinal hernial repair, after the external oblique aponeurosis has been opened, the ilioinguinal nerve should be displaced from the spermatic cord cranially. In performing a lower paramedian incision (Lennander) and Pfannenstiel's suprapubic incision, the iliohypogastric nerve will be spared if the incision passes at least 5 cm cranial to the inguinal ligament. During oblique lumbar incision for nephrectomy (Bergmann-Israel) the iliohypogastric nerve can easily be found in the middle third of the lateral margin of the quadratus lumborum muscle. The nerve should be displaced carefully downwards. Positional changes of the kidney or ureter, perinephric inflammation, etc. are often referred to the skin areas (Head, Mackenzie) of the iliohypogastric and ilioinguinal nerves.

Abdominal Muscles

[Compression syndromes in the popliteal area].

In young, active patients with intermittent or sudden-onset ischemic pain in the lower leg, the presence of an entrapment syndrome of the popliteal artery must be considered. This compression syndrome can be clinically and angiographically verified by an interruption in the continuity of the middle segment of the artery. As irritation of the arterial wall can lead to complete occlusion of the artery, all cases of entrapment syndrome within the popliteal fossa--even those causing few symptoms or none at all--require surgical revision. A dorsal approach should be used, and the anatomical variations of the artery listed elsewhere must be considered. The surrounding musculature on the fibrous structures causing compression must be incised or resected; in some cases vascular reconstruction is necessary. In the relatively rare soleus syndrome, there is entrapment of nerves and veins as well as of the artery. In such cases, the tendon of the soleus muscle must be split to obtain adequate decompression of the vascular nerve bundle.

Constriction, Pathologic

[Anatomy and clinical aspects of sartoriusplasty].

According to Mathes and Nahai (1982) the sartorius muscle is supplied in a segmental fashion (Type IV) from six to ten branches arising from the superficial femoral artery. They state that the use of this flap is limited because of the segmental blood supply. In contrast, dissecting 40 cadaver specimens at the Anatomy Department of Munich University a different vascular anatomy was revealed in which only two to four branches from the femoral artery supply the whole muscle. Based on this pattern of intramuscular vascular connections, the most proximal arterial branch provides the blood supply to the whole muscle. Elevated on the proximal vascular pedicle the muscle can cover defects of symphysis, fill the acetabulum following disarticulation of the septic hip joint and osteomyelitic defects of femur.

Arteries

[Osteoid induction].

Osteoinduction is a biological principle. The implantation of tissue with inductive properties results in the proliferation and differentiation of undifferentiated cells to cartilage and bone. This process, which is similar to a cascade-type mechanism, is controlled by a series of humoral and local growth factors. It was possible to isolate a number of macromolecular substances with osteoinductive, mitogenic, or chemotactic properties specifically from the extracellular bone matrix. A deeper understanding of the regulative mechanisms as well as the greater availability of growth factors may lead to new therapeutic approaches in bone surgery.

Animals