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Biomedical subjects

H Menke

Publications and source records attributed to H Menke.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Standard technique of breast reduction surgery with vertical scar].

In 1991, we started to use a new surgical technique for breast reduction with a single vertical scar incision as developed by Marchac, Lassus, and Lejour. The operative procedure wsa changed step-by-step according to the following significant modifications: Simultaneous liposuction is carried out only in the presence of extensive axillary fatty tissue. The undermining of the glandular tissue is limited to the extension of glandular resection. The number of glandular sutures is significantly reduced. A central fixating suture to the pectoral fascia is performed only in the presence of extreme ptosis. The positioning of the nipple-areola complex represents the final step of the reduction procedure after the resection of the glandular tissue. Based on our experience with more than 800 breast reductions, this technique is considered to be a safe standard procedure for nearly all breast sizes.

Cicatrix↗
PubMed1997

[Infected decubitus ulcer].

The treatment of pressure sores, which have a high incidence in hospital patients, is a long standing problem. Pathogenesis, treatment modalities and the results, including long-term follow-up, are discussed. The value of a step-by-step concept is emphasized, starting with simple procedures like local flap rotation up to musculocutaneous flaps. Furthermore, the reconstructive options, especially in patients with pressure sores of the sacral and ischial region, are presented.

Bacterial Infections↗
PubMed1994

Incidence and clinical importance of perioperative histamine release: randomised study of volume loading and antihistamines after induction of anaesthesia. Trial Group Mainz/Marburg.

Although histamine release is recognised as a common event during anaesthesia and surgery, few clinicians judge the resultant cardiorespiratory disturbances serious enough to warrant prophylaxis with antihistamines. We have assessed the incidence and importance of histamine release in a randomised 2 x 2 factorial study. 240 patients representing a routine throughput of major general surgery were studied during a standardised induction of anaesthesia and preoperative loading of the circulation with either Ringer solution or Haemaccel-35, with or without antihistamine prophylaxis with dimetindene (H1) plus cimetidine (H2). Cardiorespiratory disturbances were graded as detectable, clinically relevant, or life-threatening from observers' records of the anaesthesia and the actions taken by the anaesthetists. Disturbances that were accompanied by significant rises in plasma histamine were further designated histamine-related, and those that were not were designated histamine-unrelated. Anaesthetists, observers, and designators were blinded to whether or not the patients had received antihistamines and to which solution was used for circulatory volume loading. Clinically relevant or life-threatening histamine-related disturbances occurred in 8% of the patients who after induction of anaesthesia received Ringer without antihistamines, in 26% of those who received Haemaccel without antihistamines, and in 2% or less of those who received antihistamines (p < or = 0.0001). There were 4 life-threatening histamine-related disturbances, all in patients who received Haemaccel without antihistamines (p < 0.01). Histamine-unrelated disturbances occurred in 16% overall, with no obvious effect of Haemaccel or antihistamines. The histamine-related disturbances under anaesthesia were remarkable for their severity (even with small rises in histamine concentrations), for the prevalence of bradycardia, and for the absence of skin signs. Their likelihood and severity were increased in patients with tumours. The results of the trial make a case for routine prophylaxis with antihistamines as part of anaesthetic management.

Adolescent↗
PubMed1993

Characterization of the NR1, NR2A, and NR2C receptor proteins.

N-Methyl-D-aspartate (NMDA) receptor subunits were characterized with seven polyclonal antibodies. The antibodies were directed against NR1-A, NR2A-N1, and NR2C-N1, representing N-terminal sequences of the NR1, NR2A, and NR2C subunits, and against NR1-E, NR2A-C1, and NR2C-C1, derived from C-terminal sequences of these subunits. The anti-NR1-D antibody was raised against the putative internal loop of NR1. A size of 118 kDa was found in sodium dodecyl sulfate-polyacrylamide gel electrophoresis for NR1 (from rat brain) detected by anti-NR1-D and -NR1-E, but not anti-NR1-A. With the anti-NR1-A antibody, a 125-kDa protein was discovered that may represent a glutamate receptor not yet characterized. NR2A and NR2C were identified as proteins with sizes of 175 and 140 kDa, respectively. Enzymatic N-deglycosylation generated a 97-kDa protein from NR1, a 105-kDa protein from the 125-kDa protein, a 162-kDa protein from NR2A, and a 127-kDa protein from NR2C. In contrast to the deglycosylation product of the NR2A, the 97- and 127-kDa proteins derived from NR1 and NR2C, respectively, were found significantly smaller than the molecular masses of 103 and 141 kDa, respectively, predicted on the basis of DNA data. These products may represent truncated proteins. The tissue content of the NR1 and NR2A was high in bovine hippocampus and cortex but lower in the cerebellum. In contrast, NR2C was solely found in the cerebellum. The 125-kDa protein was highest in the cerebellum and cortex.

Amino Acid Sequence↗
PubMed1993

Perioperative nonspecific histamine release: a new classification by aetiological mechanisms and evaluation of their clinical relevance.

As a consequence of the performance of a randomized controlled clinical trial on perioperative histamine release and cardiovascular and respiratory disturbances, several types of increases in plasma histamine had to be distinguished instead of only two which existed at the beginning of the study: drug-induced allergic and pseudoallergic reactions. First of all, the new classification by aetiology (clinical epidemiology) was derived from a meta-analysis (secondary analysis) of the most recent literature. According to that histamine release in the perioperative period has several, different causes and is involved in several, different disease manifestations. A clear distinction (classification), however, is necessary if histamine release as an unwanted (adverse) effect has to be recognized, value judged according to its clinical relevance and therefore also prevented by histamine antagonists. Histamine release by neuro-endocrine and neuro-inflammatory mechanisms, cytotoxic histamine release and local, cytokine induced histamine release have been distinguished from pseudoallergic histamine release, but its functions are not yet clear. It has been analysed in prospective trials which used special clinical situations as models: patients on a normal ward or before and during upper GI endoscopy without premedication, but also in specific phases of laparoscopic cholecystectomy (trocar phase and dissection phase). Their existence in the clinical reality is now very likely, but new trials must investigate the pathophysiological effects such as in metabolism, coagulation, pulmonary haemodynamics (shunt volume) and gastric acid secretion. Histamine release by pseudoallergic mechanisms, however, was identified in the very vulnerable post-induction phase of anaesthesia up to skin incision. Its incidence was much higher than ever expected and its clinical relevance was demonstrated by the severity of reactions and the intervention strategies of the anaesthetists who were blinded concerning the type of the plasma substitute given and the prophylaxis with antihistamines. Pseudoallergic histamine release was clearly unwanted (adverse). Its occurrence in the other phases of anaesthesia has to be further evaluated in the tedious procedure of data analysis of the Mainz-Marburg-trial. The overall incidence of histamine release in the trial was so incredible high (72% of all patients, some of them with up to 4 episodes of histamine release) that a distinction between pseudoallergic (unwanted) and other types of histamine release (possibly less unwanted or even beneficial) is urgently needed. In the phase of steady state (maintenance) of anaesthesia the H1-(+)H2-prophylaxis was highly effective. Further analysis must show whether this is also the case during the phases of induction of anesthesia.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1993

[Thoracoscopic operation of a tumor of the esophageal wall].

Improvements in video endoscopic technique opens a wide spreaded field of indications of thoracoscopic surgery especially in benign tumors of the esophagus. A 58-years old patient presented with dysphagia. Preoperatively a benign, intramural tumor of the esophagus wall was diagnosed. Enucleation of the tumor was performed by right videothoracoscopy. The use of thoracoscopic operative technique implies rapid disappearance of complaints and a reduced time of hospitalisation.

Deglutition Disorders↗
PubMed1993

[Risk factors of perioperative morbidity and mortality in colorectal cancer with special reference to tumor stage, site and age].

The perioperative risk was prospectively analyzed in 511 patients with colorectal cancer, out of which 5% had an emergency procedure. The morbidity rate was 23.6% without an association with tumour stage or localization. The incidence of nonsurgical complications rose with increasing age because of a rising number of concomitant illnesses (< 50: 5.7%, > 80: 28.1%). The morbidity was associated with an increasing blood loss during the operation (< 500 ml: 10.6%, > 2000 ml: 30.4%), but not with the type of treatment. The overall operative mortality rate was 2.3% with the same rate of surgical complications and complications of preexisting conditions. Morbidity and mortality following emergency procedure were 56%, respectively 20%, expressing mainly septical complications of colorectal cancer.

Adult↗
PubMed1992

[Morbidity and fatality of surgery for stomach cancer. Results of a prospective study on the importance of various risk factors].

A total of 172 patients with cancer of the stomach presenting between 1986 and 1990 were entered into a prospective study. Total gastrectomy including extended lymph node dissection and splenectomy was done in 84 patients, simply gastrectomy in 28, resection in 29, and other operative procedures with no resection in 31 patients. Postoperative morbidity rates were 38%, 21%, 17% and 26%, respectively, with 16% surgical and 24% nonsurgical complications, mainly pulmonary. Important parameters proved to be extensive resections such as extended total gastrectomy, intraoperative blood loss and general physical condition (ASA I/II 24%, ASA III 34%). Total gastrectomy can be performed even in geriatric patients (greater than 70 years), although these patients had a clearly higher morbidity rate (48% vs. 35%) after extended procedures, the mortality rate not being increased. The overall mortality rate was 3.5%.

Aged↗
PubMed1992

[Local excision of rectal tumors. Indications, preoperative diagnosis, surgical technique and results].

Between January 1986 and October 1991 255 patients with rectal tumors were treated by local excision. In 239 patients local excision was performed by transanal endoscopic microsurgery, 16 tumors were removed with the retractor developed by Parks. Operative mortality was 1% in 189 local removed adenomas, complications were observed in two patients (2.1%), local recurrences in seven patients (3.7%). 66 rectal carcinomas were treated by local excision (operative mortality 1%, complication rate 3%). In one of 28 local excised "low risk" T1-carcinomas a recurrence was observed. Five of eleven local treated patients with "high risk" tumors developed a recurrence. Endosonography was of utmost importance in preoperative staging of rectal tumors. Between June 1987 and October 1991 204 patients with rectal tumors (92 sessile adenomas, 30 T1-carcinomas and 82 advanced carcinomas) were examined preoperatively by endosonography. The diagnosis of an adenoma or a T1-carcinoma was made with a sensitivity of 0.9, although no differentiation was possible between adenomas and T1-carcinomas. Results of digital examination were comparable to endosonography, under condition that digital examination was complete. Insufficient information was obtained from the endosonographic detection of lymph-node metastatic spread.

Adult↗
PubMed1992

[Comparison of DNA analysis with histomorphologic parameters in stomach cancer].

After curative resection of stomach carcinomas (adenocarcinomas: n = 58, signet ring cell carcinomas: n = 24, undifferentiated carcinomas: n = 21) the DNA content of the tumor cells was compared with the histomorphological parameters. There was a correlation between the DNA content and the histomorphological parameters. The DNA analysis had no additionally prognostic influence. In the multivariate regression analysis the prognosis depended on lymph node status (p = 0.0009), pT-stage (p = 0.02), tumor localization (p = 0.03) and the histological type (p = 0.05). The prognosis was independent of the DNA content. Furthermore, neither did the degree of differentiation, the operative procedure, the safety distance, the size of the tumor, the sex nor the age of the patient have any influence on the prognosis.

Adenocarcinoma↗
PubMed1992

[Risks and follow-up of choledocho-jejunostomy for nonresectable cancers of the head of the pancreas. A prospective study].

In 44 patients with palliative operative procedures due to non-resectable pancreatic cancer the preoperative risk factors and the intra- and postoperative course as well as the long-term results were prospectively investigated. Postoperatively 2 patients developed severe complications and 3 patients died. The median survival time was 5 months. The results of this investigation show, that the biliodigestive anastomosis offers a good palliation in patients with non-resectable pancreatic cancer. Indication for non-operative palliative procedure are patients in poor general condition with a life expectance of less than 4 months.

Aged↗
PubMed1992

[Fascia dehiscence--cause and prognosis].

During a period of 5 years, 4476 interventions in abdominal surgery were prospectively analyzed. The incidence of fascial dehiscence was 0.7% (n = 30). Seventeen of these patients underwent surgery on account of intraabdominal infection (total incidence of intraabdominal infection 4.4%). Fascial dehiscence developed in 22 out of 30 patients (73%) after emergency surgery. All of them had to be operated out of routine surgical schedule with the exception of four patients. Using multivariate stepwise logistic regression analysis, main determinant factors in fascial dehiscence were the ASA score (p = 0.0001), reflecting the severity of primary or concomitant diseases, and wound infection (p = 0.0075), mostly due to intraabdominal contaminations. Fascial dehiscence was associated significantly with a higher morbidity, reflected by longer inpatient management. Nevertheless, the overall lethality of 20% was associated to serious primary or concomitant diseases. Therefore, the results emphasize the significance of diligent preoperative work-up. Adequate treatment for concomitant disorders should be performed preoperatively, whenever possible even in emergency surgery.

Abdomen↗
PubMed1992

[Cardiac morbidity and fatalities in patients with vascular surgery. Identification of risk groups].

Incidence and type of cardiac complications in 701 patients undergoing arterial vascular surgery were prospectively investigated to identify high-risk groups. Cardiac morbidity was 10.1%. Cardiac complications were responsible for 28 deaths (57%). Using logistic regression analysis, age (cardiac morbidity greater than 7017.3%), impaired renal function (19.8%), and congestive heart failure (17.3%) were the main independent risk factors. In addition, 4 risk factors (arrhythmia, coronary artery disease, anemia, emergency surgery) showed significant individual association with cardiac complications. Cardiac morbidity increased to 27.8% in patients with more than 2 of these 7 risk factors. A further association could be demonstrated between the degree of peripheral vascular disease and cardiac morbidity, but not with the extent of the operation. Based on our results a distinction between three groups of different cardiac risk can be made. A clinical algorithm for further cardiac assessment in high-risk patients is presented.

Adolescent↗
PubMed1992

[Preoperative risk assessment with the ASA classification. A prospective study of morbidity and mortality in various ASA classes in 2,937 patients in general surgery].

The value of ASA classification in assessment of perioperative risk, i.e. especially postoperative morbidity, was analyzed prospectively using the data of 2937 patients. The analysis took into account the criteria validity, reliability, and sensitivity. The incidence of post-operative morbidity after elective surgery rose from 3.9% in ASA class I to 36% in ASA class IV. Mortality was 0.6% in ASA class II, whereas 9.3% died in ASA class IV. Morbidity, mortality respectively, after emergency surgery was 10.2% in ASA class II compared to 69% in class IV, mortality 1.4% compared to 21.5%. Differences between the ASA classes were confirmed (p-value < 0.05) considering separate kinds of complications and different periods. Furthermore, ASA classification was a valuable reference to length of stay and severity of necessary therapy at the ICU.

Adult↗