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Biomedical subjects

T Muehlberger

Publications and source records attributed to T Muehlberger.

At least 19 recordsLinked to original sources
PubMed2007

[Liposuction curettage versus Botox for axillary hyperhidrosis. A prospective study of the quality of life].

BACKGROUND: Axillary hyperhidrosis is a dysfunction of the secretion of sweat glands. Conservative treatment modalities are mostly ineffective. Liposuction combined with subcutaneous curettage (TLC) destroys the sweat glands, while Botox injections inhibit the cholinergic transmission. MATERIAL AND METHOD: Of a total of 88 patients, TLC was carried out in 47 and 41 patients received intradermal Botox injections. The effect of both forms of treatment on the quality of life was assessed using a specific hyperhidrosis questionnaire and was correlated with sweat volumes measured by gravimetry. RESULTS: Follow-up after 6 months showed significantly changed sweat volumes of 52+/-41 mg/min of TLC patients versus 78+/-87 mg/min in the Botox group. In the TLC group 91% and in the Botox group 98% were satisfied with the result. CONCLUSION: The stress of a single surgical intervention is to be weighed against the necessary repetitive application of multiple Botox injections. Both methods are superior to other, more radical surgical methods in terms of efficacy and complication rates. Botox and TLC lead to a significant improvement of the quality of life.

Adolescent↗
PubMed2005

[Serious complications of injections--retrospective analysis of incidences, complication-management, prophylaxis and economic aspects].

The parenteral drug application is a routinely used method in all medical disciplines. Intramuscular, intraarticular, intravenous injections and infusions can cause local complications such as abscesses, articular infections or paravasates. These local complications can lead to bacteraemia, sepsis and may lead to multiple organ failure associated with high morbidity and mortality. Although these complications are rare, they are sometimes disastrous and result in life threatening clinical conditions. During a retrospective analysis (review period 1998-2002) 24 patients were admitted and hospitalized in our department. Within this report we demonstrate 7 patients with fatal complications after injections. In the majority of cases minor patients' complaints were proceeding before major complications were present. A long and expensive treatment period with multiple surgical interventions ends up in functional disabilities and unsatisfactory aesthetic results. Instead of delayed surgical treatment immediate radical surgical care is crucial to prevent disastrous complications. In case of the inability of sufficient debridement, amputations are sometimes indicated in the sense of "life before limb". Besides the consequences for the patient these disastrous complications have a high socioeconomic impact and result in reduced reimbursement for the hospital stay.

Abscess↗
PubMed2005

[The anatomy of the surgical treatment of migraine].

OBJECTIVE: The transpalpebral resection of the corrugator and depressor supercilii muscles is a new treatment option for migraine headaches. Hyperactive contractility of these muscles can provoke the peripheral compression of the supratrochlear nerve and induce a neurogenic inflammation triggering the symptoms of migraine. In order to gather detailed knowledge of the respective anatomy in the eyebrow region, a macroscopic cadaver study was conducted. MATERIALS AND METHODS: The relevant muscles of the forehead, glabella and eyebrow were dissected in five fresh, non-preserved heads. The supracanthal origins and dermal points of insertion were marked. Following the preparation of the neurovascular structures, the muscles were measured and weighed. The course of the supraorbital and supratrochlear nerves was demonstrated from the forehead to the orbital cavity. RESULTS: There are three, paired groups of muscles in the superomedial region of the orbital rim. They can be divided into the superficial frontalis and procerus muscle, the orbicularis muscle in a middle layer and the corrugator and depressor supercilii in a deeper layer. The corrugator measured approximately 4.5 cm, whose origin is superior and posterior to the depressor origin situated cranial to the medial canthus. The corrugator inserts lateral to the exit of the supraorbital nerve in the dermis above the eyebrow after penetrating the orbicularis and frontalis muscles and a subgaleal fat pad. The length and weight of the muscles is highly variable. The muscle is penetrated by the supratrochlear nerve whereas the supraorbital nerve runs underneath it. The corrugator is innervated medially and laterally by branches of the facial nerve. CONCLUSION: A detailed knowledge of the complex arrangement of the muscles acting upon the glabella and the different communicating subgaleal and preseptal fat pads allow the identification and resection of the corrugator and depressor muscles without damaging the supratrochlear nerve. The course of the specific nerves is variable. The double-innervation of the corrugator suggests its complete resection instead of the selective denervation of the muscle.

Cadaver↗
PubMed2004

[In vitro fabrication of tendon substitutes using human mesenchymal stem cells and a collagen type I gel].

BACKGROUND AND PURPOSE: Reconstruction of tendon tissue is problematic in many cases. Since direct tendon suture is often impossible, major reconstruction with the use of free tendon transplants or tendon transposition is necessary. Important motor units often have to be sacrificed for reconstructive purposes. In this study we investigated whether long tendon-like substitutes can be fabricated in vitro from human mesenchymal stem cells (MSCs) and a collagen type I gel when cultured under cyclic stretching conditions. MATERIAL AND METHODS: MSCs were obtained from bone marrow aspirates of the iliac crest. Cells were suspended in a collagen type I gel and polymerized in a glass-cylinder with defined size. The fabricated tendon substitutes underwent static stretching for 14 days followed by cyclic stretching for 21 days in a special manufactured bioreactor. Non-stretched substitutes served as a control. RESULTS: Macroscopically the stretched tendon substitutes showed an increased opacity and a smoother surface structure compared to the non-stretched control. The stretched substitutes displayed more spindle-shaped, longitudinal orientated cells, a tendon-like organization of the collagen matrix, and a parallel organization of the collagen fibers when stained with Hematoxylin/Eosin and Elastica. CONCLUSION: Long tendon substitutes could be fabricated from MSCs and a collagen type I gel by cyclic stretching and showed tendon-like parallel collagen fibers and spindle-shaped cells. The use of MSCs in combination with adequate scaffold materials has great therapeutic potential for the development of autologous transplantable tendon substitutes.

Bioreactors↗
PubMed2004

[The V.A.C. system (vacuum assisted closure) as bridging between primary osteosynthesis in conjunction with functional reconstructed of soft tissue--open fractures type 2 and type 3].

Open fractures are complex injuries affecting the integrity of bones and adjacent soft tissue. The therapeutic goals in dealing with open fractures should consist of primary osteosynthesis in conjunction with functional reconstruction of soft tissue. In a period over 2 years, 26 patients were treated with extensive trauma in an interdisciplinary approach. These patients suffered from open fractures type 2 and 3. All patients were treated by primary osteosynthesis, and temporary wound closure with V.A.C.-system. Definitive wound closure was achieved by day 31 after injury. In contrast to a review of the pertinent literature we report the successful free tissue transfer in 21 patients during the critical period between 72 hours and several months preceded by the use of V.A.C.-system for the temporary coverage of open wounds.

Adult↗
PubMed2002

[Carl von Reyher's studies of wound therapy].

Carl von Reyher (1846-1890), a young Russian army surgeon of the late nineteenth century, established the principle of repeated debridements on a scientific basis. After a visit to Lister's clinic, acquainting himself with antiseptic wound management, von Reyher was the first to present a controlled study of debridement in contaminated gunshot wounds. He was able to show that the combination of primary debridement and antiseptic treatment decreased the mortality rate of gunshot injuries from 66% to 23%. Although published in more than 16 papers and presented at international congresses, Reyher's contribution was completely negated. Finally more than 30 years later in World War I, the Inter-allied Surgical Conference officially endorsed primary excision with delayed wound closure as the rule for treatment of gunshot wounds.

Antisepsis↗
PubMed2002

The effect of wound ointments on tissue microcirculation and leucocyte behaviour.

An intact microcirculation is essential for normal healing to occur. Wound repair may be impaired by various endogenous and exogenous factors, such as reduced microvascular perfusion, infection and debris. In the nonhealing wound, radical surgical debridement is critical. To supplement healing, various ointments are used in clinical practice. Little is known about their effects on tissue perfusion. We have therefore selected two substances widely used, the antiseptic Betadine and the enzyme combination Elase and investigated their impact on the microcirculation and on leucocyte activity, using the cremaster muscle as a model. We found that functional capillary density and arteriolar diameters were significantly reduced by Betadine, whereas leucocyte activity was not affected. In the Elase group, capillary flow and arteriolar diameters were significantly increased, and again leucocyte activity was not changed. The mechanism by which Betadine reduces microvascular flow is believed to be the same as in reperfusion injury. The positive effect of Elase on the microcirculation might be attributed to plasmin, which has been shown to dilate blood vessels.

Analysis of Variance↗
PubMed2002

The lymphatic system of the deep inferior epigastric artery perforator flap: an anatomical study.

The anatomical basis of the lymphatic system of the deep inferior epigastric perforator (DIEP) flap was studied in 24 abdominoplasty specimens and in three fresh cadavers. Methylene (n = 4), patent (n = 4) and Turnbull's (n = 8) blue were compared by injecting the dye intradermally. To facilitate staining, two different types of vacuum technique were used: a vacuum chamber (n = 4) and the vacuum-assisted method (n = 4). The lymphatic collectors were dissected, and embedded in paraffin for histological investigation. The most useful dye was Turnbull's blue. The vacuum had no effect on the distribution of the dye. Manual injection showed three parallel superficial collectors situated directly under the skin. Turnbull's blue was also injected into the rectus fascia to demonstrate the collectors of the deep abdominal structures. They run horizontally, and perforate the fascia to run with the inferior epigastric artery. Care should be taken when dissecting the pedicle, or removing the epithelium, to avoid destroying the lymphatic system of the flap.

Abdomen↗
PubMed2001

[Etiology, clinical aspects and therapy of penoscrotal lymphedema].

Penoscrotal lymphedema has serious functional, cosmetic, psychological and potentially malignant consequences. In contrast to the relatively common occurrence of this disease in areas with endemic filariasis, the incidence in the rest of the world is almost exclusively due to therapeutic sequelae of other illnesses or as congenital entities. As conservative forms of treatment have proved to be inefficient, we discuss different surgical options based on the treatment of 12 patients seen in our clinic. Only the complete excision of the edematous and fibrotic tissues, together with reconstructive methods using local flaps and skin grafts, can guarantee a definitive solution, irrespective of the etiology. A detailed anatomical knowledge of the regional lymphatic drainage pathways allows safe operative treatment. Despite the rarity of this disease, a number of different surgical procedures have been reported in the literature that are compared with the findings in our patients.

Adult↗
PubMed2001

[Propane-induced tissue damage: burn or freezing injury?].

Tissue damage due to direct contact of liquid propane with the integument is extremely rare. Only five such cases have been described in the literature. We report the case of a girl who sustained a full-thickness skin necrosis of 14.5 % of her body surface area. There is little agreement about the optimal treatment of these injuries in previous reports. The pathophysiological mechanism suggests a freezing injury. The treatment, however, should be analogous to that of third-degree burns.

Adolescent↗
PubMed2001

[Electric accident. New aspects regarding pathophysiology and treatment].

The complex pathophysiology of electrical injury is caused by several mechanisms which are superimposed and cumulative in action. Existing empirical guidelines are only partially compatible with the results of recent studies. The significance of the joule effect, theories about progressive tissue necrosis, and the traditional surgical approach should be reviewed in view of electroporation and anatomical arrangements. The quality of long-term treatment results and the consistently high rate of amputations have prompted the development of alternative surgical options.

Burns, Electric↗
PubMed2001

The long-term consequences of lightning injuries.

The risk of being struck by lightning is extremely low. Although dying instantly through lightning-induced cardiac arrest is a well-documented cause of death, the majority of cases reported in the literature describe infrequently occurring and enormously disparate sequelae of this injury. A total number of 12 patients were treated in our burn intensive care unit following a lightning accident within a period of 12 years. We have analysed the incidence of cardiac, muscular and sensory disturbances, keraunographic skin markings and significant laboratory results, as well as episodes of audiovisual dysfunction and amnesia at the time of the initial admission. In order to determine possible long-term complications, ten of these 12 patients were evaluated at an average time of 6.7 years following the injury (range, 1 month-12.3 years). Considering specific findings during their hospital stay (average length, 1.58+/-0.23 days), patients were assessed for residual neurologic, ocular, oto-vestibular or psychological deficits. The outcome showed that none of the patients suffered from any deficits or long-term problems that could be related to the original lightning injury. Based on these findings and a literature review, we believe that the overall outcome of lightning injuries is more favourable than generally reported.

Adolescent↗
PubMed2001

Augustus V. Waller and plastic surgery.

Augustus V. Waller's name is associated eponymously with the regressive changes in transected nerves. This article intends to present the many other aspects of Waller's scientific ventures. Apart from pioneering intravital microscopy, Waller made significant contributions to the understanding of the process of tissue inflammation. In addition to his observations of the degenerative changes in severed nerve fibers, he developed a concept of trophic dependence that is relevant for the management of the regeneration of peripheral nerves in plastic surgery.

England↗
PubMed2000

Patterns of expression and secretion of vascular endothelial growth factor in malignant soft-tissue tumours.

Vascular endothelial growth factor (VEGF) is an important cytokine especially in the process of tumour angiogenesis. A total of 46 soft-tissue sarcomas were analysed for the expression and possible secretion of VEGF by immunohistochemistry, in-situ hybridisation, and enzyme-linked immunosorbent assays (ELISA). VEGF was demonstrated immunohistochemically in tumour tissue in 45 of 46 cases. The detection of mRNA transcripts yielded evidence of synthesis of VEGF in these sarcomas. ELISA could be performed in 21 cases. Higher concentrations of VEGF were found in tumour-related intraoperatively sampled venous blood in 16 out of 21 patients (76%) than in systemic concentrations taken preoperatively. The results indicated the secretion of VEGF by tumour cells although these raised concentrations were not statistically significant. In 12 out of these 16 patients (75%) a concurrent moderate to strong immunoexpression of VEGF was detected. The relevance of VEGF blood concentrations as a potential "progress parameter" for the course of disease remains questionable. This is mainly due to the lack of statistical significance in the difference between systemic VEGF concentrations in patients and those of a control group. Further long-term follow-up studies are needed, which should include patients with tumour recurrences.

Adolescent↗
PubMed2000

APC and beta-catenin in alveolar soft part sarcoma (ASPS)--immunohistochemical and molecular genetic analysis.

Apart from its role in cell-adhesion, beta-catenin is regarded as an oncoprotein, the cytoplasmic level of which is regulated by APC as a tumor suppressor protein. Changes of chromosome 5q, the region that includes the APC-gene, are known to be important in the pathogenesis of fibromatosis; however, little is known about the significance of APC and beta-catenin in other mesenchymal tumors. Therefore, we used immunohistochemistry and DNA-analysis to investigate four cases of alveolar soft-part sarcoma (ASPS) as a mesenchymal tumor with a distinct histologic appearance. In three cases of ASPS the APC-gene product was found to have strong nuclear expression and only faint cytoplasmic staining. Beta-catenin showed a partly membranous, partly strong intracytoplasmic expression. No gene mutations for APC and beta-catenin were detected in any of the four cases. These investigations suggest that, apart from their function in carcinogenesis and fibromatoses, APC and beta-catenin play a role in the pathogenesis of soft tissue tumors such as ASPS. The significance of a striking nuclear accumulation of non-mutated, virtually functionally active APC-tumor suppressor protein has not yet been investigated. A nuclear function of APC in ASPS in down-regulating nuclear transcription processes linked to overexpression of beta-catenin, as is known in colorectal carcinogenesis, may be hypothesized.

Adenomatous Polyposis Coli Protein↗
PubMed2000

Beta-catenin in soft tissue sarcomas: expression is related to proliferative activity in high-grade sarcomas.

Besides its role in cell adhesion, beta-catenin exerts a function as an oncoprotein. The aim of this study was the characterization of its expression, possible mutation, and the assessment of beta-catenin as a prognostic indicator for soft tissue sarcomas. A total of 115 soft tissue sarcomas were analyzed using immunohistochemistry, immunogold-electron microscopy, and DNA analysis. Information from 56 patients was available for follow-up. A statistically significant correlation was found between intracellular distribution of beta-catenin and the proliferative activity (MIB-1 expression) in high-grade sarcomas (P = .0008). Beta-catenin was identified with intracytoplasmic and nuclear accumulation, showing additional membranous staining in sarcomas with epithelioid pattern. Ultrastructurally, a colocalization between beta-catenin and nuclear heterochromatin was demonstrated. In 22 analyzed tumors, only one (yet undescribed) mutation of the beta-catenin gene (C-A transversion) could be detected. Prognostic validity of the cellular expression of beta-catenin, however, was not proven. Apart from its membranous function as an effective molecule for cell-adhesion in sarcomas with epithelioid pattern, beta-catenin may act as an oncoprotein in sarcomas with intracytoplasmic and nuclear localization with binding to nuclear DNA. A previously discussed stimulation of cell proliferation caused by an increased beta-catenin level can also be postulated for high-grade soft tissue sarcomas in correlation with the rate of proliferation. Mutations of the beta-catenin gene are probably of lesser importance for the accumulation of beta-catenin in soft tissue sarcomas.

Adult↗