Biomedical subjects
Publications and source records attributed to W Mühlbauer.
A new technique in craniofacial surgery to separate the cranial and nasal cavities from each other is described. This can be achieved by preserving the complete anterior cranial fossa while simultaneously correcting the forehead, orbit, and face in craniofacial dysostosis. With this procedure, the risk of infection deriving from nasal sinuses and cavities should be minimized.
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The easily malleable Champy miniplates are suitable for fixation not only in the viscero- but also in the neurocranium in craniofacial surgery of complex craniofacial deformities. The miniplate osteosynthesis stabilizes the skeletal segments in their new position and function so securely that intermaxillary fixation is no longer necessary. This modality of internal fixation is applicable even in small children and infants allowing total osteotomy and mobilisation of the cranium and the facial skeleton at this early age. The miniplates may also prevent restenosis after radical stripping of prematurely closed sutures. The plates and screws are usually removed 6 to 12 months later through small stab incisions. The craniofacial surgery groups in Munich and Innsbruck have successfully applied this form of fixation in 10 selected children with severe malformations, their age ranging from 3 months to 14 years. The technique and results are demonstrated in appropriate examples. The pros and cons of the miniplate osteosynthesis versus other methods of fixation are discussed. During a period of nearly 3 years (1980-1982) no complications have been observed.
Deformities in the orbital area can also be corrected by craniofacial surgery. Early surgery within the first year of life is indicated in cases with intracranial pressure if permanent damage to the eye is to be avoided. Otherwise, corrective surgery should be performed in early childhood, although it can also be performed on adult patients. More severe strabismus cannot be treated, but disturbance of lid function can be positively influenced. From the esthetic point of view considerable improvement can be achieved. These very protracted operations require intensive interdisciplinary cooperation.
We present our experimental and clinical experiences with the free neurovascular forearm flap. The flap is based on the radial artery, one of the great veins of the forearm (cephalic, basilic, or interconnecting vein), and one or two cutaneous forearm nerves (ulnar, median, or lateral). Because of the standard anatomy, the large caliber of blood vessels, the good sensory supply, the quality and quantity of the forearm skin, and the thin layer of subcutaneous fat, the free forearm flap is a technically easy and safe flap for reconstruction of soft-tissue defects, especially those in the head and neck and those areas of the extremities where sensitive skin is desired.
Craniofacial surgery deals with the correction of congenital acquired deformities of the skull and face. This kind of surgery together with microsurgery can be regarded as the most outstanding development within the past decade. Plastic surgery, as the center of organisation is responsible for coordination with many other medical disciplines. Since 1978 an interdisciplinary group for craniofacial surgery started with operations at the University Hospital for Plastic Surgery in Innsbruck and the Department for Plastic Surgery at the Klinikum rechts der Isar in Munich. In this article first experiences are reported and three cases, a Morbus Apert, a Morbus Crouzon and a Hypertelorismus presented. The indication for such treatment is directed for functional disturbance but also for aesthetical reasons to improve the psycho-social structure of the patient. An early operation is indicated in stenosis of cranium and face to avoid damage of the brain and eyes. If not urgent, these interventions should be started beyond the age of about 8, after dentition.
306 patients underwent extensive plastic surgery in the last five years for advanced basal cell carcinoma. In 12 patients either due to delay in presentation or due to inadequate treatment squamous cell carcinoma supervened. In all 12 cases reconstruction was very limited or impossible. Prostheses were used to mask those defects which could not be reconstructed. The infiltrative growth of these squamous cell carcinomas towards the brain could not be controlled. Eventually all the patients developed wide-spread systemic metastases.
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The effect of high doses of ethinyl estradiol (0.4 mg/day) on renin substrate concentration, renin activity and aldosterone concentration in plasma was studied in eight ovariectomized women. Plasma renin substrate (angiotensinogen) increased already within 24--48 h, reaching a maximum on the third to fifth day after starting estrogen treatment. Thereafter, renin substrate concentration remained relatively constant in a range which was fourfold above the baseline levels. The increase of plasma renin activity was less pronounced and showed considerable between-patient variability; this increase was statistically significant only after 48 hours of estrogen intake. A rise in plasma aldosterone concentration was observed in two of four subjects examined. In one patient treated with 5 mg estradiol benzoate intramuscularly, plasma renin activity increased without any measurable change in renin substrate concentration. Only in one subject treated with ethinyl estradiol did plasma renin activity increase before plasma renin substrate concentration; the results presented do not preclude factors other than the stimulation of renin substrate synthesis in the liver from contributing to the activation of the renin-aldosterone axis during treatment with ethinyl estradiol.
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In seven healthy male subjects, a natriuretic effect of 17 alpha-hydroxyprogesterone caproate (17 alpha-OHPC) was demonstrated. Three of these subjects were kept on an uncontrolled diet and were examined over a period of 12 days. To the remaining four subjects, a single dose of 250 mg 17 alpha-OHPC was given intramuscularly after four days of intake of a chemically defined diet (Vivasorb). In this second test procedure, blood samples were taken in the recumbent position every two hours throughout a period of 12 h after the injection. For two more days and during the days before the administration of 17 alpha-OHPC, blood was taken at 8 a.m. before getting up from bed in same intervals, urine was collected for analysis of sodium and potassium excretion. During the first 12 h after the injection of 17 alpha-OHPC, the urinary sodium/potassium ratio significantly increased in all subjects. Plasma renin activity showed no characteristic changes at this time, whereas the plasma concentrations of aldosterone and cortisol decreased. The decrease of cortisol concentration started immediately after the injection and was more pronounced than that of plasma aldosterone. During the following 36 h, renin activity as well as aldosterone and cortisol concentrations in plasma showed an increase; in contrast, the sodium/potassium ratio decreased. On the basis of these results, the following effects of 17 alpha-OHPC are discussed: (1) an acute natriuresis which may be due to a competitive inhibition of aldosterone at the renal tubules, and (2) an inhibition of pituitary ACTH secretion or of adrenal steroid biosynthesis.
Problems of indication (premalignant disease, difficult check-up, carcinophobia), of resection (incomplete, unilateral, compromises) and of breast reconstruction (one- or two stage procedure, capsular fibrosis, difficult follow-up) are discussed.
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Indications and operative techniques for dermolipectomies in the abdominal and lumbar region are discussed including resections of excess skin after weight reduction, intestinal bypass, and pregnancy. Dangers and complications are discussed.
The well known advantages of xero-radiography make this particularly suitable for the evaluation of silicone prostheses which were implanted either after a subcutaneous mastectomy or during plastic surgery. Xero-radiography is valuable for demonstrating the soft tissues behind NaCl and Makrodex prostheses and is therefore particularly suitable when searching for tumours in these patients. In addition, it allows one to judge the cosmetic results, such as thickness and shape of the soft tissues, contours and wrinkling of the prostheses.
In 1841 A. POLAND described a rare complex of malformations in the male, characterized a unilateral pectoral muscle defect combined with ipsilateral symbrachydaktyly. If in the female a POLAND Syndrome is associated with ipsilateral hypo- or aplasia of the breast as a leading feature, we propose to name this entity "Amazone Syndrome". Altogether 5 POLAND Syndromes and 40 "Amazone Syndromes" were seen in our department. For the latter a morphological grading into four groups was performed for clinical purposes. The malformation complex of the poland syndrome develops between the 2nd and 5th week of gestation as a result of damage to an upper extremity bud. It is from this extremity-"Anlage" that the muscles of the shoulder girdle and the lateral thoracic wall (with common innervation by the brachial plexus) arise. In early embryonal life the lacteal ridge lies in close proximity to the exrremity bud. The "Amazone Syndrome" can be explained by simultaneous damage to an extremity bud and the lacteal ridge. Its aetiology is not clear. Lack of embryonal material, heredity, and teratogenic damage by medication are discussed. In our patients there was a strong suspicion of unwanted pregnancies with failed induced interruptions. On the other hand some siblings had various other congenital deformities. In conclusion we may state that any inhibition of the normal growth of the upper extremity bud may lead to the POLAND Syndrome, while a simultaneous damage to the extremity bud and the close-by lacteal mound may result in the "Amazone Syndrome.
A report on the treatment of capillary hemangiomas and nevi flammei using laser or broad-band infrared light to initiate thermal coagulation in the blood-filled vascular spaces, leaving intact the nonaffected overlying skin layers. Clinical experiences with 26 patients treated with equipment developed by the group are discussed.