Stephan Spendel

Skin transplantation to monitor clinical donor‐related tolerance in mixed hematopoietic chimerism

Abstract:  Mixed hematopoietic chimerism usually carries with it the tolerance to any other tissue from the same donor. Consequently, the establishment of a sustained chimerism may allow long‐term acceptance of transplanted organs without immunosuppression. We report a girl with refractory severe aplastic anemia who developed low recipient level hematopoietic chimerism following transplantation of maternal highly purified CD34+ cells without prophylactic immunosuppression. Renal thrombotic microangiopathy led to chronic renal failure and she received skin allografts from her mother in view of a future kidney donation. The maternal skin grafts were accepted without immunosuppression and the hematopoietic chimerism remained stable. Skin transplantation may be a helpful and easily applicable tool to monitor donor‐related tolerance in hematopoietic chimerism clinically. It should contribute to minimize the risks of subsequent solid organ transplantation from the same donor without immunosuppression.

Ultrasound-Navigated Interstitial Nd:YAG LaserCoagulation of Congenital Vascular Disorders

Summary The treatment of voluminous hemangiomas or vascular malformations, particularly of the infiltrative type, is difficult and requires a combination of methods such as surgical excision, embolisation, laser therapy, sclerotherapy and magnesium spiking. The goal of this study was to investigate the efficacy of ultrasound-navigated interstitial Nd:YAG (Neodymium:Yttrium-Aluminium-Garnet) laser coagulation of hemangiomas and vascular malformations. Ultrasound-navigated interstitial Nd:YAG laser coagulation was performed on 21 patients with cavernous hemangiomas or vascular malformations. 12 patients had vascular malformations primarily of the venous kind, whereas arteriovenous components were predominant in 5 patients. In 4 children, an extensive hemangioma was the indication for interstitial laser therapy. Laser energy with a power of 7–10 W was applied via puncture canula through a 600 μm glass fiber and with support of ultrasound guided to the vessel wall. Immediately after laser application the blood flow was controlled with color-coded duplexsonography. Three months after lasertreatment, a volume reduction between 60% and 80% in hemangiomas (n = 4), between 20% and 70% in venous malformations (n = 12) and 0% to 70% in arteriovenous malformations (n = 5) was achieved. With exception of necrosis in one patient which healed spontaneously, no further complications occurred. Ultrasound-navigated interstitial Neodym-YAG-laser coagulation is an effective and minimally invasive method for treating voluminous hemangiomas and vascular malformations and is an alternative or complimentary to other therapies.

Surgical management of extensive gnathophyma

Rhinophyma is an uncommon disease of the nose characterized by irregular skin thickening and nodular deformation. The extensive growth causing ‘whisky nose’ is due to hyperplasia of the sebaceous glands and the surrounding connective tissue. Other facial regions may concomitantly be affected. We present a case of extensive gnathophyma accompanying minor lesions of the nose. Surgical treatment led to an excellent cosmetic result.

Acne inversa of the anogenital region: early radical surgical excision with plastic defect coverage is treatment of choice.

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Körperformung – Body Contouring

Unter „body contouring“ versteht man alle an der Korperoberflache formenden Eingriffe, die einzeln fur sich oder in Abfolge einer Kombination von Eingriffen bis hin zur Korrektur „vom Scheitel bis zur Sohle“ durchgefuhrt werden.

Körperformung nach massivem Gewichtsverlust

Adipositas, hauptsachlich als Folge einer Form von Essstorungen, wurde in den letzten Jahrzehnten zunachst in den USA, in jungeren Jahren aber auch in Europa ein rapid zunehmendes Gesundheitsproblem. Ahnlich der okonomischen Globalisierung ergreift die Fettsucht die Menschen vieler Teile der Welt, so erstaunlicherweise auch diejenigen der Entwicklungslander. Als Ursachen sind einerseits die Art und Weise der ubermasigen Kalorienaufnahme, andererseits der unzureichende Kalorienverbrauch durch Bewegungsarmut fur die Adipositas verantwortlich. Soziookonomischer Stress ist neben einer Reihe anderer moglicher Faktoren die psychische Ursachenkomponente fur die Ubergewichtigkeit der Gesellschaft der Gegenwart. Dazu kommen noch genetische Faktoren. Alarmierend ist der zunehmende Prozentsatz an adiposen Jugendlichen.

Approach to the upper body after massive weight loss

SummaryBackgroundUpper and lower body lifts are key concepts in re-shaping the body after massive weight loss. Because of their mutual interaction, the whole body should be examined and evaluated before any contouring operation. Upper body contouring covers the arms, thoracic flanks, male or female breast and back.MethodBefore the operation, the excess tissue is determined by pinching and then marking the skin. These lines are supplemented by perpendicular orientation lines to help the surgeon to recognise corresponding wound edges and join them after resection of the skin. As the skin excess on the upper arms is often overestimated, the actual resection line is usually well within the line determined by the pinch test. After the fatty tissue is suctioned off, the deep subcutaneous layer is left undisturbed to protect lymphatic vessels and the nerves, and the excess skin is removed from the superficial subcutaneous layer.On the lateral thoracic wall, the skin is firmed up from the back and upper abdomen to the breast fold. The latter must be secured topographically in its typical position with sutures to the ribs, rib periosteum or fascia so that the breast is not skewed. Contouring operations on the breast always require pre-operative imaging studies. Besides breast lift and reduction, breast enlargement to correct involution is not uncommon. Pedicled, de-epithelialized subcutaneous flaps from the thoracic flank and upper abdomen are more suitable than implants. If needed, breast volume may be further enhanced with secondary lipofilling.ResultThe combination of a thoracic flank and lower body lift usually avoids separate lifts and scars on the back. If necessary, however, any folds or bulges are removed from their base after liposuction.ConclusionThe optical result correlates directly with the body mass index at the time of surgery. As almost all the patients are above the BMI norms, there are limits to what can be expected.The majority of the patients under consideration here considered the optical result of the upper body lift to be good to very good and were well satisfied.

Angeborene Gefäßanomalien im Bereich der oberen Extremität und Hand

Unter dem Begriff Hamangiom wurden in der Vergangenheit unterschiedlichste Veranderungen des Gefassystems zusammengefasst. Mulliken und Glowacki haben schlieslich 1982 eine Trennung von Hamangiomen einerseits und von Gefasfehlbildungen anderseits gefordert. Die »International Society for Study of Vascular Anomalies« (ISSVA) hat diese Trennung ubernommen und spater die Bezeichnung Hamangiom durch den Begriff vaskularer Tumor ersetzt. Sie strebt fur die weitere Klassifizierung eine eher forschungsorientierte Einteilung der vaskularen Tumore nach histologischen Kriterien an, dies spiegelt sich auch weitgehend in der angloamerikanischen Literatur wider. Im deutschsprachigen Raum hat sich hingegen eine vorwiegend praxisorientierte Einteilung nach klinischen Kriterien durchgesetzt.

Toxic epidermal necrolysis and Stevens-Johnson syndrome: Things we should know!

therapy relates to changes in lipid metabolism in critically ill patients. There is a reduction in total cholesterol. The mechanism for this remains unclear, but it is possible that hydroxymethylglutaryl coenzyme A reductase is already maximally downregulated, which may attenuate any benefit of additional inhibition by statins. There is strong evidence that statins may be a potentially beneficial pharmacologic treatment in the critically ill. Although the data to date are reassuring, there are still limited safety data on the use of statins in the critically ill. The excellent review by Brealey et al (2) is an important reminder about the potential for adverse effects of statins, including those mediated through decreased ubiquinone levels. It also highlights the need for large clinical trials powered for important clinical outcomes in patients with sepsis and ALI to answer the question of whether statins improve outcomes and are safe in the critically ill. Peter J. McGuigan, MB BcH BAO, FCARCSI Regional Intensive Care Unit Royal Victoria Hospital Belfast Health and Social Care Trust Belfast, United Kingdom Cecilia M. O’Kane, MD, PhD Centre for Infection and Immunity Queen’s University Belfast Belfast, United Kingdom Danny F. McAuley, MD Regional Intensive Care Unit Royal Victoria Hospital, Belfast Health and Social Care Trust, and Centre for Infection and Immunity Queen’s University Belfast Belfast, United Kingdom

Die V.A.C.™-Behandlung bei der Fournierschen Gangrän — Erste Erfahrungen

ren sowohl am linken Unterarm als auch am linken Ful3 freie Lappenplastiken notwendig. Auch am rechten Ful3 lagen die Metatarsalknochen fret. Da schon zwei freie Lappenplastiken investiert worden waren, wurde bet der Deckung des linken Fu6es mit einem freien Lappen anf der rechten Seite zuntichst in derselben Sitzung ein V.A.C.rXLSchwamm angelegt (Abb. I). Schlussendlich konnte am rechten Fur3 bet guter Granulation auf eine weitere Lappenplastik verzichtet und die Wunde mit Spalthaut zur Abheilung gebracht werden (Abb. 2). Ein Jahr nach dem Unfall kann der Patient beide Beine belasten, die Narben nach V.A.C.TV-Behandlung sind jedoch deutlich instabiler als auf der Seite der freien Lappenplastik (Abb. 3).