Stuttgart Mühlhausen, Germany
Stuttgart Mühlhausen, Germany

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Gitt A.K.,University of Heidelberg | Halle M.,TU Munich | Hanefeld M.,TU Dresden | Kellerer M.,Marienhospital Stuttgart | And 5 more authors.
European Journal of Heart Failure | Year: 2012

AimsPatients with type 2 diabetes are at high risk for developing heart failure. Evidence-based treatment recommendations with respect to the specific benefits or possible hazards of antidiabetic treatment are scarce.Methods and resultsIn a systematic search we only identified randomized, controlled trials for thiazolidinediones. Further evidence is largely based on subgroup analyses of larger intervention studies in mostly systolic heart failure, on observational studies, or on registries. Acknowledging this lack of data, hyperglycaemia should be treated to appropriate guideline-recommended targets and hypoglycaemia avoided until this evidence becomes available. Thiazolidinediones should not be used because of an increased event rate in diabetic patients with established heart failure and a large increase in incident heart failure. All other glucose-lowering strategies might be used in patients with diabetes and heart failure, but specific precautions must be considered.ConclusionsThe documented lack of data calls for specific trials, as diabetes and heart failure as well as their co-morbidities are highly prevalent and are becoming even more important with an increasing prevalence of obesity and an ageing population. © 2012 The Author.


Schwarz J.,Bethesdahospital Stuttgart | Boekeler U.,Marienhospital Stuttgart | Bittner R.,Bethesdahospital Stuttgart
Surgical Endoscopy and Other Interventional Techniques | Year: 2010

Background: Advantages and disadvantages of open and endoscopic hernia surgery are still being discussed. Until now there has been no study that evaluated the advantages and disadvantages of bilateral hernia repair in a large number of patients. Methods: Our prospectively collected database was analyzed to compare the results of laparoscopic bilateral with laparoscopic unilateral hernia repair. We then compared these results with the results of a literature review regarding open and laparoscopic bilateral hernia repair. Results: From April 1993 to December 2007 there were 7240 patients with unilateral primary hernia (PH) and 2880 patients with bilateral hernia (5760 hernias) who underwent laparoscopic transabdominal preperitoneal patch plastic (TAPP). Of the 10,120 patients, 28.5% had bilateral hernias. Adjusted for the number of patients operated on, the mean duration of surgery for unilateral hernia repair was shorter than that for bilateral repair (45 vs. 70 min), but period of disability (14 vs. 14 days) was the same. Adjusted for the number of hernias repaired, morbidity (1.9 vs. 1.4%), reoperation (0.5 vs. 0.43%), and recurrence rate (0.63 vs. 0.42%) were similar for unilateral versus bilateral repair, respectively. The review of the literature shows a significantly shorter time out of work after laparoscopic bilateral repair than after the bilateral open approach. Conclusions: Simultaneous laparoscopic repair of bilateral inguinal hernias does not increase the risk for the patient and has an equal length of down time compared with unilateral repair. According to literature, recovery after laparoscopic repair is faster than after open simultaneous repair. Laparoscopic/endoscopic inguinal hernia repair of bilateral hernias should be recommended as the gold standard. © 2010 Springer Science+Business Media, LLC.


Germany has approximately 6 millions of type-2 diabetics. Due to pathophysiologic considerations different treatment options for type-2 diabetes like insulin, insulinotropic and non-insulinotropic medication are available. The optimal point in time for the beginning of insulin treatment can be determined only by individual criteria considering the individual disease stage, comorbidities and patients preference after careful consideration of pros and cons of therapeutic options.


Huemer G.M.,Sect. of Plast. and Reconstr. Surg. | Puelzl P.,Marienhospital Stuttgart | Schoeller T.,Sect. of Plast. and Reconstr. Surg.
Plastic and Reconstructive Surgery | Year: 2012

Poland syndrome is a complex chest wall deformity with unilateral hypoplasia of the breast and pectoralis muscle, with a missing anterior axillary fold in its most common form. The authors report their combined experience and technique with the transverse myocutaneous gracilis flap to reconstruct the chest wall and breast either alone or simultaneously. Between June of 2004 and July of 2010, 11 patients (two male patients) were operated on and 14 flaps were transplanted. The authors found that the transverse myocutaneous gracilis flap proved to be a very valuable microsurgical alternative for reconstructing the chest wall and female breast in Poland syndrome with autologous tissue. The flap provides the surgeon maximal freedom of flap insetting for optimal symmetry together with a very inconspicuous donor site regardless of unilateral or bilateral harvesting. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. Copyright © 2012 by the American Society of Plastic Surgeons.


Muller A.,University of Tübingen | Eckert F.,University of Tübingen | Heinrich V.,University of Tübingen | Bamberg M.,University of Tübingen | And 2 more authors.
BMC Cancer | Year: 2011

Background: Repeat radiation is a rarely used treatment strategy that must be performed with caution. The efficacy and toxicity of a second curative radiotherapy series was investigated in cases of recurrent breast cancer.Methods: Forty-two patients treated from 1993 to 2003 with resection (n = 30) and postoperative re-irradiation or definitive re-irradiation (n = 12) for recurrent breast cancer were enrolled in the study. Concurrent hyperthermia was performed in 29 patients. The median age was 57 years. The median pre-radiation exposure was 54Gy. Re-irradiation was conventionally fractionated to a median total dose of 60Gy.Results: After a median follow-up of 41 months (range 3-92 months) higher graded late toxicity > G3 according to CTC 3.0 and LENT-SOMA was not observed. The estimated 5-year local control rate reached 62%. The estimated 5-year overall survival rate was 59%. Significantly inferior survival was associated with recurrence within two years (40 vs. 71%, p < ([0-9]).01) and presence of macroscopic tumour load (24 vs. 75%, p = 0.03).Conclusions: Repeat radiotherapy for recurrent breast cancer with total radiation doses of 60 Gy and the addition of hyperthermia in the majority of patients was feasible, with acceptable late morbidity and improved prognosis, particularly in patients with previous resection of recurrent tumours. © 2011 Müller et al; licensee BioMed Central Ltd.


Haack S.,Marienhospital Stuttgart | Gubisch W.,Marienhospital Stuttgart
Aesthetic Plastic Surgery | Year: 2014

Background: One of the most important preconditions for a straight nose is a straight and stable cartilaginous L-shaped frame with sufficient support for the nasal tip and the cartilaginous dorsum. Where the structure of the septal cartilage is destroyed, a sufficient L-strut must be reconstructed. This article presents a technique for reconstruction of an autogenous L-strut using double-layered conchal cartilages.Methods: A retrospective review was conducted with a subsequent follow-up evaluation 10.5–22 months later. The conchal L-strut was used for 26 patients to reconstruct a new septal frame. The full details of the planning process, L-frame construction, and technical data are described together with two typical cases.Results: In all 26 cases, the authors were able to reconstruct a sufficient neoseptum. In 25 cases, the neoseptum remained straight. Only in one case did the anterior border deviate immediately after the operation. No slippage from the nasal spine was found. The anchoring to the nasal bones and the upper lateral cartilages was stable. However, one asymmetric columella base was found, caused by an asymmetric support to the footplates by the transplant. The osteocartilagenous vault was successfully reconstructed in all the patients. Of the 26 patients, 25 described a marked improvement in their nasal breathing.Conclusion: The reported technique enables the surgeon to reconstruct the complete cartilagenous L-frame with both conchal cartilages. For certain cases, this technique of autogenous reconstruction of the nasal septum could be a valuable alternative to reconstruction with rib cartilage.Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. © 2014, Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery.


Haack S.,Marienhospital Stuttgart | Gubisch W.,Marienhospital Stuttgart
Aesthetic Plastic Surgery | Year: 2011

Background: Excessive concavities of the lower lateral crura can lead to heavy aesthetic disfigurement of the nasal tip and to insufficiencies of the external nasal valve. This study reviewed experience with the lower lateral crural reverse plasty technique that uses the existing cartilage to create the desired lower lateral cartilage contour and provides sufficient alar rim support. Methods: A retrospective review was conducted with a follow-up period ranging from 9 to 33 months. The technique was applied in primary (n = 13) and secondary (n = 3) open rhinoplasties to correct severe concavities of the lower lateral cartilages. Two case examples and intraoperative photographs are presented to illustrate the technique and its results. Results: The lower lateral crural reverse plasty proved its applicability for the functional and aesthetical correction of severe lower lateral crura concavities. By dissecting the distorted lateral crus, turning it around, and suturing it back in place, surgeons can "reconstruct" a new lateral crus with existing cartilage. No additional cartilage is needed, and no harvesting at a different location needs to be performed. After rhinoplasty, no alar rim instabilities were observed. In three cases, even preexisting instabilities were corrected. Aesthetically enduring results were observed, and no overcorrection or alar retraction was seen. Conclusion: With the lower lateral crural reverse plasty, severe concavities of the lower lateral crura can be corrected. This technique is a useful and reproducible procedure, performed without additional tissue to achieve functionally and aesthetically satisfying and enduring results. © 2010 Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery.


Pulzl P.,Innsbruck Medical University | Huemer G.M.,Linz General Hospital | Schoeller T.,Marienhospital Stuttgart
Annals of Plastic Surgery | Year: 2015

Capsular contracture is a common complication associated with implant-based breast reconstruction and augmentation leading to pain, displacement, and rupture. After capsulectomy and implant exchange, the problem often reappears. We performed 52 deepithelialized free transverse musculocutaneous gracilis (TMG) flaps in 33 patients for tertiary breast reconstruction or augmentation of small- and medium-sized breasts. The indications for implant removal were unnatural feel and emotion of their breasts with foreign body feel, asymmetry, pain, and sensation of cold. Anyway, most of the patients did not have a severe capsular contracture deformity. The TMG flap is formed into a cone shape by bringing the tips of the ellipse together. Depending on the contralateral breast, the muscle can also be shaped in an S-form to get more projection if needed. The operating time for unilateral TMG flap breast reconstruction or augmentation was on average 3 hours and for bilateral procedure 5 hours. One patient had a secondary revision of the donor site due to disruption of the normal gluteal fold. Eighty percent of the unilateral TMG f lap reconstructions had a lipofilling procedure afterward to correct small irregularities or asymmetry. The advantages of the TMG flap such as short harvesting time, inconspicuous donor site, and the possibility of having a natural breast shape make it our first choice to treat capsular contracture after breast reconstruction and augmentation. Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.


Haack S.,Marienhospital Stuttgart | Fischer H.,Marienhospital Stuttgart | Gubisch W.,Marienhospital Stuttgart
Facial Plastic Surgery | Year: 2014

Restoring nasal lining is one of the essential parts during reconstruction of full-thickness defects of the nose. Without a sufficient nasal lining the whole reconstruction will fail. Nasal lining has to sufficiently cover the shaping subsurface framework. But in addition, lining must not compromise or even block nasal ventilation. This article demonstrates different possibilities of lining reconstruction. The use of composite grafts for small rim defects is described. The limits and technical components for application of skin grafts are discussed. Then the advantages and limitations of endonasal, perinasal, and hingeover flaps are demonstrated. Strategies to restore lining with one or two forehead flaps are presented. Finally, the possibilities and technical aspects to reconstruct nasal lining with a forearm flap are demonstrated. Technical details are explained by intraoperative pictures. Clinical cases are shown to illustrate the different approaches and should help to understand the process of decision making. It is concluded that although the lining cannot be seen after reconstruction of the cover it remains one of the key components for nasal reconstruction. When dealing with full-thickness nasal defects, there is no way to avoid learning how to restore nasal lining. © 2014 by Thieme Medical Publishers, Inc.


Liener U.C.,Marienhospital Stuttgart
Trauma und Berufskrankheit | Year: 2016

The incidence of periprosthetic femoral fractures will continue to rise because of the high number of total hip and knee replacements currently performed in Germany. The fractures are often caused by low energy trauma or a predisposition to fractures around loose stems. One of the risk factures in the geriatric patient population is the implantation of uncemented hip prostheses. The hip fractures are classified according to the Vancouver classification and those around the knee according to Rorabeck and Taylor. As with proximal femoral fractures, surgical treatment should be commenced as soon as possible with immediate full weight bearing in the postoperative period. A large selection of implants and revision prostheses are available. © 2016, Springer-Verlag Berlin Heidelberg.

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