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Boeer B, Helms G, Pasternak J, Roehm C, Kofler L, Haefner HM, Moehrle M, Heim E, Fischer H, Brucker SY, Hahn M. Back to the future: breast surgery with tumescent local anesthesia (TLA)? Arch Gynecol Obstet 2023; 308:935-940. [PMID: 36872392 PMCID: PMC10348980 DOI: 10.1007/s00404-023-06938-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/16/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE Breast surgery is usually performed under general anesthesia. Tumescent local anesthesia (TLA) offers the possibility to anesthetize large areas with highly diluted local anesthetic. METHODS In this paper, the implementation, and experiences with TLA in the field of breast surgery are discussed. CONCLUSION For carefully selected indications, breast surgery in TLA represents an alternative to ITN.
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Affiliation(s)
- B Boeer
- Department of Women's Health, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany.
| | - G Helms
- Department of Women's Health, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - J Pasternak
- Department of Women's Health, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - C Roehm
- Department of Women's Health, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - L Kofler
- Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | - H M Haefner
- Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | - M Moehrle
- Praxisklinik Haut Und Venen, Tuebingen, Germany
| | - E Heim
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - H Fischer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - S Y Brucker
- Department of Women's Health, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - M Hahn
- Department of Women's Health, University Hospital Tuebingen, Calwerstrasse 7, 72076, Tuebingen, Germany
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Maier JC, Kofler K, Forchhammer S, Skardelly M, Mentzel T, Häfner HM, Kofler L. [Infiltration of the skull by dedifferentiated cutaneous leiomyosarcoma]. Hautarzt 2021; 72:1098-1101. [PMID: 33760962 PMCID: PMC8613129 DOI: 10.1007/s00105-021-04800-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
Wir berichten über einen 81-jährigen Patienten mit bereits mehrfach voroperiertem Tumor der Kopfhaut. In der histologischen erneuten Aufarbeitung ließ sich ein dedifferenziertes Leiomyosarkom nachweisen, das bereits die Schädeldecke infiltriert hatte. In einem interdisziplinären Ansatz mit den Kollegen der Klinik für Neurochirurgie konnte eine Komplettexzision erreicht werden. Kutane Leiomyosarkome sind seltene Tumoren der Haut, die typischerweise als langsam wachsende, erythematöse Knoten imponieren. Aufgrund des Metastasierungspotenzials ist eine komplette, schnittrandkontrollierte Resektion erforderlich.
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Affiliation(s)
- J C Maier
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.
| | - K Kofler
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - S Forchhammer
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - M Skardelly
- Praxis für Neurochirurgie Reutlingen, Steinenbergstr. 31, 72764, Reutlingen, Deutschland
| | - T Mentzel
- Dermatopathologie Friedrichshafen, Siemensstr. 6/1, 88048, Friedrichshafen, Deutschland
| | - H M Häfner
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - L Kofler
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
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Kofler L, Breuninger H, Schreiber RH, Eichner M, Häfner HM, Schnabl SM. Three-dimensional histology vs. serial section histology in the treatment of primary basal cell carcinoma: a randomized, prospective, blinded study of 569 tumours. J Eur Acad Dermatol Venereol 2021; 35:1323-1330. [PMID: 33539573 DOI: 10.1111/jdv.17155] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/14/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND For basal cell carcinoma (BCC), only few controlled data have been published so far, which directly compare micrographically controlled surgery with conventional serial section histology. In addition to Mohs surgery, which uses cryostat sections, also three-dimensional histology (3D-histology), based on paraffin sections, is available to ensure complete control of the margins and basic sections. OBJECTIVES To investigate the rate of local recurrence (LR) as well as the number of required re-excisions for basal cell carcinomas with serial section histology vs. 3D-histology. METHODS We compared serial sections histology with 3D-histology in a prospective, randomized, controlled blinded trial and analysed 569 BCC of all subtypes up to 30 mm diameter, 287 BCC in the 3D group and 282 BCC in the serial section group. Excisions were performed with adapted primary resection margin according to location and size of the tumour. Surgeons were blinded at the time of surgery as they did not know which histological method will be used. Both methods used paraffin sections. RESULTS Both groups did not differ regarding patients age, tumour location, tumour diameter, tumour subtypes or primary resection margins. In the serial section group, re-excisions were required in 21%; 24 tumours (8.4%) recurred after a median of 2.2 years. In the 3D-histology group, re-excisions were required in 39%; 10 tumours recurred (3.5%) after a median of 2.8 years. The recurrence rates differed significantly between both groups. Mean follow-up was 4.5 years. CONCLUSIONS 3D-histology is a useful technique to detect tumour outgrowths at the excision margins, but required a high rate of re-excisions. 3D-histology was associated with a significantly lower LR rate than serial section histology.
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Affiliation(s)
- L Kofler
- Department of Dermatology, Eberhard-Karls University, Tübingen, Germany
| | - H Breuninger
- Department of Dermatology, Eberhard-Karls University, Tübingen, Germany
| | - R H Schreiber
- Department of Dermatology, Eberhard-Karls University, Tübingen, Germany
| | - M Eichner
- Institute of Clinical Epidemiology and Applied Biometry, Eberhard-Karls University, Tübingen, Germany
| | - H-M Häfner
- Department of Dermatology, Eberhard-Karls University, Tübingen, Germany
| | - S M Schnabl
- Department of Dermatology, Eberhard-Karls University, Tübingen, Germany
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Volc S, Maier JCP, Breuninger H, Hund V, Häfner HM, Kofler L. Manufacture and use of tumescence solution meeting hospital-required hygiene conditions - practical implications. J Eur Acad Dermatol Venereol 2019; 33:e434-e435. [PMID: 31220369 DOI: 10.1111/jdv.15754] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/15/2019] [Accepted: 06/06/2019] [Indexed: 12/28/2022]
Affiliation(s)
- S Volc
- Department of Dermatology, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - J C P Maier
- Department of Dermatology, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - H Breuninger
- Department of Dermatology, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - V Hund
- University Pharmacy, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - H-M Häfner
- Department of Dermatology, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - L Kofler
- Department of Dermatology, Eberhard-Karls University Tübingen, Tübingen, Germany
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Abstract
Pyoderma gangraenosum and subcorneal pustulosis are neutrophilic diseases. Different neutrophilic dermatoses can very rarely occur together in one patient, even with a latent period. Furthermore, there seems to be a direct association between IgA gammopathy and neutrophilic dermatosis. Therefore, a gammopathy must always be clarified in the presence of a neutrophilic dermatosis.
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Affiliation(s)
- F Wolfsperger
- Universitätshautklinik, Eberhard-Karls-Universität Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - A Müller
- Universitätshautklinik, Eberhard-Karls-Universität Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.
| | - L Kofler
- Universitätshautklinik, Eberhard-Karls-Universität Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - A Yazdi
- Klinik für Dermatologie und Allergologie - Hautklinik, Universitätsklinikum Aachen, Aachen, Deutschland
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Kofler L, Schweinzer K, Heister M, Kohler M, Breuninger H, Häfner HM. Surgical treatment of hidradenitis suppurativa: an analysis of postoperative outcome, cosmetic results and quality of life in 255 patients. J Eur Acad Dermatol Venereol 2018; 32:1570-1574. [DOI: 10.1111/jdv.14892] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 01/29/2018] [Indexed: 12/30/2022]
Affiliation(s)
- L. Kofler
- Department of Dermatology; University Medical Center; Eberhard Karls University; Tübingen Germany
| | - K. Schweinzer
- Department of Dermatology; University Medical Center; Eberhard Karls University; Tübingen Germany
| | - M. Heister
- Department of Dermatology; University Medical Center; Eberhard Karls University; Tübingen Germany
| | - M. Kohler
- Department of Dermatology; University Medical Center; Eberhard Karls University; Tübingen Germany
| | - H. Breuninger
- Department of Dermatology; University Medical Center; Eberhard Karls University; Tübingen Germany
| | - H.-M. Häfner
- Department of Dermatology; University Medical Center; Eberhard Karls University; Tübingen Germany
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Heister M, Häfner H, Breuninger H, Schulz C, Meier K, Kofler L, Spott C, Röcken M, Schnabl S, Eberle F. Tumescent local anaesthesia for early dermatosurgery in infants. J Eur Acad Dermatol Venereol 2017; 31:2077-2082. [DOI: 10.1111/jdv.14461] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 06/20/2017] [Indexed: 01/02/2023]
Affiliation(s)
- M. Heister
- Department of Dermatology; Eberhard Karls University; Tübingen Germany
| | - H.M. Häfner
- Department of Dermatology; Eberhard Karls University; Tübingen Germany
| | - H. Breuninger
- Department of Dermatology; Eberhard Karls University; Tübingen Germany
| | - C. Schulz
- Department of Dermatology; Eberhard Karls University; Tübingen Germany
| | - K. Meier
- Department of Dermatology; Eberhard Karls University; Tübingen Germany
| | - L. Kofler
- Department of Dermatology; Eberhard Karls University; Tübingen Germany
| | - C. Spott
- Operational Controlling and Reporting; Eberhard Karls University; Tübingen Germany
| | - M. Röcken
- Department of Dermatology; Eberhard Karls University; Tübingen Germany
| | - S.M. Schnabl
- Department of Dermatology; Eberhard Karls University; Tübingen Germany
| | - F.C. Eberle
- Department of Dermatology; Eberhard Karls University; Tübingen Germany
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Möhrle M, Kofler L, Häfner HM. Defektverschluss durch Dehnungsplastiken nach Anwendung eines neuen externen Gewebsexpanders. Akt Dermatol 2015. [DOI: 10.1055/s-0035-1558592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- L Kofler
- Universitäts-Hautklinik, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
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Abstract
BACKGROUND Melanoma screening is possible using the naked eye, a loupe, a dermatoscope or a sequential digital dermatoscopic imaging (SDDI) device. The latter provides photodocumentation and makes it possible to assess changes over time. One potential disadvantage of this method has been felt to be in the time expenditure per patient. OBJECTIVES Objective was to prospectively assess the time required for routine melanoma screening, using a SDDI device. MATERIALS AND METHODS All patients screened for melanoma using a SDDI system (Mole Max2) in a private dermatology practice during 1 year were included prospectively. The time needed per patient was measured. Suspicious lesions were excised and histologically evaluated. The number needed to treat (NNT) was calculated. Excisions performed exclusively due to cosmetic reasons were not included. RESULTS 381 patients with 10,356 melanocytic lesions were documented using SDDI and clinically assessed (mean: 27.18 melanocytic lesions per patient; min:1, max:110). Mean time consumption per lesion was 15.4 s. (min:3, max:57) and per patient about 7 min. 98 suspicious lesions were excised, among them13 melanomas; yielding a NNT of 7.54. CONCLUSIONS SDDI can be easily integrated into the daily routine; a variety of systems are available. The time required is reasonable, about 7 min per patient and about 15 s per lesion. The quality of the evaluation is operator-dependent; it can be evaluated by determining the NNT. A major advantage of this diagnostic procedure is the photodocumentation which makes it possible to assess potential progression of a melanocytic lesion.
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Affiliation(s)
- L Kofler
- Dermatologische Ordination Hall i.T., Thurnfeldgasse 3a, 6060, Hall in Tirol, Österreich
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Kofler L, Kofler H, Mattsson L, Lidholm J. A case of dog-related human seminal plasma allergy. Eur Ann Allergy Clin Immunol 2012; 44:89-92. [PMID: 22768730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Allergy to human seminal plasma (HSP) is rare. It presents with a variety of symptoms, ranging from localized changes to generalized reactions or even anaphylactic shock. Symptoms typically start within minutes to one hour after exposure. Diagnosis is based on history, evidence of specific IgE antibodies and skin prick testing (SPT). A 25-year-old Caucasian woman presented with eyelid swelling, generalized urticaria and dyspnea immediately after unprotected coitus with her partner. No symptoms occurred when barrier contraception was used. SPTand IgE testing (ImmunoCAP) demonstrated sensitization to HSP and dog dander. The patient's self-designed desensitization protocol, consisting of H1 blocker premedication followed by unprotected sexual intercourse, ameliorated her systemic reactions gradually and reduced the frequency of emergency hospital visits. She had a known allergy to male but not female dogs, and was highly sensitized to dog allergen Can f 5, a protein homologous to human prostate-specific antigen (PSA), suggesting a possible link to her HSP allergy.
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Affiliation(s)
- L Kofler
- Allergieambulatorium Hall i.T, Austria.
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Chevallier D, Fourcy A, Kofler L. [On the determination of manganese of fungal spores]. C R Acad Hebd Seances Acad Sci D 1969; 268:1789-92. [PMID: 4976839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Prodinger W, Mayer FX, Kofler L, Zacherl MK. Buchbesprechungen. Mikrochim Acta 1950. [DOI: 10.1007/bf01414136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kofler L. Chemisches Kolloquium der Universität Mainz. Angew Chem Int Ed Engl 1950. [DOI: 10.1002/ange.19500621513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kofler A, Kofler L. Zur Bestimmung der Schmelzpunkte instabiler Modifikationen organischer Stoffe. Monatshefte f�r Chemie 1948. [DOI: 10.1007/bf00942483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kofler L, Doser H. Zur Beurteilung der Flüchtigkeit organischer Substanzen. Angew Chem Int Ed Engl 1942. [DOI: 10.1002/ange.19420550105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kofler L. Mikrophotographie. Von Dr. G. Stade und Dr. H. Staude. VIII und 202 Seiten und 164 Figuren im Text. Akademische Verlagsgesellschaft, Leipzig 1939. Preis geh. RM. 11,80, geb. RM. 13,20. Angew Chem Int Ed Engl 1939. [DOI: 10.1002/ange.19390521410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Hochberg S, Mer VK, Gicklhorn J, Nistler A, Collander R, Peskoff NP, Wright AE, Szegv�ri A, Liu YP, Chou TP, Fang HY, Sah PPT, Kofler L, Linck G, K�hler E, Sandstr�m AE, Gro� P, Steiner H, Krauss F, Hauser EA, Frosch CJ, Dushman S, Abramson HA, Moyer LS, Voet A, Grossman EB, Komagata S, Gils GE. Mikrochemie Physikalische und physikochemische Methoden und Apparate. Anal Bioanal Chem 1939. [DOI: 10.1007/bf01457471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kofler L. Über physikalische Methoden im chemischen Laboratorium. XXXVIII. Mikroskopische Methoden zur Identifizierung organischer Substanzen. Angew Chem Int Ed Engl 1938. [DOI: 10.1002/ange.19380514102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kofler L, v. Herrensschwand G. Über die Bestimmung der ätherischen Öle in Drogen und über den Ölgehalt von Pfefferminze, Salbei, Fenchel und Kümmel. Arch Pharm (Weinheim) 1935. [DOI: 10.1002/ardp.19352732505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kofler L, Steidl G. Über das Vorkommen und die Verteilung von Saponinen in pflanzlichen Drogen. II. Blätter, Früchte, Rinden, Hölzer, Wurzeln und Rhizome. Arch Pharm (Weinheim) 1934. [DOI: 10.1002/ardp.19342721016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kofler L. Die Bedeutung und Rolle der Saponine für die Therapie. Dtsch Med Wochenschr 1932. [DOI: 10.1055/s-0028-1123661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kofler L. �ber den Nachweis von Saponinen in Arzneimitteln und Nahrungs-mitteln. Anal Bioanal Chem 1930. [DOI: 10.1007/bf01400150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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