Publications by authors named "Dominik Promny"

9 Publications

  • Page 1 of 1

Abdominal Panniculectomy Can Simplify Kidney Transplantation in Obese Patients.

Urol Int 2021 Jun 15:1-8. Epub 2021 Jun 15.

Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany.

Background: Obesity is frequently present in patients suffering from end-stage renal disease (ESRD). However, overweight kidney transplant candidates are a challenge for the transplant surgeon. Obese patients tend to develop a large abdominal panniculus after weight loss creating an area predisposed to wound-healing disorders. Due to concerns about graft survival and postoperative complications after kidney transplantation, obese patients are often refused in this selective patient cohort. The study aimed to analyze the effect of panniculectomies on postoperative complications and transplant candidacy in an interdisciplinary setting.

Methods: A retrospective database review of 10 cases of abdominal panniculectomies performed in patients with ESRD prior to kidney transplantation was conducted.

Results: The median body mass index was 35.2 kg/m2 (range 28.5-53.0 kg/m2) at first transplant-assessment versus 31.0 kg/m2 (range 28.0-34.4 kg/m2) at panniculectomy, and 31.6 kg/m2 (range 30.3-32.4 kg/m2) at kidney transplantation. We observed no major postoperative complications following panniculectomy and minor wound-healing complications in 2 patients. All aside from 1 patient became active transplant candidates 6 weeks after panniculectomy. No posttransplant wound complications occurred in the transplanted patients.

Conclusion: Abdominal panniculectomy is feasible in patients suffering ESRD with no major postoperative complications, thus converting previously ineligible patients into kidney transplant candidates. An interdisciplinary approach is advisable in this selective patient cohort.
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http://dx.doi.org/10.1159/000516678DOI Listing
June 2021

First preliminary Clinical Experiences using Hyperspectral Imaging for Burn Depth Assessment of Hand Burns.

J Burn Care Res 2021 May 20. Epub 2021 May 20.

Department of Plastic, Reconstructive and Hand surgery, Burn Centre for Severe Burn Injuries, Nuremberg Clinics, University Hospital Paracelsus Medical University.

The accurate assessment of burn wounds is challenging but crucial for correct diagnosis and following therapy. The most frequent technique to evaluate burn wounds remains the clinical assessment often subjective depending on the experience of the physician. Hyperspectral Imaging is intended to counteract this subjective diagnosis by an accurate and objective analysis of perfusion parameters. The purpose of this study was to analyse the ability of technical burn depth assessment and to investigate a possible link between a certain value to burn depth versus value of healthy skin references.

Methods: A total of 118 subjects were included in this study between July 2017 and July 2019. 74 images with dorsal hand burns and 44 images of healthy skin on the dorsal hand as control group were analysed. In Hyperspectral Imaging recordings burn wounds were analysed with special interest to wound centre, intermediate zone, and wound margin.

Results: Significant results were determined for the differentiation between superficial partial burns and healthy skin. Furthermore, the distinction of full thickness burns was significantly possible.

Conclusion: Currently, it cannot be shown that the use of Hyperspectral Imaging technology significantly assesses the actual burn depth of thermal wounds of the dorsal hand reliably. However, the results show tendencies to improved analysis for differentiations supporting physicians in early objective optimal treatment selection.
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http://dx.doi.org/10.1093/jbcr/irab082DOI Listing
May 2021

3D-perfusion analysis of burn wounds using hyperspectral imaging.

Burns 2021 02 12;47(1):157-170. Epub 2020 Jun 12.

Klinik für Plastische und Handchirurgie und Brandverletztenzentrum, BG-Klinikum Bergmannstrost, D-06002 Halle (Saale), Germany. Electronic address:

Background: Determination of the depth of burn wounds is still a challenge in clinical practise and fundamental for an optimal treatment. Hyperspectral imaging (HSI) has a high potential to be established as a new contact-free measuring method in medicine. From hyperspectral spectra 3D-perfusion parameters can be estimated and the microcirculatory of burn wounds over the first 72h after thermal injury can be objectively described.

Methods: We used a hyperspectral imaging camera and extended data processing methods to calculate 3D-perfusion parameters of burn wounds from adult patients. The data processing results in the estimation of perfusion parameters like volume fraction and oxygenation of haemoglobin for 6 different layers of the injured skin. The parameters are presented as depth profiles. We analyzed and compared measurements of wounds of different degrees of damage and present the methodology and preliminary results.

Results: The depth profiles of the perfusion parameters show characteristic features and differences depending on the degree of damage. With Hyperspectral Imaging and the advanced data processing the perfusion characteristics of burn wounds can be visualized in more detail. Based on the analysis of this perfusion characteristics, a new and better reliable classification of burn degrees can be developed supporting the surgeon in the early selection of the optimal treatment.
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http://dx.doi.org/10.1016/j.burns.2020.06.001DOI Listing
February 2021

[Glomus tumour of the finger: a rare but painful hand surgical entity].

Handchir Mikrochir Plast Chir 2020 Jun 12;52(3):207-209. Epub 2020 Jun 12.

Universitätsklinikum Erlangen Plastische und Handchirurgische Klinik.

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http://dx.doi.org/10.1055/a-1160-5886DOI Listing
June 2020

Extended Perfusion Parameter Estimation from Hyperspectral Imaging Data for Bedside Diagnostic in Medicine.

Molecules 2019 Nov 17;24(22). Epub 2019 Nov 17.

Institute of Applied Bioscience and Process Management, University of Applied Science Anhalt, D-06366 Köthen (Anhalt), Germany.

Hyperspectral Imaging (HSI) has a strong potential to be established as a new contact-free measuring method in medicine. Hyperspectral cameras and data processing have to fulfill requirements concerning practicability and validity to be integrated in clinical routine processes. Calculating physiological parameters which are of significant clinical value from recorded remission spectra is a complex challenge. We present a data processing method for HSI remission spectra based on a five-layer model of perfused tissue that generates perfusion parameters for every layer and presents them as depth profiles. The modeling of the radiation transport and the solution of the inverse problem are based on familiar approximations, but use partially heuristic methods for efficiency and to fulfill practical clinical requirements. The parameter determination process is consistent, as the measured spectrum is practically completely reproducible by the modeling sequence; in other words, the whole spectral information is transformed into model parameters which are easily accessible for physiological interpretation. The method is flexible enough to be applicable on a wide spectrum of skin and wounds. Examples of advanced procedures utilizing extended perfusion representation in clinical application areas (flap control, burn diagnosis) are presented.
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http://dx.doi.org/10.3390/molecules24224164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6891704PMC
November 2019

[Possibilities and limitations of enzymatic debridement in burns of the hand].

Handchir Mikrochir Plast Chir 2019 Sep 1;51(5):372-376. Epub 2019 Oct 1.

Klinikum Nürnberg Süd, Klinik für Plastische, Wiederherstellende und Handchirurgie, Zentrum für Schwerbrandverletzte, Universitätsklinik der Paracelsus Medizinischen Privatuniversität.

Hands are often affected from burns, due to their unprotected exposure to thermal injuries. Burn injuries also pose a major threat for hands as there is a high risk of severe functional and aesthetical disabilities. Bromelain-based enzymatic debridement is a novel treatment alternative for early surgical excision of burn eschar. This case study describes three patients who were treated with enzymatic debridement in deep thermal burns of the hand.
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http://dx.doi.org/10.1055/a-0999-7786DOI Listing
September 2019

[Objective burn depth assessment of hand burns].

Handchir Mikrochir Plast Chir 2019 Sep 1;51(5):362-366. Epub 2019 Oct 1.

Klinikum Nürnberg Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Klinik für Plastische, Wiederherstellende und Handchirurgie, Zentrum für Schwerbrandverletzte.

The depth assessment of thermal wounds is subject to many variables. Therefore, technical systems are increasingly being used to determine severity. Particularly hand burns can have clinically relevant consequences in terms of function and aesthetic appearance. Hence, a secure assessment for an adequate treatment is necessary.Technical analyzes such as Hyperspectral Imaging, Laser-Doppler-Imaging or Laser-Speckle-Imaging are intended to simplify and objectify the examination by helping to determine the necessary depth of necrectomy and thus to define the skin transplantation area. Furthermore, the diverse technical devices are to improve the functional result, reduce the severity of scarring and cosmetic complaints, and facilitate the evaluation of inexperienced personnel in the field of burn medicine.Therefore, various technical approaches have been pursued, which are largely based on optical principles. The respective devices are not yet used in the standard diagnosis of burn wounds.In future studies it will be necessary to determine an algorithm for the measurement intervals based on the wound dynamics and to evaluate which methodology is superior to the specificity and sensitivity.
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http://dx.doi.org/10.1055/a-0991-7869DOI Listing
September 2019

Association of increased CD8+ and persisting C-reactive protein levels with restenosis in HIV patients after coronary stenting.

AIDS 2016 06;30(9):1413-21

aI. Medizinische Klinik und Poliklinik bII. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München cDeutsches Herzzentrum München dInstitut für Medizinische Statistik und Epidemiologie, Technische Universität München eMedizinisches Versorgungszentrum am Stachus, München fGerman Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Berlin, Germany.

Objectives: The life expectancy of HIV-infected patients has recently been increasing. Although the mortality and morbidity associated with AIDS is decreasing, those associated with cardiovascular diseases and percutaneous coronary intervention (PCI) are receiving greater attention. Only limited data regarding coronary restenosis are available in these patients.

Design: In this prospective, systematic angiographic follow-up study, we enrolled HIV patients who underwent PCI for de-novo lesions and subsequent routine angiographic follow-up for 6-8 months. Angiographic restenosis was defined as stenosis of at least 50% of the in-segment area.

Methods: Univariate and multivariate analyses were performed to evaluate restenosis and its predictors.

Results: Between May 2002 and March 2014, 47 patients with HIV underwent PCI in two high-volume centers in Munich, Germany. Of these patients, 41 with 131 de-novo lesions underwent invasive surveillance. One-quarter of the lesions treated subsequently presented with restenosis. Univariate analysis indicated that CD8 T-cell levels (P = 0.006), serum cholesterol (P = 0.042) and low-density lipoprotein-cholesterol (P = 0.042) levels at baseline, total number of stents (P = 0.047), and C-reactive protein level (P = 0.001) at follow-up were associated with restenosis. Multivariate analysis indicated that CD8 T-cell levels (P = 0.006) and persistent C-reactive protein elevation at 6-month follow-up (P = 0.00013) were independent predictors of restenosis.

Conclusion: Inflammation, represented by CD8 T-cell levels, and persistent C-reactive protein elevation are independent predictors of angiographic restenosis and should therefore be closely monitored in HIV patients undergoing PCI.
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http://dx.doi.org/10.1097/QAD.0000000000001063DOI Listing
June 2016

Impact of sympathetic renal denervation: a randomized study in patients after renal transplantation (ISAR-denerve).

Nephrol Dial Transplant 2015 Nov 1;30(11):1928-36. Epub 2015 Sep 1.

Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.

Background: Sympathetic overactivity is frequently observed following renal transplantation (RTx), and post-transplant hypertension is a major contributing factor to graft failure and cardiovascular morbidity. This process is perpetuated by preservation of sympathetic afferent activity from the native non-functional kidneys, in the absence of efferent feedback to the renal transplant, which would otherwise modulate neurohumoral activity. We investigated the feasibility and efficacy of renal sympathetic denervation (RDN) in renal transplant recipients.

Methods: Patients (n = 18) with post-transplant hypertension were randomized 1:1 to receive RDN or medical treatment alone. The primary efficacy end point was change in office systolic blood pressure (SBP) and mean 24-h ambulatory blood pressure monitoring (ABPM) at 6 months. Safety end points were changes in renal function or renovascular complications.

Results: After 6 months, patients in the RDN group had a significant reduction in office SBP of 23.3 ± 14.5 mmHg (P = 0.001 for change difference between the groups). In ABPM, nocturnal blood pressure was reduced in the RDN group by -10.38 ± 12.8 mmHg (P = 0.06), whereas no change was measured during the day. In the RDN group, significantly more patients converted from non-dippers to dippers (P = 0.035). There were no adverse safety events in either group.

Conclusion: RDN is feasible and safe in renal transplant recipients. However, larger sham-controlled studies will be necessary to clarify the potential role of RDN in this population.

Clinical Trial Registration: NCT01899456.
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http://dx.doi.org/10.1093/ndt/gfv311DOI Listing
November 2015
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