Publications by authors named "Karin M Dunst"

30 Publications

  • Page 1 of 1

Gluteal reshaping in the massive weight loss patient.

Arch Plast Surg 2014 Sep 15;41(5):594-6. Epub 2014 Sep 15.

Section of Plastic and Reconstructive Surgery, General Hospital Linz, Linz, Austria. ; Microsurgical Training and Research Center (maz), Linz, Austria.

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http://dx.doi.org/10.5999/aps.2014.41.5.594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179367PMC
September 2014

Recurrent appendicitis after conservative management of perityphlitic abscess: report of two cases.

Int Surg 2009 Jan-Feb;94(1):27-30

Department of General and Transplant Surgery, Medical University Innsbruck, Innsbruck, Austria.

We report on two cases of recurrent appendicitis after conservative management consisting of antibiotics and percutaneous drainage of perityphlitic abscess. The first patient presented 13 years after acute appendicitis with a perityphlitic abscess that was treated operatively. This patient refused to undergo interval appendectomy after the initial event. The second patient with appendicitis and perityphlitic abscess was equally managed conservatively initially but presented with reperforated appendicitis and diffuse peritonitis 1 week before scheduled interval appendectomy and also had to undergo surgery. Based on our experience with these two cases, we conclude that interval appendectomy after the recommended period of 6-12 weeks might not be appropriate and may better be managed by performing it in the case of a recurrence.
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March 2010

Strategies for the reduction of live animal use in microsurgical training and education.

Altern Lab Anim 2008 May;36(2):153-60

Department of Trauma Surgery, Allgemeines Krankenhaus Linz, Linz, Austria.

Education and training in microsurgical techniques have historically relied on the use of live animal models. Due to an increase in the numbers of microsurgical operations in recent times, the number of trainees in this highly-specialised surgical field has continued to grow. However, strict legislation, greater public awareness, and an increasing sensitivity toward the ethical aspects of scientific research and medical education, emphatically demand a significant reduction in the numbers of animals used in surgical and academic education. Hence, a growing number of articles are reporting on the use of alternatives to live animals in microsurgical education and training. In this review, we report on the current trends in the development and use of microsurgical training models, and on their potential to reduce the number of live animals used for this purpose. We also share our experiences in this field, resulting from our performance of numerous microsurgical courses each year, over more than ten years. The porcine heart, in microvascular surgery training, and the fresh chicken leg, in microneurosurgical and microvascular surgery training, are excellent models for the teaching of basic techniques to the microsurgical novice. Depending on the selected level of expertise of the trainee, these alternative models are capable of reducing the numbers of live animals used by 80-100%. For an even more enhanced, "closer-to-real-life" scenario, these non-animated vessels can be perfused by a pulsatile pump. Thus, it is currently possible to provide excellent and in-depth training in microsurgical techniques, even when the number of live animals used is reduced to a minimum. With these new and innovative techniques, trainees are able to learn and prepare themselves for the clinical situation, with the sacrifice of considerably fewer laboratory animals than would have occurred previously.
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http://dx.doi.org/10.1177/026119290803600206DOI Listing
May 2008

Solid apocrine carcinoma of the skin: report of a rare adnexal neoplasm mimicking lobular breast carcinoma.

J Cutan Pathol 2008 Mar;35(3):332-6

Institute of Pathology, Innsbruck Medical University, Innsbruck, Austria.

The so called 'sweat gland carcinoma' is a rare skin malignancy. The differentiation between apocrine and eccrine neoplasms remains difficult. Skin tumors of the axilla are often suspected to be metastasis of other neoplasms in particular breast cancer. A 71-year-old man presented with a morphea-like plaque of the right axilla which in punch biopsy was first suspected as metastasis of primary lobular breast carcinoma. After further clinical and laboratory work up including immunohistochemistry the original diagnosis of a breast cancer had to be changed to solid apocrine carcinoma of the skin. Wide excision with en-bloc axillary lymph node dissection was performed. Final tumor stage was pT2 N0 M0 (V0 L0). No adjuvant treatment was necessary, and there is no evidence of disease after 3 years. Solid apocrine carcinoma of the skin is a rare variant with apocrine differentiation. A survey of the stereotypical presentation of this lesion and a comparison with lobular breast carcinoma and other types of apocrine carcinoma of the skin is given.
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http://dx.doi.org/10.1111/j.1600-0560.2007.00804.xDOI Listing
March 2008

Postoperative splinting after open carpal tunnel release does not improve functional and neurological outcome.

Muscle Nerve 2007 Oct;36(4):528-31

Department of Plastic Surgery, Sisters of Mercy Hospital, Seilerstaette 4, 4020, Linz, Austria.

Although surgical division of the transverse carpal ligament is the operative treatment of choice for carpal tunnel syndrome (CTS), controversy exists about the immediate postoperative treatment regimen. Splinting for up to 6 weeks after surgery is recommended by some investigators. We therefore evaluated effectiveness of splinting after open carpal tunnel surgery by a randomized, controlled trial. Fifty consecutive patients with clinically and electrophysiologically confirmed idiopathic CTS were assigned to open carpal tunnel release and randomized to receiving a light bandage (25 patients) or a bulky dressing with a volar splint (25 patients) for 2 days each. All patients were followed up at 3 months. Parameters retrieved were pain as measured using a visual analog scale, two-point discrimination, and grip strength, and nerve conduction studies. At follow-up, all patients reported definite improvement of symptoms, but there was no statistically significant difference between the two groups for any of our outcome measures. Thus, postoperative splinting after open carpal tunnel release does not yield any benefit to eventual outcome. In fact, it adds to the overall operating time and can safely be abandoned.
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http://dx.doi.org/10.1002/mus.20839DOI Listing
October 2007

Giant lipoma of the thenar.

Wien Klin Wochenschr 2007 ;119(5-6):149

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http://dx.doi.org/10.1007/s00508-006-0750-7DOI Listing
August 2007

Pulsatile perfused porcine coronary arteries for microvascular training.

Ann Plast Surg 2006 Aug;57(2):213-6

Department of Trauma Surgery, Allgemeines Krankenhaus Linz, Austria.

Microsurgery is today an established technique in specialties such as plastic surgery, neurosurgery, and trauma surgery. However, specialized training is a prerequisite for mastering anastomosis of small-diameter vessels or coaptation of nerves in the operating room. The training should be as realistic as possible and thus, laboratory animals such as the rat are preferably used as a substitute. In an attempt to minimize the use of living animals without jeopardizing a realistic training setting, we developed a pulsatile perfused porcine coronary artery model for microsurgical education. The training model consists of a membrane pump that generates a pulsatile flow within a coronary artery of a porcine heart. The pump is commercially available with a dimension of approximately 130 x 100 x 60 mm and a weight of 190 g. The pump is energized by 220 B and the motor is run on a transformed power of approximately 12 V (range, 1.5-12 V). Different fluids from simple saline solution to theoretically whole blood can be used for perfusion. The membrane pump proved to be very reliable during microvascular training because of its convenient size and wide range of feed rate providing a very realistic training setting. A maximum fluid output of 850 mL/min can be achieved. The pump has a high acceptance in microsurgical trainees evaluated by questionnaires during several microsurgical courses. The pulsatile perfused porcine coronary artery system for microsurgical training enables the trainee to work under the most realistic training settings. It proved to be a valuable tool during microsurgical education, reducing the costs and sparing living laboratory animals. Thus, we can recommend this system to anyone who is involved in training and teaching microsurgical skills.
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http://dx.doi.org/10.1097/01.sap.0000215248.70308.aeDOI Listing
August 2006

Finger amputation by a sausage packing machine.

Wien Klin Wochenschr 2006 Jun;118(11-12):321

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http://dx.doi.org/10.1007/s00508-006-0613-2DOI Listing
June 2006

Diffuse phlegmonous phlebitis after endovenous laser treatment of the greater saphenous vein.

J Vasc Surg 2006 May;43(5):1056-8

Department of General Surgery, Allgemeines Krankenhaus, Linz, Austria.

Endovenous laser treatment (EVLT) has become a valuable and safe option in the treatment of varicose veins. Although long-term results are lacking, most patients seem to benefit in the short-term from EVLT. Reported postoperative complications are limited, consisting usually of pain, ecchymosis, induration, phlebitis, or spot skin burn injuries. The most feared complication is an extension of the saphenous thrombus into the femoral vein, with possible pulmonary embolism. Here we report a septic thrombophlebitis after EVLT resulting in a phlegmonous infection of the whole leg that was treated by surgical drainage. Aggressive local therapy and antibiotic treatment resulted in complete resolution of symptoms and eventual satisfactory healing.
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http://dx.doi.org/10.1016/j.jvs.2006.01.030DOI Listing
May 2006

Progressive thoracic scoliosis due to a large plexiform neurofibroma.

Orthopedics 2006 02;29(2):163-4

Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria.

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http://dx.doi.org/10.3928/01477447-20060201-12DOI Listing
February 2006

Adolf Jarisch (1850-1902): an important contributor to Austrian dermatology.

Arch Dermatol Res 2006 Mar 10;297(9):383-8. Epub 2005 Dec 10.

Adolf Jarisch was born on the 15th of February 1850 in the city of Vienna, where he also studied medicine. He soon pursued a career in dermatology and venereology and, thus, joined the clinic of von Hebra, one of the founders of the famous new Vienna School of Medicine. After temporarily replacing von Hebra, Jarisch became the chief of the Department of Dermatology at the University of Innsbruck (1887). Although Adolf Jarisch was appointed chief of the dermatologic department at the University of Graz 5 years later (1892), his biggest dream, to become successor of his former teacher Ferdinand von Hebra and head the dermatological department of the Wiener Allgemeines Krankenhaus (Vienna General Hospital) did not come true. Although Adolf Jarisch is mainly known for his observations on skin reactions and a profound worsening of symptoms in syphilitic patients immediately following treatment with mercury (Jarisch-Herxheimer reaction), he authored more than 25 scientific articles and wrote a book, "Hautkrankheiten", which was considered as the most important in German-speaking literature at the beginning of the twentieth century. The purpose of this historical article is to discuss Jarisch's achievements in the field of dermatology based on a detailed analysis of his scientific work.
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http://dx.doi.org/10.1007/s00403-005-0631-3DOI Listing
March 2006

Comparison of the effectiveness of gene therapy with transforming growth factor-beta or extracorporal shock wave therapy to reduce ischemic necrosis in an epigastric skin flap model in rats.

Wound Repair Regen 2005 May-Jun;13(3):262-8

Clinical Department of Plastic and Reconstructive Surgery, Medical University Innsbruck, Austria.

The induction of neoangiogenesis by exogenous growth factors in failing skin flaps has recently yielded promising results. Gene transfer with virus vectors has been introduced as a highly capable route of administration for growth factors, such as vascular endothelial growth factor or fibroblast growth factor. Extracorporal shock waves (ESW) deliver energy by means of high amplitudes of sound to the target tissue and have been shown to induce angiogenesis. We compared the effectiveness of gene therapy with adenovirus-mediated transforming growth factor-beta (TGF-beta) and ESW therapy to treat ischemically challenged epigastric skin flaps in a rat model. Thirty male Sprague-Dawley rats were divided into three groups of 10 each with an 8 x 8 cm epigastric skin flap. Rats received either subdermal injections of adenovirus (Ad) encoding TGF-beta (10(8) pfu) or ESW treatment with 750 impulses at 0.15 mJ/mm2. The third group received no treatment and served as a control group. Flap viability was evaluated after 7 days and digital images of the epigastric flaps were taken and areas of necrotic zones relative to total flap surface area calculated. Histologic evaluation and increased angiogenesis were confirmed by CD31 immunohistochemistry. Overall, there was a significant increase in mean percent surviving area in the Ad-TGF-beta group and the ESW group compared to the control group (ESW group: 97.7 +/- 1.8% vs. Ad-TGF-beta: 90.3 +/- 4.0% and control group: 82.6 +/- 4.3%; p < 0.05). Furthermore, in the ESW group mean percent surviving areas were significantly larger than in the Ad-TGF-beta group (ESW group: 97.7 +/- 1.8% vs. Ad-TGF-beta: 90.3 +/- 4.0%; p < 0.05). Flap vascularization was increased by Ad-TGF-beta and ESW with numerous vessels, however, there was no significant difference between the two treatment groups. We conclude that treatment with ESW enhances epigastric skin flap survival significantly more than Ad-TGF-beta treatment and thus represents a modality that is feasible, cost-effective, and less invasive compared to gene therapy with growth factors to improve blood supply to ischemic tissue.
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http://dx.doi.org/10.1111/j.1067-1927.2005.130308.xDOI Listing
November 2005

Cardiac hepatopathy before and after heart transplantation.

Transpl Int 2005 Jun;18(6):697-702

Clinical Division of Cardiology, Innsbruck Medical University, Innsbruck, Austria.

Chronic cardiac hepatopathy is a common entity in patients evaluated for heart transplantation (HTX). Hepatic injury is caused by severe heart failure resulting from prolonged recurrent congestion and/or impaired arterial perfusion. No data are available on the reversibility of cardiac hepatopathy in patients undergoing HTX. Data of 56 consecutive adult patients undergoing HTX during 2000-02 at the University Hospital of Innsbruck were analysed retrospectively. The following parameters were evaluated at the time of listing and 3, 6 and 12 months after HTX. Plasma levels of gamma-glutamyl transferase (gamma-GT), alkaline phosphatase (AP), bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and total plasma protein. When listed for HTX, only 12% of all patients analysed had physiological values throughout the seven laboratory parameters assessed. Elevated levels of gamma-GT, AP, bilirubin, AST, ALT, LDH and total plasma protein were detected in 66.6%, 29%, 50%, 16.7%, 10%, 40% and 18% of all patients respectively. Accordingly, median plasma levels of gamma-GT, bilirubin and LDH were elevated, whereas the mean plasma level of AP was at the upper normal range. In contrast, median plasma level of AST and mean plasma levels of ALT and total plasma protein were within the normal range: gamma-GT (median, 109.0; range, 634.0 U/l; n = 36), AP (mean, 120.2 +/- 78.9 U/l; n = 29), bilirubin (median, 1.3; range, 16.1 mg/dl; n = 32), LDH (median, 226.0; range, 2355.0 U/l; n = 33), AST (median, 29.0; range, 145.0 U/l; n = 36), ALT (mean, 28.3 +/- 20.8 U/l; n = 36) and total plasma protein (mean, 7.2 +/- 1.1 g/dl; n = 25). Within 3 months after HTX, elevated parameters except LDH significantly ameliorated: gamma-GT (median, 59.0; range, 1160.0 U/l; P = 0.011), AP (92.2 +/- 75.2 U/l; P = 0.016), bilirubin (median, 0.9; range, 8.1 mg/dl; P = 0.004), LDH slightly increased (median, 281.0; range, 543.0 U/l; P = 0.039), but there was a delayed improvement of this parameter after 6 and 12 months post-HTX. End-stage heart failure is characterized by a cholestatic liver enzyme profile with elevated plasma levels of gamma-GT and bilirubin. These parameters significantly improve within 3 months after HTX. Therefore, chronic cardiac hepatopathy seems to be a benign, potentially reversible disease.
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http://dx.doi.org/10.1111/j.1432-2277.2005.00122.xDOI Listing
June 2005

Control of suture hole bleeding after aortic valve replacement by application of BioGlue during circulatory arrest.

Int Heart J 2005 Jan;46(1):175-9

Clinical Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria.

Bleeding from suture holes in aortic valve replacement (AVR) may represent a difficult problem especially if the aortic wall is friable. We describe a case in which suture hole bleeding after AVR was present at the posterior aortic wall close to the pulmonary artery. Following several attempts to suture the leak using felt pledget armed prolene sutures, deep hypothermic circulatory arrest was induced and BioGlue in combination with Tabotamp was applied for successful sealing of the bleeding source.
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http://dx.doi.org/10.1536/ihj.46.175DOI Listing
January 2005

Images in clinical medicine. Finger avulsion with pulled-out flexor tendon.

N Engl J Med 2005 Feb;352(6):e5

Medical University Innsbruck, 6020 Innsbruck, Austria.

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http://dx.doi.org/10.1056/NEJMicm030406DOI Listing
February 2005

Analysis of original contributions in three dermatology journals.

J Am Acad Dermatol 2005 Feb;52(2):355-9

Clinical Departments of Surgery, Innsbruck Medical University, Austria.

In a cross-sectional analysis, the three top ranking dermatology journals ( Archives of Dermatology , British Journal of Dermatology , and the Journal of the American Academy of Dermatology ) were evaluated for their scientific content, the characteristics of their authors, and funding aspects in 2002. A flood of scientific papers are published each year covering a broad variety of dermatologic topics. Aside from the actual content, a scientific article provides information about the number of authors, their nationality and affiliations, and, with some limitation, about previous presentations and funding. The present study analyzes this situation in dermatology by evaluating the content in the three top dermatologic journals.
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http://dx.doi.org/10.1016/j.jaad.2004.10.878DOI Listing
February 2005

Restoration of the gluteal fold by a deepithelialized skin flap: preliminary observations.

Aesthetic Plast Surg 2005 Jan-Feb;29(1):13-7

Clinical Department of Plastic and Reconstructive Surgery, Innsbruck Medical University, Innsbruck, Austria.

Background: The gluteal fold represents an important aspect of the gluteal region. Destruction of this anatomic landmark as a consequence of trauma or tissue harvest can result in an aesthetically disturbing disfigurement. A technique for reconstruction of the gluteal fold and preliminary results are presented.

Methods: The newly formed gluteal fold is created by fixation of a deepithelialized skin flap to the periosteum of the tuber ischiadicum.

Results: The operative procedure is quick and easy to apply. The method is used mainly for patients with a distorted gluteal fold after tissue harvest for breast reconstruction. However, it also can be used after trauma such as that associated with burn injuries. In all patients, reconstruction of the gluteal fold yielded aesthetically pleasing and reliable results with high patient satisfaction.

Conclusions: The authors present a simple and effective technique for reconstruction of the gluteal fold by a deepithelialized skin flap. The technique is applicable for patients who have lost their natural gluteal sulcus, with a resultant altered buttock shape, after trauma or other causes.
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http://dx.doi.org/10.1007/s00266-004-0006-8DOI Listing
June 2005

Massive weight loss after bariatric surgery: friend or foe?

Plast Reconstr Surg 2004 Nov;114(6):1663-4

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November 2004

Management of a traumatically avulsed skin-flap on the dorsum of the foot.

Arch Orthop Trauma Surg 2004 Oct 3;124(8):559-62. Epub 2004 Aug 3.

Department of Plastic and Reconstructive Surgery, Leopold-Franzens University, Anichstrasse 35, 6020 Innsbruck, Austria.

Background: It is common for traumatologists to see avulsion injuries with resulting composite skin flaps. Simply reattaching the avulsed flap by suturing it back into its bed may result in ischemic necrosis of the distal portion of the flap.

Case Report: The authors present a case in which an extensive avulsion injury of the dorsum of the foot with amputation of the fourth and fifth toe was treated by defatting the avulsed flap and reattachment as a full-thickness graft. Healing was uneventful and no skin necrosis was encountered. At 1-year follow-up there was a stable skin situation at the dorsum of the foot. The patient has no difficulties with wearing shoes. However, there is diminished sensibility.

Conclusions: Indications for this type of surgical technique include all types of avulsion or degloving injuries that create composite skin flaps prone to undergo ischemic necrosis if simply reattached. This quick and easy method should be in the armamentarium of each surgeon possibly dealing with this type of injury.
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http://dx.doi.org/10.1007/s00402-004-0723-0DOI Listing
October 2004

Surgical management of bilateral multiple invasive pulmonary aspergillosis.

J Thorac Cardiovasc Surg 2004 Oct;128(4):621-2

Department of Cardiac Surgery, Leopold-Franzens University, Innsbruck, Austria.

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http://dx.doi.org/10.1016/j.jtcvs.2004.02.015DOI Listing
October 2004

Analysis of publications in three plastic surgery journals for the year 2002.

Plast Reconstr Surg 2004 Oct;114(5):1147-54

Department of Plastic and Reconstructive Surgery, Ludwig-Boltzmann Institute for Quality Control in Plastic and Reconstructive Surgery, Innsbruck, Austria. georg@

The goal of this study was to analyze the publications in the plastic surgery literature for the year 2002. Contents of these articles, authors' information (such as nationality affiliation of the first author), type of institution, presence of grant support, and previous presentation were analyzed. For inclusion in this study, the publications had to be original articles from the three most frequently read general plastic surgery journals: Annals of Plastic Surgery, British Journal of Plastic Surgery, and Plastic and Reconstructive Surgery. With this approach, 533 articles were included in the study. To give a cross-sectional analysis of the content of all articles, 11 distinct categories were created in which all the articles were subsummarized. The categories were based on anatomical regions and specific plastic surgical areas. A summary is given for each of the categories to provide an overview of the field in which most of the research in plastic surgery was taking place in 2002 and which topics were focused on. The authors found that only 7 percent of all articles had grant support, whereas 36 percent of articles were presented previously during a scientific meeting. Most of the articles came from university-based institutions (68 percent), followed by non-university-based institutions (29 percent) and private practice (3 percent). Regarding nationality affiliation, most of the articles came from the United States (n = 229) and Europe (n = 128); in Asia, Turkey (n = 39) and Japan (n = 36) were the countries with the most published articles.
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http://dx.doi.org/10.1097/01.prs.0000135851.23100.7eDOI Listing
October 2004

Area enlargement of the gracilis muscle flap through microscopically aided intramuscular dissection: ideas and innovations.

Microsurgery 2004 ;24(5):369-73

Department of Plastic and Reconstructive Surgery and Ludwig-Boltzmann Institute for Quality Control in Plastic and Reconstructive Surgery, Leopold-Franzens University, Anichstrasse 35, 6020 Innsbruck, Austria.

The gracilis muscle is one of the most extensively used muscles for free tissue transplantation. Its advantages are low donor-site morbidity with a concealed donor scar, a constant anatomy with large-diameter vessels, and the potential for a neurosensory flap as well as a large skin paddle. However, limitations comprise its limited size, and thus the muscle is limited to small-to-medium-sized defects. We present a novel technique by which the muscle can be enlarged 3-4 times over the regular muscle width. This can be achieved by microscopically aided intramuscular dissection of connective tissue with preservation of the intrinsic vessels of the muscle. With this technique, the field of application of the versatile gracilis muscle in reconstructive surgery can be further expanded.
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http://dx.doi.org/10.1002/micr.20050DOI Listing
February 2005

Severe atherosclerosis in the internal mammary artery after aortic coarctation.

Eur J Cardiothorac Surg 2004 May;25(5):892-3

Department of Cardiac Surgery, University Clinic of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.

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http://dx.doi.org/10.1016/j.ejcts.2004.01.053DOI Listing
May 2004

Purpura fulminans due to E. coli septicemia.

Wien Klin Wochenschr 2004 Feb;116(3):82

Department of Plastic Surgery, Leopold-Franzens University, Anichstrasse 35, A-6020 Innsbruck, Austria.

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http://dx.doi.org/10.1007/BF03040700DOI Listing
February 2004

Unilateral blepharochalasis.

Br J Plast Surg 2003 Apr;56(3):293-5

Department of Plastic and Reconstructive Surgery, Ludwig Boltzmann Institute for Quality Control in Plastic and Reconstructive Surgery, Leopold-Franzens University, Innsbruck, Austria.

Unilateral blepharochalasis is an extremely rare disorder with an unknown etiology and pathogenesis. The authors present a 22-year old patient in whom a right-sided skin overhang of the upper eyelid caused visual field impairment. The condition was corrected by a standard blepharoplasty. The histological examination suggested a localised anomaly of the lymphatic system and an almost complete absence of elastic fibres as the causative agent.
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http://dx.doi.org/10.1016/s0007-1226(03)00108-5DOI Listing
April 2003