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O Thomusch

Publications and source records attributed to O Thomusch.

At least 19 recordsLinked to original sources
PubMed2006

Successful transplantation of kidneys from a donor with myoglobinuric acute renal failure.

The shortage of donor organs is reflected in the growing number of patients on the waiting list for kidney transplantation worldwide. It seems to be sensible to expand the scarce donor pool by the cautious use of extended donor criteria. Kidneys from a 21-year-old deceased donor road traffic accident victim who suffered acute renal failure (ARF) due to myolysis were transplanted. Both transplantations were successful after an initial period of delayed graft function. Therefore, kidneys from deceased donors with ARF should not be excluded for transplantation in general.

Accidents, Traffic↗
PubMed2006

MMP-9 in serum correlates with the development of pulmonary complications in experimental acute pancreatitis.

INTRODUCTION: The prediction of the course of acute pancreatitis and its arising complications is of clinical importance. The aim of this study was to judge the time course and relevance of matrix metalloproteinase-9 (MMP-9), a PMN-derived protease, for the development of pulmonary complications in two models of acute pancreatitis. METHODS: MMP-9 was evaluated in a standardized experimental model of acute pancreatitis. Mild edematous (n = 12) and severe necrotizing pancreatitis (n = 48) were induced by intravenous cerulein or intravenous cerulein and intraductal application of glycodeoxycholic acid and compared to control animals. 1, 6, 9, 12, 24 and 72 h after induction, rats were sacrificed and damage to the lung and the pancreas was quantified by histology and extravasation of Evans blue. At 1, 6, 9, 12, 24 and 72 h, we determined MMP-9 in serum by ELISA. RESULTS: In our model, MMP-9 in serum was increased in the group with severe acute pancreatitis in comparison to mild edematous pancreatitis and controls at each evaluated time point (p < 0.05). The maximum release of MMP-9 preceded the development of pulmonary complications, verified by histology and extravasation of Evans blue. MMP-9 showed a negative predictive value of 96.2% and a positive predictive value of 100% for the development of pulmonary complications. CONCLUSION: MMP-9 in serum allows a valid grouping to severe and mild courses of experimental acute pancreatitis with a good predictive value for the development of pulmonary complications. MMP-9 should be evaluated as a valid single marker for the prediction of progression and the development of pulmonary complications in acute pancreatitis in clinical studies.

Animals↗
PubMed2004

[Not all vocal cord failure following thyroid surgery is recurrent paresis due to damage during operation. Statement of the German Interdisciplinary Study Group on Intraoperative Neuromonitoring of Thyroid Surgery concerning recurring paresis due to intubation].

Since the phoniatrician H. Bauer described the first case of recurrent laryngeal nerve palsy most likely caused by intubation some 45 years ago, several case reports have been published. However, systematic analyses regarding the frequency of recurrent laryngeal nerve palsies due to intubation are scarce, and none of them has used the proper methods to demonstrate clearly that such a mechanism exists. Currently available data justify the assumption that not every recurrent laryngeal nerve palsy following thyroid surgery is due to the operation itself and that the damage caused by intubation, however, may only account for a minority of these cases. The differential diagnosis of postoperative recurrent laryngeal nerve palsy requires the use of specific tools which go beyond simple laryngoscopy and include stroboscopy as well as intra- and extralaryngeal electromyography. A partial palsy of recurrent laryngeal nerve due to intubation would be associated with severe dysphonia or aphonia, not with dyspnea because of the typical intermediate position of the paralyzed vocal folds with a normal electromyographic function of the cricothyroid muscle. The use of these methods to identify the nature of postoperative recurrent laryngeal nerve palsy is recommended in cases of regular intraoperative neuromonitoring but postoperatively impaired function of the vocal cords.

Diagnosis, Differential↗
PubMed2004

[Effectiveness and results of intraoperative neuromonitoring in thyroid surgery. Statement of the Interdisciplinary Study Group on Intraoperative Neuromonitoring of Thyroid Surgery].

Intraoperative neuromonitoring (IONM) has yielded an increasing effect on thyroid surgery. During IONM, the recurrent laryngeal nerve is stimulated electrically and an acoustically transformed electromyographic signal is derived via either a needle electrode placed in the vocalis muscle or an electrode adjusted to the intubation tube. The IONM is used for identifying and predicting the function of the recurrent laryngeal nerve. Especially under difficult anatomic conditions, IONM has proven a valuable tool for identification of recurrent laryngeal nerves. This can lead to decreased occurrence of nerve palsy rates, as shown in numerous studies. The reliability of the IONM signal (defined as the correlation between intraoperative signal interpretation and postoperative vocal cord function) is reflected by a specificity as high as 98.2%, as shown by German multicenter studies. Thus, normal vocal cord function could be demonstrated postoperatively in over 98.2% of patients with intraoperatively unchanged neuromonitoring signals. If the neuromonitoring signal changed during operation, 39% of the patients suffered from transient vocal cord immobility and 12% had permanent loss of vocal cord function.

Electrodes↗
PubMed2003

[Is primary total thyroidectomy justified in benign multinodular goiter? Results of a prospective quality assurance study of 45 hospitals offering different levels of care].

INTRODUCTION: After subtotal resection of multinodular goiter, rates of up to 40% are reported for recurrent goiter in the long-term follow-up. Because of the increased morbidity of surgery for recurrent goiter, this study evaluated the preconditions that would justify total thyroidectomy as part of the primary therapy concept for benign multinodular goiter. MATERIAL AND METHODS: The Quality Assurance Study of Benign and Malignant Goiter covering the period from 1 January to 31 December 1998 assessed 5195 patients treated for benign goiter by primary bilateral resection. With respect to the extent of resection three groups were analyzed: bilateral subtotal resection (ST+ST, n=4580), subtotal resection with contralateral lobectomy (ST+HT, n=527), and total thyroidectomy (TT, n=88). RESULTS: The age of the patients was significantly higher (60.3 years) in the TT group than in the ST+ST (52.5 years) and ST+HT (55.6 years) groups. ASA classification grades III and IV were significantly more frequent in the TT group. The postoperative morbidity increased with the extent of resection. The rate of permanent recurrent laryngeal nerve (RLN) palsy was 0.8% for ST+ST, 1.4% for ST+HT, and 2.3% for TT and of permanent hypoparathyroidism 1.5% for ST+ST, 2.8% for ST+HT, and 12.5% for TT. Multivariate analysis showed that the extent of resection significantly increased the risk of RLN palsy (transient RR 0.5, permanent RR 0.4) and hypoparathyroidism (transient RR 0.2,permanent RR 0.08). The surgeon's experience (RR 0.6) and identification of the RLN (RR 0.5) reduced the risk of permanent RLN palsy. Additionally, the development of permanent hypoparathyroidism was reduced if at least two parathyroid glands (RR 0.4) were identified. CONCLUSION: Total thyroidectomy is associated with an increased rate of RLN palsies and hypoparathyroidism in comparison to less extensive thyroid surgery. In the hands of well-trained surgeons using an appropriate intraoperative technique, primary thyroidectomy is justified if the patient has an increased risk of recurrent goiter. Due to the increased postoperative morbidity after total thyroidectomy, subtotal thyroid resection based on the morphologic changes in the thyroid gland is still recommended as the standard treatment regimen for multinodular goiter.

Female↗
PubMed2003

Transmission of a pancreatic adenocarcinoma to a renal transplant recipient.

Transmission of donor tumours in solid organ transplant recipients is rare, but has been reported with fatal outcome in some cases depending on the original tumour type and location. We report a case of a pancreatic adenocarcinoma of donor origin presented as lymphangitis carcinomatosa of the lung in a renal transplant recipient 9 months after transplantation, which is likely to have contributed to the death of the patient 15 months after transplantation. The donor tumour was originally diagnosed on adrenal tissue removed from the donor kidney during bench preparation. At the time of the diagnosis this kidney and the liver of the multi-organ donor had been transplanted. The liver patient was urgently retransplanted within 24 h. The renal recipient opted not to have a transplant nephrectomy having been made aware of the risk of tumour transmission. The contralateral kidney was discarded. Management of recipients with potential transmission of initially undiagnosed donor malignancy is difficult. Early transplant nephrectomy may be the safest option.

Adenocarcinoma↗
PubMed2002

[Does intraoperative nerve monitoring reduce the rate of recurrent nerve palsies during thyroid surgery?].

Two different aspects of the influence of neuromonitoring on the possible reduction of post-operative recurrent laryngeal nerve palsies require critical examination: the nerve identification and the monitoring of it's functions. Due to the additional information from the EMG signals, neuromonitoring is the best method for identifying the nerves as compared to visual identification alone. There are still no randomized studies available that compare the visual and electrophysiological recurrent laryngeal nerve detection in thyroid operations with respect to the postoperative nerve palsies. Nevertheless, comparisons with historical collectives show that a constant low nerve-palsy-rate was achieved with electrophysiological detection in comparison to visual detection. The rate of nerve identification is normally very high and amounts to 99 % in our own patients. The data obtained during the "Quality assurance of benign and malignant Goiter" study show that in hemithyreoidectomy and subtotal resection, lower nerve-palsy-rates are achieved with neuromonitoring as compared to solely visual detection. Following subtotal resection, this discrepancy becomes even statistically significant. While monitoring the nerve functions with the presently used neuromonitoring technique, it is possible to observe the EMG-signal remaining constant or decreasing in volume. Assuming that a constant neuromonitoring signal represents a normal vocal cord, our evaluation shows that there is a small percentage of false negative and positive results. Looking at the permanent recurrent nerve palsy rates, this method has a specificity of 98 %, a sensitivity of 100 %, a positive prognostic value of 10 %, and a negative prognostic value of 100 %. Although an altered neuromonitoring signal can be taken as a clear indication of eventual nerve damage, an absolutely reliable statement about the postoperative vocal cord function is presently not possible with intraoperative neuromonitoring.

Electromyography↗
PubMed2001

Calcitonin kinetics in the early postoperative period of medullary thyroid carcinoma.

INTRODUCTION: Calcitonin is a sensitive marker for medullary thyroid carcinoma. Normalisation of calcitonin levels following resection of medullary thyroid carcinoma has been described after a few hours; however, it may be observed more than 4 weeks after surgery. The aim of this study was to correlate the postoperative calcitonin kinetics with preoperative calcitonin levels and tumour stage. Furthermore, we wanted to test the prognostic impact of the calcitonin kinetics. Therefore, only patients with postoperative normalisation of calcitonin levels (biochemical cure) were included in this study. METHODS: Fourteen biochemically cured patients were analysed, including measurement of postoperative basal and pentagastrin-stimulated calcitonin concentration. With respect to the time of postoperative basal calcitonin normalisation, patients were classified into two groups: (A) patients with normalisation of basal calcitonin levels within 24 h and (B) patients with normalisation of basal calcitonin levels later than 24 h postoperatively. RESULTS: Eight patients were found to have normalisation of basal calcitonin levels within 24 h (group A). In the remaining six patients (group B), the period to normalisation of basal calcitonin levels varied from 6 days to 14 days and longer. There were no differences between the two groups with regard to tumour size, number and pattern of lymph node metastases and tumour stage. However, preoperative basal calcitonin levels were significantly different (258 ng/ml vs 955 ng/ml, P<0.01). In the group with slow-decreasing calcitonin levels, no strong correlation between the preoperative level and the postoperative time to normalisation of basal calcitonin levels could be established, which may be due to the small number of patients. After a median follow-up of 21 months, no patient developed tumour recurrence. However, an increased basal calcitonin level was observed in one patient from group B. All other patients had normal basal and peak calcitonin levels. CONCLUSION: Using a highly sensitive calcitonin assay, we demonstrated that normalisation of basal calcitonin levels may be delayed in patients suffering from medullary thyroid carcinoma. The lack of correlation of preoperative levels and the time to normalisation of the basal calcitonin levels, as well as the positive pentagastrin test in some of the patients, argues that this phenomenon is not simply due to prolonged biochemical calcitonin elimination. Nevertheless, a prognostic influence could not be shown in this study due to the short follow up-period. Further investigations and a longer follow-up are necessary to determine the nature and the prognostic impact of delayed normalisation of calcitonin levels.

Adult↗
PubMed2001

Importance of early screening and prophylactic thyroidectomy in asymptomatic nonindex RET germline carriers.

Genetic testing for RET germline mutations affords rapid identification of germline carriers, offering the prospect of cure before C-cell hyperplasia (CCH) has progressed to medullary thyroid carcinoma (MTC). Although nonindex RET mutation carriers have a better prognosis than do the index patients, it remains to be ascertained whether age represents a risk factor for MTC when screening patients. The current institutional study (October 1994 through June 1999) was set up to compare asymptomatic nonindex patients who were grouped by age: < 20 years and > or = 20 years. Inclusion criteria were confirmed RET mutations in the germline, with no MTC being more advanced than pT1pN1M0. Adult patients (> or = 20 years) had MTC significantly more often (84% vs. 43%), significantly larger tumors (5 mm vs. 3 mm), and significantly higher basal calcitonin levels preoperatively (78.0 vs. 9.7 pg/ml) than their pediatric/adolescent counterparts (< 20 years). There was a close correlation between pT1 MTC and an elevated basal serum calcitonin level (r = 0.67; Spearman's rho). All three patients with lymph node metastases from MTC had elevated basal calcitonin levels. The two groups did not differ in terms of multifocality of MTC (pT1b), lymph node involvement (pN1) or bilateral lymph node metastasis (pN1b), or preoperative stimulated and postoperative basal and stimulated serum calcitonin. Prophylactic thyroidectomy should not be postponed beyond the age of 20, and it should be performed before basal serum calcitonin has turned positive. Pathologic conversion of stimulated serum calcitonin obviously marks the time in carriers of RET germline mutations when surgery should be scheduled at the latest to be prophylactic.

Adolescent↗
PubMed2001

[Quality assurance study of benign and malignant goiter. Prospective multicenter data collection regarding 7,617 patients].

A quality control study was undertaken on 7,265 patients with benign goitre and 352 patients with malignant goitre who were surgically treated between 1.1.98 and 31.12.98. 3 hospital groups were defined according to surgical workload: Group 1: < 50 operations/yr; Group 2: 50-150 operations/yr; Group 3: > 150 operations/yr. The temporary rate of recurrent laryngeal nerve (RLN) palsies for benign goitre was 3.9% and the permanent 1.1%. For malignant goitre the rates were 12.8% and 6.8% respectively. The rate of temporary (p < 0.040) and permanent (0.003) palsies after surgery for benign goitre was lower in group 3 compared to group 1 and 2. There were too few cases for statistical analysis of the malignant goitres. After benign goitre surgery a transient hypocalcaemia rate of 6.3% and a permanent of 1.1% were observed. For malignant goitre the incidence was 23.8% and 7.1%, respectively. A significantly increased rate of permanent hypocalcaemia (p < 0.003) was demonstrated in group 3 after surgery for multinodular goitre. Centres in group 3 made more extended (smaller thyroid remnants) resections (p < 0.01) with the equivalent rate of general complications. The average inpatient stay for malignant goitres was 13.1 days and for benign goitres 8.7 days. On average, patients with bilateral resections for benign goitre stayed 0.4 days longer in hospital than those with unilateral procedures. Prophylactic antibiotics were administered to 2.1% of patients and 94.6% received thrombosis prophylaxis.

Adult↗
PubMed2001

Thyroid carcinoma invading the cervicovisceral axis: routes of invasion and clinical implications.

BACKGROUND: Controversy exists about the routes of invasion (extrathyroidal versus lymphogenic extension) when differentiated carcinoma (DTC) and medullary thyroid carcinoma (MTC) invade the cervicovisceral axis (ie, larynx, trachea, esophagus). METHODS: We carried out an institutional analysis, from November 1994 to October 1999, of 451 consecutive patients undergoing surgery for DTC and MTC. RESULTS: Irrespective of tumor entity, carcinomas with cervicovisceral invasion (n = 34) were significantly larger and displayed higher pT categories (mainly pT4) than noninvasive carcinomas. In invasive papillary thyroid carcinoma (PTC) and MTC, the rates of positive lymph nodes were significantly higher than in noninvasive controls. When separate logistic regression analyses were fitted for laryngeal, tracheal, and esophageal invasion, extrathyroidal growth (pT4) consistently was a significant factor predictive of invasion in both DTC and MTC, with relative risks of 10.9 to 67.8. As the routes of invasion are similar in DTC and MTC, all data were pooled for multivariate analyses. Herein, the pN1 category had a significant impact only on esophageal invasion, with a relative risk of 4.7. CONCLUSIONS: Invasion of the cervicovisceral axis is more often caused by extrathyroidal growth than by nodal metastasis. To keep nodal metastasis from encroaching onto the cervicovisceral axis, paratracheal and paraesophageal lymph nodes should be cleared from the cervicocentral compartment at the primary operation.

Carcinoma, Medullary↗
PubMed2001

Extended surgery and early postoperative radiotherapy for undifferentiated thyroid carcinoma.

The current study was devised to evaluate the therapeutic potential of extended surgery for improving survival in undifferentiated thyroid carcinoma (UTC). An institutional retrospective survival analysis (July 1994 to December 1998) of 30 patients who underwent surgery for UTC with locally curative intent was done. Median and 1-year survival was 4 months and 37%, respectively. Primary patients were older (70 vs. 59 years; p = 0.026) and deceased earlier (median survival 4 vs. 20 months; p = 0.027, log-rank test) than their reoperative counterparts, suggesting a referral bias toward younger patients. Survival analysis was restricted to primary pT4 UTC, leaving 18 patients. On univariate analysis, pN and M category, degree of resection (R2 versus R0/1 and radiotherapy (0-30 Gy versus >30 Gy) were identified as parameters suitable for further testing. On multivariate analysis, pN1 was a significant prognosticator of decreased survival (RR = 5.9; p = 0.043), followed by R2 (RR = 4.1, p = 0.088) and M1 (RR = 3.6; p = 0.089). Because of low patient numbers after stratification for radiotherapy, only pN and degree of resection were analyzed on subsequent multivariate analysis. In the incomplete radiotherapy stratum, neither of the two parameters affected survival, whereas R2 and pN1 limited survival in the complete radiotherapy stratum. In primary pT4 UTC, a subset of pN0 patients with R0/1 resections and radiotherapy greater than 30 Gy seemed to benefit from extended surgery. Because pN1 and R2 patients with radiotherapy of 30 Gy or less comprised most UTC patients, only 1-year, but not median, survival improved compared to literature controls.

Aged↗
PubMed2001

Prophylactic completion thyroidectomy for differentiated thyroid carcinoma: prediction of extrathyroidal soft tissue infiltrates.

Controversy exists on the extent of completion surgery for differentiated thyroid carcinoma (DTC). Between November 1994 and October 1999, 88 consecutive DTC patients who had no evidence of residual tumor after primary surgery underwent completion total thyroidectomy in conjunction with a systematic en bloc resection of the cervicocentral lymph node compartment. To identify individual parameters predictive of occult residual tumor, three separate logistic regression analyses were fitted for intrathyroidal tumor, extrathyroidal soft tissue infiltrate and cervicocentral nodal metastasis. Altogether, occult residual tumor was found in 22% (19/88) of patients. Occult intrathyroidal tumor, extrathyroidal soft tissue infiltrate, and cervicocentral nodal metastasis were encountered in 11%, (10/88), 6% (5/88), and 10% (9/88), respectively. On logistic regression analysis, patients with multifocal DTC on primary surgery had a 17.4 times higher risk (p = 0.026) on reoperation to harbor extrathyroidal soft tissue infiltrates within the cervicocentral compartment. At least in multifocal DTC, a systematic en bloc resection of the thyroid remnant and cervicocentral lymph node compartment is warranted to ensure clearance of occult extrathyroidal soft tissue infiltrates, setting the stage for radioiodine therapy. Selective lymph node dissection alone does not seem capable of eliminating these soft tissue infiltrates from the cervicocentral compartment.

Humans↗
PubMed2000

[Endocrine surgery and evidence-based medicine].

INTRODUCTION: The aim of this literature review is to classify current knowledge on nine questions of current interest for endocrine surgery and their classification with regard to levels of evidenced-based medicine (EBM). METHODS: The literature in Medline and EMBase was reviewed. Only retrospective or prospective comparative studies with statistical analysis were selected. RESULTS: (See Table 8.). CONCLUSION: With respect to the current literature, only routine identification of the RLN and the minimally-invasive approach for adrenalectomy can be regarded as EBM. To answer the remaining questions prospective studies are needed.

Adrenal Glands↗
PubMed2000

[Delayed diagnosis of odontoid fracture after whiplash trauma of the cervical spine].

Fractures of the odontoid process represent about 10-20% of all diagnosed cervical spine fractures. Approximately 35% of these fractures are classified as Type II according to Anderson and D'Alonzo. They can be potentially unstable especially if combined with a dens displacement of over 6 mm. In severe cervical spine trauma, these fractures do not usually cause difficulties in diagnosis. However, in whiplash injuries, which are very common and only rarely associated with such fractures, the surgical management can be complicated if they are underestimated. These patients can present without significant neurological deficits or the situation can be complicated due to intoxication or additional trauma. Under these circumstances in particular, the diagnosis can be delayed or missed, if no strict protocols for diagnostic effort in all whiplash injuries are employed. A case of delayed diagnosis of an odontoid fracture in a neurological asymptomatic patient after whiplash injury is presented.

Adult↗