Biomedical subjects

O Thomusch

Publications and source records attributed to O Thomusch.

25 records · Page 2Linked to original sources

PubMed2000

Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany.

Risk factors for postoperative complications of benign goiter surgery have not been investigated systematically. To this end, a prospective multicenter study (January 1 through December 31, 1998) was conducted involving 7266 patients with surgery for benign goiter from 45 East German hospitals. High-volume providers (>150 operations per year) performed 69% (5042/7266), intermediate-volume providers 27% (50-150), and low-volume providers 4% (258/7266) of operations. Among the hospital groups, the pattern of thyroid disease did not vary significantly, but there was a trend that small-volume providers tended to perform more operations for uninodular goiter and high-volume providers treated more patients with Graves' disease and recurrent goiter. Extent of resection (p < 0.0001) and remnant size (multinodular goiter and recurrent goiter, p < 0.001), differed significantly, with total thyroidectomy being performed more often in hospitals with more than 150 operations compared to hospitals with an operative volume of less than 150 procedures per year. Despite the larger extent of resection and smaller remnant size, rates of recurrent laryngeal nerve (RLN) palsy or hypoparathyroidism were not increased. When the logistic regression analyses were fitted to evaluate the impact of risk factors on transient and permanent RLN palsy and hypoparathyroidism, larger extent of resection [relative risk (RR) 1.5-2.1] and recurrent goiter (RR 1.8-3.4) consistently evolved as independent risk factors. With hypoparathyroidism, additional significant factors included patient gender (RR 2.1-2.4), hospital operative volume (RR 0.8-1.5), and Graves' disease (RR 2.8). Unlike parathyroid gland identification during hypoparathyroidism, RLN identification (RR 1.6) significantly (p = 0.01) reduced permanent RLN palsy rates. The multivariate analyses clearly confirmed the pivotal role of routine RLN identification, independent of the extent of the thyroid resection. These findings might help hospitals with lower operative volumes to identify patients at increased risk whom they might consider for specialist care.

Adult↗

PubMed2000

Differential diagnosis of calcitonin-secreting neuroendocrine carcinoma of the foregut by pentagastrin stimulation.

BACKGROUND AND AIMS: This study assessed the suitability of pentagastrin stimulation in hypercalcitoninaemia for differential diagnosis of neuroendocrine carcinoma of the foregut. PATIENTS: A prospective institutional study (March 1997-September 1999) was conducted involving all patients admitted to the pneumological and general surgical wards for small cell lung cancer (SCLC) or primary medullary thyroid carcinoma (MTC). Basal and stimulated serum calcitonin levels were measured using an improved immunoradiometrical assay for the monomeric form of calcitonin. RESULTS: Increased basal calcitonin levels were noted in six non-MTC patients (one mediastinal and one laryngeal neuroendocrine carcinoma, and four SCLCs). Because of chronic renal failure, one SCLC patient had to be excluded. The remaining five non-MTC patients with normal renal function were compared to eight primary MTC patients. In terms of pentagastrin stimulation, an increase in serum calcitonin levels of less than twofold the baseline significantly correlated with both non-MTC (r=0.85; P=0.005) and SCLC (r=0.81; P=0.024). Immunostaining of tissue specimens for calcitonin was positive in the patients with mediastinal and laryngeal neuroendocrine carcinoma and in all eight patients with primary MTC, but was negative in the two SCLC patients with adequate tissue samples. CONCLUSIONS: Irrespective of the pathophysiological background, pentagastrin stimulation affords a differential diagnosis in neuroendocrine carcinoma of the foregut when chronic renal failure is excluded.

Aged↗

PubMed2000

Hypercalcitoninemia in a sporadic asymptomatic neuroendocrine tumor of the pancreatic tail.

BACKGROUND/AIM: Asymptomatic neuroendocrine tumors of the gastroenteropancreatic tract represent a significant challenge in terms of postoperative monitoring. METHODS: A case report of a calcitonin-secreting asymptomatic neuroendocrine tumor of the pancreatic tail is presented. RESULTS: Hypercalcitoninemia was noted in the 76-year-old Caucasian man who had a recurrent neuroendocrine tumor of the pancreatic tail. Upon pentagastrin stimulation, basal calcitonin increased only moderately from 82.3 (<10) to 100.9 and 125 pg/ml after 2 and 5 min, respectively. Surgical removal of the neuroendocrine tumor resulted in postoperative normalization of both basal and stimulated serum calcitonin levels. On immunohistochemistry, the neuroendocrine tumor was positive for calcitonin. CONCLUSION: Routine measurements of serum calcitonin might be a highly sensitive adjunct capable of identifying a subset of neuroendocrine tumors in which calcitonin monitoring may aid in the early detection of postoperative recurrence.

Adenoma, Islet Cell↗

PubMed2000

[Quality assurance study in thyroid gland surgery. Initial comparative intermediate -term results for benign thyroid gland surgery]].

In 1998 the East German Association for Quality Securing of Surgery performed a study to evaluate the standard of performance of surgical treatment for benign goiter. In total, 46 hospitals participated and 6,029 operations could be analysed. The documentation was based on a detailed registration sheet and recorded items of preoperative complaints, diagnostic procedures, intraoperative findings with operative strategy, postoperative complications and definitive histology. All hospitals were divided into three groups regarding their number of surgical performances for benign goiter (< 50 operations, 50-150 operations, > 150 operations) to assess their training and expertise. Indications for surgical treatment were similar in all three groups with 78% for multinodular goiter and 19% for uninodular goiter. There was no statistical difference in distribution for M. Basedow, recurrent goiter or thyroid carcinoma. Hospitals with more than 150 operations per year for benign goiter performed statistical significant more extended procedures with routinely preparation of the laryngeal recurrent nerve and parathyroid glands. There was no statistical significant difference regarding postoperative complications. Because of the not finished check up (follow up 6 months postoperative), results for temporary nerve palsies (3.9%) and temporary hypoparathyroidism (6.3%) could only be stated.

Cross-Sectional Studies↗

PubMed1998

Cost analysis of surgical procedures for toxic nodular goiter.

Effective by January 1, 1993, the Federal Care Rate Regulation (Bundespflegesatzverordnung; BPflV) has started increased competition between hospitals by introducing performance related reimbursements. All three categories of flat payments, Fallpauschale (FP), Sonderentgelt (SE) and Budget-patient (BP), apply to toxic nodular goiter surgery, governed solely by the extent of thyroid resection. Unlike FP 2.01 and FP 2.02 which do not cover all surgical expenses, the BP flat rate provides a comparatively generous refund for total thyroidectomy. With the oncoming reduction of upper values for residual radioactivity, hospitalization will fall after radioiodine therapy, resulting in lower overall refunds. With this anticipated fall in reimbursement, refunds for radioactive therapy must be increased in the near future to ensure adequate financial compensation. Economic arguments for either therapeutic option will then cease to play a major role, allowing medical therapeutic considerations to prevail.

Costs and Cost Analysis↗

PubMed1997

[Cost analysis of thyroid gland surgery in a university surgical clinic].

On 1 January 1996, the implementation of the new recompense system, the Bundespflegesatzverordnung (BPflV), at the Medical University Halle replaced the former German hospital financing system based on clinic-dependent individual prices. This was the beginning of a new price-performance system of the German hospital market. Since then, for all surgical procedures (catalogue section 301 SGB V ICPM 5061-5064) for benign and malignant thyroid diseases a detailed cost analysis has been performed. Our personnel and material inputs were documented on-line in the operating theatre on a special designed cost-analysis record. The cost analysis was based on 14 cases of lobectomy (average operative costs DM 1886.82), and 20 each of bilateral subtotal thyroidectomy (average DM 1970.48), unilateral subtotal thyroidectomy with contralateral lobectomy (average DM 2164.26) and total thyroidectomy (average DM 2396.70) respectively. In 12 cases the costs of total thyroidectomy with cervical and transthoracal lymphadenectomy have been analyzed (average DM 4664.48).

Costs and Cost Analysis↗

PubMed1997

[Long-term results and costs of elective bypass operation of infrarenal aortic aneurysm].

During a 10-years-period from 1978-1987 n = 545 patients were operated upon for infrarenal aortic aneurysm. Hospital mortality was 6.4%. In 95.6% of the patients information concerning state and cause of death were achieved. Cumulative survival was 64.6% at 5 years and 41.0% at 10 years, the mean survival being 95.1 month. Preoperative risk factors like age, coronary artery disease and hypertension had a negative impact on the long-term results. The costs were calculated according to the "Gesundheitsstrukturgesetz" and on the mean in-hospital-stay of 16.4 days.

Aged↗