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S Walgenbach

Publications and source records attributed to S Walgenbach.

At least 37 records · Page 2Linked to original sources
PubMed1998

Prospective evaluation of parathyroid graft function after total parathyroidectomy and heterotopic autotransplantation in renal hyperparathyroidism by bilateral determination of intact parathormone in cubital venous blood.

The value of gradients for intact parathyroid hormone (PTH) in the assessment of graft function after total parathyroidectomy/autotransplantation for renal hyperparathyroidism was evaluated in a prospective follow-up study. Altogether 99 patients who underwent operation from August 1, 1987 to December 31, 1996 were prospectively investigated and reexamined postoperatively, including analyses of serum calcium, alkaline phosphatase, and intact PTH in the antecubital venous blood of both arms. The postoperative course is known for all patients. Of the 99 patients included in the study, 95 underwent one to nine reexaminations (median three) over follow-up periods of 1 month to 5 years (median 24 months). Reproducible PTH gradients were established during follow-up. Ninety percent of the calculated gradients were < or = 20. Intermittent postoperative hypocalcemia, due to calcium deficiency of the skeleton in renal osteopathy, led to an increase in PTH secretion and gradients. Increasing gradients > 20 during follow-up make graft-dependent recurrence probable. The presence of a gradient of approximately 1 in bilaterally elevated PTH levels may be an indication of hyperfunctioning parathyroid tissue in the neck or mediastinum. The combined assessment of the course of gradients for intact PTH, hormone levels in both arms, and serum calcium permits an objective evaluation of parathyroid graft function.

Calcium↗
PubMed1998

Prophylactic thyroidectomy in 75 children and adolescents with hereditary medullary thyroid carcinoma: German and Austrian experience.

When mutations of the RETproto-oncogene were found in 1993 to account for hereditary medullary thyroid carcinoma (MTC), surgeons obtained the opportunity to operate on patients prophylactically (i. e., at a clinically asymptomatic stage). Whether this approach is justified, and, if so, when and to which extent surgery should be performed remained to be clarified. A questionnaire was sent to all surgical departments in Germany and Austria. All of the patients who fulfilled the following criteria were enrolled: (1) preoperatively proved RET mutation; (2) age </= 20 years, (3) clinically asymptomatic thyroid C cell disease; and (4) TNM classification pT0-1/pNX/pN0-1/M0. Seventy-five patients were identified, and fifteen mutations were detected in six codons. Two adolescents had unilateral pheochromocytomas as part of the multiple endocrine neoplasia II (MEN-II) syndrome. No hyperparathyroidism was noted. All patients underwent total thyroidectomy, and 57 patients went on to have lymph node dissection. Parathyroid glands were removed in 34 patients and autografted in 11. Histopathology revealed MTC in 46 patients (61%, youngest 4 years); C cell hyperplasia (CCH) only was detected in the other 29 patients. Three patients had lymph node metastases (LNMs) the youngest being age 14 years. Calcitonin levels were not useful for differentiating between CCH and MTC, but in all patients with LNMs at least the stimulated calcitonin levels were assayed. After surgery, five patients (6.7%) sustained permanent hypoparathyroidism, and one patient (1.3%) had a permanent unilateral recurrent nerve palsy. All but three patients (96%) were biochemically cured. In conclusion, prophylactic total thyroidectomy can be performed safely in experienced centers. We recommend prophylactic total thyroidectomy at age 6. Cervicocentral lymph node dissection should be included when calcitonin levels are elevated or if patients are older than 10 years. Bilateral lymph node dissection should be performed if LNMs are suspected or when patients with elevated calcitonin are older than 15 years.

Adolescent↗
PubMed1998

Is there an ectopic secretion of monomeric calcitonin in the human being?

INTRODUCTION: Persistent detectable calcitonin (CT) values can be frequently observed after treatment of medullary thyroid carcinomas (MTCs). Apart from residual C cells or incomplete tumor extirpation, ectopic CT production should be taken into account. CT determination in patients without MTC and after total thyroidectomy should reveal to what extent, apart from the C cells, other neuroendocrine cells show a relevant CT production. OBJECTIVES: The objective of this study was to find out whether ectopic CT production can be detected using an assay specifically recognizing the monomeric form of CT. METHODS: The CT serum values were obtained from 94 healthy individuals and 64 patients who had undergone total thyroidectomy and radioiodine therapy because of follicular or papillary carcinoma. RESULTS: In the group of thyroidectomized patients, the CT values were below the detection limit of the assay. In the tested patients, there was neither a physiological (C cell) nor a pathological (MTC cell) secretion of monomeric CT. CONCLUSION: A relevant ectopic monomeric CT production could be excluded because the patients were without detectable CT concentration. For this reason, postoperative CT concentrations of the monomeric form in MTC patients can be traced either to remaining C cells or to tumor cells. For a differentiation of these two possibilities further diagnostics is necessary.

Adult↗
PubMed1997

[Prospective observational study of surgical therapy of renal hyperparathyroidism].

A prospective long-term follow-up study in patients who had had surgical therapy for renal hyperparathyroidism was launched to investigate the results of surgical treatment and to evaluate possible correlations between preoperative laboratory values and the course of symptoms. From August 1987 to December 1995, 79 patients underwent surgery for renal hyperparathyroidism. It was the first neck exploration for 72 patients. Total parathyroidectomy with autotransplantation to a forearm was our preferred procedure (n = 67). The postoperative course of all patients is know. We carried out one to nine reexaminations (median 4) in 74 of 79 patients. The follow-up period ranged from 1 month to 5 years with a median of 18 months. After the operation transient hypocalcaemia occurred in 84.4% of patients. Postoperative hypocalcaemia correlated negatively with the preoperative levels of alkaline phosphatase and intact parathyroid hormone. Within the first month after surgery 60% of the preoperatively affected patients completely recovered from pruritus, whereas the skeletal syndrome took longer to disappear. One year after surgery 75% of the patients with pruritus and 79% of those with skeletal syndrome had became asymptomatic. After total parathyroidectomy with autotransplantation, patients with preoperatively elevated concentrations of alkaline phosphatase (> 200 U/I) experienced faster relief from joint pain than patients with preoperatively normal concentrations (P = 0.0297). To date 4.5% of the patients developed recurrent hyperparathyroidism after total parathyroidectomy with autotransplantation. Morbidity of surgery for renal hyperparathyroidism is influenced by patients' risk factors. Postoperative hypocalcaemia correlates negatively with the grade of renal osteopathy at the time of operation. Preoperative concentrations of alkaline phosphatase influence the rapidity of the relief from joint pain.

Adult↗
PubMed1997

[Results of endoscopic, retroperitoneal adrenalectomy with special reference to the intraoperative course].

In 20 patients the hemodynamic and ventilatory data during endoscopic retroperitoneal adrenalectomy were checked retrospectively to analyze the hemodynamic and ventilatory effects of a pneumoretroperitoneum. After insufflation of CO2 into the retroperitoneal space we observed an increase in systolic blood pressure [median 180 mm Hg ([130-200)]. Analyzing the ventilatory parameters we noted that the minute ventilation had to be increased by a median value of 4.25 I (0.4-13) to reduce the increased carbon dioxide levels during CO2 insufflation. After insufflation of CO2 into the retroperitoneal space we observed no major complications. We therefore believe that retroperitoneal endoscopic adrenalectomy is also indicated in patients with cardiac or pulmonary diseases.

Adrenal Gland Neoplasms↗
PubMed1997

[Surgical therapy of differentiated thyroid gland carcinoma].

Surgical excision is the treatment of choice for differentiated thyroid carcinoma. Because no prospective randomized clinical trials are available, decisions regarding the extent of surgical resection and the mode of lymph node dissection must be made on the basis of imperfect retrospective data. Recommendations for surgical strategy in differentiated thyroid cancer are discussed.

Adenocarcinoma, Follicular↗
PubMed1996

Results of endoscopic retroperitoneal adrenalectomy.

BACKGROUND: From March 1994 to August 1995 we performed extraperitoneal endoscopic adrenalectomy in 18 patients with adrenal gland tumors. METHODS: Two of these patients underwent bilateral adrenalectomy. For the extraperitoneal approach a pneumoretroperitoneum was established and three 10-mm trocars were inserted in the area of the conventional flank incision. Adrenalectomy was performed via these ports. Endoscopic retroperitoneal adrenalectomy was successful in 15 patients; three patients required a conventional operation via an extraperitoneal lumbar approach because of inadequate exposure of the adrenal gland. In patients with endoscopic retroperitoneal adrenalectomy median operative time amounted to 180 min (95-330). RESULTS: No postoperative complications were observed; median postoperative hospital stay was 5 days (3-12). CONCLUSIONS: The described approach produces rapid recovery and creates less postoperative pain.

Adrenal Gland Neoplasms↗
PubMed1996

[Morbidity in concomitant interventions in neck exploration for primary hyperparathyroidism. Results of a prospective study].

A prospective follow-up study was undertaken in patients undergoing surgical therapy for primary hyperparathyroidism to establish the frequency of concomitant surgical procedures and their influence on the morbidity of cervical exploration. From 1 August 1987 to October 1995, 231 patients underwent cervical exploration for primary hyperparathyroidism. In 16 patients 18 (7.8%) concomitant abdominal and thoracic surgical procedures as well as surgical interventions for soft-tissue tumors were performed. A total of 133 patients (57.6%) underwent thyroid resections of varying extent; 4.8% had carcinoma of the thyroid. Catamnestic data were obtained on the basis of a standardized follow-up in 94.4% of all patients (1-9 follow-up examinations in 216 patients). Hematoma occurred after adrenalectomy in a patient undergoing a concomitant extracervical procedure. In patients with a first manifestation of primary hyperparathyroidism due to a solitary parathyroid adenoma (n = 189), an increase in the morbidity of parathyroid surgery performed in combination with a thyroid resection was observed. Furthermore, a relationship was established between the number of intraoperatively identified parathyroid glands and the incidence of permanent hypoparathyroidism (permanent hypoparathyroidism: initial cervical intervention with parathyroid exploration alone, 2.2%; with concomitant thyroid resection, 6.5%; after secondary thyroid resection and parathyroid exploration alone, 0%; after concomitant thyroid resection, 28.6%; four parathyroid glands identified intraoperatively, 3.1%; fewer than four parathyroid glands identified, 8.2%). The increase in the morbidity of parathyroid surgery in combination with thyroid resection is justifiable, because unsuspected thyroid carcinomas can potentially be treated curatively.

Abdominal Neoplasms↗
PubMed1996

PECAM-1 expression in human mesothelial cells: an in vitro study.

Mesothelial cells are actively involved in inflammatory processes by expressing a set of cell adhesion molecules (CAMs). Transmigration of leukocytes into inflamed tissues requires a chemotactic stimulus and engagement of platelet-endothelial cell adhesion molecule-1 (PECAM-1). To investigate the kinetics involved in peritonitis, pure cultures of mesothelial cells are necessary. In previous studies, we have found that human mesothelial cells (HOMES) show a weak constitutive expression of PECAM-1, which cannot be further stimulated by cytokines. It is known that all serous cavities and body fluids contain numerous macrophages which strongly express this adhesion molecule. To identify the cells responsible for the expression of PECAM-1, mesothelial cells freshly obtained from omental tissue were isolated using PECAM-1-conjugated magnetic beads by cell sorting. For these studies, the negative as well as the positive fraction of isolated cells were used. As a control, freshly isolated monocytes were studied. Cell cultures were characterized by light and electron microscopy, as well as immunocytochemistry. The negative cell fraction was cultivated and stimulated for different times with tumor necrosis factor-alpha (30 and 300 U/ml), interleukin-1 beta (10 and 100 U/ml) and interferon-gamma (500 U/ml) and PECAM-1 expression was analyzed by a comparative quantitative cell enzyme immunoassay (EIA). The positive cell fraction was treated in the same manner. Both fractions of isolated cells showed strong positivity for cytokeratins 8, 18, 7 and 19, as well as vimentin. CD68, a monocyte marker, was not detected on mesothelial cells. In addition, EIA analysis confirmed the constitutive expression of PECAM-1 obtained from previous studies. This expression on HOMES was not inducible, irrespective of the type and concentration of cytokine studied. These data confirm PECAM-1 expression on mesothelial cells obtained from human omental tissue and suggest a critical role in transmigration of leukocytes during peritoneal inflammation.

Cell Separation↗
PubMed1995

[Diagnosis of dysfunctions of replanted parathyroid gland tissue by bilateral analysis of intact parathyroid hormones in cubital vein blood. A prospective study].

AIM: In a prospective long-term follow-up study after operative therapy of hyperparathyroidism the value of bilateral determination of parathyroid hormone levels in cubital venous blood after total parathyroidectomy/autologous parathyroid gland reimplantation (musculus brachioradialis) for diagnosis of dysfunctioning grafted tissue is evaluated. PATIENTS AND MATERIAL: From August, 1, 1987 to March, 31, 1994 68 of 243 patients operated on for hyperparathyroidism underwent total parathyroidectomy. Autologous reimplantation of parathyroid gland was carried out simultaneously in 64 patients. Twice delayed reimplantation of cryopreserved tissue was carried out, and there was no reimplantation in two patients up to this day. Three patients were operated on for hyperfunctioning parathyroid autograft after former total parathyroidectomy/reimplantation. RESULTS: During follow-up 5 patients developed dysfunction of (reimplanted) parathyroid gland. Because of low or unprovable levels of intact parathormone the gradients of intact parathyroid hormone between grafted and nongrafted forearm were about 1:1 in postoperative hypoparathyroidism as well as in hypofunction of parathyroid gland. After successful replantation of cryopreserved parathyroid tissue gradients of intact parathyroid hormone increased (> 1:10). In hyperfunction of grafted parathyroid tissue hormone gradients were high (> 1:20 to 1:45,3) because of excessive high levels of intact parathormone in the cubital vein of the graft bearing arm. Successful reduction of parathyroid graft was followed by decrease of parathyroid hormone gradients. CONCLUSION: Regular follow-up of intact parathormone gradients together with intact parathyroid hormone levels and serumcalcium analysis allow the determination of parathyroid graft function. Also differentiation between graft dependent hyperparathyroidism and hyperfunctioning parathyroid tissue in the neck or mediastinum seems to be possible by bilateral determination of intact parathormone. Normal values or a normal range for intact parathyroid hormone gradients can not yet be defined.

Adult↗
PubMed1995

[Modified cryopreservation of parathyroid gland tissue. Evaluation and comparison in an animal experiment].

A modified cryopreservation technique for parathyroid tissue was investigated in an animal model. The modified technique was compared with a previously described method [10, 11] using a programmed freezer and also with other simplified cryopreservation techniques [1, 8]. Total parathyroidectomy was performed in 90 Sprague-Dawley rats, which were allocated to 7 groups. Group I had no autotransplantation (n = 10) and group II underwent immediate autotransplantation of one parathyroid gland (n = 17). In the other five groups of rats the parathyroids were cryopreserved and one gland was reimplanted after 10 days' storage in liquid nitrogen (LN) at -196 degrees C. The following techniques for cryopreservation of the parathyroid glands were used. Group III: immediate placement in LN, n = 7; group IV: immediate placement in a freezer at -20 degrees C, transfer to LN after 2 h, n = 12; group V: immediate placement in a freezer at -80 degrees C, transfer to LN after 2 h, n = 13, group VI: manually controlled freezing initially at a rate of 1 degree C/min to -25 degrees C, and subsequently at 10 degrees C/min to -70 degrees C before transfer to LN [8], n = 19, group VII: programmed freezing at a controlled rate of 1 degree C/min to -80 degrees C prior to transfer to LN [10, 11], n = 12. Serum calcium concentrations were determined over a period of 60 days. Furthermore, the individual difference in the calcium concentration was assessed for each rat on the basis of the calcium levels recorded preoperatively and at day 60.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

[Orthograde intestinal irrigation or Fordtran solution for bowel preparation in elective colorectal surgery. Prospective outcome study].

In a prospective cohort study, which was carried out at the department for abdominal surgery of the university of Mainz from June to December 1993, two methods of bowel preparation for elective colorectal surgery were compared: oral bowel preparation with Fordtran a new polyethylene glycol solution (63 patients), and whole-gut lavage with Ringer's solution (37 patients). The serum chloride levels and the bodyweight increased significantly more in the whole-gut lavage group. These patients also showed a higher frequency of vomiting during bowel preparation. Neither the bowel cleansing effect nor the postoperative complications differed significantly between the two groups. Owing to these results, the better patient acceptance, and the easier handling and lower costs of PEG solution, we recommend this method of preoperative bowel preparation for elective colorectal surgery.

Adult↗
PubMed1995

Effects of cytokines on the expression of cell adhesion molecules by cultured human omental mesothelial cells.

Cultured mesothelial cells (HOMES) are very responsive to the proinflammatory cytokines, interleukin (IL)-1 and tumor necrosis factor-alpha (TNF-alpha). E-selectin, ICAM-1 and VCAM-1 are known to play an important role, because they are presented by diverse cell types, for example endothelial cells (ECs), and interact with co-responding ligands on white blood cell membranes. In this study, the expression of ICAM-1, VCAM-1, E-selectin as well as PECAM-1 on cultured HOMES was studied over 5, 24, 48 and 72 h exposure to IL-1 beta, interferon-gamma and TNF-alpha. In previous studies we have shown that IL-1 beta and TNF-alpha increase the expression of ICAM-1, E-selectin and VCAM-1 on the cytoplasmatic membranes of HUVECs, HSVECs and HAFECs (ECs from human umbilical vein, saphenous vein and femoral artery, respectively). Using a comparative quantitative cell enzyme immunoassay, we found that expression of the adhesion molecules ICAM-1 and VCAM-1 was significantly increased on HOMES in a dose- and time-dependent manner, compared to nonstimulated cells. Thus, ICAM-1 increased dramatically after 5 h incubation with TNF-alpha. Values of about 450% of the control level were measured. VCAM-1 was similarly stimulated after 24 h incubation with the same cytokine, although its level of expression was significantly lower than that of ICAM-1. In contrast to findings in the literature, VCAM-1 was not found to be expressed constitutively. E-selectin was neither constitutively expressed nor markedly inducible on HOMES. Only weak expression was found after 24 h incubation with high-dose IL-1 beta. PECAM-1 was expressed constitutively, as became evident in antibody dilution studies. These data indicate that HOMES respond to inflammatory stimuli, in some ways in a similar fashion to vascular endothelial cells, but also show a specific pattern of antigen presentation. The results are important for a better understanding of inflammatory processes in serous cavities. The data are also relevant for the improvement of antithrombogenous surfaces of the lumina of vascular prostheses by cell seeding.

Cell Adhesion Molecules↗
PubMed1994

[Long-term animal experiment analysis of the use of resorbable staple sutures in partial gastrectomy].

In animal experiments with a 12-month follow-up, the safety and compatibility of absorbable staple lines following gastrointestinal surgery were analysed. In two groups of pigs, partial gastrectomies with gastroduodenostomy (Billroth I, n = 10) or gastrojejunostomy (Roux-en-Y, n = 12) were performed, and Lactomer-a copolymer of glycolic acid and lactic acid-staple lines were used for closure of the lesser curvature of the stomach and the duodenal stump. Application of the staple lines caused no problems and was safe. In 1 of the 22 pigs, which died of an ileus 9 days postoperatively a suture dehiscence (4.5%) at the lesser curvature of the stomach was observed. Macroscopic examination showed no major inflammation around the staples. Microscopically complete absorption of the Lactomer staples without extensive scarification in the gastrointestinal wall could be demonstrated 12 months postoperatively. Our results yielded no contraindications for the clinical use of absorbable staple lines in gastrointestinal surgery. The manufacturer has given advance notice of smaller staples, which it is considered will be an advantage.

Absorption↗
PubMed1994

[Rupture of a splenic artery aneurysm intra partum].

The rupture of a splenic artery aneurysm in pregnancy and during labour is a rare event with a high maternal and fetal mortality rate. This report is, in view of previously reported cases, on the thirteenth case of a ruptured splenic artery aneurysm reporting survival of both mother and fetus. The etiology, clinical signs, diagnosis and therapy are discussed with reference to consideration of the literature. The necessity of an early differential diagnostic consideration of this rare occurrence is discussed, because this is the only way to achieve survival of mother and fetus.

Adult↗
PubMed1994

[Scintigraphic display of an ectopic parathyroid adenoma using 99mTc-MIBI--2 case reports].

Radionuclide imaging of the parathyroid gland is used in the preoperative localization of parathyroid adenoma. Until recently radionuclide imaging of parathyroid tumors was performed using a dual-tracer subtraction technique with 201TI and 99mTcO4-. As an alternative radionuclide imaging with 99mTc-sestamibi (MIBI) has been introduced some years ago. The utility of preoperative parathyroid localization lies in its ability to direct surgical exploration, particularly of ectopic localizations. We present two cases of parathyroid adenoma in which radionuclide imaging with 99mTc-MIBI was successful in detecting atypical locations. In the first case remaining primary hyperparathyroidism was caused by a mediastinal gland. The second case suffered from a recurrence of secondary hyperparathyroidism caused by hyperplasia of the autotransplanted gland after removal of all four parathyroid glands.

Adenoma↗
PubMed1992

[Perforation of gastroduodenal ulcer: a risk analysis].

In 90 patients who, between 1.1.1986 and 31.12.1991, underwent surgery for a perforated gastric/duodenal ulcer, the importance of age, sex, ulcer history, ulcer site, free/covered perforation, extent of peritonitis, duration of history and the pre-operative risk assessment (ASA classification) was analysed with respect to the risk of dying of the perforated ulcer. The univariate analysis showed the following to be prognostically relevant factors: time interval between onset of acute symptoms and surgery (less than or equal to 24 hours: mortality rate 12%, greater than 24 hours: mortality rate 21%; p = 0.006); physical status of the patient as reflected in the ASA category prior to surgery (mortality: ASA II 0%, ASA III 8%, ASA IV 32%; p = 0.009), and the presence of a spontaneous pneumoperitoneum (free perforation 21% mortality, covered perforation 5% mortality; p = 0.049). Investigation of the overall influence of the univariate relevant factors in the logistic model showed a relative risk of 4.9 for duration of history, and of 5.4 for the ASA classification. The mortality risk for a patient who is operated on more than 24 hours after onset of the acute symptoms is 4.9 times that of a patient operated on within 24 hours. In the ASA classification, the mortality risk increases by 5.4 from one category to the next higher one.

Adult↗