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Biomedical subjects

B Niederle

Publications and source records attributed to B Niederle.

At least 145 records · Page 8Linked to original sources
PubMed1988

[Falipamil for decreasing intraoperative heart rate in pheochromocytoma].

In 4 patients (2 males, 2 females), aged between 16 and 62 years, who had surgery for pheochromocytoma, the effects of Falipamil, a compound with selective negative chronotropic action, was tested. This drug, which is a slow calcium channel blocking agent, was administered during the period of massive endogenous catecholamine output caused by tumor mobilisation; the influence on mean arterial pressure, pulmonary artery pressure, central venous pressure and cardiac index as well as catecholamines was investigated. When the pulse rate exceeded 100 beats per minute in the course of surgical preparation, 2 mg/kg BW Falipamil were administered as in i.v. bolus dose. Epinephrine and norepinephrine were determined before and 5 minutes after Falipamil administration in one patient. The effect of this bolus dose was a significant decrease in heart rate. There was also a moderate decrease in mean arterial pressure and cardiac index, with was probably caused by pretreatment with alpha- and beta-blockers prior to surgery, whereas central venous pressure and pulmonary artery pressure remained unchanged. Norepinephrine increased, epinephrine decreased. These findings lead us to conclude that Falipamil is a valuable adjunct to control circulation in patients with high catecholamines.

Adolescent↗
PubMed1988

[Malignant aldosteronoma in the differential diagnosis of Conn syndrome].

Primary aldosteronism-characterized by hypertension, hypokalemia and metabolic alkalosis--is caused by benign adenomata or bilateral adrenal hyperplasia in most cases. Aldosterone producing carcinomata of the adrenal cortex are very rare tumors. As the histological classification is difficult, the diagnosis is often drawn from tumor size, very high levels of plasma aldosterone, severe hypokalemia and malignant behaviour. The prognosis is very poor: Overall median and 5 year survival rate from diagnosis of adrenocortical carcinoma are 14 months and 24%.

Adenoma↗
PubMed1987

Clinical long-term results after parathyroidectomy for primary hyperparathyroidism.

The long-term clinical results of parathyroidectomy for primary hyperparathyroidism were analyzed in 176 patients. Preoperatively 152 patients (86%) showed classic symptoms, 15 (9%) were classified as minimally symptomatic (only hypertension, diffuse osteopenia or manifestations of the hypercalcemic syndrome), and nine (5%) were asymptomatic. All patients were normocalcemic at follow-up, but renal, skeletal or gastrointestinal symptoms were eliminated in only 88-91%. Preoperatively impaired renal function and hypertension were seldom improved by parathyroidectomy. Deterioration of renal function and hypertension occurred only in the symptomatic and minimally symptomatic patients, in whom the course was varied and unpredictable. During observation periods up to 22 years, 7% of the patients died of acute/chronic renal failure or consequences of hypertension. Death from uremia was more common when there was also skeletal involvement. Acute pancreatitis could occur without preoperative symptoms, but other gastrointestinal disorders responded to normalization of parathyroid metabolism. Multiple bone lesions responded functionally and lacked prognostic significance. Hypercalcemic syndrome was rapidly and lastingly relieved by parathyroidectomy.

Aged↗
PubMed1987

Successful parathyroidectomy in primary hyperparathyroidism: a clinical follow-up study of 212 consecutive patients.

The long-term clinical courses of 212 "cured" (normocalcemic) patients were analyzed for 1 to 25 years (mean, 6.8 +/- 5.4 years). Preoperatively, 181 patients (85%) were classified as having typical symptoms, 22 patients (11%) as having minimal symptoms, and nine patients (4%) as having no symptoms of primary hyperparathyroidism (PHP). Although the formation of urinary calculi was stopped in 91% of patients, deteriorated renal function and hypertension were seen in patients with symptoms (14% and 8%, respectively) and patients with minimal symptoms of PHP (6% and 15%, respectively). Renal function changes and hypertension were unpredictable despite normalization of the hyperactive parathyroid metabolism and had decisive results: 7% of the patients died of uremia or of the consequences of hypertension (stroke). Large, multiple bone lesions healed functionally and were of no prognostic significance. In the majority of patients with symptoms of PHP, gastrointestinal manifestations healed postoperatively, but two patients who had no preoperative gastrointestinal complaints died of acute pancreatitis. Almost all symptoms of the hypercalcemia syndrome disappeared immediately and permanently in patients with symptoms and patients with minimal symptoms of PHP. Neither deterioration of renal function nor elevation of blood pressure were observed postoperatively in "cured" patients who showed no symptoms of PHP preoperatively. Even in these patients, immediate surgical treatment may have avoided the complications of chronic renal failure or hypertension. As soon as organic manifestations, even in mild form, have been established, it seems impossible to predict the course and to prevent an unfavorable clinical outcome.

Adult↗
PubMed1986

[Parathyroidectomy and autotransplantation].

Total parathyroidectomy, immediate heterotopic autotransplantation and cryopreservation of parathyroid tissue was introduced in the surgical treatment of drug-resistant renal hyperparathyroidism (rHPT) in 1980 and was performed in 36 patients. During 34 initial bilateral cervical explorations including transcervical thymectomy 142 glands were removed (orthotopic localization: 84%; heterotopic localization: 16%). Supernumerary glands were found in 6 patients (18%; thymus: 3; cervical fatty tissue: 4). The elevated parathyroid metabolism was successfully corrected, in all, but one patient in whom only three glands were removed. Biochemical and clinical follow-up examinations showed a restitution of the symptoms in 88% 3 to 79 months postoperatively. Graft-dependent recurrence of rHPT was diagnosed in one patient. Normocalcemia was reestablished by partially excising the grafted tissue under local anesthesia. Graft-dependent hypoparathyroidism was suspected in one patient because of low levels of serum calcium and parathyroid hormone. Late graft failure was not observed during the follow-up period. None of the patients required delayed autotransplantation of cryopreserved tissue.

Adolescent↗
PubMed1986

[Clinical experiences following the surgical therapy of asymptomatic, oligosymptomatic and symptomatic parathyroid gland hyperfunction].

Depending on their symptomatology 152 cured (i.e., normocalcemic) patients with surgically proven primary hyperparathyroidism (pHPT) showed typical symptoms preoperatively. Besides hypercalcemia and elevated parathyroid hormone levels, 15 patients suffered only from hypertension and/or diffuse osteoporosis and/or complaints caused by the hypercalcemic syndrome (oligosymptomatic patients). Nine patients had no complaints (asymptomatic patients). The long-term clinical course of all patients was analyzed up to 22 years. Although the formation of urinary calculi was stopped in 94% of cases, a deterioration of renal function and hypertension was seen in symptomatic (12.5% and 9.2%, respectively) and oligosymptomatic patients (6.7% and 13.3%, respectively). Renal function and hypertension were unpredictable despite normalization of the hyperactive parathyroid metabolism and were of decisive prognostic significance; 6% died of acute or chronic renal failure, or of the consequences of hypertension. Multiple bone lesions, even large, healed functionally and were of no prognostic significance. In the majority of symptomatic patients gastrointestinal manifestations held postoperatively, but two patients died of acute pancreatitis without gastrointestinal complaints preoperatively. Almost all symptoms of the hypercalcemic syndrome disappeared immediately and permanently in symptomatic and oligosymptomatic patients. No deterioration of renal function and no elevation of blood pressure was observed in cured asymptomatic patients postoperatively. Immediate surgical treatment even in asymptomatic patients may have avoided complications of chronic renal failure or of hypertension. As soon as organic manifestations, even in a mild form, have been established, it seems impossible to predict the course and to prevent an unfavorable clinical outcome.

Bone Diseases, Metabolic↗
PubMed1986

Irradiation-induced changes in the subclavian and axillary arteries after radiotherapy for carcinoma of the breast.

Three case reports are reviewed to illustrate the possibility of treating irradiation-induced lesions of the subclavian-brachial vascular segment (aneurysm and segmental occlusions) 14, 20, and 26 years after radical mastectomy and subsequent radiotherapy. All patients had an extraanatomic vein bypass graft from the carotid to the brachial artery crossing the shoulder near the acromioclavicular joint, with the advantage that the tissue changed by radiotherapy or infected by ulceration could be circumvented. There were no postoperative complications, with adequate function of the grafts (follow-up, 17, 24, and 20 months, respectively).

Aged↗
PubMed1986

Surgical treatment of distant metastases in differentiated thyroid cancer: indication and results.

A total of 45 patients have received surgical treatment for distant metastases in 41 follicular and four papillary carcinomas. Fifty-four metastatic lesions were removed. In the majority of cases (n = 25, 46%), surgical intervention was indicated on the basis of oncologic data (reduced administration of radioiodine). Sixteen patients (30%) underwent surgery to relieve pain, and 13 other patients (24%) had surgical treatment of pathologic fracture. At the time of surgery, 29 patients (64%) had only one resectable metastasis, while 16 patients (36%) had further nonresectable metastases (six in the bone, 10 in the bones and lungs). In the course of 53 operations, metastases were resected from bone in 46 cases, from the lungs and greater omentum in two cases, and from the skin, suprarenal gland, pleura, and intra-abdominal lymph node in one case each. A total of 25 metastases (17 bone, eight soft tissue) could be removed by resection. In 16 patients, the resulting bone defect was filled with bone cement after resection of the metastases. Osteosynthesis was necessary in another six cases, while seven required the implantation of an endoprosthesis. Thirty-eight patients died between 1 and 136 months after surgical treatment. Twenty-six (58%) died of their primary disease after an average 49.3 months, seven (15%) died with their carcinomas of other causes after an average of 12 months, and five (11%) died intercurrently after an average of 16 months. Seven patients (15%) are still alive after 12 to 264 months (average, 99.3 months); four of them are without recurrence and three have metastases. Five of these patients exhibit normal activity, while the activity of the other two is limited by the progress of the carcinoma or as a result of surgical treatment. The estimated cumulative survival rate (Kaplan-Meier) was 44.8 +/- 11.2% for 5 years and 32.7 +/- 11.0% for 10 years after removal of a solitary metastasis. Analysis of these patients shows that the surgical removal of resectable metastases can be a valuable complement to nuclear medical therapy. The complicated surgical treatment of metastases is justified by the favorable effect it has on prognosis and on the patient's quality of life.

Adenocarcinoma↗
PubMed1985

Transsternal operations in thyroid cancer.

Large thyroid carcinomas extending into the anterior mediastinum were removed from six patients by a transsternal surgical approach (partial median sternotomy). Transcervical mediastinal dissection offers obscure exposure and therefore entails the risk of the operation not being radical. The transsternal procedure was used as an alternative to remove affected lymphatic and fatty tissue from an additional nine patients. Sternal metastases were extirpated from 10 patients. Irrespective of the stage of the tumor, the indications for a transsternal approach to onocologically radical extirpation of tumors and mediastinal lymphatic fatty tissue should be more liberal, particularly with differentiated and medullary thyroid carcinomas. The prognosis for differentiated carcinomas is improved by radioiodine treatment, and optimal conditions for this therapy are ensured by the most radical possible removal of the tumor with its affected lymph nodes and sternal metastases. In the case of mixed differentiated/anaplastic and medullary carcinomas, this operative procedure ensures favorable conditions for other adjuvant forms of therapy. Although it was not possible to extend the life expectancy of patients suffering from anaplastic carcinomas, their quality of life was at least improved by the prevention of mechanical dyspnea caused by the mediastinal tumor.

Adult↗
PubMed1984

[Value of digital subtraction angiography in extra-anatomic bypass].

DSA is a well-established diagnostic procedure. A special indication and technique was employed in the application of DSA, using a low-dose contrast medium in 11 patients with extra-anatomic arterial reconstructions (3 axillofemoral, 4 femoro-femoral suprapubic cross-over bypasses, 4 obturator bypasses). This approach has not been previously described in literature. The authors performed direct puncture of the very proximal part of the bypass with a small (0.6 mm.) "subcutaneous" needle. Less than 2 ml of contrast medium was applied, and DSA was accomplished in several positions. In 11 patients high-quality imaging of the entire extra-anatomic bypass was achieved. Advantages of the procedure are: 1. Minimal dose of contrast medium (1-2 ml.). 2. Possibility of angiography even during anticoagulant therapy. 3. Complete imaging of extended bypass procedures with minimal discomfort to high-risk patients.

Aged↗
PubMed1983

[The significance of the 5th gland as a cause of primary hyperparathyroidism. Case report and review of the literature].

Of 140 patients surgically treated for primary hyperparathyroidism one patient had persistent hypercalcemia due to an abnormal and ectopic fifth parathyroid gland (0.7%). The possibility of an abnormal fifth gland as the cause of primary hyperparathyroidism should be considered when four glands of normal size and histology have been found in the neck, and of such a gland should be thought in all patients with diffuse hyperplasia after subtotal parathyroidectomy suffering from persistent hyperparathyroidism. The fifth gland is usually found in the lower neck or upper mediastinum, frequently within the thymus. If present, it should be excised by transcervical thymectomy during first operation. In reoperations sternal splitting should be performed.

Adenoma↗
PubMed1982

[Free intestinal grafts for oesophageal reconstruction: indications, technics and results].

Autotransplantation of intestinal segments for oesophageal reconstruction using microsurgical techniques has been reported in the literature in 137 patients. In 8 patients (5.8%) arterial thrombosis occurred, necessitating removal of the transplant in 6 patients (4.4%); two of them (1.5%) died of sepsis. Altogether 6 patients (4.4%) died postoperatively. Salivary fistulae are reported in 15 patients (10.9%) and these usually resolved spontaneously. This technique seems satisfactory for the reconstruction of oesophageal defects in patients with recurrent cancer in whom the classical procedures are no longer feasible.

Burns, Chemical↗
PubMed1982

[Resection of intrathoracic oesophageal cancer by blunt dissection without thoracotomy (author's transl)].

The resection of thoracic oesophageal cancer by blunt finger-dissection and stripping is a further palliative procedure at the disposal of the surgeon. This method represents an alternative to intubation or bypass without resection. The advantages are the better functional results and at least palliative removal of the tumour. This method should be used, however, if there is the possibility of carrying out radical resection from the oncological point of view, with the aim of curing the patient. The technical details are described and the indications and results discussed on the basis of six case reports.

Adenocarcinoma↗