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Biomedical subjects

D Branscheid

Publications and source records attributed to D Branscheid.

52 records · Page 3Linked to original sources
PubMed1992

Surgery for congenital malformations of the lung.

In the course of a survey conducted in 59 hospitals performing thoracic surgery, 14 hospitals supplied data that could be used for the study. Out of 1347 anomalies diagnosed 1343 were surgically treated, with a 30-day mortality rate of 0.3% (5 patients). In a retrospective study over a period of 10 years (1978-1988) we identified 198 anomalies out of a total of 6350 thoracotomies; so our percentage grading of pulmonary anomalies is supported by the data of the above-mentioned survey according to which cystic pulmonary malformations such as inhibition malformations, excess malformation and lobar emphysema represent a majority with 72.2% (survey 83%). Congenital anomalies of lung formation occurred in 23% of the patients of the survey and in 15% of our own patients. Therapy consisted of parenchyma-saving surgery, i.e. enucleation (n = 87), segmental resection (n = 65) and lobectomy (n = 63) with bronchoplastic reconstruction; there was no 30-day mortality. Adenomatoid-cystic malformation, lymphangiectasis, congenital lobar emphysema and stenosis of the tracheobronchial tree are often an indication for immediate surgical treatment in neonates. Solitary cysts, bronchiectasis, sequestration of the lung, an AV-fistula present with symptoms mostly between the ages of 20-40 and therefore were surgically treated secondarily.

Adolescent↗
PubMed1991

Diagnostic and therapeutic strategy in malignant pleural mesothelioma.

We retrospectively analysed 301 patients with diffuse malignant pleural mesothelioma (235 male, 66 female; median age 59 years). Prognosis depended significantly on patient age, evidence of pain, loss of weight, tumour cell type, stage, local and distant metastasis, involvement of peritoneum and surgical treatment. The overall median survival rate was 238 days, after extended pleuropneumonectomy 284 days, and after decortication 315 days - significantly better than the prognosis in patients without surgical treatment or exploratory thoracotomy. Pleuropneumonectomy should only be considered in young patients with an epithelial cell-type tumour (possibly with adjuvant chemotherapy). Decortication seems nowadays to be the treatment of choice.

Adult↗
PubMed1991

[Esophageal perforation and pneumothorax. Complications due to placement of a stomach tube].

Perforation of the oesophagus, as well as a pneumothorax are described as complications of the use of a nasogastric feeding tube. Clinical tests to determine correct placement are noted to be unreliable and the importance of radiological control, especially in the unconscious patient, ist stressed. The suspected diagnosis of oesophageal perforation should be verified without delay to immediately initiate conservative or surgical treatment.

Adult↗
PubMed1990

[Treatment of pleural metastases in an interdisciplinary concept].

A retrospective examination involved 414 patients (260 m, 154 w, mean 60 y) with pleural metastasis/pleural effusion of the following primary tumors: 37.2% bronchogenic (23.2% malignant pl. mesothelioma), 14.5% breast, 8.7% adeno-ca (unknown primary) 2.4% gastrointestinal, 2.2% uterus/ovar, and 11.8% others. Thoracoscopy with histologic confirmation played a central role in our diagnostic procedures in 97% of the cases. Malignancy was defined by CEA (less than 5 mg/ml) (71.9%) and cytology (76.9%) in 90.4%. Our strategy had the following success rate: desiccation by pleural drainage (greater than 26 Charr) alone 74%, in combination with pleurodesis 81%, pleurectomy/decortication 95%, and extended pleuropneumonectomy (in 80% mesothelioma) 96%.

Combined Modality Therapy↗
PubMed1988

[Reintervention in C-cell carcinoma].

Cervical re-exploration in persistent medullary thyroid cancer usually fails to normalize serum calcitonin levels, which is the most sensitive criterion of tumour-free status (2 out of 21 patients in our re-exploration series). Positive lymph nodes - even at an early tumour stage - seem much more important (postoperative normal serum calcitonin: 86% in the occult tumour group, 71% in patients with palpable primary tumour and negative lymph nodes, as opposed to only 18% with a palpable cervical mass and positive lymph nodes). However, local re-exploration in case of persistent medullary thyroid cancer seems to offer a possible curative chance for the control of recurrence, especially after inadequate primary surgery. In cases without visible distant metastases a marked reduction in serum calcitonin level may be expected (21% of the preoperative level for stages N1 and N2 and 16% for stage N3 on average). In patients with elevated calcitonin levels after stimulation as sole indicator of persistent tumour the indication for reoperation should be handled cautiously. Thus, in 3 out of 5 patients with occult medullary thyroid cancer diagnosed only on the basis of venous sampling who were subjected to multiple cervical re-explorations, distant metastases were subsequently found during follow-up.

Calcitonin↗
PubMed1988

[Results of surgical therapy of spontaneous pneumothorax].

Twenty-one percent of 758 patients (1.1.82-31.8.87) underwent operations for spontaneous pneumothoraces (SPP); 79% were successfully treated with thorax suction drainage. The clinical symptoms and signs did not correlate with BGA values or extent of SPP on x-ray. Thoracoscopy had a diagnostic sensitivity of 70%. Wedge resections (120), partly combined with pleurectomies (63) and pleurodesis (78), were the most frequent operations (death rate 1.6%, recurrence 0.6%). Due to the high rate of recurrence after a first relapse (75%; up to 8 relapses) we recommend surgery at the 1st relapse of SPP, and especially after a relapse. This policy reduces stays in hospital by 37%.

Adult↗
PubMed1987

Nerve growth factor (NGF) sensitizes human medullary thyroid carcinoma (hMTC) cells for cytostatic therapy in vitro.

Medullary thyroid carcinoma (hMTC) cells were established from nine patients with MTC disease to initiate a new approach of adjuvant medical therapy in these patients. We measured calcitonin (CT) secretion, DNA synthesis, and cell proliferation in vitro and their response to various substances. Nerve growth factor (NGF) (0.01 to 10 micrograms/ml), glucagon (0.01 to 100 micrograms/ml), and isoproterenol (4 to 500 micrograms/ml) stimulated CT secretion and DNA synthesis in hMTC cells. Other substances, calcium (1.0 to 15 mmol), pentagastrin (1.0 to 50 mumol), dibutyryl-cyclic-adenosine-monophosphate (1.0 to 100 mumol), and phorbol ester TPA (1.0 to 100 nmol), stimulated CT secretion but not DNA synthesis. In addition, NGF enhanced cell proliferation of hMTC cells 2- to 3- fold and caused an increased sensitivity of these cells for chemotherapy in vitro. Thus 0.5 microgram/ml doxorubicin (half-maximal effective dose) induced a cell death rate of up to 32.8%, which was enhanced by preincubation with NGF to 68.1% (1.0 microgram/ml, NGF) and to 100% (10.0 micrograms/ml, NGF), respectively. Pulsative stimulation of APUD cell carcinomas with NGF may therefore improve the response rate of these tumors to chemotherapy, which would be of significant clinical importance for patients with residual postoperative MTC tissue.

Antineoplastic Agents↗
PubMed1986

The effect of thyrotropin and cAMP on DNA synthesis and cell growth of human thyrocytes in monolayer culture.

Monolayer cultures of human thyrocytes from normal tissue (n = 10), and adenomas (n = 7), differentiated (n = 4), poorly differentiated (n = 2), and undifferentiated (n = 3) thyroid cancers were established to assess the significance of thyrotropin (TSH) and cAMP (adenosine 3',5'-cyclic monophosphate) on cell growth and DNA (deoxyribonucleic acid) synthesis. Cell growth of thyrocytes from normal and adenomatous tissues increased more rapidly (p less than 0.01) after TSH (0.1 IU/ml) was added but was unaffected by cAMP (10(-4) mol/L). In these cells, TSH also enhanced DNA synthesis twofold to twelvefold (p less than 0.01). The adenylate cyclase (AC) inhibitor, 2',3' dideoxyadenosine (ddA), increased DNA synthesis 1.3 to 6 times at a concentration of 2 X 10(-4) mol, whereas the membrane/passable cAMP analogue, dibutyryl-cAMP, and the AC stimulator, forskolin, failed to show any effect on DNA synthesis up to a concentration of 10(-5) mol/L (p less than NS). When administered simultaneously, TSH (1/2 maximum) and ddA (20 mumol) had no cumulative effect on DNA synthesis (p = NS). TSH stimulation in cancerous thyroid tissue (n = 11) demonstrated a lack of TSH response in seven of 11 monolayer cultures with no apparent correlation to cancer differentiation, patient age, or sex. Thus TSH was demonstrated to stimulate DNA synthesis and cell growth of human thyrocytes in monolayer cultures independent of the AC system. However, the TSH effect on cell growth and DNA synthesis was unpredictable in thyrocytes from cancerous tissues.

Adenoma↗
PubMed1984

Absence of high-affinity binding sites for beta-adrenergic blockers and lack of adenyl cyclase stimulation to beta-adrenergic stimulators in most normal and adenomatous human thyroid tissues.

To determine whether the beta-blocking drug propranolol had any physiologic effect on normal (n = 14) and adenomatous (n = 15) human thyroid tissues, experiments were performed to study the binding of the beta-blockers 125I-iodocyanopindolol (125I-ICYP) and 125I-iodohydroxybenzylpindolol (125I-IHYP) and the stimulation of adenyl cyclase (AC) by isoproterenol. 125I-ICYP and 125I-IHYP failed to show high-affinity binding in 27 of 29 specimens, whereas two (one normal and one adenomatous) thyroid tissues demonstrated high-affinity binding (Kd 5.5 +/- 1 X 10(-9) M) for 125I-ICYP. Thyroid-stimulating hormone (0.3 IU/ml), guanosine triphosphate (10(-4) M), and Gpp (NH)p(10(-4) M) stimulated AC in all thyroid tissues, although in two tissues (normal) Gpp (NH)p failed to cause a significant increase. Isoproterenol (10(-4) M), in contrast, had no effect on basal AC activity or on guanosine triphosphate, and Gpp (NH) p stimulated AC activity in 26 of the 29 thyroid tissues. In one of the two tissues that increased AC in response to isoproterenol, the beta-blocking drugs propranolol hydrochloride, bunitrolol hydrochloride, and tolilprolol hydrochloride decreased AC stimulation to isoproterenol at concentrations of 10(-6) M (p less than 0.05). Higher concentrations of propranolol (10(-4) - 10(-2) M) decreased AC stimulation to thyroid-stimulating hormone (p less than 0.01), not only in this responsive tissue but also in tissues that failed to demonstrate high-affinity binding for 125I-ICYP and AC stimulation to isoproterenol (p less than 0.01). Thus most normal and adenomatous human thyroid tissues lack beta-receptors and a functioning beta-receptor AC system. High concentrations of propranolol in vitro decreased AC response by thyroid-stimulating hormone, but this is probably a nonreceptor-mediated effect.

Adenoma↗
PubMed1983

Surgery for hyperthyroidism: indications, pretreatment, operative strategy and results.

In an endemic area nodular toxic goitre is the dominating type of hyperthyroidism, while Graves' or Basedow's disease with diffuse toxic goitre accounts for only 25 to 30% of the patients. Since antithyroid drug therapy has poor permanent effect and recurrence rates of about 50 to 60% and radioiodine in turn requires higher doses and often repeated application, surgery is to be recommended as the primary treatment of choice for the nodular hyperthyroid goitre. -For Graves' disease the method of therapy is not as clear cut. Operation is indicated mainly when the disease is severe with a larger goitre or in younger age groups (below 40 years) where radioiodine may not be advisable. For preoperative treatment the use of antithyroid drugs in preferred, although iodine perhaps in combination with beta blockers may be used safely as well at least for moderate cases. In the presence of alternative means of treatment surgery should not exceed an operative risk of 0.5-1.5% with virtually no mortality. Our own experiences are based on a retrospective analysis of 702 patients from three hospitals.

Adolescent↗
PubMedDate not supplied

[Lobar emphysema. Important differential diagnosis of obstructive lung diseases in childhood].

The lobar emphysema is characterised by a lobe-restricted overinflation combined with dislocation of the neighbouring organs. Surgical treatment is indicated because of the high mortality by waiting and conservative treatment. Differential diagnosis has to exclude other causes for overinflation as atelectasis with compensated emphysema, diaphragmatic hernia, and stenotic changing of the tracheobronchial tree and others. In the course of a retrospective study of 6350 thoracotomies (1978-1988) out of 198 patients with congenital malformations of the lungs 5 (2.5%) children less than 5 years were found to have undergone surgical therapy because of lobar emphysema. Five patients were found with additional malformations in four patients this was held to be the cause. All patients were dyspnoeic at the time of operation. The most important diagnostic procedure was the routine x-ray of the chest and fluoroscopic examination. In 4 patients surgical treatment consisted in lobectomy, in one patient segmental resection was sufficient. There was no 30-day-mortality, postoperative recovery was uneventful in all patients.

Child↗