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Biomedical subjects

I Klempa

Publications and source records attributed to I Klempa.

At least 55 records · Page 3Linked to original sources
PubMed1982

[Zollinger-Ellison syndrome--changes in surgical therapy. Analysis of 27 patients].

In 10 out of 27 patients with a Zollinger-Ellison syndrome a gastrin-producing tumor was removed, in 5 localized with phlebography. In the remaining 12 patients the diagnosis of a gastrinoma was based on clinical data only. The 10 patients with surgically proven gastrinoma did not differ in their fasting blood-glucose levels, rise of gastrin serum levels after administration of secretin and calcium, in acid production patterns nor in survival time from those 12 patients in whom no gastric-producing tumor had been found. 5 of the 27 patients died, 4 just after surgery. One patient died from advanced malignant disease. In three of our patients localizing diagnostic procedures and consecutive tumor-removal were feasible with the protection of H2-receptor antagonists. The trend in the treatment of ZES goes away from elective total gastrectomy towards conservative treatment with H2-receptor antagonists in view of the low morbidity and the attempt of curative treatment by tumor-removal.

Adult↗
PubMed1981

Tumour-like growth of parathyroid autografts in uraemic patients.

Total parathyroidectomy with autotransplantation of parathyroid tissue into the forearm musculature has been recommended as surgical treatment for renal hyperparathyroidism. Five of 41 patients, in whom this procedure was performed, developed hyperparathyroidism 7 to 33 months after surgery due to graft hyperplasia. Grafts had to be removed. Whereas about 20--25mg were implanted, the removed grafts weighed 0.9--3.1g. Morphological examination showed signs of accelerated growth, infiltration of adjacent structures and invasion of blood vessels. For total removal, repeated and extensive surgery was necessary. Conservative treatment failed to prevent tumour-like growth of autografts. We no longer recommend parathyroidectomy with autotransplantation of parathyroid tissue as the method of choice for the surgical treatment of renal hyperparathyroidism.

Adult↗
PubMed1980

Transplantation of human fetal pancreas: experience in thymusaplastic mice and rats and in a diabetic patient.

The aim of the present study was to investigate if thymusaplastic nude mice and rats are favorable as recipients for transplantation of human fetal pancreas. Twenty human fetal pancreases were transplanted subcutaneously to 20 nude mice, and six human fetal pancreases were transplanted to six rats. The xenografts showed histotypical development of islets of Langerhans. Insulin, glucagon, somatostatin, and pancreatic polypeptide immunoreactivities were also seen in very early stages of the transplant development within the monolayered ducts. With the described "epigastric pouch technique" in rats, we co-ld demonstrate a new in vivo method for selective stimulations and simultaneous blood sampling from tissue-isolated xenografts. Transplantation of human fetal pancreas to the brachioradial muscle of an insulin-dependent patient in combination with a kidney transplant revealed that rejection crises of the kidney led to necrosis of the pancreas transplant, whereas rejection of the kidney was overcome by steroid pulse therapy.

Animals↗
PubMed1980

[Endocrine tumors of the gastrointestinal and pancreatic systems. Multiple endocrine adenoma from another viewpoint].

The 24 endocrine pancreatic tumors and 14 carcinoids were examined immunohistochemically for cholecystokinin, insulin, gastrin, GIP, glucagon, sercretin, VIP, motilin, neurotensin, pancreatic polypeptide (PP), somatostatin, and ACTH. In 12 tumors of the pancreas more than one peptide-containing cell type was observed. The clinical symptoms showed hypersecretion of only one of the hormones, however. The midgut carcinoids (jejunum, appendix) represented the classical view of the carcinoid as an argentaffin cell tumor secreting 5-hydroxytryptamine. Tumors originating in the foregut (bronchus, stomach, duodenum) and hindgut carcinoids (rectum) were nonargentaffine, containing and secreting various polypeptide hormones. We conclude that light microscopic immunohistochemical methods are useful in distinguishing endocrine from nonendocrine tumors and multihormonal syndromes (MEA) in the classification of predominant hormone-secreting tumors.

Adenoma, Islet Cell↗
PubMed1980

[Adrenal cortex transplantation. Animal experimental models for the human Cushing and Conn syndromes--clinical aspects of adrenal cortex transplantation].

Thymusaplastic mutants of mice (nu/nu) and rats (rnu/rnu) were used as recipients for tissue of one aldosteronoma of a 21-year-old male patient with Conn's syndrome and for tissue of one adenoma of a 28-year-old female patient with Cushing's syndrome. In this animal experimental study we succeeded in demonstrating that congenitally athymic rodents are ideal recipients for xenotransplantation of adrenal cortical tissue. The graft viability was demonstrated by obtaining light and electron micrographs of the biopsied transplants and its endocrine function documented by the measurements of plasma renin, cortisol, and urinary excretion of aldosterone, cortisol, and corticosterone. Fifteen patients are presented who were surgically treated for Cushing's disease. Fourteen patients with adrenocortical hyperplasia underwent total adrenalectomy and two had after adrenalectomy autotransplantation of adrenal tissue in the forearm muscle. One patient was treated with a transsphenoidal, partial hypophysectomy. Our clinical experience with Cushing's disease showed that the initial surgical procedure may be directed to the pituitary and only in unsuccessful surgery to the adrenals. Adrenal autotransplantation after total adrenalectomy is an obsolete procedure.

Adrenal Cortex↗
PubMed1979

Effect of somatostatin on bile-induced acute hemorrhagic pancreatitis in the dog.

In 21 female Beagle dogs an experimental pancreatitis was induced by injection of bile into the pancreatic duct system. Beside controls, dogs received 62.5 micrograms/h cyclic somatostatin (SRIF) a continuous i.v. infusion starting with a bolus of 250 micrograms 15 minutes before or 2 hours after bile injection. Following blood parameters were determined: lipase, amylase, blood count, minerals, glucose, insulin, gastrin, secretin and CCK. Two controls died within 24 hours, the others were sacrificed after 48 hours. All pancreata were examined morephologically. The controls developed all clinical signs of acute hemorrhagic pancreatitis, whereas all SRIF-treated dogs were in much better general condition. Lipase and amylase increased in all groups. In the controls insulin, gastrin and secretin remained unchanged and CCK rose slightly. SRIF-treatment diminished insulin, CCK and the test meal-induced increase of secretin. At autopsy the pancreata of the controls were nearly entirely apoplectic. The SRIF-treated dogs showed less damage of the pancreas and no severe hemorrhagic necrosis was noted. The beneficial effect of SRIF cannot only be due to an interaction with intestinal hormones. An additional direct protective effect on the exocrine parenchyma is proposed to exist.

Acute Disease↗
PubMed1979

[Prevention of postoperative pancreatic complications following duodenopancreatectomy using somatostatin].

Somatostatin was prophylactically administered to 10 patients who had surgery for pancreatic diseases. The postoperative course uncomplicated with no increase in serum amylase levels. Bile induced acute pancreatitis in six beagles was prophylactically treated with somatostatin. The results demonstrate that SRIF not only inhibits basal but also pancreatic-induced blood amylase and enzyme activities in the dog. SRIF-treated animals were in good general condition compared with untreated controls, macroscopic and histologic aspects of the pancreas were significantly improved.

Adult↗
PubMed1978

[Recurrent hyperparathyroidism following subtotal parathyroidectomy].

Recurrent hyperparathyreoidism occurred in 3 of 9 patients in terminal renal failure from 9 months to 2 years after an initially successful subtotal parathyroidectomy. In all cases we find temporary remission of clinical signs of hyperparathyreoidism after surgery. Our clinical experience provided by followup in these patients showed an insufficient biochemical and clinical control. We find recurrence in 3 cases and repeat neck exploration was indicated for 2 patients.

Humans↗
PubMed1978

[Parathyroid neoplasm associated with hyperparathyroidism].

Over a 25-year period, two carcinomas of the parathyroid were observed in 67 cases of primary hyperparathyroidism. The most important signs and symptoms were bone disease, palpable neck metastases, renal stones, and hypercalceamia with high blood levels of parathyroid hormone. Histology revealed that in principle parathyroid carcinoma can be distinguished from adenoma by a trabecular pattern and thick fibrous bands. The presence of cellular atypia and variation or mitotic figures (regressive polymorphia) was not a useful criteria for carcinoma. Local recurrence occurred in both cases.

Carcinoma↗
PubMed1978

[Transposition of the jejunum and selective proximal vagotomy following duodenopancreatectomy].

We report the use of a new surgical procedure following pancreaticoduodenectomy in nine patients with chronic relapsing pancreatitis and its complications. The modification of the Whipple reconstruction following resection of the head of the pancreas consists in selective proximal vagotomy, transposition of a jejunal loop for bile duct, and pancreatic anastomosis. The longest follow up period has been 18 months. In agreement with reports on other procedures for resection of the head of pancreas, the patients who had been operated on suffered few symptoms. With one exception they had no pain at all; they all gained weight. The results of early follow-up examinations of the patients treated by to these procedures encourage continued use of duodenopancreatectomy.

Adult↗
PubMed1978

[Morphological aspects of parathyroid gland transplantation. Contribution on the clinical relevance of induced, invasive tissue growth].

The results of morphologic studies performed in 18 patients who had total parathyroidectomy and autotransplantation of parathyroid tissue into the forearm muscle are presented. All patients had long-standing renal disease with azotemia, hyperphosphatemia and high levels of parathyroid hormone. The histologic findings after total parathyroidectomy, before gland transplantation, are important for selection of parathyroid tissue for surgery. Diffuse hyperplasia with the development of multiple nodules of the parathyroids can possibly be adverse for the transplant. In one case, nine month after autotransplantation we found a tumor in the forearm, measuring 2.0 X 3.0 X 2.2 cm in diameter. Morphologic findings in this case before implantation showed diffuse hyperplasia with adenomatous nodules but no signs of carcinoma. The grafted parathyroid tissue after excision was seen with blood vessel invasion in the normal skeletal muscle. In the case of primary renal disease with secondary parathyroid hyperplasia, the light microscopic examination revealed an autonomous tumorlike adenomatous formation in the autografted parathyroid tissue, with graft-dependent hypercalcemia. The invasive growth with some signs of neoplasia following autotransplantation raises the question of the development of certain neoplasia.

Adult↗
PubMed1978

Total parathyroidectomy with autograft of parathyroid tissue in treatment of secondary hyperparathyroidism.

In 16 patients with severe symptomatic hyperparathyroidism reduction of hyperplastic parathyroid mass was performed by total parathyroidectomy with autotransplantation of parathyroid tissue. In all patients except one serum parathormone (PTH) levels returned to normal and postoperative difficulties in calcium homeostasis were rarely observed. Fifteen patients had normal PTH levels after surgery. Graft function was proven in 10 cases, but in 5 cases graft function could not be definitely established with the methods applied. One graft failure was observed. Total parathyroidectomy with autotransplanation of parathyroid tissue is recommended as the treatment of choice when surgical correction of secondary hyperparathyroidism is necessary.

Adult↗
PubMed1977

[Parathyreoid autoransplantation in secondary hyperparathyreoidism (author's transl)].

Subtotal Parathyreoidectomy offers no problem after surgery, nor after Kidney transplantation. But a recurrence needs extensive investigations for localisation of recurrent hyperplastic glands. The necessary reoperation is loaded with difficulties. After total Parathyreoidectomy hypocalcaemia is a severe complication. Therefore in patients awaiting Kidney transplants in a chronic dialysis program the procedure is not opportune. In 11 patients following total Parathyreoidectomy and autoplastic parathyreoid transplant, we found nearly normal parathyreoid hormone plasma levels. The advantage of this method is: The function of the autoplastic graft is testable and a possible recurrence is easily resectable.

Calcinosis↗
PubMed1977

[Improvement of the preoperative localization technique in the surgery of hyperparathyroidism (author's transl)].

The possibility of preoperatively localizing overactive parathyroid adenoma by measuring the difference in parathormone levels in selective blood samples from the thyroid venous plexus and from the periphery (large veins) by radioimmunoassay has brought a decisive advance in parathyroid surgery. We report our experience with this preoperative localization technique, which we have used in 10 patients.

Adenoma↗