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Biomedical subjects

J Witte

Publications and source records attributed to J Witte.

At least 55 records · Page 3Linked to original sources
PubMed1997

[Current status of vaccination and antibiotic prophylaxis in splenectomy. II: Children].

Children are exposed to a greater risk than adults for severe late postsplenectomy infection. Therefore, prophylaxis against bacterial infections need to be more extensive. This paper presents a protocol for preventive measures in children. Repeated education of the patient and his/her parents about the consequences of splenic loss is mandatory. Vaccinations against Streptococcus pneumoniae and Hemophilus influenzae are highly recommended and also against Neisseria meningitidis in certain situations. The importance of long-term antibiotic prophylaxis in children is emphasized. Recent advances in vaccine development and the increasing problems with antibiotic resistance are discussed.

Antibiotic Prophylaxis↗
PubMed1997

[Bone conduction hearing aids with fluid medium].

In patients with chronic otorrhoea or middle ear pathology, traditional hearing aids which depend on air conduction are of little use. In these situations a bone conduction hearing aid is preferable. Such devices by-pass the middle ear cleft and ossicular chain by conducting sound waves through bone to the cochlea. To date, bone conduction hearing aids have transmitted sound via a vibrating transducer applied either to skin (transcutaneous) or to bone (percutaneous). Unfortunately, these hearing aids possess a number of disadvantages, which include: cost, aesthetic appeal, a general anaesthetic for percutaneous aids, and most notably pressure discomfort to the side of the head. To overcome some of these problems a new bone conducting hearing aid is being developed which differs from conventional aids in that sound transmission is through a liquid medium. This has been tentatively named the "Hydro-Hearing Aid" and a prototype is now being tested.

Adult↗
PubMed1997

[Does decreased preoperative diagnosis in goiter surgery present special challenges for the surgeon? What stays indispensible? What is superfluous?].

Patient history, clinical examination, basal TSH, and ultrasound are the crucial factors for the indication of surgical treatment of the goiter. In our study, additional scintiscan failed to locate additional nodules found by intraoperative digital examination of the thyroid in 10.3%, and therefore leads to no additional security in determining the extent of thyroid resection (exception: autonomous goiter). Intraoperative inspection and palpation of both thyroid lobes remains the most important factor in preventing goiter recurrence.

Diagnosis, Differential↗
PubMed1996

Transmission of Mycobacterium tuberculosis from tuberculosis patients with HIV infection or AIDS.

Contacts exposed to tuberculosis patients with acquired immunodeficiency syndrome (AIDS) or human immunodeficiency virus (HIV) infection were compared with contacts of HIV-negative patients for evidence of Mycobacterium tuberculosis transmission, based on a review of records of tuberculin skin tests administered during routine health department follow-up investigations in Miami/Dade County, Florida, from 1985 through 1989. After an adjusted analysis designed to balance background prevalence, tuberculin positivity was 42.0% in 2,158 contacts of HIV-negative patients compared with 28.6% and 31.3% in 363 contacts of HIV-infected patients and 732 contacts of AIDS patients, respectively. Similar results were observed in a subset of 5- to 14-year-old contacts of United States-born black or white tuberculosis patients chosen to minimize the possibility of false-negative tuberculin tests in contacts due to undiagnosed HIV infection. Analysis of contacts as sets showed a more than expected number of sets with none or all contacts infected, but this did not differ by HIV/AIDS group. In this study, tuberculosis patients with AIDS or HIV infection were less infectious to their contacts and, in this community, exposed fewer contacts than HIV-negative tuberculosis patients.

AIDS-Related Opportunistic Infections↗
PubMed1996

Incidence of regional recurrence guiding radicality in differentiated thyroid carcinoma.

Total thyroidectomy has become the routine procedure for treatment of differentiated thyroid carcinoma. However, the necessity of unilateral or bilateral neck dissection is far less standardized. Our usual procedure has been to perform a routine neck dissection in T4 tumors and in all other tumor stages only in the presence of positive diagnostic or intraoperative findings. The results concerning regional tumor recurrence in cervical lymph nodes subsequent to thyroidectomy are studied and discussed. Between April 1986 and December 1992 a group of 252 patients were operated on for differentiated thyroid carcinoma (DTC) (176 papillary, 76 follicular). Postoperative treatment included radioiodine therapy as a rule in all patients more than stage T1, and follow-up encompassed thyroglobulin measurements, cervical ultrasonography, and radioiodine scintigraphy. After a mean follow-up of 6.9 years, 77 (31%) of the patients underwent reoperation because of regional tumor recurrence [46 of 176 (26%) papillary, 31 of 76 (41%) follicular]. In papillary thyroid cancer a significant difference could be demonstrated between patients with thyroidectomy only versus thyroidectomy plus neck dissection in all tumor stages (T2, 13 of 29 (45%) versus 1 of 34 (3%); T3, 10 of 13 (77%) versus 4 of 11 (36%); T4, 6 of 8 (75%) versus 6 of 18 (33%) (p < 0.0001). Similar results could be achieved for follicular thyroid cancer, showing statistical significance with regard to operative procedure (p < 0.009). Our experience demonstrates a positive correlation of regional tumor recurrence with increasing tumor stage for both histologic tumor types. The high rate of regional recurrence justifies a more radical approach, including neck dissection at the initial operation. The impact on survival, however, must be proved by further evaluation.

Adenocarcinoma, Follicular↗
PubMed1996

A frequent mutation/polymorphism in tumor suppressor gene INK4B (MTS-2) in papillary and medullary thyroid cancer.

BACKGROUND: Structural genetic changes of tumor suppressor genes MTS-1/INK4A and MTS-2/INK4B were demonstrated in a variety of human cancers but not in thyroid cancer until now. METHODS: Because MTS-2 encodes the tumor suppressor p15, a protein related to the transforming growth factor-beta inhibition of many epithelial cells such as thyrocytes, we investigated MTS-1 and MTS-2 genes in 87 thyroid cancers (29 papillary, 26 follicular, 31 medullary, and 1 anaplastic), 8 goiters, and 38 control DNAs by using a semiquantitative polymerase chain reaction technique. RESULTS: We failed to demonstrate homozygous deletions of MTS-1 and MTS-2 in thyroid tumors, but we demonstrated a highly frequent base pair exchange of the MTS-2 gene 27 codons upstream the 5' end of exon 2. This genetic change formerly described as polymorphism was found to a lesser degree (15%), in control DNA when compared with papillary thyroid cancer and medullary thyroid cancer (35% and 32%, respectively), and it paralleled a higher prevalence of extensive lymph node metastases in thyroid cancer (p < 0.01). In addition, we could demonstrate that genetic changes at site 27 upstream the 5' end of exon 2 were harbored as somatic mutations in 2 of 10 thyroid cancers with simultaneously investigated corresponding control tissue. CONCLUSIONS: We conclude that base pair exchange at this site most likely has biologic importance for the tumor suppressor p15 and may contribute to tumorigenesis and lymphatic spread of differentiated and medullary thyroid cancer.

Adult↗
PubMed1996

[Suction-irrigation attachment for the flexible endoscope without integrated operating channel].

BACKGROUND: Endoscopic inspection of the larynx in patients with long-term intubation or patients pharyngolaryngeal injuries is frequently obscured by blood and other secretions. We developed a simple procedure to improve visibility. METHODS: A flexible 4-mm endoscope without an operating channel is inserted into an 18-French suction tube through one branch of a Y-shaped connecting tube (Fig.1). Fluid can be aspirated between the endoscope and the surrounding tube. The site can be flushed in a similar manner. RESULTS: In all examined patients (n = 11) we successfully aspirated fluid (blood/saliva/etc.). CONCLUSIONS: Our proposed suction and irrigation attachment for flexible 4-mm endoscopes without an operating channel permits reliable aspiration under endoscopic inspection, simplifying endoscopic visualization of laryngeal or pharyngeal findings.

Equipment Design↗
PubMed1996

[Is total thyroidectomy and lymph node excision as therapy of differentiated thyroid gland carcinomas in childhood justified?].

The extent of radical resection of differentiated thyroid carcinomas in children (< 18 years) is discussed controversially because of good prognosis, on the one hand, but a high rate of lymph node metastases, greater tumor size, lung metastases and tumor recurrences on the other. Because of our data we advocate thyroidectomy, cervical lymph node dissection and postoperative 131J-therapy as the treatment of choice in patients with manifest disease in order of further detection and/or treatment of lung metastases. Limited radicality (i.e. hemithyroidectomy) should be reserved for children with small and occult tumors.

Adenocarcinoma, Follicular↗
PubMed1995

[Current aspects of surgery of the parathyroid glands].

Diagnosis and treatment of primary hyperparathyroidism has changed substantially during recent years. Routine serum calcium measurements and development of specific as well as sensitive PTH assays made primary hyperparathyroidism the most prevalent diagnosis of hypercalcaemia in the normal population. With increasing numbers of asymptomatic patients secondary complications are reduced but the demands made on surgeon's technical skill are much higher. In view of our experience in 329 patients with primary hyperparathyroidism during the last six years and a success rate of 98% we refrain from any localisation technique and advocate visualisation of all four glands.

Adenoma↗
PubMed1995

[Leiomyosarcoma of the rectum].

The distinction between leiomyoma and high differentiated leiomyosarcoma can be difficult. The most important distinguishing feature is the number of mitoses. Additionally the tightness of the cells, the number of necroses and cell atypias and the size of the tumor are significant. The most common therapy for large and low differentiated leiomyosarcomas of the rectum are the abdomino-perineal resection or the low anterior resection. In high graded tumors of less than 2.5 cm the radicality of the surgical treatment is questioned. Some authors recommend a wide local excision, but in this case a high local recurrence rate has to be expected. This is the reason for a more radical treatment of all leiomyosarcomas of the rectum. Chemotherapy and radiotherapy are generally not effective. The prognosis is poor.

Adult↗
PubMed1995

[Differentiated thyroid gland carcinomas in "autonomous adenomas" in childhood].

Thyroid surgery is seldomly indicated in childhood and adolescence mainly because of suspicious nodules or proven carcinoma. Indications for operation in Graves disease and focal autonomy are discussed controversially, however. In a retrospective case control study two of our 6 patients up to 18 years demonstrated differentiated thyroid cancer with focal autonomy in the autonomous nodule. Other studies show similar results. Thyroid surgery is therefore warranted in all children and adolescents with focal thyroid autonomy.

Adenocarcinoma, Follicular↗
PubMed1994

[Solitary metastasis to the head of the pancreas in hypernephroid carcinoma].

Metastatic renal cell carcinoma is a major cause of cancer death. Most metastases occur within the first three months after diagnosis of the primary. Solitary metastases at unusual sites are not untypical, and therefore require particular attention. Pancreatic metastasis in general and from a renal cell carcinoma in particular, represent a rare finding. Within the period between 1986 and 1993, only a single patient with a solitary pancreas metastasis was diagnosed and surgically treated at our hospital. Four years after operation, the patient continued to be tumor- and symptom-free.

Carcinoma, Renal Cell↗
PubMed1994

[Simplified combination bypass or biliodigestive anastomosis alone in nonresectable carcinoma of the head of the pancreas?].

Between January 1, 1986 and December 31, 1992 93 patients with irresectable carcinoma of the pancreatic head underwent surgical palliation: In group I (n = 51) a single loop biliary (BB)- and gastric bypass (GB) was performed. 34 times the gastrojejunostomy was performed prophylactically. In group II (n = 42) surgical palliation was carried out only by biliary decompression in Roux-Y technique. In 30.9% gastric outlet obstruction (GOO) developed during follow-up. Both groups were comparable according to effectiveness of biliary drainage (93% (n = 42) (I); 97% (n = 38) (II)) with median post-operative bilirubin levels of 3.21 mg/dl (I) and 4.1 mg/dl (II). Cholecysto-choledocho- and hepaticojejunostomy were equally effective. Median operative time, morbidity (19.6 (I) vs. 26.2 (II)) and postoperative hospitalization were similar. Since there is a high frequency of secondary GOO after single BB we think that GB should be performed in all patients that undergo BB because secondary gastrojejunostomy at a later stage significantly increases morbidity and mortality.

Adult↗
PubMed1994

[Therapy of anal cancer].

The primary non-invasive treatment of anal-carcinoma by radiochemotherapy (RCT) is generally accepted although prospective randomised trials have not been finished yet. Finally the complex interaction of the radiotherapy and the commonly used cytotoxic agents 5-FU and Mitomycin-C are unknown, besides the radiosensitization. In the radiotherapy quality assurance is warranted in different radiotherapy-techniques and the total and single doses are well established for primary tumor (50-55 Gy) and lymphatic pathways (40-50 Gy) with 1,8 Gy single dose per fraction. According to the slow tumor regression restaging is made three months after completion of RCT. Residual tumor needs abdomino-perineal-resection.

Anal Canal↗
PubMed1993

Surgical reintervention for differentiated thyroid cancer.

Reoperation was performed in 110 of 185 patients with a differentiated thyroid carcinoma. In 25 patients (23 per cent) the indication for reintervention was a large thyroid remnant and in the other 85 (77 per cent) persistent or recurrent cancer was suspected. In 32 (29 per cent) of the 110 patients undergoing reoperation no evidence of cancer tissue was found. Tumour tissue in 33 patients (30 per cent) was resectable. Of 45 patients (41 per cent) with residual tumour after operation 24 showed only occult thyroid carcinoma with a raised serum thyroglobulin level. Eight of 21 patients with macroscopically persistent tumour died from the disease during a mean follow-up of 2.3 years. In 13 of 38 patients the investigated recurrent tumours were histologically less differentiated than the primary lesions, stressing the importance of total tumour clearance. The treatment of choice for persistent and recurrent differentiated thyroid carcinoma is surgical reintervention, if feasible, before radioiodine and radiation therapy are considered.

Adenocarcinoma, Follicular↗