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Biomedical subjects

K Ernst

Publications and source records attributed to K Ernst.

At least 55 records · Page 3Linked to original sources
PubMed1983

Subtotal parathyroidectomy for primary hyperparathyroidism. Long-term results in 292 patients.

Subtotal parathyroidectomy was performed in a consecutive series of 292 patients with primary hyperparathyroidism. We evaluated the long-term postoperative results during a period of 16 years. Patients ranged in age from 14 to 83 years and included 176 women and 116 men. Of these, 16% had a history of exposure to radiation in childhood or adolescence, while thyroid disease requiring some form of thyroidectomy coexisted in 91 (31%) of the patients. Histologic information on three or more parathyroid glands was obtained in 73% of the cases. We considered 285 patients (97.6%) cured after their first operation. The remaining seven patients (2.4%) had persistent hyperparathyroidism. However, five were cured after a sternum-splitting mediastinal exploration and one after a second neck exploration. The seventh remains hypercalcemic despite a subsequent mediastinal exploration. Temporary postoperative hypoparathyroidism occurred in 10% of our cases and permanent hypoparathyroidism in 1%. There have been no instances of recurrent hyperparathyroidism.

Adenocarcinoma↗
PubMed1983

[Isolation and forced injection in the opinion of affected patients and patient care personnel. An accompanied quarter year sample].

All cases of seclusion and emergency sedation at a regional psychiatric university hospital were studied for a period of 3 months. The patients involved, and their nursing staff, were questioned on the day following the above mentioned incidents and the patients again after their remission from the exceptional state that had caused them. Every sixth patient underwent, at least once, either seclusion or emergency sedation, or both. These occurred most frequently during the first week of hospitalization, and in patients with a predominantly negative attitude. Women showed violent behaviour more often than men and also admitted to it more frequently. Seclusion was generally better accepted than emergency sedation. In less than half the cases the patients clearly rejected the past coercive measure; cases of total acceptance, however, were even less frequent, though acceptance tended to increase with remission. The authors dealt with the legal status of coercive measures. They also stressed the importance of discussing them afterwards both with patients and nursing staff in order to preserve the self-respect of all concerned.

Adult↗
PubMed1983

[Recovery curves of the soleus H-reflex in endogenous depression].

H-reflex recovery curves were plotted for 37 patients suffering from endogenic depressions and 18 control subjects. Psychopathological examinations were performed at the same time. The stimulability returned significantly later and maximum stimulability was significantly delayed in the depressive patients, particularly in the case of severely inhibited unipolar depressions.

Adult↗
PubMed1983

[Quantitative amino acid determination in the serum and cerebrospinal fluid in endogenous depressions].

The levels of 20 amino acids were measured in the plasma and cerbrospinal fluid of 41 patients with endogenic depressions. The plasma levels of 12 amino acids were found to be significantly lower in the patients than in the control group, but cerebrospinal fluid levels were significantly lower only in the case of taurine, glutamine, phenylalanine and aginine. Comparison of the same amino acid levels in treated and non-treated patients showed that serine and alpha-aminobutyric acid serum concentrations were higher in the nontreated patients. The tyrosine and phenylalanine levels in the cerebrospinal fluid of the patients who had received medicamentous treatment were higher than in the other group.

Adolescent↗
PubMed1983

[Solitary confinement as risk factor for psychiatric hospitalization].

The subjects of this study are prisoners who were hospitalized from custody in a psychiatric clinic. All of such patients of one psychiatric clinic during the period from 1976 till 1978 were compared with a random sample of other psychiatric patients using case reports and other data. Differences were found concerning social, personal, psychiatric, and criminal history as well as psychopathological state and diagnosis. Compared to the complete population of prisoners of the area, prisoners from solitary confinement (mostly remanding custody) were overrepresented. Other risk factors for psychiatric hospitalization of prisoners are described. The results are discussed from prophylactic, therapeutic, and humanitarian points of view.

Adjustment Disorders↗
PubMed1983

Parathyroid cysts: a report of eleven cases including two associated with hyperparathyroid crisis.

Eleven parathyroid cysts were found in 325 patients who underwent parathyroid operations. Ten cysts were located in the neck and one was located in the mediastinum. The cysts ranged in size from 1.6 to 10 cm with a mean of 3.9 cm. The patients who had cysts included six women and five men, and their ages ranged from 28 to 72 years with a mean of 51 years. In contrast to other reports that have suggested that most parathyroid cysts are nonfunctional, all but one of our patients had hyperparathyroidism, as evidenced by hypercalcemia, hypophosphatemia, and elevated parathyroid hormone level, which was corrected by cyst removal. The nonfunctional cyst first appeared to be an asymptomatic neck mass. Two patients had acute hyperparathyroid crises, which required emergency operations. It is postulated that the crises may have been the result of spontaneous necrosis of preexisting parathyroid adenomas. This is supported by the pathologic findings of degeneration and early organization as well as by the presence within the cyst of sanguineous fluid that contained a parathormone concentration greater than 100 times normal serum levels.

Acute Disease↗
PubMed1983

Effects of radiation on parafollicular C cells of the thyroid gland.

While radiation has well-recognized effects on follicular cells of the thyroid gland, those on parafollicular C cells are not yet established. Low-dose radiation that has been proved to be nonablative and carcinogenic to follicular cells was administered to 8-week-old Long-Evans rats to study the changes in C cell number and function. Circulating calcitonin levels were significantly reduced in animals that had undergone radiation at age 24 months. Mean calcitonin values were 0.66 (+/- 0.20) ng/ml and 1.64 (+/- 0.59) ng/ml for control males and females compared with 0.14 (+/- 0.06) ng/ml and 0.11 (+/- 0.01) ng/ml for males (P less than 0.05) and females (P less than 0.001) that had undergone radiation, respectively. These levels correlated well with C cell population density in thyroid glands in the control group and in the group that had undergone radiation as evidenced by light microscopy. Routine hematoxylin and eosin staining showed C cell hyperplasia in 77% of control animals of both sexes compared with 4% in animals that had undergone radiation (P less than 0.005). Immunoperoxidase staining with an anticalcitonin antibody showed virtual absence of C cells in most animals that had undergone radiation compared with diffusely scattered cells in animals in the control group. Medullary carcinomas occurred in 14% of animals in the control group compared with 3% of animals that had undergone radiation (P less than 0.05). These data indicate that the radiation dosage that is carcinogenic to the follicular epithelium causes lethal injury to C cells and thus suggest that C cells are more sensitive to radiation than are follicular cells. This increased sensitivity could explain the virtual absence of C cells, decrease in calcitonin levels, and reduced numbers of medullary carcinomas in the animals that had undergone radiation.

Animals↗
PubMed1983

[Mental illness without institutions. A field study in the Canton of Fribourg in 1875].

In 1875, the government of the Canton of Fribourg decided that a field study should be carried out on the number of mentally ill people in their territory. This happened in view of the construction of a new state mental hospital. With the support of members of the local administration, an experienced psychiatric expert examined 164 mentally ill persons, 147 at home and 17 in general hospitals and homes. In the author's report, the sick person's case history, his present state and proposals for treatment cover on average two pages per patient. Almost all of the mentally ill described in this report can quite easily be classified according to the main categories of modern nosology: there are 69 schizophrenics, 28 cases of affective psychoses, 28 mental retardations, and 39 further mental disorders, most of them identifiable as well. The case histories of the patients, too, correspond with the courses of mental illness as we know them today. There is a very high tendency to develop chronic symptoms. 25 patients lived temporarily or permanently like prisoners, locked in and/or tied up, some of them in repellent conditions. This study disproves the following hypotheses: 1. that the symptoms and the course of psychiatric illnesses have changed significantly since the last century, due to the development in civilisation; 2. that the absence of psychiatric hospitalism and psychiatric labelling prevents the worst and most characteristic kind of schizophrenic and affective disorders and their chronification; 3. that the mentally ill were better cared for in a pre-industrial and agricultural society without psychiatric care such as the community described in the Fribourg report.

Adult↗
PubMed1983

Successful autotransplantation of parathyroid adenomas in seven patients.

The autotransplantation of normal as well as adenomatous parathyroid tissue is currently being used with increasing frequency. In the present report, we describe our experiences with the successful transplantation of adenomatous or hyperplastic parathyroid tissue in seven patients. Prior to transplant surgery, six of these patients had recurrent or persistent primary hyperparathyroidism. The last patient was on hemodialysis for chronic renal failure and was presumed to have tertiary hyperparathyroidism. A large superior mediastinal parathyroid adenoma was found at a second neck exploration. In all patients, the only remaining parathyroid tissue was either adenomatous or hyperplastic. A total of 30 to 75 mg of this parathyroid tissue was diced and transplanted into single subfascial pockets of the forearm muscles (6) or sternocleidomastoid muscle (1). Following transplantation, all patients required transient calcium and vitamin D supplements for six to 12 weeks. In follow-up studies of ten months to 12 years, all patients have remained eucalcemic with normal parathyroid hormone levels. The use of a single subfascial pocket (versus the popular method of multiple implants) may explain the lack of recurrent hyperparathyroidism in our small population.

Adenoma↗
PubMed1982

[Treatment trials with hemofiltration/hemodialysis in pernicious catatonia].

Two juvenile patients affected for the first time with pernicious catatonia were treated repeatedly with combined hemofiltration and hemodialysis. During the first two or three sessions, the distinct psychopathological improvement only persisted during the session itself and in a lesser degree during the following hours. It was only after further treatments that the therapy effect lasted longer and passed over into a continuous remission tendency. The findings might support a toxin hypothesis (in a broad sense) with respect to the genesis of catatonia and encourage a continuation of the studies.

Adolescent↗
PubMed1982

Castration induces a marked reduction in the incidence of thyroid cancers.

Although thyroid disease in humans predominates in females, the prognosis of thyroid cancer in males is much less favorable. To further explore the role of male sex hormones, we utilized the experimental model of radiation-induced follicular cancer in the rat, studying the effects of castration on tumor development. Microscopic evidence of tumor formation was correlated with the biochemical parameters serum thyroxine (T4), thyrotropin (TSH), and thyrocalcitonin (TC) at 24 months. The incidence of follicular carcinomas in intact males ws 58%, compared to 28% in comparable females. Castration of males caused a reduction in the incidence to 22%. Mean circulating levels of TSH were markedly elevated in all three irradiated groups. Mean T4 levels were reduced significantly only in irradiated castrated animals. TC levels were reduced in all irradiated groups. We conclude that although elevated levels of TSH probably play a significant role in the development of radioactive iodine-triggered follicular thyroid neoplasms in the rat, male sex hormone may also play an important role beyond their known effect on basal and thyrotropin-releasing hormone-stimulated TSH.

Adenocarcinoma↗
PubMed1981

Subtotal parathyroidectomy: normalization of circulating parathormone.

Subtotal parathyroidectomy was performed in 52 consecutive patients with primary hyperparathyroidism. The postoperative results, 6-24 months following the operation, were evaluated according to a calcium-parathormone normogram. In 48 patients the values returned to the normal zone. Two patients had persistent hypercalcemia. The other two patients remained in the hyperparathyroid zone of the normogram, with moderate elevations of serum parathormone, in spite of normocalcemia. The significance of the failure to achieve normal circulating parathormone levels in patients with postoperative eucalcemia is discussed. The importance of serum parathormone and calcium relationship in the evaluation of patients following parathyroidectomy is emphasized.

Calcium↗
PubMed1981

[The status of extracorporeal detoxication procedures as a therapy method in schizophrenia].

The literature on the problem of extracorporeal detoxication in chronic schizophrenia was critically studied. For the statistically considered 132 cases of chronic schizophrenia without uraemia treated with haemodialysis, haemoperfusion and haemofiltration which are published in the literature (including 12 own cases) it was found that 38 per cent are considered as improved. The insufficient comparability of the examination methods and the want of clearness with respect to the specific therapy influence (placebo effect, etc.) leave the question open whether these are in fact efficient methods of treatment for some cases of chronic schizophrenia. A final decision on this requires continued, methodically more strictly controlled, and above all standardised examinations. The results obtained until now make efforts in this direction appear reasonable.

Adolescent↗
PubMed1980

[Increasing suicides of psychiatric inpatients: reality or artefact? (author's transl)].

In several countries the suicide rate for psychiatric inpatients has increased more than that for admissions and suicides in the general population. This was also the case in our clinic. This hypothesis was tested: today, because of more liberal management, suicides are committed during hospitalization that in an earlier and more restrictive age would have taken place after discharge. All suicides taking place 1960-1979 in the clinic's main catchment area were examined for previous hospitalization. The hypothesis was not supported. Over twenty years neither the suicide cases nor all discharged patients changed significantly in distribution of age, sex, number of previous admissions, duration of hospitalization, or diagnosis. Therefore, none of these variables explain the increase. In both decades, on the other hand, patients that committed suicide during their stay at the clinic had been hospitalized longer; those that committed suicide within three months after discharge had been hospitalized for a shorter time than the sum of discharged patients. Among the suicides that occurred after discharge, the percentage of depressives and addicts was higher and the percentage of schizophrenic patients was smaller than among all discharged patients. A change in patient management (more time off, more working outside, more open wards) has preceded the increase in suicides; medical staff, however, has doubled over the decades considered here. Rising pressure for resocialization to avoid hospitalism may heighten suicidal behavior. Preventive measures are discussed.

Adult↗