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Biomedical subjects

M Rothmund

Publications and source records attributed to M Rothmund.

At least 235 records · Page 13Linked to original sources
PubMed1988

[Reoperations in persistent and recurrent secondary hyperparathyroidism].

Among 181 patients who had been surgically treated in the Department of Surgery, Mainz University, for secondary hyperparathyroidism between 1975 and 1986, 33 had to be reoperated because of persistent or recurrent disease or because of failing autotransplanted tissue after total parathyroidectomy and autotransplantation. In 17 patients 26 reoperations had to be performed in the neck; in 9 patients, 3 of whom are already included in the group mentioned before, autotransplanted tissue had to be reduced eleven times. In another 10 patients autologous, cryopreserved tissue was replanted. 15 of the 17 patients reoperated in the neck became normocalcaemic, postoperatively, as well as 7 out of 9 patients in whom the autotransplanted tissue had been partially taken off. The results with replantation of cryopreserved tissue are being published in a separate article in this volume.

Chronic Kidney Disease-Mineral and Bone Disorder↗
PubMed1988

[Surgical therapy of primary hyperparathyroidism in newborn infants].

This is a report on a neonatal primary hyperparathyroidism (NPHPT) treated by total parathyroidectomy and autotransplantation of parathyroid tissue into the forearm musculature. Histologically, the glands were composed of a "chief cell hyperplasia" of the parathyroid tissue. Clinical manifestation in neonates and differential diagnosis of HPT are discussed. Indication for operation and surgical procedure are described.

Humans↗
PubMed1988

Reoperations for persistent and recurrent secondary hyperparathyroidism.

Forty-nine reoperations for persistent or recurrent secondary hyperparathyroidism (HPT) in 30 patients are reported. The patients are part of a total of 184 patients operated on for secondary HPT; 28 reoperations in 18 patients were performed in the neck or in the upper mediastinum for remaining glands. Eleven reoperations at the forearm autograft revealed hyperplasia of the grafted tissue as the reason for recurrent disease in seven patients; they were treated by excision of all grossly enlarged particles. Ten patients received autologous cryopreserved tissue because of permanent postoperative hypoparathyroidism. The rate of graft-dependent recurrent HPT was 7%, and inadequate graft function was found in 6% of the patients.

Adolescent↗
PubMed1988

[Intraoperative sonography of the bile ducts].

The experience with intraoperative ultrasonography (IOUS) during biliary surgery demonstrates positive and negative aspects. An evaluation of the method is possible by two prospective studies from the literature. The IOUS of the bile ducts is not a substitute for intraoperative cholangiography. Imaging of the papilla is possible in 30% only and examination of the drainage into the duodenum is impossible. The predictive value of a positive IOUS test is higher in comparison with cholangiography.

Bile Duct Neoplasms↗
PubMed1988

[Principles of technology assessment in surgical diagnosis].

Principles of technology assessment in surgical diagnostics comprise definitions, criteria for measurement and methods of measurement. Technology assessment is part of a general health policy and has to be represented by experts of specific disciplines, in this case by surgeons. Contradictory criteria for technology assessment in various fields warn the surgeons of the necessity of developing specific objectives. The concept of surgical diagnostics includes aids for decision making, strategies and surgical techniques. It is therefore an integral part of surgical care.

Diagnosis↗
PubMed1988

[Evaluating ultrasound].

An assessment of diagnostic methods must consider three steps: (1) Diagnostic workup: ultrasound has contributed to rational strategies in many fields of medicine. (2) Therapeutic principles: there is evidence that ultrasound has had a significant influence (3) Outcome of a disease; ultrasound has not been proven to have an unequivocal influence.

Diagnosis, Differential↗
PubMed1988

[Changes in pulmonary hemodynamics, gas exchange and extravascular lung fluid in esophageal resection].

Postoperative convalescence after esophagectomy is frequently complicated by pulmonary insufficiency and a high mortality rate. The literature and our own observations suggest that pathological changes actually begin during the operative procedure; we therefore studied 11 male patients during and after esophageal surgery by monitoring heart rate, systemic and pulmonary arterial pressures, cardiac output, extravascular lung water (EVLW), cardiac index, and systemic (TPR) and pulmonary vascular resistance (PVR). Blood samples were taken for analysis of epinephrine, norepinephrine, serotonin, and arterial and mixed-venous blood gases. The changes were found to be most marked during esophageal resection: PaO2 decreased from 217 to 147 mmHg while PaCO2 increased, i.e. pulmonary gas exchange was disturbed (Fig. 4). PVR (Fig. 3) and mean pulmonary arterial pressure (MPAP) (Fig. 2) increased after esophagectomy. Norepinephrine, but not epinephrine (Fig. 6), increased continuously until the end of the operation. EVLW was slightly elevated at approximately 9 ml/kg body weight before operation and did not change during surgery. Six patients who developed severe pulmonary complications showed lung water retention up to 18 ml/kg body weight on the 4th postoperative day (Fig. 5). Compression of the heart and lungs as well as injury of the vagus nerve during esophagectomy may provoke increased MPAP, PVR, and disorders of pulmonary gas exchange. Furthermore, the non-respiratory function of the lung must be taken into consideration: the lung is known to have clearance activities for various endogenous substances such as norepinephrine, serotonin, some prostaglandins, and bradykinin. Most of these substances may provoke vasoconstriction followed by disturbances of microvascular permeability and gas exchange in the lung.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Replantation of autologous cryopreserved parathyroid tissue in permanent postoperative hypoparathyroidism].

Cryopreserved autologous parathyroid tissue was reimplanted into 16 patients with permanent postoperative hypoparathyroidism. In 13 cases the number of necrotic cells in the thawed cryopreserved tissue was determined histologically and compensated by using a greater amount of tissue particles during re-implantation. These patients had normal transplant functioning after a median period of 6 months. On the other hand, delayed onset of functioning of the autotransplant was seen if the rate of necrotic cells had not been compensated. The results show that re-implantation of autologous cryopreserved parathyroid tissue is a suitable method for treating permanent postoperative hypoparathyroidism. The method should be used as a firmly established part of parathyroid surgery.

Freezing↗
PubMed1987

[Type II multiple endocrine neoplasms. Diagnosis, therapy and prognosis].

From 1979 to 1986, seven patients with multiple endocrine neoplasia (MEN) type IIa and three with type IIb were treated. Nine had a C-cell carcinoma, one had C-cell hyperplasia. None had hyperparathyroidism. Three patients had multiple mucous neuromas. Six patients had proven pheochromocytoma: adrenalectomy was performed in these six (unilateral or bilateral depending on whether the tumor was uni- or bilateral). All ten patients had a total thyroidectomy--three later required neck dissection for regional lymphnode metastases. One patient died from the consequences of diffuse liver metastases of a C-cell carcinoma. Extensive family screening is necessary with patients who have MEN type II, in order to discover early any occult disease carriers. In addition, MEN type II should be excluded in all patients who have C-cell carcinoma, pheochromocytoma or hyperparathyroidism.

Adolescent↗
PubMed1987

[Asymptomatic hyperparathyroidism. An indication for surgery?].

From 1965 to 1985, 412 patients were operated on for primary hyperparathyroidism (pHPT). Of these, 35 (8.7%) were without specific symptoms and findings. The follow-up investigations after six months to 14 years (median: 31 months) revealed a normalization of the preoperative pathological parameters of alkaline phosphatase, uric acid, creatinine and hypertension in the majority of patients apart from the improvement of their general condition. All patients were normocalcemic. According to these results, the indication for early surgical therapy of the asymptomatic pHPT is to be advocated in order to avoid long-term complications.

Female↗
PubMed1987

[Biomedical and clinimetric approaches in determining the causes of perioperative risk: developing a German ASA classification].

Perioperative risk research with biomedical (biochemical, physiological) methods must grow up as a main topic in surgical research. However, operative risk has also to be analysed with methods of clinimetrics, such as formal (objective) decision making and epidemiology. Only by this way a convincing practical dimension is added to basic scientific statements. ASA-classification of the preoperative physical status is a global index for estimating the operative risk. It contains objective findings, subjective impressions and the final clinical judgement. For this reason it is so flexible. For a multicentre trial on perioperative risk and histamine an empirical index was constructed using both the ASA-classification and the Mannheim-Munich risk check list.

Germany, West↗
PubMed1987

[Therapeutic problems in alkaline reflux esophagitis].

Alkaline reflux esophagitis occurs most frequently after gastric surgery, especially after total gastrectomy. Anastomoses causing this disease are esophagoduodenostomy or esophagojejunostomy end-to-side. As in the stomach bile, pancreatic juice and small bowel contents cause erosions and ulcers of the esophageal mucosa. For symptomatic treatment aluminium-hydroxide-antacids or cholestyramine can be tried. A definite cure of alkaline esophagitis can only be reached by reversing the anastomosis, creating an interposition of the jejunum between esophagus and duodenum of 50 to 60 cm in length or a Roux-Y-esophagojejunostomy, the minimum length of the loop being 40 cm.

Anastomosis, Roux-en-Y↗
PubMed1987

The influence of parathyroid hormone and its fragments on results from midregion and C-terminal specific radioimmunoassays.

We compared a midregion (44-68) human parathyroid hormone (hPTH) specific radioimmunoassay (M-RIA) with a C-terminal (65-84) hPTH specific radioimmunoassay (C-RIA). The M-RIA discriminated 21 of 23 patients with primary hyperparathyroidism from 95 normals (normal range: 22.4-106.5 pmol/l). With the C-RIA 12 patients including the 2 patients not discriminated by the M-RIA had immunoreactive PTH (iPTH) values within the normal range of this assay (normal range: undetectable to 88.6 pmol/l). To investigate the reasons for these different abilities of separation, hyperparathyroid sera were subjected to gel-filtration and analyzed using the two assays. Intact PTH appeared to have a major influence on the immunoreactivity of circulating PTH in the M-RIA. In contrast, the C-RIA showed the highest immunoreactivity with midregion-C-terminal PTH fragments. Hyperparathyroid sera not discriminated by the C-RIA but with elevated iPTH in the M-RIA showed decreased amounts of midregion-C-terminal PTH fragments, while intact PTH comprised the highest amount of total circulating PTH immunoreactivity in the M-RIA. From the present results we conclude that the superiority of the M-RIA is due to the determination of intact PTH which is preferable for clinical measurements with relation to the diagnosis of primary hyperparathyroidism.

Adolescent↗
PubMed1987

The effect of high parathyroid hormone concentration on calcitonin in patients with primary hyperparathyroidism.

Serum calcitonin (CT), parathyroid hormone (PTH), and calcium levels were measured in 23 patients with primary hyperparathyroidism. PTH was determined by a midregion (M-RIA) and a carboxyl-terminal (C-RIA) specific PTH-RIA. Only 2 patients had elevated CT levels. In contrast to the findings in 46 healthy controls, the CT levels did not correlate with calcium levels. Patients who had the highest iPTH values showed a negative correlation between CT and iPTH (M-RIA (n = 7): R = -1.0000, p less than 0.001; C-RIA (n = 13): R = -0.5604, p less than 0.05). The results of the C-RIA were subtracted from those of the M-RIA. In 12 patients with the highest levels of intact PTH (M-RIA - C-RIA), serum PTH concentration was inversely correlated with serum CT concentration (R = -0.7343, p less than 0.01). In the same patients a negative correlation between CT and calcium was found (R = -0.6783, p less than 0.02). These findings suggest that high PTH levels may have a direct suppressive effect on CT concentration and this may be, at least in part, responsible for failure of CT concentrations to rise in many patients with primary hyperparathyroidism.

Calcitonin↗