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Biomedical subjects

M Rothmund

Publications and source records attributed to M Rothmund.

At least 127 records · Page 7Linked to original sources
PubMed1997

[Laparoscopic adrenalectomy].

Minimally-invasive adrenalectomy is a new and attractive procedure, which has advanced to the method of choice in the surgical treatment of benign adrenal diseases. This technique is contraindicated in the treatment of adrenal malignancies. The endoscopic removal of large benign adrenal tumors (> 6-8 cm) may be difficult. The preoperative management of the patients does not differ from the preparation for conventional adrenalectomy. Like in open adrenalectomy several different endoscopic approaches to the adrenals have been described: the transperitoneal approach with the patient in supine position, the transperitoneal approach in lateral position, the retroperitoneal approach in lateral position and the retroperitoneal approach in prone position. Excellent results have been achieved with all four techniques. The approaches with the patient in lateral position have the disadvantage that in case of bilateral adrenalectomy the patient has to be repositioned during the operation. Large tumors are more difficult to be removed with the retroperitoneal techniques, because of the limited space in the retroperitoneum. Operative times and conversion rates have been markedly reduced with increasing experience with these techniques.

Adrenal Gland Diseases↗
PubMed1997

[Value of clinical research in Germany in an international comparison].

Clinical research in Germany, compared with other countries, is not well off. There is enough evidence showing that German speakers in international conferences are underrepresented as well as German authors in international (English-speaking) journals. There are a multitude of reasons why this is so. The main problem is an overwhelming clinical workload in university hospitals, which does not allow enough time to be saved for research. There is obviously no lack of money for research and development.

Cross-Cultural Comparison↗
PubMed1996

[Diagnostic localization of insulinoma. Experiences with 25 patients with solitary tumors].

OBJECTIVE: The most effective way to localize the mostly small ( < 2 cm), benign and solitary insulinomas is still under discussion. Especially the evaluation of the different preoperative localization methods is not clarified. The aim of our study was to support the ongoing discussion in that matter. PATIENTS AND METHODS: In total 25 patients have been included in our study since 1987. All showed sporadic insulinomas and underwent surgery. The following preoperative localization methods had been used: ultrasonography (US): 25 patients, computed tomography (CT): 23 patients, somatostatin receptor scintigraphy (SRS): four patients since 1990, angiography: six patients, endosonography (ES): five patients since 1995, selective portal venous sampling (PVS): two patients, magnetic resonance imaging (MRI): four patients since 1993. All 25 patients underwent a bidigital palpation in combination with intraoperative ultrasonography (IOUS). Four of the 25 patients were reoperated and had a prior unsuccessful operation elsewhere. RESULTS: Preoperatively 19 of 25 insulinomas were localized (76%). The following sensitivity rates had been found: ultrasonography: 56%, computed tomography: 43%, endosonography: 100%, angiography: 66%, magnetic resonance imaging: 25%, selective portal venous sampling: 100%, somatostatin receptor scintigraphy: 0%. All 25 insulinomas were detected during operation, 100% by palpation in combination with intraoperative ultrasonography and 92% by palpation on its own. CONCLUSION: After an insulinoma is biochemically proven and after exclusion of a malignant metastasizing tumor by ultrasonography, all patients should be operated on. Intraoperative ultrasonography should be performed in any case. As other preoperative localization methods did not prove a convincing cost-utility-relation, one should not consider the usage of these methods before the initial operations. Before re-operations one should consider the use of costly pre-operative methods to localize insulinomas. Here endosonography and selective portal venous sampling are recommended as the first procedures of choice.

Adolescent↗
PubMed1996

Symptom reporting in cancer patients: the role of negative affect and experienced social stigma.

BACKGROUND: Recent research suggests that patients' appraisal of somatic symptoms is more closely related to emotional variables (particularly negative affect) than to their actual health as determined by external criteria. METHODS: Sixty surgical cancer patients who at the time of a routine follow-up examination filled out the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire-C30, which included a positive/negative affect scale and a scale tapping into experienced social stigma. Patients' health status was determined in two ways: the examining physician gave a global judgement on a standardized scale at the end of the examination, and an additional two external physicians later rated the patients based on the findings listed in the medical record. RESULTS: Patients' reports of somatic symptoms were strongly correlated with two measures of negative affect (r = 0.75 and r = 0.65, respectively) and with experienced social stigma (r = 0.51). In contrast, the correlations between reported symptoms and the examining or external physicians' ratings were considerably weaker (r = 0.31 and r = 0.19). According to a multiple linear regression with 6 predictors, negative affect was the best single predictor of symptom reporting (beta = 0.68; P < 0.001) and global quality of life (beta = 0.48; P < 0.001). Factor analysis yielded a dimension of somatopsychosocial distress that accounted for 44.1% of the variance and is comprised of reported symptoms (factor loading = 0.86), negative affect (0.90 and 0.82), experienced social stigma (0.74), and global quality of life (0.70). Physicians' ratings and positive affect constituted two additional separate factors. CONCLUSIONS: Cancer patients' reporting of somatic symptoms by means of a standardized quality of life questionnaire is closely related to emotional and social distress and is not equivalent to health status as determined from a clinical perspective. Researchers and practitioners have to be aware of this fact when interpreting quality of life data. Furthermore, negative affect deserves attention as an important signal for intervention in tumor follow-up programs.

Abdominal Neoplasms↗
PubMed1996

[Impalement injury of the colon, iliac vein and sacrum--a rare combination in penetrating abdominal trauma. A case report].

We report on the treatment of a patient who sustained a penetrating abdominal wound with injury of the left common iliac vein, the sigmoid colon and the sacrum in a motorbike accident. The left iliac vein injury was treated using a Gore-Tex vein patch and an A-V fistula. The colon was restored after an intraoperative washout. The punched fragment of the sacrum was removed. An additional fracture of the proximal left humerus was managed with an osteosynthesis in a second operation. The principles of management of combined colon and vascular injuries are discussed and a short review of the literature is given.

Abdominal Injuries↗
PubMed1996

Value of somatostatin receptor scintigraphy for preoperative localization of carcinoids.

Most carcinoid primary tumors are small and do not cause symptoms until complications (e.g. intestinal obstruction) or symptoms and signs of the carcinoid syndrome occur. Therefore in most cases an assessment of the primary tumor and its metastases must be performed. To determine the value of somatostatin receptor scintigraphy (SRS) for localizing carcinoid tumors, we compared the results of SRS with those obtained with computed tomography (CT) and ultrasonography (US) in 22 patients who had not undergone surgery for removal of the primary tumor. We could not find an advantage of SRS over CT and US for detecting the primary lesions. Tumors > 2 cm in diameter were regularly detected using all methods. SRS was not superior to CT or US for the detection of liver metastases. SRS showed the liver metastases in 16 of 18 patients, whereas CT and US detected liver metastases in all patients. For localization of extrahepatic abdominal and extraabdominal metastases (lymph nodes, bone), whole-body SRS showed an advantage over CT and US. We conclude that SRS is not superior to CT or US for localization of primary carcinoid tumors or liver metastases, although it did prove successful for visualizing extrahepatic and extraabdominal tumor spread. Additionally, SRS is useful for identifying receptor-positive metastases that may be treated by somatostatin analogs. Thus SRS should be performed in patients with a known carcinoid tumor, except those with an appendiceal carcinoid measuring < 1 cm in diameter.

Adult↗
PubMed1996

Surgical management for carcinoid tumors of small bowel, appendix, colon, and rectum.

Carcinoid tumors occur most frequently in the gastrointestinal tract. Despite their ability to produce hormones, most of the midgut and hindgut carcinoids covered in this study are clinically silent, and the diagnosis is often not made before emergency surgery or evaluation for liver metastases. Because the rate of lymph node involvement and the prognosis of carcinoid tumors depend on their site and size, surgery refers to these two factors too. Lymph node metastases are most commonly found with small bowel carcinoids (20-45%), providing the rationale for an extended resection including the adjacent lymph node drainage area. Carcinoid tumors of the appendix < 1 cm in diameter rarely metastasize, simply requiring appendectomy for treatment. Lesions > 2 cm should be treated by right hemicolectomy because of their approximately 30% risk of lymph node metastases. Resection should always be done for carcinoid tumors of the colon resection as for adenocarcinomas. Rectal carcinoids < 2 cm rarely metastasize, directing the conclusion that for these smaller lesions local excision is sufficient; for lesions >2 cm a standard cancer resection should be performed provided distant metastases are absent. In general, the younger the patient or the larger the primary tumor, the more aggressive the treatment should be.

Age Factors↗
PubMed1996

Duration of antibiotic treatment in surgical infections of the abdomen. Introduction--the different ways to reach consensus.

The many interrelated issues concerning administration of antibiotics following operations for abdominal contamination and infection were a powerful impetus to create this Discussion Forum in The European Journal of Surgery, which focuses on the duration of administration-a previously neglected topic. The guidelines presented herein are not based on previous randomised trials alone, nor are they prescribed by dictatorship of one person. Instead, they are proposed by a steering committee in the form of a table and are confirmed by consensus of many experts. The science of consensus has to be recognized in surgery. The Discussion Forum offers written judgements that provide more details than the usual Consensus Development Conference statements. It can be used for a nominal group process organized by sepsis trial groups and may be of value for a consensus-based treatment of individual patients.

Abdomen↗
PubMed1996

Prospective evaluation of different diagnostic techniques for the detection of liver metastases at the time of primary resection of colorectal carcinoma.

OBJECTIVE: To evaluate preoperative and operative methods of detecting liver metastases in patients undergoing primary resection for colorectal carcinoma. DESIGN: Prospective, open study. SETTING: Teaching hospital, Germany. SUBJECTS: 51 Patients with confirmed primary colorectal carcinoma. INTERVENTIONS: Computed tomography during arterial portography (CT-AP), percutaneous ultrasonography (US), operative palpation and examination of the liver, operative US, and computed tomography (CT) follow-up 6-12 months postoperatively. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive and negative predictive value, and accuracy. RESULTS: Overall accuracy was worst for CT during portography, because of the diagnosis of many false positive lesions. Exploration and palpation of the liver had the highest sensitivity (83%) and specificity (100%), and operative US did not give any useful additional information. CONCLUSIONS: Preoperative percutaneous US is recommended as the best non-invasive screening test; otherwise careful inspection and palpation during operation are sufficient for the evaluation of the liver during primary resection for colorectal carcinoma.

Colonic Neoplasms↗
PubMed1996

Transplantation of parathyroid tissue in experimental hypoparathyroidism: in vitro and in vivo function of parathyroid tissue microencapsulated with a novel amitogenic alginate.

Microencapsulation of tissues is an alternative to postoperative immunosuppression in transplantation. In 1994 iso-, allo- and xenotransplantation of microencapsulated parathyroid tissue was achieved in vivo. However, continued analysis of the coating substance (an alginate) determined mitogenic properties. Here, we report on the in vitro and in vivo function of parathyroid tissue microencapsulated with a novel amitogenic alginate suitable for use in humans. To assess in vitro function, parathyroid tissue encapsulated with mitogenic and amitogenic alginate was exposed to rising concentrations of calcium. For in vivo experiments, it was isotransplanted into parathyroidectomized rats. PTH release into medium and PTH serum levels as well as calcium levels of recipient rats were analyzed and compared to native (non-microencapsulated) tissue and empty capsules, respectively. In vivo, transplants were excised and subjected to histologic examination six months after trans-plantation. In vitro, parathyroid tissue encapsulated with amitogenic alginate releases approximately half of the PTH of the native tissue, not different from tissue encapsulated with the mitogenic alginate. In vivo, the novel alginate preserved parathyroid function similar to that of native tissue over the six month period resulting in complete reversal of hypoparathyroidism. Correspondingly, histologic examination revealed vital parathyroid tissue in intact microcapsules. By establishing in vitro function and successful long-term transplantation, we have documented the principle of microencapsulation of parathyroid tissue to be effective also with the novel amitogenic alginate, which is suitable for clinical use.

Alginates↗
PubMed1996

[Interventional endoscopy with the argon plasma coagulator: experiences in general surgery].

The results of the application of argon plasma coagulation (APC) in surgical endoscopy on tumorous stenosis of the esophagus and trachea, angiodysplasia and gastrointestinal bleeding are presented here. Primary therapeutic goals were always achieved and complications were harmless except one loss after duodenal perforation. We conclude that APC is a useful and easily handled tool in the careful hands of an experienced endoscopist.

Aged↗
PubMed1995

Clinical and surgical aspects of double adenoma in patients with primary hyperparathyroidism.

The incidence of double parathyroid adenoma in 277 prospectively documented patients suffering from primary hyperparathyroidism was 5.4 per cent (15 patients). Patients with double adenoma were all symptomatic and had a significantly higher parathyroid hormone (PTH) level and tumour weight than those with a solitary adenoma or four-gland hyperplasia. In 11 patients the adenomas were located bilaterally. Bilateral neck exploration must be performed routinely to deal successfully with this condition at initial operation. In six patients one enlarged gland was found in the thymus or posterior mediastinum. These locations should be explored, especially in patients with high PTH levels, in those in whom all four parathyroid glands cannot be detected or if only one small adenoma is found. In all such patients, selective resection of the enlarged parathyroid glands resulted in normocalcaemia (median follow-up 3.5 years). Selective resection of the pathological glands is the treatment of choice.

Adenoma↗
PubMed1995

Influence of somatostatin to biochemical parameters in patients with primary hyperparathyroidism.

Somatostatin (SRIF) is effective in the nonoperative management of a variety endocrine tumors. A potential role of SRIF for treatment of patients with primary hyperparathyroidism (pHPT) has been suggested. In a controlled, prospective, triple-blinded, randomized clinical trial, the somatostatin analogue octreotide (SMS 201-995, Sandostatin) was evaluated in 40 patients with well documented pHPT. Amongst other biochemical parameters, serum calcium and-phosphate and levels of parathyroid hormone, calcitonin, and osteocalcin as well as octreotide were assessed before and for 4 hours after a single iv. application of 200 micrograms ocreotide or placebo. SRIF-receptor autoradiography was performed in parathyroid tissue samples. Baseline values revealed a constellation of biochemical parameters typically found in pHPT. Following 200 micrograms octreotide, no significant changes in any of the biochemical parameters investigated for were observed. Multivariate analysis was performed to identify patient subpopulations in which any given combination of laboratory parameters changed in response to either drug or placebo. However, no 'responders' to octreotide were identified. 45% of patients receiving octreotide, reported side effects. Parathyroid tissue samples were negative for SRIF-receptor expression. It is concluded that a single dose iv. application of octreotide does not result in appreciable changes of biochemical parameters relevant in pHPT and carries a high rate of side effects. Furthermore, absence of SRIF-receptors in parathyroid tissue from patients with pHPT, together with lack of octreotide effects, suggests that somatostatin-analogues may not be effective in the non-operative therapy of pHPT.

Adolescent↗