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Biomedical subjects

P K Wagner

Publications and source records attributed to P K Wagner.

At least 19 recordsLinked to original sources
PubMed1992

[Cystic parathyroid gland adenomas: pathologic-anatomic variants of parathyroid gland adenomas or a separate disease entity?].

Between 01.01.1987 and 31.12.1990 a primary operation was performed on 126 patients in the Dept. of General Surgery, University of Marburg Hospital for primary hyperparathyroidism due to a parathyroid adenoma. Their clinically relevant data were prospectively documented. In 6 patients (4.8%) a total of 7 cystic parathyroid adenomas was found. While there was no difference in age- and sex-distribution, patients with cystic adenomas were found to have markedly higher serum parathormone and alkaline phosphatase levels than patients with solid adenomas. Calcium levels were similar in both groups. Cystic adenomas were much heavier than solid adenomas. A significant number of cystic adenomas was found to be displaced into the posterior mediastinum. The property of cystic parathyroid adenomas to be frequently located away from their usual anatomical position can make the intraoperative search for them difficult.

Adenoma↗
PubMed1992

[Assessing performance in surgical research and teaching].

The clinical registration of performance mainly serves to ascertain the staff plan. The measure of teaching and research is not quality but quantity in hours. For teaching, the time of lectures is taken with an added factor of 1.5 for lectures and 0.5 for practical training for preparation. For research it is customary to take an index of 10% of yearly working hours of all physicians working in medical care. Therefore, in an university hospital approximately 25% of the staff plan accounts for research and teaching.

Curriculum↗
PubMed1992

[Surgical treatment of stomach and duodenal ulcer].

Despite lots of innovation in conservative treatment, surgery has established in ulcer therapy. Elective surgery shows a very low mortality rate whereas that of emergency operations is approximately ten times that high. If one intends to improve the currently insufficient results of ulcer treatment, this is only possible by decreasing the number of emergency operations which for many years remains on a nearly unchanged level, in favour of elective surgery. This especially is true for patients on high risk regarding an ulcer complication. Most important complications are recurrent phases within short time and poor compliance. A further complication is any critical factor in general which leads to the assumption that an appearing ulcer complication may most likely not be survived. Critical factors mainly are advanced age and attendant cases of illness. It may be expected that the still high mortality of this benign disease can be considerably reduced by applying the formula "more elective--less emergency surgery".

Duodenal Ulcer↗
PubMed1991

Lymph node counts in the upper abdomen: anatomical basis for lymphadenectomy in gastric cancer.

The number of regional lymph nodes was determined in sites relevant to lymphadenectomy in gastric cancer in 30 cadavers. Tissue was cleared by dissolving fatty tissue, thus making lymph nodes with a diameter of at least 1 mm visible. All lymph node stations indicated by the Japanese Research Society for Gastric Cancer were studied. In stations 1-11 (corresponding with R2 resection) an average of 27 nodes (range 17-44 nodes) was found, whereas stations 1-16 (corresponding with R3 resection) showed an average of 43 nodes (range 25-64 nodes). These values are higher than those usually obtained from lymphadenectomy for gastric cancer. Striking individual differences in the total number of lymph nodes and the number of single stations was observed. The number of lymph nodes in these investigations are the normal anatomical values and serve as quality control of lymph node dissection in gastric carcinoma.

Adult↗
PubMed1991

[Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation in secondary hyperparathyroidism. A randomized study].

In this randomised study subtotal parathyroidectomy (PTX) is being compared with total parathyroidectomy including autotransplantation (PTX + AT) in 40 patients with secondary hyperparathyroidism. Both groups were followed up twice, first 19 +/- 6 months (PTX + AT) respectively 19 +/- 7 months (subtotal PTX) and secondly 43 +/- 9 respectively 40 +/- 7 months after surgery. In each group there were 17 patients alive at the time of the second postoperative follow-up. In the meantime 2 patients with subtotal PTX required reoperation because of recurrences originating from the remaining parathyroid tissue, another 2 patients of this group were hypercalcaemic. After PTX + AT serum-calcium normalized significantly more often (p less than 0.03), a corresponding result was seen in alkaline phosphatase. Reoperation was not required in this group. Also radiological alterations reformed significantly more often after PTX + AT, so did clinical signs like pruritus (p less than 0.005) and muscular weakness (p less than 0.04). Considering these results and the fact that in case of recidive a reoperation of the autograft in the forearm is much easier to perform than a reoperation in the neck, PTX + AT is recommended as method of choice in surgical treatment of sHPT.

Adult↗
PubMed1990

[Long-term results after implantation of autologous cryopreserved parathyroid tissue].

Autologous cryopreserved parathyroid tissue was implanted into 25 patients (12 men and 12 women, median age 45 [24-75] years, and an 18-month-old child) who after a parathyroidectomy for primary or secondary hyperparathyroidism, had developed permanent postoperative hypoparathyroidism. In 12 of the patients it had developed after a second operation for persisting or recurrent hyperparathyroidism. In ten patients it had occurred after total parathyroidectomy and autologous transplantation of fresh parathyroid tissue, in two patients after subtotal parathyroidectomy and in one patient after excision of a solitary parathyroid adenoma following goitre resection. In 22 patients the state of the tissue to be implanted was examined histologically before implantation after defrosting and any necrosis made up by replacement with more than 20 tissue particles. Re-examination took place a median of 40 [3-120] months postoperatively. The high doses of calcium and vitamin D preparations required preoperatively were reduced stepwise in all patients, completely discontinued in 16. At the time of follow-up nine patients were still receiving low doses of calcium and/or vitamin D. Symptoms of hypocalcaemia disappeared in all patients. Thus implantation of autologous cryopreserved parathyroid tissue is a reliable method for the treatment of permanent postoperative hypoparathyroidism.

Adenoma↗
PubMed1990

[Lessons from reoperations in 55 patients with primary hyperparathyroidism].

On the basis of 70 re-operations in 55 patients (34 women, 21 men, median age 58 [43-83] years) suffering from primary hyperparathyroidism the reasons for failure of the first operations were analysed. The main reasons were inadequate exploration of the neck (failure to identify all four glands), failure to recognize multiple gland involvement, or inadequate resection in cases where more than one gland was affected. An abnormally situated gland was a less common cause, as shown by the fact that 41 out of the 73 glands removed at the last re-operation were situated in the normal position or in its immediate vicinity; in 20 cases the surgeon had failed to recognise multiple gland disease. Next in order of importance were anatomical variations in the location (32 out of 73 tumours) or the number of the glands (9 patients with hyperplasia of 5 glands). At the re-operations 89% of the parathyroid tumours were found in the neck region or would have been accessible from the neck at the time of the first operation. Overall, the hypercalcaemia was permanently rectified in 96.6% of the patients. During the last 10 years 94% of patients have been normocalcaemic postoperatively, thanks mainly to the re-implantation of autologous parathyroid tissue, preserved by low-temperature storage. The incidence of permanent unilateral recurrent nerve paresis attributable to the re-operations was 6%.

Adult↗
PubMed1990

[Primary hyperparathyroidism. A disease picture has changed].

Data were retrospectively analysed on 544 consecutive patients (362 females and 182 males, mean age 53.6 [2 weeks and 86 years]) who had been operated on for primary hyperparathyroidism between 1965 and 1989. During this period the rate of renal, bone and intestinal complications decreased from 90% in the first 5 years to 29% in the last 5 years. Organ manifestations and hypercalcaemia were often combined (70% in the early period, 30% now). The proportion of those with an asymptomatic course gradually and continuously rose to 21% now. The patients' average age at diagnosis rose from 46 +/- 10 to 58 +/- 14 years. Serum calcium concentrations in the last few years averaged 3.1 mmol/l, as high during the last few years as at the beginning of the period. Age, serum calcium concentration and parathyroid weight of the asymptomatic patients did not differ from those of the group as a whole.

Adolescent↗
PubMed1990

Extracorporeal gas exchange in adult respiratory distress syndrome: associated morbidity and its surgical treatment.

Extracorporeal carbon dioxide removal (ECCO2-R) over a membrane lung is a new therapy for patients with adult respiratory distress syndrome (ARDS) who frequently suffer from lung complications caused by long-term artificial ventilation and who may require major thoracic surgery. This is a report of 76 patients with severe ARDS who were treated by ECCO2-R. Twenty-six of these 76 patients required thoracotomy: 19 for pneumothorax and pneumatocele, and seven for haemothorax, infected lung necrosis or oesophagotracheal fistula. Most pneumothoraces were bilateral. Ten of these 26 patients required reoperation, usually for extensive persisting alveolar air leaks. Sixteen (62 per cent) of the 26 patients who had a thoracotomy and 22 (44 per cent) of the 50 patients without surgery survived. These results demonstrate that performing a thoracotomy, if necessary, does not diminish the survival chance of high-risk patients with severe ARDS.

Adolescent↗
PubMed1990

[Primary hyperparathyroidism].

The diagnosis of primary hyperparathyroidism is based on laboratory tests showing high levels of calcium and parathyroid hormone. Primary hyperparathyroidism is treated by surgery, which is indicated in symptomatic as well as in asymptomatic disease, provided the latter patients are at low risk. Primary parathyroidectomy should be successful in at least 90% of the patients. Epidemiological studies show that pHPT occurs much more often than operation statistics imply. This situation can be improved by a more consequent differential diagnosis that detects up all cases of hypercalcemia.

Diagnosis, Differential↗
PubMed1990

[Surgical therapy of lung complications of long-term ventilation for severe adult respiratory distress syndrome].

Long-term respiratory therapy with high pressure levels in case of ARDS can lead to several symptoms requiring surgical treatment. Various forms of manifesting barotrauma predominate (bronchopleural fistula, pneumothorax, pneumatocele and soft tissue emphysema), while hematothorax, infected necrosis of parenchyma or esophagotracheal fistula are rare. Most of the operations became necessary because of bronchopleural fistula resp. pneumothorax, and with this indication the number of reoperations was especially high. Of 21 patients 13 (62%) survived.

Adolescent↗
PubMed1990

[Simplified storage procedure of cryopreserved human parathyroid tissue].

Parathyroid tissue that is stored for replantation purposes is usually kept in a special tank containing fluid nitrogen at -196 degrees C. Our studies demonstrate that storage is also possible in a deep-freezer at -70 degrees C without any loss of quality. Most hospitals own such freezers for storing bone marrow cells at the same temperature. Parathyroid tissue of 11 patients who were operated on because of primary hyperparathyroidism was stored in this way. After six months the tissue showed 75.7% morphologically intact cells. The control group's tissue was stored in liquid nitrogen according to the common method; after the same period of time it showed 76% histologically normal cells.

Adenoma↗
PubMed1990

[Normal value of the number of lymph nodes in the epigastrium. An anatomic study for lymphadenectomy in stomach cancer].

The number of regional lymph nodes relevant for lymphadenectomy in gastric cancer was investigated in an autopsy study. In group N1-16 as described by JRSGC on the average 43 lymph nodes were found (range 25 to 64 lymph nodes). For group N1-11 (R1 and R2 resection, compartments I and II respectively) 27 lymph nodes were found on the average (range 17 to 44 lymph nodes). The results differed considerably in total number as well as within each single group and in the groups N1-16/N1-11. These results can be taken as statistical standard values.

Aged↗
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

[Results of treatment of ulcer hemorrhages].

The results of 270 patients, admitted from 1978 to 1985 because of upper gastrointestinal bleeding from ulcers or erosions were analysed retrospectively. Chronic peptic ulcers were the most common bleeding sites (192 patients, 71%). 49 patients (18%) bled from acute lesions and 29 (11%) from drug-induced ulcers. 53% of all patients exhibited an oozing hemorrhage (type Forrest 1 b) during emergency endoscopy. Within the eight-year-period hospital mortality dropped from 18% to 8%. In parallel the prognosis of oozing bleeding improved. In this period the patients were more often treated with secretin or somatostatin. Hence the frequency of emergency operations for patients with oozing bleeding could be reduced from 44% in 1978 to 10% in 1985 and the death rate from 22% to 5%.

Adult↗
PubMed1988

Food-induced histaminosis as an epidemiological problem: plasma histamine elevation and haemodynamic alterations after oral histamine administration and blockade of diamine oxidase (DAO).

In a randomized controlled trial, 30 pigs were orally treated with histamine (60 mg). In addition, half of the animals underwent a specific blockade of the enzyme diamine oxidase (DAO), which is the main histamine catabolising enzyme in the intestinal tract. Only these DAO-blocked animals exhibited severe clinical symptoms (e.g. hypotension, flush, vomiting) and, in parallel, showed tremendous elevations of plasma histamine levels of up to 160 ng/ml. 3 out of 15 animals in this group died within the experimental period. In contrast, the control animals neither exhibited plasma histamine levels above 5 ng/ml nor had any clinical reactions. These results contradict the current opinion that oral histamine intake in food is not clinically relevant, especially since many commonly used drugs are DAO-inhibitors and approximately 20% of our population take these drugs. Apart from drugs, some other factors (alcohol, spoilt food etc.) can also function via a blockade of DAO as an additional risk. DAO-blockade is therefore a real epidemiological problem. Evidence is presented here for the new disease concept: Food-Induced Histaminosis.

Amine Oxidase (Copper-Containing)↗