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Biomedical subjects

T Junginger

Publications and source records attributed to T Junginger.

At least 181 records · Page 10Linked to original sources
PubMed1995

[Diagnosis of dysfunctions of replanted parathyroid gland tissue by bilateral analysis of intact parathyroid hormones in cubital vein blood. A prospective study].

AIM: In a prospective long-term follow-up study after operative therapy of hyperparathyroidism the value of bilateral determination of parathyroid hormone levels in cubital venous blood after total parathyroidectomy/autologous parathyroid gland reimplantation (musculus brachioradialis) for diagnosis of dysfunctioning grafted tissue is evaluated. PATIENTS AND MATERIAL: From August, 1, 1987 to March, 31, 1994 68 of 243 patients operated on for hyperparathyroidism underwent total parathyroidectomy. Autologous reimplantation of parathyroid gland was carried out simultaneously in 64 patients. Twice delayed reimplantation of cryopreserved tissue was carried out, and there was no reimplantation in two patients up to this day. Three patients were operated on for hyperfunctioning parathyroid autograft after former total parathyroidectomy/reimplantation. RESULTS: During follow-up 5 patients developed dysfunction of (reimplanted) parathyroid gland. Because of low or unprovable levels of intact parathormone the gradients of intact parathyroid hormone between grafted and nongrafted forearm were about 1:1 in postoperative hypoparathyroidism as well as in hypofunction of parathyroid gland. After successful replantation of cryopreserved parathyroid tissue gradients of intact parathyroid hormone increased (> 1:10). In hyperfunction of grafted parathyroid tissue hormone gradients were high (> 1:20 to 1:45,3) because of excessive high levels of intact parathormone in the cubital vein of the graft bearing arm. Successful reduction of parathyroid graft was followed by decrease of parathyroid hormone gradients. CONCLUSION: Regular follow-up of intact parathormone gradients together with intact parathyroid hormone levels and serumcalcium analysis allow the determination of parathyroid graft function. Also differentiation between graft dependent hyperparathyroidism and hyperfunctioning parathyroid tissue in the neck or mediastinum seems to be possible by bilateral determination of intact parathormone. Normal values or a normal range for intact parathyroid hormone gradients can not yet be defined.

Adult↗
PubMed1995

[Modified cryopreservation of parathyroid gland tissue. Evaluation and comparison in an animal experiment].

A modified cryopreservation technique for parathyroid tissue was investigated in an animal model. The modified technique was compared with a previously described method [10, 11] using a programmed freezer and also with other simplified cryopreservation techniques [1, 8]. Total parathyroidectomy was performed in 90 Sprague-Dawley rats, which were allocated to 7 groups. Group I had no autotransplantation (n = 10) and group II underwent immediate autotransplantation of one parathyroid gland (n = 17). In the other five groups of rats the parathyroids were cryopreserved and one gland was reimplanted after 10 days' storage in liquid nitrogen (LN) at -196 degrees C. The following techniques for cryopreservation of the parathyroid glands were used. Group III: immediate placement in LN, n = 7; group IV: immediate placement in a freezer at -20 degrees C, transfer to LN after 2 h, n = 12; group V: immediate placement in a freezer at -80 degrees C, transfer to LN after 2 h, n = 13, group VI: manually controlled freezing initially at a rate of 1 degree C/min to -25 degrees C, and subsequently at 10 degrees C/min to -70 degrees C before transfer to LN [8], n = 19, group VII: programmed freezing at a controlled rate of 1 degree C/min to -80 degrees C prior to transfer to LN [10, 11], n = 12. Serum calcium concentrations were determined over a period of 60 days. Furthermore, the individual difference in the calcium concentration was assessed for each rat on the basis of the calcium levels recorded preoperatively and at day 60.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

[Orthograde intestinal irrigation or Fordtran solution for bowel preparation in elective colorectal surgery. Prospective outcome study].

In a prospective cohort study, which was carried out at the department for abdominal surgery of the university of Mainz from June to December 1993, two methods of bowel preparation for elective colorectal surgery were compared: oral bowel preparation with Fordtran a new polyethylene glycol solution (63 patients), and whole-gut lavage with Ringer's solution (37 patients). The serum chloride levels and the bodyweight increased significantly more in the whole-gut lavage group. These patients also showed a higher frequency of vomiting during bowel preparation. Neither the bowel cleansing effect nor the postoperative complications differed significantly between the two groups. Owing to these results, the better patient acceptance, and the easier handling and lower costs of PEG solution, we recommend this method of preoperative bowel preparation for elective colorectal surgery.

Adult↗
PubMed1995

[Lymph node excision in stomach cancer--a statistical analysis of survival and surgical mortality].

Between January, 1st, 1980 and December, 31st, 1993 all patients with curative removed gastric carcinoma were registered to evaluate the effect of an extended lymph node dissection on prognosis and perioperative risk. Therefore an analysis of all resected lymphatic nodes in 260 patients could be performed. Referring to the depth of tumor infiltration and the extension of the lymph node dissection (< 10 vs > 10 tumor negative lymph nodes) a significant difference could be found only for the pT 2 group. In this group the average survival time could be improved from 21 to 62 months (p < 0.018) by extended lymph node dissection, without increasing the perioperative morbidity. In our experience the extended lymphadenectomy offers a significantly improved survival for patients with non invasive gastric cancer without enhanced perioperative risk or mortality.

Adult↗
PubMed1995

[Risk and follow-up after multi-visceral resections including the left side of the pancreas].

Aim of this study was to analyze the operative risk of multivisceral resection including the left side of the pancreas. Between September 1 th, 1985 and May 31 th, 1994 18 multivisceral resections including the left side of the pancreas and 8 left-sided pancreatic resections were performed at the University Hospital for General and Abdominal Surgery, Mainz. Postoperatively 5 of the 18 patients with multivisceral resections and 3 of the 8 patients with left-sided pancreatic resections developed minor complications (wound infections, pneumonia). One insufficiency of an esophagojejunostomy was seen. One patient died after gastrectomy and left-sided pancreatic resection due to a pneumonia. In this case the operation was performed after substitution of 22 red cell packs under emergency conditions because of an infiltration of the splenic artery by a lymphoma of the stomach. The best prognosis had patients with neuroendocrine tumors. These results show that in case of an elective operation the risk of multi-visceral resections including the left side of the pancreas is comparable to that of left-sided pancreatic resections alone.

Adrenalectomy↗
PubMed1995

[Effect of lymph node dissection on prognosis of colon carcinoma].

Surgical treatment is essential for the prognosis of colon carcinoma. The extension of the lymph node excision depends on several factors, as operative technique and quality of the histopathological examination. In a retrospective analysis of 278 patients who had undergone curative primary resection for colon carcinoma the influence of lymph node excision on the prognosis has been proved. In the period of the analysis (between 1985 and 1993) the mean number of dissected lymph nodes could be increased. This had a strong influence on the prognosis. Whereas in early tumor stages and in patients with an extended lymph node metastasis no correlation between the quantity of lymph node excision and the prognosis could be found, patients with an extended local tumor growth without lymph node metastasis (pT3/4 pN0; p < 0.03) and patients with local lymph node metastasis (pN1; p < 0.0001) gained from the radical lymphadenectomy.

Aged↗
PubMed1995

[Differentiated surgical therapy of esophageal carcinoma].

Between September 1985 and December 1993 280 patients suffering from esophageal cancer underwent treatment at the department of general and abdominal surgery at the University of Mainz. Of the 167 patients operated, 152 patients had an esophageal resection performed in 113 cases as abdominothoracic resection and in 39 cases via the transmediastinal approach. 104 patients were curative resected (R0). Recurrence-free and total survival were correlated to the extent of the mediastinal lymph node dissection supposing comparable operative stress. The mean recurrence-free and the mean total survival after abdominothoracic resection with 2-field lymph node dissection were 42.4 months resp. 47.3 vs. 18.9 months resp. 25.2 months after transmediastinal resection (p = 0.015 and p = 0.035). We suggest a differentiated surgical approach concerning abdominothoracic resection with 2-field lymph node dissection for limited tumor size (pT1-3 pN0-1 M0), if the operative risk is tolerable. The transmediastinal resection appears to be only enough radical in cases with early tumor stages (UICC 0-I) and also is advantageous for risk patients with simultaneously more advanced tumor (palliative resection), because of the lower operative stress.

Adenocarcinoma↗
PubMed1995

In vitro studies of lymph node analysis.

Endosonography has become a widely accepted diagnostic procedure in the staging of gastrointestinal tumors over the past 10 years. The question of whether endosonography is equally as effective in the diagnosis of regional lymph node metastases has not been conclusively answered. This article presents a brief review of in vitro studies of lymph node analysis in the upper and lower gastrointestinal tract.

Computers↗
PubMed1995

[Immunoscintigraphy with MAb B72.3 for preoperative detection of lymph node metastases of colorectal carcinoma].

From April 1, 1992 to December 31, 1993 we investigated 30 patients with suspected primary colorectal carcinoma or questionable tumor relapse by immunoscintigraphy prospective with the monoclonal antibody MAb B72.3 in order to detect the tumor and especially regional lymph node metastases. All the patients underwent surgical treatment. The diagnosis was based on surgery and biopsy. The diagnostic sensitivity of immunoscintigraphy in detecting the tumor was 76%, the specificity 94% (predictive value positive [PVP] 95%) and 43%, respectively 85% in detecting lymph node metastases (PVP 60%). The diagnostic sensitivity in detecting rectosigmoid tumors was 79 and 60% in detecting lymph node metastases of rectosigmoid carcinoma (PVP 60%). The specificity was 90%. It could be shown, that the detection of metastases in singularly lymph nodes smaller than 1 cm was not possible and often a final decision could not be done. We conclude, that the benefit of this method in detection of lymph node metastases compared to basic diagnostic, expenses and costs is doubtfully.

Adenocarcinoma↗
PubMed1995

[Prognostic parameters after surgical therapy of achalasia].

For operative treatment of achalasia transabdominal myotomy combined with a semifundoplication was performed in 37 patients. 35 patients could be followed up during an average period of 41 months. 19 patients (54%) were completely and 12 (34%) almost symptom-free. In one case a peptic esophageal stenosis developed. The results of operation were especially in the group of young patients under 40 years favourable and there was no influence on results of preoperative duration of symptoms or number of dilatations before surgery. Transabdominal myotomy with semifundoplication has shown as a procedure with low complication rates and good long-time results for the symptomatically therapy of achalasia.

Adolescent↗
PubMed1995

[Free small intestine transplantation with microvascular anastomosis for complete replacement of the hypopharynx and cervical esophagus].

12 patients were operated on due to a cancer of the hypopharynx (T2-T4, N2-3). After resection, the reconstruction was performed with a free jejunal segment. Intraoperatively the venous anastomosis had to be renewed in 2 cases. One of these patients developed postoperatively a partial necrosis of the transplant. A further patient developed an insufficiency of the proximal anastomosis. One patient died on the 12th postoperative day due to a myocardial infarction. The median survival time was 17 months.

Adult↗
PubMed1995

[Risks and follow-up after crural vascular reconstruction in the extremity at risk for ischemia].

After 36 crural bypass operations the operative risk and the long-term results were analyzed in 34 patients. For reconstruction autologous vein (n = 12), a composite graft (saphenous vein and PTFE, n = 10) and in 14 cases a 6 mm PTFE graft were used. In 18 cases a monobypass, in another 16 patients a jump graft and in two patients a sequential bypass were performed. Postoperative complications were seen in 16.7%. An early bypass occlusion was seen in one patient, an amputation was necessary in 2 patients. After 1,2 and 3 years the bypass patency rate was 85%, 67% and 67%. The long-term results were dependent on the bypass material. The best results were seen with vein or composite grafts with a 3 year patency rate of 82% in contrast to only 39% of a PTFE graft.

Aged↗
PubMed1995

[Diagnostic and therapeutic strategy in multiple insulinoma].

Four of 59 patients with organic hyperinsulinism had multiple insulinomas and two patients a micro- and macroadenomatosis. Excluding patients with adenomatosis 3 of 10 tumors could be detected preoperatively by ultrasound (5 of 10 by CT). 6 of 7 macroadenomas could be visualized by angiography. Intraoperatively 9 of 10 macroadenomas were palpable. The nonpalpable tumor could be localized by intraoperative ultrasound. Pancreatic resection had better results than multiple enucleations. Excisional biopsy is recommended to exclude nesidioblastosis or microadenomatosis.

Adenoma, Islet Cell↗
PubMed1995

Autoantibodies to Auerbach's plexus in achalasia.

Achalasia is a motor disorder of the oesopagus characterized by decrease in ganglion cell density in Auerbach's plexus. The cause of the lesion is unknown. This is to repeat on the occurrence of autoimmune phenomena in patients with achalasia, in particular circulating antibodies against Auerbach's plexus and its possible meaning. IgG-antibodies against Auerbach's plexus were determined by standard indirect immunofluorescence. Antibodies to the cytoplasm of Auerbach's plexus were found in 37 of 58 patients with achalasia at variable stages of the disease (I-IV) with a disease duration ranging from 1 to 20 years but only in 4 out of 54 healthy controls (specificity 93%, sensitivity 64%, p < 0.0001), and in none of 12 patients with Hirschsprung's disease as well as 12 patients with cancer of oesophagus and only in one of 11 patients with peptic oesophagitis as well as in one of 13 patients with myasthenia gravis. The present observations suggest that autoimmunity to Auerbach's plexus plays a role in the pathogenesis of achalasia, the mechanism of action is unknown.

Adolescent↗
PubMed1994

Incidence and clinical importance of perioperative histamine release: randomised study of volume loading and antihistamines after induction of anaesthesia. Trial Group Mainz/Marburg.

Although histamine release is recognised as a common event during anaesthesia and surgery, few clinicians judge the resultant cardiorespiratory disturbances serious enough to warrant prophylaxis with antihistamines. We have assessed the incidence and importance of histamine release in a randomised 2 x 2 factorial study. 240 patients representing a routine throughput of major general surgery were studied during a standardised induction of anaesthesia and preoperative loading of the circulation with either Ringer solution or Haemaccel-35, with or without antihistamine prophylaxis with dimetindene (H1) plus cimetidine (H2). Cardiorespiratory disturbances were graded as detectable, clinically relevant, or life-threatening from observers' records of the anaesthesia and the actions taken by the anaesthetists. Disturbances that were accompanied by significant rises in plasma histamine were further designated histamine-related, and those that were not were designated histamine-unrelated. Anaesthetists, observers, and designators were blinded to whether or not the patients had received antihistamines and to which solution was used for circulatory volume loading. Clinically relevant or life-threatening histamine-related disturbances occurred in 8% of the patients who after induction of anaesthesia received Ringer without antihistamines, in 26% of those who received Haemaccel without antihistamines, and in 2% or less of those who received antihistamines (p < or = 0.0001). There were 4 life-threatening histamine-related disturbances, all in patients who received Haemaccel without antihistamines (p < 0.01). Histamine-unrelated disturbances occurred in 16% overall, with no obvious effect of Haemaccel or antihistamines. The histamine-related disturbances under anaesthesia were remarkable for their severity (even with small rises in histamine concentrations), for the prevalence of bradycardia, and for the absence of skin signs. Their likelihood and severity were increased in patients with tumours. The results of the trial make a case for routine prophylaxis with antihistamines as part of anaesthetic management.

Adolescent↗