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Cupisti K, Antke C, Schmidt D, Knoefel WT, Müller HW, Schommartz B. Lokalisation von Nebenschilddrüsenadenomen mit planarer 99mTc-Sestamibi-Szintigraphie. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1625329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungZiel: Im Rahmen der präoperativen Lokalisationsdiagnostik beim primären Hyperparathyreoidismus (pHPT) wurden die Subtraktions- und die 2-Phasen-Technik der 99mTc-Sestamibi- Szintigraphie untereinander und mit den Operationsergebnissen verglichen. Patienten, Methoden: Prospektiv wurden 126 Patienten mit pHPT präoperativ untersucht. Die Darstellung der Schilddrüse (99mTc-Pertechnetat) wurde von dem Perfusionsbild (99mTc-Sestamibi) subtrahiert, eine weitere Aufnahme 2 h p. i. diente zur Feststellung einer Aktivitätsretention. Die zeitnahe Befunderstellung erfolgte unter Berücksichtigung beider Techniken. Retrospektiv wurden die Auswertungen getrennt vier erfahrenen Fachärzten vorgelegt. Ergebnisse: In der klinischen Routine wurden bei 109 Patienten präoperativ korrekte Befunde erhoben (87%). Von 129 resezierten Nebenschilddrüsenadenomen wurden 118 richtig lokalisiert (Sensitivität 91%, pos. Vorhersagewert 94%). Bei der retrospektiven Analyse führten in 75% der Fälle beide Techniken zum richtigen Ergebnis, bei 14% war nur die 2-Phasen-Technik zielführend, bei 7% nur die Subtraktionstechnik. Mit der 2-Phasen-Technik wurden signifikant mehr Untersuchungen richtig beurteilt als mit der Subtraktionstechnik (88,7 ± 3,2% versus 81,6 ± 1,2%, p <0,01, zweiseitiger t-Test). Schlussfolgerung: Die präoperative szintigraphische Lokalisationsdiagnostik hyperaktiver Nebenschilddrüsen bei pHPT unterstützt das minimal-invasive operative Vorgehen durch eine hohe Rate an richtigen Befunden. Die 2-Phasen- erscheint sensitiver als die Subtraktionstechnik. In einigen Fällen kann die richtige Lokalisation nur mit Hilfe der Subtraktionstechnik angegeben werden. Für eine optimale Vorbereitung der Operation empfiehlt sich die vorgestellte Kombination beider Techniken.
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Abstract
Purpose: Fundamental gray-scale imaging (FGI) is known to be unuseful for thyroid imaging in the early postoperative setting. Thus, we evaluated the feasability of tissue harmonic imaging (THI) early after thyroid resection. Material and Methods: FGI and THI of the neck were perfomed in 48 consecutive patients 4 days after surgery. The examiner was blinded to patient diagnoses and types of surgery. FGI and THI examinations were stored on videotape and reviewed offline by two different readers who rated the quality of delineation of the organ borders and presence or absence of focal lesions. The results were compared to neck US performed 12 weeks after surgery. Results: Delineation of the thyroid remnants in THI/FGI was rated to be excellent in 22/2, good in 11/9, poor in 3/16 and not visible at all in 4/13 patients. The correlation between THI-volumetry and control-volumetry was very high (r=0.81; p<0.0001). THI but not FGI depicted presence or absence of solid thyroid nodules with 100% accuracy. Conclusion: THI is a feasible method for thyroid US in the early postoperative setting. It permits volumetry of the residual thyroid tissue and accurately depicts nodules within the thyroid remnant.
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Affiliation(s)
- A Saleh
- Institute of Diagnostic Radiology, University Hospital, Düsseldorf, Germany
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Cupisti K, Lehwald N, Anlauf M, Riemer J, Werner TA, Krieg A, Witte J, Chanab A, Baldus SE, Krausch M, Raffel A, Herdter C, Schott M, Knoefel WT. Encapsulation status of papillary thyroid microcarcinomas is associated with the risk of lymph node metastases and tumor multifocality. Horm Metab Res 2014; 46:138-44. [PMID: 24356791 DOI: 10.1055/s-0033-1361158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The management of papillary microcarcinoma (PMC) of the thyroid is controversial, especially after partial thyroid resection for benign thyroid disease. In order to detect prognostic factors for PMC, we analyzed 116 patients with PMC for encapsulation status and lymph node metastases. Between 10/1992 and 12/2010, 116 patients with PMC have been operated in our department (87 females, 29 males, median age 49 years). Eighty per cent of PMCs were diagnosed postoperatively. Seventy-six patients (66%) received a more extended resection with either thyroidectomy, near total thyroidectomy, or Dunhill operation either primarily or after completion operation, whereas 40 patients (34%) had only partial resection. Fifty patients (43%) received radioiodine (RIA) ablation. Lymph node metastases were found in 21 patients (18%). Univariate analysis showed four risk factors to be significantly associated with the risk of lymph node metastasis (p<0.05): male gender, younger age, age group<50 years and nonencapsulation of the tumor. Multivariate analysis demonstrated statistical significance for gender and tumor capsulation status. The tumor capsulation status also correlated with tumor multifocality. Our data show that the risk of lymph node metastases is significantly higher in partially or nonencapsulated PMC than in encapsulated specimens. We therefore suggest that the WHO classification should be extended to a compulsory notification of the encapsulation status in PMC.
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Affiliation(s)
- K Cupisti
- Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - N Lehwald
- Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Anlauf
- Institute of Pathology, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - J Riemer
- Institute of Pathology, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - T A Werner
- Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - A Krieg
- Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - J Witte
- Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - A Chanab
- Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - S E Baldus
- Institute of Pathology, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Krausch
- Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - A Raffel
- Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - C Herdter
- Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - M Schott
- Department of Endocrinology, Rheumatology and Diabetes, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - W T Knoefel
- Department of General, Visceral and Pediatric Surgery, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany
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Lehwald N, Krausch M, Cupisti K, Geisler S, Gerlach P, Raffel A, Knoefel WT. One hundred double adenomas in primary hyperparathyroidism. Eur Surg 2013. [DOI: 10.1007/s10353-013-0233-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Krausch M, Raffel A, Anlauf M, Schott M, Lehwald N, Krieg A, Kröpil F, Cupisti K, Knoefel WT. Secondary malignancy in patients with sporadic neuroendocrine neoplasia. Endocrine 2013; 44:510-6. [PMID: 23494366 DOI: 10.1007/s12020-013-9911-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 02/20/2013] [Indexed: 12/19/2022]
Abstract
The incidence of neuroendocrine neoplasias (NENs), especially of the gastro-entero-pancreatic (GEP), system relatively increased over the past decades, as a result of advanced diagnostic tools, a better clinical awareness, and distinguished pathological diagnostic recognition. Previous reports hypothesized an increased risk for secondary malignancies in patients with NEN especially in GEP-NENs. The present study was designed to investigate the coincidence of NENs and secondary malignancies in a large patient collective. A retrospective analysis was performed on 161 patients (85 female and 76 male) with NEN of various origins. Clinical data of these patients, different classification systems (TNM/WHO), proliferations-based grading, and clinical follow-up were collected and analyzed. Out of 143 patients with a sporadic NEN, 15 (10.49 %) patients were identified with secondary malignant tumors. Median age at the time of the primary operation for NEN was 65 years, whereas the median age of initial diagnosis of associated tumors was 59 years. Mean follow-up time was 61 months. The risk of developing a secondary malignancy was most elevated for patients with an NEN of the lung, the stomach, and the ileum (60, 50 and 20 %, respectively). The spectrum of secondary malignancies included various types of cancer. Kaplan-Meier survival analysis shows a difference suggesting that patients with a secondary malignancy demonstrate a worse survival compared to patients without a secondary tumor; no significance was detected (p = 0.349). Our data suggest that secondary malignancies in patients with NEN's especially in GEP-NENs are found more frequently than in general population. Therefore, patients with NEN need a continuous and detailed follow-up. The reason for the increased incidence of secondary malignancies in patients with NENs remains to be elucidated.
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Affiliation(s)
- M Krausch
- Department of General, Visceral and Pediatric Surgery, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany,
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Abstract
The incidence of primary hyperparathyroidism (pHPT) combined with nonmedullary thyroid carcinoma (NMTC) has been reported between 2-13%. To date, it remains controversial whether these 2 pathologies occur coincidental or are caused by specific risk factors or genetic changes. The aim of this study was to evaluate the clinical and histological characteristics of NMTC associated with pHPT. We reviewed prospective database records of 1 464 unselected, consecutive patients who were treated for pHPT in our institution between 1986 and 2012 and identified 41 NMTC (2.8%). The collective consisted of 35 papillary (PTC) and 6 follicular (FTC) thyroid carcinomas. Our collective of 41 NMTC including 34 single adenomas and 7 multiglandular diseases consisted of 33 females and 8 males. Patients with FTC demonstrated significant lower preoperative PTH levels compared to PTC. Interestingly, NMTC were predominantly located on the right side. FTC had significant larger tumors as well as demonstrated increased extrathyroidal growth and lymph node metastases. In 71% pHPT and NMTC were diagnosed synchronously. The comorbidity of pHPT and NMTC occurs in about 3%. As pHPT is often operated by a focal minimally invasive approach, we advocate a mandatory preoperative thyroid ultrasound for all patients with pHPT to be able to identify synchronous thyroid disease.
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MESH Headings
- Ablation Techniques
- Aged
- Carcinoma, Medullary/complications
- Carcinoma, Medullary/pathology
- Carcinoma, Medullary/surgery
- Female
- Humans
- Hyperparathyroidism, Primary/complications
- Hyperparathyroidism, Primary/pathology
- Hyperparathyroidism, Primary/surgery
- Iodine Radioisotopes/therapeutic use
- Male
- Middle Aged
- Neoplasms, Multiple Primary/complications
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Second Primary/complications
- Neoplasms, Second Primary/pathology
- Thyroid Neoplasms/complications
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/surgery
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Affiliation(s)
- N Lehwald
- Department of General, Visceral and Pediatric Surgery, University Hospital, Düsseldorf, Germany
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Krausch M, Raffel A, Anlauf M, Schott M, Willenberg H, Lehwald N, Hafner D, Cupisti K, Eisenberger CF, Knoefel WT. Loss of PTEN expression in neuroendocrine pancreatic tumors. Horm Metab Res 2011; 43:865-71. [PMID: 22105477 DOI: 10.1055/s-0031-1291333] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
PTEN (phosphatase and tensin homologue deleted from chromosome 10) is a well established tumor suppressor gene, which was cloned to chromosome 10q23. PTEN plays an important role in controlling cell growth, apoptosis, cell adhesion, and cell migration. In various studies, a genetic change as well as loss of PTEN expression by different carcinomas has been described. To date, the role of PTEN as a differentiation marker for neuroendocrine tumors (NET) and for the loss of PTEN expression is still unknown. It is assumed that loss of PTEN expression is important for tumor progression of NETs. We hypothesize that PTEN might be used as a new prognostic marker. We report 38 patients with a NET of the pancreas. Tumor tissues were surgically resected, fixed in formalin, and embedded in paraffin. PTEN expression was evaluated by immunohistochemistry and was correlated with several clinical and pathological parameters of each individual tumor. After evaluation of our immunohistochemistry data using a modified Remmele Score, a widely accepted method for categorizing staining results for reports and statistical evaluation, staining results of PTEN expression were correlated with the clinical and pathological parameters of each individual tumor. Our data demonstrates a significant difference in survival with existence of lymph node or distant metastases. Negative patients show a significant better survival compared with positive patients. Furthermore, we show a significant difference between PTEN expression and WHO or TNM classification. Taken together, our data shows a positive correlation between WHO classification and the new TNM classification of NETs, and loss of PTEN expression as well as survival. These results strongly implicate that PTEN might be helpful as a new prognostic factor.
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Affiliation(s)
- M Krausch
- Department of General, Visceral and Pediatric Surgery, Heinrich-Heine University of Düsseldorf, Germany.
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Krausch M, Raffel A, Anlauf M, Baldus SE, Lehwald N, Cupisti K, Eisenberger CF, Knoefel WT. Coincidence of mature cystic teratoma and serotonin-producing neuroendocrine tumor of the ileum. Horm Metab Res 2011; 43:872-6. [PMID: 22105478 DOI: 10.1055/s-0031-1291304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Mature cystic teratomas are often found in gonadal sites, but are very rarely located extragonadally, for example, in retroperitoneum, mediastinum, central nervous system, lung, or liver. In the literature, only 10 cases of cystic teratoma originating from the diaphragm have been reported. Here, we report for the first time a metachronous occurrence of a benign mature cystic teratoma in the left diaphragm together with a serotonin-producing neuroendocrine tumor of the ileum. The 51-year-old, female patient received a partial resection of the ileum due to a neuroendocrine tumor (pT3N1M0) 4 years ago. Furthermore, she was operated for a benign cystadenoma of the right ovary 3 years ago. In her past medical history, she had an appendectomy in her childhood and a subtotal thyroidectomy 10 years ago. To our knowledge, this is the first report describing the metachronous occurrence of benign mature cystic teratoma in the diaphragm and a highly differentiated neuroendocrine tumor of the ileum. The possible coincidence of both diseases is discussed.
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Affiliation(s)
- M Krausch
- Department of General, Visceral and Pediatric Surgery, Heinrich-Heine-University, Düsseldorf, Germany.
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Alexander A, Rehders A, Riediger R, Cupisti K, Schulte am Esch J, Stoecklein NH, Knoefel WT. Primäre und Sekundäre Sarkome des Pankreas. Ist die radikale Resektion immer indiziert? Zentralbl Chir 2011. [DOI: 10.1055/s-0031-1289032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Flügen G, Kröpil F, Schmitz N, Kraus S, Iskender Ö, Krieg A, Cupisti K, Topp S, Knoefel WT. Intrahepatische Endometriosezysten als Differenzialdiagnose von Leberraumforderungen. Zentralbl Chir 2011. [DOI: 10.1055/s-0031-1289103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Kröpil F, Vay C, Cupisti K, Flügen G, Rehders A, Eisenberger CF, Knoefel WT. Differenzierte Therapiestrategie bei Ösophagusperforationen. Zentralbl Chir 2011. [DOI: 10.1055/s-0031-1289057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Ülgen F, Kühn MC, Cupisti K, Herder C, Willenberg HS, Schott M, Scherbaum WA, Schinner S. The CB-1 Receptor Antagonist Rimonabant Modulates the Interaction Between Adipocytes and Pancreatic Beta-Cells in Vitro. Exp Clin Endocrinol Diabetes 2010; 119:41-6. [DOI: 10.1055/s-0030-1261963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Björklund P, Cupisti K, Fryknäs M, Isaksson A, Willenberg HS, Akerström G, Hellman P, Westin G. Stathmin as a marker for malignancy in pheochromocytomas. Exp Clin Endocrinol Diabetes 2009; 118:27-30. [PMID: 19449284 DOI: 10.1055/s-0029-1202789] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pheochromocytomas of the adrenal medulla may be life-threatening catecholamine-producing tumors which are malignant in about 10% of cases. Differential diagnosis between malignant and benign tumors is dependent on the development of metastasis or extensive local invasion. A number of genetic aberrations have been described in pheochromocytomas, but no marker associated to malignancy has been reported. We applied an expression microarray containing 7770 cDNA clones and analysed the expression profiles in eleven tumors compared to normal adrenal medulla. Stathmin (STMN1, Op18) was most conspiciously overexpressed among the differentially expressed genes. RT-PCR analysis further confirmed mRNA overexpression, 6 to 8-fold for benign and malignant tumors, and 16-fold for metastases. Stathmin protein overexpression was observed by immunohistochemistry, and distinct differential protein expression between benign and malignant/metastasis specimens was confirmed by Western blot analysis. The results introduce stathmin as a possible diagnostic marker for malignant pheochromocytomas, and further evaluations are warranted.
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Affiliation(s)
- P Björklund
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Lachenmayer A, Lichtenauer UD, Cox T, Schott M, Malendowicz LK, Goretzki PE, Cupisti K, Scherbaum WA, Bornstein SR, Willenberg HS. Nestin as a marker in the classification of adrenocortical tumors. Horm Metab Res 2009; 41:397-401. [PMID: 19294612 DOI: 10.1055/s-0029-1202788] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Expression of the intermediate filament, nestin, was long believed to be restricted to neuroectodermal stem cells. However, nestin expression has recently been detected in several tumors. Since adrenocortical carcinoma, a tumor entity still very difficult to classify, may gain the ability to aberrantly express neuroectodermal proteins including chromogranin A and synaptophysin, we asked the question whether nestin might also be detected in adrenocortical carcinomas, and if so, whether it might serve as a tool for clinical pathology. Therefore, we studied the expression of nestin in normal adrenal glands, adrenocortical adenomas, and adrenocortical cancers using specific immunohistochemistry and semi-quantitative reverse transcriptase-polymerase chain reaction. Immunostaining was nestin-positive in 1 out of 9 normal adrenal glands (11%), 2 out of 20 adrenocortical adenomas (10%), and 13 out of 16 adrenocortical carcinomas (81%). Expression of nestin mRNA could be detected in all microdissected tissues, independently of their grade of dedifferentiation. We conclude that our findings provide further evidence that nestin, as a marker, is not restricted to neuronal stem cells and nestin expression is worth to be studied in adrenocortical tumors.
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Affiliation(s)
- A Lachenmayer
- Department of General, Visceral and Pediatric Surgery, University Hospital Düsseldorf, Düsseldorf 40225, Germany
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Willenberg HS, Kolentini C, Quinkler M, Cupisti K, Krausch M, Schott M, Scherbaum WA. The serum sodium to urinary sodium to (serum potassium)2 to urinary potassium (SUSPPUP) ratio in patients with primary aldosteronism. Eur J Clin Invest 2009; 39:43-50. [PMID: 19067735 DOI: 10.1111/j.1365-2362.2008.02060.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aldosterone-to-renin ratio (ARR) is an established diagnostic tool in the screening for primary aldosteronism (PA). However, hormonal determinations are time consuming and expensive. Therefore, we studied the effectiveness of the serum sodium to urinary sodium to (serum potassium)(2) to urinary potassium (SUSPPUP) ratio in the diagnosis of PA. DESIGN This study included 35 patients with PA, 71 patients with essential hypertension to whom this diagnosis could be excluded, 23 normal subjects without hypertension, and 22 patients with primary adrenal insufficiency. We compared the SUSPPUP ratios with the ARR in these patient groups. RESULTS We show that the ARR distinguished PA from essential hypertension with a sensitivity of 94.2% and a specificity of 92.1% at a cutoff of 33 (ng L(-1): ng L(-1)). It correlated well with the SUSPPUP ratio. The sensitivity and specificity of SUSPPUP was 88.6% and 85.9% at a cutoff of 5.3 (mmol L(-1))(-1), respectively, and thus not as good as the ARR. CONCLUSIONS The ARR is a good parameter in the screening for PA. The SUSPPUP ratio is a cheap and rapid tool to assess the extent of mineralocorticoid excess and, therefore, can be offered to more patients. In addition, the application of the SUSPPUP ratio can be extended to patients who suffer from other forms of mineralocorticoid hypertension (e.g. with low aldosterone levels).
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Affiliation(s)
- H S Willenberg
- Department of Endocrinology, Diabetes and Rheumatology, University Hospital Düsseldorf, Düsseldorf, Germany.
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Liu C, Hermsen D, Domberg J, Graeber C, Hautzel H, Duan Y, Xu KF, Liu CP, Mao XD, Cupisti K, Scherbaum WA, Schott M. Comparison of M22-based ELISA and human-TSH-receptor-based luminescence assay for the measurement of thyrotropin receptor antibodies in patients with thyroid diseases. Horm Metab Res 2008; 40:479-83. [PMID: 18504673 DOI: 10.1055/s-2008-1077051] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Previously, a new procedure for measuring serum TSH receptor autoantibodies (TRAb) was reported in which the autoantibodies inhibit binding of a human monoclonal thyroid stimulating antibody M22 to TSHR-coated ELISA plate wells (TRAb ELISA). The aim of the present study was to evaluate the clinical performance of this assay in comparison to the second generation TRAb assay (TRAb LIA) based on the recombinant human TSH-receptor and chemiluminescence technology (TRAb LIA). Among the 158 patients, 84 patients suffered from Graves' disease (GD), 34 patients had Hashimoto's thyroiditis (HT), and 40 patients had euthyroid nodular thyroid disease (NTD) without signs of autoimmunity. TRAb measurements were performed according to the manufacturer's instructions. Out of 84 GD patients, 80 (95.2%) were TRAb positive as detected by the TRAb LIA. One GD patient had TRAb values within the grey zone (1.0-1.5 IU/l). All patients with HT and NTD were negative except in 6 (8.1%) cases whose TRAb values were within the grey zone. On the basis of the recommended cutoff value (TRAb 1.0 IU/l), the TRAb ELISA found 78 of 84 (92.9%) GD patients to be TRAb positive. None of the patients with HT, but two cases (5.0%) with NTD were TRAb positive. The diagnostic sensitivity of the TRAb LIA and TRAb ELISA assays was 95.2 and 92.9%, while the specificity was 100% and 97.3%, respectively. There was a close correlation (r=0.968, p<0.0001) between both assays in 84 patients with GD. Additionally, the between-run imprecision close to the cutoff limit was assessed. The calculated between-run coefficient of variation (CV) of the TRAb ELISA was 28.2% at the recommended cutoff value of 1.0 IU/l. Due to the evaluated imprecision data we propose a higher cutoff value correlating with a between-run CV of 20% (functional assay sensitivity). Our results indicate that due to a worse imprecision the TRAb ELISA has a slightly lower sensitivity and specificity compared to the TRAb LIA assay. These findings suggest that the M22 monoclonal antibody-based TRAb ELISA is not as reliable as other second generation TRAb assays in the diagnosis of Graves' diseases.
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Affiliation(s)
- C Liu
- Department of Endocrinology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China
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Lehwald N, Cupisti K, Willenberg HS, Schott M, Krausch M, Raffel A, Wolf A, Brinkmann K, Eisenberger CF, Knoefel WT. Standard-radical vs. function-preserving surgery of benign nodular goiter—a sonographic and biochemical 10-year follow-up study. Langenbecks Arch Surg 2008; 394:279-83. [DOI: 10.1007/s00423-008-0328-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Accepted: 03/18/2008] [Indexed: 10/22/2022]
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Bahlo M, Schott M, Kaminsky E, Cupisti K. [Multiple endocrine neoplasia 2a: late manifestation of a newly-discovered mutation]. Dtsch Med Wochenschr 2008; 133:464-6. [PMID: 18302097 DOI: 10.1055/s-2008-1046733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HISTORY A 55-year-old patient presented with a painless right-sided cervical swelling, which had been present for four months and seemed to get larger. The patient denied dyspnea, dysphagia, "a lump in the throat" or thyroid disease. Two of his paternal aunts had thyroid carcinoma and an adrenal tumor. INVESTIGATIONS Ultrasonography revealed an enlarged lymphoid nodule and a large lesion in the right thyroid lobe, the latter with deficient technetium uptake on scintigraphy. THERAPY AND COURSE A total thyroidectomy with bilateral centrocervical and lateral neck dissection was performed. Histology revealed a bilateral medullary thyroid carcinoma [MTC: pT3, pN1b (9/34), pM0 (UICC 2002)] and the genetic screening showed a double mutation in codon 611 (TGC>TAT; p.Cys611Tyr; C611Y), and exon 10 of the RET proto-oncogene, which has not been described before. Pheochromocytoma and hyperparathyroidism were excluded. Genetic screening of all close family members was initiated and showed that four of them were gene carriers. Three of them have been operated and a MTC found. CONCLUSION The described newly discovered mutation is associated with MTC and pheochromocytoma. This case underlines the need of genetic screening in all patients who present with a MTC only, no matter what the person's age of manifestation, even in the absence of any other MEN-related disease.
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Affiliation(s)
- M Bahlo
- Klinik für Endokrinologie, Diabetologie und Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf
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Papewalis C, Wuttke M, Jacobs B, Domberg J, Willenberg H, Baehring T, Cupisti K, Raffel A, Chao L, Fenk R, Seissler J, Scherbaum WA, Schott M. Dendritic cell vaccination induces tumor epitope-specific Th1 immune response in medullary thyroid carcinoma. Horm Metab Res 2008; 40:108-16. [PMID: 18283628 DOI: 10.1055/s-2007-1022565] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The existence of inherited aggressive forms of medullary thyroid carcinoma (MTC) and their resistance to classical therapies make it a prime candidate for adoptive immunotherapy. Highly potent antigen-presenting cells, namely dendritic cells (DCs), may serve as an interesting tool for anticancer vaccination. Here we report on the IN VITRO findings of a vaccination trial in five MTC patients, who were treated with a new DC generation protocol consisting of granulocyte-macrophage colony-stimulating factor and interferon-alpha (IFN-DCs). These cells were pulsed with tumor-specific calcitonin and administered twice. In two patients who responded to therapy we found a large increase (in mean 2.9+/-1.9%) of antigen-specific IFN-gamma-secreting CD4+ cells as well as an increase of granzyme B positive CD8+ cells (mean 2.2+/-0.2%) in the peripheral blood. In parallel, a decrease of CD4+/CD25+/FoxP3+ regulatory T cells was seen. Importantly, IN VITRO stimulation of PBMC with 10 different 15mer calcitonin peptides resulted in the identification of two HLA class II epitope regions within the central part of full-length calcitonin. These data were in accordance with the results drawn from the computer-based algorithm epitope prediction software SYFPEITHI. Measurement of different pro- and anti-angiogenic factors did not allow for a distinct outcome of prediction of the treated patients. In summary, we have demonstrated that immunization with IFN-DCs leads to a tumor epitope-specific immune response in MTC patients and may, therefore, represent a promising tool for future vaccination trials.
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Affiliation(s)
- C Papewalis
- Department of Endocrinology, Diabetes, and Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany
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Alldinger I, Siebler M, Peiper M, Cupisti K, Rado Y, Kindgen-Milles D, Knoefel WT. Episodic respiratory failure due to focal epileptic activity. Eur J Med Res 2006; 11:90-2. [PMID: 16504967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
We report on a patient with a complicated course after surgical abdominal intervention and episodic life threatening respiratory failures successfully treated with carbamazepine after diagnosis of a ponto-medullary lesion in the MRI.
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Affiliation(s)
- Ingo Alldinger
- Department of General and Visceral Surgery, University Hospital Düsseldorf, Heinrich-Heine-University, Germany.
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21
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Schommartz B, Cupisti K, Antke C, Schmidt D, Knoefel WT, Müller HW. [Localisation of parathyroid glands using planar (99m)Tc-sestamibi scintigraphy. Comparison between subtraction- and dual-phase technique]. Nuklearmedizin 2006; 45:115-21. [PMID: 16710507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
AIM In the context of presurgical localisation of parathyroid adenomas in primary hyper-parathyreoidism (pHPT) using (99m)Tc-sestamibi scintigraphy, subtraction- and dualphase technique are compared with each other and with the surgical findings. PATIENTS, METHODS Prospectively, 126 patients with pHPT were investigated presurgically. For visualisation of parathyroid adenomas, an image of the thyroid ((99m)Tc-pertechnetat) was subtracted from a perfusion image ((99m)Tc-sestamibi) and 2 h p. i. another image was acquired for identification of retention of activity. Considering both techniques the clinical findings were reported promptly. Retrospectively, the evaluations were presented separately to four experienced raters. RESULTS In clinical routine for 109 patients correct findings were reported presurgically (87%). From 129 resected parathyroid adenomas 118 were localised correctly (sensitivity 91%, positive predictive value 94%). Concerning the retrospective analysis, in 75% of the cases both techniques provided the correct site, in 14% only the dual-phase technique and in 7% only the subtraction-technique was correct. With the help of the dual-phase technique significantly more investigations were correctly rated than with the help of the subtraction technique (88.7 +/- 3.2% vs. 81.6 +/- 1.2%, p < 0.01, two-sided t-test). CONCLUSION The presurgical scintigraphic localisation of hyperactive parathyroid glands in pHPT assists minimal invasive surgery serving a high rate of correct findings. According to our data the dual-phase technique seems to be more sensitive than the subtraction technique. In some cases, however, the correct site may only be found using the subtraction technique. For an optimal surgical strategy we suggest the combination of both techniques.
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Affiliation(s)
- B Schommartz
- Nuklearmedizinische Klinik, Universitätsklinikum Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf.
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Raffel A, Cupisti K, Krausch M, Eisenberger CF, Knoefel WT. [Decision making in postoperative incidentally found small C-cell-carcinoma]. Zentralbl Chir 2005; 130:434-9. [PMID: 16220440 DOI: 10.1055/s-2005-836891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Surgical therapy of incidentally postoperative diagnosed small sporadic medullary thyroid cancer (MTC) is discussed controversially. In principle completion thyroidectomy with neck dissection and regulary tumor follow-up are under discussion. A total of 277 patients with MTC were treated between 1986 and 2004. In 22 cases diagnosis of a small (pT1 or pT2) sporadic MTC was incidental and only postoperatively confirmed. Normally total thyroidectomy with neck dissection is standard surgical therapy of a known MTC. Because of postoperative incidental diagnosis in all 22 cases surgical therapy was less then total thyroidectomy. Mutation analysis of RET Proto-Oncogen and familial history were negative in all cases. All patients were systematically followed-up in defined intervals by calcitonin, pentagastrin stimulation test, carcinoembryonic antigen and ultrasound. Median follow-up is 6.2 years (range: 2-13 years) and although a hemithyroidectomy or less was performed all 22 patients are cured by the MTC. We conclude that completion thyroidectomy and neck dissection are not mandatory in such patients, if the tumor is completely resected and genetic background is excluded. Indispensably a systematic long term follow-up of at least 10 years, better a life-long, is mandatory.
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Affiliation(s)
- A Raffel
- Klinik für Allgemein- und Viszeralchirurgie, Heinrich-Heine-Universität, Universitätsklinikum Düsseldorf.
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Raffel A, Krausch M, Cupisti K, Gerharz CD, Eisenberger CF, Knoefel WT. Ghrelin expression in neuroendocrine tumours of the gastrointestinal tract with multiple endocrine neoplasia type 1. Horm Metab Res 2005; 37:653-5. [PMID: 16278790 DOI: 10.1055/s-2005-870535] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Ghrelin is a novel gastrointestinal-brain hormone that was first described by Kojima et al. as a growth-hormone-releasing peptide. It can be isolated and purified from different tissues. Evidence of antiproliferative effects in neoplastic cells (binding to normal and neoplastic tissues) supports the hypothesis that ghrelin also plays an important role in endocrine regulation. Whether ghrelin may be involved in formation of neuroendocrine tumours (NET) of the gastrointestinal tract (GIT) in cases of MEN-1 is under discussion. Over the last sixteen years, 227 patients with GIT NET were treated at our institution. Mutations of the menin gene were identified in twelve patients. Eleven of these tumours (islet cell tumours) were localized in the pancreas and one in the stomach. Tissues from these tumours were resected, fixed in formalin and embedded in paraffin. Sections were examined by immunohistochemistry with a primary antibody for ghrelin. Three out of twelve NET in MEN-1 patients (25%) showed ghrelin expression by immunohistochemistry. Comparison between ghrelin-positive and ghrelin-negative tumours regarding biological activity, morphological aspects and clinicopathological parameters shows no substantial differences. The reported incidence of ghrelin expression in NET of the gastrointestinal tract by MEN-1 was not seen in our patients. Whether or not ghrelin has an influence on neuroendocrine tumour development related to deficient menin-genes is unknown.
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Affiliation(s)
- A Raffel
- Department of General and Visceral Surgery, Heinrich-Heine-University Düsseldorf, Germany.
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Wolf A, Willenberg HS, Cupisti K, Schott M, Geddert H, Raffel A, Bornstein SR, Scherbaum WA, Knoefel WT. Adrenal pheochromocytoma with contralateral cortisol-producing adrenal adenoma: diagnostic and therapeutic management. Horm Metab Res 2005; 37:391-5. [PMID: 16001333 DOI: 10.1055/s-2005-870159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There is evidence for a close interrelation between the adrenomedullary and adrenocortical tissues, and there are well-characterized models of their paracrine interaction. To contribute to the studies of systemic interactions between these tissues, we studied a 52-year-old female patient with a pheochromocytoma and a contralateral cortisol-producing adenoma. Due to a misunderstanding, she presented to her family doctor to have an inherited kidney disease ruled out. An adrenal mass was discovered incidentally by ultrasound. A computerized tomography of the abdomen revealed bilateral adrenal masses. Due to excess catecholamine secretion, bilateral pheochromocytomas based on multiple endocrine neoplasia syndrome were suspected. Laboratory work-up, selective adrenal venous sampling and magnetic resonance imaging studies established the diagnosis of a pheochromocytoma in the right-hand adrenal gland and a cortisol-producing adenoma on the left. Simultaneous bilateral laparoscopic subtotal adrenalectomy was performed. Immunohistochemistry showed positive staining against chromogranin A in a histological specimen obtained from the right-hand adrenal gland, while the left was negative; the left-hand adrenal gland stained positive against the ACTH receptor (MC2R) while the right was negative. Genetically, the patient was negative for MEN2, von Hippel-Lindau disease, and mutations in subunits B, C, and D of the succinate dehydrogenase gene. Although presence of bilateral adrenal adenomas or bilateral adrenal pheochromocytomas in certain inherited disorders are possible, this rare case of an adrenal pheochromocytoma combined with a contralateral cortisol-producing adrenal adenoma may further underline the wide range of complex interactions between the two endocrine systems.
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Affiliation(s)
- A Wolf
- Department of General and Visceral Surgery, University Hospital, Moorenstrasse 5, 40225 Düsseldorf, Germany.
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Raffel A, Cupisti K, Krausch M, Braunstein S, Tröbs B, Goretzki PE, Willnow U. Therapeutic strategy of papillary cystic and solid neoplasm (PCSN): a rare non-endocrine tumor of the pancreas in children. Surg Oncol 2004; 13:1-6. [PMID: 15145028 DOI: 10.1016/j.suronc.2003.09.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Papillary-cystic and solid neoplasm (PCSN) are rare tumors. Two personal observations and a review of the literature are presented with a total of 44 pediatric patients in addition to a total of 67 published cases in the review of Cohen (Pediatr. Surg. Int. 6 (1991) 128) and Snadjauf (Eur. J. Pediatr. Surg. 9 (1999) 416). Overall, PCSN shows a clear predominance in females and only occasionally occurs in males. Typically they grow to a large tumor mass with minimal symptoms. Their histologic and immunocytologic characteristics cause diagnostic difficulties, especially on frozen sections of small biopsies. The tumors are assumed to origin from pluripotent stem cells and present as tumors of low malignancy with a favorable prognosis. Nevertheless 10 children have been reported to develop metastases, 5 have demonstrated an invasive growth pattern and 4 local recurrence. But only two of the 111 pediatric cases have died from their tumor burden. Treatment of choice is a complete surgical resection, which is true for the primary tumor and for metastases as well as local recurrences. In our 2 patients one had spleen-conserving left pancreatic resection and one mesopancreatectomy with roux-en-y-reconstruction leading to long-term cure. Adjuvant therapy in curative resected patients is unnecessary and does not appear to improve prognosis.
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Affiliation(s)
- A Raffel
- Department of General and Trauma Surgery, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, Düsseldorf 40005, Germany.
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Abstract
Pancreas divisum is the most common congenital anomaly of the pancreas, characterized by missing fusion of the ventral and dorsal pancreatic duct. It may cause pancreatitis, but is rarely associated with malignancy.We report herein for the first time the rare association, in a symptomless patient, of multiple neuroendocrine tumors of the pancreas with pancreas divisum and a failure of the exocrine system. Diagnosis was made incidentally by routine abdominal ultrasound. Laboratory examinations and a fine-needle aspiration revealed the neuroendocrine nature of the tumor. Spleen-preserving left pancreas resection was performed, with evidence of multiple neuroendocrine tumors of the pancreas with the typical histological characteristics. Eighteen months later the patient is still free of tumor burden.
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Affiliation(s)
- A Raffel
- Department of General and Visceral Surgery, Heinrich-Heine-University Dusseldorf, Moorenstr. 5, 40225 Dusseldorf, Germany.
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Raffel A, Cupisti K, Dotzenrath B, Krüger B, Ohmann C, Schulte KM, Goretzki PE, Röher HD. [Economic restraints shorten the length of hospital stay: thyroid operation as a model case]. Chirurg 2004; 75:702-5. [PMID: 15138657 DOI: 10.1007/s00104-003-0811-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Decreasing the length of stay is a possible means of cost control in the medical system. Therefore we performed a study to test the feasibility of reducing hospital stay to 2 days after thyroid operation. METHODS In a controlled prospective trial, 238 patients were randomly assigned to group A (2 days of stay) or group B (more than 2 days). Studied were medical standard, practicability, patient acceptance, and quality of life. RESULTS Of those in group A, 56.6% did not leave the hospital at the scheduled 2nd day post operation. Reasons were preoperative hyperthyroidism ( P<0.011), postoperative hypocalcemia ( P<0.03), or unspecific disturbances. In group B, 28% of the patients left before the established borderline of 3-4 days, and only 35% left on the 2nd postoperative day. CONCLUSION Reduced length of stay has no negative influence on medical standards. The quality of life of patients leaving the hospital on the 2nd postoperative day was significantly higher. Reducing hospital stay after thyroid operation to 2 postoperative days is desirable and possible without a loss in quality of care, except in case of postoperative complications or unspecific complaints.
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Affiliation(s)
- A Raffel
- Klinik für Allgemein- und Unfallchirurgie, Universitätsklinikum Düsseldorf.
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Raffel A, Cupisti K, Rees M, Jänig U, Bernbeck B, Jazbec J, Goretzki PE, Göbel U. Spindle Epithelial Tumour with Thymus-like Differentiation (SETTLE) of the Thyroid Gland with Widespread Metastases in a 13-year-old Girl. Clin Oncol (R Coll Radiol) 2003; 15:490-5. [PMID: 14690006 DOI: 10.1016/s0936-6555(03)00153-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Raffel
- Department of Pediatric Haematology and Oncology, Heinrich-Heine-University, Düsseldorf, Germany
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Schulte KM, Cupisti K, Dotzenrath C, Schabram J, Röher HD. The actual role of classic bilateral cervicotomic approach for primary hyperparathyroidism in the era of minimally invasive surgery. Ann Ital Chir 2003; 74:389-93. [PMID: 14971280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
UNLABELLED Recent advances in preoperative localisation of parathyroid adenomas and intraoperative prove of complete removal of hyperfunctioning parathyroid tissue have fostered less invasive operative procedures which directly target the diseased gland. Such strategies have partially replaced the previous gold standard procedure of bilateral neck exploration. We herein report on our own series of 1099 consecutive operations for primary hyperparathyroidism performed in a 16 year period and provide information and arguments for primary bilateral exploration in selected cases. 97.1% of patients were cured by the primary operation. From 1999 through 2001, 200 patients underwent bilateral neck exploration, whereas 63 unilateral operations were performed (33 patients were treated by minimally invasive video-assisted parathyroidectomy (MIVAP) and 30 by minimally invasive open parathyroidectomy (MIOP). In the remaining 200 patients minimally invasive unilateral parathyroid surgery was not feasible due to concomitant goiter (n = 102), lack of preoperative localisation (n = 30), previous thyroid surgery (n = 10), suspected multiglandular disease (n = 10), or other reasons (n = 8). In 40 patients the decision for bilateral neck exploration was made despite feasibility of a unilateral approach. CONCLUSION Whereas unilateral exploration produced excellent cure rates in older patients, it is not recommended in patients with a high likelihood of multiglandular disease, presence of a large or multinodular goitre, high PTH levels, giant adenoma, unclear MIBI scans or an unreliable OPTH assay. Contrasting recent reports on a dramatic shift of technique towards minimally invasive procedures unilateral parathyroid surgery may not be preferably advisable in a majority of patients from countries with insufficient iodine supplementation.
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Affiliation(s)
- K M Schulte
- Heinrich-Heine-Universität, Düsseldorf, Germany.
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Ernst S, Cupisti K, Kemper J, Dotzenrath C, Goretzki PE, Fürst G. Angiographic ablation of an ectopic mediastinal hyperplastic parathyroid gland using a left internal mammary artery coronary bypass. AJR Am J Roentgenol 2003; 181:95-7. [PMID: 12818837 DOI: 10.2214/ajr.181.1.1810095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- S Ernst
- Department of Diagnostic Radiology, University of Duesseldorf, Moorenstr. 5, D-40225 Duesseldorf, Germany.
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Dotzenrath C, Cupisti K, Goretzki E, Mondry A, Vossough A, Grabensee B, Röher HD. Operative treatment of renal autonomous hyperparathyroidism: cause of persistent or recurrent disease in 304 patients. Langenbecks Arch Surg 2003; 387:348-54. [PMID: 12536330 DOI: 10.1007/s00423-002-0322-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2002] [Accepted: 08/26/2002] [Indexed: 11/24/2022]
Abstract
BACKGROUND Subtotal parathyroidectomy (SPTX) and total parathyroidectomy with autotransplantation (TPTX and AT) are standard procedures in the treatment of renal autonomous hyperparathyroidism. In contrast to primary hyperparathyroidism, the persistence/recurrence rate is reported of up to 12.0%. PATIENTS AND METHODS Between 1986 and 2000 we operated on 304 patients with renal autonomous hyperparathyroidism including 14 patients who were admitted after a primary operation in an outside hospital. Mean observation period was 51.4+/-38.9 months. RESULTS The overall persistence/recurrence rate in our patients was 9.0% (26/290). After SPTX, excluding patients with an incomplete operation, it was 3.7%, and after TPTX and AT it was 6.0%. Reasons for developing recurrent or persistent disease in these patients were removal of less than 3.5 glands ( n=12), hyperplastic autograft ( n=5), and supernumerary gland ( n=4). After the first reoperation 7 patients (26.9%) had persistent or recurrent disease. CONCLUSIONS An incomplete primary operation caused by missed cervical glands was the major reason for persistent ( n=8) or recurrent ( n=4) disease after different operative strategies in renal autonomous hyperparathyroidism.
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Affiliation(s)
- C Dotzenrath
- Department of Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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32
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Schulte KM, Cupisti K, Röher HD. [Monitoring the recurrent laryngeal nerve as a routine measure in thyroid gland surgery]. Kongressbd Dtsch Ges Chir Kongr 2002; 118:229-31. [PMID: 11824252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Intra-operative monitoring of the recurrent laryngeal nerve by electromyography of the inner laryngeal muscles facilitates the nerves preparation. The positive and negative predictive values of the method with regard to vocal cord function have not sufficiently been examined. Prospective randomized data concerning the usefulness with regard to permanent nerve palsy rates are lacking. The impressive reduction in palsy rates over the last 20 years is due to routine preparation and protection of the visualized nerve. This principle must not be abandoned. Depending on the setting, neuromonitoring may be a valuable help. It is not an obligation in thyroid surgery.
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Affiliation(s)
- K M Schulte
- Klinik für Allgemein- und Unfallchirurgie, Universitätsklinikum Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf
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Schulte KM, Cupisti K, Röher HD. [Neurostimulation of the recurrent laryngeal nerve--a routine method in thyroid gland surgery?]. Kongressbd Dtsch Ges Chir Kongr 2002; 118:232-3. [PMID: 11824253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Thyroid operations belong to the most frequent procedures in Germany (100,000/year). An important quality parameter is the incidence of postoperative recurrent nerve paralysis. Intraoperative identification by visualization of the nerve with a paralysis rate of 1% is the present gold standard in dedicated centers. PROBLEM Can this results be further improved by use of an intraoperative neuromonitoring system (NM). RESULTS The use of NM is helpful in difficult situations (recurrent goiter, advanced carcinoma, anatomic variants), but a quality improvement is not yet proven. CONCLUSION NM can not replace the current nerve identification by meticulous preparation of anatomic structures. It should be used at the discretion of the operative surgeon.
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Affiliation(s)
- K M Schulte
- Klinik für Allgemein- und Unfallchirurgie, Universitätsklinikum Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf
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Dotzenrath C, Goretzki PE, Sarbia M, Cupisti K, Feldkamp J, Röher HD. Parathyroid carcinoma: problems in diagnosis and the need for radical surgery even in recurrent disease. Eur J Surg Oncol 2001; 27:383-9. [PMID: 11417985 DOI: 10.1053/ejso.2001.1122] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION From 1986 to 1999 we operated on 963 patients with primary hyperparathyroidism (pHPT). METHODS AND RESULTS Parathyroid carcinoma was diagnosed clinically and histologically in four patients (0.4%). In two of these patients diagnosis of parathyroid cancer was delayed by misinterpretation of the histopathology leading to an autotransplantation of malignant parathyroid tissue in one case. In two patients multivisceral surgery was performed: beside thyroidectomy, neck dissection, tracheal wall resection and resection of the muscular layer of the oesophagus one patient received oesophagectomy and gastric transposition and one patient a lung wedge resection. Both patients had a temporary palliation of tumour-associated symptoms after multivisceral surgery. The first patient died 2 years after oesophagectomy and 12 years after primary diagnosis from local tumour recurrence and cachexia. The second patient is living with tumour recurrence presenting a serum calcium level of 4.2 mmol/l (normal range 2.0 to 2.5 mol/l) and multiple brown tumours 2 years after lung resection and 6 years after the primary diagnosis. CONCLUSIONS We conclude that parathyroid carcinomas, being difficult to diagnose, warrant radical surgery, including multivisceral resection to prolong survival and reduce tumour and hypercalcaemia associated symptoms.
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Affiliation(s)
- C Dotzenrath
- Department of Surgery, Heinrich Heine-University Düsseldorf, Düsseldorf, Germany.
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35
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Saleh A, Cupisti K, Fürst G, Feldkamp J, Grust A, Mödder U. Erlaubt das Tissue Harmonic Imaging eine frühe postoperative Schilddrüsenvolumetrie? ROFO-FORTSCHR RONTG 2001; 173:325-8. [PMID: 11367841 DOI: 10.1055/s-2001-12459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AIM Therapy for endemic goitre after surgical resection depends on the residual thyroid volume. Post-operative changes have been known to impair the fundamental sonographic evaluation of residual thyroid tissue. It was our aim to determine whether THI is a feasible method for thyroid volumetry after surgery. METHODS 48 patients underwent thyroidectomy, hemithyroidectomy, near total resection, or partial resection of the thyroid gland. In all patients THI of the neck was performed 4 (mean; range: 2-7 days) days after surgery using an Elegra sonographic device (Siemens, Erlangen, Germany) with a transmitted frequency of 3.4 MHz and received frequency of 6.8 MHz. The examiner was blinded to the patient's diagnosis and the type of surgery. The residual tissue volume measured by means of THI and intra-operative volumetry were both compared to sonographic volumetry 12 weeks after surgery, the latter serving as the gold standard. Accuracy of THI and intraoperative volumetry were tested for significant differences using a paired t-test. RESULTS Volumetry by the surgeon was available in 26 patients (54%). The men error of THI volumetry was 2.4 ml (SD: 3.3 ml; maximum: 17 ml). The mean error of intraoperative volumetry was 1.4 ml (SD: 1.9 ml; maximum: 6 ml). The mean difference between THI and intraoperative volumetry was 1 ml (SD: 2.7 ml; maximum: 7 ml; p = 0.085). CONCLUSIONS THI permits early volumetry of the residual tissue after thyroid surgery comparable with the intraoperative volumetry. Thus, THI may be helpful in guiding the substitution of thyroid hormones.
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Affiliation(s)
- A Saleh
- Institut für Diagnostische Radiologie, Heinrich-Heine-Universität Düsseldorf.
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Dotzenrath C, Cupisti K, Goretzki PE, Yang Q, Simon D, Ohmann C, Röher HD. Long-term biochemical results after operative treatment of primary hyperparathyroidism associated with multiple endocrine neoplasia types I and IIa: is a more or less extended operation essential? Eur J Surg 2001; 167:173-8. [PMID: 11316400 DOI: 10.1080/110241501750099294] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To analyse our long term results in patients operated on for primary hyperparathyroidism associated with multiple endocrine neoplasia types I and IIa. DESIGN Retrospective (data collection) and prospective (follow-up) analysis. SETTING University hospital, Germany. SUBJECTS 39 patients with MEN type I-associated and 7 patients with MEN-type-IIa-associated primary hyperparathyroidism. INTERVENTIONS Subtotal parathyroidectomy (n = 25 with MEN I and 1 with MEN IIa), total parathyroidectomy and autotransplantation (one in each group) and removal of only enlarged glands (13 with MEN type I and 5 with MEN type IIa). MAIN OUTCOME MEASUREMENTS Recurrence rate of hyperparathyroidism and permanent hypocalcaemia postoperatively. RESULTS Subtotal parathyroidectomy in patients with MEN type I gave a significantly lower recurrence rate than removal of only enlarged glands (3/25 compared with 3/13, log rank, p = 0.04). Permanent hypocalcaemia developed in 3/25 compared with 3/13, respectively. 2/5 patients with MEN type IIa developed recurrences after removal of only enlarged glands and the rate was higher than expected. CONCLUSIONS A more extensive operation is essential for patients with MEN type I; the rate of permanent hypocalcaemia is not increased, but the recurrence rate is reduced. Patients with MEN type IIa should be treated by excision of enlarged glands alone, but this may be extended to subtotal parathyroidectomy in patients with severe symptoms.
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Affiliation(s)
- C Dotzenrath
- Department of Surgery, Heinrich Heine University Düsseldorf, Germany
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Dotzenrath C, Goretzki PE, Cupisti K, Simon D, Witte J, Yang Q, Ohmann C, Röher HD. Is there any consensus in diagnostic and operative strategy with respect to medullary thyroid cancer? A questionnaire answered by 73 endocrine surgical units. Langenbecks Arch Surg 2001; 386:47-52. [PMID: 11405089 DOI: 10.1007/s004230000186] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this investigation was to analyze the individual diagnostic and operative strategy in the treatment of medullary thyroid carcinoma (MTC) in international specialized centers and to assess whether standard procedures are carried out in practice everywhere. METHODS A questionnaire concerning diagnosis and treatment of patients with primary, persistent, or recurrent sporadic or familial MTC was sent to 263 members of the International Association of Endocrine Surgeons. RESULTS Primary treatment of MTC does not show significant differences for patients with sporadic or familial disease (Chi-square, n.s.), and standard procedures are performed in only 25-40% of patients. Computed tomography scan is the most common localization procedure in persistent or recurrent disease (52-72%), followed by scintigraphy (43-71%), ultrasonography (41-56%), and magnetic resonance imaging (31-49%). In case of negative localization studies, 68-86% of colleagues do not recommend reoperation. In symptomatic patients with stage-IV tumors, however, 84% of colleagues advocate reoperation to provide relief from the tumor burden. CONCLUSIONS Even with experienced endocrine surgeons, a consensus to uni- and/or bilateral neck dissection in primary MTC is lacking. The majority of authors supports at least total thyroidectomy with central lymph-node dissection. In recurrent disease, there is a general tendency to reoperate in case of positive localization studies and in case of symptomatic disease.
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Affiliation(s)
- C Dotzenrath
- St. Antonius Kliniken, Marienheim, Hardtstr. 46, D-42107 Wuppertal, Germany.
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Abstract
BACKGROUND In contrast with multiple endocrine neoplasia type 2, malignancies are of minor importance in multiple endocrine neoplasia type 1 (MEN 1) syndrome. METHODS The data for 42 patients with MEN 1 syndrome were evaluated. Twelve patients (29%) had 1 or more associated malignancies: malignant gastrinoma (1 patient), neuroendocrine tumors of the thymus (2 patients), neuroendocrine tumors of the lung (3 patients), neuroendocrine tumor of the ileum (1 patient), adrenocortical carcinomas (2 patients), and a combination of neuroendocrine tumors of thymus, lung or pancreas (3 patients). RESULTS Despite suspected MEN 1 syndrome in 7 patients, malignancies were detected late in 4 patients and could not be resected curatively. The survival rates for 5 years and 10 years after operation of the malignant tumor were 66% +/- 14% (SE) and 33% +/- 15% (SE), respectively. CONCLUSIONS In patients at risk for the MEN 1 syndrome, genetic screening is indispensable. Gene carriers have to be followed up closely with hormone analysis and routine examination of the thorax, pancreas, and adrenal glands to detect malignancies as early as possible.
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Affiliation(s)
- C Dotzenrath
- Department of Surgery, Heinrich-Heine Universität, Düsseldorf, Germany
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Cupisti K, Simon D, Wolf A, Gerharz CD, Goretzki PE, Dotzenrath C, Witte J, Röher HD. Surgical treatment of postoperative, incidentally diagnosed small sporadic C-cell carcinomas of the thyroid. Langenbecks Arch Surg 2000; 385:526-30. [PMID: 11201009 DOI: 10.1007/s004230000166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS The surgical strategy in small sporadic C-cell carcinomas of the thyroid that are incidentally diagnosed after goiter resection for benign disease is controversial. It remains unclear whether a completion thyroidectomy should be performed in every case. PATIENTS AND METHODS We present nine patients who were operated on between October 1992 and October 1997 in whom an unexpected, small sporadic C-cell carcinoma (seven with pT1, two with pT2) was found in the postoperative histology. RESULTS All patients were calcitonin negative and there were no signs of the disease being inherited (no familial history, negative RET proto-oncogene). No patient underwent a completion thyroidectomy. All patients had a follow-up with pentagastrin-stimulated calcitonin and carcinoembryonic antigen (CEA) 3 months, 6 months and annually after the operation. No patient became calcitonin positive or showed any other signs of tumor recurrence after a follow-up period of 2-7 years. CONCLUSION A completion thyroidectomy is not necessary in small sporadic C-cell carcinoma that is incidentally diagnosed after resection for benign disease if there is no sign of familial cancer and if calcitonin is negative. A close follow-up is necessary.
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Affiliation(s)
- K Cupisti
- Klinik für Allgemein und Unfallchirurgie, Heinrich-Heine-Universität Düsseldorf, Germany
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Abstract
BACKGROUND Multiple endocrine neoplasia type 1 (MEN 1) is an autosomal dominant familial cancer syndrome characterized by tumours of the parathyroids, anterior pituitary gland and endocrine pancreas. Since the cloning of the MEN1 gene (encoding menin) on chromosome 11q13 by Chandrasekharappa et al. in 1997, it has become possible to identify mutations that are responsible. We examined whether MEN1 gene mutations are present in sporadic insulinomas, a rare sporadic tumour that is seen more frequently in patients with the MEN 1 syndrome. PATIENTS AND METHODS We sequenced the coding part of the MEN1 gene (exons 2-10) in tumour tissue of 27 patients suffering from an insulinoma (24 benign, three malignant). To validate our methods we also examined tumour tissue from five patients with primary hyperparathyroidism (HPT) at a younger age and/or multiple gland disease, with increased risk of MEN 1. RESULTS We found no mutations in the nine coding exons of the MEN1 gene in the insulinoma tissues. We could confirm three benign polymorphisms (S145S, R171Q, D418D) reported previously. In the control patients we found two new point mutations (one mis-sense, one non-sense mutation) and one deletion. CONCLUSION Mutations of the MEN1 gene do not play an important role in the pathogenesis of sporadic insulinomas. Therefore genetic screening is not cost effective in sporadic insulinoma patients without other indicators of MEN 1. Patients with primary HPT at a younger age and/or multiple gland disease should be screened for MEN1 gene mutations.
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Affiliation(s)
- K Cupisti
- Heinrich-Heine-University, Düsseldorf; Institute for Hormone and Fertility Research at the University of Hamburg, Hamburg, Germany
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Goretzki PE, Höppner W, Dotzenrath C, Clark OH, Simon D, Cupisti K, Schulte H, Röher HD. Genetic and biochemical screening for endocrine disease. World J Surg 1998; 22:1202-7. [PMID: 9841744 DOI: 10.1007/s002689900545] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The development of biochemical and genetic screening tests for inherited endocrine diseases has dramatically changed our approach to surgical patients with endocrine tumors. Among more than 1800 patients with endocrine tumors and a possible inherited disease operated on between 1986 and 1997, there were 6.1% to 7.3% who were found to have a familial disease associated with familial medullary thyroid cancer, (MTC), multiple endocrine neoplasia type IIa (MEN-IIa), MEN-IIb, or MEN-I. Genetic testing for the RET proto-oncogene is therefore recommended for all patients with MTC, and testing for the MEN-I gene is recommended in patients with suspected MEN-I and in specific clinical subgroups with an increased probability of endocrine tumor heredity. Early treatment based on early diagnosis by genetic testing appears to improve survival and to decrease morbidity in these patients.
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Affiliation(s)
- P E Goretzki
- Chirurgische Klinik A, Heinrich-Heine-Universität Düsseldorf, Germany
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Cupisti K, Simon D, Dotzenrath C, Goretzki PE, Röher HD. [Results of selective venous site-specific catheterization in occult C-cell carcinoma of the thyroid gland]. Langenbecks Arch Chir 1998; 382:295-301. [PMID: 9498199 DOI: 10.1007/s004230050070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Medullary thyroid carcinoma (MTC) can--even in recurrent cases--only be treated surgically. Therefore, preoperative localization of the tumor is essential. METHODS From April 1986 through April 1997, 137 patients with MTC were operated on at our clinic. In 22 patients with recurrent tumor which had not been radiologically localized, 28 selective venous catheterizations (SVC) with determination of calcitonin levels were carried out. RESULTS In 23 examinations a suspected tumor could be identified (nine cervical unilateral, seven mediastinal, four cervical unilateral and mediastinal, one cervical bilateral and mediastinal, one liver, one cervical unilateral and liver). In 18 cases surgery was performed for recurrence (nine cervical revisions, one mediastinal dissection, six cervicomediastinal dissections, two laparotomies). In 15 of 18 cases, tumor tissue was found in the previously suspected area. In ten cases serum calcitonin levels dropped postoperatively by 6%-75%. A normalization of the hormone level was achieved only once by yet another operation. During further follow-up, five of the reoperated patients died from their disease. The other 17 patients are being followed up, whereby calcitonin levels are elevated but there is no clinical or radiological evidence of tumor. CONCLUSIONS Although in the patient cohort presented a normalization of serum calcitonin could be achieved only once, the authors consider SVC useful because it is the only means of localization of tumor tissue in cases of negative radiologic studies and therefore allows a planned approach to the operation procedure in these cases.
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Affiliation(s)
- K Cupisti
- Klinik für Allgemein- und Unfallchirurgie, Heinrich-Heine-Universität Düsseldorf, Germany
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Abstract
Neuroendocrine tumors of the thymus, also known as thymic carcinoids, are rare tumors of the anterior mediastinum. They occur sporadically or in association with MEN I syndrome. We present five patients (four male, one female; age of first manifestation 19-53 years) who were operated on at our hospital between 1984 and 1995 for neuroendocrine thymic tumors. A hormone-producing tumor presented with Cushing's syndrome in two patients. Two patients had MEN I syndrome. Only in the female patient the primary tumor was confined to the thymus. We found lymph node metastases in three patients and a distant metastasis in one. The neuroendocrine tumors have a high rate of local recurrences and thus we performed 11 operations using a transthoracic or transsternal approach. Since there was no operative mortality and adjuvant therapies are of limited value, we recommend surgery even in case of recurrence.
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Affiliation(s)
- K Cupisti
- Klinik für Allgemein und Unfallchirurgie, Heinrich-Heine-Universität Düsseldorf
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Dotzenrath C, Teh BT, Farnebo F, Cupisti K, Svensson A, Toell A, Goretzki P, Larsson C. Allelic loss of the retinoblastoma tumor suppressor gene: a marker for aggressive parathyroid tumors? J Clin Endocrinol Metab 1996; 81:3194-6. [PMID: 8784068 DOI: 10.1210/jcem.81.9.8784068] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Allelic loss of the retinoblastoma tumor suppressor gene has recently been shown to be highly specific for parathyroid carcinoma. It has been proposed that this genetic abnormality may have diagnostic and prognostic implications for parathyroid carcinoma, but to date no further studies are available to substantiate these findings. In the present study, three cases of atypical recurrent hyperparathyroidism were examined: a patient with parathyroid carcinoma and an autotransplanted adenoma that progressed into carcinoma, a patient with recurrent juvenile hyperparathyroidism, and a patient with severe recurrent secondary hyperparathyroid disease due to rapidly growing autotransplant. Six pairs each of sporadic parathyroid adenoma and secondary parathyroid disease were also studied for comparison. Allelic losses of RB and D13S71 at 13q14 was found in the parathyroid carcinoma and the corresponding autotransplant that had previously been considered benign tissue and in the case of recurrent juvenile hyperparathyroidism, but not in any of the other tumors. Our findings support the findings of the previous study that RB or 13q loss is specific for parathyroid tumors with increased aggressiveness and might be of clinical significance.
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Affiliation(s)
- C Dotzenrath
- Department of Surgery, Heinrich Heine Universität, Dusseldorf, Germany
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