[Diffuse pulmonary meningotheliomatosis]. / Diffuse pulmonale Meningotheliomatose.

In two patients with bilateral micronodular pulmonary changes a diffuse pulmonary meningotheliomatosis was found. A 73-year-old woman presented with bilateral disseminated miliary pulmonary nodules as a radiological incidental finding. The surgical lung biopsy showed multiple tiny nodular proliferations meningothelial-like cells, corresponding "minute pulmonary meningothelial-like nodules", MPMN. A 60-year-old lady with similar radiological findings showed also proliferations of meningothelial-like cells in a transbronchial cryo-biopsy. These lesions are well known to pathologists as curious isolated incidental findings on histological examination of lung specimens. The here described diffuse form of these changes is very rare; its knowledge is important for the differential diagnosis with neoplastic proliferations and other diffuse parenchymal diseases of the lung. This rare diagnosis is made on histological grounds and is also possible in transbronchial biopsies when careful correlation with clinical and radiological data, knowledge of the entity and adequate specimens are provided.

Enhanced immune response to MMP3 stimulation in microglia expressing mutant huntingtin.

Huntington's Disease (HD) is an inherited neurodegenerative disease caused by a polyglutamine expansion in the huntingtin protein. The YAC128 mouse model of HD expresses the full-length human huntingtin protein with 128 CAG repeats and replicates the phenotype and neurodegeneration that occur in HD. Several studies have implicated a role for neuroinflammation in HD pathogenesis. Studies on presymptomatic HD patients have illustrated microgliosis (activated microglia) in brain regions affected in HD. Mutant huntingtin expressing isolated primary monocytes (human HD patients) and primary macrophages (YAC128) are overactive in response to lipopolysaccharide (LPS) stimulation. In this study we demonstrate that cultured primary microglia (the resident immune cells of the brain cells) from YAC128 mice differentially express a wide number of cytokines compared to wildtype microglia cultures in response to LPS. Furthermore, this study outlines a direct interaction between mutant huntingtin and cytokine secretion in HD microglia. Increased cytokine release in YAC128 microglia can be blocked by cannabinoid activation or by mutant huntingtin knockdown with anti-sense oligonucleotide treatment. Matrix metalloprotease 3 (MMP3), an endogenous neuronal activator of microglia, also induces increased cytokine release from YAC128 microglia compared to wildtype microglia. We found elevated MMP levels in HD CSF, and MMP levels correlate with disease severity in HD. These data support a novel role for MMPs and microglial activation in HD pathogenesis. With an improved understanding of the specific cellular processes involved in HD neuroinflammation, novel therapeutic agents targeting these processes can be developed and hold great promise in the treatment of HD.

The effect of cryopreservation on hormone secretion in vitro and morphology of human parathyroid tissue.

The hormone secretion from human parathyroid tissue autografted after cryopreservation can fail frequently. In this study we examined the effects of the cryopreservation procedure on parathyroid hormone secretion in vitro and the viability of parathyroid cells to identify possible reasons for graft failure. Cryopreservation did not affect quantitative parathyroid hormone release from single-cell suspensions or its calcium-and magnesium-dependent regulatory mechanisms. However, morphometric analysis of thawed 1 mm3 graft particles showed various degrees of necrosis when compared with fresh grafts. Thus partial necrosis of cryopreserved tissue appears to contribute to poor transplantation results compared with immediate replantation of fresh parathyroid tissue. This limitation can be overcome by increasing the number of frozen graft particles used for autotransplantation. The percentage of viable cells should be accounted for by morphometric analysis and this factor used when calculating the number of graft particles employed.

[Embolization of a pseudoaneurysm of the hepatic artery with hemobilia by direct percutaneous puncture]. / Embolisation eines Pseudoaneurysmas der A. hepatica mit Hämobilie durch direkte perkutane Punktion.

Haemobilia is a rare cause of gastrointestinal bleeding that carries a high mortality. It occurs as a complication of percutaneous trans-hepatic biliary drainage in up to 6% cases. The cause is usually a pseudo-aneurysm of the hepatic artery, which can be treated by trans-catheter embolisation. If this fails, direct puncture and embolisation of the aneurysm is a possible alternative to surgical ligation of the hepatic artery.

[B-scan sonography for tumour localisation in hyperparathyroidism (author's transl)]. / B-Scan-Sonographie zur Lokalisationsdiagnostik beim Hyperparathyreoidismus.

Thirty-four patients with known primary, secondary or tertiary hyperparathyroidism were examined sonographically in order to localise the enlarged glands. Of 40 tumours found at operation, 27 (67%) could be demonstrated sonographically as oval or round structures with low echoes. The smallest tumour diagnosed pre-operatively was 10 x 5 x 4 mm. Sonography is useless for adenomas in the mediastinum. Sonographic localisation is desirable before primary operations for hyperparathyroidism, although it is not indispensable for the experienced surgeon. Sonography is essential before surgery for recurrences and should be performed before CT, arteriography or selective parathormone sampling.

[Reoperations in persistent and recurrent secondary hyperparathyroidism]. / Reoperationen bei persistierendem und rezidivierendem sekundären Hyperparathyreoidismus.

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

[Surgical techniques for benign goiter]. / Taktik und Technik der partiellen Schilddrüsenresektion.

For surgical therapy of benign thyroid diseases several different procedures are available. The specific use of these techniques depends on the particular morphologic and functional findings. Tissue that is benign is left in place as far as possible - pathologically changed tissue has to be removed. Practicable operation techniques are: excision or enucleation of solitary thyroid nodule, upper or lower pole resection, subtotal resection, near total resection and hemithyroidectomy.

[Reoperations in persistent and recurrent secondary hyperparathyroidism]. / Reoperationen bei persistierendem und rezidivierendem sekundärem Hyperparathyreoidismus.

Forty-seven reoperations for persistent or recurrent secondary hyperparathyroidism (HPT) in 29 patients are reported. The patients are part of a group of 181 patients operated on for secondary HPT between 1975 to 1986. Most reoperations were performed in the neck (26 operations in 17 patients). The main cause were remaining parathyroid glands in the mediastinum (9 patients), followed by normally localized glands in the neck, which had not been discovered during previous operations. In 7 patients a hyperplasia of the autografted tissue was the reason for recurrent disease. They were treated by resection of the autograft. In 10 other patients autologous cryopreserved parathyroid tissue was reimplanted because of persistent postoperative hypoparathyroidism.

[Autotransplantation of cold preserved human parathyroid gland tissue. Indications--technic--results]. / Autotransplantation von kältekonserviertem menschlichem Nebenschilddrüsengewebe. Indikationen--Technik--Ergebnisse.

Autotransplantation of cryopreserved tissue is of increasing clinical value after parathyroid surgery became more common. The results in the literature show a high rate of non functioning grafts after autotransplantation of cryopreserved tissue in comparison to fresh autografted tissue. The reason for that is a partial necrosis of the tissue caused by the freezing and thawing process. To obtain better results after autotransplantation of cryopreserved tissue the rate of necrosis should be estimated. The loss of functioning cells should be compensated by autografting a greater amount of tissue fragments.

[Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation in secondary hyperparathyroidism. A randomized study]. / Subtotale Parathyreoidektomie versus totale Parathyreoidektomie mit Autotransplantation beim sekundären Hyperparathyreoidismus. Eine randomisierte Studie.

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

[Simplified procedure for cold preservation of human parathyroid gland tissue for replantation]. / Vereinfachtes Verfahren der Kältekonservierung von menschlichem Nebenschilddrüsengewebe zur Replantation.

A simplified technique for cryopreservation of human parathyroid tissue is described. It allows to achieve the same quality of tissue than using the programmable expensive freezing method which is usually employed up to now. Cryovials are placed in a methanol bath. The temperature is decreased by -1 degree C/min down to -25 degrees C, thereafter by -10 degrees C/min down to -70 degrees C by repeated adding of cryo ice-cubes into the methanol. Thereafter the vials are stored in LN2. The temperature lowering is controlled by a stop watch and a thermometer in a reference vial. This simple and cheap technique may allow a more general application of cryopreservation in surgery of hyperparathyroidism.

[Perioperative antibiotic prophylaxis (single or multiple dose) in elective colorectal surgery. A randomized study]. / Perioperative Antibioticaprophylaxe (Einmal- oder Mehrfachgabe) bei elektiven colorectalen Eingriffen. Eine randomisierte Studie.

In a randomized trial in 60 patients undergoing elective colorectal surgery the efficiency of intravenous antibiotic short time prophylaxis was determined. We compared single dose application with multiple dose prophylaxis for 24 h. The substance used was cefotaxime. The rate of wound infections was comparable in both groups (16.6 vs. 13.3%) as well as postoperative infections of the urinary tract (33.3 vs. 23.3%). The results of the study suggest that single dose prophylaxis is as efficient as multiple dose application to reduce postoperative infections in elective colorectal surgery.

[Simplified storage procedure of cryopreserved human parathyroid tissue]. / Vereinfachtes Lagerungsverfahren von kältekonserviertem menschlichem Nebenschilddrüsengewebe.

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

[Diagnostic and therapeutic procedures in splenic and hepatic artery aneurysms]. / Diagnostische und therapeutische Vorgehensweisen beim Milz- und Leberarterienaneurysma.

The diagnosis and therapy of splenic and hepatic artery aneurysms is besides clinical findings based on ultrasound and selective arteriography. Surgical treatment depends on the exact localization of the aneurysm. Because of postsplenectomy sepsis preservation of spleen should be reached. Otherwise splenectomy with resection of the aneurysm must be performed. If the aneurysm is localized at the common hepatic artery ligation of the vessel is possible. The interposition of an autologous vein graft is the most favorable proceeding in aneurysms of proper hepatic artery. Those of intrahepatic arteries should be treated just as aneurysms in high risk patients by selective percutaneous embolization.

[Normal value of the number of lymph nodes in the epigastrium. An anatomic study for lymphadenectomy in stomach cancer]. / Normalwert der Lymphknotenzahl im Oberbauch. Eine anatomische Studie zur Lymphadenektomie beim Magencarcinom.

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

[Surgical therapy of lung complications of long-term ventilation for severe adult respiratory distress syndrome]. / Chirurgische Therapie von Lungenkomplikationen bei Langzeitbeatmung wegen schweren ARDS.

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