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1.
Intra-operative quick insulin assay to confirm complete resection of insulinomas guided by selective arterial calcium injection (SACI) 总被引:1,自引:0,他引:1
Oliver Gimm Evelyn König Phuong Nguyen Thanh Michael Brauckhoff Wolfram Karges Henning Dralle 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2007,392(6):679-684
Background and aims Insulinomas are rare endocrine disorders. Pre-operatively, conventional imaging techniques often fail to localise the tumor.
In addition, due to the lack of quick insulin assays, intra-operative confirmation of complete resection was impossible until
recently.
Materials and methods Six patients with biochemical evidence of an insulinoma underwent pre-operative localisation studies and selective arterial
calcium injection (SACI). In addition, insulin was measured before surgery and every 10–15 min after resection of the tumor
using a quick insulin assay.
Results Pre-operative localisation studies identified the tumor correctly as follows: endosonography: three of four, magnetic resonance
imaging: two of four and SACI: six of six. Tumors in the head and body were enucleated while those in the tail were resected
(n = 2, each). Those three patients, in whom magnetic resonance imaging and/or endosonography could localise the tumors pre-operatively,
underwent laparoscopic surgery while the remaining three patients underwent open surgery. Intra-operatively, insulin dropped
to normal levels within 20 min in all cases. After a follow-up of 0.8–3 years, all patients remained biochemically cured.
Conclusions Pre-operatively, SACI appears to be a very sensitive localisation technique and may be most helpful in guiding the surgeon
if conventional imaging techniques fail to localise the tumor. Complete removal of an insulinoma can be reliably predicted
using a quick insulin assay.
This paper was presented at the 2nd Biennial Meeting of the European Society of Endocrine Surgeons (ESES), May 18–20, 2006,
Krakow, Poland. 相似文献
2.
Herzog BA Ott PA Dittrich MT Quast S Karulin AY Kalbacher H Karges W Tary-Lehmann M Lehmann PV Boehm BO Durinovic-Belló I 《Journal of autoimmunity》2004,23(1):45-54
Active T cell recognition of islet antigens has been postulated as the pathogenic mechanism in human type 1 diabetes, but evidence is scarce. If T cells are engaged, they are expected to display increased clonal size and exhibit a T helper (Th)1/Th2 differentiation state. We used a peptide library that covers tyrosine phosphatase IA-2, a target antigen expressed in pancreatic beta cells, to probe 8 diabetic patients and 5 HLA-matched controls. When tested in a high resolution IFNgamma/IL-4 double color ELISPOT assay directly ex vivo, the number of IA-2-reactive IFNgamma producing cells was 17-fold higher in patients than in controls and IL-4 producing cells were not present. An average of 9 peptides was recognized in the patients vs. one in the controls. Determinant recognition primarily involved CD4+ cells and showed high variability among the patients. Furthermore, anti-CD28 antibody signal enhances quantitative assessment of effector T cells in T1D patients. In vitro expansion with peptides and IL-2 results in detection of responding cells in the controls and loss of disease specificity of the T cell response. Together these data provide strong evidence for the active targeting of IA-2 by Th1 memory effector cells in human type 1 diabetes. 相似文献
3.
D'Souza Vinita N.; Man Nguyen thi; Morris Glenn E.; Karges Wolfram; Pillers De-Ann M.; Ray Peter N. 《Human molecular genetics》1995,4(5):837-842
Dystrophin is present in the outer plexiform layer of the retinaand is required for normal retinal function as measured by electroretinography.We describe the identification of a novel isoform of dystrophln(Dp260) present in the mouse retina. The unIque 5' terminusof the mRNA originates from a newly identified exon and is splicedin frame to exon 30 of the Duchenne muscular dystrophy (DMD)gene. The retinal isoform of dystrophln has 13 novel amino acidsas its N-terminus followed by most of the dystrophin rod domainand the cysteine-rich C-terminal domains. Analysis of mousetissues indicated this isoform of dystrophin Is expressed inretina, brain and cardiac tissue. Comparison of retinal electrophysiologyin mdx and mdxcv3 mouse suggests that Dp260 is required fornormal retinal function. 相似文献
4.
One hundred seven pilon fractures in 107 patients were treated according to a staged prospective protocol. All pilon fractures were stabilized immediately by the application of calcaneal traction. Open fractures or fractures in patients with multiple injuries were stabilized with traveling traction that was applied in the operating room. A distraction computed tomography scan was obtained before definitive treatment. Treatment groups were based on the degree of soft tissue compromise. Forty-one patients with Tscherne Grade 0 or Grade I injuries underwent open reduction and internal fixation (open plating) using contemporary techniques and low-profile implants. Sixty-four patients with Tscherne Grade II and Grade III closed injuries and all patients with open fractures underwent definitive treatment with limited open reduction and stabilization using small wire circular external fixators. Clinical and radiographic evaluations were performed at an average 4.9 years after injury. For all fracture types (AO classification), 81% of the patients who were treated with external fixation and 75% of the patients who were treated with open plating had good or excellent results. For severe fracture patterns (Type C), patients in both groups had significantly poorer results than patients with Types A and B fractures. The patients in the open plating group had a significantly higher rate of nonunion, malunion, and severe wound complications compared with the patients who received external fixation for Type C fracture patterns. Because of the increased incidence of bony and soft tissue complications when treating open or closed Type C fractures, use of limited exposures and stabilization with small wire circular external fixators is recommended. 相似文献
5.
Karges W Jostarndt K Maier S Flemming A Weitz M Wissmann A Feldmann B Dralle H Wagner P Boehm BO 《The Journal of endocrinology》2000,166(1):1-9
Germ line mutations of the multiple endocrine neoplasia type 1 (MEN1) tumour suppressor gene cause MEN1, a rare familial tumour syndrome associated with parathyroid hyperplasia, adenoma and hyperparathyroidism (HP). Here we investigated the role of the MEN1 gene in isolated sporadic and familial HP. Using RT-PCR single-strand conformational polymorphism screening, somatic (but not germ line) mutations of the MEN1 coding sequence were identified in 6 of 31 (19.3%) adenomas from patients with sporadic primary HP, but none in patients (n=16) with secondary HP due to chronic renal failure. MEN1 mutations were accompanied by a loss of heterozygosity (LOH) for the MEN1 locus on chromosome 11q13 in the adenomas as detected by microsatellite analysis. No DNA sequence divergence within the 5' region of the MEN1 gene, containing the putative MEN1 promoter, was detectable in HP adenomas. Clinical characteristics were not different in HP patients with or without MEN1 mutation. Heterozygous MEN1 gene polymorphisms were identified in 9.6% and 25% of patients with primary and secondary HP respectively. In a large kindred with familial isolated familial HP, MEN1 germ line mutation 249 del4 and LOH was associated with the HP phenotype and a predisposition to non-endocrine malignancies. We suggest that the bi-allelic somatic loss of MEN1 wild-type gene expression is involved in the pathogenesis of a clinically yet undefined subset of sporadic primary HP adenomas. MEN1 genotyping may further help define the familial hyperparathyroidism-MEN1 disease complex, but it seems dispensable in sporadic primary HP. 相似文献
6.
Kreitschmann-Andermahr Ilonka Siegel Sonja Unger Nicole Streetz-van der Werf Christine Karges Wolfram Schilbach Katharina Schröder Bernadette Szybowicz Janine Sauerwald Janina Zopf Kathrin Grzywotz Agnieszka Bidlingmaier Martin Sommer Heide Strasburger Christian J. 《Pituitary》2020,23(5):479-487
Pituitary - While reasons for non-adherence in children requiring growth hormone (GH) replacement (GH-Rx) are well researched, few studies have investigated adherence in adult GH deficient... 相似文献
7.
Daily insulin doses and injection frequencies of neutral protamine hagedorn (NPH) insulin,insulin detemir and insulin glargine in type 1 and type 2 diabetes: a multicenter analysis of 51 964 patients from the German/Austrian DPV‐wiss database 下载免费PDF全文
8.
Karges W Rajasalu T Spyrantis A Wieland A Boehm B Schirmbeck R 《European journal of immunology》2007,37(8):2097-2103
Type 1 diabetes mellitus can result from the specific destruction of pancreatic beta cells by autoreactive T cells. As shown here, experimental autoimmune diabetes (EAD) is efficiently induced in RIP-B7.1 mice by preproinsulin (ppins)-encoding DNA vaccines. EAD develops in RIP-B7.1 mice within 3-4 wk after a single immunization with ppins-encoding plasmid DNA. RIP-B7.1 mice develop insulitis, insulin deficiency and hyperglycemia after vaccination with plasmids encoding murine ppins-I or murine ppins-II or human hu-ppins. EAD induction critically depends on CD8 T cells and is independent of CD4 T cells. To be diabetogenic, ppins-specific CD8 T cells had to express IFN-gamma. Neither expression of perforin nor signaling through the type I IFN receptor is an essential component of this pathogenic CD8 T cell phenotype. Using plasmids encoding truncated ppins variants, we show that EAD is only induced by DNA vaccines encoding the insulin A-chain. Diabetogenic CD8 T cells specifically recognize the Kb-restricted A12-21 epitope of the insulin A-chain. The RIP-B7.1 model hence represents an attractive model for the characterization of cellular and molecular events involved in the CD8 T cell-mediated immune pathogenesis of diabetes. 相似文献
9.
Henning Dralle Thomas J. Musholt Jochen Schabram Thomas Steinmüller Andreja Frilling Dietmar Simon Peter E. Goretzki Bruno Niederle Christian Scheuba Thomas Clerici Michael Hermann Jochen Kußmann Kerstin Lorenz Christoph Nies Peter Schabram Arnold Trupka Andreas Zielke Wolfram Karges Markus Luster Kurt W. Schmid Dirk Vordermark Hans-Joachim Schmoll Reinhard Mühlenberg Otmar Schober Harald Rimmele Andreas Machens 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2013,398(3):347-375
Introduction
Over the past years, the incidence of thyroid cancer has surged not only in Germany but also in other countries of the Western hemisphere. This surge was first and foremost due to an increase of prognostically favorable (“low risk”) papillary thyroid microcarcinomas, for which limited surgical procedures are often sufficient without loss of oncological benefit. These developments called for an update of the previous practice guideline to detail the surgical treatment options that are available for the various disease entities and tumor stages.Methods
The present German Association of Endocrine Surgeons practice guideline was developed on the basis of clinical evidence considering current national and international treatment recommendations through a formal expert consensus process in collaboration with the German Societies of General and Visceral Surgery, Endocrinology, Nuclear Medicine, Pathology, Radiooncology, Oncological Hematology, and a German thyroid cancer patient support organization.Results
The practice guideline for the surgical management of malignant thyroid tumors includes recommendations regarding preoperative workup; classification of locoregional nodes and terminology of surgical procedures; frequency, clinical, and histopathological features of occult and clinically apparent papillary, follicular, poorly differentiated, undifferentiated, and sporadic and hereditary medullary thyroid cancers, thyroid lymphoma and thyroid metastases from primaries outside the thyroid gland; extent of thyroidectomy; extent of lymph node dissection; aerodigestive tract resection; postoperative follow-up and surgery for recurrence and distant metastases.Conclusion
These evidence-based recommendations for surgical therapy reflect various “treatment corridors” that are best discussed within multidisciplinary teams and the patient considering tumor type, stage, progression, and inherent surgical risk. 相似文献10.
Thomas J. Musholt Thomas Clerici Henning Dralle Andreja Frilling Peter E. Goretzki Michael M. Hermann Jochen Ku?mann Kerstin Lorenz Christoph Nies Jochen Schabram Peter Schabram Christian Scheuba Dietmar Simon Thomas Steinm��ller Arnold W. Trupka Robert A. Wahl Andreas Zielke Andreas Bockisch Wolfram Karges Markus Luster Kurt W. Schmid 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2011,396(5):639-649