Carsten Sekulla

Martin Luther University of Halle-Wittenberg, Halle-on-the-Saale, Saxony-Anhalt, Germany

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Publications (64)101.5 Total impact

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    ABSTRACT: Unambiguous identification of the recurrent laryngeal nerve with detection of nerve dysfunction giving rise to postoperative vocal cord palsy (VCP) is the principal objective of intraoperative neuromonitoring (IONM) in thyroid surgery. Because intraoperative loss of the electromyographic (EMG) signal (LOS) does not result in VCP in one third of patients, controversy surrounds the issue of whether a change in strategy is needed in planned total thyroidectomy after LOS on the first side of resection. This was a retrospective institutional study of 1,049 consecutive patients (2,086 nerves at risk) with intended bilateral thyroid surgery who were operated on between April 2010 and July 2012 with the use of IONM. The rates of temporary and permanent VCP were analyzed on the basis of the IONM results of the first side of resection and the extent of contralateral resection for completion: resection without LOS (group 1); resection with LOS and contralateral thyroidectomy (group 2); resection with LOS and contralateral subtotal resection (group 3); resection with LOS without any contralateral resection (group 4). LOS on the first side of resection was noted in 27 patients (2.6 %). All VCPs were unilateral. The rates of temporary and permanent VCP were 2.5 and 0.4 %, respectively, overall; specifically: group 1: 0.5 and 0 %; group 2: 64 and 9.1 %; group 3: 100 and 50 %; group 4: 83 and 8.3 %, respectively. Because an abnormal intraoperative electromyogram carries an 80 % risk for early postoperative VCP, the initial plan of bilateral surgery needs to be critically reviewed after LOS has occurred on the first side of resection, taking into account the underlying thyroid disease of the patient and surgeon expertise. Since more than 80 % of affected nerves will fully recover after the operation, staged completion thyroidectomy is recommended.
    Der Chirurg 05/2014; · 0.52 Impact Factor
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    ABSTRACT: The increase of certain operations in the wake of the introduction of the German Diagnosis-Related Groups (G-DRG) system rekindled debate on the risk-benefit profile of what is widely being perceived as a too high number of thyroidectomies for benign goiter in Germany. The numbers of thyroidectomy for benign goiter from 2005-2011 were obtained from the Federal Bureau of Statistics ("Statistisches Bundesamt"). For the purpose of the study, the following operation and procedure key (OPS) codes were selected: hemithyroidectomy (OPS code 5-061); partial thyroid resection (OPS code 5-062); total thyroidectomy (OPS code 5-063); and thyroid surgeries via sternotomy (OPS code 5-064). The rates of permanent hypoparathyroidism and vocal cord palsy were calculated based on two prospective multicenter evaluation studies conducted in 1998-2001 (PETS 1) and 2010-2013 (PETS 2) in Germany. Between 2005 and 2011, the number of thyroidectomies for benign thyroid goiter decreased by 8 %, and the age-standardized surgery rate decreased by 6 % in men (2005: 599 per 1 million; 2011: 565 per 1 million) and 11 % in women (2005: 1641 per 1 million; 2011: 1463 per 1 million). At the same time, the rates of partial and subtotal thyroidectomy decreased by 59 % in men and 64 % in women, whereas the rates of hemithyroidectomy and total thyroidectomy increased by 65 % (113 %) in men and 42 % (97 %) in women. Despite a greater proportion of thyroidectomies over time, the approximated rates for postoperative hypoparathyroidism were reduced from 2.98 to 0.83 % and for postoperative vocal cord palsy from 1.06 to 0.86 %. Irrespective of that decline, either complication was more frequent after total than after subtotal thyroidectomy. The total number of thyroid surgeries due to benign goiter has decreased substantially in Germany from 2005 through 2011. Despite changes in the resectional strategy with an increase in the total number thyroidectomies and a decrease of subtotal resections, the rates for postoperative hypoparathyroidism and vocal cord palsy have decreased. The complication rates for total thyroidectomy, however, are still higher compared to subtotal resection. An individualized risk-oriented surgical approach is warranted.
    Der Chirurg 03/2014; 85(3):236-45. · 0.52 Impact Factor
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    ABSTRACT: Vor dem Hintergrund der seit Einführung der diagnosebezogenen Fallpauschalen in einigen Bereichen gestiegenen Operationszahlen hat die große Zahl von Schilddrüsenoperationen wegen benigner Strumae in Deutschland eine kritische Diskussion über die Indikationsstellung zur Operation und die Qualität der Schilddrüsenchirurgie ausgelöst.Zur quantitativen Analyse der von 2005 bis 2011 wegen benigner Strumae durchgeführten Schilddrüsenoperationen wurden die vom Statistischen Bundesamt kalkulierten bundesweiten Fallzahlen für Hemithyreoidektomien, andere partielle Schilddrüsenresektionen, Thyreoidektomien und Schilddrüsenoperationen durch Sternotomie herangezogen. Die Raten permanenter Hypokalzämien und permanenter Stimmlippenparesen wurden auf Grundlage der multizentrischen prospektiven Evaluationsstudien PETS 1 (1998−2001) und PETS 2 (2010−2013) kalkuliert.Im Zeitraum 2005−2011 verringerte sich die Zahl der wegen benigner Strumae durchgeführten Schilddrüsenoperationen um 8 %. Die altersstandardisierten Operationsraten sanken um 6 % (Männer), bzw. 11 % (Frauen). Der Anteil der Hemithyreoidektomien und totalen Thyreoidektomien nahm nominal um 65 % bzw. 113% (Männer), und um 42 % bzw. 97% (Frauen) zu, der Anteil partieller bzw. subtotaler Resektionen um 59 % (Männer) bzw. 64 % (Frauen) ab. Unter Einschluss der geänderten Resektionsstrategien kam es zu einer Abnahme der approximierten Gesamtkomplikationsraten von 2,98 auf 0,83 % beim permanenten Hypoparathyreoidismus und von 1,06 auf 0,86 % bei permanenten Stimmlippenparesen. Beide Komplikationen waren trotz insgesamt rückläufiger Tendenz nach totaler Thyreoidektomie weiterhin häufiger als nach subtotaler Resektion.Die Anzahl der wegen benigner Schilddrüsenerkrankungen in Deutschland durchgeführten Operationen nahm von 2005 bis 2011 deutlich ab. Trotz geänderter Resektionsstrategie mit Abnahme subtotaler und Zunahme totaler Thyreoidektomien ist in Deutschland eine Abnahme der Gesamtlast an permanenten Hypokalzämien und Stimmlippenparesen zu verzeichnen. Die Komplikationsraten der totalen Thyreoidektomie sind jedoch noch immer höher als nach subtotaler Resektion. Ein individualisiertes, risikoorientiertes Resektionskonzept erscheint daher vorteilhaft.
    Der Chirurg 01/2014; 85(3). · 0.52 Impact Factor
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    ABSTRACT: Systematic studies of intermittent intraoperative neuromonitoring (IONM) have shown that IONM enhances recurrent laryngeal nerve (RLN) identification via functional assessment, but does not significantly reduce rates of vocal cord (VC) paralysis (VCP). The reliability of functional nerve assessment depends on the preoperative integrity of VC mobility. The present study was therefore performed to analyze the validity of IONM in patients with pre-existing VC paralysis. Of 8,128 patients, 285 (3.5 %) with preoperative VCP underwent thyroid surgery using standardized IONM of the RLN and vagus nerves (VNs). VC function was assessed by pre- and postoperative direct videolaryngoscopy. Quantitative parameters of IONM in patients with VCP were compared with IONM in patients with intact VC function. Clinical symptoms and surgical outcomes of patients with pre-existing VCP were analyzed. A total of 244 patients revealed negative, and 41 revealed positive IONM on the side of the VCP. VCP with positive IONM revealed significantly lower amplitudes of VN and RLN than intact VN (p = 0.010) and RLN (p = 0.011). Symptoms of patients with VCP included hoarseness (25 %), dyspnea (29 %), stridor (13 %), and dysphagia (13 %); 13 % were asymptomatic. New VCP occurred in five patients, ten needed tracheostomy for various reasons, and one patient died. Patients with pre-existing VCP revealed significantly reduced amplitude of ipsilateral VN and RLN, indicating retained nerve conductivity despite VC immobility. Preoperative laryngoscopy is therefore indispensable for reliable IONM and risk assessment, even in patients without voice abnormalities.
    World Journal of Surgery 12/2013; · 2.23 Impact Factor
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    ABSTRACT: OBJECTIVETWENTY YEARS AGO, THE GROUND-BREAKING DISCOVERY THAT REARRANGED DURING TRANSFECTION (RET) MUTATIONS UNDERLIE MULTIPLE ENDOCRINE NEOPLASIA 2 (MEN 2) AND FAMILIAL MEDULLARY THYROID CANCER (FMTC) USHERED IN THE ERA OF PERSONALIZED MEDICINE. MEN2-ASSOCIATED SIGNS, TAKING TIME TO MANIFEST, CAN BE SUBTLE. THIS STUDY SOUGHT TO CLARIFY TO WHAT EXTENT CONVENTIONAL ESTIMATES OF 1:200,000-500,000 UNDERESTIMATE THE INCIDENCE OF RET MUTATIONS IN THE POPULATION.DESIGNINCLUDED IN THIS RETROSPECTIVE INVESTIGATION WERE 333 RET CARRIERS BORN BETWEEN 1951 AND 2000 AND OPERATED ON AT THE LARGEST GERMAN SURGICAL REFERRAL CENTER (286 CARRIERS) OR ELSEWHERE (47 CARRIERS).METHODSTO ESTIMATE THE INCIDENCE OF RET MUTATIONS, THE NUMBER OF RET CARRIERS BORN IN GERMANY IN FIVE DECADES (1951-1960, 1961-1970, 1971-1980, 1981-1990, AND 1991-2000) WAS DIVIDED BY THE CORRESPONDING NUMBER OF GERMAN LIVE BIRTHS.RESULTSOWING TO IMPROVED DIAGNOSIS AND CAPTURE OF FMTC AND MEN2 PATIENTS, MINIMUM INCIDENCE ESTIMATES INCREASED OVER TIME: overall from 5.0 (1951-1960) to 9.9 (1991-2000) per million live births and year (P=0.008), and by American Thyroid Association/ATA class from 1.7 to 3.7 for ATA class C (P=0.008); from 1.8 to 2.7 for ATA class A (P=0.017); from 1.5 to 2.2 for ATA class B (P=0.20); and from 0 to 1.4 for ATA class D mutations per million live births and year (P=0.008). Based on 1991-2000 incidence estimates, prevalence in Germany approximates 1:80,000 inhabitants.Conclusions The molecular minimum incidence estimate of ≈ 1:100,000 was 2-5-fold greater than conventional estimates of 1:200,000-500,000.
    European Journal of Endocrinology 12/2012; · 3.14 Impact Factor
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    ABSTRACT: BACKGROUND: Conventional intraoperative nerve monitoring, predicated on intermittent stimulation, can predict recurrent laryngeal nerve (RLN) palsy only after the damage has been done. METHODS: Fifty-two patients (52 nerves at risk) who underwent continuous intraoperative nerve monitoring (CIONM) for thyroid surgery via vagus nerve stimulation had their electromyographic (EMG) tracings recorded and correlated with surgical maneuvers and postoperative RLN function. RESULTS: There was 1 imminent loss of signal (LOS) with intraoperative signal recovery and there were 4 losses of signal with corresponding unilateral transient RLN palsy. When EMG amplitude decreased >50% and EMG latency increased >10%, LOS and postoperative RLN palsy were noted in 4 of 8 patients (50%) who had multiple combined events. In 9 of 13 patients (70%) who developed adverse EMG changes, modification of the causative surgical maneuver resulted in recovery of those EMG changes and aversion of impending RLN palsy. CONCLUSION: CIONM reliably signaled impending nerve injury, enabling immediate corrective action. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
    Head & Neck 11/2012; · 2.83 Impact Factor
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    ABSTRACT: BACKGROUND: Head and neck paraganglioma (HNP) represent rare endocrine tumors. Therapy is decided on genetic findings, tumor characteristics (e.g. tumor size, localization and dignity), age of patient and symptoms. In terms of local control radiation therapy is as equally effective as surgery but surgical morbidity rates secondary to cranial nerve injuries remain high. PATIENTS: Based on 6 patients with 11 solitary (4 patients) and multiple (2 patients) HNP (8 carotid body tumors, 1 vagal, 1 jugular and 1 jugulotympanic paraganglioma) the specific characteristics of the need for surgery as well as correct choice of treatment in cases of sporadic succinate dehydrogenase (SDH) negative and hereditary SDH positive HNP will be exemplarily demonstrated. RESULTS: A total of 6 carotid body tumors (four sporadic, two hereditary) were resected in 4 patients, five as primary surgery and one as a revision procedure. In one case a preoperative embolization was performed 24 h before surgery. Malignancy could not be proven in any patient. The 30-day mortality was zero. In the patient with bilateral hereditary carotid body tumors, unilateral local recurrent disease occurred. After resection of the recurrent tumor permanent unilateral paralysis of the laryngeal nerve, glossopharyngeal nerve and hypoglossal nerve occurred. All patients were followed-up postoperatively for a mean of 64 months (range 23-78 months) with a local tumor control rate of 100%. The overall survival rate after 5 years was 100%. CONCLUSIONS: Given a very strict indication with awareness of surgical risks selective surgery has a key position with low postoperative morbidity in the treatment of HNPs. We prefer surgery for small unilateral paraganglioma, malignant or functioning tumors.
    Der Chirurg 07/2012; · 0.52 Impact Factor
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    ABSTRACT: This study aimed to assess current use of recurrent laryngeal nerve monitoring (RLNM) for bilateral thyroid surgery in Germany. It explored the willingness of surgeons to change strategy after loss of signal (LOS) on the first side of resection. Surgical departments in Germany equipped with nerve monitors were asked to complete a structured questionnaire, specifying the number of thyroidectomies done in 2010, and the frequencies of RLNM, vagal stimulation, and electromyographic (EMG) recording before and after thyroidectomy. They were also asked about the surgical plan for bilateral goitre after LOS on the first side of resection. Based on manufacturers' sales data, 1119 (89·1 per cent) of 1256 surgical departments in Germany were equipped with nerve monitors in 2010. A total of 595 departments (53·2 per cent), accounting for approximately 75 per cent of all thyroidectomies in Germany during that year, returned a completed questionnaire. RLNM was used in 91·7-93·5 per cent of thyroidectomies, with the addition of routine vagal stimulation in 49·3 per cent before, and 73·8 per cent after resection. EMG responses to vagal stimulation were recorded in 54·8 per cent before, and 72·5 per cent after resection. Some 93·5 per cent of surgeons changed the resection plan for the other side in bilateral thyroid surgery after LOS had occurred on the first side. RLNM is now the standard of care during thyroidectomy in Germany. After LOS on the first side of resection in bilateral goitre, more than 90 per cent of respondents declared their willingness to change the resection plan for the contralateral side to avoid the risk of bilateral recurrent laryngeal nerve palsy.
    British Journal of Surgery 06/2012; 99(8):1089-95. · 4.84 Impact Factor
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    ABSTRACT: In 2004, a Diagnosis Related Groups (DRG)-based hospital reimbursement system became mandatory in Germany. The aim of this study was to provide nationwide data on the surgery of thyroid cancer by analyzing DRG statistics of the years 2005 and 2006. The unit of analysis was hospital admission with a diagnosis of thyroid cancer. We assessed the influence of age, sex and region on the relative frequency of thyroid cancer-related hospitalisations with surgery of the thyroid and we measured the association between hospitalisation rates and incidence rates of thyroid cancer among the Federal States of Germany. Over the period 2005 to 2006, 11,107 thyroid cancer-associated hospitalisations included surgical treatment of the thyroid. The age-standardised DRG-based hospitalisation rates and the corresponding cancer registry-based incidences of thyroid cancer were positively associated. Overall, 68% of the hospitalisations with thyroid surgery included a total thyroidectomy. The percentage of surgery of the thyroid with a total thyroidectomy was nearly identical among men and women, decreased among men aged over 60 and varied considerably by region (minimum, 48% in Saarland; maximum, 78% in Saxony-Anhalt). Our analyses of DRG statistics provide for the first time representative population-based data of the surgical management of thyroid cancer patients in Germany. Despite an identical health care system all over Germany and existing guidelines for surgical treatment of thyroid cancer, we observed a considerable regional variation in the proportion of total thyroidectomies performed in Germany.
    Langenbeck s Archives of Surgery 03/2012; 397(3):421-8. · 1.89 Impact Factor
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    ABSTRACT: The aim of study was an evaluation of prognostic factors of the current TNM version (UICC/AJCC 2009, 7th revision) for differentiated thyroid carcinoma (DTC). A total of 368 patients with DTC (papillary thyroid carcinoma [PTC] n = 269, follicular thyroid carcinoma [FTC] n = 99) were included. Disease-specific survival (DSS) was calculated based on the different TNM stages (mean follow-up 60 ± 37.5 months). When compared to patients with FTC, PTC patients had smaller tumors (diameter 19 mm versus 33 mm), more often lymph node metastases (40.9% versus 9.1%) but less frequent distant metastases (2.6 versus 13.1%) and poorly differentiated variants (PDTC 3.0% versus 8.1%). The 5-year and 10-year DSS for PTC versus FTC were 97.3% versus 91.5% and 96.2% versus 91.5% (p = 0.086), respectively. When comparing different TNM categories between well-differentiated PTC and FTC, no statistically significant differences were found but PDTCs, had a significantly worse DSS. The current TNM system is a sufficient tool for predicting DSS in well-differentiated PTC. In FTC, the extent of capsular and vascular invasion should also be considered. The implementation of a specific TNM system for PDTC needs to be confirmed in further studies.
    Der Chirurg 01/2012; 83(7):646-51. · 0.52 Impact Factor
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    ABSTRACT: Quantitative electromyographic signals recorded after vagus nerve stimulation during intraoperative neuromonitoring (IONM) were analyzed for their clinical usefulness to identify and track a nonrecurrent inferior laryngeal nerve (NRLN) before dissection. A NRLN is anatomically shorter than a recurrent inferior laryngeal nerve (RLN). This disparity should cause differential latencies after vagus nerve stimulation during IONM, which may aid in distinguishing a NRLN from a RLN. Failure to identify a NRLN early on entails a great risk of nerve injury. Included in this IONM case-control study were 18 cases with a NRLN and 36 controls with RLN anatomy matched for gender, age, body size, and underlying thyroid and parathyroid disease. All 18 NRLN were found in the right neck only. Cases with a NRLN had significantly shorter latencies than controls (medians of 2.7 vs. 4.6 ms; P < 0.001) but comparable amplitude and duration after stimulation of the right vagus nerve. With a latency threshold of <3.5 ms, sensitivity, specificity, positive and negative predictive value, and accuracy, respectively, were 100%, 94%, 100%, 97%, and 98% for diagnosis of a NRLN. A latency threshold of 3.5 ms after ipsilateral vagus nerve stimulation during IONM was able to discriminate well between a NRLN and a RLN in adults, helping avoid injury to the aberrant nerve. Additional studies should explore latency thresholds in children and adolescents who have shorter inferior laryngeal nerves and conceivably shorter latencies than adults.
    Annals of surgery 03/2011; 253(6):1172-7. · 7.90 Impact Factor
  • K Lorenz, C Sekulla, H Dralle
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    ABSTRACT: Conservative management of renal hyperparathyroidism has changed recently. Innovative substances, especially the advent of calcimimetics, have influenced the therapeutic concept. Consequently, a decline in surgical frequency for renal hyperparathyroidism has been reported. In this context it is now mandatory to evaluate the role of surgery, the surgical strategy and procedures for renal hyperparathyroidism anew. Based on a review of the literature the current position of surgical indications and care for renal hyperparathyroidism as well as possible influences of innovative medical treatment are highlighted. In summary, the timing and indications for surgery have been influenced, however, surgery still remains the only permanently effective treatment option for renal hyperparathyroidism.
    Zentralblatt für Chirurgie 02/2011; · 0.69 Impact Factor
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    ABSTRACT: The appropriate resection for thyroid cancer invading the aerodigestive tract remains controversial. A total of 174 patients underwent resections for aerodigestive tract invasion from differentiated thyroid cancer (103 patients), medullary thyroid cancer (40 patients), and undifferentiated thyroid cancers/unusual thyroid neoplasms (31 patients). In all, 82 patients submitted to transmural resections (window resection, sleeve resection, or cervical evisceration), 65 patients underwent nontransmural resections (shaving or extramucosal esophageal resections), and 27 patients had grossly incomplete resections. The measures of outcome included surgical morbidity, locoregional recurrence, and disease-specific survival. Surgical morbidity was 38% after transmural and 25% after nontransmural resection (P = .02). On histopathologic examination, surgical margins were microscopically involved in 9% of patients after transmural and 23% of patients after nontransmural resection (P = .014). At a mean follow-up of 35.3 months, locoregional recurrence developed in 10 (46%) of 22 patients with microscopically incomplete and 18 (15%) of 121 patients with microscopically complete resection (P = .001). After grossly complete resection, the mean disease-specific survival was 101.2, 69.8, and 25.5 months for differentiated thyroid cancer, medullary thyroid cancer, and undifferentiated thyroid cancer/unusual neoplasms, respectively (P < .001). This outcome was independent of the type of resection. The type of cancer and resection are key determinants of outcome among thyroid cancer patients with aerodigestive tract invasion.
    Surgery 12/2010; 148(6):1257-66. · 3.37 Impact Factor
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    ABSTRACT: Postoperative lymphatic leakage following thyroid surgery represents a management problem with considerate potential morbidity, psychological, and economical impact. Conservative and surgical management strategies for high- and low-output lymph fistulas are inconsistent. Reliable criteria to predict outcome of conservative versus surgical treatment in clinically evident lymph fistula are lacking. A retrospective single-center chart review of consecutively quality-control-documented thyroid surgeries from January 1998 to December 2009 was performed to identify reported postoperative lymph fistulas. Documentation of surgical procedures, drainage, medical, and nutritional management was analyzed to identify risk factors for occurrence and criteria for management of evident lymph fistulas. There were 29 patients identified with postoperative clinical evidence of lymph fistulas following thyroid surgery; incidence was 0.5%. Indication to surgery comprised benign nodular goiter, recurrent nodular goiter, and thyroid carcinoma or local and lymphonodal carcinoma recurrences. There were 12 (41%) primary and 17 (59%) redo surgeries performed. Surgical procedures performed included thyroidectomy, completion thyroidectomy, and primary and redo central and lateral systematic microdissection of lymphatic compartments. All patients were initially submitted to fasting diet and medical treatment, successfully in 19 (66%), whereas ten (34%) patients underwent surgical intervention for fistula closure after failure of conservative treatment. Complications were one wound infection and fistula recurrence in five (26%) patients in the conservative group and two (20%) in the surgical group. Hospital stay was exceedingly prolonged in both groups with a median of 21 and 11 versus 6 days in patients with regular postoperative course following thyroid surgery. Data of this series support definition of the two categories of high- and low-output fistulas according to drainage collection with >300 versus <200 ml/day. Fasting in low-output fistula facilitates conservative treatment with closed drainage, whereas in high-output fistulas surgical intervention should be sought. Attendant criteria for treatment stratification are equally important, like patient's compliance, nutritional, and general health status as well as evidence for wound infection. Surgical closure of lymph fistula may be demanding when identification of the secreting fistula is limited and even muscle flap fortification may fail. Ultimately, in unsuccessfully reoperated fistula recurrences, open drainage may become necessary. Lymph fistulas cause significantly prolonged hospital stay, possible critical clinical decay, and unfavorable cosmetic and oncologic outcome while the superior management remains to be defined.
    Langenbeck s Archives of Surgery 09/2010; 395(7):911-7. · 1.89 Impact Factor
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    ABSTRACT: This study aimed at definition of normal quantitative parameters in intraoperative neuromonitoring during thyroid surgery. Only few and single center studies described quantitative data of intraoperative neuromonitoring. Definition of normal parameters in intraoperative neuromonitoring is believed to be a prerequisite for interpretation of results and intraoperative findings when using this method. Moreover, these parameters seem important in regard to the prognostic impact of the method on postoperative vocal cord function. In a prospective multicenter study, quantitative analysis of vagal nerve stimulation pre- and postresection was performed in thyroid lobectomies. A standardized protocol determined set up and installation of neuromonitoring and defined assessment of quantitative parameters. Data of intraoperative neuromonitoring were respectively print-documented and centrally analyzed. In six participating centers a total of 1,289 patients with 1,996 nerves at risk underwent surgery for benign and malignant thyroid disease. Median amplitude was significantly larger for the right vs. left vagal nerve, latency was significantly longer for left vs. right vagal nerve and duration of the left vs. right vagal nerve significantly longer. Age disparities were only present in form of significantly higher amplitude in patients below 40 years; however, there is no continuous increase with age. Regarding gender, there was significantly higher amplitude and smaller latency in women compared to men. Duration of surgery revealed a reduction of amplitude with operative time; contrarily, latency and signal duration remained stable. The type of underlying thyroid disease showed no influence on quantitative parameters of intraoperative neuromonitoring. Systematic data of multicenter evaluation on quantitative intraoperative neuromonitoring parameters revealed differences between left and right vagal nerves in regard to amplitude, latency and duration of signal, gender, and age. The nature of thyroid disease showed no significant influence on quantitative parameters of intraoperative neuromonitoring. This study presents for the first time collective data of a large series of nerves at risk in a multicenter setting. It seems that definitions of "normal" parameters are prerequisite for the interpretation of quantitative changes of intraoperative neuromonitoring during thyroid surgery to enable interpretation of influence on surgical strategy and prediction of postoperative vocal cord function.
    Langenbeck s Archives of Surgery 09/2010; 395(7):901-9. · 1.89 Impact Factor
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    ABSTRACT: Our previous studies demonstrated that retinoic acid (RA)-induced reduction of both, the key glycolytic enzyme ENO1 and proliferation-promoting c-Myc, resulted in decreased vitality and invasiveness of the follicular thyroid carcinoma cell lines FTC-133 and FTC-238. By employing two-dimensional electrophoresis and mass spectrometry, we identified proteins affected by RA treatment. In addition to previously reported decrease in ENO1 expression, we found that RA led to significantly reduced levels of glyceraldehyde-3-phosphate dehydrogenase (GAPDH), pyruvate kinase isoenzymes M1/M2 (PKM1/M2), peptidyl-prolyl cis-trans isomerase A (PPIA), transketolase (TKT), annexin A2 (ANXA2), glutathione S-transferase P (GSTP1) and peroxiredoxin 2 (PRDX2) as compared to untreated control. The same proteins investigated on thyroid tissues were found to be significantly up-regulated in follicular, papillary and undifferentiated thyroid carcinomas when compared with goiter and adenoma tissues. These findings identify new target proteins for RA-mediated anti-tumor and re-differentiation therapies and provide novel insights into treatments for thyroid carcinoma.
    Molecular and Cellular Endocrinology 08/2010; 325(1-2):110-7. · 4.04 Impact Factor
  • Gesundheitswesen. 01/2010; 72.
  • Polish Journal of Surgery. 01/2010; 82(6):325-328.
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    Atlas of Genetics and Cytogenetics in Oncology and Haematology. 11/2009;
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    ABSTRACT: Men and women differ in thyroidal C-cell mass and calcitonin secretion. This difference may have implications for the definition of calcitonin thresholds to distinguish sporadic C-cell hyperplasia from occult medullary thyroid cancer. This retrospective study examined the hypothesis that gender-specific calcitonin thresholds predict occult medullary thyroid cancer more accurately among patients with increased basal calcitonin levels than unisex thresholds. A total of 100 consecutive patients were evaluated with occult sporadic C-cell disease no larger than 10 mm who were referred for increased basal calcitonin levels and underwent pentagastrin stimulation preoperatively at this institution. Altogether, gender-specific calcitonin thresholds predicted medullary thyroid cancer better than unisex thresholds. At lower (<or=50 pg/ml basally; <or=500 pg/ml after stimulation), but not higher, calcitonin serum levels, women revealed medullary thyroid cancer four to eight times more often than men. Most discriminatory between C-cell hyperplasia and medullary thyroid cancer was a basal calcitonin threshold of 15 pg/ml (corrected 20 pg/ml) for women and 80 pg/ml (corrected 100 pg/ml) for men, based on the greatest accuracy at the lowest possible calcitonin level. The respective gender-specific stimulated peak calcitonin thresholds were 80 pg/ml (corrected 100 pg/ml) and 500 pg/ml. Corresponding positive predictive values for medullary thyroid cancer at these calcitonin thresholds were 89 and 90% for women, as opposed to 100% for men. To increase the positive predictive value for women to 100%, the respective calcitonin thresholds would have to be raised to 40 pg/ml (corrected 50 pg/ml) and 250 pg/ml. These findings indicate that gender-specific calcitonin thresholds predict sporadic occult medullary thyroid cancer better than unisex thresholds.
    Endocrine Related Cancer 09/2009; 16(4):1291-8. · 5.26 Impact Factor

Publication Stats

1k Citations
101.50 Total Impact Points

Institutions

  • 1997–2014
    • Martin Luther University of Halle-Wittenberg
      • Clinic for General, Visceral and Vascular Surgery
      Halle-on-the-Saale, Saxony-Anhalt, Germany
  • 2010–2011
    • Universitätsklinikum Halle (Saale)
      • Department of General, Visceral and Vascular Surgery
      Halle, Saxony-Anhalt, Germany
  • 2003
    • University of Freiburg
      Freiburg, Baden-Württemberg, Germany