J Witte

Heinrich-Heine-Universität Düsseldorf, Düsseldorf, North Rhine-Westphalia, Germany

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Publications (29)31.93 Total impact

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    ABSTRACT: Increased numbers of mitochondria in differentiated thyroid cancer and, most strikingly, mutations in human mitochondrial DNA (mtDNA) in older people have led to speculation that mtDNA mutations might contribute to aging or accumulate in postmitotic tissues with age. Mutation analyses of mtDNA in papillary (PTCs) and follicular (FTCs) thyroid carcinomas have been limited to date. The significance and frequency of mtDNA mutations in PTC and FTC are therefore controversial, as is age dependence. We analyzed eight sample pairs of PTC and six of FTC tissue with the corresponding normal thyroid tissue. DNA was extracted from frozen and formaldehyde-fixed tissue using the QIAmp Tissue Kit. Sequence differences in the mtDNA between tumor and normal tissue were detected using appropriate polymerase chain reaction (PCR) products for heteroduplex analysis in a denaturing high performance liquid chromatography (HPLC) Wave System (Transgenomic). Mutations were confirmed and identified by sequencing the PCR products of conspicuous chromatograms. The samples were obtained from 346 patients with PTC and 105 patients with FTC. We analyzed the whole mitochondrial genome from seven PTC and three FTC tumors along with the corresponding normal thyroid tissue. 3/7 PTC samples showed two heteroplasmic mutations and one polymorphism; all 3 FTCs showed homoplasmic and/or heteroplasmic mutations. All but one of these tumors are well documented in the mitochondrial database MITOMAP. MtDNA mutations were found in all three patients aged 45 years and older. There was no correlation, however, in this small group to clinical prognostic factors for recurrence and especially for survival in differentiated thyroid carcinomas, such as histology, tumor size, lymph node metastases, distant metastases, and gender, most likely because of the short follow-up. While univariate analysis of the findings in the whole cohort of 346 patients with PTC suggested that age is a significant prognostic factor for survival (P = 0.0237) but not for recurrence (P = 0.65), this was not the case in the 105 patients with FTC. Although we found accumulation of mutations in two older patients with PTC and one patient with FTC (all three patients older than 45 years had mtDNA mutations), the low frequency of these mutations in the small group of 10 analyzed patients did not correlate with statistically validated clinical prognosticators for recurrence or survival, especially not with age. The low power of our data are therefore not able to support or refute the hypothesis that these mtDNA mutations are related to age-dependent tumor progression in the thyroid or that they "may be involved in thyroid tumorigenesis."
    World Journal of Surgery 02/2007; 31(1):51-9. DOI:10.1007/s00268-005-0447-5 · 2.35 Impact Factor
  • Viszeralchirurgie 12/2002; 37(6):404-409. DOI:10.1055/s-2002-36062 · 0.06 Impact Factor
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    ABSTRACT: There are many concepts of risk and prognostic factor analysis for differentiated thyroid cancer. The prognostic role of lymph node metastases in follicular thyroid cancer (FTC), however, is still controversial. We performed a retrospective trial in 186 patients with FTC (124 women, 62 men; mean follow-up 5.5 years) questioning whether lymph node metastases and radical thyroid surgery with neck dissection contribute to the prognosis of FTC. Univariate analysis demonstrated that lymph node metastasesp <0.005), tumor size (p <0.005), tumor stage (p <0.005), distant metastases p = 0.0063), and gender (p = 0.003) are significant prognostic factors for recurrence (Kaplan-Meier). Tumor size (p = 0.004), lymph node metastases p = 0.0478), and distant metastases p = 0.0064) influenced mortality. Age and extent of surgery were not significant for recurrence nor was gender for mortality. Multivariate analysis (Cox regression test) characterized tumor size (p <0.005) and lymph node metastases p = 0.004) as prognostic factors for recurrence of FTC. No significant difference was detected between patients being treated by thyroidectomy when compared to patients treated by thyroidectomy plus neck dissection in relation to recurrence. Our data demonstrate lymph node metastases to be a significant prognostic factor for recurrence of FTC and the patient's survival. We advocate thyroidectomy plus central lymph node dissection as the basic surgical strategy. For T3 and T4 tumors, unilateral modified neck dissection is an all but optional procedure. Whether radical surgery with thyroidectomy plus neck dissection has an impact on survival remains questionable.
    World Journal of Surgery 08/2002; 26(8):1017-22. DOI:10.1007/s00268-002-6668-y · 2.35 Impact Factor
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    ABSTRACT: 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. 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. 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. 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.
    Langenbeck s Archives of Surgery 03/2001; 386(1):47-52. · 2.16 Impact Factor
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    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.
    Langenbeck s Archives of Surgery 02/2001; 386(1):47-52. DOI:10.1007/s004230000186 · 2.16 Impact Factor
  • P E Goretzki · J Witte
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    ABSTRACT: Today, surgical treatment of thyroid carcinoma is oriented to the underlying histology and the extent of the tumourous process. Total thyroidectomy with postoperative radioiodine treatment represents only one of the spectrum of possibilities that ranges from limited to extended radical interventional procedures. Such an individualized operative strategy should be applied not only for the primary intervention, but also for locoregional tumour recurrence and confirmed distant metastases, with the aim of keeping operative morbidity to a minimum.
    MMW Fortschritte der Medizin 02/2001; 143(1-2):32-4.
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    ABSTRACT: 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. 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. 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. 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.
    Langenbeck s Archives of Surgery 01/2001; 385(8):526-30. DOI:10.1007/s004230000166 · 2.16 Impact Factor
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    ABSTRACT: The effect of surgery on Graves' orbitopathy (GO) is still controversial. Retrospective analyses of many authors (including our own group) demonstrated GO improvement after subtotal thyroid resection in up to 70% of operated patients, so the question arose whether total thyroidectomy could add anything to this pronounced positive effect on GO. We therefore performed a prospective randomized trial on 150 patients with Graves' disease (125 women, 25 men; mean thyroid volume 80.5 ml) comparing three surgical procedures (bilateral subtotal thyroid resection-total remnant < 4 ml; unilateral hemithyroidectomy with contralateral subtotal thyroid resection-remnant < 4 ml; total thyroidectomy) and their effect on postoperative GO changes, postoperative thyroid-stimulating hormone receptor (TSH-R) antibody titers, and postoperative complication rates. After a period of at least 6 months (6-36 months) GO had improved in 71% to 74% of all patients regardless of whether total or subtotal thyroidectomy was performed. TSH-R antibody titers showed no differences for the three surgical groups. Postoperative recurrent hyperthyroidism occurred in two patients with subtotal resections, and early postoperative hypoparathyroidism was more frequently detected in patients with total thyroidectomy than in those with subtotal thyroid resection (28% vs. 12%; p < 0.002). In respect to possible postoperative hypoparathyroidism and a lack of difference in postoperative GO changes, we do not advocate total thyroidectomy for patients with Graves' disease and Graves' orbitopathy but prefer radical subtotal thyroid resection with a remnant of less than 4 ml.
    World Journal of Surgery 12/2000; 24(11):1303-11. DOI:10.1007/s002680010216 · 2.35 Impact Factor
  • Viszeralchirurgie 04/2000; 35(2):117-123. DOI:10.1055/s-2000-7465 · 0.06 Impact Factor
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    ABSTRACT: Developments in thyroid surgery during the last 20 years have reduced the number of complications significantly with rates from the literature of less than 1 % of laryngeal nerve paralysis and hypoparathyroidism. Specific problems are connected, however, with patients presenting with recurrent goitres, requiring extended operations for Graves' disease and for malignant diseases. Our own experience in almost 6,000 operations during the last 12 years confirms the results from the literature with regard to more complicated thyroid surgery. Thus, laryngeal nerve paralysis in recurrent thyroid surgery is between 2 and 8 %, depending on the extent of surgery, which is necessary. In surgical treatment of hyperthyroidism, permanent laryngeal nerve paralysis may be reduced to less than 1 %, while hypoparathyroidism is still a severe problem in patients with Graves' disease, and due to the necessity for an extensive operation is approximately 2 % in all cases. The same is true for patients with thyroid malignancies who suffer from permanent laryngeal nerve paralysis in 2-5 % and permanent hypoparathyroidism in 1-4 %, the range related to primary, secondary completion, or recurrent operation. The danger of postoperative bleeding still deserves special attention because it may be followed by life-threatening acute asphyxia. It is essential that surgeons also take care of all operative consequences at least by recommending additional treatment.
    Der Chirurg 10/1999; 70(9):999-1010. · 0.52 Impact Factor
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    ABSTRACT: Die Entwicklungen in der Schilddrüsenchirurgie in den vergangenen 20 Jahren zeigt in einschlägigen Veröffentlichungen einen Rückgang der Komplikationen mit Nervus-laryngeus-recurrens-Paresen und Hypoparathyreoidismus von weniger als 1 %. Besondere Probleme treten bei Patienten mit Rezidivstrumen auf, mit ausgedehnten Operationen wegen Morbus Basedow und bei Patienten mit bösartigen Schilddrüsenerkrankungen. Unsere eigenen Erfahrungen mit nahezu 6.000 Operationen während der letzten 12 Jahre decken sich mit den Resultaten aus aktueller Literatur. Die Nervus-laryngeus-recurrens-Parese konnte bei Rezidivstrumen unter 3 % gesenkt werden, wird zur Zeit in der Literatur mit 2–8 % angegeben, wobei eine zweifelsfreie Abhängigkeit von der Ausdehnung der individuell erforderlichen Operation gegeben ist. Recurrensparesen stellen in der Therapie der Hyperthyreose keine größeren Risikoprobleme dar und werden gleichfalls mit weniger als 1 % Häufigkeit angegeben; die postoperative Hypocalciämie bzw. ein Hypoparathyreoidismus wird hingegen besonders bei Patienten mit Morbus-Basedow-Erkrankungen in etwa 2 % aller unserer Patienten verzeichnet. Patienten mit bösartigen Schilddrüsenerkrankungen erleiden permanente Recurrensparesen in 2–5 % und einen dauerhaften Hypoparathyreoidismus in 1–4 %, je nachdem, ob es sich um Primär-, komplettierende Zeit- oder Rezidivoperation handelt. Unveränderte Aufmerksamkeit erfordert die postoperative Nachblutungsgefahr, die heute zwar selten auftritt, aber jederzeit zur akuten Asphyxie, schlimmstenfalls auch einmal mit letalem Ausgang führen kann. Sie erfordert umgehendes Handeln mit Wundentlastung und Blutstillung. Im Hinblick auf Patientenaufklärung und Operationsindikation sollte die tatsächliche klinikeigene Komplikationsrate bekannt sein. Das Eintreten operationsbedingter Komplikationen verlangt selbstverständlich vom Operateur ein Engagement für nachfolgend einzusetzende Behandlungsfürsorge. Developments in thyroid surgery during the last 20 years have reduced the number of complications significantly with rates from the literature of less than 1 % of laryngeal nerve paralysis and hypoparathyroidism. Specific problems are connected, however, with patients presenting with recurrent goitres, requiring extended operations for Graves' disease and for malignant diseases. Our own experience in almost 6,000 operations during the last 12 years comfirms the results from the literature with regard to more complicated thyroid surgery. Thus, laryngeal nerve paralysis in recurrent thyroid surgery is between 2 and 8 %, depending on the extent of surgery, which is necessary. In surgical treatment of hyperthyroidism, permanent laryngeal nerve paralysis may be reduced to less than 1 %, while hypoparathyroidism is still a severe problem in patients with Graves' disease, and due to the necessity for an extensive operation is approximately 2 % in all cases. The same is true for patients with thyroid malignancies who suffer from permanent laryngeal nerve paralysis in 2–5 % and permanent hypoparathyroidism in 1–4 %, the range related to primary, secondary completion, or recurrent operation. The danger of postoperative bleeding still deserves special attention because it may be followed by life-threatening acute asphyxia. It is essential that surgeons also take care of all operative consequences at least by recommendating additional treatment.
    Der Chirurg 09/1999; 70(9):999-1010. DOI:10.1007/s001040050757 · 0.52 Impact Factor
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    ABSTRACT: Dagegen gehören anaplastische Karzinome der Schilddrüse auch heute noch zu den menschlichen Tumoren mit der schlechtesten Prognose und zeigen eine mittlere Überlebenswahrscheinlichkeit betroffener Patienten von unter einem Jahr [20, 22]. Eine spezielle Untereinheit der malignen Schilddrüsentumoren sind die medullären Karzinome oder C-Zell-Karzinome, die sich aus den parafollikulären Zellen der Schilddrüse entwickeln. Das familiär gehäufte Auftreten dieser Tumoren (familiäres C-Zell Karzinom, MEN-2 Syndrom) führt heute zu frühzeitiger genetischer Diagnose Betroffener und ermöglicht eine prophylaktische Behandlung mit exzellenter Prognose [6, 29]. Frühzeitige Diagnosen maligner Schilddrüsentumore unter Zuhilfenahme molekular-biologischer und zytologischer Befunde mit nachfolgender tumorspezifischer Behandlungsstrategie hat die Prognose der Patienten mit differenzierten Schilddrüsenkarzinomen und C-Zell-Karzinomen der Schilddrüse entscheidend gebessert und gleichzeitig zu einer Reduktion perioperativer Morbidität geführt [29].
    Der Onkologe 01/1999; 5(2):104-114. DOI:10.1007/s007610050330 · 0.13 Impact Factor
  • J Witte · P E Goretzki · H D Röher
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    ABSTRACT: The high recurrence rate of hyperthyroidism after drug therapy in Graves disease and the high incidence of differentiated thyroid cancer in autonomously functioning thyroid nodules are the most common indications for surgical treatment in children and adolescents (less than 18 years old). Between April 1986 and March 1998, 101 adolescents were operated on: 24 children (23.8%) for Graves disease, 9 adolescents (8.9%) for autonomously functioning thyroid nodules. Surgery for hyperthyroidism is recommended in children and adolescents because of the low morbidity, the guarantee that this approach will successfully treat hyperthyroidism and the necessity for histological exploration.
    Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress 02/1998; 115:1048-50.
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    ABSTRACT: Geographical differences have been demonstrated for the cancer incidence and histology of differentiated thyroid cancer. Iodine intake and specific external noxes, such as nitrosamine ingestion or external radiation are important factors. It is still questionable whether histologically identical differentiated thyroid cancers are prognostically different in low and rich iodine areas. Despite increased knowledge of molecular and genetic changes in differentiated cancer, the present therapy is primarily related to patient age, tumor stage and histology.
    Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress 02/1998; 115:200-2.
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    ABSTRACT: Surgical therapy of differentiated thyroid cancer (DTC) includes thyroidectomy plus central lymph node dissection and postoperative radioiodine therapy. In cases of lymph node metastasis, T3/T4 tumors and C-cell-carcinoma (after thyroidectomy) uni- or bilateral modified radical lymph node dissection of the neck (neck dissection) and of the mediastinum is recommended. The importance of lymph node metastasis for prognosis of survival in papillary, follicular and C-cell-carcinoma is discussed controversial, however. Even the kind of surgical radicality is questioned. Thus a metaanalysis of 35 studies in 29 independent publications from a pool of 2186 studies was performed. Univariate analysis demonstrates lymph node metastasis as a negative prognostic factor in papillary carcinoma with a 3.25/2.97, in follicular carcinoma with a 7.62/4.0 and in C-cell-carcinoma with a 3.33/3.37 higher probability of mortality 5 and 10 years after operation. Modification of the present surgical therapy can therefore only be accepted after univariate and multivariate analysis of all prognostic factors (age, sex, cell type, tumor extent, lymph node- and distant metastasis) and after it has proven superiority to the present strategy in prospective randomised trials.
    Zentralblatt für Chirurgie 02/1997; 122(4):259-65. · 1.19 Impact Factor
  • J Witte · P E Goretzki · H D Röher
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    ABSTRACT: Children and adolescents with thyroid disorders are predominantly treated by pediatricians and pediatric endocrinologists. Surgery for thyroid disorders still represents the third frequent operation in adults in Germany, but is seldomly indicated in children. Thus children and adolescents make up for 1.3% of all our patients and of these 89 patients only 21 (23.6%) suffered from Graves disease. Nevertheless surgery for Graves disease in children and adolescence is recommended because medical therapy has proven a high rate of recurrences in children and because radioiodine is only reluctantly applied to children, at least in Germany.
    Experimental and Clinical Endocrinology & Diabetes 02/1997; 105 Suppl 4(S 04):58-60. DOI:10.1055/s-0029-1211935 · 1.76 Impact Factor
  • J. Witte · P. E. Goretzki · H. D. Röher
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    ABSTRACT: Die 5-Jahres-Überlebensrate von differenzierten Schilddrüsenkarzinomen ist generell sehr gut und beträgt 80 – 95%. Hierbei bestehen Abhängigkeiten zum Alter des Patienten [15], zum primären Tumorstadium, zur histologischen Differenzierung und zum Ausmaß der regionären und Fernmetastasierung [6]. Patienten mit Tumorfreiheit haben ebenfalls eine bessere Prognose gegenüber denen mit einem Resttumor. Dies spricht für ein konsequentes Vorgehen beim Primäreingriff mit Thyreoidektomie und Entfernung der Lymphknoten des zentralen Kompartments. Stadienadaptiert schließt sich eine Radiojodtherapie oder die Kombination mit einer externen Radiatio an. Bei der Reoperation differenzierter Schilddrüsenkarzinome muß zwischen der individuellen Prognose des Patienten, dem Ziel der Operation und der postoperativen Morbidität/Mortalität entschieden werden. Aufgrund des hohen Risikos sollten diese Operationen in Zentren durchgeführt werden, so daß postoperative Komplikationen (permanente Recurrensparese/Hypoparathyreoidismus) vertretbar gering gehalten werden können (Tabelle 11). Dennoch sollte nicht außer Acht gelassen werden, daß individuell bei differenzierten Schilddrüsenkarzinomen im Stadium pT1 auch ein eingeschränkt radikales Vorgehen (Hemithyreoidektomie) ohne Verschlechterung der Prognose möglich scheint. Strenge Nachuntersuchungsergebnisse und Ergebnisse weiterer klinischer Studien müssen hierzu abgewartet werden.
    Der Onkologe 01/1997; 3(1):22-27. DOI:10.1007/s007610050089 · 0.13 Impact Factor
  • J Witte · P E Goretzki · H D Röher
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    ABSTRACT: Patient history, clinical examination, basal TSH, and ultrasound are the crucial factors for the indication of surgical treatment of the goiter. In our study, additional scintiscan failed to locate additional nodules found by intraoperative digital examination of the thyroid in 10.3%, and therefore leads to no additional security in determining the extent of thyroid resection (exception: autonomous goiter). Intraoperative inspection and palpation of both thyroid lobes remains the most important factor in preventing goiter recurrence.
    Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress 01/1997; 114:1145-7.
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    ABSTRACT: Structural genetic changes of tumor suppressor genes MTS-1/INK4A and MTS-2/INK4B were demonstrated in a variety of human cancers but not in thyroid cancer until now. Because MTS-2 encodes the tumor suppressor p15, a protein related to the transforming growth factor-beta inhibition of many epithelial cells such as thyrocytes, we investigated MTS-1 and MTS-2 genes in 87 thyroid cancers (29 papillary, 26 follicular, 31 medullary, and 1 anaplastic), 8 goiters, and 38 control DNAs by using a semiquantitative polymerase chain reaction technique. We failed to demonstrate homozygous deletions of MTS-1 and MTS-2 in thyroid tumors, but we demonstrated a highly frequent base pair exchange of the MTS-2 gene 27 codons upstream the 5' end of exon 2. This genetic change formerly described as polymorphism was found to a lesser degree (15%), in control DNA when compared with papillary thyroid cancer and medullary thyroid cancer (35% and 32%, respectively), and it paralleled a higher prevalence of extensive lymph node metastases in thyroid cancer (p < 0.01). In addition, we could demonstrate that genetic changes at site 27 upstream the 5' end of exon 2 were harbored as somatic mutations in 2 of 10 thyroid cancers with simultaneously investigated corresponding control tissue. We conclude that base pair exchange at this site most likely has biologic importance for the tumor suppressor p15 and may contribute to tumorigenesis and lymphatic spread of differentiated and medullary thyroid cancer.
    Surgery 12/1996; 120(6):1081-8. DOI:10.1016/S0039-6060(96)80059-6 · 3.11 Impact Factor
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    ABSTRACT: BackgroundA critical analysis of early and late postoperative complications is necessary to assure the quality of surgery for benign thyroid diseases. The 2 major complications are palsy of the recurrent laryngeal nerve and hypoparathyroidism. Yet, long-term and follow up studies. as well as pre and post operative investigations are rather scarce. Methods3246 patients operated on for benign thyroid diseases between 4/86 and 12/93 were retrospectively screened and analyzed for early postoperative recurrent laryngeal nerve palsy and hypoparathyroidism. Permanent laryngeal nerve paralysis and hypocalcemia was investigated by sending questionnaires to these patients and their physicians. Results88 patients (2.7%) had aerly postoperative laryngeal nerve palsy. 58 (1.78%) of them recovered completely. reducing the cases of permanent paralysis to 30 patients (0.92%), 22 of which had proven (0.68%) permanent recurrent laryngeal nerve paralysis. The 8 questionable cases (0.24%) could not be evaluated. Hypoparathyroidism necessitating calcium and/or vitamin D-treatment for more than 2 years was present in 18 patients (0.6%), which were without symptoms under this medication. ConclusionsDissecting the recurrent laryngeal nerve and visualizing the parathyroid glands during surgery for benign thyroid diseases decrease nerve paralysis and hypoparathyroidism to a permanent prevalence of less than 1%. GrundlagenDie Qualität der Chirurgie gutartiger Schilddrüsenerkrankungen wird u.a. an der Häufigkeit postoperativer Komplikationen gemessen. Die beiden wichtigsten Komplikationen sind hierbei die Nervus-recurrens-Parese und der Hypoparathyreoidismus. Insgesamt gibt es jedoch nur wenige Langzeitstudien, deren Zahlen über Rekurrensparesen und Hypoparathyroidismus auf nachprüfbaren Untersuchungsergebnissen beruhen. MethodikRetrospektiv wurden 3246 Patienten, die im Zeitraum von 4/86 bis 12/93 an einer gutartigen Schilddrüsenerkrankung operiert worden waren, analysiert. Alle Patienten mit einer frühpostoperativen Rekurrensparese und frühpostoperativem Hypoparathyroidismus wurden erfaßt und mittels eines Fragebogens an den Patienten und den weiterbehandelnden Arzt kontrolliert. Ergebnisse88 Patienten (2,7%) zeigten frühpostoperativ eine Rekurrensparese. Bei 58 Patienten (1,78%) erholte sich die Stimmbandbeweglichkeit komplett. Bei 22 Patienten (0.68%) war eine dauerhafte Beeinträchtigung der Stimmbandbeweglichkeit nachweisbar, und von 8 Patienten (0,24%) fehlen Langzeitdaten. Die permanente Hypoparathyroidismusrate betrug 0,6%. Dabei handelte es sich um 18 Patienten, die unter einer länger als 2 Jahre durchgeführten Substitutionstherapie beschwerdefrei waren. SchlußfolgerungenBei konsequenter Darstellung des Nervus recurrens und der Epithelkörperchen kann die Rate von permanenten Rekurrensparesen und Nebenschilddrüsenfunktionsstörungen bei Operationen gutartiger Schilddrüsenerkrankungen unter 1% gesenkt werden.
    European Surgery 12/1996; 28(6):361-363. DOI:10.1007/BF02616290 · 0.26 Impact Factor