[Cystic space-occupying lesion with involvement of the pelvis: unusual site of echinococcosis. Case report and surgical treatment]. / Cystische Raumforderung mit Beteiligung des Beckens: ungewöhnliche Lokalisation einer Echinokokkose. Fallbericht und chirurgische Behandlung.

A case of an unusual localization of cystic echinococcosis is presented. Initially it appeared as a retropertioneal tumor with bone involvement and the diagnosis was only recognized intraoperatively. The patient was treated by radical surgery and chemotherapy according to the guidelines of the WHO. We conclude that echinococcosis should be considered in extrahepatic cystic tumors, especially in patients from endemic areas.

Immunohistochemical studies on specificity and affinity of the BB5-antibody against human parathyroid tissue.

Localisation of parathyroid tissue in hyperparathyroidism may be difficult with standard methods. Immunoscintigraphy, using radiolabeled antibodies against epitopes of human parathyroid cells, could be a promising alternative. Therefore, we studied the necessary preconditions, whether the so-called BB5-antibody, directed against parathyroid cell membranes possesses sufficient specificity and affinity to be employed in immunoscintigraphy. Specificity was tested immunohistochemically with APAAP-staining of 39 different human tissues. Additionally, an immunoscore-based quantitative comparison was performed to test the affinity of BB5-antibody for normal and pathologic parathyroid tissue. Specificity was proven by the fact that of all 39 tested tissue-types only the parathyroid tissue was BB5-positive. Normal parathyroid tissue showed a significantly higher affinity to the BB5-antibody than pathologic parathyroid tissue (p < 0.03). However, all tissue samples from primary or secondary hyperparathyroidism exhibited sufficient staining. We conclude that the BB5-antibody fulfills the necessary conditions to be tried for immunoscintigraphical localisation of the parathyroid glands.

Replantation of cryopreserved human parathyroid tissue.

Twenty-five patients with permanent postoperative hypoparathyroidism received cryopreserved parathyroid autografts. Twelve patients had undergone cervical re-operations due to persistent or recurrent hyperparathyroidism and 10 patients had malfunction of a fresh autograft after total parathyroidectomy. Hypoparathyroidism occurred in 2 patients after subtotal parathyroidectomy and in 1 after the resection of a solitary adenoma following previous thyroid resection. The viability of the tissue was examined histologically prior to replantation in 22 patients and the amount of tissue needed for transplantation was determined by the ratio of necrotic cells vs. viable cells in the material. The patients were examined between 6 months and 125 months (median: 40 months) after replantation. Pre-operatively each patient required high doses of calcium and vitamin D metabolites to establish normocalcemia. This medication was reduced postoperatively, with 16 patients requiring no supplemental treatment. Nine patients still needed low doses of calcium and/or vitamin D. At follow-up all patients were free of hypocalcemic symptoms. Our results demonstrate that replantation of autologous cryopreserved parathyroid tissue is safe and effective therapy for permanent postoperative hypoparathyroidism. Thus, we regard it as an essential part of today's parathyroid surgery.

[Primary hyperparathyroidism. A disease picture has changed]. / Primärer Hyperparathyreoidismus. Ein Krankheitsbild hat sich gewandelt.

Data were retrospectively analysed on 544 consecutive patients (362 females and 182 males, mean age 53.6 [2 weeks and 86 years]) who had been operated on for primary hyperparathyroidism between 1965 and 1989. During this period the rate of renal, bone and intestinal complications decreased from 90% in the first 5 years to 29% in the last 5 years. Organ manifestations and hypercalcaemia were often combined (70% in the early period, 30% now). The proportion of those with an asymptomatic course gradually and continuously rose to 21% now. The patients' average age at diagnosis rose from 46 +/- 10 to 58 +/- 14 years. Serum calcium concentrations in the last few years averaged 3.1 mmol/l, as high during the last few years as at the beginning of the period. Age, serum calcium concentration and parathyroid weight of the asymptomatic patients did not differ from those of the group as a whole.