Chirurgie der Hyperthyreose

Pathophysiologie, Diagnostik, Operationsindikation und Vorbehandlung, chirurgisches Krankengut, Operationsverfahren und Nachbehandlung mit funktionellen Spätergebnissen wurden gezeigt. Der ätiologisch bedingte Unterschied in Therapie und Prognose der Hyperthyreose vom Typ des M. Basedow gegenüber den anderen Hyperthyreoseformen war dargestellt. Von 1891 schilddrüsenoperierten Patienten in den letzten 10 Jahren waren fast (n = 625) hyperthyreot; 22,7% der Hyperthyreosen waren vom Typ des M. Basedow, 26,5 % multinoduläre Strumen, der Rest autonome AdenomePathophysiology, diagnosis, indication for operation and pretreatment, data of operated patients, surgical treatment, and postoperative care with late results are demonstrated. The differences between Graves' disease and other kinds of hyperthyroidism are pointed out. About (n = 625) of all patients operated upon for goiter (n= 1891) within the last ten years had hyperthyroidism. Exophthalmia was present in 22.7 %, toxic multinodular goiter in 26.5 %; the rest of the patients had autonomous adenoma. The importance of radioimmunoassays to determine preoperative treatment and postoperative hormone levels for long-term results is stressed

Journal of Geophysical Research: Earth Surface / The topography of a continental indenter : the interplay between crustal deformation, erosion, and base level changes in the eastern Southern Alps

The topography of the eastern Southern Alps (ESA) reflects indenter tectonics causing crustal shortening, surface uplift, and erosional response. Fluvial drainages were perturbed by Pleistocene glaciations that locally excavated alpine valleys. The Late Miocene desiccation of the Mediterranean Sea and the uplift of the northern Molasse Basin led to significant base level changes in the far field of the ESA and the Eastern Alps (EA), respectively. Among this multitude of mechanisms, the processes that dominate the current topographic evolution of the ESA and the ESA-EA drainage divide have not been identified. We demonstrate the expected topographic effects of each mechanism in a one-dimensional model and compare them with observed channel metrics. We find that the normalized steepness index increases with uplift rate and declines from the indenter tip in the northwest to the foreland basin in the southeast. The number and amplitude of knickpoints and the distortion in longitudinal channel profiles similarly decrease toward the east. Changes in slope of -transformed channel profiles coincide spatially with the Valsugana-Fella fault linking crustal stacking and uplift induced by indenter tectonics with topographic evolution. Gradients in across the ESA-EA drainage divide imply an ongoing, north directed shift of the Danube-ESA watershed that is most likely driven by a base level rise in the northern Molasse basin. We conclude that the regional uplift pattern controls the geometry of ESA-EA channels, while base level changes in the far field control the overall architecture of the orogen by drainage divide migration.(VLID)222030

Analysis of pharmaceuticals in wastewater and removal using a membrane bioreactor

Much attention has recently been devoted to the life and behaviour of pharmaceuticals in the water cycle. In this study the behaviour of several pharmaceutical products in different therapeutic categories (analgesics and anti-inflammatory drugs, lipid regulators, antibiotics, etc.) was monitored during treatment of wastewater in a laboratory-scale membrane bioreactor (MBR). The results were compared with removal in a conventional activated-sludge (CAS) process in a wastewater-treatment facility. The performance of an MBR was monitored for approximately two months to investigate the long-term operational stability of the system and possible effects of solids retention time on the efficiency of removal of target compounds. Pharmaceuticals were, in general, removed to a greater extent by the MBR integrated system than during the CAS process. For most of the compounds investigated the performance of MBR treatment was better (removal rates >80%) and effluent concentrations of, e.g., diclofenac, ketoprofen, ranitidine, gemfibrozil, bezafibrate, pravastatin, and ofloxacin were steadier than for the conventional system. Occasionally removal efficiency was very similar, and high, for both treatments (e.g. for ibuprofen, naproxen, acetaminophen, paroxetine, and hydrochlorothiazide). The antiepileptic drug carbamazepine was the most persistent pharmaceutical and it passed through both the MBR and CAS systems untransformed. Because there was no washout of biomass from the reactor, high-quality effluent in terms of chemical oxygen demand (COD), ammonium content (N-NH(4)), total suspended solids (TSS), and total organic carbon (TOC) was obtained

Uptake, Translocation, and Accumulation of Pharmaceutical and Hormone Contaminants in Vegetables

A team led by Wei Zheng, senior research scientist at ISTC, investigated whether our food is at risk of accumulating PPCPs when irrigated with wastewater from concentrated animal feedlot operations (CAFOs) and wastewater treatment plants (WWTPs). The results appeared in Zheng, Wei et al (2014). "Uptake, Translocation, and Accumulation of Pharmaceutical and Hormone Contaminants in Vegetables." in Kyung Myung, Norbert M. Satchivi, and Colleen K. Kingston, eds. Retention, Uptake, and Translocation of Agrochemicals in Plants. Washington, DC : American Chemical Society, 167-181. DOI: 10.1021/bk-2014-1171.ch009.Ope

Pharmaceutical Formulation Facilities as Sources of Opioids and Other Pharmaceuticals to Wastewater Treatment Plant Effluents

Facilities involved in the manufacture of pharmaceutical products are an under-investigated source of pharmaceuticals to the environment. Between 2004 and 2009, 35 to 38 effluent samples were collected from each of three wastewater treatment plants (WWTPs) in New York and analyzed for seven pharmaceuticals including opioids and muscle relaxants. Two WWTPs (NY2 and NY3) receive substantial flows (>20% of plant flow) from pharmaceutical formulation facilities (PFF) and one (NY1) receives no PFF flow. Samples of effluents from 23 WWTPs across the United States were analyzed once for these pharmaceuticals as part of a national survey. Maximum pharmaceutical effluent concentrations for the national survey and NY1 effluent samples were generally <1 μg/L. Four pharmaceuticals (methadone, oxycodone, butalbital, and metaxalone) in samples of NY3 effluent had median concentrations ranging from 3.4 to >400 μg/L. Maximum concentrations of oxycodone (1700 μg/L) and metaxalone (3800 μg/L) in samples from NY3 effluent exceeded 1000 μg/L. Three pharmaceuticals (butalbital, carisoprodol, and oxycodone) in samples of NY2 effluent had median concentrations ranging from 2 to 11 μg/L. These findings suggest that current manufacturing practices at these PFFs can result in pharmaceuticals concentrations from 10 to 1000 times higher than those typically found in WWTP effluents

PDGF-BB regulates splitting angiogenesis in skeletal muscle by limiting VEGF-induced endothelial proliferation

VEGF induces normal or aberrant angiogenesis depending on its dose in the microenvironment around each producing cell in vivo. This transition depends on the balance between VEGF-induced endothelial stimulation and PDGF-BB-mediated pericyte recruitment, and co-expression of PDGF-BB normalizes aberrant angiogenesis despite high VEGF doses. We recently found that VEGF over-expression induces angiogenesis in skeletal muscle through an initial circumferential vascular enlargement followed by longitudinal splitting, rather than sprouting. Here we investigated the cellular mechanism by which PDGF-BB co-expression normalizes VEGF-induced aberrant angiogenesis. Monoclonal populations of transduced myoblasts, expressing similarly high levels of VEGF alone or with PDGF-BB, were implanted in mouse skeletal muscles. PDGF-BB co-expression did not promote sprouting and angiogenesis that occurred through vascular enlargement and splitting. However, enlargements were significantly smaller in diameter, due to a significant reduction in endothelial proliferation, and retained pericytes, which were otherwise lost with high VEGF alone. A time-course of histological analyses and repetitive intravital imaging showed that PDGF-BB co-expression anticipated the initiation of vascular enlargement and markedly accelerated the splitting process. Interestingly, quantification during in vivo imaging suggested that a global reduction in shear stress favored the initiation of transluminal pillar formation during VEGF-induced splitting angiogenesis. Quantification of target gene expression showed that VEGF-R2 signaling output was significantly reduced by PDGF-BB co-expression compared to VEGF alone. In conclusion, PDGF-BB co-expression prevents VEGF-induced aberrant angiogenesis by modulating VEGF-R2 signaling and endothelial proliferation, thereby limiting the degree of circumferential enlargement and enabling efficient completion of vascular splitting into normal capillary networks despite high VEGF doses

Characterization of highly frequent epitope-specific CD45RA(+)/CCR7(+/- )T lymphocyte responses against p53-binding domains of the human polyomavirus BK large tumor antigen in HLA-A*0201+ BKV-seropositive donors

Human polyomavirus BK (BKV) has been implicated in oncogenic transformation. Its ability to replicate is determined by the binding of its large tumor antigen (LTag) to products of tumor-suppressor genes regulating cell cycle, as specifically p53. We investigated CD8+ T immune responses to BKV LTag portions involved in p53 binding in HLA-A*0201+ BKV LTag experienced individuals. Peptides selected from either p53-binding region (LTag(351–450 )and LTag(533–626)) by current algorithms and capacity to bind HLA-A*0201 molecule were used to stimulate CD8+ T responses, as assessed by IFN-γ gene expression ex vivo and detected by cytotoxicity assays following in vitro culture. We observed epitope-specific immune responses in all HLA-A*0201+ BKV LTag experienced individuals tested. At least one epitope, LTag(579–587); LLLIWFRPV, was naturally processed in non professional antigen presenting cells and induced cytotoxic responses with CTL precursor frequencies in the order of 1/20'000. Antigen specific CD8+ T cells were only detectable in the CD45RA+ subset, in both CCR7+ and CCR7- subpopulations. These data indicate that widespread cellular immune responses against epitopes within BKV LTag-p53 binding regions exist and question their roles in immunosurveillance against tumors possibly associated with BKV infection