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  • 1
    Electronic Resource
    Electronic Resource
    Klinische Erfahrungen nach operativer Therapie der asymptomatischen, oligosymptomatischen und symptomatischen Nebenschilddrüsenüberfunktion (1986)
    Springer
    Journal of molecular medicine 64 (1986), S. 917-923 
    Details
    ISSN: 1432-1440
    Keywords: Primary hyperparathyroidism ; Symptomatic hyperparathyroidism ; Oligosymptomatic hyperparathyroidism ; Asymptomatic hyperparathyroidism ; Long-term follow-up
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Depending on their symptomatology 152 cured (i.e., normocalcemic) patients with surgically proven primary hyperparathyroidism (pHPT) showed typical symptoms preoperatively. Besides hypercalcemia and elevated parathyroid hormone levels, 15 patients suffered only from hypertension and/or diffuse osteoporosis and/or complaints caused by the hypercalcemic syndrome (oligosymptomatic patients). Nine patients had no complaints (asymptomatic patients). The long-term clinical course of all patients was analyzed up to 22 years. Although the formation of urinary calculi was stopped in 94% of cases, a deterioration of renal function and hypertension was seen in symptomatic (12.5% and 9.2%, respectively) and oligosymptomatic patients (6.7% and 13.3%, respectively). Renal function and hypertension were unpredictable despite normalization of the hyperactive parathyroid metabolism and were of decisive prognostic significance; 6% died of acute or chronic renal failure, or of the consequences of hypertension. Multiple bone lesions, even large, healed functionally and were of no prognostic significance. In the majority of symptomatic patients gastrointestinal manifestations held postoperatively, but two patients died of acute pancreatitis without gastrointestinal complaints preoperatively. Almost all symptoms of the hypercalcemic syndrome disappeared immediately and permanently in symptomatic and oligosymptomatic patients. No deterioration of renal function and no elevation of blood pressure was observed in cured asymptomatic patients postoperatively. Immediate surgical treatment even in asymptomatic patients may have avoided complications of chronic renal failure or of hypertension. As soon as organic manifestations, even in a mild form, have been established, it seems impossible to predict the course and to prevent an unfavorable clinical outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01728615
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  • 2
    Electronic Resource
    Electronic Resource
    Der Stellenwert präoperativer Lokalisationsmethoden beim primären Hyperparathyreoidismus (1999)
    Springer
    Der Chirurg 70 (1999), S. 1082-1088 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Primary hyperparathyroidism ; Localization studies ; Ultrasonography ; 99 mSestaMIBI scan ; Minimal invasive parathyroidectomy. ; Schlüsselwörter: Primärer Hyperparathyreoidismus ; Lokalisationsdiagnostik ; Ultraschall ; 99 mSestaMIBI Scan ; minimal invasive Parathyreoidektomie.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Die bilaterale Halsexploration ist das Standardverfahren in der chirurgischen Therapie des primären Hyperparathyreoidismus. Eine Lokalisationsdiagnostik ist vor diesem Vorgehen nicht obligatorisch notwendig. Grundvoraussetzung für ein geplantes minimal invasives Verfahren ist eine lokalisierte Eindrüsenerkrankung. Präoperative Lokalisationstechniken haben somit eine zentrale Stellung in der Therapieplanung des Ersteingriffs. Die 99 mTc-SestaMIBI Szintigraphie in Kombination mit dem hochauflösendem Ultraschall erlaubt eine richtige Lokalisation bei etwa 86 % aller Eindrüsenerkrankungen. Mehrdrüsenerkrankungen können nur im Einzelfall richtig vorhergesehen werden. Computertomographie und Magnetresonanztomographie erlauben keine Verbesserung bei dieser Fragestellung. Rezidiveingriffe sollen nur nach positiver Lokalisationsdiagnostik durchgeführt werden.
    Notes: Summary. Bilateral neck exploration is the standard procedure in primary hyperparathyroidism. Using a bilateral approach, preoperative localization studies are not mandatory. A localized single gland disease is the basis for a minimally invasive procedure. Therefore preoperative localization techniques play an important role in planning (minimally invasive) first time exploration for primary hyperparathyroidism. The combination of 99 mTc-SestaMIBI scintigraphy with ultrasound allows correct localization of the parathyroid adenoma in 86 % of all single gland diseases. Multiple gland disease could be predicted in isolated cases only. Computerized tomography and magnetic resonance imaging could not improve the results. Surgery for persistent or recurrent hyperparathyroidism should only be performed after positive localization studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050869
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  • 3
    Electronic Resource
    Electronic Resource
    Results following surgical treatment of hyperthyroidism (1981)
    Springer
    Surgery today 11 (1981), S. 15-21 
    Details
    ISSN: 1436-2813
    Keywords: hyperthyroidism ; old age ; hypothyroidism
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In the years 1965–1978, 1,222 patients with different types of thyrotoxicosis underwent surgical treatment at the 1st Department of Surgery, University of Vienna. Wherever possible a psaring selective surgical appraoch was considered preferable: autonomous adenoma (45%) enucleartion resection or subtotal uni-lateral resection; multinodular toxic goiter (35%) and Graves disease (5%) uni- or bilateral subtotal resection. The remaining 5% were rather rare types of goiter (recurrent goiter, thyroidits, adenocarcinoma). Overall mortality due was 0.7%. One-hundred and seven patients (8.76%) were over 70 years old at the time of the operation. Post-operative death occurred in the group of patients with toxic adenomas (2.7%). Four-hundred and ninety-five patients were followed up from 3–13 years postoperatively: the rate of recurrent thyrotoxicosis was 4.4%, 4.8% of the patients with hypothyroidism. In this paper the significance of the rapid effect of surgery in, cases of hyperthyroidism is discussed and the results are compared with findings in other studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02468814
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  • 4
    Electronic Resource
    Electronic Resource
    Das Oesophaguscarcinom: Einzeitiges Vorgehen und Magentransposition als therapeutisches Konzept (1982)
    Springer
    Langenbeck's archives of surgery 357 (1982), S. 53-62 
    Details
    ISSN: 1435-2451
    Keywords: Esophageal cancer ; Esophageal replacement ; Isoperistaltic gastric bypass
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Seit Ende des Jahres 1979 bis einschließlich Oktober 1981 wurden an der 1. Chirurgischen Universitätsklinik 29 Patienten wegen einer malignen Oesophagusstenose behandelt, die bei 3 Patienten im oberen, bei 17 im mittleren und bei 9 im unteren Oesophagusdrittel lokalisiert war. Bei 25 Fällen war eine kurative Therapie (Exstirpation des Oesophagus) möglich, bei 4 erfolgte eine Bypass-Operation (retrosternal, antethorakal). In sechs Fällen erfolgte die Oesophagektomie durch stumpfe Dissektion ohne Thoracotomie. Als Oesophagusersatz wurde in allen Fällen der isoperistaltisch transponierte Magen verwendet. Bei 11 von 13 Patienten heilte eine Fistel der cervicalen Anastomose spontan binnen 2 Wochen. 5 Patienten verstarben, 3 an respiratorischen Komplikationen. Der Magenbypass wird mit anderen Methoden zur Rekonstruktion des thorakalen Oesophagus verglichen. Der als Oesophagusersatz verwendete Magen bietet große operative Sicherheit und sehr gute funktionelle Ergebnisse.
    Notes: Summary From December 1979 until October 198129 patients with malignant esophageal stenosis were treated in surgical department I of the University of Vienna. The tumor was located in 3 patients in the upper third of the esophagus, in 17 cases in the middle, and in 9 in the lower third. The tumor stage permitted curative treatment (exstirpation of the esophagus) in 25 cases; in the remaining 4 patients bypass procedures were performed (retrosternal, antethoracic). In 6 cases the esophagus was excluded by blunt dissection without thoracotomy. For esophageal replacement the stomach was used in all cases in isoperistaltic fashion with cervical anastomosis. Of 13 cervical anastomotic leaks 11 healed spontaneously within 2 weeks. Five patients died, 3 of them because of respiratory failure. Using the stomach for replacement is a safe method with excellent functional results.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01239661
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  • 5
    Electronic Resource
    Electronic Resource
    The prognosis of rectal carcinoid tumours (1992)
    Springer
    International journal of colorectal disease 7 (1992), S. 11-14 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Les tumeurs carcinoïdes du rectum sont très rares et peuvent présenter des problèmes thérapeutiques particuliers pour le chirurgien. Le calibre de la tumeur et l'invasion des couches musculaires sont les deux facteurs les plus importants pour prévoir leur potentiel malin. Une série de 20 malades présentant une tumeur carcinoïde du rectum a été revue. Les 16 tumeurs de moins de 2 cm de diamètre ne présentaient ni invasion des couches musculaires, ni métastase lymphatique à l'exception d'une seule. 4 patients avec des tumeurs plus grandes que 2 cm sont morts de métastases carcinoïdes. En vue de planifier la conduite opératoire l'échographie endo-rectale devrait être pratiquée pré-opératoirement. Les tumeurs carcinoïde du rectum devraient être traitées comme des cancers du rectum si leur diamètre dépasse 2 cm où si elles démontrent une invasion de la musculaire propre, indépendamment de la taille de la tumeur.
    Notes: Abstract Carcinoid tumours of the rectum are very rare, and they may present sprecial therapeutic problems for the surgeon. Tumour size and muscle layer invasion are the two most important factors predicting their malignant potential. A series of 20 patients with carcinoid tumours of the rectum were reviewed. 16 tumours less than 2 cm in diameter had neither muscle layer invasion nor lymph node metastases, with the exception of one tumour. Four patients with tumours larger than 2 cm died from metastatic carcinoid. In order to plan operative management endoluminal ultrasound should be performed preoperatively. Rectal carcinoid tumours should be treated like carcinomas of the rectum if they are 2 cm or more in diameter or if they demonstrate muscularis propria invasion independent of tumour size.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01647653
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  • 6
    Electronic Resource
    Electronic Resource
    Serum osteocalcin levels in primary hyperparathyroidism (1991)
    Springer
    Journal of molecular medicine 69 (1991), S. 351-353 
    Details
    ISSN: 1432-1440
    Keywords: Osteocalcin ; Bone GLA protein ; Parathyroid hormone ; Alkaline phosphatase ; Primary hyperparathyroidism
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The serum levels of osteocalcin, a 49-amino-acid bone-matrix protein, have been found to be a specific biochemical parameter of bone formation. The aim of our study was to compare the sensitivity of serum osteocalcin levels with that of alkaline phosphatase in the evaluation of patients with primary hyperparathyroidism. In 40 patients with biochemically and histologically confirmed primary hyperparathyroidism, the serum levels of osteocalcin, intact parathyroid hormone, alkaline phosphatase, calcium, phosphorus, and creatinine were determined preoperatively. The serum levels of osteocalcin were elevated in 22 patients (55%), whereas the serum levels of alkaline phosphatase were increased in 18 patients (45%). In 10 patients (25%) the serum levels of osteocalcin, but not those of alkaline phosphatase, were increased, whereas in six patients the activity of alkaline phosphatase was high, but the serum osteocalcin levels were normal. When the biochemical data of the patients with increased serum osteocalcin levels were compared with those of the patients with serum osteocalcin levels within the normal range, the serum levels of intact parathyroid hormone and alkaline phosphatase were significantly increased in the group of patients with elevated serum osteocalcin levels. Our data indicate that serum osteocalcin levels might be a clinically useful additional parameter in the evaluation of patients with primary hyperparathyroidism.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02115782
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  • 7
    Electronic Resource
    Electronic Resource
    Relationship of CD15 immunoreactivity and prognosis in sporadic medullary thyroid carcinoma (1992)
    Springer
    Journal of cancer research and clinical oncology 118 (1992), S. 629-634 
    Details
    ISSN: 1432-1335
    Keywords: Medullary thyroid carcinoma ; Prognosis ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Immunoreactivity with monoclonal antibody CD15 (Leu-M1) was investigated in the primary tumours, the metastases and local recurrences of 47 cases of sporadic medullary carcinoma of the thyroid (MTC). Of these tumours, 36.5% showed a varying degree of CD15 immunostaining; in 7 carcinomas the CD15 immunoreactivity was found to be significant (〉15% tumour cells positively stained). Staining of the amyloid stroma was observed in 3 tumours. Significantly higher epithelial CD15 positivity was seen more frequently in the group with larger tumours (〉4 cm) and was found exclusively in the presence of lymph node metastases. No substantial difference in the percentage of immunostained cells was seen between primary tumours and metastatic or recurrent lesions, except for two cases that revealed a significant increase in the number of CD15-immunostained cells in metastatic and recurrent lesions. Five of 7 patients with recurrences showing significant CD15 immunostaining died of cancer, while in the absence of significant CD15 staining all patients with recurrences were still alive at the conclusion of the study. The prognostic value of CD15 immunoreactivity, found by univariate analysis, becomes weaker after adjustment for the size and stage of tumour. Particularly in patients with tumour recurrences CD15 immunostaining may be of clinical relevance for the selection of patients in whom a more radical surgical approach would be justified.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01211810
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  • 8
    Electronic Resource
    Electronic Resource
    Charakterisierung von Nebennierenraumforderungen Kann die Bildgebung die Biopsie ersetzen? (1999)
    Springer
    Der Radiologe 39 (1999), S. 578-583 
    Details
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Nebennierenläsionen ; Native CT ; Kontrastmittelspätserien ; Chemical Shift MRT ; Nebennierenszintigraphie ; Nebennierenbiopsie ; Key words Adrenal lesions ; Unenhanced CT ; Delayed enhanced CT ; Chemical shift MRI ; Adrenal scintigraphy ; Adrenal biopsy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary This paper describes the diagnostic value of new imaging techniques in characterization of adrenal masses and evaluates the role of adrenal biopsy. For differentiation of benign and malignant adrenal lesions, sensitivities and specificities of 85–100% can be reached by unenhanced computed tomography (CT) methods, chemical shift techniques in magnetic resonance imaging (MRI), delayed enhanced CT techniques, and by evaluation of wash-out curves in contrast-enhanced CT. The diagnostic value of all CT techniques depends on threshold values. The value of dynamic contrast-enhanced MRI is under discussion and should be reevaluated by using delayed enhanced series. Biochemical and scintigraphic methods (NP 59 iodine iodomethyl-norcholesterol and MIBG meta-iodobenzylguanidine scintigrams) are valuable for the diagnosis of functional adrenal masses; however, they do not allow differentiation of benign and malignant tumors. According to excellent results of new imaging techniques in characterization of adrenal masses, the indications for fine-needle aspiration biopsy have already regressed, as have complications associated with this invasive technique.
    Notes: Zusammenfassung Diese Arbeit beschreibt die Möglichkeiten der Charakterisierung von Nebennierenläsionen durch die Bildgebung mit besonderer Berücksichtigung von neuen Untersuchungstechniken und evaluiert den geänderten Stellenwert der Nebennierenbiopsie. Mittels der nativen Computertomographie (CT), der Chemical-Shift-Technik der Magnetresonanztomographie (MRT) oder Dichtemessungen in CT-Kontrastmittelspätserien bzw. der Bestimmung des prozentuellen Dichteverlustes in CT-Kontrastmittelserien können in der Differenzierung von benignen und malignen Nebennierenläsionen Sensitivitäten und Spezifitäten von 85%–100% erreicht werden. Die diagnostische Wertigkeit der CT-Techniken ist abhängig von der Definition eines Schwellenwertes. Die Wertigkeit der dynamischen KM-verstärkten MRT wird derzeit unterschiedlich beurteilt und sollte anhand verbesserter Techniken reevaluiert werden. Biochemische und nuklearmedizinische Techniken wie der Iodcholesteroltest sowie die Metaiodobenzylguanidin- und Somatostatinrezeptor-Szintigraphie sind als nichtinvasive Methoden geeignet zum Nachweis von hormonell aktiven Nebennierenadenomen bzw. von Phäochromozytomen, erlauben aber keine Dignitätsbeurteilung. Durch die hohe Sensitivität, Spezifität und Treffsicherheit der neuen Bildgebungstechniken in der Charakterisierung von Nebennierenläsionen ist die diagnostische Bedeutung der doch mit Komplikationen behafteten Feinnadelbiopsie deutlich zurückgedrängt worden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001170050553
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  • 9
    Electronic Resource
    Electronic Resource
    Parathyreoidektomie und Autotransplantation beim renalen Hyperparathyreoidismus (1988)
    Springer
    Langenbeck's archives of surgery 373 (1988), S. 325-336 
    Details
    ISSN: 1435-2451
    Keywords: Total parathyroidectomy ; Autotransplantation ; Morphology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Im Rahmen der totalen Parathyreoidektomie und Autotransplantation wegen therapieresistentem renalen Hyperparathyreoidismus wurden bei 35 Hämodialysepatienten (normocalciämisch:n =14; hypercalciämisch:n = 21) insgesamt 140 vergrößerte Epithelkörperchen entfernt und am Querschnitt intraoperativ klassifiziert. Ohne Hilfsmittel war nur die Unterscheidung von diffusen (Typ 1) und nodulär hyperplastischen (Typ 2) Drüsen möglich. Innerhalb der Typ 1-Drüsen konnten unter Verwendung einer Stereolupe (10-und 16fache Vergrößerung) in Typ 1a- (Fettzellen!) und Typ 1b-Drüsen (Fehlen von Fettzellen!) differenziert werden. Ähnlich aufgebaute Areale fanden sich auch zwischen den Knoten der inhomogen aufgebauten Typ 2-Drüsen. Nodulär hyperplastische Drüsen kamen signifikant häufiger bei hypercalciamischen Patienten vor (χ 2-Test:p 〈0,001). Unterschiedliche Farbschattierungen am frischen Querschnitt der Typ 2-Drüsen erlaubten Rückschlüsse auf den cellulären Aufbau der durch Bindegewebssepten isolierten Knoten („dunkel”: oxyphile Zellknoten; „mittel”: Hauptzellknoten; „hell”: Knoten aus überwiegend degenerierenden` oxyphilen Zellen). Vor allem in Typ 1b-Düsen und Typ 1bähnlichen Arealen sowie in den isolierten Knoten der Typ 2-Drüsen fand sich ein erhöhter Mitoseindex (〉 1:10 000) als Zeichen einer erhöhten Proliferation. Diese Areale sollten von einer Autotransplantation ausgeschlossen werden.
    Notes: Summary During total parathyroidectomy and autotransplantation 140 enlarged glands were removed in 35 hemodialyzed patients (normocalcemic:n =14; hypercalcemic:n = 21). The crosssections of all glands were classified intraoperatively. Diffuse hyperplastic (type 1) and nodular hyperplastic (type 2) glands could be distinguished. Using a stereo-magnifier (magnification: × 10 − × 16), type 1a- (stromal fat cells!) and type lbglands (without stromal fat cells!) could be differentiated. Those areas were also found between the nodules of type 2-glands. Significantly, nodular hyperplastic glands predominated in hypercalcemic patients (χ 2-Test:p 〈 0.001). The colour of the nodules on the cross-sections of type 2-glands correlated with the predominating cell type (“dark”: nodule of oxyphile cells; “medium”: nodule of chief cells; “light”: nodule of ‘degenerating’ oxyphile cells). As sign of proliferation the mitotic index was elevated (〉1:10000) in type 1b-glands, in type 1 b-like areas and in nodules of type 2-glands. These areas should not be used for autotransplantation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01272551
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  • 10
    Electronic Resource
    Electronic Resource
    Parathyreoidektomie und Autotransplantation beim renalen Hyperparathyreoidismus (1988)
    Springer
    Langenbeck's archives of surgery 373 (1988), S. 337-344 
    Details
    ISSN: 1435-2451
    Keywords: Total parathyroidectomy ; Autotransplantation ; In vitro studies
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Gewebefragmente von 83 reaktiv hyperplastischen Nebenschilddrüsen (Typ 1a:n=24; Typ 1b:n=20, Typ 2:n=39) wurden in vitro durch Simulation einer Hypo- (0,3 mmol Ca++=maximale Parathormonsekretion), Normo-(0,9 und 1,2 mmol Ca++) und Hypercalciämie (3,0 mmol Ca++=basale=basale Parathormonsekretion; maximale Suppression) funktionell untersucht. Bei 56 der 83 untersuchten Drüsen (67%) war die Parathormonsekretion unter 50% der maximalen Hormonsekretion supprimierbar, wobei kein signifikanter Unterschied zwischen diffusen und nodulären Hyperplasien festzustellen war (50% versus 74%). Dem unterschiedlichen cytologischen Aufbau des diffus hyperplastischen Drüsentyps entsprachen deutlich unterscheidbare funktionelle Eigenschaften: So waren Typ 1a-Drüsen (Fettzellen zwischen Hauptzellen) signifikant häufiger supprimierbar als Typ 1b-Drüsen (keine Fettzellen! 92% versus 25%; Fischer Test:p〈0,001). Die weitere Untersuchung von unterschiedlich zusammengesetzten (= selektierten) Arealen innerhalb der Typ 2-Drüsen erbrachte eine signifikant schlechtere Supprimierbarkeit der Hormonsekretion in oxyphilen und/oder Hauptzellknoten (18%) sowie in zwischen Knoten liegenden Typ 1b-ähnlichen Arealen (17%). Zwischen Knoten liegende Typ 1a-ähnliche Areale waren in 91 % supprimierbar (Fischer Test:p〈0,001). Morphologisch unterschiedlich aufgebaute Drüsen oder Drüsenregionen reagieren auch funktionell unterschiedlich. Dieser enge Zusammenhang erlaubt somit aus der Morphologie die Vorhersage des wahrscheinlichen funktionellen Verhaltens. Darum sollten vor allem Typ 1a-Regionen zur Autotransplantation ausgewählt werden. Typ 1b- oder knotige Areale scheinen für eine Autotransplantation ungeeignet.
    Notes: Summary The PTH secretion was studied in fragments of 83 (reactive) hyperplastic parathyroids (type 1a:n=24; type 1b:n=20, type 2:n=39) simulating hypo- (0.3 mmol Ca++=maximal PTH secretion), normo- (0.9 and 1.2 mmol Ca++) and hypercalcemia (3.0 mmol Ca++=basic PTH secretion, maximal suppressibility) in vitro. 56 out of 83 glands (67%) were suppressible (PTH secretion decreased under 50% of maximal secretion) with no significant difference in suppressibility of diffuse and nodular hyperplasia (50% and 74%, respectively). Differentiating diffuse hyperplastic glands in those with (type 1 a) and without (type 1b) stroma fat cells, 92% of type 1a glands and only 25% of type 1b glands were suppressible (Fischer's test:p〈0.001). Separated (oxyphilic and/or chief cell) nodules, type 1 b- and type 1 a-like areas (both localized between nodules) of types 2 glands were suppressible in 18%, 17% and 91%, respectively (Fischer's test:p 〈 0.001). Thus fragments of type 1a regions should be autotransplanted for preference. Type 1b regions or nodules should not be used for grafting.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01272552
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