bluuebunny/crossref_metadata_2025 huggingface dataset:
Distinctive Cortical Articulatory Representation in Cleft Lip and Palate: A Preliminary Functional Magnetic Resonance Imaging Study
Authors: Shinagawa Hideo , Ono Takashi , Honda Ei-ichi , Kurabayashi Tohru , Iriki Atsushi , Ohyama Kimie
Published: August 2005

Objective:

To investigate cortical representation of articulation of the bilabial plosive in patients with cleft lip and palate.

Design:

We examined cortical representation for /pa/-articulation in cleft lip and palate patients using blood oxygenation level–dependent functional magnetic resonance imaging.

Subjects:

Data from four postsurgical adult cleft lip and palate patients were compared with those from six healthy volunteers.

Results:

Activation foci were found in the bilateral primary sensorimotor cortex in all cleft lip and palate patients, as in the controls. The sensorimotor cortex ipsilateral to the side of cleft lip and palate showed greater activation in unilateral cleft lip and palate patients, whereas the sensorimotor cortex contralateral to the side on which cheiloplasty had been performed earlier showed greater activation in a bilateral cleft lip and palate patient.

Conclusions:

The results suggest that there may be an ipsilateral dominance in cortical representation during bilabial articulation to the side of the cleft in the upper lip.
Endoscopic management of nonvariceal gastrointestinal bleeding
Authors: Steffes Christopher P. , Sugawa Choichi
Published: August 2005

Endoscopic management of upper gastrointestinal bleeding has been expanded from a purely diagnostic role to a therapeutic role in many patients. In addition to controlling active bleeding, it is an option in a patient who is clinically at a high risk of rebleeding, or in patients who have peptic ulcers with visible vessels or stigmata indicating high risk. Several methods have been studied, and currently the most useful include thermal cautery with the heater probe or bipolar electrocoagulation, and injection using epinephrine and/or sclerosants. Endoscopic hemostasis can effect permanent control of bleeding in many patients, but should be considered complementary to conventional surgical control in other patients, where temporary control to stabilize the patient is a desired end.
Approaches to the endoscopic treatment of esophageal varices
Authors: Van Stiegmann Greg , Yamamoto Manabu
Published: August 2005

Endoscopic therapy is commonly employed for both initial and subsequent definitive treatment of variceal bleeding. Sclerotherapy performed with a flexible endoscope is currently the most widespread technique. Available data suggests that such treatment does not improve outcome in the acute treatment of variceal bleeding (first 30 days) but appears superior to conventional medical management in the long term. Sclerotherapy does not appear better or worse than pharmacological therapy or surgical therapy when these treatments are compared in the elective setting. Although effective, endoscopic sclerotherapy is recognized to be associated with many major and minor treatment‐related complications and a significant incidence of recurrent hemorrhage. In response to these shortcomings newer forms of endoscopic therapy such as polymer injection and endoscopic ligation have been developed. Polymer injection appears well suited for patients with active bleeding and for those with gastric varices but does not have advantages for chronic treatment aimed at variceal eradication. Endoscopic ligation appears at least as effective as conventional sclerotherapy for control of acute bleeding and prevention of rebleeding and is associated with few treatment induced complications. While endoscopic therapy will likely continue as the most commonly employed treatment for patients with hemorrhage from esophageal varices, newer methods with wider margins of safety and efficacy seem destined to supplement or replace conventional endoscopic sclerotherapy.
Laser therapy of gastrointestinal tumors
Authors: Eckhauser Marc L.
Published: August 2005

Surgical resection remains the therapy of choice for the treatment of potentially curable gastrointestinal tract (GI) malignancies. Many of these tumors are incurable at the time of diagnosis and therapy should be directed towards palliation with the intent of minimizing pain, bleeding, obstruction, and potential morbidity. Endoscopic laser therapy is uniquely applicable for the palliation of GI tumors and in selective instances may be appropriate for the treatment of early lesions. Eighty‐six patients with GI malignancy have been treated at our institution since 1985. Thirty‐one patients had advanced upper GI lesions (esophagus: 26, gastric: 3, duodenal: 1, and pancreatic: 1) and 55 patients had lower GI tumors (colon: 37 and rectal: 18). Pre‐resectional recanalization for obstructing colorectal carcinomas obviating initial operative diversion was performed in 31 (56%) of 55 patients. Twenty‐four patients had palliative laser therapy (obstruction: 17 and hemorrhage: 7) with resolution of their symptoms. There was 1 laser related perforation in the pre‐resectional group and the overall complication rate was 1.2%. Endoscopic Nd:YAG and currently photodynamic laser therapy for GI tumors has proven to be an effective mode of therapy for advanced GI neoplasms with minimal morbidity. The utility of photodynamic therapy for the treatment of early stage esophageal and gastric cancers remains controversial.
Laparoscopy in the emergency setting
Authors: Sackier Jonathan M.
Published: August 2005

Laparoscopy has been available for 90 years and was actively undertaken by the gynecologists. Today the vast majority of gynecological procedures are performed by this route. Despite the efforts of a few enthusiastic surgeons, the general surgical community did not incorporate laparoscopy into their armamentarium until the advent of laparoscopic cholecystectomy. However, this endoscopic technique has much to contribute, especially in the setting of emergency care. It is of value in formulating a treatment algorithm and in avoiding unnecessary laparotomy in both blunt and penetrating trauma. Laparoscopy helps to define the nature of obscure abdominal diagnoses, avoids unnecessary appendectomy, and provides the window of opportunity for surgery in mesenteric ischemia due to either arterial or venous thrombosis or embolus. It is also of value in patients with pain or fever of unknown origin, displaced gastrostomy or dialysis tubes, and in the rare patient with gastrointestinal bleeding where other diagnostic modalities have been unable to yield the diagnosis.

In this article the instrumentation and techniques will be outlined and the role of laparoscopy in each of the above situations will be detailed. As with all surgical procedures, it is vital that the surgeon be well‐trained and knowledgeable about the correct use of the technique, its possible pitfalls and how to avoid them, as well as knowing the contraindications.
The spectrum of laparoscopic surgery
Authors: Cuschieri A.
Published: August 2005

Laparoscopic procedures have begun to replace many conventional operations because of the avoidance of major surgery and the rapid recovery of the patient. The majority of these traditional operations will be performed laparoscopically in the future. For example, patients who suffer from achalasia will be able to undergo laparoscopic cardiomyotomy and patients with non‐cardiac chest pain of esophageal origin will be able to undergo thoracoscopic myotomy. Likewise, a viable alternative to long‐term medication with H2blockers or omeprozole will be laparoscopic posterior vagotomy and anterior lesser curve seromyotomy. As methods are developed to deal with the extraction of large specimens, many ablative procedures will be undertaken by the laparoscopic route. Extraction techniques must not compromise the need for histopathalogical examination of the resected specimen in cancer resections. The ultimate spectrum of laparoscopic surgery will be determined by the progress in remote handling technology, overcoming the manipulative restrictions inherent in the current instrumentation. Research evaluating the efficacy of new methods will be essential.
Endosonography in patient selection for surgical treatment of esophageal carcinoma
Authors: Fok Manson , Cheng Stephen W. K. , Wong John
Published: August 2005

A prospective study was carried out to examine the usefulness of endosonography (ES) in the pre‐operative staging of patients with carcinoma of the esophagus, and its relevance in predicting resectability and the type of resection. The results of ES were compared with staging by conventional pre‐operative methods and with operative staging according to the new American Joint Commission of Cancer staging classification. Of the 89 patients studied, 62 had a resection, 22 a bypass operation, and 5 had no operation. ES examination was unsuccessful in 19 patients because of complete or near complete tumor obliteration of the esophageal lumen and was incomplete in 13 patients because of distal tumor obstruction. These 32 patients accounted for 36% of all ES examinations, 27% of resection group, 55% of bypass group, and 60% of no operation group. The 45 patients who had a satisfactory ES examination and who had underwent a transthoracic resection were analyzed. The sensitivity and specificity of ES in detecting the depth of esophageal involvement were 89% and 96%, respectively, and for lymph node metastasis were 85% and 86%, respectively. However, ES was neither sensitive in detecting extra‐esophageal infiltration to mediastinal organs nor was it able to determine the extent of intra‐abdominal spread. The accuracy of pre‐operative staging was 82% by ES compared with 51% by conventional staging (p<0.001). ES correctly identified more advanced stage of disease in 14 (31%) patients as compared with conventional staging. On the evaluation of resectability, which was based on conventional investigations without ES, the result was unaffected even if the additional findings of ES were available. Furthermore, the prediction of whether the resection was curative or palliative was similar by conventional assessment (71%) and by ES (80%).

ES can provide more precise pre‐operative staging, but when surgery is the preferred treatment for palliation even for advanced stages of disease, the added information of ES has not helped in guiding the decision to operate nor the pre‐operative assessment of the type of resection, both of which can be determined by simple conventional pre‐operative investigations.
Pre‐operative radiotherapy prolongs survival in operable esophageal carcinoma: A randomized, multicenter study of pre‐operative radiotherapy and chemotherapy. The second scandinavian trial in esophageal cancer
Authors: Nygaard Knut , Hagen Steinar , Hansen Hanne Sand , Hatlevoll Reidulv , Hultborn Ragnar , Jakobsen Anders , Mäntyla Matti , Modig Hans , Munck‐Wikland Eva , Rosengren Bengt , Tausjø Johan , Elgen Kjell
Published: August 2005

In a prospective multicenter study, 186 patients with squamous cell esophageal carcinoma, who after evaluation were considered suitable for surgery, were randomized to 4 treatment groups: Group 1, surgery alone; Group 2, pre‐operative chemotherapy (cisplatin and bleomycin) and surgery; Group 3, pre‐operative irradiation (35 Gy) and surgery; Group 4, pre‐operative chemotherapy, radiotherapy, and surgery. Three‐year survival was significantly higher in the pooled groups receiving radiotherapy as compared with the pooled groups not receiving radiotherapy. Comparison of the groups having pre‐operative chemotherapy with those not having chemotherapy showed no significant difference in survival. Female patients had a significantly better survival than males. The results indicate that pre‐operative irradiation had a beneficial effect on intermediate term survival, whereas the chemotherapy regime used did not influence survival.
The effects of positive airway pressure and intra‐abdominal pressure in diaphragmatic rupture
Authors: Ali Jameel , Qi Wan
Published: August 2005

Arterial blood gases (80% oxygen), intraperitoneal pressure (IP), stomach position relative to the diaphragm (S/D by fluoroscopy), blood pressure, and cardiac output were monitored in 16 anaesthetized New Hampshire piglets with a 12 cm laceration of the left hemidiaphragm. Group I (8 animals) were spontaneously breathing. Group II (8 animals) had a pneumatic antishock garment (PASG) inflated to an IP of 40 torr for 15 mins followed by positive pressure ventilation (PPV) of 20 cm H2O for 15 min and PPV of 40 cm H2O (PPV‐40) for 30 more minutes.

All Group I animals survived. Three Group II animals died by 15 min after PASG inflation. Seven Group I animals showed no displacement of the stomach above the diaphragm. Blood pressure, cardiac output, and blood gases remained unchanged in Group I compared to baseline with pO2 varying from 436 ± 44 torr to 417 ± 31 torr, pCO2 from 38 ± 1 torr to 39 ± 1 torr, and pH 7.4 ± 0.02. Blood pressure in Group I was 109 ± 3 torr at baseline to 110 ± 2 torr at 60 mins, and baseline cardiac output was 3.9 ± 0.2 L/min and 3.8 ± 0.2 L/min at 60 min.

Group II animals had a baseline arterial pO2 of 423 ± 15 torr and 100 ± 15 torr at 15 min after PASG. With PPV‐20 arterial pO2 increased to 178 ± 13 torr and further increased to 230 ± 9 torr at PPV‐40. pCO2 increased from 38 ± 1 torr to 78 ± 4 torr after PASG and with PPV‐20 pCO2 decreased to 60 ± 1 torr and further decreased to 49 ± 2 torr at PPV‐40. pH varied from a baseline of 7.4 ± 0.02 to 7.2 ± 0.01 in this group. Blood pressure fell from 110 ± 2 torr and 60 ± 10 torr post‐PASG and improved to 89 ± 3 torr after PPV‐20 and 93 ± 2 torr at PPV‐40. Cardiac output decreased from 3.8 ± 0.1 L/min to 1.2 ± 0.2 L/min post‐PASG and improved to 1.8 ± 0.1 L/min at PPV‐20 and 2.1 ± 0.1 L/min at PPV‐40. With PASG inflation to an IP of 40 torr S/D was 13.8 ± 1.3 cm. With PPV‐20 S/D decreased to 10.5 ± 1.5 cm and to 8.2 ± 0.8 cm at PPV‐40.

In this porcine model of diaphragmatic rupture cardiorespiratory function is not severely compromised during spontaneous breathing. Increased intra‐abdominal pressure produces marked visceral herniation with cardiorespiratory deterioration which is partially reversed with positive pressure ventilation.
Long‐term functional results and quality of life after ileal pouch‐anal anastomosis and cholecystectomy
Authors: Köhler Lothar W. , Pemberton John H. , Hodge David O. , Zinsmeister Alan R. , Kelly Keith A.
Published: August 2005

Among 971 patients with chronic ulcerative colitis who underwent ilealpouch anal anastomosis during an 8‐year period from January, 1982 to December 1989, 30 patients were randomly selected from each year (total = 240 patients) for an assessment of their long‐term functional results and quality of life as of 1990. Patients undergoing cholecystectomy during each of the same years served as “controls” (20 patients/year, total = 160 patients). All 400 patients completed a written questionnaire that measured bowel habits, overall quality of life, general health, and performance in sports/recreation, travel, sex life, family relationship, occupational work, social activities, and household activities. Ileo‐anal patients had more frequent stools (median, 6 stools/day) and more fecal spotting (68% of patients had episodes) than cholecystectomy patients (median, 1 stool/day, 13% had episodes,p<0.05). In spite of the altered bowel habits, 90% of ileo‐anal patients had an excellent overall quality of life, 76% enjoyed good health, and 91% had good performance scores in the areas examined. In fact, quality of life and performance were similar among ileo‐anal patients and cholecystectomy patients. Moreover, quality of life and bowel habits remained steady in both groups of patients during the 8‐year follow‐up. In conclusion, functional results were satisfactory and quality of life was excellent after ileal pouch‐anal anastomosis; neither deteriorated as patients aged over an 8‐year period after operation.
Routine versus selective intra‐operative cholangiography during laparoscopic cholecystectomy
Authors: Soper Nathaniel J. , Dunnegan Deanna L.
Published: August 2005

Opinion is divided whether intra‐operative cholangiography should be performed routinely or on a selective basis during laparoscopic cholecystectomy. We therefore performed the first prospective randomized trial of static cholangiography in patients who did not have indications for cholangiograms. Laparoscopic cholecystectomy was attempted on 164 consecutive patients, of whom 49 (30%) patients were excluded from the trial due to indications for or against cholangiography. In the remaining 115 (70%) patients, 56 were randomized to the cholangiography group while 59 patients did not receive cholangiograms. Duration of postoperative hospitalization and interval to return to full activity were identical in the two groups. Static cholangiograms added 16 ± 1 min (mean ± SEM) to the procedures (p<0.01). Cholangiography increased the total charges for the operation by almost $700 (p<0.01). Cholangiograms were performed successfully in 94.6% of the patients and changed the operative management in 4 (7.5%) patients. There was 1 (1.9%) false negative study. Intra‐operative cholangiography did not reveal aberrant bile ducts at risk of injury from the operative dissection. There was no mortality or cholangiogram‐related morbidity in either group. In follow‐up ranging from 2–12 months, there has been no clinical evidence of bile duct injury or retained common bile duct stones. In summary, in patientswithout indications for cholangiography, the performance of static cholangiograms markedly increased the operative time and cost of laparoscopic cholecystectomy. The operative management of a minority of patients was changed by the information obtained, but laparoscopic cholecystectomy may be performed safely in the absence of cholangiograms with little risk of injury to the major ductal system or retained calculi.
Thromboembolic complications in thermally injured patients
Authors: Rue Loring W. , Cioffi William G. , Rush Robert , McManus William F. , Pruitt Basil A.
Published: August 2005

The frequency of thromboembolic complications in burn patients has been estimated to range from 0.4% to 7%. The clinical significance of these events is often debated and has prompted some centers to adopt the routine prophylactic use of low dose heparin prophylaxis. A 10 year review of 2,103 burn patients treated at this institution was undertaken. Twenty‐five (1.2%) patients, with a mean age of 40.0 years and an average burn size of 49.3% total body surface area (TBSA), were identified as having significant pulmonary thromboembolism (PTE). In only 3 (0.14%) patients was the thromboembolism considered to be a cause of death. Nineteen (0.9%) patients, with an average age of 36.7 years and a mean burn size of 48.3% TBSA, developed clinically evident deep venous thrombosis (DVT); however, in only 1 (0.05%) patient did the disease progress to fatal PTE.

A review of the literature reveals a 0.6% to 5% incidence of complications related to low dose heparin therapy which includes bleeding, thrombocytopenia, and arterial thrombosis. We feel that the infrequency of clinically significant PTE and DVT in burn patients and the comparable or greater rate of complications associated with heparin prophylaxis mitigate against the routine use of low dose heparin therapy except in patients at high risk for these events.
Acute acalculous cholecystitis complicating trauma: A prospective sonographic study
Authors: Imhof M. , Raunest J. , Ohmann Ch. , Röher H. ‐D.
Published: August 2005

Acute acalculous cholecystitis (AAC) is a well known complication in severely traumatized patients. Existing data of AAC originate from retrospective analyses and episodic case reports. In a prospective study 45 polytraumatized patients admitted to our intensive care unit from January 1989 to June 1990 were clinically and sonographically screened for this condition at defined time intervals. Trauma scoring was performed according to the injury severity score and polytrauma score. AAC was defined as a combination of hydrops of the gallbladder, an increased wall thickness (>3.5 mm), and the demonstration of sludge. We were able to document this diagnostic triad in 8 (18%) of 45 patients. As a consequence early elective cholecystectomy was performed in 1 of the 8 patients. The remaining patients were treated conservatively. The incidence of AAC in severely traumatized patients is higher than figures so far published suggest. Ultrasound is a reliable method of early detection and follow‐up of this complication.
Repeat operation for nodular recurrent hepatocellular carcinoma within the cirrhotic liver remnant: A comparison with transcatheter arterial chemoembolization
Authors: Jeng Kuo‐Shyang , Yang Fi‐Sh , Chiang Hsein‐Jar , Ohta Ikuho
Published: August 2005

Management of recurrent hepatocellular carcinoma in a cirrhotic liver remnant is a difficult but challenging problem. To investigate the difference in survival between treatment by repeat resection and treatment by transcatheter arterial chemoembolization (TAE), a retrospective controlled study was conducted. Four patients with nodular recurrence received limited second operations which included right hepatic segmentectomy (2 patients), left lateral segmentectomy (1 patient), and subsegmental wedge resection (1 patient). Eight matched patients received a total of 16 repeated sessions of chemoembolizations. Complications of the TAE group consisted of gastrointestinal bleeding (2 patients), acute pancreatitis (1 patient), and acute cholecystitis (1 patient). No complication developed in the resection group. The 4 patients undergoing a second operation have survived 21, 26, 34, and 54 months after repeat surgery. Seven (87.5%) of the 8 patients receiving TAE died 4 to 11 months after TAE. The resection group survived significantly longer than the TAE group (p<0.01). Our results suggest that it is more advisable to perform a second operation than to undertake chemoembolizations for patients with cirrhosis and nodular recurrent hepatocellular carcinoma with acceptable functional liver reserve.
Effect of somatostatin on adenylate cyclase activity in normal and neoplastic thyroid tissue
Authors: Siperstein Allan E. , Levin Kenneth E. , Gum Elizabeth T. , Clark Orlo H.
Published: August 2005

Thyroid stimulating hormone (TSH) and other substances increase adenylate cyclase (AC) activity and growth of normal and neoplastic thyroid tissue. Factors that inhibit cAMP may provide targeted therapy to tumors dependent on cAMP for growth. Somatostatin has been reported to inhibit the growth of gastrinomas and carcinoid tumors. We therefore studied the effects of somatostatin on basal, TSH, pertussis toxin, and forskolin stimulated adenylate cyclase activity in normal and neoplastic thyroid tissue from 19 patients. Adenylate cyclase (AC) activity was determined by the conversion of alpha32P‐ATP to32P‐cAMP in pmoles/mg protein/30 minutes in an 8000 × g particulate fraction rich in thyroid plasma membranes.

TSH (300 mU/ml) and forskolin (100 mM) (a diterpine that directly stimulates the catalytic unit of AC) increased AC activity in normal and neoplastic thyroid tissue. The AC stimulation was greater in the neoplasms (p<0.01). Somatostatin (5 × 10−6M) decreased basal and TSH stimulated AC activity below basal levels in both normal and neoplastic thyroid tissue (including papillary, follicular, and medullary carcinomas). The inhibition of AC by somatostatin was greater in neoplastic tissue (p<0.025). Pertussis toxin (which blocks the inhibitory guanyl nucleotide regulatory protein) was able to partially reverse the effect of somatostatin. Somatostatin partially inhibited forskolin stimulated AC activity.

Somatostatin inhibits basal and TSH stimulated AC activity in both normal and neoplastic human thyroid tissue, with a greater effect on neoplasms. These studies establish that somatostatin blocks a major regulator of thyroid growth and provides the rationale for the use of somatostatin analogs in the treatment of thyroid cancers.
Causes of failed primary exploration and technical aspects of re‐operation in primary hyperparathyroidism
Authors: Åkerström G. , Rudberg C. , Grimelius L. , Johansson H. , Lundström B. , Rastad J.
Published: August 2005

Hypercalcemia was corrected in 62 (90%) of 69 patients after re‐operation for primary hyperparathyroidism during a mean follow‐up of 6.3 years. Failed primary exploration was mainly due to inadequate visualization of the pathological parathyroid glands, often in association with misleading or absent peroperative histology. Other causes included seeding of parathyroid adenoma tissue, truly recurrent adenomas, and recurrent hyperplasia, especially in patients with multiple endocrine neoplasia type 1. A considerable number of parathyroid glands missed at the primary operations were subsequently found in essentially normal positions. Ectopic superior glands were most frequently positioned para‐esophageally or retro‐esophageally, while abnormally placed inferior glands were generally situated within or close to the thymus. Glands in 3 patients were dissected from around the large vessels in the mediastinum. Concomitant thyroid procedures during the primary operation yielded few abnormal parathyroids and made the re‐exploration considerably more difficult. We suggest a semilateral approach and caudal identification of the recurrent laryngeal nerve to reduce the hazards of difficult parathyroid re‐operations. Mediastinal exploration may require total removal of the thymus and careful dissection of the middle mediastinum.
Parathyroid adenomectomy under local anesthesia with intra‐operative monitoring of UcAMP and/or 1‐84 PTH
Authors: Chapuis Y. , Icard Ph. , Fulla Y. , Nonnenmacher L. , Bonnichon Ph. , Louvel A. , Richard B.
Published: August 2005

Because 80% of patients with primary hyperparathyroidism have a single adenoma and because most adenomas are now visualized by ultrasonography, we have attempted to remove these suspected single adenomas under local anesthesia with intra‐operative monitoring of urinary cAMP (UcAMP) and 1‐84 parathyroid hormone (PTH) serum levels. In the last 2 years, 45 patients (mean age 65 years) with primary hyperparathyroidism underwent surgery with local anesthesia when a single adenoma was strongly suspected by ultrasonography. Patients with equivocal or misleading ultrasonography, e.g., those with associated thyroid or multiglandular pathology and those who were non‐cooperative, were excluded from this procedure. UcAMP and 1‐84 PTH were determined prior to the incision, at the time of removal of the adenoma, and at regular intervals until 120 minutes after the operation. Results were available 45 min to 60 min after sampling for PTH and 60 min to 80 min for UcAMP. Forty‐two adenomas were removed through a 2 cm to 3 cm skin incision in a mean time of 25 minutes, with no adverse effect, no morbidity, and minimal discomfort. The 42 patients were normocalcaemic on follow‐up. The monitorings always predicted the success of the operation. In the 3 remaining patients, because the monitorings remained elevated at the end of the procedure, the patients underwent classical bilateral neck dissection under general anesthesia. This new approach can be safely accomplished with short operative time and hospital stay. The absence of general anesthesia is reassuring for the patients who are reluctant to undergo general anesthesia. The intra‐operative monitoring which predicts the cure of primary hyperparathyroidism with high accuracy allows the surgeon to conclude the operation with confidence.
Outcome of long standing solitary thyroid nodules
Authors: Kuma Kanji , Matsuzuka Fumio , Kobayashi Akira , Hirai Keisuke , Morita Sinji , Miyauchi Akira , Katayama Shoichi , Sugawara Masahiro
Published: August 2005

We investigated the outcome of long standing palpable solitary thyroid nodules by surveying 441 patients and examining 140 patients who had untreated thyroid nodules for 15±4.5 years. In our clinical survey, the most common outcome was disappearance of the thyroid nodule (38.3%). Also a significant number of patients (36.3%) underwent surgery in other hospitals. Five (1.1%) patients died of thyroid cancer. When thyroid nodules were re‐examined, most nodules indeed decreased in size or disappeared; however, 13% of nodules increased in size. Ultrasound of the nodules showed that most solitary nodules were multiple and partially cystic and solid. There was an increased incidence of calcification in long standing nodules. Thyroid cancer was found by fine needle aspiration biopsy in 26.3% of enlarging nodules and 6.4% of nodules without changing size. The risk of cancer decreased when the size of the nodule decreased. A total of 15 patients with suspicion of malignancy underwent surgery. Surgical procedures were lobectomy, near total thyroidectomy, or resection of nodules with or without modified neck dissection. Seven patients had papillary carcinoma and 2 patients with benign cytology had microscopically evident papillary carcinoma. In our study, the majority of palpable solitary thyroid nodules tended to decrease in size; these nodules do not require treatment. Enlarging solid nodules are a definite risk for thyroid cancer. If the size of the nodule remains the same, judicious approach with fine needle aspiration biopsy is needed.
Prominent corneal nerves in patients with multiple endocrine neoplasia type 2A: Diagnostic implications
Authors: Takai Shin‐Ichiro , Kinoshita Shigeru , Tanaka Fumi , Ikeda Masataka , Tanaka Norifumi , Kobayashi Tetsuro
Published: August 2005

We examined corneal nerves of 22 patients from 10 families with multiple endocrine neoplasia type 2A (MEN‐2A). According to the findings in slit‐lamp biomicroscopic examination and photographic documentation, the increased visibility of corneal nerves were classified into 5 grades (Grade 0=invisible to Grade 4=as thick as in MEN‐2B). All eyes of normal subjects, 19 of 20 eyes of patients with anterior keratoconus, and 11 of 12 eyes of patients with non‐hereditary medullary thyroid carcinoma (MTC) were either grade 0 or 1, and the remaining 2 eyes were evaluated as grade 2. Of the 44 eyes of MEN‐2A patients, 5 (11.4%) eyes were grade 0, 11 (25%) eyes were grade 1, 19 (43.2%) eyes were grade 2, 8 (18.2%) eyes were grade 3, and 1 (2.3%) eye was grade 4. Thus, more than 60% of eyes of MEN‐2A patients showed pathologically thickened corneal nerves of varying degree (grade 2 or higher). There was no definite relationship between the grade of corneal nerve thickening and the patient's age or presence of pheochromocytoma. Differences in the grade of corneal nerve thickening were observed among affected members belonging to the same MEN‐2A family, but unaffected members of the family never showed prominent corneal nerves of grade 2 or higher. Our findings suggest that MTC patients with thickened corneal nerves might actually be MEN‐2A patients and should be carefully followed for other components of this syndrome.
Dynamics of parathyroid hormone release and serum calcium regulation after surgery for primary hyperparathyroidism
Authors: Graf Wilhelm , Rastad Jonas , Åkerström Göran , Wide Leif , Ljunghall Sverker
Published: August 2005

Analysis of 14 patients with primary hyperparathyroidism (HPT) prior to and during the first year after parathyroid surgery disclosed that the operation was associated with rapid reductions of intact serum parathyroid hormone (PTH) and total serum and ionized plasma calcium values. A decreased urinary calcium excretion, a gradual elevation of renal calcium reabsorption, a transient reduction of serum calcitriol, and a late increase in 25‐hydroxycholecalciferol values were also noted. Dynamic tests of parathyroid function by EDTA infusion and an oral calcium load revealed a sigmoidal relationship between serum PTH and calcium levels, and that parathyroid surgery induced considerable changes in both the position and slope of the dose‐response curve. It was also apparent that PTH release was submaximally stimulated event at periods of hypocalcemia. The findings substantiate that adjustments of PTH release to acute alterations of serum calcium occur along the prevailing dose‐response relationship, while stimuli being maintained for longer periods of time induce compensatory shifts in the position and slope of this curve. It is further suggested that unknown factors with PTH‐like function may participate in the calcium regulation after surgery for primary HPT.
Is it still worthwhile to treat bone metastases from differentiated thyroid carcinoma with radioactive iodine?
Authors: Proye C. A. G. , Dromer D. H. R. , Carnaille B. M. , Gontier A. J. P. , Goropoulos A. , Carpentier P. , Lefebvre J. , Decoulx M. , Wemeau J. L. , Fossati P. , Sulman C.
Published: August 2005

From 1964 to 1989, bone metastases were found in 28 of 600 patients operated on for differentiated thyroid carcinoma. Bone metastasis was the presenting symptom in 15 (54%) patients, was detected from the initial symptom in 4 (14.5%) patients, and occurred subsequently in 9 (32%) patients, with an average lag time of 4.5 years after surgical treatment. Pathological pattern of the thyroid cancer was follicular in 26 (93%) patients and papillary in 2 (7%) patients. Bone metastatic involvement was multiple in 21 (75%) patients and associated with other synchronous or metachronous distant metastases in 13 (46%) patients, especially in the lung (10 patients) or the brain (3 patients).

The primary treatment of thyroid carcinoma was total thyroidectomy in all 28 patients, with additional modified neck dissection in 8 patients. All 15 patients presenting with symptoms had bone metastases demonstrated by x‐ray studies. Six of the bone metastases only took up radioactive iodine 6 weeks after total thyroidectomy, as did 2 of 4 bone metastases detected at initial observation and 4 of 9 metachronous bone metastases. All 12 patients with functioning bone metastases were given radioactive iodine therapy; 4 of the metastases were surgically resected. Only 2 patients with bone metastases showed a complete response after an ablative dose of I‐131; none of the metastases had been demonstrated by x‐ray studies.

Radioactive iodine therapy cures no more than 17% of patients with bone metastases taking up radioactive iodine and 7% of all patients with bone metastases. All patients cured of bone metastases were given radioactive iodine, either alone, or combined with other treatment. Bone metastases, when evident on x‐ray examination, never disappear after radioactive iodine therapy alone.
Hürthle cell (oxyphilic) papillary thyroid carcinoma: A variant with more aggressive biologic behavior
Authors: Herrera Miguel F. , Hay Ian D. , Wu Patricia S. ‐C. , Goellner John R. , Ryan John J. , Ebersold Jan R. , Bergstralh Erik J. , Grant Clive S.
Published: August 2005

The latest World Health Organization International Classification defines papillary thyroid carcinoma by its “follicular cell differentiation. .. as well as characteristic nuclear changes”. However the oxyphilic (Hürthle cell) papillary carcinoma have nuclei which generally resemble the nuclei seen in oxyphilic follicular carcinomas, and such oxyphilic papillary tumors may behave more aggressively than typical papillary cancers. To further characterize these rare tumors, we identified during a 32‐year period 22 patients with oxyphilic papillary cancer and compared them with 1,084 patients with typical papillary cancers and 57 patients with oxyphilic follicular cancers treated by the Mayo surgical group during the same time period. Although typical papillary and oxyphilic papillary cancers were comparable with regards to patient age, tumor size and extent, TNM stage, and prognostic score (AGES), there were significant differences. Compared to typical papillary tumors, oxyphilic papillary cancers had fewer neck nodal metastases at primary diagnosis (5% vs 40%,p<0.0001), were more often DNA non‐diploid (71% vs 21%,p<0.001), and after 10 postoperative years had higher rates of both tumor recurrence (28% vs 11%,p<0.0001) and cause‐specific mortality (1.7% vs 4%,p<0.0005). In these four important respects the oxyphilic papillary cancers more resembled the oxyphilic follicular cancers. For oxyphilic follicular cancers, the frequency of initial neck nodal metastases was 7% (cf 5%); 83% of the oxyphilic follicular tumors were non‐diploid (cf 71%), and at 10 years postoperatively the tumor recurrence and cause‐specific mortality rates were 28% and 18%, insignificantly different from 28% and 17% seen with the oxyphilic papillary cancers. These results demonstrate that oxyphilic papillary tumors are more similar to oxyphilic follicular than typical papillary cancers, and suggest that in a differentiated follicular cell‐derived carcinoma a predominance of oxyphilic cells may be a prognostically more relevant feature than the individual tumor's predominant papillary or follicular morphologic pattern. Perhaps in future Histologic Classifications the World Health Organization should group the oxyphilic papillary cancers with the oxyphilic follicular rather than the typical papillary carcinomas.
Retrospective analysis of prognostic factors affecting the thyroid functional status after subtotal thyroidectomy for Graves' disease
Authors: Okamoto Takahiro , Fujimoto Yoshihide , Obara Takao , Ito Yukio , Aiba Motohiko
Published: August 2005

To determine the factors causing thyroid dysfunction after surgery for Graves' disease, we studied 321 patients who underwent subtotal thyroidectomy during the 7‐year period from 1981 to 1987. Thyroid functional status was evaluated biochemically and the patients were divided into four categories: recurrent hyperthyroidism, euthyroidism, latent hypothyroidism, and hypothyroidism. The following factors were analyzed: sex, age at onset of the disease, indication for surgery, serum titer of antimicrosomal hemagglutination antibody (MCHA), weight of resected thyroid tissue, size of remnant thyroid relative to body surface area, pathological findings of lymphoid follicles, and lymphocytic infiltration in the thyroid tissue. Probabilities of failure (recurrent hyperthyroidism and hypothyroidism) were estimated by the Kaplan‐Meier method. Prognostic factors for failure were identified by using Cox's proportional hazards model.

The incidence of hyperthyroidism and hypothyroidism 5 years after subtotal thyroidectomy was 16.2% and 9.6%, respectively. Significant factors for hyperthyroidism were relatively large thyroid remnant, high serum titer of MCHA (≥1:3200), and age at onset of the disease <20 years. The significant factor for hypothyroidism was severe lymphocytic infiltration. The level of postoperative thyroid stimulating hormone (TSH)‐binding inhibition immunoglobulins (TBII) in patients with recurrence was significantly higher than in patients in remission.

It is reasonable to determine the amount of remnant thyroid tissue in relation to patient body surface area. Although subtotal thyroidectomy can induce immunological remission by reduction of antigen, if the remission disappears, that is if TBII increases, recurrence of hyperthyroidism may develop even in patients without the unfavorable factors.
The incidence of bilateral well‐differentiated thyroid cancer found at completion thyroidectomy
Authors: Pasieka Janice L. , Thompson Norman W. , McLeod Michael K. , Burney Richard E. , Macha Mahender
Published: August 2005

The purpose of this study was to evaluate the surgical outcome of completion thyroidectomy in patients with presumed unilateral well‐differentiated thyroid cancer (WDTC). The medical records of all patients having had unilateral thyroid lobectomy for WDTC, who subsequently underwent completion thyroidectomy, were reviewed. From 1980 to 1991, 60 patients with WDTC underwent completion thyroidectomy. Forty‐seven patients had presumed unilateral WDTC, with no evidence of residual disease prior to their completion thyroidectomy. Twenty‐five (53%) of these patients were found to have residual neoplastic disease in the neck. In 20 (43%) of 47 patients, a focus of cancer was found in the remaining thyroid lobe and in 5 additional patients no cancer was found in the contralateral lobe, however, unsuspected nodal disease was found. The remaining 13 of the 60 patients presented with either regional recurrence (n=12) or distant metastases (n=1) at the time of their completion thyroidectomy. All (92%) but 1 of these 13 patients had cancer in the remaining thyroid lobe. Multifocal disease in the primary lobe was associated with bilateral thyroid cancer (p<0.01). Complications were infrequent; transient hypocalcemia occurred in 5 (8%) patients, permanent hypoparathyroidism occurred in 1 (1.7%) patient, and transient recurrent laryngeal nerve palsy occurred in 3 (5%) patients. Residual WDTC was found in 37 (62%) of 60 patients undergoing completion thyroidectomy. Multifocal disease in the primary resected lobe was associated with a high incidence of contralateral thyroid cancer. Completion thyroidectomy is a safe procedure and may prevent the development of regional recurrence by eliminating an unsuspected focus of cancer.
Findings and long‐term results of parathyroid surgery in multiple endocrine neoplasia type 1
Authors: Hellman Per , Skogseid Britt , Juhlin Claes , Åkerström Göran , Rastad Jonas
Published: August 2005

Forty‐two patients with primary hyperparathyroidism (HPT) of multiple endocrine neoplasia type 1 (MEN‐1) were evaluated a mean of 8.9 years after subtotal parathyroid resection (SPX, n=34) or total parathyroidectomy with autotransplantation to the forearm (TPX, n=23). TPX as the primary operation revealed asymmetric and mainly nodular enlargement of the parathyroid glands with the presence of at least one normal‐size gland in half of the individuals. TPX and SPX were accompanied by resolution of the hypercalcemia in 78% and 38% of the patients. Persistent and recurrent HPT occurred in 22% and 61% of the patients, while hypoparathyroidism requiring oral supplements occurred in 30% and 12% of the patients, respectively. Intact serum parathyroid hormone (PTH) in the arm of parathyroid autograft was high in the normocalcemic patients, somewhat lower in the patients with recurrent HPT, and normal to very low in the hypoparathyroid patients. Ratios of intact PTH between the grafted and non‐grafted arms varied from 1 to 56.3, with average of 28.1 in the normocalcemic individuals, 8.2 in the patients with recurrent HPT, and 3.3 in those requiring supplements to maintain normocalcemia. These findings substantiate an 80% to 92% reversal of hypercalcemia during long‐term follow‐up of MEN‐1 patients undergoing total parathyroidectomy or subtotal resection of 3–4 parathyroid glands as primary operative procedures and demonstrate the usefulness of intact serum PTH for functional evaluation of parathyroid autografts.
Long‐term effects of parathyroidectomy for primary hyperparathyroidism on arterial hypertension
Authors: Sancho J. J. , Rouco J. , Riera‐Vidal R. , Sitges‐Serra A.
Published: August 2005

The prevalence of arterial hypertension in primary hyperparathyroidism (PHPT) is higher than in the general population. With the aim of determining the evolution of hypertension associated with PHPT, we analyzed a group of 56 patients followed for a mean of 60 months (range 10–101 months) after successful parathyroidectomy for PHPT. The study group consisted of 16 men and 40 women. The mean age was 49±12 years (range 18–73 years). None of the patients had renal impairment. Two hypertensive patients died during the follow‐up from complications related to their hypertension. Twelve (21.8%) patients were hypertensive before parathyroid surgery (systolic >160 mmHg and/or diastolic >90 mmHg). Pre‐operative midregion serum parathyroid hormone concentration was higher in the hypertensive patients than in normotensive patients (2.7±2.4 vs 0.82±0.4 µiEq/l,p=0.018). Pre‐operative creatinine clearance was lower in the hypertensive patients than in normotensive patients (65.4±27.5 vs 86.7±26 ml/min,p=0.002). There were no significant differences between normotensive and hypertensive patients in age, sex, body weight, clinical manifestations, weight of parathyroid tissue removed, and calcium metabolism, or in plasma concentrations of magnesium, uric acid, cholesterol, proteins, or albumin. During follow‐up, none of the patients with pre‐operative hypertension became normotensive, whereas 32% of the patients who were normotensive preoperatively developed clinical hypertension. The global prevalence of postoperative hypertension was thus 48%. The patients that developed hypertension after parathyroidectomy were followed for a longer period than the normotensive patients (76±17 vs 53±10 months,p=0.005), had a lower postoperative creatinine clearance (74±28 vs 90±25 mg/min,p=0.07), and higher cholesterol levels (6.2±1.5 vs 5.5±0.9 mmol/L,p=0.08). The pre‐operative blood pressure recordings of patients who developed hypertension postoperatively were significantly higher than those of the patients who remained normotensive (131±11 vs 117±7 mmHg‐systolic; 81±6 vs 73±5 mmHg‐diastolic,p<0.001). The mechanism that raises blood pressure in some patients with PHPT appears to continue to exert its effect even long after parathyroidectomy. Hypertension seems to precede renal impairment in those patients.
Survival rates and prognostic factors in adrenocortical carcinoma
Authors: Icard Ph. , Louvel A. , Chapuis Y.
Published: August 2005

In the last 12 years, 41 patients with adrenocortical carcinoma were operated on at Cochin Hospital. There were 29 females and 12 males having an average age of 42±17 years. Seven of them underwent repeat operation for local recurrence after an average interval of 22 months. Eighty per cent of the tumors had secretory activity while 20% did not. Adrenalectomy and lymphadenectomy were performed on all patients. Thirteen (32%) patients underwent extensive resection because of invasive cancer. The same procedure was performed on 7 patients undergoing re‐operation. Operative mortality was 4% (2 of 48 patients). Twenty‐four patients died of cancer with an average survival time of 22 months (range 2–86 months) and 15 (37%) patients were still alive, 4 of them with metastases, with an average survival time of 51 months. Curative resection for the 31 patients with local (n=21) or regional disease (n=10) allowed a 5 year actuarial survival rate of 45%. The 5 year actuarial survival rate for patients undergoing repeat surgery was 33%. Only 1 of the 10 patients with metastases, and who had an impressive response to OP'DDD, was alive 2 years after the operation. The other 9 patients died within 3–4 months after operation. We found that neither patient characteristics or tumor characteristics were of significant prognostic value. There was no overall prolongation of survival in patients receiving OP'DDD. However 4 patients with metastases occurring in the course of their disease experienced an impressive response with OP'DDD and a relatively long survival.