bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modified Sujura Operation: Long‐Term Results
Authors: Battaglia G. , Ancona E. , Patarnello E. , Morbin T. , Anselmino M. , Peracchia A. 
Published: August 2002

AbstractFrom January 1980 to January 1986 a total of 93 patients with portal hypertension (59 males, 34 females; average age 51.5 years) underwent the modified Sujura’s operation. All patients presented with esophageal varices during the preoperative endoscopic workup. Child’s risk category was A in 6 patients and B in the remaining 87. Our technique consisted of: (1) devascularization of the upper half of the gastric corpus and fundus; (2) devascularization of the last 10 to 12 cm of the thoracic esophagus; (3) pyloric divulsion; (4) resection and anastomosis at the esophagogastric junction; and (5) antireflux fundoplication. In the presence of severe hypersplenism we added splenectomy. The surgical approach was through a xiphoumbilical laparotomy, extended to the left side when splenectomy was anticipated. We observed 19.8% early mortality (10% with elective procedures and 27.2% with emergency operations) and two cases of early rebleeding from acute mucosal lesions. Long‐term follow‐up of 82 patients revealed 30 cases of rebleeding (36.6%). Ruptured esophageal varices occurred in 12 patients (11 were treated with endoscopic sclerotherapy), whereas in 11 patients the cause of bleeding was a hemorrhagic gastritis. Of the remaining patients, two had rebleeding from a gastric ulcer, one from gastric varices, one from duodenal varices; in three patients the source of the hemorrhage remains unknown. The survival for elective procedure patients was 59.2% at 5 years and 40.7% at 10 years.
Role of Preoperative Transcatheter Arterial Oily Chemoembolization for Resectable Hepatocellular Carcinoma
Authors: Uchida Masaaki , Kohno Hitoshi , Kubota Hirofumi , Hayashi Takafumi , Yamanoi Akira , Kimoto Takeo , Ono Takashi , Nagasue Naofumi 
Published: August 2002

AbstractTo clarify the effect of preoperative transcatheter arterial oily chemoembolization (TAOE) for resectable hepatocellular carcinoma (HCC) on long‐term survival after curative resection, we retrospectively evaluated 60 patients with and 68 patients without preoperative TAOE. Although there was no substantial difference in the clinical backgrounds between the two groups, the 5‐year survival rate was lower for the patients with preoperative TAOE than for those without TAOE: 24% versus 63%, respectively (p< 0.05). A worse survival rate was particularly observed for the cirrhotic patients with TAOE than for those without TAOE: 35% and 72% at 4 years, respectively (p< 0.01). As the cause of death, liver failure and gastrointestinal bleeding were more frequent in the patients with TAOE (13.3% versus 1.5%;p< 0.05). Although the TAOE seemed to retard intrahepatic recurrence during the first 1.5 years after operation (1.7% versus 10.3%;p< 0.05), the overall cancer death rate was similar between the two groups (18.3% versus 11.8%). Therefore we suggest that preoperative TAOE must not be performed for resectable HCC as a routine procedure, particularly in patients with cirrhosis. A prospective randomized trial is warranted to elucidate the merits and demerits of preoperative TAOE for surgically resectable HCC.
Parathyroid Tissue in Normocalcemic and Hypercalcemic Primary Hyperparathyroidism Recruited by Health Screening
Authors: Lundgren Ewa , Ridefelt Peter , Åkerström Göran , Ljunghall Sverker , Rastad Jonas 
Published: August 2002

AbstractParathyroid tissue from 57 women (mean age 65.5 years) with sporadic primary hyperparathyroidism (HPT) was analyzed mainly to clarify its characteristics versus tissue from those with normocalcemia. Patients were recruited by population‐based health screening of menopausal women. Analysis of three or four total serum calcium values showed normocalcemia in 16 patients (mean 2.53 mmol/L); 20 and 21 of the women were consistently (mean 2.82 mmol/L) or intermittently (mean 2.59 mmol/L) hypercalcemic, respectively. Parathyroid operation demonstrated a single adenoma in 81% of the individuals, and these lesions were most prevalent and commonly dominated by oxyphil parathyroid cells in the persistently hypercalcemic patients. Chief cell hyperplasia (two or three abnormal glands) of the nodular type was found more often in the normocalcemic patients. Total glandular weight was the smallest (mean 270 mg) among the normocalcemic women and contributed to delicate decisions with regard to the extent of resection. Immunostaining of cryosections with a monoclonal antibody recognizing a putative Ca2+sensor demonstrated variably heterogeneous down‐regulation of the recognized glycoprotein in the pathologic parathyroid glands from all the individuals. Dose–response relations for PTH release and the cytoplasmic Ca2+concentration ([Ca2+]i) were determined in Ca2+0.5–3.0 mmol/L by examining dispersed cells with radioimmunoassay and microfluorometry after fura‐2 loading, respectively. ED50 for PTH release and [Ca2+]i and the [Ca2+]i concentrations at Ca2+3.0 mmol/L were the least deranged in cells from pathologic glands of the normocalcemic patients. The findings substantiate that the abnormal parathyroid tissue of normocalcemic HPT principally is characterized by the same, albeit less extensive, morphologic and functional derangements, which consistently have been demonstrated in patients with HPT accompanied by hypercalcemia and detected clinically.
Adrenaloma: A Call for More Aggressive Management
Authors: Linos Dimitrios A. , Stylopoulos Nikolaos , Raptis Sotirios A. 
Published: August 2002

AbstractWe review our experience from the surgical management of 57 patients (24 males, 33 females) with a mean age of 48.5 years who underwent adrenalectomy because of the computed tomography (CT) finding of a “nonfunctioning” adrenal tumor (adrenaloma). We found that CT consistently underestimated the real histologic size of the adrenal tumor (p= 0.001). Of the 57 resected tumors, 23 were cortical adenomas, 7 myelolipomas, 8 adrenal cysts, 11 nodular hyperplasias, 2 primary adenocarcinomas, 2 metastatic carcinomas, and 4 pheochromocytomas. The mean diameter was 5.89 cm and the mean weight 114.07 g. The mean diameter of the resected primary adenocarcinomas was 3.0 cm and 4.5 cm, respectively. The operative mortality was zero and the perioperative morbidity minimal. The mean operating time was 137 minutes (range 60–240 minutes). The posterior approach had the shortest operating time and the laparoscopic approach the shortest hospital stay and the least postoperative need for narcotics. During the 6.2 years mean follow‐up period, five patients with preoperative hypertension remained normotensive, and both patients with the resected primary adenocarcinomas are alive without recurrence. We suggest a more liberal surgical approach to patients with adrenalomas because: (1) even small tumors can be malignant or potentially lethal (e.g., pheochromocytomas); (2) some tumors that appear to be nonfunctioning may in reality be functioning; and (3) other nonfunctioning tumors may, with time (and without prior notice), function. The low risk of adrenalectomy especially via the laparoscopic approach can provide an early definitive diagnosis and treatment, avoiding the cost of repeated CT scans and other studies as suggested by the currently prevailing conservative management of these tumors.
Survival of Patients with Disseminated Midgut Carcinoid Tumors after Aggressive Tumor Reduction
Authors: Wängberg B. , Westberg G. , Tylén U. , Tisell L.‐E. , Jansson S. , Nilsson O. , Johansson V. , Scherstén T. , Ahlman H. 
Published: August 2002

AbstractSixty‐four consecutive patients with disseminated midgut carcinoids were treated during an 8‐year period according to a single clinical protocol aimed at aggressive tumor reduction by surgery alone or with subsequent hepatic artery embolization. All patients had markedly elevated urinary 5‐hydroxyindoleacetic acid (5‐HIAA) levels (581 ± 79 μmol/24 h) and hormonal symptoms. Fourteen patients (22%) reached anatomic and biochemical cure by surgery alone. At follow‐up, the mean 5‐HIAA levels were still normal after 69.0 ± 6.2 months; two patients had died from unrelated causes. With the introduction of somatostatin receptor scintigraphy, subclinical disease was diagnosed in 7 of these 14 patients. Forty patients with bilobar hepatic disease underwent embolization in combination with octreotide. In this group, 5‐HIAA levels were still reduced by 55% after 71 ± 11 months of follow‐up, and the 5‐year survival was 56%, estimated from the total death hazard function. After embolization, two subgroups could be identified with marked differences in their long‐term response to treatment. Ten patients were not embolized owing to complicating diseases. The 5‐year survival for the entire series was 58%. A significantly increased risk of cardiovascular deaths was seen, which underlines the importance of total survival analysis in a disease with multiple hormonal effects. It is concluded that an active surgical approach must be recommended to patients with the midgut carcinoid syndrome. In patients with bilobar hepatic disease, embolization combined with octreotide treatment markedly reduced the 5‐HIAA excretion and suggested a prolonged 5‐year survival.
Family history as a marker of risk for colorectal cancer: Austrian experience
Authors: Karner‐Hanusch Judith , Mittlböck Martina , Fillipitsch Thomas , Herbst Friedrich 
Published: August 2002

AbstractA family history of colorectal cancer is a known risk factor for the disease. As a result of different study designs from different populations, the strength of this association varies in the literature. We intended to define the incidence and the risk predictors in first‐degree relatives of patients with colorectal cancer in the Austrian population. A family history was obtained from first‐degree relatives of 100 consecutive patients with sporadic colorectal cancer. Life‐table methods were used to compare the observed and expected incidence of colorectal cancer and the influence of differences in risk for first‐degree family members. The calculated lifetime risk for colorectal cancer in Austria is 1:16. Individuals with a positive family history had a 4.6‐fold risk (p ≤ 0.0001), particularly in the case of a young index patient (p ≤ 0.011) or if two or more family members were affected (p ≤ 0.001). In addition, the risk for gastric cancer in relatives was increased almost fourfold (p ≤ 0.0001). We have confirmed for Austria that a positive family history of colorectal cancer is a strong risk factor, and that this risk is comparable to that in other Western countries. We have shown that relatives are also at increased risk for gastric cancer.
Relations among Plasma Prolactin, Testosterone, and Injury Severity in War Casualties
Authors: Cernak Ibolja , Savic Jovan , Lazarov Angel 
Published: August 2002

AbstractTissue trauma leads to a complex hormonal response of pituitary end‐organ axis. This response can be recorded by determining parameters that represent the functional integrity of these systems. The concentrations of serum prolactin (PRL), serum testosterone, and plasma adrenocorticotropin (ACTH) were measured in 62 adult male casualties from the recent war in former Yugoslavia. Patients with brain injury were not included. Venous blood samples were taken as soon as possible (2–18 hours) after admission and at 1, 2, 5, and 14 days after injury. The severity of gunshot/missile wounds was assessed by the Injury Severity Score (ISS). The control group consisted of healthy blood donors. Uninjured subjects who had undergone great stress on the battlefield (explosion in the vicinity without injury) served as the sham‐control group. Tissue trauma leads to a severity‐dependent decrease in serum testosterone concentrations during the first 5 days following injury. Significant correlations were observed between ACTH, prolactin, and ISS during the first 18 hours after injury. A strong negative correlation between testosterone and prolactin serum concentrations was found during the first 18 hours. In patients with additional complications or unsatisfactory outcome, the prolactin concentrations remained elevated, whereas testosterone concentrations were reduced. Our results support the usefulness of recording hormonal changes for determining trauma severity and monitoring the clinical course. Such monitoring also helps assess the efficacy of therapeutic strategies. The relation between testosterone and prolactin might be helpful for predicting the clinical course and trauma outcome.
Repeat Hepatic Resection for Recurrent Colorectal Cancer
Authors: Chu Quyen D. , Vezeridis Michael P. , Avradopoulos Konstantine A. , Wanebo Harold J. 
Published: August 2002

AbstractRecurrence in the liver following hepatic resection for metastatic colorectal carcinoma is a predictable phenomenon, occurring in about two‐thirds of patients who develop recurrence. There are few data, however, about the value of repeated hepatic resection in patients who have a recurrence in the liver following initial resection of their hepatic metastases. We have reviewed our experience with 10 patients (of whom 9 were evaluable), culled from a series of 74 patients who had an initial hepatic resection for metastastic colorectal carcinoma. There were seven men and two women, mean age 52 (range 34–75 years). Duke's stages of the primary cancer were B1 in two patients, B2 in one patient, and C2 in six patients. Most of the patients had elevated carcinoembryonic antigen (CEA) and constitutional symptoms as indications for the second‐look procedure. There was one surgical death due to hepatic failure in a patient who required a trisegmentectomy. The average interval between the first and second hepatic resections was 21 months. The estimated 1‐ and 5‐year actuarial survivals from the second liver resection were 78% and 23%, respectively. The median survival was 41 months from the first resection (range 14–100 months) and 16 months from the second resection (range 0–92 months). In conclusion, repeat hepatectomy for recurrent liver metastases is a viable option for the well selected patient. It is a low risk surgical procedure and may augment survival in the patient with well documented metastases limited to the liver.
Perioperative Radiation Therapy
Authors: Påhlman Lars , Dahlberg Michael , Glimelius Bengt 
Published: August 2002

AbstractThe use of radiotherapy, as a complementary procedure prior to surgery for immobile, nonresectable, rectal cancers or as an adjuvant treatment in patients with mobile rectal cancer is discussed. Locally nonresectable rectal cancer can be resected after prolonged preoperative radiotherapy. The proportion of patients possible to cure after this prolonged treatment is not precisely known, mainly due to differences in the criteria for nonresectability. Literature data show that between 35% and 80% can undergo resection for cure, and 25% to 40% can be long‐term disease‐free survivors. Moreover, the role of chemotherapy in combination with radiotherapy in this group is not yet settled owing to the lack of convincing data from randomized trials. Data from the literature clearly indicate that preoperative radiotherapy in patients with mobile rectal cancer is superior to postoperative irradiation. Provided the dose is sufficiently high, a relative reduction in the local recurrence rate of 60% in combination with “standard surgery” is to be expected, and this reduction increases long‐term survival. An important question is the role of adjuvant radiotherapy together with “more optimized surgery.” It is likely that the local recurrence rate will decrease with the same magnitude, indicating that local recurrent rectal cancer in patients with mobile rectal cancer can be more or less eradicated if optimized surgery is combined with preoperative radiotherapy. With proper timing and treatment technique, the adverse effects on surrounding tissues, both immediate and late, can be kept acceptably low.
Heterologous Desensitization in Neoplastic Thyroid Cells: Influence of the Phospholipase C Signal Transduction System on the Thyrotropin–adenylate Cyclase Signal Transduction System
Authors: Tezelman S. , Hoelting T. , Jossart G.H. , Wong M.G. , Siperstein A.E. , Duh Q.‐Y. , Clark O.H. 
Published: August 2002

AbstractDesensitization is defined as a decreased functional response after continuous or repetitive stimulation of a receptor with its agonist. Thyrotropin (TSH) increases cAMP levels in normal and neoplastic thyroid tissue. The tumor promoter 12‐O‐tetradecanoyl‐phorbol‐13‐acetate (TPA) activates protein kinase C (PKC). The aim was to determine whether TPA induces heterologous desensitization of the TSH–adenylate cyclase (AC) signal transduction system. Three human thyroid neoplasms in culture for 6 months or longer (one papillary carcinoma, one Hurthle cell carcinoma, one follicular adenoma) were incubated with TSH (10 mU/ml) and TPA (1.6 × 10\‐8 M) separately and together for various time periods (from 10 minutes to 24 hours). The mixture was subsequently incubated for 30 minutes with TSH. TPA alone had no effect on cAMP levels, but co‐incubation of TPA and TSH caused a significant reduction in cAMP response when compared to the cAMP response that resulted after stimulation with only TSH (p < 0.001). cAMP levels in response to TSH decreased by 31%, 44%, and 57% after preincubation with TSH for 10 minutes, 4 hours, and 24 hours, respectively. cAMP levels in response to TSH decreased by 44%, 33%, and 29% after preincubation with TPA for 10 minutes, 4 hours, and 24 hours, respectively (p < 0.01; ANOVA). Co‐incubation of cells with TPA and staurosporine (10 ng/ml), a PKC inhibitor, prevented the effect of TPA on desensitization at 10 minutes and blunted the effect at 4 hours. This is the first demonstration in human neoplastic thyroid cells that TPA induced heterologous desensitization of the cAMP response to TSH. This TPA‐induced effect appears to involve PKC activation, as it can be blocked by staurosporine.
Desensitization in Normal and Neoplastic Human Thyroid Cell Lines
Authors: Al‐Sobhi Saif S. , Soh Euy Y. , Wong Mariwil G. , Siperstein Allan E. , Duh Quan‐Yang , Clark Orlo H. 
Published: August 2002

AbstractBecause some papillary thyroid cancers continue to grow when thyroid‐stimulating hormone (TSH) levels are suppressed, we questioned whether desensitization (i.e., a decreased cAMP response to repeat stimulation with TSH) occurs in normal and neoplastic thyroid tissue. If desensitization does occur, is it similar or different in these human thyroid cells? Normal and papillary thyroid cancer cells from the same patient were cultured as we have previously described. Normal and neoplastic thyroid tissues responded to TSH (0.01–10.0 mU/ml) by increasing cAMP production and growth in a dose‐dependent manner. In normal cells there was an 11‐fold mean increase in cAMP production at 4 hours, and all thyroid cultures responded. In neoplastic cells cAMP production increased from 1.5‐fold to 3.0‐fold with a mean 2.0‐fold increase at 4 hours. In normal thyroid cells the cAMP response to a second TSH stimulus (desensitization) decreased up to 75% (range 25–75%), and desensitization occurred in all normal thyroid cell cultures. In neoplastic thyroid cells, however, the cAMP response to a second TSH stimulus decreased up to 17% (range 0–17%); and desensitization occurred in only two of the five neoplastic thyroid cell cultures. Thus when normal thyroid and neoplastic cells from the same patients were studied, greater desensitization occurred in the normal cells (75% vs. 17%). These studies document that there is greater desensitization in normal tissue than in neoplastic thyroid tissue, which may account for the increased growth of thyroid neoplasms in the presence of ever‐changing low levels of TSH.
Prospective Study of Calcium Homeostasis after Renal Transplantation
Authors: Claesson Kerstin , Hellman Per , Frödin Lars , Rastad Jonas 
Published: August 2002

AbstractNineteen consecutive patients receiving renal transplants underwent prospective evaluation of their calcium homeostasis for 1 year after transplantation to characterize indices of hyperparathyroidism (HPT) amelioration. All but one underwent dialysis, and six had vitamin D supplementation before grafting. The rapid falls in serum creatinine concentrations and increased creatinine clearances the first weeks after grafting were accompanied by rapidly reversed hypercalcemia and hypermagnesemia, induced hypophosphatemia, maintained parathyroid hormone (PTH) excess and calcitriol deficiency, and decreased alkaline phosphatases. At 3 months when the serum calcitriol had started to rise, serum PTH levels were the lowest and parathyroid responses to induced hypocalcemia the least abnormal. This was coupled to peaks in serum calcium, 24‐hour urine calcium excretions, and serum alkaline phosphatase levels. All patients had subnormal creatinine clearances at the study end, and normal serum PTH occurred in only seven of them. Arbitrary subgrouping of the material was performed according to posttransplant creatinine clearance and serum PTH levels. More satisfactory graft function related to lower serum PTH values and less abnormal parathyroid responses to induced hypocalcemia, earlier and higher rises in serum calcitriol, and higher urine calcium excretion. Patients with mild HPT at the study end generally had higher creatinine clearance, lower serum PTH, calcium, and alkaline phosphatase values, and lower urine calcium excretion. Moreover, they had fewer prevalent signs of radiologic bone involvement before grafting. These temporal diversities in conjunction with the variable graft function and intensity of immunosuppression provide a complex interaction in renal transplant recipients, which should be considered in the light of improved function of the PTH/PTHrP receptor in bone and kidney and cation receptors in the parathyroid and kidney.
Tumor Recurrence following Resection for Early Gastric Carcinoma and Its Implications for a Policy of Limited Resection
Authors: Namieno Tsutomu , Koito Kazumitsu , Higashi Tsunemi , Shimamura Tsuyoshi , Yamashita Kenichiro , Kondo Yukifumi 
Published: August 2002

AbstractSome patients suffer postoperative recurrence after curative resection of early gastric carcinoma. This study reviewed consecutive patients with a single primary lesion and analyzed the relation between the pathologic findings and recurrence of early gastric carcinomas for determining indications for limited surgery. Among the 1585 consecutive patients with a solitary primary lesion of an early gastric carcinoma who had undergone curative surgery between 1963 and 1989 at one general hospital, pathologic findings relating to recurrence were analyzed according to Japan's General Rules for Gastric Cancer Study in Surgery and Pathology. Of these carcinomas, mucosal carcinomas comprised 701 (44.2%) and submucosal ones 884 (55.8%). The total recurrence rate in this series was 1.0%. Submucosal carcinomas (1.6%) were significantly (p < 0.02) more recurrent than mucosal ones (0.29%). Of the 16 patients with recurrence, 10 (62.5%) died within 5 years after surgery, frequently because of blood‐borne metastasis. Macroscopically elevated components, the degree of histologic differentiation, and lymph node metastasis significantly contributed to the postoperative recurrence. After detailed analysis of submucosal carcinomas, it is strongly suspected that carcinomas with a macroscopically elevated component were significantly associated with nodal involvement and microvessel invasion, and that these abnormalities lead to recurrence. Among the early gastric carcinomas, differentiated submucosal carcinomas with a macroscopically elevated component, lymph node metastasis, or both have the most potential of recurrence after surgery. Mucosal carcinomas must be restricted to limited surgery, but, blood‐borne metastasis should be carefully avoided.