bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immediate breast reconstruction after mastectomy for cancer
Authors: Malata C M , McIntosh S A , Purushotham A D 
Published: March 2003

Abstract

Background
Immediate breast reconstruction after mastectomy has increased over the past decade following the unequivocal demonstration of its oncological safety and the availability of reliable methods of reconstruction. Broadly, it is undertaken in the treatment of breast cancer, after prophylactic mastectomy in high-risk patients, and in the management of treatment failure after breast-conserving surgery and radiotherapy. Immediate breast reconstruction can be achieved reliably with a variety of autogenous tissue techniques or prosthetic devices. Careful discussion and evaluation remain vital in choosing the correct technique for the individual patient.

Methods
This review is based primarily on an English language Medline search with secondary references obtained from key articles.

Results and Conclusion
Immediate breast reconstruction is a safe and acceptable procedure after mastectomy for cancer; there is no evidence that it has untoward oncological consequences. In the appropriate patient it can be achieved effectively with either prosthetic or autogenous tissue reconstruction. Patient selection is important in order to optimize results, minimize complications and improve quality of life, while simultaneously treating the malignancy. Close cooperation and collaboration between the oncological breast and reconstructive surgeons is desirable in order to achieve these objectives.
Duodenal injuries
Authors: Degiannis E , Boffard K 
Published: March 2003

Abstract

Background
The worldwide increase in road traffic accidents and use of firearms has increased the incidence of duodenal trauma.

Methods
The English language literature on duodenal trauma over the period 1970–1999 was reviewed.

Results and Conclusion
Upper gastrointestinal radiological studies and computed tomography may lead to the diagnosis of blunt duodenal trauma. Exploratory laparotomy remains the ultimate diagnostic test if a high suspicion of duodenal injury continues in the face of absent or equivocal radiographic signs. The majority of duodenal injuries may be managed by simple repair. More complicated injuries require more sophisticated techniques. High-risk duodenal injuries are followed by a high incidence of suture line dehiscence and they should be treated by duodenal diversion. Pancreaticoduodenectomy should be considered only if no alternative is available. ‘Damage control’ should precede definitive reconstruction.
Epidemiology of cholecystectomy and irritable bowel syndrome in a UK population
Authors: Kennedy T M , Jones R H 
Published: March 2003

Abstract

Background
Some patients with irritable bowel syndrome (IBS) may undergo unnecessary cholecystectomy. This paper describes the prevalence of cholecystectomy and IBS in a sample of British adults in Teesside. Associations between the two conditions and their relationship to consultation behaviour and socioeconomic status are described. The results are compared with those from Bristol in an attempt to determine the influence of service-related factors on the prevalence of cholecystectomy.

Methods
A postal questionnaire was sent to 4432 adults aged 20–69 years registered with six general practices. The Standard Occupational Classification was used as a proxy for socioeconomic status.

Results
In Teesside cholecystectomy was reported by 4·1 per cent of women and 1·3 per cent of men. Some 22·9 per cent of the women had IBS, and 10·5 per cent of men. Cholecystectomy was more common in patients with IBS (odds ratio 1·9 (95 per cent confidence interval 1·2–3·2); P &lt; 0·01). The prevalence of cholecystectomy, of IBS and of consultation for symptoms of IBS was not influenced by socioeconomic status.

Conclusion
Symptoms of IBS may cause diagnostic confusion and unproductive surgery. Cholecystectomy may cause IBS-like symptoms, a single underlying disorder may produce symptoms in both gastrointestinal and biliary tracts, or the associations might be due to a combination of these factors.
Thyroid cancer management in North Trent. Case record review confirms the need for specialist care
Authors: Millar B A , Moore S , Harrison B J 
Published: March 2003

Abstract

Background
The Calman–Hine Report mandates the need for specialist care of patients with cancer within the UK. The next round of accreditation will include an assessment of care available to patients with thyroid cancer. The Joint Thyroid Cancer Clinic in Sheffield allows secondary and tertiary referral to a multidisciplinary specialist team for the two million people of North Trent.

Methods
A retrospective case record review of the last 159 patients referred to the clinic by specialist and non-specialist surgeons was performed to assess surgical and pathological aspects of care, including preoperative, peroperative and postoperative management, as well as operative morbidity.

Results
A total of 37 surgeons at ten hospitals were involved in the initial management of 128 women and 31 men (mean age 53 (range 10–99) years) with thyroid cancer (111 differentiated, nine medullary, 16 anaplastic, 15 lymphoma, eight others), including 23 general surgeons (69 patients), ten ear, nose and throat surgeons (ten patients) and three specialist endocrine surgeons (66 patients). Non-specialist surgeons carried out 78 reoperative procedures. Histopathological review after referral by a specialist pathologist resulted in a change in diagnosis in 10 per cent of 125 patients (13 cases). Operation-specific surgical morbidity was recorded as follows:
Cancer Registry data indicated that a further 101 patients with thyroid cancer were never referred to the Joint Thyroid Cancer Clinic during the same period.

Conclusion
In North Trent, despite the presence of a longstanding and well established clinic, many patients with thyroid cancer do not receive specialist/multidisciplinary care. Patients are often treated by surgeons with little experience of thyroid cancer, and the rates of inaccurate pathological diagnosis and operative morbidity are unacceptably high in patients treated by non-specialist teams.
Role of frozen section, sex, age and tumour size in differentiating follicular adenoma from carcinoma: a meta-analysis
Authors: Miltenburg D M , Prost H M , Graviss E A , Arem R 
Published: March 2003

Abstract

Background
Frozen section (FS) has been the mainstay of intraoperative decision-making in thyroid neoplasms for many years. However, since the widespread use of preoperative fine-needle aspiration, the need for FS in patients with follicular neoplasms (FNs) has been debated. Preoperative features may be better at distinguishing follicular carcinoma (FC) from adenoma (FA). One reason why these issues are unresolved is because clinical studies are often too small to reach statistical significance. The purpose of this study was to combine modern trials and use the technique of meta-analysis to determine the efficacy of FS and the role of sex, age and tumour size in patients with FNs.

Methods
Inclusion criteria were published and unpublished studies between 1990 and 1999 inclusive, in which patients had a permanent pathology (PP) diagnosis of FA or FC (including Hurthle cell tumours) and underwent FS or had clinical features recorded. A pooled sample of the combined data was analysed for the prognostic variables and outcomes. P &lt; 0·05 was considered significant.

Results
Nineteen studies were included. FS was evaluated in 11 studies (n = 2204). FS matched PP in 82 per cent of patients and was considered helpful. FS was indeterminate in 13 per cent of cases and was considered unhelpful. FS was detrimental in 4 per cent of patients. In 27 per cent of FCs, FS reported FA (false negative) and in 1 per cent of FAs, FS reported FC (false positive). Overall, FS had an 87 per cent sensitivity, 48 per cent specificity, 92 per cent positive predictive value, 35 per cent negative predictive value and 82 per cent accuracy. Clinical features were examined in ten studies (n = 1980). Nine studies (n = 1780) reported sex; 20 per cent of patients were male. A disproportionately high percentage of patients with FC were male (28 per cent) compared with female (P &lt; 0·001). Two studies (n = 548) reported age; 36 per cent of patients were over 50 years old. A disproportionately high percentage of patients with FC were aged over 50 years (52 per cent) compared with those younger than 50 years (P &lt; 0·001). Six studies (n = 1620) reported tumour size; 19 per cent of FNs were larger than 3–5 cm. A disproportionately high percentage of FCs were larger than 3–5 cm (33 per cent) compared with smaller lesions (P &lt; 0·001).

Conclusion
FS is able to differentiate FC from FA in over 80 per cent of patients. It has a false-positive rate of less than 1 per cent and therefore may be trusted most when it reports a FC. In cases in which FS reports FA, male sex, age greater than 50 years and tumour size larger than 3–5 cm can be used as indicators that a FN will be a FC.
Discovery of germline and somatic mutations in apparently sporadic parathyroid tumours
Authors: Uchino S , Noguchi S , Sato M , Yamashita H , Yamashita H , Watanabe S , Ohshima A , Nagatomo M , Adachi M 
Published: March 2003

Abstract

Background
To discriminate between sporadic and hereditary parathyroid tumours and characterize multiple endocrine neoplasia type 1 (MEN1) somatic mutations, MEN1 gene mutations were examined in patients with apparently sporadic parathyroid tumours.

Methods
DNA was extracted from fresh frozen parathyroid tumour specimens from 112 patients, as well as from peripheral blood leucocytes (PBL) from 60 of the 112 patients. Sequencing was performed to examine exons 2–10 of the MEN1 gene for mutations. In addition, exons 10 and 11 of the RET gene were sequenced.

Results
MEN1 mutations were found in 25 (22 per cent) of the 112 patients. Two patients had two simultaneous point-mutations. A total of 27 mutations were characterized, 24 of which have not been reported previously. There were seven nonsense mutations, ten frameshift mutations, two splice-site deletions, five missense mutations and three in-frame mutations. Nineteen mutations resulted in truncation of menin protein. Germline MEN1 mutations were found in three of 60 patients who had no family history of endocrine tumours associated with MEN1, and these patients were identified as MEN1 gene family probands. No somatic or germline RET exon 10 and 11 mutations were found in this series.

Conclusion
These findings suggest that MEN1 gene mutation may be associated not only with endocrine tumours of affected patients with MEN1 but also with sporadic parathyroid tumours. MEN1 gene analysis can distinguish inheritable from non-inheritable parathyroid tumours and MEN1 gene evaluation of patients with apparently sporadic parathyroid tumours is necessary before parathyroid surgery.
Non-invasive imaging of freshly excised parathyroid glands using confocal reflectance microscopy
Authors: White W M , Tearney G J , Fabian R L , Gaz R D 
Published: March 2003

Abstract

Background
Successful surgical management of primary hyperparathyroidism requires an understanding of the underlying pathological diagnosis. Various methods have been employed to distinguish normal from hyperfunctional diseased glands. Confocal reflectance microscopy (CRM) is a novel optical method of imaging tissue non-invasively without the need for fixation, sectioning and staining as in standard histopathology. Gray-scale images are displayed in real time on a monitor, and represent horizontal (en face) optical sections through the tissue. Using CRM, the goal of this study was to delineate histological features characteristic of the parathyroid gland, and to determine if confocal imaging could distinguish normal from adenomatous parathyroid tissue.

Methods
In this pilot observational cohort study, a total of 18 parathyroid glands was imaged using CRM immediately after excision in eight patients undergoing surgery for primary hyperparathyroidism. Confocal images were compared with corresponding permanent, haematoxylin and eosin-stained sections obtained from the same gland. For each patient, the percentage area occupied by fat cells was calculated in ten independent images (593 μm × 509 μm) of both normal and diseased glands.

Results
Characteristic histological features of the parathyroid gland were readily discernible by CRM and correlated well with permanent, haematoxylin and eosin-stained sections. The fat content of both normal and diseased glands could be determined easily. The percentage area occupied by fat cells was distinctly different in normal (mean(s.d.) 21·8(5·3) per cent) and diseased (0·9(2·4) per cent) parathyroid glands.

Conclusion
CRM rapidly revealed histological features of the parathyroid gland without histological processing. This new, simple, rapid and non-invasive technique has the potential for use as an adjunct to frozen-section analysis in intraoperative consultation during parathyroidectomy. This may provide a technique for in situ histological diagnosis of endocrine or other tissues without an excisional biopsy. Work is currently under way to develop an intraoperative probe for in vivo use.
Murine model of allogeneic adrenocortical cell transplantation: perspectives for the treatment of Addison's disease in man
Authors: Ellerkamp V , Musholt T J , Klebs S H G , Musholt P B , Scheumann G F W , Klempnauer J , Hoffman M W 
Published: March 2003

Abstract

Background
Hormone substitution for the treatment of adrenocortical insufficiency (Addison's disease) does not adequately substitute the physiological circadian secretion of corticosteroids leading to long-term sequelae and reduced quality of life. Moreover, oral administration of corticosteroids cannot mimic the hormone peaks required in stress situations. This lack of adaptation to physical and psychological stress may lead to life-threatening Addisonian crises. Allogeneic transplantation of adrenal cortex may offer an alternative.

Methods
Major histocompatibility complex (MHC) class I transgenic mice (H-2Kb) were used for the implementation of an animal model of adrenocortical transplantation. Tissue fragments or selectively isolated cell suspensions of the adrenal cortex were transplanted underneath the kidney capsule of adrenalectomized mice. Kb-transgenic murine cells as well as allogeneic adrenal cortex cells were cocultured in mixed lymphocyte cultures (MLC) in order to examine the alloimmune response. Lymphocytes from T-cell receptor transgenic mice and normal allogeneic mice respectively served as responder cells. The immune response, i.e. lymphocyte proliferation, was quantified by measuring the [3H]thymidine uptake of responder cells. The effect of corticosteroids secreted by adrenocortical cells was antagonized by the steroid receptor antagonist Mifepristone (RU 486).

Results
Without need for immunosuppressive drugs, adrenocortical grafts were demonstrated to proliferate and produce corticosteroids at physiological concentrations 20 days after transplantation. Coculture of adrenal cortical cells in MLC markedly suppressed lymphocyte proliferation. This inhibited immune response was not completely antagonized by RU 486.

Conclusion
In vitro, the presence of adrenocortical cells potently suppressed allogeneic immune responses. This effect was not only due to the secretion of corticosteroids, pointing to a additional immunomodulatory property of adrenocortical cells. Successful allogeneic transplantation of MHC-II-matched adrenal cortex grafts in a murine model raises the possibility of applying these methods in humans.
Cardiac disease and midgut carcinoid syndrome
Authors: Westberg G , Caidahl K , Bergh C-H , Ahlman H , Wangberg B 
Published: March 2003

Abstract

Background
Valvular heart disease is a well known complication of the midgut carcinoid syndrome but its impact on survival and effects of modern tumour treatment remain to be analysed.

Methods
In a prospective study cardiac abnormalities and clinical outcome were analysed in 64 consecutive patients with high urinary excretion of the serotonin metabolite 5-HIAA and carcinoid tumours with liver metastases (mean(s.d.) follow-up 119(7) months). A tumour reduction programme by radical surgery alone (including hemihepatectomy) or with hepatic artery embolization following primary surgery (in bilobar liver disease) was offered to all patients. At entry into the study, patients underwent Doppler echocardiography, exercise electrocardiography, Holter monitoring and urinary 5-HIAA determination.

Results
At follow-up, patients were grouped according to clinical outcome. Twenty-four patients were alive, 11 after radical surgery alone (group 1) and 13 after embolization plus octreotide (group 2). Forty patients had died during follow-up (group 3), three with radical surgery (unrelated disease) and 27 patients with embolization plus octreotide. Ten deceased patients had medical therapy alone after primary surgery owing to complicating diseases. The mean 5-HIAA levels before treatment were lower in group 1 (185 mol per 24 h) than in group 2 (956 (mol per 24 h) or group 3 (566 (mol per 24 h). Tricuspid valve structural abnormalities (TSA) were found in 13, 38 and 33 per cent, and holosystolic tricuspid regurgitation (TR) in 36, 54 and 60 per cent of patients in groups 1, 2 and 3 respectively. No patient had pulmonary stenosis, but 9 per cent (group 1), 15 per cent (group 2) and 13 per cent (group 3) had holodiastolic pulmonary regurgitation. A novel index (TSA–TR) of TSA (0–4) and TR (0–4) was formed. Patients with TSA–TR (3 had significantly (P = 0·025) higher 5-HIAA levels than patients with an index (1. Patients with 5-HIAA levels above 500 (mol per 24 h demonstrated a significantly (P = 0·04) higher late-to-early peak ratio (A/E) of diastolic tricuspid Doppler flow than patients with 5-HIAA levels less than 500 (mol per 24 h. Of the six patients who suffered cardiac death, five died from ischaemic heart disease or sudden death and one from advanced right heart failure.

Conclusion
Tricuspid abnormalities were common findings in patients with the midgut carcinoid syndrome and severe findings were related to high urinary excretion of 5-HIAA. The highest initial hormone levels were seen in one of the surviving groups. Sudden or ischaemic heart death was more common than death from right-sided heart failure.
Value of preoperative diagnostic modalities in patients with recurrent thyroid carcinoma
Authors: Frilling A , Tecklenberg K , Goerges R , Clausen M , Broelsch C E 
Published: March 2003

Abstract

Background
The prognosis of differentiated thyroid carcinoma is usually excellent, but the majority of patients who develop a recurrence have a higher risk of death from the disease. Beside clinical examination, several diagnostic tools, such as ultrasonography, 131I scanning, [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) and thyroglobulin (TG) measurement under raised thyroid-stimulating hormone in serum can detect tumour recurrences. This prospective study compared the value of different diagnostic modalities in the detection of recurrent differentiated thyroid cancer.

Methods
From April 1992 to October 1999, 181 patients with thyroid carcinoma, of whom 150 had a well differentiated tumour, subjected to surgical treatment were identified prospectively. Some 107 patients (71 per cent) presented with primary tumour and 43 patients (29 per cent) with recurrent disease. The patients with tumour recurrence were evaluated regarding the mode of detection of recurrent disease, including clinical examination, ultrasonography, fine-needle biopsy (FNB), TG measurement and FDG-PET, the surgical treatment and outcome.

Results
Some 63 per cent of patients presented with regional lymph node metastases and 37 per cent with local recurrence. None of the patients with local recurrence was operated on for primary tumour in this department. In 87 per cent the recurrence was detected by clinical examination. Ultrasonography and 131I scan revealed suspicious findings in 97 and 69 per cent respectively. FNB disclosed abnormal cytological findings in 95 per cent. There were pathological TG levels in 86 per cent of patients. Among patients with a raised level of TG and negative scan results, 13 underwent FDG-PET, with pathological findings in 82 per cent.

Conclusion
In patients with well differentiated thyroid carcinoma, ultrasonography and FNB are the most sensitive methods for the detection of local recurrence or regional lymph node metastases. FDG-PET is a useful diagnostic tool in patients with a negative 131I scan and a raised level of TG.
Prognostic significance of RET and NTRK1 rearrangements in sporadic papillary thyroid carcinoma
Authors: Musholt T J , Musholt P B , Khaladj N , Schulz D , Scheumann G F W , Klempnauer J 
Published: March 2003

Abstract

Background
The genetic background of papillary thyroid carcinoma (PTC) has been elucidated by the identification of somatic translocations of the tyrosine kinases RET and NTRK1. Expression of RET/PTC chimeras has been demonstrated in 10–25 per cent of sporadic PTCs while rearrangements of NTRK1 were detected less frequently. Based upon the limited data available, some investigators have hypothesized that RET/PTC activation is preferentially associated with slow growing tumours of low malignancy in elderly patients, while other studies support the contrary.

Methods
Tumour tissues from 115 patients with sporadic PTC were harvested at operation and snap frozen. Following RNA extraction, expression analysis of the RET proto-oncogene as well as the NTRK1 gene was performed by multiplex reverse transcriptase–polymerase chain reaction. Samples with suspected rearrangements of the genes were further analysed for expression of the hybrid messenger RNAs RET/PTC1 to RET/PTC4, and for known NTRK1 chimeras. Clinical data of all patients were documented in an extensive database of thyroid carcinomas maintained by this research group.

Results
Twenty-one (18 per cent) of 115 tumour samples revealed somatic rearrangements of RET while translocations of the NTRK1 gene were demonstrated in 2 per cent of all samples analysed to date. The mean age of all patients was 52 (range 14–86, median 54) years and that of patients positive for RET rearrangements was 49 (range 14–82, median 49) years. Nine of 21 RET-rearranged tumours showed aggressive behaviour with locally invasive tumour growth and infiltration of adjacent structures such as muscles, vessels and trachea. Tumour samples without detectable RET translocations were associated with organ-exceeding tumour growth in only 20 per cent of cases.

Conclusion
These data represent one of the most comprehensive studies on gene translocations and their clinical significance in PTC. In accordance with international publications, an incidence of 2 per cent of NTRK1 rearrangements and 18 per cent of RET translocations is reported, which is in contrast to other national reports of low rearrangement rates. Somatic translocations were associated with tumours demonstrating aggressive behaviour in almost half of patients with PTC in all age groups, indicating a prognostic role of oncogenic RET/PTC activation.