bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic ultrasonography in the evaluation of idiopathic acute pancreatitis
Authors: Norton S A , Alderson D 
Published: March 2003

Abstract

Background
‘Idiopathic’ pancreatitis may be diagnosed when gallstones are excluded by transabdominal ultrasonography and less common causes are not implicated by history or other investigations. Transabdominal ultrasonography may not, however, detect small stones responsible for acute pancreatitis. The aim of this study was to determine if endoscopic ultrasonography (EUS) is able to identify undetected gallstones in cases of ‘idiopathic’ pancreatitis.

Methods
Consecutive patients presenting with ‘idiopathic’ pancreatitis were assessed using EUS for the presence of gallstones or other potential causes of the attack. A control group was also imaged.

Results
Forty-four patients with ‘idiopathic’ pancreatitis were assessed. Ten had suffered earlier attacks of pancreatitis before this study. EUS revealed proven pathology in 18 patients. Unconfirmed pathology was evident in 14. No abnormality was seen in only nine patients. EUS failed in one patient and there were two possible false-positive results.

Conclusion
EUS is able to identify significant pathology in patients in whom a diagnosis of ‘idiopathic’ pancreatitis has been made following standard investigations. Patients with untreated gallstones are at risk of recurrent attacks. Idiopathic pancreatitis should not be diagnosed unless EUS has been performed.
Risk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn's disease
Authors: Bernell O , Lapidus A , Hellers G 
Published: March 2003

Abstract

Background
Previous studies on risk factors for resection and postoperative recurrence in Crohn's disease have given inconclusive results. The aim of this study was to assess the risk for resection and postoperative recurrence in the treatment of ileocaecal Crohn's disease and to define factors affecting the course of the disease.

Methods
A population-based cohort of 907 patients with primary ileocaecal Crohn's disease was reviewed retrospectively.

Results
Resection rates were 61, 77 and 83 per cent at 1, 5 and 10 years respectively after the diagnosis. Relapse rates were 28 and 36 per cent 5 and 10 years after the first resection. A younger age at diagnosis resulted in a low resection rate. The presence of perianal Crohn's disease and long resection segments increased the incidence of recurrence, and resection for a palpable mass and/or abscess decreased the recurrence rate. A decrease in recurrence rate during the study period (1955–1989) was observed.

Conclusion
In ileocaecal Crohn's disease the probability of resection is high and the risk of recurrence moderate. Crohn's disease in childhood carries a lower risk of primary resection. Perianal disease and extensive ileal resection increase the risk of recurrence.
Quality of life in long-term survivors after curative transhiatal oesophagectomy for oesophageal carcinoma
Authors: de Boer A G E M , Oñorbe Genovesi P I , Sprangers M A G , van Sandick J W , Obertop H , van Lanschot J J B 
Published: March 2003

Abstract

Background
Transhiatal resection for oesophageal cancer is a major operation with potentially severe physical, emotional and social consequences. The aim of this study was to assess various aspects of quality of life in long-term survivors following oesophageal resection for cancer.

Methods
Between January 1993 and May 1996, 100 consecutive patients with cancer of the oesophagus or oesophagogastric junction underwent a potentially curative transhiatal oesophagectomy. Patients with a minimum follow-up of 2 years and with no tumour recurrence (n = 35) were mailed questionnaires which consisted of: (a) the Short Form-36 Health Survey to assess general quality of life, (b) an adapted Rotterdam Symptom Checklist to assess disease-specific quality of life, and (c) additional questions about other effects of the operation.

Results
All patients returned the questionnaire. General quality of life was comparable with reference values for the same age group. However, more than half of the patients still experienced at least some early satiety, fatigue, dysphagia, heartburn and/or psychological irritability. Nine of 13 patients who worked in paid employment before operation continued to do so.

Conclusion
Patients who survive 2 years or more after transhiatal oesophageal resection for cancer can lead satisfactory lives. Although some residual symptoms may persist, their general quality of life is similar to that of healthy individuals of the same age.
Multicentre study comparing aggressive behaviour of familial non-medullary thyroid carcinoma and sporadic thyroid cancer
Authors: Alsanea O , Wada N , Ain K , Wong M , Taylor K , Ituarte P , Tressler P , Weier H-U , Freimer N , Siperstein A , Duh Q , Takami H , Clark O H 
Published: March 2003

Abstract

Background
Familial non-medullary thyroid cancer represents about 5 per cent of all thyroid cancers of follicular cell origin. Whether familial non-medullary thyroid cancer is more aggressive than sporadic thyroid cancer is controversial.

Methods
Each patient with familial non-medullary thyroid cancer was matched with three controls for age, sex and tumour node metastasis (TNM) stage of disease. Possible prognostic factors were compared in relation to recurrence, metastases and mortality rate in both groups. Univariate analysis was performed using contingency table analysis and McNemar's χ2 test for paired measurements. Multivariate analysis was used to evaluate factors significant in univariate analysis.

Results
Forty-eight cases (ten men) and 144 matched controls (30 men) were analysed with a mean follow-up of 102 and 94 months respectively. The mean age was 39 years for cases and 46 years for controls. Some 29 per cent of the cases and 12 per cent of the controls had history of prior or coexistent benign thyroid disease (P &lt; 0·05). Ninety-four per cent of cases and 90 per cent of controls had papillary cancers; the remainder were Hurthle cell cancers. Based on TNM staging, there were 66 per cent stage I, 21 per cent stage II and 13 per cent stage III tumours in the familial non-medullary thyroid cancer group; the distribution was similar in the control group. Modified radical neck dissection was performed in 42 per cent of cases and 22 per cent of controls. Multifocal or bilateral disease was seen in 75 per cent of cases and 41 per cent of controls (P &lt; 0·05); 35 per cent of cases and 16 per cent of controls had at least one recurrence (P &lt; 0·05). Ten per cent of cases and 2 per cent of controls developed distant metastases (P &lt; 0·05). Six per cent of cases but no controls died from thyroid cancer (P &lt; 0·05). In patients with familial non-medullary thyroid cancer aged over 45 years (n = 14), distant metastases affected four, of whom three died. In multivariate analysis, age was the only significant variable that affected the disease outcome (P &lt; 0·01).

Conclusion
Familial non-medullary thyroid cancer is more aggressive than sporadic thyroid cancer and is associated with increased recurrence, metastasis and death, especially in patients over 45 years of age.
Surgery for primary hyperparathyroidism
Authors: Dudley N E 
Published: March 2003

Abstract

Background
Routine open bilateral neck exploration without preoperative localization or intraoperative parathyroid hormone assay has been repeatedly challenged over recent years as the optimal surgical strategy for the treatment of idiopathic primary hyperparathyroidism (HPT). This has prompted a review of the Oxford experience with adherence to traditional practice, questioning whether results could have been improved upon or cost justified by targeting unilateral exploration and immediate hormonal assay.

Methods
The records of all patients undergoing first-time surgery for idiopathic primary HPT over a 32-year period have been reviewed. In every patient bilateral neck exploration was performed and an attempt made to identify all four parathyroid glands. All macroscopically enlarged glands were removed and the operating time recorded. A successful outcome was defined as normocalcaemia without any therapy at 3-month review after surgery, with good cosmesis.

Results
Between 1968 and 2000, 688 patients were operated upon; a total of 2520 parathyroids were identified, of which 968 were abnormal. A single adenoma was found in 542 patients (79 per cent) (eight in a fifth gland), multiple gland disease in 120 (17 per cent) and parathyroid carcinoma in ten (1 per cent). Mean operating time for all patients was 65 min, including those requiring thyroid lobectomy and cervical thymectomy. When a single adenoma was found in a normal anatomical site the mean operating time was 35 min. Some 672 patients (98 per cent) were treated successfully.

Conclusion
Open bilateral neck exploration and removal of all macroscopically enlarged parathyroid glands resulted in a high level of success in this series. No evidence has been found in a worldwide literature search to suggest that expensive high technology would have provided greater benefit for the group as a whole.
Metabolic abnormalities and treatment of mild asymptomatic primary hyperparathyroidism
Authors: Hagstrom E , Lundgren E , Lithell H , Berglund L , Hellman P , Rastad J 
Published: March 2003

Abstract

Background
Primary hyperparathyroidism (pHPT) is associated with increased morbidity and mortality rates, especially due to cardiovascular disease. This may be an effect of metabolic alterations in lipoprotein, glucose and urate turnover. The few previous reports studying this matter have been inconclusive and have included only hypercalcaemic patients.

Methods
In a population-based screening of 5202 postmenopausal women, 109 were diagnosed with mild pHPT. Some 92 patients, together with matched controls, were investigated to analyse metabolic disturbances, and the effect of parathyroidectomy and hormone replacement therapy (HRT). Sixty-nine pairs completed the 5-year study.

Results
Patients had higher serum calcium and parathyroid hormone levels than controls. They had hypertriglyceridaemia and a significantly increased amount of triglyceride-rich lipoproteins. Furthermore, patients had pronounced hypercholesterolaemia, although the level of high-density lipoprotein–cholesterol was lower, and higher serum blood glucose and urate levels. While 5 years of surveillance only failed to affect these alterations, parathyroidectomy with or without addition of HRT normalized the metabolic changes. Thus, 4 years after surgery no differences were seen between cases and controls.

Conclusion
The metabolic alterations in mild pHPT span over many extraparathyroid metabolic systems and constitute an increased risk of cardiovascular disease and death. Parathyroidectomy has a reversing effect on these proatherosclerotic changes, while surveillance does not affect the outcome. Even in mild pHPT surveillance may be questioned.
Prospective case–control analysis of treatment of menopausal primary hyperparathyroidism: calcium and parathyroid hormone
Authors: Lundgren E , Naessen T , Ljunghall S , Rastad J 
Published: March 2003

Abstract

Background
Therapeutic options in primary hyperparathyroidism (HPT) have not been analysed in postmenopausal women recruited by population-based screening.

Methods
Postmenopausal women (n = 92) with HPT detected at population-based screening entered into a prospective case–control comparison at mean(s.d.) 66·5(6·0) years of age. Biochemical signs of HPT were mild (mean(s.d.) serum calcium 2·59(0·14) mmol l−1) and cases were considered overtly asymptomatic. Parathyroid surgery, oestrogen replacement therapy (ERT; ethinyloestradiol), ERT and surgery, and conservative surveillance were evaluated after 1, 2 and 5 years. Follow-up was complete in 75 per cent of the patients.

Results
Parathyroid surgery rendered the total and ionized calcium, and intact parathyroid hormone (PTH) values in blood, and the urinary calcium excretion indistinguishable between cases and controls. ERT was maintained during approximately 80 per cent of the follow-up period. It reduced the blood calcium levels significantly and tended to increase the serum PTH level. Significant discrepancies, however, persisted towards the controls. ERT added no significant changes to the biochemical outcome of parathyroidectomy. Conservatively treated cases had essentially stable parameters over the study period.

Conclusion
Parathyroidectomy was the only treatment option that normalized basic variables of the calcium homoeostasis to control levels in postmenopausal women with mild primary HPT.
Identification of a novel glucose transporter in medullary thyroid carcinomas and phaeochromocytomas
Authors: Phay J E , Hussain H B , Moley J F 
Published: March 2003

Abstract

Background
The authors previously reported that medullary thyroid carcinomas (MTCs) and phaeochromocytomas avidly take up the glucose analogue fluorodeoxyglucose (FDG) on FDG positron emission tomography. It was also shown that these tumours do not express any of the known human glucose transporters (Glut 1–5), which are responsible for glucose and FDG uptake into cells. It was hypothesized that a novel glucose transporter is responsible for glucose uptake in MTCs and phaeochromocytomas.

Methods
Using protein sequences from the known human glucose transporters (Glut 1–5), the National Center for Biotechnical Information expressed sequence tag database was screened for novel homologous sequences. Clones derived were used to screen a pooled kidney complementary DNA (cDNA) library, and cDNAs identified were used to identify patterns of expression by Northern blot analysis.

Results
A novel member of the human glucose transporter family, called Glut X2, was identified. This transporter had 33 per cent protein sequence identity to Glut 3. Hydropathic analysis showed exofacial and transmembrane domain structure consistent with a hexose transporter. Northern blot analysis showed expression of Glut X2 in all seven MTCs studied, all three phaeochromocytomas and in TT cells, an MTC cell line. These tumours did not express any of the other known facilitative glucose transporters (Glut 1–5).

Conclusion
A novel member of the human glucose transporter family has been identified which may be responsible for glucose uptake in MTCs and phaeochromocytomas.
Pitfalls of intraoperative (1–84) parathyroid hormone measurement during surgery for primary hyperparathyroidism in 154 consecutive operations
Authors: Mondragon-Sanchez A , Minuto M , Mullineris B , Lokey J , Pattou F , Smellie W J B , Proye C 
Published: March 2003

Abstract

Background
Rapid intraoperative assay of peripheral blood intact parathyroid hormone (PTH) levels has been proposed to supersede frozen-section analysis and assure complete removal of pathological tissue after unilateral (minimal access) exploration. This is a review of the author's surgical, pathological and rapid PTH assay results.

Methods
Some 152 patients (26 men) had 154 explorations for primary hyperparathyroidism (HPT) with rapid intraoperative assay of intact PTH at Centre Hospitalier Regional et Universitaire de Lille.

Results
After neck dissection, before removal of any tissue, the PTH level altered from 11 to 900 per cent of the level at induction of anaesthesia. Decay of blood PTH levels after excision was rapid but some late raised levels may be have been due to a pre-excision increase. Recurrent or persistent HPT was seen in eight patients. This was predicted correctly in two and missed in six by the PTH assay (i.e. PTH greater than 50 per cent at more than 5 min). One Schwannoma and one thyroid nodule were removed resulting in diagnostic drops of PTH. There was no instance of non-hyperparathyroid tissue removal and intraoperative PTH assay. Multiple pathological glands were missed by PTH assay in four patients and predicted in a further two. In five patients the fall in PTH was slow; one was taking lithium, one was in mild renal failure and one had such a high initial PTH level that the assay saturated and it appeared that the results remained static. In 140 operations HPT was identified correctly and excised with a concomitant drop in PTH.

Conclusion
The intraoperative PTH levels vary markedly in either direction between induction of anaesthesia and the end of dissection. After excision of hyperparathyroid tissue the PTH level normally falls briskly from the postdissection level. The number of patients with a potentially unfavourable outcome is small; these data suggest that rapid intrapoperative PTH assay would have missed further HPT in ten of 14 instances had the surgical strategy been solely dependent on PTH levels. The routine use of intraoperative PTH assay in surgery for primary HPT is therefore questioned.
Screening for genetic aberrations in papillary thyroid cancer using comparative genomic hybridization
Authors: Singh B , Lim D , Cigudosa J C , Rao P H , Ghossein R , Poluri A , Wreesmann V , Shaha A , Shah J P 
Published: March 2003

Abstract

Background
Papillary thyroid carcinomas (PTCs) are a heterogenous group of neoplasms that display a wide variability in clinical behaviour. Knowledge of the genetic composition of these tumours may help improve prognostication, but is currently limited. The aim of this study was to identify the genetic composition of pathologically low-risk papillary thyroid cancers and identify differences based on age, using a powerful, genome-wide analytical technique, comparative genomic hybridization (CGH).

Methods
Tumour samples from patients with pathologically confirmed well differentiated PTC, less than 4 cm in size and without extrathyroidal extension or distant metastasis, were procured from the institutional tumour bank. CGH analysis was performed by differentially labelling tumour and normal DNA with fluorescent agents. The labelled DNAs were coprecipitated and simultaneously hybridized to normal metaphase chromosomes on glass slides. After chromosomal segregation, computerized image analysis was performed to detect fluorochrome intensity along the entire length of each chromosome. The ratio of fluorescent signal intensity was used to identify the presence of genetic abnormalities. Statistical age-group comparisons of the CGH findings were performed using Fisher's exact test.

Results
Genetic abnormalities were detected in ten of 21 cases. A recurrent pattern of aberrations was identified, involving losses at chromosomes 1p, 9q, 17, 19 and 22, and gains at 4, 6 and 13. The prevalence of CGH-detectable aberrations was not influenced by age, but loss of chromosome 22 was unique to patients aged less than 40 years (P = 0·05) and was associated with a higher rate of locoregional metastasis (19 versus 80 per cent; P = 0·02).

Conclusion
Two distinct patterns of genetic composition were observed in PTC. One group had no detectable abnormalities, while the other had a recurrent pattern of gains and losses that localized to identical chromosomal loci. Although a divergent pattern of involvement was seen in younger patients, the direct clinical significance of this finding needs to be elucidated. Moreover, the identified pattern of alterations suggests that novel oncologically consequential genes are present within the involved loci. Molecular cloning of the genes at each of these sites is warranted.
Risk profile for bone fractures in primary hyperparathyroidism
Authors: Westerdahl J , Valdemarsson S , Lindblom P , Bergenfelz A 
Published: March 2003

Abstract

Background
Contemporary patients with primary hyperparathyroidism (pHPT) have an increased fracture risk, although they are often otherwise asymptomatic with mild hypercalcaemia. Decreased bone density has, therefore, been considered an indication for surgery. However, many patients with pHPT are old with concomitant chronic diseases and therefore have a multifocal risk profile for osteoporosis and bone fractures. The aim of the present study was to evaluate bone density as well as other clinical and biochemical variables of importance for bone metabolism with regard to fracture risk in patients with pHPT.

Methods
Two hundred and five consecutive patients, 154 women and 51 men, operated for pHPT were investigated for bone mineral content (BMC), biochemical variables reflecting bone metabolism and severity of pHPT, medication and potential other risk factors for osteoporosis. Mean(s.d.) age of the patients was 64(14) years and serum level of calcium was 2·78(0·18) mmol l−1.

Results
Eighteen patients (9 per cent) had a history of at least one bone fracture during the 5 years before pHPT surgery. In univariate analyses age, BMC, serum level of PTH, 25-hydroxyvitamin D, alkaline phosphatase and collagen telopeptide (ICTP), cortisone treatment and a history of cardiovascular disease were found to be associated with a history of bone fractures. When these variables, and in addition sex, were included in a multiple logistic regression analysis, ICTP was the only variable independently related to bone fractures.

Conclusion
The present data highlight the multifocal bone fracture risk profile in pHPT including low bone density. However, bone resorption (ICTP) was the only variable in the multivariate analysis that was independently associated with bone fractures in pHPT. This finding supports the important role of bone resorption in the pathogenesis of fractures in pHPT. Furthermore, it suggests that ICTP may be a useful tool for risk evaluation of fractures in patients with pHPT.
Overexpression of haem oxygenase 1 protects allogeneic thyroid grafts from rejection in naive mice
Authors: Niimi M , Takashina M , Ikeda Y , Takami H , Wood K J 
Published: March 2003

Abstract

Background
Endocrine allografts are an option for the treatment of endocrine failure. This study examined whether anti-CD4 monoclonal antibody (mAb) could induce survival of allogeneic thyroid grafts and investigated the mechanisms involved in graft survival.

Methods and Results
One lobe of thyroid was transplanted under the kidney capsule and graft survival was examined histologically. C57BL/10 (H2b) thyroids were rejected in naive CBA (H2k) mice within 14 days after transplantation. When mice were treated with a depleting anti-CD4 mAb (YTA 3·1; 100 μg on day −1, 0 and 3), all C57BL/10 thyroid grafts survived for over 30 days. In order to determine if donor-specific tolerance had been induced, mice with the surviving C57BL/10 thyroid grafts were transplanted with second C57BL/10 or Balb/c (H2d) thyroids under the left kidney capsule at 30 days. Interestingly, all of the second grafts were rejected in the left kidney capsule but the first C57BL/10 thyroid grafts continued to survive in the right kidney capsule for a further 30 days. These findings suggest that grafts themselves were modified under anti-CD4 mAb treatment. To confirm this hypothesis, C57BL/10 thyroid grafts in mice treated with anti-CD4 mAb were resected and retransplanted into naive mice 30 days after transplantation. All of the grafts survived when retransplanted to naive mice and this was found to correlate with overexpression of haem oxygenase 1 in the thyroid grafts. In an attempt to demonstrate the pivotal role of haem oxygenase 1 on graft survival, an inhibitor of haem oxygenase 1 (zinc protoporphyrin) or control compound (copper protoporphyrin) that did not inhibit the enzyme was injected intraperitoneally (30 mmol l−1 every day) after transplantation of C57BL/10 thyroid grafts into the primary CBA recipients treated with anti-CD4 mAb. The grafts in mice treated with zinc protoporphyrin but not copper protoporphyrin were rejected when retransplanted to naive recipients.

Conclusion
Overexpression of haem oxygenase 1 protects allogeneic thyroid grafts from rejection in recipients treated with anti-CD4 mAb. This observation may be applied for clinical endocrine grafts using gene transfer of haem oxygenase 1.