bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Survival of Patients With Supraclavicular Metastases at Diagnosis of Breast Cancer
Authors: Olivotto Ivo A. , Chua Boon , Allan Sharon J. , Speers Caroline H. , Chia Stephen , Ragaz Joseph 
Published: February 2003

Background: Patients with supraclavicular metastases at diagnosis of breast cancer were classified between 1987 and 2002 as having stage M1 breast cancer according to the tumor-node-metastasis (TNM) system. The 2003 edition of the TNM staging guidelines has classified such patients as having stage IIIC disease. To determine relative prognosis, we compared long-term survival in a population-based cohort of patients with isolated supraclavicular metastases (nodal-M1) to outcomes of patients with stage IIIB or M1 (other) disease at presentation. Materials and Methods: Among patients with breast cancer and known tumor stage referred to the British Columbia Cancer Agency from 1976 to 1985, 336 IIIB, 233 M1, and 51 nodal-M1 patients were identified. Actuarial overall and breast cancer–specific survival rates were determined to 20 years. Results: Overall survival at 20 years was 13.2% for nodal-M1 cases (95% confidence interval [CI], 5% to 26%), 9.4% for IIIB cases (95% CI, 6% to 14%), and 1.3% for M1 (other) cases (95% CI, 0.4% to 3.5%; log-rank P < .0005). Overall survival was similar between nodal-M1 and IIIB cases (P = .27). Breast cancer–specific survival at 20 years was 24.1% for nodal-M1 cases (95% CI, 13% to 37%), 30.2% for IIIB cases (95% CI, 23% to 38%), and 3.9% for M1 (other) cases (95% CI, 2% to 8%; log-rank P < .0005). Breast cancer–specific survival was significantly different for nodal-M1 cases compared with either IIIB or M1 (other) cases (P = .008 for both). Conclusion: Patients with supraclavicular metastases at diagnosis have significantly better outcomes than patients with M1 (other) disease and overall survival similar to patients with IIIB disease. Reclassification as stage IIIC is appropriate for patients with breast cancer who present with supraclavicular nodal metastases alone.
Regulation of the Rat Follicle-Stimulating Hormone β-Subunit Promoter by Activin
Authors: Suszko Magdalena I. , Lo Denise J. , Suh Hoonkyo , Camper Sally A. , Woodruff Teresa K. 
Published: February 2003

AbstractFSH is controlled by a variety of positive and negative stimuli, and the unique FSHβ-subunit is a major target for this regulation. Activin is a key modulator of FSHβ transcription and hormone secretion. The signal transduction pathway leading to FSH expression was previously unknown. Here, we show that the transcription factors Smad3 and Smad4 mediate activin-stimulated activity of the rat FSHβ promoter in a pituitary-derived cell line, LβT2. Cells were transiently transfected with the rat FSHβ promoter fused to a luciferase reporter gene (−338rFSHβ-Luc), and a minimal activin-responsive region was identified. Transfection of Smad3, but not the highly related Smad2, led to a ligand-independent stimulation of the FSHβ promoter activity. As expected, activin caused an additional increase of luciferase expression, which was blocked by cotreatment with follistatin. Although Smad4 alone had no effect on FSHβ transcription, it significantly augmented Smad3 and activin-mediated stimulation of the promoter. A palindromic consensus Smad-binding element in the proximal promoter was found to bind Smad4, and elimination of the region resulted in a loss of activin-mediated FSHβ transcription.The activin signaling pathway is conserved in a number of cells, but FSHβ expression is restricted to gonadotropes. A pituitary-specific transcription factor necessary for activin-dependent induction of the FSHβ promoter has been identified that permits FSHβ expression in nongonadotrope cells. Pitx2 is a member of Pitx subfamily of bicoid-related homeodomain factors that is required for pituitary development and is present in the adult pituitary. This factor was transfected into LβT2 cells, where it caused up-regulation of basal and activin-mediated FSHβ promoter activity. Furthermore, cotransfection of Pitx2c with Smad3 in kidney-derived TSA cells resulted in activin-regulated FSHβ response, suggesting its important role in tissue-restricted regulation of FSHβ by activin. A Pitx2c binding site was identified within the proximal promoter, and elimination of this region also resulted in a loss of activin-regulated FSHβ promoter activity. Taken together, these studies suggest that the regulation of FSHβ is dependent on activin-mediated signaling factors in concert with pituitary-derived nuclear regulatory proteins.
Local Insulin-Like Growth Factor-II Mediates Prolactin-Induced Mammary Gland Development
Authors: Hovey Russell C. , Harris Jessica , Hadsell Darryl L. , Lee Adrian V. , Ormandy Christopher J. , Vonderhaar Barbara K. 
Published: February 2003

AbstractProlactin (PRL) is a major determinant of mammary epithelial cell proliferation during alveolar development in sexually mature and pregnant mice. To date, it has not been clear whether PRL effects these responses alone or by also invoking the action of autocrine/paracrine growth factors. In this study, we provide evidence that part of the effect of PRL on mammary gland growth is mediated by IGF-II. During sexual maturity and in early pregnancy, the level of IGF-II mRNA in the mammary gland was increased concurrent with increased PRL receptor expression. The level of IGF-II mRNA was reduced in mammary tissue from PRL receptor−/− mice during early pregnancy, and explants of mouse mammary gland and HC11 mammary epithelial cells both increased their expression of IGF-II after exposure to PRL in vitro. These findings coincided with the demonstration that IGF-II stimulated alveolar development in mammary glands in whole organ culture. PRL was most efficacious in stimulating IGF-II gene transcription from promoter 3 of the mouse IGF-II gene in vitro. Insight into the mechanism by which PRL induced IGF-II expression was provided by the fact that it was blocked by the Jak2 inhibitor AG490 and the MAPK inhibitor PD98059. Finally, induction of insulin receptor substrate (IRS)-1 in the mammary glands of PRL-treated mice and induction of IRS-1 and IRS-2 after treatment with PRL plus progesterone indicates that these molecules are induced by PRL as potential signaling intermediates downstream from IGF-I/insulin receptors. Together, these data demonstrate a role for IGF-II as a mediator of PRL action in the mouse mammary gland during ductal branching and alveolar development.
Insulin-Like Growth Factor I Receptor Signaling and Nuclear Translocation of Insulin Receptor Substrates 1 and 2
Authors: Sun HongZhi , Tu Xiao , Prisco Marco , Wu An , Casiburi Ivan , Baserga Renato 
Published: February 2003

AbstractThe insulin receptor substrate 1 (IRS-1) can translocate to the nuclei and nucleoli of several types of cells. Nuclear translocation can be induced by an activated insulin-like growth factor 1 receptor (IGF-IR), and by certain oncogenes, such as the Simian virus 40 T antigen and v-src. We have asked whether IRS-2 could also translocate to the nuclei. In addition, we have studied the effects of functional mutations in the IGF-IR on nuclear translocation of IRS proteins. IRS-2 translocates to the nuclei of mouse embryo fibroblasts expressing the IGF-IR, but, at variance with IRS-1, does not translocate in cells expressing the Simian virus 40 T antigen. Mutations in the tyrosine kinase domain of the IGF-IR abrogate translocation of the IRS proteins. Other mutations in the IGF-IR, which do not interfere with its mitogenicity but inhibit its transforming capacity, result in a decrease in translocation, especially to the nucleoli. Nuclear IRS-1 and IRS-2 interact with the upstream binding factor, which is a key regulator of RNA polymerase I activity and, therefore, rRNA synthesis. In 32D cells, wild-type, but not mutant, IRS-1 causes a significant activation of the ribosomal DNA promoter. The interaction of nuclear IRS proteins with upstream binding factor 1 constitutes the first direct link of these proteins with the ribosomal DNA transcription machinery.
Eddy genesis and transformation of Stokes flow in a double-lid driven cavity
Authors: Gürcan F , Gaskell P H , Savage M D , Wilson M C T 
Published: February 2003

Stokes flow is considered in a rectangular driven cavity of depth 2 H and width 2 L, with two stationary side walls and two lids moving in opposite directions with speeds U1 and U2. The flow is governed by two control parameters: the cavity aspect ratio, A = H/L, and the speed ratio, S = U1/ U2. The solution for the streamfuntion is expressed as an infinite series of Papkovich-Faddle eigenfunctions, which is then expanded about any stagnation point to reveal changes in the local flow structure as A and S are varied. An (S, A) control space diagram is constructed, which exhibits an intricate structure due to the intersection and confluence of several critical curves representing flow bifurcations at degenerate critical points. There are eight points where two critical curves intersect and the flow bifurcations are described and interpreted with reference to the theoretical work of Bakker ( Bifurcations in Flow Patterns, Kluwer Academic, 1991) and Brøns and Hartnack ( Phys. Fluids, 1999, 11, 314). For a speed ratio in the range -1 ≤ S < O the various flow trnsformations are tracked as A increases in the range O < A < 3.2, and hence the means is identified by which new eddies appear and become fully developed. It is shown that for S ≠ O, the number of eddies increases from 1 to 3 via several key flow transformations, which become more complicated as | S| is reduced.
Effects of a Femoral Shaft Fracture on Multiply Injured Patients with a Head Injury
Authors: Nau Thomas , Kutscha‐Lissberg Fritz , Muellner Thomas , Koenig Franz , Vecsei Vilmos 
Published: February 2003

AbstractTo study the effects of a femoral shaft fracture and its early stabilization on the morbidity, mortality, and outcome of patients with multiple injuries and a concomitant head injury, we analyzed the clinical course of patients using a prospectively gathered database. A series of 42 patients with multiple injuries, including head injuries and femoral fractures, formed the study group. A series of 133 patients with multiple injuries and head injuries but without femoral fractures formed the control group. The parameters examined included injury severity, injury pattern, hemodynamics at admission, mortality, duration of ventilation, length of intensive care unit (ICU) stay, and outcome. There were no significant differences regarding the demographics, injury severity score (ISS), injury pattern except the extremity Abbreviated Injury Scale (AIS) between the study and control groups. No significant differences were found in terms of mortality, duration of ventilation/ICU stay, and outcome. Injury severity (ISS), severity of the head injury (AIS), and hemodynamics at admission were shown to have a significant effect on the examined parameters. The present study suggests that a femoral fracture and its early stabilization in a multitrauma patient with a concomitant head injury do not adversely affect mortality and outcome and supports aggressive surgical management for these patients.
Management of 100 Consecutive Cases of Pancreatic Serous Cystadenoma: Wait for Symptoms and See at Imaging or Vice Versa?
Authors: Bassi Claudio , Salvia Roberto , Molinari Enrico , Biasutti Carlo , Falconi Massimo , Pederzoli Paolo 
Published: February 2003

AbstractPancreatic serous cystadenomas have a low malignancy rate. When nonsymptomatic, in selected patients, they can be managed without surgery; however, a high degree of diagnostic reliability is crucial. We admitted 100 consecutive cases (87 women with a median age of 51.86 years). Of these, 44 were symptomatic and 56 were diagnosed incidentally. Ultrasound correctly diagnosed 53% of the cases, incorrectly 31%, and was nondiagnostic in 16%. Computed tomography scan had similar rates (54%, 34% and 12%, respectively), while magnetic resonance imaging improved diagnostic accuracy to 74% and reduced incorrect diagnoses to 26%. In 21 cases, exploratory needle aspiration of the cyst was carried out; only 8 samples (38%) resulted in a diagnosis; in 12 patients (57%) insufficient material was acquired to allow for diagnosis, one case demonstrated epithelial dysplasia. In 1 patient an exploratory puncture resulted in a very serious bleeding. Sixty‐eight patients were treated surgically, the 44 symptomatic cases and another 24 patients with ill‐defined oligocystic lesions that could not be differentiated as serous or mucinous in the preoperative period. Two patients underwent resection because of frank tumor growth. In the two time periods analyzed (the first 7 years and the subsequent 6.5 years) the relationship between cases observed/operated on did not significantly change. Twenty‐one (30.8%) distal pancreatectomies, 14 (20.5%) intermediate resections, 10 (14.7%) pancreaticoduodenectomies 4 (5.8%) enucleations, and 1 (1.4%) duodenum‐preserving pancreatic head resection were carried out. Nine patients (13.2%), underwent exploratory laparotomy with a diagnostic biopsy. Another 9 underwent decompressive interventions with cystojejunostomies. The morbidity was 27.9%, with a reoperation rate of 7.3% and zero mortality. In general the patient’s pain resolved in the postoperative period. Median follow‐up was 43 months (range, 4–191 months). One patient died from other causes, and all others are currently alive. In the group of 32 patients who did not undergo operation, the median follow‐up is 69 months (range, 8–164 months). Until more sophisticated technologies can be developed, the current diagnostic work‐up will not result in increased preoperative diagnosis of serous‐cystic tumors of the pancreas. This is mainly relevant to the oligocystic forms, which account for about one fourth of all serous tumors observed.
Evaluating the Hilar Bifurcation Territory in the Human Liver Caudate Lobe to Obtain Critical Information for Delimiting Reliable Margins during Caudate Lobe Surgery: Anatomic Study of Livers with and without the External Caudate Notch
Authors: Kanamura Tetsuhiro , Murakami Gen , Ko Saiho , Hirai Ichiro , Hata Fumitake , Nakajima Yoshiyuki 
Published: February 2003

AbstractThe hilar bifurcation (HB), a wedged portion between the left and right portal vein origins, often issues the caudate branch. However, the HB territory in the caudate lobe has not been well recognized during liver surgery. In 50% of 48 human livers (25 usual livers and 23 with the external caudate notch), the HB gave off thick portal branches (> 1 mm) to supply the caudate lobe. Using minute dissections, we identified four cross‐sectional configurations of three subdivisions of the caudate lobe (i.e., left, right, and HB portal territories). The HB territory was consistently located in the paracaval portion, although it sometimes (29.2%: type A) extended slightly or deeply into Spiegel’s lobe. This leftward HB territorial extension was seen more frequently in livers with the notch (43.6%) than in those without it (“usual” livers) (16.0%). Moreover, in livers with the notch the caudate lobe (usually its right portal territory) tended to extend upward and rightward to attach or surround the terminal portion of the right hepatic vein. Our results suggested that in many cases subdivisions of the caudate lobe cannot be divided simply into right and left portions. The HB branch or territory should be examined to determine the real principal border as well as the subdivisional configuration of the caudate lobe. Combined evaluation of the HB branch(es) and external notch could provide critical information for anatomically sophisticated caudate lobe surgery.
Completion Radical Surgery after Cholecystectomy for Accidentally Undiagnosed Gallbladder Carcinoma
Authors: Toyonaga Takayuki , Chijiiwa Kazuo , Nakano Kenji , Noshiro Hirokazu , Yamaguchi Koji , Sada Masayuki , Terasaka Reiji , Konomi Kohki , Nishikata Fujihiko , Tanaka Masao 
Published: February 2003

AbstractSurvival time of 73 patients with undiagnosed gallbladder carcinoma incidentally found after cholecystectomy treated between 1982 and 2000 was evaluated in relation to various variables, with special reference to the significance of the radical second resection. The most significant prognostic factor was the depth of tumor invasion as assessed by univariate and multivariate analyses (odds ratio 3.40, 95% CI 1.65–7.00, p < 0.001). None of the 23 pT1 patients received radical second resection, and all of them were doing well without recurrence at their last follow‐up examination. The 3‐year survival rate was 68% for patients with pT2 and 14% for patients with pT3. Patient characteristics for the 18 pT2 patients who underwent radical second resection were similar to the characteristics of the 25 pT2 patients who did not; nor did postoperative survival times differ significantly. Survival time was not correlated with the interval from initial to second surgery or the type of initial cholecystectomy (open vs laparoscopic). In 11 patients with pT2 whose surgical margin was judged positive at initial cholecystectomy, the radical second resection significantly lengthened survival time. Radical second resection tended to prolong the median survival period from 7 to 15 months in 7 patients with pT3, although the difference was not significant. In conclusion, patients with pT1 undiagnosed carcinoma need no further treatment. The redo surgery was found to prolong survival only in patients with pT2 with positive surgical margin at initial cholecystectomy.
Possibilities of Chromoesophagoscopy for Diagnosis of Barrett’s Esophagus
Authors: Khadjibaev Abdukhakim M. , Nizamkhodjaev Zaynuddin M. , Kholmatov Rustam M. , Mirzakhmedov Bokhodir M. , Mirzaev Botir B. 
Published: February 2003

AbstractWhen the distal esophagus is covered with columnar gastric mucosa up to 2 cm from the esophagogastric junction it is considered normal. If the distal esophagus is covered with columnar epithelium more than 2 cm from the esophagogastric junction, it is called Barrett’s esophagus. We have developed a new chromoesophagoscopic method to improve diagnostic testing for Barrett’s esophagus. The distinctive feature of this method is that 4 to 5 ml of a 1% solution of neutral red is administered intravenously, after which excretion of the stain by the esophageal mucosa is examined by endoscopy. Chromoesophagoscopy has been carried out in 11 patients with reflux esophagitis. It revealed Barrett’s esophagus in four patients, which was proved by histologic evaluation of biopsy specimens obtained from the stained zone of the esophageal mucosa. These observations suggest that chromoesophagoscopy is an effective, accessible, feasible, safe method for diagnosing Barrett’s esophagus. It allows us to determine the length of the metaplastic epithelium and the topography of gastric glands; it also allows us to examine parietal cells in the esophagus and estimate the functional activity of these parietal cells in metaplastic epithelium.
Long‐term Results of Partial Pancreaticoduodenectomy for Ductal Adenocarcinoma of the Pancreatic Head: 25‐Year Experience
Authors: Richter Axel , Niedergethmann Marco , Sturm Jörg W. , Lorenz Dietmar , Post Stefan , Trede Michael 
Published: February 2003

AbstractThe prognosis of patients who undergo resection for pancreatic ductal adenocarcinoma with curative intention is generally poor unless they have early‐stage disease. Based on our 25‐year experience, the results of 194 patients after a standardized Kausch‐Whipple resection for adenocarcinoma of the pancreatic head were analyzed and the prognostic factors were evaluated. Between 1972 and 1998 a total of 221 patients were diagnosed for ductal adenocarcinoma of the pancreatic head, and 194 of them subsequently underwent a standardized Kausch‐Whipple resection. Long‐term results and prognostic factors were examined by multivariate and univariate analyses. The overall postoperative mortality was 3.09%, and the morbidity was 29.9%. By multivariate analysis only curative resection (R0) was significantly related to a favorable prognosis (p < 0.0001). Furthermore, in case of a curative resection, the presence of lymph node metastases showed prognostic significance in the multivariate analysis (p = 0.005). Cumulative survival analysis revealed a 5‐year survival rate of 25.4%, a 7‐year survival rate of 12.3%, and a 10‐year survival rate of 8.2% for patients who underwent curative resection (R0) for adenocarcinoma of the pancreatic head. We demonstrated that the R0 status is the only independent prognostic factor after surgery for adenocarcinoma of the pancreatic head. In the case of a curative resection, the presence of lymph node metastases is of prognostic relevance. In view of considerable surgical morbidity and mortality, resection for cancer of the pancreatic head is the only option if the lesion is resectable. We concluded that surgical treatment is “as good as it gets,” as extended techniques have not proved to produce better results.
Hepatic Resection for Colorectal Metastasis with Macroscopic Tumor Thrombus in the Portal Vein
Authors: Tada Keiichiro , Kokudo Norihiro , Seki Makoto , Ueno Masashi , Azekura Kaoru , Ohta Hirotoshi , Yamaguchi Toshiharu , Matusbara Toshiki , Takahashi Takashi , Nakajima Toshifusa , Yanagisawa Akio , Muto Tetsuichiro 
Published: February 2003

AbstractMetastatic lesions in the liver derived from colorectal cancer rarely invade the portal vein macroscopically. Little is known about the clinical characteristics and outcome of surgical treatment in patients with tumor thrombus in the portal vein. Medical charts of 142 consecutive patients who underwent hepatic resection for colorectal metastasis were reviewed retrospectively. Of the 142 patients, 4 (2.8%) had macroscopic portal vein invasion. The most prominent characteristic on preoperative imaging was segmental staining in the arterial phase shown by dynamic computed tomography (CT) or by CT arteriography. This finding was positive in all four of the patients. All patients underwent anatomic liver resection and were alive with no evidence of disease for an average of 52.3 months (range 21–102 months). Macroscopic tumor thrombus in the portal vein is rare with colorectal metastasis. It is accurately detected by CT by checking for signs of segmental staining. In this setting, anatomic major resection of the liver is essential for curative treatment.
Surgical Therapy and Histological Abnormalities in Functional Isolated Small Bowel Obstruction and Idiopathic Gastrointestinal Perforation in the Very Low Birth Weight Infant
Authors: Miserez Marc , Barten Suzanna , Geboes Karel , Naulaers Gunnar , Devlieger Hugo , Penninckx Freddy 
Published: February 2003

AbstractWe examined surgical treatment, outcome, and histological findings in very low birth weight (VLBW) infants with functional isolated small bowel obstruction (FISBO) and idiopathic gastrointestinal perforation (IGIP). The files of 18 neonates (average gestational age 27.5 weeks; average birth weight 880 g), surgically treated for IGIP (n = 12) or FISBO (n = 6), were retrospectively reviewed. In both groups segmental or diffuse dilatation of the small bowel was seen. All but two perforations were localized in the small bowel. In half of the patients a discontinuous absence of the internal layer of the muscularis propria or muscularis mucosae was found. Signs of necrotizing enterocolitis (NEC) were absent. Most of the patients were treated with an enterostomy (IGIP: n = 11; FISBO: n = 4). Overall survival in both groups was 83%. Follow‐up after enterostomy closure (mean 23 months) shows normal gastrointestinal function without failure to thrive in 67% of the survivors. Muscular wall abnormalities and small bowel distension are found in both FISBO and IGIP. Although the underlying etiology remains unclear, segmental muscular wall absence may be a major predisposing factor in both conditions. Creation of a temporary enterostomy is a valid surgical option in VLBW infants with minimal risk for recurrent obstruction and/or perforation. Survival and long‐term gastrointestinal function is excellent. IGIP should be distinguished from NEC.