bluuebunny/crossref_metadata_2025_split huggingface dataset:
Axillary Node Sample to Evaluate the Axilla
Authors: Chetty Udi 
Published: October 2003

AbstractLymphatic drainage from the breast is principally to the ipsilateral axilla. In patients with breast cancer the status of the lymph nodes in the axilla is an important prognostic factor and can be used to determine local and systemic therapies. Clinical assessment of the axillary lymph nodes is unreliable, and imaging techniques, although they show some promise, are at present not practical. Standard policy for management of the axilla is clearance of the axillary lymph nodes (either level II or level III), which is justified on the grounds that it both stages and treats the axilla. In those who are axillary node‐negative, however, it is an unnecessary operation and is associated with some morbidity. Various methods to obtain lymph nodes for histologic assessment in an attempt to stage the axilla have been tried. The pectoral node biopsy, where a single node is removed from the axillary tail, has been shown to be unreliable. A triple‐node biopsy (pectoral node, apical node, internal mammary node) provides excellent prognostic data but is difficult to perform in patients who have been treated by breast conservation. The four‐node sampling technique has been evaluated in Edinburgh in two randomized trials comparing node sampling to level III axillary clearance. It was shown to be reliable for staging the axilla; and in those who are node‐negative no further treatment is required. Detailed morbidity has been assessed in patients who underwent axillary clearance; and node sampling plus radiotherapy and node sampling without radiotherapy showed that those with node sampling had the least morbidity. Those who had node sampling plus radiotherapy have reduced movement around the shoulder joint, and the axillary clearance group have increased swelling of the upper limb and slightly reduced abduction. The sentinel node biopsy is presently being assessed in several centers by randomized studies. Several large series have shown the technique to be accurate (98%) when the sentinel node is identified (around 90% of cases).
Lymphoscintigraphy and Lymphatic Mapping for Identification of Sentinel Lymph Nodes
Authors: Hsueh Eddy C. , Turner Roderick R. , Giuliano Armando E. 
Published: October 2003

AbstractThe recently introduced technique of sentinel lymph node dissection (SLND) may replace complete axillary lymph node dissection for axillary staging of early breast cancer. Successful SLND is predicated on meticulous delineation of the lymphatic pathway and sentinel node(s). Currently employed lymphatic mapping materials include vital blue dyes and radioactive tracers. Techniques of intraoperative lymphatic mapping and SLND using dye, tracer, or both have high success rates in the hands of experienced investigators, but their routine and widespread use awaits resolution of questions about the timing, dose, and type of radioactive tracer; the optimal lymphatic mapping technique; indications and contraindications for SLND; and certification of qualified surgeons, pathologists, and nuclear medicine physicians.
Pathologic Examination of Sentinel Lymph Node for Breast Carcinoma
Authors: Turner Roderick R. , Giuliano Armando E. , Hoon Dave S.B. , Glass Edwin C. , Krasne David L. 
Published: October 2003

AbstractComprehensive pathologic evaluation of the sentinel lymph node using step sections and cytokeratin immunohistochemistry enhances detection of micrometastases and optimizes the staging of breast carcinoma. This review discusses our current understanding of the pathologic and molecular techniques for sentinel node examination.
Sentinel Node Biopsy in Breast Cancer: ALMANAC Trial
Authors: Clarke Dayalan , Khonji Nader I. , Mansel Robert E. 
Published: October 2003

AbstractSentinel node biopsy of breast cancer is becoming an increasingly popular topic. The concept of the sentinel node being the first lymph node to contain metastatic cancer within a tumor’s lymphatic basin was introduced by Cabanas, a South American surgeon, following his work on carcinoma of the penis. Morton and his colleagues then applied this principle to malignant melanomas, and more recently this concept has gained popularity for carcinoma of the breast. In breast cancer patients, the fact that a sentinel node can be localized and the suggestion that the sentinel node is representative of the axillary nodal status has been confirmed by a number of studies across the world. Most authors writing on this subject, however, end with a caution that the results of randomized trials are needed before this new surgical technique can be accepted as part of routine breast cancer management. The Medical Research Council of the United Kingdom has funded the audit phase of a multicenter, two phase, randomized trial called the Axillary Lymphatic Mapping Against Nodal Axillary Clearance (ALMANAC) trial, which will compare standard axillary management with sentinel node‐guided axillary management. The aims and protocol of the trial are discussed in detail here.
Hepatic Metastases of Gastroenteropancreatic Neuroendocrine Tumors: Safe Hepatic Surgery
Authors: Jaeck Daniel , Bachellier Philippe , Lemarque Pascal , Weber Jean‐Christophe , Nakano Hiroshi , Wolf Philippe 
Published: October 2003

Abstract.Liver metastases of neuroendocrine tumors are usually slow‐growing, and cytoreductive hepatectomy can help reduce the effects of endocrinopathies and increase life expectancy and symptom‐free survival. However, it has yet to be fully investigated how hepatectomy for metastatic neuroendocrine tumors can be performed safely. Here we report the results of 13 patients with neuroendocrine liver metastases operated on in our institution and those of a French multicentric study that included 131 patients. Preoperative patient selection and appropriate surgical technique, sometimes combined with preoperative portal embolization and local tumor destruction (radiofrequency and cryotherapy), may increase the resectability and the safety of the procedure. The mortality rate after hepatectomy was 0% (2.3% in the French study); the 3‐ and 6‐year survival rates were 91% and 68%, respectively, in our institution (the mean survival time was 66 months in the French multicentric survey). Significant prolonged survival with complete palliation of symptoms can be obtained after liver metastases resection with low mortality.
Subtotal Parathyroidectomy in Renal Failure: Still Needed after All These Years
Authors: Decker P. Anthony , Cohen Eric P. , Doffek Kara M. , Ashley Blake A. , Bienemann Mary E. , Zhu Yong Ran , Adams Mark E. , Wilson Stuart D. , Demeure Michael J. 
Published: October 2003

Abstract.There are scant data on the frequency of parathyroidectomy (PTX) for end‐stage renal disease (ESRD). Medical therapy for ESRD and secondary hyperparathyroidism has evolved to include better dialytic urea removal and the use of calcitriol. The aim of this study was to determine whether medical therapy has changed the frequency or indications for PTX in the management of renal failure. Hospital and clinic records were analyzed to gather information on all patients undergoing PTX for secondary hyperparathyroidism (2HPT) (n= 48) and tertiary hyperparathyroidism (3HPT) (n= 26) from 1986 through 1998 at our institution. Prospective computer databases were queried for information concerning both chronic dialysis and renal transplant patients at our center. The patients were divided based on date of operation before or after 1991, a divider that separated the patients into groups before or after the widespread adoption of intravenous calcitriol treatment during hemodialysis at our institution. Over the 12 year period, the proportion of our chronic dialysis patients undergoing PTX did not change significantly, ranging from 0% to 2.5% per year. Comparing all patients undergoing PTX for 2HPT during 1986–1991 versus 1992–1998, there was no significant difference in time on dialysis [7.0 ± 4.2 (n= 11) vs. 7.5 ± 4.6 (n= 36) years, mean ± SD]. The later group had higher intact parathyroid hormone (iPTH) levels [765 ± 415 (n= 6) vs. 1377 ± 636 (n= 28) pg/ml; p= 0.03], lower serum calcium [11.2 ± 1.0 (n= 12) vs. 9.9 ± 1.5 (n= 34) mg/dl; p= 0.006], and higher serum phosphate [5.7 ± 1.6 (n= 12) vs. 7.2 ± 2.3 (n= 31) mg/dl; p= 0.042]. Among the population of patients with transplants undergoing PTX for 3HPT, the average percent per year undergoing PTX ranged from 0% to 4.2% and did not change during the study period. Comparing the 1986–1991 group to the 1992–1998 group, the time from transplantation to PTX did not change during the study period (3.3 ± 2.3 vs. 2.9 ± 3.0 years; p= 0.391), and there were no significant differences between preoperative calcium levels or iPTH levels. Despite advances in dialysis technique and pharmacologic therapy, there has been no change in the proportion of dialysis patients requiring PTX for 2HPT or 3HPT. There was also no change in the time on dialysis for patients with 2HPT or the time from transplant to PTX for patients with 3HPT. Analysis of preoperative biochemical markers as evidence of disease severity suggests there was no change in indications for PTX during our study. From this information we conclude that parathyroid pathophysiology is incompletely understood and medical therapy is not optimal, resulting in a continuing need for PTX in some patients.
Importance of Early Screening and Prophylactic Thyroidectomy in Asymptomatic Nonindex RET Germline Carriers
Authors: Ukkat Jörg , Lorenz Kerstin , Hinze Raoul , Thomusch Oliver , Dralle Henning 
Published: October 2003

Abstract.Genetic testing for RET germline mutations affords rapid identification of germline carriers, offering the prospect of cure before C‐cell hyperplasia (CCH) has progressed to medullary thyroid carcinoma (MTC). Although nonindex RET mutation carriers have a better prognosis than do the index patients, it remains to be ascertained whether age represents a risk factor for MTC when screening patients. The current institutional study (October 1994 through June 1999) was set up to compare asymptomatic nonindex patients who were grouped by age: < 20 years and ≥ 20 years. Inclusion criteria were confirmed RET mutations in the germline, with no MTC being more advanced than pT1pN1M0. Adult patients (≥ 20 years) had MTC significantly more often (84% vs. 43%), significantly larger tumors (5 mm vs. 3 mm), and significantly higher basal calcitonin levels preoperatively (78.0 vs. 9.7 pg/ml) than their pediatric/adolescent counterparts (< 20 years). There was a close correlation between pT1 MTC and an elevated basal serum calcitonin level (r= 0.67; Spearman's rho). All three patients with lymph node metastases from MTC had elevated basal calcitonin levels. The two groups did not differ in terms of multifocality of MTC (pT1b), lymph node involvement (pN1) or bilateral lymph node metastasis (pN1b), or preoperative stimulated and postoperative basal and stimulated serum calcitonin. Prophylactic thyroidectomy should not be postponed beyond the age of 20, and it should be performed before basal serum calcitonin has turned positive. Pathologic conversion of stimulated serum calcitonin obviously marks the time in carriers of RET germline mutations when surgery should be scheduled at the latest to be prophylactic.
Merits and Demerits of Operative Procedure to the Trachea in Patients with Differentiated Thyroid Cancer
Authors: Nakao Kazuyasu , Kurozumi Kazushi , Fukushima Satsuki , Nakahara Masaaki , Tsujimoto Masahiko , Nishida Toshirou 
Published: October 2003

Abstract.Local radical thyroidectomy, including cervical lymph node dissection and combined circumferential resection of the trachea, has been performed over the past 20 years in 31 patients with differentiated cancer invading the trachea. The 5‐ and 10‐year survival rates for these patients were 77.4% and 66.7%, respectively. In 19 of the 31 (61%) cases the recurrent nerve was resected because of direct cancer invasion. Bilateral recurrent nerve palsy occurred in 12 patients, 3 of whom were managed postoperatively using a T‐shaped tube for preservation of the larynx. Hoarseness remained in 21 patients. In two patients with recurrent cancer invasion of the larynx, partial laryngectomy and hemilaryngectomy were performed, and reconstruction was done using ear cartilage without postoperative dyspnea or dysphagia. Parathyroid function is an important factor in regard to the quality of life of patients. In 22 patients at least one of the parathyroids was preserved. Postoperative calcium administration was necessary in 14 patients. Our long‐term observations indicate that local radical thyroidectomy with combined resection of the trachea can serve as a useful treatment for advanced differentiated cancer invading the airway.
Adrenocortical Carcinoma: Is Prognosis Different in Nonfunctioning Tumors? Results of Surgical Treatment in 31 Patients
Authors: Favia Gennaro , Lumachi Franco , D'Amico Davide F. 
Published: October 2003

Abstract.From 1980 to 1998 a series of 265 patients with adrenal tumors underwent surgery, with an adrenocortical carcinoma found in 31 (11.7%). Altogether, 17 (54.8%) patients (group A) had Cushing syndrome (n= 15) or virilization (n= 2), and 14 (45.2%) patients (group B) had nonfunctioning adrenal tumors. Tumor staging was as follows: (groups A/B): stage I, n= 5 (3/2), stage II, n= 14 (9/5), stage III, n= 5 (1/4), stage IV, n= 7 (4/3) patients. There were 12 (38.7%) men and 19 (61.3%) women (median age 51 years, range 25–73 years), and the size of the mass ranged from 3.5 to 20.0 cm (median 8.0 cm), with no differences (p= NS) between groups A and B. Two (6.4%) patients (stage IV) did not undergo surgery and received only palliative drug treatment; 6 (19.4%) were treated with debulking surgery; 15 (48.4%) had unilateral adrenalectomy; and 8 (25.8%) had an extended adrenalectomy. Eighteen (58.0%) patients underwent adjuvant postoperative mitotane treatment, and in 8 (25.8%) patients one or more reoperations for recurrence were required. Nine (29.0%) patients are still alive with a mean follow‐up of 34 months; 22 (71.0%) died 2 to 60 months (median 20 months) after surgery. The overall 2‐ and 5‐year survival rates were 62.1% and 10.3%, with no difference (p= NS) between groups A and B. The survival rates at the 1‐ and 3‐year follow‐ups were 90.3% and 32.3% (stages I and II) and 71.0% and 6.5% (stages III and IV). In conclusion, adrenocortical carcinoma remains a highly malignant tumor, and stage III–IV patients still have a poor prognosis; but nonfunctioning tumors do not seem to be more aggressive.
Cohort Study of Fever and Leukocytosis as Diagnostic and Prognostic Indicators in Infected Surgical Patients
Authors: Crabtree Traves D. , Pelletier Shawn J. , Antevil Jared L. , Gleason Thomas G. , Pruett Timothy L. , Sawyer Robert G. 
Published: October 2003

Abstract.The presence of fever and leukocytosis have traditionally been utilized as important diagnostic markers of infection despite some who question their reliability. To examine this point, the role of fever and leukocytosis as diagnostic and prognostic indicators for surgical infections was evaluated. A prospective observational study was performed on all patients with suspected infection in 1997 on the general surgical services at a university hospital. Fever was defined as maximum temperature (Tmax) ≥ 38.5°C, and leukocytosis was defined as a white blood cell (WBC) count ≥ 11,000/μl. Among all infections, patients presenting with a Tmax ≥ 38.5°C were younger (51.3 ± 1.1 vs. 53.8 ± 0.9 years, p= 0.005) and had a higher APACHE II score (15.1 ± 0.5 vs. 11.4 ± 0.4; p < 0.001). By logistic regression analysis chronic renal insufficiency was associated with a Tmax < 38.5°C [odds ratio (OR) 0.371, 95% confidence interval (CI) 0.195–0.704], and chronic steroid therapy was associated with a WBC count < 11,000/μl (OR 0.556, 95% CI 0.335–0.921). In addition, infected transplant patients were more likely to present with a Tmax < 38.5°C and a WBC count < 11,000/μl (OR 0.195, 95% CI 0.075–0.502). Mortality rates for infected patients with a Tmax < 38.5°C or > 38.5°C were 11.6% and 12.9%, respectively (p < 0.7), and the lengths of stay were 14 ± 1 and 18 ± 1 days, respectively (p < 0.03). Mortality rates for patients with a WBC count < 11,000/μl or > 11,000/μl were 4.7% and 18.6%, respectively (p < 0.001), and the lengths of stay were 14 ± 1 and 19 ± 1 days, respectively (p < 0.001). In the setting of infection, chronic renal insufficiency and chronic steroid therapy are associated with suppression of fever and leukocytosis, respectively. Transplantation is an independent predictor of infection in patients presenting without fever or leukocytosis. Leukocytosis, but not fever, may be predictive of hospital mortality in infected surgical patients.
Adrenal cortical carcinoma
Authors: Dackiw Alan P. B. , Lee Jeffrey E. , Gagel Robert F. , Evans Douglas B. 
Published: October 2003

AbstractAdrenal cortical carcinoma is a rare endocrine tumor for which complete surgical resection is the only potentially curative treatment. Accurate preoperative evaluation (biochemical and radiographic) of the patient who presents with an adrenal mass maximizes the opportunity for the patient to undergo a complete, margin‐negative resection of the primary tumor, which is the most powerful prognostic variable for long‐term survival. The response to chemotherapy or mitotane is modest in patients with advanced disease. Hopefully, an improved understanding of the molecular pathogenesis of this challenging tumor will lead to the development of more effective therapies in the future.
Hyperparathyroidism in multiple endocrine neoplasia type I: Surgical trends and results of a 256‐patient series from groupe d’Etude des Néoplasies endocriniennes multiples study group
Authors: Goudet Pierre , Cougard Patrick , Vergès Bruno , Murat Arnaud , Carnaille Bruno , Calender Alain , Faivre Jean , Proye Charles 
Published: October 2003

AbstractThe French and Belgian GENEM study group’s multiple endocrine neoplasia type I (MEN‐I) database was used to evaluate trends in clinical presentation, surgical treatment of primary hyperparathyroidism (pHPT) (n=245), and prognostic factors for hypercalcemia correction among 256 MEN‐I cases. The patients were retrieved through the GENEM network from various Belgian and French instititutions with the help of genetics laboratories. Among the 245 pHPT patients (96%), 42% were men. The mean age at the time of diagnosis was 39.5 ± 13.3 years. Trends were studied for three periods: before 1986, from 1986 to 1990, and thereafter. After 1990 MEN‐I patients were more often diagnosed with isolated pHPT (8%, 11%, 28%, for the three periods, respectively; p=0.002); it was seen more often in screened patients (31%, 28%, 53%; p=0.001), more often among those in already known MEN‐I families (64%, 45%, 72%; p=0.005), and among those with lower preoperative calcemia (2.93, 2.87, 2.79 mmol/L; p=0.001). The age at pHPT diagnosis remained constant throughout the study. The percentage of cervical explorations dropped during the entire study (87%, 87%, 53%; p<0.0001). After 1985 the percentage of subtotal parathyroidectomies increased (25%, 59%, 51%; p=0.0004). Pathology disclosed more hyperplasias (59%, 85%, 74%; p=0.008). Postoperative hypercalcemia decreased (47%, 15%, 19%; p<0.0001); and postoperative hypocalcemia increased nonsignificantly (5%, 15%, 15%; p=0.1). Subtotal parathyroidectomy [odds ratio (OR) 13], no MEN‐I family background (OR 3), and the most recent study period (>1985) (OR 3) were significant predictive factors of hypercalcemia correction according to the multivariate analysis. This is the first multicentric study on the management of MEN‐I‐related pHPT. Immediate postoperative hHPT cure increased, but only 80% of the operated patients were cured after 1990. Fifteen percent were hypocalcemic. Because MEN‐I‐related hHPT cure remains difficult to achieve, we advocate that subtotal parathyroidectomies be performed in specialized centers.
Adrenocortical carcinomas: surgical trends and results of a 253‐patient series from the French Association of Endocrine Surgeons study group
Authors: Icard Philippe , Goudet Pierre , Charpenay Cyril , Andreassian Bernard , Carnaille Bruno , Chapuis Yves , Cougard Patrick , Henry Jean‐François , Proye Charles 
Published: October 2003

AbstractBecause of the rarity of adrenocortical carcinoma, survival rates and the prognosis for patients who have undergone operation are not well known. The purpose of the French Association of Endocrine Surgery was to evaluate these factors over an 18‐year period. A trend study was associated to assess changes in the clinical and biochemical presentations as well as the surgical evolution. A total of 253 patients (158 women, 95 men) with a mean age of 47 years were included. Cushing syndrome was the main clinical presentation (30%), and hormonal studies revealed secreting tumors in 66% of the cases. Altogether, 72% (n=182) of patients underwent resection for cure, and 41.5% (n=105) of them had an extensive resection because of metastatic cancer. A lymphadenectomy was performed in 32.5% (n=89) of the cases. The operative mortality was 5.5% (n=14). Patients were given mitotane as adjuvant therapy in 53.8% of the cases (n=135). The results of staging were stage I in 16 patients (6.3%), stage II (local disease) in 126 patients (49.8%), stage III (locoregional disease) in 57 patients (22.5%), and stage IV (metastases) in 54 patients (21.3%). Neither tumor staging nor the rate of curative surgery changed during the study period. More subcostal incisions were performed, and the use of mitotane increased significantly. The 5‐year actuarial survival rates were 38% overall, 50% in the curative group, 66% for stage I, 58% for stage II, 24% for stage III, and 0% for stage IV. Multivariate analysis showed that mitotane benefited only the group of patients not operated on for cure. A better prognosis was found in patients operated on after 1988 (p=0.04), in those with precursor‐secreting tumors (p=0.005), and in those at local stages of the disease (p=0.0003). Thus mitotane benefited only patients not operated on for cure. Curative resection, precursor secretion, recent diagnosis, and local stage were favorably associated with survival.
Indications for Early Postoperative Intraperitoneal Chemotherapy of Advanced Gastric Cancer: Results of a Prospective Randomized Trial
Authors: Yu Wansik , Whang Ilwoo , Chung Ho Young , Averbach Andrew , Sugarbaker Paul H. 
Published: October 2003

AbstractPrevious analysis of this prospective randomized trial and meta‐analysis of published randomized trials of adjuvant intraperitoneal chemotherapy demonstrated improved survival in patients with advanced gastric cancer. Simple criteria applicable at the time of surgery for patient selection were sought in this analysis. From 1990 to 1995 a series of 248 patients with biopsy‐proven gastric cancer were randomized intraoperatively to receive early postoperative intraperitoneal mitomycin C and 5‐fluorouracil (125 patients) versus surgery only (123 patients). Gastric resection plus early postoperative intraperitoneal chemotherapy showed improved overall survival compared to surgery only (54% and 38%, respectively; p= 0.0278). There were statistically significant differences in patients with stage III (57% and 23%, respectively; p= 0.0024) and in those with stage IV (28% and 5%, respectively; p= 0.0098) gastric cancer. The improvement in survival rate was statistically significant for the subgroup of patients with gross serosal invasion (52% and 25%, respectively; p= 0.0004) and patients with lymph node metastasis (46% and 22%, respectively; p= 0.0027). The surgeons' impression about lymph node status was unreliable, but assessment of serosal invasion was accurate in 80% of cases. Gross serosal invasion with or without frozen section evaluation of lymph nodes can be used as the major selection criteria for early postoperative intraperitoneal chemotherapy of advanced gastric cancer.