bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraoperative decay profile of intact (1–84) parathyroid hormone in surgery for secondary hyperparathyroidism in a consecutive series of 50 patients on haemodialysis
Authors: Lokey J , Pattou F , Mondragon-Sanchez A , Minuto M , Mullineris B , Wambergue F , Proye C A G 
Published: March 2003

Abstract

Background
The usefulness of rapid intraoperative monitoring of intact (1–84) parathyroid hormone (PTH) is not clearly defined in the surgical management of secondary HPT in the patients on haemodialysis. The aim of this study was to define the normal pattern of decay during surgery for secondary HPT using the rapid intact (1–84) PTH assay during operation.

Methods
Fifty patients on haemodialysis underwent neck exploration for secondary HPT. The therapeutic goal in all patients was the subtotal resection of four or more glands and bilateral transcervical thymectomy. PTH levels were monitored using a rapid immunochemiluminometric assay. Peripheral blood samples were assayed at induction of anaesthesia, after dissection but before resection, and 20 and 40 min after resection in all patients. All patients were followed up for at least 6 months. PTH levels were expressed as absolute values, as multiples of the upper limit of normal and as the percentage decline from pre-excision values.

Results
Forty-eight patients (96 per cent) were considered cured after surgery. Twenty patients (40 per cent) had a PTH level less than twice normal and 20 patients (40 per cent) had a PTH level between two and four times normal at 20 min. At late follow-up, all these patients were cured. Ten patients (20 per cent) had a PTH level greater than four times normal at 20 min. Eight of these patients were cured. Seven of these eight had a PTH level at 20 min, while not less than four times normal, less than 40 per cent of the original value. In contrast, the two failures had neither a decline to less than four times normal nor a decay to less than 40 per cent of the original value. One has been reoperated with resection of a fifth gland and one awaits reoperation.

Conclusion
The intraoperative decay of PTH during surgery for secondary HPT in patients on haemodialysis is slower than that in patients with normal renal function. However, 20 min after resection, a decline to less than four times the upper limit of normal is predictive of cure. Variability of decay slopes in individual patients may reflect molecular heterogeneity or biphasic metabolism of the hormone.
Evaluation of Wilm's tumour suppressor gene and insulin-like growth factor receptors in parathyroid glands
Authors: Wong C , Newcomb P , Sheffield E , Holly J M P , Brown K , Farndon J 
Published: March 2003

Abstract

Background
The precise cause of hyperparathyroidism (HPT) is uncertain. Alteration of growth factors (epidermal growth factor, fibroblast growth factor) and genetic mutations (parathyroid hormone (PTH) gene (11p15), PRAD1 oncogene (11q13) and multiple endocrine neoplasia type 1 (MEN1) gene (11q13)) are implicated in the pathogenesis. The escape of secretory function from physiological control and excess growth is still incompletely understood. The insulin-like growth factor (IGF) axis is a ubiquitous growth and regulatory system (IGF-1 and -II, IGF receptors (IGFRs) and binding proteins (IGFBPs)). Hormonal/endocrine signals (e.g. androgens, thyroid-stimulating hormone) and tumour supressor genes (e.g. Wilms' tumour suppressor gene (WT-1) (11p13) and p53) modulate the IGF axis. Expression of the WT-1 gene is tissue specific (kidney, mesothelium, prostate). Wild-type WT-1 governs normal kidney development and mutation results in Wilm's tumour. Loss of transcriptional repression of WT-1 and IGF control can lead to mitogenesis. A mutation (chromosome 11) appears to be the key event in the evolution of primary HPT. This mutation may increase IGFR expression, IGF production giving rise to unregulated autocrine growth. In polyclonal hyperplasia (secondary HPT and MEN1) a serum factor initiates polyclonal growth, thereby increasing the susceptibility to mutation and resulting in nodular hyperplasia.

Methods
Immunohistochemical examination of paraffin-embedded parathyroid glands was done using polyclonal anti-WT-1 (C19, Santa Cruz) and anti-IGFR-I (C20, Santa Cruz) antibodies and a horseradish peroxidase-labelled secondary antibody for detection. The strength of immunoreactivity was graded using a standardized colour chart and assessed independently by three observers.

Results
Two hundred and fifty-four parathyroid glands from 112 patients were examined. There were 81 women and 31 men (2·6: 1). Of these, 94 had primary HPT (70 women) and 18 secondary HPT (11 women). Immunoreactivity to WT-1 was found in normal parathyroid glands. In contrast, reduced WT-1 immunostaining was observed in abnormal parathyroid glands. Positive immunostaining for IGFR-I was found in all parathyroid glands. Increased immunoreactivity was found in pathological compared with normal glands.

Conclusion
WT-1 and IGFR are expressed in parathyroid cells. Abnormal expression of WT-1 and the IGF axis may play a role in the pathogenesis of HPT.
Laparoscopic adrenalectomy for malignancy
Authors: Li R , Whang K , Ituarte P , Siperstein A , Clark O , Du Q-Y 
Published: March 2003

Abstract

Background
Controversy exists as to whether laparoscopic adrenalectomy should be performed for malignant or potentially malignant tumours affecting the adrenals.

Methods
This was a retrospective analysis of all patients undergoing laparoscopic adrenalectomy at this institution from 1993 to 1999. Patients were classified by their preoperative diagnosis and analysed with respect to their final pathological diagnosis, operation and postoperative course.

Results
Some 121 patients underwent 133 laparoscopic adrenalectomies. Preoperative classification was type I (benign disease; 67 patients), type II (possibly malignant disease; 46 patients) and type III (malignant disease; eight patients). After operation, 11 patients had malignancy on pathological diagnosis including all eight patients with known preoperative malignancy (one adrenocortical carcinoma (3 × 3 cm) presenting as a virilizing tumour, two neuroblastomas, one lymphoma, one bilateral staged adrenalectomy for metastatic colon cancer, two metastatic lung cancers and one metastatic renal cell carcinoma). One patient with adrenocortical cancer (8 × 6 cm) had incorrect preoperative classification by cytology (type I; oncocytoma). Two of 14 patients with Cushing's adrenal tumour (type II) had adrenocortical cancer (12 × 9 cm and 3 × 3 cm). Mean length of stay was 1·8 days in patients with malignancy. No procedure was converted to open adrenalectomy and no significant complications were encountered. Only the four patients with adrenocortical carcinoma had a recurrence (two required open re-resection 3 months and 2 years after initial operation, one had laparoscopic re-resection 2 years after operation for local recurrence and one presented with recurrence 1 year after operation).

Conclusion
Forty-five per cent of patients undergoing laparoscopic adrenalectomy may be classified as having potentially malignant disease (type II or III). Most malignant tumours of the adrenals can be treated laparoscopically, but adrenocortical carcinomas are at high risk of recurrence after laparoscopic adrenalectomy.
Non-insulinoma pancreatogenous hypoglycaemia syndrome
Authors: Service F J , Thompson G B , Natt N , Grant C S , van Heerden J A , Andrews J C , Lloyd R V 
Published: March 2003

Abstract

Background
The authors have reported a newly recognized hypoglyacemic disorder, non-insulinoma pancreatogenous hypoglycaemia syndrome (NIPHS), which is characterized by postprandial hyperinsulinaemic hypoglycaemia, negative 72-h fast, negative transabdominal and intraoperative ultrasonography, spiral computed tomography and coeliac axis angiography, positive selective arterial calcium stimulation test (SACST), absence of insulinoma but presence of islet hypertrophy and nesidioblastosis, and relief of symptoms from gradient-guided partial pancreatectomy. Experience with the next five patients with this disorder (6–10; 1998–1999) compared with the original five (1–5; 1996–1998) is reported.

Results
Wide age range, male predominance, postprandial occurrence of symptoms, negative radiological localization, nesidioblastosis/islet hypertrophy, but no insulinoma characterized all ten cases. Response to SACST indicated widespread islet hyperfunction in patients 1 and 5; limitation to distribution of the SPA and GDA in patients 3, 4, 6 and 8, to distribution of the SPA in patients 2, 7 and 9, and to distribution of the SMA in patient 10. Except for patient 5, pancreatic resection to the left of the SMV was performed when only the SPA was positive on the SACST. Patients 5 and 8 have had recurrence of symptoms; they resolved within 3 months for patient 5.

Conclusion
NIPHS can usually be treated successfully with gradient-guided partial pancreatectomy.
Outcome of a conservative surgical policy for differentiated thyroid cancer: a prospective population-based cohort study
Authors: Ravindran R , Krukowski Z H 
Published: March 2003

Abstract

Background
The extent of surgery and the requirement for routine total thyroidectomy in patients with papillary or follicular differentiated thyroid cancer (DTC) is contentious. It is desirable to strike a balance between achieving cure and local disease control and avoidable surgical morbidity. Routine total thyroidectomy increases the rate of permanent hypoparathyroidism and may not improve cure or local recurrence rates in patients categorized at low risk. An ongoing prospective study of the outcome of a conservative surgical policy based on an unselected population from the north east of Scotland is reported.

Methods
With few exceptions, all patients with thyroid cancer in north-east Scotland are treated in a specialist unit. Data are recorded prospectively and all patients are reviewed at a dedicated thyroid clinic or by postal review if they leave the area. The mortality, morbidity (including recurrent laryngeal nerve and parathyroid function), recurrence and reoperation rates, and administration of radioactive iodine are recorded. The population of this region is very stable and follow-up is complete in over 97 per cent of patients. The surgical policy is to remove all macroscopic disease from the neck at the first operation and reserve total thyroidectomy for patients with bilateral disease or who are considered at high risk and likely to require postoperative radioactive iodine therapy.

Results
During the period 1977–1996, 238 patients with thyroid cancer were treated of whom 193 (81 per cent) had DTC. Some 148 (77 per cent) of the DTCs were categorized ‘low risk’. Fifty-five (28 per cent) of the 193 patients underwent total or near-total thyroidectomy. The majority of patients (75 per cent low risk; 59 per cent high risk) underwent lobectomy. Seven patients (five low risk; two high risk) have required subsequent completion total thyroidectomy, usually for a rising thyroglobulin level, only three of whom had evidence of DTC in the resected lobe. The mortality rate from DTC was 13 and 1 per cent in high- and low-risk patients respectively. Four (2 per cent) of the 193 patients developed postoperative hypoparathyroidism.

Conclusion
This prospective study suggests that appropriate selection of patients for total thyroidectomy in an endocrine surgical unit is associated with a low mortality rate and little requirement for completion total thyroidectomy. Routine total thyroidectomy is not necessary.
Analysis of local recurrence and optimizing excision margins for cutaneous melanoma
Authors: Ng A K T , Jones W O , Shaw J H F 
Published: March 2003

Abstract

Background
Current guidelines for the treatment of melanoma favour conservatism; however there is still uncertainty regarding best practice for lesions of intermediate thickness. Local recurrence, a measure of treatment adequacy, can be used to determine optimum excision margins and give prognostic information for survival.

Methods
An analysis of the Auckland Melanoma Unit database was performed. Patients with local recurrence were identified and stratified by lesion thickness. Optimum excision margins were derived by regression analysis and evaluated against the database population. Survival and prognostic factors were studied.

Results
Eighty-four of 1155 patients (7 per cent) developed local recurrence. Median follow-up was 51 months. Margins predicted to give a local recurrence of zero were: 1 cm for lesions ≤ 1 mm thick; 1.5 cm for lesions 1–2 mm thick; and 2 cm for lesions &gt; 2 mm thick. Applied to 1155 patients, there were significant differences in both local recurrence and mortality rates between optimally and suboptimally excised lesions, except for those &gt; 4 mm thick. Thirty-three patients (39 per cent) with local recurrence died. Thickness, local recurrence and ulceration were of prognostic significance.

Conclusion
Development of local recurrence in melanomas ≤ 4 mm thick is due to inadequate treatment. It signifies progressive disease and a poor prognosis. Care must be taken to ensure that all such lesions are optimally excised.
The intestinal flora influences adhesion formation around surgical anastomoses
Authors: Bothin C , Okada M , Midtvedt T , Perbeck L 
Published: March 2003

Abstract

Background
Postsurgical adhesion formation is still a cause of postoperative morbidity because no satisfactory treatment or prophylaxis has yet been developed. The present study was designed to investigate the influence of the gastrointestinal flora on adhesion formation around surgical anastomoses.

Methods
Anastomoses were constructed in germfree, conventional, ex-germfree and mono-contaminated rats (Escherichia coli X7 and Lactobacillus acidophilus La5), and adhesion formation was recorded.

Results
The germfree group had a significantly lower adhesion score than all other groups (P &lt; 0·05) apart from the lactobacillus group, which had a significantly lower score than the conventional group (P &lt; 0·05).

Conclusion
The bacterial flora of the gastrointestinal tract enhances adhesion formation around surgical anastomoses.
Suitability for endovascular aneurysm repair in an unselected population
Authors: Woodburn K R , Chant H , Davies J N , Blanshard K S , Travis S J 
Published: March 2003

Abstract

Background
Tertiary referral centres report that up to 60 per cent of patients may be suitable for endovascular repair of abdominal aortic aneurysm (EVAR). The aim of this study was to determine the percentage of abdominal aortic aneurysms (AAAs) presenting to a county-wide vascular service that were suitable for EVAR, and to examine the outcome of subsequent AAA repair in relation to aneurysm morphology.

Patients and methods
All patients being assessed for AAA repair between January 1998 and December 1999 underwent spiral computed tomography angiography to determine aneurysm morphology and suitability for EVAR. Subsequent outcome for all patients in the study was recorded in a prospective vascular database.

Results
A total of 115 patients was assessed. Sixty-three aneurysms (55 per cent) had one or more absolute contraindications to EVAR, a further 13 (11 per cent) had at least one relative contraindication, and 39 (34 per cent) had no contraindication. Of patients with no absolute contraindication to EVAR, ten underwent successful EVAR, five did not meet recognized criteria for surgery, one awaits EVAR, four remain under observation, one awaits open repair, and 31 underwent open repair without death.

Conclusion
Only 30 per cent of unselected AAAs presenting to a vascular service are entirely suitable for EVAR; most of these patients can safely undergo open AAA repair. These data suggest that increased use of EVAR is only possible by deploying devices in suboptimal morphology, and in treating patients who would not normally be considered for open AAA repair.
Clinical significance of mutator phenotype and chromosome 17p and 18q allelic loss in gastric cancer
Authors: de Manzoni G , Tomezzoli A , Di Leo A , Moore P S , Talamini G , Scarpa A 
Published: March 2003

Abstract

Background
Tumour stage is the only reliable prognostic factor for gastric cancer. The molecular anomalies involved in this process have the potential to serve as additional prognostic markers.

Methods
Forty-four gastric cancers, treated by surgery alone, have been analysed for chromosome 17p and 18q allelic loss and for the presence of microsatellite instability (MSI), using microsatellite markers and DNA from paraffin-embedded tumours.

Results
Eight cancers showed a MSI-positive (MSI+) phenotype. Among the 36 MSI-negative cancers, chromosome 17p and 18q allelic losses were found in 22 of 34 and 19 of 33 informative cases respectively. Multivariate survival analysis indicated MSI status to be an independent prognostic factor along with the tumour stage. MSI+ cancers were associated with longer patient survival, whereas MSI-negative cancers had a significantly poorer prognosis (P = 0·007), with a median actuarial survival of 24 months.

Conclusion
MSI status is an independent prognostic factor among gastric cancers at the same stage. Chromosome 17p and 18q status added no additional prognostic information to that of tumour stage. The combined use of tumour stage and MSI status may help in deciding whether patients with advanced gastric cancer require additional therapy other than surgery alone.
A normal appendix found during diagnostic laparoscopy should not be removed
Authors: van den Broek W T , Bijnen A B , de Ruiter P , Gouma D J 
Published: March 2003

Abstract

Background
Diagnostic laparoscopy has been introduced as a new diagnostic tool for suspected appendicitis. While the normal appendix used to be removed routinely, laparoscopy allows us to leave a normal looking appendix in place. This latter strategy is, however, not generally accepted. The long-term results of not removing a normal looking appendix were evaluated.

Methods
This was a prospective evaluation of 109 diagnostic laparoscopies for suspected appendicitis in which a normal looking appendix was left in place. After a median follow-up of 4·4 years a telephone questionnaire was performed.

Results
There were no false-negative laparoscopies. In 65 patients (60 per cent) another diagnosis was obtained (group 1). In 44 patients (40 per cent) no diagnosis was obtained (group 2). After a median interval of 8 months, 15 patients presented to the emergency department for symptoms possibly involving the appendix, during the median follow-up of 4·4 years. This resulted in readmission of nine patients, of whom eight were reoperated. In only one patient (1 per cent) was a histologically proven appendicitis found and the appendix removed. Some 105 patients were eligible for follow-up. Of the 100 patients interviewed (95 per cent), nine patients (9 per cent) (six in group 1 and three in group 2) still had recurrent pain in the right lower abdominal quadrant. There were no differences between patients with or without another diagnosis obtained during preceding laparoscopy.

Conclusion
It is safe to leave a normal looking appendix in place when a diagnostic laparoscopy for suspected appendicitis is performed, even if another diagnosis cannot be found at laparoscopy.
Blockade of growth factor receptors in ductal carcinoma in situ inhibits epithelial proliferation
Authors: Chan K C , Knox W F , Gandhi A , Slamon D J , Potten C S , Bundred N J 
Published: March 2003

Abstract

Background
Ductal carcinoma in situ (DCIS) expresses c-erbB-2 receptor and epidermal growth factor receptor (EGFR). The aim of this study was to determine whether blocking of c-erbB-2 receptor with a humanized monoclonal antibody, 4D5 (HerceptinTM), or of EGFR with an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), ZD1839 (IressaTM), would decrease epithelial proliferation in DCIS.

Methods
DCIS tissue from 18 women undergoing surgery was implanted into 16 to 20 athymic nude mice per experiment (eight xenografts per mouse). Treatment commenced 2 weeks after implantation and consisted either of twice-weekly intraperitoneal injections of 4D5 10 mg/kg or of daily gavage with ZD1839 at 100–200 mg/kg for 14 days; appropriate controls were included. Xenografts were removed on days 14, 21 and 28. Proliferation was assessed by counting 1000 epithelial cells after Ki67 immuno- staining.

Results
ZD1839 inhibited proliferation compared with that in controls after 14 days (P &lt; 0·01), whereas 4D5 did not.

Conclusion
Proliferation in DCIS was decreased by EGFR tyrosine kinase inhibition but not by c-erbB-2 receptor blockade. ZD1839, an orally active and selective EGFR-TKI, has potential as adjuvant therapy in DCIS.
Gastrointestinal complications in lung transplant survivors that require surgical intervention
Authors: Hoekstra H J , Hawkins K , de Boer W J , Rottier K , van der Bij W 
Published: March 2003

Abstract

Background
Lung transplantation is widely accepted as a treatment for end-stage lung disease. At present, information regarding the incidence and outcome of acute gastrointestinal complications in lung transplant survivors is limited.

Methods
Since 1990, 127 lung transplantations have been performed in 125 patients: 73 males (58 per cent) and 52 females (42 per cent) of median age 43 (range 9–64) years. Patients received a standard induction and maintenance regimen of immunosuppression.

Results
At a median follow-up of 2·6 (range 0–8·6) years the overall survival rate was 68 per cent. An acute abdomen requiring surgical intervention was diagnosed in 12 patients (10 per cent). The median time following lung transplantation was 19 (range 3–68) months. Eight cases of bowel perforation, two of appendicitis, one of colitis, one of cholecystitis, and one pneumoperitoneum were encountered. Four Hartmann procedures, two sigmoid resections, one small bowel resection, two appendicectomies, a subtotal colectomy, a cholecystectomy and an exploratory laparotomy were performed with minimal morbidity and no postoperative death.

Conclusion
Lung transplant survivors are at increased risk of developing an acute abdomen because of the use of high-dose immunosuppressive agents. Physicians who evaluate lung transplant patients for an acute abdomen should have a low threshold for surgical intervention.
Scintigraphic assessment of colonic transit in women with slow-transit constipation arising de novo and following pelvic surgery or childbirth
Authors: Scott S M , Knowles C H , Newell M , Garvie N , Williams N S , Lunniss P J 
Published: March 2003

Abstract

Background
Colonic transit has not been compared between patients with slow-transit constipation (STC) arising de novo (idiopathic) and those whose symptoms followed pelvic surgery or childbirth (acquired).

Methods
In 48 women, with either idiopathic (n = 36) or acquired (n = 12) STC, 111In-radiolabelled diethylene-triamine penta-acetic acid colonic scintigraphy was performed to determine patterns of delay (generalized or left sided), the ‘severity’ of transit disturbance between subgroups, and the association with age or duration of symptoms. Results were compared with those in healthy women. Patterns of colonic transit disturbance were assessed using previously defined criteria. In those with a generalized delay, variables reflecting the overall rate of isotope progression throughout the colon were calculated: gradient of geometric centre of isotope progression and estimated evacuation time of the isotope.

Results
The pattern of transit delay was similar between the subgroups, but the ‘severity’ of the transit abnormality was significantly worse in those with chronic idiopathic symptoms. In the chronic idiopathic STC subgroup only, there was a significant correlation between both age and duration of symptoms and severity of transit disturbance.

Conclusion
This study demonstrates that differences in colonic transit exist between subgroups of patients with STC. These might be explained by differences in duration of symptoms or differences in aetiology.