bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hürthle cell (oxyphilic) papillary thyroid carcinoma: A variant with more aggressive biologic behavior
Authors: Herrera Miguel F. , Hay Ian D. , Wu Patricia S. ‐C. , Goellner John R. , Ryan John J. , Ebersold Jan R. , Bergstralh Erik J. , Grant Clive S. 
Published: August 2005

AbstractThe latest World Health Organization International Classification defines papillary thyroid carcinoma by its “follicular cell differentiation. .. as well as characteristic nuclear changes”. However the oxyphilic (Hürthle cell) papillary carcinoma have nuclei which generally resemble the nuclei seen in oxyphilic follicular carcinomas, and such oxyphilic papillary tumors may behave more aggressively than typical papillary cancers. To further characterize these rare tumors, we identified during a 32‐year period 22 patients with oxyphilic papillary cancer and compared them with 1,084 patients with typical papillary cancers and 57 patients with oxyphilic follicular cancers treated by the Mayo surgical group during the same time period. Although typical papillary and oxyphilic papillary cancers were comparable with regards to patient age, tumor size and extent, TNM stage, and prognostic score (AGES), there were significant differences. Compared to typical papillary tumors, oxyphilic papillary cancers had fewer neck nodal metastases at primary diagnosis (5% vs 40%,p<0.0001), were more often DNA non‐diploid (71% vs 21%,p<0.001), and after 10 postoperative years had higher rates of both tumor recurrence (28% vs 11%,p<0.0001) and cause‐specific mortality (1.7% vs 4%,p<0.0005). In these four important respects the oxyphilic papillary cancers more resembled the oxyphilic follicular cancers. For oxyphilic follicular cancers, the frequency of initial neck nodal metastases was 7% (cf 5%); 83% of the oxyphilic follicular tumors were non‐diploid (cf 71%), and at 10 years postoperatively the tumor recurrence and cause‐specific mortality rates were 28% and 18%, insignificantly different from 28% and 17% seen with the oxyphilic papillary cancers. These results demonstrate that oxyphilic papillary tumors are more similar to oxyphilic follicular than typical papillary cancers, and suggest that in a differentiated follicular cell‐derived carcinoma a predominance of oxyphilic cells may be a prognostically more relevant feature than the individual tumor's predominant papillary or follicular morphologic pattern. Perhaps in future Histologic Classifications the World Health Organization should group the oxyphilic papillary cancers with the oxyphilic follicular rather than the typical papillary carcinomas.
Retrospective analysis of prognostic factors affecting the thyroid functional status after subtotal thyroidectomy for Graves' disease
Authors: Okamoto Takahiro , Fujimoto Yoshihide , Obara Takao , Ito Yukio , Aiba Motohiko 
Published: August 2005

AbstractTo determine the factors causing thyroid dysfunction after surgery for Graves' disease, we studied 321 patients who underwent subtotal thyroidectomy during the 7‐year period from 1981 to 1987. Thyroid functional status was evaluated biochemically and the patients were divided into four categories: recurrent hyperthyroidism, euthyroidism, latent hypothyroidism, and hypothyroidism. The following factors were analyzed: sex, age at onset of the disease, indication for surgery, serum titer of antimicrosomal hemagglutination antibody (MCHA), weight of resected thyroid tissue, size of remnant thyroid relative to body surface area, pathological findings of lymphoid follicles, and lymphocytic infiltration in the thyroid tissue. Probabilities of failure (recurrent hyperthyroidism and hypothyroidism) were estimated by the Kaplan‐Meier method. Prognostic factors for failure were identified by using Cox's proportional hazards model.The incidence of hyperthyroidism and hypothyroidism 5 years after subtotal thyroidectomy was 16.2% and 9.6%, respectively. Significant factors for hyperthyroidism were relatively large thyroid remnant, high serum titer of MCHA (≥1:3200), and age at onset of the disease <20 years. The significant factor for hypothyroidism was severe lymphocytic infiltration. The level of postoperative thyroid stimulating hormone (TSH)‐binding inhibition immunoglobulins (TBII) in patients with recurrence was significantly higher than in patients in remission.It is reasonable to determine the amount of remnant thyroid tissue in relation to patient body surface area. Although subtotal thyroidectomy can induce immunological remission by reduction of antigen, if the remission disappears, that is if TBII increases, recurrence of hyperthyroidism may develop even in patients without the unfavorable factors.
The incidence of bilateral well‐differentiated thyroid cancer found at completion thyroidectomy
Authors: Pasieka Janice L. , Thompson Norman W. , McLeod Michael K. , Burney Richard E. , Macha Mahender 
Published: August 2005

AbstractThe purpose of this study was to evaluate the surgical outcome of completion thyroidectomy in patients with presumed unilateral well‐differentiated thyroid cancer (WDTC). The medical records of all patients having had unilateral thyroid lobectomy for WDTC, who subsequently underwent completion thyroidectomy, were reviewed. From 1980 to 1991, 60 patients with WDTC underwent completion thyroidectomy. Forty‐seven patients had presumed unilateral WDTC, with no evidence of residual disease prior to their completion thyroidectomy. Twenty‐five (53%) of these patients were found to have residual neoplastic disease in the neck. In 20 (43%) of 47 patients, a focus of cancer was found in the remaining thyroid lobe and in 5 additional patients no cancer was found in the contralateral lobe, however, unsuspected nodal disease was found. The remaining 13 of the 60 patients presented with either regional recurrence (n=12) or distant metastases (n=1) at the time of their completion thyroidectomy. All (92%) but 1 of these 13 patients had cancer in the remaining thyroid lobe. Multifocal disease in the primary lobe was associated with bilateral thyroid cancer (p<0.01). Complications were infrequent; transient hypocalcemia occurred in 5 (8%) patients, permanent hypoparathyroidism occurred in 1 (1.7%) patient, and transient recurrent laryngeal nerve palsy occurred in 3 (5%) patients. Residual WDTC was found in 37 (62%) of 60 patients undergoing completion thyroidectomy. Multifocal disease in the primary resected lobe was associated with a high incidence of contralateral thyroid cancer. Completion thyroidectomy is a safe procedure and may prevent the development of regional recurrence by eliminating an unsuspected focus of cancer.
Findings and long‐term results of parathyroid surgery in multiple endocrine neoplasia type 1
Authors: Hellman Per , Skogseid Britt , Juhlin Claes , Åkerström Göran , Rastad Jonas 
Published: August 2005

AbstractForty‐two patients with primary hyperparathyroidism (HPT) of multiple endocrine neoplasia type 1 (MEN‐1) were evaluated a mean of 8.9 years after subtotal parathyroid resection (SPX, n=34) or total parathyroidectomy with autotransplantation to the forearm (TPX, n=23). TPX as the primary operation revealed asymmetric and mainly nodular enlargement of the parathyroid glands with the presence of at least one normal‐size gland in half of the individuals. TPX and SPX were accompanied by resolution of the hypercalcemia in 78% and 38% of the patients. Persistent and recurrent HPT occurred in 22% and 61% of the patients, while hypoparathyroidism requiring oral supplements occurred in 30% and 12% of the patients, respectively. Intact serum parathyroid hormone (PTH) in the arm of parathyroid autograft was high in the normocalcemic patients, somewhat lower in the patients with recurrent HPT, and normal to very low in the hypoparathyroid patients. Ratios of intact PTH between the grafted and non‐grafted arms varied from 1 to 56.3, with average of 28.1 in the normocalcemic individuals, 8.2 in the patients with recurrent HPT, and 3.3 in those requiring supplements to maintain normocalcemia. These findings substantiate an 80% to 92% reversal of hypercalcemia during long‐term follow‐up of MEN‐1 patients undergoing total parathyroidectomy or subtotal resection of 3–4 parathyroid glands as primary operative procedures and demonstrate the usefulness of intact serum PTH for functional evaluation of parathyroid autografts.
Long‐term effects of parathyroidectomy for primary hyperparathyroidism on arterial hypertension
Authors: Sancho J. J. , Rouco J. , Riera‐Vidal R. , Sitges‐Serra A. 
Published: August 2005

AbstractThe prevalence of arterial hypertension in primary hyperparathyroidism (PHPT) is higher than in the general population. With the aim of determining the evolution of hypertension associated with PHPT, we analyzed a group of 56 patients followed for a mean of 60 months (range 10–101 months) after successful parathyroidectomy for PHPT. The study group consisted of 16 men and 40 women. The mean age was 49±12 years (range 18–73 years). None of the patients had renal impairment. Two hypertensive patients died during the follow‐up from complications related to their hypertension. Twelve (21.8%) patients were hypertensive before parathyroid surgery (systolic >160 mmHg and/or diastolic >90 mmHg). Pre‐operative midregion serum parathyroid hormone concentration was higher in the hypertensive patients than in normotensive patients (2.7±2.4 vs 0.82±0.4 µiEq/l,p=0.018). Pre‐operative creatinine clearance was lower in the hypertensive patients than in normotensive patients (65.4±27.5 vs 86.7±26 ml/min,p=0.002). There were no significant differences between normotensive and hypertensive patients in age, sex, body weight, clinical manifestations, weight of parathyroid tissue removed, and calcium metabolism, or in plasma concentrations of magnesium, uric acid, cholesterol, proteins, or albumin. During follow‐up, none of the patients with pre‐operative hypertension became normotensive, whereas 32% of the patients who were normotensive preoperatively developed clinical hypertension. The global prevalence of postoperative hypertension was thus 48%. The patients that developed hypertension after parathyroidectomy were followed for a longer period than the normotensive patients (76±17 vs 53±10 months,p=0.005), had a lower postoperative creatinine clearance (74±28 vs 90±25 mg/min,p=0.07), and higher cholesterol levels (6.2±1.5 vs 5.5±0.9 mmol/L,p=0.08). The pre‐operative blood pressure recordings of patients who developed hypertension postoperatively were significantly higher than those of the patients who remained normotensive (131±11 vs 117±7 mmHg‐systolic; 81±6 vs 73±5 mmHg‐diastolic,p<0.001). The mechanism that raises blood pressure in some patients with PHPT appears to continue to exert its effect even long after parathyroidectomy. Hypertension seems to precede renal impairment in those patients.
Survival rates and prognostic factors in adrenocortical carcinoma
Authors: Icard Ph. , Louvel A. , Chapuis Y. 
Published: August 2005

AbstractIn the last 12 years, 41 patients with adrenocortical carcinoma were operated on at Cochin Hospital. There were 29 females and 12 males having an average age of 42±17 years. Seven of them underwent repeat operation for local recurrence after an average interval of 22 months. Eighty per cent of the tumors had secretory activity while 20% did not. Adrenalectomy and lymphadenectomy were performed on all patients. Thirteen (32%) patients underwent extensive resection because of invasive cancer. The same procedure was performed on 7 patients undergoing re‐operation. Operative mortality was 4% (2 of 48 patients). Twenty‐four patients died of cancer with an average survival time of 22 months (range 2–86 months) and 15 (37%) patients were still alive, 4 of them with metastases, with an average survival time of 51 months. Curative resection for the 31 patients with local (n=21) or regional disease (n=10) allowed a 5 year actuarial survival rate of 45%. The 5 year actuarial survival rate for patients undergoing repeat surgery was 33%. Only 1 of the 10 patients with metastases, and who had an impressive response to OP'DDD, was alive 2 years after the operation. The other 9 patients died within 3–4 months after operation. We found that neither patient characteristics or tumor characteristics were of significant prognostic value. There was no overall prolongation of survival in patients receiving OP'DDD. However 4 patients with metastases occurring in the course of their disease experienced an impressive response with OP'DDD and a relatively long survival.
Invasion by cultured human follicular thyroid cancer correlates with increasedβ1 integrins and production of proteases
Authors: Demeure Michael J. , Damsky Caroline H. , Elfman Fred , Goretzki Peter E. , Wong Mariwil G. , Clark Orlo H. 
Published: August 2005

AbstractA recognized model of tumor invasion requires cells to adhere to epithelial basement membrane and extracellular matrix components triggering release of proteases thus allowing cancer cells to invade the substrate. This adhesion is mediated byβ1 integrins, a family of receptors to substrates such as collagen, laminin, and fibronectin. In order to study tumor invasion in follicular thyroid cancer (FTC), we used cell lines derived from a single patient's FTC primary tumor (FTC‐133), neck lymph node metastases (FTC‐236), and lung metastases (FTC‐238).In vitro invasion as determined by the ability of the tumor cells to penetrate Matrigel® was assessed by scanning electron microscopy. FTC‐133 did not invade, FTC‐236 was moderately invasive, and FTC‐238 was highly invasive. Immunoprecipation with a monoclonal antibody toβ1 integrin subunits and SDS‐PAGE showed increased synthesis and flow cytometry showed increased expression of this subunit in FTC‐236 and FTC‐238 compared to FTC‐133. Proteolytic activity was assessed by gelatin zymography. FTC‐238 cell extract and conditioned media exhibited a more complex array of proteases consistent with activated type I collagenase and stromelysin compared to the less invasive clones, however 72 and 92 kd gelatinases consistent with type IV collagenases were present in the conditioned media from all three lines. In conclusion,in vitro invasion parallelsin vivo metastasis by the source cells in the FTC‐133/236/238 cell‐lines. The ability to invade basement membrane preparation correlates with increased synthesis and expression ofβ1 integrins and activation of tumor proteases.
Primary hyperparathyroidism in Austria: Results of an 8‐year prospective study
Authors: Niederle Bruno , Stamm Ludwig , Längle Friedrich , Schubert Edith , Woloszczuk Wolfgang , Prager Rudolf 
Published: August 2005

AbstractSerum calcium determinations in 45,217 hospitalized patients during an 8 year period revealed sustained hypercalcemia in 124 (0.3%) patients. Further clinical and biochemical investigations established primary hyperparathyroidism (PHP) in at least 40 (32%) patients, an incidence of PHP of 89.6±41.5 per 100,000 patients per year. The incidence of PHP in males and females was 31.5 and 124.2 per 100,000, respectively. The highest incidence was found in females >66 years of age (268.8 per 100,000). Nineteen (48%) patients showed classical symptoms of PHP, 14 (35%) patients were minimally symptomatic, and 7 (17%) patients were asymptomatic. The incidence and symptomatology of PHP in Austria is nearly the same as in other countries. Because of the multiple actions of parathyroid hormone in the body, PHP can cause debilitating symptoms but too often it remains undiagnosed clinically. Routine calcium determinations are very important and PHP must always be considered in the differential diagnosis, especially in minimally symptomatic patients.
Primary hyperparathyroidism in younger and older patients: Symptoms and outcome of surgery
Authors: Udén Per , Chan Allen , Duh Quan‐Yang , Siperstein Allan , Clark Orlo H. 
Published: August 2005

AbstractTwo‐hundred and fifty patients undergoing initial exploration for primary hyperparathyroidism were analyzed for differences in clinical presentation, biochemical status, pathology, and outcome of surgery. In patients <60 years of age (younger patients, n=119) the most common preoperative symptoms and signs were fatigue (40.3%), bone pain (33.6%), renal stones (31.0%), hypertension (27.7%), and psychiatric illness (27.7%). In patients ≥60 years of age (older patients, n=131) the most frequent symptoms and signs were hypertension (46.6%), fatigue (35.1%), bone pain (30.5%), muscle weakness (28.2%), and joint pain (22.9%). Renal stones were 2.6 times more common (p<0.001, chi2) in younger patients and hypertension 1.7 times more common (p<0.05, chi2) in older patients. There was no significant difference in the preoperative and postoperative laboratory values typically associated with primary hyperparathyroidism. Double adenomas were more common in older (9.2%) than in younger patients (2.5%,p<0.05, chi2). Surgical cure was obtained in 98.8% of patients, and after parathyroidectomy 83% of the younger and 82% of the older patients experienced substantial relief of pre‐operative symptoms. Specific questioning revealed most patients to be symptomatic and older patients appear to receive the same clinical and metabolic benefits from parathyroidectomy as younger patients.
The detection and management of dysplastic nevi and early melanoma
Authors: Rivers Jason K. 
Published: August 2005

AbstractWorldwide, the incidence and mortality rates for melanoma are increasing at an alarming rate. Recently, the recognition of dysplastic nevi as markers and potential precursors for melanoma has identified one group of individuals with an increased risk to develop this disease. Close surveillance of these individuals should improve the ability of clinicians to detect melanoma at an early stage when surgical excision of the primary tumor is curative in the majority of patients.
Predicting survival and recurrence in localized melanoma: A multivariate approach
Authors: Soong Seng‐Jaw , Shaw Helen M. , Balch Charles M. , McCarthy William H. , Urist Marshall M. , Lee Jeannette Y. 
Published: August 2005

AbstractSeveral clinical and pathologic factors appear to affect melanoma recurrence and survival. While much attention has been directed at identifying prognostic factors, few researchers have developed predictive models for survival and recurrence. Two major clinical questions are of interest in the management of melanoma: 1) what is the patient's chance of surviving for a given period, e.g., 5 or 10 years, after diagnosis of melanoma; and 2) after a patient has been disease free for a period of time, e.g., 5 years, what is his or her chance of melanoma recurrence or death in the following interval, e.g., 5 years or 10 years. In this paper, a generalized multivariate prognostic model to address both of these clinical questions is presented.Tables of the estimated probabilities of melanoma recurrence and death for prognostic subgroups are shown to facilitate prediction of an individual patient's outcome. The model was based on a database of 4,568 patients with localized melanoma, one of the largest melanoma databases in the world with detailed clinical and pathologic information, and long‐term follow‐up. Tumor thickness at diagnosis was the single most important prognostic factor for all outcomes. Tumor ulceration, Clark's level, lesion location, and sex had an impact on overall survival from diagnosis for some of the subgroups defined by tumor thickness. Tumor thickness at diagnosis was strongly indicative of melanoma recurrence and death even after a disease free interval of 2, 5, or 10 years. Lesion location and ulceration were of prognostic importance after disease free intervals up to 5 years, but their impact on melanoma recurrence and death diminished after longer disease free intervals.Prediction models for melanoma outcome at diagnosis and after a disease free period can provide useful information to clinicians in the management of melanoma patients. Utilization of the model will be valuable in identifying patients at high risk for melanoma recurrence and death.
Elective lymph node dissection for melanoma: Two perspectives
Authors: McCarthy W. H. , Shaw H. M. , Cascinelli N. , Santinami M. , Belli F. 
Published: August 2005

AbstractNode dissection for melanoma remains the most important therapeutic decision for the optimal management of the patient with melanoma. In Australia and in some parts of the United States, the majority of patients with intermediate thickness melanoma (1.6–4.00 mm) will undergo elective lymph node dissection. In Europe, the majority of patients with similar lesions are treated with wide local excision only. The development of an agreed policy for node dissection for melanoma awaits the results of 2 current, prospective randomized trials confirming or disproving the efficacy of elective lymph node dissection. Non‐randomized studies showing a benefit or not showing a benefit are readily available but the only 2 prospective randomized studies published to date showing a benefit, have been criticized on methodologic grounds. This paper summarizes the evidence and opinions on both sides of this debate. The clinician charged with responsibility for this important decision must, as yet, make the decision to dissect lymph nodes on the basis of a perspective derived from the best available evidence.
Management of the regional lymph nodes in patients with cutaneous malignant melanoma
Authors: Cochran Alistair J. , Wen Duan‐Ren , Morton Donald L. 
Published: August 2005

AbstractOne of the most difficult decisions in the management of patients with melanoma remains whether or not to dissect electively the regional lymph nodes of patients with high risk primary tumors. There is abundant evidence that a proportion of such patients will eventually develop nodal metastases and that the probability of metastasis increases with increasing tumor thickness and depth of invasion. If elective node dissection is performed on all patients with high risk primaries, most patients (who have no tumor in the nodes) will be subjected to a potentially morbid operation from which they can achieve no benefit. On the other hand, a “wait and see” policy accepts that a minority of patients will go on to develop nodal metastases and that if definitive therapy is delayed until metastases are detected clinically their likelihood of survival is much reduced. We describe a new technique of dye‐directed selective lymphadenectomy that allows accurate and objective identification of individual patients who have subclinical metastases, the individuals whoa priori are most likely to benefit from lymphadenectomy. We also discuss new approaches to the assessment of prognosis after lymphadenectomy for node‐spread melanoma, a group of patients in whom the prognosis is not uniformly bad. We end with a consideration of quality assurance aspects of the pathological evaluation of lymphadenectomy specimens.