bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thyroxine suppressive therapy of benign solitary thyroid nodules: A prospective randomized study
Authors: Cheung Polly S. Y. , Lee Joseph M. H. , Boey John H. 
Published: May 2005

AbstractPatients with solitary thyroid nodules that are benign on aspiration biopsy are often treated nonsurgically. To find out if thyroxine therapy is effective, 74 patients were randomized to receive levothyroxine treatment or nothing. There were 8 males and 66 females. Their mean age was 39 years. The mean nodule size was 3.6 cm and the mean nodule duration was 11 months. All patients had normal serum thyroxine and thyroid stimulating hormone (TSH) levels, and positive thyrotropin releasing hormone (TRH) tests. The dose of thyroxine was adjusted until the TRH test was negative. Patients were followed at 6‐month intervals in the first 2 years and yearly thereafter, with measurement of the nodule diameter. The mean follow‐up period was 1.5 years.In the 37 patients receiving thyroxine therapy, 8 had disappearance of nodules, 6 had greater than 50% reduction in nodule size. In 19, the nodules were unchanged and in 4, the nodules were enlarged. In the 37 patients receiving no drug, 8 had disappearance of nodules, 5 had greater than a 50% reduction in nodule size, 17 had nodules unchanged, and 7 had enlarged nodules (p >0.9). The mean reduction in nodule diameter at various follow‐up periods was greater in the thyroxine group, but the difference did not reach statistical significance. Carcinoma was found in 1 patient in each group and both of them experienced nodule enlargement.We conclude that an adequate suppressive dose of levothyroxine does not alter the natural course of benign solitary thyroid nodules. An enlargement of the nodule or a change in its consistency should be further investigated to exclude malignancy.
Cancer of the extrahepatic bile duct: A clinicopathologic study of immunohistochemistry for CEA, CA19‐9, and p21
Authors: Yamaguchi Koji , Enjoji Munetomo , Nakayama Fumio 
Published: May 2005

AbstractA total of 86 patients with extrahepatic bile duct cancer (excluding intraduodenal bile ducts and the ampulla of Vater) selected from 422 patients with cancer of the biliopancreatoduodenal region were studied clinicopathologically. Significant parameters influencing the prognosis include histologic grade of differentiation, lymph node metastasis, perineural invasion, and immunohistochemical demonstration of carcinoembryonic antigen (CEA). Tumor cells had CEA, carbohydrate antigen 19‐9 (CA19‐9),and c‐Ha‐ras p21 antigen (p21) reactants in 75, 58, and 20 patients, respectively, of the 82 patients with bile duct cancer. Four tumors were classified as early bile duct cancers, showing a polypoid mass restricted within the bile duct wall. The patients with such early carcinoma were alive with the postoperative course ranging from 1 1/2 to 7 1/2 years.
The role of ultrasound, percutaneous transhepatic cholangiography, computed tomographic scanning, and magnetic resonance imaging in the preoperative assessment of bile duct cancer
Authors: Okuda Kunio , Ohto Masao , Tsuchiya Yukihiro 
Published: May 2005

AbstractThe diagnosis of bile duct carcinoma currently depends largely on radiographic imaging. Imaging provides certain information that is necessary for determining operability and the proper surgical procedure to be employed. In an early stage of bile duct carcinoma, elevated serum enzymes may be the only abnormality detectable, but once the mass has grown to cause sufficient stenosis along the biliary tract, serum bilirubin starts to rise. Differentiation of intra‐ and extrahepatic cholestases is the primary task of the gastroenterologist. The site and nature of the obstructing lesion must then be determined by means of imaging. This article deals mainly with the diagnosis of dile duct carcinoma through imaging, excluding the endoscopic procedure.
The role of preoperative biliary decompression in the treatment of bile duct cancer
Authors: Yanagisawa Jiro , Ichimiya Hitoshi , Kuwano Nagako , Nakayama Fumio 
Published: May 2005

AbstractUsefulness of preoperative biliary decompression by percutaneous transhepatic biliary drainage (PTBD) in patients with obstructive jaundice remains controversial. We determined bile and bile acid outputs in patients with complete biliary obstruction following biliary decompression by PTBD. Bile and bile acid outputs correlated well with the decline index of serum bilirubin. Patients with a poor decline index tended to have low bile acid output in spite of high bile output, i.e., secretion of watery bile. Daily bile acid output reflecting daily bile acid synthesis remained low or increased only slowly in almost all cases, indicating that recovery of liver function is considerably delayed. We stress the importance of bile acid output as a function of bile acid synthesis as an index of the recovery of liver function. Although many studies comparing operative intervention alone and PTBD followed by operation have already been carried out, and because of the increasing use and greater safety of a 2‐staged approach with ultrasound‐guided PTBD, the advantages and disadvantages of preoperative PTBD should continue to be reevaluated with respect to technical improvement and a concomitant decrease in complications.
Resection or palliation: Priority of surgery in the treatment of hilar cancer
Authors: Bismuth Henri , Castaing Denis , Traynor Oscar 
Published: May 2005

AbstractDuring the past 25 years, 213 patients with hilar cancer have been treated in this unit. One hundred seventy‐eight patients had some form of surgical intervention and 35 were unfit for any surgery. The preoperative and peroperative assessment of the 178 patients having surgery was directed toward identifying tumors which might be suitable for potentially curative resection. On this basis, 18 patients (10.1%) had tumor resection and the remaining 160 patients had a palliative procedure. When possible, some form of surgical bypass procedure was performed to achieve palliation (96 patients) but when this was either impossible or contraindicated, an intubation and drainage procedure was performed (64 patients). There was no operative mortality among the 18 patients having surgical resection (10 having local resection and 8 having hepatic resection). There was a complete disappearance of jaundice in all patients and the mean survival was 53 months with a mean duration of well‐being of 39 months. Among the 96 patients having surgical bypass, the operative mortality rate was 7%, and 20% of these patients had a postoperative complication. There was a complete relief of jaundice in more than 75% of these patients. The average survival time was 9 months with a duration of well‐being of 8 months. Among the 64 patients having intubation and drainage, the operative mortality rate was 30%, and 26% of these patients had postoperative complications. Less than half of these patients experienced a complete relief of jaundice. Although the average survival time was 7 months, the duration of well‐being was usually only 2–4 months. We conclude that surgical resection offers the best possibility of prolonged survival and the best quality of life for suitable patients with hilar cancer. The majority of patients are, however, suitable only for a palliative procedure and the best palliation is achieved by a surgical bypass procedure.
Skeletization resection and central hepatic resection in the treatment of bile duct cancer
Authors: White Thomas Taylor 
Published: May 2005

AbstractWe were able to carry out skeletization resection and central hepatic resection in 24 of 50 patients referred for treatment of Klatskin tumors. Thirteen of the 24 operations were primary. The other 11 patients had 14 prior operations. The average hospital stay was 18.4 days (including work‐up), ranging from 10 to 30 days. There were 3 postoperative deaths. The average survival of patients with lesions 14‐mm in diameter or less was 34 months, while the larger tumors averaged a 9‐month survival. Other factors such as blood vessel invasion, lymph node metastasis, and perineural invasion did not seem to be important in survival. The operative technique utilized is illustrated in this article.
Radical surgery for middle and distal thirds bile duct cancer
Authors: Nakayama Fumio , Miyazaki Kohji , Nagafuchi Kazumitsu 
Published: May 2005

AbstractA total of 38 patients with middle and distal thirds bile duct cancer treated in our department during a period of 20 years were reviewed and analyzed in respect to the type of operative procedures employed and the long‐term results. The purpose of the study was to evaluate the impact of various recently available modalities for diagnosis and treatment on the prognosis of patients with these malignancies.The longest mean survival was 22.8 months after resection and the shortest was 3.5 months after intubation. Resectability increased during the course of the study, especially for distal bile duct cancer, and reached 70% in the last 10 years. Either local excision of the bile duct or pancreatoduodenectomy was chosen as a radical operative procedure for middle bile duct cancer, however, curative resection was obtained only by the latter. Pancreatoduodenectomy was the only choice of radical treatment for distal thirds bile duct cancer. Postoperative morbidity decreased during the last 10 years and preoperative biliary decompression significantly improved the postoperative survival time.
Radical resection and liver grafting as the two main components of surgical strategy in the treatment of proximal bile duct cancer
Authors: Pichlmayr Rudolf , Ringe Burckhardt , Lauchart Werner , Bechstein Wolf O. , Gubernatis Gundolf , Wagner Ernst 
Published: May 2005

AbstractIn the treatment of adenocarcinoma of the proximal bile duct, our current strategy is to resect the tumor radically and to offer patients with unresectable tumors the chance of hepatic transplantation, if extrahepatic tumor growth is exluded. Tumor resection is performed by resection of the hilum alone or combined with partial hepatectomy. The latter procedure enables radical treatment of more advanced tumor stages and, eventually, a higher degree of radically is achieved, and is recommended. This concept is based on our experience with 108 patients with proximal bile duct carcinoma operated on between February, 1975 and October, 1986.In 10 patients, no therapeutic or palliative surgical procedure could be performed during laparotomy because of advanced tumor stage. In 30 patients, various drainage procedures were performed. Fifty‐two patients underwent resection: 25 underwent resection of the hilum only, and 27 underwent resection of the hilum combined with partial liver resection. Twenty‐eight of these resections were classified as curative and 24 as palliative. Sixteen patients with unresectable tumors had hepatic transplantation. In 7 of these patients, extrahepatic tumor growth was already present at the time of liver transplantation.Median survival times were: laparotomy only, 1 month; drainage procedures, 5 months; total resection, 15 months; curative resection, 23 months; palliative resection, 7 months; liver grafting, 16 months. Seven patients are alive up to 21 months posttransplantation. On the basis of favorable results in our more recent group of patients, liver grafting as the ultimate chance for tumor removal in patients otherwise treatable only by palliative drainage procedures may be justified.
Endoscopic retrograde drainage for bile duct cancer
Authors: Soehendra Nib , Grimm Horst 
Published: May 2005

AbstractEndoscopic biliary drainage is a palliative measure. It is mainly indicated for inoperable malignant jaundice. Extrahepatic obstructions are suitable for the transpapillary decompression, which may be successful in 80–90% of patients. Morbidity and mortality rates are approximately 5% and 1–2%, respectively. Tumors of the hilum region, which usually already involve the intrahepatic ducts, are less eligible for drainage treatment. In the case of insufficient drainage, cholangitis may occur. A satisfactory decompression can only be achieved if both hepatic ducts are catheterized. Apart from the technique, the long‐term results of the drainage treatment also depend on the consistency of the follow‐up. A regular check of the patients is required because, after an average of 3 months, the biliary stent may be occluded, which is usually followed by cholangitis.
The role of chemotherapy in the treatment of bile duct cancer
Authors: Oberfield Richard A. , Rossi Ricardo L. 
Published: May 2005

AbstractCancer of the bile ducts continues to account for about 4,000 deaths yearly in the United States. Resection is often not possible, and overall survival is poor. In view of this, chemotherapy has been employed over the years in the hope of achieving enhanced response rates with increased survival. Despite the limitation of the approach, it does have a role as is indicated by a review of the literature. Systemic chemotherapy, employing such drugs as 5‐fluorouracil (5‐FU) and mitomycin C as single agents and the combination of 5‐FU with adriamycin and mitomycin C (FAM), resulted in a collective response rate of 29% (28 of 97 patients).Regional infusion chemotherapy may have a special role as a more effective treatment for this disease, which is locally confined for long periods with dissemination only in the later stages. The blood supply to the bile ducts allows a high concentration of such drugs as 5‐FU, floxuridine (FUDR), and mitomycin C to be given over prolonged periods with enhanced response rates. A recent report of biliary sclerosis as a toxic effect from regional infusion by implantable pumps further corroborates the selective action of this treatment. The series from the literature show a collective response rate of 39% (15 of 38 patients) for regional infusion chemotherapy. This article should provide stimulation for further investigation of this method of treatment for bile duct cancer.
Diagnostic and prognostic utility of flow cytometric DNA measurements in follicular thyroid tumors
Authors: Grant Clive S. , Hay Ian D. , Ryan John J. , Bergstralh Erik J. , Rainwater Leslie M. , Goellner John R. 
Published: May 2005

AbstractDistinguishing cellular follicular adenomas (FA) from minimally invasive follicular carcinomas (FC) continues to plague even experienced thyroid pathologists. DNA ploidy analysis has been promoted as a means of making this differentiation; however, the finding of DNA aneuploidy in FA has caused concern that they may demonstrate potential for malignant behavior or should even be reclassified as low‐grade noninvasive cancers. In histologically‐proven FC, nuclear DNA content has been claimed to have predictive power equivalent to that of all other prognostic factors combined. The aims of the present study, therefore, were to define the DNA ploidy characteristics of FA and FC, to assess the diagnostic potential of cell‐cycle parameters, and, in FC, to investigate the prognostic role of such measurements.We measured DNA content of 124 tumors (60 FA, 64 FC). DNA pattern was normal (diploid) in 75% of FA and 45% of FC, tetraploid/polyploid (T/P) in 13% of FA and 25% of FC, and aneuploid in 12% of FA and 30% of FC. FC was histologically verified in 39% of DNA normal, 67% of T/P, and 73% of aneuploid tumors. DNA index, S‐phase, G2M, and S‐phase plus G2M were analyzed and were not helpful in differentiating between FA and FC. No patient with FA developed tumor recurrence. In FC (excluding the Hürthle cell variant), no significant differences were found among the 3 DNA ploidy groups with respect to either cancer death or tumor recurrence; however, combining the Hürthle cell variant of follicular carcinomas with pure follicular carcinomas, the presence of distant metastases, DNA aneuploidy, and patient age were the only independently significant prognostic variables. Based on these data, while not valuable for determining the presence of malignancy, DNA ploidy determination is of major prognostic value in follicular carcinomas (including the Hürthle cell variant).
Immunohistochemical reclassification of anaplastic carcinoma reveals small and giant cell lymphoma
Authors: Hölting T. , Möller P. , Tschahargane C. , Meybier H. , Buhr H. , Herfarth C. 
Published: May 2005

AbstractThirty‐one cases of thyroid malignancies which were originally classified as anaplastic carcinoma were reexamined immunohistochemically using PAP methods (peroxidase:antiperoxidase) for IgM, IgG, IgA, cytoceratin, calcitonin, lysozyme and alpha‐1‐antitrypsin. The reclassification results were compared with patient data such as clinical symptoms, treatment modalities, and clinical outcome. Postoperative radiotherapy was carried out in more than 80% of cases, chemotherapy in none. Seven of 31 tumors showed a positive staining for IgM (n=4), IgG (n=2), and IgA (n=1) antibodies. All of these cases were negative for epithelial markers. Surprisingly, not only all small cell tumors (n=3) but also 4 tissues with predominantly giant cell areas were among those reclassified as primary malignant lymphoma.
Sporadic unilateral adrenomedullary hyperplasia with hypertension cured by adrenalectomy
Authors: Dralle Henning , Schröder Sören , Gratz Klaus F. , Grote Reinhard , Padberg Barbara , Hesch Rolf D. 
Published: May 2005

AbstractAdrenomedullary hyperplasia (AMH) with increased urinary excretion of epinephrine is regarded as the earliest adrenal manifestation in familial pheochromocytoma; however, pathogenetic mechanisms and morphogenesis involved in the development of sporadic adrenomedullary diseases are unknown as yet. We present 4 patients with clinical, biochemical, imaging, and morphological findings of sporadic unilateral adrenomedullary hyperplasia cured by unilateral adrenalectomy. All patients were hypertensive with intermittent hypertensive crises, and with increased catecholamine concentrations in urine and serum. Correct unilateral localization was achieved by 123‐I‐BG‐scan (planar and SPECT) (n=2) or cavovenous blood sampling with selective catheterization of both suprarenal veins (n=2). Histomorphometric analyses revealed diffuse adrenomedullary hyperplasia in all 4 specimens with significant increase of relative volume to 17.6% (controls, 8.7%), and of estimated medullary weight to 0.95 g (controls, 0.45 g); corticomedullary ratio (C∶M) was decreased to 5.4 (controls, 11.2). DNA histograms showed euploidy in all cases. In 3 patients, DNA analysis revealed evidence of cell proliferation, but without increase to grade of malignancy indices (0.101–0.523). Adrenalectomy was performed preferentially by a translumbar approach; the operative and postoperative course was uneventful in all 4 patients. Blood pressure without antihypertensive drugs returned to normal in 3 patients, in 1 patient to the upper normal limit.
Clinical significance of associated nodular lesions of the adrenal in patients with aldosteronoma
Authors: Ito Yukio , Fujimoto Yoshihide , Obara Takao , Kodama Takaya 
Published: May 2005

AbstractThirty‐seven patients with primary aldosteronism were treated by unilateral total adrenalectomy during a 7‐year period (1981–1987). The 37 patients were classified into 3 groups on the basis of adrenal pathology: unilateral solitary adenoma, 23 cases (group 1); unilateral adenomas, 3 cases (group 2); and adenoma with multiple macro‐ or microscopic nodules, 11 cases (group 3). The preoperative conditions of the patients (age, duration of hypertension, plasma renin activity, plasma aldosterone concentration, and serum potassium concentration), postoperative sequential changes of hormone levels, and outcome of hypertension were compared among the groups in order to determine whether the differences of adrenal pathology would affect the postoperative course. The preoperative parameters excluding age at surgery did not differ significantly among the 3 groups. The mean age in group 3, however, was slightly higher than in groups 1 and 2 (47.8 versus 42.8 versus 42.7 years).Postoperative hormonal changes were also similar, particularly in groups 1 and 3, staying within the normal range throughout the follow‐up period (mean, 31 months; range, 3–86 months). However, postoperative improvement of hypertension showed marked differences, being significantl retarded in patients with multinodular lesions (group 3), about half of whom remained hypertensive even after 1 year. Nodular lesions other than adenoma(s) were, therefore, thought not to contribute to hormonal excess but to result from intractable hypertension.
Aberrant hormone production from ovarian neoplasms: Strategies for diagnosis and therapy
Authors: Leach Steven D. , LaMorte Annette I. , True Lawrence D. , Flynn Stuart D. , Schwartz Peter E. , Cahow C. Elton , Kinder Barbara K. 
Published: May 2005

AbstractSyndromes involving peptide or nonsex steroid hormone secretion due to aberrantly located tumors are rare. We report a collected series of 16 patients with ectopic hormone production from ovarian neoplasms, including 3 patients recently encountered at our institution as well as 13 additional cases identified in the recent literature. These tumors included 2 insulin‐producing ovarian carcinoids, 1 ACTH‐producing pituitary adenoma within a benign ovarian cystic teratoma, 2 cortisol‐producing ovarian neoplasms, 8 gastrin‐producing ovarian cystadenomata or cystadenocarcinomata, and 3 thyroxine‐producing ovarian strumal carcinoids. All patients presented with syndromes of hormone excess. Only 62% of all tumors were localized preoperatively. Following ovarian resection, 87% of patients remained disease‐free with a median follow‐up period of 1.5 years. In addition to ovariectomy, 8 additional unnecessary ablative procedures were performed in 7 patients. These included distal pancreatectomy, pancreaticoduodenectomy, adrenalectomy, total gastrectomy, selective vagotomy, and subtotal thyroidectomy. Failure to localize the ovarian neoplasm preoperatively was associated with a significantly higher risk of subsequent unnecessary ablative procedures. Because of the potential for the ovary to act as a source of aberrant hormone secretion, we recommend complete preoperative evaluation of the pelvis in female patients presenting with nonlocalizable endocrine tumors.
Intraoperative and postoperative PTH secretion mode in patients with hyperparathyroidism
Authors: Fischer S. , Flentje D. , Kettelhack C. , Schmidt‐Gayk J. , Buhr H. , Herfarth C. 
Published: May 2005

AbstractThe development of a sensitive 2‐site immunoradiometric assay which detects only intact human PTH (1–84) enabled us to study kinetics of PTH secretion intraoperatively. In a prospective study, we assessed the PTH (1–84) secretion mode intraoperatively in 54 patients with adenomas, in 14 patients with tertiary hyperparathyroidism (HPT), and in 2 patients with persistent HPT. After the removal of adenomatous or hyperplastic tissue, a significant drop of PTH (1–84) concentration was seen. A 50% decrease in the basal PTH concentration was reached significantly earlier for adenomas than for hyperplasias. In the 2 cases with unrevealing neck exploration, the PTH (1–84) concentrations showed hardly any change. The recovery of PTH secretion was studied in 23 patients, 20 of whom had a single adenoma; in 2 cases, a hyperplasia was present and 1 patient showed the clinical signs of a toxic HPT. We found an initial drop of PTH concentration 4 hours postoperatively below the limit of detection and a rapid recovery within 24 hours postoperatively. The PTH concentration values were well within the normal range after 48–72 hours.