bluuebunny/crossref_metadata_2025_split huggingface dataset:
Radiolabeled Sentinel Node Biopsy: Collaborative Trial with the National Cancer Institute
Authors: Krag David N. , Harlow Seth , Weaver Donald , Ashikaga Taka 
Published: October 2003

AbstractThe objective of this study was to maximize the success rate of sentinel node (SN) localization in breast cancer patients with the tracer that demonstrated the highest initial success during a preliminary evaluation. Altogether, 145 patients with operable invasive breast cancer and clinically negative lymph nodes were studied. Technetium 99m (99mTc)‐sulfur colloid was injected into the breast parenchyma surrounding the invasive cancer or the biopsy cavity. Variable volumes of tracer, amounts of 99mTc, and duration of time between injection and surgery were evaluated. A hand‐held gamma detector was used at surgery to locate and guide resection of all radioactive sentinel nodes (SNs), including those that were extraaxillary. A conventional lymphadenectomy was then performed in all cases. Based on previous studies, unfiltered sulfur colloid provided a higher success rate of SN identification than the other tracer types. Further evaluation with 99mTc‐sulfur colloid demonstrated that increased volume increased the success rate of SN identification. An injection volume of 8 ml resulted in a success rate of 98%. SNs were not exclusively located in the axilla: In 8.6% of cases SNs were removed from an internal mammary location. The overall accuracy of patients with SNs resected was 98.4%, and the false‐negative rate was 4.4%. It was concluded that (1) unfiltered 99mTc‐sulfur colloid at a volume of 8 ml resulted in a high success rate for SN identification; (2) a significant number of the SNs were extraaxillary in location; and (3) the accuracy of the SNs for determining whether regional metastases had occurred was high. The U.S. National Cancer Institute is funding a randomized phase III clinical trial to evaluate SN resection compared to conventional axillary lymphadenectomy in clinical node‐negative breast cancer patients. Major endpoints of this trial include long‐term regional control and survival.
Natural History of Liver Metastasis of Gastroenteropancreatic Neuroendocrine Tumors: Place for Chemoembolization
Authors: Proye C. 
Published: October 2003

Abstract.Hepatic metastases of gastroenteropancreatic tumors are observed in at least 10% of cases at presentation and in 85% of cases after 20 years of follow‐up. They are slow‐growing; and there is a 5‐year life expectancy that varies between 13% and 60% depending of the degree of differentiation, with occasional survival of more than 20 years. Curative liver resection is the best treatment, with a 4‐year survival rate of 73%, but this is possible in only 10% of cases. Chemoembolization is indicated for nonresectable multiple bilobar metastases: 87% of patients respond, half with tumor reduction and the other half with diminution of the symptoms of hypersecretion. The mean survival is 2 years; complete remission of more than 2 years is exceptional. The technique can be repeated but is not without risks, with a possible postembolization syndrome lasting up to 10 days and subsiding spontaneously, without indication for operation. Therefore one lobe only should be embolized at a session. It is not impossible that chemoembolization increases the occurrence of lung metastases. It is only a palliative method but with great functional benefit for patients with hypersecreting tumors.
Cryoablation, Percutaneous Alcohol Injection, and Radiofrequency Ablation for Treatment of Neuroendocrine Liver Metastases
Authors: Siperstein Allan E. , Berber Eren 
Published: October 2003

Abstract.Neuroendocrine liver metastases are associated with slow clinical progression, prolonged patient survival, and symptoms of hormone oversecretion. Although surgical resection is the gold standard of treatment, most of the patients are not candidates for resection, and the 5‐year survival of patients with neuroendocrine liver metastases is 11% to 40%. Cryotherapy, percutaneous alcohol injection, and radiofrequency thermal ablation are among the alternative regional treatment options available for these patients. The current role of these treatment options for neuroendocrine liver tumors are discussed in this review. Cryosurgery is the classic technique for local tumor destruction, mostly performed with open surgery. There has been limited experience with percutaneous alcohol injection for neuroendocrine liver metastasis. Radiofrequency thermal ablation is a relatively new modality that can be performed percutaneously or laparoscopically, and encouraging results have been obtained with it for treatment of neuroendocrine liver metastases.
Treatment of Hepatic Metastases from Gastroenteropancreatic Neuroendocrine Tumors: Role of Liver Transplantation
Authors: Ringe Burckhardt , Lorf Thomas , Döpkens Karen , Canelo Ruben 
Published: October 2003

Abstract.The role of liver transplantation in malignancy has been discussed, but controversially, over the past two decades. This is particularly true for hepatic metastases from neuroendocrine tumors, which have a wide variety of primary tumor localizations, morphologic types, functional activities, and clinical presentations. Despite generally slow tumor progression, the prognosis is often unpredictable. Total hepatectomy and liver replacement has been offered primarily to patients with nonresectable metastases and symptomatic disease. The results from retrospective single and multicentric analyses show that most liver recipients experience significant palliation despite tumor recurrence, and in some patients long‐term cure can be achieved. The existing data emphasize the importance of proper selection and timing for this approach.
Nonsurgical Treatment of Advanced Malignant Neuroendocrine Pancreatic Tumors and Midgut Carcinoids
Authors: Skogseid Britt 
Published: October 2003

Abstract.Neuroendocrine enteropancreatic tumors are relatively uncommon and present variable biologic and clinical features. Surgery at early disease stages is currently the only available cure. Evidenced‐based medicine and consensus on systemic treatment of advanced malignant disease is virtually nonexistent, and the various available therapeutic regimens should be considered primarily palliative. Symptomatic treatment of patients with endocrine functioning tumors, however, is of utmost importance and leads to extensive prolongation of survival. Biotherapy by means of somatostatin analogs and interferon‐α facilitates symptomatic control and offers stabilization of tumor progression for extended periods of time. Pancreatic endocrine tumors metastatic to the liver frequently respond to chemotherapy by means of a significant reduction in tumor volume. Programs including streptozotocin and 5‐fluorouracil or doxorubicin are generally regarded as first line treatment for pancreatic endocrine tumors with liver metastases, whereas midgut carcinoid tumors often are resistant to systemic chemotherapy. Treatment attempts in patients with the latter disease may rather include interferon‐α and somatostatin analogs. Somatostatin receptor‐targeted radiotherapy is still investigational. Repeated surgical intervention including various debulking procedures should be considered here and in patients with advanced neuroendocrine pancreatic tumors and midgut carcinoids requiring systemic antitumor treatment.
Minimally Invasive Video‐assisted Parathyroidectomy: Multiinstitutional Study
Authors: Lorenz Kerstin , Miccoli Paolo , Monchik John M. , Düren Mete , Dralle Henning 
Published: October 2003

Abstract.Unilateral and minimally invasive parathyroidectomies with endoscopic and video‐assisted technique have been introduced. Most of these procedures utilize preoperative localization and intraoperative monitoring of parathyroid hormone. There are only a few reports on these procedures. The objective of this study was to evaluate video‐assisted parathyroidectomy (MIVAP) for surgery in patients with primary hyperparathyroidism (pHPT). From February 1997 to June 1999 a series of 123 consecutive patients with pHPT at four surgical centers were evaluated. The patients' ages ranged from 18 to 77 years (median 50 years). Preoperatively, sestamibi scintigraphy and ultrasonography for localization were performed for all patients. Selection criteria for a MIVAP procedure excluded patients with negative localization, suspicion of multiglandular disease (MGD) or thyroid malignancy, a large thyroid mass, and prior surgery or irradiation to the neck. MIVAP was performed with a 1.5 cm suprasternal incision; the operation was then done through this incision with a 30 degree 5 mm endoscope and microsurgical instruments with brief CO2 insufflation for adenoma identification. We then proceeded with an open technique through the small incision under video‐assistance. Intraoperative monitoring of intact parathyroid hormone (iPTH) assays was used in all patients. Among the 123 patients in whom MIVAP was attempted, the procedure was accomplished in 109 (89%). Conversion to conventional cervicotomy was required in 14 (11%) patients because of failed localization, failure of the iPTH level to fall appropriately, or technical problems. There was no persistent or recurrent HPT during the 3 to 12‐month follow‐up. Oral calcium replacement for symptomatic hypocalcemia postoperatively was given in 7 (6%) cases. A unilateral transient laryngeal nerve palsy, resolving within 6 months postoperatively, occurred in two (2%) patients. The median hospital stay was 1.5 days (range 0.5–5.0 days). This study showed the feasibility of MIVAP as an alternative surgical treatment for pHPT in a selected group of patients. Further studies are necessary to evaluate the efficacy and rationale of MIVAP compared to other techniques for parathyroidectomy in pHPT patients.
Association between Residual Thyroid Carcinoma and Diffuse Hepatic Uptake of 131I following Radioiodine Ablation in Postoperative Total Thyroidectomy Patients
Authors: Tatar Fatma Atalay , Morita Eugene , Ituarte Philip H.G. , Cavalieri Ralph R. , Duh Quan‐Yang , Price David C. , Siperstein Allan E. , Clark Orlo H. 
Published: October 2003

Abstract.In patients with differentiated thyroid cancer (DTC) total or near‐total thyroidectomy, postoperative 131I ablation, and thyroid suppression therapy are reported to be associated with fewer recurrences than other treatments. Many patients with DTC after total thyroidectomy and radioablation therapy have diffuse hepatic uptake of radioiodine, and its clinical importance is debated. Some investigators report that diffuse liver uptake correlates with uptake in the thyroid bed or the presence of metastatic thyroid cancer somewhere in the body, whereas others note no such correlation. The purpose of this research was to determine the clinical importance of diffuse hepatic uptake of radioiodine after 131I ablative therapy in patients with DTC. We retrospectively reviewed 141 posttherapy scans done in 118 patients with DTC. Patients had had total thyroidectomy and were hypothyroid when serum thyroglobulin (Tg) levels were obtained, and they were treated with 30 to 200 mCi of 131I. Scans were performed 3 to 21 days after radioablation therapy. Information was collected regarding the patients' age and gender, the interval between the ablation therapy and scan, uptake of radioiodine, serum thyroglobulin level, thyroid‐stimulating hormone (TSH) level, thyroglobulin antibodies, TNM classification, mortality, and recurrence. Diffuse liver uptake was classified from 0 to 4 depending on hepatic brightness. Radioiodine scans were done to determine whether there was uptake in the thyroid bed or elsewhere. Statistical analyses included analysis of variance and Kaplan‐Meier survival analysis. Diffuse hepatic uptake was observed (grades 1–4) in 96.4% of the patients; thus 3.6% had no hepatic uptake. There was no significant association between liver uptake and the uptake in the thyroid bed, the dose of 131I administered for ablation therapy, thyroglobulin levels, age, stage of the disease, presence of local or distant metastases, recurrence, or survival. Diffuse hepatic uptake was therefore not associated with residual normal thyroid or metastases as suggested by some but not all previous investigators.
Posterior Retroperitoneoscopic Adrenalectomy: Lessons Learned within Five Years
Authors: Walz Martin K. , Peitgen Klaus , Walz Markus V. , Hoermann Rudolf , Saller Bernhard , Giebler Reiner M. , Jockenhövel Friedrich , Philipp Thomas , Broelsch Christoph E. , Eigler Friedrich W. , Mann Klaus 
Published: October 2003

Abstract.Posterior retroperitoneoscopic adrenalectomy is one of the new endoscopic methods in endocrine surgery. In a prospective clinical study 142 posterior retroperitoneoscopic adrenalectomies (72 right, 70 left) were performed in 130 patients (52 males, 78 females, age 49.1 ± 14.9 years). Indications were primary adrenal tumors (unilateral, n= 118; bilateral, n= 2), adrenal metastases (n= 2), and bilateral ACTH‐dependent hyperplasias (n= 10). Tumor size ranged from 0.5 to 7.0 cm (mean 2.7 ± 1.4 cm). Partial adrenalectomies were performed in 39 patients. Conversion to open posterior adrenalectomy was necessary in five patients and seven procedures (5%). Intraoperative and postoperative complications were minor and occurred in 5% and 13%, respectively. Mortality was zero. Operating time was 101 ± 39 minutes (range 35–285 minutes) and depended on tumor type (pheochromocytoma versus others; p < 0.01), tumor size (< 3 vs. ≥ 3 cm; p < 0.05), gender (p < 0.05), and extent of resection (partial versus complete, p < 0.05. Twenty‐three adrenalectomies (17%) were performed within 1 hour or less. Blood loss was 54 ± 72 ml. Consumption of analgesics was low (mean 6 mg piritramide postoperatively). Median duration of hospitalization was 3 days. Posterior retroperitoneoscopic adrenalectomy is a safe method that has become a standard procedure in endocrine surgery.
Achalasia and Esophageal Cancer: Incidence, Prevalence, and Prognosis
Authors: Brücher Björn Lucas Dietrich Maria , Stein Hubert Jakob , Bartels Holger , Feussner Hubert , Siewert Jörg Rüdiger 
Published: October 2003

Abstract.Reported incidence rates of carcinoma in patients with achalasia and the prevalence of achalasia in patients with esophageal cancer vary widely in the literature. The prognosis of an “achalasia‐carcinoma” is generally considered poor, although systematic studies assessing the incidence, prevalence, and prognosis of patients with “achalasia‐carcinoma” are scant. We investigated the incidence of esophageal cancer in a large series of patients with known achalasia, assessed the prevalence of achalasia in patients presenting with esophageal cancer, and evaluated the prognosis of these patients compared to that of patients with esophageal cancer without achalasia. Between 1982 and 1998 a total of 124 patients with primary achalasia were treated and followed at our department. During the same time period 1366 patients presented with esophageal cancer (879 esophageal squamous cell carcinomas, 487 adenocarcinomas). Of the 124 patients with primary achalasia, 4 developed a carcinoma during a mean follow‐up of 5.6 years (i.e., an incidence of one carcinoma per 173.6 patient‐years of follow‐up). Altogether, 13 of 879 patients (1.5%) presenting with esophageal squamous cell carcinoma and 1 of 487 patients (0.2%), presenting with esophageal adenocarcinoma had a history of primary achalasia. Seven patients with achalasia‐carcinoma (50%) had early‐stage disease (stage I, IIA, or IIB). There was no difference in the prognosis of patients with resected achalasia‐carcinoma versus those with esophageal carcinoma but no achalasia. Thus in our population of patients with long‐standing achalasia the risk for developing an esophageal cancer was increased about 140‐fold over that of the general population. With liberal use of surveillance, carcinoma could often be detected at an early stage in these patients, with a prognosis that was not worse than that of patients with squamous cell esophageal cancer but no achalasia.
Surgery for Abdominal Metastases of Cutaneous Melanoma
Authors: Gutman Haim , Hess Kenneth R. , Kokotsakis John A. , Ross Merrick I. , Guinee Vincent F. , Balch Charles M. 
Published: October 2003

Abstract.The objective of this study was to support our hypothesis that surgical resection of abdominal metastases of melanoma, regardless of symptomatology, could provide prolonged palliation and improved survival. We performed a retrospective chart review at M.D. Anderson Cancer Center. A series of 251 melanoma patients (stages I, II, or III at registration) who developed intraabdominal metastases during follow‐up were studied. Altogether, 96 patients underwent 119 laparotomies; 51 underwent endoscopic or percutaneous procedures; and 116 patients were treated medically. Surgery was associated with a median survival of 11 months, significantly longer than that with other treatment (p < 0.001). Tumor was extirpated during 37% of the first laparotomies, and in an additional 33% very good palliation was achieved with incomplete resection. Tumor extirpation was associated with 10‐month symptom‐free survival (SFS), significantly longer than that with any other approach (p < 0.0001). In the nonsurgically treated patients, good palliation was achieved in 8% to 17% of patients with no complete response. The median SFS after surgery was 5 months, but 23% of patients were symptom‐free more than 12 months; 87 patients with minimal symptoms; and 72 severely symptomatic patients underwent surgery. Complete resection was feasible in 42% and 34%, respectively. Surgery was associated with 12 months median survival in both groups. There was a significant survival benefit from surgery in patients with gastrointestinal (GI) tract metastases in contrast to those who had non‐GI metastases. For the 96 surgically treated patients, a time interval of more than 4 years between diagnosis of the primary lesion and the abdominal recurrence predicted decreased risk of death (p= 0.038). The 30‐day postoperative complication and mortality rates were 19.0% and 3.3%, respectively. Complete surgical resection of melanoma metastases in the abdomen is associated with median and symptom‐free survival benefits. Symptomatic and asymptomatic patients benefit equally, especially if abdominal metastases appear more than 4 years after the initial diagnosis and do not involve non‐GI viscera. Less than complete resection can provide durable palliation.
Adrenal locidentaloma
Authors: Brunt L. Michael , Moley Jeffrey F. 
Published: October 2003

AbstractBecause of the frequent use of computed tomography and other abdominal imaging modalities, clinicians more frequently see the incidentally discovered, clinically silent adrenal mass. Most adrenal incidentalomas should be evaluated for hormonal activity and assessed for their risk of malignancy. Adrenalectomy is indicated for hyperfunctioning tumors and for any potential primary malignant adrenal lesion. Nonfunctioning cortical adenomas<4 to 5 cm in size should be followed clinically and radiographically. Laparoscopic adrenalectomy has been used increasingly as the preferred approach in patients who require surgical resection whereas open adrenalectomy is reserved for patients with large, malignant tumors. The indications for adrenalectomy in patients with nonfunctioning adrenal tumors should not be liberalized because of the laparoscopic approach.
Cytotoxic treatment of adrenocortical carcinoma
Authors: Ahlman Håkan , Khorram‐Manesh Amir , Jansson Svante , Wängberg Bo , Nilsson Ola , Jacobsson Carl‐Erik , Lindstedt Sven 
Published: October 2003

AbstractAdrenocortical carcinoma (ACC) is a rare, aggressive tumor that is often detected in an advanced stage. Medical treatment with the adrenotoxic drug mitotane has been used for decades, but critical prospective trials on its role in residual disease or as an adjuvant agent after surgical resection are still lacking. The concept of a critical threshold plasma level of the drug must be confirmed in controlled studies. Because individual responsiveness cannot be predicted, the use mitotane is still advised for nonresectable disease. In case of Cortisol or other steroid overproduction, several drugs (e.g., ketoconazole or aminoglutethimide) may be used. Chemotherapy with single agents (e.g., doxorubicin or cisplatin) have been disappointing, with low response rates (< 30%) and a short response duration. Part of this refractoriness may be explained by the fact that ACC tumors express the multidrug‐resistance gene MDR‐1. Chemotherapy with multiple agents has been tested in smaller series and has resulted in significant side effects. The best results were achieved by the combination of etoposide, doxorubicin, and cisplatin associated with mitotane, achieving a response rate of 54%, including individual complete responses. To be able to make progress in treating advanced ACC disease, adjuvant multicenter trials must be encouraged. When mitotane‐based therapies are used, monitored drug levels are mandatory.
Gushing syndrome doe to ectopic adrenocorticotropic hormone secretion
Authors: Aniszewski Jaroslaw P. , Young William F. , Thompson Geoffrey B. , Grant Clive S. , van Heerden Jon A. 
Published: October 2003

AbstractGushing syndrome (CS) caused by ectopic adrenocorticotropic hormone (ACTH) production (EA) poses major challenges diagnostically by mimicking the pituitary‐dependent form of CS and therapeutically by producing severe, life‐threatening hypercortisolemia. This retrospective follow‐up study describes the clinical characteristics and course of EA in a large referral center. Computer‐based cross‐index codes for EA, CS, and bilateral adrenalectomy were used to identify patients treated at the Mayo Clinic between 1956 and 1998. EA was confirmed in 106 patients. Gender distribution showed a slight female predominance (61:45). Bronchial carcinoid was the most frequent cause of EA (25%), followed by islet cell cancer (16%), small‐cell lung carcinoma (11%), medullary thyroid cancer (8%), disseminated neuroendocrine tumor of unknown primary source (7%), thymic carcinoid (5%), pheochromocytoma (3%), disseminated gastrointestinal carcinoid (1%), and other tumors (8%). No tumor was found in 16% of patients. Altogether, 28 patients were managed medically, and the others underwent curative tumor resection (13 patients) or bilateral adrenalectomy (65 patients). Surgically treated patients had longer survival, but this was most likely affected by treatment bias. The diagnoses of CS and ACTH‐secreting neoplasm were usually concurrent, although, there were remarkable cases in which the two conditions were diagnosed several years apart. Curative resection of the tumor producing EA was possible in a small proportion of patients (12%). When curative resection is not possible, patients who are reasonable surgical candidates are likely to benefit from adrenalectomy. Additional experience with bilateral laparoscopic adrenalectomy should increase the number of patients who benefit from adrenal‐directed surgery.