bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serum chromogranin A in the diagnosis and follow‐up of neuroendocrine tumors of the gastroenteropancreatic tract
Authors: Schürmann Guido , Raeth Ulrich , Wiedenmann Bertram , Buhr Heinz , Herfarth Christian 
Published: August 2005

AbstractHormonally active neuroendocrine tumors may easily be diagnosed by elevated serum levels of their specific peptides and hormonal products, but there are no reliable markers for neuroendocrine tumors without hormonal activity. Chromogranin A (CgA), a secretory protein of neuroendocrine cells, has recently been characterized as a valuable tissue marker in hormonally activeand non‐functioning neuroendocrine tumors. This study analyzes the role of CgA as a serum marker for different neuroendocrine tumors. Thirty‐three patients with neuroendocrine tumors of the stomach (n=7), the ileum (n=18), and the pancreas (n=8) were investigated. Serum CgA levels were analyzed by radioimmunoassay at the time of diagnosis and during follow‐up under different therapeutic regimens. Serum CgA was elevated in 30 (91%) patients. Mean CgA serum levels varied with tumor location (pancreas: 7068±3008 ng/ml, ileum: 5381±1740 ng/ml, stomach: 529±179 ng/ml, x±SEM ng/ml) but did not differ between functioning and non‐functioning tumors. Eight of 10 patients treated with either somatostatin or interfer‐on‐alpha showed changes of CgA concentrations corresponding to tumor growth. We conclude that CgA is a useful broad‐spectrum tumor marker in gastroenteropancreatic neuroendocrine tumors. Its determination is especially recommended in tumors without hormonal activity.
Prognostic factors in parathyroid cancer: A review of 95 cases
Authors: Sandelin Kerstin , Auer Gert , Bondeson Lennart , Grimelius Lars , Farnebo Lars‐Ove 
Published: August 2005

AbstractThe clinical course, histopathology, and tumor DNA distribution patterns were analyzed in 95 patients with parathyroid cancer. The median follow‐up was 6 years (range 1–25 years). Eighteen patients received a benign diagnosis at their first operation. The initial procedure was tumor resection in 42 patients and tumor resection plus partial or total thyroidectomy in 40 patients. Forty patients developed recurrent disease and 36 patients underwent 1 to 9 re‐operations. Cervical recurrence and lung metastases were most commonly encountered. The median time from the first operation to recurrence was 33 months (range 1–228 month). Twenty‐one patients died of parathyroid cancer a median of 28 months following discovery of their first recurrence. The histopathological reevaluation confirmed unequivocal parathyroid cancer, i.e., infiltration and/or metastases, in 41 cases. Fifty‐four cases lacked these criteria but showed various forms of atypia. Image cytometry demonstrated tumor aneuploidy in 26 of 39 cases with definite cancer by histological criteria, compared to the 13 of the 52 with equivocal histological diagnosis. Twelve patients with aneuploid tumors and 7 patients with euploid tumors died of parathyroid cancer. In a multivariate analysis, patients treated with extensive surgery, i.e., tumor resection and unilateral or bilateral thyroidectomy, had a longer survival and a longer relapse‐free period. Other factors of importance for survival were age and histopathology. Histopathology and an aberrant nuclear DNA content were important factors for the time to recurrence. We conclude that histopathology alone is unable to confirm a cancer diagnosis in the absence of infiltration and/or metastases. Because recurrence may occur late, patients should be followed closely. Even repeated surgical interventions have proven beneficial.
The value of measurement of RAS oncogenes and nuclear DNA analysis in the diagnosis of Hürthle cell tumors of the thyroid
Authors: Schark Claudia , Fulton Noreen , Yashiro Tohru , Stanislav Greg , Jacoby Russell , Straus Francis H. , Dytch Harvey , Bibbo Marluce , Kaplan Edwin L. 
Published: August 2005

AbstractHürthle cell tumors (HCT) remain difficult to treat because some which appear non‐malignant on light microscopy later metastasize. In order to improve diagnostic accuracy, the value of ras mutations and nuclear DNA analysis was determined in 65 patients with HCT. Rapid nuclear DNA cytometry (MicroTICAS system) was performed. Mutations of H‐ras, K‐ras, and N‐ras genes were analyzed by oligonucleotide probe hybridizations to polymerase chain reaction (PCR) amplified DNA. HCT were classified by light microscopy as benign (n=22), intermediate (n=30), and malignant (n=13). After a mean follow‐up of 7 years, 1 (4.5%) of 22 benign tumors and 4 (13%) of 30 intermediate tumors had metastasized, leading to tumor death in 3 of these 5 patients. Six of the 13 cancers diagnosed by light microscopy also resulted in tumor‐related deaths.Aneuploidy was found in 83% of all Hürthle cell cancers, including 3 (60%) of the 5 cancers not diagnosed microscopically. However, 49% of non‐malignant HCT also demonstrated aneuploidy. A nuclear area of less than 55 square microns was found in 83% of all Hürthle cell cancers and in 100% of those cancers not diagnosed by light microscopy. However, 47% of non‐malignant HCT also demonstrated a “small” nuclear area. Aneuploidy correctly identified 8 of 9 cancers that resulted in tumor death and each of 3 other tumors that developed metastases. However, 1 patient with a diploid tumor died of metastatic cancer. A nuclear area of less than 55 square microns identified each cancer that resulted in a tumor death.Ras mutations were found in 9 (14%) of 65 Hürthle cell tumors. Only N‐ras mutations were found, and 8 of 9 were N‐ras, codon 61. Twenty‐two percent of Hürthle cell cancers and 11% of non‐malignant HCT exhibited ras mutations (p=N.S.) Ras mutations were found in 2 (40%) of 5 cancers which were not recognized microscopically. Of 4 cancers which exhibited ras mutations, 2 (50%) resulted in tumor death. Of 14 cancers that were ras negative, 7 (50%) resulted in death from tumor.We conclude that nuclear DNA cytometric studies are not useful in separating benign from malignant Hürthle cell neoplasms. However, aneuploidy and a nuclear area less than 55 square microns clearly demonstrate those cancers that are likely to act in an aggressive manner and result in tumor death. It should be noted, however, that one patient with a diploid cancer died of metastatic Hürthle cell cancer. Finally, the presence of ras mutations has limited usefulness as a prognostic factor.
Percutaneous ethanol injection treatment of autonomously functioning single thyroid nodules: Optimization of treatment and short term outcome
Authors: Goletti O. , Monzani F. , Caraccio N. , Del Guerra P. , Lippolis P. V. , Pucciarelli M. , Seccia M. , Carmassi F. , Cavina E. , Baschieri L. 
Published: August 2005

AbstractTwenty‐five patients with solitary autonomous thyroid nodules (15 nontoxic, 10 toxic) received percutaneous ethanol injection treatment (PEIT) under sonographic guidance in 4–7 sessions (1–2 weekly). To test different doses, smaller nodules (volume <15 mL) were given 0.75–2.8 mL ethanol/mL nodular tissue while larger nodules received 0.5–1 mL/mL. Except for 1 patient who developed hyperpyrexia, no relevant adverse effects were observed. A slight, asymptomatic increase in serum thyroid hormone levels was observed in both groups during the treatment. Three months after treatment, a biochemical and clinical remission of hyperthyroidism was observed in 8 of 10 patients with toxic nodules. A significant increase of TSH level was seen in both groups (p<0.01). Significant shrinkage of volume (p<0.001) as well as structural alternations of nodules were consistently recorded at sonography. A linear relationship (r=0.98;p<0.0001) between pretreatment volume and volume reduction was found both for large and small nodules, thus suggesting that even limited ethanol doses may be therapeutically effective. A recovery of extranodular parenchyma activity at scintiscan occurred in 16 (64%) of 25 patients. These data confirm that PEIT is effective in obtaining functional ablation and in inducing remission of hyperthyroidism. Adverse effects are infrequent. In spite of the small patient sample, a 0.5–1 mL ethanol dose per each mL of tissue appears as effective as larger doses and seems appropriate for treatment.
Melanoma and sun exposure: Contrasts between intermittent and chronic exposure
Authors: Elwood J. Mark 
Published: August 2005

AbstractThe evidence relating cutaneous malignant melanoma to previous sun exposure is now very strong. Major northern hemisphere studies consistently show increases in melanoma in association with recreational and vacation activities related to intermittent sun exposure. These studies have also recorded amounts of sun exposure from such activities. Several studies suggest an increased risk related to short periods of intensive exposure in early adult life. In contrast, regular outdoor occupation confers a decreased risk in these same studies. Australian studies, in populations with much higher levels of total sun exposure, do not show such a clear distinction between intermittent and chronic exposure. The evidence is consistent with a complex relationship of melanoma risk to sun exposure, the risk being increased by intermittent exposure to levels of sun which are higher than normal for that individual, but no increased risk or even a decreased risk related to long term chronic exposure. Possible biological mechanisms for this complex relationship are discussed. In the Western Canada Melanoma Study the effects of occupational and recreational exposure are different in form and are independent. The increased risks seen with various measures of sun exposure do not appear to be systematically different for individuals who have a good tanning response as compared to individuals who do not.
Desmoplastic melanoma: Patterns of recurrence
Authors: Smithers B. Mark , McLeod G. Roderick , Little John H. 
Published: August 2005

AbstractDesmoplastic melanoma is a rare type of malignant melanoma, recognized since 1971. Other variants of desmoplastic melanoma include neural transforming melanoma and neurotropic melanoma.The pathology and clinical features of 58 patients whose tumor had the features of desmoplastic melanoma, neural transforming melanoma, and neurotropic melanoma, either separately or in combination, were examined to assess patterns of recurrent disease. The tumor was situated on the head and neck in 41% of patients and was amelanotic in 71% of patients. There was an associated superficial melanoma in 48% of patients. There was a combination of the 3 histologic patterns, commonly found in the 1 melanoma. Local recurrence occurred in 29% of patients and malignant cranial neuropathies were documented in 4 patients. Nineteen percent of patients have died from disseminated disease. Neurotropic melanomas had a lower incidence of visceral recurrence. Desmoplastic and neural transforming melanomas had similar rates of local and visceral recurrence.When this specific variant of melanoma is compared with larger series of malignant melanoma in general, they appear to be more advanced locally, with a higher incidence of local recurrence. When considered in relation to the thicker nondesmoplastic melanomas, the survival is no worse and may be more favorable.Surgeons should excise the primary tumor and local recurrences with wide margins and adopt close follow‐up. On the head and neck, symptoms and signs relating to trigeminal or facial nerve innervation may herald a developing malignant cranial neuropathy.
Cutaneous melanomas exhibiting unusual biologic behavior
Authors: Shaw H. M. , Rivers J. K. , McCarthy S. W. , McCarthy W. H. 
Published: August 2005

AbstractIn rare instances, primary malignant melanoma thickness fails to predict the biologic course of the disease: lesions <0.8 mm thick may recur locally or metastasize, lesions >5.5 mm thick may not prove to be fatal within the expected interval of time, and melanoma recurrences may develop >10 years after first definitive melanoma treatment. The large Sydney Melanoma Unit data base of over 9,500 patients treated over a 41‐year period provided a unique opportunity to study the characteristics and prognosis of these patients with unusual melanomas. In stage I patients with thin lesions, and no sign of disease elsewhere, presence of ulceration, high mitotic activity, and/or penetration into the reticular dermis predisposed these melanomas to recur and regression did not emerge as a risk factor for recurrence. This was in sharp contrast to the histology of the thin lesions in patients with concurrent regional lymph node metastases (stage II). Moderate to severe regression was present in all the latter lesions, ulceration and mitoses were absent, and none penetrated beyond the papillary dermis. No specific criteria were found that could identify those stage I or II patients with thick melanomas but at low risk for recurrence or those patients with localized disease (stage I) who required long‐term follow‐up beyond 10 years.These results indicate that guidelines for follow‐up of melanoma patients after first definitive treatment may not be appropriate for a small proportion of patients. Since recurrences are mainly loco‐regional and most patients who develop a recurrence detect the recurrence themselves, education of the patient in self‐examination, and also self‐referral may be the best pragmatic approaches to facilitate early diagnosis of recurrences without imposing too heavy a burden on health services.
Neck dissection for cutaneous malignant melanoma
Authors: O'Brien Christopher J. , Gianoutsos Mark P. , Morgan Matthew J. 
Published: August 2005

AbstractThis retrospective study examines the experience of the Sydney Melanoma Unit in the management of cervical lymph nodes among patients with cutaneous melanoma of the head and neck. From 1960 to 1990, 397 patients had neck dissections for cutaneous malignant melanoma of the head and neck. This number represents 40% of all patients treated for head and neck melanoma at the Sydney Melanoma Unit during this period. Neck dissections were therapeutic in 152 patients, elective in 234 patients and for an unknown indication in 11 patients. Lymph nodes were histologically positive in 39% of operations overall and in 7% of elective neck dissections. The incidence of recurrence in the neck after dissection was 24% overall, 28% when nodes were histologically positive and 13% when nodes were histologically negative. Patients who developed recurrent neck disease after neck dissection had a worse prognosis than those with positive nodes who did not recur, but the difference in survival was not statistically significant. Patients with histologically positive nodes had a significantly worse survival than those with negative nodes, 34% vs 67% respectively at 10 years (p < 0.001). Elective neck dissection was associated with a significant improvement in survival for patients with melanomas 1.5–3.9 mm thick, using univariate analysis. This apparent benefit was lost when multivariate analysis was carried out. Patients having elective neck dissection currently have selective modified radical dissections depending upon the anatomic site of the primary melanoma. Postoperative radiotherapy is used for multiple positive nodes or extracapsular spread.
In transit metastases of malignant melanoma treated by high dose rTNFα in combination with interferon‐γ and melphalan in isolation perfusion
Authors: Liénard Danielle , Lejeune Ferdy J. , Ewalenko Patricia 
Published: August 2005

AbstractTo increase the therapeutic efficacy of recombinant tumor necrosis factor alpha (rTNFα) and reduce the systemic side effects, a protocol was designed using isolation perfusion of the limbs with hyperthermia for in transit metastases of melanoma. A triple combination of high dose rTNFα + recombinant interferon‐gamma (rIFN‐γ) + melphalan was chosen because of a synergistic anti‐tumor effect of rTNFα with rIFN‐γ and of rTNFα with alkylating agents reported in the literature. Twenty‐nine patients of mean age 60 years (range 22–82 years) entered the study after informed consent and received a total of 31 isolation perfusions with the triple combination. There were 24 women and 5 men with multiple progressivein transit melanoma metastases of the lower limb (stage IIIa or IIIab). rTNFα at the unique dose of 4 mg was injected as a bolus in the arterial line, under mild hyperthermic conditions (40 to 40.5°C) for 90 minutes. rIFN‐γ was given subcutaneously on days −2 and −1 and in the perfusate, with rTNFα, at the dose of 0.2 mg. Melphalan was administered in the perfusate at dose giving a concentration of 40 µg/ml.In all the 31 isolation perfusions performed in the triple combination protocol, in order to prevent a septic shock‐like syndrome which had been encountered in 2 patients treated outside this protocol for sarcoma and carcinoma, the patients received dopamine continuous infusion at 3 µg/kg/min from the start of isolation perfusion and for 48 hours, and only showed mild hyptension and very transient chills and temperature. Regional toxicity attributable to rTNFα was minimal. There have been 16 patients with hematologic toxicity consisting of neutropenia (11 cases, 1 case grade 4 and 1 case grade 3) and neutropenia with thrombocytopenia (12 cases, 1 case grade 4 and 4 cases grade 2). Eighteen of 29 patients had been previously treated with melphalan in isolation perfusion (n=13) or with cisplatinum (n=2), rTNFα‐Melphalan (n=1), or rTNFα alone (n=2). Median follow‐up has been 41 weeks. The 29 patients are evaluable: there have been 26 (90%) complete remissions (CR), 3 (10%) partial remissions (PR), and no failures. Actuarial disease‐free survival and total survival have been 63% and 73%, respectively, at 12 months. In all cases, softening of the nodules was obvious within 3 days after isolation perfusion and time to definite response ranged between day 6 and 22.This interim analysis of a phase II study suggests that high dose of rTNFα can be administered with acceptable toxicity by isolation perfusion with dopamine and hyperhydration. Tumor responses can be evidenced in all patients, with 90% CR. Furthermore, combination of rTNFα, rIFN‐γ, and melphalan seems to achieve high efficacy with minimal toxicity, even after failure of prior therapy with melphalan alone.
What has the surgeon to know about pathophysiology of reflux disease?
Authors: Sivri Bulent , McCallum Richard W. 
Published: August 2005

AbstractMuch has been learned about the pathophysiology of gastro‐esophageal reflux (GER) since it was initially described by Asher Winkelstein in 1935. With the development and refinement of esophageal function tests in the past decades, the diagnostic modalities have become available for a deliberate and systematic evaluation of antireflux mechanisms. Some of the newer concepts of the pathogenesis of reflux esophagitis are reviewed in this article.
The neoplastic potential of columnar‐lined (Barrett's) esophagus
Authors: Tytgat G. N. J. , Hameeteman W. 
Published: August 2005

AbstractReflux of gastric contents is the most important factor contributing to the development of a columnar‐lined esophagus (CLE). CLE should be considered a “mosaic” of cells, glands, and architectural types showing variable degrees of maturation towards intestinal and gastric epithelium. Dysplasia refers to an unequivocally neoplastic alteration in the epithelium. High‐grade (severe) dysplasia consists of neoplastic cellular and/or architectural changes within the columnar epithelium, without invasion through the basement membrane. The prevalence of dysplasia is usually 5% to 10%. Dysplasia has been found in the vast majority in the specialized columnar‐type or intestinal‐type epithelium. Adenocarcinoma in CLE is most often seen in males. At the time of diagnosis transmural tumor infiltration is found in 60% to 88% of patients, and lymph node invasion in 55% to 74% of patients. The prognosis is poor with a low 5 year survival. Estimates of incidence of cancer vary from 1 case per 52 patient years of follow‐up to 1 case per 441 patient years of follow‐up.
Fundoplication: How to do it? Peri‐esophageal wrapping as a therapeutic principal in gastro‐esophageal reflux prevention
Authors: Siewert J. R. , Feussner H. , Walker S. J. 
Published: August 2005

AbstractThe prerequisites for a successful outcome after fundoplication are careful patient selection, good technique, and an understanding of the principles of antireflux surgery. The most important aspect of any such operation is the construction of a peri‐esophageal ring around the gastro‐esophageal junction buttressing the sphincter and, thus, neutralizing the gastric opening pressure. Accordingly, the operation has to comprise: 1) generous dissection around the gastric fundus to allow the formation of a “floppy” fundoplication; 2) construction of the cuff as short as possible (2 cm to 3 cm); and 3) proper fixation of the cuff at the correct site in the region of the lower esophageal sphincter. Adherence to these principles will avoid postoperative dysphagia or functional gastro‐intestinal disorders and produce long‐lasting reflux control in approximately 90% of patients at 10 years. Problems of hypercontinence may occasionally occur since gastro‐esophageal reflux suppression is usually complete and any physiological reflux abolished. With the advent of modern drug treatment, the excellent results achieved by fundoplication need to be maintained despite fewer operations. Careful postoperative quality control including pH monitoring is therefore mandatory. The principle of periesophageal wrapping is likely to remain the cornerstone of antireflux surgery. Current techniques are, however, likely to evolve. One direction being investigated is laparoscopic fundoplication, rendering the procedure much less invasive.
The relationship between intra‐operative manometry and clinical outcome in patients operated on for gastro‐esophageal reflux disease
Authors: Jamieson Glyn G. , Myers Jennifer C. 
Published: August 2005

AbstractLower esophageal sphincter pressure has been assessed pre‐operatively, intra‐operatively, and more than 6 months postoperatively in 34 patients having antireflux surgery for gastro‐esophageal reflux disease. The sphincter pressures associated with the outcome in relation to pH measured reflux and the symptoms of recurrent heartburn, gas bloating, and dysphagia have been determined. There was no significant difference between the intra‐operative sphincter pressure or the postoperative sphincter pressure and any of these parameters. It is concluded that intra‐operative manometry in its present form is not useful in antireflux surgery for primary gastro‐esophageal reflux disease.