bluuebunny/crossref_metadata_2025_split huggingface dataset:
Results of adrenal surgery for cushing's syndrome: 10 Years' experience
Authors: Watson Ronald G. K. , van Heerden Jon A. , Northcutt Robert C. , Grant Clive S. , Ilstrup Duane M. 
Published: May 2005

AbstractEighty‐nine patients underwent adrenal exploration for Cushing's syndrome at our institution during the period 1970–1979. On the basis of clinical and histological findings related to the initial adrenal operation, patients were divided into 6 major subgroups: (a) adrenocortical adenoma; (b) adrenocortical carcinoma; (c) proven ectopic ACTH adrenocortical hyperplasia; (d) Cushing's disease; (e) uncertain diagnostic group (probably ectopic ACTH syndrome—site unknown); and (f) “non‐ACTH‐dependent” hypercortisolism due to micronodular hyperplasia.Results of pathologic examination included 25 adrenal adenomas, 15 adrenocortical carcinomas, 40 bilateral adrenocortical hyperplasias, and a single case of micronodular hyperplasia. The postoperative mortality rate was 5.6%, and significant morbidity occurred in 40% of patients. Four of the 5 patients who died within 30 days of operation were in the subgroups with adrenal carcinoma (2 patients) and Cushing's disease (2 patients). Survival in patients with adrenocortical adenomas was significantly decreased at 2 years (relative adrenocortical insufficiency?), but thereafter, it paralleled the expected survival. Patients with the ectopic ACTH syndrome and adrenocortical carcinoma had significantly decreased survival, with only one‐third of carcinoma patients alive 2 years postoperatively. The survival of patients with Cushing's disease was lower than expected at both 5 and 10 years.These results confirm that the diagnosis of patients with endogenous hypercortisolism is usually straightforward and accurate, surgical intervention in this group of patients is still accompanied by significant short‐term mortality and morbidity, and long‐term survival in all subgroups is decreased.
DNA distribution pattern in intestinal carcinoid tumors
Authors: Cohn Gabriella , Erhardt Kerstin , Cedermark Björn , Hamberger Bertil , Auer Gert 
Published: May 2005

AbstractThe DNA distribution pattern has been suggested to be of prognostic value in several malignant tumors in which diploidy is indicative of low malignancy potential. The present study retrospectively evaluates the DNA content in intestinal carcinoid tumors. The charts of 27 patients treated for carcinoid tumors between 1965 and 1984 were reviewed. Paraffin‐embedded specimens from 22 primary tumors were available. The DNA content in individual cells was measured on histological sections of 4‐μm thickness, according to a cytophotometric method based on light transmission measurements of Feulgen‐stained nuclei. Seventeen tumors were localized to the small intestine, 1 to the appendix, 3 to the colon, and 1 to the rectum. There were 13 men and 9 women with a mean age of 59 years. Nine patients died of disseminated disease, with survival times ranging from 3 to 12 years (median: 5 years). For the 13 living patients, the follow‐up times ranged from 8 months to 16 years and 8 months. All but 1 tumor showed a majority of their nuclear DNA values around the diploid level. One tumor had 87% nondiploid cells and 14% aneuploid cells. The patient underwent a radical operation and is disease free 2 years after surgery. According to this preliminary study, intestinal carcinoid tumors are rarely aneuploid. The patients also had fairly long survival times. Thus, these observations are in agreement with the fact that carcinoid tumors often have a relatively benign course compared to other malignant tumors of the intestinal tract.
Clinical management of persistent and/or recurrent primary hyperparathyroidism
Authors: Grant Clive S. , van Heerden Jon A. , Charboneau J. William , James E. Meredith , Reading Carl C. 
Published: May 2005

AbstractPersistent or recurrent hypercalcemia following operation for benign hyperparathyroidism (HPT) remains a surgical challenge. From 1978 to 1984 at the Mayo Clinic, 157 patients underwent reexploration. This included 110 cervical, 38 combined cervical and mediastinal, and 9 mediastinal explorations. A total of 197 previous operations (range 1–5) had been performed, including 136 patients for sporadic disease, 14 for multiple endocrine neoplasia, and 7 for familial HPT. Preoperative localizing studies were employed in 137 patients (87%), Cervical ultrasonography had an accuracy of 76% (sensitivity, 82%; positive predictive value, 81%), while mediastinal computed tomography was accurate in 76% (sensitivity, 57%; positive predictive value, 80%). Arteriography, venography, and venous sampling were not used. Guided by high‐resolution, small parts ultrasonography, fine‐needle aspiration biopsy confirmed localization of parathyroid tissue in 3 patients. Successful resolution of hypercalcemia occurred in 139 patients (89%) with a mean follow‐up of 22 months. There were no operative deaths; 12 patients (8%) had temporary neuropraxia of the recurrent laryngeal nerve, 6 patients (4%) suffered permanent unilateral paralysis, and 20 (13%) became permanently hypoparathyroid. Two of 4 hypoparathyroid patients who were autotransplanted with cryopreserved parathyroid tissue have become eucalcemic. The results indicate that the disease site is usually in the neck, that noninvasive localizing techniques have superseded arteriography and venous sampling, and that reoperative parathyroid surgery can be performed with rare mortality and acceptable morbidity. Although these refinements have led to improved success, reoperative parathyroid surgery should not be performed by the occasional parathyroid surgeon.
Bone histomorphometry and serum bone gla‐protein in the diagnosis of primary hyperparathyroidism
Authors: Delmas Pierre D. , Meunier Pierre J. , Faysse E. , Saubier E. C. 
Published: May 2005

AbstractThe diagnosis of primary hyperparathyroidism (PHP) may be difficult, especially in the case of asymptomatic hypercalcemia. Since bone is the major target organ of parathyroid hormone (PTH), the hypersecretion of PTH in patients with PHP can be assessed by bone biopsy and by measured markers of bone turnover. In a first study, a transiliac bone biopsy was performed in 184 patients with surgically proven parathyroid adenoma (159 cases) or parathyroid hyperplasia (25 cases), and quantitative measurements were compared with age‐and sex‐matched controls. In patients with parathyroid adenoma, there was a marked and significant increase of the resorption surfaces, the area of the periosteocytic lacunae, and the osteoid surfaces measured on the trabecular bone. Similar results were found in patients with parathyroid hyperplasia. Only 4 patients (2.2% of cases) had a normal bone biopsy, indicating that bone histomorphometry is a sensitive method for detecting an increase of bone turnover in PHP. However, this method is not specific and does not differentiate between primary and secondary hyperparathyroidism.In a second study, we measured serum bone gla‐protein (sBGP), also called osteocalcin, which is a new specific marker of bone turnover, in 25 patients with primary hyperparathyroidism: sBGP was increased (14.2±9.6 ng/ml versus 6.2±2.4 ng/ml in controls, p<0.001) and was significantly correlated with serum PTH, serum calcium, and adenoma weight. In the patients who had a simultaneous bone biopsy, sBGP was found to be significantly correlated with the parameters reflecting bone formation. In conclusion, bone histomorphometry and measurement of sBGP are 2 sensitive methods for detecting increased bone turnover in patients with PHP. These methods may be useful for the diagnosis of PHP when other biochemical tests fail.
Current results of conservative surgery for differentiated thyroid carcinoma
Authors: Rossi Ricardo L. , Cady Blake , Silverman Mark L. , Wool Marvin S. , Horner Tia A. 
Published: May 2005

AbstractFrom 1961 to 1980 at the Lahey Clinic, 309 patients had initial surgical therapy for differentiated thyroid carcinoma. Review of this experience in comparison with previous decades revealed a progressive increase in the incidence of the disease in men, an increase in less extensive forms of the disease, an increase in use of bilateral subtotal thyroidectomy (77% of patients), the discontinuation of use of prophylactic nodal dissection, and the progressive replacement of radical neck dissections by modified and limited neck dissections. In this series, with a median follow‐up period of 13 years, 11% of patients had recurrence, and 7% died of disease. Determinants of outcome were shown to be risk groups as defined by age and sex, extent of disease (size of tumor and extent of extraglandular involvement), capsular invasion, blood vessel invasion, ability to remove all tumor at operation, and, to a lesser extent, pathologic type. Presence of nodes affected recurrence rate but did not have any deleterious effects on survival. Multifocal involvement did not appear to be an adverse prognostic factor. Treatment was successful in 73% of patients with nodal recurrences, in 53% with local recurrences, and in 27% with distant recurrences. Recurrences more often were treated successfully in low‐risk patients than in high‐risk patients. None of the deaths from local recurrence could have been prevented by initial total thyroidectomy. Recurrent nerve paralysis and hypoparathyroidism each occurred in only 1 patient (0.4%) who underwent bilateral subtotal or near‐total thyroidectomy. We conclude that a selective approach using lesser operations than total thyroidectomy is sufficient for management of patients with well‐differentiated thyroid carcinoma and that total thyroidectomy is not required.
False‐negative errors in fine‐needle aspiration biopsy of dominant thyroid nodules: A prospective follow‐up study
Authors: Boey John , Hsu C. , Collins Robert J. 
Published: May 2005

AbstractReluctance to adopt fine‐needle aspiration (F‐NA) of dominant thyroid nodules stems largely from fear of overlooking a malignancy in a nodule diagnosed as benign on FNA (false‐negative error). Published error rates have been derived from surgical series without regard to the outcome of those who were followed without operation. In order to ascertain the overall false‐negative error rate, we conducted a prospective study in 600 patients who underwent FNA. Among the 482 study patients who had a benign FNA diagnosis or inadequate specimens, 117 underwent surgery because of the concurrent large‐needle biopsy result or a clinical suspicion of malignancy. Eight false‐negative errors were identified in this group, 5 of which were detected by large‐needle biopsy. Among the remaining 365 patients who were followed for an average of 2 1/2 years, 2 patients were found to have well‐differentiated carcinomas in recurrent cysts. The overall false‐negative error rate of FNA alone in all 482 patients was 2.1%. This was reduced to 1.0% by the use of concurrent large‐needle biopsy. Properly applied, FNA can reduce unnecessary surgery among patients with clinically benign nodules without incurring an unacceptably high false‐negative error rate. Furthermore, this error rate may be reduced substantially by combining large‐needle biopsy with FNA and by close follow‐up with surgery performed later in patients who manifest clinical features suggestive of malignancy.
99mTc(V)‐dimercaptosuccinic acid scintigraphy for medullary thyroid carcinoma
Authors: Miyauchi Akira , Endo Keigo , Ohta Hitoya , Torizuka Kanji , Matsuzuka Fumio , Kobayashi Akira , Kuma Kanji , Maeda Masazumi 
Published: May 2005

AbstractTen patients with medullary thyroid carcinoma (MTC) and 2 patients with papillary carcinoma of the thyroid were investigated by scintigraphy using99mTc(V)‐dimercaptosuccinic acid [99mTc(V)‐DMS], a new radiopharmaceutical agent for imaging MTC. At surgery, a tracer dose of the agent was administered intravenously, and the distribution of the agent was studied in the surgically removed tissues. Among the patients with MTC, 7 had clear scintigraphic images of tumors, 2 had faint images, and 1 patient with a recurrent tumor in a lymph node had no significant image. In 3 patients, mediastinal involvements were clearly demonstrated, and mediastinal dissection confirmed the scintigraphic findings. No significant images were obtained in the patients with papillary carcinoma. The tissue distribution studies of99mTc(V)‐DMS revealed specific accumulation of the agent in MTC tissue and low uptake in other tissues. This new scintigraphy for MTC is of great value in deciding the surgical approach and follow‐up.
Reoperation for secondary hyperparathyroidism in hemodialysis patients
Authors: Dubost Claude , Kracht Matthias , Assens Pierre , Sarfati Emile , Zingraff Johanna , Drüeke Tilman 
Published: May 2005

AbstractParathyroidectomy (PTx) in uremic patients is only performed in case of severe hyperparathyroidism. In some instances, PTx may be either insufficient or, on the contrary, lead to intolerable hypoparathyroidism. Recurrence is always possible because of persistent renal failure. Reoperations may, therefore, be necessary. We report here on 25 reoperations done in 21 patients who are part of a series of 248 patients operated on for secondary hyperparathyroidism. Nine patients had initial parathyroidectomy (PTx) at another institution. Six patients underwent reoperation after initial surgery, which was incomplete leaving 1–3 glands in place. In 7 patients reoperation was done after initially successful, subtotal PTx. In these we found hypertrophic remnants and a supernumerary gland in 1. Seven patients had total PTx, with immediate parathyroid reimplantation in 5 instances. Reoperation on the graft was judged necessary in 5 patients, but hypertrophy of grafted fragments was observed in only 3 of them. In 3 patients secondary autografting was performed with cryopreserved tissue. The analysis of our cases shows the difficulties of localizing unique or multiple sites of parathyroid hormone overproduction despite the availability of many diagnostic approaches. From a practical point of view, we try at present to resect all parathyroid tissue in case of reoperation for recurrent hyperparathyroidism. If hypoparathyroidism results by this procedure or in case of hypoparathyroidism obtained unexpectedly, we then proceed to delayed parathyroid autotransplantation with cryopreserved tissue.
Serum calcium as an early indicator for surgical treatment of hyperparathyroidism after renal transplantation
Authors: Sitges‐Serra A. , Gores P. , Hesse U. , Fryd D. S. , Najarian J. S. , Sutherland D. E. R. 
Published: May 2005

AbstractIn an attempt to find out if a particular group of patients with hyperparathyroidism after renal transplantation (HRT) are at risk of developing complications, 14 patients with overt untreated HRT who had at least 1 serum calcium determination ≥ 12 mg/100 ml were evaluated and compared retrospectively with 11 normocalcemic transplant recipients at 6 and 30± 8 months after successful renal allografting. Serum calcium was ≥ 12 mg/100 ml within 6 months of transplantation in 13 of the 14 HRT patients. At 6 months significant differences were found between HRT and controls in mean serum calcium (11.6 versus 9.2 mg/100 ml) and alkaline phosphatase (228 versus 120 U/l). At 30±8 months differences were found in serum calcium (10.2 versus 9.4 mg/100 ml), phosphate (2.8 versus 4.8 mg/100 ml), and alkaline phosphatase (180 versus 88 U/l). Serum creatinine levels were similar in the 2 groups. A significant correlation was found between early and late determinations of alkaline phosphatase when all 25 patients were studied as a single group (r=0.72, p<0.001). Bone pain and/or radiological evidence of hyperparathyroid bone disease were significantly associated with HRT (8 versus 1 and 7 versus 0, respectively). A higher but not significant incidence of vascular calcifications (5 versus 1) and acute pancreatitis (2 versus 0) was found in HRT. Patients who develop moderate to severe HRT as defined by at least 1 serum calcium determination ≥ 12 mg/100 ml do so within 6 months of renal transplantation, have increased morbidity, particularly involving the skeleton, and might benefit from early subtotal parathyroidectomy.
Treatment of toxic multinodular goiter (hummer's disease): Surgery or radioiodine?
Authors: Jensen Michael D. , Gharib Hossein , Naessens James M. , van Heerden Jon A. , Mayberry W. Eugene 
Published: May 2005

AbstractThe records of patients treated at the Mayo Clinic for toxic multinodular goiter during 1950–1954, 1960–1964, and 1970–1974 were reviewed to compare results of surgical and131I therapy, to define trends in treatment policy and outcome, and to attempt to elucidate factors associated with posttreatment hypothyroidism. The series involved 446 patients who underwent thyroidectomy as initial treatment and 89 who initially received131I. The time to success was significantly shorter (p=0.001) in surgically treated patients than in patients initially receiving131I. Compared with patients treated medically, patients treated initially with surgery were much less likely to require a second treatment (0% versus 24%) during the first year after initial treatment. The probability of postthyroidectomy hypothyroidism increased from approximately 12% in the 1950s to more than 70% in the 1970s at 2 years after surgery. Neither more aggressive surgery nor use of more sensitive tests to diagnose hypothyroidism accounted for the increased probability in recent years.
Thyroid function after hemithyroidectomy for benign nodules
Authors: Cheung Polly , Boey John , Wong John 
Published: May 2005

AbstractIn order to assess the need for thyroxine therapy to maintain normal thyroid function in patients who have undergone hemithyroidectomy for benign solitary nodules, pre‐ and postoperative serum thyroxine (T4) and serum thyrotropin (TSH) concentrations were measured in a prospective study on 103 patients. Thyroid function measurements were normal before the operation. Postoperative thyroid function tests showed a significant reduction of serum T4 at 3 years and a significant elevation of serum TSH between 6 months and 3 years after surgery, but the altered levels remained within the normal range. Thirteen patients had abnormal postoperative thyroid function tests. Eight patients had subnormal T4 levels, which were accompanied by concomitant increases in TSH levels above normal in 3 individuals. Five patients had supranormal TSH values associated with normal T4 levels, but only 1 of them showed clinical recurrence of a goiter. These observations suggest that most patients remain clinically and biochemically euthyroid after hemithyroidectomy. Thus, routine replacement thyroxine therapy is not necessary to prevent biochemical hypothyroidism, but it may be indicated in the few patients in whom a subnormal T4 level develops. The clinical significance of these subtle changes in serum T4 and TSH within the normal range is not clear especially with respect to goiter recurrence.
Secretory pattern and blood pressure in pheochromocytoma
Authors: Gröndal Staffan , Hamberger Bertil , Telenius‐Berg Margaretha 
Published: May 2005

AbstractThe diagnostic accuracy of urinary and plasma catecholamines was studied in 16 patients with pheochromocytoma. Five of 16 patients had 1 or more plasma samples within the normal range, while all 16 patients had increased urinary samples. Urinary catecholamines, therefore, have a higher diagnostic specificity than plasma catecholamines. No diurnal rhythm of catecholamine secretion was found in 7 patients in whom plasma catecholamines and blood pressure were followed for 24 hours. No correlation was found between blood pressure and plasma catecholamines in patients at rest.
Surgical pathology of bone sarcomas
Authors: Huvos Andrew G. 
Published: May 2005

AbstractMalignant tumors arising from the skeleton are uncommon neoplasms, comprising only a small proportion of the malignant lesions in the body. Despite their rarity, they are of great clinicopathologic interest because of their prevalence in all age groups, the manifold histologic and radiographic presentations, and the complexities of treatment. This article addresses some of the problems the surgical pathologist faces in the diagnosis of the more important bone tumors with an aggressive clinical behavior.
Management of bone sarcomas at Memorial Sloan‐Kettering Cancer Center
Authors: Gebhart Michael J. , Lane Joseph M. 
Published: May 2005

AbstractSurvival of bone sarcoma patients has markedly improved during the last 20 years. This was followed by a new trend toward limb‐sparing procedures instead of amputations.This article will review the current preoperative approach, the biopsy techniques, the surgical treatments in different anatomical locations and their indications as well as the results in osteogenic sarcoma patients treated at Memorial Sloan‐Kettering Cancer Center, New York, New York, U.S.A.
Isolation perfusion of the lower limb with platinum
Authors: Vaglini M. , Belli F. , Santinami M. 
Published: May 2005

AbstractFrom August, 1983 to February, 1986, a total of 14 patients affected by osteogenic sarcoma of the limbs have been treated at the National Cancer Institute, Milan, Italy. For all patients, due to the size of tumor and the extracompartmental invasion, the only possible treatment was an amputation or disarticulation and, for this reason, it was decided to submit the patients to combined treatments according to this schedule: 2 subsequent intraarterial infusions of cis‐platinum (CDDP) + systemic high‐dose methotrexate (MTX), followed by hyperthermic antiblastic perfusion in extracorporeal circulation and 2 more cycles of systemic high‐dose MTX + CDDP.This schedule of treatment is reasonably well tolerated by the patients, despite the side effects and the length of the entire presurgical period. No significant complications have been observed, either local or systemic.
The role of the pathologist in the management of soft tissue sarcomas
Authors: Hajdu Steven I. , Shiu Man H. , Brennan Murray F. 
Published: May 2005

AbstractWe have described the diagnostic handling of surgical specimens from patients with soft tissue sarcomas and summarized our experience with 244 patients with soft tissue sarcomas in 1985. Of the 244 patients admitted with soft tissue sarcomas, 157 had primary lesions, 60, recurrent lesions, and 27, metastatic lesions. Eight tumors were biopsied, 133 excised, 56 resected, and 20 patients were treated with amputation. In 24 cases, the gross specimen margins were positive for sarcoma, and in 22, the microscopic margins were positive for sarcoma. Bone was included with 43 surgical specimens, 16 of which showed microscopic evidence of bone invasion and 4 of which showed periosteac involvement. Six sarcomas metastasized to lymph nodes and 7 invaded blood vessels. Primary sarcomas included 78 liposarcomas, 44 myosarcomas, 41 malignant fibrous histiocytomas, 27 tendosynovial sarcomas, 19 fibrosarcomas, 13 angiosarcomas, 11 malignant peripheral nerve tumors, and 11 other sarcomas. While 75% of the sarcomas were histologically high‐grade and 54% were advanced (stage III and stage IV tumors), 21% were small (less than 5 cm) and 14% were early (stage 0 and stage I) lesions. Histologic variation of tumor type, grade, and cellular components were observed in 84 of the 244 patients.