Biomedical subjects

Herbert Chen

Publications and source records attributed to Herbert Chen.

At least 19 recordsLinked to original sources

PubMed2007

Effective surgical residents strongly influence medical students to pursue surgical careers.

BACKGROUND: There is a paucity of data about the influence of surgical residents on the career choices of medical students. We hypothesized that medical students exposed to effective surgical residents would be more likely to pursue careers in surgery. STUDY DESIGN: From 1998 to 2003, 108 surgical residents were evaluated by medical students rotating on the third-year clerkship. Residents were scored on a 4-point scale (1 = outstanding to 4 = poor). The career choices of all medical students were also tabulated. RESULTS: We examined 2,632 evaluations on 108 residents. Medical students who eventually pursued surgical residency training were exposed to surgical residents who were more effective clinical teachers, role models, and overall residents. In addition, medical students exposed to the highest-rated residents were more likely to pursue surgical residency training compared with students exposed to the least effective residents (12% versus 4.9%, p = 0.022). CONCLUSIONS: These data suggest that surgical residents who are effective educators and mentors influence medical students to pursue surgical careers. Efforts to provide more leadership and teaching workshops to surgical residents may not only create better future surgeon educators, but may also increase the number of students pursuing surgical training.

Career Choice↗

PubMed2006

Equal oncologic results for laparoscopic and open resection of adrenal metastases.

BACKGROUND: While open adrenalectomy is often performed for malignant adrenal tumors, increasing numbers of surgeons have adopted the laparoscopic approach. The postoperative benefits of laparoscopic adrenalectomy are well established, but questions persist about long-term oncologic outcomes when used for malignant lesions. The current study was undertaken to compare laparoscopic with open adrenalectomy for isolated adrenal metastases. METHODS: From March 1993 to April 2006, 20 adults underwent adrenalectomy for isolated metastases to the adrenal gland. Three patients were excluded because of a concomitant nephrectomy (2) and an unresectable tumor (1). Patient demographics, tumor characteristics, and oncologic outcomes of the remaining patients were reviewed and analyzed. RESULTS: Of the 17 patients who received adrenalectomy for an isolated metastasis, there were 11 men and 6 women with a mean age of 58 +/- 3 y. Nine patients underwent laparoscopic adrenalectomy, and 8 patients had open adrenalectomy. Laparoscopic adrenalectomy was associated with less blood loss (63 +/- 8 mL versus 2207 +/- 1067 mL, P=0.05), a lower complication rate (0% versus 63%, P=0.009), and a shorter length of stay (2.4 +/- 0.6 d versus 5.4 +/- 0.7 d, P=0.02). With a follow-up of up to 97 mo, there were no port site metastases, no tumor recurrences, and no difference in survival between laparoscopic and open adrenalectomy (median 19 months versus 17 months, 5-year survival 34% versus 54%, P=0.96). CONCLUSIONS: When not limited by tumor size or invasion of surrounding tissue, laparoscopic adrenalectomy is a safe alternative to open adrenalectomy with equivalent oncologic outcomes and clear postoperative benefit for patients with isolated metastases to the adrenal gland.

Adrenal Gland Neoplasms↗

PubMed2006

Radioguided parathyroidectomy in patients with familial hyperparathyroidism.

BACKGROUND: In patients with sporadic hyperparathyroidism (HPT), radioguided parathyroidectomy (RGP) has been shown to facilitate intraoperative localization of parathyroid glands, reduced operative time, and improve patient outcomes. No studies have focused on the role of RGP in patients with familial HPT. METHODS: Between 3/01 and 6/05, 419 patients underwent RGP. Nineteen had familial HPT, including 12 with Multiple Endocrine Neoplasia (MEN), and 94 had sporadic HPT with parathyroid hyperplasia. All patients were injected with sestamibi pre-operatively and a gamma probe was used intraoperatively. Radiotracer counts were recorded prospectively. RESULTS: In patients with familial HPT, the gamma probe detected all abnormal parathyroid glands with a mean in vivo radiotracer count of 157 +/- 9% above background. Importantly, 5 patients (25%) had ectopic parathyroid glands localized by the probe in the thymus, thyroid and retroesophageal region. All resected hyperplastic parathyroid glands had ex vivo counts > 20%. All patients were cured after surgery with mean calcium and parathyroid hormone levels of 9.4 +/- 0.1 mg/dl and 31 +/- 7 pg/ml, respectively, and a mean hospital stay of 0.7 +/- 0.1 days. In comparing the 2 groups, while patients with familial HPT had lower pre-operative parathyroid hormone levels, the ex vivo radiotracer counts were significantly higher. CONCLUSION: RGP in patients with familial HPT is technically feasible and perhaps more sensitive than in patients with sporadic hyperplastic disease. The gamma probe efficiently localized all parathyroid glands including those in ectopic locations, and resulted in high cure rates and short hospital stays. RGP is a viable and useful technique in patients with familial HPT.

Adenoma↗

PubMed2006

Local/cervical block anesthesia versus general anesthesia for minimally invasive parathyroidectomy: what are the advantages?

BACKGROUND: Minimally invasive parathyroidectomy (MIP) under local/cervical block anesthesia (LA) is safe and effective for patients with primary hyperparathyroidism (HPT). Advantages of LA versus general anesthesia (GA) for these focused procedures have not been clearly demonstrated. METHODS: Between 3/01 and 6/04, 177 consecutive patients with primary HPT and positive localization studies underwent MIP. Seventy-three (41%) had surgery under LA while 104 (59%) had GA. Primary endpoints were IV narcotic use, anti-emetic use, nausea, vomiting, and post-operative pain. RESULTS: Patients who had parathyroidectomy under LA were older (64 +/- 2 vs. 57 +/- 2 years, P = 0.001). Cure and complication rates were identical between the two groups. Patients who had parathyroidectomy under LA required less IV narcotic pain mediation (mean morphine equivalents 11.4 +/- 1.3 mg vs. 22.5 +/- 1.1 mg; P < 0.001) compared to GA patients. The LA patients had better pain control as shown by lower post-operative peak pain scores (2.9 +/- 0.3 vs. 5.0 +/- 0.4; P < 0.001) and lower overall pain scores (mean 1.9 +/- 0.2 vs. 3.1 +/- 0.2; P < 0.001). The LA group required fewer anti-emetic medications compared to the GA patients (mean 0.4 +/- 0.1 vs. 1.7 +/- 0.1 doses; P < 0.001). Fewer LA patients experienced post-operative nausea (16% vs. 49%; P < 0.001), and vomiting (7% vs. 24%; P = 0.002). Length of stay was similar between the groups (0.4 +/- 0 vs. 0.3 +/- 0; P = 0.22). CONCLUSIONS: In this study the choice of anesthesia did not affect surgical cure rate, morbidity, or length of stay. LA was associated with significantly lower post-operative pain, nausea, and vomiting. LA appears to offer specific advantages more than GA for patients undergoing MIP.

Anesthesia, General↗

PubMed2006

Overexpression of the NOTCH1 intracellular domain inhibits cell proliferation and alters the neuroendocrine phenotype of medullary thyroid cancer cells.

The role of NOTCH1 as an oncogene or tumor suppressor appears to be cell type-specific. Medullary thyroid cancer (MTC) cells characteristically express the transcription factor ASCL1 (achaete-scute complex-like 1) as well as high levels of the neuroendocrine (NE) markers calcitonin and chromogranin A (CgA). In this study, we show that the active NOTCH1 intracellular domain is absent in human MTC tumor tissue samples and MTC-TT cells. To determine the effects of NOTCH1 expression, we created a doxycycline-inducible NOTCH1 intracellular domain in MTC cells (TT-NOTCH cells). Treatment of TT-NOTCH cells with doxycycline led to dose-dependent induction of NOTCH1 protein with corresponding decreases in ASCL1 protein and NE hormones. ASCL1 promoter-reporter assay and Northern analysis revealed that ASCL1 reduction by NOTCH1 activation is predominantly via silencing of ASCL1 gene transcription. Overexpression of ASCL1 in MTC cells indicated that CgA expression is highly dependent on the levels of ASCL1. This was further confirmed by experiments using small interfering RNA against ASCL1, in which reduction in ASCL1 led to reduction in both CgA and calcitonin. Furthermore, we demonstrate that NOTCH1 signaling activation leads to ERK1/2 phosphorylation, but that reduction in NE markers is independent of ERK1/2 activation. Activation of NOTCH1 resulted in significant MTC cell growth inhibition. Notably, reduction in MTC cell growth was dependent on the level of NOTCH1 protein present. Moreover, no increase in growth upon expression of ASCL1 in NOTCH1-activated cells was observed, indicating that the growth suppression observed upon NOTCH1 activation is independent of ASCL1 reduction. Mechanistically, we show that MTC cell growth inhibition by NOTCH1 is mediated by cell cycle arrest associated with up-regulation of p21.

Basic Helix-Loop-Helix Proteins↗

PubMed2006

Apoptosis-mediated medullary thyroid cancer growth suppression by the PI3K inhibitor LY294002.

BACKGROUND: Medullary thyroid cancer (MTC) cells exhibit frequent activation of the PI3K pathway as evidenced by the presence of hyperactivation of Akt kinases and overexpression of neuroendocrine (NE) markers. We hypothesized that the inhibition of the PI3K pathway in MTC may lead to a reduction in cell growth and NE tumor marker production. METHODS: Human MTC-TT cells were treated with the PI3K inhibitor LY294002 (0-60 micromol/L) for 8 days, and cellular growth was measured. Further, TT cells were treated with nontoxic concentrations of LY294002 for 2 days, and Western blot analyses were performed for phospho-Akt, total Akt, and the NE tumor markers CgA and human achaete-scute homolog1 (ASCL1). RESULTS: Treatment of TT cells with LY294002 significantly suppressed levels of phospho-Akt. Notably, a dose-dependent reduction in cellular proliferation was also observed. Importantly, NE marker production was also reduced. Mechanistically, we show that cell growth inhibition by PI3K inactivation is mediated by apoptosis attributable to an increase in the levels of cleaved poly(ADP-ribose) polymerase and caspase-3. CONCLUSIONS: MTC cell growth and NE marker production appear to depend on activation of the PI3K-signaling cascade. Inhibition of this important signal transduction pathway may lead to a possible therapeutic strategy to treat patients with MTC.

Apoptosis↗

PubMed2006

Mitogen-activated protein kinases and chemoresistance in pancreatic cancer cells.

BACKGROUND: Chemoresistance is an important clinical problem in pancreatic cancer. As the mitogen-activated protein kinases (MAPKs) have been found to be involved in the development of chemoresistance in a variety of cancer cell lines, the aim of the current study was to assess the role and mechanism of MAPK signaling in mediating chemoresistance in pancreatic cancer cells. MATERIALS AND METHODS: The effects of pharmacological inhibition of MAPKs on resistance of pancreatic cancer cells to apoptosis induced by treatment with chemotherapeutic drugs were analyzed. RESULTS: Compared with parental cells, the activity of extracellular signal-regulated kinase (ERK) was elevated in all of the three chemoresistant sublines at basal conditions. Inhibition of the ERK pathway by PD98059 sensitized cells to 5-fluorouracil (5-FU), whereas cells became more resistant to Adriamycin (ADM; Meiji Seika, Tokyo, Japan) and gemcitabine (GEM). 5-FU induced apoptosis primarily via a caspase-8-dependent pathway, and ADM and GEM via caspase-9. PD98059 enhanced the activity of caspase-8 and inhibited the activation of caspase-9. In addition, PD98059 regulated the level of phospho-Bcl-2. CONCLUSIONS: These data suggest that although constitutive activation of the ERK pathway might be a marker of chemoresistance, the effects of this pathway on chemoresistance of pancreatic cancer cells are drug dependent. This study also provides evidence for a possible link between the ERK pathway and activation of the caspases and Bcl-2.

Antibiotics, Antineoplastic↗

PubMed2006

Does frozen section alter surgical management of multinodular thyroid disease?

BACKGROUND: Frozen section (FS) evaluation during thyroid surgery is often used to guide intraoperative management. We sought to determine the utility of FS in patients undergoing thyroidectomy for multinodular thyroid disease. METHODS: From May 1994 through November 2004, 236 patients with multinodular goiter underwent thyroidectomy at our institution. Patient data were retrospectively analyzed to see if a frozen section was performed during the procedure and whether it changed the patient's outcome. RESULTS: Of the 236 patients, 135 (57%) had intra-operative FS. There were no differences between patients who had FS analysis and those who did not with regard to age, gender, and the incidence of malignancy. Of the patients who had FS, 4/135 (3%) were subsequently diagnosed with thyroid cancer on permanent histology. Three of these FS were misread as benign. Therefore, the sensitivity of FS for the diagnosis of thyroid cancer was only 25%. Importantly, in none of the 135 patients did FS alter the intraoperative management. CONCLUSION: While FS was commonly used in patients undergoing thyroidectomy at our institution, in no patient over the last decade did FS correctly alter the intraoperative management. Given the time required to perform FS and the cost associated with it, we believe that routine FS should not be performed in these patients.

Adult↗

PubMed2006

Ex vivo radioactive counts and decay rates of tissues resected during radioguided parathyroidectomy.

BACKGROUND: Radioguided parathyroidectomy using TC-99m-sestamibi injection and the handheld gamma probe allows more precise and rapid intraoperative localization of abnormal parathyroid glands. This technique is based on the principle that hypercellular parathyroid tissues have markedly higher in vivo radiotracer counts than surrounding tissue including thyroid and lymph nodes. While in vivo radioactivity after TC-99m-sestamibi administration in various tissues has been documented, there is a lack of data regarding ex vivo radioactive properties after surgical resection. METHODS: During a 6-week period in June/July 2005, 21 patients underwent radioguided parathyroidectomy by a single surgeon. Fifty-four tissue samples (39 parathyroid, 15 nonparathyroid) from these patients were collected and analyzed for ex vivo radioactive counts over a 30-min period. These data were then compared with the pathologic results. RESULTS: There is a significant difference in ex vivo counts between parathyroid adenomas, hyperplastic glands, and nonparathyroid tissue immediately after resection. However, radioactive decay/slope rates do not differ between the tissues. Importantly, an ex vivo count of >20% of background is 100% specific for parathyroid tissue. These differences persisted for up to 30 min. CONCLUSIONS: This is the first comprehensive study of ex vivo radioactive properties after TC-99m-sestamibi injection during radioguided parathyroidectomy. Parathyroids have a greater rate of uptake compared to nonparathyroid tissue, allowing ex vivo counts to predict tissue type. These tissues have similar decay rates, allowing these predictions to be made anytime up to 30 min after gland resection.

Adenoma↗

PubMed2006

Is tumor size the best predictor of outcome for papillary thyroid cancer?

BACKGROUND: There are many risk classification schemes that determine both treatment and outcome for patients with papillary thyroid cancer. Most of these formulas often utilize tumor size as the key predictor of outcome. Furthermore, there is no clear consensus regarding the treatment of small papillary cancers. Therefore, we reviewed our experience in order to determine which factors best predict outcome for papillary thyroid cancer. In addition, we sought to establish a tumor size threshold beyond which papillary cancers require treatment. METHODS: From May 1994 to October 2004, 174 patients underwent surgery for papillary thyroid cancer (PTC) at our institution. These patients were divided into five groups based on tumor size. The data from these groups were analyzed utilizing ANOVA, Chi-square and linear regression analysis. RESULTS: The mean age of the patients was 42 +/- 1 years and 126 (72%) were female. Mean tumor size was 17.2 +/- 1.1 mm. The overall outcome was quite good with a survival rate of 97% and a recurrence rate of 12%. On univariate analysis, there was no difference amongst the groups in regards to age or gender. However, there was a significantly higher incidence of lymph node metastasis amongst those with the largest tumors. Consequently, those patients with the largest tumors were treated more aggressively, with 75% undergoing total thyroidectomies and 85% receiving radioactive iodine therapy. However, on univariate and multivariate analysis, tumor size was not shown to correlate with higher recurrence. Rather, the only factor associated with a greater recurrence rate was the presence of lymph node metastases. CONCLUSION: At our institution, the recurrence rates for PTC were similar for all sizes of tumors. Furthermore, presence of metastatic disease at the time of diagnosis, rather than tumor size, seems to be a better predictor of recurrence and outcome.

Adult↗

PubMed2006

What is the biology and optimal treatment for papillary microcarcinoma of the thyroid?

BACKGROUND: Papillary microcarcinomas of the thyroid, defined as tumors measuring < or =10 mm, are believed to be a less aggressive subset of papillary cancers that behave more like benign lesions and are often more conservatively treated. However, some groups have reported a high incidence of metastases from papillary microcarcinomas and favor aggressive surgical resection followed by radioiodine therapy. Therefore, to characterize the biology and optimal treatment for papillary microcarcinomas, we reviewed our experience. METHODS: From May 1994 to October 2004, 184 patients underwent thyroid surgery at the University of Wisconsin and had papillary thyroid cancer present in the resected gland. Of these patients, 10 were excluded because there was no record of tumor size. Of the remaining 174 patients, 74 (42%) had papillary microcarcinomas. Data from these patients were retrospectively analyzed. RESULTS: The mean age of these patients was 42 +/- 1.48 year and 57 (77%) were female. The mean tumor size was 5.7 +/- 0.38 mm. Of the 74 patients, 12 (16%) had lymph node metastases. The majority of patients (65%) underwent a total thyroidectomy and 61% had radioiodine ablation therapy after surgery. With follow-up up to 134 months, the recurrence rate was 8% and only two patients currently have active disease. No patients with papillary microcarcinoma have died during this period. CONCLUSION: Papillary microcarcinomas of the thyroid are quite common, comprising almost half of all papillary cancers. Despite a significant rate of metastatic disease, the prognosis for patients with microcarcinomas has been excellent with 100% survival and a low recurrence rate. These outcomes may be the result of the aggressive surgical therapy used at our institution. Thus, papillary microcarcinomas appear to have a similar biology to other low risk papillary thyroid cancers and, in our opinion, may warrant similar treatment.

Adult↗

PubMed2006

ZM336372, a Raf-1 activator, inhibits growth of pheochromocytoma cells.

BACKGROUND: Surgical resection is the only curative treatment for patients with pheochromocytomas, paragangliomas, and other catecholamine-producing tumors. Patients with metastatic disease can often have significant symptoms associated with catecholamine excess. Activation of the Raf-1/MEK/ERK1/2 pathway has been shown to inhibit growth and hormone production for neuroendocrine tumors (NE) such as carcinoid and medullary thyroid cancer. However, the role of the Raf-1/MEK/ERK1/2 signaling pathway in pheochromocytomas is unknown. MATERIALS AND METHODS: Pheochromocytoma PC-12 cells were treated with varying concentrations of ZM336372, a pharmacologic Raf-1 activating drug. Levels of phosphorylated ERK1/2 and the NE marker Chromogranin A (CgA) were determined by Western blot. Cellular growth was measured by MTT cell-proliferation assay. RESULTS: At baseline, PC-12 cells had very little phosphorylated ERK1/2, similar to other NE tumors. Treatment of PC-12 cells with increasing dosages of ZM336372 resulted in increased phosphorylated ERK1/2. Importantly, ZM336372 inhibited pheochromocytoma cellular proliferation. Furthermore, Raf-1 pathway activation by ZM336372 was associated with suppression of NE marker, CgA, by the tumor cells. CONCLUSIONS: These data suggest that Raf-1/MEK/ERK1/2 pathway activation may be a novel strategy to treat pheochromocytoma and other catecholamine-producing tumors. In pheochromocytoma cells, ZM336372 blocks cellular proliferation and suppresses NE vasoactive peptide production. Thus, ZM336372 may be used for both therapeutic and palliative treatment for patients with pheochromocytomas.

Animals↗

PubMed2006

A prospective evaluation of novel methods to intraoperatively distinguish parathyroid tissue utilizing a parathyroid hormone assay.

BACKGROUND: Frozen section analysis has traditionally been used to confirm the identity of parathyroid tissue intraoperatively; however, it is time-consuming and costly and requires the excision of a significant portion of tissue. An intraoperative biopsy and analysis with a parathyroid hormone (PTH) assay is a possible alternative; however, this technique has not been perfected. METHODS: Two hundred twenty-three tissue specimens were collected prospectively from patients undergoing neck exploration. Each specimen was sampled intraoperatively using three different biopsy techniques: a fine-needle aspiration (FNA) with 10 passes of a needle (FNA10), a FNA with 20 passes of a needle (FNA20), and a tissue biopsy of approximately 1.0 mm3 (BIOPSY). The PTH concentration of each sample was determined via the Elecsys 1010 PTH immunoassay. The final tissue diagnosis was determined by histology or operative data. RESULTS: Parathyroid samples from all techniques had higher median PTH concentrations than nonparathyroid samples. However, the accuracies for the detection of parathyroid tissue varied markedly (PTH cutoff of 1000 pg/ml): the accuracies of the FNA10 and FNA20 were 71 and 80%, respectively, while the BIOPSY was 99% accurate. CONCLUSIONS: This is the first prospective study evaluating multiple methods to diagnose parathyroid tissue intraoperatively using a rapid PTH assay. We conclusively show that the BIOPSY technique is 99% accurate for the diagnosis of parathyroid tissue, and therefore, should be the method of choice when the intraoperative confirmation of parathyroid tissue is needed.

Adult↗

PubMed2006

Fine-needle aspiration optimizes surgical management in patients with thyroid cancer.

BACKGROUND: Fine-needle aspiration (FNA) is accurate in diagnosing papillary, medullary, and anaplastic thyroid cancer, as well as lymphoma. Although many surgeons routinely perform FNA before surgery, some question whether FNA influences operative management. Therefore, to determine whether FNA affects surgical management in patients with thyroid cancer, we reviewed our experience. METHODS: A total of 442 consecutive patients underwent thyroid surgery at 1 academic center. Of these, 411 had surgery for an index nodule in the absence of previous radiation or familial thyroid cancer. FNA, operative, and permanent histology findings were reviewed. RESULTS: The average patient age was 46 years, and 79% were female. A total of 211 patients (51%) had a preoperative FNA, and 71 (17%) had a final diagnosis of cancer. The sensitivity and specificity of FNA for thyroid cancer were 89% and 92%, respectively. In the FNA group, 1 (2.4%) of 41 patients with papillary thyroid cancer required completion thyroidectomy. In contrast, in the no-FNA group, 4 (40%) of 10 patients with papillary thyroid cancer required a second operation. No patient in the FNA group received thyroid resection for lymphoma, whereas three (100%) of three patients with lymphoma in the no-FNA group were treated surgically. A total of 98% of the FNA group, compared with 54% of the no-FNA group, received optimal surgical treatment for thyroid cancer. CONCLUSIONS: FNA is a sensitive and specific test for the diagnosis of thyroid cancer, allowing definitive initial surgery and avoiding unnecessary procedures. Therefore, we recommend routine use of preoperative thyroid FNA, even in those patients in whom a resection is already planned.

Biopsy, Needle↗

PubMed2006

The surgical management of Graves' disease.

BACKGROUND: The historical aspects of the pathophysiology and treatment of Graves' disease are briefly discussed in this paper. MATERIALS AND METHODS: The three treatment modalities of Graves' disease are anti-thyroid drug therapy, radioactive iodine therapy, and surgery. Although the majority of patients with Graves' disease in the U.S. are treated with radioactive iodine, surgery still plays an important role when patients cannot tolerate anti-thyroid drug therapy, when medical treatment is rejected by patients, or when surgery is deemed the fastest and safest route in managing the patient. CONCLUSIONS: The indications for surgical management of Graves' disease are discussed with emphasis on available data supporting the extent of thyroid resection based on the incidences of hypothyroidism, recurrence of hyperthyroidism, recurrent laryngeal nerve injury and hypoparathyroidism.

Graves Disease↗

PubMed2006

Long-term outcomes in patients with calciphylaxis from hyperparathyroidism.

BACKGROUND: Calciphylaxis is a rare condition associated with chronic renal failure and entails a very poor prognosis. Pathogenesis is poorly understood but involves abnormalities in calcium and phosphorus metabolism that lead to vascular and extravascular calcification. Patients present with painful ulcerating plaques that progress to gangrenous wounds. Parathyroidectomy has been advanced as a life-saving intervention in these patients, but long-term results with wound healing and survival after parathyroidectomy are not well described. METHODS: Between January 1987 and October 2003, 15 patients with biopsy-confirmed calciphylaxis were treated at the University of Wisconsin. Of these 15 patients, 9 were treated with medical therapy (bisphosphonates and phosphate binders), whereas 6 underwent parathyroidectomy. The medical records were reviewed, and patients or relatives were interviewed. Survival was determined by Kaplan-Meier analysis. RESULTS: Four patients underwent subtotal parathyroidectomy, and two patients underwent total parathyroidectomy. All had reductions in the intact parathyroid hormone level (mean +/- SD, 25.2 +/- 4.5 pg/mL). Whereas all six patients treated with parathyroidectomy had partial/complete wound healing, only two of nine in the medical group had any improvements in the skin lesions (P = .006). With up to 80 months of follow-up, patients who underwent parathyroidectomy had a longer median survival compared with those who did not have surgery (39 vs. 3 months; P = .017). CONCLUSIONS: On the basis of our long-term follow-up of this patient population, subtotal or total parathyroidectomy was associated with long-term survival and was more likely to promote healing if performed earlier in the course of disease. Therefore, patients with calciphylaxis from secondary hyperparathyroidism should be referred promptly for potential parathyroidectomy.

Adult↗

PubMed2006

Metastatic neuroendocrine hepatic tumors: resection improves survival.

BACKGROUND: The optimal treatment for hepatic metastases from neuroendocrine tumors remains controversial because of the often indolent nature of these tumors. We sought to determine the effect of 3 major treatment modalities including medical therapy, hepatic artery embolization, and surgical resection, ablation, or both in patients with liver-only neuroendocrine metastases, with the hypothesis that surgical treatment is associated with improvement in survival. DESIGN: Retrospective study. SETTING: Tertiary care center. PATIENTS: Patients with metastatic liver-only neuroendocrine tumors were identified from hospital records. INTERVENTIONS: Patients were subdivided into those receiving medical therapy, hepatic artery embolization, or surgical management. MAIN OUTCOME MEASURES: Effect of treatment on survival and palliation of symptoms was analyzed. RESULTS: From January 1996 through May 2004, 48 patients with liver-only neuroendocrine metastases were identified (median follow-up, 20 months), including 36 carcinoid and 12 islet cell tumors. Seventeen patients were treated conservatively, which consisted of octreotide (n = 7), observation (n = 6), or systemic chemotherapy (n = 4). Hepatic artery embolization was performed in 18 patients. Thirteen patients underwent surgical therapy, including anatomical liver resection (n = 6), ablation (n = 4), or combined resection and ablation (n = 3). No difference was noted in the percentage of liver involved with tumor between the 3 groups. An association of improved survival was noted in patients treated surgically, with a 3-year survival of 83% for patients treated by surgical resection, compared with 31% in patients treated with medical therapy or embolization (P = .01). No difference in palliation of symptoms was noted among the 3 treatment groups (P = .2). CONCLUSION: In patients with liver-only neuroendocrine metastases, surgical therapy using resection, ablation, or both is associated with improved survival.

Adenoma, Islet Cell↗

PubMed2006

Carcinoid tumors.

Carcinoid tumors can present a difficult diagnostic and therapeutic dilemma. Despite their reputation as indolent tumors, they frequently metastasize and can cause significant symptomatology. The only curative therapy remains surgical resection. The prognosis and treatment of carcinoids vary based on location and histology, and therapy must be tailored to each patient.

Antineoplastic Agents, Hormonal↗