Racial disparities in clinical and economic outcomes from thyroidectomy.

Context: Thyroid disease is common, and thyroidectomy is a mainstay of treatment for many benign and malignant thyroid conditions. Overall, thyroidectomy is associated with favorable outcomes, particularly if experienced surgeons perform it.

Objective: To examine racial differences in clinical and economic outcomes of patients undergoing thyroidectomy in the United States.

Management of follicular tumors of the thyroid.

The incidence of well-differentiated thyroid cancers is rising. Follicular cancer represents 10-20% of these lesions. While the vast majority of thyroid nodules of follicular origin are benign, fine needle aspiration cannot provide cytologic evidence of capsular and/or vascular invasion; therefore, patients should undergo surgical excision.

Leiomyosarcoma of the adrenal vein: a novel approach to surgical resection.

Background: Leiomyosarcomas typically originate within smooth muscle cells. Leiomyosarcomas arising from the adrenal vein are rare malignancies associated with delayed diagnosis and poor prognosis. The most common vascular site of origin is the inferior vena cava.

Phase II trial of weekly docetaxel/irinotecan combination in advanced pancreatic cancer.

Background: Docetaxel and irinotecan have activity in pancreatic cancer. The combination of docetaxel and irinotecan is attractive because of preclinical evidence of synergy between the two drugs. We have previously demonstrated the safety of docetaxel 35 mg/m(2) and irinotecan 50 mg/m(2) given on days 1, 8, 15, and 21 of a 35-day schedule.

Filling a void: thyroid cancer surgery information on the internet.

Background: Thyroid cancer incidence is increasing, making it an important public health issue. Many patients use the Internet for health-related decisions. Our purposes were to measure the quality of thyroid cancer surgery information on the Internet, and to identify quality predictors.

Outdated and incomplete: a review of thyroid cancer on the World Wide Web.

Objective: To evaluate the most frequently searched thyroid cancer websites for completeness, accuracy, and consumer friendliness.

Design: The 50 most popular thyroid cancer websites were evaluated using a novel instrument developed by a Delphi panel of endocrine experts and based on practice guidelines. Each website received independent scores for disease-specific information and a final quality score.

Psychiatric and cognitive aspects of primary hyperparathyroidism.

Purpose Of Review: Clinical guidelines for the treatment of primary hyperparathyroidism have been established by the 2002 NIH workshop on asymptomatic primary hyperparathyroidism. The panel called for further study of the ill-defined psychiatric and cognitive changes often seen in patients with primary hyperparathyroidism. The present paper provides a rigorous, updated review of the most recent advances and studies that have measured health-related quality of life, neurocognitive and psychiatric changes, as well as neurophysiologic imaging in patients with primary hyperparathyroidism undergoing parathyroidectomy.

Total thyroidectomy for differentiated thyroid cancer.

There has been a long debate about the optimal surgical management of differentiated thyroid cancer. It has focused on the extent of thyroidectomy, with recommendations ranging from thyroid lobectomy to total thyroidectomy. There is no randomized prospective trial addressing this issue; such a trial would be prohibitive, since differentiated thyroid cancer has a good prognosis and a long natural history.

Prognosis of medullary thyroid carcinoma: demographic, clinical, and pathologic predictors of survival in 1252 cases.

Background: Medullary thyroid cancer (MTC) is a rare cancer. There is a relative paucity of data over the last decade with regard to the prognosis of these patients. Therefore, the authors used the population-based Surveillance, Epidemiology, and End Results (SEER) registry to update what to their knowledge is one of the largest series of patients with MTC reported to date.

Fine needle aspiration of poorly differentiated oxyphilic (Hürthle cell) thyroid carcinoma: a case report.

Background: Poorly differentiated oxyphilic (Hürthle cell) carcinomas are a more recently described variant of poorly differentiated thyroid carcinoma and are characterized by a prominent Hürthle cell component in a solid or trabecular arrangement. Clinically, poorly differentiated oxyphilic carcinomas behave more aggressively as compared to classic Hürthle cell carcinomas, which have a predominantly follicular pattern. Although the histology of these rare thyroid tumors has been reported in the literature, the cytologic features on fine needle aspiration biopsy have not been described before.

Papillary thyroid cancer.

In summary, PTC is common, although it rarely results in disease-specific mortality. It is being diagnosed increasingly in the subclinical phase as a result of enhanced ultrasound imaging and more aggressive surveillance of smaller thyroid nodules. US-guided FNA is the "gold-standard" for diagnosis.

Surgical perspectives in gastrointestinal disease: a study of quality of life outcomes in esophageal, pancreatic, colon, and rectal cancers.

Outcomes assessment in surgery traditionally has included data regarding peri-operative mortality and morbidity, as well as long-term survival and recurrence in surgical oncology. However, quality of life (QOL) is another important patient-related outcome measure. QOL data can be used to tailor treatment and improve clinical outcomes by detecting physical or psychological problems in patients that otherwise might be overlooked, but which have profound implications for the effective delivery of care.

Do not roll the videotape: effects of the health insurance portability and accountability act and the law on trauma videotaping practices.

Background: We hypothesized that trauma video practices would be affected as a result of Health Insurance Portability and Accountabilty Act (HIPAA) enactment.

Methods: A survey was distributed electronically to coordinators and/or directors of level 1 trauma centers. Centers were queried on demographics, trauma video use, and reasons for changes, if any, in their video practice patterns.

Parathyroidectomy improves neurocognitive deficits in patients with primary hyperparathyroidism.

Background: Clinical guidelines for the treatment of primary hyperparathyroidism (pHPT) often suggest parathyroidectomy, but generally fail to consider neurocognitive and psychiatric symptoms because of the relative paucity of evidence.

Methods: In this prospective study, patients with pHPT (PTX) and benign euthyroid thyroid disease (THY) referred for operation were evaluated pre- and postoperatively with validated psychometric and neurocognitive instruments to determine whether learning, memory, or concentration improved with after parathyroidectomy. Statistical comparisons between groups were performed with univariate analysis and repeated measures of analysis of variance.

A HIF1alpha regulatory loop links hypoxia and mitochondrial signals in pheochromocytomas.

Pheochromocytomas are neural crest-derived tumors that arise from inherited or sporadic mutations in at least six independent genes. The proteins encoded by these multiple genes regulate distinct functions. We show here a functional link between tumors with VHL mutations and those with disruption of the genes encoding for succinate dehydrogenase (SDH) subunits B (SDHB) and D (SDHD).

[Evaluation of different methods of utilization of sugars in Neisseria gonorrhoeae].

5 methods of utilization of sugars were evaluated in 25 strains previously identified as N. gonorrhoeae: CTA agar, modified CTA agar, gelatin starch agar, Mueller Hinton agar plus bromotimol blue and rapid method. 100% of the strains of N.

Current advances in the diagnosis and treatment of pancreatic endocrine tumors.

Purpose Of Review: A comprehensive literature review of more than 200 original manuscripts published in the last 18 months was conducted to summarize landmark studies performed on the molecular biology, diagnosis, imaging, and treatment of endocrine tumors of the pancreas.

Recent Findings: Recent achievements occurred on many fronts. Identification of a novel insulin splice variant with increased translation efficiency moved forward the understanding of the molecular biology of insulinomas.

Laparoscopic gastric bypass beyond age 60.

Background: Previous reports have questioned the safety and efficacy of gastric bypass in older patients. We examine our results in the older group of patients to shed some light on the appropriateness of offering gastric bypass to senior patients.

Methods: A retrospective review of a prospectively collected database on all laparoscopic Roux-en-Y gastric bypass (LRYGBP) cases performed from March 2001 to October 2003 was conducted.

Luteinizing hormone-releasing hormone fusion protein vaccines block estrous cycle activity in beef heifers.

Two LHRH fusion proteins, thioredoxin and ovalbumin, each containing seven LHRH inserts were tested for their ability to inhibit estrous cycle activity. The objective was to evaluate immune and biological responses from alternating the two fusion proteins in an immunization schedule. One hundred ten heifers were divided equally into 11 groups.

Surgical treatment of right coronary arteries with anomalous origin and slit ostium.

Background: Right coronary arteries arising in the left sinus or ectopically in the anterior coronary sinus with slit ostium course inside the aorta. They are subject to variable systolic compression and can cause myocardial ischemia with its sequelae or death.

Methods: From May 1991 to March 2003, we treated 16 patients with anomalous origin of the right coronary artery from the left sinus and 4 whose right coronary artery arose ectopically in the anterior sinus.

Assessment and management of patients with abnormal calcium.

Calcium is essential for homeostasis, and normocalcemia should be maintained strictly during the perioperative period. The biochemistry of calcium equilibrium results from the calcium-sensing receptors on the parathyroid glands, which detect changes in calcium concentrations and initiate the proper response. Asymptomatic hypercalcemia is a common metabolic derangement that is often discovered on routine serum screening.

Evaluation of four methods for detecting the beta-lactamase activity in Neisseria gonorrhoeae isolated in Cuba.

Four methods (chromogenic, acidimetric, inhibition, and iodometric) for demonstration of the beta-lactamase production by 70 isolates of Neisseria gonorrhoeae, were evaluated in Cuba. There was 100% correlation between all beta-lactamase methods and the standardized penicillin dilution susceptibility test for penicillinase-non-producing N. gonorrhoeae.

Clinical management of primary hyperparathyroidism and thresholds for surgical referral: a national study examining concordance between practice patterns and consensus panel recommendations.

Objective: To determine whether 1990 guidelines established by the National Institutes of Health (NIH) for the optimal management (surgical versus nonsurgical) of patients with asymptomatic primary hyperparathyroidism (PHPT) are known and followed by endocrinologists.

Methods: We surveyed endocrinologists in the United States who were randomly selected in 1998 from two endocrine societies. Endocrinologists were asked about management of asymptomatic patients with PHPT, awareness of NIH recommendations, practice demographics, and annual PHPT case volume.