ISSN:8756-0437    

DOI:10.1002/ssu.2980060202

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractAdenomas of the adrenal cortex which produce aldosterone (APA) are among the surgically correctible causes of hypertension accounting for 0.5 to 1.0% of all hypertensive etiologies. The adenomas have a 5:1 predilection for women and generally present with hypertension or profound hypokalemia. A low plasma renin activity completes the triad for primary hyperaldosteronism which could be caused by adrenocortical cancer, a neoplasm with an average diameter of 12 cm, or idiopathic hyperaldosteronism (IHA), a bilateral hyperplasia of the zona glomerulosa of the adrenal cortex which responds poorly to surgical resection. The adenomas are small (2 cm) but can be localized by imaging or selective venous sampling. Resection has a high success rate with minimal morbidity.

ISSN:8756-0437    

DOI:10.1002/ssu.2980060203

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractSince the demonstration in 1941 by Huggins and Hodges that prostatic cancers are androgen dependent, hormonal treatment by androgen ablation has been the principal treatment for patients with advanced adenocarci‐noma of the prostate. Although not able to permanently and totally eradicate every cancer cell since prostate cancer cells are quite heterogeneous in their sensitivity to androgens, hormonal therapy can produce dramatic subjective improvement as well as objective remissions. This results in an improved quality of survival and for patients with metastatic adenocarci‐noma, endocrine therapy does reduce the death rate from cancer, and if death from other concurrent illness is controlled, there is an absolute increase in survival. At present, a variety of strategies are available for ablation of testicular and adrenal androgens, but results are not clinically significantly better than orchiect

ISSN:8756-0437    

DOI:10.1002/ssu.2980060204

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractSequential administration of endocrine therapies can result in objective remission in a significant fraction of patients with metastatic breast cancer. Combined hormonal therapies and combined hormonochemothera‐pies have not resulted in better results than the sequential administration of these same therapies. Tamoxifen (an antiestrogen) given as an initial therapy results in local control of the disease in a significant fraction of patients with locally advanced breast cancer who are not candidates for cytotoxic therapy. Tamoxifen as an adjuvant therapy for operable breast cancer prolongs disease‐free survival and reduces mortality in patients>50 yr of age with higher estrogen receptor concentrationsThe role of tamoxifen as adjuvant therapy for patients<50 yr of age remains unclear. Also, adjuvant tamoxifen in combination with cytotoxic drugs has not produced superior results, and the duration of adjuvant tamoxifen therapy remains to be determined. Experimental data suggest prolonged administration of tamoxifen may be needed to control microme‐tas

ISSN:8756-0437    

DOI:10.1002/ssu.2980060205

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractHormonally active gynecologic tumors include gestational trophoblastic disease (GTD) and some of the primary ovarian tumors. The presenting symptoms in patients with these tumors are frequently related to their endocrine activity. The main hormone produced by gestational tropho‐blastic disease is human chorionic gonadotropin (HCG) and the main symptoms are those associated with a normal pregnancy, except they are frequently exaggerated. The endocrinally active ovarian tumors are mainly those of the sex—cord stromal group and these may produce any of the sex steroids (estrogens, androgens, or progestins). Some germ cell tumors of the ovary are hormonally active because they contain syncytio‐trophoblastic cells which produce HCG. There are two specialized types of mature teratomas that are discussed: struma ovarii, which produce thyroid hormones, and carcinoids, which produce sero

ISSN:8756-0437    

DOI:10.1002/ssu.2980060206

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractThe Zollinger‐Ellison syndrome with its main symptom of massive gastric hypersecretion presents problems with both the medical and surgical approaches to treatment. Successful medical treatment depends on a lifelong commitment to rigid medication schedules requiring careful ongoing supervision and is subject to pitfalls of compliance, drug side effects, drug resistance, and complications of persistent tumor growth. Surgical therapy carries risks of operative mortality and complications. If a low operative mortality can be maintained and the nutritional results after total gastrectomy are good, then it is the authors' opinion that the permanent relief from dangers of hypersecretion afforded by total gastrectomy makes surgery a worthwhile approach. Based on our operative experience in 34 patients and interpretation of the experience of others, we believe that resection of all tumor that can be resected, combined with total gastrectomy, is safe and dependable. The results compare well with those of long‐term medical managem

ISSN:8756-0437    

DOI:10.1002/ssu.2980060207

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractAlthough neoplasms that produce gut regulatory peptides and amines can be found throughout the gastroenteropancreatic axis (excluding carci‐noids), the vast majority of these lesions are found within the pancreas. Recognition of the various clinical syndromes produced by the secretions of these tumors, the development of sensitive and specific radioimmu‐noassays for the elaborated peptides, and development of more effective localization techniques have contributed to earlier diagnosis and marked improvement in patient care. Treatment is directed toward medical management to correct the metabolic disturbances produced by the excessive amounts of gut regulatory peptides, followed by localization and extirpation of tumor. In the presence of unresectable tumor or metastases, palliative treatment directed at reducing peptide secretion or preventing its effects by surgery, chemotherapy, hormonal therapy, and hepatic‐artery embolization can produce long‐term remission of symptoms. Because the majority of these tumors are malignant, the ultimate goal in successful patient management is the early detection and surgical excision of the islet cell tumor before metastase

ISSN:8756-0437    

DOI:10.1002/ssu.2980060208

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractA review of the evaluation, treatment, and end results for 52 patients with thymoma treated at The University of Texas M.D. Anderson Cancer Center (1950‐1984) is presented. The objective of the study was to examine the influence of a number of clinical characteristics on survival, including histologic and staging classifications, associated diseases, symptom status, and treatment. Forty‐nine patients (94%) underwent surgical exploration; 13 were stage I, 12 were stage 11, and 24 were stage 111. Complete resection was accomplished in all of the stage I and I1 groups and in 6 of the stage I11 patients. An asymptomatic history, surgical stage I disease, lymphocytic thymoma cell type, and complete resection favorably influenced prognosis. The cumulative 5‐year survival rate for all patients was 40%. No patient with stage I thymoma had recurrent disease, however, there were 9 recurrences (50%) in the completely resected stage II/III patients, six of whom remained disease‐free following treatment with radiotherapy, chemotherapy, or a combined a

ISSN:8756-0437    

DOI:10.1002/ssu.2980060209

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractAutotransplantation of the parathyroid glands is a clinically useful modality for the management of patients with certain forms of hyperparathyroidism. In conjunction with total parathyroidectomy, this procedure has been used to treat patients with primary and secondary hyperparathyroidism who have generalized parathyroid hyperplasia. Parathyroid autotrans plantation is also an important adjunct to the management of patients undergoing radical thyroid or laryngeal surgery to prevent permanent hypoparathyroidism from devascularization of all in situ parathyroid tissue. The technique of parathyroid cryopreservation has been well established and provides surgeons with greater flexibility in the approach to patients undergoing reoperative parathyroid surgery in whom there is uncertainty about the functional status of the remaining parathyroid tissue. Parathy‐ roid allotransplantation has been successfully performed in immunosuppressed patients but is rarely indicated. Parathyroid autografts can be placed heterotopically in a forearm muscle or in the sternocleidomastoid, but the former site is preferred in patients with hyperplastic or adenomatous tissue. This technique results in a low incidence of permanent hypoparathyroidism after radical parathyroidectomy, and recurrent hypercalcemia can be easily managed by local excision of a portion of the grafted tissu

ISSN:8756-0437    

DOI:10.1002/ssu.2980060210

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY

摘要:

AbstractThe biological validation of islet grafts would free total pancreas resection from the onus of severe diabetes mellitus. Islet cell transplants can reverse diabetes mellitus and prevent complications in animal models. Immune rejection has foiled attempts at human transplantation despite moderate success with whole pancreas grafts. Aggressive rejection of islet grafts has been extensively studied in animal models and seems no different in substance from standard cell‐mediated rejection but vastly different in tenacity. Rejection cannot be prevented by immunosuppression strategies effective for transplantation of heart, kidney, or liver. New strategies to circumvent islet rejection include encapsulation of the islets to obfuscate immune recognition, pretreatment of the islets in vitro to reduce immunogenicity, donor manipulation to provide specific tolerance, and combination strategies. In the development of these strategies, much has been learned or confirmed about the nature of immune rejection, and another round of human trials can be anticipate

ISSN:8756-0437    

DOI:10.1002/ssu.2980060211

出版商:John Wiley&Sons, Inc.    

年代:1990

数据来源: WILEY