Citations

AbstractAt the Mayo Clinic, 103 patients with primary malignant lymphoma of the thyroid have been diagnosed and treated through 1978. This study examines the clinical findings in the 57 new cases seen since the last review in 1966; pathology and survival are evaluated for the series as a whole, including the 46 patients reported previously. Age and sex patterns were unchanged since the earlier review; thyroid lymphoma tended to occur in middle‐ to older‐aged women, and patients typically presented with a fairly rapidly enlarging, painless, and firm thyroid mass. The most common histologic subtype of lymphoma encountered was diffuse large cell (diffuse histiocytic). Hashimoto's disease was found in 36% of the pathologic specimens available for review. Follow‐up was completed for all patients up to 1979. Age, sex, and histologic subtype of tumor did not appear to be significant determinants of prognosis. Patients in whom the lymphoma was confined to the thyroid (intrathyroidal type) had a better overall 5‐year survival rate (86%) than those in whom tumor invaded soft tissues surrounding the hyroid or involved regional cervical nodes (38% for the extrathyroidal type). Almost all of the patients who had intrathyroidal tumors underwent surgical resection before irradiation. However, 3 of the 5 patients in this group who were treated by radiotherapy alone survived more than 5 years. There were approximately equal numbers of patients with the extrathyroidal type of lymphoma who were treated either by radiotherapy combined with surgical resection or by radiotherapy alone. The one form of therapy was just as effective as the other.

AbstractIdentification of multiple clinical and pathologic prognostic factors in differentiated thyroid cancer has permitted some degree of risk stratification. However, these clinical indices fail to distinguish potential intrinsic differences in tumor virulence. The nm23 gene has been identified as a potential metastasis suppressor gene that is homologous to nucleoside diphosphate kinases. Studies in human breast cancer have shown a significant inverse correlation between nm23 levels and nodal involvement/tumor recurrence. Given the possible clinical utility of a marker of metastatic potential in the management of thyroid carcinoma, we examined 34 thyroid neoplasms and a human medullary thyroid cancer (MTC) cell line (TT) for nm23 expression. Normalized nm23 expression was assessed by Northern analysis of tumor RNA. nm23 Expression (tumor expression/TT cell expression, mean ±SE) was 1.14 ±0.15* in MTCs (n =5), 0.70 ±0.10* in follicular cancers (n=6), 0.51 ±0.11 in papillary cancers (n=19), and 0.31 ±0.03 in follicular adenomas (n=4) (*p< 0.05 when compared to adenomas). Within histologicgroups, we found no correlation between nm23 expression and nodal involvement or distant métastases. Our results indicate that thyroid neoplasms of different histologies express varying levels of the nm23 transcript. Although nm23 expression seems diminished in metastatic breast cancer, it appears not to be the case in metastatic thyroid cancer. The nm23 gene may therefore have different roles in the evolution and metastases of different neoplasms.

AbstractPotentially curative surgery for cancer of the rectum and rectosigmoid is associated with frequent recurrence of the tumor in the pelvis. Data suggest that perioperative radiation therapy can considerably reduce the local failure rate. Pathological risk factors for local recurrence are described. Preoperative and postoperative adjuvant radiation therapy both appear to be effective. Postoperative radiation allows more accurate case selection based on operative findings and pathological staging. Patients with transmural tumor penetration and/or lymph node metastases appear to benefit from adjuvant radiation.

AbstractThe EEA stapler is a convenient, well‐designed, and reliable instrument. It will anastomose the bowel with reliability and speed at least equivalent to hand‐sewn techniques, and probably offers a technical advantage in performing very low rectal anastomoses. Unfortunately, intraoperative misadventures are greater with this device than with hand‐sewn techniques, and its use would seem best restricted to those situations in which it has its greatest advantage. Postoperative complications are not increased by its use, but the long‐term incidence of anastomotic stricture and possibly increased rate of local recurrence need to be clarified.

AbstractThe use of craniofacial surgical techniques has stimulated the development of new approaches to the excision of skull base tumors. Experience gained from operating on 200 skull base tumors (45 nonmalignant and 155 malignant) is presented. The cranial base area is subdivided into specific areas, and surgical approaches have been devised. In addition, the use of vascularized tissue such as the galea, temporalis fascia, temporalis muscle, or free vascularized tissue transfer has prevented the complication of infection so frequently seen as a cause for morbidity and mortality in the past.In this series, there were no major infections. The variety of pathology seen in this area is considerable. Therefore, in a series such as this operated on by a single surgeon, only trends can be observed. We suggest that with experience, surgery in this area is safe, and the long‐term survival of this mixture of tumors (primary, recurrent, carcinomas, and sarcomas) is between 40% and 50%, and, therefore, makes excisional procedures worthwhile.

AbstractThree‐dimensional display of medical image data has under gone rapid development since its introduction. This article explores the current state‐of‐the‐art of 3‐dimensional imaging applied to surgery planning and discusses the various image acquisition sources: computed tomography (CT), cine CT, magnetic resonance imaging, and ultrasound. Since increased physician involvement is the goal of the surgery planning software described, the future directions discussed emphasize the inclusion of “expert“ knowledge and ways to facilitate realistic interaction for surgery simulation.