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1.
Management of recurrent and persistent metastatic lymph nodes in well‐differentiated thyroid cancer: A multifactorial decision‐making guide for the thyroid cancer care collaborative 下载免费PDF全文
Mark L. Urken MD Mira Milas MD Gregory W. Randolph MD Ralph Tufano MD Donald Bergman MD Victor Bernet MD Elise M. Brett MD James D. Brierley MD Rhoda Cobin MD Gerard Doherty MD Joshua Klopper MD Stephanie Lee MD PhD Josef Machac MD Jeffrey I. Mechanick MD Lisa A. Orloff MD Douglas Ross MD Robert C. Smallridge MD David J Terris MD Jason B Clain BS Michael Tuttle MD 《Head & neck》2015,37(4):605-614
2.
Do consensus indications for resection in branch duct intraductal papillary mucinous neoplasm predict malignancy? A study of 147 patients 总被引:6,自引:0,他引:6
Pelaez-Luna M Chari ST Smyrk TC Takahashi N Clain JE Levy MJ Pearson RK Petersen BT Topazian MD Vege SS Kendrick M Farnell MB 《The American journal of gastroenterology》2007,102(8):1759-1764
BACKGROUND AND AIMS: Recent consensus guidelines suggest that presence of > or =1 of the following is an indication for resection (IR) of branch duct intraductal papillary mucinous neoplasm (IPMN-Br): cyst-related symptoms, main pancreatic duct diameter > or =10 mm, cyst size > or =30 mm, intramural nodules, or cyst fluid cytology suspicious/positive for malignancy. Among a cohort of patients with IPMN-Br we determined if the consensus IR (CIR), presence of multifocal IPMN-Br, or growth of cyst size on follow-up predict malignancy. METHODS: We identified 147 patients with IPMN-Br of whom 66 underwent surgical resection at diagnosis and 81 were followed conservatively, of whom 11 were resected during follow-up. Clinical, imaging, histological, and cyst fluid characteristics from all 147 patients with IPMN-Br were obtained from clinical records and/or by contacting the patients. In all cases, presence of CIR at baseline and during follow-up (N = 66), presence of multifocal cysts (N = 57), and increase in cyst size (N = 38) were noted. RESULTS: Among the 77 resected IPMN-Brs, at initial evaluation 61 had at least one CIR and 16 had none. Malignancy was present in 9/61 (15%) with CIR and 0/16 without IR (P= 0.1). When presence of any one of the CIR was taken as an indicator of malignancy, the CIR had a sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 23%, 14%, and 100%, respectively. Prevalence of malignancy in those with single versus multifocal IPMN-Br was similar (13%vs 11%). No patient has developed malignancy after a median follow-up of 15 months. So far, none of the 38 patients with increase in cyst size on follow-up has developed malignancy related symptoms. CONCLUSIONS: Suggested consensus indications for resection identify all patients with malignancy; however, their specificity is low. In the short term it would be safe to follow patients without these features. 相似文献
3.
Val J. Lowe MD Fargol Booya MD J. G. Fletcher MD Mark Nathan MD Eric Jensen MD Brian Mullan MD Eric Rohren MD PhD Maurits J. Wiersema MD Enrique Vazquez-Sequeiros MD Joseph A. Murray MD Mark S. Allen MD Michael J. Levy MD Jonathan E. Clain MD 《Molecular imaging and biology》2005,7(6):422-430
Introduction Improvement in esophageal cancer staging is needed. Positron emission tomography (PET), computed tomography (CT), and endoscopic
ultrasound (EUS) in the staging of esophageal carcinoma were compared.
Methods PET, CT, and EUS were performed and interpreted prospectively in 75 patients with newly diagnosed esophageal cancer. Either
tissue confirmation or fine needle aspiration (FNA) was used as the gold standard of disease. Sensitivity and specificity
for tumor, nodal, and metastatic (TNM) disease for each test were determined. TNM categorizations from each test were used
to assign patients to subgroups corresponding to the three treatment plans that patients could theoretically receive, and
these were then compared.
Results Local tumor staging (T) was done correctly by CT and PET in 42% and by EUS in 71% of patients (P value > 0.14). The sensitivity and specificity for nodal involvement (N) by modality were 84% and 67% for CT, 86% and 67%
for EUS, and 82% and 60% for PET (P value > 0.38). The sensitivity and specificity for distant metastasis were 81% and 82% for CT, 73% and 86% for EUS, and 81%
and 91% for PET (P value > 0.25). Treatment assignment was done correctly by CT in 65%, by EUS in 75%, and by PET in 70% of patients (P value > 0.34).
Conclusions EUS had superior T staging ability over PET and CT in our study group. The tests showed similar performance in nodal staging
and there was a trend toward improved distant disease staging with CT or PET over EUS. Assignment to treatment groups in relation
to TNM staging tended to be better by EUS. Each test contributed unique patient staging information on an individual basis.
This work was presented in part at The Society of Nuclear Medicine Annual Meeting, Los Angeles, CA June 15–19, 2002. 相似文献
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G E Thomas A C Wicks D J Clain N Loon J Seggie B Bramstom 《The American journal of digestive diseases》1977,22(7):573-581
We have carried out a prospective survey of 28 primary liver carcinomas over one year. Hepatocellular carcinoma is the commonest malignancy seen in Rhodesian blacks, which results in a high index of suspicion and accounts for the 96.4% positive diagnosis before death in this study. The age distribution was evenly spread through adult life with no definite peak incidence. Some were young and without evidence of chronic liver disease, but many had the stigmata of established hepatic disease. This contrasts with the common assertion that in areas of high incidence for primary liver cancer those affected are mainly young and lack signs of chronic liver disease. The commonest presenting symptoms were abdominal pain and swelling and weight loss. Hepatomegaly, often tender and nodular, was present in all but one. The incidence of alpha-feto protein, 46.5%, is low compared with other countries where primary liver cancer is common. Hepatitis B antigen was absent in all 28, suggesting that there is no association between the persistence of the antigen and hepatocellular carcinoma in Rhodesia. Liver function tests, although abnormal, were never diagnostic of primary liver cancer. We have confirmed the association of high alcohol consumption and cirrhosis with hepatocellular carcinoma. 相似文献
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Huaiyu Yang Lara Sinicropi-Yao Sarah Chuzi Soo Jeong Youn Alisabet Clain Lee Baer Ying Chen Patrick J McGrath Maurizio Fava George I Papakostas 《Annals of general psychiatry》2010,9(1):10
Background
Relapse of major depressive disorder (MDD) is a common clinical problem. This study was designed to determine whether residual sleep disturbance (insomnia and hypersomnia) predict risk of relapse during the continuation and maintenance treatment of MDD. 相似文献10.
Robert J. Greenstein M.D. David J. Clain M.D. Eugene Straus M.D. Rosalyn S. Yalow Ph.D. 《The American journal of gastroenterology》1987,82(9):886-889
A patient with metastatic gastrinoma whose plasma gastrin ranged from 7.6 nmol X ml-1 at presentation to 18.9 nmol X ml-1 just before death 4 yr later has been studied. The presence of such high circulating levels facilitated study of the biological and immunological activities as well as the molecular forms of gastrin in plasma, ascitic fluid, urine and cerebrospinal fluid. The results indicate: 1) the 34 amino acid gastrin (G34) was the only molecular form detectable in the body fluids studied; 2) bioactivity of G34 is maintained despite passage across the renal endothelium and the blood brain barrier; 3) the blood brain barrier significantly limits diffusion of G34. 相似文献