Abstract:
BACKGROUND:Surgical treatment of hereditary pheochromocytoma remains controversial because of the need for lifelong corticosteroid therapy and the risk of Addisonian crisis associated with bilateral total adrenalectomy. We examined our large series of patients with hereditary pheochromocytoma to evaluate postsurgical outcomes, particularly in those who underwent cortical-sparing adrenalectomy. STUDY DESIGN:We retrospectively reviewed the outcomes of all patients with histopathologic diagnoses of hereditary pheochromocytoma treated at our institution from 1962 to 2003. Familial disease was initially determined by pedigree analysis, genetic testing, or both for multiple endocrine neoplasia (MEN) types 1, 2A, or 2B; von Hippel-Lindau disease (VHL); neurofibromatosis type 1 (NF-1); or familial paraganglioma syndrome (FP). RESULTS:Adrenal pheochromocytomas were present in 56 of 59 patients (95%): MEN2A (39), MEN2B (7), VHL (6), MEN1 (2), NF-1 (2). Paragangliomas (extraadrenal pheochromocytomas) were present in the remaining 3 of 59 patients (5%): FP (2) and NF-1 (1). Thirty-eight of 56 patients with pheochromocytomas had cumulative operations resulting in total or subtotal bilateral adrenalectomy. Acute adrenal insufficiency (Addisonian crisis) occurred in 4 of these 38 patients (11%). Cortical-sparing adrenalectomy was performed in 26 patients who underwent bilateral adrenal resection; 17 (65%) were corticosteroid independent at a median followup of 71 months. Recurrent pheochromocytoma developed in an adrenal remnant in 3 of 30 patients (10%) who underwent unilateral or bilateral cortical-sparing procedures. Metastatic disease did not develop in any patient with pheochromocytoma, but has occurred in two of three patients with paragangliomas. CONCLUSIONS:Our data suggest that a cortical-sparing adrenalectomy can successfully avoid the need for corticosteroid replacement in the majority of patients who undergo a bilateral adrenalectomy. Long-term followup should include monitoring of the remnant gland for recurrent pheochromocytoma with yearly biochemical screening studies.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Yip L,Lee JE,Shapiro SE,Waguespack SG,Sherman SI,Hoff AO,Gagel RF,Arens JF,Evans DBdoi
10.1016/j.jamcollsurg.2003.12.001keywords:
subject
Has Abstractpub_date
2004-04-01 00:00:00pages
525-34; discussion 534-5issue
4eissn
1072-7515issn
1879-1190pii
S1072-7515(03)01382-6journal_volume
198pub_type
杂志文章abstract:BACKGROUND:The hazards of operative treatment for variceal hemorrhage and intractable ascites in patients with cirrhosis are well known. Much less information is available on the morbidity and mortality in these patients after abdominal operations not directly related to the sequelae of portal hypertension. STUDY DESI...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1994-10-01 00:00:00
abstract:BACKGROUND:Appendiceal cancer (AC) patients treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) often demonstrate an unpredictable variability in their survival outcomes. Biomarkers predictive of CRS/HIPEC efficacy could better guide treatment decisions. We hypothesized that v...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.12.012
更新日期:2016-04-01 00:00:00
abstract:BACKGROUND:Dysplastic oral leukoplakia (DOL) has been the index lesion in prevention trials for upper aerodigestive tract squamous cell carcinoma (SCC). Vitamin A derivatives, including 13-cis retinoic acid (13-CRA), have been used to treat DOL and to reduce the risk of subsequent SCC. Results from a trial of 13-CRA in...
journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s1072-7515(02)01219-x
更新日期:2002-08-01 00:00:00
abstract:BACKGROUND:Palliative surgery for advanced cancer patients involves complex decision making. Surgeons with a cancer-focused practice were surveyed to determine the extent to which palliative surgery was currently practiced, to identify ethical dilemmas and barriers they faced in performing palliative surgery, and to ev...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(02)01306-6
更新日期:2002-09-01 00:00:00
abstract:BACKGROUND:Neoadjuvant chemotherapy has been shown to increase the rate of breast conservation in clinical trials and small institutional series, but it has never been studied on a national level. STUDY DESIGN:We performed a retrospective review of the National Cancer Database (NCDB). The NCDB is a joint project of th...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.02.011
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND:Several factors may influence the degree of carbon dioxide (CO2) absorption during laparoscopy. Hypercapnia as a result of excessive CO2 absorption may have adverse clinical effects. STUDY DESIGN:To identify factors associated with increased CO2 absorption, we retrospectively calculated the CO2 elimination ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,评审
doi:
更新日期:1995-05-01 00:00:00
abstract:BACKGROUND:Minimally invasive radioguided parathyroidectomy (MIRP) combines technetium sestamibi scan, intraoperative gamma probe, methylene blue dye, and measurement of circulating parathyroid hormone (PTH) levels. STUDY DESIGN:All patients presented with biochemically proved primary hyperparathyroidism. A technetium...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(00)00297-0
更新日期:2000-07-01 00:00:00
abstract:BACKGROUND:Vascularized lymph node transfer (VLNT) is a surgical treatment for lymphedema. Multiple donor sites have been described and each has significant disadvantages. We propose the jejunal mesentery as a novel donor site for VLNT. STUDY DESIGN:We performed a cadaveric anatomic study analyzing jejunal lymph nodes...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2017.08.001
更新日期:2017-11-01 00:00:00
abstract:BACKGROUND:Trauma is the number one cause of maternal death during pregnancy, but incidence of fetal loss exceeds maternal loss by more than 3 to 1. We hypothesized that we could identify women at risk for injury during pregnancy and focus our prevention efforts. STUDY DESIGN:Women of childbearing age in the American ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2004.09.016
更新日期:2005-01-01 00:00:00
abstract:BACKGROUND:Near infrared autofluorescence (NIRAF) can guide intraoperative parathyroid gland (PG) identification. NIRAF detection devices typically rely on imaging and fiber probe-based approaches. Imaging modalities provide NIRAF pictures on adjacent display monitors, and fiber probe-based systems measure tissue NIRAF...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2019.09.003
更新日期:2019-12-01 00:00:00
abstract:BACKGROUND:Thyroid surgery is associated with low mortality and morbidity and often is performed in an ambulatory setting. The majority of patients undergoing thyroidectomy have an uncomplicated outcome, but common comorbidities may increase mortality and morbidity. Due to low complication rates, studies using single s...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2014.01.055
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:Neoadjuvant locoregional therapies (LRTs) have been widely used to reduce tumor burden or to downstage hepatocellular carcinoma (HCC) before orthotopic liver transplantation (OLT). We examined the impact of LRT response on HCC recurrence after OLT. STUDY DESIGN:We performed a retrospective study of 384 pati...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2017.03.015
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:The role of preoperative ERCP and endoscopic sphincterotomy (ES) in the diagnosis and treatment of suspected common bile duct stones (CBDS) in the laparoscopic age is controversial. The preoperative diagnosis of CBDS by ERCP and the removal of CBDS by ES are advantageous because of technical difficulties in ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,评审
doi:10.1016/s1072-7515(98)00241-5
更新日期:1998-12-01 00:00:00
abstract:BACKGROUND:The role of imaging studies before parathyroidectomy has been extensively debated and recent advances in unilateral parathyroidectomy intensify this controversy. The purpose of this study was to review the parathyroidectomy experience of a single surgeon, looking at the role of sestamibi scans and a standard...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(00)00258-1
更新日期:2000-05-01 00:00:00
abstract:BACKGROUND:Since 1968, there have been three published reports in the United States literature of 41, 118, and 145 consecutive patients undergoing pancreaticoduodenectomy without mortality. In all of these series, the pancreatic remnant was anastomosed to the jejunum. STUDY DESIGN:This study was designed to review 152...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/S1072-7515(03)00331-4
更新日期:2003-08-01 00:00:00
abstract:BACKGROUND:The most effective treatment for traumatic injuries is to prevent them from occurring. Currently, few surgeons receive any formal training in injury' control and prevention. This study was designed to test the knowledge of injury prevention principles among practicing surgeons, in order to identify areas in ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(01)01001-8
更新日期:2001-08-01 00:00:00
abstract:BACKGROUND:Inefficient operating room (OR) use wastes resources. Studies have suggested "first case on-time starts" (FCOTS) reduce OR "idle time," yet no direct association between FCOTS and markers of OR efficiency, like "last case on-time end" (LCOTE) or overtime costs, have been reported. We performed this study to ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2019.10.017
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Acute limb ischemia initiates a systemic inflammatory response, including pulmonary polymorphonuclear leukocyte (PMN) sequestration and acute lung injury. Lung injury is partly attributed to release by PMN's of extracellular matrix (ECM) modifying metalloproteinases (MMPs). We hypothesized that acute hindlim...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/S1072-7515(03)00134-0
更新日期:2003-05-01 00:00:00
abstract:BACKGROUND:Axillary nodal status is an important prognostic predictor in patients with breast cancer. This study evaluated the sensitivity and specificity of ultrasound-guided core biopsy (Ax US-CB) at detecting axillary nodal metastases in patients with primary breast cancer, thereby determining how often sentinel lym...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2011.09.024
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:The Tennessee Surgical Quality Collaborative analyzes NSQIP data from 21 participating hospitals. The Tennessee Surgical Quality Collaborative has reduced surgical complications, but causative factors are unclear. We sought to correlate surgical duration with complications to reveal mitigating strategies. S...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jamcollsurg.2014.12.040
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:Advanced Automatic Crash Notification algorithms use vehicle telemetry measurements to predict risk of serious motor vehicle crash injury. The objective of the study was to develop an Advanced Automatic Crash Notification algorithm to reduce response time, increase triage efficiency, and improve patient outc...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2016.03.028
更新日期:2016-06-01 00:00:00
abstract:BACKGROUND:Enteric drainage (ED) of pancreas allografts is an alternative to the bladder drainage (BD) technique and eliminates unique metabolic complications seen in the BD pancreas transplant recipients. Little longterm data has been reported in ED pancreas transplants. STUDY DESIGN:Of 53 patients who underwent panc...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,评审
doi:10.1016/s1072-7515(97)00110-5
更新日期:1997-12-01 00:00:00
abstract:BACKGROUND:Laparoscopic antireflux surgery has replaced conventional operation despite the fact that currently no randomized trials have been published regarding its cost effectiveness. The objective of the present study was to compare costs and some short-term outcomes of laparoscopic and open Nissen fundoplication. ...
journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s1072-7515(98)00328-7
更新日期:1999-04-01 00:00:00
abstract:BACKGROUND:Although a risk score estimating postoperative mortality for patients undergoing gastric bypass exists, there is none predicting postoperative morbidity. Our objective was to develop a validated risk calculator for 30-day postoperative morbidity of bariatric surgery patients. STUDY DESIGN:We used the Americ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2010.11.003
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND:The management of dysplasia arising in Barrett's esophagus is controversial. STUDY DESIGN:Twenty patients (group 1, prompt attitude) underwent operation as soon as high-grade dysplasia (HGD) was discovered (n = 8) or just after either the presence of HGD was confirmed (n = 9) or invasive carcinoma (IC) was ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/S1072-7515(03)00417-4
更新日期:2003-09-01 00:00:00
abstract:BACKGROUND:The aim of this study was to review a Level I trauma center's pattern of use of IVC filters over a 6-year period. STUDY DESIGN:During the years 1999 to 2004, 878 patients underwent placement of an IVC filter at our institution. We reviewed patient charts and collected data pertaining to patient demographics...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2007.05.026
更新日期:2007-10-01 00:00:00
abstract:BACKGROUND:Occult hypoperfusion (OH), or global hypoperfusion with normal vital signs, is a risk factor for poor outcomes in elderly trauma patients. We hypothesized that OH is associated with worse outcomes than shock in both young and elderly trauma patients. METHODS:We conducted a single-center cohort study of adul...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2019.12.011
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:Laparoscopic liver resection is a procedure in evolution. In the last decade it has evolved from a novel procedure to a standard part of the hepatic surgeon's armamentarium. Few data exist on the development of a laparoscopic resection program. STUDY DESIGN:With IRB approval, a retrospective review of 300 c...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2011.04.032
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:Male breast cancer accounts for < 1% of breast cancers. Sentinel lymph node (SLN) operation is commonly used in the evaluation of female breast cancer patients. The purpose of this study was to determine whether SLN operation is as feasible and accurate in male patients compared with female patients. STUDY ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2006.06.014
更新日期:2006-10-01 00:00:00
abstract:BACKGROUND:There has been a dramatic increase in the use of endovascular technology for treatment of abdominal aortic aneurysms (AAA), but practice patterns have not been well-evaluated. Hospital resource use and outcomes after elective endovascular abdominal aortic repair (EVAR) and open surgical repair were assessed ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2009.05.024
更新日期:2009-09-01 00:00:00