Abstract:
BACKGROUND:Tumors producing adrenocorticotropic hormone (ACTH) or corticotropin releasing hormone (CRH) often remain undiagnosed until severe Cushing's syndrome appears, and it may be difficult to distinguish from Cushing's syndrome due to pituitary tumors. Many patients suffer from disease spread, with metastases in the liver or other locations, and the main symptoms may be mineral disturbances, diabetes mellitus, or psychological symptoms from the severe hypercortisolism. Bilateral adrenalectomy may alleviate this situation, but is sometimes a troublesome procedure in these severely ill patients. METHODS:We have retrospectively investigated 8 patients with ectopic Cushing's syndrome who have undergone bilateral adrenalectomy at the University Hospital in Uppsala. In addition, another 5 patients who underwent bilateral adrenalectomy for other reasons (recurrent pituitary Mb Cushing or bilateral hyperplasia) were scrutinized for technical considerations. Indications, timing of surgery, and operative procedures were studied to identify signs that may support our approach to management in the future. RESULTS:Curative surgery was not possible in any of the cases with ectopic Cushing's syndrome. Of the 13 operated patients, handport-assisted laparoscopic adrenalectomy was successfully performed bilaterally in 5 patients and unilaterally in combination with contralateral open surgery in 1 patient; conventional open surgery was performed on 7 patients, 3 of which were conversions from intitial handport-assisted procedures. Non-fatal complications occurred in 4 out of 10 patients. CONCLUSIONS:We conclude that bilateral handport-assisted laparoscopic adrenalectomy is safe, and that all surgical techniques in these severely ill patients may be troublesome and technically demanding. Early surgical intervention may reduce the technical disadvantages. Moreover, bilateral adrenalectomy can substantially reduce the symptoms of Cushing's syndrome, although effects on mortality are not obvious.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Hellman P,Linder F,Hennings J,Hessman O,Eriksson B,Orlefors H,Akerström Gdoi
10.1007/s00268-005-0347-8keywords:
subject
Has Abstractpub_date
2006-05-01 00:00:00pages
909-16issue
5eissn
0364-2313issn
1432-2323journal_volume
30pub_type
杂志文章abstract:BACKGROUND:Parathyroid cancer is a rare endocrine tumor, and the prognostic factors for this cancer remain unclear. The standard therapy is en bloc resection of the primary tumor at the time of the initial operation. However, the clinical significance of prophylactic neck dissection (PND) in the management of parathyro...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-010-0618-x
更新日期:2010-11-01 00:00:00
abstract:BACKGROUND:The histone deacetylase (HDAC) inhibitors have emerged as the useful reagents that epigenetically modulate the expression of various genes. In the present study, the effects of HDAC inhibitors on the expression of inflammation-related genes and lung injury during sepsis were investigated. METHODS:Mice were ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-010-0493-5
更新日期:2010-07-01 00:00:00
abstract:BACKGROUND:There is a paucity of data on the presentation and surgical management of pheochromocytoma in developing nations, particularly in Africa. METHODS:This study was a retrospective review, which included all patients managed by the Groote Schuur Hospital/University of Cape Town Endocrine Surgery unit for pheoch...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-020-05420-6
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:The aim of this study was to evaluate the available resources for trauma care at health centers (HCs) and referral hospitals (RHs) in rural Cambodia and to examine whether the resources at HCs are allocated on the basis of actual need based on the referral distance and number of severely injured patients ref...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-008-9900-6
更新日期:2009-04-01 00:00:00
abstract:BACKGROUND:We reported phonatory recovery in the majority of 88 patients after recurrent laryngeal nerve (RLN) reconstruction. Here we analyzed factors that might influence the recovery, in a larger patient series. METHODS:At Kuma Hospital, 449 patients (354 females and 95 males) underwent RLN reconstruction with dire...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-016-3634-7
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:Open surgical cricopharyngeal myotomy(CM) is considered standard of care for Zenker's diverticulum(ZD). Trans-oral CM has been described using a rigid stapling device for two decades; however, this remains problematic for severely kyphotic patients. This problem can be overcome with flexible endoscopy utiliz...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-016-3442-0
更新日期:2016-06-01 00:00:00
abstract::Patients with early-stage non-small-cell lung cancer (NSCLC) should be treated with complete surgical resection whenever possible. Incomplete resections do not cure, and the optimal pulmonary resection is anatomic lobectomy. Limited resections (wedge resection and segmentectomy) are associated with a threefold increas...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
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更新日期:2001-02-01 00:00:00
abstract:BACKGROUND:Although multidetector-row computed tomography (MDCT) before biliary drainage is useful for the assessment of the resectability of perihilar cholangiocarcinoma (PHC), the impact of biliary drainage on MDCT images before surgical resection for PHC has been poorly studied, and its possible consequences for R0 ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-018-4654-2
更新日期:2018-11-01 00:00:00
abstract::The safe and permissible limits of hepatectomy in obstructive jaundice patients and the usefulness of preoperative portal embolization (PE) for increasing the limit for safe hepatectomy were examined. We classified 416 patients with hepatectomy performed over 9 years under the following headings: normal liver function...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-004-7128-7
更新日期:2004-05-01 00:00:00
abstract::The surgical treatment of 30 cases of vascular thoracic outlet syndrome (TOS) in 25 patients is presented. Patients included 17 women and 8 men with average age of 26.1 years. The causes of compression were cervical rib ( n = 16), soft tissue anomalies ( n = 12), and scar tissue after clavicle fracture ( n = 2). Ten s...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-003-6808-z
更新日期:2003-05-01 00:00:00
abstract::Percutaneous dilatational tracheostomy (PDT) is being increasingly used. Concerns have been raised as to its safety, especially when it is done at the bedside. A prospective evaluation was conducted of 100 consecutive, unselected critically ill patients with PDT. The mean intensive care unit (ICU) stay before PDT was ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s002680010180
更新日期:2000-09-01 00:00:00
abstract::During the three decades since the recognition of the Zollinger-Ellison syndrome (ZES), major progress has been made in the diagnosis and treatment of this disease. However, the many failed operations in patients with ZES, the existence of primary lymph node gastrinomas, and the surgical approach of patients with ZES ...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/BF01655107
更新日期:1993-07-01 00:00:00
abstract:BACKGROUND:Unrecognized reduction of blood supply to intestinal organs is associated with significant postoperative morbidity in abdominal surgery. The aim of this study was to determine whether--in the absence of hypovolemia--intestinal hypoperfusion as a result of blood flow redistribution occurs after abdominal surg...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-010-0560-y
更新日期:2010-09-01 00:00:00
abstract::Nuss described a minimally invasive technique for correcting pectus excavatum in children. A curved stainless-steel bar is inserted behind the sternum through the chest cavity with the convex surface face down, then rotated 180 degrees to elevate the sternum and correct the deformity. The procedure gained wide accepta...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-002-6519-x
更新日期:2002-10-01 00:00:00
abstract::This study aimed to investigate the effects and timing of local anesthesia during laparoscopic surgery in terms of postoperative pain, nausea, and the need for opioids and antiemetics. This prospective study was carried out on 142 patients who underwent laparoscopic cholecystectomy. Peroperative local anesthesia was n...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-004-7350-3
更新日期:2004-08-01 00:00:00
abstract::Incisional hernia is a serious postoperative complication of laparotomy. Selecting an appropriate suture material may lessen such morbidity. This study undertook a prospective, randomized comparison of early-absorbable polyglactin 910 suture versus late-absorbable polydioxanone loop suture for fascial closure after ab...
journal_title:World journal of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s002689910120
更新日期:2000-06-01 00:00:00
abstract::Quality of life is an important outcome measure following surgery for ulcerative colitis. Quality of life incorporates not only the physical or functional outcome; it also considers the emotional and social well-being of patients. Quality of life may be measured using disease-specific or generic quality of life measur...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s002689900400
更新日期:1998-04-01 00:00:00
abstract:BACKGROUND:Chagas disease is a serious public health issue in South and Central America due to its high prevalence, morbidity, and mortality. The esophageal form of the disease leads to achalasia and consequent megaesophagus. In advanced or recurrent cases of megaesophagus, there is no consensus for which of three esta...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-013-2445-3
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:Three decades of internal conflict in the North and East of Sri Lanka have taken a toll on the health care system in that area. METHODS:We proposed to quantify the current status of capacity to deliver emergency, anesthesia, and surgical interventions in the conflict affected areas of Sri Lanka. The World H...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-009-0254-5
更新日期:2010-03-01 00:00:00
abstract:BACKGROUND:Frailty is a customized marker of biological age that helps to gauge an individual's functional physiologic reserve and ability to react to stress and is associated with increased postoperative morbidity and mortality. In order to mitigate frailty preoperatively, the concept of prehabilitation has entered th...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s00268-020-05658-0
更新日期:2020-11-01 00:00:00
abstract:OBJECTIVE:Gastroesophageal reflux disease (GERD) symptoms are commonly reported in primary hyperparathyroidism (pHPT). Although a calcium-mediated cause-and-effect relationship has been suggested, it remains unknown if parathyroidectomy improves GERD symptoms. METHODS:Over a 22-month period, 1,175 (39%) of 3,000 conse...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-014-2876-5
更新日期:2015-03-01 00:00:00
abstract::A randomized, double-blind multicenter trial was performed to compare the safety and efficacy of a new low-molecular-weight heparin (LMWH) (LU 47311, Clivarine) and standard unfractionated heparin for the prophylaxis of postoperative venous thromboembolism. Altogether 1351 patients scheduled to undergo abdominal surge...
journal_title:World journal of surgery
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1007/s002689900185
更新日期:1997-01-01 00:00:00
abstract:BACKGROUND:Nipple-sparing mastectomy (NSM) has gained widespread popularity in recent years. Nonetheless, patient selection, technical consideration and oncological safety of its extension to breast cancer treatment remain uncertain. Few publications have reviewed the application of NSM in Asian populations. METHODS:W...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-017-4197-y
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:A PubMed search of the biomedical literature was carried out to systematically review the role of laparoscopy in colonic diverticular disease. All original reports comparing elective laparoscopic, hand-assisted, and open colon resection for diverticular disease of the colon, as well as original reports evalu...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s00268-012-1872-x
更新日期:2013-03-01 00:00:00
abstract::We have previously demonstrated that one dimensional (1D) proton (1H) magnetic resonance spectroscopy (MRS) can distinguish normal thyroid tissue from thyroid carcinoma using a spectral ratio of peak intensity at 1.7 ppm/0.9 ppm. Two dimensional (2D) 1H-MRS allows identification of specific molecules that have overlap...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s002689900128
更新日期:1996-09-01 00:00:00
abstract::Benign esophageal obstruction is virtually always responsive to dilation therapy. Dilation therapy should, therefore, be the initial approach. The introduction of the Savary-type dilating equipment and of balloon dilation systems are, or will become, standard practice. These systems will increasingly be preferred over...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/BF01658390
更新日期:1989-03-01 00:00:00
abstract:BACKGROUND:Intraoperative identification of the difficult-to-spot parathyroid gland is critical during surgery for thyroid and parathyroid disease. Recently, intrinsic fluorescence of the parathyroid gland was identified, and a new method was developed for intraoperative detection of the parathyroid with an original fl...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-017-3903-0
更新日期:2017-06-01 00:00:00
abstract::Incisional hernia repair without mesh mainly consists of tissue transfer to bridge or close the defect. Bridging includes rotational or free musculocutaneous flaps, rendering acceptable short-term results but a rather disappointing long-term outcome. Abdominal wall closure where there has been significant loss of doma...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s00268-005-7972-0
更新日期:2005-08-01 00:00:00
abstract:BACKGROUND:The quality of surgical performance depends on the technical skills of the surgical team as well as on non-technical skills, including teamwork. The present study evaluated the impact of familiarity among members of the surgical team on morbidity in patients undergoing elective open abdominal surgery. METHO...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-014-2680-2
更新日期:2014-12-01 00:00:00
abstract:INTRODUCTION:The follicular variant of papillary thyroid carcinoma (FVPTC) is the most common histologic subtype of papillary thyroid carcinoma (PTC). However, it is still controversial whether FVPTC should behave differently from classical PTC (CPTC). The present study aimed at evaluating any potential difference in c...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-005-0356-7
更新日期:2006-05-01 00:00:00