ABSTRACT
No abstract available.
Subject(s)
Aged , Humans , Male , Adosterol , Adrenal Cortex/diagnostic imaging , Adrenal Cortex Neoplasms/pathology , Adrenalectomy/methods , Adrenocortical Adenoma/pathology , Aldosterone/blood , Blood Specimen Collection/methods , Hyperaldosteronism/diagnostic imaging , Radiopharmaceuticals , Tomography, X-Ray ComputedABSTRACT
Antecedentes: La cirugía de la glándula suprarrenal ha sido tradicionalmente acompañada de una elevada mortalidad, pero nuevas técnicas permiten realizarla en forma más segura. Objetivos: Analizar nuestra experiencia en el diagnóstico y tratamiento de los tumores suprarrenales. Lugar de Aplicación: Servicio de Cirugía General, Hospital Privado de Comunidad. Diseño: Estudio observacional retrospectivo. Población y Métodos: Hemos revisado en forma retrospectiva una serie de 53 pacientes (56 procedimientos quirúrgicos) sometidos a resecciones de tumores de glándula seprarrenal. En total se realizaron 57 seprarrenalectomías (5 bilaterales). Resultados y conclusiones: El tumor más frecuente fue el feocromocitoma. En 13 pacientes hallamos adenomas corticoles, de los cuales 8 fueron Sindromes de Conn. La edad promedio fue de 42 años y 31 fueron mujeres. El 60 por ciento de los enfermos pudieron ser seguidos entre 2 y 180 meses. La suma de RMN, TC y ecografía permitió localizar las lesiones en el 98 por ciento de los casos. La mortalidad de esta serie fue 0 por ciento y la morbilidad fue 9.4 por ciento. En 33 oportunidades se utilizó la vía anterior, en 16 cirugía mininvasiva (laparoscópica) y en 8 la vía lumbar posterior. La vía laparoscópica resulta más costo eficiente en días de internación comparada con las otras (P < 0.01)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Adrenal Gland Neoplasms/diagnosis , Adrenal Gland Neoplasms/surgery , Pheochromocytoma/surgery , Adosterol , Adrenal Cortex Neoplasms/diagnosis , Adrenocortical Carcinoma/diagnosis , Breast Neoplasms/pathology , Adrenocortical Hyperfunction/etiology , Hyperaldosteronism/etiology , Intraoperative Complications , Pheochromocytoma/diagnosis , Postoperative Complications , Retrospective Studies , Cushing Syndrome/etiologyABSTRACT
131I-6beta-iodomethyl-19-norcholesterol(NP-59) has an advantage to assess adrenal dysfunction caused by adrenal cortical disorders. The aim of this study is to evaluate the clinical usefulness of NP-59 scintigraphy in each adrenral disease. Ten patients who did eleven NP-59 adrenal scintigraphies at Dong-A University Hospital from March 1990 to December 1996 were selected as the subject. Among the subject there were 5 cases of Cushing's syndrome, 2 cases of incidentaloma, 1 case of metastatic adrenal tumor, liver cirrhosis with hirsutism and hypertension respectively. Among 5 case of Cushing's syndrome, there were 2 cases of Cushing's disease, 2 cases of adrenal adenoma and 1 case of adrenal carcinoma. There are no disagreement between clinical diagnosis and scan finding in Cushing's syndrome. In 2 incidentaloma cases, even though one is interpretated as a functioning tumor, both of 2 cases could avoid unnecessary biopsy according to scintigraphy result. One case of hirsutism, clinically adrenal originated, revealed the normal scintigraphic hirsutism was extra-adrenal origin. One case of hypertension took the study to exclude the possibility of primary aldosteronism. Normal suppression scan finding revealed that primary aldosteronism did not exist in this case. In conclusion, NP-59 scintigraphy was very useful in diagnosis and differential diagnosis of Cushing's syndrome and it could avoid unnecessary biopsy in the incidental adrenal tumor.
Subject(s)
Humans , Adenoma , Adosterol , Biopsy , Cholecystectomy, Laparoscopic , Cholecystography , Cushing Syndrome , Diagnosis , Diagnosis, Differential , Hirsutism , Hyperaldosteronism , Hypertension , Liver Cirrhosis , Radionuclide ImagingABSTRACT
Laparoscopic cholecystectomy can be performed safely in most patients with symptomatic cholelithiasis. Preoperative evaluation should assess the potential problems that affect the performance of laparoscopic cholecystectomy. Hepatobiliary scintigraphy or oral cholecystography can assess the gallbladder function and nonvisualization of gall bladder usually indicates acute or severe chronic cholecystitis. The purpose of this study was to evaluate the role of preoperative hepatobiliary scintigraphy or oral cholecystography in predicting the performance of laparoscopic cholecystectomy. The study group consists of 176 patients who underwent both hepatobiliary scintigraphy with Tc-99m DISIDA and oral cholecystography within one month before laparoscopic cholecystectomy. Nonvisualization of gallbladder was defined as persistent nonvisualization of gall- bladder until 4 hours on hepatobiliary scintigraphy or 12 hours on oral cholecystography. Among 176 patients, gallbladder was not visualized in 38 patients on hepatobiliary scintigraphy and 41 patients on oral cholecystography, Concordance rate between hepatobiliary scintigraphy and oral cholecystography was 89.2%. The conversion rate to open cholocystectomy was significantly higher in patients with nonvisualization of gallbladder than in patients with gallbladder visualization(15.8% vs 2.9% on hepatobiliary scintigraphy, 12.2% vs 3.7% on oral cholecystography: p<0.01 and p<0.05 respectively). The operative complication rate was also significantly higher in patients with nonvisualization of gallbladder (13.2% vs 2.9% on hepatobiliary scintigraphy, 14.6% vs 2.2% on. oral cholecystography : p<0.0l and p<0.001, respectively). Similarly, operation time was significantly prolonged in patients with nonvisualization of gall bladder (88.8+/-41.9min vs 62.5+/-23.6min on hepatobiliary scintigraphy : p<0.001, 89.4+/-41.3 min vs 61.8+/-22.8 min on oral cholecystography : p<0.001). It is concluded that nonvisualization of gallblader on hepato biliary scintigraphy or oral cholecystography is a valuable preoperative clincal risk factor in predicting increased conversion rate to open cholecystectomy, increased operative complication and prolonged operation time.