ABSTRACT
BACKGROUND: The management of incidentalomas with tumor size 3 cm and larger is still under controversial discussion. STUDY DESIGN: Clinical charts of 65 patients who underwent adrenalectomy for an incidentaloma were reviewed. RESULTS: Sixty-five patients were operated. There were 28 men and 37 women with a median age of 56.9 years. Median size of all resected lesions was 4.1 cm. Indications for surgery were tumor size equal and larger than 3 cm, recurrent pain, hormone status and patients' fear of malignancy. In 45 patients, the adenomas did not meet the defined criteria of malignancy. There were 9 cases of adrenal hyperplasia, and two cysts and two hematomas were found in 4 patients. Moreover, 1 schwannoma and 1 myelolipoma were removed. In 3 patients, a primary adrenocortical carcinoma of 3.4, 4.0, and 5.0 cm in diameter, respectively, was identified. In 1 patient, an adrenal cortical carcinoma of 10.0 cm in diameter was operated. In 1 patient, the status (size: 4.5 cm) could not be determined conclusively. CONCLUSION: Hormonal activity should be determined independent of the size, and lesions with hormonal activity should be resected; in the presence of hormonally inactive masses, removal of tumors of 3 cm and larger in size is recommended.
Subject(s)
Adrenal Gland Neoplasms/diagnosis , Adrenal Gland Neoplasms/surgery , Adrenalectomy , Incidental Findings , Adrenal Gland Neoplasms/metabolism , Adrenal Gland Neoplasms/pathology , Diagnostic Techniques, Endocrine , Female , Hormones/metabolism , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neoplasm Staging , Tomography, X-Ray Computed , UltrasonographyABSTRACT
BACKGROUND/AIM: The aim of the study was to characterize the hepatic injury (HI) of the nonischemic liver lobe after selective portal triad clamping and investigate the influence of pharmacological pretreatment with alpha-lipoic acid (LA). METHODS: Brown-Norway rats received 500 micromol LA injected via the inferior vena cava 15 min prior to the induction of 90 min of selective ischemia. Another group of rats received vehicle prior to ischemia. Both groups were compared with sham-operated animals. RESULTS: Lipid peroxidation (LPO) was increased in the ischemic as well as in the nonischemic liver tissue (NIL) in the untreated group. Levels of adenosine triphosphate and reduced glutathione content of the nonischemic liver lobe were decreased in the untreated group 1 h after reperfusion. Activity of caspases 3 and 8 was not detectable, whereas expression of the Bax protein was demonstrated in the NIL. We observed areas of necrotic hepatocytes and large gaps of sinusoids in the NIL of the untreated rats. LA attenuated LPO as well as Bax expression in the NIL. Moreover adenosine triphosphate and glutathione content of the NIL was increased 1 h after reperfusion by LA. LA pretreatment reduced release of alpha-glutathione-s-transferase in plasma. Histology of the nonischemic liver lobe did not markedly differ from sham-operated animals after LA pretreatment. CONCLUSION: HI of the NIL seems to be mediated by LPO and proapoptotic proteins such as Bax. Besides its described potential to reduce ischemia/reperfusion injury of the ischemic lobe, LA attenuates HI of the nonischemic tissue after selective portal triad clamping.
Subject(s)
Antioxidants/pharmacology , Ischemia/complications , Liver Diseases/prevention & control , Liver/drug effects , Thioctic Acid/pharmacology , Animals , Antioxidants/therapeutic use , Constriction , Disease Models, Animal , Lipid Peroxidation/drug effects , Liver/blood supply , Liver Diseases/etiology , Male , Rats , Reperfusion Injury/etiology , Reperfusion Injury/prevention & control , Thioctic Acid/therapeutic useABSTRACT
BACKGROUND: The authors evaluated the impact of laparoscopic adjustable gastric banding (LAGB) on obesity-associated diseases in a series at 3 to 8 years postoperatively, namely diabetes, pulmonary disease, hypertension and knee joint pain. METHODS: 145 morbidly obese patients underwent LAGB with mean age 38 years and preoperative BMI 48.5 kg/m2 (range 34-77). Changes in BMI and excess BMI loss (EBL) were evaluated. RESULTS: 138 of the 145 patients (95%) were available for full follow-up. At last follow-up, BMI had dropped to 34.0 +/- 6.4 SD kg/m2, and mean EBL was 61.9 +/- 26.1%. Prevalence of obesity-associated disease was significantly reduced: diabetes decreased from 10% to 4%, treatment-requiring pulmonary disease from 15% to 5%, hypertension from 43% to 27%, and knee pain from 47% to 38%. CONCLUSION: Following gastric banding, >75% of patients suffering from obesity-related disease had significant decrease or resolution of their co-morbidities.
