Adrenalectomy has become the standard of care for the management of hormonally active adrenal masses. Various surgical therapies
have been proposed to excise completely or destroy these adrenal lesions, which may be benign or malignant. New minimally
invasive, adrenal-sparing procedures have recently been introduced, among them laparoscopic partial adrenalectomy, cryosurgery,
and radiofrequency ablation. These procedures focus on reducing patient morbidity and hastening postoperative recovery while
preserving normal adrenal tissue. However, questions remain about the risks and benefits associated with routine application
of minimally invasive therapies for adrenal-sparing surgery in terms of complete tumor extirpation. Clearly, more experience
and longer follow-up is necessary to validate these procedures. Herein we describe the surgical techniques and early results
of treatment with adrenal-sparing surgery. 相似文献
METHODS: Out of 105 patients with tuberous sclerosis (TS) admitted to the Hospital Nacional de Pediatría "Juan P. Garrahan" (Buenos Aires, Argentina), we surgically treated 17 children between January 1988 and December 2000. Two patients were operated on because of epilepsy and 15 patients because of an intraventricular tumor (subependymal giant cell astrocytoma [SGCA]). In this report we focus on tumors. Twelve of the 15 patients presented with hydrocephalus but none of them had a preoperative shunt. All tumors were surgically resected using frontal transventricular or transcallosal routes. Total removal was achieved in 12 out of 15 and subtotal removal in 3 out of 15 patients (resection of 70-95%). RESULTS: Exeresis of the tumor was not accompanied by significant morbidity and there was no perioperative mortality. Seizures and mental retardation did not improve after tumor resection. It was necessary to insert a postoperative shunt a long time after surgery in only one patient. There were no recurrences of SGCA that were totally removed after a mean follow-up of 51.7 months. CONCLUSIONS: We encourage surgery as soon as a lesion is diagnosed as a tumor. The "transformation" of subependymal nodules (SEN) into tumors (SGCA) may be considered controversial. 相似文献
David A. Wheeler, MD; Eduardo G. Arathoon, MD; Michael Pitts, MBBS; Rolando A. Cedillos, MD; T. Efrain Bu, MD; Guillermo D. Porras, MD; Gisela Herrera, MD; Nestor R. Sosa, MD
JAMA. 2001;286:853-860.
Central America is an area with a growing human immunodeficiencyvirus (HIV) epidemic, but with marked limitations in its healthcare infrastructure. Estimated adult HIV infection rates rangefrom 0.20% in Nicaragua to 2.01% in Belize. Hospitals and clinicianswith experience in HIV care exist mainly, if not only, in capitalcities and principal economic centers. Nationally sponsoredsocial security systems in each country consistently offer awider range of services than do ministry of health systems.Estimated access to the social security system ranges from 0%in Belize and 10% of the population in Honduras to 95% in CostaRica. Combination antiretroviral therapy is not available throughthe ministries of health and zidovudine is only sporadicallyavailable for prevention of perinatal transmission. Combinationtherapy is available through the social security system in thecountries of Guatemala, Panama, and Costa Rica only. A widevariety of antiretroviral agents are available through privatepharmacies in all countries except Belize. With the exceptionof Costa Ricans, most people with HIV infection in Central Americahave limited access to HIV-specific health services and limitedor no access to antiretroviral agents.
The topical anti-inflammatory activity of Thymus willdenowii Boiss (Labiatae) leaves, a herbal drug used in Moroccan folk medicine, has been studied using the croton oil ear test in mice. A bioassay-oriented fractionation procedure showed that the activity concentrates in the chloroform extract, which has a potency similar to that of indometacin, the non-steroidal anti-inflammatory drug used as reference (ID50 (dose giving 50% oedema inhibition) = 83 microg cm(-2) and 93 microg cm(-2), respectively). The main compounds responsible for the anti-inflammatory activity of T. willdenowii are ursolic acid and oleanolic acid. The flavonoids luteolin-3'-O-glucuronide and eriodictyol-7-O-glucoside were found for the first time in the genus Thymus. 相似文献
BACKGROUND AND OBJECTIVES: Adrenalectomy is indicated for patients with large adrenal lesions or functional tumors. Cryoablation is currently used as a surgical alternative for the treatment of prostate, lung, brain, pharynx, and liver tumors. The purpose of this study was to determine if cryosurgery could be delivered to small areas in the adrenal gland in a controllable and reproducible manner, so that tissue could heal in a nonpathological way. MATERIALS AND METHODS: Fourteen female mongrel dogs underwent acute (N = 8) or chronic (4 weeks) (N = 6) cryoablation using the Cryounit. In the acute study, using an open transabdominal approach, a 2-mm cryoprobe was placed interstitially into the adrenal tissue, while 0.032-inch thermocouples were cannulated into the ipsilateral adrenal artery and vein. Adrenal parenchymal temperature changes were measured using thermocouples placed at 0.4- and 0.8-cm intervals from the cryoprobe. In the chronic study, cryoablation was achieved by transperitoneal laparoscopic access using standard laparoscopic technique. RESULTS: Interstitial cryoprobe temperatures decreased from 33.1 +/- 1.9 degrees C to -148 +/- 1.2 degrees C following 15 minutes of freezing in the acute study. Cryoablation of adrenal tissue achieved temperatures of -41.8 +/- 5.7 degrees C and -21.8 +/- 1 degrees C at distances of 0.4 and 0.8 cm from the cryoprobe, respectively. There were no significant changes in adrenal artery or vein temperatures during cryoablation. Histologically, there was a clear demarcation between viable and nonviable tissue, the latter being characterized by areas of multifocal hemorrhage and pyknosis. After 4 weeks of healing, there was a well-defined line between necrotic and viable tissue. CONCLUSION: Cryoablation of the adrenal gland can be obtained in an effective, controllable, and reproducible manner. This controllable energy form may provide new modality for tissue destruction where adrenal gland preservation is necessary and can be delivered by the laparoscopic approach. Understanding the effect of adrenal cryoablation may allow us to treat selected patients with small tumors in whom organ preservation is necessary. 相似文献
Melanosis Coli (MC) is a benign pigmentation disorder of the colon occasionally diagnosed at endoscopy. The authors report a case of M. coli in a patient with a gunshot to the abdomen, in whom the entity produced an interesting clinical picture, and a review of the literature on this condition. 相似文献
IntroductionIbuprofen is a non-steroidal anti-inflammatory drug frequently used in children for fever and pain. It is usually considered to be safe and of low risk at low doses and short-term use.Patients and methodsThe aim of our study was to review the cases of gastrointestinal bleeding and assessment of gastrointestinal bleeding after recommended doses of ibuprofen.ResultsWe describe 9 previously healthy patients with upper gastrointestinal bleeding after receiving weight-related doses of ibuprofen for fever. 相似文献
We describe a total arthroplasty of the hip in a 40-year-old male patient with haemophilia A and a high-titre inhibitor to factor VIII, treated with rFVIIa. The patient received sequential therapy first as bolus in the early postoperative phase in order to obtain appropriate haemostasis and then as continuous infusion with lower doses to avoid frequent episodes of bleeding without a higher consumption of product. After an initial dose of 150 micro g kg-1 for the first five days after surgery, we used bolus doses of 120-90 micro g kg-1 every 2.5-3 h, achieving plasma FVII:C levels above 40 U mL-1. We then continued with continuous infusion at decreasing doses 15-7 micro g kg-1 h-1 for 12 days (FVII:C 19-7 U mL-1). There were no bleeding complications nor signs of clotting activity. The rehabilitation programme was continued without prophylactic treatment. The total consumption of rFVIIa was 6.3 mg kg-1, implying a saving of at least 30% of the product with respect to previous publications. 相似文献