Objective To analyze the clinical characteristics of nonfunctioning pheochromocytoma, and to evaluate the efficacy of 131I-metaiodobenzylguanidine (MIBG) scan in the diagnosis and perioperative treatment of nonfunctio...Objective To analyze the clinical characteristics of nonfunctioning pheochromocytoma, and to evaluate the efficacy of 131I-metaiodobenzylguanidine (MIBG) scan in the diagnosis and perioperative treatment of nonfunctioning pheochromocy- toma. Methods The clinical data of 14 patients with nonfunctioning pheochromocytoma were analyzed retrospectively. Plasma free corticoid, renin, aldosterone, and urine catecholamines levels were estimated. B-mode ultrasonography, computed tomo- graphy scan, thoracic X-ray and 131I-MIBG were used. Results All patients with nonfunctioning pheochromocytoma had no hypertension and the tumors were found inciden- tally. The 24 hours urine catecholamines levels in 80% (8/10) patients were normal. The positive rate of 131I-MIBG was 80% (8/10) and the specificity was 100%. All patients underwent surgical operation of tumor resection. No preoperative volume expansion was given to all patients. All tumors were resected completely, and no death accident happened. There was no recurrence and metastasis after operation by long-term follow-up. Conclusion 131I-MIBG scan is the first choice technique for the diagnosis of nonfunctioning pheochromocytoma. Blood volume expansion is unnecessary before resection of pheochromocytoma.no recurrence and metastasis})展开更多
Objective To investigate the expression of cyclooxygenase-2 （ Cox-2 ） and microvessel density （MVD） in benign and malignant pheochromocytomas, and the relationship between Cox-2 and MVD. Methods Specimens and clin...Objective To investigate the expression of cyclooxygenase-2 （ Cox-2 ） and microvessel density （MVD） in benign and malignant pheochromocytomas, and the relationship between Cox-2 and MVD. Methods Specimens and clinical data from 38 patients （ 21 benign and 17 malignant pheochromocytomas ） were studied. Slides of normal adrenal glands in nephrectomy specimens from another 20 patients with benign renal tumors were used as control. Irnmunohistochemical technology was performed to detect the Cox-2 and MVD in all specimens. Results Expression of Cox-2 was observed in 5 of the 21 benign pheochromocytomas （23. 8% ） , and in 14 of the 17 malignant （82.4%）. No expression of Cox-2 was observed in control slides. There were significant differences of Cox-2 expression between benign and malignant pheochromocytomas, as well as between malignant pheochromocytomas and control （ P 〈0. 05）. Expressions of MVD were 36. 41 ±13. 00, 21.43 ±8. 05, and 13. 36 ±4.34 in malignant, benign pheochromocytomas, and in control, respectively. Conclusion Cox-2 may contribute to the invasive characteristics of malignant pheochromocytomas and be used as a marker to distinguish malignant from benign pheochromocytomas. Expression of MVD in malignant pheochromocytomas was directly correlated with Cox-2.展开更多
Nonfunctional pheochromocytoma is a particular type of pheochromocytoma without typical clinical features of catecholaminism. It is difficult to diagnose or differentially diagnose. This type of pheochromocytoma is ra...Nonfunctional pheochromocytoma is a particular type of pheochromocytoma without typical clinical features of catecholaminism. It is difficult to diagnose or differentially diagnose. This type of pheochromocytoma is rarely reported in the literature. From January 1, 1990 to June 1, 2004, we performed operations for 197 patients with pheochromocytomas, including 26 patients with nonfunctional pheochromocytoma. We analyzed the clinical data of the 26 patients.展开更多
BACKGROUND Phaeochromocytoma and paragangliomas(PPGL)are rare neuroendocrine tumors usually caused by parasympathetic or sympathetic nerves,with an overall incidence of approximately 0.66 cases per 100000 people per y...BACKGROUND Phaeochromocytoma and paragangliomas(PPGL)are rare neuroendocrine tumors usually caused by parasympathetic or sympathetic nerves,with an overall incidence of approximately 0.66 cases per 100000 people per year.Most PPGLs are asymptomatic,and a few develop symptoms,such as elevated blood pressure and rapid heart rate,because of the release of catecholamines.According to the literature,surgical resection is the mainstay of PPGL treatment.However,the choice between minimally invasive surgery and open surgery remains controversial,particularly in cases involving complex anatomical relationships.We successfully resected a tumor located between the inferior vena cava and abdominal aorta using a minimally invasive approach with the assistance of computed tomography(CT)angiography and three-dimensional reconstruction,resulting in a favorable outcome.CASE SUMMARY A 56-year-old woman was admitted to the hospital with right upper abdominal discomfort for more than 6 months,experiencing occasional pins and needles sensation and radiation from the right shoulder and back.Prehospital CT of the upper abdomen revealed a retroperitoneal mass suspected to be a retroperitoneal ganglioneuroma.Surgery was recommended,and an enhanced CT scan of the upper abdomen,along with preoperative three-dimensional reconstruction,was performed after admission.The imaging indicated that the mass,measuring approximately 4.1 cm×3.8 cm×4.8 cm,was situated between the abdominal aorta and the inferior vena cava,extending downward to the level of the left renal vein.After ruling out any contraindications to surgery,a minimally invasive laparoscopy was performed to excise the mass precisely.The surgery was successful without any postoperative complications,and the 2-month follow-up revealed no abnormal signs of recurrence.CONCLUSION This case report describes successful and precise laparoscopic resection of a retroperitoneal tumor.The patient recovered well during the 2-month follow-up,and postoperative pathology revealed a paraganglioma.展开更多
BACKGROUND Pheochromocytoma(PHEO)is a type of tumor that originates from chromaffin cells in the adrenal medulla and is classified as an adrenal paraganglioma.PHEOs can secrete catecholamines,leading to a variety of s...BACKGROUND Pheochromocytoma(PHEO)is a type of tumor that originates from chromaffin cells in the adrenal medulla and is classified as an adrenal paraganglioma.PHEOs can secrete catecholamines,leading to a variety of symptoms.Accurate diagnosis and appropriate treatment selection are crucial for favorable outcomes in these cases.CASE SUMMARY The patient presented with unexplained chest tightness,palpitations,and pink sputum.Upon examination and analysis of laboratory results,a diagnosis of adrenal PHEO was established.The PHEO secreted high levels of catecholamines,causing sudden fluctuations in blood pressure and heart rate,leading to extre-mely unstable hemodynamics.Treatment with extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation helped stabilize the patient’s vital signs,allowing for timely surgical intervention.CONCLUSION The combination of extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation can enhance tissue perfusion,thus providing a solid foundation for the accurate diagnosis and effective surgical treatment of PHEO.展开更多
Pheochromocytoma (PHEO) is a rare endocrine tumor from the chromaffin cells in the adrenomedullary gland and sympathetic/parasympathetic ganglia, secreting one or more catecholamines. It is frequently associated with ...Pheochromocytoma (PHEO) is a rare endocrine tumor from the chromaffin cells in the adrenomedullary gland and sympathetic/parasympathetic ganglia, secreting one or more catecholamines. It is frequently associated with hypertension and described in the literature as a cause of secondary diabetes mellitus. In patients with known persistent uncontrolled diabetes, PHEO is rarely mentioned as the cause of uncontrolled diabetes. The authors report a rare case of PHEO diagnosed in a 64-year-old female patient treated for 10 years with type 2 diabetes mellitus and hypertension. She was treated using a combination of insulin (2 injections) and Metformin 1000 mg twice a day. The glycemic control was poor (HbA1c-11%), and persistent High Blood Pressure (HBP). She presented with unexplained weight loss associated with permanent hyperhidrosis (sweating), affecting her quality of life and diffuse abdominal pain. The investigations confirmed the diagnosis of PHEO, which resection led to improvement of glycemic control and hypertension.展开更多
BACKGROUND Pheochromocytoma,a rare catecholamine-secreting tumor,typically presents with the classic triad of headache,palpitations,and diaphoresis,often accompanied by cardiovascular manifestations.While vomiting occ...BACKGROUND Pheochromocytoma,a rare catecholamine-secreting tumor,typically presents with the classic triad of headache,palpitations,and diaphoresis,often accompanied by cardiovascular manifestations.While vomiting occurs in approximately 34.5%of cases,it is rarely the predominant and persistent presenting symptom.Pheochro-mocytoma-induced cardiomyopathy leading to heart failure is a recognized but uncommon complication.Due to its heterogeneous presentations,misdiagnosis and diagnostic delay are frequent.CASE SUMMARY A 53-year-old female presented predominantly with persistent and refractory vomiting as her chief complaint,accompanied by signs of acute heart failure[left ventricular ejection fraction(LVEF)30%].Initial evaluation at a primary hospital,including coronary angiography(revealing only mild stenosis),led to a misdia-gnosis of coronary artery disease.Despite standard anti-thrombotic,anti-heart failure,and anti-emetic therapy,her vomiting persisted and heart failure did not resolve.Subsequent hospitalization revealed dramatic paroxysmal hypertension(202/129 mmHg to 97/51 mmHg)and fever.Significantly elevated plasma meta-nephrines and normetanephrine,combined with abdominal computed tomogra-phy and magnetic resonance imaging,confirmed a right adrenal pheochromo-cytoma.This diagnosis was significantly delayed due to the atypical prominence of gastrointestinal symptoms masking the underlying endocrine crisis.CONCLUSION This case highlights a highly atypical presentation of pheochromocytoma domi-nated by refractory vomiting and complicated by acute catecholamine-induced cardiomyopathy.It emphatically underscores that pheochromocytoma must be considered in the differential diagnosis for patients presenting with unexplained,treatment-resistant vomiting,particularly when co-existing with acute heart failure.The presence of labile hypertension,even if not initially evident,provides a crucial diagnostic clue.Prompt biochemical screening(catecholamine metabolites)and adrenal imaging are essential to prevent diagnostic delay and enable timely,life-saving surgical intervention.展开更多
Pheochromocytomas or paragangliomas are rare and the diagnosis remains a challenge for clinicians.We present a woman suffering from recurrent myocardial infarction and cardiomyopathy,who was finally diagnosed with par...Pheochromocytomas or paragangliomas are rare and the diagnosis remains a challenge for clinicians.We present a woman suffering from recurrent myocardial infarction and cardiomyopathy,who was finally diagnosed with paraganglioma.Pheochromocytomas or paraganglioma should be considered in the differential diagnosis of a patient with symptoms possibly referring to acute coronary syndrome and cardiomyopathy.展开更多
Background： Edaravone had been validated to effectively protect against ischemic injuries. In this study, we investigated the protective effect of edaravone by observing the effects on anti-apoptosis, regulation of B...Background： Edaravone had been validated to effectively protect against ischemic injuries. In this study, we investigated the protective effect of edaravone by observing the effects on anti-apoptosis, regulation of Bcl-2/Bax protein expression and recovering from damage to mitochondria after OGD （oxygen-glucose deprivation）-reperfusion. Methods： Viability of PC 12 cells which were injured at different time of OGD injury, was quantified by measuring MTT （2-（4,5-dimethylthia-zol-2-yl）-2,5-diphenyltetrazolium bromide） staining. In addition, PC 12 cells＇ viability was also quantified after their preincubation in different concentration of edaravone for 30 min followed by （OGD）. Furthermore, apoptotic population of PC 12 cells that reinsulted from OGD-reperfusion with or without preincubation with edaravone was determined by flow cytometer analysis, electron microscope and Hoechst/Pl staining. Finally, change of Bcl-2/Bax protein expression was detected by Western blot. Results： （1） The viability of PC12 cells decreased with time （1-12 h） after OGD. We regarded the model of OGD 2 h, then replacing DMEM （Dulbecco＇s Modified Eagle＇s Medium） for another 24 h as an OGD-reperfusion in this research. Furthermore, most PC 12 cells were in the state of apoptosis after OGD-reperfusion. （2） The viability of PC 12 cells preincubated with edaravone at high concentrations （1, 0.1, 0.01 μmol/L） increased significantly with edaravone protecting PC 12 cells from apoptosis after OGD-reperfusion injury. （3） Furthermore, edaravone attenuates the damage of OGD-reperfusion on mitochondria and regulated Bcl-2/Bax protein imbalance expression after OGD-reperfusion. Conclusion： Neuroprotective effects of edaravone on ischemic or other brain injuries may be partly mediated through inhibition of Bcl-2/Bax apoptotic pathways by recovering from the damage of mitochondria.展开更多
The measurement of urine catecholamine and metanephrine concentrations is important for biochemical screening and diagnosis of pheochromocytoma.The goal of this work was to develop a simple liquid chromatography-tande...The measurement of urine catecholamine and metanephrine concentrations is important for biochemical screening and diagnosis of pheochromocytoma.The goal of this work was to develop a simple liquid chromatography-tandem mass spectrometry(LC-MS/MS)method for determining catecholamines and metanephrines in urine to replace an existing liquid chromatographic method using electrochemical detection.Urine samples were prepared using Oasis weak-cation-exchange cartridges.The eluate was analyzed on an Agilent ZORBAX Eclipse Plus Phenyl-Hexyl column in 3 min.Adrenaline,noradrenaline,dopamine,metanephrine,normetanephrine,and their deuterated internal standards were monitored in positive electrospray ionization mode by multiple reaction monitoring(MRM).No evidence of ion suppression was observed.The assay was linear up to 5μmol/L for adrenaline,5μmol/L for noradrenaline,6.1μmol/L for dopamine,5.6μmol/L for metanephrine,and 34.6μmol/L for normetanephrine,with lower limits of quantification of 5,5,12,6 and 7nmol/L,respectively.The intra-day and inter-day precisions for all analytes ranged from 0.59%to 4.64%and1.98%to 4.80%,respectively.External quality assurance samples were assayed and showed excellent agreement with the target values.This simple method provides an improved assay for determining urine catecholamines and metanephrines.展开更多
Objective： To study the diagnosis and treatment ofpheochromocytoma in urinary bladder. Methods： Six cases of bladder pheochromocytoma were studied. Four cases showed hypertension, 3 of which were paroxysmal hyperten...Objective： To study the diagnosis and treatment ofpheochromocytoma in urinary bladder. Methods： Six cases of bladder pheochromocytoma were studied. Four cases showed hypertension, 3 of which were paroxysmal hypertension during urination. Catecholamine （CA） was increased in a case, and vanillymandelic acid （VMA） was increased in 2 cases. Bladder submucosal mass was detected by B-ultrasound in 5 cases （5/5）, computerized tomography （CT） in 3 cases （3/3）, cystoscopy in 5 cases （5/6）. Four cases took a-receptor blocker for 2 weeks, 1 case took β-receptor blocker to decrease heart rate. All patients were treated with surgical operation including 4 partial cystectomies, 2 excavations. Results： Three cases had manifestations including headache, excessive perspiration and hypertension during cystoscopy. Four cases were confirmed before operation. Two cases showed hypertension during operation. All patients were pathologically diagnosed as pheochromocytoma post- operatively. In five cases followed up, blood pressure returned to normal. No patient had relapse and malignancy. Conclusions： Typical hypertension during urination comprised the main symptoms. We should highly suspect bladder pheochromocytoma if a submucosal mass was discovered with B-ultrasound, CT, ^131I-M1BG （methyliodobenzylguanidine） and cystoscopy. The determination of CA in urine is valuable for qualitative diagnosis. The preoperative management of controlling blood pressure and expansion of the blood volume are very important. Surgical operation is a good method for effective treatment. Postoperative long-time followed up is necessary.展开更多
The coincidence of a gastrointestinal stromal tumor (GIST) and a neuroendocrine tumor (NET) in neurofibromatosis type 1 (NF1) is described only five times within the literature. We report on a 63 year old Caucasian fe...The coincidence of a gastrointestinal stromal tumor (GIST) and a neuroendocrine tumor (NET) in neurofibromatosis type 1 (NF1) is described only five times within the literature. We report on a 63 year old Caucasian female with the rare condition of neurofibromatosis type 1 coinciding with recurrent gastrointestinal stromal tumor plus bilateral pheochromocytoma (PCC). After a history of palpitations and dizziness that lasted for years, a left adrenal mass was detected by CT. Laparotomy revealed a pheochromocytoma of the left adrenal gland while an ileoterminal GIST was found incidentally intraoperatively. After six months contralateral PCC and multiple recurrent GIST were resected again. After four years the patient is doing well without any signs of further recurrent tumors. Discussion includes review of the literature.展开更多
Pheochromocytoma is a tumor arising from neuroectodermal chromaffin tissues in the adrenal gland or extra-adrenal paraganglia(paragangliomas). The prevalence of the tumor is 0.1%-0.6% in the hypertensive population, o...Pheochromocytoma is a tumor arising from neuroectodermal chromaffin tissues in the adrenal gland or extra-adrenal paraganglia(paragangliomas). The prevalence of the tumor is 0.1%-0.6% in the hypertensive population, of which 10%-20% are malignant. Pheochromocytoma produces, stores, and secretes catecholamines, as well as leads to hypertensive crisis, arrhythmia, angina, and acute myocardial infarction without coronary artery diseases. We report a case of acute coronary syndrome(ACS) with a final diagnosis of multiple endocrine neoplasia with pheochromocytoma and medullary thyroid carcinoma(MTC).展开更多
BACKGROUND Von Hippel-Lindau disease(also known as VHL syndrome),is an autosomal dominant inherited disease.We describe a sporadic case of VHL syndrome where bilateral pheochromocytomas were unexpectedly identified.Th...BACKGROUND Von Hippel-Lindau disease(also known as VHL syndrome),is an autosomal dominant inherited disease.We describe a sporadic case of VHL syndrome where bilateral pheochromocytomas were unexpectedly identified.The patient underwent selective laparoscopic resections of the pheochromocytomas,and the anesthetic management during surgery was complex and challenging.CASE SUMMARY A 22-year-old man presented to our hospital to seek medical advice for infertility without any other complaints.The results of computed tomography and catecholamine levels in blood and urine demonstrated adrenal gland masses which were diagnosed as pheochromocytomas.Further examination confirmed that the patient also had VHL syndrome.After thorough preparation,the patient underwent selective laparoscopic resection of the pheochromocytomas and was discharged 10 d after surgery.We describe the process of perioperative anesthesia management in this patient undergoing pheochromocytoma resection.CONCLUSION This case summaries specific clinical traits and considerations in perioperative anesthesia management for VHL syndrome patients undergoing bilateral pheochromocytoma resection.展开更多
We reviewed the data of all patients managed for retroperitoneal paragangliomas(PGLs)between June 2010and June 2011 to present our experience concerning this uncommon entity to highlight diagnostic and therapeutic cha...We reviewed the data of all patients managed for retroperitoneal paragangliomas(PGLs)between June 2010and June 2011 to present our experience concerning this uncommon entity to highlight diagnostic and therapeutic challenges of retroperitoneal PGLs.All patients were admitted to the department of general and hepatobiliary surgery in the regional hospital of Jendouba,Tunisia.The size of the tumor was taken at its largest dimension,as determined in a computed tomography(CT)scan and pathological reports.There were 4 patients(all women)with a median age of 48 years(range46-56 years).Abdominal pain was the commonest presentation.CT showed and localized the tumors which were all retroperitoneal.All patients had successfu surgical resection of the tumors under invasive arterial blood pressure monitoring.One patient underwent surgery for a presumed tumor of the pancreatic head.The fresh-mount microscopic study of the peroperative biopsy yielded inflammatory tissue without malignancy and no resection was performed.Final histologica examination of the biopsy concluded PGL.A secondlaparotomy was performed and the tumor was entirely resected.The diagnosis was made after surgery by histology in all patients.The control of the blood pressure was improved after surgery in 3 patients.Paragangliomas are rare tumors.The retroperitoneal localization is uncommon.Complete surgical resection remains the only curative treatment but it is often challenging as these tumors are located near multiple vital blood vessels.展开更多
Oxidative stress has an important role in the development of Alzheimer＇s disease （AD）. Beta amyloid protein 25-35 （Aβ25-35） can generate oxygen free radicals, and MCI-186 （3-methyl-l-phenyl-2-pyrazolin-5-one, e...Oxidative stress has an important role in the development of Alzheimer＇s disease （AD）. Beta amyloid protein 25-35 （Aβ25-35） can generate oxygen free radicals, and MCI-186 （3-methyl-l-phenyl-2-pyrazolin-5-one, edaravone） can specifically eliminate hydroxyl radicals. The present study introduced Aβ25-35 into PC12 cells to establish a cell model of AD, and investigated the neuroprotective effects of MCI-186 on AD. Results showed that MCI-186 had a positive effect on the prevention and treatment of AD by inhibiting protein oxidative products, advanced glycation end products, lipid oxidative end products and DNA oxidative damage in PC12 cells induced by Aβ25-35.展开更多
Objective To investigate the clinical and genetic features of a Chinese family with yon Hippel- Lindau （VHL） disease revealed by bilateral pheochromocytoma. Methods The proband and other members in a Chinese family...Objective To investigate the clinical and genetic features of a Chinese family with yon Hippel- Lindau （VHL） disease revealed by bilateral pheochromocytoma. Methods The proband and other members in a Chinese family with familial pheochromocytoma were clinically evaluated and followed up. Genomic DNA extracted from the peripheral blood of 8 family members （including 3 patients） was amplified by polymerase chain reaction （PCR） and the PCR products were directly sequenced. Results The first presentation in the proband, his mother, and his sister was bilateral pheochromocytoma, and the missense mutation of 695G-A （Arg161Gln） in exon 3 of VHL gene was detected in the three patients. In the follow-up study, the proband and his mother were found to have other VHL tumors, induding retinal and cerebellar hemangioblastomas and pancreatic tumor. Neither clinical presentation of VHL disease nor gene mutation was found in other family members. Conclusion VHL disease should be suspected in some patients with familial pheochromocytoma, and VHL gene screening helps to achieve early diagnosis of the disease.展开更多
AIM:To review the benefits of single photon emission computed tomography(SPECT)/computed tomography(CT)hybrid imaging for diagnosis of various endocrine disorders.METHODS:We performed MEDLINE and Pub Med searches usin...AIM:To review the benefits of single photon emission computed tomography(SPECT)/computed tomography(CT)hybrid imaging for diagnosis of various endocrine disorders.METHODS:We performed MEDLINE and Pub Med searches using the terms:"SPECT/CT";"functional anatomic mapping";"transmission emission tomography";"parathyroid adenoma";"thyroid cancer";"neuroendocrine tumor";"adrenal";"pheochromocytoma";"paraganglioma";in order to identify relevant articles published in English during the years 2003 to 2015.Reference lists from the articles were reviewed to identify additional pertinent articles.Retrieved manuscripts(case reports,reviews,meta-analyses and abstracts)concerning the application of SPECT/CT to endocrine imaging were analyzed to provide a descriptive synthesis of the utility of this technology.RESULTS:The emergence of hybrid SPECT/CT camera technology now allows simultaneous acquisition of combined multi-modality imaging,with seamless fusion of three-dimensional volume datasets.The usefulness of combining functional information to depict the biodistribution of radiotracers that map cellular processes of the endocrine system and tumors of endocrine origin,with anatomy derived from CT,has improved the diagnostic capability of scintigraphy for a range of disorders of endocrine gland function.The literature describes benefits of SPECT/CT for^(99m)Tc-sestamibi parathyroid scintigraphy and^(99m)Tc-pertechnetate thyroid scintigraphy,^(123)I-or^(131)I-radioiodine for staging of differentiated thyroid carcinoma,^(111)In-and^(99m)Tclabeled somatostatin receptor analogues for detection of neuroendocrine tumors,^(131)I-norcholesterol(NP-59)scans for assessment of adrenal cortical hyperfunction,and^(123)I-or^(131)I-metaiodobenzylguanidine imaging for evaluation of pheochromocytoma and paraganglioma.CONCLUSION:SPECT/CT exploits the synergism between the functional information from radiopharmaceutical imaging and anatomy from CT,translating to improved diagnostic accuracy and meaningful impact on patient care.展开更多
OBJECTIVE:To investigate the neuroprotective effects of Fructus Chebulae extract using both in vivo and invitromodels of cerebral ischemia.METHODS:As an in vitro model,oxygen glucose deprivation followed by reoxygenat...OBJECTIVE:To investigate the neuroprotective effects of Fructus Chebulae extract using both in vivo and invitromodels of cerebral ischemia.METHODS:As an in vitro model,oxygen glucose deprivation followed by reoxygenation(OGD-R)and hydrogen peroxide(H2O2)induced cellular damage in rat pheochromocytoma(PC12)cells was used to investigate the neuroprotective effects of extract of Fructus Chebulae.3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was used to calculate cell survival.For in vivo,occlusion of left middle cerebral artery on rats was carried out as a focal cerebral ischemic model.RESULTS:Fructus Chebulae extract increases the PC12 cell survival against OGD-R and H2O2by 68%and 91.4%respectively.Fructus Chebulae also de-creases the cerebral infarct volume by 39%and extent of hemisphere swelling from 17%in control group to 10%in FructusChebulaetreated group.CONCLUSION:Fructus Chebulae,as a traditional medicine,can rescue the neuronal cell death against ischemia related damage.The possible mechanism for the neuroprotection might be the inhibition of oxidative damages occurring after acute phase of cerebral ischemia.展开更多
Objective In the last years,robotic surgery was introduced in several different settings with good perioperative results.However,its role in the management of adrenal masses is still debated.In order to provide a cont...Objective In the last years,robotic surgery was introduced in several different settings with good perioperative results.However,its role in the management of adrenal masses is still debated.In order to provide a contribution to this field,we described our step-by-step technique for robotic adrenalectomy(RA)and related modifications according to the type of adrenal mass treated.Methods We retrospectively analyzed 27 consecutive patients who underwent RA at Onze-Lieve-Vrouw hospital(Aalst,Belgium)between January 2009 and October 2022.Demographic,intra-and post-operative,and pathological data were retrieved from our prospectively maintained institutional database.Continuous variables are summarized as median and interquartile range(IQR).Categorical variables are reported as frequencies(percentages).Results Twenty-seven patients underwent RA were included in the study.Median age,body mass index,and Charlson's comorbidity index were 61(IQR:49-71)years,26(IQR:24-29)kg/m^(2),and 2(IQR:0-3),respectively,and 16(59.3%)patients were male.Median tumor size at computed tomography scan was 6.0(IQR:3.5-8.0)cm.Median operative time and blood loss were 105(IQR:82-120)min and 175(IQR:94-250)mL,respectively.No intraoperative complications were recorded.Overall postoperative complications rate was 11.1%,with a postoperative transfusion rate of 3.7%.A total of 10(37.0%)patients harbored malignant adrenal masses.Among them,3(11.1%)had adrenocortical carcinoma,6(22.2%)secondary metastasis,and 1(3.7%)malignant pheochromocytoma on final pathological exam.Only 1(10.0%)patient had positive surgical margins.Conclusion We described our step-by-step technique for RA,which can be safely performed even in case of high challenging settings as malignant tumors,pheochromocytoma,and large masses.The standardization of perioperative protocol should be encouraged to maximize the outcomes of this complex surgical procedure.展开更多
文摘Objective To analyze the clinical characteristics of nonfunctioning pheochromocytoma, and to evaluate the efficacy of 131I-metaiodobenzylguanidine (MIBG) scan in the diagnosis and perioperative treatment of nonfunctioning pheochromocy- toma. Methods The clinical data of 14 patients with nonfunctioning pheochromocytoma were analyzed retrospectively. Plasma free corticoid, renin, aldosterone, and urine catecholamines levels were estimated. B-mode ultrasonography, computed tomo- graphy scan, thoracic X-ray and 131I-MIBG were used. Results All patients with nonfunctioning pheochromocytoma had no hypertension and the tumors were found inciden- tally. The 24 hours urine catecholamines levels in 80% (8/10) patients were normal. The positive rate of 131I-MIBG was 80% (8/10) and the specificity was 100%. All patients underwent surgical operation of tumor resection. No preoperative volume expansion was given to all patients. All tumors were resected completely, and no death accident happened. There was no recurrence and metastasis after operation by long-term follow-up. Conclusion 131I-MIBG scan is the first choice technique for the diagnosis of nonfunctioning pheochromocytoma. Blood volume expansion is unnecessary before resection of pheochromocytoma.no recurrence and metastasis})
文摘Objective To investigate the expression of cyclooxygenase-2 （ Cox-2 ） and microvessel density （MVD） in benign and malignant pheochromocytomas, and the relationship between Cox-2 and MVD. Methods Specimens and clinical data from 38 patients （ 21 benign and 17 malignant pheochromocytomas ） were studied. Slides of normal adrenal glands in nephrectomy specimens from another 20 patients with benign renal tumors were used as control. Irnmunohistochemical technology was performed to detect the Cox-2 and MVD in all specimens. Results Expression of Cox-2 was observed in 5 of the 21 benign pheochromocytomas （23. 8% ） , and in 14 of the 17 malignant （82.4%）. No expression of Cox-2 was observed in control slides. There were significant differences of Cox-2 expression between benign and malignant pheochromocytomas, as well as between malignant pheochromocytomas and control （ P 〈0. 05）. Expressions of MVD were 36. 41 ±13. 00, 21.43 ±8. 05, and 13. 36 ±4.34 in malignant, benign pheochromocytomas, and in control, respectively. Conclusion Cox-2 may contribute to the invasive characteristics of malignant pheochromocytomas and be used as a marker to distinguish malignant from benign pheochromocytomas. Expression of MVD in malignant pheochromocytomas was directly correlated with Cox-2.
文摘Nonfunctional pheochromocytoma is a particular type of pheochromocytoma without typical clinical features of catecholaminism. It is difficult to diagnose or differentially diagnose. This type of pheochromocytoma is rarely reported in the literature. From January 1, 1990 to June 1, 2004, we performed operations for 197 patients with pheochromocytomas, including 26 patients with nonfunctional pheochromocytoma. We analyzed the clinical data of the 26 patients.
文摘BACKGROUND Phaeochromocytoma and paragangliomas(PPGL)are rare neuroendocrine tumors usually caused by parasympathetic or sympathetic nerves,with an overall incidence of approximately 0.66 cases per 100000 people per year.Most PPGLs are asymptomatic,and a few develop symptoms,such as elevated blood pressure and rapid heart rate,because of the release of catecholamines.According to the literature,surgical resection is the mainstay of PPGL treatment.However,the choice between minimally invasive surgery and open surgery remains controversial,particularly in cases involving complex anatomical relationships.We successfully resected a tumor located between the inferior vena cava and abdominal aorta using a minimally invasive approach with the assistance of computed tomography(CT)angiography and three-dimensional reconstruction,resulting in a favorable outcome.CASE SUMMARY A 56-year-old woman was admitted to the hospital with right upper abdominal discomfort for more than 6 months,experiencing occasional pins and needles sensation and radiation from the right shoulder and back.Prehospital CT of the upper abdomen revealed a retroperitoneal mass suspected to be a retroperitoneal ganglioneuroma.Surgery was recommended,and an enhanced CT scan of the upper abdomen,along with preoperative three-dimensional reconstruction,was performed after admission.The imaging indicated that the mass,measuring approximately 4.1 cm×3.8 cm×4.8 cm,was situated between the abdominal aorta and the inferior vena cava,extending downward to the level of the left renal vein.After ruling out any contraindications to surgery,a minimally invasive laparoscopy was performed to excise the mass precisely.The surgery was successful without any postoperative complications,and the 2-month follow-up revealed no abnormal signs of recurrence.CONCLUSION This case report describes successful and precise laparoscopic resection of a retroperitoneal tumor.The patient recovered well during the 2-month follow-up,and postoperative pathology revealed a paraganglioma.
文摘BACKGROUND Pheochromocytoma(PHEO)is a type of tumor that originates from chromaffin cells in the adrenal medulla and is classified as an adrenal paraganglioma.PHEOs can secrete catecholamines,leading to a variety of symptoms.Accurate diagnosis and appropriate treatment selection are crucial for favorable outcomes in these cases.CASE SUMMARY The patient presented with unexplained chest tightness,palpitations,and pink sputum.Upon examination and analysis of laboratory results,a diagnosis of adrenal PHEO was established.The PHEO secreted high levels of catecholamines,causing sudden fluctuations in blood pressure and heart rate,leading to extre-mely unstable hemodynamics.Treatment with extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation helped stabilize the patient’s vital signs,allowing for timely surgical intervention.CONCLUSION The combination of extracorporeal membrane oxygenation and intra-aortic balloon counterpulsation can enhance tissue perfusion,thus providing a solid foundation for the accurate diagnosis and effective surgical treatment of PHEO.
文摘Pheochromocytoma (PHEO) is a rare endocrine tumor from the chromaffin cells in the adrenomedullary gland and sympathetic/parasympathetic ganglia, secreting one or more catecholamines. It is frequently associated with hypertension and described in the literature as a cause of secondary diabetes mellitus. In patients with known persistent uncontrolled diabetes, PHEO is rarely mentioned as the cause of uncontrolled diabetes. The authors report a rare case of PHEO diagnosed in a 64-year-old female patient treated for 10 years with type 2 diabetes mellitus and hypertension. She was treated using a combination of insulin (2 injections) and Metformin 1000 mg twice a day. The glycemic control was poor (HbA1c-11%), and persistent High Blood Pressure (HBP). She presented with unexplained weight loss associated with permanent hyperhidrosis (sweating), affecting her quality of life and diffuse abdominal pain. The investigations confirmed the diagnosis of PHEO, which resection led to improvement of glycemic control and hypertension.
基金Supported by National Natural Science Foundation of China,No.82200353Jiangsu Province Double Innovation Doctoral Program,No.JSSCBS20221948+4 种基金Suzhou Gusu Health Talent Program,No.(2022)043Suzhou Gusu Health Talent Plan Talent Research Project,No.GSWS2022014Suzhou Science and Technology Innovation Policy Funding Projectthe Jiangsu Province College Students’Innovation and Entrepreneurship Training Program Project,No.202410285087Z“Bo Xi”Talent Casting Plan of the First Affiliated Hospital of Soochow University.
文摘BACKGROUND Pheochromocytoma,a rare catecholamine-secreting tumor,typically presents with the classic triad of headache,palpitations,and diaphoresis,often accompanied by cardiovascular manifestations.While vomiting occurs in approximately 34.5%of cases,it is rarely the predominant and persistent presenting symptom.Pheochro-mocytoma-induced cardiomyopathy leading to heart failure is a recognized but uncommon complication.Due to its heterogeneous presentations,misdiagnosis and diagnostic delay are frequent.CASE SUMMARY A 53-year-old female presented predominantly with persistent and refractory vomiting as her chief complaint,accompanied by signs of acute heart failure[left ventricular ejection fraction(LVEF)30%].Initial evaluation at a primary hospital,including coronary angiography(revealing only mild stenosis),led to a misdia-gnosis of coronary artery disease.Despite standard anti-thrombotic,anti-heart failure,and anti-emetic therapy,her vomiting persisted and heart failure did not resolve.Subsequent hospitalization revealed dramatic paroxysmal hypertension(202/129 mmHg to 97/51 mmHg)and fever.Significantly elevated plasma meta-nephrines and normetanephrine,combined with abdominal computed tomogra-phy and magnetic resonance imaging,confirmed a right adrenal pheochromo-cytoma.This diagnosis was significantly delayed due to the atypical prominence of gastrointestinal symptoms masking the underlying endocrine crisis.CONCLUSION This case highlights a highly atypical presentation of pheochromocytoma domi-nated by refractory vomiting and complicated by acute catecholamine-induced cardiomyopathy.It emphatically underscores that pheochromocytoma must be considered in the differential diagnosis for patients presenting with unexplained,treatment-resistant vomiting,particularly when co-existing with acute heart failure.The presence of labile hypertension,even if not initially evident,provides a crucial diagnostic clue.Prompt biochemical screening(catecholamine metabolites)and adrenal imaging are essential to prevent diagnostic delay and enable timely,life-saving surgical intervention.
文摘Pheochromocytomas or paragangliomas are rare and the diagnosis remains a challenge for clinicians.We present a woman suffering from recurrent myocardial infarction and cardiomyopathy,who was finally diagnosed with paraganglioma.Pheochromocytomas or paraganglioma should be considered in the differential diagnosis of a patient with symptoms possibly referring to acute coronary syndrome and cardiomyopathy.
基金Project (No. 2005C30059) supported by the Science and TechnologyProgram of Zhejiang Province, China
文摘Background： Edaravone had been validated to effectively protect against ischemic injuries. In this study, we investigated the protective effect of edaravone by observing the effects on anti-apoptosis, regulation of Bcl-2/Bax protein expression and recovering from damage to mitochondria after OGD （oxygen-glucose deprivation）-reperfusion. Methods： Viability of PC 12 cells which were injured at different time of OGD injury, was quantified by measuring MTT （2-（4,5-dimethylthia-zol-2-yl）-2,5-diphenyltetrazolium bromide） staining. In addition, PC 12 cells＇ viability was also quantified after their preincubation in different concentration of edaravone for 30 min followed by （OGD）. Furthermore, apoptotic population of PC 12 cells that reinsulted from OGD-reperfusion with or without preincubation with edaravone was determined by flow cytometer analysis, electron microscope and Hoechst/Pl staining. Finally, change of Bcl-2/Bax protein expression was detected by Western blot. Results： （1） The viability of PC12 cells decreased with time （1-12 h） after OGD. We regarded the model of OGD 2 h, then replacing DMEM （Dulbecco＇s Modified Eagle＇s Medium） for another 24 h as an OGD-reperfusion in this research. Furthermore, most PC 12 cells were in the state of apoptosis after OGD-reperfusion. （2） The viability of PC 12 cells preincubated with edaravone at high concentrations （1, 0.1, 0.01 μmol/L） increased significantly with edaravone protecting PC 12 cells from apoptosis after OGD-reperfusion injury. （3） Furthermore, edaravone attenuates the damage of OGD-reperfusion on mitochondria and regulated Bcl-2/Bax protein imbalance expression after OGD-reperfusion. Conclusion： Neuroprotective effects of edaravone on ischemic or other brain injuries may be partly mediated through inhibition of Bcl-2/Bax apoptotic pathways by recovering from the damage of mitochondria.
文摘The measurement of urine catecholamine and metanephrine concentrations is important for biochemical screening and diagnosis of pheochromocytoma.The goal of this work was to develop a simple liquid chromatography-tandem mass spectrometry(LC-MS/MS)method for determining catecholamines and metanephrines in urine to replace an existing liquid chromatographic method using electrochemical detection.Urine samples were prepared using Oasis weak-cation-exchange cartridges.The eluate was analyzed on an Agilent ZORBAX Eclipse Plus Phenyl-Hexyl column in 3 min.Adrenaline,noradrenaline,dopamine,metanephrine,normetanephrine,and their deuterated internal standards were monitored in positive electrospray ionization mode by multiple reaction monitoring(MRM).No evidence of ion suppression was observed.The assay was linear up to 5μmol/L for adrenaline,5μmol/L for noradrenaline,6.1μmol/L for dopamine,5.6μmol/L for metanephrine,and 34.6μmol/L for normetanephrine,with lower limits of quantification of 5,5,12,6 and 7nmol/L,respectively.The intra-day and inter-day precisions for all analytes ranged from 0.59%to 4.64%and1.98%to 4.80%,respectively.External quality assurance samples were assayed and showed excellent agreement with the target values.This simple method provides an improved assay for determining urine catecholamines and metanephrines.
文摘Objective： To study the diagnosis and treatment ofpheochromocytoma in urinary bladder. Methods： Six cases of bladder pheochromocytoma were studied. Four cases showed hypertension, 3 of which were paroxysmal hypertension during urination. Catecholamine （CA） was increased in a case, and vanillymandelic acid （VMA） was increased in 2 cases. Bladder submucosal mass was detected by B-ultrasound in 5 cases （5/5）, computerized tomography （CT） in 3 cases （3/3）, cystoscopy in 5 cases （5/6）. Four cases took a-receptor blocker for 2 weeks, 1 case took β-receptor blocker to decrease heart rate. All patients were treated with surgical operation including 4 partial cystectomies, 2 excavations. Results： Three cases had manifestations including headache, excessive perspiration and hypertension during cystoscopy. Four cases were confirmed before operation. Two cases showed hypertension during operation. All patients were pathologically diagnosed as pheochromocytoma post- operatively. In five cases followed up, blood pressure returned to normal. No patient had relapse and malignancy. Conclusions： Typical hypertension during urination comprised the main symptoms. We should highly suspect bladder pheochromocytoma if a submucosal mass was discovered with B-ultrasound, CT, ^131I-M1BG （methyliodobenzylguanidine） and cystoscopy. The determination of CA in urine is valuable for qualitative diagnosis. The preoperative management of controlling blood pressure and expansion of the blood volume are very important. Surgical operation is a good method for effective treatment. Postoperative long-time followed up is necessary.
文摘The coincidence of a gastrointestinal stromal tumor (GIST) and a neuroendocrine tumor (NET) in neurofibromatosis type 1 (NF1) is described only five times within the literature. We report on a 63 year old Caucasian female with the rare condition of neurofibromatosis type 1 coinciding with recurrent gastrointestinal stromal tumor plus bilateral pheochromocytoma (PCC). After a history of palpitations and dizziness that lasted for years, a left adrenal mass was detected by CT. Laparotomy revealed a pheochromocytoma of the left adrenal gland while an ileoterminal GIST was found incidentally intraoperatively. After six months contralateral PCC and multiple recurrent GIST were resected again. After four years the patient is doing well without any signs of further recurrent tumors. Discussion includes review of the literature.
文摘Pheochromocytoma is a tumor arising from neuroectodermal chromaffin tissues in the adrenal gland or extra-adrenal paraganglia(paragangliomas). The prevalence of the tumor is 0.1%-0.6% in the hypertensive population, of which 10%-20% are malignant. Pheochromocytoma produces, stores, and secretes catecholamines, as well as leads to hypertensive crisis, arrhythmia, angina, and acute myocardial infarction without coronary artery diseases. We report a case of acute coronary syndrome(ACS) with a final diagnosis of multiple endocrine neoplasia with pheochromocytoma and medullary thyroid carcinoma(MTC).
文摘BACKGROUND Von Hippel-Lindau disease(also known as VHL syndrome),is an autosomal dominant inherited disease.We describe a sporadic case of VHL syndrome where bilateral pheochromocytomas were unexpectedly identified.The patient underwent selective laparoscopic resections of the pheochromocytomas,and the anesthetic management during surgery was complex and challenging.CASE SUMMARY A 22-year-old man presented to our hospital to seek medical advice for infertility without any other complaints.The results of computed tomography and catecholamine levels in blood and urine demonstrated adrenal gland masses which were diagnosed as pheochromocytomas.Further examination confirmed that the patient also had VHL syndrome.After thorough preparation,the patient underwent selective laparoscopic resection of the pheochromocytomas and was discharged 10 d after surgery.We describe the process of perioperative anesthesia management in this patient undergoing pheochromocytoma resection.CONCLUSION This case summaries specific clinical traits and considerations in perioperative anesthesia management for VHL syndrome patients undergoing bilateral pheochromocytoma resection.
文摘We reviewed the data of all patients managed for retroperitoneal paragangliomas(PGLs)between June 2010and June 2011 to present our experience concerning this uncommon entity to highlight diagnostic and therapeutic challenges of retroperitoneal PGLs.All patients were admitted to the department of general and hepatobiliary surgery in the regional hospital of Jendouba,Tunisia.The size of the tumor was taken at its largest dimension,as determined in a computed tomography(CT)scan and pathological reports.There were 4 patients(all women)with a median age of 48 years(range46-56 years).Abdominal pain was the commonest presentation.CT showed and localized the tumors which were all retroperitoneal.All patients had successfu surgical resection of the tumors under invasive arterial blood pressure monitoring.One patient underwent surgery for a presumed tumor of the pancreatic head.The fresh-mount microscopic study of the peroperative biopsy yielded inflammatory tissue without malignancy and no resection was performed.Final histologica examination of the biopsy concluded PGL.A secondlaparotomy was performed and the tumor was entirely resected.The diagnosis was made after surgery by histology in all patients.The control of the blood pressure was improved after surgery in 3 patients.Paragangliomas are rare tumors.The retroperitoneal localization is uncommon.Complete surgical resection remains the only curative treatment but it is often challenging as these tumors are located near multiple vital blood vessels.
基金the Talent Introduction Project of Affili-ated Hospital of Jiangsu University,No.jdfyRC 2008003
文摘Oxidative stress has an important role in the development of Alzheimer＇s disease （AD）. Beta amyloid protein 25-35 （Aβ25-35） can generate oxygen free radicals, and MCI-186 （3-methyl-l-phenyl-2-pyrazolin-5-one, edaravone） can specifically eliminate hydroxyl radicals. The present study introduced Aβ25-35 into PC12 cells to establish a cell model of AD, and investigated the neuroprotective effects of MCI-186 on AD. Results showed that MCI-186 had a positive effect on the prevention and treatment of AD by inhibiting protein oxidative products, advanced glycation end products, lipid oxidative end products and DNA oxidative damage in PC12 cells induced by Aβ25-35.
基金Supported by the "tenth five-years " National Science and Technology Tackle Key Project (2004BA720A29)
文摘Objective To investigate the clinical and genetic features of a Chinese family with yon Hippel- Lindau （VHL） disease revealed by bilateral pheochromocytoma. Methods The proband and other members in a Chinese family with familial pheochromocytoma were clinically evaluated and followed up. Genomic DNA extracted from the peripheral blood of 8 family members （including 3 patients） was amplified by polymerase chain reaction （PCR） and the PCR products were directly sequenced. Results The first presentation in the proband, his mother, and his sister was bilateral pheochromocytoma, and the missense mutation of 695G-A （Arg161Gln） in exon 3 of VHL gene was detected in the three patients. In the follow-up study, the proband and his mother were found to have other VHL tumors, induding retinal and cerebellar hemangioblastomas and pancreatic tumor. Neither clinical presentation of VHL disease nor gene mutation was found in other family members. Conclusion VHL disease should be suspected in some patients with familial pheochromocytoma, and VHL gene screening helps to achieve early diagnosis of the disease.
文摘AIM:To review the benefits of single photon emission computed tomography(SPECT)/computed tomography(CT)hybrid imaging for diagnosis of various endocrine disorders.METHODS:We performed MEDLINE and Pub Med searches using the terms:"SPECT/CT";"functional anatomic mapping";"transmission emission tomography";"parathyroid adenoma";"thyroid cancer";"neuroendocrine tumor";"adrenal";"pheochromocytoma";"paraganglioma";in order to identify relevant articles published in English during the years 2003 to 2015.Reference lists from the articles were reviewed to identify additional pertinent articles.Retrieved manuscripts(case reports,reviews,meta-analyses and abstracts)concerning the application of SPECT/CT to endocrine imaging were analyzed to provide a descriptive synthesis of the utility of this technology.RESULTS:The emergence of hybrid SPECT/CT camera technology now allows simultaneous acquisition of combined multi-modality imaging,with seamless fusion of three-dimensional volume datasets.The usefulness of combining functional information to depict the biodistribution of radiotracers that map cellular processes of the endocrine system and tumors of endocrine origin,with anatomy derived from CT,has improved the diagnostic capability of scintigraphy for a range of disorders of endocrine gland function.The literature describes benefits of SPECT/CT for^(99m)Tc-sestamibi parathyroid scintigraphy and^(99m)Tc-pertechnetate thyroid scintigraphy,^(123)I-or^(131)I-radioiodine for staging of differentiated thyroid carcinoma,^(111)In-and^(99m)Tclabeled somatostatin receptor analogues for detection of neuroendocrine tumors,^(131)I-norcholesterol(NP-59)scans for assessment of adrenal cortical hyperfunction,and^(123)I-or^(131)I-metaiodobenzylguanidine imaging for evaluation of pheochromocytoma and paraganglioma.CONCLUSION:SPECT/CT exploits the synergism between the functional information from radiopharmaceutical imaging and anatomy from CT,translating to improved diagnostic accuracy and meaningful impact on patient care.
基金Supported by a Grant of the Korean Health Technology Re-search and Development Project,Ministry of Health&Wel-fare(B110072)National Research Foundation of Korea Funded by the Ministry of Science,Information and Commu-nication Technology&Future Planning,Republic of Korea(2012M3A9C4048795)
文摘OBJECTIVE:To investigate the neuroprotective effects of Fructus Chebulae extract using both in vivo and invitromodels of cerebral ischemia.METHODS:As an in vitro model,oxygen glucose deprivation followed by reoxygenation(OGD-R)and hydrogen peroxide(H2O2)induced cellular damage in rat pheochromocytoma(PC12)cells was used to investigate the neuroprotective effects of extract of Fructus Chebulae.3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was used to calculate cell survival.For in vivo,occlusion of left middle cerebral artery on rats was carried out as a focal cerebral ischemic model.RESULTS:Fructus Chebulae extract increases the PC12 cell survival against OGD-R and H2O2by 68%and 91.4%respectively.Fructus Chebulae also de-creases the cerebral infarct volume by 39%and extent of hemisphere swelling from 17%in control group to 10%in FructusChebulaetreated group.CONCLUSION:Fructus Chebulae,as a traditional medicine,can rescue the neuronal cell death against ischemia related damage.The possible mechanism for the neuroprotection might be the inhibition of oxidative damages occurring after acute phase of cerebral ischemia.
文摘Objective In the last years,robotic surgery was introduced in several different settings with good perioperative results.However,its role in the management of adrenal masses is still debated.In order to provide a contribution to this field,we described our step-by-step technique for robotic adrenalectomy(RA)and related modifications according to the type of adrenal mass treated.Methods We retrospectively analyzed 27 consecutive patients who underwent RA at Onze-Lieve-Vrouw hospital(Aalst,Belgium)between January 2009 and October 2022.Demographic,intra-and post-operative,and pathological data were retrieved from our prospectively maintained institutional database.Continuous variables are summarized as median and interquartile range(IQR).Categorical variables are reported as frequencies(percentages).Results Twenty-seven patients underwent RA were included in the study.Median age,body mass index,and Charlson's comorbidity index were 61(IQR:49-71)years,26(IQR:24-29)kg/m^(2),and 2(IQR:0-3),respectively,and 16(59.3%)patients were male.Median tumor size at computed tomography scan was 6.0(IQR:3.5-8.0)cm.Median operative time and blood loss were 105(IQR:82-120)min and 175(IQR:94-250)mL,respectively.No intraoperative complications were recorded.Overall postoperative complications rate was 11.1%,with a postoperative transfusion rate of 3.7%.A total of 10(37.0%)patients harbored malignant adrenal masses.Among them,3(11.1%)had adrenocortical carcinoma,6(22.2%)secondary metastasis,and 1(3.7%)malignant pheochromocytoma on final pathological exam.Only 1(10.0%)patient had positive surgical margins.Conclusion We described our step-by-step technique for RA,which can be safely performed even in case of high challenging settings as malignant tumors,pheochromocytoma,and large masses.The standardization of perioperative protocol should be encouraged to maximize the outcomes of this complex surgical procedure.
