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The aim of the study was to present own experience in the treatment of adrenal pathology using laparoscopic adrenalectomy (LA) via lateral transperitoneal approach.Material and methods. From 29.10.1997 to 30.04.2008 in the Department of General, Vascular and Transplant Surgery of Warsaw Medical University 417 LA have been performed in 405 patients. The indications were 195 (48%) non-functioning incidentaloma type tumors and 210 (52%) functioning tumors. Among them hypercortisolism in 66 (31.5%) patients (Cushing's disease - 3, Cushing's syndrome -28, subclinical Cushing's syndrome - 35), pheochromocytoma in 82 (39%), Conn's syndrome in 61 (29%) and adrenogenital syndrome in 1 (0.5%). There where 288 (71%) women and 117 (29%) men with the mean age of 51.8 years. The mean size of adrenal tumor was 41.1 mm. In 62 (15%) bilateral lesions were noted. All patients were operated laparoscopically via lateral transabdominal approach.Results. LA was successful in 393 patients (97%). We performed 393 (97%) unilateral LA, 10 (2.5%) bilateral simultaneous LA, 2 (0.5%) bilateral two-staged LA and also 2 (0.5%) sparing LA. 12 (3%) patients underwent simultaneous LA with laparoscopic cholecystectomy due to symptomatic cholecystolithiasis and 2 (0,5%) with laparoscopic umbilical hernioplasty. 12 (3%) conversions were necessary. 15 (3.7%) complications occurred, 3 (0.7%) intraoperative and 12 (3%) postoperative. There was 1 remote death on the 56th postoperative day.Conclusions. 1. LA should be recognize as the referential method in the treatment of adrenal pathology. 2. Results, as well as avoiding unnecessary complications and intraoperative difficulties is possible thanks to: close cooperation with the endocrinologist, experience gained from performing other laparoscopic operations, experience got at making open adrenalectomies.
Content available remote Videoscopic Extraperitoneal Operations of Suprarenal Glandules
An adrenal tumors are a clinical problem encountered by all health care providers go into endocrinological surgery. Nowadays the videoscopic adrenalectomy gains mounting acceptance. In the adrenal operations two kinds of operative access are used: an itraperitoneal and an extraperitoneal.The aim of the study was to analyse its own material and literature in purpose to find the answer if extraperitoneal access may be acknowledged as widely used method in adrenal tumor operations.Material and methods. 68 videoscopic adrenalectomy with extraperitoneal access were made in the Surgery Department of MSWiA Hospital in Łódź, between 2005 to 2007. The time of the operation, the time of the hospitalization, intraoperative blod loose, probability of complications, number and reasons of the conversies were taken into account.Results. In all the patients was performed complete tumor resection with adrenal gland. The diameter of removed tumors was between 4-14 cm. In 23 cases (33.8%), intraoperatively, during tumor preparation, the continuity of the peritoneum was broken however it didn't have any influence for the operation's proceedings and postoperative condition of the patients. Three conversions were made (4.4%). The average time of hospitalization was about 3.1 days. There weren't observed, in the postoperative period any wound suppurations or postoperative hernias.Conclusions. The own observations in confrontation with literature let find an extraperitoneal videoscopy as method with wide application in various size and origination in adrenal tumor operations.
Adrenal tumours incidentally found in patients with arterial hypertension pose a severe clinical problem when no endocrine hyperactivity is confirmed and their features in diagnostic imaging do not suggest malignancy.The aim of the study was to evaluate the clinical consequences of unilateral adrenalectomy in a long term follow up period for patients that have adrenal tumours without confirmed endocrine hyperactivity.Material and methods. We evaluated the clinical consequences of unilateral adrenalectomy in a long term follow up of 48 hypertensive patients with a unilateral adrenal tumour lacking biochemical confirmation of adrenal hyperactivity. The mean duration of hypertension was 87 months; observation time ranged from 6 to 62 months.Results. Normalisation of blood pressure was observed in 8.3% of patients. In addition, better blood pressure control was documented in 35.4% of patients. There were no significant differences between group of patients with normalization or improvement of blood pressure control and those with no improvement with respect to age, BMI, duration of hypertension, tumour size, renin activity, aldosterone to plasma renin activity ratio, or the preoperative plasma concentration of potassium, aldosterone, or cortisol. The maximum values of systolic, but not diastolic, blood pressure before surgery were lower in patients with normalization or improvement of blood pressure control.Conclusions. Improvement of blood pressure control after unilateral adrenalectomy in 43.7% of patients may suggest tumour endocrine hyperactivity which remains unconfirmed by laboratory tests. It is not possible to predict improvement of blood pressure control after adrenalectomy in this group of patients according to tumour size and routine biochemical examination.
Content available remote Adrenal Tumors - Diagnostics and the Factual Situation
The study presented three cases of patients diagnosed with adrenal tumors subject to surgical intervention during the past 6 months in our Department. The patients presented with radiological diagnostic difficulties, as to the character and location of the primary tumor.The aim of the study was to demonstrate differences between radiological examination results and the factual situation observed during the adrenalectomy. In all the presented cases patients' were subject to laparoscopic intervention. In two cases conversion to open surgery was necessary. The histopathological results of the surgically removed samples were as follows: leiomyoma, myoperycytoma and pheochromocytoma. In selected cases imaging examinations might be of limited value, especially when determining the character and location of the primary lesion of the adrenal gland.
It has been believed that overproduction of free radicals and/or deficiency of antioxidant systems, and stress hormones may play a role in etiopathogenesis of many diseases, including gastric ulcer. This study evaluated whether there was an effect of adrenalectomy on lipid peroxidation [malondialdehyde (MDA)] and antioxidant [superoxide dismutase (SOD), glutathione peroxidase (GPX) and glutathione (GSH) levels] systems in gastric tissue and erythrocyte in rats. As well, the impacts of administration of prednisolone and epinephrine on these systems in adrenalectomized rats were investigated. Thirty-three rats were randomly grouped as sham-operated (group I), adrenalectomized (group II), adrenalectomized + prednisolone (group III) and adrenalectomized + epinephrine (group IV). After experimental procedures, blood and gastric tissues samples were taken from each animal in all groups. Colorimetric assays were employed to determine gastric tissue and erythrocyte levels of MDA and GSH, and SOD and GPX activities. Adrenalectomy in group II rats caused a marked decrease of SOD and GPX activities and MDA levels, and an increase of GSH levels in gastric tissue and erythrocyte, when compared to sham-operated rats. However, especially epinephrine injection after adrenalectomy resulted in a significantly increase of measured antioxidant enzyme activities and GSH levels in both gastric tissue and erythrocyte. These results indicate that adrenalectomy appeared to alter the levels of antioxidants and lipid peroxidation product in gastric tissue and erythrocyte. Thus, the present study provides a physiological regulatory role of adrenal gland in the maintenance of oxidant/antioxidant balance in gastric tissue and erythrocyte.
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