Background
Because of co-morbidity, adrenalectomy for adrenal Cushing’s syndrome may be associated with an increased complication rate and long operating times. In the present study we report our ...experience with the posterior retroperitoneoscopic adrenalectomy in a large group of patients with clinical or subclinical Cushing’s syndrome.
Patients and methods
Between July 1994 and June 2009, 170 patients (17 males, 153 females age 50 ± 13 years; range: 12–78 years) affected by Cushing’s syndrome underwent operation via posterior retroperitoneoscopic access. Patients were divided into two groups, those with manifest Cushing’s syndrome (mCS) 99 patients: 6 male, 93 female; age 45 ± 13 years and those with subclinical Cushing’s syndrome (sCS) 71 patients: 11 male, 60 female; age: 56 ± 11 years. The sCS classification was assumed in cases without typical clinical symptoms but with a pathological dexamethasone suppression test. Partial adrenalectomy was performed in 35 cases (24 in the mCS-group and 11 in the sCS-group).
Results
Mortality was zero; major complications did not occur. The incidence of postoperative minor complications was 5.3%. Mean operating time was 58 ± 36 min (range: 20–230 min) and did not differ between mCS and sCS patients (58 versus 59 min;
p
= ns). Postoperative oral steroids supplementation (POSS) was administered in 136 patients (99 mCS, 37 sCS). If POSS was started, mean duration of therapy was 12.3 months (mCS) and 10.3 months (sCS)
p
= 0.08, respectively. After a mean follow-up of 70.9 ± 46.5 months the cure rate was 99.4%.
Conclusions
The posterior retroperitoneoscopic approach is fast and safe even in patients with Cushing’s syndrome. Partial adrenalectomy represents a new option in the treatment of cortisol-producing adenomas.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
2.
The Borg Scale at high altitude Küpper, Thomas; Heussen, N.; Morrison, Audry ...
Health Promotion & Physical Activity,
6/2021, Volume:
15, Issue:
2
Journal Article
Open access
Introduction: The Borg Scale for perceived exertion is well established in science and sport to keep an appropriate level of workload or to rate physical strain. Although it is also often used at ...moderate and high altitude, it was never validated for hypoxic conditions. Since pulse rate and minute breathing volume at rest are increased at altitude it may be expected that the rating of the same workload is higher at altitude compared to sea level. Material and methods: 16 mountaineers were included in a prospective randomized design trial. Standardized workload (ergometry) and rating of the perceived exertion (RPE) were performed at sea level, at 3,000 m, and at 4,560 m. For validation of the scale Maloney-Rastogi-test and Bland-Altmann-Plots were used to compare the Borg ratings at each intensity level at the three altitudes; p < 0.05 was defined as significant. Results: In Bland-Altmann-Plots more than 95% of all Borg ratings were within the interval of 1.96 x standard deviation. There was no significant deviation of the ratings at moderate or high altitude. The correlation between RPE and workload or oxygen uptake was weak. Conclusion: The Borg Scale for perceived exertion gives valid results at moderate and high altitude – at least up to about 5,000 m. Therefore it may be used at altitude without any modification. The weak correlation of RPE and workload or oxygen uptake indicates that there should be other factors indicating strain to the body. What is really measured by Borg’s Scale should be investigated by a specific study.
Background
A positive and concordant result of at least two diagnostic modalities is generally recommended prior to focused parathyroidectomy. The aim of this study was to analyze the results of ...surgery and the accurateness of preoperative ultrasonography (US) as single localization modality in patients who underwent parathyroidectomy without the adjunct of intraoperative Parathormone (PTH) measurement.
Methods
The cases with a preoperative US as the only localization technique, who underwent parathyroidectomy between 10/1999 and 12/2017, were selected from a prospectively maintained database. Therefore, a total number of 242 patients with a mean age of 58.6 ± 13.7 years were included in the present study. US was performed by referral endocrinologist or by the surgeon during office visits.
Results
The overall “cure rate” was 99.2% (240 out of 242 patients). In 228/242 patients (94.2%), a drop of perioperative PTH levels consistent with the definition of cure was observed on the day of surgery. In four of the remaining 14 patients, healing was confirmed by PTH level dropping into the normal range on the first postoperative day. Eight patients were cured after a reoperation was performed at our department. Postoperative complications included one case of permanent recurrent laryngeal nerve palsy (0.4%).
Conclusions
If performed by an experienced endocrinologist and/or endocrine surgeon, a positive US could be the only preoperative localization study in patients with pHPT. Moreover, the add-value of intraoperative PTH is limited. Major advantages of US are a very high accuracy, the ease of performance (accessibility) and its cost-effectiveness compared with Sesta-MIBI scintigraphy.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Abstract Objective To identify risk factors for anastomotic leakage (AL) in patients undergoing primary advanced ovarian cancer surgery and to evaluate the prognostic implication of AL on overall ...survival in these patients. Methods We analyzed our institutional database for primary EOC and included all consecutive patients treated by debulking surgery including any type of full circumferential bowel resection beyond appendectomy between 1999 and 2015. We performed logistic regression models to identify risk factors for AL and log-rank tests and Cox proportional hazards models to evaluate the association between AL and survival. Results AL occurred in 36/800 (4.5%; 95% confidence interval 3%–6%) of all patients with advanced ovarian cancer and 36/518 (6.9% 5%–9%) patients undergoing bowel resection during debulking surgery. One hundred fifty-six (30.1%) patients had multiple bowel resections. In these patients, AL rate per patient was only slightly higher (9.0% 5%–13%) than in patients with rectosigmoid resection only (6.9% 4%–10%), despite the higher number of anastomosis. No independent predictive factors for AL were identified. AL was independently associated with shortened overall survival (HR 1.9 1.2–3.4, p = 0.01). Conclusion In the present study, no predictive pre- and/or intraoperative risk factors for AL were identified. AL rate was mainly influenced by rectosigmoid resection and only marginally increased by additional bowel resections.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Background
We evaluated the prognostic impact of the age-adjusted Charlson Comorbidity Index (ACCI) on both postoperative morbidity and overall survival (OS) in patients with advanced epithelial ...ovarian cancer (EOC) treated at a tertiary gynecologic cancer center.
Patients and Methods
Exploratory analysis of our prospectively documented tumor registry was performed. Data of all consecutive patients with stage IIIB–IV ovarian cancer who underwent primary cytoreductive surgery (PDS) from January 2000 to June 2016 were analyzed. Patients were divided into three groups, based on their ACCI: low (0–1), intermediate (2–3), and high (≥4), and postoperative surgical complications were graded according to the Clavien–Dindo classification (CDC). The Fisher’s exact test, log-rank test, and Cox regression models were used to investigate the predictive value of the ACCI on postoperative complications and OS.
Results
Overall, 793 consecutive patients were identified; 328 (41.4%) patients were categorized as low ACCI, 342 (43.1%) as intermediate ACCI, and 123 (15.5%) as high ACCI. A high ACCI was significantly associated with severe postoperative complications (CDC 3–5; odds ratio 3.27, 95% confidence interval 1.97–5.43,
p
< 0.001). Median OS for patients with a low, intermediate, or high ACCI was 50, 40, and 23 months, respectively (
p
< 0.001), and the ACCI remained a significant prognostic factor for OS in multivariate analysis (
p
= 0.001). The same impact was observed in a sensitivity analysis including only those patients with complete tumor resection.
Conclusion
The ACCI is associated with perioperative morbidity in patients undergoing PDS for EOC, and also has a prognostic impact on OS. The potential role of the ACCI as a selection criteria for different therapy strategies is currently under investigation in the ongoing, prospective, multicenter AGO-OVAR 19 trial.
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Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
Sarcopenia was reported as a prognostic factor in cancer patients. Using computed tomography (CT), we analyzed the impact of sarcopenia on overall survival (OS) in patients with advanced ...epithelial ovarian cancer (EOC) after primary debulking surgery (PDS).
Methods
Preoperative CT scans of consecutive EOC patients (
n
= 323) were retrospectively assessed for skeletal muscle index (SMI) and muscle attenuation (MA; Hounsfield units HU). The optimal cut-off point for MA (32 HU) was calculated using the Martingale residuals method, and previously reported cut-offs for SMI were used. Logistic regression was used to determine univariate and multivariate factors associated with OS.
Results
Sarcopenia defined as SMI < 38.5, < 39, and 41 cm
2
/m
2
was detected in 29.4, 33.7, and 47.1% of patients, respectively; however, none of these SMI cut-off levels were associated with OS. MA < 32 HU was present in 21.1% (68/323) of the total cohort. Significant differences between patients with MA < 32 and ≥ 32 HU were detected for median age (67 vs. 57 years), Eastern Cooperative Oncology Group (ECOG) > 0 (13.2 vs. 3.1%), comorbidity (age-adjusted Charlson Comorbidity Index ACCI ≥ 4; 36.8 vs. 13.3%), median body mass index (BMI; 27 vs. 24 kg/m
2
), International Federation of Gynecology and Obstetrics (FIGO) stage, histology (high-grade serous 95.6 vs. 84.7%), and complete resection (38.2 vs. 68.2%). MA < 32 HU remained a significant prognostic factor for OS in multivariate Cox regression analysis (hazard ratio 1.79,
p
= 0.003). Median OS in patients with MA < 32 HU versus MA ≥ 32 HU was 28 versus 56 months (
p
< 0.001). Furthermore, MA < 32 HU was significantly associated with OS in the prognostically poor population of patients with residual tumor (
p
= 0.015).
Conclusions
Low MA was significantly associated with poor survival, especially in patients with residual tumor after PDS. MA assessment could be used for risk stratification after PDS.
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Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Purpose
Recurrent laryngeal nerve (RLN) palsy is the major concern of reoperative thyroid surgery, and the introduction of neuromonitoring could reduce the rate of this complication. The present ...study is a retrospective analysis of the experience with completion thyroidectomy with and without neuromonitoring in a referral center.
Methods
Between October 1999 and April 2011, 246 patients 37 men, 209 women; mean age, 55 ± 12.5 (range, 25–80) years underwent 250 reoperations for recurrent goiter (
n
= 203), hyperthyroidism (
n
= 26), or recurrent thyroid cancer (
n
= 17). The mean interval between the initial and the reoperative procedure was 17.5 years. According to the availability of the neuromonitoring system and to the surgeon preference, 91 operations were performed with neuromonitoring (NM-group), whereas 159 were performed with direct nerve visualization (NV-group) alone. Patients’ characteristics, perioperative data, and postoperative complications were collected in a prospectively maintained database.
Results
In the NM-group, 51 unilateral and 40 bilateral resections were performed. The NV-group included 122 unilateral and 37 bilateral procedures. The number of nerves at risk after previous surgery was 128 (NM-group) and 161 (NV-group), respectively. We registered eight RLN palsy in the NM-group (6.2 %) and four in the NV-group (2.5 %;
p
= 0.1).
Conclusions
The routine use of intraoperative neuromonitoring seems not to reduce the incidence of RLN during redo thyroid surgery, at least in the setting of a tertiary referral center.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Vanadium(V) complexes predominantly of composition VO(
O
3
N), modeling the active center of vanadate-dependent haloperoxidases, are investigated with respect to (i) their catalytic potential in ...enantio-selective oxidation by peroxide of prochiral sulfides, and (ii) their in vitro cytotoxicity and insulin-mimetic ability towards fibroblast cell cultures. The peroxidation of methyl-tolylsulfide with cumyl-hydroperoxide, which is related to the sulfideperoxidase activity of haloperoxidases, is catalyzed by (
RRR)-VO(OMe)L H
2L=(
R,
R)-bis(2-phenylethanol)-(
R)-1-phenylethylamine as well as by a mixture of VO(O
iPr)
3 and H
2L to an enantiomeric excess (ee) of 25%. The crystal and molecular structures of (
RRR)-VO(OMe)L · 1/2MeOH are reported. In the context of the phosphatase activity of the apo-haloperoxidases, possible modes of action of vanadium compounds in insulin-mimesis are addressed. In vitro results for seven oxovanadium(IV) and -(V) coordination compounds show that, at essentially non-toxic concentrations
c(V)<0.1 mM, the compounds trigger glucose intake into human and simian virus modified mice fibroblasts, in several cases at a higher level than insulin.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Introduction
Cortical-sparing adrenalectomy in bilateral pheochromocytomas offers a postoperative corticoid-free course and has to be balanced against the risk of local recurrence. In this study we ...report our experience with the minimally invasive cortical-sparing adrenalectomy in patients with bilateral pheochromocytomas.
Methods
From January 1996 to February 2011, 66 patients (45 men, 21 women; mean age 36 ± 16 years) were treated for bilateral pheochromocytomas. Fifty-seven patients (88%) were affected by genetic diseases. In 32 patients surgery was synchronously performed on both side, in 34 cases adrenalectomy followed previous surgery. All in all, 101 operations (47 right, 54 left) were conducted using the retroperitoneoscopic access (
n
= 97) or the laparoscopic route (
n
= 4).
Results
The mortality in our series was zero. Postoperative complications included one patient with a bleeding requiring reoperation and one patient developing a cerebral stroke on the fifth postoperative day. The mean operative time was 67 ± 26 min for unilateral adrenalectomy and 128 ± 68 min for bilateral surgery (range 25–300 min). A cortical-sparing resection was possible in 89 procedures resulting in a corticoid-free postoperative course in 60 patients (91%). A postoperative corticosteroid substitution therapy was necessary in six patients. During a median follow-up period of 48 months, one patient showed a persistent disease and needed reoperation, none developed a recurrent disease.
Conclusion
Cortical-sparing surgery for bilateral pheochromocytomas has a low recurrence rate and avoids lifelong cortisone substitution therapy in the majority of cases.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
