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Biomedical subjects

S G Sheps

Publications and source records attributed to S G Sheps.

155 records · Page 9Linked to original sources
PubMedDate not supplied

Long-term evaluation following resection of apparently benign pheochromocytoma(s)/paraganglioma(s).

In the absence of distant disease, the pathologic diagnosis of malignancy in pheochromocytoma or paraganglioma is impossible. In an effort to establish the true incidence of recurrence in this disease, we have analyzed long-term follow-up (average, 15.8 years) of 98 patients who underwent complete resection of localized, noninvasive, histologically-benign pheochromocytomas and paragangliomas at our institution between 1960 and 1976. Eighty-eight patients had nonfamilial, sporadic pheochromocytoma/paraganglioma. Nine had multiple endocrine neoplasia (MEN) type 2 (2A: 7, 2B: 2), and 1 had familial pheochromocytoma. Seventy-nine patients had single pheochromocytomas; 10 had single extraadrenal tumors (paragangliomas); and 9 had multicentric or bilateral adrenal tumors. Six patients (6.5%) developed recurrent pheochromocytoma after documentation of normal postoperative urinary catecholamine levels. One of these patients had MEN 2A. The recurrences developed at intervals from 5 to 13 years following initial resection. These were distant in 3 patients, local in 2, and both local and distant in a single patient. None of the recurrences occurred in the 13 patients who, on pathologic rereview, had either local or vascular invasion. No paraganglioma recurred. Life-long follow-up of all patients who have had pheochromocytomas or paragangliomas resected is mandatory.

Adolescent↗
PubMedDate not supplied

The value of two-dimensional echocardiography and Doppler examination in the assessment of hypertensive patients: a pilot study.

There has been hesitation in accepting the routine use of echocardiography in patients with hypertension. The concept of "limited" or "focused" echocardiography has been introduced but incompletely evaluated. In this prospective observational cohort study, 100 consecutive hypertensive adults underwent comprehensive two-dimensional echocardiography and Doppler assessment regardless of referral question. Patients were categorized on the basis of echocardiographic referral questions into two groups: (1) determination of left ventricular mass only (limited echocardiography) and (2) determination of left ventricular mass and associated cardiac problems. In group 1, missed diagnoses were rare (5%). Additional, clinically relevant information was provided by comprehensive echocardiography in 9% of patients. Doppler echocardiography did not provide any additional useful information in group 1 but was useful in group 2. In both groups, echocardiography affected clinical management. In patients referred for determination of left ventricular mass only, the equivalent of limited echocardiography, missed diagnoses are rare. Additional, clinically relevant information is provided in only a small number of patients by comprehensive two-dimensional echocardiography. Comprehensive two-dimensional echocardiography, including Doppler echocardiography, was useful in selected patients referred with hypertension and other cardiac problems and should be part of the echocardiographic assessment of such patients. With careful selection of hypertensive patients, limited echocardiography can be a cost-effective strategy.

Cost-Benefit Analysis↗
PubMedDate not supplied

Cold pressor test as a predictor of hypertension.

To determine the usefulness of the cold pressor test as a predictor of hypertension, we compared the blood pressure recordings available from 142 patients in 1979 with readings obtained during performance of two cold pressor tests, the first in 1934 when these subjects were children, and the second in 1961. Forty-eight subjects were hyperreactors to the tests in either 1934 or 1961, and 94 were normoreactors. At last follow-up, blood pressures in 14 of the hyperreactors were between 140 and 160 mm Hg systolic or 90 and 100 mm Hg diastolic (Stratum 1) and in 20 exceeded 160 mm Hg systolic or 100 mm Hg diastolic (Stratum 2). Ten normoreactors had casual blood pressures in Stratum 1 and eight in Stratum 2. Hypertension had thus occurred in 71% of the hyperreactors and 19% of the normoreactors. Fifteen hyperreactors were receiving antihypertensive therapy, and this reduced the severity of the casual blood pressure elevation in most patients to Stratum 1. Antihypertensive therapy had been started in three normoreactors. The duration of follow-up, 45 years, and the mean age at follow-up, almost 57 years, were greater in this study than in any previously reported study. Early hyperreactivity was related to future hypertension in enough subjects to suggest that an abnormal response to an external cold stimulus may be useful as an indicator of future hypertension.

Adolescent↗