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At least 883 records · Page 49Linked to original sources
PubMed2000

Anesthetic aspects of laparoscopic and open adrenalectomy for pheochromocytoma.

OBJECTIVES: To compare the anesthetic aspects and intraoperative hemodynamic data and immediate postoperative outcomes in patients whose pheochromocytoma resection was performed either laparoscopically or by traditional open surgery. METHODS: Fourteen consecutive patients who underwent laparoscopic procedures (a single surgeon) were compared with 20 patients who underwent open surgery. The patients' records were reviewed for demographic information, preoperative medical history and therapy, intraoperative hemodynamic data, fluid balance, and immediate postoperative course. RESULTS: No differences between the highest intraoperative blood pressures and number of hypertensive episodes between the two groups were found. However, in laparoscopic patients, the intraoperative hypotension was less severe (mean lowest blood pressure 98/57 mm Hg versus 88/50 mm Hg, P = 0.05), and the hypotensive episodes were less frequent (median 0 versus 2, P = 0.005) and required fewer interventions with vasopressors (P = 0.02). Extreme high and extreme low heart rates did not differ between the two groups. The estimated blood loss was lower in the laparoscopic group (P = 0.0001), but the total intraoperative fluid requirement and operative times were similar in the two groups. Patients in the laparoscopic group resumed walking earlier (median 1.5 versus 4 days, P = 0.002) and resumed oral food intake sooner (median 1 versus 3.5 days, P = 0.0001). The median duration of hospitalization in patients who underwent laparoscopic and open adrenalectomy was 3 and 7.5 days, respectively (P = 0.001). CONCLUSIONS: Intraoperative hemodynamic values during laparoscopic adrenalectomy for pheochromocytoma were comparable to those of traditional open surgery, but the patients who underwent the laparoscopic procedure had a faster postoperative recovery.

Adolescent↗
PubMed2001

Laparoscopic adrenalectomy: retroperitoneal approach.

The most important procedure in retroperitoneoscopic adrenalectomy is en bloc dissection of the perinephric fat, including the upper pole of the kidney and the adrenal gland, from the surrounding muscles (transversus abdominalis, psoas, and diaphragm) just inside Gerota's fascia. It is not recommended that the surgeon directly identify the adrenal gland at the start of the operation. After dividing the perinephric fat between the adrenal gland and kidney, the upper pole of the kidney is exposed, and dissection proceeds along the renal surface. The lateral retroperitoneoscopic approach promises to be a safer and less invasive treatment for patients with small unilateral adrenal tumors. In all cases, careful patient selection and correct choice of the surgical approach based on tumor size, the patient's condition, and the surgeon's skill are vital to avoid complications during laparoscopic adrenalectomy.

Adolescent↗
PubMed1997

Technique of laparoscopic adrenalectomy.

Laparoscopic adrenalectomy by the transperitoneal route has been shown to be a safe and effective approach to select adrenal pathology. Although the specific indications will continue to be refined, it is clear that for adrenal masses of 6 cm or less, laparoscopy provides excellent access with little additional risk to the patient. In addition there appears to be an improved postoperative course when compared with open adrenalectomy. This latter point, however, requires careful prospective studies to confirm this impression objectively. The operative times are longer by the laparoscopic approach, but undoubtedly these times will decrease with increasing experience and improved laparoscopic instrumentation.

Adrenalectomy↗
PubMed1996

NADPH-diaphorase activity and vasopressin in the paraventricular nucleus of the hypothalamus following adrenalectomy.

In order to investigate novel neuroendocrine functions of the nitric oxide synthesizing enzyme a combined histochemical and immunocytochemical study focused on the paraventricular nucleus of the hypothalamus was conducted to check a possible influence of bilateral adrenalectomy on three different neuronal populations, NADPH diaphorase (ND)-positive, vasopressin (VP)-immunoreactive and neurons expressing both markers. In the adrenalectomized animals, a slight increase (P > 0.05) of the number of ND magnocellular neurons was detected, whereas no changes were observed in the ND-parvicellular population and in the neurons showing coexistence (magno- and parvicellular) (P > 0.05). By contrast, following bilateral adrenalectomy, a significant increase (P < 0.05) in the VP-parvicellular population (anterior, medial and periventricular subdivisions) was detected, which was reversed when the animals received daily doses of corticosterone. These results suggest that nitric oxide is not closely related to the hypothalamic regulation of the adenocorticotropin secretion exerted by the paraventricular nucleus.

Adrenal Glands↗
PubMed1998

The effects of fetal adrenalectomy at 110 days gestational age on AVP and CRH mRNA expression in the hypothalamic paraventricular nucleus of the ovine fetus.

AVP and CRH produced in the parvocellular neurons of the paraventricular nucleus (PVN) have both been implicated in the regulation of anterior pituitary ACTH synthesis and secretion. In sheep, fetal ACTH secretion increases around 120 days gestational age (dGA). Little is known about adrenal regulation of AVP and CRH immediately prior to this critical period. We investigated the effects of adrenalectomy and subsequent cortisol (F) administration on PVN AVP and CRH mRNA in the fetal sheep PVN at 109-125 dGA. At 109-113 dGA, fetal sheep adrenals were removed (ADX)(n = 8); or sham surgery performed (CONT)(n = 4). From day 6 post ADX, maternal plasma cortisol and fetal plasma ACTH and cortisol levels were determined daily by radioimmunoassays. From day 7 post ADX, cortisol (4 micrograms/min) was continuously infused intravenously to four ADX fetuses (ADX + F). Fetal hypothalami were collected at 123-125 dGA, and studied by in-situ hybridization and quantitative autoradiography for AVP and CRH mRNA. Plasma cortisol levels remained low in CONT and ADX fetuses (< 4.9 ng/ml), while during cortisol infusion to ADX + F fetuses, plasma F increased to 16.4 +/- 2.2 and 22.3 +/- 3.2 ng/ml (mean +/- S.E.M.) on day 10 and 13, respectively. Plasma ACTH levels increased significantly in ADX compared with CONT fetuses. This ACTH increase was completely suppressed in ADX + F fetuses. AVP mRNA abundance in the whole PVN was the same in all three groups, however, a separate analysis of AVP mRNA abundance in parvocellular and magnocellular regions of the PVN revealed that AVP mRNA in the parvocellular PVN showed a significant increase in ADX and suppression in ADX + F fetuses when compared to CONT. AVP mRNA in the magnocellular PVN remained unchanged. PVN CRH mRNA expression was augmented in ADX and suppressed in ADX + F when compared to CONT fetuses. We conclude that in fetal sheep at 109-125 dGA: AVP and CRH mRNA abundance in the parvocellular region of the PVN are increased by adrenalectomy and that cortisol inhibits this increase.

Adrenal Glands↗
PubMed2000

Fasting, but not adrenalectomy, reduces transport of leptin into the brain.

Food deprivation and adrenalectomy are associated with low concentrations of leptin in blood and the absence of obesity. Because leptin is known to cross the blood-brain barrier (BBB) by a saturable transport system, we examined whether fasting and adrenalectomy (ADX) also act at the BBB. Multiple-time regression analysis showed that fasting, but not ADX, significantly decreased the entry of leptin into mouse brain. After 3 days of food deprivation, the influx of leptin became indistinguishable from that of the vascular control (albumin); 5 h of refeeding significantly reversed this reduced rate of influx. Thus, the results indicate that the BBB provides a dynamic site for the regulation of physiological processes involving leptin.

Adrenalectomy↗
PubMed1998

Effects of adrenalectomy and glucocorticoid receptor antagonist, RU38486, on pituitary growth hormone-releasing hormone receptor gene expression in rats.

We examined the effects of adrenalectomy and a glucocorticoid receptor antagonist, RU38486, on pituitary GH-releasing hormone (GRH) receptor gene expression in rats. GRH receptor mRNA levels were significantly decreased in adrenalectomized rats and replacement of dexamethasone reversed the decrease to normal. GH secretion was inhibited by adrenalectomy, whereas dexamethasone replacement failed to restore the impaired GH secretion. A high dose of RU38486 had an agonistic effect on GRH receptor mRNA levels. These results suggest that endogenous glucocorticoid is necessary for normal expression of pituitary GRH receptor mRNA in rats.

Adrenalectomy↗
PubMed2005

[Laparoscopic adrenalectomy in adrenal carcinoma].

There is general agreement on the suitability of the laparoscopic approach for benign adrenal lesions against open procedures because of the efficacy and less morbidity. For suspected adrenal malignancies laparoscopic use is controversial. We report our experience in 6 cases of laparoscopic adrenalectomy in patients with the suspicion of adrenal malignancy confined in the gland. In medium a follow up of 24 months (range 12 to 48 months) we observed no recurrences. We concluded that in a suspected adrenal malignancy organ confined laparoscopic adrenalectomy presents the advantage compared with open surgery of reduced morbidity and similar results in the follow up of the patient.

Adrenal Gland Neoplasms↗
PubMed1998

Adrenalectomy-induced neuronal degeneration.

The binding of glucocorticoids to CNS receptors results in the modulation of many processes, ranging from neurotransmission to cell birth and death. It is of no surprise, therefore, that the removal of these steroids following adrenalectomy disrupts a variety of physiological functions throughout the brain. It is the aim of this review to briefly describe the findings of research examining some of these glucocorticoid-mediated CNS effects; however, as many of these areas have been reviewed extensively by others, this review will focus on the recently described phenomenon, adrenalectomy-induced hippocampal cell death.

Adrenalectomy↗
PubMed2001

Morphological and functional properties of rat dentate granule cells after adrenalectomy.

After complete adrenalectomy, part of the granule cells in the dentate gyrus undergo apoptosis. Findings on morphological changes in non-apoptotic granule cells, though, have been equivocal. In the present study we examined the dendritic trees of dentate granule cells 7 days after adrenalectomy or sham operation, and tested the hypothesis that changes in dendritic trees have considerable consequences for ionic currents, as measured in the soma with whole cell recording. For the latter, we focussed on voltage-gated calcium currents, which are partly generated in distal dendrites. All cells were passively filled with a fluorescent dye via the patch pipette while recording calcium currents; subsequently the cells were three-dimensionally reconstructed with the use of a confocal microscope. In sham-operated rats, dendritic trees of cells with a soma located in the inner part of the granule cell layer (facing the hilus) were significantly smaller than trees of cells located in the outer part of the layer. Neurons from rats that had extremely low (undetectable-0.3 microg/dl) circulating levels of corticosterone displayed very small and simple dendritic trees compared to cells from adrenalectomized rats that still had residual levels of corticosterone (0.6-1.0 microg/dl), regardless of the location of their soma. Despite the observation that simple dendritic trees were seen in rats where corticosterone was extremely low, the whole cell calcium current amplitude recorded from the soma of these cells was not reduced compared to the remaining cells from adrenalectomized or sham-operated rats. Our data indicate that in the absence of corticosterone dendritic trees of dentate granule cells display atrophy but that this does not necessarily reduce ionic currents measured in the soma.

Adrenalectomy↗
PubMed2002

Adrenalectomy abolishes the food-induced hypothalamic serotonin release in both normal and monosodium glutamate-obese rats.

Corticosteroids influence energy homeostasis through centrally-mediated stimulation of energy intake and inhibition of expenditure, while central serotonin (5-HT) has opposite effects. Both serotonergic dysfunction and high glucocorticoid levels may be relevant in obesity. The neurotoxin monosodium glutamate (MSG) induces a non-hyperphagic and hypometabolic obesity with hypercorticosteronemia. We investigated the influence of corticosterone levels on the serotonergic system of MSG-obese and control rats. Applying microdialysis, we found a similar feeding-induced stimulation of serotonin release in the lateral hypothalamus (LH) in sham-adrenalectomized control and MSG rats. The concomitant serum corticosterone variations were markedly distinct between them, in that an increase occurred in the control group, while the initially high levels of the MSG rats decreased with feeding. It is suggested that this lowering of corticosterone prevented a higher serotonergic activation, which would lead to a higher meal-induced thermogenesis and a better adequation of the caloric intake to a low metabolism. Adrenalectomy completely abolished the feeding-evoked serotonergic stimulation in both groups. This observation demonstrates that glucocorticoids are necessary for food intake to acutely stimulate 5-HT release and indicates that serotonergic activity in the LH is not likely to participate in the adrenalectomy-induced attenuation of the MSG-obesity.

Adrenalectomy↗
PubMed2000

Laparoscopic adrenalectomy: posterior approach.

Adrenalectomy for benign adrenal diseases is currently performed by transperitoneal laparoscopy. The transperitoneal approach, however, invades the intraperitoneal cavity, and may cause injury to the abdominal organs. The posterior lumbar approach allows direct access to the main adrenal vascular supply before the gland is manipulated. Retroperitoneoscopic adrenalectomy by this approach is technically feasible and most effective as regard to the simplicity of vascular control. The operating time, perioperative morbidity and cost have been reduced with this approach.

Adrenalectomy↗
PubMed2000

Laparoscopic adrenalectomy: transperitoneal vs retroperitoneal approaches.

PURPOSE: To compare the results between transperitoneal and retroperitoneal approaches. MATERIALS: Between 17 January 1992 and 31 December 1997, 76 patients (31 men and 45 women, 37 right and 37 left, mean 46.7 years old) with adrenal tumors including 37 primary aldosteronism. 19 Cushing's syndrome, 15 non-functioning adrenal tumors, and five pheochromocytomas, underwent laparoscopic removal operations in one hospital. Fifty-seven open adrenalectomies were also included. METHODS: Fifty-two patients by transperitoneal laparoscopic approach, and the other 24 patients by retroperitoneal laparoscopic approach were compared. RESULTS: Mean operative time, operative blood loss, time to oral intake, and ambulation of transperitoneal approach were 203 min, 115.6 mL, 1.9 days, and 1.4 days. In patients operated on by the retroperitoneal approach, these factors were 257 min, 141.6 mL, 1.1 days, and 1.4 days. There was no significant difference in any item between the two groups. In patients operated on by open procedure, these factors were 143 min, 214 mL, 2.5 days, and 2.4 days. Operating time of the open surgery group was significantly shorter than either of the other two groups, and all of the other three items of open surgery group were significantly greater than either of the other two groups. Open surgery was required in two of 76 patients treated by endoscopic procedure due to inadvertent injury of the anomalous adrenal vein during the transperitoneal approach, and pancreatic injury during the retroperitoneal approach. During and after the operation, no significant complication was observed. CONCLUSION: Both transperitoneal and retroperitoneal laparoscopic adrenalectomies are feasible for adrenal tumors.

Adrenal Gland Neoplasms↗
PubMed2000

Complications of laparoscopic and retroperitoneoscopic adrenalectomies in 370 cases in Japan: a multi-institutional study.

A total of 370 laparoscopic adrenalectomies, including 311 transperitoneal (TP) and 59 retroperitoneal (RP) approaches, were performed in nine urologic centers, where the laparoscopic adrenalectomy was first begun independently in Japan, and their affiliated hospitals between January 1992 and September 1996. The clinical diagnoses of those 370 adrenal diseases were primary aldosteronism in 155 patients, Cushing's syndrome in 61. preclinical Cushing's syndrome in 21. pheochromocytoma in 16, nonfunctioning adenoma in 87, complicated cyst in ten, myelolipoma in nine, adrenal cancer in four and other diagnoses in eight (table 1). There was no mortality in this series. Intraoperative complication rate was 33/370 (9%) in total: 26/311(8%) in the TP procedures and 7/59 (12%) in the RP procedures (table 11). Postoperative complication rate was 24/370 (6%) in total: 22/311 (7%) in the TP procedures and 2/59 (3%) in the RP ones (table 111). Conversion rates to open surgery in total, in the TP and in the RP procedures were 13/370 (3.5%), 10/311 (3.2%) and 3/59 (5.1 %). respectively (table IV). Although the RP procedure has a lower morbidity rate compared to the TP procedure, more skill is required to overcome the drawback of the narrow working space and fewer anatomical landmarks.

Adenoma↗
PubMed2002

Laparoscopic partial adrenalectomy.

Since corticosteroids are indispensable hormones, partial or cortical-sparing adrenalectomies may be adopted for the surgical treatment of adrenal diseases. In this article, we describe the technique and results of these procedures. Laparoscopic partial or cortical-sparing adrenalectomy has been performed in 10 patients. Seven cases had an aldosterone-producing adenoma (APA) and three had a pheochromocytoma. Three cases with an APA and a case with a pheochromocytoma had tumors located far from the adrenal central vein, and the vein could be preserved. Four cases with an APA and two with a pheochromocytoma had tumors located close to the adrenal central vein, and it was necessary to section the central vein to resect them. All endoscopic procedures were performed successfully. There were no postoperative complications. At follow-up, adrenal 131I-adosterol scintigrams showed the preservation of remnant adrenal function in all patients. Laparoscopic partial or cortical-sparing adrenal surgery was safely performed, and adrenal function was preserved irrespective of whether the adrenal central vein could be preserved or not. We consider this to be a useful operative technique for selected cases.

Adrenal Gland Neoplasms↗
PubMed1998

Adrenalectomy and dexamethasone treatment alter the patterns of basal and acute phase response-induced expression of acute phase protein genes in rat liver.

Hormonal requirements for full hepatic expression of alpha2-macroglobulin (alpha2M), alpha1-acid glycoprotein (AGP), haptoglobin (Hp) and gamma-fibrinogen (Fb) were assessed at the level of mRNA. Prior to exposure to turpentine-induced inflammation, rats were either depleted of glucocorticoids by adrenalectomy or supplemented with an excess of dexamethasone. Adrenalectomy alone did not affect the basal level of acute phase protein (APP) expression except for alpha2M mRNA, the level of which was enhanced. In contrast, dexamethasone treatment alone promoted full induction of alpha2M, significant, but not maximal increase of AGP and Hp mRNAs and suppression of Fb. In adrenalectomized rats, acute phase (AP)-cytokines, released in response to inflammation, promoted full expression of Fb and Hp and increased the level of AGP mRNA whereas alpha2M mRNA remained at the basal level. Inflammation in dexamethasone pretreated rats elicited changes which, in comparison to mRNA values for dexamethasone unpretreated inflamed rats, were seen as overexpression of alpha2M, full expression of AGP and incomplete expression of Hp, whereas Fb mRNA remained at the basal level. These data suggest that glucocorticoids are the principal inducers of alpha2M and AP-cytokines of Fb. For full induction of AGP, additive actions of glucocorticoids and AP-cytokines are required whereas expression of Hp is predominantly controlled by AP-cytokines.

Acute-Phase Proteins↗
PubMed2006

Long-term disease-free survival after adrenalectomy for isolated colorectal metastases.

Metastasis to the adrenal glands occurs in approximately 16% of patients with metastatic colorectal carcinoma. Historically, these metastases are found at autopsy, but due to improved imaging and diagnostic techniques, many of these lesions are now discovered on routine follow-up imaging. In general, adrenal metastasis is an indicator of widespread disease, but in rare cases, isolated adrenal metastasis can be found. Although potential improvement in overall survival after adrenalectomy for isolated colorectal metastases has been reported, there has only been one long-term disease-free survivor reported. Here, we report a patient who is a 7-year disease-free survivor after adrenalectomy for an isolated colorectal metastasis.

Adenocarcinoma↗