scholarly journals Эндогенный гиперкортизолизм: достижения и перспективы в диагностике и лечении

2021 ◽  
Vol 23 (3) ◽  
pp. 9-16
Author(s):  
Nicolay A. Maistrenko ◽  
Pavel N. Romashchenko ◽  
Vsevolod Yu. Cherebillo ◽  
Vitaly S. Dovganyuk

The results of examination and treatment of 647 patients with endogenous hypercortisolism were studied: pituitary corticotropinoma was detected in 494 (76.4%) patients, corticosteroma and pre corticosteroma of the adrenal gland in 142 (21.9%), bilateral macro-nodular hyperplasia of the adrenal glands of primary adrenal origin-in 11 (1.7%). Differential diagnosis of clinical forms of endogenous hypercortisolism was based on the assessment of the level of adrenocorticotropic hormone and cortisol, both in peripheral blood, and with selective bilateral blood sampling from the adrenal veins and lower stony sinuses, and the study of the nature of samples with 8 mg of dexamethasone. Topical diagnostics consisted in assessing the state of the adrenal glands and pituitary gland during computed tomography and magnetic resonance imaging with the use of contrast agents, and the use of special software 3D-Volume Rendering Technique allowed optimizing tactical and technical approaches to performing surgical interventions. Of the operated patients with adrenocorticotropic hormone dependent endogenous hypercortisolism, total removal according to the control magnetic resonance imaging was achieved in 92.3% of cases, subtotal in 7.7%. However, hormonal remission was achieved only in 82.4% of cases. All patients with corticosteroma and pre-corticosteroma of the adrenal gland underwent adrenalectomy: in 6 patients by open method, in 136 patients by endovideosurgical method (in 11 patients by laparoscopic method, in 124 patients by retroperitoneoscopic method, and in 1 patient by thoracoscopic transdiaphragmatic adrenalectomy). In all patients, the operation led to recovery. Patients with benign macronodular hyperplasia of the adrenal glands needed conservative treatment with steroidogenesis blockers. Indications for surgical treatment in the volume of unilateral adrenalectomy occurred only in 2 patients.

1990 ◽  
Vol 14 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Richard B. Rafal ◽  
Peter A. Kosovsky ◽  
John A. Markisz

1986 ◽  
Vol 8 (1) ◽  
pp. 127-138 ◽  
Author(s):  
Reuben Mezrich ◽  
Marc P. Banner ◽  
Howard M. Pollack

2021 ◽  
Author(s):  
Jeanette Henkelmann ◽  
Timm Denecke ◽  
Philipp Pieroh ◽  
Stephanie Einhorn ◽  
Nicolas H. von der Hoeh ◽  
...  

Abstract Background:Due to the unspecific symptoms of spondylodiscitis (SpD), an early radiological examination is necessary. However, controversially discussed is the need for magnetic resonance imaging of the entire spine to exclude multisegmental infections and to determine the required surgical interventions. The aims of this study were to assess the incidence of multilevel non-contiguous pyogenic SpD and compare comorbidities, pain symptoms, and subsequent surgical strategies between unifocal (uSpD) and multifocal (mSpD) SpD.Methods:We retrospectively evaluated the data of patients with confirmed, surgically treated, pyogenic SpD who had received a total spine MRI in a single spine center between 2016 and 2018. MRI findings were classified according to Pola-classification and demographics, duration of clinical symptoms (pain and neurology) and Charlson Comorbidity-Index (CCI) results were compared between uSpD und mSpD groups. Surgical therapy was evaluated in patients with mSpD. Results: uSpD was detected by MRI in 69 of 79 patients (87 %). Of these, mSpD was detected in 10 patients (13%) with 21 infected segments (cervical and/ or thoracic and/ or lumbar region). Age and CCI were similar between uSpD and mSpD and 24 of all SpD regions were clinically unapparent. All patients with uSpD were treated operatively. In seven patients with mSpD, all infected levels of the spine were treated surgically in a one-stage procedure; one patient had a two-stage procedure and one patient had surgery at the lumbar spine, and an additional infected segment of the upper thoracic spine was treated conservatively. One patient died before a planned two-stage procedure was performed.Conclusions:Due to mSpD being found in approximately 13% of SpD cases, and considering the risk of overlooking an mSpD case, MRI imaging of the total spine is recommended. The detection of multiple infection levels can have an impact on the therapeutic strategy chosen.


2005 ◽  
Vol 26 (3) ◽  
pp. 162-171 ◽  
Author(s):  
Nomdo S. Renken ◽  
Gabriel P. Krestin

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
İhsan Yıldız ◽  
Yavuz Savaş Koca ◽  
Sezayi Kantar

Background. The anatomical variability of bile ducts can leave surgeons in very difficult conditions.Ultrasonography, computed tomography, magnetic resonance imaging (MRCP) and endoscopic imaging methods are used in diagnosis. In addition to conservative approaches, endoscopic procedures and laparoscopic or open surgical interventions may be necessary for treatment. In this article, we present a case of aberrant bile duct in left triangular ligament (appendix fibrosa hepatis), which is rarely seen. Case. We report the case of a 67-year-old female patient who was operated on due to dumping syndrome symptoms and hiatal hernia. There was a drainage of bile from the left side of the liver which was placed under the cardioesophageal junction. MRCP found bile esophageal in the left triangular ligament of the liver. Aberrant bile ducts were found in the left triangular ligament and ligated. The patient was discharged on the 7th day after operation. Conclusion. The anatomical variability of bile ducts can leave surgeons in very difficult conditions. We recommend that the dissected left triangular ligament should be ligated for the aberrant bile duct, especially in female patient.


1984 ◽  
Vol 143 (6) ◽  
pp. 1235-1240 ◽  
Author(s):  
CL Schultz ◽  
Haaga ◽  
BD Fletcher ◽  
RJ Alfidi ◽  
MA Schultz

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