scholarly journals The Incidence of Long-Term Adrenal Insufficiency Following Unilateral Adrenalectomy is Low: Case Series and Review of Literature

2019 ◽  
pp. 1-4
Author(s):  
Jay D. Raman ◽  
Augustyna Gogoj ◽  
Brian D. Saunders ◽  
Daniel J.Canter ◽  
Jay D. Raman ◽  
...  
Keyword(s):  
Adrenal Gland ◽  
Adrenal Insufficiency ◽  
Cushing Syndrome ◽  
Case Series ◽  
Large Majority ◽  
Review Of Literature ◽  
Unilateral Adrenalectomy ◽  
Different Types ◽  
One Year

Introduction: Acquired adrenal insufficiency is a known risk of unilateral adrenalectomy. However, the rates of early and prolonged adrenal insufficiency following unilateral adrenalectomy are not well defined in the literature. Patients and Methods: We reviewed a case series of 184 consecutive patients to determine the likelihood of steroid supplementation at 30 days and 1 year following adrenalectomy. 109 lesions were non-functional and 75 (41%) demonstrated functionality, including 33 pheochromocytomas, 20 cortisol-producing adenomas, 19 aldosteronomas, and 3 cases of cortisol-secreting hyperplasia. No patients with a nonfunctional lesion, pheochromocytoma, or aldosteronoma required steroid supplementation following surgery. Eleven of 23 patients (48%) with primary adrenal Cushing syndrome required cortisol supplementation at 30 days, and only 1 patient (4%) necessitated supplementation one year following surgery. Discussion: Approximately 50% of patients with cortisol-producing lesions in the adrenal gland will require supplementation 30-days following surgery. Only 4% will require persistent exogenous steroids at 1-year. Conversely, less than 1% of patients with different types of functional or non-functional tumors required supplementation after surgery. Conclusion: The incidence of adrenal insufficiency following unilateral adrenalectomy is low. A large majority of patients requiring steroid supplementation 30 days following surgery are able to wean off this requirement by 1 year. With this information, we can better counsel our patients and set clearer expectations for the potential need of cortisol supplementation following adrenalectomy

scholarly journals Flat Glass or Crystal Dome Aperture? A Year-Long Comparative Analysis of the Performance of Light Pipes in Real Residential Settings and Climatic Conditions

2020 ◽  
Vol 12 (9) ◽  
pp. 3858 ◽  
Author(s):  
Magda Sibley ◽  
Antonio Peña-García
Keyword(s):  
Comparative Analysis ◽  
Flat Glass ◽  
Climatic Conditions ◽  
Long Term Effect ◽  
Different Types ◽  
The Difference ◽  
The Aesthetic ◽  
One Year ◽  
The One

This paper presents the first comparative study of its type of the performance of light pipes with different types of apertures: a flat glass versus a bohemian crystal dome. Measurements were taken at 20-minute intervals over a period of one year in the bathrooms of two newly built identical houses of the same orientation located in Manchester, UK. The comparative analysis of the data collected for both light pipes types reveals that the crystal domed aperture consistently outperforms the flat glass one. Furthermore, the difference in the recorded horizontal illuminance is most marked during the winter months and at the end of the one-year experiment, indicating that the crystal dome has better performance for low incident winter light and higher resistance for the long term effect of weathering and pollution. This study provides strong evidence based on long term real measurements. Such evidence informs architects’ decisions when weighing up the aesthetic considerations of a flat glass aperture versus the higher illumination levels afforded by a crystal dome aperture with higher resistance to weathering and pollution.

scholarly journals Consecutive Case Series of Healed Single-Molar Sites Immediately Restored with Wide-Diameter Implants: A 1-Year Evaluation

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Hadi Antoun ◽  
Pierre Cherfane ◽  
Bouchra Sojod
Keyword(s):  
Success Rate ◽  
Case Series ◽  
Marginal Bone Loss ◽  
Wide Diameter ◽  
Bone Level ◽  
One Year ◽  
Lost To Follow Up ◽  
Single Crowns

Introduction. To evaluate outcomes of wide-diameter (6 mm) implants immediately provisionalized with cement-retained single crowns in posterior molar sites.Materials and Methods. Forty-eight consecutive patients received a total of 53 moderately rough-surface, 6 mm diameter implants in healed sites. All implants were immediately provisionalized with a cement-retained provisional crown. Final prosthesis with cement-retained porcelain fused to metal crowns was delivered 3–6 months later. Patients were followed up for 1 year. Outcome measures were implant failures and success rate, complications, marginal bone levels, bone level changes, papilla index, bleeding on probing, and inflammation.Results. One patient was lost to follow-up. At one year, the implant survival and success rate were 98.1%. The mean marginal bone loss after 1 year was −0.17±1.84 mm. Ideal papilla score was recorded at 83.8% of the sites. More than 95.6% of the sites showed no bleeding or inflammation. No procedure-related or device-related adverse events were reported.Conclusion. Wide-diameter (6 mm) implants can safely and successfully replace single posterior molars. Longer follow-up studies are necessary to evaluate the long-term success of these implants.

Aortic Valve Intervention During Aortic Root Surgery in Children: A Systematic Review

2020 ◽  
Vol 11 (5) ◽  
pp. 611-618
Author(s):  
Maria Rodriguez ◽  
Anahita Malvea ◽  
Dayre McNally ◽  
Vid Bijelic ◽  
Ming Guo ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Small Sample Size ◽  
Case Series ◽  
Small Sample ◽  
Aortic Root Surgery ◽  
Valve Sparing ◽  
One Year

Background: Pediatric aortic root dilatation is a life-threatening condition that lacks guidelines for surgical management. We aimed to analyze the data on aortic valve interventions during root surgery to guide decision-making. Methods: A search was performed of MEDLINE, Embase, CENTRAL, ClinicalTrials.gov , and WHO ICTRP. Citations were screened in duplicate and independently to identify randomized controlled trials, cohorts, and case series involving populations aged 0 to 18 years, who received valve-sparing and valve-replacing aortic root surgeries between 1999 and 2019. Outcomes considered included mortality (perioperative, one year, five year), reintervention rates. Results: After duplicate removal, 689 citations were screened through abstract and full text review, identifying five eligible studies. All five were observational studies evaluating valve-sparing procedures. There were 81 patients with a mean study age range of 9.9 to 13.9 years. Both reimplantation (74%) and remodeling (26%) subtypes were done. Range of mean duration of follow-up was 1.2 to 4.4 years. There was no mortality reported until the one-year follow-up period. The long-term mortality rate was calculated as 0.02 per patient-year (95% CI: 0.01-0.05). The long-term reintervention rate was 0.08 per patient-year (95% CI: 0.05-0.13). Conclusions: There is limited experience on aortic valve intervention during aortic root surgery in children. Single-arm studies on valve-sparing surgeries show excellent survival up to one year. Mortality and reintervention rates increase in the longer term. The small sample size and lack of controlled studies do not allow for direct comparisons between procedure types.

Simple Techniques for Monitoring Footpath Erosion in Mountain Areas of North-West England

1977 ◽  
Vol 4 (2) ◽  
pp. 145-148 ◽  
Author(s):  
Rosalind A. Coleman
Keyword(s):  
Aerial Photography ◽  
Technical Expertise ◽  
Short Term ◽  
Mountain Areas ◽  
North West ◽  
Different Types ◽  
Different Seasons ◽  
One Year ◽  
Site Types

Very precise measurements of the movement of coarse-textured, unconsolidated materials may be meaningless. Therefore the study of individual processes operating on footpaths may require a different approach. However, for identification of changes of reasonable dimensions, methods such as those described above are inexpensive, quick, and require no technical expertise. It may be argued that, for path management, erosion that is too limited to be measured by these methods is too limited to be a problem. It can certainly be argued that the problem of spatial correlation implies a large number of measurements. What is lost in lack of precision may be more than compensated for by the gain in data from the larger area and wider variation in site-types that it is possible to monitor with such simple techniques.To monitor the effects of recreation in mountain areas, it is desirable to be able to measure any change in path-state and relate this to recreation factors at different seasons and under different sit; -conditions. Three methods of measurement have been considered in this paper, corresponding to three time-scales. Aerial photography has been used to demonstrate trends over the long term, and has proved adequate to differentiate between path sections with differing resistance to erosion.Short-term measurement has been carried out relative to known fixed positions. Two methods are suggested. One is less precise, but simple and widely applicable, and can be used for measurement intervals of six months to one year. The other is more detailed and can be used for measurement intervals of a few days, but is limited in its application by practical considerations.It is suggested that simple techniques used at a large number of different types of site may be more effective than detailed measurements at a few sites.

Is the effect of topical intranasal steroids on obstructive adenoids transient or long-lasting? Case series and systematic review of literature

2016 ◽  
Vol 130 (4) ◽  
pp. 357-362 ◽  
Author(s):  
M A Bitar ◽  
J Nassar ◽  
R Dana
Keyword(s):  
Systematic Review ◽  
Case Series ◽  
Clinical Score ◽  
Review Of Literature ◽  
Long Term Effects ◽  
Positive Effects ◽  
Number Of Patients ◽  
Intranasal Steroids ◽  
One Year ◽  
Cessation Of Treatment

AbstractObjectives:To study and review the short- and long-term effects of intranasal steroids on obstructive adenoids.Methods:In this prospective cohort study, 19 children previously treated with mometasone furoate for 3 months were contacted at 3, 6 and 12 months after cessation of treatment. Main outcome measures included: change in severity of nasal obstruction, allergic rhinitis and obstructive symptoms. A systematic review of literature was also performed.Results:By one year, 25 per cent of patients required adenoidectomy; the remaining children had no significant change in clinical score (p = 0.464), obstruction severity (p = 0.191) or allergic symptoms (p = 0.284). Fourteen pertinent studies were identified; all but one study showed improvement in the patients’ symptoms and/or degree of obstruction. Two studies with follow up reaching 25 months showed positive effects.Conclusion:The short-term positive effect of some intranasal steroids on obstructive adenoids seems to persist in a significant number of patients after the cessation of treatment.

scholarly journals SUN-189 A Case of Delayed Hypoaldosteronism Following Unilateral Adrenalectomy for Primary Aldosteronism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Julie Schommer ◽  
Amal A Shibli-Rahhal
Keyword(s):  
Adrenal Gland ◽  
Plasma Renin Activity ◽  
Potassium Chloride ◽  
Primary Aldosteronism ◽  
Plasma Renin ◽  
Renin Activity ◽  
Endocrine Society ◽  
Unilateral Adrenalectomy ◽  
One Year ◽  
Aldosterone To Renin Ratio

Abstract BACKGROUND: Hypoaldosteronism occurs in 6–30% of patients following unilateral adrenalectomy for primary aldosteronism. The Endocrine Society guidelines recommend discontinuing potassium supplementation and spironolactone postoperatively with repeat renin and aldosterone after surgery to monitor for cure. Clinical Case: A 69-year-old male with a 15-year history of hypertension on amlodipine 10 mg daily, atenolol 100 mg daily, terazosin 5 mg daily, valsartan 160 mg daily, spironolactone 50 mg three times daily, with longstanding hypokalemia on potassium chloride 20 mEq four times daily presented with an ischemic stroke and persistent hypertension (BP 182/79). Following discontinuation of spironolactone, evaluation revealed aldosterone concentration of 214 ng/dL (normal 4.0 - 31) and plasma renin activity of 0.1 ng/mL/hr (normal 0.5 - 4.0), giving an aldosterone-to-renin ratio of 2,140. CT of the abdomen showed a 3 cm right adrenal mass. He underwent uncomplicated right adrenalectomy for primary aldosteronism. Postoperative potassium was 3.4 mEq/L (normal 3.5–5.0) and hypertension persisted, so he was discharged on potassium chloride 10 mEq, losartan 100 mg daily, amlodipine 10 mg daily, and labetalol 200 mg twice daily. Two weeks later potassium level was 5.1 mEq/L and potassium chloride supplement was discontinued. Six months postoperatively, potassium was 5.7 mEq/L with well-controlled blood pressure, so losartan was discontinued. Labs over the subsequent several weeks showed persistent hyperkalemia up to 6.2 mEq/L and new hyponatremia to 128 mEq/L (normal 134 - 150). Repeat plasma renin activity was 0.51 ng/mL/hr and aldosterone concentration <1.0 ng/dL. Morning cortisol concentration was 18.3 ug/dL (normal 6.7 - 22.6) and ACTH 38 pg/mL (normal 6.0 - 50 pg/mL). He was diagnosed with postsurgical hypoaldosteronism. Potassium stabilized at 5.1 mEq/L and sodium stabilized at 134 mEq/L, so he was monitored without treatment for hypoaldosteronism. One year postoperatively his labs showed: potassium 5.1 mEq/L, sodium 135 mEq/L, renin 1.0 ng/mL/hr, and aldosterone 5.7 ng/dL. Conclusion: This patient had primary aldosteronism leading to suppression of aldosterone secretion from the contralateral healthy adrenal gland. This resulted in postoperative hypoaldosteronism once the affected adrenal gland was resected. This case demonstrates the need for continued monitoring of potassium, sodium, renin, and aldosterone following unilateral adrenalectomy for primary aldosteronism, especially in the setting of postoperative angiotensin receptor blocker use or other medications which can affect the renin-angiotensin-aldosterone system.

scholarly journals Transperitoneal laparoscopic adrenalectomy: a review and single-center experience

2014 ◽  
Vol 8 (4) ◽  
pp. 533-539
Author(s):  
Kamol Panumatrassamee ◽  
Manint Usawachintachit ◽  
Supoj Ratchanon ◽  
Apirak Santi-ngamkun
Keyword(s):  
Adrenal Gland ◽  
Laparoscopic Adrenalectomy ◽  
Complete Resolution ◽  
Cushing Syndrome ◽  
Secondary Hypertension ◽  
Complication Rates ◽  
Open Approach ◽  
Unilateral Adrenalectomy ◽  
Estimated Blood Loss ◽  
Adrenal Gland Tumors

Abstract Background: Laparoscopic adrenalectomy (LA) is the preferred approach to adrenal gland tumors. Objective: To evaluate the perioperative and functional outcomes of transperitoneal LA. Methods: We retrospectively reviewed data of all consecutive patients who underwent transperitoneal LA at our institution between April 2000 and December 2011. Results: Two hundred two patients with mean age of 46 years were included in the study. There were 109 left, 89 right, and 4 bilateral tumors. Preoperative diagnosis included 126 aldosterone-producing adenomas (APA), 33 patients with Cushing syndrome, 19 pheochromocytomas, 20 nonfunctional tumors, and 4 adrenal metastases. Mean tumor size was 3.3 cm (range 0.4-22 cm). Mean operative time was 109 min and estimated blood loss 90 mL for unilateral adrenalectomy; and 195 min and 300 mL for bilateral adrenalectomy. Four patients with pheochromocytoma required transfusion and 2 required conversion to an open approach. Seven intraoperative complications and 18 30-day postoperative complications occurred. These included 5 major complications (Clavien-Dindo grade 3-5). Ninety-seven percent of APA patients had normal serum potassium levels after surgery. Among the patients with functioning endocrine tumors, complete resolution rate from secondary hypertension was significantly higher in the pheochromocytoma group compared with those with APA or Cushing syndrome (82% vs. 48% vs. 68% respectively, p = 0.02). Mean follow up was 35.2 months. Conclusion: LA is the treatment of choice for most adrenal gland tumors with excellent outcomes and low complication rates. There was a high chance for complete resolution of secondary hypertension after surgery for pheochromocytoma.

scholarly journals Amelogenesis imperfecta: A case series

2021 ◽  
Vol 7 (3) ◽  
pp. 145-148
Author(s):  
Jijin M J ◽  
Thabsheera P P ◽  
Mohamed Labeeb K P ◽  
Anjana R
Keyword(s):  
Dental Treatment ◽  
Tooth Development ◽  
Genetic Disorders ◽  
Case Series ◽  
Gene Mutations ◽  
Amelogenesis Imperfecta ◽  
Clinical Case Study ◽  
Different Types

Amelogenesis imperfecta (AI) refers to a group of rare genetic disorders that involve tooth development and that are passed down through families as a dominant trait. This condition is characterized by abnormal enamel formation caused by gene mutations that alter the quality and/or quantity of enamel. This dental problem can impact both primary and permanent dentition, varies among affected individuals, and results in esthetic and functional problems. The treatment planning for patients with AI is related to many factors, including the age of the patient, the type and severity of the disorder, intraoral conditions, and the socioeconomic status of the patient. It is crucial to plan a proper remedy, which requires collaboration among dental specialties to execute comprehensive dental treatment in order to provide a long-term solution with adequate esthetics. This clinical case study looks at three different types of amelogenesis imperfecta patients.

scholarly journals Therapeutic Challenges for Elderly Patients with Primary Hyperparathyroidism

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Kenneth Sluis ◽  
Hyon Kim ◽  
Yuling He ◽  
Beatrice Wong ◽  
Xiangbing Wang
Keyword(s):  
Primary Hyperparathyroidism ◽  
Chart Review ◽  
Treatment Options ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Long Term Stability ◽  
Feasible Option ◽  
One Year

Primary hyperparathyroidism (PHPT) predominantly affects older adults, and parathyroidectomy can achieve definitive cure in symptomatic PHPT and asymptomatic meeting surgical criteria. As the population continues to age, the treatment of PHPT in octogenarians and nonagenarians presents a clinical conundrum. This case series presents the management of eight patients 85 years of age and older diagnosed with PHPT. A retrospective chart review of patients diagnosed with primary hyperparathyroidism were identified in a single institution. Those patients 85 years of age and older who were followed up for over one year were included in this case series. The literature on treatment options for this age group was also reviewed. Eight cases of PHPT patients aged 88 ± 2.5 years old with a follow-up average of 5.6 ± 4.4 years were reported in our case series. Six PHPT patients were medically managed and two PHPT patients underwent parathyroid resection. Most of the medically managed PHPT patients except for one had long-term stability of disease for over five years. The treatment of PHPT diagnosed in patients over 85 years of age presents a clinical challenge for which there is no clear consensus guideline. Our case series supports that medical therapy is a feasible option for PHPT patients over 85 years old.

Sign in / Sign up

Export Citation Format

Share Document