• Nenhum resultado encontrado

Int. braz j urol. vol.35 número1

N/A
N/A
Protected

Academic year: 2018

Share "Int. braz j urol. vol.35 número1"

Copied!
12
0
0

Texto

(1)

Pheochromocytoma: A Long-Term Follow-Up of 24 Patients

Undergoing Laparoscopic Adrenalectomy

Lísias N. Castilho, Fabiano A. Simoes, Andre M. Santos, Tiago M. Rodrigues, Carlos A. dos Santos Junior

Section of Urology, Catholic University of Campinas, Campinas, Sao Paulo, Brazil

ABSTRACT

Purpose: 3KHRFKURPRF\WRPDVDUHWXPRUVGHULYHGIURPFKURPDI¿QFHOOVWKDWRIWHQVHFUHWHFDWHFKRODPLQHVDQGFDXVHK\SHU

-WHQVLRQ7KHFOLQLFDOGLDJQRVLVRISKHRFKURPRF\WRPDGHSHQGVRQWKHSUHVHQFHRIH[FHVVLYHSURGXFWLRQRIFDWHFKRODPLQHV &RQYHQWLRQDOLPDJLQJPRGDOLWLHVWKDWKDYHEHHQXVHGLQWKHSUHRSHUDWLYHHYDOXDWLRQLQFOXGH&705,DQG,0,%* VFLQWLJUDSK\6XUJLFDOUHVHFWLRQLVWKHGH¿QLWLYHWUHDWPHQWIRUSDWLHQWVZLWKSKHRFKURPRF\WRPD7KHJRDORIWKLVVWXG\ZDV WRHYDOXDWHWKHORQJWHUPIROORZXSRISDWLHQWVXQGHUJRLQJODSDURVFRSLFDGUHQDOHFWRP\IRUSKHRFKURPRF\WRPD Materials and Methods: )URP-DQXDU\WR6HSWHPEHUSDWLHQWVXQGHUZHQWODSDURVFRSLFDGUHQDOHFWRP\IRU DGUHQDOSKHRFKURPRF\WRPD7ZHQW\SDWLHQWVKDGDUWHULDOK\SHUWHQVLRQ7KHLQFOXVLRQFULWHULDRISDWLHQWVLQWKLV UHWURVSHFWLYHVWXG\ZHUHODSDURVFRSLFDSSURDFKXQLODWHUDORUELODWHUDODGUHQDOWXPRUSDWKRORJLFDOGLDJQRVLVRISKHRFKUR

-PRF\WRPDDQGDPLQLPXPIROORZXSRIPRQWKV

Results:,QWUDRSHUDWLYHFRPSOLFDWLRQVRFFXUUHGLQSDWLHQWV7ZRSDWLHQWVKDGSRVWRSHUDWLYHFRPSOLFD

-WLRQV7ZRSDWLHQWVKDGEORRGWUDQVIXVLRQ7KHPHDQSRVWRSHUDWLYHKRVSLWDOVWD\ZDVGD\VUDQJHWR (LJKWHHQRIWKHWZHQW\SDWLHQWVZKRKDGV\PSWRPDWLFK\SHUWHQVLRQUHWXUQHGWRQRUPDOEORRGSUHVVXUHLPPHGLDWHO\ DIWHUVXUJHU\GXULQJWKHKRVSLWDOVWD\,QRQHSDWLHQWWKHKLJKEORRGSUHVVXUHOHYHOVUHPDLQHGXQFKDQJHG$QRWKHUSDWLHQW SHUVLVWHGZLWKPLOGK\SHUWHQVLRQZHOOFRQWUROOHGE\DVLQJOHDQWLK\SHUWHQVLYHGUXJ

Conclusions:2XUUHVXOWVFRQ¿UPHGWKDWODSDURVFRSLFDGUHQDOHFWRP\IRUSKHRFKURPRF\WRPDLVDVDIHDQGHIIHFWLYHSUR

-FHGXUHSURYLGLQJWKHEHQH¿WVRIDPLQLPDOO\LQYDVLYHDSSURDFK,QRXUVWXG\WKHLQLWLDOSRVLWLYHUHVXOWVREWDLQHGLQWKH WUHDWPHQWRISDWLHQWVZHUHFRQ¿UPHGDIWHUDPHDQIROORZXSRIPRQWKV

Key words: laparoscopy; pheochromocytoma; adrenalectomy

Int Braz J Urol. 2009; 35: 24-35

INTRODUCTION

3KHRFKURPRF\WRPDV 3&&V DUH WXPRUV GHULYHGIURPFKURPDI¿QFHOOVWKDWSURGXFHDQGRIWHQ VHFUHWHFDWHFKRODPLQHV2YHURI3&&VDUHLQWKH DEGRPHQPRVWIUHTXHQWO\LQWKHFKURPDI¿QFHOOVRI WKHDGUHQDOPHGXOOD$SSUR[LPDWHO\DUHIRXQGLQ H[WUDDGUHQDOVLWHVZKHUHWKH\DUHFDOOHGSDUDJDQJOLR -PDVGXHWRWKHLUDVVRFLDWLRQZLWKV\PSDWKHWLFQHUYRXV V\VWHPJDQJOLDLQWKHFKHVWDEGRPHQRUSHOYLV

(2)

GLVHDVH9+/DQGWKHQHXURHFWRGHUPDOG\VSODVLDV FRQVLVWLQJRIQHXUR¿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¿UPHGSKHRFKURPRF\WRPD LQFOXGH&705,DQG,RGLQHPHWDLRGREHQ]\O -JXDQLGLQH ,0,%* VFLQWLJUDSK\ &7 HDVLO\ GHWHFWVWXPRUVRIFPRUPRUHZLWKKLJKVHQVLWLYLW\ ZKLFK YDULHV EHWZHHQ DQG IRU DGUHQDO JODQGWXPRUGHWHFWLRQDQGDSSUR[LPDWHO\IRU H[WUDDGUHQDOGLVHDVHLGHQWL¿FDWLRQ)LJXUH05, LVDOVRVHQVLWLYH&KDUDFWHUL]DWLRQRIDGUHQDOPDVVHVLV GRQHZLWKFKHPLFDOVKLIW05,EDVHGRQWKHDEVHQFHRI IDWLQ3&&V,QDGGLWLRQWKHK\SHUYDVFXODULW\RISKHR -FKURPRF\WRPDVPDNHVWKHPDSSHDUFKDUDFWHULVWLFDOO\ EULJKWZLWKDKLJKVLJQDORQ7ZHLJKWHGLPDJHV)LJ -XUH,0,%*VFDQQLQJZRUNVE\DGPLQLVWHULQJ DUDGLRODEHOHGDPLQHIRUZKLFKFKURPDI¿QWLVVXHLV VHOHFWLYHO\DYLG6LQFHLWLVDSK\VLRORJLFVWXG\0,%* FDQLGHQWLI\SKHRFKURPRF\WRPDVUHJDUGOHVVRIWKHLU ORFDWLRQ7KLV PRGDOLW\ PD\ EH XVHIXO LQ SDWLHQWV ZLWKELRFKHPLFDOHYLGHQFHRIDSKHRFKURPRF\WRPD WKDWKDVQRWEHHQORFDOL]HGE\&7RU05,RULQWKH IROORZXSHYDOXDWLRQRISDWLHQWVZLWKVXVSHFWHGRU GRFXPHQWHGUHFXUUHQWRUPHWDVWDWLFGLVHDVH 6XUJLFDOUHVHFWLRQLVWKHGH¿QLWLYHWUHDWPHQW IRU SDWLHQWV ZLWK SKHRFKURPRF\WRPD 3ULRU WR WKH VXUJHU\WKHSDWLHQWPXVWEHDGHTXDWHO\SUHSDUHGZLWK DOSKDDGUHQHUJLFEORFNDGHDQGFRPSOHWHUHVWRUDWLRQRI ÀXLGDQGHOHFWURO\WHEDODQFH$OSKDEORFNDGHZRUNVWR RSSRVHFDWHFKRODPLQHLQGXFHGYDVRFRQVWULFWLRQDQG VRPHWLPHVPXVWEHDVVRFLDWHGZLWKWKHEHWDDGUHQHU -JLFEORFNDGHZLWKSURSUDQRORODQGH[SDQGLQJYROXPH

3KHRFKURPRF\WRPDZDVLQLWLDOO\FRQVLGHUHG DFRQWUDLQGLFDWLRQWRODSDURVFRSLFDSSURDFKGXHWR WKHIHDURIK\SHUWHQVLYHFULVLVDVVRFLDWHGZLWKWKH

SQHXPRSHULWRQHXP+RZHYHUDQLQFUHDVLQJVHULHVRI ODSDURVFRS\XVLQJWKHWUDQVSHULWRQHDORUUHWURSHULWR -QHDODSSURDFKKDYHEHHQUHSRUWHGDQGSURYHGWREHD VDIHSURFHGXUHZLWKVLPLODUEORRGORVVDQGQRGLIIHU -HQFHLQEORRGSUHVVXUHRUKHDUWUDWHLQFUHPHQWVZKHQ FRPSDUHGZLWKRSHQDGUHQDOHFWRP\3DWLHQWVDOVR H[SHULHQFHIDVWHUUHVROXWLRQRISRVWRSHUDWLYHLOHXP GHFUHDVHGDQDOJHVLFUHTXLUHPHQWVDVKRUWHUOHQJWKRI KRVSLWDOVWD\DQGDVKRUWHUFRQYDOHVFHQFHZLWKDPRUH UDSLGUHWXUQWRQRUPDODFWLYLW\

Figure 2 – MRI showing large adrenal mass - hypersignal in T2.

(3)

7KHJRDORIWKLVVWXG\ZDVWRHYDOXDWHWKH ORQJWHUPUHVXOWVRISDWLHQWVXQGHUJRLQJODSDUR -VFRSLFDGUHQDOHFWRP\IRUSKHRFKURPRF\WRPD

MATERIALS AND METHODS

)URP-DQXDU\WR6HSWHPEHUZH

UHWURVSHFWLYHO\UHYLHZHGWKHUHVXOWVRIWUDQVSHULWRQHDO ODSDURVFRSLFDGUHQDOHFWRP\SHUIRUPHGLQSDWLHQWV ZLWKSKHRFKURPRF\WRPD7KLVVHULHVFRQVLVWHGRI PDOHVDQGIHPDOHVZLWKWKHPHDQ DJHRI\HDUVUDQJHWR\HDUVPHGLDQ 7KH%RG\0DVV,QGH[%0,UDQJHGIURP WR 1LQH FDVHV SUHVHQWHG ZLWK RYHUZHLJKW%0,EHWZHHQDQGDQGRQH FDVHZLWKREHVLW\%0,

7ZHQW\RIWKHWZHQW\IRXUSDWLHQWV KDGDUWHULDOK\SHUWHQVLRQKDOIRIWKHPZLWKVHYHUH K\SHUWHQVLYH FULVLV DQG WKH RWKHU SDWLHQWV ZLWK PLOGWRPRGHUDWHK\SHUWHQVLRQ7KHPHDQWLPHEH -WZHHQLQVWDOODWLRQRIK\SHUWHQVLRQDQGWKHGLDJQRVLV RISKHRFKURPRF\WRPDZDV\HDUVPRQWKVWR \HDUV)RXUSDWLHQWVKDGQRUPDOEORRGSUHV -VXUH OHYHOV7KUHH ZHUH FRPSOHWHO\ DV\PSWRPDWLF LQFLGHQWDO¿QGLQJVDQGKDGDEGRPLQDOSDLQDQG UHFXUUHQWDQ[LHW\FULVHV

7KHPHDQWXPRUVL]HHVWLPDWHGE\&7VFDQ ZDVFPWRFPPHGLDQFP,Q SDWLHQWVWKHWXPRUVZHUHRQWKHULJKWVLGH RQWKHOHIWDQGRQO\ZDVELODWHUDO7DEOH 7KHLQFOXVLRQFULWHULDRISDWLHQWVLQWKLVUHWUR -VSHFWLYHVWXG\ZHUHODSDURVFRSLFDSSURDFKXQLODWHUDO RUELODWHUDODGUHQDOWXPRUSDWKRORJLFDOGLDJQRVLVRI SKHRFKURPRF\WRPDDQGDPLQLPXPIROORZXSRI PRQWKV

7KHSUHRSHUDWLYHGLDJQRVLVRISKHRFKURPR -F\WRPDLQWKHV\PSWRPDWLFSDWLHQWVZDVFRQ¿UPHG E\WKHFOLQLFDOSUHVHQWDWLRQDQGWKHELRFKHPLFDODQG UDGLRJUDSKLF¿QGLQJV7KHYDQ\OPDQGHOLFDFLGOHYHO RIDKRXUXULQHVDPSOHDQGSODVPDQRUHSLQHSKULQH DQGHSLQHSKULQHOHYHOVZHUHURXWLQHO\WHVWHGEHIRUH VXUJHU\DQGHYHU\VL[PRQWKVDIWHUVXUJHU\$EGRPLQDO &7VFDQVZHUHREWDLQHGLQDOOFDVHVERWKLQSUHRSHUD -WLYHDVLQWKHSRVWRSHUDWLYHDQQXDOO\,0,%*ZDV SHUIRUPHGLQSDWLHQWVFDVHVZLWKFOLQLFDODQG ODERUDWRU\VXVSLFLRQRISKHRFKURPRF\WRPDDQGRQH

FDVHZLWKRXWDQ\VXVSLFLRQWKDWSUHVHQWHGDQLQFLGHQ -WDO¿QGLQJ,QDOOFDVHV0,%*ZHUHUHSHDWHGDQQXDOO\ DIWHUVXUJHU\05,ZDVSHUIRUPHGLQSDWLHQWVLQWKH SUHRSHUDWLYHHYDOXDWLRQEHFDXVHRILRGLQHDOOHUJ\RU LQFRQFOXVLYH&7LPDJHV

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

7KH VXUJLFDO WHFKQLTXH RI WUDQVSHULWRQHDO ODSDURVFRSLF DGUHQDOHFWRP\ KDV EHHQ H[WHQVLYHO\ GHVFULEHG

7KHIROORZXSRISDWLHQWVZDVGRQHEDVHG RQGDWDUHYLHZIURPPHGLFDOUHFRUGVDQGWHOHSKRQH FRQWDFWV 'XULQJ WKH ¿UVW \HDU RI IROORZXS HDFK SDWLHQWZDVH[DPLQHGLQDWOHDVWIRXUGLIIHUHQWRFFD -VLRQV7KHLUEORRGSUHVVXUHZDVPHDVXUHGDQGUHJLV -WHUHGLQWKHLUUHFRUGV,QWKHVL[WKDQGWHQWKPRQWKV IROORZLQJWKHVXUJHU\HDFKSDWLHQWZDVVXEPLWWHG WRGRVDJHRIFDWKHFKRODPLQHVLQXULQHDQGVHUXP 7KH\ZHUHVXEPLWWHGWR0,%*DWWKHHQGRIWKH¿UVW \HDUDIWHUVXUJHU\$IWHUWKH¿UVW\HDUHDFKSDWLHQW ZDVH[DPLQHGDWOHDVWRQFHD\HDUDQGVXEPLWWHGWR ODERUDWRU\H[DPVDQG0,%*IRUDWOHDVW¿YH\HDUV $OOWKHFDVHVLQFOXGHGLQWKHVWXG\KDGDPLQLPXP IROORZXSRIPRQWKVWRPRQWKVPHDQ PRQWKV

RESULTS

(4)

GXHWRDPDMRUYHQRXVEOHHGLQJDQGWKHRWKHUGXHWR GLI¿FXOW\LQIUHHLQJWKHJODQGORFDWHGDOPRVWHQWLUHO\ EHKLQGWKHLQIHULRUYHQDFDYD

7KHPHDQRSHUDWLYHWLPHH[FOXGLQJWKHWZR FRQYHUWHGFDVHVZDVPLQXWHVWRPLQ ,QWUDRSHUDWLYHFRPSOLFDWLRQVRFFXUUHGLQ SDWLHQWV7DEOH

,QRQHFDVHGXULQJVSHFLPHQZLWKGUDZDOWKH H[WUDFWRUEDJUXSWXUHGDQGWKHVSHFLPHQZDVQRWIRXQG E\ODSDURVFRSLFLQVSHFWLRQ,WZDVQHFHVVDU\WRPDNH

DVPDOOLQFLVLRQLQWKHDEGRPHQWRUHPRYHWKHJODQG ,QDQRWKHUFDVHZHKDGDVPDOOYHQDFDYDLQMXU\WKDW ZDVVXWXUHGE\ODSDURVFRS\ZLWKRXWDQ\GLI¿FXOW\$ \HDUROGSDWLHQWVXIIHUHGDQLQMXU\LQDQRPDORXV ULJKWDGUHQDOYHLQ7KHVXEVHTXHQWEOHHGLQJUHTXLUHG FRQYHUVLRQWRRSHQVXUJHU\7KHROGHVWSDWLHQWLQWKLV VHULHVD\HDUROGZRPDQZLWKDFPOHIWDGUHQDO WXPRUWKHUHZDVDQLQMXU\RIWKHVSOHQLFDUWHU\GXULQJ GLVVHFWLRQ7KHDUWHULDOLQMXU\FRXOGQRWEHUHSDLUHG DQGDODSDURVFRSLFVSOHQHFWRP\ZDVSHUIRUPHG

Table 1 – Pre-operative data.

Case Age

\HDUV Gender Clinical Presentation Antecedent Side CT - Tumor SizePP

0DOH +\SHUWHQVLYHFULVHV 1RQH /HIW

)HPDOH +\SHUWHQVLRQ )DPLOLDOSKHRFKURPRF\WRPD /HIW

0DOH +\SHUWHQVLYHFULVHV 1RQH 5LJKW

0DOH +\SHUWHQVLYHFULVHV )DPLOLDOSKHRFKURPRF\WRPD 5LJKW

0DOH +\SHUWHQVLYHFULVHV 1RQH 5LJKW

)HPDOH +\SHUWHQVLRQ +\VWHUHFWRP\ /HIW

0DOH +\SHUWHQVLYHFULVHV 1RQH 5LJKW

0DOH +\SHUWHQVLRQ .LGQH\WUDQVSODQWDWLRQ /HIW

)HPDOH ,QFLGHQWDOO\GLVFRYHUHG 'HSUHVVLRQ /HIW

0DOH +\SHUWHQVLRQ 5DGLFDOSURVWDWHFWRP\ 5LJKW

0DOH +\SHUWHQVLYHFULVHV &KROHF\VWHFWRP\ 5LJKW

0DOH +\SHUWHQVLYHFULVHV 1RQH 5LJKW

)HPDOH +\SHUWHQVLRQ 1RQH /HIW

0DOH $EGRPLQDOSDLQ

$Q[LHW\FULVHV :LWKRXWK\SHUWHQVLRQ

1RQH 5LJKW

0DOH +\SHUWHQVLYHFULVHV 0HGXOODU\WK\URLGFDQFHU

)DPLOLDOSKHRFKURPRF\WRPD %LODWHUDO

0DOH +\SHUWHQVLRQ 1RQH 5LJKW

0DOH +\SHUWHQVLYHFULVHV 1RQH /HIW

)HPDOH +\SHUWHQVLYHFULVHV 1RQH 5LJKW

)HPDOH +\SHUWHQVLRQ 1RQH 5LJKW

)HPDOH +\SHUWHQVLRQ 1RQH 5LJKW

)HPDOH ,QFLGHQWDOO\GLVFRYHUHG +\VWHUHFWRP\ /HIW

0DOH ,QFLGHQWDOO\GLVFRYHUHG 1RQH 5LJKW

)HPDOH ,QFLGHQWDOO\ GLVFRYHUHG

+\SHUWHQVLRQ %LODWHUDOOXPEDUV\PSDWKHFWRP\ /HIW

(5)

1RFDVHVRIVHYHUHKHPRG\QDPLFLQVWDELOLW\ ZHUHREVHUYHGWKURXJKRXWWKHGXUDWLRQRIDQHVWKHVLD EXWPRVWRIWKHSDWLHQWVKDGWUDQVLHQWHOHYDWLRQRI EORRGSUHVVXUHGXULQJWKHPDQLSXODWLRQRIWKHJODQG EHIRUHDGUHQDOYHLQOLJDWLRQ7KHVHHOHYDWLRQVZHUH LQJHQHUDOFRQWUROOHGZLWKVRGLXPQLWURSUXVVLGH 7ZRSDWLHQWVKDGSRVWRSHUDWLYHFRP -SOLFDWLRQV7DEOH,QRQHRIWKHFRQYHUWHGSURFH -GXUHVWKHSDWLHQWGHYHORSHGDQDFXWHUHQDOIDLOXUH SRVWRSHUDWLYHLOHXPDQGVXEFXWDQHRXVLQIHFWLRQ+H OHIWWKHKRVSLWDOLQDJRRGFRQGLWLRQRQWKHthSRVWRS -HUDWLYHGD\$QRWKHUSDWLHQWGHYHORSHGDQDEGRPLQDO DQGOXPEDUHFFK\PRVLVDIWHUKRVSLWDOGLVFKDUJHZLWK VSRQWDQHRXVUHVROXWLRQ

7ZRSDWLHQWVUHFHLYHGDEORRGWUDQVIX -VLRQ7DEOHRQHRIWKHPLQWKHRSHUDWLQJURRPDQG WKHRWKHUGXULQJWKH¿UVWSRVWRSHUDWLYHGD\

$OOSDWLHQWVUHVXPHGRUDOQXWULWLRQDQGDP -EXODWLRQWRGD\VDIWHUWKHVXUJHU\

7KHPHDQSRVWRSHUDWLYHKRVSLWDOVWD\ZDV GD\VWRGD\V

$OOWKHWXPRUVZHUHSDWKRORJLFDOO\LGHQWL -¿HGDVSKHRFKURPRF\WRPDV7KHUHZDVQRHYLGHQFH RIPDOLJQDQF\VXFKDVORFDOLQYDVLRQRUPHWDVWDVLV 7KHODUJHVWVSHFLPHQUHPRYHGPHDVXUHGFPDQG ZHLJKHGJFDVH

2IWKHWZHQW\SDWLHQWVZKRKDGV\PSWRPDWLF K\SHUWHQVLRQ UHWXUQHG WR QRUPDO EORRG

Table 2 – Intra-operative (IO) occurrences.

Case IO Complication Conduct Operative Time PLQXWHV Transfusion

([WUDFWRUEDJUXSWXUH 0LQLODSDURWRP\ 1RQH

1RQH 1RQH

9HQRXVLQMXU\ &RQYHUVLRQ &RQYHUVLRQ XQLWV,2

1RQH 1RQH

1RQH 1RQH

1RQH 1RQH

1RQH 1RQH

1RQH 1RQH

1RQH 1RQH

9HQDFDYDLQMXU\ /DSDURVFRSLFVXWXUH 1RQH

1RQH &RQYHUVLRQ &RQYHUVLRQ 1RQH

1RQH 1RQH

1RQH ELODWHUDO 1RQH

1RQH 1RQH

1RQH 1RQH

1RQH 1RQH

1RQH 1RQH

1RQH 1RQH

1RQH 1RQH

1RQH 1RQH

1RQH 1RQH

1RQH 1RQH

6SOHQLFDUWHU\LQMXU\ /DSDURVFRSLFVSOHQHFWRP\ XQLWV32

1RQH 1RQH

(6)

Table 3 – Postoperative (PO) results.

Case PO Complication Long-term Follow-up Follow-up

PRQWKV Final Diagnosis

1RQH Cure Pheochromocytoma

1RQH Cure )DPLOLDOSKHRFKURPRF\WRPD

1RQH Cure Pheochromocytoma

1RQH Cure )DPLOLDOSKHRFKURPRF\WRPD

1RQH +\SHUWHQVLYHFULVHV Pheochromocytoma

1RQH Cure Pheochromocytoma

1RQH Cure Pheochromocytoma

1RQH Cure Pheochromocytoma

1RQH Cure 1RQVHFUHWRU\SKHR

1RQH Cure Pheochromocytoma

5HQDOIDLOXUHSRVWRSHUDWLYH

LOHXP6&LQIHFWLRQ Cure Pheochromocytoma

1RQH Cure Pheochromocytoma

1RQH 0LOGK\SHUWHQVLRQ Pheochromocytoma

1RQH Cure Pheochromocytoma

1RQH &XUHGHDWKGXHWRDKHDUW

DWWDFNDIWHUPRQWKV )DPLOLDOSKHRFKURPRF\WRPD

1RQH Cure Pheochromocytoma

1RQH Cure Pheochromocytoma

1RQH Cure Pheochromocytoma

1RQH Cure Pheochromocytoma

1RQH Cure 'RSDPLQHVHFUHWRU\SKHR

1RQH Cure Pheochromocytoma

1RQH Cure Pheochromocytoma

1RQH Cure Pheochromocytoma

Ecchymosis Cure 1RQVHFUHWRU\SKHR

SUHVVXUH LPPHGLDWHO\ DIWHU WKH VXUJHU\ GXULQJ WKHKRVSLWDOVWD\,QRQHRIWKHSDWLHQWVWKHEORRG SUHVVXUHOHYHOUHPDLQHGXQFKDQJHGK\SHUWHQVLYH FULVHV$QRWKHUSDWLHQWSHUVLVWHGZLWKPLOGK\SHU -WHQVLRQFRQWUROOHGZLWKDVLQJOHDQWLK\SHUWHQVLYH GUXJ7KHVHUHVXOWVUHPDLQHGXQFKDQJHGGXULQJWKH IROORZXS

,Q RQH RI IRXU QRUPRWHQVLYH SDWLHQWV WKH EORRG SUHVVXUH KDG D SHDN GXULQJ WKH DQHVWKHWLF LQGXFWLRQ EXW ZDV HDVLO\ FRQWUROOHG ZLWK VRGLXP QLWURSUXVVLGH$QRWKHU QRUPRWHQVLYH SDWLHQW FRP -SODLQHGRIDEGRPLQDOSDLQDQGDQ[LHW\+LVV\PSWRPV

GLVDSSHDUHGDIWHUVXUJHU\FDVH$OOWKHVHFDVHV UHPDLQHGQRUPRWHQVLYHLQWKHODWHSRVWRSHUDWLYHSH -ULRG7DEOH

(7)

COMMENTS

6LQFHWKH¿UVWUHSRUWRIODSDURVFRSLFDGUHQDO -HFWRP\E\*DJQHUHWDOLQWKLVSURFHGXUHKDV EHFRPHWKHSUHIHUUHGVXUJLFDOPDQDJHPHQWRIEHQLJQ DGUHQDOWXPRUVGXHWRLWVQXPHURXVDGYDQWDJHV &RPSDUDWLYHVWXGLHVEHWZHHQRSHQDQGODSDURVFRSLF VXUJHU\KDYHVKRZQWKDWODSDURVFRSLFLQWHUYHQWLRQ VKRXOGEHFRQVLGHUHGWKHJROGVWDQGDUGSURFHGXUHIRU DGUHQDOVXUJHU\

7RGDWHQRUHOHYDQWSURVSHFWLYHDQGUDQGRP -L]HGVHULHVFRPSDULQJODSDURVFRSLFDGUHQDOHFWRP\ YHUVXVFRQYHQWLRQDOVXUJHU\IRUSKHRFKURPRF\WRPD WRRXUNQRZOHGJHKDVEHHQSXEOLVKHGLQWKHOLWHUDWXUH 1HYHUWKHOHVVWKHDFFXPXODWHGLQWHUQDWLRQDOH[SHUL -HQFHLVVLJQL¿FDQWDQGVXJJHVWVWKDWODSDURVFRSLFDS -SURDFKLVEHWWHUWKDQRSHQVXUJHU\UHJDUGLQJPRUELG -LW\EOHHGLQJOHQJWKRIKRVSLWDOL]DWLRQFRQYDOHVFHQFH SRVWRSHUDWLYHSDLQDQGDHVWKHWLFVHTXHOV 3KHRFKURPRF\WRPDZDVLQLWLDOO\FRQVLG -HUHGDFRQWUDLQGLFDWLRQWR/$EHFDXVHLWZDVUH -SRUWHGE\0HXULVVHHWDOWKDWSQHXPRSHULWRQHXP FRXOGSURPRWHDQDFXWHUHOHDVHRIFDWHFKRODPLQHV +RZHYHU VHYHUDO DXWKRUV KDYH VKRZQ WKDW ZKHQWKHUHLVDQDGHTXDWHSUHRSHUDWLYHSUHSDUD -WLRQWKHVHFKDQJHVDUHGLVFUHWHDQGZHOOWROHUDWHG E\SDWLHQWV

,QDUHFHQWVWXG\6RRGHWDOVKRZHGWKDWWKH PDLQWHQDQFHRIDORZHULQWUDDEGRPLQDOSUHVVXUH PP+JUHGXFHVWKHUHOHDVHRIFDWHFKRODPLQHVDQG KHOSVSUHYHQWKHPRG\QDPLFLQVWDELOLW\

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

DSSURDFKIRUDGUHQDOHFWRP\YDULHVDFFRUGLQJWRSHU -VRQDOH[SHULHQFHDQGSUHIHUHQFHRIWKHODSDURVFRSLF VXUJHRQ

,Q RXU H[SHULHQFH WKH VPDOO LQFLGHQFH RI FRPSOLFDWLRQVWKHVKRUWFRQYDOHVFHQFHSHULRGDQG WKHORQJWHUPVDWLVIDFWRU\UHVXOWVKDYHHQDEOHGXV WRHVWDEOLVKWKHODSDURVFRSLFDGUHQDOHFWRP\DVWKH SURFHGXUHRIFKRLFHLQSKHRFKURPRF\WRPDPDQDJH -PHQW

:LWKWKHLQWURGXFWLRQRIURERWLFVXUJHU\DGUH -QDOHFWRP\XVLQJURERWLFHQGRVFRSLFVXUJLFDOGHYLFHV 'D9LQFLV\VWHPKDVUHFHQWO\EHHQSURSRVHG0RULQR HWDOSXEOLVKHGDSURVSHFWLYHUDQGRPL]HGWULDOZLWK SDWLHQWVFRPSDULQJWKHRXWFRPHVRIURERWLF5$ YHUVXVODWHUDOWUDQVSHULWRQHDOODSDURVFRSLFSURFHGXUHV 7KLVVWXG\VKRZHGWKDW5$LVDVVRFLDWHGZLWKDORQJHU RSHUDWLYHWLPHLQFUHDVHGFRVWDQGDKLJKHUPRUELGLW\ ZKHQFRPSDUHGWRODWHUDOWUDQVSHULWRQHDO/$ +RZHYHUIXUWKHUVWXGLHVDUHQHHGHGWRGH¿QHWKHUROH RIURERWLFDVVLVWHGDGUHQDOHFWRP\

3HULRSHUDWLYHPDQDJHPHQWRISDWLHQWVZLWK SKDHRFKURPRF\WRPDUHTXLUHVGHWDLOHGNQRZOHGJHRI WKHSRWHQWLDOFRPSOLFDWLRQV,QWUDRSHUDWLYHO\K\SHU -WHQVLYHFULVLVDQGWDFK\DUUK\WKPLDPD\RFFXUUHVXOWLQJ IURPPDVVLYHFDWHFKRODPLQHUHOHDVH7KXVLQDJUHH -PHQWZLWKRWKHUDXWKRUVZHFRQVLGHUSUHRSHUDWLYH WUHDWPHQWZLWKWKHDOSKDDQWDJRQLVWSKHQR[\EHQ]D -PLQHREOLJDWRU\

0RVWUHVHDUFKSXEOLVKHGRQODSDURVFRSLFDG -UHQDOHFWRP\UHIHUWRWXPRUVVPDOOHUWKDQFPZLWKRXW SUHRSHUDWLYHFKDUDFWHULVWLFVVXJJHVWLQJPDOLJQDQF\ 'HVSLWHVRPHUHSRUWVRIVXUJHULHVSHUIRUPHGLQODUJH WXPRUVZLWKLGHQWL¿HGPDOLJQDQF\SRWHQWLDOLQSUH RSHUDWLYH DVVHVVPHQW WKHVH SURFHGXUHV VKRXOG EH OHIWWRDFDGHPLFFHQWHUVZLWKH[WHQVLYHH[SHULHQFHLQ ODSDURVFRSLFVXUJHU\RIWKHDGUHQDOJODQG

CONCLUSIONS

(8)

CONFLICT OF INTEREST

1RQHGHFODUHG

REFERENCES

.DUDJLDQQLV$ 0LNKDLOLGLV '3$WK\URV9* +DU

-VRXOLV)3KHRFKURPRF\WRPDDQXSGDWHRQJHQHWLFV DQG PDQDJHPHQW (QGRFU 5HODW &DQFHU

0LWWHQGRUI ($ (YDQV '% /HH -( 3HUULHU 1' 3KHRFKURPRF\WRPDDGYDQFHVLQJHQHWLFVGLDJQRVLV ORFDOL]DWLRQDQGWUHDWPHQW+HPDWRO2QFRO&OLQ1RUWK $P

&DVWLOKR/10HGHLURV3-2WUDWDPHQWRODSDURVFySLFR GRIHRFURPRFLWRPD5HY&LHQF0HG

.DVWXUL6.XWLNRY$*X]]R7-6PLWK$/:HLQ$-0RGHUQPDQDJHPHQWRISKHRFKURPRF\WRPD1DW&OLQ 3UDFW8URO

&DVWLOKR /1 6XSUDUUHQDOHFWRPLD ,Q &DVWLOKR /1 HG/DSDURVFRSLD8UROyJLFD&DPSLQDV/3&&R

-PXQLFDo}HVSS

*DJQHU0/DFURL[$%ROWp(/DSDURVFRSLFDGUH

-QDOHFWRP\LQ&XVKLQJ¶VV\QGURPHDQGSKHRFKURPR

-F\WRPD1(QJO-0HG

&DVWLOKR /1 /LDQJ /6 )HUUHLUD 8 )UHJRQHVL$ 6DDGH5'1HWWR-U15&LUXUJLDGRWXPRUEHQLJQRGH VXSUDUHQDOSRUYLGHRODSDURVFRSLD-%UDV8URO

&DVWLOKR/10HGHLURV3-0LWUH$,'pQHV)7/XFRQ $0$UDS63KHRFKURPRF\WRPDWUHDWHGE\ODSDUR

-VFRSLFVXUJHU\5HY+RVS&OLQ)DF0HG6DR3DXOR

-DQHWVFKHN*$OWDUDF6)LQNHQVWHGW**DVVHU5 %DUWVFK *7HFKQLTXH DQG UHVXOWV RI ODSDURVFRSLF DGUHQDOHFWRP\(XU8URO

0HXULVVH0-RULV-+DPRLU(+XEHUW%&KDUOLHU& /DSDURVFRSLFUHPRYDORISKHRFKURPRF\WRPD:K\" :KHQ"DQG:KR"UHÀHFWLRQVRQRQHFDVHUHSRUW6XUJ (QGRVF

)HUQiQGH]&UX] / 6iHQ]$ 7DXUi 3 6DEDWHU / $VWXGLOOR()RQWDQDOV-+HOLXPDQGFDUERQGLR[LGH SQHXPRSHULWRQHXPLQSDWLHQWVZLWKSKHRFKURPRF\

-WRPDXQGHUJRLQJODSDURVFRSLFDGUHQDOHFWRP\:RUOG -6XUJ

&KLJRW-30RYVFKLQ0HO%DUGLVVL0)HUFRFT2 3DUDVNHYDV$ &RPSDUDWLYH VWXG\ EHWZHHQ ODSDUR

-VFRSLFDQGFRQYHQWLRQDODGUHQDOHFWRP\IRUSKHRFKUR

-PRF\WRPDV$QQ&KLU

&RO9GH&DQQLqUH/&ROODUG(0LFKHO/'RQFNLHU -/DSDURVFRSLFDGUHQDOHFWRP\IRUSKDHRFKURPRF\

-WRPDHQGRFULQRORJLFDODQGVXUJLFDODVSHFWVRIDQHZ WKHUDSHXWLFDSSURDFK&OLQ(QGRFULQRO2[I

6RRG--D\DUDPDQ/.XPUD93&KRZEH\3./DSD

-URVFRSLFDSSURDFKWRSKHRFKURPRF\WRPDLVDORZHU LQWUDDEGRPLQDOSUHVVXUHKHOSIXO"$QHVWK$QDOJ

*LOO,6/DSDURVFRSLF$GUHQDO6XUJHU\,QWK$QQXDO 0HHWLQJ$WODQWD/DSDURVFRSLF2UJDQ$EODWLYH 8URORJ\±3RVWJUDGXDWH&RXUVH+RXVWRQ$8$2I¿FH RI(GXFDWLRQS

6XEUDPDQLDP53DQGLW%6DGKDVLYDP66ULGHYL.% .DXO+/5HWURSHULWRQHRVFRSLFH[FLVLRQRISKDHRFKUR

-PRF\WRPDKDHPRG\QDPLFHYHQWVFRPSOLFDWLRQVDQG RXWFRPH$QDHVWK,QWHQVLYH&DUH 5XELQVWHLQ0*LOO,6$URQ0.LOFLOHU00HUDQH\

$0)LQHOOL$HWDO3URVSHFWLYHUDQGRPL]HGFRP

-SDULVRQ RI WUDQVSHULWRQHDO YHUVXV UHWURSHULWRQHDO ODSDURVFRSLFDGUHQDOHFWRP\-8URO GLVFXVVLRQ

0RULQR0%HQLQFj**LUDXGR*'HO*HQLR*0 5HEHFFKL)*DUURQH&5RERWDVVLVWHGYVODSDURVFRSLF DGUHQDOHFWRP\DSURVSHFWLYHUDQGRPL]HGFRQWUROOHG WULDO6XUJ(QGRVF

%UXQDXG/%UHVOHU/$\DY$=DUQHJDU55DSKR] $//HYDQ7HWDO5RERWLFDVVLVWHGDGUHQDOHFWRP\ ZKDWDGYDQWDJHVFRPSDUHGWRODWHUDOWUDQVSHULWRQHDO ODSDURVFRSLFDGUHQDOHFWRP\"$P-6XUJ

.QWWJHQ':DSSOHU)$QDHVWKHVLDIRUSDWLHQWVZLWK SKDHRFKURPRF\WRPDVSHFL¿FVSRWHQWLDOFRPSOLFD

-WLRQV DQG GUXJ VWUDWHJLHV$QDVWKHVLRO ,QWHQVLYPHG 1RWIDOOPHG6FKPHU]WKHU

Accepted after revision: September 1, 2008

Correspondence address:

(9)

EDITORIAL COMMENT

6XUJLFDO FXUH RI SKHRFKURPRF\WRPDV LV D UHDOFKDOOHQJHDQGPXVWEHFRQVLGHUHGDPRGHOZKHQ PXOWLGLVFLSOLQDU\DSSURDFKLVHVVHQWLDOWRDFKLHYHWKH EHVWUHVXOWV7KHHQGRFULQRORJLVWFDUGLRORJLVWWKH DQHVWKHVLRORJLVWDVZHOODVWKHVXUJHRQPXVWZRUN WRJHWKHUWRDYRLGWKHGHYDVWDWLQJHIIHFWVRIQRQSUR -JUDPPDWLFVXUJLFDODSSURDFKWKDWLQWKHSDVWKDGKLJK PRUWDOLW\

3KHRFKURPRF\WRPDVRIWHQVHFUHWHFDWHFKRO -DPLQHWKDWFDXVHVYDVRFRQVWULFWLRQDQGK\SHUWHQVLRQ DV WKH PDLQ V\PSWRP7KH FRPSOLFDWLRQV RI WKH DGHTXDWHWUHDWPHQWDUHPLOGDQGPRUWDOLW\LVPRUH UHODWHGWRWKHSDWLHQW¶VFRQGLWLRQWKDQWRWKHVXUJLFDO WHFKQLTXH

7KHYDULDWLRQVRQWKHEORRGSUHVVXUHDUHWKH ELJJHVW SUREOHP GXULQJ WKH DQHVWKHWLF SURFHGXUH (QGRFULQHDQGFDUGLRORJLFSUHSDUDWLRQVEHIRUHWKH RSHUDWLRQDUHWKH¿UVWVWHSVWRUHGXFHFRPSOLFDWLRQV $OSKDEORFNLQJDJHQWVLQWKHSUHRSHUDWLYHSHULRG DUHREOLJDWRU\LQWKHPDMRULW\RISDWLHQWVIRUDWOHDVW GD\VEHIRUHWKHSURFHGXUH%HWDEORFNLQJFDQEH DVVRFLDWHGLQFDVHVRIH[FHVVLYHWDFK\FDUGLDRUDU -UK\WKPLDV)OXLGLQWDNHSULRUWRWKHSURFHGXUHLVDOVR PDQGDWRU\(FKRFDUGLRJUDPGH¿QHVVHOHFWHGSD -WLHQWVZLWKH[FHVVLYHFRPSURPLVHVRIOHIWYHQWULFXOXP ZKHQFDUGLRWRQLFVFDQVKRZVRPHEHQH¿WV$IWHU VXUJLFDOUHVHFWLRQK\SRWHQVLRQRUOHIWYHQWULFXOXP IDLOXUHPD\RFFXUDQGYDVRSUHVVRUVPXVWEHLQIXVHG 3DUWLFXODUO\ZKHQFRQVLGHULQJFXUHRIK\SHUWHQ -VLRQDIWHUVXUJHU\FDUGLDFIDLOXUHFDQEHFRQVLGHUHG DFRQIRXQGLQJIDFWRUIRUWKHLPPHGLDWHHYDOXDWLRQ $V UHJDUGV WKH VXUJLFDO WHFKQLTXH LQ WKH SDVWWHQ\HDUVODSDURVFRSLFVXUJHU\KDVEHFRPHWKH JROGVWDQGDUGIRUWXPRUVVPDOOHUWKDQFP$W WKHEHJLQQLQJRIWKHODSDURVFRSLFH[SHULHQFHLWKDV EHHQWKRXJKWWKDWSQHXPRSHULWRQHXPFRXOGDIIHFWWKH EORRGSUHVVXUHGXULQJVXUJHU\

6RPHFRQWHPSRUDU\UHSRUWVKDYHVKRZQWKDW WKHYDULDWLRQLQEORRGSUHVVXUHRFFXUUHGLQGHSHQGHQWO\ FRQYHQWLRQDOVXUJHU\RUODSDURVFRSLFDSSURDFK $GGLWLRQDOO\VRPHDXWKRUVKDYHGHIHQGHGWKDWEH\RQG WKHYDQWDJHVRIORZHUEOHHGLQJDQGIDVWHUUHFRYHU\ WKHGHOLFDWHPDQLSXODWLRQRQODSDURVFRSLFWHFKQLTXH ZRXOGEHDQDGGLWLRQDOIRUPLQLPXPLQYDVLYHSURFH -GXUH

,QWR SKHRFKURPRF\WRPD VXUJHU\ LW LV LP -SRUWDQWWRKDYHDQHDUO\VWDJHFRQWURORIWKHPDLQ DGUHQDOYHLQZLWKWKHLQWHQWLRQRIUHGXFLQJWKHEORRG SUHVVXUHGHFRPSHQVDWLRQ\HWLWKDVEHHQDTXHVWLRQ -DEOH SDUDGLJP WKHVH GD\V 6RPH VWXGLHV KDYH SURSRVHGWKDWWKHHDUO\FRQWURORIWKHYHLQFRXOGEH GRQHRQO\YLDWKHWUDQVSHULWRQHDOWHFKQLTXH6DORPRQ HWDOGHVFULEHGWKHIHDVLELOLW\RIGRLQJWKLVWKURXJK H[WUDSHULWRQHDODSSURDFK

,QRXUH[SHULHQFHWKHFRQWURORIWKHYHLQLVQRW RQO\ELODWHUDOIHDVLEO\EXWVHHPVHDVLHURQWKHULJKW VLGHZKHUHWKHDGUHQDOYHLQLVVKRUWHUDQGIUHTXHQWO\ UHWURFDYDOWKDQWKURXJKWUDQVSHULWRQHDODSSURDFK VSHFLDOO\ZKHQLWLVDODUJHWXPRU

$QRWKHULPSRUWDQWLVVXHLVWKHWUHDWPHQWRI WKHPDOLJQDQWGLVHDVHWKDWRFFXUVLQDSSUR[LPDWHO\ 6RPHLQLWLDOVHULHVVXJJHVWWKDWLWLVSRVVLEOH WRRIIHUODSDURVFRSLFWUHDWPHQWZLWKJRRGUHVXOWVEXW WKHUHDUHVRPHFDVHVRIWXPRUUHFXUUHQFHDQGSRUWDO LPSODQWV

7KHEHQH¿WRIWKHODSDURVFRSLFSURFHGXUHLQ WKHFDVHRIPDOLJQDQWSKHRFKURPRF\WRPDDWDORFDOO\ FRQ¿QHG VWDJH VWLOO UHPDLQV XQFOHDU DQG UHTXLUHV SURVSHFWLYHUDQGRPL]HGVWXGLHV

REFERENCES

*DJQHU03RPS$+HQLIRUG%73KDUDQG'/DFURL[ $/DSDURVFRSLFDGUHQDOHFWRP\OHVVRQVOHDUQHGIURP FRQVHFXWLYHSURFHGXUHV$QQ6XUJ GLVFXVVLRQ

*LO&iUGHQDV$&RUGyQ&*DPLQR55XOO-$*y

-PH]3pUH])3DQWRMD-3HWDO/DSDURVFRSLFDGUHQDO

-HFWRP\OHVVRQVOHDUQHGIURPDQLQLWLDOVHULHVRI SDWLHQWV6XUJ(QGRVF

$GDPV+$+HPSHOPDQQ*$QHVWKHVLDIRUSDWLHQWV ZLWKSKHRFKURPRF\WRPD2XURZQUHVXOWVDQGDUH

-YLHZ$QDVWKHVLRO,QWHQVLYPHG1RWIDOOPHG6FKPHU]

-WKHU

0HXQH&%HUWKHUDW-'RXVVHW%-XGH1%HUWDJQD ;'XERF'HWDO5HGXFHGP\RFDUGLDOFRQWUDFWLOLW\ DVVHVVHGE\WLVVXH'RSSOHUHFKRFDUGLRJUDSK\LVDV

(10)

*XD]]RQL * &HVWDUL$ 0RQWRUVL ) %HOOLQ]RQL 3 &HQWHPHUR$1DVSUR5HWDO/DSDURVFRSLFWUHDWPHQW RIDGUHQDOGLVHDVHV\HDUVRQ%-8,QW

0LWWHQGRUI ($ (YDQV '% /HH -( 3HUULHU 1' 3KHRFKURPRF\WRPDDGYDQFHVLQJHQHWLFVGLDJQRVLV ORFDOL]DWLRQDQGWUHDWPHQW+HPDWRO2QFRO&OLQ1RUWK $P

3XJOLHVH5%RQLDUGL06DQVRQQD)0DJJLRQL''H &DUOL6&RVWDQ]L$HWDO2XWFRPHVRIODSDURVFRSLF DGUHQDOHFWRP\&OLQLFDOH[SHULHQFHZLWKSDWLHQWV 6XUJ2QFRO

7RELDV0DFKDGR05LQFyQ5tRV)7XOLR/DVPDU0 7ULVWmR5+HUPtQLR)RUVHWR3-U9D]-XOLDQR5HW DO/DSDURVFRSLFUHWURSHULWRQHDODGUHQDOHFWRP\DVD PLQLPDOO\LQYDVLYHRSWLRQIRUWKHWUHDWPHQWRIDGUHQDO WXPRUV$UFK(VS8URO

/DQJ%)X%2X<DQJ-=:DQJ%-=KDQJ*;;X .HWDO5HWURVSHFWLYHFRPSDULVRQRIUHWURSHULWRQHR

-VFRSLFYHUVXVRSHQDGUHQDOHFWRP\IRUSKHRFKURPRF\

-WRPD-8UROGLVFXVVLRQ

6DORPRQ / 5DELL 5 6RXOLH 0 0RXO\ 3 +R]QHN $&LFFR$HWDO([SHULHQFHZLWKUHWURSHULWRQHDO ODSDURVFRSLFDGUHQDOHFWRP\IRUSKHRFKURPRF\WRPD -8URO

7RELDV0DFKDGR0/DVPDU07=DPERQ-37ULVWmR 5 )RUVHWR 3+ -U -XOLDQR 59 HW DO /DSDURVFRSLF DGUHQDOHFWRP\DSURVSHFWLYHVWXG\FRPSDULQJWUDQV

-SHULWRQHDODQGUHWURSHULWRQHDODSSURDFKHV5HY$VVRF 0HG%UDV

6WURQJ 9( .HQQHG\ 7$O$KPDGLH + 7DQJ / &ROHPDQ-)RQJ<HWDO3URJQRVWLFLQGLFDWRUVRI PDOLJQDQF\LQDGUHQDOSKHRFKURPRF\WRPDVFOLQLFDO KLVWRSDWKRORJLFDQGFHOOF\FOHDSRSWRVLVJHQHH[SUHV

-VLRQDQDO\VLV6XUJHU\

7RELDV0DFKDGR07ULVWmR5$6LOYD015:UR

-FODZVNL(5/DSDURVFRSLFDGUHQDOHFWRP\IRUPDOLJ

-QDQW GLVHDVH7HFKQLFDO IHDVLELOLW\ DQG RQFRORJLFDO UHVXOWV(LQVWHLQ

Dr. Marcos Tobias-Machado & Dr. Maria Claudia Bicudo

Section of Urology ABC Medical School São Paulo, SP, Brazil E-mail: [email protected]

EDITORIAL COMMENT

7KHVXUJLFDOPDQDJHPHQWRISDWLHQWVZLWK SKHRFKURPRF\WRPD LV SRWHQWLDOO\ FXUDWLYH DQG LW KDVDOZD\VEHHQDTXHVWLRQRIGHEDWHEHFDXVHRIWKH FOLQLFDOFRPSOH[LW\RIVXFKSDWLHQWVZLWKSRWHQWLDO KLJKULVNSHULRSHUDWLYHPRUELGPRUWDOLW\

:KHQODSDURVFRSLFVXUJHU\ZDVLQWURGXFHGDV DQDOWHUQDWLYHDSSURDFKIRURSHQVXUJHU\WKHWHQVLRQ URVHDPRQJWUDGLWLRQDOVXUJHRQVXVHGWRWKHFRPPRQ SUREOHPVDVVRFLDWHGZLWKSDWLHQWVZLWKSKHRFKURPR -F\WRPDWKDWZHUHPDLQO\FRQFHUQHGZLWKWKHVDIHW\ RIWKHODSDURVFRSLFDSSURDFK

$VWKHH[SHULHQFHDPRQJODSDURVFRSLVWVJUHZ LWEHFDPHFOHDUWKDWWKLVDSSURDFKZDVQRWRQO\DPDW -WHURIEHWWHUFRVPHVLVZKHUHDVRQWKHFRQWUDU\VHYHUDO UHSRUWVUHYHDOHGWKHEHQH¿WVRIWUHDWLQJSDWLHQWVZLWK SKHRFKURPRF\WRPD SUHIHUHQWLDOO\ YLD ODSDURVFRS\

RYHUWKHFRQYHQWLRQDORSHQDSSURDFKVXFKDVOHVV FDWKHFRODPLQHVUHOHDVHOHVVEOHHGLQJOHVV 8&,OHQJWKRIVWD\OHVVKRVSLWDOVWD\VKRUWHU FRQYDOHVFHQFHDQGPDLQO\UHYHDOLQJWREHDVVDIH DVRSHQVXUJHU\

(11)

VDIHW\RIODSDURVFRSLFDSSURDFKDVDPHDQVRIFXUH DQGWXPRUUHFXUUHQFHLQDGGLWLRQWRWKHVDIHW\DOVR UHSRUWHGGXULQJWKHSHULRSHUDWLYHWLPH

7UHDWPHQWRISDWLHQWVZLWKSKHRFKURPRF\ -WRPDUHTXLUHVDFRPPLWWHGPXOWLGLVFLSOLQDU\WHDPRI XURORJLVWHQGRFULQRORJLVWDQHVWKHVLRORJLVWUDGLROR -JLVWDQGDOOVWDIILQDZHOOHTXLSSHGKRVSLWDODQGDZDUH RIDOOSRWHQWLDOQHHGVRIVXFKSDWLHQWV/DSDURVFRSLF VXUJHU\SHUIRUPHGE\DQH[SHULHQFHGVXUJLFDOJURXS DORQJDNQRZOHGJHDEOHFRPPLWWHGPXOWLGLVFLSOLQDU\ WHDPLQDSUHSDUHGKRVSLWDOKDYHSURYHQHI¿FDF\DQG VDIHW\,WVKRXOGEHNHSWLQPLQGWKDWODSDURVFRS\LV RQO\RQHRIWKHDGYDQFHVQRZDSSOLHGWRSDWLHQWVZLWK SKHRFKURPRF\WRPD

1HYHUWKHOHVVODSDURVFRSLFVXUJHU\PD\QRW \HWKDYHHOLPLQDWHGRSHQVXUJHU\$WRXULQVWLWXWLRQ SDWLHQWVZLWKSKHRFKURPRF\WRPDRXWRIWKDW

ZHUHRSHUDWHGRQIURPWRQRQSXEOLVKHG GDWDVWLOOUHTXLUHGRSHQFRQYHQWLRQDODSSURDFKHLWKHU EHFDXVHRIPDMRUYHVVHOLQYROYHPHQWRUWXPRUVL]H JUHDWHUWKDQFPRUDGMDFHQWRUJDQFRQFRPLWDQW UHPRYDO

)XUWKHUVWXGLHVDUHHQFRXUDJHGWRFRQWLQXHWR LPSURYHRXUVXUJLFDOUHVXOWVRQVXFKFRPSOH[SDWLHQWV ZLWKDFRPSOH[GLVHDVH

REFERENCES

*LOO,67KHFDVHIRUODSDURVFRSLFDGUHQDOHFWRP\-8URO

)DULD ()$QGUHRQL & .UHEV 5. 1DVFLPHQWR + *ROGPDQ60.DWHU&HWDO$GYDQFHVLQSKHRFKUR

- PRF\WRPDPDQDJHPHQWLQWKHHUDRIODSDURVFRS\-(QGRXURO

Dr. Cassio Andreoni

Section of Urology Federal University of Sao Paulo, UNIFESP Sao Paulo, SP, Brazil E-mail: [email protected]

EDITORIAL COMMENT

3KHRFKURPRF\WRPDVDUHUHODWLYHO\XQFRP -PRQ WXPRUV ZKRVH RSHUDWLYH UHVHFWLRQ KDV FOHDU PHGLFDODQGWHFKQLFDOFKDOOHQJHV

:KLOHWKHVDIHW\DQGHI¿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ÀDWLRQDQGWXPRUPDQLSXODWLRQ,Q

(12)

DGUHQDOHFWRP\&RQYHUVLRQUDWHZDVDQG WXPRUFDSVXOHZDVUXSWXUHGLQSDWLHQWZLWKDULJKW FPF\VWLFSKHRFKURPRF\WRPDF\VWUXSWXUH 0RUHRYHU SHURSHUDWLYH KHPRG\QDPLF PRGL¿FDWLRQVVHHPWREHVLPLODUGXULQJURERWLFDQG FRQYHQWLRQDODGUHQDOHFWRP\IRUSKHRFKURPRF\WRPD XQSXEOLVKHGGDWD7KLVHPSKDVL]HVWKDWURERWLFDS -SURDFKFDQQRWEHFRQVLGHUHGGHIDFWRDVSUHFOXGLQJDOO GLI¿FXOWLHVWKDWFDQEHREVHUYHGGXULQJFRQYHQWLRQDO ODSDURVFRSLFDGUHQDOHFWRP\IRUSKHRFKURPRF\WRPD /DSDURVFRSLFH[FLVLRQVRISKHRFKURPRF\WRPDVZLWK RUZLWKRXWURERWLFV\VWHPUHPDLQFKDOOHQJLQJVXUJLFDO SURFHGXUHVEHFDXVHRILQWUDRSHUDWLYHFDWHFKRODPLQH UHOHDVHDQGWXPRUYDVFXODUL]DWLRQ([WHQVLYHH[SHUL -HQFHLQPLQLPDOO\LQYDVLYHWHFKQLTXHVDVZHOODVLQ HQGRFULQHVXUJHU\DUHWZRNH\HOHPHQWVIRUVXUJHRQV SHUIRUPLQJODSDURVFRSLFDGUHQDOHFWRP\IRUSKHRFKUR -PRF\WRPD

REFERENCES

.HUFKHU.:1RYLWVN\<:3DUN$0DWWKHZV%' /LWZLQ'(+HQLIRUG%7/DSDURVFRSLFFXUDWLYHUH

-VHFWLRQRISKHRFKURPRF\WRPDV$QQ6XUJ GLVFXVVLRQ

%UXQDXG/$\DY$=DUQHJDU55RXHUV$.OHLQ0 %RLVVHO3%UHVOHU/3URVSHFWLYHHYDOXDWLRQRI URERWLFDVVLVWHGXQLODWHUDODGUHQDOHFWRPLHV6XUJHU\

Dr. M Fau & Dr. Laurent Brunaud

Imagem

Figure 1 – CT scan showing a 2 cm left adrenal mass.
Table 3 – Postoperative (PO) results.

Referências

Documentos relacionados

3, $%6 PRVWO\GXHWRORZHI¿FLHQF\LQWKHWUDQVIHURIHQHUJ\ LQ36,,DVDUHVXOWRIDGHFUHDVHLQWKHGHQVLW\RIUHDFWLRQ FHQWUHV 6 UHWLFXODWD ZDV IRXQG WR EH WKH VSHFLHV ZLWK WKH KLJKHVW QXPEHU

)LJXUHV DQG VKRZ WKH VXUIDFH UHVSRQVH RI WKH JHUPLQDWLRQ DQG UDGLFOH SURWUXVLRQ YDULDEOHV RI WKH &amp; FDQHSKRUD VHHGV DIWHU IRXU PRQWKV RI VWRUDJH GULHG DW

7KH UHVXOWV RI WKLV VWXG\ VKRZ WKDW WHPSHUDWXUH EXW QRW WKH DYDLODELOLW\ RI ZDWHU PD\ EH DQ LPSRUWDQW IDFWRU UHVSRQVLEOH IRU WKH GLIIHUHQFHV LQ WKH TXDOLW\ DQG

Considero a passagem pelo contexto de 1.º CEB - 3.º ano (a última prática pedagógica do Mestrado) – um pouco diferente das restantes, uma vez que as componentes de

3UHPL[PRGXOH:LWKWKHUHDFWLRQVLQYROYHGLQWKHSURSRVHG PHFKDQLVPV WKH YDULDWLRQ RI WKH$3 FRPEXVWLRQ EHKDYLRU ZDV REVHUYHG DV WKH SUHVVXUH RI WKH FRPEXVWLRQ FKDPEHU RI D VROLG

,Q WKLV VHFWLRQ WKH VWUHVV GLVWULEXWLRQ ZDV DQDO\]HG LQ WKH LQWHUIDFH UHJLRQ RI WKH EODGH DQG GLVF LQ D GRYHWDLO

7KH HOHFWURFKHPLFDO UHGXFWLRQ RI DFWLYDWHG ROHILQV LQ QRQDTXHRXVVROYHQWVLVZHOOGRFXPHQWHGLQWKHOLWHUDWXUH ,Q WKH DEVHQFH RI D SURWRQ GRQRU WKH UHGXFWLRQ RI

5HVXOWV IRU WKH GHYHORSPHQW RI 7 DYHOODQHGDH VKRZHGWKDWVSHFLHVPDLQWDLQHGJURZWKRIVWHPLQ H[WHQVLRQ GXULQJ IORRGLQJ 7KH URRWV KRZHYHU KDG SURQRXQFHG JURZWK LPSDLUPHQW 6LPLODUO\ WR