The American surgeon
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The American surgeon · Apr 2009
Comparative StudyPatients with Cushing's syndrome are care-intensive even in the era of laparoscopic adrenalectomy.
We report outcomes from laparoscopic adrenalectomy (LA) comparing patients with Cushing's syndrome with those with other adrenal pathology with respect to length of stay (LOS), overall complications, and financial implications. We conducted a retrospective review of 80 continuous patients (103 glands) undergoing LA. The clinical diagnoses were: hypercortisolism (Cushing' syndrome; n=33), hyperaldosteronism (Conn's syndrome; n=20), phaeochromocytoma (n=16), and neoplasm (others; n=11). ⋯ LA in patients with Cushing's syndrome is associated with longer hospitalizations, more frequent major complications, and higher advanced care requirements, especially for patients undergoing bilateral adrenalectomy. Minor complications were infrequent and median LOS was brief regardless of diagnosis. Patients with Cushing's syndrome had higher costs for overall hospital charges, advanced care, and anesthesia.
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The American surgeon · Apr 2009
Roger T. Sherman Lecture. Advances in the management of blunt thoracic aortic injury: Parmley to the present.
This article traces the evolution in management of blunt aortic injury (BAI) over the past 50 years from the time of the seminal description from Parmley in 1958. There have been major advances in both diagnostics and treatment paradigms with very rapid technologic advances occurring over the past decade. For many years, conventional aortography was the principle diagnostic tool, but it has been replaced by the progression of CT. ⋯ Many patients with major associated injuries have definitive treatment of BAI managed in a delayed fashion with the use of hypertensives, which appears to improve outcomes. In the past 5 years, definitive treatment has changed with the majority of injuries being treated today with endoluminal stent grafts as opposed to open thoracotomy and traditional repair techniques. Paraplegia rates have diminished from 8 to 10 per cent down to 1 to 2 per cent in association with these therapeutic advances.