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Pinghung Liu - One of the best experts on this subject based on the ideXlab platform.
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intra abdominal bleeding with hemorrhagic shock a case of adrenal myelolipoma and review of literature
BMC Surgery, 2017Co-Authors: Huipu Liu, Wenyen Chang, Shantao Chien, Chinwen Hsu, Wenching Kung, Pinghung LiuAbstract:Adrenal myelolipoma is an uncommon, benign, and hormonally non-Functioning Tumor that is composed of mature adipose tissue and normal hematopoietic tissue. Most cases to date are asymptomatic or have epigastric pain. Acute hemorrhage is the most dramatic manifestation of adrenal myelolipoma; though, it is a rare entity. Hemorrhagic shock due to adrenal myelolipoma, to our knowledge, was much less mentioned so far. Persistent bleeding and uncontrollable hypotension are considered to be absolute indications for immediate surgical operation. Herein we presented a 32-year-old male patient with initial symptoms of nausea, vomiting, and epigastric pain progressing to altered consciousness and hypotension during ER course. Hemorrhagic shock due to a giant adrenal myelolipoma, R’t was diagnosed. Emergent exploratory laparotomy was executed, and en bloc excision of Tumor was done. Adrenal myelolipoma might be diagnosed as a adjunction to other main causes of illness; furthermore, adrenal myelolipoma could be asymptomatic in lifetime. In our case, however, manifesting as hemorrhage shock was challenging to diagnose step by step; instead, maintaining vital organs perfusion and identifying bleeding sources were to be done. Management of myelolipoma should be done on a case-to-case basis.
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Intra-abdominal bleeding with hemorrhagic shock: a case of adrenal myelolipoma and review of literature
BMC, 2017Co-Authors: Huipu Liu, Wenyen Chang, Shantao Chien, Chinwen Hsu, Wenching Kung, Pinghung LiuAbstract:Abstract Background Adrenal myelolipoma is an uncommon, benign, and hormonally non-Functioning Tumor that is composed of mature adipose tissue and normal hematopoietic tissue. Most cases to date are asymptomatic or have epigastric pain. Acute hemorrhage is the most dramatic manifestation of adrenal myelolipoma; though, it is a rare entity. Hemorrhagic shock due to adrenal myelolipoma, to our knowledge, was much less mentioned so far. Persistent bleeding and uncontrollable hypotension are considered to be absolute indications for immediate surgical operation. Case presentation Herein we presented a 32-year-old male patient with initial symptoms of nausea, vomiting, and epigastric pain progressing to altered consciousness and hypotension during ER course. Hemorrhagic shock due to a giant adrenal myelolipoma, R’t was diagnosed. Emergent exploratory laparotomy was executed, and en bloc excision of Tumor was done. Conclusion Adrenal myelolipoma might be diagnosed as a adjunction to other main causes of illness; furthermore, adrenal myelolipoma could be asymptomatic in lifetime. In our case, however, manifesting as hemorrhage shock was challenging to diagnose step by step; instead, maintaining vital organs perfusion and identifying bleeding sources were to be done. Management of myelolipoma should be done on a case-to-case basis
Huipu Liu - One of the best experts on this subject based on the ideXlab platform.
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intra abdominal bleeding with hemorrhagic shock a case of adrenal myelolipoma and review of literature
BMC Surgery, 2017Co-Authors: Huipu Liu, Wenyen Chang, Shantao Chien, Chinwen Hsu, Wenching Kung, Pinghung LiuAbstract:Adrenal myelolipoma is an uncommon, benign, and hormonally non-Functioning Tumor that is composed of mature adipose tissue and normal hematopoietic tissue. Most cases to date are asymptomatic or have epigastric pain. Acute hemorrhage is the most dramatic manifestation of adrenal myelolipoma; though, it is a rare entity. Hemorrhagic shock due to adrenal myelolipoma, to our knowledge, was much less mentioned so far. Persistent bleeding and uncontrollable hypotension are considered to be absolute indications for immediate surgical operation. Herein we presented a 32-year-old male patient with initial symptoms of nausea, vomiting, and epigastric pain progressing to altered consciousness and hypotension during ER course. Hemorrhagic shock due to a giant adrenal myelolipoma, R’t was diagnosed. Emergent exploratory laparotomy was executed, and en bloc excision of Tumor was done. Adrenal myelolipoma might be diagnosed as a adjunction to other main causes of illness; furthermore, adrenal myelolipoma could be asymptomatic in lifetime. In our case, however, manifesting as hemorrhage shock was challenging to diagnose step by step; instead, maintaining vital organs perfusion and identifying bleeding sources were to be done. Management of myelolipoma should be done on a case-to-case basis.
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Intra-abdominal bleeding with hemorrhagic shock: a case of adrenal myelolipoma and review of literature
BMC, 2017Co-Authors: Huipu Liu, Wenyen Chang, Shantao Chien, Chinwen Hsu, Wenching Kung, Pinghung LiuAbstract:Abstract Background Adrenal myelolipoma is an uncommon, benign, and hormonally non-Functioning Tumor that is composed of mature adipose tissue and normal hematopoietic tissue. Most cases to date are asymptomatic or have epigastric pain. Acute hemorrhage is the most dramatic manifestation of adrenal myelolipoma; though, it is a rare entity. Hemorrhagic shock due to adrenal myelolipoma, to our knowledge, was much less mentioned so far. Persistent bleeding and uncontrollable hypotension are considered to be absolute indications for immediate surgical operation. Case presentation Herein we presented a 32-year-old male patient with initial symptoms of nausea, vomiting, and epigastric pain progressing to altered consciousness and hypotension during ER course. Hemorrhagic shock due to a giant adrenal myelolipoma, R’t was diagnosed. Emergent exploratory laparotomy was executed, and en bloc excision of Tumor was done. Conclusion Adrenal myelolipoma might be diagnosed as a adjunction to other main causes of illness; furthermore, adrenal myelolipoma could be asymptomatic in lifetime. In our case, however, manifesting as hemorrhage shock was challenging to diagnose step by step; instead, maintaining vital organs perfusion and identifying bleeding sources were to be done. Management of myelolipoma should be done on a case-to-case basis
Michael I Dangelica - One of the best experts on this subject based on the ideXlab platform.
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disease free interval and Tumor functional status can be used to select patients for resection ablation of liver metastases from adrenocortical carcinoma insights from a multi institutional study
Hpb, 2020Co-Authors: Reed I. Ayabe, Seth M. Steinberg, Jeremy L. Davis, Pieter M. H. Nierop, Raja R Narayan, Samantha M Ruff, Michael M Wach, Taylor R Ripley, Bas Groot Koerkamp, Michael I DangelicaAbstract:Background: Adrenocortical carcinoma (ACC) is an aggressive malignancy that frequently metastasizes to the liver. Given the limitations of systemic therapy in this setting, we sought to determine characteristics associated with a two-fold increase in survival with resection/ablation compared to that reported with chemotherapy alone (∼12 months). Methods: Patients who underwent resection/ablation at our institutions for ACC liver metastases were identified. Those who survived 12–24 months after metastasectomy were excluded, as the aim was to characterize patients who most clearly benefited from these procedures. Clinicopathologic and treatment characteristics were assessed for associations with survival. Results: Sixty-two patients met inclusion criteria, of whom 44 survived >24 months and 18 survived <12 months. Patients with extended survival were less likely to have Functioning Tumors (p = 0.047), had fewer liver metastases (p = 0.047), and a longer disease-free interval (DFI) (median 17.6 vs 2.3 months, p < 0.0001). On multivariable analysis, DFI (OR = 1.33, 95% CI = 1.12–1.58) and non-Functioning Tumor (OR = 0.13, 95% CI = 0.13–0.56) were independently associated with prolonged survival. Conclusion: Metastasectomy/ablation should be considered for patients with ACC liver metastases. DFI and Tumor functional status may be useful in selecting optimal candidates for these procedures.
Bertil Hamberger - One of the best experts on this subject based on the ideXlab platform.
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in vitro release of aldosterone and cortisol in human adrenal adenomas correlates to mrna expression of steroidogenic enzymes for genes cyp11b2 and cyp17
World Journal of Surgery, 2001Co-Authors: Ulla Enberg, Larsove Farnebo, Anna Wedeil, Staffan Grondai, Marja Thoren, Lars Grimelius, Magnus Kjellman, Martin Backdahl, Bertil HambergerAbstract:Adenomas of the adrenal cortex cause different disorders depending on the main steroid synthesized and released. The aim of this research is to increase our understanding of the pathophysiology of steroidogenesis in adrenocortical disorders by comparing the release of steroids from adrenocortical adenomas in vitro with the messenger RNA (mRNA) expression of steroid synthesizing enzymes. Fourteen patients with adrenal Tumors were included in the present study; nine were diagnosed with primary aldosteronism and three with Cushing’s syndrome. Two patients had an adrenal Tumor discovered on computed tomography (CT) during workup for an unrelated disease. Serum cortisol, plasma aldosterone, and urinary catecholamines were normal. Tissue was taken for in vitro steroid release, and aldosterone and cortisol in the medium after a 1-hour incubation were determined. Oligonucleotide probes with sequences complementary to mRNAs encoding for the steroid synthesizing enzymes 11β-hydroxylase (CYP11B1), 18-hydroxylase (CYP11B2), 17α-hydroxylase (CYP17), and 21-hydroxylase (CYP21) were synthesized (Genset, Paris, France) and in situ hybridization was performed. Moderate expression of CYP11B2 and low expression of CYP11B1 were seen in the zona glomerulosa. The zona fasciculata of the control adrenals expressed a high signal of CYP11B1, whereas the expression of CYP11B2 was very low. There was considerable variation in aldosterone release from the aldosteronomas, whereas the Tumors from the Gushing patients showed no detectable release of aldosterone. In contrast, Tumors from patients with primary aldosteronism, Cushing’s syndrome, and no hyper-function all had the ability to synthesize and release cortisol in vitro. The highest cortisol release was found in Tumors from patients with Cushing’s syndrome, but also the nonhyperFunctioning Tumors and some of the aldosteronomas released significant amounts of cortisol. The two patients with highest release of aldosterone in vitro showed the highest expression of CYP11B2 and the lowest expression of CYP11B1 and CYP17. The remaining aldosteronomas had low expression of CYP11B2, similar to the two other groups. Expression of CYP11B1 was high as expected in the Gushing adenomas, but also the two nonhyperFunctioning Tumors and some of the aldosteronomas showed a moderate expression. Adenomas from Cushing’s syndrome, nonhyperFunctioning adenomas, and some of the aldosterone- producing adenomas had moderate to high expression of CYP17. This paper presents new means for functional characterization of adrenocortical Tumors. Diagnosis of an aldosteronoma is often difficult, and with the advent of these methods it is possible to determine the functional capacity of a Tumor, once it is removed. This is of special interest if the patient remains hypertensive postoperatively, and it is not clear whether the patient indeed had a Functioning Tumor.
Wenching Kung - One of the best experts on this subject based on the ideXlab platform.
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intra abdominal bleeding with hemorrhagic shock a case of adrenal myelolipoma and review of literature
BMC Surgery, 2017Co-Authors: Huipu Liu, Wenyen Chang, Shantao Chien, Chinwen Hsu, Wenching Kung, Pinghung LiuAbstract:Adrenal myelolipoma is an uncommon, benign, and hormonally non-Functioning Tumor that is composed of mature adipose tissue and normal hematopoietic tissue. Most cases to date are asymptomatic or have epigastric pain. Acute hemorrhage is the most dramatic manifestation of adrenal myelolipoma; though, it is a rare entity. Hemorrhagic shock due to adrenal myelolipoma, to our knowledge, was much less mentioned so far. Persistent bleeding and uncontrollable hypotension are considered to be absolute indications for immediate surgical operation. Herein we presented a 32-year-old male patient with initial symptoms of nausea, vomiting, and epigastric pain progressing to altered consciousness and hypotension during ER course. Hemorrhagic shock due to a giant adrenal myelolipoma, R’t was diagnosed. Emergent exploratory laparotomy was executed, and en bloc excision of Tumor was done. Adrenal myelolipoma might be diagnosed as a adjunction to other main causes of illness; furthermore, adrenal myelolipoma could be asymptomatic in lifetime. In our case, however, manifesting as hemorrhage shock was challenging to diagnose step by step; instead, maintaining vital organs perfusion and identifying bleeding sources were to be done. Management of myelolipoma should be done on a case-to-case basis.
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Intra-abdominal bleeding with hemorrhagic shock: a case of adrenal myelolipoma and review of literature
BMC, 2017Co-Authors: Huipu Liu, Wenyen Chang, Shantao Chien, Chinwen Hsu, Wenching Kung, Pinghung LiuAbstract:Abstract Background Adrenal myelolipoma is an uncommon, benign, and hormonally non-Functioning Tumor that is composed of mature adipose tissue and normal hematopoietic tissue. Most cases to date are asymptomatic or have epigastric pain. Acute hemorrhage is the most dramatic manifestation of adrenal myelolipoma; though, it is a rare entity. Hemorrhagic shock due to adrenal myelolipoma, to our knowledge, was much less mentioned so far. Persistent bleeding and uncontrollable hypotension are considered to be absolute indications for immediate surgical operation. Case presentation Herein we presented a 32-year-old male patient with initial symptoms of nausea, vomiting, and epigastric pain progressing to altered consciousness and hypotension during ER course. Hemorrhagic shock due to a giant adrenal myelolipoma, R’t was diagnosed. Emergent exploratory laparotomy was executed, and en bloc excision of Tumor was done. Conclusion Adrenal myelolipoma might be diagnosed as a adjunction to other main causes of illness; furthermore, adrenal myelolipoma could be asymptomatic in lifetime. In our case, however, manifesting as hemorrhage shock was challenging to diagnose step by step; instead, maintaining vital organs perfusion and identifying bleeding sources were to be done. Management of myelolipoma should be done on a case-to-case basis
