The Experts below are selected from a list of 129 Experts worldwide ranked by ideXlab platform
Brett C. Sheppard - One of the best experts on this subject based on the ideXlab platform.
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The adrenal Psoas Sign: surgical outcomes following a simple technique to maximize removal of extracortical adrenal tissue during bilateral laparoscopic adrenalectomy
Surgical Endoscopy, 2014Co-Authors: Erin W. Gilbert, Vincent L. Harrison, Brett C. SheppardAbstract:Background Bilateral laparoscopic adrenalectomy (BLA) is an effective therapy for the management of persistent hypercortisolism in patients after failed transphenoidal pituitary tumor resection for Cushing’s disease. Extracortical adrenal tissue has been identified as a source of persistent hypercortisolism and, if not resected along with both adrenal glands, may lead to treatment failure. We report a reliable and reproducible technique called the “Psoas Sign” for BLA in patients with Cushing’s disease which reduces the likelihood of retained extra-adrenal cortical rests and may reduce intraoperative complications. Methods A 16-year retrospective review of all consecutive patients who underwent transabdominal BLA at a single tertiary care center was performed. All patients underwent BLA utilizing the Psoas Sign technique and all procedures were performed replicating these predetermined surgical steps: (1) Identification of the inferior pole of the gland. (2) Identification of the inferior aspect of the adreno-caval groove on the right or the adrenal vein/renal vein confluence on the left. (3) Division of the adrenal vein. (4) Dissection and removal of the adrenal gland with clearance of all retroperitoneal fat overlying the Psoas muscle. Results Between October 1996 and December 2012, 92 patients underwent BLA for refractory Cushing’s disease. Patients were predominantly female (90 %) with a median age of 40 years (17–71). There were 3 intraoperative complications (3.2 %), 2 conversions (2.2 %), and 1 death (1.09 %). Four patients were identified as having extracortical rests of adrenal tissue within the retroperitoneal fat (4.3 %). Mean operative time was 272 min (±79.25, n = 68) and median estimated blood loss was 50 mL (10–800 mL). Conclusions The Psoas Sign technique provides a clear view of the adrenal fossa and facilitates careful dissection of the anatomic planes around the adrenal gland. This technique is feasible, reproducible and in our experience allows for safe removal of both adrenal glands and all surrounding extracortical adrenal tissue.
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The adrenal Psoas Sign: surgical outcomes following a simple technique to maximize removal of extracortical adrenal tissue during bilateral laparoscopic adrenalectomy.
Surgical Endoscopy and Other Interventional Techniques, 2014Co-Authors: Erin W. Gilbert, Vincent L. Harrison, Brett C. SheppardAbstract:Background Bilateral laparoscopic adrenalectomy (BLA) is an effective therapy for the management of persistent hypercortisolism in patients after failed transphenoidal pituitary tumor resection for Cushing’s disease. Extracortical adrenal tissue has been identified as a source of persistent hypercortisolism and, if not resected along with both adrenal glands, may lead to treatment failure. We report a reliable and reproducible technique called the “Psoas Sign” for BLA in patients with Cushing’s disease which reduces the likelihood of retained extra-adrenal cortical rests and may reduce intraoperative complications.
Michael W. Jung - One of the best experts on this subject based on the ideXlab platform.
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Hanging" pelvic gallbladder simulating occult hip fracture versus appendicitis.
Western Journal of Emergency Medicine, 2010Co-Authors: Katherine W. Davisson, George L. Higgins, Michael W. JungAbstract:An 81-year-old Caucasian woman presented to the emergency department (ED) complaining of right groin pain of one month’s duration. She was able to bear weight but was finding it increasingly difficult to ambulate. She described a vague history of falling, prompting a prior negative work-up for hip fracture. In the ED, she was noted to be kyphotic, but exhibited no Signs of trauma. Exam revealed tenderness to deep palpation in the right lower quadrant without rebound or mass. She had full range of motion of her right hip with minimal discomfort, but hip extension elicited a positive Psoas Sign. Given concern about the possibility of either an occult hip fracture or a subacute presentation of appendicitis, imaging studies were ordered. The patient had an inflamed pelvic gallbladder. Anatomic malposition of organs can result in unusual clinical presentations. Abnormalities in the gallbladder mesentery, including a wide mesentery, absent mesentery or mesentery covering only the cystic duct and artery, can result in a “floating” or “hanging” gallbladder, predisposing it to torsion. Factors associated with this condition include atrophy of the liver, loss of visceral fat and elasticity with aging, weight loss, and kyphosis. Triggering events for torsion include violent peristalsis of neighboring organs, as well as atherosclerosis and tortuosity of the cystic artery.1–3 Torsion is most common in the elderly with a female-to-male ratio of 3:1 and can be incomplete, causing intermittent pain, or complete, with resultant gangrene or rupture.2 Laboratory data are typically not helpful. Ultrasound and computed tomography imaging often demonstrate an enlarged, thickened-walled gallbladder located outside its normal anatomic fossa.3 Most patients with torsion have no gallstones. Torsion or inflammation of a hanging pelvic gallbladder should be considered in the differential diagnosis of an elderly, kyphotic female patient with right lower quadrant or pelvic pain.
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Image in Emergency Medicine “Hanging ” Pelvic Gallbladder Simulating Occult Hip Fracture Versus Appendicitis
2009Co-Authors: Katherine W. Davisson, George L. Higgins, Michael W. JungAbstract:An 81-year-old Caucasian woman presented to the emergency department (ED) complaining of right groin pain of one month’s duration. She was able to bear weight but was finding it increasingly difficult to ambulate. She described a vague history of falling, prompting a prior negative work-up for hip fracture. In the ED, she was noted to be kyphotic, but exhibited no Signs of trauma. Exam revealed tenderness to deep palpation in the right lower quadrant without rebound or mass. She had full range of motion of her right hip with minimal discomfort, but hip extension elicited a positive Psoas Sign. Given concern about the possibility of either an occult hip fracture or a subacute presentation of appendicitis, imaging studies were ordered. The patient had an inflamed pelvic gallbladder. Anatomic malposition of organs can result in unusual clinica
Erin W. Gilbert - One of the best experts on this subject based on the ideXlab platform.
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The adrenal Psoas Sign: surgical outcomes following a simple technique to maximize removal of extracortical adrenal tissue during bilateral laparoscopic adrenalectomy
Surgical Endoscopy, 2014Co-Authors: Erin W. Gilbert, Vincent L. Harrison, Brett C. SheppardAbstract:Background Bilateral laparoscopic adrenalectomy (BLA) is an effective therapy for the management of persistent hypercortisolism in patients after failed transphenoidal pituitary tumor resection for Cushing’s disease. Extracortical adrenal tissue has been identified as a source of persistent hypercortisolism and, if not resected along with both adrenal glands, may lead to treatment failure. We report a reliable and reproducible technique called the “Psoas Sign” for BLA in patients with Cushing’s disease which reduces the likelihood of retained extra-adrenal cortical rests and may reduce intraoperative complications. Methods A 16-year retrospective review of all consecutive patients who underwent transabdominal BLA at a single tertiary care center was performed. All patients underwent BLA utilizing the Psoas Sign technique and all procedures were performed replicating these predetermined surgical steps: (1) Identification of the inferior pole of the gland. (2) Identification of the inferior aspect of the adreno-caval groove on the right or the adrenal vein/renal vein confluence on the left. (3) Division of the adrenal vein. (4) Dissection and removal of the adrenal gland with clearance of all retroperitoneal fat overlying the Psoas muscle. Results Between October 1996 and December 2012, 92 patients underwent BLA for refractory Cushing’s disease. Patients were predominantly female (90 %) with a median age of 40 years (17–71). There were 3 intraoperative complications (3.2 %), 2 conversions (2.2 %), and 1 death (1.09 %). Four patients were identified as having extracortical rests of adrenal tissue within the retroperitoneal fat (4.3 %). Mean operative time was 272 min (±79.25, n = 68) and median estimated blood loss was 50 mL (10–800 mL). Conclusions The Psoas Sign technique provides a clear view of the adrenal fossa and facilitates careful dissection of the anatomic planes around the adrenal gland. This technique is feasible, reproducible and in our experience allows for safe removal of both adrenal glands and all surrounding extracortical adrenal tissue.
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The adrenal Psoas Sign: surgical outcomes following a simple technique to maximize removal of extracortical adrenal tissue during bilateral laparoscopic adrenalectomy.
Surgical Endoscopy and Other Interventional Techniques, 2014Co-Authors: Erin W. Gilbert, Vincent L. Harrison, Brett C. SheppardAbstract:Background Bilateral laparoscopic adrenalectomy (BLA) is an effective therapy for the management of persistent hypercortisolism in patients after failed transphenoidal pituitary tumor resection for Cushing’s disease. Extracortical adrenal tissue has been identified as a source of persistent hypercortisolism and, if not resected along with both adrenal glands, may lead to treatment failure. We report a reliable and reproducible technique called the “Psoas Sign” for BLA in patients with Cushing’s disease which reduces the likelihood of retained extra-adrenal cortical rests and may reduce intraoperative complications.
Katherine W. Davisson - One of the best experts on this subject based on the ideXlab platform.
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Hanging" pelvic gallbladder simulating occult hip fracture versus appendicitis.
Western Journal of Emergency Medicine, 2010Co-Authors: Katherine W. Davisson, George L. Higgins, Michael W. JungAbstract:An 81-year-old Caucasian woman presented to the emergency department (ED) complaining of right groin pain of one month’s duration. She was able to bear weight but was finding it increasingly difficult to ambulate. She described a vague history of falling, prompting a prior negative work-up for hip fracture. In the ED, she was noted to be kyphotic, but exhibited no Signs of trauma. Exam revealed tenderness to deep palpation in the right lower quadrant without rebound or mass. She had full range of motion of her right hip with minimal discomfort, but hip extension elicited a positive Psoas Sign. Given concern about the possibility of either an occult hip fracture or a subacute presentation of appendicitis, imaging studies were ordered. The patient had an inflamed pelvic gallbladder. Anatomic malposition of organs can result in unusual clinical presentations. Abnormalities in the gallbladder mesentery, including a wide mesentery, absent mesentery or mesentery covering only the cystic duct and artery, can result in a “floating” or “hanging” gallbladder, predisposing it to torsion. Factors associated with this condition include atrophy of the liver, loss of visceral fat and elasticity with aging, weight loss, and kyphosis. Triggering events for torsion include violent peristalsis of neighboring organs, as well as atherosclerosis and tortuosity of the cystic artery.1–3 Torsion is most common in the elderly with a female-to-male ratio of 3:1 and can be incomplete, causing intermittent pain, or complete, with resultant gangrene or rupture.2 Laboratory data are typically not helpful. Ultrasound and computed tomography imaging often demonstrate an enlarged, thickened-walled gallbladder located outside its normal anatomic fossa.3 Most patients with torsion have no gallstones. Torsion or inflammation of a hanging pelvic gallbladder should be considered in the differential diagnosis of an elderly, kyphotic female patient with right lower quadrant or pelvic pain.
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Image in Emergency Medicine “Hanging ” Pelvic Gallbladder Simulating Occult Hip Fracture Versus Appendicitis
2009Co-Authors: Katherine W. Davisson, George L. Higgins, Michael W. JungAbstract:An 81-year-old Caucasian woman presented to the emergency department (ED) complaining of right groin pain of one month’s duration. She was able to bear weight but was finding it increasingly difficult to ambulate. She described a vague history of falling, prompting a prior negative work-up for hip fracture. In the ED, she was noted to be kyphotic, but exhibited no Signs of trauma. Exam revealed tenderness to deep palpation in the right lower quadrant without rebound or mass. She had full range of motion of her right hip with minimal discomfort, but hip extension elicited a positive Psoas Sign. Given concern about the possibility of either an occult hip fracture or a subacute presentation of appendicitis, imaging studies were ordered. The patient had an inflamed pelvic gallbladder. Anatomic malposition of organs can result in unusual clinica
Vincent L. Harrison - One of the best experts on this subject based on the ideXlab platform.
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The adrenal Psoas Sign: surgical outcomes following a simple technique to maximize removal of extracortical adrenal tissue during bilateral laparoscopic adrenalectomy
Surgical Endoscopy, 2014Co-Authors: Erin W. Gilbert, Vincent L. Harrison, Brett C. SheppardAbstract:Background Bilateral laparoscopic adrenalectomy (BLA) is an effective therapy for the management of persistent hypercortisolism in patients after failed transphenoidal pituitary tumor resection for Cushing’s disease. Extracortical adrenal tissue has been identified as a source of persistent hypercortisolism and, if not resected along with both adrenal glands, may lead to treatment failure. We report a reliable and reproducible technique called the “Psoas Sign” for BLA in patients with Cushing’s disease which reduces the likelihood of retained extra-adrenal cortical rests and may reduce intraoperative complications. Methods A 16-year retrospective review of all consecutive patients who underwent transabdominal BLA at a single tertiary care center was performed. All patients underwent BLA utilizing the Psoas Sign technique and all procedures were performed replicating these predetermined surgical steps: (1) Identification of the inferior pole of the gland. (2) Identification of the inferior aspect of the adreno-caval groove on the right or the adrenal vein/renal vein confluence on the left. (3) Division of the adrenal vein. (4) Dissection and removal of the adrenal gland with clearance of all retroperitoneal fat overlying the Psoas muscle. Results Between October 1996 and December 2012, 92 patients underwent BLA for refractory Cushing’s disease. Patients were predominantly female (90 %) with a median age of 40 years (17–71). There were 3 intraoperative complications (3.2 %), 2 conversions (2.2 %), and 1 death (1.09 %). Four patients were identified as having extracortical rests of adrenal tissue within the retroperitoneal fat (4.3 %). Mean operative time was 272 min (±79.25, n = 68) and median estimated blood loss was 50 mL (10–800 mL). Conclusions The Psoas Sign technique provides a clear view of the adrenal fossa and facilitates careful dissection of the anatomic planes around the adrenal gland. This technique is feasible, reproducible and in our experience allows for safe removal of both adrenal glands and all surrounding extracortical adrenal tissue.
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The adrenal Psoas Sign: surgical outcomes following a simple technique to maximize removal of extracortical adrenal tissue during bilateral laparoscopic adrenalectomy.
Surgical Endoscopy and Other Interventional Techniques, 2014Co-Authors: Erin W. Gilbert, Vincent L. Harrison, Brett C. SheppardAbstract:Background Bilateral laparoscopic adrenalectomy (BLA) is an effective therapy for the management of persistent hypercortisolism in patients after failed transphenoidal pituitary tumor resection for Cushing’s disease. Extracortical adrenal tissue has been identified as a source of persistent hypercortisolism and, if not resected along with both adrenal glands, may lead to treatment failure. We report a reliable and reproducible technique called the “Psoas Sign” for BLA in patients with Cushing’s disease which reduces the likelihood of retained extra-adrenal cortical rests and may reduce intraoperative complications.
