35 results on '"Siperstein, A."'
Search Results
2. Impact of Localization Studies and Clinical Scenario in Patients With Hyperparathyroidism Being Evaluated for Reoperative Neck Surgery
- Author
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Shin, Joyce J., Milas, Mira, Mitchell, Jamie, Berber, Eren, Ross, Louis, and Siperstein, Allan
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- 2011
- Full Text
- View/download PDF
3. Robotic Posterior Retroperitoneal Adrenalectomy: Operative Technique
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Berber, Eren, Mitchell, Jamie, Milas, Mira, and Siperstein, Allan
- Published
- 2010
4. Prospective Randomized Trial of LC+LCBDE vs ERCP/S+LC for Common Bile Duct Stone Disease
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Rogers, Stanley J., Cello, John P., Horn, Jan K., Siperstein, Allan E., Schecter, William P., Campbell, Andre R., Mackersie, Robert C., Rodas, Alex, Kreuwel, Huub T., and Harris, Hobart W.
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- 2010
5. The Changing Presentation of Hyperparathyroidism Over 3 Decades
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Mazzaglia, Peter J., Berber, Eren, Kovach, Alexandra, Milas, Mira, Esselstyn, Caldwell, and Siperstein, Allan E.
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- 2008
6. Complication of Thyroidectomy in Patients With Radiation-Induced Thyroid Neoplasms
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Kikuchi, Shoichi, Perrier, Nancy D., Cheah, W. Keat, Siperstein, Alan E., Duh, Quan-Yang, and Clark, Orlo H.
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- 2004
7. Results of Laparoscopic Adrenalectomy for Suspected and Unsuspected Malignant Adrenal Neoplasms
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Kebebew, Electron, Siperstein, Allan E., Clark, Orlo H., and Duh, Quan-Yang
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- 2002
8. The Use of the Harmonic Scalpel vs Conventional Knot Tying for Vessel Ligation in Thyroid Surgery
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Siperstein, Allan E., Berber, Eren, and Morkoyun, Ebru
- Published
- 2002
9. Laparoscopic Posterior Adrenalectomy: Technical Considerations
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Siperstein, Allan E., Berber, Eren, Engle, Kristen L., Duh, Quan-Yang, and Clark, Orlo H.
- Published
- 2000
10. Laparoscopic Ultrasound vs Triphasic Computed Tomography for Detecting Liver Tumors
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Foroutani, Arash, Garland, Adella M., Berber, Eren, String, Andreas, Engle, Kristen, Ryan, Tamara L., Pearl, Jeffrey M., and Siperstein, Allan E.
- Published
- 2000
11. Selective Use of Tube Cholecystostomy With Interval Laparoscopic Cholecystectomy in Acute Cholecystitis
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Berber, Eren, Engle, Kristen L., String, Andreas, Garland, Adella M., Chang, George, Macho, James, Pearl, Jeffrey M., and Siperstein, Allan E.
- Published
- 2000
12. Localization of Insulinomas
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Boukhman, Milana P., Karam, John M., Shaver, John, Siperstein, Allan E., DeLorimier, Alfred A., and Clark, Orlo H.
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- 1999
13. Laparoscopic vs Open Adrenalectomy for the Treatment of Primary Hyperaldosteronism
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Shen, Wen T., Lim, Robert C., Siperstein, Allan E., Clark, Orlo H., Schecter, William P., Hunt, Thomas K., Horn, Jan K., and Duh, Quan-Yang
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- 1999
14. Laparoscopic Gastrostomy and Jejunostomy: Safety and Cost With Local vs General Anesthesia
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Duh, Quan-Yang, Senokozlieff-Englehart, Andrea L., Choe, Yong S., Siperstein, Allan E., Rowland, Kathleen, and Way, Lawrence W.
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- 1999
15. Sestamibi Scanning Is Inadequate for Directing Unilateral Neck Exploration for First-Time Parathyroidectomy
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Shen, Wen, Sabanci, Unal, Morita, Eugene T., Siperstein, Allan E., Duh, Quan-Yang, and Clark, Orlo H.
- Published
- 1997
16. Reoperation for Persistent or Recurrent Primary Hyperparathyroidism
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Shen, Wen, Duren, Mete, Morita, Eugene, Higgins, Charles, Duh, Quan-Yang, Siperstein, Allan E., and Clark, Orlo H.
- Published
- 1996
17. Laparoscopic Adrenalectomy: Comparison of the Lateral and Posterior Approaches
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Duh, Quan-Yang, Siperstein, Allan E., Clark, Orlo H., Schecter, William P., Horn, Jan K., Harrison, Michael R., Hunt, Thomas K., and Way, Lawrence W.
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- 1996
18. Familial Nonmedullary Thyroid Cancer: An Emerging Entity That Warrants Aggressive Treatment
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Grossman, Richard F., Tu, Shih-Hsin, Duh, Quan-Yang, Siperstein, Allan E., Novosolov, Faina, and Clark, Orlo H.
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- 1995
19. The Changing Presentation of Hyperparathyroidism Over 3 Decades
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Alexandra Kovach, Peter J. Mazzaglia, Mira Milas, Caldwell B. Esselstyn, Eren Berber, and Allan Siperstein
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Adult ,Male ,Parathyroidectomy ,medicine.medical_specialty ,Time Factors ,Adolescent ,Referral ,medicine.medical_treatment ,Osteoporosis ,Preoperative care ,Humans ,Medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Hyperparathyroidism ,business.industry ,Middle Aged ,medicine.disease ,Surgery ,Osteopenia ,Hypercalcemia ,Female ,business ,Densitometry ,Primary hyperparathyroidism - Abstract
To analyze changes in the presentation of primary hyperparathyroidism over the last 3 decades.Retrospective review.Tertiary referral center.Three hundred patients undergoing parathyroidectomy for primary hyperparathyroidism, 100 each in the years 1985, 1995, and 2005.Analysis was performed based on patient age, sex, preoperative calcium value, duration of hypercalcemia, symptoms at presentation, and reason for surgical referral.Patients from the years 1985, 1995, and 2005 were similar in age and sex. Mean (SEM) preoperative calcium values decreased from 11.8 (0.1) mg/dL in 1985 to 11.2 (0.1) mg/dL in 2005 (P.001) (to convert milligrams per deciliter to millimoles per liter, multiply by 0.25). The proportion of patients with preoperative calcium values less than 11.0 mg/dL steadily rose from 10% in 1985 to 43% in 2005 (P.001). The mean (SEM) time from diagnosis of hypercalcemia until surgical referral decreased from 2.5 (0.4) years in 1985 to 1.6 (0.2) years in 2005 (P = .08). The primary reason for referral has shifted toward osteoporosis (20% in 2005 vs 7% in 1985; P = .03). The percentage of patients diagnosed with osteoporosis or osteopenia preoperatively increased from 10% in 1985 to 44% in 2005 (P.001), and the recognition of these conditions in men increased from 3% to 26% (P = .10).Over the last 3 decades, increased awareness of hyperparathyroidism and its consequences as well as the institution of screening bone densitometry have changed the profile of patients who are referred for surgery. Patients are being referred sooner, with a lesser degree of hypercalcemia and greater recognition of osteoporosis.
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- 2008
20. Robotic vs Laparoscopic Posterior Retroperitoneal Adrenalectomy
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Orhan Agcaoglu, Allan Siperstein, Shamil Aliyev, Eren Berber, and Koray Karabulut
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Male ,medicine.medical_specialty ,Postoperative pain ,medicine.medical_treatment ,Adrenal Gland Neoplasms ,Postoperative Complications ,medicine ,Humans ,Prospective Studies ,Laparoscopy ,Prospective cohort study ,Pain Measurement ,Pain score ,medicine.diagnostic_test ,business.industry ,Adrenalectomy ,Robotics ,Perioperative ,Length of Stay ,Middle Aged ,Surgery ,Treatment Outcome ,Anesthesia ,Operative time ,Female ,business ,Hospital stay - Abstract
Objective To compare robotic vs laparoscopic posterior retroperitoneal adrenalectomy with regard to perioperative outcomes. Design Prospectively study. Setting Tertiary academic center. Patients Thirty-one patients who underwent robotic posterior retroperitoneal adrenalectomy and 31 consecutive patients who underwent laparoscopic posterior retroperitoneal adrenalectomy from a prospective institutional review board–approved database. Main Outcome Measures Demographic and clinical parameters, operative time, presence of complications, length of hospital stay, and pain score on postoperative days 1 and 14. Results The mean (SEM) tumor sizes for the robotic and laparoscopic groups were similar (3.1 [0.2] and 3.0 [0.2] cm, respectively; P = .48). For all patients, the mean (SEM) skin-to-skin operative times were similar in both groups (163.2 [10.1] and 165.7 [9.5] minutes, respectively; P = .43). When the last 21 patients who underwent robotic posterior retroperitoneal adrenalectomy were compared with the 31 patients from the laparoscopic series, it was seen that the mean (SEM) operative time was shorter for the robotic group than for the laparoscopic group (139.1 [10.9] vs 166.9 [8.2] minutes; P = .046). The mean (SEM) estimated blood losses and hospital stays were similar between groups. The mean (SEM) pain score on postoperative day 1 was lower in the robotic group than in the laparoscopic group (2.5 [0.3] vs 4.2 [0.4]; P = .008); however, the mean (SEM) pain scores for the groups were similar on postoperative day 14 (P = .53). There were no deaths or cases of morbidity in either group. Conclusions Our study shows that, beyond the learning curve for experienced laparoscopic surgeons, robotic posterior retroperitoneal adrenalectomy shortens the skin-to-skin operative time compared with the laparoscopic approach. Our results also suggest that the immediate postoperative pain may be less severe for patients who undergo robotic posterior retroperitoneal adrenalectomy.
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- 2012
21. Impact of Localization Studies and Clinical Scenario in Patients With Hyperparathyroidism Being Evaluated for Reoperative Neck Surgery
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Allan Siperstein, Eren Berber, Mira Milas, Louis Ross, Jamie Mitchell, and Joyce Shin
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Adult ,Male ,Reoperation ,Technetium Tc 99m Sestamibi ,medicine.medical_specialty ,Biopsy, Fine-Needle ,Disease ,Sensitivity and Specificity ,Parathyroid Glands ,Young Adult ,Postoperative Complications ,Recurrence ,Image Processing, Computer-Assisted ,medicine ,Humans ,In patient ,Clinical scenario ,Aged ,Retrospective Studies ,Ultrasonography ,Aged, 80 and over ,Parathyroidectomy ,Tomography, Emission-Computed, Single-Photon ,Hyperparathyroidism ,business.industry ,Lumbar spinal stenosis ,Middle Aged ,medicine.disease ,Predictive value ,Surgery ,Parathyroid Hormone ,Referral center ,Female ,Parathyroid surgery ,Tomography, X-Ray Computed ,business - Abstract
Background Previous studies have focused on the success of localization studies (LSs) in patients undergoing reoperative parathyroid surgery; however, patients who did not undergo reexploration surgery have been excluded from analysis. In addition, the concept of whether clinical scenario (CS) suggests single- vs multiple-gland disease in reoperative strategy is often underemphasized. Objective To evaluate how LSs and CS direct operative strategy in patients being considered for reexploration. Design Retrospective review of a prospective database. Setting Tertiary referral center. Patients Two hundred three patients with hyperparathyroidism who underwent previous neck surgery. The CS stratified patients as candidates for single- or multiple-site exploration (or unknown). Main Outcome Measure Ability of CS and LSs to direct successful reexploration. Results Of 203 patients, 27 were not explored owing to nonlocalizing studies. Of the remaining 176 patients, LSs accurately guided reexploration in 85%. However, when including the 27 nonexplored patients, the success of LSs decreased to 73%. The cure rate in reoperated patients was 96% but was reduced to 83% when including nonexplored patients. Of the reoperated patients, 83% had single-site disease and 17% had multiple-site disease. The positive predictive value of LSs in predicting single- or multiple-site disease was 92% and 73%, respectively. However, when stratified by CS, the positive predictive value increased to 95% for single-site disease and to 100% for multiple-site disease. Conclusions Failure to cure patients was 4 times more likely to be due to nonlocalizing studies than to a failed reexploration. Stratification by CS was useful in the interpretation of LSs and in determining the most accurate reoperative approach.
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- 2011
22. Complication of Thyroidectomy in Patients With Radiation-Induced Thyroid Neoplasms
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W. Keat Cheah, Quan-Yang Duh, Nancy D. Perrier, Orlo H. Clark, Alan Siperstein, and Shoichi Kikuchi
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Male ,Thyroid nodules ,medicine.medical_specialty ,Neoplasms, Radiation-Induced ,medicine.medical_treatment ,medicine.disease_cause ,Postoperative Complications ,Hematoma ,Humans ,Medicine ,Thyroid Neoplasms ,Thyroid neoplasm ,Retrospective Studies ,business.industry ,Thyroid ,Thyroidectomy ,Retrospective cohort study ,Middle Aged ,Nerve injury ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Female ,medicine.symptom ,business ,Complication - Abstract
Hypothesis The complication rate for thyroidectomy is the same in patients with and without a history of radiation exposure. Design Retrospective medical record review of 171 consecutive patients who had a previous history of radiation treatment and had undergone a thyroid operation from 1961 to 1999. Setting University of California, San Francisco, Medical Center and affiliated hospitals. Patients We selected 107 patients with a history of radiation exposure who had undergone thyroid operations (81 total thyroidectomies) and 107 control patients who underwent comparable operations but had no history of radiation exposure. Results Among patients with a history of radiation exposure (mean age, 47.2 years), there was 1 recurrent nerve injury, 1 external nerve injury, 20 patients with transient hypocalcemia, and 1 patient with a hematoma. Among patients without a history of radiation exposure (mean age, 47.5 years), there were 2 recurrent nerve injuries, 18 patients with transient hypocalcemia, and 1 patient with a hematoma. All cases of hypocalcemia and recurrent nerve injury in both groups were transient. One patient had a permanent superior laryngeal nerve injury. In patients who underwent operations since January 1, 1990, duration of hospitalization was 1.2 days in patients with a history of radiation exposure (65 patients) and 1.1 days in patients without (101 patients). Conclusions Our data document that the risk of transient and permanent complications after total thyroidectomy is similar in patients with and without a history of radiation exposure. The relatively low long-term complication rate supports prophylactic total thyroidectomy for patients with thyroid nodules and a history of radiation exposure.
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- 2004
23. Laparoscopic Posterior Adrenalectomy
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Siperstein, Allan E., primary
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- 2000
- Full Text
- View/download PDF
24. The Use of the Harmonic Scalpel vs Conventional Knot Tying for Vessel Ligation in Thyroid Surgery
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Allan Siperstein, Ebru Morkoyun, and Eren Berber
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Adult ,Male ,Laparoscopic surgery ,medicine.medical_specialty ,medicine.medical_treatment ,Statistics, Nonparametric ,Electrocoagulation ,medicine ,Harmonic scalpel ,Humans ,Ultrasonics ,Ligation ,Retrospective Studies ,Total thyroidectomy ,Chi-Square Distribution ,business.industry ,Thyroid ,Thyroidectomy ,Middle Aged ,Surgical Instruments ,Hemostasis, Surgical ,Surgery ,Knot tying ,Treatment Outcome ,medicine.anatomical_structure ,Case-Control Studies ,Female ,business ,Complication - Abstract
The technique of thyroidectomy has undergone little change in several decades. The harmonic scalpel, using ultrasonic frictional heating to ligate vessels, is widely used in laparoscopic surgery, but there is little experience in open thyroidectomy. We hypothesized that the use of the harmonic scalpel could lead to a significant reduction in operative time as compared with knot tying in thyroid surgery.Retrospective case-controlled study.Teaching institution.One hundred seventy-one consecutive patients undergoing lobectomy or total thyroidectomy by one surgeon (A.E.S.).Eighty-six patients underwent thyroid surgery with the conventional clamp-and-tie technique (lobectomy, n = 49; total thyroidectomy, n = 36) and 85 with the harmonic scalpel (lobectomy, n = 38; total thyroidectomy, n = 47).Demographics, pathological characteristics, thyroid size, operative time, blood loss, and complications using a 2-tailed t test, chi(2)test, and Wilcoxon rank sum test.The 2 groups were similar regarding age and sex. There were no intraoperative complications. Mean +/- SD thyroid size tended to be larger in the harmonic scalpel group for both lobectomy (5.1 +/- 2.6 cm vs 4.2 +/- 2.2 cm; P =.06) and total thyroidectomy specimens (6.3 +/- 3.8 cm vs 4.8 +/- 2.9 cm; P =.08) compared with the conventional technique. Mean +/- SD operative time was shorter in the harmonic scalpel group compared with the conventional technique group for both lobectomy (89 +/- 20 minutes vs 115 +/- 25 minutes; P.01) and total thyroidectomy (132 +/- 39 minutes vs 161 +/- 42 minutes; P.01) procedures. There was no difference between the 2 techniques regarding the amount of blood loss for different procedures. There was no effect of tumor size on operative time (Pearson correlation factors: 0.14 for total, 0.21 for unilateral thyroidectomy).The use of the harmonic scalpel for the control of thyroid vessels during thyroid surgery is safe, and it shortens the operative time by almost 30 minutes compared with the conventional technique for both unilateral lobectomy or total thyroidectomy procedures.
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- 2002
25. Selective Use of Tube Cholecystostomy With Interval Laparoscopic Cholecystectomy in Acute Cholecystitis
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Andreas String, George J. Chang, Eren Berber, Allan Siperstein, Adella M. Garland, Jeffrey M. Pearl, Kristen L. Engle, and James R. Macho
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Adult ,Male ,Reoperation ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Anesthesia, General ,Cohort Studies ,Postoperative Complications ,Liver Function Tests ,Cholecystitis ,Humans ,Medicine ,Local anesthesia ,Laparoscopy ,Cholecystostomy ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,General surgery ,Gallbladder ,Equipment Design ,Middle Aged ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Cholecystectomy, Laparoscopic ,Esophagectomy ,Acute Disease ,Female ,Cholecystectomy ,business ,Anesthesia, Local ,Follow-Up Studies - Abstract
Hypothesis Tube cholecystostomy followed by interval laparoscopic cholecystectomy is a safe and efficacious treatment option in critically ill patients with acute cholecystitis. Design Retrospective cohort study within a 4½-year period. Setting University hospital. Patients Of 324 patients who underwent laparoscopic cholecystectomy, 65 (20%) had acute cholecystitis; 15 of these 65 patients (mean age, 75 years) underwent tube cholecystostomy. Intervention Thirteen patients at high risk for general anesthesia because of underlying medical conditions underwent percutaneous tube cholecystostomy with local anesthesia. Laparoscopic tube cholecystostomy was performed on 2 patients during attempted laparoscopic cholecystectomy because of severe inflammation. Interval laparoscopic cholecystectomy was attempted after an average of 12 weeks. Main Outcome Measures Technical details and clinical outcome. Results Prompt clinical response was observed in 13 (87%) of the patients after tube cholecystostomy. Twelve patients (80%) underwent interval cholecystectomy. Laparoscopic cholecystectomy was attempted in 11 patients and was successful in 10 (91%), with 1 conversion to open cholecystectomy. One patient had interval open cholecystectomy during definitive operation for esophageal cancer and another had emergency open cholecystectomy due to tube dislodgment. Two patients (13%) had complications related to tube cholecystostomy and 2 patients died from sepsis before interval operation. One patient died from sepsis after combined esophagectomy and cholecystectomy. Postoperative minor complications developed in 2 patients. At a mean follow-up of 16.7 months (range, 0.5-53 months), all patients were free of biliary symptoms. Conclusions Tube cholecystostomy allowed for resolution of sepsis and delay of definitive surgery in selected patients. Interval laparoscopic cholecystectomy was safely performed once sepsis and acute infection had resolved in this patient group at high risk for general anesthesia and conversion to open cholecystectomy. Just as catheter drainage of acute infection with interval appendectomy is accepted in patients with periappendiceal abscess, tube cholecystostomy with interval laparoscopic cholecystectomy should have a role in the management of selected patients with acute cholecystitis.
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- 2000
26. Laparoscopic vs Open Adrenalectomy for the Treatment of Primary Hyperaldosteronism
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Quan-Yang Duh, Jan K. Horn, Robert C. Lim, Thomas K. Hunt, Orlo H. Clark, Allan Siperstein, William P. Schecter, and Wen T. Shen
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Adult ,Male ,medicine.medical_specialty ,Adenoma ,medicine.medical_treatment ,Preoperative care ,Hyperaldosteronism ,medicine ,Humans ,Adrenocortical carcinoma ,Laparoscopy ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Adrenalectomy ,medicine.disease ,Hypokalemia ,Surgery ,Treatment Outcome ,Blood pressure ,Female ,medicine.symptom ,business - Abstract
Hypothesis That the clinical presentations, biochemical profiles, and surgical outcomes of patients treated with laparoscopic vs open adrenalectomy for primary hyperaldosteronism are different. Design, Settings, Patients, and Interventions The medical records of 80 patients with primary hyperaldosteronism who underwent open adrenalectomy between 1975 and 1986 or laparoscopic adrenalectomy between 1993 and 1998 at the University of California–San Francisco were reviewed by a single unblinded researcher (W.T.S.). Main Outcome Measures Severity of hypertension and hypokalemia at diagnosis, their improvement after adrenalectomy, and operative complications. Results Thirty-eight patients underwent open adrenalectomy and 42 patients underwent laparoscopic adrenalectomy. The patients who underwent open adrenalectomy had documented hypertension for a median of 5 years before surgery; all had diastolic blood pressures greater than 100 mm Hg. Laparoscopically treated patients had documented hypertension for a median of 2.5 years preoperatively, and 20 (48%) had diastolic blood pressures greater than 100 mm Hg. The median preoperative serum potassium levels for the open and laparoscopic groups were 2.6 mmol/L and 3.3 mmol/L, respectively; the mean serum aldosterone levels were 1.47 nmol/L and 1.30 nmol/L. Thirty-two (84%) of the 38 patients who underwent open surgery and 41 (98%) of the 42 patients treated laparoscopically had adrenal adenomas. The sensitivity of preoperative computed tomographic scanning for adenomas was 83% for the patients treated with open adrenalectomy and 93% for those treated laparoscopically. There were 4 postoperative complications in the open surgery group and none in the laparoscopic group. Postoperatively, 30 (81%) of 37 patients (excluding 1 patient who died of adrenocortical carcinoma) in the open surgery group and 37 (88%) of 42 patients treated laparoscopically were normotensive. Postoperative values were 3.6 to 5.0 of serum potassium per liter and 3.5 to 4.9 of serum potassium per liter in the open and laparoscopic groups, respectively. Conclusions Patients who are treated with laparoscopic adrenalectomy for primary hyperaldosteronism are being referred with less severe hypertension and hypokalemia than patients formerly treated with open adrenalectomy. Patients treated laparoscopically had fewer postoperative complications and were equally likely to improve in blood pressure and hypokalemia. Laparoscopic adrenalectomy has become the treatment of choice for patients with primary hyperaldosteronism because of lower morbidity.
- Published
- 1999
27. Sestamibi Scanning Is Inadequate for Directing Unilateral Neck Exploration for First-Time Parathyroidectomy
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Eugene T. Morita, Orlo H. Clark, Allan Siperstein, Unal Sabanci, Quan-Yang Duh, and Wen T. Shen
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Adult ,Male ,Technetium Tc 99m Sestamibi ,Parathyroidectomy ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Scintigraphy ,Sensitivity and Specificity ,Technetium (99mTc) sestamibi ,Parathyroid Glands ,Neck exploration ,medicine ,Humans ,Child ,Radionuclide Imaging ,Aged ,Retrospective Studies ,Aged, 80 and over ,Hyperparathyroidism ,medicine.diagnostic_test ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Female ,Radiology ,Radiopharmaceuticals ,business ,Neck ,Primary hyperparathyroidism ,medicine.drug - Abstract
Objective: To determine whether technetium Tc 99m sestamibi scanning is accurate enough to allow surgeons to perform unilateral neck exploration for first-time parathyroidectomy in patients with primary hyperparathyroidism. Design: Retrospective review. Setting: University tertiary care center. Patients: Forty patients with primary hyperparathyroidism who underwent sestamibi scanning before first-time parathyroidectomy, of whom 28 had single adenomas, 9 had multiple adenomas, and 3 had hyperplasia. Interventions: All 40 patients underwent bilateral neck exploration with identification of 4 parathyroid glands. Main Outcome Measures: We compared the results of preoperative sestamibi scanning with operative and histologic findings. We then used these data to calculate the projected success rates of parathyroidectomy if unilateral neck explorations had been performed based on the results of sestamibi scanning, instead of bilateral explorations. Results: Sestamibi scanning was correct in 20 (71%) of 28 patients with single adenomas, 4 (44%) of 9 patients with multiple adenomas, and O (0%) of 3 patients with hyperplasia. If unilateral neck explorations had been performed on the basis of localization by sestamibi scanning, parathyroidectomy would have failed in 4 (10%) of 40 patients. Conclusions: Sestamibi scanning, although helpful, is inadequate for directing unilateral neck exploration for first-time parathyroidectomy. Surgeons who perform unilateral neck exploration based on the results of sestamibi scanning will record a higher failure rate and incur higher costs than those who perform bilateral neck exploration for first-time parathyroidectomy. Arch Surg. 1997;132:969-976
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- 1997
28. Normocalcemic Hyperparathyroidism
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Siperstein, Allan E., primary
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- 1992
- Full Text
- View/download PDF
29. Reoperation for Persistent or Recurrent Primary Hyperparathyroidism
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Mete Duren, Quan-Yang Duh, Charles B. Higgins, Wen T. Shen, Orlo H. Clark, Eugene Morita, and Allan Siperstein
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Adult ,Male ,Reoperation ,Parathyroidectomy ,medicine.medical_specialty ,Adenoma ,medicine.medical_treatment ,Sensitivity and Specificity ,Recurrence ,medicine ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,Hyperparathyroidism ,business.industry ,Dissection ,Thyroid ,Mediastinum ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Female ,Secondary hyperparathyroidism ,business ,Primary hyperparathyroidism - Abstract
Objective: To analyze the causes and outcomes of reoperation for persistent or recurrent primary hyperparathyroidism. Data Sources: Medical records of 102 patients with persistent or recurrent primary hyperparathyroidism who underwent reoperation by 1 surgeon between 1985 and 1995. Study Selection: Only patients with persistent or recurrent primary hyperparathyroidism were selected; patients with secondary hyperparathyroidism, parathyroid cancer, familial hyperparathyroidism, and previous thyroid operations were omitted. Data Extraction: Performed by a single unblinded researcher. Data Synthesis: Reasons for failed parathyroid operations included tumor in ectopic position (53%), incomplete resection of multiple abnormal glands (37%), adenoma in normal position missed during previous surgery (7%), and regrowth of previously resected tumor (3%). Of the ectopic glands, 28% were paraesophageal, 26% in the mediastinum (nonthymic), 24% intrathymic, 11% intrathyroidal, 9% in the carotid sheath, and 2% in a high cervical position. Eighty-three percent of ectopic glands were accessible via cervical incision. The success rate of reoperations was 95%. One patient (1%) became permanently hypocalcemic after reoperation; 1 patient (1%) suffered permanent unilateral vocal cord paralysis. The sensitivities of preoperative localization studies were as follows: technetium Tc 99m sestamibi scan, 77%; magnetic resonance imaging, 77%; selective venous catheterization for intact parathyroid hormone, 77%; thalium-technetium scan, 68%; ultrasonography, 57%; and computed tomography, 42%. Conclusions: Repeated parathyroidectomy can be avoided in more than 95% of patients if an experienced surgeon performs bilateral cervical exploration during the initial parathyroid operation. For patients with persistent or recurrent primary hyperparathyroidism, preoperative localization studies and a focused surgical approach can result in a 95% success rate with minimum complications. Arch Surg. 1996;131:861-869
- Published
- 1996
30. Laparoscopic Adrenalectomy
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William P. Schecter, Michael R. Harrison, Jan K. Horn, Allan Siperstein, Lawrence W. Way, Orlo H. Clark, Quan-Yang Duh, and Thomas K. Hunt
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Adult ,Male ,Myelolipoma ,medicine.medical_specialty ,Time Factors ,Adolescent ,medicine.medical_treatment ,Adrenal Gland Diseases ,Cushing syndrome ,Laparotomy ,medicine ,Humans ,Prospective Studies ,Child ,Prospective cohort study ,Laparoscopy ,Aged ,medicine.diagnostic_test ,business.industry ,Patient Selection ,Adrenalectomy ,Length of Stay ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Concomitant ,Female ,business ,Complication - Abstract
Objective: To compare the lateral transabdominal and posterior retroperitoneal laparoscopic methods for performing adrenalectomy. Design: Nonrandomized. Setting: Hospitals affiliated with the University of California, San Francisco. Patients: Thirty-six patients (15 men and 21 women), aged 5 to 78 years (mean age, 49 years), were treated for the following conditions: aldosteronoma, 18 patients; pheochromocytoma, 4 patients; Cushing syndrome, 6 patients; androgen-secreting tumor, 1 patient; nonfunctioning adenoma, 3 patients; adrenal hemorrhage, 1 patient; metastatic neoplasm, 2 patients; and myelolipoma, 1 patient. Interventions: Twenty-three lateral and 14 posterior laparoscopic adrenalectomies. Main Outcome Measures: Success rate, operating time, complications, and length of hospital stay. Results: The tumors, which ranged in size from 1 to 13 cm (mean, 4.2 cm; median, 2.5 cm), were all successfully resected laparoscopically. All 8 tumors larger than 6 cm were resected by the lateral approach. One critically ill patient died. No patient required blood transfusions or conversion to laparotomy. Mean operating time was 3.8 hours vs 3.4 hours (median, 3.5 hours vs 3 hours) and mean hospital stay was 2.2 days vs 1.5 days (median, 2 days vs 1 day) for the lateral and posterior approaches, respectively. All patients without concomitant procedures were ready to be discharged within 48 hours. Conclusions: Both approaches were effective and safe. We prefer the lateral approach for tumors larger than 6 cm and the posterior approach for bilateral tumors. Arch Surg. 1996;131:870-876
- Published
- 1996
31. Familial Nonmedullary Thyroid Cancer
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Faina Novosolov, Richard F. Grossman, Quan-Yang Duh, Shih Hsin Tu, Orlo H. Clark, and Allan Siperstein
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Follicular cell ,Thyroid carcinoma ,Consanguinity ,medicine ,Carcinoma ,Humans ,Thyroid Neoplasms ,Stage (cooking) ,Aged ,Retrospective Studies ,Epithelioma ,business.industry ,Incidence (epidemiology) ,Thyroidectomy ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Female ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies - Abstract
Objective: To determine whether familial nonmedullary thyroid carcinoma behaves like sporadic carcinoma of follicular cell origin. Design: Retrospective review. Setting: University medical center. Patients: Fourteen patients were treated for familial nonmedullary thyroid carcinoma between 1980 and 1994. Thirteen families were identified, with 30 affected individuals. Interventions: Patients were treated with total or completion total thyroidectomy. Thirteen additional operations were performed to control recurrent disease. Main Outcome Measures: Stage, recurrence, and survival. Patients were followed up for a mean of 6.5 years. Results: In our 14 patients, 13 tumors were multifocal, and six of these were bilateral. The incidences of lymph node metastasis and local invasion were both 57% (n=8). Seven patients (50%) had recurrences during follow-up. Conclusions: Familial nonmedullary thyroid carcinoma has a high incidence of multifocality and invasion and a high rate of local recurrence. Aggressive initial treatment and careful follow-up seem to be indicated. (Arch Surg. 1995;130:892-899)
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- 1995
32. Normocalcemic Hyperparathyroidism
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Allen K. Chan, Quan-Yang Duh, Wen T. Shen, Orlo H. Clark, and Allan Siperstein
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Adenoma ,Adult ,Male ,medicine.medical_specialty ,Adolescent ,endocrine system diseases ,chemistry.chemical_element ,Calcium ,Neoplasms, Multiple Primary ,Parathyroid Glands ,Clinical investigation ,medicine ,Humans ,Aged ,Aged, 80 and over ,Parathyroidectomy ,Hyperparathyroidism ,Hyperplasia ,business.industry ,Middle Aged ,medicine.disease ,Surgery ,Elevated serum calcium ,Parathyroid Neoplasms ,Symptom profiles ,chemistry ,Parathyroid Hormone ,Hypercalcemia ,Female ,business ,Serum chemistry - Abstract
• Patients with normocalcemic hyperparathyroidism represent a diagnostic and therapeutic challenge. It is unclear to what extent these patients benefit from surgery in terms of correction of their serum chemistry abnormalities and their symptoms. We studied 142 patients: 23 with normocalcemic hyperparathyroidism (serum calcium levels below 2.62 mmol/L), 35 with intermittent hypercalcemia, and 84 with hypercalcemic hyperparathyroidism. Serum chemistry analyses and a standardized questionnaire of symptoms were completed before and after surgery. Overall, patients in the normocalcemic group reported a similar frequency of preoperative symptoms; had a similar reduction in postoperative symptoms; and had a similar normalization of serum calcium, parathormone, and phosphate levels as those in the two control groups. This study indicates that factors other than elevated serum calcium levels are in large part responsible for the symptoms of hyperparathyroidism and that these patients benefit from operation. (Arch Surg.1992;127:1157-1163)
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- 1992
33. Normocalcemic Hyperparathyroidism: Biochemical and Symptom Profiles Before and After Surgery
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Siperstein, Allan E., Shen, Wen, Chan, Allen K., Duh, Quan-Yang, and Clark, Orlo H.
- Abstract
• Patients with normocalcemic hyperparathyroidism represent a diagnostic and therapeutic challenge. It is unclear to what extent these patients benefit from surgery in terms of correction of their serum chemistry abnormalities and their symptoms. We studied 142 patients: 23 with normocalcemic hyperparathyroidism (serum calcium levels below 2.62 mmol/L), 35 with intermittent hypercalcemia, and 84 with hypercalcemic hyperparathyroidism. Serum chemistry analyses and a standardized questionnaire of symptoms were completed before and after surgery. Overall, patients in the normocalcemic group reported a similar frequency of preoperative symptoms; had a similar reduction in postoperative symptoms; and had a similar normalization of serum calcium, parathormone, and phosphate levels as those in the two control groups. This study indicates that factors other than elevated serum calcium levels are in large part responsible for the symptoms of hyperparathyroidism and that these patients benefit from operation.(Arch Surg. 1992;127:1157-1163)
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- 1992
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34. Localization Procedures in Patients With Persistent or Recurrent Hyperparathyroidism
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Rodriquez, José M., Tezelman, Serdar, Siperstein, Allan E., Duh, Quan-Yang, Higgins, Charles, Morita, Eugene, Dowd, Christopher F., and Clark, Orlo H.
- Abstract
OBJECTIVE: To determine the accuracy of noninvasive and invasive localization studies in patients with persistent or recurrent hyperparathyroidism (HPT). DESIGN AND SETTING: Reoperations based on patients who were treated surgically for recurrent or persistent HPT at the University of California—San Francisco Hospitals from 1982 to 1993. PATIENTS: This study evaluated 174 localization studies performed in 152 patients before reoperation (110 women and 42 men). MAIN OUTCOME MEASURES: The accuracy of localization studies, including ultrasonography, thallous chloride Tl 201–technetium Tc 99m pertechnetate scanning, technetium Tc 99m sestamibi scanning, magnetic resonance imaging, computed tomography, and selective venous catheterization, were evaluated, as were the results of parathyroid reoperations. RESULTS: A total of 174 consecutive reoperations were performed in 152 patients with HPT (persistent, 113; recurrent, 39; mean age, 54 years; range, 21 to 88 years). One hundred thirty-three patients had primary HPT, 15 had secondary HPT, and four had tertiary HPT. Overall, 141 (93%) became normocalcemic, two (1%) became hypocalcemic, and nine (6%) remained hypercalcemic. Abnormal parathyroid glands at reoperation were situated in a normal location in 77 cases (44%), in the mediastinum in 37 cases (22%), in a deep cervical location in 34 cases (19%), or in an intrathyroidal location in 14 cases (8%), or were undescended in four cases (2%); supernumerary glands were found in 26 cases (15%). Some patients had more than one remaining abnormal gland. Selective venous catheterization with a parathyroid hormone assay was done in cases in which the results of noninvasive localization studies were equivocal or negative, and it frequently converted an equivocal result of a localization study to a definitely positive result. There were no complications from the localization studies. At reoperation, permanent hypoparathyroidism that required parathyroid autotransplantation of cryopreserved tissue developed in two patients and two patients had recurrent laryngeal nerve palsies. CONCLUSION: We currently recommend using ultrasonography and technetium Tc 99m sestamibi scanning and magnetic resonance imaging for patients with recurrent or persistent HPT. Selective venous catheterization with a parathyroid hormone assay is done selectively. Localization tests decrease morbidity and improve overall results in these patients.(Arch Surg. 1994;129:870-875)
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- 1994
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35. Tumoral Calcinosis: Controversies in the Etiology and Alternatives in the Treatment
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Tezelman, Serdar, Siperstein, Allan E., Duh, Quan-Yang, and Clark, Orlo H.
- Abstract
OBJECTIVE: To examine our experience and review the literature concerning the diagnosis, origin, and treatment of tumoral calcinosis (TC). DESIGN/SETTING: Case series based on patients with TC treated in University of California—San Francisco hospitals from 1981 to 1992 and the review of the patients described in the English-language literature. PATIENTS: The study included a total of 17 patients: 10 women and seven men. MAIN OUTCOME MEASURES: Sex, age, origin, symptoms, localization, treatment, and morbidity. RESULTS: Seven men and six women, from 32 to 62 years of age, had known disorders of calcium metabolism, and four women, from 37 to 84 years of age, did not. The main causes of the calcium metabolic disorder were secondary hyperparathyroidism in 11 patients (85%) and primary hyperparathyroidism in two patients. In three patients there was a history of trauma at the involved site and in one patient the origin was unknown. Swelling and pain are the most common presenting complaints. Generalized pruritus was observed in 54% of the patients with metabolic disorders (P<.001) but not in patients without metabolic disorders. Among our patients with metabolic disorders, TC occurred most frequently at the shoulder (46%) and elbow (31%). Eleven patients with secondary hyperparathyroidism had received calcium carbonate to bind phosphate, a high level of calcium in the dialysate, and calcitriol (1,25-vitamin D) either orally, intravenously, or both, and three received epoetin alfa (Epogen). Following parathyroidectomy, the patients with hyperparathyroidism improved symptomatically, although calcifications did not change in size. One patient had the calcifications resected and did well, whereas another was treated by subtotal resection and had a recurrence 3 years later. All four of our patients without a metabolic disorder had complete resection of TC with no recurrence. CONCLUSION: We believe TC is becoming more common in uremic patients with secondary hyperparathyroidism because of recent changes in the medical treatment of these patients. The increased use of calcium carbonate to bind phosphate as well as calcitriol and calcium to suppress parathyroid function and possibly epoetin alfa are causing more patients to develop TC.(Arch Surg. 1993;128:737-745)
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- 1993
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